Lipoprotein(a) (Lp(a)) is increasingly used in the evaluation of patients with vascular risk due to its association with cardiovascular events. The purpose of this study was to identify the clinical ...characteristics of patients with elevated levels of Lp(a) attended in an outpatient vascular risk unit.
An observational, retrospective study was conducted to assess the clinical characteristics of patients with elevated levels of Lp(a) (≥50 mg/dL), as compared to patients with normal values (<50 mg/dL). The sample was composed of 878 patients identified as having a high vascular risk due to a diagnosis of vascular disease, attended in a vascular risk unit between 2021 and 2022.
The highest levels of Lp(a) were independently associated with a higher probability of having a history of peripheral arterial disease (p=0.024), polygenic familial hypercholesterolemia (PH, p=0.030) and combined familial hypercholesterolemia (CFH, p=0.015); and using PCSK9 inhibitor treatment (p=0.029) and combination therapy with statins and ezetimibe (p=0.018). In contrast, there were no significant differences in relation to familial history of early cardiovascular disease (p=0.143) or personal history of cardiovascular disease (p=0.063), which contrasts with other series.
Elevated levels of Lp(a) were associated with a history of peripheral arterial disease, diagnosis of FHP and CFH, and need for more intense lipid-lowering treatments.
Resumen
Objectivos
La lipoproteína(a) (Lp(a)) es cada vez más relevante en la evaluación de pacientes con riesgo vascular debido a su asociación con una mayor incidencia de eventos cardiovasculares. ...Este estudio tiene como objetivo identificar las características clínicas de los pacientes con niveles elevados de Lp(a) atendidos en consultas externas por riesgo vascular.
Métodos
Estudio observacional retrospectivo en donde se compararon las características clínicas de los pacientes con niveles elevados de Lp(a) (≥50 mg/dL) con la de los pacientes con valores normales (<50 mg/dL), en un total de 878 pacientes atendidos por riesgo o enfermedad vascular durante los años 2021 y 2022.
Resultados
Los valores más elevados de Lp(a) se asociaron de forma independiente con una mayor probabilidad de antecedentes de enfermedad arterial periférica (p=0,024), hipercolesterolemia familiar poligénica (HFP, p=0,030) e hipercolesterolemia familiar combinada (HFC, p=0,015), el tratamiento de inhibidores de PCSK9 (p=0,029) y la combinación de estatinas y ezetimiba (p=0,018). Sin embargo, no se obtuvieron diferencias significativas para las variables antecedentes familiares de enfermedad cardiovascular precoz (p=0,143) ni para antecedentes de enfermedad cardiovascular previa (p=0,063) a diferencia de lo identificado en otras series.
Conclusiones
Los niveles elevados de Lp(a) se asociaron con antecedentes de enfermedad arterial periférica, diagnóstico de HFP y HFC, así como con la necesidad de utilizar tratamientos hipolipemiantes más intensos.
In-hospital care of chronic patients is based on their characteristics and risk levels. Adjusted morbidity groups (AMG) is a population stratification tool which is currently being used in Primary ...Care but not in Hospitals. The objectives of this study were to describe the use of hospital services by chronic patients according to their risk levels assigned by AMG and to analyze influencing variables.
In this cross-sectional study, patients aged ≥18 years from a healthcare service area classified as chronically ill by the AMG classification system who used their referral hospital services from June 2015 to June 2016 were included. Predisposing and needs factors were collected. Univariate, bivariate and multiple linear regressions were performed.
Of the 9,443 chronic patients identified (52.1% of the population in the selected area), 4,143 (43.9%) used hospital care services. Their mean age was 62.1 years (standard deviation (SD) = 18.4); 61.8% were female; 9% were high risk; 30% were medium risk, and 61% were low risk. The mean number of hospital service contacts was 5.0 (SD = 6.2), with 3.8 (SD = 4.3) visits to outpatient clinic, 0.7 (SD = 1.2) visits to emergency departments, 0.3 (SD = 2.8) visits to day hospital, and 0.2 (SD = 0.5) hospitalizations. The factors associated with greater service use were predisposing factors such as age (coefficient B (CB) = 0.03; 95% confidence interval (CI) = 0.01-0.05) and Spanish origin (CB = 3.9; 95% CI = 3.2-4.6). Among the needs factors were palliative care (CB = 4.8; 95% CI = 2.8-6.7), primary caregiver status (CB = 2.3; 95% CI = 0.7-3.9), a high risk level (CB = 2.9; 95% CI = 2.1-3.6), multimorbidity (CB = 0.8, 95% CI = 0.4-1.3), chronic obstructive pulmonary disease (COPD) (CB = 1.5, 95% CI = 0.8-2.3), depression (CB = 0.8, 95% CI = 0.3-1.3), active cancer (CB = 4.4, 95% CI = 3.7-5.1), and polymedication (CB = 1.1, 95% CI = 0.5-1.7).
