Influencia de la concentración de triglicéridos en la lipoproteína(a) en función de la dislipidemia / Influence of triglyceride concentration in lipoprotein (a) as a function of dyslipidemia

Introducción Recientemente se ha demostrado una relación inversa entre la concentración en sangre de la lipoproteína(a) (Lp[a]) y los triglicéridos (TG). A mayor tamaño de lipoproteínas de muy baja densidad (VLDL), mayor presencia de VLDL ricas en apoliproteína E (apo E) y en sujetos con genotipo apo E2/E2, Lp(a) más baja. El mecanismo de esta asociación contrapuesta es desconocido. El objetivo de nuestro análisis fue evaluar la correspondencia Lp(a)-TG en los pacientes atendidos en las Unidades de Lípidos incluidos en el registro de la Sociedad Española de Arteriosclerosis (SEA) comparando las diferentes dislipidemias. Pacientes y métodos Se incluyeron 5.275 usuarios de ≥ 18 años registrados antes del 31 de marzo de 2023, con datos de concentración de Lp(a) e información completa del perfil lipídico sin tratamiento. Resultados La media de edad fue de 53,0 ± 14,0 años, con 48% de mujeres. Un total de 9,5% (n = 502) tenían diabetes mellitus (DM) y 1.184 sujetos (22,4%) presentaban obesidad. La mediana de TG fue de 130 mg/dL (rango intercuartílico [IQR] 88,0-210) y de Lp(a) 55,0 nmol/L (IQR 17,9 -156). La concentración de Lp(a) mostró una asociación negativa con la de TG cuando los valores de estos superaban los 300 mg/dL. Los pacientes con TG > 1.000 mg/dL mostraron el menor nivel de Lp(a) 17,9 nmol/L y los usuarios con TG < 300 mg/dL, presentaron una media de Lp(a) de 60,1 nmol/L. En pacientes sin DM ni obesidad, la relación inversa de Lp(a)-TG fue especialmente importante (p < 0,001). La mediana de Lp(a) fue de 58,3 nmol/L en aquellos con TG < 300 mg/dL y 22,0 nmol/L si TG > 1.000 mg/dL. No se encontró asociación entre TG y Lp(a) en sujetos con DM y obesidad, ni en los que contaban con hipercolesterolemia familiar (HF). En los que padecen hiperlipemia combinada multifactorial con TG < 300 mg/dL la Lp(a) fue 64,6 nmol/L, en el rango de 300-399 mg/dL de TG la Lp(a) desciende hasta 38,8 nmol/L y hasta 22,3 nmol/L si TG > 1.000 mg/dL. Conclusiones ... (AU)

Background Recently, an inverse relationship between the blood concentration of lipoprotein(a) (Lp(a)) and triglycerides (TG) has been demonstrated. The larger the VLDL particle size, the greater the presence of VLDL rich in apoliprotein E and in subjects with the apoE2/E2 genotype, the lower Lp(a) concentration. The mechanism of this inverse association is unknown. The objective of this analysis was to evaluate the Lp(a)–TG association in patients treated at the lipid units included in the registry of the Spanish Society of Atherosclerosis (SEA) by comparing the different dyslipidemias. Patients and methods Five thousand two hundred and seventy-five subjects ≥18 years of age registered in the registry before March 31, 2023, with Lp(a) concentration data and complete lipid profile information without treatment were included. Results The mean age was 53.0 ± 14.0 years, with 48% women. The 9.5% of subjects (n = 502) had diabetes and the 22.4% (n = 1184) were obese. The median TG level was 130 mg/dL (IQR 88.0–210) and Lp(a) 55.0 nmol/L (IQR 17.9–156). Lp(a) concentration showed a negative association with TG concentration when TG values exceeded 300 mg/dL. Subjects with TG > 1000 mg/dL showed the lowest level of Lp(a), 17.9 nmol/L, and subjects with TG < 300 mg/dL had a mean Lp(a) concentration of 60.1 nmol/L. In subjects without diabetes or obesity, the inverse association of Lp(a)–TG was especially important (p < 0.001). The median Lp(a) was 58.3 nmol/L in those with TG < 300 mg/dL and 22.0 nmol/L if TG > 1000 mg/dL. No association was found between TG and Lp(a) in subjects with diabetes and obesity, nor in subjects with familial hypercholesterolemia. In subjects with multifactorial combined hyperlipemia with TG < 300 mg/dL, Lp(a) was 64.6 nmol/L; in the range of 300–399 mg/dL of TG, Lp(a) decreased to 38. 8 nmol/L, and up to 22.3 nmol/L when TG > 1000 mg/dL. Conclusions ... (AU)

[Impact of diabetes on cardiovascular risk in patients with dyslipidemia]. / Impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia.

