Nursing workload. Calculation of cardiovascular risk and therapeutic objectives. / Carga de enfermedad. Cálculo del riesgo cardiovascular y objetivos terapéuticos.

Therapeutic intervention should be determined by the risk of developing atheromatous cardiovascular disease (CVD). The higher the risk, the more intense the action should be. This is the reason for the stratification of patient risk. In primary prevention, the two main guidelines used, the American Heart Association and the American College of Cardiology (ACC/AHA) use the Pooled cohort equations (PCE) and the guidelines of the European societies use the SCORE tables. The PCE calculates the risk of fatal and non-fatal CVD, and the SCORE calculates risk of fatal CVD only. In young people, it is useful to consider the lifetime risk calculation. The Spanish Society of Arteriosclerosis (SEA) recommends the SCORE system in Spain. SCORE and PCE calculate the risk for people up to 70 and 75 years of age. Prediction and potentials are available for 80 years of age and above, with the data available being much more scarce. Risk stratification in secondary prevention may be useful to identify the subgroup of patients who may benefit from more intensive treatment. Imaging tests, especially coronary calcium scans and vascular ultrasound, can help to better the profile risk. European guidelines identify LDL cholesterol as a therapeutic target. They recommend initiating treatment with statins, and increasing dose and potency until targets are achieved, and then to treatment with potent statins at a maximum tolerated dose, and ezetimibe if targets are not achieved. As a third step, PCSK9 inhibitors are indicated. They set very ambitious targets, as low as 40 mg/dL in those subjects with recurrences before two years of CVD despite high-intensity statin therapy, and below 55 mg/dL for all very high-risk subjects.

Persistent hypoglycemia due to an IGF-II-secreting malignant pheochromocytoma: a case report and literature review.

A malignant pheochromocytoma with IGF-II-mediated hypoglycemia is reported; although treatment was cumbersome and evolution unfortunate, this diagnosis must be kept in mind when dealing with NICTH's differential diagnosis.

[Cardiovascular risk factor progression in young males at 15-year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study]. / Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA).

INTRODUCTION AND OBJECTIVES: The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. METHODS: In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. RESULTS: In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m(2), cholesterol +68.0 mg/dL, HDL cholesterol -5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. CONCLUSIONS: Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups.

Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA) / Cardiovascular risk factor progression in young males at 15-Year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study

Introducción y objetivos. La cohorte AGEMZA son varones militares cuyos factores de riesgo fueron estudiados en 1985 a la edad de 20 años. A la edad de 35 años se estudian la antropometría, los lípidos y la presión arterial y se investiga su estabilidad, sus cambios y la interdependencia en su evolución. Métodos. En 2000, se obtuvieron datos (encuesta transversal) que se compararon con los originales: índice de masa corporal (IMC), colesterol y sus fracciones, triglicéridos y presiones arteriales. La persistencia o tracking se evalúa mediante el coeficiente de regresión estandarizado y la permanencia en quintiles. Se crearon modelos de regresión multivariante para los datos actuales. Resultados. Tras estudiar a 250 sujetos, se observaron modificaciones significativas de los siguientes factores: peso, +12,1 kg; IMC, +3,9 kg/m², colesterol, +68,0 mg/dl; colesterol unido a lipoproteínas de alta densidad, -­5,2 mg/dl; colesterol unido a lipoproteínas de baja densidad (cLDL), +57,9 mg/dl, y triglicéridos, +76,3 mg/dl. Todos los factores presentaron una persistencia elevada, excepto la presión arterial diastólica. Es más pronunciada la persistencia de IMC, colesterol y cLDL. Estos cambios suponen un peor riesgo cardiovascular independientemente de la diferente edad. El perfil de lípidos se vio influido por el incremento del IMC experimentado y los valores de presión arterial por el IMC alcanzado. Ser fumador activo también se asoció a peores valores de las fracciones de colesterol y triglicéridos. Conclusiones. Durante la tercera década de la vida los factores de riesgo cardiovascular se incrementan. Estudios precoces (en la postadolescencia) permiten identificar sujetos con mayor riesgo posterior. Se constató la influencia en el perfil final de circunstancias modificables (incremento ponderal, tabaquismo). Es razonable planificar medidas preventivas orientadas a estos colectivos

Introduction and objectives. The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. Methods. In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. Results. In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m², cholesterol +68.0 mg/dL, HDL cholesterol ­-5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. Conclusions. Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups

Síndrome metabólico. Concepto y fisiopatología / Metabolic syndrome. Characteristics and pathophysiology

En la fisiopatología del síndrome metabólico (SM) se imbrican alteraciones en el metabolismo glucolipídico, estados proinflamatorios y protrombóticos. El vínculo entre todas ellas se atribuye a la resistencia insulínica (RI), favorecida por el aumento de ácidos grasos libres, muchas veces relacionado con el sobrepeso. Este estado provoca trastornos en la utilización de glucosa celular, así como desregulación de su producción hepática. El metabolismo lipídico presenta también las consecuencias de la RI, que desembocan en las alteraciones características del SM: hipertrigliceridemia e hipocolesterolemia HDL. La hipertensión se relaciona con diferentes mecanismos como consecuencia de alteraciones en la vía de la insulina y en la regulación del sistema nervioso vegetativo. Además de las repercusiones en el desarrollo de la aterosclerosis, últimamente se han relacionado el SM y la RI con otras enfermedades, como el hígado graso no alcohólico y el síndrome del ovario poliquístico (AU)

