Brotons Carlos, Camafort Miguel, Castellanos María Del Mar, Clarà Albert, Cortés Olga, Díaz Rodríguez Ángel, Elosúa Roberto, Gorostidi Manuel, Hernández Antonio M, Herranz María, Justo Soledad, Lahoz Carlos, Niño Pilar, Pallarés-Carratalá Vicente, Pedro-Botet Juan, Pérez Pérez Antonio, Royo-Bordonada Miguel Ángel, Santamaría Rafael, Tresserras Ricard, Zamora Alberto, Zuza Inés, Armario Pedro
Sociedad Española de Medicina de Familia y Comunitaria-semFYC. Barcelona. España.
Sociedad Española de Medicina Interna. Barcelona. España.
Rev Esp Salud Publica. 2022 Mar 1;96:e202203027.
We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm (SCORE2, SCORE-OP) is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (<50, 50-69, >70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.
我们展示了《2021年欧洲临床实践心血管疾病（CVD）预防指南》的西班牙语改编版。当前指南除了针对个体的方法外，还极大地强调了在人群层面预防心血管疾病方法的重要性。建议对任何具有主要血管危险因素的个体进行系统性全球CVD风险评估。对于糖尿病患者的低密度脂蛋白胆固醇、血压和血糖控制，目标与先前指南所推荐的一致。然而，提出了一种新的逐步治疗强化方法（步骤1和步骤2），作为帮助医生和患者以适合患者情况的方式实现这些目标的工具。在步骤1之后，必须考虑进入步骤2的强化目标，这种强化将基于10年CVD风险、终生CVD风险和治疗益处、合并症以及患者偏好。这些指南推荐了更新后的SCORE算法（SCORE2、SCORE-OP），该算法可估计40 - 89岁健康男性和女性发生致命和非致命CVD事件（心肌梗死、中风）的10年风险。另一项新的重要建议是根据不同年龄组（<50岁、50 - 69岁、>70岁）使用不同类别的风险。推荐了针对看似健康的人、已确诊动脉粥样硬化性CVD的患者以及糖尿病患者的不同CVD风险和风险因素治疗流程图。根据肾小球滤过率和白蛋白与肌酐比值水平，慢性肾病患者被视为高危或极高危患者。纳入了与西班牙卫生部发布的建议相适应的新的生活方式建议，以及侧重于血脂、血压、糖尿病和慢性肾衰竭管理的建议。
