Riesgo cardiovascular: componentes, valoración e intervenciones preventivas

Autores/as

  • P AMARILES Profesor Facultad de Química Farmacéutica, Universidad de Antioquia, Medellín (Colombia). Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).
  • M MACHUCA Grupo de Investigación en Farmacoterapia y Atención Farmacéutica de la Universidad de Sevilla, Sevilla (España)
  • A JIMÉNEZ-FAUS Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).
  • MM SILVA-CASTRO Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).
  • D SABATER Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).
  • MI BAENA Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).
  • J JIMÉNEZ-MARTÍN Catedrático de Farmacología, Universidad de Granada, Granada (España).
  • MJ FAUS Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada CTS-131. Facultad de Farmacia. Campus Universitario de Cartuja 18071 Granada (España).

Palabras clave:

Riesgo cardiovascular, Factores de riesgo cardiovascular, Prevención primaria, Prevención secundaria

Resumen

Se realiza una revisión de los aspectos relacionados con los factores de riesgo, los métodos de valoración y lasintervenciones en prevención primaria y secundaria de las enfermedades cardiovasculares (ECV). Se pretende, desdela perspectiva farmacéutica, sistematizar conceptos para la fijación y el logro de los objetivos terapéuticos de lasintervenciones en pacientes con factores de riesgo cardiovascular. Existen varios modelos propuestos para determinarel riesgo cardiovascular (RCV), el cual es un concepto que indica la probabilidad a 10 años de padecer una delas formas de la ECV y permite estratificar a la población en grupos de riesgo, facilitando la optimización ypriorización de las intervenciones. En España existen modelos de valoración vigentes que no recogen los avances yel acercamiento a las características de su población. Los estudios realizados evidencian la importancia y el impactopositivo de las intervenciones terapéuticas preventivas sobre las ECV, al igual que algunas dificultades en la consecuciónde los objetivos perseguidos. La participación del farmacéutico en el control de los pacientes con factoresde riesgo o con ECV es necesaria y puede generar beneficios para la salud, en especial con su contribución a laestructuración de programas tendientes a que la población general adopte hábitos y estilo de vida saludables y a lautilización eficaz y segura de las intervenciones terapéuticas.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

World Health Organization. The World Health Report. 2002 ‘Reducing risks and promoting healthy life’. Geneva, World

Health Organization, 2002.

Ministerio de Sanidad y Consumo – España. Datos básicos de la salud y los servicios sanitarios en España 2003.

Disponible en: www.msc.es/Diseno/informacionProfesional/profesional_sistemas_informacion.htm.

Instituto Nacional de Estadística de España. España en cifras 2003-2004. Salud. Defunciones según las causas de muerte

más significativas. Disponible en www.ine.es/especif/especifes/especif0304.htm.

NHLBI fact book, fiscal year 2003. Bethesda, Md.: National Heart, Lung, and Blood Institute, February 2004. Disponible

en http://www.nhlbi.nih.gov/about/factpdf.htm.

NHLBI morbidity and mortality chartbook, 2002. Bethesda, Md.: National Heart, Lung, and Blood Institute, May 2002.

Disponible en http://www.nhlbi.nih.gov/resources/docs/cht-book.htm.

Junta de Andalucía, Consejería de Salud. Riesgo Vascular: Proceso Asistencial Integrado. Sevilla, Consejería de Salud,

241 p.

Jackson R. Guidelines on preventing cardiovascular disease in clinical practice. BMJ 2000; 612534-2542.

National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. Seventh Report of the Joint

National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) JAMA

; 289:2560-2572.

Guideliness Commitee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the

management of arterial hypertension. Journal Of Hypertension 2003; 21:1011-1053.

Lloyd-Jones DM. Impact of systolic versus diastolic blood pressure level of JNC-VI blood pressure stage classification.

Hypertension 1999; 34:381–385.

Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blood-pressure-lowering regimens on major

cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362:1527–1535.

Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering

drugs: analysis of 354 randomised trials. BMJ 2003; 326:1427-1431.

Pini R, Cavallini MC, Bencini F, et al. Cardiac and Vascular Remodeling in Older Adults With Borderline Isolated

Systolic Hypertension: The ICARe Dicomano Study. Hypertension 2001; 38:1372-1376.

Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with

isolated systolic hypertension: SHEP Cooperative Research Group. Lancet 1997; 351:1755–1762.

West of Scotland Coronary Prevention Group. West of Scotland Coronary Prevention Study: identification of high-risk

groups and comparison with other cardiovascular intervention trials. Lancet 1996; 348:1339-42.

Ministerio de Sanidad y Consumo – España. Instituto Información S.N.S. Encuesta Nacional de Salud 2001: Primera

oleada Noviembre 2003. Disponible en: www.msc.es/Diseno/informacionProfesional/profesional_sistemas_

informacion.htm.

Banegas JR, Rodriguez-Artalejo F, Ruilope LM, et al. Hypertension magnitude and management in the elderly population

of Spain. J Hypertension 2002; 20:2157-2162.

Plaza-Pérez I, Villar-Álvarez F, Mata-López P, et al. Control de la colesterolemia en España, 2000. Un instrumento para

la prevención cardiovascular. Rev Esp Cardiol 2000; 53:815-837.

Villar F, Maiques A, Cuixart C, Torcal J, Ortega R, Vilaseca J. Actividades preventivas cardiovasculares en atención

primaria. Aten Primaria 2003; 32(Supl 2):15-29.

Tomás I, Abadal L, Varas-Lorenzo C, Pérez I, Puig T, Balaguer Vintró I. Factores de riesgo y morbi-mortalidad

coronaria en una cohorte laboral mediterránea seguida durante 28 años. Estudio de Manresa. Rev Esp Cardiol 2001;

:1146-1154.

Toth PP. High-Density Lipoprotein and Cardiovascular Risk. Circulation 2004; 109:1809-1812.

Dows JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women

with average cholesterol levels: results of the AFCAPS/TexCAPS. JAMA 1998; 279:1615-1622,

LaRosa JC, He J, Vupputuri S. Effects of statins on risk of coronary disease: a meta-analysis of randomized control

trials. JAMA 1999; 282:2340-2346.

Pignone M, Phillips C, Mulrow C. Use of lipid lowering drugs for primary prevention of coronary heart disease: metaanalysis

of randomized trials. BMJ 2000; 321:983-986.

Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Program. Prevention of cardiovascular

events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol

levels. N Eng J Med 1998; 339:1349-1357.

Xydakis AM, Ballantyne CM. Role of non-high-density lipoprotein cholesterol in prevention of cardiovascular disease:

updated evidence from clinical trials. Curr Opin Cardiol. 2003; 18:503-509.

Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major

vascular events in 20 536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004; 363:757–

Heart Protection Study Collaboration Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin

in 20 536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360:7-22.

Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic hearth

disease, and stroke: systematic review and meta-analysis. BMJ 2003; 326:1423-1427.

Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on

progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291:1071-1080.

Cannon CP, Braunwald E, McCabe CH, et al. Comparison of intensive and moderate lipid lowering with statins

following acute coronary syndrome. N Engl J Med 2004; 350:1495-1504.

Magro-López AM, Molinero de Miguel E, Sáez-Meabe Y, et al. Prevalencia de los principales factores de riesgo

cardiovascular en mujeres de Vizcaya. Rev Esp Cardiol 2003; 56:783-788.

Robledo-de Dios T, Ortega-Sánchez R, Cabezas-Peña C, Forés-García D, Nebot-Adell M, Córdoba-García R. Recomendaciones

sobre estilos de vida. Aten Primaria 2003; 32(supl 2):30-44.

Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years´ observations on male

British doctors. BMJ 1994; 309:901-911.

Humphries SE, Talmud EM, Bolla M, DAY IN, Miller GJ. Apolipoprotein E4 and coronary hear disease in middleaged

men who smoke: a prospective study. Lancet 2001; 358:115-119.

Rosemberg L, Palmer JR, Shapiro S. Decline in the risk of myocardial infarction among women who stop smoking.

N Eng J Med 1990; 332:213-217.

Wilson K, Gibson N, Willian A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: metaanalysis

of cohort studies. Arch Intern Med 2000; 160:939-944.

