Cantú-Brito C, Mimenza-Alvarado A, Sánchez-Hernández JJ

Idioma: Español
Referencias bibliográficas: 35
Paginas: 333-342
Archivo PDF: 137.27 Kb.

RESUMEN

El riesgo de complicaciones vasculares se incrementa en pacientes ancianos con diabetes. En promedio tienen alrededor de tres veces más probabilidades de tener enfermedad vascular cerebral (EVC) en comparación con sujetos sin diabetes. Además, hasta 75 a 80% de las muertes en pacientes con diabetes se deben a complicaciones cardiovasculares, incluyendo EVC. Aunque se tiene la impresión de que las complicaciones macrovasculares asociadas a la diabetes se desarrollan a largo plazo, estudios de población han documentado que la EVC sobreviene tempranamente después del diagnóstico de diabetes: el riesgo de EVC fue de 9% (mortalidad de 21%), en los primeros cinco años, lo cual representa el doble de la población general. A partir de registros observacionales, multicéntricos, en pacientes con eventos isquémicos cerebrales, desarrollados por un Grupo Colaborativo Multicéntrico de EVC en México, se analizan las características clínicas, factores de riesgo, neuroimagen y evolución clínica en 1,182 pacientes con diabetes mellitus con énfasis en los pacientes en edad geriátrica. Se observó alta frecuencia de descontrol metabólico en la etapa aguda del EVC: mediana de 140 mg/dL (40% con valores superiores a los 180 mg/dL). La evolución clínica a corto plazo (30 días) es más desfavorable en personas ancianas con tasa de defunción de 30% y presencia de discapacidad moderada a severa de 45%. Lo anterior en relación con su mayor propensión a las complicaciones sistémicas durante el internamiento. Estudios de prevención primaria de la EVC han demostrado que el control estricto de la glucosa no se asocia a reducción del riesgo de EVC. Por lo tanto, el control de otros factores de riesgo presentes en el paciente diabético es fundamental, en particular de la hipertensión arterial.

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