The use of hospital services by chronic patients was high and increased with the risk level assigned by the AMG. The most frequent type of contact was outpatient consultation. Use was increased with predisposing factors such as age and geographic origin and by needs factors such as multimorbidity, risk level and severe diseases requiring follow-up, home care, and palliative care.
A large variation in seed coat colors and seed phenolic metabolites is present in common bean (Phaseolus vulgaris L.). The study of the relationships between seed coat color phenotype and the ...phenolic profile is an important step in the elucidation of the gene network involved in the phenylpropanoid biosynthetic pathway. However, this relationship is still poorly understood in this species.
A genome-wide association study (GWAS) was used to investigate the genomic regions associated with the synthesis of 10 flavonoids (5 anthocyanins and 5 flavonols) and with 10 seed coat color traits using a set of 308 common bean lines of the Spanish Diversity Panel (SDP) which have been genotyped with 11,763 SNP markers.. A total of 31 significant SNP-trait associations (QTNs) were identified, grouped in 20 chromosome regions: 6 for phenolic metabolites on chromosomes Pv01, Pv02, Pv04, Pv08, and Pv09, 13 for seed coat color on chromosomes Pv01, Pv02, Pv06, Pv07, and Pv10, and 1 including both types of traits located on chromosome Pv08. In all, 58 candidate genes underlying these regions have been proposed, 31 of them previously described in the phenylpropanoid pathway in common bean, and 27 of them newly proposed in this work based on the association study and their homology with Arabidopsis anthocyanin genes.
Chromosome Pv08 was identified as the main chromosome involved in the phenylpropanoid pathway and in consequence in the common bean seed pigmentation, with three independent chromosome regions identified, Phe/C_Pv08(2.7) (expanding from 2.71 to 4.04 Mbp), C_Pv08(5.8) (5.89-6.59 Mbp), and Phe_Pv08(62.5) (62.58 to 63.28 Mbp). Candidate genes previously proposed by other authors for the color genes V and P were validated in this GWAS. Candidate genes have been tentatively proposed from this study for color genes B and Rk on Pv02, Asp on Pv07, and complex C on Pv08. These results help to clarify the complex network of genes involved in the genetic control of phenolic compounds and seed color in common bean and provide the opportunity for future validation studies.
Cardiovascular (CV) polypills are a useful baseline treatment to prevent CV diseases by combining different drug classes in a single pill to simultaneously target more than one risk factor. The aim ...of the present trial was to determine whether the treatment with the CNIC-polypill was at least non-inferior to usual care in terms of low-density lipoprotein cholesterol (LDL-c) and systolic BP (SBP) values in subjects at high or very high risk without a previous CV event.
The VULCANO was an international, multicentre open-label trial involving 492 participants recruited from hospital clinics or primary care centres. Patients were randomised to the CNIC-polypill -containing aspirin, atorvastatin, and ramipril- or usual care. The primary outcome was the comparison of the mean change in LDL-c and SBP values after 16 weeks of treatment between treatment groups.
The upper confidence limit of the mean change in LDL-c between treatments was below the prespecified margin (10 mg/dL) and above zero, and non-inferiority and superiority of the CNIC-polypill (p = 0.0001) was reached. There were no significant differences in SBP between groups. However, the upper confidence limit crossed the prespecified non-inferiority margin of 3 mm Hg. Significant differences favoured the CNIC-polypill in reducing total cholesterol (p = 0.0004) and non-high-density lipoprotein cholesterol levels (p = 0.0017). There were no reports of major bleeding episodes. The frequency of non-serious gastrointestinal disorders was more frequent in the CNIC-polypill arm.
