Overweight, Obesity, and Age Are the Main Determinants of Cardiovascular Risk Aggregation in the Current Mexican Population: The FRIMEX III Study.

Background: The Mexican population exhibits several cardiovascular risk factors (CVRF) including high blood pressure (HBP), dysglycemia, dyslipidemia, overweight, and obesity. This study is an extensive observation of the most important CVFRs in six of the most populated cities in Mexico. Methods: In a cohort of 297,370 participants (54% female, mean age 43 ± 12.6 years), anthropometric (body mass index (BMI)), metabolic (glycemia and total cholesterol (TC)), and blood pressure (BP) data were obtained. Results: From age 40, 40% and 30% of the cohort's participants were overweight or obese, respectively. HBP was found in 27% of participants. However, only 8% of all hypertensive patients were controlled. Fifty percent of the subjects 50 years and older were hypercholesterolemic. Glycemia had a constant linear relation with age. BMI had a linear correlation with SBP, glycemia, and TC, with elevated coefficients in all cases and genders. The ß1 coefficient for BMI was more significant in all equations than the other ß, indicating that it greatly influences the other CVRFs. Conclusions: TC, glycemia, and SBP, the most critical atherogenic factors, are directly related to BMI.

The TG/HDL-c Lipid Ratio as a Cardiovascular Risk Marker in a Mexican Urban Middle-Class Population: Do We Need a Risk Score Tailored for Mexicans?

INTRODUCTION: Risk scores are essential in primary prevention to detect high-risk patients. The most common scores exclude hypertriglyceridemia and abdominal obesity in their risk assessment. We examined the triglyceride/HDL-cholesterol (TG/HDL-c) ratio as a cardiovascular (CV) risk marker in a middle-class urban Mexican population sample. AIM: Our aim was to test the concept of a scoring system reflecting Mexican population characteristics. METHODS: A total of 2602 healthy adults from the Lindavista primary prevention program were considered, evaluating gender, age, blood pressure, smoking, body mass index, waist circumference, lipid profile, and fasting glucose. According to the abnormality, a score from -3 to +3 was assigned. RESULTS: The summation of eleven variables yielded the Lindavista score (LS), which was calibrated versus the TG/HDL ratio and ACC ASCVD Risk Estimator Plus score to determine its correlation with risk categories. The TG/HDL-c ratio had a linear correlation with LS and high-risk ACC ASCVD categories. CONCLUSIONS: Compared with LS and TG/HDL-c, the ACC ASCVD system underestimates the high-risk category. The high prevalence of obesity and lipid triad in the Mexican population requires a scale that considers those traits. The TG/HDL-c ratio is a practical, easy, and economical instrument to categorize risk in Mexicans.

Is Local Nitric Oxide Availability Responsible for Myocardial Salvage after Remote Preconditioning? / A Disponibilidade de Óxido Nítrico Local é Responsável por Resgate Miocárdio após Pré-Condicionamento Remoto?

Abstract Background: Remote ischemic preconditioning (RIPC) represents an attractive therapy for myocardial protection, particularly when ischemic events can be anticipated. Although several hypothetic mechanisms have been proposed, no definite molecular pathways have been elucidated. Objective: We evaluated the effect of brachial circulation cuff occlusion on myocardial ischemic tolerance, necrosis, and nitric oxide (NO) in patients with ischemic heart disease undergoing elective percutaneous coronary interventions (PCI). Methods: 46 patients were randomly allocated into two groups: control and RIPC before PCI procedures. Electrocardiographic analysis, serum concentrations of troponin I (cTn-I) were measured at baseline and 24 hours after PCI. A blood sample from the atherosclerotic plaque was drawn to determine nitrate and nitrites. Results: RIPC increased the availability of NO in the stented coronary artery. Control patients presented a small but significant increase in cTn-I, whilst it remained unchanged in preconditioned group. The preconditioning maneuver not only preserved but also enhanced the sum of R waves. Conclusions: RIPC induced an intracoronary increase of NO levels associated with a decrease in myocardial damage (measured as no increase in cTn-I) with electrocardiographic increases in the sum of R waves, suggesting an improved myocardium after elective PCI.

Resumo Fundamento: Pré-condicionamento isquêmico remoto (PCIR) é uma terapia para proteção miocárdica, em particular quando é possível prever eventos isquêmicos. Embora vários mecanismos hipotéticos tenham sido propostos, nenhuma via molecular definitiva foi elucidada. Objetivo: Avaliar o efeito da oclusão da circulação braquial com manguito sobre a tolerância à isquemia miocárdica, a necrose miocárdica e a biodisponibilidade de óxido nítrico (NO) em pacientes com cardiopatia isquêmica submetidos a intervenção coronariana percutânea (ICP) eletiva. Métodos: 46 pacientes foram alocados aleatoriamente em dois grupos: controle e PCIR antes da ICP. Análise eletrocardiográfica e medidas da concentração sérica de troponina I (cTn-I) foram realizadas na condição basal e 24 horas após ICP. Coletou-se amostra de sangue da placa aterosclerótica para determinar os níveis de nitratos e nitritos. Resultados: O PCIR aumentou a disponibilidade de NO na artéria coronária que recebeu o stent. O grupo controle apresentou um aumento pequeno, mas significativo, da cTn-I, que permaneceu inalterada no grupo pré-condicionado. O pré-condicionamento não só preservou, como melhorou o somatório de ondas R no eletrocardiograma. Conclusões: O PCIR induziu aumento intracoronariano dos níveis de NO associado com redução do dano miocárdico (medido como aumento da cTn-I) e com aumento do somatório de ondas R, sugerindo melhora miocárdica após ICP eletiva.

