Prevención de la enfermedad coronaria en España. ¿Tenemos claro a quién debemos tratar?

Laburpena

Background. In the last years many clinical guidelines aimed at the prevention of coronary heart disease have been published. Many such guides are aimed at controlling blood cholesterol levels. However, the successive clinical guidelines do not have a clear tendency and are based on changeable criteria. With the purpose of assessing the practical implications of the use of these clinical guidelines, we evaluated their application to the general Spanish population, analyzing the proportion of individuals to be treated according to each one of them. We also assessed whether this population was equivalent or, at least, it was distributed in a coherent way from the most to the least interventionist guidelines. Methods. The study population available for analysis came from the database of the DRECE Study, a population study of alimentary habits and blood lipid levels in Spain, and consisted of 4787 individuals (2324 men, 2453 women) with an age range from 5 to 60 years. The subjects were classified with respect to the need of cholesterol-lowering treatment according to the following guidelines: Sociedad Española de Arteriosclerosis (SEA), NCEPII, and Second Joint Task Force (SJTF), in addition to a quantitative assessment of coronary risk within 10 years according to the new Framingham tables (AHA statement). Following classification, we analyzed the number of individuals that were considered in need of cholesterol-lowering pharmacological treatment by each of these recommendations. Results. The recommendations issued by SEA classified the largest segment of the DRECE population as being in need of pharmacological treatment (5.5% of the population could be considered at high risk), while SJTF guidelines included only 1.8% of the population in the high risk group. Moreover, depending on the specific guidelines used, the characteristics of the population included in each risk group changed, attesting to the lack of equivalence among the high risk groups. Among those considered as needing treatment by SJTF guidelines, only 40% of them would be considered as high risk individuals by the other guidelines, while among those with an indication for treatment by the other guidelines, 80% would not be considered as such by SJTF recommendations. Conclusion. The various clinical guidelines for individual risk-guided cholesterol treatment are not equivalent, thus resulting in dissimilar risk classifications. It appears advisable that, in order to facilitate clinical practice, intervention criteria are homogenized leading to truly consensus recommendations rather than misleading ones.