Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999-2014.

The association between low density lipoprotein cholesterol (LDL-C) and all-cause mortality has been examined in many studies. However, inconsistent results and limitations still exist. We used the 1999-2014 National Health and Nutrition Examination Survey (NHANES) data with 19,034 people to assess the association between LDL-C level and all-cause mortality. All participants were followed up until 2015 except those younger than 18 years old, after excluding those who died within three years of follow-up, a total of 1619 deaths among 19,034 people were included in the analysis. In the age-adjusted model (model 1), it was found that the lowest LDL-C group had a higher risk of all-cause mortality (HR 1.708 [1.432-2.037]) than LDL-C 100-129 mg/dL as a reference group. The crude-adjusted model (model 2) suggests that people with the lowest level of LDL-C had 1.600 (95% CI [1.325-1.932]) times the odds compared with the reference group, after adjusting for age, sex, race, marital status, education level, smoking status, body mass index (BMI). In the fully-adjusted model (model 3), people with the lowest level of LDL-C had 1.373 (95% CI [1.130-1.668]) times the odds compared with the reference group, after additionally adjusting for hypertension, diabetes, cardiovascular disease, cancer based on model 2. The results from restricted cubic spine (RCS) curve showed that when the LDL-C concentration (130 mg/dL) was used as the reference, there is a U-shaped relationship between LDL-C level and all-cause mortality. In conclusion, we found that low level of LDL-C is associated with higher risk of all-cause mortality. The observed association persisted after adjusting for potential confounders. Further studies are warranted to determine the causal relationship between LDL-C level and all-cause mortality.

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC).

BACKGROUND: The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS: Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS: Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION: Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING: Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.

Phytosterol supplementation in the treatment of dyslipidemia in children and adolescents: a systematic review / Suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: To carry out a systematic review on the effects of phytosterol supplementation on the treatment of dyslipidemia in children and adolescents. Data sources: Review in the SciELO, Lilacs, Bireme, PubMed and Web of Science databases, with no time limit. Descriptors: phytosterols or plant sterols and dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, in English and Portuguese. The articles included were published in Portuguese, English or Spanish and evaluated the effect of phytosterol supplementation in pediatric patients with dyslipidemia. Documents that involved adults or animals, review papers, case studies and abstracts were excluded. Two authors performed independent extraction of articles. Of 113 abstracts, 19 were read in full and 12 were used in this manuscript. Data synthesis: Phytosterol supplementation to reduce cholesterol levels has been shown to be effective in reducing LDL-cholesterol levels by approximately 10%, with reductions above 10% in LDL-cholesterol levels observed after 8 to 12 weeks of intervention. Studies have not shown significant changes in HDL-cholesterol and triglyceride levels. Based on the absence of adverse effects, its use seems to be safe and of good tolerance in children and adolescents. Conclusions: Phytosterol supplementation seems to be of great therapeutic aid for the treatment of hypercholesterolemia in children and adolescents. Further studies assessing the long-term effect of phytosterol supplementation are necessary.

RESUMO Objetivo: Realizar uma revisão sistemática sobre os efeitos da suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes. Fontes de dados: Revisão nos bancos SciELO, Lilacs, Bireme, Pubmed e Web of Science, sem limite de tempo. Descritores: phytosterols or plant sterols, dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, nas línguas inglesa e portuguesa. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e avaliaram o efeito da suplementação de fitoesteróis em pacientes pediátricos com dislipidemia. Estudos que envolviam adultos ou animais, trabalhos de revisão, estudos de caso e resumos foram excluídos. A extração independente de artigos foi realizada por dois autores. Do total de 113 resumos, 19 foram lidos na íntegra, e 12 utilizados neste manuscrito. Síntese de dados: A suplementação de fitoesteróis para a redução dos níveis de colesterol mostrou-se eficiente, de forma a promover a redução de aproximadamente 10% dos níveis de LDL-colesterol, sendo observadas reduções acima de 10% em 8 a 12 semanas de intervenção. Os estudos não mostraram alterações significantes nos níveis de HDL-colesterol e triglicérides. Com base na ausência de efeitos adversos, seu uso parece ser seguro e de boa tolerância em crianças e adolescentes. Conclusões: A suplementação com fitoesteróis parece ser de grande auxílio terapêutico para o tratamento da hipercolesterolemia em crianças e adolescentes. São necessários mais estudos que avaliem o efeito em longo prazo da suplementação de fitoesteróis.

Familial hypercholesterolaemia.

Familial hypercholesterolaemia is a common inherited disorder characterized by abnormally elevated serum levels of low-density lipoprotein (LDL) cholesterol from birth, which in time can lead to cardiovascular disease (CVD). Most cases are caused by autosomal dominant mutations in LDLR, which encodes the LDL receptor, although mutations in other genes coding for proteins involved in cholesterol metabolism or LDLR function and processing, such as APOB and PCSK9, can also be causative, although less frequently. Several sets of diagnostic criteria for familial hypercholesterolaemia are available; common diagnostic features are an elevated LDL cholesterol level and a family history of hypercholesterolaemia or (premature) CVD. DNA-based methods to identify the underlying genetic defect are desirable but not essential for diagnosis. Cascade screening can contribute to early diagnosis of the disease in family members of an affected individual, which is crucial because familial hypercholesterolaemia can be asymptomatic for decades. Clinical severity depends on the nature of the gene that harbours the causative mutation, among other factors, and is further modulated by the type of mutation. Lifelong LDL cholesterol-lowering treatment substantially improves CVD-free survival and longevity. Statins are the first-line therapy, but additional drugs, such as ezetimibe, bile acid sequestrants, PCSK9 inhibitors and other emerging therapies, are often required.

Predictive factors of mortality in patients with acute mesenteric ischemia. A retrospective study.

AIM: The aim of this retrospective study was to evaluate the impact of some risk factors on mortality in patients with Acute mesenteric ischemia (AMI). MATERIALS AND METHODS: From September 2003 to August 2011, 200 patients were operated on for bowel infarction at our unit: 149 were included in the study. For each patient, socio-demographic (gender and age) and clinical data (extent of necrosis, predisposing factors, WBC, LDH, comorbidities) were collected from patients' clinical records. RESULTS: Of the 149 patients who underwent surgery, 57 (38.3%) died. A significantly higher mortality was associated with older age (79.9 versus 74.2 years, p < 0.01), higher LDH serum levels (695 versus 636 UI/L, p < 0.01), higher WBC (25.1 versus 22.5 X 103/mm3; p < 0.01), and extent of necrosis (p< 0.01). Otherwise, there was no correlation between comorbidities and mortality. Finally, multivariate analysis confirmed the significantly higher risk of death in patients with right colon and massive small bowel infarction (adjOR= 3.58; 95% CI=1.36-9.42) and intestinal perforation (adjOR=31.1; 95% CI=2.45-395.7). DISCUSSION: The results of our study suggest that the contribution of laboratory tests is limited, even if increased indexes of necrosis (such as LDH) associated with neutrophilic leukocytosis and metabolic acidosis, may help in defining diagnosis/ prognosis, though with low accuracy. CONCLUSIONS: The extent of necrosis and diagnostic delay seem to be the most important prognostic factors even after adjusting for confounding due to age, presence of comorbidities, and laboratory tests (LDH and WBC). KEY WORDS: Acute mesenteric ischemia, Mortality, Predictive factors.

Pharmacist-led group medical appointments for the management of type 2 diabetes with comorbid depression in older adults.

