Dislipemia aterogénica: prevalencia y control en las unidades de lípidos / Atherogenic dyslipidemia: prevalence and management in lipid clinics

Antecedentes y objetivo. La dislipemia aterogénica, caracterizada por un aumento de triglicéridos y descenso del colesterol HDL, está infravalorada e infratratada en la práctica clínica. Hemos evaluado su prevalencia y la consecución de los objetivos terapéuticos de colesterol HDL y triglicéridos en los pacientes atendidos en unidades de lípidos y riesgo vascular en España. Pacientes y método. Estudio observacional, longitudinal, retrospectivo, multicéntrico, realizado en 14 Comunidades Autónomas, que incluyó de forma consecutiva a 1.828 pacientes ≥ 18 años de edad remitidos por dislipemia y riesgo vascular a 43 unidades de lípidos acreditadas por la Sociedad Española de Arteriosclerosis. Se recogió información de la historia clínica correspondiente a dos visitas realizadas durante los años 2010 y 2011-12, respectivamente. Resultados. De los 1.649 pacientes que disponían de un perfil lipídico en la visita inicial (90,2%), 295 (17,9%) tenían una dislipemia aterogénica. Los factores asociados a la dislipemia aterogénica fueron el sobrepeso/obesidad, no recibir fármacos hipolipemiantes (estatinas y/o fibratos), diabetes, infarto de miocardio e insuficiencia cardiaca previos. De los 273 (92,5%) pacientes con dislipemia aterogénica que disponían del perfil lipídico en la última visita, 44 (16,1%) alcanzaron el objetivo terapéutico de colesterol HDL y triglicéridos. Los factores predictivos del éxito terapéutico fueron el normopeso y la normoglucemia. Conclusión. Uno de cada seis pacientes atendidos en las unidades de lípidos y riesgo vascular presenta una dislipemia aterogénica. El grado de consecución del objetivo terapéutico en colesterol HDL y triglicéridos en estos pacientes es muy bajo (AU)

Background and objective. Atherogenic dyslipidemia, which is characterized by increased triglyceride levels and reduced HDL cholesterol levels, is underestimated and undertreated in clinical practice. We assessed its prevalence and the achievement of therapeutic objectives for HDL cholesterol and triglyceride levels in patients treated at lipid and vascular risk units in Spain. Patients and method. This was an observational, longitudinal, retrospective, multicenter study performed in 14 autonomous Spanish communities that consecutively included 1828 patients aged ≥18 years who were referred for dyslipidemia and vascular risk to 43 lipid clinics accredited by the Spanish Society of Arteriosclerosis. We collected information from the medical records corresponding to 2 visits conducted during 2010 and 2011-12, respectively. Results. Of the 1649 patients who had a lipid profile in the first visit (90.2%), 295 (17.9%) had atherogenic dyslipidemia. The factors associated with atherogenic dyslipidemia were excess weight/obesity, not taking hypolipidemic drugs (statins and/or fibrates), diabetes, myocardial infarction and previous heart failure. Of the 273 (92.5%) patients with atherogenic dyslipidemia that had a lipid profile in the last visit, 44 (16.1%) achieved the therapeutic objectives for HDL cholesterol and triglyceride levels. The predictors of therapeutic success were normal weight and normoglycemia. Conclusion. One of every 6 patients treated in lipid and vascular risk units had atherogenic dyslipidemia. The degree to which the therapeutic goals for HDL cholesterol and triglyceride levels were achieved in these patients was very low (AU)

Retrospective study assesing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI (AU)

Hipertrofia ventricular izquierda por electrocardiograma o ecocardiograma y complicaciones cardiovasculares en hipertensos tratados de la Comunidad Autónoma de Madrid. Estudio MAVI-HTA / Left ventricular hypertrophy seen by electrocardiogram or echocardiogram and cardiovascular complications in hypertense subjects treated in the regional Community of Madrid. Anatomical modifications of left ventricle-HBP (AMLV-HBP) study

