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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.

This research was supported by the Aula de Empresa "Vellsam-UGR para la Innovacion en Nutricion y Salud". Vito Verardo thanks the Spanish Ministry of Economy and Competitiveness (MINECO) for "Ramon y Cajal" contract (RYC-2015-18795)., Bell peppers are one of the most important species consumed and cultivated in Spain. Peppers are a source of carotenoids and phenolic compounds widely associated with biological activities such as antimicrobial, antiseptic, anticancer, counterirritant, cardioprotective, appetite stimulator, antioxidant, and immunomodulator. However, undersized and damaged fruits are usually wasted. Thus, in order to evaluate the phenolic content, a Box–Behnken design has been carried out to optimize the extraction from Capsicum annuum yellow pepper by ultrasound-assisted extraction (UAE). The independent factors were time (min), ethanol/water (% v/v) and solvent/sample ratio (v/w). The model was validated by ANOVA and confirmed. Furthermore, the whole pepper and the pepper without peduncles and seeds were extracted using optimal conditions and characterized by HPLC-ESI-TOF-MS. Moreover, their antioxidant activities, measured by three different methods (DPPH, ABTS, and FRAP), carotenoid composition, assessed by HPLC-MS, and chlorophyll content, assessed by a spectrophotometric method, were compared. A total of 38 polar compounds were found of which seven have been identified in pepper fruit extracts for the first time. According to the results, whole pepper (WP) samples presented higher content in phenolic acids; meanwhile, the edible portion (EP) was higher in flavonoids. No differences were found in the antioxidant activity except for the FRAP assay where the WP sample showed higher radical scavenging activity. EP samples showed the highest content of carotenoids and WP ones in chlorophylls., Aula de Empresa "Vellsam-UGR para la Innovacion en Nutricion y Salud", Spanish Ministry of Economy and Competitiveness (MINECO) for "Ramon y Cajal" RYC-2015-18795

Background and aims Lifestyle has been found to play an important role in the prevention of cardiovascular disease (CVD). There is evidence to suggest that if lifestyle factors are modified successfully, the relative risk of CVD can be reduced. Risk factors for CVD such as high blood pressure, diabetes mellitus and dyslipidaemias can be modified by lifestyle changes. The main aim of this article is to provide best practice approaches and support for healthcare professionals on the role of lifestyle changes in the prevention of CVD. Methods A working group of experts discussed existing guidelines, clinical practice and evidence, and provided their recommendations on ten topics concerning the role of lifestyle in CVD prevention. These topics covered important lifestyle factors as well as tools/approaches to assess or encourage lifestyle changes. Results The group of clinical experts collaborated to provide their opinion on the following topics: one diet versus customised diets; the role of alcohol consumption in a healthy diet; a diet based on nutrient composition or on whole foods; a Mediterranean versus low-fat diet; the role of dietary supplements; physical activity; smoking cessation; the role of a nutritionist/dietitian in a CVD risk multidisciplinary team; tools to be implemented to assess diet, physical activity and smoking status; and the most effective approaches to encourage lifestyle changes. Conclusions The expert working group agreed that lifestyle changes were important in preventing CVD and provided recommendations which complemented current guidance and increased clarity on several topics.

Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD.Cross-sectional.5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry.Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions.Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP130/80 mm Hg) or masked hypertension (office BP140/90 mm Hg, 24-hour BP ≥130/80 mm Hg).Standardized office-based BP and 24-hour ABPM.Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP140/90 and130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP130/80 mm Hg.Cross-sectional design, longitudinal associations cannot be established.Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.

