Peer-reviewed general biomedical journal
Living FRIendly Summaries of the Body of Evidence using Epistemonikos (FRISBEE)
Medwave 2017; 17(Suppl1):e6853 doi: 10.5867/medwave.2017.6853
Are statins beneficial for chronic heart failure? - First update
Carmen Rain, Gabriel Rada
Resumen
Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en mayo de 2015, basado en nueve revisiones sistemáticas aparecidas con posterioridad.
Si bien las estatinas disminuyen parámetros inflamatorios y mejoran algunos parámetros ecocardiográficos en pacientes con insuficiencia cardiaca, no está claro si esto se traduce en beneficios clínicamente relevantes. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos 15 revisiones sistemáticas que en conjunto incluyen 25 estudios aleatorizados que responden la pregunta de interés. Extrajimos los datos, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que las estatinas no disminuyen la mortalidad en pacientes con insuficiencia cardiaca. Podrían tener un efecto pequeño sobre el riesgo de hospitalización, pero la certeza de esta evidencia es baja.
Sobre la actualización
Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en mayo de 2015 (doi: 10.5867/medwave.2015.04.6140), basado en nueve revisiones sistemáticas aparecidas con posterioridad.
La nueva evidencia incorporada en este resumen no lleva a cambios en la certeza de la evidencia de los desenlaces, los mensajes clave ni las consideraciones para la toma de decisión.
Problema
Además de su efecto hipolipemiante, se postula que las estatinas poseen efectos pleiotrópicos, tales como propiedades antihipertróficas, antifibróticas, antioxidantes e inhibitorias de la activación neurohumoral, todo lo cual forma parte de la fisiopatología de la insuficiencia cardiaca. Algunos estudios han mostrado que podrían mejorar la fracción de eyección y disminuir los niveles de factores inflamatorios, sin embargo no está claro que esto se traduzca en un beneficio clínicamente relevante.
Métodos
Utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, para identificar revisiones sistemáticas y sus estudios primarios incluidos. Con esta información generamos un resumen estructurado, siguiendo un formato preestablecido, que incluye mensajes clave, un resumen del conjunto de evidencia (presentado como matriz de evidencia en Epistemonikos), metanálisis del total de los estudios, tablas de resumen de resultados con el método GRADE, y tabla de otras consideraciones para la toma de decisión.
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Mensajes clave
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Acerca del conjunto de evidencia para esta pregunta
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Cuál es la evidencia. |
Encontramos 15 revisiones sistemáticas [1],[2],[3],[4],[5],[6], [7],[8],[9],[10],[11],[12],[13],[14],[15] que incluyen 45 estudios primarios [16],[17],[18],[19],[20],[21],[22],[23], [24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35], [36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47], [48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59], [60],[61],[62],[63],[64], de los cuales 25 corresponden a estudios controlados aleatorizados (reportados en 29 referencias) [17],[18],[20],[30],[31],[33],[34],[36],[40],[41], [45],[46],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57], [58],[59],[61],[62],[63],[64]. Esta tabla y el resumen en general se basan en estos últimos. |
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Qué tipo de pacientes incluyeron los estudios |
Los estudios incluyeron pacientes con insuficiencia cardiaca recibiendo tratamiento estándar, con representación de todas las etiologías. La mayoría de los estudios incluyó sólo pacientes con fracción de eyección disminuida, con excepción de tres estudios [36],[50],[57]. De acuerdo a la capacidad funcional según NYHA, cuatro estudios incluyeron pacientes con capacidad funcional I [40],[46],[48],[61], 23 estudios con capacidad funcional II [18],[31],[34],[36],[40],[41],[45],[46],[48],[49],[50], [53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63], [64], todos los estudios incluyeron capacidad funcional III y nueve incluyeron capacidad funcional IV [34],[36],[49], [53],[55],[58],[59],[63],[64]. El promedio de colesterol LDL osciló entre 96 y 167 mg/dL en los diferentes estudios. |
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Qué tipo de intervenciones incluyeron los estudios |
Dieciséis estudios evaluaron atorvastatina [34],[40],[41], [46],[48],[49],[50],[51],[52],[53],[55],[56],[60],[61], [62],[64], cinco rosuvastatina [18],[31],[36],[58],[59], uno cerivastatina [57], uno pivastatina [54] y dos simvastatina [45],[63]. La mayoría de los estudios compararon contra placebo, con excepción de 11 estudios que compararon con no-intervención [34],[48],[49],[50],[51],[52],[53],[54],[61], [62],[63]. |
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Qué tipo de desenlaces midieron |
Las distintas revisiones sistemáticas identificadas agruparon los desenlaces en:
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Resumen de los resultados
La información sobre el efecto de las estatinas está basada en 25 estudios controlados aleatorizados. Diecisiete estudios midieron mortalidad por cualquier causa [36],[40],[45],[48],[49],[50],[51],[52],[54],[55],[56],[58],[59],[60],[61],[62],[63] y 14 estudios midieron hospitalización por falla cardiaca [36],[45],[48],[49],[50],[52],[54],[55],[56],[58],[59],[60],[61],[62]. El resumen de los resultados es el siguiente:
- Las estatinas en pacientes con insuficiencia cardiaca no disminuyen la mortalidad. La certeza de la evidencia es alta.
