medigraphic.com
ISSN 0016-3813 (Impreso)

2004, Número 5

<< Anterior Siguiente >>

Gac Med Mex 2004; 140 (5)


Cumplimiento de las metas con reductores del colesterol en pacientes mexicanos. El estudio COMETA México

Meaney E, Vela A, Ramos A, Alemao E, Yin D

Idioma: Español
Referencias bibliográficas: 41
Paginas: 493-501
Archivo PDF: 74.56 Kb.


RESUMEN

En un estudio retrospectivo para determinar el porcentaje de pacientes que alcanzan las metas terapéuticas de C-LDL con hipolipemiantes, se seleccionaron 20 especialistas y médicos generales, quienes trabajaron con 120 pacientes y les midieron los lípidos después de por lo menos 12 semanas de tratamiento. Fueron agrupados en tres categorías: grupo A (riesgo absoluto de cardiopatía coronaria a 10 años ‹10%); grupo B, con riesgo entre 10 y 20%, y grupo C, con riesgo ›20%. Los valores meta del C-LDL fueron: ‹160 mg/dl para el grupo A, ‹130 para el B y ‹100 para el C. La edad fue 57 ± 12 años, 59% fueron hombres y 51% del grupo C. De éstos 83% recibió estatinas, 12% fibratos solos y 5% combinaciones. Atorvastatina y Simvastatina fueron los fármacos más utilizados, a dosis promedio moderadas (12 y 27 mg/día). El C-LDL se redujo 25%. En 22% se ajustó la dosis. Alcanzó las metas de C-LDL con la primera dosis (29%) y al final del estudio (42%). Las metas se alcanzaron mejor en los grupos de menor riesgo. No hubo diferencias entre los distintos tipos de médicos. Los datos indican pobre apego a las recomendaciones internacionales e insuficiente alcance de las metas terapéuticas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Rajavashisth TB, Liao JK, Galis ZS, Tripathi S; Laufs U; Tripathi J; et al. Inflammatory cytokines and oxidized low density lipoproteins increase endothelial cell expression of membrane type 1-matrix metalloproteinase. J Biol Chem. 1999;274:11924–11929

  2. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witzum JL. Beyond cholesterol. Modifications of low-density lipoproteins that increases its atherogenicity. N Engl J Med 1989;320:915-924.

  3. Gerrity RG, Naito HK, Richardson M, Schwartz CJ. Dietary induced atherogenesis in swine: Morphology of the intima in prelesion stages. Am J Pathol 1979;95:779-786.

  4. Keys A. Coronary heart disease in seven countries. American Heart Association, Monograph No.29. New York 1970.

  5. Kagan A, Harris BR, Winkelstein W Jr., Johnson KG, Kato H, Syme SL, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawai, and California: demographic, physical, dietary and biochemical characteristics J Chronic Dis 1974;27:345-364.

  6. Castelli WP, Garrison KJ, Wilson PW, Abbott RD; Kalousdian S; Kannel WB et al. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 1986;256:2835-2838

  7. Stamler J, Wentsworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention trial (MRFIT) JAMA 1986;256:2823-2828

  8. .La Rosa JC, Hunninghake D, Bush D. Criqui MH, Getz GS, Gotto AM Jr., et al. The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease: A joint statement by the American heart Association and the National Heart, Lung, and Blood Institute. Circulation 1990;81:1721-1733.

  9. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. High-density lipoprotein cholesterol and cardiovascular disease: Four prospective American studies. Circulation 1989;79:8-15.

  10. Green MS, Heiss G, Rifkind BM, Cooper GR; Williams OD; Tyroler HA et al. The ratio of plasma high density lipoprotein cholesterol to total and low density lipoprotein cholesterol: age-related changes and race and sex differences in selected North American populations; the Lipid Research Clinics Program Prevalence Study. Circulation 1985;72:93-104.

  11. Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. JAMA 1987;257:2176-2180.

  12. Assman G, Schulte H. Triglycerides and atherosclerosis: Results from the Prospective Cardiovascular Münster Study. Atherosc Rev 1991;22:51-57.

  13. Criqui MH, Heiss G, Cohn R, Cowan LD; Suchindran CM; Bangdiwala S; et al. Plasma triglyceride level and mortality from coronary heart disease. N Engl J Med 1993;328:1220-1225.

  14. Stamler J, Dyer AR, Shekelle RB, Neaton J; Stamler R. Relationship of baseline major risk factors to coronary and all causes mortality, and to longevity: Findings from long-term follow-up of Chicago cohorts. Cardiology 1993;82:191-222.

