Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study. / Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.

INTRODUCTION: Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache. SUBJECTS AND METHODS: A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed. RESULTS: A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements. CONCLUSION: Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

TITLE: Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.Introducción. La cefalea es un síntoma frecuente en la fase aguda de la enfermedad por coronavirus 2019 (COVID-19) y también uno de los efectos adversos más comunes tras la vacunación. En ambos casos, la fisiopatología de la cefalea parece estar relacionada con la respuesta inmunitaria del huésped y podría presentar similitudes. Nuestro objetivo fue comparar el fenotipo clínico y la frecuencia de los síntomas asociados y los síntomas de inicio en pacientes con cefalea relacionada con la COVID-19 y cefalea relacionada con la vacuna de la COVID-19. Sujetos y métodos. Se realizó un estudio de casos y controles. Se incluyó a pacientes con infección confirmada por COVID-19 y receptores de la vacuna de la COVID-19 que experimentaron un nuevo inicio de cefalea. Se administró un cuestionario estandarizado que incluyó variables demográficas, antecedentes previos de cefaleas, síntomas asociados y variables relacionadas con la cefalea. Ambos grupos se emparejaron por edad, sexo y antecedentes previos de cefaleas. Se realizó un análisis de regresión multivariante. Resultados. Un total de 238 pacientes cumplieron con los criterios de elegibilidad (143 pacientes con cefalea relacionada con la COVID-19 y 95 sujetos con cefalea relacionada con la vacuna de la COVID-19). Los pacientes con cefalea relacionada con la COVID-19 presentaron una mayor frecuencia de artralgia, diarrea, disnea, dolor torácico, expectoración, anosmia, mialgia, odinofagia, rinorrea, tos y disgeusia. Además, los pacientes con cefalea relacionada con la COVID-19 experimentaron una duración diaria más prolongada de la cefalea y describieron la cefalea como la peor que habían experimentado. Los pacientes con cefalea relacionada con la vacuna de la COVID-19 experimentaron con más frecuencia dolor en la región parietal, fonofobia y empeoramiento de la cefalea por movimientos de la cabeza o de los ojos. Conclusión. La cefalea causada por la infección por el SARS-CoV-2 y la cefalea relacionada con la vacunación de la COVID-19 presentan más similitudes que diferencias, lo que respalda una fisiopatología compartida y la activación de la respuesta inmunitaria innata. Las principales diferencias estuvieron relacionadas con los síntomas asociados.

Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry).

BACKGROUND: Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. OBJECTIVES: This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. METHODS: This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. RESULTS: A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). CONCLUSION: SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

OBJECTIVES: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS: Mean age (years) ±â€¯S.D. at diagnosis was 14.2 ±â€¯2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ±â€¯S.D. was 1.27 ±â€¯1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

Association of IL1Β (-511 A/C) and IL6 (-174 G > C) polymorphisms with higher disease activity and clinical pattern of psoriatic arthritis.

The objective of this study is to analyze whether IL1ß (-511G > A) and IL6 (-174 G > C) polymorphisms are associated with inflammatory activity, radiographic damage or clinical pattern of psoriatic arthritis (PsA). One hundred twenty-five patients classified as PsA according to the Classification of Psoriatic Arthritis (CASPAR) criteria were included. Patients were stratified according to their clinical pattern at inclusion as peripheral, axial, or mixed involvement. Disease activity in peripheral or mixed forms was measured using the number of swollen and tender joints, pain analog visual scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used for axial and mixed forms, as were pain visual analog scale, ESR and CRP. Radiographic damage was evaluated using a modified Sharp score and modified stoke ankylosing spondylitis spinal score (SASSSm). The polymorphisms for the promoter region of IL1ß (-511 G/A) and IL-6 (-174 G/C) were analyzed. The G allele of IL1B (-511G/A) polymorphism was associated with higher peripheral joint disease activity (OR 3.13; p < 0.0004; CI 95 % 1.43-6.82, p (corrected) <0.008), while the G allele of the IL6 (174G > C) polymorphism presented a strong trend to be associated with peripheral forms (70.86 %) (OR 1.89; p < 0.03; CI 95 % 1.06-3.39, p-corrected 0.05). In addition, this allele showed a lower association with HLA-B27 (15.78 %) compared with C allele (28.57 %) (OR 0.469; p = 0.02; CI 95 % 0.238-0.923, p-corrected 0.03). This study suggests that the G allele polymorphism of IL1B (-511 A/C) is associated with higher peripheral joint disease activity. On the other hand, the IL6 (-174 G/C) polymorphism showed a strong trend to be associated with the peripheral pattern of PsA.

