The long-term effects of consecutive COVID-19 waves on mental health.

BACKGROUND: Although several studies have documented the impact of the COVID-19 pandemic on mental health, the long-term effects remain unclear. AIMS: To examine longitudinal changes in mental health before and during the consecutive COVID-19 waves in a well-established probability sample. METHOD: An online survey was completed by the participants of the COVID-19 add-on study at four time points: pre-COVID-19 period (2014-2015, n = 1823), first COVID-19 wave (April to May 2020, n = 788), second COVID-19 wave (August to October 2020, n = 532) and third COVID-19 wave (March to April 2021, n = 383). Data were collected via a set of validated instruments, and analysed with latent growth models. RESULTS: During the pandemic, we observed a significant increase in stress levels (standardised ß = 0.473, P < 0.001) and depressive symptoms (standardised ß = 1.284, P < 0.001). The rate of increase in depressive symptoms (std. covariance = 0.784, P = 0.014), but not in stress levels (std. covariance = 0.057, P = 0.743), was associated with the pre-pandemic mental health status of the participants. Further analysis showed that secondary stressors played a predominant role in the increase in mental health difficulties. The main secondary stressors were loneliness, negative emotionality associated with the perception of COVID-19 disease, lack of resilience, female gender and younger age. CONCLUSIONS: The surge in stress levels and depressive symptoms persisted across all three consecutive COVID-19 waves. This persistence is attributable to the effects of secondary stressors, and particularly to the status of mental health before the COVID-19 pandemic. Our findings reveal mechanisms underlying the surge in mental health difficulties during the COVID-19 waves, with direct implications for strategies promoting mental health during pandemics.

Pharmacogenomic profile of a central European urban random population-Czech population.

The genetic basis of variability in drug response is at the core of pharmacogenomics (PGx) studies, aiming at reducing adverse drug reaction (ADR), which have interethnic variability. This study used the Kardiovize Brno 2030 random urban Czech sample population to analyze polymorphisms in a wide spectrum of genes coding for liver enzymes involved in drug metabolism. We aimed at correlating real life drug consumption with pharmacogenomic profile, and at comparing these data with the SUPER-Finland Finnish PGx database. A total of 250 individuals representative of the Kardiovize Brno 2030 cohort were included in an observational study. Blood DNA was extracted and 59 single nucleotide polymorphisms within 13 genes (BCHE, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A5, F2, F5, IFNL3, SLCO1B1, TPMT, UGT1A1, VKORC1), associated to different drug metabolizing rates, were characterized by genotyping using a genome wide commercial array. Widely used drugs such as anti-coagulant warfarin and lipid lowering agent atorvastatin were associated to an alarmingly high percentage of users with intermediate/poor metabolism for them. Significant differences in the frequency of normal/intermediate/poor/ultrarapid/rapid metabolizers were observed for CYPD26 (p<0.001), CYP2C19 (p<0.001) and UGT1A1 (p<0.001) between the Czech and the Finnish study populations. Our study demonstrated that administration of some popular drugs to a Czech random sample population is associated with different drug metabolizing rates and therefore exposing to risk for ADRs. We also highlight interethnic differentiation of some common pharmacogenetics variants between Central (Czech) and North European (Finnish) population studies, suggesting the utility of PGx-informed prescription based on variant genotyping.

Is Drinking Alcohol Really Linked to Cardiovascular Health? Evidence from the Kardiovize 2030 Project.

Existing data have described benefits and drawbacks of alcohol consumption on cardiovascular diseases (CVD), but no research has evaluated its association with the cardiovascular health (CVH) score proposed by the American Heart Association. Here, we conducted a cross-sectional analysis on the Kardiovize cohort (Brno, Czech Republic), to investigate the relationship between alcohol consumption and CVH. We included 1773 subjects (aged 25-64 years; 44.2% men) with no history of CVD. We compared CVD risk factors, CVH metrics (i.e., BMI, healthy diet, physical activity level, smoking status, blood pressure, fasting glucose, and total cholesterol) and CVH score between and within several drinking categories. We found that the relationship between drinking habits and CVH was related to the amount of alcohol consumed, drinking patterns, and beverage choices. Heavy drinkers were more likely to smoke tobacco, and to report diastolic blood pressure, fasting glucose, triglycerides, and low-density lipoprotein (LDL)-cholesterol at higher level than non-drinkers. Among drinkers, however, people who exclusively drank wine exhibited better CVH than those who exclusively drank beer. Although our findings supported the hypothesis that drinking alcohol was related to the CVH in general, further prospective research is needed to understand whether the assessment of CVH should incorporate information on alcohol consumption.

Risk Factors Underlying COVID-19 Lockdown-Induced Mental Distress.

Recent reports suggest that the COVID-19 lockdown resulted in changes in mental health, however, potential age-related changes and risk factors remain unknown. We measured COVID-19 lockdown-induced stress levels and the severity of depressive symptoms prior to and during the COVID-19 lockdown in different age groups and then searched for potential risk factors in a well-characterized general population-based sample. A total of 715 participants were tested for mental distress and related risk factors at two time-points, baseline testing prior to COVID-19 and follow-up testing during COVID-19, using a battery of validated psychological tests including the Perceived Stress Scale and the Patient Health Questionnaire. Longitudinal measurements revealed that the prevalence of moderate to high stress and the severity of depressive symptoms increased 1.4- and 5.5-fold, respectively, during the COVID-19 lockdown. This surge in mental distress was more severe in women, but was present in all age groups with the older age group exhibiting, cross-sectionally, the lowest levels of mental distress prior to and during the lockdown. Illness perception, personality characteristics such as a feeling of loneliness, and several lifestyle components were found to be associated with a significant increase in mental distress. The observed changes in mental health and the identified potential risk factors underlying these changes provide critical data justifying timely and public emergency-tailored preventive, diagnostic, and therapeutic mental health interventions, which should be integrated into future public health policies globally.

Diabetes and depression were not associated in Venezuelan adults: The EVESCAM study, a national cross-sectional sample.

BACKGROUND: Evidence suggests that depression is more common in patients with diabetes than in the general population. However, contradictory results expose controversy in this association. OBJECTIVE: To evaluate the relationship between diabetes and depression in a national sample of Venezuelan adults. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,454 adults from July 2014 to January 2017 (response rate of 77.3%). Diabetes was defined using fasting blood glucose and a 2-hour oral glucose tolerance test. Depressive symptoms were determined using the Hospital Anxiety and Depression Scale. RESULTS: 3255 subjects were assessed. Depressive symptom score was different between genders and among age groups (p<0.001), and similar in those subjects with or without diabetes (p=0.899). Depressive symptoms prevalence was higher in women than in men and increased with age (p<0.05), but was similar in those with and without diabetes (p=0.215). Using a multivariate regression analysis model, the association of depressive symptoms and diabetes remains non-significant after adjusting for age and gender (Odds ratio=0.98; 95% Confidence Intervals 0.95 - 1.02, p=0.504). CONCLUSION: Diabetes and depression were not associated in a large sample of Venezuelan adults.

Prevalence of cardiometabolic risk factors in three populations from Venezuela: the VEMSOLS STUDY 2006-2010 / Prevalencia de factores de riesgo cardiometabólico en 3 poblaciones de Venezuela: estudio VEMSOLS 2006-2010

Abstract Introduction: No previous studies had reported the prevalence of cardiometabolic diseases various regions of Venezuela. Objective: To determine the prevalence of cardiometabolic risk factors in 3 populations of Venezuela. Methods: The VEMSOLS study is a sub-national, cross-sectional, population based, with bi-stage random sampling study, evaluating 751 subjects aged 20 or older from 3 selected municipalities of Venezuela. Anthropometric and biochemical measurements were obtained. ANOVA was used to continous variables and Chi-square to proportions, a p<0.05 was significant. Results: 69% were females and 81.4% from urban areas. Low HDL-c was the most prevalent disorder (63.8% [-CI- 95% 60.1-67.4]), being more common in women than in men (74.1% [69.9 -77.9] and 40.4% [33.7-43.4], respectively, p < 0.05); followed by abdominal obesity (47.4% [43.8 -51.1]) and hypertriglyceridemia (45.2% [41.5 - 49.0]). One third (30.0% [26.7-33.4]) had hypertension, 11.8% (9.5 -14.5) diabetes, 23.1% (20.2-26.3) obesity, and 20.1% (17.2-23.4) elevated LDL-cholesterol. Metabolic syndrome was present in 29.9% (26.5-33.5) of the sample. Rural population from the Andeans mountains (Páramo) presented a lower prevalence of obesity and low HDL-c (p < 0.05) comparing with urban samples. Lara's population, which had the highest Body Mass Index of the 3 municipalities, had a higher prevalence of abdominal obesity, atherogenic dyslipidemia and elevated LDL-c than the other two populations (p < 0.05). Conclusion: A high prevalence of cardiometabolic abnormalities in 3 populations of Venezuela was observed with a lower prevalence of alterations in the rural area. MÉD.UIS. 2018;31(1):15-22.

Resumen Introducción: Ningún estudio ha reportado la prevalencia de factores de riesgo cardiometabólico en varias regiones de Venezuela. Objetivo: Determinar la prevalencia de factores de riesgo cardiometabólico en 3 poblaciones de Venezuela. Materiales y Métodos: El estudio VEMSOLS es un estudio sub-nacional, transversal, poblacional, de muestreo aleatorio bi-etápico, evaluando 751 sujetos de 20 o más años de edad de 3 municipios de Venezuela. Mediciones antropométricas y bioquímicas fueron obtenidas. Analysis of Variance se utilizó para variables continuas y Chi-cuadrado para proporciones, significancia fue p<0,05. Resultados: 69% fueron mujeres y 81,4% del área urbana. Colesterol HDL bajo fue la alteración más prevalente (63,8% [Intervalo de Confianza -IC- 95%: 60,1-67,4]), siendo más común en mujeres que en hombres (74,1% [69,9 -77,9] y 40,4% [33,7-43,4], respectivamente, p< 0,05); seguidos por obesidad abdominal (47,4% [43,8 -51,1]) e hipertrigliceridemia (45,2% [41,5 - 49,0]). Un tercio (30,0% [26,7-33,4]) tenía hipertensión, 11,8% (9,5 -14,5) diabetes, 23,1% (20,2 - 26,3) obesidad y 20,1% (17,2-23,4) colesterol LDL elevado. El síndrome metabólico estuvo presente en 29,9% (26,5-33,5) de la muestra. La población rural de los Andes (Páramo) presentó una baja prevalencia de obesidad y colesterol HDL bajo comparado con las muestras urbanas (p < 0,05). La población de Lara, quien tenía el índice de masa corporal más elevado de las 3 municipalidades, mostró una alta prevalencia de obesidad abdominal, dislipidemia aterogénica y colesterol LDL elevado en comparación con las otras dos poblaciones (p< 0.05). Conclusión: Se observó una elevada prevalencia de anormalidades cardiometabólicas en 3 poblaciones de Venezuela con una menor prevalencia de alteraciones en el área rural. MÉD.UIS. 2018;31(1):15-22.

Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results.

OBJECTIVE: The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. METHODS: During 2006-2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FINDINGS: Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%-10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%-9.9%). This figure increased with age, with the lowest prevalence in the 20-29year old group (1.8% [95% CI, 0.6%-4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%-40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%-2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%-16.7%), and only 48.2% were aware of their diabetes condition. CONCLUSION: In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.

