Reduced HDL-cholesterol in long COVID-19: A key metabolic risk factor tied to disease severity

Abstract This controlled study investigated metabolic changes in non-vaccinated individuals with Long-COVID-19, along with their connection to the severity of the disease. The study involved 88 patients who experienced varying levels of initial disease severity (mild, moderate, and severe), and a control group of 29 healthy individuals. Metabolic risk markers from fasting blood samples were analyzed, and data regarding disease severity indicators were collected. Findings indicated significant metabolic shifts in severe Long-COVID-19 cases, mainly a marked drop in HDL-C levels and a doubled increase in ferritin levels and insulin resistance compared to the mild cases and controls. HDL-C and ferritin were identified as the leading factors predicted by disease severity. In conclusion, the decline in HDL-C levels and rise in ferritin levels seen in Long-COVID-19 individuals, largely influenced by the severity of the initial infection, could potentially play a role in the persistence and progression of Long-COVID-19. Hence, these markers could be considered as possible therapeutic targets, and help shape preventive strategies to reduce the long-term impacts of the disease.

Lipoproteína de alta densidade e hipertensão arterial sistêmica estão associados à atividade necroinflamatória hepática em pacientes com hepatite C crônica / High-density lipoprotein cholesterol and systemic arterial hypertension are associated with hepatic necroinflammatory activity in patients with chronic hepatitis c

ABSTRACT Background: Approximately 71 million people are chronically infected with hepatitis C virus (HCV) worldwide. A significant number of these individuals will develop liver cirrhosis and/or hepatocellular carcinoma. Beyond the liver, there is a sizeable body of scientific evidence linking cardiovascular disease and chronic hepatitis C (CHC); however, the biological mechanisms behind the concurrence of these conditions have not been completely clarified yet. Objective: To evaluate associations between hepatic histology, clinical comorbidities and lipid profile in patients with CHC. To investigate associations between liver histology and demographic, nutritional, biochemical and virological parameters. Methods: Eight-five patients with CHC prospectively underwent hepatic biopsy. Liver fragments were obtained from each patient by percutaneous route using a Menghini needle. Fibrosis was evaluated according to the METAVIR scoring system, as follows: F0, no fibrosis; F1, fibrous portal expansion; F2, fibrous portal widening with few septa; F3, bridging fibrosis with architectural distortion; and F4, liver cirrhosis. The activity was classified based on the degree of lymphocyte infiltration and hepatocyte necrosis, from A0 to A3. The diagnosis of liver disease was based on clinical, biochemical, histological, and radiological methods. The data were analyzed by logistic regression models. Results: This cross-sectional study included 85 outpatients followed at the tertiary care ambulatory centre with a mean age of 57.2±10.7 years and 45 (52.9%) were females. There were 10 patients with cirrhosis. Patients with a METAVIR F3-F4 were significantly older (P=0.02) and had higher levels of ALT (P=0.0006), AST (P<0.0001), γ-GT (P=0.03) and bilirubin (P=0.001) and higher prothrombin time than patients with F0-F2 score. Albumin levels (P=0.01) were significantly lower in METAVIR F3-F4. Age (OR=1.09; 95%CI=1.02-1.16; P=0.02), steatosis (OR=4.03; 95%CI=1.05-15.45; P=0.04) and high-density lipoprotein cholesterol (HDL-C) <60 mg/dL (OR=7.67; 95%CI=1.71-34.49; P=0.008) were independently associated with fibrosis. Hypertension (OR=6.36; 95%CI=1.31-30.85; P=0.02) and HDL-C <60 mg/dL (OR=9.85; 95%CI=2.35-41.39; P=0.002) were independently associated with necroinflammatory activity. Hypertension (OR=6.94; 95%CI=1.92-25.05; P=0.003) and HDL-C <60 mg/dL (OR=3.94; 95%CI=1.27-12.3; P=0.02) were associated with interface inflammatory activity. Triglycerides (TG ≥150 mg/dL) remained associated with lobular inflammatory activity. Conclusion: cholesterol levels <60 mg/dL were independently associated with necroinflammatory activity in chronic hepatitis C. Patients with hypertension are at an increased risk of developing necroinflammatory activity.

RESUMO Contexto: Aproximadamente 71 milhões de pessoas estão infectadas pelo vírus da hepatite C em todo o mundo. Um número significativo desses indivíduos desenvolverá cirrose hepática e/ou carcinoma hepatocelular. Além do fígado, há evidências científicas que associam doenças cardiovasculares e hepatite C crônica; no entanto, os mecanismos biológicos implicados na ocorrência dessas condições ainda não foram completamente esclarecidos. Objetivo: Avaliar a associação entre histologia hepática, comorbidades clínicas e perfil lipídico em pacientes com hepatite C crônica. Investigar associações entre histologia hepática e parâmetros demográficos, nutricionais, bioquímicos e virológicos. Métodos: Oitenta e cinco pacientes com hepatite C crônica foram prospectivamente submetidos à biópsia hepática. Biópsias hepáticas foram obtidas de cada paciente por via percutânea com agulha de Menghini. A fibrose foi avaliada de acordo com o sistema de pontuação METAVIR, como segue: F0, sem fibrose; F1, expansão portal fibrosa; F2, alargamento portal fibroso com poucos septos; F3, fibrose em ponte com distorção arquitetônica; e F4, cirrose hepática. A atividade foi classificada com base no grau de infiltração de linfócitos e necrose de hepatócitos, de A0 a A3. O diagnóstico da doença hepática foi baseado em métodos clínicos, bioquímicos, histológicos e radiológicos. Os dados foram analisados por modelos de regressão logística. Resultados: Neste estudo transversal, realizado em um ambulatório do hospital universitário, foram incluídos 85 pacientes que tinham média de idade de 57,2±10,7 anos, sendo 45 (52,9%) do sexo feminino. Havia 10 pacientes com cirrose. Os pacientes com METAVIR F3-F4 eram significativamente mais velhos (P=0,02) e tinham níveis mais elevados de ALT (P=0,0006), AST (P<0,0001), γ-GT (P=0,03) e bilirrubina (P=0,001) e, maior tempo de protrombina do que pacientes com escore F0-F2. Os níveis de albumina (P=0,01) foram significativamente mais baixos naqueles classificados como METAVIR F3-F4. Idade (OR=1,09; IC95%=1,02-1,16; P=0,02), esteatose (OR=4,03; IC95%=1,05-15,45; P=0,04) e HDL-C <60 mg/dL (OR=7,67; 95%IC=1,71-34,49; P=0,008) foram independentemente associados à fibrose. Hipertensão (OR=6,36; IC95%=1,31-30,85; P=0,02) e HDL-C <60 mg/dL (OR=9,85; IC95%=2,35-41,39; P=0,002) foram independentemente associados à atividade necroinflamatória. Hipertensão (OR=6,94; IC 95%=1,92-25,05; P=0,003) e HDL-C <60 mg/dL (OR=3,94; IC95%=1,27-12,3; P=0,02) foram associados à atividade inflamatória de interface. Os triglicerídeos (TG >150 mg/dL) permaneceram associados à atividade inflamatória lobular. Conclusão: Níveis de coleterol HDL <60 mg/dL foram independentemente associados à atividade necroinflamatória na hepatite C crônica. Pacientes com hipertensão têm risco aumentado de desenvolver atividade necroinflamatória.

