Genomic and phenotypic characterization of 26 novel marine bacterial strains with relevant biogeochemical roles and widespread presence across the global ocean.

Prokaryotes dominate global oceans and shape biogeochemical cycles, yet most taxa remain uncultured and uncharacterized as of today. Here we present the characterization of 26 novel marine bacterial strains from a large isolate collection obtained from Blanes Bay (NW Mediterranean) microcosm experiments made in the four seasons. Morphological, cultural, biochemical, physiological, nutritional, genomic, and phylogenomic analyses were used to characterize and phylogenetically place the novel isolates. The strains represent 23 novel bacterial species and six novel genera: three novel species pertaining to class Alphaproteobacteria (families Rhodobacteraceae and Sphingomonadaceae), six novel species and three new genera from class Gammaproteobacteria (families Algiphilaceae, Salinispheraceae, and Alteromonadaceae), 13 novel species and three novel genera from class Bacteroidia (family Flavobacteriaceae), and one new species from class Rhodothermia (family Rubricoccaceae). The bacteria described here have potentially relevant roles in the cycles of carbon (e.g., carbon fixation or energy production via proteorhodopsin), nitrogen (e.g., denitrification or use of urea), sulfur (oxidation of sulfur compounds), phosphorus (acquisition and use of different forms of phosphorus and remodeling of membrane phospholipids), and hydrogen (oxidation of hydrogen to obtain energy). We mapped the genomes of the presented strains to the Tara Oceans metagenomes to reveal that these strains were globally distributed, with those of the family Flavobacteriaceae being the most widespread and abundant, while Rhodothermia being the rarest and most localized. While molecular-only approaches are also important, our study stresses the importance of culturing as a powerful tool to further understand the functioning of marine bacterial communities.

Description of clinical and genetic features of 122 patients included in the Spanish Pompe registry.

Pompe disease is a rare genetic disorder with an estimated prevalence of 1:60.000. The two main phenotypes are Infantile Onset Pompe Disease (IOPD) and Late Onset Pompe Disease (LOPD). There is no published data from Spain regarding the existing number of cases, regional distribution, clinical features or, access and response to the treatment. We created a registry to collect all these data from patients with Pompe in Spain. Here, we report the data of the 122 patients registered including nine IOPD and 113 LOPD patients. There was a high variability in how the diagnosis was obtained and how the follow-up was performed among different centres. Seven IOPD patients were still alive being all treated with enzymatic replacement therapy (ERT) at last visit. Ninety four of the 113 LOPD patients had muscle weakness of which 81 were receiving ERT. We observed a progressive decline in the results of muscle function tests during follow-up. Overall, the Spanish Pompe Registry is a valuable resource for understanding the demographics, patient's journey and clinical characteristics of patients in Spain. Our data supports the development of agreed guidelines to ensure that the care provided to the patients is standardized across the country.

Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations.

The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.

Screening for late-onset Pompe disease in Internal Medicine departments in Spain.

BACKGROUND: The screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain. METHODS: This epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing. RESULTS: The diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis. CONCLUSIONS: Our study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients.

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

Alcohol-impaired Walking in 16 Countries: A Theory-Based Investigation.

Alcohol is a global risk factor for road trauma. Although drink driving has received most of the scholarly attention, there is growing evidence of the risks of alcohol-impaired walking. Alcohol-impaired pedestrians are over-represented in fatal crashes compared to non-impaired pedestrians. Additionally, empirical evidence shows that alcohol intoxication impairs road-crossing judgements. Besides some limited early research, much is unknown about the global prevalence and determinants of alcohol-impaired walking. Understanding alcohol-impaired walking will support health promotion initiatives and injury prevention. The present investigation has three aims: (1) compare the prevalence of alcohol-impaired walking across countries; (2) identify international groups of pedestrians based on psychosocial factors (i.e., Theory of Planned Behaviour (TPB) and perceptions of risk); and (3) investigate how segments of pedestrians form their intention for alcohol-impaired walking using the extended TPB (i.e. subjective norm, attitudes, perceived control, and perceived risk). A cross-sectional design was applied. The target behaviour question was "have you been a pedestrian when your thinking or physical ability (balance/strength) is affected by alcohol?" to ensure comparability across countries. Cluster analysis based on the extended TPB was used to identify groups of countries. Finally, regressions were used to predict pedestrians' intentions per group. A total of 6,166 respondents (Age M(SD) = 29.4 (14.2); Males = 39.2%) completed the questionnaire, ranging from 12.6% from Russia to 2.2% from Finland. The proportion of participants who reported never engaging in alcohol-impaired walking in the last three months ranged from 30.1% (Spain) to 83.1% (Turkey). Four groups of countries were identified: group-1 (Czech Republic, Spain, and Australia), group-2 (Russia and Finland), group-3 (Japan), and group-4 (final ten countries including Colombia, China, and Romania). Pedestrian intentions to engage in alcohol- impaired walking are predicted by perceptions of risk and TPB-psychosocial factors in group-1 and group-4. Favourable TPB-beliefs and low perceived risk increased alcohol-impaired walking intentions. Conversely, subjective norms were not significant in group-2 and only perceived risk predicted intention in group-3. The willingness of pedestrians to walk when alcohol-impaired differs significantly across the countries in this study. Perceived risk was the only common predictor among the 16 countries.

