La Gran Crisis Aterosclerótica en mujeres peri-menopáusicas de un área primaria de salud de La Habana. Frecuencia y factores de riesgo

Vivian Herrera Gómez, Lourdes Rodríguez Domínguez, Santa González O’Farrill, Imilsys La O Herrera, Mayte Mas Gómez, Olga Valdés Almaral, Pedro Morejón Martín, Georgina María Zayas Torriente

Texto completo:

PDF

Resumen

La asociación entre la GCA Gran Crisis Ateroesclerótica y factores selectos de riesgo se evaluó mediante la encuesta propuesta por el CIRAH Centro de Investigaciones y Referencias de Ateroesclerosis de la Habana (La Habana, Cuba), aplicada transversalmente a 423 mujeres con edades entre 45 – 59 años, domiciliadas en el Municipio Centro Habana, La Habana, Cuba. Los pretendidos factores de riesgo se comportaron como sigue: Tabaquismo: 50.4%; Hipertensión arterial: 50.4%; Menopausia: 65.0%; Indice de Masa Corporal ³ 30.0 Kg.m-2: 21.0%; Circunferencia de la cintura ³ 88 cm: 53.7%; e Indice Cintura-Cadera ³ 1.05: 36.4%. La GCA afectó a 10 mujeres a la conclusión de la investigación: Infarto del miocardio: 4 (0.9%); Enfermedad cerebrovascular: 4 (0.9%); y Amputación de miembros inferiores por insuficiencia arterial periférica: 2 (0.5%); respectivamente. No se comprobó asociación entre las formas encuestadas de la GCA y los factores de riesgo estudiados. La presencia en la mujer perimenopáusica de alguno de los factores propuestos de riesgo puede constituirse en condición necesaria pero no suficiente para la ocurrencia de la GCA. El efecto nocivo de los factores estudiados de riesgo de la GCA podría estar contrarrestado por otros elementos que protegerían a la mujer durante un tiempo adicional después del cese de la esteroidogénesis ovárica, y que deberían ser identificados, para integrarlos en los programas requeridos de prevención y promoción de salud.

Palabras clave

Obesidad; Circunferencia de la cintura; Menopausia; Infarto del miocardio; Tabaquismo; Hipertensión arterial; Enfermedad cerebrovascular; Amputación

Referencias

Alvaro González LC, Freijo Guerrero MM, Sádaba Garay F. Inflammatory mechanisms, arteriosclerosis and ischemic stroke: clinical data and perspectives. Rev Neurol 2002;35(5):452-62.

Zhou J, Chew M, Ravn HB, Falk E. Plaque pathology and coronary thrombosis in the pathogenesis of acute coronary syndromes. Scand J Clin Lab Invest Suppl 1999;230:3-11.

Daemen J, Serruys PW. Optimal revascularization strategies for multivessel coronary artery disease. Curr Opin Cardiol 2006;21:595-601.

Williams M, Patil S, Toledo EG, Vannemreddy P. Management of acute ischemic stroke: current status of pharmacological and mechanical endovascular methods. Neurol Res 2009;31:807-15.

Allaqaband S, Kirvaitis R, Jan F, Bajwa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 2009;34:359-476.

Hankey GJ. Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 2003;16(Suppl 1):14-9.

Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial infarction. Cardiol J 2008;15:481-7.

Valentine RJ, Myers SI, Inman MH, Roberts JR, Clagett GP. Late outcome of amputees with premature athero-sclerosis. Surgery 1996;119:487-93.

Donati MB, Zito F, Castelnuovo AD, Iacoviello L. Genes, coagulation and cardiovascular risk. J Hum Hypertens 2000;14:369-72.

Saner H. Manifestation and course of coronary heart disease in men and women- consequences for diagnosis and treatment. Ther Umsch. 2007;64:305-10.

Rohlfs I, del Mar García M, Gavaldà L, Medrano MJ, Juvinyà D, Baltasar A, Saurina C, Faixedas MT, Muñoz D. Gender and ischemic heart disease. Gac Sanit 2004;18(Suppl 2):55-64.

