Estimación del riesgo cardiovascular en población española adulta y control de los factores de riesgo en pacientes con enfermedad cardiovascular establecida

Identificador:  TDX:3421

Handle: https://hdl.handle.net/20.500.11797/TDX3421

Autores:  Fernández Valverde, Diana Elizabeth

Resumen:
Introduction Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Objectives -To develop a predictive function of lifetime cardiovascular risk (CVR). -To assess the impact of using SCORE / SCORE OP tools in Spain. -To assess the control of CVR factors in patients with established CVD. Methods Study1: Cohort study. Workers (18-65 years old) visited between 2004-2007 participated. 70% of the cohort was used to develop the equation, the remaining 30% was used as the validation cohort. Study2: Cross-sectional study. Subjects without history of CVD between 65-85 years of age participated, with valid records of systolic blood pressure (SBP) and total cholesterol (TC). Study3: European cross-sectional study. Subjects aged 18-85 years with established CVD between 6 months and 3 years after diagnosis were selected. Results Study1: 762,054 subjects were included, mean age: 35.48 years, 71.14% male. The final model included: occupation, smoking, diabetes mellitus, antihypertensive and lipid-lowering treatment, SBP, TC; in men, in addition it was included: alcohol consumption, body mass index, family history of early coronary disease, renal failure and diastolic blood pressure. Study2: 3,425 patients were included. 25.46% were at high risk using SCORE and 22.90% using SCORE OP. Using the SCORE we would treat with lipid-lowering drugs 16.43% of the individuals, while using with the SCORE OP only 13.45%. Study3: 973 patients participated, 32.4% women, 14% smokers, 32% physically inactive, 30% with unhealthy eating habits. 75% and 23% achieved good blood pressure control (<140/80mmHg), and good LDL-c control (<70mg/dl), respectively. Women were under-treated. Conclusions The model to calculate the lifetime CVR showed satisfactory discrimination and calibration. SCORE OP tables identify fewer high-risk patients, which means treating less older patients, thus avoiding overtreatment. A high percentage of patients with established CVD do not modify their lifestyle and do not reach the therapeutic goals.