Xavier Pintó

Fibrates in the secondary prevention of cardiovascular disease (infarction and stroke). Results of a systematic review and meta-analysis of the Cochrane collaboration

Abstract Fibrates are a group of drugs that are known mainly for reducing triglycerides, increasing high density lipoproteins (HDL), and reducing the fraction of small, dense LDL particles. The results of a Cochrane Collaboration study have recently been published on their efficacy and safety in the secondary prevention of severe cardiovascular accidents, including coronary and cerebrovascular disease. The study included randomised clinical trials in which the fibrate was compared with placebo or with no treatment. Clinical trials comparing two different fibrates were excluded. The clinical trials evaluated included a total of 16,112 patients (13 trials). The meta-analysis (including all the trials with fibrates) showed evidence of a protective effect of the fibrates compared with placebo as regards a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin (hazard ration of 0.88, with a 95% confidence interval of 0.83–0.94; in 16,064 individuals included in 12 studies). Thus, the results showed, with a moderate level of evidence, that fibrates could be effective in secondary prevention considering a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin.

Los fibratos en la prevención secundaria de la enfermedad cardiovascular (infarto e ictus). Resultados de una revisión sistemática y metaanálisis de la colaboración Cochrane

Fibrates are a group of drugs that are known mainly for reducing triglycerides, increasing high density lipoproteins (HDL), and reducing the fraction of small, dense LDL particles. The results of a Cochrane Collaboration study have recently been published on their efficacy and safety in the secondary prevention of severe cardiovascular accidents, including coronary and cerebrovascular disease. The study included randomised clinical trials in which the fibrate was compared with placebo or with no treatment. Clinical trials comparing two different fibrates were excluded. The clinical trials evaluated included a total of 16,112 patients (13 trials). The meta-analysis (including all the trials with fibrates) showed evidence of a protective effect of the fibrates compared with placebo as regards a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin (hazard ration of 0.88, with a 95% confidence interval of 0.83 to 0.94; in 16,064 individuals included in 12 studies). Thus, the results showed, with a moderate level of evidence, that fibrates could be effective in secondary prevention considering a compound objective of non-fatal stroke, non-fatal myocardial infarction, and death of cardiovascular origin.

Consenso Delphi sobre el manejo de la dislipidemia en pacientes con alteración del metabolismo de la glucosa: estudio Diana. [Delphi consensus on management of dyslipidaemia in patients with impaired glucose metabolism: Diana study].

OBJECTIVES The aim of the present study was to develop a multidisciplinary consensus based on the Delphi system to establish clinical recommendations for the management of dyslipidaemia when hyperglycaemia is present, and the relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. METHODS The questionnaire developed by the scientific committee included four blocks of questions about dyslipidaemia in patients with impaired glucose metabolism. The results of the first two blocks are presented here: a) management of dyslipidaemia; b) relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. RESULTS Among the 497 experts who participated in the study, an agreement of over 90% was attained for recommending screening for dyslipidaemia in patients with diabetes or pre-diabetes and/or cardiovascular disease or a family history and/or abdominal obesity and/or hypertension. There was a high degree of agreement that a statin is the lipid-lowering treatment of choice, and that it should be switched when side effects develop. Also, the choice of statin and dose should be made according to baseline LDL cholesterol levels, the target to achieve, and the possible drug-drug interactions. CONCLUSIONS The screening of dyslipidaemia is primarily conducted in patients with cardiovascular disease, or any major cardiovascular risk factor. When prescribing a statin, physicians mainly focus on the ability to reduce LDL cholesterol and the risk of drug interactions.

Documento de consenso de la Sociedad Española de Arteriosclerosis sobre las indicaciones de los inhibidores de la PCSK9 [Consensus document of the Spanish Society of Arteriosclerosis on indications of inhibitors of PCSK9]

http://dx.doi.org/10.1016/j.arteri.2016.02.001 0214-9168/© 2016 Publicado por Elsevier España, S.L.U. en nombre de S izadas de forma aislada o asociadas a ezetimiba o resinas, en aquellos sujetos de alto o muy alto riesgo intolerantes estatinas. Las efectos beneficiosos y secundarios tras la admiistración de anticuerpos monoclonales inhibidores de la CSK9 han sido resumidos en un metaanálisis publicado ecientemente1, que incluye más de 10.000 sujetos trataos, en los que se obtuvo una reducción media del colesterol DL de un 50% (entre el 42-66%), tanto en sujetos no trataos previamente, como en los que ya llevaban tratamiento on estatinas. Esta reducción estadísticamente significativa

Importancia del colesterol ligado a lipoproteínas de alta densidad (cHDL) en la prevención del riesgo cardiovascular. Recomendaciones del Foro HDL

Resumen En el abordaje de los factores de riesgo de enfermedad cardiovascular relacionados con los lipidos, los valores sericos de colesterol ligado a lipoproteinas de alta densidad (cHDL) comportan una importancia especial, dado que se considera que esta lipoproteina es un factor antiaterogenico debido principal, pero no exclusivamente, a su influencia e impacto sobre el transporte inverso del colesterol. Se deriva de aqui la necesidad y el requisito de tener en cuenta los valores sericos de cHDL para la prevencion tanto primaria como secundaria en todo paciente con enfermedad cardiovascular. Un aspecto particularmente importante es la asociacion del “sindrome de cHDL bajo” con el sindrome metabolico. Estos factores nos obligan a considerar el valor serico de cHDL como un objetivo terapeutico por si mismo, o incluso en asociacion con las concentraciones de colesterol ligado a lipoproteinas de baja densidad (cLDL), cuando estas ultimas se encuentran elevadas. La presente revision resalta los aspectos que establecen un nexo entre los valores sericos de cHDL y el riesgo cardiovascular, y examina las poblaciones que deberian considerarse susceptibles de intervencion terapeutica debido a valores sericos de cHDL bajos. Se revisan las estrategias terapeuticas, tanto farmacologicas como no farmacologicas. El objetivo de esta revision es exponer recomendaciones de manejo terapeutico para la correccion de la proporcion del riesgo cardiovascular atribuible a cambios en el cHDL. El objetivo terapeutico en prevencion primaria y secundaria debe ser alcanzar valores de cHDL > 40 mg/dl. Esta meta reviste particular importancia en pacientes con valores sericos de cHDL bajo y cardiopatia isquemica (CI) o sus equivalentes, incluso si se han alcanzado los objetivos terapeuticos para las concentraciones sericas de cLDL ( 20%), hipertrigliceridemia, diabetes mellitus tipo 2 o sindrome metabolico.