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Proyecto PROFUND., [ES] Objetivos: Analizar la sensibilidad (S), la especificidad (E) y los valores predictivos positivo (VPP) y negativo (VPN) de cada dimensión del índice de Barthel (IB) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). Métodos: Estudio transversal multicéntrico. Se consideraron dos puntos de corte del IB (≥ 90 puntos para el cribado de fragilidad y < 60 puntos para el diagnóstico de dependencia severa). Para cada dimensión y combinaciones de dos dimensiones se calcularon la S, la E, el VPP y el VPN con respecto al IB completo. Resultados: El IB medio de los 1.632 PPP incluidos (edad media de 77,9 ± 9,8 años, 53% varones) fue 69 ± 31 (< 90 en el 58,7% y < 60 en el 31,4% de pacientes). La dimensión «alimentación» obtuvo los mayores VPN para tener un IB ≥ 60 y ≥ 90 puntos (87% y 99,6%, respectivamente). Las dimensiones «deambular» y «subir y bajar escaleras» obtuvieron el mayor VPP para tener un IB ≥ 60 y ≥ 90 (99,2/99,5% y 81/92%, respectivamente; la combinación de ambas preguntas aumentó el VPP al 95 y al 99,6%, respectivamente. Conclusiones: Los PPP de ámbito hospitalario presentan con elevada frecuencia deterioro funcional. La dimensión referente a alimentarse obtuvo el mayor VPN, por lo que se puede utilizar para el diagnóstico de dependencia severa, mientras que la combinación de deambular y subir y bajar escaleras obtuvo el mayor VPP, pudiendo utilizarse para plantear el cribado de fragilidad de los PPP., [EN] Objectives: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). Methods: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥ 90 points for screening frailty and < 60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. Results: The mean BI of the 1,632 included PPPs (mean age, 77.9 ± 9.8 years; 53% men) was 69 ± 31 (< 90 for 58.7% and < 60 for 31.4% of the patients). The “feeding” measure achieved the highest NPV, for a BI ≥ 60 and ≥ 90 points (87% and 99.6%, respectively). The “walking” and “going up and down stairs” measures achieved the highest PPV, for a BI ≥ 60 and ≥ 90 (99.2%/99.5% and 81%/92%, respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. Conclusions: PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.

Resumen Objetivos Determinar el grado de consecucion del objetivo terapeutico del colesterol de las lipoproteinas de baja densidad (cLDL) en pacientes de alto y muy alto riesgo vascular atendidos en las unidades de lipidos, asi como las causas de no consecucion. Pacientes y metodo Estudio observacional retrospectivo multicentrico. Se incluyo a los pacientes mayores de 18 anos con alto o muy alto riesgo vascular, segun los criterios de la Guia europea de prevencion cardiovascular de 2012, remitidos de forma consecutiva a las unidades de lipidos entre enero y junio del 2012 y con seguimiento a los 2 anos de la primera visita. Resultados Se incluyo a 243 pacientes procedentes de 16 unidades de lipidos. La edad media fue de 52,2 anos (DE 13,7) con un 62,6% de varones. Un 40,3% eran de muy alto riesgo. En la primera visita seguian tratamiento hipolipidemiante el 86,8% (en combinacion 25,1%) y en la segunda visita el 95,0% (en combinacion 47,3%) (p Conclusiones Se consiguieron los objetivos de cLDL en cerca de un tercio de los pacientes. La baja adherencia del paciente, seguida de la inercia medica, son las causas mas frecuentes que pueden explicar estos resultados.

Objectives To determine the extent to which low-density lipoprotein cholesterol (LDL-C) therapeutic targets are achieved in patients with high and very high vascular risk treated in lipid units, and the reasons why these targets are not met. Patients and method Observational and retrospective multi-centre study. Patients over the age of 18 with high or very high vascular risk according to the criteria set forth by the 2012 European guidelines on cardiovascular disease prevention who were consecutively referred to lipid units between January and June 2012 and with follow-up two years after the first visit were included. Results 243 patients from 16 lipid units were enrolled. The mean age was 52.2 years (SD 13.7) and 62.6% of the patients were male. 40.3% were classified as very high risk. At the first visit, 86.8% were on lipid-lowering treatment (25.1% on combination therapy), which rose to 95.0% at the second visit (47.3% on combination therapy) (p Conclusions LDL-C therapeutic targets were achieved in around one third of patients. Patient non-adherence, followed by clinical inertia, are the primary causes that could explain these results.