Association between Serum Uric Acid to HDL-Cholesterol Ratio and Nonalcoholic Fatty Liver Disease Risk among Chinese Adults / 生物医学与环境科学（英文）

OBJECTIVE@#The aim of this case-control study was to explore the association between serum uric acid to high density lipoprotein cholesterol ratio (UHR) and the risk of nonalcoholic fatty liver disease (NAFLD) in Chinese adults.@*METHODS@#A total of 636 patients with NAFLD and 754 controls were enrolled from the Affiliated Hospital of Qingdao University, China, between January and December 2016. All patients completed a comprehensive questionnaire survey and underwent abdominal ultrasound examination and a blood test. NAFLD was diagnosed using ultrasonography after other etiologies were excluded. Logistic regression and restricted cubic spline model were conducted to evaluate the relationship of UHR with NAFLD risk.@*RESULTS@#The multivariable adjusted odds ratio (95% confidence interval, CI) for NAFLD in the highest versus lowest quartile of UHR was 3.888 (2.324-6.504). In analyses stratified by sex and age, we observed significant and positive associations between UHR and the risk of NAFLD in each subgroup. In analyses stratified by body mass index (BMI), a significant and positive association was found only in individuals with a BMI of ≥ 24 kg/m2. Our dose-response analysis indicated a linear positive correlation between UHR and the risk of NAFLD.@*CONCLUSION@#UHR is positively associated with the risk of NAFLD and may serve as an innovative and noninvasive marker for identifying individuals at risk of NAFLD.

Serum monocyte/high-density lipoprotein cholesterol ratio and urinary albumin/creatinine ratio in evaluating osteoporosis in diabetic nephropathy patients / 中华内分泌外科杂志

Objective:To investigate the value of serum monocyte/high-density lipoprotein cholesterol ratio (MHR) and urinary albumin/creatinine ratio (ACR) in the evaluation of osteoporosis in diabetic nephropathy patients.Methods:Diabetic nephropathy patients treated in Hangzhou Ninth People’s Hospital from Jun. 2019 to Jun. 2022 were selected. Gender, age, height and weight of all patients were collected and recorded, and body mass index (BMI) was calculated. Blood calcium (Ca), blood phosphorus (P), parathyroid hormone (PTH), monocyte count (M), high density lipoprotein (HDL-C), urinary microalbumin and creatinine were measured and recorded in all patients. MHR and ACR were calculated, MHR=M/HDL-C, ACR=urinary microalbumin/creatinine. Lumbar spine bone mineral density (L1-L4) was measured by dual-energy X-ray absorptiometry, which was divided into osteoporosis group and non-osteoporosis group.Results:Among the 117 diabetic nephropathy patients, 47 cases were osteoporotic and 70 cases were non-osteoporotic. The proportion of women in osteoporosis group was significantly higher than that in non-osteoporosis group, and BMI, PTH, MHR, ACR and bone mineral density were significantly higher than those in non-osteoporosis group, with statistical significance (all P<0.05). Multivariate binary Logistic regression analysis showed that female, MHR and ACR were independent risk factors for osteoporosis in diabetic nephropathy patients (all P<0.05). Spearman correlation analysis showed that serum MHR and ACR were negatively correlated with lumbar bone density, with statistical significance ( r=0.524 and 0.497, P=0.004 and 0.009, respectively). ROC curve analysis showed that the area under the curve (AUC) of serum MHR and ACR for evaluating osteoporosis in diabetic nephropathy patients was 0.870 (0.809-0.931) and 0.849 (0.792-0.905), respectively. The AUC of serum MHR combined with ACR for osteoporosis in diabetic nephropathy patients was 0.927 (0.891-0.964) . Conclusion:Serum MHR and ACR can be used as the evaluation indexes of osteoporosis in diabetic nephropathy patients, and their combined efficacy is better.

Efeitos da suplementação de óleo de abacate sobre o perfil lipídico e índices aterogênicos em intervenção duplo-cego e randomizada em pacientes com síndrome metabólica / Effects of avocado oil supplementation on lipid profile and atherogenic indices in a double-blind and randomised intervention in patients with metabolic syndrome

Introdução: A síndrome metabólica é definida como um conjunto de condições clínicas que acometem cerca de 25% da população mundial e 29,6% dos brasileiros. Essa síndrome está relacionada ao aumento dos desfechos cardiovasculares, que podem ser preditos através do perfil lipídico. Compostos bioativos, tais como os ácidos graxos monoinsaturados (MUFA), são fortes aliados na prevenção desses desfechos. Um alimento importante por conter compostos bioativos e MUFA em abundância é o abacate. Há, porém, poucos estudos avaliando o efeito do óleo puro/virgem de abacate sobre o perfil lipídico em humanos com síndrome metabólica, e seus efeitos sobre os índices aterogênicos inexistem. Objetivo: O estudo buscou avaliar a suplementação de óleo de abacate sobre os níveis lipídicos e índices aterogênicos em pacientes portadores de síndrome metabólica. Método: 31 indivíduos adultos e obesos foram randomizados em grupo controle (óleo de soja) e grupo intervenção (óleo de abacate). Estes foram avaliados nos períodos pré e pós-intervenção (12 semanas) através de anamnese clínica e avaliação nutricional. Resultados: Observou-se que tanto o grupo controle quanto o grupo intervenção tinham a ingestão de lipídeos e gordura saturada maior que o recomendável. Quanto ao perfil lipídico e índices aterogênicos, não foi observada diferença significativa entre os períodos pré e pós. Conclusão: Os resultados podem ter se dado pela ausência do controle alimentar, sobrecarga de medicamentos, duração da intervenção, modo de administração e dose do suplemento. Logo, são necessários estudos futuros sobre os efeitos do óleo de abacate nessa população, que controlem melhor essas variáveis.

Introduction: Metabolic syndrome is defined as a set of clinical conditions that affect approximately 25% of the world's population and 29.6% of Brazilians. This syndrome is related to increased cardiovascular outcomes, which may be predicted by the lipid profile. Bioactive compounds, such as monounsaturated fatty acids (MUFAs), are strong allies in preventing these outcomes. Avocado is an important food because it contains abundant bioactive compounds and MUFAs. However, few studies evaluated the effects of pure/virgin avocado oil on the lipid profile in humans with metabolic syndrome, and its effects on atherogenic indices are not known. Objective:This study evaluated avocado oil supplementation on lipid levels and atherogenic indices in patients with metabolic syndrome. Method: Thirty-one obese adults were randomised into a control group (soybean oil) and an intervention group (avocado oil). These groups were evaluated in the pre- and post-intervention periods (12 weeks) via clinical anamnesis and nutritional assessment. Results: The control group and the intervention group had higher intakes of lipids and saturated fat than recommended. For the lipid profile and atherogenic indices, no significant difference was observed between the pre- and postintervention periods. Conclusion: These results may have been due to the absence of dietary control, medication overload, intervention duration, mode of administration and dose of the supplement. Therefore, future studies on the effects of avocado oil are needed in this population to better control these variables.

