Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review

Background: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. Objective: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). Material and methods: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. Results: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55% (AU)

Antecedentes: La eficacia y la seguridad de la profilaxis con ácido acetilsalicílico (AAS) para la prevención primaria de la enfermedad cardiovascular arteriosclerótica (ECVA) siguen siendo controvertidas en personas con diabetes (DM) sin ECVA, ya que el posible aumento del riesgo de hemorragias graves podría superar la posible disminución del riesgo de mortalidad y de los principales episodios adversos cardiovasculares (MACE) considerados individualmente o en conjunto. Objetivo: Evaluar el riesgo-beneficio de la profilaxis con AAS en prevención primaria en personas con DM y comparar las recomendaciones de las guías de práctica clínica con los resultados de los metaanálisis (MA) y revisiones sistemáticas (RS). Material y métodos: Se realizaron búsquedas en Medline, Google Scholar, Embase y Biblioteca Cochrane de RS y MA publicados desde 2009 hasta 2020 que compararan los efectos de AAS versus placebo o control en seguimiento durante al menos un año en personas con DM sin ECVA. Se valoraron la heterogeneidad entre los ensayos clínicos aleatorizados (ECA) incluidos en las RS y MA. Se mostraron los resultados cardiovasculares de eficacia (muerte por cualquier causa [MCC], muerte cardiovascular [MCV], infarto de miocardio [IM], ictus y MACE) y de seguridad (episodios hemorrágicos importantes [EHI], episodios hemorrágicos gastrointestinales importantes [EHGI], hemorragias intracraneales y extracraneales). Resultados: Se valoraron las recomendaciones de 12 guías de práctica clínica. Se evaluaron los resultados de 25 RS y MA que incluyeron un total de 20ECA. Ningún MA ni RS mostró que la profilaxis con AAS disminuyera el riesgo de MCC, MCV o IM. Solo dos de los 19 SR y MA que evaluaron el ictus isquémico mostraron una disminución en el riesgo de ictus (media 20,0% [DE±5,7]), rozando la significación estadística (AU)

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (EMERGEN) / Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)

Parece necesario que las sociedades científicas de AP, ámbito en el cual la prevalencia de HTA es considerable, evalúen periódicamente las directrices internacionales para el manejo de la HTA, sobre todo ante recomendaciones dispares que dificultan la toma de decisiones, en la práctica clínica diaria. El presente documento tiene como objetivo analizar los cambios y novedades propuestos en la guía del American College of Cardiology y de la American Heart Association (ACC/AHA 2017) y en la guía de la European Society of Cardiology y de la European Society of Hypertension (ESC/ESH 2018). Además, analizar las posibles diferencias, limitaciones y su aplicabilidad a la AP de España. En definitiva, se trata de extraer la información más relevante disponible y pertinente, e integrarla para homogeneizar la asistencia al paciente hipertenso desde una perspectiva crítica, pero también razonada. Las discrepancias entre ambas GPC en aspectos tan trascendentales como el manejo de la enfermedad obligan a la recopilación y análisis crítico de la información que nos permita tomar posición como sociedad científica, interesada en trasladar a todos los médicos de AP las recomendaciones más relevantes, pero a la vez sensatas, de ambas GPC

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines

[Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. / Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.

Control de la presión arterial en una población hipertensa diabética asistida en atención primaria. «Estudio PRESCAP-Diabetes» / Blood pressure control in a diabetic hypertensive population attended in primary care setting. “PRESCAP-Diabetes study”

