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1. Comprehensive management of risk factors in peripheral vascular disease. Expert consensus

Author

Pilar Caridad Morata Barrado, Carlos Guijarro Herraiz, Jorge Jesús Martín Cañuelo, J.F. Merino-Torres, Cristina Tejera Pérez, María Ángeles Martínez López, Teresa Rama Martínez, Sergio Cinza-Sanjurjo, Mª Dolores Aicart Bort, C. Brotons, Vicente Pascual Fuster, Emilio Ortega, Tomás Ripoll Vera, Carmen Peinado Adiego, Alberto Cordero, Carlos Jericó Alba, Luis Castilla-Guerra, Francisco Valls-Roca, Pablo Antonio Toledo Frías, Rosa María Sánchez-Hernández, Antonio Pérez Pérez, Ángel Brea Hernando, Juan Girbés Borrás, Miguel Ángel Prieto Díaz, J.M. Mostaza, María Soledad Navas de Solís, Elisa Velasco Valdazo, Estíbaliz Jarauta Simón, Juan Carlos Ferrer García, José Manuel Ruiz Palomar, Francisco M. Morales-Pérez, Julio Sánchez Álvarez, Javier de Juan Bagudá, Núria Muñoz Rivas, Elías Delgado, Manuel Frías Vargas, Ovidio Muñiz Grijalvo, Esther Doiz Artázcoz, Pedro Valdivielso, Adriana Saltijeral Cerezo, Rebeca Reyes García, Manuel Rodríguez Piñero, Beatriz Jiménez Muñoz, Luis Leiva Hernando, Enrique Rodilla Sala, Alfonso Barquilla García, Jose Daniel Mosquera Lozano, Carlos Santos Altozano, Antonio Miguel Hernández Martínez, Alejandro Berenguel Senén, Manuel Gargallo Fernández, María Gloria Cánovas Molina, Julio Antonio Carbayo Herencia, Ignacio Párraga Martínez, Elena Iborra Ortega, Aurora García Lerín, Vicente Ignacio Arrarte Esteban, Vivencio Barrios, Jose Polo García, Manuel Antonio Botana López, Ruth Sánchez Ortiga, Manuel Suárez Tembra, Miguel Brito Banfiel, Ángel Carlos Matía Cubillo, José María Cepeda Rodrigo, Daniel Escribano Pardo, P. Beato, M. Comellas, Inés Gil Gil, R. Campuzano, Martín Ruiz Ortiz, Víctor Rodríguez Sáenz de Buruaga, Agustín Blanco Echevarría, Rosario Lorente Calvo, José Manuel Comas Samper, Sergio Hevia, Natalia de la Fuente, Juan Cosin Sales, Rafael Vidal-Pérez, Virginia Bellido Castañeda, N. Plana, Amelia Carro, Carlos Lahoz, Magdalena León Mazorra, Sergio Martínez Hervas, Maria Seoane Vicente, Melina Vega de Ceniga, M. Antonia Pérez Lázaro, Sergio Jansen Chaparro, Antonio Ruiz García, Isabel Ayala Vigueras, Miren Morillas Bueno, Esther Merino Lanza, Andrés Galarza Tapia, Marta Casañas Martínez, Daiana Ibarretxe Gerediaga, María Durán Martínez, José Antonio Rubio, Óscar Moreno-Pérez, Andrés García León, Luis Estallo Laliena, Eduardo Carrasco Carrasco, Vicente Pallarés-Carratalá, Alberto Zamora Cervantes, Javier Escalada, Juan Carlos Obaya Rebollar, Mercedes Guerra Requena, José Antonio Quindimil Vázquez, Pedro J. Pinés Corrales, Carlos Escobar Cervantes, Lisardo García-Martín, Albert Clarà, Jose María Fernández Rodriguez-Lacin, Miguel Turégano Yedro, Francisco Javier Félix Redondo, Luis Masmiquel, Jacinto Fernández Pardo, Laura Calsina Juscafresa, María Eugenia López Valverde, Eva María Pereira López, Fátima Almagro Múgica, and Agustín Medina Falcón

Subjects
medicine.medical_specialty, Consensus, Vascular disease, business.industry, Arterial disease, Delphi method, Expert consensus, General Medicine, Disease, medicine.disease, Quit smoking, Peripheral Arterial Disease, Risk Factors, Multidisciplinary approach, Diabetes Mellitus, medicine, Humans, Ankle Brachial Index, Medical prescription, Intensive care medicine, business
Abstract