Is Local Nitric Oxide Availability Responsible for Myocardial Salvage after Remote Preconditioning?

BACKGROUND: Remote ischemic preconditioning (RIPC) represents an attractive therapy for myocardial protection, particularly when ischemic events can be anticipated. Although several hypothetic mechanisms have been proposed, no definite molecular pathways have been elucidated. OBJECTIVE: We evaluated the effect of brachial circulation cuff occlusion on myocardial ischemic tolerance, necrosis, and nitric oxide (NO) in patients with ischemic heart disease undergoing elective percutaneous coronary interventions (PCI). METHODS: 46 patients were randomly allocated into two groups: control and RIPC before PCI procedures. Electrocardiographic analysis, serum concentrations of troponin I (cTn-I) were measured at baseline and 24 hours after PCI. A blood sample from the atherosclerotic plaque was drawn to determine nitrate and nitrites. RESULTS: RIPC increased the availability of NO in the stented coronary artery. Control patients presented a small but significant increase in cTn-I, whilst it remained unchanged in preconditioned group. The preconditioning maneuver not only preserved but also enhanced the sum of R waves. CONCLUSIONS: RIPC induced an intracoronary increase of NO levels associated with a decrease in myocardial damage (measured as no increase in cTn-I) with electrocardiographic increases in the sum of R waves, suggesting an improved myocardium after elective PCI.

Metformin enhances left ventricular function in patients with metabolic syndrome / La metformina mejora la función ventricular izquierda en pacientes con síndrome metabólico

Background: Metabolic syndrome foretells several cardiovascular complications, including heart failure (HF). Left ventricular (LV) dysfunction accompanies the MS. Although metformin improves LV function in diabetics with HF, there is no evidence of its effect on LV dysfunction in MS patients. We studied the effect of metformin on LV dysfunction in MS patients using tissue Doppler myocardial imaging and two-dimensional speckle tracking. Aims: To evaluate the effects of metformin on metabolic syndrome (MS) induced left ventricular dysfunction. Material and methods: Patients with MS were randomly allocated into two groups (n = 20 each) receiving, an antagonist of angiotensin 2 receptors and; statins, fibrates or both. One group received 850 mg of metformin daily. LV mass, relative wall thickness (RWT), ejection fraction, E/A and E/E' relationship, systolic tissue Doppler velocity (Sm), mean peak systolic strain (SS), and peak early diastolic strain rate (SR-LVe) echocardiographic measurements, at baseline and six months were obtained. Results: All patients had LH concentric hypertrophy or remodeling. Metformin reduced LV mass and RWT. There were LV systolic and diastolic alterations in both groups that metformin improved significantly. SR-LVe increased nearly 2-fold with metformin. Diastolic function improvement was not related to regression of hypertrophy. Conclusions: Patients with MS experienced subtle alterations of systolic and diastolic functions, which improved significantly with a small dosage of metformin over a treatment period of six months.

Antecedentes: El síndrome metabólico (SM) predice varias complicaciones cardiovasculares, como la insuficiencia cardiaca (IC). La disfunción ventricular izquierda (DVI) acompaña al síndrome metabólico. Aunque la metformina mejora la función del ventrículo izquierdo en pacientes diabéticos con insuficiencia cardiaca, no hay evidencia de su efecto sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico. Se estudió el efecto de la metformina sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico utilizando imágenes Doppler de tejido miocárdico y rastreo de manchas bidimensional. Objetivos: Evaluar los efectos de la metformina sobre la disfunción ventricular izquierda inducida por el SM. Material y métodos: Los pacientes con SM fueron asignados al azar en dos grupos (n = 20 cada uno) que recibieron, un antagonista de la angiotensina 2 y receptores; estatinas, fibratos o ambos. Un grupo recibió 850 mg de metformina diaria. La masa del VI, el espesor relativo de la pared (ERP), fracción de eyección, E/A y relación E/E', la velocidad Doppler tisular sistólica (Sm), el promedio de pico de tensión sistólica (SS), y la velocidad de deformación diastólica precoz pico (VDDPP) se obtuvieron por mediciones ecocardiográficas al inicio del estudio y a los seis meses. Resultados: Todos los pacientes presentaban hipertrofia concéntrica o remodelado. La metformina reduce la masa del VI y el ERP. Había alteraciones del ventrículo izquierdo sistólica y diastólica, alteraciones en ambos grupos que la metformina mejoró significativamente. VDDPP aumentó casi al doble con metformina. La mejoría de la función diastólica no se relacionó con regresión de la hipertrofia. Conclusiones: Los pacientes con SM experimentaron alteraciones sutiles de las funciones sistólica y diastólica, lo que mejoró significativamente con una pequeña dosis de metformina en un periodo de tratamiento de seis meses.

