Lipoproteína de alta densidade e hipertensão arterial sistêmica estão associados à atividade necroinflamatória hepática em pacientes com hepatite C crônica / High-density lipoprotein cholesterol and systemic arterial hypertension are associated with hepatic necroinflammatory activity in patients with chronic hepatitis c

ABSTRACT Background: Approximately 71 million people are chronically infected with hepatitis C virus (HCV) worldwide. A significant number of these individuals will develop liver cirrhosis and/or hepatocellular carcinoma. Beyond the liver, there is a sizeable body of scientific evidence linking cardiovascular disease and chronic hepatitis C (CHC); however, the biological mechanisms behind the concurrence of these conditions have not been completely clarified yet. Objective: To evaluate associations between hepatic histology, clinical comorbidities and lipid profile in patients with CHC. To investigate associations between liver histology and demographic, nutritional, biochemical and virological parameters. Methods: Eight-five patients with CHC prospectively underwent hepatic biopsy. Liver fragments were obtained from each patient by percutaneous route using a Menghini needle. Fibrosis was evaluated according to the METAVIR scoring system, as follows: F0, no fibrosis; F1, fibrous portal expansion; F2, fibrous portal widening with few septa; F3, bridging fibrosis with architectural distortion; and F4, liver cirrhosis. The activity was classified based on the degree of lymphocyte infiltration and hepatocyte necrosis, from A0 to A3. The diagnosis of liver disease was based on clinical, biochemical, histological, and radiological methods. The data were analyzed by logistic regression models. Results: This cross-sectional study included 85 outpatients followed at the tertiary care ambulatory centre with a mean age of 57.2±10.7 years and 45 (52.9%) were females. There were 10 patients with cirrhosis. Patients with a METAVIR F3-F4 were significantly older (P=0.02) and had higher levels of ALT (P=0.0006), AST (P<0.0001), γ-GT (P=0.03) and bilirubin (P=0.001) and higher prothrombin time than patients with F0-F2 score. Albumin levels (P=0.01) were significantly lower in METAVIR F3-F4. Age (OR=1.09; 95%CI=1.02-1.16; P=0.02), steatosis (OR=4.03; 95%CI=1.05-15.45; P=0.04) and high-density lipoprotein cholesterol (HDL-C) <60 mg/dL (OR=7.67; 95%CI=1.71-34.49; P=0.008) were independently associated with fibrosis. Hypertension (OR=6.36; 95%CI=1.31-30.85; P=0.02) and HDL-C <60 mg/dL (OR=9.85; 95%CI=2.35-41.39; P=0.002) were independently associated with necroinflammatory activity. Hypertension (OR=6.94; 95%CI=1.92-25.05; P=0.003) and HDL-C <60 mg/dL (OR=3.94; 95%CI=1.27-12.3; P=0.02) were associated with interface inflammatory activity. Triglycerides (TG ≥150 mg/dL) remained associated with lobular inflammatory activity. Conclusion: cholesterol levels <60 mg/dL were independently associated with necroinflammatory activity in chronic hepatitis C. Patients with hypertension are at an increased risk of developing necroinflammatory activity.

RESUMO Contexto: Aproximadamente 71 milhões de pessoas estão infectadas pelo vírus da hepatite C em todo o mundo. Um número significativo desses indivíduos desenvolverá cirrose hepática e/ou carcinoma hepatocelular. Além do fígado, há evidências científicas que associam doenças cardiovasculares e hepatite C crônica; no entanto, os mecanismos biológicos implicados na ocorrência dessas condições ainda não foram completamente esclarecidos. Objetivo: Avaliar a associação entre histologia hepática, comorbidades clínicas e perfil lipídico em pacientes com hepatite C crônica. Investigar associações entre histologia hepática e parâmetros demográficos, nutricionais, bioquímicos e virológicos. Métodos: Oitenta e cinco pacientes com hepatite C crônica foram prospectivamente submetidos à biópsia hepática. Biópsias hepáticas foram obtidas de cada paciente por via percutânea com agulha de Menghini. A fibrose foi avaliada de acordo com o sistema de pontuação METAVIR, como segue: F0, sem fibrose; F1, expansão portal fibrosa; F2, alargamento portal fibroso com poucos septos; F3, fibrose em ponte com distorção arquitetônica; e F4, cirrose hepática. A atividade foi classificada com base no grau de infiltração de linfócitos e necrose de hepatócitos, de A0 a A3. O diagnóstico da doença hepática foi baseado em métodos clínicos, bioquímicos, histológicos e radiológicos. Os dados foram analisados por modelos de regressão logística. Resultados: Neste estudo transversal, realizado em um ambulatório do hospital universitário, foram incluídos 85 pacientes que tinham média de idade de 57,2±10,7 anos, sendo 45 (52,9%) do sexo feminino. Havia 10 pacientes com cirrose. Os pacientes com METAVIR F3-F4 eram significativamente mais velhos (P=0,02) e tinham níveis mais elevados de ALT (P=0,0006), AST (P<0,0001), γ-GT (P=0,03) e bilirrubina (P=0,001) e, maior tempo de protrombina do que pacientes com escore F0-F2. Os níveis de albumina (P=0,01) foram significativamente mais baixos naqueles classificados como METAVIR F3-F4. Idade (OR=1,09; IC95%=1,02-1,16; P=0,02), esteatose (OR=4,03; IC95%=1,05-15,45; P=0,04) e HDL-C <60 mg/dL (OR=7,67; 95%IC=1,71-34,49; P=0,008) foram independentemente associados à fibrose. Hipertensão (OR=6,36; IC95%=1,31-30,85; P=0,02) e HDL-C <60 mg/dL (OR=9,85; IC95%=2,35-41,39; P=0,002) foram independentemente associados à atividade necroinflamatória. Hipertensão (OR=6,94; IC 95%=1,92-25,05; P=0,003) e HDL-C <60 mg/dL (OR=3,94; IC95%=1,27-12,3; P=0,02) foram associados à atividade inflamatória de interface. Os triglicerídeos (TG >150 mg/dL) permaneceram associados à atividade inflamatória lobular. Conclusão: Níveis de coleterol HDL <60 mg/dL foram independentemente associados à atividade necroinflamatória na hepatite C crônica. Pacientes com hipertensão têm risco aumentado de desenvolver atividade necroinflamatória.

Perfil lipídico por trimestres del embarazo en gestantes sanas / Lipid profile by trimesters of pregnancy in healthy pregnant women / Perfil lipídico por trimestres de gestação em gestantes saudáveis

RESUMEN Con el objetivo de describir el perfil lipídico por trimestres de gestación en gestantes sanas, se realizó un estudio descriptivo, de corte transversal, el cual se condujo con 40 embarazadas entre 20 y 35 años, de un universo de 110, pertenecientes al policlínico "Jimmy Hirzel" de Bayamo, Granma, entre enero del 2017 y marzo del 2019. Se determinaron las concentraciones de colesterol total, triglicéridos, HDL-colesterol, LDL-colesterol y VLDL-colesterol. Se utilizó el análisis de varianza de un factor, y la prueba de Tukey de comparación múltiple de parejas de medias. El colesterol, los triglicéridos, el LDL-colesterol y el VLDL-colesterol variaron de forma significativa con el trimestre de gestación. El colesterol total se incrementó en el segundo y tercer trimestre en comparación con el primero, mientras que los triglicéridos, el LDL-colesterol y el VLDL-colesterol se incrementaron en el tercer trimestre en comparación con el primero. El HDL-colesterol no tuvo una variación significativa durante el embarazo. Se concluye que los valores del colesterol total, los triglicéridos, el LDL-colesterol y el VLDL-colesterol varían en relación con el trimestre de la gestación, aumentan de forma significativa en el tercer trimestre en comparación con el primer trimestre del embarazo, en tanto el HDL-colesterol no varía significativamente durante el embarazo.

ABSTRACT In order to describe the lipid profile by trimesters of pregnancy in healthy pregnant women, a descriptive, cross-sectional study was conducted with 40 pregnant women between 20 and 35 years of age, from a universe of 110, belonging to the "Jimmy Hirzel" Hospital in Bayamo, Granma, between January 2017 and March 2019. The concentrations of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and VLDL-cholesterol were determined. One-factor analysis of variance was used, and the Tukey's multiple comparison test of pairs of means Cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol varied significantly with gestational trimester total cholesterol increased in the second and third trimesters compared with the first, while triglycerides, LDL-cholesterol and VLDL-cholesterol increased in the third trimester compared to the first. HDL-cholesterol did not have a significant variation time during pregnancy. It is concluded that the values ​​of total cholesterol, triglycerides, LDL-cholesterol and VLDL-cholesterol vary in relation to the trimester of pregnancy, they increase significantly in the third trimester compared to the first trimester of pregnancy, while HDL-cholesterol does not vary significantly during pregnancy.

