RESUMO
BACKGROUND AND AIMS: Rare (611C) and common (1062V) variants of the Low-Density Lipoprotein Receptor-Related Protein 6 (LRP6) display reduced activation of Wnt/ß-catenin signaling. The rare gene variant was associated with hypertension, metabolic abnormalities, and early coronary artery disease. We investigated whether the common 1062V LRP6 variant was related to carotid artery atherosclerosis (CAA) in hypertensive patients. METHODS AND RESULTS: Retrospective study of 334 hypertensive patients (<65 years old) who underwent carotid artery ultrasonography. Hypertension, type 2 diabetes, dyslipidemia, glomerular filtration rate, and smoking habit were evaluated. CAA was defined by the presence of atherosclerotic plaques (focal intima-media thickness ≥ 1.3 mm). Logistic regression models were used to estimate the independent effect of 1062V allele. The relationship between LRP6 genotypes and LRP6 gene expression in carotid plaques was also investigated. No difference was observed between genotypes in clinical variables except for a slightly higher fasting glucose in 1062V carriers. The 1062V LRP6 variant was an independent risk factor for CAA in both unadjusted (OR 2.08, 95%CI 1.27-3.41, p=0.003) and adjusted models (OR 1.92, 95%CI 1.09-3.39, p=0.02). LRP6 was expressed in carotid atherosclerotic plaques at significantly lower levels (p=0.015) in 1062V carriers. CONCLUSION: Beside the role of established risk factors, 1062V variant of LRP6 and CAA are strongly associated in hypertensive patients, making LRP6 a novel relevant candidate gene for atherosclerosis in the presence of hypertension.
Assuntos
Doenças das Artérias Carótidas/genética , Hipertensão/genética , Proteínas Relacionadas a Receptor de LDL/genética , Proteínas Relacionadas a Receptor de LDL/metabolismo , Adulto , Doenças das Artérias Carótidas/metabolismo , Feminino , Expressão Gênica , Humanos , Hipertensão/metabolismo , Modelos Logísticos , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/metabolismo , Estudos Retrospectivos , Fatores de Risco , Transdução de Sinais , Proteínas Wnt/genética , Proteínas Wnt/metabolismo , beta Catenina/genética , beta Catenina/metabolismoRESUMO
INTRODUCTION: The authors describe an unusual case of giant aneurysm of the splenic artery. The problem of deciding between endovascular and open vascular surgery and what are the tools necessary to choose the most appropriate procedure are discussed in this report. CASE REPORT: A man 55 years old was admitted to the hospital for an unspecified abdominal pain. Subsequent examinations (TC and angiography) showed a large aneurysm of the splenic artery without any sign of rupture. Endovascular treatment was excluded because of the extreme tortuosity of the artery; the patient underwent open surgical operation of legation of the aneurysm and splenectomy. The patient was discharged in 6th postoperative day. DISCUSSION: Splenic artery aneurysm are usually an occasional finding but they are related with an important risk of rupture and mortality; elective treatment both surgical and endovascular is recommended. Emergency surgery is still complicated with an high rate of mortality related to the patient's comorbidities. Endovascular treatment by covered stent-graft or selective embolization may represent the best option but it can be proposed only after an accurate selection of the patients. Endovascular treatment also seems to be feasible even in emergency but only in very selected cases and in expert vascular-interventional units. Laparoscopic surgery has been performed only sporadically. CONCLUSIONS: We would like to point out that nowadays the treatment of splenic artery aneurysm doesn't give a real choice and each case should be assessed singularly with the purpose to choose the best therapeutic approach either percutaneous or surgical.