We do not need more Guidelines, nor more Drugs, nor more Combinations! The priority is a Medical Ecosystem that favors Evidence-Based Medicine, Personalization, Empowerment, Access, and Reflection

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Enrique C. Morales-Villegas, MD Hector A. Rodriguez-Martinez, MPHIL


A growing number of publications evidencing the poor achievement of the therapeutic goals of the so-called atherosclerotic cardiovascular risk factors (especially hypercholesterolemia, hypertension, and diabetes). Many authors propose therapeutic inertia as the most compelling cause of this situation.


This article aims to provide a vision from a dedicated cardiovascular prevention physician's perspective, based on four pillars (in order of importance): "face-to-face" assistance with social responsibility, clinical research, teaching, and consulting. Beyond the bureaucratic vision, it proposes the necessary conditions to achieve an efficient medical ecosystem (evidence-based medicine, personalization, empowerment, access, and reflection). Likewise, the therapeutic failure palliatives, as called by the author (more guidelines, more high-tech drugs, and more combinations of drugs), are exposed. These palliatives feed into a vicious circle and are insufficient to mitigate a medical-social problem, as is the cardio-metabolic risk and diseases

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MORALES-VILLEGAS, Enrique C.; RODRIGUEZ-MARTINEZ, Hector A.. We do not need more Guidelines, nor more Drugs, nor more Combinations! The priority is a Medical Ecosystem that favors Evidence-Based Medicine, Personalization, Empowerment, Access, and Reflection. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3391>. Date accessed: 17 june 2024. doi: https://doi.org/10.18103/mra.v10i12.3391.


1.- Vrablik, M, Seifert, B, Parkhomenko, A, et al., Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study, Atherosclerosis, 2021;334:66-75.
2.- Cífková, R, Bruthans, J, Wohlfahrt, P, et al., 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA, and Czech post-MONICA, 1985 - 2016/17, PLoS One, 2020;15: e0232845.
3.- Dyrbus, K, Gasior, M, Desperak, P, et al., Characteristics of lipid profile and effectiveness of management of dyslipidaemia in patients with acute coronary syndromes - Data from the TERCET registry with 19,287 patients, Pharmacol Res, 2019;139:460-466.
4.- Reiner, Ž, De Backer, G, Fras, Z, et al., Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries--Findings from the EUROASPIRE IV survey, Atherosclerosis, 2016;246:243-250.
5.- Klimchak, AC, Patel, MY, Iorga Ş, R, et al., Lipid treatment and goal attainment characteristics among persons with atherosclerotic cardiovascular disease in the United States, Am J Prev Cardiol, 2020;1:100010.
6.- Kotseva, K and Investigators, E, The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention, Cardiovasc Diagn Ther, 2017;7:633-639.
7.- Kotseva, K, De Backer, G, De Bacquer, D, et al., Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries, Eur J Prev Cardiol, 2020:2047487320908698.
8.- Enrique C Morales-Villegas, Carlos Yarleque and Maria Luisa Almeida. Management of Hypertension and dyslipidemia in México: Evidence, gaps, and approach. Arch Cardiol Mex (Eng). Available online 29-03-2022. www.archivoscardiologia.com.
9.- Manuel Odin De los Rios-Ibarra, José Luis Leyva-Pons, Humberto Rodríguez-Reyes et al. Risk stratification and lipid Evaluation in Mexican patients, evidence of lipid and cardiovascular analysis in REMECAR. The Mexican registry of cardiovascular diseases (REMECAR group), Atherosclerosis Plus (2022), doi: https://doi.org/10.1016/j.athplu.2022.08.002.
10.- Lloyd-Jones DM, Braun LT, Ndumele CE et al, Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease, Journal of the American College of Cardiology (2018). DOI: 10.1016/j.jacc.2018.11.005.
11.- Mach F, Baigent C, Catapano A et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal (2019) 00, 1-78. DOI: 10.1093/eurheartj/ehz455.
12.- Kahneman, D. (2011). In Thinking, fast and slow. Farrar, Straus, and Giroux.
13.- Evans, J. (2008). Dual-processing accounts of reasoning, judgment, and social cognition. Annu Rev Psychol 59:255-278.
14.- Zhai MZ, Avorn J, Liu J et al. Variations in Use of Diabetes Drugs With Cardiovascular Benefits Among Medicaid Patients. JAMA Network Open. 2022; 5(11)e2240117. doi:10.1001/jamanetworkopen.2022.40117.
15.- Yusuf S, Rangarajan K, Teo S et al. Prospective Urban Rural Epidemiologic (PURE) Cohort Study. N Engl J Med. 2014; 371:818-826.
16.- Morales-Villegas E, Vega-Velasco A, Moreno-Virgen G. LDL-cholesterol Lowering Efficacy of Atorvastatin®. In Primary Prevention. Real-World Experience in a Developing Country: a program based on Evidence, Personalization and Empowerment. Med Res Arch. 2021. Vol 9, Issue 11. November 2021: 1-13.
17.- Morales-Villegas E, Alcocer-Diaz Barreiro L, Moreno-Virgen G. Experience with Azilsartan and Azilsartan combined with Chlorthalidone in a Preventive Cardiology Center. Fighting Therapeutic Inertia with a Program based on Evidence, Personalization and Empowerment. Med Res Arch. Vol 9, Issue 10. October 2021: 1-13.
18.- Visseren FLJ, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and twelve medical societies. Eur Heart J. 2021; 42:3227-3337.
19.- CEPAC: Comparative Effectiveness Public Advisory Council. PCSK9 Inhibitors for Treatment of High Cholesterol: Effectiveness, Value, and Value-Based Price Benchmarks Draft Report. A Technology Assessment. Completed for ICER: Institute for Clinical and Economic Review. September 8, 2015.
20.- Wilkins JT, Lloyd-Jones DM. Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk. JAMA. JAMA Insights. Clinical Update. JAMA. July 20. 2021. Volume 326. Number 3.
21.- O´Neil AO, Calderbank S, Brown J et al. Quantification of Utilization Management Barriers for Patients Initiating Therapy to Lower Lipid Levels. JAMA Network Open. 2022: 5(11): e2240513. Doi: 10.1001/jamanetworkopen.2022.40513.
22.- atorvastatina más fenofibrato - Bing images. Consulted November 12, 2022.
23.- Blood AJ, Cannon CP, Gordon WJ et al. Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10,000 Patients Across a Diverse Health Care Network. JAMA Cardiology. Published online November 9. 2022. doi: 10.1001/jamacardio.2022.4018.