Article information
Resumen
El aumento del riesgo cardiovascular (RCV) entre los pacientes postivos al virus de la inmunodeficiencia humana (VIH) hace indispensable adoptar medidas de prevención de la morbimortalidad cardiovascular y, para ello, se necesitan escalas de estimación de éste, entre ellas: Framingham, PROCAM y Score. Los factores de RCV (FRCV) clásicos guardan una estrecha relación con el RCV en los pacientes con VIH, pero no se conoce sí es equiparable al de la población general. Es por ello que estas escalas probablemente infravaloren el riesgo en estos pacientes. Actualmente, se recomienda aplicar las mismas estrategias que en población general, sin olvidar las singularidades de los pacientes VIH-positivos y la importancia del estado inflamatorio persistente que presentan, que podría acelerar el desarrollo de arteriosclerosis y traducirse en un aumento en la morbimortalidad cardiovascular. Es por esto que, además de los FRCV tradicionales, los marcadores biológicos de inflamación podrían contribuir a identificar a los pacientes más susceptibles de presentar un episodio cardiovascular, por lo que son revisados. También se revisan diversas técnicas para la valoración de aterosclerosis subclínica que podrían ayudar a identificar pacientes de riesgo de forma precoz.
Los cambios en el estilo de vida (dieta saludable, dejar de fumar, mantener un peso adecuado y ejercicio físico diario) consiguen, en la población general, un descenso en la probabilidad de presentar un episodio coronario de hasta el 80%. Se revisan las medidas terapéuticas tradicionales (dislipemia, hipertensión arterial, diabetes mellitus) y las particulares de la condición VIH (supresión viral, tratamientos discontinuos, etc.).
Palabras clave:
Estimación del riesgo cardiovascular
VIH
Factores de riesgo cardiovascular
Score
Escala de Framingham
Biomarcadores
Abstract
Because of the increased cardiovascular risk (CVR) in HIV-positive patients, preventive measures are essential, requiring algorithms for risk estimation, such as the Framingham risk equation, the Prospective Cardiovascular Munster Study (PROCAM) algorithm and the Systematic Coronary Risk Evaluation (SCORE) chart. Classical cardiovascular risk factors (CVRF) are closely related to CVR in HIV-infected patients but whether this risk is comparable to that in the general population is unknown. Therefore, these algorithms probably underestimate the risk in these patients. Currently, application of the same strategies as those used in the general population is recommended, without forgetting the specific characteristics of HIVpositive patients or the importance of their inflammatory status, which can accelerate the development of arteriosclerosis and lead to an increase in cardiovascular morbidity and mortality. Therefore, in addition to traditional CVRF, biological markers of inflammation could help to identify the patients most at risk of a cardiovascular event. These markers, as well as the diverse techniques for assessment of subclinical atherosclerosis that could help in the early identification of at-risk patients, are reviewed in the present study. Lifestyle changes (healthy diet, smoking cessation, maintaining a healthy weight and daily physical exercise) reduce the probability of a coronary event by up to 80% in the general population. Traditional therapeutic measures (dyslipidemia, hypertension, diabetes mellitus) and those specific to HIV infection (viral suppression, discontinuous treatment, etc.) are reviewed.
Key words:
Cardiovascular risk estimation
HIV
Cardiovascular risk factors
SCORE
Framingham scale
Biomarkers
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