Objective: To determine the impact of diabetes on cardiovascular risk in patients with dyslipidemia. Method: Observational, cross-sectional and comparative study in which cardiovascular risk was determined at 10 years in 100 patients with dyslipidemia, of these, 50 non-diabetic patients and 50 diabetic patients. Results: Both groups had similar characteristics in terms of age, blood pressure figures, average body mass index, and HDL and LDL levels. It was observed that the diabetic group has almost double the risk compared to the dyslipidemia group, 13.7 vs. 7.9 (p = 0.014), and the calculated heart age is also higher in patients with diabetes, 80 vs. 66 years (p = 0.003). Even in patients with diabetes there is a greater difference between the real age and the age of the heart, 24 years vs. 15 years of patients without diabetes (p = 0.000). Conclusion: Having diabetes and dyslipidemia doubles the cardiovascular risk of patients. Little metabolic control was found in the population studied, which significantly increases complications at an early age and the economic burden on the health system and the families of patients, so it is necessary to rethink treatment strategies to improve metabolic control and with it the prognosis for the patient in the long term.

Objetivo: Determinar el impacto de la diabetes en el riesgo cardiovascular en pacientes con dislipidemia. Método: Estudio observacional, transversal y comparativo, en el que se determinó el riesgo cardiovascular en 100 pacientes con dislipidemia, de los cuales 50 eran diabéticos, sin complicaciones crónicas. Resultados: Ambos grupos tenían características similares en cuanto a edad, presión arterial, índice de masa corporal, niveles de c-HDL y c-LDL. Sin embargo, al comparar el porcentaje de riesgo cardiovascular, observamos que el grupo de diabéticos tenía casi el doble de riesgo cardiovascular, 13.7 contra 7.9 (p = 0.014), y la edad del corazón calculada también fue mayor en los pacientes con diabetes, 80 contra 66 años (p = 0.003). Incluso, en los pacientes diabéticos la diferencia entre la edad real y la edad del corazón fue mayor, 24 años contra 15 años (p = 0.000). Conclusión: Padecer diabetes y dislipidemia duplica el riesgo cardiovascular. En la población estudiada se encontró poco control metabólico, lo que aumenta significativamente las complicaciones en edades tempranas y la carga económica al sistema de salud y a las familias de los pacientes; por tanto, es necesario replantear las estrategias de tratamiento para mejorar el control metabólico y el pronóstico del paciente a largo plazo.

Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria / Clinical profile of severe hypercholesterolemia in 156.000 adults in primary care

Objetivo Estimar la frecuencia y el perfil clínico de la hipercolesterolemia severa (HS) y del fenotipo de hipercolesterolemia familiar (HF) en el ámbito de atención primaria, en un área sanitaria de la comunidad de Madrid (CAM). Material y métodos Estudio transversal, multicéntrico de sujetos con tarjeta sanitaria adscritos a 69 centros de salud (área NorOeste/CAM). Se definió HS como colesterol ≥300mg/dl o colesterol-LDL ≥220mg/dl en alguna analítica realizada (1-1-2018 a 30-12-2021), y fenotipo de HF como cLDL ≥240mg/dl (≥160mg/dl si tratamiento hipolipemiante), con triglicéridos <200mg/dl y TSH <5μIU/ml. Resultados Se analizaron 156.082 adultos ≥18años con perfil lipídico disponible. 6.187 sujetos tenían HS (3,96% de las analíticas estudiadas; IC95%: 3,87-4,06%). El tiempo medio de evolución del diagnóstico de hiperlipemia en la historia clínica informatizada fue 10,8años; el 36,5% tenían hipertensión, el 9,5%, diabetes, y el 62,9%, sobrepeso/obesidad. El 83,7% tomaban hipolipemiantes (65,7% de baja/moderada y 28,6% de alta/muy-alta intensidad). El 6,1% tenían enfermedad cardiovascular (94,2% tratados con hipolipemiantes), con colesterol LDL <55, <70 y <100mg/dl de 1,8%, 5,8% y 20,2%, respectivamente (vs 1%, 2,3% y 11,2% si no había enfermedad cardiovascular). Mil seiscientos sujetos tenían fenotipo de HF (IC95%: 1,03%, 0,98-1,08%). Conclusiones Cuatro de cada 100 pacientes analizados en atención primaria tienen HS. Hay un elevado nivel de tratamiento farmacológico, pero de insuficiente intensidad, y escaso logro de objetivos terapéuticos. Uno de cada 100 tiene fenotipo de HF. La identificación de ambas situaciones por registros informatizados permitiría su detección más precisa y precoz y establecer estrategias preventivas cardiovasculares. (AU)

Objective To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). Material and methods Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5μIU/mL. Results 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). Conclusions Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies. (AU)

Consumo de fructosa y síndrome metabólico en pacientes adultos de un Hospital Militar / Fructose consumption and metabolic syndrome in adult patients of a military hospital

Introducción: La fructosa de la dieta se metaboliza a nivel hepático, en donde estimula la fructólisis, la glucólisis, la lipogénesis y la producción de glucosa, esto conlleva a la dislipidemia mixta, hiperglucemia e hígado graso; aumentando el riesgo de síndrome metabólico.Objetivo: Determinar la asociación entre el consumo de fructosa y síndrome metabólico en pacientes adultos atendidos en el Hospital Militar Central “Coronel Luis Arias Schreiber”.Materiales y Métodos: Investigación de enfoque cuantitativo, diseño no experimental, transversal, correlacional-causal. La población de estudio estuvo conformada por 75 pacientes adultos. Se incluyó pacientes mayores de 18 años de edad; quienes en forma voluntaria firmaron el consentimiento informado y presentaron registros actualizados de perfil bioquímico, fueron excluidos pacientes con discapacidad mental, motora y/o física. Los valores de presión arterial y perfil bioquímico; se obtuvo de las historias clínicas y la valoración antropométrica a través de la medición del peso corporal, talla y circunferencia abdominal; la ingesta de fructosa se obtuvo a través de un cuestionario de frecuencia de consumo semicuantitativo. Se utilizó la prueba estadística de Chi cuadrado para evaluar la asociación de variables.Resultados: El 61,3% presentó Síndrome Metabólico (SM), el 88% presentan un inadecuado consumo de fructosa (>25g/día). El índice de masa corporal (IMC) promedio fue de 30,34 (DE ±4,0); el nivel de glucosa en ayunas fue 100,13 mg/dL (DE ±11,25). Al asociar el consumo inadecuado de fructosa con el Síndrome Metabólico, se obtuvo un valor p= 0,010 (p<0,05). Asimismo, el consumo inadecuado de fructosa añadida tuvo asociación con el SM (p<0,05). No obstante, al asociar ingesta de fructosa natural con el SM, se obtuvo p =0.466 (p>0,05).(AU)

Introduction: Dietary fructose is metabolized in the liver,where it stimulates fructolysis, glycolysis, lipogenesis andglucose production, which leads to mixed dyslipidemia, hy-perglycemia and fatty liver; increasing the risk of metabolicsyndrome. Objetive: Determine the association between fructose con-sumption and metabolic syndrome in adult patients treated atthe “Coronel Luis Arias Schreiber” Central Military Hospital. Materials and methods: A quantitative approach studywas carried out, with a non-experimental, cross-sectional andcorrelational-causal design. The study population consisted of 75 adult patients. Patients over 18 years of age were in-cluded; who voluntarily signed the informed consent and pre-sented updated biochemical profile records. Patients withmental, motor and/or physical disabilities were excluded.Blood pressure and biochemical profile values were obtainedfrom medical records and anthropometric assessmentthrough measurement of body weight, height, and abdominalcircumference. Fructose intake was obtained through a semi-quantitative consumption frequency questionnaire. The Chisquare statistical test was used to evaluate the association ofvariables. Results: 61.3% presented Metabolic Syndrome (MS), 88%presented inadequate fructose consumption (>25g/day). Theaverage body mass index (BMI) was 30.34 (SD ±4.0); Thefasting glucose level was 100.13 mg/dL (SD ±11.25). Whenassociating inadequate fructose consumption with MetabolicSyndrome, a p value = 0.010 (p < 0.05) was obtained.Likewise, inadequate consumption of added fructose was as-sociated with MS (p<0.05). However, when associating natu-ral fructose intake with MS, p =0.466 (p>0.05) was obtained.Conclusions. A high consumption of added fructose in in-dustrialized foods has a greater association with the develop-ment of Metabolic Syndrome; It is necessary to reduce thefructose content in industrialized foods.(AU)