RESUMO Com o objetivo de descrever o perfil lipídico por trimestres de gestação em gestantes saudáveis, foi realizado um estudo descritivo, transversal, com 40 gestantes entre 20 e 35 anos, de um universo de 110, pertencentes ao grupo "Jimmy Hirzel" Hospital em Bayamo, Granma, entre janeiro de 2017 e março de 2019. Foram determinadas as concentrações de colesterol total, triglicerídeos, HDL-colesterol, LDL-colesterol e VLDL-colesterol. Foi utilizada a análise de variância de um fator e o teste de comparação múltipla de Tukey de pares de médias Colesterol, triglicerídeos, LDL-colesterol e VLDL-colesterol variou significativamente com o trimestre gestacional O colesterol total aumentou no segundo e terceiro trimestres em comparação com o primeiro, enquanto os triglicerídeos, LDL-colesterol e VLDL-colesterol aumentaram no terceiro trimestre comparado ao primeiro. O HDL-colesterol não teve variação significativa durante a gravidez. Conclui-se que os valores de colesterol total, triglicerídeos, LDL-colesterol e VLDL-colesterol variam em relação ao trimestre de gestação, aumentam significativamente no terceiro trimestre em relação ao primeiro trimestre de gestação, enquanto o HDL-colesterol não não variam significativamente durante a gravidez.

Alteración en la expresión de proteínas transportadoras de colesterol y moléculas inmunomoduladoras en pacientes con VIH-1 / Altered expression of cholesterol transport proteins and immunomodulators molecules in HIV-1 infected patients

Debido a que la terapia antirretroviral no logra controlar la activación inmune asociada a la infección por VIH-1, el estudio de moléculas inmunomoduladoras puede proporcionar alternativas para su control. En este sentido, el propósito de este estudio fue evaluar la expresión transcripcional de moléculas asociadas con el metabolismo del colesterol-HDL (C-HDL) y con la respuesta inflamatoria mediada por el inflamasoma NLRP3 en pacientes infectados con VIH-1. En este estudio transversal, se incluyeron 23 pacientes VIH-1 sin tratamiento antirretroviral, con diferentes estadios de progresión, 7 de los cuales son controladores (Carga viral <2000 copias/mL) y 16 progresores (Carga viral >2000 copias/mL), además de 7 controles sanos. En células mononucleares de sangre periférica, se cuantificaron los niveles de la expresión transcripcional de ABCA-1, ABCA-3, Caspasa-5 y TXNIP mediante RT-PCR. Se evaluó la asociación de estos parámetros con variables demográficas y de laboratorio, y se encontró que los individuos VIH-1 progresores mostraron niveles significativamente menores de TXNIP y ABCA-3, sugiriendo que durante la infección por VIH-1 se produce una alteración en la expresión de estas moléculas. Dada la complejidad de las interacciones inmuno-metabólicas durante la infección por VIH-1, se necesitan estudios adicionales para establecer los mecanismos precisos involucrados en estas alteraciones

Because antiretroviral therapy fails to control the immune activation that occurs during HIV-1 infection, the study of immunomodulatory molecules may provide alternative strategies for their control. In this sense, the aim of the research was to evaluate the transcriptional expression of molecules associated with the metabolism of high-density lipoproteins and with the inflammatory response mediated by the NLRP3 inflammasome in patients infected with HIV-1. This is a cross-sectional study, which included 23 HIV-1 patients without antiretroviral treatment, with different stages of progression, 7 of which are controllers (Viral load <2000 copies/mL) and 16 progressors (Viral load >2000 copies/mL), in addition to 7 healthy controls. In peripheral blood mononuclear cells, the levels of transcriptional expression of ABCA-1, ABCA-3, Caspase-5 and TXNIP were quantified by RT-PCR. The association of these parameters with laboratory and demographic variables was evaluated and it was found that HIV-1 progressing individuals showed significantly lower levels of TXNIP and ABCA-3, suggesting that during HIV-1 infection there is an alteration in the expression of these molecules. Given the complexity of the immuno-metabolic interactions during HIV-1 infection, additional studies are needed to establish the precise mechanisms involved in these alterations

Association between metabolic syndrome and euthyroid nodular goiter: a case-control study / Asociación entre el síndrome metabólico y el bocio nodular eutiroideo: un estudio de casos y controles

Abstract Background: Metabolic syndrome is a cluster of metabolic abnormalities and abdominal obesity; its pathophysiologic basis, insulin resistance, has been shown to act as agent in thyroid cell proliferation. Few studies analyze the relationship between metabolic syndrome and thyroid nodular disease, with a substantial knowledge gap. Objective: Determine the association between metabolic syndrome and nodular thyroid disease in a region with adequate iodine intake. Methods: Case-control study. A total of 182 patients referred to radiology to undergo thyroid ultrasonography due to suspicion of thyroid disease. Cases had at least one thyroid nodule greater than 3 mm (n= 91). Controls did not have evidence of thyroid nodules (n= 91). Results: Bivariate analysis showed a significant association between metabolic syndrome and the presence of thyroid nodule (OR 2.56, 95% CI: 1.41-4.66, p <0.05). Low levels of HDL (OR 2.81, 95% CI: 1.54-5.12, p <0.05) and impaired fasting glucose (OR 2.05, 95%CI 1.10 to 3.78, p <0.05) were significantly associated with the presence of thyroid nodule, independent of the presence of metabolic syndrome. Multivariate analysis maintained the association between metabolic syndrome and thyroid nodule with an OR of 2.96 (95%CI 1.47 to 5.95, p <0.05); similarly, the associations of low levels of HDL (OR 2.77, 95%CI 1.44 to 5.3, p <0.05) and impaired fasting glucose (OR 2.23, 95%CI 1.14 to 4.34, p<0.05) with thyroid nodule remained significant. Conclusion: The thyroid nodular disease is associated with increased risk of metabolic syndrome, specifically decreased HDL and impaired fasting glucose levels were the factors that increased association was found.

Resumen Antecedentes: el síndrome metabólico es un conjunto de anormalidades metabólicas y obesidad abdominal; Se ha demostrado que su base fisiopatológica, la resistencia a la insulina, actúa como agente en la proliferación de las células tiroideas. Pocos estudios analizan la relación entre el síndrome metabólico y la enfermedad nodular tiroidea, con una brecha de conocimiento sustancial. Objetivo: determinar la asociación entre el síndrome metabólico y la enfermedad tiroidea nodular en una región con una ingesta adecuada de yodo. Métodos: estudio de casos y controles. Un total de 182 pacientes remitidos a radiología para someterse a una ecografía tiroidea debido a la sospecha de enfermedad tiroidea. Los casos tenían al menos un nódulo tiroideo mayor de 3 mm (n = 91). Los controles no tenían evidencia de nódulos tiroideos (n = 91). Resultados: El análisis bivariado mostró una asociación significativa entre el síndrome metabólico y la presencia de nódulo tiroideo (OR 2.56, IC 95%: 1.41-4.66, p <0.05). Los niveles bajos de HDL (OR 2.81, IC 95%: 1.54-5.12, p <0.05) y glucosa en ayunas alterada (OR 2.05, IC 95% 1.10 a 3.78, p <0.05) se asociaron significativamente con la presencia de nódulo tiroideo, independiente de la presencia de síndrome metabólico. El análisis multivariado mantuvo la asociación entre el síndrome metabólico y el nódulo tiroideo con un OR de 2.96 (IC 95% 1.47 a 5.95, p <0.05); de manera similar, las asociaciones de niveles bajos de HDL (OR 2.77, IC 95% 1.44 a 5.3, p <0.05) y glucosa en ayunas alterada (OR 2.23, IC 95% 1.14 a 4.34, p <0.05) con nódulo tiroideo permanecieron significativas. Conclusión: la enfermedad nodular tiroidea se asocia con un mayor riesgo de síndrome metabólico, específicamente la disminución de HDL y los niveles de glucosa en ayunas alterados fueron los factores que aumentaron la asociación.

