0000000000385189
AUTHOR
Vicente Bertomeu-martínez
Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study
Introduction The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with allcause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to corona…
Efecto pronóstico de una estrategia terapéutica guiada por los valores del antígeno carbohidrato 125 (CHANCE-HF). Diseño del estudio
Resumen Introduccion y objetivos La morbilidad y la mortalidad despues de un ingreso por insuficiencia cardiaca aguda siguen siendo extremadamente elevadas. En este contexto, se ha demostrado que las concentraciones plasmaticas del antigeno carbohidrato 125 muestran correlacion con la gravedad de la sobrecarga hidrica y el riesgo de muerte y reingreso. Los datos preliminares indican un posible papel del antigeno carbohidrato 125 como guia para el tratamiento. El objetivo de este estudio es evaluar el efecto pronostico de una estrategia de tratamiento guiada por el antigeno carbohidrato 125 comparada con el tratamiento estandar en pacientes dados de alta recientemente tras un ingreso por ins…
Choice of New Oral Anticoagulant Agents Versus Vitamin K Antagonists in Atrial Fibrillation: FANTASIIA Study.
Introduction: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. Many patients with AF receive chronic anticoagulation, either with vitamin K antagonists (VKAs) or with non-VKA oral anticoagulants (NOACs). We sought to analyze variables associated with prescription of NOAC. Methods: Patients with AF under anticoagulation treatment were prospectively recruited in this observational registry. The sample comprised 1290 patients under chronic anticoagulation for AF, 994 received VKA (77.1%) and 296 NOAC (22.9%). Univariate and multivariate analyses were performed to identify variables associated with use of NOAC. Results: Mean age was 73.8 ± 9.4 years, and 4…
Carbohydrate Antigen-125–Guided Therapy in Acute Heart Failure
Abstract Objectives This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)–guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF). Background CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding. Methods In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in th…
Diuretic Strategies in Acute Heart Failure and Renal Dysfunction: Conventional vs Carbohydrate Antigen 125-guided Strategy. Clinical Trial Design
Abstract Introduction and objectives The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic str…
Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure.
Aims To evaluate the relationship between systolic blood pressure (SBP) and long-term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (≤40%) vs. preserved (≥50%). Methods and results We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left-ventricular ejection fraction was categorized as ≤40% (n = 288), 41–49% (n = 174), or ≥50% (n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 ± 11 years and 150 ± 36 mmHg, respectively. During a median follow-up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated …
Prognostic effect of carbohydrate antigen 125-guided therapy in patients recently discharged for acute heart failure (CHANCE-HF). Study design.
Abstract Introduction and objectives Morbidity and mortality after admission for acute heart failure remain prohibitively high. In that setting, plasma levels of antigen carbohydrate 125 have shown to correlate with the severity of fluid overload and the risk of mortality and readmission. Preliminary data suggests a potential role of antigen carbohydrate 125 to guide therapy. The objective of this study is to evaluate the prognostic effect of an antigen carbohydrate 125-guided management strategy vs standard therapy in patients recently discharged for acute heart failure. Methods This is a multicenter, randomized, single-blind, efficacy trial study of patients recently discharged from acute…
El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial
ResumenObjetivoComparando los resultados obtenidos en los estudios EUROASPIRE I y EUROASPIRE III en pacientes con cardiopatía isquémica se muestra que el grado de control de los factores de riesgo mayores es mejorable. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial orientada a la mejora del grado de control en estos pacientes en el ámbito de la atención primaria.MétodosEn este estudio de intervención aleatorizado, con 1 año de seguimiento, se reclutó a pacientes con diagnóstico de cardiopatía isquémica (145 en el grupo de intervención y 1.461 en el grupo control). Se aplicó una intervención organizativa mixta basada en la mejora de la relación profesio…
Quality of Anticoagulation With Vitamin K Antagonists
Background Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF). Hypothesis Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF. Methods Patients with AF under VKA treatment were prospectively recruited in this observational registry. The sample comprised 948 patients. The estimated time spent in the therapeutic range (TTR) was calculated, and variables related with a TTR >65% were analyzed. Results Mean age was 73.8 ± 9.…
