Additive value of diabetes and peripheral arterial disease in the risk stratification of patients admitted after an acute coronary syndrome: a subanalysis of the PAMISCA Study.

BACKGROUND: There is an increasing interest in the use of non-invasive methods for the detection of subclinical atherosclerosis to better identify patients with high risk of cardiovascular events The presence of diabetes mellitus (DM) and peripheral arterial disease (PAD) is associated with increased risk of events but their value in the acute coronary syndrome (ACS) patient has not been ascertained. METHODS: We performed a subanalysis of the PAMISCA study, designed to investigate the prevalence of PAD in patients admitted to Spanish hospitals with a diagnosis of an ACS. RESULTS: A total of 1410 patients were analysed (71.4% men, age 66 +/- 11.9 years, 35% DM). The prevalence of PAD was higher in DM vs. no-DM (41.5% vs. 30.6% respectively, p < 0.001). Patients with PAD and DM had more in-hospital cardiac complications such as atrial fibrillation/flutter, recurrent myocardial ischaemia and heart failure and a trend towards higher in-hospital mortality (p = 0.08). Non-DM patients with PAD and DM without PAD shared similar cardiac complications and the group without neither PAD nor DM had the best prognosis. In patients without PAD, DM was an independent predictor of three-vessel coronary disease (OR 1.6; 95% CI: 1.1-2.5, p < 0.05) after adjustment by age, sex, low density lipoproteins (LDL), smoking and the previous myocardial infarction. However, in PAD patients, DM failed to be an independent risk factor in the multivariate analysis (OR 1.0; 95% CI 0.6-1.6, p < 0.05). CONCLUSIONS: The concurrence of DM and PAD helps identify patients with an adverse risk profile.

Hipertensión arterial e insuficiencia cardíaca en las consultas de Atención Primaria y de Cardiología en España / Hypertension and heart failure in Primary Care and Cardiology consultations of in Spain

Objetivo del estudio. Analizar los resultados referentes a los pacientes con insuficiencia cardíaca del estudio CARDIOTENS 99, un estudio transversal de la hipertensión arterial asociada a patología cardiovascular realizado sobre 32.051 pacientes atendidos en consultas de Cardiología y de Atención Primaria. Métodos. Se incluyeron prospectivamente los datos demográficos, clínicos, de presión arterial y terapéuticos de todos los pacientes atendidos en un mismo día por 1.159 médicos (21 por ciento cardiólogos; 79 por ciento de Atención Primaria).Resultados. El 4 por ciento del total de 32.051 pacientes tenía insuficiencia cardíaca, representando el 23 por ciento de los pacientes con cardiopatía. La edad media fue de 70,8ñ6,7 años; 53 por ciento mujeres. La hipertensión fue el factor de riesgo más frecuente, apareciendo en el 71 por ciento de los pacientes con insuficiencia cardíaca. La hipertensión fue más frecuente en Atención Primaria (76 por ciento frente a 63 por ciento; p0,05). Los fármacos más usados fueron los diuréticos (63 por ciento). El 44 por ciento de los pacientes con insuficiencia cardíaca tomaba un inhibidor de la enzima conversora de angiotensina y el 14 por ciento tomaban bloqueadores beta. Sólo el 19 por ciento de los hipertensos con insuficiencia cardíaca tenían la presión arterial sistólica bien controlada según las directrices internacionales (<130 mmHg). La proporción de pacientes con presión arterial mayor de 140 mmHg fue superior en los pacientes atendidos por cardiólogos que en los atendidos por Atención Primaria (57 por ciento frente a 47 por ciento; p<0,01).Conclusiones. La insuficiencia cardíaca se asocia con gran frecuencia con la hipertensión arterial. La mayoría de los pacientes con insuficiencia cardíaca tienen un control inadecuado de la presión arterial. En los pacientes atendidos por cardiólogos es más frecuente la cardiopatía isquémica como causa de insuficiencia cardíaca que en los pacientes de Atención Primaria, donde la causa principal es la hipertensión. El empleo de los fármacos recomendados en insuficiencia cardíaca es, en general, muy escaso (AU)

[Hypertension and heart failure in Primary Care and Cardiology consultations of in Spain]. / Hipertensión arterial e insuficiencia cardíaca en las consultas de Atención Primaria y de Cardiología en España.

