Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children / A razão ApoB/ApoA1 aumentada está associada ao excesso de peso, de adiposidade corporal e ao perfil lipídico alterado em crianças

Abstract Objective: To investigate ApoB/ApoA1 ratio and its association with cardiovascular risk factors in children. Methods: Cross-sectional study with 258 children aged 8 and 9 years old, enrolled in all urban schools in the city of Viçosa-MG. Anthropometric and body composition assessment, as well as biochemical profile of the children was performed. Socioeconomic variables and sedentary lifestyle were evaluated through a semi-structured questionnaire. Results: Many children had excess weight (35.2%), abdominal adiposity (10.5%), and body fat (15.6%), as well as increased ApoB/ApoA1 ratio (14.7%), total cholesterol (51.8%), and triglycerides (19.8%). Children with excess weight and total and central fat had a higher prevalence of having a higher ApoB/ApoA1 ratio, as well as those with atherogenic lipid profile (increased LDL-c and triglycerides and low HDL-c). A direct association was found between the number of cardiovascular risk factors and the ApoB/ApoA1 ratio (p = 0.001), regardless of age and income. Conclusion: The increased ApoB/ApoA1 ratio was associated with excess weight, body adiposity (total and central), and altered lipid profile in children. Children with a higher number of cardiovascular risk factors had higher ApoB/ApoA1 ratio, in both genders.

Resumo Objetivo: Investigar a razão ApoB/ApoA1 e sua relação com fatores de risco cardiovascular em crianças. Métodos: Estudo transversal com 258 crianças de 8 e 9 anos, matriculadas em todas as escolas urbanas de Viçosa-MG. Foi feita avaliação antropométrica, da composição corporal e bioquímica das crianças. As variáveis socioeconômicas e o sedentarismo foram avaliados por questionário semiestruturado. Resultados: Muitas crianças apresentaram excesso de peso (35,2%), de adiposidade abdominal (10,5%) e de gordura corporal (15,6%), bem como a razão ApoB/ApoA1 (14,7%), colesterol-total (51,8%) e triglicerídeos (19,8%) aumentados. Crianças com excesso de peso e de gordura total e central apresentaram maiores prevalências de maior razão ApoB/ApoA1, bem como as com perfil lipídico aterogênico (LDL-c e triglicerídeos aumentados e baixo HDL-c). Foi encontrada associação direta entre o número de fatores de risco cardiovascular e a razão ApoB/ApoA1 (p = 0,001), independente da idade e renda. Conclusão: A razão ApoB/ApoA1 aumentada esteve associada ao excesso de peso, de adiposidade corporal (total e central) e ao perfil lipídico alterado nas crianças. As crianças com maior número de fatores de risco cardiovascular apresentaram maior razão ApoB/ApoA1, em ambos os sexos.

Infarto isquémico mesencefálico: síndrome de Weber / Ischemic mesencephalic infarction: Weber's syndrome

La enfermedad cerebrovascular constituye la tercera causa de muerte en la población adulta, la primera causa de discapacidad a escala mundial y la segunda causa de demencia, problema de salud actual relacionado con otras enfermedades crónicas no transmisibles. Se presenta un caso de un infarto isquémico mesencefálico aterotrombótico en una anciana de 77 años con la expresión clínica de un síndrome de Weber. El síndrome de Weber es uno de los síndromes cruzados o alternos de la clínica y la neurología por lesión peduncular. Es poco frecuente y a la vez, el más frecuente de los alternos de tronco encefálico(AU)

Cerebrovascular disease is the third leading cause of death in the adult population, the leading cause of disability worldwide and the second cause of dementia. It is a current health problem related to other chronic noncommunicable diseases. We present a case of atherothrombotic mesencephalic ischemic infarction in a 77-year-old woman with the clinical expression of Weber syndrome, which is a crossed or alternating clinical syndrome and neurology by pedicle injury. It is rare and, at the same time, the most frequent alternating brainstem(AU)

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Association of postalimentary lipemia with atherosclerotic manifestations

