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Revista Espanola de Cardiologia Suplementos最新文献

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Introducción 导言
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30016-0
Juan M. Ruiz-Nodar
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引用次数: 0
Una historia resumida. La inhibición de la PCSK9 y su desarrollo clínico 一个简短的故事。PCSK9的抑制及其临床发展
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30011-1
José López-Sendón, Almudena Castro, Regina Dalmau

Hypercholesterolaemia is one of the major cardiovascular risk factors; however, conventional treatment with diet, exercise and cholesterol-lowering drugs are insufficient to control low-density lipoprotein (LDL) cholesterol in a significant number of patients. Inhibition of the PCSK9 protein by using specific monoclonal antibodies increases the number of LDL cholesterol receptors in the hepatocyte, contributing to LDL destruction. The use of these drugs, whether as monotherapy or in combination with statins and ezetimibe, significantly reduces LDL cholesterol, allowing LDL cholesterol levels in most patients to be maintained within limits recommended by clinical practice guidelines. To determine their clinical efficacy, 3 multicenter trials of morbidity and mortality have been conducted with alirocumab, evolocumab and bococizumab. The trial involving evolocumab, a fully human monoclonal antibody, demonstrated a significant reduction of the primary efficacy endpoint, including cardiovascular mortality, myocardial infarction, stroke, unstable angina or myocardial revascularisation. However, no clinical benefit was observed with bococizumab (a humanised but not fully human monoclonal antibody), probably due to a decrease in efficacy secondary to the formation of anti-drug antibodies. This new therapeutic option is already used in clinical practice and is considered a new advance in the prevention of cardiovascular disease.

高胆固醇血症是心血管疾病的主要危险因素之一;然而,传统的饮食、运动和降胆固醇药物治疗不足以控制大量患者的低密度脂蛋白(LDL)胆固醇。使用特异性单克隆抗体抑制PCSK9蛋白可增加肝细胞中LDL胆固醇受体的数量,从而促进LDL的破坏。这些药物的使用,无论是单独治疗还是与他汀类药物和依折替米布联合使用,都能显著降低低密度脂蛋白胆固醇,使大多数患者的低密度脂蛋白胆固醇水平维持在临床实践指南推荐的范围内。为了确定它们的临床疗效,用alirocumab、evolocumab和bococizumab进行了3项发病率和死亡率的多中心试验。这项涉及evolocumab(一种全人源单克隆抗体)的试验显示,主要疗效终点显著降低,包括心血管死亡率、心肌梗死、中风、不稳定型心绞痛或心肌血运重建。然而,bococizumab(一种人源化但不是完全人源化的单克隆抗体)没有观察到临床益处,可能是由于抗药物抗体的形成导致疗效下降。这种新的治疗选择已经在临床实践中使用,被认为是预防心血管疾病的新进展。
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引用次数: 5
Medicina traslacional, tratamiento de las dislipemias y prevención secundaria: conclusiones 转化医学、血脂异常的治疗和二级预防:结论
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30014-7
Manuel Anguita Sánch
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引用次数: 0
Factores determinantes del riesgo isquémico del paciente tras un infarto agudo de miocardio 急性心肌梗死后缺血性风险的决定因素
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30018-4
Juan M. Ruiz-Nodar , Emad Abu-Assi

The assessment of ischemic risk in patients presenting with a myocardial infarction is crucial for helping to select (from hospital admission onwards) the best management strategy and for deciding which antiplatelet treatment will produce the greatest improvement in prognosis. Risk assessments, which have improved in recent years, provide us with quantitative indicators of the patient’s short-and long-term prognosis. This article contains a review of the different approaches to ischemic risk assessment in patients admitted with an infarction, the most commonly used risk scores, the assessment of residual risk in patients with an infarction and the identification of patients with an elevated medium-and long-term risk. It also considers how angiographic characteristics and percutaneous revascularization influence prognosis in these patients.

