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Royo Bordonada M.A.,Institute Salud Carlos III | Lobos Bejarano J.M.,Coordinador Del CEIPC | Millan Nunez-Cortes J.,Sociedad Espanola de Arteriosclerosis | Villar Alvarez F.,Sociedad Espanola de Arteriosclerosis | And 6 more authors.
Medicina Clinica | Year: 2011

In Spain, where cardiovascular disease (CVD) is the leading cause of death, hypercholesterolemia, one of the most prevalent risk factors in adults, is poorly controlled. Dyslipidemia should not be approached in isolation, but in the context of overall cardiovascular risk (CVR). Measurement of CVR facilitates decision making, but should not be the only tool nor should it take the place of clinical judgment, given the limitations of the available calculation methods. This document, prepared by the Interdisciplinary Spanish Committee on Cardiovascular Prevention, at the proposal of the Spanish Society of Arteriosclerosis, reviews the cardiovascular prevention activities of the regional health authorities, scientific societies and medical professionals. An initiation of a national strategy on cardiovascular prevention is proposed based on lifestyle modification (healthy diet, physical activity and smoking cessation) through actions in different settings. At the population level, regulation of food advertising, elimination of trans fats and reduction of added sugar are feasible and cost-effective interventions to help control dyslipidemias and reduce CVR. In the health setting, it is proposed to facilitate the application of guidelines, improve training for medical professionals, and include CVR assessment among the quality indicators. Scientific societies should collaborate with the health authorities and contribute to the generation and transmission of knowledge. Finally, it is in the hands of professionals to apply the concept of CVR, promote healthy lifestyles, and make efficient use of available pharmacological treatments. © 2010 Elsevier España, S.L. All rights reserved. Source


Royo-Bordonada M.A.,Institute Salud Carlos III | Lobos Bejarano J.M.,Sociedad Espanola de Medicina de Familia y Comunitaria | Villar Alvarez F.,Sociedad Espanola de Arteriosclerosis | Sans S.,Sociedad Espanola de Salud Publica y Administracion Sanitaria | And 17 more authors.
Neurologia | Year: 2013

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses. © 2013 Sociedad Española de Neurología. Source


Royo-Bordonada M.A.,Institute Salud Carlos III | Lobos J.M.,Sociedad Espanola de Medicina de Familia y Comunitaria | Brotons C.,Sociedad Espanola de Medicina de Familia y Comunitaria | Villar F.,Sociedad Espanola de Arteriosclerosis | And 7 more authors.
Medicina Clinica | Year: 2014

Background and objective: In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems. Method: Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems. Results: Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles. Conclusions: Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management. © 2012 Elsevier España, S.L. All rights reserved. Source


Lobos Bejarano J.M.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Galve E.,Seccion de Riesgo Vascular y Rehabilitacion Cardiaca | Royo-Bordonada M.T.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Royo-Bordonada M.T.,Institute Salud Carlos III | And 11 more authors.
Semergen | Year: 2015

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Source


Lobos Bejarano J.M.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Galve E.,Seccion de Riesgo Vascular y Rehabilitacion Cardiaca | Royo-Bordonada M.T.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Royo-Bordonada M.T.,Institute Salud Carlos III | And 11 more authors.
Clinica e Investigacion en Arteriosclerosis | Year: 2015

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management.The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.Full English text available from: www.revespcardiol.org/en. © 2014 . Source

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