Control del riesgo cardiovascular: el bosque antes que el árbol / Cardiovascular risk control: the forest before the tree

There has been growing evidence through epidemiological and clinical studies of the importance to implement strategies for a comprehensive approach to the reduction of cardiovascular risk clustersboth in individuals and populations. Recent trials have documented the limitations and perils of prioritizing target levels of isolated risk factors over the approach to achieve them. A more inclusive strategy for cardiovascular riskcontrol has a special relevance today in view of the threat represented by the worldwide obesity epidemic.

La rehabilitación cardíaca como punto de partida en la prevención secundaria de la enfermedad coronaria / Cardiac rehabilitation as a first step in the secondary prevention of coronary heart disease

Despite that coronary heart disease is still the major cause of death in the industrialized countries and in some with emerging economies, a steady decline in the mortality for coronary heart disease has been observed in the last 30 years. This has been attributed predominantly to a reduction in smoking and in the cholesterol blood levels, two of the major risks factors for coronary heart disease. Cardiac rehabilitation programs represent today one of the most cost effective interventions to reduce the morbidity and mortality after a coronary event. They offer a unique opportunity to guide a patient immediately after an acute coronary episode through the inpatient care to the outpatient environment. In these programs a strong emphasis is made in the educational aspects of secondary prevention of coronary heart disease as well as in motivating patients to achieve life long lasting behavioral changes impacting on the major risk factors (smoking cessation, regular exercise, weight control, etc). The current subutilization of the Cardiac Rehabilitation Programs appears to be related to a variety of factors that include, among others, financial restraints and cultural values and perceptions with reference to health care