Efecto de la hiperglucemia en el síndrome coronario agudo y sus implicaciones en el tratamiento antiagregante plaquetario / Effect of hyperglycemia on acute coronary syndrome and the implications of antiplatelet therapy

RESUMEN La enfermedad cardiovascular representa, según los datos de la Organización Mundial de la Salud, la principal causa de muerte asociada con factores de riesgo como el tabaquismo, el sedentarismo, la hipertensión, la dislipidemia y la diabetes mellitus. Precisamente, esta última enfermedad es una de las que más se relaciona con la aparición, la progresión y las complicaciones de un evento coronario. La hiperglucemia potencia diferentes vías bioquímicas y celulares como la del sorbitol, el factor nuclear kβ, la formación de productos finales de glicación avanzada, la vía de la proteína cinasa C y el estrés oxidativo, que terminan favoreciendo en el paciente coronario un estado proinflamatorio y procoagulante, que se asocia con un peor pronóstico y agrava la lesión miocárdica; además, inhibe y compite con la acción de los antiagregantes plaquetarios, generando resistencia no solo a estos sino también a la terapia trombolítica. Por lo anterior, se hace necesario generar una actualización del tema, para sensibilizar a la comunidad médica sobre la importancia del control glucémico, sobre todo en pacientes con cardiopatía isquémica, y así mejorar las estrategias de control. Se realizó la búsqueda bibliográfica en PubMed, de una forma estructurada, no sistemática. Se incluyeron artículos publicados en inglés y español, sin restricción por fecha de publicación.

SUMMARY According to data from the World Health Organization, cardiovascular disease is the main cause of death associated with risk factors such as smoking, sedentary lifestyle, hypertension, dyslipidemia and diabetes mellitus. Precisely, this last disease is one of the most related to the appearance, progression, and complications of a coronary event. Hyperglycemia potentiates different biochemical and cellular pathways such as sorbitol, the nuclear factor kβ, the formation of advanced glycation end products, the protein kinase C pathway and oxidative stress, which end up favoring in the coronary patient a proinflammatory state and procoagulant, which is associated with a worse prognosis and aggravates myocardial injury; in addition, it inhibits and competes with the action of platelet antiaggregants, generating resistance not only to these but also to thrombolytic therapy. Therefore, it is necessary to generate an update of the topic, to sensitize the medical community about the importance of glycemic control, especially in patients with ischemic heart disease and thus improve control strategies. The bibliographic search was carried out in PubMed, in a structured, non-systematic way. Articles published in English and Spanish were included, without restriction by publication date.

Cardiometabolic risk factors in preschool children with abdominal obesity from Medellín, Colombia.

Background Abdominal obesity (AO) is linked to inflammation and insulin resistance (IR). However, there is limited information on whether preschoolers with AO present these risk factors. We evaluated the association between AO and cardiovascular risk factors in preschoolers. Methods We enrolled 232 children (2-5 years), of whom 50% had AO. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG), apolipoprotein B (Apo-B) and apolipoprotein A-1 (Apo-A1), glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1ß, monocyte chemoattractant protein (MCP-1/CCL2), leptin, adiponectin, vascular cell adhesion molecule (VCAM-1/CD106) and intercellular adhesion molecule (ICAM-1/CD54) were measured. The homeostatic model assessment of IR (HOMA-IR) was calculated. We analyzed these variables according to the presence of AO and other metabolic syndrome (MetS) components. Results A total of 75.8% of children with AO had one or more risk factors for MetS. Children with AO had significantly higher body mass indexes (BMIs), insulin, HOMA-IR, TG, very low-density lipoprotein-cholesterol (VLDL-c) and TC/HDL-c ratio and lower HDL-c, compared to children without AO; but there were no differences in inflammatory markers. After adjusting for BMI, sex and age, the differences between groups were not significant for any variable. Waist circumference (WC) was correlated with insulin (r=0.547; p<0.001), TG (r=0.207; p=0.001), ICAM-1 (r=0.213; p=0.039), hs-CRP (r=0.189; p=0.015) and glucose (r=0.187; p=0.004). After adjusting for BMI, age and sex, AO plus one MetS component contributed to individual variation in glucose, insulin, HOMA-IR and TG. Conclusions AO in preschool children is associated with greater IR and atherogenic lipid profiles, although these findings seem to be more related to general obesity than just central obesity. In addition, our data suggest that IR may precede the elevation of systemic cytokines in obese children, unlike findings in adults. More studies in pediatric populations are needed to elucidate these associations.

