Metabolic syndrome: scope of therapeutic goals. Family medicine outpatient clinic at a healthcare institution (IPS) in Bogotá
Síndrome metabólico: alcance de metas terapéuticas consulta de medicina familiar en una IPS de Bogotá
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Goyeneche, H., Ardila, R., Villamil, P., & Moncayo, A. F. (2013). Metabolic syndrome: scope of therapeutic goals. Family medicine outpatient clinic at a healthcare institution (IPS) in Bogotá. Journal of Medicine and Surgery Repertoire, 22(2), 98–107. https://doi.org/10.31260/RepertMedCir.v22.n2.2013.857
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Abstract
Previous works on controlling the major components of the metabolic syndrome (MS), have reported significant results on reducing overall cardiometabolic risk although it usually proves insufficient in clinical practice. Objective: to describe the scope of therapeutic goals in patients with MS seen at the family medicine outpatient clinic at an IPS in Bogotá DC. Methods: a descriptive retrospective study was performed; MS patients older than 20 were identified in electronic medical records from May 1 to October 31 2008; an 18-month follow-up was conducted. Results: 79 patients were eligible, predominantly females (64.5%); 69.6% belonged to the mature adult group;. mean age was 54.5 years (SD 9.3); 84.8% (n 67) were in the medium risk group and 15.2% (n 12) in the high risk group. At first follow-up, 64.5% and 58.2% met the targeted blood pressure and serum glucose goals as well as the cholesterol goals, LDL, non-HDL-C and HDL-C in 54.4%, 32.9% and 11.3%. Only 30% (n 24) attended a second follow-up visit and met blood pressure and serum glucose goals in 66.6% and 41.6%, and LDL-C, non-HDL-C and HDL-C goals in 45.8%, 45.8% and 4.1%. Waist circumference measurement goals were not met. Conclusions: goal achie vement was high compared to other available reports, although this data is not representative for it corresponds to only 30.7% of the initial records. Further studies are required to determine the real goal scope enabling effective intervention policies to be implemented.
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References
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24. Alonso M, Llisterri J, Rodrlguez G, Ferreiro M, Gonziilez D, División J, et al. Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006. Rev Clin Esp. 2008;208(8):393-9.
25. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al. Pri mary prevention of acute coronary events with lovastatin in men and women with averagecholesterollevels: results of AFCAPS/TexCAPS. AirForce/Texas Coro nary Atherosclerosis Prevention Study. JAMA. 1998 May 27;279(20):1615-22.
26. Pascual JM, Rodilla E, Costa JA, Perez-Lahiguera F, Gonzalez C, Lurbe E, et al. Body weight variation and control of cardiovascular risk factors in essential hypertension. Blood Press. 2009;18(5):247-54.
27. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002Feb 7;346(6):393-403.
28. Roussel R, TravertF, Pasquet B, Wilson PW, Smith SC, Jr., Goto S, et al. Metfor min use and mortality among patients with diabetes and atherothrombosis. Arch lntern Med. 2010 Nov 22;170(21):1892-9.
2. Eckel RH, Grundy SM, ZimmetPZ. The metabolic syndrome. Lancet. 2005 Apr l 6;365(9468):1415-28.
3. Mottillo S,Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010 Sep 28;56(14):1113-32.
4. Organización Panamericana de la Salud. CARMEN Una Iniciativa para Conjunto de Acciones para la Reducción Multifactorial de Enfermedades No transmisibles [monografía en Internet]. Habana, Cuba: OPS; 2002 [citado 12Feb.2013]. Dispo nible en: http://www.paho.org/spanish/ad/dpc/nc/CARMEN-doc2.pdf
5. National Cholesterol Education Program (NCEP) Expert Panel on Detec tion, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation. and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Ill) final report. Circulation. 2002 Dec l7;106(25):3143-42I.
6. Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003- 2006. Natl Health Stat Report. 2009 May 5;(13):1-7.
7. Villegas A, Botero J, Arango !, Arias S, Toro M. Prevalencia del síndrome meta bólico en El Retiro, Colombia. Iatreia. 2010;16(4):291-7.