BACKGROUND: Depression is associated with poor glycemic control, increased number of microvascular and macrovascular complications, functional impairment, mortality, and 4.5 times higher total health care costs in patients with diabetes. Shared medical appointments (SMAs) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support, counseling, problem solving, and improved access to care. OBJECTIVE: To test the efficacy as assessed by attainment of a hemoglobin A(1c) (A1C) <7% of pharmacist-led group SMA visits, Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression (VA-MEDIC-D), in patients with type 2 diabetes mellitus. METHODS: This was a randomized controlled trial of VA-MEDIC-D added to standard care versus standard care alone in depressed patients with diabetes with A1C >6.5%. VA-MEDIC-D consisted of 4 once-weekly, 2-hour sessions followed by 5 monthly 90-minute group sessions. Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes, lipids, smoking, and blood pressure. No pharmacologic interventions for depression were provided. The change in the proportion of participants who achieved an A1C <7% at 6 months was compared. RESULTS: Compared to standard care (n = 44), a lower proportion of patients in VA-MEDIC-D (n = 44) had systolic blood pressure (SBP) <130 mm Hg at baseline, but were similar in other cardiovascular risk factors and psychiatric comorbidity. The change in the proportion of participants achieving an A1C <7% was greater in the VA-MEDIC-D arm than in the standard care arm (29.6% vs 11.9%), with odds ratio 3.6 (95% CI 1.1 to 12.3). VA-MEDIC-D participants also achieved significant reductions in SBP, low-density lipoprotein cholesterol, and non-high-density lipoprotein (HDL) cholesterol from baseline, whereas significant reductions were attained only in non-HDL cholesterol with standard care. There was no significant change in depressive symptoms for either arm. CONCLUSIONS: Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms.

Estado nutricional de trabajadores bajo turnos rotativos o permanentes / Nutritional state of workers under steady or rotating shifts

Restrictions of sleep predispose to experience, in the long-term, excess malnutrition and non-transmissible chronic diseases. The objective of this research has to study the influence of working shifts on nutritional status lipid profile and fasting blood glucose (FBG). Study of a series of cases considered a total of47 recruited workers from which 31 of them had a rotating shift (day and night) and 16 a steady shift (day). The nutritional assessment involved: BMI (Body Mass index), waist and hip circumference, tricipital, bicipital, sub scapular and supra iliac skin folds. Sleep hours were studied with a weekly record, food intake was studied by means of 24-hours dietary recall. It was determined: total cholesterol, c-HDL, c-LDL, blood triglycerides and fasting blood glucose (FBG). The sample was composed by 87 percent women and 13 percent men, average age of 38,7years [19,0] v/s 44,7[25¿2] (p=0,420) in rotating and steady shifts respectively. The rotating shift did not show any significant differences compared to the steady shift in terms of anthropometric parameters except for sub scapular skin fold that was significantly higher (p=0,032) in relation to the macronutrients intake. Lipid profile and glycerin did not show important differences (p=>0,05). The prevalence of the nutritional status was: rotating shift 35,4 percent normal, 45,1 percent overweight and 19,5 percent obese. On the other hand, the steady shift showed: 43,7 percent normal and 56¿ percent overweight. Seniority only in the rotating shift showed a positive correlation of BMI (r=0,436 p<0,005) body fat (r=0,454 p<0,005) total cholesterol (r= 0,¿94 p<0,005) LDL (r=0,484 p<0,005) and glycerin (r=0,405 p<0,005). We concluded that workers of the rotating and steady shift did not show significant differences among variables studied except for the sub scapular skin fold that was significantly higher in the rotating shift, that can be associated to predominantly central fat distribution.

