Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC.

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).

Tratamiento de la hiperglucemia en el hospital / Hospital management of hyperglycemia

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[Prevalence of the metabolic syndrome in Spanish patients with established cardiovascular disease: CLYDIA study]. / Prevalencia del síndrome metabólico en pacientes con enfermedad cardiovascular en España: estudio CLYDIA.

BACKGROUND AND OBJECTIVE: To assess the prevalence of metabolic syndrome (MS) and cardiovascular risk factors in patients with established cardiovascular disease (CVD). PATIENTS AND METHOD: Epidemiologic, cross-sectional, multicentre and national study. 1,342 evaluable patients were recruited by 95 physicians of primary care, cardiology, endocrinology and internal medicine. All patients had confirmed diagnosis of CVD (myocardial infarction, coronary disease, ischaemic cerebrovascular disease and/or peripheral vascular disease) and analytical data for the study of MS according to Adult Treatment Panel-III (MS identified as presence of at least 3 components: abdominal obesity, triglycerides > or = 150 mg/dl, high density lipoproteins-cholesterol < 40 mg/dl in men and < 50 mg/dl in women, blood pressure > 130/85 mmHg and fasting glucose > 110 mg/dl). RESULTS: 37% (n = 497) of patients presented MS, with a higher prevalence among women (51.5% versus 31.8%) (chi2 test, p < 0.0001). 58% of patients had abdominal obesity, 50.4% hyperglycemia, 39.7% hypertriglyceridemia, 34.4% low values of high density lipoproteins-cholesterol and 28% high blood pressure. Abdominal obesity (86.7%) and hyperglycemia (82.7%) were the most prevalent components among patients with MS. Previous ischaemic cerebrovascular disease was more prevalent among patients with MS (22.3% versus 17.5%) (chi2 test, p < 0.05), as well as family history of hypertension, diabetes, ischaemic cardiopathy and ischaemic cerebrovascular disease (49.1%, 46.3%, 41.1% and 27.5%) (chi2 test, p < 0.05). Patients with MS showed a higher probability of suffering cardiac event in the next 10 years (25.3% vs. 17.4%). CONCLUSIONS: The prevalence of MS among Spanish population with CVD is high, specially among women.

Prevalencia del síndrome metabólico en pacientes con enfermedad cardiovascular en España: estudio CLYDIA / Prevalence of the metabolic syndrome in Spanish patients with established cardiovascular disease: CLYDIA study

Fundamento y objetivo: El propósito del presente estudio ha sido evaluar la prevalencia del síndrome metabólico (SM) y de los factores de riesgo cardiovascular en pacientes con enfermedad cardiovascular (ECV). Pacientes y método: Se ha realizado un estudio epidemiológico, transversal, multicéntrico y nacional. Un total de 95 profesionales de atención primaria, cardiología, endocrinología y medicina interna incluyeron a 1.342 pacientes valorables con diagnóstico clínico de ECV (infarto de miocardio, enfermedad coronaria, enfermedad cerebrovascular isquémica y/o enfermedad vascular periférica) y determinaciones analíticas para establecer el posible diagnóstico de SM según los criterios del Adult Treatment Panel-III (presencia de al menos 3 de los siguientes componentes: obesidad abdominal, triglicéridos >= 150 mg/dl, colesterol unido a lipoproteínas de alta densidad 130/85 mmHg y glucemia en ayunas > 110 mg/dl). Resultados: El 37% (n = 497) de la población presentaba SM, con una prevalencia mayor entre las mujeres (el 51,5 frente al 31,8%) (prueba de la *2, p < 0,0001). Un 58,0% de los pacientes presentaba obesidad abdominal; un 50,4%, hiperglucemia; un 39,7%, hipertrigliceridemia; un 34,4%, concentraciones bajas de colesterol unido a lipoproteínas de alta densidad, y un 28%, presión arterial alta. La obesidad abdominal (86,7%) y la hiperglucemia (82,7%) fueron también los componentes más prevalentes en la población con SM. Los antecedentes de enfermedad cerebrovascular isquémica fueron más prevalentes en pacientes con SM (el 22,3 frente al 17,5%) (prueba de la *2, p < 0,05), así como los antecedentes familiares cardiovasculares en general: hipertensión, diabetes, cardiopatía isquémica y accidente vascular cerebral/accidente isquémico transitorio (el 49,1, el 46,3, el 41,1 y el 27,5%, respectivamente) (prueba de la *2, p < 0,05). Los pacientes con SM mostraron mayor probabilidad de sufrir un evento cardíaco en los 10 años siguientes (un 25,3 frente al 17,4%). Conclusiones: La población española con ECV presenta elevada prevalencia de SM, especialmente en mujeres

Background and objective: To assess the prevalence of metabolic syndrome (MS) and cardiovascular risk factors in patients with established cardiovascular disease (CVD). Patients and method: Epidemiologic, cross-sectional, multicentre and national study. 1,342 evaluable patients were recruited by 95 physicians of primary care, cardiology, endocrinology and internal medicine. All patients had confirmed diagnosis of CVD (myocardial infarction, coronary disease, ischaemic cerebrovascular disease and/or peripheral vascular disease) and analytical data for the study of MS according to Adult Treatment Panel-III (MS identified as presence of at least 3 components: abdominal obesity, triglycerides >= 150 mg/dl, high density lipoproteins-colesterol 130/85 mmHg and fasting glucose > 110 mg/dl). Results: 37% (n = 497) of patients presented MS, with a higher prevalence among women (51.5% versus 31.8%) (*2 test, p < 0.0001). 58% of patients had abdominal obesity, 50.4% hyperglucemia, 39.7% hypertriglyceridemia, 34.4% low values of high density lipoproteins-cholesterol and 28% high blood pressure. Abdominal obesity (86.7%) and hyperglucemia (82.7%) were the most prevalent components among patients with MS. Previous ischaemic cerebrovascular disease was more prevalent among patients with MS (22.3% versus 17.5%) (*2 test, p < 0.05), as well as family history of hypertension, diabetes, ischaemic cardiopaty and ischaemic cerebrovascular disease (49.1%, 46.3%, 41.1% and 27.5%) (*2 test, p < 0.05). Patients with MS showed a higher probability of suffering cardiac event in the next 10 years (25.3% vs. 17.4%). Conclusions: The prevalence of MS among Spanish population with CVD is high, specially among women

A twelve-week, multicenter, randomized, double-blind, parallel-group, noninferiority trial of the antihypertensive efficacy and tolerability of imidapril and candesartan in adult patients with mild to moderate essential hypertension: the Iberian Multicenter Imidapril Study on Hypertension (IMISH).

OBJECTIVE: The aim of this study was to evaluate the annhypertensive efficacy and tolerability of the angiotensin-converting enzyme inhibitor imidapril and the angiotensin II type 1 receptor antagonist candesartan in mild to moderate essential hypertension. METHODS: The trial was conducted at 8 centers across Portugal and Spain (the Iberian Multicenter Imidapril Study on Hypertension [IMISH] Study Group). Patients aged between 30 and 70 years with essential hypertension were eligible. Following a 2- to 4-week, single-blind, placebo run-in period, patients were randomly assigned to receive imidapril at doses of up to 20 mg/d, or candesartan at doses up to 16 mg/d, once daily in a double-blind, parallel-group design with a 12-week active-treatment period. To achieve the target systolic/diastolic blood pressure (SBP/DBP) of <140/<90 mm Hg, imidapril was titrated from 5 to 20 mg/d and candesartan was titrated from 4 to 16 mg/d. The main end point was the change from baseline in sitting blood pressure (BP) at trough. Secondary end points were response rate, evaluation of SBP and DBP throughout the study, and change of SBP and DBP in subgroup of patients with moderate hypertension, as well as incidence and severity of adverse events related to treatment reported throughout the study. RESULTS: The intent-to-treat analysis consisted of 122 patients (imidapril group, 60 patients; 32 men, 28 women; mean [SD] age, 54.7 [9.2] years; white race, 59 [99.2%], Hispanic race, 1 [0.8%]; mean [SD] weight, 80.1 [12.8] kg; candesartan group, 62 patients; 36 men, 26 women; mean [SD] age, 53.9 [9.9] years; white race, 62 [100%]; mean [SD] weight, 77.6 [14.1] kg). In the imidapril group, the mean (SD) SBP and DBP were, respectively, 155.7 (10.2) and 96.7 (4.7) mm Hg at baseline and 139.4 (11.9) and 86.9 (7.6) mm Hg at the end of the 12-week treatment period (visit 5); SBP had decreased significantly from baseline, by 10.5% (mean [SD] Delta, -16.3 [12.3] mm Hg [95% CI, -19.5 to -13.1; P < 0.001]) and DBP had decreased significantly, by 10.1% (mean [SD] A, -9.8 [7.8] mm Hg [95% CI, -11.8 to -7.8; P < 0.001]). In the candesartan group, the mean (SD) SBP and DBP values were, respectively, 158.4 [11.2] and 98.3 [4.1] mm Hg at baseline and 139.8 [12.5] and 87.6 7.5] mm Hg at 12 weeks, corresponding to decreases of 11.7% in SBP (mean [SD] A, -18.6 [12.8] mm Hg [95% CI, -21.9 to -15.4; P < 0.001]) and 10.9% in DBP (mean [SD] A, -10.7 [7.3] mm Hg [95% CI, -12.5 to -8.8; P < 0.001]). Response rates were 78.3% (47/60) with imidapril and 69.4% (43/62) with candesartan, and BP normalization (<140/<90 mm Hg) was achieved in 55.0% (33/60) of patients with imidapril and 45.2% (28/62) of patients with candesartan. The incidences of adverse events were similar between groups. Most (73.9%) adverse events were mild in intensity. A serious adverse event (severe anxiety) was reported in the candesartan group and led to study discontinuation. No cases of dry cough or hypotension were reported. CONCLUSIONS: The results of this study suggest that imidapril once daily at doses up to 20 mg and candesartan once daily at doses up to 16 mg were effective in this population of mildly to moderately hypertensive patients. Both treatments were well tolerated.

Guías de práctica clínica de la sociedad española de cardiología en la monitorización ambulatoria del electrocardiograma y presión arterial / Guidelines of the Spanish Society of Cardiology on Dynamic Electrocardiography and Ambulatory Blood Pressure Monitoring

En este artículo se hace una revisión histórica y una puesta al día, tanto desde un punto de vista tecnológico como clínico, de dos procedimientos de exploración dinámica del aparato cardiovascular de tanto interés médico como son el electrocardiograma de Holter y la monitorización ambulatoria de la presión arterial. En cada uno de los procedimientos se detallan las características técnicas y metodológicas de los equipos actuales, haciéndose énfasis en la normativa que debe regular dicha tecnología para que su fiabilidad diagnóstica sea máxima. Basándose en los documentos científicos internacionales, así como en la experiencia de los propios autores, se detallan las indicaciones, aplicaciones y limitaciones de cada una de las técnicas adaptándolas a las capacidades operativas del sistema sanitario español. Nuevos desarrollos en electrocardiografía de Holter, como el QT dinámico o la variabilidad RR o la velocidad de la onda de pulso en monitorización ambulatoria de la presión arterial, son abordados con suficiente extensión, indicándose igualmente algunas directrices futuras que mejoren el rendimiento y su aplicación clínica (AU)