Ateromatosis carotídea y características del tratamiento en pacientes con disfunción sistólica de origen isquémico y no isquémico: comparación con población control

摘要

Background: systolic heart failure (SHF) is associated with an increased oxidative stress which may be related with anincreased risk of atherosclerosis; but it is unknown if carotid atherosclerosis is more frequent in patients with SHF ofnon-ischemic etiology than general population. Statins treatment in heart failure is discussed, although some groupsmay benefit from them. Identification of patients withSHFwith non-ischemic etiology and atherosclerosis, would recognizea 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 patientswithout 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.Acontrol 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 thepresence 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 reachedtarget LDL (LDL 70mg/dL); 40% in G2 reached LDL target level (LDL 100mg/dL). If LDL target level were 70mg/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 ishigher than subjects with similar CV risk factors without SHF. Target LDL levels for treatment are not reached in mostpatients with SHF.