Uso clínico de las estatinas y objetivos terapéuticos en relación con el riesgo cardiovascular

[The secondary prevention of ischaemic heart disease in Spain. A systematic review of observational studies]

OBJECTIVE

To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System.

DESIGN

Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD.

SETTING

Primary care and specialised out-patient clinics.

DATA SOURCES

Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge.

SELECTION OF STUDIES

A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22.

DATA EXTRACTION

One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. RESULTS. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied.

CONCLUSIONS

In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement.

[Lipid lowering goals in high risk and very high cardiovascular risk patients: a reasonable challenge?]

OBJECTIVE

The last modifications of the National Cholesterol Education Program (NCEP) indicate some lower therapeutic targets of low density protein cholesterol (LDL-c) in patients with very high vascular risk. Our study aims to establish the degree of compliance of the therapeutic targets defined by these modifications.

PATIENTS AND METHOD

Descriptive and cross sectional study of patients from a cardiovascular clinic. Low-density lipoprotein cholesterol (LDL-c) was calculated and targets were established according the new update of NCEP-ATP III.

RESULTS

836 patients, 625 (75%) with HR and 211(25%) with VHR were studied 45% of HR and 67% of VHR were receiving treatment with statins (p < 0.001) but only 38% of HR and 15% of VHR achieved target LDL-c levels. The percentage of patients who could achieve LDL-goals using the maximum approved dose of the statins plus other lipid lowering drug was calculated: The 31% of HR and 51% of VHR were unable to achieve the LDL-c targets.

CONCLUSIONS

Only 15% of very high risk patients achieve target levels of LDL-c according to the new NCEP-ATP III recommendations. Even using maximum dose of statins in combination with other lipid lowering drugs, less than half of the patients will be able to achieve LDL-c goal (< 70 mg/dl).