Reintervenciones tras cirugía del sector aorto-ilíaco

Se realiza un estudio de la evolución tardía de los pacientes sometidos a reintervención mediante el diseño de los registro vascular específico y mediante su explotación estadística se determina la incidencia y características de las complicaciones y fracasos tardíos surgidos tras el tratamiento quirúrgico de las enfermedades del sector AORTO-ILIACO. Así como la existencia de factores predictivos de complicación o fracaso, destacando en las conclusiones el logro de los objetivos planteados

Microsomal prostaglandin E synthase-1 is involved in the metabolic and cardiovascular alterations associated with obesity

Background and Purpose: Microsomal prostaglandin E synthase-1 (mPGES-1) is an inducible isomerase responsible for prostaglandin E2 production in inflammatory con ditions. We evaluated the role of mPGES-1 in the development and the metabolic and cardiovascular alterations of obesity. Experimental Approach: mPGES-1+/+ and mPGES-1 / mice were fed with normal or high fat diet (HFD, 60% fat). The glycaemic and lipid profile was evaluated by glu cose and insulin tolerance tests and colorimetric assays. Vascular function, structure and mechanics were assessed by myography. Histological studies, q-RT-PCR, and western blot analyses were performed in adipose tissue depots and cardiovascular tissues. Gene expression in abdominal fat and perivascular adipose tissue (PVAT) from patients was correlated with vascular damage. Key Results: Male mPGES-1 / mice fed with HFD were protected against body weight gain and showed reduced adiposity, better glucose tolerance and insulin sensi tivity, lipid levels and less white adipose tissue and PVAT inflammation and fibrosis, compared with mPGES-1+/+ mice. mPGES-1 knockdown prevented cardiomyocyte hypertrophy, cardiac fibrosis, endothelial dysfunction, aortic insulin resistance, and vascular inflammation and remodelling, induced by HFD. Obesity-induced weight gain and endothelial dysfunction of resistance arteries were ameliorated in female mPGES-1 / mice. In humans, we found a positive correlation between mPGES-1 expression in abdominal fat and vascular remodelling, vessel stiffness, and systolic blood pressure. In human PVAT, there was a positive correlation between mPGES-1 expression and inflammatory markers. Conclusions and Implications: mPGES-1 inhibition might be a novel therapeutic approach to the management of obesity and the associated cardiovascular and meta bolic alterations

Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC ) on the 2012 European Cardiovascular Prevention Guidelines

Las guías europeas de prevención cardiovascular contemplan dos sistemas de evaluación de la evidencia (SEC y GRADE) y recomiendan combinar las estrategias poblacional y de alto riesgo, interviniendo en todas las etapas de la vida, con la dieta como piedra angular de la prevención. La valoración del RCV incorpora los niveles de HDL y los factores psicosociales, una categoría de muy alto riesgo y el concepto edad-riesgo. Se recomienda e luso de métodos cognitivo-conductuales (entrevistamotivadora, intervenciones psicológicas), aplicados por profesionales sanitarios, con la participación de familiares de los pacientes, para contrarrestar el estrés psicosocial y reducir el RCV mediante dietas saludables, entrenamiento físico, abandono del tabaco y cumplimiento terapéutico. También se requieren medidas de salud pública, como la prohibición de fumar en lugares públicos o eliminar los ácidos grasos trans de la cadena alimentaria. Otras novedades consisten en desestimar el tratamiento antiagregante en prevención primaria y la recomendación de mantener la PA dentro del rango13-139/80-85 mmHg en pacientes diabéticos o con RCV alto. Se destaca el bajo cumplimiento terapéutico observado, porque influye en el pronóstico de los pacientes y en los costes sanitarios. Para mejorar la prevención cardiovascular se precisa una verdadera alianza entre políticos, administraciones, asociaciones científicas y profesionales de la salud, fundaciones de salud, asociaciones de consumidores, pacientes y sus familias, que impulse las estrategias poblacional e individual, mediante el uso de toda la evidencia científica disponible, desde ensayos clínicos hasta estudios observacionales y modelo matemáticos para evaluar intervenciones a nivel poblacional, incluyendo análisis de coste-efectividadBased on the two main frameworks for evaluating scientific evidence—SEC and GRADE—European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL level and psycho-social factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g.,motivational interviewing, psychological interventions, led by health professionals and with the participation of the patient’s family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions—such as smoking ban in public areas or the elimination of trans fatty acids from the food chain—are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure (BP) within the1 30-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally ,due to the significant impact on patient progress and medical costs, special emphasisis given to the low therapeutic adherence levels observed . In sum ,improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage o the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyse

Registro de actividad de la Sociedad Española de Angiología y Cirugía Vascular, año 2004

Objetivo. Describir la actividad asistencial, correspondiente al año 2004, de los Servicios de Angiología y Cirugía Vascular en España. Pacientes y métodos. Estudio transversal. La población muestreada se constituyó, por los procedimientos quirúrgicos y endovasculares que se realizaron, en el año 2004, en 50 servicios de Angiología y Cirugía Vascular que voluntariamente aceptaron la participación en el registro. El instrumento de recogida de la información fue un formulario específico, Registro Vascular (RV) de la Sociedad Española de Angiología y Cirugía Vascular (SEACV). Se realizó un análisis descriptivo de los datos recogidos. Resultados. El RV fue cumplimentado por 50 servicios, 29 de los cuales poseen acreditación para la docencia. Hubo un total de 33.210 ingresos hospitalarios, 13.024 urgentes (39,21%), 20.186 (60,78%) programados y una estancia media global de 9,4 días. En la lista de espera, a fecha 31/12/04, existía un predominio de pacientes con patología venosa (n = 5.420), y el total de pacientes en lista de espera por patología arterial era de 2.411 en la misma fecha. El detalle de la actividad quirúrgica comprende en cirugía arterial directa 1.525 procedimientos practicados en los troncos supraaórticos, 549 en miembros superiores, 68 en la aorta torácica, 2.712 vía anatómica (de los cuales 1.273 por AAA) y 882 vía extraanatómica en sector aortoilíaco por oclusión, 48 a los troncos viscerales digestivos, 35 a arterias renales, 2.057 en sector femoropoplíteo y 1.080 en sector femorodistal de los miembros inferiores. La cirugía venosa, tuvo un alto predominio de cirugía de varices con 13.611 procedimientos realizados por esta entidad. Se realizaron procedimientos endovasculares correspondiendo 196 a TSA, 111 a accesos vasculares, 68 a sector aórtico, implantándose además 81 endoprótesis por aneurisma en aorta torácica y 434 por aneurisma de aorta abdominal, 10 en troncos viscerales digestivos, 102 renales y 2.001 en arterias de miembros inferiores. Los procedimientos endovasculares venosos fueron 77. Se encontraron diferencias significativas entre los centros docentes y no docentes en los parámetros relativos a cirugía arterial directa, el tratamiento endovascular de los aneurismas de aorta abdominal y parámetros asistenciales. Conclusiones. No se ha producido incremento en la participación. De nuevo este año, la mayoría de los procedimientos registrados son arteriales, tanto quirúrgicos como endovasculares. También se han demostrado diferencias cuantitativas entre centros docentes y no docentes

Simposio I. Controversias en la úlceras de la extremidad inferior

Las úlceras vasculares de las extremidades inferiores (EEII) ocasionan un problema sanitario importante con gran consumo de recursos humanos y materiales. Estas úlceras se manifiestan, generalmente, en personas de edad avanzada y conducen, con frecuencia, a una limitación de su autonomía funcional, ya de por sí disminuida, lo que origina una sobrecarga del entorno familiar y para los centros de asistencia sociosanitaria. Cuando revisamos los artículos publicados y la situación de la asistencia en nuestro entorno, nos encontramos con numerosos interrogante que se plantearán y desarrollarán a lo largo de la exposición. A modo de introducción, se revisan algunas cuestiones

Microsomal prostaglandin E synthase-1 (mPGES-1) is involved in the metabolic and cardiovascular alterations associated with obesity

