Almudena Castro Conde

EUROASPIRE IV : a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries

Aims To determine whether the Joint European Societies guidelines on cardiovascular prevention are being followed in everyday clinical practice of secondary prevention and to describe the lifestyle, risk factor and therapeutic management of coronary patients across Europe. Methods and results EUROASPIRE IV was a cross-sectional study undertaken at 78 centres from 24 European countries. Patients <80 years with coronary disease who had coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome were identified from hospital records and interviewed and examined ≥ 6 months later. A total of 16,426 medical records were reviewed and 7998 patients (24.4% females) interviewed. At interview, 16.0% of patients smoked cigarettes, and 48.6% of those smoking at the time of the event were persistent smokers. Little or no physical activity was reported by 59.9%; 37.6% were obese (BMI ≥ 30 kg/m2) and 58.2% centrally obese (waist circumference ≥ 102 cm in men or ≥88 cm in women); 42.7% had blood pressure ≥ 140/90 mmHg (≥140/80 in people with diabetes); 80.5% had low-density lipoprotein cholesterol ≥ 1.8 mmol/l and 26.8% reported having diabetes. Cardioprotective medication was: anti-platelets 93.8%; beta-blockers 82.6%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75.1%; and statins 85.7%. Of the patients 50.7% were advised to participate in a cardiac rehabilitation programme and 81.3% of those advised attended at least one-half of the sessions. Conclusion A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes. Risk factor control is inadequate despite high reported use of medications and there are large variations in secondary prevention practice between centres. Less than one-half of the coronary patients access cardiac prevention and rehabilitation programmes. All coronary and vascular patients require a modern preventive cardiology programme, appropriately adapted to medical and cultural settings in each country, to achieve healthier lifestyles, better risk factor control and adherence with cardioprotective medications.

Challenges in Oral Lipid-lowering Therapy: Position Document of the Spanish Society of Cardiology

Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups.

Vascular Risk and Cardiac Rehabilitation 2015: A Selection of Topical Issues.

Almudena Castro Conde*, Domingo Marzal Martin, Regina Dalmau Gonzalez-Gallarza, Vicente Arrarte Esteban, Miren Morillas Bueno, Xavier Garcia-Moll Marimon, Alejandro Berenguel Senen, Nekane Murga y Manuel Abeytua a Servicio de Cardiologia, Unidad de Rehabilitacion Cardiaca, Hospital Universitario La Paz, Madrid, Espana b Servicio de Cardiologia, Complejo Hospitalario de Merida, Merida, Badajoz, Espana c Servicio de Cardiologia, Hospital Universitario La Paz, Madrid, Espana Unidad de Rehabilitacion Cardiaca, Hospital General Universitario de Alicante, Alicante, Espana e Servicio de Cardiologia, Hospital Osakidetza, Barakaldo, Vizcaya, Espana f Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Espana g Servicio de Cardiologia, Complejo Hospitalario de Toledo, Toledo, Espana h Servicio de Cardiologia, Seccion de Cardiologia Clinica, Hospital de Basurto, Bilbao, Vizcaya, Espana i Servicio de Cardiologia, Unidad de Rehabilitacion Cardiaca, Hospital General Universitario Gregorio Maranon, Madrid, Espana

Guías de tratamiento

El tratamiento de la angina cronica estable esta reflejado en las guias de la Sociedad Europea de Cardiologia, aceptadas por la Sociedad Espanola de Cardiologia, e incluye el uso razonable de terapia medica y revascularizacion miocardica. De acuerdo con las guias, todos los pacientes deben recibir los consejos y la medicacion adecuados para la prevencion secundaria de la cardiopatia isquemica, asi como medicacion para controlar la isquemia. Se puede identificar facilmente a los enfermos en alto riesgo empleando escalas de riesgo clinicas sencillas. Una estratificacion adicional del riesgo puede incluir pruebas de deteccion de isquemia cuando el paciente recibe el tratamiento medico adecuado y angiografia coronaria. Los factores relacionados con mayor riesgo incluyen edad, gravedad de la isquemia, funcion ventricular, persistencia de la isquemia con el tratamiento medico optimo y comorbilidades. El tratamiento medico para controlar la isquemia incluye bloqueadores beta, antagonistas del calcio, nitratos, inhibidores de los canales de potasio, inhibidores de la corriente If e inhibidores de la corriente lenta del sodio. Todavia se considera que los bloqueadores beta son la primera opcion terapeutica, aunque la informacion obtenida en ensayos clinicos contemporaneos indica un beneficio a favor del empleo de los nuevos farmacos antiisquemicos en un grupo amplio de pacientes y tendra impacto en las proximas ediciones de guias de practica clinica. La revascularizacion es actualmente objeto de controversia, con nueva informacion procedente de estudios recientes que influiran en las estrategias de tratamiento, pero la revascularizacion miocardica aun debe considerarse en pacientes con isquemia no controlada a pesar del tratamiento medico optimo, asi como en pacientes en alto riesgo con lesiones adecuadas para revascularizacion

Comments on the 2016 ESC/EAS Guidelines for the Management of Dyslipidemias☆

In the present article, we discuss the recently published guidelines for the treatment of dyslipidemia developed by the European Society of Cardiology (ESC) in conjunction with the European Atherosclerosis Society and with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation.1 To comment on these guidelines, the Guidelines Committee formed a task force composed of members of the Spanish Society of Cardiology (SEC). Thus, following the same order as the guidelines, the current article reviews the most important aspects of the various sections.

Clinical outcomes in myocardial infarction and multivessel disease after a cardiac rehabilitation programme: Partial versus complete revascularization

BACKGROUND Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI. AIM To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme. METHODS We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups. RESULTS Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years; P=0.02), diabetes mellitus prevalence (34.3% vs. 20.1%; P=0.01) and number of arteries with stenosis (2.6 vs. 2.3; P=0.001). During the mean follow-up of 48.0±25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19-1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62-3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk. CONCLUSIONS There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation.