Salivary glucose as a metabolic control marker in patients with type 2 diabetes.

A study was made of the correlation between the serum and salivary glucose levels in healthy subjects and in patients with type 2 diabetes, in order to establish the validity of salivary glucose determination in monitoring glycemia. Ninety-seven subjects were included in the study: 47 diabetic patients and 46 controls, aged between 40- and 80-years-of-age. Venous blood and saliva samples were collected in both groups under fasting conditions and after administering a test meal (15% proteins, 55% carbohydrates and 30% lipids). The glucose levels were measured using the glucose oxidase technique. The salivary glucose levels were seen to be greater in the diabetic group vs the controls both under fasting conditions (baseline) and after the meal (postprandial) (p=0.023 and p=0.008, respectively). A significant positive correlation was found between the serum and salivary glucose levels at baseline and under resting conditions, particularly in the diabetic group (r=0.389, p=0.002). The coefficient of determination of the simple linear regression model was R2=0.042, showing salivary glucose to be related to the blood glucose levels. In conclusion, salivary glucose concentration is correlated to serum glucose, particularly in type 2 diabetics.

Oxidative and endoplasmic reticulum stress is impaired in leukocytes from metabolically unhealthy vs healthy obese individuals.

BACKGROUND: Oxidative stress and inflammation are related to obesity, but the influence of metabolic disturbances on these parameters and their relationship with endoplasmic reticulum (ER) stress is unknown. Therefore, this study was performed to evaluate whether metabolic profile influences ER and oxidative stress in an obese population with/without comorbidities. SUBJECTS AND METHODS: A total of 113 obese patients were enrolled in the study; 29 were metabolically healthy (MHO), 53 were metabolically abnormal (MAO) and 31 had type 2 diabetes (MADO). We assessed metabolic parameters, proinflammatory cytokines (TNFα and IL-6), mitochondrial and total reactive oxygen species (ROS) production, glutathione levels, antioxidant enzymes activity, total antioxidant status, mitochondrial membrane potential and ER stress marker expression levels (glucose-regulated protein (GRP78), spliced X-box binding protein 1 (XBP1), P-subunit 1 alpha (P-eIF2α) and activating transcription factor 6 (ATF6). RESULTS: The MAO and MADO groups showed higher blood pressure, atherogenic dyslipidemia, insulin resistance and inflammatory profile than that of MHO subjects. Total and mitochondrial ROS production was enhanced in MAO and MADO patients, and mitochondrial membrane potential and catalase activity differed significantly between the MADO and MHO groups. In addition, decreases in glutathione levels and superoxide dismutase activity were observed in the MADO vs MAO and MHO groups. GRP78 and CHOP protein and gene expression were higher in the MAO and MADO groups with respect to MHO subjects, and sXBP1 gene expression was associated with the presence of diabetes. Furthermore, MAO patients exhibited higher levels of ATF6 than their MHO counterparts. Waist circumference was positively correlated with ATF6 and GRP78, and A1c was positively correlated with P-Eif2α. Interestingly, CHOP was positively correlated with TNFα and total ROS production and GRP78 was negatively correlated with glutathione levels. CONCLUSIONS: Our findings support the hypothesis that both inflammation and oxidative stress are involved in the induction of ER stress signaling pathways in the leukocytes of metabolically unhealthy obese vs healthy obese subjects.

