Revista Uruguaya de Cardiología
Print version ISSN 0797-0048
MANFREDI, JOSÉ ANÍBAL et al. Disfunción endotelial, espesor de íntima media y placas de ateroma carotídeas en pacientes con factores de riesgo aterosclerótico. Rev.Urug.Cardiol. [online]. 2005, vol.20, n.1, pp. 21-31. ISSN 0797-0048.
Endothelial dysfunction is an atherosclerotic precursor. Sub-clinical atherosclerosis can be detected with non invasive methods. Objectives: to study the prevalence of peripheral endothelial dysfunction, atherosclerotic plaques and intimal medial thickness, in patients with atherosclerotic risk factors (RF), who asks for medical care in a metabolism and prevention clinic. We study, also, the association between endothelial dysfunction and risk factors, intimal medial thickness and atherosclerotic plaques. Method: It was a prospective study of one hundred patients (group I), with either multiply RF, in primary prevention or in secondary prevention, and ten safe controls (group II, with cero to two risk factors). All were done flow mediated dilatation of the brachial artery (FMD) to asses endothelial dysfunction (FMD < 10%), carotid intimal medial thickness and atherosclerotic plaques. In group I were greater: median age, prevalence of men, waist and numbers of risk factors. Results: in group I endothelial dysfunction prevalence was 66,0% and FMD 7,4±4,5%. In group II, endothelial dysfunction prevalence was 0% and FMD 14,0±5,1%. In group I intimal medial thickness was 0,77±0,11 mm and in group II was 0,56±0,06 mm (p < 0,0001). Endothelial dysfunction was associated with intimal medial thickness ³ 0,82 mm (OR = 4,77, IC 95% 1,36-16,77; p = 0,001). The risk factors significantly associated with intimal medial thickness ³ 0,76 mm. were: lipid disorder, systolic arterial pressure > 140 mmHg, hypertension and five or more RF. Atherosclerotic plaques prevalence was 41% in group I (32,5% in primary prevention; 75% in secondary prevention) and 0% in group II, (p = 0,01). Endothelial dysfunction was associated to atherosclerotic plaques (OR 3,66 IC 1,52-8,8, p= 0,0001). Conclusion: Endothelial dysfunction, greater intimal medial thickness and atherosclerotic plaques, was associated and frequent, in patients with multiple risk factors or secondary prevention. Endothelial dysfunction was associated to sub-clinical atherosclerosis: greater intimal medial thickness and atherosclerotic plaques. High prevalence of endothelial dysfunction, sub-clinical atherosclerosis and the association between each other, in this population, suggests the clinical relevance of their detection to prevention treatment.
Keywords : ATEROSCLEROSIS; RISK FACTORS; CROSS-SECTIONAL STUDIES.