Clinical and subclinical arteriosclerotic disease in octagenarians with hip fracture. A case-control study.

BACKGROUND AND OBJECTIVES: Evaluate clinical and subclinical arteriosclerotic disease in older patients with hip fracture compared with patients without fracture in order to increase knowledge about the relation between both diseases in older individuals. PATIENTS AND METHODS: Age- and sex-matched case-control study of octogenarians with and without recent hip fracture. Vascular risk factors, subclinical vascular diseases (assessed by carotid plaques, carotid intima media thickness and arterial stiffness) as well as cardiovascular diseases were analyzed. Univariate and multivariate logistic models were used to estimate odds ratios (OR) with their 95% confidence intervals (CI) to assess the association of the arteriosclerosis and hip fracture. RESULTS: We analyzed 95 patients per group with a median age of 82 [79-87] years of whom 77.9% were female. Patients in both groups have elevated rates of vascular disease (25%) without differences between them. Patients with hip fracture had higher subclinical arteriosclerotic alterations with higher percentage of carotid plaques (OR 3.25 [1.06-9.97]) compared with the control group. CONCLUSIONS: Older patients with hip fracture had significantly higher presence of subclinical alterations but not increase on rate of cardiovascular arteriosclerotic disease compared with those without hip fracture.

Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia. / Caracterización clínica y detección de arteriosclerosis subclínica en sujetos con hiperalfalipoproteinemia extrema.

INTRODUCTION AND OBJECTIVES: The association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterize a sample of subjects with extreme hyperalphalipoproteinemia (HAE). MATERIAL AND METHODS: 53 cases with HAE were recruited, 24 women (HDL-C>135mg/ dL) and 29 men (HDL-C>116mg/ dL). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis. RESULTS: The most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p=0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p=0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p<0.05). CONCLUSIONS: Men had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

Detection of subclinical atherosclerosis using vascular ultrasound as a vascular risk assessment method. Simplified protocol. / Detección de aterosclerosis subclínica mediante ecografía vascular como método de evaluación de riesgo vascular. Protocolo simplificado.

Cardiovascular disease secondary to atherosclerosis is the main cause of morbidity and mortality in the world. Cardiovascular risk stratification has proven to be an insufficient approach to detect those subjects who are going to suffer a cardiovascular event, which is why for years other markers have been sought to help stratify each individual with greater precision. Two-dimensional vascular ultrasound is a excellent method for vascular risk assessment.

Documento de consenso de la Sociedad Española de Obstetricia y Ginecologia (SEGO)y el Comité Español Interdisciplinario para la Prevención Vascular (CEIPV). Ventanade oportunidad: prevención del riesgo vascular en la mujer. Resultados adversos delembarazo y riesgo de enfermedad vascular* / Consensus document from the Spanish Society of Obstetrics and Gynecology (SEGO) and the Spanish Interdisciplinary Committee for Vascular Prevention (CEIPV). Window of opportunity: vascular risk prevention in women. Adverse pregnancy outcomes and risk of vascular diseas

Este documento resume la evidencia que existe entre los resultados adversos del embarazo (RAE) y el riesgo que tiene una persona gestante de desarrollar factores de riesgo vascular (RV) que pueden terminar provocando enfermedad vascular (EV) futura. Asimismo, este documento destaca la importancia de saber reconocer los RAE cuando se evalúa el RV en mujeres. Un antecedente de RAE es un indicador suficiente para hacer una prevención primaria de EV. De hecho, adoptar una dieta saludable y aumentar la actividad física entre las mujeres con RAE, de inicio en el embarazo o en el posparto y manteniéndolas a lo largo de la vida, son intervenciones importantes que permiten disminuir el RV. Por otro lado, la lactancia materna también puede disminuir el RV posterior de la mujer, incluyendo menos riesgo de mortalidad. Estudios futuros que evalúen el uso del ácido acetilsalicílico, las estatinas y la metformina, entre otros, en las mujeres con antecedentes de RAE podrían reforzar las recomendaciones sobre el uso de la farmacoterapia en la prevención primaria de la EV entre estas pacientes. Existen diferentes opciones dentro de los sistemas de salud para mejorar la transición de la atención de las mujeres con RAE entre los diferentes profesionales e implementar estrategias para reducir su RV a largo plazo. Una posible estrategia podría ser la incorporación del concepto del cuarto trimestre en las recomendaciones clínicas y las políticas de atención de la salud.(AU)

