ABSTRACT
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
ABSTRACT
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
Subject(s)
Cardiovascular Diseases , Lipids , Humans , Laboratories, Clinical , Consensus , Cardiovascular Diseases/prevention & controlABSTRACT
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
Subject(s)
Cardiovascular Diseases , Laboratories, Clinical , Humans , Consensus , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/etiology , Lipid Metabolism , LipidsABSTRACT
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
Subject(s)
Cardiovascular Diseases , Laboratories, Clinical , Humans , Consensus , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , LipidsABSTRACT
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
Subject(s)
Cardiovascular Diseases , Laboratories, Clinical , Lipids , Lipids/analysis , Lipid Metabolism Disorders/complications , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Consensus , HumansABSTRACT
OBJECTIVES: To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences. DESIGN AND SETTING: A cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease. RESULTS: The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females. CONCLUSION: Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
Subject(s)
Cardiovascular Diseases/etiology , Diabetes Complications/etiology , Diabetes Mellitus, Type 2/complications , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Cross-Sectional Studies , Diabetes Complications/epidemiology , Diabetes Complications/prevention & control , Female , Goals , Humans , Male , Risk Assessment , Sex Distribution , Sex FactorsABSTRACT
PCSK9 is a protease, synthesized mainly in the liver, which promotes the hepatic degradation of the LDL receptor and consequently decreases LDL receptor density and clearance of LDL particles. Statins inhibit HMG-CoA-reductase activity, an enzyme that catalyses an important step in hepatic cholesterol biosynthesis. The decrease of the hepatic intracellular cholesterol pool produced by these drugs upregulates the activity of the SREBP2 transcription factor, which subsequently stimulates the expression of the LDL receptor gene, an effect that is followed by an increase in the serum concentration of PCSK9. This article aims to review the effects of different lipid-lowering drugs on plasma PCSK9 concentrations. Overall, statins increase blood PCSK9 levels, an effect that is enhanced by ezetimibe. In contrast, others drugs, such as fibrates and niacin, could decrease PCSK9 levels.
Subject(s)
Hypolipidemic Agents/pharmacology , Proprotein Convertase 9/metabolism , Receptors, LDL/metabolism , Cholesterol/metabolism , Ezetimibe/pharmacology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Liver/metabolism , Proprotein Convertase 9/blood , Receptors, LDL/genetics , Sterol Regulatory Element Binding Protein 2/metabolismABSTRACT
El tratamiento hipolipemiante es uno de los pilares de la prevención cardiovascular; en la prevención secundaria de pacientes con cardiopatía isquémica, es una de las estrategias de mayor eficacia, pero el tratamiento hipolipemiante actual, junto con cambios en el estilo de vida, en una importante proporción de pacientes no consigue alcanzar los objetivos recomendados por las guías de práctica clínica. Los inhibidores PCSK9 han mostrado eficacia y seguridad en el tratamiento de la dislipemia y se han incorporado recientemente en España para empleo clínico con el objetivo de reducir el riesgo cardiovascular debido a su efecto en la reducción del colesterol unido a lipoproteínas de baja densidad (AU)
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups (AU)
Subject(s)
Humans , Hypolipidemic Agents/therapeutic use , Hyperlipidemias/drug therapy , Coronary Disease/complications , Antibodies, Monoclonal/therapeutic use , Needs Assessment , Hyperlipidemias/epidemiology , Practice Patterns, Physicians' , SubtilisinABSTRACT
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hyperlipidemias/drug therapy , Hyperlipoproteinemia Type II/drug therapy , Hypolipidemic Agents/therapeutic use , PCSK9 Inhibitors , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Cardiology , Cholesterol, LDL/blood , Humans , Hyperlipidemias/blood , Hyperlipoproteinemia Type II/blood , Patient Care Planning , Primary Prevention , Secondary Prevention , Societies, Medical , SpainABSTRACT
PCSK9 (proproteína convertasa subtilisina/kexina tipo 9) es una proteasa producida principalmente en el hígado, que promueve la degradación del receptor de lipoproteínas de baja densidad (rLDL) y, consecuentemente, disminuye su cuantía favoreciendo el aclaramiento de las partículas de LDL. Las estatinas son fármacos que inhiben la enzima HMG-CoA-reductasa, una enzima que cataliza un paso importante en la biosíntesis hepática de colesterol. El descenso del colesterol intracelular hepático producido por estos fármacos se acompaña de un aumento de la actividad del factor de transcripción SREBP2, que conduce al incremento de la expresión génica del rLDL. Al mismo tiempo, este efecto provoca un incremento de PCSK9. El objetivo del presente trabajo es señalar el efecto de los distintos fármacos hipocolesterolemiantes sobre las concentraciones plasmáticas de PCSK9. En términos generales, las estatinas provocan una regulación al alza de PCSK9 y la ezetimiba incrementa este efecto. Por el contrario, otros fármacos como los Þbratos y la niacina pueden disminuir los valores de PCSK9