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Abstract Background Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity. Objectives To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease. Methods Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the "undesirable" levels, consisting of the sum of "borderline" and "low" values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant. Results Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c. Conclusion In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

Asociación del índice triglicérido-glucosa con colesterol-no-HDL aumentado como indicador de riesgo cardiometabólico en estudios poblacionales / Association of the triglyceride-glucose index with increased non-HDL-cholesterol as an indicator of cardiometabolic risk in population studies / Associação do índice triglicerídeo-glicose com colesterol-não-HDL aumentado como indicador de risco cardiometabólico em estudos populacionais / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen Se propone la asociación de dos indicadores para la detección de personas con riesgo cardiometabólico (RCM) en estudios poblacionales: triglicéridoglucosa (TyG) >8,75 y colesterol-no-HDL (C-no-HDL) ≥160 mg/dL, que se denominará indicador de RCM. La enfermedad cardiovascular aterosclerótica (ECVA) y la diabetes tipo 2 (DT2) son muy frecuentes. TyG aumentado es un estimador de insulinorresistencia y síndrome metabólico (SM) y está relacionado con la detección precoz de riesgo para DT2. C-no-HDL ≥160 mg/ dL ha sido recomendado informarlo en los estudios de laboratorio vinculados con el riesgo para ECVA, sus aumentos están relacionados con todas las lipoproteínas aterogénicas y es de mucho interés en hipertrigliceridemias y SM, por la presencia de lipoproteínas remanentes. En un estudio poblacional sobre 540 personas del sur argentino se halló un aumento significativo de RCM luego de los 20 años y luego de los 40 años de edad un tercio de la población lo tenía presente. El RCM se halló asociado con el índice de masa corporal (IMC), luego de ajustar para edad y género. Después de los 30 años, el RCM estaba presente en un tercio de las personas con IMC ≥27 kg/m2. En otro estudio realizado en personas con riesgo para DT2 con RCM presente, 65,8% tenían HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 y 61,8% SM. Se concluye que la asociación de TyG >8,75 y C-no-HDL ≥160 mg/dL (RCM) podría ser de interés para la detección de grupos poblacionales con alto riesgo cardiometabólico, en la prevención de ECVA y DT2.

Abstract The association of two indicators was proposed for the detection of people with cardiometabolic risk (CMR) in population studies: triglyceride-glucose (TyG) >8.75 and non-HDL-cholesterol (Non-HDL-C) ≥160 mg/dL, which will be called CMR indicator. Atherosclerotic cardiovascular disease (ACVD) and type 2 diabetes (T2D) are very common. Increased TyG is an estimator of insulin resistance and metabolic syndrome (MS) and is related to the early detection of risk for T2D. Non-HDL-C≥160 mg/dL has been recommended to be reported in laboratory studies related to the risk for CVA and its increases are related to all atherogenic lipoproteins and it is of great interest in hypertriglyceridemia and MS, due to the presence of lipoproteins remnants. In a population study of 540 people from Southern Argentina, a significant increase in CMR was found after 20 years of age, and after 40 years of age; a third of the population had it. CMR was found to be associated with body mass index (BMI), after adjusting for age and gender. After age 30 years, CMR was present in a third of the people with a BMI ≥27 kg/m2. In another study conducted in people at risk for T2D with CMR present, 65.8% had HOMA-IR (homeostasis model assessment-insulin-resistance) >2.1 and 61.8% MS. It is concluded that the association of TyG <8.75 and non-HDL-C ≥160 mg/dL (CMR) could be of interest for the detection of population groups with high cardiometabolic risk, in the prevention of ACVD and T2D.

Resumo A associação de dois índices é proposta para a detecção de pessoas com risco cardiometabólico (RCM) em estudos populacionais: triglicerídeo-glicose (TyG) >8,75 e colesterol-não-HDL (C-não-HDL) ≥160 mg/ dL, que será denominado indicador de RCM. A doença cardiovascular aterosclerótica (DCVA) e o diabetes tipo 2 (DT2) são muito comuns. TyG aumentado é um estimador de resistência à insulina e síndrome metabólica (SM) e está relacionado com a detecção precoce de risco para DT2. C-não-HDL ≥160 mg/dL tem sido recomendado para relatá-lo em estudos laboratoriais vinculados com o risco de DCVA e seus aumentos estão relacionados com todas as lipoproteínas aterogênicas e é de grande interesse na hipertrigliceridemia e SM devido à presença de restos de lipoproteínas. Em um estudo populacional de 540 pessoas do sul da Argentina, foi encontrado um aumento significativo de RCM após os 20 anos de idade e, depois dos 40 anos, um terço da população o apresentava. A RCM foi associada ao índice de massa corporal (IMC), após ajustar para idade e gênero. Após os 30 anos, a RCM estava presente em um terço das pessoas com IMC ≥27 kg/m2. Em outro estudo realizado em pessoas com risco para DT2 com RCM presente, 65,8% tinham HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 e 61,8% SM. Conclui-se que a associação de TyG >8,75 e C-não-HDL ≥160 mg/dL (RCM) poderia ser de interesse para a detecção de grupos populacionais com alto risco cardiometabolico, na prevenção de DCVA e DT2.

Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry

Background & aims: Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. Methods: Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. Results: 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol _x0001_200 mg/dl [women 1.52(1.03 e2.25) and 1.59(0.79e3.20); men 1.73(1.38e2.17) and 1.92(1.22e3.03)], non-HDL cholesterol _x0001_130 mg/dl [women 1.84(1.35e2.52) and 1.32(0.72e2.42); men 1.69(1.43e1.90) and 1.67(1.17e2.34)], LDL cholesterol [men 1.10(0.95e1.25) and 1.04(0.77e1.41)], and tobacco [women 1.40(0.84e2.35) and 2.14(0.95e4.82); men 1.63(1.34e1.98) and 1.27(0.81e1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85e1.51)] and very premature [1.29(0.75e2.22)] CAD and was significantly higher in men [1.35(1.16e1.56) and 1.79(1.29e2.49)]. Location and extent of CAD were not different. Conclusions: In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.

