SGLT2 inhibitors and GLP1 agonists administered without metformin compared to other glucose-lowering drugs in patients with type 2 diabetes mellitus to prevent cardiovascular events: A systematic review.

OBJECTIVES: To assess the efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, administered without metformin on cardiovascular outcomes in type 2 diabetes patients. METHODS: A systematic review was performed according to Cochrane's methodological standards. We included randomized clinical trials (RCTs) on adult type 2 diabetes patients, assessing the efficacy of SGLT2 inhibitors and GLP1-RAs compared to other glucose-lowering drugs and/or RCTs that presented data of a subgroup of type 2 diabetes patients without metformin use at baseline. The main outcome was the reduction of the risk of any major adverse cardiovascular events (MACE) reported individually or as a composite outcome. RESULTS: Five RCTs including 50,725 type 2 diabetes patients, of whom 10,013 had not received metformin, were included in this meta-analysis. Three of these studies assessed the efficacy of GLP1-RAs and two of SGLT2 inhibitors. In patients without metformin at baseline, GLP1-RAs in comparison with placebo reduced the risk of MACE significantly by 20% (HR: 0.80; 95% CI: 0.71-0.89). SGLT2 inhibitors also significantly reduced the risk of MACE by 32% (HR: 0.68; 95% CI: 0.57-0.81). CONCLUSIONS: SGLT2 inhibitors and GLP1-RAs provided without metformin at baseline may reduce the risk of MACE in comparison with placebo in type 2 diabetes patients at increased risk of cardiovascular events.

Consenso de expertos sobre la insuficiencia cardiaca con fracción de eyección reducida: más allá de las guías / Expert consensus statement on heart failure with reduced ejection fraction: beyond the guidelines

No disponible

Uso de la polipíldora cardiovascular 40mg en prevención cardiovascular secundaria / Use of the cardiovascular polypill 40mg in secondary cardiovascular prevention

El control de los factores de riesgo cardiovascular (CV) es esencial en pacientes con enfermedad cardiovascular. La polipíldora CV contiene ácido acetilsalicílico 100 mg, atorvastatina 20 mg o 40 mg y ramipril 2,5 mg, 5 mg o 10 mg en combinación fija. El objetivo fue revisar las evidencias sobre la prevención secundaria de la enfermedad cardiovascular, establecer los posibles perfiles de pacientes donde usar la polipíldora CV con atorvastatina 40mg en prevención CV secundaria (P40PS) y definir las situaciones prioritarias de empleo de la P40PS. Se realizó una revisión bibliográfica, que se complementó con la opinión clínica de 19 especialistas. Durante la hospitalización y al alta, la P40PS es una opción en pacientes ingresados por un evento aterotrombótico de cualquier territorio, enfermedad arterial periférica u otras causas y con indicación de los monocomponentes. Se plantea su uso prioritario en: intolerancia previa a la dosis de atorvastatina 80 mg, edad > 75 años, bajo peso, insuficiencia renal crónica estadio 3, hipotiroidismo, interacciones farmacológicas y origen asiático. En el ámbito extrahospitalario, la P40PS es una alternativa terapéutica en los pacientes con necesidad de prevención CV secundaria con indicación para recibir los monocomponentes y las situaciones prioritarias son recibir los tres componentes por separado, requerir polimedicación, falta de adherencia o de comprensión del tratamiento, y falta de control de los factores de riesgo CV. Este trabajo es el primero con propuestas de uso de la P40PS y puede facilitar el tratamiento de los pacientes con enfermedad cardiovascular en prevención secundaria

Controlling cardiovascular risk factors (CV) is essential for patients with cardiovascular disease. The CV polypill contains aspirin 100 mg, atorvastatin 20 mg or 40 mg, and ramipril 2.5 mg, 5 mg or 10 mg in a fixed combination pill. The objective was to review the evidence on the secondary prevention of cardiovascular disease, to establish the eventual patient profiles suitables to consider the use of CV polypill with atorvastatin 40 mg in secondary CV prevention (P40PS), and to define the priority situations most adequate for the use of P40PS. A bibliographic review was carried out, which was complemented with the clinical opinion of 19 specialists. During hospitalization and discharge, P40PS is an option for patients admitted because of an atherothrombotic event, peripheral arterial disease, or other causes, and with the indication of the monocomponents. Its priority use is proposed in: prior intolerance to the highest dose of atorvastatin (80 mg), age > 75 years, low weight, stage 3 of chronic renal failure, hypothyroidism, drug interactions and Asian origin. Outside the hospital setting, the P40PS is a therapeutic alternative in patients with a need for secondary CV prevention and with indication to receive the monocomponents. The priority situations to receive the P40PS are: to be taking the three components separately, to require polypharmacy, lack of adherence or understanding of the treatment, and lack of control of CV risk factors. This work is the first with proposals for the use of P40PS and can facilitate the treatment of patients with cardiovascular disease in secondary prevention

Use of the cardiovascular polypill 40mg in secondary cardiovascular prevention. / Uso de la polipíldora cardiovascular 40mg en prevención cardiovascular secundaria.

Controlling cardiovascular risk factors (CV) is essential for patients with cardiovascular disease. The CV polypill contains aspirin 100mg, atorvastatin 20mg or 40mg, and ramipril 2.5mg, 5mg or 10mg in a fixed combination pill. The objective was to review the evidence on the secondary prevention of cardiovascular disease, to establish the eventual patient profiles suitables to consider the use of CV polypill with atorvastatin 40mg in secondary CV prevention (P40PS), and to define the priority situations most adequate for the use of P40PS. A bibliographic review was carried out, which was complemented with the clinical opinion of 19 specialists. During hospitalization and discharge, P40PS is an option for patients admitted because of an atherothrombotic event, peripheral arterial disease, or other causes, and with the indication of the monocomponents. Its priority use is proposed in: prior intolerance to the highest dose of atorvastatin (80mg), age>75 years, low weight, stage 3 of chronic renal failure, hypothyroidism, drug interactions and Asian origin. Outside the hospital setting, the P40PS is a therapeutic alternative in patients with a need for secondary CV prevention and with indication to receive the monocomponents. The priority situations to receive the P40PS are: to be taking the three components separately, to require polypharmacy, lack of adherence or understanding of the treatment, and lack of control of CV risk factors. This work is the first with proposals for the use of P40PS and can facilitate the treatment of patients with cardiovascular disease in secondary prevention.

Selección de temas de actualidad en cardiología clínica, cardiología geriátrica e insuficiencia cardiaca y trasplante 2015 / Clinical cardiology, geriatric cardiology, heart failure, and transplantation 2015: a selection of topical issues

No disponible

Patients with cardiac disease: Changes observed through last decade in out-patient clinics.

AIM: To describe current profile of patients with cardiovascular disease (CVD) and assessing changes through last decade. METHODS: Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999 (n = 6194) and 2009 (n = 4639). The types of CVD were coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF). Patients were collected from outpatient clinics. Investigators were 80% cardiologist and 20% primary care practitioners. Clinical antecedents, major diagnosis, blood test results and medical treatments were collected from all patients. RESULTS: An increase in all risk factors, except for smoking, was observed; a 54.4% relative increase in BP control was noted. CHD was the most prevalent CVD but HF and AF increased significantly, 41.5% and 33.7%, respectively. A significant reduction in serum lipid levels was observed. The use of statins increased by 141.1% as did all cardiovascular treatments. Moreover, the use of angiotensin-renin system inhibitors in patients with HF, beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%, 80.3% and 156.0%, respectively (P < 0.01). CONCLUSION: The prevalence of all cardiovascular risk factors has increased in patients with CVD through last decade. HF and AF have experienced the largest increases.

Trends in clinical profile and medical treatments of atrial fibrillation patients over the last 10 years.

