Severidad de presentación de acrocordones relacionada al riesgo cardiovascular medido en función de índice de masa corporal y obesidad central / Accuracy of presentation of acrochordons related to cardiovascular risk measured according to body mass index and central obesity

Contexto: los acrocordones son protrusiones benignas de piel presentes en zonas de roce; usualmente acompañan a enfermedades metabólicas. Objetivo: caracterizar la asociación entre la severidad de presentación de acrocordones y el riesgo cardiometabólico medido en función del índice de masa corporal y obesidad central en pacientes mayores de 18 años que acuden a la Consulta de Dermatología Hospital San Francisco de Quito (HSFQ). Sujetos y métodos: pacientes de ambos sexos, mayores a 18 años que acuden espontáneamente a Consulta Externa del Servicio de Dermatología del Hospital San Francisco de Quito, perteneciente al Instituto Ecuatoriano de Seguridad Social, durante los meses septiembre a octubre de 2015. Antecedentes familiares y personales de la enfermedad, medición de peso, talla, perímetro de cintura y presencia de acrocordones (coloración, número y localización) asociados a acantosis nigricans. Resultados: se estudiaron 111 sujetos, con una edad media de 47 años; predominaron pacientes del sexo femenino (60,7%). Se determinó en el 55,9% de casos un índice de masa corporal (IMC) superior a 30 Kg/m2, siendo el fototipo IV más común (59,4%) asociado a obesidad abdominal (69,3%). La zona más afectada es cuello (96,4%); se catalogaron como severos el 75,6% de casos. La prevalencia de acrocordones de coloración mixta y forma severa de la enfermedad estuvo presente en 39 pacientes (29%). Un IMC ≥30 Kg/m2 y la forma severa de acrocordones es considerado un factor riesgo, sin demostrarse asociación estadística (OR 1,83; IC 95% 0,76-4.41). Sujetos con IMC ≥ 30 Kg/m2 tiene mayor riesgo de presentar acrocordones de forma severa asociados a acantosis nigricans (OR 2,62; IC 95% 1,07-6,36). Conclusión: se demostró relación estadística en el grupo de pacientes con obesidad y acrocordones de presentación severa, que presentan acantosis nigricans asociada. (AU)

Context: acrochordons are benign skin protrusions present in areas of friction; they usually accompany metabolic diseases. Ojective: to characterize the association between the severity of the presentation of acrochordons and the cardiometabolic risk measured according to the body mass index and central obesity in patients over 18 years of age who attend the San Francisco de Quito Hospital Dermatology Consultancy (HSFQ). Subjects and methods: patients of both sexes, over 18 years of age, who spontaneously go to the External Consultation of the Dermatology Service of the San Francisco de Quito Hospital, belonging to the Ecuadorian Social Security Institute, from September to October 2015. Main measurements: Family and personal history of the disease, measurement of weight, height, waist circumference and presence of acrochordons (coloration, number and location) associated with acanthosis nigricans. Results: 111 subjects were studied, with an average age of 47 years; female patients predominated (60.7%). A body mass index (BMI) greater than 30 kg / m2 was determined in 55.9% of cases, with phototype IV being the most common (59.4%) associated with abdominal obesity (69.3%). The most affected area is neck (96.4%); 75.6% of cases were classified as severe. The prevalence of acrochordons of mixed coloration and severe form of the disease was present in 39 patients (29%). A BMI =30 Kg / m2 and the severe form of acrochordons is considered a risk factor, without showing a statistical association (OR 1.83, 95% CI 0.76-4.41). Subjects with BMI = 30 Kg / m2 have a higher risk of presenting acrochordons of severe form associated with acanthosis nigricans (OR 2.62, 95% CI 1.07-6.36). Conclusion: Statistical relationship was demonstrated in the group of patients with obesity and acrochordons of severe presentation, who presented associated acanthosis nigricans. (AU)

Analysis of Cardiovascular Risk Factors in Adults with Congenital Heart Disease

BACKGROUND AND OBJECTIVES: The objective of this study was to analyze cardiovascular risk factors in adults with congenital heart disease (ACHD). SUBJECTS AND METHODS: The subjects for this study comprised 135 patients, aged 18 years and above, who visited the ACHD clinic at the Samsung Medical Center and 135 adults with a structurally normal heart who were randomly selected from the Center for Health Promotion during the same period. For the analysis, the ACHD group was further divided into an ACHD group that underwent correction by cardiac surgery and a cyanotic group. RESULTS: The mean (standard diviation) age (years) of patients in the surgically corrected group was 48.4 (10.9) years, while that of patients in the cyanotic group was 43.1 (9.0) years and that of patients in the control group was 47.1 (10.3) years (p=0.042). The adjusted odds ratios (ORs) for past smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and metabolic syndrome were significantly higher in the surgically corrected patients than in the controls. However, the ORs for all variables excluding past smoking were significantly lower in the cyanotic group compared with the control group. After adjustment for age, gender, smoking, alcohol use, and exercise, the ORs for metabolic syndrome were 0.46 (0.35-0.57, p<0.001) and 1.48 (1.14-1.92, p=0.003) in the cyanotic and surgically corrected groups, respectively. CONCLUSION: Cardiovascular risk factors need to be considered in surgically corrected ACHD patients as well as in adults with a structurally normal heart. A further study with a long-term follow-up is needed for developing guidelines for prevention.

