Lluis Molina

Response of oxidative stress biomarkers to a 16-week aerobic physical activity program, and to acute physical activity, in healthy young men and women.

Physical activity (PA) is associated with a reduced risk of coronary heart disease, and may favorably modify the antioxidant-prooxidant balance. This study assessed the effects of aerobic PA training on antioxidant enzyme activity, oxidized LDL concentration, and LDL resistance to oxidation, as well as the effect of acute PA on antioxidant enzyme activity before and after the training period. Seventeen sedentary healthy young men and women were recruited for 16 weeks of training. The activity of superoxide dismutase in erythrocytes (E-SOD), glutathione peroxidase in whole blood (GSH-Px), and glutathione reductase in plasma (P-GR), and the oxidized LDL concentration and LDL composition, diameter, and resistance to oxidation were determined before and after training. Shortly before and after this training period they also performed a bout of aerobic PA for 30 min. The antioxidant enzyme activity was also determined at 0 min, 30 min, 60 min, 120 min, and 24 h after both bouts of PA. Training induces an increase in GSH-Px (27.7%), P-GR (17.6%), and LDL resistance to oxidation, and a decrease in oxidized LDL (-15.9%). After the bout of PA, an increase in E-SOD and GSH-Px was observed at 0 min, with a posterior decrease in enzyme activity until 30-60 min, and a tendency to recover the basal values at 120 min and 24 h. Training did not modify this global response pattern. Regular PA increases endogenous antioxidant activity and LDL resistance to oxidation, and decreases oxidized LDL concentration; 30 min of aerobic PA decreases P-GR and B-GSH-Px activity in the first 30-60 min with a posterior recovery.

Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study

AIMS The aim of this study is to determine the incidence of lone atrial fibrillation (LAF) in males according to sport practice and to identify possible clinical markers related to LAF among marathon runners. METHODS AND RESULTS A retrospective cohort study was designed. A group of marathon runners (n = 252) and a population-based sample of sedentary men (n = 305) recruited in 1990-92 and 1994-96, respectively, were contacted in 2002-03 and invited to attend an outpatient clinic to identify suggestive symptoms of having experienced an arrhythmia requiring medical attention. In those with suggestive symptoms of atrial fibrillation, medical records were reviewed. Finally, LAF was diagnosed on the basis of the presence of atrial fibrillation in an electrocardiographic recording. In the group of marathon runners, an echocardiogram was performed at inclusion and at the end of the study. The annual incidence rate of LAF among marathon runners and sedentary men was 0.43/100 and 0.11/100, respectively. Endurance sport practice was associated with a higher risk of incident LAF in the multivariate age- and blood pressure-adjusted Cox regression models (hazard ratio = 8.80; 95% confidence interval: 1.26-61.29). In the group of marathon runners, left atrial inferosuperior diameter and left atrial volume were both associated with a higher risk of incident LAF. CONCLUSION Long-term endurance sport practice is associated with a higher risk of symptomatic LAF in men. This risk is associated with a larger left atrial inferosuperior diameter and volume in physically active subjects.

Clinical profile of Trypanosoma cruzi infection in a non-endemic setting: Immigration and Chagas disease in Barcelona (Spain)

BACKGROUND Chagas disease is no longer limited to Latin America and is becoming frequent in industrialised countries in Europe and United States. METHODS A descriptive study of Latin American immigrants in Barcelona attending two centres for imported diseases during a period of 3 years. The main outcome was the identification of Trypanosoma cruzi-infected individuals in a non-endemic country and the characterization of their clinical and epidemiological features. RESULTS A total of 489 Latin American patients participated in the study. Forty-one percent were infected by T. cruzi, and the most frequent country of origin was Bolivia. All T. cruzi infected patients were in chronic stages of infection. 19% of cases had cardiac disorders and 9% had digestive disorders. CONCLUSIONS A high percentage of participants in this study were infected by T. cruzi and various factors were found to be associated to the infection. It is important to improve clinical and epidemiological knowledge of T. cruzi infection in non-endemic countries and to develop appropriate screening and treatment protocols in these settings.

Six-Month Outcome in Patients With Myocardial Infarction Initially Admitted to Tertiary and Nontertiary Hospitals

OBJECTIVES The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. BACKGROUND The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. METHODS A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospitals cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. RESULTS Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. CONCLUSIONS Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.

