Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary renal disease. There is an increased rate of cardiovascular disease (CVD) in ADPKD. In this study, we evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls. METHODS: We evaluated 2445 CKD patients (2010-2012). The information collected was: clinical, anthropometric and analytical parameters, treatments and CVD evaluation (intima-media thickness (IMT), atheromatous plaque presence and ankle-brachial index (ABI)). Laboratory, vital status, CVE and hospitalizations were collected for 4 years. RESULTS: ADPKD patients had a worse renal function and worst achievement of blood pressure, higher parathormone levels but lower proteinuria compared to CKDoe. ADPKD patients presented lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present. More than half of the patients received statins, achieving LDL-c levels < 100 only in 50 and 39.8% of them (ADPKD and CKDoe respectively). The number of CVE during the follow-up period was low. In adjusted Cox regression model, ADPDK had the lowest occurrence of CVE of all three groups (HR:0.422, 95%CI 0.221-0.808, p = 0.009). CONCLUSION: ADPKD patients show intermediate control rates of CVD. A better control of CVD risk seems to be related with a lower load of CVD compared to other groups, which may lead in the long term to a better prognosis. Further investigation is necessary to determine cardiovascular prognosis in ADPKD.

Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN / Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study

Objetivos: Conocer la prevalencia de enfermedad renal crónica (ERC) y determinar los factores asociados al deterioro de la función renal en población asistida en atención primaria.Pacientes y métodoEstudio transversal y multicéntrico realizado en los pacientes basales del estudio IBERICAN (identificación de la población española de riesgo cardiovascular y renal). Se consideró ERC a un filtrado glomerular estimado (FGe)<60ml/min/1,73m2 o albuminuria elevada (≥30mg/g). Según el FGe se clasificó la ERC en 6 estadios (1, 2, 3a, 3b, 4 y 5) y según la albuminuria en 3 (A1 o normal/ligeramente aumentada, A2 o moderadamente aumentada y A3 o gravemente aumentada). Se analizaron las características clínicas y la relación de la ERC con los principales factores de riesgo cardiovascular (FRCV) y otras variables de interés mediante regresión logística no condicional.ResultadosSe incluyeron 7.895 pacientes (edad media 57,9±14,8 años; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observó un aumento continuo de la prevalencia con la edad (24,8%≥65años) y con la agregación de FRCV. Las variables que más se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p<0,001), diabetes (OR: 1,58; p<0,001) e hipertensión (OR: 1,56; p<0,001).ConclusionesCatorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes≥65 años y aumenta exponencialmente con la agregación de FRCV. (AU)

Objectives: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC).Patients and methodCross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression.Results7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001).ConclusionsFourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV. (AU)

Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study. / Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN.

OBJECTIVES: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC). PATIENTS AND METHOD: Cross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression. RESULTS: 7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001). CONCLUSIONS: Fourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV.

Documento de consenso de la Sociedad Española de Obesidad (SEEDO) y de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) sobre la continuidad asistencial en obesidad entre Atención Primaria y Unidades Especializadas Hospitalarias 2019 / SEEDO-SEMERGEN consensus document on continuous care of obesity between Primary Care and Specialist Hospital Units 2019

La elevada prevalencia de obesidad en nuestro medio, una enfermedad crónica con un abordaje complejo y responsable de múltiples comorbilidades, nos lleva a la necesidad de implementar estrategias de coordinación en la asistencia clínica entre Atención Primaria y las Unidades Especializadas Hospitalarias. En un modelo asistencial transversal, el médico de Atención Primaria constituye el eje conductor de todo el abordaje terapéutico relacionado con la obesidad. Junto a él, el especialista en Endocrinología y Nutrición y otros profesionales sanitarios ayudan a definir una Unidad funcional centrada en la obesidad. El objetivo principal de este documento es mejorar la coordinación entre niveles asistenciales en el tratamiento de la obesidad, para optimizar recursos, evitar la creación de falsas expectativas en los pacientes y mejorar su seguimiento al alta hospitalaria

