1. Investigación

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarises the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.

Una prevención cardiovascular eficiente exige aprovechar todas las oportunidades de contacto de las personas con los Servicios de Salud para la detección de los factores de riesgo modificables (FRV) y estratificar el riesgo cardiovascular global (RCV). Ello implica especialmente a los servicios de Atención Primaria (AP), que deben coordinarse con la Atención Hospitalaria (AH) para poner a disposición de la población todos los recursos sanitarios disponibles. Además, es preciso tener en cuenta la aportación de la Salud Laboral (Medicina del Trabajo) y de las oficinas de Farmacia. Existen se˜nales esperanzadoras respecto a la posibilidad de superar las barreras que limitan el necesario intercambio de información entre los profesionales de AP y AH, como base para una adecuada coordinación entre ambos niveles asistenciales. Ello incluye la implantación de algoritmos de derivación y alta (en esta revisión nos referimos a los relacionados con las dislipidemias) aceptados por los profesionales de ambos niveles y facilitados en la actualidad por la disponibilidad de nuevas herramientas corporativas (móvil, correo electrónico, consulta virtual). El reto radica en aprovechar la oportunidad que ofrecen para hacer efectiva su implementación.

Probiotic foods, including fermented dairy (FD) products such as yogurt and cheese, naturally contain live microorganisms, but the relationship between the consumption of probiotic foods and health is unclear. The aim of the present narrative review is to integrate the available information on the relationship between the most studied FD products, which are yogurt and cheese, and cardiometabolic risk factors obtained from meta-analysis, systematic reviews of prospective cohort studies (PCSs) and PCSs published up to 2 November 2019. Additionally, the effects identified by randomized controlled trials of less-studied FD products, such as kefir and kimchi, on cardiometabolic risk factors are provided. PCSs have shown that the consumption of cheese, despite its high saturated fat content, is not associated with expected hypercholesterolemia and an increased cardiovascular risk. PCSs have revealed that the total consumption of FD appears to be associated with a lower risk of developing stroke and cardiovascular disease. The consumption of yogurt seems to be associated with a lower risk of developing type 2 diabetes. There is a lack of sufficient evidence of a protective relationship between FD or cheese consumption and metabolic syndrome. Moreover, the association of FD, cheese and yogurt with hypertension needs further evidence. In conclusion, the intake of fermented foods containing probiotics, particularly yogurt and cheese (of an undetermined type), opens up new opportunities for the management of cardiometabolic risk factors.

El estilo de vida es un concepto complejo que incluye los aspectos externos a nosotros mismos que pueden modular e influir en nuestra salud. Los conocimientos sobre la relación entre el estilo de vida y el riesgo cardiovascular están lejos de proporcionar los niveles de evidencia que se han conseguido con los ensayos clínicos con fármacos, debido a que los estudios son escasos, fundamentalmente de tipo observacional y en grandes cohortes, con la dificultad añnadida de la no existencia de métodos seguros para conocer con precisión la ingesta diaria o lo largo de tiempo, así como la dificultad en la recogida de datos y en la medición de la adherencia debido a diferencias en la composición de los alimentos en distintas épocas y a la conducta alimentaria cambiante que posee el ser humano a lo largo del tiempo. En este documento nos hemos propuesto llevar a cabo una revisión actualizada y jerarquizada en base a las evidencias actuales, prestando atención a tres aspectos que tienen gran importancia patogénica y que podemos modificar directamente: la actividad física, el consumo de tabaco y el patrón de alimentación. Con ello pretendemos actualizar los nuevos conocimientos sobre su relación con el riesgo cardiovascular aportando evidencias útiles, constituyendo una herramienta sencilla dirigida especialmente a todos los profesionales de la salud implicados en el cuidado de personas con riesgo cardiovascular para trasladarlos a la práctica clínica, definiendo unas líneas de actuación sencillas y fáciles para ser transmitidas a las personas que reciban un consejo para la prevención primaria y secundaria de las enfermedades cardiovasculares. / Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases.