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Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment. Consensus / Dislipidemia aterogénica en Latinoamérica: prevalencia, causas y tratamiento. Un consenso
Ponte-Negretti, Carlos Ignacio; Isea-Pérez, Jesús; Lanas, F; Medina, J; Gómez-Mancebo, José; Morales, Enrique; Acevedo, M; Pirskorz, Daniel; Machado, Livia; Lozada, Alfredo; Bryce, Alfonzo; Lorenzatti, Alberto; Carrera, Carlos; López-Jaramillo, Patricio; Pinto, Xavier; Wyss-Quintana, Fernando S.
Afiliação
  • Ponte-Negretti, Carlos Ignacio; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Isea-Pérez, Jesús; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Lanas, F; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Medina, J; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Gómez-Mancebo, José; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Morales, Enrique; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Acevedo, M; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Pirskorz, Daniel; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Machado, Livia; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Lozada, Alfredo; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Bryce, Alfonzo; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Lorenzatti, Alberto; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Carrera, Carlos; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • López-Jaramillo, Patricio; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Pinto, Xavier; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
  • Wyss-Quintana, Fernando S; South American Society of Cardiology (SSC). Interamerican Society of Cardiology (SIAC). Latin American Association for the study of Lipids (ALALIP). US
Rev. mex. cardiol ; 28(2): 57-85, Apr.-Jun. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-902322
Biblioteca responsável: BR1.1
ABSTRACT
Abstract Atherogenic dyslipidemia (DA) is a poorly recognized entity in the current clinical practice guidelines. Due to the frequent lipid alterations associated with this metabolic abnormality in Latin America (LA), we organized a group of experts that has adopted the name of Latin American Association for the study of Lipids (ALALIP), to generate a document for analyzing in LA the prevalence of the lipid profile related to this condition, and to offer practical recommendations for its optimal diagnosis and treatment.

Methodology:

It was is selected a group of regional experts and, using a modified Delphi methodology, we conducted a comprehensive literature review, with emphasis on studies or reviews that had implications for LA. Subsequently developed a series of key questions about the epidemiology, pathophysiology, diagnosis, and treatment of the AD to be discussed by the group of experts. As a convention those recommendations that had 100% acceptance was consider unanimous; those with at least 80% as for consensus, and of disagreement, those with less than 80%.

Results:

Although there is no a global study on risk factors that has been made on the basis of a representative sample of the entire population of LA, the systematic analysis of the national health surveys and regional cohort studies based on local population sampling shows a consistent evidence of the high prevalence of the lipid abnormalities that define the AD. The prevalence of low levels of high density lipoprotein cholesterol (HDL-C) ranges from 34.1% (CESCAS I study) to 53.3% (LASO study), with different frequencies between men and women and the selected cut-off point. The prevalence of elevated triglycerides (TRG) varies from 25.5% (LASO study) to 31.2% (National Health Survey of Chile) being always more prevalent in men than in women. Only two studies report the prevalence of AD in LA the National Health Survey of Mexico 2006 with an 18.3%, and a Venezuelan study that estimates the weighted prevalence of AD in 24.7%. There are multiple causes for these

findings:

an inadequate nutrition-characterized for high consumption of foods with a high caloric density and a high intake of cholesterol and trans fats-, a sedentary lifestyle, a high prevalence of obesity in the region, and possibly epigenetic changes that make our population more susceptible for having this abnormal lipid profile.

Conclusions:

Lipid abnormalities that define AD have a high prevalence in LA; the interaction between the style of living, the inheritance, and epigenetic changes possibly are its cause. Since they are considered as an important cause of residual cardiovascular risk, they must be diagnosed and treated actively as a secondary target after reaching the goal for low density lipoprotein-cholesterol (LDL-C). It is important to design a global study of risk factors in our region to let us know the true prevalence of AD and its causes, and to help us in the design of public policies adapted to our reality in a population and individual scale.
RESUMEN
Resumen La dislipidemia aterogénica (DA) es una entidad poco reconocida en las guías de práctica clínica actuales. Debido a las frecuentes alteraciones lipídicas asociadas a esta anomalía metabólica en América Latina (AL), hemos organizado un grupo de expertos que ha adoptado el nombre de Asociación Latinoamericana para el Estudio de Lípidos (ALALIP), para generar un documento en el que se analice la prevalencia en AL del perfil lipídico relacionado con esta afección y ofrecer recomendaciones prácticas para su óptimo diagnóstico y tratamiento.

