Obesity, diabetes, hypertension, and tobacco consumption in an urban adult Mexican population.

BACKGROUND: The aim of this study was to describe the prevalence of some of the main coronary risk factors in an open Mexican adult population. METHODS: This is a cross-sectional study that includes individuals from eight different cities. Except for Mexico City, all centers were located in medium-sized cities ranging from 1 to 5 million inhabitants. Eligible subjects were adults 20 years of age or older. Exclusion criteria included subjects seeking medical attention due to an acute illness or individuals unable to provide the requested information or written consent to participate in the study. Men (n = 567) and women (n = 1,018) were included. A previously validated interview was conducted. A questionnaire assessed demographic and lifestyle factors. Capillary glucose concentration and blood pressure were obtained. Remarkably, 40% of the population had a body mass index (BMI) between 25 and 29.9 kg/m(2); an additional 28% had a BMI >30 kg/m(2). A large proportion of the individuals had abdominal fat distribution (62% of men and 81% of women). At the time of the evaluation, 30% of men and 18% of women were regular smokers. RESULTS: Blood pressure >140/90 mmHg was found in 29.4% of the population. Less than one half of the subjects had a previous measurement of plasma cholesterol (47%) or triglycerides (42%). The prevalence of diabetes was 9.02%. A significant percentage of these subjects were <40 years of age (18.8% of the diabetic population). CONCLUSIONS: The prevalence of obesity, diabetes, and hypertension in the population reported here is among the highest reported in Mexican populations.

Efficacy and safety of atorvastatin in hyperlipidemic, type 2 diabetic patients. A 34-week, multicenter, open-label study.

Hyperlipidemia is common in type 2 diabetic patients and is an independent risk factor for cardiovascular disease. The aim of this trial was to evaluate the efficacy and safety of once-daily atorvastatin 10-80 mg for the treatment of hyperlipidemia in type 2 diabetics with plasma low-density lipoprotein cholesterol (LDL-C) levels exceeding 3.4 mmol/l (130 mg/dl). One hundred and two patients met the study criteria and received 10 mg/day atorvastatin. Patients who reached the target LDL-C level of

[Plasma malondialdehyde in patients with type 2 diabetes mellitus and in patients with coronary disease]. / Malondialdehído plasmático en pacientes con diabetes mellitus tipo 2 y en pacientes con enfermedad coronaria.

UNLABELLED: After intracoronary platelet aggregation, malondialdehyde (MDA), a lipid peroxide product is released. MDA renders some lipoproteins more atherogenic. OBJECTIVE: The objective of this study was to determine the sanguineous concentration of MDA in patients with type 2 diabetes mellitus (DM2) and patients with coronary disease. We measured methods and material MDA in plasma of 131 consecutive normal subjects, 44 hyperlipidemic, hyperglycemic patients with type 2-diabetes mellitus (DM2), 60 normolipidemic patients with angina, and 62 normolipidemic patients with acute myocardial infarction with and without DM2. STATISTICAL ANALYSIS: The concentration of MDA was lowest in normal subjects (42.5 +/- 7.2 micrograms per deciliter), intermediate in those with DM2 (62.7 +/- 10.1 micrograms per deciliter, p < 0.002), and highest in those with myocardial infarction (101.6 +/- 31.7 micrograms per deciliter, p < 0.001). The mean MDA concentration of patients with infarction was similar to that of patients with angina (121.8 +/- 51.9 micrograms per deciliter, p < 0.07). Stepwise logistic regression analysis showed that MDA was a possible predictor of myocardial infarction. CONCLUSIONS: The increase of plasma MDA might be a biochemical marker of coronary artery disease. We suggest that MDA levels greater than 62.7 micrograms per deciliter could indicate a high risk for myocardial infarction.

[Effects of bezafibrate in the diet of hypertensive patients with dyslipidemia and hyperfibrinogenemia]. / Efecto de bezafibrato en la dieta de hipertensos con dislipidemia e hiperfibrinogenemia.

OBJECTIVE: To evaluate the fibrinogen and lipids response to diet plus bezafibrate in insulin-resistant patients with arterial hypertension and mixed hyperlipidemia. METHODS: A randomized double blind parallel design was used during a 90 days treatment period. Fibrinogen, lipids, insulin and peptide C assays as well as a glucose tolerance test were done at the start and end of treatment. The 28 patients received a hypolipemic diet low in refined sugars with bezafibrate added (400 mg/day) in 15 and a placebo in 13. RESULTS: The groups were similar in age, blood pressure and BMI. At the end of treatment, fibrinogen, cholesterol, triglycerides and LDL-C were lower in both groups as compared to the initial values, but only in the bezafibrate group there were: a) significant decrease in triglycerides (64 mg/dL, p 0.01); and b) marginal changes in fibrinogen (decreased 35 mg/dL, p = 0.09), total cholesterol (decreased 26 mg/dL, p = 0.10) and glucose/insulin ratio (increased from 4.4 to 5.2, p = 0.09). Bezafibrate lowered slightly the insulin level but did not affect peptide C. A correlation of changes in fibrinogen levels and the 60 min insulin concentration in the glucose tolerance test was higher in the bezafibrate group (r = 0.61) than in the placebo group (r = 0.23). CONCLUSIONS: In insulin resistant patients with high cardiovascular risk, bezafibrate and a placebo added to a hypolipemic diet decreased plasma fibrinogen. Bezafibrate lowered significantly the levels of triglycerides in these patients.