Vitale C, Miceli M, Rosano GM. Gender-specific characteristics of athero-sclerosis in menopausal women: risk factors, clinical course and strategies for prevention. Climacteric 2007;10(Suppl 2):16-20.

Pilote L, Dasgupta K, Guru V, Humphries KH, McGrath J, Norris C; et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ 2007;176:S1-S44.

Murphy SJ, McCullough LD, Smith JM. Stroke in the female: role of biological sex and estrogen. ILAR J 2004;45:147-59.

Liu M, Dziennis S, Hurn PD, Alkayed NJ. Mechanisms of gender-linked ischemic brain injury. Restor Neurol Neurosci 2009;27:163-79.

Allison MA, Manson JE, Langer RD, Carr JJ, Rossouw JE, Pettinger MB; et al.; Women's Health Initiative and Women's Health Initiative Coronary Artery Calcium Study Investigators. Oophorectomy, hormone therapy, and subclinical coronary artery disease in women with hysterectomy: the Women's Health Initiative coronary artery calcium study. Menopause 2008;15(4 Pt 1):639-47.

Rubanyi GM, Johns A, Kauser K. Effect of estrogen on endothelial function and angiogenesis. Vascul Pharmacol 2002;38:89-98.

Davison S, Davis SR. New markers for cardiovascular disease risk in women: impact of endogenous estrogen status and exogenous postmenopausal hormone therapy. J Clin Endocrinol Metab 2003; 88:2470-8.

Landmark K. Smoking and coronary heart disease. Tidsskr Nor Laegeforen 2001;121:1710-2.

Murphy BP, Stanton T, Dunn FG. Hypertension and myocardial ischemia. Med Clin North Am 2009;93:681-95.

Mostaza JM, Martín Jadraque R, Vicente I, San Martin MA, Lahoz C. Patients at high risk of cerebrovascular disease: the REACH study. Cerebrovasc Dis 2009;27(Suppl 1):77-81.

Cerdas Pérez S, Sittenfeld A. Epidemiología e importancia de la enfermedad cerebrovascular en la mujer. Rev Iberoam Menop 2000;2:3-8.

Siavash M, Sadeghi M, Salarifar F, Amini M, Shojaee-Moradie F. Comparison of body mass index and waist/height ratio in predicting definite coronary artery disease. Ann Nutr Metab 2008;53:162-6.

Barrios V, Escobar C, Bertomeu V, Murga N, de Pablo C, Calderón A. Sex differences in the hypertensive population with chronic ischemic heart disease. J Clin Hypertens (Greenwich) 2008;10:779-86.

Millen BE, Pencina MJ, Kimokoti RW, Zhu L, Meigs JB, Ordovas JM, D'Agostino RB. Nutritional risk and the metabolic syndrome in women: opportunities for preventive intervention from the Framingham Nutrition Study. Am J Clin Nutr 2006;84:434-41.

Fernández Britto JE. El Centro de Investigaciones y Referencias de la Aterosclerosis de la Habana (CIRAH). Rev Cubana Invest Biomed 1998;17:101-11.

Lugones Botell M, Quintana Riverón TY, Cruz Oviedo Y. Climaterio y menopausia: importancia de su atención en el nivel primario. Rev Cubana Med Gen Integr 1997;13:494-503.

Navarro Despaine D, Pérez Piñera J, Artiles L. Consenso Cubano sobre climaterio y menopausia. Editorial Ciencias Médicas. La Habana: 1999. pp 1-20.

Weiner JA, Lourie JA. Practical Human Biology. Academic Press. London: 1981.

Lohman TG, Roche A, Martorell R. Anthropometric standardization reference manual. Human Kinetics Books. Primera Edición. Champaign, Illinois: 1988.

Anónimo. Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature. Circulation 1979;59:607-9.

Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008;371:1612–23.

Bewick V, Cheek L, Ball J. Statistics review 11: Assessing risk. Critical Care 2004;8:287-91.

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Fergusson TB, Flegal K; et al. Heart Disease and Stroke Statistics 2009 Update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119: e1-e161.