Relación de riesgo entre dislipidemia y COVID-19 / Risk relationship between dyslipemia and COVID-19

La presencia de dislipidemia en pacientes con la COVID-19 parece agravar el curso clínico de la enfermedad. En esta revisión bibliográfica se describen los principales mecanismos que las vinculan y sus implicaciones en el tratamiento de los pacientes afectados. Para realizar este trabajo se efectuó una búsqueda bibliográfica en bases de datos, tales como Google académico, SciELO, Annual Reviews y PMC. Los descriptores analizados fueron COVID-19, SARS-CoV-2, dislipidemia, LDL-colesterol, HDL-colesterol, triglicéridos, hipercolesterolemia y lipoproteínas VLDL. Se revisaron preferentemente artículos de revistas arbitradas por pares y disponibles a texto completo, publicados en inglés y español. A pesar de las controversias, la dislipidemia es un factor de riesgo de pronóstico desfavorable en afectados con la COVID-19 y el tratamiento para los pacientes con esa condición desfavorable mejora dicho pronóstico.

The presence of dyslipemia in patients with COVID-19 seems to increase the clinical course of the disease. In this literature review the main mechanisms that link them and their implications in the treatment of the affected patients are described. To carry out this work a literature search was made in databases, such as academic Google, SciELO, Annual Reviews and PMC. The analyzed describers were COVID-19, SARS-CoV-2, dyslipemia, LDL-cholesterol, HDL-cholesterol, triglycerides, hypercholesterolemia and VLDL lipoproteins. Articles of magazines arbitrated by pairs and available to complete text, published in English and Spanish were preferably revised. In spite of the controversies, dyslipemia is a risk factor of unfavorable prognosis in patients affected with COVID-19 and the treatment for the patients with that unfavourable condition improve this prognosis.

Perfil lipídico por trimestres del embarazo en gestantes sanas / Lipid profile by trimesters of pregnancy in healthy pregnant women / Perfil lipídico por trimestres de gestação em gestantes saudáveis

RESUMEN Con el objetivo de describir el perfil lipídico por trimestres de gestación en gestantes sanas, se realizó un estudio descriptivo, de corte transversal, el cual se condujo con 40 embarazadas entre 20 y 35 años, de un universo de 110, pertenecientes al policlínico "Jimmy Hirzel" de Bayamo, Granma, entre enero del 2017 y marzo del 2019. Se determinaron las concentraciones de colesterol total, triglicéridos, HDL-colesterol, LDL-colesterol y VLDL-colesterol. Se utilizó el análisis de varianza de un factor, y la prueba de Tukey de comparación múltiple de parejas de medias. El colesterol, los triglicéridos, el LDL-colesterol y el VLDL-colesterol variaron de forma significativa con el trimestre de gestación. El colesterol total se incrementó en el segundo y tercer trimestre en comparación con el primero, mientras que los triglicéridos, el LDL-colesterol y el VLDL-colesterol se incrementaron en el tercer trimestre en comparación con el primero. El HDL-colesterol no tuvo una variación significativa durante el embarazo. Se concluye que los valores del colesterol total, los triglicéridos, el LDL-colesterol y el VLDL-colesterol varían en relación con el trimestre de la gestación, aumentan de forma significativa en el tercer trimestre en comparación con el primer trimestre del embarazo, en tanto el HDL-colesterol no varía significativamente durante el embarazo.

ABSTRACT In order to describe the lipid profile by trimesters of pregnancy in healthy pregnant women, a descriptive, cross-sectional study was conducted with 40 pregnant women between 20 and 35 years of age, from a universe of 110, belonging to the "Jimmy Hirzel" Hospital in Bayamo, Granma, between January 2017 and March 2019. The concentrations of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and VLDL-cholesterol were determined. One-factor analysis of variance was used, and the Tukey's multiple comparison test of pairs of means Cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol varied significantly with gestational trimester total cholesterol increased in the second and third trimesters compared with the first, while triglycerides, LDL-cholesterol and VLDL-cholesterol increased in the third trimester compared to the first. HDL-cholesterol did not have a significant variation time during pregnancy. It is concluded that the values ​​of total cholesterol, triglycerides, LDL-cholesterol and VLDL-cholesterol vary in relation to the trimester of pregnancy, they increase significantly in the third trimester compared to the first trimester of pregnancy, while HDL-cholesterol does not vary significantly during pregnancy.

RESUMO Com o objetivo de descrever o perfil lipídico por trimestres de gestação em gestantes saudáveis, foi realizado um estudo descritivo, transversal, com 40 gestantes entre 20 e 35 anos, de um universo de 110, pertencentes ao grupo "Jimmy Hirzel" Hospital em Bayamo, Granma, entre janeiro de 2017 e março de 2019. Foram determinadas as concentrações de colesterol total, triglicerídeos, HDL-colesterol, LDL-colesterol e VLDL-colesterol. Foi utilizada a análise de variância de um fator e o teste de comparação múltipla de Tukey de pares de médias Colesterol, triglicerídeos, LDL-colesterol e VLDL-colesterol variou significativamente com o trimestre gestacional O colesterol total aumentou no segundo e terceiro trimestres em comparação com o primeiro, enquanto os triglicerídeos, LDL-colesterol e VLDL-colesterol aumentaram no terceiro trimestre comparado ao primeiro. O HDL-colesterol não teve variação significativa durante a gravidez. Conclui-se que os valores de colesterol total, triglicerídeos, LDL-colesterol e VLDL-colesterol variam em relação ao trimestre de gestação, aumentam significativamente no terceiro trimestre em relação ao primeiro trimestre de gestação, enquanto o HDL-colesterol não não variam significativamente durante a gravidez.

Modelo de predicción para Síndrome metabólico en adultos de Trujillo, Perú / Prediction model for metabolic syndrome in adults from Trujillo, Peru

RESUMEN Introducción: El síndrome metabólico es una confluencia de alteración metabólica que involucra la glicemia y el perfil lipídico, la presión arterial, y en especial la obesidad que aumentan el riesgo cardiovascular. Objetivo: Estimar un modelo de predicción de síndrome metabólico en adultos del Distrito de Trujillo (Perú), a partir de indicadores aterogénicos, antropométricos y estilos de vida. Material y Métodos: Participaron 260 adultos de 30 a 65 años de la Ciudad de Trujillo. El síndrome metabólico se identificó mediante criterios del ALAD y ATP III armonizado, y se aplicó un cuestionario de preguntas para estilos de vida. Para el análisis estadístico se utilizó la regresión logística. Resultados: Consumen gaseosa y snack 70,8 % y 38,5 %; no consumen frutas y verduras en 56,2 % y 58,1 %; y no realiza actividad física 47,7 %. Presentó síndrome metabólico según ALAD y ATP III 46,2 % y 48,1 %, respectivamente. Se asociaron según ALAD; el Índice de Masa Corporal (OR: 11,014; IC 95 %: 4,337-27,971); Índice Castelli (OR: 2,344; IC95 %: 1,074-5,113) y TG/HDL (OR: 3,584; IC 95 %: 1,774-7,242). Se asociaron según ATP III; el sexo (OR: 2,385; IC 95 %: 1,2-4,739); edad (OR: 1,939; IC 95%: 1,032 - 3,644); Índice de Masa Corporal (OR: 5,880; IC 95 %: 2,547-13,576); índice de Castelli (OR: 2,935; IC 95 %: 1,295-6,653) y TG/HDL (OR: 6,937; IC 95 % 3,232-14,889). No hubo asociación entre estilos de vida y síndrome metabólico. Conclusiones: El modelo de predicción para síndrome metabólico por ALAD involucra al Índice de Masa Corporal, Castelli e Índice TG/HDL; se adiciona género y edad en el modelo para síndrome metabólico por ATP III armonizado.