Optimizando la medición de la presión arterial en la consulta / Optimizing the office blood pressure measurement

La medición de la presión arterial (PA) en la consulta de forma correcta permite una adecuada estratificación del riesgo de los pacientes, sin embargo, su técnica puede estar sometida a errores frecuentes que deben ser evitados. Los esfigmomanómetros de mercurio han sido el estándar de oro en la toma de PA, sin embargo, no están actualmente recomendados debido al riesgo de toxicidad; sus alternativas, el esfigmomanómetro aneroide, requiere calibración periódica para evitar mediciones erróneas, y los equipos oscilométricos deben ser validados y adecuadamente seleccionados para su función. Mediciones complementarias a la realizada en la consulta, como el monitoreo ambulatorio de PA y la medición en casa, suplementan algunas debilidades de la medición en la oficina. El objetivo de la presente revisión fue evaluar cada uno de los aspectos de la técnica para medir la PA en la consulta.

A proper office blood pressure (BP) measurement allows a right risk stratification of the patients, however, its technique can have frequently errors that must be avoided. Mercury sphygmomanometers has been the gold standard on BP measurement, however, due to its toxicity risk are not currently recommended; other alternatives, like the aneroid sphygmomanometer require routinely calibration to avoid mistakes, and oscillometric devices require be validated and properly selected. Complementary techniques of office BP measurement, like the ambulatory BP measurement and home measurement, supplement some weaknesses related to the office BP measurement. The objective of this review was to evaluate each aspect on the technique to perform the office BP measurement.

[Psychological resistance to use insulin in type 2 diabetes mellitus patients from Venezuela]. / Resistencia psicológica al uso de insulina en pacientes con diabetes mellitus tipo 2 en una población venezolana.

The psychological resistance to use insulin (PIR) is a condition where the patient with type 2 diabetes mellitus (T2DM) refuses to use insulin. Our objective was to determine the frequency of PIR in a Venezuelan population and their beliefs regarding insulin and current medication. In several states of Venezuela, from January to March 2013, 254 patients with T2DM, over 18 years old and naive to insulin treatment were interviewed. We applied an interview to evaluate the disposition of the patients to use insulin if their doctor prescribes it and to determine their beliefs about insulin and their current medication. The patients were categorized in: not willing (PIR group), ambivalent and willing to use insulin. The beliefs about insulin and their current medication were grouped into positive or negative. The mean age was 56.2 years, with 7.1 years of duration of the T2DM; 58.6% were females. One third (32.7%) had PIR, 20.9% were ambivalent and 46.4% were willing to use insulin. PIR patients showed lower frequency of positive beliefs and more frequency of negative beliefs to insulin and to their current treatment (p < 0.0001). Negative beliefs to insulin increased 14 times the risk of PIR, and people without university studies had a four times increase in the risk of PIR compared to the willing group. In conclusion, a high frequency of PIR in patients with T2DM (32.7%) was found in Venezuela; they showed low frequency of positive beliefs and high frequency of negative beliefs about insulin use. It is necessary to improve T2DM patient education on this issue.

Resistencia psicológica al uso de insulina en pacientes con diabetes mellitus tipo 2 en una población venezolana / Psychological resistance to use insulin in type 2 diabetes mellitus patients from Venezuela

La resistencia psicológica al uso de insulina (RPI) es una condición donde el paciente con diabetes mellitus tipo 2 (DM2) se niega a utilizar insulina. Nuestro objetivo fue determinar la frecuencia de RPI en la población venezolana y sus creencias hacia la insulina y medicación actual. En el primer trimestre del año 2013 se entrevistaron 254 pacientes con DM2, mayores de 18 años de edad, libres de tratamiento con insulina, ubicados en áreas de consulta de varios estados de Venezuela. Se aplicó una encuesta para evaluar la disposición a utilizar insulina si su médico se la indicaba y sus creencias hacia la insulina y la medicación actual. Los pacientes se clasificaron en: no dispuestos (grupo con RPI), ambivalentes y dispuestos al uso de insulina. Las creencias hacia la insulina y medicación actual se agruparon en positivas o negativas. El promedio de edad fue de 56,2 años, con 7,1 años de duración de la DM2. El 58,6% correspondió a población femenina. Un tercio (32,7%) cursó con RPI, el 20,9% fue ambivalente y el 46,4% dispuesto a usar insulina. Los pacientes con RPI tuvieron una menor frecuencia de creencias positivas y mayor frecuencia de creencias negativas hacia la insulina y hacia su tratamiento actual (p< 0,0001). Las creencias negativas hacia la insulina incrementaron 14 veces el riesgo de presentar RPI y el no tener educación universitaria lo incrementó 4 veces, comparado con el grupo dispuesto. En conclusión, se encontró una alta frecuencia de RPI en pacientes con DM2 en Venezuela (32,7%), caracterizados por baja frecuencia de creencias positivas y alta de creencias negativas hacia la insulina. Es necesario mejorar la educación del paciente con DM2 al respecto.

