Información del artículo
La angiografía coronaria ha sido la técnica estándar para valorar la enfermedad coronaria y sus cambios con el tratamiento. Esta técnica visualiza el lumen y las estenosis coronarias, pero no la pared arterial. Otras limitaciones son su agresividad, su alto coste y su aplicabilidad restringida a pacientes con enfermedad coronaria establecida. Las nuevas técnicas de detección por la imagen de la aterosclerosis preclínica (ecografía carotídea, tomografía computarizada para la detección de calcio coronario y resonancia magnética vascular) permiten evaluar de manera incruenta la carga aterosclerótica y sus cambios con el tratamiento en individuos con o sin enfermedad coronaria. Otra técnica reciente, la ecografía intravascular, también es agresiva, pero resulta útil porque evalúa tanto el lumen como la pared arterial. Aunque todavía no está estandarizada, la medición ecográfica del grosor íntima-media carotídeo es la técnica más asequible y la única recomendada para estudios de regresión de la aterosclerosis. Varios estudios clínicos han demostrado detención de la progresión o regresión de la aterosclerosis carotídea tras el tratamiento con estatinas durante 1-4 años. Los estudios angiográficos para la valoración de la eficacia terapéutica del tratamiento hipolipemiante no son realmente necesarios.
Palabras clave:
Aterosclerosis
Tratamiento hipolipemiante
Estudios de regresión
Ecografía carotídea
Grosor íntima-media
Ecografía intravascular
Calcio coronario
Resonancia magnética vascular
Coronary angiography has been the standard technique to evaluate coronary disease and its changes with treatment. This technique can visualize the coronary lumen and stenosis but not the arterial wall. Other limitations are that it is an aggressive and expensive procedure and its use is restricted to patients with established coronary disease. New imaging techniques for the protection of preclinical atherosclerosis (carotid ultrasonography, computed tomography for the detection of coronary calcium and vascular magnetic resonance imaging) allow atherosclerotic load and its changes with treatment to be evaluated noninvasively in individuals with or without coronary disease. Another recent technique, intravascular ultrasonography, is also aggressive, but is useful because it evaluates both the lumen and the arterial wall. Although still not standardized, ultrasonographic measurement of carotid intima-media thickness is the most accessible technique and is the only procedure recommended for studies of atherosclerosis regression. Various clinical studies have demonstrated that progression of carotid atherosclerosis is halted or that there is regression after 1-4 years of treatment with statins. Angiographic studies to evaluate the therapeutic efficacy of lipid lowering drugs are not really required.
Key words:
Atherosclerosis
Lipid-lowering therapy
Regression studies
Carotid ultrasonography
Intima-media thickness
Intravascular ultrasonography
Coronary calcium
Vascular magnetic resonance imaging
El Texto completo está disponible en PDF
Bibliografía
[1.]
J.P. Kane, M.J. Malloy, T.A. Ports, N.R. Phillips, J.C. Diehl, R.J. Havel.
Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens.
Jama, 264 (1990), pp. 3007-3012
[2.]
G. Brown, J.J. Albers, L.D. Fisher, S.M. Schaefer, J.T. Lin, C. Kaplan, et al.
Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B.
N Engl J Med, 323 (1990), pp. 1289-1298
[3.]
R.A. Archbold, A.D. Timmis.
Modification of coronary artery disease progression by cholesterol-lowering therapy: the angiographic studies.
Curr Opin Lipidol, 10 (1999), pp. 527-534
[4.]
D. Hackett, G. Davies, A. Maseri.
Pre-existing coronary stenoses in patients with first myocardial infarction are not necessarily severe.
Eur Heart J, 9 (1988), pp. 1317-1323
[5.]
J.A. Ambrose, M.A. Tannenbaum, D. Alexopoulos, C.E. Hjemdahl-Monsen, J. Leavy, M. Weiss, et al.
Angiographic progression of coronary artery disease and the development of myocardial infarction.
J Am Coll Cardiol, 12 (1988), pp. 56-62
[6.]
M. Aikawa, P. Libby.
The vulnerable atherosclerotic plaque. Pathogenesis and therapeutic approach.
Cardiovasc Pathol, 13 (2004), pp. 125-138
[7.]
E. Ros, D. Zambón, R. Gilabert.
Técnicas de diagnóstico de aterosclerosis preclínica y su utilización para mejorar la predicción de riesgo cardiovascular.
Clin Invest Arterioscler, 14 (2002), pp. 187-197
[8.]
S.E. Nissen, P. Yock.
Intravascular ultrasound: novel pathophysiological insights and current clinical applications.
Circulation, 103 (2001), pp. 604-616
[9.]
P. Greenland, S.C. Smith, S.M. Grundy.
Current perspective. Improving coronary risk assessment in asymptomatic people: role of traditional risk factors and non-invasive cardiovascular tests.
