sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain).

OBJECTIVE: A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE. METHODS: This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. RESULTS: A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index. CONCLUSIONS: The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Relationship between lipoprotein(a) concentrations and intima-media thickness: a healthy population study.

BACKGROUND: High levels of lipoprotein(a) [Lp(a)] have been linked to an increased risk of ischaemic cardiovascular events. We examined whether Lp(a) plasma levels are associated with early arteriosclerosis by measuring intima media thickness in an asymptomatic population of Burgos, Spain. METHODS: We determined lipids, lipoprotein(a) by a nephelometry method and the intima-media thickness (IMT) in the far wall of both common carotid arteries by B-mode ultrasound in a group of 172 asymptomatic subjects. RESULTS: No association was found in the population group between Lp(a) concentrations and left, right, or overall mean IMT by univariate or multivariate regression analysis. The median IMT was not significantly different in individuals with Lp(a) levels >300 mg/l and in individuals with Lp(a) levels <300 mg/l. CONCLUSIONS: These results suggest that increased Lp(a) levels do not confer cardiovascular risk by promoting early atherogenesis, but rather increasing the susceptibility to thrombosis.

No association of apolipoprotein E epsilon4 genotype with faster progression or less recovery of relapses in a Spanish cohort of multiple sclerosis.

BACKGROUND: Recent data have suggested a faster deterioration of multiple sclerosis (MS) patients who harbour the epsilon4 allele of the apolipoprotein E (APOE) gene. We investigate the relationship of APOE genotypes with disease severity and clinical recovery of relapses in a MS population of the north of Spain. METHODS: One hundred and thirty-three patients with clinically defined MS were studied. Disease course (relapsing versus progressive), age of onset, duration of the disease and disability measured by the Expanded Disability Status Scale (EDSS) were recorded. Worsening was measured by the Progression Index (PI) and by EDSS 4 and 6 latencies. In 79 patients with relapsing-remitting (RR) MS the degree of clinical recovery of relapses (total versus partial) was assessed. RESULTS: The frequency of the APOE epsilon4 allele in our patients was similar to that found in other southern European populations. APOE epsilon4 patients did not have a faster progression as assessed by PI and EDSS 4 and 6 latencies. Among 79 patients with RRMS there were no significant differences in the degree of recovery of relapses. CONCLUSIONS: In this MS population, APOE epsilon4 polymorphism is not associated with a more severe clinical course and does not appear to influence recovery of exacerbations.

Lipids, lipoproteins and apolipoprotein (a) isoforms in type 2 diabetic patients.

BACKGROUND: Patients with type 2 diabetes mellitus have a greater than normal risk of developing atherosclerotic vascular diseases. Higher than normal plasma concentrations of lipoprotein (a) [Lp(a)] have been associated with premature atherosclerosis in several studies. OBJECTIVE: To determine the concentrations of lipids, lipoproteins, and Lp(a) in 107 type 2 diabetic patients, and the distribution of apolipoprotein (a) [apo(a)] phenotypes for this group, and to compare the results found with results for healthy subjects. RESULTS: Plasma concentrations of cholesterol, triglycerides, and apolipoprotein B in the diabetics were significantly higher than those in control subjects. Diabetic patients had slightly lower Lp(a) concentrations than did nondiabetic subjects, but these differences were not statistically significant. Distributions of Lp(a) concentrations both in type 2 diabetic patients and in control subjects were markedly skewed, the highest prevalences being of low values. CONCLUSION: Distributions of apo(a) phenotypes for patients with type 2 diabetes mellitus and controls were remarkably alike. Smaller isoforms were similarly prevalent for the two populations, as were the null, single-band and double-band apo(a) phenotypes.

[Lipoprotein(a) and other lipid parameters in cord blood: a study of 528 cases]. / Lipoprotéine (a) et autres paramètres lipidiques dans le sang de cordon: une étude de 528 cas.

We have studied the concentrations of cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoproteins A-I and B, and lipoprotein (a) in cord blood, from children born in our hospital for a five-month period. Cholesterol and triglycerides values were slightly lower than values obtained in cord blood within other populations. The distribution of lipoprotein (a) concentrations was markedly skewed towards low values (mean = 1.74 mg/dl, median = 1 mg/dl), similar to that of other young or adult Caucasian populations. Children with a positive familial history of cardiovascular heart disease had a higher mean lipoprotein level (a), and a higher prevalence of lipoprotein values exceeding 5 mg/dl, than children with a negative familial history. These results suggest that lipoprotein (a) is an important risk factor for cardiovascular heart disease.