El papel de lasffracciones lipídicas, lipoproteínas y apolipoproteínas en preeclampiaa / The role f lipidd fractions, lipoproteins and apolipoproteins in preeclampsia / O papel das raçõões lipídicas, lipoproteínas e apolipoproteínas na preeclampsia

La Preeclampsia (PE) es un trastorno multisistémico, exclusivo de la gestación humana y responsable de aproximadamente 44.000 muertes maternas anuales a nivel mundial; esta enfermedad está asociada a múltiples complicaciones tanto en la madre como en el feto, sin embargo, su etiología no se encuentra totalmente dilucidada y en consecuencia ha sido difícil definir estrategias válidas de predicción. La PE es una enfermedad compleja y comparte diferentes factores de riesgo con las enfermedades cardiovasculares; como la obesidad, hipertensión arterial, resistencia a la insulina y dislipidemias. Con esto se evidencia que algunas alteraciones en los niveles lípidos y apolipoproteínas, se asocian con mayor peroxidación lipídica y estrés oxidativo lo cual puede desencadenar en disfunción endotelial para ambas patologías. Por tanto, la exploración de la evidencia de una asociación entre las fracciones lipídicas y riesgo de PE, puede aportar nuevo conocimiento en torno a la etiología de esta enfermedad. En la presente revisión, se plantearán las principales implicaciones biológicas de las alteraciones del perfil lipídico y apolipoproteínas en la génesis de la PE. Se describirán los estudios observacionales que se han aproximado a su evaluación y se identificarán sus principales debilidades metodológicas, con el fin de plantear estrategias para una evaluación integral de esta vía fisiopatológica, con posibles implicaciones predictivas de la enfermedad.

Preeclampsia (PE) is a multisystemic disorder unique to human pregnancy and responsible for about 44,000 maternal deaths worldwide. This disease is associated with multiple complications for both mother and fetus; however, its etiology is not totally clear and it has therefore been difficult to define valid prediction strategies. PE is a complex disease and it shares different risk factors with cardiovascular disease, such as obesity, hypertension, insulin resistance and dyslipidemia, evidencing that the presence of disturbances in lipid and apolipoprotein levels are associated with increased lipid peroxidation and oxidative stress which can lead to endothelial dysfunction in both diseases. Therefore, exploring the evidence of an association between lipid fractions and PE risk can provide new knowledge about the etiology of this disease. In this review, the major biological implications of lipid profile and apolipoproteins alterations in the genesis of PE will be presented, describing the observational studies and identifying its main methodological weaknesses in order to create strategies for comprehensive assessment of the pathophysiological pathway with potential predictive implications of the disease.

A Preeclampsia (PE) é um transtorno multissistêmico, exclusivo da gestação humana e responsável por aproximadamente 44.000 mortes maternas anuais a nível mundial; esta doença esta associada a múltiplas complicações tanto na mãe como no feto, porém, sua etiologia não está totalmente esclarecida e consequentemente tem sido difícil definir estratégias válidas de predição. A PE é uma doença complexa e compartilha diferentes fatores de risco com as doenças cardiovasculares, como a obesidade, hipertensão arterial, resistência à insulina e dislipidemias; evidenciando que alterações nos níveis dos lipídios e apolipoproteínas, se associam com maior peroxidação lipídica e estresse oxidativo que pode desencadear disfunção endotelial para ambas patologias. Portanto, a exploração da evidência de uma associação entre las frações lipídicas e risco de PE, pode contribuir com novo conhecimento ao redor da etiologia desta doença. Na presente revisão, serão apresentadas as principais implicações biológicas das alterações do perfil lipídico e apolipoproteínas na gênese da PE, descrevendo os estudos observacionais que se aproximaram à sua avaliação e identificando suas principais fraquezas metodológicas, com o objetivo de propor estratégias para uma avaliação integral desta via fisiopatológica, com possíveis implicações preditivas da doença.

[Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia]. / Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia.

INTRODUCTION: The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). OBJECTIVE: The prevalence statistic for generated metabolic syndrome was compared on the basis of each of the three criteria in an adult population. MATERIALS AND METHODS: The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen's kappa. RESULTS: Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalences (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). CONCLUSION: The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.

Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia / Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia

Introducción. La prevalencia de síndrome metabólico depende de los criterios de clasificación empleados, como son los de la International Diabetes Federation y el Adult Treatment Panel o su modificación.Objetivo. Comparar la prevalencia del síndrome metabólico generada por cada una de las tres definiciones en una población de adultos. Materiales y métodos. Se estudiaron 155 personas (54,2 por ciento varones, edad promedio de 40,9 años). Se aplicaron las tres definiciones y se comparó la prevalencia con la prueba de Wilcoxon y la concordancia con kappa de Cohen. Resultados. La prevalencia de síndrome metabólico según el Adult Treatment Panel-III (ATP-III) fue 12,3 por ciento (IC95 por ciento 7,5-18,5), según el Adult Treatment Panel-IIIa (ATP-IIIa), 34,8 por ciento (IC95 por ciento 27,4-42,9) y según la International Diabetes Federation (IDF), 32,9 por ciento (IC95 por ciento 25,6-40,9). La prevalencia por ATP-III es inferior a la vista por ATP-IIIa e IDF (p<0,001), pero entre estas dos últimas es similar (p=0,083). Hay pobre concordancia entre ATP-III y ATP-IIIa (k=0,414, IC95 por ciento 0,409-0,420), y entre ATP-III e IDF (k=0,374, IC95 por ciento 0,368–0,379), pero muy buena entre ATP-IIIa e IDF (k=0,957, IC95 por ciento 0,950–0,963). Conclusión. Las nuevas definiciones para el síndrome metabólico (ATP-IIIa e IDF) aumentan tres veces la prevalencia del diagnóstico, sin encontrar diferencias entre ellas, a pesar de que la última organización incluye la obesidad central como un criterio necesario para el diagnóstico, cuando en la primera no se hace igual ponderación.

Introduction. The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). Objective. The prevalence statistic for generated for metabolic syndrome was compared for on the basis of each of the three criteria. Materials and methods. The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen’s kappa. Results. Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalances (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). Conclusion. The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.