Microsomal prostaglandin E synthase-1 (mPGES-1) is an inducible isomerase responsible for prostaglandin E2 production in inflammatory conditions. We evaluated the role of mPGES-1 in obesity development and in the metabolic and cardiovascular alterations associated.mPGES-1+/+ and mPGES-1-/- mice were fed with normal or high fat diet (HFD, 60% fat). The glycaemic and lipid profile was studied by glucose and insulin tolerance tests and colorimetric assays. Vascular function, structure and mechanics were evaluated by myography. Histological studies, q-RT-PCR and Western Blot analyses were performed in adipose tissue depots and cardiovascular tissues. Gene expression in abdominal fat and perivascular adipose tissue (PVAT) from patients and its correlation with vascular damage was determined.Male mPGES-1-/- mice fed with HFD were protected against body weight gain and showed reduced adiposity, better glucose tolerance and insulin sensitivity, lipid levels and less white adipose tissue and PVAT inflammation and fibrosis, compared to mPGES-1+/+ mice. mPGES-1 knockdown prevented cardiomyocyte hypertrophy, cardiac fibrosis, endothelial dysfunction, aortic insulin resistance, and vascular inflammation and remodeling, induced by HFD. Obesity-induced weight gain and endothelial dysfunction of resistance arteries were ameliorated in female mPGES-1-/- mice. In humans, we found a positive correlation between mPGES-1 expression in abdominal fat and vascular remodeling, vessel stiffness and systolic blood pressure. In human PVAT, there was a positive correlation between mPGES-1 expression and inflammatory markers.mPGES-1 inhibition might be a novel therapeutic approach for the management of obesity and the associated cardiovascular and metabolic alterationsThis work was supported by the Ministerio de Ciencia e Innovación and Fondo Europeo de Desarrollo Regional (FEDER)/FSE (SAF2016-80305P), Instituto de Salud Carlos III (ISCIII; FIS PI18/0257); Comunidad de Madrid (CM) (B2017/BMD-3676 AORTASANA) FEDER-a way to build Europe. MGA was supported by a FPI-UAM fellowship, RRD by a Juan de la Cierva contract (IJCI-2017-31399). The authors thank Victor Gutierrez his help with some experiment

Myeloid GRK2 Regulates Obesity-Induced Endothelial Dysfunction by Modulating Inflammatory Responses in Perivascular Adipose Tissue

Perivascular adipose tissue (PVAT) is increasingly being regarded as an important endocrine organ that directly impacts vessel function, structure, and contractility in obesity-associated diseases. We uncover here a role for myeloid G protein-coupled receptor kinase 2 (GRK2) in the modulation of PVAT-dependent vasodilation responses. GRK2 expression positively correlates with myeloid- (CD68) and lymphoid-specific (CD3, CD4, and CD8) markers and with leptin in PVAT from patients with abdominal aortic aneurysms. Using mice hemizygous for GRK2 in the myeloid lineage (LysM-GRK2+/), we found that GRK2 deficiency in myeloid cells allows animals to preserve the endothelium-dependent acetylcholine or insulin-induced relaxation, which is otherwise impaired by PVAT, in arteries of animals fed a high fat diet (HFD). Downregulation of GRK2 in myeloid cells attenuates HFD-dependent infiltration of macrophages and T lymphocytes in PVAT, as well as the induction of tumor necrosis factor- (TNF) and NADPH oxidase (Nox)1 expression, whereas blocking TNF or Nox pathways by pharmacological means can rescue the impaired vasodilator responses to insulin in arteries with PVAT from HFD-fed animals. Our results suggest that myeloid GRK2 could be a potential therapeutic target in the development of endothelial dysfunction induced by PVAT in the context of obesityMinisterio de Economía y Competitividad (MINECO/FEDER), Spain (grant SAF2017-84125-R to F.M.J. and C.M.; SAF2016-80305P to M.S. and A.M.B.); CIBER de Enfermedades Cardiovasculares (CIBERCV); Instituto de Salud Carlos III, Spain (grant CB16/11/00278 to F.M.J. and CB16/11/00286 to M.S.); European Foundation for the Study of Diabetes (EFSD) Novo Nordisk Partnership for Diabetes Research in Europe Grant (to F.M.J.); and Programa de Actividades en Biomedicina de la Comunidad de Madrid—FEDER-a way to build Europe B2017/BMD-3671-INFLAMUNE to F.M.J. and B2017/BMD-3676-AORTASANA to M.S. M.G.-A. was supported by a FPI-UAM fellowship, R.R.-D. by a Juan de la Cierva contract (IJCI-2017-31399). We appreciate the help of the CBMSO Facilities, in particular Animal Care. We also acknowledge the institutional support to the CBMSO.from Funcación Ramón Arece