This document summarises the evidence regarding the association between adverse pregnancy outcomes (APOs),such as hypertensive disorders, preterm birth, gestational diabetes, fetal growth defects (small for gestational ageand/or fetal growth restriction), placental abruption, fetal loss, and the risk that a pregnant individual in developingvascular risk factors (VR) that may lead to future vascular disease (VD): coronary heart disease, stroke, peripheralvascular disease, and heart failure. Furthermore, this document emphasises the importance of recognising APOswhen assessing VR in women. A history of APOs serves as a sufficient indicator for primary prevention of VD. In fact,adopting a healthy diet and increasing physical activity among women with APOs, starting during pregnancy and/or postpartum, and maintaining it throughout life are significant interventions that can reduce VR. On the otherhand, breastfeeding can also reduce the future VR of women, including a lower risk of mortality. Future studies evaluating the use of aspirin, statins, and metformin, among others, in women with a history of APOscould strengthen recommendations regarding pharmacotherapy for primary prevention of VD in these patients.Various healthcare system options exist to improve the transition of care for women with APOs between differenthealthcare professionals and implement long-term VR reduction strategies. One potential process could involveincorporating the fourth-trimester concept into clinical recommendations and healthcare policies.(AU)

Obstructive sleep apnea and cardiovascular risk. / Apnea obstructiva del sueño y riesgo cardiovascular.

Patients with obstructive sleep apnea (OSA) experience repetitive episodes of upper airway obstruction due to recurrent collapse during sleep. This leads to intermittent hypoxia episodes, which, through complex pathophysiological mechanisms, trigger sympathetic overactivation, endothelial dysfunction, hypercoagulation, and metabolic dysregulation. Consequently, other cardiovascular risk factors such as hypertension, metabolic syndrome, and diabetes are induced. Furthermore, this enhances target organ damage, affecting the heart, arteries, and kidneys, leading to an increased risk of cardiovascular morbidity and mortality. Among the various treatments for OSA, Continuous Positive Airway Pressure (CPAP) has been extensively studied. To date, this treatment has shown mild benefits in reducing blood pressure, particularly noticeable in patients with resistant hypertension. Furthermore, CPAP treatment appears to reduce cardiovascular events, both in primary and secondary prevention, though this benefit is limited to individuals with good compliance (CPAP use ≥4h/night). Future research perspectives in OSA seem to focus on identifying patients in whom the condition significantly influences cardiovascular risk, thus determining those who would benefit the most from treatment in the reduction of cardiovascular risk.

Características y tratamiento de los pacientes nonagenarios con enfermedad vascular ingresados en los servicios de medicina interna. Registro NONAVASC-2 / Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry

Introducción La enfermedad vascular es la causa más frecuente de morbimortalidad, y su prevalencia incrementa con la edad. Los pacientes muy añosos no se encuentran incluidos en los estudios sobre enfermedad vascular, desconociéndose sus características y tratamientos. Objetivo Conocer las características clínicas de los pacientes nonagenarios hospitalizados en servicios de medicina interna con diagnóstico de EV establecida y la adecuación de su manejo farmacológico. Material y métodos El Registro NONAVASC-2 es un estudio observacional, prospectivo y multicéntrico. Se incluyeron pacientes hospitalizados por cualquier causa. La recogida de datos se realizó a través de una base anonimizada online con parámetros sociodemográficos, clínicos, analíticos, terapéuticos y evolutivos. Resultados Se incluyeron 1.049 pacientes con una edad media de 93,14 años (57,8% mujeres). La prevalencia de los factores de riesgo fue muy elevada: hipertensión (84,9%), dislipemia (50,9%) y diabetes mellitus (29,4%). El 33,4% presentaba dependencia grave/total. El 82,9% recibía tratamiento antitrombótico (53,7% antiagregantes, 25,4% anticoagulación y 3,8% doble terapia). Solo el 38,2% recibía estatinas. El porcentaje de dependencia (39,2 vs. 24,1%; p=0,00) y deterioro cognitivo grave (30,8 vs. 13,8%; p=0,00) era significativamente mayor entre los pacientes que no las recibían. El 19% falleció durante el ingreso. Conclusión Los pacientes nonagenarios con EV presentan una elevada comorbilidad, dependencia y mortalidad. A pesar de estar en prevención secundaria, el 17% de ellos no recibía antitrombóticos y solo el 38% estatinas. Esta infraprescripción está condicionada por la situación funcional, entre otros factores, por lo que es necesario realizar más estudios para conocer el impacto sobre su pronóstico (AU)

