Prevención secundaria de la cardiopatía isquémica en la provincia de Ciudad Real. Efectividad de la terapéutica hipolipemiante en atención primaria
Secondary prevention of ischemic heart disease in the Ciudad Real province, Spain. Effectiveness of lipid-lowering therapy in primary health care
Grupo de Investigacion del estudio Elipse *
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"documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Clin. 2000;115:326-31" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2307 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 2069 "PDF" => 231 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Prevalencia de fractura vertebral en población asturiana mayor de 50 años de acuerdo con diferentes criterios radiológicos" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "326" "paginaFinal" => "331" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prevalence of vertebral fracture in population older than 50 years In Asturias (Spain) defined following different radiological criteria" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Bernardino Díaz López, Manuel Naves Díaz, Carlos Gómez Alonso, José Luis Fernández Martín, Ana Rodríguez Rebollar, Jorge B. Cannata Andía" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Bernardino Díaz López" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Naves Díaz" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Gómez Alonso" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Luis Fernández Martín" ] 4 => array:2 [ "nombre" => "Ana" "apellidos" => "Rodríguez Rebollar" ] 5 => array:2 [ "nombre" => "Jorge B." "apellidos" => "Cannata Andía" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775300715478?idApp=UINPBA00004N" "url" => "/00257753/0000011500000009/v1_201307291648/S0025775300715478/v1_201307291648/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "Prevención secundaria de la cardiopatía isquémica en la provincia de Ciudad Real. Efectividad de la terapéutica hipolipemiante en atención primaria" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "325" ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:2 [ "colaborador" => "Grupo de Investigacion del estudio Elipse" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "fn0005" ] ] ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Secondary prevention of ischemic heart disease in the Ciudad Real province, Spain. Effectiveness of lipid-lowering therapy in primary health care" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-02-29" "fechaAceptado" => "2000-07-04" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec222518" "palabras" => array:4 [ 0 => "Prevención secundaria" 1 => "Cardiopatía isquémica" 2 => "Terapéutica hipolipemiante" 3 => "Atención primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La eficacia de la terapéutica hipolipemiante en la cardiopatia isquémica está bien establecida. Existen dudas sobre su efectividad en atención primaria, donde se desarrolla el control de esta enfermedad a largo plazo y son difíciles de reproducir las condiciones de los ensayos clínicos.</p> <span class="elsevierStyleSectionTitle">Métodosm</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo, transversal y multicéntrico. Se diseñó para averiguar el grado de control lipidémico en pacientes con cardiopatía isquémica de más de un año de evolución, en atención primaria de nuestro medio geográfico. Para analizar el impacto de la terapéutica hipolipemiante, se utilizaron las concentraciones de colesterol total (Ct), colesterol-LDL (LDL), triglicéridos (Tg), colesterol-HDL (HDL) y Ct/HDL. Se recogieron 205 enfermos por 14 médicos de diversos centros de atención primaria.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los valores medios obtenidos (Ct: 218 mg/dl; LDL: 151 mg/dl; Tg: 136 mg/dl; HDL: 49 mg/dl, y Ct/HDL: 4,8) estuvieron lejos de las directrices internacionales. Los objetivos idóneos (LDL < 100 mg/dl) y aceptable (LDL < 130 mg/dl) se alcanzaron en el 9 y el 30%. El HDL no se determinó en el 26,4% de los pacientes. Existió discreta mejoría del perfil de riesgo en la mujer, por concentraciones más elevadas de HDL (54,4 frente a 46,9 mg/dl en el varón; p = 0,0002). Sólo 98 enfermos (45,85%) recibieron terapéutica hipolipemiante, cuando el 70% presentó LDL > 130 mg/dl. Las dosis de hipolipemiantes fueron insuficientes y apenas se utilizó la combinación de fármacos (2,7%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevención secundaria hipolipemiante en atención primaria fue incorrecta, con una gran laguna entre la eficacia de la terapéutica hipolipemiante y la efectividad real. La mayoría de los pacientes (75-80%) no consiguió concentraciones lipidémicas aceptables. En un cuarto de los sujetos nunca existió un objetivo terapéutico definido, al desconocerse los valores de HDL y, por tanto, los de LDL. No se utilizaron dosis adecuadas de fármacos, ni combinaciones para lograr objetivos lipidémicos preventivos.