[Hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in human immunodeficiency virus-infected patients]. / El fenotipo "hipertrigliceridemia-cintura abdominal aumentada" es un factor de riesgo de aterosclerosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: To study the association between hypertriglyceridemic waist phenotype and the presence of subclinical atherosclerosis in human immunodeficiency virus (HIV) infected patients. PATIENTS AND METHODS: Cross sectional study. Hypertriglyceridemic waist phenotype was considered if the waist was ≥90cm and triglycerides ≥2.0mmol/l (178mg/dl) in men and ≥85cm and ≥1.5mmol/L (133mg/dl) in women, respectively. We used the intima-media thickness (IMT) to detect carotid subclinical atherosclerosis. RESULTS: We analyzed 152 patients, of whom 128 (84.2%) were receiving antiretroviral therapy, 40.7% were receiving protease inhibitors and 38.1% were treated with non-nucleoside reverse transcriptase inhibitors. The prevalence of hypertriglyceridemic waist phenotype was 23.6% (95% confidence interval [CI] 16.8-30.3%). Patients with hypertriglyceridemic waist phenotype had higher cardiovascular risk according to the Framingham score (11.09 [7.6] vs 3.88 [4], P=0.001) and lipodystrophy (33.3 vs. 13.7%, P=0.032) and metabolic syndrome (69.4 vs. 1.9%, P<0.001) were more frequent. The IMT was elevated in 21 (13.8%) patients. Hypertriglyceridemic waist phenotype (odds ratio [OR] 4.66 [95%CI 1.05-20.6; P = 0.043]) and metabolic syndrome (OR 3.74 [95%CI 1.25-11.23; P = 0.018]) were independently associated with higher IMT. CONCLUSIONS: The hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in HIV infected patients and it is useful to detect patients with lipodystrophy, metabolic syndrome and high cardiovascular risk.

Trunk muscle involvement in late-onset Pompe disease: study of thirty patients.

Late-onset Pompe disease is characterized by progressive weakness involving proximal limb and respiratory muscles. Recently, treatment with enzyme replacement therapy (ERT) has been introduced partially improving patients' prognosis, but a standard consensus on when to start ERT is still lacking. There is also a lack of biomarkers related to the clinical progression of the disease. Here we used muscle magnetic resonance imaging (MRI) or computed tomography (CT) to study the abdominal and paravertebral muscles of 30 late-onset Pompe patients at different stages of disease. We observed a selective pattern of muscle damage, with early involvement of the Multifidus muscle, followed by the Obliquus internus abdominis and Longissimus muscle. Some degree of trunk involvement on MRI occurred even in asymptomatic patients. Severity of muscle involvement in MRI correlated with patients' functional stage. We suggest that: (a) the combination of paravertebral and abdominal muscle involvement may serve as a useful tool in the diagnostic work-up of patients with a clinical suspicion of Pompe disease; (b) trunk abnormalities appear at very early stages of disease and even in asymptomatic patients, possibly "announcing" the onset of the disease and thus the need for a closer clinical follow-up.

Common carotid artery intima-media thickness and intracranial pulsatility index in non-ST-elevation acute coronary syndromes.

BACKGROUND: Common carotid intima-media thickness (CIMT) has been related to cardiovascular risk factors, coronary atherosclerosis and a higher risk of myocardial infarction. Evaluation of intracranial arteries by transcranial Doppler explores the presence of vascular dysfunction at this level. We tested the hypothesis that CIMT and Doppler Pulsatility Index (DPI) can be related to the Thrombolysis in Myocardial Infarction (TIMI) risk score for non-ST-elevation acute coronary syndrome (nST-ACS). The relation to the prognosis after an acute event was also assessed. METHODS: We recruited 126 consecutive patients (80 males; mean age: 66.6 +/- 13.1 years) admitted with nST-ACS. A carotid assessment with bidimensional mode, measuring the CIMT in the posterior wall of the common carotid artery, and a transcranial Doppler assessment of the middle cerebral artery, with measurement of the Pulsatility Index were carried out. Clinical follow-up at 6 months was performed for endpoints (cardiovascular death, recurrent ACS or revascularization). RESULTS: Fifty-nine patients had an abnormal (> or =0.8 mm) CIMT, whilst 70 patients had an abnormal DPI (> or =1.2). CIMT was correlated with TIMI risk score (Pearson r: 0.26; p = 0.004), whilst abnormal DPI was associated with TIMI risk scale (p < 0.001). Using a logistic regression analysis, the presence of an abnormal CIMT was only related to age > or =65 (p = 0.0012) and diabetes mellitus (p = 0.0028). Abnormal DPI was also associated with age > or =65 (p < 0.0001) and diabetes mellitus (p = 0.0466). Neither CIMT nor DPI were related to 6 months' clinical outcome. CONCLUSIONS: Patients with nST-ACS have a high prevalence of dates of abnormal DPI, which was associated with increased CIMT. Both variables were related to age and diabetes but not with clinical outcomes.