Resumen del documento "Control de la colesterolemia en España 2000. Un instrumento para la prevención cardiovascular" / Cholesterolemia control in Spain, 2000. A tool for cardiovascular disease prevention

El documento "Control de la colesterolemia en España 2000: un instrumento para la prevención cardiovascular" revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto el objetivo terapéutico se establece en un c-LDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un c-LDL 130 mg/dl y el objetivo terapéutico será c-LDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearán los fibratos. En el síndrome coronario agudo el tratamiento hipolipidemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

[Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention]. / Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular.

The document "Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular / Cholesterolemia control in Spain, 2000: a tool for cardiovascular disease prevention

El control de la hipertensión arterial mediante monoterapia farmacológica en Atención Primaria El documento 'Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular' revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto el objetivo terapéutico se establece en un c-LDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un c-LDL 130 mg/dl y el objetivo terapéutico será c-LDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y c-HDL bajo se emplearán los fibratos. En el síndrome coronario agudo el tratamiento hipolipidemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

[Control of cholesterolemia in Spain, 2000. A tool for cardiovascular prevention]. / Control de la colesterolemia en España, 2000. Un instrumento para la prevención cardiovascular.

The document "Cholesterolemia Control in Spain, 2000: A Tool for Cardiovascular Disease Prevention" reviews the current evidence on cardiovascular disease prevention and the therapeutic advances achieved in recent years, in order to aid risk-based clinical decision-making. Cardiovascular diseases rank as the first cause of death in Spain. Their demographic, health and social impact is increasing and it is likely to continue to do so in the next decades. Appropriate treatment for high blood cholesterol and other major risk factors is crucial in cardiovascular disease prevention. Individual risk stratification is essential to determine follow-up periodicity and treatment. Priorities for the control of cholesterolemia and the consequent cardiovascular risk are based on risk stratification. In primary prevention, the therapeutic objective in high risk patients has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol > or = 130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. In moderate-severe hypertriglyceridemia or low HDL-cholesterol, fibrates are preferred. In acute coronary syndrome, hypolipemiant treatment, should be started as soon as possible, when indicated. Secondary prevention programmes that continually provide good clinical and risk factor control should be provided to coronary heart disease patients.

[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.

[Attitude change of Spanish cardiologist with respect to hypolipidemic treatment in secondary prevention. The role of outside hospital care]. / Cambio de actitud de los cardiólogos españoles con respecto al tratamiento hipolipemiante en prevención secundaria. Papel de la asistencia extrahospitalaria.

INTRODUCTION AND OBJECTIVES: Hypolipemic treatment is a matter of controversy. The objective of this paper is to analyze how Spanish cardiologist knows the lipid role in ischemic heart disease and their intention of treatment hypercholesterolemia in ischemic cardiomiopathy patients. We also evaluate the grade of control and treatment of hypercholesterolemia in patients with ischemic heart disease who belong to a primary care center. MATERIAL AND METHODS: Two inquests were done to 1,850 Spanish cardiologist using a question paper in 1993 and 1996. At the Primary Care Center of Fuencarral (Madrid) we made a transversal study from February till March 1996. RESULTS: In 1993, 11% answered the questionnaire and 25% in 1996. Cardiologists who considered the ideal level of cholesterol lower than 200 mg/dl raised from 62% in 1993 to 86% in 1996 (p < 0.001). Cardiologists who considered that cholesterol linked to low density lipoproteins should be lower than 100 mg/dl raised from 0% in 1993 to 28% in 1996 (p < 0.001). Drug treatment was prescribed by 68% when total cholesterol levels were higher than 300 mg/dl in 1993 and 14% of cardiologists never prescribed drugs. In 1996, 71% prescribed drug treatment when total cholesterol was between 200 and 250 mg/dl (p < 0.001). Cardiologists who worked at hospitals began with drugs with a lower cholesterol levels than out-hospital cardiologists. Hypercholesterolemia was considered as the most important risk factor in secondary prevention. We review 94 patients with ischemic heart disease; 37 did not receive hypolipemic treatment, though they had more than 200 mg/dl of cholesterol. Just 12 of the 45 treated reached figures below 200 mg/dl. 32% of the patients where controlled by family doctor's. CONCLUSIONS: Results of the two surveys in 1993 and 1996 have produced a change in Spanish cardiologist attitude about indication of hypolipemic treatment for patients suffering from ischemic cardiomiopathy. Family doctor's and cardiologists must assume secondary prevention. Indeed, it is necessary to make them both become aware of the importance of a correct treatment of those patients.

