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This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Resumen El incremento de la supervivencia del enfermo con cancer, junto con el desarrollo de nuevas terapias antitumorales, han puesto de relieve el impacto negativo que las complicaciones vasculares asociadas con el tratamiento oncohematologico tienen en la salud cardiovascular del paciente con cancer. El objetivo de este documento de consenso, promovido por el Grupo de Trabajo de Cardio-oncologia de la Sociedad Espanola de Cardiologia (SEC) y elaborado conjuntamente con diferentes areas de conocimiento de la SEC junto con la Sociedad Espanola de Hematologia y Hemoterapia (SEHH), la Sociedad Espanola de Oncologia Medica (SEOM), la Sociedad Espanola de Oncologia Radioterapica (SEOR), la Sociedad Espanola de Medicos Generales y de Familia (SEMG), la Asociacion Espanola de Especialistas en Medicina del Trabajo (AEEMT), la Asociacion Espanola de Enfermeria Cardiovascular (AEEC), la Fundacion Espanola del Corazon (FEC) y la Asociacion Espanola contra el Cancer (AECC), es proporcionar un enfoque coordinado, multidisciplinar y practico para la estratificacion, la monitorizacion y el tratamiento del riesgo cardiovascular de los pacientes con cancer.

Background Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

Purpose To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. Methods This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18–70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. Results The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). Conclusion The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

INTRODUCTION AND OBJECTIVES To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P

Resumen Introduccion y objetivos En un estudio de base poblacional, se analizaron las posibles diferencias en funcion del sexo en la atencion al dolor toracico o las palpitaciones como motivo de consulta. Metodos El estudio OFRECE incluyo una muestra aleatoria de la poblacion espanola de 8.400 participantes de edad ≥ 40 anos, de los que 1.132 (13,5%) tenian antecedentes de consulta por dolor en el pecho y 1.267 (15,1%), por palpitaciones y se incluyen en este estudio. Se calculo la odds ratio (OR) de que se practicaran determinadas pruebas y se comunicaran los resultados de las consultas en relacion con el hecho de ser mujer, tanto brutas como ajustadas por los factores de riesgo cardiovascular clasicos, antecedentes de enfermedad cardiovascular y diagnostico de angina estable o fibrilacion auricular confirmado en este estudio en cada caso. Resultados No se observaron diferencias en los antecedentes de consulta por dolor toracico entre mujeres y varones (el 13 y el 14,1%; p = 0,159) y si en las consultas por palpitaciones (el 19,0 y el 10,4% respectivamente; p Conclusiones Este trabajo no confirma un sesgo en razon del sexo en la atencion a estos sintomas, aunque no es descartable completamente un sesgo de genero en el diagnostico confirmado en el estudio que limite su capacidad para identificar diferencias en la atencion a las pacientes.

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC). (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Objectives: Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. Methods: This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. Results: One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02–1.04; p

Desde la Seccion de Cardiologia Clinica y Extrahospitalaria se revisan las novedades actuales en el campo de la cardiologia clinica, en esta ocasion con especial enfasis en las novedades en electrocadiografia de superficie y en el campo de mujer y cardiopatia. Se realiza asimismo una somera revision de las principales novedades terapeuticas con fuerte impacto en la clinica diaria y se resume la actividad de la seccion.

En este articulo se presentan las conclusiones y las recomendaciones finales del estudio sobre la enfermedad cardiovascular de la mujer en Espana, realizado por la Sociedad Espanola de Cardiologia. Hay diferencias notables entre mujeres y varones respecto a las caracteristicas clinicas, el perfil de riesgo, la realizacion de pruebas diagnosticas, las medidas terapeuticas y el pronostico en la mayor parte de las enfermedades estudiadas, sobre todo en el sindrome coronario agudo, la insuficiencia cardiaca y la hipertension arterial. Las diferencias en el manejo diagnostico y terapeutico son, en general, desfavorables para las mujeres. No existe informacion adecuada respecto a la fibrilacion auricular y las enfermedades valvulares, por lo que es preciso realizar estudios especificos de estas afecciones. Son necesarias campanas de informacion y educacion para concienciar tanto a la sociedad en general como a los profesionales sanitarios sobre estas desigualdades, asi como adoptar medidas que contribuyan a mejorar la atencion de las enfermedades cardiovasculares en las mujeres.

