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Introducción: Los sujetos con prediabetes, definida como glucemia alterada en ayunas (IFG), tienen un riesgo cardiovascular aumentado. El objetivo principal del estudio es establecer si la prediabetes se asocia con la presencia de placa ateroesclerótica subclínica (pATS) en forma independiente de la edad, el sexo, la hipertensión arterial y otros factores de riesgo cardiovascular. Materiales y métodos: Estudio observacional apareado por puntaje de propensión (PSM). Se incluyeron 481 sujetos con prediabetes (según los criterios de la Asociación Americana de Diabetes [ADA]) y 481 controles apareados por edad, sexo e hipertensión arterial. Se excluyeron sujetos con enfermedad coronaria y/o vascular periférica y/o diabetes. La pATS fue definida como la presencia de placa detectada por ecografía doppler carotídea. Resultados: La prevalencia de pATS fue del 34,7% en los sujetos prediabéticos comparado con el 28,8% en los controles. El odds ratio (OR) ajustado tras realizar el control por edad, sexo, hipertensión arterial y c-HDL fue de 1,29 (IC 95%: 1,12-1,48; p<0,001). La prevalencia de pATS fue del 42,3% en los sujetos prediabéticos hipertensos comparada con el 32,9% en los controles (OR: 1,49; IC 95%: 1,05-2,12; p: 0,02). También observamos mayor pATS (18,7%) en los sujetos más jóvenes (≤55 años) comparada con los controles (11,1%) de igual edad (OR: 1,83; IC 95%: 1,05-3,2; p: 0,03). Conclusiones: Los sujetos con prediabetes se asociaron con mayor prevalencia de pATS. La posibilidad (odds) de presentar ateroesclerosis subclínica fue del 29% mayor en los sujetos con prediabetes tras ajustar por edad, sexo, hipertensión arterial y c-HDL. (AU)

Introduction: Subjects with prediabetes, defined as impaired fasting blood glucose (IFG), have an increased cardiovascular risk. The main objective of the study is to establish whether prediabetes is associated with the presence of subclinical atherosclerotic plaque (pATS) regardless of age, sex, arterial hypertension and other cardiovascular risk factores. Material and methods: Observational study with propensity score matching (PSM). We included 481 subjects with prediabetes (according to the criteria of the American Diabetes Association) and 481 controls matched for age, sex, and hypertension. Subjects with coronary artery disease and/or peripheral vascular disease and/or diabetes were excluded. pATS was defined as the presence of plaque detected by carotid doppler ultrasound. Results: The prevalence of pATS was 34.7% in prediabetic subjects compared to 28.8% in controls. The adjusted odds ratio (OR) after controlling for age, sex, hypertension, and HDL-c was 1.29 (95% CI: 1.12-1.48; P<.001). The prevalence of pATS was 42.3% in hypertensive prediabetic subjects compared to 32.9% in controls (OR: 1.49; 95% CI: 1.05-2.12; P: .02). We also observed higher pATS (18.7%) in younger subjects (≤55 years) compared to controls (11.1%) of the same age (OR: 1.83; 95% CI: 1.05-3.2; P: .03). Conclusion: Subjects with prediabetes were associated with a higher prevalence of pATS. The possibility (odds) of presenting subclinical atherosclerosis was 29% higher in subjects with prediabetes after adjusting for age, sex, hypertension and HDL-c. (AU)

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INTRODUCTION: Subjects with prediabetes, defined as impaired fasting blood glucose (IFG), have an increased cardiovascular risk. The main objective of the study is to establish whether prediabetes is associated with the presence of subclinical atherosclerotic plaque (pATS) regardless of age, sex, arterial hypertension and other cardiovascular risk factores. MATERIAL AND METHODS: Observational study with propensity score matching (PSM). We included 481 subjects with prediabetes (according to the criteria of the American Diabetes Association) and 481 controls matched for age, sex, and hypertension. Subjects with coronary artery disease and/or peripheral vascular disease and/or diabetes were excluded. pATS was defined as the presence of plaque detected by carotid doppler ultrasound. RESULTS: The prevalence of pATS was 34.7% in prediabetic subjects compared to 28.8% in controls. The adjusted odds ratio (OR) after controlling for age, sex, hypertension, and HDL-c was 1.29 (95% CI: 1.12-1.48; P<.001). The prevalence of pATS was 42.3% in hypertensive prediabetic subjects compared to 32.9% in controls (OR: 1.49; 95% CI: 1.05-2.12; P: .02). We also observed higher pATS (18.7%) in younger subjects (≤55 years) compared to controls (11.1%) of the same age (OR: 1.83; 95% CI: 1.05-3.2; P: .03). CONCLUSION: Subjects with prediabetes were associated with a higher prevalence of pATS. The possibility (odds) of presenting subclinical atherosclerosis was 29% higher in subjects with prediabetes after adjusting for age, sex, hypertension and HDL-c.

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Background: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Introducción: La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía. Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

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INTRODUCTION: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. METHODS: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. RESULTS: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. CONCLUSIONS: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

INTRODUCCIÓN: La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía. MÉTODOS: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. RESULTADOS: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). CONCLUSIONES: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

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Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

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INTRODUCTION AND OBJECTIVES: The equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. METHODS: This study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. RESULTS: Carotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. CONCLUSIONS: Most cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH.