AIM: We sought to define trends in AF prevalence and its medical management using recent data based on data from two cross-sectional studies performed in a European country in 1999 and 2009. METHODS: CARDIOTENS 1999 and CARDIOTENS 2009 were two observational, cross-sectional, multicenter studies. Patients were recruited in from primary care and cardiology outpatient clinics. A total of 32 051 and 25 137 subjects were analyzed in the two studies, 1540 and 1524 of them, respectively, diagnosed with AF. RESULTS: Over the course of the study period there was an increase in the prevalence of AF (from 4.8% to 6.1%), mainly due to the higher prevalence of AF in patients aged over 70 years (24.7% vs. 37.1%). Furthermore, patients with AF had a higher prevalence of hypertension (64.9% vs. 87.0%), diabetes (19.0% vs. 37.4%), heart failure (30.8% vs. 34.8%), coronary artery disease (23.0% vs. 25.8%) and previous stroke (1.5% vs. 8.9%). An overall increase in prescription of antithrombotic/antiplatelet therapy was observed (33.0% vs. 62.7% and 31.0% vs. 38.2% respectively); the difference observed in 1999 between prescription of oral anticoagulation by general practitioners and cardiologists was not seen in the later study. Differences in prescription of angiotensin-converting enzyme inhibitors (28.0% vs. 40.7%), angiotensin receptor blockers (10.0% vs. 40.0%), beta-blockers (14.0% vs. 41.5%) and calcium channel blockers (21.0% vs. 34.9%) were also identified. CONCLUSIONS: The number of patients with AF and a higher risk for thromboembolic events increased over the last 10 years. More aggressive antithrombotic treatment has been observed, especially in older patients.

Actitud y eficacia de los cardiólogos frente al tabaquismo de los pacientes tras un síndrome coronario agudo / Attitude and efficacy of cardiologists with respect to smoking in patients after acute coronary syndromes

Introducción y objetivos. El tabaquismo es uno de los factores más prevalentes entre los pacientes con síndrome coronario agudo. El objetivo del estudio es analizar la actitud de los cardiólogos frente al tabaquismo de estos pacientes. Métodos. Registro prospectivo y multicéntrico de pacientes con síndrome coronario agudo. El objetivo primario se definió como abstinencia de tabaco y el secundario, incidencia de muerte o infarto no fatal. Resultados. Se incluyó a 715 pacientes, de los que 365 eran fumadores. Durante el seguimiento (mediana, 375,0 [amplitud intercuartílica, 359,3-406,0] días), 110 (30,6%) pacientes recibieron algún tipo de apoyo antitabáquico (el 19,7% al alta y el 37,6% en el tercer mes); las unidades antitabáquicas y la vareniclina fueron las estrategias más empleadas. No se observaron diferencias clínicas en función de recibir apoyo antitabáquico, salvo mayor prevalencia de cardiopatía isquémica previa entre los que sí lo recibieron. En el análisis multivariable, la única variable que se asoció independientemente con recibir apoyo antitabáquico fue el antecedente de cardiopatía isquémica (odds ratio=3,16; intervalo de confianza del 95%, 1,64-6,11; p<0,01). La tasa de abstinencia de tabaco en la visita del tercer mes fue del 72,3% y al año, del 67,9%, sin diferencias en función de haber recibido algún apoyo antitabáquico. Durante el seguimiento hubo una tendencia no significativa a menor incidencia del objetivo secundario entre los fumadores que consiguieron abstenerse de tabaco (p=0,07). Conclusiones. La utilización de estrategias de apoyo para el abandono del tabaquismo es baja entre los pacientes tras un síndrome coronario agudo y es más frecuente entre los pacientes con cardiopatía isquémica previa (AU)

Introduction and objectives. Smoking is one of the most prevalent risk factors in acute coronary syndrome patients. The aim of this study was to assess the attitudes of cardiologists to the smoking habits of these patients. Methods. A prospective multicenter registry of acute coronary syndrome patients. The primary endpoint was defined as smoking abstinence and the secondary endpoint as the incidence of all-cause mortality or nonfatal myocardial infarction. Results. The study population included 715 patients; 365 were current smokers. During follow-up (median, 375.0 days [interquartile range, 359.3-406.0 days]), 110 patients (30.6%) received smoking cessation support (19.7% at hospital discharge and 37.6% at month 3), specialized units and varenicline being the strategies most frequently used. No clinical differences were observed between patients who received smoking cessation support and those who did not, except for a higher prevalence of previous coronary heart disease in those who received support. In the multivariate analysis, the only variable independently associated with receiving smoking cessation support was previous coronary heart disease (odds ratio=3.16; 95% confidence interval, 1.64-6.11; P<.01). The abstinence rate was 72.3% at month 3 and 67.9% at 1 year; no differences were observed between the patients who received smoking cessation support and those who did not. During follow-up, a nonsignificant trend toward a lower incidence of the secondary endpoint was observed among the patients who were smokers at the time of acute coronary syndrome and who achieved abstinence (P=.07). Conclusions. Use of smoking cessation support strategies is limited in acute coronary syndrome patients and is more widespread among those with previous coronary heart disease (AU)

Attitude and efficacy of cardiologists with respect to smoking in patients after acute coronary syndromes.

