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1.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222381

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
2.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222382

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
3.
Rev. ecuat. pediatr ; 22(1): 1-10, Abril 30, 2021.
Article in English | LILACS | ID: biblio-1222385

ABSTRACT

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.


Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.


Subject(s)
Cardiovascular Diseases , Systematic Review , Hydroxymethylglutaryl CoA Reductases , Lipoproteins, LDL , Protocols , Hypercholesterolemia , Cholesterol, LDL , Anticholesteremic Agents
4.
Rev. colomb. cardiol ; 28(1): 14-17, ene.-feb. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1341254

ABSTRACT

Abstract Introduction: Among the main causes of death in Colombia, Latin America, and the general population are pathologies of cardiovascular origin, which have an important relationship with dyslipidemias. Objective: The objective of the study was to establish the prevalence of the use of lipid-lowering drugs in a Colombian population during 2016. Material and methods: A cross-sectional study was conducted using a population database of the Colombian Health System between January and June 2016. Site: outpatients of Colombia. Participants. Researchers considered all patients who had received this class of drug to establish the prevalence of the use of lipid-lowering drugs. Main measurements. Prevalence of use of lipid-lowering drugs. Results: From a population of 4,328,688 patients, a total of 282,002 were prescribed a lipid-lowering drug; the mean age was 64.2 ± 13.3 years and women comprised 50.4% of the users. The estimated prevalence of lipid-lowering drug use was 6.5%. Statins (86.3%) were the most commonly used lipid-lowering drugs (atorvastatin: 81.0%, lovastatina: 14.4%) followed by fibrates (13.1%) and ezetimibe (0.6%). Conclusions: A low proportion of people are being treated with lipid-lowering drugs, according to the estimated prevalence of dyslipidemia.


Resumen Introducción: Las patologías de origen cardiovascular son la primera causa de muerte en Colombia y América Latina, y la dislipidemia tiene una importante relación. Objetivo: El objetivo fue establecer la prevalencia o proporción de uso de hipolipemiantes en una población colombiana durante el año 2016. Materiales y métodos: Estudio de corte transversal a partir de una base de datos poblacional de pacientes afiliados al Sistema de Salud de Colombia entre enero y junio de 2016. Sitio. Pacientes ambulatorios de Colombia. Participantes. Se consideraron todos los pacientes que recibieron algún hipolipemiante, de cualquier sexo y mayores de 18 años. Mediciones principales: prevalencia de uso de hipolipemiantes. Resultados: A partir de una población de 4328688 pacientes, se prescribieron hipolipemiantes a 282002, con una edad media de 64,2 13,3 años y el 50,4% eran mujeres. La prevalencia estimada de uso fue de 6,5%. Las estatinas (86,3%) fueron los hipolipemiantes más comúnmente utilizados (atorvastatina: 81,0%, locastatina: 14,4%) seguido de los fibratos (13,1%) y ezetimibe (0,6%). Conclusiones: Una baja proporción de personas están siendo tratados con hipolipemiantes de acuerdo a la prevalencia estimada de dislipidemia para la población del país.


Subject(s)
Humans , Male , Female , Adult , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Pharmacology , Epidemiology , Hypercholesterolemia
5.
São Paulo; s.n; 2021. 128 p.
Thesis in Portuguese | LILACS | ID: biblio-1352769

ABSTRACT

Introdução - O risco de doenças cardiovasculares, dentre elas a aterosclerose, está associado com a hipercolesterolemia, resultado de fatores de risco comportamentais, metabólicos e genéticos. Intervenções dietéticas como o uso do guaraná (Paullinia cupana), podem ser úteis, uma vez que é um alimento rico em compostos bioativos como as catequinas, que possuem elevada atividade antioxidante, inibem a oxidação da lipoproteína de densidade baixa (LDL) e a peroxidação lipídica, sendo capazes de reduzir a concentração plasmática de colesterol, por mecanismos ainda não totalmente elucidados. Objetivo - Investigar os efeitos do extrato aquoso de guaraná (Paullinia cupana) em pó sobre mecanismos envolvidos com a absorção de colesterol em modelos in vitro e em células Caco-2. Métodos - O extrato aquoso do guaraná em pó foi submetido à digestão in vitro, os fenólicos totais foram quantificados pelo método de Folin-Ciocalteu e a determinação do perfil de fenólicos foi realizada por cromatografia líquida de alta eficiência (HPLC), com detector UV/VIS a 210 nm. A atividade antioxidante foi determinada pela capacidade de absorbância de radical oxigênio (Oxygen Radical Absorbance Capacity - ORAC) e foram avaliadas a capacidade de inibição da lipase pancreática, de ligação com ácidos biliares, de interação com a fosfatidilcolina micelar e de inibição da solubilização micelar do colesterol de forma in vitro. Foi realizado ensaio de permeação do colesterol por um período de 2 h em células Caco-2 semeadas e diferenciadas em placas transwell de 24 poços com uma solução de micelas de colesterol e extrato de guaraná em diferentes concentrações. O teor de colesterol permeado foi determinado por HPLC/UV a 206 nm. Foi realizado o ensaio de Western blotting para determinar o conteúdo proteico dos transportadores de colesterol (NPC1L1, ABCG5, ABCG8) e LXR-alfa em células intestinais Caco-2 após a incubação com diferentes concentrações do extrato em 2 e 16 horas. Resultados: O conteúdo total de fenólicos do extrato de guaraná foi 104,36 (± 3,62) mg EAG/g de guaraná em pó. Após o processo de digestão, este valor foi de 48,62 (± 3,97) mg EAG/g de guaraná em pó, demonstrando a bioacessibilidade dos polifenóis. Foram identificados os compostos procianidina B1 (1,56 ± 0,04 mg/g) e B2 (2,34 ± 0,06 mg/g), catequina (24,26 ± 0,63 mg/g), epicatequina (20,39 ± 1,20 mg/g) e cafeína (34,93 ± 0,75 mg/g) no extrato não digerido. Após digestão in vitro, somente a catequina, epicatequina e cafeína foram bioacessíveis com 181,16 %, 136,78 % e 213,51 % de bioacessibilidade, respectivamente. A atividade antioxidante do extrato aquoso não digerido foi menor que do digerido, sendo os valores finais de ORAC de 2512 (± 399) e 4321 (± 778) µmol Eq Trolox/g de guaraná em pó, respectivamente. O extrato exibiu uma atividade inibitória da enzima lipase pancreática de forma dose-dependente, com IC50 de 1033 µg/mL. O extrato também demonstrou uma capacidade de ligação ao taurocolato de sódio de 45,63 (± 8,50) % e de 44,30 (± 8,88) % com concentrações de 1,0 mg/mL e 0,5 mg/mL, respectivamente, correspondendo a 71,78 (± 13,36) % e 93,11 (± 18,65) % da capacidade de ligação da colestiramina quando utilizada nas mesmas concentrações. Observou-se uma redução de 20,47 (± 10,24) % e 17,06 (± 12,88) % na concentração da fosfatidilcolina micelar quando o guaraná foi utilizado nas concentrações de 1,0 e 0,50 mg/mL, respectivamente, em comparação com a micela padrão sem amostra e uma inibição da solubilização micelar do colesterol de 10,14 % pelo guaraná a 1,0 mg/mL. Após o experimento de permeação, as concentrações de colesterol no compartimento basolateral foram de 197,89 (± 3,95), 151,76 (± 1,39) e 94,51 (± 9,49) µg/mL, quando 0,025, 0,050 ou 0,075 mg/mL de guaraná foram utilizados, respectivamente, demonstrando redução de 23,31 % e 52,24 % à medida que a concentração de guaraná utilizada aumentou. Observou-se uma redução do conteúdo proteico do NPC1L1 após 16 horas de incubação com guaraná nas concentrações de 0,050 e 0,075 mg/mL. Em relação ao ABCG5, observou-se um aumento do conteúdo nas concentrações de 0,025 e 0,075 mg/mL de guaraná após 02 horas. Não foram observadas diferenças importantes nos conteúdos de ABCG8 e do LXR-alfa. Conclusões: O extrato aquoso de guaraná em pó demonstrou uma redução da absorção de colesterol em células Caco-2. O extrato também demonstrou uma atividade inibitória da lipase pancreática dose-dependente, uma boa capacidade de ligação aos ácidos biliares e de interação com a fosfatidilcolina micelar, além de uma capacidade de inibição da solubilização micelar do colesterol de forma in vitro. O extrato também foi capaz de modular negativamente o conteúdo proteico do NPC1L1 e positivamente o conteúdo do ABCG5. A sua ingestão pode ser considerada uma importante fonte alimentar com potencial efeito hipocolesterolêmico, capaz de reduzir a absorção de lipídios no intestino, podendo ser utilizado como adjuvante na regulação da hipercolesterolemia, provavelmente devido à presença de polifenóis.