Determination of the level of achievement of the low density lipoprotein cholesterol (LDL-C) therapeutic target in patients with high and very high vascular risk treated in Lipid Units, as well as the causes of non-achievement.Multicentre retrospective observational study that included patients over 18 years with high and very high vascular risk, according to the criteria of the 2012 European Guidelines on Cardiovascular Disease Prevention, referred consecutively to Lipid Units between January and June 2012 and with follow-up two years after the first visit.The study included a total of 243 patients from 16 lipid units. The mean age was 52.2 years (SD 13.7), of whom 62.6% were males, and 40.3% of them were very high risk. At the first visit, 86.8% (25.1% in combination) and 95.0% (47.3% in combination) in the second visit (P.001) were treated with lipid-lowering treatment. The therapeutic target was achieved by 28% (95 CI: 22.4-34.1). As regards the causes of non-achievement, 24.6% were related to the medication (10.3% maximum tolerated dose and 10.9% due to the appearance of adverse effects), 43.4% due to the physician (19.4% by inertia, 13.7% considering that target already reached), and 46.9% due to the patient, highlighting the therapeutic non-compliance (31,4%).LDL-C targets were achieved in about one-third of patients. The low adherence of the patient, followed by medical inertia are the most frequent causes that can explain these results.

Resumen En los pacientes con dislipidemia se deben alcanzar los objetivos terapeuticos para obtener la maxima reduccion del riesgo de padecer eventos cardiovasculares, sobre todo de infarto de miocardio. A pesar de disponer de guias de practica clinica y de farmacos hipolipidemiantes potentes, dificilmente se alcanzan los objetivos de colesterol de las lipoproteinas de baja densidad (cLDL), siendo una de las causas la inercia terapeutica. Para evitarla existen herramientas que permiten planificar el tratamiento y facilitar las decisiones. Sin embargo, uno de los problemas que se plantea en la clinica diaria para aplicarlas es desconocer el porcentaje de reduccion de cLDL que se pretende conseguir para seleccionar el medicamento mas adecuado. Eso es asi tanto en la instauracion del tratamiento como cuando se necesita modificar por no alcanzar el objetivo buscado. Este articulo propone un metodo practico que puede ayudar a resolver estas cuestiones.

The management of cardiovascular risk and dyslipidemia are justified in guidelines. In the elderly, when they are in primary prevention, recommendations are controversial, even if there is evidence in reducing morbidity. In secondary prevention, between 65 and 85 years, there is enough evidence to recommend statins. The decision to start or to continue further treatment must be complemented by comprehensive assessment of the risk-benefit factor. In elderly patients we have to support in decision-making, we take clinical judgment and not just the age criteria. In women the risk is underestimated and may be untreated. The recomendations are the same as in men. During pregnancy there are particular recommendations.

Resumen Objetivo Conocer el origen y los motivos de la derivacion de pacientes dislipidemicos a las unidades de lipidos (UL) en la practica habitual. Metodos Se registraron los datos de las primeras visitas relacionadas con dislipidemias efectuadas durante un mes en 10 UL de Cataluna. Resultados Se estudio a 146 pacientes (edad media de 48±23 anos; el 53,8% eran hombres). La alteracion lipidica que con mayor frecuencia origino la derivacion fue la hipercolesterolemia (56%), seguida de la dislipidemia mixta (36%). En 114 casos (78%), el motivo principal de derivacion fue el diagnostico de la dislipidemia y en 32 casos (22%) obtener orientacion terapeutica. El diagnostico final mas frecuente fue el de dislipidemia genetica, generalmente una hipercolesterolemia familiar heterocigota (68%). En 20 pacientes (14%) existian antecedentes de enfermedad isquemica. La atencion primaria fue el ambito de procedencia en 80 casos (55%). Conclusiones El estudio diagnostico de las hiperlipidemias geneticas es la causa mas frecuente de la derivacion a las UL de ambito hospitalario. Aunque la hipercolesterolemia es la alteracion mas frecuente, la dislipidemia mixta afecta a un alto porcentaje de los casos remitidos. La derivacion de pacientes dislipidemicos a unidades especializadas es todavia escasa en nuestra comunidad autonoma.