The high prevalence of obesity in our environment, a chronic disease of complex management and responsible for multiple comorbidities, requires the implementation of coordination strategies in clinical care between primary care and specialist hospital units. In a cross-sectional care model, primary care physicians guide all therapeutic management related to obesity. Together with them, specialists in endocrinology and nutrition and other health staff help to form a functional unit that focuses on obesity. The main goal of this document is to improve the coordination between care levels, to optimize resources, avoid patients' unrealistic expectations and improve patient follow-up after discharge from hospital

COVID-19 y enfermedad cardiovascular y renal: ¿dónde estamos? ¿Hacia dónde vamos? / COVID-19 and cardiovascular and kidney disease: where are we? Where are we going?

La pandemia SARS-CoV-2, es una emergencia sanitaria global y necesitamos conocer más sobre ella. Los pacientes con riesgo cardiovascular (ECV) y renal previo, se han identificado especialmente vulnerables para una mayor morbi-mortalidad cuando sufren la COVID-19; y una proporción considerable de pacientes puede desarrollar una lesión vascular en el contexto de la enfermedad que conlleva una mayor letalidad. Las complicaciones cardiovasculares y renales representan un problema y, probablemente en un futuro próximo, puedan suponer una amenaza para los pacientes que han sobrevivido a la COVID-19. Cómo médicos no podemos olvidar que durante una epidemia como esta, otras enfermedades -crónicas- siguen presentes, y los pacientes continúan precisando atención. Estamos obligados a vigilar de una forma incluso más intensa, sus tratamientos y grado de control. Además, no debemos olvidar que las situaciones urgentes siguen presentándose en esta situación de pandemia y precisando atención rápida; en esta situación actual es muy probable que muchos pacientes, por miedo, no hayan buscado atención médica. La situación durante la epidemia y la incertidumbre de la época post COVID-19, exige la intensificación en el control y seguimiento de la ECV y renal de nuestros pacientes. La atención primaria constituye un nivel asistencial clave para el cuidado de la población con ECV. Del mismo modo, y ante este nuevo escenario sanitario, necesitamos impulsar las medidas de prevención y control que emanen de los estudios actualmente en desarrollo. Ahora, más que nunca, necesitamos la investigación, crucial para mejorar el pronóstico cardiovascular y renal de nuestros pacientes

The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk (CVD) and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of CVD and kidney in our patients. Primary care constitutes a key level of care for the care of the population with CVD. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients

La educación ante el consumo de riesgo de bebidas alcohólicas: propuesta de actuación multidisciplinar desde el profesional de la salud / Education facing risk consumption of alcoholic beverages - A proposal for multidisciplinary action from the health care professionals

Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud

Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC

[Education facing risk consumption of alcoholic beverages - A proposal for interdisciplinary action from the health care professional]. / La educación ante el consumo de riesgo de bebidas alcohólicas: propuesta de actuación multidisciplinar desde el profesional de la salud.

INTRODUCTION: Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC.

INTRODUCCIÓN: Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud.

SEEDO-SEMERGEN consensus document on continuous care of obesity between Primary Care and Specialist Hospital Units 2019. / Documento de consenso de la Sociedad Española de Obesidad (SEEDO) y de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) sobre la continuidad asistencial en obesidad entre Atención Primaria y Unidades Especializadas Hospitalarias 2019.

The high prevalence of obesity in our environment, a chronic disease of complex management and responsible for multiple comorbidities, requires the implementation of coordination strategies in clinical care between primary care and specialist hospital units. In a cross-sectional care model, primary care physicians guide all therapeutic management related to obesity. Together with them, specialists in endocrinology and nutrition and other health staff help to form a functional unit that focuses on obesity. The main goal of this document is to improve the coordination between care levels, to optimize resources, avoid patients' unrealistic expectations and improve patient follow-up after discharge from hospital.

OPENCRONIC Study. Knowledge and Experiences of Spanish Patients and Carers about Chronic Disease.

Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.