ABSTRACT Introduction: The metabolic syndrome is a confluence of metabolic alteration that involves blood glucose and lipid profile, blood pressure, and especially obesity that increase cardiovascular risk. Objective: To estimate a prediction model for metabolic syndrome (MS) in adults from the District of Trujillo (Peru) on the basis of atherogenic, anthropometric and lifestyle indicators. Material and Methods: A total of 260 adults between 30 and 65 years old from the City of Trujillo participated in the study. MS was identified using the ALAD and harmonized ATP III criteria, and a questionnaire containing questions on lifestyles was applied. Logistic regression was used for statistical analysis. Results: The results of the study show that 70.8% and 38.5% consume soda and snack; 56.2 % and 58.1 % do not consume fruits and vegetables; and 47.7 % of them do not do physical activity. According to ALAD and ATP III, 46.2 % and 48.1 % presented MS, respectively. The BMI (OR: 11.014; 95 % CI: 4.337-27.971); Castelli Index (OR: 2.344; 95 % CI: 1.074-5.113) and TG / HDL (OR: 3.584; 95 % CI: 1.774-7.242) were associated with MS according to ALAD criteria. Sex (OR: 2.385; 95 % CI: 1.2-4.739); Age (OR: 1,939; 95 % CI: 1,032 - 3,644); BMI (OR: 5.880; 95 % CI: 2.547-13.576); Castelli index (OR: 2,935; 95 % CI: 1,295-6,653) and TG/HDL (OR: 6,937; 95 % CI 3,232-14,889) were associated with MS according to ATP III criteria. There was no association between lifestyle and MS. Conclusions: It is concluded that the prediction model for MS according to ALAD criteria involves BMI, Castelli index and TG/HDL index; gender and age are added in the model for MS according to harmonized ATP III criteria.

Inflammation and Nocturnal Pattern of Blood Pressure in Normotensives

Abstract Background: In most healthy individuals, blood pressure (BP) shows a circadian rhythm. Being non-dipper increases cardiovascular risk in normotensive and hypertensive individuals. Nocturnal dipping shows a correlation with the state of inflammation. Objetive: To investigate the relationship between inflammation-based indexes and nocturnal BP pattern in normotensive individuals. Method: This is a retrospective study that included patients evaluated with ambulatory BP monitoring (ABPM). A total of 131 normotensive individuals were included and grouped as dippers and non-dippers. The normality of the data was verified with a Shapiro-Wilk test. We compared ABPM variables and inflammation-based indexes derived from blood tests (monocyte to high-density lipoprotein ratio [MHR], platelet to lymphocyte ratio [PLR], neutrophil to lymphocyte ratio [NLR], and systemic immune-inflammation index [SII]) between groups. The independent samples t-test and Mann-Whitney U test were used for comparing variables with normal and non-normal distributions, respectively. The Pearson's chi-squared test was used to compare categorical variables, and Spearman's correlation coefficient was used to examine the relationships between variables. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performances of inflammation-based indexes. The level of statistical significance was 5%. Results: The study included 131 patients (mean±standard deviation [SD] age 49.2±15.1 years, 58 [76.0%] of which were women). SII was significantly higher in the non-dipper group (p=0.033). Significant negative correlations were observed between the change in systolic BP [ΔSBP] and SII (r=-0.172, p=0.049) and between ΔSBP and PLR (r=-0.179, p=0.040). Conclusion: SII is a predictor of nocturnal BP pattern in normotensives.

Associação entre Atividade Física no Tempo Livre e HDL-C em Participantes do Elsa-Brasil: Existem Diferenças entre Homens e Mulheres no Efeito Dose-Resposta? / Association between Leisure Time Physical Activity and HDL-C in the Elsa-Brasil Study Participants: Are There Any Gender Differences in the Dose-Response Effect?

Resumo Fundamento Níveis elevados de lipoproteína de alta densidade (HDL-C) podem ter efeitos positivos para proteção de agravos cardiovasculares, e prática regular de atividade física no tempo livre (AFTL) tem sido associada ao seu aumento. Objetivo Verificar a existência de possíveis diferenças entre homens e mulheres no efeito dose-resposta na associação entre AFTL e HDL-C. Métodos Estudo transversal com dados de 13,931 participantes de ambos os sexos (7,607 mulheres) do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). A AFTL foi mensurada por meio do International Physical Activity Questionnary (IPAQ) e classificada em quatro categorias: inativos, pouco ativos, ativos e muito ativos. O poder discriminatório da AFTL para HDL-C elevado, nas diferentes intensidades analisadas (caminhada, atividade física moderada e atividade física vigorosa) foi testado por meio das curvas ROC. As associações, ajustadas por variáveis de confundimento entre AFTL e HDL-C foram analisadas por meio de regressão logística, estimando-se a odds ratio (OR) com intervalo de confiança (IC) de 95%. Resultados Observou-se associação positiva, com efeito dose-resposta, entre AFTL e HDL-C tanto em homens quanto em mulheres. Com relação à intensidade, apenas a atividade física vigorosa discriminou o HDL-C elevado em homens, enquanto tanto a atividade física de caminhada quanto a moderada e a vigorosa discriminaram o HDL-C elevado em mulheres. Conclusão A AFTL apresenta associação positiva com gradiente dose-resposta com HDL-C; no entanto, entre os homens, a associação não é observada para aqueles classificados como pouco ativos fisicamente. Nas mulheres, tanto a intensidade da caminhada quanto a atividade física moderada ou vigorosa podem discriminar níveis de HDL-C mais altos; já nos homens, essa relação é observada apenas na intensidade vigorosa.

Abstract Background High levels of high-density lipoprotein (HDL-C) are known for their protective effect against cardiovascular diseases and the regular practice of leisure time physical activity (LTPA) may be associated with their increase. Objective To verify the existence of differences between genders in the dose-response effect regarding the association between LTPA and HDL-C in the ELSA-Brasil study cohort. Methods Cross-sectional study with data from wave 2 of 13,931 participants of both genders (7,607 women) from the Longitudinal Study of Adult Health ELSA-Brasil. The LTPA was measured using the International Physical Activity Questionnaire (IPAQ) and classified into four categories: sedentary, low active, active and very active. The discriminatory power of LTPA at different intensities analyzed for high HDL-C was tested using ROC curves. Associations, adjusted for confounders between LTPA and HDL-C were analyzed by logistic regression. A 95% confidence interval was used. Results A positive association, with a dose-response effect, was observed between LTPA and HDL-C in both men and women. With regard to intensity, only vigorous physical activity discriminated high HDL-C in men, while both walking and moderate and vigorous physical activity discriminated high HDL-C in women. Conclusions LTPA shows a positive association with gradient dose-response and HDL-C, but in men, the association is not observed for those classified as physically unfit. In women, both walking intensity and moderate or vigorous physical activity can discriminate high HDL-C levels, whereas only vigorous intensity-exercise discriminate elevated HDL-C levels in men, demonstrating that males need to do more physical activity for this benefit to be observed.