COVID-19 in older adults: What are the differences with younger patients?

AIM: The present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID-19), in comparison with those of younger patients, and to identify risk factors for mortality. METHODS: A retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID-19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic medical records. RESULTS: The dataset comprised 340 patients. Of them, 152 (44.6%) were aged >70 years. Comorbidities were more common in the older groups. Confusion was more common in older adults, whereas typical symptoms of COVID-19, such as fever, cough and myalgia, were less common. Oxygen saturation ≤93% on room air, neutrophilia, D-dimer >0.5 µg/mL, creatinine >1.5 mg/dL, lactate dehydrogenase ≥250 U/L and elevation of creatine kinase were higher in the older adult groups. Complications during hospitalization, such as acute respiratory distress syndrome (53.3% vs 33.2%, P < 0.001), acute kidney injury (11.8% vs 5.3%; P = 0.030) and mortality (28.9% vs 6.5%; P < 0.001) were more common in patients aged >70 years. Oxygen saturation ≤93% on room air on admission was a predictor of mortality (odds ratio 11.65, 95% confidence interval 3.26-41.66, P < 0.001) in patients aged >70 years. CONCLUSIONS: Older adults with COVID-19 have more atypical presentation, more complications and higher mortality. Oxygen saturation ≤93% on room air on admission is a predictive factor of death. Geriatr Gerontol Int 2021; 21: 60-65.

Persistent traffic offenders: alcohol consumption and personality as predictors of driving disqualification / Los infractores de tráfico persistentes: el consumo de alcohol y la personalidad como predictores de la retirada del permiso de conducir

Traffic safety is an important social problem. Many accidents are due to non-compliance with traffic regulations. Serious or repeated offenses are sanctioned with penalty points or court conviction, and sanctions can lead to disqualification from driving. This paper explores the relevance of alcohol consumption and personality factors as predictors of driving disqualification. The aim of the study is to determine whether the behaviors of persistent offenders and their propensity for law-breaking are related to their characteristics and patterns of drinking. A sample of 358 drivers participated in the study: 126 non-offender habitual drivers and 232 persistent traffic offenders disqualified from driving for serious or repeated traffic offenses, 127 of them after conviction, 105 without conviction (by accumulation of penalties). Participants were given a battery of tests measuring a set of explanatory personality and alcohol consumption factors. We used a cross-sectional study design and performed statistical analysis of variance and regression searching for differences among the groups. The results reveal group effects, with significant differences in a number of factors between traffic offenders and non-offenders, and between both categories of offenders in a number of variables, including traffic violations that lead to demerit points and/or loss of a driver's license and crash involvement. Certain variables, including problem drinking, high levels of activity or excitement, penchant for thrill or sensation seeking, and propensity to hostility while driving, can accurately predict group membership. Alcohol disorders are the best predictors of disqualification from driving for serious or repeat traffic offenses, both penalized and convicted