Las enfermedades cardiovasculares son la causa principal de mortalidad de varones y mujeres en los paises de nuestro entorno. Sin embargo, el riesgo de la enfermedad cardiovascular en la mujer se subestima frecuentemente, debido a la percepcion de que las mujeres estan «protegidas» contra la cardiopatia isquemica. Ademas, las manifestaciones clinicas de la enfermedad coronaria en las mujeres pueden ser distintas de las observadas en los varones. Estos factores pueden llevar a una peor atencion a las mujeres que sufren enfermedades cardiovasculares, no solo cardiopatia isquemica, y a un peor pronostico. En este articulo se discuten algunos aspectos relacionados con las diferencias en los factores de riesgo cardiovascular, las caracteristicas clinicas, el tratamiento y el pronostico relacionados con el sexo, y se detalla la metodologia general del proyecto de estudio sobre la situacion en Espana de la enfermedad cardiovascular en la mujer.

Este articulo es una revision de las principales novedades que se han publicado en el ultimo ano sobre el syndrome metabolico, el envejecimiento de la poblacion y las nuevas guias de fibrilacion auricular. Nuestro objetivo ha sido ofrecer al cardiologo clinico una revision sobre las ultimas conferencias y publicaciones de 2006 relacionadas con estos temas que hemos seleccionado como de gran utilidad para todos.

Introduccion y objetivos El impacto negativo de la insuficiencia renal (IR) en la supervivencia de los pacientes con insuficiencia cardiaca congestiva (ICC) se ha descrito en ensayos clinicos realizados, principalmente, en pacientes con funcion sistolica deprimida (FS-D). El objetivo es valorar las caracteristicas clinicas y el pronostico en pacientes hospitalizados por ICC y diferentes grados de disfuncion renal en los grupos con FS-D y funcion sistolica preservada (FS-P). Pacientes y metodo Se analizo a 552 pacientes ingresados entre el ano 2000 y el 2002 en el servicio de cardiologia con ICC. La funcion renal se valoro utilizando la tasa de filtracion glomerular (TFG) y se consideraron 3 grupos: TFG > 60, 30-60 y Resultados La IR grave se asocio con el perfil de riesgo cardiovascular mas adverso: mayor edad, mayor prevalencia de factores de riesgo cardiovascular, anemia, marcadores de inflamacion y una menor prescripcion de inhibidores de la enzima de conversion de la angiotensina (IECA). Los pacientes con IR grave tenian una supervivencia inferior a la de los otros grupos (riesgo relativo ([RR] = 2,4; intervalo de confianza [IC] del 95%, 1,3-4,4), tanto en FS-D (RR = 3,8; IC del 95%, 1,4-10,6) como en FS-P (RR = 2,9; IC del 95%, 1,2-6,9) e independiente de otras variables con influencia pronostica. La prescripcion de IECA en los enfermos con IR atenuo el impacto negativo de esta sobre el pronostico. Conclusiones La IR es un predictor comun y potente de mortalidad en pacientes hospitalizados por ICC, tanto con FS-P como FS-D, y se asocia con un perfil de riesgo mas elevado.

