1
|
Masana L, Díaz Moya G, Pérez de Isla L. Patients who suffer a first atherosclerotic cardiovascular event while taking statins are often far off of lipid targets. Nutr Metab Cardiovasc Dis 2024; 34:90-97. [PMID: 38092606 DOI: 10.1016/j.numecd.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND AIMS Despite considerable evidence that lipid-lowering therapies (LLTs) afford clinical benefit, the control of low-density lipoprotein cholesterol (LDL-C) is suboptimal, and available LLTs are underused, especially in patients at high and very high cardiovascular (CV) risk. This study assesses the real-world LDL-C target attainment rate in patients on LLT before experiencing a first major acute cardiovascular event (MACE). METHODS AND RESULTS The HEARTBEAT was a retrospective, multicentre observational study. From March to June 2021 a total of 334 patients on LLT who had a first MACE while being on statins were included in the study. Of these patients, 83.2 % had a high (40.7 %) or very high CV risk (29.0 %) prior to MACE. Overall, 87.5 % and 89.7 % of the patients at high and very high CV risk, respectively, failed to reach the LDL-C target. Regarding LLTs, only 11.8 % and 19.6 % of the patients at high and very high risk had received high-intensity LLTs prior to MACE. It was estimated that if these patients had reached their recommended LDL-C targets, the risk of MACE may have been reduced by a median of 24.5 % and 23.2 % in patients at high and very high risk respectively. CONCLUSIONS Patients who suffer a first MACE while on statin therapy often were at high/very high CV risk. Despite their risk, LDL-levels and being on statins they are undertreated, and too far from lipid targets. A proper use of high-intensity LLTs led to an increase attainment of LDL targets and lower CV events.
Collapse
Affiliation(s)
- Luis Masana
- Unidad Medicina Vascular y Metabolismo, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain.
| | | | | |
Collapse
|
2
|
Aneri M, Fernández G, Gras M, Campaña A, Sánchez R, Sánchez J. Degree of lipid control in a Healthcare Management Area in patients at very high cardiovascular risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:198-202. [PMID: 34090715 DOI: 10.1016/j.arteri.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines. METHODS This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55mg/dl. RESULTS The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome. CONCLUSIONS In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.
Collapse
|
3
|
Hernández-Teixidó C, Quirós C, Bureo C, Martínez I, Cabeza F. [Analysis of patients with type 2 diabetes in an urban Primary Healthcare centre. DESENROQUE Study]. Semergen 2019; 46:46-52. [PMID: 31331768 DOI: 10.1016/j.semerg.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the health status of patients with type 2 diabetes (T2D) in an urban Primary Healthcare centre, and to assess the follow-up carried out by health professionals. To analyse the pharmacological treatment in patients with T2D, as well as to assess the individualisation according to their comorbidities. MATERIAL AND METHODS Descriptive and cross-sectional analysis conducted on patients with DM2. Out of a total of 920 patients, a randomised and simple sample of 460 individuals was obtained, from which the parameters related to associated comorbidities and the integral treatment of T2D were collected. RESULTS The study included 460 patients (42.4% women) with a mean age of 67.1 years (SD=13.07). The mean value of their last HbA1c was 6.75% (SD=1.24). The large majority (83.7%) fulfilled the proposed individualised HbA1c objectives according to their age and comorbidities. Approximately two-thirds (65.43%) of patients had a suboptimal follow-up by health professionals. As regards the suitability of the treatment, 19.8% had non-recommended pharmacological combinations or drugs applied outside the indications of the data sheet. A comprehensive T2D treatment that could be improved was observed in 74.3%. CONCLUSIONS Although 83.7% of patients had good control of HbA1c, the treatment is centred on blood glucose and improvable in a high percentage of patients (74.3%). Given that the therapy must be adjusted to the needs of each patient, and since the BMI (body mass index) is a determining factor for the selection of treatment, it is striking that it is not recorded in the clinical histories of 44.13% of the patients.
Collapse
Affiliation(s)
- C Hernández-Teixidó
- Medicina Familiar y Comunitaria, Centro de Salud San Roque, Badajoz, España.
| | - C Quirós
- Medicina Familiar y Comunitaria, Centro de Salud San Roque, Badajoz, España
| | - C Bureo
- Medicina Familiar y Comunitaria, Centro de Salud San Roque, Badajoz, España
| | - I Martínez
- Medicina Familiar y Comunitaria, Centro de Salud San Roque, Badajoz, España
| | - F Cabeza
- Enfermería Familiar y Comunitaria, Centro de Salud San Roque, Badajoz, España
| |
Collapse
|
4
|
Díaz Vera AS, Abellán Alemán J, Segura Fragoso A, Martínez de Esteban JP, Lameiro Couso FJ, Golac Rabanal MDS, Díaz Vera LA, Matta Solis HH. The prevalence and risk factors associated with dyslipidemia in type 2 diabetic patients in the autonomous Region of Cantabria. ACTA ACUST UNITED AC 2019; 67:102-112. [PMID: 31235401 DOI: 10.1016/j.endinu.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Dyslipidemia is one of the main risk factors in cardiovascular disease in patients with diabetes mellitus type 2 (DM2). The aim of this study is to evaluate the prevalence and risk factors associated with dyslipidemia in the population with diabetes mellitus type 2 in the region of Cantabria. MATERIAL AND METHODS This is a transversal study carried out at Cantabrian primary health care centres (n=680). A representative, random sample of the population with DM2, ranging from 18-85, was selected using a multistage procedure. The medical records were obtained, and by means of interviews the data of the risk factors to be studied was secured. The correlation with dyslipidemia was analysed by means of logistic regression. RESULTS There were 52.1% of males, the average age was 69.8, the evolution of diabetes was 9.99 years, 84.3% had arterial hypertension, 76.6% were overweight or obese and the average HbA1c was 6.96%. The prevalence of dyslipidemia was 85.3%, and in the bivariate analysis this is associated with a history of peripheral artery disease, controlled diabetes, antihypertensive treatment, glomerular filtration, HbA1c>7%, body fat estimated as being either overweight or obese, a history of cardiovascular disease, age and HbA1c. In the multivariate analysis the independent factors were being female and a history of cardiovascular disease. CONCLUSION The prevalence of dyslipidemia in our study was 85.3%, and is consistent with figures found in previous published studies. The independent associated risk factors were being female and a past medical history of cardiovascular disease.
Collapse
Affiliation(s)
| | - José Abellán Alemán
- Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Antonio Segura Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina (Toledo), España
| | | | | | | | | | | |
Collapse
|
5
|
Serrano A, Pascual V. Opinión de los médicos sobre la necesidad de cribado de la dislipidemia ante el riesgo cardiovascular. Coincidencias y diferencias entre Atención Primaria y otras especialidades. Estudio DIANA. Semergen 2017; 43:486-492. [DOI: 10.1016/j.semerg.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 11/25/2022]
|
6
|
Morales C, Plana N, Arnau A, Matas L, Mauri M, Vila À, Vila L, Soler C, Montesinos J, Masana L, Pedro-Botet J. Causes of failure to achieve the low density lipoprotein cholesterol therapeutic target in patients with high and very high vascular risk controlled in Lipid and Vascular Risk Units. EROMOT study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 30:1-9. [PMID: 28916128 DOI: 10.1016/j.arteri.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Determination of the level of achievement of the low density lipoprotein cholesterol (LDL-C) therapeutic target in patients with high and very high vascular risk treated in Lipid Units, as well as the causes of non-achievement. PATIENTS AND METHOD Multicentre retrospective observational study that included patients over 18 years with high and very high vascular risk, according to the criteria of the 2012 European Guidelines on Cardiovascular Disease Prevention, referred consecutively to Lipid Units between January and June 2012 and with follow-up two years after the first visit. RESULTS The study included a total of 243 patients from 16 lipid units. The mean age was 52.2 years (SD 13.7), of whom 62.6% were males, and 40.3% of them were very high risk. At the first visit, 86.8% (25.1% in combination) and 95.0% (47.3% in combination) in the second visit (P<.001) were treated with lipid-lowering treatment. The therapeutic target was achieved by 28% (95 CI: 22.4-34.1). As regards the causes of non-achievement, 24.6% were related to the medication (10.3% maximum tolerated dose and 10.9% due to the appearance of adverse effects), 43.4% due to the physician (19.4% by inertia, 13.7% considering that target already reached), and 46.9% due to the patient, highlighting the therapeutic non-compliance (31,4%). CONCLUSIONS LDL-C targets were achieved in about one-third of patients. The low adherence of the patient, followed by medical inertia are the most frequent causes that can explain these results.
Collapse
Affiliation(s)
- Clotilde Morales
- Servei de Medicina Interna, Unitat de Lípids i Risc Vascular, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España.
