Análisis de la relación entre Diabetes Mellitus tipo 2 y la obesidad con los factores de riesgo cardiovascular / Analysis of the relationship between Type 2 Diabetes Mellitus and obesity with cardiovascular risk factors

La “diabesidad” es un concepto en auge que hace referencia a los individuos con diabetes mellitus tipo 2 y obesidad. Ambos conceptos se encuentran íntimamente relacionados.Se ha llevado a cabo una búsqueda en Web Of Science para realizar una revisión bibliográfica con el objetivo de establecer la relación existente entre la obesidad, la diabetes mellitus tipo 2 y los factores de riesgo cardiovascular.El tejido adiposo es una glándula endocrina capaz de secretar hormonas, citoquinas y sustancias vasoactivas. En los individuos obesos, este tejido adiposo se muestra disfuncional, secretando de forma inusual ciertas adipocinas como la leptina y adiponectina. Tanto es así, que en individuos obesos sometidos a una cirugía bariátrica se ha visto como la relación adiponectina/leptina se invierte. Además, en un ambiente obesogénico, el tejido adiposo muestra un fenotipo proinflamatorio, que ayuda a perpetuar el proceso de resistencia a la insulina y el consiguiente desarrollo de prediabetes y diabetes mellitus tipo 2.Es importante determinar nuevas dianas terapéuticas para la diabesidad, como el factor de transcripción GPS2, que muestra una disminución de sus niveles en sujetos obesos, lo cual predispone a un fenotipo pro-diabético.Recientemente se ha demostrado que mi-483-5p se expresa en tejidos relevantes de diabetes y enfermedad cardiovascular, lo cual predice su potencial como biomarcador en sangre de dichas enfermedades.En conclusión, esta revisión pretende recalcar la importancia de controlar los factores de riesgo cardiovascular, como la obesidad, para impedir el desarrollo posterior de una enfermedad estrechamente ligada a ésta como es la diabetes tipo 2.(AU)

"Diabesity" is a booming concept that refers to individuals with type 2 diabetes mellitus and obesity. Both concepts are closely related.A search of Web Of Science was carried out to carry out a bibliographic review with the aim of establishing the relationship between obesity, type 2 diabetes mellitus and cardiovascular risk factors.Adipose tissue is an endocrine gland capable of secreting hormones, cytokines, and vasoactive substances. In obese individuals, this adipose tissue is dysfunctional, secreting certain adipokines such as leptin and adiponectin in an unusual way. So much so, that in obese individuals undergoing bariatric surgery, the adiponectin / leptin ratio has been reversed. Furthermore, in an obesogenic environment, adipose tissue displays a proinflammatory phenotype, which helps perpetuate the process of insulin resistance and the consequent development of prediabetes and type 2 diabetes mellitus.It is important to determine new therapeutic targets for diabesity, such as the GPS2 transcription factor, which shows a decrease in its levels in obese subjects, which predisposes to a pro-diabetic phenotype.Mi-483-5p has recently been shown to be expressed in relevant tissues of diabetes and cardiovascular disease, which predicts its potential as a blood biomarker for these diseases.In conclusion, this review aims to emphasize the importance of controlling cardiovascular risk factors, such as obesity, to prevent the subsequent development of a disease closely related to it, such as type 2 diabetes.(AU)

Adherencia a la dieta mediterránea en pacientes diabéticos con mal control / Adhesion to the Mediterranean diet in diabetic patients with poor control

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Adhesion to the Mediterranean diet in diabetic patients with poor control. / Adherencia a la dieta mediterránea en pacientes diabéticos con mal control.

OBJECTIVE: To analyse the relationship between the level of adherence to the Mediterranean diet and the control of cardiovascular risk factors. METHOD: A descriptive, observational study was conducted on patients diagnosed with Diabetes Mellitus type 2, with poor blood glucose control and a Body Mass Index greater than 25kg/m2. The relationship between the adherence to the Mediterranean diet and cardiovascular risk factors was evaluated before and after education about the Mediterranean diet. The patients were given a questionnaire on the level of adherence to the Mediterranean diet (the Mediterranean diet score), at the beginning of the study and at 6 month after having education about the Mediterranean diet in the Primary Care medical and nursing clinics. An analysis was carried out on the variables including, gender, age, weight, height, and Body Mass Index, as well as the analytical parameters of blood glucose, glycosylated haemoglobin, total, HDL, LDL cholesterol, and triglycerides. The relationship between the primary variable, 'adherence to the Mediterranean diet', and the rest of the variables was calculated before and after the educational intervention. RESULTS: The initial 'adherence to the Mediterranean diet score' in the questionnaire was relatively low (6.22). Excess weight, as well as to have an elevated Body Mass Index are associated with a lower adherence to the Mediterranean diet, as well as low adherence to treatment (P<.00 and P<.02, respectively). The values of HDL cholesterol values increased with greater adherence (P<.04). Elevated LDL and total cholesterol are associated with a lower adherence to the Mediterranean diet (P<.01 and P<.05, respectively), similar to that of elevated triglycerides (P<.00). Elevated baseline blood glucose levels are also associated with low adherence to the Mediterranean diet (P<.04), as well as the increase in glycosylated haemoglobin (P<.06). Thus the cardiovascular risk increases with low adherence (P<.08). After the educational intervention, a moderate increase was observed in the adherence to the Mediterranean diet (a score of 6.84) as well as a notable improvement in the control of the cardiovascular risk factors. CONCLUSIONS: Adherence to the Mediterranean diet is associated with improved control of cardiovascular risk factors.

Esteatosis hepática no alcohólica y factores de riesgo cardiovascular en atención primaria / Nonalcoholic Steatohepatitis and Cardiovascular Risk Factors in Primary Care

Varias circunstancias motivan el creciente interés por la esteatosis hepática no alcohólica (EHNA): la elevada prevalencia de la enfermedad en el mundo occidental, su capacidad de progresión a formas histológicas más agresivas y su asociación con enfermedades que incrementan el riesgo cardiovascular. Objetivo: analizar la relación de la esteatosis hepática no alcohólica con los factores de riesgo cardiovascular en pacientes con criterios de síndrome metabólico. Método: fue realizado un estudio descriptivo transversal con una muestra de 100 pacientes, con 2 o más factores de riesgo cardiovascular, con nula o baja ingesta de alcohol, que acudían a consulta de atención primaria. A los seleccionados se les solicitó analítica completa e interconsulta para ecografía de abdomen completo. Se evaluó si tenían esteatosis hepática; en caso de ser afirmativo, se estratificaba en 3 grados. Se recogieron las siguientes variables tanto cualitativas (sexo, antecedentes personales y familiares de diabetes, hipertensión arterial, dislipidemia, entre otros) y cuantitativas (edad, peso, talla, índice de masa corporal, tratamiento farmacológico, cifras de distintos parámetros analíticos, cifras de tensión arterial y perímetro abdominal). Resultados: participaron 100 pacientes, 56% de los cuales eran mujeres, con una edad media de 61,84 DE ± 9,5 años. Del total de sujetos del estudio, el 23 % no tenía esteatosis hepática no alcohólica; un 29% tenía esteatosis hepática leve; otro 29%, esteatosis hepática moderada; y el 19% restante, esteatosis hepática severa. En los hombres, el 82% presentó esteatosis hepática. De las mujeres, el 28,57% no presentó hígado graso. Un 22% tenía sobrepeso y un 38% de los pacientes eran obesos. Solo un 22% y un 18% tenían alteradas las cifras tensionales sistólica y diastólica, respectivamente. El 60% tenía una glucemia basal alterada. En cuanto a los parámetros lipídicos, el 36% tenía hipertrigliceridemia; el 41%, hipercolesterolemia, con un 65% de colesterol LDL alto y un 16% de colesterol HDL bajo. El 83% de los pacientes tenía 2 o más criterios de síndrome metabólico. Conclusiones: hay una estrecha relación entre la aparición de esteatosis hepática no alcohólica y los factores de riesgo cardiovascular en pacientes con síndrome metabólico, por lo que se recomienda que, ante la aparición de estos, se analice el hígado.

