Dietary plant microRNAs as potential regulators of cellular cholesterol efflux.

AIM: Epidemiological evidence suggests adherence to vegetable-rich diets is associated to atheroprotective effects and bioactive components are most likely to play a relevant role. The notion of inter-kingdom regulation has opened a new research paradigm and perhaps microRNAs (miRNAs) from edible vegetables could influence consumer gene expression and lead to biological effects. We aimed to investigate the potential impact of broccoli-derived miRNAs on cellular cholesterol efflux in vitro. METHODS: Four miRNAs (miR159a, miR159b, miR166a and miR403) from Brassica oleracea var. italica (broccoli), a widely consumed cruciferous vegetable, were selected for further investigation, based on their high abundancy in this vegetable and their presence in other plants. Selected miRNAs were synthesized with a 3'-terminal 2'-O-methylation and their cellular toxicity, in vitro gastrointestinal resistance and cellular uptake were evaluated. Potential target genes within the mammalian transcriptome were assessed in silico following pathway analysis. In vitro cholesterol efflux was assessed in human THP-1-derived macrophages. RESULTS: miRNAs survival to in vitro GI digestion was around 1%, although some variation was seen between the four candidates. Cellular uptake by mammalian cells was confirmed, and an increase in cholesterol efflux was observed. Pathway analysis suggested these miRNAs are involved in biological processes related to phosphorylation, phosphatidylinositol and Wnt signaling, and to the insulin/IGF pathway. CONCLUSIONS: Health-promoting properties attributed to cruciferous vegetables, might be mediated (at least in part) through miRNA-related mechanisms.

Monocyte-to-High-Density Lipoprotein Ratio Is Associated with Systemic Inflammation, Insulin Resistance, and Coronary Subclinical Atherosclerosis in Psoriasis: Results from 2 Observational Cohorts.

Systemic inflammation or insulin resistance drive atherosclerosis. However, they are difficult to capture for assessing cardiovascular risk in clinical settings. The monocyte-to-high-density lipoprotein ratio (MHR) is an accessible biomarker that integrates inflammatory and metabolic information and has been associated with poorer cardiovascular outcomes. Our aim was to evaluate the association of MHR with the presence of subclinical atherosclerosis in patients with psoriasis. The study involved a European and an American cohort including 405 patients with the disease. Subclinical atherosclerosis was assessed by coronary computed tomography angiography. First, MHR correlated with insulin resistance through homeostatic model assessment for insulin resistance, with high-sensitivity CRP and with 18F-fluorodeoxyglucose uptake in spleen, liver, and bone marrow by positron emission tomography/computed tomography. MHR was associated with both the presence of coronary plaques >50% of the artery lumen and noncalcified coronary burden, beyond traditional cardiovascular risk factors (P < .05). In a noncalcified coronary burden prediction model accounting for cardiovascular risk factors, statins, and biologic treatment, MHR added value (area under the curve base model = 0.72 vs area under the curve base model plus MHR = 0.76, P = .04) within the American cohort. These results suggests that MHR may detect patients with psoriasis who have subclinical burden of cardiovascular disease and warrant more aggressive measures to reduce lifetime adverse cardiovascular outcomes.

HOURS OF WORKING DAY AND CHOLESTEROL LEVEL IN LAND TRANSPORTATION DRIVERS IN A COMPANY IN LIMA / HORAS DE JORNADA LABORAL Y NIVEL DE COLESTEROL EN CONDUCTORES DE TRANSPORTE TERRESTRE EN UNA EMPRESA DE LIMA / HORAS DE JORNADA DE TRABALHO E NÍVEL DE COLESTEROL EM MOTORISTAS DE TRANSPORTE TERRESTRE DE UMA EMPRESA DE LIMA

Introduction: Ground transportation drivers face substantial risks to cardiovascular health, mainly hypercholesterolemia, possibly related to the hours of the workday.Objective. Determine the relationship between working hours and cholesterol level in land transport drivers in a company in Lima between the period from January 2022 to August 2023.Materials and methods. Correlational, cross-sectional research, which included 107 transport drivers. The main variables were: Hours of daily and weekly workday, total cholesterol and high-density lipoproteins (HDL), the instrument used was a data collection form. Spearman's Rho correlation test was used in the statistical analysis. The study was approved by the Ethics Committee of the Universidad Nacional Mayor de San Marcos.Results. It was observed that 47.02% of the workers worked between 9 and 10 hours a day, while 57.9% worked 61 to 72 hours a day. Furthermore, the majority of drivers had total cholesterol levels between 160 and 199 mg/dl (38.3%), and HDL cholesterol between 35 and 59 mg/dl (93.5%). A significant and direct correlation was determined between daily (p=0.026, Rho=0.216) and weekly (p=0.038, Rho=0.201) working hours with total cholesterol. No significant relationship was found with HDL cholesterol.Conclusions. It was identified that the hours of daily and weekly work hours were significantly related to the level of total cholesterol.