Elaboración mediante el método Delphi de recomendaciones para el manejo coordinado (reumatólogo/dermatólogo) de la artritis psoriásica / Recommendations for the Coordinated Management of Psoriatic Arthritis by Rheumatologists and Dermatologists: A Delphi Study

La artritis psoriásica es una enfermedad inflamatoria crónica que afecta al sistema musculoesquelético, se asocia a psoriasis y suele producir destrucción articular con pérdida de función y calidad de vida. Su presentación clínica es heterogénea, con extremos fenotípicos que pueden solaparse con la artritis reumatoide o la espondilitis anquilosante. La psoriasis suele preceder a la artritis psoriásica, y la consulta de dermatología es el lugar clave para su detección precoz. Muchos tratamientos utilizados en psoriasis también se utilizan en artritis psoriásica, por tanto las recomendaciones terapéuticas para la psoriasis deben realizarse teniendo en cuenta el tipo y la gravedad de la artritis psoriásica, y viceversa. El objetivo de este documento es establecer pautas para el manejo coordinado (reumatólogo/dermatólogo) de la artritis psoriásica. Ha sido elaborado mediante la técnica Delphi por un grupo multidisciplinar (6 reumatólogos, 6 dermatólogos y 2 epidemiólogos) y contiene recomendaciones, tablas y algoritmos para diagnóstico, criterios de derivación y tratamiento de la artritis psoriásica

Psoriatic arthritis, a chronic inflammatory musculoskeletal disease that is associated with psoriasis, causes joint erosions, accompanied by loss of function and quality-of-life. The clinical presentation is variable, with extreme phenotypes that can mimic rheumatoid arthritis or ankylosing spondylitis. Because psoriasis usually presents before psoriatic arthritis, the dermatologist plays a key role in early detection of the latter. As many treatments used in psoriasis are also used in psoriatic arthritis, treatment recommendations should take into consideration the type and severity of both conditions. This consensus paper presents guidelines for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists. The paper was drafted by a multidisciplinary group (6 rheumatologists, 6 dermatologists, and 2 epidemiologists) using the Delphi method and contains recommendations, tables, and algorithms for the diagnosis, referral, and treatment of patients with psoriatic arthritis

Recommendations for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists: a Delphi study.

Psoriatic arthritis, a chronic inflammatory musculoskeletal disease that is associated with psoriasis, causes joint erosions, accompanied by loss of function and quality-of-life. The clinical presentation is variable, with extreme phenotypes that can mimic rheumatoid arthritis or ankylosing spondylitis. Because psoriasis usually presents before psoriatic arthritis, the dermatologist plays a key role in early detection of the latter. As many treatments used in psoriasis are also used in psoriatic arthritis, treatment recommendations should take into consideration the type and severity of both conditions. This consensus paper presents guidelines for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists. The paper was drafted by a multidisciplinary group (6rheumatologists, 6dermatologists, and 2epidemiologists) using the Delphi method and contains recommendations, tables, and algorithms for the diagnosis, referral, and treatment of patients with psoriatic arthritis.

Haemodialysis course is associated to changes in pain threshold and in the relations between arterial pressure and pain.

ANTECEDENTS: Arterial pressure is negatively associated to pain perception. OBJECTIVES: In this study, pain and the relations between arterial pressure and pain threshold were compared at the beginning and end of the haemodialysis. METHODS: 14 patients with chronic renal disease participated in the study. Pain thresholds were evaluated with pressure algometry bilaterally at two tender points: the second rib and the knee. Arterial pressure and pain thresholds were assessed twice: 1) 15 min alter dialysis onset and 2) 30 min before dialysis ended. RESULTS: Arterial pressure remains unchanged through the dialysis. The course of dialysis was associated to a decrease in pain threshold in the second left rib and left and right knees. At the beginning of dialysis arterial pressure were uncorrelated with pain, while at the end of the dialysis both systolic and diastolic arterial pressure were strongly associated to pain thresholds (rs between 0.552 and 0.806): increased arterial pressure was associated to lower pain in terms of increased threshold. CONCLUSIONS: Haemodialysis is associated to changes in pain sensitivity and in the relationships between arterial pressure and pain, suggesting a modification in the ascending pain inhibition system arising from the cardiovascular system. Possible explanations of this effect include the changes produced by haemodialysis in cognitive-perceptive functions, in autonomic cardiovascular regulation, and in the habituation of stress-related variables.

Attitude of health professionals toward cadaveric tissue donation.

INTRODUCTION: A positive attitude toward organ donation would be expected among health professionals from transplant centers with active donor activities. However, acceptance and knowledge about cadaveric tissue donation has been insufficiently studied. OBJECTIVE: The objective of this study was to analyze the knowledge and attitude of health professionals toward cadaveric tissue donation. METHODS: An anonymous survey composed of 23 questions was given to health professionals from 2 university hospitals with donation experience. Sociodemographic and professional characteristics were described to analyze knowledge and acceptance of cadaveric tissue donation. RESULTS: Among 600 distributed questionnaires we collected 514 completely answered surveys. Gender distribution was 399 females/115 males of ages ranging from 18-65 years, namely 18-28 years, 27%; 29-39 years, 31%; 40-50 years, 32%; and 51-65 years, 10%. Among the sample, 31% of health professionals had never been in contact with a transplant recipient. In this study 99.4% had knowledge about cadaveric organ donation compare with 89.7% about tissue donation. The knowledge about various types of tissue donation was as follows: eye, 96%; musculoskeletal, 87%; skin, 72%, and cardiovascular, 67%. In the sample, 93% and 92% accepted the opportunity to receive an organ or tissue transplantation, respectively. The acceptance of a tissue varied according to the type: cardiovascular, 93%; ocular, 94%; skin, 89%; and musculoskeletal, 87%. Participant acceptance of a relative's tissue donation was 74%, refusal was 22%, and with doubts was 4%. CONCLUSIONS: Insufficient knowledge about cadaveric tissue was demonstrated among health professionals more exposed to the donation process. These results highlighted the importance of health professional's education to facilitate public information about organ and tissue donation.

Effects of minor constituents (non-glyceride compounds) of virgin olive oil on plasma lipid concentrations in male Wistar rats.

We aimed to assess the effects of minor constituents (MC) from virgin olive oil upon the plasma lipid profile of experimental animals. Therefore, 32 Wistar rats were fed for 6 weeks with one of four different diets with a similar fatty acid composition but different MC: high-oleic sunflower oil (HOSO), virgin olive oil (VOO), 400%-MC enriched olive oil (EOO) and MC poor (impoverished) olive oil (IOO). At the end of the week 6 of dietary treatment, blood samples were obtained for analysis of lipid composition. A statistically significant influence was observed upon both total HDL (1.593+/-0.4, 1.204+/-0.212, 0.991+/-0.244 and 0.827+/-0.279 mmol/L for EOO, HOSO, VOO and IOO, respectively, Kruskal-Wallis test, P<0.05) and HDL(2)cholesterol levels (1.16+/-0.26, 0.576+/-0.191, 0.585+/-0.216 and 0.583+/-0.207 mmol/L for EOO, HOSO, VOO and IOO, respectively, Kruskal-Wallis test, P<0.05). No statistically significant effect was observed upon LDL-cholesterol or triglycerides. Thus, MC supplementation has beneficial effects on HDL concentrations in Wistar rats.

Apolipoprotein E gene polymorphism is related to metabolic abnormalities, but does not influence erythrocyte membrane lipid composition or sodium-lithium countertransport activity in essential hypertension.

The aim of this study was to analyze the influence of the apolipoprotein E (apoE) gene polymorphism on insulin resistance and plasma lipid composition of essential hypertensive patients. A secondary objective was to analyze if differences regarding plasma lipids had an effect on the erythrocyte membrane lipid composition and the activity of the erythrocyte membrane sodium-lithium countertransport. We studied 128 untreated nondiabetic essential hypertensive patients enrolled from our outpatient clinic. We considered as hyperinsulinemic all subjects having more than 80 mU/L of plasma insulin 120 minutes after a 75-g oral glucose intake. The number of hyperinsulinemic subjects among carriers of the epsilon4 allele was higher that in epsilon4 noncarrier subjects (13 of 19 v45 of 109, P < .05; odds ratio [OR], 3.08; confidence interval [CI], 0.99-10.57). Plasma insulin at baseline and plasma insulin and glucose at 120 minutes after overload was higher in carriers of the epsilon4 allele (respectively, 17.5 +/- 6.9 v 12.4 +/- 4.9 mU/L, P < .01; 111.9 +/- 39.9 v 88.7 +/- 48.2, P < .05; and 143.8 +/- 29.3 v 121.2 +/- 30.8 mg/dL, P < .005). Subjects with the epsilon4 allele had a plasma lipid profile more atherogenic than those without this allele. This profile was mainly characterized by higher levels of low-density lipoprotein (LDL) cholesterol (150.1 +/- 31.2 v 133.0 +/- 34.3 mg/dL, P < .05) and very-low-density lipoprotein (VLDL) triglycerides (134.7 +/- 85.5 v 99.2 +/- 68.8 mg/dL, P < .05) and by lower levels of high-density lipoprotein (HDL) cholesterol (41.8 +/- 10.7 v 50.0 +/- 14.7 mg/dL, P < .05). There were no differences between groups regarding erythrocyte membrane cholesterol or phospholipids composition and sodium-lithium countertransport (SLC) activity.

