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Lipid-lowering medication is effective in reducing the risk of cardiovascular disease in several clinical scenarios. However, the evidence in patients with familial hypercholesterolemia (FH) and severe primary hypercholesterolemia is less robust.The main objective of the present systematic review was to analyze the association between lipid-lowering medication and cardiovascular risk reduction in patients with FH or severe primary hypercholesterolemia.This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between lipid-lowering medication and cardiovascular events in FH patients. The diagnosis of FH varied in the studies analyzed. Genetic and clinical criteria or a combination of both were used. Likewise, we considered patients with severe primary hypercholesterolemia.Fourteen studies including 21059 patients were considered eligible for this research. This systematic review showed that the vast majority of the studies with statins reported a significant cardiovascular risk reduction. Statin use was associated with a lower risk of major adverse cardiovascular events (3 studies), coronary heart disease (2 studies), cardiovascular death (4 studies), all-cause mortality (4 studies) and combined endpoint of coronary heart disease and mortality (1 study). When analyzing the association between non-statin lipid-lowering medications and the incidence of cardiovascular events, the results were conflicting.Despite the low level of evidence, this systematic review showed that statins reduce cardiovascular events in patients with HeFH. Evidence for other lipid-lowering drugs is not conclusive.

Sodium Glucose Co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) were associated with a reduction in cardiovascular disease events in cardiovascular outcomes trials (CVOTs) in type 2 diabetes. Most of the patients included in these trials received metformin as background therapy. To evaluate the effect of glucagon-like peptide 1 receptor agonists on major cardiovascular events (MACE) and mortality in metformin-naive patients with type 2 diabetes. A systematic review and meta-analysis of randomized controlled clinical trials of GLP-1RAs on type 2 diabetes population was performed, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoints were cardiovascular death and all-cause mortality. A meta-analysis of time-to-event outcomes was performed. This meta-analysis was registered in PROSPERO (CRD42021260040) Seven trials, including 11510 patients, were identified and considered eligible for the analyses. GLP-1RAs were associated with a significant reduction in MACE incidence (HR: 0.86, 95% confidence interval: 0.79–0.94; I2: 0%). The secondary endpoints analysis showed a non-significant reduction in all-cause mortality (HR: 0.86, 95% confidence interval: 0.73–1.00 I2: 0%) and cardiovascular mortality (HR: 0.81, 95% confidence interval: 0.63–1.05; I2: 0%). In this meta-analysis, GLP-1RAs reduced the incidence of MACE in patients with type 2 diabetes without metformin at baseline, without significant reduction in all-cause mortality and cardiovascular mortality. These results support the fact that when a GLP-1RAs is administered, the benefit on cardiovascular outcomes is independent of the use of metformin.

International audience; Introduction Obesity and its co-morbidities, including type 2 diabetes (T2DM) and dyslipidemia, are accompanied by excess cardiovascular morbi-mortality. Aside from excess low density lipoprotein-cholesterol (LDL-C), atherogenic dyslipidemia (AD), mainly characterized by elevated triglycerides and decreased high density lipoprotein-cholesterol (HDL-C) levels, is often present in T2DM obese patients. Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), has become a reference treatment in that population. However, the respective effects of RYGB vs SG on lipid metabolism in T2DM patients have been rarely studied.Methods A meta-analysis of randomized controlled trials, comparing the effects of RGYBG vs SG on lipid metabolism 12 months after surgery in T2DM patients, was performed.Results Four studies including a total of 298 patients (151 patients in the RYGB and 147 patients in the SG group) were examined. Despite a greater decrease in body mass index and greater improvement in glycemic control in RYGB compared to SG. RYGB vs SG was more effective in reducing total cholesterol, LDL-C, and non-HDL-C levels (mean difference [MD] -26.10 mg/dL, 95 % CI -38.88 to -13.50, p

Elevated lipoprotein(a) [Lp(a)] levels are independently associated with atherosclerotic cardiovascular disease, although this association is less explored in postmenopausal women. The main objective of this systematic review was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes in posmenopausal women. Studies that evaluated this association were searched in the current literature. Ten studies including 157.690 women were considered eligible for this study. In total, 4 prospective cohorts, 3 cross-sectional studies, 2 nested case-control studies, and one post-hoc analysis from a randomized clinical trial were analyzed. The included studies showed different results regarding the association between Lp(a) levels and cardiovascular outcomes: a positive association (4 studies), no association (2 studies), or different results depending on the subgroups or outcomes evaluated (4 studies). The results were robust when evaluating coronary events. The reduction in coronary events attributed to a hormone replacement therapy-associated decrease in Lp(a) levels was controversial.

