Evaluation of the participation of ABCA1 transporter in epicardial and mediastinal adipose tissue from patients with coronary artery disease

ABSTRACT Objective: Recent studies have shown a relationship between adipose tissue and coronary artery disease (CAD). The ABCA1 transporter regulates cellular cholesterol content and reverses cholesterol transport. The aim of this study was to determine the relationship between single nucleotide polymorphisms (SNPs) R230C, C-17G, and C-69T and their expression in epicardial and mediastinal adipose tissue in Mexican patients with CAD. Subjects and methods: The study included 71 patients with CAD and a control group consisting of 64 patients who underwent heart valve replacement. SNPs were determined using TaqMan probes. mRNA was extracted using TriPure Isolation from epicardial and mediastinal adipose tissue. Quantification and expression analyses were done using RT-qPCR. Results: R230C showed a higher frequency of the GG genotype in the CAD group (70.4%) than the control group (57.8%) [OR 0.34, 95% CI (0.14-0.82) p = 0.014]. Similarly, C-17G (rs2740483) showed a statistically significant difference in the CC genotype in the CAD group (63.3%) in comparison to the controls (28.1%) [OR 4.42, 95% CI (2.13-9.16), p = 0.001]. mRNA expression in SNP R230C showed statistically significant overexpression in the AA genotype compared to the GG genotype in CAD patients [11.01 (4.31-15.24) vs. 3.86 (2.47-12.50), p = 0.015]. Conclusion: The results suggest that the GG genotype of R230C and CC genotype of C-17G are strongly associated with the development of CAD in Mexican patients. In addition, under-expression of mRNA in the GG genotype in R230C is associated with patients undergoing revascularization.

La importancia de la determinación de la deuda de oxígeno en el perioperatorio / The importance of oxygen debt determination in the perioperative period

Resumen: El fenómeno de la deuda de oxígeno (dO2) descrito hace varias décadas en el contexto del ejercicio físico se ha incorporado progresivamente al terreno de la medicina. En particular se ha utilizado durante los cambios hemodinámicos producidos por la cirugía y la anestesia en los pacientes de alto riesgo. La dO2 se definió como el aumento en la cantidad de oxígeno consumida por el organismo inmediatamente después de realizar un ejercicio físico hasta que el consumo se normaliza nuevamente. En el perioperatorio se llega a producir cuando se presenta un desbalance entre la oferta (DO2) y la demanda de oxígeno (VO2) que lleva a hipoxia tisular. El grado de la dO2 tisular se ha relacionado directamente con la falla de órganos múltiples y morbimortalidad perioperatoria. A pesar de los avances en la medicina, aún no es posible prevenir o disminuir la dO2 con la administración de líquidos o con el uso de agentes vasoactivos. Por lo que un retardo o manejo inadecuado de la hemodinámica perioperatoria producirá hipoperfusión e hipoxia tisular afectando los resultados de la cirugía. El conocimiento y la valoración de la dO2 es esencial durante la anestesia del paciente de alto riesgo. Para lograr este objetivo se requiere del uso de índices adecuados que permitan detectar y cuantificar la hipoperfusión tisular y el desbalance entre la DO2 y la VO2. En esta revisión se presentan los conceptos fundamentales de la dO2, su mecanismo, detección y cuantificación; además de las intervenciones para evitarla o disminuirla y las recomendaciones para los anestesiólogos con el fin de asegurar mejores resultados en los pacientes quirúrgicos de alto riesgo.

Abstract: The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.

La lesión miocárdica en el perioperatorio de cirugía no cardíaca / Myocardial injury in the perioperative period of non-cardiac surgery

Resumen: Estudios recientes sobre las causas de muerte en el postoperatorio de cirugía no cardíaca han identificado a la lesión miocárdica como una complicación que se asocia con eventos cardíacos adversos mayores que aumentan la mortalidad a 30 días. La lesión miocárdica se manifiesta como una elevación de las troponinas cardíacas que se produce durante o a los 30 días después de la cirugía, sin que los pacientes presenten síntomas y sin cambios en el electrocardiograma de superficie. En la actualidad, se busca mejorar el diagnóstico oportuno de esta complicación y desarrollar terapias preventivas. En esta revisión abordamos la evidencia de esta lesión, sus mecanismos fisiopatológicos y su manejo.

