Pub Date : 2022-11-01DOI: 10.1016/j.arteri.2022.03.007
Victoria Marco-Benedí , Ana M. Bea , Rosa M. Sánchez Hernández , Núria Plana , Pedro Valdivielso , Fernando Civeira
Introduction
Clinical studies show that patients with high cardiovascular risk are still far from reaching the therapeutic objectives, especially of the levels of LDL cholesterol. If the management of these patients in specialized units differs from other scenarios is known.
Patients and methods
61 certified Lipid Units were selected in the Registry of Dyslipemias of the Spanish Arteriosclerosis Society for the collection of study data.
The study included 3958 subjects >18 years of age who met the criteria for hypercholesterolemia (LDL cholesterol ≥160 mg/dL or non-HDL cholesterol ≥190 mg/dL) without familial hypercholesterolemia. A total 1,665 subjects were studied with a mean follow-up time of 4.2 years.
Results and conclusions
A total of 42 subjects had a cardiovascular event since their inclusion in the Registry, which represents 0.6%. There were no differences in the treatment used at follow-up, but 50% of the patients did not reach the therapeutic goals at the visit end of follow-up. An increase in the potency of the lipid-lowering treatment was observed, including PCSK9 inhibitors use in 16.7% of subjects with recurrences.
{"title":"Estrategias de tratamiento de las dislipemias en prevención primaria y secundaria. Registro de la Sociedad Española de Arteriosclerosis","authors":"Victoria Marco-Benedí , Ana M. Bea , Rosa M. Sánchez Hernández , Núria Plana , Pedro Valdivielso , Fernando Civeira","doi":"10.1016/j.arteri.2022.03.007","DOIUrl":"10.1016/j.arteri.2022.03.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Clinical studies show that patients with high cardiovascular risk are still far from reaching the therapeutic objectives, especially of the levels of LDL cholesterol. If the management of these patients in specialized units differs from other scenarios is known.</p></div><div><h3>Patients and methods</h3><p>61 certified Lipid Units were selected in the Registry of Dyslipemias of the Spanish Arteriosclerosis Society for the collection of study data.</p><p>The study included 3958 subjects >18 years of age who met the criteria for hypercholesterolemia (LDL cholesterol ≥160 mg/dL or non-HDL cholesterol ≥190 mg/dL) without familial hypercholesterolemia. A total 1,665 subjects were studied with a mean follow-up time of 4.2 years.</p></div><div><h3>Results and conclusions</h3><p>A total of 42 subjects had a cardiovascular event since their inclusion in the Registry, which represents 0.6%. There were no differences in the treatment used at follow-up, but 50% of the patients did not reach the therapeutic goals at the visit end of follow-up. An increase in the potency of the lipid-lowering treatment was observed, including PCSK9 inhibitors use in 16.7% of subjects with recurrences.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54195074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.arteri.2022.03.004
Jorge Francisco Gómez Cerezo , José Enrique López Paz , Jacinto Fernández Pardo
Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.
{"title":"Actualización sobre las nuevas formas de consumo de tabaco","authors":"Jorge Francisco Gómez Cerezo , José Enrique López Paz , Jacinto Fernández Pardo","doi":"10.1016/j.arteri.2022.03.004","DOIUrl":"10.1016/j.arteri.2022.03.004","url":null,"abstract":"<div><p>Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916822000377/pdfft?md5=02d6adb35580061a733a0d4895094a21&pid=1-s2.0-S0214916822000377-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54194768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.arteri.2022.05.002
Almudena Martin-Romero , Jary Perelló-Martínez , Juan Carlos Hidalgo-Santiago , Alfredo Michan-Doña , Juan Bosco López Sáez , Pablo Gómez-Fernández
Background and objectives
Vitamin D(vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables.
Patients and methods
We studied in 97 patients with CKD stages 3-4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vpc-f), and on albuminuria. A group of patients with stages 3-4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7 ± 2 months.
Results
In the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vpc-f value of 10.5 (9.2-12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43-876) mg / g (median (interquartile range)), with no differences between the groups.
