Eva Estirado

Prevalencia de enfermedad arterial periférica asintomàtica, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II

Fundamento y objetivo Los pacientes con enfermedad arterial en varios territorios presentan una elevada tasa de complicaciones vasculares y de mortalidad. Su identificacion permitiria definir a un subgrupo de la poblacion de muy alto riesgo, candidatos a recibir medidas preventivas mas energicas. El objetivo del presente estudio ha sido estimar la prevalencia de enfermedad arterial periferica subclinica en personas con antecedentes de enfermedad vascular en otros territorios arteriales. Pacientes y metodo Se incluyo en el estudio a pacientes con historia de enfermedad coronaria y/o cerebrovascular entre los 3 meses y los 5 anos previos, atendidos en consultas de medicina interna repartidas por toda la geografia nacional. Se les realizaron anamnesis, exploracion fisica, analitica sanguinea y urinaria, y se les determino el indice tobillo-brazo (ITB). Resultados Se estudio a 1.203 pacientes (64% varones), con una edad media de 74,3 anos. El 55,4% tenia antecedentes de enfermedad coronaria, un 38% de enfermedad cerebrovascular y un 6,7% de afectacion en ambos territorios. La prevalencia de ITB bajo ( Conclusiones La prevalencia de un ITB bajo es elevada en pacientes asintomaticos con enfermedad coronaria o cerebrovascular, especialmente si presentan afectacion conjunta de ambos territorios.

Carotid atherosclerosis severity in relation to glycemic status: A cross- sectional population study

OBJECTIVE Intima-media thickness (IMT) is increased in subjects with prediabetes or newly diagnosed diabetes. However, no previous studies have evaluated the relationship between the severity of carotid atherosclerosis, assessed by the presence of carotid plaques or stenosis, and the glycemic status, assessed either by fasting glucose, an oral glucose tolerance test (OGTT) or A1C levels. METHODS Cross-sectional analysis of 1475 subjects (mean age 62 years, 44% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and A1C levels. An OGTT was performed in non-diabetic subjects. Carotid atherosclerosis was evaluated by echo-doppler. RESULTS A 10.5% of the population had a previous diagnosis of diabetes. Of the 1320 non-diabetic participants, 349 (26.4%) had normal fasting glucose, normal glucose tolerance and A1C < 5.7%, and were considered controls. Prediabetes was diagnosed in 850 subjects (64.4%), and diabetes was newly diagnosed in 121 (9.2%). The prevalence of patients with carotid plaques was 34.2% in controls, 45.1% in prediabetics, 64.2% in newly diagnosed diabetics, and 72.9% in established diabetic patients. These numbers were 0.3%, 1.1%, 5.0% and 7.7% for carotid stenosis, respectively. In multivariate analysis, glycemic status remained significantly associated with the prevalence of carotid plaques after adjusting for age, sex, statin treatment, and cardiovascular risk factors. CONCLUSIONS Glycemic status is associated with all grades of carotid atherosclerosis, from early signs, as demonstrated by the IMT, to intermediate degrees, as demonstrated by the presence of carotid plaques, to advance atherosclerosis, as established by the presence of carotid stenosis.

Peripheral Atherosclerosis in Patients With Erectile Dysfunction: A Population-Based Study

INTRODUCTION The presence of erectile dysfunction (ED) could be a warning of vascular disease in different arterial territories. AIM The aim of this study was to investigate the association between ED and the presence of atherosclerosis in 2 different vascular beds: carotid and lower limbs. METHODS A total of 614 volunteers between 45 and 74 years of age (mean age 61.0 years) were randomly selected from the general population. ED was assessed using the International Index of Erectile Function (IIEF-5). Ankle-brachial index (ABI) measurement and carotid atherosclerosis were evaluated by echo-Doppler. MAIN OUTCOME MEASURES Mean carotid intima-media thickness (IMT), prevalence of carotid plaques, mean ABI, and prevalence of ABI < 0.9 were the main outcome measures. RESULTS ED was present in 373 subjects (59.7%). Mean carotid IMT was significantly higher in men with ED (0.762 ± 0.151 mm vs 0.718 ± 0.114 mm, P < .001). Also the global prevalence of carotid plaques was more frequent in men with ED (63.8% vs 44.8%, P < .001), even after adjusting by age, cardiovascular risk factors, and ongoing treatment (P = .039). Both the IMT and the prevalence of carotid plaques increased significantly with ED severity (P trend .004 and <.001, respectively). There were no significant differences between groups neither in mean ABI nor in the prevalence of subjects with ABI < 0.9. However, there was a trend to a lower ABI and a higher prevalence of ABI < 0.9 with increasing ED severity. CONCLUSION In the general population, the presence of ED identifies subjects with higher atherosclerosis burden in carotid arteries but not in the lower extremities.