Abstract: Recent studies on the death causes in the postoperative period of non-cardiac surgery have identified myocardial injury as a complication that is associated with major adverse cardiac events that increase mortality at 30 days after surgery. This kind of myocardial lesion is characterized by the elevation of the cardiac troponins levels during or in the 30 days after the surgery, without symptoms ischemia or changes in the electrocardiogram. Currently, one main goal has been the timely diagnosis of this complication, besides preventive therapies development. The present review article examines the current body of knowledge of this injury, the physiopathological mechanisms and its management.

Modificación de los niveles excretados por orina de angiotensina II y angiotensina-(1-7) en pacientes con estenosis aórtica grave o crítica, sometidos a reemplazo valvular aórtico / Modification of levels excreted by urine of angiotensin II and angiotensin- (1-7) in patients with severe or critical aortic stenosis, undergoing aortic valve replacement

Antecedentes: La postcarga elevada y el sistema renina angiotensina aldosterona (SRAA) se han relacionado a la progresión de la enfermedad en estenosis aórtica, pero su elemento contra regulador, la angiotensina-(1-7), no ha sido estudiada en este contexto. Objetivo y Metodología: Establecer si existe diferencia significativa a través de prueba U de Mann-Whitney en las concentraciones urinarias de angiotensina-(1-7) y angiotensina-II de pacientes con estenosis aórtica de importante repercusión hemodinámica y sin disfunción contráctil del ventrículo izquierdo (Grupo A), en comparación con sujetos normales (Grupo C) y con sujetos sometidos a reemplazo valvular aórtico en condiciones de sobrecarga hemodinámica similar al grupo de casos (Grupo B)...

Myocardial postconditioning: anesthetic considerations / Posacondicionamiento miocárdico: consideraciones anestésicas

Recently, it has been shown that the heart can be protected against the ischemia-reperfusion injury if brief coronary occlusions are performed just at the beginning of the reperfusion. This procedure has been called postconditioning (PostC). It can also be elicited by pharmacologicalinterventions, which are named pharmacological PostC. In general, PostC reduces the reperfusion-induced injury, blunts oxidant-mediated damages and attenuates the local inflammatory response to reperfusion, decreases infarct size, diminishes apoptosis, neutrophil activation, and endothelial dysfunction. The mechanisms that participate in PostC are still not completely understood. In this regard, adenosine, glycine, bradykinin, ciclosporin A are involved in PostC triggering. Similar to ischemic preconditioning, PostC triggers several signaling pathways and molecular components, including nitric oxide (NO), protein kinase C, adenosine triphosphate-sensitive potassium channels, the Reperfusion Injury Salvage Kinases (RISK) pathway, which comprises phosphatidylinositol-3-OH kinase (PI3K) and extracellular signal-regulated kinase (ERK 1/2), and, finally, the Survivor Activating Factor Enhancement (SAFE) pathway. In this review, we describe the mechanisms of reperfusion-induced injury as well as the proposed protective pathways activated by PostC, which seem to converge in inhibition of mitochondrial permeability transition pores opening. On the other hand, experimental evidence indicates that volatile anesthetics and opioids are capable of exerting cardioprotective effects under certain conditions, constituting a very useful pharmacological PostC. Thus, the first minutes of reperfusion represent a window of opportunity for triggering the aforementioned mediators, which acting in concert lead to protection of the myocardium against reperfusion injury. Pharmacological, especially anesthetic, PostC may have a promising future in the clinical scenarios in the operating room.