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The efficacy of lipid-lowering therapy (LLT) in ischemic heart disease (IHD) is well established. But there are some doubts about its effectiveness on Primary Health Care (PHC) where we develop the long-term control of this sickness and it is difficult to reproduce the terms of the clinical trials.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicenter cross-sectional study designed to evaluate the control of dyslipidemia achieved in patients with IHD diagnosed more than a year ago in our geografic primary health care system. The total cholesterol (tC), LDL, triglyceride, HDL levels and tC/HDL were determined to analyze the impact of LLT. 205 patients were collected by 14 general practitioners in several PHC centers.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The average lipid profiles recorded (tC: 218 mg/dl; LDL: 151 mg/dl; triglyceride: 136 mg/dl; HDL: 49 mg/dl, and tC/HDL: 4,8) were far to the recommended by the international guidelines. The ideal (LDL < 100 mg/dl) and the acceptable targets (LDL < 130) were achieved by 9 and 30%. The HDL was not assess in 26.4% of the patients. It had had slight improvement of the women profile risk by more elevated values of HDLc than men (54.4 mg/dl vs. 46.9 mg/dl; p = 0.0002). Only 98 patients (45.85%) receive LLT, while 70% presented LDL > 130 mg/dl. The average dosis of hypolipidemiants was small and the combination therapy had been scanty used (2.7%).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The hypolipidemic secondary prevention was incorrect, with a big gap between the efficacy of the LLT and the actual effectiveness. In the mayority of cases (75-80%) the values exceeded the secondary prevention targets. In a quarter of patients had never existed a clearly defined therapeutic target because the levels of HDL and LDL were not assessed. It was not prescribed neither fitting drug doses nor combinations to reach lipidemic preventive levels.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Forman el Grupo de Investigacion del estudio ELIPSE: Ballesteros Villar, Joaquin (CS Puertollano I); Cristobal Rodriguez, Fco. Javier (CS Alcazar de San Juan); Del Burgo Fernandez, Jose Luis (CS Porzuna); Dominguez Sanchez-Mingallon, Pedro (CS Manzanares); Galiana Gomez del Pulgar, Jesus (Complejo Hospitalario de Ciudad Real. Servicio de Medicina Interna. Unidad de Lipidos); Garcia Garcia, Rafael (CS Manzanares); Garcia del Valle, Lourdes (CS Sta. Cruz de Mudela); Iglesias Fernandez, Antonio (CS Manzanares); Maestre Moyano, Isabel (CS Porzuna); Perez Sanchez, angel Fermin (CS Alcoba de los Montes); Rayo Olmo, Maria Jesus (CS Sta. Cruz de Mudela); Ruiz Serrano, Antonio Lorenzo (CS Porzuna); Sanchez Higueruelo, Fernando (CS Manzanares); Torres Consuegra, Jose (CS Corral de Calatrava), y Zafra Alcantara, Justa (CS Puertollano I)</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| 2017 Febrero | 21 | 0 | 21 |
| 2017 Enero | 17 | 1 | 18 |
| 2016 Diciembre | 8 | 5 | 13 |
| 2016 Noviembre | 18 | 3 | 21 |
| 2016 Octubre | 47 | 1 | 48 |
| 2016 Septiembre | 16 | 1 | 17 |
| 2016 Agosto | 13 | 0 | 13 |
| 2016 Julio | 13 | 0 | 13 |
| 2016 Junio | 14 | 0 | 14 |
| 2016 Mayo | 13 | 0 | 13 |
| 2016 Abril | 9 | 0 | 9 |
| 2016 Marzo | 17 | 0 | 17 |
| 2016 Febrero | 13 | 0 | 13 |
| 2016 Enero | 11 | 0 | 11 |
| 2015 Diciembre | 18 | 0 | 18 |
| 2015 Noviembre | 14 | 0 | 14 |
| 2015 Octubre | 15 | 0 | 15 |
| 2015 Septiembre | 28 | 0 | 28 |
| 2015 Agosto | 11 | 0 | 11 |
| 2015 Julio | 10 | 0 | 10 |
| 2015 Junio | 5 | 0 | 5 |
| 2015 Mayo | 17 | 0 | 17 |
| 2015 Abril | 13 | 0 | 13 |
| 2015 Marzo | 12 | 0 | 12 |
| 2015 Febrero | 12 | 0 | 12 |
| 2015 Enero | 17 | 0 | 17 |
| 2014 Diciembre | 24 | 0 | 24 |
| 2014 Noviembre | 9 | 0 | 9 |
| 2014 Octubre | 9 | 0 | 9 |
| 2014 Septiembre | 7 | 0 | 7 |
| 2014 Agosto | 6 | 0 | 6 |
| 2014 Julio | 4 | 0 | 4 |
| 2014 Junio | 4 | 0 | 4 |
| 2014 Mayo | 4 | 0 | 4 |
| 2014 Abril | 1 | 0 | 1 |
| 2014 Marzo | 1 | 0 | 1 |
| 2014 Febrero | 3 | 0 | 3 |
| 2014 Enero | 3 | 0 | 3 |
| 2013 Diciembre | 5 | 0 | 5 |
| 2013 Noviembre | 3 | 0 | 3 |
| 2013 Octubre | 7 | 0 | 7 |
| 2013 Septiembre | 7 | 0 | 7 |
| 2013 Agosto | 5 | 0 | 5 |
| 2000 Septiembre | 839 | 0 | 839 |
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