Tabaquismo y niveles de colesterol HDL en pacientes que asisten a una unidad de prevención secundaria cardiovascular / Smoking and HDL colesterol levels in patiens assisting a cardiovascular secundary prevention unit / Tabagismo e níveis de colesterol HDL em pacientes atendidos em unidade de prevenção secundária cardiovascular

Resumen: Introducción: El tabaquismo es un importante factor de riesgo de enfermedad cardiovascular a nivel mundial y local. Los fumadores presentan niveles de colesterol HDL bajos. La cesación del tabaquismo eleva los niveles de HDL y reduce el riesgo cardiovascular. Objetivo: determinar la relación de los niveles de colesterol HDL en función del status fumador. Métodos: Estudio observacional, longitudinal, analítico, retrospectivo. La información fue tomada de historias clínicas de pacientes con cardiopatía isquémica revascularizados, con status de fumador y niveles de colesterol HDL asistidos en una Unidad de Prevención Secundaria. Los resultados se analizaron en frecuencias y medias. Se realizó chi-cuadrado para comparación de frecuencias y test de t de student para la comparación medias. Resultados: Se estudiaron 97 pacientes. El 48.5% eran fumadores, el 30% ex fumadores y el 22% no fumadores. El 58% de los fumadores activos, 57% de los fumadores en cesación y el 55% de los ex fumadores tenían valores de colesterol HDL bajo. A los seis meses: el 60% de los fumadores activos, el 40% de los fumadores en cesación y el 41% de los ex fumadores tenían valores de HDL bajo. Al comparar las frecuencias se obtuvo un valor de p 0,732 al inicio y un valor de p 0,311 a los 6 meses, no estadísticamente significativos. La media total de los valores de HDL al inicio fue de 40,72 mg/dl y a los 6 meses de 43,42 mg/dl con un valor de p 0,003, estadísticamente significativo. Se comparó las medias de HDL inicial de los pacientes en cesación versus las medias de HDL de los ex fumadores a los 6 meses con un valor de p 0,054, que roza la significancia estadística. Conclusiones: Los niveles de colesterol HDL fueron bajos en los fumadores. Observamos que la cesación del tabaquismo provocó una tendencia al incremento delos niveles de colesterol HDL.

Abstract: Introduction: Smoking is an important risk factor for cardiovascular disease worldwide and locally. Smokers present low levels of HDL cholesterol. Cessation of smoking raises HDL levels and reduces cardiovascular risk. Objective: Determine the relationship of HDL cholesterol levels according to smoking status. Methods: An Observational, longitudinal, analytical, retrospective study. The information was taken from medical records of patients with revascularized ischemic heart disease, with smoker status and HDL cholesterol levels assisted at the Secondary Prevention Unit. The results were analyzed in frequencies and means. Chi-square was performed for comparison of frequencies and student's test for the means comparison. Results: 97 patients were studied, 48.5% were smokers, 30% were ex-smokers and 22% were non-smokers. The 58% of active smokers, 57% of smokers in cessation and 55% of ex-smokershad low values of HDL cholesterol. Six months later: 60% of active smokers, 40% of smokers in cessation and 41% of ex-smokers had low HDL values. When comparing frequencies, a value of p 0.732 was obtained at the beginning and a value of p 0.311 6 months later, not statistically significant. The total mean HDL values ​​at baseline were 40.72 mg / dl and at 6 months, 43.42 mg / dl, with a p-value of 0.003, statistically significant. The initial HDL mean of smokers in cessation was compared to the HDL mean of the ex-smokers at 6 months with a p-value 0.054 that borders on statistical significance. Conclusions: HDL levels were low in smokers. We observed that the cessation of smoking caused a tendency to increase HDL cholesterol levels.

Resumo: Introdução: O tabagismo é um importante fator de risco para doenças cardiovasculares em todo o mundo e localmente. Fumantes têm baixos níveis de colesterol HDL. A cessação do tabagismo aumenta os níveis de HDL e reduz o risco cardiovascular. Objetivo: determinar a relação dos níveis de colesterol HDL de acordo com o status de tabagismo. Métodos: Estudo observacional, longitudinal, analítico, retrospectivo. As informações foram retiradas de prontuários de pacientes com doença cardíaca isquêmica revascularizada, com status de fumante e níveis de colesterol HDL atendidos em uma Unidade de Prevenção Secundária. Os resultados foram analisados em frequências e médias. O qui-quadrado foi realizado para comparação de frequências e teste t de Student para comparação. Resultados: 97 pacientes foram estudados. 48,5% eram fumantes, 30% ex-fumantes e 22% não fumantes. 58% dos fumantes ativos, 57% dos fumantes em cessação e 55% dos ex-fumantes tinham baixos valores de colesterol HDL. Aos seis meses: 60% dos fumantes ativos, 40% dos fumantes em cessação e 41% dos ex-fumantes tinham baixos valores de HDL. Ao comparar frequências, um valor de p 0,732 foi obtido no início e um valor de p 0,311 aos 6 meses, não estatisticamente significante. Os valores médios totais de HDL no início do estudo foram de 40,72 mg / dl e aos 6 meses, 43,42 mg / dl com um valor p de 0,003, estatisticamente significativo. Comparamos as médias iniciais do HDL dos pacientes que deixaram de fumar versus as médias do HDL dos ex-fumantes aos 6 meses, com um valor p de 0,054, o que limita a significância estatística. Conclusões: Os níveis de colesterol HDL foram baixos em fumantes. Observamos que a cessação do tabagismo causou uma tendência a aumentar os níveis de colesterol HDL.

Cupremia y colesterolemia como factores de riesgo en pacientes con enfermedad de Alzheimer / Plasma levels of copper and cholesterol as risk factors in Alzheimer disease patients / Cupremia e colesterolemia como fatores de risco em pacientes com doença de Alzheimer

Se estudiaron 241 personas, 119 controles y 122 pacientes con enfermedad de Alzheimer (EA) subagrupados en tres categorías de acuerdo con el estadio clínico de la dolencia, con el objetivo de investigar la influencia de niveles elevados de cobre libre y colesterol plasmático como factores de riesgo para la EA. Las conclusiones obtenidas de los resultados indicaron que los pacientes expuestos a una combinación de alto colesterol y de cobre no unido a ceruloplasmina tuvieron mayor proporción de marcadores de estrés oxidativo (carbonilos proteicos, sustancias reactivas al tiobarbiturato, glutatión oxidado y descenso de antioxidantes totales en sangre), conjuntamente con un incremento de HDL-colesterol peroxidado y lipoproteína "a" que correlacionó con la gravedad de su cuadro. Lo mismo sucedió con la relación entre péptidos amiloides (1-40) y (1-42) en plasma y los valores del mini-test de estado cognitivo (MMSE). Se halló que una función de adición de efectos que cuantificó el daño por cobre libre y colesterol oxidado resultó directamente proporcional a la pérdida de desempeño cognitivo estimada por medio del MMSE. Esta función es de fácil determinación y puede considerarse un nuevo biomarcador para estudiar riesgo en poblaciones expuestas, apoyar el diagnóstico clínico, o evaluar la eficacia de estrategias terapéuticas en pacientes con EA.

Alzheimer disease (AD) patients (122) compared to control subjects (119) were studied to determine the role of chronic exposure of hypercholesterolemic plasma levels and free copper (not bound to ceruloplasmin) as biomarkers of progression for AD. Oxidative stress parameters, lipid profile, amyloid levels, and cognitive status were studied in all participants. Conclusions obtained indicated that patients exposed simultaneously to free copper and increased cholesterol levels present higher indicators of oxidative stress (protein carbonyls, thiobarbituric acid-reactive substances, decreased total antioxidant activity in plasma and elevated oxidized HDL-cholesterol). Lipoprotein "a" concentrations also correlated with the clinical progression of the disease. The ratio amyloid ß(1-40)/ß(1-42) in plasma inversely correlated with the cognitive performance estimated by the Mini-Mental State Examination Test (MMSE). A defined function that weighs the contribution of the deleterious effect produced by combined free copper and Ox-HDL-cholesterol exposure directly correlated with the loss of cognitive performance. Thus, this biomarker could be a new tool for the screening of large populations under risk, or may be a useful way to estimate the efficacy of therapeuti approaches in patients suffering AD.

Foram estudadas 241 pessoas, 119 controles e 122 pacientes com doença de Alzheimer (DA), agrupados em três categorias de acordo com o estágio clínico da doença, com o objetivo de investigar a influência de níveis elevados de cobre livre e colesterol plasmático como fatores de risco para a DA. As conclusões obtidas a partir dos resultados indicaram que os pacientes expostos a uma combinação de colesterol alto e de cobre não ligados à ceruloplasmina apresentaram maior proporção de marcadores de estresse oxidativo (carbonilos proteicos, substâncias reativas ao tiobarbiturato, glutationa oxidada e diminuição dos antioxidantes totais no sangue ), juntamente com um aumento da HDL-colesterol peroxidado e lipoproteína "a" que correlacionou com a gravidade de sua condição. O mesmo aconteceu com a relação entre os peptídeos amilóides (1-40) e (1-42) em plasma e os valores do mini-teste do estado cognitivo (MMSE). Verificou-se que uma função de adição de efeitos que quantificou o dano por cobre livre e colesterol oxidado resultou diretamente proporcional à perda de desempenho cognitivo estimada através do MMSE. Esta função é fácil de determinar e pode ser considerada um novo biomarcador para estudar o risco em populações expostas, apoiar o diagnóstico clínico ou avaliar a eficácia de estratégias terapêuticas em pacientes com DA.

