Plaza Pérez I, Taboada Taboada M, Bautista Herrero Jimeno J, Gómez Guindal J A, Román León M T
Servicio de Cardiología, Hospital Universitario La Paz, Madrid.
Rev Esp Cardiol. 1998;51 Suppl 6:54-62.
Hypolipemic treatment is a matter of controversy. The objective of this paper is to analyze how Spanish cardiologist knows the lipid role in ischemic heart disease and their intention of treatment hypercholesterolemia in ischemic cardiomiopathy patients. We also evaluate the grade of control and treatment of hypercholesterolemia in patients with ischemic heart disease who belong to a primary care center.
Two inquests were done to 1,850 Spanish cardiologist using a question paper in 1993 and 1996. At the Primary Care Center of Fuencarral (Madrid) we made a transversal study from February till March 1996.
In 1993, 11% answered the questionnaire and 25% in 1996. Cardiologists who considered the ideal level of cholesterol lower than 200 mg/dl raised from 62% in 1993 to 86% in 1996 (p < 0.001). Cardiologists who considered that cholesterol linked to low density lipoproteins should be lower than 100 mg/dl raised from 0% in 1993 to 28% in 1996 (p < 0.001). Drug treatment was prescribed by 68% when total cholesterol levels were higher than 300 mg/dl in 1993 and 14% of cardiologists never prescribed drugs. In 1996, 71% prescribed drug treatment when total cholesterol was between 200 and 250 mg/dl (p < 0.001). Cardiologists who worked at hospitals began with drugs with a lower cholesterol levels than out-hospital cardiologists. Hypercholesterolemia was considered as the most important risk factor in secondary prevention. We review 94 patients with ischemic heart disease; 37 did not receive hypolipemic treatment, though they had more than 200 mg/dl of cholesterol. Just 12 of the 45 treated reached figures below 200 mg/dl. 32% of the patients where controlled by family doctor's.
Results of the two surveys in 1993 and 1996 have produced a change in Spanish cardiologist attitude about indication of hypolipemic treatment for patients suffering from ischemic cardiomiopathy. Family doctor's and cardiologists must assume secondary prevention. Indeed, it is necessary to make them both become aware of the importance of a correct treatment of those patients.
降血脂治疗存在争议。本文旨在分析西班牙心脏病专家对脂质在缺血性心脏病中的作用的了解程度，以及他们对缺血性心肌病患者高胆固醇血症的治疗意图。我们还评估了一家初级保健中心中缺血性心脏病患者高胆固醇血症的控制和治疗水平。
1993年和1996年，使用问卷对1850名西班牙心脏病专家进行了两次调查。1996年2月至3月，在富恩卡拉尔（马德里）初级保健中心进行了一项横向研究。
1993年，11%的人回答了问卷，1996年为25%。认为胆固醇理想水平低于200毫克/分升的心脏病专家从1993年的62%升至1996年的86%（p<0.001）。认为与低密度脂蛋白相关的胆固醇应低于100毫克/分升的心脏病专家从1993年的0%升至1996年的28%（p<0.001）。1993年，当总胆固醇水平高于300毫克/分升时，68%的人开了药物治疗，14%的心脏病专家从未开过药。1996年，当总胆固醇在200至250毫克/分升之间时，71%的人开了药物治疗（p<0.001）。在医院工作的心脏病专家开始用药时的胆固醇水平低于医院外的心脏病专家。高胆固醇血症被认为是二级预防中最重要的危险因素。我们对94名缺血性心脏病患者进行了复查；37人未接受降血脂治疗，尽管他们的胆固醇水平超过200毫克/分升。在45名接受治疗的患者中，只有12人的胆固醇水平降至200毫克/分升以下。32%的患者由家庭医生控制。
1993年和1996年的两项调查结果使西班牙心脏病专家对缺血性心肌病患者降血脂治疗指征的态度发生了变化。家庭医生和心脏病专家必须承担二级预防责任。确实，有必要让他们都意识到正确治疗这些患者的重要性。