PCSK9 is a protease, synthesized mainly in the liver, which promotes the hepatic degradation of the LDL receptor and consequently decreases LDL receptor density and clearance of LDL particles. Statins inhibit HMG-CoA-reductase activity, an enzyme that catalyses an important step in hepatic cholesterol biosynthesis. The decrease of the hepatic intracellular cholesterol pool produced by these drugs upregulates the activity of the SREBP2 transcription factor, which subsequently stimulates the expression of the LDL receptor gene, an effect that is followed by an increase in the serum concentration of PCSK9. This article aims to review the effects of different lipid-lowering drugs on plasma PCSK9 concentrations. Overall, statins increase blood PCSK9 levels, an effect that is enhanced by ezetimibe. In contrast, others drugs, such as Þbrates and niacin, could decrease PCSK9 levels
Subject(s)
Humans , Receptors, LDL/metabolism , Proprotein Convertase 9/metabolism , Hypolipidemic Agents/pharmacology , Cholesterol/metabolism , Receptors, LDL/blood , Proprotein Convertase 9/blood , Liver/metabolism , Ezetimibe/pharmacology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Sterol Regulatory Element Binding Protein 2/metabolismABSTRACT
INTRODUCTION: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS: Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74â years. ANALYSIS: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION: The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.
Subject(s)
Blood Glucose/analysis , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Early Diagnosis , Glucose Tolerance Test/methods , Prediabetic State/diagnosis , Aged , Bias , Female , Humans , Logistic Models , Male , Mass Screening , Middle Aged , Prospective Studies , ROC Curve , Risk Factors , Spain/epidemiologySubject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/history , Hypercholesterolemia , Hypolipidemic Agents/history , Coronary Disease/epidemiology , Coronary Disease/history , History, 20th Century , Hypercholesterolemia/drug therapy , Hypercholesterolemia/epidemiology , Hypercholesterolemia/history , Japan , Norway , Wolman Disease/epidemiology , Wolman Disease/historyABSTRACT
No disponible
Subject(s)
Humans , History, 20th Century , Hydroxymethylglutaryl-CoA Reductase Inhibitors/history , Hypercholesterolemia/drug therapy , Hypercholesterolemia/epidemiology , Hypercholesterolemia/history , Hypolipidemic Agents/history , Coronary Disease/epidemiology , Coronary Disease/history , Japan , Norway , Wolman Disease/epidemiology , Wolman Disease/historyABSTRACT
OBJECTIVE: To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. DESIGN: Transversal, multi-centre study, conducted between March and November, 2004. SETTING: Three-hundred seventy six primary care and specialist doctors from all over the country. PARTICIPANTS: A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. METHOD: Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. RESULTS: Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. CONCLUSION: Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/diet therapy , Hypercholesterolemia/drug therapy , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Education as Topic , Surveys and QuestionnairesABSTRACT
Objetivo. Evaluar el conocimiento de los sujetos que reciben tratamiento con estatinas sobre las medidas dietéticas y terapéuticas dirigidas a su control, relacionándolo con la consecución de objetivos terapéuticos. Diseño. Estudio transversal, multicéntrico, realizado entre marzo y noviembre de 2004. Emplazamiento. En total, 376 médicos de atención primaria y especializada distribuidos por toda la geografía nacional. Participantes. Se incluyó a 2.347 sujetos, con una edad media de 59 ± 12 años, el 48%, mujeres, y en tratamiento con estatinas. Método. Encuesta dirigida a evaluar el conocimiento sobre la dieta hipolipidemiante y el tratamiento farmacológico. Se determinó el porcentaje de sujetos que alcanzó los objetivos terapéuticos según el ATP III. Resultados. El conocimiento de la dieta era adecuado sólo para los alimentos con efectos negativos sobre la concentración de colesterol. Globalmente, el conocimiento fue mejor en los sujetos jóvenes, con un superior nivel de educación, con una hiperlipidemia de origen familiar, con más tiempo en tratamiento y que eran atendidos en consultas de atención primaria o medicina interna, y peor en los pacientes diabéticos y con enfermedad cardiovascular. Los sujetos con un mayor nivel de conocimientos sobre el tratamiento alcanzaron en mayor proporción los objetivos terapéuticos. Conclusión. Los pacientes que reciben tratamiento con estatinas tienen un adecuado conocimiento de la dieta y escasa información sobre el tratamiento farmacológico. Este conocimiento se asocia con la consecución de objetivos terapéuticos
