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Interacción entre un control glucémico deficiente y el locus 9p21 sobre el riesgo de enfermedad arterial coronaria en
Alessandro Doria1, Joanna Wojcik, Rui Xu
1Research Division, Joslin Diabetes Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA. alessandro.doria@joslin.harvard.edu
JAMA
|November 27, 2008
Resumen
La variante genética 9p21 aumenta el riesgo de enfermedad de las arterias coronarias (CAD) en pacientes con diabetes tipo 2, especialmente cuando se combina con un mal control glucémico. Esta interacción magnifica significativamente el riesgo tanto de CAD como de mortalidad.
Área de la Ciencia:
- Genética La genética.
- Cardiología Cardiología.
- Endocrinología Endocrinología.
Sus antecedentes:
- Un alelo común del cromosoma 9p21 está relacionado con el riesgo de enfermedad arterial coronaria (CAD) en la población general.
- El impacto de esta variante 9p21 en el riesgo de CAD dentro de la población de diabetes tipo 2 sigue sin estar claro.
Objetivo del estudio:
- Investigar la asociación entre la variante genética 9p21 y la EAC en individuos con diabetes tipo 2.
- Evaluar la interacción entre la variante 9p21 y el control glucémico deficiente en el riesgo de CAD y la mortalidad.
Principales métodos:
- Un estudio de caso-control involucró a 734 pacientes con diabetes tipo 2 (322 con CAD, 412 sin).
- Un estudio de cohorte independiente monitoreó a 475 pacientes con diabetes tipo 2 para la mortalidad a 10 años.
- Los participantes fueron genotipados para el polimorfismo de un solo nucleótido 9p21 (rs2383206) y evaluados para el control glucémico a largo plazo (HbA1c).
Principales resultados:
- Los individuos homocigotos para el alelo de riesgo 9p21 tenían tasas de CAD significativamente más altas (42,3% frente a 28,9%).
- El riesgo de CAD asociado con la variante 9p21 fue amplificado sustancialmente por un mal control glucémico (interacción P = .048).
- El mal control glucémico combinado con el genotipo de riesgo 9p21 aumentó las probabilidades de CAD 4 veces y el riesgo de mortalidad a 10 años.
Conclusiones:
- La variante genética 9p21 eleva el riesgo de enfermedad arterial coronaria en pacientes con diabetes tipo 2.
- Este mayor riesgo se ve agravado significativamente por la presencia de un mal control glucémico.
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