Abstract Objective To analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured. Method We included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004). Results In stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI <1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II. Conclusions In our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.

Resumen Objetivo Analizar la supervivencia poblacional del cáncer de mama (CM) en estadios precoces, estimando la tendencia temporal del exceso de mortalidad (EM) a largo plazo en periodos anuales y quinquenales, y determinando, si es posible, una proporción de pacientes que puedan considerarse curadas. Método Se incluyó la cohorte de pacientes diagnosticadas de CM en estadios I y II antes de los 60 años de edad en Gerona y Tarragona (N = 2453). Se calcularon la supervivencia observada (SO) y la supervivencia relativa (SR) al CM hasta los 20 años de seguimiento. Para valorar el EM se estimó la SR a intervalos anuales (SRI) y quinquenales (SR5). Los resultados se presentan por grupos de edad (≤49 y 50-59), estadio (I/II) y periodo de diagnóstico (1985-1994 y 1995-2004). Resultados En el estadio I, la SO y la SR fueron mayores en 1995-2004 que en 1985-1994: 3,5% a los 15 años de seguimiento y 4,5% a los 20 años. La SO superó el 80% en el estadio I y se mantuvo inferior al 70% en el estadio II. Sin embargo, el EM a largo plazo no desapareció (SRI <1) independientemente del grupo de edad, el estadio y el periodo de diagnóstico. A los 15 años de seguimiento, el EM a 5 años osciló entre el 1-5% en el estadio I (SR5 ≥0,95) y el 5-10% en el estadio II. Conclusiones En nuestra cohorte, a los 15 años de seguimiento se detectó que el EM anual no desapareció y el quinquenal fue del 1-10%. Por ello, no se pudo determinar una proporción de curación del CM durante el periodo de estudio.

Abstract Objective To analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured. Method We included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004). Results In stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI <1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II. Conclusions In our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.

Resumen Objetivo Analizar la supervivencia poblacional del cáncer de mama (CM) en estadios precoces, estimando la tendencia temporal del exceso de mortalidad (EM) a largo plazo en periodos anuales y quinquenales, y determinando, si es posible, una proporción de pacientes que puedan considerarse curadas. Método Se incluyó la cohorte de pacientes diagnosticadas de CM en estadios I y II antes de los 60 años de edad en Gerona y Tarragona (N = 2453). Se calcularon la supervivencia observada (SO) y la supervivencia relativa (SR) al CM hasta los 20 años de seguimiento. Para valorar el EM se estimó la SR a intervalos anuales (SRI) y quinquenales (SR5). Los resultados se presentan por grupos de edad (≤49 y 50-59), estadio (I/II) y periodo de diagnóstico (1985-1994 y 1995-2004). Resultados En el estadio I, la SO y la SR fueron mayores en 1995-2004 que en 1985-1994: 3,5% a los 15 años de seguimiento y 4,5% a los 20 años. La SO superó el 80% en el estadio I y se mantuvo inferior al 70% en el estadio II. Sin embargo, el EM a largo plazo no desapareció (SRI <1) independientemente del grupo de edad, el estadio y el periodo de diagnóstico. A los 15 años de seguimiento, el EM a 5 años osciló entre el 1-5% en el estadio I (SR5 ≥0,95) y el 5-10% en el estadio II. Conclusiones En nuestra cohorte, a los 15 años de seguimiento se detectó que el EM anual no desapareció y el quinquenal fue del 1-10%. Por ello, no se pudo determinar una proporción de curación del CM durante el periodo de estudio.

ABSTRACT Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population).

RESUMEN La supervivencia relativa se ha utilizado habitualmente como medida de la evolución temporal del exceso de riesgo de mortalidad en cohortes de pacientes diagnosticados de cáncer, teniendo en cuenta la mortalidad de una población de referencia. Una vez estimado el exceso de riesgo de mortalidad pueden calcularse tres probabilidades acumuladas a un tiempo T: 1) la probabilidad de fallecer asociada a la causa de diagnóstico inicial (enfermedad en estudio), 2) la probabilidad de fallecer asociada a otras causas, y 3) la probabilidad de supervivencia absoluta en la cohorte a un tiempo T. Este trabajo presenta la aplicación WebSurvCa (https://shiny.snpstats.net/WebSurvCa/), mediante la cual los registros de cáncer de base hospitalaria y poblacional, y los registros de otras enfermedades, estiman dichas probabilidades en sus cohortes seleccionando como población de referencia la mortalidad de la comunidad autónoma que consideren.

