Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Barcelona, España.
Sociedad Española de Medicina Interna, Madrid, España.
Clin Investig Arterioscler. 2022 Jul-Aug;34(4):219-228. doi: 10.1016/j.arteri.2022.03.003.
We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease 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 cardiovascular disease 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 (steps 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 cardiovascular disease risk, lifetime cardiovascular disease risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm ?SCORE2, SCORE2-OP? is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal cardiovascular disease 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 to different age groups (<50, 50-69, ≥70 years). Different flow charts of cardiovascular disease risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic cardiovascular disease, 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.
我们呈现了 2021 年欧洲心血管疾病预防临床实践指南的西班牙语版本。当前的指南除了强调个体化方法外，还非常重视人群水平方法在预防心血管疾病方面的重要性。建议在有任何主要血管风险因素的个体中进行系统性的全球心血管疾病风险评估。对于患有糖尿病的患者，LDL 胆固醇、血压和血糖控制的目标和靶值仍与以前的指南中推荐的一致。然而，建议采用一种新的、逐步强化治疗的方法（步骤 1 和 2）作为帮助医生和患者以适合患者特征的方式追求这些目标的工具。在完成步骤 1 后，考虑进行强化目标的步骤 2 是强制性的，这种强化将基于 10 年心血管疾病风险、终生心血管疾病风险和治疗获益、合并症和患者偏好。建议在这些指南中使用更新的 SCORE 算法 -SCORE2、SCORE2-OP-，该算法估计 40-89 岁健康男性和女性个体发生致命和非致命心血管疾病事件（心肌梗死、中风）的 10 年风险。另一个新的重要建议是根据不同年龄组（<50 岁、50-69 岁、≥70 岁）使用不同的风险类别。建议为看似健康的人、已确诊的动脉粥样硬化性心血管疾病患者和糖尿病患者制定不同的心血管疾病风险和风险因素治疗流程图。根据肾小球滤过率和白蛋白-肌酐比值，慢性肾脏病患者被视为高危或极高危患者。还包括了新的生活方式建议，这些建议适应了西班牙卫生部发布的建议，以及专注于血脂、血压、糖尿病和慢性肾衰竭管理的建议。
