Martín-Rioboó Enrique, Brotons-Cuixart Carlos, Ruiz García Antonio, Villafañe Sanz Fátima, Frías Vargas Manuel, Moyá Amengual Ana, Divisón Garrote Juan Antonio, Seoane Vicente María Cruz, Banegas José R, Pallarés Carratalá Vicente
Médico de Familia; Unidad de Gestión Clínica Poniente; Distrito Universitario Córdoba-Guadalquivir; Departamento de Medicina; Universidad de Córdoba. / IMIBIC; Hospital Reina Sofía. Córdoba. España.
Médico de familia; Instituto de Investigaciones Biomédicas Sant Pau; Equipo de Atención Primaria Sardenya. Barcelona. España.
Rev Esp Salud Publica. 2023 Aug 16;97:e202308064.
General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines for Cardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), with the aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a critical analysis of these guidelines, offering possible solutions that can be implemented in Primary Care. It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (from seventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it is proposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated using different websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implementing nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in the potential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions could delay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease. Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of the guideline in primary care.
全科医生在诊疗过程中会接待大量具有高血管风险(VR)的患者。《欧洲心血管疾病预防指南(2021)》推荐了一种新的风险分类以及针对血管危险因素(RF)的干预策略,旨在为专业人员和患者之间提供共同决策建议。在本文档中,我们对这些指南进行了批判性分析,提出了一些可在初级保健中实施的可能解决方案。需要注意的是,存在一些积极方面(亮点),例如SCORE2(40至69岁)和SCORE2 - OP模型(70至89岁)基于更新的队列,并更准确地测量心血管风险。此外,建议根据年龄组区分不同的风险阈值。为了实用起见,可以使用不同的网站和新的计算机模型来估计心血管风险。然而,在消极方面(阴影),根据年龄或风险水平实施九个亚组的受试者似乎增加了复杂性,设定的阈值可能会导致潜在治疗对象数量大幅增加,而没有明确证据支持这一点。此外,两步式RF干预可能会延迟治疗目标的实现,尤其是在极高风险患者、糖尿病患者或心血管疾病患者中。鉴于这些局限性,在本文档中我们提出了实用建议,以简化并促进该指南在初级保健中的实施。
Rev Esp Salud Publica. 2023-8-16
Rev Esp Cardiol (Engl Ed). 2015-5
Rev Esp Salud Publica. 2023-10-11
Aten Primaria. 2024-11
Eur Heart J Cardiovasc Pharmacother. 2023-2-2
Eur J Prev Cardiol. 2023-1-24
N Engl J Med. 2022-9-15