[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

[Cardiovascular preventive recommendations. PAPPS 2020 update]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2020.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.

Barriers to improved dyslipidemia control: Delphi survey of a multidisciplinary panel.

OBJECTIVE: To assess the barriers that make it difficult for the health care professionals (physicians, nurses and health care managers) to achieve a better control for dyslipidemia in Spain. METHODS: The study has an observational design and was performed using the modified Delphi technique. One hundred and forty-nine panel members from medicine, nursing and health care management fields and from different Spanish regions were selected randomly and were invited to participate. Individual and anonymous opinions were asked by answering a 42-items questionnaire via e-mail (two rounds were done). Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the three groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 81%. The agreement index was 33.3 (95% CI: 18.9-47.7). Regarding the non-compliance with therapy, it improves with patient education degree in dyslipidemia, patient motivation, the agreement on decisions with the patient and with the use of cardiovascular risk measure and it gets worse with lack of information on the objectives to achieve. Clinical inertia improves with professional's motivation, cardiovascular risk calculation, training on objectives and the use of indicators and it gets worse with lack of treatment goals. CONCLUSION: Different perceptions and attitudes between medicine, nursing and health care management were found. An agreement in interventions in non-compliance and clinical inertia to improve dyslipidemia control was reached.

[Luces y sombras de la Guía Europea esc-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica.] / Lights and shadows of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.

General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines for Cardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), with the aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a critical analysis of these guidelines, offering possible solutions that can be implemented in Primary Care. It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (from seventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it is proposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated using different websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implementing nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in the potential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions could delay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease. Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of the guideline in primary care.

Los médicos de familia atienden un importante número de pacientes con alto riesgo vascular (RV). Las Guías Europeas de Prevención Cardiovascular (2021) proponen una nueva clasificación del riesgo y estrategias de intervención sobre los factores de riesgo (FRV), orientada a la toma de decisiones compartidas entre profesionales y pacientes. En el presente trabajo realizamos un análisis crítico de dichas guías, ofreciendo posibles soluciones prácticas para la Atención Primaria. Son destacables aspectos positivos (luces) que los modelos de RV SCORE2 (entre cuarenta y sesenta y nueve años) y SCORE2-OP (entre setenta y ochenta y nueve años) se basan en cohortes más actuales y miden con mayor exactitud y discriminación dicho riesgo. Además, se propone actuar diferenciadamente sobre el riesgo según la edad. Pragmáticamente, se presentan nuevos modelos informáticos para calcular el riesgo. Sin embargo, entre los aspectos negativos (sombras), parece colegirse una mayor dificultad de implementación al proponerse nueve subgrupos de sujetos según su edad o nivel de riesgo, con un dintel definitorio de alto RV subjetivo que podría ocasionar un incremento sustancial en el número de sujetos susceptibles de tratar sin una discriminación objetiva que lo sustente. Además, las intervenciones sobre los FRV en dos pasos podrían retrasar la consecución de objetivos terapéuticos, sobre todo en pacientes de muy alto riesgo, diabéticos o con enfermedad cardiovascular. Ante las dificultades que plantea la valoración del riesgo, proponemos unificar criterios y simplificar los mensajes claves para hacer unas guías más atractivas y que realmente ayuden a los profesionales de Atención Primaria en su práctica habitual.

[Primary prevention of cardiovascular disease with aspirin: what do the guidelines say?]. / Prevención primaria de la enfermedad cardiovascular con aspirina: ¿qué dicen las guías de práctica clínica?

OBJECTIVE: To review the guideline recommendations on aspirin use in primary prevention of cardiovascular diseases. DESIGN: Systematic review. The search was made by condition, treatment and type of prevention. DATA SOURCES: Science Citation Index, SCOPUS, PubMed, Spanish Ministry of Health, World Health Organisation, web sites of national and international scientific societies. DATA EXTRACTION: Two investigators independently reviewed all the guidelines. Specific topics assessed: a) use of antiplatelet treatment in primary prevention b) identification of target population c) identification of recommended dosage, d) identification of criteria of aspirin use, e) publications in English and/or Spanish, f) dissemination at national (Spain) or international level. RESULTS: Nine guidelines on primary prevention and 5 guidelines on diabetes were reviewed. Most of them recommended low dose aspirin ranging between 75mg and 325mg per day. All the guidelines recommend a specifc level of coronary risk to define the target population to be treated, showing high variability in risk tables used and in the level of risk which should be used to recommend treatment. The diabetes guidelines do not define any level of risk. Three guidelines recommend the use of aspirin when blood pressure is well controlled. CONCLUSIONS: There is high variability among guidelines in terms of the level of risk from which patients should be treated, and also in dosages. Most of the guidelines recommend the use aspirin in diabetics, although some discrepancies exist among international panels, and even in different documents of the same scientific society.

[Randomized clinical trial on the efficacy of global geriatric assessment in primary care]. / Ensayo clínico aleatorizado sobre la eficacia de la valoración geriátrica integral seguida de intervención en atención primaria.

OBJECTIVE: the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed. MATERIAL AND METHODS: a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG. RESULTS: there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P< .001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64). CONCLUSIONS: the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention.

Luces y sombras de la Guía Europea ESC-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica / Lights and shadows of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Los médicos de familia atienden un importante número de pacientes con alto riesgo vascular (RV). LasGuías Europeas de Prevención Cardio-vascular (2021) proponen una nueva clasificación del riesgo y estrategias de intervención sobre los factores de riesgo (FRV), orientada a la tomade decisiones compartidas entre profesionales y pacientes. En el presente trabajo realizamos un análisis crítico de dichas guías, ofreciendoposibles soluciones prácticas para la Atención Primaria.Son destacables aspectos positivos (luces) que los modelos de RV SCORE2 (entre cuarenta y sesenta y nueve años) y SCORE2-OP (entre setenta yochenta y nueve años) se basan en cohortes más actuales y miden con mayor exactitud y discriminación dicho riesgo. Además, se propone actuardiferenciadamente sobre el riesgo según la edad. Pragmáticamente, se presentan nuevos modelos informáticos para calcular el riesgo. Sin embargo,entre los aspectos negativos (sombras), parece colegirse una mayor dificultad de implementación al proponerse nueve subgrupos de sujetos segúnsu edad o nivel de riesgo, con un dintel definitorio de alto RV subjetivo que podría ocasionar un incremento sustancial en el número de sujetossusceptibles de tratar sin una discriminación objetiva que lo sustente. Además, las intervenciones sobre los FRV en dos pasos podrían retrasar laconsecución de objetivos terapéuticos, sobre todo en pacientes de muy alto riesgo, diabéticos o con enfermedad cardiovascular.Ante las dificultades que plantea la valoración del riesgo, proponemos unificar criterios y simplificar los mensajes claves para hacer unas guíasmás atractivas y que realmente ayuden a los profesionales de Atención Primaria en su práctica habitual.(AU)

General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines forCardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), withthe aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a criticalanalysis of these guidelines, offering possible solutions that can be implemented in Primary Care.It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (fromseventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it isproposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated usingdifferent websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implemen-ting nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in thepotential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions coulddelay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease.Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of theguideline in primary care.(AU)

Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain: the MAMPA study.

OBJECTIVE: To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain. METHODS: Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate). RESULTS: Participants' mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases. CONCLUSION: Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines' recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.

[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.

[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 Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management: differences between the European and American Guidelines.

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

[Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines]. / Posicionamiento del comité español interdisciplinario de prevención cardiovascular y la sociedad española de cardiología en el tratamiento de las dislipemias. divergencia entre las guías europea y estadounidense.

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. Full English text available from:www.revespcardiol.org/en.

[Spanish interdisciplinary committee for cardiovascular disease prevention and the spanish society of cardiology position statement on dyslipidemia management. Differences between the European and american guidelines]. / Posicionamiento del Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología en el tratamiento de las dislipemias. Divergencia entre las guías europea y estadounidense.

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.