Introducción: Los conductores de transporte terrestre enfrentan riesgos sustanciales para la salud cardiovascular, principalmente hipercolesterolemia, posiblemente relacionadas a las largas horas de jornada laboral.Objetivo. Determinar la relación entre las horas de jornada laboral y nivel de colesterol en conductores de transporte terrestre en una empresa de Lima entre el periodo de enero 2022 hasta agosto de 2023.Materiales y métodos. Investigación correlacional, de corte transversal, que incluyó a 107 conductores de transporte. Las variables principales fueron: Horas de jornada laboral diaria y semanal, colesterol total y lipoproteínas de alta densidad (HDL), el instrumento empleado fue una ficha de recolección de datos. En el análisis estadístico se empleó la prueba de correlación Rho de Spearman. El estudio fue aprobado por el Comité de Ética de la Universidad Nacional Mayor de San Marcos.Resultados. Se observó que el 47,02% de los trabajadores laboraba entre 9 y 10 horas diarias, mientras que el 57,9% lo hacía de 61 a 72 horas. Además, la mayoría de los conductores presentaba niveles de colesterol total entre 160 y 199 mg/dl (38,3%), y colesterol HDL entre 35 a 59 mg/dl (93,5%). Se determinó correlación significativa y directa entre las horas de jornada laboral diaria (p=0,026, Rho=0,216) y semanal (p=0,038, Rho=0,201) con el colesterol total. No se encontró relación significativa con el colesterol HDL.Conclusiones. Se identificó que las horas de jornada laboral diaria y semanal se relacionaron significativamente con el nivel de colesterol total.

Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease. / Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica.

INTRODUCTION AND OBJECTIVES: Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets. METHOD: We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis. RESULTS: The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23). CONCLUSIONS: Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.

Asociación del colesterol remanente con el grado de control glucémico y la presencia de complicaciones microvasculares en personas con diabetes mellitus tipo 1 / Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus

Introducción Este trabajo investiga la relación entre el colesterol remanente, las métricas de glucosa y las complicaciones crónicas de la diabetes tipo 1 en individuos con sistemas flash de glucosa. Material y métodos Se recopilaron variables clínicas y métricas de glucosa de personas usuarias de sensores de glucosa. Se llevaron a cabo modelos estadísticos para estudiar la asociación del colesterol remanente con las métricas de glucosa, así como con la retinopatía y la nefropatía diabética. Resultados Se incluyeron 383 personas con una edad de 48,3±16,2 años, siendo un 54,1% mujeres, con un colesterol remanente de 16±10mg/dl. Los resultados mostraron que el colesterol remanente se asocia a un menor tiempo en rango (p=0,015) y a un mayor tiempo por encima del rango (p=0,003). La nefropatía diabética fue la única complicación que se asoció con un colesterol remanente mayor a 30mg/dl, OR: 8,93: IC 95%: 2,99-26,62; p<0,001. Conclusión El colesterol remanente se asocia de forma independiente con la hiperglucemia y la nefropatía diabética en personas con diabetes tipo 1. (AU)

Introduction This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. Material and methods Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. Results A total of 383 individuals, aged 48.3±16.2 years, with 54.1% women, and a remnant cholesterol level of 16±10mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (P=.015) and more time above the target range (P=.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30mg/dL; OR: 8.93; 95% CI: 2.99-26.62, P<.001. Conclusion Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes. (AU)

Atingimento das Metas de Colesterol LDL em Pacientes com Histórico de Infarto Agudo do Miocárdio: Estudo Transversal do Mundo Real / Attainment of LDL-Cholesterol Goals in Patients with Previous Myocardial Infarction: A Real-World Cross-Sectional Analysis

Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.

Abstract Background: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. Objectives: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. Methods: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. Results: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. Conclusions: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.

Factors associated with the presence of tendon xanthomas in familial hypercholesterolemia.

INTRODUCTION AND OBJECTIVES: Tendon xanthomas (TX) are lipid deposits highly specific to familial hypercholesterolemia (FH). However, there is significant variability in their presentation among FH patients, primarily due to largely unknown causes. Lipoprotein(a) is a well-established independent risk factor for atherosclerotic cardiovascular disease in the general population as well as in FH. Given the wide variability of lipoprotein(a) among FH individuals and the likelihood that TX may result from a proatherogenic and proinflammatory condition, the objective of this study was to analyze the size of TX in the Achilles tendons of FH participants and the variables associated with their presence, including lipoprotein(a) concentration. METHODS: A cross-sectional study was conducted on 377 participants with a molecular diagnosis of heterozygous FH. Achilles tendon maximum thickness (ATMT) was measured using ultrasonography with standardized equipment and procedures. Demographic variables and lipid profiles were collected. A multivariate linear regression model using a log-Gaussian approach was used to predict TX size. Classical cardiovascular risk factors and lipoprotein(a) were included as explanatory variables. RESULTS: The mean low-density lipoprotein cholesterol level was 277mg/dL without lipid-lowering treatment, and the median ATMT was 5.50mm. We demonstrated that age, sex, low-density lipoprotein cholesterol, and lipoprotein(a) were independently associated with ATMT. However, these 4 variables did not account for most the interindividual variability observed (R2=0.205). CONCLUSIONS: TX, a characteristic hallmark of FH, exhibit heterogeneity in their presentation. Interindividual variability can partially be explained by age, male sex, low-density lipoprotein cholesterol, and lipoprotein(a) but these factors account for only 20% of this heterogeneity.

Asociación del colesterol remanente con el grado de control glucémico y la presencia de complicaciones microvasculares en personas con diabetes mellitus tipo 1 / Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus

Introducción Este trabajo investiga la relación entre el colesterol remanente, las métricas de glucosa y las complicaciones crónicas de la diabetes tipo 1 en individuos con sistemas flash de glucosa. Material y métodos Se recopilaron variables clínicas y métricas de glucosa de personas usuarias de sensores de glucosa. Se llevaron a cabo modelos estadísticos para estudiar la asociación del colesterol remanente con las métricas de glucosa, así como con la retinopatía y la nefropatía diabética. Resultados Se incluyeron 383 personas con una edad de 48,3±16,2 años, siendo un 54,1% mujeres, con un colesterol remanente de 16±10mg/dl. Los resultados mostraron que el colesterol remanente se asocia a un menor tiempo en rango (p=0,015) y a un mayor tiempo por encima del rango (p=0,003). La nefropatía diabética fue la única complicación que se asoció con un colesterol remanente mayor a 30mg/dl, OR: 8,93: IC 95%: 2,99-26,62; p<0,001. Conclusión El colesterol remanente se asocia de forma independiente con la hiperglucemia y la nefropatía diabética en personas con diabetes tipo 1. (AU)

Introduction This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. Material and methods Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. Results A total of 383 individuals, aged 48.3±16.2 years, with 54.1% women, and a remnant cholesterol level of 16±10mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (P=.015) and more time above the target range (P=.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30mg/dL; OR: 8.93; 95% CI: 2.99-26.62, P<.001. Conclusion Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes. (AU)

Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus.

INTRODUCTION: This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. MATERIAL AND METHODS: Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. RESULTS: A total of 383 individuals, aged 48.3 ±â€¯16.2 years, with 54.1% women, and a remnant cholesterol level of 16 ±â€¯10 mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (p = 0.015) and more time above the target range (p = 0.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30 mg/dL, OR 8.93, 95% CI (2.99-26.62), p < 0.001. CONCLUSION: Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Abstract Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P 0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

