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Published on: June 16, 2014
Estudio prospectivo de la hiperhomocisteinemia como un factor de riesgo cardiovascular adverso en la enfermedad renal
A Moustapha1, A Naso, M Nahlawi
1Department of Internal Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.
Circulation
|January 28, 1998
Resumen
Los niveles elevados de homocisteína aumentan significativamente el riesgo cardiovascular en pacientes con enfermedad renal en etapa terminal. Este estudio prospectivo confirma la hiperhomocisteinemia como un predictor independiente de los eventos cardiovasculares y la mortalidad.
Área de la Ciencia:
- Nefrología Nefrología.
- Cardiología Cardiología.
- La bioquímica clínica es la bioquímica clínica.
Sus antecedentes:
- La hiperhomocisteinemia es un factor de riesgo conocido para la aterosclerosis en pacientes con enfermedad renal en estadio terminal (ESRD).
- Estudios previos sugieren una asociación, pero los datos prospectivos son limitados.
Objetivo del estudio:
- Investigar prospectivamente la asociación entre los niveles totales de homocisteína y los resultados cardiovasculares en pacientes con ESRD.
- Identificar predictores independientes de la morbilidad y mortalidad cardiovascular en esta población.
Principales métodos:
- Estudio de cohorte prospectivo de 167 pacientes con ESRD (edad media de 56,3 años).
- La duración promedio del seguimiento fue de 17,4 meses.
- Análisis de regresión de Cox utilizado para determinar predictores independientes de eventos cardiovasculares y mortalidad.
Principales resultados:
- 55 pacientes (33%) experimentaron eventos cardiovasculares; 31 (19%) fallecieron, 12 por causas cardiovasculares.
- Se observaron niveles más altos de homocisteína total en pacientes con eventos cardiovasculares o mortalidad cardiovascular (43,0 ± 48,6 frente a 26,9 ± 14,9 μmol / L, P = 0,02).
- Un aumento del 1% en el riesgo relativo de eventos cardiovasculares por cada 1 μmol/L de aumento en la homocisteína total (RR 1.01; IC del 95% 1.00-1.01; P=.01).
Conclusiones:
- La hiperhomocisteinemia se confirma como un factor de riesgo independiente para la morbilidad y mortalidad cardiovascular en la ERD.
- Un aumento del 1% en el riesgo relativo de eventos cardiovasculares se asocia con cada aumento de 1 μmol/L en la homocisteína total.
- Se necesitan más estudios de intervención para evaluar el impacto de la modificación de los niveles de homocisteína en pacientes con ESRD.
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