La seguridad vial es un importante problema social. Muchos accidentes se deben al incumplimiento de las normas de tráfico. Las infracciones graves o reiteradas se sancionan por la vía administrativa o judicial y en ambos casos las sanciones pueden suponer la pérdida del permiso de conducir. Este artículo explora la relevancia del alcohol y la personalidad como factores predictivos. El objetivo del estudio es determinar si el comportamiento delictivo de los infractores persistentes está relacionado con sus características de personalidad y patrones de consumo de alcohol. Se utilizó una muestra de 358 conductores: 232 infractores persistentes, a los que les había sido retirado el carnet de conducir (127 por sentencia judicial y 105 por pérdida total de puntos), y 126 conductores habituales no infractores. Se administró una batería de pruebas que miden un conjunto de factores explicativos de personalidad y consumo de alcohol. Se utilizó un diseño transversal y se realizaron análisis estadísticos de varianza y regresión buscando diferencias entre los grupos. Los resultados revelan diferencias significativas en el tipo de infracciones y accidentes entre infractores de tráfico y no infractores y entre ambas categorías de infractores. Además, ciertas variables, como el abuso de alcohol, altos niveles de actividad, activación emocional, búsqueda de sensaciones y la tendencia a la hostilidad durante la conducción, pueden predecir con precisión la pertenencia a uno u otro grupo. Los problemas con la bebida son el mejor predictor de la pérdida del permiso de conducir, tanto por condena como por acumulación de sanciones

Inadequate empirical antimicrobial treatment in older people with bacteremic urinary tract infection who reside in nursing homes: A multicenter prospective observational study.

AIM: The aim of the study was to determine the rate of inadequate empirical antimicrobial treatment in older nursing home residents with bacteremic urinary tract infection and its influence on prognosis. METHODS: We carried out a multicentric prospective observational study in five Spanish hospitals. Patients aged >65 years with pyelonephritis or urinary sepsis with bacteremia were included. Clinical characteristics, the percentage of inadequate empirical antibiotic treatment, length of hospital stay and mortality were evaluated. RESULTS: A total of 181 patients, 54.7% women, were included in the study, and 35.9% of the patients came from nursing homes. These patients had higher percentages of ultimately or rapidly fatal disease (92.3% vs 53.4%; P < 0.001), were older (83.15 ± 6.97 years vs 79.34 ± 7.25 years; P = 0.001) and had higher Acute Physiology And Chronic Health Evaluation II (28.38 ± 8.57 vs 19.83 ± 5.88). The percentage of extended-spectrum beta-lactamases was higher in patients from nursing homes (30.6% vs 16.3%; P = 0.045), as was the percentage of inadequate empirical antibiotic treatment (40% vs 20.7%; P = 0.005). Length of hospital stay was longer (10.82 ± 3.62 days vs 9.04 ± 4.88 days; P < 0.001). However, 30-day mortality was not related to nursing home by multivariate analysis (OR 1.905, 95% CI 0.563-6.446; P = 0.300). CONCLUSIONS: Nursing home patients with bacteremic urinary tract infections had a higher rate of extended-spectrum beta-lactamase-producing enterobacteriacea and inadequate empirical antimicrobial treatment. Clinicians should consider these findings and avoid inappropriate antimicrobial agents for empirical treatment. Geriatr Gerontol Int 2019; 19: 1112-1117.

The clinical impact of bacteremia on outcomes in elderly patients with pyelonephritis or urinary sepsis: A prospective multicenter study.

BACKGROUND: Bacteremia is common in severe urinary infections, but its influence on the outcomes is not well established. The aim of this study was to assess the association of bacteremia with outcomes in elderly patients admitted to hospital with pyelonephritis or urinary sepsis. METHODS: This prospective muticenter observational study was conducted at 5 Spanish hospitals. All patients aged >65 years with pyelonephritis or urinary sepsis admitted to the departments of internal medicine and with urine and blood cultures obtained at admission to hospital were eligible. Transfer to ICU, length of hospital stay, hospital mortality and all cause 30-day mortality in bacteremic and non-bacteremic groups were compared. Risk factors for all cause 30-day mortality was also estimated. RESULTS: Of the 424 patients included in the study 181 (42.7%) had bacteremia. Neither transfer to ICU (4.4% vs. 2.9%, p = 0.400), nor length of hospital stay (9.7±4.6 days vs. 9.0±7.3 days, p = 0.252), nor hospital mortality (3.3% vs. 6.2%, p = 0.187), nor all cause 30-day mortality (9.4% vs. 13.2%, p = 0.223) were different between bacteremic and non-bacteremic groups. By multivariate analysis, risk factors for all cause 30-day mortality were age (OR 1.05, 95% CI 1.00-1.10), McCabe index ≥2 (OR 10.47, 95% CI 2.96-37.04) and septic shock (OR 8.56, 95% CI 2.86-25.61); whereas, bacteremia was inversely associated with all cause 30-day mortality (OR 0.33, 95% CI 0.15-0.71). CONCLUSIONS: In this cohort, bacteremia was not associated with a worse prognosis in elderly patients with pyelonephritis or urinary sepsis.