ABSTRACT Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population).

RESUMEN La supervivencia relativa se ha utilizado habitualmente como medida de la evolución temporal del exceso de riesgo de mortalidad en cohortes de pacientes diagnosticados de cáncer, teniendo en cuenta la mortalidad de una población de referencia. Una vez estimado el exceso de riesgo de mortalidad pueden calcularse tres probabilidades acumuladas a un tiempo T: 1) la probabilidad de fallecer asociada a la causa de diagnóstico inicial (enfermedad en estudio), 2) la probabilidad de fallecer asociada a otras causas, y 3) la probabilidad de supervivencia absoluta en la cohorte a un tiempo T. Este trabajo presenta la aplicación WebSurvCa (https://shiny.snpstats.net/WebSurvCa/), mediante la cual los registros de cáncer de base hospitalaria y poblacional, y los registros de otras enfermedades, estiman dichas probabilidades en sus cohortes seleccionando como población de referencia la mortalidad de la comunidad autónoma que consideren.

Objectives: To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics. Methods: Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. Results: In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³). In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%). Conclusions: Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis.

Objetivos: Conocer la incidencia de gastroenteritis aguda en los peregrinos del Camino de Santiago, los factores de riesgo asociados y su caracterización microbiológica. Métodos: Se diseñaron dos estudios simultáneos, uno transversal mediante encuestas autocumplimentadas de peregrinos llegados a Santiago y otro de casos y controles a los peregrinos en el camino. Se hizo un análisis multivariado mediante regresión logística. Resultados: En el estudio transversal la densidad de incidencia fue de 23,5 episodios de gastroenteritis aguda por 1.000 peregrinos-día (intervalo de confianza del 95% [IC95%]: 18,9-29,4/10³). En el estudio de casos y controles los factores de mayor riesgo fueron la edad <20 años (odds ratio [OR]=4,72; IC95%: 2,16-10,28), viajar en grupo (tres personas o más) (OR=1,49; IC95%: 0,98-2,28) y consumir agua no embotellada (OR=2,09; IC95%: 0,91-4,82). Norovirus fue el microorganismo aislado con más frecuencia (56%). Conclusiones: Ser peregrino menor de 20 años, realizar el camino en grupo y consumir agua no embotellada se asocian con un mayor riesgo de presentar gastroenteritis aguda.

Objectives: To determine the incidence of acute gastroenteritis in pilgrims on St. James´ Way, as well as associated risk factors and microbiological characteristics. Methods: Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. Results: In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³). In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%). Conclusions: Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis.

Objetivos: Conocer la incidencia de gastroenteritis aguda en los peregrinos del Camino de Santiago, los factores de riesgo asociados y su caracterización microbiológica. Métodos: Se diseñaron dos estudios simultáneos, uno transversal mediante encuestas autocumplimentadas de peregrinos llegados a Santiago y otro de casos y controles a los peregrinos en el camino. Se hizo un análisis multivariado mediante regresión logística. Resultados: En el estudio transversal la densidad de incidencia fue de 23,5 episodios de gastroenteritis aguda por 1.000 peregrinos-día (intervalo de confianza del 95% [IC95%]: 18,9-29,4/10³). En el estudio de casos y controles los factores de mayor riesgo fueron la edad <20 años (odds ratio [OR]=4,72; IC95%: 2,16-10,28), viajar en grupo (tres personas o más) (OR=1,49; IC95%: 0,98-2,28) y consumir agua no embotellada (OR=2,09; IC95%: 0,91-4,82). Norovirus fue el microorganismo aislado con más frecuencia (56%). Conclusiones: Ser peregrino menor de 20 años, realizar el camino en grupo y consumir agua no embotellada se asocian con un mayor riesgo de presentar gastroenteritis aguda.

