Control metabólico o reducción del riesgo vascular con los tratamientos actuales¿qué es prioritario?

  1. Margarita Alonso Fernández 1
  1. 1 Centro de Salud La Ería, Oviedo, España Universidad de Oviedo, Asturias, España
Revista:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Año de publicación: 2018

Título del ejemplar: Uso de inhibidores de la dipeptidil peptidasa 4 en pacientes con diabetes

Número: 1

Páginas: 26-32

Tipo: Artículo

DOI: 10.1016/S1138-3593(18)30372-1 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Semergen: revista española de medicina de familia

Objetivos de desarrollo sostenible

Resumen

En el paciente con diabetes tipo 2, el control estricto de la glucemia previene o retrasa la aparición de complicaciones microvasculares. Por el contrario, sigue siendo debatido el efecto sobre las complicaciones macrovasculares y cuál es el papel del control glucémico precoz sobre la enfermedad cardiovascular subsiguiente. Aunque grandes ensayos clínicos aleatorizados no han mostrado un efecto claramente benefcioso del control intensivo a corto plazo, estudios posteriores de seguimiento de los participantes en estos ensayos sugieren un efecto cardiovascular favorable a largo plazo. Desde hace unos años, a raíz de las dudas sobre el aumento del riesgo de infarto de miocardio provocado por la rosiglitazona, las agencias reguladoras solicitan que, previa aprobación de una nueva molécula para el tratamiento de la hiperglucemia, el patrocinador demuestre que es segura desde el punto de vista cardiovascular. Los ensayos de seguridad cardiovascular publicados hasta el momento han evidenciado que los nuevos fármacos no incrementan el riesgo e, incluso, que algunas moléculas pueden proporcionar cierta protección cardiovascular. Ante estos hallazgos, ¿qué es prioritario al elegir el tratamiento hipoglucemiante: el control metabólico o la reducción del riesgo cardiovascular? La palabra individualización ofrece la respuesta. No se puede situar el foco terapéutico únicamente en la seguridad cardiovascular dejando al margen las complicaciones micro-vasculares, causa de elevada morbimortalidad. Las personas con diabetes poco evolucionada y larga expectativa de vida se benefciarán de un control metabólico estricto. Los pacientes con diabetes y enfermedad cardiovascular establecida o elevado riesgo serán candidatos a un tratamiento que incluya fármacos que han demostrado un benefcio en este perfl de pacientes.

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