Pathway Analysis of Metabolic Syndrome Using a Genome-Wide Association Study of Korea Associated Resource (KARE) Cohorts

Metabolic syndrome (MetS) is a complex disorder related to insulin resistance, obesity, and inflammation. Genetic and environmental factors also contribute to the development of MetS, and through genome-wide association studies (GWASs), important susceptibility loci have been identified. However, GWASs focus more on individual single-nucleotide polymorphisms (SNPs), explaining only a small portion of genetic heritability. To overcome this limitation, pathway analyses are being applied to GWAS datasets. The aim of this study is to elucidate the biological pathways involved in the pathogenesis of MetS through pathway analysis. Cohort data from the Korea Associated Resource (KARE) was used for analysis, which include 8,842 individuals (age, 52.2 +/- 8.9 years; body mass index, 24.6 +/- 3.2 kg/m2). A total of 312,121 autosomal SNPs were obtained after quality control. Pathway analysis was conducted using Meta-analysis Gene-Set Enrichment of Variant Associations (MAGENTA) to discover the biological pathways associated with MetS. In the discovery phase, SNPs from chromosome 12, including rs11066280, rs2074356, and rs12229654, were associated with MetS (p < 5 x 10(-6)), and rs11066280 satisfied the Bonferroni-corrected cutoff (unadjusted p < 1.38 x 10(-7), Bonferroni-adjusted p < 0.05). Through pathway analysis, biological pathways, including electron carrier activity, signaling by platelet-derived growth factor (PDGF), the mitogen-activated protein kinase kinase kinase cascade, PDGF binding, peroxisome proliferator-activated receptor (PPAR) signaling, and DNA repair, were associated with MetS. Through pathway analysis of MetS, pathways related with PDGF, mitogen-activated protein kinase, and PPAR signaling, as well as nucleic acid binding, protein secretion, and DNA repair, were identified. Further studies will be needed to clarify the genetic pathogenesis leading to MetS.

The association of breast arterial calcification and metabolic syndrome

OBJECTIVES: We investigated the relationship between metabolic syndrome and breast arterial calcification detected via mammography in a cohort of postmenopausal subjects. METHODS: Among 837 patients referred to our radiology department for mammographic screening, 310 postmenopausal females (105 patients with and 205 patients without breast arterial calcification) aged 40 to 73 (mean 55.9±8.4) years were included in this study. The groups were compared with respect to clinical characteristics and metabolic syndrome criteria. Univariate and multivariate analyses identified the factors related to breast arterial calcification. RESULTS: Age, postmenopausal duration and the frequencies of diabetes mellitus, hypertension and metabolic syndrome were significantly higher in the subjects with breast arterial calcification than in those without (p<0.05). Multivariate analysis indicated that age (OR = 1.3, 95% CI = 1.1-1.6, p = 0.001) and metabolic syndrome (OR = 4.0, 95% CI = 1.5−10.4, p = 0.005) were independent predictors of breast arterial calcification detected via mammography. The independent predictors among the features of metabolic syndrome were low levels of high-density lipoproteins (OR = 8.1, 95% ...

Linkage of Epidemiologic Evidence With the Clinical Aspects of Metabolic Syndrome

Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors, such as hypertension, glucose intolerance, high triglycerides, and a low high density lipoprotein-cholesterol level. MetS is known to be associated with cardiovascular diseases. In order to diagnose MetS, definitions such as National Cholesterol Education Program Adult Treatment Panel III, American Heart Association/National Heart Lung and Blood Institute, International Diabetes Federation, World Health Organization, European Group for the Study of Insulin Resistance and American College of Endocrinology are widely used. However, using different criteria may lead to confusion regarding the diagnosis and treatment of patients with MetS in the primary care setting. Our objected was to review 3 aspects concerning MetS using the Metabolic Syndrome Research Initiatives study of 123892 healthy Koreans (1994-2001) that had a maximum follow-up of 12 years. The 3 aspects were reviewed by determination of the association of MetS with the development of atherosclerotic cardiovascular disease (ASCVD) and ischemic heart disease (IHD). Based on our findings, each metabolic factor associated with MetS was not weighted equally. The hazard ratio (HR) was higher in individuals with higher glucose compared with the HR in individuals with higher body mass index. Individuals with pre-MetS (having 1 or 2 metabolic factors) had 1.5-2.3 fold higher risk of developing ASCVD and IHD in both genders. In the presence of MetS, both singly and in combination, precede the development of ASCVD and IHD and individuals with pre-MetS must not be ignored as there is no apparent threshold in defining MetS. Furthermore, MetS may complement the Framingham Risk Score and can be used as the first line approach to treat the ASCVD or IHD.

