[Familial combined hyperlipidemia: consensus document]. / Hiperlipidemia familiar combinada: documento de consenso.

Familial combined hyperlipidemia (FCH) is a frequent disorder associated with premature coronary artery disease. It is transmitted in an autosomal dominant manner, although there is not a unique gene involved. The diagnosis is performed using clinical criteria, and variability in lipid phenotype and family history of hyperlipidemia are necessaries. Frequently, the disorder is associated with type2 diabetes mellitus, arterial hypertension and central obesity. Patients with FCH are considered as high cardiovascular risk and the lipid target is an LDL-cholesterol <100mg/dL, and <70mg/dL if cardiovascular disease or type 2 diabetes are present. Patients with FCH require lipid lowering treatment using potent statins and sometimes, combined lipid-lowering treatment. Identification and management of other cardiovascular risk factors as type 2 diabetes and hypertension are fundamental to reduce cardiovascular disease burden. This document gives recommendations for the diagnosis and global treatment of patients with FCH directed to specialists and general practitioners.

[The importance of genetics in the study of hypertriglyceridemia]. / La importancia de la genética en el estudio de la hipertrigliceridemia.

Hypertriglyceridemia encompasses a set of lipid disorders common in clinical practice, generally defined as a fasting concentration above 150mg/dL. There are various classifications of the severity of hypertriglyceridaemia based on serum values, with levels generally considered moderate when below 500mg/dL and severe when above 1000mg/dL. Its importance lies in its association with other alterations in the lipid profile, contributing to increased cardiovascular risk and increased risk of acute pancreatitis, mainly with concentrations above 500mg/dL.

A randomized double-blind controlled clinical trial demonstrating efficacy of different probiotic strains on serum lipids and glycemic biomarker.

Introduction: Background: the aim of this randomized placebo-controlled study was to investigate the effect of probiotics mainly on plasma lipids, homocysteine levels, glycemic biomarkers and inflammatory marker in people with hyperlipidemia, compared to a placebo. Methods: a randomized, double-blind placebo-controlled study was completed with a total of 51 men and women who have diagnosed with hyperlipidemia. The three study interventions were: 1) probiotic group I asked to take once a day 1 x 106 colony forming unit (CFU) Lactobacillus rhamnosus GG microorganism (n = 18) capsule; 2) probiotic group II asked to take once a day of a combined Lactobacillus acidophilus 1 x 109 CFU and Bifidobacterium animalis subsp.lactis 1 x 109 CFU probiotic capsule (n = 17); and 3) placebo group: emptied capsule (n = 16), plasma lipids, homocysteine, and glycemic biomarkers were were performed at baseline and week 8. Also, hs-CRP levels was assessed as inflammatory parameter. Results: compared to baseline there was a significant decrease in triglyceride and total cholesterol levels of the both intervention groups compared to the placebo group. Regarding the glycemic biomarkers. both intervention groups significantly alter the HOMA-IR values compared to the placebo group (p < 0.05). When homocysteine values were evaluated. a statistically significant decrease was observed only in the group using the combined strain (p < 0.05). Results demonstrated that regular and strain-specific use of probiotics have effective and favorable consequences on plasma lipids and glycemic biomarkers. Conclusion: probiotics containing Lactobacillus or Bifidobacterium could be effective in hypercholesterolemic patients, reducing serum lipids as well as homocysteine and glycaemia.

Introducción: Objetivo: el objetivo de este estudio aleatorizado controlado con placebo fue investigar el efecto de los probióticos principalmente en los lípidos plasmáticos, los niveles de homocisteína, los biomarcadores glucémicos y el marcador inflamatorio en personas con hiperlipidemia, en comparación con un placebo. Métodos: se realizó un estudio doble ciego aleatoria controlado con placebo con un total de 51 hombres y mujeres a quienes se les había diagnosticado hiperlipidemia. Las tres intervenciones del estudio fueron: 1) un grupo probiótico que tomaban una vez al día 1 x 106 cápsulas de unidades formadoras de colonias (UFC) del microorganismo Lactobacillus rhamnosus GG (n = 18); 2) un grupo probiótico II que tomaba una vez al día una cápsula probiótica combinada de Lactobacillus acidophilus 1 x 109 CFU y Bifidobacterium animalis subsp.lactis 1 x 109 CFU (n = 17); y 3) un grupo placebo: cápsula vacía (n = 16), lípidos plasmáticos. Se realizaron biomarcadores de homocisteína y glucémico al inicio y también en la semana 8. Los niveles de hs-CRP se evaluaron como parámetro inflamatorio. Resultados: en comparación con el valor inicial, hubo una disminución significativa en los niveles de triglicéridos y colesterol total de ambos grupos de intervención en comparación con los del grupo de placebo. En cuanto a los biomarcadores glucémicos, ambos grupos de intervención alteran significativamente los valores de HOMA-IR en comparación con el grupo placebo (p < 0,05). Cuando se evaluaron los valores de homocisteína, se observó una disminución estadísticamente significativa solo en el grupo que utilizó la cepa combinada (p < 0,05). Los resultados demostraron que el uso regular y específico de cepas de probióticos tiene consecuencias favorables sobre los lípidos plasmáticos y los biomarcadores glucémicos. Conclusión: los probióticos que contienen Lactobacillus o Bifidobacterium podrían ser eficaces en pacientes hipercolesterolémicos, reduciendo los lípidos séricos, así como la homocisteína y la glucemia.