OBESITY PHENOTYPES IN URBAN MIDDLE-CLASS COHORTS; THE PRIT-LINDAVISTA MERGING EVIDENCE IN MEXICO: THE OPUS PRIME STUDY.

BACKGROUND AND AIMS: even though overweight and obesity (O/O) are stated diseases, there is still a claim for a so-called "healthy obese" phenotype. Only few reports have explored the presence of different metabolic phenotypes along the body mass index (BMI) range and their corresponding associations to cardiovascular risks. METHODS: as of BMI, and according to the presence of metabolic syndrome (MS) features (waist circumference, blood pressure, fasting glycemia, and lipid profile), phenotypes were determined. Cardiovascular risk was estimated with atherogenic quotients: total cholesterol/ HDL-c, LDL-c/HDL-c and the triglycerides (TG)/HDL-c index. RESULTS: in 8 405 mexican adults, 36% lean, 43% overweighed and 21% obese, nine phenotypes were identified: for each weight category there were subjects with normal metabolism (none MS factors), intermediate (≤ 2) and dysmetabolic (≥ 3). Only 10.8% of O/O had normal metabolism, and 5.8% of the lean persons were dysmetabolic. Atherogenic risk was higher in dysmetabolic obese persons, but the risk was high among all dysmetabolic people, independently of the weight status. TG/HDL-c showed the same trend. CONCLUSIONS: elevated cardiometabolic risk derives from the high prevalence of O/O. A great proportion of non-obese people have intermediate dysmetabolism. A genetic predisposition to obesity, insulin resistance, diabetes and dyslipidemia in Mexican population is blended to an unhealthy lifestyle, yielding to a catastrophic epidemic of diabetes, and cardiovascular diseases.

Antecedentes y metas: aun cuando el sobrepeso y la obesidad (S/O) son enfermedades reconocidas, hay un reclamo por la existencia de un fenotipo llamado "obeso sano". Pocos estudios han explorado la presencia de diferentes fenotipos metabólicos en los rangos del índice de masa corporal (IMC) y su asociación con riesgo cardiovascular. Métodos: se determinaron fenotipos de acuerdo al IMC y a la presencia de marcadores del síndrome metabólico (SM) (circunferencia abdominal, presión sanguínea, glucemia en ayunas y perfil de lípidos). El riesgo cardiovascular fue estimado con los índices aterogénicos: colesterol total/HDL-c, LDL-c/HDL-c y triglicéridos(TG)/HDL-c. Resultados: en 8.405 adultos mexicanos, 36% delgados, 43% con sobrepeso y 21% obesos, se identificaron 9 fenotipos. Por cada categoría de peso se encontraron sujetos con metabolismo normal (ningún factor de SM), intermedios (≤ 2) y dismetabólicos (≥ 3). Solo el 10.8% de los sujetos con S/O tuvieron metabolismo normal y el 5.8% de los sujetos delgados fueron dismetabólicos. El riesgo aterogénico fue mayor en los sujetos obesos dismetabólicos. El riesgo fue alto entre todos los sujetos dismetabólicos independientemente del peso. El índice TG/ HDL-c mostró las mismas tendencias. Conclusiones: el riesgo cardiometabólico incrementado deriva de la alta prevalencia de S/O. Una gran proporción de sujetos no obesos tiene dismetabolismo intermedio. Una predisposición genética a la obesidad, la resistencia a la insulina, la diabetes y la dislipidémia en la población mexicana, junto con un estilo de vida no saludable da como consecuencia una epidemia catastrófica de diabetes y enfermedades cardiovasculares.

Obesity phenotypes in urban middle-class cohorts; the PRIT-Lindavista merging evidence in Mexico: the OPUS PRIME study / Fenotipos de obesidad en cohortes urbanas de clase media; evidencia conjunta prit-lindavista en México: el estudio Opus Prime

Background and aims: even though overweight and obesity (O/O) are stated diseases, there is still a claim for a so-called 'healthy obese' phenotype. Only few reports have explored the presence of different metabolic phenotypes along the body mass index (BMI) range and their corresponding associations to cardiovascular risks. Methods: as of BMI, and according to the presence of metabolic syndrome (MS) features (waist circumference, blood pressure, fasting glycemia, and lipid profile), phenotypes were determined. Cardiovascular risk was estimated with atherogenic quotients: total cholesterol/ HDL-c, LDL-c/HDL-c and the triglycerides (TG)/HDL-c index. Results: in 8405 mexican adults, 36% lean, 43% overweighed and 21% obese, nine phenotypes were identified: for each weight category there were subjects with normal metabolism (none MS factors), intermediate (≤2) and dysmetabolic (≥3). Only 10.8% of O/O had normal metabolism, and 5.8% of the lean persons were dysmetabolic. Atherogenic risk was higher in dysmetabolic obese persons, but the risk was high among all dysmetabolic people, independently of the weight status. TG/HDL-c showed the same trend. Conclusions: elevated cardiometabolic risk derives from the high prevalence of O/O. A great proportion of non-obese people have intermediate dysmetabolism. A genetic predisposition to obesity, insulin resistance, diabetes and dyslipidemia in Mexican population is blended to an unhealthy lifestyle, yielding to a catastrophic epidemic of diabetes, and cardiovascular diseases (AU)