- Las estatinas podrían disminuir levemente las hospitalizaciones por falla cardiaca, pero la certeza de la evidencia es baja.
Otras consideraciones para la toma de decisión
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A quién se aplica y a quién no se aplica esta evidencia |
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| Sobre los desenlaces incluidos en este resumen |
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| Balance riesgo/beneficio y certeza de la evidencia |
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| Consideraciones de recursos |
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| Diferencias entre este resumen y otras fuentes |
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| ¿Puede que cambie esta información en el futuro? |
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Cómo realizamos este resumen
Mediante métodos automatizados y colaborativos recopilamos toda la evidencia relevante para la pregunta de interés y la presentamos en una matriz de evidencia.
Siga el enlace para acceder a la versión interactiva: Estatinas para la insuficiencia cardiaca crónica
Notas
Si con posterioridad a la publicación de este resumen se publican nuevas revisiones sistemáticas sobre este tema, en la parte superior de la matriz se mostrará un aviso de “nueva evidencia”. Si bien el proyecto contempla la actualización periódica de estos resúmenes, los usuarios están invitados a comentar en Medwave o contactar a los autores mediante correo electrónico si creen que hay evidencia que motive una actualización más rápida.
Luego de crear una cuenta en Epistemonikos, al guardar las matrices recibirá notificaciones automáticas cada vez que exista nueva evidencia que potencialmente responda a esta pregunta. El detalle de los métodos para elaborar este resumen están descritos aquí: http://dx.doi.org/10.5867/medwave.2014.06.5997.
La Fundación Epistemonikos es una organización que busca acercar la información a quienes toman decisiones en salud, mediante el uso de tecnologías. Su principal desarrollo es la base de datos Epistemonikos (www.epistemonikos.org).
Los resúmenes de evidencia siguen un riguroso proceso de revisión por pares interno.
Declaración de conflictos de intereses
Los autores declaran no tener conflictos de intereses con la materia de este artículo.
Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.
Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en mayo de 2015, basado en nueve revisiones sistemáticas aparecidas con posterioridad.
Si bien las estatinas disminuyen parámetros inflamatorios y mejoran algunos parámetros ecocardiográficos en pacientes con insuficiencia cardiaca, no está claro si esto se traduce en beneficios clínicamente relevantes. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos 15 revisiones sistemáticas que en conjunto incluyen 25 estudios aleatorizados que responden la pregunta de interés. Extrajimos los datos, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que las estatinas no disminuyen la mortalidad en pacientes con insuficiencia cardiaca. Podrían tener un efecto pequeño sobre el riesgo de hospitalización, pero la certeza de esta evidencia es baja.
Authors:
Carmen Rain[1], Gabriel Rada[1,2,3,4,5]
Affiliation:
[1] Proyecto Epistemonikos, Santiago, Chile
[2] Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[3] Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[4] GRADE working group
[5] The Cochrane Collaboration
E-mail: radagabriel@epistemonikos.org
Author address:
[1] Facultad de Medicina Pontificia Universidad Católica de Chile Diagonal Paraguay 476 Santiago Centro Chile
Citation: Rain C, Rada G. Are statins beneficial for chronic heart failure? - First update. Medwave 2017; 17(Suppl1):e6853 doi: 10.5867/medwave.2017.6853
Submission date: 22/12/2016
Acceptance date: 23/12/2016
Publication date: 25/4/2017
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July 2022, Vol 22, Issue 6
Research papers
Association of biomarkers and severity of COVID-19: A crosssectional study
Systematization of initiatives in sexual and reproductive health about good practices criteria in response to the COVID-19 pandemic in primary health care in Chile
Clinical, psychological, social, and family characterization of suicidal behavior in Chilean adolescents: a multiple correspondence analysis
Systematization of initiatives in sexual and reproductive health about good practices criteria in response to the COVID-19 pandemic in primary health care in Chile
Clinical, psychological, social, and family characterization of suicidal behavior in Chilean adolescents: a multiple correspondence analysis
