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This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure.We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up.A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763).Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist’s field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Grupo de Trabajo de Riesgo Vascular de la SEMI., [ES ]En la actualidad la enfermedad vascular constituye un problema de salud de primer orden, no solo por su elevada prevalencia, sino también por la gran morbimortalidad y discapacidad que conlleva. El médico internista juega un papel central en el diagnóstico y tratamiento de la enfermedad vascular, así como en el control de los factores de riesgo vascular (RV) que la causan. De hecho, dentro del campo de acción del internista figura específicamente la atención clínica a enfermos en unidades de RV. En este artículo se recoge el documento de consenso para la formación de residentes en RV. Esta propuesta del Grupo de Trabajo de Riesgo Vascular de la Sociedad Española de Medicina Interna surge como respuesta de nuestra Sociedad a una necesidad específica formativa en RV. Pensamos que su implantación supondrá un beneficio importante, no solo para el médico internista en formación, sino también para la sociedad en su conjunto., [EN] Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Resumen Objetivos Si bien se desconocen los motivos, la prevalencia de hipertension arterial y de eventos cardiovasculares ateroscleroticos en la poblacion adulta con sindrome de Down (SD) es anecdotica. Para entender mejor este hallazgo evaluamos las caracteristicas hemodinamicas de una cohorte de adultos con SD. Metodos Estudio transversal en adultos con SD incluidos de modo consecutivo de las consultas externas del servicio de medicina interna entre junio y noviembre 2018. Se recogieron variables demograficas, clinicas y analiticas. Se utilizo un dispositivo de bioimpedancia toracica (HOTMAN® System) para las medidas hemodinamicas. Se realizo una monitorizacion ambulatoria de presion arterial en un subgrupo de sujetos. Resultados Veintiseis sujetos de edad media 45 ± 11 anos participaron en el estudio (50% varones). La presion arterial (PA) media en la muestra fue de 109/69 ± 11/9 mm Hg, con una frecuencia cardiaca media de 60 ± 12 lpm. Ningun sujeto era hipertenso. El perfil hemodinamico predominante consistio en normodinamismo (65%), normotension (96%), hipocronotropismo (46%), normoinotropismo (50%) e hipervolemia (54%), con valores normales de resistencias vasculares perifericas (58%). Se realizo una monitorizacion ambulatoria de la presion sarterial a 12 sujetos (46%). Los valores medios en 24 horas de PA sistolica fueron 105 ± 11 mm Hg, PA diastolica 67 ± 11 mm Hg, PA media 80 ± 11 mm Hg y frecuencia cardiaca media 61 ± 6 lpm. Conclusiones El perfil hemodinamico mas frecuentemente observado en adultos con SD consistio en hipocronotropismo e hipervolemia, con valores normales de resistencias vasculares perifericas y valores medios optimos de PA. No identificamos ningun sujeto hipertenso en nuestra muestra.

Objectives Although the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD. Methods We conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants. Results Twenty-six participants (mean age, 45 ± 11 years) participated in the study (50 % men). The sample’s mean blood pressure (BP) was 109/69 ± 11/9 mm Hg, with a mean heart rate of 60 ± 12 bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65 %), normal BP (96 %), hypochronotropism (46 %), normal inotropism (50 %) and hypervolaemia (54 %), with normal peripheral vascular resistance values (58 %). Twelve participants underwent OBPM (46 %). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105 ± 11 mm Hg, 67 ± 11 mm Hg, 80 ± 11 mm Hg and 61 ± 6 bpm, respectively. Conclusions The most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample.

COVID-19 has placed a significant burden on the healthcare system, making it necessary to implement new tools that allow patients to be monitored remotely and guarantee quality and continuity of care. The usefulness and acceptance by patients of a virtual caregiver designed for follow-up in the month following hospital discharge for COVID-19 are evaluated. The virtual assistant, based on voice and artificial intelligence technology, made telephone calls at 48 h, seven days, 15 days, and 30 days after discharge and asked five questions about the patient’s health. If the answer to any of the questions was affirmative, it generated an alert that was transferred to a healthcare professional One hundred patients were included in the project and 85 alerts were generated in 45 of the patients, most at one month after hospital discharge. The nursing staff resolved 94% of them by telephone. Patient satisfaction with the virtual caregiver was high.

Resumen La COVID-19 ha supuesto una gran sobrecarga para el sistema sanitario, y ha sido necesario poner en marcha herramientas nuevas para realizar el seguimiento no presencial de los pacientes y garantizar la calidad de sus cuidados. Se evalua la utilidad y aceptacion de los pacientes de un cuidador virtual disenado para su seguimiento tras el alta hospitalaria por COVID-19. El asistente virtual, con tecnologia de voz e inteligencia artificial, realizo llamadas telefonicas a las 48 h, 7, 15 y 30 dias del alta, formulando 5 preguntas sobre su estado de salud. Si la contestacion era afirmativa, generaba una alerta que se transferia a un profesional sanitario. Se incluyeron 100 pacientes en el proyecto. Se generaron 85 alertas en 45 de los pacientes, la mayoria de ellas al mes del alta; el 94% lo resolvio enfermeria telefonicamente. La satisfaccion de los pacientes con el cuidador virtual fue alta.

