Search

Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.

The reduction of low-density lipoprotein cholesterol with lipid lowering therapy has demonstrated to decrease the risk of developing cardiovascular complications during the follow-up in primary and secondary prevention. Unfortunately, a great number of patients do not achieve recommended targets. This is mainly due to an insufficient use of the lipid-lowering therapy currently available. Although healthy life style changes are the basis of the treatment, in many cases this is not enough and it is necessary to add lipid lowering drugs to attain these targets. For these reasons, the current consensus document of the Spanish Society of Cardiology proposes 4 simple and feasible decision-making algorithms according to cardiovascular risk, with the aim of attaining cholesterol goals in the majority of primary prevention patients in a rapid an efficient way.

Resumen La reduccion del colesterol unido a lipoproteinas de baja densidad con el tratamiento hipolipidemiante ha demostrado disminuir el riesgo de presentar complicaciones cardiovasculares durante el seguimiento, tanto en prevencion primaria como secundaria. Desafortunadamente, un gran numero de pacientes no logran los objetivos de control recomendados. Esto se debe principalmente a un uso insuficiente de las terapias hipolipidemiantes actualmente disponibles. Aunque la base del tratamiento lo constituyen los cambios hacia un estilo de vida mas saludable, en numerosas ocasiones esto no es suficiente y es necesario anadir un tratamiento hipolipidemiante para alcanzar estos objetivos. Por estos motivos, en el presente documento de consenso de la Sociedad Espanola de Cardiologia se proponen 4 algoritmos de abordaje en funcion del riesgo cardiovascular de los pacientes, sencillos y facilmente aplicables, con el objetivo de lograr que la mayoria de los pacientes en prevencion primaria cumplan los objetivos de control de colesterol de manera rapida y eficiente.

Resumen Durante los ultimos meses han aparecido importantes novedades terapeuticas en el area del tratamiento antitrombotico con gran repercusion para nuestra actividad. En el campo de la anticoagulacion de la fibrilacion auricular, la aparicion de nuevas guias que continuan priorizando el uso de anticoagulantes de accion directa supone una contradiccion con las posibilidades que tenemos en nuestra practica clinica, por las limitaciones que impone el visado de estos farmacos. En el sindrome coronario cronico, el tratamiento antitrombotico doble va a pasar a ser una opcion preferencial para un alto porcentaje de enfermos, por lo que sera de gran utilidad poder identificarlos. En los pacientes con enfermedad vascular periferica, tambien el tratamiento antitrombotico doble tendra un papel muy importante. En la insuficiencia cardiaca, los resultados son contrapuestos y las novedades surgidas ayudaran a elegir al mejor candidato. Una area en continuo crecimiento es la de las protesis aorticas percutaneas, pero el tratamiento antitrombotico en estos pacientes no esta claro y han surgido importantes novedades en los ultimos meses. Por ultimo, la anticoagulacion en el paciente oncologico sigue siendo un reto en la practica clinica.

The new coronavirus SARS-CoV-2, which gives rise to the highly contagious COVID-19 disease, has caused a pandemic that is overwhelming health care systems worldwide. Affected patients have been reported to have a heightened inflammatory state that increases their thrombotic risk. However, there is very scarce information on the management of thrombotic risk, coagulation disorders, and anticoagulant therapy. In addition, the situation has also greatly influenced usual care in patients not infected with COVID-19. This article by the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology aims to summarize the available information and to provide a practical approach to the management of antithrombotic therapy. Full English text available from: www.revespcardiol.org/en

Resumen La emergencia sanitaria por COVID-19 en Espana fue de tal magnitud que el 14 de marzo de 2020 se declaro un estado de alarma que se mantuvo durante mas de tres meses. Esta pandemia esta afectando a un numero muy elevado de personas. Para reducir su riesgo de contagio, entre las medidas tomadas se han minimizado las visitas a los centros sanitarios y se han incrementado las consultas telematicas. Una vez se supere la situacion de pandemia, cabra plantearse si la practica de la telemedicina queda limitada a situaciones de crisis sanitaria o puede convertirse en una nueva forma de practicar la medicina. La telemedicina carece de regulacion especifica y presenta lagunas que abocan al medico a considerables dosis de inseguridad. El presente articulo analiza los limites, las precauciones y los estandares legales del uso de la telemedicina.

