An adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in familial hypercholesterolemia: A pilot study protocol

BACKGROUND AND AIMS: A healthy diet is one of the pillars of familial hypercholesterolemia (FH) treatment. However, the best dietary pattern and indication for specific supplementation have not been established. Our aim is to conduct a pilot study to assess the effect of an adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in participants with a probable or definitive diagnosis of FH, treated with moderate/high potency statins. METHODS: A national, multicenter, factorial, and parallel placebocontrolled randomized clinical trial with a superiority design and 1:1:1:1 allocation rate will be conducted. The participants will undergo whole exome sequencing and be allocated into four treatment groups: 1) a cardioprotective diet adapted for FH (DICAFH) þ phytosterol placebo þ krill oil placebo; 2) DICA-FH þ phytosterol 2 g/day þ krill oil placebo; 3) DICA-FH þ phytosterol placebo þ krill oil 2 g/day; or 4) DICA-FH þ phytosterol 2 g/day þ krill oil 2 g/day. The primary outcomes will be low-density lipoprotein (LDL)-cholesterol and lipoprotein (a) levels and adherence to treatment after a 120-day follow-up. LDL- and high-density lipoprotein (HDL)-cholesterol subclasses, untargeted lipidomics analysis, adverse events, and protocol implementation components will also be assessed. RESULTS: A total of 58 participants were enrolled between May e August 2023. After the end of the follow-up period, the efficacy and feasibility results of this pilot study will form the basis of the design of a large-scale randomized clinical trial. CONCLUSIONS: This study's overall goal is to recommend dietary treatment strategies in the context of FH.

Different adipose tissue depots: Metabolic implications and effects of surgical removal / Diferentes depósitos de tejido adiposo: implicaciones metabólicas y efectos de la extirpación quirúrgica

Increased adiposity has been associated to worse metabolic profile, cardiovascular disease, and mortality. There are two main adipose tissue depots in the body, subcutaneous and visceral adipose tissue, which differ in anatomical location. A large body of evidence has shown the metabolic activity of adipose tissue; lipectomy and/or liposuction therefore appear to be alternatives for improving metabolic profile through rapid loss of adipose tissue. However, surgical removal of adipose tissue may be detrimental for metabolism, because subcutaneous adipose tissue has not been associated to metabolic disorders such as insulin resistance and type 2 diabetes mellitus. In addition, animal studies have shown a compensatory growth of adipose tissue in response to lipectomy. This review summarizes the implications of obesity-induced metabolic dysfunction, its relationship with the different adipose tissue depots, and the effects of lipectomy on cardiometabolic risk factors

El aumento de la adiposidad se ha asociado con un peor perfil metabólico, enfermedad cardiovascular y mortalidad. Hay 2 depósitos principales de tejido adiposo en el cuerpo, el tejido adiposo subcutáneo y el tejido adiposo visceral, y difieren en la localización anatómica. Un gran cuerpo de evidencia ha demostrado la actividad metabólica del tejido adiposo; por lo tanto, la lipectomía y/o la liposucción parecen ser alternativas para mejorar el perfil metabólico a través de la pérdida rápida de tejido adiposo. Sin embargo, la extirpación quirúrgica del tejido adiposo podría ser perjudicial para el metabolismo, ya que el tejido adiposo subcutáneo no ha sido asociado con trastornos metabólicos, tales como resistencia a la insulina y diabetes mellitus tipo 2. Además, estudios en animales han demostrado un crecimiento compensatorio del tejido adiposo en respuesta a la lipectomía. Esta revisión resume las implicaciones de la disfunción metabólica inducida por la obesidad, su relación con los diferentes depósitos de tejido adiposo y los efectos de la lipectomía sobre los factores de riesgo cardiometabólico

Depression and its relation with uncontrolled hypertension and increased cardiovascular risk.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and hypertension is one of the main cardiovascular risk factors. A large body of evidence have demonstrated the increased risk for CVD and mortality associated with uncontrolled hypertension and also the benefits of an adequate blood pressure (BP) control. In some cases, lack of adherence to treatment found during the evaluation of a subject with poor BP control may be part of a more complex scenario, as depression. It is known that individuals with depression have a higher risk of CVD-related morbidity and mortality, and early diagnosis and treatment have beneficial effects.

