Factores de riesgo para la enfermedad coronaria temprana en mujeres

Clara Inés Saldarriaga, Gloria Franco, Ana María Garzón, Isabel García, Nataly Mejía, Astrid Restrepo, .

Palabras clave: enfermedad coronaria, factores de riesgo, mujeres, complicaciones del embarazo, preeclampsia, trabajo de parto prematuro

Resumen

Introducción. La enfermedad coronaria es la causa principal de muerte en las mujeres; por esta razón, es prioritario el control del riesgo cardiovascular. Los estudios recientes sugieren una relación entre las alteraciones de la gestación y la enfermedad coronaria; sin embargo, esta hipótesis no ha sido evaluada en la población de mujeres latinoamericanas.
Objetivo. Identificar la asociación de riesgo que existe entre la enfermedad coronaria prematura y las alteraciones de la gestación en una población de mujeres colombianas.
Materiales y métodos. Es un estudio de casos y controles. Se consideraron casos a las mujeres menores de 55 años sometidas a nueva irrigación quirúrgica o percutánea, y los controles fueron mujeres menores de 55 años con diagnóstico de coronarias sanas por angiografía.
Resultados. Se incluyeron 200 pacientes, 100 con coronarias sanas y 100 con enfermedad coronaria, con edad promedio de 46,5±4,3 y 49,5±3,7 años, respectivamente. El análisis univariado mostró asociación entre la enfermedad coronaria y los antecedentes de preeclampsia, partos prematuros, recién nacidos de bajo peso, diabetes mellitus, dislipidemia y tabaquismo. El análisis multivariado mostró persistencia de la asociación con partos pretérmino (OR=6,05; IC95% 2,3-15; p=0,00), dislipidemia (OR=4,09; IC95% 2,1-7,8; p=0,00) y tabaquismo (OR=1,7; IC95% 0,93-3,2; p=0,08). La práctica de actividad física regular se encontró como factor protector (OR=0,5; IC95% 0,27-0,97; p=0,04).
Conclusiones. El presente estudio sugiere asociación entre la presencia de enfermedad coronaria prematura y el antecedente de alteraciones de la gestación.

Descargas

Los datos de descargas todavía no están disponibles.
  • Clara Inés Saldarriaga Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia
  • Gloria Franco Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia
  • Ana María Garzón Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia
  • Isabel García Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia
  • Nataly Mejía Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia
  • Astrid Restrepo Unidad de Cuidados Coronarios, Clínica Cardiovascular Santa María, Medellín, Colombia