[Insulin resistance: an etiological factor in essential arterial hypertension and coronary cardiopathy]. / Resistencia a la insulina: factor etiológico de la hipertensión arterial esencial y de la cardiopatía coronaria.

Insulin resistance has been implicated in the pathogenesis of essential hypertension. Studies from other countries discovered insulin resistance; in people with essential hypertension in was also associated with obesity, however, insulin resistance was found in lean people too. In obesity, insulin resistance occurs secondarily to many physiopathological states and circulating factors which adversely affects insulin action. The metabolic abnormality in this action was mainly found in relation to abdominal fat; in other cases, insulin resistance was found to be inherited. Hyperinsulinaemia can actually increase blood pressure and is associated with venous and arterial thrombosis and it also rises lipid levels. It is interesting too that insulin resistance and hyperinsulinaemia are associated with impaired fibrinolysis through high levels of fibrinogen and plasminogen activator inhibitor of endothelial type and in identifying individuals prone to myocardial infarction. Some antihypertensive drugs like beta-blockers, methyl-dopa and diuretics increase insulin resistance, while angiotensin converting enzyme-inhibitors have not shown any adverse metabolic affects. Alfa-1-blocker were beneficial and alfa-2-agonists were neutral, whereas calcium channel-antagonists are still in controversy. Treatment should be designed to improve the metabolic state; physical exercise, a diet rich in fruit, vegetable and rott vegetables, the reduction of abdominal fat and, finally, the use of antihypertensive drugs which decrease insulin resistance would be expected to reverse hyperinsulinaemia. Biguanides like metformin have also been found to reduce insulin resistance.

[The diagnosis of Cushing's disease by the nocturnal dexamethasone administration test]. / Diagnóstico de la enfermedad de Cushing mediante la prueba de administración nocturna de dexametasona.

Prospective study performed at the General Hospital, National Medical Center, XXI Century, Endocrinology Ward, Mexico-City, to compare the diagnostic sensitivity in Cushing's disease of the oral high doses (8 mg) dexametazone suppression test in single doses with nocturnal administration (DXM-N) and the classic doses of two days (DXM-C). Fourteen patients with hypercortisolism were studied; on thirteen the hypophyseal origin was surgical confirmed. Sensitivity of high doses of oral dexametazone test was proved by using serial samples of serum cortisol; the Fisher test was used for analysis of the suppression of serum cortisol after the test was done.

[Effect of the treatment of hyperthyroidism on the course of exophthalmos]. / Influencia del tratamiento del hipertiroidismo en el curso del exoftalmos.

The exophthalmos evolution in hyperthyroid patients was investigated: twenty patients were randomly assigned to treatment with radioiodine (group I followed 2-162 months) and 20 to treatment with thyroidectomy (group II followed 2-158 months). There was no correlation of sex age and follow up with exophthalmos evolution. In group I, exophthalmos improved in one patient (5%), did not change in ten (50%) and worsened in nine (45%). In group II it got better in six (30%), did not change in seven (35%) and got worse in seven (35%). The differences between the two groups were not statistically significant (p greater than 0.05). The postsurgical thyroid gamma-gram with one mCi of I-131 in group II showed absence of thyroid tissue in nine patients (45%) and remainders of the gland in 11 (55%) and apparently this did not influence the post treatment evolution. The length of pretreatment evolution did not influence the evolution post treatment. In summary, there was no correlation between exophthalmos evolution and kind of treatment in Graves' disease.

[Thyroid hemiagenesis. Report of 3 cases and review of the literature]. / Hemiagenesia tiroidea. Reporte de 3 casos y revisión de la literatura.

The absence of one lobe of the thyroid gland is named thyroid hemiagenesis, the left is affected more frequently (80 percent), in the 50 percent is associate with isthmus agenesis. Predominant in the women, with relation 3:1, the oppose lobe may be of big size and in the 38-47 percent have alteration in the function, of which the hyperthyroidism is more frequently. In 1896 Handfield-Jones reported the first case, having in this moment 118 cases in the world literature, we reported three more, one of which is the second associated with hyperparathyroidism and other is the third with hypothyroidism. The diagnosis was made with I-131 thyroid gammogram and neck echosonography that which evidence the hemiagenesis, and was not necessary to realize the thyroid gammagram with thyroid stimulation hormone. In different series of surgery, necropsis or by thyroid illness the frequency of thyroid hemiagenesis is estimate below 1 percent.

Extirpacion transesfenoidal del macroprolactinoma. / Transphenoidal resection of macroprolactinoma

El tratamiento del prolactinoma sigue presentandose a discusion entre los que favorecen la extirpacion quirurgica y los que apoyan el uso de bromoergocriptina. En la presente comunicacion se muestran los resultados con la adenectomia transesfenoidal de 21 casos de macropolactinoma que fueron operados por tener trastornos visuales y no juzgarse indicado un tratamiento medico. La cirugia logro la desaparicion de la compresion quismatica, pero la amenorrea y galactorrea concomitante solo se resolvieron en la mitad de los casos; asimismo la concentracion serica de prolactina descentro que la prueba de metoclopramida para discriminar el origen de la hiperprolactinemia ofrece resultados tan variados que carece de valor paraclinico. Se concluye que la adenectomia transesfenoidal como tratamento del nacroprolactinoma be indicarse para cada caso