Envíe este artículo por correo electrónico (Inicie sesión)
Enviar un correo electrónico al autor/a (Inicie sesión) Open Journal Systems
Evaluación de factores de riesgo cardiovascular antes y después de cirugía bariátrica
Resumen
Introducción: México posee una de las más altas prevalencias de obesidad severa en el mundo. La mortalidad por causas cardiovasculares en estos pacientes alcanza el 90%. Existen distintas escalas para valorar el riesgo, como la escala de Framingham que evalúa a 10 años, y la ASCVD10 que evalúa a 10 años y a lo largo de la vida. Ninguna se ha usado para evaluar el riesgo cardiovascular en mexicanos con obesidad severa antes y después de la cirugía bariátrica.
Métodos: se efectuó un estudio cuasiexperimental con 109 pacientes con obesidad severa, con evaluación antropométrica y bioquímica, antes y un año después de la cirugía bariátrica. Se obtuvo el puntaje de riesgo con las escalas de Framingham y ASCVD10.
Resultados: la mediana de edad fue 45.3 ± 10.1 años, 70% eran mujeres, en 79% se realizó bypass laparoscópico con Y de Roux. Hubo disminución de peso en cada evaluación posterior a la cirugía, independientemente del procedimiento, y mejoría en todos los parámetros bioquímicos. El riesgo evaluado por Framingham disminuyó de 9.4 a 5.9%, el porcentaje de pacientes de “alto riesgo” disminuyó de 25 a 11%; con respecto al riesgo evaluado por ASCVD10 se redujo de 4.1 a 2.5%, con porcentaje de pacientes de alto riesgo que disminuyó de 28 a 16%. El tabaquismo fue el mayor determinante de riesgo cardiovascular.
Conclusiones: el riesgo cardiovascular evaluado por ambas escalas disminuyó un año después de la cirugía bariátrica.
Palabras clave
Referencias
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894(I-XII):1-253.
Barrera-Cruz A, Ávila-Jiménez L, Cano-Pérez E, Molina-Ayala MA, Parrilla-Ortiz JI, Ramos-Hernández RI, et al. Practice clinical guideline. Prevention, diagnosis and treatment of overweight and obesity. Rev Med Inst Mex Seguro Soc. 2013;51(3):344-57.
Mason EE, Doherty C, Maher JW, Scott DH, Rodriguez EM, Blommers TJ. Super obesity and gastric reduction procedures. Gastroenterol Clin North Am. 1987;16(3):495-502.
Nguyen NT, Ho HS, Palmer LS, Wolfe BM. Laparoscopic Roux-en-Y gastric bypass for super/super obesity. Obes Surg. 1999;9(4):403-6.
Barquera S, Campos-Nonato I, Hernandez-Barrera L, Pedroza A, Rivera-Dommarco JA. Prevalence of o besity in Mexican adults 2000-2012. Salud Publica Mex. 2013;55(Suppl 2):S151-60.
Laing ST, Smulevitz B, Vatcheva KP, Rahbar MH, Reininger B, McPherson DD et al. Subclinical atherosclerosis and obesity phenotypes among Mexican Americans. J Am Heart Assoc. 2015;4(3):e001540.
Mechanick JI, Kushner RF, Sugerman HJ, González-Campoy JM, Collazo-Clavell ML, Guven S et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008;4(Suppl 5):S109-84.
Marinou K, Tousoulis D, Antonopoulos AS, Stefanadi E, Stefanadis C. Obesity and cardiovascular disease: from pathophysiology to risk stratification. Int J Cardiol. 2010;138(1):3-8.
D’Agostino RB Sr, Grundy S, Sullivan LM, Wilson P, CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: Results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180-7.
Alcocer LA, Lozada O, Fanghanel G, Sanchez-Reyes L, Campos-Franco E. Global cardiovascular risk stratification: Comparison of the Framingham method with the SCORE method in the Mexican population. Cir Cir. 2011;79(2):168-74.
Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-45.
Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack [Internet]. Estados Unidos de Norteamérica: National Heart, Lung, and Blood Institute; 2014 [Actualizado abril 2014; citado marzo 2015]. Disponible en: http://cvdrisk.nhlbi.nih. gov/calculator.asp
Lindegaard KK, Jorgensen NB, Just R, Heegaard PM, Madsbad S. Effects of Roux-en-Y gastric bypass on fasting and postprandial inflammation-related parameters in obese subjects with normal glucose tolerance and in obese subjects with type 2 diabetes. Diabetol Metab Syndr. 2015;7:12.
Vogel JA, Franklin BA, Zalesin KC, Trivax JE, Krause KR, Chengelis DL et al. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol. 2007;99(2):222-6.
Pai MP, Paloucek FP. The origin of the “ideal” body weight equations. Ann Pharmacother. 2000;34(9):1066-9.
Asz-Sigall D, Lopez-Garcia L, Vega-Memije ME, Lacy-Niebla RM, García-Corona C, Ramírez-Rentería C et al. HLA-DR6 association confers increased resistance to T. rubrum onychomycosis in Mexican Mestizos. Int J Dermatol. 2010;49(12):1406-9.
Mechanick JI, Kushner RF, Sugerman HJ, González-Campoy JM, Collazo-Clavell ML, Guven S et al. American Association of Clinical Endocrinologists, The Obesity Society and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008;14(Suppl 1):1-83.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chem. 1972;18(6):499-502.
D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53.
Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837-47.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987-1003.
ASCVD Risk Estimator [Internet]. Estados Unidos de Norteamérica: American College of Cardiology/American Heart Association; [Actualizado 2014, citado marzo 2015]. Disponible en: tools.acc.org/ascvd-risk-estimator/
Goff DC Jr., Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49-73.
Torquati A, Wright K, Melvin W, Richards W. Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class II to III obesity. J Am Coll Surg. 2007;204(5):776-82.
Kligman MD, Dexter DJ, Omer S, Park AE. Shrinking cardiovascular risk through bariatric surgery: application of Framingham risk score in gastric bypass. Surgery. 2008;143(4):533-8.
Benaiges D, Goday A, Ramon JM, Hernandez E, Pera M, Cano JF et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575-80.
Borrayo-Sanchez G, Madrid-Miller A, Arriaga-Nava R, Ramos-Corrales MA, Garcia-Aguilar J, Almeida Gutierrez E. Risk stratified in the National Registry of Acute Coronary Syndromes at the IMSS. Rev Med Inst Mex Seguro Soc. 2010;48(3):259-64.
Perez-Escamilla R, Villalpando S, Shamah-Levy T, Mendez-Gomez Humaran I. Household food insecurity, diabetes and hypertension among Mexican adults: results from Ensanut 2012. Salud Publica Mex. 2014;56(Suppl 1):s62-70.
Moschen AR, Molnar C, Geiger S, Graziadei I, Ebenbichler CF, Weiss H et al. Anti-inflammatory effects of excessive weight loss: potent suppression of adipose interleukin 6 and tumour necrosis factor alpha expression. Gut. 2010;59(9):1259-64.
Mor A, Omotosho P, Torquati A. Cardiovascular risk in obese diabetic patients is significantly reduced one year after gastric bypass compared to one year of diabetes support and education. Surgical Endosc. 2014;28(10):2815-20.
Zerrweck C, Sepulveda EM, Maydon HG, Campos F, Spaventa AG, Pratti V et al. Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study. Obes Surg. 2014;24(5):712-7.
Goktas Z, Moustaid-Moussa N, Shen CL, Boylan M, Mo H, Wang S. Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance. Front Endocrinol (Lausanne). 2013;4:69.
Enlaces refback
- No hay ningún enlace refback.