Abstract
Objetivos
Evaluar la modificación de los factores de riesgo y del riesgo coronario en adultos (14–75 años) tras un período de entre 1 y 5 años de ser incluidos en el PAPPS.
Diseño
Estudio multicéntrico de intervención sin asignación aleatoria antesdespués.
Emplazamiento
Atención primaria
Participantes
Se evalúa a los pacientes incluidos en el PAPPS de 3 centros salud, 634 seguidos durante 5 años, 890 durante 4 años, 1.605 durante 3 años y 2.829 durante 2 años.
Intervenciones
Consejo mínimo para abandonar tabaco y consumo excesivo de alcohol, medidas educacionales y farmacológicas para reducir colesterol y presión arterial.
Mediciones principales
Toma de la presión arterial, colesterol, peso, consumo tabaco y alcohol. En el subgrupo 30–75 años determinación del riesgo coronario. Estas variables se determinaron al inicio y al final de los distintos períodos de seguimiento.
Resultados
La reducción del riesgo coronario fue entre el 0,2 y el 0,3%, de la presión arterial sistólica entre 0,4 y 0,9 mmHg, y de la diastólica entre 0,3 y 0,7 mmHg, del colesterol entre 0,5 y 2,5 mg/dl, del porcentaje de fumadores entre el 0,3 y el 2,8% y del consumo excesivo de alcohol entre el 0,2 y el 1%.
Conclusiones
Escasa repercusión de las intervenciones realizadas para reducir el riesgo coronario o los factores de riesgo en la población total. La utilidad principal de los programas de prevención cardiovascular y multifactoriales estribaría en la detección de los pacientes de alto riesgo para, posteriormente, intervenir sobre ellos.
Palabras clave: Efectividad, Atención primaria, Prevención cardiovascular
Abstract
Objectives
To evaluate the modification of risk factors and of coronary risk (CR) in adults (14–75 years old) after a period of 1 to 5 years in the PAPPS (special prevention programme).
Design
Multi-centre intervention study with no before-and-after random allocation.
Setting
Primary care.
Participants
Patients included in the PAPPS at 3 health centres, 634 monitored for five years, 890 for four years, 1605 for 3 years and 2829 for 2 years, were evaluated
Interventions
Minimum counselling to give up tobacco and over-consumption of alcohol, and educational and pharmacological measures to reduce cholesterol and blood pressure.
Main measurements
Recording of blood pressure, cholesterol, weight, and tobacco and alcohol consumption. CR was determined in the sub-group of 30–75 years old. These variables were determined at the start and end of the various monitoring periods.
Results
CR was reduced by between 0.2 and 0.3%; systolic blood pressure, by between 0.4 and 0.9 mmHg; diastolic pressure, by between 0.3 and 0.7 mmHg; cholesterol, by between 0.5 and 2.5 mg/dl; percentage of smokers, by between 0.3 and 2.8%; and over-consumption of alcohol, by between 0.2 and 1%.
Conclusions
Scant success of the interventions to reduce CR and risk factors in the population as a whole. The main use of cardiovascular prevention programmes with many factors resides in detecting high-risk patients for subsequent intervention.
Key words: Effectiveness, Primary care, Cardiovascular prevention
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