Estrategias diuréticas en insuficiencia cardiaca aguda con disfunción renal: terapia convencional frente a guiada por el antígeno carbohidrato 125. Diseño de ensayo clínico
Resumen Introduccion y objetivos El tratamiento optimo de pacientes con insuficiencia cardiaca aguda (ICA) y sindrome cardiorrenal tipo 1 (SCR-1) no esta bien definido. La hipoperfusion arterial y la congestion venosa tienen un papel fundamental en la fisiopatologia del SCR-1. El antigeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diuretico de pacientes con SCR-1. Metodos Ensayo clinico multicentrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulacion ba…
Evolución y repercusión científica de las becas de investigación de la Sociedad Española de Cardiología y la Fundación Española del Corazón (2000-2006)
Resumen Introduccion y objetivos La Sociedad Espanola de Cardiologia convoca anualmente becas para financiar proyectos de investigacion en el campo de las enfermedades cardiovasculares. Nuestro objetivo es identificar la repercusion de estas inversiones durante el periodo 2000-2006 a partir de los articulos derivados de las becas y publicados en revistas cientificas. Metodos Utilizando los datos de identificacion de cada proyecto como terminos de busqueda, se recuperaron todos los articulos derivados de estas becas en las bases de datos del Indice Medico Espanol, el Indice Bibliografico Espanol en Ciencias de la Salud, el Science Citation Index-Expanded y Scopus. Los articulos se sometieron…
Beneficios del tratamiento con estatinas según los valores plasmáticos del antígeno carbohidrato 125 tras un ingreso por insuficiencia cardiaca aguda
Introduccion y objetivos La utilidad de las estatinas en pacientes con insuficiencia cardiaca es motivo de controversia. Bajo la hipotesis de que el tratamiento con estatinas seria util en los pacientes con insuficiencia cardiaca y mayor actividad inmunoinflamatoria, pretendimos conocer si la elevacion del antigeno carbohidrato 125, un biomarcador asociado a la congestion sistemica y actividad inflamatoria, identificaria a los que se beneficiarian, en cuanto a mortalidad, del tratamiento con estatinas tras un ingreso por insuficiencia cardiaca aguda. Metodos Analizamos a 1.222 pacientes consecutivos ingresados por insuficiencia cardiaca aguda. El antigeno carbohidrato 125 se determino duran…
Benefits of Statin Therapy Based on Plasma Carbohydrate Antigen 125 Values Following an Admission for Acute Heart Failure
The prognostic benefit of statins in patients with heart failure is a topic of controversy. Under the hypothesis that statins may provide greater benefit in a subgroup of patients with heightened inflammatory activity, we sought to explore whether statins are associated with a decreased risk of long-term mortality in patients with acute heart failure based on elevated levels of carbohydrate antigen 125, a biomarker related to systemic congestion and proinflammatory status.We analysed 1222 consecutive patients admitted with acute heart failure in a single teaching center during a median follow-up of 20 months. carbohydrate antigen 125 was measured during index hospitalization and dichotomize…
Anticoagulation prescription in atrial fibrillation.
We seek to assess the factors associated with the anticoagulation prescription in a cohort of patients with atrial fibrillation (AF) collected from out-patient clinics.A total of 1524 patients with a history of AF were collected from out-patients clinics. CHADS(2), CHA(2)DS(2)-VASc and HAS-BLED scores were calculated in every patient. Variables associated with anticoagulant treatment prescription were analyzed in univariant and multivariant models.Most patients received either anticoagulant (62%) or antiplatelet treatment (37%). Anticoagulation rates increased among higher CHADS(2) and CHA(2)DS(2)-VASc score values. A logistic regression model was performed to assess the variables associate…
Hemorrhage in patients under oral anticoagulation for atrial fibrillation. The other side of the coin
Abstract Introduction and objectives Oral anticoagulation therapy is prescribed to most patients with atrial fibrillation. The main limitation of anticoagulant treatment is the occurrence of bleeding episodes. We sought to assess the type of hemorrhages and mortality in patients anticoagulated for nonvalvular atrial fibrillation. Methods Observational retrospective study analyzing 2 081 138 hospitalization reports from 2014 corresponding to 151 hospitals of the Spanish National Health System. Patients were selected with the diagnosis of hemorrhage, nonvalvular atrial fibrillation, and oral anticoagulation. Results A total of 5783 hospitalizations were analyzed. Most hemorrhages were digesti…
Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk:An International Expert Consultation
Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99. mm. Hg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treat…