Juan Pedro-Botet Montoya

Dislipidemias: un reto pendiente en prevención cardiovascular. Documento de consenso CEIPC/SEA

In Spain, where cardiovascular disease (CVD) is the leading cause of death, hypercholesterolemia, one of the most prevalent risk factors in adults, is poorly controlled. Dyslipidemia should not be approached in isolation, but in the context of overall cardiovascular risk (CVR). Measurement of CVR facilitates decision making, but should not be the only tool nor should it take the place of clinical judgment, given the limitations of the available calculation methods. This document, prepared by the Interdisciplinary Spanish Committee on Cardiovascular Prevention, at the proposal of the Spanish Society of Arteriosclerosis, reviews the cardiovascular prevention activities of the regional health authorities, scientific societies and medical professionals. An initiation of a national strategy on cardiovascular prevention is proposed based on lifestyle modification (healthy diet, physical activity and smoking cessation) through actions in different settings. At the population level, regulation of food advertising, elimination of trans fats and reduction of added sugar are feasible and cost-effective interventions to help control dyslipidemias and reduce CVR. In the health setting, it is proposed to facilitate the application of guidelines, improve training for medical professionals, and include CVR assessment among the quality indicators. Scientific societies should collaborate with the health authorities and contribute to the generation and transmission of knowledge. Finally, it is in the hands of professionals to apply the concept of CVR, promote healthy lifestyles, and make efficient use of available pharmacological treatments.

Estudio REALIST (REsiduAl risk, LIpids and Standard Therapies): Un análisis del Riesgo Residual dependiente del perfil lipídico en el síndrome coronario agudo

The R3i Foundation (Residual Risk Reduction Initiative), an independent, multinational and academic organization, is conducting the REALIST (Residual Risk, Lipids and Standard Therapies) study in 40 centers in different countries. This is a retrospective epidemiological study, designed to provide new data on the residual risk of major coronary events attributable to lipid abnormalities in patients receiving the current standard treatment. The initial results are expected in mid 2010, and the overall results at the end of 2010.

[The REALIST (REsiduAl risk, LIpids and Standard Therapies) study: an analysis of residual risk attributable to lipid profile in acute coronary syndrome].

The R3i Foundation (Residual Risk Reduction Initiative), an independent, multinational and academic organization, is conducting the REALIST (Residual Risk, Lipids and Standard Therapies) study in 40 centers in different countries. This is a retrospective epidemiological study, designed to provide new data on the residual risk of major coronary events attributable to lipid abnormalities in patients receiving the current standard treatment. The initial results are expected in mid 2010, and the overall results at the end of 2010.

Mejorar la salud cardiovascular: estamos obligados a no perder impulso

En los últimos años hemos asistido a un gran avance en la batalla contra la enfermedad cardiovascular, debido en parte al control de los distintos factores de riesgo modificables. En este contexto, ocupa un lugar destacado la terapia hipolipidemiante con fármacos eficaces y seguros. Las abundantes evidencias científicas al respecto quedan recogidas en las distintas y numerosas guías de práctica clínica, documentos y consensos nacionales o internacionales, algunos de los cuales son de amplia difusión y seguimiento en nuestro medio. En cierta medida, «señalan el camino» basado en las mayores y mejores evidencias, y de ahí la responsabilidad asumible en su formulación y en su aplicación. El objetivo fundamental de una guía de práctica clínica es, incluyendo un «estado de la cuestión» y considerando las evidencias, formular recomendaciones buscando un «modelo» que sea fácil de explicar: sin contradicciones, fácil de entender, organizado de manera lógica y focalizando el interés científico, y fácil de aplicar, porque el objetivo último es ofrecer un instrumento sencillo pero simple para la práctica clínica diaria. En la actualidad, las guías de práctica clínica se han convertido en un instrumento fundamental en nuestra actividad asistencial, ya que facilitan la toma de decisiones clínicas a los profesionales de la salud. Pero elaborar un documento de esta índole tiene algunos riesgos. Al pretender formular mensajes sencillos y asumibles que aporten una cierta novedad, pueden aparecer documentos que a veces con argumentos incompletos cuando no sesgados

La diabetogenicidad de las estatinas

Statins are the cornerstone of cardiovascular prevention for general population, and in patients with type 2 diabetes mellitus (T2DM). However, statin therapy predisposes to type 2 diabetes, particularly in patients with predisposition to this condition. Some statins have been associated with increases in blood glucose in patients with or without DM2, and others have shown to have neutral effects, varying from one another their glucose or diabetogenic capacity. In many statin trials the incidence of DM2 has not been systematically evaluated and others the power to detect differences between statins is lacking. Evidence highest quality available comes from the meta-analysis of controlled clinical trials. The only controlled clinical trial to evaluate the incidence of new-onset T2DM is the J-PREDICT conducted with pitavastatin in patients with abnormal glucose tolerance. Preliminary results of this study show that pitavastatin is associated with a significant decrease in the incidence of de novo T2DM compared to only modification lifestyle. Therefore, pitavastatin may be an appropriate therapeutic alternative of choice to reduce vascular risk in patients with T2DM or at risk of presenting it.