Several factors motivate the growing interest in this disease. They include the high prevalence of the disease in the Western world, its ability to progress to more aggressive histological forms, and its association with diseases that increase cardiovascular risk. Objective: The objective of this study was to analyze the relationship of nonalcoholic steatohepatitis (NASH) with cardiovascular risk factors in patients with criteria for metabolic syndrome. Method: This is a descriptive cross-sectional study of 100 patients who had two or more cardiovascular risk factors, who did not consume alcohol or consumed only small amounts of alcohol, and who came to the primary care clinic. The patients selected underwent complete analyses including abdominal ultrasound. They were evaluated for hepatic steatosis, and, if they tested positive, it was stratified into three degrees. Among the qualitative variables used were sex, personal and family history of diabetes, hypertension, dyslipidemia, and the quantitative variables included age, weight, height, body mass index, pharmacological treatment, numbers of different analytical parameters, blood pressure and abdominal perimeter.Results: There were 100 patients, 56% of whom were women. Patients’ mean age was 61.84 SD +/- 9.5 years. Of the total number of subjects in the study, 23% did not have NASH, 29% had mild hepatic steatosis, 29% had moderate hepatic steatosis and 19% had severe hepatic steatosis. Of the men in the study, 82% had hepatic steatosis. Of the women, 28.57% did not have fatty livers. 22% were overweight and 38% obese. Only 22% had altered the systolic blood pressure and and 18% had altered diastolic blood pressure. 60% had altered basal glycemia. 36% had hypertriglyceremia, 41% had hypercholesterolemia including 65% with high LDL cholesterol and 16% with low HDL cholesterol. 83% of the patients had two or more criteria for metabolic syndrome.Conclusions: There is a close relationship between the occurrence of NASH and cardiovascular risk factors in patients with metabolic syndrome, and it is advisable that the liver be analyzed.

Disfunción eréctil asociada a factores de riesgo cardiovascular / Erectile dysfunction associated with cardiovascular risk factors

Objetivos Determinar la prevalencia de disfunción eréctil (DsE) en pacientes con factores de riesgo cardiovascular (FRCV) y valorar su incidencia en relación con el grado de control de los FRCV. Metodología Los participantes se captaron en los centros de salud incluidos en el estudio. El tamaño de la muestra, con un nivel de confianza del 95% y un error alfa del 0,005, fue de 210 personas, de las cuales 30 no pudieron concluir el estudio por diversos motivos (cambio de domicilio, fallecimiento, negación a realizar al cuestionario, etc.).En la cita se cumplimentaba el cuaderno de recogida de datos previamente diseñado, al que se añadía el cuestionario Shim y LISAT-8.Se trata de un estudio de observación, descriptivo y analítico, de sección transversal. Las variables cualitativas se exponen como valor exacto y en porcentaje, las cualitativas como media y desviación estándar (DE).La comparación entre medias se realizó a través de la prueba t de Student para grupos independientes o la U de Mann-Whitney si las condiciones de normalidad (aplicación del test de Kolmogorov-Smirnoff o de Shapiro-Wilks) no se cumplían. En las variables cualitativas se empleó la prueba de ji al cuadrado. Resultados De las 210 personas seleccionadas, 179 (85,2%) completaron correctamente la encuesta. La edad media fue de (..)(AU)

