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Introduction: Statins are used with the understanding that a slightly increased risk of diabetes is outweighed by their cardiovascular benefits. However, it may be necessary to reconsider whether statin therapy really increase this risk mainly in the population with prediabetes., Methods: A multicenter, cross-sectional, observational study was conducted to assess the relationship between statin therapy and glucose metabolism in 407 patients aged 63.1 years (11SD) diagnosed with dyslipidemia and prediabetes treated in specialized lipid clinics in Spain., Results: Significant differences were found in HbA1c values among treatment groups (p=0.015). Patients treated with pitavastatin (1-4mg/day) showed the lowest HbA1c levels, with significant differences compared to patients treated with atorvastatin 40-80mg/day (p=0.016) and simvastatin 10-40mg/day (p=0.036). By contrast, patients treated with atorvastatin 40-80mg/day showed the highest HbA1c levels compared to those receiving atorvastatin 10-20mg/day (p=0.003), pitavastatin 1-4mg/day (p=0.016), pravastatin 20-40mg/day (p=0.027), rosuvastatin 5-10mg/day (p=0.043), and no statin treatment (p=0.004). Patients treated with simvastatin 10-40mg/day also had higher values than those treated with atorvastatin 10-20mg/day (p=0.016) and pitavastatin 1-4mg/day (p=0.036) or with no statin treatment (p=0.018)., Conclusions: This study suggests that there are differences in the diabetogenic effect of statins. Simvastatin and high doses of atorvastatin may be associated with greater impairment in glucose metabolism than pitavastatin and other statins with less lipid-lowering potency such as pravastatin., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The benefit of secondary prevention of ischaemic heart disease in terms of mortality in people of advanced age has not been well demonstrated. In this study we analyse the relationship of all-cause mortality with meeting the objectives of secondary prevention of ischaemic heart disease in elderly patients., Methods: An observational study of a sample of 106 patients ≥70 with a history of acute coronary syndrome in the previous year. We analysed the association between meeting the objectives of secondary prevention of ischaemic heart disease and global mortality at 3 years., Results: During the 3 years of follow-up, 15.1% of the patients died. Control of LDL cholesterol was associated with lower mortality (HR=.08 [.01-.61], p=.014). By contrast, strict control of blood pressure was associated with a tendency towards higher mortality (HR=3.2 [.9-11.47], p=.073)., Conclusion: Control of LDL cholesterol in the elderly population with ischaemic heart disease is the single therapeutic objective that can have a favourable effect on medium-term survival., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the effect of an intervention with a Mediterranean diet supplemented with either extra virgin olive oil or nuts, on the fatty liver index (FLI), compared to a low-fat control diet., Methods: Participants of the PREDIMED-Malaga trial, free from cardiovascular disease at baseline, but with a high risk to develop it, were included in this study. Anthropometric measurements were assessed and blood samples were taken to calculate participants' FLI at study baseline and after one, 3, 5 and 6 years. Mixed linear models were used to explore the fixed effects of the 3 intervention groups on the FLI as well as their interaction with time., Results: A total of 276 participants were included in the study. Average participant age was 67 years, with 66% of participants being women. The baseline prevalence of NAFL was 57%. The change in the FLI of the control group increased significantly over time (1.13±0.41; P=.006). In the MedDiet+EVOO group, the time trend of the change in the FLI was similar to that of the control group, although it was seen to be lower (-3.90±1.9; P=.038). In the MedDiet+Nuts group, the trend was significantly lower than that of the control group (-1.63±0.62; P=.009). In the MedDiet+Nuts group, the trend of changes in participants' BMI was 0.100 points lower per year compared to the control group (P=.004). In the control group, the change in waist circumference increased significantly over time (0.61±0.16cm/year; P<.001) in contrast to the MedDiet+EVOO group, in which this variable remained stable (-0.51±0.22; P=.019)., Conclusions: A dietary intervention consisting of a Mediterranean diet could delay or slow down the natural progression of NAFL, thus, being beneficial for its prevention and treatment. However, further studies supporting these conclusions have yet to be carried out., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