OBJECTIVE: Analyze the results concerning the heart failure population of CARDIOTENS 99, a cross-sectional study of hypertension associated with cardiovascular disease carried out on 32,051 patients seen in Cardiology and Primary Care consultations. METHODS: In the analysis we included prospectively demographic, clinical, blood pressure, and therapeutic data of all patients seen on a single day by 1,159 physicians (21% cardiologists; 79% Primary Care physicians). RESULTS: 4% of the total sample of 32,051 patient had heart failure, representing 23% of the patients with heart disease. Median age was 70,8 6,7 years; 53% were women. Hypertension was the most frequent risk factor, appearing in 71% of the patients with heart failure. Hypertension was most frequent in Primary Care patients (76% versus 63%; p < 0,01), while ischemic heart disease was most frequent in cardiology patients (38% versus 27%; p < 0,01). Cardiology patients showed a trend for greater use of drugs in comparison with patients seen in primary care consultations but without significant differences (3,39 versus 3,35; p > 0,05). Diuretics were the drugs with greater prescription (63%). 44% patients with heart failure were on an angiotensin-conversing enzyme inhibitor and 14% on beta-adrenergic blockers. Systolic blood pressure was well controlled in only 19% of hypertensive patients with heart failure, according to the international recommendations (< 130 mmHg). The proportion of patients with blood pressure higher than 140 mmHg was superior among the patients seen by cardiologists than between those seen by Primary Care physicians (57% versus 47%; p < 0.01). CONCLUSIONS: Heart failure is often associated with hypertension. Control of blood pressure is inadequate in the majority of patients with heart failure. Ischemic heart disease is a more frequent cause of in the patients seen by cardiologists than in those seen by Primary Care physicians, and hypertension is the leading cause of heart failure in these patients. Prescription of drugs recommended for the treatment of heart failure it is generally very scant.

Prognostic evaluation of bacteremia and fungemia in patients with acquired immunodeficiency syndrome.

The incidence of bacterial infections in general and of bacteremia in particular is high among patients with acquired immunodeficiency syndrome (AIDS). The factors influencing the prognosis of bacteremia in these patients are not well known. In order to better define those factors associated with a poor prognosis, all episodes of bacteremia or fungemia in patients with AIDS who were hospitalized in four general hospitals between 1 September 1987 and 31 December 1996 were studied prospectively. Among 1,390 patients diagnosed with AIDS, 238 (17.1%) developed 274 episodes of bacteremia or fungemia. Mortality related to bacteremia was 21.3%. Variables associated with high mortality were fungemia (odds ratio [OR], 6.19; 95% confidence interval [CI], 1.99 - 19.28), hypotension (OR, 19.65; 95%CI, 7.42 - 52.07), inappropriate antimicrobial treatment (OR, 16.94; 95%CI, 4.92 - 58.32), and unknown origin of bacteremia (OR, 3.93; 95%CI, 1.58 - 9.76). The mortality rate among patients with at least one of these factors was 46.7%, whereas in patients without any of these factors, the rate was 4.9% ( P < 0.001). Bacteremic episodes of unknown origin were significantly more frequently associated with community acquisition ( P = 0.001), inappropriate antimicrobial treatment ( P = 0.04), and etiology by gram-negative microorganisms or fungi ( P < 0.001) and were significantly less frequently associated with the presence of a previous intravenous catheter ( P = 0.004), resulting in peculiar etiologic and epidemiological profiles. The factors that influence the outcome of AIDS patients who develop bacteremia are sometimes avoidable or known during the first days after admission. Therefore, knowledge about these factors could improve the prognosis of bloodstream infections in this population.

[The role of diabetes mellitus in cardiac disease in Spain. The CARDIOTENS Study 1999]. / Impacto de la diabetes en las enfermedades cardíacas en España, Estudio CARDIOTENS 1999.

