Influence of lipoprotein (a) on inflammatory biomarkers in metabolic syndrome.

OBJECTIVE: To examine the relation between plasma lipoprotein (a) (Lp[a]) levels and oxidative stress biomarkers, serum cytokines, and atherosclerotic burden among individuals recently diagnosed as having metabolic syndrome (MS). METHODS: Eighty-four white patients with MS were classified according to two Lp(a) levels (normal Lp[a]: < 30 mg/dL or high Lp[a]: > 30 mg/dL) and were compared with 42 healthy controls. Oxidative stress biomarkers (oxidized low-density lipoprotein, antibodies to oxidized low-density lipoprotein, and nitric oxide metabolites) and proinflammatory cytokines (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-10, IL-12P70, IL-13, and interferon-γ) were measured in plasma. Atherosclerotic significance was determined using carotid ultrasound and endothelial function by standardized protocols. RESULTS: Patients with MS had higher levels of serum cytokines, oxidative stress markers, and C-reactive protein, and greater atherosclerosis burden as compared with controls. Among the group members, 58 patients had normal Lp(a) levels and 26 had high Lp(a) levels. Cytokines and C-reactive protein levels were significantly higher in patients with high Lp(a) compared with those with normal Lp(a) (P < 0.01 for IL-2 and P < 0.001 for the others). Nitric oxide metabolites were significantly lower in patients with high Lp(a) as compared with those with normal Lp(a) (P < 0.05). No differences were found in oxidized low-density lipoprotein and atherosclerotic burden between the two groups of patients with MS with respect to Lp(a) levels. CONCLUSIONS: Elevated Lp(a) plasma levels are associated with higher proinflammatory markers in patients newly diagnosed as having MS.

Atorvastatina, anticuerpos LDL oxidada y su relación con la edad / Atorvastatin and oxidized low density lipoprotein antibody. Relationship to age

Fundamento y objetivos: En pacientes hipercolesterolémicos, estudiamos las relaciones de los valores plasmáticos de anticuerpos anti lipoproteínas de baja densidad (LDL) oxidadas con diferentes variables de interés cardiovascular y sus cambios tras el tratamiento con atorvastatina. Pacientes y método: En 48 pacientes se determinaron los valores de anticuerpos anti-LDL oxidadas, biomarcadores lipídicos, de estrés oxidativo e inflamatorios, a la entrada del estudio y tras 24 semanas de tratamiento con 20mg de atorvastatina. Resultados: Los valores basales de anticuerpos anti-LDL oxidadas se correlacionaron con la edad (r=0,41, p=0,03), cintura (r=0,38, p=0,04) y la proteína C reactiva ultrasensible (PCRs) (r=0,46, p=0,02), pero no con el resto de variables. El tratamiento con atorvastatina no disminuyó los valores de anticuerpos anti-LDL oxidadas (valor basal medio [intervalo de confianza del 95%] de 413 mUI/ml [187-1196] y a las 24 semanas de 349 mUI/ml [101-1559]). El porcentaje de cambio de anticuerpos anti-LDL oxidadas en la semana 24 se correlacionó negativamente con la edad (r=−0,37, p=0,03), pero no con cambios en el resto de las variables. Conclusiones: En sujetos con hipercolesterolemia, los valores plasmáticos de anticuerpos anti-LDL oxidadas se relacionaron positivamente con la edad, cintura y PCRs. No se observaron cambios de los valores plasmáticos de anticuerpos anti-LDL oxidadas tras el tratamiento con atorvastatina, pero su variación se relacionó con la edad, lo que sugiere que las acciones inmunomoduladoras de las estatinas pueden depender de ésta (AU)

Background and objectives: In hypercholesterolemic patients, we studied the relationships of plasma levels of LDLoxab with cardiovascular variables and its changes after treatment with atorvastatin. Patients and methods: We studied, in 48 patients, the levels of LDLoxab, as well as lipid, oxidative stress and inflammatory biomarkers, at baseline and 24 weeks after treatment with 20mg of atorvastatin. Results: Baseline: a correlation was observed between LDLoxab and age (r= 0.41, P=.03), waist (r=0.38, P=.04) and C reactive protein (r= 0.46, P=.02), but not with other variables. Atorvastatin treatment did not decrease LDLoxab;(mU/mL, median [CI 95%]: baseline: 413 [187-1,196] and 24 weeks: 349 [101-1559]). The percentage change at week 24, was negatively correlated with age (r=−0.37, P=.03) but not with other variables. Conclusion: In hypercholesterolemic subjects plasma LDLoxab levels were positively corelated with age, waist and C reactive protein. There were no changes in plasma levels of LDLoxab after treatment with atorvastatin, but the variation was associated with age, suggesting that the immunomodulatory actions may depend of this (AU)

Efectos de un consejo nutricional simple en pacientes de alto riesgo vascular / Effects of brief nutritional counseling in patients at high risk of cardiovascular events