The switch from conventional treatment to the CNIC-polypill approach was safe and appears a reasonable strategy to control risk factors and prevent CVD. Trial registration This trial was registered in the EU Clinical Trials Register (EudraCT) the 20th February 2017 (register number 2016-004015-13; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2016-004015-13 ).
Unless contraindicated, anticoagulant therapy should be prescribed to elderly patients with atrial fibrillation. Direct-acting oral anticoagulants (DOACs) are superior to vitamin K antagonists for ...preventing stroke. This, together with their higher net clinical benefit, makes DOACs the treatment of choice in this population. However, due to the concerns about bleeding and the need for dose adjustment based on clinical variables, underdosing of DOACs is common and the risk of stroke high. Drugs with more easily adjusted doses are likely associated with a lower risk of dosing errors and, therefore, a greater protective effect. Correct dosing can ensure a maximal net benefit of DOACs in elderly patients with atrial fibrillation.
Background
There is still debate regarding the principal role and ideal timing of perioperative chemotherapy (CTx) for patients with upfront resectable colorectal liver metastases (CRLM). This study ...assesses long-term oncological outcomes in patients receiving neoadjuvant CTx only versus those receiving neoadjuvant combined with adjuvant therapy (perioperative CTx).
Methods
International multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010 and 2015. Characteristics and outcomes were compared before and after propensity score matching (PSM). Primary endpoints were long-term oncological outcomes, such as recurrence-free survival (RFS) and overall survival (OS). Furthermore, stratification by the tumour burden score (TBS) was applied.
Results
Of 967 patients undergoing hepatectomy, 252 were analysed, with a median follow-up of 45 months. The unmatched comparison revealed a bias towards patients with neoadjuvant CTx presenting with more high-risk patients (
p
= 0.045) and experiencing increased postoperative complications ≥Clavien-Dindo III (20.9% vs. 8%,
p
= 0.003). Multivariable analysis showed that perioperative CTx was associated with significantly improved RFS (hazard ratio HR 0.579, 95% confidence interval CI 0.420–0.800,
p
= 0.001) and OS (HR 0.579, 95% CI 0.403–0.834,
p
= 0.003). After PSM (
n
= 180 patients), the two groups were comparable regarding baseline characteristics. The perioperative CTx group presented with a significantly prolonged RFS (HR 0.53, 95% CI 0.37–0.76,
p
= 0.007) and OS (HR 0.58, 95% CI 0.38–0.87,
p
= 0.010) in both low and high TBS patients.
Conclusions
When patients after resection of CRLM are able to tolerate additional postoperative CTx, a perioperative strategy demonstrates increased RFS and OS in comparison with neoadjuvant CTx only in both low and high-risk situations.
Hypertension is one of the main cardiovascular risk factors. In the elderly, the most common form is isolated systolic hypertension, a consequence of the increase in arterial stiffness. None of the ...antihypertensives currently used affects arterial stiffness, whereas nitrates seem to have an effect. The aim of this work was to assess their effect on elderly patients with uncontrolled isolated systolic hypertension, defined as systolic blood pressure over 140 mmHg and diastolic blood pressure under 90 mmHg. The present study is a phase III, randomized, multicenter, double-blind, placebo-controlled clinical trial, conducted at the University Hospital La Princesa in Madrid. Patients of both sexes, aged 65 years or older, with poorly controlled isolated systolic hypertension, were treated with 40-60 mg of sustained-release isosorbide mononitrate or matching placebo for 12 weeks. The main objective was to assess the effect on clinical pulse pressure (PP); in addition, its effect on vascular function was evaluated. Analysis was performed by intention to treat. The study was registered at the European Union Clinical Trials Register (EUDRACT 2012-002988-10) and was funded by the Spanish Ministry of Health. A total of 58 patients with an average age of 77 years were enrolled, 32 were treated with nitrate, and 26 with placebo. No significant differences were found either in PP decline (5.28 vs 7.49 mmHg, p = 0.79) or in other variables, including parameters of vascular function. There were no differences in adverse events. The results of this study have not confirmed the benefit of nitrate treatment in isolated systolic hypertension or the improvement of vascular function.
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