Restricciones del sueño predisponen a padecer, a largo plazo, malnutrición por exceso y enfermedades crónicas no transmisibles. El objetivo fue estudiar la influencia del turno laboral sobre estado nutricional, perfil lipídico y glicemia en ayuno. Estudio exploratorio del tipo de serie de casos, 47 reclutados; 31 turnos rotativos (día y noche), y 16 turno permanente (día). La evaluación nutricional se efectuó mediante el IMC, la circunferencia cintura-cadera y los pliegues tricipital, bícipital, subescapular y suprailiaco. Se estudió las horas sueño mediante un registro semanal, la ingesta dietética por encuesta de recordatorio de 24 horas. Se determinó el colesterol total, c-HDL, c-LDL, triglicéri-dos séricos y glicemia. La muestra estuvo representada en un 87 por ciento mujeres y 13 por ciento por hombres, cuya mediana de edad fue de 38,7 años [19,0] y 44,7[25,2] (p=0,420) en turno rotativo y permanente, respectivamente. El turno rotativo no mostró diferencias significativas respecto al turno permanente en los parámetros antropométricos a excepción, del pliegue subescapular que fue significativamente superior (p=0,032), respecto a ingesta de macronutrientes, perfil lipídico y glicemia tampoco mostró diferencias significativas (p=> 0,05). La prevalencia del estado nutricional en el turno rotativo fue en 35,4 por ciento normal, en 45,1 por ciento sobrepeso y en 19,5 por ciento obesidad, y turno permanente: 43,7 por ciento normal y 56,3 por ciento sobrepeso. La antigüedad laboral sólo en el turno rotativo se correlacionó positivamente con IMC (r=0,436 p<0,005), grasa corporal (r=0,454 p<0,005), el colesterol total (r= 0,394 p<0,005) el LDL (r=0,484 p<0,005) y la glicemia (r=0,405 p<0,005). En conclusión, los funcionarios del turno rotativo y permanente no mostraron diferencias significativas entre las variables estudiadas, a excepción del pliegue subescapular que fue significativamente mayor en el turno rotativo, lo que podría asociarse a la distribución de la...

Comparison of percent of United States adults weighing>or=300 pounds (136 kilograms) in three time periods and comparison of five atherosclerotic risk factors for those weighing>or=300 pounds to those<300 pounds.

The radiologic tables used for many imaging procedures have maximum weight limits. Many United States (US) adults may have a body weight that exceeds these limits and may be ineligible for diagnostic imaging procedures. Using data from the National Health and Nutrition Examination Surveys in 1976 to 1980, 1988 to 1994, and 1999 to 2004, we determined the increase in the percentage and number of US adults weighing>or=300 pounds (i.e., the weight limit for an electron beam computed tomography table). In addition, the prevalence and clustering of 5 cardiovascular disease risk factors (current smoking, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, and elevated C-reactive protein) was determined for US adults weighing>or=300 pounds, and compared with their counterparts weighing<300 pounds. The percentage of US adults, >or=20 years, weighing>or=300 pounds was 0.10%, 0.79%, and 1.50% in 1976 to 1980, 1988 to 1994, and 1999 to 2004, respectively (p trend<0.001). This corresponds to an increase from 130,000 US adults weighing>or=300 pounds in 1976 to 1980, to 1,390,000 in 1988 to 1994 and 3,020,000 in 1999 to 2004 (p trend<0.001). After age standardization, in 1999 to 2004, 34.1% and 24.0% of adults weighing>or=300 pounds had 2 and >or=3, respectively, of the 5 cardiovascular disease risk factors, compared with 17.7% and 5.3%, respectively, of adults weighing<300 pounds (each p<0.001). In conclusion, morbid obesity has increased dramatically among US adults. The clustering of cardiovascular disease risk factors associated with morbid obesity and the exclusion from diagnostic imaging may affect those most in need of such procedures.

[Prevalence of endometrial injury in asymptomatic obese women]. / Prevalência de lesões endometriais em mulheres obesas assintomáticas.

OBJECTIVE: Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS: A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index > or = 30 kg/m2) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS: In pre-menopausal women, 12.8% of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4% of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS: The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In pre-menopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis.

Prevalência de lesões endometriais em mulheres obesas assintomáticas / Prevalence of endometrial injury in asymptomatic obese women

OBJETIVOS: A obesidade representa importante fator de risco para alterações endometriais. O presente estudo teve por objetivo avaliar a prevalência de lesões endometriais, como pólipos, hiperplasia e câncer de endométrio em mulheres obesas assintomáticas, assim como reconhecer os fatores de risco associados. MÉTODOS: Entre dezembro de 2004 e fevereiro de 2006, em estudo transversal foram avaliadas 94 mulheres obesas (índice de massa corpóreo >30Kg/m²), divididas em dois grupos com 47 participantes cada: em idade reprodutiva e após a menopausa. Foram analisados: história clínica, exame físico (antropométrico/ginecológico), determinações bioquímicas e avaliação do endométrio por ultra-sonografia endovaginal, biópsia e histeroscopia (para confirmar patologia endometrial). RESULTADOS: Nas mulheres em idade reprodutiva foram encontrados 12,8 por cento de casos de patologia endometrial, que se associaram significativamente com as elevações da idade, hipertensão arterial (HAS), colesterol e LDL-c. Após a menopausa, foram identificadas 40,4 por cento de lesões endometriais que se associaram significativamente com pressão arterial sistólica (PAS) > 140mmHg, elevação do LDL-c e da estrona. Dois casos de câncer de endométrio foram constatados, sendo um em cada grupo. CONCLUSÃO: O aumento de incidência da obesidade nos últimos anos tem elevado os fatores de risco para o câncer de endométrio. Na idade reprodutiva tivemos um pequeno tamanho amostral de alterações endometriais; com isso, poderíamos apenas sugerir, uma maior atenção àquelas com idade superior a 40 anos, que apresentem HAS e/ou elevação do LDL-c. O status menopausal eleva o risco de lesão endometrial; associado com elevações da PAS, LDL-c e/ou estrona, elas se tornarão candidatas à biópsia de endométrio, visando o diagnóstico precoce do câncer, decisivo para o prognóstico favorável da mulher.

OBJECTIVE: Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS: A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index > 30 kg/m²) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS: In pre-menopausal women, 12.8 percent of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4 percent of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS: The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In pre-menopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis.

Conduta diagnóstica e terapêutica nas hiperlipidemias em Pediatria / Diagnosis and therapeutic approach to hyperlipidemias in Pediatrics

Os autores realizam uma revisäo sobre a conduta diagnóstica e terapêutica nas hiperlipidemias na faixa etária pediátrica. Inicialmente apresentam as vias de produçäo das lipoproteínas, classificando as dislipidemias e mencionando as indicaçöes para a mensuraçäo dos níveis lipídicos em crianças: além da interpretaçäo dos testes laboratoriais, é apresentado um esquema terapêutico baseado na orientaçäo nutricional, estímulo à atividade física, modificaçäo do estilo de vida e utilizaçäo da terapêutica medicamentosa

Niveles lipídicos y calcificaciones coronarias detectadas por radioscopia con intensificador de imágenes TV en una población asintomática / Lipidic levels and fluoroscopyc detection of coronary artery calcification in asymptomatic subjects

Es sabido que la detección precoz de la arterosclerosis coronaria disminuye el riesgo de infarto. Con tal motivo se estudiaron 104 pacientes, de 52 años de edad promedio, mediante radioscopia TV. De acuerdo a los resultados de la calcificación coronaria CC y al número de territorios involucrados se clasificaron los pacientes en varios grupos, concluyendo que la radioscopia TV es un método de alta sensibilidad, bajo costo, rapidez y seguridad para la detección de CC

Cellular effects of hypercholesterolemia in modulation of cancer growth and metastasis: a review of the evidence.

Hypercholesterolemia and increased cancer risk have been associated, particularly with the high fat diets characteristic of Western societies. We were interested in the possible association between preexisting hypercholesterolemia and the rapidity and extent of tumor metastases in these patients. To date there has been only a few studies that have suggested and explored this determinant of cancer metastases although it may play a role in a subset of patients who develop cancers. This article will review the literature on the effects of LDL-cholesterol on cell proliferation and differentiation and speculate on mechanisms of involvement of a hypercholesterolemic milieu on cancer progression and enhancement of metastatic potential.

