SEA 2022 Standards for Global Control of Cardiovascular Risk. / Estándares SEA 2022 para el control global del riesgo cardiovascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.

Modelos animales experimentales de enfermedad de hígado graso y síndrome metabólico / Experimental animal models of fatty liver disease and metabolic syndrome

Los estudios en modelos animales constituyen una valiosa herramienta para comprender los procesos fisiopatológicos asociados a la enfermedad del hígado graso, sus características histológicas y ensayo de nuevas terapias. Una gran parte de los trabajos se desarrollan en roedores (ratones y ratas principalmente), dada su similitud biológica con el hombre y el gran conocimiento que se tiene a todos los niveles (genético, molecular, enzimático…) de estas especies. Por su facilidad de desarrollar los procesos de esteatosis hepática también destacan las aves. En este trabajo se describen los principales modelos de enfermedad del hígado graso en diversas especies animales, y las formas de inducción de enfermedad. Básicamente, el excesivo acúmulo de grasa en hígado puede ser consecuencia de aporte elevado de grasa, aumento de la síntesis grasa, oxidación reducida, y/o reducción de su salida en forma de VLDL. Así, se describen modelos basados en alteraciones genéticas (animales transgénicos o bien mutaciones naturales) que incrementan la lipogénesis, otros que dificultan la eliminación de grasa hepática (genes que regulan la oxidación de ácidos grasos), inducción mediante dietas que dan lugar a obesidad (ricas en fructosa, sacarosa, grasas, dietas aterogénicas) o bien sin producir obesidad (dietas deficientes en arginina o ricas en fructosa y grasas), tóxicos que incrementan la lipogénesis hepática, o factores que disminuyen la oxidación de ácidos grasos (como dietas deficientes en colina o metionina, administración de estrógenos, glucocorticoides o ciertos tóxicos). Se describen por último modelos aviares inducidos por la dieta (AU)

Animal models are important tools for the study of fatty liver disease, mainly related to physiopathology, pathology and therapeutical trials. Most studies have been developed in rodents (usually in mice and rats), because of biological similarities with humans, and also because of the deep knowledge (genetics, molecular, enzymatic…) of these species. Hepatic steatosis is also easily developed in avian species. We describe the most used animal models of fatty liver disease, and the several means of disease induction. Basically, excessive fat accumulation in the liver can occur as a result of increased fat delivery, increased fat synthesis, reduced fat oxidation, and/or reduced fat export in the form of VLDL. Several animal models of hepatic steatosis are described: genetically engineered animals or spontaneous mutations, which increase lipogenesis; others show reduced fatty acid oxidation, and therefore interfere fat elimination; induction by diets producing obesity: high content in fructose, sacarose, fat, and atherogenic diets; induction by diets which don’t produce obesity (arginine deficient diets), toxic agents which increase hepatic lipogenesis, or factors inducing a decrease of fatty acid oxidation such as choline / methionine deficient diets, strogens and glucocorticoids administration, or toxic agents. Diet-induced avian models are also described (AU)

Hepatomegalia gigante con calcificaciones / Giant hepatomegaly with calcifications

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Arteriosclerosis y riesgo vascular en la obesidad / Arteriosclerosis and vascular risk in the obesity

La obesidad constituye un auténtico problema de salud pública, originando un enorme gasto sanitario, estrechamente relacionada con la arteriosclerosis y asociada a una mayor morbimortalidad. Los objetivos del presente estudio son valorar el nexo de la obesidad con la arteriosclerosis en los diferentes territorios vasculares, su relación con otros factores de riesgo vascular y si una vez corregido el defecto metabólico disminuye la morbimortalidad asociada. Para ello se analiza especialmente y a la luz de los datos actuales la relación de la obesidad con la hipertensión arterial, con el metabolismo hidrocarbonado, las dislipemias, el síndrome plurimetabólico y la mortalidad. Cuando el tratamiento de la obesidad es efectivo, la reducción de peso disminuye con la morbimortalidad, mejora la insulinorresistencia, disminuye la presión arterial; el estado protrombótico, el nivel de glucemia y favorece el perfil lipídico. Como conclusión final, la reducción de peso, aunque necesaria, no es fácil, por lo que para lograr este objetivo se insiste en que debe existir una gran motivación por parte del profesional sanitario y del paciente, ya que requiere unos cambios permanentes en los hábitos de vida, de difícil implantación. Por ello, el mejor tratamiento en la actualidad lo constituye la intervención de los sistemas de salud, padres y educadores en una adecuada divulgación de la nutrición correcta en las primeras etapas de la vida, con el fin de que quede consolidada en todas las etapas posteriores (AU)

Planimetric and histological study of the aortae in atherosclerotic chickens treated with nifedipine, verapamil and diltiazem.

