Compliance with a WHO guideline for cardiovascular disease prevention. A population based cross-sectional study in Argentina

CVD prevention recommendations

Authors

  • Pablo Gulayin Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
  • Laura Gutierrez Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
  • Fernando Lanas CIGES, Universidad de La Frontera (UFRO), Temuco, Chile
  • Nora Mores Municipalidad de Marcos Paz, Buenos Aires, Argentina
  • Jacqueline Ponzo Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
  • Matías Calandrelli Sociedad Argentina de Cardiología
  • Rosana Poggio Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina
  • Vilma Irazola departamento de Investigación en Enfermedades Crónicas del Instituto de Efectividad Clínica y Sanitaria

DOI:

https://doi.org/10.31053/1853.0605.v81.n1.41876

Keywords:

practice guideline, disease prevention, heart disease risk factors

Abstract

Introduction: Current recommendations for cardiovascular disease (CVD) prevention are guided CVD risk classification. This study aims to analyze the level of compliance with pharmacological and non-pharmacological recommendations outlined in the World Health Organization (WHO) CVD prevention clinical practice guideline within the general population of two cities in Argentina.

Methods: We analyzed the compliance with preventive recommendations from the WHO 2007 Guidelines for Management of Cardiovascular Risk in two cities of Argentina participating in the CESCAS population-based study in the Southern Cone of Latin America.

Results: 3990 participants were included. Considering the WHO recommendations, the use of antiplatelet medication was 5.6% (95% CI 3.5, 8.9) in primary prevention and 20.5% (95%= CI 16.0, 25.9) in secondary prevention. Regarding lipid-lowering medication, it was 6.7% (CI 95%= 4.4, 10.1) and 15.4% (CI 95%= 11.6, 20.1), respectively. As per non-pharmacological recommendations in the general population: low intake of fruit and vegetables was 78.4% (CI 95%= 76.8, 79.9); low physical activity was 26.9% (CI 95%= 25.3, 28.5), current cigarette smoking was 28.3% (CI 95%= 26.6, 30.0), overweight/obesity was 73.9% (CI 95%= 72.3, 75.6), and excessive alcohol intake was 2.6% (CI 95%= 2.1, 3.4).

Conclusions: It was observed a significantly low compliance with pharmacological and non-pharmacological recommendations for CVD prevention in the general population of two cities in Argentina. Urgent efforts are needed to improve compliance to cardiovascular preventive recommendations promoted by CPG, especially in Low- and Middle- Income Countries. 

Downloads

Download data is not yet available.

Author Biographies

Pablo Gulayin, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina

Médico, especialista en cardiología y salud pública. Magíster y Doctor de la Universidad de Buenos Aires. Investigador del Departamento de Investigación en Enfermedades Crónicas del Instituto de Efectividad Clínica y Sanitaria (IECS). Docente de la Cátedra de Salud Pública de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata.

Laura Gutierrez, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina

Licenciada en estadística. Investigadora del Departamento de Investigación en Enfermedades Crónicas del Instituto de Efectividad Clínica y Sanitaria (IECS). Investigadora del estudio CESCAS.

Fernando Lanas, CIGES, Universidad de La Frontera (UFRO), Temuco, Chile

Médico, especialista en medicina interna y cardiología. Doctor de la Universidad Autónoma de Barcelona. Profesor titular de la Facultad de Medicina, Universidad de La Frontera. Académico de la Unidad de Epidemiología Clínica del Centro de Excelencia CIGES, Chile. Investigador del estudio CESCAS.

Nora Mores, Municipalidad de Marcos Paz, Buenos Aires, Argentina

Médica, se desempeñó como secretaria de Salud del Municipio de Marcos Paz, provincia de Buenos Aires. Investigadora del estudio CESCAS.

Jacqueline Ponzo, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay

Médica especialista en Medicina Familiar y Comunitaria. Profesora adjunta de Medicina Familiar y Comunitaria en la Facultad de Medicina de la Universidad de la República, Uruguay. Investigadora del estudio CESCAS.

Matías Calandrelli, Sociedad Argentina de Cardiología

Médico especialista en cardiología de la ciudad de San Carlos de Bariloche. Miembro titular de la Sociedad Argentina de Cardiología (SAC). Investigador del estudio CESCAS.

Rosana Poggio, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina

Médica, especialista en cardiología. Magíster y Doctora de la Universidad de Buenos Aires. Investigadora del Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET). Se desempeñó como investigadora del estudio CESCAS.

Vilma Irazola, departamento de Investigación en Enfermedades Crónicas del Instituto de Efectividad Clínica y Sanitaria

Médica, cardióloga. Directora del departamento de Investigación en Enfermedades Crónicas del Instituto de Efectividad Clínica y Sanitaria (IECS). Investigadora del Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET). Directora de la Maestría en Efectividad Clínica de la Facultad de Medicina de la Universidad de Buenos Aires. 