Resumen La cardiologia clinica es muy amplia y esta en continua actualizacion. Para ofrecer la mejor asistencia a los pacientes, es de gran importancia permanecer actualizados. Hemos revisado usos del acido acetilsalicilico en prevencion primaria que ponen en duda su indicacion, los excelentes resultados de los omega 3 a altas dosis, las novedades en el tratamiento del paciente con diabetes mellitus, con farmacos que reducen eventos cardiovasculares, y lo que aportan las nuevas guias sobre dislipidemias, con recomendaciones de objetivos lipidicos realmente bajos. Tambien revisamos las nuevas aportaciones para el tratamiento del paciente con fibrilacion auricular y cardiopatia isquemica, en los que los anticoagulantes de accion directa deben ser la preferencia terapeutica. Importante es tambien el papel del implante percutaneo de valvula aortica en el abordaje de los pacientes con estenosis aortica. Por ultimo, revisamos la importancia creciente de la cardiooncologia y las nuevas tecnologias en el area de la cardiologia clinica.

The health emergency in Spain caused by COVID-19 was of such a magnitude that on March 14, 2020, a state of alarm was declared that lasted for more than three months. This ongoing pandemic has affected a vast number of people. Among the measures taken to reduce the risk of contagion, visits to health centers have been reduced and virtual consultations have increased. Once the pandemic ends, it will be necessary to consider whether telemedicine should be limited to periods of health crises or whether it could become a new way of practicing medicine. Telemedicine lacks specific regulations and has loopholes that leave physicians with a considerable degree of insecurity. This article analyzes the limits, precautions, and legal standards of the use of telemedicine.

[Purpose]: We examined the association between dietary folate intake and a score of MetS (metabolic syndrome) and its components among older adults at higher cardiometabolic risk participating in the PREDIMED-Plus trial. [Methods]: A cross-sectional analysis with 6633 with overweight/obesity participants with MetS was conducted. Folate intake (per 100 mcg/day and in quintiles) was estimated using a validated food frequency questionnaire. We calculated a MetS score using the standardized values as shown in the formula: [(body mass index + waist-to-height ratio)/2] + [(systolic blood pressure + diastolic blood pressure)/2] + plasma fasting glucose–HDL cholesterol + plasma triglycerides. The MetS score as continuous variable and its seven components were the outcome variables. Multiple robust linear regression using MM-type estimator was performed to evaluate the association adjusting for potential confounders., [Results]: We observed that an increase in energy-adjusted folate intake was associated with a reduction of MetS score (β for 100 mcg/day = − 0.12; 95% CI: − 0.19 to − 0.05), and plasma fasting glucose (β = − 0.03; 95% CI: − 0.05 to − 0.02) independently of the adherence to Mediterranean diet and other potential confounders. We also found a positive association with HDL-cholesterol (β = 0.07; 95% CI: 0.04–0.10). These associations were also observed when quintiles of energy-adjusted folate intake were used instead., [Conclusion]: This study suggests that a higher folate intake may be associated with a lower MetS score in older adults, a lower plasma fasting glucose, and a greater HDL cholesterol in high-risk cardio-metabolic subjects., The PREDIMED-Plus trial was supported by grants from the Instituto de Salud Carlos III, co-financed by the Fondo Europeo de Desarrollo Regional-FEDER including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926; the Cohorte PREDIMED-Plus grant; the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the Recercaixa grant to J.S.-S. (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03 and CB12/03), The International Nut & Dried Fruit Council—FESNAD (Long-term effects of an energy-restricted Mediterranean diet on mortality and cardiovascular disease 2014–2015, No. 201302) [M.A.M.-G.]; the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 [D.R.], EU-COST Action CA16112, Grant of support to research groups no. 35/2011 from the Balearic Islands Government, Grants from Balearic Islands Health Research Institute (IDISBA). This work is partially supported by ICREA under the ICREA Academia programme.