An elevated proportion of high cardiovascular risk patients do not achieve the therapeutic c-LDL goals. This owes to physicians' inappropriate or insufficient use of cholesterol lowering medications or to patients' bad tolerance or therapeutic compliance. Another cause is an insufficient efficacy of current cholesterol lowering drugs including statins and ezetimibe. In addition, proprotein convertase subtilisin kexin type 9 inhibitors are a new cholesterol lowering medications showing safety and high efficacy to reduce c-LDL in numerous already performed or underway clinical trials, potentially allowing an optimal control of hypercholesterolemia in most patients. Agents inhibiting apolipoprotein B synthesis and microsomal transfer protein are also providing a new potential to decrease cholesterol in patients with severe hypercholesterolemia and in particular in homozygote familial hypercholesterolemia. Last, cholesteryl ester transfer protein inhibitors have shown powerful effects on c-HDL and c-LDL, although their efficacy in cardiovascular prevention and safety has not been demonstrated yet. We provide in this article an overview of the main characteristics of therapeutic agents for hypercholesterolemia, which have been recently approved or in an advanced research stage., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: In this paper we analyze the lipid profile of a cohort of patients attended in different tertiary hospitals with acute coronary syndrome (angor pectoris or acute myocardial infarction)., Patients and Methods: We have analysed different variables of patients with acute coronary syndrome, related with the prevalence and grade of main cardiovascular risk factors, and related with different treatments. We have analysed the lipid profile, and stratified the results according with the status of the first acute coronary event or recurrent coronary event., Results: Patients with recurrent disease showed lower levels of total cholesterol and LDL-c, and similar levels of HDL-c and triglycerides in relation with patients with a first event., Conclusions: We found similar HDL-c and triglycerides levels in both groups of patients meaning that, despite a standard statins treatment, patients with a first coronary event did not modify such a lipid profile. It is necessary to do a more intensive therapeutic effort over all the lipid fractions with the aim to reduce the recurrences of coronary events., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: to show clinical features of subjects with hypertriglyceridemia (HTG) referred to the Lipid Units associated to Spanish Arteriosclerosis Society (ULSEA)., Patients and Method: it is a prospective, cross-sectional, multicentric study of patients with serum Tgs > 200mg/dL, recruited from January 2007 to December 2008. Demographic, drug therapies, anthropometrical, main diagnosis and biochemical parameters were registered., Results: We included 1,033 men and 361 women, 50±12 years-old. Vascular disease, smoking, alcohol intake and liver steatosis were more prevalent in men than in women; by contrast, hypertension, diabetes and abdominal obesity were they in women. Regular physical exercise and a healthy diet were kept sparsely. Most patients suffered from a primary HTG (54%), mainly familial combined hyperlipidemia or familial hypertriglyceridemia. Obesity, alcohol intake and diabetes were the most common secondary forms of HTG. Among patients, 27% were diet-only treated, 44% received drugs in monotherapy and 24% drugs in combinations., Conclusions: Although primary forms of HTG are common, we show here a high prevalence of secondary forms and conditions worsening the HTG, being smoking and alcohol intake in men and abdominal obesity and diabetes in women. Even though most patients are drug-treated, diet and regular exercise recommendations should be clearly improved., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Hypertriglyceridemia constitutes an independent risk factor for coronary disease. The gene apolipoprotein A5 (ApoA5) is a newly discovered member in the ApoA1/C3/A4/A5 cluster, and its product, apolipoprotein A5, influences on triglycerides through an unknown mechanism. Recently, there have been described the clinical consequences and the functional effects over more than 10 variants of the ApoA5 gene, associated with atherosclerosis. In different studies carried out in different ethnic groups, it has been observed a great variation in the distribution of the ApoA5 genotypes for the respective polymorphisms. Different authors have described associations among the ApoA5 gene, high triglyceride concentrations and an increase in the cardiovascular risk. In this context, the ApoA5 gene is considered as a probable biochemical and genetic marker of increased triglyceride concentrations and also a risk factor of coronary disease in some populations.

