Factores de riesgo tradicionales y no tradicionales en una población de pacientes con artritis reumatoide
Keywords:
Artritis reumatoide, riesgo cardiovasculares, Escala de FraminghamAbstract
Antecedentes: los pacientes con artritis reumatoide (AR) tienen el doble de riesgo de presentar enfermedades cardiovasculares. Este riesgo no se explica únicamente por los factores no tradicionales, ya que estos pacientes presentan factores asociados a la propia enfermedad los cuales producen una inflamación crónica.
Objetivo: determinar la prevalencia de los factores de riesgo cardiovascular (RCV) tradicionales y no tradicionales en una población de pacientes con AR.
Métodos: se realizó un estudio descriptivo, transversal, observacional y prospectivo, en 126 pacientes con el diagnóstico de AR según los criterios ACR/EULAR 2010. Se revisaron los expedientes clínicos, excluyendo aquellos pacientes con enfermedad cardiovascular previa. Se registraron los factores de RCV tradicionales (diabetes mellitus (DM), hipertensión arterial sistémica (HAS), hipotiroidismo, tabaquismo, obesidad, colesterol total, HDL y LDL, triglicéridos), así como factores asociados a la AR (duración de la enfermedad, DAS-28 PCR, niveles de PCR, uso de glucocorticoides, factor reumatoide positivo, y anticuerpos anti péptido cíclico citrulinado (Ac APCC) positivos.
Resultados: el 68 % presentó hipertrigliceridemia, el 60.3% elevación de LDL, el 50% hipercolesterolemia, el 44.3% hipoalfalipoproteinemia, el 58.7% presentaron obesidad, el 35.7% presentaron DM, el 16.6% HAS, el 7.1% fumaban y el 3.1% tenían hipotiroidismo. Con respecto a los factores de riesgo no tradicionales el 68.2% tenían factor reumatoide positivo, el 54.7% tomaban glucocorticoides, el 25.4% tuvieron una PCR > 2 mg/L, el 20.6% tenían más de 10 años de duración de la enfermedad, el 7.9% tenían Ac APCC positivos y el 1.6% presentaron un índice de actividad grave. Se calculo el RCV a 10 años por medio de la escala de Framingham; 74.6% presentó riesgo leve, 24.6% moderado y 0.8% grave.
Conclusiones: Nuestros pacientes con AR presentaron aproximadamente dos factores de RCV no tradicionales en promedio, lo cual hace que determinantes de riesgo como la escala de Framingham no sean útiles.
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