The psychological resistance to use insulin (PIR) is a condition where the patient with type 2 diabetes mellitus (T2DM) refuses to use insulin. Our objective was to determine the frequency of PIR in a Venezuelan population and their beliefs regarding insulin and current medication. In several states of Venezuela, from January to March 2013, 254 patients with T2DM, over 18 years old and naive to insulin treatment were interviewed. We applied an interview to evaluate the disposition of the patients to use insulin if their doctor prescribes it and to determine their beliefs about insulin and their current medication. The patients were categorized in: not willing (PIR group), ambivalent and willing to use insulin. The beliefs about insulin and their current medication were grouped into positive or negative. The mean age was 56.2 years, with 7.1 years of duration of theT2DM; 58.6% were females. One third (32.7%) had PIR, 20.9% were ambivalent and 46.4% were willing to use insulin. PIR patients showed lower frequency of positive beliefs and more frequency of negative beliefs to insulin and to their current treatment (p <0.0001). Negative beliefs to insulin increased 14 times the risk of PIR, and people without university studies had a four times increase in the risk of PIR compared to the willing group. In conclusion, a high frequency of PIR in patients with T2DM (32.7%) was found in Venezuela; they showed low frequency of positive beliefs and high frequency of negative beliefs about insulin use. It is necessary to improve T2DM patient education on this issue.

Dislipidemias: Controversias del riesgo residual

Las estatinas son el principal tratamiento para la reducción del colesterol LDL habiendo demostrado un claro beneficio en la reducción de enfermedad cardiovascular (ECV). Sin embargo, a pesar de los pacientes alcanzar la meta de colesterol LDL, queda un remanente de riesgo relativo de ECV entre un 60% a 70%, el cual ha sido denominado Riesgo Residual. Por ello, el enfoque actual se inclina sobre objetivos adicionales al colesterol LDL, siendo el colesterol HDL bajo y/o triglicéridos elevados los objetivos terapéuticos para reducir el riesgo residual. Se han empleado diversas combinaciones de hipolipemiantes asociados a las estatinas para optimizar el perfil lipídico. La mayorías de estas drogas clásicas (fibratos, niacina y ácidos grasos omega-3), así como un nuevo grupo de moléculas inhibidoras de la Proteína Transportadora de Esteres de Colesterol, son capaces de mejorar las concentraciones de colesterol HDL y triglicéridos en asociación con estatinas, sin embargo, dichas combinaciones en la mayoría de los casos, no han demostrado beneficios en reducir la presencia de ECV, incluso, en el caso de la niacina, se observan efectos deletéreos en las combinaciones a pesar de la optimización del perfil lipídico. Estos hechos nos hacen replantear el conocimiento que tenemos sobre la dislipidemia y su tratamiento, por lo que se presenta la siguiente revisión.

