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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.

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 Los marcados efectos antiaterogenicos y antioxidantes de las particulas de lipoproteinas de alta densidad (HDL) justifican la busqueda de nuevas estrategias que mejoren no tanto los valores de colesterol unido a HDL (cHDL), sino que tambien promuevan un transporte reverso de colesterol mas eficiente. Este capitulo revisa farmacos que han sido testados en investigacion animal y que se han mostrado capaces de aumentar el eflujo de colesterol (agonistas LXR), promover la captacion hepatica de cHDL (inactivadores parciales de SRB1) o de incrementar la capacidad antioxidante (antiinflamatoria) de las HDL (D4F, mimeticos de apo A-I). Solo este ultimo, junto con la perfusion de apo A-I Milano y la administracion de un PPAR-α/γ (aleglitazar) han sido evaluados en humanos, mostrando resultados prometedores, lo que justifica la inversion en nuevos proyectos de investigacion en este campo.

Lupus eritematoso sistemico. La manifestacion cardiaca mas comun al inicio del lupus eritematoso sistemico (LES) es la pericarditis, sin embargo a lo largo de la evolucion la deteccion clinica y/o ecografica de las vegetaciones de Libman-Sacks son mas fecuentes. A largo plazo, la enfermedad coronaria acorta la expectativa de vida en el LES; la identificacion y la correccion de los factores de riesgo convencionales es obligatoria en estas pacientes. Sindrome antifosfolipido. Clinicamente, la trombosis coronaria marca la afectacion en el sindrome antifosfolipido primario y secundario, aunque es aun mas comun ecograficamente la enfermedad valvular, con fenomenos embolicos. Para algunos autores,la afectacion valvular deberia incluirse entre una de las caracteristicas del sindrome. La anticoagulacion es uno de los pilares del tratamiento del sindrome. Artritis reumatoide. Aunque cualquier area del corazon puede afectarse en la artritis reumatoide, la coronaria es la forma mas comun de lesion cardiaca y junto con las lesiones arterioscleroticas de otros lechos vasculares, la principal causa de muerte de la enfermedad. Aunque en la artritis reumatoide existe mayor numero de factores de riesgo vascular que en la poblacion general, los marcadores sistemicos de inflamacion son predictores independientes de enfermedad. Esclerosis sistemica. En la esclerodermia, los espasmos de los pequenos vasos yla fibrosis miocardica y del lecho pulmonar, con la consiguiente hipertension pulmonar, son los trastornos de mayor prevalencia.

Prevencion primaria. La prevencion de la arteriosclerosis pasa en primer lugar por identificar a los pacientes de alto riesgo; en nuestro pais, estos sujetos son aquellos que ya han tenido un episodio isquemico, los diabeticos tipo 1 con microalbuminuria o diabeticos tipo 2 y aquellos que alcancen un riesgo de muerte vascular en la puntuacion SCORE de mas del 5% a los 10 anos. Medidas no farmacologicas. Enmarcadas dentro del concepto de estilo de vida saludable, son la base de la prevencion de la enfermedad y cuentan con grandes ventajas: se pueden aconsejar a toda la poblacion, incluida la infantil, las medidas son baratas, no tienen apenas efectos adversos y han demostrado su eficiencia a traves de ensayos clinicos y estudios epidemiologicos. Dislipidemias. Las estatinas son el grupo terapeutico de eleccion en el tratamiento de la hipercolesterolemia y de la arteriosclerosis. La dosis depende del farmaco elegido, la gravedad de la hiperlipidemia y del objetivo terapeutico, ademas de otras consideraciones farmacocineticas. Diabetes mellitus. A los pacientes diabeticos se les debe tratar de forma mas energica las elevaciones de los lipidos y de la presion arterial que a los sujetos no diabeticos, ya que son estos dos factores los que mas predisponen a la enfermedad macrovascular. Respecto del control glucemico, tienen preferencia los hipoglucemiantes orales que reducen la resistencia a la insulina. Hipertension arterial. Varios grupos terapeuticos para el control de la hipertension arterial son eficaces en reducir la morbilidad y mortalidad vascular; la eleccion del hipotensor esta condicionada por las comorbilidades.

Synchronous bilateral paramedian thalamic stroke (SBPTS), usually equated to Percheron artery infarction, is considered to be uncommon and difficult to diagnose clinically. Its characterization is based on the original description plus a few small series.To characterize SBPTS clinically by collecting cases and identifying the key difficulties for an early diagnosis.Six cases at our centre plus another 115 located by systematic literature search and critical reading of articles fulfilled the criteria for SBPTS. An analysis was made of the variables age, gender, vascular risk factors, aetiology, alterations and fluctuations of consciousness, need for intubation, cognitive-behavioural disorders, pupillary changes, other neurological focal disorders and brainstem involvement on imaging studies.Of note in our series were disorders of consciousness (n=5), their fluctuations (n=3) and the diagnostic delay (seven days, with MRI in four patients). In only one case was a bilateral thalamic lesion seen on the initial CT. Joint analysis of all the cases showed a mean age of 61 years, a predominance of men (58%), the presence of vascular risk factors in 77%, a mainly cardioembolic aetiology (34% among those that were specified), sensory involvement in 75% (intubation in 7% and fluctuations in 16.5%), cognitive-behavioural disorders in 43%, oculomotor in 73%, pupillary in 31%, other in 67% and specified brainstem lesion in 37%.The SBPTS syndrome has a variable presentation with a low sensitivity on the initial CT, requiring brain MRI for typification. This explains the diagnostic difficulty and the fact that its frequency is probably underestimated.

Introduccion. El infarto talamico paramediano bilateral sincronico, asimilado habitualmente al infarto de la arteria de Percheron, se considera infrecuente y de dificil diagnostico clinico, basandose su caracterizacion en la descripcion original y en pequenas series. Objetivo. Caracterizar el infarto talamico paramediano bilateral sincronico clinicamente mediante aglutinacion de casos e identificar las claves de su dificultad diagnostica precoz. Pacientes y metodos. Seis casos de nuestro centro, y 115 mediante busqueda sistematica y lectura critica de articulos, cumplieron los criterios de infarto talamico paramediano bilateral sincronico. Se analizaron las variables edad, genero, factores de riesgo vascular, etiologia, alteracion y fluctuaciones del nivel de consciencia, necesidad de intubacion, trastorno cognitivo-conductual, alteraciones pupilares, otra focalidad neurologica y afectacion del troncoencefalo en neuroimagen. Resultados. En nuestra serie, destacan el trastorno del nivel de consciencia (n = 5), sus fluctuaciones (n = 3) y la demora diagnostica (siete dias, con resonancia magnetica en cuatro pacientes). Solo en uno se objetivo lesion bitalamica en la tomografia computarizada inicial. El analisis conjunto determino edad media de 61 anos; predominio masculino (58%); presencia de factores de riesgo vascular en el 77%; etiologia dominante, la cardioembolica (el 34% entre los especificados); afectacion del sensorio en el 75% (intubacion en el 7% y fluctuaciones en el 16,5%), cognitivo-conductual en el 43%, oculomotora en el 73%, pupilar en el 31%, y de otro tipo en el 67%; y lesion del tronco especificada en el 37%. Conclusiones. El infarto talamico paramediano bilateral sincronico constituye un sindrome de presentacion variable, con una tomografia computarizada inicial de baja sensibilidad, y que precisa una resonancia magnetica cerebral para su tipificacion. Ello explica la dificultad diagnostica y la probable infraestimacion de su frecuencia.

We have studied the birth weights, obstetrics data and anthropometrical data from 1.157 full-term newborns who were delivered in the Hospital del Insalud-Cruz Roja in Ceuta (Spain). Of these newborns, 489 were of arabic origin and 668 of hispanic origin. Arabic newborns were heavier (3.248 +/- 473 g versus 3.280 +/- 431 g, p0.001) and longer (50.2 +/- 1.8 cm versus 49.6 +/- 1.8 cm, p0.001) than their hispanic counterparts. These differences were not due to a disproportion in sex or gestational age between the groups. Furthermore, the differences were still present after adjustments were made for maternal age, parity and the mother's smoking habit. Thus, this difference in size at birth between arabic and hispanic newborns could be, at least in part, ethnically related.

To assess the abnormalities induced by alcohol on plasma lipids and lipoproteins and their possibly involved mechanisms three basis of the daily intake: social drinkers (less than or equal to 20 g/day; n = 10), moderate drinkers (greater than 20 to less than 70 g/day; n = 11), and severe drinkers (greater than or equal to 70 g/day; n = 15). Eleven nondrinkers were evaluated as control group. Very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoproteins (HDL)-2 and HDL-3 were isolated by preparative sequential isopicnic centrifugation, and their apolipoprotein and lipidic composition were measured. In the group of severe drinkers, a marked tendency of HDL-3 cholesterol to be higher than in the remaining groups was found. There was no correlation between this parameter and hepatic enzymes. The HDL-2 cholesterol of severe drinkers was significantly increased (p less than 0.005). The parallel enrichment in apolipoproteins C of the HDL-2 particle in all groups of alcohol users suggests a transfer phenomenon from VLDL. The apoA/C ratio of HDL-2 might be useful as a marker of alcohol intake.