Objetivos: Conocer el grado de control de la PA en una amplia muestra de pacientes hipertensos diabéticos atendidos en atención primaria, y determinar los factores asociados al mal control tensional. Material y métodos: Estudio transversal y multicéntrico que incluyó a hipertensos diabéticos de 18 años o más, reclutados mediante muestreo consecutivo por médicos de familia de toda España. La medida de PA se realizó siguiendo normas estandarizadas, calculándose la media aritmética de al menos 2 tomas sucesivas separadas entre sí 2 minutos. Se consideró buen control de la HTA al promedio de PA inferior a 140/90mmHg según recomienda la European Society Hypertension (ESH 2009). Se evaluó igualmente el porcentaje de pacientes con PA por debajo de 130/80mmHg (ESH 2007 y American Diabetes Association 2010). Se registraron datos sociodemográficos, clínicos, factores de riesgo cardiovascular, trastornos clínicos asociados y tratamientos farmacológicos. Resultados: Se incluyeron a 2.752 pacientes (55,6% mujeres) con una edad media de 67,1 (9,8) años. El 64,3% presentaba dislipemia, 61,8% sedentarismo, 46,5% obesidad, 41,2% antecedentes de ECV y el 16,0% tabaquismo. El 66,1% recibía terapia combinada (2 fármacos 43,5%, 3 fármacos17,9% y 4 fármacos o más 4,7%). Siguiendo las recomendaciones de 2009 el 47,3% (IC 95%: 45,4–49,2) presentó buen control de PAS y PAD, 50,2% (IC 95%: 48,3–52,1) solo de PAS y el 79,8% (IC 95%: 78,3–81,3) únicamente de PAD; considerando los criterios de 2007 el 15,1% (IC 95%: 13,8–16,4) mostró buen control de PAS y PAD, 22,5% (IC 95%: 20,9–24,1) de PAS y el 38,2% (IC 95%: 36,4–40,0) de PAD. La obesidad, el sedentarismo y no haber tomado la medicación el día de la visita fueron los factores que más se asociaron al mal control de la HTA (χ2 de Wald; p<0,01)...(AU)

Objectives: To know the grade of blood pressure (BP) control in a large sample of diabetic hypertensive patients attended in Primary Care (PC) and to determine the factors associated to poor blood pressure control. Material and methods: A cross-sectional and multicenter study that included diabetic hypertensive subjects of 18 years or older, recruited by consecutive sampling by family doctors throughout Spain. The measurement of BP was performed following standardized guidelines, calculating the arithmetic mean of at least two successive measurements separated by two minutes. Good control of arterial hypertension (AHT) was considered to be the average of BP lower than 140/90mmHg as recommended by the European Society Hypertension (ESH 2009). The percentage of patients with BP below 130/80mmHg (ESH 2007 and American Diabetes Association 2010) was also evaluated. Socio-demographic, clinical data, cardiovascular risk factors, associated clinical disorders and drug treatments were also recorded. Results: A total of 2752 patients (55.6% women) with a mean (SD) age of 67.1 (9.8) years were included. Of these, 64.3% presented dyslipidemia, 61.8% sedentary life style, 46.5% obesity, 41.2% background of cardiovascular disease and 16.0% smoked. A total of 66.1% received combined therapy (two drugs 43.5%, three 17.9% and four or more 4.7%). Following the 2009 recommendations, 47.3% (95% CI: 45.4–49.2) had good control of the systolic BP (SBP) and diastolic BP (DBP), 50.2% (95% CI: 48.3–52.1) only of the SBP and 79.8% (95% CI: 78.3–81.3) only of DBP. Considering the 2007 criteria, 15.1% (95% CI: 13.8–16.4) showed good control of SBP and DBP, 22.5% (95% CI: 20.9–24.1) of SBP and 38.2% (95% CI: 36.4–40.0) of DBP. Obesity, sedentary life, and not having taken the medication on the day of the visit were the factors that were most associated to the poor control of AHT (Wald χ2; p<0.01)...(AU)

Conducta del médico ante el mal control de la hipertensión arterial. Aportaciones de los estudios PRESCAP 2002 y PRESCAP 2006 al conocimiento de la inercia terapéutica en España / Attitude of the physician towards poorly controlled arterial hypertension. Contributions of the PRESCAP 2002 and PRESCAP 2006 studies to knowledge on the therapeutic inertia in Spain