A relação entre as modificações no escore de condição corporal (BCS) e a fertilidade de vacas de corte durante o pós-parto foi examinada em grupos organizados em função das datas dos partos. Foram efetuadas quatro avaliações com início em torno de um mês pós-parto. Na segunda avaliação, as vacas receberam pessários impregnados com acetato de medroxi-progesterona e uma injeção de benzoato de estradiol. Na sua remoção, foi efetuada a terceira avaliação e separação dos terneiros durante quatro dias. Durante esse período foi observado cio duas vezes ao dia, sendo as inseminações realizadas 12 horas após. Depois do retorno dos terneiros às vacas, foram introduzidos touros até completar 60 dias de estação reprodutiva. As distribuições dos BCS diferiram significativamente entre grupos de parição e momentos de avaliação. Os resultados indicaram que apenas vacas com BCS 3 (escala de 1 a 5) em torno do primeiro mês pós-parto podem ser incluídas em programas de inseminação artificial com possibilidade de ficarem prenhas. Não foi observada diferença estatisticamente significativa entre grupos de parição quanto a taxa de prenhez. A evolução do BCS durante o pós-parto pode ser empregada para ajustar a estação reprodutiva à melhor época do ano, visando maiores taxas de gestação.

The relationship between changes in body condition score (BCS) during the postpartum and fertility in beef cows suckling calves under extensive conditions were investigated. Cows were subjected to four BCS evaluations over the postpartum period, starting around one month after calving. In the second evaluation cows were treated with medroxy-progesterone acetate impregnated pessaries and received an injection of estradiol benzoate. At the third evaluation, pessaries were removed and calves were separated from the cows for 96 hours, during which time estrous was observed twice a day, and animals artificially inseminated 12 hours after detection. When calves returned to their dams, bulls were introduced until a 60-day mating period was reached. The distribution of BCS differed among calving groups and evaluations. Results indicated that only cows comprising a BCS 3 (1 to 5 scale) around the first month postpartum can be used in an artificial insemination program with possibilities of becoming pregnant. There was no statistical difference between the calving groups in pregnancy rate. The evolution of the BCS of the cows during postpartum can be used to adjust the start of the breeding season to coincide with the time of the year where herd pregnancy rates will be highest.

Debido al ambiente empresarial extremadamente competitivo en el que se encuentran inmersas las empresas de nuestro entorno, cobra cada vez mayor importancia el establecimiento de alianzas o acuerdos duraderos en el tiempo entre empresas con intereses comunes. Así, será de especial relevancia el análisis de la calidad de dichas relaciones entre las partes, como medida de evaluación total de la fuerza de una relación entre empresas.Tomando en consideración que no existe uniformidad aparente entre los autores sobre la dimensionalidad de este constructo, estudiaremos en este caso como dimensiones o constructos de segundo orden de la calidad de la relación el compromiso, la confianza y la satisfacción.

Devido ao entorno empresarial extremamente competitivo no qual são submersas as empresas do nosso entorno, assume cada vez mais importância o estabelecimento de alianças ou acordos duradouros no tempo entre empresas com interesses comuns. Assim, será de especial importância a análise da qualidade de tais relações entre as partes, como medida de avaliação total da força duma relação entre empresas. Tomando-se em consideração que não existe uniformidade aparente entre os autores sobre a dimensionalidade deste construto estudaremos neste caso como dimensões ou construtos de segunda ordem da qualidade da relação ao compromisso, a confiança e a satisfação.

Establishing alliances or lasting agreements between Colombian companies having common interests has become increasingly important due to the extremely competitive entrepreneurial setting facing companies in Colombia. Analysing the quality of such relationships between parties has thus become especially important for measuring the strength of relationships between companies. The lack of apparent uniformity amongst authors concerning this construct's dimensionality led to it being decided to study how second order dimensions or constructs affect the quality of relationships re commitment, trust and satisfaction.

En raison de l'environnement patronal extrêmement compétitif où se trouvent plongées les entreprises de notre entourage, l'établissement d'accords ou d'alliances durables dans le temps entre des entreprises ayant des intérêts communs devient chaque fois plus important. Ainsi, l'analyse de la qualité de ces relations entre les intervenants aura une importance particulière, comme mesure de l'évaluation totale de la force d'une relation entre entreprises. En prenant en considération qu'il n'existe pas d'uniformité apparente entre les auteurs sur la dimension de ce "constructo" (association), nous étudierons dans ce cas les dimensions ou les "constructos" (associations) de deuxième ordre de la qualité de la relation vers le compromis, la confiance et la satisfaction.

A produção de leite de vacas Hereford primíparas e multíparas manejadas sobre campo nativo foi estudada utilizando-se 144 lactações em um período de quatro anos (1995, 1998, 2000, 2001). A estimativa da produção de leite foi realizada em intervalos de 21 dias pela técnica da pesagem antes e após a mamada, do nascimento à desmama (189 dias). Foram considerados os fatores fixos ano, ordem de parto, prenhez, sexo do bezerro e raça do touro. As vacas multíparas produziram mais leite (8,27+0,26) que as primíparas (5,81+0,25 kg dia-1) no pico de lactação (42 dias). A produção total de leite em multíparas também foi superior (158,34+25,51) à das primíparas (915,44+24,47 kg). A produção de leite não foi influenciada pelos demais fatores. A maior produção de leite durante o pico de lactação consiste na principal diferença entre as curvas de lactação de vacas multíparas e primíparas, que, no entanto, apresentam amplitude de produção de leite similar nas condições estudadas. O leite fornece a energia suficiente para atender às exigências de mantença e ganho dos bezerros durante os dois primeiros meses da lactação e, apenas para mantença, até o quarto mês de lactação.

Milk yield of primiparous and multiparous Hereford cows grazing native pastures was studied using 144 lactations from four different years (1995, 1998, 2000, 2001). Estimates of milk yield were obtained every 21-day interval from birth to weaning (189 d) by the weigh-suckle-weigh technique. Effects of year, calving order, pregnancy, calf sex, and sire breed were studied. Multiparous cows (8.27+0.26 kg/d) yielded more milk than primiparous cows (5.81+0.25 kg/d) at peak of lactation (42 d). Total milk yield also was higher for multiparous (1,158.34+25.51 kg/d) compared to primiparous (915.44+24.47 kg/d). Therefore, the main difference between multiparous and primiparous lactation curves was production at peak although similar lactation persistence was found. All remaining effects did not affect milk yield in the present trial. Milk met calf requirements for maintenance and growth in the first 2 months of lactation and only maintenance requirements until the fourth month.

A produção de leite e o desempenho pós parto de 52 vacas multíparas Hereford em condição corporal média (3 em escala de 1 a 5), gestantes (45) e não gestantes (24), em condições extensivas, foram estudados, em 69 lactações, durante dois anos (2000 e 2001). A estimativa da produção de leite foi realizada em seis intervalos (3 de 21 d e 3 de 42 d), do nascimento à desmama (189d), por meio da técnica da pesagem do terneiro antes e após a mamada. Os fatores fixos foram ano, prenhez, sexo do terneiro e raça do touro (Hereford e Nelore). A produção de leite diária, do pico de lactação, total e a persistência da lactação, não foram influenciadas pelos fatores estudados (P>0,05). O peso ao parto foi maior (P<0,05) em 2001, (417,49 ± 6,94kg), que em 2000 (353, 97 ± 5,57kg), e não teve efeito (P>0,05) dos demais fatores avaliados. O peso vivo na concepção (99 d média), e à desmama, foi maior nas vacas gestantes (432,10 ± 5,78 e 433,30 ± 6,36kg) que nas não gestantes 399,37 ± 7,92 e 393,46 ± 8,70kg), respectivamente. O sexo dos terneiros teve efeito significativo (P<0,05) sobre peso ao nascer (41,75 ± 1,21 e 37,6 ± 1,13kg, para machos e fêmeas, respectivamente). No peso à desmama, todos os fatores demonstraram efeito (P<0,05) e os terneiros das vacas gestantes (194,22 ± 3,41kg) foram mais pesados que das vazias (177,43 ± 4,67kg). Em vacas de corte com produção de leite e condição corporal similar, do parto à desmama, o melhor desempenho das gestantes, em peso vivo e peso do terneiro à desmama demonstra que, provavelmente, uma melhor adaptação ao sistema tenha sido responsável pela fertilidade pós-parto.

Milk production and pospartum performance from 52 multiparous Hereford cows, with the same body condition score (3 in a 1 to 5 scale), pregnant (45) or not pregnant (24), was studied in 69 lactations during two years, 2000 (42) and 2001 (27) under range conditions. Estimates of milk yield were obtained during six intervals (three 21d and three 42d), by the weigh-suckle-weigh technique, from birth to weaning (189d). Effects studied were year, pregnancy, calf sex and sire breed. None of the effects studied affected (P>0.05) milk production parameters: daily milk production, total milk yield, lactation peak and persistency. Body weight at calving was greater (P<0.05) in 2001 (417.49 ± 6.94kg) that in 2000 (353. 97 ± 5.57kg) and was not affected by the other effects. Body weight at conception (99d; 432.10 ± 5.78 and 399,37 ± 7.92kg) and at weaning (189d; 433.30 ± 6.36 and 393.46 ± 8.70kg), were greater (P<0.05) in pregnant cows than in non-pregnant animals, respectively. Sex of calf had a significant effect (P<0.05) on calf birth weight (41.75 ± 1.21kg and 37.6 ± 1.13kg for males and females, respectively). All studied effects affected significantly calf weaning weight (P<0.05) and pregnant cows had heavier calves at weaning (194.22 ± 3.41kg) than non-pregnant cows (177.43 ± 4.67kg). The greatest performance of pregnant beef cows with similar milk yield and body condition score from calving to weaning can be explained by the superior adaptation characteristics of these cows.