Objetivos Realizamos un estudio prospectivo aleatorizado en pacientes de alto riesgo vascular para valorar la efectividad de un consejo dietético sobre dieta mediterránea (DiMe) presentado de dos maneras diferentes. Métodos Un total de 188 pacientes se aleatorizaron en 2 grupos. Grupo 1: unas recomendaciones escritas simples (86 pacientes), y grupo 2: las mismas recomendaciones, pero más elaboradas y razonadas (102 pacientes). El seguimiento de DiMe se evaluó por un cuestionario de 14 puntos. Se valoraron factores de riesgo vascular clásicos y la adherencia a DiMe a la entrada del estudio y a las 24 semanas. Resultados Ambos grupos mejoraron la puntuación de adherencia a DiMe (basal versus 24 semanas; media, intervalo de confianza [IC] del 95%): grupo 1: 9,8 (9,4 a 10,2) versus 11,4 (11,1 a 11,7) y grupo 2: 9,6 (9,2 a 9,9) versus 11,5 (11,0 a 11,9); p<0,001 para ambos, sin diferencias entre los grupos. Los grupos alimenticios con más mejoría al final del estudio fueron los cereales integrales y los frutos secos. A las 24 semanas se observó mejoría en los niveles de colesterol HDL en ambos grupos de pacientes (diferencias en mg/dl, IC del 95%): grupo 1: 2,9 (0,01 a 5,8), y grupo 2: 2,3 (0,4 a 4,3), p<0,05, sin diferencias entre los grupos. Otras variables cardiovasculares no se modificaron. Conclusión Unas recomendaciones simples sobre DiMe a pacientes de alto riesgo vascular del ambiente hospitalario puede mejorar el perfil lipídico, y son tan eficaces como una presentación más extensa. Un mayor consumo de cereales integrales y frutos secos podría contribuir a estos beneficios (AU)

Objective: We conducted a prospective randomized trial in patients at high cardiovascular(CV) risk to assess the effectiveness of advice on the Mediterranean diet in reducing this risk,presented in two different ways. Methods: A total of 188 patients were randomly allocated to either group 1 (n=86), who weregiven short dietary advice, or group 2 (n=102), who were given more complex counseling aboutthe Mediterranean diet. Adherence to the Mediterranean diet was evaluated by a 14-item questionnaire. Changes in baseline CV risk factors and dietary adherence rates per self-report wasascertained after 24 weeks. Results: Compliance with the Mediterranean diet improved in both groups. The food questionnaire score [baseline versus 24 weeks: mean, 95% confidence interval (CI)] was as follows: group1: 9.8 (9.4 to 10.2) versus 11.4 (11.1 to 11.7) and group 2: 9.6 (9.2 to 9.9) versus 11.5 (11.0to 11.9), p<0.001, with no differences between the two groups. Compliance was better withwhole-grain cereals and nuts. An increase in high-density lipoprotein (HDL)-cholesterol levelsat the end of the trial was observed in both groups (differences in mg/dl, 95% CI): group 1: 2.9(0.01 to 5.8) and group 2: 2.3 (0.4 to 4.3), p<0.05 for both groups, with no differences. OtherCV risk factors were unmodified. Conclusions: Providing short and simple written advice on the Mediterranean diet in the hospitalsetting to patients with high CV risk improved lipid profiles and was as effective as more detailedadvice. Some of the benefits observed may have been due to greater intake of nuts and wholegrain cereals (AU)

Telmisartan improves insulin resistance in patients with low cytokine levels.

UNLABELLED: Metabolic syndrome (MS) is a disease with an inflammatory component. Telmisartan improves insulin resistance in MS, but its relationship with the inflammatory state is unknown. We investigated the effect of 3-month telmisartan therapy on homeostatic model assessment-insulin resistance (HOMA-IR) in hypertensive subjects with MS with regard to the levels of circulating plasma cytokines. METHODS: A total of 42 patients were included in this study; 30 were men (71%), aged 50 ± 8.2 years (mean ± SD). Cytokines and metabolic parameters were analyzed before and after treatment with telmisartan. RESULTS: Twenty-eight patients showed low plasma levels of cytokines (group 1) similar to control subjects, and 14 showed high levels (group 2). Treatment with telmisartan diminished by 35% HOMA-IR in group 1 (4.5 ± 3.1 vs 2.9 ± 2.1), without improvement in group 2. In the multivariate analysis, the predictors of improvement of HOMA-IR in response to telmisartan treatment were low levels of cytokines, whereas systolic and diastolic blood pressure and the elevation of high-sensitivity C-reactive protein had a negative effect. CONCLUSIONS: Our study provides evidence of a more favorable effect of telmisartan on glucose homeostasis in patients with MS and low levels of serum cytokines.

[Atorvastatin and oxidized low density lipoprotein antibody. Relationship to age]. / Atorvastatina, anticuerpos LDL oxidada y su relación con la edad.