Background and Objective: APOE genotype has been shown to have an influence on lipid concentrations. However, its relation with response to lipid-lowering treatment is not well established. The aim of our work was to analyze whether this genotype is associated with changes in the lipid profile in response to statins treatment., Patients and Method: A total of 222 consecutive patients with acute ischemic episodes and subjected to treatment with statins were included in a retrospective study. The patients' lipid profile was determined at the first visit to the Lipids Unit and after one year on a statin regime. APOE genotypes were determined by PCR-RFLP, and separated in three groups: E2 (E2 carriers), E4 (E4 carriers) and E3 (E3/E3). E2/E4 patients were not included in the study., Results: Relative frequencies of alleles epsilon2, epsilon3 and epsilon4 were 10.5%, 70.9% and 18.6% respectively. Significant differences among groups (p = 0.039) were observed for c-LDL concentrations. E2 group had lower c-LDL than E3 group (p = 0.017) and E4 group (p = 0.01). No significant differences in c-LDL, c-HDL and c-HDL/CT were observed among the three groups with regard to variation after statin treatment., Conclusion: APOE genotype does not significantly affect the lipid response in patients with acute ischemic episodes after statin treatment.

Background and Objective: High cholesterol levels might contribute to the presence of albuminuria. The objective of our study was to evaluate the influence of lipid levels on the development of incipient diabetic nephropathy. Secondary objectives were to evaluate the effects of diabetes control, high blood pressure, age, sex, years of diabetes evolution, body mass index and smoking., Patients and Method: 930 subjects were enrolled in an open observational prospective cohort study of subjects with type 2 diabetes mellitus and high cholesterol levels (ESODIAH study) for 2 years. In our nephropathy study we selected 590 patients who had albuminuria measurements done. In every 4-month interval visit we made a clinical evaluation and blood analysis including HbA1c, lipid profile and microalbuminuria. Statistical analysis included t-Student, chi2 test, and binary logistic regressions., Results: 51.7% men, aged 62.08 years of age and with an evolution of their diabetes of 8.49 years were studied. 40.6% had microalbuminuria and 59.4% had normoalbuminuria. High HbA1c correlated with the presence of albuminuria (odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.12-1.55; p = 0.001). The development of microalbuminuria was more frequent in younger (OR = 0.93; 95% CI, 0.89-0.98), smoker (OR = 3.19; 95% CI, 1.02-9.96), subjects with high systolic blood pressure (OR = 1.02; 95% CI, 1-1.05). Total cholesterol levels at the end of the study were higher in new microalbuminuric (group I) than normoalbuminuric patients (group II) (group I: 211.08 [34.75] mg/dl vs group II: 200.67 [30.50]; p = 0.042)., Conclusions: Tobacco, blood pressure and diabetes control influences the presence and development of microalbuminuria. More studies are required to study the influence of hypercholesterolemia.

Background and Objective: Lipid therapeutic goals are not achieved in a high percentage of patients with coronary artery disease (CAD). We describe in this paper the methodology and results of the Hospital Universitario de Bellvitge Atherosclerosis Secondary Preventive Program (PPSHB), which is aimed at preventing ischemic recurrences by controlling atherogenic factors., Patients and Method: From January 1992 to December 1996, 882 patients with acute CAD entered the PPSHB and were seen on at least 2 occasions at the Unidad de Lípidos y Arteriosclerosis during a mean period of 10.4 (3.8) months. In 753 patients data on clinical follow-up were available. Follow-up data were collected by telephone interview and review of medical records., Results: During the follow-up period at the Unidad de Lípidos y Arteriosclerosis, 71.9% of patients achieved the therapeutic goals or their LDLc improved >= 15%. These results were seen in 83.6%, 78.7% and 83.6% of patients with regard to HDLc, triglycerides and HDLc/LDLc ratio, respectively, while the percentage of patients receiving lipid-lowering drugs increased from 28% to 69%. During a follow-up of 33.7 (15.9) months, death (all causes; mean survival time: 20 [13.4] months) occurred in 41 patients (5.4%). On the other hand, hospitalization for cardiovascular disease was required in 113 patients (15%) during a mean follow-up until the first admission of 18.4 (14.2) months. The main independent predictor of unfavourable clinical course was not to reach the HDLc/LDLc ratio goal (HDLc/LDLc >= 0.27 or an increase >= 15%; OR = 2.1; 95% CI, 1.1-4.03)., Conclusions: A systematic secondary preventive strategy may help achieve an adequate control of dyslipidemia in most CAD patients. In these patients, achieving the HDLc/LDLc therapeutic goal is associated with a less than half risk of hospitalization for cardiovascular disease or death from any cause.

