Large Accumulation of Collagen and Increased Activation of Mast Cells in Hearts of Mice with Hyperlipidemia / Grande Acúmulo de Colágeno e Aumento da Ativação de Mastócitos nos Corações de Ratos com Hiperlipidemia

Abstract Background: Hyperlipidemia, which is characterized by an elevation of lipids in the bloodstream, is a major risk factor for cardiac disease. Objectives: The present study investigated the role of fibrosis in the progression of hyperlipidemia in the mice heart, and whether mast cell activation was associated with the fibrosis process. Methods: Hyperlipidemia was produced in C57BL / 6 mice by feeding them on a high-fat diet for 8 weeks.To assess tissue fibrosis, picrosirius red staining was performed. Hematoxylin & eosin (H&E) staining was performed to identify the histopathological changes in the hearts. Immunohistochemistry was also accomplished to determine the localization of transforming growth factor (TGF)-β and α-smooth muscle actin (α-SMA). Western blotting was performed to analyze the expression of chymase, tryptase, TGF-β, α-SMA and activity of Wnt/β-catenin pathway. At the end, serum total cholesterol (TC) and triglycerides (TG) levels were measured. All the values were expressed as means ± SD, the statistical significance level adopted was 5%. Results: Hyperlipidemia mice showed significantly increased collagen deposition in the hearts compared with normal mice. In addition, H&E staining showed significant cellular degeneration. Cardiac muscle was arranged in disorder with fracture in mice of the model group. Immunohistochemistry and western blot analysis revealed that expression levels of tryptase, chymase, β-catenin, TGF-β and α-SMA were significantly increased in the hyperlipidemia mice compared with the control group. Conclusions: The results indicated that mast cell activation might induce cardiac fibrosis by tryptase and chymase in hyperlipidemia, which had a close relationship with the increased activity of TGF-β/Wnt/β-catenin pathway.

Resumo Fundamentos: A hiperlipidemia, que se caracteriza por uma elevação dos lipídeos na corrente sanguínea, é um importante fator de risco para a doença cardíaca. Objetivos: O presente estudo investigou o papel da fibrose na progressão da hiperlipidemia no coração do rato e se a ativação dos mastócitos estava associada ao processo de fibrose. Método: A hiperlipidemia foi produzida em ratos C57BL/6 alimentando-os com uma dieta rica em gordura durante 8 semanas. Para avaliar a fibrose tecidual, foi realizada coloração vermelha picro-Sirius. A coloração com hematoxilina e eosina (H & E) foi feita para identificar as alterações histopatológicas nos corações. A imuno-histoquímica também foi levada a cabo para determinar a localização do fator de crescimento transformante (TGF) -β e α-actina do músculo liso (α-SMA). O Western Blot foi realizado para analisar as expressões de quimase, triptase, TGF-β, α-SMA e a atividade da via Wnt / β-catenina. Finalmente, se mediram os níveis séricos de colesterol total (TC) e triglicerídeos (TG). Todos os valores foram expressos como média ± DP, o nível de significância estatística adotado foi de 5%. Resultados: Os ratos hiperlipidêmicos mostraram aumento significativo da deposição de colágeno nos corações em comparação com ratos normais. Além disso, a coloração de H & E mostrou degeneração celular significativa. O músculo cardíaco estava em desordem com ruptura de fibras em ratos do grupo modelo. A análise imuno-histoquímica e o Western Blot revelaram que os níveis de expressão de triptase, quimase, β-catenina, TGF-β e α-SMA estavam significativamente aumentados nos ratos hiperlipidêmicos em comparação com o grupo controle. Conclusões: Os resultados indicaram que a ativação de mastócitos pode induzir fibrose cardíaca por triptase e quimase em hiperlipidemia, a qual teve uma relação estreita com a atividade aumentada da via TGF-β / Wnt / β-catenina.

Sindrome metabólico en niños y adolescentes: qué hay de nuevo? / Metabolic syndrome in children and adolescents: what is new?

