Article information
Resumo
A utilização de estatinas em prevenção secundária na patologia arterial periférica (extra-coronária) não é universal. As razões para a sua eventual utilização são relativamente recentes e os dados da literatura são, por vezes, controversos ou não se encontram divulgados. O objectivo deste trabalho consiste em rever a literatura recente e discutir as razões eventuais para uma maior utilização de estatinas em doentes com patologia do foro vascular «extra-coronário» tendo sido seleccionadas as áreas em que estes fármacos têm sido estudados.
Conclui-se que as estatinas devem ser utilizadas com o objectivo de reduzir a morbilidade e a mortalidade de causa coronária em doentes com patologia carotídea, aneurisma da aorta e doença oclusiva dos membros inferiores. Há evidência suficiente que comprova a redução do risco per-operatório em Cirurgia Vascular e a sua utilização em doentes com estenose carotídea é também recomendada com o objectivo de reduzir o risco per-operatório da endarterectomia. No entanto, não há dados que permitam recomendar o uso de estatinas para controlo da re-estenose após endarterectomia carotídea.
Há evidência que sugere um papel benéfico das estatinas nos doentes com claudicação intermitente, em termos de melhoria da distância de marcha, pelo que a sua utilização com este objectivo é recomendada.
Finalmente, não há evidência suficiente que permita recomendar a utilização de estatinas com o objectivo de prevenir a re-estenose e melhorar a performance dos procedimentos de revascularização convencional dos membros inferiores, de controlar a progressão dos aneurismas da aorta abdominal nem de melhorar a gravidade da estenose ou da disfunção renal.
Palavras-chave:
Estatinas
Doença arterial periférica
Abstract
The use of statins for secondary prevention in patients with peripheral (extracoronary) arterial disease is not widespread. Their possible use has only relatively recently been studied and data in the literature are sometimes controversial or are not disclosed.
The aim of this paper is to review the recent literature and to discuss possible reasons for using statins in patients with extracoronary atherosclerotic arterial involvement, focusing on the areas in which they have been investigated.
The main conclusions are that statins should be prescribed with the objective of reducing coronary and cerebrovascular morbidity and mortality in patients with carotid disease, abdominal aortic aneurysm and lower limb occlusive disease. There is sufficient evidence to suggest a reduction in the perioperative risk of vascular surgery when statins are used, and in patients with carotid stenosis they also appear to reduce perioperative risk in endarterectomy. Nevertheless, there are insufficient data to recommend the use of statins to control post-endarterectomy restenosis.
In patients with intermittent claudication, statins improve walking distance and may be used for this purpose.
Finally, there is insufficient evidence to recommend statins to prevent restenosis in lower limb revascularization procedures, to control progression of abdominal aortic aneurysms, or to reduce the severity of renal artery stenosis or renal dysfunction.
Keywords:
Statins
Peripheral arterial disease
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