We identified different lipemic and metabolic responses after the ingestion of a standardized meal by healthy adults and related them to atherosclerotic markers. Samples from 60 normolipidemic adults were collected before and after a liquid meal (40 g fat/m² body surface) at 0, 2, 4, 6, and 8 h for measurements of lipids, free fatty acids (FFA), insulin, cholesteryl ester transfer protein (CETP), autoantibodies to epitopes of oxidized LDL (oxLDL Ab), lipolytic activities, and apolipoprotein E polymorphism. Mean carotid intima-media thickness (cIMT) was determined by Doppler ultrasound. The volunteers were classified into early (N = 39) and late (N = 31) triacylglycerol (TAG) responders to the test meal. Late responders showed lower HDL cholesterol concentration at fasting and in the TAG peak, lower insulin and higher FFA concentrations compared to early responders. Multivariate regression analyses showed that mean cIMT was associated with gender (male) and age in early responders and by cholesterol levels at the 6th hour in late responders. oxLDL Ab were explained by lipoprotein lipase and negatively by hepatic lipase and oxLDL Ab (fasting period) by CETP (negative) and FFA (positive). This study is the first to identify a postalimentary insulin resistance state, combined with a reduced CETP response exclusively among late responders, and the identification of the regulators of postalimentary atherogenicity. Further research is required to determine the metabolic mechanisms described in the different postalimentary phenotypes observed in this study, as well as in different pathological states, as currently investigated in our laboratory.

The effect of maternal hypercholesterolemia on the placenta and fetal arteries in rabbits / Efeito da hipercolesterolemia maternal sobre a placenta e as artérias fetais em coelhos

PURPOSE: To investigate the degree of placental permeability in dyslipidemic rabbits and the consequent vascular dysfunction in fetuses of female rabbits with high lipoprotein levels. METHODS: Fifteen adult females New Zealand White rabbits were divided into two groups. Group 1(n=5) - hypercholesterolemic diet with 0.5 percent cholesterol, and Group 2 (n=10) - control. On day 30, the levels of plasma lipoproteins and triglycerides were analyzed in the mothers, and the presence of collagen was analyzed in the placenta as well as in fetal coronary and aorta. Statistical analyses used the Student's t and the Mann-Whitney tests. RESULTS: Lipoprotein levels were significantly different (p=0.02 to p<0.001) in experimental and control groups. In the hypercholesterolemic group, total cholesterol levels were in average 793mg/dl; triglycerides were in average 257mg/dl; HDL-C was 48mg/dl, and LDL-C was in average 692mg/dl. The amount of collagen per micrometers square (mµ²) in samples from hypercholesterolemic animals was significantly higher than in the control group. CONCLUSIONS: The study confirmed placental permeability to lipoproteins, shown by increased amounts of collagen in fetal tissues. This alteration results in increased susceptibility to atherosclerosis in adult life, representing a risk factor for the early development of disease, which may appear even in the prenatal period.

OBJETIVO: Investigar a permeabilidade placentária em coelhos adultos fêmeas dislipidêmicas e a consequente disfunção vascular em seus fetos. MÉTODOS: Quinze coelhos adultos fêmeas Nova Zelândia Brancas foram distribuídas em grupo dislipidêmico e grupo controle. No trigésimo dia de gestação foram medidos os triglicerídeos e as lipoproteínas nas coelhas e verificada a presença de colágeno na placenta e coronárias fetais. Análise estatística foi feita com teste t de Student´s e Mann-Whitney. RESULTADOS: Os níveis de lipoproteínas foram diferentes estatisticamente entre os grupos (p=0,02 a p<0,001). A quantidade de colágeno por micrômetro quadrado foi significantemente maior no grupo hipercolesterolêmico em comparação ao grupo controle. CONCLUSÕES: O estudo confirmou a permeabilidade placentária para lipoproteínas demonstrando aumento de colágeno nos tecidos fetais. Esta alteração induz ao aumento da suscetibilidade para aterosclerose na vida adulta, representando um fator de risco para desenvolvimento precoce da doença aterosclerótica a qual pode estar presente mesmo no período pré-natal.

Pesquisa de marcadores precoces de arterioesclerosis en sujetos pre-hipertensos e hipertensos / Detection of early markers for atherosclerosis in pre-hypertensive and hypertensive subjects

