[Prevalence of metabolic syndrome in patients with stable coronary disease: therapeutic objectives and utilization of cardiovascular drugs]

[Dyslipidemia management in patients with high cardiovascular risk in Spain. ALMA study]

Objetivo

Evaluar la actitud de los médicos de atención primaria (MAP) y de atención especializada (MAE) ante el tratamiento de pacientes con dislipemia, especialmente en aquellos con factores de riesgo cardiovascular (RCV).

Diseño

Estudio observacional, descriptivo, multicéntrico, basado en una encuesta.

Emplazamiento

Diferentes áreas sanitarias de España.

Participantes

1.402 MAP y 596 MAE.

Mediciones principales

Perfil de los médicos, hábitos de tratamiento en pacientes con dislipemia.

Resultados

El 84,3% consideraban el RCV para establecer el tratamiento. El objetivo de concentración de cLDL en pacientes sin factores de RCV fue < 130 mg/dl y < 160 mg/dl para el 51,9 y el 29,0%, respectivamente. En pacientes con hipertensión, tabaquismo o diabetes el objetivo de cLDL fue < 100 mg/dl para el 49-55%, mientras que en pacientes con complicación cardiovascular, cardiopatía isquémica o ictus fue < 70 mg/dl para el 71-88%. El fármaco de elección en pacientes sin factores de RCV fue atorvastatina (66%), mientras que en pacientes con diabetes, enfermedad renal o síndrome metabólico fue pitavastatina (80-89%). Los MAE mostraron una mayor tendencia que los MAP a considerar un objetivo de cLDL < 70 mg/dl en pacientes con antecedentes de ictus (77,5% vs 66,8%) o enfermedad coronaria (92,1% vs 80,6%) (p < 0,0001), y una mayor preferencia por el tratamiento combinado al no alcanzar el objetivo de cLDL (58,1% vs 50,2%; p = 0,0013).

Conclusiones

Aunque el cálculo del RCV se acepta de forma general, existe disparidad en los objetivos del cLDL. Los MAE consideran unos objetivos más ambiciosos y la asociación de fármacos hipolipemiantes con más frecuencia que los MAP.

Prevalence, Treatment, and Control of Hypercholesterolemia in High Cardiovascular Risk Patients: Evidences from a Systematic Literature Review in Spain

Introduction

Cardiovascular diseases (CVDs) represent a major Public Health burden. High serum cholesterol levels have been linked to major CV risk. The objectives of this study were to review the epidemiology of hypercholesterolemia in high risk CV patients from Spain, by assessing its prevalence, the proportion of diagnosed patients undergoing pharmacological treatment and the degree of attained lipid control.

Methods

A systematic literature review was carried out using Medline and two Spanish databases. Manuscripts containing information on hypercholesterolemia in several high CV risk groups [diabetes mellitus (DM), Systematic COronary Risk Evaluation (SCORE) risk >5, or documented CVD], published between January 2010 and October 2014, were included.

Results

Of the 1947 published references initially retrieved, a full-text review was done on 264 manuscripts and 120 were finally included. Prevalence of hypercholesterolemia ranged from 50 to 84% in diabetics, 30–60% in patients with DM or elevated SCORE risk, 64–74% with coronary heart disease, 40–70% in stroke patients, and 60–80% in those with peripheral artery disease. Despite the finding that most of them were on pharmacological treatment, acceptable control of serum lipids was very variable, ranging from 15% to 65%. Among those with heterozygous familial hypercholesterolemia, 95–100% received treatment but less than 50% achieved their therapeutic goals.

Conclusions

An elevated prevalence of hypercholesterolemia can be found in targeted groups at high CV risk. Although most patients are receiving pharmacological treatment, rates of lipid control continue to be low, both in primary and secondary prevention.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-015-0252-y) contains supplementary material, which is available to authorized users.

Metabolic syndrome in patients with peripheral arterial disease

BACKGROUND AND OBJECTIVE

The prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS.

PATIENTS AND METHODS

Multicenter, cross-sectional study of 3.934 patients aged ≥ 45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization.

RESULTS

In the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI 61.5-64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin-angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265).

CONCLUSION

Patients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs.