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dc.contributor.advisorParra Serrano, Gustavospa
dc.contributor.advisorCamacho López, Paul Anthonyspa
dc.contributor.advisorVesga Angarita, Boris Eduardospa
dc.contributor.authorDelgado Muñoz, Erika Noeliaspa
dc.coverage.spatialFloridablanca (Santander, Colombia)spa
dc.date.accessioned2020-07-19T18:22:08Z
dc.date.available2020-07-19T18:22:08Z
dc.date.issued2020-02
dc.identifier.urihttp://hdl.handle.net/20.500.12749/6980
dc.description.abstractIntroducción: La Hipercolesterolemia Familiar Heterocigota (HFHe) es una enfermedad genética caracterizada por tener niveles plasmáticos de c-LDL elevados, generalmente mayores de 190 mg/dL y una alta morbimortalidad cardiovascular. A pesar de su alto impacto social y económico, continúa siendo una patología infradiagnosticada e infratratada. Diseño: Estudio observacional, analítico de corte transversal, de datos secundarios anonimizados Métodos: Los criterios de inclusión fueron, pacientes adultos mayores o iguales a 18 años con enfermedad aterosclerótica coronaria (Pacientes con cardiopatía isquémica definida por infarto de miocardio, angina de pecho, cirugía o cualquier otro procedimiento de revascularización coronaria) y/o cerebral establecida (pacientes con enfermedad cerebrovascular o accidente isquémico transitorio); en tanto que el criterio de exclusión fue no tener un perfil lipídico valorable. Resultados: Se realizó una revisión del registro de la base de datos de 470 pacientes. La edad promedio fue de 64.83 años y la mayoría fueron hombres (63.83%). La HTA fue el factor de riesgo más prevalente (72.77%) seguido por la dislipidemia o estar en tratamiento farmacológico hipolipemiante (57.45%) y el tabaquismo (40.42%). El Infarto agudo de miocardio (IAM) fue la forma de presentación más frecuente de los eventos cardiovasculares (44.04%), seguido de la angina de pecho (45.53%) y Enfermedad cerebrovascular (ECV) isquémica (9.36%) principalmente. 33.19% de los casos tuvo afectación de un único vaso en la arteriografía coronaria, mientras que el 20.64% y 23.40% de los casos tuvo afectación de 2 y 3 o más vasos, respectivamente. El valor promedio de colesterol LDL (c-LDL) fue de 112.60 mg/dl y solo el 11.91% de los pacientes tenían valores en la meta establecida para esta condición. El 43.96% de la población recibía algún tipo de estatina, pero solo el 7.60% en dosis máxima. La Atorvastatina fue la estatina más prescrita (86.85%) posterior al evento cardiovascular. El 7.45% de los sujetos fueron clasificados como casos posibles de HFHe y el 0.43% como casos probables. No se encontraron casos definitivos al no disponerse de análisis genético. Se estableció que el 7.8% de la población estudiada tiene HFHe posible/probable. Se determinó dependencia estadísticamente significativa (p<0.0001), entre la HFHe y la edad de presentación de eventos cardiovasculares más tempranos (55.83 años vs 65.60 años), así como con el sexo femenino (p 0.021). En cuanto a los factores de riesgo, solo se observó dependencia entre tener historia de HF en primer grado de consanguinidad e historia familiar de IAM prematuro con la prevalencia de HFHe posible/probable (p<0.0001). Los pacientes con HFHe posible/probable tuvieron niveles de CT (colesterol total), TAG (triglicéridos) y c-LDL más elevados (p<0.0001). Se encontró dependencia entre el valor de creatinina (0.82 mg/dl) y la prevalencia de HFHe (p 0.005). La mayoría de los pacientes con HFHe posible/probable realizan otro tipo de ejercicio aeróbico diferente a la caminata (p 0.016). El tratamiento combinado fue prescrito 4 veces más (10.81% vs 2.54%) después del evento cardiovascular en el grupo de HF posible/probable (p 0.02). Mientras que la implantación de Stent coronario fue la estrategia de revascularización más usada en general (63.19%), la cirugía de revascularización miocárdica fue usada 2 veces más en la población con HFHe posible/probable (p 0.042). Conclusiones: La HFHe es una enfermedad infradiagnosticada entre los pacientes que presentan enfermedad aterosclerótica establecida y acorta la edad de presentación de eventos cardiovasculares con respecto a la población general. Los resultados consolidan la importancia de crear una cohorte de pacientes con HFHe que padezcan algún evento cardiovascular con el fin de optimizar las medidas de tratamiento para poder reducir el impacto de la enfermedad cardiovascular y los costos relacionados con la atención y el tratamiento.spa
dc.description.sponsorshipClínica Foscalspa
dc.description.sponsorshipInstituto del Corazón de Bucaramangaspa
