[Consensus on objectives and action guidelines on low density lipoproteins-cholesterol control in very high risk cardiovascular patients]. / Consenso sobre los objetivos y pautas de actuación en el control del colesterol ligado a lipoproteínas de baja densidad en pacientes de muy alto riesgo cardiovascular.

INTRODUCTION: Cardiovascular disease is the leading cause of death in developed countries. Among cardiovascular disease risk factors one of the most relevant is low-density lipoprotein-associated cholesterol (LDL-c), but there is controversy about the methods used to control it. The aim was to obtain an expert opinion to clarify the most relevant issues regarding the control of dyslipidemia in very high cardiovascular risk patients. MATERIALS AND METHODS: A survey with 55 items, stratified into 4 blocks: LDL-c as a therapeutic target, therapeutic goals, causes of the failure to achieve LDL-c goals, and recommendations to optimize their achievement, was addressed to 41 specialists (Cardiology and Internal Medicine) using the Delphi method to achieve professional consensus criteria. RESULTS: A high consensus was reached among all items, in line with the European recommendations. The panelists considered that the goal of 70mg/dl for LDL-c for high cardiovascular disease risk (mainly vascular disease, diabetes mellitus, and renal failure), using combined treatment when necessary. Lack of adherence and therapeutic inertia were considered the main reasons for treatment failure. CONCLUSION: The Spanish experts show an elevated consensus with the European recommendations, confirming the LDL-c control target of <70mg/dl. The simplification of the guidelines and the combined treatment may favor an improvement the achievement of lipid target goals.

[LDL cholesterol control in patients with very high cardiovascular risk. A simplified algorithm for achieving LDL cholesterol goals "in two steps"]. / Control del colesterol LDL en pacientes de muy alto riesgo vascular. Algoritmo simplificado para alcanzar objetivos de colesterol LDL "en dos pasos".

Reducing low density lipoprotein-cholesterol (LDL-c) is the main lipid goal of treatment for patients with very high cardiovascular risk. In these patients the therapeutic goal is to achieve a LDL-c lower than 70 mg/dL, as recommended by the guidelines for cardiovascular prevention commonly used in Spain and Europe. However, the degree of achieving these objectives in this group of patients is very low. This article describes the prevalence of the problem and the causes that motivate it. Recommendations and tools that can facilitate the design of an optimal treatment strategy for achieving the goals are also given. In addition, a new tool with a simple algorithm that can allow these very high risk patients to achieve the goals "in two-steps", i.e., with only two doctor check-ups, is presented.

Consenso sobre los objetivos y pautas de actuación en el control del colesterol ligado a lipoproteínas de baja densidad en pacientes de muy alto riesgo cardiovascular / Consensus on objectives and action guidelines on low density lipoproteins-cholesterol control in very high risk cardiovascular patients

Introducción: La enfermedad cardiovascular es la principal causa de muerte en los países desarrollados. Entre sus factores de riesgo destaca los niveles de colesterol asociado a lipoproteínas de baja densidad (cLDL), pero existe gran controversia sobre la forma de reducirlos. Se obtuvo la opinión de un panel de expertos para clarificar los puntos más relevantes del control de la dislipidemia en pacientes de muy alto riesgo cardiovascular. Material y métodos: Encuesta realizada mediante el método Delphi en 2 rondas a 41 especialistas (cardiología/medicina interna). El cuestionario constaba de 55 ítems, estratificados en 4 bloques: cLDL como diana terapéutica, objetivos de reducción, causas del fracaso en la reducción y recomendaciones para optimizar la consecución de los objetivos terapéuticos. Resultados: Se alcanzó un alto grado de consenso en los ítems consultados en línea con las recomendaciones de las guías europeas. El panel consideró adecuado el objetivo terapéutico de 70 mg/dl de lipoproteínas de baja densidad en pacientes de muy alto riesgo cardiovascular (principalmente enfermedad vascular, diabetes mellitus e insuficiencia renal), empleando si es preciso tratamiento combinado. Sin embargo, la consecución de ese objetivo se vuelve compleja debido a distintos factores, como la falta de adherencia y la inercia. Conclusiones: Los expertos españoles tienen un alto grado de acuerdo con las recomendaciones europeas, ratificando el objetivo de control del cLDL en los pacientes de muy alto riesgo < 70 mg/dl. La simplificación de las guías y el tratamiento combinado pueden favorecer la mejora del control de los objetivos lipídicos