Recientemente, se ha demostrado que el corazón puede protegerse contra el daño por isquemia-reperfusión si se aplican breves oclusiones coronarias justo al inicio de la reperfusión. Este procedimiento ha sido llamado posacondicionamiento y puede ser producido mediante intervenciones farmacológicas, las cuales constituyen el posacondicionamiento farmacológico. En general, el posacondicionamiento reduce el daño inducido por la reperfusión, disminuyendo el daño oxidativo y atenuando la respuesta inflamatoria local durante la reperfusión, así también disminuye el tamaño del infarto, disminuyendo el proceso de apoptosis, la activación neutrofílica y la disfunción endotelial. Los mecanismos que participan en el posacondicionamiento aún no son bien entendidos, aunque se sabe que moléculas como la adenosina, la glicina, la bradicinina y la ciclosporina A están involucradas en la activación del posacondicionamiento. De manera similar al preacondicionamiento isquémico, el posacondicionamiento activa rutas de señalización en las cuales participan diversos componentes moleculares como el óxido nítrico, la proteína cinasa C, los canales sensibles a ATP, la ruta de aumento del factor de activación de sobrevivencia, así como la ruta de las cinasas de salvamento de la lesión por reperfusión las cuales comprenden la cinasa de fosfatidilinositol-3-0H y la cinasa regulada por señales extracelulares. En esta revisión describimos los mecanismos de daño inducido por la reperfusión así como las vías protectoras propuestas activadas por el posacondicionamiento, las cuales parecen converger en una inhibición de la apertura de los poros de transición de la permeabilidad mitocondrial. Por otro lado, la evidencia experimental indica que los anestésicos volátiles y los opiáceos son capaces de ejercer efectos cardioprotectores bajo ciertas condiciones, constituyendo un posacondicionamiento farmacológico muy útil. De esta manera, los primeros minutos de la reperfusión representan una ventana de oportunidad para activar los mediadores antes mencionados, los cuales actúan en concierto para llevar a la protección del miocardio contra el daño por reperfusión. El posacondicionamiento farmacológico especialmente el anestésico puede tener un futuro promisorio en los escenarios clínicos de las salas de operaciones.

Taxus globosa S. cell lines: initiation, selection and characterization in terms of growth, and of baccatin III and paclitaxel production

Of the initial six cell lines originating from explants of Taxus globosa, or Mexican yew (stem internode, leaves and meristematic tissue), three were selected for their microbial and oxidation resistance, two from leaves and the other from stem internode. A study of their behavior, both in terms of cell growth, and of baccatin III and paclitaxel production, was developed in suspension cultures with an initially standardized biomass (fresh weight 0.23 g/L) using modified Gamborg's B5 medium, and an elicitor (methyl jasmonate), on either the first or seventh day of culture, at several levels (0, 0.1, 1, 10, 100 microM). In most of the conditions used, the three cell lines showed growth associated baccatin III production. The cell line from stem internode was the highest producer of baccatin III using 1 microM elicit or, sampling at 10 days.

Antiarrhythmic and cardioprotective effects of remifentanil in anesthetized dogs / Efectos antiarrítmicos y cardioprotectores de remifentanil en perros anestesiados

OBJECTIVE: To study the antiarrhythmic effect of remifentanil in experimental arrhythmias in dogs. METHODS: We used dogs weighing 12 kg-18 kg anesthetized with 30 mg/kg sodium pentobarbital given intravenously. Ventricular arrhythmia, ventricular fibrillation and death were induced with digoxin (9 microg/kg/min). In another model, two types of arrhythmia were induced in the right atrium, one of them with aconitine crystals placed on the right atrium and the other was induced in the basement of the right atrium by electrical stimulation. The potential antiarrhythmic action of remifentaniL was investigated in ventricular and atrial arrhythmias by the administration of an intravenous bolus after toxic signs were evident. Thus, two arrhythmias with different mechanisms were generated. Leads DII, unipolar left intraventricular and right atrial leads, and left ventricular pressure were used to record control tracings and tracings in presence of remifentanil, during ventricular arrhythmia. RESULTS: Remifentanil abolished toxic effects of digoxin, it eliminated the A-V dissociation and ventricular extrasystoles, reverting to sinus rhythm in each case. Remifentanil extended the time to reach lethal doses from 63.25 +/- 11.3 to 100 +/- 11.8 min. These effects were blocked by naloxone (0.01 microg/kg) applied before remifentanil. In the two arrhythmias model, remifentanil suppressed both, ectopic focus and atrial flutter. CONCLUSIONS: Remifentanil elicits antiarrhythmic and cardioprotective effects in experimental ventricular arrhythmias induced by digoxin and in a model of two atrial arrhythmias induced by aconitine and by electrical stimulation.

Hipertensión arterial sistémica en el embarazo / Hypertension and pregnancy

Increasing evidence indicates that hypertension in pregnancy is an under recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Hipertensión arterial sistémica en la mujer / Hypertension in women

The cardiovascular disease is a crucial cause of morbidity and mortality in the woman mainly when they arrive at menopause. The pathophysiology and neurohormonal mechanisms widely vary with respect to the man. This finding has given the support to think that the estrogens may be playing a protector role in cardiovascular disease. However, the associated risk factors like obesity, diabetes, dislipidemia, smoking and sedentary life are increasing in an exponential form. In Mexico the population age distribution establishes that 60% of the women with hypertension are aged < 54 years old. This is reason why as factor of independent cardiovascular risk is commonest. Nevertheless, after the menopause cardiovascular mortality is greater in the woman than in the man. In this review, the importance of the new pathophysiological mechanisms and the clinical-therapeutic approach are analyzed, making emphasis in the importance of the change in the life style and also in the nutritional aspects. In Mexico the woman still have a unique role in the nutritional culture.

