Cardiovascular risk and adequate use of aspirin in primary prevention of cardiovascular events in the outpatient clinic of Clínica Médica of Hospital de Clínicas
DOI:
https://doi.org/10.18004/anales/2020.053.02.53Keywords:
Primary prevention, Aspirin, Ambulatory care, Hypertension, Diabetes, Dyslipidemias, ParaguayAbstract
Introduction: The adequate use of aspirin for the primary prevention of cardiovascular disease events requires the evaluation of the benefits and risks for the patient. Objectives: To determine the global cardiovascular risk and the adequate use of aspirin as primary prevention of cardiovascular diseases in outpatients of the Clínica Médica del Hospital de Clínicas. Materials and methods: Observational, descriptive, cross-sectional, prospective study in outpatients of the Clínica Médica del Hospital de Clínicas between September 2017 and September 2018. Patients of both sexes, between 40 and 79 years of age, who had one or more of the following cardiovascular risk factors: HT, dyslipidemia, T2DM, smoking. Sociodemographic variables, systolic and diastolic blood pressure, total cholesterol, HDL-c, LDL-c, history of HT, DM2, smoking, use of statins and acetylsalicylic acid were measured. To measure the variables, a questionnaire was prepared. The global cardiovascular risk score was calculated according to ACC / AHA, using the ASCVD Risk calculator. Results: 100 questionnaires were analyzed, average age of 61 ± 5.3 years, 67% women and 100% are white. 88% were hypertensive, 73% dyslipidemic, 43% diabetic and 24% tobacco addicted. 50% presented high global cardiovascular risk, the average cardiovascular risk is 15 ± 3.6%. 60% with adequate indication of aspirin for the primary prevention of cardiovascular events. Conclusion: Half of the patients presented high cardiovascular risk and in 60% the use of aspirin was adequate for the primary prevention of cardiovascular events.
References
1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Lond Engl. 10 de 2018;392(10159):1789-858.
2. Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. diciembre de 2014;45(12):3754-832.
3. Prevención primaria cardiovascular y toma de decisiones compartida [Internet]. [citado 10 de junio de 2020]. Disponible en: http://scielo.isciii.es/scielo.php?pid=S1699-695X2019000300132&script=sci_arttext&tlng=pt
4. Fleites EJQ, Quintero SF de la M, López LG. La promoción de la salud y su vínculo con la prevención primaria. Medicentro. 24 de abril de 2017;21(2):101-11.
5. Jackson R, Lawes CMM, Bennett DA, Milne RJ, Rodgers A. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet Lond Engl. 29 de febrero de 2005;365(9457):434-41.
6. Mainous AG, Tanner RJ, Shorr RI, Limacher MC. Use of aspirin for primary and secondary cardiovascular disease prevention in the United States, 2011-2012. J Am Heart Assoc. 14 de julio de 2014;3(4).
7. Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet Lond Engl. 22 de 2018;392(10152):1036-46.
8. Hennekens CH, Sacks FM, Tonkin A, Jukema JW, Byington RP, Pitt B, et al. Additive benefits of pravastatin and aspirin to decrease risks of cardiovascular disease: randomized and observational comparisons of secondary prevention trials and their meta-analyses. Arch Intern Med. 12 de enero de 2004;164(1):40-4.
9. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly - PubMed [Internet]. [citado 10 de junio de 2020]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30221595/
10. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 24 de junio de 2014;129(25 Suppl 2):S49-73.
REFERENCIAS BIBLIOGRAFICAS
11. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 1 de julio de 2014;63(25 Pt B):2889-934.
12. Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet Lond Engl. 30 de noviembre de 2013;382(9907):1762-5.
13. Muntner P, Colantonio LD, Cushman M, Goff DC, Howard G, Howard VJ, et al. Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations. JAMA. 9 de abril de 2014;311(14):1406-15.
14. Vásquez-Carrillo P, Castillo-Rivas J, Salazar-Nassar J, Silva de la Fuente S, Quirós-Meza G. Riesgo cardiovascular global en una población adulta mayor del área rural, Cantón de Garabito, Puntarenas. Acta Médica Costarric. septiembre de 2015;57(3):117-23.
15. Acevedo M, Valentino G, Kramer V, Bustamante MJ, Adasme M, Orellana L, et al. Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago. Rev Médica Chile. marzo de 2017;145(3):292-8.
16. Chaves G, Brítez N, Maciel V, Klinkhof A, Mereles D. Prevalencia de factores de riesgo cardiovascular en una población adulta ambulatoria urbana: estudio AsuRiesgo, Paraguay. Rev Panam Salud Pública. agosto de 2015;38:136-43.
17. Briones CN, Cartes-Velásquez R. Prevalencia de factores de riesgocardiovascular en comunidades pehuenches, Chile. Rev Médica Electrónica. 2014;36(1):34-48.
18. Martínez S MA, Leiva O AM, Celis-Morales C. Prevalencia de factores de riesgo cardiovascular en trabajadores de la Universidad Austral de Chile. Rev Chil Nutr. marzo de 2016;43(1):32-8.
19. Orozco-González CN, Cortés-Sanabria L, Viera-Franco JJ, Ramírez-Márquez JJ, Cueto-Manzano AM. Prevalencia de factores de riesgo cardiovascular en trabajadores de la salud. Rev Médica Inst Mex Seguro Soc. 15 de septiembre de 2016;54(5):594-601.
20. Prevalencia de factores de riesgo cardiovascular en América Latina: una revisión de la evidencia publicada de 2010 a 2015 [Internet]. [citado 10 de junio de 2020]. Disponible en: http://www.scielo.org.mx/scielo.php?pid=S0188-21982015000300004&script=sci_arttext&tlng=en
21. Guirguis-Blake JM, Evans CV, Senger CA, O’Connor EA, Whitlock EP. Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 21 de junio de 2016;164(12):804-13.
22. Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 29 de noviembre de 2011;58(23):2432-46.
23. ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 18 de 2018;379(16):1529-39.
24. Association American Diabetes. Updates to the Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(9):2045-7.