Referencias bibliográficas

1. Bairey N, Bonow RO, Sopko G, Balaban RS, Cannon RO 3rd, Gordon D, et al. Women's Ischemic Syndrome Evaluation: Current status and future research directions. Report of the National Heart, Lung and Blood Institute workshop, October 2-4, 2002, executive summary. Circulation. 2004;109:805-7.
2. Lloyd-Jones DM, Wilson PW, Larson MG, Beiser A, Leip EP, D'Agostino RB, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol. 2004;9420-4.
3. Chambless LE, Heiss G, Shahar E, Earp MJ, Toole J. Prediction of ischemic stroke risk in the atherosclerosis risk in communities. Am J Epidemiol. 2004;160:259-69.
4. Shaw LJ, Lewis JF, Hlatky MA, Hsueh WA, Kelsey SF, Klein R, et al. Women's Ischemic Syndrome Evaluation: Current status and future research directions. Report of the National Heart, Lung and Blood Institute workshop, October 2-4, 2002. Section 5: gender-related risk factors for ischemic heart disease. Circulation. 2004;109:e56-8.
5. Bairey CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, et al. Insights from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) Study. Part II: Gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006;47(Suppl.):S21-9.
6. Howard BV, Kuller L, Langer R, Manson JE, Allen C, Assaf A, et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: The Women's Health Initiative Observational Study. Circulation. 2005;111:1462-70.
7. Germain AM, Romanik MC, Guerra I, Solari S, Reyes MS, Johnson RJ, et al. Endothelial dysfunction: a link among pre-eclampsia, recurrent pregnancy loss, and future cardiovascular events? Hypertension. 2007;49:90-5.
8. Agatisa PK, Ness RB, Roberts JM, Costantino JP, Kuller LH, McLaughlin MK. Impairment of endothelial function in women with a history of pre-eclampsia: An indicator of cardiovascular risk. Am J Physiol Heart Circ Physiol. 2004;286:H1389-93.
9. Haukkamaa L, Salminen M, Laivuori H, Leinonen H, Hiilesmaa V, Kaaja R. Risk for subsequent coronary artery disease after pre-eclampsia. Am J Cardiol. 2004;93:805-8.
10. Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001;357:2002-6.
11. Sattar N, Greer IA. Pregnancy complications and maternal cardiovascular risk: Opportunities for intervention and screening? BMJ. 2002;325:157-60.
12. Nardi O, Zureik M, Courbon D, Ducimetière P, Clavel-Chapelon F. Preterm delivery of a first child and subsequent mothers' risk of ischaemic heart disease: A nested case-control study. Eur J Cardiovasc Prev Rehabil. 2006;13:281-3.
13. Smith GC, Pell JP, Walsh D. Spontaneous loss of early pregnancy and risk of ischaemic heart disease in later life: Retrospective cohort study. BMJ. 2003;326:423-4.
14. Løkkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: Influence of hormone therapy. Maturitas. 2006;53:226-33.
15. Shufelt CL, Bairey CN. Contraceptive hormone use and cardiovascular disease. J Am Coll Cardiol. 2009;53:221-31.
16. Vlietstra RE, Frye RL, Kronmal RA, Sim DA, Tristani FE, Killip T 3rd. Risk factors and angiographic coronary artery disease: A report from the coronary artery surgery study (CASS). Circulation. 1980;62:254-61.
17. Lipinski M, Do D, Morise A, Froelicher V. What percent luminal stenosis should be used to define angiographic coronary artery disease for noninvasive test evaluation? Ann Noninvasive Electrocardiol. 2002;7:98-105.
18. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J 3rd. Factors of risk in the development of coronary heart disease -six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33-50.
19. Pepine CJ, Kerensky RA, Lambert CR, Smith KM, von Mering GO, Sopko G, et al. Some thoughts on the vasculopathy of women with ischemic heart disease. J Am Coll Cardiol. 2006;47(Suppl.):S30-5.
20. Nohria A, Vaccarino V, Krumholz HM. Gender differences in mortality after myocardial infarction. Why women fare worse than men. Cardiol Clin. 1998;16:45-57.
21. Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women. Eur Heart J. 2002;23:1738-52.
22. Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, et al. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000;355:675-87.
23. Lapidus L, Bengtsson C, Lindquist O, Sigurdsson JA, Rybo E. Triglycerides -main lipid risk factor for cardiovascular disease in women? Acta Med Scand. 1985;217:481-9.
24. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3:213-9.
25. Willett WC, Hennekens CH, Bain C, Rosner B, Speizer FE. Cigarette smoking and non-fatal myocardial infarction in women. Am J Epidemiol. 1981;113:575-82.
26. Laing SP, Swerdlow AJ, Slater SD, Burden AC, Morris A, Waugh NR, et al. Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia. 2003;46:760-5.
27. Bedinghaus J, Leshan L, Diehr S. Coronary artery disease prevention: What's different for women? Am Fam Physician. 2001;63:1393-406.
28. Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE, et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal' weight range. JAMA. 1995;273:461-5.
29. Schulte H, von Eckardstein A, Cullen P, Assmann G. Obesity and cardiovascular risk. Herz. 2001;26:170-7.
30. Wessel TR, Arant CB, Olson MB, Johnson BD, Reis SE, Sharaf BL, et al. Relationship of physical fitness Vs. body mass index with coronary artery disease and cardiovascular events in women. JAMA. 2004;292:1179-87.
31. Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol. 1990;132:612-28.
32. Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol. 1990;132:612-28.
33. Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med. 1996;334:1311-5.
34. Sesso HD, Lee IM, Gaziano JM, Rexrode KM, Glynn RJ, Buring JE. Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women. Circulation. 2001;104:393-8.
35. Barker D. Birth weight and coronary heart disease in a historical cohort. Int J Epidemiol. 2006;35:886-7.
36. Morris JA. Fetal origin of maturity onset diabetes mellitus: Genetic or environmental cause? Med Hypotheses. 1998;51:285-8.
37. Haukkamaa L, Salminen M, Laivuori H, Leinonen H, Hiilesmaa V, Kaaja R. Risk for subsequent coronary artery disease after pre-eclampsia. Am J Cardiol. 2004;93:805-8.
38. Kaaja R, Kinnunen T, Luoto R. Regional differences in the prevalence of pre-eclampsia in relation to the risk factors for coronary artery disease in women in Finland. Eur Heart J. 2005;26:44-50.
39. McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of pre-eclampsia/eclampsia: A systematic review and meta-analyses. Am Heart J. 2008;156:918-3.
40. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. BMJ. 2007;335:974.
41. Chavez-B L, Salazar L, Brilla-S A, Herrmann FH. Estudio de factores trombogénicos en pacientes menores de 45 años con infarto de miocardio. Rev Costarric Cardiol. 2002;4:5-10.
42. Jumbo LA, Aragón JC, Aguiar B, Álvarez A, López J. Enfermedad coronaria en la mujer ama de casa con prueba de esfuerzo positiva. Rev Ecuat Cardiol. 1997;5:212-7.
43. Ciruzzi MA, Rozlosnik J, Pramparo PC, Delmonte H, Paterno C, Soifer S, et al. Factores de riesgo para infarto agudo de miocardio en la Argentina. Rev Argent Cardiol. 1996;64(Suppl.2):9-40.
44. Sattar N, Ramsay J, Crawford L, Cheyne H, Greer IA. Classic and novel risk factor parameters in women with a history of pre-eclampsia. Hypertension. 2003;42:39-42.
45. Hwang SJ, Ballantyne CM, Sharrett AR, Smith LC, Davis CE, Gotto AM Jr, et al. Circulating adhesion molecules VCAM-1, ICAM -1 and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: The atherosclerosis risk in communities (ARIC) study. Circulation. 1997;96:4219-25.
Cómo citar
1.
Saldarriaga CI, Franco G, Garzón AM, García I, Mejía N, Restrepo A. Factores de riesgo para la enfermedad coronaria temprana en mujeres. biomedica [Internet]. 1 de diciembre de 2010 [citado 28 de marzo de 2024];30(4):559-66. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/294

Algunos artículos similares:

Publicado
2010-12-01
Sección
Artículos originales

Métricas

Estadísticas de artículo
Vistas de resúmenes
Vistas de PDF
Descargas de PDF
Vistas de HTML
Otras vistas
QR Code