Objetivos. Evaluar la prevalencia de hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) y ecocardiográfica (HVI-ECO) en pacientes hipertensos en la Comunidad de Madrid, y su relación con la enfermedad cardiovascular (ECV) establecida. Pacientes y métodos. Estudio epidemiológico, transversal y multicéntrico en centros de Atención Primaria de la Comunidad Autónoma de Madrid. Se incluyeron pacientes hipertensos de edad >= 50 años. Se recogieron datos demográficos, antropométricos, de presión arterial, factores de riesgo y enfermedades cardiovasculares. La HVI-ECG se evaluó con los criterios de voltaje de Cornell y Sokolow-Lyon, y la HVI-ECO mediante la masa ventricular izquierda (MVI) utilizando la fórmula de Devereux. Resultados. En 620 pacientes evaluables, 71 presentaron HVI-ECG (prevalencia del 11,5 %, similar en varones [10,6 %] y en mujeres [12,1 %; p = 0,565], sin asociación con la edad). En 580 pacientes con ecocardiograma, la prevalencia de HVI-ECO (MVI indexada por la superficie corporal >= 125 g/m2 [varones] y >= 110 g/m2 [mujeres]) fue de 56,4 %, mayor en mujeres (66,6 % frente a 42,4 % en hombres; p < 0,001), y mayor en edades más avanzadas (p tendencia lineal < 0,001). En el análisis multivariante no se observó asociación entre HVI-ECG y prevalencia de ECV. Sin embargo, los pacientes con HVI-ECO presentaron, respecto a los pacientes sin HVI-ECO, una prevalencia más de tres veces superior de ECV (odds ratio: 3,48 [intervalo de confianza 95 %: 1,75-6,74]). Conclusiones. La prevalencia de HVI-ECG fue del 11,5 %, mientras que por ECO ascendió a 56,4 %, y ésta se asoció a una prevalencia de ECV tres veces superior. Determinados pacientes hipertensos podrían beneficiarse del ecocardiograma en la valoración del riesgo cardiovascular

Objective. To assess the prevalence of left ventricular hypertrophy using electrocardiogram (ECG-LVH) and echocardiogram (ECHO-LVH) in hypertensive patients of the Autonomic Community of Madrid and its relationship to established cardiovascular disease (CVD). Patients and methods. Cross-sectional multicenter, epidemiological study conducted in Primary Health Care Centers of the Madrid Community. Hypertensive patients aged 50 years or more were included. Demographic, anthropometric, blood pressure, cardiovascular risk factors and disease data were obtained. ECG-LVH was assessed using the voltage criteria of Cornell and Sokolow-Lyon and ECHO-LVH by calculating the left ventricular mass (LVM) with the Devereux equation. Results. A total of 71 out of 620 evaluable patients had ECG-LVH (prevalence 11.5 %, similar in men and in women [10.6 % vs. 12.1 %; p = 0.565]), with no association to age. Prevalence of ECHO-LVH (LVM indexed by body surface >= 125 g/m2 [men] and >= 110 g/m2 [women]) in 580 patients with echocardiographic evaluation was 56.4 %, this being greater in women (66.6 % vs. 42.4 % in men; p < 0.001) and in older subjects (p linear trend < 0,001). In the multivariate analysis, no association was observed between ECG-LVH and established CVD. However, patients with ECHO-LVH, compared to those without ECHO-LVH, had more than a three-fold prevalence of CVD (OR 3.48 [95 % CI: 1.75-6.74]). Conclusions. Prevalence of ECG-LVH was 11.5 %, while it increased to 56.4% when the ECHO-LVH was used. The latter was associated to a three-fold prevalence of CVD. Some hypertensive patients could benefit from an echocardiogram in the assessment of their cardiovascular risk

Prevalencia de insuficiencia renal en Centros de Atención Primaria en España: Estudio EROCAP / CKD stages 3-5 in primary care population in Spain: EROCAP study