To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF).Prospective, multicenter cohort study.Internal medicine departments in Spain.Inpatients75 years with NVAF.We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up.We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p0.001). The CONUT score (HR, 1.076; 95%CI 1.009-1.148; p=0.025), the Charlson index (HR, 1.080; 95%CI 1.017-1.148; p=0.013) and the presence of pressure ulcers (HR, 1.700; 95%CI 1.028-2.810; p=0.039) were independently associated with increased mortality at one year of follow-up. The prescription of oral anticoagulants at discharge was associated with lower mortality (HR, 0.440; 95%CI 0.304-0.638; p0.001).More than a third of elderly patients hospitalized with NVAF have a moderate to high nutritional risk. These patients have greater mortality at the end of one year.

Objective To identify factors associated with poor anticoagulation control with vitamin K antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. Methods Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6 months before the inclusion. Results Out of 1337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6 months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94 ± 1.54; 3.10 ± 1.26; 4.63 ± 1.54, and 2.20 ± 0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95% CI: 1.144–5.659), prior labile INR (OR: 35.371; 95% CI: 15.058–83.083) and the determination of >6 INR controls in the last 6 months (OR: 4.747; 95% CI: 2.094–10.759), and according to the Rosendaal method, with prior labile INR (p Conclusions Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6 INR controls and HAS-BLED.

Resumen Objetivo Identificar los factores asociados con el mal control de la anticoagulacion con antagonistas de la vitamina K (AVK) en pacientes con fibrilacion auricular no valvular (FANV) atendidos en consultas de Neurologia y Medicina Interna de Espana. Metodos Estudio transversal, multicentrico, anidado en el estudio ALADIN, de sujetos con FANV, tratados con AVK, atendidos en consultas de Medicina Interna o Neurologia de Espana. El grado de control de la anticoagulacion se estudio mediante el metodo directo y el de Rosendaal, considerando los 6 meses previos a la inclusion. Resultados De los 1.337 pacientes incluidos en ALADIN, 750 estaban tratados con AVK, con informacion completa sobre el INR de los ultimos 6 meses en 383 pacientes. Las puntuaciones medias del indice de Charlson, CHADS2, CHA2DS2-VASc y HAS-BLED fueron 1,94 ± 1,54; 3,10 ± 1,26; 4,63 ± 1,54 y 2,20 ± 0,90, respectivamente. El 46,2% y el 47,0% de los pacientes presentaban un control adecuado de la anticoagulacion por los metodos directo y Rosendaal, respectivamente. El control inadecuado de la anticoagulacion se asocio por el metodo directo con diabetes (OR: 2,511; IC 95%: 1,144-5,659), antecedentes de INR inestable (OR: 35,371; IC 95%: 15,058-83,083) y la realizacion de > 6 controles en los ultimos 6 meses (OR: 4,747; IC 95%: 2,094-10,759), y por el metodo de Rosendaal, con los antecedentes de INR inestable (p Conclusiones Pese al alto riesgo tromboembolico, solo estaban bien controlados algo mas de la mitad. Los factores asociados al mal control de la anticoagulacion fueron la diabetes, INR inestable, > 6 controles de INR y el HAS-BLED.

Over the years, the life expectancy for individuals with Down syndrome (DS) has increased significantly. This fact involves a higher risk for developing numerous medical conditions associated with the aging of adults with DS. A high level of awareness is required by the professional, due to the lack of clinical expressiveness and their higher pain threshold, often makes the diagnosis difficult. Health care professionals must be aware of the specific recommendations for the appropriate care of the adult population with DS. The aim of this article is to describe the most frequent comorbidities in adults with DS adults, to summarise the specific preventive recommendations after comparing the main guidelines published, and to evaluate them according to their specific needs.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Although the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD.We conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants.Twenty-six participants (mean age, 45±11years) participated in the study (50% men). The sample's mean blood pressure (BP) was 109/69±11/9mmHg, with a mean heart rate of 60±12bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65%), normal BP (96%), hypochronotropism (46%), normal inotropism (50%) and hypervolaemia (54%), with normal peripheral vascular resistance values (58%). Twelve participants underwent OBPM (46%). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105±11mmHg, 67±11mmHg, 80±11mmHg and 61±6bpm, respectively.The most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample.

Objectives To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. Material and methods A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. Results Of the total 260 hospitals identified in the SNHS, 142 responses were obtained from 139 hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14 ± 8, with a mean rate of 7.2 ± 3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2987 ± 2066, and those discharged by internists was 232 ± 107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. Conclusions The 2013 RECALMIN survey revealed a number of important aspects of the organization, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement.

Se han estudiado clinicamente 80 casos de brucelosis hospitalizados entre los años 1969-1975 en la provincia de León, donde la enfermedad se ha extendido intensamente durante la última década. Se ha revisado sexo, edad, fecha de comienzo del 1° y 2° brote, sintomatologia, cuadro hemático, evolución de las seroaglutinaciones, aglutinaciones TAB positivas en la brucelosis, evolución clínica, localizaciones osteoarticulares y viscerales, entre ellas un 8 % de hepatitis brucelar, un caso de pancreatitis y otro de endocarditis brucelares que se comentan. Se resalta que hoy día las localizaciones viscerales son menos frecuentes que hace unos años.

