Eduardo Alegría

ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies’ Task forces on CVD prevention in clinical practice.2 – 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.

Prevalencia del síndrome metabólico en población laboral española: registro MESYAS

Introduccion y objetivos Estudiar la prevalencia del sindrome metabolico (SM) en la poblacion laboral activa espanola y analizar sus diferencias segun las categorias laborales. Sujetos y metodo Se recogieron los datos de 7.256 trabajadores activos (un 82,4% varones), con una edad media de 45,4 ± 9,8 anos, empleados en una factoria de coches y unos grandes almacenes. El diagnostico del SM se realizo mediante los criterios modificados del ATP-III (se utilizo el indice de masa corporal en lugar del perimetro abdominal). Resultados La prevalencia bruta del SM fue del 10,2%. Ajustada por edad y sexo en una poblacion plana (20-60 anos) fue del 5,8% (intervalo de confianza [IC] del 95%, 4,1-7,6%), significativamente mas alta en varones que en mujeres (el 8,7%; IC del 95%, 7,3-10,0 frente al 3,0%; IC del 95%, 0,8-5,1). Todos los componentes del SM fueron significativamente mas prevalentes en varones, excepto las concentraciones de lipoproteinas de alta densidad, que fueron mas bajas. La prevalencia aumento con la edad y el sexo masculino (odds ratio [OR] = 1,7), la obesidad (OR = 9,6), la hipertension (OR = 3,4) y la diabetes (OR = 15,4). Los trabajadores manuales presentaron la mayor prevalencia de SM (11,8%), seguidos por los trabajadores de oficina (9,3%) y los directivos (7,7%) (gradiente social inverso). Los trabajadores manuales tienen un riesgo superior de presentar SM, con independencia de la edad y el sexo (OR = 1,3); este efecto parece depender de las concentraciones de trigliceridos. Conclusiones Uno de cada 10 trabajadores activos tiene SM; la prevalencia aumenta con la edad y el sexo masculino. La obesidad y la diabetes suponen gran incremento de la prevalencia. Los trabajadores manuales son el colectivo con mayor prevalencia.

Usefulness of Triglycerides-to–High-Density Lipoprotein Cholesterol Ratio for Predicting the First Coronary Event in Men

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.

Prevalence of Metabolic Syndrome in the Spanish Working Population: MESYAS Registry

INTRODUCTION AND OBJECTIVES To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.

Guías de práctica clínica de la Sociedad Española de Cardiología en pruebas de esfuerzo

La mayor parte de las pruebas de esfuerzo se realizan a pacientes adultos con cardiopatia isquemica en estudio o ya conocida. En los ultimos anos se ha producido la incorporacion de las tecnicas de imagen en este campo, mejorando asi la informacion aportada por la prueba de esfuerzo convencional. Pero cada vez existen mas situaciones que escapan a esta norma general, tanto en sujetos sanos (asintomaticos, atletas, discapacitados, etc.) como en pacientes con cardiopatias diferentes de la isquemica (insuficiencia cardiaca congestiva avanzada, hipertension, trastornos del ritmo, cardiopatias congenitas etc.). Todos estos aspectos justifican un documento de consenso en Espana, necesariamente multidisciplinario. Este documento revisa en profundidad la metodologia de las pruebas de esfuerzo convencionales, sin olvidar las realizadas con determinacion de consumo de oxigeno. El papel de esta exploracion en el manejo de la cardiopatia isquemica, asi como las aplicaciones de las tecnicas de imagen al campo del estres, ocupan un lugar fundamental en esta revision. Por ultimo, se analiza la utilidad de las pruebas de esfuerzo en diversas cardiopatias no isquemicas y en diferentes poblaciones de sujetos sanos.

Prevalencia y caracteristicas de la dislipemia en pacientes en prevencion primaria y secundaria tratados con estatinas en Espana. Estudio DYSIS-Espana

INTRODUCTION AND OBJECTIVES Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. METHODS DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. RESULTS Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters. CONCLUSIONS Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement.

Comparison of Serum Lipid Values in Subjects With and Without the Metabolic Syndrome

Insulin resistance is supposed to be the basis of metabolic syndrome (MS), although it is difficult to measure. The ratio of triglyceride (TG) to high-density lipoprotein (HDL) has been proposed as a surrogate marker of insulin resistance in overweight subjects. The aim of the present study was to assess the accuracy of the TG/HDL ratio for the diagnosis of MS. Data of 18,778 active workers (77.6% men) enrolled in 3 insurance companies in Spain were collected from their annual health examinations. Mean age was 42.2 +/- 10.7 years. MS was assessed according to modified Adult Treatment Panel III criteria. Prevalences of MS were 18.8% in men and 6.1% in women. Mean value of the TG/HDL ratio was 2.50 +/- 2.2 and increased in parallel to the number of MS components present. Subjects with MS had a ratio that was 2 times higher compared with those without (5.10 vs 2.03, p <0.001). Receiver operating characteristic curves were performed to assess the capability of the TG/HDL ratio to contribute to a diagnosis of MS and 80% sensitivity and 78% specificity were obtained for values >2.75 in men and >1.65 in women. In conclusion, the TG/HDL ratio is a feasible and accurate measurement for assessment of MS in healthy subjects. We propose cut-off values of 2.75 for men and 1.65 for women for a diagnosis of MS.

Guía de la ESC/EAS sobre el manejo de las dislipemias

This approach is different from the one used in the U.S. which recommends the use of statins in all high risk patients even if they have low cholesterol levels. But as Prof. Graham points out, the American approach would put more people in Europe on statins and the task force does not support this blanket approach. They believe that people who are inert and overweight may have their cholesterol reduced but other risk factors may be ignored.

Mortalidad a largo plazo y reingreso hospitalario tras infarto agudo de miocardio: un estudio de seguimiento de ocho años

INTRODUCTION AND OBJECTIVES Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. METHODS This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. RESULTS Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. CONCLUSIONS Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.

Left ventricular pacing site in cardiac resynchronization therapy: clinical follow-up and predictors of failed lateral implant.

The effects of the left ventricular (LV) pacing site on the clinical results of resynchronization therapy (CRT) are not well characterized. The aim of this study was to define the effect of LV lead location on clinical response and LV remodelling, and to identify predictors of failure to implant the LV lead in a lateral location.