The effect of probiotics on the serum lipid levels in non-obese healthy adults with hyperlipidemia: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Introduction: probiotics might have a potential effect to manage serum lipid levels as nutraceuticals. Objective: this systematic review was conducted to explore whether probiotics have an efficient result in non-obese healthy adults with hyperlipidemia. Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials (from their commencement to January 2021). This meta-analysis was performed by Review Manager 5.3 and STATA 15.1. Changes in serum lipid levels after the intervention were used to evaluate the effect of the probiotics, which were expressed as the weighted mean difference (WMD) with a 95 % confidence interval (CI). Results: a total of 16 studies, which could be regarded as 21 independent trials with 1429 participants, were included in this meta-analysis following our inclusion criteria. It could be observed that probiotics could significantly lower total cholesterol (TC) (WMD: -0.34 mmol/L, 95 % CI: -0.45 to -0.23 mmol/L; p < 0.001, I2 = 73.9 %) and low-density lipoprotein cholesterol (LDL-C) (WMD: -0.26 mmol/L, 95 % CI: -0.36 to -0.17 mmol/L; p < 0.001, I2 = 79.0 %) levels in non-obese healthy adults with hyperlipidemia, while no significant effect between the probiotic intervention and control groups was observed on high-density lipoprotein cholesterol (HDL-C) (WMD: 0.00 mmol/L, 95 % CI: -0.02 to 0.02 mmol/L; p = 0.001, I2 = 56.6 %) and triglyceride (TG) (WMD: -0.08 mmol/L, 95 % CI: -0.18 to 0.01 mmol/L; p = 0.003, I2 = 52.4 %) levels. Conclusion: this systematic review showed that probiotics may provide a promising way to reduce serum lipid levels in non-obese healthy adults with hyperlipidemia, but their specific effect still needs more clinical experiments to be proven.

INTRODUCCIÓN: Introducción: los probióticos podrían tener efecto para controlar los niveles de lípidos séricos como nutracéuticos. Objetivo: esta revisión sistemática se realizó para explorar si los probióticos tienen un resultado eficiente en adultos sanos no obesos con hiperlipidemia. Métodos: se realizaron búsquedas de ensayos controlados aleatorios en PubMed, Embase, el Registro Cochrane Central de Ensayos Controlados y Web of Science (desde su inicio hasta enero de 2021). Este metanálisis fue realizado mediante Review Manager 5.3 y STATA 15.1. Los cambios de los niveles de lípidos séricos después de la intervención se utilizaron para evaluar el efecto de los probióticos, que se expresaron como la diferencia de medias ponderada (DMP) con un intervalo de confianza (IC) del 95 %. Resultados: en este metaanálisis se incluyeron un total de 16 estudios, que podrían considerarse 21 ensayos independientes con 1429 participantes, siguiendo nuestros criterios de inclusión. Se pudo observar que los probióticos podían reducir significativamente el colesterol total (CT) (DMP: -0,34 mmol/L, IC del 95 %: -0,45 a -0,23 mmol/L; p < 0,001, I2 = 73,9 %) y el colesterol de lipoproteínas de baja densidad (C-LDL) (DMP: -0,26 mmol/L, IC del 95 %: -0,36 a -0,17 mmol/L; p < 0,001, I2 = 79,0 %) en los adultos sanos no obesos con hiperlipidemia, mientras que no hubo efectos significativos entre los grupos de intervención y de control en el colesterol de lipoproteínas de alta densidad (HDL-C) (DMP: 0,00 mmol/L, IC del 95 %: -0,02 a 0,02 mmol/L; p = 0,001, I2 = 56,6 %) y los triglicéridos (TG) (DMP: -0,08 mmol/L, IC del 95 %: -0,18 a 0,01 mmol/L; p = 0,003, I2 = 52,4 %). Conclusión: esta revisión sistemática manifestó que los probióticos podrían suponer una forma prometedora de reducir los niveles de lípidos séricos en los adultos sanos no obesos con hiperlipidemia, pero se necesitan más experimentos clínicos para demostrar su efecto específico.

Time-restricted feeding in dark phase of circadian cycle and/or westernized diet cause mixed hyperlipidemia in rats.

INTRODUCTION: Background: the dietary pattern that characterizes western diet is strongly associated with metabolic diseases and excess weight, as well as chronic illnesses. Misaligned feeding schedules can lead to or aggravate the development of such conditions. Aim: this study evaluated the influence of dietary composition and/or time-restricted feeding on the anthropometric and biochemical profile of adult rats. Methods: forty male rats, at 60 days of life, were divided into the following groups: Control (C), Restricted Control (RC), Westernized (W), and Restricted Westernized (RW). Results: westernized groups, in spite of a low energy intake (C = 5399 ± 401.2 kcal; RC = 4279.0 ± 476.2 kcal; W = 4302 ± 619.8 kcal; RW = 4081.0 ± 404.4 kcal, p < 0.001), had a higher body weight (C = 404.6 ± 39.1 g; RC = 335.1 ± 36.5 g; W = 488.9 ± 51.2 g; RW = 438.8 ± 36.5 g, p < 0.001) as compared to their paired controls (RC and C) - around 30 % and 20 % more for RW and W, respectively. The westernized diet caused glucose intolerance and mixed hyperlipidemia, characterized by higher concentrations of cholesterol (C = 40.8 ± 7.4 mg/dL; RC = 76.7 ± 10.8 mg/dL; W = 61.3 ± 20.2 mg/dL; RW = 42.2 ± 8.2 mg/dL), LDLc (C = 17.4 ± 7.5 mg/dL; RC = 38.8 ± 7.2 mg/dL ; W = 45.3 ± 15.8 mg/dL; RW = 11.0 ± 5.8 mg/dL), and triacylglycerol (C = 45.2 ± 15.0 mg/dL; RC = 73.2 ± 21.5 mg/dL ; W = 83.6 ± 23.4 mg/dL; RW = 57.5 ± 13.6 mg/dL) in the serum (p < 0.05). Conclusion: the effect of time-restricted feeding on body weight was strongly dependent on diet composition. The glucose tolerance test showed an influence of the circadian cycle phase. Mixed hyperlipidemia varied according to the presence of westernized diet and/or time-restricted food.

