[Ankle-brachial index in patients with diabetes mellitus: prevalence and risk factors]. / Indice tobillo-brazo en pacientes con diabetes mellitus: prevalencia y factores de riesgo.

INTRODUCTION: Diabetic patients have a high cardiovascular morbidity and mortality rate. Ankle brachial index (ABI) is an available, straightforward and reproducible method for the detection of peripheral vascular disease and for improving risk stratification in this population. The objective of our study was to evaluate the prevalence of a low and a pathological ABI in type 2 diabetics older than 60 years and to study the risk factors associated with its development. PATIENTS AND METHODS: 1,360 subjects between 60 and 79 years, 213 of them diabetics, without symptoms of intermittent claudication and who gave their consent to have an ABI measurement in their primary care center were included in the study. Cardiovascular risk factors were evaluated in all participants. An ABI < 0.9 was considered low and a value < 0.9, >or= 1.4 or non-compressible was considered pathological. RESULTS: Prevalence of a low ABI in subjects with or without diabetes was 11.3% and 4.3% and prevalence of a pathological ABI was 18.8% and 7%, respectively. Factor associated with a low or pathological ABI were gender, age, duration of diabetes, the type of antidiabetic treatment and the presence of vascular disease in another vascular bed. After multivariate adjustment, only age (OR: 1.15; 95% CI: 1.04-1.27) and duration of diabetes (OR: 1.05; 95% CI: 1.01-1.10) continue being significant. The prevalence of a pathological ABI did not differ between diabetics without vascular disease and non-diabetics with previous cardiovascular disease. CONCLUSION: The prevalence of a low or pathological ABI is elevated in diabetic subjects and relates with age, duration of diabetes and the presence of vascular disease in another vascular bed.

[Are statins indicated in the prevention of cerebral infarct?]. / Están indicadas las estatinas en la prevención del infarto cerebral?

INTRODUCTION: Some studies of ischemic cardiopathy have shown that when pravastatin is used for the prevention of strokes, these are reduced. Whilst we await suitable clinical trials, we discuss the possible role played by these drugs in this subgroup of patients. DEVELOPMENT: A panel of experts from different specialties assess the data published on dislipemias in the epidemiology of strokes, the possible effect of statins in the prevention of cerebral infarcts in patients with atheromatous stenosis of the carotid artery and their mode of action. CONCLUSIONS: Pravastatin is indicated in all patients with ictus of atheromatous origin as primary prevention of ischemic cardiopathy, in patients with strokes and hypercholesterolemia, and in patients with symptomatic or asymptomatic carotid stenosis while we wait for more specific clinical trials.

¿Se deben recomendar antioxidantes para la prevención cardiovascular? / Should antioxidants be recommended for cardiovascular prevention?

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[The parenteral drug addict in the emergency service]. / El adicto a drogas por vía parenteral en el servicio de urgencias.

Clinical and epidemiological features of intravenous drug addicts (IVDA), who attended the emergency department between 1984 and 1988, were studied. The number of cases treated over these 4 years had increased three-fold (256 vs 724). The median age had increased by 3 years (p less than 0.01). The sex ratio had not changed. A third of the cases knew that they were HIV-seropositive in 1988. The main reason for consultation in 1984 was overdosage and in 1988 it was fever. The rate of admission was similar in both years (around 21%). There was a significant increase in admissions caused by respiratory diseases in 1988 (p less than 0.0001) and a significant decrease of admissions caused by overdosage (p less than 0.001).