Introduction - The risk of cardiovascular diseases, such as atherosclerosis, is associated with hypercholesterolemia, a result of behavioral and metabolic risk factors. Dietary interventions with the use of guarana (Paullinia cupana) may be useful, since it is a food rich in bioactive compounds such as catechins, which have high antioxidant activity, inhibit oxidation of LDLc and lipid peroxidation, being able to lower blood cholesterol levels, by mechanisms not yet fully elucidated. Objective - To investigate the effects of guarana (Paullinia cupana) powder aqueous extract on mechanisms involved with the absorption of cholesterol in vitro and in Caco-2 cells. Methods - The guarana powder aqueous extract was subjected to in vitro digestion, the total phenolics content were quantified by the Folin-Ciocalteu method and the determination of the phenolic profile was performed by high performance liquid chromatography (HPLC) UV/VIS at 210 nm. The antioxidant activity was determined by Oxygen Radical Absorbance Capacity (ORAC) and the ability to inhibit pancreatic lipase, to binding with bile acids, the interaction with micellar phosphatidylcholine and the inhibition of micellar solubilization of cholesterol in vitro were evaluated. Cholesterol permeation assay was performed for a period of 2 hours in Caco-2 cells seeded and differentiated in 24- transwell plates with a solution of cholesterol micelles and guarana extract at different concentrations. The permeated cholesterol content was determined by HPLC/UV at 206 nm. The Western blotting assay was performed to determine the protein content of cholesterol transporters (NPC1L1, ABCG5, ABCG8) and LXR-alpha in Caco-2 cells after incubation with different concentrations of the extract in 2 and 16 hours. Results: The total phenolic content of the guarana extract was 104.36 (± 3.62) mg EAG/g of guarana powder. After the digestion process, this value was 48.62 (± 3.97) mg EAG/g of guarana powder, demonstrating the bioaccessibility of the polyphenols. Procyanidin B1 (1.56 ± 0.04 mg/g) and B2 (2.34 ± 0.06 mg/g), catechin (24.26 ± 0.63 mg/g), epicatechin (20.39 ± 1.20 mg/g) and caffeine (34.93 ± 0.75 mg/g) were identified in the undigested extract. After in vitro digestion, only catechin, epicatechin and caffeine were bioaccessible with 181.16 %, 136.78 % and 213.51 % of bioaccessibility, respectively. The antioxidant activity of the undigested aqueous extract was lower than that digested, with the final ORAC values of 2512 (± 399) and 4321 (± 778) µmol Eq Trolox/g of guarana powder. The extract exhibited an inhibitory activity of the pancreatic lipase enzyme in a dose-dependent manner, with an IC50 of 1033 µg/mL. The extract also demonstrated a sodium taurocholate binding capacity of 45.63 (± 8.50) % and 44.30 (± 8.88) % with concentrations of 1.0 mg/mL and 0.5 mg/mL, respectively, corresponding to 71.78 (± 13.36)% and 93.11 (± 18.65)% of the cholestyramine binding capacity when used at the same concentrations. A reduction of 20.47 (± 10.24) % and 17.06 (± 12.88) % was observed in the concentration of micellar phosphatidylcholine when guarana was used at concentrations of 1.0 and 0.50 mg/mL, respectively, compared to the standard micelle without sample and an inhibition of 10.14 % micellar cholesterol solubilization by guarana at 1.0 mg/mL. After the permeation experiment, the cholesterol concentrations in the basolateral compartment were 197.89 (± 3.95), 151.76 (± 1.39) and 94.51 (± 9.49) µg/mL, when 0.025, 0.050 or 0.075 mg/mL of guarana were used, respectively, showing a reduction of 23.31 % and 52.24 % as the concentration of guarana used increased. A reduction in the protein content of NPC1L1 was observed after 16 hours of incubation with guarana at concentrations of 0.050 and 0.075 mg/mL. After 02 hours, an increase in the content of ABCG5 at concentrations of 0.025 and 0.075 mg/mL of guarana was observed. No significant differences were observed in the contents of ABCG8 and LXR-α. Conclusions: The aqueous extract of guarana powder showed a reduction in the absorption of cholesterol in Caco-2 cells. The extract also demonstrated a dose-dependent pancreatic lipase inhibitory activity, a good ability to bind bile acids and to interact with micellar phosphatidylcholine, in addition to an ability to inhibit micellar solubilization of cholesterol in vitro. The extract was also able to negatively modulate the protein content of NPC1L1 and positively the content of ABCG5. Its intake can be considered an important dietary source with a potential hypocholesterolemic effect, capable of reducing the absorption of lipids in the intestine, and can be used as an adjunct in the control of hypercholesterolemia, probably due to the presence of polyphenols.