INTRODUCCIÓN: Antecedentes: el patrón dietético que caracteriza a la dieta occidental está fuertemente asociado con las enfermedades metabólicas, así como con el sobrepeso y las enfermedades crónicas. Los horarios de alimentación desorganizados pueden conducir o agravar el desarrollo de tales trastornos. Objetivo: este estudio evaluó la influencia de la composición dietética y/o la alimentación restringida en el perfil antropométrico y bioquímico de ratas adultas. Métodos: cuarenta ratas macho, a los 60 días de vida, se dividieron en los seguientes grupos: control (C); control restringido (RC); occidentalizado (W) y occidentalizado restringido (RW). Resultados: los grupos occidentalizados, a pesar de la baja ingesta energética (C = 5399 ± 401,2 kcal; RC = 4279,0 ± 476,2 kcal; W = 4302 ± 619,8 kcal; RW = 4081,0 ± 404,4 kcal, p < 0,001), tuvieron mayor peso corporal (C = 404,6 ± 39,1 g; RC = 335,1 ± 36,5 g; W = 488,9 ± 51,2 g; RW = 438,8 ± 36,5 g, p < 0,001) que los respectivos grupos de control (RC y C): alrededor de un 30 % y un 20 % más para RW y W, respectivamente. La dieta occidentalizada provocó intolerancia a la glucosa e hiperlipidemia mixta, caracterizada por una mayor concentración de colesterol (C = 40,8 ± 7,4 mg/dL; RC = 76,7 ± 10,8 mg/dL; W = 61,3 ± 20,2 mg/dL; RW = 42,2 ± 8,2 mg/dL), cLDL (C = 17,4 ± 7,5 mg/dL; RC = 38,8 ± 7,2 mg/dL; W = 45,3 ± 15,8 mg/dL; RW = 11,0 ± 5,8 mg/dL) y triacilglicerol (C = 45,2 ± 15,0 mg/dL; RC = 73,2 ± 21,5 mg/dL; W = 83,6 ± 23,4 mg/dL; RW = 57,5 ± 13,6 mg/dL) en el suero (p < 0,05). Conclusión: el efecto de la alimentación restringida en el tiempo sobre el peso corporal fue muy dependiente de la composición de la dieta. La prueba de tolerancia a la glucosa mostró la influencia de la fase del ciclo circadiano. La hiperlipidemia mixta varió según la presencia de la dieta occidentalizada y/o la comida con restricción de tiempo.

Calcification of the cavernosal bodies may be responsible for development of erectile dysfunction in uremic apolipoprotein E deficient (apoE-/-) mice.

INTRODUCTION AND OBJECTIVE: Erectile dysfunction's physiopathology in uremia is complex and multifactorial, involving a combination of classical risk factors and specific uremia-related risk factors such as increased oxidative stress, endothelial dysfunction and inflammation. The aim of the study is to investigate the effect of chronic kidney disease (CKD) on vascular calcification and endothelial function of cavernosal bodies in apolipoprotein E deficient (apoE-/-) mice, a well known model of erectile dysfunction. MATERIALS AND METHODS: Eight-week-old male apoE-/- mice were randomly assigned to the following 3 groups: (i) subtotally nephrectomised (SNX apoE-/-, 12 mice), (ii) uninephrectomised (UNX apoE-/-, 11 mice) or (iii) sham operated (sham-op apoE-/-, 15 mice). At 16 weeks after surgery, aortas and penile erectile tissues were harvested for histological studies to assess atherosclerosis, vascular calcification, nitrotyrosine staining, total collagen content and macrophage staining. RESULTS: At sacrifice, SNX and UNX mice had significantly higher serum urea, total cholesterol, and triglyceride concentrations than sham-op controls. Atherosclerotic lesions in thoracic aorta were significantly larger in uremic apoE-/- mice than in controls. There were no atheromatous lesions in cavernosal bodies or penile artery observed in any group. However, SNX and UNX animals showed a significant increase in calcification score, collagen content and nitrotyrosine staining in cavernosal bodies when compared with controls. The degree of macrophage infiltration was comparable between the 3 groups. CONCLUSION: In conclusion, even mild renal dysfunction, i.e., after uninephrectomy increases calcification score and aggravates endothelial function of cavernosal bodies in apoE-/- mice and this effect might be linked to increased oxidative stress in penile endothelium.

Efficacy of therapeutic lifestyle changes on lipid profiles assessed by NMR in children with familial and non-familial hypercholesterolemia.

BACKGROUND AND AIMS: The first line of therapy in children with hypercholesterolaemia is therapeutic lifestyle changes (TLSC). The efficacy of lifestyle intervention in children with familial hypercholesterolaemia (FH), where LDL-C levels are genetically driven, deserves a focused study. AIMS: To evaluate the impact of a lifestyle education program, focused on food patterns and physical activity, on lipid profiles assessed by nuclear magnetic resonance (NMR) in children with FH vs. non-FH. METHODS: Phase 1 was a cross-sectional study of baseline characteristics, and phase 2 was a prospective TLSC intervention study. In total, the study included 238 children (4 to 18 years old; 47% girls) attending the lipid unit of our hospital due to high cholesterol levels. Eighty-five were diagnosed with FH (72% genetic positive), and 153 were diagnosed with non-Familial hypercholesterolaemia. A quantitative food frequency questionnaire (FFQ) including 137 items was used. Physical activity (PA) was assessed by the Minnesota questionnaire. The lipid profile was assessed using the 2D-1H-NMR (Liposcale test). A total of 127 children (81 in the FH group) participated in the prospective phase and were re-assessed after 1 year of the TLSC intervention, consisting of education on lifestyle changes delivered by a specialized nutritionist. RESULTS: The FH and non-FH groups were similar in anthropometry and clinical data, except that those in the FH were slightly younger than those in the non-FH group. Both the FH and non-FH groups showed a similar diet composition characterized by a high absolute calorie intake and a high percentage of fat, mainly saturated fat. The PA was below the recommended level in both groups. After one year of TLSC, the percentage of total and saturated fats was reduced, and the amount of fiber increased significantly in both groups. The percentage of protein increased slightly. The number of children engaged in at least 1 hour/day of PA increased by 56% in the FH group and by 53% in the non-FH group, and both these increases were significant. The total and small-LDL particle numbers were reduced in both groups, although the absolute change was greater in the FH group than in the non-FH group. CONCLUSIONS: Educational strategies to implement TLSC in children lead to empowerment, increased adherence, and overall metabolic improvement in children with high blood cholesterol, including those with FH.

Criteria for referring patients to Spanish Atherosclerosis Society lipid units. / Criterios de derivación para pacientes a las unidades de lípidos de la Sociedad Española de Arteriosclerosis.

The Spanish Arteriosclerosis Society has accredited more than 70 lipid units across the country. The main criteria for patients to be referred to these units are presented. These are not only grouped by the type of dyslipidaemia or the lipid levels, but also on certain clinical characteristics suggesting primary hyperlipidaemia, a complex diagnosis, or difficult management due to inefficacy, or side effects.

Impact of the application of the JNC 8 and KDIGO-2013 guidelines on hypertension and lipid control in a Nephrology outpatient clinic. / Impacto de la aplicación del 8.o JNC y de las guías KDIGO-2013 en el control de la hipertensión arterial y los lípidos en una consulta de Nefrología.

OBJECTIVE: Observational retrospective study with consecutive patients with CKD to assess the degree of accomplishment of the therapeutic objectives in hypertension and dyslipidaemia recommended by JNC 8 and KDIGO-2013 CKD guidelines the impact of their implementation compared with previous guidelines. RESULTS: 618 patients were included, mean age 67±15 years, 61.33% male. Mean eGFR was 45.99±18.94ml/min, with median albumin/creatinine 26 (0-151)mg/g. A total of 87.6% received antihypertensive treatment and 50.2% received statins. According to KDIGO guidelines, 520 patients (84.14%) should receive statins, but only 304 (58.46%) were receiving them. Patients on statin treatment had more diabetes and hypertension, and a greater cardiovascular history and lower levels of total and LDL-cholesterol. A total of 97.7% of patients were under 60 years of age or had eGFR<60ml/min/1.73m2 or were diabetic, so according to the JNC 8 report, they should have a target blood pressure<140/90mmHg. A total of 289 patients did (47.85%). According to the JNC 7 report, this group had a tighter target blood pressure<130/90mmHg, reducing the number of patients who fulfilled the target: 136 (22.52%). Patients reclassified were older, had a greater cardiovascular history and less DM. CONCLUSION: The new KDIGO guidelines for dyslipidaemia treatment increase the indication of statin therapy, especially in patients at high cardiovascular risk. The JNC 8 guidelines improve the percentage of patients with controlled blood pressure, especially the elderly and patients with increased cardiovascular risk, in whom the target blood pressure is currently controversial.

Impacto de la cuarentena por COVID-19 en el perfil metabólico de personas con infección por VIH en Argentina / Impact of COVID-19 related lockdown on the metabolic profile of people with HIV infection in Argentina

INTRODUCCIÓN: Para mitigar la propagación del SARS-CoV-2 se requirió de un confinamiento generalizado. Las autoridades argentinas impusieron aislamiento social preventivo durante 234 días (20 de marzo al 9 de noviembre de 2020), modificando el estilo de vida de la población. OBJETIVOS: Examinar la influencia de las medidas de bloqueo en el perfil metabólico de pacientes infectados por VIH en Argentina. PACIENTES Y MÉTODOS: Estudio de cohorte retrospectivo de 10.239 pacientes en seguimiento en una clínica de atención privada de personas con infección por VIH. Se incluyeron pacientes adultos con terapia antirretroviral (TARV) en curso que tuvieran una determinación de glucemia, colesterol total, colesterol HDL y trigliceridemia antes de la cuarentena (Pre-C: segundo semestre 2019) y una segunda determinación durante la misma (Intra-C: mayo 2020). Se excluyeron los pacientes con cambios en la TARV con impacto metabólico, los que iniciaron o suspendieron hipolipemiantes o hipoglucemiantes y mujeres embarazadas. Las variables categóricas se compararon mediante la prueba de la χ2 o la prueba exacta de Fisher y las continuas mediante la prueba t o la prueba de Mann-Whitney según correspondiera. Se consideró significativo un valor de p a dos colas < 0,05. RESULTADOS: Se incluyeron 540 individuos. La mediana de edad fue de 47 años y 74,6% fueron de sexo masculino. La mediana de índice de masa corporal fue 26,1 y 94,6% tenían bajo riesgo cardiovascular. Hubo un aumento significativo en el porcentaje de pacientes con hiperglucemia (Pre-C 5,2% vs Intra-C 8,5%, p 0,04), hipertrigliceridemia (Pre-C 33,9% vs Intra-C 40,7%, p 0,02) e hipercolesterolemia LDL (Pre-C 12,6% vs Intra-C 17,2%, p 0,04). CONCLUSIÓN: Nuestros resultados sugieren que la cuarentena, al menos en sus fases iniciales, puede tener un impacto negativo en el perfil metabólico de esta población.

BACKGROUND: The spread of SARS-CoV-2 required widespread lockdown to mitigate the pandemic. Argentine authorities imposed preventive social isolation for 234 days (March 20th to November 9th 2020). This measure led to major changes in the population's lifestyle. AIM: To examine the influence of COVID-19 lockdown measures on the metabolic profile of HIV-infected patients in Argentina. METHODS: Retrospective cohort study of 10,239 HIV-infected patients under follow up in a private clinic for HIV care. Adult patients with ongoing antiretroviral therapy (ART) and a baseline determination of blood glucose, total cholesterol, HDL-cholesterol and triglycerides done before lockdown (BL: second semester of 2019) and a second determination during lockdown (DL: May 2020) were included. Patients with recent changes in ART that may have metabolic impact, those starting lipid/glucose lowering agents and pregnant women were excluded. Categorical variables were compared using the χ2 test or Fisher's exact test, and continuous variables using the t-test or the Mann-Whitney test. A two-tailed value of p < 0.05 was considered significant. RESULTS: 540 individuals were included, median of age was 47 years and 74.6% were male. Median body mass index was 26.1 and 94.6% had low cardiovascular risk. There was a significant increase in the percentage of patients that met criteria for hyperglycemia (BL 4.8% and DL 8.5%, p < 0.001). We also observed significant (p < 0.001) increase in median (IQR) BL vs DL values in LDL-cholesterol [109 (90-128) vs 118 (97-139) mg/dL]; and triglycerides [120 (87-172) vs. 132 mg/dL (96-184)]. The proportion of patients with hyper-LDL cholesterolemia according to individual cardiovascular risk increased from 12.6 to 17.2% (p = 0.04). CONCLUSION: Our results suggest that quarantine, at least in its initial phases, may have a negative impact on the metabolic profile of this population.