Abordaje clínico terapéutico del paciente adulto mayor con hipertensión arterial sistémica: recomendaciones para la práctica clínica / Therapeutic clinical approach for the elderly patient with hypertension: recommendations for clinical practice

The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.

Elevación extrema de la presión arterial (crisis hipertensiva): recomendaciones para su abordaje clínico-terapéutico / Extreme elevation of the blood pressure (hypertensive crisis): recommendations for its clinical-therapeutic approach

From beginnings of last century the hypertensive emergency was defined as the association of acutely elevation from the arterial pressure and the appearance of damage to end organ. At present is recognized the effects of the hypertensive emergency, the aspects of its patophysiology in which are included phenomenon of vasomotricity and the participation of different substances with vasoactives properties. The clinical presentation includes not only the manifestations of the increase of the arterial pressure, the end organ damage too; for this reason the hypertensive emergency needs the immediate reduction of the arterial tension to prevent the damage to specific organs. The treatment in every case will have to be individualized, with a wide knowledge of the characteristics of every medicament to obtain the best results. The diagnosis and treatment of the hypertensive emergencies needs often of the attention of its complications if they have appeared and later, of a treatment of support for the arterial hypertension.

Prevención y tratamiento de la hipertensión arterial sistémica en el paciente con enfermedad arterial coronaria / Prevention and treatment of hypertension and coronary heart disease

The association between arterial systemic hypertension arterial coronary disease has been demonstrated by cumulated evidence of several epidemiological studies. Hypertension is an important independent risk factor for the development of coronary artery disease, vascular cerebral disease and nephropathy. Important advances exist in the knowledge of neurohumoral and hemodynamic factors that come together in the pathophysiology of the hypertension and in the development of coronary disease that allow to establish better strategies not only of treatment, but also of prevention, with the purpose of diminishing the cardiovascular mortality. The spectrum of the coronary artery disease secondary to atherosclerosis is wide and the strategies of treatment of hypertension must be adapted to each particular case. The treatment of both conditions needs of specific limits of agreement to the conditions of the patient and the form of presentation of each one of these disease.

Guías clínicas para la detección, prevención, diagnóstico y tratamiento de hipertensión arterial sistémica en México (2008) / Clinical guidelines for detection, prevention, diagnosis and treatment of systemic arterial hypertension in Mexico (2008)

The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology [quot ]Ignacio Chávez[quot ] presents its update (2008) of [quot ]Guidelines and Recommendations[quot ] for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). [quot ]We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases[quot ]. In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes that hypertension is not an isolated disease; therefore its approach must be in the context of the prevalence and interaction with other cardiovascular risk factors such as obesity, diabetes, dislipidemia and smoking among others. The urgent necessity is emphasized to approach in a concatenated form the diverse cardiovascular risk factors, since independently of which they share common pathophysiological mechanisms, its suitable identification and cont

Remodelación cardíaca e inflamación / Cardiac remodeling and inflammation

The cardiac remodeling is a progressive response of the heart to acute and chronic insults regardless its etiology. This process is characterized by changes in the size, shape and function and is associated with a worse prognosis in patients with heart failure. The acute myocardial infarction is the most common cause of remodeling. In the first minutes after injury in the ischemic zone there is an important augment in the synthesis and release of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) interleukin-6 (IL-6), interleukin-1-beta (IL-1beta) and transforming growth factor 1-beta (TGF-1beta). This acute releasing of cytokines could regulate the survival or apoptosis of myocytes in infarcted zone and, their negative inotropic effects could represent an adaptative response to delimit the injury and to decrease myocardial energy demand. This significant upregulation of proinflammatory cytokines can extend to noninfarcted zone and triggers a second phase of elevated levels of cytokines that promote interstitial fibrosis and collagen deposition in the contralateral noninfarcted myocardium leading to a dysfunctional ventricle. This article will review the recent reports that support the idea of a cardioprotective role for this early inflammatory response and a deleterious role of the delayed response that mediate the fibrosis that is a typical feature of the remodeling process.