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP <140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity, drugs being administered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.

Presentamos la Guía europea para la prevención de las enfermedades cardiovasculares (ECV), traducida y adaptada por el Comité Español Interdisciplinario para la Prevención Cardiovascular. Esta guía se centra en la prevención de la ECV en su conjunto, recomienda el modelo SCORE para valorar el riesgo y prioriza la atención a los pacientes y sujetos de alto riesgo. El objetivo es prevenir la muerte prematura por ECV, mediante el manejo de sus factores de riesgo en la práctica clínica. Así, se requiere una intervención profesional sostenida para que los pacientes e individuos de alto riesgo incrementen su actividad física y elijan dietas cardiosaludables, y para que los fumadores abandonen el tabaco. La decisión de iniciar el tratamiento de la presión arterial dependerá de sus valores, del riesgo cardiovascular y de posibles lesiones de órganos diana. La meta terapéutica es lograr una presión arterial <140/90 mmHg, pero en pacientes con diabetes, enfermedad renal crónica, historia de ictus, enfermedad coronaria o insuficiencia cardíaca, se deben perseguir niveles inferiores. La colesterolemia debe ser menor de 200 mg/dl y el colesterol LDL menor de 130 mg/dl, aunque en pacientes con ECV o diabetes se deben perseguir niveles inferiores a 175 y 100 mg/dl, respectivamente. Un buen control de la glucemia siempre exige consejo dietético profesional. En la diabetes tipo 1 se precisa una adecuada terapia insulínica. En la diabetes tipo 2 y en los pacientes con síndrome metabólico se debe reducir el peso y aumentar la actividad física y, en su caso, aplicar fármacos. Finalmente, se incluye un anexo con recomendaciones dietéticas adaptadas a nuestro entorno y criterios de derivación o consulta con el especialista de los pacientes hipertenso y dislipémico.

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP <140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity, drugs being administered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.

Presentamos la Guía europea para la prevención de las enfermedades cardiovasculares (ECV), traducida y adaptada por el Comité Español Interdisciplinario para la Prevención Cardiovascular. Esta guía se centra en la prevención de la ECV en su conjunto, recomienda el modelo SCORE para valorar el riesgo y prioriza la atención a los pacientes y sujetos de alto riesgo. El objetivo es prevenir la muerte prematura por ECV, mediante el manejo de sus factores de riesgo en la práctica clínica. Así, se requiere una intervención profesional sostenida para que los pacientes e individuos de alto riesgo incrementen su actividad física y elijan dietas cardiosaludables, y para que los fumadores abandonen el tabaco. La decisión de iniciar el tratamiento de la presión arterial dependerá de sus valores, del riesgo cardiovascular y de posibles lesiones de órganos diana. La meta terapéutica es lograr una presión arterial <140/90 mmHg, pero en pacientes con diabetes, enfermedad renal crónica, historia de ictus, enfermedad coronaria o insuficiencia cardíaca, se deben perseguir niveles inferiores. La colesterolemia debe ser menor de 200 mg/dl y el colesterol LDL menor de 130 mg/dl, aunque en pacientes con ECV o diabetes se deben perseguir niveles inferiores a 175 y 100 mg/dl, respectivamente. Un buen control de la glucemia siempre exige consejo dietético profesional. En la diabetes tipo 1 se precisa una adecuada terapia insulínica. En la diabetes tipo 2 y en los pacientes con síndrome metabólico se debe reducir el peso y aumentar la actividad física y, en su caso, aplicar fármacos. Finalmente, se incluye un anexo con recomendaciones dietéticas adaptadas a nuestro entorno y criterios de derivación o consulta con el especialista de los pacientes hipertenso y dislipémico.