<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0420</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Cardiología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev.Urug.Cardiol.]]></abbrev-journal-title>
<issn>1688-0420</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Cardiología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-04202019000300401</article-id>
<article-id pub-id-type="doi">10.29277/cardio.34.3.28</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Encare clínico de las dislipemias]]></article-title>
<article-title xml:lang="en"><![CDATA[Clinical care of dyslipidemias]]></article-title>
<article-title xml:lang="pt"><![CDATA[Encargo clínico de dislipidemias]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Layerle]]></surname>
<given-names><![CDATA[Bernardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vignolo]]></surname>
<given-names><![CDATA[Washington]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Británico Departamento de Medicina ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<volume>34</volume>
<numero>3</numero>
<fpage>401</fpage>
<lpage>433</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-04202019000300401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-04202019000300401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-04202019000300401&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: El manejo de los pacientes con dislipemias en la práctica clínica diaria implica el conocimiento de la evidencia científica relevante, la experiencia clínica, el sentido común, así como el respeto a la voluntad del paciente. La evidencia demuestra que el tratamiento hipolipemiante con estatinas reduce la morbimortalidad cardiovascular en un amplio grupo de pacientes, con un porcentaje de efectos colaterales bajo. Un punto crítico en el tratamiento es la decisión de iniciar o no dichos fármacos. Hay pacientes que tienen indicación formal de estatinas sin necesidad de hacer una evaluación del riesgo vascular. Tal es el caso de los que están en prevención secundaria, pacientes con colesterol unido a las lipoproteínas de baja densidad (C-LDL) muy alto (&gt;190 mg/dl) y diabéticos entre 40 y 75 años. En los demás individuos la indicación de estatinas pasa en primer lugar por una evaluación formal del riesgo cardiovascular. Con este fin, las guías estadounidenses sugieren el uso de las Pooled Cohort Equations, en tanto que las guías europeas utilizan el Heartscore. Ambos scores estratifican a los pacientes en cuatro grupos según la intensidad del riesgo. El beneficio absoluto en la reducción del riesgo de eventos es tanto mayor cuanto más elevado sea el riesgo basal del paciente. Es por ello que se recomienda que tanto la intensidad del tratamiento, como el nivel de descenso objetivo de C-LDL, sean tanto mayores cuanto mayor sea el riesgo del paciente. Las recomendaciones de ambas guías no son coincidentes en algunos casos. Por lo tanto, además del riesgo cardiovascular se debe considerar el riesgo de efectos adversos potenciales y la voluntad del paciente en una discusión franca con su médico. El ezetimibe primero y los inhibidores PCSK9 después (limitados en estos momentos por costos y disponibilidad) aparecen como los grandes aliados de las estatinas, cuando no se toleran las dosis adecuadas o no se llega al C-LDL objetivo. A los efectos del abordaje del tema hemos optado por analizar cinco historias clínicas representativas de los principales escenarios clínicos que obligan al médico a tomar decisiones terapéuticas específicas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: In daily clinical practice the management of patients with dyslipidemias implies knowledge of relevant clinical scientific evidence, common sense, as respect of patient preferences. There is strong evidence that treatment of dyslipidemias mainly with statins reduces morbidity and mortality in a wide group of patients with few side effects. A critical step in management of this individuals is to make the decision of whether statin treatment is indicated or not. There are patients that have a clear indication of statin use without any further cardiovascular risk calculation. Such is the case in secondary prevention, patients with extremely high low density lipoprotein cholesterol levels (&gt;190 mg/dl) and diabetics between 40 and 75 years-old. In all other patients, statin indication should start with a formal cardiovascular risk evaluation. American guidelines suggest using the Pooled Cohort Risk Equations and European guidelines prefer Heartscore. Both scoring systems stratify risk in four categories according to risk intensity. The absolute cardiovascular risk reduction obtained with treatment increases in parallel with the basal cardiovascular risk. This explains the recommendation that both treatment intensity and magnitude of low density lipoprotein cholesterol lowering should increase as the risk of the patient increases. Recommendations provided by American and European guidelines do not always coincide. Thus, besides basal cardiovascular risk estimation, potential adverse drug effects and patient preferences should always be considered in the context of a clinician-patient frank discussion. Ezetimibe first and PCSK9 inhibitors eventually (currently limited by costs and availability) appear as the great allies of statins, when adequate doses are not tolerated or the target is not reached. We will tackle the subject through five cases that illustrate the main clinical situations in which physicians have to adopt specific therapeutic decisions.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: O manejo de pacientes com dislipidemias na prática clínica diária envolve conhecimento de provas científicas relevantes, experiência clínica, senso comum, bem como a respeito da vontade do paciente. A evidência mostra que o tratamento hipolipemiente com estatina reduz a morbimortalidade cardiovascular em um grande grupo de pacientes com uma baixa taxa de efeitos colaterais. Um ponto crítico no tratamento desses pacientes é a decisão de iniciar ou não estas drogas. Há pacientes que têm indicação formal de estatinas sem necessidade de fazer uma avaliação de risco vascular. Tal é o caso dos pacientes que estão na prevenção secundária, pacientes com colesterol da lipoproteína de baixa densidade muito alta (&gt;190 mg/dl) e diabéticos entre 40 e 75 anos. Em outros indivíduos a indicação de uma estatinas passa primeiro através de uma avaliação formal de risco cardiovascular. Para este fim diretrizes Americanas sugerem o uso do Pooled Cohort Equations, enquanto as directrizes europeias usam o Heartscore. Ambos scores estratificam pacientes em quatro grupos de acordo com a intensidade do risco. O benefício absoluto na redução do risco de eventos é maior quanto mais elevado seja o risco base do paciente. Por isso, recomenda-se que tanto a intensidade do tratamento e do nível de descida desejada da lipoproteína de baixa densidade, são muito maior quanto maior for o risco do paciente. As recomendações de ambas as guias em alguns casos não são coincidentes. Portanto, além do risco cardiovascular deve ser considerado o risco de efeitos adversos potenciais e a vontade do paciente em uma discussão franca entre médico e paciente. Ezetimiba primeiro e os inibidores PCSK9 depois (limitado atualmente pela disponibilidade e custo) aparecem como os grandes aliados das estatinas, quando não são toleradas doses adequadas ou não se chega ao objetivo. Para efeitos da abordagem do assunto que escolhemos para analisar cinco histórias clínicas de pacientes representativos dos principais cenários clínicos que exige do médico a tomar decisões terapêuticas específicas.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Dislipemias]]></kwd>
<kwd lng="es"><![CDATA[Inhibidores de Hidroximetilglutaril-CoA Reductasa]]></kwd>
<kwd lng="es"><![CDATA[Riesgo vascular]]></kwd>
<kwd lng="es"><![CDATA[Colesterol unido a lipoproteínas de baja densidad]]></kwd>
<kwd lng="en"><![CDATA[Dyslipidemias]]></kwd>
<kwd lng="en"><![CDATA[Hydroxymethylglutaryl-CoA Reductase Inhibitors]]></kwd>
<kwd lng="en"><![CDATA[Vascular risk]]></kwd>
<kwd lng="en"><![CDATA[Low density lipoprotein cholesterol]]></kwd>
<kwd lng="pt"><![CDATA[Dislipidemias]]></kwd>
<kwd lng="pt"><![CDATA[Inibidores de Hidroximetilglutaril-CoA Redutase]]></kwd>
<kwd lng="pt"><![CDATA[Risco vascular]]></kwd>
<kwd lng="pt"><![CDATA[Colesterol da lipoproteína de baixa densidade]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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