The selective peroxisome proliferator-activated receptor alpha modulator (SPPARM) paradigm : conceptual framework and therapeutic potential: A consensus statement from the International Atherosclerosis Society (IAS) and the Residual Risk Reduction Initiative (R3i) Foundation

In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARM) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARM agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARM agonist safely reduces residual cardiovascular risk.Peer reviewe

Residual vascular risk in diabetes – will the SPPARM alpha concept hold the key?

No abstract available

Curva de aprendizaje en ecocardioscopia. Utilidad de un programa docente interespecialidad

Resumen: Objetivo: Comprobar los resultados de un entrenamiento en habilidad para realizar ecocardioscopias para oncólogos por parte de cardiólogos y estudiar la variabilidad en las mediciones y la significación clínica de esa variabilidad. Métodos: Se incluyeron pacientes consecutivos que habían sido atendidos en las consultas de oncología previamente. Un oncólogo les realizó una ecocardioscopia con un equipo portátil. Por otro lado, un cardiólogo realizó un ecocardiograma reglado con un equipo de gama alta. Todos los oncólogos participantes recibieron un entrenamiento básico en ecocardioscopia por parte de cardiólogos especializados en imagen cardiovascular. Resultados: Se incluyeron 101 pacientes (31,7% varones; edad media 56,03 ± 16,88 años). Los resultados mostraron una clara curva de aprendizaje durante el periodo de reclutamiento, alcanzando a los dos meses una buena similitud entre oncólogo y cardiólogo para las medidas de los diámetros ventriculares, pero sin alcanzar la misma similitud hasta pasados 4 meses las medidas de la fracción de eyección del ventrículo izquierdo. De la misma manera, se produjo una importante reducción de las diferencias clínicamente significativas de la fracción de eyección del ventrículo izquierdo a partir del cuarto mes. Conclusiones: Un entrenamiento breve dirigido a Facultativos Especialistas en Oncología en ecocardioscopia dirigido por cardiólogos expertos en imagen cardiovascular permite al oncólogo obtener las habilidades necesarias para evaluar las dimensiones del ventrículo izquierdo y la fracción de eyección del ventrículo izquierdo de una forma precisa. El tiempo de entrenamiento se estima en una semana de formación teórico-práctica intensa, y adicionalmente cuatro meses de realización de ecocardioscopias supervisadas estrechamente por los cardiólogos. Abstract: Objective: To assess the results of a training to perform echocardioscopic studies to oncologists by cardiologists, and to study the variability in measurements, as well as the clinical significance of this variability. Methods: Participant oncologists received basic training in echocardioscopy by cardiologists specialised in cardiovascular imaging. Consecutive patients attending the oncology outpatient clinic were included in the study. Every patient underwent an echocardioscopic study performed by an oncologist with a portable device and an echocardiogram performed by a cardiologist using high-end equipment. Results: The study included 101 patients, with a mean age of 56.03 ± 16.88 years, and 31.7% were males. The results showed a clear learning curve over time, with a good similarity in ventricular diameters measurements between oncologists and cardiologist being reached in two months, but it took 4 months to reach the same similarity for left ventricular ejection fraction (LVEF) measurements. Likewise, there was a significant reduction in clinically significant differences in LVEF after the fourth month. Conclusions: A brief training in echocardioscopy for oncologists, led by cardiology experts in cardiovascular imaging, allows the oncologist to obtain the necessary skills to accurately assess left ventricular ejection fraction and diameters. The training time proposed is a week of intensive theoretical and practical training, followed by four months of completion of echocardioscopic examinations closely monitored by the cardiologist. Palabras clave: Ecocardiografía portátil, Oncología, Quimioterapia, Cardiotoxicidad, Entrenamiento, Keywords: Portable echocardiography, Oncology, Chemotherapy, Cardiotoxicity, Trainin