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As doenças cardiovasculares correspondem atualmente à principal causa de morbilidade e mortalidade a nível global. A aterosclerose constitui a principal causa de aparecimento deste tipo de doenças. Sendo o seu desenvolvimento precipitado pela ação de diversos fatores de risco, nomeadamente hipertensão arterial, DM, obesidade, tabagismo, dislipidemia, consumo abusivo de álcool e inatividade física. Surgem evidencias de que certos fármacos, nomeadamente as estatinas, podem atuar através de mecanismos que levem à estabilização ou mesmo regressão das placas de ateroma, podendo assim contribuir para a diminuição da incidência de doenças cardiovasculares.
A presente monografia tem como objetivo a revisão bibliográfica de artigos científicos selecionados com vista a clarificar o possível efeito das estatinas sobre as placas de ateroma, de forma a que estas atinjam um estado de regressão ou, pelo menos, de estabilização, no sentido de diminuir o risco de ocorrência de eventos cardiovasculares.
Metodologia: Recolha e revisão de artigos de literatura científica, incluindo artigos de revisão e de investigação, que tenham relevo para o tema em estudo. Foram feitas pesquisas na “Pubmed” e outras bases científicas de referência utilizando os termos “statins”, “atherosclerosis”, “ateroma plaque”, “stabilization”, regression”, “cardiovascular diseases”. Foi dada prevalência aos artigos mais recentes na medida que podem traduzir um conhecimento mais atual e portanto mais rigoroso acerca do tema em questão.
Após a análise dos diferentes estudos há diversas conclusões que se podem retirar relativamente à influência das estatinas sobre a placa de ateroma. Uma conclusão universal é de que estes fármacos efetivamente têm influência positiva sobre este o processo aterosclerótico, e que os possíveis efeitos adversos que advêm do seu uso são largamente suplantados pelos efeitos benéficos associados ao seu uso.
Este tipo de fármacos leva a uma maior estabilização da placa aterosclerótica através de modificações induzidas na sua composição, de forma a torná-la mais estável e menos propensa a rutura. Dessa forma, abrandam a progressão da aterosclerose e podem mesmo induzir sua a regressão. Em alguns dos estudos analisados, foi relatada a ocorrência de regressão do volume da placa, enquanto noutros apenas foi descrita uma desaceleração do processo de aterosclerose.
Outras modificações da composição da placa de ateroma incluem um aumento da espessura da camada fibrosa da placa aterosclerótica e da macrocalcificação intraplaca, bem como uma redução do número de macrófagos que se infiltram na parede arterial, do nível sérico de colesterol-LDL, da oxidação das partículas lipoproteicas e da Proteína C-reativa ultrassensível (hsPCR).
A utilização de estatinas em pacientes com níveis normais de c-LDL e a diminuição da ocorrência de eventos CV que dai resultou permitiu salientar a importância dos efeitos pleiotrópicos destes fármacos, comprovando que a sua ação vai muito para além da redução dos níveis lipídicos em circulação. Assim, é possível afirmar com segurança, que as estatinas contribuem para a estabilização da placa e consequentemente para a diminuição da probabilidade de ocorrência de eventos CV.