There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Published
2022

2. The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia

Author

Antonio Gallo, Leopoldo Pérez de Isla, Sybil Charrière, Alexandre Vimont, Rodrigo Alonso, Ovidio Muñiz-Grijalvo, José L. Díaz-Díaz, Daniel Zambón, Philippe Moulin, Eric Bruckert, Pedro Mata, Sophie Béliard, Denis Angoulvant, Sophie Beliard, Franck Boccara, Bertrand Cariou, Valérie Carreau, Alain Carrie, Sybil Charrieres, Yves Cottin, Mathilde Di Filippo, Pierre Henri Ducluzeau, Sonia Dulong, Vincent Durlach, Michel Farnier, Emile Ferrari, Dorota Ferrieres, Jean Ferrieres, Philippe Giral, Sophie Gonbert, Regis Hankard, Jocelyn Inamo, Olga Kalmykova, Michel Krempf, Julie Lemale, François Paillard, Noel Peretti, Agnes Perrin, Alain Pradignac, Jean Pierre Rabes, Vincent Rigalleau, François Schiele, Ariane Sultan, Patrick Tounian, René Valero, Bruno Verges, Cecile Yelnik, Olivier Ziegler, Rocío Aguado, Ma Pilar Álvarez-Baños, Rosa Argüeso, Francisco Arrieta, Miguel Ángel Barba, Marta Casañas, José María Cepeda, Raimundo De Andrés, Gonzalo Díaz-Soto, Jose Luis Díaz-Diaz, Marta Dieguez, Ceferino Faedo, Francisco Fuentes, Juan A. Garrido, Aurora González, Pablo González-Bustos, Ma Dolores Mañas, Marta Mauri, Juan Diego Mediavilla, Alfredo Michán, Pablo Miramontes, Ovidio Muñiz, Leire Pérez, Leopoldo Perez De Isla, Xavier Pintó, Manuel J. Romero, Patricia Rubio, Juan F. Sánchez Muñoz-Torrero, Jose I. Vidal-Pardo, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire d'Imagerie Biomédicale (LIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Public Health Expertise [Paris, France], Hospital Universitario Virgen del Rocío [Sevilla], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire d'Imagerie Biomédicale [Paris] (LIB), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Hospital Abente y Lago, Fundación Hipercolesterolemia Familiar, and ANR-16-RHUS-0007,CHOPIN,CHOPIN(2016)

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Coronary Artery Disease, Disease, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Risk Assessment, Sudden death, Cohort Studies, Hyperlipoproteinemia Type II, risk prediction, 03 medical and health sciences, 0302 clinical medicine, cardiovascular disease, genetic disease, Predictive Value of Tests, Risk Factors, Interquartile range, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Vascular Calcification, Stroke, coronary artery calcium, ComputingMilieux_MISCELLANEOUS, familial hypercholesterolemia, business.industry, Proportional hazards model, nutritional and metabolic diseases, Middle Aged, Atherosclerosis, medicine.disease, 3. Good health, Coronary Calcium Score, Cardiology, Calcium, Cardiology and Cardiovascular Medicine, business, coronary imaging, Cohort study
Abstract

International audience; ObjectivesThis study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH).BackgroundCommon cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD).MethodsREFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death.ResultsWe included 1,624 patients (mean age: 48.5 ± 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%.ConclusionsCAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.

Published
2021

3. Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART

Author

Leopoldo Pérez de Isla, Raquel Arroyo-Olivares, Rodrigo Alonso, Ovidio Muñiz-Grijalvo, José Luis Díaz-Díaz, Daniel Zambón, Francisco Fuentes, Nelva Mata, Mar Piedecausa, M. Dolores Mañas, Juan F. Sánchez Muñoz-Torrero, José Pablo Miramontes-González, Raimundo de Andrés, Marta Mauri, Rocío Aguado, Ángel Brea, José M. Cepeda, José I. Vidal-Pardo, Ceferino Martínez-Faedo, Miguel Ángel Barba, Rosa Argüeso, Enrique Ruiz-Pérez, Alfredo Michán, Francisco Arrieta, María Riestra Fernández, Leire Pérez, José M. Pinilla, Gonzalo Díaz-Soto, Xavier Pintó, Teresa Padró, Lina Badimón, Pedro Mata, Begoña Perez-Corral, Fátima Almagro, Raquel Arroyo, Adriana Saltijeral, Daniel Mosquera, Marta Casañas, Julio Carbayo, Jose María Cepeda, Raimundo De Andrés, José L. Díaz, Marta Diéguez, María Riestra, José López-Miranda, Jesús Galiana, Jesús García-Cruces, Juan Antonio Garrido, Luis Irigoyen, Pedro L. Martínez, Lorena Suárez, Rosa M. Borrallo, Juan Diego Mediavilla, Fernando Jaén, Pablo González, Patricia Rubio, Pablo Miramontes, Juan L. Morera, Ovidio Muñiz, Aurora González, Francisca Pereyra, José Pastor, José Miguel Pinilla, Manuel J. Romero, Enrique Ruiz, M. Pilar Álvarez, Pedro Sáenz, Juan F. Sánchez, Consuelo Sanz, and Jose I. Vidal

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract

Resumen Introduccion y objetivos El estudio SAFEHEART se diseno para analizar la situacion y mejorar el conocimiento de la hipercolesterolemia familiar heterocigota (HFH) en Espana. Nuestro objetivo es determinar la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento y su modificacion, el empleo de tratamiento hipolipemiante y la consecucion de objetivos de colesterol unido a lipoproteinas de baja densidad en pacientes con HFH. Metodos El SAFEHEART es un estudio prospectivo de cohorte, abierto, multicentrico, de escala nacional, con seguimiento protocolizado a largo plazo en una poblacion de HFH caracterizada molecularmente. Se analizo a los pacientes mayores de 18 anos con seguimiento completo. Resultados El analisis en este estudio se hizo con 2.648 pacientes con HFH. La mediana de seguimiento fue de 6,6 (4,8-9,7) anos. La tasa de incidencia general de eventos cardiovasculares fue de 1,3 eventos/100 pacientes-ano. El riesgo estimado de sufrir un evento cardiovascular a 10 anos se redujo en el seguimiento, y paso del 1,6 al 1,3% (p Conclusiones En este estudio se muestra la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento cardiovascular en la mayor poblacion de pacientes con HF en Espana, asi como su modificacion, la consecucion de objetivos en colesterol unido a lipoproteinas de baja densidad y su tratamiento. Aunque el riesgo cardiovascular de la HFH es elevado, un adecuado tratamiento reduce la probabilidad de sufrir un evento. Estudio registrado en ClinicalTrials.gov (Identificador: NCT02693548).

Published
2020

4. Incidence of cardiovascular events and changes in the estimated risk and treatment of familial hypercholesterolemia: the SAFEHEART registry

Author

Leopoldo Pérez de Isla, Raquel Arroyo-Olivares, Rodrigo Alonso, Ovidio Muñiz-Grijalvo, José Luis Díaz-Díaz, Daniel Zambón, Francisco Fuentes, Nelva Mata, Mar Piedecausa, M. Dolores Mañas, Juan F. Sánchez Muñoz-Torrero, José Pablo Miramontes-González, Raimundo de Andrés, Marta Mauri, Rocío Aguado, Ángel Brea, José M. Cepeda, José I. Vidal-Pardo, Ceferino Martínez-Faedo, Miguel Ángel Barba, Rosa Argüeso, Enrique Ruiz-Pérez, Alfredo Michán, Francisco Arrieta, María Riestra Fernández, Leire Pérez, José M. Pinilla, Gonzalo Díaz-Soto, Xavier Pintó, Teresa Padró, Lina Badimón, Pedro Mata, Begoña Perez-Corral, Fátima Almagro, Raquel Arroyo, Adriana Saltijeral, Daniel Mosquera, Marta Casañas, Julio Carbayo, Jose María Cepeda, Raimundo De Andrés, José L. Díaz, Marta Diéguez, María Riestra, José López-Miranda, Jesús Galiana, Jesús García-Cruces, Juan Antonio Garrido, Luis Irigoyen, Pedro L. Martínez, Lorena Suárez, Rosa M. Borrallo, Juan Diego Mediavilla, Fernando Jaén, Pablo González, Patricia Rubio, Pablo Miramontes, Juan L. Morera, Ovidio Muñiz, Aurora González, Francisca Pereyra, José Pastor, José Miguel Pinilla, Manuel J. Romero, Enrique Ruiz, M. Pilar Álvarez, Pedro Sáenz, Juan F. Sánchez, Consuelo Sanz, and Jose I. Vidal

Subjects
Adult, Male, medicine.medical_specialty, Population, Familial hypercholesterolemia, Disease, 030204 cardiovascular system & hematology, LDL-cholesterol targets, Cohort Studies, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, In patient, Prospective Studies, Registries, education, education.field_of_study, business.industry, PCSK9, Incidence (epidemiology), Incidence, General Medicine, Middle Aged, medicine.disease, Cardiovascular disease, Clinical trial, Cardiovascular Diseases, Spain, Female, business, Cohort study, Lipid lowering therapy
Abstract

Introduction and objectives: The SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. Methods: SAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. Results: We included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P

Published
2020

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