[Treatment of alteplase-induced orolingual angioedema by means of icatibant]. / Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

TITLE: Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

Homocisteína: ¿factor de riesgo vascular? / Homocysteine: vascular risk factor?

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[Women and strokes: specific therapy for female patients]. / Tratamiento específico del ictus en la mujer.

INTRODUCTION: Stroke is the primary cause of mortality and incapacity of women in Spain. Current therapeutic guidelines are based on clinical trials in which the number of females taking part is insufficient, and overall benefits are then dangerously extrapolated to women. DEVELOPMENT AND CONCLUSIONS: Strokes in women have important features that distinguish them from those suffered by males, both as regards risk factors and aetiology, and in prevention and the therapeutic treatment that is performed during the fertile stage, pregnancy and menopause. There is, then, a need for further studies and specific clinical trials about strokes in females. Health professionals, society and the authorities, as well as women themselves, also need to be made more aware of the importance of strokes and to be provided with more information. If not, this epidemic will increase, especially if we bear in mind the foreseeable increase in life expectancy, and mortality and loss of independence in women will rise along with it.

[Women and strokes. Hospital epidemiology in Spain]. / El ictus en la mujer. Epidemiología hospitalaria en España.

INTRODUCTION: Although in clinical practice no distinction is usually made in the prevention and management of strokes according to the sex of the patient, some studies suggest the existence of significant clinical differences in the strokes suffered by females. PATIENTS AND METHODS: The purpose of our study was to confirm and characterize these differences in patients admitted to hospitals in our community; to do so, we performed an analysis of the stroke or little stroke patients included in the Spanish Neurology Society's Stroke Database (BADISEN), from 1996 to 2001, belonging to eight Spanish hospitals. We analyzed the social aspects, risk factors, clinical features, diagnostic data, situation and referral on discharge of 4,248 female patients (39%). A univariate and, later, a multivariate analysis were performed using logistic regression of the variables that showed significant differences (p<0.2). RESULTS: The findings from our study confirm a number of differences between male and female stroke victims. Strokes occur later in females (71 years old compared with 69 in males), when the patient lives alone. The following also occur more frequently in these patients than in males: arterial hypertension (62.8 versus 51.9%, p<0.0001), cardiac insufficiency (8.0 as opposed to 4.5%, p<0.0001) and atrial fibrillation (21.4 versus 11.3%, p<0.0001) as risk factors; cardioembolic causation (22.4 against 15.4%, p<0.0001) in anterior circulation (44.0 compared to 36.1%, p<0.0001); severity is increased (6.8 on the Canadian scale versus 7.5%, p<0.0001); more medical complications (40.5 compared to 33.7%, p<0.0001), more serious sequelae (64.2 on the Barthel index compared to 72.9%, p<0.0001) and a higher institutionalization rate, among other distinguishing facts. CONCLUSIONS: Such differences must be taken into account in the prevention and management of strokes in females.

[New therapeutic approaches in stroke prevention]. / Nuevos enfoques terapeúticos en la prevención del ictus.

Stroke is the second most common cause of death and dementia and the number one cause of serious disability in adults in developed countries. After the stroke there remains a maximum vascular risk of recurrence (stroke, heart attack or vascular death). The known vascular risk factors (RF) could only explain 50% of vascular events. A better knowledge of atherogenesis, of the mechanisms that cause instability in the atheroma plaque and of new vascular RF gives rise to new preventive therapeutic approaches. This knowledge is the result of new clinical trials, such as the use of ACE inhibitors, statins, vitamins related with homocysteine, and the use of antihypertensive drugs to prevent cognitive deterioration or dementia, which add to those that have already been conducted.

Nuevos enfoques terapéuticos en la prevención del ictus / New therapeutic approaches in stroke prevention

El ictus es la segunda causa de muerte y demencia en los países desarrollados, y la primera causa de discapacidad grave del adulto. Tras el ictus existe un riesgo vascular máximo para la recurrencia (ictus, infarto de miocardio o muerte vascular). Los factores de riesgo (FR) vascular conocidos sólo explicarían el 50 por ciento de los eventos vasculares; el mejor conocimiento de la aterogénesis, de los mecanismos de inestabilización de la placa de ateroma y de nuevos FR vascular, da pie a nuevos enfoques terapéuticos de prevención, a la luz de nuevos ensayos clínicos, como la utilización de inhibidores de la ECA, estatinas, vitaminas relacionadas con homocisteína, y el uso de fármacos antihipertensivos para evitar deterioro cognitivo o demencia, que se suman a los ya existentes (AU)

Advantages of lipid-lowering therapy in cerebral ischemia: role of HMG-CoA reductase inhibitors.

