Clinica e Investigacion en Arteriosclerosis最新文献

Introduction: Clinical decision support systems can improve guideline adherence and reduce variability. HTE-DLP 3.0 (Virtual Lipidologist) provides recommendations based on scientific evidence, safety, and cost-effectiveness criteria.

Methods: A proof-of-concept study was conducted using 10 standardized clinical cases evaluated by 9 clinicians before and after the use of the HTE-DLP 3.0. Therapeutic variability was analyzed using the Simpson Diversity Index and the kappa coefficient. Usability and user experience were assessed using the CSUQ and QoE questionnaires, together with a qualitative survey on strengths and areas for improvement.

Results: Baseline assessment showed very significant interprofessional variability. Uniform adherence to the shared algorithmic recommendation is observed. The CSUQ showed good efficiency scores (6.40) and high satisfaction (5.42/7), with error messages and the availability of clinical support tools identified as areas for improvement. The QoE showed high scores for data security (4.71), clinical usefulness (4.57), and social impact (4.57), with learning time being the lowest-rated aspect (2.85/5).

Conclusions: HTE-DLP 3.0 demonstrated the ability to act as a decision standardization tool based on clinical practice guidelines. Further studies in real-world clinical practice will be necessary to evaluate its clinical and cost-effectiveness impact.

Vascular diseases are the main cause of mortality in Spain, are associated with a high degree of disability and involve high healthcare costs. The Spanish Society of Arteriosclerosis meets this challenge by trying to improve the knowledge, prevention and management of these disorders. For prevention to be effective, the multifactorial nature of atherosclerosis encourages a global approach that addresses all risk factors. This document updates the clinical evidence, summarizes recent progress in research and covers all phases of the vascular patient's journey: initial examination and tests, diagnostic criteria, vascular risk assessment, general and pharmacological recommendations and criteria for referral and discharge. Furthermore, guidelines to set up a vascular risk consultation are issued. The aim is to provide healthcare professionals with a reference handbook for the daily practice in the vascular field.

Background and aims: Lipoprotein(a) (Lp(a)) is a proatherogenic particle that is considered an important cardiovascular risk modifier due to its association with atherosclerotic cardiovascular disease (ASCVD) as well as calcific aortic valve stenosis (CAVS). Data on the clinical burden associated with elevated lipoprotein(a) levels in patients at high and very high cardiovascular risk remain limited. We evaluated the prevalence of ASCVD and LDL-C target achievement in subjects with high and very high elevated Lp(a) levels referred to a lipid unit.

Methods and results: In this retrospective study, 1755 subjects were evaluated; 265 with Lp(a) ≥240nmol/L were included. The population was divided into two groups: high Lp(a) (240-429nmol/L, n=216) and very high Lp(a) (≥430nmol/L, n=49). ASCVD prevalence was 58% in the very high group and 48% in the high group (p=0.23). Age and statin intensity were higher in the very high Lp(a) group. LDL-C target achievement was low in both groups: 20.0% and 25.4% of very high-risk patients reached <55mg/dL as well as 18.2% and 17.2% of high-risk patients reached <70mg/dL in very high and high Lp(a) groups, respectively.

Conclusions: Subjects with elevated Lp(a) levels showed a high prevalence of ASCVD and low LDL-C target attainment despite high-intensity statin therapy. These findings support the need for Lp(a) screening and additional lipid-lowering strategies in high-risk patients.

Background: Atherogenic dyslipidemia (AD) and associated lipid ratios are critical markers for cardiovascular risk, yet little is known about how these markers vary by occupational sector and sociodemographic or lifestyle factors in working populations.

Objective: To evaluate the prevalence and determinants of elevated atherogenic risk according to total cholesterol/HDL-c (TC/HDL-c), LDL-c/HDL-c, triglycerides/HDL-c (TG/HDL-c), and AD in workers from the commerce and industry sectors, stratified by sex, age, education, physical activity, diet, and smoking.

Methods: This cross-sectional study included 56,856 Spanish workers (39,448 men and 17,408 women) from commerce (n=27,448) and industry (n=29,408). Sociodemographic, clinical, and lifestyle data were collected, and atherogenic risk was assessed using TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios, and AD presence. Mean values and prevalence were compared by group, and multinomial logistic regression was used to estimate the association between risk markers and covariates.

Results: Workers in the industry sector showed higher mean values and prevalence of all atherogenic risk scales compared to those in commerce, particularly among men and older age groups. Male sex, older age, lower education, physical inactivity, absence of Mediterranean diet, and smoking were consistently associated with higher odds of elevated lipid ratios and AD. Notably, the absence of physical activity was strongly associated with all outcomes, with ORs ranging from 3.08 to 11.66. The industrial sector was independently associated with increased risk: TC/HDL-c (OR=1.23), LDL-c/HDL-c (OR=1.15), TG/HDL-c (OR=1.16), and AD (OR=1.19).

Conclusions: Atherogenic risk profiles are less favorable among industrial workers and are significantly influenced by modifiable lifestyle factors. These findings support the need for preventive strategies tailored to the occupational context, with emphasis on promoting physical activity, smoking cessation, and healthier dietary habits, in order to reduce cardiovascular risk in these populations.