The pathophysiology of metabolic syndrome involves altered glucose and lipid metabolism, and proinflammatory and prothrombotic states. All of these abnormalities appear to be linked to insulin resistance, which is associated with an increase in the free fatty acid level, usually due to obesity. This condition disturbs cellular glucose management and hepatic synthesis. In addition, lipid metabolism is also impaired by insulin resistance. In these circumstances, hypertriglyceridemia and HDL hypocholesterolemia both develop. Moreover, hypertension is related to altered insulin regulation and impaired autonomic nervous system activity. In addition to the well-demonstrated relationship with atherosclerosis, recently metabolic syndrome has also been associated with steatohepatitis and polycystic ovary syndrome (AU)

Obesidad, dislipemia y síndrome metabólico / Obesity, dyslipidemia, and metabolic syndrome

El síndrome metabólico (SM) define una enfermedad centrada en la resistencia insulínica (RI) y en la que se encuentra implicado el tejido adiposo disfuncionante. Las alteraciones del metabolismo glucolipídico tienen un componente genético y son favorecidas por la inactividad física y la obesidad. En la actualidad, la obesidad es un problema de salud con una alta prevalencia y múltiples repercusiones orgánicas. El aumento del sobrepeso infantil es especialmente llamativo. El papel de la obesidad como factor de riesgo independiente para la enfermedad cardiovascular es controvertido, ya que, en parte, se explica por factores de riesgo clásicos asociados a ella. La dislipemia característica del SM, la hipertrigliceridemia con cifras bajas de colesterol unido a lipoproteínas de alta densidad, es consecuencia de la hiperinsulinemia en el metabolismo de las lipoproteínas. Aunque la elevación de las lipoproteínas de baja densidad no es característica del SM, la presencia de cambios en su composición sí lo es y da lugar a las denominadas SDLDL, más pequeñas, densas y aterogénicas (AU)

Insulin resistance plays a central role in the pathophysiology of the metabolic syndrome, though adipose tissue abnormalities may also be involved. Physical inactivity and excessive weight can lead to impaired lipid and glucose metabolism in patients with a genetic predisposition to insulin resistance. Today, obesity is a serious public health problem, in children as well as adults. Whether or not being overweight is an independent risk factor for cardiovascular disease is controversial, since it is associated with more traditional cardiovascular risk factors. The dyslipidemia typical of the metabolic syndrome, which is characterized by a high triglyceride level with a low high-density lipoprotein cholesterol level, results from the effect of hyperinsulinemia on lipoprotein metabolism. However, an elevated low-density lipoprotein (LDL) cholesterol level is not characteristic of the syndrome. Nevertheless, structural changes occur in LDL cholesterol particles, which become smaller, more dense and more atherogenic (AU)

Síndrome metabólico y diabetes mellitus / Metabolic syndrome and diabetes mellitus

La diabetes mellitus (DM) es una enfermedad metabólica crónica que está adquiriendo en los últimos años proporciones de auténtica epidemia. Se asocia frecuentemente con obesidad, alteraciones del metabolismo lipídico y proteínico, así como con hipertensión arterial y otros factores de riesgo cardiovascular, lo que constituye el síndrome metabólico. La DM tipo 2 (DM2) es un factor de riesgo importante para la enfermedad coronaria y la aterosclerosis precoz. Su etiopatogenia es multifactorial y está muy relacionada con la resistencia insulínica (RI), que es el proceso fisiopatológico común al conjunto de factores de riesgo cardiovascular. Respecto a la prevención y el tratamiento de la DM2, es fundamental la modificación del estilo de vida, con especial hincapié en la alimentación equilibrada y la introducción del ejercicio físico aeróbico en la vida cotidiana. Cuando las pautas higiénico-dietéticas no son suficientes, se debe recurrir a fármacos que actúen sobre la diana de la resistencia insulínica, como la metformina y las tiazolidinas (AU)

Diabetes mellitus is a chronic metabolic disease that has acquired the nature of an epidemic in recent years. It is frequently associated with obesity, abnormalities of the lipid and protein metabolism, high blood pressure, and other cardiovascular risk factors, which are often clustered together in the metabolic syndrome. Type 2 diabetes mellitus is an important risk factor for coronary disease and premature atherosclerosis. It has a multifactorial pathogenesis and it is closely linked to insulin resistance, which is also involved in the pathophysiology of cardiovascular risk factors associated with metabolic syndrome. One fundamental intervention for the prevention and treatment of type 2 diabetes mellitus is lifestyle modification, in particular the adoption of a balanced diet and the inclusion of aerobic physical activity in daily life. When these measures are insufficient, the use of drugs that target insulin resistance, such as metformin and thiazolidinediones, is necessary (AU)