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.

Lipoproteína (a) y fenotipos de apolipoproteína (a) en pacientes diabéticos tipo 1 / Lipoprotein (a) concentrations and apolipoprotein (a) phenotypes in type 1 diabetic patients

Objetivos. En este estudio se ha querido comparar laconcentración de lipoproteína (a) y la distribución defrecuencias de los distintos fenotipos de apolipoproteína(a) entre un grupo de pacientes diabéticos de tipo 1 y ungrupo de personas sanas (controles). Pacientes. Seleccionamos 42 pacientes diabéticos de tipo 1,diagnosticados de acuerdo con los criterios delNational Diabetes Data Group y se compararon conun grupo de 134 individuos sanos. Los fenotipos de apolipoproteína (a) se determinaron mediante electroforesis seguida de inmunoblotting(Phastsystem-Pharmacia). Resultados. La concentración media en plasma de lipoproteína (a) de los pacientes diabéticos y de los controles no mostró diferencias estadísticamente significativas. La proporción de isoformas de apolipoproteína (a) de bajo peso molecular (LMW) fue más baja en los pacientes con diabetes mellitus de tipo 1 de más larga duración que en los pacientes con diabetes de duración más corta, pero estas diferencias no fueron estadísticamente significativas. Esto podría tener interés, pero se necesitan estudios más amplios para aclarar estos hallazgos. Conclusiones. Siempre ha de tenerse en cuenta tanto la concentración de lipoproteína (a) como el fenotipo de apolipoproteína (a) para identificar el mayor número posible de personas con riesgo cardiovascular ligado al gen de apolipoproteína (a)

Objectives. The aim of this study was to compare the lipoprotein (a) concentrations and the frequency distribution of the apolipoprotein (a) isoforms of a group of type 1 diabetic patients and a group of healthy subjects (controls). Design. We selected 42 type 1 diabetic patients diagnosed according to National Diabetes Data Group Criteria and compared them with a group of 134 healthy subjects. Apolipoprotein (a) phenotypes were determined by electrophoresis followed by inmunoblotting (Phastsystem- Pharmacia). Results. The mean plasma concentration of type 1 diabeticpatients and controls did not significantly differ. Theproportion of smaller isoforms for the twopopulations was not significantly different by X2analysis. The frequency of low molecular weight(LMW) apolipoprotein (a) phenotypes was lower inpatients with long diabetes duration than in patients with short disease duration, but these differences were not statistically significant. This might be of considerable interest, but we need longer studies to clarify these findings. Conclusions. We need to take into account both lipoprotein (a) levels and apolipoprotein (a) phenotypes to identify the highest number of subjects with high cardiovascular risk linked to apolipoprotein (a) gene, as peoplewith the same apolipoprotein (a) phenotype often show widely lipoprotein (a) levels and vice versa

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.

Diabetes mellitus gestacional: prevalencia y factores de riesgo / Gestational diabetes mellitus: prevalence and risk factors

Objetivos: Investigar la prevalencia de diabetes mellitus gestacionalen nuestro medio. Evaluar la utilidad del doble screeningy del screening selectivo, así como la relación existenteentre diabetes mellitus gestacional y edad, índice de masa corporalo antecedentes familiares maternos de diabetes mellitus.Material y métodos: Estudio retrospectivo de los resultadosobtenidos al realizar una prueba de cribado con 278 mmol deglucosa a 2088 mujeres entre las semanas 24 y 28 de gestación,de las cuales 591 fueron sometidas a un cribado previoentre las semanas 12 y 14 de embarazo.Resultados: La prevalenciade diabetes gestacional en nuestro medio fue de 4.5%.La presencia de diabetes mellitus gestacional se relacionaba deforma independiente con la edad materna (p<0.001) así comocon la presencia de antecedentes familiares maternos de diabetesmellitus (p<0.05). Conclusiones: Excluyendo del screeninguniversal a las mujeres que poseen bajo riesgo, se habríandiagnosticado correctamente todas las pacientes queacabaron desarrollando diabetes mellitus gestacional

