Effectiveness of multifactorial interventions in primary health care settings for primary prevention of cardiovascular disease: A systematic review of systematic reviews.

OBJECTIVE: To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients. METHODS: Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool. RESULTS: Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness. CONCLUSION: Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity.

Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2 / Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes

Fundamento y objetivo: Determinar la prevalencia de insuficiencia renal crónica (IRC) oculta y las variables clínicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y método: Estudio observacional, analítico y transversal en pacientes con DM2 ambulatorios de atención primaria. De la historia clínica electrónica se registraron datos demográficos y antropométricos, antecedentes patológicos y medidas de riesgo cardiovascular y de función renal. Se determinó la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmática normales (Cr ≤1,4mg/dl en las mujeres y Cr ≤1,5mg/dl en los varones), y la estimación del filtrado glomerular (eFG) reducida (<60ml/min/1,73m2). La eFG se determinó mediante la fórmula Modification of Diet in Renal Disease (MDRD). Resultados: La muestra estuvo formada por 3.197 pacientes, con una media (DE) de edad de 67,7 años (11,7); el 53,9% eran varones. La prevalencia de IRC según los valores de la MDRD fue del 16,6% (n=532), de los que el 60,3% (n=321) fue IRC oculta. El 6,6% (n=211) de los sujetos presentó IRC con valores de Cr elevados. El análisis multivariante mostró una asociación del sexo femenino con la IRC oculta (odds ratio: 2,7; intervalo de confianza del 95%: 1,83–3,99). La IRC se asoció a la edad, a la presión arterial superior a 150/100mmHg, a la dislipidemia y a los antecedentes de cardiopatía isquémica, insuficiencia cardíaca y arteriopatía periférica. Conclusión: La prevalencia de IRC según la fórmula MDRD fue del 16,6%, del que el 60,3% presentaba IRC oculta. El sexo femenino se asoció directamente a la presencia de IRC oculta (AU)

Background and objective: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). Patients and method: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (<60ml/min/1,73m2). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. Results: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD=11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n=532), of which 60.3% (n=321) corresponded to occult CKD. 6.6% (n=211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR=2.7; CI 95%=1,83–3,99). Occult CKD was associated with age, blood pressure higher than 150/100mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. Conclusions: The prevalence of CKD is 16.6%, of which 60.3% (n=321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD (AU)