心肌梗死患者的缺血风险评估对于帮助选择(从住院开始)最佳管理策略和决定哪种抗血小板治疗将产生最大的预后改善至关重要。近年来,风险评估得到了改进,为我们提供了患者短期和长期预后的定量指标。本文综述了对梗死患者进行缺血性风险评估的不同方法,最常用的风险评分,梗死患者剩余风险评估以及中期和长期风险升高患者的识别。它还考虑了血管造影特征和经皮血运重建术如何影响这些患者的预后。
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引用次数: 2
Importancia de la medicina traslacional: mecanismos del beneficio del tratamiento de las dislipemias y su implicación en la reducción de la placa 转化医学的重要性:血脂异常治疗的益处机制及其在减少斑块中的作用
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30012-3
Mónica Domenecha , Ramón Estruch , Raúl Moreno , Manuel Anguita Sánchez

Cardiovascular disease continues to be the most common cause of morbidity and mortality in western countries. Hyperlipidaemia, including hypercholesterolemia and atherogenic dyslipidaemia, is one the main risk factors for atherosclerotic heart disease. Routine therapies for hypercholesterolaemia include HMG-CoA reductase inhibitors (statins), NPC1L1 inhibitors (ezetimibe), phytosterols, menacholyne K, bile salt sequestrants and PCSK9 inhibitors. New drugs under development are CEPT inhibitors, antisense oligonucleotides and inhibitors of microsomal triglyceride transfer protein. The association between hyperlipidaemia and atherosclerosis is well documented. Arterial wall remodelling, described by Glagov more than 3 decades ago, is a key phenomenon in coronary artery atherosclerosis. When atherosclerotic plaque increases, artery diameter also increases to compensate lumen reduction. It is only in the final stage of the process, when the increase in diameter is unable to compensate for plaque growth, that clinical ischaemia develops. In this article, we review the mechanisms of action of drugs used for the treatment of dyslipidaemia, and the role of lipid level control in plaque reversal.

在西方国家,心血管疾病仍然是最常见的发病和死亡原因。高脂血症,包括高胆固醇血症和动脉粥样硬化性血脂异常血症,是动脉粥样硬化性心脏病的主要危险因素之一。高胆固醇血症的常规治疗包括HMG-CoA还原酶抑制剂(他汀类药物)、NPC1L1抑制剂(依折替米贝)、植物甾醇、menacholyne K、胆汁盐封存剂和PCSK9抑制剂。正在开发的新药有CEPT抑制剂、反义寡核苷酸和微粒体甘油三酯转移蛋白抑制剂。高脂血症和动脉粥样硬化之间的关系是有充分证据的。三十多年前由Glagov描述的动脉壁重构是冠状动脉粥样硬化的关键现象。当动脉粥样硬化斑块增加时,动脉直径也增加以补偿管腔缩小。只有在这个过程的最后阶段,当直径的增加无法补偿斑块的增长时,才会出现临床缺血。在本文中,我们回顾了用于治疗血脂异常的药物的作用机制,以及血脂水平控制在斑块逆转中的作用。
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引用次数: 0
Avances en el control lipídico, de la teoría a la práctica. El reto de la medicina traslacional 脂质控制的进展,从理论到实践。转化医学的挑战
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30013-5
Juan Cosin Sales , Regina Dalmau , Manuel Anguita Sánchez

Lipid control is one of the pillars of secondary prevention, but despite multiple evidence showing that the risk of new cardiovascular events decreases with lower low-density lipoprotein cholesterol (LDL-C) levels, this remains the most poorly controlled risk factor in our patients. The development of new drugs, such as PCSK9 inhibitors, will help us to improve this problem, but programmes that improve the continuity of care between cardiologists and primary care physicians are also very important. Although good drugs are available, lipid goals will not be achieved unless they are used in our patients. Despite the clinical development of lipid-lowering therapies in the last few years, there is currently an important gap between the evidence generated by many clinical trials, reflected in the clinical practice guidelines, and its clinical application in our patients, contributing to the fact that a significant number of patients with established cardiovascular disease do not achieve lipid control targets, and consequently continue to be at high risk or have recurrent events. To narrow this gap, it seems necessary to critically analyse the main barriers and to develop strategies to solve these problems. Basic and clinical investigators, cardiologists and primary care physicians, other health professionals, scientific societies and health authorities working together will contribute to close the gap and to improve cardiovascular health outcomes.