El Síndrome Metabólico (SM) comprende alteraciones antropométricas, clínicas y metabólicas predisponentes del desarrollo de diabetes tipo 2 y enfermedades cardiovasculares; resulta de la interacción de factores genéticos y ambientales mediados por regulación epigenética; algunos loci pueden tener mayor efecto en los fenotipos metabólicos modificados por la dieta u otros factores ambientales. Una vez caracterizados los componentes del SM, diversos estudios se enfocan en identificar los mejores predictores de riesgo cardio-metabólico en adultos: obesidad central (CCi) y resistencia a la insulina (RI). La obesidad gestacional y RI en tejidos fetales se asocian a riesgo alto de SM en niños y adolescentes. En adultos jóvenes: mayor prevalencia de HTA y RI en nacidos pretérmino (peso al nacer < 1500 g) vs nacidos a término, sin diferencias significativas en perfil lipídico entre ambos. Estudios recientes reportan asociación entre suministro bajo de ácidos grasos ώ-3 y elevado de ώ-6 en < 2 años con características posteriores del SM: dislipidemia, RI e hiperfagia. Adolescentes obesos no diabéticos con SM tenían menores habilidades aritméticas, de deletreo, atención y flexibilidad mental y más probabilidades de desempeño inadecuado en las evaluaciones cognitivas que sus pares saludables. Se encontraron reducciones de la integridad microestructural en la materia blanca y menores volúmenes del hipocampo, capaces de ocasionar complicaciones cerebrales a corto plazo. Se ha descrito adelanto fisiológico de indicadores de maduración sexual y ósea (MO) en obesos, pero se carece de información en SM; el análisis individual en obesos de 9-16 años con SM evidenció alto porcentaje de MO adelantada(AU)

Metabolic Syndrome (MS) includes anthropometric, clinic and metabolic changes that predispose to the development of diabetes type 2 and cardiovascular diseases. MS results from the interaction of genetic and environmental factors mediated by epigenetic regulation; some loci have greater effect on metabolic phenotypes modified by diet and other environmental factors. Once MS components are characterized, several studies focus on the best predictors to identify cardiometabolic risk in adults: Waist circumference (WC) and insulin resistance (IR). Obesity during pregnancy and IR in fetal tissues is associated to high risk of MS in children and adolescents. In young adults there is a higher prevalence of high blood pressure and IR in children born preterm (weight < 1500 g) vs. children born at term, without significant differences in lipidic profile between both groups. Recent studies have proposed the association between low intake of ώ-3 and high intake of ώ-6 fatty acids in infants with latter appearance of MS characteristics: dyslipidemia, IR and hyperphagia. Non-diabetic obese adolescents with MS were found to have lower arithmetic skills, spelling and mental flexibility and inappropriate performance in cognitive evaluations when compared with their healthy peers. Decreased microstructural integrity of the white matter and smaller hippocampus volume that may cause cerebral complications at short time was found. Early physiological puberty and skeletal development have been described in obesity, but no information is available in obese patients with MS. In obese 9-16 years old, we found high percentage of advanced bone age in those with MS criteria(AU)

Glycogen storage disease type I.

Glycogen storage diseases (GSD) are inherited autosomal recessive disorder.Type-IGSD(Von Gierkes disease) is due to glucose- 6-phosphatase defect, which mainly affects liver and is life threatening if not treated. The main features are fasting hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia. Here we present a case of six month female baby who presented with fever, abdominal distension and on investigation biochemical parameters were suggestive of type-I GSD.

Niña con hiperlipemia grave, secundaria a hipotiroidismo por tiroiditis atrófica autoinmunitaria / Severe hyperlipidemia, secondary to hypothyroidism due to atrophic thyroiditis in a girl

Se presenta una niña de 5 años y 8 meses de edad afectada de hiperlipemia grave, no sólo por valores elevados de colesterol total y colesterol asociado a lipoproteínas de baja densidad, sino también por depósito ectópico de grasa en pericardio visceral. Fue tratada con dieta y colestiramina sin diagnóstico de su enfermedad causal. Al momento de la consulta presentaba detención del crecimiento, pérdida de peso, signos clínicos de hipometabolismo y Rx con edad ósea retrasada. El perfil tiroideo confirmó el diagnóstico de hipotiroidismo. Por anticuerpos antitiroideos positivos y franca disminución del volumen tiroideo se hizo diagnóstico de tiroiditis atrófica autoinmunitaria, patología de presentación muy rara en la primera infancia. El diagnóstico tardío afectó el crecimiento lineal.

