Abstract

ALBISTUR, Juan et al. Ateromatosis carotídea y características del tratamiento en pacientes con disfunción sistólica de origen isquémico y no isquémico: comparación con población control. Rev.Urug.Cardiol. [online]. 2014, vol.29, n.2, pp.192-199. ISSN 1688-0420.

Background: systolic heart failure (SHF) is associated with an increased oxidative stress which may be related with an increased risk of atherosclerosis; but it is unknown if carotid atherosclerosis is more frequent in patients with SHF of non-ischemic etiology than general population. Statins treatment in heart failure is discussed, although some groups may benefit from them. Identification of patients with SHF with non-ischemic etiology and atherosclerosis, would recognize a sub group of patients who can benefit from specific treatment strategies. Objective: to compare the prevalence of carotid plaques in patients with ischemic SHF, non-ischemic SHF and patients without HF or systolic dysfunction and similar cardiovascular risk factors. Method: thirty nine patients with ischemic SHF (Group 1, G1, age: 65±8 years; 67% men), 23 with non-ischemic SHF (Group 2, G2, age: 62±12, 78% men) were included. A control group with 199 patients (Group 3, G3; age 58±9 years, 75% men) with similar characteristics to G2 (age, sex, CV risk factors) was selected. Ultrasound was used to determine the presence of atherosclerotic carotid plaque. We defined prevalence of plaque in relation to the history of dyslipidemia, treatment with statins and low density lipoproteins (LDL) target level. Results: the prevalence of carotid plaque was: G1:87% (95% confidence interval (CI95%): 76-98%); G2:61% (CI95%:41-81%) and G3:37% (CI95%:30-44%) (p<0,05). Statins indication in G2 was limited to patients with dyslipidemia (65%). Twenty two % of patients in G2 with plaque were not receiving statins. Twenty six % of patients in G1 reached target LDL (LDL 70mg/dL); 40% in G2 reached LDL target level (LDL 100mg/dL). If LDL target level were 70 mg/dL in patients with heart failure and atherosclerosis, the objective was met in 25%. Conclusion: the prevalence of atherosclerotic carotid plaque is high in patients with SHF regardless etiology and it is higher than subjects with similar CV risk factors without SHF. Target LDL levels for treatment are not reached in most patients with SHF.

Keywords : HEART FAILURE; HEART FAILURE, SYSTOLIC; PLAQUE, ATHEROSCLEROTIC; CAROTID ARTERY DISEASES; DYSLIPIDEMIAS; HYDROXYMETHYL-GLUTARYL-COA REDUCTASE INHIBITORS.

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