Outcome ipertensione arteriosa
T ABELLA 43: T ABELLA RIASSUNTIVA DEL RUOLO DELLA TERAPIA PER L ’ ACROMEGALIA NELL ’ INFLUENZARE LA COMPARSA DEI VARI OUTCOME PRESI IN ESAME IN QUESTO STUDIO
Outcome considerato Influenza sulla comparsa Influenza sui tempi di comparsa
Ipertensione arteriosa SI SI
Diabete e prediabete SI SI
Ipercolesterolemia SI NO
Ipertrigliceridemia SI NO
Iperuricemia SI SI
Più complesso è discriminare quanto della differenza tra i due gruppi di terapia sia attribuibile all’azione diretta dell’analogo della somatostatina e quanto sia attribuibile al peggior controllo di malattia che, per la modalità con cui si somministrano questi farmaci e per la modalità con cui abbiamo suddiviso i pazienti entro i gruppi terapeutici, è maggiormente associato al raggruppamento della terapia medica. Nello specifico, un ruolo diretto del farmaco è ravvisabile per il diabete e il prediabete, per l’ipertrigliceridemia e, sebbene in misura minore, per l’ipercolesterolemia; il ruolo del farmaco per l’ipertensione arteriosa e per l’iperuricemia pare invece essere indiretto, ovvero riconducibile al peggior controllo di malattia.
98 Successivamente si è condotta un’analisi sullo sviluppo di eventi cardiovascolari per valutare quanto influiscono su di essi la terapia per l’acromegalia e le complicanze sistemiche già prese in esame come outcome nella prima parte dello studio: non si è vista un’influenza diretta da parte della terapia per l’acromegalia; si è invece visto che le complicanze sistemiche considerate hanno un’influenza sullo sviluppo di questi eventi cardiovascolari, influenza che appare tuttavia mitigata dall’utilizzo di terapie specificamente dirette contro di essi.
Una moderna gestione multidisciplinare dell’acromegalia è volta non soltanto alla correzione dell’iperincrezione del GH, ma anche ad agire mediante trattamenti dedicati sulle specifiche alterazioni provocate dalla malattia: è questo che permetterebbe di ridurre il rischio di eventi cardiovascolari, che sono favoriti dalle complicanze sistemiche della malattia, complicanze il cui sviluppo è influenzato dal tipo di terapia a cui il paziente viene sottoposto.
In conclusione si può dire che la terapia a cui vengono sottoposti i pazienti acromegalici ha un’influenza sullo sviluppo di fattori di rischio cardiovascolare, ma che essa, grazie anche al controllo di questi fattori mediante terapie dedicate, non si traduce in differenze significative nel realizzarsi degli eventi avversi presi in esame.
99
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