RESUMEN
We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 ± 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4-6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (-39.23 ± 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1-2 and 40-45% in subsequent days (R2 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4-6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription.
RESUMEN
En Europa hay una considerable variabilidad en las estructuras, en los programas de formación y en el acceso a la especialidad de medicina del trabajo, variabilidad acentuada por el carácter multidisciplinar de los servicios de prevención de riesgos laborales, las legislaciones vigentes en materia laboral y la organización de los sistemas sanitarios de cada país. En nuestro trabajo se describen las peculiaridades en la formación en medicina del trabajo, tanto pregraduada como posgraduada, así como la forma de acceso a la especialización. Comprobamos la gran variabilidad que existe en la formación entre los distintos países, lo que repercutirá en el ejercicio profesional de médico del trabajo y por tanto, en la salud de los trabajadores (AU)
In Europe there is considerable variability in the structures, training programs and Access to the specialty of occupational medicine, accentuated by the multidisciplinary nature of the services to prevent occupational hazards, existing laws on labor and the organization of health systems of each country. In our paper we describe the peculiarities of occupational training, both undergraduate and postgraduate, as well as how to access to expertise. We not the great variability that exists in the training between different countries, which will affect the physician´s professional work and, therefore, the health of workers (AU)
