Riesgo cardiovascular: evaluación del tabaquismo y revisión en atención primaria del tratamiento y orientación sanitaria. Estudio RETRATOS

Abstract

Aim To evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics. Design Epidemiologic, cross-sectional and multicentre study. Setting Primary Care. Patients Every investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria. Measurements The 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events. Results 10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40 ± 5.3) vs. non-smokers (1.9 ± 2.5) ( P < .0001). Risk stratification: low (< 3%) [78.0% non-smokers vs. 60.7% smokers ( P < .0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers ( P < .001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers ( P < .001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P < .0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P = .0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P = .0507). Conclusions Smoking is related to a high risk of fatal cardiovascular disease. Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality.