Calcificaciones cardiovasculares: factores etiológicos implicados

Las calcificaciones cardiovasculares afectan a un importante sector de la población y pueden ser causa de serios problemas de salud. Así, alteran la flexibilidad de las arterias y facilitan la trombosis y su ruptura. Las calcificaciones valvulares dan lugar a diversos desórdenes que acaban en fallo cardíaco. En todos los casos la fase mineral corresponde a fosfatos cálcicos (fundamentalmente hidroxiapatita) y en las arterias puede localizarse en la media o en la íntima. En las válvulas cardíacas naturales, la calcificación suele comenzar en la parte interna, mientras que en las prostéticas es superficial. El mecanismo general del proceso de calcificación implica la existencia de una lesión previa (debida a agentes citotóxicos, hipercolesterolemia, insuficiencia renal terminal, edad avanzada, hiperlipemia, obesidad, diabetes, infecciones bacterianas) que actúa como inductora (nucleante heterogéneo) de la calcificación. Si los factores represores (inhibidores de la cristalización, moduladores de la acción celular) no poseen capacidad suficiente para impedir las primeras fases del proceso de calcificación, acabarán formándose placas calcificadas que ya será imposible eliminar sin utilizar cirugía. Puede concluirse, por lo tanto, que la prevención es fundamental para evitar el desarrollo de calcificaciones cardiovasculares, siendo necesario tanto identificar los factores promotores, relacionarlos con el tipo de calcificación y estudiar las vías de su control, como identificar los factores inhibidores de la cristalización y estudiar sus efectos.Cardiovascular calcifications affect to a wide sector of the population and can cause serious health problems. Thus, they alter arterial flexibility and facilitate thrombosis and arterial rupture. Calcification of heart valves generates several disorders responsible for heart failure. In all cases the mineral phase corresponds to calcium phosphates (fundamentally hydroxyapatite) that can be located in the media or intimal layers. In native heart valves, calcification is usually generated in the internal part, while in the bioprosthetic is superficial. The basic mechanism of the calcification process implies the existence of an underlying lesion (due to cytotoxic agents, hypercholesterolemia, endstage renal disease, ageing, hyperlipidaemia, obesity, diabetes, bacterial infections) that acts as inducer (heterogeneous nucleant) of the calcification. If the repressive factors (crystallization inhibitors, modulators of cellular action) are not capable enough to avoid the first steps of the calcification process, calcified plaques will developed and will become impossible to eliminate them without surgery. Therefore, it can be concluded that prevention is fundamental to avoid the development of cardiovascular calcifications, being necessary: 1) to identify the trigger factors, to relate them with the type of calcification, and to study the ways of their control, and 2) to identify the crystallization inhibitor factors and to study their effects

Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP).

BACKGROUND: Computerised databases of primary care clinical records are widely used for epidemiological research. In Catalonia, the Information System for the Development of Research in Primary Care (SIDIAP) aims to promote the development of research based on high-quality validated data from primary care electronic medical records. OBJECTIVE: The purpose of this study is to create and validate a scoring system (Registry Quality Score, RQS) that will enable all primary care practices (PCPs) to be selected as providers of researchusable data based on the completeness of their registers. METHODS: Diseases that were likely to be representative of common diagnoses seen in primary care were selected for RQS calculations. The observed/expected cases ratio was calculated for each disease. Once we had obtained an estimated value for this ratio for each of the selected conditions we added up the ratios calculated for each condition to obtain a final RQS. Rate comparisons between observed and published prevalences of diseases not included in the RQS calculations (atrial fibrillation, diabetes, obesity, schizophrenia, stroke, urinary incontinence and Crohn's disease) were used to set the RQS cutoff which will enable researchers to select PCPs with research-usable data. RESULTS: Apart from Crohn's disease, all prevalences were the same as those published from the RQS fourth quintile (60th percentile) onwards. This RQS cut-off provided a total population of 1 936 443 (39.6% of the total SIDIAP population). CONCLUSIONS: SIDIAP is highly representative of the population of Catalonia in terms of geographical, age and sex distributions. We report the usefulness of rate comparison as a valid method to establish research-usable data within primary care electronic medical records

Internalization of Calcium Oxalate Calculi Developed in Narrow Cavities

We describe the case of a patient with calcium oxalate monohydrate and calcium oxalate dihydrate calculi occluded in cavities. All those calculi were located inside narrow cavities covered with a thin epithelium that permits their visualization. Urinary biochemical analysis showed high calciuria, not hypercalciuria, hypocitraturia, and a ratio [calcium]/[citrate] >0.33. The existence of cavities of very low urodynamic efficacy was decisive in the formation of such calculi. It is important to emphasize that we observed a thin epithelium covering such cavities, demonstrating that this epithelium may be formed after the development of the calculi through a re-epithelialization process. Keywords: Calcium oxalate stones, Calculi occluded in cavitie