Lipid profile; correlation with high socio-economic status among adult males

To assess the lipid profile among adult males belonging to high socioeconomic status and to probe the dietary habits playing a key role as causative factors in multiple complicated and grievous health hazards e.g. hyperlipidemia, hypertension, diabetes and ischemic heart diseases, which can be managed by just controlling diet and regular exercise. Cross sectional observational study. From March 2003 to September 2003. In this study, research was conducted for 150 respondents of age 20-50 belonging to high socioeconomic status in three posh areas of Faisalabad city, by using simple random sampling technique and SPSS was used for statistical analysis. It was concluded that lipid profile including LDL, HDL, TG and TC had a significant relationship with high socio-economic status adult males and recommendations were designed to avoid the problems related with hyperlipidemia in the said class

Comparison of Factors Associated with Atypical Symptoms in Younger and Older Patients with Acute Coronary Syndromes

Patients with acute coronary syndromes (ACS) who are accompanied by atypical symptoms are frequently misdiagnosed and under-treated. This study was conducted to examine and compare the factors associated with atypical symptoms other than chest pain in younger ( or =70 yr) patients with first-time ACS. Data were obtained from the electronic medical records of the patients (n=931) who were newly diagnosed as ACS and hospitalized from 2005 to 2006. The 7.8% (n=49) of the younger patients and 13.4% (n=41) of the older patients were found to have atypical symptoms. Older patients were more likely to complain of indigestion or abdominal discomfort (P=0.019), nausea and/or vomiting (P=0.040), and dyspnea (P<0.001), and less likely to have chest pain (P=0.007) and pains in the arm and shoulder (P=0.018). A logistic regression analysis showed that after adjustment made for the gender and ACS type, diabetes and hyperlipidemia significantly predicted atypical symptoms in the younger patients. In the older patients, the co-morbid conditions such as stroke or chronic obstructive pulmonary disease were positive predictors. Health care providers need to have an increased awareness of possible presence of ACS in younger persons with diabetes and older persons with chronic concomitant diseases when evaluating patients with no chest pain.

Clinical Effects of Hypertension on the Mortality of Patients with Acute Myocardial Infarction

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.

Xantomas eruptivos: A propósito de dos casos familiares / Eruptive xanthomas: Two familial clinical cases

Se presentan dos pacientes de sexo masculino, familiares de primer grado, tabaquistas y etilistas severos, sin antecedentes patológicos conocidos. Ambos presentan en forma eruptiva la aparición de xantomas y uno de ellos una pancreatitis necrohemorrágica atribuida a su hipertrigliceridemia, complicación muy grave de este trastorno. Si bien los xantomas eruptivos no son muy frecuentes de observar, deben hacernos sospechar en una dislipidemia severa, confirmándola con una examen de laboratorio que pondrá de manifiesto una elevación significativa de los triglicéridos y frecuentemente alteración de los niveles de glucosa en sangre. Además, el estudio histopatológico de las lesiones mostrará macrófagos cargados de lípidos, de aspecto espumoso e infiltrado polimorfonuclear y mononuclear en dermis.

We report a case of two male patients, first-grade relatives, who are heavy drinkers and smokers but apparently have no pathological records. Both show eruptive xanthomas and one of them presents acute necrotic and hemorrhagic pancreatitis due to hypertriglyceridemia, a serious complication of this disorder. Despite the fact that eruptive xanthomas are not frequently observed, they should make us suspect an instance of severe dyslipidemia. In order to verify it, a laboratory test will show a dramatic raise of serum triglyceride levels and usual changes in the blood glucose levels. Moreover, a histopathologic study of the lesion will reveal macrophages full of lipids (foam cells) with polymorphonuclear and mononuclear infiltrate.

Relation between chronic periodontal disease and plasmatic levels of triglycerides, total cholesterol and fractions

A doença periodontal crônica, bastante prevalente na população adulta, tem sido relacionada com diversas alterações sistêmicas, entre elas as dislipidemias, que são fatores de risco conhecidos para a aterosclerose. Bacteremias transitórias e recorrentes, que podem ser causadas pela infecção periodontal, levam a uma intensa resposta inflamatória local e sistêmica, promovendo modificações ao longo do corpo. A proposta do presente estudo foi verificar se a presença da doença periodontal, de moderada a severa, está relacionada com a elevação dos lipídios séricos. Participaram do estudo sessenta indivíduos, acima de vinte anos, divididos em grupo teste, com doença periodontal, e grupo controle, sem doença periodontal, pareados quanto ao gênero e à idade, provenientes da Clínica Odontológica da Universidade de Taubaté/SP, nos quais foram determinados os níveis de colesterol total, de frações e de triglicérides. Foram avaliadas também variáveis como idade, gênero e índice de massa corpórea. Para classificação da lipidemia, foram considerados os valores recomendados pela Sociedade Brasileira de Cardiologia. As médias dos valores do colesterol total (192,1 mg/dl ± 40,9) e dos triglicérides (153,5 mg/dl ± 105,6), no grupo teste, foram superiores às do grupo controle, 186,1 mg/dl ± 35,4 e 117,5 mg/dl ± 68, respectivamente, porém sem significância estatística. Concluiu-se, assim, que, na população estudada e com a metodologia empregada, a doença periodontal, independentemente da intensidade, não mostrou relação estatisticamente significante com a lipidemia.

