Climaterio para el manejo clínico de la mujer climatérica, Riesgo Cardiovascular

b. Riesgo cardiovascular.

b1. Cambios de estilos de vida33-36:

• Actividad física. Mejora los factores de riesgo CV. Disminuye hasta en 43% el riesgo coronario.
• Dieta. El riesgo coronario disminuye 4% por cada fruta o porción de verdura que se ingiera al día.
• Cigarrillo. Aumenta el riesgo de eventos coronarios y cerebro-vasculares. El aban-dono del hábito provoca una reducción de 36% en la mortalidad coronaria.

b2. Terapias farmacológicas37-40:
• Dislipidemia. Estatina, fibratos.
• Hipertensión arterial. Hipotensores, diuréticos.
• Resistencia a insulina. Metformina.
• Obesidad. Sibutramina, orlistat.

c. Riesgo de Osteoporosis.
c1. Cambios de estilos de vida41-44:

• Actividad física. Caminar 4 hrs. a la semana disminuye el riesgo de fractura en 41%.
• Mayor exposición al sol. Las personas que sufren fracturas tienen menos exposi-ción al sol (Vit D).
• Disminuir cigarrillos. Fumar se asocia con mayor riesgo de fractura (RR: 1,25; IC 95%:1,15- 1,36).

c2. Calcio y Vitamina D (45-46):

• Tienen un efecto positivo sobre la densidad ósea y cierta tendencia a reducir fracturas vertebrales; no es claro si disminuyen las fracturas no vertebrales.
• Para lograr efectos terapéuticos las evidencias sugieren dosis de 1200 mg. de Ca y 800 UI de vitamina D al día.

c3. Terapias farmacológicas47-48:
• Alendronato, calcitonina, risedronato y raloxifeno disminuyen fracturas vertebrales. Alendronato y risedronato disminuyen el riesgo de fracturas de cadera.
• Alendronato disminuye 45% el riesgo de fracturas vertebrales. La reducción de fracturas de cadera es de 40%, pero sólo en prevención secundaria.
• La TH y la Tibolona son también otras opciones terapéuticas válidas.

Conclusión. Mejorar los estilos de vida y aplicar terapias farmacológicas son terapias efectivas para prevenir el deterioro de la calidad de vida y el aumento de las enfermedades crónicas que se asocian con la menopausia.

Conclusiones

1. Evaluar en toda mujer climatérica la cali-dad de vida y el riesgo de enfermedades crónicas.
2. Si hay deterioro clínico indicar terapias.
3. Las principales medidas terapéuticas son mejorar los estilos de vidas y las terapias farmacológicas específicas.

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