Hiperaldosteronismo primario por hiperplasia suprarrenal unilateral con resolución quirúrgica / Primary hyperaldosteronism due to unilateral adrenal hyperplasia with surgical resolution

La hiperplasia suprarrenal unilateral es una causa rara de hiperaldosteronismo primario (sobre un 3%) que tiene tratamiento quirúrgico. Presentamos el caso de una mujer de 50 años con hipertensión arterial refractaria en tratamiento con 7 fármacos con hiperaldosteronismo primario por hiperplasia suprarrenal unilateral, que tras suprarrenalectomía izquierda presenta curación sin necesidad de ningún fármaco antihipertensivo tras 2 años desde la cirugía. La hiperplasia suprarrenal unilateral es una entidad diferente y no es una variante asimétrica de la hiperplasia bilateral. En el estudio de pacientes con hiperaldosteronismo primario y pruebas de imagen sin presencia de adenoma suprarrenal, es un diagnóstico que hay que considerar antes de catalogar a los pacientes con hiperplasia suprarrenal bilateral y de iniciar tratamiento médico, ya que la hiperplasia unilateral tendría resolución quirúrgica

Unilateral adrenal hyperplasia is a rare cause of primary hyperaldosteronism (around a 3%) that has surgical treatment. A case of a patient with hypertension resistant to conventional therapy in treatment with 7 drugs who presented with primary hyperaldosteronism due to unilateral adrenal hyperplasia is presented. A left adrenalectomy was performed, and the patient had a good clinical response, with no need of any drug after 2 years of surgery. Unilateral adrenal hyperplasia is a different entity and it is not an asymmetric variant of the bilateral adrenal hyperplasia. In the study of patients with primary hyperaldosteronism and imaging tests with absence of adenoma is a diagnosis that must be considered before cataloguing patients with bilateral adrenal hyperplasia and start a medical treatment, because unilateral adrenal hyperplasia would have a surgical resolution

[Primary hyperaldosteronism due to unilateral adrenal hyperplasia with surgical resolution]. / Hiperaldosteronismo primario por hiperplasia suprarrenal unilateral con resolución quirúrgica.

Unilateral adrenal hyperplasia is a rare cause of primary hyperaldosteronism (around a 3%) that has surgical treatment. A case of a patient with hypertension resistant to conventional therapy in treatment with 7 drugs who presented with primary hyperaldosteronism due to unilateral adrenal hyperplasia is presented. A left adrenalectomy was performed, and the patient had a good clinical response, with no need of any drug after 2 years of surgery. Unilateral adrenal hyperplasia is a different entity and it is not an asymmetric variant of the bilateral adrenal hyperplasia. In the study of patients with primary hyperaldosteronism and imaging tests with absence of adenoma is a diagnosis that must be considered before cataloguing patients with bilateral adrenal hyperplasia and start a medical treatment, because unilateral adrenal hyperplasia would have a surgical resolution.

Hodgkin's lymphoma of the thyroid in a woman with autoimmune thyroiditis / / Linfoma Hodgkin de tiroides en una mujer con tiroiditis autoinmune

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Predictive factors of achieving therapeutic goals of hypertriglyceridemia.

OBJECTIVES: The aim of this study was to ascertain the factors associated with non-achievement of triglyceride (TG) goals in a cohort of hypertriglyceridemic patients attending the lipid clinics of the Spanish Arteriosclerosis Society (LC-SAS). METHODS: Patients with high TG levels (>2.2 mmol/L; 200 mg/dL) were included in this multicenter, prospective, observational study and followed up for 1 year. The TG goal was ≤2.2 mmol/L (200 mg/dL). Main limitations of this study are that etiologic diagnosis of hypertriglyceridemia was not done under unified criteria and drug compliance was not evaluated. RESULTS: From 1394 patients initially included in the study, 929 (age range: 50 ± 12 years, 26% women) were followed up for 1 year; 523 patients (56%) failed to reach the TG target. These patients were younger, had a higher body mass index (BMI), were more frequently smokers, hypertensive and diabetic and had more severe dyslipidemia. They were also more sedentary, their diet was of poorer quality and they had higher alcohol consumption. The independent predictors of treatment failure were hypertriglyceridemia severity, low high density lipoprotein cholesterol (HDL-C), and high non-HDL-C, alcohol consumption and a raised BMI, while drug treatment had no predictive power. CONCLUSION: Independent predictors of failure to achieve hypertriglyceridemia treatment goals are inappropriate lifestyle, evidenced by insufficient weight loss, alcohol consumption and dyslipidemia severity.

Relation between lipoprotein subfractions and TSH levels in the cardiovascular risk among women with subclinical hypothyroidism.

OBJECTIVE: Subclinical hypothyroidism (SCH) is a common condition associated with increased cardiovascular risk. A standard treatment is yet to be established, as there is no consensus on the TSH cut-off values which should be used as indicators. Thus, the aim of this study was to assess cardiovascular risk in patients with SCH and to differentiate it according to TSH levels. DESIGN: This was an observational study conducted in an academic medical centre. PATIENTS: The study population consisted of 95 middle-aged women recently diagnosed with SCH and 65 euthyroid controls. MEASUREMENTS: We measured anthropometric parameters, lipid cardiovascular risk markers and lipoprotein subclasses of HDL and LDL. RESULTS: Patients with SCH exhibited a significant increase in triglycerides and atherogenic index of plasma and a significant reduction in HDL-cholesterol with respect to the control group after adjusted by age and BMI. A similar lipid profile was observed in both SCH groups. However, patients with TSH levels higher than 10 mIU/l showed a significant reduction in LDL particle size, which was associated with a higher prevalence of atherogenic pattern B. CONCLUSIONS: Our findings indicate that cardiovascular risk is affected in patients with TSH levels over 10 mIU/l, who have a lipid profile characteristic of atherogenic dyslipidemia.

Serum lipid responses to phytosterol-enriched milk in a moderate hypercholesterolemic population is not affected by apolipoprotein E polymorphism or diameter of low-density lipoprotein particles.

BACKGROUND/OBJECTIVES: The importance of both low-density lipoprotein cholesterol (LDLc) size and the apolipoprotein E (Apo E) in the atherogenic process is known, but there is little information with regard to the effect of phytosterols (PS) on these parameters. The aim of this study was to evaluate the influence of PS on lipid profile and LDLc size according to Apo E genotype. SUBJECTS/METHODS: This was a randomized parallel trial employing 75 mild-hypercholesterolemic subjects and consisting of two 3-month intervention phases. After 3 months of receiving a standard healthy diet, subjects were divided into two intervention groups: a diet group (n=34) and a diet+PS group (n=41) that received 2 g/day of PS. Total cholesterol (TC), triacylglycerols, LDLc, high-density lipoprotein cholesterol (HDLc), non-HDLc, Apo A-I and B-100, LDLc size and Apo E genotype were determined. RESULTS: Patients receiving PS exhibited a significant decrease in TC (5.1%), LDLc (8.1%), non-HDLc (7.4%) and Apo B-100/Apo A-I ratio (7.7%), but these effects did not depend on Apo E genotype. No significant changes were found in lipid profile according to Apo E genotype when patients following dietary recommendations were considered as a whole population or separately. No variations in LDLc size were observed in any of the intervention groups. CONCLUSION: The results of this study show that Apo E genotype does not have an impact on the lipid response to PS as a cholesterol-lowering agent in mild-hypercholesterolemic patients. Furthermore, the evidence obtained confirms that LDLc particle size is not modified when PS are added to a standard healthy diet.

Oxidative stress and endothelial dysfunction in cardiovascular disease: mitochondria-targeted therapeutics.

Functional impairment of endothelial activity (endothelial dysfunction) precedes the development of cardiovascular diseases (CVD). This condition is a result of a reduced bioavailability of nitric oxide (NO), a well known vasodilator, which is mainly due to increased NO degradation caused by its reaction with reactive oxygen species (ROS). Although there are several conditions that contribute independently to endothelial dysfunction, such as hyperglycemia, insulin resistance, hyperinsulinemia and dyslipidemia, increased oxidative stress seems to play a key role. In addition to their original pharmacological properties, drugs used clinically at present, including anti-hypertension reagents, angiotensin receptor blockers and anti-hyperlipidemic reagents such as statins, protect various organs via anti-oxidative stress mechanisms. Moreover, some substances with antioxidant properties, such as vitamin C or vitamin E, have been used to eradicate the oxidative stress associated with CVD. The results of the clinical trials employing anti-oxidative stress reagents in patients with CVD are contradictory, which could be a result of inadequate study design or selected targets. This review considers the process of endothelial dysfunction and CVD from a mitochondrial perspective and evaluates strategies currently under development for the targeted delivery of antioxidants or NO to mitochondria. It endorses the idea that selectively targeting specific antioxidants and NO donors to mitochondria is an effective strategy for modulating mitochondrial respiration and ROS production and protecting mitochondria against oxidative stress.

Inhibidores de la DPP-4 frente a análogos del receptor de GLP-1 tras el fracaso de la monoterapia con metformina en la diabetes tipo 2 / DPP-4 inhibitors vs GLP-1 receptor agonists after failure of metformin monotherapy in type 2 diabetes

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Inhibidores de la DPP-4 frente a análogos del receptor de GLP-1 tras el fracaso de la monoterapia con metformina en la diabetes tipo 2 / DPP-4 inhibitors vs GLP-1 receptor agonists after failure of metformin monotherapy in type 2 diabetes

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Standardisation of the waist circumference (WC) for each range of body mass index (BMI) in adult outpatients attended to in Endocrinology and Nutrition departments.

By this study we seek the expectable range of waist circumference (WC) for every degree of body mass index (BMI), which will serve to studies targeting ascertaining the health risk. We studied 2,932 patients (39.6% men and 60.4% women, between 18 and 96 years ) of the same ethnic group who consecutively attended outpatient departments of our clinics between 2000 and 2004. BMI correlated linearly with the WC (cc: 0.85; p < 0.001). The men, the obese, and diabetics were older (p < 0.001). BMI was greater in women and WC in men. The women had a greater WC if they had diabetes (p < 0.01), being equal to diabetic males. The men had greater WC when they had diabetes (p < 0.001). Waist at risk was detected (men > or = 102 cm and women > or = 88 cm) in 94.3% of the obese, in 32.3% of overweight patients, in 3.8% of patients with BMI < 25, in 84.3% of diabetics, and in 72.6% of patients without diabetes. We made graphic standardisation of WC with regard to BMI, and we calculated the percentiles 10, 25, 50, 75 and 90, grouping in ranges of 2 kg/m(2) of BMI. The diabetic patients are grouped in ranges of 4 kg/m(2). As conclusion we present a standardisation of the WC measurement of patients attended to in our Endocrinology and Nutrition practices distributed in percentiles as a clinically usable tool to define the ranges of WC for every BMI value.

Standardisation of the Waist Circumference (WC) for each range of Body Mass Index (BMI) in adult outpatients attended to in Endocrinology and Nutrition Departments / Estandarización de la circunferencia de cintura (WC), para cada rango de índice de masa corporal (BMI) en pacientes adultos atendidos en un servicio de endocrinología y nutrición

By this study we seek the expectable range of waist circumference (WC) for every degree of body mass index (BMI), which will serve to studies targeting ascertaining the health risk. We studied 2,932 patients (39.6% men and 60.4% women, between 18 and 96 years ) of the same ethnic group who consecutively attended outpatient departments of our clinics between 2000 and 2004.. BMI correlated linearly with the WC (cc: 0.85; p < 0.001). The men, the obese, and diabetics were older (p < 0.001). BMI was greater in women and WC in men. The women had a greater WC if they had diabetes (p < 0.01), being equal to diabetic males. The men had greater WC when they had diabetes (p < 0.001). Waist at risk was detected (men > = 102 cm and women > = 88 cm) in 94.3% of the obese, in 32.3% of overweight patients, in 3.8% of patients with BMI < 25, in 84.3% of diabetics, and in 72.6% of patients without diabetes. We made graphic standardisation of WC with regard to BMI, and we calculated the percentiles 10, 25, 50, 75 and 90, grouping in ranges of 2 kg/m2 of BMI. The diabetic patients are grouped in ranges of 4 kg/m2. As conclusion we present a standardisation of the WC measurement of patients attended to in our Endocrinology and Nutrition practices distributed in percentiles as a clinically usable tool to define the ranges of WC for every BMI value (AU)

