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Factores de riesgo cardiovascular y tromboembolismo venoso: un metanálisis
Walter Ageno1, Cecilia Becattini, Timothy Brighton
1Department of Clinical Medicine, University of Insubria, Varese, Italy. agewal@yahoo.com
Circulation
|December 19, 2007
Resumen
Los factores de riesgo cardiovasculares como la obesidad y la hipertensión están significativamente asociados con un mayor riesgo de tromboembolismo venoso (TEV). Este hallazgo pone de relieve la importancia de controlar estos factores para la prevención de TEV.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Hematología Hematología.
- Epidemiología La epidemiología.
Sus antecedentes:
- La visión tradicional del tromboembolismo venoso (TEV) y la aterosclerosis como entidades distintas es desafiada por la evidencia de factores de riesgo compartidos.
- Los pacientes con TEV presentan tasas más altas de aterosclerosis asintomática y eventos cardiovasculares en comparación con los controles.
Objetivo del estudio:
- Realizar un metanálisis que evalúe la asociación entre los principales factores de riesgo cardiovascular y la aparición de TEV.
- Evaluar la relevancia clínica de estas asociaciones para las estrategias de detección y prevención de TEV.
Principales métodos:
- Una búsqueda sistemática en las bases de datos Medline y EMBASE identificó 21 estudios de caso-control y de cohorte (63.552 pacientes).
- Se extrajeron y analizaron datos sobre factores de riesgo cardiovascular, calidad del estudio y resultados utilizando modelos de efectos aleatorios.
- La heterogeneidad estadística se evaluó utilizando las estadísticas chi-cuadrado e I-cuadrado.
Principales resultados:
- La obesidad (OR 2.33), la hipertensión (OR 1.51) y la diabetes mellitus (OR 1.42) se asociaron significativamente con un mayor riesgo de TEV.
- El tabaquismo (OR 1.18) y la hipercolesterolemia (OR 1.16) mostraron una tendencia hacia la asociación.
- Los pacientes con TEV tenían niveles significativamente más bajos de colesterol de lipoproteínas de alta densidad, pero los niveles de colesterol total y de lipoproteínas de baja densidad no diferían.
Conclusiones:
- Los factores de riesgo cardiovascular están demostradamente asociados con el tromboembolismo venoso.
- Estas asociaciones tienen importancia clínica para el cribado individual, la modificación de los factores de riesgo y la prevención primaria y secundaria de TEV.
- Se recomienda una mayor investigación prospectiva para dilucidar los mecanismos subyacentes que conectan los factores de riesgo cardiovascular y TEV.
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