[Purpose]: We examined the association between dietary folate intake and a score of MetS (metabolic syndrome) and its components among older adults at higher cardiometabolic risk participating in the PREDIMED-Plus trial., [Methods]: A cross-sectional analysis with 6633 with overweight/obesity participants with MetS was conducted. Folate intake (per 100 mcg/day and in quintiles) was estimated using a validated food frequency questionnaire. We calculated a MetS score using the standardized values as shown in the formula: [(body mass index + waist-to-height ratio)/2] + [(systolic blood pressure + diastolic blood pressure)/2] + plasma fasting glucose–HDL cholesterol + plasma triglycerides. The MetS score as continuous variable and its seven components were the outcome variables. Multiple robust linear regression using MM-type estimator was performed to evaluate the association adjusting for potential confounders., [Results]: We observed that an increase in energy-adjusted folate intake was associated with a reduction of MetS score (β for 100 mcg/day = − 0.12; 95% CI: − 0.19 to − 0.05), and plasma fasting glucose (β = − 0.03; 95% CI: − 0.05 to − 0.02) independently of the adherence to Mediterranean diet and other potential confounders. We also found a positive association with HDL-cholesterol (β = 0.07; 95% CI: 0.04–0.10). These associations were also observed when quintiles of energy-adjusted folate intake were used instead., [Conclusion]: This study suggests that a higher folate intake may be associated with a lower MetS score in older adults, a lower plasma fasting glucose, and a greater HDL cholesterol in high-risk cardio-metabolic subjects., The PREDIMED-Plus trial was supported by grants from the Instituto de Salud Carlos III, co-financed by the Fondo Europeo de Desarrollo Regional-FEDER including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926; the Cohorte PREDIMED-Plus grant; the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the Recercaixa grant to J.S.-S. (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03 and CB12/03), The International Nut & Dried Fruit Council—FESNAD (Long-term effects of an energy-restricted Mediterranean diet on mortality and cardiovascular disease 2014–2015, No. 201302) [M.A.M.-G.]; the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 [D.R.], EU-COST Action CA16112, Grant of support to research groups no. 35/2011 from the Balearic Islands Government, Grants from Balearic Islands Health Research Institute (IDISBA). This work is partially supported by ICREA under the ICREA Academia programme.

Resumen La pandemia producida por la infeccion por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes mas vulnerables (aquellos con cardiopatias) y del personal sanitario, se han suspendido la mayoria de las consultas presenciales y se han puesto en marcha las consultas telematicas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Espanola de Cardiologia, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telematicas, revisando las afecciones que el cardiologo clinico atiende con mas frecuencia en su consulta ambulatoria y proponiendo unos minimos en ese proceso asistencial. Estas enfermedades son la cardiopatia isquemica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefonica, a que pacientes habra que atender en una consulta presencial y cuales seran los criterios para su seguimiento en atencion primaria. El documento tambien recoge distintas mejoras que pueden introducirse en la consulta telematica para mejorar la asistencia de nuestros pacientes.

The name of author M. Alejandra Restrepo-Cordoba was parsed incorrectly (in such a way as to suggest that her surname is "Alejandra Restrepo-Cordoba") in this article as published.

Introduction and aims Mutations in the troponin T gene ( TTNT2 ) have been associated in small studies with the development of hypertrophic cardiomyopathy characterized by a high risk of sudden death and mild hypertrophy. We describe the clinical course of patients carrying mutations in this gene. Methods We analyzed the clinical characteristics and prognosis of patients with mutations in the TNNT2 gene who were seen in an inherited cardiac disease unit. Results Of 180 families with genetically studied cardiomyopathies, 21 families (11.7%) were identified as having mutations in TNNT2 : 10 families had Arg92Gln, 5 had Arg286His, 3 had Arg278Cys, 1 had Arg92Trp, 1 had Arg94His, and 1 had Ile221Thr. Thirty-three additional genetic carriers were identified through family assessment. The study included 54 genetic carriers: 56% were male, and the mean average age was 41 ± 17 years. There were 33 cases of hypertrophic cardiomyopathy, 9 of dilated cardiomyopathy, and 1 of noncompaction cardiomyopathy, and maximal myocardial thickness was 18.5 ± 6 mm. Ventricular dysfunction was present in 30% of individuals and a history of sudden death in 62%. During follow-up, 4 patients died and 14 (33%) received a defibrillator (8 probands, 6 relatives). Mean survival was 54 years. Carriers of Arg92Gln had early disease development, high penetrance, a high risk of sudden death, a high rate of defibrillator implantation, and a high frequency of mixed phenotype. Conclusions Mutations in the TNNT2 gene were more common in this series than in previous studies. The clinical and prognostic profiles depended on the mutation present. Carriers of the Arg92Gln mutation developed hypertrophic or dilated cardiomyopathy and had a significantly worse prognosis than those with other mutations in TNNT2 or other sarcomeric genes.

