The usefulness of aspirin in patients without a cardiovascular history continues to be a subject of controversy. 1. Perform an updated meta-analysis on the use of aspirin in primary cardiovascular prevention. 2. Analyze the results by risk. This meta-analysis was performed according to the PRISMA guidelines. The primary endpoint was cardiovascular death, AMI, and ischemic stroke. The measures of effect size are expressed as odds ratios. The level of statistical significance was established at 0.05. Characteristics of the studies Trials Year N Follow-up Risk RTPDABMD 1988 5,139 5.5 Middle PHS 1989 22,071 5 Low HOT 1998 18,790 3.8 Middle TPT 1998 5,085 6.7 Middle PPP 2001 44,95 3.6 Low WHS 2005 39,876 10.1 Low JPAD 2008 2,539 4.4 Low POPADAD 2008 1276 6.7 High AAA 2010 3,350 8.2 Low JPPP 2014 14,464 5 Low ASCEND 2018 15,480 7.4 Middle ARRIVE 2018 12,546 5 Low ASPREE 2018 19,114 4.7 Low RTPDABMD, Randomised trial of prophylactic daily aspirin in British male doctors; PHS, Physicians' Health Study; HOT, Hypertension Optimal Treatment; TPT, Thrombosis Prevention Trial; PPP, Primary Prevention Project; WHS, Women's Health Study; JPAD, Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes; POPADAD, Prevention of Progression of Arterial Disease and Diabetes; AAA, Aspirin for Asymptomatic Atherosclerosis; JPPP, Japanese Primary Prevention Project; ASCEND, A Study of Cardiovascular Events in Diabetes; ARRIVE, Aspirin to Reduce Risk of Initial Vascular Events; ASPREE, Aspirin in Reducing Events in the Elderly. Figure 1 Thirteen works were considered for the analysis (Table 1). A total of 164,225 patients were included, 82,900 in the aspirin arm and 81,325 in the control group. A reduction of the primary endpoint was observed in the AAS group (OR 0.90, 95% CI 0.85–0.94). No differences by risk group (Figure 1). Risk of severe bleeding was significantly higher in patients treated with ASA (OR 1.45, 95% CI 1.34–1.56), this difference was maintained by risk (Figure 1). None

Background: A novel lipid relation, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) ratio gathers information on all atherogenic and antiatherogenic particles on a single date. The relationship between this lipid marker and the presence of carotid atherosclerotic plaque (CAP) in postmenopausal women is unknown. Methods: Postmenopausal women in primary prevention up to 70 years of age were recruited. Association between the non-HDL-C/HDL-C ratio and presence of CAP, assessed by ultrasonography, was analyzed. Receiver operating characteristic (ROC) curve analysis was performed. Results: A total of 440 females with a mean age of 58.1 +/- 5.3 years were recruited. The mean non-HDL-C/HDL ratio was 3.1 +/- 1.2 and 28.2% of woman had CAP. A positive relationship was seen between quintiles of the non-HDL-C/HDL-C ratio and prevalence of CAP (p < 0.001). Regardless of other risk factors, women with higher non-HDL-C/HDL-C ratios had a greater chance of having CAP (odds ratio 1.30, 95% confidence interval: 1.07-1.58, p = 0.009). In the ROC curve analysis, the area under the curve of the non-HDL-C/HDL ratio for detecting CAP was 0.703 (95% confidence interval: 0.640-0.765) and the optimal cut-off point was 3.0 (Youden index 0.395). Conclusion: The present study suggests that the non-HDL-C/HDL-C ratio might be a strong marker for predicting the risk of CAP in postmenopausal women.

Background. - Cholesteryl ester transfer protein (CETP) inhibitors are a class of drugs that targets the CETP enzyme to significantly increase serum high-density lipoprotein cholesterol (HDL-C) and decrease low-density lipoprotein cholesterol (LDL-C) levels. As HDL-C has potential antidiabetic properties, and the beneficial effects of CETP drugs on glucose homoeostasis have not been sufficiently studied, the aims of this study were: (1) to evaluate the effect of CETP inhibitors on the incidence of diabetes; and (2) to assess the association between CETP inhibitor-induced changes in HDL-C levels and incidence of diabetes. Methods. - A meta-analysis was performed of randomized controlled clinical trials of CETP inhibitor therapy, either alone or combined with other lipid-lowering drugs, reporting data from new cases of diabetes with a minimum of 6 months of follow-up, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A fixed-effects meta-regression model was then applied. Results. - Four eligible trials of CETP inhibitors, involving a total of 73,479 patients, were considered for the analyses, including 960 newly diagnosed cases of diabetes in the CTEP inhibitor group vs 1086 in the placebo group. CETP inhibitor therapy was associated with a significant 12% reduction in incidence of diabetes (OR: 0.88, 95% CI: 0.81-0.96; P = 0.005). Assessment of the relationship between on-treatment HDL-C and the effect of CETP inhibitors showed a statistically non-significant trend (Z = -1.13, P = 0.26). Conclusion. - CETP inhibitors reduced the incidence of diabetes. The improvement in glucose metabolism may have been related, at least in part, to the increase in HDL-C concentration. (C) 2018 Elsevier Masson SAS. All rights reserved.

La enfermedad arterial periférica de las extremidades inferiores (EAP) conlleva una mayor morbimortalidad en pacientes con diabetes mellitus tipo 2 (DM2); este trabajo evalúa la prevalencia en dichos pacientes y su asociación con variables socio-demográficas y clínicas.Estudio descriptivo transversal con muestreo consecutivo de pacientes con DM2, entre 50-80 años, en Atención Primaria. La presencia de EAP fue diagnosticada mediante un índice tobillo-brazo (ITB) ≤ 0,9. Variables independientes: socio-demográficas, clínicas y de laboratorio. Para determinar qué factores se asociaban a ITB bajo se hizo un análisis bivariado y regresión logística múltiple.Muestra de 251 pacientes, de los que el 52,6% eran mujeres; la edad media ± desviación estándar fue de 68,5 ± 8,5 años. Presentaron ITB bajo el 18,3% (intervalo de confianza del 95% [IC del 95%], 13,3-23,3%); 6 sujetos (2,4%) estaban diagnosticados previamente de EAP. Tras el análisis multivariante, los factores que se vieron asociados con un ITB bajo fueron la edad (OR = 1,07; IC del 95%, 1,02-1,12) y la presencia de retinopatía (OR = 2,69; IC del 95%, 1,06-6,81).Hay un bajo porcentaje de pacientes diagnosticados de EAP, a pesar de su elevada prevalencia en pacientes con DM2 seguidos en Atención Primaria, especialmente aquellos de mayor edad y con retinopatía, por lo que hay que insistir en la recomendación de realizar sistemáticamente el ITB en esta población de riesgo.Peripheral artery disease in the lower limbs (PAD) is a prevalent condition that entails high morbidity in diabetic patients; this study assesses PAD in these patients and its socio-demographic and clinic associated variables.Descriptive study in a systematic sample of diabetic patients (DM2) aged 50-80 years, in Primary Care settings. The dependent variable was the presence of PAD diagnosed by ankle-brachial index (ABI) ≤ 0.9; independent variables: socio-demographic, clinical and laboratory. Statistics: bivariate and multiple logistic regression analyses were performed to determine the variables associated with low ABI.A sample of 251 patients, 52.6% women; mean age: 68.5 ±8.5. A low ABI was detected in 18.3% (95% Confidence Interval (95% CI):13.3-23.3%), with 6 subjets (2.4%) previously diagnosed as suffering PAD. Age (OR = 1.07; 95% CI: 1.02-1.12) and retinopathy (OR = 2.69; 95% CI: 1.06-6.81) were associated (multiple logistic regression analysis) with ABI.The percentage of patients diagnosed with PAD is very low, although PAD prevalence is high among DM2 patients attending Primary Care clinics, especially in older patients and those with retinopathy. We emphasize the recommendation of performing the ABI test in this population at risk.

La fisiopatología de la diabetes gestacional provoca por sí misma una hiperestimulación del tejido adiposo y de las células placentarias que aumenta la producción de citocinas inflamatorias, las cuales provocan cambios en los tejidos expuestos como la placenta y el feto, por lo que en este estudio el objetivo fue comparar los marcadores metabólicos y de disfunción endotelial en sangre de cordón umbilical, así como determinar la presencia de aterosclerosis en las placentas de hijos neonatos de pacientes con diabetes gestacional y en pacientes con embarazo normoevolutivo.Se realizó un estudio transversal analítico en 84 pacientes, de las cuales se obtuvieron datos como edad, tabaquismo y ganancia de peso en el embarazo; del recién nacido se determinó la edad gestacional por Capurro, el peso y el destino posterior al nacimiento. Además se utilizaron las placentas para la búsqueda de aterosclerosis mediante estudio anatomopatológico y en las muestras sanguíneas obtenidas de cordón umbilical se determinaron glucosa, insulina, colesterol, c-VLDL, c-HDL, triglicéridos, fibrinógeno, PCR y los marcadores de disfunción endotelial (adiponectina, VCAM-1, ICAM-1 e IL-6).La aterosclerosis placentaria se presentó en un 28,94% del grupo que cursó con diabetes gestacional frente a un 10,52% del grupo con embarazo normoevolutivo (p = 0,044); se encontraron diferencias en glucosa, colesterol, triglicéridos, fibrinógeno, HOMA-IR, PCR-us y c-HDL, no encontrándose en c-VLDL. El 21,05% de los recién nacidos de las pacientes con diabetes gestacional requirieron hospitalización frente al 5,2% del grupo control.Los embarazos que cursan con diabetes presentan una mayor proporción de aterosclerosis, de hospitalización en el recién nacido, de resistencia a la insulina, así como de elevación de marcadores relacionados con inflamación y disfunción endotelial en sangre de cordón umbilical.The pathophysiology of gestational diabetes itself causes hyperstimulation of adipose tissue and of the placenta cells increasing the production of inflammatory cytokines, which cause changes in the tissues exposed such as the placenta and foetus. Therefore, the objective of this study was to compare metabolic markers and endothelial dysfunction in umbilical cord blood, as well as to determine the presence of atherosclerosis in the placentas of newborn infants of patients with gestational diabetes and in patients with normally progressing pregnancies.An analytical cross-sectional study was carried out in 84 patients, obtaining data such as age, smoking and weight gain in pregnancy; the gestational age of the newborns was determined by Capurro, and their weight and destination subsequent to birth, the placentas were also collected in order to look for atherosclerosis through histological studies and glucose, insulin, VLDL-C, HDL-C, triglycerides, cholesterol, fibrinogen, PCR and markers of endothelial dysfunction (adiponectin, VCAM-1, ICAM-1 and IL-6) were determined in blood samples obtained from the umbilical cord.Placental atherosclerosis presented in 28.94% of the group with gestational diabetes compared to 10.52% of the group with normally progressing pregnancies (P=.044); differences were found in glucose, cholesterol, triglycerides, fibrinogen, HOMA-IR, PCR-us, HDL-C, not in VLDL-C. Twenty-one point five percent of the newborns of the gestational diabetes patients required hospitalization, against 5.2% in the control group,Pregnancies that involve diabetes have higher proportion of atherosclerosis, hospitalization of the newborn, insulin resistance, as well as elevation of markers associated with inflammation and endothelial dysfunction in umbilical cord blood.