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.

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.

Thoracic epidural anesthesia decreases C-reactive protein levels in patients undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass.

BACKGROUND: Coronary artery bypass graft surgery with cardiopulmonary bypass induces a systemic inflammatory response. However, when thoracic epidural anaesthesia is administered as part of a combined anesthetic technique, the stress response associated with the cardiopulmonary bypass (CPB) may be attenuated. METHODS: Twenty-two patients undergoing elective coronary artery bypass graft surgery were randomized to receive either balanced general anesthesia with 7-20 microg/kg fentanyl (GA group) or combined anesthesia with 3-6 microg/kg fentanyl and an epidural bolus of 0.33% bupivacaine followed by a continuous perfusion of 0.175% bupivacaine, which was continued up to 48 hours after surgery (TEA group). The hemodynamic levels, troponin I, C-reactive protein (CRP), fibrinogen, leukocyte and platelet counts were recorded preoperatively, and 5 h, 16 h, 24 h, and 36 h after termination of the cardiopulmonary bypass. The time to tracheal extubation and cardiopulmonary complication rate were measured postoperatively. Data were analyzed with the Student's t and Mann Whitney tests, as appropriate. Differences were considered significant at P<0.05. RESULTS: All parameters significantly increased following CPB. The increase in CRP levels were lower in the TEA group at 16 hours (P=0.048). The increase of fibrinogen levels were lower in the TEA group at 24 hours (P=0.047). No differences were found in troponin levels between groups during the study. No significant differences were observed in extubation times (GA group 750+/-144 min; TEA group 702+/-451 min). CONCLUSION: Thoracic epidural anaesthesia, as a part of a combined anesthetic technique, attenuated the inflammatory response (CRP and fibrinogen levels) to cardiac surgery with cardiopulmonary bypass. However, this effect was not reflected in a decrease of troponin I levels, reduced incidence of complications, or in an earlier extubation time.

[Smoking-attributable deaths in Spain in 1998]. / Mortalidad atribuible al tabaquismo en España en 1998.

BACKGROUND: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998. POPULATION AND METHOD: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over. RESULTS: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke. CONCLUSIONS: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

[Recommendations for the control of cholesterolemia in Spain]. / Recomendaciones para el control de la colesterolemia en España.

A number of recommendations are provided regarding the detection, assessment and management in primary and secondary prevention, approaching hypercholesterolaemia from a multifactorial standpoint based on cardiovascular risk. Cardiovascular diseases are the leading cause of death in Spain. The major risks involved are coronary heart disease and cerebrovascular disease. The demographic, health-related and social impact thereof will be increasing over the coming decades. Controlling hypercholesterolaemia, in conjunction with eradicating the smoking habit and controlling hypertension, diabetes, obesity and physical inactivity comprise one of the main strategies for preventing cardiovascular diseases. Breaking down the risk of individuals based on the major cardiovascular risk factors is essential, given that these factors condition the frequency with which these individuals must be monitored and the type and degree of treatment entailed. Based on this breakdown, the priorities have been set for taking steps to prevent cardiovascular disease. In primary prevention, the therapeutic objective in high-risk persons (20% risk or higher or those persons involving two or more risk factors) has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol (130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Those patients having coronary heart disease must be included in secondary prevention programs that will ensure good, constant clinical and risk factor-related control.

[Trends in the mortality attributable to tobacco use in Spain, 1978-1992: 600,000 deaths in 15 years]. / Tendencia de la mortalidad atribuible al tabaquismo en España, 1978-1992: 600.000 muertes en 15 años.

BACKGROUND: The main objective is to describe time trends and evolution of mortality attributable to tobacco use in Spain in the period 1978-1992. MATERIAL AND METHODS: Spanish pevalences for never smokers, current smokers and former smokers estimated from national health surveys, and relative risks for death attributed to tobacco use from the Cancer Prevention Study II were used. The proportion and number of deaths attributed to tobacco use in the Spanish population of 35 years and over have been calculated by cause of death, sex and age. The trend in mortality attributable to tobacco use over the period 1978-1992 has also been calculated, expressed as the mean percentage change per year in the standardised mortality rates, estimated by a log-lineal model. RESULTS: Tobacco consumption caused 46,226 deaths in Spain in 1992. Most of them occurred in males (93.4%). One of every 4 deaths in males, and one of every 50 in females were attributable to tobacco consumption. One third of the deaths attributed to tobacco use were premature deaths (under 65 years). Lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and cerebrovascular disease caused 75% of deaths attributed to tobacco use. Lung cancer was the first specific cause in males, and chronic obstructive pulmonary disease was the main cause in females. A total of 621,678 deaths attributed to tobacco consumption were produced in the period (1978-1992). The main percentage change per year in the mortality rates shows a moderate increment of 0.1% (-0.2% in males +6.7% in females). CONCLUSIONS: Mortality attributable to tobacco use in Spain represents a high cost in terms of avoidable deaths and shows the limited impact of the interventions directed to tobacco control in Spain. One of every 4 deaths in males and a disturbing and rapidly increasing proportion in females are attributable to smoking.

