Abstract

ADAN VALERO, Inmaculada; MARTINEZ SORIANO, Yoana; PERONA CARO, Javier  and  GARCIA MATEOS, David. Cardiovascular risk and Clinical Practice Guidelines: clarification or confusion? Repercussion according to which Clinical Practice Guideline is used. Rev Clin Med Fam [online]. 2009, vol.2, n.7, pp.348-353. ISSN 2386-8201.

Objective. To evaluate the indication of antihypertensive and lipid-lowering treatment in primary prevention, according to the recommendations of the most commonly used clinical practice guidelines in Spain. Design. Descriptive Cross-sectional Study. Setting. Urban Primary Health Care Centres in Cuenca. Participants. A total of 449 individuals aged between 35 and 74, recorded as having hypertension, hypercholesterolemia, diabetes mellitus, obesity or being smokers, without previous cardiovascular disease, corresponding to four GPs quotas at three healthcare centres in the city of Cuenca, Spain. Main measurements. CVR was determined using risk the equations of Framingham, REGICOR and SCORE. The appropriate use of treatment was assessed according to the criteria of the Program on Prevention and Health Promotion Activities for Primary Care (PAPPS), the Spanish Association for Family and Community Medicine (SEMFYC) and the Spanish Interdisciplinary Committee for the Prevention of Cardiovascular Disease (CEIPC). Results. The average overall risk was: Framingham 11.31±8 (median 9); Regicor 4.63 ±2.98 (median 4); Score 4.06±4.41 (median 2). According to the PAPPS recommendations, 39,9 % of the subjects should receive antihypertensive treatment, whereas, according the SCORE-CEIPC recommendations, 41,2 % should receive such treatment. (IC 91,1 %), (Kappa 0,82). With regard to lipid-lowering treatment, according to the PAPPS recommendations 8.5 % should receive treatment compared to 21.2 % according to the SCORE-CEIPC recommendations. (IC 82,4 %), (Kappa 0,32). Conclusions. The two most frequently used guidelines lines in Spain show high conformity for indicating antihypertensive treatment, but they differ greatly in the indication of lipid-lowering treatment. The SCORE-CEIPC recommendations indicate lipid lowering treatment in a greater percentage of patients than do those of PAPPS.

Keywords : Models, Cardiovascular; Practice Guidelines; Antihypertensive Agents; Anticholesterem Agents.

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