INTRODUCTION AND OBJECTIVES: Smoking is one of the most prevalent risk factors in acute coronary syndrome patients. The aim of this study was to assess the attitudes of cardiologists to the smoking habits of these patients METHODS: A prospective multicenter registry of acute coronary syndrome patients. The primary endpoint was defined as smoking abstinence and the secondary endpoint as the incidence of all-cause mortality or nonfatal myocardial infarction. RESULTS: The study population included 715 patients; 365 were current smokers. During follow-up (median, 375.0 days [interquartile range, 359.3-406.0 days]), 110 patients (30.6%) received smoking cessation support (19.7% at hospital discharge and 37.6% at month 3), specialized units and varenicline being the strategies most frequently used. No clinical differences were observed between patients who received smoking cessation support and those who did not, except for a higher prevalence of previous coronary heart disease in those who received support. In the multivariate analysis, the only variable independently associated with receiving smoking cessation support was previous coronary heart disease (odds ratio=3.16; 95% confidence interval, 1.64-6.11; P<.01). The abstinence rate was 72.3% at month 3 and 67.9% at 1 year; no differences were observed between the patients who received smoking cessation support and those who did not. During follow-up, a nonsignificant trend toward a lower incidence of the secondary endpoint was observed among the patients who were smokers at the time of acute coronary syndrome and who achieved abstinence (P=.07). CONCLUSIONS: Use of smoking cessation support strategies is limited in acute coronary syndrome patients and is more widespread among those with previous coronary heart disease.

Características clínicas y evolución hospitalaria de los pacientes con síndrome coronario agudo en función del tabaquismo / Clinical features and hospital complications of patients with acute coronary syndromes according to smoking habits

Fundamento y objetivo: Los pacientes fumadores que presentan síndromes coronarios agudos (SCA) suelen presentar mejor pronóstico durante la fase hospitalaria. El objetivo de este estudio fue analizar las características y evolución hospitalaria de pacientes con SCA en función del tabaquismo.Pacientes y método: Estudio observacional, multicéntrico y nacional de pacientes con SCA. Los investigadores incluyeron el mismo número de pacientes fumadores y no fumadores. El objetivo primario fue la mortalidad hospitalaria y el secundario la combinación de muerte, angina o insuficiencia cardiaca. Resultados: Se reclutaron 825 pacientes. Fueron fumadores activos 413 (50,1%) y éstos presentaron una edad media 12 años inferior a los no fumadores, menor prevalencia de factores de riesgo y enfermedad cardiovascular previa. La tasa de complicaciones fue similar en función de los hábitos tabáquicos. El análisis multivariante ajustado identificó la edad > 75 años (odds ratio [OR] 12,80, intervalo de confianza del 95% [IC 95%] 1,35-41,44; p=0,03) y el filtrado glomerular (FG) < 60ml/min/1,73 m2 (OR 10,20, IC 95% 1,06-97,92; p=0,04) como los únicos factores de mortalidad. Los asociados al objetivo secundario fueron edad > 75 años (OR 1,72, IC 95% 1,03-2,84; p=0,04), FG < 60ml/min/1,73 m2 (OR 1,76, IC 95% 1,08-2,91; p=0,02) y el tabaquismo activo (OR 1,05, IC 95% 1,01-1,10; p=0,02). Los pacientes fumadores con edad > 75 años presentaron la mayor mortalidad (19,0%), seguidos de los exfumadores con edad > 75 años (5,8%). Conclusiones: Los pacientes fumadores que ingresan por SCA tienen una menor edad que los no fumadores y una tasa de complicaciones similar durante la estancia hospitalaria (AU)

