Alcocer Díaz-Barreiro L, Solache-Ortiz G, Aldrete-Velasco J

Language: Spanish
References: 31
Page: 57-71
PDF size: 334.94 Kb.

ABSTRACT

For a long time, efforts to reduce cardiovascular risk in adults focused on the attempt to reduce plasmatic LDL cholesterol (LDLc) levels as much as possible. Until very recently, it was concluded that in clinical studies of drugs with action on circulating lipids, there was no direct evidence to determine the best LDLc target for cardiovascular risk reduction, and that adverse events, or the almost absent demonstration of impact on hard outcomes of the different pharmacological combinations recommended for the achievement of the lowest possible LDLc concentrations, were not considered. The comprehensive analysis for the update of NCEP-ATP-III (National Cholesterol Education Program, Adult Treatment Panel III), which included a large number of controlled and randomized trials, allowed in 2013 the postulation of a new treatment paradigm, which leaves the concept of specific goals of LDLc and postulates the importance of favorable lifestyle modifications and which commends the pre-ferential use of statins, fixed doses and type, because a large volume of evidence has shown that these agents attenuate the progression of coronary atherosclerosis and promote the regression of this, which significantly decrease cardiovascular morbidity and mortality in both primary and secondary prevention. In this new therapeutic paradigm, it was also possible to identify the groups of patients that can benefit from the use of statins. In more recent consensuses and guidelines, some associations support the need to achieve risk-adjusted LDLc, but keep statins as the mainstay of treatment, alone or in combination with ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCKS-9) antagonists. This article reviews the clinical evidence regarding the use of atorvastatin, which allowed the development of the new cardiovascular risk management paradigm.

REFERENCES

1. O’Donnell CJ, Elosua R. Factores de riesgo cardiovascular; perspectivas derivadas del Framingham Heart Study. Rev Esp Cardiol 2008;61(3):299-310.

2. Castillo-Arocha I, Armas-Rojas NB, Dueñas-Herrera A, et al. Riesgo cardiovascular según tablas de la OMS, el estudio Framingham y la razón apolipoproteína B/apolipoproteína A1. Rev Cubana Invest Bioméd 2010;29(4):479-88.

3. Organización Mundial de la Salud (OMS). Enfermedades cardiovasculares; nota descriptiva, enero de 2015. Disponible: www.who.int/mediacentre/factsheets/fs317/es/; consultado: febrero 24, 2017.

4. Organización Mundial de la Salud (OMS), Organización Panamericana de la Salud (OPS). México: perfil de enfermedades cardiovasculares 2014. Disponible: http://www.paho.org/ hq/index.php?cx=014283770845240200164%3Aprvkaxcn ku0&q=mexico+enfermedades+cardiovasculares&search word=&cof=FORID%3A0&searchphrase=all&scope=1&opt ion=com_search&Itemid=40145&ie=utf8&site=who&clien t=amro_es&proxystylesheet=amro_es&output=xml_no_dt d&oe=utf8&getfields=doctype&ai=41037#gsc.tab=0&gsc. q=mexico%20enfermedades%20cardiovasculares&gsc. page=1; consultado: febrero 24, 2017.

5. Trentman TL, Avey SG, Ramakrishna H. Current and emerging treatments for hypercholesterolemia: a focus on statins and proprotein convertase subtilisin/kexin type 9 inhibitors for perioperative clinicians. J Anaesthesiol Clin Pharmacol 2016;32(4):440-5.

6. Schultz AE, Snider MJ, Blais DM, Gulati M. Statin desensitization in a patient with probable familial hypercholesterolemia. J Clin Lipidol 2015;9 (4):597-601.

7. Alcocer L. Las nuevas guías ACC/AHA/NHLBI 2013 (ATP IV): un cambio radical en el manejo del riesgo cardiovascular. J&C Ediciones Médicas, México, 2014.

8. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/ AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol 2013; doi: 10.1016/j.jacc.2013.11.002.

9. Reiner Z, Catapano AL, De Backer G, et al; Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) y de la Sociedad Europea de Aterosclerosis (EAS). Guía de la ESC/ EAS sobre el manejo de las dislipemias. Rev Esp Cardiol 2011;64(12):1168.e1-60.

10. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia; Part 1: full report. J Clin Lipidol 2015;9:129-69.

11. Secretaría de Salud, México. NORMA Oficial Mexicana NOM037SSA22012, para prevención, tratamiento y control de las dislipidemias. Diario Oficial de la Federación (DOF), México, 13/07/2012.

12. Alcocer L, Hernández y Hernández H, Navarro-Robles J. Probable influencia de las Guías de la ACC/AHA 2013 sobre el tratamiento de la hipercolesterolemia en la nueva Norma Oficial Mexicana para el manejo de los niveles inadecuados de lípidos. Rev Mex Cardiol 2015;26(1):34-8.

13. Abufhele A, Acevedo M, Varleta P, et al. Nuevas guías ACC/ AHA 2013 en el manejo del colesterol: una mirada crítica del Departamento de Prevención Cardiovascular de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular. Rev Chil Cardiol 2014;33:136-41.

14. Pedro-Botet J, Chillarón JJ, Benaiges D, Flores-Le-Roux JA. Las guías estadounidenses de dislipemia: fortalezas y debilidades. Rev Esp Cardiol Supl 2015;15(A):18-21.

15. American College of Cardiology (ACC), American Heart Association (AHA). ASCVD Risk Estimator. Disponible: http://tools.acc.org/ASCVD-Risk-estimator/; consultado: febrero 26, 2017.

16. Hajifathalian K, Ueda P, Lu Y, et al. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): a pooled analysis of prospective cohorts and health examination surveys. Lancet Diabetes Endocrinol 2015;3(5):339-55.

17. Athyros VG, Papageorgiou AA, Mercouris BR, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus “usual” care in secondary coronary heart disease prevention; the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) study. Curr Med Res Opin 2002;18(4):220-8.

18. Koren MJ, Hunninghake DB; ALLIANCE Investigators. Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the ALLIANCE Study. J Am Coll Cardiol 2004;44:1772-9.

19. Cannon CP, Braunwald E, McCabe CH, et al; Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350:1495-504.

20. LaRosa JC, Grundy SM, Waters DD, et al; Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352:1425-35.

21. Amarenco P, Goldstein LB, Szarek M, et al; SPARCL Investigators. Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial. Stroke 2007;38:3198-204.

22. Wagner M, Lindgren P, Merikle E, et al. Economic evaluation of high-dose (80 mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40 mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial. Can J Cardiol 2009;25(11):e362-9.

23. Charlton-Menys V, Betteridge DJ, Colhoun H, et al. Targets of statin therapy: LDL cholesterol, non-HDL cholesterol, and apolipoprotein B in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS). Clin Chem 2009;55(3):473-80.

24. Colhoun HM, Betteridge DJ, Durrington PN, et al; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo controlled trial. Lancet 2004;364(9435): 685-96.

25. Erviti J, Brugos A. Estudio ASCOT-LLA (Atorvastatina en hipertensos con colesterol normal): revisión bibliográfica y evaluación crítica. Bol Inf Farmacoter Navarra 2003;11(3):17-22.

26. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia; part 1: executive summary. J Clin Lipidol 2014;8(5):473-88.

27. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2016;68(1):92-125.

28. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement. JAMA 2016;316(19):1997-2007.

29. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016;253:281-344.

30. American Diabetes Association (ADA). Standards of medical care in diabetes, 2017. Diabetes Care 2017;40(Suppl 1):S1-135.

31. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm, 2017, executive summary. Endocr Pract 2017;23 (2):207-238.