[C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks]. / Porcentaje de cesáreas en mujeres de bajo riesgo: un indicador útil para comparar hospitales que atienden partos con riesgos diferentes.

BACKGROUND: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. METHODS: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. RESULTS: a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. CONCLUSION: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

Porcentaje de cesáreas en mujeres de bajo riesgo: Un indicador útil para comparar hospitales que atienden partos con riesgos diferentes (*) / C-Section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks

Fundamentos: el uso del "porcentaje de cesáreas" como indicador de calidad ha sido criticado por no considerar que los hospitales atienden partos con riesgos diferentes que podrían justificar su variabilidad. El objetivo de este trabajo es explorar las características de un indicador restringido al porcentaje de cesáreas en partos de bajo riesgo. Métodos: cohorte retrospectiva de todos los partos atendidos en hospitales públicos de la Comunidad Valenciana durante el periodo 2005- 2010 (n=214.611; fuente: Conjunto mínimo de datos básicos), en la que se identificaron los partos de bajo riesgo (edad menor 35 años, sin antecedentes de cesárea, duración de las gestación entre 37-41 semanas, y feto único, presentación cefálica y normopeso. Se analizó la variabilidad en el indicador, su correlación con el indicador bruto y, mediante modelos de regresión logística multinivel, la presencia de riesgos remanentes. Resultados: un total de 117.589 (58,4% del total) partos fueron identificados como de bajo riesgo. El porcentaje de cesáreas en este subgrupo fue del 11,9% (24,4% para el total) con un rango entre hospitales del 7,0% al 28,9%. El porcentaje de cesáreas en bajo riesgo y total se correlacionaron fuertemente (r=0,88). El ajuste de los riesgos remanentes en la población de bajo riesgo no alteró el efecto hospital sobre el porcentaje de cesáreas. Conclusiones: el porcentaje de cesáreas en partos de bajo riesgo incluye un alto volumen de partos, correlaciona con el indicador bruto y los riesgos remanentes no están influidos diferencialmente por los hospitales, monitorizar la calidad de la atención obstétrica en el Sistema Nacional de Salud (AU)

Background: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. Methods: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: mini- mum basic dataset). A low-risk subpopulation consisting of women under- 35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. Results: a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. Conclusion: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System (AU)

[C-reactive protein changes with antihypertensive and statin treatment]. / Variaciones de la proteína C reactiva inducidas por el tratamiento antihipertensivo e hipolipemiante.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the modifications of high sensitivity C-reactive protein (CRP) with antihypertensive and statin treatment in a hypertensive population with a wide range of coronary risks (CR). PATIENTS AND METHOD: Retrospective follow-up study in 665 hypertensive patients: 556 (52% male) without dyslipidemia and CR (Framingham at 10 years) of 8.3 (7.6) as a control group (C) and 109 (61% male) with dyslipidemia and CR of 13.1 (8.8) who were treated with statins (T). Statins treatment was established according to NCEP-ATP-III. In both groups, the antihypertensive treatment was optimized in order to achieve blood pressure (BP) control (< 140/90 mmHg). A lipid profile and high sensitivity CRP (analyzed by nephelometry) was performed at the beginning and at the end of follow up [14.3 (3.6) months]. RESULTS: CRP levels were reduced in the T group -0.17 (0.2) mg/L vs. 0.14 (0.09) mg/L (p = 0.003, Mann-Whitney) in C. The lessening of CRP was not related to the reduction of lipids levels: total cholesterol (r = 0.06; p = 0.49), LDL-C (r = 0.11; p = 0.24), triglycerides (r = -0.02; p = 0.81) (Spearman), or to the reduction of systolic BP (r = -0.07; p = 0.44) and diastolic BP (r = -0.121; p = 0.21). The T group was treated with more antihypertensive drugs than C (2.2 [2.3] vs. 2.5 [1.2]; p = 0.02). Patients treated with ECA inhibitors or angiotensin II antagonist showed a tendency to decreasing the CRP levels more (p = 0.08). CONCLUSION: In hypertensive populations, statins induce a reduction of CRP levels. The reduction is not related to the lowering of lipids levels or BP values. The effect of statins on the reduction of CRP in hypertensive patients is not related to the lowering of lipids or BP.

