Publicado
Dieta y prevención secundaria de la enfermedad cardiovascular
Diet and secondary prevention of cardiovascular disease
Palabras clave:
dieta, ácidos grasos omega-3, enfermedades cardiovasculares, prevención secundaria, tasa de mortalidad. (es)diet, fatty acids, omega-3, risk assessment, cardiovascular diseases, secondary prevention, mortality rate. (en)
Antecedentes. La evidencia de los efectos de la dieta como estrategia de manejo de los factores de riesgo cardiovascular en la prevención primaria es muy abundante y abarca todo tipo de situaciones y complicaciones, e incluye toda una gama de estudios desde casos y controles, cohortes retrospectivas, prospectivas y ensayos clínicos aleatorios controlados.
Objetivos. Establecer la evidencia a partir de estudios recientes y de guías revisadas y actualizadas de práctica clínica acerca de la prevención secundaria de la enfermedad cardiovascular mediante el manejo dietario.
Material y métodos. La búsqueda se realizó por medios electrónicos en las bases de datos con las palabras "secondary prevention", conexiones "Heart" y "cardiovascular risk". Se aceptaron únicamente los estudios cuyo objetivo principal fue la reducción de nuevos eventos cardiovasculares.
Resultados. La dieta de tipo mediterráneo mostró menores tasas de mortalidad global y de causa cardíaca. La dieta reductora de colesterol redujo la tasa de reinfartos y de aparición de angina, así como el infarto recurrente asociado al consumo del ácido graso 18:omega-3 (niveles de evidencia y recomendación: B-IIa). El pescado rico en grasa incrementó el riesgo de muerte y la muerte súbita por causa cardíaca en los sujetos con angina y favoreció la recurrencia de arritmias ventriculares (B-III). Los ácidos grasos omega-3 de pescado y vegetal no reducen los eventos cardiovasculares mayores en pacientes con terapia farmacológica adecuada antihipertensiva, antitrombótica y dislipidemia (B-III).
Conclusiones. Las dietas de tipo mediterráneo y reductora del colesterol ricas en ácidos grasos omega-3 probablemente tienen un efecto favorable en la prevención cardiovascular secundaria (B-IIa), este efecto desaparece si se asocia con tratamiento farmacológico de los factores cardiovasculares de riesgo (B-III). Los ácidos grasos omega-3 probablemente incrementan la mortalidad en pacientes con angina y favorecen la recurrencia de arritmias ventriculares (B-III).
Background. There is abundant evidence regarding the effects of diet as a strategy for managing cardiovascular risk factors in primary prevention, covering all types of situations and complications including a whole range of studies from cases and controls, retrospective cohorts, prospective studies to controlled random clinical trial.
Objectives. Establishing evidence from recent studies and revised and updated clinical practice guidelines about secondary prevention of cardiovascular disease by dietary management.
Materials and methods. Databases were electronically searched using the words «secondary prevention» and connectors «heart» and «cardiovascular risk.» Only studies whose main objective had been the reduction of new cardiovascular events were accepted.
Results. A Mediterranean-type diet was shown to be associated with lower overall mortality rates, particularly due to cardiac causes. A cholesterol-reducing diet lowered the recurrent heart-attack rate and appearance of angina, as well as recurrent heart-attacks associated with omega 3 fatty acid 18 consumption (recommendations and level of evidence: B-IIa). A fish fat oil rich diet increased the risk of death and sudden death from cardiac causes in subjects suffering from angina and favored the recurrence of ventricular arrhythmias (B-III). Omega-3 fatty acids from fish and vegetables did not reduce greater cardiovascular events in patients with suitable antihypertensive, antithrombotic and dyslipidaemia (BIII) pharmacological therapy.
Conclusions. Mediterranean-type diets and those reducing cholesterol rich in omega-3 fatty acids probably have a favourable effect on preventing secondary cardiovascular disease (B-IIa). Such effect disappears when associated with pharmacological treatment of cardiovascular risk factors (B-III). Omega-3 fatty acids probably increase mortality in patients suffering from angina and favour the recurrence of ventricular arrhythmias (B-III).
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Derechos de autor 2011 Revista de la Facultad de Medicina
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