ROLE OF ESTIMATING PULSE WAVE VELOCITY IN COMMUNITY PHARMACIES IN SPAIN COMPARED TO SCORE

Abstract

Objective: European Guidelines clearly state the need to estimate cardiovascular (CV) risk using tables validated for this purpose. However, they also recommend assessing subclinical organ damage to improve stratification, since target organ lesions, such as arterial stiffness, estimated by brachial oscillometry, have an independent and additional prognostic value. Previous studies have shown that Community Pharmacies are able to correctly measure arterial stiffness.The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification according to SCORE in Community Pharmacies. Design and method: This is an observational prospective epidemiological study in which everyone who enters the participating Community Pharmacies will be offered a voluntary measurement of blood pressure and arterial stiffness to compare the stratification of their CV risk according to SCORE with or without considering pulse wave velocity. The expected duration of the study is 12 months. Results: In the first month of recruitment, data from 275 patients (173 women, 102 men) were collected. Five of 39 (12.8%) patients under 40 years of age and 42 of 109 (38.5%) over 65 years of age presented pathological stiffness and could be classified as high risk even though being out of the age-range of SCORE. Of the 133 (48.4%) who were capable of calculating SCORE, the cholesterol value was available only in 69 patients (51.9%). Among them, according to SCORE, 18 patients (26.0%) were at low risk, 50 (72.5%) at moderate risk and only 1 (1.5%) at high risk, while 28 patients (21.1%) presented pathological arterial stiffness. Conclusions: Almost half of the people who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in a third. Of the other half, one in five presented arterial damage and, therefore, high CV risk, when SCORE only detected it in a single patient. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.