Cardiovascular diseases are currently the leading cause of global morbidity and mortality. Atherosclerosis is the leading cause of this type of disease. Its development is precipitated by the action of several risk factors, namely hypertension, diabetes, obesity, smoking, dyslipidemia, alcohol abuse and physical inactivity. There is evidence that certain drugs, such as statins, may act through mechanisms that lead to the stabilization or even regression of atherosclerosis, thus contributing to a reduction in the incidence of cardiovascular diseases. This monograph aims to review the literature of selected scientific articles to clarify the possible effect of statins on atheroma plaques, so that they reach a state of regression or, at least, stabilization, in order to decrease the risk of cardiovascular events. Methods: Collection and review of articles in scientific literature, including review articles and research articles, which are relevant to the topic under study. Pubmed and other scientific bases of reference were used using the terms "statins", "atherosclerosis", "atheroma plaque", "stabilization", "regression", "cardiovascular diseases" Prevalence has been given to the most recent articles insofar as they can translate a more current and therefore more rigorous knowledge about the subject in question. After analyzing the different studies there are several conclusions that can be drawn regarding the influence of statins on the atherosclerotic plaque. A universal conclusion is that these drugs effectively have a positive influence on this atherosclerotic process, and that the possible adverse effects arising from its use are largely supplanted by the beneficial effects associated with its use. This type of drug leads to a greater stabilization of the atherosclerotic plaque through induced changes in its composition, in order to make it more stable and less prone to rupture. Thus, they slow the progression of atherosclerosis and may even induce their regression. In some of the studies analyzed, plaque volume regression was reported, while in others only a deceleration of the atherosclerosis process was reported. Further modifications of the atherosclerotic plaque composition include an increase in fibrous layer thickness of the atherosclerotic plaque and intraplate macrocalcification, as well as a reduction in the number of macrophages infiltrating the arterial wall, serum LDL-cholesterol level, oxidation of lipoprotein particles and hsCRP. The use of statins in patients with normal levels of LDL-C and the decrease in the occurrence of CV events resulted in the importance of the pleiotropic effects of these drugs, proving that their action goes far beyond the reduction of circulating lipid levels. Thus, it is possible to safely state that statins contribute to plaque stabilization and consequently decrease the likelihood of CV events.
Cardiovascular diseases are currently the leading cause of global morbidity and mortality. Atherosclerosis is the leading cause of this type of disease. Its development is precipitated by the action of several risk factors, namely hypertension, diabetes, obesity, smoking, dyslipidemia, alcohol abuse and physical inactivity. There is evidence that certain drugs, such as statins, may act through mechanisms that lead to the stabilization or even regression of atherosclerosis, thus contributing to a reduction in the incidence of cardiovascular diseases. This monograph aims to review the literature of selected scientific articles to clarify the possible effect of statins on atheroma plaques, so that they reach a state of regression or, at least, stabilization, in order to decrease the risk of cardiovascular events. Methods: Collection and review of articles in scientific literature, including review articles and research articles, which are relevant to the topic under study. Pubmed and other scientific bases of reference were used using the terms "statins", "atherosclerosis", "atheroma plaque", "stabilization", "regression", "cardiovascular diseases" Prevalence has been given to the most recent articles insofar as they can translate a more current and therefore more rigorous knowledge about the subject in question. After analyzing the different studies there are several conclusions that can be drawn regarding the influence of statins on the atherosclerotic plaque. A universal conclusion is that these drugs effectively have a positive influence on this atherosclerotic process, and that the possible adverse effects arising from its use are largely supplanted by the beneficial effects associated with its use. This type of drug leads to a greater stabilization of the atherosclerotic plaque through induced changes in its composition, in order to make it more stable and less prone to rupture. Thus, they slow the progression of atherosclerosis and may even induce their regression. In some of the studies analyzed, plaque volume regression was reported, while in others only a deceleration of the atherosclerosis process was reported. Further modifications of the atherosclerotic plaque composition include an increase in fibrous layer thickness of the atherosclerotic plaque and intraplate macrocalcification, as well as a reduction in the number of macrophages infiltrating the arterial wall, serum LDL-cholesterol level, oxidation of lipoprotein particles and hsCRP. The use of statins in patients with normal levels of LDL-C and the decrease in the occurrence of CV events resulted in the importance of the pleiotropic effects of these drugs, proving that their action goes far beyond the reduction of circulating lipid levels. Thus, it is possible to safely state that statins contribute to plaque stabilization and consequently decrease the likelihood of CV events.
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Keywords
Aterosclerose Doenças Cardiovasculares Estabilização Estatinas Placa de Ateroma Regressão