Objective: The association between the use of colchicine and the incidence of acute myocardial infarction (AMI) is inconsistent. The main objective of this study was to evaluate the effect of colchicine on the incidence of AMI. Assessment of the incidence of stroke and cardiovascular mortality were secondary endpoints. Methods: A meta-analysis of randomized studies that evaluated the use of colchicine in patients with atherosclerotic disease and reported cardiovascular events was performed, after searching the PubMed/MEDLINE, Embase, Scielo and Cochrane Controlled Trials databases. A fixed or random effects model were used depending on the heterogeneity observed. Results: Seven studies were selected for the analysis of the primary end point (5966 subjects in the colchicine arm and 5948 patients in the control arm). This meta-analysis demonstrated that colchicine therapy was associated with a lower risk of AMI (OR: 0.76, 95% CI: 0.62-0.92; I2 = 15%). Likewise, a significant reduction in the incidence of stroke was observed without a significant effect on cardiovascular mortality with pharmacological intervention. Conclusion: The use of colchicine in patients with atherosclerotic cardiovascular disease was associated with a significant reduction in the incidence of AMI. The incorporation of colchicine into the therapeutic arsenal of cardiovascular disease should be considered by future clinical practice guidelines.

Introducción y objetivos: La asociación entre el uso de colchicina y la incidencia de infarto agudo de miocardio (IAM) es heterogénea. El objetivo principal del presente estudio fue evaluar el efecto de la colchicina sobre la incidencia de IAM. La evaluación de la incidencia de accidente cerebrovascular (ACV) y la mortalidad cardiovascular fueron los objetivos secundarios. Material y métodos: Se realizó un metaanálisis de estudios aleatorizados que evaluaron el uso de colchicina en pacientes con enfermedad aterosclerótica y que reportaron los eventos cardiovasculares, luego de una búsqueda en las bases de datos PubMed/MEDLINE, Embase, Scielo y Cochrane Controlled Trials. Se utilizó un modelo de efectos fijos o aleatorios según la heterogeneidad observada. Resultados: Se seleccionaron para el análisis del punto final primario 7 estudios (con un total de 5966 sujetos en la rama colchicina y 5948 pacientes en la rama control). Este metaanálisis demostró que la terapia con colchicina se asoció a un menor riesgo de IAM (OR: 0,76, IC 95%: 0,62-0,92; I2 =15%). Asimismo, se observó una reducción significativa en la incidencia de ACV, sin un efecto significativo en la mortalidad cardiovascular, con la intervención farmacológica. Conclusión: El uso de colchicina en pacientes con enfermedad cardiovascular aterosclerótica se asoció a una reducción significativa en la incidencia de IAM. La incorporación de la colchicina dentro del arsenal terapéutico de la enfermedad cardiovascular deberá ser considerada por las futuras guías de práctica clínica.

Background Given the complex aetiology and a limited amount of evidence, the medical treatment (including statin use) of myocardial infarction with non-obstructive coronary artery disease (MINOCA) remains uncertain. The objective of the present study was to evaluate the effect of statin therapy on major cardiovascular events (MACE) and mortality in MINOCA patients. Methods A systematic review and meta-analysis of time-to-event outcomes were performed of studies of statin therapy on MINOCA patients, reporting data from MACE or mortality, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A fixed-effects meta-analysis model was then applied. Results Six observational studies of statin therapy on MINOCA, involving a total of 11,171 patients, were identified and considered eligible for analysis (9129 subjects received statin therapy while 2042 patients were part of the respective control arms). Quantitative analysis (5 studies were included) showed that statin use was associated with lower mortality (HR: 0.65; 95% CI: 0.56-0.75, I2: 0%). Also, the meta-analysis showed that statin therapy was associated with a lower incidence of MACE (HR: 0.78; 95% CI: 0.69-0.88, I2:27%). Conclusion Our data suggest that in a population with MINOCA, the use of statin therapy results in significant reduction on MACE and mortality. These results must be confirmed in future clinical trials.

