Las últimas 2 décadas han resultado especialmente importantes en el conocimiento de la fisiopatología de las lesiones ateroscleróticas. Esta breve revisión tratará aspectos habitualmente poco mencionados y obviará la fisiopatología que puede encontrarse fácilmente en la literature médica. Se tratará la teoría de Glagov; la relevancia de la actividad de la placa (independientemente de la gravedad de la estenosis de la placa); una actualización sobre la relevancia de la infección por Chlamydia pneumoniae en la fisiopatología de la aterosclerosis; la importancia de los linfocitos en la actividad de la placa (además de la conocida actividad de los macrófagos); el papel de las lipoproteínas HDL más allá del transporte reverse de colesterol, y una obligada mención a la diabetes como factor de riesgo en la aterosclerosis. Finalmente, se repasará la utilidad de marcadores biológicos en el tratamiento clínico de la cardiopatía isquémica.
Palabras clave
Aterosclerosis
Fisiología
Inflamación
Colesterol HDL
Diabetes mellitus
Infección
Proteína C reactiva
Factor natriurético cerebral
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Bibliografía
[1.]
S. Glagov, E. Weisenberg, C.K. Zarins, R. Stankunavicius, G.J. Kolettis.
Compensatory enlargement of human atherosclerotic coronary arteries.
N Engl J Med, (1987), 316 pp. 1371-1375
[2.]
M. Naghavi, P. Libby, E. Falk, S.W. Casscells, S. Litovsky, J. Rumberger, et al.
From vulnerable plaque to vulnerable patient. a call for new definitions and risk assessment strategies: part I.
Circulation, (2003), 108 pp. 1664-1672
[3.]
P. Saikku, M. Leinonen, K. Mattila, M.R. Ekman, M.S. Nieminen, P.H. Makela, et al.
Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction.
Lancet, (1988), 2 pp. 983-986
[4.]
S. Gupta, E.W. Leatham, D. Carrington, M.A. Mendall, J.C. Kaski, A.J. Camm.
Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction.
Circulation, (1997), 96 pp. 404-407
[5.]
E. Gurfinkel, G. Bozovich, A. Daroca, E. Beck, B. Mautner.
Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS Pilot Study. ROXIS Study Group.
Lancet, (1997), 350 pp. 404-407
[6.]
J.B. Muhlestein, J.L. Anderson, J.F. Carlquist, K. Salunkhe, B.D. Horne, R.R. Pearson, et al.
Randomized secondary prevention trial of azithromycin in patients with coronary artery disease: primary clinical results of the ACADEMIC study.
Circulation, (2000), 102 pp. 1755-1760
[7.]
J.T. Grayston, R.A. Kronmal, L.A. Jackson, A.F. Parisi, J.B. Muhlestein, J.D. Cohen, et al.
ACES Investigators. Azithromycin for the secondary prevention of coronary events.
N Engl J Med, (2005), 352 pp. 1637-1645
[8.]
R. Zahn, S. Schneider, B. Frilling, K. Seidl, U. Tebbe, M. Weber, et al.
Antibiotic therapy after acute myocardial infarction: a prospective randomized study.
Circulation, (2003), 107 pp. 1253-1259
[9.]
B. Cercek, P.K. Shah, M. Noc, D. Zahger, U. Zeymer, S. Matetzky, et al.
AZACS Investigators. Effect of short-term treatment with azithromycin on recurrent ischaemic events in patients with acute coronary syndrome in the Azithromycin in Acute Coronary Syndrome (AZACS) trial: a randomised controlled trial.
Lancet, (2003), 361 pp. 809-813
[10.]
J. Sinisalo, K. Mattila, V. Valtonen, O. Anttonen, J. Juvonen, J. Melin, et al.
Effect of 3 months of antimicrobial treatment with clarithromycin in acute non-Q-wave coronary syndrome.
Circulation, (2002), 105 pp. 1555-1560
[11.]
F. Neumann, A. Kastrati, T. Miethke, G. Pogatsa-Murray, J. Mehilli, C. Valina, et al.
Treatment of Chlamydia pneumoniae infection with roxithromycin and effect on neointima proliferation after coronary stent placement (ISAR-3): a randomised, double-blind, placebo-controlled trial.
Lancet, (2001), 357 pp. 2085-2089
[12.]
C.P. Cannon, E. Braunwald, C.H. McCabe, J.T. Grayston, B. Muhlestein, R.P. Giugliano, et al.
PROVE IT-TIMI 22 Investigators. Antibiotic treatment of Chlamydia pneumoniae after acute coronary syndrome.
N Engl J Med, (2005), 352 pp. 1646-1654
[13.]
