Dietary virgin olive oil triacylglycerols as an independent determinant of very low-density lipoprotein composition.

OBJECTIVE: We examined the effects of virgin olive oil (VOO) triacylglycerols (TGs) on the lipid composition of human very low-density lipoprotein (VLDL). METHODS: Twenty-one normocholesterolemic, normotensive, non-diabetic elderly subjects were recruited for the study. Two VOOs (VOO1 and VOO2) of the same variety, with an equivalent composition in minor components and differing only in the oleic and linoleic acid concentrations, were administered for 4 wk each to assess the effect of their TG molecular species compositions. Blood was collected after an overnight fast, VLDLs were isolated by ultracentrifugation, and lipid classes, TG molecular species, and TG fatty acid composition were determined. RESULTS: Dietary VOOs significantly differed in TG molecular species composition. VOO1 represented larger amounts of triolein (P < 0.01), whereas VOO2 was significantly enriched with dilinoleoyl-oleoyl-glycerol, linoleoyl-dioleoyl-glycerol, and linoleoyl-oleoyl-palmitoyl-glycerol (P < 0.01). For VLDL, intake of VOO1 caused an increase of total TG (P < 0.01) due mainly to increases in triolein and linoleoyl-dioleoyl-glycerol. Conversely, VOO2 increased VLDL cholesteryl esters (P < 0.01) and TG rich in arachidonic acid (P < 0.01). CONCLUSIONS: The different TG molecular species compositions of dietary oils may be an independent determinant of the lipid composition of VLDL in elderly people and therefore may play a role in regulating lipoprotein metabolism in these subjects.

[The clinical practice guidelines of the Sociedad Española de Cardiología on cardiomyopathies and myocarditis]. / Guías de práctica clínica de la Sociedad Española de Cardiología en miocardiopatías y miocarditis.

Myocardial diseases are a extraordinarily heterogeneous group of processes that only have in common the fact that they involve heart muscle and that they cause a wide spectrum of myocardial dysfunction. The approach of the management and treatment of the cardiomyopathies is a continuous matter of discussion because the vast majority of alternatives in this field have not been based on the best scientific possible evidence and, since except for the case of heart failure associated with dilated cardiomyopathy. The majority of different options have not been studied by means of large (or even small) randomized trials. Nevertheless, this chapter has tried to provide the reader with different approaches on how to deal with important clinical problems in dilated, hypertrophic and restrictive cardiomyopathies, and in myocarditis as well. For this, we have utilized the most relevant information found coupled with our best clinical judgment, although we admit that many of the clinical recommendations can be controversial.

[Conditions leading patients to the hypertensive cardiac units]. / Criterios de derivación de pacientes hacia las unidades de cardiopatía hipertensiva.

The heart, as a "target" organ of Hypertension, acquires a "central" role in our daily practice from different angles of view: diagnosis, classification, therapy and prognosis of Hypertensive Cardiopathy. A computerized database provided by the Working Group of Hypertension of the Spanish Cardiac Society should unify the actions of recently established Units of Hypertensive Cardiopathy. Those patients, who are selected in the Primary Health Center, referred to the Cardiology Service would be theoretically allocated in one of four headings: lef ventricular hypertrophy, left ventricular disfunction, ischemic coronary disease and electric instability. The fundamental bases standing current management of this unique and colorful cardiovascular pathology are detailed.

[Diagnostic methods and the prognosis of the heart-hypertension interaction: cardiac echo-Doppler]. / Métodos de diagnóstico y pronóstico de la interacción corazón-hipertensión: eco-Doppler cardíaco.

Among all the cardiovascular risk factors, Left Ventricular Hypertrophy (LVH) is the most important and its diagnosis by echocardiography is essential in routine evaluation of Arterial Hypertension (AHT). Calculation of the cardiac mass and of the relative thickness of the left ventricular wall are necessary steps in morphological classification of the heart of AHT into four subtypes: normal, concentric remodeling, concentric and eccentric hypertrophy. Study with M and 2D echo can be complemented by the analysis of systolic function and ventricular afterload. Alteration of the diastolic function by pulsed Doppler is sometimes the first sign of cardiac dysfunction in AHT. The three classic patterns of mitral filling, prolonged relaxation, restrictive and pseudonormal, often give only a rough analysis. The diversity of the factors involved in diastolic dysfunction opens the door to new indicators derived from analysis of flow in the pulmonary veins, especially the relative amplitude of the inverted "a" (ar) and "decalage" between this and the A of the anterograde mitral flow. The "decalage" between the inverted A (Ar) of the left ventricular outflow in relation to the mitral A is the latest approximation in the study of ventricular compliance. The poor overall prognosis which is implied by an increase in cardiac mass is modified by the geometric subtypes, the high morbidity and mortality of concentric hypertrophy being apparently noteworthy. The true prognostic significance of the regression of LVH and the accompanying diastolic dysfunction are still subject to debate.

[The usefulness of the electrocardiogram in the diagnosis of left ventricular hypertrophy in essential arterial hypertension]. / Utilidad del electrocardiograma en el diagnóstico de hipertrofia ventricular izquierda en la hipertensión arterial esencial.

The aim of the study is to analyse the usefulness of electrocardiographic criteria of left ventricular hypertrophy in essential hypertension. Seventy four patients (27 males, 47 females), 49 +/- 11 years--old with mild--moderate systemic hypertension (blood pressure greater than or equal to 140/90 mmHg) have been prospectively studied. A 12-lead electrocardiogram and an echocardiogram (M and 2D mode) have been performed after the basic clinical study. A left ventricular mass index (Devereux's method) greater than 131 g/square meters (males) or greater than 110 g/square meters (females) has been considered as left ventricular hypertrophy. Sensitivity, specificity and accuracy of 11 current electrocardiographic criteria of left ventricular hypertrophy have been determined. Sensitivity of these criteria was very low (0-0.35), while specificity was high (0.71-1). Total QRS voltage showed the best accuracy (0.51), while V5 or V6 R wave amplitude greater than 26 mm showed the best sensitivity (0.35). Current electrocardiographic criteria of left ventricular hypertrophy are not very useful in the diagnosis of left ventricular hypertrophy in essential hypertension.

[The comparative treatment with lovastatin and bezafibrate of primary hypercholesterolemia. A randomized and double-blind trial]. / Tratamiento comparativo de la hipercolesterolemia primaria con lovostatina y bezafibrato. Ensayo randomizado y a doble ciego.

The efficacy and tolerability of lovostatin (L) and bezafibrate (B) were compared in a total of 39 patients, 24 males and 15 females, 59 +/- 9 years old. Showing a total serum cholesterol superior to 250 mg/dl and total serum triglycerides inferior to 350 mg/dl, after 1 month on a low cholesterol diet and another on placebo, were eligible for participation. After randomization 19 treated with L started with 20 or 40 mg at night according to baseline cholesterol under or above 300 respectively and 20 with B received 200 mg tid. If after 6 weeks of therapy cholesterol remained above 200, the doses of L or matching placebo in those with B was double while dose of B or matching placebo remained constant. Cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were determined using an enzymatic analytical method. Apolipoproteins were obtained by radial immunodiffusion. Routine hematological analysis and blood chemistry safety tests were performed at baseline and every 6 weeks during active treatment. The average most important results, after 12 weeks of treatment, comparing L vs B were: 1) cholesterol was reduced 26 vs 10% (p less than 0.001); 2) LDL-cholesterol decreased 35 vs 15% (p less than 0.001); 3) HDL-cholesterol increased 5 vs 19% (p = NS); 4) triglycerides diminished 15 vs 18% (p = NS). Three patients in L and 1 in B showed adverse events and two of them, one each group, were drop-out. In summary: a) L was more effective lowering total cholesterol and LDL-cholesterol; b) B was more potent decreasing triglycerides and increasing HDL-cholesterol; c) both drugs showed good tolerability.

[Arterial hypertension unit in the health area]. / La consulta de hipertensión arterial en el área sanitaria.

For several decades the study of hypertension has been the subject of special attention in the arterial hypertension units and there has been a continuous search for different organizational models in order to improve diagnostic and therapeutic efficiency. The duty assigned to the cardiologist in each health area, according to the new model regulated by the Spanish health authority, and as a result of new scientific developments, convert him into a principal health agent in the fields of hypertension and risk factors. According to our organizational scheme the treatment of the hypertensive patient is undertaken in the preventive cardiology outpatient unit in conjunction with other hospital medical branches and the Family physician. This is backed up by a nursing team that selects the patients on entrance and carries out routine post-therapy.

[Heart effect of arterial hypertension. Heart hypertrophy as a risk factor. Study technics (electrocardiogram, echocardiography, exercise test and Holter]. / Repercusión cardíaca de la hipertensión arterial. Hipertrofia cardíaca como factor de riesgo. Técnicas de estudio (electrocardiograma, ecocardiografía, prueba de esfuerzo y Holter).

Left ventricular hypertrophy, a known consequence of hypertension, is associated with an excess mortality independent of other known cardiovascular risk factors. There are multiple mechanisms in which left ventricular hypertrophy may account for this excess mortality including increased incidence of arrhythmias, systolic an diastolic dysfunction, relative ischemia, and associated coronary artery disease. Diastolic dysfunction, manifested by reduced ventricular distensibility of the hypertrophic left ventricle, appears to be an early characteristic of the hypertensive heart since echocardiographic techniques have demonstrated diastolic filling abnormalities in untreated essential hypertensives even before significant left ventricular hypertrophy appears. The presence of left ventricular hypertrophy is difficult to detect by electrocardiography. Echocardiography seems to be the best non-invasive method for the detection of hypertensive heart disease: it shows early abnormalities of left ventricular compliance, frequently left ventricular hypertrophy and late abnormalities of myocardial contractility.

[Up-dated treatment of arterial hypertension: progressive and individualized. Reduction of the heart mass]. / Tratamiento actualizado de la hipertensión arterial: escalonado e individualizado. Reducción de la masa cardíaca.

The usefulness and limitations of the current medical treatment of high blood pressure are analysed. The latest strategies in the management of hypertension are presented, with emphasis on the treatment of all associated cardiovascular risk factors. This is and important therapeutic goal of Preventive Cardiology. The individualized treatment, that is to say, the selection of the antihypertensive therapy according to the characteristics of each patient, is discussed as an objective of the present therapy. Finally, the new drugs and the recent advances in the classic ones are examined with a special focus on their hemodynamic actions and on their role in left ventricular hypertrophy.