Variaciones de la proteína C reactiva inducidas por el tratamiento antihipertensivo e hipolipemiante / C-reactive protein changes with antihypertensive and statin treatment

Fundamento y objetivo: Valorar las alteraciones de la proteína C reactiva (PCR) inducidas por el tratamiento con estatinas y fármacos antihipertensivos en una población de hipertensos con riesgo coronario (RC) diverso. Pacientes y método: Estudio retrospectivo longitudinal de seguimiento en el que se incluyó a 665 pacientes con hipertensión arterial: 556 (52% varones) pacientes sin dislipemia y con RC (Framingham a los 10 años) de 8,3 (7,6) que se utilizaron como grupo control y 109 (un 61% varones) pacientes con dislipemia y RC de 13,1 (8,8) que recibieron tratamiento con estatinas. El tratamiento con estatinas se indicó de acuerdo con los criterios de RC según el National Cholesterol Education Program in Adults (Adults Treatment Panel III). En caso necesario se les optimizó el tratamiento antihipertensivo aumentando la dosis del fármaco que estaban tomando y/o añadiendo diurético. Al principio y al final del estudio, se determinó a todos los pacientes el perfil lipídico (colesterol total [CT], colesterol unido a lipoproteínas de alta densidad [c-HDL] y triglicéridos [TG]) y la PCR por un método de alta sensibilidad. El tiempo medio de seguimiento fue de 14,3 (3,6) meses. Resultados: Los valores de PCR disminuyeron en el grupo de tratamiento respecto al control (media de ­0,17 [0,2] frente a a 0,14 [0,09] mg/l; p = 0,003, prueba de la U de Mann-Whit-ney). En el grupo de tratamiento, el descenso de los valores de PCR no guardó relacion (coeficientes de correlacion de Spearman) con el descenso de los valores lipídicos: colesterol total (r = 0,06; p = 0,49), colesterol unido a lipoproteínas de baja densidad [cLDL] (r = 0,11; p = 0,24) y triglicéridos (r = ­0,02; p = 0,81). Para la variación de la presión arterial, los resultados fueron para la presión arterial sistólica, r = ­0,07 y p = 0,44, y para la presión arterial diastólica, r = ­0,121 y p = 0,21. El grupo de tratamiento recibió más fármacos antihipertensivos que el control (2,2 [2,3] frente a 2,5 [1,2]; p = 0,02). Al agrupar a los pacientes tratados con estatinas según el grupo farmacológico de antihipertensivos que recibían, los que tomaban inhibidores de la enzima conversiva de la angiotensina o antagonistas del receptor de la angiotensina de tipo II tuvieron una mayor tendencia a disminuir sus valores de PCR (p = 0,08) que el resto. Conclusión: En pacientes hipertensos, las estatinas inducen un descenso de los valores de la PCR. Dicho descenso no guardó relación con la disminución de los valores de colesterol total, cLDL, ni triglicéridos ni con la variación de la presión arterial. El efecto de la disminución de los valores de PCR inducido por estatinas en pacientes hipertensos es independiente de la disminución de los valores de LDL y de la presión arterial

Background and objective: The aim of this study was to evaluate the modifications of high sensitivity C-reactive protein (CRP) with antihypertensive and statin treatment in a hypertensive population with a wide range of coronary risks (CR). Patients and method: Retrospective follow-up study in 665 hypertensive patients: 556 (52% male) without dyslipidemia and CR (Framingham at 10 years) of 8.3 (7.6) as a control group (C) and 109 (61% male) with dyslipidemia and CR of 13.1 (8.8) who were treated with statins (T). Statins treatment was established according to NCEP-ATP-III. In both groups, the antihypertensive treatment was optimized in order to achieve blood pressure (BP) control (< 140/90 mmHg). A lipid profile and high sensitivity CRP (analyzed by nephelometry) was performed at the beginning and at the end of follow up [14.3 (3.6) months]. Results: CRP levels were reduced in the T group ­0.17 (0.2) mg/L vs. 0.14 (0.09) mg/L (p = 0.003, Mann-Whitney) in C. The lessening of CRP was not related to the reduction of lipids levels: total cholesterol (r = 0.06; p = 0.49), LDL-C (r = 0.11; p = 0.24), triglycerides (r = ­0.02; p = 0.81) (Spearman), or to the reduction of systolic BP (r = ­0.07; p = 0.44) and diastolic BP (r = ­0.121; p = 0.21). The T group was treated with more antihypertensive drugs than C (2.2 [2.3] vs. 2.5 [1.2]; p = 0.02). Patients treated with ECA inhibitors or angiotensin II antagonist showed a tendency to decreasing the CRP levels more (p = 0.08). Conclusion: In hypertensive populations, statins induce a reduction of CRP levels. The reduction is not related to the lowering of lipids levels or BP values. The effect of statins on the reduction of CRP in hypertensive patients is not related to the lowering of lipids or BP

[Clinical use of statins and cholesterol goals in patients with several cardiovascular risk factors]. / Uso clínico de las estatinas y objetivos terapéuticos en relación con el riesgo cardiovascular.

