2023-07-20 09:23:28
Therapeutic adherence, vital in patients with high and very high cardiovascular risk
Cardiovascular diseases are the leading cause of death worldwide. Also in Spain, where the figure represents around 30 percent of all deaths, so therapeutic adherence is vital in patients with high or very high cardiovascular or vascular risk.
The probability of presenting a disease in this group is strongly influenced by risk factors. Among these are hypercholesterolemia and hypertension, which are the most important controllable risk factors.
According to medical guidelines and recommendations, high-risk patients are considered to be those with a history of prior cardiovascular disease, such as myocardial infarction or stroke, or those with coronary artery disease, peripheral artery disease, or cerebrovascular disease.
Patients at very high cardiovascular risk are those who, in addition to the aforementioned criteria, have multiple additional risk factors, such as the presence of type 2 diabetes mellitus, chronic kidney disease, or metabolic syndrome.
Patients with high or very high cardiovascular risk often require more intensive care and treatment, as they are at higher risk of serious complications.
Its specific incidence in Spain, according to different sources and studies, is estimated at around 10% of the adult population at high risk, while approximately 5% are in the very high risk category.
The main objective in these cases is to reduce this risk through medical interventions, lifestyle changes, and strict adherence to prescribed treatments, which will help improve their quality of life and prevent potentially fatal cardiovascular events.
A cardiologist and a patient discuss cardiovascular risk
“Your medicines” has brought together a cardiologist and a representative of the patients to delve into the high and very high cardiovascular risk.
The cardiologist is Dr. Carlos Escobar Cervantes, from the La Paz University Hospital in Madrid, and the patient, José Luis Blanco Ávila, vice president of the Spanish Association of Carriers of Cardiac Valves, Anticoagulated Patients and Adults with Congenital Heart Disease (AEPOVAC). We have spoken with them in this hospital.
From left on the right, José Luis Blanco, vice president of AEPOVAC; Javier Tovar; and the cardiologist Carlos Escobar/EFE/Sergio Asensio
Doctor Carlos Escobar, manage cardiovascular risk
Doctor Escobar, what is cardiovascular risk, what diseases does it cause and who are the patients with high or very high cardiovascular risk?
First of all, I want to emphasize that many times it is said that a patient is hypertensive, diabetic, and in reality it is not so. A patient has arterial hypertension, dyslipidemia, diabetes and this is important because something can always be done to improve their condition and her situation.
Regarding cardiovascular risk, there is already talk of vascular risk, because it is not only heart disease, it is also cerebrovascular and peripheral arterial disease.
We all have a cardiovascular risk, which means the probability of having a vascular event in a series of years. The patients who are at higher risk are the ones who have to be treated much more aggressively with the treatment because they are more likely to suffer an event, and they insist a lot on lifestyle changes.
To assess vascular risk, we rely on different variables such as age, sex, whether the patient smokes, cholesterol and blood pressure levels. And then there are a series of conditions such as diabetes, having had a previous vascular event or having chronic kidney disease, factors that greatly increase vascular risk.
With these data, the patient is analyzed globally, we determine the probability of developing a vascular event, and based on the patient’s risk, we prescribe the treatment to control blood pressure, cholesterol, diabetes and try to reduce that risk.
The patients who are most at risk are those who have had a previous event, a heart attack, a stroke, but treatment can always be applied.
What factors influence cardiovascular risk?
As I have mentioned, high blood pressure, diabetes, high cholesterol, having suffered a heart attack or stroke, but there are other lesser-known risk factors that are also important, for example, being overweight, obesity, sedentary lifestyle and stress. And the vascular risk increases with a poor diet.
Dr. Carlos Escobar, cardiologist at the La Paz University Hospital/EFE/Sergio Asensio
Doctor, what is therapeutic adherence like in this type of patient and how can it be improved?
We are dealing with pathologies that generally do not hurt or do not cause any apparent damage until they already have an event, but they are very serious pathologies that can leave very important sequelae in the patient.
The problem is that if the patient is not aware of how important it is to control blood pressure, cholesterol, diabetes, stop smoking, exercise, have a healthy diet, and relaxes, forgets medication, does not follow the diet well or becomes sedentary, their risk increases.
Therefore, it is very important, it is vital, to take the medication, otherwise, sooner or later, you can have a vascular event with fatal consequences.
Before suffering an event, many patients have a lack of adherence of around 50 percent, it is a very high figure that we cannot afford; really, the health of each one depends on ourselves and we must follow the recommendations of the doctors and comply with the treatments and all the indications.
José Luis Blanco, complying with therapeutic adherence is the line between life and death in cardiovascular risk
José Luis Blanco, what is your pathology?
My pathology is congenital heart disease from birth, 50 years ago. In 2007 I had an aortic valve and a mitral valve. I’m anticoagulated. I also have diabetes, hypertension and cholesterol. Normally, when you have a pathology, you have other associated ones.
How important is therapeutic adherence in patients with high and very high cardiovascular risk?
Fundamental, it is the line that separates life from death. When you put yourself in the hands of a health professional, it is to follow their instructions from start to finish. It can be difficult to do it, but you have to comply with the treatments, the patient has to be consistent.
And if at any time you have a question, have the confidence to consult the doctor, or if not, seek help in the experience of the patients through the associations.
José Luis Blanco, vice president of AEPOVAC/EFE/Sergio Asensio
José Luis, is the role of patient associations therefore essential?
The role that we as patient associations play is huge, but we could play a bigger role, since the rate of involvement of patients in associations is around three per cent, while in some European countries it is between 60 and 80%.
Patients have many resources. When we go to a consultation with a doctor, trust is a binomial between the two, this is essential.
And when we leave the consultation, patients should know that there are associations that help and contribute a lot in the management of the disease and in their emotional, personal and professional concerns.
From left to right, Dr. Carlos Escobar; Javier Tovar; and the vice president of AEPOVAC, José Luis Blanco/EFE/Sergio Asensio
EFEsalud and the Viatris Foundation maintain their common objective of raising awareness in society about the importance of taking medications correctly and improving levels of therapeutic adherence.
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