Estudio transversal sobre estilos de vida saludable y su relación con el colesterol HDL en la población adulta / Cross-sectional study of healthy lifestyles and their effect on HDL cholesterol in the adult population

Resumen Introducción: la patología cardiovascular es la principal causa de muerte en Colombia y en el mundo y los estilos de vida saludables constituyen factores protectores ante esta. No se ha estudiado en Medellín el efecto de los estilos de vida saludable sobre el colesterol HDL. Objetivo: Establecer la relación entre los niveles de colesterol HDL y la actividad física y alimentación en población de 18 a 65 años en Medellín. Métodos: Estudio descriptivo transversal analítico de la base de datos de la aplicación del método STEPS de la Organización Mundial de la Salud hecho en Medellín en el año 2011 a personas entre 18 y 65 años. La evaluación de la relación entre colesterol HDL y los estilos de vida saludable se hizo a través de regresión logística. Resultados: Se analizaron datos de 1.300 adultos con medición de colesterol HDL, con una edad promedio de 40,6 ± 13,5 años. El 50% tenía el colesterol HDL por debajo de 36,7 mg/dl (RI 31,2-43,5). El nivel socioeconómico alto (OR 0,168; IC95% 0,064 - 0,442) y medio (OR 0,154; IC95% 0,084 - 0,282) así como la actividad física intensa en el tiempo libre (OR 0,600; IC95% 0,383-0,939) constituyen un factor protector frente a un HDL bajo. Conclusión: Los bajos niveles de colesterol HDL tienen alta prevalencia en población adulta de Medellín y se requieren políticas administrativas y de salud pública que promuevan estilos de vida saludable para modificarlos.

Abstract Introduction: Cardiovascular disease is the primary cause of death in Colombia and in the world, and healthy lifestyles are protective factors against this. The effect of healthy lifestyles on HDL cholesterol has not been studied in Medellin. Objective: To establish the relationship between HDL cholesterol levels and physical activity and diet in the population aged 18 to 65 in Medellín. Methods: A cross-sectional, descriptive and analytical study was carried out by applying the World Health Organisation STEPS method on a data base gathered in Medellin in the year 2011 onindividuals between 18 and 65 years. The evaluation of the relationship between HDL colesterol and healthy lifestyles was made using logistic regression. Results: The data were analysed from 1,300 adults, with a mean age of 40.6 ± 13.5 years, and with an HDL measurement. Half of them (50%) had an HDL cholesterol below 36.7 mg/dL (RI 31.2-43.5). Protective factors against a low HDL were a high (OR 0.168; 95% CI; 0.064-0.442) and medium socio-economic level (OR 0.154; 95% CI; 0.084-0.282), as well as the carrying out intense physical activity in their free time (OR 0.600; 95% CI; 0.383-0.939). Conclusion: Low HDL levels are highly prevalent in the adult population of Medellin, and require governmental and public health policies that promote health lifestyles in order to modify them.

Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment. Consensus / Dislipidemia aterogénica en Latinoamérica: prevalencia, causas y tratamiento. Un consenso

Abstract: Atherogenic dyslipidemia (DA) is a poorly recognized entity in the current clinical practice guidelines. Due to the frequent lipid alterations associated with this metabolic abnormality in Latin America (LA), we organized a group of experts that has adopted the name of Latin American Association for the study of Lipids (ALALIP), to generate a document for analyzing in LA the prevalence of the lipid profile related to this condition, and to offer practical recommendations for its optimal diagnosis and treatment. Methodology: It was is selected a group of regional experts and, using a modified Delphi methodology, we conducted a comprehensive literature review, with emphasis on studies or reviews that had implications for LA. Subsequently developed a series of key questions about the epidemiology, pathophysiology, diagnosis, and treatment of the AD to be discussed by the group of experts. As a convention those recommendations that had 100% acceptance was consider unanimous; those with at least 80% as for consensus, and of disagreement, those with less than 80%. Results: Although there is no a global study on risk factors that has been made on the basis of a representative sample of the entire population of LA, the systematic analysis of the national health surveys and regional cohort studies based on local population sampling shows a consistent evidence of the high prevalence of the lipid abnormalities that define the AD. The prevalence of low levels of high density lipoprotein cholesterol (HDL-C) ranges from 34.1% (CESCAS I study) to 53.3% (LASO study), with different frequencies between men and women and the selected cut-off point. The prevalence of elevated triglycerides (TRG) varies from 25.5% (LASO study) to 31.2% (National Health Survey of Chile) being always more prevalent in men than in women. Only two studies report the prevalence of AD in LA: the National Health Survey of Mexico 2006 with an 18.3%, and a Venezuelan study that estimates the weighted prevalence of AD in 24.7%. There are multiple causes for these findings: an inadequate nutrition-characterized for high consumption of foods with a high caloric density and a high intake of cholesterol and trans fats-, a sedentary lifestyle, a high prevalence of obesity in the region, and possibly epigenetic changes that make our population more susceptible for having this abnormal lipid profile. Conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between the style of living, the inheritance, and epigenetic changes possibly are its cause. Since they are considered as an important cause of residual cardiovascular risk, they must be diagnosed and treated actively as a secondary target after reaching the goal for low density lipoprotein-cholesterol (LDL-C). It is important to design a global study of risk factors in our region to let us know the true prevalence of AD and its causes, and to help us in the design of public policies adapted to our reality in a population and individual scale.

Resumen: La dislipidemia aterogénica (DA) es una entidad poco reconocida en las guías de práctica clínica actuales. Debido a las frecuentes alteraciones lipídicas asociadas a esta anomalía metabólica en América Latina (AL), hemos organizado un grupo de expertos que ha adoptado el nombre de Asociación Latinoamericana para el Estudio de Lípidos (ALALIP), para generar un documento en el que se analice la prevalencia en AL del perfil lipídico relacionado con esta afección y ofrecer recomendaciones prácticas para su óptimo diagnóstico y tratamiento. Metodología: Se seleccionó un grupo de expertos regionales y, utilizando una metodología Delphi modificada, se realizó una revisión bibliográfica exhaustiva, con énfasis en estudios o revisiones que tuvieran implicaciones para AL. Posteriormente se desarrolló una serie de preguntas clave sobre la epidemiología, la fisiopatología, el diagnóstico y el tratamiento de la DA, que fueron discutidas por el grupo de expertos. Como convención, las recomendaciones que tuvieron un 100% de aceptación fueron consideradas unánimes; aquellas con al menos el 80% como para el consenso, y de desacuerdo, aquellas con menos del 80%. Resultados: Aunque no existe un estudio global sobre los factores de riesgo que se haya realizado sobre la base de una muestra representativa de toda la población de AL, el análisis sistemático de las encuestas nacionales de salud y los estudios de cohortes regionales evidencian la alta prevalencia de las anormalidades lipídicas que definen la DA. La prevalencia de niveles bajos de colesterol de lipoproteínas de alta densidad (HDL-C) oscila entre el 34.1% (estudio CESCAS I) y el 53.3% (estudio LASO), con diferentes frecuencias entre hombres y mujeres y el punto de corte seleccionado. La prevalencia de triglicéridos elevados (TRG) varía de 25.5% (estudio LASO) a 31.2% (Encuesta Nacional de Salud de Chile) siendo siempre más prevalente en hombres que en mujeres. Sólo dos estudios informan la prevalencia de DA en AL: la Encuesta Nacional de Salud de México 2006 con un 18.3%, y un estudio venezolano que estima la prevalencia ponderada de la DA en 24.7%. Existen múltiples causas para estos hallazgos: una nutrición inadecuada -caracterizada por el alto consumo de alimentos con alta densidad calórica y un alto consumo de colesterol y grasas trans- un estilo de vida sedentario, una alta prevalencia de obesidad en la región y posiblemente cambios epigenéticos que hacen que nuestra población sea más susceptible a tener este perfil lipídico anormal. Conclusiones: Las anomalías lipídicas que definen la DA tienen una alta prevalencia en AL; la interacción entre el estilo de vida, la herencia, y los cambios epigenéticos posiblemente son su causa. Debido a que se consideran una causa importante de riesgo cardiovascular residual, deben ser diagnosticados y tratados activamente como un objetivo secundario después de alcanzar la meta para el colesterol de lipoproteína de baja densidad (LDL-C). Es importante diseñar un estudio global de los factores de riesgo en nuestra región para hacernos conocer la verdadera prevalencia de la DA y sus causas y ayudarnos en el diseño de políticas públicas adaptadas a nuestra realidad en una escala poblacional e individual.

Prevalencia del síndrome metabólico en pre-eclampsia / Metabolic syndrome prevalence in preeclampsia

OBJETIVO: Determinar la prevalencia del síndrome metabólico (SM) en mujeres embarazadas con preeclampsia, Hospital Materno Infantil de la Caja Nacional de Salud, La Paz-Bolivia. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal de 181 mujeres embarazadas durante un periodo de 22 meses. Se determinó el índice de masa corporal (IMC) y la presión arterial sistémica en el brazo derecho. El diagnóstico de SM fue realizado de acuerdo con el consenso de la IDF y NCEP ATP III; de los 5 criterios para diagnóstico de SM, se excluyó la circunferencia abdominal debido al cambio fisiológico del útero. Los datos fueron procesados con paquetes estadísticos SPSS 15.0 y Epi Info 3.5. Los resultados fueron correlacionados con tablas de contingencia 2 x 2 y evaluados con la prueba del Chi cuadrado. RESULTADOS: De las 181 mujeres embarazadas con pre-eclampsia, 49.7% presentaron SM, 80.1% hipertrigliceridemia, 60.9% colesterol HDL menor a 50 mg/ dl, 19.2% glucemia mayor a 110 mg/dl y 75.6% de IMC mayor a 25. Se encontró asociaciones estadísticamente significativas entre SM/preeclampsia y IMC mayor a 25/preeclampsia (X²:12,83, p<0,05). CONCLUSIONES: La prevalencia de SM en mujeres con preeclampsia es alta, existe una asociación estadísticamente significativa entre ambas variables.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) in pregnant women with preeclampsia at Materno Infantil Hospital, Caja Nacional de Salud in La Paz-Bolivia. MATERIAL AND METHODS: It was conducted an observational, descriptive and transversal study in 181 pregnant patients over a period of 22 months. Body mass index (BMI) and systemic blood pressure on rightarm were measured. MS diagnosis was based on the IDF and NCEP ATP III consensus, considering 5 criteria of MS diagnosis, it was excluded waist circumference due to the uterine physiological changes. All data were processed with SPSS 15.0 and Epi Info 3.5 statistical packages. Results were correlated with 2x2 contingency tables and evaluated with the chi-square test. RESULTS: Pregnant women displayed a 49.7% of metabolic syndrome, 80.1% hypertriglyceridemia, 60.9% HDL cholesterol less than 50 mg/dl, 19.2% of glucose higher than 110 mg/dl and 75.6% of BMI higher than 25. Statistically significant associations between SM/preeclampsia and BMI over 25/ preeclampsia (J² 12, 83, p<0, 05) were found. CONCLUSIONS: There is a higher prevalence of metabolic syndrome in women with preeclampsia, stating a statistically significant relationship between variables.

Alteración de los analitos medibles del síndrome metabólico en el laboratorio clínico en pacientes de consulta externa del cantón de Guápiles en el año 2015 / Alteration of measurable analytes of the metabolic syndrome in the clinical laboratory in outpatient patients of the canton of Guapiles in 2015

Resumen:Justificación: conocer el nivel de alteración de los componentes del síndrome metabólico en la población permite evaluar el riesgo de desarrollar diabetes mellitus tipo 2 y enfermedades cardiovasculares.Objetivo: comparar los valores sanguíneos de tres analitos del síndrome metabólico (triglicéridos, glucosa y colesterol HDL) en adultos de ambos sexos de Consulta Externa del Hospital de Guápiles, en el año 2015, con respecto a los valores de referencia según la NCEP ATP III.Métodos: se tomaron valores de glucosa, triglicéridos y colesterol HDL de la base de datos del Laboratorio del Hospital de Guápiles, del año 2015. Luego se procedió a determinar por sexo, por grupo de edad y en forma combinada (hombres y mujeres) la alteración, absoluta y porcentual, de cada analito con respecto a los valores de referencia de la NCEP ATP III. Además, se determinó el perfil de alteración (frecuencia absoluta y porcentaje) por sexo, por grupo de edad y combinado.Resultados: en las mujeres el HDL-C es el parámetro más alterado, con un 75.3% de las pacientes teniéndolo disminuido. Lo mismo sucede analizando por grupo de edad. En los hombres el parámetro más alterado es también el HDL-C (60.1 %), seguido de los triglicéridos (53.8 %). En las mujeres la alteración únicamente del HDL-C es la situación más común (31.1%), seguida de la alteración conjunta de TRG-HDL-C (22.6 %). En los hombres la situación se invierte: la alteración de TRG-HDL-C es la más frecuente (25.4 %), seguida de la de HDL-C (13.8 %).Discusión: los parámetros que más se alteraron fueron los lipídicos. Además, conforme aumentaba la edad se incrementaban el porcentaje de valores alterados y el porcentaje de pacientes con los tres analitos alterados. El aumento del sedentarismo, del sobrepeso y de la obesidad con la edad ayuda a explicar este fenómeno.

Abstract:Justification: Knowing the degree of alteration in the metabolic syndrome's components within the target population allows us to evaluate the risk of developing type 2 diabetes mellitus and cardiovascular diseases.Objective: To compare the blood values of three analytes of the metabolic syndrome (triglycerides, glucose, and HDL cholesterol) taken from adult outpatients from Hospital de Guápiles, from both sexes, during the year 2015, in accordance to the reference values of NCEP ATP III.Methods: Glucose, triglycerides, and HDL cholesterol values were taken from Hospital de Guápiles' Laboratory, belonging to the year 2015. The absolute and percentage alteration of each analyte was determined according to sex, age group, as well as in a joint manner (both men and women), following the reference values of NCEP ATP III.The alteration profile (absolute frequency and percentage) was also determined according to sex, age group, andin a joint manner.Results: HDL-C in women is the most altered parameter, with a 73% of the patients exhibiting it diminished. The same occurs when analyzing it by age group. In men the most altered parameter is also HDL-C (60.1%), followed by triglycerides (53.8%). The most common situation for women is the exclusive alteration of HDCL-C (3.1%), followed by the joint alteration of TRG-HDL-C (22.6%). For men it is rather the opposite: TRG-HDL-C is the most frequent (25.4), being followed by HDL-C (13-8%).Discussion: The most altered parameters were lipids. Also, as the age increased, so did the percentage of altered values, as well as the percentage of patients who had the three analytes altered. The age-related increase of a sedentary lifestyle, and overweight condition and obesity helps to explain this phenomenon.

Prevalencia de síndrome metabólico en pacientes psoriáticos chilenos / Prevalence of metabolic syndrome in Chilean patients with psoriasis

Introducción: Existe poca información de la asociación entre Psoriasis y síndrome metabólico (SM) en Chile. Objetivos: Determinar la prevalencia de SM en psoriáticos chilenos. Material y métodos: Se realizó un estudio caso-control, con 487 pacientes (238 psoriáticos y 239 controles). En ambos grupos se analizó la prevalencia de SM además del exceso de peso, hipertensión arterial, diabetes mellitus 2, hipertrigliceridemia y niveles de HDL bajo. Resultados: Los psoriáticos presentaron mayor probabilidad de padecer SM versus los controles (35,29% vs 23,29%) OR 1,8 (1,20-2,66) p<0,05. Se asoció también con circunferencia abdominal aumentada (57,14% vs 36,94) OR 2,6 (1,79 - 3,78), exceso de peso (85,99% vs 63,45%) OR 2,46 (1,62 ­ 3,73) p<0,05 y diabetes mellitus 2 (13,45% vs 4,42%) OR 3,85 (1,79 - 8,26) p<0,05. Conclusiones: Se encontró una mayor prevalencia de SM, exceso de peso, circunferencia abdominal aumentada y diabetes mellitus 2 en el grupo psoriático en comparación al grupo control.

Background: There is a paucity of information about Psoriasis and metabolic syndrome (MS) association in Chile. Aim: To determine the MS prevalence in Chilean psoriatic patients. Material and Methods: A case-control study was conducted which included 487 patients (238 psoriatic patients and 239 controls). In both groups, MS prevalence, overweight, hypertension, diabetes mellitus type 2, hypertriglyceridemia and low HDL were analyzed. Results: Psoriatic patients were more likely to present MS than controls (35.29% vs 23.29%) OR 1.8 (1.20 to 2.66) p <0.05. In addition, it was associated with increased abdominal circumference (57.14% vs 36.94) OR 2.6 (1.79 to 3.78), overweight (85.99% vs 63.45%) OR 2.46 (1.62 to 3.73) p <0.05 and diabetes mellitus type 2 (13.45% vs. 4.42%) OR 3.85 (1.79 to 8.26) p <0.05. Conclusions: There is a higher prevalence of MS, overweight, increased abdominal circumference and type 2 diabetes mellitus in the psoriatic group compared with the control group.

