Documento de consenso para la formación de residentes en riesgo vascular / Consensus document for the training of residents in cardiovascular risk

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Consensus document for the training of residents in cardiovascular risk. / Documento de consenso para la formación de residentes en riesgo vascular.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular / Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk

Objetivo: Determinar la prevalencia de aneurisma de aorta abdominal (AAA), definido por un diámetro arterial ≥30mm, en pacientes con alto o muy alto riesgo cardiovascular (RCV) y evaluar sus características clínicas. Pacientes y métodos: Estudio observacional, transversal y multicéntrico realizado en servicios de Medicina Interna del país a varones con edad >55años y mujeres >65años que tenían un RCV alto o muy alto reclutados durante 24meses. Resultados: Se incluyeron 659 pacientes. La prevalencia de AAA fue del 8% (53 pacientes). El 76,9% fueron varones, con edad media de 71±8,7años. El análisis multivariante demostró asociación entre AAA y la edad (OR: 1,06; IC95%: 1,02-1,1; p<0,01), el sexo masculino (OR: 5,6; IC95%: 1,6-18,8; p=0,01), el tabaquismo activo (OR: 3,22; IC95%: 1,16-8,93; p=0,024) y la arteriopatía periférica (OR: 3,51; IC95%: 1,73-7,09; p<0,01), siendo la diabetes mellitus un factor protector independiente (OR: 0,41; IC95%: 0,22-0,78; p=0,06). Los pacientes con dilatación subaneurismática de la aorta (diámetro de la aorta abdominal 25-29,9mm) presentaban similares características que los pacientes con AAA. Conclusiones: La prevalencia de AAA en pacientes de alto RCV es elevada. El cribado ecográfico puede ser realizado por médicos generalistas. Pueden beneficiarse de un cribado oportunista los varones de más de 65años, con RCV elevado, especialmente si presentan tabaquismo activo o arteriopatía periférica

Background: To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. Patients and methods: Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR. Results: The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA. Conclusions: The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease

Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. / Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular.

BACKGROUND: To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. PATIENTS AND METHODS: Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR. RESULTS: The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA. CONCLUSIONS: The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease.

Prevalencia de colesterol LDL inadecuado en pacientes con enfermedad coronaria y/o diabetes mellitus tipo 2 / Prevalence of inapropriate LDL cholesterol levels in patients with coronary disease and/or type 2 diabetes

Antecedentes y objetivo. Las guías de práctica clínica aconsejan conseguir concentraciones de colesterol LDL (cLDL) menor de 100mg/dl (y en ciertos casos menor de 70mg/dl) en pacientes con enfermedad coronaria y/o diabetes mellitus tipo 2 (DM2). Hemos examinado el cumplimiento de estos objetivos en enfermos atendidos en España con estas afecciones. Métodos. Estudio epidemiológico transversal. Los datos se obtuvieron en la visita del estudio o, en su defecto, a partir de datos que constaban en la historia clínica. Participaron 874 médicos de 17 comunidades autónomas de España. Se recogieron datos demográficos, factores de riesgo cardiovascular y tratamientos prescritos. Resultados. En el análisis final se incluyeron 6.988 pacientes (varones, 62,7%) de los cuales 2.586 (37%) tenían enfermedad coronaria, 2.654 (38%) DM2 y 1.748 (25%) ambas afecciones. El 65% tenían síndrome metabólico y la mediana de factores de riesgo vascular fue de 4. Un 57 y un 86% mostraron una concentración de cLDL>100 y>70 mg/dl, respectivamente. La proporción de pacientes con cLDL>100mg/dl fue un 4% superior en el grupo DM2 (62,4%) que entre los enfermos coronarios (57,1%; p<0,0001). La concentración de triglicéridos >150mg/dl fue superior entre los enfermos con DM2 (50,5%), que entre los enfermos coronarios (43,5%; p<0,0001). La proporción de pacientes con cLDL>70mg/dl fue similar en el grupo coronario y en el grupo DM2 (88,4 y 87,0%, respectivamente). Algo más de la mitad de los enfermos con afección coronaria (57,5%) o DM2 (55,7%) mostraron unos niveles de HDL inadecuados (varones, <40mg/dl; mujeres, <50mg/dl). Conclusiones. Más de la mitad de los pacientes con diabetes mellitus y/o arteriopatía coronaria incluidos en el estudio CODIMET no alcanzan el objetivo de colesterol LDL recomendado para pacientes de alto riesgo cardiovascular(AU)