Background: Sodium Glucose Co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were associated with a reduction in cardiovascular events in cardiovascular outcomes trials (CVOTs) in type 2 diabetes. Most of the patients included in these trials received metformin as background therapy. The purpose of this study was to evaluate the effect of glucagon-like peptide-1 receptor agonists on major cardiovascular events (MACE) in metformin-naïve patients with type 2 diabetes.Methods: A meta-analysis was performed of randomized controlled clinical trials of GLP-1RAs on type 2 diabetes populations, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoints were cardiovascular death and all-cause mortality. A meta-analysis of time-to-event outcomes was performed.Results: Six eligible trials, including 10419 patients, were identified and considered eligible for the analyses. GLP-1RAs were associated with a significant reduction in MACE incidence (HR: 0.87, 95% confidence interval: 0.80–0.94; I2:0%). The analysis of the secondary endpoints showed a non-significant reduction in all-cause mortality (HR: 0.86, 95% confidence interval: 0.73-1.00 I2:0%) and cardiovascular mortality (HR: 0.81, 95% confidence interval: 0.63–1.05; I2:0%). Conclusions: In this meta-analysis, GLP-1RAs reduced the incidence of MACE in patients with type 2 diabetes without metformin at baseline, without significant reduction in all-cause mortality and cardiovascular mortality. These results support the fact that benefit in cardiovascular outcomes is independent of metformin use when GLP-1Ras are administered.

Due to their anti-inflammatory properties, it has been suggested that the use of statins could influence the evolution of influenza virus infection.To evaluate the effect of statin therapy on mortality from influenza.A meta-analysis that included studies evaluating the use of statins in patients with influenza and reporting data on mortality, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases, was performed. A random effects model was applied. The risk of bias was analyzed and a sensitivity analysis was performed.Eight studies (10 independent cohorts), which included a total of 2,390,730 patients, were identified and eligible for analysis. A total of 1,146,995 subjects analyzed received statins, while 1,243,735 subjects were part of the control group. Statin therapy was associated with lower mortality (OR: 0.66; 95% CI: 0.51-0.85). The sensitivity analysis showed that the results were robust.Our data suggest that, in a population with influenza, the use of statins was associated with a significant reduction in mortality. These results must be confirmed in future clinical trials.

To evaluate the effect of very low levels of LDL-C (55 mg/dl) achieved with lipid-lowering therapy on hemorrhagic stroke incidence.We performed a meta-analysis including randomized trials that achieved LDL-C levels under 55 mg/dl in more intensive lipid-lowering arms, regardless of the lipid-lowering drug used. A fixed-effects model was used. This meta-analysis was performed according to PRISMA guidelines.Eight eligible trials including 122.802 patients, were identified and considered eligible for the analyses. A total of 62.526 subjects were allocated to receive more intensive lipid-lowering therapy while 60.276 subjects were allocated to the respective control arms. There were no differences in the incidence of hemorrhagic stroke between the group that received a more intensive lipid-lowering therapy (achieved LDL-C level55 mg/dl), and the group that received a less intense scheme (OR, 1.05; 95%CI, 0.85-1.31). The statistical heterogeneity was low (IThe use of more intensive lipid-lowering therapy that achieved an LDL-C level lower than 55 mg/dl in patients with high cardiovascular risk, is not associated with an increased risk of hemorrhagic stroke. Considering the cardiovascular benefit and safety observed with the achievement of very low LDL-C values, the challenging lipid goals recommended by the new guidelines seem consistent.

