[Adequacy of clinical interventions in patients with advanced and complex disease. Proposal of a decision making algorithm]. / Adecuación de las intervenciones clínicas en pacientes con enfermedad avanzada y compleja. Propuesta de algoritmo para la toma de decisiones.

Decision making in the patient with chronic advanced disease is especially complex. Health professionals are obliged to prevent avoidable suffering and not to add any more damage to that of the disease itself. The adequacy of the clinical interventions consists of only offering those diagnostic and therapeutic procedures appropriate to the clinical situation of the patient and to perform only those allowed by the patient or representative. In this article, the use of an algorithm is proposed that should serve to help health professionals in this decision making process.

[Serum cholesterol during the course of acute coronary events and secondary prevention of coronary heart disease]. / Determinación del colesterol en pacientes ingresados por eventos coronarios agudos y prevención secundaria de la cardiopatía isquémica.

OBJECTIVES: To assess changes in the serum cholesterol (CT) during acute coronary events (infarction -IAM- and unstable angina) in clinical practice, to raise to begin pharmacologic lipid therapy knowing only a lipid profile. METHODS: Lipid clinic database was revised. SELECTION CRITERIA: patients who were sent to the clinic 1 to 3 months after the acute coronary event and who were not begun pharmacologic lipid therapy. RESULTS: 56 patients, 69% with IAM. Admission CT mean was lower. Among 17 who had CT lower than 200 mg/dl during acute phase, 16 had CT higher than 200 in ambulatory lipid profile. The bigger acute phase drop took place between those who had CT higher during ambulatory consultation. CONCLUSIONS: Theses results confirm the CT decrease during IAM and reports this reduction happens during unstable angina too. That permits to suggest mostly to begin the lipid lowering drug therapy earlier, even although there was only a lipid value known.

[Decisions regarding cholesterol-lowering therapy in the elderly: the experience in a lipid clinic and a review of the literature]. / Indicaciones del tratamiento hipolipemiante en el anciano: experiencia de una unidad de lípidos y revisión de la literatura.

BACKGROUND: Therapy for hypercholesterolemia is long known one of the interventions with higher benefit on coronary heart disease secondary prevention and on primary prevention in middle-age high-risk people. Data about elderly persons are more scarce. The aim of this work is to study elderly patients sent to a Lipid Clinic, focusing on Serum Lp (a) levels and criteria to prescript cholesterol-lowering drugs. We have reviewed current knowledge to discuss and to clarify these criteria. METHOD: Observational study. Review of the medical charts from the patients sent to the Lipid Clinic. Elderly patients were compared with middle-aged persons attended to the same Clinic. RESULTS: From 348 total Lipid-Clinic cohort 72 (20.7%) patients were more than 65 years old (31 male). A 3 months or longer follow-up was available in 49/72 and 36/49 were taking cholesterol-lowering drugs. Among these 36, 21 had coronary disease; the other 15 had, at least, another risk factor, besides dyslipidemia. Serum Lp (a) level were higher in older group (38.7 +/- 36.9 mg/dl, median 29, vs 26.3 +/- 24.2, median 18 mg/dl, p < 0.01). Considering the accepted cardiovascular risk threshold (Lp (a) > 30 mg/dl), difference were found only in women. Coronary disease was present in 79 patients followed 3 months or longer and 24/79 were more than 65 years old. Twenty-one of them were taking cholesterol-lowering drugs, vs 50 from the 55 younger (pNS). The reasons for no drug-therapy were similar in both groups. CONCLUSIONS: Coronary heart disease or cardiovascular risk factors association were the criteria used for starting cholesterol-lowering drug therapy. Published evidence supporting this therapeutic approach is reviewed. There were not found age related differences for cholesterol-lowering drugs prescriptions in patients suffering coronary disease. Serum Lp (a) level were higher in elderly sample because of the increase in older women; it could be linked to the postmenopausal hormonal state.