Background and objective. Clinical practice guidelines recommend achieving concentrations of LDL cholesterol less than 100mg/dl (and in some cases less than 70mg/dl) in patients with coronary artery disease and/or diabetes mellitus type 2 (DM2). We have examined the compliance with these objectives in patients treated in Spain with these conditions. Methods. Cross-sectional epidemiological study. Data were obtained during the visit of the study or, in their absence, based on data contained in the medical record by 874 doctors of the 17 autonomous communities in Spain. Demographic information, risk factors, cardiovascular and prescribed treatments were collected. Results. In the final analysis 6.988 (62.7% male) patients were included. 2586 (37%) had coronary disease, 2654 (38%) DM2 and 1748 (25%) both conditions. 65% had metabolic syndrome. Vascular risk factors median number was 4. 57% and 86% showed a concentration of LDL cholesterol >100 and >70mg/dl respectively. The proportion patients with LDL concentration >100mg/dl was 4% greater in the DM2 (62.4%) than in coronary patients (57.1%; p0.0001). Concentration of triglycerides >150mg/dl was higher in patients with DM2 (50.5%) than in coronary patients (43.5%; p0.0001). The proportion of patients with LDL>70mg/dl was similar in the coronary group and in the DM2 Group (88.4% and 87.0%, respectively). More than half of patients with coronary heart disease (57.5%) or DM2 (55.7%) showed inadequate levels of HDL (<40mg/dl men; <50mg/dl women). Conclusions. More than a half of patients with diabetes mellitus and/or coronary artery disease enrolled in the CODIMET study do not achieve the recommended LDL cholesterol target for high cardiovascular risk patients(AU)

[Prevalence of inapropriate LDL cholesterol levels in patients with coronary disease and/or type 2 diabetes]. / Prevalencia de colesterol LDL inadecuado en pacientes con enfermedad coronaria y/o diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Clinical practice guidelines recommend achieving concentrations of LDL cholesterol less than 100 mg/dl (and in some cases less than 70 mg/dl) in patients with coronary artery disease and/or diabetes mellitus type 2 (DM2). We have examined the compliance with these objectives in patients treated in Spain with these conditions. METHODS: Cross-sectional epidemiological study. Data were obtained during the visit of the study or, in their absence, based on data contained in the medical record by 874 doctors of the 17 autonomous communities in Spain. Demographic information, risk factors, cardiovascular and prescribed treatments were collected. RESULTS: In the final analysis 6.988 (62.7% male) patients were included. 2586 (37%) had coronary disease, 2654 (38%) DM2 and 1748 (25%) both conditions. 65% had metabolic syndrome. Vascular risk factors median number was 4. 57% and 86% showed a concentration of LDL cholesterol >100 and >70 mg/dl respectively. The proportion patients with LDL concentration >100 mg/dl was 4% greater in the DM2 (62.4%) than in coronary patients (57.1%; p0.0001). Concentration of triglycerides >150 mg/dl was higher in patients with DM2 (50.5%) than in coronary patients (43.5%; p0.0001). The proportion of patients with LDL>70 mg/dl was similar in the coronary group and in the DM2 Group (88.4% and 87.0%, respectively). More than half of patients with coronary heart disease (57.5%) or DM2 (55.7%) showed inadequate levels of HDL (<40 mg/dl men; <50 mg/dl women). CONCLUSIONS: More than a half of patients with diabetes mellitus and/or coronary artery disease enrolled in the CODIMET study do not achieve the recommended LDL cholesterol target for high cardiovascular risk patients.