Background: The role of lipoproteins as markers of peripheral arterial disease (PAD) is not well defined., Methods: We measured both lipid and non-lipid risk factors in 51 male patients with angiographically proven PAD and in 56 control subjects. The independent association of risk factors with PAD was evaluated by means of a multiple logistic regression analysis., Results: The levels of cholesterol bound to high density lipoprotein (HDLc) and to its subfraction HDL2 were lower and triglycerides were higher in patients than in control subjects (1.0 +/- 0.3 vs 1.2 +/- 0.3, p < 0.003; 0.4 +/- 0.2 vs 0.5 +/- 0.3, p < 0.03; and 1.8 +/- 1.2 vs 1.3 +/- 0.7, p < 0.02, respectively). Total cholesterol and LDLc levels were similar in both groups. In the multiple logistic regression analysis that was done with lipid parameters, a statistically significant association of triglycerides (OR = 1.73; CI95% = 1.06-2.80) and HDLc (OR = 0.15; CI95% = 0.05-0.50) with PAD was observed, while HDL subfractions and apolipoproteins were not significantly associated. In the multiple logistic regression analysis that was done with non-lipid parameters, hypertension (OR = 5.35; CI95% = 1.86-15.4) and smoking (packs-year) (OR = 1.04; CI95% = 1.10-1.06) were the only significantly associated with PAD. When lipid and non-lipid parameters were included in the regression analysis, a statistically significant association between hypertension, smoking and HDLc with PAD was observed., Conclusions: Among lipid risk factors, a low HDLc and high triglycerides, and among non-lipid risk factors hypertension and smoking, are significantly and independently associated with lower limb arteriopathy.

Background: In May 1989 and June 1990, consensus conferences of treatment of hypertension and hypercholesterolemia respectively were held in Spain, at the General Division of Health Planning from the Ministry of Health. The objective of this article is to assess the effect of such conferences of physicians' knowledge, attitudes and practices., Subjects and Methods: Cross-sectional telephone survey was carried out in physicians of general medicine, family practice, internal medicine and cardiology specialties. 807 physicians were selected, 347 family physicians, 177 general practitioners, 156 cardiologists and 128 internists. A questionnaire of 30 items was designed to obtain information about demographic and professional characteristics, knowledge of the consensus conferences and attitudes related to a case of an otherwise healthy asymptomatic 48-years-old man., Results: The response rate was 57% (463 physicians), and 60% of physicians had knowledge about the conferences, being general practitioners the ones who had less knowledge of the conferences. The items about recommendations of diet and pharmacological treatment were property answered (about 50% of the physicians answered correctly). The mean of serum cholesterol when diet and drugs are recommended was 232 mg/dl (SD 23) (6.01 mmol/l) and 260 mg/dl (SD 25) (6.7 mmol/l) respectively. The first-choice cholesterol lowering drugs were statines. A patient was considered as hypertensive it the mean of systolic blood pressure was 149 mmHg (9.4) and the mean for diastolic blood pressure was 92 mmHg (3.8). The mean of diastolic blood pressure considered for drug treatment was 96.7 mmHg (SD 4.6). The first-choice antihypertensive drugs were angiotensin conversive enzyme inhibitors., Conclusions: Diffusion of the conferences has been unequal, being general practitioners less knowledgeable about the content of the conferences. Although physicians know reasonably well the recommendations about diet and drug treatments, the attitude in practice is more aggressive than recommended. Globally, the knowledge of the contents of the conferences was acceptable, although there were differences between specialties; however the effect on clinical practice is still low.

