Impacto de un tratamiento integral e intensivo de factores de riesgo sobre la mortalidad cardiovascular en prevención secundaria: estudio MIRVAS

Moreno-Palanco, Miguel A.; Ibáñez-Sanz, Patricia; Pablo, Cristina Ciria-de; Pizarro-Portillo, Alberto; Rodríguez-Salvanés, Francisco; Súarez-Fernández, Carmen

doi:10.1016/j.recesp.2010.07.009

Cited by 27 publications

(6 citation statements)

References 16 publications

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“…Data from stable patients undergoing secondary prevention is scarce, nevertheless, our rate of events is very similar to the one described in other observational reports such as the REACH registry [47], where a population with a similar profile to ours presented a 15.4 % rate of events in the first year of follow-up. Regarding Spanish registries, similar populations presented a rate of events between 14 and 44 % after 3 years of follow-up according to the cardiovascular risk factors [48]. Other registries like the CLARIFY registry [49] showed a year rate of events inferior to ours (around 7 %), however, stroke was not included in the rate calculations reported.…”

Section: Discussionmentioning

confidence: 90%

Grape Resveratrol Increases Serum Adiponectin and Downregulates Inflammatory Genes in Peripheral Blood Mononuclear Cells: A Triple-Blind, Placebo-Controlled, One-Year Clinical Trial in Patients with Stable Coronary Artery Disease

Tomé‐Carneiro

Gonzálvez

Larrosa

et al. 2012

Cardiovasc Drugs Ther

209

166

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PurposeThe grape and wine polyphenol resveratrol exerts cardiovascular benefits but evidence from randomized human clinical trials is very limited. We investigated dose-depending effects of a resveratrol-containing grape supplement on stable patients with coronary artery disease (CAD) treated according to currently accepted guidelines for secondary prevention of cardiovascular disease.MethodsIn a triple-blind, randomized, placebo-controlled, one-year follow-up, 3-arm pilot clinical trial, 75 stable-CAD patients received 350 mg/day of placebo, resveratrol-containing grape extract (grape phenolics plus 8 mg resveratrol) or conventional grape extract lacking resveratrol during 6 months, and a double dose for the following 6 months. Changes in circulating inflammatory and fibrinolytic biomarkers were analyzed. Moreover, the transcriptional profiling of inflammatory genes in peripheral blood mononuclear cells (PBMCs) was explored using microarrays and functional gene expression analysis.ResultsAfter 1 year, in contrast to the placebo and conventional grape extract groups, the resveratrol-containing grape extract group showed an increase of the anti-inflammatory serum adiponectin (9.6 %, p = 0.01) and a decrease of the thrombogenic plasminogen activator inhibitor type 1 (PAI-1) (−18.6 %, p = 0.05). In addition, 6 key inflammation-related transcription factors were predicted to be significantly activated or inhibited, with 27 extracellular-space acting genes involved in inflammation, cell migration and T-cell interaction signals presenting downregulation (p < 0.05) in PBMCs. No adverse effects were detected in relation to the study products.ConclusionsChronic daily consumption of a resveratrol-containing grape nutraceutical could exert cardiovascular benefits in stable-CAD patients treated according to current evidence-based standards, by increasing serum adiponectin, preventing PAI-1 increase and inhibiting atherothrombotic signals in PBMCs.Electronic supplementary materialThe online version of this article (doi:10.1007/s10557-012-6427-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 90%

Grape Resveratrol Increases Serum Adiponectin and Downregulates Inflammatory Genes in Peripheral Blood Mononuclear Cells: A Triple-Blind, Placebo-Controlled, One-Year Clinical Trial in Patients with Stable Coronary Artery Disease

