[Secondary prevention of ischemic heart disease in the Cuidad Real Province, Spain. Effectiveness of lipid-lowering therapy in primary health care].
BACKGROUND
The efficacy of lipid-lowering therapy (LLT) in ischemic heart disease (IHD) is well established. But there are some doubts about its effectiveness on Primary Health Care (PHC) where we develop the long-term control of this sickness and it is difficult to reproduce the terms of the clinical trials.


METHODS
Multicenter cross-sectional study designed to evaluate the control of dyslipidemia achieved in patients with IHD diagnosed more than a year ago in our geographic primary health care system. The total cholesterol (tC), LDL, triglyceride, HDL levels and tC/HDL were determined to analyze the impact of LLT. 205 patients were collected by 14 general practitioners in several PHC centers.


RESULTS
The average lipid profiles recorded (tC: 218 mg/dl; LDL: 151 mg/dl; triglyceride: 136 mg/dl; HDL: 49 mg/dl, and tC/HDL: 4,8) were far to the recommended by the international guidelines. The ideal (LDL < 100 mg/dl) and the acceptable targets (LDL < 130) were achieved by 9 and 30%. The HDL was not assess in 26.4% of the patients. It had had slight improvement of the women profile risk by more elevated values of HDLc than men (54.4 mg/dl vs. 46.9 mg/dl; p = 0.0002). Only 98 patients (45.85%) receive LLT, while 70% presented LDL > 130 mg/dl. The average dose of hypolipidemiants was small and the combination therapy had been scanty used (2.7%).


CONCLUSIONS
The hypolipidemic secondary prevention was incorrect, with a big gap between the efficacy of the LLT and the actual effectiveness. In the majority of cases (75-80%) the values exceeded the secondary prevention targets. In a quarter of patients had never existed a clearly defined therapeutic target because the levels of HDL and LDL were not assessed. It was not prescribed neither fitting drug doses nor combinations to reach lipidemic preventive levels.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000517:prevention & control*; D013030:Spain
D000960:Hypolipidemic Agents; D008055:Lipids