Serrano M, Madoz E, Ezpeleta I, San Julián B, Amezqueta C, Pérez-Marco JA, Irala J. Abandono del tabaco y riesgo

de un nuevo infarto en pacientes coronarios: estudio de casos y controles anidado. Rev Esp Cardiol 2003; 56:445-

Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart

disease: a systematic review. JAMA 2003; 290:86-97.

Anderson KM, Wilson PWF, Odell PM, Kannel WB. Un update coronary risk profile. A statement for health professionals.

Circulation 1991; 83:356-362.

Wilson PWF, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease

using risk factor categories. Circulation 1998; 97: 1837-1847.

Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-riskfactor

assessment equations. A statement for healthcare professionals from the American Heart Association and the

American College of Cardiology. Circulation 1999; 100: 1481-1492.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and

Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-2496.

British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association.

Joint British recommendations on prevention of coronary heart disease in clinical practice: summary. BMJ

;320:705–708.

Jackson R. Updated New Zealand cardiovascular disease risk-benefit prediction guide. BMJ 2000; 320:709–710.

Pocock SJ, McCormack V, Gueyffier F, Boutitie F, Fagard RH, Boissel JP. A score for predicting risk of death from

cardiovascular disease in adults with raised blood pressure, based on individual patient data from randomised

controlled trials. BMJ 2001; 323:75-81.

Assmann G, Cullen P, Schulte H. Simple Scoring Scheme for Calculating the Risk of Acute Coronary Events Based

on the 10-Year Follow-Up of the Prospective Cardiovascular Münster (PROCAM) Study. Circulation. 2002; 105:310-

(Correction in Circulation 2002; 105:900).

Assmann G, Cullen P, Schule H. Risk assessment of myocardial infarction and stroke. International Congress Series

; 1262:30-38.

Marrugat J, Solanas P, D’Agostino R, et al. Estimación del riesgo coronario en España mediante la ecuación de

Framingham calibrada. Rev Esp Cardiol 2003; 56:253-261.

Conroy RM, Pyörälä K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the

SCORE project. Eur Heart J 2003; 24:987-1003.

De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J. Executive summary European

guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2003; 24: 1601-1610.

Pietinen P, Rimm EB, Korhonen P, et al. Intake of dietary fibre and risk coronary heart disease in a cohort of Finnish

men. Circulation 1999; 94:2720-2727.

Knekt P, Reunanen A, Jarvinen R, Heliovaara M, Aromaa A. Antioxidant vitamin intake and coronary mortality in a

longitudinal population study. Am J Epidemiol 1994; 139:1180-1189.

Knekt P, Isotupa S, Rissanen H, et al. Quercetin intake in the incidence of cerebrovascular disease. Eur J Clin Nutr

; 54:415-417.

Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of stroke. JAMA 1999;

:1233-1239.

Hu FB, Stampfer MJ, Colditz GA, et al. Physical Activity and Risk of Stroke in Women. JAMA 2000; 283:2961-2967.

Lee CD, Folsom AR, Blair SN. Physical Activity and Stroke Risk: A Meta-Analysis. Stroke 2003; 34:2475-2482.

Hakim AA, Curb JD, Petrovitch H, et al. Effects of Walking on Coronary Heart Disease in Elderly Men: The Honolulu

Heart Program. Circulation 1999; 100:9-13.

Press V, Freestone I, George CF. Physical activity: the evidence of benefit in the prevention of coronary heart disease.

Q J Med 2003; 96.245-251.

Tanasescu M, Leitzmann MF, Rimm EB, et al. Exercise Type and Intensity in Relation to Coronary Heart Disease in

Men. JAMA 2002; 288:1994-2000.

Thompson PD, Buchner D, Piña IL, et al. Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic

Cardiovascular Disease: A Stamement From the Council on Clinical cardiology (Subcommitee on Exercise,

Rahabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommitee on

Physical Activity). Circulation 2003; 107:3109-3116.

Higashi Y, Yoshizumi M. Exercise and endothelial function: Role of endothelium-derived nitric oxide and oxidative

stress in healthy subjects and hypertensive patients. Pharmacology & Therapeutics 2004; 102:87– 96.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of WHO consultation on

Obesity. Geneva: World Health organization,1998.

