Obesidad y dislipoproteinemia / Obesity and dyslipoproteinemia

En esta revisión se define la obesidad, sus causas generales, cuantificación y distribución corporal. Se hace una revisión general de la bioquímica de las fracciones lipoproteicas de la sangre, así como la forma de realizar el diagnóstico de las dislipoproteinemias. La dislipoproteinemia de la obesidad es una forma secundaria a la resistencia a la insulina y disminución de la actividad de la lipasa lipoproteica, con elevación de los triglicéridos, disminuye el colesterol HDL y se constituye el síndrome metabólico. Se describe su fisiopatología, así como el desarrollo de las morbilidades conexas. Se caracteriza la dislipoproteinemia de la obesidad no solo en condiciones basales sino también en el período posprandial. Se intenta estimar la prevalencia de dislipoproteinemia en la obesidad. Se delinea el tratamiento de la obesidad y de la dislipoproteinemia, considerando el cambio de estilo de vida mediante el régimen alimenticio y la actividad física, la farmacoterapia y la cirugía bariátrica, así como el uso de hipolipemiantes.

The definition, main general causes, quantification and body distribution of obesity are described. A general review of the different blood lipoprotein fractions as well as the procedure for the diagnosis of dyslipoproteinemia is done. Dyslipoproteinemia of obesity is a secondary form of insulin resistance as a result of lowering of lipoprotein lipase activity resulting in increase of triglycerides, decrease of HDL cholesterol,and establishment of the metabolic syndrome. Its pathophysiology and the development of obesity related morbidities are described. Dyslipoproteinemia of obesity is present in both the basal and postprandial status. An attempt is made to estimate the prevalence of dyslipoproteinemia. Treatment is outlined and includes change in lifestyle regarding diet and physical activity, pharmacotherapy, and bariatric surgery, as well as the hypolipidemic treatment.

A Review On Etiopathogenesis Of Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM) is a hyperglycemic syndrome with several characteristic features. It continues to rise unabatedly in all pockets of the world, parallels with affluence and can be controlled but not cured. It has a definite involvement of genetic component but environmental factors play overwhelmingly dominant role in etiopathogenesis. Insulin resistance (IR) and obesity are singular instigators of T2DM. Hyperglycemia induces OS through multiple routes : a)stimulated polyol pathway where in ≤ 30% glucose can be diverted to sorbitol and fructose, b)increased transcription of genes for proinflammatory cytokines and plasminogen activator inhibitor-1 (PAI-1) c) activation of protein kinase-C (PKC) leading to several molecular changes d)increased synthesis of Advanced Glycation End Products (AGEs) e)changes in a receptor far AGEs and f) autooxidation of glucose with formation of ketoimines and AGEs. All these processes are accompanied with alteration in redox status, Reactive Oxygen Species (ROS), Reactive Nitrogen Species (RNS) and Oxidative Stress (OS) which trigger T2DM and its complications. Initial hurriedly planned and executed experimental and clinical studies showed promising results of antioxidant therapies, but recent studies indicate that excess intake/ supplement may have adverse outcomes including increased mortality. It is advocated that antioxidants should be given only if preexisting deficiency is present. Selection of antioxidant is another important aspect. Lastly but most importantly the impact of OS is not obligatory but facultative. As such only those diabetic patients will be benefited by antioxidant therapies that have impelling punch of prooxidants.

Estatinas, uso racional en el tratamiento de la dislipoproteinemia / Statins related to a rational use in treatment of dyslipoproteinemia

Las estatinas constituyen un grupo de medicamentos eficaces en el control de la hipercolesterolemia. La mayor parte de la información sobre las estatinas está dedicada a resaltar sus virtudes. El propósito del artículo es llamar la atención sobre aspectos no tan difundidos, o al menos, no suficientemente tomados en cuenta. A las estatinas se asocian algunos efectos indeseables que deben ser tomados en consideración para lograr un mejor tratamiento de los pacientes dislipoproteinémicos. Las interacciones medicamentosas, las altas dosis, la edad, el sexo, y otras enfermedades concomitantes como la diabetes, pueden condicionar efectos colaterales indeseables, como los trastornos del sistema nervioso central, la opacidad del cristalino o la elevación de las transaminasas, entre otros, que pueden afectar notablemente la calidad de vida de los pacientes. La rabdomiolisis es uno de los efectos colaterales adversos que más debe tomarse en consideración.

Statins are a group of effective drugs in control of hypercholesterolemia. Most of information on statins is devoted to emphasize its virtues. The aim of present paper is to attract the attention on features not so known or at least, non enough took account. Statins have some associated undesirable effects that must to be considered to achieve a better treatment of patients presenting with dyslipoproteinemia. Drug interactions, high doses, age, sex, and other concomitant diseases, e.g. diabetes, may cause undesirable collateral effects, e.g. central nervous system disorders, crystalline lens, or raise of transaminases, among others, that may to affect notably the patients' quality of life. The rabdomyolisis is one of the adverse collateral effects to take into account.

Un análisis de la ubicación clínica del síndrome metabólico / The clinical frame of metabolic syndrome

El síndrome metabólico (SM) se describió originalmente como un conjunto de factores de riesgo para la enfermedad cardiovascular, lo que desencadenó un torrente de estudios con el fin de confirmar su impacto epidemiológico. No obstante la información que se ha reunido, cada vez resulta más difícil conocer los límites que permitirían realizar el diagnóstico clínico en la práctica médica cotidiana. La inclusión de la resistencia a la insulina despertó nuevamente el interés por fundamentar el concepto de prediabetes, pero se ha encontrado que no necesariamente existe resistencia a la insulina en el SM. Por otra parte el tratamiento del SM implica un multienfoque versátil, lo que dificulta la evaluación del resultado terapéutico. De manera colateral, pero provechosa, se ha ampliado el conocimiento de la función metabólica del tejido adiposo y la fisiopatogenia de los procesos preinflamatorios y procoagulantes para la explicación de la ateroesclerosis y trombosis.

The metabolic syndrome was first described as a cluster of cardiovascular risk factors; however further studies have shown the difficulty to carry out a clinical diagnosis as well as the need for laboratory tests in order to confirm it. The study of the metabolic syndrome brought about a renewed interest in the prediabetes concept and the role of insulin resistance. It is worth noting however, that not all patients with metabolic syndrome will show insulin resistance. Currently there is no single therapy available for this syndrome, therefore we need to use multiple approaches that make assessment more cumbersome. The role of adipose tissue has received considerable attention in the research of the metabolic process; moreover a preinflammatory process and coagulation have also been associated with this syndrome. The impact of the metabolic syndrome in clinical practice remains unclear.

Clinicopathologic Study of 37 Cases of Xanthelasma Palpebrarum; Clinical Significance of Xanthelasma Palpebrarum in Hyperlipidemiae and Cardiovascular Diseases / 대한피부과학회지

BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma. Although xanthelasma is a type of xanthoma, a half of patients in most series are known to be normolipemic. OBJECTIVE: This study is an attempt to elucidate the clinical and pathologic features of xanthelasma in Korea and to know the clinical significance of xanthelasma, especially suggested role as a marker for hyperlipidemiae and increased risk for cardiovascular diseases. METHOD: Thirty seven cases of xanthelasma were clinially and pathologically analyzed. Incidence of abnomal lipid profiles and cardivascular diseases were compared with those of control group using logistic regression statistics. RESULTS: 1. The incidence of xanthelasma was 0.09% of the total number of dermatologic patients. 2. The ratio between male and female was 1: 1.8 and the mean age was 52.4 years (range;17-71 years). 3. Clinically, it typically presented as yellow or orange papules on the inner canthus of both upper eyelids. 4. The incidences of abnormal lipid profiles(hyperlipidemia and dyslipoproteinemia) are 42.4-44.0%. The levels of total cholesterol and low density lipoprotein-cholesterol were increased significantly. The incidence of the cardiovascular diseases was 16.2%, which was not statistically different from that of control group. 5. Histopathologic findings of 23 cases showed masses of foam cells in the upper dermis accompanied with sparse inflammatory cells and few giant cells. CONCLUSION: Xanthelasma seems to help to identify persons with abnormal lipid profiles which are risk factors of cardiovascular diseases and we recommand examination of lipid profiles in patients with xanthelasma.