Resumen

MINISTERIO DE SANIDAD Y CONSUMO; SOCIEDAD ESPANOLA DE CARDIOLOGIA  y  SOCIEDAD ESPANOLA DE ARTERIOESCLEROSIS. Cholesterolemia control in Spain, 2000. A toolfor   cardiovascular disease prevention. Rev. Esp. Salud Publica [online]. 2000, vol.74, n.3, pp.00-00. ISSN 2173-9110.

The report "Cholesterolemia Control In Spain, 2000. A tool for Cardiovascular Disease Prevention" reviews current evidence on cardiovascular prevention and therapeutical advances occurred in the last years, in order to help overall risk-based clinical decision-making. Cardiovascular disease ranks as the first cause of death in Spain, accounting for almost 40% of total mortality. During the last years age-adjusted cardiovascular death rates have been declining, but the absolute number of deaths by coronary heart disease is ascending due mainly to the population aging. Coronary heart disease is the first cause of hospital consultation due both to the lesser coronary heart disease mortality and to the increase in coronary heart disease incidence. The demographic, health and social impact of cardiovascular disease is increasing and it is likely to go on in the next decades. Appropriate treatment of high blood cholesterol and of other major modifiable risk factors is crucial for preventing cardiovascular disease. Specific actions to carry out depend on the risk to get ill. Individual risk stratification is essential as it determines the follow up periodicity and treatment intensity. Priorities of control of cholesterolemia and its consequent risk are based on risk stratification. The groups for intervention are ordered in a descendent priority hierarchy as follows: 1. - Secondary prevention: Patients with established coronary heart disease or other atherosclerotic disease. 2. - Primary prevention: Healthy individuals who are at high risk of developing coronary heart disease or other atherosclerotic disease, because of a combination of risk factors - including lipids (raised total cholesterol, and LDL-cholesterol, low HDL-cholesterol and raised triglycerides), smoking, raised blood pressure, raised blood glucose, family history of premature coronary disease - or who have severe hypercholesterolaemia, or other forms of dyslipidaemia, hypertension or diabetes. 3. - Close relatives of patients with early onset coronary heart disease or other atherosclerotic disease. 4. - Others individuals met in connection with ordinary clinical practice. In primary prevention, the therapeutic objective in high risk patients (risk ³ 20% -upon the risk chart of the European Societies of Cardiology, Atherosclerosis, Hypertension- or individuals with 2 or more risk factors -National Cholesterol Education Program II-) is set up at LDL-cholesterol <130 mg/dl. In secondary prevention, the drug treatment will be indicated when LDL-cholesterol ³ 130 mg/dl and the therapeutic objective will be LDL-cholesterol <100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. Where moderate-severe hypertrigliceridemia or low HDL-cholesterol fibrates are prefered. In acute coronary syndrome hypolipemiant treatment, where indicated, should be used as soon as possible. Coronary heart disease patients should be offered secondary prevention programmes which provide, in a continuous manner, a good clinical and risk factor control, with appropriate cost-effectiveness drugs.

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