脂质控制是二级预防的支柱之一,但尽管有多项证据表明,随着低密度脂蛋白胆固醇(LDL-C)水平的降低,新的心血管事件的风险降低,但在我们的患者中,这仍然是控制最差的风险因素。新药的开发,如PCSK9抑制剂,将帮助我们改善这个问题,但提高心脏病专家和初级保健医生之间护理连续性的计划也非常重要。虽然有很好的药物可用,但除非在我们的患者中使用,否则血脂目标将无法实现。尽管近年来降脂疗法的临床发展,但目前在临床实践指南中反映的许多临床试验得出的证据与其在我们患者中的临床应用之间存在重要差距,导致大量已确定心血管疾病的患者未能达到血脂控制目标,从而继续处于高风险或复发事件中。为了缩小这一差距,似乎有必要批判性地分析主要障碍,并制定解决这些问题的战略。基础和临床研究人员、心脏病专家和初级保健医生、其他卫生专业人员、科学学会和卫生当局将共同努力,为缩小差距和改善心血管健康结果作出贡献。
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引用次数: 1
Novedades en la evaluación del riesgo hemorrágico del paciente con cardiopatía isquémica 缺血性心脏病患者出血风险评估的新进展
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30019-6
Sergio Raposeiras Roubín , Albert Ariza Solé

The assessment of bleeding risk is the limiting factor in determining the balance between the risk of ischemia and hemorrhage, which must be determined before the type and duration of antithrombotic therapy can be selected. The best data for estimating bleeding risk are available during hospitalization and several suitable risk scores have been developed and have undergone extensive validation and comparison. The CRUSADE bleeding score appears to be the most useful. In addition, several risk scores for assessing bleeding risk over the medium to long term after hospital discharge or after coronary artery revascularization have recently appeared, such as the PRECISE-DAPT (PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy), the PARIS (Patterns of non-Adherence to Anti-Platelet Regimens in Stented Patients), the DAPT (Dual AntiPlatelet Therapy) and the TRILOGY-ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) risk scores. All have demonstrated reasonably good predictive power but they have some important limitations, which mean that they will have to undergo comparative validation studies before their usefulness can be extended to patients treated with new antiplatelet agents (e.g. ticagrelor and prasugrel) and oral anticoagulants, including both vitamin K antagonists and direct-acting oral anticoagulants.

出血风险的评估是确定缺血和出血风险平衡的限制因素,必须在选择抗血栓治疗的类型和持续时间之前确定。估计住院期间出血风险的最佳数据是可用的,并且已经开发了几个合适的风险评分,并经过了广泛的验证和比较。CRUSADE出血评分似乎是最有用的。此外,最近出现了一些用于评估出院后或冠状动脉血运重建术后中长期出血风险的风险评分,如precision - dapt(预测接受支架植入和随后的双重抗血小板治疗的患者的出血并发症),PARIS(支架患者不遵守抗血小板方案的模式),DAPT(双重抗血小板治疗)和TRILOGY-ACS(靶向血小板抑制以阐明医学管理急性冠脉综合征的最佳策略)风险评分。所有这些方法都显示出相当好的预测能力,但它们有一些重要的局限性,这意味着它们必须经过比较验证研究,才能将其应用于使用新的抗血小板药物(例如替格瑞洛和普拉格雷)和口服抗凝剂(包括维生素K拮抗剂和直接作用口服抗凝剂)治疗的患者。
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引用次数: 2
Introducción 导言
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30008-1
José López-Sendón
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引用次数: 0
Indicación del tratamiento con doble antiagregación más allá del año. A quién y por qué 一年以上双抗聚集治疗的适应症。给谁,为什么
Q4 Medicine Pub Date : 2017-01-01 DOI: 10.1016/S1131-3587(19)30020-2
Juan Carlos Gómez-Polo , David Vivas , Inmaculada Roldán

