RIESGO CARDIOVASCULAR 1- Interpretación de analíticas sanguíneas para entrenadores

Biomedicina-fisiología, Interpretación de analíticas para entrenadores | 32.559 Comentarios

BIOMARCARDORES RELACIONADOS CON EL RIESGO CARDIOVASCULAR:

 

Las enfermedades cardiovasculares ocupan un lugar en el pódium de las patologías que más afectan a los países occidentales.

Por desgracia se hace un enfoque demasiado simplista a la hora de prevenir su aparición e incluso durante su tratamiento.

El control periódico de los biomarcadores que nos dan información sobre el grado de riesgo de accidente cardiovascular es muy importante. Algo tan sencillo como realizar una analítica sanguínea o dos al año puede darnos información muy útil para prevenir y tratar este tipo de enfermedades.

Concretamente hablamos de los ácidos grasos plasmáticos y de las proteínas y lipoproteínas que los transportan. Estos marcadores nos dan información de gran utilidad tanto clínica como a la hora de controlar la progresión del programa de ejercicio.

 

COLESTEROL TOTAL

 

El colesterol total el colesterol total, que ha sido durante mucho tiempo el principal exponente de esta categoría, aunque actualmente esta tendencia está evolucionando un enfoque más completo.

Este valor se compone de la suma de los valores de los parámetros de colesterol HDL (high density lipoprotein) comúnmente conocido como colesterol ‘bueno’), y  los valores del LDL (low density lipoprotein, conocido popularmente como colesterol “malo”.

La suma de ambos parámetros nos da el colesterol total.

Como valor de referencia, ese colesterol total se estima que debe de estar por debajo de 200 miligramos decilitro (<200 mg/dl). A pesar de ello, como veremos un poco más adelante, esto criterio está dejando de ser entendido cómo un válido de forma universal.

 

HDL, LDL y TRIGLICERIDOS

 

Se ha demostrado que existe una relación inversa entre la concentración del colesterol vehiculizado por las lipoproteínas de alta densidad (HDL-colesterol) y la incidencia de enfermedad coronaria.

Ya hemos comentado que al HDL se le denomina como “colesterol bueno” y al LDL se le denomina “colesterol malo”. Realmente la interpretación en este en ese sentido es bastante  simplista o desacertada.

Estas  lipoproteínas de alta densidad HDL o de baja densidad LDL nos van a dar información sobre la el nivel de peroxidabilidad de los ácidos grasos que transportan. En otras palabras, nos indican “la calidad” del colesterol sanguíneo.

En función de su densidad las lipoproteínas tendrán una facilidad mayor o menor de oxidarse, siendo mayor la probabilidad, cuanta menor densidad tienen.

Explicándolo de una manera sencilla, podemos decir que el HDL protege y cuida el tejido endotelial (recubrimiento de las paredes arteriales) y que el LDL tiene mayor capacidad de producir daño en endotelial*  y de unirse con iones de calcio circulantes a nivel sanguíneo, provocando la placa de ateroma. **

*Nota del autor: Existen diversas lipoproteínas de baja densidad y cada una de ellas tiene un efecto diferente con respecto al daño endotelial, este epígrafe no trata sobre fisiopatología cardiovascular y no debe ser tomado al pie de la letra.

**Nota del autor: Este es un proceso bastante más complejo en el que intervienen diferentes órganos y sustancias, pero para el tema que nos ocupa en este epígrafe esta explicación nos sirve como orientación.

Es importante mencionar que no sólo importa la cantidad de LDL, sino también su calidad determinada por el tipo de lipoproteína de baja densidad que sea. Cómo estos valores nos suelen aparecer en las analíticas sanguíneas no entraremos en mayor en profundidad.

 

Valores de referencia HDL:

  • Hombres > 40 mg/dl (1.0 mmol/L)
  • Mujeres > 50 mg/dL (1.3 mmol/L)

Valores de referencia LDL:

  • <130-159 mg/dL

Valores de referencia Trygliceridos:

  • <150 mg/dl

Atendiendo a estos valores, la primera valoración que podríamos hacer es la comparar HDL y LDL. Siempre será un mal signo tener valores de HDL por debajo del rango de normalidad, pero esto empeora si los valores de LDL están en el rango superior o incluso por encima del rango de normalidad. En estos casos, podemos concluir que existe riesgo cardiovascular.

A esto habría que añadirle los valores de triglicéridos marcados como normalidad por debajo de 150 mg/dl. Realmente estos son los valores que ya de por sí nos dan una información importante y que pueden servir para emitir un juicio clínico, cosa que no es nuestro cometido como entrenadores.

Si prestamos atención a la interrelación existente entre cada uno de ellos vamos a obtener información de mayor calidad. De esta manera se establecen unas ratios para detectar factores de riesgo cardiovascular.

LA IMPORTANCIA DE SABER RELACIONAR CONCEPTOS

 

Es fundamental que entendamos que, para prevenir y tratar estas patologías, es importante conocer y evaluar la relación que existe entre todos estos biomarcadores.

Más allá del valor reflejado en las analíticas de cada uno de ellos, debemos calcular una serie de ratios que nos den información de tipo cualitativo. Es decir, lo importante es conocer la calidad de esos biomarcadores y las proporciones en las que están presentes en sangre.

Si somos capaces de realizar estos sencillos cálculos veremos como no siempre es importante o prioritario bajar el nivel de colesterol total por debajo de 200 mg/dl, sino reajustar las proporciones de HDL/LDL y triglicéridos.

Esto es sólo un ejemplo de las ratios que podemos calcular.

En próximas entradas hablaremos sobre cada una de estas ratios y que implicaciones prácticas tienen sus resultados.

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