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Introducción: La recomendación actual para la estratificación de riesgo de las nuevas guías ACC/AHA sobre tratamiento del colesterol para la reducción del riesgo cardiovascular aterosclerótico plantea un interrogante sobre la utilidad de la detección de aterosclerosis subclínica en prevención primaria. Objetivos: Analizar la prevalencia de aterosclerosis subclínica evaluada con eco carotídeo en los diferentes grupos de riesgo según las nuevas guías. Analizar la prevalencia de aterosclerosis subclínica de los diferentes subgrupos cuando se agrega una subestratificación basada en el número de factores de riesgo. Material y métodos: Se seleccionaron pacientes consecutivos de prevención primaria. Se excluyeron los pacientes con historia de diabetes y/o enfermedad coronaria y/o vascular periférica. Se definió aterosclerosis subclínica a la presencia de una o más placas ateroscleróticas detectadas por eco-Doppler carotídeo. Resultados: Se analizaron 541 pacientes, de los cuales 243 (45%) se estratificaron de riesgo bajo, 100 (18%) de riesgo intermedio y 198 (37%) de riesgo alto. La prevalencia de placa (aterosclerosis subclínica) fue del 12% (IC 95% 9-17) en el grupo de riesgo bajo, del 23% (IC 95% 16-32) en el de riesgo intermedio y del 41% (IC 95% 34-48) en el grupo de riesgo alto (p < 0,001). Al analizar los diferentes subgrupos, en los pacientes de riesgo intermedio con dos o más factores de riesgo se observó una prevalencia de aterosclerosis subclínica del 30% (IC 95% 20-43); en cambio, en el subgrupo con 0 a 1 factor de riesgo, la prevalencia fue del 14% (IC 95% 6-27) (p < 0,05). Conclusiones: La evaluación de la aterosclerosis subclínica sumada al número de factores de riesgo permite identificar a sujetos con diferentes riesgos, más allá de la estratificación de las nuevas guías americanas, lo cual puede ser de utilidad al momento de decidir la terapéutica individual.

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BACKGROUND AND OBJECTIVE: The triglyceride/HDL cholesterol ratio, as a surrogate marker of insulin resistance, may be associated to presence of subclinical carotid atherosclerosis in postmenopausal women. The aim of this study was to explore this association. PATIENTS AND METHODS: Women (last menstrual period≥2 years) in primary prevention up to 65 years of age were recruited. Association between the triglyceride/HDL cholesterol (HDL-C) ratio and presence of carotid plaque, assessed by ultrasonography, was analyzed. ROC analysis was performed, determining the precision of this ratio to detect carotid plaque. RESULTS: A total of 332 women (age 57±5 years) were recruited. Triglyceride/HDL-C ratio was 2.35±1.6. Prevalence of carotid plaque was 29%. Women with carotid plaque had higher triglyceride/HDL-C ratios (3.33±1.96 vs. 2.1±1.2, P<.001) than women with no carotid plaque. A positive relationship was seen between quintiles of this ratio and prevalence of carotid plaque (p<.001). Regardless of other risk factors, women with higher triglyceride/HDL-C ratios were more likely to have carotid plaque (odds ratio 1.47, 95% confidence interval 1.20-1.79, P<.001). The area under the curve of the triglyceride/HDL-C ratio to detect carotid plaque was .71 (95% confidence interval .65 to .76), and the optimal cut-off point was 2.04. CONCLUSIONS: In postmenopausal women in primary prevention, insulin resistance, estimated from the triglyceride/HDL-C ratio, was independently associated to a greater probability of carotid plaque. A value of such ratio greater than 2 may be used for assessing cardiovascular risk in this particular group of women.

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Para evaluar el nivel de riesgo cardiovascular de la población latinoamericana se diseñó un estudio en siete ciudades de la región a fin de realizar un muestreo poblacional homogéneo con metodología única, exámenes de laboratorio y físicos estandarizados y controlados para obtener así datos epidemiológicos confiables. El estudio CARMELA (Cardiovascular Risk Factor Multiple Evaluation in Latin America) evaluó 11.550 sujetos de la población general. Los resultados mostraron que la hipertensión tuvo una prevalencia equiparable a nivel mundial sólo en tres ciudades, en tanto que en el resto fue menor. La hipercolesterolemia fue muy prevalente aun en ciudades de diferente nivel socioeconómico. La diabetes se halló entre el 7% y el 9% en Ciudad de México, Bogotá y Santiago de Chile. El tabaquismo fue muy alto en ambos sexos en Santiago de Chile y en Buenos Aires. La obesidad abdominal y el síndrome metabólico predominaron en las mujeres de bajos recursos. El espesor íntima-media y la prevalencia de placa carotídea tuvieron una amplia variación entre ciudades. Los datos epidemiológicos recabados en el estudio CARMELA completan el panorama del riesgo cardiovascular de nuestra región y muestran que su prevalencia indica la necesidad de contar con políticas de salud racionales.

To assess the cardiovascular risk of the Latin American population, we conducted a homogeneous population-based sampling study in seven cities of the region following controlled and standardized methods, laboratory tests and physical examination and thus obtain reliable epidemiological data. The CARMELA study (Cardiovascular Risk Factor Multiple Evaluation in Latin America) evaluated 11550 subjects from the general population. The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes ranged between 7% and 9% in Mexico City, Bogotá and Santiago de Chile. Tobacco use was high in both sexes in Santiago and Buenos Aires. Abdominal obesity and the metabolic syndrome were more prevalent in women of low resources. Intima-media thickness and carotid plaque prevalence varied widely. The epidemiological data obtained in the CARMELA study complete the outlook of the cardiovascular risk in our region and indicate the need of rationale urban health policies.