La prevalencia de la insuficiencia renal en pacientes que acuden a los Centros de Atención Primaria (CAPs) es desconocida en España. Presentamos un estudio epidemiológico transversal y multicéntrico en una población adulta (mayor de 18 años) que acude a los CAPs en España. Para clasificar a los pacientes según los estadios NFK-KDOQI (The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) se estimó el filtrado glomerular mediante la ecuación de MDRD. Se recogieron los datos de creatinina sérica, otros índices de laboratorio, presión arterial e historia médica de factores de riesgo cardiovascular (HTA, dislipemia, diabetes, insuficiencia cardíaca congestiva, enfermedad coronaria, ACVA o arteriopatía periférica) en 7.202 pacientes. El 47,3% fueron varones, edad media de 60,6 ± 14,3 años; IMC 28,2 ± 5,3; con un 27,6% de sobrepeso (27-30 kg/m2) y un 32,1% de obesidad (IMC mayor o igual a 30 kg/m2). La prevalencia de factores de riesgo cardiovascular fue: ausencia en el 17,3%, un factor en el 26,9%, dos en 31,2% y tres o más en el 23,6%. La frecuencia se distribuyó en: hipertensión en el 66,7%, dislipemia 48%, diabetes 31,5%. La presencia de trastornos clínicos asociados (Insuficiencia cardíaca congestiva, enfermedad coronaria, ACVA o arteriopatía periférica) fue inferior al 10%. La prevalencia de un filtrado glomerular estimado (eFG) inferior a 60 ml/min/1,73 m2 fue: estadio 3 (FGe 30-59 ml/min/1,73 m2) 19,7%; estadio 4 (15-29 ml/min/1,73 m2) 1,2%; estadio 5 no en diálisis (eFG < 15 ml/min) 0,4%. Esta prevalencia aumentó con la edad en ambos sexos y el 33,7% de los pacientes que acudieron a los CAPs mayores de 70 años presentaron un eFG < 60 ml/min/1,73 m2. Del total de pacientes con eFG inferior a 60 ml/min 37,3% tuvieron unos niveles normales de creatinina sérica. Este estudio documenta la prevalencia importante de alteraciones significativas de la función renal en pacientes que acuden a las consultas de atención primaria. Es importante una identificación temprana y un cuidado nefrológico apropiado en estos pacientes con la finalidad de evitar la prescripción de drogas que interfieren con la función renal, retrasar la progresión de la enfermedad renal y especialmente modificar los factores de riesgo cardiovasculares asociados

This cross-sectional, multicenter study investigated the prevalence of chronic kidney disease and associated disorders, in an adult population sample (> 18 years old) attending Primary Care services in Spain. Estimated glomerular filtration rate (Modification Diet in Renal Disease equation) was used for analysis of kidney disease prevalence according to NFK-KDOQI (The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) stages. Data were collected on serum creatinine, other laboratory parameters blood pressure, and medical history of cardiovascular risk factors or disease (hypertension, dislypidemia, diabetes, congestive heart failure, coronary artery disesase, stroke or peripheral arteriopathy) in 7,202 patients attending Primary Care Centers. 47.3% were males, mean age 60,6 ± 14,3 years, BMI 28.2 ± 5.3, with 27,6% overweight (27-30 kg/m2) and 32,1% obese (BMI �� 30 kg/m2), The prevalence of cardiovascular risks factors were: absence in 17.3%, one factor 26.9% two 31.2%, and 23.6% presented three or more The frequency of CV risk factors was: hypertension (66.7%), dyslipidemia (48%) and diabetes (31.5%). Congestive heart failure, coronary artery disease, stroke or peripheral vascular disease frequency was lower than 10% The prevalence of eGFR < 60 ml/min × 1.73 m2 was: stage 3 (30-59 ml/min/1.73 m2) 19.7%; stage 4 (15-29 ml/min/1.73 m2) 1.2%; stage 5 no dialysis (GFR < 15 ml/min) 0.4%. This prevalence increased with age in both sexes and 33,7% of patients attending Primary Care services over 70 years presented a eGFR < 60 ml/min. Of the total patients with eGFR < 60 ml/min 37.3% had normal serum creatinine levels. This study documents the substantial prevalence of significantly abnormal renal function among patients at Primary Care level. Early identification and appropriate nephrological management of these patients with renal disease is an important opportunity for an adequate prescription of drugs that interfere with renal function, to delay the progression of renal disease and modify CV risk factors