Background and objective: Current smoking patients with acute coronary syndromes (ACS) seem to have better prognosis during hospital stay. The objective of this study was to describe the clinical characteristics and complications of patients with ACS according to smoking habits. Patients and methods: Observational, multicentre and nationwide registry. Primary endpoint was hospital mortality and secondary endpoint was the combination of mortality, angina or heart failure. Results: 825 ACS patients were collected. Current smokers were 413 (50.1%) and their mean age was 12years lower than the rest and also had lower prevalence of risk factors or previous cardiovascular disease. Complications and mortality were similar according to smoking habits. Multivariate adjusted analysis identified age > 75 (OR: 12.80, 95% CI 1.35-41.44; p=0.03) and GFR < 60ml/min/1.73 m2 (OR: 10.20, 95% CI 1.06-97.92; p=0.04) independently associated with mortality; age > 75 (OR: 1.72, 95% CI 1.03-2.84; p=0.04), GFR < 60ml/min/1.73 m2 (OR: 1.76, 95% CI 1.08-2.91; p=0.023) and current smoking (OR: 1.05, 95% CI 1.01-1.10; p=0.02) were independently associated with the combined end-point. Elderly current smokers patients had the highest mortality rate (19.0%) followed by elderly former smokers patients (5.8%). Conclusions: Current smoker patients with ACS have lower mean age and have similar hospital complications (AU)

[Clinical features and hospital complications of patients with acute coronary syndromes according to smoking habits]. / Características clínicas y evolución hospitalaria de los pacientes con síndrome coronario agudo en función del tabaquismo.

BACKGROUND AND OBJECTIVE: Current smoking patients with acute coronary syndromes (ACS) seem to have better prognosis during hospital stay. The objective of this study was to describe the clinical characteristics and complications of patients with ACS according to smoking habits. PATIENTS AND METHODS: Observational, multicentre and nationwide registry. Primary endpoint was hospital mortality and secondary endpoint was the combination of mortality, angina or heart failure. RESULTS: 825 ACS patients were collected. Current smokers were 413 (50.1%) and their mean age was 12 years lower than the rest and also had lower prevalence of risk factors or previous cardiovascular disease. Complications and mortality were similar according to smoking habits. Multivariate adjusted analysis identified age > 75 (OR: 12.80, 95% CI 1.35-41.44; p=0.03) and GFR < 60 ml/min/1.73 m(2) (OR: 10.20, 95% CI 1.06-97.92; p=0.04) independently associated with mortality; age > 75 (OR: 1.72, 95% CI 1.03-2.84; p=0.04), GFR < 60 ml/min/1.73 m(2) (OR: 1.76, 95% CI 1.08-2.91; p=0.023) and current smoking (OR: 1.05, 95% CI 1.01-1.10; p=0.02) were independently associated with the combined end-point. Elderly current smokers patients had the highest mortality rate (19.0%) followed by elderly former smokers patients (5.8%). CONCLUSIONS: Current smoker patients with ACS have lower mean age and have similar hospital complications.

Impacto de los nuevos criterios para el tratamiento anticoagulante de la fibrilación auricular / Impact of new criteria for anticoagulant treatment in atrial fibrillation

Introducción y objetivos. Las guías de fibrilación auricular (FA) de la Sociedad Europea de Cardiología incluyen en la estratificación del riesgo tromboembólico nuevos factores «moduladores» que recalifican a un porcentaje de pacientes anteriormente catalogados de riesgo «bajo» o «moderado» a categorías superiores. El objetivo de nuestro estudio es analizar el impacto de la escala CHA2DS2-VASc y las nuevas recomendaciones de anticoagulación oral (ACO) en una muestra contemporánea de pacientes con FA reclutados en consultas externas de cardiología y atención primaria. Métodos. Estudio epidemiológico observacional, transversal y multicéntrico diseñado por la sección de hipertensión arterial con el objetivo de conocer la prevalencia y el control de la hipertensión en la práctica clínica habitual. Cada médico debía incluir a los primeros 6 pacientes de cada día durante 5 días. Resultados. Se reclutó a 25.137 pacientes, de los que 1.544 tenían el antecedente de FA. De estos, el 77,3% tenía una puntuación CHADS2 ≥ 2. Se recalificó según la escala CHA2DS2-VASc a la población restante con CHADS2 < 2. El 14,4% tenía ≥ 75 años (CHA2DS2-VASc = 2). De los menores de 75 años, el 42,3% tenía un CHA2DS2-VASc = 2; el 23,7%, CHA2DS2-VASc = 3 y el 1,1%, CHA2DS2-VASc = 4. Esto supone que el 85,1% de los pacientes con CHADS2 < 2 tendrán, en ausencia de contraindicaciones, indicación de ACO. Conclusiones. Las nuevas indicaciones supondrán un incremento significativo en el número de pacientes con indicación de ACO, a expensas de los previamente categorizados como con riesgo «bajo-moderado». Por lo tanto, será indispensable identificarlos con vistas a disminuir el riesgo tromboembólico sin dejar de prestar atención al perfil de riesgo hemorrágico (AU)

Introduction and objectives. The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the ‘low’, ‘moderate’, and ‘high’ risk categories. The objective of this study was to determine the impact of the new scheme CHA2DS2-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists. Methods. Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period. Results. Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS2 score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA2DS2-VASc score: 14.4% were aged 75 years or older (CHA2DS2-VASc=2). Of those younger than 75, 42.3% had a CHA2DS2-VASc=2; 23.7% CHA2DS2-VASc=3, and 1.1% CHA2DS2-VASc=4. This means that the 85.1% of the patients with a CHADS2 score<2 and no contraindications are indicated for OAC. Conclusions. The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation (AU)

Factores asociados a la falta de control de la hipertensión arterial en pacientes con y sin enfermedad cardiovascular / Factors associated with uncontrolled hypertension in patients with and without cardiovascular disease

Introducción y objetivos. La hipertensión arterial es uno de los factores de riesgo más prevalentes y peor controlados, especialmente en los pacientes con enfermedad cardiovascular (ECV) establecida. El objetivo del estudio es describir el control de la presión arterial (PA) y las características asociadas. Métodos. Registro multicéntrico, transversal y observacional de pacientes con hipertensión arterial reclutados en consultas de cardiología y atención primaria. Se consideró PA controlada la < 140/90mmHg. Resultados. El 55,4% de los 10.743 pacientes incluidos presentaron PA controlada y estos tenían una media de edad ligeramente superior. Entre los pacientes con PA no controlada había mayor prevalencia de sexo masculino y pacientes con tabaquismo activo, obesidad y diabetes mellitus. El grado de control de la PA fue similar en los pacientes con y sin ECV. Los pacientes con PA no controlada presentaban valores más elevados de glucemia, colesterol total, lipoproteínas de baja densidad y ácido úrico. Los pacientes con PA no controlada estaban recibiendo una media ligeramente superior de fármacos antihipertensivos respecto a los que tenían la PA controlada. Los pacientes con ECV estaban tratados más frecuentemente con algún fármaco que bloquease el sistema renina-angiotensina-aldosterona: el 83,5 frente al 73,2% (p<0,01). El análisis multivariable identificó que la obesidad y el tabaquismo activo se asociaban a la falta de control de la PA tanto en pacientes con ECV como sin ella y diferencias relevantes en los demás factores entre unos y otros. Conclusiones. El 55% de los pacientes con hipertensión arterial tenían controlada la PA, independientemente de la presencia de ECV. Los estilos de vida y alimentación, especialmente el tabaquismo y la obesidad, se relacionan independientemente con la falta de control de la PA (AU)

Introduction and objectives. Hypertension is one of the most prevalent and poorly controlled risk factors, especially in patients with established cardiovascular disease (CVD). The aim of this study was to describe the rate of blood pressure (BP) control and related risk factors. Methods. Multicenter, cross-sectional and observational registry of patients with hypertension recruited from cardiology and primary care outpatient clinics. Controlled BP defined as <140/90mmHg. Results. 55.4% of the 10 743 patients included had controlled BP and these had a slightly higher mean age. Patients with uncontrolled BP were more frequently male, with a higher prevalence of active smokers, obese patients, and patients with diabetes. The rate of controlled BP was similar in patients with or without CVD. Patients with uncontrolled BP had higher levels of blood glucose, total cholesterol, low density lipoproteins and uric acid. Patients with uncontrolled BP were receiving a slightly higher mean number of antihypertensive drugs compared to patients with controlled BP. Patients with CVD were more frequently receiving a renin-angiotensin-aldosterone axis inhibitor: 83.5% vs. 73.2% (P<.01). Multivariate analysis identified obesity and current smoking as independently associated with uncontrolled BP, both in patients with or without CVD, as well as relevant differences between the two groups on other factors. Conclusions. Regardless of the presence of CVD, 55% of hypertensive patients had controlled BP. Lifestyle and diet, especially smoking and obesity, are independently associated with lack of BP control (AU)

[Factors associated with uncontrolled hypertension in patients with and without cardiovascular disease]. / Factores asociados a la falta de control de la hipertensión arterial en pacientes con y sin enfermedad cardiovascular.

