Morales VE

Idioma: Español
Referencias bibliográficas: 122
Paginas: 173-188
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RESUMEN

En 1939 Himsworth postuló que la diabetes mellitus tipo 2 (DM2) no sólo era secundaria a deficiencia de insulina sino también obedecía a insensibilidad celular a esta hormona. Treinta años después DeFronzo y Reaven demostraron secuencialmente que la resistencia a la insulina (RI) antecedía y predisponía a la DM2 y a la enfermedad-cardiovascular-aterosclerosa (ECVA). Reaven, asoció la RI con trastornos en la regulación glucémica, lipídica y tensional arterial, como los sustratos etiopatogénicos para la ECVA, creando el concepto de síndrome X (SX). Antecedido por la OMS, el ATP-III en el 2002, fundamentado en la imposibilidad clínica de diagnosticar RI en forma sencilla, confiable y económica, propuso el concepto de síndrome metabólico (SM), como un conjunto de 5 variables que asociando a la obesidad visceral como el agente causal más frecuente de RI, con las manifestaciones metabólicas más significativas de ésta, a saber hiperglucemia, hipertrigliceridemia, hipocolesterolemia-HDL e hipertensión arterial, permitiría al clínico una aproximación facilitada para sospechar y tratar un riesgo incrementado de DM2 y ECVA. A la fecha existen controversias extensas y profundas sobre este tema, mismas que sin embargo en realidad no existen, dado que son más bien de forma que de fondo. El por qué de la inexistencia real de dichas controversias es el eje principal de este artículo, cuyo objetivo es diferenciar y armonizar los conceptos SX y SM; analizar la fisiopatología que hace al SM una buena “ventana clínica” para ver hacia la RI y sus manifestaciones subrogadas y comprender que el concepto SM, complementa no sustituye ni antagoniza a las escalas tradicionales para el cálculo del riesgo cardiovascular como la de Framingham.

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