To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS).
Observational and ...prospective study of patients admitted for ACS in a single Spanish center during a period of six months.
The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge.
A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6-2.2), neither other components of the panel.
The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis.
To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients.
This is a descriptive, ...cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests.
The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor.
After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.
Summary
Background: There is an increasing interest in the use of non‐invasive methods for the detection of subclinical atherosclerosis to better identify patients with high risk of cardiovascular ...events The presence of diabetes mellitus (DM) and peripheral arterial disease (PAD) is associated with increased risk of events but their value in the acute coronary syndrome (ACS) patient has not been ascertained.
Methods: We performed a subanalysis of the PAMISCA study, designed to investigate the prevalence of PAD in patients admitted to Spanish hospitals with a diagnosis of an ACS.
Results: A total of 1410 patients were analysed (71.4% men, age 66 ± 11.9 years, 35% DM). The prevalence of PAD was higher in DM vs. no‐DM (41.5% vs. 30.6% respectively, p < 0.001). Patients with PAD and DM had more in‐hospital cardiac complications such as atrial fibrillation/flutter, recurrent myocardial ischaemia and heart failure and a trend towards higher in‐hospital mortality (p = 0.08). Non‐DM patients with PAD and DM without PAD shared similar cardiac complications and the group without neither PAD nor DM had the best prognosis. In patients without PAD, DM was an independent predictor of three‐vessel coronary disease (OR 1.6; 95% CI: 1.1–2.5, p < 0.05) after adjustment by age, sex, low density lipoproteins (LDL), smoking and the previous myocardial infarction. However, in PAD patients, DM failed to be an independent risk factor in the multivariate analysis (OR 1.0; 95% CI 0.6–1.6, p < 0.05).
Conclusions: The concurrence of DM and PAD helps identify patients with an adverse risk profile.
El objetivo de este trabajo fue caracterizar y establecer una tipología de sistemas ganaderos de Cotopaxi en el norte de la región Sierra en Ecuador. Los datos fueron recogidos mediante encuestas ...directas a 212 ganaderos y reflejan los principales aspectos técnicos, económicos y productivos de las explotaciones. La tipología fue establecida utilizando técnicas analíticas multivariantes. El análisis de Clusters reveló cuatro agrupamientos. Grupo I, definido como Granjas Pequeñas Familiares (GPF), Grupo II, como Granjas Medianas Familiares (GMF), Grupo III, como Granjas Medianas Familiares Tecnificadas (GMFT) y Grupo IV, como Granjas Muy Pequeñas Familiares (GMPF). Se aplicó un ANAVA. La evaluación indicó diferencias importantes en las explotaciones agrupadas a pesar de que se desarrollan en el mismo entorno agroclimático, operan en los mismos mercados y además, cuentan con información similar, el resultado es un variado universo de situaciones con variaciones relevantes entre sistemas medianos y pequeños por escala y en razón de sus superficies dedicadas a ganadería y a cultivos y sus resultados productivos y de eficiencia medida como ingresos por cada actividad y nivel de gastos.
Abstract Background Our objective were to know whether coronary flow velocity reserve measured by transthoracic Doppler echocardiography, as marker of microvascular integrity, affects the recovery of ...global systolic function. Secondly, we intended to define the best cut-off point of coronary flow velocity reserve to predict recovery of global systolic function. Methods We studied 57 patients with coronary flow recorded by transthoracic Doppler echocardiography, after suffering a first anterior acute myocardial infarction and undergoing a successful primary percutaneous coronary intervention (TIMI 3 flow). We measured, at discharge and at 1 month: ejection fraction, volume indexes and anterior wall motion score index. Coronary flow in left anterior descending artery was detected by transthoracic Doppler echocardiography and coronary flow velocity reserve was calculated. Results After applying ROC curves, 1.54 was the best cut-off value of coronary flow velocity reserve for detection of recovery of global systolic function. Ejection fraction only increased significantly in patients with normal coronary flow velocity reserve. Only end-systolic volume index increased significantly at 1 month in patients with impaired coronary flow velocity reserve. Conclusion We showed that coronary flow velocity reserve, measured by transthoracic Doppler echocardiography, influence the recovery of global systolic function, mainly by ventricular dilation. Furthermore, a quite lower value of coronary flow velocity reserve than that used for diagnostic purpose should be used to predict improvement of systolic function.