Subject(s)
Cholesterol , Caco-2 Cells , Paullinia , Polyphenols , Cardiovascular Diseases , Hypercholesterolemia
6.
Rev. colomb. cardiol ; 27(6): 501-510, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1289265

ABSTRACT

Resumen Introducción: La hipercolesterolemia familiar homocigótica (HFHo) se caracteriza por niveles muy elevados de cLDL y por enfermedad aterosclerótica temprana. Aunque la frecuencia es baja (1/300.000), las complicaciones son muy severas y pueden ser evitadas. Encontrar y tratar esta población de manera temprana podría reducir la mortalidad. Se describen 36 casos en Colombia, en donde se calcula que haya entre 160 y 200 casos. Resultados: Un total de 36 pacientes con fenotipo sugestivo de HFHo fueron identificados y tratados en un período de observación de cuatro años. La media de edad fue 27 años (24 mujeres). 34 pacientes tuvieron un puntaje según la Red de Clínicas de Lípidos de Holanda (RCLH) mayor de 8 (diagnóstico definitivo) y los restantes 2 tenían puntaje equivalente a diagnóstico probable. Un cuarto de los casos procedían de la costa norte colombiana. En las pruebas genéticas, 14 fueron homocigóticos verdaderos para mutación del gen que codifica para el receptor de LDL (LDLR), 12 heterocigóticos compuestos, 2 heterocigóticos dobles y uno autosómico recesivo (LDLRAP1); 5 pacientes fueron heterocigóticos simples (LDLR) y 2 pacientes no autorizaron la prueba. En los homocigóticos verdaderos, la variante más frecuente encontrada fue la c.11G>A. 14 pacientes cursaron con enfermedad coronaria, 9 con estenosis carotídea, 8 con estenosis aórtica y 2 tuvieron ataques cerebrovasculares (ACV). 34 pacientes recibían estatinas (24 rosuvastatina), 30 recibían ezetimibe, 2 recibían evolocumab y 20 recibían lomitapide (dosis promedio 12,7mg). Ninguno recibió aféresis de cLDL. Los medicamentos, en general, fueron bien tolerados y la reducción promedio de cLDL con la terapia fue de 533,7mg/dl a 245,1mg/dl (54%). Conclusiones: Todos los pacientes recibieron tratamiento hipolipemiante y se encontraron alteraciones genéticas diagnósticas en todos aquellos que autorizaron el examen. Los niveles elevados de cLDL conllevan tanto riesgo que el tratamiento debe establecerse aún sin conocer el diagnóstico genético.


Abstract Background: Homozygous familial hypercholesterolemia (HoFH) is characterized for very high levels of cLDL and early cardiovascular disease. Although incidence is low (1/300 000), complications are very severe and can be avoided. Finding and treating this population promptly could reduce mortality. We describe 36 cases in Colombia, where 160 to 200 cases are expected. Results: 36 patients with phenotype of HoHF were identified and treated in a follow-up of 4 years. The mean age was 27 years (24 women). 34 of them had at least 8 points in the FH Dutch Lipid Clinic Criteria (definitive diagnosis) and two had probable diagnosis. A quarter of the cases came from the Colombian North Coast. In molecular tests, 14 were true homozygous for LDLR, 12 were compound heterozygous for LDLR, 2 double heterozygous and one was autosomal recessive; 5 were heterozygous and 2 patients did not authorized genetic test. In true homozygous subjects, the most frequent variant was c.11G>A. 14 patients had coronary disease, 9 carotid stenosis, 8 aortic stenosis and 2 had stroke. 34 patients were on statins (25 rosuvastatin), 30 were receiving ezetimibe, 2 were receiving a PSCK9 inhibitor (evolocumab) and 20 were on lomitapide with mean doses of 12.7mg. None received lipoprotein apheresis. Medications were very well tolerated. Changes in cLDL after therapy was from 533.7 mg/dL to 245 mg/dL, (54%). Conclusions: Treatment was started in all patients. We found genetic mutations in all patients with genetic tests. The high levels of cLDL mean such a high risk that treatment must be started promptly, even without a genetic test.


Subject(s)
Humans , Male , Female , Adult , Hypercholesterolemia , Alleles , Genetics , Hyperlipoproteinemia Type II , Lipids , Cholesterol, LDL , Mutation
7.
Acta bioquím. clín. latinoam ; 54(3): 267-277, set. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1130601

ABSTRACT

Diversos estudios evidencian la asociación entre los niveles elevados del colesterol de LDL (cLDL) y el riesgo de desarrollar enfermedad cardiovascular aterosclerótica. Con el objetivo de comparar los valores de cLDL obtenidos mediante la medición directa y los valores estimados por las ecuaciones de Friedewald tradicional, modificada y de regresión, se valoró el cLDL de 4.621 pacientes mediante el ensayo directo en el autoanalizador ADVIA 1800. Dichos resultados se agruparon en los estados de normolipemia, hipercolesterolemia, hiperlipemia mixta e hipertrigliceridemia y se establecieron diferencias de estimación con las mencionadas fórmulas en el total de la muestra y en los niveles de decisión clínica para el cLDL. Las tres fórmulas presentaron correlación significativa con el método directo en la totalidad de la muestra; sin embargo, cuando los niveles de triglicéridos de las muestras superaron los 200 mg/dL, la diferencia entre la fórmula de Friedewald y el método directo resultó -11,94%, y llegó a -19,13% para el nivel de triglicéridos mayor de 400 mg/dL. Por otro lado, las ecuaciones de Friedewald modificada y de regresión se vieron afectadas en menor cuantía por el nivel de triglicéridos. Las fórmulas de regresión y de Friedewald modificada se constituyen como alternativas razonables para estimar el cLDL y presentan buena concordancia con el método directo, incluso en niveles altos de colesterol y triglicéridos.


Several studies show the association between high LDL cholesterol (LDLc) levels and the risk of developing atherosclerotic cardiovascular disease. In order to compare the LDLc values obtained by direct measurement and the values estimated by the traditional, modified and regression Friedewald equations, the LDLc of 4,621 patients was assessed by means of the direct test in the ADVIA 1800 autoanalyzer.These results were grouped into the states of normolipemia, hypercholesterolemia, mixed hyperlipemia and hypertriglyceridemia, establishing differences in estimation with the aforementioned formulas in the total sample and in clinical decision levels for LDLc. The three formulas showed a significant correlation with the direct method in the entire sample; however, when the triglyceride levels of the samples exceeded 200 mg/dL, the difference between Friedewald's formula and the direct method was -11.94% reaching -19,13% for the triglyceride level greater than 400 mg/dL, while the modified Friedewald and regression equations were affected to a lesser extent by the triglyceride level. Regression and modified Friedewald formulas are constituted as reasonable alternatives to estimate LDLc and have good agreement with the direct method, even at high cholesterol and triglyceride levels.


Varios estudos evidenciam a associacao entre niveis elevados do colesterol LDL (cLDL) e o risco de desenvolver doenca cardiovascular aterosclerotica. Visando comparar os valores de cLDL obtidos atraves da medicao direta e os valores estimados pelas equacoes de Friedewald tradicional, modificada e de regressao, o cLDL de 4.621 pacientes foi avaliado por meio do teste direto no analisador automatico ADVIA 1800. Tais resultados foram agrupados nos estados de normolipemia, hipercolesterolemia, hiperlipemia mista e hipertrigliceridemia, estabelecendo-se diferencas na estimativa com as formulas mencionadas no total da amostra e nos niveis de decisao clinica para cLDL. As tres formulas apresentaram correlacao significativa com o metodo direto em toda a amostra, no entanto, quando os niveis de triglicerideos das amostras excederam 200 mg/dL, a diferenca entre a formula de Friedewald e o metodo direto foi de -11,94% atingindo -19,13% para o nivel de triglicerideos superior a 400 mg/dL. Por outra parte, as equacoes de Friedewald modificada e de regressao foram afetadas em menor grau pelo nivel de triglicerideos. As formulas de regressao e de Friedewald modificada se constituem como alternativas razoaveis para estimar o cLDL, e apresentam boa concordancia com o metodo direto, mesmo em niveis elevados de colesterol e triglicerideos.


Subject(s)
Triglycerides , Hypertriglyceridemia , Cholesterol , Hypercholesterolemia , Hyperlipidemias , Hyperlipoproteinemia Type V , Cholesterol, LDL , Cholesterol, LDL/blood , Patients , Association , Cardiovascular Diseases , Disease , Risk , Minors , Methods
8.
Rev. saúde pública (Online) ; 54: 138, 2020. tab, graf
Article in English | LILACS, BBO, SES-SP | ID: biblio-1145071

ABSTRACT

ABSTRACT OBJECTIVE: To assess the prevalence of multimorbidity among Brazilian adults and its association with socioeconomic indicators. METHODS: Cross-sectional study that used data from the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - Brazilian National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between 2013 and 2014. The definition of multimorbidity was the coexistence, in a single individual, of two or more chronic diseases, measured through a list of 14 morbidities (self-reported medical diagnosis throughout life). Economic status and educational level were the socioeconomic indicators used, being the inequalities assessed through the Slope Index of Inequality (SII) and the Concentration Index, stratified by gender. RESULTS: The study comprehended 23,329 adults (52.8% of which were women), with an average age of 37.9 years. Hypertension and high cholesterol levels were the most prevalent conditions. The prevalence of multimorbidity was of 10.9% (95%CI 10.1-11.7) representing nearly 11 million individuals in Brazil, of which 14.5% (95%CI 13.5-15.4) were women and 6.8% (95%CI 5.9-7.8) were men. The occurrence of multimorbidity was similar according to the socioeconomic indicators. In the inequality analysis, we observed absolute and relative differences in men with a higher purchasing power (SII = 3.7; 95%CI 0.3-7.0) and higher educational level (CIX = 7.1; 95%CI 0.9-14.7), respectively. CONCLUSIONS: The frequency of comorbidities in Brazilian adults is high, especially in absolute terms. We only observed socioeconomic inequalities in multimorbidities among men.


RESUMO OBJETIVO: Avaliar a prevalência de multimorbidade e a associação desta com indicadores socioeconômicos entre adultos brasileiros. MÉTODOS: Estudo transversal que utilizou dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil, realizada entre 2013 e 2014. Multimorbidade foi definida como a coexistência, no mesmo indivíduo, de duas ou mais doenças crônicas, e é mensurada a partir de uma lista de 14 morbidades (autorrelato de diagnóstico médico na vida). Classe econômica e escolaridade foram os indicadores socioeconômicos utilizados, sendo as desigualdades avaliadas pelo Slope Index of Inequality (SII) e pelo Concentration Index (CIX), estratificadas por sexo. RESULTADOS: O estudo considerou 23.329 mil adultos (52,8% de mulheres), com média de idade de 37,9 anos. Hipertensão e colesterol alto foram as condições mais prevalentes. A prevalência de multimorbidade foi de 10,9% (IC95% 10,1-11,7), representando, aproximadamente, 11 milhões de indivíduos no Brasil, sendo 14,5% (IC95% 13,5-15,4) entre mulheres e 6,8% (IC95% 5,9-7,8) entre homens. A ocorrência de multimorbidade foi similar segundo os indicadores socioeconômicos. Nas análises de desigualdade, observou-se diferença absoluta e relativa para homens com maior poder aquisitivo (SII = 3,7; IC95% 0,3-7,0) e maior escolaridade (CIX = 7,1; IC95% 0,9-14,7), respectivamente. CONCLUSÕES: A frequência de adultos brasileiros com multimorbidade é alta, principalmente em termos absolutos. Desigualdades socioeconômicas na multimorbidade foram observadas somente entre homens.


Subject(s)
Humans , Male , Female , Adult , Educational Status , Multimorbidity , Hypercholesterolemia/epidemiology , Hypertension/epidemiology , Brazil/epidemiology , Cholesterol/blood , Cross-Sectional Studies , Health Surveys , Sex Distribution , Age Distribution , Health Status Disparities
9.
Rev. cuba. angiol. cir. vasc ; 20(3): e56, jul.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093136

ABSTRACT

Introducción: El perfil lipídico mínimo está relacionado con la enfermedad vascular de tipo aterosclerótica, pero se desconoce cuál es el tipo de perfil más frecuente en los adultos y el tipo de riesgo que representan para la enfermedad vascular periférica de los miembros inferiores. Objetivo: Determinar si el perfil lipídico mínimo sirve para diagnosticar el riesgo de enfermedad vascular periférica de los miembros inferiores. Métodos: Se trabajó con 533 muestra sanguíneas de personas adultas de diferentes municipios de la provincia La Habana. Se cuantificaron las concentraciones de colesterol total y de triglicéridos. Se calculó la media y la desviación estándar. Se diagnosticó y clasificó la hiperlipemia, se identificó el riesgo de enfermedad vascular periférica de los miembros inferiores y su asociación con la hiperlipemia. Se trabajó con un nivel de confiabilidad del 95 por ciento (a=0,05). Resultados: Los perfiles lipídicos mínimos más frecuentes fueron: el hipercolesterolemia leve (46,0 por ciento) y la hipertrigliceridemia (22,6 por ciento). El 53,8 por ciento presentó riesgo de enfermedad vascular periférica de los miembros inferiores entre potencial (24,8 por ciento) y alto (29,0 por ciento). Existió una asociación entre la hiperlipemia y la presencia de enfermedades vasculares periféricas de los miembros inferiores (chi cuadrada= 120,4; p= 0,00000). Se detectó que el 50 por ciento de las personas requería de un tratamiento hipolipemiante. Conclusión: El perfil lipídico mínimo sirve para diagnosticar el tipo de riesgo de enfermedad vascular periférica de los miembros inferiores. Se observó una fuerte asociación de dicha enfermedad con la presencia de hiperlipemia(AU)


Introduction: The minimum lipid profile is related to atherosclerotic vascular disease, but it is not known what is the most common type in adults and the kind of risk it represent for peripheral vascular disease of the lower limbs. Objective: To determine if the minimum lipid profile is used to diagnose the risk of peripheral vascular disease of the lower limbs. Methods: It was carried out a study with 533 blood sample of adults from different municipalities in Havana province. Concentrations of total cholesterol and triglycerides were quantified. Average and standard deviation were calculated. Hyperlipidemia was diagnosed and classified, the risk of peripheral vascular disease of the lower limbs and the association of the latter with hyperlipidemia were identified. The level of reliability used was of 95 percent (a= 0.05). Results: The most common minimum lipid profiles were: mild hypercholesterolemia (46 percent) and hypertriglyceridemia (22.6 percent). 53.8 percent presented a risk of peripheral vascular disease of the lower limbs between potential (24.8 percent) and high (29 percent). There was a relation between the hyperlipidemia and the presence of peripheral vascular diseases of the lower limbs (chi-cudrada= 120.4, p= 0.00000). It was detected that 50 percent of the people required a hypolipidemic treatment. Conclusion: The minimum lipid profile is used to diagnose the risk's type of peripheral vascular disease of the lower limbs, observing a strong relation of the latter with the presence of hyperlipidemia(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vascular Diseases , Peripheral Vascular Diseases , Lower Extremity , Hypercholesterolemia , Triglycerides , Hypertriglyceridemia , Hyperlipidemias
10.
Rev. cient. Esc. Univ. Cienc. Salud ; 6(2): 17-26, jun.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1117034

ABSTRACT

Introducción: La hipertensión arterial causa millones de fallecimientos anualmente. Su origen es heterogéneo; implicando factores, tanto modificables como no modificables. Objetivos Identificar los factores de riesgo asociados a hipertensión arterial en estudiantes de la Universidad Nacional Autónoma de Honduras en el Valle de Sula (UNAH-VS) en el II y III trimestre del 2018. Pacientes y métodos Se realizó un estudio cuantitativo de casos y controles con una proporción 1:1 durante el II y III trimestre del año 2018 en el Área de Salud de la Subdirección de Desarrollo Estudiantil, Cultura, Arte y Deporte (SUDECAD) de la UNAH-VS. Mediante un muestreo no probabilístico por conveniencia, se obtuvo una muestra de 34 universitarios, casos, diagnosticados con hipertensión arterial y 34 controles que no padecían la enfermedad. Resultados 24 (35.29%) de los pacientes eran hombres. Los factores con una importante asociación a la enfermedad son el antecedente familiar de hipertensión familiar en primer grado (OR: 3.8 IC: 95%, 1.3 ­ 11.2), la obesidad (OR: 5.1 IC: 95%, 1.6 ­ 16.5), el sedentarismo (OR: 4.8 IC: 95%, 1.6 ­ 14.2), la dieta no saludable (OR: 7.6 IC: 95%, 1.5 ­ 37.8), la hipertrigliceridemia (OR: 5.2 IC: 95%, 1.7 ­ 15.9) y la hipercolesterolemia (OR: 7.3 IC: 95%, 2.2 ­ 23.5). Conclusiones En los factores de riesgo no modificables, el antecedente familiar de la enfermedad fue el más importante. En los factores de riesgo modificables, predominaron aquellos asociados fuertemente a riesgo cardiovascular...(AU)


Subject(s)
Humans , Male , Female , Adult , Hyperlipoproteinemia Type IV , Hypertension , Dyslipidemias , Hypercholesterolemia/complications
12.
Rev. cuba. reumatol ; 21(3): e106, sept.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093832

ABSTRACT

Introducción: la artritis reumatoide es una enfermedad sistémica, de etiología desconocida, caracterizada por provocar inflamación crónica, cursa con manifestaciones articulares, extrarticulares y comportamiento clínico variable. Objetivo: caracterizar los factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide e identificar su relación con el tiempo de diagnóstico, actividad inflamatoria y tratamiento. Método: se realizó estudio descriptivo transversal, en pacientes con artritis reumatoide atendidos en el Centro de Reumatología del Hospital Docente Clínico Quirúrgico 10 de Octubre entre febrero 2016 y junio 2017. Resultados: la mayor frecuencia fue para el sexo femenino, el rango etario 45-54 años. Se observó placa ateromatosa en 37.2 por ciento y engrosamiento complejo íntima media en el 15.4 por ciento. Los factores de riesgo que mostraron asociación con la presencia de placa fueron: hipertrigliceridemia (p= 0.000), hipercolesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) y los niveles elevados de proteína C Reactiva (p= 0.003). Conclusiones: los factores de riesgo tradicionales que presentaron significación estadística fueron la hipercolesterolemia, hipertrigliceridemia y la Diabetes Mellitus. La presencia de más de un factor elevó la frecuencia de alteraciones en el eco doppler; existió asociación entre la elevación de los niveles de PCR y la presencia de alteraciones del eco doppler. Se constató en aquellos pacientes con alteraciones eco doppler carotídeo relación con el tiempo de evolución, actividad de la enfermedad y dosis acumulada de esteroides(AU)


Introduction: rheumatoid arthritis is a systemic disease, of unknown etiology, characterized by chronic inflammation; It presents with joint, extra-articular manifestations and variable clinical behavior. Objective: to characterize the risk factors for the appearance of atherosclerosis in patients with rheumatoid arthritis and to identify their relationship with the time of diagnosis, inflammatory activity and treatment. Method: a cross-sectional, descriptive study was conducted in patients with rheumatoid arthritis treated at the Rheumatology Center of the Surgical Clinical Teaching Hospital 10 de Octubre in the period between February 2016 and June 2017. Results: the highest frequency was for the female sex, the age range 45-54 years. Atheromatous plaque was observed in 37.2 percent and intimal complex thickening in 15.4 percent. The risk factors that showed association with the presence of plaque were: hypertriglyceridemia (p= 0.000), hypercholesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) and high levels of C-reactive protein (p= 0.003) Conclusions: the traditional risk factors that presented statistical significance were hypercholesterolemia, hypertriglyceridemia and Diabetes Mellitus. The presence of more than one traditional risk factor increased the frequency of alterations in Doppler echo; There was an association between the elevation of C-Reactive Protein levels and the presence of Doppler echo alterations. It was found in those patients with carotid echo Doppler alterations, relationship with the time of evolution, activity of the disease and cumulative dose of steroids(AU)


Subject(s)
Humans , Arthritis, Rheumatoid/complications , C-Reactive Protein/analysis , Hypertriglyceridemia/complications , Polymerase Chain Reaction/methods , Diabetes Mellitus/diagnosis , Atherosclerosis/complications , Hypercholesterolemia/complications , Epidemiology, Descriptive , Cross-Sectional Studies , Risk Factors
13.
Cambios rev. méd ; 18(2): 13-17, 2019/12/27. tabs.
Article in Spanish | LILACS | ID: biblio-1097601

ABSTRACT

INTRODUCCIÓN. El hipotiroidismo e hipertiroidismo, constituyen patologías tiroideas, que si no reciben tratamiento apropiado llegan a provocar alteraciones sistémicas, siendo una de las principales las cardiovasculares. OBJETIVO. Conocer la influencia que tiene el hipotiroidismo e hipertiroidismo como factores de riesgo para el desarrollo de enfermedad cardiovascular. MATERIALES Y MÉTODOS. Estudio retrospectivo de enfoque cuantitati-vo; desarrollado en una población y muestra conocida de 111 pacientes, que acudieron al Servicio de Endocrinología del Hospital Manuel Ygnacio Monteros Valdivieso de la ciudad de Loja, atendidos en el año 2015. RESULTADOS. Predominó el sexo femenino, con un 20,72% (23; 69) en el grupo etario de 61 a 70 años de las pacientes hipotiroideas; y las de 51 a 60 años en 5,40% (6; 11) de las hipertiroideas. De acuerdo a los parámetros que pue-den condicionar mayor riesgo cardiovascular, el sobrepeso y obesidad presentaron una mayor frecuencia para hipotiroidismo en 67,70% (65; 111) e hipertiroidismo en un 66,67% (10; 111). El riesgo bajo cardiovascular prevaleció en 75,00% (72; 96) de la población hipo-tiroidea y 93,33% (14; 15) de la hipertiroidea. La hipertensión arterial fue la patología car-diovascular diagnosticada con mayor frecuencia sobre todo en los pacientes hipotiroideos representado por el 14,58% (14; 19). CONCLUSIÓN. Estas patologías, de no controlarse pudieran condicionar en la población de estudio un mayor riesgo cardiovascular.


INTRODUCTION. Hypothyroidism and hyperthyroidism, constitute thyroid pathologies, that if they do not received appropriate treatment, cause systematic alterations, treatment, cause systematic cardiovascular diseases being one of the main ones. OBJECTIVE. Know the influence of hypothyroidism and hyperthyroidism as risk factors for the development of cardiovascular disease. MATERIALS AND METHODS. Retrospective study of quantitative approach; developed in a population and known sample of 111 patients, who went to the Endocrinology Service of the Manuel Ygnacio Monteros Valdivieso Hospital in the city of Loja, attended in 2015. RESULTS. The female sex predominated, with 20,72% (23; 69) in the age group predominated 61 to 70 years of age in 5,40% (6; 11) of hyperthyroids. According to the parameters that may condition higher cardiovascular risk, overweight and obesity presented a higher frequency for hypothyroidism in 67,70% (65; 111) and hyperthyroidism in 66,67% (10; 111). Low cardiovascular risk prevailed in 75,00% (72; 96) of the hypothyroid population and 93,33% (14; 15) of the hyperthyroid population. Arterial hypertension was the most frequently diagnosed cardiovascular disease, especially in hypothyroid patients by 14,58% (14; 19). CONCLUSION. These pathologies, if not controlled, could condition a higher cardiovascular risk in the study population.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cardiovascular Diseases , Body Mass Index , Risk Factors , Essential Hypertension , Hyperthyroidism , Hypothyroidism , Thyroid Diseases , Hypertriglyceridemia , Overweight , Hypercholesterolemia , Obesity
14.
Rev. cuba. endocrinol ; 30(2): e197, mayo.-ago. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126436

ABSTRACT

RESUMEN El síndrome de Van Wyk-Grumbach se caracteriza por hipotiroidismo primario de larga duración asociado a pubertad precoz. Se presenta una paciente de 7 años, mestiza, que acude por sangrado vaginal, acompañado de hiperpigmentación de las areolas sin galactorrea, abdomen globuloso, mixedema, hirsutismo, baja talla, astenia y retraso escolar. La química sanguínea mostró anemia, hipercolesterolemia y hipertransaminasemia; los estudios de imágenes constataron derrame pericárdico, retraso marcado de la edad ósea, incremento de las dimensiones de la silla turca y gran quiste del ovario con aparente criterio quirúrgico. Los estudios hormonales confirmaron la sospecha de hipotiroidismo primario asociado a hiperprolactinemia. El tratamiento sustitutivo con levotiroxina sódica revirtió los signos y síntomas de pubertad precoz, lo que evitó la cirugía del quiste de ovario; la recuperación en el ambiente escolar y social fue indiscutible. Reconocer esta entidad evita tratamientos absolutamente contraindicados, como la extirpación de los quistes o el tratamiento quirúrgico de la hiperplasia hipofisaria(AU)


ABSTRACT Van Wyk-Grumbach syndrome is characterized by long-lasting primary hypothyroidism associated with precocious puberty. A case of a 7-year-old female mestizo patient is reported. She came to consultation for vaginal bleeding, accompanied by hyperpigmentation of the areolas without galactorrhea, globular abdomen, myxedema, hirsutism, short stature, asthenia and school delay. Blood chemistry showed anemia, hypercholesterolemia and hypertransaminasemia. Imaging studies showed pericardial effusion, marked delay in bone age, increased dimensions of Turkish chair and large ovarian cyst with apparent surgical criteria. Hormonal studies confirmed the suspicion of primary hypothyroidism associated with hyperprolactinemia. Substitute treatment with levothyroxine sodium reversed the signs and symptoms of precocious puberty, which prevented ovarian cyst surgery; the recovery in the school and social environment was certain. Recognizing this entity avoids absolutely contraindicated treatments, such as the removal of cysts or the surgical treatment of pituitary hyperplasia(AU)


Subject(s)
Humans , Female , Child , Puberty, Precocious , Thyroxine/therapeutic use , Hypercholesterolemia/etiology , Hypothyroidism/diagnosis , Anemia/etiology
15.
Prensa méd. argent ; 105(5): 284-292, jun 2019. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1024554

ABSTRACT

Diabetes remains unique among the main non-communicable ailments (NCDs) recognized by the World Health Organization (WHO), apart from the circulatory diseases, tumours, and long-lasting respiratory ailments. The current study aimed to determine the correlation between ABCA1 gene polymorphismo and lipid profile in type 2 diabetes mellitus patients. Serum samples from 100 type 2 diabetes mellitus patients (46 males and 54 females) and 50 standard subjects (26 males and 24 females) were colected from Najaf province/Irak. Fasting blood sugar (FBS), and lipid profiles (total cholesterol (TC), triglycerides (TH), HDL, LDL, and VLDL) were meassured. Plymerase chain reaction (PCR) with the Taq1 enzye was used for the amplification of the ABCA1 gene, which contains 525bp of the AABCA1 gene in the locus V825I. The present study revaled a positive corrrelation between FBS and body mass index (BMI) (r= 0.2390, p= 0.0463), TG (r = 0.1836, p= .01743), and VLDL (r = 0.1836, p = 0.1839). The frequencies of the GG genotype and the G allele were higher in the normal groups compared to the patientes (58% vs. 56% and 70% vs. 67%, respectively); conversely, the frequencies of the AA genotype (18% vs. 22%) and the A allele (30% vs. 33%) were higher in the patients compared to the normal groups. The data also showed a significant relationship between ABCA1 gene polymorphim and both TG and VLDL (P=0.007 for cach). There is relationship between the ABCA1 gene and HDL level. Additiionally, the G allele could be a defensive factor against diabetes mellitus in Iraqi peole (AU)


Subject(s)
Humans , Polymorphism, Genetic , Blood Glucose/analysis , Diabetes Mellitus, Type 2 , ATP Binding Cassette Transporter 1/genetics , Gene Frequency , Hypercholesterolemia/blood
16.
Medicina (B.Aires) ; 79(2): 104-110, abr. 2019. ilus, graf
Article in Spanish | LILACS | ID: biblio-1002615

ABSTRACT

La reducción del colesterol-LDL (C-LDL) es un objetivo primordial en prevención cardiovascular. Estudios recientes demostraron beneficio clínico al administrar inhibidores de la proprotein convertase subtilisin/kexin-9 (iPCSK9) a pacientes que no habían logrado la meta de C-LDL con estatinas de alta intensidad y ezetimibe, sin embargo el uso de estos fármacos está limitado por su costo. El American College of Cardiology, la Sociedad Argentina de Cardiología y la European Society of Cardiology recomiendan una meta de C-LDL menor a 70 mg/dl en prevención secundaria, determinando umbrales de C-LDL de 70, 100 o 140 mg/dl respectivamente, para iniciar el tratamiento con iPCSK9. Con el objetivo de evaluar el esquema hipolipemiante prescripto en internados por síndrome coronario agudo o revascularización coronaria y analizar la proporción de elegibles para ser tratados con iPCSK9 en un escenario real y simulado, realizamos un estudio que incluyó 351 pacientes con enfermedad coronaria, tomados de una base de datos electrónica de un hospital universitario. El 48.4% recibió estatinas de elevada intensidad, 11.4% ezetimibe y 54.7% no logró la meta de C-LDL menor a 70 mg/dl. Utilizando un modelo de simulación en el que todos serían medicados con estatinas de elevada intensidad y ezetimibe, la elegibilidad para prescribir iPCSK9 fue de 31.1%, 12.8% y 9.1% según los umbrales de C-LDL determinados por las tres sociedades científicas. Nuestro estudio demostró una brecha entre las recomendaciones de los consensos para reducir el colesterol y la práctica habitual que debería ser minimizada para optimizar la relación costo/efectividad en prevención secundaria.


LDL-cholesterol (LDL-C) lowering is a primary objective in cardiovascular prevention. Recent studies demonstrated clinical benefit when proprotein convertase subtilisin/kexin-9 inhibitors (PCSK9i) were added to the treatment in patients who had not achieved the LDL-C goal despite being treated with high intensity statins and ezetimibe, however the use of these drugs is limited by their cost. The American College of Cardiology, the Argentine Society of Cardiology and the European Society of Cardiology recommend an LDL-C goal less than 70 mg/dl in secondary prevention, determining thresholds of LDL-C to start treatment with PCSK9i of 70, 100 or 140 mg/dl respectively. In order to evaluate the lipid-lowering regimen prescribed in patients hospitalized for acute coronary syndrome or coronary revascularization and analyze the proportion of eligible to be treated with PCSK9i in a real and simulated scenario, we conducted a study that included 351 patients with coronary disease collected from an electronic database of a university hospital. The 48.4% received high intensity statins, 11.4% ezetimibe and 54.7% did not achieve the LDL-C goal of less than 70 mg/dL. Using a simulation model in which all would be treated with high intensity statins and ezetimibe, the eligibility to prescribe PCSK9i was 31.1%, 12.8% and 9.1% according to the C- LDL thresholds determined by the three scientific societies. Our study demonstrated a gap between the consensus recommendations for LDL-C lowering and the current practice that should be minimized to optimize the cost/effectiveness ratio in secondary prevention.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Proprotein Convertase 9/antagonists & inhibitors , Hypercholesterolemia/drug therapy , Anticholesteremic Agents/therapeutic use , Argentina , Societies, Scientific , Time Factors , Sex Factors , Cross-Sectional Studies , Age Factors , Treatment Outcome , Practice Guidelines as Topic , Statistics, Nonparametric , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Ezetimibe/therapeutic use
18.
Arq. bras. cardiol ; 112(4): 453-460, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001278