Introduction Vascular disease is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on vascular disease, their characteristics and treatments being unknown. Objective Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. Material and methods The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. Results One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p=0.00) and severe cognitive impairment (30.8% vs 13.8%; p=0.00) was significantly higher among patients who did not receive them. 19% died during admission. Conclusions Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis (AU)

Documento de consenso de la Sociedad Española de Obstetricia y Ginecologia (SEGO) y el Comité Español Interdisciplinario para la Prevención Vascular (CEIPV). Ventana de oportunidad: prevención del riesgo vascular en la mujer. Resultados adversos del embarazo y riesgo de enfermedad vascular / Consensus document of the Spanish Society of Obstetrics and Gynecology (SEGO) and the Spanish Interdisciplinary Committee for Vascular Prevention (CEIPV). Opportunity window: vascular risk prevention in women. Adverse pregnancy outcomes and risk of vascular disease

Este documento resume la evidencia que existe entre los resultados adversos del embarazo (RAE), tales como son los trastornos hipertensivos, el parto pretérmino, la diabetes gestacional, los defectos en el crecimiento fetal (feto pequeño para la edad gestacional y/o restricción del crecimiento), el desprendimiento de placenta y la pérdida fetal, y el riesgo que tiene una persona gestante de desarrollar factores de riesgo vascular (RV) que pueden terminar provocando enfermedad vascular (EV) futura: cardiopatía coronaria, accidente cerebrovascular, enfermedad vascular periférica e insuficiencia cardíaca. Asimismo, este documento destaca la importancia de saber reconocer los RAE cuando se evalúa el RV en mujeres. Un antecedente de RAE es un indicador suficiente para hacer una prevención primaria de EV. De hecho, adoptar una dieta saludable y aumentar la actividad física entre las mujeres con RAE, de inicio en el embarazo y/o postparto y manteniéndolo a lo largo de la vida, son intervenciones importantes que permiten disminuir el RV. Por otro lado, la lactancia materna también puede disminuir el RV posterior de la mujer, incluyendo menos riesgo de mortalidad. Estudios futuros que evalúen el uso del ácido acetilsalicílico, las estatinas y la metformina, entre otros, en las mujeres con antecedentes de RAE podrían reforzar las recomendaciones sobre el uso de la farmacoterapia en la prevención primaria de la EV entre estas pacientes. Existen diferentes opciones dentro de los sistemas de salud para mejorar la transición de la atención de las mujeres con RAE entre los diferentes profesionales e implementar estrategias para reducir su RV a largo plazo. Una posible estrategia podría ser la incorporación del concepto delcuarto trimestre en las recomendaciones clínicas y las políticas de atención de la salud.(AU)

This document summarises the evidence regarding the association between adverse pregnancy outcomes (APOs), such as hypertensive disorders, preterm birth, gestational diabetes, fetal growth defects (small for gestational age and/or fetal growth restriction), placental abruption, fetal loss, and the risk that a pregnant individual in developing vascular risk factors (VR) that may lead to future vascular disease (VD): coronary heart disease, stroke, peripheral vascular disease, and heart failure. Furthermore, this document emphasises the importance of recognising APOs when assessing VR in women. A history of APOs serves as a sufficient indicator for primary prevention of VD. In fact, adopting a healthy diet and increasing physical activity among women with APOs, starting during pregnancy and/or postpartum, and maintaining it throughout life are significant interventions that can reduce VR. On the other hand, breastfeeding can also reduce the future VR of women, including a lower risk of mortality.Future studies evaluating the use of aspirin, statins, and metformin, among others, in women with a history of APOs could strengthen recommendations regarding pharmacotherapy for primary prevention of VD in these patients. Various healthcare system options exist to improve the transition of care for women with APOs between different healthcare professionals and implement longterm VR reduction strategies. One potential process could involve incorporating the fourth-trimester concept into clinical recommendations and healthcare policies.(AU)

Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry.

INTRODUCTION: Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE: Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS: The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS: One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p = 0.00) and severe cognitive impairment (30.8% vs 13.8%; p = 0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS: Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.

