Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines.

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

Cardiovascular safety of noninsulin antidiabetic drugs: facts and promises. / Seguridad cardiovascular de los antidiabéticos no insulínicos: hechos y promesas.

Non insulin antidiabetic drugs are widely used in patients with type 2 diabetes. However, the drugs' effect in terms of reducing cardiovascular risk has been the subject of controversy. In 2008, based on the evidence of cardiovascular risk resulting from the use of a number of non insulin antidiabetic drugs, the US Food and Drug Administration published directives on the need to perform cardiovascular safety studies. These directives have helped obtain more evidence, such that at present there are 2 families of drugs that can reduce cardiovascular risk. These recent data have helped us add the reduction of cardiovascular morbidity and mortality to the objective of controlling blood glucose. Nevertheless, research continues with the development of new long-term studies.

Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

Influence of dispersion and aging on the frequency of some common interventions in the elderly.

BACKGROUND AND OBJECTIVE: Public administrations have to procure equitable care that compensates resistance factors such as communication problems and those arising from aging. Our objective was to analyze the influence of population dispersion and aging on the frequency rate of some common surgical procedures in elderly patients. PATIENTS AND METHODS: We used the database of surgical activity of the only hospital in a Spanish province to identify cataract surgeries, hip replacements and pacemaker implants performed during 2010. Using the National Statistics Institute Census, we calculated the rate for each procedure and the proportion of inhabitants over 65 in each municipality. Time needed to access the hospital by road from each municipality was used as a measure of dispersion. RESULTS: The population was distributed into 339 population centers, 90% of which had less than 1,000 inhabitants. The worst communicated populations were smaller (r=-0.194; P<.0001) and had a higher proportion of elderly (r=0.406; P<.0001). No relationship was found between the frequentation of the selected interventions and the number of inhabitants or travel time. Similarly, no differences were found when the analysis was done by pooling the population for 30 minutes isochrones. The percentage of those over 65 years was independently associated to the frequency rate of cataract surgery (beta=0.211; P<.001) and showed a trend to increased frequency for the implantation of pacemakers and hip replacements. CONCLUSIONS: Our study shows that, with the current organization of care and in the territory analyzed, neither population dispersion nor aging seems to reduce frequentation of several interventions typical of the elderly population.