Cardiovascular accidents do not arrive by surprise. More than 99% of people who suffered a heart attack, a stroke or heart failure already had at least one risk factor above the optimal level in advance. He is the striking of a large -scale study led by Northwestern Medicine and the University of Yensei in South Korea. The factors are well known: high blood pressure, cholesterol, glucose and smoking. It is the scales to consider them at risk that are novel.
The study analyzed health records for more than a decade of more than nine million adults in South Korea and almost 7,000 people in the United States. Refutes the notion that these events often affect people without warning signs with overwhelming percentages. Almost 100 % had them, and in 93 % of cases they presented two or more. “It is what we intended to demonstrate,” explains in an exchange of messages Philip Greenland, professor of cardiology at the Faculty of Medicine of the Northwestern University and main author of the study.
Recent studies situ around 75% patients who have suffered a cardiovascular event that had some previous risk factor. It is a high percentage, but leaves a negligible nothing 25% of cases without a clear explanation. Greenland’s team believes that this is because only risk factors were sought that had a clinical diagnosis. “The idea of our study was to use the non -optimal level as the best indicator of a certain level of increased risk, instead of the level at which medications are usually prescribed,” he explains.
Thus, within that 99% are the smokers, but also the exfusters. Diabetics, prediabetics and those with a blood sugar level greater than 100. Those who have clinically high cholesterol (more than 240), simply high (more than 200) or those who have it low for being treated. And those who have blood pressure equal to or greater than 120/80 (it is usually considered clinically high 140/90) or in treatment. “Recent research was overlooking these exhibitions,” explains the cardiologist. And this made us not have a reliable photograph of what could be happening.
“His conclusion is devastating, but his criteria are very strict,” explains in telephone conversation Jaume Marrugat, an epidemiologist at the Hospital del Mar. Marrugat believes that the study is well done, which has a broad database, but that this requirement in the scales can be excessive, giving a too round result. “I would like to know what percentage of the population that did not suffer a cardiovascular accident is above the optimal levels,” he reflects. The study does not say it. But to give an example, more than half of the Spaniards have cholesterol levels above 200, a percentage that would rise even more if we count those who treat this condition. In addition, in the American database, people were between 45 and 84 years. There are no concrete data for that age strip, but it is known that cholesterol increases with age.
This demand may make the most striking data, but the underlying idea is no less valid. To demonstrate, at a later time in the study, researchers only took into account patients with clinically high levels. And the pattern remained. At least 90 % of patients still had at least one important risk factor before their first cardiovascular event.
“This study provides forceful evidence that reinforces the current prevention paradigm,” says Alfonso Valle, head of the Cardiology Service of Denia Hospital (Alicante) and clinical cardiologist. Valle emphasizes that “it questions excessive recent attention to the calls SMURF-LESS (infarcted patients without traditional risk factors) and shows that, despite the interest in emerging risk factors such as inflammation and genetic, the bulk of cardiovascular risk continues to reside in classical factors. ”These data have an obvious clinical application, explains the cardiologist.“ The prevention and systematic approach of hypertension, dyslipemia, diabetes and smoking continue to be the fundamental basis to reduce cardiovascular load population ”.
Mardruga is shown according to this idea, and remember that in Spain, the rate of this type of incidents has been slightly reduced in the last 30 years. “This is attributable to the battle that our colleagues in primary care. Primary care is responsible for prevention, to act before there is a disease.” Therefore, beyond the specific reflections on the measurement scales. Mardruga positively values the study, because he points out in the right direction.
Beyond numbers, scientific evidence goes in this sense. A recent analysis published in the magazine New England of Journal Medicine He pointed out that the risk of a cardiovascular accident throughout life was 24 % among women and 38 % among men with the five classic risk factors (the aforementioned obesity). The absence of these five factors at 50 was associated with a higher life expectancy in more than a decade. In this case, for these people, the numbers may be important.
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