[Projections of the impact of the smoking habit on the health of the Spanish population and on the potential benefits from its control]. / Proyección del impacto del hábito tabáquico sobre la salud de la población española y de los beneficios potenciales de su control.

BACKGROUND: Smoking continues to be an important public health problem in Spain. With the aim to know some of the health care consequences derived from the evolution of this habit in the Spanish population and to anticipate the health care benefits which would be a result of intervention on the same the estimations of mortality related with smoking and its control in the next few decades were predicted. METHODS: Mathematic models of simulation of the effects derived from changes in the prevalence of smoking based on the techniques of attributable risk, the multiplicity of the diseases involved and the time of reversal of the risk of death following health care intervention were used. RESULTS: In absence of intervention on smoking the number of total deaths by the causes under consideration will, in general, increase, from 1987 to 2020. The reduction of 40% in the prevalence of smoking in adult Spanish smokers over a period of 8 years (1992-2000) would potentially decrease the number of cardiovascular deaths by 6,035, deaths by COPD by 394 and the deaths by malignant tumors studied in the year 2020 by 5,237. By the year 2020 the effects of intervention would, in general, be completely manifest. A part of this reduction of mortality would translate in a gaining of 57,323 real years of life in the year 2020. These benefits are also appreciable, although lesser, in the previous years from the beginning of intervention. CONCLUSIONS: Smoking will continue to be an important public health problem in Spain in the future. The health care benefits which may be derived from correct application of effective control programs of the same would be appreciable.

[An epidemiological study on cardiovascular risk factors in 35-64 years old Spanish population]. / Estudio epidemiológico de los factores de riesgo cardiovascular en la población Española de 35 a 64 años.

BACKGROUND: Cardiovascular disease (CVD), specifically Coronary Health Disease and Cerebrovascular Disease, are the first cause of death in Spain. Information about their main modifiable risk factors (RF) distribution is needed in order to CVD prevention. The purpose of this paper is to estimate these RF prevalence and distribution by age, sex and habitat groups, i.e. tobacco smoking, cholesterolemia, high blood pressure, and obesity in the Spanish population. METHODS: A random cluster sampling cross-sectional study, stratified by habitat (rural and urban), age and sex, was carried out on 2021 men and women of 35 to 64 years of age in 1989. Definition criteria for variables studied were those from WHO and European Atherosclerosis Society. Additional data for study were treatment and control level of hypertensives, cardiovascular drugs consumption and CVD family history. RESULTS: Participation rate was 73.3%. Mean cholesterolemia was 211.2 mg/dl (210.1 mg/dl in males and 211.9 mg/dl in females). Mean systolic blood pressure was 132.3 mmHg (133.4 and 131.6 mmHg in men and women, respectively). Mean Quetelet Index was 27.5 kg/m2 (27.2 and 27.6 for men and women). 49.4% of males and 16.7% of females were smokers (25.7% and 78.3% were never smokers, respectively). Prevalence of hypercholesterolemia (> or = 250 mg/dl) was 18.6% in men and 17.6% in women, and that of high blood pressure (> or = 160/95 mmHg) was 21.5% in men (49.1% of them treated, and 26.7% controlled), and 19% in women (60.9% treated and 38% controlled). 18.4% of men and 27.4% of women had a Quetelet Index greater than thirty. 15 to 20% of individuals reported a CVD family history. For all these variables there were generally differences according to age, sex, and habitat. CONCLUSIONS: Risk factors distributions and prevalences in Spanish middle-aged individuals rank relatively high. This suggest need of further study and control of them to address CVD prevention properly.

[Deaths attributable to tobacco consumption in Spain]. / Muertes atribuibles al consumo de tabaco en España.

Spain is one of the European countries with greater prevalence of tobacco consumption among general population. In order to encourage the implementation of tobacco consumption reduction programmes, the number of deaths caused by cardiovascular diseases and chief cancer localizations attributable to tobacco consumption in Spain were calculated by epidemiologic methods. Estimates suggest that, in 1983, 39.816 tobacco related deaths occurred, which accounted for 13% of total deaths reported during that year. The four tobacco related diseases producing the greatest number of deaths were ischemic cardiopathy (10.821 deaths), bronchopulmonary cancer (8.337 deaths), chronic obstructive pulmonary disease (7.473 deaths), and acute cerebrovascular accident (6.636 deaths). These results suggest that tobacco consumption is the isolated cause responsible of the greatest number of deaths in Spain, whose control must become a priority objective in our health policy.