Resumen La fibrilacion auricular (FA) en el anciano es una entidad compleja debido al elevado numero de comorbilidades frecuentemente asociadas, como las enfermedades cardiovasculares y la enfermedad renal, los trastornos cognitivos, las caidas o la polimedicacion. Excepto cuanto este contraindicada, la anticoagulacion es necesaria para la prevencion de los eventos tromboembolicos en esta poblacion. Tanto los antagonistas de la vitamina K como los anticoagulantes orales de accion directa (dabigatran, rivaroxaban y apixaban) estan indicados en este contexto. En este grupo de edad la funcion renal debe ser estrechamente vigilada cuando se utilizan estos ultimos. En los ultimos anos se han publicado diferentes guias de practica clinica sobre el paciente con FA. La mayoria de estas guias realizan recomendaciones especificas sobre las caracteristicas clinicas y el tratamiento en los pacientes ancianos. En esta actualizacion se revisan los comentarios especificos sobre las recomendaciones referentes al tratamiento antitrombotico en los pacientes ancianos con FA no valvular.

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

To identify factors associated with poor anticoagulation control with vitaminK antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain.Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6months before the inclusion.Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6months was available in 383 patients. Mean scores of Charlson Index, CHADSDespite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR,6INR controls and HAS-BLED.

Over the years, the life expectancy for individuals with Down syndrome (DS) has increased significantly. This fact involves a higher risk for developing numerous medical conditions associated with the aging of adults with DS. A high level of awareness is required by the professional, due to the lack of clinical expressiveness and their higher pain threshold, often makes the diagnosis difficult. Health care professionals must be aware of the specific recommendations for the appropriate care of the adult population with DS. The aim of this article is to describe the most frequent comorbidities in adults with DS adults, to summarise the specific preventive recommendations after comparing the main guidelines published, and to evaluate them according to their specific needs.

Objectives: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. Methods: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. Results: We evaluated 804 patients with a mean age of 85 +/- 5.1 years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32). Conclusion: The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Resumen Objetivos Elaborar un diagnostico de situacion sobre la asistencia en las unidades de medicina interna (UMI) en Espana y desarrollar, basandose en el analisis anterior, propuestas de mejora de calidad en dichas unidades. Material y metodos Estudio descriptivo transversal entre las UMI de hospitales generales de agudos del Sistema Nacional de Salud (SNS), con datos referidos a 2013. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados De un total de 260 hospitales identificados en el SNS espanol, se han obtenido 142 respuestas de 139 hospitales de toda Espana, que representan el 53,5% de las UMI del SNS. La media de internistas por UMI fue de 14 ± 8, siendo la tasa media de internistas por cada 100.000 habitantes de 7,2 ± 3,3. El promedio de altas hospitalarias de las UMI en 2013 fue de 2.987 ± 2.066 y las altas anuales por internista 232 ± 107. El 61% de las UMI ha desarrollado una unidad de interconsulta y el 41% un programa de atencion sistematica al paciente cronico complejo. En el 33% de las UMI se realiza un pase de visita multidisciplinar y un 60% de las mismas planifica el alta. Conclusiones La encuesta RECALMIN 2013 desvela aspectos relevantes sobre la organizacion, estructura y gestion de las UMI. La notable variabilidad hallada en los indicadores de estructura, actividad y gestion probablemente refleja diferencias notables en eficiencia y productividad y, por tanto, propicia un amplio margen de mejora.

Objective Cost-effectiveness analysis of apixaban versus dabigatran in preventing venous thromboembolism (VTE) in total knee (TKR) or hip (THR) replacement. Methods Model with two periods: post-prophylaxis period of 90 days (short-term) and 5 years (Markov). VTE complications (distal and proximal deep vein thrombosis, pulmonary embolism, bleeding and post-thrombotic syndrome) were included. The comparative efficacy was obtained from a meta-analysis, and the costs from Spanish sources. An annual discount rate of 3.5% for costs and benefits was applied. Results According to the meta-analysis, the relative risk (RR) of VTE or death, compared with enoxaparin, was lower with apixaban than with dabigatran in TKR (RR 0.89, 95% CI 0.32–1.65 and RR 1.35, 95% CI, 0.19–3.39) and THR (RR 0.35, 95% CI, 0.05–2.51 and RR 0.89, 95% CI 0.22–3.21, respectively). In the short-term, there were more life years (LYG) and more quality-adjusted life years (QALY) per patient in TKR (0.2037; 0.1908) and THR (0.2417; 0.1921) with apixaban than with dabigatran (0.1818; 0.1901 and 0.2345; 0.1918, respectively) were obtained. With apixaban lower costs per patient in TKR (€−14) were generated, so it was the dominant treatment. Additional costs (€15) could be incurred in THR, with a cost per LYG of €2083 and €50,000 per QALY gained. In 5 years, apixaban was cheaper and more effective in both TKR and THR. Conclusions According to this study, apixaban was shown to be a cost-effective treatment compared with dabigatran for VTE prevention.

