ASPIRINA PARA LA PREVENCION PRIMARIA DE EVENTOS CARDIOVASCULARES EN LA DIABETES




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ASPIRINA PARA LA PREVENCION PRIMARIA DE EVENTOS CARDIOVASCULARES EN LA DIABETES

(especial para SIIC © Derechos reservados)
Los individuos diabéticos con alto riesgo de enfermedad coronaria deberían ser tratados con bajas dosis de aspirina (75-162 mg/día).
colwell9.jpg Autor:
John A Colwell
Columnista Experto de SIIC

Institución:
Medical University of South Carolina


Artículos publicados por John A Colwell
Recepción del artículo
19 de Mayo, 2005
Aprobación
26 de Mayo, 2005
Primera edición
9 de Febrero, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Las personas con diabetes tienen de dos a cuatro veces más riesgo de morir por enfermedad coronaria (EC). Un individuo con diabetes tipo 2 que no sufrió un infarto de miocardio tiene el mismo riesgo de padecerlo que una persona sin diabetes que tuvo un infarto de miocardio previo. La tasa de eventos coronarios en la diabetes tipo 2 oscila entre 2% a 8% por año, las tasas en los adultos con diabetes tipo 1 con factores de riesgo cardiovascular superan el 1% por año. Las plaquetas de las personas con diabetes son sensibles a los agentes agregantes plaquetarios y liberan una cantidad excesiva de tromboxano. Las bajas dosis de aspirina bloquean la síntesis de tromboxano al acetilar irreversiblemente la ciclooxigenasa plaquetaria. Los ensayos sobre prevención primaria y secundaria indican que la utilización de bajas dosis de aspirina podría reducir el riesgo de infarto de miocardio no mortal en un tercio. La American Diabetes Association (ADA), la American Heart Association (AHA) y el US Preventive Services Task Force concordaron en que los individuos con alto riesgo para EC deberían ser tratados con bajas dosis de aspirina (75-162 mg/día). Los beneficios superan los riesgos de hemorragia grave con tasas de infarto de miocardio de 1% o más por año. Existe una base racional para la terapia con bajas dosis de aspirina en adultos con diabetes más al menos un factor de riesgo adicional para EC. Es necesaria la realización de más estudios sobre el tratamiento antiplaquetario en las personas con diabetes a fin de clarificar estas recomendaciones para los subgrupos específicos de diabetes.

Palabras clave
Aspirina, infarto de miocardio, diabetes, prevención


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Extensión:  +/-10.13 páginas impresas en papel A4
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Abstract
People with diabetes have at least a two-to-four fold risk of dying from coronary heart disease (CHD). A person with type 2 diabetes who has not had a heart attack has the same risk for myocardial infarction as a non-diabetic individual who has already had a heart attack. CHD event rates in type 2 diabetes usually range from 2-8% per year, and rates in type 1 diabetic adults with at least one cardiovascular risk factor exceed 1% per year. Platelets from people with type 1 and type 2 diabetes are sensitive to platelet aggregating agents, and release excessive thromboxane. Low doses of aspirin block thromboxane synthesis by irreversibly acetylating platelet cyclooxygenase. Analyses of primary and secondary prevention trials have shown that low dose aspirin will reduce the risk for myocardial infarction by approximately 30-35%. The American Diabetes Association, American Heart Association, and the US Preventive Services Task Force agree that individuals at high CHD risk should be treated with low dose aspirin therapy (75-162 mg/day). The benefit exceeds the risk for serious bleeding at myocardial infarction rates > 1%/year. In summary, there is a pathophysiological rationale for using low-dose aspirin therapy in adults (> age 40) with diabetes plus at least one additional CV risk factor. Further studies of antiplatelet therapy in diabetes are indicated to refine these recommendations for specific diabetes subgroups.

Key words
Aspirin, myocardial infarction, diabetes, prevention


Full text
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Especialidades
Principal: Cardiología, Diabetología
Relacionadas: Atención Primaria, Farmacología, Medicina Farmacéutica, Medicina Interna, Salud Pública



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Bibliografía del artículo
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