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Disminución de las tasas de recurrencia de accidentes cerebrovasculares y eventos vasculares en ensayos de prevención
Keun-Sik Hong1, Sharon Yegiaian, Meng Lee
1Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Circulation
|May 4, 2011
Resumen
Las tasas de accidente cerebrovascular recurrente y eventos cardiovasculares han disminuido significativamente en 50 años debido a un mejor control de la presión arterial y la terapia antiplaquetaria. Esta tendencia requiere ensayos más amplios para detectar futuras mejoras en la prevención.
Área de la Ciencia:
- Cardiología Cardiología.
- Neurología Neurología.
- Los ensayos clínicos son ensayos clínicos.
Sus antecedentes:
- Se cree ampliamente que los avances en la atención estándar reducen el recurrente accidente cerebrovascular y los eventos cardiovasculares.
- La evidencia que demuestra esta reducción en los ensayos de prevención secundaria es limitada.
Objetivo del estudio:
- Para analizar las tendencias en los accidentes cerebrovasculares recurrentes y los eventos vasculares mayores en los ensayos de prevención de accidentes cerebrovasculares secundarios.
- Identificar los factores que contribuyen a los cambios observados en las tasas de eventos a lo largo del tiempo.
Principales métodos:
- Búsqueda sistemática de ensayos controlados aleatorios (ECA) para la prevención médica del accidente cerebrovascular secundario (1960-2009).
- Los ensayos excluidos se centraron en los mecanismos de un solo golpe.
- Datos extraídos de los brazos de control sobre las características de referencia y las tasas anuales de eventos.
- Analizó las tendencias utilizando regresión múltiple.
Principales resultados:
- Se analizaron 59 ECA con 66.157 pacientes en los brazos de control.
- Las tasas anuales de eventos disminuyeron significativamente en cinco décadas: recurrente accidente cerebrovascular por 0,996%, accidente cerebrovascular fatal por 0,282% y eventos vasculares mayores por 1,331% por década.
- El aumento del uso de antitrombóticos y la presión arterial más baja fueron los principales contribuyentes a la reducción de los accidentes cerebrovasculares recurrentes.
- Las tasas de accidentes cerebrovasculares recurrentes disminuyeron del 8,71% en la década de 1960 al 4,98% en la década de 2000.
- El tamaño de la muestra requerida para los ensayos aumentó 2,2 veces.
Conclusiones:
- Las tasas de accidentes cerebrovasculares recurrentes y eventos vasculares han disminuido sustancialmente en las últimas cinco décadas.
- Un mejor control de la presión arterial y un mayor uso de la terapia antiplaquetaria son los principales impulsores de esta disminución.
- Demostrar mejoras incrementales en la prevención secundaria del accidente cerebrovascular ahora requiere muestras considerablemente más grandes.
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