Resumo Diabetes mellitus (DM) é uma síndrome endócrina caracterizada por níveis elevados de glicose no sangue devido à atividade anulada da insulina. Os tratamentos existentes para o DM têm efeitos colaterais e vários graus de eficácia. Portanto, é fundamental que novas abordagens sejam desenvolvidas para aprimorar o manejo do DM. As plantas terapêuticas foram acreditadas como tendo eficácia comparativamente alta com menos efeitos adversos. O presente estudo visa elucidar o perfil fitoquímico, efeitos anti-hiperlipidêmicos e antidiabéticos do extrato metanólico de D. salicifolia (folhas) em camundongos diabéticos induzidos por aloxana. Alloxan foi injetado por via intraperitoneal (150 mg kg-1, b.w), para induzir diabetes em camundongos. Os camundongos foram divididos em três grupos (n = 10). Grupo 1 (controle normal) recebeu ração normal e água purificada, Grupo II (controle diabético) recebeu ração regular e água limpa, e o grupo III (tratamento diabético) recebeu extrato metanólico da planta (300 mg kg-1) por 28 dias com uma dieta típica e água limpa durante todo o experimento. Amostras de sangue foram coletadas para verificar a glicose sérica e a concentração de LDL, TC, TG. O extrato demonstrou atividade anti-hiperglicêmica significativa (P 0,05), enquanto melhorias no peso corporal e no perfil lipídico dos camundongos foram observadas após o tratamento com o extrato. Este estudo estabelece que o extrato tem alta eficácia com comparativamente menos toxicidade e pode ser usado para o controle do DM.

Participación de rafts en enfermedades neurológicas / Role of rafts in neurological disorders

Introducción: Los rafts constituyen nano-dominios estructurales de naturaleza lipoproteica que propician la eficiente transducción de señales y la modulación de procesos fisiológicos asociados a la membrana plasmática. En el sistema nervioso, la alteración de estos dominios se ha asociado con el desarrollo de diversos padecimientos. Desarrollo: En el presente artículo se revisa el concepto de rafts, los procesos del sistema nervioso en los cuales están involucrados y su papel en distintas afectaciones, entre las que se destacan las enfermedades de Parkinson, Alzheimer y Huntington. Conclusiones: Dadas las evidencias de su participación en diversas neuropatologías, la preservación y/o reconstitución de los rafts se vislumbran como una atractiva estrategia terapéutica.(AU)

Introduction: Rafts are function-structural cell membrane nano-domains. They contribute to explain the efficiency of signal transduction at the low physiological membrane concentrations of the signaling partners by their clustering inside specialized signaling domains. Development: In this article, we review the current model of the membrane rafts and their physio-pathological relevance in the nervous system, including their role in Parkinson, Alzheimer, and Huntington diseases. Conclusions: Rafts disruption/dysfunction has been shown to relate diverse neurological diseases. Therefore, it has been suggested that preservation of membrane rafts may represent a strategy to prevent or delay neuronal dysfunctions in several diseases.(AU)

Impacto de la optimización del tratamiento hipolipemiante en el riesgo cardiovascular residual / Impact of Optimizing Lipid-Lowering Therapy on Residual Cardiovascular Risk

RESUMEN Introducción: el modelo SMART-REACH predice el riesgo de eventos cardiovasculares recurrentes. Objetivos: los objetivos de este estudio fueron: a) evaluar el riesgo residual en una población en prevención secundaria y niveles de colesterol asociado a lipoproteínas de baja densidad (C-LDL) fuera de meta; b) mediante un modelo de simulación, determinar el impacto de optimizar las terapias hipolipemiantes en términos de reducción del riesgo residual. Material y métodos: estudio transversal, descriptivo y multicéntrico. Se incluyeron consecutivamente pacientes con antecedentes cardiovasculares y un C-LDL mayor o igual que 55 mg/dL. El riesgo de eventos recurrentes (infarto agudo de miocardio, accidente cerebrovascular o muerte vascular) a 10 años y a lo largo de la vida se estimó utilizando el modelo SMART-REACH. Mediante una simulación, se optimizó el tratamiento hipolipemiante de cada paciente (utilizando estatinas, ezetimibe o inhibidores de proproteína convertasa subtilisina kexina tipo 9 [iPCSK9]), se estimó el descenso del C-LDL, se verificó el alcance del objetivo lipídico y se calculó la reducción del riesgo cardiovascular y el número necesario a tratar (NNT) correspondiente. Resultados: se incluyeron 187 pacientes (edad media 67,9 ± 9,3 años, 72,7% hombres). Los riesgos residuales calculados a 10 años y a lo largo de la vida fueron 37,1 ± 14,7% y 60,3 ± 10,7%, respectivamente. Globalmente, se pudo optimizar una sola estrategia farmacológica con estatinas, ezetimibe o un iPCSK9 en el 38,5%, el 11,5% y el 5,5% de la población, respectivamente. La optimización basada en dos tratamientos se realizó en el 27,5% (estatinas + ezetimibe), el 7,7% (estatinas + iPCSK9) y el 1,1% (ezetimibe + iPCSK9) de los casos. En 15 pacientes se optimizó el tratamiento considerando los tres fármacos. El 53,9% y el 62,9% de las acciones para optimizar el tratamiento mostraron un NNT menor que 30 para evitar un evento a 10 años o a lo largo de la vida, respectivamente. Conclusión: en este estudio, los pacientes con antecedentes cardiovasculares que no alcanzan la meta de C-LDL mostraron un riesgo residual considerable. La simulación mostró un importante margen para optimizar el tratamiento, con un impacto notable en el riesgo residual.