Association of Native American ancestry and common variants in ACE, ADIPOR2, MTNR1B, GCK, TCF7L2 and FTO genes with glycemic traits in Colombian population.

Insulin resistance and defects in other related glycemic traits are common findings in the context of Metabolic Syndrome. Although genetic factors are clearly implied in susceptibility, and some gene variants have been identified mainly in populations of European ancestry, little is known about this aspect in admixed populations. The association of insulin resistance, ß-cell function, fasting insulin and glucose levels with 48 gene variants, previously related to metabolic syndrome components, and with the ancestral genetic composition, estimated on 50 ancestry informative markers, was evaluated in 417 individuals from the Colombian admixed population. The Native American genetic ancestry was associated with a low ß-cell function (odds ratio (OR) of 1.73 and 95% confidence interval (95% CI) of 1.07-2.81, p = 0.026). Significant genotypic associations were obtained (q-value < 0.05) for gene variants in ACE (rs4340; OR (95% CI): 2.79 (1.58-4.91), insulin resistance; mean difference (95% CI): 0.273 (0.141; 0.406), fasting insulin), ADIPOR2 (rs11061971; OR (95% CI): 0.14 (0.04-0.48), low ß-cell function), MTNR1B (rs10830963; mean difference (95% CI): 0.032 (0.013; 0.051), fasting glucose) and GCK (rs4607517; mean difference (95% CI): 0.038 (0.020;0.056) and rs1799884; mean difference (95% CI): 0.027 (0.013-0.041), fasting glucose). Also the well-known gene variants rs7903146 in TCF7L2, and rs17817449 in FTO, were nominally associated with hyperglycemia (rs7903146), as well as with higher fasting insulin levels (rs17817449). Our findings indicate that gene variants in ACE, ADIPOR2, MTNR1B, GCK, TCF7L2 and FTO, are associated with glycemic traits in the admixed Colombian population, while a higher Native American genetic component is related to lower ß-cell function.

Insulin resistance and ß-cell function in Colombian mestizo and Embera-Chamí populations and their relation with adiposity degree.

BACKGROUND AND OBJECTIVE: Insulin resistance (IR) is a condition favored by metabolic and endocrine changes experienced by adipose tissue in the context of obesity. The prevalence and the presentation of both IR and obesity vary among the populations, and may be affected by ancestral genetic composition among other factors. The aim of this study was to compare the presence of IR and obesity in Amerindians of the Embera-Chamí ethnicity and Colombian mestizo population. PATIENTS AND METHODS: A sample of 630 individuals, 471 mestizos and 159 Amerindians of the Embera-Chamí ethnicity, from the general population of Colombia were studied. For each participant, anthropometric and biochemical measurements, as well as blood pressure and the Homeostatic Model Assessment (HOMA) of IR and ß-cell function (%B) were recorded. These values were compared between the two populations. RESULTS: While prevalence of central obesity was similar in both populations (48.7% and 42.6% in the mestizo and Embera groups respectively; p=0.148), body mass index (BMI) values suggested a higher prevalence of overweight in the Embera than in mestizo population (43.4% Embera, 31.8% mestizo; p=0.027). Despite the similarities in the prevalence of HOMA-IR and HOMA-%B status between both populations, the Embera population had a significantly greater pancreatic ß-cell function, higher insulin levels, and better glucose control, across BMI and central obesity categories, than the mestizo population. CONCLUSION: There are differences in aspects related to energy metabolism between the samples of the mestizo and Amerindian populations analyzed.

Insulin resistance and Beta-cell function in Colombian mestizo and Embera-Chamí populations and their relation with adiposity degree

Background and objective: Insulin resistance (IR) is a condition favored by metabolic and endocrine changes experienced by adipose tissue in the context of obesity. The prevalence and the presentation of both IR and obesity vary among the populations, and may be affected by ancestral genetic composition among other factors. The aim of this study was to compare the presence of IR and obesity in Amerindians of the Embera-Chamí ethnicity and Colombian mestizo population. Patients and methods: A sample of 630 individuals, 471 mestizos and 159 Amerindians of the Embera-Chamí ethnicity, from the general population of Colombia were studied. For each participant, anthropometric and biochemical measurements, as well as blood pressure and the Homeostatic Model Assessment (HOMA) of IR and β-cell function (%B) were recorded. These values were compared between the two populations. Results: While prevalence of central obesity was similar in both populations (48.7% and 42.6% in the mestizo and Embera groups respectively; p=0.148), body mass index (BMI) values suggested a higher prevalence of overweight in the Embera than in mestizo population (43.4% Embera, 31.8% mestizo; p=0.027). Despite the similarities in the prevalence of HOMA-IR and HOMA-%B status between both populations, the Embera population had a significantly greater pancreatic β-cell function, higher insulin levels, and better glucose control, across BMI and central obesity categories, than the mestizo population. Conclusion: There are differences in aspects related to energy metabolism between the samples of the mestizo and Amerindian populations analyzed (AU)

Antecedentes y objetivo: La resistencia a la insulina (RI) es una condición favorecida por las alteraciones metabólicas y endocrinológicas experimentadas por el tejido adiposo en el contexto de obesidad. Tanto la prevalencia como la presentación de RI y obesidad varían entre las poblaciones y puede ser afectada, entre otros factores, por la composición genética ancestral. El objetivo de este estudio fue comparar la presentación tanto de RI como de obesidad entre amerindios de la etnia embera-chamí y población mestiza colombiana. Pacientes y métodos: Se estudió una muestra de 630 individuos de la población general mestiza colombiana (471 individuos) y de amerindios de la etnia embera-chamí (159 individuos). Para todos los participantes se registraron tanto medidas antropométricas, bioquímicas así como de presión arterial y el índice homeostatic model assessment (HOMA) para la RI y función de la célula β, valores que fueron comparados entre las poblaciones. Resultados: Mientras que ambas poblaciones mostraron una prevalencia de obesidad central similar (48,7% en mestizos, 42,6% en embera; p=0,148), los embera presentaron mayor exceso de peso de acuerdo al índice de masa corporal que los mestizos (43,4% en embera, 31,8% en mestizos; p=0,027). A pesar de las similitudes en la prevalencia de HOMA2-RI y HOMA2- %B entre ambas poblaciones, los embera presentan una función significativamente mayor de las células β del páncreas, niveles de insulina comparativamente mayores y un mejor control glucémico que los mestizos. Conclusión: Existen diferencias en aspectos del metabolismo energético entre las muestras de población mestiza y amerindia analizadas (AU)

Síndrome metabólico en niños: problemática, componentes y criterios diagnósticos / Metabolic syndrome in children: issues, components and diagnostic criteria

RESUMEN Antecedentes el síndrome metabólico en niños aumenta el riesgo de diabetes mellitus tipo 2 y enfermedad cardiovascular en la adultez. Objetivo describir los componentes del síndrome metabólico en niños, su prevalencia y criterios diagnósticos propuestos por diferentes organizaciones y autores. Materiales y métodos se realizó una búsqueda bibliográfica en las siguientes bases de datos: Pubmed, Science Direct, Embase, Lilacs y Scielo. Resultados y discusión varias organizaciones han establecido definiciones para diagnosticar el síndrome metabólico en niños, algunas abordando criterios utilizados en adultos o adoptando puntos de corte derivados de poblaciones seleccionadas como niños obesos o sin incluir niños pre-adolescentes, aduciendo en estos últimos una baja prevalencia de alteraciones. Así, la prevalencia de este síndrome en una misma población puede variar (0,9 a 11,4%) según la definición empleada. Sin embargo, dicha prevalencia aumenta con el grado de obesidad infantil y se han demostrado prevalencias altas en pre-púberes, independiente de la clasificación empleada. Recientemente, se propuso usar puntajes continuos para mejorar la evaluación en niños. Conclusión los puntos de corte actualmente empleados ponderan de forma diferente los componentes del síndrome metabólico. Por tanto, se recomienda emplear percentiles según edad, sexo y población para cada componente y evaluar la utilidad de puntajes continuos en esta población.

ABSTRACT Background The metabolic syndrome in children increases the risk for type 2 diabetes and cardiovascular disease in adulthood. Aim To describe the components of metabolic syndrome in children, their prevalence, and diagnostic criteria proposed by different authors and organizations. Materials and methods A literature search of articles published in Pubmed, Science Direct, Embase, Lilacs and Scielo databases was conducted. Results and discussion: Several organizations have established definitions for metabolic syndrome diagnosis in children, some including criteria used for adults or adopting cutoffs derived from selected populations such as obese children or without including pre-adolescent children, arguing a low prevalence of alterations in these. Thus, the prevalence of metabolic syndrome in a particular population varies (0,9% to 11,4%) according to the definition used. However, this prevalence increases according to the obesity grade, and a high prevalence in pre-pubers has been reported, independent of the classification used. Recently, it was proposed the use of a continuous score to improve the metabolic syndrome evaluation in children. Conclusion: The cutoffs currently used give different weighting for each component of metabolic syndrome. Therefore, it is recommended the use of percentiles according to sex and age and population for each component and to evaluate the utility of continuous scores in this population.