Estimación de riesgo cardiovascular ateroesclerótico en pacientes adultos sin sospecha de cifras tensionales elevadas

Fabiola Ivette García Castillo; Metzli Yolotzin López Carrillo; Indira Mendiola-Pastrana; Eduardo López Ortiz; Diana Guízar-Sánchez; Geovani López-Ortiz

Fabiola Ivette García Castillo Clínica de Medicina Familiar Marina Nacional. Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE)1 (Ciudad de México, México)
Metzli Yolotzin López Carrillo Clínica de Medicina Familiar Ermita. Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Ciudad de México, México)
Indira Mendiola-Pastrana Hospital General de Zona con Medicina Familiar No.8 (Ciudad de México, México)
Eduardo López Ortiz Facultad de Medicina. Universidad Nacional Autónoma de México (Ciudad de México, México)
Diana Guízar-Sánchez Facultad de Medicina. Universidad Nacional Autónoma de México (Ciudad de México, México)
Geovani López-Ortiz Facultad de Medicina. Universidad Nacional Autónoma de México (Ciudad de México, México)

Palabras clave: Factores de riesgo de enfermedad cardiaca, Hipertensión, Enfermedad cardiovascular, Factores de riesgo, Comorbilidad, México

Key-words: Heart disease risk factors, Hypertension, Cardiovascular disease, Risk factors, Comorbidity, Mexico

Palavras chave: Fatores de risco de doenças cardíacas, Hipertensão, Doença cardiovascular, Fatores de risco, Comorbidade, México

Resumen

Introducción: Las enfermedades cardiovasculares representan la primera causa de muerte en el mundo. La estimación del Riesgo Cardiovascular (RCV) podría disminuir la carga de la enfermedad y mejorar la calidad de vida de los pacientes. Objetivo: Estimar el RCV en pacientes sin sospecha de cifras tensionales elevadas en una Clínica de Medicina Familiar en la Ciudad de México. Métodos: Estudio transversal descriptivo, participaron 101 pacientes de sexo masculino y femenino, de 40 a 69 años, sin diagnóstico previo de Hipertensión Arterial (HTA), pero que presentaron cifras tensionales altas al momento del estudio. Para diagnosticar HTA se utilizaron los criterios de la Asociación Americana del Corazón-2017. El RCV se evaluó con el ASCVD-Risk Estimator Plus. Resultados: En la muestra la HTA estuvo presente en el 55.4 %, 44.6 % manifestaron presión arterial elevada. Respecto al RCV, 54.4 % presentaron bajo riesgo, 11.8 % riesgo límite, 25.7 % intermedio y 7.9 % alto. Los factores de RCV con mayor prevalencia fueron diabetes mellitus tipo 2 (DM2), sobrepeso, obesidad y elevación de cifras tensionales. Discusión: Un porcentaje importante de participantes presentó RCV en sus diferentes categorías. Se requiere ser más estrictos en los parámetros utilizados para definir la HTA; pues sin intervenciones oportunas las enfermedades cardiovasculares continuarán incrementándose. Conclusión: Cerca de la mitad de los casos presentaron un RCV de límite a alto. Existió alta prevalencia de factores de riesgo individuales como DM2, HTA y dislipidemia. Se deben fortalecer búsquedas intencionadas de pacientes con características similares a las de este estudio para prevenir el desarrollo de enfermedades cardiovasculares

Abstract

Introduction: Cardiovascular diseases are the main cause of death in the world. The estimation of the Cardiovascular Risk (CVR) could both reduce the burden of the illness and improve the quality of life of the patients. Objective: To estimate the CVR in adult patients without a suspicion of having high pressure readings in a Clinic of Family Medicine in Mexico City. Methods: This is a descriptive and transversal study with a sample of 101 male and female patients in the range of 40 to 69 years old, who did not have a previous hypertension diagnosis but who, at the moment of this study, showed high tension readings. The American Heart Association 2017 criteria were used. The cardiovascular risk was assessed using the ASCVD-Risk Estimator Plus. Results: Arterial hypertension readings were found in 55.4 % of the sample. 54.4 % of the sample met the criteria for low risk, 11.8 % for limit risk, 25.7 % for medium risk, and 7.9 % for high risk. The most prevalent factors associated with cardiovascular risk were type 2 diabetes mellitus, overweight, obesity, and hypertension. Discussion: An important percentage of the sample showed cardiovascular risk to some degree, suggesting that perhaps using stricter parameters to define hypertension could prompt more timely interventions. Conclusion: Considering both the high percentage of participants who demonstrated having a cardiovascular risk of concern and the high prevalence of risk factors such as Type 2 Diabetes Mellitus, hypertension, and overweight, timely monitoring interventions should be promoted in order to prevent the development of cardiovascular diseases