[Not Available]. / Estudio del impacto del índice de masa corporal pretrasplante sobre el pronto funcionamiento del injerto renal.

Introducción: la obesidad y el sobrepeso presentan efectos adversos sobre la salud, lo que contribuye a la aparición de enfermedades metabólicas y cardiovasculares que ponen en peligro la integridad del injerto.Objetivo: investigar la influencia del IMC pretrasplante renal sobre el funcionamiento del injerto renal al año de trasplante mediante el estudio de cuatro métodos distintos de medir la filtración glomerular.Material y métodos: en este trabajo se ha seguido a 1.336 pacientes de ambos sexos trasplantados renales; se les realizaron mediciones pretrasplante y postrasplante de parámetros bioquímicos, mediciones antropométricas y función renal mediante medidas de filtrado glomerular.Resultados: a mayor índice de masa corporal pretrasplante se produce una disminución del filtrado glomerular medido por cuatro métodos distintos, así como mayor porcentaje de rechazos.Conclusiones: un IMC elevado pretrasplante contribuye a la disfunción del injerto, a una disminución del filtrado glomerular y a complicaciones del injerto en el primer año postrasplante.

[LDL-cholesterol control in patients with genetic dyslipidemia followed up by Lipid and Vascular Risk Units of the Spanish Society of Arteriosclerosis]. / Control del colesterol-LDL en pacientes con dislipidemias genéticas seguidos en unidades de lípidos y riesgo vascular de la Sociedad Española de Arteriosclerosis.

OBJECTIVE: To evaluate low-density lipoprotein-cholesterol (LDLc) achieved in patients with genetic dyslipidemia treated during one year in Lipid and Vascular Risk Units (LVRU) of the Spanish Society of Arteriosclerosis (SSA). DESIGN: Observational, longitudinal, retrospective, multicenter national study that included consecutive patients of both sexes over 18 years of age referred due to dyslipidemia to LVRU of the SSA. Information was collected from medical records corresponding to two visits in the lipid unit. RESULTS: A total of 527 patients (mean age 48 years, 60.0% men) diagnosed with genetic dyslipidemia (241 with heterozygous familial hypercholesterolemia, and 286 with familial combined hyperlipidemia) were included. The mean follow-up was 12.9 months. In the last visit, 94% were taking statins, one third combined with ezetimibe, although only 41% were taking a high-intensity hypolipidemic treatment. Overall, 28.5% of patients attained an LDLc level<100 mg/dL, 35.8% decreased their LDLc by >50%, and 53.8% achieved one of the two. Predictors of target LDLc levels in the multivariate analysis were age, smoking habit and the presence of vascular disease. CONCLUSION: Over half of the patients with genetic dyslipidemia followed up by LVRU of SSA achieve LDLc objectives after one year of follow-up. The use of high-intensity hypolipidemic treatment could improve these results.

Inhibición de la oxidación in vitro de lipoproteínas de baja densidad (LDL), por extractos acuosos de Camellia sinensis e Hibiscus sabdariffa / Inhibition of low-density lipoprotein (LDL) oxidation in vitro by aqueous extracts of Camellia

Introducción: el uso de bebidas funcionales como las infusiones de Camellia sinensis e Hibiscus sabdariffa, ha crecido en los últimos años a nivel mundial gracias a su contenido en compuestos bioactivos con un alto poder antioxidante, atribuyéndoles diversos efectos entre los que destaca su capacidad hipolipemiente. Objetivo: el estudio tuvo como propósito evaluar la capacidad de dos extractos acuosos de C. sinensis e H. sabdariffa en la inhibición de la oxidación de las LDL obtenidas de plasma. Material y métodos: se emplearon hojas de té verde orgánico y cálices deshidratados para la obtención de los extracto. Se determino el contenido de fenoles totales por el método de Folin-Ciocalteu y el ensayo de la oxidación de las LDL como modelo biológico para la evaluación de la capacidad inhibitoria de los extractos. Resultados: se observó inhibición de la oxidación de las LDL por ambos extractos con diferencia estadística respecto al control (p≤0,05), siendo el extractos de C. sinensis el mayor actividad. Conclusiones: las dos especies aportan un alto contenido de antioxidantes fundamentales para el organismo, por lo que la ingesta regulada y dirigida por expertos podría contribuir sin duda al tratamiento de hiperlipidemia

Introduction: the use of functional beverages such as the infusions of Camellia sinensis and Hibiscus sabdariffa, has grown in recent years worldwide thanks to its content in bioactive compounds with a high antioxidant power, attributing various effects among which its lipid-lowering capacity stands out. Objective: the purpose of the study was to evaluate the capacity of two aqueous extracts of C. sinensis and H. sabdariffa in inhibiting the oxidation of LDL obtained from plasma. Material and methods: organic green tea leaves and dehydrated calyces were used to obtain the extracts. The total phenol content was determined by the Folin-Ciocalteu method and the LDL oxidation test as a biological model for the evaluation of the inhibitory capacity of the extracts. Results: inhibition of LDL oxidation by both extracts was observed with statistical difference from the control (p≤0.05), with C. sinensis extracts being the highest activity. Conclusions: the two species provide a high content of fundamental antioxidants for the body, so that regulated and expertly directed intake could certainly contribute to the treatment of hyperlipidemia

Effect of Hydro-alcoholic Extract from Prosopis Farcta Leaves on Liver Injury Caused by High-fat Diet in Rats / Efecto del extracto hidro-alcohólico de las hojas de Prosopis Farcta en la lesión hepática causada en ratas por una dieta rica en grasas

ABSTRACT Objective: To determine the hepatoprotective and antioxidant effects of hydro-alcoholic extract of Prosopis farcta (P farcta) leaves on high fat diet-fed (HFDF) rats. Methods: In this experimental study, 40 male Wistar rats were divided into four groups - group 1: normal control group; group 2: untreated control group, fed a high-fat diet; group 3: hyperlipidaemic + P farcta (500 mg/kg orally per day); and group 4: hyperlipidaemic + simvastatin (1.0 mg/kg). All groups were treated for 30 days. Liver enzymes, levels of total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein, blood urea nitrogen and creatinine, antioxidant enzyme activity, lipid peroxidation and liver histopathology were assessed. Results: Prosopis farcta extract reduced the elevated levels of total cholesterol, triglycerides, LDL and body weight. Catalase and superoxide dismutase activity were reduced in the HFDF animals, whose levels were increased statistically significantly by extract of P farcta leaves. The statistically significant increases in liver malondialdehyde in HFDF rats were reduced after treatment with P farcta. Histopathological findings also revealed positive effects of the extract. Conclusion: These results indicate the lipid-lowering and antioxidative activity of extract of P farcta leaves.

RESUMEN Objetivo: Determinar los efectos hepatoprotectores y antioxidantes del extracto hidroalcohólico de las hojas de Prosopis farcta (P farcta) en ratas alimentadas con dieta rica en grasas (ADRG). Métodos: En este estudio experimental, 40 ratas macho Wistar se dividieron en cuatro grupos - Grupo 1: Grupo de control normal; Grupo 2: Grupo de control no tratado, alimentado con una dieta alta en grasas; Grupo 3: hiperlipidémico + P farcta (500 mg/kg por vía oral por día); y Grupo 4: hiperlipidémico + simvastatina (1.0 mg/kg). Todos los grupos fueron tratados durante 30 días. Se evaluaron las enzimas hepáticas, los niveles de colesterol total, los triglicéridos, la lipoproteína de baja densidad (LBD), la lipoproteína de alta densidad (LAD), el nitrógeno ureico y la creatinina en sangre, la actividad enzimática antioxidante, la peroxidación lipídica, y la histopatología hepática. Resultados: El extracto de Prosopis farcta redujo los niveles elevados de colesterol total, los triglicéridos, la LBD, y el peso corporal. La actividad de la catalasa y el superóxido dismutasa se redujo en los animales ADRG, cuyos niveles se incrementaron estadísticamente en grado significativo mediante el extracto de hoja de P farcta. Los aumentos estadísticamente significativos en el malondialdehído hepático en ratas ADRG, disminuyeron después del tratamiento con P farcta. Los hallazgos histopatológicos también revelaron efectos positivos del extracto. Conclusión: Estos resultados indican la actividad de reducción de lípidos y la actividad anti-oxidantes del extracto de las hojas de P farcta.

[Familial combined hyperlipidemia: consensus document]. / Hiperlipidemia familiar combinada: documento de consenso.

Familial combined hyperlipidemia (FCH) is a frequent disorder associated with premature coronary artery disease. It is transmitted in an autosomal dominant manner, although there is not a unique gene involved. The diagnosis is performed using clinical criteria, and variability in lipid phenotype and family history of hyperlipidemia are necessaries. Frequently, the disorder is associated with type2 diabetes mellitus, arterial hypertension and central obesity. Patients with FCH are considered as high cardiovascular risk and the lipid target is an LDL-cholesterol <100mg/dL, and <70mg/dL if cardiovascular disease or type 2 diabetes are present. Patients with FCH require lipid lowering treatment using potent statins and sometimes, combined lipid-lowering treatment. Identification and management of other cardiovascular risk factors as type 2 diabetes and hypertension are fundamental to reduce cardiovascular disease burden. This document gives recommendations for the diagnosis and global treatment of patients with FCH directed to specialists and general practitioners.

Proteomics: a tool to investigate of composition and function of HDL in hyperlipidemia / Proteômica: uma ferramenta para a investigação da composição e função da HDL em hiperlipidemia

The inverse relationship between HDL-C (high-density lipoprotein cholesterol) and cardiovascular disease is well established. However, it is consensus that the cholesterol content present in HDL does not capture its complexity, and other metrics need to be explored. HDL is a heterogeneous, protein-enriched particle with functions going beyond lipid metabolism. In this way, its protein content seems to be attractive to investigate its behavior in the face of pathologies. Many of the proteins with important function in HDL are in low abundance (<1% of total proteins), which makes their detection challenging. Quantitative proteomics allows detecting proteins with high precision and robustness in complex matrix. However, quantitative proteomics is still poorly explored in the context of HDL. In this sense, in the second chapter of this thesis, the analytical performance of two quantitative methodologies was carefully investigated. These methods achieved adequate linearity and high precision using labeled peptides in a pool HDL, in addition to comparable ability to differentiate proteins from HDL subclasses of healthy subjects. Another bottleneck that waits for a solution in proteomics is the lack of standardization in data processing and analysis after mass spectrometry acquisition. In addition, interest in the cardioprotective properties of omega-3 is growing, but little is known about its effects on the HDL proteome. Thus, in the third chapter of this thesis, we compared five protein quantification strategies using Skyline and MaxDIA software platforms in order to investigate the HDL proteome from mice submitted to a high-fat diet supplemented or not with omega-3. MaxDIA with label-free quantification (MaxLFQ) achieved high precision to show that polyunsaturated fatty acids remodel the HDL proteome to a less inflammatory profile. Therefore, the two studies presented in this thesis begin to open new paths for a deeper and more reliable understanding of HDL, both at the level of protein quantification by mass spectrometry and after data acquisition

