Disfunción Endotelial como Eje Fisiopatológico común en Enfermedades Crónicas No Transmisibles: Una Revisión Narrativa con Perspectiva desde la Atención Primaria
Resumen
Antecedentes. Las enfermedades crónicas no transmisibles (ECNT) concentran la mayor carga global de mortalidad prematura y discapacidad ajustada por años de vida (AVAD). Pese a su heterogeneidad clínica, comparten un sustrato fisiopatológico recurrente: la disfunción endotelial (DE), entendida como la pérdida del fenotipo vasodilatador, antiinflamatorio, antitrombótico y antiproliferativo del endotelio. Objetivo. Sintetizar críticamente la evidencia que sustenta a la DE como eje patogénico común a las principales ECNT —hipertensión arterial (HTA), diabetes mellitus tipo 2 (DM2), enfermedad cardiovascular aterosclerótica (ECVA), insuficiencia cardíaca con fracción de eyección preservada (ICFEp), enfermedad renal crónica (ERC), enfermedad pulmonar obstructiva crónica (EPOC), enfermedades reumáticas inmunomediadas (ERIM), obesidad/síndrome metabólico y secuelas post-agudas de COVID-19 (PASC)— y derivar implicaciones operativas para la atención primaria con énfasis en el contexto latinoamericano. Métodos. Revisión narrativa estructurada con búsqueda no sistemática en PubMed/MEDLINE, Scopus, EMBASE, Cochrane y LILACS (enero 2010–enero 2026; última actualización 30 de abril de 2026). Se priorizaron metaanálisis, ensayos clínicos pivotales, guías de práctica clínica vigentes (EULAR 2022, ESC 2024, ADA 2026, KDIGO 2024) y evidencia mecanística posterior a 2020. Resultados. La DE puede conceptualizarse como un cuarteto mecanístico unificado: (i) reducción de la biodisponibilidad de óxido nítrico (NO) por desacoplamiento de eNOS y aumento de especies reactivas de oxígeno (ROS); (ii) inflamación vascular crónica de bajo grado mediada por NF-κB, inflamasoma NLRP3 e interferón tipo I; (iii) deterioro del glicocálix y pérdida de la integridad de la barrera endotelial; y (iv) senescencia endotelial con fenotipo secretor asociado a senescencia (SASP) y transición endotelio-mesenquimal (EndMT). Tres moduladores emergentes —el eje microbiota-intestino-endotelio, la regulación epigenética (miRNAs, lncRNAs) y la cronobiología endotelial— actúan como integradores upstream. Estos mecanismos son detectables antes de la enfermedad clínicamente manifiesta y constituyen dianas explotadas por estatinas, inhibidores del SRAA, iSGLT2, agonistas del receptor GLP-1, sacubitril/valsartán, finerenona, colchicina e inhibidores de PCSK9, con evidencia traslacional creciente en 2023–2026. Conclusiones. La DE constituye un punto de convergencia mecanística que justifica una aproximación clínica integradora desde la atención primaria. Su consideración explícita en la estratificación de riesgo, la selección farmacoterapéutica y la educación al paciente con multimorbilidad cardiometabólica abre oportunidades para una medicina preventiva basada en mecanismos compartidos, particularmente relevante en escenarios latinoamericanos con transición epidemiológica acelerada y recursos diagnósticos limitados.
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Derechos de autor 2026 Brenda Natalia Leon Osorio, Luisa Fernanda Remolina Yáñez, Maria Catalina Vargas Quintero, Anggie Marcela Rueda Riaño , Juan Nicolás Ortiz Beltrán , Daniel Esteban Vega López , Michel Jousep Chedraui Ardila , Antonia Isabella Manrique Acosta
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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