[Secondary prevention and cardiac rehabilitation in Spain. Section of Preventive Cardiology]. / Prevención secundaria y rehabilitación cardíaca en España. Sección de Cardiología Preventiva.

Secondary prevention and cardiac rehabilitation constitute both a unique strategy in the prevention of coronary heart disease. Comprehensive cardiac care must be considered one of the main objectives and the Spanish cardiologists dedicate less attention to it than to other cardiological procedures. Several international recommendations on secondary prevention and cardiac rehabilitation have been published during the last years, and both strategies have shown a good cost-benefit ratio. Several measures for secondary prevention, like reducing cholesterol levels in hypercholesterolaemic patients, and the treatment with aspirin, have also shown a decrease in CHD mortality and total mortality. Cardiac rehabilitation programmes improved some sociolaboral outcomes. In spite of those facts, the Spanish cardiologists pay little attention to secondary prevention and cardiac rehabilitation, as the results of two recently distributed questionnaires show.

[Report on cholesterol levels of Spanish children and adolescents. Group of Experts of Spanish Societies of Arteriosclerosis, Cardiology, Pediatrics, Nutrition and Preventive Medicine]. / Informe sobre el colesterol en niños y adolescentes españoles. Grupo de Expertos de las Sociedades Españolas de Arteriosclerosis, Cardiología, Pediatría, Nutrición y Medicina Preventiva.

The epidemiological association between blood cholesterol levels and the development of clinical complications of arteriosclerosis, particularly coronary heart disease, is presently well established. The importance of measuring blood cholesterol levels in children and adolescents is supported by numerous evidences: beginning of arteriosclerosis in infancy, relationship between the extent of fatty streaks as determined by post mortem examination of accidentally dead children and previous blood lipid levels, aggregation in children (as in adults) of elevated blood cholesterol levels with other cardiovascular risk factors, tracking of high cholesterol levels (and of other risk factors) from childhood to adolescence and early adulthood, and association of risk factors in children with a parental history of cardiovascular disease. The few epidemiological studies of blood cholesterol in children published in Spain have demonstrated relatively high mean values of blood cholesterol at all ages, which are similar or even higher than those obtained by the LRC Program in the United States during the 1970's. The present report constitutes a metaanalysis of data provided by the authors of 21 Spanish studies, both published and unpublished, carried out during the 1980's on the blood lipid levels of children and adolescents (0-18 years-old) including a total of 19,630 subjects (10,834 males, 8,102 females, and 694 newborns). All data were obtained in cross-sectional studies of normal populations employing different biochemical and statistical methods, thus limiting the value of the conclusions on the true values of blood cholesterol in Spanish children and its changes during recent years. Weighted means were calculated for the means of the different studies taking into account the number of cases in each population, and the distribution in percentiles by age and sex of total cholesterol, triglycerides, LDLc, and HDLc were estimated. For the overall study population, the mean blood cholesterol level and the moderate risk percentile (75) and high risk percentile (95) for both sexes were 173 mg/dl (4.5 mmol/l), 200 mg/dl (5.2 mmol/l), and 225 mg/dl (5.8 mmol/l), respectively. Such levels are between 10 and 15 mg/dl (0.3 and 0.4 mmol/l) higher than those of the LRC Program, and a clear rise was observed from the early to the late 1980's. The present levels of blood cholesterol in children and adolescents have a great potential impact for Public Health policy in Spain. As it occurs in adults, the distributions of blood cholesterol levels in children of different populations reflect their coronary heart disease mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)

[The Fuenlabrada study: smoking habits in children and adolescents. Effect on various cardiovascular risk factors]. / Estudio de Fuenlabrada: hábito tabáquico en niños y adolescentes. Influencia sobre las variables de riesgo cardiovascular.

