Está bien establecida la relación entre la hipercolesterolemia y el desarrollo de enfermedad cardiovascular, especialmente la cardiopatía isquémica. Algunos tipos de hiperlipemia, como las de base genética, tienen un mayor riesgo cardiovascular. La evidencia actualmente disponible apoya el beneficio de la terapia hipolipemiante crónica en la reducción del riesgo de la morbimortalidad cardiovascular. La estratificación del riesgo es fundamental para definir el objetivo terapéutico del colesterol unido a lipoproteínas de baja densidad (cLDL) y el tratamiento. Las estatinas son los fármacos de elección en las hipercolesterolemias y los fibratos, en las hipertrigliceridemias. Ambos grupos farmacológicos son seguros y tienen una buena tolerancia, y los ensayos clínicos han demostrado su beneficio en la reducción del riesgo cardiovascular. En los pacientes en los que no se consigue el objetivo terapéutico, es preciso asociar fármacos. Las combinaciones más utilizadas son una estatina y un inhibidor selectivo de la absorción del colesterol, ezetimiba, para las hipercolesterolemias puras, y estatinas con fibratos para las hiperlipemias mixtas.
Palabras clave
Hiperlipemia
Enfermedad cardiovascular
Estatinas
Fibratos
Ezetimiba
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Este trabajo se ha realizado gracias a la ayuda de la Red de Hiperlipemias Genéticas, del Instituto de Salud Carlos III (FIS G03/181), Ministerio de Sanidad y Consumo.
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2006. Sociedad Española de Cardiología