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Resumen
En el abordaje de los factores de riesgo de enfermedad cardiovascular relacionados con los lípidos, los valores séricos de colesterol ligado a lipoproteínas de alta densidad (cHDL) comportan una importancia especial, dado que se considera que esta lipoproteína es un factor antiaterogénico debido principal, pero no exclusivamente, a su influencia e impacto sobre el transporte inverso del colesterol. Se deriva de aquí la necesidad y el requisito de tener en cuenta los valores séricos de cHDL para la prevención tanto primaria como secundaria en todo paciente con enfermedad cardiovascular. Un aspecto particularmente importante es la asociación del “síndrome de cHDL bajo” con el síndrome metabólico.
Estos factores nos obligan a considerar el valor sérico de cHDL como un objetivo terapéutico por sí mismo, o incluso en asociación con las concentraciones de colesterol ligado a lipoproteínas de baja densidad (cLDL), cuando estas últimas se encuentran elevadas. La presente revisión resalta los aspectos que establecen un nexo entre los valores séricos de cHDL y el riesgo cardiovascular, y examina las poblaciones que deberían considerarse susceptibles de intervención terapéutica debido a valores séricos de cHDL bajos.
Se revisan las estrategias terapéuticas, tanto farmacológicas como no farmacológicas. El objetivo de esta revisión es exponer recomendaciones de manejo terapéutico para la corrección de la proporción del riesgo cardiovascular atribuible a cambios en el cHDL. El objetivo terapéutico en prevención primaria y secundaria debe ser alcanzar valores de cHDL > 40 mg/dl. Esta meta reviste particular importancia en pacientes con valores séricos de cHDL bajo y cardiopatía isquémica (CI) o sus equivalentes, incluso si se han alcanzado los objetivos terapéuticos para las concentraciones séricas de cLDL (< 100 mg/dl). La primera elección terapéutica para esta situación clínica son los fibratos. Esta misma opción terapéutica será la primera que se deberá tener en cuenta en pacientes sin CI pero con valores de cHDL bajos y riesgo cardiovascular aumentado (> 20%), hipertrigliceridemia, diabetes mellitus tipo 2 o síndrome metabólico.
In the approach to lipid-related risk factors for cardiovascular diseases, serum high-density lipoprotein-cholesterol (HDL-C) levels bear a particular significance as this lipoprotein is considered to be an antiatherogenic factor mainly, but not only, because of its influence and impact on reverse cholesterol transport. Hence the need and requirement to consider serum HDL-C levels for both primary and secondary prevention of cardiovascular disease. A particularly important aspect is the association of the “low HDL syndrome” with the metabolic syndrome.
These factors force us to consider serum HDL-C level as a therapeutic target by itself, or even in association with low-density lipoproteincholesterol (LDL-C) levels when the latter are increased. This review stresses the aspects connecting serum HDL-C levels and cardiovascular risk, and looks at the populations that should be considered amenable to therapeutic management because of low serum HDL-C levels.
We review therapeutic strategies, both pharmacological and nonpharmacological. The aim of this review is to present therapeutic management recommendations for correcting the proportion of cardiovascular risk that is attributable to changes in HDL-C. HDL-C levels of > 40 mg/dL must be a therapeutic target in primary and secondary prevention. This goal is particularly important in patients with low serum HDL-C levels and ischemic heart disease (IHD) or its equivalents, even if the therapeutic target for serum LDL-C levels (< 100 mg/dL) has been achieved. The first choice for this clinical condition is fibric acid derivates. The same therapeutic option should be considered in patients without IHD with low serum HDL-C levels and high cardiovascular risk (> 20%), hypertriglyceridemia, type 2 diabetes mellitus, or metabolic syndrome.
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