Objectives To determine the prevalence of erectile dysfunction (ED) in patients with cardiovascular risk factors (CVRF) and to evaluate the incidence of this disorder according to the degree of control of CVRF. Methodology Participants were recruited in the health centers included in this study. A sample size with 95% confidence level and an alpha error of 0.005 was calculated and 210 persons were selected, of which 30 could not complete the study for various reasons (change of address, death, refusal to complete the questionnaire, etc.).A previously designed data collection sheet and the SHIM and LISAT-8 questionnaires were completed at interview. The study design was observational, descriptive, analytical cross-sectional. Qualitative variables are shown as exact values and as percentages and qualitative variables as means and standard deviation (SD).Comparison among means was performed using Student's t-test for independent samples or the Mann-Whitney U-test if the conditions of normality (application of the Kolmogorov-Smirnoff or Shapiro-Wilks’ test) were not met. For qualitative variables, the chi-square test was used. Results Of the 210 persons selected, 179 (85.2%) completed the survey correctly. The mean age was 64.5±11.6 years. Analysis of all the study variables in relation to the main variable of the presence or absence of ED revealed that age played a major role, with the incidence of ED increasing with greater age.(..) (AU)

Efectividad de la combinación de atorvastatina 10 mg más ezetimiba en el control de la hipercolesterolemia en atención primaria / Effectiveness of the combination of atorvastatin 10 mg plus ezetimibe in controlling hypercholesterolemia in primary care

Objetivos. Analizar la efectividad de atorvastatina 10 mg combinada con ezetimiba respecto a atorvastatina en altas dosis para el tratamiento de la hipercolesterolemia en pacientes de alto riesgo cardiovascular en atención primaria. Pacientes y método. Estudio transversal retrospectivo, de intervención en condiciones de uso habitual en pacientes hipercolesterolémicos con alto riesgo cardiovascular (diabéticos tipo II o postinfarto de miocardio y cifras de colesterol de las lipoproteínas de baja densidad [cLDL] > 100 mg/dl). Se incluyó un total de 102 pacientes (el 44,8% varones) con una media ± desviación estándar de edad de 60,9 ± 9,4 años. Un 61,4% eran diabéticos, el 52,1% había tenido episodio de cardiopatía isquémica. Recibieron tratamiento con atorvastatina 10 mg + ezetimiba 49 pacientes y 53 recibieron atorvastatina 40 mg/día durante 4 meses. Resultados. El cLDL, el colesterol total y los triglicéridos se redujeron significativamente con ambos tratamientos, si bien la combinación de ambos tratamientos redujo más rápidamente los parámetros lipídicos (2 meses; p < 0,05) que atorvastatina en altas dosis; a los 4 meses hubo reducciones de cLDL del 35,42% con la combinación de la estatina con ezetimiba y del 25,69% con la estatina sola; la reducción del cLDL fue de 57,58 ± 27,83 mg/dl y 58,33 ± 14,22 mg/dl a los 2 y 4 meses, respectivamente, con la combinación, frente a 16,4 ± 22,62 mg/dl y 40,14 ± 10,8 mg/dl con atorvastatina en altas dosis. A los 4 meses alcanzaron los objetivos terapéuticos de control de cLDL de acuerdo con las recomendaciones de la Adaptación Española de la Guía Europea de Prevención Cardiovascular de 2004 un 60,4% de los tratados con la combinación de fármacos y un 51,5% de los tratados con atorvastatina. Conclusiones. Ambos tratamientos se han mostrado efectivos en reducir las cifras de colesterol. Sin embargo, la combinación de atorvastatina en dosis de 10 mg y ezetimiba ha sido más efectiva y rápida que atorvastatina sola en altas dosis (AU)

