Download Ataque cardiaco y accidente cerebrovascular: prevencion by Organizacion Panamericana de la Salud PDF

By Organizacion Panamericana de la Salud

This book summarizes the proof for the effectiveness of interventions for secondary prevention of heart illness (CHD) and cerebrovascular affliction (CeVD). A remark at the facts for cardiovascular prevention in peripheral vascular ailment and diabetes is additionally incorporated. every one assessment of proof is through a brief precis of medical innovations for secondary prevention. A evaluation of different issues influencing policy-makers within the implementation of secondary prevention suggestions together with healthiness economics follows. eventually, the publication identifies parts during which examine is required to enhance secondary prevention of CVD in low- and middle-income populations. This e-book is meant for practising physicians accountable for the care of sufferers with demonstrated heart problems (CVD) - in particular CHD and CeVD - in low- and middle-income populations and international locations. the purpose is to supply common suggestions in regards to the effectiveness - or loss of effectiveness - of particular interventions, either pharmacological and non-pharmacological. furthermore, the data may help quite a lot of future health pros fascinated with person and group care and may supply suggestions to overall healthiness policy-makers in regards to the broader concerns concerning implementation of interventions in low- and middle-income populations.

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Estos resultados fueron confirmados en un metanálisis subsiguiente de todos los ensayos sobre tienopiridinas, llevado a cabo por el Grupo de Colaboración de Investigadores de Antiplaquetarios, lo que indica que en comparación con la aspirina, las tienopiridinas redujeron 9% el riesgo de un episodio vascular (IC de 95%, 2-16%) (32). Las pruebas obtenidas del ensayo CURE indicaron que en personas con angina de pecho inestable o con IM sin elevación del segmento ST, la aspirina y las tienopiridinas son más eficaces que la aspirina sola (88), resultado que ahora se examina en otros grupos de pacientes con CC establecida.

En varios ensayos aleatorizados controlados sobre el tratamiento con estatinas se han demostrado reducciones en el número de episodios cardiovasculares recurrentes y de defunciones por causas cardiovasculares, y en la tasa de mortalidad por todas las causas en individuos con IM y angina de pecho. En un análisis sistemático de los tres primeros ensayos aleatorizados extensos de prevención secundaria (30 817 participantes), se administraron estatinas por vía oral durante una media de 5,4 años. Por lo general, el tratamiento se inició varios meses después del diagnóstico de CC; el colesterol total medio osciló entre 5,4 y 7,03 mmol/L y el colesterol LDL entre 3,59 y 4,97 mmol/L.

En un período de tratamiento de cinco años se logra reducir casi a la mitad el número de episodios vasculares previstos en estudios prospectivos de observación; se esperarían resultados aún más favorables si se administran los medicamentos durante un tiempo más largo (50). Sin embargo, todavía no se puede determinar con seguridad si se obtienen otros beneficios con la iniciación muy temprana del tratamiento. Los medicamentos más extensamente estudiados son la simvastatina y la pravastatina, aunque no hay indicaciones particulares de que un tipo especial de estatina sea mejor que otros productos de esa clase.

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