Serum Lipid Levels and Risk Of Hand Osteoarthritis : The Chingford Prospective Cohort Study

The development of hand osteoarthritis (HOA) could be linked to hyperlipidaemia. No longitudinal studies have addressed the relationship between serum lipid profile and HOA. The study aim was to determine the association between serum lipid profile and the incidence of radiographic hand osteoarthritis (RHOA). All women in a prospective population-based cohort from the Chingford study with available baseline lipid measurements and without RHOA on a baseline were included. Study outcome was the incidence of RHOA in year 11 of follow-up. Serum lipid profile variables were analysed as continuous variables and categorised into quartiles. The association between serum lipid profile and RHOA was modeled using multivariable logistic regression. Overall RHOA incidence was 51.6% (45.7-57.4%). An inverse association between HDL cholesterol levels and the incidence of RHOA was observed by quartile: OR of 0.36 [95%CI 0.17-0.75], 0.52 [95%CI 0.26-1.06], and 0.48 [95%CI 0.22-1.03]. Triglycerides levels showed a significant trend. No relationship was found with total or LDL cholesterol. Higher levels of HDL cholesterol appear to protect against RHOA after 11 years of follow-up. More research is needed to elucidate HOA risk factors, the mechanisms related to the lipid pathway, and the effects of lipid-lowering agents on reducing the incidence of OA

Association between chronic immune-mediated inflammatory diseases and cardiovascular risk

OBJECTIVE: To examine the association between chronic immune-mediated diseases (rheumatoid arthritis, systemic lupus erythematosus or the following chronic immune-mediated inflammatory diagnoses groups: inflammatory bowel diseases, inflammatory polyarthropathies, systemic connective tissue disorders and spondylopathies) and the 6-year coronary artery disease, stroke, cardiovascular disease incidence and overall mortality; and to estimate the population attributable fractions for all four end-points for each chronic immune-mediated inflammatory disease. METHODS: Cohort study of individuals aged 35-85 years, with no history of cardiovascular disease from Catalonia (Spain). The coded diagnoses of chronic immune-mediated diseases and cardiovascular diseases were ascertained and registered using validated codes, and date of death was obtained from administrative data. Cox regression models for each outcome according to exposure were fitted to estimate HRs in two models 1 : after adjustment for sex, age, cardiovascular risk factors and 2 further adjusted for drug use. Population attributable fractions were estimated for each exposure. RESULTS: Data were collected from 991 546 participants. The risk of cardiovascular disease was increased in systemic connective tissue disorders (model 1: HR=1.38 (95% CI 1.21 to 1.57) and model 2: HR=1.31 (95% CI 1.15 to 1.49)), rheumatoid arthritis (HR=1.43 (95% CI 1.26 to 1.62) and HR=1.31 (95% CI 1.15 to 1.49)) and inflammatory bowel diseases (HR=1.18 (95% CI 1.06 to 1.32) and HR=1.12 (95% CI 1.01 to 1.25)). The effect of anti-inflammatory treatment was significant in all instances (HR=1.50 (95% CI 1.24 to 1.81); HR=1.47 (95% CI 1.23 to 1.75); HR=1.43 (95% CI 1.19 to 1.73), respectively). The population attributable fractions for all three disorders were 13.4%, 15.7% and 10.7%, respectively. CONCLUSION: Systemic connective tissue disorders and rheumatoid arthritis conferred the highest cardiovascular risk and population impact, followed by inflammatory bowel diseases

Effectiveness of statins as prevention in people with gout: a population-based cohort study

Background: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. Aim: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. Methods: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. Results: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). Conclusions: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations

Blood chemistry and end-systolic volume in subjects according to urinary phytate level tertiles (low, intermediate and high).

<p>Statistics: Continuous variables are expressed as mean ± standard deviation and categorical variables are expressed as total number (percentage). Continuous variables with normal distributions were compared using one-way analysis of variance (ANOVA) and t-test for independent samples. Continuous variables with abnormal distributions were compared using the Kruskal-Wallis one-way analysis of variance by ranks and Mann-Whitney U test. For categorical variables, the chi-square test was used. The Bonferroni correction was used to account for multiple comparisons. The p-values correspond to the analysis of variance or chi-square test. a: p<0.05/3 <i>vs</i>. low group for the <i>post-hoc</i> tests.</p><p>Blood chemistry and end-systolic volume in subjects according to urinary phytate level tertiles (low, intermediate and high).</p