“Efforts need to be redoubled to prevent cardiovascular risk”

Internist at the Alcorcón Foundation University Hospital and professor at the Rey Juan Carlos University, Carlos Guijarro heads the Spanish Society of Atherosclerosis. at a pivotal moment for the world of dyslipidemia, with major therapeutic innovations, but also with an important awareness of the need to act consistently in the approach to cardiovascular disease (CVD).

CVDs remain the leading cause of death in the world. What are we failing at?

This is a global health issue and there are many intersections. On the one hand, a sedentary lifestyle and obesity; On the other hand, we are not making therapeutics available with sufficient intensity and thirdly because follow-up is not as thorough as it should be and some patients refuse treatment due to bad press that exaggerates minor side effects compared with ordinary ones. important mid-term clinical benefits are long-term.

In 2022, health authorities, the CCAA, healthcare professionals, healthcare managers and patients developed a Cardiovascular Health Strategy. How are you?

The strategy takes years of implementation to become effective and has not achieved all of its desired goals. Lack of effective communication between healthcare levels. If any physician identifies a patient at high cardiovascular risk, he or she must be guaranteed control and access to medications, preventive treatments, etc. The key element is that we not only have a national strategy, but also guidelines and protocols are increasingly supported by consensus of scientific societies at European level.

To promote the call to action to combat cardiovascular diseases in Spain, the Pulso Vital initiative presented its report with recommendations to the Congress of Deputies a few weeks ago. What main lines would you highlight?

This is a key initiative as civil society and health workers go hand in hand to insist on the need for joint action protocols to citizen representatives.

What’s most urgent?

There are two priority elements: the definition of uniform protocols throughout the country and convergence in the management of health information, so that although they are heterogeneous in each autonomy, patients have common indicators. The current situation shows us serious shortcomings in the control of multiple cardiovascular risk factors.

What positive progress has been made recently?

We have an expansion of the therapeutic armamentarium to treat people at high vascular risk with hypertriglyceridemia and for whom we had nothing specific, new treatments for statin intolerance, and a drug that can recycle the LDL cholesterol receptor in the liver, achieving significant and sustained reduction LDL cholesterol levels. All of these advances offer improved control and very encouraging prospects for dyslipidemia.

The greatest risk factor for cardiovascular disease is a previous event. What needs to be done to prevent this from happening again?

The risk is very great, and the worst thing is that this means that we are already late. In such patients, the therapeutic effort must be intense. After the first episode, we must improve communication between the specialist and primary care services through effective protocols and increase patient awareness to prevent a large proportion of them from dropping out of treatment after a year.

What should be improved in monitoring protocols?

Cardiac rehabilitation and coordinated vascular risk units can play an important role. In addition, there must be protocols and mechanisms for prompt communication between hospital specialists and primary health care services. Not forgetting the shortage of family doctors, which does not allow them to monitor these chronic patients.

Is fairness achieved in the approach to these pathologies?

There is a large imbalance between the degree of control of cardiovascular risk factors carried out in different autonomies, and this is unjustified. Elements of discrimination and lack of equality in access to certain types of treatment must be eliminated. There is particular “institutional discrimination” against drugs aimed at changing lipid metabolism. Paradoxically, they have demonstrated efficacy and safety in reducing cardiovascular events when taken regularly, but have not received the historical benefit of being considered chronic medications with less economic contribution for high-risk patients who must take them indefinitely. This can make a significant difference in favoring continuity of care for high-risk patients, especially vulnerable populations with limited economic resources.

What fee will we pay for this?

Limiting certain preventative measures sometimes leads to more serious complications when much more expensive “heavy artillery” has to be deployed. We must redouble our prevention efforts through comprehensive cardiovascular risk assessment.

Every year we conduct examinations to exclude the occurrence of certain pathologies. Is it advisable to do this in the GCC?

There are many tools available to detect the presence of subclinical vascular damage, but using them in the general population will be difficult. However, it is important to create cardiovascular risk programs starting from 40-45 years of age and always, if necessary, for younger people who have one or another risk factor (hypertension, diabetes, smoking, obesity, family history…). If we are to do this well, it requires a full assessment and preventative measures to reduce risk in the medium to long term.