Hepatobiliary involvement in systemic sclerosis and the cutaneous subsets: Characteristics and survival of patients from the Spanish RESCLE Registry.

OBJECTIVE: To assess the prevalence and causes of hepatobiliary involvement (HBI) in systemic sclerosis (SSc), to investigate the clinical characteristics and prognosis of SSc patients with HBI (SSc-HBI) and without HBI (SSc-non-HBI), and to compare both groups according to the cutaneous SSc subsets. METHODS: In all, 1572 SSc patients were collected in the RESCLE registry up to January 2015, and all hepatobiliary disturbances were recorded. We investigated the HBI-related characteristics and survival from the entire SSc cohort and according to the following cutaneous subsets: diffuse cutaneous SSc (dcSSc), limited cutaneous SSc (lcSSc), and SSc sine scleroderma (ssSSc). RESULTS: Out of 1572, 118 (7.5%) patients had HBI. Primary biliary cholangitis (PBC) was largely the main cause (n = 67, 4.3%), followed by autoimmune hepatitis (n = 19, 1.2%), and anti-mitochondrial negative PBC (n = 6, 0.4%). Other causes of HBI were as follows: secondary liver diseases (n = 11, 0.7%), SSc-related HBI (n = 7, 0.4%), nodular regenerative hyperplasia (n = 3, 0.2%), liver cirrhosis (n = 3, 0.2%), and HBI of unknown origin (n = 2, 0.1%). In multivariate analysis, HBI was independently associated to lesser risk of dcSSc (5.1% vs. 24.4%), and higher frequency of calcinosis (26% vs. 18%), left ventricular diastolic dysfunction (46% vs. 27%), sicca syndrome (51% vs. 29%), and anti-centromere antibodies (ACA, 73% vs. 44%). According to the cutaneous subsets, HBI was associated (1) in lcSSc, to longer time from SSc onset to diagnosis (10.8 ± 12.5 vs. 7.2 ± 9.3 years), sicca syndrome (54% vs. 33%), and ACA (80% vs. 56%); (2) in ssSSc, to sicca syndrome (44% vs. 19%), and (3) in dcSSc, no associations were found. HBI was the cause of death in 2.3% patients but the cumulative survival according to the presence or absence of HBI showed no differences. CONCLUSIONS: HBI prevalence in SSc is 7.5% and dcSSc is the least involved subset. PBC is the main cause of HBI. Patients with SSc-HBI exhibited specific clinical and immunologic profile. Survival is similar for SSc patients with HBI.

Tratamiento de la hipercolesterolemia: los nuevos ensayos con estatinas. ¿Se deben revisar las guías de tratamiento? / Treatment of hypercholesterolemia: new trials with statins. Should guidelines be revised?

En el año 2001, el National Cholesterol Education Program-Adult Treatment Panel-III (NCEP ATP III) publicó su tercer informe para la detección, evaluación y tratamiento de la hipercolesterolemia. Desde entonces se han publicado varios estudios relacionados con nuevas estrategias de tratamiento. Algunos de ellos, centrados en los valores de colesterol unido a lipoproteínas de baja densidad (cLDL), han dado resultados que obligan a replantear los objetivos determinados hasta ahora. Y es que los resultados sugieren que la terapia hipolipemiante debería ser más intensa y buscar mayores reducciones del cLDL. En general, las nuevas orientaciones afectan a los subgrupos de alto riesgo, lo que ha motivado que se planteen valores de cLDL tan bajos que hasta hace poco eran inimaginables. No obstante, aún hay bastantes incertidumbres que deberán resolverse en los próximos años, incluido el valor inferior de cLDL que se debe conseguir para una prevención más efectiva (AU)

In 2001, the National Cholesterol Education Program published its third expert-panel report on the detection, evaluation, and treatment of hypercholesterolemia in adults (Adult Treatment Panel III). Since then, many new studies of the best way to achieve LDL cholesterol targets have been completed. These indicate that a more aggressive approach to LDL cholesterol therapy should be taken and that modification of previous treatment guidelines should be considered. In particular, new approaches are especially important for high-risk patients, who need to achieve extremely low LDL cholesterol levels. The present paper contains a review of these recent trials and an assessment of their implications for managing the cholesterol level (AU)

[Effect of the Mediterranean diet on fasting concentrations of activated factor VII in healthy persons]. / Efecto de la dieta mediterránea en los valores plasmáticos de factor VII activado en personas sanas.

