Algo más que una dislipemia mal controlada / Something more than a poorly controlled dyslipaemia

Mujer de 55 años, obesa no diabética, remitida por su médico de atención primaria para estudio, de la unidad de lípidos de nuestro hospital, dedislipemia mixta sin control óptimo tras tratamiento con gemfibrozilo 900 mg al día. En la exploración clínica, la paciente presenta unos nódulos de consistencia blanda, móviles, no dolorosos a la palpación, de 1,2 × 0,8 cm el mayor de ellos, enmetacarpofalángicas y cara palmar de ambas manos, compatibles con xantomas tuberosos, sin otros hallazgos de interés. En el perfil bioquímico de factores de riesgo cardiovascular llamaba la atención un valor de cVLDL/TG de 0,38 (normal, hasta 0,27),lo cual nos puso en la pista del diagnóstico de una disbetalipoproteinemia. Realizamos una determinación del polimorfismo del gen de la ApoE, que nos confirmó que la paciente era portadora del genotipo E2/E2. Se llevó a cabo tratamiento con medidas dietéticas y atorvastatina 40 mg al día, con una notable mejoría de los valores lipídicos. Posteriormente, la paciente presentó un cuadro de claudicación intermitente, que llevó al diagnóstico de arteriopatía periférica severa (AU)

55-year old woman, obese, non-diabetic was referred by her primary care doctor for a study in the lipid unit of our hospital. She had mixed dyslipaemia which was not optimally controlled after treatment with 900 mg of gemfibrozil per day. In the clinical examination, the patient had soft, movable nodules, the largest of them being 1.2 ×0.8 cm, and painless on palpation, in the metacarpal phalanges and palms of both hands, compatible with tuberous xanthomas. There were no other findings of interest. The biochemical profile of cardiovascular risk factors highlighted ac-VLDL/TG value of 0.38 (normal up to 0.27),which led us to the diagnosis of adysbetalipo proteinemia. We performed apolymorphism analysis of the ApoE gene, which confirmed that the patient was a carrier of the E2/E2 genotype. Treatment was prescribed with dietetic measures and atorvastat in 40 mg per day, with a marked improvement in the lipid values. The patient later presented with a clinical picture of intermittent claudication, which was diagnosed as severe peripheral artery disease (AU)

Secondary prevention of arterial disease in very elderly people: results from a prospective registry (FRENA).

There is little information on the effectiveness of secondary prevention interventions in very elderly patients. In this article, the incidence of major cardiovascular events during a 12-month follow-up period in a series of consecutive patients with coronary, cerebrovascular, or peripheral artery disease is analyzed. As of October 2006, 1264 patients had been enrolled. Of these, 324 (26%) were >or=75 years of age. Their incidence rate of 22 events per 100 patient-years (95% CI, 17-28) was over 2-fold the 7.9 (95% CI, 6.2-10) found in those <75 years of age. Among them, only chronic heart failure and diabetes were independently associated with an increased risk for major events, whereas the use of angiotensin II antagonists was associated with a lower risk. Patients >or=75 years of age had an over 2-fold higher incidence of major cardiovascular events. The use of angiotensin II antagonists was associated with a lower risk.