Since publication of the Spanish Society of Cardiology Clinical Practice Guidelines on High Blood Pressure in January 2000, a new body of scientific evidence has been obtained that needs to be taken ...into account in clinical practice. A complete clinical evaluation by assessment of the global cardiovascular risk score should be done in patients with hypertension. In this connection, ECG findings and urine albumin excretion are of particular value. Up to now, the results of most important clinical trials indicate that the aim should be to normalize blood pressure, with stricter control in patients at higher risk (diabetes, target organ damage or left ventricular hypertrophy). Antihypertensive therapy should be selected on an individual basis, taking in account that patients with certain associated pathologies will benefit more from particular groups of drugs. Those with diabetes or left ventricular hypertrophy seem to benefit from pharmacological block of the renin-angiotensin system, and patients with heart failure from combined therapy with ACE inhibitors plus beta-blockers.
Naturally occurring or surgically related hormonal deprivation at menopause is associated with cardiovascular and non-cardiovascular complications. Hormonal replacement therapy helps to prevent and ...treat these complications, not only symptoms associated with menopause (which continue to be their major indication) but also bone and cardiovascular related problems. It is well known that oral contraceptive use is one of the most common reversible causes of secondary hypertension. This is, in part, why the use of hormonal replacement therapy has provoked such suspicion among clinicians who have mainly believed that a similar effect on blood pressure would probably occur with the use of hormonal replacement therapy. However, the results of a variety of clinical studies and surveys do not confirm these suspicions. These beneficial effects have to be weighed against the risk of endometrial hyperplasia, endometrial cancer and breast cancer (among other unwanted effects) that could occur when long-term therapy is implemented. If one considers that the overall risk associated with cardiovascular mortality is more than four times higher than the risk associated with gynecological malignancies, even a modest decrease in the cardiovascular risk could easily outweigh other risks and result in an overall improved risk profile in postmenopausal women.
The Influence of diabetes mellitus in the late outcome of coronary stenting remains controversial.
The aim of this study was to determine the late clinical outcome of diabetics in comparison with non ...diabetics and to establish whether there are subgroups of diabetic patients with a greater need for target lesion revascularization.
Two hundred sixteen consecutive patients (74 diabetics; 95 stents in 90 lesions and 142 non diabetics) who had successfully undergone coronary stenting were included in the study and followed over 17.6 +/- 10 months. The clinical events evaluated were target lesion revascularization, death and acute myocardial infarction. Independent predictive variables of target lesion revascularization were studied in both groups of patients.
The diabetic patients presented greater cardiovascular mortality (6.7% vs 1.4%; p=0.02) but the incidence of infarction was similar in the two groups (2.7% vs. 3.5%; p=0.6). The accumulated rate of target lesion revascularization at two years was 18.2% in diabetics vs 13.3% in non diabetics (p=0.09), respectively. The presence of three vessel disease (p=0.014), history of arterial hypertension (=0.011) and residual stenosis > 0% (p=0.005) were specific predictive factors of target lesion revascularization for diabetic patients and together with vessel diameter < 3mm (p<0.001) subgroups of diabetics were independently selected with a significantly greater incidence of target lesion revascularization than the non diabetic patients.
Following coronary stenting, diabetic patients show a greater cardiovascular mortality than non diabetics, but only some subgroups of diabetics (small vessels extensive coronary disease, associated arterial hypertension, residual stenosis) show a significantly greater risk of target lesion revascularization.
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