8. Manzur F, Alvear C, Alayón A. Caracterización fenotípica y metabólica del síndrome metabólico en Cartagena de Indias. Rev Colomb Cardiol. 2008;15(3): 99-101.
9. Navarro E, Vargas R. Síndrome metabólico en el suroccidente de Barranquilla (Colombia). Salud Uninorte. 2008;24(1):40-52.
10. Pinzón J.B. Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia. Biomedica. 2007;27(172):179.
11. Manzur F, De la Ossa M, Trespalacios E, Abuabara T, Lujan M. Prevalencia de síndrome metabólico en el municipio de Arjona,Colombia. Rev. Colomb. Car diol. 2008 Sep;l 5(5):215-22.
12. Lombo B, Villalobos C, Tique C, Satizábal C, Franco C. Prevalencia del sín drome metabólico entre los pacientes que asisten al servicio Clínica de Hiper tensión de laFundación SantaFe de Bogotá. Rev. Colomb. Cardiol. 2006 May; 12(7):472-8.
13. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood lnstitute Scientific Statement. Exe cutive summary. Cardiol Rev. 2005 Nov;l3(6):322-7.
14. Athyros VG, Mikhailidis DP, Papageorgiou M, Didangelos TP, Peletidou A, Kleta D, et al. Targeting vascular risk in patients with metabolic syndrome but without diabetes. Metabolism. 2005 Aug; 54(8):1065-74.
15. Alvarez M, Suarez C, Mantilla T, Franch J, Ruilope L, Banejas J. Estudio PRE VENCAT: control del riesgo cardiovascular en atención primaria. Med Clin (Barc). 2005;124(11):406-10.
16. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome -a new world- wide defini tion. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5J:469-80.
17. ldg.org [página en Internet]. Brussels, Belgium: lnternational Diabetes Federa tion; 2010 [citado Nov. 2010]. Disponible en: http://www.idforg
18. Arias L, Montero J, Catellanos J. lnteración humana integralidad y ciclos vitales: el ciclo vital individual. Bogotá: Ministerio de Salud; 1993.
19. Friedewald WT, Levy Rl, Fredrickson OS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ul tracentrifuge. Clin Chem. 1972 Jun;18(6):499-502.
20. EUROASPIRE. A European Society of Cardiology survey of secondary preven tion of coronary heart disease: principal results. EUROASPIRE Study Group. European Action on Secondary Prevention through Intervention to Reduce Events. Eur Heart J. 1997 Oct;18(10):1569-82.
21. Gaede P, Vede! P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93.
22. Barrios V, Escobar C, Calderon A, Llisterri JL, Alegria E, Muniz J, et al. Preva lence of the metabolic syndrome in patients with hypertension treated in general practice in Spain: an assessment of blood pressure and low-density lipoprotein cholesterol control and accuracy of diagnosis. J Cardiometab Syndr. 2007;2(1):9- 15.
23. Llisterri Caro JL, Rodríguez Roca GC, Alonso MorenoFJ, Lou AS, Divisan Ga rrote JA, Santos Rodríguez JA, et al. [Blood pressure control in Spanish hyper tensive patients in Primary Health Care Centres. PRESCAP 2002 Study]. Med Clin (Barc). 2004Feb 14;122(5):165-71.
24. Alonso M, Llisterri J, Rodrlguez G, Ferreiro M, Gonziilez D, División J, et al. Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006. Rev Clin Esp. 2008;208(8):393-9.
25. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al. Pri mary prevention of acute coronary events with lovastatin in men and women with averagecholesterollevels: results of AFCAPS/TexCAPS. AirForce/Texas Coro nary Atherosclerosis Prevention Study. JAMA. 1998 May 27;279(20):1615-22.
26. Pascual JM, Rodilla E, Costa JA, Perez-Lahiguera F, Gonzalez C, Lurbe E, et al. Body weight variation and control of cardiovascular risk factors in essential hypertension. Blood Press. 2009;18(5):247-54.
27. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002Feb 7;346(6):393-403.
28. Roussel R, TravertF, Pasquet B, Wilson PW, Smith SC, Jr., Goto S, et al. Metfor min use and mortality among patients with diabetes and atherothrombosis. Arch lntern Med. 2010 Nov 22;170(21):1892-9.