Tomé‐Carneiro

Gonzálvez

Larrosa

et al. 2012

Cardiovasc Drugs Ther

209

166

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“…In lifestyle interventions like the present one, it is important to have a multidisciplinary approach with different health professionals working together with a focus on behavioural changes of unhealthy lifestyle habits, cardiovascular risk factor management and optimized medication treatment [ 2 , 3 , 7 , 10 ]. In the present study, the focus was to strengthen the individual’s ability to change their lifestyle with a person-centered approach, which have shown positive effects on risk factor management and reaching treatment guidelines for individuals with CVD and diabetes [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice

Lidin

Hellénius

Rydell-Karlsson

et al. 2018

BMC Cardiovasc Disord

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BackgroundCardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology. The aim of the present study was to investigate the effects on cardiovascular risk factors and cardiovascular risk after 6 months and 1 year, in individuals with increased cardiovascular risk enrolled in a lifestyle multidisciplinary program in a clinical setting.MethodIndividuals with increased cardiovascular risk were referred from primary health care and hospitals to a program at an outpatient clinic at a department of cardiology. The program consisted of three individual visits including a health check-up with a physical examination and blood sampling, and a person-centered dialogue for support in behavioural change of unhealthy lifestyle habits (at baseline, 6 months and 1 year). Furthermore, five educational group sessions were given at baseline. Cardiovascular risk was assessed according to Framingham cardiovascular risk predicting model.ResultsOne hundred individuals (mean age 59 years, 64% women) enrolled between 2008 and 2014 were included in the study. Waist circumference, systolic and diastolic blood pressure and total cholesterol decreased significantly over 1 year. In parallel, cardiovascular risk according to the cardiovascular risk profile based on Framingham 10-year risk prediction model, decreased with 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease.ConclusionParticipating in a structured lifestyle program over a year was associated with significant improvement in multiple cardiovascular risk factors and decreased overall cardiovascular risk.Trial registrationThe study is registered at www.clinicaltrials.gov (ClinicalTrial.gov ID: NCT02744157).

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“…Reducing multiple cardiovascular risk factors simultaneously in subjects with type 2 diabetes has already been demonstrated as a feasible strategy [ 42 – 45 ], but with overwhelming support to systems of care during the clinical trials. Those levels of gain have not been replicated in routine care.…”

Section: Discussionmentioning

confidence: 99%

Adequacy of control of cardiovascular risk factors in ambulatory patients with type 2 diabetes attending diabetes out-patients clinic at a county hospital, Kenya

et al. 2017

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Background: Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in the study patients from rural and peri-urban dwelling. Methods: This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of Nyeri County Hospital, a public health facility located in the central region of Kenya. Results: Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0-14 years. Their mean age was 63.3 years, IQR of 56-71 years. Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were as follows: HbA1c above 7% was 60.5% (95% CI, 55.6-65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5-80.8) were poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0-81.3) and Albuminuria occurred in 32.7% (95% CI 27.8-37.4). The prevalence of the other habits with cardiovascular disease risk were: excess alcohol intake at 26.5% (95% CI 27.8-37.4) and cigarette-smoking at 23.6%. A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target <2.0 mmol/L. There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above 50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant determinants of high levels of serum LDL-cholesterol.

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Impacto de un tratamiento integral e intensivo de factores de riesgo sobre la mortalidad cardiovascular en prevención secundaria: estudio MIRVAS

Cited by 27 publications

References 16 publications

Grape Resveratrol Increases Serum Adiponectin and Downregulates Inflammatory Genes in Peripheral Blood Mononuclear Cells: A Triple-Blind, Placebo-Controlled, One-Year Clinical Trial in Patients with Stable Coronary Artery Disease

Grape Resveratrol Increases Serum Adiponectin and Downregulates Inflammatory Genes in Peripheral Blood Mononuclear Cells: A Triple-Blind, Placebo-Controlled, One-Year Clinical Trial in Patients with Stable Coronary Artery Disease

Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice

Adequacy of control of cardiovascular risk factors in ambulatory patients with type 2 diabetes attending diabetes out-patients clinic at a county hospital, Kenya

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