Revista Costarricense de Cardiología
Print version ISSN 1409-4142
WHAYNE, JR, Thomas F. Tratamiento agresivo hipolipemiante en las enfermedades cardiovasculares. Rev. costarric. cardiol [online]. 2007, vol.9, n.2, pp. 11-20. ISSN 1409-4142.
To the 3 major traditional risk factors for cardiovascular (CV) disease consisting of hypercholesterolemia, hypertension and cigarette smoking, an essentially equal fourth can be added, namely diabetes mellitus. There are many other risk factors such as elevated levels of homocysteine and lipoprotein (a) but the benefit of their treatment remains to be clarified. Also, there is an interest in inflammatory risk factors for CV disease such as high sensitivity C-reactive protein and lipoprotein-associated phospholipase A2, the measurement of both is commercially available, however their role in routine clinical practice is not clearly established. Therefore, low density lipoproteins (LDL) remain the gold standard to predict CV risk. For dyslipidemias involving specific lipoproteins and for patients that are difficult to manage, it is important to individualize the treatment with specific diets and targeted medications. There exist erroneous perceptions in CV medicine such as the thought that only caucasians of the Western World and males have a significant CV risk. However, it is now known that many other ethnic groups also suffer from various CV diseases, especially in urban populations. Also, women as a group have a worse prognosis than men if they present with a myocardial infarction before the age of 50. Perhaps the most important medical problem of the current era is the metabolic syndrome in which the combination of multiple CV risk factors multiplies the total CV risk. Future management of CV disease will involve genetics but for now, the aggressive use of medications may not eliminate CV risk but can very favorably modify the severity and clinical significance of that risk and lead to better clinical outcomes. Key-words: Atherosclerosis, vascular disease, cardiovascular risk factors, inflammation, high density lipoproteins, low density lipoproteins, very low density lipoproteins, metabolic syndrome.
Keywords : Aterosclerosis; enfermedad vascular; factores de riesgo cardiovascular; inflamación; lipoproteínas de alta densidad; lipoproteínas de baja densidad; lipoproteínas de muy baja densidad; síndrome metabólico.