Terapéutica hormonal de reemplazo, estudio prospectivo: 17 beta estradiol transdermal, efectos sobre las lipoproteínas LDL y HDL del colesterol plasmático y modificaciones en la sintomatología climatérica sistematizada / Hormone replacement therapy, prospective study: estradiol 17b, effects above the lipoproteins LDL and HDL of the plasmatic cholesterol and modifications in the climateric symptomatology

Se investigaron los resultados de estrogenoterapia transdermal sostenida, durante un año y medio, en una población homogeneizada. No solo la edad, ausencia de patología asociada, talla, peso, antigüedad en la menopausia, sino fundamentalmente el programa dietético y de ejercitación física, en el grupo tratado THR, 35 casos y el grupo control PHD, 56 casos, fuesen semejantes. Se enfatizó la motivación para el cumplimiento en 18 meses del programa higiénico dietético. Con respecto a las lipoproteínas del colesterol, el análisis de varianza anidado evidenció una curva descendente significativamente más pronunciada, en el grupo THR, que la pendiente descendente del grupo PHD. Interacción p < 1 por ciento. En lo que atañe al HDL colesterol, la franca curva ascendente del grupo tratado difiere muy significativamente, de la curva muy levemente descendente, del grupo control. Interacción p < 1 por ciento. En la sintomatología se observó un impacto favorable general. Se realizó test no paramétrico de Wilcoxon y Wilcox comparando las observaciones con la basal y para comparar la THR el test U de Mann-Withney, que demostró diferencias significativas en orden decrecientes, para ostealgias, desinterés sexual, depresión y tuforadas

La terapia hormonal sustitutiva modifica la composición en ácidos grasos de fosfolípidos de HDL / Hormone replacement therapy modifies the fatty-acid composition of HDL phospholipids

Las mujeres postmenospáusicas tienen un riesgo aumentado de padecer enfermedad coronaria en comparación con las premenospáusicas. Sin embargo, el riesgo disminuye cuando se realiza terapia hormonal sustitutiva. El objetivo de este estudio es investigar el posible efecto de la terapia con 17 ß Estradiol (E2) o de la combinación de 17 ß Estradiol y Acetato de Medroxiprogesterona (AMP), sobre las concentraciones plásmicas de colesterol total, colesterol HDL, colesterol LDL, colesterol VLDL y triglicéridos, fracciones de conocida participación en la aterogénesis. También se estudió la composición de ácidos grasos de fosfolípidos de la fracción no retenida obtenida por cromatografía de afinidad con Concanavalina A. Al cabo de 30 días de tratamiento con E2, el colesterol total disminuyó desde 226,0 ñ 54,4 mg/dl hasta 202,0 ñ 51,7 mg/dl; los niveles de triglicéridos descendieron desde 106,3 ñ 31,3 mg/dl hasta 80,6 ñ 13,9 mg/dl (p < 0,05), posiblemente a expensas de la fracción VLDL (21,3 ñ 6,2 mg/dl vs. 16,9 ñ 2,5 mg/dl); los fosfolípidos de la fracción no retenida de Concanavalina A mostraron una disminución de los ácidos grasos mirístico, palmítico y esteárico, y un aumento concomitante de los ácidos grasos oleico y linoleico. Los cambios observados con la administración de E2 tendieron a anularse cuando se agregó Acetato de Medroxiprogesterona

Perfil lipídico y factores de riesgo modificables en cardiopatía isquémica / Lipidic profile and exchange risk factors in isquemic cardiopathy

El presente es un estudio de casos y controles con el objetivo de determinar en nuestro medio las caracteristicas del perfil lipídico y los factores de riesgo modificables en la cardiopatía isquémica y 136 controles (67 hombres, 69 mujeres) con promedio de edad y distribución similar. Se encontro que en todos el incremento de colesterol total y LDL-colesterol asi como la hipertensión tuvo un riesgo relativo mayor en mujeres que en hombres. En los hombres mayores de 60 años la hipertensión fue el único factor de riesgo estadísticamente significativo, no asi los componenetes del perfil lipídico. La hipertrigliciridemia en general tuvo un riesgo relativo significativo y como riesgo relativo fue mas alto en mujeres pero sin alcanzar en ellas valores significativos. Los fenotipos mas frecuentes de hiperlipidemias en pacientes con cardiopatía isquémica fueron IIa, IIb, IV. La diabetes, tabaquismo y obesidad no alcanzaron valores significativos como factor de riesgo