Prevención de eventos cardiovasculares en la insuficiencia renal crónica factores de riesgo no tradicionales

La principal causa de muerte de los pacientes con insuficiencia renal crónica es el evento cardiovascular. El control de los "factores de riesgo tradicionales" son las estrategias ampliamente utilizadas, a pesar de ello, la mortalidad por eventos cardiovasculares no ha disminuido considerablemente. Otros factores "no tradicionales2 como la anemia, la inflamación crónica, las calcificaciones vasculares, el aumento de la Lp(a) y de homocisteina han demostrado solo asociaciones con la aumentada mortalidad de esto pacientes, pero aun requieren estudios que demuestren causales de esta aumentada incidencia de eventos cardiovasculares durante la insuficiencia renal crónica.Fil: Flores Allende, Gustavo Alberto. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Gobierno de la Provincia de Cordoba. Hospital Misericordia Nuevo Siglo; ArgentinaFil: Perez, Hernan A.. Blossom Dmo; ArgentinaFil: Garcia, Nestor Horacio. Fundacion J Robert Cade; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentin

Factores de riesgo cardiovascular y estratificación de riesgo: ¿Qué calculador debo utilizar?

Los eventos cardiovasculares son la primera causa de muerte a nivel mundial. En este sentido las enfermedades cardiovasculares (ECV) son producto principalmente de la aterosclerosis (ATR) cuyo origen es multifactorial. La identificación mensurable de los denominados "Factores de Riesgo Cardiovasculares" (FRC), fue un gran avance para su prevención. De esta forma ha sido demostrado que la reducción de mortalidad por enfermedad cardiovascular es producto del control óptimo de FRC. Sin embargo, una gran proporción de pacientes presentan eventos cardiovasculares aún cuando los FRC se encuentran controlados. Estratificar el riesgo del paciente es necesario para diseñar la estrategia de tratamiento específica e individual. Actualmente, existen escalas de clasificación de riesgo cardiovascular (RCV) que contemplan la combinación de los múltiples FRC que pueden presentar los pacientes. Aunque se conoce que la mayoría de estos algoritmos sub o sobreestima la posibilidad de eventos cardiovasculares. La incorporación de subrrogados cardiovasculares intermedios al FRC y a los eventos, como la medición de aterosclerosis carotidea, están demostrando una mejoría en el diagnóstico y menor cantidad de eventos en población presuntamente sana, con alto riesgo cardiovascular, tratados con la incorporación de estos a los algoritmos diagnósticos y terapéuticos.Fil: Porta, Daniela Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Blossom Dmo; Argentina. Universidad Nacional de Córdoba; Argentin

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Atherosclerosis plaque area reduction: working hypothesis to prevent cardiovascular event

Cardiovascular events are the leading cause of death worldwide. In this sense, cardiovascular diseases (CVD) are the main products of atherosclerosis (ATR), whose origin is multifactorial. The measurable identification of the so-called cardiovascular risk factors (CRF) was a great advance for its prevention. Scientific evidences have shown that the reduction of mortality due to cardiovascular disease is an important achievement of the optimal control of CRF. However, a large proportion of patients have cardiovascular events when CRF is controlled. It is therefore imperative to stratify the patient’s risk in order to design the specific and individual treatment strategy. Currently, there are cardiovascular risk classification (CVR) scales that contemplate the combination of the multiple CRF that patients may present, although it is known that most of these algorithms sub- or overestimate the possibility of cardiovascular events. The incorporation of intermediate cardiovascular surrogates to CRF and events, such as the measurement of carotid atherosclerosis, is demonstrating an improvement in the diagnosis and fewer events in the healthy population, with high cardiovascular risk, treated with the incorporation of these to the diagnostic and therapeutic algorithms.Fil: Perez, Hernán A.. Blossom DMO; Argentina. Sanatorio Del Salvador Privado; ArgentinaFil: Flores Allende, Gustavo Alberto. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Ajayi, Ebenezer Idowu O. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra. Universidad Nacional de Córdoba. Instituto de Investigación Médica Mercedes y Martín Ferreyra; Argentina. Osun State University; NígerFil: Porta, Daniela Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Garcia, Nestor Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentin

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN