EFECTOS DEL TRATAMIENTO CON RALOXIFENO O CON ESTROGENOS MAS PROGESTERONA SOBRE LOS PREDICTORES DE ENFERMEDAD VASCULAR ATEROTROMBOTICA EN MUJERES POSMENOPAUSICAS SANAS. INTERPRETACION DE LOS DATOS EN EL CONTEXTO DE LOS ESTUDIOS HERS Y WHI





EFECTOS DEL TRATAMIENTO CON RALOXIFENO O CON ESTROGENOS MAS PROGESTERONA SOBRE LOS PREDICTORES DE ENFERMEDAD VASCULAR ATEROTROMBOTICA EN MUJERES POSMENOPAUSICAS SANAS. INTERPRETACION DE LOS DATOS EN EL CONTEXTO DE LOS ESTUDIOS HERS Y WHI

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Los efectos del tratamiento con raloxifeno o con la combinación estrógenos más progesterona sobre los predictores de riesgo cardiovascular difieren significativamente, en mujeres posmenopáusicas. Ello avala la hipótesis de que estas terapias influyen de diferente modo sobre los principales eventos cardiovasculares.
anderson.jpg Autor:
Pamela W. Anderson
Columnista Experto de SIIC
Artículos publicados por Pamela W. Anderson
Coautor
David A Cox* 
*
Recepción del artículo
3 de Junio, 2003
Aprobación
21 de Octubre, 2003
Primera edición
10 de Diciembre, 2003
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los datos de estudios clínicos controlados en mujeres posmenopáusicas no sólo han fracasado en corroborar efectos cardiovasculares beneficiosos del tratamiento con estrógenos y progesterona, sino que señalan aumento en el riesgo cardiovascular tanto en las que presentan enfermedad coronaria conocida como en las que no la presentan. El raloxifeno, un modulador selectivo de los receptores de estrógenos actualmente indicado para la prevención y tratamiento de la osteoporosis en mujeres posmenopáusicas, también ha sido estudiado para su empleo en la prevención de eventos cardiovasculares. Así, se conoce que disminuye los niveles del colesterol asociado con lipoproteínas de baja densidad y de otros predictores de riesgo cardiovascular, con un alcance comparable al tratamiento con estrógenos y progesterona. Sin embargo, mientras que el tratamiento con estrógenos y progesterona incrementa las concentraciones circulantes de proteína C reactiva, de matriz de metaloproteinasa-9 y de triglicéridos, los cuales pueden aumentar el riesgo de eventos cardiovasculares, el raloxifeno no tiene efectos sobre estos marcadores en esta población de mujeres. El análisis de eventos cardiovasculares en 7 705 mujeres posmenopáusicas que participaron en un estudio sobre tratamiento de osteoporosis reveló que no hubo indicios de aumento del riesgo de enfermedad coronaria o accidente cerebrovascular en la población total del estudio; además, en un subgrupo de mujeres con riesgo aumentado de enfermedad coronaria, las que recibieron raloxifeno presentaron reducción significativa del riesgo cardiovascular. Aunque estos hallazgos requieren ser confirmados en un estudio prospectivo sobre efectos cardiovasculares, los datos avalan la hipótesis de que los tratamientos con estrógenos más progesterona y con raloxifeno pueden tener diferentes consecuencias cardiovasculares en mujeres posmenopáusicas.

Palabras clave
Modulador selectivo del receptor de estrógenos, raloxifeno, mujeres posmenopáusicas, enfermedad coronaria


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Abstract
Data from controlled clinical trials have not only failed to support a beneficial cardiovascular effect of estrogen-progestin therapy in postmenopausal women, they have suggested an increase in cardiovascular risk with estrogen-progestin in postmenopausal women with or without established coronary heart disease (CHD). Raloxifene, a selective estrogen receptor modulator (SERM) currently indicated for the prevention and treatment of osteoporosis in postmenopausal women, also is being studied for prevention of cardiovascular events. Raloxifene lowers low-density lipoprotein (LDL) cholesterol and certain other predictors of cardiovascular risk to an extent comparable to estrogen-progestin therapy. However, whereas estrogen-progestin therapy increases circulating levels of C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9), and triglycerides, all of which could potentially increase the risk of cardiovascular events, raloxifene has no effect on these markers in postmenopausal women. Analysis of cardiovascular events from 7705 postmenopausal women participating in an osteoporosis treatment trial revealed no evidence for an increased risk of coronary events or stroke in the overall trial population and, in a subset of women at increased risk for coronary events, women assigned to raloxifene had a significant reduction in the risk of cardiovascular events. Although these findings require confirmation in a prospective cardiovascular outcomes trial, these data support the hypothesis that estrogen-progestin therapy and raloxifene may have different effects on cardiovascular outcomes in postmenopausal women.KEYWORDS = SERM, raloxifene, postmenopausal women, coronary heart disease, C-reactive protein


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Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Cardiología, Endocrinología y Metabolismo, Epidemiología, Farmacología, Medicina Farmacéutica, Medicina Interna, Obstetricia y Ginecología



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