dc.description.tableofcontentsLISTA DE TABLAS ............................................................................................. 9 LISTA DE FIGURAS ......................................................................................... 11 LISTA DE ANEXOS .......................................................................................... 12 RESUMEN ........................................................................................................ 13 ABSTRACT ...................................................................................................... 16 1. INTRODUCCION ....................................................................................... 19 2. PLANTEAMIENTO DEL PROBLEMA ......................................................... 21 3. JUSTIFICACIÓN ........................................................................................ 22 4. OBJETIVOS ............................................................................................... 23 4.1 Objetivo general ................................................................................... 23 4.2 Objetivos específicos ........................................................................... 23 5. MARCO TEÓRICO Y ESTADO DEL ARTE ................................................ 24 6. METODOLOGÍA......................................................................................... 40 6.1 Diseño: .................................................................................................... 40 6.2 Tiempo de Estudio: .................................................................................. 40 6.3 Población Blanco o diana: ....................................................................... 40 6.4 Selección de los pacientes ...................................................................... 40 6.6 Variables del estudio: .............................................................................. 41 6.9 Análisis de datos ..................................................................................... 42 7. CONSIDERACIONES ÉTICAS ................................................................... 43 8. RESULTADOS ........................................................................................... 44 8.1 ANÁLISIS UNIVARIADO...................................................................... 44 8.1.1 Características sociodemográficas de la población .......................... 44 8.1.2 Características clínicas de la población ............................................ 45 8.2 ANÁLISIS BIVARIADO ........................................................................ 56 8.2.1 Dependencia entre las variables sociodemográficas y la prevalencia de hipercolesterolemia familiar ...................................................................... 56 8.2.2 Dependencia entre las variables clínicas y la prevalencia de hipercolesterolemia familiar ........................................................................... 57 8 9. DISCUSIÓN ............................................................................................... 66 10. CONCLUSIONES ................................................................................... 71 11. LIMITACIONES ....................................................................................... 72 12. BIBLIOGRAFÍA ....................................................................................... 81spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titlePrevalencia de hipercolesterolemia familiar heterocigota en pacientes con enfermedad aterosclerótica establecida en dos instituciones de cuarto nivel del Nororiente Colombianospa
dc.title.translatedPrevalence of Heterozygous familial hypercholesterolemia in patients with atherosclerotic diseases in two level-IV institutions in a Northeast Colombianeng
dc.degree.nameEspecialista en Medicina Internaspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Internaspa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsInternal medicineeng
dc.subject.keywordsMedicineeng
dc.subject.keywordsHeterozygous familial hypercholesterolemiaeng
dc.subject.keywordsPrevalenceeng
dc.subject.keywordsCardiovascular diseaseeng
dc.subject.keywordsCardiological manifestations of general diseaseseng
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.contributor.cvlacDelgado Muñoz, Erika Noelia [0000070079]*
dc.contributor.cvlacCamacho López, Paul Anthony [0000323578]*
dc.contributor.cvlacCamacho López, Paul Anthony [0000323578]
dc.contributor.googlescholarCamacho López, Paul Anthony [-u8d7_QAAAAJ]*
dc.contributor.googlescholarCamacho López, Paul Anthony [OvqUoOAAAAAJ]
dc.contributor.orcidVesga Angarita, Boris Eduardo [0000-0001-6258-1195]*
dc.contributor.orcidCamacho López, Paul Anthony [0000-0002-6233-9582]*
dc.contributor.orcidCamacho López, Paul Anthony [0000-0002-6233-9582]
