Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Pseudo-hypertriglyceridaemia or hyperglycerolemia?

Hyperglycerolemia is a very rare genetic disorder caused by glycerol kinase deficiency. Although usually is presented unexpectedly in routine checks, there are severe forms, especially in children. In general, glycerol and glycerol kinase activity analyses are not included in routine laboratory determination. Glycerol presents positive interferences with some biochemical analytic techniques, e.g. in serum triglycerides and plasma ethylene glycol levels assays. Here, we report a Spanish patient with a pseudo-hypertriglyceridaemia, a falsely elevated triglycerides concentration that was not corrected with lipid-lowering therapy for 3 years.

Under-recognized renal insufficiency in hospitalized patients: implications for care.

BACKGROUND: The consequences of undetected low glomerular filtration rate (GFR) are important in hospitalized patients who receive potentially nephrotoxic drugs or undergo major surgery. This study estimated the prevalence of estimated GFR (eGFR) <60mL/min/1.73m(2) in hospitalized patients. METHODS: This cross-sectional descriptive study included 14,658 adults hospitalized at 10 centers in Spain. Serum samples were analyzed for hemoglobin, creatinine, albumin and urea nitrogen. eGFR was estimated using Modification of Diet in Renal Disease (MDRD) 4 or MDRD IDMS, and MDRD 6 when serum albumin and BUN were included (n=8611). Individuals were classified as having GFR>or=60mL/min/1.73m(2), stages 3, 4 and 5 (GFR 30-59, 15-29 and <15mL/min/1.73m(2), respectively). Additionally, stages 3a and 3b (GFR 45-59 and 30-44mL/min/1.73m(2), respectively) were assessed. RESULTS: MDRD 4 eGFR showed that 28.3% of patients had renal insufficiency stages 3-5 and 14.2% had stages 3b, 4 or 5, which represents important-severe renal deterioration. Forty-three percent of patients with stages 3-5 had hemoglobin or=60mL/min/1.73m(2). A good correlation was observed between eGFR MDRD 4 and MDRD 6. CONCLUSIONS: A high percentage of hospitalized patients in Spain have deteriorated renal function stages 3-5. Using eGFR equations to assess eGFR could identify more hospitalized patients with renal insufficiency, potentially leading to improved care.

Patrón de agregación y análisis factorial de los factoresde riesgo cardiovascular integrantes del síndrome metabólicoen población española no diabética: estudio VIVA / Aggregation pattern and factorial analysis of cardiovascular risk factors included

Objetivos: Describir las agregaciones más frecuentes de los factoresde riesgo cardiovascular (FRCV) que integran con el síndrome metabólico(SM) en una muestra de población española no diabética. Comprobarmediante análisis factorial si los diferentes FRCV considerados en elSM son manifestaciones de un posible único factor común. Material ymétodos: Estudio poblacional transversal, multicéntrico, realizado en2.583 sujetos de 30-65 años elegidos al azar de 9 registros poblacionales.Para el cálculo de la frecuencia de cada uno de los FRCV y de susagregaciones se utilizaron las definiciones clásicas de cada factor.Las agregaciones de factores se calcularon de forma excluyente. Lacorrelación entre los FRCV se realizó mediante análisis factorial. Resultados:De mayor a menor, la prevalencia de los distintos FRCV clásicosconsiderados en la defi nición del SM según el NCEP ATP III fue: dislipemia34% (intervalo de confi anza [IC] del 95%: 32-35,5); hipertensión32% (IC del 95%: 30,2-33,8); obesidad 27% (IC del 95%: 25,3-28,7) e hiperglucemia 23% (IC del 95%: 21,6-25). Se observan diferenciassignifi cativas entre sexos: predominaba la dislipemia en hombresy la obesidad en mujeres. El 22% de la población mostraba agregaciónde dos FRCV y el 11% de tres FRCV. Las agregaciones más frecuentesfueron: hipertensión-obesidad, 5,3% (IC del 95%: 4,4-6,2), e hipertensión-obesidad-hiperglucemia, 4,1% (IC del 95%: 3,3-5). Los FRCVconsiderados tienden en general a formar tres conglomerados: 1) índicede masa corporal, diámetro sagital abdominal y glucemia; 2) insulina,glucemia a las 2 horas y presión arterial, y 3) razón colesterol total/colesterolunido a las lipoproteínas de alta densidad y triglicéridos. En loshombres pueden identifi carse hasta cuatro conglomerados de FRCV,mientras que en las mujeres éstos pueden reducirse hasta dos (AU)

Aims: The aim of this study is to describe the most frequent cardiovascularrisk factors (CVRF) clustering related to the metabolic syndrome(MS) in a non-diabetic Spanish population sample. Test by factorial analysisif the CVRF in the MS can be considered manifestations of a uniquecommon factor. Materials and methods: Observational, multicenter,transversal epidemiologic study. 2583 subjects aged 30-65 were randomlyassigned from nine population registries. Exclusive aggregationswere considered. Correlation among the MS variables was analyzed usingfactorial analysis. Results: In order of frequency the prevalence ofconventional CVRF was: dyslipidemia: 34% (IC95%: 32-35.5); hypertension:32% (IC95%: 30.2-33.8); obesity: 27% (IC95%: 25.3-28.7);hyperglycaemia: 23% (IC95%: 21.6-25). 22% of the population showed2 CVRF and 11% 3 CVRF. The most common CVRF aggregations werehypertension-obesity (5.3%; IC95%: 4.4-6.2) and hypertension-obesity-hyper glycaemia (4.1%; IC95%: 3.3-5). MS specifi c risk variablestended to aggregate in three factors: factor 1 (BMI, waist circumferenceand basal glycaemia), factor 2 (insulin, glycaemia 2h, and arterial bloodpressure), factor 3 (total cholesterol/HDL, triglycerides). Conclusions:There is a high prevalence of CVRF and MS in the population studied.Analysis of the metabolic syndrome does not contribute with additionalinformation to predict cardiovascular risk in susceptible patients, as comparedto the clustering of CVRF. Factorial analysis do not confi rm theexistence of a unifying factor to explain MS (AU)

Does bicarbonated mineral water rich in sodium change insulin sensitivity of postmenopausal women?

AIM: To study the effects of drinking 0.5 L of two sodium-rich bicarbonated mineral waters (BMW-1 and 2), with a standard meal, on postprandial insulin and glucose changes. And to determine, if the effects vary depending on insulin resistance, measured by homeostasis model assessment (HOMA). METHODS: In a 3-way randomized crossover study, 18 healthy postmenopausal women consumed two sodium-rich BMWs and a low-mineral water (LMW) with a standard fat-rich meal. Fasting and postprandial blood samples were taken at 30, 60 and 120 min. Serum glucose, insulin, cholesterol and triacylglycerols were determined. Insulin resistance was estimated by HOMA and insulin sensitivity was calculated by quantitative insulin sensitivity check index (QUICKY). RESULTS: Glucose levels did not change. HOMA and QUICKY values were highly inversely correlated (r = -1,000; p < 0.0001). Insulin concentrations showed a significant time effect (p < 0.0001) and a significant water x time interaction (p < 0.021). At 120 min insulin levels with BMW-1 were significantly lower than with LMW (p = 0.022). Postprandial insulin concentrations showed significantly different patterns of mineral water intake depending on HOMA n-tiles (p = 0.016). CONCLUSION: Results suggests an increase in insulin sensitivity after BMWs consumption. This effect is more marked in the women, who have higher HOMA values. These waters should be considered part of a healthy diet in order to prevent insulin resistance and cardiovascular disease.

Effects of pork vs veal consumption on serum lipids in healthy subjects.

AIMS: To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN: Double-crossover, randomized and controlled trial SUBJECTS: 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS: The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS: After both stages of intervention had been completed, there was a mean reduction of 5.5% in low-density lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS: Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterol-controlled diet, could therefore be included in food guidelines, both for normal and therapeutic diets.

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (II) micronutrient intake. Dieta y Riesgo de Enfermedades Cardiovasculares en España.

OBJECTIVE: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. METHODS: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people 'with cardiovascular risk' and 600 'without risk' answered a food frequency questionnaire. RESULTS: Significant increases in vitamin C, retinol, lycopenes, beta-cryptoxanthin and vitamin E intakes were found. Vitamin A, alpha-carotenoid and lutein intakes decreased. Vitamin B(12), B(6) and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B(12) and B(6) and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B(1) and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. CONCLUSION: Antioxidant vitamins and vitamin B(12), B(6) and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B(1) and zinc intakes are not appropriate.

Estudio DRECE: dieta y riesgo de enfermedades cardiovasculares en España. Hábitos alimentarios en la población española / DRECE Study: dietary habits and risk from cardiovascular diseases in Spain. Nutritional pattern, in the Spanish population

Antecedentes. Las tasas de mortalidad por enfermedades cardiovasculares en las poblaciones están íntimamente ligadas con los valores de lípidos sanguíneos, y éstos, a su vez, dependen de los hábitos alimentarios. En España, la alimentación ha cambiado notablemente en las últimas 3 décadas, orientándose hacia un patrón menos cardiosaludable. Nuestro objetivo fue estudiar los hábitos alimentarios de la población española y analizar la asociación con las concentraciones plasmáticas de lípidos. Población y métodos. En 1992 realizamos un estudio epidemiológico transversal (estudio DRECE) a partir de una muestra representativa de la población española, con la finalidad de estudiar los hábitos alimentarios y los factores de riesgo cardiovasculares. Participaron 4.787 individuos de ambos sexos, con edades entre 5 y 59 años, seleccionados aleatoriamente por todo el territorio nacional. A todos los sujetos se les realizó una encuesta validada de frecuencias de consumo alimentario semicuantitativo y se procedió a una extracción de sangre para determinación de diferentes parámetros lipídicos (colesterol total, triglicéridos, colesterol unido a lipoproteínas de alta densidad [cHDL]), colesterol unido a lipoproteínas de baja densidad [cLDL]). A partir del cuestionario alimentario se estima la energía y los siguientes macronutrientes: hidratos de carbono, proteínas, grasas totales, grasas saturadas, grasas monoinsaturadas, grasas poliinsaturadas, colesterol dietético, fibra, alcohol y cálculo del índice colesterol grasa-saturada (expresados en g/día, porcentajes o ajustados/1.000 kcal). Todos los datos se muestran de manera descriptiva para la totalidad de la población española o siguiendo la distribución por ocho grandes regiones: noreste (Cataluña, Aragón, Baleares); norte (País Vasco, Navarra, Rioja, Cantabria); noroeste (Galicia, Asturias); Castilla-León; centro-sur (Madrid, Castilla-La Mancha, Extremadura), Levante (Valencia, Murcia), Andalucía y Canarias. Por último, se estudia la correlación entre los parámetros lipídicos y los nutrientes grasas totales, grasas saturadas, colesterol e índice colesterol-grasa saturada para las regiones analizadas. Resultados. El consumo promedio de grasas saturadas (14 por ciento) y de colesterol dietético (514 mg/día) de la población española sobrepasa las recomendaciones de una dieta prudente. El mayor consumo de grasas saturadas y colesterol corresponde principalmente a las regiones de Levante y Andalucía, siendo Castilla-León la comunidad con los valores más bajos. Las concentraciones de cLDL y triglicéridos son igualmente elevadas en las comunidades de Levante, Andalucía y Canarias. Existe una correlación positiva y significativa entre las grasas totales, grasas saturadas, índice de colesterol-grasas saturadas, colesterol dietético con el colesterol total. Además el índice colesterol-grasa saturada se correlaciona positivamente con las concentraciones de cLDL y triglicéridos, mientras que la correlación es negativa con las concentraciones de cHDL, para el conjunto de las 8 regiones estudiadas. Conclusiones. Los resultados de este estudio ponen de manifiesto una asociación entre ingestión de grasas saturadas y colesterol dietético con las concentraciones plasmáticas de lípidos en diferentes regiones españolas (AU)

[Analysis of evaluation process of research projects submitted to the Fondo de Investigación Sanitaria, Spain]. / Análisis del proceso evaluador de los proyectos de investigación en el Fondo de Investigación Sanitaria.

BACKGROUND: At the present time it seems very clear that research improvement is both an unquestionable fact and the right way to develop technological innovation, services and patents. However, such improvement and corresponding finances needs to be done under fine and rigorous evaluation process as an assessment tool under which all the research projects applying to a public or private call for proposals should be submitted to assure a coherence point according to the investment to be made. At this end, the main target of this work has been focused to analysis and study the evaluation process traditionally made by Fondo de Investigación Sanitaria (FIS) as well as to propose most adequate modifications. MATERIAL AND METHOD: A sample of 431 research projects corresponding to year 1998 proposal was analysed. The evaluation from FIS and ANEP (National Evaluation and Prospective Agency) was evaluated and scored (evaluation quality) in its main contents by 3 independent evaluators, the showed results submitted to a comparative frame between these agencies at indoor (FIS) and outdoor (FIS/ANEP) level. RESULTS: FIS evaluation had 20 commissions or areas of knowledge. The analysis indoor (FIS) clearly showed that evaluation quality was correlated to the assigned commission (F = 3.71; p < 0.001) and to the time last of the researched proposal (F = 3.42; p < 0.05) but no related to the evaluator. On the other hand, the quality of ANEP evaluation showed a correlated dependency of the three mentioned facts. In all terms, the ANEP evaluation was better than FIS for the three years time projects, but in did not show significant differences in one or two years time projects. In all cases, the evaluation with final results as negative (financing denied) showed an average quality higher than positive evaluation. CONCLUSIONS: The obtained results advice about the convenience of making some changes in the evaluative structure and to review the sort of FIS technical commissions focusing an improvement of the evaluation process.

Colesterol en la infancia: un terreno abonado a la confusión / Cholesterol levels in children: a matter of confusion

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Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control.

BACKGROUND: Data on the prevalence of dyslipidemia in type 1 diabetes mellitus are scarce and are based on total triglyceride and total cholesterol concentrations alone. OBJECTIVE: To assess the effect of glycemic optimization on the prevalence of dyslipidemia and low-density lipoprotein cholesterol (LDL-C) concentrations requiring intervention in patients with type 1 diabetes. PATIENTS: A total of 334 adults with type 1 diabetes and 803 nondiabetic control subjects. METHODS: Levels of glycosylated hemoglobin, total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), and LDL-C were assessed at baseline and after 3 to 6 months of intensive therapy with multiple insulin doses. RESULTS: Levels of LDL-C greater than 4.13 mmol/L (>160 mg/dL) and total triglyceride greater than 2.25 mmol/L (>200 mg/dL) and low HDL-C levels (<0.9 mmol/L [<35 mg/dL] in men or <1.1 mmol/L [<45 mg/dL] in women) were found in 16%, 5%, and 20% of patients and 13%, 6%, and 9% of controls, respectively (P<.001 for HDL-C). Diabetic women showed more hypercholesterolemia than nondiabetic women (15.6% vs 8.5%; P =.04). After glycemic optimization (mean +/- SD glycosylated hemoglobin decrease, 2.2 +/- 1.96 percentage points), the prevalence of LDL-C levels greater than 4.13 mmol/L (>160 mg/dL) became lower in diabetic men than in nondiabetic men (9.7% vs 17.5%; P =.04), but women showed frequencies of dyslipidemia similar to their nondiabetic counterparts. The proportion of patients with LDL-C concentrations requiring lifestyle (>2.6 mmol/L [>100 mg/dL]) or drug (>3.4 mmol/L [>130 mg/dL]) intervention decreased from 78% and 42% to 66% and 26%, respectively. CONCLUSIONS: Low HDL-C is the most frequent dyslipidemic disorder in patients with poorly controlled insulin-treated type 1 diabetes, and a high proportion show LDL-C levels requiring intervention. Less favorable lipid profiles could explain the absence of sex protection in diabetic women. The improvement caused by glycemic optimization puts forward intensive therapy as the initial treatment of choice for dyslipidemia in poorly controlled type 1 diabetes.

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (I). Diet and Cardiovascular Events Risk in Spain.

BACKGROUNDS/AIMS: To investigate dietary habits and their evolution with regard to cardiovascular risk status in Spain. METHODS: Cross-sectional study performed in two phases in 1991 and 1996 in 43 primary care clinics. One thousand and two hundred people classified as 'with cardiovascular risk' and 600 'without risk' were studied. Each participant answered a food frequency questionnaire. RESULTS: The risk group did not change oil, cereals and dairy products consumption, decreased egg, legume and meat, and increased fish, fruits and vegetables intake. The control group differed in increasing dairy products and not decreasing eggs and vegetables consumption. A small decrease in energy intake happened, from 11,315. 1 to 10,941.5 kJ in the risk group (p < 0.05). Carbohydrates intake showed a not statistically significant falling trend from 41.3 to 40.6% in people at risk and 41.8 to 40.7% in those without risk. Protein intake increased in both groups up to 16.5% and fat consumption kept at around 42.9% in both groups. The decrease in saturated fat and increase in polyunsaturated fat were statistically significant in people at risk (p = 0.000). High cholesterol intakes were found. CONCLUSION: People with cardiovascular problems changed their dietary habits in a 'healthier' way than people without risk.

Red wine intake prevents nuclear factor-kappaB activation in peripheral blood mononuclear cells of healthy volunteers during postprandial lipemia.

BACKGROUND: Several epidemiological studies have demonstrated the beneficial effect of red wine intake in reducing total and cardiovascular mortality. This effect has been attributed in part to its antioxidant properties. Because the monocytes/macrophages and the nuclear transcription factor kappaB (NF-kappaB) are implicated in the pathogenesis of atherosclerotic lesions, we examined the effect of red wine intake on the activation of NF-kappaB in peripheral blood mononuclear cells. METHODS AND RESULTS: Sixteen healthy volunteers were studied 3 times each: after a moderate dose, a low dose, and no wine with a fat-enriched breakfast. Lipid profile and NF-kappaB activation (electrophoretic mobility shift assay) were examined in blood samples taken before and 3, 6, and 9 hours after wine intake. In addition, mononuclear cells were incubated with VLDL in the presence of some antioxidants (quercetin and alpha-tocopherol succinate) contained in red wine to study their effects on NF-kappaB activation. Subjects receiving a fat-enriched breakfast had increased NF-kappaB activation in peripheral blood mononuclear cells coinciding with the augmentation in total triglycerides and chylomicrons. Red wine intake prevented NF-kappaB activity even though it induced a certain increase in serum lipids, particularly VLDL, that did not increase after the fat ingestion alone. However, another form of alcohol intake (vodka) did not modify the NF-kappaB activation provided by postprandial lipemia. In cultured mononuclear cells, isolated human VLDL caused NF-kappaB activation in a time-dependent manner that did not occur in the presence of the red wine antioxidants quercetin and alpha-tocopherol. CONCLUSIONS: Our results provide a new potential mechanism to explain the beneficial effects of red wine intake in the reduction of cardiovascular mortality.

[Phenotypic expression of Lp(a) in Spanish children and adolescents]. / Expresión fenotípica de la Lp(a) en niños y adolescentes españoles.

BACKGROUND: To know the distribution of phenotypes Lp(a) in an young population. METHODS: Lipoprotein levels, lipoprotein(a), apolipoproteins and the Lp(a) phenotypes were determined in 105 children, selected according to their cholesterol concentrations. RESULTS: The Lp(a) concentrations were significantly higher in group with low molecular weight respect to group with high molecular weight. The most frequent isoform was S3. CONCLUSIONS: The Lp(a) concentrations correlate inversely with the molecular weight of Apo(a) isoforms.

Lipoprotein abnormalities in patients with asymptomatic acute porphyria.

There have been discrepancies in reports of total cholesterol and low density lipoprotein (LDL)-cholesterol levels in patients with acute porphyria. Some studies have found that acute porphyria patients have increased levels while others do not. The aim of this study has been to evaluate the lipid profile in a series of patients with acute porphyria, in order to help clarify these differences. Serum lipoprotein levels were studied in 30 patients (25 women and five men; age:38+/-10 years) with asymptomatic acute porphyria. Controls were 30 healthy volunteers matched for age and gender. For 13 patients and 15 controls, lipoprotein lipase and hepatic lipase activities were determined. Patients exhibited increased levels of total-cholesterol, LDL-cholesterol, high density lipoprotein (HDL)-cholesterol and apolipoprotein (apo)-A1 compared with controls (P4 mmol/l in 15 patients (50%). Levels of total triglycerides, very low density lipoprotein (VLDL)-triglycerides, VLDL-cholesterol, apo-B and lipoprotein(a) were similar in patients and controls. The hepatic lipase activity tended to be lower in patients than controls (33.8+/-17.7 vs. 50.4+/-23.0 pkat/ml; P=0.05). In conclusion, in patients with asymptomatic acute porphyria an increase of total and LDL-cholesterol was found. The cardiovascular risk conferred by this factor may be attenuated by increased HDL-cholesterol and apo-A1.

Jornada de análisis de las dislipidemias en España (estudio Jade): subanálisis de los pacientes dislipidémicos hipertensos

Se trata de un estudio observacional efectuado en un mismo día de trabajo en centros de Atención Primaria repartidos por todo el territorio del Estado. El objetivo fue analizar el impacto que las dislipidemias y la hipertensión tienen en Atención Primaria, así como su grado de control. Se registraron un total de 12.101 pacientes, de los cuales 10.641 cumplían los criterios de inclusión. Del total de 12.101 pacientes, 7.832 (73,6 por ciento) presentaban dislipidemia, y de éstos, 3.996 (51,02 por ciento) también eran hipertensos y sólo el 20,8 por ciento mantenían un control óptimo de la presión arterial. La población estudiada soporta un alto índice de riesgo cardiovascular, resaltando el bajo porcentaje de control (AU)

[Lipid profile of the Spanish population: the DRECE (diet and risk of cardiovascular disease in Spain) study. DRECE study group]. / Perfil lipídico de la población española: estudio DRECE (Dieta y Riesgo de Enfermedad Cardiovascular en España). Grupo de estudio DRECE.

BACKGROUND: In Spain the mortality rate due to cardiovascular disease (CVD) is relatively low compared to that of other developed countries. Until now few epidemiological studies have been performed among the global Spanish population to evaluate a relation between CVD risk factors and the lipid profile that could justify our privileged situation. For, this reason, the DRECE study was designed to know the situation at present in Spain respect to the risk of suffering from CVD in particular, the lipid profile. POPULATION AND METHODS: This study included 4,787 subjects (2,324 males and 2,463 females) with an age ranging from 5-60 years, representative of the total Spanish population with these characteristics during the period from 1992 to 1994. Medical history was made for all participants, who also underwent a physical examination. The following parameters were determined: total cholesterol (TC), triglycerides, high-density lipoproteins cholesterol HDLc, cholesterol transported by low-density lipoproteins, LDLc (estimated by the Friedewald's formula), apolipoprotein AI and apoliprotein B (immunoturbidimetry). RESULTS: The results obtained and expressed in mean (SD) show that, although the population has total cholesterol concentrations (190.1 [42.4] and 192.8 [44.8] mg/dl for females and males, respectively) and LDLc (113.9 [37.9] and 117.5 [38.1] mg/dl for females and males, respectively) with values as high as those found in developed countries, the HDLc concentrations (58.6 [13.2] and 51.5 [13.4] mg/dl for women and men, respectively) are also increased and this could be the reason why the mortality rate in Spain caused by CVD is lower than in other countries. CONCLUSIONS: The finding of high HDLc levels and their antiatherogenic role could justify that, at best in part, the rate mortality in Spain is lower than in other developed countries.

Changes in phenotypes of apolipoprotein E and apolipoprotein(a) in liver transplant recipients.

The aim of this study has been to confirm that liver is the main site of apolipoprotein (apo) E and apo(a) synthesis, based in the changes of their phenotypes after transplantation. Apo E phenotypes were studied in 34 patients and apo(a) phenotypes in 27 of them before and after liver transplant. Thirteen patients changed the apo E phenotype after transplantation. Eight patients with E3/3 phenotype changed to the others with 2 or 4 alleles. Three patients with E4/3 phenotype changed to E3/3, one changed from E3/2 to E3/3 and another one changed from E4/2 to E3/2 phenotype after transplantation. Twenty one of the 27 patients changed the apo(a) phenotype. Thirteen of them also changed lipoprotein (Lp)(a) serum concentration at least twofold, showing in 11 an increase and in 2 a decrease, in relation with the change to phenotype associated with high and low Lp(a) concentration, respectively. Changes in apo E and apo(a) phenotypes in liver transplant recipients studied show that most of these apolipoproteins are synthesized by the liver.