Disfunción eréctil asociada a factores de riesgo cardiovascular / Erectile dysfunction associated with cardiovascular risk factors

Objetivos Determinar la prevalencia de disfunción eréctil (DsE) en pacientes con factores de riesgo cardiovascular (FRCV) y valorar su incidencia en relación con el grado de control de los FRCV. Metodología Los participantes se captaron en los centros de salud incluidos en el estudio. El tamaño de la muestra, con un nivel de confianza del 95% y un error alfa del 0,005, fue de 210 personas, de las cuales 30 no pudieron concluir el estudio por diversos motivos (cambio de domicilio, fallecimiento, negación a realizar al cuestionario, etc.).En la cita se cumplimentaba el cuaderno de recogida de datos previamente diseñado, al que se añadía el cuestionario Shim y LISAT-8.Se trata de un estudio de observación, descriptivo y analítico, de sección transversal. Las variables cualitativas se exponen como valor exacto y en porcentaje, las cualitativas como media y desviación estándar (DE).La comparación entre medias se realizó a través de la prueba t de Student para grupos independientes o la U de Mann-Whitney si las condiciones de normalidad (aplicación del test de Kolmogorov-Smirnoff o de Shapiro-Wilks) no se cumplían. En las variables cualitativas se empleó la prueba de ji al cuadrado. Resultados De las 210 personas seleccionadas, 179 (85,2%) completaron correctamente la encuesta. La edad media fue de (..)(AU)

Objectives To determine the prevalence of erectile dysfunction (ED) in patients with cardiovascular risk factors (CVRF) and to evaluate the incidence of this disorder according to the degree of control of CVRF. Methodology Participants were recruited in the health centers included in this study. A sample size with 95% confidence level and an alpha error of 0.005 was calculated and 210 persons were selected, of which 30 could not complete the study for various reasons (change of address, death, refusal to complete the questionnaire, etc.).A previously designed data collection sheet and the SHIM and LISAT-8 questionnaires were completed at interview. The study design was observational, descriptive, analytical cross-sectional. Qualitative variables are shown as exact values and as percentages and qualitative variables as means and standard deviation (SD).Comparison among means was performed using Student's t-test for independent samples or the Mann-Whitney U-test if the conditions of normality (application of the Kolmogorov-Smirnoff or Shapiro-Wilks’ test) were not met. For qualitative variables, the chi-square test was used. Results Of the 210 persons selected, 179 (85.2%) completed the survey correctly. The mean age was 64.5±11.6 years. Analysis of all the study variables in relation to the main variable of the presence or absence of ED revealed that age played a major role, with the incidence of ED increasing with greater age.(..) (AU)

Efectividad de la combinación de atorvastatina 10 mg más ezetimiba en el control de la hipercolesterolemia en atención primaria / Effectiveness of the combination of atorvastatin 10 mg plus ezetimibe in controlling hypercholesterolemia in primary care

Objetivos. Analizar la efectividad de atorvastatina 10 mg combinada con ezetimiba respecto a atorvastatina en altas dosis para el tratamiento de la hipercolesterolemia en pacientes de alto riesgo cardiovascular en atención primaria. Pacientes y método. Estudio transversal retrospectivo, de intervención en condiciones de uso habitual en pacientes hipercolesterolémicos con alto riesgo cardiovascular (diabéticos tipo II o postinfarto de miocardio y cifras de colesterol de las lipoproteínas de baja densidad [cLDL] > 100 mg/dl). Se incluyó un total de 102 pacientes (el 44,8% varones) con una media ± desviación estándar de edad de 60,9 ± 9,4 años. Un 61,4% eran diabéticos, el 52,1% había tenido episodio de cardiopatía isquémica. Recibieron tratamiento con atorvastatina 10 mg + ezetimiba 49 pacientes y 53 recibieron atorvastatina 40 mg/día durante 4 meses. Resultados. El cLDL, el colesterol total y los triglicéridos se redujeron significativamente con ambos tratamientos, si bien la combinación de ambos tratamientos redujo más rápidamente los parámetros lipídicos (2 meses; p < 0,05) que atorvastatina en altas dosis; a los 4 meses hubo reducciones de cLDL del 35,42% con la combinación de la estatina con ezetimiba y del 25,69% con la estatina sola; la reducción del cLDL fue de 57,58 ± 27,83 mg/dl y 58,33 ± 14,22 mg/dl a los 2 y 4 meses, respectivamente, con la combinación, frente a 16,4 ± 22,62 mg/dl y 40,14 ± 10,8 mg/dl con atorvastatina en altas dosis. A los 4 meses alcanzaron los objetivos terapéuticos de control de cLDL de acuerdo con las recomendaciones de la Adaptación Española de la Guía Europea de Prevención Cardiovascular de 2004 un 60,4% de los tratados con la combinación de fármacos y un 51,5% de los tratados con atorvastatina. Conclusiones. Ambos tratamientos se han mostrado efectivos en reducir las cifras de colesterol. Sin embargo, la combinación de atorvastatina en dosis de 10 mg y ezetimiba ha sido más efectiva y rápida que atorvastatina sola en altas dosis (AU)