En España tan solo 4 de cada 10 hipertensos tratados con fármacos antihipertensivos que reciben asistencia sanitaria en Atención Primaria tienen bien controlada la PA. La inercia terapéutica está reconocida como una de las principales causas de mal control de la HTA y de otras enfermedades crónicas. Los PRESCAP fueron estudios tranversales y multicéntricos diseñados para estimación de prevalencias, que se realizaron en los años 2002 y 2006 con la misma metodolología en poblaciones similares asistidas en AP. Uno de los objetivos de ambos estudios fue analizar la conducta terapéutica del médico ante pacientes mal controlados (PA sistólica o diastólica ≥140 o ≥90mmHg, respectivamente, en población hipertensa en general, o PA≥130 o ≥80mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). El estudio PRESCAP 2002 mostró que el porcentaje de pacientes con inadecuado control de la PA en los que el médico modificó la pauta terapéutica fue del 18,3% (IC 95%: 17,5–19,1), siendo el cambio de fármaco la opción más elegida (47%), seguida de la combinación (34,7%) y del aumento de dosis (18,3%). En el estudio PRESCAP 2006 el médico modificó el tratamiento en el 30,4% (IC 95%: 29,2–31,6) de los sujetos mal controlados, resultando las acciones más frecuentemente llevadas a cabo la combinación con otro fármaco (46,3%), el incremento de dosis (26,1%) y la sustitución del antihipertensivo (22,8%). La percepción de buen control de la PA por parte del médico fue la variable que más se relacionó con la no modificación del tratamiento farmacológico. Aunque la conducta terapéutica del médico dista de ser idónea, nuestros resultados parecen indicar que se ha producido una mejora importante en la inercia terapéutica de los médicos de Atención Primaria ante los hipertensos mal controlados que siguen tratamiento farmacológico antihipertensivo (AU)

In Spain, only 4 out of 10 hypertensive patients treated with antihypertensive drugs who are attended in Primary Care (PC) have well-controlled blood pressure (BP). Therapeutic inertia (TI) is recognized as one of the main causes for poorly controlled arterial hypertension and other chronic diseases. The PRESCAPs were cross-sectional and multicenter studies designed to calculate prevalence. These studies were conducted in the years 2002 and 2006 using the same methodology in similar populations attended in PC. One of the purposes of both studies was to analyze the therapeutic attitude of the physician in regards to poorly-controlled patients (systolic or diastolic BP≥140 or ≥90mmHg, respectively, in hypertensive population in general, or BP PA≥130 or ≥80mmHg in patients with diabetes, nephropathy or cardiovascular disease). The PRESCAP 2002 study showed that the percentage of patients with inadequate control of PB in whom the physician changed the therapeutic regime was 18.3% (95% CI: 17.5–19.1), the change in the drug of choice being the action chosen the most (47%), followed by combination (34.7%) and dose increase (18.3%). In the PRESCAP 2006 study, the physician modified the treatment in 30.4% (95% CI: 29.2–31.6) of the poorly controlled subjects. The most frequently performed actions were combination with another drug (46.3%), dose increase (26.1%) and substitution of the antihypertensive drug (22.8%). Perception of good control of BP by the physician was the variable that was most related with the non-modification of the drug treatment. Although the therapeutic attitude of the physician is far from being the best, our results seem to indicate that there has been an important improvement in the therapeutic inertia of the primary care physicians in regards to poorly controlled hypertensive patients who follow a treatment with antihypertensive drugs (AU)

Coxalgia prolongada en el tiempo: a propósito de dos casos / Prolonged coxalgia: two case reports

Estudio de dos pacientes con dolor intenso de cadera, sin causa aparente, que aumenta al caminar o subir escaleras y mejora con el reposo. En la radiografía de caderas se observan signos de inflamación, que se confirman con la ecografía de partes blandas en dicha zona, y que en la resonancia magnética nuclear (RMN) se informan como necrosis avascular de cabeza femoral. El tratamiento en los dos enfermos fue conservador (reposo y antiinflamatorios no esteroideos [AINE], principalmente), resolviéndose ambos casos sin secuelas clínicas, con RMN de control normal y confirmando el diagnóstico de osteoporosis transitoria de cadera

Study of two patients with intense hip pain without apparent cause that increases when they walk and climb stairs, and improves with rest. The hip X-ray shows signs of inflammation, that is confirmed with the soft tissue ultrasonography in that area and the MRI shows it as femoral head avascular necrosis. Treatment of the two patients was conservative (mainly rest and NSAIDs), both cases resolving without clinical sequels, with normal MRI control and in which the diagnosis of transient hip osteoporosis was confirmed

[Blood pressure measurement devices used in primary care office]. / Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria.