ABSTRACT

Abstract Coronary artery disease (CAD) is one of the leading causes of mortality. High circulating levels of low-density lipoprotein (LDL) in the blood are associated with cardiovascular mortality, whether through an etiological role or through its association with the progression of CAD per se. Randomized clinical trials have shown that, when LDL levels are reduced, cardiovascular risk is also reduced, which reinforces this association. The first major trial involving a hypolipidemic agent of the statin family, the Scandinavian Simvastatin Survival Study (4S), was published in 1994 and found a significant reduction in mortality in patients at high cardiovascular risk. However, even in subsequent studies with different statins, a residual risk persisted, and this seems not to have changed over time; it is speculated that this risk may be due to statin intolerance. In this scenario, the potential exists for novel hypolipidemic agents to drive a true revolution in the therapy of dyslipidemia. The recent discovery of PCSK9 inhibitors (PCSK9i), a class of hypolipidemic monoclonal antibodies, is extremely promising. PCSK9 inhibition is capable of promoting a mean LDL reduction of up to 60%, with potential for very significant clinical repercussions, as every 38 mg/dL reduction in LDL appears to be associated with a 22% reduction in cardiovascular risk. This review addresses a brief history of PCSK9i, major trials of these drugs, cardiovascular outcomes, and aspects related to their efficacy and safety. Finally, the molecular mechanisms and possible pleiotropic effects of PCSK9i are also discussed.


Resumo A doença arterial coronariana (DAC) é uma das principais causas de mortalidade. Níveis circulantes elevados de lipoproteína de baixa densidade (LDL) no sangue estão associados com mortalidade cardiovascular, seja por um papel etiológico ou por sua associação com a progressão da DAC em si. Estudos clínicos randomizados mostram que, quando os níveis de LDL são reduzidos, o risco cardiovascular também é reduzido, o que reforça tal associação. O primeiro ensaio importante envolvendo um agente hipolipemiante da família da estatina, o estudo Scandinavian Simvastatin Survival Study (4S), foi publicado em 1994 e encontrou uma redução significativa na mortalidade de pacientes com risco cardiovascular elevado. Contudo, mesmo em estudos subsequentes com diferentes estatinas, observou-se um risco residual persistente, o qual aparentemente não mudou ao longo dos anos. Especula-se que esse risco se deve à intolerância às estatinas. Nesse cenário, existe um potencial para novos agentes hipolipemiantes que levem a uma verdadeira revolução no tratamento das dislipidemias. A descoberta recente dos inibidores de PCSK9 (PCSK9i), uma classe de anticorpos monoclonais, é extremamente promissora. A inibição da PCSK9 é capaz de promover uma redução média nos níveis de LDL de até 60%, com potencial para repercussões clínicas muito significativas, já que para cada redução de 38 mg/dL, parece haver uma redução de 22% no risco cardiovascular. Esta revisão aborda uma breve história dos PCSK9i, os principais ensaios envolvendo esses medicamentos, desfechos cardiovasculares, e aspectos relacionados a sua eficácia e segurança. Finalmente, os mecanismos moleculares e possíveis efeitos pleiotrópicos dos PCSK9i são também discutidos.


Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Proprotein Convertase 9/antagonists & inhibitors , Hypercholesterolemia/drug therapy , Cholesterol, LDL/drug effects , Anticholesteremic Agents/therapeutic use , Cardiovascular Diseases/etiology , Reproducibility of Results , Risk Factors , Risk Assessment , Diabetes Mellitus/physiopathology , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal, Humanized/pharmacology , Hypercholesterolemia/complications , Cholesterol, LDL/blood , Anticholesteremic Agents/pharmacology
19.
J. bras. nefrol ; 41(1): 142-144, Jan.-Mar. 2019. graf
Article in English | LILACS | ID: biblio-1002417

ABSTRACT

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.


RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.


Subject(s)
Humans , Male , Aged , Renal Insufficiency/diagnostic imaging , Atherosclerosis/complications , Dyslipidemias/complications , Hypertension/complications , Biopsy , Platelet Aggregation Inhibitors/therapeutic use , Hypertriglyceridemia , Aspirin/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Creatinine/blood , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/etiology , Renal Insufficiency/etiology , /therapeutic use , Hypercholesterolemia , Kidney/pathology , Microscopy , Anti-Inflammatory Agents/therapeutic use
20.
Yonsei Medical Journal ; : 1203-1208, 2019.
Article in English | WPRIM | ID: wpr-762063

ABSTRACT

Little is known about the benefits of statin use on liver cancer mortality among patients with chronic hepatitis B (CHB) considering hypercholesterolemia and obesity. A nationwide retrospective cohort study was conducted using data from a Health Examination Cohort of the National Health Insurance Service of Korea. Data on CHB patients with no other concurrent liver disease were acquired, and statin use was defined as a cumulative daily dose ≥28. A 3-year landmark analysis was performed to avoid immortal time bias. Patients who started statin therapy within the landmark date were considered statin users. A Cox regression analysis was applied to assess associations between statin use and liver cancer mortality considering hypercholesterolemia and obesity. Among 13063 patients, 193 (1.5%) died of liver cancer during the mean follow-up period of 10.6 years. After adjusting for demographic and metabolic factors, statin use [hazard ratio (HR), 0.17; 95% confidence interval (CI), 0.04–0.70] and hypercholesterolemia (HR, 0.46; 95% CI, 0.24–0.88 for total cholesterol ≥240 mg/dL) were associated with a decreased risk of liver cancer mortality, whereas body mass index (BMI) ≥30 kg/m² was associated with an increased risk of liver cancer mortality (HR, 2.46; 95% CI, 1.20–5.06). This study showed that statin use was associated with decreased liver cancer mortality when adjusting for cholesterol levels and BMI. This study found that hypercholesterolemia was independently associated with decreased liver cancer mortality regardless of statin use.


Subject(s)
Bias , Body Mass Index , Carcinoma, Hepatocellular , Cholesterol , Cohort Studies , Follow-Up Studies , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hypercholesterolemia , Korea , Liver Diseases , Liver Neoplasms , Liver , Mortality , National Health Programs , Obesity , Retrospective Studies
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