Resumen Objetivo Analisis de coste-efectividad de apixaban frente a dabigatran en la prevencion de la tromboembolia venosa (TEV) en la artroplastia total de rodilla (ATR) o cadera (ATC). Metodos Modelo con 2 periodos: posprevencion de 90 dias (corto plazo) y a 5 anos (Markov). Se incluyeron las complicaciones de la TEV (trombosis venosa profunda distal y proximal, embolia pulmonar, sangrados y sindrome postrombotico). La eficacia comparada se obtuvo de un metaanalisis y los costes de fuentes espanolas. Se aplico una tasa de descuento del 3,5% anual para costes y beneficios. Resultados Segun el metaanalisis, el riesgo relativo (RR) de TEV o muerte, frente a enoxaparina, fue menor con apixaban que con dabigatran en ATR (RR: 0,89; IC 95% 0,32-1,65 y RR: 1,35, IC 95% 0,19-3,39) y en ATC (RR: 0,35, IC 95% 0,05-2,51 y RR: 0,89, IC 95% 0,22-3,21, respectivamente). A corto plazo, con apixaban se obtendrian mas anos de vida (AVG) y mas anos de vida ajustados por calidad (AVAC) por paciente, tanto en ATR (0,2037; 0,1908) como en ATC (0,2417; 0,1921) que con dabigatran (0,1818; 0,1901, y 0,2345; 0,1918, respectivamente). Habria menos costes por paciente con apixaban en ATR (-14 €) por lo que este seria el tratamiento dominante. En ATC se producirian costes adicionales (15 €) con un coste por AVG de 2.083 y de 50.000 € por AVAC ganado. A 5 anos, apixaban fue mas barato y mas efectivo en ATR y en ATC. Conclusiones Segun el presente estudio, apixaban es un tratamiento coste-efectivo en comparacion con dabigatran en la prevencion de la TEV.

Resumen Este articulo recoge las novedades que se han producido en riesgo vascular en el ano 2010. Resume cinco ponencias, en el orden que se expusieron, en la reunion anual del grupo de trabajo de riesgo vascular de la Sociedad Espanola de Medicina Interna (Valencia, 5 y 6 mayo 2010): hipertension arterial antitrombosis, lipidos, diabetes mellitus y estratificacion del riesgo vascular. Los autores han revisado en profundidad las investigaciones mas relevantes publicadas en 2010 con algunos datos del ano 2011.

Statin therapy reduces the incidence of cardiovascular (CV) disease by 30-40%. However, some risk of unprevented CV complications still persists. Thus, new drugs that when associated to the statins favorably modify the lipid profile and further reduce CV risk are needed. In this clinical commentary, we review the role of other lipids (HDL cholesterol and triglycerides) in CV risk and those potentially useful agents that could be added to statins. Fibrates are especially effective to decrease triglycerides, whilst niacin has a global effect, decreasing LDL cholesterol and triglycerides and is the most effective drug to increase HDL cholesterol. The association of statins plus niacin may be the immediate future to tackle the comprehensive treatment of dyslipidemia and potentially further reduce the risk of CV disease.

Resumen Las enfermedades cardiovasculares constituyen la primera causa de muerte en Espana. Mientras que su peso relativo en la mortalidad esta disminuyendo, aumenta como causa generadora de morbilidad, hospitalizacion y discapacidad. Hasta ahora el abordaje de estos pacientes habia sido unifactorial; sin embargo, el objetivo actual de la prevencion cardiovascular es reducir el riesgo absoluto, es decir, disminuir la probabilidad de un evento cardiovascular de cualquier tipo en cualquier territorio vascular. De esta forma es el riesgo general lo que determina el tipo y la intensidad de la intervencion. Los pacientes que mas se benefician del control de los factores son aquellos que presentan un alto riesgo cardiovascular; estos son, segun las ultimas guias, los pacientes en prevencion secundaria, los que tienen varios factores de riesgo cardiovascular o un solo factor muy elevado, los diabeticos y los pacientes con sindrome metabolico. El control de los factores de riesgo cardiovascular en todos los ambitos de la sanidad es deficitario, incluso en las poblaciones de alto riesgo, aunque la tendencia en el tiempo es favorable. El manejo intensivo y general del riesgo cardiovascular mejora el pronostico de estos pacientes.

La elevacion de la presion arterial se asocia a un aumento continuo y gradual de la incidencia de enfermedad cardiovascular (ECV). Ademas, la hipertension arterial (HTA) puede ser tratada de forma efectiva, disminuyendo de esta forma la ocurrencia de las ECV, especialmente el ictus. La conciliacion de la continuidad del riesgo cardiovascular a lo largo de los valores crecientes de la presion arterial, con las decisiones clinicas practicas, se solventa calculando el riesgo cardiovascular absoluto multifactorial de cada individuo, y de ese modo priorizando y aumentando la intensidad de la intervencion en los sujetos de mayor riesgo cardiovascular. Se dispone de un modelo semicuantitativo de valoracion del riesgo cardiovascular propuesto por las Sociedades Europeas de Hipertension y Cardiologia. Otra estrategia es el empleo de ecuaciones tipo SCORE, con datos obtenidos en personas del sur de Europa, con menor riesgo cardiovascular que las del norte. Sin embargo, el uso de las tablas de riesgo cardiovascular, donde el enfasis se pone en el valor del riesgo y no en el de cada factor aislado, puede hacer olvidar al clinico la necesidad perentoria de controlar los factores de riesgo una vez iniciado el tratamiento. Es importante recordar que el grado de control de los factores de riesgo cardiovascular, incluida la HTA, es todavia muy bajo en practicamente todos los paises. Por ello, debe hacerse enfasis en que el riesgo cardiovascular solo se controla eficazmente alcanzando los objetivos terapeuticos en cada factor de riesgo que se haya decidido tratar.