ABSTRACT Background: The SMART-REACH model predicts the risk or recurrent cardiovascular events. Objectives: The objectives of this study were: a) to evaluate the residual cardiovascular risk in a secondary prevention population with LDL-C levels above the recommended goal, using a simulation model; and b) to determine the impact of optimizing lipid-lowering therapies in terms of residual cardiovascular risk reduction. Methods: We conducted a cross-sectional, descriptive and multicenter study. Patient with a history of cardiovascular disease and a LDL-C ≥55 mg/dL were consecutively included. The 10-year and lifetime risk of recurrent events (myocardial infarction, stroke, or vascular death) were estimated using the SMART-REACH model. By means of a simulation, lipid-lowering treatment was optimized for each patient [using statins, ezetimibe and/or PCSK9 (PCSK9) inhibitors], with estimation of LDL-C reduction, checking if lipid-lowering goal was achieved and calculating the reduction in cardiovascular risk and the corresponding number needed to treat (NNT). Results: The cohort was made up of 187 patients; mean age was 67.9 ± 9.3 years and 72.7% were men. The calculated 10-year and lifetime residual risks were 37.1 ± 14.7% and 60.3 ± 10.7%, respectively. Overall, treatment was optimized with a single pharmacological strategy with statins, ezetimibe or PCSK9 inhibitor in 38.5%, 11.5% and 5.5% of the population, respectively. Optimization based on two treatments was performed in 27.5% (statins + ezetimibe), 7.7% (statins + PCSK9 inhibitor) and 1.1% (ezetimibe + PCSK9 inhibitor) of the cases. In 15 patients, treatment was optimized when the three drugs (statins + ezetimibe + PCSK9 inhibitor) were considered. Overall, 53.9% and 62.9% of the actions implemented to optimize treatment showed a 10-year or lifetime NNT < 30 to prevent an event, respectively. Conclusion: In this study, patients with a history of cardiovascular disease who do not reach LDL-C goal showed significant residual cardiovascular risk. The simulation model showed a significant margin for optimizing treatment, with a marked reduction in residual cardiovascular risk.

Evaluación de la composición en ácidos grasos, colesterol, magnesio potasio y sodio de los menús servidos en los comedores colectivos de un colegio e instituto de la Comunidad Valenciana / Evaluation of the composition in fatty acids, cholesterol, magnesium,potassium and sodium of the menus served in the collective canteens of a school and institute of the Valencian Community

Introducción: El aumento de la incidencia y prevalenciade la obesidad en la población infantojuvenil, el exceso deconsumo de sodio, colesterol y grasas saturadas son factoresque implican un incremento del riesgo cardiovascular en laedad adulta, y como consecuencia un problema de salud co-munitaria grave. Por ello se ha desarrollado el presente tra-bajo que incluye la segunda parte del Programa Bon Profitpara una alimentación saludable y responsable en el comedorescolar. Se ha evaluado: la calidad de los lípidos, (atendiendoa su composición en ácidos grasos, contenido en colesterol),así como el contenido en sodio (Na), Potasio(K) y Magnesio(Mg) de los menús servidos en el comedor escolar.Objetivo: Estudio y valoración de la composición en ácidosgrasos, colesterol, Na, K y Mg de los menús escolares, paraevaluar el riesgo cardiovascular, para posteriormente haceruna intervención nutricional: en diseño y elaboración de me-nús y en hábitos alimentarios, con el fin de corregir los me-nús ofertados por la empresa y prevenir el riesgo cardiovas-cular y de obesidad.Materiales y métodos: Se han valorado 28 menús queconstituyen un total de 56 platos. Cada plato se ha muestre-ado durante un periodo de tres meses, mediante método depesada directa, y valorado con el programa informáticoDIAL®, para determinar la composición lipídica: ácidos gra-sos saturados (AGS), monoinsaturados (AGM) y poliinsatura-dos (AGP), colesterol y contenido en sodio (Na), potasio(K) ymagnesio (Mg). Posteriormente se han comparado los valoresobtenidos con las recomendaciones nutricionales para la po-blación estudiada de 900 escolares entre 3 y 19 años.Conclusiones y resultados: Se puede concluir que tantoen los menús del colegio como en los del instituto, la compo-sición en AGS, AGM y AGP sobrepasa las recomendaciones (AU)

