Aplicación de un modelo de pesquisa por oportunidad para la estratificación de dislipidemias y detección de portadores de Hipercolesterolemia Familiar en un establecimiento de alta complejidad en la región del Biobío.
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Date
2024
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Universidad de Concepción
Abstract
Las enfermedades cardiovasculares son la principal causa de muerte en Chile y el mundo, promovidas por factores como hipertensión, tabaquismo, diabetes y dislipidemia, siendo esta última un factor de riesgo importante debido a su directa contribución en la formación de placas ateroscleróticas causadas por niveles elevados de lípidos. Las dislipidemias se clasifican en mixtas o aisladas, según el parámetro del perfil lipídico que se encuentra alterado, como también, según su etiología como primarias (de origen genético) o secundarias (causada por factores externos). Entre las dislipidemias primarias, se encuentra la Hipercolesterolemia Familiar (HF), caracterizada por la elevación del colesterol de las Lipoproteínas de Baja Densidad (c-LDL) y un aumento del riesgo de enfermedad cardiovascular precoz. La detección de esta patología requiere el diagnóstico clínico y análisis genético, según criterios como el programa de la Red de Clínica de Lípidos Holandesa (DLCN). En Chile, no existen programas sistemáticos para la detección de HF, lo que limita la identificación de casos índice. Este estudio aplicó un modelo de pesquisa por oportunidad para hiperlipidemias y HF, a través del análisis de una base de datos del perfil lipídico determinado por el Laboratorio Clínico del Complejo Asistencial Dr. Víctor Ríos Ruiz entre los años 2021 y 2023. Los datos fueron analizados para identificar hipertrigliceridemia aislada, hipercolesterolemia aislada e hiperlipidemia mixta en población pediátrica y adulta. Por último, al grupo de hipercolesterolemia aislada se aplicaron los criterios DLCN según niveles de c-LDL para identificar posibles casos índices de HF. En los adultos, el 60,4% del grupo presentó algún tipo de hiperlipidemia, mientras que en pacientes pediátricos se observó en el 28,5%. Entre los tipos de hiperlipidemias, en ambas poblaciones, la hipertrigliceridemia es la más frecuente, con una prevalencia de 24,7% en adultos y 20,1% en niños. Según el grupo de hipercolesterolemia aislada, 17 pacientes obtuvieron 8 puntos según el criterio DLCN, de estos 2 eran pediátricos y 15 adultos. La aplicación de pesquisa por oportunidad permite obtener la prevalencia de hiperlipidemias en los usuarios del Servicio Salud Biobío, permitiendo actualizar la epidemiología nacional de estas patologías y conocer posibles portadores de HF.
Cardiovascular diseases are the leading cause of death in Chile and worldwide, driven by factors such as hypertension, smoking, diabetes, and dyslipidemia. Dyslipidemia is a major risk factor due to its direct contribution to the formation of atherosclerotic plaques caused by elevated lipid levels. Dyslipidemias are classified as mixed or isolated, depending on the altered lipid profile parameter, as well as by etiology, either primary (genetic origin) or secondary (caused by external factors). Among primary dyslipidemias is Familial Hypercholesterolemia (FH), characterized by elevated Low-Density Lipoprotein Cholesterol (LDL-C) levels and an increased risk of early cardiovascular disease. The detection of this condition requires clinical diagnosis and genetic analysis, following criteria such as those outlined in the Dutch Lipid Clinic Network (DLCN) program. In Chile, there are no systematic programs for FH detection, limiting the identification of index cases. This study applied an opportunistic screening model for hyperlipidemias and FH through the analysis of a lipid profile database from the Clinical Laboratory of the Dr. Víctor Ríos Ruiz Healthcare Complex between 2021 and 2023. The data were analyzed to identify isolated hypertriglyceridemia, isolated hypercholesterolemia, and mixed hyperlipidemia in pediatric and adult populations. Finally, the DLCN criteria based on LDL-C levels were applied to the isolated hypercholesterolemia group to identify possible FH index cases. In adults, 60.4% of the group presented some type of hyperlipidemia, while 28.5% was observed in pediatric patients. Among the types of hyperlipidemias, hypertriglyceridemia was the most frequent in both populations, with a prevalence of 24.7% in adults and 20.1% in children. According to the isolated hypercholesterolemia group, 17 patients scored 8 points based on the DLCN criteria, of which 2 were pediatric and 15 were adults. The application of opportunistic screening allows for determining the prevalence of hyperlipidemias in the users of the Biobío Health Service, contributing to updating the national epidemiology of these conditions and identifying potential FH carriers.
Cardiovascular diseases are the leading cause of death in Chile and worldwide, driven by factors such as hypertension, smoking, diabetes, and dyslipidemia. Dyslipidemia is a major risk factor due to its direct contribution to the formation of atherosclerotic plaques caused by elevated lipid levels. Dyslipidemias are classified as mixed or isolated, depending on the altered lipid profile parameter, as well as by etiology, either primary (genetic origin) or secondary (caused by external factors). Among primary dyslipidemias is Familial Hypercholesterolemia (FH), characterized by elevated Low-Density Lipoprotein Cholesterol (LDL-C) levels and an increased risk of early cardiovascular disease. The detection of this condition requires clinical diagnosis and genetic analysis, following criteria such as those outlined in the Dutch Lipid Clinic Network (DLCN) program. In Chile, there are no systematic programs for FH detection, limiting the identification of index cases. This study applied an opportunistic screening model for hyperlipidemias and FH through the analysis of a lipid profile database from the Clinical Laboratory of the Dr. Víctor Ríos Ruiz Healthcare Complex between 2021 and 2023. The data were analyzed to identify isolated hypertriglyceridemia, isolated hypercholesterolemia, and mixed hyperlipidemia in pediatric and adult populations. Finally, the DLCN criteria based on LDL-C levels were applied to the isolated hypercholesterolemia group to identify possible FH index cases. In adults, 60.4% of the group presented some type of hyperlipidemia, while 28.5% was observed in pediatric patients. Among the types of hyperlipidemias, hypertriglyceridemia was the most frequent in both populations, with a prevalence of 24.7% in adults and 20.1% in children. According to the isolated hypercholesterolemia group, 17 patients scored 8 points based on the DLCN criteria, of which 2 were pediatric and 15 were adults. The application of opportunistic screening allows for determining the prevalence of hyperlipidemias in the users of the Biobío Health Service, contributing to updating the national epidemiology of these conditions and identifying potential FH carriers.
Description
Tesis presentada para optar al título de Bioquímico/a.
Keywords
Hiperlipoproteinemia tipo II, Enfermedades cardiovasculares, Hiperlipidemias, Colesterol, Centros de salud Chile