En este estudio hemos buscado el rango de circunferencia de cintura (WC) para cada grado de índice de masa corporal (BMI), que sirva para estudios que determinen riesgos de salud. Estudiamos 2.932 pacientes (39,6% varones y 60,4% mujeres, entre 18 y 96 años) del mismo grupo étnico que consecutivamente asistieron a consultas externas de nuestras clínicas entre 2000 and 2004. El BMI correlacionó linealmente con la WC (cc: 0,85; p < 0,001). Eran mayores los varones, los obesos y los diabéticos. El BMI era mayor en mujeres y la WC en varones. Las mujeres tenían mayor WC si eran diabéticas (p < 0,01), igualando a los hombres. Los varones tenían mayor WC si eran diabéticos (p < 0,001). La circunferencia de riesgo (varones > = 102 cm y mujeres > = 88 cm) la presentaban el 94,3% de los obesos, el 32,3% de los pacientes con sobrepeso y el 3,8% de pacientes con BMI < 25, el 84,3% de diabéticos y el 72,6% de pacientes sin diabetes. Elaboramos una estandarización gráfica de WC en relación con BMI y calculamos los precentiles 10, 25, 50, 75 y 90, agrupados en rangos de 2 kg/m2 de BMI. Como el número de diabeticos es menor, los agrupamos en rangos de 4 kg/m2. En conclusión presentamos una estandarización de la WC de pacientes atendidos en nuestra consulta de endocrinología y nutrición distribuidos en percentiles como herramienta utilizable clínicamente para definir rangos de WC para cada valor de BMI (AU)

Oxidative stress and mitochondrial dysfunction in atherosclerosis: mitochondria-targeted antioxidants as potential therapy.

Chronic and acute overproduction of reactive oxygen species (ROS) under pathophysiologic conditions forms an integral part of the development of cardiovascular diseases (CVD), and in particular atherosclerosis. These ROS are released from different sources, such as xanthine oxidase, lipoxygenase, nicotinamide adenine dinucleotide phosphate oxidase, the uncoupling of nitric oxide synthase and, in particular, mitochondria. Endothelial dysfunction, characterized by a loss of nitric oxide (NO) bioactivity, occurs early on in the development of atherosclerosis, and determines future vascular complications. Although the molecular mechanisms responsible for mitochondria-mediated disease processes are not clear, oxidative stress seems to play an important role. In general, ROS are essential to cell function, but adequate levels of antioxidant defenses are required in order to avoid the harmful effects of excessive ROS production. Mitochondrial oxidative stress damage and dysfunction contribute to a number of cell pathologies that manifest themselves through a range of conditions. This review considers the process of atherosclerosis from a mitochondrial perspective, and assesses strategies for the targeted delivery of antioxidants to mitochondria that are currently under development. We will provide a summary of the following areas: the cellular metabolism of reactive oxygen species (ROS) and its role in pathophysiological processes such as atherosclerosis; currently available antioxidants and possible reasons for their efficacy and inefficacy in ameliorating oxidative stress-mediated diseases; and recent developments in mitochondrially-targeted antioxidants that concentrate on the matrix-facing surface of the inner mitochondrial membrane in order to protect against mitochondrial oxidative damage, and their therapeutic potential as a treatment for atherosclerosis.