Objectives. To analyze the effectiveness of atorvastatin 10 mg plus ezetimibe versus high-dose atorvastatin in the treatment of hypercholesterolemia in patients with high cardiovascular risk in primary care. Patients and method. We performed a retrospective, cross-sectional study of an intervention performed under conditions of normal use in hypercholesterolemic patients with high cardiovascular risk (type II diabetes or postmyocardial infarction and low density lipoprotein cholesterol [LDLc] values > 100 mg/dl). A total of 102 patients (44.8% men) with a mean age ± standard deviation of 60.9 ± 9.4 years were included. Of these, 61.4% were diabetic and 52.1% had had an episode of ischemic heart disease. Forty-nine patients received treatment with atorvastatin 10 mg plus ezetimibe and 53 received atorvastatin 40 mg/day for 4 months. Results. Values of LDLc, total cholesterol (TC) and triglycerides were significantly reduced with both treatments. However, the combined treatments produced a more rapid reduction in lipid parameters (2 months; p < 0.05) than did high-dose atorvastatin. At 4 months, a reduction in LDLc of 35.42% was found for the combination of atorvastatin plus ezetimibe versus 25.69% with atorvastatin alone; at 2 and 4 months, LDLc was reduced by 57.58 ± 27.83 mg/dl and 58.33 ± 14.22 respectively with the combined treatment compared with a decrease of 16.4 ± 22.62 and 40.14 ± 10.8 mg/dl with high-dose atorvastatin. At 4 months, the therapeutic targets for LDLc control, based on the recommendations of the Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention of 2004, had been achieved by 60.4% of patients receiving the combined treatment and by 51.5% of those treated with atorvastatin. Conclusions. Both treatments were effective in reducing cholesterol values. However, atorvastatin 10 mg and ezetimibe were faster and more effective than high-dose atorvastatin alone (AU)

A pharmacoeconomic evaluation of statins in the treatment of hypercholesterolaemia in the primary care setting in Spain.

BACKGROUND: Cardiovascular disease is one of the leading causes of death and it has been shown that primary prevention with the HMG-CoA reductase inhibitor (statin) lipid-lowering drugs can reduce cardiovascular events. Acquisition costs vary between statins and this may be an important consideration in the overall cost effectiveness (CE) of different options. OBJECTIVE: To perform a CE study of the main statins used in Spain for primary prevention of cardiovascular disease in patients with high cholesterol levels [corrected] STUDY DESIGN: The CE analysis was based on an open-label, prospective, naturalistic, randomised intervention study under usual care conditions in primary care settings in patients with high cholesterol levels (total cholesterol [TC] >240 mg/dL, low-density lipoprotein cholesterol [LDL-C] >160 mg/dL) and one or more cardiovascular risk factors. The analysis was conducted from the perspective of the Spanish National Health System; the year of costing was 2001. PATIENTS: A total of 161 patients (49.7% males), mean age 65 +/- 10.3 years, without evidence of cardiovascular disease were included in the study. Of those, 82.1% were hypertensive, 37.1% had diabetes mellitus and 17.9% were smokers. INTERVENTIONS: Forty-eight patients received oral atorvastatin 10 mg/day, 32 received fluvastatin 40 mg/day, 44 received simvastatin 20 mg/day and 37 patients received pravastatin 20 mg/day for 6 months. MAIN MEASUREMENTS AND RESULTS: After 6 months, the therapeutic goals of LDL-C control, according to the recommendations of the Spanish Society of Arteriosclerosis--Consensus-2000, were reached in 62.5%, 43.8%, 45.5% and 40.5% of patients treated with atorvastatin, fluvastatin, simvastatin and pravastatin, respectively. The average CE ratio, expressed as the cost in euros (euro) per patient achieving the therapeutic goals, was euros 424.3 for atorvastatin, euros 503.5 for fluvastatin, euros 527.0 for simvastatin and euros 683.4 for pravastatin. The incremental CE ratios for atorvastatin versus fluvastatin and simvastatin were euros 238.9 and euros 149.5, respectively, per additional patient reaching therapeutic goals. Atorvastatin, fluvastatin and simvastatin all dominated pravastatin. CONCLUSIONS: All the statins studied have been shown to be effective for reducing both TC and LDL-C levels. In this study, atorvastatin was the most efficient drug, with the best CE ratio (cost per patient reaching therapeutic goals). Atorvastatin was more effective and less costly than pravastatin, and when compared with fluvastatin or simvastatin the additional cost per additional patient achieving therapeutic goals was