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Introduction: Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events., Objective: To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO)., Method: 1.752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel's C Indices, Nam d'Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated., Results: At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51-58.03, pvalor<.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38-4.21, pvalor=.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76-18.72, pvalor=.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36-7.71, pvalor<.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed., Conclusions: MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Fatty acid metabolic dysregulation in mitochondria is a common mechanism involved in the development of heart failure (HF) and atrial fibrillation (AF). We evaluated the association between plasma acylcarnitine levels and the incidence of HF or AF, and whether the mediterranean diet (MedDiet) may attenuate the association between acylcarnitines and HF or AF risk., Methods: Two case-control studies nested within the Prevención con dieta mediterránea (PREDIMED) trial. High cardiovascular risk participants were recruited in Spain: 326 incident HF and 509 AF cases individually matched to 1 to 3 controls. Plasma acylcarnitines were measured with high-throughput liquid chromatography-tandem mass spectrometry. Conditional logistic regression models were fitted to estimate multivariable OR and 95%CI. Additive and multiplicative interactions were assessed by intervention group, obesity (body mass index ≥ 30 kg/m 2 ), and type 2 diabetes., Results: Elevated levels of medium- and long-chain acylcarnitines were associated with increased HF risk (adjusted OR per DE , 1.28; 95%CI, 1.09-1.51 and adjusted OR per DE , 1.21; 95%CI, 1.04-1.42, respectively). A significant association was observed for AF risk with long-chain acylcarnitines: 1.20 (1.06-1.36). Additive interaction of the association between long-chain acylcarnitines and AF by the MediDiet supplemented with extra virgin olive oil (P for additive interaction=.036) and by obesity (P=.022) was observed in an inverse and direct manner, respectively., Conclusions: Among individuals at high cardiovascular risk, elevated long-chain acylcarnitines were associated with a higher risk of incident HF and AF. An intervention with MedDiet+extra-virgin olive oil may reduce AF risk associated with long-chain acylcarnitines. This trial was registered at controlled-trials.com (Identifier: ISRCTN35739639)., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Quantification of cardiovascular risk has been based on scores such as Framingham, Framingham-REGICOR, SCORE or Life's Simple 7 (LS7). In vitro, animal, and randomized clinical studies have shown that polyphenols may provide benefits to the vascular system and reduce the inflammatory response. However, some clinical-epidemiological studies have yielded inconsistent results. Our aim was to assess the possible association between intake of the various polyphenol classes and established cardiovascular scores., Methods: This cross-sectional analysis involved 6633 PREDIMED-Plus study participants. Food polyphenol content was estimated by a semiquantitative food frequency questionnaire, adjusted for total energy intake according to the residual method. The association between polyphenol intake and cardiovascular risk was tested using linear regression analyses., Results: Total polyphenol and flavonoid intake were directly and significantly associated only with the LS7 scale. Intake of lignans was directly and significantly associated with SCORE and LS7 scales, stilbene intake with SCORE, and phenolic acid intake with Framingham and Framingham-REGICOR scores. Other polyphenol classes were associated in a protective and significant manner in Framingham, SCORE and LS7 scores. In women, intake of all the polyphenol classes, except phenolic acids, showed a protective trend in the results of the Framingham, Framingham-REGICOR scores and LS7 scale., Conclusions: An inverse association was found between consumption of the 'other polyphenols' class and, especially among women, with estimated cardiovascular risk. The results were similar to those of Framingham, Framingham-REGICOR and LS7 (after eliminating the diet component) and differed from those of SCORE, but the predictors included were limited in the latter case., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The ankle-brachial index (ABI) is an indicator of peripheral artery disease (PAD). The aim of this study was to assess the association between PAD, measured with the ABI, and cognitive function in persons with overweight or obesity and metabolic syndrome., Methods: Cross-sectional study conducted with baseline data from the PREDIMED-Plus study, which included 4898 participants (after exclusion of those without ABI measurements) aged between 55 and 75 years, and with overweight or obesity and metabolic syndrome. At the baseline assessment, we measured the ABI with a standardized protocol and assessed the presence of other cardiovascular risk factors (eg, diabetes, dyslipidemia, hypertension). Cognitive function was evaluated using several tests validated for the Spanish population (mini-mental state examination [MMSE], phonological and semantic verbal fluency test, WAIS-III working memory index [WMI], parts A and B of the trail making test (TMT), and clock drawing test). Generalized linear models were used to assess the association between the ABI and cognitive function., Results: Among the participants, 3.4% had PAD defined as ABI ≤ 0.9, and 3.3% had arterial calcification defined as ABI ≥ 1.4. PAD was associated with age, systolic blood pressure and obesity indicators, while arterial calcification was also associated with obesity and diabetes. No significant associations were observed between cognitive function and ABI or PAD., Conclusions: In our sample, the presence of PAD increased with age, blood pressure, and obesity. No significant association was observed between ABI, PAD, or cognitive function., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The Life's Simple 7 strategy of the American Heart Association proposes 7 metrics of ideal cardiovascular health: body mass index (BMI) <25mg/m 2 , not smoking, healthy diet, moderate physical activity ≥ 150min/wk, total blood cholesterol <200mg/dL, systolic and diastolic blood pressures <120 and <80mmHg, respectively, and fasting blood glucose <100mg/dL. It is important to assess the combined effect of these 7 metrics in the Spanish population. We prospectively analyzed the impact of baseline Life's Simple 7 metrics on the incidence of major cardiovascular events in the PREDIMED cohort (57.5% women, average baseline age, 67 years)., Methods: The healthy diet metric was defined as attaining ≥ 9 points on a validated 14-item Mediterranean diet adherence screener. An incident major cardiovascular event was defined as a composite of myocardial infarction, stroke, or cardiovascular death. Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and their 95% confidence intervals (95%CI) for successive categories of health metrics., Results: After a median follow-up of 4.8 years in 7447 participants, there were 288 major cardiovascular events. After adjustment for age, sex, center, and intervention group, HRs (95%CI) were 0.73 (0.54-0.99), 0.57 (0.41-0.78), and 0.34 (0.21-0.53) for participants with 2, 3, and ≥ 4 metrics, respectively, compared with participants with only 0 to 1 metrics., Conclusions: In an elderly Spanish population at high cardiovascular risk, better adherence to Life's Simple 7 metrics was progressively associated with a substantially lower rate of major cardiovascular events., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The cardiovascular benefits of the Mediterranean diet have usually been assessed under assumptions of ad libitum total energy intake (ie, no energy restriction). In the recently launched PREDIMED-Plus, we conducted exploratory analyses to study the baseline associations between adherence to an energy-restricted Mediterranean diet (MedDiet) and the prevalence of cardiovascular risk factors (CVRF)., Methods: Cross-sectional assessment of all PREDIMED-Plus participants (6874 older adults with overweight/obesity and metabolic syndrome) at baseline. The participants were assessed by their usual primary care physicians to ascertain the prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidemia). A 17-point PREDIMED-Plus score was used to measure adherence to the MedDiet. Multivariable models were fitted to estimate differences in means and prevalence ratios for individual and clustered CVRF., Results: Better adherence to a MedDiet pattern was significantly associated with lower average triglyceride levels, body mass index, and waist circumference. Compared with low adherence (≤ 7 points in the 17-point score), better adherence to the MedDiet (11-17 points) showed inverse associations with hypertension (prevalence ratio=0.97; 95%CI, 0.94-1.00) and obesity (prevalence ratio=0.96; 95%CI, 0.92-1.00), but positive associations with diabetes (prevalence ratio=1.19; 95%CI, 1.07-1.32). Compared with the lowest third of adherence, women in the upper third showed a significantly lower prevalence of the clustering of 3 or more CVRF (prevalence ratio=0.91; 95%CI, 0.83-0.98)., Conclusions: Among participants at high cardiovascular risk, better adherence to a MedDiet showed significant inverse associations with CVRF among women, and improved lipid profiles and adiposity measures. This trial was registered in 2014 at the International Standard Randomized Controlled Trial Registry (ISRCTN89898870)., (Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases., (Copyright © 2018 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