Tema de revisión: factores de riesgo de resistencia insulínica en niños / Topic revision: risk factors for insulin resistance in children

En las últimas décadas hemos visto surgir una enorme proporción de niños y adolescentes con obesidad, síndrome metabólico y diabetes mellitus tipo 2. La resistencia insulinica ha pasado a ser uno de los problemas mayores de salud pública de nuestros tiempos. La enfermedad asteroesclerótica cardiovascular es el asesino N° 1 en la población adulta de las sociedades occidentales, pero los procesos patológicos y factores de riesgo asociados con su desarrollo han sido demostrados que se inician durante la infancia. La obesidad juega un rol central en el síndrome de resistencia a la insulina el cual incluye hiperinsulinemia, hipertensión, hiperlipidemia, diabetes mellitus tipo 2, y un incrementado riesgo de enfermedad cardiovascular ateroesclerótica. La obesidad que comienza en la niñez a menudo precede el estado hiperinsulinémico. Otros componentes del síndome de resistencia a la insulina están también presentes en los niños y adolescentes. La especificidad de la transmisión de los factores de riesgo en la infancia a diabetes y enfermedad cardiovascular no están claros, pero la evidencia poderosa apunta a su asociación con una enfermedad abierta en adultos. Sobre la base del conocimiento actual y la extrapolación de estudios en adultos, es razonable sugerir que la modificación del estilo de vida y el control del peso en la infancia podrían reducir el riesgo de desarrollar el síndrome de resistencia a la insulina, la diabetes mellitus tipo 2, y la enfermedad cardiovascular.

Beneficial effects of a polar fraction of garlic (Allium sativum Linn) oil in rats fed with two different high fat diets.

Feeding a diet containing 20% of sesame oil (SO) or coconut oil (CNO) along with 2% cholesterol to rats for two months showed differences in their serum and tissue lipid profile and certain enzyme activities. Hyperlipidemia and related oxidative effects were more pronounced in coconut oil fed rats than those fed sesame oil. Feeding a combination of the oils (10% CNO +10% SO) lowered significantly the hyperlipidemia and certain other deleterious effects of CNO. Feeding a polar fraction of garlic oil (PFGO) prepared in the same way as for ajoene and administered at a dosage of 100 mg/kg along with each of the above oil containing diets counteracted significantly the hyperlipidemic, oxidant and also most of the other deleterious effects of the oils like raised lipid levels in serum and tissues, raised serum levels of AST and tissue levels of HMGCoA reductase and the lowered serum and tissue levels of glutathione reductase. The results support the claims that ajoene, the major polar compound of garlic oil, has very good biological action, which warrants further study.

Frecuencia de dislipidemia en una población de adultos jóvenes / Frequency of dislipidemia in a population young-adult

Analizar la frecuencia de dislipidemias en una población hospitalaria y ambulatoria sin enfermedad predisponente. La muestra estuvo conformada por 200 pacientes, 100 hospitalizados y 100 ambulatorios en los Servicios de Medicina Interna del Hospital Universitario de Caracas de 15 a 45 años. Se determinaron los valores de lípidos en sangre de dichas poblaciones y se realizó una encuesta conformada por antecedentes, hábitos y examén físico que incluyó la evolución de los parámetros del síndrome metabólico. De 200 pacientes estudiados (121 mujeres y 79 hombres 30,19 años, la dislipidemia prevalente fue el HDL colesterol bajo (41 por ciento) predominantemente en los masculinos. El 21,5 por ciento de la muestra fue diagnósticada como síndrome metabólico. El 47,5 por ciento resultó con sobrepeso y al 14,5 por ciento con algún grado de obesidad. No se encontró relación entre los resultados obtenidos con los antecedentes familiares. Se encontró relación entre sedentarismo y hábito tabáquico con colesterol total elevado, LDL colesterol elevado y dislipidemia mixta. La pesquisa de dislipidemia en la población joven asintóm tica es de gran utilidad para realizar prevención. La frecuencia encontrada en este grupo fue elevada en comparación con la obtenida en otros trabajos. Se sugiere continuar el estudio de prevalencia en todo el país.