OBJECTIVE: To know different blood pressure (BP) measurement devices used in primary care (PC). DESIGN: Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. SETTING: Primary care practices from all the country. PARTICIPANTS: PC patients treated and they all were of age. METHODS: Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. RESULTS: In this study participated 3592 PC physicians, BP were measured to 14,137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. CONCLUSIONS: In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted.

[Screening and effectiveness evaluation of a brief intervention in risk drinkers seen in primary health care]. / Evaluación del cribado y la efectividad de una intervención breve en bebedores de riesgo atendidos en consultas de atención primaria.

AIMS: To evaluate the screening, the effectiveness of an antialcoholic brief intervention for risk drinkers, the acceptation level to participate in this study, and the analytical parameters evolution associated to the alcohol consumption after of the intervention. DESIGN: Longitudinal prospective intervention study of 1 year of duration. SETTING: 5 urban primary care physician's practices. PARTICIPANTS: Of an aleatory pattern of 681 patients, men and women of 18-65 years old, were selected 78 risk drinkers. Patients with exclusion criteria (n=10), didn't wanted to participate (n=24) and had suspicion of alcoholic dependence syndrome (ADS) (n=11), didn't participated in this intervention. INTERVENTIONS: Were offered antialcoholic brief counselling with written supporter and were followed with alcohol consumption rate and analytical control at 2 and 12 months. MAIN MEASURES: Was estimated the prevalence of risk drinkers, the acceptation level to participate in this study, alcohol consumption and risk drinkers decreased at 2 and 12 months, analytical parameters evolution after of the intervention. RESULTS: Prevalence of risk drinkers: 11.5% (95% confidence interval [CI], 8.3%-14.7%). Acceptation level to participate in this study: 64.7%. Significative alcohol consumption decreased at 2 and 12 months (P<.05). Risk drinkers decreased: at 2 months were 57.6% (95% CI, 50.3%-64.9%; P=.01) and at 12 months were 42.4% (95% CI; 35.9%-48.9%) (P=.003). GGT, MCV, cholesterol, and triglycerides significative decreased. CONCLUSIONS: Low prevalence of risk drinkers without suspicion of ADS in our setting; high effectiveness of antialcoholic brief counselling and high acceptation level to participate in this study; reduction of the GGT, MCV, cholesterol, and triglycerides after of the intervention.

Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria / Blood pressure measurement devices used in primary care office

Objetivo. Conocer diferentes aparatos de medida de la presión arterial (PA) utilizados en atención primaria (AP). Diseño. Estudio transversal, multicéntrico, con muestreo no probabilístico de selección de casos consecutivos. Emplazamiento. Consultas de atención primaria de todo el Estado. Participantes. Pacientes hipertensos tratados > 18 años de edad. Métodos. Se hicieron 2 medidas consecutivas de PA y se anotaron los aparatos de medida utilizados. Resultados. Participaron en el estudio 3.592 médicos de AP que midieron la PA en 14.137 pacientes. En un 69,8% de los pacientes, la PA se midió con un esfigmomanómetro de mercurio, en un 16,5% con un aparato electrónico, en un 11,8% con un manómetro aneroide y en un 1,9% con más de un método de medida. En el medio rural se utilizaron más los aparatos electrónicos y los manómetros aneroides, observándose diferencias en las distintas comunidades autónomas de nuestro país. Había diferencias en los valores de PA según el método de medida; la tercera medida la realizaron con más frecuencia los médicos que empleaban aparatos electrónicos y la utilización de los dígitos 0 y 5 fue mayor cuando el método de medida no era un aparato electrónico. Conclusiones. En las consultas de AP se siguen utilizando preferentemente los esfigmomanómetros de mercurio y también los aparatos aneroides. Su utilización implica sesgos importantes en el proceso de medición: por ello, se debería fomentar el uso de los aparatos electrónicos para medir la PA

Objective. To know different blood pressure (BP) measurement devices used in primary care (PC). Design. Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. Setting. Primary care practics from all the country. Participants. PC patients treated and they all were of age. Methods. Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. Results. In this study participated 3592 PC physicians, BP were measured to 14 137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. Conclusions. In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted

Evaluación del cribado y la efectividad de una intervención breve en bebedores de riesgo atendidos en consultas de atención primaria / Screening and effectiveness evaluation of a brief intervention ub risk drinkers seen in primary health care

Objetivos. Evaluar el cribado y la efectividad de una intervención breve antialcohólica, el grado de aceptación y la evolución de los parámetros biológicos asociados con el consumo de alcohol tras la intervención. Diseño. Estudio prospectivo longitudinal de intervención de 1 año de duración. Emplazamiento. Cinco consultas de atención primaria urbanas. Participantes. De una muestra aleatoria de 681 sujetos de ambos sexos y de edad de 18-65 años, se seleccionó a 78 bebedores de riesgo. Los que cumplían criterios de exclusión (n = 10), no aceptaban participar (n = 24) y presentaban sospecha de síndrome de dependencia alcohólica (n = 11) no participaron en el estudio. Intervenciones. Se ofrecía un breve consejo antialcohólico apoyado con soporte escrito, y se realizaba un seguimiento a los 2 y 12 meses mediante la cuantificación del consumo de alcohol y un control analítico. Mediciones principales. Se estimó la prevalencia de bebedores de riesgo, el grado de aceptación a participar en el estudio, la disminución del consumo de alcohol y de bebedores de riesgo a los 2 y 12 meses, y la evolución de los parámetros analíticos tras la intervención. Resultados. La prevalencia de bebedores de riesgo fue del 11,5% (intervalo de confianza [IC] del 95%, 8,3-14,7%). El grado de aceptación a participar en el estudio fue del 64,7%. Se observó un decremento significativo (p < 0,05) en el consumo de alcohol a los 2 y 12 meses, así como una disminución de los bebedores de riesgo, que a los 2 meses fue del 57,6% (IC del 95%, 50,3-64,9%; p = 0,01) y a los 12 meses del 42,4% (IC del 95%, 35,9-48,9%; p = 0,003). Asimismo, se produjeron disminuciones significativas en las concentraciones de GGT, VCM, colesterol y triglicéridos. Conclusiones. Se observa una baja prevalencia de bebedores de riesgo sin sospecha de síndrome de dependencia alcohólica en nuestro medio, así como una elevada efectividad del consejo breve antialcohol y del grado de aceptación a participar en el estudio. Se apreció una disminución de las concentraciones de GGT, VCM, colesterol y triglicéridos tras la intervención

Aims. To evaluate the screening, the effectiveness of an antialcoholic brief intervention for risk drinkers, the acceptation level to participate in this study, and the analytical parameters evolution associated to the alcohol consumption after of the intervention. Design. Longitudinal prospective intervention study of 1 year of duration. Setting. 5 urban primary care physician's practices. Participants. Of an aleatory pattern of 681 patients, men and women of 18-65 years old, were selected 78 risk drinkers. Patients with exclusion criteria (n=10), didn't wanted to participate (n=24) and had suspicion of alcoholic dependence syndrome (ADS) (n=11), didn't participated in this intervention. Interventions. Were offered antialcoholic brief counselling with written supporter and were followed with alcohol consumption rate and analytical control at 2 and 12 months. Main measures. Was estimated the prevalence of risk drinkers, the acceptation level to participate in this study, alcohol consumption and risk drinkers decreased at 2 and 12 months, analytical parameters evolution after of the intervention. Results. Prevalence of risk drinkers: 11.5% (95% confidence interval [CI], 8.3%-14.7%). Acceptation level to participate in this study: 64.7%. Significative alcohol consumption decreased at 2 and 12 months (P<.05). Risk drinkers decreased: at 2 months were 57.6% (95% CI, 50.3%-64.9%; P=.01) and at 12 months were 42.4% (95% CI; 35.9%-48.9%) (P=.003). GGT, MCV, cholesterol, and triglycerides significative decreased. Conclusions. Low prevalence of risk drinkers without suspicion of ADS in our setting; high effectiveness of antialcoholic brief counselling and high acceptation level to participate in this study; reduction of the GGT, MCV, cholesterol, and triglycerides after of the intervention