Evaluación de la distribución de los criterios diagnósticos para síndrome metabólico, en Pereira, Colombia / Evaluation of diagnostic criteria distribution for metabolic syndrome, in Pereira, Colombia / Avaliação da distribuição dos criterios diagnósticos para síndrome metabólico, en Pereira, Colombia

Introducción: el síndrome metabólico (SM) es una agrupación de múltiples factores de riesgo cardiovascular, que se ha tornado mundialmente epidémico.Objetivo: comparar los criterios actuales para su diagnóstico, en pacientes con SM, familiares sanos en primer grado de consanguinidad (FS) y controles sanos (S), en Pereira, Colombia. Metodología: estudio descriptivo de corte transversal. Se seleccionaron 116 personas para evaluar los parámetros de química sanguínea, perímetro abdominaly presión arterial. Resultados: la población de estudio se clasificó en los grupos SM (n=53), FS (n=36) y S (n=27). El criterio más prevalente fue el perímetro abdominal, en losgrupos SM (96,2%) y FS (38,8%), mientras que en el grupo S fue el HDLc (25,9%). La diferencia en el perímetro abdominal entre el grupo FS (38,8%) y el S (14,8%) fue significativa (0.24, IC: 95% 0,04 - 0,44). Conclusión: este estudio encontró que el criterio perímetro abdominal podría emplearse para la detección temprana de personas con riesgo de desarrollar SM.

Introduction: the metabolic syndrome (MS) is a cluster of multiple cardiovascular risk factors which has become epidemic around the world.Objective: compare the currently accepted MS diagnosis criteria among patients with MS (SM), first-degree healthy relatives (FS) and healthy controls (S) in the city of Pereira (Colombia).Methods: this was a cross-sectional study in which 116 persons were evaluated for blood chemistry, waist circumference and blood pressure.Results: population was classified as SM (n=53), FS (n=36) and S (n=27) groups. The most prevalent criterion was waist circumference (96.2%) for SM and FS (38.8%) groups, but for S was HDLc (25.9%). The waist circumference difference between FS (38.8%) and S (14.8%) groups was significant (0.24, CI 95% 0.04 to 0.44).Conclusion: this study found that waist circumference criterion could be used for early detection of people at risk for developing MS.

Introdução: a síndrome metabólico (SM) é uma agrupação de múltiplos fatores de risco cardiovascular, que se tornou mundialmente epidémico.Objetivo: comparar os criterios atuais para diagnosticar SM em pacientes com SM, familiares sãos em primeir grau de consanguinidade (FS) e controles sãos (S), em Pereira, Colômbia.Metodologia: estudo descritivo de corte transversal. Se seleccionaram 116 pessoas para avaliar os parámetros de química sanguínea, perímetro abdominal e presão arterial.Resultados: a população estudada foi classificada em dois grupos grupos SM (n=53), FS (n=36) e S (n=27). O critério mais importante foi o perímetro abdominal, nos grupos SM (96,2%) e FS (38,8%), emquamto que no grupo S foi o HDLc (25,9%). A diferença no perímetro abdominal entre o grupo FS (38,8%) e o S (14,8%) foi significativa (0.24, IC: 95% 0,04 - 0,44).Conclusão: este estudo constatou que o critério perímetro abdominal podería ser empregado para a detecção precoce de pessoas com risco de desenvolver SM.

Comparación de oos métodos para la determinación de los niveles de colesterol hdl en bovinos / Comarison of twoo methods for the measurement of hdl cholesterol levels in cattle

Objetivo: Comparar dos métodos para la determinación del colesterol HDL en bovinos Bos taurus. Materiales y Métodos: Fueron tomadas 100 muestras de sangre de hembras bovinas de raza lechera en estado de ayuno sin discriminación de edad. Se realizó la extracción de suero para determinar los niveles de colesterol HDL mediante el método directo y posteriormente fueron determinados estos mismos valores mediante el método de precipitación, los resultados se obtuvieron mediante un análisis estadístico de ANOVA simple. Resultados: El método directo reportó valores expresados en mg/dl para el promedio, desviación estándar, mínimo y máximo de 97,217; 66,200; 31,023 y 295,251 respectivamente, y el método de precipitación reportó valores expresados en mg/dl para el promedio, mínimo, máximo y desviación estándar de 101,292; 33,588; 27,767 y 193,189 respectivamente. El valor de P en el test F, >0,05, indica que no existe diferencia estadísticamente significativa con un nivel de confiabilidad del 95%. Conclusión: Puede ser utilizado cualquiera de los dos métodos analizados para la determinación del colesterol HDL, en bovinos.

Objective: To compare two methods for the measurementdetermining of HDL cholesterol in Bos taurus cattle. Materials and Methods: Blood samples from 100 female cattle bovineof dairy breeds in the fasting state without discrimination of age were obtained. Serum extraction was obtained carried out to determine levels of HDL cholesterol by using the direct method and subsequently those same valuesHDL-cholesterol was determined were determined through by the precipitation method. Statistical analysis was performed using ANOVA single ANOVA. statistics analysis. Results: The direct method showed values inof 97.217, 66.200, 31.023 and 295.251 mg/dl for media, standard deviation, minimum and maximum were 97.217, 66.200, 31.023 and 295.251 respectively, and for the precipitation method reported values in mg/dl for media, standard deviation, minimum and maximum wereof 101.292, 33.588, 27.767 and 193.189 mg/dl for average, minimum, maximum and standard deviation respectively. The P value in test F >0.05, indicates that there is no statistically significant difference with a confidence level of 95%. Conclusion: Either one of the two methods analyzed for determining It is recommended to use any of the two analytical methods for determining HDL-cholesterol in cattle can be used.

Prevalencia de colesterol HDL-bajo asociado a otros factores de riesgo cardiovascular en una población adulta en la Policlínica del Hospital Central del Instituto de Previsión Central / Prevalence of low HDL cholesterol associated with other cardiovascular risks factors in an adult population in the IPS Polyclinic of the Central Hospital from the Central Previtional Institut

Introducción: el colesterol HDL (c-HDL) es una lipoproteína encargada de la remoción del colesterol en exceso a nivel de las arterias, por lo que sus niveles bajos promueven la formación de placas ateromatosas y si a esto le sumamos otros factores de riesgo cardiovascular, en su gran mayoría modificables, a nuestra población adulta, no es de extrañar que la enfermedad cardiovascular sea la primera causa de muerte en nuestro país. Con la intervención precoz sobre los factores de riesgo cardiovasculares se podría disminuir la mortalidad por esta causa. Objetivo: determinar la prevalencia del c-HDL-bajo en una población adulta aparentemente sana y su asociación a otros factores de riesgo cardiovascular. Material y método: estudio observacional, descriptivo de corte transverso con componente analítico de pacientes adultos que consultaron en la Policlínica del IPS Hospital Central por cualquier razón en el periodo abril-mayo 2013. Resultados: en una población adulta de 110 pacientes, aparentemente sanos, la frecuencia del c-HDL bajo fue del 48%, las mujeres fueron más asiduas a consulta (83%), y en su mayoría tuvieron tendencia al HDL normal. Los varones acudieron menos a consulta y presentaron porcentajes más elevados de c-HDL bajo. La mitad de los pacientes presentaban hipercolesterolemia; predomino del sobrepeso y la obesidad sobre el peso normal; 95% de los pacientes eran sedentarios. Hubo un bajo porcentaje de intolerantes a la glucosa y elevado de hipertensos no controlados. El c-LDL no fue elevado en promedio y no arrojó diferencias entre los grupos c-HDL normal y bajo. Conclusiones: los sujetos eran procedentes de la capital y del Departamento Central, es decir de aéreas más bien urbanas. La mayoría de los pacientes en estudio eran mujeres adultas, con sobrepeso, sedentarias, con colesterol elevado e hipertensas. El grupo con c-HDL bajo se encontraba asociado a otros factores de riesgo como: sexo masculino, sobrepeso u obesidad, sedentarismo, hipercolesterolemia, hipertrigliceridemia e hipertensión arterial. Los pacientes de peso normal presentaba c-HDL bajo en una proporción importante. Las mujeres, sedentarias, con sobrepeso u obesas, presentaban c-HDL normal en una proporción significativa. La mayoría de los factores de riesgo cardiovascular encontrados en los pacientes son modificables.

Introduction: HDL cholestero (HDL-C) is a lipoprotein responsible for the remoral of excess cholesterol from arteries, low promote the formation of atheromatous plaques and if we add other cardiovascular risk factors, the vast majority to our adult population, it is no wonder how cardiovascular disease is the leading cause of death in our country. With early intervention on cardiovascular risk factors we could reduce mortality from this cause.Objetive: To determine the prevalence of low HDL-C in apparently healthy adult population and its association with other cardiovascular risk factors. Methods: Observational descriptive cross sectional study with analytical component of adult patients concurrent the Central Polyclinic Hospital IPS for any reason in the period April-May 2013. Results: In a population of 110 adult patients, apparently healthy, the frequency of low HDL-C was 48%, women were assiduous to consulation (83%) and majority had normal HDL-C tendency. The male came less to consultation and presented higher percentages of low HDL-C. Half of the patients had hypercholesterolemia; predominance of overweight and obesity over normal weigth, 95% of patients were sedentary. There was a low porcentage of glucose intolerance and high uncontrolled hypertension. The LDL-C was not high on average and showed no difference between low and normal HDL groups. Conclusions: Subjects were from the capital and the Central Departament, predominantly from urban areas. Most patients studied were adult women, overweight, sedentary, with high cholesterol and hypertension. The group with low HDL-C was assiociated with other risk factors such as male gender, overweight or obesity, physical inactivity, hipercholesterolemia, hypertriglyceridemia and hypertension. Normal weight patients had low HDL-C in a significant proportion. Women, sedentary, overweight or obese, had normal HDL-C in a significant proportion. The majority of cardiovascular risk factors found in patients were modifiable.

Prevalence of the metabolic syndrome in patients presenting to the University Hospital of the West Indies: a need to adopt proactive screening and specific management policy / Prevalencia del síndrome metabólico en pacientes que acuden al Hospital Universitario de West Indies: necesidad de adoptar un tamizaje proactivo y políticas de tratamiento específico

Studies have shown that the metabolic syndrome (MetS), a major risk factor for the development of Type 2 diabetes mellitus and cardiovascular disease, is higher among psychiatric patients on antipsychotic medications than the general population. While studies on the prevalence of MetS in the Jamaican adult population have been undertaken, no such study has been done on the corresponding psychiatric population. The purpose of this study was to determine the prevalence of MetS in a Jamaican adult psychiatric inpatient population. The study group comprised thirty-eight patients with a primary DSM-IV-TR Axis 1 diagnosis. Criteria for the diagnosis of MetS were the presence of any three or more of five factors as defined by using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) consensus agreement. The prevalence of MetS in this cohort was 28.9% and was associated with significantly higher abdominal obesity (p = 0.010), elevated blood pressure (p = 0.000), elevated triglycerides (p = 0.019) and low high density lipoprotein-cholesterol (p = 0.016) when compared with patients not diagnosed with MetS. Metabolic syndrome was common in this group of psychiatric patients and likely represents a pathway to the future development of Type 2 diabetes mellitus and cardiovascular disease. Screening and continuous monitoring will allow for early intervention and possibly prevention of increased morbidity and mortality in this vulnerable population.

Los estudios han mostrado que el síndrome metabólico (SMet) - un factor de riesgo mayor para el desarrollo de la diabetes mellitus tipo 2 y la enfermedad cardiovascular - es más alto entre los pacientes psiquiátricos bajo medicamentos antipsicóticos que entre la población general. Si bien se han llevado a cabo estudios sobre la prevalencia del SMet en la población adulta jamaicana, no se han realizado estudios de esta clase en la población psiquiátrica correspondiente. El propósito de este estudio fue determinar la prevalencia del SMet en una población jamaicana adulta de pacientes hospitalizados. El grupo de estudio comprendió treinta y ocho pacientes con diagnóstico primario DSM-IV-TR de eje I. Los criterios para el diagnóstico de SMet se basaron en la presencia de tres o más de cinco factores, los cuales fueron definidos usando el acuerdo por consenso de la Federación Internacional de la Diabetes (FID) y la Asociación Nacional de Cardiología/Instituto Nacional del Corazón, el Pulmón y la Sangre (AHA/NHLBI). La prevalencia de SMet en esta cohorte fue 28.9%, y se hallaba asociada con obesidad abdominal significativamente más alta (p = 0.010), presión sanguínea elevada (p = 0.000), triglicéridos elevados (p = 0.019), y bajos niveles de colesterol-lipoproteína de alta densidad (p = 0.016), al compararse con pacientes no diagnosticados con SMet. El síndrome metabólico fue común en este grupo de pacientes psiquiátricos y probablemente representa una vía al desarrollo futuro de la diabetes mellitus tipo 2 y la enfermedad cardiovascular. El tamizaje así como el monitoreo continuos permitirán la intervención temprana y la posible prevención del aumento de la morbosidad y la mortalidad en esta población vulnerable.

A importância do HDL-C e da PCR na avaliação do risco cardiovascular em idosos longevos / The importance of HDL-C and CRP in cardiovascular risk evaluation in longevous elderly individuals

The association between total mortality, lipoproteinS, and inflammatory markers, and their implications with aging and longevity are often controversial. Among the most often studied markers are low HDL cholesterol and high C-reactive protein. Particularly in octogenarians, it is expected that the impact of the inclusion of HDL cholesterol and C-reactive protein will improve the stratification of absolute cardiovascular risk. In the present study, we performed a literature review in PubMed about the relation between HDL cholesterol, inflammation and longevity. Applying the inclusion and exclusioncriteria adopted, we selected 30 studies, among which one systematic review on the relation between HDL cholesterol and stroke, one metaanalysis on the relation between total cholesterol and HDL cholesterol with mortality, 22 longitudinal studies, and six cross-sectional studies. The results show an inverse association between HDL cholesterol and total mortality, and between cardiovascular mortality and C-reactive protein, as well as a positive association between C-reactive protein and mortality in longevous individuals. C-reactive protein and HDL cholesterol displayed promising characteristics as predictors of cardiovascular mortality in longevous elderly persons.

A associação entre mortalidade total, lipoproteínas e marcadores inflamatórios, e suas implicações com o envelhecimento e a longevidade são, muitas vezes, controversas. Entre os marcadores mais estudados, encontram-se o colesterol HDL baixo e a proteína C-reativa alta. Particularmente, nos octogenários, espera-se que o impacto da inclusão do colesterol HDL e da proteína C-reativa melhore a estratificação do risco cardiovascular absoluto. No presente trabalho, realizamos uma revisão da literatura por meio do PubMed sobre a relação entre colesterol HDL, inflamação e longevidade. Aplicando os critérios de inclusão e exclusão adotados, selecionamos 30 estudos, dentre os quais 1 revisão sistemática sobre a relação entre colesterol HDL e acidente vascularcerebral, 1 meta-análise sobre a relação entre colesterol total e colesterol HDL com mortalidade, 22 estudos longitudinais e 6 estudos transversais. Os resultados mostram uma associação inversa entre o colesterol HDL e a mortalidade total, e entre a mortalidade cardiovascular e a proteína C-reativa, assim como uma associação positiva entre a proteína C-reativa e a mortalidade em longevos. A proteína C-reativa e o colesterol HDL apresentam características promissoras como preditores de mortalidadecardiovascular em idosos longevos.

Influência dos níveis plasmáticos de lipoproteína de alta densidade na contagem de leucócitos e plaquetas em camundongos dislipidêmicos / Influence of plasma high density lipoprotein levels on leukocyte and platelet count in dyslipidemic mice

Neste estudo experimental investigou-se a influência da dislipidemia nos parâmetros do hemograma. Coletaram-se amostras de sangue de camundongos wild type, alimentados com dieta padrão, e de camundongos knockout para o gene do receptor de lipoproteína de baixa densidade, alimentados com dietas padrão e hiperlipídica. Determinaram-se os parâmetros do hemograma associando-os com os níveis plasmáticos de lipídeos. Os resultados mostraram uma associação negativa entre os níveis plasmáticos de lipoproteína de alta densidade e as contagens total e diferencial de leucócitos e plaquetas nos camundongos knockout para o gene do receptor de lipoproteína de baixa densidade. Essa relação demonstrou importante influência da lipoproteína de alta densidade na modulação da resposta imunológica e inflamatória na dislipidemia. Portanto, a avaliação dos resultados do hemograma correlacionada com os níveis plasmáticos de lipídeos, rotineiramente, pode ser promissora na prevenção e no prognóstico da severidade de quadros patológicos que envolvam respostas imunológicas nas dislipidemias.