Metodología:

Se seleccionó un grupo de expertos regionales y, utilizando una metodología Delphi modificada, se realizó una revisión bibliográfica exhaustiva, con énfasis en estudios o revisiones que tuvieran implicaciones para AL. Posteriormente se desarrolló una serie de preguntas clave sobre la epidemiología, la fisiopatología, el diagnóstico y el tratamiento de la DA, que fueron discutidas por el grupo de expertos. Como convención, las recomendaciones que tuvieron un 100% de aceptación fueron consideradas unánimes; aquellas con al menos el 80% como para el consenso, y de desacuerdo, aquellas con menos del 80%.

Resultados:

Aunque no existe un estudio global sobre los factores de riesgo que se haya realizado sobre la base de una muestra representativa de toda la población de AL, el análisis sistemático de las encuestas nacionales de salud y los estudios de cohortes regionales evidencian la alta prevalencia de las anormalidades lipídicas que definen la DA. La prevalencia de niveles bajos de colesterol de lipoproteínas de alta densidad (HDL-C) oscila entre el 34.1% (estudio CESCAS I) y el 53.3% (estudio LASO), con diferentes frecuencias entre hombres y mujeres y el punto de corte seleccionado. La prevalencia de triglicéridos elevados (TRG) varía de 25.5% (estudio LASO) a 31.2% (Encuesta Nacional de Salud de Chile) siendo siempre más prevalente en hombres que en mujeres. Sólo dos estudios informan la prevalencia de DA en AL la Encuesta Nacional de Salud de México 2006 con un 18.3%, y un estudio venezolano que estima la prevalencia ponderada de la DA en 24.7%. Existen múltiples causas para estos hallazgos una nutrición inadecuada -caracterizada por el alto consumo de alimentos con alta densidad calórica y un alto consumo de colesterol y grasas trans- un estilo de vida sedentario, una alta prevalencia de obesidad en la región y posiblemente cambios epigenéticos que hacen que nuestra población sea más susceptible a tener este perfil lipídico anormal.

Conclusiones:

Las anomalías lipídicas que definen la DA tienen una alta prevalencia en AL; la interacción entre el estilo de vida, la herencia, y los cambios epigenéticos posiblemente son su causa. Debido a que se consideran una causa importante de riesgo cardiovascular residual, deben ser diagnosticados y tratados activamente como un objetivo secundario después de alcanzar la meta para el colesterol de lipoproteína de baja densidad (LDL-C). Es importante diseñar un estudio global de los factores de riesgo en nuestra región para hacernos conocer la verdadera prevalencia de la DA y sus causas y ayudarnos en el diseño de políticas públicas adaptadas a nuestra realidad en una escala poblacional e individual.

Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: LILACS Tipo de estudo: Estudo de etiologia / Guia de prática clínica / Estudo observacional / Estudo de prevalência / Pesquisa qualitativa / Fatores de risco / Estudo de rastreamento / Revisão sistemática Idioma: Inglês Revista: Rev. mex. cardiol Assunto da revista: Cardiologia Ano de publicação: 2017 Tipo de documento: Artigo País de afiliação: Estados Unidos Instituição/País de afiliação: South American Society of Cardiology (SSC)/US
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: LILACS Tipo de estudo: Estudo de etiologia / Guia de prática clínica / Estudo observacional / Estudo de prevalência / Pesquisa qualitativa / Fatores de risco / Estudo de rastreamento / Revisão sistemática Idioma: Inglês Revista: Rev. mex. cardiol Assunto da revista: Cardiologia Ano de publicação: 2017 Tipo de documento: Artigo País de afiliação: Estados Unidos Instituição/País de afiliação: South American Society of Cardiology (SSC)/US
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