BACKGROUND AND OBJECTIVES: In hypercholesterolemic patients, we studied the relationships of plasma levels of LDLoxab with cardiovascular variables and its changes after treatment with atorvastatin. PATIENTS AND METHODS: We studied, in 48 patients, the levels of LDLoxab, as well as lipid, oxidative stress and inflammatory biomarkers, at baseline and 24 weeks after treatment with 20mg of atorvastatin. RESULTS: Baseline: a correlation was observed between LDLoxab and age (r= 0.41, P=.03), waist (r=0.38, P=.04) and C reactive protein (r= 0.46, P=.02), but not with other variables. Atorvastatin treatment did not decrease LDLoxab;(mU/mL, median [CI 95%]: baseline: 413 [187-1,196] and 24 weeks: 349 [101-1559]). The percentage change at week 24, was negatively correlated with age (r=-0.37, P=.03) but not with other variables. CONCLUSION: In hypercholesterolemic subjects plasma LDLoxab levels were positively corelated with age, waist and C reactive protein. There were no changes in plasma levels of LDLoxab after treatment with atorvastatin, but the variation was associated with age, suggesting that the immunomodulatory actions may depend of this.

Cirurgia da obesidade mórbida por videolaparoscopia / Videolaparoscopy surgery in morbid obesity

BACKGROUND: Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Laparoscopic techniques have been reported, but refer longer operative time and seemingly higher initial complication rates as compared to the open procedure. The minimally invasive aproach continues to be a challenge even to the most experienced laparoscopic surgeons. The purpose of this paper is to describe our experience with the laparoscopic Roux-en-Y gastric bypass (LRYG), using a gastric pouch to jejunal anastomosis with a EEA stapler. METHOD: From September 1999 to May 2001, 102 patients were submitted to LRYG, using a gastric pouch jejuno anastomosis with a EEA stapler. Jejuno-jejunal anastomosis was carryed on at a distance of 100cm to 150cm according to the body mass index (BMI). A prospective analysis was undertaken to identify technical success, leak rate and postoperative incidence of anastomotic stenosis and its management, in a consecutive series of patients undergoing LRYG, with gastrojejunal anastomosis performed with a 25mm or 28mm stapler. In the last 10 cases this anastomosis was carryed on by hand suture. RESULTS: Mean age was 37,5 years (range 17-62) and mean BMI was 50,3kg/m² (range 35-78). The mean operative time was 119min. (55-210). The mean postoperative hospital stay was 4,3 days (2-10). Two super obese patients were converted to an open precedure for technical difficulties. Two patients died (1,9 percent) both from pulmonary embolism. There was 1 leak (0,9 percent) from the gastrojejunal anastomosis managed without operation. Fifteen patients (14,7 percent) developed anastomotic stenosis, that required endoscopic baloon dilatation. Nine of them required only a single dilatation and had no recurrence of dysphagia. Six needed 2 to 4 dilatations and all of them are swallowing normaly. In twenty patients, after 12 months of follow-up, the mean decrease in BMI was 21,1kg/m². CONCLUSIONS: LRYG with the stapled EEA gastrojejunal...

OBJETIVO: Demonstrar nossa experiência com a gastroplastia em Y de Roux por videolaparoscopia (GYRL), usando pequena bolsa gástrica e anastomose jejunal com grampeador circular. A gastroplastia com desvio em Y de Roux é uma das operações mais comuns para o tratamento da obesidade mórbida. Técnicas por laparoscopia têm sido relatadas, mas descrevem maior tempo operatório e maiores complicações quando comparadas com a cirurgia aberta. A abordagem por videocirurgia continua a ser um desafio mesmo para os cirurgiões mais experientes. MÉTODO: De setembro de 1999 a maio de 2001, 102 pacientes foram submetidos à gastroplastia em Y de Roux. A anastomose jejuno-jejunal foi feita a uma distância de 100cm a 150cm de acordo com o índice de massa corporal (IMC). Uma análise prospectiva identificou o índice de fístula e de estenose pós-operatória e a conduta em uma série consecutiva de pacientes, submetidos a GYRL com anastomose gastrojejunal realizada com grampeador circular 25mm ou 28mm. Nos últimos dez casos esta anastomose foi executada com sutura manual. RESULTADOS:. A média etária foi de 37,5 anos (17-62) e a média de IMC foi de 50,3kg/m² (35-78). O tempo operatório variou de 55min a 210min com média de 119min. O tempo médio de internação foi 4,3 dias (2-10). Dois pacientes superobesos tiveram a cirurgia convertida para o procedimento aberto por dificuldades técnicas. Houve dois óbitos (1,9 por cento), ambos por embolia pulmonar. Houve uma fístula (0,9 por cento) da anastomose gastrojejunal tratada conservadoramente. Quinze pacientes (14,7 por cento), desenvolveram estenose na anastomose e necessitaram de dilatação endoscópica. Nove pacientes sofreram uma única dilatação e seis receberam duas a quatro dilatações e permaneceram sem disfagia. Vinte pacientes foram avaliados após um ano e mostraram uma média de IMC 33,4kg/m² (24-44). CONCLUSÃO: A GYRL com anastomose gastrojejunal com grampeador é segura e efetiva. Ocorreram estenoses que foram tratadas...