Objetivo: Evaluar el impacto del aislamiento social, preventivo y obligatorio sobre al aumento de peso, el nivel de actividad fisica, la adherencia al tratamiento y la inmunizacion antigripal y antineumococica en pacientes con diabetes tipo 2 (DM2). Metodo: Se realizo un seguimiento telefonico de pacientes con DM2 luego de al menos 100 dias de comienzo del aislamiento. Se compararon dos regiones agrupadas en relacion con el numero de casos: region 1, mas de 150 casos/100, 000 habitantes, y region 2, mas de 150 casos/100,000 habitantes. Resultados: Se contactaron 454 pacientes con DM2. El 42% reportaron incremento de peso y el 7% refirio haber aumentado mas de 5 kg. En relacion con la actividad fisica, se observo un promedio mas bajo en la region 1 (367.5 [0-5698] MET/sem) que en la region 2 (720 [0-7066] MET/sem) (p = 0.0009). La adherencia al tratamiento farmacologico disminuyo en forma global, pero aumento en las zonas de mayor circulacion viral. Por otra parte, hubo un incremento de vacunacion antigripal y antineumococica, alcanzando coberturas del 80% y el 70%, respectivamente. Conclusiones: En una poblacion de alto riesgo cardiovascular y con una prevalencia de sobrepeso/obesidad elevada, el aislamiento social, preventivo y obligatorio se asocio con ganancia de peso y menos actividad fisica, lo que podria resultar deletereo sobre la salud cardiovascular de los pacientes con DM2. Por otro lado, se observan algunos aspectos positivos, como el aumento de las inmunizaciones y el incremento de la adherencia en las zonas mas afectadas.

Background Bempedoic acid is a novel non-statin drug that was developed to treat hyperlipidemia in combination with other lipid-lowering drugs in those patients who need additional lipid lowering. Objectives (1) To investigate the lipid efficacy of bempedoic acid; (2) to analyze the anti-inflammatory effects of bempedoic acid estimated through high sensitivity C-reactive protein (hsCRP). Methods We performed a meta-analysis including randomized trials of bempedoic acid therapy, reporting low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B and hsCRP with a minimum of 4 weeks of follow-up. The primary endpoint was defined as the percentage change in lipids and hsCRP levels measured from baseline to follow-up, comparing groups of subjects on bempedoic acid versus placebo. Results Seven eligible trials of bempedoic acid (3892 patients) were included. The bempedoic acid therapy was associated with a significant reduction in LDL-C levels [−20.3% (CI 95% −23.5 to −17.1)]; I2 = 43%]. Similarly, a significant percentage reduction in the apolipoprotein B levels [−14.3% (CI 95% −16.4 to −12.1)]; p Conclusion Our data suggests that the use of bempedoic acid significantly reduces the levels of all atherogenic lipid markers, including LDL-C, non-HDL-C and apolipoprotein B. Furthermore, considering hsCRP levels, the drug produces an anti-inflammatory effect.

AimsTo evaluate the effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major cardiovascular events (MACE) in metformin-naïve patients with type 2 diabetes (T2D).Methods and resultsA meta-analysis was performed of randomized controlled clinical trials of GLP-1RAs and SGLT-2 inhibitors on T2D populations, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoint, explored in the subgroup of SGLT-2 inhibitors studies, was cardiovascular death or hospitalization for heart failure. A random-effects meta-analysis model was applied. Six eligible trials (three studies of SGLT-2 inhibitors and three trials of GLP-1RAs), including 13 049 patients, were identified and considered eligible for the analyses. The new antidiabetic drugs were associated with a significant reduction in MACE [odds ratio (OR): 0.80, 95% confidence interval: 0.70–0.93; I2: 53%]. The subgroup analysis showed the following findings: GLP-1RAs group, OR: 0.77 (95% confidence interval 0.67–0.88); SGLT-2 inhibitors, OR: 0.85 (95% confidence interval 0.63–1.15). SGLT-2 inhibitors were associated with a significant reduction in hospitalization for heart failure or cardiovascular mortality incidence (OR: 0.67, 95% confidence interval: 0.47–0.95; I2: 78%).ConclusionIn this meta-analysis, new antidiabetic drugs reduced the incidence of MACE in metformin-naïve T2D patients. The beneficial effect was especially observed in the GLP-1RAs subgroup. The use of SGLT-2 inhibitors was associated with a reduction in cardiovascular death or hospitalization for heart failure. These results support the fact that metformin would not be indispensable to obtain positive cardiovascular effects when new antidiabetic drugs are administered.