Resumen Introduccion y objetivos Las mutaciones en el gen de la troponina T (TNNT2) se han asociado en pequenos estudios al desarrollo de miocardiopatia hipertrofica caracterizada por alto riesgo de muerte subita e hipertrofia leve. Se describe el curso clinico de los pacientes portadores de mutaciones en este gen. Metodos Se analizaron las caracteristicas clinicas y el pronostico de los sujetos con mutaciones en el gen TNNT2 atendidos en una unidad de cardiopatias familiares. Resultados A partir de 180 familias con miocardiopatias estudiadas geneticamente, se identifico a 21 (11,7%) con mutaciones en TNNT2: 10 familias Arg92Gln, 5 Arg286His, 3 Arg278Cys, 1 Arg92Trp, 1 Arg94His y 1 Ile221Thr. A traves de la evaluacion familiar se identifico a 33 portadores geneticos adicionales. El estudio incluyo a 54 portadores geneticos: el 56% varones con una media de edad de 41 ± 17 anos; 33 miocardiopatias hipertroficas, 9 dilatadas y 1 no compactada, con grosor maximo de 18,5 ± 6 mm; con disfuncion ventricular el 30% y antecedentes de muerte subita el 62%. En el seguimiento 4 fallecieron y 14 (33%) recibieron un desfibrilador (8 probandos, 6 familiares). La supervivencia media fue de 54 anos. Los portadores de Arg92Gln tuvieron desarrollo precoz, alta penetrancia, alto riesgo de muerte subita, alta tasa de implante de desfibrilador y alta frecuencia de fenotipo mixto. Conclusiones Las mutaciones en el gen TNNT2 fueron mas frecuentes en esta serie. Su perfil clinico y pronostico depende de la mutacion hallada. Los portadores de la mutacion Arg92Gln desarrollaron miocardiopatia hipertrofica o dilatada y tuvieron un pronostico significativamente peor que con otras mutaciones en TNNT2 u otros genes sarcomericos.

Resumen Objetivos Las enfermedades cardiovasculares son la primera causa de muerte en mujeres, particularmente la cardiopatia isquemica, que aun se sigue considerando una enfermedad de hombres. En Espana hay diversos registros sobre cardiopatia isquemica, aunque ninguno exclusivo de mujeres. Los objetivos de SIRENA fueron describir el perfil clinico de las mujeres con cardiopatia isquemica atendidas en las consultas de cardiologia, estimar su prevalencia de factores de riesgo cardiovascular y conocer su manejo clinico y tratamiento. Pacientes y metodos Estudio multicentrico, observacional, con una muestra de 631 mujeres con cardiopatia isquemica estable, incluidas consecutivamente en las consulta de cardiologia. Participaron 41 investigadores de toda Espana. Resultados La edad media fue de 68,5 anos. La presentacion clinica fue en forma de sindrome coronario agudo hasta en un 67,2%. La prevalencia de factores de riesgo cardiovascular fue elevada (77,7% hipertension, 40,7% diabetes y 68% dislipidemia), con un 30,7% de hipertension no controlada, un 78,4% con cifras de colesterol-LDL superiores a 70 mg/dl y un 49,2% con HbA1c superior al 7%. La gran mayoria de las pacientes recibian tratamiento medico optimo con antiagregantes, betabloqueantes, bloqueadores del eje renina-angiotensina-aldosterona e hipolipidemiantes. Se realizo coronariografia en el 88,3% de los casos e intervencionismo coronario percutaneo en el 63,4%. Conclusiones La mujer con cardiopatia isquemica estable en Espana tiene una presentacion clinica inicial con alguna forma de sindrome coronario agudo y una elevada prevalencia de factores de riesgo cardiovascular inadecuadamente controlados, pese a recibir terapia medica optima. Un elevado porcentaje se somete a revascularizacion coronaria. Son precisos mas esfuerzos en la prevencion secundaria de las mujeres con cardiopatia isquemica estable.

Objectives Cardiovascular diseases are the leading cause of death for women, especially ischemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. Patients and methods A multicentre observational study was conducted with a sample of 631 women with stable ischemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. Results The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70 mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin–angiotensin–aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Conclusions Women with stable ischemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischemic heart disease.

Aims: This study sought to determine the usefulness of genetic testing to predict evolution in hypertrophic cardiomyopathy (HCM) and to assess the role of genetic testing in clinical practice. Methods and Results: Genetic results of 100 HCM patients tested for mutations in ≥10 HCM-causing genes were evaluated. Patients were classified as with poor (Group A) or favourable(Group B) clinical course. Forty-five pathogenic mutations (PM) were identified in 28 patients (56%) from Group A and in 23 (46%) from Group B (p=0.317). Only 40 patients (40%) exhibited PM that had been previously reported and only 15 (15%) had PM reported in ≥10 individuals. PM associated with poor prognosis were identified in just 5 patients from Group A (10%). Conclusion: Genetic findings are not useful to predict prognosis in most HCM patients. By contrast, real-world data reinforce the usefulness of genetic testing to provide genetic counselling and to enable cascade genetic screening. pre-print 298 KB

The relationship between diabetes and the cardiovascular clinical characteristics of Spanish women with stable ischaemic heart disease was studied in a nationwide cross-sectional study. Diabetes was related to a higher burden of risk factors, comorbidity, multivessel disease and coronary surgery.