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Artículos sobre Dislipidemias

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Siguiendo el mismo tenero del artículo previo, envío dos artículos nuevos para su publicación, uno de a mediados del mes pasado, publicado en la revista Lancet, en él se analiza el papel de los lípidos, apolipoproteínas y lipoproteínas como marcadores para el riesgo de enfermedades cardiovasculares. Para ello se realizó un estudio de casos y controles en 52 países, incluido México, les dejo el resumen para que lo conozcan:

Pueden discutir el caso en: http://www.medicinaintegrada.org.mx/foros/topic.php?id=25

Para descargarlo: http://www.thelancet.com/journals/lancet/article/PIIS0140673608610764/abstract

Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study

Lancet 2008; 372: 224–33

Background Whether lipoproteins are better markers than lipids and lipoproteins for coronary heart disease is widely debated. Our aim was to compare the apolipoproteins and cholesterol as indices for risk of acute myocardial infarction.

Methods We did a large, standardised case-control study of acute myocardial infarction in 12 461 cases and
14 637 age-matched (plus or minus 5 years) and sex-matched controls in 52 countries. Non-fasting blood samples were available from 9345 cases and 12 120 controls. Concentrations of plasma lipids, lipoproteins, and apolipoproteins were measured, and cholesterol and apolipoprotein ratios were calculated. Odds ratios (OR) and 95% CI, and population-attributable risks (PARs) were calculated for each measure overall and for each ethnic group by comparison of the top four quintiles with the lowest quintile.

Findings The apolipoprotein B100 (ApoB)/apolipoprotein A1 (ApoA1) ratio had the highest PAR (54%) and the highest OR with each 1 SD diff erence (1·59, 95% CI 1·53–1·64). The PAR for ratio of LDL cholesterol/HDL cholesterol was 37%. PAR for total cholesterol/HDL cholesterol was 32%, which was substantially lower than that of the ApoB/ApoA1 ratio (p<0·0001). These results were consistent in all ethnic groups, men and women, and for all ages.

Interpretation The non-fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infarction in all ethnic groups, in both sexes, and at all ages, and it should be introduced into worldwide clinical practice.

Funding Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, the International Clinical Epidemiology Network (INCLEN). Unrestricted grants from pharmaceutical companies (with major contributions from AstraZeneca, Novartis, Aventis, Abbott, Bristol Myers Squibb, King Pharma, and Sanofi -Synthelabo), and by various national bodies.

Por otro lado tenemos un artículo publicado en la revista Mayo Clinic Proceedings este mes, en él se analizan los efecto de una terapia intensiva para disminuir los lípidos comparado con métodos menos agresivos, para ello se utilizó atorvastatina a dosis diferentes:

Para discutir el artículo: http://www.medicinaintegrada.org.mx/foros/topic.php?id=26

Puedes descargarlo en: http://www.mayoclinicproceedings.com/inside.asp?AID=4745

Intensive Lipid Lowering With Atorvastatin in Patients With Coronary Artery Disease, Diabetes, and Chronic Kidney Disease

Mayo Clin Proc. 2008;83(8):870-879

Objetive: To investigate the effect of intensive lipid lowering with high-dose atorvastatin on the incidence of major cardiovascular events compared with low-dose atorvastatin in patients with coronary artery disease and type 2 diabetes, with and without chronic kidney disease (CKD).

Patients and Methods: Following 8 weeks’ open-label therapy with atorvastatin (10 mg/d), 10,001 patients with coronary artery disease were randomized to receive double-blind therapy with either 80 mg/d or 10 mg/d of atorvastatin between July 1, 1998, and December 31, 1999. Of 1501 patients with diabetes, renal data were available for 1431. Patients with CKD were defined as having a baseline estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2, using the Modification of Diet in Renal Disease equation.

Rersults: After a median follow-up of 4.8 years, 95 (17.4%) of 546 patients with diabetes and CKD experienced a major cardiovascular event vs 119 (13.4%) of 885 patients with diabetes and normal eGFRs (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.00-1.72; P<.05). Compared with 10 mg of atorvastatin, 80 mg of atorvastatin reduced the relative risk of major cardiovascular events by 35% in patients with diabetes and CKD (20.9% [57/273] vs 13.9% [38/273]; HR, 0.65; 95% CI, 0.43-0.98; P=.04) and by 10% in patients with diabetes and normal eGFR (14.1% [62/441] vs 12.8% [57/444]; HR, 0.90; 95% CI, 0.63-1.29; P=.56). The absolute risk reduction in patients with diabetes and CKD was substantial, yielding a number needed to treat of 14 to prevent 1 major cardiovascular event over 4.8 years. Both treatments werewell tolerated.

Conclusions: Patients with diabetes, stable coronary artery disease, and mild to moderate CKD experience marked reduction in cardiovascular events with intensive lipid lowering, in contrast to previous observations in patients with diabetes and end-stage renal disease.

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