Circulation, 104 (2001), pp. 1863-1867
[10.]
P. Pignoli, E. Tremoli, A. Poli, P. Oreste, R. Paoletti.
Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging.
Circulation, 74 (1986), pp. 1399-1406
[11.]
D.H. O’Leary, J.F. Polak.
Intima-media thickness: a tool for atherosclerosis imaging and event prediction.
Am J Cardiol, 90 (2002), pp. L18-21
10C
[12.]
J.J.P. Kastelein, E. De Groot, R. Sakatsing.
Atherosclerosis measured by B-mode ultrasonography: effects of statin therapy on disease progression.
Am J Med, 116 (2004), pp. S31-S36
[13.]
K.S. Cheng, D.P. Mikhailidis, G. Hamilton, A.M. Seifalian.
A review of the carotid and femoral intima-media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors.
Cardiovasc Res, 54 (2002), pp. 528-538
[14.]
C.D. Furberg, H.P. Adams, W.B. Applegate, R.P. Byington, M.A. Espeland, T. Hartwell, et al.
Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.
Circulation, 90 (1994), pp. 1679-1687
[15.]
J.R Crouse III., R.P. Byington, M.G. Bond, M.A. Espeland, T.E. Craven, J.W. Sprinkle, et al.
Pravastatin, Lipids, and Atherosclerosis in the Carotid arteries (PLAC-II).
Am J Cardiol, 75 (1995), pp. 455-459
[16.]
R. Salonen, K. Nyyssonen, E. Porkkala, J. Rummukainen, R. Belder, J.S. Park, et al.
Kuopio Atherosclerosis Prevention Study (KAPS): a population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries.
Circulation, 92 (1995), pp. 1758-1764
[17.]
M. Mercuri, M.G. Bond, C.R. Sirtori, F. Veglia, G. Crepaldi, F.S. Feruglio, et al.
Pravastatin reduces carotid intima-media thickness progression in an asymptomatic hypercholesterolemic mediterranean population: the Carotid Atherosclerosis Italian Ultrasound Study.
Am J Med, 101 (1996), pp. 627-634
[18.]
D. Baldassarre, F. Veglia, C. Gobbi, G. Gallus, A. Ventura, G. Crepaldi, et al.
Intima-media thickness after pravastatin stabilizes also in patients with moderate to no reduction in LDL-cholesterol levels: the Carotid Atherosclerosis Italian Ultrasound Study.
Atherosclerosis, 151 (2000), pp. 575-583
[19.]
H.N. Hodis, W.J. Mack, L. LaBree, R.H. Selzer, C. Liu, P. Alaupovic, et al.
Reduction in carotid arterial wall thickness using lovastatin and dietary therapy: a randomized controlled clinical trial.
Ann Intern Med, 124 (1996), pp. 548-556
[20.]
H.N. Hodis, W.J. Mack, M. Dunn, C. Liu, R.H. Selzer, R.M. Krauss.
Intermediate-density lipoproteins and progression of carotid arterial wall intima-media thickness.
Circulation, 95 (1997), pp. 2022-2026
[21.]
S. MacMahon, N. Sharpe, G. Gamble, H. Hart, J. Scott, J. Simes, et al.
Effects of lowering average or below-average cholesterol levels on the progression of carotid atherosclerosis. Results of the LIPID atherosclerosis substudy. LIPID Trial Research Group.
Circulation, 97 (1998), pp. 1784-1790
[22.]
E. De Groot, J.W. Jukema, A.D. Montauban van Swijndregt, A.H. Zwinderman, R.G. Ackerstaff, A.F. Van der Steen, et al.
B-mode ultrasound assessment of pravastatin treatment effect on carotid and femoral artery walls and its correlations with coronary arteriographic findings: a report of the Regression Growth Evaluation Statin Study (REGRESS).
J Am Coll Cardiol, 31 (1998), pp. 1561-1567
[23.]
B. Heldblad, J. Wikstrand, L. Janzon, H. Wedel, G. Berglund.
Low dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the Beta-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS).
Circulation, 103 (2001), pp. 1721-1726
[24.]
T.J. Smilde, S. Van Wissen, H. Wollersheim, M.D. Trip, J.J. Kastelein, A.F. Stalenhoef.
Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial.
Lancet, 357 (2001), pp. 577-581
[25.]
A.J. Taylor, S.M. Kent, P.J. Flaherty, L.C. Coyle, T.T. Markwood, M.N. Vernalis.
ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol. A randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness.
Circulation, 106 (2002), pp. 2055-2060
[26.]
S.M. Kent, L.C. Coyle, P.J. Flaherty, T.T. Markwood, A.J. Taylor.
Marked low-density lipoprotein cholesterol reduction below current National Cholesterol Education Program targets provides the greatest reduction in carotid atherosclerosis.
Clin Cardiol, 27 (2004), pp. 17-21
[27.]