INTRODUCTION AND OBJECTIVES: Many clinical and epidemiologic studies suggest that activated factor VII may be involved in the pathogenesis of coronary heart disease. Our objective was to determine the effect of a Mediterranean diet on plasma levels of activated factor VII in comparison to a low-fat diet and a diet rich in saturated fat. PATIENTS AND METHOD: The study population comprised 16 healthy normolipemic men who consumed 3 different diets in consecutive 28-day periods. The first diet was rich in saturated fat (38% calories as fat, 20% saturated fat), the second was a low-fat, high-carbohydrate diet (28% calories as fat, 10% saturated fat), and the third was enriched in monounsaturated fatty acids (38% calories as fat, 22% monounsaturated fat). At the end of each period, plasma concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, total triglycerides, apolipoprotein A-I, apolipoprotein B, and glucose were measured. Activated factor VII was determined with a coagulation assay. RESULTS: The diet rich in saturated fat was associated with a significant increase in total cholesterol, LDL cholesterol, apolipoprotein AI, and apolipoprotein B in comparison to the other 2 diets. There were no significant differences between the carbohydrate-rich diet and the Mediterranean diet in any of the lipid parameters. The Mediterranean diet decreased plasma levels of factor VIIa in comparison to the diet rich in saturated fat (34.6+/-15.3 mU/mL vs 101.5+/-19.2 mU/mL; P<.05). CONCLUSIONS: In comparison to the diet rich in saturated fat or the high-carbohydrates diet, the Mediterranean diet decreased plasma concentrations of activated factor VII in healthy young men. This phenomenon may constitute another protective mechanism of the Mediterranean diet in reducing cardiovascular risk.

Efecto de la dieta mediterránea en los valores plasmáticos de factor VII activado en personas sanas / Effect of the mediterranean diet on fasting concentrations of activated factor VII in healthy persons

Introducción y objetivos. Numerosos estudios clínicos y epidemiológicos sugieren que el factor VII activado puede estar implicado en la patogenia de la enfermedad coronaria. Nuestro objetivo es determinar el efecto de una dieta típica mediterránea en los valores plasmáticos de dicho parámetro, cuando se compara con una dieta pobre en grasa y con una dieta rica en grasa saturada. Pacientes y métodos. Dieciséis varones sanos normolipémicos recibieron 3 dietas, durante 4 semanas cada una. La primera era rica en grasa saturada (38% grasa,20% saturada), la segunda rica en hidratos de carbono y pobre en grasa (28% grasa, 10% saturada) y, finalmente, una dieta mediterránea (38% grasa, 22% de grasa monoinsaturada).Al final de cada período se determinaron las concentraciones plasmáticas de colesterol total, colesterol unido a lipoproteínas de baja (cLDL) y alta(cHDL) densidad, triglicéridos totales, apolipoproteínaA-1, apolipo-proteína B y glucosa. El factor VII activado semidió mediante un ensayo de coagulación. Resultados. La dieta rica en grasa saturada se asoció con un incremento significativo de los valores de colesterol total, cLDL, apolipoproteína A-1 y apolipoproteína B, en comparación con las otras 2 dietas. No hubo diferencias significativas entre la dieta rica en hidratos de carbono y la mediterránea para cualquiera de los parámetros lipídicos examinados. El paso de una dieta rica en grasa saturada a una dieta mediterránea produjo un descenso en los valores de FVIIa (101,5 ± 19,2 frente a 34,6 ± 15,3mU/ml; p < 0,05).Conclusiones. La dieta mediterránea, cuando se compara con la dieta rica en grasa saturada o la rica en hidratos de carbono, disminuye las concentraciones plasmáticas del factor VII activado en varones sanos. Este fenómeno podría constituir otro mecanismo protector dela dieta mediterránea en la reducción del riesgo cardiovascular

Introduction and objectives. Many clinical and epidemiologic studies suggest that activated factor VII may be involved in the pathogenesis of coronary heart disease. Our objective was to determine the effect of a Mediterranean diet on plasma levels of activated factor VII in comparison to a low-fat diet and a diet rich in saturated fat. Patients and method. The study population comprised16 healthy normolipemic men who consumed 3 different diets in consecutive 28-day periods. The first diet was rich in saturated fat (38% calories as fat, 20% saturated fat),the second was a low-fat, high-carbohydrate diet (28% calories as fat, 10% saturated fat), and the third was enriched in monounsaturated fatty acids (38% calories as fat,22% monounsaturated fat). At the end of each period, plasma concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, total triglycerides, apolipoprotein A-I, apolipo-protein B, and glucose were measured. Activated factor VII was determined with a coagulation assay. Results. The diet rich in saturated fat was associated with a significant increase in total cholesterol, LDL cholesterol, apolipoprotein AI, and apolipoprotein B in comparison to the other 2 diets. There were no significant differences between the carbohydrate-rich diet and the Mediterranean diet in any of the lipid parameters. The Mediterranean diet decreased plasma levels of factor VIIain comparison to the diet rich in saturated fat (34.6±15.3mU/mL vs 101.5±19.2 mU/mL; P<.05).Conclusions. In comparison to the diet rich in saturated fat or the high-carbohydrates diet, the Mediterranean diet decreased plasma concentrations of activated factor VII in healthy young men. This phenomenon may constitute another protective mechanism of the Mediterranean diet in reducing cardiovascular risk