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili de Reus, Reus, Tarragona, España
| | - Anna Arnau
- Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - Laia Matas
- Servei de Medicina Interna, Unitat de Risc Vascular i Lípids, Hospital de Sant Pau de Barcelona, Barcelona, España
| | - Marta Mauri
- Servei de Medicina Interna, Unitat de Lípids, Consorci Sanitari de Terrassa-Hospital de Terrassa, Terrassa, Barcelona, España
| | - Àlex Vila
- Servei de Medicina Interna, Unitat de Lípids, Hospital de Figueres, Figueres, Girona, España
| | - Lluís Vila
- Servei d'Endocrinologia i Nutrició, Unitat de Lípids, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
| | - Cristina Soler
- Hospital de Santa Caterina de Salt, Parc Hospitalari Martí i Julià, Salt, Girona, España
| | - Jesús Montesinos
- Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - Lluís Masana
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili de Reus, Reus, Tarragona, España
| | - Juan Pedro-Botet
- Unitat de Lípids i Risc Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | | |
Collapse
|
7
|
Pintó X, Trias Vilagut F, Rius Taruella J, Mairal Sallán E. [Dyslipidemia management in patients with high cardiovascular risk in Spain. ALMA study]. Aten Primaria 2017; 50:35-43. [PMID: 28619533 PMCID: PMC6839209 DOI: 10.1016/j.aprim.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/13/2017] [Accepted: 02/25/2017] [Indexed: 12/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Xavier Pintó
- Unidad de Riesgo Cardiovascular y Lípidos, Servicio de Medicina Interna, Fipec. Idibell. CiberObn. Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Ferran Trias Vilagut
- Medicina de Familia, CAP Jacinto Verdaguer, Hospitalet de Llobregat, Barcelona, España
| | | | - Esther Mairal Sallán
- Medical Affairs Cardiovascular Area, Laboratorios Dr. Esteve S.A., Barcelona, España.
| |
Collapse
|
8
|
Gómez-Barrado JJ, Ortiz C, Gómez-Turégano M, Gómez-Turégano P, Garcipérez-de-Vargas FJ, Sánchez-Calderón P. [Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:13-19. [PMID: 28062171 DOI: 10.1016/j.arteri.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of <70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. METHODS An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. RESULTS The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P<.001). A total of 52.3% patients achieved the LDLc target of <70mg/dl, with no gender differences. Only 44.8% of the patients <55 years achieved their lipid targets, compared to 59.3% of the patients >75 years. About 68.2% of men had an HDLc>40mg/dl, and 54.8% of women had an HDLc>50mg/dl. Overall, 79.4% of patients had a TG<150mg/dl, with no gender differences, and 59.8% had a non-HDLc<100mg/dl. CONCLUSIONS Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.
Collapse
Affiliation(s)
- José J Gómez-Barrado
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España.
| | - Carolina Ortiz
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
| | - Marta Gómez-Turégano
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
| | - Paula Gómez-Turégano
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
| | | | | |
Collapse
|
9
|
Pedro-Botet J, Climent E, Giralt Martínez E, Flores-Le Roux JA. [Map of resources and healthcare needs for patients with dyslipidaemia in Spain: The MADI study]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:257-264. [PMID: 27692631 DOI: 10.1016/j.arteri.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Dyslipidaemia is a major modifiable determining factor of vascular risk and, despite this, a significant number of patients do not achieve lipid goals. The aim of this study is to describe the resources and current needs in clinical practice in Spain, through an analysis of management, organisation and the patient care circuit of dyslipidaemia patient. METHODS A descriptive, cross-sectional, multicentre study, using a questionnaire, was conducted on physicians, 266 in primary care (PC) and 258 in specialised care (SC), who attended patients with dyslipidaemia in hospitals and centres within the National Health System. Probabilistic analyses were performed, stratifying by care-level, existence of a lipid unit (LU), and geographic area. RESULTS Observed differences were mostly due to geographic location, rather than the existence of LU in the referral hospitals. Most system deficiencies were found in the southern provinces of the country. Nearly all primary care physicians declared that they diagnose, manage and control dyslipidaemia patients, but a general agreement was lacking for diagnostic and referral criteria. The scarce use of a shared protocol between PC and SC showed evidence of poor coordination between health care providers. Furthermore, there was a remarkably low proportion of patients receiving health care education for their disease. CONCLUSIONS This study emphasises the need to identify weaknesses in the dyslipidaemia patient care circuit, and to perform the appropriate remedial actions, in particular, to promote coordination between levels of care and to foster patient education about their disease.