Cultivo in vitro de patrones de cítricos tolerantes al virus de la tristeza, empleando sustratos inertes alterativos al agar / Tissue cultive of citrus rootstocks tolerant to citrus trieteza virus, using inert substrates as substitutes for agar

Se evaluó el efecto de los sustratos agrolita, vermiculita y tezontle como sustitutos del agar en la germinación, multiplicación, enraizamiento y sobrevivencia de plántulas de los portainjertos tolerantes al virus de la tristeza de cítricos (VTC) Citrus volkameriana, Citrumelo swingle y Citrange 35. El medio de cultivo utilizado fue el Murashige y Skoog (MS) adicionado en la etapa de multiplicación con 3 por ciento de sacarosa, vitaminas y BAP (1mgúl-1). En el enraizamiento se diluyeron las sales MS y la sacarosa al 50 por ciento de su concentración, adicionándole también 2,5mgúl-1 de AIB y vitaminas. El porcentaje de germinación, multiplicación y enraizamiento fue de 96-100, 95-100 y 93-100 por ciento, respectivamente, en todos los sustratos utilizados, al igual que en el agar, no mostrando diferencias estadísticas (P>0,05). Se observó una frecuencia de dos brotes por explante en todos los tratamientos. La sobrevivencia fue superior estadísticamente (P<0,05) en las plántulas que provenían del medio de cultivo con sustratos inertes (91-100 por ciento) en relación a los brotes enraizados con agar (48-5 por ciento). Los sustratos inertes evaluados pueden sustituir como medio de soporte al agar en el cultivo de tejidos, reduciendo el costo y mejorando la sobrevivencia de las plántulas

Hipercolesterolemia e hipertensión arterial en México: Consolidación urbana actual con obesidad, diabetes y tabaquismo / Hypercholesterolemia and hypertension in Mexico: urban conjunctive consolidation with obesity, diabetes and smoking

Se llevó a cabo una encuesta en los estados de la República Mexicana, donde existe la mayor concentración poblacional, con el propósito de profundizar en el conocimiento de la prevalencia y la forma de interacción de factores de riesgo cardiovascular como hipercolesterolemia (HCL), hipertensión arterial sistémica (HTA), obesidad, trastornos del metabolismo de carbohidratos y tabaquismo. La encuesta es de carácter transversal, tipo III de la OMS e incluyó a 120,005 personas, de 6 centros urbanos de gran población (México, D. F., Guadalajara, León, Puebla, Monterrey y Tijuana). A cada persona se le extrajo una muestra de sangre para la determinación capilar de glucosa y colesterol. La presión arterial, la estatura y el peso se midieron con sistemas validados previamente. Los datos recabados se sometieron a análisis multicategórico mediante el método de consolidación conjuntiva y también a un modelo analítico de regresión múltiple. La prevalencia global de HCL (colesterol ≥ 200 mg/dL) resultó ser de un 43.3% para una población con edad promedio de 44.1 años. El género femenino mostró una prevalencia de HCL ligeramente mayor que en el género masculino (44% vs 42.2%) pero estadísticamente significativa. El 33.2% de las mujeres encuestadas declararon ser menopáusicas y en este grupo, la prevalencia de HCL se incrementó en forma significativa al 59.7% (p < .05). La prevalencia de HCL se encontró en relación directa con el índice de masa corporal (IMC), el subgrupo de IMC de < de 25 tuvo una prevalencia de HCL de 34.1%; las personas con IMC de entre 25 y 29.9 tuvieron una prevalencia de HCL de 45.9% y el de IMC de 30 o más alcanzó una prevalencia de HCL de 47.3%. De toda la población encuestada, 30.2% fueron portadores de HTA y de ellos el 52.5% tuvo HCL. Además, hubo correlación entre la severidad de la HTA y el nivel de HCL. La prevalencia de diabetes mellitus tipo 2 (DM-2) fue del 10.7%, en este subgrupo, la prevalencia de HCL fue del 55.2%. El análisis por consolidación conjuntiva indica que para el grupo de edad entre 20 y 34 años, el impacto de la obesidad es determinante crucial de la mayor prevalencia de HCL. La prevalencia de HCL en este estudio resultó de proporciones similares en la población con y sin tabaquismo. En conclusión la prevalencia de HCL presenta cuatro gradientes de cambio porcentual muy importantes en función de los grupos de edad, de la presencia de HTA, de DM-2 y de IMC.