Background: The distribution of serum fibrinogen levels and factor VII in a population of dyslipemic women and their association with other cardiovascular risk factors are herein described., Methods: Dyslipemic women between 40-70-years of age without cardiovascular disease and with no hypolipemic treatment who attended 21 primary health care consultations were studied. The following data were collected in a questionnaire: smoking habit, high blood pressure, alcohol consumption and menopause. The analytical parameters determined were: total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, fibrinogen and factor VII. The Pearson correlation coefficient was determined to evaluate the association of fibrinogen and factor VII with other cardiovascular risk factors., Results: Serum fibrinogen levels correlated positively with LDL-cholesterol and with the body mass index and negatively with HDL-cholesterol. Factor VII correlated positively with the triglycerides and total cholesterol. No significant differences were observed in the hematic factors among the hypertensive women and those who were not hypertensive. The same was observed in diabetic and in the pre- and postmenopausal women., Conclusions: In this transversal study a relationship was found between serum fibrinogen level and factor VII activity and other known cardiovascular risk factors.

Background: The aims of this study were to estimate the number of people who should receive some intervention (pharmacologic and/or dietetic) to reduce cholesterol concentrations and to evaluate selective case finding in comparison to opportunistic detection., Methods: Six hundred twenty-five individuals participating in a study of cardiovascular risk factors were included in the study. Those with total cholesterol concentrations (TC) greater than 6.2 mmol/l and those with CT concentrations greater than 5.2 mmol/l observed upon lipid profile analysis and history of cardiovascular disease and/or risk factors were considered as candidates. Out of these individuals, those with cholesterol concentrations linked to low density lipoproteins greater than 4.14 mmol/l or greater than 3.37 mmol/l and previous history of cardiovascular disease or two risk factors were considered candidates to undergo intervention to reduce cholesterol concentrations. Moreover, the number of individuals with CT concentrations greater than 6.2 mmol/l which would not be detected if CT was only determined in those who already had another cardiovascular risk factor was estimated., Results: 37.5% (CI 95%; 33.8%-41.5%) of the individuals required lipid profile and out of these 88.8% (CI 95%; 3.8%-92.4%) were candidates to receive intervention. Upon evaluating the efficacy of the strategy of selective case finding it was observed that the sensitivities of the risk factors were low, ranging from 22.6% in those with family history of cardiovascular disease to 34.8% in cases with personal history of high blood pressure., Conclusions: If selective case finding of high risk subjects was the only strategy applied, many individuals with hypercholesterolemia would remain undetected, therefore the strategy of opportunistic detection is preferable whenever possible.

Background: The aim of this study was to analyze the percentage of individuals with hypoalphalipoproteinemia and isolated hypertriglyceridemia which would not be detected if only total cholesterol were included in the initial detection of dyslipemia., Methods: Five hundred forty-one individuals participating in a study concerning factors of cardiovascular risk were included in the present study which consisted in a survey on risk factors and a medical examination. The population studied was divided according to the concentration of total cholesterol (TC) in desirable concentrations (5.2 mmol/l), intermediate (5.2-6.2 mmol/l) and elevated (6.2 mmol/l). The concentrations of cholesterol bound to high density lipoproteins (cHDL) less than 0.9 mmol/l and of triglycerides (TG) greater than 2.3 mmol/l were considered as high risk., Results: Hypoalphalipoproteinemia would not be detected in 2.9% of the population studied (IC 95%: 1.5%-4.3%) and isolated triglyceridemia in 2.4% (IC 95%: 1.1%-3.7%) if the cHDL and the TG were only determined in the individuals who had high or elevated CT concentrations and two or more cardiovascular risk factors., Conclusions: These data support the efficacy of CT as the only test for initial detection of dyslipemia and question the convenience of initial quantification of cHDL and triglycerides in all cases as some authors request.