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Guía Europea de Prevención Cardiovascular en la Práctica Clínica: adaptación Española del CEIPC 2008

espanolPresentamos la adaptacion espanola del Comite Espanol lnterdisciplinario para la Prevencion Cardiovascular (CEIPC) 2008 de la Guia Europea de Prevencion Cardiovascular (IV Cuarto Grupo de Trabajo Conjunto de la ESC y otras sociedades). Esta guia se centra en la prevencion de la enfermedad cardiovascular en su conjunto, incluyendo las distintas manifestaciones clinicas (coronaria, cerebrovascular, periferica y otras) y mantiene la recomendacion del modelo SCORE de bajo riesgo en la poblacion espanola para la valoracion del riesgo cardiovascular global, con un punto de corte en el 5% para definir alto riesgo. El objetivo es prevenir la mortalidad y morbilidad debidas a las ECV, mediante la prevencion y el manejo adecuado de sus factores de riesgo en la practica clinica. Se enfatiza la prevencion primaria basada en la modificacion de los habitos y estilos de vida, buscando o manteniendo el perfil de las personas sanas. Se requiere una intervencion profesional adecuada y duradera, generalmente multidisciplinar, para que la poblacion y los pacientes en riesgo incrementen su actividad fisica, sigan una alimentacion saludable y abandonen el tabaco si son fumadores. Respecto a las guias previas, se subraya el papel del medico y enfermeria de Atencion Primaria, por su proximidad y accesibilidad en los cuidados e intervenciones preventivas y en la promocion de un estilo de vida cardiosaludable. La decision de iniciar el tratamiento para reducir la presion arterial dependera de sus valores, del riesgo cardiovascular y de la existencia o no de lesiones de organos diana o ECV asociada. La meta terapeutica es, en general, PA EnglishWe are pleased to present the Spanish adaptation from the Spanish Committee for Cardiovascular Disease Prevention (CEIPC) of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (IV Joint Task Force of the European Society of Cardiology and Other Societies). This guide is focused on the prevention of cardiovascular disease (CVD) as a whole, including coronary, cerebrovascular, periphery and others, recommending the SCORE model for risk assessment with a 5% threshold for the definition of high-risk. We empathize the need of primary prevention based on lifestyle changes included stop smoking, suitable nutrition and diary physical exercise, with the focus on the health people. The objective is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. A maintained and multidisciplinary professional intervention is required in order to obtain an increase of physical activity, healthy alimentation and smoking cessation in smokers, to the general population and individuals at risk. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs or definite CVD. The treatment goal is to achieve BPThe present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

BackgroundThe successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs.MethodsA cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire.ResultsMore than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations.ConclusionsMost PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools.

Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC) on the 2012 European Cardiovascular Prevention Guidelines

Based on the two main frameworks for evaluating scientific evidence--SEC and GRADE--European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions, led by health professionals and with the participation of the patients family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions--such as smoking ban in public areas or the elimination of trans fatty acids from the food chain--are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure (BP) within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

Comentarios del Comité Español Interdisciplinario de Prevención Cardiovascular (CEIPC) a las guías europeas de prevención cardiovascular 2012

Las guias europeas de prevencion cardiovascular contemplan dos sistemas de evaluacion de la evidencia (SEC y GRADE) y recomiendan combinar las estrategias poblacional y de alto riesgo, interviniendo en todas las etapas de la vida, con la dieta como piedra angular de la prevencion. La valoracion del RCV incorpora los niveles de HDL y los factores psicosociales, una categoria de muy alto riesgo y el concepto edad-riesgo. Se recomienda el uso de metodos cognitivo-conductuales (entrevista motivadora, intervenciones psicologicas), aplicados por profesionales sanitarios, con la participacion de familiares de los pacientes, para contrarrestar el estres psicosocial y reducir el RCV mediante dietas saludables, entrenamiento fisico, abandono del tabaco y cumplimiento terapeutico. Tambien se requieren medidas de salud publica, como la prohibicion de fumar en lugares publicos o eliminar los acidos grasos trans de la cadena alimentaria. Otras novedades consisten en desestimar el tratamiento antiagregante en prevencion primaria y la recomendacion de mantener la PA dentro del rango 130-139/80-85 mmHg en pacientes diabeticos o con RCV alto. Se destaca el bajo cumplimiento terapeutico observado, porque influye en el pronostico de los pacientes y en los costes sanitarios. Para mejorar la prevencion cardiovascular se precisa una verdadera alianza entre politicos, administraciones, asociaciones cientificas y profesionales de la salud, fundaciones de salud, asociaciones de consumidores, pacientes y sus familias, que impulse las estrategias poblacional e individual, mediante el uso de toda la evidencia cientifica disponible, desde ensayos clinicos hasta estudios observacionales y modelos matematicos para evaluar intervenciones a nivel poblacional, incluyendo analisis de coste-efectividad.

Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008

Resumen Presentamos la adaptacion espanola realizada por el Comite Espanol Interdisciplinario para la Prevencion Cardiovascular (CEIPC) de la Guia Europea de Prevencion de las Enfermedades Cardiovasculares 2008. Esta guia recomienda el modelo SCORE de riesgo bajo para valorar el riesgo cardiovascular. El objetivo es prevenir la mortalidad y la morbilidad debidas a las enfermedades cardiovasculares (ECV) mediante el tratamiento de sus factores de riesgo en la practica clinica. La guia hace enfasis en la prevencion primaria y en el papel del medico y el personal de enfermeria de atencion primaria en la promocion de un estilo de vida cardiosaludable, basado en el incremento de los grados de actividad fisica, la adopcion de una alimentacion saludable y, en los fumadores, el abandono del tabaco. La meta terapeutica para la presion arterial es en general

Comentarios del Comité Español Interdisciplinario de Prevención Cardiovascular (CEIPC) a las Guías Europeas de Prevención Cardiovascular 2012

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patients family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.