References

Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J. 2010 Mar;31(6):642-8. doi: 10.1093/eurheartj/ehq030.

World Health Organization. The Global Burden Disease 2004 update. Available in: https://apps.who.int/iris/handle/10665/43942

Joshi R, Jan S, Wu Y, MacMahon S. Global inequalities in access to cardiovascular health care: our greatest challenge. J Am Coll Cardiol. 2008 Dec 2;52(23):1817-1825. doi: 10.1016/j.jacc.2008.08.049.

Mendis S, Abegunde D, Yusuf S, Ebrahim S, Shaper G, Ghannem H, Shengelia B. WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE). Bull World Health Organ. 2005 Nov;83(11):820-9.

Prevention of Cardiovascular Disease. Guidelines for assessment and management of cardiovascular risk. World Health Organization. Ginebra, 2007. Available in: https://apps.who.int/iris/handle/10665/43685

Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation. 2010 Apr 20;121(15):1768-77. doi: 10.1161/CIRCULATIONAHA.109.849166.

Guía ESC 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol. Oct. 2016;69(10). doi: 10.1016/j.recesp.2016.09.004

Argentina. Ministerio de Salud de la Nación. Prevención de las enfermedades cardiovasculares. Guía de bolsillo para la estimación y el manejo del riesgo cardiovascular. Buenos Aires, Argentina. 2009. Available in: http://iah.salud.gob.ar/doc/Documento13.pdf. Accessed April, 3rd of 2016.

Rubinstein Rubinstein AL, Irazola VE, Poggio R, Bazzano L, Calandrelli M, Lanas Zanetti FT, Manfredi JA, Olivera H, Seron P, Ponzo J, He J. Detection and follow-up of cardiovascular disease and risk factors in the Southern Cone of Latin America: the CESCAS I study. BMJ Open. 2011 May 26;1(1):e000126. doi: 10.1136/bmjopen-2011-000126.

Rubinstein AL, Irazola VE, Calandrelli M, Elorriaga N, Gutierrez L, Lanas F, Manfredi JA, Mores N, Olivera H, Poggio R, Ponzo J, Seron P, Chen CS, Bazzano LA, He J. Multiple cardiometabolic risk factors in the Southern Cone of Latin America: a population-based study in Argentina, Chile, and Uruguay. Int J Cardiol. 2015 Mar 15;183:82-8. doi: 10.1016/j.ijcard.2015.01.062.

Ministerio de Salud de la Nación.

Argentina. Códigos ATC. ANMAT. Available

in:

http://www.anmat.gov.ar/atc/CodigosATC.asp.

Collins D, Lee J, Bobrovitz N, Koshiaris C, Ward A, Heneghan C. whoishRisk - an R package to calculate WHO/ISH cardiovascular risk scores for all epidemiological subregions of the world. F1000Res. 2016 Oct 14;5:2522. doi: 10.12688/f1000research.9742.2.

Ceška R, Štulc T. Implementation of cardiovascular disease prevention guidelines into clinical practice: an unmet challenge? Curr Pharm Des. 2015;21(9):1180-4. doi: 10.2174/1381612820666141013152521.

World Health Organization. Best buys and other recommended interventions for the prevention and control of non-communicable diseases. Geneva: WHO; 2007. Available in: https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf?sequence=1.

Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, Gupta R, Kelishadi R, Iqbal R, Avezum A, Kruger A, Kutty R, Lanas F, Lisheng L, Wei L, Lopez-Jaramillo P, Oguz A, Rahman O, Swidan H, Yusoff K, Zatonski W, Rosengren A, Teo KK; Prospective Urban Rural Epidemiology (PURE) Study Investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011 Oct 1;378(9798):1231-43. doi: 10.1016/S0140-6736(11)61215-4.

Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, Amouyel P, Bruthans J, Castro Conde A, Cífková R, Deckers JW, De Sutter J, Dilic M, Dolzhenko M, Erglis A, Fras Z, Gaita D, Gotcheva N, Goudevenos J, Heuschmann P, Laucevicius A, Lehto S, Lovic D, Miličić D, Moore D, Nicolaides E, Oganov R, Pajak A, Pogosova N, Reiner Z, Stagmo M, Störk S, Tokgözoğlu L, Vulic D; EUROASPIRE Investigators. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016 Apr;23(6):636-48. doi: 10.1177/2047487315569401.

Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan-Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stöerk S, Tokgözoğlu L, Tsioufis C, Vulic D, Wood D; EUROASPIRE Investigators*. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol. 2019 May;26(8):824-835. doi: 10.1177/2047487318825350.

Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Reiner Z, Keil U; EUROASPIRE Study Group. EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):530-40. doi: 10.1097/HJR.0b013e3283383f30.

Lopez-Carmona D, Bernal-Lopez M, Mancera-Romero J, Jansen-Chaparro S, Portales-Fernandez I, Baca-Osorio AJ, Perez-Gonzalez R, Tinahones FJ, Gomez-Huelgas R. Compliance with cardiovascular drug prevention measures in a general population: the Multidisciplinary Intervention in Primary Care (IMAP) study. Eur J Prev Cardiol. 2012 Oct;19(5):1074-81. doi: 10.1177/1741826711418166.

Rosende, A., Caniggia, C., Casuscelli, J., Mirada, M., Comtesse, D. Conductas frente a la utilización de estatinas en una muestra de médicos de la Argentina. Estudio COFEMA. Sociedad Argentina de Cardiología.. Rev Argent Cardiol, 2016;84(6), 558-64.

Gulayin PE, Lozada A, Beratarrechea A, Gutierrez L, Poggio R, Chaparro RM, Santero M, Masson W, Rubinstein A, Irazola V. An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina. Am J Prev Med. 2019 Jul;57(1):95-105. doi: 10.1016/j.amepre.2019.02.018.

Sociedad Argentina de Cardiología.. Aspirina en prevención primaria: nueva recomendación. Available in: https://www.sac.org.ar/actualidad/aspirina-en-prevencion-primaria-nueva-recomendacion/

Masson G, Lobo M, Masson W, Molinero G. Aspirin in primary prevention. Meta-analysis stratified by baseline cardiovascular risk. Arch Cardiol Mex. 2020;90(3):293-299. doi: 10.24875/ACM.20000267.

Ministerio de Salud de la Nación, Argentina. Guía de Práctica Clínica Nacional sobre Prevención Cardiovascular. 2023. Avialable in: https://bancos.salud.gob.ar/recurso/guia-de-practica-clinica-nacional-sobre-prevencion-cardiovascular.

Ministerio de Salud de la Nación. Argentina. Abordaje Integral de personas con Enfermedades Crónicas. Modelo MAPEC. Preograma REDES. 2016: Available in: https://bancos.salud.gob.ar/sites/default/files/2018-10/0000000715cnt-2017-06_mapec.pdf

INDEC (Instituto Nacional de Estadística y Censos). Argentina. Cuarta Encuesta Nacional de Factores de Riesgo. Resultados definitivos. 2019. Available in: https://www.indec.gob.ar/ftp/cuadros/publicaciones/enfr_2018_resultados_definitivos.pdf

Marchal S, Van't Hof AWJ, Hollander M. The new European guideline on cardiovascular disease prevention; how to make progress in general practice? Eur J Gen Pract. 2018 Dec;24(1):57-59. doi: 10.1080/13814788.2017.1401063.

Barth JH, Misra S, Aakre KM, Langlois MR, Watine J, Twomey PJ, Oosterhuis WP. Why are clinical practice guidelines not followed? Clin Chem Lab Med. 2016 Jul 1;54(7):1133-9. doi: 10.1515/cclm-2015-0871.

Sabaté E. (Ed.). Adherence to long-term therapies: Evidence for action. World Health Organization, Geneva, Switzerland. (2003). Available in: https://www.paho.org/en/documents/who-adherence-long-term-therapies-evidence-action-2003.

Schargrodsky H, Hernández-Hernández R, Champagne BM, Silva H, Vinueza R, Silva Ayçaguer LC, Touboul PJ, Boissonnet CP, Escobedo J, Pellegrini F, Macchia A, Wilson E; CARMELA Study Investigators. CARMELA: assessment of cardiovascular risk in seven Latin American cities. Am J Med. 2008 Jan;121(1):58-65. doi: 10.1016/j.amjmed.2007.08.038.

Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010 Apr;100(4):590-5. doi: 10.2105/AJPH.2009.185652.

Zeballos JL. Argentina: efectos sociosanitarios de la crisis 2001-2003, 1ª. ed. Buenos Aires: Organización Panamericana de la Salud, 2003. Available In: https://iris.paho.org/handle/10665.2/6247.

Published

2024-03-27

How to Cite

1.
Gulayin P, Gutierrez L, Lanas F, Mores N, Ponzo J, Calandrelli M, Poggio R, Irazola V. Compliance with a WHO guideline for cardiovascular disease prevention. A population based cross-sectional study in Argentina: CVD prevention recommendations. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2024 Mar. 27 [cited 2024 Jul. 18];81(1):96-114. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/41876

Issue

Section

Original Papers