Collapse
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eva Giralt Martínez
- Línea de investigación, Grupo Saned, Esplugues de Llobregat, Barcelona, España
| | - Juana A Flores-Le Roux
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
10
|
Galve E, Cordero A, Cequier A, Ruiz E, González-Juanatey JR. Grado de control lipídico en pacientes coronarios y medidas adoptadas por los médicos. Estudio REPAR. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Galve E, Cordero A, Cequier A, Ruiz E, González-Juanatey JR. Degree of Lipid Control in Patients With Coronary Heart Disease and Measures Adopted by Physicians. REPAR Study. ACTA ACUST UNITED AC 2016; 69:931-938. [PMID: 27178117 DOI: 10.1016/j.rec.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/01/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Lipid control is insufficient in patients with coronary heart disease but this situation may be improving with the implementation of the latest clinical practice guidelines. The aim of this study was to analyze whether target values of low-density lipoprotein cholesterol are achieved and to identify associated factors and physicians' attitudes to deficient control. METHODS We conducted a national, multicenter, prospective, observational study of 1103 patients with stable coronary heart disease, analyzing lipid values and a broad set of clinical variables. The statistical analysis involved a binary logistic regression model using backward stepwise elimination. RESULTS Low-density lipoprotein cholesterol was < 70 mg/dL in only 26% of patients, even though 95.3% were receiving cholesterol-lowering agents, 45% of which were high-intensity therapies. Independent predictors of low-density lipoprotein cholesterol < 70 mg/dL were diabetes mellitus, wholegrain bread, shorter history of dyslipidemia, and, especially, high-intensity cholesterol-lowering therapies. Physicians increased therapy in only 26% of poorly controlled patients. The main predictor of increased therapy was low-intensity baseline therapy (odds ratio=5.05; 95% confidence interval, 3.3-9.2). A more proactive approach was observed in older physicians (P=.019) and longer physician practice (P=.02). CONCLUSIONS Despite the new guidelines, only 26% of patients with coronary heart disease have adequate lipid control. In 70% of patients, physicians continue the same therapy, even though high-intensity cholesterol-lowering therapies are a key factor in good control.
Collapse
Affiliation(s)
- Enrique Galve
- Servicio de Cardiología, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
| | - Alberto Cordero
- Departamento de Cardiología, Hospital de San Juan, San Juan de Alicante, Alicante, Spain
| | - Angel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | |
Collapse
|
12
|
Félix-Redondo FJ, Lozano Mera L, Consuegra-Sánchez L, Giménez Sáez F, Garcipérez de Vargas FJ, Castellano Vázquez JM, Fernández-Bergés D. Risk factors and therapeutic coverage at 6 years in patients with previous myocardial infarction: the CASTUO study. Open Heart 2016; 3:e000368. [PMID: 27127637 PMCID: PMC4847157 DOI: 10.1136/openhrt-2015-000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the degree of risk factor control, the clinical symptoms and the therapeutic management of patients with a history of previous myocardial infarction. METHODS Cross-sectional study at 6 years of a first episode of acute myocardial infarction between 2000 and 2009, admitted at a hospital in the region of Extremadura (Spain). Of 2177 patients with this diagnosis, 1365 remained alive and therefore were included in the study. RESULTS We conducted a person-to-person survey in 666 (48.8%) individuals and telephone survey in 437 (31.9%) individuals. The former are analysed. 130 were female (19.5%). The mean age was 67.4 years and the median time since the event was 5.8 (IQR 3.6-8.2) years. Active smokers made up 13.8%, low-density lipoprotein (LDL) cholesterol was ≥70 mg/dL: 82%, blood pressure ≥140/90 mm Hg (≥140/85 in diabetics): 49.8%, fasting glucose ≥126 mg/dL: 26%, heart rate 50-59 bpm: 60.7%, and obesity: 45.9%. Patients reported presenting angina comprised 22.4% and those with dyspnoea, 29.3%. Drug coverage was: 88.0% antiplatelet drugs, 86.5% statins, 75.6% β-blockers and 65.8% blockers of the renin-angiotensin system. Patients receiving all four types of drugs made up 41.9%, with only 3.0% having jointly controlled cholesterol, blood pressure, heart rate and glycaemia. CONCLUSIONS LDL cholesterol, heart rate and blood pressure were risk factors with less control. More than 1/5 of patients had angina and more than 1/4, dyspnoea. Risk factor control and the clinical condition were far from optimal, as was drug coverage, although to a lesser degree.
Collapse
Affiliation(s)
- Francisco Javier Félix-Redondo
- Primary Care Unit "Villanueva Norte" , Programme of Investigation in Cardiovascular Diseases (PERICLES). GRIMEX Group , Villanueva de la Serena, Badajoz , Spain
| | - Luis Lozano Mera
- Primary Care Unit "Urbano I" , Programme of Investigation in Cardiovascular Diseases (PERICLES). GRIMEX Group . Mérida, Badajoz , Spain
| | - Luciano Consuegra-Sánchez
- Cardiac Hemodynamic Unit, Cardiology Department , Programme of Investigation in Cardiovascular Diseases (PERICLES). GRIMEX Group, "Santa Lucia" University Hospital , Cartagena, Murcia , Spain
| | - Fernando Giménez Sáez
- Cardiology Department , Don Benito-Villanueva de la Serena Hospital , Don Benito, Badajoz , Spain
| | | | - José María Castellano Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Monteprincipe University Hospital (HM Hospitales), Boadilla del Monte, Madrid, Spain
| | - Daniel Fernández-Bergés
- Cardiology Department , Programme of Investigation in Cardiovascular Diseases (PERICLES). GRIMEX Group, Don Benito-Villanueva de la Serena Hospital , Don Benito, Badajoz , Spain
| |
Collapse
|
13
|
de la Sierra A, Pintó X, Guijarro C, Miranda JL, Callejo D, Cuervo J, Subirà R, Rubio M. Prevalence, Treatment, and Control of Hypercholesterolemia in High Cardiovascular Risk Patients: Evidences from a Systematic Literature Review in Spain. Adv Ther 2015; 32:944-61. [PMID: 26499178 PMCID: PMC4635180 DOI: 10.1007/s12325-015-0252-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Indexed: 12/13/2022]
Abstract
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.
Collapse
|
14
|
Mazón-Ramos P, Cordero A, González-Juanatey JR, Bertomeu Martínez V, Delgado E, Vitale G, Fernández-Anaya S. Control de factores de riesgo cardiovascular en pacientes diabéticos revascularizados: un subanálisis del estudio ICP-Bypass. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
15
|
Millán Longo C, García Montero M, Tebar Márquez D, Beltrán Romero L, Banegas JR, García Puig J. Obesidad y episodios vasculares en la diabetes mellitus tipo 2. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
16
|
Millán Longo C, García Montero M, Tebar Márquez D, Beltrán Romero L, Banegas JR, García Puig J. Obesity and vascular events in type 2 diabetes mellitus. ACTA ACUST UNITED AC 2014; 68:151-3. [PMID: 25440181 DOI: 10.1016/j.rec.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Claudia Millán Longo
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain
| | - Marta García Montero
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain
| | - Daniel Tebar Márquez
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Beltrán Romero
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain
| | - José R Banegas
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain
| | - Juan García Puig
- Servicio de Medicina Interna, Unidad Metabólico-Vascular, Hospital Universitario La Paz, Madrid, Spain.
| |
Collapse
|
17
|
Pedro-Botet J, Flores-Le Roux J, Mostaza J, Pintó X, de la Cruz J, Banegas J. Dislipemia aterogénica: prevalencia y control en las unidades de lípidos. Rev Clin Esp 2014; 214:491-8. [DOI: 10.1016/j.rce.2014.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/27/2014] [Accepted: 06/01/2014] [Indexed: 02/06/2023]
|
18
|
Atherogenic dyslipidemia: prevalence and management in lipid clinics. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
19
|
Mazón-Ramos P, Cordero A, González-Juanatey JR, Bertomeu Martínez V, Delgado E, Vitale G, Fernández-Anaya S. Control of cardiovascular risk factors in revascularized patients with diabetes: a subanalysis of the ICP-Bypass study. ACTA ACUST UNITED AC 2014; 68:115-20. [PMID: 25224523 DOI: 10.1016/j.rec.2014.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/12/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. METHODS The analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. RESULTS The mean age (standard deviation) of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%,<7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5 mg/dL (in 73%, > 70 mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80 mmHg in 52% and < 140/90 mmHg in 93%. CONCLUSIONS Cardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.