Relationship of lipid oxidation with subclinical atherosclerosis and 10-year coronary events in general population

OBJECTIVES To assess 1) the association of lipid oxidation biomarkers with 10-year coronary artery disease (CAD) events and subclinical atherosclerosis, and 2) the reclassification capacity of these biomarkers over Framingham-derived CAD risk functions, in a general population. METHODS Within the framework of the REGICOR study, 4782 individuals aged between 25 and 74 years were recruited in a population-based cohort study. Follow-up of the 4042 who met the eligibility criteria was carried out. Plasma, circulating oxidized low-density lipoprotein (oxLDL) and oxLDL antibodies (OLAB) were measured in a random sample of 2793 participants. End-points included fatal and non-fatal acute myocardial infarction (AMI) and angina. Carotid intima-media thickness (IMT) in the highest quintile and ankle-brachial index <0.9 were considered indicators of subclinical atherosclerosis. RESULTS Mean age was 50.0 (13.4) years, and 52.4% were women. There were 103 CAD events (34 myocardial infarction, 43 angina, 26 coronary deaths), and 306 subclinical atherosclerosis cases. Oxidized LDL was independently associated with higher incidence of CAD events (HR = 1.70; 95% Confidence Interval: 1.02-2.84), but not with subclinical atherosclerosis. The net classification index of the Framingham-derived CAD risk function was significantly improved when ox-LDL was included (NRI = 14.67% [4.90; 24.45], P = 0.003). No associations were found between OLAB and clinical or subclinical events. The reference values for oxLDL and OLAB are also provided (percentiles). CONCLUSIONS OxLDL was independently associated with 10-year CAD events but not subclinical atherosclerosis in a general population, and improved the reclassification capacity of Framingham-derived CAD risk functions.

Long-Term Prognosis of First Myocardial Infarction According to the Electrocardiographic Pattern (ST Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction and Non-Classified Myocardial Infarction) and Revascularization Procedures

The aim of this study was to describe differences in the characteristics and short- and long-term prognoses of patients with first acute myocardial infarction (MI) according to the presence of ST-segment elevation or non-ST-segment elevation. From 2001 and 2003, 2,048 patients with first MI were consecutively admitted to 6 participating Spanish hospitals and categorized as having ST-segment elevation MI (STEMI), non-ST-segment elevation MI (NSTEMI), or unclassified MI (pacemaker or left bundle branch block) according to electrocardiographic results at admission. The proportions of female gender, hypercholesterolemia, hypertension, and diabetes were higher among NSTEMI patients than in the STEMI group. NSTEMI 28-day case fatality was lower (2.99% vs 5.26%, p = 0.02). On multivariate analysis, the odds ratio of 28-day case fatality was 2.23 for STEMI patients compared to NSTEMI patients (95% confidence interval 1.29 to 3.83, p = 0.004). The multivariate adjusted 7-year mortality for 28-day survivors was higher in NSTEMI than in STEMI patients (hazard ratio 1.31, 95% confidence interval 1.02 to 1.68, p = 0.035). However, patients with unclassified MI presented the highest short- and long-term mortality (11.8% and 35.4%, respectively). The excess of short-term mortality in unclassified and STEMI patients was mainly observed in those patients not treated with revascularization procedures. In conclusion, patients with first NSTEMI were older and showed a higher proportion of previous coronary risk factors than STEMI patients. NSTEMI patients had lower 28-day case fatality but a worse 7-year mortality rate than STEMI patients. Unclassified MI presented the worst short- and long-term prognosis. These results support the invasive management of patients with acute coronary syndromes to reduce short-term case fatality.

Heart failure in acute ischemic stroke

AbstractBackgroundTo determine the impact of heart failure (HF), with preserved or decreased left ventricular function (LVF), on outcome in patients with acute ischemic stroke (AIS).MethodsWe studied 503 unselected ischemic stroke patients. Poor outcome was defined as moderate-severe disability or death at 90 days. We analyzed the association between poor outcome and HF with preserved LVF or decreased LVF (systolic HF: ejection fraction lower than 50%). We tested this association adjusted by possible confounders in a logistic regression model.Results89 patients (17.7 %) had HF; 49 patients (9.7%) with systolic HF, and 40 (8%) patients with HF and preserved LVF. HF with preserved LVF patients were older [79.4 (7.9) vs. 74.3 (10.4), p = 0.013],more likely to be women [p < 0.001,OR = 8.61, 95% CI (3.3–22.6)], and with lower current smoking habits [p = 0.018, OR = 8.77 (1.1–72.6)] than patients with systolic HF. 151 patients (30 %) had poor outcome. We found an independent association with initial stroke severity, systolic HF (adjusted OR = 3.01), HF with preserved LVF (adjusted OR = 2.52), thrombolytic treatment, statin pre-treatment (as protectors) and poor outcome.ConclusionBoth forms of HF (with or without decreased systolic function) are associated with poor outcome in AIS.

Evolución de la mortalidad intrahospitalaria y el pronóstico a seis meses de los pacientes con un primer infarto agudo de miocardio. Cambios en la última década

Introduccion y objetivos. El tratamiento del infarto agudo de miocardio (IAM) ha cambiado considerablemente en los ultimos anos. El objetivo es determinar la evolucion de la mortalidad intrahospitalaria y del pronostico a 6 meses de los pacientes que ingresan con un primer IAM en dos registros realizados en 1992-1994 y 2001-2003. Metodos. Entre 1992 y 1994, ingresaron consecutivamente 1.440 pacientes con un primer IAM en cuatro hospitales universitarios (RESCATE I). Entre 2001 y 2003, ingresaron en los mismos centros 1.288 pacientes con un primer IAM con los mismos criterios diagnosticos (RESCATE II). Se compara el manejo clinico, la mortalidad hospitalaria y el pronostico y la evolucion a 6 meses entre estos dos registros. Resultados. Se realizo reperfusion en el 60,7% de los pacientes del primer registro y en el 72,6% del segundo (p < 0,001). En el RESCATE II, se redujo la mediana de tiempo puerta-aguja (41 frente a 93 min; p < 0,001), se realizaron mas coronariografias (el 65,2 frente al 28,1%; p < 0,001) y revascularizaciones (el 34,9 frente al 8,1%; p < 0,001). La mortalidad hospitalaria disminuyo en el RESCATE II (el 7,5 frente al 10,9%; p < 0,001). Al ajustar por edad, sexo, comorbilidad, gravedad del IAM y terapia de reperfusion, la odds ratio de mortalidad hospitalaria del RESCATE II, comparada con el primer registro, fue 0,52 (intervalo de confianza del 95%, 0,31-0,86). En el RESCATE II tambien disminuyo la mortalidad (el 1,4 frente al 3,6%; p = 0,001) y el reingreso a 6 meses. Conclusiones. La mortalidad intrahospitalaria y a 6 meses de los pacientes con un primer IAM ha disminuido en la ultima decada, probablemente debido a que se reperfunde y se revasculariza mas y al mejor tratamiento medico.

LDL oxidada, lipoproteína(a) y otros factores de riesgo emergentes en el infarto agudo de miocardio (estudio FORTIAM)

Introduccion y objetivos. Determinar la prevalencia de pacientes que sufren un infarto agudo de miocardio (IAM) sin factores de riesgo (FR) clasicos, si presentan una mayor prevalencia de FR emergentes y si algun FR emergente modifica el pronostico a 6 meses. Metodos. FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) es un estudio multicentrico de cohortes de 1.371 pacientes que sufrieron un IAM e ingresaron en las primeras 24 h. Se utilizaron definiciones estrictas para los FR clasicos y se determinaron: lipoproteina (a) [Lp(a)], lipoproteina de baja densidad oxidada (LDLox), proteina C reactiva ultrasensible, fibrinogeno, homocisteina y anticuerpos anticlamidia. Los acontecimientos de interes a 6 meses fueron: muerte, angina o reIAM. Resultados. La prevalencia de pacientes con IAM sin FR clasicos fue del 8%. La ausencia de FR clasicos no afecto al pronostico a 6 meses. Lp(a) y LDLox fueron los unicos FR emergentes que de forma independiente se asociaron a un peor pronostico. Puntos de corte (suavizacion con splines): 60 mg/dl para Lp(a) y 74 U/l para LDLox. La hazard ratio ajustada por edad, sexo y FR clasicos, 1,40 (intervalo de confianza [IC] del 95%, 1,06-1,84) y 1,48 (IC del 95%, 1,06-2,06) respectivamente. Conclusiones. La proporcion de pacientes con un IAM sin FR clasicos es baja y su pronostico es similar al resto de pacientes con IAM. LDLox y de Lp(a) se asociaron a un peor pronostico a 6 meses de forma independientemente de los FR clasicos.

Usefulness of hospital admission risk stratification for predicting nonfatal acute myocardial infarction or death six months later in unstable angina pectoris

The aim of this study was to assess the clinical course of unstable angina and the prognostic value of clinical and electrocardiographic variables measured during admission in a prospective, multicenter cohort study with 6-month follow-up. The population corresponds to 4 general teaching hospitals in Catalonia, Spain. The clinical course was analyzed in 839 consecutive patients aged up to 80 years with primary unstable angina, without myocardial infarction or previous coronary bypass. The main outcome measures were cardiac mortality and nonfatal myocardial infarction. Patients involved in the present analysis belonged to the Resources Used in Acute Coronary Syndromes and Delays in Treatment (RESCATE) study. Six-month overall mortality, cardiac mortality, and nonfatal myocardial infarction rates were 4.6%, 4.1%, and 3.9%, respectively. Six-month cardiac mortality or myocardial infarction rate did not differ among clinical forms of presentation. Peripheral artery disease (RR 3.5, 95% confidence interval [CI] 1.88 to 6.50, p = 0.0001), ST-T-wave electrocardiographic changes on admission (RR 2.22, 95% CI 1.13 to 4.36, p = 0.0203), and age >65 years (RR 1.74, 95% CI 1.04 to 2.91, p = 0.0356) independently predicted 6-month cardiac mortality or nonfatal myocardial infarction. Their positive predictive values were 21%, 10%, and 11%, respectively, whereas their negative predictive value was > or = 93% in all cases. Prevalences were 9%, 70%, and 41%, respectively. In this prospective study, patients with unstable angina without prior myocardial infarction have a relatively low, although not negligible, 6-month severe complication rate. Stratification risk can easily be established with clinical and electrocardiographic characteristics measured during admission. Their absence almost rules out future adverse events, while their presence does not necessarily imply bad prognosis.