Long-term treatment persistence and maintained reduction of LDL-cholesterol levels with evolocumab over 30 months: Results from the Spanish cohort of the European prospective HEYMANS study / Persistencia al tratamiento a largo plazo y reducción mantenida de los niveles de colesterol LDL con evolocumab durante 30 meses: resultados de la cohorte española del estudio prospectivo europeo HEYMANS

Aims: Limited data exist on low-density lipoprotein-cholesterol (LDL-C) level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. HEYMANS (NCT02770131) is the first multi-country, multicenter, observational study of European patients initiating evolocumab as part of their routine clinical management, based on local reimbursement criteria (overall data recently published). The aim of this analysis is to describe clinical characteristics, baseline and changes in LDL-C levels, treatment patterns and persistence to evolocumab over 30 months in the Spanish cohort using data from the HEYMANS Registry. Methods: HEYMANS was a prospective study of adult patients (≥18 years) who received at least one dose of evolocumab. A total of 1951 patients were enrolled from 12 countries and were followed up for 30 months after evolocumab initiation. Data were collected for 6 months before evolocumab initiation and up to 30 months thereafter. The Spanish cohort included patients who started evolocumab in routine clinical practice from March 2016 to September 2019. Demographic and clinical characteristics, lipid-lowering therapies (LLT), and lipid levels were collected. (AU)

Objetivos: Existen datos limitados sobre la variabilidad del nivel de colesterol de lipoproteínas de baja densidad (cLDL) o la persistencia a largo plazo con el anticuerpo monoclonal evolocumab en la práctica clínica habitual. HEYMANS (NCT02770131) es el primer estudio observacional multicéntrico y multinacional de pacientes europeos que iniciaron tratamiento con evolocumab en la práctica clínica habitual, basado en criterios de reembolso locales. El objetivo fue evaluar las características clínicas, los cambios en los niveles de cLDL, los patrones de tratamiento y la persistencia a este con evolocumab en la cohorte española con un seguimiento de 30 meses, utilizando datos del registro HEYMANS. Métodos: HEYMANS fue un estudio prospectivo de pacientes adultos (≥18 años) que recibieron al menos una dosis de evolocumab prescrita. Se incluyeron 1.951 sujetos de 12 países. Los datos fueron recopilados desde los seis meses previos al inicio del tratamiento hasta los 30 meses posteriores. La cohorte española incluyó pacientes que comenzaron evolocumab en la práctica clínica habitual desde marzo del 2016 hasta septiembre del 2019. Se recogieron las características demográficas y clínicas, los tratamientos hipolipemiantes (LLT) y el perfil lipídico. (AU)

Long-term treatment persistence and maintained reduction of LDL-cholesterol levels with evolocumab over 30 months: Results from the Spanish cohort of the European prospective HEYMANS study.

AIMS: Limited data exist on low-density lipoprotein-cholesterol (LDL-C) level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. HEYMANS (NCT02770131) is the first multi-country, multicenter, observational study of European patients initiating evolocumab as part of their routine clinical management, based on local reimbursement criteria (overall data recently published). The aim of this analysis is to describe clinical characteristics, baseline and changes in LDL-C levels, treatment patterns and persistence to evolocumab over 30 months in the Spanish cohort using data from the HEYMANS Registry. METHODS: HEYMANS was a prospective study of adult patients (≥18 years) who received at least one dose of evolocumab. A total of 1951 patients were enrolled from 12 countries and were followed up for 30 months after evolocumab initiation. Data were collected for 6 months before evolocumab initiation and up to 30 months thereafter. The Spanish cohort included patients who started evolocumab in routine clinical practice from March 2016 to September 2019. Demographic and clinical characteristics, lipid-lowering therapies (LLT), and lipid levels were collected. RESULTS: In total, 201 patients were included in the Spanish cohort. Median follow-up (Q1-Q3) was 30.0 (12-30) months. A total of 61.7% of patients were men and the mean (standard deviation) age was 59.5 (10.8) years. Most patients (68.7%) had experienced a prior cardiovascular event, 45.3% had coronary artery disease or stable angina, and 60.2% had a diagnosis of familial hypercholesterolemia. Overall, 57.7% of patients were receiving treatment with statins, most of them with high-intensity statins (85.3%); 45.8% of patients were intolerant to statins, and 26.4% of patients did not receive any LLT. At baseline, median (Q1-Q3) LDL-C levels were 151 (123-197) mg/dL. After 3 months of treatment, baseline LDL-C decreased by 66% to a median of 50 (30-83) mg/dL and these levels were maintained over time, with a median LDL-C of 55 (40-99) mg/dL at 30 months. At months 10-12 of treatment, LDL-C levels<55mg/dL were achieved by 56.3% of patients. LDL-C levels<70mg/dL were achieved by 70.1% of patients, and a lowering of LDL-C levels ≥50% was achieved by 76.8% of patients. The percentage of patients on evolocumab treatment was 95% at 12 months and 93% at 30 months. CONCLUSIONS: In the Spanish cohort in routine clinical practice, evolocumab therapy provided a reduction in LDL-C levels consistent with that reported in previous clinical trials, which was sustained during 30 months of follow-up. Treatment with evolocumab was started at LDL-C levels 50% higher than those recommended by The Spanish Society of Arteriosclerosis and the Therapeutic Positioning Report. The probability of achieving the 2019 ESC/EAS LDL-C goals would improve with combination therapy and also with a lower LDL-C threshold when starting evolocumab. Persistence to evolocumab remained high during follow-up, with a very low percentage of discontinuation (5% at 12 months; 7% at 30 months).

Nuevos tratamientos en la hipertrigliceridemia y en la hiperquilomicronemia / Novel therapeutics in hypertriglyceridaemia and chylomicronaemia

Existen evidencias del papel de la hipertrigliceridemia como factor de riesgo independiente de ateromatosis. Cuando es severa, la hiperquilomicronemia puede asociarse a pancreatitis aguda grave y recurrente. En la mayoría de las hipertrigliceridemias se combina una base predisponente poligénica con diversos factores ambientales u otras patologías precipitantes. Algunas hiperquilomicronemias son formas familiares monogénicas autosómicas recesivas. Una característica de los triglicéridos plasmáticos es la marcada variabilidad y su descenso con ajustes en la dieta y el estilo de vida. Los fármacos disponibles contribuyen también a su control, pero es más controvertida la disminución del riesgo vascular o de pancreatitis. Los avances en el conocimiento del metabolismo lipídico a nivel molecular y en la tecnología farmacológica posibilitan el desarrollo de nuevas estrategias terapéuticas que pueden facilitar el tratamiento de pacientes en los que las medidas convencionales no son efectivas. En algunos casos, el elevado coste podría limitar su acceso y su sostenibilidad

Currently there is evidence on hypertriglyceridaemia as an independent risk factor of atherosclerosis. Chylomicronaemia associated with very high concentration of triglycerides may cause severe and recurrent acute pancreatitis. The cause of most cases is a combination of a polygenetic basis with some lifestyles and pathological conditions. Some rare and familial chylomicronaemias are mendelian diseases with an autosomal recessive pattern. On the other hand, plasma triglycerides have considerable biological variability and usually descend with non-pharmacological interventions alone. In some cases, drugs are also required for their control, but their impact on vascular risk reduction or pancreatitis prevention is more controversial. The recent advances in knowledge of molecular lipid metabolism and pharmacological technologies are resulting in the development of new therapeutic strategies, which can be applied to patients with refractory hypertrigliceridaemia. The challenge may be how the health systems can cover its high costs

Novel therapeutics in hypertriglyceridaemia and chylomicronaemia. / Nuevos tratamientos en la hipertrigliceridemia y en la hiperquilomicronemia.

Currently there is evidence on hypertriglyceridaemia as an independent risk factor of atherosclerosis. Chylomicronaemia associated with very high concentration of triglycerides may cause severe and recurrent acute pancreatitis. The cause of most cases is a combination of a polygenetic basis with some lifestyles and pathological conditions. Some rare and familial chylomicronaemias are mendelian diseases with an autosomal recessive pattern. On the other hand, plasma triglycerides have considerable biological variability and usually descend with non-pharmacological interventions alone. In some cases, drugs are also required for their control, but their impact on vascular risk reduction or pancreatitis prevention is more controversial. The recent advances in knowledge of molecular lipid metabolism and pharmacological technologies are resulting in the development of new therapeutic strategies, which can be applied to patients with refractory hypertrigliceridaemia. The challenge may be how the health systems can cover its high costs.

Primary constitutional MLH1 epimutations: a focal epigenetic event.

BACKGROUND: Constitutional MLH1 epimutations are characterised by monoallelic methylation of the MLH1 promoter throughout normal tissues, accompanied by allele-specific silencing. The mechanism underlying primary MLH1 epimutations is currently unknown. The aim of this study was to perform an in-depth characterisation of constitutional MLH1 epimutations targeting the aberrantly methylated region around MLH1 and other genomic loci. METHODS: Twelve MLH1 epimutation carriers, 61 Lynch syndrome patients, and 41 healthy controls, were analysed by Infinium 450 K array. Targeted molecular techniques were used to characterise the MLH1 epimutation carriers and their inheritance pattern. RESULTS: No nucleotide or structural variants were identified in-cis on the epimutated allele in 10 carriers, in which inter-generational methylation erasure was demonstrated in two, suggesting primary type of epimutation. CNVs outside the MLH1 locus were found in two cases. EPM2AIP1-MLH1 CpG island was identified as the sole differentially methylated region in MLH1 epimutation carriers compared to controls. CONCLUSION: Primary constitutional MLH1 epimutations arise as a focal epigenetic event at the EPM2AIP1-MLH1 CpG island in the absence of cis-acting genetic variants. Further molecular characterisation is needed to elucidate the mechanistic basis of MLH1 epimutations and their heritability/reversibility.

Hereditary apolipoprotein AI-associated renal amyloidosis: A diagnostic challenge.

Hereditary renal amyloidosis is an autosomal dominant condition with considerable overlap with other amyloidosis types. Differential diagnosis is complicated, but is relevant for prognosis and treatment. We describe a patient with nephrotic syndrome and progressive renal failure, who had a mother with renal amiloidosis. Renal biopsy revealed amyloid deposits in glomerular space, with absence of light chains and protein AA. We suspected amyloidosis with fibrinogen A alpha chain deposits, which is the most frequent cause of hereditary amyloidosis in Europe, with a glomerular preferential affectation. However, the genetic study showed a novel mutation in apolipoprotein AI. On reviewing the biopsy of the patient's mother similar glomerular deposits were found, but there were significant deposits in the renal medulla as well, which is typical in APO AI amyloidosis. The diagnosis was confirmed by immunohistochemistry. Apo AI amyloidosis is characterized by slowly progressive renal disease and end-stage renal disease occurs aproximately 3 to 15 years from initial diagnosis. Renal transplantation offers an acceptable graft survival and in these patients with hepatorenal involvement simultaneous liver and kidney transplantation could be considered.

Amiloidosis renal hereditaria por depósito de apolipoproteína AI: un reto diagnóstico / Hereditary apolipoprotein AI-associated renal amyloidosis: A diagnostic challenge

La amiloidoisis renal hereditaria es un trastorno autosómico dominante cuya clínica se solapa con la de otros tipos de amiloidoisis. Hacer un adecuado diagnóstico diferencial puede ser difícil, pero tiene una gran relevancia respecto al pronóstico y tratamiento, que difiere según sea el origen de la enfermedad. Presentamos el caso clínico de un paciente con síndrome nefrótico e insuficiencia renal progresiva, con antecedente familiar de madre con amiloidosis renal. En la biopsia renal se observó depósito de amiloide a nivel glomerular, con negatividad para cadenas ligeras y proteína AA. La sospecha clínica inicial fue la de amiloidosis por depósito de cadena A alfa de fibrinógeno, que es la causa más frecuente de amiloidosis hereditaria en Europa, con afectación preferentemente glomerular. Sin embargo, el estudio genético determinó una nueva mutación previamente no descrita de la Apolipoproteina AI (APO AI). En la biopsia de la madre se detectó depósito glomerular, pero también depósito masivo en médula, lo que caracteriza a la amiloidosis por depósito de APO AI. El diagnóstico se confirmó mediante inmunohistoquímica. La amiloidosis por depósito de Apo AI progresa a enfermedad renal crónica terminal en el plazo de de 3 a 15 años. Se diferencia clínicamente de la amiloidosis AL por su menor afectación extrarrenal y su mejor pronóstico. El trasplante renal ofrece una supervivencia del injerto aceptable y el trasplante hepato-renal se podría tener en cuenta en pacientes con disfunción significativa de ambos órganos (AU)

Hereditary renal amyloidosis is an autosomal dominant condition with considerable overlap with other amyloidosis types. Differential diagnosis is complicated, but is relevant for prognosis and treatment. We describe a patient with nephrotic syndrome and progressive renal failure, who had a mother with renal amiloidosis. Renal biopsy revealed amyloid deposits in glomerular space, with absence of light chains and protein AA. We suspected amyloidosis with fibrinogen A alpha chain deposits, which is the most frequent cause of hereditary amyloidosis in Europe, with a glomerular preferential affectation. However, the genetic study showed a novel mutation in apolipoprotein AI. On reviewing the biopsy of the patient's mother similar glomerular deposits were found, but there were significant deposits in the renal medulla as well, which is typical in APO AI amyloidosis. The diagnosis was confirmed by immunohistochemistry. Apo AI amyloidosis is characterized by slowly progressive renal disease and end-stage renal disease occurs aproximately 3 to 15 years from initial diagnosis. Renal transplantation offers an acceptable graft survival and in these patients with hepatorenal involvement simultaneous liver and kidney transplantation could be considered (AU)

[Therapeutic strategies. Evolution and current status of the European Guidelines on Cardiovascular disease prevention]. / Estrategias terapéuticas. Evolución y estado actual de las Guías Europeas de Prevención Cardiovascular.

The European Guidelines on Dyslipidaemias (2011) and Cardiovascular Prevention (2012) have incorporated important changes. Firstly, it highlights the identification of a group of "very high risk" patients: patients with atherosclerotic disease in any vascular area, diabetes with associated risk factors, advanced chronic renal failure, or a SCORE estimate >10%. Patients with diabetes and no other risk factors, moderate renal failure, severe hypertension, genetic dyslipidaemias, or a SCORE estimate 5-10%, are considered as "high risk". The HDL cholesterol and triglycerides levels are considered as modulators of risks, but not therapeutic objectives per se. The therapeutic objectives are set at LDL cholesterol levels < 70 mg/dl (or at least a reduction of at least 50%) for patients at very high risk, and an LDL < 100 mg/dl for high risk patients. As well as the changes in lifestyle, pharmacological treatment with statins is the focal point of lipid lowering treatments. Other pharmacological options may be considered if the treatment with the maximum tolerable doses of statins do not achieve the therapeutic objectives.

Estrategias terapéuticas. Evolución y estado actual de las Guías Europeas de Prevención Cardiovascular / No disponible

Las Guias Europeas sobre Dislipemias (2011) y Prevención Cardiovascular (2012) han incorporado importantes modificaciones. En primer lugar destaca la identificación de un grupo de pacientes de muy alto riesgo vascular: pacientes con enfermedad aterosclerosa de cualquier territorio vascular, diabetes con factores de riesgo asociados, insuficiencia renal crónica avanzada o estimación SCORE >10%. Se consideran de ‘alto riesgo’ los pacientes con diabetes sin otros factores de riesgo, insuficiencia renal moderada, hipertensión severa, dislipemias genéticas o estimación SCORE 5-10%. Los niveles de colesterol HDL y triglicéridos se consideran como moduladores de riesgo, pero no objetivos terapéuticos per se. Los objetivos terapéutico se cifran en niveles de colesterol LDL < 70 mg/dl (o al menos una reducción de al menos el 50%) para pacientes de muy alto riesgo y LDL < 100 mg/dl para pacientes de alto riesgo. Además de las modificaciones de los estilos de vida, el tratamiento farmacológico con estatinas son el eje del tratamiento hipolipemiante. Otras opciones farmacológicas pueden ser consideradas si el tratamiento con las dosis máximas de estatinas tolerable no alcanza los objetivos terapéuticos (AU)

The European Guidelines on Dyslipidaemias (2011) and Cardiovascular Prevention (2012) have incorporated important changes. Firstly, it highlights the identification of a group of “very high risk” patients: patients with atherosclerotic disease in any vascular area, diabetes with associated risk factors, advanced chronic renal failure, or a SCORE estimate >10%. Patients with diabetes and no other risk factors, moderate renal failure, severe hypertension, genetic dyslipidaemias, or a SCORE estimate 5-10%, are considered as “high risk”. The HDL cholesterol and triglycerides levels are considered as modulators of risks, but not therapeutic objectives per se. The therapeutic objectives are set at LDL cholesterol levels < 70 mg/dl (or at least a reduction of at least 50%) for patients at very high risk, and an LDL < 100 mg/dl for high risk patients. As well as the changes in lifestyle, pharmacological treatment with statins is the focal point of lipid lowering treatments. Other pharmacological options may be considered if the treatment with the maximum tolerable doses of statins do not achieve the therapeutic objectives (AU)

Utilidad de la Genética Clínica en la práctica médica / Usefulness of Clinical Genetics in medical practice

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[Determinants of carotid subclinical atherosclerosis in patients with rheumatoid arthritis. A case-control study]. / Determinantes de la arteriosclerosis subclínica carotídea en pacientes con artritis reumatoide. Estudio de casos y controles.

BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which seems related to systemic inflammation. Our aim was to quantify carotid atherosclerosis in RA and its relationship with the disease. PATIENTS AND METHOD: 73 RA patients and the same number of sex and age matched controls were enrolled, without history of cardiovascular events. Carotid intima-media thickness (IMT) and plaques were measured by ultrasonography. Its relationship with risk factors (RF), rheumatic disease characteristics, and inflammatory markers were analysed. RESULTS: Controls showed higher body mass index (BMI) and dyslipidemia. There were no differences in other risk factors or IMT. Age (p = 0.001), sex (p = 0.02), BMI (p = 0.002), waist perimeter (p = 0.001), and hypertension (p = 0.005) had a relationship with IMT. Among disease characteristics, only time elapsed since RA diagnosis was associated with IMT. CONCLUSIONS: There was not an increased carotid subclinical atherosclerosis in patients with RA, beyond the effects of classical RF.

Significado de la resistencia a la insulina en la enfermedad vascular asociada a la artritis reumatoide / Significance of the insulin resistance in vascular disease associated to rheumatoid arthritis

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Determinantes de la arteriosclerosis subclínica carotídea en pacientes con artritis reumatoide. Estudio de casos y controles / Determinants of carotid subclinical atherosclerosis in patients with rheumatoid arthritis. A case-control study

Fundamento y objetivo: En la artritis reumatoide (AR) hay un aumento de la morbimortalidad cardiovascular. Nuestro objetivo fue cuantificar la arteriosclerosis subclínica carotídea en pacientes con AR y su relación con la enfermedad. Pacientes y método: En 73 pacientes con AR y 73 controles, emparejados por edad y sexo, sin enfermedad vascular, se midió el grosor íntima-media (GIM) carotídeo y la presencia de placas mediante ecografía. Se analizó su relación con los factores de riesgo vascular (FRV), las características de la enfermedad y los parámetros inflamatorios. Resultados: Los controles presentaban mayor índice de masa corporal (IMC) y dislipemia, sin diferencias significativas entre ambos grupos en el resto de los FRV o en los valores del GIM. La edad (p = 0,001), el sexo (p = 0,02), el IMC (p = 0,002), el perímetro abdominal (p = 0,001) y la hipertensión arterial (p = 0,005) se relacionaron con el GIM. El tiempo desde el diagnóstico fue la única característica de la AR que se relacionó con el GIM. Conclusiones: No se ha encontrado un incremento de ateromatosis carotídea en pacientes con AR más allá del efecto atribuible a los FRV clásicos

Background and objective: Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which seems related to systemic inflammation. Our aim was to quantify carotid atherosclerosis in RA and its relationship with the disease. Patients and method: 73 RA patients and the same number of sex and age matched controls were enrolled, without history of cardiovascular events. Carotid intima-media thickness (IMT) and plaques were measured by ultrasonography. Its relationship with risk factors (RF), rheumatic disease characteristics, and inflammatory markers were analysed. Results: Controls showed higher body mass index (BMI) and dyslipidemia. There were no differences in other risk factors or IMT. Age (p = 0.001), sex (p = 0.02), BMI (p = 0.002), waist perimeter (p = 0.001), and hypertension (p = 0.005) had a relationship with IMT. Among disease characteristics, only time elapsed since RA diagnosis was associated with IMT. Conclusions: There was not an increased carotid subclinical atherosclerosis in patients with RA, beyond the effects of classical RF

Relación del perfil lipoproteico en sangre de cordón con las variables obstétricas y antropométricas en los recién nacidos. Diferencias en función del sexo / Relationship between lipoprotein profile in cord blood with obstetric variables and anthropometry in newborns. Differences related with sex

Introducción. El bajo peso al nacer se ha reconocido como un nuevo factor de riesgo cardiovascular. La razón parece ser una resistencia a la insulina de origen genético o por nutrición insuficiente durante el desarrollo intrauterino. No se conoce la importancia que pueden tener en esta situación las alteraciones del metabolismo lipídico. Pacientes y método. Estudio prospectivo de una cohorte consecutiva de 265 niños recién nacidos a término de embarazos no gemelares. Se recogieron los datos sobre la edad materna, las semanas de gestación, el tipo de parto, la puntuación en el test de Apgar y las variables antropométricas (circunferencia cefálica, talla, peso e índice ponderal [kg/m3]). Además, en todos ellos se analizó sangre del cordón para determinar las concentraciones de colesterol total, colesterol unido a lipoproteínas de baja densidad (cLDL) y lipoproteínas de alta densidad (cHDL), triglicéridos y apolipoproteínas (apo) A-1 y B. Se investigaron las posibles asociaciones y correlaciones entre los parámetros lipídicos y las variables obstétricas y antropométricas del recién nacido, así como la influencia del sexo. Resultados. Los parámetros antropométricos estuvieron muy correlacionados entre sí y con las semanas de gestación. No hubo diferencias relevantes de éstos entre ambos sexos, salvo en la circunferencia cefálica. Las niñas presentaron concentraciones medias significativamente más altas que los niños de colesterol total (68,7 frente a 62,2 mg/dl), HDL (23,4 frente a 21,2), LDL (37,3 frente a 32,9), apo A-1 (70,7 frente a 66,5) y apo B (30,8 frente a 28,4). Los valores de los triglicéridos fueron similares (40,1 frente a 40,7). Se observaron correlaciones elevadas y significativas entre las distintas fracciones lipídicas y con las apoproteínas. Sin embargo, sólo se observó una correlación ligera entre la edad gestacional y los triglicéridos (rho = 0,27) y del peso de las niñas con su HDL (rho = 0,26). No hubo diferencias lipídicas relevantes entre los recién nacidos con índice ponderal bajo o normal. Conclusiones. Las diferencias en el perfil lipídico de los recién nacidos dependen más de su sexo que de factores relacionados con el desarrollo fetal. La posible dislipemia asociada al peso bajo al nacer sería un factor aterogénico de aparición posterior (AU)

Introduction. Low birth weight has been recognized as a new risk factor for the development of cardiovascular disease in adulthood. Possible causes are insulin resistance of genetic origin or adaptation to poor fetal nutrition during intrauterine growth. The importance of lipid metabolism at birth is unknown and data on the relationship between birth weight and later lipid profile are contradictory. Patients and method. We performed a prospective study of a consecutive cohort of 265 full term newborns from single pregnancies. Data on maternal age, weeks of gestation, route of delivery, Apgar test, and anthropometric measures [head circumference, height, weight and ponderal index (kg/m3)] were gathered. In addition, a cord blood sample was analyzed to determine concentrations of total cholesterol, low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol, triglycerides, and apolipoproteins A-1 and B. The possible relationship between lipid parameters and obstetric and anthropometric variables in newborns, as well as the influence of sex, were investigated. Results. Anthropometric measures were highly interrelated and were also correlated with gestational weeks, but no differences were found between the sexes, with the exception of head circumference. Girls showed a higher average concentration than boys of total cholesterol (68.7 vs. 62.2 mg/dl), HDL-cholesterol (23.4 vs. 21.2), LDL-cholesterol (37.3 vs. 32.9), apolipoprotein A1 (70.7 vs. 66.5), and apolipoprotein B (30.8 vs. 28.4). Triglyceride levels were similar (40.1 vs. 40.7) between girls and boys. Significant and elevated correlations among lipid values were observed. However, there was only a weak correlation between gestational age and triglyceride values (rho=0.27) and between birth weight in girls and HDL (rho=0.26). No lipid differences were found between newborns with low or normal ponderal index. Conclusions. Lipid profile in newborns is more closely related to sex than to fetal growth. Any possible association of dyslipidemia with low birth weight would appear later in life (AU)

Changes in lipid profile after biliopancreatic diversion.

BACKGROUND: Bariatric operations have varying degrees of effectiveness and different mechanisms of action. Our objective was to evaluate the efficacy of the biliopancreatic diversion (BPD) in reduction of weight and serum lipids. METHODS: A prospective study was conducted with follow-up from 12 to 72 months (average 39.4 months) of 58 patients with morbid obesity (10 men, 48 women, mean BMI 49.4 kg/m2). Their lipid levels were generally normal or slightly high. All the patients were subjected to subtotal gastrectomy and BPD with jejunoileostomy 50 cm proximal to the ileocecal valve, and they were instructed to maintain the same hypocaloric diet as before BPD. Serum lipoproteins and apolipoproteins B and A1 were measured before BPD and every 6 months during follow-up. RESULTS: Early and very significant reduction (P<0.001) of total cholesterol (32.8%), LDL (46.3%), total cholesterol/HDL ratio (29.7%) and apolipoprotein B (37%), with more moderate decrease of triglycerides (21.3%, P=0.004), were observed. This lipid decrease was maximum at 1 year after BPD. Important and persistent weight reduction that did not correlate with changes in lipids was observed. The youngest patients and those with high basal lipid levels proved to benefit most from BPD. There were no important side-effects. CONCLUSION: BPD, with careful selection of patients, is a well tolerated procedure that offers excellent results in the short- and mid-term in reduction in weight and blood levels of most atherogenic lipoproteins.

Hepatotoxicidad por clopidogrel / Clopidogrel-induced hepatoxicity

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