INTRODUCTION AND OBJECTIVES: Hypertension is one of the most prevalent and poorly controlled risk factors, especially in patients with established cardiovascular disease (CVD). The aim of this study was to describe the rate of blood pressure (BP) control and related risk factors. METHODS: Multicenter, cross-sectional and observational registry of patients with hypertension recruited from cardiology and primary care outpatient clinics. Controlled BP defined as <140/90 mmHg. RESULTS: 55.4% of the 10 743 patients included had controlled BP and these had a slightly higher mean age. Patients with uncontrolled BP were more frequently male, with a higher prevalence of active smokers, obese patients, and patients with diabetes. The rate of controlled BP was similar in patients with or without CVD. Patients with uncontrolled BP had higher levels of blood glucose, total cholesterol, low density lipoproteins and uric acid. Patients with uncontrolled BP were receiving a slightly higher mean number of antihypertensive drugs compared to patients with controlled BP. Patients with CVD were more frequently receiving a renin-angiotensin-aldosterone axis inhibitor: 83.5% vs. 73.2% (P<.01). Multivariate analysis identified obesity and current smoking as independently associated with uncontrolled BP, both in patients with or without CVD, as well as relevant differences between the two groups on other factors. CONCLUSIONS: Regardless of the presence of CVD, 55% of hypertensive patients had controlled BP. Lifestyle and diet, especially smoking and obesity, are independently associated with lack of BP control. Full English text available from: www.revespcardiol.org.

Impact of new criteria for anticoagulant treatment in atrial fibrillation.

INTRODUCTION AND OBJECTIVES: The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the 'low', 'moderate', and 'high' risk categories. The objective of this study was to determine the impact of the new scheme CHA2DS2-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists. METHODS: Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period. RESULTS: Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS2 score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA2DS2-VASc score: 14.4% were aged 75 years or older (CHA2DS2-VASc=2). Of those younger than 75, 42.3% had a CHA2DS2-VASc=2; 23.7% CHA2DS2-VASc=3, and 1.1% CHA2DS2-VASc=4. This means that the 85.1% of the patients with a CHADS2 score <2 and no contraindications are indicated for OAC. CONCLUSIONS: The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.

Aspirin therapy for inhibition of platelet reactivity in the presence of erythrocytes in patients with vascular disease.

Inhibition of erythrocyte (RBC) promotion of platelet reactivity could improve the antiplatelet effect of aspirin (ASA). We tested different ASA regimens for optimal inhibition of platelets and the effects of RBC in patients with a history of vascular diseases. Collagen-induced platelet activation (14C-5HT, TXA2 release) and platelet recruitment (proaggregatory activity of cell-free releasates from activated platelets) were measured in PRP, platelet-RBC (Hct 40%), and whole blood (WB) in 206 patients initially on 200-300-mg ASA/day. Their regimen was modified to biweekly 500 mg (loading dose, L) plus daily or twice-daily low-dose ASA (50 or 100 mg). TXA2 was inhibited with all regimens. Percentage of patients with suboptimal inhibition of platelet recruitment in WB was 200-300 ASA/day (41%), L-50/day (87%), L-100/day (58%), L-50/twice-daily (39%), and L-100/twice-daily (20%; P < 0.05 vs other regimens). 14C-5HT release was inhibited to the greatest extent with L-100/twice-daily in PRP + RBC or WB (P < 0.05 vs other regimens) due to greater inhibition of the RBC prothrombotic effect. Compared with other ASA regimens, L-100 twice-daily (equivalent to 221-mg ASA/day in the 14-day cycle), reduced by >50% the proportion of patients with suboptimal inhibition of platelet recruitment in WB and inhibited 14C-5HT release to the greatest extent.