[Atherogenic index and its association with acute coronary ischemic syndrome mortality]. / Índice aterogénico y su relación con la mortalidad del síndrome isquémico coronario agudo.

Background: Several indexes have been developed to define the risk attributable to lipid metabolism with a single value. The total cholesterol/high-density lipoprotein (TC/HDL-C) and low-density lipoprotein/high-density lipoprotein (LDL-C/HDL-C) ratios are the most used. The higher the value of these ratios, the greater the probability of cardiovascular events. Objective: To identify whether the TC/HDL-C and LDL-C/HDL-C ratios are early prognostic markers of mortality and major cardiovascular events in patients with ST-elevation acute coronary syndrome. Material and methods: 265 patients with ST-segment elevation acute coronary ischemic syndrome were included, divided into 4 groups according to the values of the atherogenic indices. Mortality and major cardiovascular events at 30-day follow-up were analyzed. Comparison of the groups was performed using the chi-squared test or ANOVA, depending on the case (p < 0.05). Results: The cut-off point for the TC/HDL-C index was 6.9 and for the LDL-C/HDL-C it was 2.7. The comparative analysis of groups showed that cardiovascular death and arrhythmia were higher in group 3 (p = 0.006 and p = 0.003, respectively). Conclusions: TC/HDL-C and LDL-C/HDL-C indexes can be used as prognostic markers of cardiovascular mortality in the first 30 days of follow-up.

Introducción: se han elaborado diferentes índices para definir el riesgo atribuible al metabolismo lipídico con un solo valor. Los coeficientes colesterol total/lipoproteínas de alta densidad (CT/C-HDL) y lipoproteínas de baja densidad/lipoproteínas de alta densidad (C-LDL/C-HDL) son los más utilizados. A mayor valor de estos cocientes, la probabilidad de eventos cardiovasculares es mayor. Objetivo: identificar si los índices CT/C-HDL y C-LDL/C-HDL son marcadores pronósticos tempranos de mortalidad y evento cardiovascular mayor en pacientes con síndrome isquémico coronario agudo con elevación del ST. Material y métodos: se incluyeron 265 pacientes con síndrome isquémico coronario agudo con elevación del segmento ST, divididos en 4 grupos según los valores de los índices aterogénicos. Se analizó la mortalidad y el evento cardiovascular mayor en los 30 días de seguimiento. Se identificó el punto de corte de cada índice mediante un análisis de curva ROC. La comparación de los grupos se hizo con chi cuadrada o ANOVA, según fuera el caso (p < 0.05). Resultados: el punto de corte para el índice CT/C-HDL fue de 6.9 y para el C-LDL/C-HDL de 2.7. El análisis comparativo de los grupos demostró que la muerte cardiovascular y arritmia fue mayor en el grupo 3 (p = 0.006 y p = 0.003, respectivamente). Conclusiones: los índices CT/C-HDL y C-LDL/C-HDL pueden ser utilizados como marcadores pronósticos de mortalidad cardiovascular en los primeros 30 días de seguimiento.

Role of rafts in neurological disorders.

INTRODUCTION: Rafts are protein-lipid structural nanodomains involved in efficient signal transduction and the modulation of physiological processes of the cell plasma membrane. Raft disruption in the nervous system has been associated with a wide range of disorders. DEVELOPMENT: We review the concept of rafts, the nervous system processes in which they are involved, and their role in diseases such as Parkinson's disease, Alzheimer disease, and Huntington disease. CONCLUSIONS: Based on the available evidence, preservation and/or reconstitution of rafts is a promising treatment strategy for a wide range of neurological disorders.

Consensus document for lipid profile determination and reporting in Spanish clinical laboratories. What parameters should be included in a basic lipid profile?

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.