Introducción: Se han descrito varias alteraciones del sistema circulatorio y corazón que aparecen en forma precoz en el curso evolutivo de la hipertensión arterial, particularmente en niveles de pre-hipertensión y en hipertensión etapa 1. Objetivo: Estudiar algunos marcadores de daño en pacientes hipertensos no tratados. Métodos: Se incluyeron 2 grupos de hipertensos no tratados, uno con cifras consideradas pre-hipertensión (120-139/80-89 mmHg) en 17 casos y otro con hipertensión Etapa 1 (Consenso 7), cifras de 140160/90-100 mmHg en 47 pacientes. Se les estudiaron marcadores de daño, tales como alteraciones iniciales de fondo de ojo, ausencia de Dip nocturno en el monitoreo ambulatorio de presión arterial (PA) de 24 hrs., hipertrofia ventricular izquierda y micro albuminuria elevada en 24 hrs. Se exigió rangos estrictos en 3 registros clínicos clásicos de medición de la PA. Resultados: En ambos grupos se observó la presencia de uno o más marcadores analizados: en el 59 por ciento del grupo de pre- hipertensos y en el 68 por ciento de los pacientes hipertensos etapa 1. Entre ambos grupos, sólo la presencia de hipertrofia ventricular fue significativamente más frecuente en los pacientes en Etapa 1 (p<0.05). Los factores de riesgo se distribuyeron con igual frecuencia en ambos grupos Conclusión: Se concluye que en etapas precoces del curso evolutivo de la PA aparecen marcadores de alteración ateroesclerótica inicial del sistema circulatorio en más de la mitad de los pacientes, antes de la aparición de daño severo de órganos blancos.

Background: Several alterations of the heart and circulatory system may appear early on during the course of hypertension, both at pre-hypertension or at stage I levels. Aim: to determine the frequency of early markers of organ damage in hypertensive subjects , both treated and un-treated Methods: two groups of un-treated hypertensive subjects, pre-hypertensives (blood pressure 120-139 / 80-89 mmHg, n=17) or stage I hypertensives (140-160 / 90100 mmHg, n=47) were studied. Three concordant measurements of blood pressure were required for inclusion. Initial fundoscopic abnormalities, absence of nocturnal blood pressure dip on 24 hr Holter monitoring, presence of left ventricular hypertrophy and increased 24hr albuminuria, were determined. Results: Both groups exhibited one or more of the abnormalities being studied. Only left ventricular hypertrophy was more frequent in stage I hypertensives compared to pre hypertensives (p<0.05). Risk factors for coronary artery disease did not differ between groups. Conclusion: More than 50% of patients with pre-hypertension or stage I hypertension exhibit initial markers for atherosclerotic changes in the circulatory system, before the development of severe target organ damage.

Relación del colesterol total con la concentración sérica de tocoferoles, un estudio probabilístico en preescolares mexicanos / Relation of total cholesterol in serum tocopherols

Estudios epidemiologicos han demostrado el efecto del estado nutricional de los tocoferoles y el desarrollo de enfermedades cardiovasculares, las cuales son cada vez mas frecuentes en edades tempranas de la vida. Este trabajo relaciona el colesterol total con las concentraciones sericas de tocoferoles en una poblacion de ninos mexicanos, evaluando ademas su estado antioxidante y oxidante. De octubre a diciembre de 2003, se cuantifico en suero a-tocoferol, γ-tocoferol y colesterol total en 1155 niños (12-59 meses) residentes de localidades urbanas y rurales; se evaluo la capacidad antioxidante y el estado oxidante con la produccion de TBARS. Los ninos con cifras de colesterol > 240 mg/dL fue de 577.3 ± 200.8 μg/dL. Sin embargo, cuando se expresaron los tocoferoles en relacion con el colesterol total (μmol/mmol), se observo que los niños con + 1.19), lo que los ubicaba en un adecuado estado nutricional de a-tocoferol, a diferencia del grupo con > 240 mg/dL de colesterol en quienes la relacion fue baja (1.93 ± 0.69). No se observaron diferencias en la capacidad antioxidante del suero, pero si en la produccion de TBARS para los niños con > 200 mg/dL de colesterol. En preescolares los incrementos en el colesterol total limitan la disponibilidad de tocoferoles sericos para los lipidos circulantes, esta condicion a traves del tiempo puede condicionar el desarrollo prematuro de lesiones vasculares mediadas por estres oxidativo.

Epidemiological studies have shown the effect of nutritional status of tocopherols and development of cardiovascular diseases that now are more frequent during early years of life. In this work we evaluated the association between the total cholesterol and serum levels of tocopherols in a population of Mexican children in whom we measured the oxidant status and antioxidant capacity (December 2003). In 1155 children (12-59 months) residents of urban and rural locations we quantified in serum a-tocopherol, γ-tocopherol and total cholesterol; the antioxidant capacity and oxidative status were evaluated with the production of TBARS. Children with serum cholesterol > 240 mg/dL cholesterol recorded an average of 577.3 ± 200.8 μg/dL. However, when tocopherols were expressed in relation to total cholesterol (μmol/mmol) found that children with > 240 mg/dL of cholesterol in whom the relationship was low (1.93 ± 0.69). There were no differences in serum antioxidant capacity, but if in the production of TBARS for children with > 200 mg/dL cholesterol. In preschools the increases in total cholesterol limits the availability of serum tocopherol for circulating lipids, this condition over time could determine the early development of vascular injury mediated by oxidative stress.

Elaboração de um sistema de pontos para intervenções dietéticas em indivíduos hiperlipidêmicos / Preparations a scoring system for dietetic interventions in hyperlipidemic individuals

Fundamentos: Sabe-se da existência de substâncias dietéticas aterogênicas e promotoras de doenças cardiovasculares. Assim a utilização de um guia de fácil compreensão e manejo poderia auxiliar na escolha de alimentos saudáveis. Objetivo: Elaborar um instrumento de orientação alimentar como ferramenta para intervenção dietética em indivíduos com hiperlipidemias. Métodos: Foi elaborado um sistema de pontos com alimentos em medidas caseiras, considerando-se as características socioculturais da população. Criou-se uma listagem de alimentos que receberam pontuações para índicede colesterol/gordura saturada (CSI). O CSI foi calculado por meio de metodologia validada, utilizando a seguinte fórmula: CSI=(1,01xg de gordura saturada) + (0,05xmg decolesterol). Um índice baixo significa alta capacidade de redução das hiperlipidemias. A necessidade individual de gorduras e colesterol para o cálculo do CSI foi extraída das recomendações da American Heart Association. Resultados: Foi organizada uma dieta de pontos para colesterol em formato de cartilha acompanhada de material explicativo. Utilizou-se como representação gráfica o Guiada Pirâmide Alimentar Saudável, pois reflete rapidamente conceitos alimentares importantes, porém em formato decoração em alusão à prevenção de doenças cardiovasculares. Conclusão: Elaborou-se, com sucesso, um instrumento de orientação alimentar denominado Sistema de Pontos para Controle de Colesterol e Gordura no Sangue. É uma ferramenta que pode apoiar a capacitação de profissionais promotores da saúde, para orientar pacientes e a população em geral.

Background: The existence of foods containing atherogenic substances that cause cardiovascular diseases is well known. An eating guide that is easy tohandle and understand could thus help patients choose healthier foods.Objective: To prepare an eating guide as a tool for dietetic intervention in hyperlipidemic individuals. Methods: A food scoring system was drawn up,assigning points to foods using ordinary home measurements, considering the social and cultural characteristics of the population. A list of foods was prepared, assigning points based on the Cholesterol / Saturated Fat Index (CSI). This Index was calculatedthrough a validated methodology based on the following formula: CSI=(1.01xg saturated fat) + (0.05xmg of cholesterol). A low score indicates goodcapacity for reducing hyperlipidemias. The individual fat and cholesterol requirements for calculating thisIndex are drawn from the American Heart Association recommendations. Results: A cholesterol score diet was designed and presented in a leaflet, together with explanatory materials,using the Healthy Food Guide Pyramid as this clearly demonstrates important food-related concepts, but reshaped into a heart in order to underscore its importance for preventing cardiovascular diseases. Conclusion: A successful eating guide was prepared,using a points system to score cholesterol and fat in the blood. This tool can provide input for trainingprofessional health promoters, as well as offering guidance to patients and the population in general.

Mieloperoxidase e doença arterial coronariana: da pesquisa à prática clínica / Myeloperoxidase and coronary arterial disease: from research to clinical practice

A mieloperoxidase (MPO) é uma enzima derivada de leucócitos que catalisa a formação de numerosas espécies reativas oxidantes. Além de integrantes da resposta imune inata, evidências têm comprovado a contribuição desses oxidantes para o dano tecidual durante inflamação. A MPO participa de atividades biológicas pró-aterogênicas relacionadas à evolução da doença cardiovascular, incluindo iniciação, propagação e as fases de complicação aguda do processo aterosclerótico. Dessa forma, a MPO e sua cascata inflamatória representam um alvo atrativo para investigação prognóstica e terapêutica na doença aterosclerótica cardiovascular. Nesta revisão, apresentamos o estado da arte no entendimento das ações biológicas às evidências clínicas da relação entre MPO e doença arterial coronariana. Vários estudos apontam para o efeito independente dos níveis de MPO na evolução da doença e ocorrência de eventos em pacientes com síndrome coronariana aguda. Entretanto, ainda não é consistente o valor preditivo adicional dos níveis de MPO na estratificação de risco cardiovascular para incorporá-la à prática clínica como sinalizadora de vulnerabilidade de placa. Estudos adicionais são necessários para confirmar seu papel nas diferentes formas de apresentação da cardiopatia isquêmica, além da padronização do ensaio, ponto fundamental para a transição desse marcador do ambiente de pesquisa para uso na rotina clínica.