Utilidad de la trimetazidina en la lesión por isquemia-reperfusión: Estudio experimental en un modelo canino de aturdimiento miocárdico / Usefulness of trimetazidine in ischemia-reperfusion lesion: experimental study in myocardial stunning model

Objetivo: Evaluar la acción de la trimetazidina en el deterioro de la función sistólica que se produce en el miocardio tras una isquemia única y prolongada. Métodos: Se analizaron 13 perros mestizos, de uno u otro sexo, asignados al azar a tratamiento oral con trimetazidina (6 perros) o placebo (7 perros) durante 7 días. Se realizó un protocolo de isquemia bajo anestesia consistente en una obstrucción completa de la arteria coronaria descendente anterior de 15 minutos de duración, seguida de 60 minutos de reperfusión. Las variables analizadas durante la obstrucción y la reperfusión fueron: Frecuencia cardíaca (FC), presión ventricular izquierda (PVI), dP/dt y las curvas de función regional de la zona isquémica y de una zona testigo (longitud telediastólica, telesistólica y fracción de acortamiento). Resultados: Las variables hemodinámicas (FC, PVI y dP/dt), no presentaron diferencias significativas entre ambos grupos, con poca variabilidad de sus valores respecto a los basales durante la isquemia-reperfusión. La fracción de acortamiento de la zona isquémica experimentó una disminución estadísticamente significativa durante la obstrucción coronaria en ambas series, alcanzando valores de discinesia, con persistencia de la disfunción contráctil tras 60 minutos de reperfusión, y sin diferencias entre ambas series (50% serie Placebo; 41% serie Trimetazidina). Conclusiones: La recuperación de la contractilidad miocárdica tras una isquemia completa en la serie tratada con TMZ no mostró diferencias significativas respecto a la serie Placebo, a diferencia de lo que ocurre con períodos de oclusión más cortos y repetidos.

Objective: The aim of this study is to evaluate the effect of trimetazidine (TMZ) on myocardial systolic dysfunction resulting from an isolated episode of induced coronary ischemia. Methods: In a double-blinded randomized design we studied 13 mongrel anesthetized dogs of either sex (6 of them treated with oral TMZ previously). The anterior descending coronary artery was totally occluded during 15 minutes followed by 60 minutes of reperfusion. Global and regional cardiac variables were recorded in control and ischemic areas. Results: There were no significant differences between TMZ and placebo series with respect to global cardiac function variables. Both series showed no significant variations in global variables during the ischemia-reperfusion process. The shortening fraction in the ischemic area fell significantly during the ischemic period in both TMZ and placebo series reaching dyskinetic values. Myocardial contractility dysfunction persisted after 60 minutes of reperfusion in both series with no significant differences (41% vs 50% placebo). Conclusions: Contrary to shorter and repeated occlusion periods, myocardial contractility recovery after a complete episode of ischemia did not show significant differences between TMZ-treated and placebo series.

[NT-proBNP levels and hypertension. Their importance in the diagnosis of heart failure]. / Hipertensión y valores de NT-proBNP. Su importancia en el diagnóstico de insuficiencia cardíaca.

INTRODUCTION: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure. We compared NT-proBNP levels in patients with and without a diagnosis of arterial hypertension. PATIENTS AND METHOD: Participants were recruited from a random sample of 999 inhabitants from the Community of Valencia (eastern Spain). Of these patients, 432 said they suffered from dyspnea and were referred to their hospital (10 hospitals involved), where blood samples were taken, an echo-Doppler study was performed, and the patients completed a questionnaire. Of the 432 participants with dyspnea, 215 gave informed consent for their inclusion in the study, and 202 completed the study. Hypertension was diagnosed in 72 participants and 130 were normotensive. RESULTS: For the whole population, NT-proBNP, expressed as the median and range, was 88 (0-2586) pg/mL. When we compared hypertensive with normotensive participants, we found higher NT-proBNP levels in the former group: median 123, range 0-2184 pg/mL, versus median 77, range 0-2586 pg/mL (P<.01). When we excluded subjects with systolic left ventricular dysfunction, we found higher levels in participants with hypertension: 119 (0-2184 pg/mL) vs 72 (0-997 pg/mL) (P<.01). When we also excluded subjects with diastolic dysfunction, we found (median 85, range 0-430 pg/mL) and (median 66, range 0-997 pg/mL), respectively (p = NS). CONCLUSION: In a population study of subjects with dyspnea, hypertensive patients have higher NT-proBNP levels than subjects with normal blood pressure. This difference disappeared when patients with diastolic dysfunction were excluded from the analysis. Hypertension can thus be a confounding factor that potentially decreases the specificity of NT-proBNP levels for the diagnosis of heart failure. These findings should be taken into account when conducting clinical and epidemiological studies in which patients with both heart failure and hypertension are included.