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[Active interventions in hypercholesteroloemia patients with high cardivascular risk in primary care]
Pedro J Tárraga López1, F J Garcia-Norro Herreros2, Loreto Tárraga Marcos3
1Profesor Asociado de Medicina. Universidad Castilla la Mancha.. pjtarraga@sescam.jccm.es.
Insights
Intensive clinical practice in primary care effectively manages hypercholesterolemia in high-risk patients, achieving therapeutic goals for cardiovascular disease prevention. This approach overcomes treatment inertia and significantly reduces LDL-C levels.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypercholesterolemia is a significant, modifiable risk factor for cardiovascular disease (CVD).
- Effective management of hypercholesterolemia reduces morbidity and mortality associated with ischemic heart disease and overall CVD.
- Primary and secondary prevention strategies are crucial for managing hypercholesterolemia.
Purpose of the Study:
- To evaluate if intensive clinical practice can overcome therapeutic inertia.
- To determine if primary care can achieve LDL-C goals (<100 mg/dL) in high-risk patients.
- To assess the effectiveness of a structured approach in managing hypercholesterolemia.
Main Methods:
- Prospective, multicenter epidemiological study.
- Inclusion of 310 high-risk cardiovascular patients (diabetic or with established CVD) previously treated with statins but not at their LDL-C goal.
- Consecutive sampling and follow-up visits to monitor treatment adherence and efficacy.
Main Results:
- Significant reduction in LDL-C from 135.6 mg/dL at baseline to 90.7 mg/dL at the final visit (p <0.0001).
- Achievement of therapeutic goals (OT) for LDL-C increased progressively: 43.57% by the 2nd visit, 62.50% by the 3rd, and 77.56% by the final visit.
- A significant increase in HDL-C levels was also observed (p = 0.013).
Conclusions:
- Reassessment and intensified treatment in primary care settings can effectively manage hypercholesterolemia in high-risk patients.
- The study achieved therapeutic goals in over three-quarters of previously uncontrolled patients within six months.
- These findings emphasize the need to overcome therapeutic inertia for early and effective control of hypercholesterolemia to prevent CVD.
Introduction:
Hypercholesterolemia is a major modifiable risk factors for cardiovascular disease (CVD). Its reduction reduces morbidity and mortality from ischemic heart disease and CVD in general, primary prevention and secondary prevention especially.
Objective:
To determine whether a notarized and intensive clinical practice can overcome inertia and achieve the therapeutic goal (OT) LDL-C <100 mg / dL in high-risk patients attended in Primary Care (PC) in our country.
Methodology:
epidemiological, prospective, multicenter study conducted in centers of different ACs By AP consecutive sampling 310 patients at high cardiovascular risk (diabetic or established CVD) previously treated with statins, which did not reach the OT included c-LDL.
Results:
The study subjects had a mean age of 65.2 years, of which 60.32% were male. The 41.64% had a previous EVC, acute myocardial infarction (20.33%), angina (16.07%), stroke / TIA (9.19%), arthropathy (5.25%), diabetes (70 , 87%), hypertension (71.01%), and abdominal obesity (69.62%). The 43.57% (95% CI: 37,21; 50,08) of patients who performed the 2nd visit (241) got the OT. 62.50% (95% CI: 55.68, 68.98) of those who took the 3rd (216) got the OT. Finally, 77.56% (95% CI: 72.13, 83.08) patients who performed the last visit (205) got the OT. Throughout the study there was a reduction in LDL-C levels from 135.6 mg / dL at baseline, 107.4 mg / dL in the 2nd visit, 97.3 mg / dL in the 3rd visit, up to 90.7 mg / dL at the final visit (p <0.0001) The increase in HDL-C from baseline (50.9 mg / dL) and final (53.6 mg / dL) was also significant (p = 0.013).
Conclusions:
The reassessment and intensification of treatment in patients at high cardiovascular risk treated in primary care, applying the indications of the guides, achieves the OT in more than three quarters of the previously uncontrolled within half a year. These results should encourage us to overcome the therapeutic inertia in the control of CVD by early and energetic performance against hypercholesterolemia.
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