Resumo

Introdução: As doenças cardiovasculares representam a principal causa de morte a nível mundial. A estimativa do risco cardiovascular (RCV) poderia diminuir o peso da doença e melhorar a qualidade de vida dos pacientes. Objetivo: Estimar o RCV em pacientes sem suspeita de tensão arterial elevada em uma Clínica de Medicina Familiar na Cidade do México. Métodos: Um estudo descritivo transversal envolvendo 101 pacientes do sexo masculino e feminino com idades entre os 40 - 69 anos, sem diagnóstico prévio de hipertensão (HTA), mas com tensão arterial elevada no momento do estudo. Os critérios da American Heart Association-2017 foram utilizados para diagnosticar o HTA. O RCV foi avaliado utilizando o ASCVD-Risk Estimator Plus. Resultados: Na amostra, a HTA esteve presente em 55,4 %, 44,6 % reportou tensão arterial elevada. Em relação à RCV, 54,4 % apresentavam baixo risco, 11,8 % risco limite, 25,7 % risco intermédio e 7,9 % alto risco. Os fatores de RCV mais prevalentes foram a diabetes melito tipo 2 (DM2), excesso de peso, obesidade e tensão arterial elevada. Discussão: Uma percentagem significativa de participantes tinha RCV em diferentes categorias. Há necessidade de ser mais rigoroso nos parâmetros utilizados para definir a HTA; sem intervenções atempadas, as doenças cardiovasculares continuarão aumentando. Conclusão: Quase metade dos casos tinham um limite de RCV elevado. Havia uma elevada prevalência de fatores de risco individuais tais como DM2, hipertensão e dislipidemia. A procura intencional de pacientes com características semelhantes às deste estudo deve ser reforçada para prevenir o desenvolvimento de doenças cardiovasculares

