Discordancia lipídica y placa carotídea en pacientes obesos en prevención primaria

espanolIntroduccion Los pacientes obesos con discordancia lipidica podrian tener una mayor prevalencia de aterosclerosis subclinica. Los objetivos de nuestro trabajo fueron: 1) determinar la prevalencia de discordancia lipidica en una poblacion de pacientes obesos en prevencion primaria; 2) investigar la asociacion entre la discordancia lipidica y la presencia de placa aterosclerotica carotidea (PAC). Metodos Se incluyeron sujetos mayores de 18 anos obesos (indice de masa corporal ≥30kg/m2) sin enfermedad cardiovascular, diabetes, o tratamiento hipolipemiante, provenientes de 6 centros de cardiologia. Se definio «discordancia lipidica» cuando, independientemente del valor de c-LDL, el valor de colesterol no HDL superaba 30mg/dL el valor de c-LDL. Se identifico la presencia de PAC por ultrasonido. Se realizaron analisis uni y multivariados explorando la asociacion entre la discordancia lipidica y la presencia de PAC. Resultados Se incluyeron 325 pacientes obesos (57,2% hombres, edad media: 52,3 anos). La prevalencia de discordancia lipidica fue del 57,9%. Mostraron PAC el 38,6% de los pacientes. Esta proporcion fue mayor en los sujetos con discordancia lipidica en comparacion con los pacientes sin este patron lipidico (44,4% vs. 30,7%, p=0,01). En el analisis univariado (OR: 1,80; IC95%: 1,14-2,87; p=0,01) y en el multivariado (OR: 2,07; IC95%: 1,22-3,54; p=0,007), la presencia de discordancia lipidica se asocio con una mayor probabilidad de presentar PAC. Conclusion En pacientes obesos, la discordancia lipidica se asocio con una mayor prevalencia de PAC. Evaluar pacientes obesos con esta estrategia podria identificar a los sujetos con mayor riesgo cardiovascular residual. EnglishIntroduction Obese patients with lipid discordance (non-HDL cholesterol levels 30mg/dL above the LDL-c value) may have a greater prevalence of carotid atherosclerotic plaque (CAP). Our study objectives were: 1) To assess the prevalence of lipid discordance in a primary prevention population of obese patients; 2) To investigate the association between lipid discordance and presence of CAP. Methods Obese subjects aged >18 years (BMI ≥30kg/m2) with no cardiovascular disease, diabetes, or lipid-lowering treatment from six cardiology centers were included. Lipid discordance was defined when, regardless of the LDL-c level, the non-HDL cholesterol value exceeded the LDL-c value by 30mg/dL. Presence of CAP was identified by ultrasonography. Univariate and multivariate analyses were performed to explore the association between lipid discordance and presence of CAP. Results The study simple consisted of 325 obese patients (57.2% men; mean age, 52.3 years). Prevalence of lipid discordance was 57.9%. CAP was found in 38.6% of patients, but the proportion was higher in subjects with lipid discordance as compared to those without this lipid pattern (44.4% vs. 30.7%, P=.01). In both the univariate (OR: 1.80; 95% CI: 1.14-2.87; P=.01) and the multivariate analysis (OR: 2.07; 95% CI: 1.22-3.54; P=.007), presence of lipid discordance was associated to an increased probability of CAP. Conclusion In these obese patients, lipid discordance was associated to greater prevalence of CAP. Evaluation of obese patients with this strategy could help identify subjects with higher residual cardiovascular risk.