A inversa relação entre HDL-C (do inglês, high-density lipoprotein cholesterol) e doenças cardiovasculares é bem estabelecida. No entanto, é consenso que o conteúdo de colesterol presente na HDL não captura sua complexidade, e outras métricas precisam ser exploradas. A HDL é uma partícula heterogênea, enriquecida em proteínas, com funções que vão além do metabolismo de lipídeos. Dessa forma, seu conteúdo proteico parece ser mais atrativo para exprimir seu comportamento frente às patologias. Muitas das proteínas com função importante estão em baixa abundância (<1% do total de proteínas), o que torna a detecção desafiadora. Métodos quantitativos de proteômica permitem detectar proteínas com alta precisão e robustez em matrizes complexas. No entanto, a proteômica quantitativa ainda é pouco explorada no contexto da HDL. Nesse sentido, no segundo capítulo dessa tese, a performance analítica de dois métodos quantitativos foi criteriosamente investigada, os quais alcançaram adequada linearidade e alta precisão usando peptídeos marcados em um pool de HDL, além de comparável habilidade em diferenciar as proteínas das subclasses da HDL de indivíduos saudáveis. Outro gargalo que aguarda por solução em proteômica é a falta de padronização no processamento e análise de dados após a aquisição por espectrometria de massas. Além disso, é crescente o interesse das propriedades cardioprotetivas do ômega-3, porém pouco se conhece sobre seus efeitos no proteoma da HDL. Então, no terceiro capítulo dessa tese, comparamos cinco estratégias de quantificação de proteínas utilizando os softwares Skyline e MaxDIA com o intuito de comparar o proteoma da HDL de camundongos submetidos a uma dieta hiperlipídica suplementados ou não com ômega-3. MaxDIA com quantificação label-free (MaxLFQ) apresentou alta precisão para mostrar que o ômega-3 remodela o proteoma da HDL para um perfil menos inflamatório. Portanto, os dois estudos apresentados nessa tesa começam a abrir novos caminhos para o entendimento mais profundo e confiável da HDL tanto por meio da quantificação das proteínas por espectrometria de massas quanto após à aquisição dos dados

Efecto del consumo de jugo de tomate de árbol (Cyphomandra betacea) sobre el perfil lipídico y las concentraciones de glucosa en adultos con hiperlipidemia, ecuador / Effect of consumption of tree tomato juice (Cyphomandra betacea) on lipid profile and glucose concentrations in adults with hyperlipidemia, ecuador

En este trabajo se evaluó el efecto del consumo del jugo de tomate de árbol (Cyphomandra betacea) sobre parámetros nutricionales y bioquímicos en 54 voluntarios (44 mujeres y 10 hombres) con edades 45±8 años de Ecuador. Al inicio se les realizó una evaluación nutricional y bioquímica, luego se les invitó a consumir el jugo (100g de fruto en 150 ml de agua) diariamente durante 6 semanas. Finalizado este tiempo, se procedió a realizar la evaluación nutricional y bioquímica nuevamente. La evaluación nutricional determinó 67% de obesidad abdominal. Disminuyendo a 53% después del consumo del jugo de tomate de árbol. El 87% de los voluntarios antes del tratamiento, mostraron hipercolesterolemia; 40,7% y 46,3% tenían los triglicéridos y el LDL elevados y 18,5% valores de glucosa entre 98-130mg/dL. Valores que disminuyeron significativamente en este grupo después de la toma del jugo En general, tanto en voluntarios con y sin sobrepeso se observó disminución significativa de colesterol total, LDL y glucosa; sin cambios significativos en los valores de HDL. El consumo del jugo no afectó la actividad de las enzimas alanina-aminotransferasa ni aspartato-aminotransferasa, tampoco las concentraciones de creatinina, urea y ácido úrico; ni la presión arterial, demostrando que no afecta la función hepática ni renal. Estos resultados indican que el consumo del jugo de tomate de árbol, durante seis semanas, parece ejercer un efecto hipolipemiante y moduladora en el metabolismo de la glucosa y colocan a C betacea como uno de los frutos andinos con alto potencial nutraceutico. Sin embargo, estos aspectos deben ser investigados con más detalles(AU)

In this work the effect of consumption of tree tomato juice (Cyphomandra betacea) was evaluated on nutritional and biochemical parameters in 54 volunteers (44 women and 10 men) aged 45 ± 8 years-Ecuador. A nutritional and biochemical evaluation was performed in volunteers; then they were invited to drink tree tomato juice (100g of fruit in 150 ml of water) daily for 6 weeks. Finished these 6 weeks, volunteers were nutritional and biochemical evaluated again. 67% abdominal obesity was found, decreasing at 53% after drinking the established dosage of juice. 87% of the volunteers before treatment, showed hypercholesterolemia, 40.7% and 46.3% had hypertriglyceridemia and elevated LDL, respectively and 18.5% glucose concentrations between 98-130 mg/dL. These values decrease significantly in this group after drinking tomato juice. In general, Total Cholesterol, LDL and glucose concentrations decrease significantly after drinking tree tomato juice in all the voluntaries with or without overweight. There is no change in HDL concentrations. The consumption of tree tomato juice did not affect the activity of alanine aminotransferase or aspartate aminotransferase enzymes either creatinine, urea and uric acid concentrations, neither blood pressure suggesting that does not affect renal or liver function. These results indicate that consumption of tree tomato juice for six weeks appears to have a lipid-lowering and modulating effect on glucose metabolism, suggesting C betacea as one of the high Andean fruits nutraceutical potential. However, this issue should be investigated in more detail(AU)

Síndrome metabólico en un grupo de adultos mayores no institucionalizados según criterios de organismos internacionales / Metabolic syndrome in a non-institutionalized elderly group according to international organizations' criteria

RESUMEN Antecedentes: aunque el síndrome metabólico es frecuente en los adultos mayores, no es claro si aumenta el riesgo cardiovascular en este grupo poblacional. Objetivo: determinar la proporción de síndrome metabólico en un grupo de adultos mayores, según los criterios de organismos internacionales. Materiales y métodos: estudio descriptivo transversal en 141 adultos ≥ 60 años de Medellín-Colombia. El síndrome metabólico se clasificó según los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) y la International Diabetes Federation (IDF). Se evaluaron variables sociodemográficas, antropométricas, clínicas, bioquímicas y estilos de vida. Resultados: el 73,8 % fueron mujeres y 84,4 % tenían edades entre 60-74 años. El síndrome metabólico fue 45,4 % según criterios de IDF y 27,0 % según ATP III. Los componentes más frecuentes fueron obesidad central, colesterol HDL bajo e hipertrigliceridemia. La presencia del síndrome según criterios de IDF fue superior en mujeres (p=0,026), en adultos mayores con nivel educativo bajo (p=0,011) y con IMC más altos (p<0,001). Conclusión: la proporción del síndrome metabólico fue mayor según los criterios de IDF, encontrándose asociación con el sexo femenino, el nivel educativo bajo y el índice de masa corporal alto.

ABSTRACT Background: Although metabolic syndrome is common in elderly people, it is not clear if cardiovascular risk is increased in this population group. Objective: To determine the proportion of metabolic syndrome in a group of elderly people older than 60 years according to international organizations criteria. Materials and methods: Cross sectional descriptive study performed in 141 adults older than 60 years in Medellin-Colombia. The metabolic syndrome was classified according to the Third Report of the National Cholesterol Education Program (NCEP ATP III) and the International Diabetes Federation (IDF) criteria. Socio-demographic, anthropometric, clinical, biochemical and life-style variables were assessed Results: Were female 73.8 % of individuals and 84.4 % had ages between 60-74 years old. The metabolic syndrome was diagnosed in 45.4 % of the population based on the IDF criteria and 27.0 % according to ATPIII. Abdominal obesity, low HDL cholesterol and hypertriglyceridemia were the most frequent components found. The metabolic syndrome based on IDF criteria was more frequent in women (p= 0,026), in elderly people with low educational level (p=0,011), and with higher BMI (p <0,001). Conclusion: The proportion of MS was high according to IDF criteria; In addition, association with female gender, level of education and BMI was found.

Metabolic syndrome resolution by Roux-en-Y gastric bypass in a real world: a case control study / Resolução da síndrome metabólica pela gastroplastia Roux-em-Y em um mundo real: estudo caso-controle

Summary Objectives: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). Methods: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. Results: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). Conclusion: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS. .

Resumo Objetivo: o objetivo deste estudo foi avaliar a eficácia do bypass gástrico em Y de Roux (BGYR), em comparação a um tratamento não cirúrgico (grupo NC), como instrumento para induzir remissão da síndrome metabólica (SMet) em pacientes com obesidade graus 2 e 3 (Ob2, 3). Métodos: duzentos e cinquenta e oito pacientes com Ob2,3 foram selecionados para análise retrospectiva em estudos de caso e controle. SMet foi definida como descrita pela Federação Internacional de Diabetes. Dos pacientes, 129 foram submetidos ao BGYR (grupo C), e 129 formaram o grupo NC. Resultados: antes dos tratamentos, os grupos C e NC não diferiram em IMC, idade, sexo feminino e prevalência de SMet (p>0,05). No grupo C, houve uma redução no IMC de 38,1% (p<0,001), circunferência da cintura de 28,6% (p<0,001), glicemia de jejum de 10,5% (p<0,001), LDL colesterol sérico de 21,9% (p<0,001) e em 85% dos casos de SMet (p<0,001). As diferenças observadas no grupo NC foram uma diminuição nos níveis de triglicérides, de 4,12% (p=0,047), e na pressão arterial diastólica, de 5,9% (p=0,031). No grupo NC, 98,6% dos pacientes persistiram com SMet. O número necessário para tratar (NNT) com a cirurgia, para resolver um caso de SMet, foi de 1,2 (IC 95%: 1,1 - 1,4). Conclusão: em um mundo real, no Sul do Brasil, em comparação ao tratamento NS e após 1 ano de observação, BGYR foi altamente eficaz para diminuir a prevalência de SMet. .

Xantomatosis eruptiva asociada a hiperlipoproteinemia tipo IV de Fredrickson: a propósito de un caso / Eruptive xanthomatosis associated with Fredrickson type IV hyperlipoproteinemia: case report

Los xantomas cutáneos son una expresión de depósito de lípidos en la piel; pueden ser normolipémicos o dislipémicos, producidos por un defecto genético primario o una alteración metabólica. Las manifestaciones cutáneas de las xantomatosis se presentan con diversas características. Presentamos una paciente joven, sin antecedentes patológicos previos, que consultó por la aparición repentina de lesiones xantomatosas cutáneas, en la cual se arribó al diagnóstico de xantomatosis eruptiva asociadaa trastorno lipídico subyacente. El interés de nuestra presentación radica en que esta afección cutánea puede constituir la única manifestación de las alteraciones de las lipoproteínas, clasificadas dentro del grupo de las dislipidemias de Fredrickson y ser el punto de partida para su diagnóstico y tratamiento oportuno ya que generan un compromiso sistémico y riesgo de vida.

Cutaneous xanthomas are an expression of lipid deposition on the skin. They can be normolipidemic or dyslipidemic and are caused by a primary genetic defect or a metabolic disorder. Cutaneous manifestations of xanthomatosis show various features. We report a young woman with no previous medical history who presented sudden onset of cutaneous xanthomatous lesions, and whose diagnosis showed eruptive xanthomatosis associated with an underlying lipid disorder. The interest of our presentation is that this cutaneous affectation may be the only manifestation of lipoproteins disorders, classified within the group of Fredrickson's dyslipidemias and also the starting point for an appropiate diagnosis and treatment because they generate a systemic commitment and life threatening.