Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines.

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

[Cardiac rehabilitation in Spain. Preventive cardiology units]. / Rehabilitación cardíaca en España. Unidades de cardiología preventiva.

Secondary Prevention by controlling the main risk factors for atherosclerosis has proved a decrease in death rate and in damage of the obstructive arteries. The Cardiac Rehabilitation Programs are not well developed in Spain and nowadays they include less than the 2% of the feasible patients. The reasons for these are the lack of interest of many Cardiological Services and principally of the Administration which at present does not want to spend part of its budget to new loans although this new type of therapeutics has proved great benefits in the decrease of death rate and evident economical savings due to the diminution of hospital re-entries and Labour Incapacity. It is very important to notice that the 100% of the Spanish population is included in the Social Security and this would help the medical treatment of a high percentage of low risk patients, making use at the same time of the human and technological resources of the Health Centres and Municipal Gyms.

[Cardiac rehabilitation in the elderly patient]. / Rehabilitación cardíaca en el anciano.

The number of people over 65 is progressively increasing. In this group, the incidence of ischemic cardiopathy is very high and nowadays revascularization procedures are being used more and more. Cardiac rehabilitation programmes have proved to be an efficacious therapy in ischemic cardiopathy. These programmes initially excluded high-risk patients and elderly patients. In the last years, it has been confirmed that the benefit obtained in people over 65 is at least similar to the benefit observed in younger patients, with no greater number of complications. The aims of a cardiac rehabilitation programme are to improve the prognosis and quality of life. In elderly patients, the aims are similar, but special stress is laid on improving their quality of life and obtaining the maximum survival rate free of incapacitation.

[Hypertrophic obstructive myocardiopathy complicated by severe mitral insufficiency secondary to rupture of the chordae tendineae]. / Miocardiopatía hipertrófica obstructiva complicada con insuficiencia mitral severa secundaria a rotura de cuerdas tendinosas.

A case of suddenly increasing dyspnea in a patient with hypertrophic obstructive cardiomyopathy is reported. Transesophageal echocardiography showed severe mitral regurgitation secondary to ruptured chordae tendineae. Mitral valve replacement was done, correcting both mitral regurgitation and subaortic gradient. Utility of transesophageal echocardiography in diagnosis and therapeutic options are discussed.

[Rehabilitation in ischemic cardiopathy. Results at the level of quality of life and prognosis]. / Rehabilitación en la cardiopatía isquémica. Resultados a nivel de calidad de vida y sobre el pronóstico.

Cardiac rehabilitation programs, by means of physical, psychosocial and risk control factors, intend to improve the life style and prognosis of coronary patients. In this study, we analyzed the results obtained from 349 patients, 310 with acute myocardial infarction and 39 after coronary artery surgery. The average follow up period was 36 months and the average age was 53.9 years. The results showed that 84.3% stopped smoking, 60% returned to work after a heart attack and 51.36% after coronary artery bypass. Functional capacity improved significantly with p < 0.001. Although 50% of the patients considered themselves sexually incapacitated, the number of coitus per month is similar to that of healthy people of the same age. There were 12 new infarctions (1.28 por 100 patients per year), and 11 cardiac-related deaths (1.18 per 100 patients per year). All the deaths occurred in the group of patients with myocardial infarction, and with a significant increase in the elevation of the ST in the necrosis area, during an exercise testing, indicating extensive areas of dyskinesis. Based on these results, we have reached the conclusion that steps must be taken to reduce the high percentage of patients who leave the program. In our study this was significantly low at 21.5%.

[Traumatic rupture of the aorta presenting as aortic coarctation syndrome]. / Rotura traumática de aorta manifestada como síndrome de coartacion aortica.

Aortic rupture is a frequent cause of death in chest trauma. The coincidence with other associated severe lesions and the absence of clear cardiographic signs may induce to an important delay in the diagnosis. We report a case in which the late apparition of arterial hypertension expressed as an acute aortic coarctation syndrome pointed out the diagnosis. We review the pathogenic mechanisms of arterial hypertension in traumatic aortic rupture and the utility of different diagnostic procedures.