2009, Número 1
<< Anterior Siguiente >>
Rev Med Inst Mex Seguro Soc 2009; 47 (1)
Uso de antioxidantes para prevenir enfermedad cardiovascular. Metaanálisis de ensayos clínicos
García-Álvarez JL, Sánchez-Tovar M, García-Vigil JL
Idioma: Español
Referencias bibliográficas: 56
Paginas: 7-16
Archivo PDF: 345.02 Kb.
RESUMEN
Objetivo: evaluar el uso de antioxidantes, antiagregantes plaquetarios, estatinas y moduladores de la inflamación en la reducción del riesgo cardiovascular.
Métodos: se realizó una búsqueda de ensayos clínicos en los que se investigó el uso de antioxidantes, antiagregantes plaquetarios, estatinas y moduladores de la inflamación para la prevención primaria y secundaria de riesgo cardiovascular. Se analizaron con revisión sistemática, aplicando metaanálisis para la combinación de resultados.
Resultados: se incluyeron 20 estudios. En el subgrupo de vitamina
E se presentaron 3623 eventos de IAM no fatal, RR = 1 (0.93-1.06) IC 95 %,
p = 0.01. En estatinas se presentaron 2795 eventos de IAM no fatal, RR = 0.68 (0.63-0.73) IC 95 %,
p = 0.02. En antiagregantes plaquetarios se presentaron 1199 eventos de IAM no fatal, RR = 0.91 (0.81- 1.02) IC 95 %,
p = 0.42. En ácidos grasos omega-3 se presentaron 434 eventos de IAM no fatal, RR = 0.93 (0.76-1.13) IC 95 %,
p = 0.002.
Conclusiones: la vitamina
E no reduce el riesgo cardiovascular, en comparación con la estatinas, antiagregantes plaquetarios y ácidos grasos omega-3.
REFERENCIAS (EN ESTE ARTÍCULO)
Sánchez-Rodríguez M, Santiago-Osorio E, Vargas L. Propuesta de un constructo para evaluar integralmente el estrés oxidativo. Bioquimica 2004;29(3):81-90.
Nakamura H. Experimental and clinical aspects of oxidative stress a redox regulation. Rinsho Byori 2003;51(2):109-114.
Park J, Ryo J, Jin LH, Bahn JH, Kim JA, Yoon CS, et al. 9-polylysine protein transduction domain: enhaced penetration efficiency of superoxide dismutase into mammalian cell and skin. Mol Cells 2002;13(2):202-208.
Griendling K, FitzGerald G. Oxidative stress and cardiovascular injury: Part I: basic mechanisms and in vivo monitoring of ROS. Circulation 2003; 108(16):1912-1916.
Griendling K, FitzGerald G. Oxidative stress and cardiovascular injury: Part II: animal and human studies. Circulation 2003;108(17):2034-2040.
Butler RN, Fossel M, Pan CX, Rothman DJ, Rothman SM. Anti-aging medicine. Efficacy and safety of hormones an antioxidants. Geriatrics 2000;55(7):55-58.
Olguín-Contreras G, Meléndez-Mier G, Zúñiga RA, Pasquetti-Ceccatelli AP. Antioxidantes y aterosclerosis. Rev Endocrinol Nutr 2004;12(4): 199-206.
Fichtischerer S, Breuer S, Schächinges V, Dimmeler S, Zeiher AM. C reactive protein levels determine systemic nitric oxide bioavailability in patients with coronary artery disease. Eur Heart J 2004;25(16):1412-1418.
Schröder H, Maurrugat J, Covas M, Elosua R, Pena A, Weinbrenner T, et al. Population dietary habits and physical activity modification with age. Eur J Clin Nutr 2004;58(2):302-311.
Schwedhelm E, Maas R, Troost R, Böger R. Clinical Pharmacokinetics of antioxidants and their impact on systemic oxidative stress. Clin Pharmacokinet 2003;42(5):437-459.
Eidelman RS, Hollar D, Hebert PR, Lamas GA, Hennekens CH. Randomized trial of vitamin E in the treatment and prevention of cardiovascular disease. Arch Intern Med 2004;164(14):1552-1556.
Polla BS. Therapy by taking away: the case of iron. Biochem Pharmacol 1999;57(12):1345-1349.
García-Vigil JL. La importancia de los oligoelementos en el paciente con insuficiencia renal. Nutricion Clinica 2003;6(3):283-290.
Schmidt E, Arnesen H, De Caterina R, Ramussen L, Kristensen S. Marine ω-3 polyunsaturated fatty acids and coronary heart disease. Part I. Background, epidemiology, animal data, effect on risk factors and safety. Thromb Res 2005;115(3):163-170.
He K, Song Y, Daviglus M, Liu K, Van Horn L, Dyer AR, et al. Fish consumption and incidence of stroke. A Meta-analysis of cohort studies. Stroke 2004;35(7):1538-1542.
Kritharides L, Stocker R. The use of antioxidant supplements in coronary heart disease. Atherosclerosis 2002;164(2):211-219.
Tomasian D, Keaney JF, Vita JA. Antioxidants and the bioactivity of endotheliumderived nitric oxide. Cardiovasc Res 2000;(47):426-435.