BACKGROUND: We analyse the characteristics of the patients with diabetes and cardiac disease included in the CARDIOTENS 1999 study. PATIENTS AND METHOD: 32,051 outpatients who were seen the same day by 1,159 primary healthcare physicians (79%) and cardiologists (21%) were prospectively registered in a database including demographic and clinical data and therapeutic profile. RESULTS: History of cardiac disease was present in 19% (6,194 patients) of the whole population, and 1,275 of them (20.6%) were diabetics. Hypertension was present in 74% of diabetic patients with cardiac disease. Coronary heart disease (angina pectoris or previous myocardial infarction) was present in 45% of diabetic patients with heart failure. Less than 30% of these patients had blood pressure levels under 130/85 mmHg, as recommended by international guidelines. An LDL-cholesterol level lower than 100 mgrs/dl was observed in only 12% of diabetic patients with coronary heart disease; the mean values of total cholesterol and LDL-cholesterol of these patients were significantly (p < 0.01) higher in those seen by primary healthcare physicians. Less than 40% of diabetic patients with cardiac disease were treated with an angiotensin converting enzyme inhibitor, a therapy which was otherwise used in 50% of diabetic patients with heart failure. A beta-blocker therapy was used in 26% of diabetic patients with coronary heart disease and 39% of them were being treated with statins. CONCLUSIONS: More than 20% of patients with cardiac disease in this study were diabetics. Blood pressure and cholesterol levels recommended by current guidelines were attained in a limited proportion of these patients. The use of drugs with demonstrated prognostic benefit in diabetic patients with heart disease is scarce.

[Impact of hypertension in cardiac diseases in Spain. The CARDIOTENS Study 1999]. / Impacto de la hipertensión en las cardiopatías en España. Estudio CARDIOTENS 1999.

INTRODUCTION AND OBJECTIVES: To analyze the prevalence and control of hypertensive patients with associated cardiac diseases in Spain. METHODS: All the 32,051 outpatients seen the same day by 1,159 primary physicians (79%) and cardiologists (21%) were prospectively included in a database including history of cardiac disease (heart failure, coronary disease or atrial fibrillation), casual blood pressure and ongoing treatments. RESULTS: Hypertension was present in 33% of the whole group and 19% had both hypertension and a cardiac disease. Hypertension was present in 77% of the patients with heart failure, in 66% of those with coronary diseases and in 66% with atrial fibrillation. Less than 60% of the hypertensive patients with heart failure were treated with an angiotensin or a converting enzyme inhibitor. Thirty-two percent of the hypertensive patients with coronary disease received a betablocker and 25% of the hypertensive patients with atrial fibrillation were on oral anticoagulation. Less than 20% of the patients with hypertension and cardiac disease had blood pressure levels under 130/85 mmHg as recommended by international guidelines. Patients seen by primary care physicians were found to be slightly better treated than those under cardiologists' care. CONCLUSIONS: High blood pressure is associated with heart failure, coronary disease and atrial fibrillation in a high percentage of patients. The blood pressure levels recommended by current guidelines for cardiac hypertensives were attained in less than 20% of the cases. The control of blood pressure in these high risk hypertensive patients was low and the use of appropriate pharmacological treatment was poor.

[Practice Guidelines of the Spanish Society of Cardiology for the management of cardiac disease in pregnancy]. / Guías de práctica clínica de la Sociedad Española de Cardiología en la gestante con cardiopatía.

Maternal adaptation to pregnancy includes reproductive hormone interaction plasma, volume changes with an increase in total body water, vascular alterations with a decrease in systemic resistance and modifications associated with hypercoagulability. These explain, in part, the appearance of signs and symptoms, even in a normal pregnant woman, that are difficult to distinguish from those occurring in heart disease and why some cardiac abnormalities are not well tolerated during pregnancy. Cardiovascular abnormalities are considered the first non-obstetric cause of morbidity and mortality during pregnancy. Rheumatic and congenital heart diseases are currently the most frequent cardiopathy found in women of childbearing age, followed by hypertension, coronary artery disease and arrhythmia. Although pregnancy is well tolerated by most women with heart disease, there are some cardiovascular abnormalities which place the mother and the infant at extremely high risk: patients with congestive heart failure and severe cardiac dysfunction, pulmonary hypertension, cyanotic congenital heart disease, Marfan's syndrome, severe obstructive lesions of the left side of the heart, patients with prosthetic cardiac valves and antecedents of peripartum cardiomyopathy should be encouraged to avoid pregnancy and the interruption of pregnancy may be advisable in cases with great risk of disability or death. The most severe cardiopathies significantly increase the risk of fetal loss and the presence of a congenital cardiac abnormality in either parent increases the risk of congenital cardiac disease in the fetus. Medical care must be initiated early, prior to conception and women with cardiopathy should be informed of the possible risks of pregnancy to both the mother and fetus.

Cholesterol reduction improves myocardial perfusion abnormalities in patients with coronary artery disease and average cholesterol levels.

OBJECTIVES: We sought to evaluate whether pravastatin treatment increases myocardial perfusion, as assessed by thallium-201 single-photon emission computed tomographic (SPECT) dipyridamole testing, in patients with coronary artery disease (CAD) and average cholesterol levels. BACKGROUND: Previous studies in hypercholesterolemic patients have demonstrated that cholesterol reduction restores peripheral and coronary endothelium-dependent vasodilation and increases myocardial perfusion. METHODS: This was a randomized, placebo-controlled study with a cross-over design. Twenty patients with CAD were randomly assigned to receive 20 mg of pravastatin or placebo for 16 weeks and then were crossed over to the opposite medication for a further 16 weeks. Lipid and lipoprotein analysis and dipyridamole thallium-201 SPECT were performed at the end of each period. The SPECT images were visually analyzed in eight myocardial segments using a 4-point scoring system by two independent observers. A summed stress score and a summed rest score were obtained for each patient. Quantitative evaluation was performed by the Cedars-Sinai method. The magnitude of the defect was expressed as a percentage of global myocardial perfusion. RESULTS: Total and low density lipoprotein cholesterol levels during placebo were 214 +/- 29 mg/dl and 148 +/- 25 mg/dl, respectively. These levels with pravastatin were 170 +/- 23 mg/dl and 103 +/- 23 mg/dl, respectively. The summed stress score and summed rest score were lower with pravastatin than with placebo (7.2 +/- 2.3 vs. 5.9 +/- 2.3, p = 0.012 and 3.2 +/- 1.6 vs. 2.4 +/- 2.2, p = 0.043, respectively). Quantitative analysis showed a smaller perfusion defect with pravastatin (29.2%) as compared with placebo (33.8%) (p = 0.021) during dipyridamole stress. No differences were found at rest. CONCLUSIONS: Reducing cholesterol levels with pravastatin in patients with CAD improves myocardial perfusion during dipyridamole stress thallium-201 SPECT.

[Fixed-dose combination therapy: reduction of side effects with enhanced tolerance and antihypertensive efficacy]. / Terapia combinada a dosis fija: reducción de los efectos colaterales con aumento de la tolerancia y la eficacia antihipertensiva.

Despite the availability of many newer antihypertensive agents, hypertensive patients remain at a higher risk of premature death than the general population. This persistence of elevated morbidity and mortality may be accounted for by the frequent failure to achieve adequate blood pressure reduction despite an extensive range of available antihypertensive agents. Such considerations have led to the reassessment of the potential role of fixed-dose combination agents. The antihypertensive efficacy may be enhanced when two classes of agents are combined. In addition, combination therapy enhances tolerability because one drug of fixed combination can antagonize some of the adverse effects of the second drug. Fixed-dose combination therapy simplifies the treatment regimen, preventing treatment failures that might result from missed doses.

Treatment of chronic stable angina with carvedilol: a multiple-action neurohormonal antagonist. A review of controlled clinical trials.

Beta-blockers and vasodilators, such as nitrates and calcium channel blockers, are all established antianginal therapies. These therapies have different antianginal mechanisms that dictate both their mode of action and their side-effect profile. An agent with both cardiac beta- and vascular alpha-receptor activity offers advantages over these conventional drugs. Carvedilol, a multiple-action neurohormonal antagonist, has potent antihypertensive and antianginal activity. Through its combination of pharmacological mechanisms, it reduces myocardial oxygen demand, increases myocardial blood supply and scavenges oxygen free radicals, which are capable of ischaemic damage. Studies have shown that carvedilol is at least as effective as other antianginal therapies in the management of chronic stable angina. Carvedilol is well tolerated--in several cases, the overall incidence of adverse events being lower than with other antianginal agents. These properties, combined with the documented antianginal effects, suggest that carvedilol may prove useful for the treatment of patients with chronic stable angina.

[Arterial hypertension and disorders of hydrocarbon metabolism]. / Hipertensión arterial y alteraciones del metabolismo hidrocarbonado.

