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Estatinas y ACV; conceptos actuales en prevención primaria y secundaria del ataque cerebral
Statins in: primary and secondary prevention
Palabras clave:
estatinas, ACV, Inhibidores de Hidroximetilglutaril-CoA Reductasas. (es)hydroxymethylglutaryl-CoA Reductase Inhibitors (en)
Los inhibidores de la HMG-CoA reductasa reducen la producción de colesterol endógeno. Distintos ensayos clínicos han demostrado que las estatinas reducen la incidencia del ataque cerebrovascular, en tanto continúa discutiéndose el papel del colesterol como factor de riesgo independiente para ataque cerebrovascular.
Las estatinas ejercen, además de su acción sobre el colesterol, unas acciones pleiotrópicas y vasculoprotectoras entre las cuales se incluyen las anti-oxidantes, el mejoramiento de la función endotelial, el aumento de la biodisponibilidad del óxido nítrico, la inhibición de la respuesta inflamatoria, la modulación de la respuesta inmune y la estabilización de la placa ateroesclerótica. Algunos modelos en animales han demostrado una actividad neuroprotectora por mecanismos relacionados con la regulación de la sintasa endotelial de óxido nítrico (eNOS).
La evidencia sugiere las estatinas podrían disminuir el riesgo de ataque cerebrovascular y mejorar su desenlace. Los estudios de prevención secundaria en curso pretenden demostrar que la intervención temprana con estatinas luego del ataque cerebral mejora el desenlace a corto plazo.
Inhibition of HMG-CoA reductase, by statins, can reduce the production of endogenous cholesterol. Different clinical trials have shown that statins reduce the incidence of stroke; in the meantime the role of cholesterol, as independent risk factor for stroke, continues to be discussed. Statins play, besides their action on the cholesterol, some pleiotropic and vasculoprotective actions in which the antioxidant activity are included, the improvement of the endothelial function, the increase of the biodisponibility of the nitric oxide, the inhibition of the inflammatory response, the modulation of the immune system and the stabilization of the atherosclerotic plaque. Some animal models have shown a neuroprotective activity, of statins, by mechanisms related to up regulation of the endotelial nitric oxid sintase (eNOS).
The evidence suggests that the statins would be able to diminish the risk of stroke and to improve its outcome. The studies of secondary prevention, under way, intend to show that early intervention with statins in stroke improves the short-term end point.
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Derechos de autor 2006 Revista de la Facultad de Medicina
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