effect of garlic on cyclosporine-a-induced hyperlipidemia in male rats

Cyclosporin A [CsA] is a potent immunosuppressive drug. However, it has adverse effects that include elevation of plasma low-density lipoprotein [LDL]. This study was designed to determine the effect of garlic on CsA-induced hyperlipidemia in male rats. Baseline serum blood samples from forty 10-month-old, male Wistar rats were obtained. They received intraperitoneal [IP] injection of CsA [25 mg/kg] for 28 days. Blood samples were again obtained after the 28-day treatment. Sixteen of 40 rats showed increased serum LDL levels. These 16 were divided into 2 groups of 8 rats each. In the first [experimental] group, 8 rats received garlic [tablets, 400 mg/d], CsA [25 mg/kg IP], and regular diet for 28 days. In the second [control] group, 8 rats received the same regimen without the garlic tablets. At the end of the experiment, blood samples were taken from animals in both groups, and LDL levels were assessed. The mean baseline LDL level in animals in the control group was 17.75 +/- 4.1 mg/dL. This increased to 21.5 +/- 1.6 mg/dL after 28 days of CsA administration. After 28 more days, the mean LDL level increased to 25.4 +/- 4.9 mg/dL [P=.004]. In animals in the experimental group, the baseline LDL level was 23.8 +/- 3.7 mg/dL, which increased to 31.3 +/- 1.6 mg/dL after the first 28 days [P<.001]. After the second 28 days, it decreased to 26.0 +/- 4.8 mg/dL [P=.06], and among 4 animals, the LDL level decreased more than 49%. In a Wistar rat model, animals given cyclosporin A subsequently treated with garlic demonstrated reduced LDL levels compared with controls. This treatment may be useful in patients receiving organ transplantation

Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population

OBJETIVO: Determinar prevalência de hipertensão arterial, diabete melito, hipercolesterolemia e hipertrigliceridemia em uma população brasileira de acordo com grau de obesidade. MÉTODO: Estudo retrospectivo em 1213 adultos (média de idade: 45,2 ± 12,8 anos; 80,6 % sexo feminino) em grupos de acordo com índice de massa corpórea (normal:18,5-24,4 Kg/m2; sobrepeso 25-29,9 Kg/m2; obesidade classe1: 30-34,9 Kg/m2; classe 2: 35-39,9 Kg/m2 ; classe 3:³ 40 Kgm2). Analisamos presença de hipertensão arterial, diabete melito, hipercolesterolemia e hipertrigliceridemia em cada grupo. Determinamos severidade do risco cardiovascular, considerando risco alto pacientes com 2 ou mais dos seguintes fatores: hipertensão arterial, HDL < 35mg/dl, colesterol total >240mg/dl, triglicérides >200mg/dl quando HDL < 35mg/dl e glicemia >126mg/dl; risco moderado aqueles com 2 ou mais dos seguintes fatores: hipertensão arterial, HDL < 45, triglicérides >200mg/dl e colesterol total >200mg/dl. RESULTADOS: Houve aumento significativo da prevalência de hipertensão arterial, diabete melito, hipertrigliceridemia, HDL-colesterol baixo, porém não houve maior prevalência de hipercolesterolemia. O odds ratio, ajustado para idade e sexo, para obesidade em relação aos indivíduos de peso normal foi 5,9, 8,6 e 14,8 para hipertensão; 3,8, 5,8 e 9,2 para diabete melito e 1,2, 1,3 e 2,6 para hipertrigliceridemia. Após estabelecer severidade do risco cardiovascular, verificamos que o índice de massa corpórea se correlacionou de forma significativa com alto risco cardiovascular (p< 0.0001). CONCLUSÃO: Em nossa população, observamos aumento do risco cardiovascular com aumento do índice de massa corpórea.