Statins are the principal treatment for highest levels of LDL cholesterol, with clear benefits in reduction of cardiovascular disease (CVD). However, although patients reach LDL cholesterol goal, 60% to 70% have a relative risk remnant of CVD, named Residual Risk. By this, the discussion is focused in other objectives beside LDL cholesterol, being the low HDL cholesterol and/or elevated triglycerides a relevant therapeutic target to reduce the residual risk. Many combinations of drugs have been associated to statins to optimize lipid profile. Most of these classics drugs (fibratos, niacin, and fatty acids omega-3) and the new drugs of Cholesteryl Ester Transfer Proteins inhibitors, increase HDL cholesterol and reduce triglycerides combined with statins, however, in mostly of cases these combinations have not reduced CVD; in studies with niacin, the combination increase deleterious effects despite the optimization of lipid profile. These facts make us reconsider the knowledge we have on dyslipidemia and its treatment, so we present the following review.

Diabetes ¿Un concepto enfocado en reducción de riesgo cardiovascular?

La enfermedad cardiovascular (ECV) es la principal causa de muerte de los pacientes con diabetes mellitus (DM). Estudios observacionales han demostrado que a mayor concentración de HbA1c mayor es el riesgo de presentar eventos cardiovasculares; sin embargo, investigaciones recientes señalan que en pacientes con ECV establecida o factores de riesgo asociados, alcanzar metas de control glucémico, iniciar tratamiento con insulina glargina de forma temprana, o una reducción de peso sostenida durante 5 años con cambios de estilo de vida, no establecen un beneficio en la reducción de riesgo en todas las causas de mortalidad incluyendo mortalidad cardiovascular. Discretos beneficios se han evidenciado en eventos macrovasculares y mortalidad a largo plazo con el tratamiento intensivo de la glucemia en pacientes de bajo riesgo cardiovascular y corta duración de la DM. La mayoría de los estudios coinciden en demostrar beneficios microvasculares al tratar intensivamente la glucemia, efecto que posiblemente se deba a que los criterios diagnósticos de DM se fundamentan en hallazgos de patología microvascular, lo cual sugiere la necesidad de formular nuevas herramientas diagnósticas de DM en la que su intervención reduzca contundentemente la aparición de ECV. Esta definición posiblemente debería preceder la aparición de hiperglucemia, la respuesta tal vez se encuentre en la determinación de resistencia a la insulina, sin embargo, actualmente no se cuenta con herramientas confiables para la detección de este trastorno.

Cardiovascular disease (CVD) is leading death cause en patients with diabetes mellitus (DM). Observational epidemiologic data indicated that highest A1c levels are associated with highest risk of CVD; however, recent research suggests that in patients with established CVD or risk factors, achieving goals for glycemic control, insulin glargine start early, or a sustained weight loss for 5 years with lifestyle changes, do not provide a benefit risk reduction in all-cause mortality including cardiovascular mortality. One study with prolonged follow-up demonstrates a little benefit on macrovascular outcomes and mortality in patients with short duration of DM and low cardiovascular risk. Most studies agree that demonstrate benefits in treating intensively microvascular blood glucose, an effect that is possibly due to the diagnostic criteria for DM are based on findings of microvascular disease, suggesting the need to develop new diagnostic tools in DM his intervention strongly to reduce the occurrence of CVD. This definition probably should precede the onset of hyperglycemia, the answer may be in determining insulin resistance, however, currently there is no reliable tools for the detection of this disorder.

Síndrome metabólico: ¿Queda espacio para este concepto?

El síndrome metabólico (SMet) es un conglomerado de factores de riesgo metabólicos que aumenta en un individuo las posibilidades para desarrollar enfermedad cardiovascular aterosclerótica (ECVA) y diabetes mellitus tipo 2 (DM2). Existe gran controversia acerca de la utilidad de este concepto. Se estima que un tercio de la población mundial cursa con SMet. Fisiopatológicamente, existen dos teorías que tratan de explicar su concepto: la obesidad y la resistencia a la insulina; esto debido, a que no todos los pacientes con resistencia a la insulina cursan con SMet, y viceversa; la búsqueda de una analogía entre ambos conceptos posiblemente sea errónea. Desde su descripción como síndrome X, diferentes asociaciones han planteado diversos criterios diagnósticos que tratan de detectar pacientes con estas alteraciones, la definición más aceptada fue la propuesta por el NCEP/ATPIII, la cual ha sufrido, desde el año 2.002 hasta la presente, escasas modificaciones; uno de los cambios más resaltantes es el ajuste de perímetro abdominal según la raza, proponiéndose recientemente para Latinoamérica: 94 cm hombres y 90 cm mujeres. El pronóstico de riesgo que establece el SMet varía notoriamente acorde a la definición aplicada y los criterios presentes. El manejo del SMet implica el control de cada una de las alteraciones halladas, lo que debilita notoriamente su necesidad diagnóstica. Se concluye que el SMet permite detectar pacientes con riesgo de ECVA y DM2, principalmente en estudios epidemiológicos, quedando un espacio para este concepto orientado primariamente al estudio de su fisiopatología y evaluación epidemiológica. Se hace una revisión del tema.