Antecedentes y metas: aun cuando el sobrepeso y la obesidad (S/O) son enfermedades reconocidas, hay un reclamo por la existencia de un fenotipo llamado 'obeso sano'. Pocos estudios han explorado la presencia de diferentes fenotipos metabólicos en los rangos del índice de masa corporal (IMC) y su asociación con riesgo cardiovascular. Métodos: se determinaron fenotipos de acuerdo al IMC y a la presencia de marcadores del síndrome metabólico (SM) (circunferencia abdominal, presión sanguínea, glucemia en ayunas y perfil de lípidos). El riesgo cardiovascular fue estimado con los índices aterogénicos: colesterol total/HDL-c, LDL-c/HDL-c y triglicéridos(TG)/HDL-c. Resultados: en 8.405 adultos mexicanos, 36% delgados, 43% con sobrepeso y 21% obesos, se identificaron 9 fenotipos. Por cada categoría de peso se encontraron sujetos con metabolismo normal (ningún factor de SM), intermedios (≤2) y dismetabólicos (≥3). Solo el 10.8% de los sujetos con S/O tuvieron metabolismo normal y el 5.8% de los sujetos delgados fueron dismetabólicos. El riesgo aterogénico fue mayor en los sujetos obesos dismetabólicos. El riesgo fue alto entre todos los sujetos dismetabólicos independientemente del peso. El índice TG/ HDL-c mostró las mismas tendencias. Conclusiones: el riesgo cardiometabólico incrementado deriva de la alta prevalencia de S/O. Una gran proporción de sujetos no obesos tiene dismetabolismo intermedio. Una predisposición genética a la obesidad, la resistencia a la insulina, la diabetes y la dislipidémia en la población mexicana, junto con un estilo de vida no saludable da como consecuencia una epidemia catastrófica de diabetes y enfermedades cardiovasculares (AU)

Atherosclerotic risk in middle-aged women with rheumatoid arthritis / Riesgo aterosclerótico en mujeres de mediana edad con artritis reumatoide

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease, with progressive joint destruction, leading to disability. In half of patients, mortality is associated to coronary events, caused by classical risk factors (RF) and/or the inflammatory process. Objectives: To explore the relevance of systemic inflammatory milieu in RA without the burden of traditional RF. Methods: Women with RA and free of traditional RF (n = 30) were compared against healthy women (n = 31). Body mass index, blood pressure, glycemia, serum creatinine, total cholesterol (TC), high density lipoprotein (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG) and oxidized LDL (oxLDL), erythrocyte sedimentation rate, high-sensitivity C reactive protein (hsCRP), lipid quotients for assessing risk (TC/HDLc, LDLc/HDLc, oxLDL/non HDL cholesterol, TG/HDLc), and ultrasonographic carotid intima media thickness (IMT) were estimated or measured. Results: hsCRP and oxLDL were significantly higher in RA patients. IMT values were among normality, but thickness was slightly increased in left carotid, suggesting early atherosclerotic changes. In RA patients inflammation is associated to a higher concentration of oxLDL. No atherosclerosis was proven but a slight greater thickness in left carotid foretells the development of the disease. Conclusions: In RA patients without vascular RF, a special follow up must be implemented to halt atherosclerosis development.

Antecedentes: La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, con destrucción progresiva de las articulaciones, que lleva a la discapacidad. En la mitad de lospacientes, la mortalidad se asocia con eventos coronarios, causados por factores de riesgo (FR) clásicos y/o el proceso inflamatorio. Objetivo: Explorar la relevancia del medio inflamatorio sistémico en la AR sin la carga de FR tradicionales. Métodos: Las mujeres con AR, sin los FR tradicionales (n = 30) fueron comparados contra mujeres sanas (n = 31). El índice de masa corporal, presión arterial, glucemia, creatinina sérica, colesterol total (CT), lipoproteínas de alta densidad (HDL-c), colesterol de lipoproteínas de baja densidad (LDL-c), triglicéridos (TG) y LDL oxidada (LDLox), velocidad de sedimentación de los eritrocitos, proteína C reactiva de alta sensibilidad (PCR-us), cocientes de lípidos para la evaluación de riesgos (TC/HDLc, LDLc/HDLc, colesterol LDLox/noHDL, TG/HDLc), y el espesor ultrasonográfico de la capa íntima-media carotídea (IMT), fueron estimados o medidos. Resultados: hsCRP y LDLox fueron significativamente mayores en los pacientes con AR. Los valores de IMT estaban dentro de la normalidad, pero el espesor se incrementó ligeramente en la carótida izquierda, lo que sugiere cambios ateroscleróticos tempranos. En los pacientes con AR la inflamación está asociada con una mayor concentración de oxLDL. No se comprobó aterosclerosis pero un espesor ligeramente mayor en la carótida izquierda, los hace propensos a desarrollar la enfermedad. Conclusiones: En los pacientes con AR sin FR vascular, un seguimiento especial debe ser implementado para frenar el desarrollo de la aterosclerosis.