Laight DW, Carrier MJ, Anggard EE. Antioxidants, diabetes and endothelial dysfunction. Cardiovasc Res 2000;(47):457-464.
Gotto AM, DPHIL, FACC. Antioxidants, statins, and atherosclerosis. J Am Coll Cardiol 2003.41(7): 1205-1210.
Rosenson R. Statins in atheroesclerosis: lipid lowering agent with antioxidants capabilities. Atherosclerosis 2004;173(1):1-12.
Von Schacky C. n-3 fatty acids and the prevention of coronary atherosclerosis. Am J Clin Nutr 2000;71(1 Suppl):224S-227S.
Stone NJ. Fish consumption, fish oil, lipids, and coronary heart disease. Circulation 1996;94(9):2337-2340.
Guyatt GH, Sackett DL. Users’ guides to the medical literature: II. How to use an article about therapy or prevention. JAMA 1992;270:2598-2601.
Evidence-Based Medicine Working Group. Evidence Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA 1992;268(17):2420-2425.
Lazcano-Ponce E, Salazar-Martínez E, Gutiérrez-Castrellón P, Ángeles-Llerenas A, Hernández-Garduño A, Viramontes JL. Ensayos clínicos aleatorizados: variantes, métodos de aleatorización, análisis, consideraciones éticas y regulación. Salud Publica Mex 2004;46(6):559-584.
Dickensin K. Systematic reviews in epidemiology: why are we so far behind. Int J Epidemiol 2002;31(1):6-12.
Petticrew M. Why certain systematic reviews reach uncertain conclusions. BMJ 2003;326;756-758.
Hernández-Ávila M, Garrido F, Salazar-Martínez E. Sesgos en estudios epidemiológicos. Salud Publica Mex 2000;42(5):438-446.
Tôrnwall ME, Virtamo J, Korhonen PA, Virtanen MJ, Taylor PR, Albanes D, et al. Effect of a-tocopherol and b-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. Eur Heart J 2004;25 (13):1171-1178.
Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996;347(9004):781-786.
GISSI-Prevenzione Investigators. Dietary supplementation with ω-3 polyunsatured fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999(9177);354:447-55.
The Heart Outcomes Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high risk patients. N Engl J Med 2000;342(3):154-160.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20536 high risk individuals: a randomised placebo-controlled trial. Lancet 2002;360(9326):23-33.
Collaborative-Group of the Primary Prevention Project (PPP). Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet 2001;357(9250):89-95.
Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Laina A, et al. Secondary prevention with antioxidants of cardiovascular disease in end stage renal disease (SPACE): randomised placebo-controlled trial. Lancet 2000;356 (9237):1213-1218.
Hercberg S, Galán P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SUVIMAX Study. A randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004;164(21):2335-2342.
Lee I, Cook N, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer. The Women’s Health Study: a randomized controlled trial. JAMA 2005;294(1):56-65.
Tonelli M, Moyé L, Sacks FM, Kiberd B, Curhan G. Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Ann Intern Med 2003;138(2):98-104.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360(9326):7-22.
The Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998;339(19):1349-1357.
Shepherd J, Blauw GJ, Murphy MB, Bollen E, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360(9346):1623-1630.
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344(8934):1383-1389.
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348(9038):1329-1339.
Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al. Clopidogrel and aspirin versus alone for the prevention of atherotrombotic events (CHARISMA). N Engl J Med 2006;354 (16):1706-1717.
Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, et al. A randomised trial of low dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352(13):1293-1304.
Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetman PM, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989;2(8666):757-61.
Lorgeril M, Renaud S, Marmelle N, Selen P, Martin JL, Monajaud I, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343(8911):1454-1159.
Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri Ml. Randomised, double-blind, placebocontrolled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival. Cardiovasc Drugs Ther 1997;11(3):485-1491.
Physicians Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Committee of the Physicians’ Health Study Research Group. N Engl J Med 1989;321(3):129-135.
He K, Rimm EB, Merchant A, Rosner BA, Stampfer MJ, Willett WC, et al. Fish Consumption and Risk of Stroke in Men. JAMA 2002;288(24):3130-3136.
Iso H, Rexrode KM, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA 2001;285(3):304-312.
Erkkilä AT, Lehto S, Pyörälä K, Uusitupa MI. ω-3 fatty acids and 5-y risk of death and cardiovascular disease events in patients with coronary artery disease. Am J Clin Nutr 2003;78 (1):65-71.
Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS. ω-3 polyunsatured fatty acids, fatal ischaemic heart disease, and nonfatal myocardial infarction in older adults; the Cardiovascular Health Study. Am J Clin Nutr 2003;77(2):319-325.
Bucher HC, Hengstler P, Schindler C, Meier G. ω-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002;112(4):298-304.
Lee KW, Lip GY. The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease. Q J Med 2003;96(7):465-480.
Von Schacky C, Angerer P, Kothny W, Theisen K, Mudra H. The Effect of dietary ω-3 fatty acids on coronary atherosclerosis: a randomized, doubleblind, placebo-controlled trial. Ann Intern Med 1999;130(7):554-562.