[Randomised clinical trial of an intensive intervention into life-styles of patients with hyperfibrinogenaemia in primary prevention of cardiovascular pathology in primary health care]. / Ensayo clínico aleatorizado de una intervención intensiva sobre los estilos de vida de pacientes con hiperfibrinogenemia en prevención primaria de las enfermedades cardiovasculares en el ámbito de la atención primaria de salud.

OBJECTIVES: To study the effect of an intensive programme to modify life-style on levels of plasma fibrinogen in patients without cardiovascular pathology, with high fibrinogen and normal cholesterol levels. To analyse whether the effect on fibrinogen is independent, or otherwise, of the effect on lipids. DESIGN: Randomised clinical trial with a control. SETTING: 11 health districts in L'Hospitalet de Llobregat and Barcelona. PARTICIPANTS: 436 patients will be included, 218 individuals between 35 and 75 years old in each group, and without cardiovascular pathology (ischaemic cardiopathy, cerebral vascular accident or peripheral arteriopathy), with hyperfibrinogenaemia (fibrinogen > 300 mg/dL) and with plasma control < 250 mg/dL. INTERVENTIONS: One group of patients will receive an intensive intervention (in frequency and intensity of counselling and treatment) for life-style changes, i.e. stopping smoking, low-calorie diet in case of overweight or obesity, and physical exercise. The follow-up of the intervention group will be every 2 months. The control group will follow customary treatments. MEASUREMENTS: Levels of plasma fibrinogen. In addition, other relevant events will be recorded over a 2-year monitoring period: modification of risk factors, changes in quality of life, cardiovascular events or death. DISCUSSION: The introduction of an intensive primary prevention intervention (life-style changes) in patients with hyperfibrinogenaemia could be a more effective measure than the habitual intervention for reducing plasma fibrinogen figures. In addition, these measures could be translated into a reduction of cardiovascular risk and an improvement in the patient s quality of life.

Ensayo clínico aleatorizado de una intervención intensiva sobre los estilos de vida de pacientes con hiperfibrinogenemia en prevención primaria de las enfermedades cardiovasculares en el ámbito de la atención primaria de salud / Randomised clinical trial of an intensive intervention into life-styles of patients with hyperfibrinogenaemia in primary prevention of cardiovascular pathology in primary health care

Objetivos. Estudiar el efecto de un programa intensivo de modificación del estilo de vida en los valores de fibrinógeno plasmático en pacientes sin enfermedad cardiovascular, con fibrinógeno elevado y valores normales de colesterol. Analizar si el efecto sobre el fibrinógeno es independiente del efecto sobre los lípidos. Diseño. Ensayo clínico controlado y aleatorizado. Emplazamiento. Once áreas básicas de L’Hospitalet de Llobregat y Barcelona. Participantes . Se incluirá a 436 pacientes,218 en cada grupo, de 35-75 años, sin enfermedad cardiovascular (cardiopatía isquémica, accidente cerebrovascular y arteriopatía periférica) con hiperfibrinogenemia (fibrinógeno > 300mg/dl) y colesterol plasmático < 250 mg/dl. Intervenciones. Un grupo de pacientes recibirá una intervención intensiva (en frecuencia e intensidad del consejo y tratamiento) sobre cambios de estilo de vida: dejar de fumar, dieta hipocalórica encaso de sobrepeso u obesidad y ejercicio físico. El seguimento del grupo intervención se realizará cada 2 meses. El grupo control seguirá los cuidados habituales. Mediciones. Se determinarán los valores de fibrinógeno plasmático. Además, se registrarán otros acontecimientos de interés(modificación de los factores de riesgo, cambios en la calidad de vida, acontecimientos cardiovasculares y muerte)durante un seguimiento de 2 años. Discusión. La instauración de una intervención intensiva de prevención primaria (cambios de estilo de vida) en los pacientes que presentan hiperfibrinogenemia podría ser una medida más eficaz que la intervención habitual para reducir las cifras de fibrinógeno plasmático. Además, estas medidas podrían traducirse en una disminución del riesgo cardiovascular y en una mejora de la calidad de vida del paciente

Objectives. To study the effect of an intensive programme to modify life-style on levels of plasma fibrinogen in patients without cardiovascular pathology, with high fibrinogen and normal cholesterol levels. To analyse whether the effect on fibrinogen is independent, or otherwise, of the effect on lipids. Design. Randomised clinical trial with a control. Setting. 11 health districts in L’Hospitalet deLlobregat and Barcelona. Participants. 436 patients will be included, 218individuals between 35 and 75 years old in each group, and without cardiovascular pathology(ischaemic cardiopathy, cerebral vascular accident or peripheral arteriopathy), with hyperfibrinogenaemia(fibrinogen › 300 mg/dL) and with plasma control‹250 mg/dL. Interventions. One group of patients will receive an intensive intervention (in frequency and intensity of counselling and treatment) for life-style changes, i.e. stopping smoking, low-calorie diet incase of overweight or obesity, and physical exercise. The follow-up of the intervention group will be every 2 months. The control group will follow customary treatments. Measurements. Levels of plasma fibrinogen. In addition, other relevant events will be recorded over a 2-year monitoring period: modification of risk factors, changes in quality of life, cardiovascular events or death. Discussion. The introduction of an intensive primary prevention intervention (life-style changes) in patients with hyperfibrinogenaemia could be a more effective measure than the habitual intervention for reducing plasma fibrinogen figures. In addition, these measures could be translated into a reduction of cardiovascular risk and an improvement in the patient´s quality of life

[Do the patients we treat with hypolipemic drugs have a coronary risk?]. / Tienen riesgo coronario los pacientes que tratamos con fármacos hipolipemiantes?

OBJECTIVE: To study the appropriateness of lipid-lowering drugs treatment through four methods of calculating coronary risk (CR). DESIGN: Crossover study. SETTING: Primary care centre. PATIENTS: All patients receiving lipid-lowering drugs. MEASUREMENTS AND MAIN RESULTS: CR was determined for individuals with application criteria by four methods: the simplified Framingham, Dundee-Risk-Disk, modified Sheffield label and Cardiovascular Risk in Primary Care (CVRap). 330 patients followed the treatment, 137 men and 193 women with an average age of 58.8 (SD 10.2). 54.2% received statims, 28.5% clofibrates, 13.6% resins and 3.6% other drugs. 186 patients were included, 75 (22.7%) being excluded because of secondary prevention and the rest because they were not the right age or had no cholesterol data prior to treatment. 38.3% were at high CR according to Framingham, 25.6% according to CVRap, 18.7% according to Dundee-Risk-Disk and 16% according to modified Sheffield. Concordance between these methods was adequate. CONCLUSIONS: Between 16% and 38.3% of the individuals treated are at high CR. If we also include patients with severe Hypercholesterolaemia and diabetics with Hypercholesterolaemia, this percentage rises to 59.7-73.3%, according to the CR assessment method used.