Resumen Fundamento y objetivo La poblacion atendida por los servicios de Medicina Interna en Espana tiene una edad creciente, pero desconocemos la prevalencia de los factores de riesgo vascular y su grado de control, asi como sus diferencias segun el tipo de hospital o de consulta. Pacientes y metodo Estudio epidemiologico, transversal y multicentrico en pacientes ≥ 18 anos. Participaron 290 investigadores de las 17 comunidades autonomas. Se determino el tipo de hospital y de consulta. La presion arterial se considero controlada si era Resultados Se analizaron 2.704 pacientes (54% varones), con una edad media (DE) de 64,1 (14,5) anos. El 93% tenia algun factor de riesgo: hipertension 73,9%, dislipidemia 59,5%, obesidad abdominal 43,4%, diabetes 39,5%. El 50,0% tenia alguna lesion de organo diana, el 46,7% alguna enfermedad clinica asociada y el 71,2% un riesgo vascular alto o muy alto. El control de los factores de riesgo fue: hipertension 33,8%, colesterol LDL 40,8% y diabetes 50,7%. No existieron diferencias relevantes segun el tipo de hospital o de consultas. Conclusiones Mas del 90% de los enfermos atendidos en las consultas hospitalarias de Medicina Interna presenta algun factor de riesgo vascular, independientemente del tipo de consulta u hospital. El control de los factores de riesgo es reducido.

Introduccion y objetivos Se dispone de escasa informacion acerca de la situacion asistencial a escala poblacional de los sindromes coronarios agudos sin elevacion del segmento ST (SCASEST) en Espana. El objetivo es conocer la situacion de la atencion medica a los pacientes con SCASEST en Espana, desde una perspectiva representativa de la realidad estatal. Pacientes y metodo Registro prospectivo de pacientes consecutivos con SCASEST ingresados en 52 hospitales espanoles con distintos recursos cardiologicos, seleccionados al azar y que cumplieron con los criterios de control de calidad del estudio. Resultados Entre abril y mayo de 2002 se recluto a 1.877 pacientes con una edad promedio de 69 anos. El 93% tenia algun factor de riesgo y 73% antecedentes cardiovasculares. Un 76% presentaba un electrocardiograma anormal y un 53% elevacion de las troponinas. El 27% fue ingresado en una unidad coronaria o de cuidados intensivos. Se estudio al 56% de los pacientes mediante ecocardiografia, al 39% mediante una prueba de deteccion de isquemia y al 41% mediante coronariografia. En el hospital, un 88% recibio aspirina, un 81% heparina, un 37% clopidogrel, un 12% inhibidores de la glucoproteina IIb/IIIa, un 63% bloqueadores beta, un 46% inhibidores de la enzima de conversion de la angiotensina y un 52% estatinas. Se realizo revascularizacion coronaria en el 24% de los pacientes. El diagnostico final fue angina en el 54%, infarto en el 28% y otros diagnosticos en el 18%. La mortalidad fue del 3,7% a los 28 dias y del 7,8% a 6 los meses. Conclusiones DESCARTES es el primer registro representativo de la actividad asistencial en la atencion a los SCASEST en Espana. Se demuestra que, pese a que son pacientes de alto riesgo, reciben una atencion suboptima segun lo recomendado.

To evaluate low-density lipoprotein-cholesterol (LDLc) achieved in patients with genetic dyslipidemia treated during one year in Lipid and Vascular Risk Units (LVRU) of the Spanish Society of Arteriosclerosis (SSA).Observational, longitudinal, retrospective, multicenter national study that included consecutive patients of both sexes over 18 years of age referred due to dyslipidemia to LVRU of the SSA. Information was collected from medical records corresponding to two visits in the lipid unit.A total of 527 patients (mean age 48 years, 60.0% men) diagnosed with genetic dyslipidemia (241 with heterozygous familial hypercholesterolemia, and 286 with familial combined hyperlipidemia) were included. The mean follow-up was 12.9 months. In the last visit, 94% were taking statins, one third combined with ezetimibe, although only 41% were taking a high-intensity hypolipidemic treatment. Overall, 28.5% of patients attained an LDLc level100 mg/dL, 35.8% decreased their LDLc by50%, and 53.8% achieved one of the two. Predictors of target LDLc levels in the multivariate analysis were age, smoking habit and the presence of vascular disease.Over half of the patients with genetic dyslipidemia followed up by LVRU of SSA achieve LDLc objectives after one year of follow-up. The use of high-intensity hypolipidemic treatment could improve these results.