Serum calcium and phosphorus increased significantly in those treated with cholecal-ciferol (native vitD) and paricalcitol (active vitD). Parathormone (PTH) values decreased in those treated with paricalcitol.bPP and cPP decreased in all groups treated with native and active vitD. No significant changes in bPP and cPP were observed in the control group.
Vpc-f did not change significantly in any of the groups, although the variation was quantitatively greater in group 3 (11.2±2 vs. 10.7±1.6 (P=.06)). No differences were observed in the changes in Vpc-f between the groups when adjusted to the baseline values of estimated glomerular filtration rate (eGFR), albuminuria, PTH, vitD, brachial and central blood pressure parameters, and their changes with treatment.Those who received treatment with native and active vitD presented a significant decrease in albuminuria of 17% (group 2) and 21% (group 3) compared to a 16% increase in the untreated group (group 1) (P=.01). A decrease in albuminuria ≥30% was observed more frequently in the groups treated with some form o
{"title":"Efecto de la administración de diferentes formas de vitamina D en la presión arterial y rigidez aórticas, y su implicación en la reducción de la albuminuria en la enfermedad renal crónica","authors":"Almudena Martin-Romero , Jary Perelló-Martínez , Juan Carlos Hidalgo-Santiago , Alfredo Michan-Doña , Juan Bosco López Sáez , Pablo Gómez-Fernández","doi":"10.1016/j.arteri.2022.05.002","DOIUrl":"10.1016/j.arteri.2022.05.002","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Vitamin D(vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables.</p></div><div><h3>Patients and methods</h3><p>We studied in 97 patients with CKD stages 3-4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vp<sub>c-f</sub>), and on albuminuria. A group of patients with stages 3-4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7 ± 2 months.</p></div><div><h3>Results</h3><p>In the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vp<sub>c-f</sub> value of 10.5 (9.2-12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43-876) mg / g (median (interquartile range)), with no differences between the groups.</p><p>Serum calcium and phosphorus increased significantly in those treated with cholecal-ciferol (native vitD) and paricalcitol (active vitD). Parathormone (PTH) values decreased in those treated with paricalcitol.bPP and cPP decreased in all groups treated with native and active vitD. No significant changes in bPP and cPP were observed in the control group.</p><p>Vp<sub>c-f</sub> did not change significantly in any of the groups, although the variation was quantitatively greater in group 3 (11.2±2 vs. 10.7±1.6 <em>(P=</em>.06)). No differences were observed in the changes in Vp<sub>c-f</sub> between the groups when adjusted to the baseline values of estimated glomerular filtration rate (eGFR), albuminuria, PTH, vitD, brachial and central blood pressure parameters, and their changes with treatment.Those who received treatment with native and active vitD presented a significant decrease in albuminuria of 17% (group 2) and 21% (group 3) compared to a 16% increase in the untreated group (group 1) <em>(P=</em>.01). A decrease in albuminuria ≥30% was observed more frequently in the groups treated with some form o","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40493716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.arteri.2022.03.006
Antonio Ruiz-García , Ezequiel Arranz-Martínez , Luis Enrique Morales-Cobos , Juan Carlos García-Álvarez , Nerea Iturmendi-Martínez , Montserrat Rivera-Teijido , en representación del Grupo de Investigación del Estudio SIMETAP
Introduction
Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations.
Methods
Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis.
Results
The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity.
Conclusions
The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.