Myeloperoxidase (MPO) is an enzyme derived of leukocytes that catalyze formation of numerous reactive oxidant species. Besides members of the innate host defense, evidences have been proving the contribution of these oxidants to tissue injury during inflammation. MPO participates in proatherogenic biological activities related to the evolution of cardiovascular disease, including initiation, propagation and acute complications of atherosclerotic process. Thereby, MPO and its inflammatory cascade represents an attractive target for prognostical investigation and therapeutics in atherosclerotic cardiovascular disease. In this review, we present the state of the art in the understanding of biological actions to clinical evidences of the relationship between MPO and coronary arterial disease. Several studies point to the independent effect of MPO levels in the evolution of disease and incidence of events in patients with acute coronary syndrome. However, the additional predictive value of MPO levels in the cardiovascular risk assessment, to incorporate it to the clinical practice as marker of plaque vulnerability, is still not consistent. Additional studies are necessary to confirm its role in the different forms of presentation of ischemic disease, besides the standardization of the assay, fundamental point for transition of this marker from research atmosphere to use in clinical routine: : from laboratory to clinical practice.

Correlación de los resultados del SPECT de perfusión miocárdica con 99mmTc-MIBI con la presencia de factores de riesgo aterosclerótico, en pacientes iguales o mayores a 40 años de edad: resultados preliminares / Correlation of myocardial perfusion SPECT with Tc-99m MIBI in presence of atherosclerotic risk factors

Objetivo: Conocer la combinación de Factores Mayores de Riesgo Aterosclerótico (FMRA) que nos sugeriría remitir directamente al paciente a coronariografía, para la optimización del uso del SPECT de Perfusión Miocárdica (SPECTPM). Material y Método: Se analizaron 577 SPECTPM, 345(59.8 por ciento) fueron masculinos, edad media: 62.26años y 79pacientes(13.7 por ciento) fueron asintomáticos. Resultados: 448(77.64 por ciento) SPECTPM fueron positivos y 129(22.36 por ciento) negativos, el FMRA más frecuente la HTA (68.80 por ciento) y el que más se asocio con SPECTPM positivo el habito de fumar, no existió riesgo significativo de SPECTPM positivo para ninguno de los FMRA estudiados, ni sus combinaciones. Conclusiones: La presente investigación sugiere que teniendo en cuenta la alta especificidad, valor predictivo negativo y valor pronostico del SPECTPM, deben realizarse coronariografía solo a los pacientes sintomáticos con resultado positivo de SPECTPM, por tanto todos los pacientes deben realizarse un SPECTPM previo a la realización de la angiografía, por tener alta probabilidad de tener resultados negativos.

Objective: Know the combination of FMRA that would suggest us to remit the patient directly to coronariography, for the optimization of the use of the SPECTPM. Material and Method: 577 SPECTPM were analyzed, 345(59.8 percent) they were masculine, mean age: 62.26 years and 79(13.7 percent) asymptomatic. Results: Positive SPECTPM 448(77.64 percent) and negative 129(22.36 percent), the most frequent FMRA was HTA(68.80 percent) and the one that was most associated with positive SPECTPM was the smoking habit. There wasn’t any significant risk of positive SPECTPM for none of the FMRA studied, not even in their combinations. Conclusions: Keeping in mind the high specificity, predictive negative value and prognostic value of the SPECTPM, this investigation paper recommends that only patients with a positive result of SPECTPM should undergo a coronariography. Therefore, all patients with angina pectoris should have a SPECTPM before undergoing an angiography, because there is a high probability of having negative results.

Effects of high-carbohydrate and high fat diet on formation of foam cells and expression of TNF-alpha in Rattus novergicus.