Calcium appears to be involved in many of the cellular events which are thought to be important in atherogenesis. Calcium channel blockers have been shown to reduce arterial lipid accumulation in animals without altering serum cholesterol. Avian models of atherosclerosis offer economic and technical advantages over mammalian models. In this study, we examine the effects of nifedipine, verapamil and diltiazem at clinical and higher doses, on the extent of atherosclerosis of egg-fed chickens. In order to assess the extent of atherosclerosis quantitatively, the aortic lesions of the thoracic and abdominal aorta, aortic arch and supraaortic regions were measured by planimetry. Atherosclerotic lesions were evaluated histologically. Statistically significant reductions in the lipid deposition of the aorta were found in all the treated groups. The extent and distribution of atherosclerotic lesions were decreased in a significant way by verapamil, nifedipine and diltiazem. The higher the dosage used, the higher the regression of the atherosclerotic lesions. At clinical dosage, nifedipine showed the highest decrease of the lesions. In addition, the chicken atherosclerosis model has proved itself useful and very suitable for in vivo drug intervention studies.

Incidencia y distribución temporal de los procesos cardiovasculares en urgencias de un hospital general durante un año / Incidence and temporal distribution of cardiovascular conditions over a year in the emergency ward of a general hospital

Objetivos: Conocer la incidencia de frecuentación por procesos cardiovasculares en el servicio de urgencias de un hospital general, así como su distribución horaria, semanal, mensual y estacional, a lo largo de un año. Métodos: Estudio prospectivo, recogiendo datos de los informes de urgencias de uno de cada seis pacientes asistidos, durante un año. Se analizaron: la hora, el día, el mes, el diagnóstico principal, la edad y sexo de los pacientes. Se realiza un análisis descriptivo y comparativo con los objetivos expuestos, sólo para aquellos pacientes que acudieron por procesos cardiovasculares como diagnóstico. Resultados: De 57.768 pacientes asistidos en un año, tomamos una muestra de 9.626, de ellos 554 pacientes (5,8 por ciento) acudieron por procesos cardiovasculares, con una incidencia mayor de mujeres (53,6 por ciento frente a un 46,4 por ciento de hombres). Precisaron ingreso hospitalario el 31,6 por ciento. Fallecieron el 0,9 por ciento. El 62,5 por ciento eran >60 años (p <0,001), disminuyendo significativamente por debajo de los 40 años. La mayor frecuentación ocurrió en otoño (28 por ciento) y la menor fue en verano (20,6 por ciento). Los pacientes acudieron más en los meses de marzo, noviembre y diciembre (10,1 por ciento) y menos en agosto (5,8 por ciento). Fueron los domingos y martes los días con mayor incidencia con un 16,4 por ciento (p<0,04) y los sábados los que tuvieron menos con un 10,5 por ciento (p<0,04). Un 41,5 por ciento acudieron durante el turno de la mañana (8 h a 15 h), un 34,8 por ciento (p<0,001) por la tarde (15 h a 22 h) y un 23,6 por ciento entre las 22 h y las 8 h. La incidencia horaria fue máxima entre las 11 h y las 12 h con un 8,8 por ciento y mínima entre las 6 h y las 7 h con un 0,4 por ciento. Conclusiones: Los procesos cardiovasculares constituyen las causas de mayor frecuentación entre la patología médica en urgencias, sobre todo en mayores de 60 años, con un alto porcentaje de ingresos y fallecimientos en urgencias y una mayor incidencia horaria en las primeras horas de la mañana (AU)

Renal metabolism of uric acid in type I insulin-dependent diabetic patients: relation to metabolic compensation.

Patients with insulin-dependent diabetes mellitus and poor glycemic control show hypouricemia with hyperuricosuria. In the present study, we have evaluated whether a good glycemic control influences the renal handling of uric acid. Sixteen patients (8 male, mean age 22.4 +/- 7.2 years) were studied under two situations, poor glycemic control (glycemia > 11 mmol/L and HbA1 c > 10%) and good glycemic control (glycemia < 6 mmol/L and HbA1 c < 8.5%). A group of 16 normal subjects served as the control group (8 male, mean age 21.9 +/- 9.1 years). In the poor glycemic control phase, patients showed lower plasma uric acid levels (0.18 +/- 0.06 mmol/L) and higher fractional urinary excretion of uric acid (16.1 +/- 9.3%) than the controls (0.28 +/- 0.06 and 8.2 +/- 1.9%, respectively). When a good glycemic control was reached, plasma uric acid increased (0.22 +/- 0.05), but it was still lower than that of the controls and fractional excretion of UA was normalized. Plasma uric acid was inversely correlated to glycemia (r = -0.34, p < 0.05) and to HbA1 c (r = -0.56, p < 0.0008) and fractional excretion of uric acid was directly correlated to glycemia (r = 0.39, p < 0.03) and HbA1 c (r = 0.73, p < 0.00005). These results indicate that the hypouricemia and hyperuricosuria of insulin-dependent diabetes mellitus is corrected by an adequate glycemic control, suggesting that these alterations are of a functional origin and due to a defective metabolic control.

Factor-V (Arg506 --> Gln) mutation in ischemic cerebrovascular disease.

Factor V Leiden is already well established to be involved in venous thrombosis but not in coronary heart disease. Results are conflicting and even antagonistic in cerebrovascular disease (CVD). In this study we examine the prevalence of factor V Leiden in 125 consecutive patients with ischemic CVD 12 additional selected CVD patients with the first CVD episode before the age of 45 years, and 102 controls from the same area. Identification of the mutation was achieved using two molecular methods. The prevalence of factor V Leiden in patients with CVD was similar to that in the normal population. The presence of the mutation was independent of the age and severity of the ischemic episode. Finally, no significant clinical differences were found between patients with and those without factor V Leiden. Therefore, factor V Leiden cannot be considered as a genetic risk factor for CVD.

High density lipoprotein subfractions and physical activity: changes after moderate and heavy exercise training.

The changes in high density lipoprotein (HDL) subfractions have been studied in 106 young healthy men after two months of physical training at a military base. Forty subjects were placed on a heavy intensity training program (HITP) with a daily average energy expenditure estimated as 3,504 Kcal, and 66 subjects followed a moderate intensity training program (MITP) with an average energy expenditure estimated as 2,942 Kcal/day. The HITP group reduced their body fat while HDL-cholesterol, HDL2-cholesterol and apoprotein (apo) A-I increased by 8.4%, 30% and 16.9% respectively (p less than 0.001). Body fat of MITP subjects did not change and HDL-cholesterol, HDL2-cholesterol and apo A-I increased by 5.6% (p less than 0.05), 17.1% (p less than 0.001) and 5.6% (p less than 0.05), respectively. The increase in serum apo A-I level was significantly higher (p less than 0.005) in the heavy intensity training group. The apo A-I/A-II ratio increased significantly in both groups (p less than 0.001), reflecting an increase in the HDL2/HDL3 ratio. This is in agreement with the significant increase in HDL2-cholesterol in both groups (p less than 0.001) with no change or decrease in HDL3-cholesterol.

[Mitral valve insufficiency in acute myocardial infarction. Assessment with pulsed and coded Doppler color]. / Insuficiencia mitral en el infarto agudo del miocardio. Valoración con Doppler pulsado y codificado en color.

We studied 108 patients who sustained an acute myocardial infarction (AMI) by means of echocardiography, pulsed doppler (PD) and Doppler color flow imaging (CD). We evaluate the presence of mitral regurgitation (MR) and it relationship to the site of the AMI and also to the ventricular function. The incidence of MR was 50.92%, (55/108), it was detected in higher percentage when the AMI was inferior (61.8%) than when anterior (39.6%). The correlation with the ejection fraction (EF) was only significative when the AMI was anterior. The incidence of MR was 57.1% when the EF was below 25%. CD had better diagnostic capabilities independently of the site of the AMI, (48% vs 32.1% when the AMI was anterior and 76.1% vs 52.6% when it was inferior).

Effects of captopril on diabetic nephropathy in hypertensive women.

The effects of the angiotensin converting enzyme inhibitor captopril on blood pressure, proteinuria, creatinine clearance and metabolic control in diabetic nephropathy have been evaluated. Captopril 144 mg per day was given to 8 longstanding, insulin-dependent, diabetic females with nephropathy. The blood pressure was significantly reduced (systolic 45.4, diastolic pressure 30.6 and mean arterial pressure 33.8 mm Hg after 24 weeks of treatment). Plasma renin activity rose significantly from a basal value of 1.60 to 6.71 ng.ml-1.h-1, and so did serum potassium (from 4.57 to 4.83 mEq.1-1). Serum aldosterone fell from 161 to 70.9 pgm.ml-1 and from 27.3 to 15.3 micrograms.24 h-1 in plasma and urine, respectively, after 6 months on captopril therapy. Urinary protein excretion was decreased by about 48% and creatinine clearance remained unchanged throughout the study. Plasma triglycerides and cholesterol also remained unchanged, and glycosylated haemoglobin was significantly reduced from 13.8 to 10.2% after captopril. The results suggest that captopril is a useful drug to treat hypertension in patients suffering from diabetic nephropathy, as the decline in kidney function can be reduced without impairing glucose tolerance or the lipid profile.

[Evidence of abnormal kidney processing of uric acid in patients with insulin-dependent diabetes mellitus]. / Evidencia del manejo renal anormal de ácido úrico en pacientes diabéticos insulinodependientes.

Renal uric acid handling in 62 insulin dependent diabetic (IDD) patients of both sexes, without clinical or biochemical signs of nephropathy or hypertension was studied and compared to healthy age matched control groups. IDD adults (n = 38, age 45-64) presented uremia similar to controls (n = 9 age 45-64). Neither, the tubular charge or filtration charge (CFU) or the uric acid excretion fraction showed statistically significant differences. Young IDD (n = 24, age 13-37) presented levels uric acid than significantly (p less than 0.001) lowers to young controls (n = 10, age 13-38) and adults IDD (p less than 0.001). The CFU is lower in both, young and adult IDD when compared to young controls (p less than 0.02). Nevertheless, the CFU is higher in young IDD than in controls of the same age (p less than 0.001) or in adult IDD (p less than 0.001). In summary, we conclude the existence of an abnormal (uric acid) renal management caused by a tubular defect probably lying on the proximal tubular segment where the uric acid secretion is carried out.