Introduccion La hipertension arterial y la edad son los factores de riesgo cardiovasculares (FRCV) principales en la poblacion anciana. Con la edad existe un incremento en los niveles de presion arterial sistolica (PAS) y un descenso de la presion arterial diastolica (PAD) debido a la rigidez arterial de las grandes arterias. Numerosos estudios epidemiologicos han demostrado que la presion de pulso (PP) es un factor de riesgo independiente, mejor que la PAS, de mortalidad global, cardiovascular, enfermedad coronaria y cerebrovascular, sobre todo en poblacion anciana. Objetivos Determinar la asociacion entre la PP con el antecedente de enfermedad cardiovascular clinica en una muestra poblacional de ancianos espanoles. Determinar si la PP se asocia mejor que la PAS, PAD y presion arterial media (PAM) con el antecedente de dano cardiovascular clinico. Pacientes y metodos Los datos empleados han sido obtenidos de una muestra del proyecto EPICARDIAN pertenecientes al barrio de Lista (Madrid) y Arevalo (Avila). Se consideraron los siguientes FRCV: edad, sexo, hipertension, diabetes, hipercolesterolemia, obesidad, obesidad abdominal y tabaquismo. Se definio enfermedad cardiovascular clinica a los antecedentes de accidente cerebrovascular (ACV), infarto agudo de miocardio (IAM), angina y/o claudicacion intermitente. Resultados Se estudiaron 2.665 sujetos (56% mujeres), edad media: 74 anos. El 74,3% eran hipertensos, el 55,6% presentaban obesidad central y el 31,9% hipercolesterolemia. De los cuatro componentes de PA, la PP elevada fue el parametro que mas se asocio a ACV, angina y claudicacion intermitente: odds ratio en el analisis multivariado de 1,015 (intervalo de confianza del 95% [IC 95%]: 1,001-1,030), 1,029 (IC 95%: 1,006-1,052) y 1,012 (IC 95%: 1,002-1,023), respectivamente. Conclusiones En la poblacion anciana estudiada la PP es el parametro de la PA que muestra una mayor asociacion con el antecedente de enfermedad cardiovascular.

Fundamento y objetivos Analizar el impacto que tiene un abordaje global en consultas de Medicina Interna para controlar de forma integral todos los factores mayores de riesgo vascular. Pacientes y metodos Estudio multicentrico de cohorte, prospectivo, sobre pacientes con alto riesgo vascular seguidos durante un ano en consultas de Medicina Interna. Se evaluo el grado de control de los factores mayores de riesgo vascular (hipertension arterial, diabetes, colesterol ligado a lipoproteinas de baja densidad [c-LDL], tabaquismo y obesidad) al principio y al final del seguimiento y el numero de recursos sanitarios consumidos para su control. Resultados Se estudiaron 456 pacientes (56,9% varones; edad: 65,1 anos; desviacion estandar: 10,6 anos). El 54,4% eran diabeticos, el 58% presentaban lesion de organo diana y el 46,2% enfermedad cardiovascular. El porcentaje de pacientes con control inicial y final, respectivamente, de los distintos factores de riesgo fue: presion arterial el 50,55% y el 60,6% (p 0,05); tabaquismo el 63,0% y el 87,5% (p Conclusiones El abordaje global sobre el paciente con alto riesgo vascular consiguio duplicar al ano el grado de control integral de los 5 principales factores de riesgo. La diabetes y la obesidad dificultaron el control. La falta de control integral incremento en 2 veces el riesgo de eventos vasculares.

To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units.A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire.Of the total 260hospitals identified in the SNHS, 142responses were obtained from 139hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14±8, with a mean rate of 7.2±3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2,987±2,066, and those discharged by internists was 232±107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge.The 2013 RECALMIN survey revealed a number of important aspects of the organisation, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement.

PUNTOS CLAVE Introduccion. El sindrome metabolico (SM) es una entidad clinica de elevada prevalencia, con una definicion variable, bajo la que subyace la obesidad y la resistencia insulinica como pilares constituyentes. Los factores que lo componen son la alteracion del metabolismo hidrocarbonado, la obesidad, la hipertension arterial y las alteraciones del perfil lipidico. Tratamiento no farmacologico. La base del tratamiento del SM es el cambio del estilo de vida, realizando ejercicio aerobico de una manera regular y adoptando una dieta cardiosaludable, siendo el prototipo de esta la llamada "dieta mediterranea". La perdida de peso a traves de los puntos anteriores es otro aspecto fundamental en el manejo del SM. Tratamiento farmacologico. La farmacoterapia de los componentes individuales del SM no difiere mucho de la que se realiza para cada uno de ellos por separado; ademas se requiere la antiagregacion del paciente en la mayoria de los casos. Habitualmente sera necesario recurrir a multiples farmacos para conseguir un adecuado control de los factores de riesgo cardiovascular. Perspectivas de futuro. Se estan realizando investigaciones prometedoras en multiples campos, dirigidas a atacar el SM en su base molecular; asi ya hay farmacos que actuan sobre nuevas dianas terapeuticas como los receptores activados por la proliferacion de los peroxisomas (PPAR), el receptor retinoide X (RXR) y los receptores CB-1.

