El colesterol y la enfermedad cardiovascular: una relación que podemos interrumpir

El colesterol, en Occidente, ha pasado a ser un elemento fundamental en el metabolismo humano a un problema de salud pública, fundamentalmente cardio-vascular, de primer orden. Conforme ha avanzado el conocimiento de su papel en la génesis, desarrollo y complicaciones de las enfermedades cardiovasculares, también ha crecido, de forma paralela, la capacidad de limitar su concentración en sangre con distintos medicamentos. Las distintas sociedades científicas que se ocupan de la prevención cardiovascular han ido publicando periódicamente recomendaciones y documentos de consenso sobre cómo, cuándo y cuánto intervenir con medicinas para el control del colesterol. Esta revisión intenta ser una puesta al día de esa información para centrar el tema del abordaje terapéutico de la hipercolesterolemia en nuestro medio

His-Bundle Pacing in a Patient With Tricuspid and Mitral Prosthetic Valves Without Suitable Coronary Veins for Lead Placement

Atrioventricular block in patients with a prosthetic tricuspid valve and a pacemaker with a dysfunctional epicardial lead is not uncommon. In such instances, coronary sinus lead placement is the preferred option, but it has a failure rate of 10%-15%. An atrial transseptal left ventricular lead placement has been proposed as an alternative, but this approach is not feasible in patients with a prosthetic mitral valve. This analysis represents the first reported case of His-bundle pacing from the atria in a patient with prosthetic tricuspid and mitral valves, with no suitable coronary veins for lead placement. © 2021 The Author

The additive effect of adherence to multiple healthy lifestyles on subclinical atherosclerosis: Insights from the AWHS

Background: Public health strategies targeting multiple healthy behaviors, rather than individual factors, have been proposed as more efficient strategies to promote cardiovascular health. However, the additive effect of multiple targets on primary prevention has not been fully characterized. Objective: To examine how adherence to multiple healthy behaviors is associated with the presence of subclinical atherosclerosis, a measure of early cardiovascular disease. Methods: Analysis of a baseline data from 1798 middle-aged men from the Aragon Workers Health Study conducted between 2009 and 2010. Healthy behaviors were defined according to American Heart Association recommendations, aligned with Spanish Nutritional recommendations and included moderate alcohol consumption, smoking abstinence, no abdominal adiposity, decreased sedentarism, and adherence to Alternate Mediterranean Dietary Index. Presence of coronary artery calcium and plaques in femoral and carotid was quantified by a 16-slice computed tomography scanner and 2D ultrasound. Results: Moderate alcohol consumption, as well as adherence to Mediterranean diet is independently associated with a 6% lower risk of having subclinical atherosclerosis. Smoking abstinence is associated with a 11% lower risk of subclinical atherosclerosis. Those who follow 3 lifestyle behaviors (Mediterranean diet, nonsmoking, and moderate alcohol intake) have 18% lower odds of presenting subclinical atherosclerosis compared with those who do not follow these protective lifestyle habits. Conclusion: Adoption of multiple healthy lifestyle behaviors early in life could be a key strategy to tackle the onset of atherosclerosis and reduce cardiovascular disease burden