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Royo-Bordonada M.A.,Institute Salud Carlos III | Bejarano J.M.L.,Sociedad Espanola de Medicina de Familia y Comunitaria | Alvarez F.V.,Sociedad Espanola de Arteriosclerosis | Sans S.,Sociedad Espanola de Salud Publica y Administracion Sanitaria | And 16 more authors.
Revista Espanola de Salud Publica | 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 populationbased 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 (BP) 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.


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 .


Lobos Bejarano J.M.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Galve E.,Seccion de Riesgo Vascular y Rehabilitacion Cardiaca | Royo-Bordonada M.A.,Comite Espanol Interdisciplinario de Prevencion Cardiovascular | Royo-Bordonada M.A.,Institute Salud Carlos III | And 11 more authors.
Revista Espanola de Cardiologia | Year: 2014

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 Sociedad Española de Cardiología.


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.


PubMed | Sociedad Espanola de Cardiologia, Institute Salud Carlos III, Seccion de Riesgo Vascular y Rehabilitacion Cardiaca, Comite Espanol Interdisciplinario de Prevencion Cardiovascular and 2 more.
Type: Journal Article | Journal: Revista espanola de cardiologia (English ed.) | Year: 2014

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.


PubMed | Sociedad Espanola de Epidemiologia., Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria., Sociedad Espanola de Arteriosclerosis., Ministerio de Sanidad and 12 more.
Type: | Journal: Hipertension y riesgo vascular | Year: 2016

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines dont recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.


PubMed | Sociedad Espanola de Epidemiologia., Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria., Sociedad Espanola de Arteriosclerosis., Ministerio de Sanidad and 12 more.
Type: | Journal: Revista espanola de salud publica | Year: 2016

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines dont recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.


PubMed | Federacion de Asociaciones de Enfermeria Comunitaria y Atencion Primaria, Sociedad Espanola de Cardiologia, Institute Salud Carlos III, Sociedad Espanola de Hipertension Liga Espanola de la Lucha Contra la Hipertension Arterial and 6 more.
Type: Journal Article | Journal: Medicina clinica | Year: 2013

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.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.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.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.


Masana L.,Sociedad Espanola de Arteriosclerosis | Civeira F.,Sociedad Espanola de Arteriosclerosis | Pedro-Botet J.,Sociedad Espanola de Arteriosclerosis | de Castro I.,Sociedad Espanola de Arteriosclerosis | And 5 more authors.
Clinica e Investigacion en Arteriosclerosis | Year: 2013

Familial hypercholesterolemia (FH) is one of the most common and severe genetic diseases, causing disabilities and premature death to those who suffer it. Lipid-lowering therapy substantially improves the prognosis of FH patients and, therefore, appropriate pharmacological treatment is of the utmost importance. The Spanish Society of Arteriosclerosis (SEA) has always been a pioneer in the diagnosis and treatment of FH. Since its inception, FH has been one of the main areas of clinical and scientific interest, mainly for Lipids Units of the SEA, where most patients with this pathology are referred in Spain. This document arises from the willingness of our society to update the scientific knowledge on this subject and to provide physicians with clear clinical guidelines regarding diagnosis and treatment of FH. These guidelines can be summarized in two main aspects: early diagnosis of the disease and a rapid normalization of LDL. cholesterol. In the coming years, health providers should accomplish that the majority of patients with FH are aware of their diagnosis and that adequate treatment is provided. © 2013 Elsevier España, S.L. and SEA.


PubMed | Sociedad Espanola de Arteriosclerosis
Type: Journal Article | Journal: Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis | Year: 2013

Familial hypercholesterolemia (FH) is one of the most common and severe genetic diseases, causing disabilities and premature death to those who suffer it. Lipid-lowering therapy substantially improves the prognosis of FH patients and, therefore, appropriate pharmacological treatment is of the utmost importance. The Spanish Society of Arteriosclerosis (SEA) has always been a pioneer in the diagnosis and treatment of FH. Since its inception, FH has been one of the main areas of clinical and scientific interest, mainly for Lipids Units of the SEA, where most patients with this pathology are referred in Spain. This document arises from the willingness of our society to update the scientific knowledge on this subject and to provide physicians with clear clinical guidelines regarding diagnosis and treatment of FH. These guidelines can be summarized in two main aspects: early diagnosis of the disease and a rapid normalization of LDLcholesterol. In the coming years, health providers should accomplish that the majority of patients with FH are aware of their diagnosis and that adequate treatment is provided.

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