Abnormalities of glucose, insulin, and lipoprotein metabolism are common in patients with hypertension. This constellation of risk factors may be recognized at a young ages and is, at least in part, inheritable. Insulin resistance and compensatory hyperinsulinemia may be primary events, and enhanced sympathetic activity and diminished adrenal medullary activity could be important links between the defect in insulin action and the development of hypertension and the associated metabolic abnormalities. But not all hypertensive patients have insulin resistance. It is possible that insulin resistance, and compensatory hyperinsulinemia have major roles in the regulation of blood pressure in susceptible subjects predisposed to hypertension by hereditary or environmental factors. Considerable evidence, both in experimental animal models and in humans, points to hypertension as being of critical importance in the pathogenesis of severe diabetic heart disease. In diabetic hypertensive cardiomyopathy, coronary artery disease as well as structural and functional abnormalities are more pronounced than would be expected from either process alone. The hypertension increases the risk of diabetic nephropathy in non-insulin-dependent diabetic patients. Microalbuminuria is a powerful predictor of mortality in these patients. It seems that angiotensin-converting-inhibitors have efficacy in postponing nephropathy in hypertensive non-insulin-dependent diabetic patients. In patients with hypertension and diabetes, additional clinical trials are required to identify the interventions that will most effectively reduce not only overall risk but also improve cardiovascular disease prognosis.

[Arterial hypertension and diabetes]. / Hipertensión arterial y diabetes.

Abnormalities of glucose, insulin, and lipoprotein metabolism are common in patients with hypertension. This constellation of risk factors may be recognized at young ages and is at least in part heritable. The insulin resistance and the compensatory hyperinsulinemia could be primary events, and enhanced sympathetic activity and diminished adrenal medullary activity would be important links between the defect in insulin action and the development of hypertension and the associated metabolic abnormalities. But not all hypertensive patients have insulin resistance. It is possible that insulin resistance, and compensatory hyperinsulinemia have major roles in the regulation of blood pressure in susceptible subjects predisposed to hypertension by heredity or environmental factors. Considerable evidence, both in experimental animal models and in humans, points to hypertension as of critical importance in the pathogenesis of severe diabetic heart disease. In diabetic hypertensive cardiomyopathy, coronary artery disease as well as structural and functional abnormalities are more pronounced than would be expected from either process alone. The hypertension increases the risk of diabetic nephropathy in non-insulin-dependent diabetic patients. The microalbuminuria is a powerful predictor of mortality in these patients. It seems that angiotensin-converting-inhibitors have efficacy in postponing nephropathy in hypertensive non-insulin-dependent diabetic patients. In patients with hypertension and diabetes, additional clinical trials are required to identify those interventions that will most effectively reduce not only overall risk but also definitive cardiovascular disease endpoints.

Suppurative mediastinitis after open-heart surgery: a comparison between cases caused by Gram-negative rods and by Gram-positive cocci.

OBJECTIVE: To compare clinical characteristics and risk factors of suppurative postsurgical mediastinitis according to its etiology. METHODS: Suppurative postsurgical mediastinitis developed in 45 (2.5%) of 1779 patients who underwent open-heart surgery at the Hospital Virgen del Rocío in Seville, Spain, from 1986 to 1996. Microbiological diagnosis was available in 42 patients. RESULTS: Gram-negative rods were isolated in 19 cases and Gram-positive cocci in 23 cases. Seventeen isolates (38%) were sensitive to the antimicrobial agent used perioperatively. Patients with Gram-negative rod infection had a longer duration of bypass (127plus minus36 min versus 96plus minus34 min, p<0.01), and a worse postoperative condition. Longer mechanical ventilation (4plus minus7 days versus 1plus minus2 days, p<0.05) and concomitant infection in a remote site (pulmonary and/or urinary infection) were more frequently observed in this group than in patients with Gram-positive infections (58% versus 22%, p<0.05). Twenty patients (51%) were bacteremic. The mortality rate was 20% (five of 45). CONCLUSIONS: Preventable postoperative remote-site infection may lead to mediastinitis, especially if Gram-negative rods are involved.

[Curative treatment with fluconazole in 5 cases of invasive candidiasis]. / Tratamiento curativo con fluconazol en 5 casos de candidiasis invasiva.

BACKGROUND: Amphotericin B is the treatment of choice for invasive and disseminated Candida sp. infections. Fluconazole is an antifungal drug with less toxicity. Because of its pharmacokinetic properties, fluconazole can be specially useful in the treatment of invasive candidiasis. Although it is useful in several forms of candidiasis, its efficacy in deep-seated candidal infections is not totally proved due to the lack of comparative studies with amphotericin. In order to contribute new data about the usefulness of fluconazole in the treatment of invasive candidiasis, we report 5 patients which cured with this antifungal drug. METHODS: The clinical records of those patients with invasive candidiasis that cured with fluconazole were retrospectively reviewed. RESULTS: Fluconazole was used in 2 patients after detecting toxicity to amphotericin. Fluconazole was used from the beginning in the other 3 patients. None of the patients were neutropenic. All the patients cured without recurrence. CONCLUSIONS: In this series, the employment of fluconazole was a non-toxic and effective alternative to amphotericin B in nonneutropenic patients with invasive candidiasis.