Alteraciones metabólicas asociadas al uso de terapia antipsicótica: [revisión] / Atypical antipsychotic induced weight gain and metabolic disorders: [revision]

The advent of new antipsychotic drugs has improved the treatment of schizophrenic patients as well as those suffering from other severe psychiatric disorders. Its widespread use, however, has been associated to the development of obesity and metabolic disturbances such as diabetes mellitus, dyslipidemia and increased coronary risk. This has caused a serious concern, due to the high cardiovascular mortality that prematurely affects these patients. The etiology of these abnormalities is still a matter of debate, although it is generally believed that the new antipsychotic drugs have a control stimulating effect on appetite, and their use is associated to an increased level of cortisol and to an insulin-resistance state. In addition, there is an increase in inflammatory mediator and cytokine production, induced by the pathophysiology of the schizophrenic process itself and also caused by the direct action of the antipsichotic drugs. In spite of the mounting evidence, the metabolic management of these patients is still deñcient. A cióse follow-up in the initial stages of the antipsychotic treatment is recommended, as well as giving advice about diet and physical exercise. Finally, when obesity or other conditions associated to metabolic syndrome appear, the recommendation is to switch to drugs with less secondary effects or to add adjuvant medications to improve the overall evolution of these patients.

Sex differences in Risk of Cardiovascular Disease, Depression and Self-Care Activities in Type 2 Diabetes with Metabolic Syndrome / 성인간호학회지

PURPOSE: This study was to investigate the sex differences in risk of cardiovascular disease(CVD), depression and self-care activities in type 2 diabetes with metabolic syndrome. METHODS: The descriptive correlational design was conducted using a convenient sample. One hundred and twenty-nine diabetic patients with metabolic syndrome were recruited in a university hospital. The data were analyzed using descriptive statistics, the Pearson correlation coefficient, Students' t-test, one way ANOVA, and stepwise multiple regression with SPSS/WIN 12.0. RESULTS: The risk of CVD in diabetic patients with metabolic syndrome indicated a significantly negative correlation to self-care activities and age, and positive correlation to waist_C, SBP, DBP and TG. The metabolic syndrome is associated with an approximate 1.7-fold increase in the relative risk in CVD in diabetic women. The main significant predictors influencing CVD risk of diabetes with metabolic syndrome were age, waist_C, SBP and TG, which explained about 29.7%. CONCLUSION: These results indicate that patients with diabetes with metabolic syndrome with a high degree of waist_C, SBP and TG are likely to be high in risk of CVD.

Optimal resting heart rate in adult population: factors related to the heart rate / 대한내과학회지

BACKGROUND: The resting heart rate (HR) or HR recovery after exercise is one of the important predictors of cardiovascular disease mortality. However, few studies have addressed the ideal range of the HR. We sought to define the normal HR of healthy adults who have no evidence of cardiovascular or systemic illness, and none of the component of metabolic syndrome (MS). METHODS: We analyzed a total of 20,162 asymptomatic adults, who were referred for a general health evaluation. All participants underwent careful clinical evaluation, including a detailed history, physical examination and laboratory workup. The mean HR for 30 seconds in the morning after an overnight fast was obtained. There were 7,823 subjects who were free of any component of MS. There were 935 MS patients, and 10,492 patients had > or =1 component of MS. RESULTS: The HR was faster in women. The resting HR of healthy men was 59.9+/-8.2 bpm, and that of healthy women was 63.7+/-8.5 bpm. There was significant correlation between the HR and the age of healthy adults (r=-0.008, p<0.001). The mean resting HR was higher in the MS patients than that of their healthy counterparts (67.4+/-10.6 bpm vs 62.0+/-8.6 bpm, respectively, p=0.000). A significant gradual increase of HR was observed as the numbers of MS component increased (r=0.127, p<0.001). The systolic blood pressure, fasting blood sugar, HbA1c, triglyceride, gamma GTP, uric acid and CRP were significantly correlated with HR. CONCLUSIONS: We herein newly define the optimal HR in a healthy adult population. Follow-up study is needed to clarify the role of HR as a risk stratifier.