Introduction and objectives. Most clinical trials that demonstrated the negative impact of renal failure on survival in patients with congestive heart failure (CHF) included a relatively small proportion of subjects with a high creatinine level and were performed in patients with depressed left ventricular systolic function. Our aim was to investigate the clinical characteristics and prognosis of hospitalized CHF patients with depressed or preserved systolic function and different degrees of renal dysfunction. Patients and method. The study included 552 consecutive CHF patients admitted to a hospital department of cardiology between 2000-2002. Renal function was determined from the estimated glomerular filtration rate (GFR), and patients were divided into three groups: GFR>60, GFR 30-60, and GFR

La cardiopatia isquemica ha sido considerada erroneamente como una enfermedad sin importancia en la mujer, debido a su baja frecuencia durante la etapa fertil, a pesar de que fallece por enfermedad cardiovascular un mayor porcentaje de mujeres que de varones. Hay diferencias entre las caracteristicas del riesgo y la enfermedad cardiovascular en las mujeres respecto a los varones, tanto en la presentacion clinica como en la evolucion, el diagnostico, el pronostico y el tratamiento. Son necesarios conocimientos y educacion, un precoz y agresivo control de los factores de riesgo y una apropiada actitud diagnostica y terapeutica. La American Heart Association ha publicado guias para la prevencion cardiovascular en la mujer y la Sociedad Europea de Cardiologia va a publicar unas bases cientificas para el manejo de la enfermedad cardiaca en las mujeres; los cardiologos espanoles tambien debemos trabajar en estos aspectos.

BACKGROUND AND OBJECTIVE: The search for novel and modifiable risk factors in heart failure (HF), a condition with still high mortality and morbidity rates, can open new strategies for treatment of a growing number of patients. We decided to evaluate the prevalence of anemia and determine its influence on the prognosis of hospitalized HF patients. PATIENTS AND METHOD: 557 consecutive patients hospitalized for HF between 31st January 2000 and 31st December 2002 in a Cardiology Department of a tertiary hospital were studied. Demographic and clinical characteristics, as well as treatment upon hospital discharge and survival data were obtained in May 2003. RESULTS: Mean follow-up was 1.4 years. 44.5% of the whole group of patients presented anemia with mean (standard deviation) hemoglobin levels of 111 (12) g/l, were older, with higher prevalence of ischemic cardiopathy, had higher levels of globular sedimentation rate but lower cholesterol and glomerular filtration rate levels. The prescription of angiotensin converting enzyme inhibitors and betablockers was less frequent among patients with anemia. The presence of anemia was related in a independent way with higher mortality (relative risk: 2.554; p = 0.001), the relation between survival and haemoglobin levels being direct. CONCLUSION: The prevalence of anemia among hospitalized HF patients is very high and its presence constitutes a powerful mortality determinant in this group of patients.

Assessment of renal function is important for bleeding risk stratification in acute coronary syndrome (ACS). There are three formulas routinely used to assess renal function: the Cockroft-Gault (C-G) formula, the MDRD-4 formula and the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Our aim was to compare the ability of these formulas to predict the risk of in-hospital bleeding in patients with ACS.The study included 3270 patients with ACS. The performance of each formula with respect to in-hospital TIMI (Thrombolysis In Myocardial Infarction) major or TIMI minor bleeding were assessed using continuous data and by dividing patients into four subgroups according to the estimated glomerular filtration rate (eGFR): ≥90, 89-60, 30-59 and30 ml/min/1.73 m(2).Bleeding predictive ability was significantly higher for the C-G formula than for MDRD-4 and CKD-EPI formulas, as evaluated by the area under the curve (AUC); continuous eGFR AUCs: 0.73, 0.69 and 0.71, respectively; categorical eGFR AUCs: 0.71, 0.66 and 0.68, respectively. Net reclassification improvement based on the eGFR categories was significantly positively favored C-G: 9.5% (95% confidence interval (CI) 1.8-17.2%) and 19.1% (95% CI 11.3-26.9%) compared with CKD-EPI and MDRD-4, respectively. After multivariable adjustment, the C-G formula predicted in-hospital bleeding better than MDRD-4 formula (severe renal dysfunction vs. normal renal function: odds ratio 7.98, 95% CI 2.61-24.38 with C-G; odds ratio 3.76, 95% CI 1.63-8.69 with MDRD-4; and odds ratio 5.77, 95% CI 2.18-15.24 with CKD-EPI.Our findings suggest that the C-G eGFR may improve risk prediction of in-hospital bleeding more than the MDRD-4 equation and the new CKD-EPI equation in patients with ACS.