World Health Organization. OBESITY AND OVERWEIGT. WHO Global Strategy on Diet, Physical Activity and

Health. Geneva: World Health organization, 2003.

Martorell R. Obesity in the developing world. En: Caballero B, Popkin BM editors. The nutrition transition. Diet and

disease in the developing world. San Diego: Academic press, 2002:147-64.

Schoenborn CA, Adams PF, Barnes PM, Vickerie JL, Schiller JS. Health Behaviors of Adults: United States, 1999–

National Center for Health Statistics. Vital Health Stat 10(219). 2004:60.

Zhu S, Heshka S, Wang Z, Shen W, Allison DB, Ross R, Heymsfield SB. Combination of BMI and Waist Circumference

for Identifying Cardiovascular Risk Factors in Whites. Obesity Research 2004; 12:633-645.

Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary

Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Eng J Med 2001;

:3-10.

Appel LJ, Moore TJ, Obarzek E. et al. A clinical trial of the effects of dietary patterns on blood pressure. N Eng J Med

; 336:1117-1124.

Whelton PK, Appel LJ, Espelland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older

persons: a randomized controlled trial of non pharmacologic intervention in the elderly (TONE). JAMA 1998;

:839-846.

Chobanian AV, Hill M. National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure. A Critical

Review of Current Scientific Evidence. Hypertension 2000; 35:858-863.

Moore TJ, Conlin PR, Ard J, Svetkey LP. DASH (Dietary Approaches to Stop Hypertension) Diet Is Effective Treatment

for Stage 1 Isolated Systolic Hipertensión. Hypertension 2001; 38:155-158.

Stevens VJ, Obarzanek E, Cook NR, et al. Long term weight loss and changes in blood pressure: results of the trials

of hypertension prevention, phase 11. Ann Intern Med 2001; 134:1-11.

He J, Whelton PK, Appel LJ, Charleston J, Klag MJ. Long-term effects of weight loss and dietary sodium reduction

on incidence of hypertension. Hypertension 2000; 35:544-549.

Georgiades A, Sherwood A, Gullette ECD, et al. Effects of Exercise and Weight Loss on Mental Stress–Induced

Cardiovascular Responses in Individuals With High Blood Pressure. Hypertension 2000; 36:171-176.

Vollmer WM, Sacks FM, Ard J, et al. Effects of diet and sodium intake on blood pressure: Subgroup analysis of the

DASH-sodium trial. Ann Intern Med 2001; 135:1019-1028.

Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized

controlled trials. Hypertension 2000; 35:838-843.

Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: A meta-analysis of randomized,

controlled trials. Ann Intern Med 2002; 136:493-503.

Xin X, He J, Frontini MG, et al. Effects of alcohol reduction on blood pressure: A meta-analysis of randomized

controlled trials. Hypertension 2001; 38:1112-1217.

AHA Guidelines. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Circulation 2004;

:672-693.

Simó-Cruzet E, Garrido-Pérez M, Ureña-Tapia M, Matí-Company F, Avilés-Fernández FJ. Prevención secundaria de la

cardiopatía isquémica: ¿lo hacemos correctamente?. Aten Primaria 2004; 33:51-53.

Law MR, Watt HC, Wald NJ. The Underlying Risk of Death After Myocardial Infarction in the Absence of Treatment.

Arc Intern Med 2002; 162:2405-2410.

Tanuseputro P, Manuel DG, Leung M, Nguyen K, Johansen H. Canadian Cardiovascular Outcomes Research Team.

Risk factors for cardiovascular disease in Canada. Can J Cardiol. 2003; 19:1249-1259.

The Vestfold Heartcare Study Group. Influence on lifestyle measures and five-year coronary risk by a comprehensive

lifestyle intervention program in patients with coronary heart disease. J Cardiovasc Risk. 2003;10:429-437.

González-Juanatey JR. Después del estudio ALLHAT, ¿qué sabemos de lo que desconocíamos sobre el tratamiento de

la hipertensión arterial?. Rev Esp Cardiol 2003; 56:642-648.

