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Inhibidores de la enzima de conversión de la angiotensina y ruptura aórtica: un estudio de caso y control basado en
Daniel G Hackam1, Deva Thiruchelvam, Donald A Redelmeier
1Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. daniel.hackam@ices.on.ca
Lancet (London, England)
|August 22, 2006
Resumen
Los inhibidores de la enzima de conversión de la angiotensina (ECA) reducen significativamente el riesgo de ruptura del aneurisma aórtico abdominal en pacientes mayores de 65 años. Este efecto protector no se observó con otros medicamentos comunes para la presión arterial.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Farmacología Farmacología.
- Epidemiología La epidemiología.
Sus antecedentes:
- Los estudios en animales indican que los inhibidores de la enzima convertidora de angiotensina (ECA) pueden prevenir la expansión y ruptura del aneurisma aórtico.
- Se necesitan pruebas clínicas para confirmar la asociación entre los inhibidores de la ECA y la ruptura del aneurisma aórtico abdominal (AAA) en pacientes humanos.
Objetivo del estudio:
- Investigar la asociación entre el uso de inhibidores de la ECA y el riesgo de ruptura en pacientes diagnosticados con aneurismas aórticos abdominales.
Principales métodos:
- Se realizó un estudio de casos y controles basado en la población utilizando bases de datos administrativas vinculadas en Ontario, Canadá.
- El estudio incluyó a 15.326 pacientes mayores de 65 años ingresados con un diagnóstico de aneurisma aórtico abdominal roto o intacto entre 1992 y 2002.
Principales resultados:
- Los pacientes que usaban inhibidores de la ECA antes del ingreso al hospital mostraron una probabilidad significativamente menor de presentar un aneurisma roto (OR 0,82).
- Esta asociación protectora se mantuvo consistente después de ajustar por varios factores demográficos, comorbilidades y utilización de la atención médica.
- No se observaron asociaciones protectoras similares para otras clases de fármacos antihipertensivos, incluidos los bloqueadores beta, los bloqueadores de los canales de calcio y los diuréticos.
Conclusiones:
- Los inhibidores de la ECA se asocian con un riesgo reducido de ruptura del aneurisma de la aorta abdominal.
- A diferencia de otros agentes antihipertensivos, los inhibidores de la ECA demuestran un potencial papel protector en la ruptura de la AAA.
- Se justifican los ensayos controlados aleatorios que investigan los inhibidores de la ECA para la prevención de la ruptura AAA.
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