Introduction Bempedoic acid is a new agent that reduces low-density lipoprotein cholesterol. Since inhibits cholesterol synthesis through a different mechanism than statins, the adverse effects related to it may also be different. Therefore, the objective of the present meta-analysis was to evaluate the effect of bempedoic acid on new onset or worsening diabetes. Methods We performed a meta-analysis including randomized trials of bempedoic acid therapy, reporting new onset or worsening diabetes with a minimum of 4 weeks of follow-up. The fixed-effects model was performed. This meta-analysis was performed according to PRISMA guidelines. Results Five eligible trials of bempedoic acid, including 3629 patients, were identified and considered eligible for the analyses. A total of 2419 subjects were allocated to receive bempedoic acid while 1210 subjects were allocated to the respective control arms. Bempedoic acid therapy is associated with a significant reduction in new onset or worsening diabetes [Odds Ratio: 0.66, 95% confidence interval: 0.48–0.90; I2: 0%]. Conclusion This data suggests that the use of bempedoic acid significantly reduces the new onset or worsening diabetes risk. This finding should be confirmed with future studies.

The aim of this meta-analysis was to analyze the risks and benefits of low-dose aspirin in patients with T2D without cardiovascular conditions according to the baseline cardiovascular risk.We performed a meta-analysis including randomized clinical trials that evaluated the use of low-dose aspirin (75-100 mg/day) versus placebo/usual care in patients with T2D. Studies were classified as low, moderate and high risk based on the number of events in the placebo/control arms or by cardiovascular risk score when reported. The incidence of MACE, cardiovascular mortality and bleeding were evaluated.Ten eligible trials (34069 patients) were considered eligible for the analyses. According to the stratified analysis, low-dose aspirin use was associated with reduced risk for MACE in the moderate/high-risk group (OR: 0.88; 95% CI, 0.80-0.97; IThis study showed that low-dose aspirin in patients with T2D reduces MACE and increases bleeding. Based on the within-subgroups results, the baseline cardiovascular risk does not modify the effect of aspirin therapy. However, few studies were included and the comparison between subgroups showed a trend in favor to the highest risk group, these results should be confirmed in future studies.

(1) Sodium–glucose cotransporter-2 inhibitors (SGLT2-i) reduce adipose tissue and cardiovascular events in patients with type 2 diabetes (T2D). Accumulation of epicardial adipose tissue (EAT) is associated with increased cardio-metabolic risks and obstructive coronary disease events in patients with T2D. (2) We performed a systematic review and meta-analysis of SGLT2-i therapy on T2D patients, reporting data on changes in EAT after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A random effects or fixed effects model meta-analysis was then applied. (3) Results: A total of three studies (n = 64 patients with SGLT2-i, n = 62 with standard therapy) were included in the final analysis. SGLT2 inhibitors reduced EAT (SMD: −0.82 (−1.49; −0.15); p < 0.0001). An exploratory analysis showed that HbA1c was significantly reduced with SGLT2-i use, while body mass index was not significantly reduced with this drug. (4) Conclusions: This meta-analysis suggests that the amount of EAT is significantly reduced in T2D patients with SGLT2-i treatment.

Background In patients with coronary artery disease anti-inflammatory drugs have been shown to be effective in reducing cardiovascular events. The effect of this intervention in the population with type 2 diabetes mellitus (T2DM) is poorly explored. The main objective of this study was to evaluate the effect of anti-inflammatory therapy on the incidence of major cardiovascular events (MACE) in patients with T2DM. Methods A meta-analysis of randomized studies that evaluated the use of anti-inflammatory therapy in patients with T2DM and reported MACE was performed, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. A fixed or random effects models were used. Results Five studies were selected for the analysis (2075 subjects in the anti-inflammatory therapy arm and 2490 patients in the placebo/control arm). All studies included patients with T2DM and history of coronary artery disease. Four studies evaluated the use of colchicine and one of them canakinumab. The use of anti-inflammatory therapy was associated with a lower risk of MACE (HR: 0.80; 95% CI, 0.69–0.93; I2 = 24%). The sensitivity analysis shows that the results are robust. Conclusion This meta-analysis demonstrated that the use of anti-inflammatory therapy in patients with T2DM and atherosclerotic cardiovascular disease was associated with reduced risk of MACE. These results suggest the need to consider the inflammatory pathway as a potential therapeutic target in patients with T2DM.