Gavin JR 3rd, Peterson K, Warren-Boulton E; National Diabetes Education Program. Reducing cardiovascular disease

risk in patients with type 2 diabetes: a message from the National Diabetes Education Program. Am Fam Physician.

15;68:1569-74.

Brotons C, Maiques A, Mostaza J, Pinto X, Vilaseca J (representantes del estudio EMOSCOL). Control lipídico en

prevención secundaria: estudio multicentrico, observacional en atención primaria. Aten Primaria 2004; 34:81-88.

Banegas JR, Rodriguez-Artalejo F, Cruz JJ, Guallar P, Rey J. Blood pressure in Spain: distribution, awareness, control,

and benefits of a reduction in average pressure. Hypertension 1998; 32:998-1002.

Ornstein SM, Nieter PJ, Dickerson LM. Hypertension Management and Control in Primary Care: A Study of 20 patients

in 14 States. Pharmacotherapy 2004; 24:500-507.

García-Ortiz L, Santos-Rodríguez I, Sánchez-Fernández PL, Mora-Santiago MC, Arganda-Maya J, Rodríguez-Corral

MT. Efectividad de una intervención de mejora de calidad en la reducción del riesgo cardiovascular en pacientes

hipertensos. Rev Esp Cardiol 2004; 57:6444-651.

Chinwong S, Reid F, McGlynn S, Hudson S, Flapan A. The need for pharmaceutical care in the prevention of coronary

heart disease: an exploratory study in acute myocardial infarction patients. Pharm World Sci 2004; 26:96-101.

Tsuyuki RT, Olson KL, Dubyk AM, Johnson JA. Effect of Community Pharmacist Intervention on Cholesterol Levels

in Patients at High Risk of Cardiovascular Events: The Second Study of Cardiovascular Risk Intervention by

Pharmacists (SCRIP-plus). Am J medicine 2004; 116:130-133

Tsuyuki RT, Johnson JA, Teo KK, et al. A Randomized Trial of the Effect of Community Pharmacist Intervention on

Cholesterol Risk Management. Arc Intern Med 2002; 162:1149-1155.

Reilly V, Cavanagh M. The clinical and economic impact of secondary heart disease prevention clinic jointly implemented

by a practice nurse and pharmacist. Pharm World Sci 2003; 25:294-298.

Atthobari J, Monster TBM, de Jong PE, de Jong-van den Berg LTW. The effect of hypertension and hypercholesterolemia

screening with subsequent intervention letter on the use of blood pressure and lipid lowering drugs. Br J

Clin Pharmacol 2003; 57:328-336.

Pasternak RC, Smith SC, Bairey-Merz CN, Grundy SM, Cleeman JI, Lefant C. ACC/AHA/NHLBI Clinical Advisory

on the Use and Safety of Statins. JACC 2002; 40:567-572.

Rosenson RS. Current Overview of Statin-Induced Myopatya. Am J Med 2004; 116:408-416.

Frijling BD, Lobo CM, Keus IM, et al. Perceptions of cardiovascular risk among patients with hypertension or diabetes.

Patient Education and Counseling 2004; 52:47-53.

Celentano A, Panico S, Palmieri V, et al. Citizens and family doctors facing awareness and management of traditional

cardiovascular risk factors: results from the Global Cardiovascular Risk Reduction Project (Help Your Heart Stay

Young Study). Nutr Metab Cardiovasc Dis 2003; 13:211-217.

Lafarga Giribets MA, Monfort Cabane M, Sanchez Pellicer R, Batlle Farran F. Relación entre el desconocimiento del

propio peso y el riesgo cardiovascular en atención primaria. Aten Primaria 2003; 32:466-470.

Descargas

Publicado

2004-06-16

Cómo citar

1.
AMARILES P, MACHUCA M, JIMÉNEZ-FAUS A, SILVA-CASTRO M, SABATER D, BAENA M, JIMÉNEZ-MARTÍN J, FAUS M. Riesgo cardiovascular: componentes, valoración e intervenciones preventivas. Ars Pharm [Internet]. 16 de junio de 2004 [citado 16 de abril de 2024];45(3):187-210. Disponible en: https://revistaseug.ugr.es/index.php/ars/article/view/5116

Número

Sección

Artículos de revisión