Relationship of the Adherence to a Mediterranean Diet and Its Main Components with CRP Levels in the Spanish Population

Background: Adherence to a Mediterranean diet seems to be inversely associated with C-reactive protein (CRP) concentration. A 14-point Mediterranean Diet Adherence Screener (MEDAS) has been developed to assess dietary compliance. Objective: The aim of this study was to assess whether each of the MEDAS questions as well as their final score were associated with the levels of CRP in general Spanish population. Methods: Cross-sectional analysis of 1411 subjects (mean age 61 years, 43.0% males) randomly selected from the general population. CRP levels were determined by a commercial ELISA kit. Adherence to the Mediterranean diet was measured by the 14-point MEDAS. Results: There was an inverse correlation between adherence to the Mediterranean diet and the CRP concentration, even after adjusting by age, gender, hypertension, metabolic syndrome, body mass index, statin treatment and hypertension treatment (p = 0.041). Subjects who consume ≥2 servings of vegetables per day (p = 0.003), ≥3 pieces of fruit per day (p = 0.003), ≥1 serving of butter, margarine, or cream per day (p = 0.041) or ≥3 servings of fish/seafood per week (p = 0.058) had significantly lower levels of CRP. Conclusions: Adherence to a Mediterranean-type diet measured by a simple questionnaire is associated with lower CRP concentration. However, this association seems to be particularly related to a higher consumption of vegetables, fruits, dairy products, and fish.

Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study

Aim To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. Methods Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle–brachial index and/or having a prior diagnosis. Results PAD prevalence was 3.81% (95% CI, 2.97–4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74–7.11) vs. 2.78% (95% CI, 1.89–4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49–12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62–10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50–9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48–5.04), and former smoker status (OR = 2.04; 95%CI, 1.00–4.16). Conclusions Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45–74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.

Factores de riesgo asociados con el grosor íntima-media y la presencia de placas en arteria carótida: Estudio ESPREDIA

OBJECTIVE To evaluate whether there were any differences in the risk factor profile associated with either the intima-media thickness (IMT) or the presence of carotid plaques. METHODS Cross-sectional study in 1475 subjects between 45 and 75years, randomly selected from the population of the Northwest area of Madrid (Spain). They had a physical exam, blood analysis, and ultrasound measurement of the IMT and of the presence of plaques. RESULTS Mean IMT was 0.725±0.132mm. Forty seven percent of the participants had carotid plaques. In multivariate analysis, factors directly associated with the IMT were, age (β0.227, P<.0001), sex (β0.104, P<.0001), presence of hypertension (β0.082, P=.002), diabetes (β0.130, P<.0001) and current smoking (β0.107, P<.0001), systolic blood pressure (SBP) (β0.219, P<.0001) and LDL-cholesterol levels (β0.074, P=.003), and inversely, diastolic blood pressure (DBP) (β-0.124, P=.001), HDL-cholesterol (β-0.111, P<.0001) and triglyceride levels (β-0.060, P=.028). The presence of plaques was directly associated with age (OR1.08; 95%CI: 1.05-1.10), sex (OR1.95; 95%CI: 1.52-2.51), current smoking (OR2.75; 95%CI: 1.92-3.95), history of hypertension (OR1.58; 95%CI: 1.22-2.04) or diabetes (OR1.84; 95%CI: 1.31-2.58), statin treatment (OR1.56; 95%CI: 1.19-2.04) and SBP (OR1.03; 95%CI: 1.02-1.05), and inversely with DBP (OR0.98; 95%CI: 0.96-0.99). CONCLUSION Factors associated with the IMT and the presence of plaques are similar, a finding that support a continuum between muscular layer hypertrophy and arteriosclerosis development.

Cáncer y enfermedad cardiovascular

Survivors of cancer have a shorter survival in the long term partly due to the increase in cardiovascular diseases (CVD). Some chemotherapy drugs, thoracic and cranial radiotherapy and above all the transplantation of hematopoietic cells are associated with an increase in the incidence of cardiovascular events compared with general population. Some of these treatments favor the development of a metabolic syndrome that could be the intermediary between these treatments and the development of CVD. It is recommended for cancer survivors to promote healthy lifestyles and the strict control of cardiovascular risk factors.