Anetoderma in systemic lupus erythematosus: relationship to antiphospholipid antibodies.

Anetoderma is an elastolytic disorder where multiple patches of slack skin are formed. Twelve patients with anetoderma associated with systemic lupus erythematous have been described, all in the dermatological literature. Recently, a role for antiphospholipid antibodies has been proposed with microthromboses as its pathogenic mechanism. We present herein a 20-year-old female patient who developed anetoderma soon after sun exposure. She was found to have a false positive VDRL and gradually developed other manifestations of SLE, including interstitial cystitis. She has had repeatedly positive antiphospholipid antibodies. Although there are patients who may have a primary form, diagnosis of anetoderma should trigger a search for SLE and/or antiphospholipid antibodies.

[Prevalence of dyslipidemia and its phenotypes in recently diagnosed essential arterial hypertension]. / Prevalencia de dislipemia y de sus distintos fenotipos en la hipertensión arterial esencial de comienzo reciente.

BACKGROUND: To know the prevalence of phenotypic dyslipidemias and their clinical and metabolic characteristics in recently diagnosed hypertensive patients. METHODS: Consecutive study of 158 essential hypertensive patients without previous pharmacological treatment. RESULTS: 69.6% of the patients had some kind of dyslipidemia, being the isolated increase of Lp(a) (27.3%) the most prevalent and the hyperapobetalipoproteinemia the less (10.0%). Age, sex, smoking, alcohol consumption, uric acid, systolic and pulse pressure and serum glucose were different among phenotypes. CONCLUSIONS: Essential hypertensive patients have high and heterogeneous prevalence of dyslipidemias.

Lack of association of lipoprotein (a) with coronary heart disease in Spaniard type 2 diabetic patients.

We tried to elucidate the possible relationship between lipoprotein (a) levels and coronary heart disease by assessing the presence of lipoprotein (a) covariates in NIDDM. We selected 41 type 2 diabetic patients with coronary heart disease and 82 type 2 diabetic patients free from cardiovascular disease. They were adjusted for age, sex and duration of diabetes. Routine chemical analysis was carried out using standard procedures, HbA1c by HPLC and lipoprotein (a) and urinary albumin excretion rate by immunonephelometry. No difference has been found in lipoprotein (a) levels between both groups of patients (18 [144.25] mg/dl in cases vs. 23 [197.25] mg/dl in controls (median [range]), Mann Whitney U-test, P > 0.1). No association has been found between coronary heart disease and lipoprotein (a) levels greater than 30 mg/dl (Pearson's chi 2, P > 0.1). Significant and independent linear relationships have been found between the square root of lipoprotein (a) levels, serum creatinine and total cholesterol (multiple r2: 0.15, P < 0.001). Patients treated with insulin had greater square root of lipoprotein (a) levels, even after adjusting for serum creatinine and total cholesterol (5.87 +/- 0.35 vs. 4.76 +/- 0.36 (mean +/- S.E.), ANCOVA, P < 0.05). These data do not show an association between symptomatic coronary heart disease and lipoprotein (a) in NIDDM. Significant and independent relationships have been found between this variable and serum creatinine, total cholesterol and insulin therapy.

Erythrocyte Na(+)-Li+ countertransport in essential hypertension: correlation with membrane lipids levels.