Background: Colchicine is a microtubule inhibitor with anti-inflammatory properties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events. Methods: A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from stroke, myocardial infarction, cardiovascular mortality and all-cause mortality, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A random-effects meta-analysis model was then applied. Results: Nine eligible trials of colchicine therapy, involving a total of 6630 patients, were considered eligible for analysis (3359 subjects were allocated to receive colchicine while 3271 subjects were allocated to the respective control arms). The stroke incidence was lower in the colchicine group compared with placebo arm (OR, .33; 95%CI, .15-.70; 6 studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality. Conclusions: Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significant reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease. The tolerability and benefits should be confirmed in ongoing clinical trials.

Este Consenso sale a la luz en medio de una de las peores crisis sanitarias globales de los últimos 100 años. El SARS-CoV-2 y su manifestación clínica, COVID-19, han provocado una disrupción en cómo médicos y pacientes nos relacionamos. Si bien se trata de una enfermedad infecciosa, una de las características más notables es que su mortalidad se acrecienta en pacientes con enfermedades crónicas no transmisibles y, en particular, con antecedentes de diabetes y enfermedad cardiovascular.En tal contexto, entonces, creemos que cobran más relevancia las recomendaciones vertidas en este documento, que apuntan a identificar y proteger a estos pacientes, al tiempo que se vuelve prioritaria la implementación, más allá de los enunciados, de políticas concretas de prevención cardiometabólica.

Introduction: Transdisciplinary treatment is one of the pillars for reaching a reduction in mortality and complications in patients (p) with type 2 diabetes (T2D). Different indicators allow us to know the quality of care in outpatients. We do not know the different modalities of control and treatment according to the specialty of the attending physician in this group of patients. Objectives: Evaluating if control by a specialist in diabetes improves the quality indicators of the process of care in patients with T2D. Materials and Methods: During 3 months in the year 2019, a survey was made for patients with T2D in 44 cardiology practices in Argentina. The doctor in charge of T2D control was registered and the sample was divided into 2: group 1, where the T2D control was in charge of a specialist (an endocrinologist or a diabetologist), and group 2, where T2D control was in charge of a doctor not specialized in diabetes (clinical/general practitioner, cardiologist, or others). For this work, we will use 3 indicators of process quality: 1- ocular fundus, 2- Monofilament Test and 3- Microalbuminuria, all undertaken during the year previous to consultation.

Introducción: el tratamiento de las denominadas enfermedades crónicas no transmisibles dentro de las cuales se encuentra la diabetes mellitus tipo 2 (DM2), requiere por lo general de cambios en el estilo de vida y medidas farmacológicas. La falta de adherencia es un problema frecuente a nivel mundial, oscilando entre un 30 y 50% en las distintas series. Los pacientes que no son adherentes presentan una mayor incidencia de eventos cardiovasculares e incluso mortalidad que los pacientes adherentes, incrementando además los costos en los sistemas de salud.Objetivos: evaluar la adherencia al tratamiento farmacológico indicado en una población de pacientes con DM2 y alto riesgo cardiovascular. Evaluar si existen diferencias entre pacientes con adherencia y sin adherencia en cuanto a características clínicas y alcance de objetivos terapeúticos.Materiales y métodos: se realizó un estudio transversal, observacional y multicéntrico. Se registraron en forma consecutiva pacientes (p) con DM2 asistidos en el consultorio de cardiología de mayo a julio de 2019. Del total de p con DM2 ingresaron al estudio los primeros dos de cada día de atención. Se evaluó la adherencia mediante el test de Morisky-Green que consta de cuatro preguntas con dos opciones de respuesta posibles: SÍ/NO. Se definió adherencia a las cuatro preguntas respondidas en forma afirmativa. En caso de presentar 1 respuesta negativa se consideró no adherente a ese paciente. Se definieron objetivos terapéuticos: 1) presión Arterial

Introducción: los pacientes (p) con diabetes mellitus tipo 2 (DM2) tienen un riesgo aumentado de presentar complicaciones cardiovasculares (CV), siendo además la principal causa de muerte en esta población. Ciertas intervenciones a nivel de estilo de vida y tratamientos farmacológicos han demostrado reducción de eventos CV por lo que se encuentran dentro de la primera línea de recomendaciones en las principales guías de tratamiento.Objetivos: evaluar la adherencia a un estilo de vida saludable y la utilización de tratamientos farmacológicos con beneficio cardiovascular en una población de p con DM2. Observar si existen diferencias entre p con y sin enfermedad cardiovascular (ECV).Materiales y métodos: estudio transversal, observacional y multicéntrico. Se registraron en forma consecutiva p asistidos en consultorio de cardiología de mayo a julio de 2019. Del total de p evaluados con DM2 ingresaron al estudio los primeros dos de cada día de atención. Se definió estilo de vida saludable: 1) actividad física (actividad física >150 minutos/semana); 2) perímetro de cintura (PC) normal(5 porciones de frutas y verduras/día; 5) no tabaquismo y estrategias farmacológicas con beneficio CV. 1) uso de estatinas; 2) uso de iSGLT2 y ARGLP-1; 3) uso de ácido acetil salicílico (AAS) en prevención secundaria. Se utilizaron medias, medianas, desvíos estándar según correspondiera. Test de T para comparar medias y chi cuadrado o test de Fisher para las variables dicotómicas.

Introduction: Chest pain represents 5 to 10% of annual visits to emergency departments. Its diagnosis is sometimes difficult, with the added problem of inappropriate discharge of patients with acute coronary syndrome or unnecessary hospitalizations. This has led to the development of different algorithms for the evaluation of these patients. Objective: The aim of this study was to validate, in terms of safety and length of hospital stay, a novel algorithm incorporated in our center, which includes measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome. Methods: The study included 528 consecutive patients attending the emergency department with suspected acute coronary syndrome and evaluated according to the chest pain unit protocol. Clinical and laboratory variables and functional tests were analyzed. Follow-up at 30 days was performed in all the patients. Results: After observation, 90.7% of the patients were discharged and 1.25% presented a cardiovascular event during follow-up, represented by percutaneous coronary intervention and hospitalization due to acute coronary syndrome. The specificity of the global algorithm for the diagnosis of acute coronary syndrome was 97% with a negative predictive value of 99%. Emergency department length of stay was 4.5 ± 2.5 hours for all the patients. Conclusion: The novel algorithm incorporated in our center with measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome has proved to be safe, as it prevents the discharge of patients with acute coronary syndrome and at the same time reduces emergency department length of stay.

Background An oral single dose of flecainide is used worldwide for conversion of recent onset atrial fibrillation (AF) in hemodynamically stable patients without structural heart disease. Vernakalant is a novel, rapid drug, which is used intravenously, with proven effectiveness and safety compared to placebo and amiodarone in randomized clinical trials. The aim of our study was to compare the time taken for conversion of recent onset AF in patients treated with vernakalant or flecainide. Methods This is a sequential study in which 32 hemodynamically stable patients with recent onset AF without structural heart disease were prospectively and consecutively included in two periods, one for each drug. A single oral dose of flecainide 300mg was administered to 15 patients and 17 patients received intravenous vernakalant. Clinical and laboratory variables, conversion rate and time to conversion were recorded. Results Baseline characteristics were similar in both groups. Time to conversion to sinus rhythm was of 163min (120–300) in the flecainide group versus 10min (6–18) in the vernakalant group (p=0.0001). Conclusion Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the flecainide group, and was associated with shorter hospital stay. This reduction in hospital stay length may produce benefits in patients' medical care, costs and welfare.