El tratamiento hipolipemiante del paciente de muy alto riesgo cardiovascular: un cambio de paradigma

20 de enero de 2021 |
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El tratamiento hipolipemiante del paciente de muy alto riesgo cardiovascular: un cambio de paradigma


Solo 1 de cada 4 pacientes con enfermedad cardiovascular establecida está tratado con una estatina de alta potencia. Ello, de alguna forma, puede explicar por qué solo alrededor de un tercio de los pacientes de muy alto riesgo alcanzan una concentración de colesterol unido a lipoproteínas de baja densidad (cLDL) < 70 mg/dl. Los resultados del estudio IMPROVE-IT respaldan el papel causal del cLDL en la enfermedad cardiovascular ateromatosa.

El concepto de «cuanto más bajo mejor» se fundamenta en una sólida base científica y, en vez de un tratamiento con estatinas de alta intensidad, se deben aplicar estrategias de alta intensidad para la reducción del cLDL. La adición de ezetimiba a las estatinas, cuyo efecto hipocolesterolemiante medio oscila entre el 30% y el 50%, incrementa la capacidad de reducción del cLDL un 20% (el 22% en el estudio IMPROVE-IT). Este aspecto es de gran relevancia en los pacientes de muy alto riesgo cardiovascular, en los que se requiere una consecución rápida de los objetivos del cLDL.

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