Estudio de prevalencia de la enfermedad arterial periférica y diabetes en España / A study of the prevalence of peripheral arterial disease and diabetes in Spain

Objetivo. Evaluar la prevalencia de la enfermedad arterial periférica (EAP) en pacientes diabéticos y la prevalenciade diabetes en pacientes con enfermedad arterial periférica en España mediante un estudio observacional y decorte transversal. Pacientes y métodos. Medición del índice tobillo-brazo en pacientes diabéticos que acuden a consultasde endocrinología y medición de la glucosa en pacientes que acuden a consultas de cirugía vascular. Los criterios de inclusiónhan sido pacientes de cualquier edad y género que hayan firmado el consentimiento. Se han incluido 2.293 pacientes,477 (20,8%) en consultas de endocrinología y 1.816 (79,2%) en consultas de cirugía vascular. Edad media de 59años en consultas de endocrinología y 68 años en consultas de cirugía vascular. El 53,2 y el 81,5% de varones en consultasde endocrinología y cirugía vascular, respectivamente. El 11,8 y el 15,8% presentaban antecedentes cerebrovasculares,el 19,5 y el 27,9% antecedentes de coronariopatía y el 25,0 y 97,8%, antecedentes de enfermedad arterial periféricaconocida en consultas de endocrinología y cirugía vascular, respectivamente. Resultados. La prevalencia de EAP en consultasde endocrinología fue del 37,3%, el 34,6% leve-moderada y 2,6%, grave. La prevalencia de EAP se incrementabacon la edad, en hombres, presencia de síndrome metabólico y años de evolución de la diabetes. La prevalencia de diabetesen consultas de cirugía vascular fue el 67,6%. La prevalencia de diabetes aumentaba con el índice de masa corporal,en mujeres, y con la presencia del síndrome metabólico. Conclusión. Este estudio confirma la alta prevalencia de EAP ydiabetes en España y marca tendencias para una optimización terapéutica

Aim. To evaluate the prevalence of peripheral arterial disease (PAD) in diabetic patients and the prevalenceof diabetes in patients with PAD in Spain by means of an observation-based cross-sectional study. Patients and methods.The method chosen for this analysis was to measure the ankle-brachial index in diabetic patients who visited endocrinologydepartments and also the measurement of glucose levels in patients who visited vascular surgery. Eligibility criteriawere patients of any age and gender who signed the consent documents. In all, 2293 patients were included, 477(20.8%) in visits to the endocrinology department and 1816 (79.2%) in visits to vascular surgery. The mean age ofpatients was 59 years old in endocrinology and 68 years old in visits to vascular surgery. Males accounted for 53.2%and 81.5% of the visits to endocrinology and vascular surgery, respectively. A history of cerebrovascular events waspresent in 11.8 and 15.8%, 19.5 and 27.9% had a history of heart disease and 25.0 and 97.8% had a history of knownperipheral arterial disease, in endocrinology and vascular surgery, respectively. Results. The prevalence of PAD amongthose who visited endocrinology was 37.3%, 34.6% of which were mild-moderate and 2.6% were severe. The prevalenceof PAD increased with age, in males, in the presence of metabolic syndrome and with the number of years since the onsetof diabetes. The prevalence of diabetes in vascular surgery patients was 67.6%. The prevalence of diabetes increasedwith body mass index, in females, and in the presence of metabolic syndrome. Conclusions. This study confirms the highprevalence of PAD and diabetes in Spain and establishes guidelines to be followed for the optimisation of therapy

Tratamiento de la diabetes mellitus tipo 2 con insulina / Insulin therapy in type 2 diabetes

