The approach to hypercholesterolemia in health strategies and plans in Spain: present situation and future proposals
DOI:
https://doi.org/10.23938/ASSN.0958Keywords:
Cardiovascular diseases, Hypercholesteremia, Strategies, Health policiesAbstract
Background. Cardiovascular diseases (CVD) are a major cause of death worldwide and Hypercholesterolemia (HC) is an important cardiovascular risk factor. In Spain, approximately 25% of middle-aged adults suffer from HC. Our objective was to analyse current health strategies and plans in Spain related to CVD and HC in order to define possible future courses of action to bring about better control from a health management and policy perspective.
Methods. The study was observational and descriptive. In the first step, a literature review was carried out, followed by six semi structured interviews. In the second step, a group of 12 experts in the field identified existing barriers to HC control and suggested ways to reduce premature mortality due to CVD.
Results. A total of 51 documents were identified, of which 43% referred to HC. There was a high variability at the regional level in the implementation of measures and initiatives for the control of HC. Barriers that were identified were : trivialization of HC, lack of active participation by key stakeholders, lack of understanding of the impact of HC, existing care models and pathways, and short-term health policies that limit the provision of resources for HC care and control.
Conclusion. Despite the considerable medical and socioeconomic burden of CVD and HC in Spain, the importance of HC is not reflected in health policies. There is a lack of HC control measures, even when they are shown to be highly feasible and beneficial. This article proposes specific measures to improve control of this issue.
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FÉLIX-REDONDO F, LOZANO MERA L, ALVAREZ-PALACIOS ARRIGHI P, GRAU MAGANA M, RAMÍREZ-ROMERO J, FERNÁNDEZ-BERGÉS D. Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva. Atención Primaria 2020; 52: 3-13. https://doi.org/10.1016/j.aprim.2018.11.006
ESCRIBANO HERNANDEZ A, VEGA ALONSO AT, LOZANO ALONSO JE, ÁLAMO SANZ R, CASTRODEZA SANZ JJ, LLERAS MUÑOZ S et al. Dislipidemias y riesgo cardiovascular en la población adulta de Castilla y Leon. Gac Sanit 2010; 24: 282-287. https://doi.org/10.1016/j.gaceta.2010.04.004
GUALLAR-CASTILLÓN P, GIL-MONTERO M, LEÓN-MUÑOZ L, GRACIANI A, BAYÁN-BRAVO A, TABOADA J et al. Magnitud y manejo de la hipercolesterolemia en la población adulta de España, 2008-2010: el estudio ENRICA. Rev Esp Cardiol 2012; 65: 551-558. doi: 10.1016/j.recesp.2012.02.005
GUALLAR E, BANEGAS JR, BLASCO-COLMENARES E, JIMÉNEZ FJ, DALLONGEVILLE J, HALCOX JP et al. Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study. BMC Public Health 2011; 11: 704. https://doi.org/10.1186/1471-2458-11-704
BARRIOS V, ESCOBAR C, LLISTERRI JL, RODRÍGUEZ ROCA G, BADIMÓN JJ, VERGARA J et al. Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN. Semergen 2015; 41: 3-12. https://doi.org/10.1016/j.semerg.2014.09.010
BANEGAS JR, LOPEZ-GARCIA E, DALLONGEVILLE J, GUALLAR E, HALCOX JP, BORGHI C et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J 2011; 32: 2143-2152. https://doi.org/10.1093/eurheartj/ehr080
NORDESTGAARD BG, CHAPMAN MJ, HUMPHRIES SE, GINSBERG HN, MASANA L, DESCAMPS OS et al. for the European Atherosclerosis Society Consensus Panel. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: Consensus Statement of the European Atherosclerosis Society. Eur Heart J 2013; 34: 3478-3490. https://doi.org/10.1093/eurheartj/eht273
GIDDING SS, CHAMPAGNE MA, DE FERRANTI SD, DEFESCHE J, ITO MK, KNOWLES JW et al. American Heart Association Atherosclerosis, Hypertension, and Obesity in Young Committee of Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and Council on Lifestyle and Cardiometabolic Health. The agenda for familial hypercholesterolemia: a scientific statement from the American Heart Association. Circulation 2015; 132: 2167-2192. https://doi.org/10.1161/CIR.0000000000000297
The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Vallejo-Vaz AJ, De Marco M, Stevens CAT et al. Overview of the current status of familial hypercholesterolaemia care in over 60 countries. Atherosclerosis 2018; 277: 234-255. https://doi.org/10.1016/j.atherosclerosis.2018.08.051