OBJECTIVE: To examine whether Na(+)-Li+ countertransport (SLC) activity is linked to erythrocyte membrane lipid content. DESIGN: An observational case-control study. The maximal efflux rate of SLC, plasma cholesterol, triglycerides, phospholipids, low- and high-density lipoprotein cholesterol levels and the erythrocyte membrane cholesterol, phospholipids and fatty acids contents were determined both in fasting normolipaemic normotensive subjects and in hypertensive patients. METHODS: The Li(+)-stimulated Na+ efflux was measured in Li(+)-preloaded erythrocytes. Membrane cholesterol and phospholipids levels were determined by the latroscan technique. Membrane fatty acids were identificated by gas chromatography. Several derived indices were also obtained. RESULTS: Erythrocyte membranes of hypertensive patients showed an increase in cholesterol: phospholipid ratio and a decrease in the total amount of polyunsaturated fatty acids, mainly at the expense of arachidonic acid and docosatetraenoic acid. SLC activity was higher in hypertensive patients and correlated positively with the plasma triglycerides level and negatively with the ratio of C20:4 to C20:3. CONCLUSION: Our data from untreated normolipaemic hypertensive patients show that a higher SLC activity was accompanied by parameters that indicate a lower membrane fluidity.

The rate of transbilayer movement of erythrocyte membrane cholesterol is correlated with sodium-lithium countertransport.

Hypertension is associated with some abnormalities in cell membrane structure, including an impaired distribution of cholesterol into the monolayers of erythrocyte membrane. Transbilayer movement of membrane cholesterol modulates the formation of these structural cholesterol domains. We tested whether the rate of cholesterol movement may influence on the erythrocyte Na(+)-Li+ countertransport, that is a marker of human essential hypertension. In single regression analysis, the half-time for the decrease in specific radioactivity of cholestenone (inverse of membrane cholesterol transbilayer movement) was negatively related to the erythrocyte cation flux mediated by Na(+)-Li+ countertransport (r = -0.8983, P < 0.0001 for control subjects; r = -0.8191, P < 0.005 for normocholesterolaemic hypertensive patients; r = -0.7664, P < 0.005 for hypercholesterolaemic hypertensive patients). These data suggest that changes in the transbilayer movement of membrane cholesterol interfere with the main cation transport system which is implicated in the pathophysiology of essential hypertension. This also provides a new link between kinetic cholesterol pools and cell membrane functions.

Transbilayer movement of erythrocyte membrane cholesterol in human essential hypertension.

OBJECTIVE: To study whether the rate of transbilayer movement of membrane cholesterol is impaired in erythrocyte membrane of normo- and hypercholesterolaemic patients with untreated essential hypertension. DESIGN: An observational case-control study. METHODS: Erythrocytes were prepared from venous blood samples obtained from normotensive subjects and hypertensive patients. The rate of transbilayer movement of membrane cholesterol was monitored in intact erythrocytes, using a radiolabelled cholesterol tracer. Erythrocytes were treated briefly or continuously with cholesterol oxidase to convert a portion of the outer leaflet cholesterol to cholestenone, and the specific radioactivity of cholestenone was determined over the period of tracer equilibration. The decrease in specific radioactivity of cholestenone reflected the transbilayer movement of radiolabelled cholesterol. RESULTS: There were no significant differences between the diffusion of cholesterol across the erythrocyte membrane of normo- and hypercholesterolaemic hypertensive patients, but the rates were significantly lower than that estimated in control subjects. The mean +/- SD half-times for the process were 55.1 +/- 8.8 and 11.3 +/- 2.1 min in controls, 63.1 +/- 9.2 and 15.8 +/- 2.3 min in normocholesterolaemic hypertensive patients, and 66.2 +/- 9.4 and 16.2 +/- 1.7 min in hypercholesterolaemic hypertensive patients, after a brief and after a continuous cholesterol oxidase treatment, respectively. CONCLUSION: There is a reduction in the transbilayer movement of membrane cholesterol in erythrocytes of patients with untreated essential hypertension.

