Specialized units to control ‘silent disease’ caused by high cholesterol

The European Health Survey (EESE) in Spain, carried out between July 2019 and July 2020 with adults over the age of 15, considers the three most frequent chronic diseases among the population from 1993 to 2020 Hypertension, hypercholesterolemia and diabetes, According to the study, all of them have maintained an upward progression: high blood pressure from 11.2% to 19.03%, diabetes from 4.10% to 7.50%, and high blood pressure gone. High cholesterol, 8.20% to 15.29%, the latter is the one that has grown the most in the last two decades. Some data regarding high cholesterol among the Spanish population, which the ENRICA study, of a cross-sectional nature, has already warned, indicated that “of the adult population, 50.5% had hypercholesterolemia (total cholesterol 200 mg/dL or pharmacological treatment) and 44.9% elevated low-density lipoprotein cholesterol (≥ 130 mg/dL or pharmacological treatment), with no significant difference between the sexes”.

in most cases High cholesterol level linked to hereditary problem, Dr. José María Mostaza, President of the Spanish Society of Arteriosclerosis (SEA), explains that hypercholesterolemia “is a very common disorder and it is estimated that at least 1 in 250 people in the general population have familial hypercholesterolemiaAccording to data published in the Fundación Hipercholesterolemia Familiar, in Spain it is calculated that there are About 200,000 people suffer from this disease, “This is why families with a tendency to high cholesterol have a higher risk of cardiovascular complications (heart attacks or strokes). Diet, a sedentary lifestyle or obesity control cholesterol levels, but they are much more likely than hereditary. has little impact”, says the SEA president.

is about A pathology known as a “silent disease”, as it does not cause any symptoms. Most patients with high cholesterol are diagnosed in routine tests performed for another reason, at company check-ups or as a result of severe cholesterol elevation found in a family member with the intention of ruling out familial hypercholesterolemia. in tests. “It’s a serious disease that causes too much cholesterol, Usually 300 or 400 mg/dL. at overand with heart disease at a very young age”, says Dr. José María Mostaza.

Cholesterol is linearly associated (the higher, the greater the risk) with the incidence of Angina pectoris, myocardial infarction, stroke or lack of perfusion in the lower extremities, An early diagnosis and treatment improves the prognosis, while reducing the future risk of these complications. In order to achieve better management and treatment of this pathology, the Spanish Society of Arteriosclerosis published a document in 1997 which lays the foundation for defining and regulating the so-called. Lipid Units (UL) in Spanish Hospitals, Units that began to operate in the 1970s, expanded their implementation during the 1980s, and which carry out care, teaching and research work of great importance in the field of lipid metabolism disorders and arteriosclerosis. ,

nowadays, There are 73 units across Spain.Associated with more initiatives created in the last four recent months we make, A training project carried out by SEA with the sponsorship of Amgen Biotechnology Company. According to the president of the SEA, “in Spain the number of lipid units (that is, units specialized in the treatment of severe cholesterol and triglyceride disorders) is scarce with a vast regional imbalance. While some communities, such as Catalonia, have several dozen, others have one. This creates disparities in healthcare. We have found that in areas of the country with no lipid units, the number of patients diagnosed with familial hypercholesterolemia is low, as evidenced by the need for sophisticated therapies to manage the disease. the number is.”

One of these is located in ULs Central University Hospital of Asturias (HUCA), Its manager, endocrinologist Francisco Villazón, explains that “these units basically work on the basis of referral criteria from primary care and, of course, to care for patients with a high prevalence of cardiovascular pathology, highlighting cardiology, neurology, vascular. This specialist says that “it is necessary to create a multidisciplinary working group that covers all the above specialties apart from clinical analysis, genetics and hospital pharmacy” . For proper management of the unit, there should be good coordination and referral criteria from the various specialties involved. Regarding the operation within the unit itself, coordinated by a specialist in endocrinology and nutrition, “we have a nurse trained in nutrition who is in charge of educating the patient on healthy habits and the correct administration of injectable drugs,” says Dr. Villazon says.

With regard to the profile of the patient attending the HUCA lipid unit, according to the person in charge, “monogenic HF, either H or O, combined familial hyperlipidemia and mixed dyslipidemia, dysbetalipoproteinemia, hypertriglyceridemia, dyslipidemia refractory to treatment and secondary dyslipidemia.” also changes in the metabolism of HDLC particles. They are all about Profile of patients with high and very high cardiovascular risk, Hence the importance of correct diagnosis and therapeutic approach”.

Proper management of this disease favors its control., A fact that is achieved due to the availability of advanced biochemical and genetic methods that allow the diagnosis of new diseases and the discovery of new therapeutic targets, the management of which requires an in-depth knowledge of metabolism. In this sense, Dr. José María Mostaza assures that “lipid units in a global way, Diagnosis and treatment of cardiovascular risk factors and, more specifically, of Diagnosis and treatment of severe changes in cholesterol and triglyceridesespecially of genetic variants”.

The way in which patients with this type of pathology begin, the role of primary care, according to the president of the SEA, noting that “most elevations in cholesterol or triglycerides that require treatment can be managed in primary care”. However, in study cases of subjects with severe dyslipidemia, hypercholesterolemia and hypertriglyceridemia of familial origin, hyperlipoproteinemia(a) or relatives with heart disease at an early age, lipid units are in charge of diagnosis and treatment. “In addition, ULs are also responsible for the diagnosis and treatment of less severe lipid disorders, but in complex situations, such as their management. In children, pregnant women, vulnerable elderlywhen there is interaction, drug intolerance, etc”, explains this expert.