LÁZARO P, PÉREZ DE ISLA L, WATTS GF, ALONSO R, NORMAN R, MUÑIZ O et al. Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia. J Clin Lipidol 2017; 11: 260-271. https://doi.org/10.1016/j.jacl.2017.01.002
Fundación Española del Corazón. ¿Cuánto cuesta un enfermo cardiovascular?. https://fundaciondelcorazon.com/corazon-facil/blog-impulso-vital/2208-cuanto-cuesta-enfermo-cardiovascular.html
World Health Organization. Newsroom. Cardiovascular diseases (CVDs). Geneva: WHO, 2017. http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Fundación Hipercolesterolemia Familiar. Conferencia Internacional de Salud Global 2018: el modelo de la HF. https://www.colesterolfamiliar.org/conferencia-internacional-de-salud-global-el-modelo-de-la-hf/
GRAINGER-GASSER A, PEREL P, LAGIER-HÄSSIG L, WOOD D. The Road to 25×25: Update on WHF CVD Roadmaps. Global Heart 2017; 12: 269-270. https://doi.org/10.1016/j.gheart.2016.05.004
Grupo de trabajo de la Guía de Práctica Clínica sobre el manejo de los lípidos como factor de riesgo cardiovascular. Guía de Práctica Clínica sobre el manejo de los lípidos como factor de riesgo cardiovascular. Ministerio de Sanidad, Servicios Sociales e Igualdad. OSTEBA; 2017. Guías de Práctica Clínica en el SNS. https://portal.guiasalud.es/wp-content/uploads/2018/12/GPC_567_Lipidos_Osteba_compl.pdf
PLAZA PÉREZ I, VILLAR ÁLVAREZ F, MATA LÓPEZ P, PÉREZ JIMÉNEZ F, MAIQUEZ GALÁNE A, CASASNOVAS LENGUAS JA et al. Control de la colesterolemia en España, 2000 un instrumento para la prevención cardiovascular. Rev Esp Cardiol 2000; 53: 815-837.
ROYO-BORDONADA MÁ, ARMARIO P, LOBOS BEJARANO JM, BOTET JP, VILLAR ALVAREZ F, ELOSUA R et al en nombre del Comité Español Interdisciplinario para la Prevención Cardiovascular (CEIPC). Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Salud Publica 2016; 90: e1-e24.
Sociedad Española de Medicina Familiar y Comunitaria. Programa de actividades preventivas y de promoción de la salud. https://papps.es/
ASCASO JF, CIVEIRA F, GUIJARRO C, LÓPEZ-MIRANDA J, MASANA L, MOSTAZA JM et al. Indicaciones de los inhibidores de PCSK9 en la práctica clínica. Recomendaciones de la Sociedad Espanola de Arteriosclerosis (SEA), 2019. Clin Investig Arterioscler 2019; 31: 128-139. https://doi.org/10.1016/j.arteri.2019.04.002
PÉREZ DE ISLA L, ALONSO R, MATA N, FERNÁNDEZ-PÉREZ C, MUÑIZ O, DÍAZ-DÍAZ JL et al. Predicting Cardiovascular Events in Familial Hypercholesterolemia: The SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study). Circulation 2017; 135: 2133-2144. https://doi.org/10.1161/CIRCULATIONAHA.116.024541
PAYNE J, WILLIAM S, MAXWELL D, PARIENTE MT, ARROYO-OLIVARES R, JANSSEN TEN HAAF M et al. Familial hypercholesterolaemia patient support groups and advocacy: A multinational perspective. Atherosclerosis 2018; 277: 377-382. https://doi.org/10.1016/j.atherosclerosis.2018.08.020
MATA P, ALONSO R, RUIZ A, GONZALEZ-JUANATEY JR, BADIMÓN L, DÍAZ-DÍAZ JL et al. Diagnóstico y tratamiento de la hipercolesterolemia familiar en España: documento de consenso. Aten Primaria 2015; 47: 56-65. https://doi.org/10.1016/j.aprim.2013.12.015
Word Heart Federation. WHF Roadmap to reducing premature CVD mortality in Brazil - situation análisis. Version 27.09.16. https://www.world-heart-federation.org/cvd-roadmaps/
World Heart Federation. WHF Roadmap to reducing premature cardiovascular disease (CVD) mortality in India - secondary prevention and hypertension summary situation analysis. Version 27.09.16. https://www.world-heart-federation.org/cvd-roadmaps/whf-global-roadmaps/cholesterol/
ALONSO R, PEREZ DE ISLA L, MUÑIZ-GRIJALVO O, MATA P. Barriers to early diagnosis and treatment of familial hypercholesterolemia: current perspectives on improving patient care. Vasc Health Risk Manag 2020; 16: 11-25. https://doi.org/10.2147/VHRM.S192401
GÓMEZ-MARTÍNEZ L, OROZCO-BELTRÁN D, QUESADA JA, BERTOMEU-GONZÁLEZ V, GIL-GUILLÉN VF, LÓPEZ-PINEDA A et al. Tendencias en la mortalidad prematura por insuficiencia cardíaca por comunidad autónoma en España: 1999 a 2013. Rev Esp Cardiol 2018; 71: 531-537. https://doi.org/10.1016/j.recesp.2017.09.014
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