Retinal vein occlusion in the general population after COVID-19 vaccination and infection / Obstrucción venosa retiniana en la población general después de la vacunación y de la COVID-19

Introduction Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). Objective To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. Methods Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. Results 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). Conclusion Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection (AU)

Introducción La oclusión venosa retiniana (OVR) es principalmente una consecuencia de los factores de riesgo vascular (FRV). Las vacunas contra la COVID-19 se han relacionado con eventos vasculares y trombóticos (EVT). Objetivo Evaluar la incidencia de OVR en la población general de nuestra área de salud y su posible relación con la COVID-19 y la vacunación. Métodos Se recopilaron prospectivamente las características demográficas, FRV clásicos, datos sobre trombofilia, padecimiento de la COVID-19 y puntuación de riesgo de Framingham. Resultados Se incluyeron 472 pacientes consecutivos con OVR, estudiados durante 13 años (Cohorte Valdecilla). Los FRV clásicos estaban presentes en el 90%, el síndrome antifosfolípido en el 12,3% y la trombofilia genética en el 13,5% de los casos. El 91% de los pacientes con OVR recibieron la vacuna frente a la COVID-19 y el 6.8% sufrió la infección. En la cohorte, ningún paciente tuvo una nueva OVR después de la vacunación o de la infección. En la población general, 20 sujetos presentaron OVR después de recibir la vacuna (0,006%). En general, 8 casos ocurrieron en el primer mes después de la vacunación y 12 después de 30 días. En los grupos precoz y tardío, 3 y 4 pacientes respectivamente, presentaban una puntuación de Framingham de riesgo bajo o intermedio. Veintinueve pacientes de la cohorte sufrieron infección por SARS-CoV-2 y 27 de ellos tuvieron una OVR antes de ésta. Dos pacientes con puntuaciones de Framingham de bajo riesgo presentaron una OVR después de la infección, uno de ellos precozmente (<1 mes). Conclusiones La vacunación y la COVID-19 podrían estar involucradas en el desarrollo de OVR en algunos casos, principalmente en pacientes sin FRV, trombofilia o procesos inflamatorios crónicos y con una puntuación de Framingham más baja, especialmente en el primer mes después de la vacunación o de la infección (AU)

Luces y sombras de la Guía Europea ESC-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica / Lights and shadows of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Los médicos de familia atienden un importante número de pacientes con alto riesgo vascular (RV). LasGuías Europeas de Prevención Cardio-vascular (2021) proponen una nueva clasificación del riesgo y estrategias de intervención sobre los factores de riesgo (FRV), orientada a la tomade decisiones compartidas entre profesionales y pacientes. En el presente trabajo realizamos un análisis crítico de dichas guías, ofreciendoposibles soluciones prácticas para la Atención Primaria.Son destacables aspectos positivos (luces) que los modelos de RV SCORE2 (entre cuarenta y sesenta y nueve años) y SCORE2-OP (entre setenta yochenta y nueve años) se basan en cohortes más actuales y miden con mayor exactitud y discriminación dicho riesgo. Además, se propone actuardiferenciadamente sobre el riesgo según la edad. Pragmáticamente, se presentan nuevos modelos informáticos para calcular el riesgo. Sin embargo,entre los aspectos negativos (sombras), parece colegirse una mayor dificultad de implementación al proponerse nueve subgrupos de sujetos segúnsu edad o nivel de riesgo, con un dintel definitorio de alto RV subjetivo que podría ocasionar un incremento sustancial en el número de sujetossusceptibles de tratar sin una discriminación objetiva que lo sustente. Además, las intervenciones sobre los FRV en dos pasos podrían retrasar laconsecución de objetivos terapéuticos, sobre todo en pacientes de muy alto riesgo, diabéticos o con enfermedad cardiovascular.Ante las dificultades que plantea la valoración del riesgo, proponemos unificar criterios y simplificar los mensajes claves para hacer unas guíasmás atractivas y que realmente ayuden a los profesionales de Atención Primaria en su práctica habitual.(AU)

General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines forCardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), withthe aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a criticalanalysis of these guidelines, offering possible solutions that can be implemented in Primary Care.It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (fromseventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it isproposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated usingdifferent websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implemen-ting nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in thepotential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions coulddelay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease.Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of theguideline in primary care.(AU)

Retinal vein occlusion in the general population after COVID-19 vaccination and infection.

