Publication: Hipercolesterolemia declarada en ancianos de la cohorte NEDICES: validez clínica, fiabilidad del diagnóstico, y mortalidad asociada
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2017-02-15
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Universidad Complutense de Madrid
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Abstract
La hipercolesterolemia es un factor de riesgo cardiovascular bien establecido para todos los grupos de edad. Los medicamentos que disminuyen la concentración plasmática de colesterol, sobre todo las estatinas, provocan una reducción de la incidencia de cardiopatía isquémica y de muerte por enfermedad cardiovascular, sobre todo en prevención secundaria. Sin embargo, los niveles de colesterol plasmático total elevados se han asociado a una disminución de la mortalidad entre ciertos grupos de sujetos, sobre todo entre los ancianos. Se ha atribuido está relación a un sesgo de selección (muerte precoz de sujetos con alto riesgo cardiovascular) o a la causalidad inversa (los niveles bajos de colesterol son consecuencia de una enfermedad grave intercurrente), aunque estos mecanismos no explican por completo la asociación. Los estudios de cohortes que analizan esta denominada “paradoja del colesterol”, como mucho otros, en ocasiones basan su información en las respuestas que los sujetos participantes aportan con respecto a sus antecedentes médicos. Sin embargo, a pesar de la frecuencia con la que se elaboran historias clínicas cada día en las consultas médicas, hasta ahora no se conoce la confianza con la que se recoge la información acerca de la hipercolesterolemia declarada por el sujeto...
Hypercholesterolemia is a well-known cardiovascular risk factor among people of all ages. Those drugs lowering the blood cholesterol levels - the most used are statins - cause a reduction of the ischemic heart disease incidence and of the cardiovascular mortality, mainly in secondary prevention. However, high blood cholesterol levels have been associated to a relatively decreased mortality among several groups of subjects, mainly the elders. This association has been attributed to a selection bias caused by early death of those people in a high cardiovascular risk; or to a reverse causality, low levels of blood cholesterol heralding a not-yet diagnosed severe disease. Nonetheless, these possible explanations are not fully satisfactory. Additionally, cohort studies addressing the so-called “cholesterol paradox” sometimes use medical information gathered by the patient or subject (self-reported). Despite the high number of clinical questions asked and answered in medical settings every day all around the world, the actual confidence with which this information about self-reported hypercholesterolemia is obtained remains unknown so far...
Hypercholesterolemia is a well-known cardiovascular risk factor among people of all ages. Those drugs lowering the blood cholesterol levels - the most used are statins - cause a reduction of the ischemic heart disease incidence and of the cardiovascular mortality, mainly in secondary prevention. However, high blood cholesterol levels have been associated to a relatively decreased mortality among several groups of subjects, mainly the elders. This association has been attributed to a selection bias caused by early death of those people in a high cardiovascular risk; or to a reverse causality, low levels of blood cholesterol heralding a not-yet diagnosed severe disease. Nonetheless, these possible explanations are not fully satisfactory. Additionally, cohort studies addressing the so-called “cholesterol paradox” sometimes use medical information gathered by the patient or subject (self-reported). Despite the high number of clinical questions asked and answered in medical settings every day all around the world, the actual confidence with which this information about self-reported hypercholesterolemia is obtained remains unknown so far...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Fisiología, leída el 09-02-2016