Vulnerabilidad cardiometabólica e indicadores bioquímicos en el momento de la captación de la embarazada y en el posparto / Cardiometabolic vulnerability and biochemical indicators during recruitment of pregnant women and in the postpartum period

Introducción: Son escasos los estudios sobre acumulaciones excesivas de tejido adiposo y su asociación con cambios en indicadores bioquímicos estudiados durante el embarazo y el posparto. Objetivo: Determinar asociaciones de la vulnerabilidad cardiometabólica por adiposidad corporal con indicadores bioquímicos en el momento de la captación de la embarazada y el posparto. Métodos: Se realizó estudio observacional prospectivo de la vulnerabilidad cardiometabólica por adiposidad corporal e indicadores bioquímicos en 773 mujeres captadas como sanas de peso adecuado, de ellas 119 al posparto, en el policlínico Chiqui Gómez Lubián. Se estudiaron por grupo de vulnerabilidad cardiometabólica indicadores bioquímicos a la captación y el posparto. Se aplicó prueba estadística de Kruskal-Wallis. Resultados: Gestantes captadas con vulnerabilidad global por adiposidad general intermedia y central alta tuvieron valores medios más bajos del ácido úrico (238,78 mmol/L), más altos de triglicéridos (1,37 mmol/L), colesterol (4,70 mmol/L) y resistencia a la insulina (8,32). Mujeres con vulnerabilidad global por adiposidad general intermedia y central alta al posparto presentaron valores medios más elevados de triglicéridos (1,18 mmol/L) y lipoproteínas de muy baja densidad (0,54 mmol/L), más bajos de lipoproteínas de alta densidad (1,06 mmol/L); mujeres con vulnerabilidad global extrema por adiposidad general y central alta, tuvieron valores medios más elevados: glicemia (4,90 mmol/L), colesterol (4,30 mmol/L), lipoproteínas de baja densidad (2,76 mmol/L), producto de acumulación de lípidos (42,63 mmol/L) e índice de adiposidad visceral (2,32 mmol/L). Conclusiones: Evaluar vulnerabilidad cardiometabólica por técnicas antropométricas, complementadas con indicadores bioquímicos, facilita orientar acciones preventivas sobre daños cardiometabólicos progresivos en la gestación y su posparto(AU)

Introduction: Few studies are available about excessive accumulation of adipose tissue and its association to changes in biochemical indicators in pregnancy and the postpartum period. Objective: Determine the association between cardiometabolic vulnerability due to body adiposity and biochemical indicators during recruitment of pregnant women and in the postpartum period. Methods: An observational prospective study was conducted of cardiometabolic vulnerability due to body adiposity and biochemical indicators in 773 women recruited as healthy and adequate weight, 119 of them in the postpartum period, at Chiqui Gómez Lubián polyclinic. Biochemical indicators were studied by cardiometabolic vulnerability group at recruitment and in the postpartum period. Statistical analysis was based on the Kruskal-Wallis test. Results: Pregnant women recruited with overall vulnerability due to high general intermediate and central adiposity had lower uric acid mean values (238.78 mmol/l), higher triglyceride mean values (1.37 mmol/l), cholesterol (4.70 mmol/l) and insulin resistance (8.32). Women with overall vulnerability due to high general intermediate and central adiposity in the postpartum period had higher triglyceride mean values (1.18 mmol/l), very low density lipoproteins (0.54 mmol/l), and lower high density lipoprotein mean values (1.06 mmol/l). Women with extreme overall vulnerability due to high general and central adiposity had higher mean values: glycemia (4.90 mmol/l), cholesterol (4.30 mmol/l), low density lipoproteins (2.76 mmol/l), lipid accumulation product (42.63 mmol/l) and visceral adiposity index (2.32 mmol/l). Conclusions: Evaluating cardiometabolic vulnerability using anthropometric techniques complemented with biochemical indicators, facilitates aiming preventive actions at progressive cardiometabolic damage during pregnancy and the postpartum period(AU)

The association between serum uric acid to high density lipoprotein-cholesterol ratio and non-alcoholic fatty liver disease: the abund study

SUMMARY OBJECTIVE: Non-alcoholic fatty liver disease, which is characterized by lipid being deposited into hepatocytes, affects nearly one in three adults globally. Inflammatory markers were suggested to be related with hepatic steatosis. Uric acid to HDL cholesterol ratio is proposed as a novel inflammatory and metabolic marker. We aimed to compare Uric acid to HDL cholesterol ratio levels of patients with Non-alcoholic fatty liver disease to those of healthy controls and find out potential correlations between Uric acid to HDL cholesterol ratio and other inflammatory and metabolic markers of Non-alcoholic fatty liver disease. METHODS: Patients with a diagnosis of Non-alcoholic fatty liver disease who were on clinical follow-up in our institution were enrolled in the study as the Non-alcoholic fatty liver disease group, while healthy volunteers were enrolled as the control group. The Uric acid to HDL cholesterol ratio of the groups was compared and potential correlations were studied between Uric acid to HDL cholesterol ratio and fasting blood glucose, transaminases, serum lipids (triglyceride, LDL-cholesterol), weight, and body mass index. RESULTS: The Uric acid to HDL cholesterol ratio of the Non-alcoholic fatty liver disease (13±5%) group was significantly higher compared to the Uric acid to HDL cholesterol ratio of the control (10±4%) group (p<0.001). Uric acid to HDL cholesterol ratio was significantly and positively correlated with fasting blood glucose, transaminases, triglyceride, body weight, waist circumference, hip circumference, and body mass index. A ROC analysis revealed that a Uric acid to HDL cholesterol ratio level greater than 9.6% has 73% sensitivity and 51% specificity in determining Non-alcoholic fatty liver disease. CONCLUSION: Due to the inexpensive and easy-to-assess nature of Uric acid to HDL cholesterol ratio, we suggest that elevated Uric acid to HDL cholesterol ratio levels be considered a useful tool in diagnosing hepatic steatosis.