Anormalidades metabólicas en pacientes con infección por VIH / Metabolic abnormalities in patients with HIV infection

La terapia antirretroviral altamente activa (TARAA) en pacientes con infección por virus de inmunodeficiencia humana (VIH) disminuyó la morbimortalidad del padecimiento, sin embargo, sus efectos sobre el metabolismo de lipoproteínas, carbohidratos y tejido adiposo son causa frecuente de consulta y en el futuro de morbimortalidad. Nuestro objetivo es describir el estado actual del conocimiento sobre la epidemiología, fisiopatología, diagnóstico y tratamiento de estas complicaciones. Se incluye un análisis crítico de las evidencias existentes. La dislipidemia es multifactorial. Antes del inicio del tratamiento es común encontrar hipertrigliceridemia con concentraciones bajas de colesterol y colesterol HDL. Los medicamentos antirretrovirales, en especial algunos inhibidores de proteasas, tienen efectos adversos sobre el metabolismo de lipoproteínas. A ello se suma la recuperación nutricional y se agrava en presencia de lipodistrofia. El efecto final es hipertrigliceridemia (moderada a severa, en especial con ritonavir) con hipercolesterolemia moderada (< 300 mg/dL). La grasa subcutánea en cara y extremidades inferiores disminuye y se deposita en sitios anormales (cuello, grasa intraabdominal). La evaluación y el tratamiento de estas complicaciones es controversial debido a la falta de evidencias. Las alteraciones metabólicas asociadas a TARAA serán una de las principales causas de morbimortalidad en los próximos años. Por ello, se requieren estudios longitudinales en distintos grupos étnicos que evalúen los determinantes de estas complicaciones y mejores estrategias de prevención y tratamiento. La interacción entre endocrinólogos, infectólogos y otros especialistas será cada vez más frecuente e indispensable en este campo.

Highly active antiretroviral therapy (HAART) decreased the mortality of patients with HIV infection, but its effects on the metabolism of lipoproteins, carbohydrates and adipose tissue are a common cause for seeking treatment. Our purpose is to present the current knowledge available regarding the epidemiology, pathophysiology, diagnosis and treatment of these conditions. A discussion about the limitations of the current evidence is included. HIV-related dyslipidemia is multifactorial. Prior to the treatment, hypertriglyceridemia is found frequently,usually with low cholesterol and HDL cholesterol levels. Antiretroviral agents, especially some protease inhibitors, have adverse effects on plasma lipids. Nutritional recovery and lipodistrophy exacerbate the lipid abnormalities. Hypertriglyceridemia (usually moderate to severe) and moderate hypercholesterolemia (< 300 mg/dL) are the most common end-results. Subcutaneous fat of the face and limbs decreases and it is deposited in the neck and in the abdomen. The diagnosis and treatment of these conditions are controversial due to the lack of appropiate evidence. The metabolic complications of HAART could be a leading cause of mortality in the near future. Thus, longitudinal studies, including subjects from several ethnic groups are needed to identify the main factors involved in the pathophysiology and to assess several therapeutical and preventive strategies. Collaboration between HIV specialists and other health professionals (i.e. endocrinologysts) will be required to accomplish these goals.

Epidemiología de las anormalidades metabólicas en pacientes con infección por VIH / Epidemiology of the metabolic abnormalitis in patients with HIV infections

Analizamos la epidemiología de las complicaciones metabólicas del tratamiento antirretroviral. Resultan de la interacción de factores del individuo y de los efectos del tratamiento. Resultados divergentes son frecuentes en este campo debido a limitaciones metodológicas. La prevalencia depende de la actividad de la infección y del tipo de tratamiento. En casos no tratados, la dislipidemia más común es colesterol-HDL bajo (< 35 mg/dL, 25.5%), seguido de la hipertrigliceridemia (> 200 mg/dL, 15.2%). La prevalencia de hipercolesterolemia es tres veces mayor en los casos tratados, en especial cuando se incluye inhibidores de proteasa (IPs). La prevalencia de hipertensión se ha reportado como baja debido al uso de definiciones con puntos de corte muy altos. La diabetes se observa en 6-7% de los casos. Prevalencias similares se encontraron en un estudio retrolectivo realizado en 464 casos. En individuos no tratados, la hipertrigliceridemia se observó preferentemente en sujetos por debajo de su peso ideal; lo opuesto se observó después del tratamiento. Después de un año, las prevalencias de hipertensión (≥ 130/85), hipertrigliceridemia (≥ 150), hipercolesterolemia (> 200 mg/dL), diabetes y colesterol HDL bajo (< 35 mg/dL) fueron 38.5, 71.1, 47.6, 2.2 y 36%. Las prevalencias fueron aún mayores en los casos con un IP. El tabaquismo fue otro factor de riesgo modificable frecuente (42.3%). Así, son muchos los aspectos que permanecen por ser analizados; se requieren de cohortes prospectivas cuyo análisis sirva para el diseño de estrategias preventivas. En población mexicana la hipertrigliceridemia, la hipertensión y el consumo de tabaco son los factores de riesgo cardiovascular más frecuentes en los pacientes con VIH.