We studied 1,274 healthy children of both sexes from 10 until 18 years of age, in Fuenlabrada, Madrid. We knew the tobacco consumption by means of direct asking to the children, without the presence of their parents. We studied the smoking habit of their parents by means of inquiries. The percentage of smoker children was 30% (24% of them had smoker parents, and 6% did not). We studied the tobacco influence in several parameters of cardiovascular risk; it was found that C-HDL levels in the smoker children were 5 mg/dl lower than the non-smokers, and the ratio C-LDL/C-HDL in the smokers was 1,2 times greater than in the non-smokers.

[The Fuenlabrada study: normal values of arterial pressure in children and adolescents]. / Estudio de Fuenlabrada: valores normales de la tensión arterial en niños y adolescentes.

We have studied 1,939 healthy children of both sexes (1.003 boys and 936 girls), aged from 4 to 18 years, of the city of Fuenlabrada (Madrid). The following parameters were determined: blood pressure, weight, height, triccipital folds, the rohrer index, total cholesterol, triglycerides, lipoproteins, blood sugar and uric acid. The results of the blood pressure have been expressed by means of percentiles in relation with age, weight, and height. The correlation coefficients have been statistically significant for the height, weight, age, triccipital skinfolds, triglycerides and C-VLDL. We have relationed our results with other national and international studies.

[The Fuenlabrada study: lipids and lipoproteins in children and adolescents]. / Estudio de Fuenlabrada: lípidos y lipoproteínas en niños y adolescentes.

We studied in 2,153 children of both sexes from birth until 18 years of age, in Fuenlabrada, Madrid, the following parameters: the height, weight, tricipital and subscapular skinfolds, blood pressure, lipids, lipoproteins, glycemia, uric acid and smoking habits. We obtained the next mean values: Total cholesterol (TC), 166 +/- 36 mg/dl; triglycerides, 63 +/- 39 mg/dl; HDL-C, 53 +/- 13 mg/dl; LDL-C, 102 +/- 34 mg/dl; VLDL-C, 13 +/- 6 mg/dl. TC, HDL-C and LDL-C levels did not present any significant differences with respect to sex until 12 years of age. But they were significantly higher in girls than in boys in adolescence. In contrast, TG and VLDL-C levels were higher in girls than in boys until 12 years of age, they did not present any difference in adolescence. The significant change of the lipoproteinic pattern in adolescence is connected with the hormonal distribution that is produced in puberty.

[Prevalence of breast feeding and its relation to cardiovascular risk factors in the pediatric population of Fuenlabrada]. / Prevalencia de la lactancia materna y su relación con los factores de reisgo cardiovascular en la población pediátrica de Fuenlabrada.

The infant nutrition is surveyed on 1893 children of both sexes, aged from 0 to 18 years, in Fuenlabrada, Madrid. The percent of children with breast feeding has strongly decreased (47%) during the period 1965-1983, so its endurance has shortened (15%). The kind of feeding is related to the age mother and her smoking habit. The statistical correlation between the newborn intake and the cardiovascular risk factors is studied; no significant differences are found, excepting a temporary increase of the total cholesterol during the first quarter of life.

[Percutaneous transluminal angioplasty in aortic coarctation in young adults]. / Angioplastia transluminal percutánea en la coartación aórtica del adulto joven.

The results of percutaneous balloon angioplasty in 9 cases of adult aortic coarctation are described. One case was associated with bicuspid aortic valve and another with organic aortic stenosis. Two of them were female, and the rest were male. The mean age range between 15-26 years (19 +/- 4.2). Pressure gradients fell from 59 +/- 13 mmHg to 15 +/- 11 mmHg postdilatation (p less than 0.0001), and the internal lumen diameters increase from 5 +/- 3 mm up to 13 +/- 2 mm (p less than 0.0001). In one case an intimal dissection appears as complication. At consequence of these results, the percutaneous balloon angioplasty seems to be a good therapeutic procedure in the adult aortic coarctation.