Control de la hipercolesterolemia en España: una misma situación con diferentes realidades autonómicas / Hypercholesterolaemia control in Spain: The same situation with different regional realities

Introducción y objetivos: La estrategia de prevención cardiovascular en las comunidades autónomas (CCAA) puede ser variable, al estar transferidas las competencias en sanidad. El objetivo del estudio fue conocer el control de la dislipemia y la terapia hipolipemiante utilizada en pacientes de alto/muy alto riesgo cardiovascular (RCV) por CCAA. Métodos: Estudio descriptivo, transversal, multicéntrico no aleatorizado basado en una metodología de consenso. Se recogió información de práctica clínica en 145 áreas sanitarias de 17CCAA españolas mediante reuniones presenciales y cuestionarios realizados a los 435 médicos participantes. Se recopilaron datos agregados no identificables de 10 pacientes dislipémicos consecutivos que cada participante hubiera visitado recientemente. Resultados: De los 4.010 pacientes compilados, 649 (16%) eran de alto y 2.458 (61%) de muy alto RCV. La distribución de los 3.107 pacientes de alto/muy alto RCV fue equilibrada entre regiones, pero hubo diferencias interterritoriales (p<0,0001) en la consecución del objetivo de cLDL<70 e <55mg/dl, respectivamente. Las estatinas de alta intensidad en monoterapia o combinadas con ezetimiba y/o inhibidores PCSK9 se utilizaron en el 44, el 21 y el 4% de los pacientes de alto RCV, mientras que en los de muy alto RCV era del 38, del 45 y del 6%, respectivamente. El uso de estas terapias hipolipemiantes a nivel nacional fue significativamente diferente entre regiones (p=0,0079). Conclusiones: A pesar de que la distribución de los pacientes de alto/muy alto RCV fue similar entre CCAA, se identificaron diferencias interterritoriales en el grado de consecución del objetivo terapéutico en cLDL y de utilización de la terapia hipolipemiante. (AU)

Introduction and objective: The cardiovascular prevention strategy by autonomous communities can be variable since the competences in health are transferred. The objective of the study was to determine the degree of dyslipidaemia control and the lipid-lowering pharmacological therapy used in patients at high/very high cardiovascular risk (CVR) by autonomous communities. Methods: Observational, cross-sectional, descriptive study based on a consensus methodology. Information on the clinical practice of 145 health areas belonging to 17 Spanish autonomous communities was collected through face-to-face meetings and questionnaires administered to the 435 participating physicians. Furthermore, aggregate non-identifiable data were compiled from 10 consecutive dyslipidaemic patients that each participant had recently visited. Results: Of the 4010 patients collected, 649 (16%) had high and 2458 (61%) very high CVR. The distribution of the 3107 high/very high CVR patients was balanced across regions, but there were inter-regional differences (P<.0001) in the achievement of target LDL-C <70 and <55mg/dL, respectively. High-intensity statins in monotherapy or in combination with ezetimibe and/or PCSK9 inhibitors were used in 44, 21 and 4% of high CVR patients, while in those at very high CVR it rose to 38, 45 and 6%, respectively. The use of these lipid-lowering therapies at national level was significantly different between regions (P=.0079). Conclusions: Even though the distribution of patients at high/very high CVR was similar between autonomous communities, inter-territorial differences were identified in the degree of achievement of LDL cholesterol therapeutic goal and use of lipid-lowering therapy. (AU)

Alimentos funcionales y nutracéuticos en el tratamiento de la hipercolesterolemia: posicionamiento de la Sociedad Española de Arteriosclerosis 2023 / Functional foods and nutraceuticals in the treatment of hypercholesterolemia: Statement of the Spanish Society of Arteriosclerosis 2023

Para el tratamiento de la hipercolesterolemia, además de aconsejar una alimentación saludable, puede ser conveniente recomendar alimentos funcionales o nutracéuticos con efecto hipolipemiante. Dado el progresivo incremento en el número de estos productos y su creciente utilización por la población, la Sociedad Española de Arteriosclerosis (SEA) ha creído conveniente revisar la información disponible, seleccionar los resultados de los estudios científicamente más sólidos y posicionarse sobre la utilidad de los mismos, para recomendar a los profesionales sanitarios y a la población general su potencial utilidad en términos de eficacia y sus posibles beneficios y limitaciones. Se han identificado los siguientes escenarios clínicos en los que se podrían utilizar estos productos y que se analizarán con más detalle en este documento: 1. Tratamiento hipolipemiante en sujetos con intolerancia a estatinas. 2. Tratamiento hipolipemiante «a la carta» en personas en prevención primaria. 3. Prevención cardiovascular a largo plazo en personas sin indicación de tratamiento hipolipemiante. 4. Pacientes con tratamiento hipolipemiante optimizado que no alcanzan objetivos terapéuticos. (AU)

