ABSTRACT
Introducción: Las últimas guías de riesgo cardiovascular, tanto europeas como estadounidenses, establecen unos objetivos de control lipídico muy exigentes que suponen un reto terapéutico tanto para el médico como para el paciente. El objetivo de este estudio es conocer el grado de adecuación de los niveles de colesterol unido a lipoproteínas de baja densidad (cLDL) que presentan los pacientes de muy alto riesgo cardiovascular de nuestra área sanitaria con respecto a las guías de riesgo cardiovascular europeas y estadounidenses. Métodos: Se trata de un estudio observacional y retrospectivo de 446 pacientes dados de alta entre junio del 2017 y junio del 2018 con diagnóstico de síndrome coronario agudo, ictus isquémico y enfermedad arterial periférica. Hemos definido una serie de variables entre las que queremos destacar las cifras de cLDL al ingreso y su evolución tras el alta con el objetivo de conocer el grado de control lipídico acorde con las guías europeas actuales, que sitúan el umbral para considerar un control óptimo en pacientes de muy alto riesgo cardiovascular por debajo de los 55mg/dl. Resultados: Los datos revisados indican un control en el 36,6% de los pacientes según las guías de 2016 (cLDL<70mg/dl) y del 14,8% según las actuales del 2019 (cLDL<55mg/dl); de todos ellos, recibía tratamiento hipolipidemiante el 75,3%. También hemos evidenciado que el número de eventos absolutos aumenta exponencialmente en función de las cifras de cLDL, siendo más evidente en los pacientes con síndrome coronario agudo. Conclusiones: En este estudio demostramos que la adecuación de las guías de práctica clínica de riesgo vascular es insuficiente en la población de muy alto riesgo vascular, lo que está en consonancia con otros estudios publicados; harían falta más estudios para determinar las causas. Una solución para este problema podría ser la colaboración con el servicio de Medicina Interna, que se ha puesto en marcha en nuestra área sanitaria...(AU)
Introduction: The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines. Methods: This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55mg/dl. Results: The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome. Conclusions: In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.(AU)
Subject(s)
Humans , Male , Female , Peripheral Arterial Disease , Stroke , Acute Coronary Syndrome , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cholesterol, LDL , Retrospective Studies , Practice Guidelines as Topic , Risk FactorsABSTRACT
INTRODUCTION: The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines. METHODS: This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55mg/dl. RESULTS: The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome. CONCLUSIONS: In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.