A.F. Stone, M.A. Mendall, J.C. Kaski, T.M. Edger, P. Risley, J. Poloniecki, et al.
Effect of treatment for Chlamydia pneumoniae and Helicobacter pylori on markers of inflammation and cardiac events in patients with acute coronary syndromes: South Thames Trial of Antibiotics in Myocardial Infarction and Unstable Angina (STAMINA).
Circulation, (2002), 106 pp. 1219-1223
[14.]
C.M. O’Connor, M.W. Dunne, M.A. Pfeffer, J.B. Muhlestein, L. Yao, S. Gupta, Investigators in the WIZARD Study, et al.
Azithromycin for the secondary prevention of coronary heart disease events: the WIZARD study: a randomized controlled trial.
JAMA, (2003), 290 pp. 1459-1466
[15.]
J. Nilsson, G.K. Hansson, P.K. Shah.
Immunomodulation of atherosclerosis: implications for vaccine development.
Arterioscler Thromb Vasc Biol, (2005), 25 pp. 18-28
[16.]
R. León de la Fuente, E.P. Gurfinkel, D. Toledo, B. Mautner.
Vacunación antigripal en pacientes con síndromes coronarios agudos: beneficio del tratamiento en diferentes subgrupos.
Rev Esp Cardiol, (2003), 56 pp. 949-954
[17.]
P.J. Barter, S. Nicholls, K.A. Rye, G.M. Anantharamaiah, M. Navab, A.M. Fogelman.
Antiinflammatory properties of HDL.
Circ Res, (2004), 95 pp. 764-772
[18.]
P. Zimmet, K.G. Alberti, J. Shaw.
Global and societal implications of the diabetes epidemic.
Nature, (2001), 414 pp. 782-787
[19.]
D. Aronson, E.J. Rayfield.
How hyperglycemia promotes atherosclerosis: molecular mechanisms.
Cardiovasc Diabetol, (2002), 1 pp. 1
[20.]
J.A. Doust, E. Pietrzak, A. Dobson, P. Glasziou.
How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review.
BMJ, (2005), 330 pp. 625
[21.]
S.D. Wiviott, J.A. De Lemos, D.A. Morrow.
Pathophysiology, prognostic significance and clinical utility of B-type natriuretic peptide in acute coronary syndromes.
Clin Chim Acta, (2004), 346 pp. 119-128
[22.]
A. Clericoa, M. Michele Emdin.
Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review.
Clin Chem, (2004), 50 pp. 33-50
[23.]
S.S. Anand, F. Razak, Q. Yi, B. Davis, R. Jacobs, V. Vuksan, et al.
Creactive protein as a screening test for cardiovascular risk in a multiethnic population.
Arterioscler Thromb Vasc Biol, (2004), 24 pp. 1509-1515
[24.]
E.S. Ford, W.H. Giles, A.H. Mokdad, G.L. Myers.
Distribution and correlates of C-reactive protein concentrations among adult US women.
Clin Chem, (2004), 50 pp. 574-581
[25.]
S. Woloshin, L.M. Schwartz.
Distribution of C-reactive protein values in the United States.
N Engl J Med, (2005), 352 pp. 1611-1613
[26.]
B. Lindahl, H. Toss, A. Siegbahn, P. Venge, L. Wallentin.
Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during instability in coronary artery disease.
N Engl J Med, (2000), 343 pp. 1139-1147
[27.]
B. Campbell, T. Badrick, R. Flatman, D. Kanowski.
Limited clinical utility of high-sensitivity plasma C-reactive protein assays.
Ann Clin Biochem, (2002), 39 pp. 85-88
[28.]
S.S. Levinson, R.J. Elin.
What is C-reactive protein telling us about coronary artery disease?.
Arch Intern Med, (2002), 162 pp. 389-392
[29.]
D.J. Campbell, M. Woodward, J.P. Chalmers, S.A. Colman, A.J. Jenkins, B.E. Kemp, et al.
Prediction of myocardial infarction by N-terminal- pro-B-type natriuretic peptide, C-reactive protein, and rennin in subjects with cerebrovascular disease.
Circulation, (2005), 112 pp. 110-116
[30.]
X. Garcia-Moll, J. Ordonez-Llanos.
Role of hs-CRP measurements in the current cardiovascular risk assessment.
Clin Chim Acta, (2005), 355 pp. 215-218
[31.]
T.A. Pearson, G.A. Mensah, R.W. Alexander, J.L. Anderson, Ro Cannon 3rd, M. Criqui, et al.
Markers of Inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
Circulation, (2003), 107 pp. 499-511
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