Introduccion A pesar de ser la medida correcta de la presion arterial (PA) el instrumento diagnostico basico para el diagnostico y manejo de la hipertension arterial (HTA), el conocimiento sobre esta tecnica es bastante deficitario. Objetivos Determinar la proporcion de medicos residentes de Medicina Familiar y Comunitaria (MFyC), Medicina Interna (MI) y Cardiologia (C) del area 2 de Madrid que conocen las recomendaciones internacionales para diagnostico de HTA y medida correcta de la PA. Comparar el grado de conocimiento en funcion de la especialidad y de haber rotado previamente por consulta de HTA. Por ultimo, identificar los aspectos relacionados con la medida de la PA que son peor y mejor conocidos.Material y metodos. Estudio descriptivo, observacional y transver-sal del conocimiento de las recomendaciones segun normativa de la Organizacion Mundial de la Salud/Sociedad Internacional de HTA y Sociedad Britanica de HTA. Sujetos: medicos residentes de dichas especialidades del area 2 de Madrid. Intervenciones: encuesta individual (12 preguntas): parte 1: numero de medidas e intervalo entre ellas para diagnostico de HTA. 2: extremidad donde debe medirse la PA. 3: evaluacion de hipotension ortostatica. 4: caracteristicas y uso correcto del manguito. Resultados De 73 residentes participaron 64 (88%): 44 de MFyC (90% de los mismos), 11 de MI (73%) y 9 de C (100%). Habian rotado por consulta de HTA 13 (20,3%). Solo 2 (3%) respondieron correctamente todas las preguntas; el 12,5% a menos de 5, el 71,9 % entre 5 y 9 y el 15,6 % mas de 9. La mediana de respuestas correctas es mayor en funcion del ano de residencia; a mayor ano mejores resultados (p = 0,001) y de la especialidad, Cardiologia frente a Medicina Interna y Medicina Familiar y Comunitaria (p =0,0441). El numero de visitas y de medidas a realizar en cada visita fueron las preguntas mas acertadas (86% y 89% de los encuestados), mientras que la actitud a seguir en caso de duda sobre el tamano del manguito a elegir y cuando distintas lecturas de PA difieren mas de 5 mmHg fueron las menos acertadas (39% en ambas). Conclusiones El grado de conocimiento sobre la tecnica para medir correctamente la PA es muy mejorable entre los residentes de especialidades medicas que estan directamente implicadas en el manejo de la HTA, por lo que parece necesario reforzar los conocimientos facilitados a lo largo de la residencia.

Justificacion .La enfermedad tromboembolica venosa (ETEV) es una patologia frecuente y grave cuyo tratamiento basado en la utilizacion de anticoagulantes no esta exento de complicaciones y fracasos. Objetivo Disponer en Internet de una amplia base de datos de pacientes con ETEV, atendidos en los hospitales espanoles, que sirva de ayuda en la practica clinica. Metodos Registro informatizado de todos los casos incidentes con diagnostico objetivo de ETEV atendidos en 27 hospitales espanoles desde el 1 de marzo de 2001. Se recogen todos los datos relacionados con el diagnostico, tratamiento y seguimiento durante un periodo de al menos tres meses. Resultados Desde el 1 de marzo hasta el 31 de agosto de 2001 se han incluido 573 pacientes (399 con trombosis venosa profunda [TVP], 108 con embolismo pulmonar [EP] y 66 con TVP y EP), con una edad media de 65,8 anos. Un 10,5% presentaba al menos una situacion de riesgo: 5,2% hipoprotrombinemia ( Conclusiones Es factible disponer de informacion sobre un numero importante de pacientes con ETEV, de los cuales el 10,5% son pacientes complicados, lo que permitira a corto plazo poder utilizarla para la toma de decisiones, especialmente en estos ultimos.

La enfermedad cardiovascular (ECV) constituye en las mujeres de los paises desarrollados la primera causa de muerte. A pesar de ello no ha generado la preocupacion y atencion que si ha recibido y recibe en el hombre. Se han descrito en las mujeres diferencias en la frecuencia de factores de riesgo y su contribucion especifica al desarrollo de la ECV en las manifestaciones clinicas, el diagnostico, tratamiento y pronostico. Se acepta que son infradiagnosticadas e infratratadas con mayor frecuencia que los hombres y adicionalmente asocian un peor pronostico vital. En cuanto a la prevencion de la ECV debemos llamar la atencion sobre la progresiva adopcion por parte de la mujer, particularmente a edades jovenes, de habitos de vida mas perniciosos como el tabaquismo, sedentarismo o dietas inapropiadas que aumentaran la prevalencia de obesidad y diabetes mellitus tipo 2, entre otras, con el consiguiente efecto deletereo sobre su salud cardiovascular, hecho que, junto con su mayor esperanza de vida, acentuara la magnitud de un problema, ya principal de salud publica. Este articulo revisa todas estas diferencias generoespecificas en la prevencion, diagnostico y tratamiento de la enfermedad cardiovascular en la mujer.