Apolipoproteína B: sus ventajas en el manejo del riesgo cardiovascular aterosclerótico / Apolipoprotein B: its advantages in the assessment of atherosclerotic cardiovascular risk / Apolipoproteína B: suas vantagens no manejo do risco cardiovascular aterosclerótico

Resumen Se analiza la determinación de apolipoproteína B (Apo B) en la evaluación y tratamiento de la enfermedad cardiovascular aterosclerótica (ECVA) con respecto a tres aspectos: a) marcador de riesgo aterogénico; b) ventajas sobre los lípidos; c) utilidad en el laboratorio bioquímico. Apo B participa en la aterogénesis. Habitualmente las partículas lipoproteicas aterogénicas se evalúan por su contenido en colesterol pero su masa por partícula es muy variable. Sin embargo, cada partícula tiene una molécula de Apo B por lo que es un estimador de su número y marcador de riesgo. Apo B desempeña un rol causal y explica mejor que el colesterol LDL (C-LDL) la relación etiológica con la enfermedad, tiene mayor capacidad discriminante que los lípidos, agregación familiar y mejor parámetro para el manejo del tratamiento en presencia de C-LDL<70 mg/dL, hipertrigliceridemia moderada, síndrome metabólico, obesidad y diabetes. Puede determinarse sin ayuno previo con trazabilidad respecto de un patrón de referencia, comparabilidad y armonía de los resultados entre los laboratorios y menor error analítico que el colesterol no-HDL. C-LDL sigue siendo el objetivo primario para la evaluación y tratamiento del riesgo aterogénico. Por consenso se han informado los valores de corte para Apo B según categorías de riesgo de ECVA y se recomendó su uso cuando sea posible determinarla. Apo B es un excelente marcador de riesgo aterogénico, presenta mayor exactitud y precisión que los lípidos y su inclusión en el manejo de casos clínicos específicos contribuye a mejorar la calidad del tratamiento.

Abstract The determination of apolipoprotein B (Apo B) in the evaluation and treatment of atherosclerotic cardiovascular disease (ACVD) is analyzed, referring to three aspects: a) marker of atherogenic risk; b) advantages over lipids; c) utility in the biochemical laboratory. Apo B participates in atherogenesis. Atherogenic lipoprotein particles are usually evaluated for their cholesterol content, but their mass per particle is highly variable. However, each particle has an Apo B molecule so it is an estimator of its number and a marker of risk. Apo B plays a causal role and explains better than LDL cholesterol (LDL-C) the etiological relationship with the disease; it has a greater discriminating capacity than lipids, family aggregation and it is a better parameter for the management of treatment in the presence of LDL-C<70 mg/dL, moderate hypertriglyceridemia, metabolic syndrome, obesity, and diabetes. It can be determined without prior fasting with traceability to a reference standard, comparability and harmony of results between laboratories and lower analytical error than non-HDL cholesterol. LDL-C remains the primary endpoint for the evaluation and treatment of atherogenic risk. By consensus, cut-off values for Apo B have been reported according to ACVD risk categories and its use was recommended when it is possible to determine it. Apo B is an excellent marker of atherogenic risk, it has greater accuracy and precision than lipids and its inclusion in the management of specific clinical cases contributes to improving the quality of treatment.

Resumo A determinação da apolipoproteína B (Apo B) na avaliação e tratamento da doença cardiovascular aterosclerótica (DCVA) é analisada, referindo-se a três aspectos: a) marcador de risco aterogênico; b) vantagens sobre os lipídios; c) utilidade no laboratório bioquímico. Apo B participa da aterogênese. As partículas de lipoproteína aterogênica são geralmente avaliadas quanto ao seu conteúdo de colesterol, mas sua massa por partícula é altamente variável. No entanto, cada partícula possui uma molécula de Apo B, por isso é um estimador de seu número e um marcador de risco. A Apo B tem papel causal e explica melhor que o colesterol LDL (C-LDL) a relação etiológica com a doença, tem maior capacidade discriminante que os lipídios, agregação familiar e melhor parâmetro para o manejo do tratamento na presença de C-LDL<70 mg/dL, hipertrigliceridemia moderada, síndrome metabólica, obesidade e diabetes. Pode ser determinado sem jejum prévio com rastreabilidade a respeito de um padrão de referência, comparabilidade e harmonia de resultados entre laboratórios e menor erro analítico do que o colesterol não-HDL. O C-LDL continua sendo o objetivo primário para a avaliação e tratamento do risco aterogênico. Por consenso, os valores de corte da Apo B foram reportados de acordo com as categorias de risco de DCVA e seu uso foi recomendado quando possível. A Apo B é um excelente marcador de risco aterogênico, possui maior acurácia e precisão que os lipídeos e sua inclusão no manejo de casos clínicos específicos contribui para a melhoria da qualidade do tratamento.

Impacto dos Índices Aterogênicos em Estenose do Enxerto de Veia Safena / Impact of Atherogenic Indexes in Saphenous Vein Graft Stenosis

Resumo Fundamento Os enxertos de veias safenas (EVS) são frequentemente usados em pacientes submetidos a cirurgia de revascularização do miocárdio (CRM). Objetivos Avaliar as relações entre índices aterogênicos e estenose de EVS. Métodos: No total, 534 pacientes (27,7% mulheres, com idade média de 65±8,4 anos) submetidos a CRM e angiografia coronariana eletiva foram incluídos no estudo. Pacientes com pelo menos uma estenose EVS ≥50% foram alocados ao grupo estenose EVS (+) (n=259) e pacientes sem estenose foram classificados como EVS (-) (n=275). O índice aterogênico plasmático (IAP) e o coeficiente aterogênico (CA) foram calculados a partir dos parâmetros lipídicos de rotina dos pacientes. A significância foi estabelecida no nível p<0,05. Resultados O número de pacientes com histórico de hipertensão (HT), diabetes mellitus (DM), acidente vascular cerebral e insuficiência cardíaca (IC) se mostrou significativamente maior no grupo EVS (+) do que no grupo EVS (-). O colesterol total, triglicerídeos e colesterol LDL mostraram-se significativamente mais altos e o colesterol HDL mostrou-se menor no grupo EVS (+) do que no grupo EVS (-). IAP (p<0,001) e CA (p<0,001) apresentaram-se significativamente mais altos no grupo EVS (+) do que no grupo EVS (-). A análise ROC mostra que tanto o IAP quanto o CA mostraram-se melhores que o colesterol HDL, colesterol LDL e colesterol não HDL na predição de estenose de EVS. Na análise multivariada, histórico de DM, HT, acidente vascular cerebral, IC, número de enxertos de safena, colesterol HDL, colesterol LDL, colesterol não HDL, IAP e CA foram fatores de risco independentes para estenose de EVS. Conclusão O IAP e o CA foram preditores independentes de estenose de EVS. Além disso, tanto o IAP quanto o CA têm melhor desempenho na predição de estenose de EVS do que o colesterol LDL, colesterol HDL e colesterol não HDL. (Arq Bras Cardiol. 2020; 115(3):538-544)