Dissecção causando estenose de artéria de rim transplando: diagnóstico por angiografia rotacional tridimensional / Dissection causing transplant renal artery stenosis: diagnosis by 3D rotational angiography

Paciente do sexo masculino, com 47 anos de idade, com diagnóstico de doença renal crônica estágio 5 por doença renal policística e em terapia dialítica por cinco anos foi submetido a transplante renal. No pós-operatório, o paciente apresentou disfunção do enxerto e hipertensão não-controlada, havendo necessidade de reintrodução da diálise. Ultrassom Doppler da artéria de rim transplantado foi sugestiva de estenose, e angiotomografia computadorizada confirmou o achado. No 49º dia de pós-operatório, foi realizada angiografia rotacional tridimensional da artéria do enxerto renal e visualizou-se imagem de dissecção causando estenose grave. Foi realizada angioplastia com implante de stent com sucesso e o paciente não mais necessita de diálise e mantém boa evolução do quadro nos últimos seis meses. Estenose de artéria renal é complicação comum, secundária, na maioria das vezes, a placa aterosclerótica. Rastreamento com ultrassom Doppler e confirmação diagnóstica com angiografia são as estratégias recomendadas, visando à intervenção. Dissecção é uma possível causa de estenose de artéria de rim transplantado.

A 47-year-old man diagnosed with stage 5 chronic kidney disease due to polycystic kidneys and on dialysis for five years was submitted to kidney transplantation. During the post-operative period the patient presented with graft dysfunction and uncontrolled hypertension, requiring reintroduction of dialysis. Doppler ultrasound suggested stenosis of the transplant renal artery, which was confirmed by CT angiography. On the 49th day after surgery, 3D rotational angiography of the renal graft artery was performed, showing dissection causing severe stenosis. Angioplasty and stent implantation were successfully performed and the patient no longer requires dialysis and has evolved well in the past six months. Transplant renal artery stenosis is a common complication, and is secondary to atherosclerotic plaque in most of the cases. Screening with Doppler ultrasound and diagnostic confirmation by angiography are the recommended strategies for intervention. Dissection is a possible cause of transplant renal artery stenosis.

Avaliação angiográfica do volume de placa e eventos cardiovasculares após implante de stents coronarianos / Angiographic evaluation of plaque volume and cardiovascular events after coronary Stent Implantation / Evaluación angiográfica del volumen de placa y eventos cardiovasculares tras implantación de stents coronarios

FUNDAMENTO: O volume de placa (VP) está relacionado a eventos cardiovasculares maiores (ECVM) após o implante de stents coronarianos. OBJETIVO: Avaliar a associação entre o VP antes do procedimento avaliado por angiografia e desfechos clínicos. MÉTODOS: Trata-se de estudo de coorte prospectivo incluindo pacientes submetidos a implante de stents coronarianos em um centro de referência. O VP antes do implante do stent foi avaliado pela fórmula descrita por Giugliano (Am J Cardiol 2005; 95:173): VP = À X (comprimento da lesão) X [(diâmetro do vaso/2)² - (diâmetro luminal mínimo/2)²]. Os ECVM foram registrados no seguimento clínico de um ano e análise de regressão linear múltipla foi realizada para identificar os preditores de eventos. RESULTADOS: A amostra estudada consistiu em 824 pacientes, com idade média de 60 ± 11 anos, sendo 70,0 por cento do gênero masculino. O diabete melito estava presente em 21,0 por cento e o comprometimento triarterial em 12,0 por cento. O diâmetro médio de referência foi de 3,3 ± 3,2 mm, a média do comprimento da lesão foi de 10,2 ± 4,7 mm e a média da estenose residual foi de 1,0 por cento ± 12,0 por cento. Os pacientes com ECVM apresentaram VP maior do que aqueles sem eventos (92,84 ± 42,85 vs 85 ± 46,85; p = 0,03). Outras variáveis associadas com ECVM na análise univariada foram comprometimento triarterial, IAM, diâmetro do vaso e comprimento da lesão tratada. O VP manteve a associação significativa com ECVM após ajuste para as variáveis descritas e diabete melito. CONCLUSÃO: O volume da placa do ateroma antes do implante do stent foi maior nos pacientes que apresentaram ECVM no seguimento clínico em um ano, independentemente de outros preditores de eventos.

BACKGROUND: Plaque volume (PV) is related to major cardiovascular events (MACE) after coronary stent implantation. OBJECTIVE: To evaluate the association between PV before the procedure evaluated by angiography and clinical outcomes. METHODS: This is a prospective cohort study of patients undergoing coronary stent implantation in a referral center. PV before the stent implantation was evaluated by the formula described by Giugliano (Am J Cardiol 2005, 95:173): VP = À X (lesion length) X [(vessel diameter/2)² - (minimum luminal diameter/2)²]. The MACE were registered at clinical follow-up of one year and multiple linear regression analysis was performed to identify predictors of events. RESULTS: The sample consisted of 824 patients, mean age 60 ± 11 years, 70.0 percent were male. Diabetes mellitus was present in 21.0 percent and triple vessel involvement in 12.0 percent. Average reference diameter was 3.3 ± 3.2 mm, average lesion length was 10.2 ± 4.7 mm and mean residual stenosis was 1.0 percent ± 12.0 percent. Patients with MACE had higher PV than those without events (92.84 ± 42.85 vs 85 ± 46.85, p = 0.03). Other variables associated with MACE in the univariate analysis were triple vessel involvement, myocardial infarction, vessel diameter and length of the lesion treated. PV maintained a significant association with MACE after adjusting for the variables described and diabetes mellitus. CONCLUSION: The volume of atheromatous plaque before stenting was higher in patients with MACE on clinical follow-up in one year, regardless of other predictors of events.

FUNDAMENTO: El volumen de placa (VP) está relacionado a eventos cardiovasculares mayores (ECVM) tras implantación de stentscoronarios. OBJETIVOS: Evaluar la asociación entre el VP antes del procedimiento evaluado por angiografía y desenlaces clínicos. MÉTODOS: Se trata de estudio de cohorte prospectivo que incluye a pacientes sometidos a implantación de stentscoronarios en un centro de referencia. El VP antes de la implantación del stent se evaluó por la fórmula descrita por Giugliano (Am J Cardiol 2005; 95:173): VP = Π X (longitud de la lesión) X [(diámetro del vaso/2)² - (diámetro luminal mínimo/2)²]. Los ECVM fueron registrados en el seguimiento clínico de un año y análisis de regresión lineal múltiple se llevó a cabo para identificar los predictores de eventos. RESULTADOS: La muestra estudiada consistió en 824 pacientes, con edad promedio de 60 ± 11 años, con el 70 por ciento del género masculino. El diabetes melito estaba presente en el 21,0 por ciento y el compromiso triarterial en el 12 por ciento. El diámetro medio de referencia fue de 3,3 ± 3,2 mm, la media del longitud de la lesión fue de 10,2 ± 4,7 mm y la media de la estenosis residual fue del 1 por ciento ± 12 por ciento. Los pacientes con ECVM presentaron VP mayor que aquellos sin eventos (92,84 ± 42,85 vs 85 ± 46,85; p = 0,03). Otras variables asociadas con ECVM en el análisis univariado fueron el compromiso triarterial, el IAM, el diámetro del vaso y longitud de la lesión tratada. El VP mantuvo la asociación significativa con ECVM tras ajuste para las variables descritas y diabetes melito. CONCLUSIÓN: El volumen de la placa del ateroma antes de la implantación del stent fue mayor en los pacientes que presentaron ECVM en el seguimiento clínico en un año, independientemente de otros predictores de eventos.

Angiographic evaluation of plaque volume and cardiovascular events after coronary stent implantation.

BACKGROUND: Plaque volume (PV) is related to major cardiovascular events (MACE) after coronary stent implantation. OBJECTIVE: To evaluate the association between PV before the procedure evaluated by angiography and clinical outcomes. METHODS: This is a prospective cohort study of patients undergoing coronary stent implantation in a referral center. PV before the stent implantation was evaluated by the formula described by Giugliano (Am J Cardiol 2005, 95:173): VP = π X (lesion length) X [(vessel diameter/2)² - (minimum luminal diameter/2)²]. The MACE were registered at clinical follow-up of one year and multiple linear regression analysis was performed to identify predictors of events. RESULTS: The sample consisted of 824 patients, mean age 60 ± 11 years, 70.0% were male. Diabetes mellitus was present in 21.0% and triple vessel involvement in 12.0%. Average reference diameter was 3.3 ± 3.2 mm, average lesion length was 10.2 ± 4.7 mm and mean residual stenosis was 1.0% ± 12.0%. Patients with MACE had higher PV than those without events (92.84 ± 42.85 vs 85 ± 46.85, p = 0.03). Other variables associated with MACE in the univariate analysis were triple vessel involvement, myocardial infarction, vessel diameter and length of the lesion treated. PV maintained a significant association with MACE after adjusting for the variables described and diabetes mellitus. CONCLUSION: The volume of atheromatous plaque before stenting was higher in patients with MACE on clinical follow-up in one year, regardless of other predictors of events.

Quadricuspid aortic valve by transthoracic echocardiography.

A 55-year-old woman seeks medical attention with palpitations, atypical chest pain and dyspnea upon exertion, lasting for 12 months. ECG showed left ventricular hypertrophy. Transthoracic Doppler echocardiogram confirmed hypertrophy of the left chambers and showed a quadricuspid aortic valve, with equal-sized cusps, in addition to a moderate regurgitant central flow. Upon echocardiography, the quadricuspid valve is identified by its characteristic "X" form during diastole and rectangular aspect during systole. Heart failure symptoms are presumably caused by valve insufficiency due to abnormal leaflet coaptation. Considering the possibility of progressive regurgitation, follow up on the patient was performed with periodic echocardiographic control. Symptoms responded to treatment.