Dyslipemia as a risk factor for ischemic stroke and indications for statins in the prevention of ischemic stroke are revised. The role of cholesterol levels as a risk factor for ischemic stroke is controversial. This could be due to failures in the design of early epidemiological studies. Recent studies, however, do suggest a clearer risk relationship between cholesterol levels and ischemic stroke. Studies conducted on the prevention of ischemic heart disease (IHD) with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), using pravastatin and simvastatin, unequivocally show reductions in overall mortality, cardiovascular mortality, acute myocardial infarction and other coronary events. These studies show a reduction in the risk of ischemic stroke, and although relative risk reduction is great, absolute risk reduction is low; the reasons for this are analyzed. Apart from lipid mechanisms, statins act on the atheroma plaque; they have antithrombotic and possibly neuroprotecting properties. Statins reduce the number of strokes due to the decrease of atherothrombotic strokes, cardioembolic strokes secondary to IHD, and lacunar strokes related to atherothrombosis and probably to microatheromas. Although there are currently no specific studies available on the secondary prevention of stroke with statins, which are required to clarify certain points, according to European and American guidelines for prevention, statins would be indicated in the secondary prevention of atherothrombotic stroke, and in cardioembolic and lacunar stroke associated with clinical or silent atherosclerosis (IHD, peripheral artery disease). Patients with ischemic stroke of other etiologies, except for stroke in the young or other unusual causes, are patients with a high vascular risk (cardiac and cerebral) owing to the stroke itself, age and other vascular risk factors, and they should also be treated with statins, at least from the point of view of primary prevention of IHD. Natural statins (pravastatin and simvastatin) play an essential part in secondary prevention of ischemic stroke, together with antiaggregants, anticoagulants, angiotensin-converting enzyme inhibitors and the treatment of other vascular risk factors.

[Risk factors for ischemic stroke. I. Conventional risk factors]. / Factores de riesgo del ictus isquémico. I. Factores de riesgo convencionales.

INTRODUCTION: Stroke, together with ischemic cardiopathy, may be considered to be a vascular epidemic in the developed world, where it is a major social and health problem. In Spain it is the commonest cause of death in women and the second commonest in men. DEVELOPMENT AND CONCLUSIONS: In this article we review the risk factors which cannot be modified (age, sex, inheritance, race, geography and climate) and the well-established risk factors which can be modified (arterial hypertension, cardiopathies with a high risk of embolization, markers for atherosclerosis, diabetes mellitus and transient ischemic accidents). A wide understanding of these risk factors permits the identification of persons with a high risk of having an ischemic stroke. Therefore preventive and therapeutic measures to reduce individual risk from strokes (and their recurrence) and hence reduce morbimortality from this, can be designed.

Factores de riesgo del ictus isquémico I. Factores de riesgo convencionales / Risk factors for ischemic stroke. I. Conventional risk factors

Introducción. El ictus, junto con la cardiopatía isquémica, puede considerarse una epidemia vascular en los países desarrollados y un problema sociosanitario de primer orden. En España es la primera causa de muerte en la mujer y la segunda en varones. Desarrollo y conclusiones. En este artículo se revisan los factores de riesgo no modificables (edad, sexo, herencia, raza, geografía y clima) y los factores de riesgo modificables bien establecidos (hipertensión arterial, cardiopatías de alto riesgo embolígeno, marcadores de aterosclerosis, diabetes mellitus y accidente isquémico transitorio). Un amplio conocimiento de estos factores de riesgo nos permite identificar individuos de alto riesgo para el ictus isquémico, y por lo tanto, posibilita el diseño de intervenciones preventivas y terapéuticas de las que se deriva una reducción del riesgo individual de sufrir un ictus y su recurrencia, disminuyendo así la morbimortalidad del ictus (AU)

[Are statins indicated in the prevention of cerebral infarct?]. / Están indicadas las estatinas en la prevención del infarto cerebral?

INTRODUCTION: Some studies of ischemic cardiopathy have shown that when pravastatin is used for the prevention of strokes, these are reduced. Whilst we await suitable clinical trials, we discuss the possible role played by these drugs in this subgroup of patients. DEVELOPMENT: A panel of experts from different specialties assess the data published on dislipemias in the epidemiology of strokes, the possible effect of statins in the prevention of cerebral infarcts in patients with atheromatous stenosis of the carotid artery and their mode of action. CONCLUSIONS: Pravastatin is indicated in all patients with ictus of atheromatous origin as primary prevention of ischemic cardiopathy, in patients with strokes and hypercholesterolemia, and in patients with symptomatic or asymptomatic carotid stenosis while we wait for more specific clinical trials.