The aim of this study was to investigate the influence of dyslipidemia on the hemogram. Blood samples were collected from wild type mice fed a standard diet and from knockout mice for the low density lipoprotein (LDL) receptor gene fed on high-fat and standard diets. The blood cell counts were analyzed for their association with plasma lipid levels. The results showed a negative association between high density lipoprotein (HDL) plasma levels and complete and differential leukocyte and platelet counts in knockout mice for the LDL receptor gene. This relation revealed the important influence of the HDL on the modulation of the immune and inflammatory response in dyslipidemia. Therefore, routine analysis of the hemogram, correlated with the plasma lipid levels, may be valuable in the prevention and prognosis of the severity of pathological processes involving immune responses in dyslipidemia.

Association of lipids with coronary heart disease in a saudi population / Associação de lípidos com doença cardíaca coronariana em população saudita

BACKGROUND: The Saudi population is known to have an unhealthy diet in addition to physical inactivity. OBJECTIVE: To investigate the lipid-mediated risk factors that might be associated with increased incidence of coronary heart diseasein the Saudi population as this was found in Western populations. MATERIALS AND METHODS: Two hundred and twenty subjects suspected of having coronary heart disease underwent coronary angiography and blood draw following a 12-hour fast. Total and HDL cholesterol, triglycerides, Lp(a) and lipoprotein lipase were measured by standard methods. Small, dense LDL was measured by the iodixanol method with an ultracentrifugation of only 2.5 hours. RESULTS: One hundred and forty subjects were found to be positive for coronary heart disease while 80 subjects were shown to be negative for this disease. Statistically significant risk factors for coronary heart disease in the Saudi population were hypertriglyceridemia (1.93±0.95 versus1.45±0.16 mmol/L;p<0.0001); low HDL cholesterol (1.09±0.55 vs 1.33±0.63 mmol/L, p=0.0001); high Lp(a) (46.8±45.58 versus 29.06±17.03 mg/dL;p=0.019); and the presence of small, dense LDL (1.0314±0.0028 versus 1.0300±0.0003 g/kg;p=0.0099). Total cholesterol (4.99±1.11 versus 4.75±1.11 mmol/L;p=0.099), LPL (35.56±26.6 versus 27.89±11.96 IU/L;p<0.059), and LDL cholesterol (3.06±1.12 versus 2.79±1.08 mmol/L;p=0.08) were not found to be statistically significant coronary heart disease risk factors. CONCLUSIONS: This study indicates that high TG, low HDL, high Lp(a) and the presence of small, dense LDL may contribute to the incidence of coronary heart disease and that TC was not significantly associated with incidence of coronary heart disease in the Saudi population.

CONTEXTO: A população saudita é conhecida por apresentar dietas não saudáveis, além de inatividade física. OBJETIVO: Investigar os lipídeos como fatores de risco que podem associar-se com o aumento da incidência de doença cardíaca coronariana na população saudita, uma vez que isso foi encontrado na população ocidental. MATERIAIS E MÉTODOS: Duzentos e vinte indivíduos com suspeita de doença cardíaca coronariana submeteram-se a angiografia coronária e coleta de sangue, após jejum de 12 horas. Colesterol total e HDL, triglicerídeos, Lp(a) e lipase lipoproteica foram calculados por métodos padrão. LDL pequena e densa foi medida pelo método do iodixanol com ultracentrifugação por apenas 2,5 horas. RESULTADOS: Cento e quarenta indivíduos apresentaram resultado positivo para doença cardíaca coronariana, enquanto 80 pacientes mostraram resultado negativo. Os fatores de risco estatisticamente significantes para doença cardíaca coronariana na população saudita foram hipertrigliceridemia (1,93±0,95 versus 1,45±0,16 mmol/L; p<0,0001); baixo colesterol HDL (1,09±0,55 versus 1,33±0,63 mmol/L; p=0,0001); Lp(a) elevada (46,8±45,58 versus 29,06±17,03 mg/dL; p=0,019) e a presença de LDL pequena e densa (1,0314±0,0028 versus 1,0300±0,0003 g/kg; p=0,0099). Colesterol total (4,99±1,11 versus 4,75±1,11 mmol/L; p=0,099), colesterol LPL (35,56±26,6 versus 27,89±11,96 IU/L; p<0,059) e LDL (3,06±1,12 versus 2,79±1,08 mmol/L; p=0,08) não foram fatores de risco estatisticamente significantes para doença cardíaca coronariana. CONCLUSÕES: Este estudo indica que elevados triglicerídeos, baixo HDL, elevada Lp(a) e a presença de LDL pequena e densa podem contribuir para a incidência de doença cardíaca coronariana. O colesterol total não foi significantemente associado à incidência de doença cardíaca coronariana na população saudita.

Perfil clínico, metabólico e antropométrico de indivíduos obesos em hospital terciário da cidade de São Paulo / Clinical, metabolic and anthropometric profile of obese individuals at a tertiary care hospital in the city of São Paulo

JUSTIFICATIVA E OBJETIVOS: A obesidade é uma condição clínica que engloba alterações metabólicas como a resistência à insulina, que podem predispor a alterações clínicas relevantes. O objetivo deste estudo foi avaliar o perfil clínico de obesos e determinar correlações com o homeostasis model assessment of insulin resistance (HOMA-IR).MÉTODO: Estudou-se 188 indivíduos não diabéticos, divididos em grupo I com índice de massa corpórea (IMC < 30 kg/m2)e grupo II (IMC ? 30 kg/m2), avaliando-se a circunferência abdominal (CA), relação cintura/quadril, relação CA/estatura (RCE),colesterol total (CT), HDL-colesterol (HDL-c), triglicerídeos(TG), relação TG/HDL-c e CT/HDL-c e HOMA-IR. RESULTADOS: O grupo II (n = 74, 59,69 ± 13,74 anos, 13 homens) demonstrou, em relação ao grupo I (n = 114, 60,96 ± 13,68 anos, 53 homens): maiores CA (109,01 ± 10,47 versus 93,39 ± 10,25, p < 0,0001), RCE (0,69 ± 0,07 versus 0,58 ± 0,06, p < 0,0001), triglicerídeos (162,32 ± 71,61 versus 128,58 ± 62,23, p = 0,001), HOMA-IR (6,16 ± 6,54 versus 2,47 ± 2,72, p= 0,007), relações TG/HDL-c (3,70 ± 2,10 versus 2,78 ± 1,90, p= 0,003) e CT/HDL-c (4,66 ± 1,28 versus 4,14 ± 1,29, p = 0,01);e menor HDL-colesterol (47,51 ± 10,40 versus 52,10 ± 14,34, p = 0,02). Não houve nenhuma correlação significativa das variáveis clínicas com o HOMA-IR no grupo II.CONCLUSÃO: Observaram-se maiores índice de HOMA-IR,TG, CA, RCE e relações TG/HDL-c e CT/HDL-c e menores níveis de HDL-c nos indivíduos obesos, contudo, tais achados não estiveram relacionados ao HOMA-IR.

BACKGROUND AND OBJECTIVES: Obesity is a clinical condition that encompasses metabolic alteration such as insulin resistance, which may lead to other clinical alterations. The aim of the study was to evaluate the clinical profile of obese individuals and determine the variables those best correlate with homeostasis model assessment of insulin resistance (HOMA-IR).METHOD: We analyzed 188 individuals, divided into groupI to body mass index (BMI < 30 kg/m2) and group II (BMI ? 30 kg/m2) and determined waist circumference (WC), waist-hipratio, waist-to-height ratio (WHtR), conicity index, total cholesterol(TC), HDL-cholesterol (HDL-c), triglycerides (TG), TG/HDL-c ratio, TC/HDL-c ratio and HOMA-IR ratio.RESULTS: Group II (n = 74, 59.69 ± 13.74 years, 13 males) when compared to group I (n = 114, 60.96 ± 13.68 years, 53 males) revealed higher: WC (109.01 ± 10.47 versus 93.39 ± 10.25, p < 0.0001), WHtR (0.69 ± 0.07 versus 0.58 ± 0.06, p < 0.0001), TG (162.32 ± 71.61 versus 128.58 ± 62.23, p = 0.001),HOMA-IR (6.16 ± 6.54 versus 2.47 ± 2.72, p = 0.007), TG/HDL-c ratios (3.70 ± 2.10 versus 2.78 ± 1.90, p = 0.003) and TC/HDL-c (4.66 ± 1.28 In group II none of the variables analyzed significantly correlated with HOMA-IR.CONCLUSION: We observed higher indices of HOMA-IR,TG, WC and WHtR, as well as TG/HDL-c and TC/HDL-c ratios;and lower levels of HDL-c in obese individuals, however, these findings were not related to HOMA-IR.