doi: 10.1016/j.rec.2011.12.002 Along the lines of the new philosophy regarding clinical practice guidelines established by the Executive Committee of the Sociedad Espanola de Cardiologia (SEC: Spanish Society of Cardiology), described and explained in an article recently published in Revista Espanola de Cardiologia (REC),1 a document has been drafted to provide the framework for the discussion of the most important and novel aspects of the guidelines for the treatment of cardiovascular diseases during pregnancy, issued by the European Society of Cardiology (ESC) and endorsed by other European scientific societies.2 In the Spanish cardiology setting, the clinical practice recommendations concerning the subject of heart disease and pregnancy were set forth in the document “Guias de practica clinica de la Sociedad Espanola de Cardiologia en la gestante con cardiopatia” (Practice Guidelines of the Spanish Society of Cardiology for the Management of Cardiac Disease in Pregnancy), published in 2000,3 and the Sociedad Espanola de Ginecologia y Obstetricia (Spanish Society of Gynecology and Obstetrics) designed a protocol for heart diseases and pregnancy (available at www.prosego.com). More recently, valuable contributions have appeared in our scientific literature,4,5 but there has been a need for an update of guidelines encompassing the body of knowledge that has been consolidated over the past decade. METHODS

doi: 10.1016/j.rec.2011.12.004 The new guidelines for the management of acute coronary syndrome in patients without persistent ST-elevation (NSTE-ACS),1 prepared in 2011 by the European Society of Cardiology (ESC), have been accepted by the Spanish Society of Cardiology (SEC) and translated to Spanish for publication in their entirety in the Revista Espanola de Cardiologia2. As a support tool for the implementation of these guidelines, and in accordance with the new SEC policy for clinical practice guidelines,3 this editorial discusses the innovations and new recommendations in these guidelines and evaluates some aspects considered to be controversial, so as to facilitate the implementation of the new guidelines in our field.

This review from the Clinical Cardiology and Outpatient Section of the Spanish Society of Cardiology details recent progress in the field of clinical cardiology. On this occasion, the emphasis is on advances in surface electrocardiography and cardiovascular disease in women. In addition, the review contains a brief overview of those major new developments in therapy that have had the greatest impact on daily clinical practice and summarizes the activities of the Clinical Cardiology and Outpatient Section.

Clinical cardiology encompasses all forms of heart disease and their more general characteristics, and its sphere of activity includes practical aspects of prevention, diagnosis, and inpatient and outpatient treatment as applied to patients on an everyday basis. Since certain areas of cardiology have become highly specialized, this review of new developments reported in the past year has attempted to bring together all those advances that are not the subject of research in some particular specialization within cardiology and that have such a wide range of application that they should be familiar to all clinical cardiologists, irrespective of their daily responsibilities. For the purposes of this review, articles were classified according to their origin as either English-language, European, or domestic publications. The review concludes with a summary of registry data collected in the last two years by the Clinical and Outpatient Cardiology Section of the Spanish Society of Cardiology.

This article reviews the main developments reported during the last year concerning metabolic syndrome, population aging, and new atrial fibrillation guidelines. The principal aim was to provide the clinical cardiologist with an overview of recent 2006 publications and conference reports on these topics, which have been selected for their broad clinical implications.

