Dra. Dora Inés Molina de Salazar.
My ACADEMIC JOURNAL NO. 1. Cardio-Diabetes
A frequent reflection on my academic activity with the aim of sharing knowledge and better medical practice.
Last Friday, May 20, I met two very relevant doctors, doctors Antonio Coca and Alberto Mello e Silva. I did not want to let the days go by without telling you that it was an honor to share with them, and to bring you new and very interesting information from what we learned by listening to them.
Key points / Diary No. 01
- Regarding the issue of hypertension, it became clear to us that all the hypertension guidelines worldwide coincide in pointing out the need to stratify the global cardiovascular risk, before the doctor makes therapeutic decisions.
- Today cardiovascular disease is considered the leading cause of morbidity and mortality in the world, despite the efforts being made to control the various cardiovascular risk factors.
Our meeting took place within the framework of the 2022 Latin American Primary Care and Attention Congress held in the city of Bogotá, at the Cosmos hotel, on May 20, 21 and 22. There I had the opportunity to share with Dr. Antonio Coca, honorary professor at the University of Barcelona and the official executive appointed by the European Hypertension Society for relations with Latin America: an internist who has participated in the development of all the hypertension guidelines at the level of Europe.
During this congress for doctors, the International Cardio Diabetes Symposium was developed. The first topic was presented by Dr. Antonio Coca and the second topic by Dr. Alberto Mello e Silva:
- Hypertension leading the patient to the ideal treatment. (MD Antonio Coca)
- Mixed atherogenic dyslipidemia with cardiovascular risk. (MD Alberto Mello)
Here are my reflections:
Lecture by Dr. Antonio Coca.
Regarding the issue of Hypertension, it became clear to us that all the Hypertension guidelines worldwide coincide in pointing out the need to stratify the global cardiovascular risk, before the doctor makes therapeutic decisions.
Well, the level of risk is decisive for the selection of the initial pharmacological treatment strategy.
In addition, it became clear to us in the conference by Dr. Antonio Coca, that in the face of antihypertensive treatment, all systolic blood pressure greater than 150 mm of mercury, at any level of cardiovascular risk, should be started with a combination of two drugs at a low dose, to reach a therapeutic goal of hypertension in most patients less than 130-80 mm of mercury.
It became clear that only monotherapy, that is, giving a single drug, should be considered in patients with grade 1 hypertension and low risk, or in very elderly patients.
That is, those patients older than 80 years. Or patients considered frail.
Only monotherapy in this group of patients on antihypertensive therapy.
The current worldwide hypertension guidelines also coincide in recommending the reduction of polypharmacy, to improve therapeutic adherence, which at this time in the subject of hypertension is very low.
This is very relevant, especially in patients who have multiple cardiovascular risk factors and are associated with various comorbidities.
In the conference given by Dr. Alberto Mello e Silva from the city of Lisbon, Portugal, the topic discussed was mixed atherogenic dyslipidemia with cardiovascular risk.
From his speech he highlighted the following:
Today cardiovascular disease is considered the leading cause of morbidity and mortality in the world, despite the efforts being made to control the various cardiovascular risk factors.
The aging of the population contributes to an absolute increase in the number of cardiovascular events.
I remember something very important about Dr. Melo. His emphasis on the importance of a topic that has been called: Residual Risk. In other words, despite the fact that our patients with high cardiovascular risk are taking medications to reduce bad cholesterol, which is LDL cholesterol, despite this, a cardiovascular risk persists.
There are some factors that contribute to this residual cardiovascular risk, such as the increase in triglyceride-rich lipoproteins and inflammation at the level of the vascular wall.
Using combined lipid-lowering therapy in patients with mixed atherogenic dyslipidemia can generate a fundamental therapeutic synergism in reducing LDL cholesterol levels.
For example, if we give pravastatin to a patient with increased cholesterol and triglycerides and associate it with fenofibrate, we can achieve a reduction of up to 50% in the LDL cholesterol level with the mixture or combined therapy of pravastatin + fenofibrate.
The importance of managing cardiovascular risk factors is emphasized in the educational context for patients, provided combined lipid-lowering or antihypertensive therapy can lead to meeting lipid and blood pressure control goals.
But this has to be associated with therapeutic changes in lifestyle, that is:
A patient who has good pharmacological therapy and good adherence must have adherence to diet and exercise, in order to have an impact and reduce cardiovascular risk.
Physicians who participated in this event were very clear about the importance of combined antihypertensive lipid-lowering therapy to achieve therapeutic adherence and improve control of therapeutic goals.
Bogota Friday May 20, 2022.
My Academic Diary No. 01
Por. Dra. Dora Inés Molina de Salazar.