Introduction: Cardiovascular disease is the leading cause of death in developed countries. Among cardiovascular disease risk factors one of the most relevant is low-density lipoprotein-associated cholesterol (LDL-c), but there is controversy about the methods used to control it. The aim was to obtain an expert opinion to clarify the most relevant issues regarding the control of dyslipidemia in very high cardiovascular risk patients. Materials and methods: A survey with 55 items, stratified into 4 blocks: LDL-c as a therapeutic target, therapeutic goals, causes of the failure to achieve LDL-c goals, and recommendations to optimize their achievement, was addressed to 41 specialists (Cardiology and Internal Medicine) using the Delphi method to achieve professional consensus criteria. Results: A high consensus was reached among all items, in line with the European recommendations. The panelists considered that the goal of 70 mg/dl for LDL-c for high cardiovascular disease risk (mainly vascular disease, diabetes mellitus, and renal failure), using combined treatment when necessary. Lack of adherence and therapeutic inertia were considered the main reasons for treatment failure. Conclusion: The Spanish experts show an elevated consensus with the European recommendations, confirming the LDL-c control target of < 70 mg/dl. The simplification of the guidelines and the combined treatment may favor an improvement the achievement of lipid target goals

Control del colesterol LDL en pacientes de muy alto riesgo vascular. Algoritmo simplificado para alcanzar objetivos de colesterol LDL «en dos pasos» / LDL cholesterol control in patients with very high cardiovascular risk. A simplified algorithm for achieving LDL cholesterol goals «in two steps»

La reducción de colesterol unido a lipoproteínas de baja densidad (cLDL) es el principal objetivo del tratamiento hipolipemiante del paciente de muy alto riesgo cardiovascular. En estos pacientes el objetivo terapéutico es conseguir un cLDL menor de 70 mg/dl, según las guías de prevención cardiovascular comúnmente utilizadas en España y en Europa. Sin embargo, el grado de consecución de objetivos en este grupo de pacientes es muy bajo. En este artículo se analiza la prevalencia de este problema y las causas que lo motivan. También se dan recomendaciones y herramientas que pueden facilitar el diseño de la estrategia de tratamiento óptima para lograr la consecución de objetivos. Además, se presenta una novedosa herramienta con un sencillo algoritmo que puede permitir el control del paciente de muy alto riesgo cardiovascular «en 2 pasos», es decir, con solo 2 visitas al médico

Reducing low density lipoprotein-cholesterol (LDL-c) is the main lipid goal of treatment for patients with very high cardiovascular risk. In these patients the therapeutic goal is to achieve a LDL-c lower than 70mg/dL, as recommended by the guidelines for cardiovascular prevention commonly used in Spain and Europe. However, the degree of achieving these objectives in this group of patients is very low. This article describes the prevalence of the problem and the causes that motivate it. Recommendations and tools that can facilitate the design of an optimal treatment strategy for achieving the goals are also given. In addition, a new tool with a simple algorithm that can allow these very high risk patients to achieve the goals «in two-steps», i.e., with only two doctor check-ups, is presented

Biomarcadores plasmáticos de arteriosclerosis coronaria / Serum markers of coronary atherosclerosis

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Dislipemia del síndrome metabólico. Documento sumario del Foro-HDL / Dyslipidemia of metabolic syndrome. Summary document of the HDL Forum

No disponible