Ischemic heart disease has mistakenly been considered of little relevance to women because it occurs infrequently during the fertile years. This is despite the fact that a larger percentage of women than men die from cardiovascular disease. There are differences in cardiovascular risk factors and disease between females and males, including differences in clinical presentation, disease course, diagnostic criteria, prognosis, and treatment. There is a need for increased information and education, earlier and more aggressive control of risk factors, and a more appropriate approach to diagnosis and treatment. The American Heart Association has published guidelines on the prevention of cardiovascular disease in women and the European Society of Cardiology is planning to publish a scientific statement on the management of heart disease in women. Spanish cardiologists should also consider adopting a similar approach.

The search for novel and modifiable risk factors in heart failure (HF), a condition with still high mortality and morbidity rates, can open new strategies for treatment of a growing number of patients. We decided to evaluate the prevalence of anemia and determine its influence on the prognosis of hospitalized HF patients.557 consecutive patients hospitalized for HF between 31st January 2000 and 31st December 2002 in a Cardiology Department of a tertiary hospital were studied. Demographic and clinical characteristics, as well as treatment upon hospital discharge and survival data were obtained in May 2003.Mean follow-up was 1.4 years. 44.5% of the whole group of patients presented anemia with mean (standard deviation) hemoglobin levels of 111 (12) g/l, were older, with higher prevalence of ischemic cardiopathy, had higher levels of globular sedimentation rate but lower cholesterol and glomerular filtration rate levels. The prescription of angiotensin converting enzyme inhibitors and betablockers was less frequent among patients with anemia. The presence of anemia was related in a independent way with higher mortality (relative risk: 2.554; p = 0.001), the relation between survival and haemoglobin levels being direct.The prevalence of anemia among hospitalized HF patients is very high and its presence constitutes a powerful mortality determinant in this group of patients.

La prevalencia, la fisiopatologia y las manifestaciones clinicas de la cardiopatia isquemica varian entre varones y mujeres. Aunque en estudios recientes se ha documentado una disminucion de la mortalidad, en mujeres este descenso es inferior al experimentado entre los varones y la enfermedad cardiovascular (ECV) sigue siendo la primera causa demuerte entre lasmujeres de todas las edades. La vertiginosa progresion del conocimiento de la ECV y su consiguiente aplicacion en el tratamiento y el control de la cardiopatia isquemica se ha traducido en una muy relevante disminucion de la morbimortalidad en las ultimas decadas. Sin embargo, continua habiendo notables diferencias entre mujeres y varones, que se hacenmas evidentes cuantomayores son los logros alcanzados. Como argumenta Noel Bairey en una reciente editorial, el sindrome de Yentl todavia esta presente. Los datos estan ahi, tozudos, pese a una supuesta mejoria en parametros relacionados con la prevencion y el tratamiento de la ECV. En este sentido, lamortalidad en Europa enmujeresmenores de 75 anos por ECV es del 42% (el 18%por cardiopatia isquemica), y en los varones de ese grupo de edad es del 38%. La proporcion de mujeres quemueren de forma subita antes de llegar al hospital es del 55%, y la de los varones, del 43%. Hoy, en el mundo occidental la ECV es la principal causa de muerte en mujeres, pero ademas aun se espera un incremento que en Europa afectara sobre todo a los paises del Este. Tambien sabemos que en las dos ultimas decadas la incidencia de infarto de miocardio ha aumentado en mujeres de 35 a 54 anos, mientras que ha descendido en los varones de la misma edad. Segun el estudio INTERHEART, los factores de riesgo clasicos son responsables del 90% de los infartos. Mas del 80% de las mujeres de edad media tienen uno o mas factores de riesgo. Las mujeres mayores de 50 anos tienen mas hiperlipidemia que los varones; ademas, la menopausia marca un punto de inflexion a partir del cual la prevalencia de hipertension y de obesidad, asi como el cambio en los valores de colesterol, ensombrecen de forma significativa el porvenir libre de episodios cardiovasculares. Por otra parte, los factores de riesgo tradicionales y las tablas de calculo como la de Framingham infraestiman el riesgo de cardiopatia