Los duendes de las estadísticas de WordPress.com prepararon un informe sobre el año 2015 de este blog.
Aquí hay un extracto:
Un teleférico de San Francisco puede contener 60 personas. Este blog fue visto por 360 veces en 2015. Si el blog fue un teleférico, se necesitarían alrededor de 6 viajes para llevar tantas personas.
Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy.
Alonso N, Traveset A, Rubinat E, Ortega E, Alcubierre N, Sanahuja J, Hernández M, Betriu A, Jurjo C, Fernández E, Mauricio D.
Cardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR.
A cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40-75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA).
The percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001).
The present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up.
Left carotid adventitial vasa vasorum signal correlates directly with age and with left carotid intima-media thickness in individuals without atheromatous risk factors
The early identification of the onset of subclinical atheromatosis is essential in reducing the high mortality risk from cardiovascular disease (CVD) worldwide. Although carotid intima-media thickness (cIMT) is the most commonly used early predictor of ongoing atherosclerosis, an experimental model of atherosclerosis, demonstrated that increases in adventitial microvessels (vasa vasorum (VV)) precede endothelial dysfunction. Using the reported accuracy of contrast-enhanced ultrasound (CEU) to measure carotid adventitial VV, this study assessed whether measurements of carotid adventitial VV serve as a marker of subclinical atherosclerotic lesions in a control population with none of the classical risk factors for CVD.
METHODS AND RESULTS:
Measurements of cIMT (B-mode ultrasound) and adventitial VV (CEU) were conducted in 65 subjects, 30-70 years old, 48% men, with none of the classical risk factors for CVD. Adventitial VV strongly correlated with its own cIMT only in the left carotid artery. Importantly, the left carotid adventitial VV directly correlated with age.
The increases with age in left carotid adventitial VV in individuals with zero risk for atheromatosis suggest that the measurement of carotid adventitial VV could be an accurate and sensitive marker for the diagnosis of subclinical atheromatosis and therefore a prominent tool for monitoring the efficacy of anti-atheromatous therapies.
Hoy divulgamos la newsletter del ERA-EDTA WORKING GROUP ON CHRONIC KIDNEY DISEASE AND MINERAL BONE DISORDER donde se comenta el último artículo del proyecto NEFRONA.
As previously mentioned and as a contribution of ERA-EDTA communication team, we hereby report and summarize the most recent papers published on the journals of our society dealing with CKD-MBD.
From July to December 2014, 25 CKD-MBD related articles have been published, 23 in Nephrology Dialysis and Transplantation and 2 in the Clinical Kidney Journal.
1) The ERA-EDTA CKD-MBD Working Group published a “NDT perspective” discussing whether CKD-MBD should be considered a syndrome or not (Nephrol Dial Transplant 29 (10):1815). While it is agreed that this concept has influenced our current clinical hypotheses and guidelines, definitive proof of a benefit of interventions is still lacking. However, it is undisputed that CKD patients have an outstanding increased risk of morbidity and mortality. In this regard, prevalence of subclinical atheromatosis and associated risk factors in CKD was published by A. Betriu et al (Nephrol Dial Transplant 29 (7):1415) from the Spanish NEFRONA study data. It is not only shown the magnitude of subclinical atheromatous disease in a large CKD population but also that patient characteristics associated with plaques differ in different CKD stages. Among other factors (including classical risk factors), high phosphate (P) and hsCRP levels were associated with subclinical atherosclerosis in stages 4-5, and low levels of calcidiol were associated with the presence of plaque in dialysis patients. Other papers in this period of time deal with the cardio-renal syndrome but they do not specifically cover aspects of CKD-MBD.
El 29 de enero publicábamos una entrada que se felicitaba a la unidad UDETMA por la publicación de un nuevo artículo, Subclinical Carotid Atherosclerosis in Asymptomatic Subjects With Type 2 Diabetes Mellitus, Journal of Cardiovascular Nursing, y también a los autores: Esther Rubinat, RN, MSc; Josep Ramon Marsal, Stat; Teresa Vidal, RN; Cristina Cebrian, RN; Mireia Falguera,MD; Ma. Belen Vilanova, MD;Àngels Betriu,MD, PhD; Elvira Fernández, MD, PhD; Josep Franch, MD, PhD; Dídac Mauricio, MD, PhD
Ya podeis encontrar el artículo.
Aquí teneis el abstract:
Background: Subjects with type 2 diabetes mellitus are considered to be at high risk for cardiovascular disease. The identification of carotid atherosclerosis is a validated surrogate marker of cardiovascular disease. Nurses are key professionals in the improvement and intensification of cardiovascular preventive strategies.