Manejo perioperatorio y periprocedimiento del tratamiento antitrombótico: documento de consenso de SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT y AEU / Perioperative and periprocedural management of antithrombotic therapy: consensus document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU

En los últimos años, el número de pacientes anticoagulados y antiagregados está aumentando significativamente. Al ser un tratamiento crónico, es de esperar que a lo largo de su vida necesiten un procedimiento quirúrgico o intervencionista que pueda requerir la interrupción del fármaco antitrombótico. La decisión de retirar o mantener dicho tratamiento estará determinada, por un lado, por el riesgo trombótico y, por otro, por el hemorrágico. De la interacción entre estos 2 factores dependerá la actitud ante la anticoagulación y la antiagregación. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología y certificado por un amplio número de sociedades científicas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones prácticas y sencillas con el fin de homogeneizar la práctica clínica diaria

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice

Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.

Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular / Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease

La enfermedad cardiovascular suele estar en fase avanzada cuando aparecen los primeros síntomas. El hecho de que la presentación clínica inicial pueda ser letal o altamente incapacitante enfatiza la necesidad de la prevención primaria y secundaria. Se estima que la proporción de pacientes con buena adherencia en prevención secundaria de la enfermedad cardiovascular es baja y disminuye progresivamente en el tiempo. La Polypill para la prevención cardiovascular secundaria es el primer tratamiento combinado en dosis fija de ácido acetilsalicílico, atorvastatina y ramipril aprobada en España. El propósito de este documento de consenso fue definir y recomendar, a través de la evidencia en la literatura y la opinión clínica de expertos, el impacto de la adherencia al tratamiento de prevención cardiovascular secundaria y el uso en la práctica clínica de la Polypill integrado en una estrategia global que incluye modificaciones en el estilo de vida. Para la realización de este consenso se ha utilizado la metodología RAND/UCLA que está basada en la evidencia científica y en el juicio colectivo y experiencia clínica de un panel de expertos. Como resultado se ha elaborado un informe final de recomendaciones sobre el impacto de la falta de adherencia al tratamiento de la prevención cardiovascular secundaria y el efecto del uso de una Polypill en la adherencia terapéutica de los pacientes. Las recomendaciones de este documento se orientan a todos aquellos especialistas, cardiólogos, médicos internistas y médicos de atención primaria con competencia en la prescripción y seguimiento de los pacientes de alto y muy alto riesgo cardiovascular y que requieran prevención secundaria (AU)

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks (AU)

Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease. / Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular.

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks.

Un paso más allá en la prevención secundaria del riesgo cardiovascular. Documento de consenso del uso clínico del policomprimido / A step ahead in secondary prevention of cardiovascular risk. Consensus document on clinical use of the polypill

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La puntuación CHADS2 como predictor de riesgo de ictus en ausencia de fibrilación auricular en pacientes hipertensos de 65 o más años / The CHADS2 score to predict stroke risk in the absence of atrial fibrillation in hypertensive patients aged 65 years or older

Introducción y objetivos: La puntuación CHADS2 es una demostrada herramienta fundamental para identificar el riesgo cardioembólico, fundamentalmente el ictus, de pacientes con fibrilación auricular no valvular, con el propósito de indicar la terapia anticoagulante. El objetivo del presente estudio es analizar la utilidad de dicha puntuación para pacientes hipertensos sin fibrilación auricular conocida en una zona mediterránea. Métodos: Se incluyó a 887 pacientes hipertensos de edad ≥ 65 años, no anticoagulados y sin fibrilación auricular, que acudieron a la consulta médica. Se recogieron los principales factores de riesgo, la historia cardiovascular, el tratamiento farmacológico, una analítica básica y un electrocardiograma y se calculó la puntuación CHADS2 (insuficiencia cardiaca, hipertensión, edad ≥ 75 años, diabetes mellitus e ictus previo o accidente isquémico transitorio). Se realizó un seguimiento clínico con recogida de los ingresos hospitalarios por ictus o accidente isquémico transitorio. La mediana del seguimiento fue 804 días. Resultados: La media de edad era 72,5 ± 5,7 años, con el 46,6% de varones, el 27,8% de diabéticos y el 8,6% de fumadores. Durante el seguimiento, 40 pacientes fueron ingresados por ictus o accidente isquémico transitorio (4,5%). El análisis de supervivencia libre de eventos mostró diferencias significativas en función de la puntuación CHADS2 (log rank test, p < 0,001). En el análisis multivariable, el tabaquismo y un CHADS2 ≥ 3 fueron predictores independientes de ictus o accidente isquémico transitorio. Conclusiones: La puntuación CHADS2 puede ser una herramienta útil para identificar el riesgo de ictus o accidente isquémico transitorio de los pacientes hipertensos sin fibrilación auricular conocida (AU)