W.J.E. Bemelmans, J.D. Lefrandt, E.J.M. Feskens, J. Broer, J.W.C. Tervaert, J.F. May, et al.
Change in saturated fat intake is associated with progression of carotid and femoral intima-media thickness, and with levels of soluble intercellular adhesion molecule-1.
Atherosclerosis, 163 (2002), pp. 113-120
[28.]
K. Okada, N. Maeda, M. Tatsukawa, C. Shimizu, Y. Sawayama, J. Hayashi.
The influence of lifestyle modification on carotid artery intima-media thickness in a suburban Japanese population.
Atherosclerosis, 173 (2004), pp. 329-337
[29.]
R.A. O’Rourke, B.H. Brundage, V.G. Froelicher.
American College of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease.
Circulation, 102 (2000), pp. 126-140
[30.]
J. Valabhji, R.S. Elkeles.
Non-invasive measurement of coronary heart disease using electron beam computed tomography.
Curr Opin Lipidol, 13 (2002), pp. 409-414
[31.]
S. Achenbach, W.G. Daniel.
Imaging of coronary atherosclerosis using computed tomography: current status and future directions.
Curr Atheroscler Rep, 6 (2004), pp. 213-218
[32.]
R.C. Detrano, N.D. Wong, T.M. Doherty, R.M. Shavelle, W. Tang, L.E. Ginzton, et al.
Coronary calcium does not accurately predict near-term future coronary events in high risk adults.
Circulation, 99 (1999), pp. 2633-2638
[33.]
H.H. Oei, R. Vliegenthart, A.E. Hak, A. Iglesias del Sol, A. Hofman, M. Oudkerk, et al.
The association between coronary calcification assessed by electron beam computed tomography and measures of extracoronary atherosclerosis. The Rotterdam Coronary Calcification Study.
J Am Coll Cardiol, 39 (2002), pp. 1745-1751
[34.]
T.Q. Callister, P. Raggi, B. Cooil, N.J. Lippolis, D.J. Russo.
Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography.
N Engl J Med, 339 (1998), pp. 1972-1978
[35.]
S. Achenbach, D. Ropers, K. Pohle, A. Leber, C. Thilo, A. Knez, et al.
Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation.
Circulation, 106 (2002), pp. 1077-1082
[36.]
P. Raggi, T.Q. Callister, L.J. Shaw.
Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy.
Arterioscler Thromb Vasc Biol, 24 (2004), pp. 1272-1277
[37.]
P. Raggi, T.Q. Callister, M. Davidson, F.K. Welty, G.A. Bachmann, R. Laskey, et al.
Aggressive versus moderate lipid-lowering therapy in postmenopausal women with hypercholesterolemia: rationale and design of the Beyond Endorsed Lipid Lowering with EBT Scanning BELLES trial.
Am Heart J, 141 (2001), pp. 722-726
[39.]
C. Yuan, X.Q. Zhao, T.S. Hatsukami.
Quantitative evaluation of carotid atherosclerotic plaques by magnetic resonance imaging.
Curr Atheroscler Rep, 4 (2002), pp. 351-357
[40.]
R. Corti, V. Fuster.
New understanding, diagnosis, and prognosis of atherothrombosis and the role of imaging.
Am J Cardiol, 91 (2003), pp. A17-A26
[41.]
X.Q. Zhao, C. Yuan, T.S. Hatsukami, E.H. Frechette, X.J. Kang, K.R. Maravilla, et al.
Effects of prolonged intensive lipid-lowering therapy on the characteristics of carotid atherosclerotic plaques in vivo by MRI. A case-control study.
Arterioscler Thromb Vasc Biol, 21 (2001), pp. 1623-1629
[42.]
R. Corti, V. Fuster, Z.A. Fayad, S.G. Worthley, G. Helft, D. Smith, et al.
Lipid lowering by simvastatin induces regression of human therosclerotic lesions. Two years’ follow-up by high-resolution noninvasive magnetic resonance imaging.
Circulation, 106 (2002), pp. 2884-2887
[43.]
S.E. Nissen, P. Yock.
Intravascular ultrasound: novel pathophysiological insights and current clinical applications.
Circulation, 103 (2001), pp. 604-616
[44.]
S.E. Nissen, E.M. Tuzcu, P. Schoenhagen, B.G. Brown, P. Ganz, R.A. Vogel, et al.
Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. A randomized controlled trial.
JAMA, 291 (2004), pp. 1071-1080
[45.]
S.A. Anderssen, A.K. Hjelstuen, I. Hjermann, et al.
Fluvastatin and lifestyle modification for reduction of carotid intima-media thickness and left ventricular mass progression in drug-treated hypertensives.
Atherosclerosis, 178 (2005), pp. 387-397
Copyright © 2005. Sociedad Española de Arteriosclerosis y Elsevier España S.L.