{"title":"Tasas de prevalencia de sobrepeso y obesidad y sus asociaciones con factores cardiometabólicos y renales. Estudio SIMETAP-OB","authors":"Antonio Ruiz-García , Ezequiel Arranz-Martínez , Luis Enrique Morales-Cobos , Juan Carlos García-Álvarez , Nerea Iturmendi-Martínez , Montserrat Rivera-Teijido , en representación del Grupo de Investigación del Estudio SIMETAP","doi":"10.1016/j.arteri.2022.03.006","DOIUrl":"10.1016/j.arteri.2022.03.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations.</p></div><div><h3>Methods</h3><p>Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis.</p></div><div><h3>Results</h3><p>The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%<span>C</span>I: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity.</p></div><div><h3>Conclusions</h3><p>The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54194802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.arteri.2022.09.001
Eva Hurt-Camejo , Matteo Pedrelli
Plasma cholesterol and triglyceride levels are twice as high in hibernating brown bears (Ursus arctos) than in healthy humans. Yet, bears display no sign of atherosclerosis development. To explore this apparent paradox, we analyzed lipoproteins from same ten individual bears plasma collected during winter (hibernation; February) and summer (active; June) in the same year. Plasma from fourteen healthy humans were analyzed as comparator. We used standard methods for lipoprotein isolation, composition and functional investigation. The results shows that in brown bears the absence of atherosclerosis despite elevated cholesterol is likely associated with two main athero-protective properties of circulating lipoproteins. First, a significant ten times lower affinity of low-density-lipoprotein (LDL) particles for arterial proteoglycans and secondly, an elevated plasma cholesterol efflux capacity. What does the brown bear data tell us? That elevated total cholesterol and ApoB-containing lipoproteins not always associates with atherosclerosis disease. We need to look also at the lipoprotein biochemical features and functionality as they are relevant for arterial pathophysiology. What is the translatability into human of these results? We humans need to control our total and LDL-cholesterol levels. We are not brown bears!
{"title":"¿Por qué los osos pardos están protegidos contra la aterosclerosis a pesar de que sus niveles de colesterol plasmático doblan al de los humanos?","authors":"Eva Hurt-Camejo , Matteo Pedrelli","doi":"10.1016/j.arteri.2022.09.001","DOIUrl":"10.1016/j.arteri.2022.09.001","url":null,"abstract":"<div><p>Plasma cholesterol and triglyceride levels are twice as high in hibernating brown bears (<em>Ursus arctos</em>) than in healthy humans<em>.</em> Yet, bears display no sign of atherosclerosis development. To explore this apparent paradox, we analyzed lipoproteins from same ten individual bears plasma collected during winter (hibernation; February) and summer (active; June) in the same year. Plasma from fourteen healthy humans were analyzed as comparator. We used standard methods for lipoprotein isolation, composition and functional investigation. The results shows that in brown bears the absence of atherosclerosis despite elevated cholesterol is likely associated with two main athero-protective properties of circulating lipoproteins. First, a significant ten times lower affinity of low-density-lipoprotein (LDL) particles for arterial proteoglycans and secondly, an elevated plasma cholesterol efflux capacity. What does the brown bear data tell us? That elevated total cholesterol and ApoB-containing lipoproteins not always associates with atherosclerosis disease. We need to look also at the lipoprotein biochemical features and functionality as they are relevant for arterial pathophysiology. What is the translatability into human of these results? We humans need to control our total and LDL-cholesterol levels. We are not brown bears!</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916822001140/pdfft?md5=89c6bc1b107e8d38ba4434c83c96cb16&pid=1-s2.0-S0214916822001140-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40669427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.arteri.2022.02.001
Juan Cosín-Sales , Raquel Campuzano Ruiz , José Luis Díaz Díaz , Carlos Escobar Cervantes , María Rosa Fernández Olmo , Juan José Gómez-Doblas , José María Mostaza , Juan Pedro-Botet , Núria Plana Gil , Pedro Valdivielso
Introduction and objectives
The treatment of dyslipidemia exhibits wide variability in clinical practice and important limitations that make lipid-lowering goals more difficult to attain. Getting to know the management of these patients in clinical practice is key to understand the existing barriers and to define actions that contribute to achieving the therapeutic goals from the most recent Clinical Practice Guidelines.
Methods
Observatory where the information gathered is based on routine clinical practice and the experience from the healthcare professionals involved in the treatment of dyslipidemia in Spain. The information is collected by health area through: (i) face-to-face meeting with three different medical specialties and (ii) quantitative information related to hypercholesterolemia patients’ management (ad-hoc questionnaire). Information includes patients’ profiles, assistance burden, guidelines and protocols used, goal attainment, limitations and opportunities in clinical practice.