Aims: To know the prevalence and the interaction among the principal cardiovascular risk factors such as hypercholesterolemia (HCL), hypertension (HTA), overweight, carbohydrates metabolism disturbances, and smoking, an urban survey was performed in the six Mexican Republic states, where the national population is more concentrated. Methods: This survey was transversally designed using the WHO type-III model in 120,005 adults from 6 highly populated urban centers (Mexico City, Guadalajara, León, Puebla, Monterrey and Tijuana) were included. A blood sample from each person was obtained to quantify fasting glucose and cholesterol. Blood pressure, height and weight were measured using daily validated systems. Data were analyzed by a multicategorical conjunctive consolidation model and by multiple regression models. Results: HCL global prevalence showed to be 43.3% for a population with an average age of 44.1 years. Female gender showed a slightly but statistically significant greater prevalence of HCL than male gender (44% vs42.2%). From whole women population 33.2% declared to be in menopause, and 59.7% of them had HCL. In addition, HCL was directly related to body mass index (BMI). Thus, in those subjects with BMI < 25 showed a HCL prevalence 34.1%; while those with BMI was between 25 and 29.9, the HCL prevalence was 45.9%, and in those subjects with BMI ≥ 30 Kg/m², ranked a HCL prevalence of 47.3%. The prevalence of hypertension was 30.2% and 52.5% of them had HCL prevalence. Type-2 diabetes mellitus prevalence (DM-2) was 10.7%, 55.2% of them had HCL. In the group aged between 20 to 34 years old, the obesity was the principal determinant for higher HCL prevalence. The HCL prevalence showed to be quite similar in population with and without smoking. In conclusion, HCL prevalence shows 4 progressively increasing gradients associated with age, HTA, DM-2 and BMI.

Análisis de la permeabilidad por trombolisis de la arteria responsable de infarto miocárdico agudo / Analysis of reperfusion of the culprit coronary artery after thrombolysis in acute myocardial infarction

Objetivo: Analizar el papel que juega el grado de permeabilidad de la arteria responsable del IAM en su evolución y su mortalidad, además de determinar su relación con los criterios clínicos de reperfusión. Material y métodos: Se estudiaron los pacientes con diagnóstico de IAM, en quienes se administró terapia trombolítica y que fueron llevados a coronariografía. Se utilizó la escala angiográfica del estudio TIMI para valorar el grado de permeabilidad de la arteria. Resultados: De un total de 473 pacientes con el diagnóstico de IAM, se realizó coronariografía a 377 (80 por ciento), la cual se efectuó en los primeros cinco días. Como arterias responsable del IAM la más frecuente fue la DA en 168 pacientes (45 por ciento) y la CD en 139 (36 por ciento). Observamos que el vaso se encontró permeable en 276 pacientes (73 por ciento); con flujo TIMI 1 en 30 enfermos; con TIMI 2 en 97 y TIMI 3 en 148 y en 102 pacientes existió oclusión total de la arteria. En los infartos de localización anterior las arritmias de reperfución que se presentaron con mayor frecuencia con arteria permeable ventricular no rápida y la taquicardia ventricular (54 por ciento). La fibrilación ventricular se presentó en seis pacientes, de éstos en cinco con flujo TIMI 2 o 3. En los infartos de localización inferior, se observó la extrasistolia ventricular y la taquicardia ventricular no rápida en el 25 por ciento. En los pacientes en los que se observó permeabilidad de la arteria, existió una disminución del desnivel del segmento ST significativa en 159 enfermos (42 por ciento) y existió lavado enzimático en 191 pacientes (51 por ciento). De los enfermos en los que se demostró oclusión total de la arteria, 21 (30 por ciento) cursaron con disfunción ventricular izquierda y de éstos, seis evolucionaron hacia el choque cardiogénico. De los sujetos en los que se observó permeabilidad del vaso, sólo el 2 por ciento presentó choque cardiogénico. La mortalidad se relacionó con mayor frecuencia a IAM anterior y a la oclusión completa de la arteria. Por lo que el análisis de la evolución clínica es el marcador que más orienta a realizar arterografía coronaria temprana en aquellos enfermos donde la evolución no sea favorable, con miras a buscar otras alternativas terapeúticas