Objective. To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. Design. Transversal, multi-centre study, conducted between March and November, 2004. Setting. Three-hundred seventy six primary care and specialist doctors from all over the country. Participants. A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. Method. Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. Results. Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. Conclusion. Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives
Subject(s)
Male , Female , Adolescent , Adult , Middle Aged , Aged , Humans , Hypercholesterolemia/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Patient Education as Topic/statistics & numerical data , Hypercholesterolemia/diet therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Spain/epidemiology , Diet, Fat-Restricted , Health Education , Primary Health CareABSTRACT
BACKGROUND: Diabetic patients have a higher rate of recurrent cardiovascular events and death than nondiabetic individuals. Although partially attributable to lower use of evidence-based preventive therapies, studies are lacking on the prescription rate during the stable phase of the disease. METHODS: Between June 1 and October 19, 2004, we obtained, from 1799 primary care centers throughout Spain, data on 8817 subjects (mean age 65.4 years, 73.7% male, 32.7% with diabetes) who had had a coronary event requiring hospitalization in the previous 6 months to 10 years. RESULTS: After adjustment for confounding variables, the diabetic patients received more frequent treatment with angiotensin-renin system blockers (73.5% vs 61%, P < .001), calcium channel blockers (29.8% vs 21.9%, P < .001), nitrates (58% vs 47.5%, P < .001), digoxin (6.6% vs 3.9%, P < .001), and diuretics (46.2% vs 32.2%, P < .001), but it is similar with respect to lipid-lowering drugs (81.1% vs 80.3%), antiplatelet drugs (80.2% vs 80.2%), or beta-blockers (45.4% vs 47.7%). The percentage of diabetic subjects attaining objectives for smoking habit, low-density lipoprotein cholesterol, blood pressure, and glycated hemoglobin were 90.7%, 29%, 38.2%, and 49.7%, respectively. Only 7% had optimum control of all their risk factors. The parameters most closely related to optimum treatment and risk-factor control were the specialist follow-up and the attending physician's awareness of appropriate treatment objectives. CONCLUSIONS: A significant percentage of diabetic patients with stable coronary disease receive evidence-based preventive medications in primary care. However, the percentage achieving adequate control of their risk factors is low and is related to the level of physician awareness of appropriate therapeutic targets.
Subject(s)
Coronary Disease/drug therapy , Diabetic Angiopathies/drug therapy , Evidence-Based Medicine , Primary Health Care , Aged , Cardiovascular Agents/therapeutic use , Cross-Sectional Studies , Drug Prescriptions/statistics & numerical data , Female , Humans , Male , Middle Aged , Risk Factors , Treatment OutcomeABSTRACT
Fundamento y objetivo: Evaluar el grado general de consecución de objetivos de control de los factores de riesgo en prevención secundaria de los pacientes que han tenido un episodio coronario y son seguidos en atención primaria. Pacientes y método: Estudio descriptivo, transversal y multicéntrico con inclusión mediante muestreo consecutivo de los primeros 5 pacientes que acudieron a consulta y habían tenido un episodio coronario en un período previo de 6 meses a 10 años. Los objetivos de control fueron: presión arterial < 140/90 mmHg en población general y < 130/85 mmHg en diabéticos, colesterol de las lipoproteínas de baja densidad (cLDL) < 100 mg/dl y no ser fumador. Resultados: Se incluyó a 8.817 pacientes (varones el 73,7%) con una media (desviación estándar) de edad de 65,4 (10,3) años. El 76,6% eran hipertensos; el 73,4%, dislipémicos, y el 32,7%, diabéticos. El 60,2% alcanzó el objetivo de presión arterial, el 26,3% alcanzó el objetivo de cLDL < 100 mg/dl y el 11,4% siguió fumando. Cumplió la totalidad de las recomendaciones el 16,4%. Los factores relacionados de forma independiente con un buen control fueron la menor edad, el sexo masculino, el ingreso por síndrome coronario agudo sin elevación del ST (odds ratio [OR] = 1,39; intervalo de confianza [IC] del 95%, 1,01-1,93; p = 0,04) o para revascularización (OR = 1,37; IC del 95%, 1,12-1,67; p = 0,002), tener enfermedad arterial periférica (OR = 1,43; IC del 95%, 1,11-1,84; p = 0,005) y que los objetivos planteados por los médicos fueran adecuados (OR = 1,90; IC del 95%, 1,48-2,44; p < 0,0001). El control fue peor en los pacientes hipertensos o dislipémicos. Conclusiones: El control general de los factores de riesgo en prevención secundaria de la enfermedad coronaria se consigue en 1 de cada 6 pacientes atendidos en atención primaria
Background and objective: Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. Patients and method: Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. Results: 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. Conclusions: Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care
