Información del artículo
Las guías de tratamiento para disminuir los lípidos y el riesgo de enfermedad coronaria (EC) diseñadas por el National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) contienen una serie de características que las diferencian de las anteriores guías. Estos nuevos aspectos incluyen modificaciones en las concentraciones de lípidos y lipoproteínas; una mayor atención a la prevención primaria a través del empleo de las puntuaciones obtenidas en las tablas de Framingham, para definir el riesgo de aquellas personas con múltiples factores de riesgo lipídicos y no lipídicos; del mismo modo, ha sido objeto de reflexión la asociación del síndrome metabólico con el riesgo de EC. Se introduce la categoría de equivalentes de riesgo coronario, donde se incluye a personas con enfermedad aterosclerótica, diabetes mellitus o aquellas que presentan un riesgo de EC a los 10 años superior al 20%, basado en las proyecciones de Framingham; se les clasifica como pacientes de alto riesgo coronario y susceptibles de un tratamiento intensivo para reducir las concentraciones del colesterol ligado a las lipoproteínas de baja densidad (cLDL). Asimismo, se ha establecido como objetivo terapéutico secundario la mejoría del colesterol ligado a lipoproteínas de alta densidad (cHDL) en pacientes con aumento de las concentraciones de triglicéridos, una vez que se han alcanzado las metas del cLDL. El ATP-III dedica una extensa sección al tratamiento no farmacológico, que se centra en la dieta aterogénica, la obesidad y los hábitos de vida sedentarios, para recomendar un programa activo de cambios en el estilo de vida.
En esta revisión se discuten algunos aspectos relacionados con: a) la evaluación del riesgo para seleccionar a pacientes susceptibles de intervención clínica, considerando los nuevos factores de riesgo emergentes y el síndrome metabólico; b) la evaluación de diversos algoritmos de evaluación del riesgo cardiovascular; c) el manejo clínico de los factores de riesgo cardiovasculares, con futuras perspectivas de objetivos del cLDL; d) atención a las características especiales de una dieta saludable cardiovascular, y e) el tratamiento de ciertas dislipemias específicas, como la elevación de triglicéridos o la dislipemia diabética.
Palabras clave:
Dislipemias
Hipertrigliceridemia
Factores de riesgo cardiovasculares
ATP-III
The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for lipid-lowering therapy to reduce coronary heart disease (CHD) risk contains a number of features that distinguish them from the previous ATP guidelines. These new features include modifications in lipid/lipoprotein levels; increased focus on primary prevention through use of Framingham risk scoring to define risk in persons with multiple lipidic/nonlipidic risk factors; and increased focus on the association of the metabolic syndrome with CHD risk. The introduction of the category of CHD risk equivalents-including persons with atherosclerotic disease, diabetes mellitus, or 10-year CHD risk lighter than 20% based on Framingham scoringresults, categorized as being at high risk and therefore eligible for more intensive low-density lipoprotein cholesterol (LDL-c)- lowering therapy. Use of the new secondary therapeutic target of non-high-density lipoprotein cholesterol should improve management of lipid risk factors in patients who have elevated triglyceride levels after LDL-c goals have been met. ATP-III has an extensive section on non-pharmacologic therapy, focused on the high-saturated fat atherogenic diet, obesity, and sedentary lifestyle and recommended a program of therapeutic lifestyle change.
This review discusses several issues, including: a) risk assessment for selection of patients for clinical intervention, considering new emerging risk factors and the metabolic syndrome; b) evaluation from differents risk scoring algorithms; c) clinical management of cardiovascular risk factors, with future perspectives on LDL-c goals; d) special features on a healthy cardiovascular diet, and e) management of specific dyslipidemias like elevated serum triglycerides or diabetic dyslipemia.
Key words:
Dyslipemias
Elevated triglycerides
Cardiovascular risk factors
ATP-III
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