[Attitude change of Spanish cardiologist with respect to hypolipidemic treatment in secondary prevention. The role of outside hospital care].
OBJECTIVE
Hypolipemic treatment is a matter of controversy. The objective of this paper is to analyze how Spanish cardiologist knows the lipid role in ischemic heart disease and their intention of treatment hypercholesterolemia in ischemic cardiomiopathy patients. We also evaluate the grade of control and treatment of hypercholesterolemia in patients with ischemic heart disease who belong to a primary care center.


METHODS
Two inquests were done to 1,850 Spanish cardiologist using a question paper in 1993 and 1996. At the Primary Care Center of Fuencarral (Madrid) we made a transversal study from February till March 1996.


RESULTS
In 1993, 11% answered the questionnaire and 25% in 1996. Cardiologists who considered the ideal level of cholesterol lower than 200 mg/dl raised from 62% in 1993 to 86% in 1996 (p < 0.001). Cardiologists who considered that cholesterol linked to low density lipoproteins should be lower than 100 mg/dl raised from 0% in 1993 to 28% in 1996 (p < 0.001). Drug treatment was prescribed by 68% when total cholesterol levels were higher than 300 mg/dl in 1993 and 14% of cardiologists never prescribed drugs. In 1996, 71% prescribed drug treatment when total cholesterol was between 200 and 250 mg/dl (p < 0.001). Cardiologists who worked at hospitals began with drugs with a lower cholesterol levels than out-hospital cardiologists. Hypercholesterolemia was considered as the most important risk factor in secondary prevention. We review 94 patients with ischemic heart disease; 37 did not receive hypolipemic treatment, though they had more than 200 mg/dl of cholesterol. Just 12 of the 45 treated reached figures below 200 mg/dl. 32% of the patients where controlled by family doctor's.


CONCLUSIONS
Results of the two surveys in 1993 and 1996 have produced a change in Spanish cardiologist attitude about indication of hypolipemic treatment for patients suffering from ischemic cardiomiopathy. Family doctor's and cardiologists must assume secondary prevention. Indeed, it is necessary to make them both become aware of the importance of a correct treatment of those patients.
Plaza Pérez
I
I
Servicio de Cardiología, Hospital Universitario La Paz, Madrid.
Taboada Taboada
M
M
Bautista Herrero Jimeno
J
J
Gómez Guindal
J A
JA
Román León
M T
MT
D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D002309:Cardiology / Q000639:trends; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000517:prevention & control*; D012016:Reference Values; D013030:Spain
D015415:Biomarkers; D000960:Hypolipidemic Agents; D002784:Cholesterol