Regression of carotid intima-media thickness with nifedipine in hypertensive patients / Regresión del grosor de la interfase íntima-media carotídea con nifedipina en pacientes hipertensos (REINA)

Background: Calcium channel blockers (CCBs) have proved to reduce both blood pressure levels and cardiovascular outcomes, including the development of atherosclerosis. The INSIGHT study showed a less pronounced progression of carotid intima-media thickness (IMT) in patients treated with nifedipine (NIF) vs. those treated with diuretics, but because IMT was normal in both groups, it was difficult to assess the anti-atherosclerotic effect of NIF. We compared the effect of NIF or hydrochlorothiazide (HCTZ) on atherosclerosis regression in hypertensive patients with abnormally thick IMT. Patients and methods: 37 hypertensive patients were randomly assigned to be treated with slow release-NIF (30 mg) and 46 to HCTZ (25 mg), all of them with IMT > 0.6 mm. IMT, lipid profile, and serum uric acid, potassium, and glucose were analyzed at baseline and 12 months later. Results: Blood pressure was equally well controlled with both treatments. No biochemical abnormality was observed in neither groups. IMT was reduced 35% in the NIF group in comparison to 9.3% in HCTZ group. Discussion: BBCs restore endothelial function, exert antioxidant activity and limit smooth muscle cells growth and proliferation, thus inhibiting fundamental atherogenic phenomena. Our results show a clear regression of IMT, marker of subclinical atherosclerosis with NIF. Conclusion: Both treatments were equally effective reducing blood pressure. HCTZ did not cause metabolic disarrays, but only NIF induced IMT regression. Basal IMT is a main determinant of regression.

Antecedentes: Los bloqueadores de los canales de calcio (BCC) han demostrado reducir tanto los niveles de presión arterial como los eventos cardiovasculares, incluyendo el desarrollo de la aterosclerosis. El estudio INSIGHT mostró una progresión menos pronunciada del grosor de la capa íntima-media de la carotídea (GIMC) en pacientes tratados con nifedipina (NIF) vs. los tratados con diuréticos, pero debido a que el GIMC fue normal en ambos grupos, resultó difícil evaluar el efecto anti-aterosclerótico de la NIF. El presente estudio comparó el efecto de la NIF o hidroclorotiazida (HCTZ) en la regresión de aterosclerosis en pacientes hipertensos con GIMC anormalmente gruesa. Pacientes y métodos: 37 pacientes hipertensos fueron asignados al azar para ser tratados con NIF de liberación lenta (30 mg) y 46 a HCTZ (25 mg), todos ellos con GIMC > 0.6 mm. GIMC, perfil lipídico, y ácido úrico en suero, potasio y glucosa se analizaron al principio y 12 meses más tarde. Discusión: Los BCC restauran la función endotelial, ejercen actividad antioxidante y limitan el crecimiento y la proliferación de las células del músculo liso, inhibiendo así fenómenos aterogénicos fundamentales. Nuestros resultados muestran una clara regresión del GIMC, marcador de aterosclerosis subclínica, con NIF. Conclusión: Ambos tratamientos fueron igualmente efectivos para reducir la presión arterial. HCTZ no causó desorden metabólico, pero sólo la NIF induce la regresión del GIMC. El GIMC basal es un determinante principal de la regresión.

Erratum to "Does Metformin Increase Paraoxonase Activity in Patients with the Metabolic Syndrome? Additional Data from the MEFISTO Study".

[This corrects the article DOI: 10.1111/j.1752-8062.2012.00391.x.].

Cardiovascular risk factors in a Mexican middle-class urban population: The Lindavista Study. Baseline data / Factores de riesgo cardiovascular en mexicanos de clase media: el estudio Lindavista. Datos basales

Introduction and objective: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. Methods: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. Results: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200mg/dL; 62% showed HDL-c levels <40mg/dL; 52% triglycerides > 150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. Conclusion: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Introducción y objetivo: el objetivo de este comunicado es describir los factores de riesgo cardiovascular en la población urbana mexicana de clase media. Métodos: La cohorte del estudio Lindavista se compone de una muestra por conveniencia de 2,602 sujetos de clase media. El estudio es prospectivo y tiene como finalidad determinar si los factores de riesgo cardiovascular tienen el mismo factor pronóstico que en otras poblaciones. Para los datos basales, se hicieron varias determinaciones: índices de obesidad, consumo de tabaco, presión arterial, glucosa, colesterol total, c-HDL, c-LDL y triglicéridos en ayuno. Resultados: La media de edad fue de 50 años; el 59% fueron mujeres. Aproximadamente el 50% de la muestra presentó sobrepeso, mientras que el 24% eran obesos. El 32% fumaban, el 32% eran hipertensos con una tasa de control del 20%. El 6% tenían diabetes y el 14% resistencia a la insulina. El 66% tuvieron colesterol total ≥ 200 mg/dl; el 62% mostraron bajos niveles de c-HDL, el 52% triglicéridos > 150 mg/dl, y el 34% niveles de c-LDL ≥ 160 mg/dl. La mitad de la muestra tenía síndrome metabólico. Conclusión: Los datos revelan una población de alto riesgo cardiovascular debido a la aglomeración de diversos factores de riesgo.

Cardiovascular risk factors in a Mexican middle-class urban population. The Lindavista Study. Baseline data.