Objectives: To investigate the gestational diabetes mellitusprevalence in our region. To evaluate the usefulness of the doubleand the selective screening and the relationship betweenthe presence of gestational diabetes mellitus and age, bodymass index and maternal familiar history of diabetes mellitus.Material and methods: Retrospective study of the results ofa screening test with 278 mmol of glucose to 2088 womenbetween the 24th and 28th gestational week.591 of these women were subjected to a previous screeningtest with 278 mmol of glucose between the 12th and 14thgestational week.Results: The gestational diabetes mellitus prevalence in Burgosand its province was 4.5%. Gestational diabetes mellituswas independently related to maternal age (p<0.001) andfamiliar maternal history of diabetes mellitus (p<0.05).Conclusions: If we had not made the O´Sullivan test to lowrisk women we would have had diagnosed correctly all thepatients with gestational diabetes mellitus

Estudio comparativo del test de 0'Sullivan y el cociente fructosamina/proteínas totales en el cribado de diabetes / Comparative study of 0'Sullivan test and Fructosamine/Total Proteins ratio as screemins tests for gestational diabetes mellitus

El test de O’Sullivan (TS) es el test más utilizado como prueba de cribado para el diagnóstico de diabetes mellitus gestacional (DM). Cuando es positivo (glucemia de 1.ª hora = ó > 140 mg/dl) se realiza una prueba de tolerancia oral a glucosa de 3 horas, la cual se considera estándar de oro en el diagnóstico de esta patología. La especificidad del test de O’Sullivan es baja (muchos falsos positivos), lo que obliga a realizar muchas curvas de tolerancia oral a glucosa innecesarias. Por ello, se pretende encontrar otras pruebas que puedan mejorar el cribado y/o diagnóstico de diabetes mellitus gestacional. En este sentido, hemos intentado valorar la utilidad y prestaciones diagnósticas del cociente fructosamina/proteínas totales (F/PT)

0'Sullivan test is the most used test for screening of gestational diabetes mellitus. When this test is positive a 3 hours oral glucose tolerance test is done. This test is considered gold standard for gestational diabetes mellitus diagnosis. The specificity of 0'Sullivan test is low (many false positives) and this is why we have to do many unnecessary 3 hours glucose tolerance tests. We have pretended to find a test that can improve the screening and diagnosis of gestational diabetes mellitus. The test that we have studied is the index Fructosamine/Total Proteins

Diabetes mellitus gestacional / Gestational diabetes mellitus

Hemos intentado evaluar la utilidad de un procedimiento de doble screening para el diagnóstico de la diabetes mellitus gestacional. Este procedimiento consiste en la realización de un primer test de O´Sullivan entre la 12 y 14 semanas de gestación y un segundo test de O´Sullivan entre la 24 y 28 semanas de gestación. nuestros resultados confirman la existencia de un gran número de falsos positivos en el test de O´Sullivan realizado entre la 12 y 14 semanas de gestación y una baja eficacia para dicho test inicial (AU)

Apolipoproteínas, colesterol y peso al nacer / Apolipoproteins, cholesterol and birthweight

Para intentar contrastar la teoría según la cual algunos autores han sugerido que los índices de desarrollo fetal, como es el peso al nacer, podrían servir como indicadores del riesgo de enfermedad cardiovascular en la vida adulta, se han estudiado las relaciones entre el peso al nacer, algunos parámetros lipoproteicos y las historias familiares de enfermedad cardiovascular o de "diabetes mellitus" en los progenitores. Se han utilizado 508 muestras de sangre de cordón umbilical, pertenecientes a los sujetos, sin problemas perinatales, nacidos en el hospital General Yagüe en un período de 6 meses. Se han determinado las concentraciones de apolipoproteínas A-I, colesterol total y contenido en las lipoproteínas de baja, muy baja y alta densidad, y triglicéridos. Se ha utilizado el programa informático SPSS (Statistical Package for the Social Sciences). Los resultados obtenidos sugieren: i/ que la historia familiar de "diabetes mellitus" da lugar a un mayor riesgo cardiovascular desde el nacimiento, ii/ que las relaciones entre peso al nacer y concentración de apoliproteína A-I deben ser revisadas, y iii/ que el supuesto aumento del riesgo cardiovascular atribuido por algunos autores para los neonatos con bajo peso al nacer debe ser seriamente puesto en cuestión (AU)

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.