En la evolución natural de la diabetes mellitus tipo 2, la capacidad secretora de insulina por el páncreas se agota de forma progresiva, empeorando el control glucémico. Por ello, en la historia natural del paciente diabético tipo 2, el tratamiento suele pasar de dieta y ejercicio físico a antidiabéticos orales y, finalmente, suele ser necesario el tratamiento con insulina para lograr un buen control metabólico. Cuando aún existe reserva pancreática, la asociación de insulina a antidiabéticos orales es la mejor opción, y puede optarse por utilizar una dosis de análogo de acción lenta, de insulina premezclada o de insulina NPH. Cuando la reserva pancreática está agotada o cuando no se logra un buen control del paciente con una única dosis de insulina, se debe plantear el tratamiento con varias dosis de insulina premezclada, o bien el régimen basal-bolo. La decisión entre ambos tipos de tratamiento debe realizarse de forma individual, en función de las características individuales del paciente (AU)

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics (AU)

Erythrocyte membrane composition in patients with primary hypercholesterolemia.

There are conflicting results regarding the erythrocyte membrane cholesterol and phospholipid content in patients with primary hypercholesterolemia (PHC), due to methodological problems in obtaining haemoglobin-free ghosts. At the same time, the different units used and the fact that the cholesterol and phospholipids are not expressed in relation with integral protein membrane content, produces contradictory results. We have analysed in 33 patients with PHC (12 male, 31 female) aged 43+/-12 years and in 33 healthy normolipaemic volunteers (9 male, 24 female) aged 43+/-13 years plasma lipids, along with, erythrocyte membrane cholesterol, phospholipids and integral proteins. PHC patients showed increased erythrocyte membrane cholesterol: 0.36+/-0.15 mg/mg when compared with controls: 0.29+/-0.75 mg/mg; p=0.018. Phospholipid membrane content, although higher in the cases, did not reach statistical significance (PHC patients: 0.38+/-0.15 mg/mg vs. 0.33+/-0.72 mg/mg; p=0.098). The cholesterol/phospholipids ratio (Chol/Ph) was 0.99+/-0.22 in PHC patients versus 0.92+/-0.28 in controls; p=0.127. Our results suggest that there is a slight increase in erythrocyte membrane cholesterol in patients with PHC. Given the increasing importance of erythrocyte membrane cholesterol in the stability of the atheroma plaque due its possible contribution to the clinical signs of ischaemic heart disease, it seems relevant to determine this parameter in risk populations. Therefore, a simple and reproducible method needs to be standardised which would enable comparisons between laboratories and facilitate further studies aimed to it as a marker of acute coronary syndromes.

Fibrinogen, plasma viscosity and blood viscosity in obesity. Relationship with insulin resistance.

Plasma viscosity (PV) and blood viscosity (BV) have been scarcely evaluated in morbid obese patients with no other concomitant cardiovascular risk factors. Contradictory results have been published regarding the influence of insulin resistance on these rheological parameters in obesity. In 67 severe or morbid obese patients without other cardiovascular risk factors (51 women and 11 men, aged 34+/-11 years), fibrinogen, PV and BV at native (nBV) and corrected 45% hematocrit (cBV) have been determined, and insulin resistance has been calculated with homeostasis model assessment (HOMA) index, in basal conditions and after a three month diet period. The same determinations were performed in 67 healthy volunteers (45 women, 22 men, aged 32+/-10 years) at baseline and three months later. When cases and controls were compared, obese patients showed higher fibrinogen levels (P<0.001), PV (P=0.050) and cBV (P=0.035), and showed a higher insulin resistance than the control group (P<0.001). Differences in PV were maintained after adjusting for BMI (P=0.001), but disappeared after adjusting for HOMA (P=0.391) fibrinogen (P=0.367) and LDL-chol (P=0.097). Differences between obese patients and the control group for cBV disappeared after adjusting for BMI (P=0.739), HOMA (P=0.744), fibrinogen (P=0.907), LDL-chol (P=0.283) and PV (P=0.112). The achieved weight loss (8.7+/-3.53%) was not accompanied by any changes in these rheological parameters (P>0.050). Obese patients show increased fibrinogen levels, PV and cBV. These rheological disturbances seem to be associated with insulin resistance and the metabolic syndrome, and do not seem to improve with moderate weight loss.