The metabolic syndrome (MetS) is a cluster of metabolic risk factors in an individual which increase cardiovascular atherosclerotic disease (CAD) and type 2 diabetes (T2DM). This concept is not accepted completely. It is estimated that one third of people around the world have MetS. Two theories try to explain his physiopathology: obesity and insulin resistance; this because, not all patients with MetS have insulin resistance, and viceversa. The search for the analogy between these theories could be a mistake. From its description as X syndrome, many diagnosis criteria have been proposed for different associations, the NCEP/ATPIII criteria is the most accepted definition, which has suffered limited amendments since 2002; the most important change is the adjustment of waist circumference by race, recently proposing to Latin America, 94 cm for men and 90 cm for women. The predicted risk of MetS varies markedly according to the definition and criteria applied. The management of MetS involves controlling each of the alterations found; this notoriously weakens its diagnostic need. We conclude that the MetS is an instrument to detect patients at risk of CAD and T2DM, mostly in epidemiological studies, leaving a space primarily oriented to the study of pathophysiology and epidemiological evaluation of this concept. We make a revision of these topics.

Estatinas en enfermedad cerebrovascular: Una nueva perspectiva

El uso de estatinas en relación con los accidentes cerebrovasculares (ACV) ha mostrado resultados controversiales, su utilización se ha asociado con una disminución en el desarrollo de ACV isquémicos, siendo este efecto contrabalanceado con un aumento en los ACV hemorrágicos. El nivel de evidencia pone en duda el beneficio de estos medicamentos en casos de riesgo alto para ACV hemorrágico, lo cual incrementa la necesidad de una evaluación adecuada de sus riesgos y beneficios potenciales. Se presenta una revisión crítica al respecto.

Statin use in relation to cerebrovascular accidents has shown controversial results. Its use has been associated with a decrease in the development of ischemic stroke, and this effect was counterbalanced by an increase in hemorrhagic stroke. The level of evidence casts doubt on the benefit of these drugs in cases of high risk for hemorrhagic stroke, increasing the need for appropriate assessment of risks and benefits. A critical review on the issue is presented.

Esquema Móvil de insulina: El principio del fin

Existe una alta prevalencia de diabetes mellitus tipo 2 (DM) a nivel mundial, y se espera que ésta se duplique en los próximos veinte años. Los pacientes con DM corresponden a un cuarto de los pacientes hospitalizados, debiendo ser manejados con insulina durante su hospitalización. El esquema móvil de insulina es el modo de administración de insulina más utilizado en el paciente con DM hospitalizado, y actualmente existe gran controversia alrededor de su uso, con escasa evidencia científica que sustente su beneficio, estableciéndose una tendencia actual a su eliminación. Se hace una revisión al respecto.

There is a high prevalence of type 2 diabetes mellitus (DM) worldwide and it is expected to double over the next twenty years. Patients with DM correspond to one quarter of hospitalized patients and should be managed with insulin during their hospitalization. The sliding scale regular insulin is the way most used of insulin therapy in hospitalized patients with DM, and there is now controversy about its use, with little scientific evidence to support its benefit, establishing a trend for disposal. A review on the matter is done.