Aims: The aim is to study the presence of carotid atherosclerosis in a group of asymptomatic subjects with type 2 diabetes mellitus and no previous clinical cardiovascular disease.
Methods: A total of 187 patients with type 2 diabetes mellitus and 187 age- and sex-matched subjects without type 2 diabetes mellitus were studied in this cross-sectional, observational, cohort study. Standard operational procedures were applied by the nursing team regarding physical examination and carotid ultrasound assessment. Common, bulb, and internal carotid arteries were explored by measuring intima-media thickness and identifying atherosclerotic plaques.
Results: Carotid intima-media thickness (c-IMT) and carotid plaque prevalence were significantly greater in diabetic subjects than in the control group. Carotid plaques and c-IMT were more frequent in men than in women and increased with increasing age. In the multivariate analysis, age, gender, waist circumference, systolic blood pressure, and hypercholesterolemia were positively associated with c-IMT, whereas age, gender, and weight were positively associated with carotid plaque.
Conclusion: The current nurse-led study shows that subjects with type 2 diabetes mellitus have a high prevalence of subclinical atherosclerosis that is associated with cardiovascular risk factors.
La Dra. Marta Gracia, del grupo de Nefrología Experimental del IRB Lleida, ha presentado en el congreso EAS (European Atherosclerosis Society) 2015, la comunicación oral con el título Predictors of subclinical atheromatosis progression in chronic kidney disease. The NEFRONA Study.
Las conclusiones de la comunicación son:
- Progression of atheromatous disease after 24 months follow-up was 60% without significal differences between CKD Stages.
- Progression of plaque after 24 months was higher in patients with already plaque at baseline (68.6%) than in patients free of plaque at baseline (40.5%).
- The main factors that were associated to atheromatous disease progression in all patients are age, smoking, diabetes, dislypemia, high SBP values and dialysis. High vitamin D levels protected in front progression.
- Factors associated with atheromatous disease progression were different according to presence of plaque at baseline. Only high SBP is a common risk factor.
- In patients without plaque at baseline: age and smoking.
- In patients with plaque at baseline: diabetes and dislypidaemia.
- Factors associated with atheromatous disease progression were different according to CKD stage. Only age is a common risk factor.
- In CKD Stage 3: Smoking, SBP, diabetes and phosphate.
- In CKD Stage 4-5: Smoking, SBP, plaque and Ferritin.
- In CKD Stage 5D: dislypidaemia, uric acid. Inversely association with BMI, cholesterol and 25-hydroxi-vitamin D.
El congreso ha tenido lugar en Glasgow del 22 al 25 de marzo.
Association of serum phosphorus with subclinical atherosclerosis in chronic kidney disease. Sex makes a difference
Cardiovascular disease is the leading cause of mortality in chronic kidney disease (CKD). Serum phosphate has been associated to cardiovascular disease in the general population and this effect seems to be different according to sex. In the present study we analyze the effect of phosphate on subclinical atherosclerosis in the NEFRONA population and its effect depending on sex.
Carotid ultrasound assessing the presence of plaques was performed by an itinerant team in 1687 CKD patients not in dialysis without previous cardiovascular events. Standard blood test and anthropometrical parameters were also recorded.
Multivariate linear regression to model phosphate levels in patients with CKD showed an interaction of sex with age. Thus, among men, serum phosphate levels declined significantly with age almost linearly. Serum phosphate levels in women under the age of 40–45 years overlapped with those in men and then stayed above, showing and overall constant relationship. Multivariate logistic regression analysis showed that higher phosphate levels associated with a higher risk of presenting atheromatous plaque. This risk however was different according to sex. In men, phosphate levels within the normal range associated with an increased risk of subclinical atheromatosis whereas in women this risk only increased with serum levels over the normal range.
This study demonstrates that phosphate levels are associated with the presence of subclinical atheromatosis in a large CKD population. This effect of phosphate on subclinical atheromatosis was different according to sex, suggesting that a recommended serum phosphate levels could be different for male than for female CKD patients.
- Chronic kidney disease;
- Sex differences
Proyecto NEFRONA: Utilidad de las técnicas de imagen y biomarcadores en la predicción del riesgo cardiovascular en pacientes con enfermedad renal crónica en España. Datos basales
- El proyecto NEFRONA se inicio con una población importante que será seguida prospectivamente.
- La prevalencia de FRCV es elevada, así como la enfermedad ateromatosa, lo que permitirá ver su relación de forma prospectiva.