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¿AFECTAN LAS ESTATINAS EL RIESGO CARDIOVASCULAR EN LOS PACIENTES EN HEMODIALISIS CRONICA?

¿AFECTAN LAS ESTATINAS EL RIESGO CARDIOVASCULAR EN LOS PACIENTES EN HEMODIALISIS CRONICA?

(especial para SIIC © Derechos reservados)
En las personas en hemodiálisis a largo plazo, las estatinas podrían atenuar la progresión de la enfermedad cardiovascular debido a su efecto sobre factores de riesgo no tradicionales, habitualmente presentes en esa población; sin embargo, se requieren aún pruebas de suficiente solidez para obtener conclusiones definitivas acerca de su utilidad.
Autor:
Luigi Vernaglione
Columnista Experto de SIIC

Institución:
Department of Nephrology and Dialysis, ¨M. Giannuzzi¨ Hospital of Manduria


Artículos publicados por Luigi Vernaglione
Recepción del artículo
27 de Julio, 2006
Aprobación
8 de Agosto, 2006
Primera edición
12 de Febrero, 2007
Segunda edición, ampliada y corregida
22 de Mayo, 2007

Resumen
Los pacientes en hemodiálisis (HD) crónica se caracterizan por presentar importante morbilidad cardiovascular (CV). En ese contexto clínico, los factores de riesgo no tradicionales se suman a aquellos conocidos para condicionar la progresión aterosclerótica del sistema CV. Los desequilibrios en la función endotelial y la inflamación representan los principales factores de riesgo no tradicionales y están presentes en aproximadamente el 50% de los pacientes en HD en todo el mundo. En verdad, las técnicas de HD con mayor biocompatibilidad y las estatinas parecen ser los tratamientos más efectivos para limitar la inflamación y la lesión endotelial en tales pacientes. Respecto de las estatinas, además de sus conocidas propiedades para reducir los lípidos, la mayor parte de la información acerca de su efecto beneficioso sobre los factores de riesgo no tradicionales proviene de estudios in vitro o ensayos clínicos pequeños. Hasta el momento, se realizaron sólo unos pocos estudios aleatorizados, controlados y con suficiente poder estadístico, los cuales mostraron resultados contradictorios. La impresión general es que las estatinas son seguras y efectivas para reducir la progresión de la aterosclerosis en los enfermos en HD. Actualmente, se aguardan pruebas científicas sólidas que permitan confirmar esa opinión.

Palabras clave
estatinas, riesgo cardiovascular, hemodiálisis, inflamación


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Abstract
Long-term hemodialysis (HD) patients are characterized by heavy CV burden. In this clinical setting non-traditional CV risk factors act besides the traditional ones in determining the atherosclerotic degeneration of the CV system. Inflammation and endothelial unbalances represent the main non-traditional risk factors for CV events and they are present in about 50% of HD patients around the world. Actually more biocompatible HD techniques and statins seem the most effective treatment in limiting inflammation and endothelial damage in these patients. Speaking about statins, apart the well known lipid lowering properties, the majority of data about their beneficial effect on non-traditional CV risk factors comes from in vitro or small clinical studies. So far, only a few wellpowered randomized controlled trials have been performed and they have given conflicting results. The overall feeling is that statins can be used safely and effectively in HD patients in order to reduce the progression of atherosclerosis. To date we are still waiting for solid scientific evidence able to confirm this feeling.

Key words
statins, cardiovascular risk, hemodialysis, inflammation


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Nefrología y Medio Interno
Relacionadas: Cardiología, Farmacología, Medicina Farmacéutica, Medicina Interna



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Luigi Vernaglione, "M. Giannuzzi" Hospital of Manduria, 74100, Via Venezia 25, Taranto, Italia
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