The epidemiology of the metabolic complications of antiretroviral agents is discussed here. Contradictory findings are common in this field due to methodological problems.The prevalence depends on the activitiy of the infection and on the type of treatment. Before treatment, the most common lipid abnormalities are low HDL-cholesterol (< 35 mg/dL, 25.5%) and hypertriglyceridemia (> 200 mg/dL, 15.2%). The prevalence of hypercholesterolemia is 3 times higher during treatment, espacially if a protease inhibitor (IP) is used. Hypertension has been described as not common because high thresholds have been used in previous reports. Diabetes has been found in 6-7%. Similar prevalences were found in a retrolective study including 464 cases. Before treatment, hypertriglyceridemia was found mainly in cases with a body weight below normal; the opposite trend was found after treatment. After one year of treatment the prevalence of hypertension (≥ 130/85), hypertriglyceridemia (≥ 150), hypercholesterolemia (> 200 mg/dL), diabetes and low HDL cholesterol (< 35 mg/dL) were 38.5, 71.1, 47.6, 2.2% and 36%, respectively. The frequencies were even greater in IP-treated cases. Smoking was a frequent modifiable risk factor in this group (42.3%). Thus, many aspects remain to be explored; the follow-up of multicentric cohorts will provide evidence for preventive actions. In Mexican HIV infected patients, hypertriglyceridemia, arterial hypertension and smoking are the most common cardiovascular risk factors.

Central obesity in women and its association with serum level of testosterone and estradiol

Central obesity is an important cause of hyperlipidemia, hypertension, diabetes mellitus and coronary heart disease. The relationship between sex hormones, especially androgens, and body fat distribution in women is controversial. This study investigated the relationship between sex hormones, such as total testosterone. DHEA-S, LH, FSH, esteradiol and insulin, with Body Mass Index [BMI] and Waist to Hip Ratio [WHR] in 176 women with age: 25.8 +/- 6.0 years [18-43] and BMI: 27.3 +/- 4.4 [17-51 kg/m2]. Serum level of sex hormones including total testosterone, estradiol, FSH, LH, Dehydroepiandrosterone Sulfate [DHEA-S] were measured by radio immuno assay. Our findings showed that WHR was positively correlated with serum level of testosterone [r = 0.15, P = 0.05] and it was negatively related to serum level of estradiol [r = -0.1, P = 0.05]. Sex hormone concentrations were not different in obese and normal weight women, but women with central obesity [WHR > 0.85] had significantly higher levels of testosterone [2.4 +/- 0.7 vs 2.1 +/- 0.7 nmol/L, P = 0.001] and lower levels of serum estradiol [24.1 +/- 8.7 vs 57.6 +/- 14.5 pmol/L, P = 0.009] than women with low WHR [WHR < 0.85]. In conclusion, these data showed that high serum testosterone and low serum estradiol levels were associated with upper body fat distribution in women. Serum level of estradiol versus testosterone possibly affects body fat distribution in women

A comparative study on the beneficial effects of garlic (Allium sativum Linn), amla (Emblica Officinalis Gaertn)and onion (Allium cepa Linn) on the hyperlipidemia induced by butter fat and beef fat in rats.

Three months feeding of butter fat (BUF) and beef (BF) separately as components of diet at a level of 21% by weight for albino rats, significantly raised their serum and tissue lipids, lipid peroxidation and activities of certain enzymes. BUF was found to be more atherogenic than BF. On incorporation of 5% garlic, amla or onion separately in the above diets, each of them ameliorated the deleterious effects of the animal fats. A higher hyperlipidemic effect of BUF as compared to that of BF may be due to the fact that the ratio of unsaturated to saturated fats is lower for the former (0.56) than for the latter (0.75) and also that the former is richer in cholesterol content than the latter. The order of the curative effects of the vegetables are garlic>amla>onion. The better hypolipidemic effects and correction of elevated levels of certain enzymes shown by garlic and amla may be due to the facts that they contain comparatively better active principles than that found in onions.