INTRODUCTION AND OBJECTIVE: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. METHODS: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. RESULTS: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200 mg/dL; 62% showed HDL-c levels<40 mg/dL; 52% triglycerides>150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. CONCLUSION: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Anthropometric traits, blood pressure, and dietary and physical exercise habits in health sciences students; the obesity observatory project.

BACKGROUND: Obesity and the metabolic syndrome affect a considerable segment of the population worldwide, including health professionals. In fact, several studies have reported that physicians tend to have more cardiovascular risk factors than their patients. The present cross-sectional study assessed whether the Health Sciences students had a healthier lifestyle, thus could have a more preventive attitude towards chronic diseases than the general population. MATERIALS AND METHODS: Students of the medical-biological areas were surveyed by answering a questionnaire about familiar cardiovascular risk factors, personal smoking, alcohol drinking, dietary and exercise habits. Blood pressure was also measured, along with weight, height, and abdominal circumference. RESULTS: 23.4% of the participants were overweight and 10% obese. Parental obesity was the most frequent risk factor, followed by social drinking and smoking. We found high consumption of animal derived foods, breakfast- like cereals, pastries, white bread and sweetened beverages; while low intake of fruit and vegetables were reported. More than half the sample reported to practice very little or no exercise at all. DISCUSSION AND CONCLUSIONS: We found similar or even higher rates of risk factors than the average population, that may eventually lead to the development of chronic cardiometabolic diseases. Thus we can infer that biomedical education is inefficient in inducing healthy lifestyles among biomedical students, which could have impact in their future practice as they will most probable become obese health-professionals, thus fail to effectively treat their own patients.

Introducción: La obesidad y el síndrome metabólico afectan a un segmento considerable de la población mundial, incluyendo a los profesionales de la salud. De hecho, diversos estudios han reportado que los médicos tienden a presentar más factores de riesgo cardiovascular que sus propios pacientes. El presente estudio transversal evaluó si los estudiantes del área de la salud tenían un estilo de vida más saludable y, por tanto, una mejor actitud en cuanto a la prevención de las enfermedades crónico-degenerativas, que el resto de la población. Materiales y métodos: Se encuestaron estudiantes del área medico-biológica a través de un cuestionario sobre antecedentes heredo-familiares de riesgo cardiovascular, consumo actual de tabaco y alcohol, así como hábitos alimentarios y de ejercicio físico. Se midió la presión arterial, el peos, la talla y la circunferencia abdominal. Resultados: 23.4% de los participantes presentaban sobrepeso y 10% obesidad. La obesidad paterna fue el factor de riesgo más frecuente, seguido de consumo social de alcohol y tabaquismo. Se encontró un alto consume de alimentos de origen animal, cereales industrializados y refrescos; por otra parte, se reportó un bajo consumo de verduras y frutas. Más de la mitad de la muestra refirió ser sedentario. Discusión y conclusiones: Se encontraron datos muy similares a aquéllos reportados sobre la población general, que eventualmente conducirán al desarrollo de enfermedades cardiometabólicas. Por tanto, es posible inferir que la educación biomédica no es eficiente en la inducción de un estilo de vida saludable entre los estudiantes de ciencias de la salud. Tal fenómeno podría impactar su práctica futura ya que probablemente se convertirán en profesionistas obesos, con la consecuente falla en la prevención primaria y secundaria de sus propios pacientes.

Anthropometric traits, blood pressure, and dietary and physical exercise habits in health sciences students: the Obesity Observatory Project / Características antropométricas, presión arterial, hábitos dietarios y de actividad física en estudiantes de ciencias de la salud; el Proyecto Observatorio de Obesidad

Background: Obesity and the metabolic syndrome affect a considerable segment of the population worldwide, including health professionals. In fact, several studies have reported that physicians tend to have more cardiovascular risk factors than their patients. The present cross-sectional study assessed whether the Health Sciences students had a healthier lifestyle, thus could have a more preventive attitude towards chronic diseases than the general population. Materials and methods: Students of the medical-biological areas were surveyed by answering a questionnaire about familiar cardiovascular risk factors, personal smoking, alcohol drinking, dietary and exercise habits. Blood pressure was also measured, along with weight, height, and abdominal circumference. Results: 23.4% of the participants were overweight and 10% obese. Parental obesity was the most frequent risk factor, followed by social drinking and smoking. We found high consumption of animal derived foods, breakfast-like cereals, pastries, white bread and sweetened beverages; while low intake of fruit and vegetables were reported. More than half the sample reported to practice very little or no exercise at all. Discussion and conclusions: We found similar or even higher rates of risk factors than the average population, that may eventually lead to the development of chronic cardiometabolic diseases. Thus we can infer that biomedical education is inefficient in inducing healthy lifestyles among biomedical students, which could have impact in their future practice as they will most probable become obese health-professionals, thus fail to effectively treat their own patients (AU)