Abstract Background Saphenous vein grafts (SVG) are frequently used in patients that have undergone coronary artery bypass graft (CABG) surgery. Objectives: To evaluate the relationship between atherogenic indexes and SVG stenosis. Methods Altogether, 534 patients (27.7% women, mean age 65±8.4 years) that underwent CABG and elective coronary angiography were included in the study. Patients with at least one SVG stenosis ≥50% were allocated to the stenosis group SVG (+) (n=259) and patients without stenosis were categorized as SVG (-) (n=275). Atherogenic index of plasma (AIP) and atherogenic coefficient (AC) were calculated from the patients' routine lipid parameters. The level of significance was p<0.05. Results The number of patients with a history of hypertension (HT), diabetes mellitus (DM), stroke, and heart failure was significantly higher in the SVG (+) group than in the SVG (-) group. Total cholesterol, triglycerides, LDL-C were significantly higher and HDL-C was lower in the SVG (+) group than in the SVG (-) group. AIP (p<0.001) and AC (p<0.001) were significantly higher in the SVG (+) group than in the SVG (-) group. The receiver operating characteristic (ROC) analysis show that both AIP and AC were better than HDL-C, LDL-C and non-HDL-C at predicting SVG stenosis. In the multivariate analysis, history of DM, HT, stroke, heart failure (HF), number of saphenous grafts, HDL-C, LDL-C, non-HDL-C, AIP and AC were found to be independent risk factors for SVG stenosis. Conclusion AIP and AC were independent predictors of SVG stenosis. Moreover, both AIP and AC have better performance in predicting SVG stenosis than LDL-C, HDL-C and non-HDL-C. (Arq Bras Cardiol. 2020; 115(3):538-544)

Índice de Masa Corporal una medida antropométrica asociada a Índice TG/HDL, un novel factor de riesgo cardio-metabólico / Body Mass Index An Anthropometric Measure Associated With TG / HDL Index, A Novel Cardio-Metabolic Risk Factor

Objetivos: determinar la relación entre obesidad e índice TG/HDL en pacientes atendidos en el servicio de consulta externa de endocrinología del hospital nacional Sergio Bernales en el año 2018. Métodos: el estudio fue observacional, analítico, tipo casos y controles no emparejado a razón de 4:1, con un total 288 sujetos de estudio siendo 230 controles y 58 casos quienes cumplieron con criterios de selección, involucro a los pacientes atendidos en el servicio de consulta externa endocrinología. La muestra fue aleatoria simple, se incluyeron las variables, Sexo, edad, Índice de masa corporal, Colesterol total, Triglicéridos total, HDL-c, LDL-c, Índice TG/HDL. Se empleó un modelo de regresión logística para obtener un Odds Ratio para fuerza de asociación. Resultados: La frecuencia relativa de obesidad fue del 65.52% y 29.13%, para los casos y controles respectivamente, a su vez una significancia estadística con la prueba exacta de Fisher, P-valor 0.000. Se encontró un por regresión logística bivariada una relación entre Obesidad e Índice TG/HDL-c (OR 4.62, p=0.000, IC95% 2.51-8.52). Conclusiones: se encontró una relación entre la Obesidad y el índice TG/HDL-c pudiéndose extrapolar a población adulta atendida en el servicio de endocrinología de Lima Metropolitana, este es el primer artículo publicado al respecto a nivel nacional, se recomiendan estudios prospectivos para determinar causalidad.

Objectives: to determine the relationship between obesity and the TG / HDL index in patients treated at the endocrinology outpatient service of the Sergio Bernales national hospital in 2018. Methods: the study was observational, analytical, case-control type not matched to ratio of 4: 1, with a total of 288 study subjects, 230 controls and 58 cases who met the selection criteria, involved the patients treated in the endocrinology outpatient service. The sample was simple random, the variables were included: Sex, age, Body mass index, Total cholesterol, Total triglycerides, HDL-c, LDL-c, TG / HDL index. A logistic regression model was used to obtain an Odds Ratio for the strength of association. Results: The relative frequency of obesity was 65.52% and 29.13%, for cases and controls respectively, in turn a statistical significance with Fisher's exact test, P-value 0.000. A bivariate logistic regression found a relationship between Obesity and TG / HDL-c Index (OR 4.62, p = 0.000, 95% CI 2.51-8.52). Conclusions: a relationship was found between Obesity and the TG / HDL-c index, which can be extrapolated to the adult population treated in the endocrinology service of Metropolitan Lima, this is the first article published in this regard at the national level, prospective studies are recommended to determine causality.

Dietary and Blood Lipids in Cardiovascular Disease

Blood lipids are essential for life; at the same time, elevated or reduced levels of some of the components of lipid are related to risk of atherosclerotic cardiovascular disease (ASCVD).This article provides a review on dietary and blood lipids with their impact on cardiovascular health. The role of apolipoprotein B (ApoB), Lipoprotein(a) ((Lp(a))and other lipoprotein particles in the development of ASCVD has been reviewed. There are newevidences that ApoB the structural protein of most of the lipoprotein particles (carrier of blood lipids), in addition to low density lipoprotein-cholesterol (LDL-C), plays a central role in the pathogenesis of atherosclerosis with increased risk for ASCVD. Elevated levels of Lp(a) concentrations are associated with an increased risk of ASCVD, but it appears to be a weaker risk factor than ApoB or LDL-C

Monocyte to HDL-Cholesterol ratio as an inflammation marker for ASCVDS / Шинэ санаа Шинэ нээлт

Background@#Monocyte / High Density Lipoprotein Ratio (MHR) has become an inflammation marker of atherosclerotic cardiovascular diseases and is a handy and reliable diagnostic marker at a low cost. @*Objectives@#to suggest MHR as a new inflammation marker for ASCVDs by comparing it with other risk factors of cardiovascular disease and assessing the significance in screening@*Methods@#This study conducted during October to December 2019 is a hospital-based cross sectional study, with a total of 396 clients, all 20 to 64 years old, were selected as subjects of the study using a certain criteria. @*Results@#78.47% of the male subjects and 34.31% of female subjects were diagnosed with dislipidemia, which shows us that males were diagnosed more frequently. The study sample consisted of 274 (72.87%) men and 102 (27.13%) women with mean age of 36.6±8.42 years (range, 20-64 years), 78.47% were male and 34.31% were females. 66.49% of total participants were newly diagnosed with dyslipidemia. An age group of 30 to 40 years old were recorded with the highest cases of dyslipidemia. Monocyte / High Density Lipoprotein Ratio (MHR) were 7.88 and 12.82 in dyslipidemic and non-dyslipidemic subjects, respectively and showed that there is a statistically significant difference(p<0.05). The 10-year ASCVD risk of 113 people aged 40-64 years, which were classified in low risk group (<7.5%) and in high risk group (≥7.5%) were assessed by pooled cohort equation and the results shows that risk percentage were 65.14% and 34.86% and there is statistically significant difference in MHR, which were 10.58±4.80 and 14.07±4. 90 in respective groups.@*Conclusions@#Prevalence of dyslipidemia in preventive screening were high in a group of 20-62 years old and the group of those were estimated high The 10-year ASCVD risk, also had relatively higher MHR. Moreover, there is a positive relation between dyslipidemia and MHR. These results show that it is possible to use MHR as a new inflammation marker in ASCVDs for early detection purpose.