Introduccion y objetivos Evaluar el patron y los factores predictivos de enfermedad cardiovascular (ECV) en los pacientes ambulatorios con diabetes tipo 2 e hipercolesterolemia. Metodos Estudio prospectivo, abierto y observacional en el que se incluyo a pacientes de ambos sexos (62 ± 8 anos) con diabetes tipo 2 e hipercolesterolemia. Se registraron las manifestaciones clinicas de ECV, incluidos la ngina, el infarto de miocardio, el ictus y la enfermedad arterial periferica; la glucosa, la hemoglobina glucosilada (HbA1c) y los factores de riesgo cardiovascular se evaluaron cada 4 meses durante un periodo de seguimiento de 2 anos, que fue completado por 838 pacientes. Resultados En total, 81 pacientes (9,6%) presentaron un episodio de ECV y 9 fallecieron durante el seguimiento. La ECV fue mas frecuente en los pacientes con historia previa de enfermedad isquemica que en los pacientes sin ella (58 de 258 [22,5%] frente a 23 de 579 [4%], respectivamente; p Conclusiones La incidencia de ECV en esta poblacion de pacientes del sur de Europa con diabetes tipo 2 e hipercolesterolemia es elevada. El hecho de haber presentado un episodio isquemico previo y el exceso de cLDL durante el seguimiento son los predictores mas potentes del riesgo de presentar futuros episodios de ECV.

We investigated the pattern of cardiovascular disease and the factors that predict such disease in outpatients with type-2 diabetes and hypercholesterolemia.This prospective open observational study included outpatients of both sexes (mean age 62 [8] years) with type-2 diabetes and hypercholesterolemia. Clinical manifestations of cardiovascular disease (e.g., angina, myocardial infarction, stroke and peripheral arterial disease), glucose and HbA1c levels, and cardiovascular risk factors were recorded every 4 months throughout the 2-year follow-up period. Overall, 838 patients completed follow-up.During follow-up, 81 patients (9.6%) presented with a cardiovascular event, nine of which were fatal. Cardiovascular events were more frequent in patients with a history of an ischemic condition than in those without: 58 of 258 (22.5%) and 23 of 579 (4%), respectively (P.01). Previous angina or myocardial infarction was the strongest predictor of cardiovascular risk (relative risk [RR]=4.08, 95% confidence interval [CI] 2.39-6.95), followed by previous stroke (RR=2.96, 95% CI 1.26-6.93), high low-density lipoprotein (LDL)-cholesterol levelor =135 mg/dL (RR=2.79, 95% CI 1.56-5.01), peripheral arterial disease (RR=2.44, 95% CI 1.27-4.68), a high HbA1c level (RR=2.08, 95% CI 1.22-3.57), and obesity (RR=1.69, 95% CI 1.0-2.86).The incidence of cardiovascular disease in this southern European population of patients with type-2 diabetes and hypercholesterolemia was high. A history of an ischemic condition and a high LDL-cholesterol level during follow-up were the strongest predictors of cardiovascular disease.