Results
145 health areas are planned to be included, with the participation of up to 435 healthcare professionals from the 17 Autonomous Regions of Spain. Information collection will result in aggregated data from over four thousand patients.
Conclusions
This observatory aims to understand how hypercholesterolemia is being treated in routine clinical practice in Spain. Even though the preliminary results show important improvement areas in the treatment of dyslipidemias, mechanisms to drive a change towards health outcomes optimization are also identified.
{"title":"Protocolo del observatorio de las dislipemias: Tratamiento de la hipercolesterolemia en España, contexto e identificación de medidas de mejora en práctica clínica habitual","authors":"Juan Cosín-Sales , Raquel Campuzano Ruiz , José Luis Díaz Díaz , Carlos Escobar Cervantes , María Rosa Fernández Olmo , Juan José Gómez-Doblas , José María Mostaza , Juan Pedro-Botet , Núria Plana Gil , Pedro Valdivielso","doi":"10.1016/j.arteri.2022.02.001","DOIUrl":"10.1016/j.arteri.2022.02.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>The treatment of dyslipidemia exhibits wide variability in clinical practice and important limitations that make lipid-lowering goals more difficult to attain. Getting to know the management of these patients in clinical practice is key to understand the existing barriers and to define actions that contribute to achieving the therapeutic goals from the most recent Clinical Practice Guidelines.</p></div><div><h3>Methods</h3><p>Observatory where the information gathered is based on routine clinical practice and the experience from the healthcare professionals involved in the treatment of dyslipidemia in Spain. The information is collected by health area through: (i) face-to-face meeting with three different medical specialties and (ii) quantitative information related to hypercholesterolemia patients’ management (ad-hoc questionnaire). Information includes patients’ profiles, assistance burden, guidelines and protocols used, goal attainment, limitations and opportunities in clinical practice.</p></div><div><h3>Results</h3><p>145 health areas are planned to be included, with the participation of up to 435 healthcare professionals from the 17 Autonomous Regions of Spain. Information collection will result in aggregated data from over four thousand patients.</p></div><div><h3>Conclusions</h3><p>This observatory aims to understand how hypercholesterolemia is being treated in routine clinical practice in Spain. Even though the preliminary results show important improvement areas in the treatment of dyslipidemias, mechanisms to drive a change towards health outcomes optimization are also identified.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54194686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.arteri.2022.01.003
Jose Seijas-Amigo , Mónica Gayoso-Rey , María José Mauriz-Montero , Pedro Suarez-Artime , Antonia Casas-Martinez , María Dominguez-Guerra , Lara Gonzalez-Freire , Ana Estany-Gestal , Alberto Codero-Fort , Moisés Rodriguez-Mañero , Jose Ramón Gonzalez-Juanatey , e investigadores MEMOGAL
Objectives
MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control; (2) descriptive analysis; (3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab; (4) communicate PCSK9i safety.
Material and methods
It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time.
Results
89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148 mg/dL and the follow-up value was 71 mg/dL. The baseline value of patients treated with alirocumab (N = 43) was 144 mg/dL and 73 mg/dL in the follow-up. With evolocumab (N = 46) was 151 mg/dL in basaline and 69 mg/dL in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70 mg/dL in six month time; 19.4% between 69 mg/dl and 55 mg/dL and 37.5% <55 mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (N = 2), myalgias (N = 1), flu-like symptoms (N = 1) and neurocognitive worsening (N = 1).
Conclusions
(1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (< 55 mg/dL and/or reduction > 50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (P = .972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed.