AIM: to examine the role of high carbohydrate and high fat diet on formation of foam cells and expression of TNFalpha, an early stage of atherosclerosis. METHOD: three months old male Rattus Novergicus strain Wistar were allocated into 3 groups, normal diet group (GI, n=8), high carbohydrate diet group (GII, n=8), and high fat diet group (G III, n=8). Those groups received an isoenergetic diet but contained different percentage of carbohydrate and fat for 12 weeks. The rest of the food was measured daily to calculate the calorie intake. The body weight was measured weekly. At the end of study, blood samples were taken using cardiac puncture to examine lipid profiles and random blood sugars. RESULTS: levels of blood glucose significantly increased in GII compared to the GI (281.87 +/- 39.66 mg/dl vs 192.5 +/- 1.4 mg/dl, p=0.002). Group II and G III showed increased of triglyseride compared to GI (138.0 +/- 47.15 vs 85.5 +/-20.3, p=0.02; 163.62 +/- 41.77 vs 85.5 +/- 20.3, p=0.00, respectively). Level of LDL significantly increased in G III compared to GI (72 +/- 35.6 vs 27.0 +/- 8.9, p=0.00). No statistical difference in level of HDL among the three groups. Level of TNFalpha significantly increased in GII and G III compared to GI (19.13 +/- 3.68 vs 2.5 +/- 1.4, p=0.00; 23.6 +/- 5.58 vs 2.5 +/- 1.4, p=0.00, respectively). The number of foam cells was significantly increased in GII and G III compared to GI (7.18 +/- 5.28 vs 1.2 +/- 1.4, p=0.00; 9.91 +/- 6.26 vs 1.2 +/- 1.4, p=0.00, respectively). The foam cell had strong correlation with triglyseride level and TNFalpha (r=0.696, p=0.00; r=0.618, p=0.00, respectively). CONCLUSION: this result shows that high carbohydrate and high fat diet potentially increase the risk factor of atherosclerosis. Both diets induced the inflammatory process and increase foam cells formation, are in the early stage of atherosclerosis.

The role of vascular smooth muscle cells on the pathogenesis of atherosclerosis.

Atherosclerosis is the leading cause of death and disability. The lesions of atherosclerosis represent a series of highly specific cellular and molecular responses. The earliest changes that precede the formation of lesions of atherosclerosis take place in the endothelium (EC), with resultant endothelial dysfunction. The EC-induced injury can result in increased lipid permeability, macrophage recruitment, formation of foam cells, and recruitment of T-lymphocytes and platelet. After intimal injury, different cell types,including ECs, platelets, and inflammatory cells release mediators, such as growth factors and cytokines that induce multiple effects including phenotype change of vascular smooth muscle cells (VSMC) from the quiescent "contractile" phenotype state to the active "synthetic" state, that can migrate and proliferate from media to the intima. The inflammatory response simulates migration and proliferation of VSMC that become intermixed with the area of inflammation to form an intermediate lesion. These responses continue uninhibited and is accompanied by accumulation of new extra cellular matrix (ECM). The migratory and proliferative activities of VSMC are regulated by growth promoters such as platelet derived growth factors (PGF), endothelin-1 (ET-1), thrombin, fibroblast growth factor (FGF), interleukin-1 (IL-1) and inhibitors such as, heparin sulfates , nitric oxide (NO), transforming growth factor (TGF)-beta. The matrix metallo proteinases (MMPs) could also participate in the process of VSMC migration. MMPs could catalyze and remove the basement membrane around VSMC and facilitate contacts with the interstitial matrix. This could promote a change from quiescent, contractile VSMC to cells capable of migrating and proliferating to mediate repair. The VSMC regulation is a very complex process, VSMC are stimulated to proliferate and migrate by some kind of cytokines, growth factors, angiotensin II (Ang-II). Together with apoptosis, proliferation and migration of VSMC are vital to the pathogenesis of atherosclerosis and plaque rupture. Rupture of the plaque is associated with increased fibrous cap macrophage, increased VSMC apoptosis, and reduced fibrous cap VSMC. VSMC are the only cells with plaques capable of synthesizing structurally important collagen isoforms, and the apoptosis of VSMC might promote plaque rupture.

Inflammation and neovascularization in diabetic atherosclerosis.

Diabetes mellitus, the major cardiovascular risk factor, accentuates the inflammation and neovascularization processes leading to enhanced progression of atherosclerotic complications. Inflammation in diabetes mellitus is the key initiator of atherosclerotic process, which results in acute coronary events. Atherosclerosis evolves from the endothelial cell dysfunction and succeeding entry of hemodynamically derived leukocytes by migration, activation and production of lipid gruel leading to atheromatous plaque progression and subsequent regression. Diabetic plaque progression is associated with increased neovascularization, which is a nature's compliment in the sustenance of plaque growth by its nutrient supply. Neovessels may act as conduit for lipid debridment and alternative channel for inflammatory process. In addition, neovascularization induces intra-plaque hemorrhage due to the fragility of the neovessels and associated inflammation, resulting in plaque instability. The intra-plaque hemorrhage is a detrimental base, which begets the progress of atheroma by inducing oxidative stress and endothelial dysfunction. Intra-plaque hemorrhage is increased in diabetes with an associated increase in hemoglobin-haptoglobin complex (Hb-Hp2-2), which further induces oxidative stress and endothelial cell dysfunction. We conclude that inflammation and neovascularization of the plaque may act as major mechanism augmenting plaque instability in diabetes mellitus.

Plasma lipid peroxidation and antioxidiant nutrients in type 2 diabetic patients.

BACKGROUND AND OBJECTIVE: Observation shows diabetic patients to be more prone to oxidative stress because of hyperglycemia. The elevation of free radical production by this hyperglycemic production may exacerbate cardiovascular complication in diabetes. This study aims to investigate the oxidative stress related parameters in type 2 DM. Since the effects of glycemic control and cardiovascular complications in DM on these parameters has been not fully determined, the comparison between plasma MDA (malondialdehyde) and antioxidant nutrients with their age-matched normal healthy group may be used to determine the susceptibility of oxidative stress in this type of DM. MATERIAL AND METHOD: MDA and antioxidant nutrients (vitamin A, C, E and beta-carotene) were analyzed in plasma of 19 subjects with poorly controlled type 2 DM (fasting plasma glucose [FPG] > 180 mg/dl), 26 subjects with fairly controlled type 2 DM (FPG < or = 180 mg/dl), and 20 subjects with type 2 DM complicated coronary heart disease (CHD) who were matched for age and gender. Twenty healthy subjects with normal plasma glucose level (FPG < 110 mg/dl) and matched for age and gender served as a control group. In all groups of DM these oxidative stress parameters were compared to a normal group. RESULTS: The plasma MDA levels were significantly higher in all types of DM compared to age-matched normal control. Plasma antioxidant vitamin C and E significantly lower only in poorly controlled and CHD complicated type 2 DM, respectively. The mean of plasma vitamin E level was lowest in type 2 DM complicated with CHD. No significant differences in both plasma vitamin A and beta-carotene were noted between any types of DM and age-matched normal healthy group. The positive correlation between MDA and FPG was demonstrated in most group of patients with their normal subjects except in fairly controlled type 2 DM and negative correlation between vitamin E and FPG was also demonstrated in type 2 DM with CHD. CONCLUSION: These findings suggested that diabetic patients were susceptible to oxidative stress and higher plasma glucose level had an association with free radical-mediated lipid peroxidation. The lowest level of vitamin E in type 2 DM complicated with CHD indicated that oxidative stress played an important role in cardiovascular complication and vitamin E supplementation may be necessary for treatment and prevention in this group of diabetics.

Breve historia de la relación entre el colesterol y las enfermedades cardiovasculares / Brief history of the relationship between cholesterol and cardiovascular diseases

The association of plasma levels of cholesterol and atherogenesis was not an easy task. During the 18th century the first evidences about the discovery of cholesterol appeared. However, in the 19th century, from the work of Anichkov, was possible to establish that atheromas originate from cholesterol deposition. The discovery and the isolation of lipoproteins by John Goffman was another landmark in cholesterol history. The observation of Laurence Kinsell that diets rich in polyunsaturated fatty acids produce a reduction of plasma cholesterol was another important landmark. The discovery of the LDL-receptor by Goldstein and Brown was one of the most important discoveries about the relationship of cholesterol with cardiovascular diseases. This work reviews the main events of the history of cholesterol.

No fue fácil asociar lo niveles plasmáticos de colesterol con la aterogénesis. En el siglo XVIII se produjeron las primeras evidencias del descubrimiento del colesterol, pero fue en el siglo XIX, con los trabajos de Anichkov, cuando fue posible establecer que los depósitos de colesterol originan los ateromas. El descubrimiento y el aislamiento de las lipoproteínas por John Gofman fue otro hito importante en la historia del colesterol. También lo fue la observación de Laurence Kinsell, quien describió que las dietas ricas en ácidos grasos poliinsaturados producen disminución del colesterol plasmático. El descubrimiento de Goldstein y Brown del receptor de LDL, ha sido quizás uno de los descubrimientos más importantes sobre la relación del colesterol y las enfermedades cardiovasculares. Este trabajo revisa los principales acontecimientos de la historia del colesterol.

Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.

