[Are treatments with statins that are considered unsuitable really unsuitable?]. / ¿Son realmente inadecuados los tratamientos con estatinas considerados como inadecuados?

In the Catalonian Institute of health there are 2 well-established circumstances for indicating lipid-lowering drug treatment with statins in the primary prevention of ischaemic heart disease. These are, severe hypercholesterolaemia, with a low density lipoprotein cholesterol equal to or greater than 240mg/dL, or above 130mg/dL when the coronary risk is equal to or greater than 10% at 10 years. There are data that suggest that these 2 criteria are not the only ones used in routine clinical practice, as such that the majority of patients to whom it is indicated, do not meet either of these 2 conditions. This study aims to determine the characteristics of the patients when statins are indicated outside the aforementioned circumstances. It is concluded that around 40% of patients have clinical characteristics that could justify the treatment. The level of suitability could not be established in about 33% of the patients, due to not being able to determine the coronary risk.

¿Son realmente inadecuados los tratamientos con estatinas considerados como inadecuados? / Are treatments with statins that are considered unsuitable really unsuitable?

Las circunstancias que están bien establecidas, en el ámbito del Institut Català de la Salut, para indicar un tratamiento farmacológico hipolipidemiante con estatinas en la prevención primaria de la cardiopatía isquémica son 2: una hipercolesterolemia severa, con valores de colesterol transportado por las lipoproteínas de baja densidad iguales o superiores a 240 mg/dL, o por encima de 130 mg/dL cuando el riesgo coronario es igual o mayor al 10% a los 10 años. Hay datos que indican que en la práctica habitual estos 2 criterios no son los únicos utilizados, de forma que la mayoría de los pacientes a quienes se indica, de novo, una estatina, no reúnen ninguna de estas 2 condiciones. Este estudio pretende conocer las características que tienen los pacientes cuando estas son indicadas fuera de los supuestos mencionados. Se concluye que cerca del 40% de los pacientes tienen características clínicas que pueden explicar la indicación del tratamiento. En una tercera parte no puede establecerse el grado de adecuación por no poderse determinar el riesgo coronario

In the Catalonian Institute of health there are 2 well-established circumstances for indicating lipid-lowering drug treatment with statins in the primary prevention of ischaemic heart disease. These are, severe hypercholesterolaemia, with a low density lipoprotein cholesterol equal to or greater than 240 mg/dL, or above 130 mg/dL when the coronary risk is equal to or greater than 10% at 10 years. There are data that suggest that these 2 criteria are not the only ones used in routine clinical practice, as such that the majority of patients to whom it is indicated, do not meet either of these 2 conditions. This study aims to determine the characteristics of the patients when statins are indicated outside the aforementioned circumstances. It is concluded that around 40% of patients have clinical characteristics that could justify the treatment. The level of suitability could not be established in about 33% of the patients, due to not being able to determine the coronary risk

Respuesta de los autores: Hipertensión arterial: más allá de las guías / Author’s reply: High blood pressure: beyond the guidelines

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The effect of office-based physician's advice on adolescent exercise behavior.

BACKGROUND: This study examines whether the adolescents' current levels of physical activity are increased by their physicians' advice provided in the office, in accordance with the American Medical Association recommendation. METHODS: The first adolescent (12-21 years old) of whichever age and gender, passing through six family physicians' offices during a 6-month period was assigned to the intervention group, and the second adolescent of the same age and gender was assigned to the control group. Each patient was classified as active, partially active, and inactive, according to how they answered the questions about their physical activity levels, and patients in the intervention group were then provided with reinforcement, increase, or initiation counseling, respectively. Identical procedures were repeated at the 6- and 12-month office visits. Changes in prevalence of activity, as well as, duration, frequency, and intensity of exercise and/or sports were verified at each visit. RESULTS: Of the 87.5% of the original sample that completed the survey, 6- and 12-month data were available for 70.1%. Among the 392 adolescents that finished the study, those provided with counseling had 41.5% more active adolescents, as well as 26.8%, 38.0% and 26.2% higher duration, frequency and intensity, respectively, than the control group. CONCLUSIONS: The proportion of active adolescents, as well as, the duration, frequency and intensity of leisure time exercise and/or sports are increased by physician advice.