Higgins JP, Higgins JA. Epidemiology of peripheral arterial disease in women. J Epidemiol 2003;13:1-14.

Kröger K, Stang A, Kondratieva J, Moebus S, Beck E, Schmermund A; et al.; para el Heinz Nixdorf Recall Study Group. Prevalence of Peripheral Arterial Disease– Results of the Heinz Nixdorf Recall Study. Eur J Epidemiol 2006;21:279-85.

Thomas D. Cardiovascular benefits of smoking cessation. Presse Med 2009; 38:946-52.

Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B; et al. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med 1993;119:992-1000.

Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: scientific review. JAMA 2002;288:1388-95.

McAlister FA, Feldman RD, Wyard K, Brant R, Campbell NR; for the CHEP Outcomes Research Task Force. The impact of the Canadian Hypertension Education Programme in its first decade. Eur Heart J 2009;30:1434-9.

Villablanca AC, Arline S, Lewis J, Raju S, Sanders S, Carrow S. Outcomes of National Community Organization Cardiovascular Prevention Programs for High-Risk Women. J Cardiovasc Transl Res 2009;2:306-320.

Franklin RM, Ploutz-Snyder L, Kanaley JA. Longitudinal changes in abdominal fat distribution with menopause. Metabolism 2009;58:311-5.

Canoy D. Distribution of body fat and risk of coronary heart disease in men and women. Curr Opin Cardiol 2008;23:591-8.

Lu B, Zhou J, Waring ME, Parker DR, Eaton CB. Abdominal obesity and peripheral vascular disease in men and women: A comparison of waist-to-thigh ratio and waist circumference as measures of abdominal obesity. Atherosclerosis 2009. Publicación electrónica en anticipación de la salida impresa.

Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, Yusuf S. Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. Am Heart J 2005;149:54-60.

Zeller M, Steg PG, Ravisy J, Lorgis L, Laurent Y, Sicard P, et al.; for the RICO Survey Working Group. Relation between body mass index, waist circumference, and death after acute myocardial infarction. Circulation 2008;118:482-90.

Page JH, Rexrode KM, Hu F, Albert CM, Chae CU, Manson JE. Waist-height ratio as a predictor of coronary heart disease among women. Epidemiology 2009;20:361-6.

Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W. General and abdominal adiposity and risk of stroke in Chinese women. Stroke 2009;40:1098-104.

Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: The evidence. Climacteric. 2007;10(Suppl 1):19-24.

Siebenhofer A, Horvath K, Jeitler K, Berghold A, Stich AK, Matyas E; et al. Long-term effects of weight-reducing drugs in hypertensive patients. Cochrane Database Syst Rev 2009;CD007654.

Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med 2009;169:1355-62.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-32.

Douketis JD, Sharma AM. Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction. Semin Vasc Med 2005;5:25-33.

Rosano GM, Vitale C, Tulli A. Managing cardiovascular risk in menopausal women. Climacteric 2006;9 (Suppl 1):19-27.

Le Feuvre C. Coronary artery disease in patients with diabetes. Presse Med 2009; 38:964-72.

Roffi M, Eberli FR. Diabetes and acute coronary syndromes. Best Pract Res Clin Endocrinol Metab 2009;23:305-16.

Saltiki K, Cimponeriu A, Lili K, Peppa M, Anastasiou E, Alevizaki M. Severity of coronary artery disease in postmenopausal diabetic women. Hormones (Athens) 2008;7:148-55.

Faget O, Hernández Yero A, Licea M, Perich P, Seuc A. Caracterización clínica de los diabéticos con ingreso ambulatorio. Rev Cub Endocrinol 1994; 5:81-9.

Guzmán M, Pérez Chil JC, Casanueva Cabeza, MF, Barreto Cruz T. Algunos factores clínicos de riesgo cardiovascular en un grupo de diabéticos del municipio Artemisa. Rev Cubana Invest Biomed 2004;22:23-30.

Enlaces refback

  • No hay ningún enlace refback.


Bookmark and Share


Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.