The first step in the prevention and treatment of many chronic diseases such as cardiovascular diseases is to follow a healthy diet. Several epidemiological studies have observed that following a traditional Mediterranean diet reduces overall and cardiovascular mortality, as well as the incidence of chronic diseases such as cardiovascular diseases, cancer and neurodegenerative diseases. However, up to now, only one study has analysed the effects of the Mediterranean diet on the primary prevention of cardiovascular disease, the PREDIMED (PREvenci&oacute;n con DIeta MEDiterr&aacute;nea) study. This trial included 7447 high vascular risk individuals who were randomly divided into three dietary intervention groups: Mediterranean diet supplemented with extra-virgin olive oil, Mediterranean diet supplemented with nuts, and a control diet (low in all types of fat). Analyses of intermediate markers demonstrated beneficial effects of the Mediterranean diet on blood pressure, lipid profile, lipoprotein particles, oxidative stress and inflammation markers and carotid atherosclerosis. However, the most important finding was the 30% reduction in the relative risk of major cardiovascular complications (heart attack, stroke and cardiovascular mortality) in both Mediterranean diet groups compared to those who followed a low-fat diet. The results of the PREDIMED trial demonstrate that a high unsaturated fat, antioxidant and anti-inflammatory diet plan such as the Mediterranean diet is a useful tool in reducing overall mortality and in preventing cardiovascular disease.