Currently, dual antiplatelet therapy with acetylsalicylic acid and an ADP-P2Y12 receptor inhibitor is regarded as the treatment of choice for patients with acute coronary syndrome and for those who have undergone percutaneous coronary intervention with coronary stent implantation. Clinical practice guidelines recommend that dual antiplatelet therapy is maintained for 12 months in most contexts and prolonging therapy beyond this time remains controversial. The aim of this article was to present a review of the literature available on which patients would benefit from the prolongation of dual antiplatelet therapy.

目前,乙酰水杨酸联合ADP-P2Y12受体抑制剂的双重抗血小板治疗被认为是急性冠状动脉综合征患者和经皮冠状动脉介入治疗合并冠状动脉支架植入术患者的治疗选择。临床实践指南建议在大多数情况下双重抗血小板治疗维持12个月,超过这个时间延长治疗仍然存在争议。这篇文章的目的是提出一个文献综述,现有的患者将受益于双重抗血小板治疗的延长。
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引用次数: 3
Escalas de evaluación del riesgo tromboembólico y hemorrágico en la fibrilación auricular 评估房颤血栓栓塞和出血性风险的量表
Q4 Medicine Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30011-5
Javier Pérez-Copete , María Asunción Esteve-Pastor , Vanessa Roldán , Mariano Valdés , Francisco Marín

Atrial fibrillation is the most prevalent cardiac arrhythmia in the general population. Its presence increases the risk of thromboembolic events five-fold. Antithrombotic therapy reduces this risk, but increases the risk of bleeding, with intracranial bleeding being the most feared complication. However, the risk varies between patients and, as a result, various thromboembolic risk scores have been developed in recent years (e.g. the CHADS2, CHA2DS2-VASc and ATRIA scores). The CHA2DS2-VASc score is recommended by clinical practice guidelines to help optimize antithrombotic therapy in patients with atrial fibrillation. In addition, these guidelines also recommend that both thromboembolic risk and the risk of bleeding should be assessed. A number of risk models have been proposed for assessing the bleeding risk in these patients (e.g. the HEMORR2HAGES, HAS-BLED, ATRIA and ORBIT-AF scores), but currently the majority of guidelines recommend the HAS-BLED score. Above all, it is essential that the net clinical benefit of antithrombotic therapy is assessed: the expected benefit of anticoagulation therapy should outweigh the expected harm caused by possible bleeding. Nevertheless, the ability of both thromboembolic and bleeding risk scores to predict clinical events is only moderate. Consequently, alternative approaches, such as the use of biomarkers (e.g. D-dimer, von Willebrand factor and GDF-15), could help evaluate the thromboembolic risk in individual patients with atrial fibrillation.

心房颤动是普通人群中最常见的心律失常。它的存在使血栓栓塞事件的风险增加了5倍。抗血栓治疗降低了这种风险,但增加了出血的风险,颅内出血是最可怕的并发症。然而,不同患者的风险不同,因此,近年来开发了各种血栓栓塞风险评分(例如CHADS2, CHA2DS2-VASc和ATRIA评分)。临床实践指南推荐CHA2DS2-VASc评分,以帮助优化房颤患者的抗血栓治疗。此外,这些指南还建议对血栓栓塞风险和出血风险进行评估。已经提出了许多风险模型来评估这些患者的出血风险(例如HEMORR2HAGES、ha - bled、ATRIA和orbito - af评分),但目前大多数指南推荐使用ha - bled评分。最重要的是,评估抗血栓治疗的净临床获益是至关重要的:抗凝治疗的预期获益应超过可能出血造成的预期危害。然而,血栓栓塞和出血风险评分预测临床事件的能力只是中等。因此,替代方法,如使用生物标志物(如d -二聚体、血管性血友病因子和GDF-15),可以帮助评估心房颤动个体患者的血栓栓塞风险。
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引用次数: 6
期刊
Revista Espanola de Cardiologia Suplementos
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