Infográficos para decisión compartida en pacientes con alto riesgo cardiovascular
DOI:
https://doi.org/10.5712/rbmfc14(41)1809Palabras clave:
Estatinas, Doenças Cardiovasculares, Transtornos Cerebrovasculares, Atenção à Primária à Saúde, Tomada de DecisõesResumen
Objetivos: Elaborar infográficos para una decisión compartida sobre el beneficio y riesgo del uso de estatinas como prevención primaria en pacientes con alto riesgo cardiovascular. Métodos: A partir del “NNT”, que analizó el uso de estatinas para prevención primaria en personas de bajo riesgo cardiovascular a partir de meta-análisis del US Preventive Services Task Force (USPSTF) y de Cochrane, se buscó definir el balance de riesgo y beneficio de esta terapia en la prevención primaria de personas con alto riesgo. Como USPSTF y Cochrane tenían 10 estudios primarios diferentes incluidos en sus análisis y poblaciones con riesgo cardiovascular variable, se realizó una búsqueda adicional por revisiones sistemáticas y meta-análisis publicadas desde la fecha de la revisión Cochrane (diciembre de 2012) hasta octubre de 2017. Se buscó en Medline vía PubMed, en la Biblioteca Virtual en Salud, en Cochrane y en NHS Evidence por estudios de personas con riesgo cardiovascular estimado en 10 años de más del 10% con más un factor de riesgo o con más del 20%, sin antecedentes de enfermedad cardiovascular previa, que comparasen el uso de estatina con placebo o ningún tratamiento. Los resultados deberían ser la reducción de enfermedades cardio y cerebrovasculares, de la mortalidad cardiovascular o general y la ocurrencia de eventos adversos. Resultados: Se encontraron ciento y veinticinco estudios entre los metanálisis y las revisiones basadas en el sitio desde diciembre de 2012 hasta octubre de 2017. Se excluyeron ciento y veinticuatro estudios por varias razones. Estatinas para la prevención primaria, 2012, con una población del 100% de diabéticos sin eventos cardiovasculares previos con reducción del riesgo absoluto (RRA) para accidente cerebrovascular mortal de 0,78 puntos porcentuales/NNT 128 y enfermedades cardiovasculares/cerebrovasculares RRA 2,6 puntos porcentuales/NNT 39, cardiovascular. En cuanto a la reducción de la mortalidad general (RR 0,79; IC del 95%: 0,58 a 1,08) y la revascularización (RR 0,74; IC del 95%: 0,55 a 1,00), no se encontraron diferencias estadísticas significativas. Debido a las limitaciones encontradas en las revisiones sistemáticas evaluadas, no fue posible compilar datos infográficos sobre la incidencia de diabetes y el abandono de la terapia. Así, para elaborar la parte relacionada con daños, se seleccionó el ECR de Aspen, con una población de diabéticos de alto riesgo para el desarrollo de eventos cardiovasculares, sin eventos previos, en cuanto a mialgia con un aumento del riesgo absoluto (ARA) del 1.43 por ciento. puntos/NND 70 (RR 1.91, IC 95% 1.03-3.53). Conclusión: Se elaboró un infográfico, con y sin estatina, para resultados cardiocerebrovasculares no fatales, accidente cerebrovascular fatal, necesidad de revascularización, mortalidad general y para la aparición adversa de síntomas musculares. Este instrumento se puede utilizar en Atención Primaria durante la reunión clínica para la toma de decisiones compartida. Facilitar la comprensión de los riesgos y beneficios del uso de estatinas en pacientes con alto riesgo cardiovascular (RCV 10% con al menos un factor de riesgo adicional o> 20% en 10 años), en quienes se considera la prescripción de estatinas.
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