dc.contributor.scopusVesga Angarita, Boris Eduardo [57192087129]*
dc.contributor.scopusVesga Angarita, Boris Eduardo [16047325700]*
dc.contributor.scopusCamacho López, Paul Anthony [16047325700]
dc.contributor.researchgateVesga Angarita, Boris Eduardo [Boris-Vesga-2]*
dc.contributor.researchgateCamacho López, Paul Anthony [Paul_Camacho_Lopez]
dc.subject.lembMedicina internaspa
dc.subject.lembMedicinaspa
dc.subject.lembManifestaciones cardiológicas de enfermedades generalesspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishIntroduction: Heterozygous Familial Hypercholesterolemia is a genetic disorder characterized by elevation of c-LDL, usually over 190 mg/dl and high risk of cardiovascular morbidity and mortality. Despite its high social and economic impact, it remains an underdiagnosed and under-treated pathology. Design: An observational study, cross sectional analysis of anonymized secondary data. Methods: Inclusion criteria included: age 18 years or more, atherosclerotic cardiovascular disease (defined by patients with ischemic cardiomyopathy including myocardial infarction, angina, surgery or myocardial revascularization) and/or cerebrovascular disease (defined by cerebrovascular disease or transient ischemic attack. Exclusion criteria was the absent of lipid profile. Results: A total of 470 patients (males 63.83%) with an average age of 64.83 years old were included in this study. The findings of this study showed that hypertension (72.77%) was the most prevalent risk factor to develop cardiovascular events followed by dyslipidemia or being under hypolipidemic drug treatment (57.45%) and smoking (40.42%). Acute myocardial infarction (AMI) was the most frequent form of cardiovascular events (44.04%), followed by angina pectoris (45.53%) and ischemic cerebrovascular disease (CVD) (9.36%). 33.19% of cases had involvement of a single vessel in coronary arteriography, while 20.64% and 23.40% of cases had involvement of 2 and 3 or more vessels, respectively. The average value of LDL cholesterol (c-LDL) was 112.60 mg / dl and only 11.91% of the patients had values in the established goal for this condition. 43.96% of the population received some type of statin, but only 7.60% in maximum dose. Atorvastatin was the most prescribed statin (86.85%) after the cardiovascular event. 7.45% of the subjects were classified as possible cases of HFHe and 0.43% as probable cases. No definitive cases were found as there was no genetic analysis. It was established that 7.8% of the population studied has possible / probable HFHe. Statistically significant dependence (p &lt;0.0001) was determined between the HFHe and the age of presentation of earlier cardiovascular events (55.83 years old vs.65.60 years old), as well as with the female sex (p 0.021). Regarding the risk factors, only dependence was observed between having a history of HF in the first degree of consanguinity and family history of premature AMI with the prevalence of possible/probable HFHe (p &lt;0.0001). Patients with possible / probable HFHe had higher levels of CT (total cholesterol), GAD (triglycerides) and c-LDL (p &lt;0.0001). Dependency was found between the value of creatinine (0.82 mg / dl) and the prevalence of HFHe (p 0.005). Most patients with possible / probable HFHe perform another type of aerobic exercise other than walking (p 0.016). The combined treatment was prescribed 4 times more (10.81% vs. 2.54%) after the cardiovascular event in the possible / probable HF group (p 0.02). While coronary stent implantation was the most widely used revascularization strategy in general (63.19%), myocardial revascularization surgery was used 2 times more in the population with possible / probable HFHe (p 0.042). Conclusions: Heterozygous Familial Hypercholesterolemia (HFH) is an underdiagnosed disorder among patients who have established HFHe is an underdiagnosed disease among patients who have established atherosclerotic disease and shortens the age of presentation of cardiovascular events with respect to the general population. The results emphasise the importance of creating a cohort of patients with HFHe suffering from a cardiovascular event in order to optimize treatment measures, to reduce the impact of cardiovascular disease, and the costs related to care and treatment.eng
dc.subject.proposalHipercolesterolemia familiar heterocigotaspa
dc.subject.proposalEnfermedades cardiovascularesspa
dc.subject.proposalPrevalenciaspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.contributor.apolounabCamacho López, Paul Anthony [paul-anthony-camacho-lópez]
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa
dc.contributor.linkedinCamacho López, Paul Anthony [paulcamachomdepi]


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