INTRODUCTION: Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). OBJECTIVE: To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. METHODS: Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. RESULTS: 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). CONCLUSIONS: Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection.

Oclusión venosa retiniana en pacientes menores de 50 años. Análisis de factores de riesgo vascular, trombofilia, hallazgos ecográficos carotídeos y etiologías poco frecuentes / Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies

Introducción La oclusión venosa retiniana (OVR) se ha relacionado con factores de riesgo vascular y trombofilia. Métodos Se trata de un estudio de cohorte prospectivo de todos los pacientes diagnosticados de OVR y remitidos a una clínica de medicina interna de un hospital universitario terciario durante un período de 10 años. Se analizaron variables clínicas, de laboratorio y ecográficas de troncos supraaórticos y se compararon según la edad. Resultados Se incluyeron unos 309 pacientes diagnosticados de OVR, 25 de ellos menores de 50 años. La prevalencia de hipertensión arterial, dislipidemia, diabetes mellitus, hiperhomocisteinemia y placa carotídea fue significativamente mayor en pacientes > 50 años que en los menores. Sin embargo, la prevalencia de trombofilia hereditaria fue mayor en el grupo más joven (32 vs. 11,4%; p = 0,005). Se observaron enfermedades poco frecuentes relacionadas con la OVR como hepatitis C, talasemia menor, enfermedad de Lyme, vasculitis y perlebitis en pacientes jóvenes sin factores de riesgo vascular. Conclusión Sugerimos realizar un estudio genético de trombofilia en pacientes con OVR menores de 50 años, siendo siempre recomendable un control exhaustivo de los factores de riesgo vascular en todos los pacientes con OVR. Además, sugerimos tener en cuenta las enfermedades poco frecuentes relacionadas con la OVR, especialmente en pacientes jóvenes sin factores de riesgo vascular (AU)

Introduction Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia. Methods This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age. Results Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients>50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0 vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors. Conclusion We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors (AU)

Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies.

INTRODUTION: Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia. METHODS: This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age. RESULTS: Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients >50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0% vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors. CONCLUSION: We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors.

Efectos de la pandemia por SARS-CoV-2 en una cohorte de pacientes con obstrucción venosa retiniana / Effects of the COVID-19 pandemic on a cohort of patients with vein occlusion

Antecedentes y objetivos En diciembre de 2019 surgió una nueva enfermedad por coronavirus en humanos causada por el virus SARS-CoV-2, la COVID-19, que se ha asociado con fenómenos trombóticos. La obstrucción venosa retiniana (OVR) es principalmente una consecuencia de los factores de riesgo vascular (FRV). El objetivo de este estudio ha sido analizar los casos de infección por SARS-CoV-2 en una cohorte de pacientes con OVR (cohorte Valdecilla). Pacientes y métodos Entre diciembre de 2008 y 2020 hemos atendido 429 pacientes con OVR. Diez han padecido COVID-19, de los que uno no presentaba FRV ni trombofilia. Los otros 9 fueron diagnosticados de OVR antes de la infección: todos tenían FRV; 6 ateromatosis carotídea y 4 presentaban un síndrome antifosfolípido. La infección no causó en ellos fenómenos trombóticos. Conclusiones La OVR es una manifestación infrecuente de la COVID-19. En nuestra cohorte de pacientes con OVR la COVID-19 no indujo eventos trombóticos (AU)

Background and objectives A new coronavirus disease in humans, COVID-19, caused by SARS-CoV-2, emerged in December 2019. It has been associated with the development of thrombotic phenomena. Retinal vein occlusion (RVO) is mainly a consequence of vascular risk factors (VRF). This study aimed to analyze cases of COVID-19 in a cohort of patients with RVO (Valdecilla cohort). Patients and methods Between December 2008 and December 2020, 429 patients with RVO were attended to in our clinic. Ten patients had COVID-19, one of which did not have VRF or thrombophilia. The remaining nine patients had RVO prior to the infection and VRF, six had carotid atherosclerosis, and four had antiphospholipid syndrome. The infection did not cause thrombotic phenomena in any of them. Conclusions RVO is a rare manifestation of COVID-19. In our cohort of patients with RVO, COVID-19 disease did not lead to thrombotic events (AU)

Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo / Variability in the neuropsychological performance of patients with acute coronary syndrome

