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Asociación entre los niveles alcanzados de colesterol de lipoproteínas de baja densidad y los resultados

Prakriti Gaba1, Michelle L O'Donoghue1, Jeong-Gun Park1

  • 1Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.G., M.L.O., J.-G.P., S.D.W., J.F.K., K.I., S.A.M., R.P.G., M.S.S.).

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Resumen

Alcanzar niveles muy bajos de colesterol de lipoproteína de baja densidad (LDL-C), por debajo de 20 mg/ dl, reduce significativamente el riesgo cardiovascular en pacientes con enfermedad cardiovascular aterosclerótica. Este estudio extendido no encontró mayores preocupaciones de seguridad con la reducción sostenida de LDL-C.

Palabras clave:
la aterosclerosisEnfermedades cardiovascularesel colesterolLas lipoproteínas, las LDL

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Área de la Ciencia:

  • Cardiología
  • Investigación clínica
  • Farmacología

Sus antecedentes:

  • El colesterol de lipoproteínas de baja densidad (LDL-C) es un factor de riesgo clave para la enfermedad cardiovascular aterosclerótica (ASCVD).
  • Los objetivos óptimos de LDL-C a largo plazo para la eficacia y la seguridad en pacientes con EACV siguen siendo indeterminados.

Objetivo del estudio:

  • Investigar la relación a largo plazo entre los niveles de LDL-C alcanzados y los resultados cardiovasculares.
  • Evaluar la seguridad de los niveles muy bajos de LDL-C en pacientes con EACV establecida.

Principales métodos:

  • Análisis de los datos del ensayo FOURIER y su extensión abierta (FOURIER-OLE).
  • Se examinaron los niveles de colesterol LDL alcanzados (< 20, 20 < 40, 40 < 55, 55 < 70, ≥ 70 mg/ dl) y los resultados cardiovasculares y de seguridad posteriores.
  • Se utilizó el modelado multivariable para ajustar los factores de referencia y se realizaron análisis de sensibilidad en toda la cohorte.

Principales resultados:

  • Se observó una disminución monótona de los eventos cardiovasculares con niveles más bajos de LDL-C, hasta < 20 mg/ dl (P ajustado < 0, 0001).
  • No hubo un aumento estadísticamente significativo del riesgo de resultados de seguridad importantes (por ejemplo, cáncer, accidente cerebrovascular, diabetes, eventos musculares) asociado con niveles más bajos de LDL-C.
  • Los hallazgos fueron consistentes en toda la población FOURIER y FOURIER-OLE con hasta 8,6 años de seguimiento.

Conclusiones:

  • El logro sostenido de niveles muy bajos de LDL-C (< 20 mg/ dl) se asocia con un riesgo cardiovascular reducido en pacientes con EASC.
  • No se identificaron problemas de seguridad significativos con niveles muy bajos de LDL-C a largo plazo.