Introducción: La obesidad y el síndrome metabólico afectan a un segmento considerable de la población mundial, incluyendo a los profesionales de la salud. De hecho, diversos estudios han reportado que los médicos tienden a presentar más factores de riesgo cardiovascular que sus propios pacientes. El presente estudio transversal evaluó si los estudiantes del área de la salud tenían un estilo de vida más saludable y, por tanto, una mejor actitud en cuanto a la prevención de las enfermedades crónico-degenerativas, que el resto de la población. Materiales y métodos: Se encuestaron estudiantes del área medico-biológica a través de un cuestionario sobre antecedentes heredo-familiares de riesgo cardiovascular, consumo actual de tabaco y alcohol, así como hábitos alimentarios y de ejercicio físico. Se midió la presión arterial, el peos, la talla y la circunferencia abdominal. Resultados: 23.4% de los participantes presentaban sobrepeso y 10% obesidad. La obesidad paterna fue el factor de riesgo más frecuente, seguido de consumo social de alcohol y tabaquismo. Se encontró un alto consume de alimentos de origen animal, cereales industrializados y refrescos; por otra parte, se reportó un bajo consumo de verduras y frutas. Más de la mitad de la muestra refirió ser sedentario. Discusión y conclusiones: Se encontraron datos muy similares a aquéllos reportados sobre la población general, que eventualmente conducirán al desarrollo de enfermedades cardiometabólicas. Por tanto, es posible inferir que la educación biomédica no es eficiente en la inducción de un estilo de vida saludable entre los estudiantes de ciencias de la salud. Tal fenómeno podría impactar su práctica futura ya que probablemente se convertirán en profesionistas obesos, con la consecuente falla en la prevención primaria y secundaria de sus propios pacientes (AU)

Testosterone metabolites mediate its effects on myocardial damage induced by ischemia/reperfusion in male Wistar rats.

The role of testosterone in cardiovascular (CV) homeostasis is in controversy, and the exact effects of testosterone on the cardiovascular system remain poorly understood. Testosterone is metabolized by aromatase into 17ß-estradiol and by 5α-reductase into dihydrotestosterone (DHT). Thus, identification of these metabolites in the heart may help to explain the controversy regarding the cardiovascular effects of testosterone. We analyzed the expression patterns of these testosterone-metabolizing enzymes and assessed the effect of its enzymatic activity inhibition on ischemia (40 min)/reperfusion (4h, I/R) via the left anterior descendent coronary artery in intact and gonadectomized male rats. Myocardial damage was measured as percentage of infarcted area vs. area at risk. Aromatase and 5α-reductase protein expression was found in the left ventricle of intact and orchidectomized rats. Exogenous testosterone had no effect on I/R induced myocardial damage in intact male rats, meanwhile exogenous testosterone protects against I/R injury in orchidectomized rats. However, enzymatic inhibition of aromatase increased myocardial damage in the presence of testosterone, while enzymatic inhibition of 5α-reductase significantly decreased the level of myocardial damage. Our results also showed that sub-chronic inhibition of 5α-reductase resulted in myocardial protection in both groups. Furthermore, in orchidectomized and intact male rats IV treatment with DHT induces a significant increase in the myocardial damage induced by I/R. Thus, the effect of testosterone on cardiovascular pathophysiology could be related, at least in part to changes in the balance of testosterone 5α-reduction and aromatization.

Does metformin increase paraoxonase activity in patients with the metabolic syndrome? Additional data from the MEFISTO study.

In a subanalysis on the metformin, arterial function, intima-media thickness, and nitroxidation in the metabolic syndrome (MEFISTO)(8) (an open-label fashion, with 1 year of 850 mg daily of metformin) subjects' samples, we measured the paraoxonase 1 (PON1) activity in 39 patients that finished the study and relate values with high density lipoprotein (HDL). The comparative PON1 activities at the beginning and at the end of the study were 5.528 ± 0.588 and 4.743 ± 0.619 nmol/mg protein/min (NS) for control group and 3.229 ± 0.403 and 5.135 ± 0.585 nmol/mg protein/min (p < 0.02) for the metformin group. Our data showed an enhance of PON1 activity in patients with metabolic syndrome treated with metformin, although in them, the raise of HDL concentration was less than control patients, suggesting that the increase in quality (measured here as PON1 activity) could be at least as important as an increase in its concentration. Our results point out that there is a relationship among PON1 activity and the reduction of carotideal intima-media thickness.

The VYtorin on Carotid intima-media thickness and overall arterial rigidity (VYCTOR) study.

This study assessed the effect of 3 lipid-lowering therapies on the reduction of the carotid intima-media thickness (IMT) in high-risk coronary Mexican patients. The study was a randomized, comparative, and open clinical trial. Ninety high-risk coronary patients were allocated to 3 groups: pravastatin 40 mg, simvastatin 40 mg, and simvastatin 20 mg and ezetimibe 10 mg initially. If the therapeutic goals were not attained (<100 mg/dL of low-density lipoprotein cholesterol [LDL-C] for type C and <70 mg for type D), patients in group 1 received pravastatin 40 mg and ezetimibe 10 mg, group 2 received simvastatin 80 mg, and group 3 received simvastatin 40 mg and ezetimibe 10 mg. The primary endpoint was the change of IMT over the course of 1 year. The secondary endpoints were changes in LDL-C and in high sensitive C-reactive protein (CRPhs). The overall baseline IMTs generated by combining measurements in the internal carotid artery were 1.33+/-0.32 mm, 1.30+/-0.11 mm, and 1.23+/-0.28 mm for groups 1, 2, and 3, respectively. After 1 year, IMT values were 0.93+/-0.13 mm, 0.90+/-0.11 mm, and 0.92+/-0.01 mm for groups 1, 2, and 3, respectively. At the end of the study, LDL-C levels were 48+/-41, 45+/-37, and 48+/-31 in groups 1, 2, and 3, respectively. No significant differences were observed in CRP, high-density lipoprotein cholesterol, triglycerides, blood pressure, and body mass index, among the groups. This study is one of the first providing evidence that dual therapy has a beneficial effect on a surrogate marker of atherosclerosis.