Objectives. To analyze the effectiveness of atorvastatin 10 mg plus ezetimibe versus high-dose atorvastatin in the treatment of hypercholesterolemia in patients with high cardiovascular risk in primary care. Patients and method. We performed a retrospective, cross-sectional study of an intervention performed under conditions of normal use in hypercholesterolemic patients with high cardiovascular risk (type II diabetes or postmyocardial infarction and low density lipoprotein cholesterol [LDLc] values > 100 mg/dl). A total of 102 patients (44.8% men) with a mean age ± standard deviation of 60.9 ± 9.4 years were included. Of these, 61.4% were diabetic and 52.1% had had an episode of ischemic heart disease. Forty-nine patients received treatment with atorvastatin 10 mg plus ezetimibe and 53 received atorvastatin 40 mg/day for 4 months. Results. Values of LDLc, total cholesterol (TC) and triglycerides were significantly reduced with both treatments. However, the combined treatments produced a more rapid reduction in lipid parameters (2 months; p < 0.05) than did high-dose atorvastatin. At 4 months, a reduction in LDLc of 35.42% was found for the combination of atorvastatin plus ezetimibe versus 25.69% with atorvastatin alone; at 2 and 4 months, LDLc was reduced by 57.58 ± 27.83 mg/dl and 58.33 ± 14.22 respectively with the combined treatment compared with a decrease of 16.4 ± 22.62 and 40.14 ± 10.8 mg/dl with high-dose atorvastatin. At 4 months, the therapeutic targets for LDLc control, based on the recommendations of the Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention of 2004, had been achieved by 60.4% of patients receiving the combined treatment and by 51.5% of those treated with atorvastatin. Conclusions. Both treatments were effective in reducing cholesterol values. However, atorvastatin 10 mg and ezetimibe were faster and more effective than high-dose atorvastatin alone (AU)

A pharmacoeconomic evaluation of statins in the treatment of hypercholesterolaemia in the primary care setting in Spain.

BACKGROUND: Cardiovascular disease is one of the leading causes of death and it has been shown that primary prevention with the HMG-CoA reductase inhibitor (statin) lipid-lowering drugs can reduce cardiovascular events. Acquisition costs vary between statins and this may be an important consideration in the overall cost effectiveness (CE) of different options. OBJECTIVE: To perform a CE study of the main statins used in Spain for primary prevention of cardiovascular disease in patients with high cholesterol levels [corrected] STUDY DESIGN: The CE analysis was based on an open-label, prospective, naturalistic, randomised intervention study under usual care conditions in primary care settings in patients with high cholesterol levels (total cholesterol [TC] >240 mg/dL, low-density lipoprotein cholesterol [LDL-C] >160 mg/dL) and one or more cardiovascular risk factors. The analysis was conducted from the perspective of the Spanish National Health System; the year of costing was 2001. PATIENTS: A total of 161 patients (49.7% males), mean age 65 +/- 10.3 years, without evidence of cardiovascular disease were included in the study. Of those, 82.1% were hypertensive, 37.1% had diabetes mellitus and 17.9% were smokers. INTERVENTIONS: Forty-eight patients received oral atorvastatin 10 mg/day, 32 received fluvastatin 40 mg/day, 44 received simvastatin 20 mg/day and 37 patients received pravastatin 20 mg/day for 6 months. MAIN MEASUREMENTS AND RESULTS: After 6 months, the therapeutic goals of LDL-C control, according to the recommendations of the Spanish Society of Arteriosclerosis--Consensus-2000, were reached in 62.5%, 43.8%, 45.5% and 40.5% of patients treated with atorvastatin, fluvastatin, simvastatin and pravastatin, respectively. The average CE ratio, expressed as the cost in euros (euro) per patient achieving the therapeutic goals, was euros 424.3 for atorvastatin, euros 503.5 for fluvastatin, euros 527.0 for simvastatin and euros 683.4 for pravastatin. The incremental CE ratios for atorvastatin versus fluvastatin and simvastatin were euros 238.9 and euros 149.5, respectively, per additional patient reaching therapeutic goals. Atorvastatin, fluvastatin and simvastatin all dominated pravastatin. CONCLUSIONS: All the statins studied have been shown to be effective for reducing both TC and LDL-C levels. In this study, atorvastatin was the most efficient drug, with the best CE ratio (cost per patient reaching therapeutic goals). Atorvastatin was more effective and less costly than pravastatin, and when compared with fluvastatin or simvastatin the additional cost per additional patient achieving therapeutic goals was