In the management of hypercholesterolemia, besides advising a healthy, plant-based diet, it may be useful to recommend functional foods or nutraceutical with cholesterol-lowering properties. Given the progressive increase in the number of these products and their rising use by the population, the Spanish Society of Arteriosclerosis (SEA) has considered it appropriate to review the available information, select the results of the scientifically more robust studies and take a position on their usefulness, to recommend to health professionals and the general population their potential utility in terms of efficacy and their possible benefits and limitations. The following clinical scenarios have been identified in which these products could be used and will be analyzed in more detail in this document: (1) Hypolipidemic treatment in subjects with statin intolerance. (2) Hypolipidemic treatment «a la carte» in individuals in primary prevention. (3) Long-term cardiovascular prevention in individuals with no indication for lipid-lowering therapy. (4) Patients with optimized lipid-lowering treatment who do not achieve therapeutic objectives. (AU)

Nutrigenómica y funcionamiento de las hormonas tiroideas, un efecto dependiente de la ingesta materna de fructosa / Nutrigenomics and thyroid hormone functioning, a dependent effect of maternal fructose intake

El consumo de fructosa se ha asociado con el desarrollo de síndrome metabólico. También se ha demostrado que la ingesta de fructosa durante la gestación puede provocar efectos perjudiciales en los descendientes (1). Además, otros autores han descrito cómo la nutrición puede afectar al funcionamiento de las hormonas tiroideas, las cuales están implicadas en diversas enfermedades metabólicas.Por ello, se determinaron el efecto del consumo materno de fructosa durante la gestación sobre el metabolismo de las hormonas tiroideas en sus descendientes, y los efectos de la suplementación de los descendientes con distintas dietas (fructosa, tagatosa, fructosa con colesterol).La tagatosa aumentó los niveles plasmáticos de T4 libre y la expresión hepática de DIO1 solamente en descendientes de madres fructosa. Sin embargo, la expresión hepática de UCP2 mostró un perfil más similar a la de THRa.En íleon y TAL los perfiles de expresión para DIO1 y UCP están correlacionados y se ven afectados por el consumo de fructosa (efecto dependiente de la ingesta materna). La adición de colesterol a la dieta potenció el efecto de la fructosa en íleon (para DIO1 y UCP2).Por tanto, el consumo materno de fructosa afecta al metabolismo de las hormonas tiroideas de la descendencia, tanto en respuesta a una dieta rica en fructosa como a la asociación de fructosa y colesterol (“Western diet”).Este trabajo pretende alertar a la población, en especial mujeres embarazadas del papel relevante que ejerce la nutrición, con posibles consecuencias negativas para la salud de sus hijos.(AU)

Fructose consumption has been associated with the development of metabolic syndrome. It has also been shown that fructose intake during pregnancy can cause detrimental effects on offspring (1). In addition, other authors have described how nutrition can affect the function of thyroid hormones, which are involved in various metabolic diseases.Therefore, we determined the effect of maternal fructose consumption during pregnancy on the metabolism of thyroid hormones in their offspring and the effects of the supplementation with different diets (fructose, tagatose, fructose with cholesterol) in the offspring.Tagatose increased plasma free T4 levels and hepatic DIO1 expression only in the offspring of fructose-fed mothers. However, the hepatic expression of UCP2 showed a profile more similar to that of THRa.In ileum and TAL, the expression profiles for DIO1 and UCP are correlated and affected by fructose consumption (effect dependent on maternal intake). The addition of cholesterol to the diet potentiated the effect of fructose in ileum (for DIO1 and UCP2).Thus, maternal fructose consumption affects the metabolism of thyroid hormones in the offspring, both in response to a fructose rich diet and a combination of fructose and cholesterol (“Western diet”).This work aims to alert the population, especially pregnant women, of the relevant role of nutrition, leading to possible negative consequences for the health of their children.(AU)

Documento de consenso para la determinación e informe del perfil lipídico en laboratorios clínicos españoles / Consensus document for lipid profile determination and reporting in Spanish clinical laboratories. What parameters should be included in a basic lipid profile?

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio (AU)

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports (AU)