Papel de los factores de riesgo en la trombogenicidad sanguínea y los síndromes coronarios agudos

doi:10.1016/S0300-8932(03)76998-X

Revista Española de Cardiología

Volume 56, Issue 10, 2003, Pages 1001-1009

https://doi.org/10.1016/S0300-8932(03)76998-X Get rights and content

Recientes avances en las ciencias básicas han vinculado algunos factores de riesgo con la disfunción endotelial que inicia la enfermedad aterosclerótica y desencadena la progresión de sus complicaciones trombóticas. En una tercera parte de los síndromes coronarios agudos sólo existe una erosión de la placa. En estos casos, la presencia de algunos factores de riesgo, como la diabetes mellitus, la hipercolesterolemia y el tabaquismo, promueve un estado de «sangre vulnerable o de alto riesgo». La elevada trombogenicidad sanguínea existente bajo estas condiciones puede exacerbar la formación trombótica y es capaz de desencadenar un síndrome coronario agudo (SCA). El endotelio vascular regula la actividad contráctil, mitogénica y trombótica de la pared vascular. Los factores de riesgo alteran la homeostasis y la hemostasis de la pared vascular y promueven las señales inflamatorias. Se activan las plaquetas y los monocitos, lo que favorece la expresión del factor tisular (FT), desencadenando la cascada de coagulación con la generación de trombina y la formación del trombo vascular. La hipertrombogenicidad sanguínea vinculada a los factores de riesgo podría estar mediada por los valores elevados de FT circulante, que son muy superiores a los que presentan los sujetos sanos sin factores de riesgo. Estas observaciones enfatizan la necesidad de un manejo agresivo de los factores de riesgo y de futuros estudios dirigidos a conseguir estrategias terapéuticas que inhiban la expresión del FT.

Recent advances in basic science have linked some systemic risk factors to endothelial dysfunction which gives rise to atherosclerotic disease and triggers the progression of thrombotic complications. Superficial erosion of the stenotic plaque can be observed in one-third of acute coronary syndromes (ACS). In these cases the presence of classic risk factors such as diabetes mellitus, hypercholesterolemia and smoking favor a state of «vulnerable blood» or high risk. Increased thrombogenicity can exacerbate thrombus formation and is able to trigger an ACS. The vessel endothelium regulates contractile, mitogenic and thrombotic activities of the vessel wall. Risk factors impair both homeostasis and hemostasis of the vessel wall and promote inflammatory signals. Platelet and monocyte activation favors the expression of tissue factor (TF), thus triggering the coagulation cascade with thrombin generation and clot formation. Increased blood thrombogenicity linked to classic risk factors may be associated with circulating TF levels which are much higher than those observed in healthy subjects without risk factors. These observations not only emphasize the usefulness of aggressive management of risk factors but open a new avenue for future studies to devise therapeutic strategies to treat ACS by inhibiting TF expression.

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Papel de los factores de riesgo en la trombogenicidad sanguínea y los síndromes coronarios agudosRole of coronary risk factors in blood thrombogenicity and acute coronary syndromes

J Am Coll Cardiol

Atherosclerosis

J Am Coll Cardiol

J Am Coll Cardiol

Atherosclerosis

Cell

J Am Coll Cardiol

J Am J Cardiol

Metabolism

J Am Coll Cardiol

J Am Coll Cardiol

Blood

Lancet

J Am Coll Cardiol

Am Heart J

The pathogenesis of coronary artery disease and the acute coronary syndromes

N Engl J Med

Atherosclerosis an inflammatory disease

N Engl J Med

Inflammation and atherosclerosis

Circulation

Coronary risk factors and plaque morphology in men with coronary disease who died suddenly

N Engl J Med

Role of risk factors in the modulation of tissue factor activity and blood thrombogenicity

Circulation

Tissue factor modulates the thrombogenicity of human atherosclerotic plaques

Circulation

Coronary plaque erosion without rupture into a lipid core: a frequent cause of coronary thrombosis in sudden coronary death

Circulation

Diabetes and cardiovascular disease. The Framingham study

JAMA

Estimation of contribution of changes in classic risk factors to trends in coronary events rates across the WHO MONICA Project population

Lancet

Activation of the tissue factor pathway of blood coagulation during prolonged hyperglycemia in young healthy men

Diabetes

Nitric oxid: physiology, pathophysiology and pharmacology

Pharmacol Rev

Activated transcription factor nuclear factor-kappa B is present in the atherosclerotic lesion

J Clin Invest

On behalf of the GISSI-2 Investigators. Influence of diabetes on mortality in acute myocardial infarction: data from the GISSI-2 Study

J Am Coll Cardiol

Coronary composition and macrophage infiltration in atheromy specimens from patients with diabetes mellitus

Circulation

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Circulation

Thromboxane biosynthesis and platelet function in type II diabetes mellitus

N Engl J Med

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Diabetes