Metas de colesterol LDL en pacientes sometidos a revascularización periférica;
LDL Cholesterol Targets in Patients Undergoing Peripheral Revascularization

INTRODUCCION Los pacientes con enfermedad vascular periférica representan un grupo de alto riesgo de eventos cardiovasculares por lo que deben alcanzar metas de prevención secundaria de enfermedad cardiovascular. OBJETIVOS Determinar qué porcentaje de pacientes sin antecedentes de enfermedad coronaria sometidos a cirugía vascular (CV) alcanzan las metas de colesterol luego de ser intervenidos en relación a  pacientes sometidos a cirugía de revascularización miocárdica (CRM) electiva. MATERIALES y METODOS Se comparó el grado de control de dislipemia de una cohorte retrospectiva de  pacientes sometidos a CV sin antecedentes clínicos de enfermedad coronaria en relación a pacientes sometidos a cirugía de revascularización coronaria. RESULTADOS Se siguieron 468 individuos, 98 operados de CV y 370 de CRM por un periodo de 18 meses. La media de LDL a los 6 meses de la cirugía fue significativamente menor en los coronarios que en los vasculares (84.7±25  vs. 98.8±35 mg/dl; p=0.001). Esta diferencia se mantuvo a los 12 meses post operatorio (91,6±28.5 vs. 102 ±39; p=0.04) pero se pierde a los 18 meses  (88±26 vs 93.3±23 mg/dl; p=0.25) La tasa de alcance de metas de LDL <100mg/dl a 6 meses en vasculares y coronarios fue 27,5% vs 48.6%; p<0.0001; OR 2.4 (1.4-4.0), a 12 meses 26.5% vs 35.1%; p=0.10; OR 1.3(0.8-2.3) y a 18 meses 22.5% vs 37.3%; p=0.006; OR 1.7(1.01-2.9). CONCLUSIONES Los pacientes sometidos a procedimientos de revascularización periférica son controlados menos intensamente y alcanzan en menor medida las metas de C-LDL que los pacientes sometidos a CRM.

Background: Patients with peripheral vascular disease represent a group at high risk of cardiovascular events, and must therefore achieve the secondary prevention goals recommended in the guidelines. Objectives: Primary: To determine what percentage of patients undergoing peripheral revascularization surgery reached LDL cholesterol goals at 6 months of the  intervention compared with patients undergoing coronary artery bypass grafting. Secondary: To determine the percentage of patients reaching these levels at 18 months of follow-up, the percentage of patients with total cholesterol dosage and lipid fraction (LDL-C, HDL-C and TG) assessment at 6 and 18 months of follow-up and the percentage of statin use during the previous year and during the long term follow-up after surgery. Methods: The degree of lipid control in a retrospective cohort of patients undergoing peripheral revascularization surgery was compared with another group of patients undergoing coronary artery bypass grafting at 6 months and 18 months of the procedure. Results: A total of 468 individuals, 98 undergoing surgery for peripheral vascular disease and 370 for coronary artery disease were followed up for a period of 18 months. Mean LDL-C at 6 months of surgery was significantly higher in the vascular than in the coronary patients (98.8±35 mg/dl vs. 84.7±25 mg/dl, p=0.001), but lost significance at 18 months (93.3±23 mg/dl vs. 88±26 mg/ dl, p=0.25). The percentage of patients achieving LDL-C targets <100 mg/dl was 27.5% vs. 48.6% (p <0.0001) at 6 months in the vascular and coronary patients, respectively, and 22.5% vs. 37.3% (p=0.006) at 18 months. Conclusion: A lower percentage of patients undergoing surgical procedures for peripheral revascularization achieve LDL-C targets compared with those undergoing coronary revascularization.