[Effectiveness of cardiovascular prevention in primary care]

Geostatistical analysis from the clinical laboratory in cardiovascular prevention for primary care

INTRODUCTION AND OBJECTIVES

Cardiovascular diseases continue to lead the ranking of mortality in Spain. The implementation of geostatistical analysis techniques in the clinical laboratory are innovative tools that allow the design of new strategies in primary prevention of cardiovascular disease. The aim of this study was to study the prevalence and geolocation of severe dyslipidemia in the health areas under study in order to implement prevention strategies in primary care. A retrospective cohort study of low-density protein-bound cholesterol, triglyceride and lipoprotein (a) levels in the years 2019 and 2020 were carried out. In addition, a geostatistical analysis was performed including representation in choropleth maps and the detection of clustering clusters, using geographic information in zip code format included in the demographic data of each analytic.

RESULTS

The analytical data included in the study were triglycerides (n=365,384), low density protein-bound cholesterol (n=289,594) and lipoprotein to lipoprotein (a) (n=502). Areas with the highest and lowest percentage of cases were identified for the established cut-off points of LDL-C>190mg/dL and TG>150mg/dL. Two clustering clusters with statistical significance were detected for cLDL>190mg/dL and a total of 6 clusters for TG values>150mg/dL.

CONCLUSIONS

The detection of clusters, as well as the representation of choropleth maps, can be of great help in detecting geographic areas that require greater attention to intervene and improve cardiovascular risk.

[Effectiveness of a preventive intervention strategy based on structured telephone interviews in a working population with a moderate to high cardiovascular risk]

OBJECTIVE

This study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR).

DESIGN

Quasi-experimental study of preventive intervention.

SETTING

Ibermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain.

PARTICIPANTS

A total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded.

INTERVENTION

A final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B). PRINCIPAL OUTCOMES: CUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters. Cardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level.

RESULTS

A total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers ("Blue Collar") and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases.

CONCLUSIONS

The results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed.

[Variability in the calculation of coronary risk in type-2 diabetes mellitus]

OBJECTIVE

To determine the concordance and predictive capacity of various methods for calculating coronary risk in diabetic patients.

DESIGN

Prospective study of cohorts, with a 10-year follow-up.

SETTING

Urban health centre in a socially depressed area, with high prevalence of DM2.

PARTICIPANTS

Population diagnosed with type-2 diabetes mellitus in 1991-93 (112 individuals, with an average age of 66.7+/-11.6 years, 59% of whom were male).

MAIN MEASUREMENTS

At the moment of diagnosis, the parameters normally used to calculate coronary risk were determined. The tables of the Framingham scale '91 and '98, of the United Kingdom Prospective Study (UKPDS) (based on an exclusively diabetic population) and of the REgistre GIroni del COr (REGICOR-Girona Heart Register) (based on a Mediterranean population) were each used to calculate individually coronary risk at 10 years. The coronary events suffered in the 10 years following DM2 diagnosis were recorded. The Kappa indices for concordance of the tables and their predictive capacity were calculated.

RESULTS

18.2% of men and 15.2% of women suffered some coronary event. The coronary risk calculations were, for men and women, 30%-20% (Framingham '91), 36%-21% (Framingham '98), 38%-23% (UKPDS), and 15%-10% (REGICOR).

CONCLUSIONS

The various methods for calculating coronary risk in diabetics suffer large variability. We should highlight their low diagnostic value in individual cases, with sensitivities of 25%-75% and low specificity (mainly in men) regarding real risk of coronary disease.

Riesgo cardiovascular del SCORE comparado con el de Framingham. Consecuencias del cambio propuesto por las Sociedades Europeas

BACKGROUND AND OBJECTIVE

The European Societies in their last update introduce substantial changes to calculate the cardiovascular risk without thinking about the practical consequences. The objective was to evaluate the agreement between the charts of cardiovascular risk of second and the third recommendations of the European Societies to classify the patients of high risk and to analyze its differences.

PATIENTS AND METHOD

Patients (1,227) belonging to 3 primary care centres. Risk calculated to the 10 years by means of the equation of Framingham and SCORE for countries lowers risk. A risk of Framingham > or = 20% or SCORE > or = 5% defined the high risk.

RESULTS

The patients of high risk were 8.4% according to Framingham and 5.5% according to SCORE and the coefficient Kappa 0.718. 41.7% of the patients of high risk disagreed: high risk Framingham and SCORE not (40 patients, 88.9%) and high SCORE and Framingham not (5 patients, 11.1%). The group high risk Framingham and SCORE not 1 is constituted by 95% of males, age 60 years, cholesterol 246.2 mg/dl and 37.5% smokers.

CONCLUSIONS

The chart SCORE and Framingham have an acceptable agreement, but classify from high risk different percentage of population and with different characteristics. The use of the chart of the SCORE would exclude an important group of patients with Framingham high risk.

[Calculation of coronary risk in the 35-60 year old population registered at a health centre]

OBJECTIVES

To stratify the population between 35 and 60 years old according to their coronary risk (CR) and to identify the modifiable cardiovascular risk factors that affect our population.

DESIGN

Transversal, descriptive study.

SETTING

Cabañaquinta Health Centre, in a rural health district in Asturias area VII.Participants. Simple randomised sampling based on the health cards of the population between 35 and 60 years old assigned to a health centre. Total number of people included was 205, and 95 did not reply.

MAIN MEASUREMENTS

The variables were: age, sex, total cholesterol, HDL-cholesterol, triglycerides, diastolic blood pressure, systolic blood pressure, tobacco dependency, diabetes, hypertension treatment, treatment for lipaemia, and personal background of cardiovascular disease (CVD). CR was calculated with the ATP-III tables (Adult Treatment Panel III). High CR was understood as over 20% likelihood of developing CVD or having recurrent episodes of CVD in the next 10 years.

RESULTS

A simple descriptive study was conducted. 53% were women; mean age was 48. 37% were smokers, 27% with lipaemia and 29% with hypertension. Mean systolic pressure was 126 mm Hg, mean diastolic pressure was 80 mm Hg. Cholesterol was 213 mg/dL (confidence interval [CI], 174-252), HDL-cholesterol 52.64 mg/dL (CI, 39.94-65.34), LDL-cholesterol 139 mg/dL (CI, 104-174) and triglycerides 106.02 mg/dL (CI, 19.72-192.32). 45% of the sample had two or more CV risk factors. Mean CV risk in the population was 5.3% (CI, <1%-11.3%). According to the table used, 2% of the population had high CR.

CONCLUSIONS

Most of our population had moderate risk. The most common group of patients is a young woman smoker with moderate risk. Tobacco is the most prevalent modifiable risk factor.