Mannose polymer induces vasodilation through a luminal mannose receptor in rat mesenteric arteries.

Several of the luminal endothelial glycocalyx functions are exerted via interactions with glycosidic components and sugar binding proteins with lectinic activity. One important example is the mannose receptor (MR). The MR has been detected in cell types that mediate the phagocytosis and pinocytosis of particles and solutes containing mannose. Using isolated constant pressurized rat mesenteric arteries (RMA), we evaluated the effects of a mannose polymer in the vascular tone. RMA were pre-contracted with 10 micromol/L phenylephrine and carbohydrates were perfused at 20 microliters/min. Perfusion of free D-mannose (1 nmol/L to 100 micromol/L) induced a concentration-dependent vasodilation of pre-contracted RMA. Perfusion of mannose polymer (1 nmol/L to 100 micromol/L) induced a larger effect in a concentration-dependent vasodilation. Mannose polymer's maximum effect reached a 96 percent of basal diameter; this significant vasodilation was not nitric oxide (NO) or cyclooxygenase (COX) dependent effect. We corroborated the binding of the mannose polymer to the endothelial lumen, by perfusion of a fluorescently labeled mannose polymer; and also, we detected a significant level of MR mRNA in whole mesenteric arteries. With all these, we proposed a novel effect of a MR in the regulation of vascular tone.

Metformin, arterial function, intima-media thickness and nitroxidation in metabolic syndrome: the mefisto study.

1. Metabolic syndrome (MS) is one of the greatest public health problems in Mexico, where more than 75% of adults in urban populations are overweight or obese. Metabolic syndrome has several comorbidities, which result in a high cardiometabolic risk. 2. Some of the vasopathogenic phenomena in MS are caused by nitroxidant stress, secondary to cardiometabolic dysfunction. 3. The action of metformin to diminish or control MS remains a matter of debate. 4. In the present study, 60 patients with at least three diagnostic criteria for MS were divided into two groups. Both groups received similar dietary counselling, but one group was given 850 mg metformin daily. 5. The variables assessed were body mass index, waist circumference, systolic and diastolic blood pressures (SBP and DBP, respectively), total cholesterol (TC), high- and low-density lipoprotein-cholesterol, triglycerides (TG), fasting glucose, nitroxidant metabolites (free carbonyls, malondialdehyde, dityrosines and advanced oxidative protein products (AOPP)), nitric oxide (NO), carotid vascular stiffness, carotid intima-media thickness (IMT) and C-reactive protein (CRP). 6. After 1 year follow up, both groups reported weight loss, as well as decreases in waist circumference, SBP and DBP. 7. Patients on metformin exhibited reductions in TC and IMT and there were marked changes in nitroxidation: levels of carbonyls, dityrosines and AOPP were reduced, whereas those of NO were increased, indicating better endothelial function. In addition, in patients given metformin, CRP levels decreased. 8. In conclusion, metformin has a considerable beneficial effect on nitroxidation, endothelial function and IMT in patients with MS.

Intraluminal-restricted 17 beta-estradiol exerts the same myocardial protection against ischemia/reperfusion injury in vivo as free 17 beta-estradiol.

Several in vitro studies show that in animals and isolated cells, 17 beta-estradiol induces cardiovascular protective effects and it has also been observed that it reduces coronary heart disease risk. However, the use of estrogens to improve or protect cardiovascular function in humans has been controversial, this might be explained by the wide variety of effects, because estrogen receptors (ER) are expressed ubiquitously. Therefore, a cell-specific targeting therapeutic approach might be necessary. 17 beta-Estradiol was coupled to a large modified dextran through an aminocaproic spacer. For this study we used intact and gonadectomized male Wistar rats, 15 days after surgical procedure. Intravascular administration of 17 beta-estradiol-macromolecular conjugate, prior to coronary reperfusion diminishes the area of damage induced by coronary ischemia reperfusion (I/R) injury on an in vivo model. This effect was observed at 17 beta-estradiol sub-physiological concentrations [0.01 nmol/L], it is mediated by luminal endothelial ER alpha activation. 17 beta-Estradiol-macromolecular conjugate decreases phosphorylation level of PKC alpha and Akt, as part of the process to induce myocardial protection against coronary I/R. We proved that the hormone-macromolecular conjugate labeled with [3H]estradiol remained confined in the intravascular space the conjugate was not internalized into organs like heart, lung or liver. It is noteworthy that the 17 beta-estradiol-macromolecular conjugate has a slow renal elimination, which might increase its pharmacological advantage. We concluded that the stimulus of endothelial estrogen receptors is enough to decrease the myocardial damage induced by coronary reperfusion.