A 52 year old male presenting chronic myeloid leukemia (CML) Philadelphia chromosome positive (Ph) four years after the diagnosis of a non Hodgkin's lymphoma is described. The patient had received high total doses of alkylating drugs (cyclophosphamide and chlorambucil) as part of chemotherapy treatment for a diffuse mixed lymphoma. At four years of diagnosis of the lymphoma the appearance of hepatosplenomegaly, leukocytosis with myeloma and basophilia and thrombocytosis were observed. These alterations augmented progressively until a cytogenetic study of the bone marrow two years late established the diagnosis of CML upon demonstrating the presence of the Ph chromosome with no other karyotypic anomalies being observed. The explorations carried out at that time confirmed that the lymphoma continued to be in remission. The CML initially responded to treatment with busulphan. However, following a year and a half the disease evolved to a phase of acceleration and the patient died a few weeks later due to pneumonia with no signs indicative of lymphoma activity having been detected since the diagnosis of the CML.

Pulmonary hemorrhage in Behçet's disease is exceptional. It usually presents as a hemoptysis and appears in advanced stages. A patient is described who sought medical care for oral and genital lesions, arthritis and progressive dyspnea. Analytical data showed anemia and chest X-ray revealed a bilateral interstitial pattern. A fiber bronchoscopy was performed which confirmed the existence of a diffuse pulmonary hemorrhage. Corticosteroid and azatioprine administration resolved the hemorrhage. Pulmonary hemorrhages in Behçet's disease are reviewed and in view of a available literature therapeutic possibilities are discussed.

During the course of Hodgkin's disease there is a low incidence of clinical manifestations of liver involvement: less than 15% of the patients present jaundice at some time during the evolution of their disease. The initial manifestation of Hodgkin's disease as an hepatic illness is a rare event. Two such cases are herein reported. The first patient was a 68 year-old male with a febrile illness of one month duration who 15 days before admission presented painless jaundice, dark urine, and discolored stools. The clinical work-up pointed to the possible existence of an extrahepatic cholestasis. At laparotomy a normal biliary tree was found, and surgical liver biopsy disclosed severe tissue cholestasis and a granulomatous portal reaction constituted by white blood cells, eosinophiles and histiocytes, most of them atypical and some showing features of Reed-Sternberg cells. The second patient was a 21 year-old male with a febrile illness of four months duration who developed jaundice and progressive mental obtundation one week before admission. The biochemical studies demonstrated severe pancytopenia and signs of advanced liver failure. Percutaneous liver biopsy disclosed a normal hepatic architecture and the presence of numerous atypical histiocytes in the portal areas. Lymphography showed sizeable pelvic and paraaortic lymph nodes. Subsequent laparotomy for lymph node biopsy confirmed the diagnosis of Hodgkin's disease, nodular sclerosis type. The authors suggest that hepatic Hodgkin's disease must be considered in the differential diagnosis of any febrile illness with jaundice.

The authors report the first two cases of legionnaires' disease from Catalonia. Both patients were chronic bronchitic males, and the cases were sporadic. The onset of the disease was characterized by a febrile illness with muscle and joint pains, respiratory symptoms (cough and mucous sputum production), and mental changes. There were no digestive complaints. Pulmonary consolidation occurred in both patients in the left upper lobe. Blood chemistries disclosed the existence of an absolute lymphopenia, altered liver function tests, and elevated CPK levels. Bacterial cultures of blood and sputum, respiratory virus screening (influenza A and B, parainfluenza 1, 2 and 3, and adenoviruses), and tests for Mycoplasma pneumoniae, Coxiella burnetti and Chlamydia psittaci were all negative. Antibody titers against Legionella pneumophila by indirect immunofluorescence were 1/1024 (positive) for serotype 1 and 1/1024 (positive) for serotype II in one patient, and 1/1024 (positive) for serotype I and 1/128 (negative) for serotype II in the other patient. The authors review the epidemiological, clinical, biochemical and diagnostic aspects of legionnaires' disease, which knowledge will undoubtedly allow to detect an increasing number of cases.