Influencia de la hiperinsulinemia en el perfil lipídico de los pacientes hipertensos / The influence of hyperinsulinemia in the lipid profile of hypertensive patients

Fundamentos: la hipertensión arterial y dislipidemia se asocian con una frecuencia superior a la atribuible al azar. El aumento de resistencia insulínica/hiperinsulinemia ha sido uno de los factores implicados en la patogenia de dicha asociación. En el presente trabajo se analiza el perfil lipídico de los pacientes hipertensos según el grado de insulinemia. Métodos: se determinó el perfil lipídico (colesterol total, sus fracciones unidas a las lipoproteínas de baja densidad -cLDL-, alta densidad -cHDL-, triglicéridos y apolipoproteínas A1 y B plasmáticas), en 87 pacientes. Además, se les administró una sobrecarga oral de 75g de glucosa con determinaciones de glucemia, insulinemia y péptido C a los 0, 60 y 120 minutos. Resultados: al separar los hipertensos en 2 grupos según la insulinemia alcanzada después de la sobrecarga oral de glucosa, aquellos hipertensos con mayor grado de insulinemia tenían un aumento significativo de triglicéridos (p<0,05) disminución también significativa del cHDL (p<0,001). Los hipertensos con menor insulinemia tenían un aumento significativo del colesterol total (p<0,05) y de su fracción unida a las LDL, aunque este último no fue significativo. Conclusiones: en los pacientes hipertensos se pueden observar dos perfiles lipídicos: uno ligado a la hiperinsulinemia y caracterizado por aumento de triglicéridos y disminución del cHDL y otro sin relación con la hiperinsulinemia, que se manifestaría por aumento del colesterol total y del colesterol transportado por las LDL

Influencia de la hiperinsulinemia en el perfil lipídico de los pacientes hipertensos / The influence of hyperinsulinemia in the lipid profile of hypertensive patients

Fundamentos: la hipertensión arterial y dislipidemia se asocian con una frecuencia superior a la atribuible al azar. El aumento de resistencia insulínica/hiperinsulinemia ha sido uno de los factores implicados en la patogenia de dicha asociación. En el presente trabajo se analiza el perfil lipídico de los pacientes hipertensos según el grado de insulinemia. Métodos: se determinó el perfil lipídico (colesterol total, sus fracciones unidas a las lipoproteínas de baja densidad -cLDL-, alta densidad -cHDL-, triglicéridos y apolipoproteínas A1 y B plasmáticas), en 87 pacientes. Además, se les administró una sobrecarga oral de 75g de glucosa con determinaciones de glucemia, insulinemia y péptido C a los 0, 60 y 120 minutos. Resultados: al separar los hipertensos en 2 grupos según la insulinemia alcanzada después de la sobrecarga oral de glucosa, aquellos hipertensos con mayor grado de insulinemia tenían un aumento significativo de triglicéridos (p<0,05) disminución también significativa del cHDL (p<0,001). Los hipertensos con menor insulinemia tenían un aumento significativo del colesterol total (p<0,05) y de su fracción unida a las LDL, aunque este último no fue significativo. Conclusiones: en los pacientes hipertensos se pueden observar dos perfiles lipídicos: uno ligado a la hiperinsulinemia y caracterizado por aumento de triglicéridos y disminución del cHDL y otro sin relación con la hiperinsulinemia, que se manifestaría por aumento del colesterol total y del colesterol transportado por las LDL (AU)

[Influences of hyperinsulinemia in the lipid profile of hypertensive patients]. / Influencias de la hiperinsulinemia en el perfil lipídico de los pacientes hipertensos.

BACKGROUND: Hypertension and dyslipemia are associated with a greater frequency than that randomly expected. The increase in insulinic resistance hyperinsulinemia is one of the factors implicated in the pathogenesis of this association. In the present study the lipid profile of hypertensive patients is analyzed according to the degree of insulinemia. METHODS: The lipid profile (total cholesterol, fraction linked to low density lipoproteins cLDL, high density cHDL, triglycerides and plasma apolipoproteins A1 and B were determined in 87 patients with essential high blood pressure. Moreover an oral overdose of 75 g of glucose was administered with determinations of glycemia, insulinemia and C peptide at the time of glucose administration, 60 and 120 minutes. RESULTS: Upon separation of the hypertense patients into two groups according to the insulinemia achieved following an oral overload of glucose, those hypertensives with a greater degree of insulinemia showed a significant increase in triglycerides (p < 0.05) and also a significant decrease in cHDL (p < 0.001). The hypertensive patients with lower insulinemia showed a significant increase in total cholesterol (p < 0.05) and fraction linked to LDL although the latter was not significant. CONCLUSIONS: Two different lipid profiles may be observed in hypertensive patients: one linked to hyperinsulinemia and characterized by an increase in triglycerides and a decrease in cHDL and another with no relation with hyperinsulinemia which is manifested by an increase in total cholesterol and cholesterol transported by the LDL.