Fundamento y objetivo: La hipercolesterolemia puede contribuir a la aparicion de microalbuminuria. El objetivo de nuestro estudio fue evaluar la influencia de la hipercolesterolemia sobre la aparicion de la nefropatia diabetica incipiente. Como objetivo secundario se estudio la influencia del control glucemico, presion arterial (PA), edad, sexo, tiempo de evolucion de la diabetes, indice de masa corporal y habito tabaquico. Pacientes y metodo: Un total de 930 individuos participaron en un estudio de cohortes observacional, abierto y prospectivo de pacientes con diabetes mellitus tipo 2 e hipercolesterolemia (estudio ESODIAH) durante 2 anos. Para el estudio de la nefropatia se selecciono a 590 pacientes de los que se disponia de determinaciones de albumina. En cada visita cuatrimestral se realizo una evaluacion clinica y analitica que incluyo hemoglobina glucosilada, perfil lipidico y microalbuminuria. Para la comparacion de variables continuas se utilizo el test de la t de Student y para la de frecuencias la prueba de la *2. Se realizaron regresiones logisticas binarias para el calculo de la odds ratio (OR). Resultados: Un 51,7% de los pacientes eran varones, la edad media era de 62,08 anos y el tiempo medio de evolucion de la diabetes de 8,49 anos. Un 40,6% de los sujetos presentaban microalbuminuria al inicio y un 59,4% eran normoalbuminuricos. Una elevada cifra de hemoglobina glucosilada se relacionaba con la presencia de albuminuria (OR = 1,3; intervalo de confianza [IC] del 95% 1,12-1,55; p = 0,001). Los pacientes que progresaron a microalbuminuria (grupo I) eran mayoritariamente fumadores (OR = 3,19; IC del 95%, 1,02-9,96), mas jovenes (OR = 0,93; IC del 95%, 0,89-0,98) y con presion arterial sistolica mas elevada (OR = 1,02; IC del 95%, 1-1,05). Los valores de colesterol total fueron mas altos al finalizar el estudio en los pacientes que presentaron microalbuminuria (211,08 [34,75] mg/dl en el grupo I frente a 200,67 [30,50] en el grupo II; p = 0,042). Conclusiones: El tabaco, el control metabolico de la diabetes y la hipertension arterial influyen en la presencia y la aparicion de la microalbuminuria. Se requieren mas estudios para ver la influencia de la hipercolesterolemia.

Beat therapeutic inertia in dyslipidemic patient management: a challenge in daily clinical practice. In patients with dyslipidemia, there is the need to reach the therapeutic goals in order to get the maximum benefit in the cardiovascular events risk reduction, especially myocardial infarction. Even having guidelines and some powerful hypolipidemic drugs, the goals of low-density lipoprotein-cholesterol (LDL-c) are often not reached, being of special in patients with a high cardiovascular risk. One of the causes is the therapeutic inertia. There are tools to plan the treatment and make the decisions easier. One of the challenges in everyday clinical practice is to know the needed percentage of reduction in LDL-c. Moreover: it is hard to know which one is the treatment we should use in the beginning of the treatment but also when the desired objective is not reached. This article proposes a practical method that can help solving these questions.

The management of cardiovascular risk and dyslipidemia are justified in guidelines. In the elderly, when they are in primary prevention, recommendations are controversial, even if there is evidence in reducing morbidity. In secondary prevention, between 65 and 85 years, there is enough evidence to recommend statins. The decision to start or to continue further treatment must be complemented by comprehensive assessment of the risk-benefit factor. In elderly patients we have to support in decision-making, we take clinical judgment and not just the age criteria. In women the risk is underestimated and may be untreated. The recomendations are the same as in men. During pregnancy there are particular recommendations.

High cholesterol levels might contribute to the presence of albuminuria. The objective of our study was to evaluate the influence of lipid levels on the development of incipient diabetic nephropathy. Secondary objectives were to evaluate the effects of diabetes control, high blood pressure, age, sex, years of diabetes evolution, body mass index and smoking.930 subjects were enrolled in an open observational prospective cohort study of subjects with type 2 diabetes mellitus and high cholesterol levels (ESODIAH study) for 2 years. In our nephropathy study we selected 590 patients who had albuminuria measurements done. In every 4-month interval visit we made a clinical evaluation and blood analysis including HbA1c, lipid profile and microalbuminuria. Statistical analysis included t-Student, chi2 test, and binary logistic regressions.51.7% men, aged 62.08 years of age and with an evolution of their diabetes of 8.49 years were studied. 40.6% had microalbuminuria and 59.4% had normoalbuminuria. High HbA1c correlated with the presence of albuminuria (odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.12-1.55; p = 0.001). The development of microalbuminuria was more frequent in younger (OR = 0.93; 95% CI, 0.89-0.98), smoker (OR = 3.19; 95% CI, 1.02-9.96), subjects with high systolic blood pressure (OR = 1.02; 95% CI, 1-1.05). Total cholesterol levels at the end of the study were higher in new microalbuminuric (group I) than normoalbuminuric patients (group II) (group I: 211.08 [34.75] mg/dl vs group II: 200.67 [30.50]; p = 0.042).Tobacco, blood pressure and diabetes control influences the presence and development of microalbuminuria. More studies are required to study the influence of hypercholesterolemia.