BACKGROUND AND OBJECTIVE: Our goal was to determine the number of patients who achieve low-density lipoprotein cholesterol (LDL-c) targets according to new guidelines. PATIENTS AND METHOD: Descriptive and transversal study of patients from a cardiovascular clinic. LDL-c was calculated and targets were established according the NCEP-ATP III. RESULTS: 1,811 patients (46% males, 54% females) were studied. 35% of these were high-risk patients (group 1: coronary risk > 20% at 10 years), 19% were intermediate-risk patients (group 2: coronary risk 10-20% at 10 years) and 46% were low-risk patients (group 3: coronary risk < 10% at 10 years). Overall, 58% of patients achieved target LDL-c levels, yet success rates were 26% among group 1 patients, 51% among group 2 patients, and 86% among group 3 patients (p = 0.001, for differences between groups). Statin treatment was significantly related to achieving target LDL-c levels in group 1 patients (OR = 1.7; 95% CI, 1.2-2.4; p = 0.007). In group 1.41% of patients had LDL-c levels > 130 mg/dl without receiving lipid-lowering drugs. CONCLUSIONS: Although an overall 58% patients achieve target LDL-C levels, only one of four high-risk patients have LDL-c levels < 100 mg/dl, and statin treatment is a determining factor to achieve this goal. These findings indicate that a more aggressive treatment with statins is needed in secondary prevention.

Uso clínico de las estatinas y objetivos terapéuticos en relación con el riesgo cardiovascular / Clinical use of statins and cholesterol goals in patients with several cardiovascular risk factors

FUNDAMENTO Y OBJETIVO: El National Cholesterol Education program (NCEP) ha publicado las últimas guías de tratamiento hipolipemiante, que amplían el número de tratamientos farmacológicos respecto a anteriores guías. El objetivo de nuestro estudio es establecer el grado de cumplimiento de los objetivos terapéuticos establecidos por las guías terapéuticas recientemente publicadas. PACIENTES Y MÉTODO: Estudio descriptivo transversal de pacientes que acudieron a una unidad de hipertensión y riesgo cardiovascular. Se calculó el colesterol unido a lipoproteínas de baja densidad (cLDL) de cada uno y se definieron los valores considerados objetivos terapéuticos acordes con su riesgo coronario, siguiendo las indicaciones del NCEP-ATP III. RESULTADOS: Se estudió a 1.811 pacientes (el 46 por ciento varones y el 54 por ciento mujeres), pertenecientes a tres categorías de riesgo definidas por el ATP III. El 35 por ciento de los pacientes pertenecía al grupo de mayor riesgo (grupo 1: riesgo coronario a los 10 años superior al 20 por ciento). El 19 por ciento tenía un riesgo del 10-20 por ciento (grupo 2) y en el 46 por ciento el riesgo era inferior a 10 por ciento (grupo 3). El 58 por ciento de los pacientes cumplía los objetivos terapéuticos de cLDL: un 26 por ciento en el grupo 1, un 51 por ciento en el grupo 2 y el 86 por ciento del grupo 3 (p = 0,001). En el análisis de los factores que intervienen por conseguir el objetivo terapéutico, el tratamiento con estatinas obtuvo un resultado estadísticamente significativo sólo en el grupo 1 de mayor riesgo coronario (odds ratio = 1,7; intervalo de confianza del 95 por ciento, 1,2-2,4; p = 0,007), pero no en los grupos de riesgo intermedio o bajo. El 41 por ciento de los pacientes del grupo 1 tenía valores de cLDL que requerían intervención farmacológica (cLDL superior a 130 mg/dl) y no tomaba tratamiento. CONCLUSIONES: En nuestro estudio, aunque el 58 por ciento de los pacientes alcanza los objetivos terapéuticos previstos, sólo uno de cada 4 pacientes con alto riesgo coronario tiene valores de cLDL inferiores a 100 mg/dl. Estos datos indican que es necesario implementar el uso correcto de estatinas a las dosis eficaces en prevención secundaria (AU)