Infográficos para decisão compartilhada no uso de estatinas em paciente de alto risco cardiovascular

Autores

  • Fernanda Karolinne Melchior Silva Pinto Preceptora do Programa de Residência em MFC da Unievangelica/GO
  • Jardel Correa de Oliveira Médico de Família e Comunidade Preceptor do programa de Residencia em Medicina de Família e Comunidade da ESP Secretaria Municipal de Saúde de Florianópolis

DOI:

https://doi.org/10.5712/rbmfc14(41)1809

Palavras-chave:

Estatinas, Doenças Cardiovasculares, Transtornos Cerebrovasculares, Atenção à Primária à Saúde, Tomada de Decisões

Resumo

Objetivos: Elaborar infográficos para decisão compartilhada sobre o benefício e risco do uso de estatinas como prevenção primária em pacientes com alto risco cardiovascular. Métodos: A partir do “the NNT”, que analisou o uso de estatinas para prevenção primária em pessoas de baixo risco cardiovascular a partir de meta-análises do US Preventive Services Task Force (USPSTF) e da Cochrane, buscou-se definir o balanço de risco e benefício dessa terapia na prevenção primária de pessoas com alto risco. Como o USPSTF e a Cochrane tinham 10 estudos primários diferentes incluídos em suas análises e populações com risco cardiovascular variável, foi realizada uma busca adicional por revisões sistemáticas e meta-análises publicadas desde a data da revisão Cochrane (dezembro de 2012) até outubro de 2017. Buscou-se no Medline via PubMed, na Biblioteca Virtual em Saúde, na Cochrane e no NHS Evidence por estudos de pessoas com risco cardiovascular estimado em 10 anos de mais de 10% com mais um fator de risco ou com mais de 20%, sem história de doença cardiovascular prévia, que comparassem o uso de estatina com placebo ou nenhum tratamento. Os desfechos deveriam ser a redução de doenças cardio e cerebrovasculares, da mortalidade cardiovascular ou geral e a ocorrência de eventos adversos. Resultados: Foram encontrados 225 estudos entre meta-análises e revisões sistemáticas elaboradas desde dezembro de 2012 até outubro de 2017. Foram excluídos 224 estudos por motivos diversos. Selecionou-se para elaboração do infográfico de benefícios o Statins for primary prevention, 2012, com população de 100% de diabéticos sem eventos cardiovasculares prévios com redução de risco absoluto (RRA) quanto a AVC fatal de 0,78 pontos percentuais/NNT 128 e Doenças Cardio/Cerebrovasculares RRA 2,6 pontos percentuais/NNT 39, cardiovascular. Quanto à redução de mortalidade geral (RR 0,79; IC95% 0,58-1,08) e revascularização (RR 0,74; IC 95% 0,55-1,00) não foi encontrada diferença estatística significante. Devido às limitações encontradas nas revisões sistemáticas avaliadas, não foi possível compilar dados, no formato de infográfico, sobre a incidência de diabetes e abandono de terapia. Assim, para elaboração da parte referente a danos, foi selecionado o ECR Aspen, com população de diabéticos de alto risco para desenvolvimento de eventos cardiovasculares, sem eventos prévios, quanto à mialgia com aumento do risco absoluto (ARA) de 1,43 pontos percentuais/NND 70 (RR 1,91; IC95% 1,03-3,53). Conclusão: Foi elaborado infográfico, com e sem uso de estatina, para desfechos cardiocerebrovasculares não fatais, AVC fatal, necessidade de revascularização, mortalidade geral e para ocorrência adversa de sintomas musculares. Esse instrumento pode ser utilizado na Atenção Primária durante o encontro clínico visando à tomada de decisão compartilhada, facilitando a compreensão dos riscos e benefícios do uso de estatina em pacientes de alto risco cardiovascular (RCV 10% com pelo menos um fator de risco adicional ou > 20 % em 10 anos), diabéticos, nos quais a prescrição de estatina seja cogitada.

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Biografia do Autor

Fernanda Karolinne Melchior Silva Pinto, Preceptora do Programa de Residência em MFC da Unievangelica/GO

Graduada em medicina pela UFG. Médica de Família pela Escola Saúde Pública Florianópolis. 

Preceptora do Programa de Residência em Medicina de Familia e Comunidade Unievangelica

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2019-03-27

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Pinto FKMS, Oliveira JC de. Infográficos para decisão compartilhada no uso de estatinas em paciente de alto risco cardiovascular. Rev Bras Med Fam Comunidade [Internet]. 27º de março de 2019 [citado 28º de março de 2024];14(41):1809. Disponível em: https://rbmfc.org.br/rbmfc/article/view/1809

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