Collapse
Affiliation(s)
- Pilar Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Elías Delgado
- Servicio de Endocrinología, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | | | | |
Collapse
|
20
|
Guijarro-Herraiz C, Masana-Marin L, Galve E, Cordero-Fort A. [LDL cholesterol control in patients with very high cardiovascular risk. A simplified algorithm for achieving LDL cholesterol goals "in two steps"]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2014; 26:242-252. [PMID: 25048471 DOI: 10.1016/j.arteri.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 06/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Carlos Guijarro-Herraiz
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Grupo de Trabajo de la Sociedad Española de Arteriosclerosis..
| | - Luis Masana-Marin
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Tarragona, España; Grupo de Trabajo de la Sociedad Española de Arteriosclerosis
| | - Enrique Galve
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, España; Grupo de Trabajo de la Sociedad Española de Cardiología
| | - Alberto Cordero-Fort
- Hospital Universitario San Juan de Alicante, Alicante, España; Grupo de Trabajo de la Sociedad Española de Cardiología
| |
Collapse
|
21
|
Pedro-Botet J, Mostaza JM, Pintó X, Banegas JR. [Achievement of low-density lipoprotein cholesterol therapeutic goal in lipid and vascular risk units of the Spanish Arteriosclerosis Society]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2013; 25:155-63. [PMID: 24041476 DOI: 10.1016/j.arteri.2013.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/26/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate low-density lipoprotein-cholesterol (LDLc) goal achievement among dyslipidemic patients treated in lipid and vascular risk units of the Spanish Society of Arteriosclerosis (SEA). The LDLc goal was based on the 2007 European guidelines for cardiovascular prevention. DESIGN Observational, longitudinal, retrospective, multicenter national study that included consecutive patients of both sexes over 18 years of age referred for dyslipidemia and cardiovascular risk. Information was collected from medical records corresponding to two visits in the lipid unit. RESULTS We included 1,828 patients from 43 lipid units. In the initial visit, 846 (46.3%) patients were on lipid lowering drug treatment. On the follow-up there was a significant increase in the use of cholesterol-lowering agents, except for a decrease in the use of nicotinic acid. 65.3% of patients with vascular disease and 50.4% with diabetes achieved an LDLc level <100mg/dL. Overall, 44.7% of patients achieved the LDLc goal and the predictors in the multivariate analysis were age, waist circumference, diabetes and the presence of vascular disease. CONCLUSION Dyslipidemic patients referred to SEA lipid units have improved LDLc goal achievement after follow-up compared with data reported from previous studies in other health care settings. This improvement was associated with a substantial increase in the prescription of statins, both in monotherapy and combined with ezetimibe. There is still a wide room for improvement in the effectiveness of hypercholesterolemia treatment.
Collapse
Affiliation(s)
- Juan Pedro-Botet
- Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | | | | | | | | |
Collapse
|
22
|
Pérez de Isla L, Saltijeral Cerezo A, Vitale G, González Timón B, Torres do Rego A, Alvarez-Sala Walther LA. Cifras de colesterol adecuadas en pacientes coronarios y diabéticos. Análisis según especialidades médicas y comunidades autónomas. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
El corazón de Revista Clínica Española, 2012. Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2013.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
Barrios V, Escobar C. The heart of Revista Clínica Española, 2012. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:677-678. [PMID: 24776345 DOI: 10.1016/j.rec.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
25
|
Pérez de Isla L, Saltijeral Cerezo A, Vitale G, González Timón B, Torres do Rego A, Alvarez-Sala Walther LA. Adequate cholesterol levels in coronary heart disease and diabetic patients. Analysis according to medical specialty and autonomous communities. ACTA ACUST UNITED AC 2013; 66:748-9. [PMID: 24773686 DOI: 10.1016/j.rec.2013.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Gustavo Vitale
- Departamento Médico, Merck Sharp and Dohme, MSD, Madrid, Spain
| | | | - Ana Torres do Rego
- Unidad de Riesgo Cardiovascular y Lípidos, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Luis Antonio Alvarez-Sala Walther
- Unidad de Riesgo Cardiovascular y Lípidos, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| |
Collapse
|
26
|
Pintó X. El largo trecho para llegar a los objetivos en el tratamiento de las dislipemias. Rev Clin Esp 2012; 212:488-90. [DOI: 10.1016/j.rce.2012.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 11/29/2022]
|