Bibliografía

1. Gómez LA. Las enfermedades cardiovasculares: un problema de salud pública y un reto global. Biomédica. 2011; 31(4): 469-73. https://bit.ly/3kk7xdB
2. OMS. Enfermedades cardiovasculares. Ginebra: OMS; 2017. https://bit.ly/39g7vwN
3. Kunstmann S, Gainza F. Herramientas para la estimación del riesgo cardiovascular. Rev. méd. Clín. Las Condes. 2018; 29(1): 6-11. https://doi.org/10.1016/j.rmclc.2017.11.010
4. Andrade-Castellanos CA. Hipertensión arterial primaria: tratamiento farmacológico basado en la evidencia. Med Int Méx. 2015; 31: 191-5. https://bit.ly/39lazHU
5. Secretaría de Salud. Guía de Práctica Clínica. Diagnóstico y tratamiento de dislipidemias (hipercolesterolemia) en el adulto. México: CENETEC; Actualización 2016. https://bit.ly/3hQl1Md
6. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 140(11): 596-646. https://doi.org/10.1161/CIR.0000000000000678
7. American Heart Association. Know your risk factors for high blood pressure. Dallas: AHA; 2020. https://bit.ly/2Xv3D8z
8. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA. 2017; 317(2): 165-82. https://doi.org/10.1001/jama.2016.19043
9. World Health Organization. The top 10 causes of death. Ginebra: WHO; 2020. https://bit.ly/2Xtsr0K
10. Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2018. Presentación de resultados. México: INEGI/INSP/SSA; 2020. https://bit.ly/3krAy7e
11. Valenzuela-Flores AA, Solórzano-Santos F, Valenzuela-Flores AG, Durán-Arenas LG, Ponce de León-Rosales SP, Oropeza-Martínez MP, et al. Key recommendations of the clinical guidelines of arterial hypertension in primary care. Rev Med Inst Mex Seguro Soc. 2016; 54(2): 249-60. https://bit.ly/3u3isLN
12. Himmelfarb CRD, Commodore-Mensah Y, Hill MN. Expanding the role of nurses to improve hypertension care and control globally. Ann Glob Health. 2016; 82(2): 243-53. https://doi.org/10.1016/j.aogh.2016.02.003
13. Spies LA, Bader SG, Opollo JG, Gray J. Nurse-led interventions for hypertension: A scoping review with implications for evidence-based practice. Worldviews Evid Based Nurs. 2018; 15(4): 247-56. https://doi.org/10.1111/wvn.12297
14. Spies LA, Nanyonga RC, Nakaggwa F. Nurse-led interventions in the interim: Waiting on universal health coverage. Int Nurs Rev. 2019; 66(4): 549-52. https://doi.org/10.1111/inr.12558
15. Taler SJ. Initial treatment of hypertension. N Engl J Med. 2018; 378(7): 636-44. https://doi.org/10.1056/NEJMcp1613481
16. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71(6): 1269-324. https://doi.org/10.1161/HYP.0000000000000066
17. Bress AP, Colantonio LD, Cooper RS, Kramer H, Booth JN, Odden MC, et al. Potential cardiovascular disease events prevented with adoption of the 2017 American College of Cardiology/American Heart Association blood pressure guideline. Circulation. 2019; 139(1): 24-36. https://doi.org/10.1161/CIRCULATIONAHA.118.035640
18. Universidad Nacional Autónoma de México. Los médicos familiares, pilar de la salud. Gaceta Facultad de Medicina. 2018; 9(251): 1-16. https://bit.ly/39tq40t
19. León E, Tranche S, Montano J. Impacto económico de la medicina familiar en los sistemas de salud de Iberoamérica. Rev Bras Med Fam Comunidade. 2018; 13(Suppl 1): 43-53. https://doi.org/10.5712/rbmfc13(1)1852
20. Institute for Health Metrics and Evaluation. GBD Compare|Viz Hub. Seattle: University of Washington; 2020.
21. Gijón-Conde T, Gorostidi M, Camafort M, Abad-Cardiel M, Martín-Rioboo E, Morales-Olivas F, et al. Documento de la Sociedad Española de Hipertensión-Liga Española para la lucha contra la hipertensión arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial. Hipertens Riesgo Vasc. 2018; 35(3): 119-29. https://doi.org/10.1016/j.hipert.2018.04.001
22. Amercian College of Cardiology. ASCVD Risk Estimator Plus. Washington, D.C.: ACC; s/f. https://bit.ly/2XyIsCq
23. Wilson PWF, Kannel WB. Obesity, diabetes, and risk of cardiovascular disease in the elderly. Am J Geriatr Cardiol. 2002; 11(2): 119-24. https://doi.org/10.1111/j.1076-7460.2002.00998.x
24. Joseph JJ, Golden SH. Type 2 diabetes and cardiovascular disease: What next? Curr Opin Endocrinol Diabetes Obes. 2014; 21(2): 109-20. https://doi.org/10.1097/MED.0000000000000044
25. Merino J, Jablonski KA, Mercader JM, Kahn SE, Chen L, Harden M, et al. Interaction between type 2 diabetes prevention strategies and genetic determinants of coronary artery disease on cardiometabolic risk factors. Diabetes. 2020; 69(1): 112–20. https://doi.org/10.2337/db19-0097
26. Secretaría de Salud/Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016 (ENSANUT MC 2016). Informe final de resultados. México: SSA/INSP; 2016. https://bit.ly/3hW6XRo
27. Hinton TC, Adams ZH, Baker RP, Hope KA, Paton JFR, Hart EC, et al. Investigation and treatment of high blood pressure in young people: Too much medicine or appropriate risk reduction? Hypertension. 2020; 75(1): 16-22. https://doi.org/10.1161/HYPERTENSIONAHA.119.13820
28. Packer M. Heart Failure: The most important, preventable, and treatable cardiovascular complication of type 2 diabetes. Diabetes Care. 2018; 41(1): 11-3. https://doi.org/10.2337/dci17-0052
29. Adiukwu F, Ofori S, Ugbomah L. Vascular cognitive impairment, a cardiovascular complication. World J Psychiatry. 2016; 6(2): 199-207. https://doi.org/10.5498/wjp.v6.i2.199
30. Hisni D, Rukmaini R, Saryono S, Chinnawong T, Thaniwattananon P. Cardiovascular self-management support program for preventing cardiovascular complication behaviors and clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus in Indonesia: A pilot study. Jpn J Nurs Sci. 2019; 16(1): 25-36. https://doi.org/10.1111/jjns.12208
31. Wenger NK. Female-friendly focus: 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease. Clin Cardiol. 2019; 42(8): 706-9. https://doi.org/10.1002/clc.23218
32. Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular health: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2017; 10(2): 1-9. https://doi.org/10.1161/CIRCOUTCOMES.116.003497
33. Woodward M. Cardiovascular disease and the female disadvantage. Int. J. Environ. Res. Public Health. 2019; 16(7): 1165.
34. Regitz-Zagrosek V. Sex and gender differences in health: Science & society series on sex and science. EMBO Rep. 2012; 13(7): 596-603. https://doi.org/10.1038/embor.2012.87
35. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020; 16(4): 223-37. https://doi.org/10.1038/s41581-019-0244-2
36. Yano Y, Reis JP, Colangelo LA, Shimbo D, Viera AJ, Allen NB, et al. Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure Guideline with cardiovascular events later in life. JAMA. 2018; 320(17): 1774-82. https://doi.org/10.1001/jama.2018.13551
37. Noubiap JJ, Bigna JJ, Nansseu JR, Nyaga UF, Balti EV, Echouffo-Tcheugui JB, et al. Prevalence of dyslipidaemia among adults in Africa: A systematic review and meta-analysis. Lancet Global Health. 2018; 6(9): e998-e1007. https://doi.org/10.1016/S2214-109X(18)30275-4
38. Harris MA, Ferguson TS, Boyne MS, Figueroa JP. High prevalence of dyslipidemia among primary care patients with hypertension and diabetes in Jamaica. Arch Med Sci Atheroscler Dis. 2017; 2: 61-7. https://doi.org/10.5114/amsad.2017.70596
39. American Diabetes Association. 10. Cardiovascular disease and risk management: Standards of medical care in diabetes-2020. Diabetes Care. 2020; 43(Suppl. 1): S111–34. https://doi.org/10.2337/dc20-s010
40. Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2019; 73(24): 3153-67. https://doi.org/10.1016/j.jacc.2018.11.005
41. Sarre-Álvarez D, Cabrera-Jardines R, Rodríguez-Weber F, Díaz-Greene E. Enfermedad cardiovascular aterosclerótica. Revisión de las escalas de riesgo y edad cardiovascular. Med. inter Méx. 2018; 34(6): 910-23. https://bit.ly/3cZgRim
42. Ahuja R, Ayala C, Tong X, Wall HK, Fang J. Public awareness of health-related risks from uncontrolled hypertension. Prev Chronic Dis. 2018; 15: 1-9. https://doi.org/10.5888/pcd15.170362
43. Thomas C, Brennan A, Goka E, Squires HY, Brenner G, Bagguley D, et al. What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England? An economic evaluation. BMJ Open. 2020; 10(9): 2-10. https://doi.org/10.1136/bmjopen-2020-03748
44. Basu S, Wagner RG, Sewpaul R, Reddy P, Davies J. Implications of scaling up cardiovascular disease treatment in South Africa: A microsimulation and cost-effectiveness analysis. Lancet Glob Health. 2019; 7(2): e270-80. https://doi.org/10.1016/S2214-109X(18)30450-9
45. Heintzman JD, Bailey SR, Muench J, Killerby M, Cowburn S, Marino M. Lack of lipid screening disparities in obese latino adults at health centers. Am J Prev Med. 2017; 52(6): 805-9. https://doi.org/10.1016/j.amepre.2016.12.020
46. Mattiuzzi C, Sanchis-Gomar F, Lippi G. Worldwide burden of LDL cholesterol: Implications in cardiovascular disease. Nutr Metab Cardiovasc Dis. 2020; 30(2): 241-4. https://doi.org/10.1016/j.numecd.2019.09.008
47. Escortell-Mayor E, Del Cura-González I, Ojeda-Ruiz E, Sanz-Cuesta T, Rodríguez-Salceda I, García-Soltero J, et al. A primary healthcare information intervention for communicating cardiovascular risk to patients with poorly controlled hypertension: The Education and Coronary Risk Evaluation (Educore) study-A pragmatic, cluster-randomized trial. PLoS ONE. 2020; 15(1): 1-17. https://doi.org/10.1371/journal.pone.0226398

Estimación de riesgo cardiovascular ateroesclerótico en pacientes adultos sin sospecha de cifras tensionales elevadas

Estimation of aterosclerotic cardiovascular risk in adult patients without a suspicion of having high pressure readings

Estimativa do risco cardiovascular aterosclerótico em pacientes adultos sem suspeita de níveis elevados de tensão arterial

Resumen

Abstract

Resumo

Bibliografía