Resumen Objetivos Presentar el Registro Informatizado de la Enfermedad Tromboembolica en Espana (RIETE), informar de las directrices del mismoy mostrar los resultados preliminares de las primeras 2.074 observaciones. Pacientes y metodos Se describen los objetivos, organizacion, sistema de recogida de datos de los pacientes y su gestion. Se analizaron los datos epidemiologicamente, y se intento relacionarlos con patologias concomitantes y unos factores de riesgo previamente determinados. Resultados Los pacientes se repartieron de forma homogeneaporedad(media de 66 ± 17 anos)y sexo. La presentacion clinica inicialfue la trombosis venosaprofunda en un 77,7% de los casos,y en el20% de los pacientes coexistio algun tipo de cancer. Se inmovilizo a 619 pacientes mas de 7dias antes del inicio de la enfermedad tromboembolica venosa (ETEV), y al 14,7% se le habia intervenido en los dos meses previos; se realizo tromboprofilaxis en el 66,7%. En cuanto al tratamiento, el 89,3% recibio alguna heparina de bajo peso molecular en la fase aguda, tratamiento que se prolongo en el 25,3% hasta la fase cronica. Los anticoagulantes orales fueron el tratamiento cronico de eleccion (74,2%). El filtro de cava se utilizo tan solo en el 2,3% de los pacientes. Conclusion Los estudios epidemiologicos mediante registros informatizados en red nos permitiran obtener datos validos sobre la evolucion natural de la ETEV en Espana,y nos ayudaran a tomar decisiones basadas en la evidencia en unapatologia en la que no existen reglas estrictas sobre el diagnostico y el tratamiento.

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

Una vez confirmada la existencia de hipertension arterial y establecida la necesidad de tratamiento farmacologico, segun la estratificacion de riesgo aceptada, existe posibilidad de elegir entre multiples farmacos, pudiendose optar por el uso de un unico farmaco o bien por una asociacion fija de dos de ellos como primer escalon. La eleccion de una determinada clase de farmaco antihipertensivo se basara en las caracteristicas del paciente, sin olvidar en todos los casos la relacion coste/beneficio. Los diureticos, betabloqueantes, inhibidores de la enzima de conversion de la angiotensina y antagonistas de los receptores de la angiotensina, calcioantagonistas y los alfabloqueantes son todos farmacos de primera eleccion. La eleccion de uno de ellos en concreto se sustentara en las caracteristicas del paciente; existen una serie de situaciones determinadas por la patologia y los factores de riesgo del paciente que, apoyadas en el peso de la evidencia disponible, indicaran o simplemente aconsejaran la eleccion o rechazo de un farmaco o grupo determinado.

This paper gathers the news concerning vascular risk in 2010. It summarizes five lectures, according to the order of presentation, at the annual meeting of the vascular risk working group of the Spanish Society of Internal Medicine (SEMI, Valencia 5(th) and 6(th) May 2011): arterial hypertension, antithrombosis, lipid disorders, diabetes mellitus and vascular risk stratification. The authors have made a depth revision of the more relevant research been published in 2010 with some data of 2011.

Control of cardiovascular risk factors (CVRF) in secondary prevention becomes very important in diabetic patients, although this can be even more difficult to achieve than in non-diabetic patients. This article compares the degree of control of CVRF and drugs prescribed to diabetics versus non-diabetics in the MIRVAS study. It also evaluates the results of an intensive and multifactorial intervention regarding both subjects in this population.The subgroups of diabetic patients are compared (71 patients: 38 in the intervention group and 33 in the control group) within groups and with the non-diabetics (176 patients: 83 and 93, respectively), all of them included in the MIRVAS study. The targets of CVRF control and drugs to be prescribed are those recommended in the international guidelines.The baseline prevalence of high blood pressure and dyslipidemia is higher in diabetic patients (70.4% vs. 54% and 73.2% vs. 50.6%, respectively). At one year after the cardiovascular event, blood pressure (BP) and HDL-cholesterol control are significantly worse in diabetics (45.9% of diabetic patients vs. 81.9% of non-diabetics with BP under control; 49.43 mg/dl in diabetics vs 53.82 mg/dl in non-diabetics). Diabetics from the intervention group have better HbA1c (5.52% vs. 6.59%), HDL-cholesterol (52.81 mg/dl vs. 45.24 mg/dl), systolic BP (123.03 mmHg vs. 136.50 mmHg) and statins prescription (96.77% vs. 76.67%).Diabetes mellitus makes it more difficult to achieve the objectives of control in secondary prevention. An intensive and multifactorial intervention such as that one done in MIRVAS study can attain better results.

Arterial hypertension and aging are the main cardiovascular risk factors (CVRF) in the elderly population. Aging is associated with an increase in systolic blood pressure (SBP) levels and a decrease of diastolic blood pressure (DBP), due to increased large artery stiffness. Several epidemiological studies have demonstrated that pulse pressure (PP) is an independent risk factor, better than SBP, for overall, cardiovascular mortality, coronary heart disease and cerebrovascular, particularly in the elderly.To determine the association of PP with clinical cardiovascular damage, in a population-based sample of Spanish elders subjects. To quantify the association between PP and the background of clinical cardiovascular damage. To determine which PP, SBP, DBP or mean arterial pressure (MAP) are better associated to the history of clinical cardiovascular damage.The sample analyzed included individuals from the EPICARDIAN study in the areas of Lista district (Madrid) and Arévalo (Avila). The following CVRF of age, gender, hypertension, diabetes, dyslipidemia, obesity, abdominal obesity and smoking were considered. Clinical cardiovascular damage is defined as the personal background of stroke, myocardial infarction, angina pectoris and/or intermittent claudication.The sample included 2665 individuals, 56% women, mean age: 74 year-old; 74.3% were hypertensive, 55.6% had central obesity and 31.9% hypercholesterolemia. In the multivariate analysis, the PP was the BP parameter associated most to stroke, angina pectoris and intermittent claudication: OR, 1.015, (95% CI: 1.001-1.030), 1.029 (95% CI: 1.006-1.052) and 1.012 (95% CI: 1.002-1.023), respectively.In the elderly population studied, an elevated PP is the component of arterial pressure with the greatest association to the background of cardiovascular damage.

