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2002, Número 1

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Arch Cardiol Mex 2002; 72 (1)


Estatinas postinfarto. Un beneficio incuestionable. Una estrategia terapéutica perfeccionable

Galve E

Idioma: Español
Referencias bibliográficas: 39
Paginas: 58-67
Archivo PDF: 121.75 Kb.


RESUMEN

La enfermedad aterosclerótica se relaciona etiopatogénicamente con la presencia de hipercolesterolemia. Nunca los médicos habían dispuesto de una generación de fármacos hipocolesterolemiantes con un grado semejante de eficacia, potencia y seguridad comparable a las estatinas. El campo que más ha sido explorado con estatinas ha sido el postinfarto de miocardio, y ello porque los pacientes de este tipo son sujetos de alto riesgo para futuros eventos cardiovasculares y, como consecuencia, son los que más pueden beneficiarse de una intervención. De esta forma, se han realizado tres grandes estudios con estatinas, los cuales han demostrado de modo concluyente una reducción significativa de eventos cardiovasculares y mortalidad tras un infarto. Sin embargo, pese a que la evidencia acerca de la necesidad de implementar el tratamiento con estatinas es consistente, aún existe un conjunto de relevantes cuestiones por resolver y actualmente bajo estudio. La primera de ellas es sobre el valor de las propiedades pleiotrópicas de las estatinas (aquéllas ajenas al simple proceso de reducir los niveles de colesterol), tan importantes para lograr la estabilización de la placa. Por otra parte, no se sabe con exactitud cuán precozmente debe comenzarse el tratamiento con estatinas tras un infarto. Otro punto que se ignora es el objetivo en la reducción de los lípidos (el nivel de colesterol total y LDL que se debe alcanzar). De hecho, prosigue el debate sobre si se deben tratar también aquellos pacientes con niveles no elevados de colesterol e incluso aquellos con niveles bajos. Y finalmente, en relación con la cuestión anterior, sería de gran interés saber si es necesario emplear niveles elevados de estatinas, o las dosis bajas ya son igualmente eficaces. En conclusión, las estatinas marcan un hito en el tratamiento hipocolesterolemiante de los pacientes postinfarto. La mayoría de estos pacientes deberían, probablemente, ser tratados. La investigación en marcha se dirige actualmente a delimitar del modo más preciso la forma como deben prescribirse las estatinas en estos pacientes para prolongar su vida.


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