Introducción: Existe un interés creciente por el estudio de la relación entre las cardiopatías, incluido el síndrome coronario agudo (SCA) y el deterioro cognitivo, y, aunque no se conocen con concreción los factores que median entre el SCA y el deterioro cognitivo, en el centro de este debate se encuentra el papel de la fracción de eyección del ventrículo izquierdo (FEVI). Objetivos: Determinar la presencia de deterioro cognitivo en pacientes con SCA y explorar su asociación con diversos factores –sociodemográficos, consumo de fármacos, rendimiento en pruebas funcionales cardíacas (en particular, la FEVI)–. Pacientes y métodos: Se recogieron variables sociodemográficas, médicas y neuropsicológicas en 80 pacientes con SCA que participaban en un programa de rehabilitación cardíaca. Se compararon sus puntuaciones en la batería neuropsicológica con los datos normativos poblacionales para determinar qué sujetos mostraban un rendimiento deficitario. Se realizaron análisis de regresión para determinar qué factores se asocian con el rendimiento en las pruebas neuropsicológicas. Resultados: En comparación con su grupo normativo, el 37,5% de los sujetos presentó una baja puntuación en tres o más test neuropsicológicos. La edad, un bajo nivel educativo y una FEVI baja explicaron hasta el 51% de la variabilidad en los resultados de las pruebas neuropsicológicas. Conclusiones: Los pacientes con SCA tienen más posibilidades de presentar un deterioro de funciones cognitivas, como la atención, la memoria y las funciones ejecutivas, junto con un enlentecimiento en la velocidad de procesamiento de la información. Una FEVI inferior al 50% podría ser un factor explicativo destacado de dicho deterioro cognitivo.

Introduction: There is a growing interest in the study of the relationship between heart disease, including acute coronary syndrome (ACS) and cognitive impairment, and although the factors mediating ACS and cognitive impairment are not well understood, the debate revolves around the role of the left ventricular ejection fraction (LVEF). Aims: To determine the presence of cognitive impairment in patients with ACS and explore its association with various factors, including sociodemographic, medication use and performance on cardiac function tests (in particular LVEF). Patients and methods: Sociodemographic, medical and neuropsychological variables were collected in 80 patients with ACS participating in a cardiac rehabilitation programme. Their scores on the neuropsychological battery were compared with normative population data to determine which subjects showed deficient performance. Regression analyses were conducted to determine which factors are associated with performance on neuropsychological tests. Results: Compared to their normative group, 37.5% of the subjects had low scores on three or more neuropsychological tests. Age, low educational level and low LVEF explained up to 51% of the variability in neuropsychological test results. Conclusions. Patients with ACS are more likely to have impaired cognitive functions, such as attention, memory and executive functions, along with a slower information processing speed. An LVEF below 50% could be a major explanatory factor for such cognitive impairment.(AU)

Effects of the COVID-19 pandemic on a cohort of patients with vein occlusion.

BACKGROUND AND OBJECTIVES: A new coronavirus disease in humans, COVID-19, caused by SARS-CoV-2, emerged in December 2019. It has been associated with the development of thrombotic phenomena. Retinal vein occlusion (RVO) is mainly a consequence of vascular risk factors (VRF). This study aimed to analyze cases of COVID-19 in a cohort of patients with RVO (Valdecilla cohort). PATIENTS AND METHODS: Between December 2008 and December 2020, 429 patients with RVO were attended to in our clinic. Ten patients had COVID-19, one of which did not have VRF or thrombophilia. The remaining nine patients had RVO prior to the infection and VRF, six had carotid atherosclerosis, and four had antiphospholipid syndrome. The infection did not cause thrombotic phenomena in any of them. CONCLUSIONS: RVO is a rare manifestation of COVID-19. In our cohort of patients with RVO, COVID-19 disease did not lead to thrombotic events.