To analyze the effect of a global approach on patients with high cardiovascular risk for the integral control of cardiovascular risk factors.Multicentric prospective study of patients with high vascular risk, followed-up for one year in internal medicine consultations. We measured the grade of control over major cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, tobacco, obesity) before and after the one-year follow-up period.We studied 456 patients (56% males; age: 66.1, standard deviation: 11.5 years); 54.4% were diabetics, 58.0% had target organ damage and 46.2% had cardiovascular disease. Blood pressure control varied from 50.5 to 60.6; LDL-cholesterol control from 44.7 to 58.1%; diabetes control from 56.5 to 56.6%; tobacco control from 63.0 to 87.5% and obesity control from 60.0 to 55.4%. Integral control of all cardiovascular risk factors varied from 10.7 to 23.2% of patients. Factors independently associated to lack of integral control were: diabetes (Odds Ratio [OR]: 4.42; 95% confidence interval [95%CI]: 2.75-7.14), basal systolic blood pressure (OR: 1.03; 95%CI 1.02-1.05) and basal body mass index (OR: 1.08; 95%CI: 1.02-1.14). Lack of integral control was independently associated to the incidence of cardiovascular events (OR: 2.00; 95%CI: 1.09-5.35).A global approach on the patient with high cardiovascular risk duplicated the integral control of the five main risk factors. Diabetes and obesity were factors which made integral control difficult. Lack of integral control increased two times the risk of cardiovascular events.

INTRODUCTION, BASES AND AIMS: The aim of this study is to present the different association patterns between cardiovascular disease risk factors and target organs lesion due to arterial hypertension (AH), and to establish the possible differences by gender and age, and compare our findings with the existing references in the medical literature.Nationwide croo-sectional study with 2264 consecutive patients in the Outpatient Clinic of Internal Medicine 18 years of age or older and with high cardiovascular risk taken from the CIFARC (Integral Control of High Risk Cardiovascular Factors) study run by the SEMI (Spanish Internal Medicine Association) cardiovascular Risk Group.We have obtained statistically significant correlations between: Raised levels of total cholesterol and LDL cholesterol, low HDL cholesterol and smoking habit. LDL cholesterol with Family History of early cardiovascular events (hereinafter FH) and ischemic cardiopathy. Low HDL cholesterol with FH. Smoking habit with FH. Left ventricular hypertrophy (LVH) with raised levels of proteinuria and creatinine, atheromatosis, retinopathy I-II, ischemic cardiopathy, and diabetic nephropathy. Ischemic cardiopathy with LVH, diabetic nephropathy, peripheral vascular disease (PVD) and age. Proteinuria with raised levels of creatinine, atheromatosis, retinopathy I-II, nephropathy and severe retinopathy. Retinopathy I-II with raised levels of creatinine, atheromatosis, nephropathy, PVD and severe retinopathy. Raised levels of creatinine with reduced levels of HDL cholesterol, proteinuria, atheromatosis, retinopathy I-II, nephropathy and PVD. FH inversely with age: patients with FH consult a doctor an average of three years earlier than patients who do not experience FH. Atheromatosis with LVH, raised levels of proteinuria and creatinine, retinopathy I-II, cerebrovascular disease, nephropathy, PVD and age. PVD with raised levels of creatinine, atheromatosis, retinopathy I-II, and ischemic cardiopathy. Cerebrovascular disease with atheromatosis, age and weight. Severe retinopathy with proteinuria, nephropathy, and retinopathy I-II. Diabetic nephropathy with raised levels of proteinuria and creatinine, atheromatosis, retinopathy I-II, ischemic cardiopathy, and severe retinopathy. Age with raised creatinine, atheromatosis, ischemic cardiopathy, and cerebrovascular disease. With respect to gender, we found differences in most of the studied variables.There exist different association patterns between the studied variables.

Quantify risk factor control and compliance of present therapeutic recommendations in the two months following an acute myocardial infarction (AMI) or ischemic stroke.Cross-sectional, descriptive study of risk factors and treatments prescribed on discharge after AMI or stroke.A total of 68% of 122 patients (65.6% AMI; 22.1% women; mean age: 64.9), had controlled BP; 70.1% BMI30 kg/m2; 54.1% LDL-cholesterol100 mg/dl. Controlled BP (78.7% versus 50%) and adequate LDL-cholesterol (62.3% versus 20.5%) were greater after AMI than after stroke (p0.001). ACEI/ARA II prescribed after AMI: 30% (p0.001). After AMI, 26.2% without beta blocker (only 8.8% contraindicated). HbA1c7% in 55.5% of diabetics; BP control inferior to non-diabetics (p0.001).Short term control of the risk factors after cardiovascular episode and prescription on hospital discharge are improvable, above all after a stroke.