[Increase of myocardial perfusion during antilipemic treatment in patients with ischemic cardiopathy]. / Incremento de la perfusión miocárdica durante el tratamiento hipolipemiante en pacientes con cardiopatía isquémica.

OBJECTIVES: To evaluate if cholesterol lowering therapy with simvastatin increases myocardial perfusion, assessed by Thallium-201 single photon emission computed tomography (SPECT) after dipyridamole, in patients with coronary artery disease. PATIENTS AND METHODS: Ten hypercholesterolemic subjects with coronary artery disease were selected for a pilot study. Lipid and lipoprotein analysis and Thallium-201 SPECT were performed before and after 16 weeks of treatment with 40 mg of simvastatin QD. SPECT images were qualitatively analyzed in 8 myocardial segments using a 4 point scoring system. Quantitative evaluation was performed in 13 segments. The myocardial region with the maximal mean counts per pixel on the stress study was considered the reference region. TI201 activity in all other myocardial regions was expressed as a percentage of the activity in the reference region. RESULTS: Total cholesterol and LDL cholesterol were reduced by 28.4% and 37.1% with treatment. Global myocardial perfusion was increased in all patients. Qualitative analysis demonstrated that cholesterol lowering improved myocardial perfusion during dipyridamole stress. Quantitative analysis showed an increased global perfusion during stress (41.8% vs 54.6%; p < 0.0001), due to increased perfusion of previous ischemic segments (32.4% vs 49.4%; p < 0.0001) but without changes in previous normally perfused segments (71.5% vs 71.3%). CONCLUSION: Reduction of cholesterol levels in hypercholesterolemic subjects with coronary artery disease increases myocardial perfusion in ischemic segments during dipyridamole stress test as assessed by single photon emission computed tomography (SPECT).

Adrenoreceptors, endothelial function, and lipid profile: effects of atenolol, doxazosin, and carvedilol.

BACKGROUND: The use of effective blood-pressure-lowering drugs has not achieved the expected reduction in the incidence of ischaemic heart disease in hypertensive patients. This study examined the cardiovascular effects of adrenergic blockade (alpha or beta, or both) and its effect on the fibrinolytic response of the endothelium to anoxia and lipoprotein metabolism in 78 hypertensive patients with ischaemic heart disease. METHODS: All patients had stable angina on positive exercise testing and silent ischaemia on 24 h Holter monitoring at baseline and 6 months after effective blood-pressure-lowering treatment with the selective beta-blocker atenolol, the alpha 1-inhibitor doxazosin, or the dual-action drug carvedilol. RESULTS: Atenolol increased the effort time (P < 0.05), total ischaemia (P < 0.05), and the number of ischaemic episodes (P < 0.05). It reduced the lipoprotein ratio (P < 0.05) but did not modify the fibrinolytic activity of the endothelium. Doxazosin increased the fibrinolytic index (ratio of plasminogen activator to its main inhibitor) before (P < 0.05) and after anoxia (P < 0.0001) and the lipoprotein ratio (P < 0.001), without an anti-ischaemic effect. Carvedilol increased the effort time (P < 0.05), reducing total ischaemia (P < 0.05), the number of ischaemic episodes (P < 0.01), and increasing the post-anoxia fibrinolytic index (P < 0.05) without modifying the lipid profile. CONCLUSIONS: At antihypertensive equipotent doses, the inhibition of alpha 1-receptors improves the endothelial fibrinolytic activity and the lipid profile. beta-Blockade has an anti-ischaemic action, but reduces the lipoprotein ratio (ApoA/ApoB) and does not improve endothelial fibrinolytic activity.

[Multiple heart valve involvement in renal polycystic disease in the adult]. / Afectación cardíaca plurivalvular en la enfermedad poliquística renal del adulto.

Adult polycystic kidney disease is associated with frequent extrarenal manifestations. Previous studies have reported a increased incidence of cardiovascular abnormalities, in particular of mitral and tricuspid-valve prolapse, and multivalvular incompetence. These findings lends support to the hypothesis that autosomal dominant polycystic kidney disease is a disorder of connective tissue. A mitral-valve prolapse, and multivalvular incompetence was detected in a 75-year old patient with a polycystic kidney disease. The cardiovascular abnormalities published in the literature are review.