Study of some risk factors of premature atherosclerosis and coronary heart disease in some Egyptian children

Coronary heart disease is a major health problem and one of the most important leading causes of adult deaths although it starts since childhood. Genetic predisposition of coronary heart diseases have been well established, so children of parents or grandparents with premature coronary heart diseases are more susceptible to develop the disease than others. Those with positive family history of premature coronary heart disease are more susceptible to lipid and lipoprotein abnormalities. Lipoprotein [a] is a strong predictor for premature coronary heart disease, together with total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol. Lipoprotein [a] is genetically determined and if it is elevated in a child, it predicts premature coronary heart disease. The effect of a high lipoprotein [a] increases if associated with high serum low density lipoprotein cholesterol or low serum high density lipoprotein cholesterol. This study was done on two groups of children: The First Group: Included 50 children [age ranging from 5-15 years] of parents with a history of premature coronary heart disease or cerberovascular disease diagnosed clinically and through investigations. The Second Group: Included 25 children [age ranging from 5-15 years] of parents without coronary heart disease or cerberovascular disease. All these children were examined clinically and the following parameters were done and recorded: Anthropometric measurements [Height [Ht], Weight [Wt], Skin fold]. Body mass index [BMI]. Blood pressure [SBP, DBP]. Fasting blood glucose [FBG]. Uric acid level [UA]. C-reactive protein [CRP]. Lipid profile: Cholesterol [TC], Triglyerides [TG], High density lipoprotein [HDL], Low density lipoprotein [LDL], Lipoprotein [a] [LP[a]]. Anti hepatitis A virus [HAV] and anti Helicobacter pylori [H.P] antibodies. The Study Showed that: There was no significant difference between cases and controls in age, HT, WT, BMI, skin fold, SBP and DBP. There was no significant difference between cases and controls in TG. FBG and UA. There was a significant increase in cases than controls in TC and LDL. Also there was a high significant increases in cases than controls in LP[a], while there was a high significant increase in controls than cases in HDL. There was no significant difference between cases and controls in sex, HAV, HP or CRP. There was insignificant correlation between LP[a] and age, BMI, skin fold, SBP, BDP, LDL, FBG and UA. There was a significant correlation between LP[a] and TC. Also there was a high significant correlation between LP[a] and TG, HDL. We concluded that high serum TC is not enough for determination of the risk of atherosclerosis and CHD and that high TG alone is not a risk factor except if associated with low serum HDL and high serum LDL. We recommend screening of all children with a positive family history of premature CHD and/or hypercholesterolemia for lipids and lipoprotein abnormalities especially LP[a] which is a strong predictor for premature CHD and this enables early diagnosis and early successful management by following special dietetic measures with avoidance of excess saturated fatty acids, avoidance of obesity and smoking and practicing physical activities. Prevention and treatment of infections especially HAV and HP is encouraged. Genetic counseling and discouraging against marriage for heterozygotes for CHD and/or hypercholestrolemia as their children may be homozygotes for the disease

Lípides séricos em criancas e adolescentes de Florianópolis, SC: Estudo Floripa saudável 2040 / Serum lipids in school kids and adolescents from Florianópolis, SC, Brazil: Healthy Floripa 2040 study

OBJETIVO: Determinar a distribuicão dos lipídeos séricos em criancas e adolescentes de Florianópolis, SC. Determinar a associacão entre colesterol não-desejável (>170 mg/dL) e outros fatores de risco para aterosclerose. MÉTODOS: Amostra aleatória estratificada (por idade e tipo de escola) de alunos da rede escolar de Florianópolis. Dados sobre fatores de risco, antropometria, pressão arterial e concentracão sérica de lípides foram coletados. RESULTADOS: Participaram 1.053 indivíduos com idade entre 7 e 18 anos. A concentracão sérica do colesterol (médianDP) foi 162n28 mg/dL; dos triglicerídeos 93n47 mg/dL; do HDL-colesterol 53n10 mg/dL; do LDL-colesterol 92n24 mg/dL e do colesterol não-HDL 109n 26 mg/dL. As médias das relacões CT/HDL e LDL/HDL foram, respectivamente, 3,1n0,6 e 1,8n0,5. Os lípides foram mais elevados nas criancas de escola privada, nos menores de 10 anos, no sexo feminino e nos de cor negra. O modelo de regressão logística que melhor previu os níveis de colesterol anormal incluía: obesidade, história familiar de acidente vascular cerebral ou infarto do miocárdio, sexo feminino, idade inferior a 10 anos e a imagem corporal definida pelo médico como sobrepeso/obesidade. CONCLUSAO: As concentracões de lipídeos em criancas e adolescentes mostraram valores intermediários quando comparados a estudos semelhantes. Uma grande parcela dos indivíduos apresenta níveis de colesterol sérico classificados como não-desejáveis para idade. Pela significância da associacão do colesterol com o excesso de peso, o controle deste fator na infância deve ser tomado como prioridade nos programas de prevencão primordial com o objetivo de reduzir a incidência das doencas relacionadas à aterosclerose na idade adulta.