  15. Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Circulation 1992;85:37-45.

  16. Tall AR. Plasma high density lipoproteins- Metabolism and relationship to atherogenesis. J Clin Invest 1990;86:379-384.

  17. Haberf RL, Dembowski K. Aterotrombosis: common factor in stroke, myocardial infarction and peripheral vascular disease. Eur Heart J Supplements 1999;1 (Suppl A):A41-A44.

  18. Brady AJ. Cardiovascular risk management in clinical practice. Role of lifestyle, hypertension, diabetes and dyslipidaemia. Eur Heart J Supplements, 2(Suppl D), 2000:D4-D6.

  19. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Guide to primary prevention of cardiovascular diseases. A statement for healthcare professionals from the Task Force on Risk Reduction. American heart Association Science Advisory and Coordinating Committee. Circulation 1997;95:2329-2331.

  20. Smith SC Jr., Blair SN, Bonow RO, Brass LM; Cerqueira MD; Dracup K; et al. AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease:2001 update. A statement for healthcare professionals from the American heart Association and the American College of Cardiology. J Am Coll Cardiol 2001;38:1581-1583

  21. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001 May 16;285(19):2486-97.

  22. Wood D, De Backer G, Faegerman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J 1998;19:1434-1503..

  23. Recomendaciones de la Segunda Reunión de Expertos en Dislipidemias organizada por la Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C. Lineamientos sobre la detección, el manejo diagnóstico y el tratamiento dietario y farmacológico de la hipercolesterolemia y la hipertrigliceridemia. Rev Mex Cardiol 1996;7:7-24

  24. Hayward DJ, Guyatt GH, Moore KA, McKibbon KA; Carter AO et al. Canadian physicians´ attitudes about and preferences regarding clinical practice guidelines. CMAJ 1997;156:1715-1723.

  25. Benjamin EJ, Smith SC Jr., Cooper RS, Hill MN; Luepker RV et al. 33rd Bethesda Conference; Preventive cardiology: How Can We Do Better? Task Force # 1-Magnitude of the prevention problem: opportunities and challenges. J Am Coll Cardiol 2002;40:588-603.

  26. Merz NB, Mensah GA, Fuster V, Greenland P; Thompson PD, et al. 33rd Bethesda Conference; Preventive cardiology: How Can We Do Better? Task Force # 5-The role of cardiovascular specialists as leaders in prevention: from training to champion. J Am Coll Cardiol 2002;40:641-649.

  27. Pearson T, Rapaport E, Criqui M, Furberg C; Fuster V; Hiratzka L et al. Optimal risk factor management in the patient after coronary revascularization. A statement for healthcare professionals from an American Heart Association Writing Group. Circulation 1994;90:3125-3133.

  28. ICH Guidelines for Good Clinical Practice. International Conference on Harmonisation for Technical Requirements for the Registration of Pharmaceuticals for Human Use. ICH Harmonised tripartite R Guideline. London. ICH. 1996.

  29. Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultra-centrifuge. Clin Chem 1972;18:499-502.

  30. Maron DJ, Fazio S; Linton MF. Current perspectives on statins. Circulation 2000;101:207-213

  31. Athyros VC, Papageorgiou AA, Mercouris BR, Athyrou VV; Symeonidis AN; Basayannis EO; et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal vs “usual” care in secondary coronary heart disease prevention. Curr Med Res Opin 2002;18:220-228.

  32. .Lipid Research Clinics program. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251:351-364.

  33. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-1255.

  34. Shepherd J, Cobbe SM, Ford I, Isles CG; Lorimer AR; MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-1307.

  35. The 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;334:1384-1389.

  36. Downs JR, Clearfield M, Weis S; Whitney E, Shapiro DR; Beere PA et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. Results of AFCAPS/TexCAPS. JAMA 1998;279:1615-1622.

  37. 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;360:7-22.

  38. Riegger G, Abletshauser C, Ludwig M, Schwandt P; Widimsky J; Weidinger G et al. The effect of fluvastin on cardiac events in patients with symptomatic coronary artery disease during one year of treatment. Atherosclerosis 1999;144:263-270.

  39. Pearson TA; Laurora I; Chu H; Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving lowdensity lipoprotein cholesterol goals. Arch Intern Med 2000;160:459-467.

  40. Cobbe SM. How best to combat the enemies? Lipid lowering Eur Heart J Suppl 2002;4:A48-A52.

  41. Estadísticas de mortalidad. Causas de mortalidad en México 2000., Secretaría de Salud. http//www.ssa.gob.mx.




2020     |     www.medigraphic.com