Resolvin D2 prevents vascular remodeling, hypercontractility and endothelial dysfunction in obese hypertensive mice through modulation of vascular and proinflammatory factors

During resolution of inflammation, specialized proresolving mediators (SPMs), including resolvins, are produced to restore tissue homeostasis. We hypothesized that there might be a dysregulation of SPMs pathways in pathological vascular remodeling and that resolvin D2 (RvD2) might prevent vascular remodeling and contractile and endothelial dysfunction in a model of obesity and hypertension. In aortic samples of patients with or without abdominal aortic aneurysms (AAA), we evaluated gene expression of enzymes involved in SPMs synthesis (ALOXs), SPMs receptors and pro-inflammatory genes. In an experimental model of aortic dilation induced by high fat diet (HFD, 60%, eighteen weeks) and angiotensin II (AngII) infusion (four weeks), we studied the effect of RvD2 administration in aorta and small mesenteric arteries structure and function and markers of inflammation. In human macrophages we evaluated the effects of AngII and RvD2 in macrophages function and SPMs profile. In patients, we found positive correlations between AAA and obesity, and between AAA and expression of ALOX15, RvD2 receptor GPR18, and pro-inflammatory genes. There was an inverse correlation between the expression of aortic ALOX15 and AAA growth rate. In the mice model, RvD2 partially prevented the HFD plus AngII-induced obesity and adipose tissue inflammation, hypertension, aortic and mesenteric arteries remodeling, hypercontratility and endothelial dysfunction, and the expression of vascular proinflammatory markers and cell apoptosis. In human macrophages, RvD2 prevented AngII-induced impaired efferocytosis and switched SPMs profile. RvD2 might represent a novel protective strategy in preventing vascular damage associated to hypertension and obesity likely through effects in vascular and immune cells

Comentarios del Comité Español Interdisciplinario de Prevención Cardiovascular (CEIPC) a las guías europeas de prevención cardiovascular 2012

Based on the two main frameworks for evaluating scientific evidence-SEC and GRADE-European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions, led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions-such as smoking ban in public areas or the elimination of trans fatty acids from the food chain-are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure (BP) within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.Las guías europeas de prevención cardiovascular contemplan dos sistemas de evaluación de la evidencia (SEC y GRADE) y recomiendan combinar las estrategias poblacional y de alto riesgo, interviniendo en todas las etapas de la vida, con la dieta como piedra angular de la prevención. La valoración del RCV incorpora los niveles de HDL y los factores psicosociales, una categoría de muy alto riesgo y el concepto edad-riesgo. Se recomienda el uso de métodos cognitivo-conductuales (entrevista motivadora, intervenciones psicológicas), aplicados por profesionales sanitarios, con la participación de familiares de los pacientes, para contrarrestar el estrés psicosocial y reducir el RCV mediante dietas saludables, entrenamiento físico, abandono del tabaco y cumplimiento terapéutico. También se requieren medidas de salud pública, como la prohibición de fumar en lugares públicos o eliminar los ácidos grasos trans de la cadena alimentaria. Otras novedades consisten en desestimar el tratamiento antiagregante en prevención primaria y la recomendación de mantener la PA dentro del rango 130-139/80-85 mmHg en pacientes diabéticos o con RCV alto. Se destaca el bajo cumplimiento terapéutico observado, porque influye en el pronóstico de los pacientes y en los costes sanitarios. Para mejorar la prevención cardiovascular se precisa una verdadera alianza entre políticos, administraciones, asociaciones científicas y profesionales de la salud, fundaciones de salud, asociaciones de consumidores, pacientes y sus familias, que impulse las estrategias poblacional e individual, mediante el uso de toda la evidencia científica disponible, desde ensayos clínicos hasta estudios observacionales y modelos matemáticos para evaluar intervenciones a nivel poblacional, incluyendo análisis de coste-efectividad