Introduction and objectives: The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population. Methods: The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients’ main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days. Results: Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack. Conclusions: The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation (AU)

Evolution of clinical profile, treatment and blood pressure control in treated hypertensive patients according to the sex from 2002 to 2010 in Spain.

OBJECTIVES: To examine the evolution of clinical profile, management of hypertension, and blood pressure (BP) control according to sex in the past decade in Spain. METHODS: Data were taken from three surveys (PRESión arterial en la población española en los Centros de Atención Primaria studies) aimed to determine BP control rates in treated hypertensive patients, who attended the primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was defined as BP lower than 140/90 mmHg for the general hypertensive population in the three surveys. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85 mmHg in the 2002 survey and lower than 130/80 mmHg in the 2006 and 2010 surveys. RESULTS: A total of 12 754 (57.2% women), 10 520 (53.7% women), and 12 961 (51.7% women) patients were included. The proportion of patients with cardiovascular disease increased from 27.1% in men and 21.9% in women in 2002, to 33.0 and 23.9%, respectively, in 2010 (P < 0.0001 in men and women, respectively). In 2002, 36.3% of men and 35.9% of women achieved BP goals (P = NS); 39.7 and 42.9% in 2006 (P < 0.001); and 44.7 and 47.9% in 2010 (P < 0.0001). The proportion of men on combined therapy increased from 44.2% in 2002 to 63.9% in 2010 (P for trend < 0.0001), and in women it increased from 43.9 and 63.2%, respectively (P for trend <0.0001). CONCLUSION: Despite the fact that clinical profile of treated hypertensive patients has worsened in the past years in Spain, BP control rates have improved, particularly in women. This improvement was related with a higher use of combined therapy, regardless of sex.

The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older.

INTRODUCTION AND OBJECTIVES: The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population. METHODS: The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients' main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days. RESULTS: Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack. CONCLUSIONS: The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation.

Evolution of therapy inertia in primary care setting in Spain during 2002-2010.

OBJECTIVE: To determine the therapeutic behavior of primary care physicians in uncontrolled hypertensive patients in Spain during the last decade. METHODS: Data were taken from three cross-sectional surveys aimed to determine the blood pressure (BP) control rates in treated hypertensive patients followed in a setting of primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was globally defined as BP lower than 140/90 mmHg for the hypertensive population in the three studies. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85 mmHg in PRESión arterial en la población Española en los Centros de Atención Primaria (PRESCAP) 2002 and lower than 130/80 mmHg in PRESCAP 2006 and 2010. RESULTS: A total of 12, 754, 10, 520, and 12, 961 patients were included in PRESCAP 2002, 2006, and 2010 studies. Of them, 36.1, 41.4, and 46.3%, respectively, achieved BP targets. In those patients with uncontrolled BP, physicians modified the treatment in 18.3, 30.4, and 41.4% of the cases, respectively (P = 0.0001). The most frequent action taken was the change to another drug in PRESCAP 2002 (47.0%), and the addition of other antihypertensive agent in PRESCAP 2006 and 2010 (46.3 and 55.6%, respectively). Predictors of therapeutic inertia were the physicians' perception of BP control, being on treatment with combined therapy, and the absence of risk factors or cardiovascular disease. CONCLUSION: Although therapeutic inertia has decreased in the last years in primary care setting in Spain, nowadays in nearly 60% of patients with uncontrolled BP, no therapeutic action is actually taken. Therefore, despite a significant improvement, therapeutic inertia still remains a relevant clinical problem in hypertension general practice.