ABSTRACT
Objetivos. Las enfermedades cardiovasculares son la primera causa de muerte en mujeres, particularmente la cardiopatía isquémica, que aún se sigue considerando una enfermedad de hombres. En España hay diversos registros sobre cardiopatía isquémica, aunque ninguno exclusivo de mujeres. Los objetivos de SIRENA fueron describir el perfil clínico de las mujeres con cardiopatía isquémica atendidas en las consultas de cardiología, estimar su prevalencia de factores de riesgo cardiovascular y conocer su manejo clínico y tratamiento. Pacientes y métodos. Estudio multicéntrico, observacional, con una muestra de 631 mujeres con cardiopatía isquémica estable, incluidas consecutivamente en las consulta de cardiología. Participaron 41 investigadores de toda España. Resultados. La edad media fue de 68,5 años. La presentación clínica fue en forma de síndrome coronario agudo hasta en un 67,2%. La prevalencia de factores de riesgo cardiovascular fue elevada (77,7% hipertensión, 40,7% diabetes y 68% dislipidemia), con un 30,7% de hipertensión no controlada, un 78,4% con cifras de colesterol-LDL superiores a 70mg/dl y un 49,2% con HbA1c superior al 7%. La gran mayoría de las pacientes recibían tratamiento médico óptimo con antiagregantes, betabloqueantes, bloqueadores del eje renina-angiotensina-aldosterona e hipolipidemiantes. Se realizó coronariografía en el 88,3% de los casos e intervencionismo coronario percutáneo en el 63,4%. Conclusiones. La mujer con cardiopatía isquémica estable en España tiene una presentación clínica inicial con alguna forma de síndrome coronario agudo y una elevada prevalencia de factores de riesgo cardiovascular inadecuadamente controlados, pese a recibir terapia médica óptima. Un elevado porcentaje se somete a revascularización coronaria. Son precisos más esfuerzos en la prevención secundaria de las mujeres con cardiopatía isquémica estable (AU)
Objectives. Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. Patients and methods. A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. Results. The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Conclusions. Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease (AU)
Subject(s)
Humans , Female , Adult , Myocardial Ischemia/pathology , Secondary Prevention/methods , Cardiovascular Diseases/pathology , Cardiology/education , Acute Coronary Syndrome/congenital , Clinical Clerkship/classification , Clinical Clerkship/methods , Myocardial Ischemia/metabolism , Secondary Prevention/classification , Cardiovascular Diseases/blood , Spain/ethnology , Cardiology/methods , Acute Coronary Syndrome/complications , Prevalence , Clinical Clerkship/standardsABSTRACT
El hiperparatiroidismo primario (HPP) clásico presenta hipercalcemia y PTH elevada. Actualmente, se describen formas atípicas con calcemia y/o PTH normal. El calcitriol inhibe la secreción de PTH en ausencia de autonomía. Para evaluarla, realizamos una prueba de inhibición con calcitriol en 103 pacientes con elevación mínima, intermitente o ausente de calcio iónico (CaI), calcio total (CaT) y/o PTH. Se midió CaT, CaI y PTH séricos, y calcio/creatinina urinaria de 24 y 2 horas previo y posterior a la administración oral de 0,75 ug de calcitriol por 10 días. Se excluyeron aquellos con 25OHD menor a 20 ng/ml y/o seguimiento inferior a un año. La respuesta se clasificó en dos grupos: A) hipercalcemia con PTH alta o normal (HPP) o B) descenso de PTH sin aumentar la calcemia (hiperparatiroidismo secundario). El HPP fue confirmado por imágenes y/o cirugía. Ambos grupos fueron similares en edad y 25OHD, con un seguimiento promedio de 70 ± 34 meses. El CaT y CaI basales y pos prueba fueron significativamente mayores en el grupo A que en el B, donde se mantuvieron estables. La calciuria se incrementó en ambos grupos por igual, en forma dependiente (grupo A) e independiente (grupo B) de la calcemia. La PTH basal fue similar en ambos grupos. Posprueba, se produjo un descenso significativamente mayor en el grupo B (44 % ± 18) que en el A (15 % ± 27), sugiriendo resistencia al calcitriol. Con curvas ROC, una inhibición menor al 30 % posee una sensibilidad (S) y especificidad (E) de 85 % y 88 % para el diagnóstico de HPP. Dos pacientes del grupo B desarrollaron HPP clásico a los 17 y 37 meses de seguimiento lo que otorga a la prueba una S 90 % y E 100 % para el diagnóstico de HPP, constituyendo una herramienta útil y rápida para evidenciar la autonomía paratiroidea.
Primary hyperparathyroidism (PHP) is a disorder characterized traditionally by hypercalcemia and elevated levels of parathyroid hormone (PTH). However, this complete biological pattern is sometimes lacking. Some PHP patients display either normal or intermit tently elevated serum calcium level as well as hypercalcemia with normal PTH levels. PTH synthesis is negatively controlled by calcitriol through the vitamin D receptor (VDR). We assessed the diagnostic value of a PTH inhibition test with calcitriol in the diagnosis of PHP, in 103 patients who have minimal, intermittent, or no elevation of the levels of total or ionized calcium, and/or intact PTH. Patients with 25OHD < 20 ng/ml or less than a year follow up were excluded. We measured serum total calcium (CaT), ionized calcium (CaI), PTH and urinary calcium in 47 patients before and after the oral administration of calcitriol 0.75 ug once daily for 10 days. The biochemical response was classified as A) increase in serum calcium with high or normal PTH levels (PHP) or B) PTH suppression without hypercalcemia (secondary hyperparathyroidism). PHP was confirmed by images or surgery. The two groups were similar in age and 25 OHD levels. The mean follow up was 70 ± 34 months. Basal serum CaT and CaI were higher in group A. After the loading, this difference was even bigger, what gives additional specificity to the measure. Urine calcium was equally augmented by calcitriol in both groups, with coincident elevation of serum calcium in group A but not in B, in which serum calcium remained stable. Basal PTH levels were similar in both groups, so they cannot reliable distinguish between both types of hyperparathyroidism. After the calcitriol load, PTH dropped 44 % ± 18 in group B versus 15 % ± 27 in group A, suggesting some degree of resistance to the hormone action in PHP. ROC curves shows that a reduction of less than 30 % in PTH levels can diagnose PHP with 85% sensibility and 88% specificity. Only two patients in group B behaved as PHP at 17 and 37 months follow up, what gives the test 90 % sensibility and 100 % specificity for the diagnosis of PHP. So, this well-tolerated and easily performed test could be used for the diagnosis of PHP in patients suspected for the disease despite the normality of some basal biological markers.
