Pedro Conthe

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.

Adaptación española de la Guía Europea de Prevención Cardivascular

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP <140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity, drugs being administered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.

Target organ damage and cardiovascular complications in patients with hypertension and type 2 diabetes in Spain: a cross-sectional study

BackgroundTarget organ damage (mainly cardiac and renal damage) is easy to evaluate in outpatient clinics and offers valuable information about patients cardiovascular risk. The purpose of this study was to evaluate, using simple methods, the prevalence of cardiac and renal damage and its relationship to the presence of established cardiovascular disease (CVD), in patients with hypertension (HT) and type 2 diabetes mellitus (DM).MethodsThe RICARHD study is a multicentre, cross-sectional study made by 293 investigators in Nephrology and Internal Medicine Spanish outpatient clinics, and included patients aged 55 years or more with HT and type 2 DM with more than six months of diagnosis. Demographic, clinical and biochemical data, and CVD were collected from the clinical records. Cardiac damage was defined by the presence of electrocardiographic left ventricular hypertrophy (ECG-LVH), and renal damage by a calculated glomerular filtration rate (GFR) of <60 ml/min/1.73 m2, and/or the presence of an albumin/creatinine ratio ≥ 30 mg/g; or an urinary albumin excretion (UAE) ≥ 30 mg/24 hours.Results2339 patients (mean age 68.9 years, 48.2% females, 51.3% with established CVD) were included. ECG-LVH was present in 22.9% of the sample, GFR <60 ml/min/1.73 m2 in 45.1%, and abnormal UAE in 58.7%. Compared with the reference patients (those without neither cardiac nor renal damage), patients with ECG-LVH alone (OR 2.20, [95%CI 1.43–3.38]), or kidney damage alone (OR 1.41, [1.13–1.75]) showed an increased prevalence of CVD. The presence of both ECG-LVH and renal damage was associated with the higher prevalence (OR 3.12, [2.33–4.19]). After stratifying by gender, this relationship was present for both, men and women.ConclusionIn patients with HT and type 2 DM, ECG-LVH or renal damage, evaluated using simple methods, are associated with an increased prevalence of established CVD. The simultaneous presence of both cardiac and renal damage was associated to the higher prevalence of CVD, affording complementary information. A systematic assessment of cardiac and renal damage complements the risk assessment of these patients with HT and type 2 DM.

Mechanisms of the association between depressive symptoms and long-term mortality in heart failure.

BACKGROUND The long-term prognostic influence of depression on patients hospitalized for heart failure (HF) is unknown. No previous study has examined systematically the mechanisms of the relationship between depression and mortality in HF. METHODS Prospective study of 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals. Baseline depressive symptoms were assessed with the 10-item Geriatric Depression Scale (GDS). The association between depressive symptoms and mortality was summarized with hazard ratios (HRs) obtained from Cox regression, with sequential adjustment for possible mechanisms of the association. RESULTS Of the 433 study participants, 103 (23.8%) had major depression (GDS-10 > or =5) at baseline. During a mean follow-up of 5.7 years, 305 deaths (70%) occurred. Compared with those who were not depressed, subjects with major depression showed higher mortality (age and sex-adjusted HR 1.52, 95% CI 1.15-2.01). Subsequent adjustment for comorbidity reduced the HR to 1.45 (95% CI 1.10-1.93). Additional adjustment for severity of cardiac lesion and for lifestyles, foremost physical inactivity, led to a HR of 1.27 (95% CI 0.95-1.70). After further adjustment for pharmacologic treatment of HF and particularly for disability in instrumental activities of daily living, the HR dropped almost to the null value (HR 1.10, 95% CI 0.82-1.49). CONCLUSIONS Depressive symptoms in patients hospitalized for HF are associated with higher long-term mortality; this association is largely explained by the frequent comorbidity, physical inactivity, and disability of these patients.

Prevalence of Depression and Associated Medical and Psychosocial Factors in Elderly Hospitalized Patients With Heart Failure in Spain

INTRODUCTION AND OBJECTIVES This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. METHODS The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. RESULTS In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). CONCLUSIONS Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España

Introduccion y objetivos En este trabajo se estima la prevalencia de depresion y se identifican los factores biomedicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en Espana. Metodos Se estudio a 433 pacientes ≥ 65 anos ingresados de urgencia en 4 hospitales espanoles desde enero de 2000 hasta junio de 2001, con diagnostico principal o secundario de insuficiencia cardiaca. Se considero que habia depresion ante la presencia de 3 sintomas en la Escala de Depresion Geriatrica de 10 items. Resultados Del total de pacientes estudiados, 210 (48,5%) presentaron depresion. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresion fue mas frecuente en los pacientes con las siguientes caracteristicas: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuacion en los aspectos fisicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades basicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o mas ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitacion en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28-3,79); hospitalizacion previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa mas de 2 h al dia (ORa = 3,24; IC del 95%, 1,93-5,45); menor satisfaccion con el medico de atencion primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones La depresion es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomedicos y psicosociales. Esta elevada frecuencia, el peor pronostico de la insuficiencia cardiaca en presencia de sintomas depresivos y la existencia de instrumentos diagnosticos sencillos y un tratamiento eficaz apoyan el cribado sistematico de la depression en estos pacientes.

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

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

Housing conditions and mortality in older patients hospitalized for heart failure

BACKGROUND Although decent housing is recognized as a prerequisite for good health, very few studies in developed countries have examined the influence of housing characteristics on disease prognosis. This work examined whether housing conditions predict mortality in older adults with heart failure (HF). METHODS This is a cohort study comprising 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001. At baseline, patients reported whether their homes lacked an elevator (in an apartment building), hot water, heating, an indoor bathroom, a bathtub or shower, individual bedroom, automatic washing machine, and telephone and whether they frequently felt cold. Analyses included all-cause deaths identified prospectively until January 1, 2005. RESULTS Among study participants, 165 (38.1%) lived in a home without one of the services considered; and 111 (25.6%) lacked ≥2 services. During follow-up, 260 deaths (60%) occurred. After adjustment for the main confounders, mortality was higher in those who lived in homes without an elevator (hazard ratio [HR] 1.39, 95% CI 1.07-1.80) and in those who frequently felt cold (HR 1.39, 95% CI 1.01-1.92). In comparison with living in a home with all the services considered, mortality was higher for persons living in a home lacking 1 service (HR 1.42, 95% CI 1.10-1.93) or ≥2 services (HR 1.94, 95% CI 1.37-2.74). Patients living in homes lacking any of the services more often had poor functional status, higher comorbidity, lower educational level, and less income. CONCLUSION Poor housing conditions are associated with higher mortality in HF. Patients living in these homes are especially vulnerable because they have poorer clinical situation and lower socioeconomic position.

El autocuidado y el conocimiento del manejo de la enfermedad predicen la rehospitalización en ancianos con insuficiencia cardiaca

Introduccion Este trabajo examino la asociacion del autocuidado y del conocimiento de los pacientes acerca del autocuidado con la rehospitalizacion en adultos mayores con insuficiencia cardiaca (IC). Metodos Analisis de casos y controles (116 casos y209 controles) alojado en una cohorte prospective de pacientes de 65 y mas anos de edad ingresados por IC en 4 hospitales espanoles. Los casos eran pacientes rehospitalizados de urgencia en los 6 meses siguientes a la hospitalizacion indice. Los controles fueron pacientes que no se rehospitalizaron durante esos 6 meses. Resultados El numero de actividades de autocuidado se asocio de forma inversa con la frecuencia de reingreso (p tendencia lineal: 0,006). En comparacion con los pacientes que realizaron el autocuidado apropiado, el reingreso hospitalario fue mas frecuente entre los que no paseaban ni realizaban actividad fisica a diario (hazard ratio [HR] 1,55; limites de confianza [LC] 95% 1,04-2,29), y entre los que se saltaban la visita al medico en la fecha programada (HR 1,82; LC 95% 1,10-3,02). El reingreso hospitalario tambien fue mas frecuente entre los pacientes que no tomaban la medicacion a su hora (HR 2,07; LC 95% 1,15-3,72), los que dejaban de tomarla cuando les sentaba mal (HR 1,76; LC 95% 1,08-2,85), y los que no mostraron adherencia al tratamiento farmacologico (HR 1,96; LC 95% 1,29-2,98). Ademas, a menor numero de actividades de manejo de la IC que se conocia que debian realizarse, mayor fue la frecuencia de rehospitalizacion (p tendencia lineal: 0,029). Conclusion A menor autocuidado y menor conocimiento del manejo de la IC, mayor riesgo de reingreso hospitalario.

Colesterol HDL y enfermedad cardiovascular en una población con hipertensión y diabetes mellitus tipo 2. Estudio RICARHD

Evaluar la prevalencia del colesterol HDL (c-HDL) bajo y su asociacion con la presencia de enfermedad cardiovascular (ECV) en pacientes con diabetes mellitus (DM) tipo 2 e hipertension arterial atendidos en consultas de medicina interna y nefrologia. Metodos. Estudio transversal multicentrico, realizado en diabeticos hipertensos de 55 anos o mas. Los datos demograficos, clinicos y bioquimicos se recogieron de las historias clinicas. Se definio el c-HDL bajo como inferior a 40 mg/dl (varones) e inferior a 46 mg/dl (mujeres). Se valoro la asociacion entre c-HDL bajo y ECV mediante modelos de regresion logistica. Resultados. En 2.021 pacientes (edad media 68,6 anos; 48,9% mujeres; 51,1% con ECV establecida), la prevalencia de c-HDL bajo fue del 33,7% (intervalo de confianza [IC] 95%: 31,5-35,7), mayor en mujeres (38,0%) que en varones (29,6%, p < 0,001) y mayor en los pacientes con ECV (37,3% frente a 29,9% en sujetos sin ECV, p = 0,001). En un analisis multivariante que incluyo los factores de riesgo cardiovascular se observo una asociacion independiente entre c-HDL bajo y ECV (odds ratio [OR] para ECV en sujetos con c-HDL bajo: 1,46 [1,19-1,79; p < 0,001], respecto a sujetos con c-HDL normal). Un segundo modelo ajustado, ademas, por la hipertrofia ventricular izquierda y el dano renal mostro una asociacion similar (OR 1,55 [1,21-2,00], p = 0,001). La magnitud de la asociacion fue superior en la mujer que en el hombre. Conclusiones. Uno de cada tres diabeticos hipertensos atendidos en consultas de medicina interna y nefrologia presento una concentracion baja de c-HDL. La concentracion baja de c-HDL se asocio, de forma independiente, a una mayor prevalencia de ECV.