{"title":"Impacto de la pandemia por COVID-19 en el control lipídico de pacientes que inician inhibidores de la PCSK9","authors":"Jose Seijas-Amigo , Mónica Gayoso-Rey , María José Mauriz-Montero , Pedro Suarez-Artime , Antonia Casas-Martinez , María Dominguez-Guerra , Lara Gonzalez-Freire , Ana Estany-Gestal , Alberto Codero-Fort , Moisés Rodriguez-Mañero , Jose Ramón Gonzalez-Juanatey , e investigadores MEMOGAL","doi":"10.1016/j.arteri.2022.01.003","DOIUrl":"10.1016/j.arteri.2022.01.003","url":null,"abstract":"<div><h3>Objectives</h3><p>MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control; (2) descriptive analysis; (3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab; (4) communicate PCSK9i safety.</p></div><div><h3>Material and methods</h3><p>It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time.</p></div><div><h3>Results</h3><p>89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148<!--> <!-->mg/dL and the follow-up value was 71<!--> <!-->mg/dL. The baseline value of patients treated with alirocumab (<em>N</em> <!-->=<!--> <!-->43) was 144<!--> <!-->mg/dL and 73<!--> <!-->mg/dL in the follow-up. With evolocumab (<em>N</em> <!-->=<!--> <!-->46) was 151<!--> <!-->mg/dL in basaline and 69<!--> <!-->mg/dL in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70<!--> <!-->mg/dL in six month time; 19.4% between 69<!--> <!-->mg/dl and 55<!--> <!-->mg/dL and 37.5% <55<!--> <!-->mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (<em>N</em> <!-->=<!--> <!-->2), myalgias (<em>N</em> <!-->=<!--> <!-->1), flu-like symptoms (<em>N</em> <!-->=<!--> <!-->1) and neurocognitive worsening (<em>N</em> <!-->=<!--> <!-->1).</p></div><div><h3>Conclusions</h3><p>(1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (<<!--> <!-->55<!--> <!-->mg/dL and/or reduction<!--> <!-->><!--> <!-->50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (<em>P</em> <!-->=<!--> <!-->.972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10325262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.arteri.2019.10.008
Ángel Díaz Rodríguez , Teresa Mantilla Morató
The incidence of atherosclerotic cardiovsacular disease (ASCVC) has increased in the developed countries. Dyslipidemia is a primary major risk factor for ASCVD and LDL lowering is one of the main objectives. Although treatment goals for dyslipidemias should be personalized in every patient, statins are cost-effective in primary and secondary prevention of ASCVD. New treatments with higher power and greater decreases in LDL, PSCK9 inhibitors, have made a new breakthrough in ASCVD treatment. The 2019 Guidelines for de Management of Dyslipidaemias: Lipid Modification to reduce Cardiovascular Risk (European Society of Cardiology/European Atherosclerosis Society) with the level of evidence and the strength of the recommendations can facilitate the best decisions and benefits to our patients in clinical practice.
{"title":"LDL como objetivo terapéutico","authors":"Ángel Díaz Rodríguez , Teresa Mantilla Morató","doi":"10.1016/j.arteri.2019.10.008","DOIUrl":"10.1016/j.arteri.2019.10.008","url":null,"abstract":"<div><p>The incidence of atherosclerotic cardiovsacular disease (ASCVC) has increased in the developed countries. Dyslipidemia is a primary major risk factor for ASCVD and LDL lowering is one of the main objectives. Although treatment goals for dyslipidemias should be personalized in every patient, statins are cost-effective in primary and secondary prevention of ASCVD. New treatments with higher power and greater decreases in LDL, PSCK9 inhibitors, have made a new breakthrough in ASCVD treatment. The 2019 Guidelines for de Management of Dyslipidaemias: Lipid Modification to reduce Cardiovascular Risk (European Society of Cardiology/European Atherosclerosis Society) with the level of evidence and the strength of the recommendations can facilitate the best decisions and benefits to our patients in clinical practice.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82481668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.arteri.2022.08.001
Juan José Tamarit García
{"title":"Índices aterogénicos: utilidad como predictores en enfermedad cardiovascular","authors":"Juan José Tamarit García","doi":"10.1016/j.arteri.2022.08.001","DOIUrl":"10.1016/j.arteri.2022.08.001","url":null,"abstract":"","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40351053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1016/j.arteri.2022.03.005
Maroua Slouma , Khaoula Ben Ali , Lobna Kharrat , Chadia Zouaoui , Haroun Ouertani , Imen Gharsallah
Introduction
Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce.
We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome.
Methods
We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc).
Results
Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89 ± 5.88 versus 23.63 ± 4.47 kg/m2, p = 0.03), higher TG (1.41 ± 0.64 versus 0.89 ± 0.5 mmol/L, p = 0.05) and a lower HDLc level (1 ± 0.28 versus 1.31 ± 0.22 mmol/L, p = 0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios).
Conclusion
Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.
代谢综合征是一种与心血管疾病高风险相关的病理实体。关于该综合征的发生频率、脂质谱和x线轴性脊柱炎患者血浆动脉粥样硬化指数的资料很少。我们的目的是确定代谢综合征在脊椎关节炎患者中的患病率。我们还旨在确定有代谢综合征和无代谢综合征患者的动脉粥样硬化指标的鉴别值。方法我们进行了一项横断面研究，包括51例符合ASAS 2009放射学标准的轴性脊柱炎患者。我们测量了以下参数:甘油三酯(TG)、高密度脂蛋白(HDLc)、低密度脂蛋白胆固醇(LDLc)和总胆固醇(TC)。我们计算了TC/HDLc、TG/HDLc、LDLc/HDLc比率和血浆的动脉粥样硬化指数(LogTG/HDLc)。结果33%的患者出现代谢综合征。活动期患者体质量指数较高(26.89±5.88比23.63±4.47 kg/m2, p = 0.03)， TG较高(1.41±0.64比0.89±0.5 mmol/L, p = 0.05)， HDLc水平较低(1±0.28比1.31±0.22 mmol/L, p = 0.01)。然而，TNFα抑制剂组患者的LogTG/HDLc和TG/HDLc较高。TG/HDLc比值和LogTG/HDLc区分有无代谢综合征的截断值分别为1.33和0.22(特异性为91.2%，敏感性为70.6%)。结论我们的研究表明，代谢综合征在轴型脊柱炎患者中是常见的。动脉粥样硬化指数可用于预测这些患者的代谢综合征。
{"title":"Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis","authors":"Maroua Slouma , Khaoula Ben Ali , Lobna Kharrat , Chadia Zouaoui , Haroun Ouertani , Imen Gharsallah","doi":"10.1016/j.arteri.2022.03.005","DOIUrl":"10.1016/j.arteri.2022.03.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce.</p><p>We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome.</p></div><div><h3>Methods</h3><p><span>We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDL</span><sub>c</sub>), low-density lipoprotein cholesterol (LDL<sub>c</sub>), and total cholesterol (TC). We calculated TC/HDL<sub>c</sub>, TG/HDL<sub>c</sub>, LDL<sub>c</sub>/HDL<sub>c</sub> ratios, and atherogenic index of plasma (LogTG/HDL<sub>c</sub>).</p></div><div><h3>Results</h3><p>Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89<!--> <!-->±<!--> <!-->5.88 versus 23.63<!--> <!-->±<!--> <!-->4.47<!--> <!-->kg/m<sup>2</sup>, <em>p</em> <!-->=<!--> <span>0.03), higher TG (1.41</span> <!-->±<!--> <!-->0.64 versus 0.89<!--> <!-->±<!--> <!-->0.5<!--> <!-->mmol/L, <em>p</em> <!-->=<!--> <!-->0.05) and a lower HDL<sub>c</sub> level (1<!--> <!-->±<!--> <!-->0.28 versus 1.31<!--> <!-->±<!--> <!-->0.22<!--> <!-->mmol/L, <em>p</em> <!-->=<!--> <!-->0.01). However, the LogTG/HDL<sub>c</sub> and TG/HDL<sub>c</sub> were higher in patients under TNFα inhibitors. The ability of the TG/HDL<sub>c</sub> ratio and LogTG/HDL<sub>c</sub> to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios).</p></div><div><h3>Conclusion</h3><p>Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75593536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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