Royo-Bordonada Miguel Angel, Lobos Bejarano José María, Villar Alvarez Fernando, Sans Susana, Pérez Antonio, Pedro-Botet Juan, Moreno Carriles Rosa María, Maiques Antonio, Lizcano Angel, Lizarbe Vicenta, Gil Núñez Antonio, Fornés Ubeda Francisco, Elosua Roberto, de Santiago Nocito Ana, de Pablo Zarzosa Carmen, de Álvaro Moreno Fernando, Cortés Olga, Cordero Alberto, Camafort Babkowski Miguel, Brotons Cuixart Carlos, Armario Pedro
Instituto de Salud Carlos III, España.
Clin Investig Arterioscler. 2013 Jul-Aug;25(3):127-39. doi: 10.1016/j.arteri.2013.03.003. Epub 2013 May 31.
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
基于评估科学证据的两个主要框架（SEC和GRADE），欧洲心血管疾病预防指南建议在所有生命阶段采用基于人群和高风险策略相结合的干预措施，以饮食作为预防的基石。心血管风险（CVR）评估纳入了高密度脂蛋白水平和社会心理因素、极高风险类别以及年龄风险概念。他们还建议由健康专业人员主导并在患者家属参与下采用认知行为方法（如动机性访谈、心理干预），以平衡社会心理压力，并通过养成健康饮食、体育锻炼、戒烟和坚持治疗等积极习惯来降低心血管风险。此外，公共卫生干预措施，如公共场所禁烟或从食物链中消除反式脂肪酸，也至关重要。其他创新措施包括在一级预防中放弃抗血小板治疗，以及建议糖尿病患者和心血管风险高的个体将血压维持在130 - 139/80 - 85mmHg范围内。最后，由于对患者病情进展和医疗成本有重大影响，特别强调了观察到的低治疗依从性水平。总之，改善心血管疾病预防需要政治阶层、公共行政部门、科学和专业协会、健康基金会、消费者协会、患者及其家属之间建立真正的伙伴关系。这种伙伴关系将利用从临床试验到观察性研究以及数学模型等广泛的科学证据，以评估基于人群的干预措施，包括成本效益分析，从而推广基于人群和个体的策略。