Glaucoma primario de ángulo abierto y factores de riesgo aterosclerótico: hallazgos por eco-Doppler orbitario / Primary open angle glaucoma and atherosclerotic risk factors: orbital echo-Doppler findings

Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)

Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)

Brachial-ankle pulse wave velocity with a custom device.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53 ±â€¯12 years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into group I (none), group II (1 or 2 CRFs) and group III (3 or more CRFs). The patients with a previous cardiovascular event were included in group III. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r = 0.93 (p < .001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: group I, 10.5 ±â€¯1.6; group II, 13.8 ±â€¯2.9 (p < .001 when compared with group I); and group III, 14.1 ±â€¯2.7 (p < .001 when compared with group I). There were no differences between groups II and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

Velocidad de onda de pulso brazo-tobillo con un dispositivo propio / Brachial-ankle pulse wave velocity with a custom device

Antecedentes y objetivos La velocidad de onda de pulso brazo-tobillo (VOPbt) es una de las variables de rigidez arterial más empleada en la valoración del riesgo vascular. VOPITB es un dispositivo que calcula distintas VOP y el índice tobillo-brazo de presión arterial (ITB). Además, con sus registros se podría determinar la VOPbt. El objetivo de este estudio fue: calcular la VOPbt con VOPITB, validarlo con un equipo de referencia (VaSera) y estudiar su utilidad clínica. Pacientes y métodos Se estudiaron 113 pacientes, con edad media de 53±12años; 59 (52%) eran mujeres y 10 (8,8%) presentaban evento cardiovascular previo. Los participantes se estatificaron según factores de riesgo vascular (FRV) en: grupoI, ninguno; grupoII, uno o 2; y grupoIII, 3 o más FRV. Los pacientes con algún evento vascular previo se incluyeron en el grupoIII. A todos se les midió la VOPbt con VOPITB y VaSera. Resultados La correlación de VOPbt entre ambos equipos fue r=0,93 (p<0,001) y el porcentaje de error calculado con análisis de Bland-Altman: 4,5%. La VOPbt con VOPITB fue (m/s): grupoI, 10,5±1,6 comparado con grupoII, 13,8±2,9 (p<0,001) y grupoIII, 14,1±2,7 (p<0,001). No se observaron diferencias entre gruposII y III. Los resultados obtenidos con VaSera fueron equiparables a los de VOPITB. Conclusiones La medición de la VOPbt con el equipo VOPITB es segura y de utilidad clínica similar a la realizada con VaSera. La incorporación de esta función a las prestaciones de VOPITB lo convertirá en un dispositivo completo para valorar la rigidez arterial (AU)

Background and objectives The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. Patients and methods We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. Results The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. Conclusions Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness (AU)

El glaucoma y las enfermedades sistémicas con compromiso vascular / Glaucoma and systemic diseases of vascular involvement

La presión intraocular es considerada el único factor causal potencialmente modificable con el propósito de prevenir la ceguera por glaucoma. Esta es una enfermedad multifactorial y, aunque es el factor de riesgo más importante en su desarrollo, la reducción de sus valores no garantiza el cese de la progresión del daño glaucomatoso. El glaucoma primario de ángulo abierto y el glaucoma de presión normal comparten factores de riesgo similares en la patogénesis y se pueden clasificar en categorías mecánicas y vasculares. La evidencia científica actual ha logrado demostrar que existe una importante asociación entre las enfermedades sistémicas con compromiso vascular, como la migraña, la apnea obstructiva del sueño, la hipotensión arterial de diferentes causas, la hipertensión arterial, la enfermedad cerebrovascular, la cardiopatía isquémica y la diabetes mellitus con los hallazgos a nivel ocular en pacientes con neuropatía óptica glaucomatosa. Esta correlación orienta a considerar estas enfermedades en conjunto para que cada profesional dedicado a la salud visual considere siempre imprescindible la evaluación de los aspectos que vinculan estas enfermedades para actuar en consecuencia. Se realiza una búsqueda sobre el glaucoma y las enfermedades sistémicas con compromiso vascular(AU)

Intraocular pressure is considered to be the only potentially modifiable causative factor to prevent glaucoma blindness. However, glaucoma is a multifactorial disease, and true as it is that its main risk factor is intraocular pressure, its reduction does not ensure cessation of the progress of glaucomatous damage. Primary open angle glaucoma and normal pressure glaucoma share similar pathogenetic risk factors, and may be classified as mechanical or vascular. According to current scientific evidence, an important association exists between systemic diseases with vascular involvement, such as migraine, obstructive sleep apnea, arterial hypotension of various causes, arterial hypertension, cerebrovascular disease, ischemic heart disease and diabetes mellitus, and ocular findings in patients with glaucomatous optic neuropathy. In view of this correlation, these diseases should be considered jointly, so that visual health professionals always bear in mind the evaluation of their common characteristics and act in consequence. A search was carried out on glaucoma and systemic diseases with vascular compromise(AU)