Analysis of the metabolic profile and comorbidities in women with endometriosis before and after surgical treatment / Análise do perfil metabólico e comorbidades em mulheres com endometriose antes e depois do tratamento cirúrgico

Aim: this study aimed to evaluate the effects of surgical treatment for endometriosis on the metabolic profile of women diagnosed with deep endometriosis. Methods: we conducted a prospective observational study with a sample of 30 women in the menacme diagnosed with deep endometriosis who underwent videolaparoscopic surgery in a reference center in Brazil between October 2020 and December 2021. A total of 30 women performed clinical and laboratory tests regarding their metabolic profile on two occasions, during preoperative tests and six months after video-laparoscopy. Results: patients had lower average levels of Total Cholesterol (TC), Low-Density Cholesterol (LDL-c), Triglycerides (TGC), and Fasting Glycemia (FG) after the surgical procedure. The average TC level was 8.2% lower after surgery, LDL-c was 12.8% lower, TGC was 10.9% lower, and FG was 7.3% lower. The results showed a statistically significant difference for all these parameters (p < 0.001). Conclusions: video-laparoscopy was associated with a favorable lipid profile compared to the preoperative lipid profile, with a significant improvement in the average levels of LDL-c, HDL-c, TC, TGC, and FG. Long-term follow-up studies are needed to determine whether surgical treatment for endometriosis can improve the metabolic parameters of women with endometriosis and favor a lower predisposition to atherogenesis.

Objetivo: Aeste estudo teve como objetivo avaliar os efeitos do tratamento cirúrgico da endometriose no perfil metabólico de mulheres com diagnóstico de endometriose profunda. Métodos: foi realizado um estudo observacional prospectivo com uma amostra de 30 mulheres na menacme, com diagnóstico de endometriose profunda, que foram submetidas à videolaparoscopia em um centro de referência no Brasil, entre outubro de 2020 e dezembro de 2021. As mulheres realizaram exames clínicos e laboratoriais quanto ao seu perfil metabólico em duas ocasiões, durante exames pré-operatórios e seis meses após a videolaparoscopia. Resultados: as pacientes apresentaram níveis médios mais baixos de Colesterol Total (CT), Colesterol de Baixa Densidade (LDL-c), Triglicerídeos (TGC) e Glicemia de Jejum (GJ) após o procedimento cirúrgico. O nível médio de CT foi 8,2% menor após a cirurgia, o LDL-c foi 12,8% menor, o TGC foi 10,9% menor e a GJ foi 7,3% menor. Os resultados mostraram diferença estatisticamente significativa para todos esses parâmetros (p < 0,001). Conclusões: a videolaparoscopia foi associada a um perfil lipídico favorável em comparação ao perfil lipídico pré-operatório, com melhora significativa nos níveis médios de LDL-c, HDL-c, CT, TGC e GJ. Estudos de acompanhamento a longo prazo são necessários para determinar se o tratamento cirúrgico da endometriose pode melhorar os parâmetros metabólicos de mulheres com endometriose e favorecer uma menor predisposição à aterogênese.

Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. / Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria.

OBJECTIVE: To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS: Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5µIU/mL. RESULTS: 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS: Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

Influence of triglyceride concentration in lipoprotein (a) as a function of dyslipidemia. / Influencia de la concentración de triglicéridos en la lipoproteína(a) en función de la dislipidemia.

BACKGROUND: Recently, an inverse relationship between the blood concentration of lipoprotein(a) (Lp(a)) and triglycerides (TG) has been demonstrated. The larger the VLDL particle size, the greater the presence of VLDL rich in apoliprotein E and in subjects with the apoE2/E2 genotype, the lower Lp(a) concentration. The mechanism of this inverse association is unknown. The objective of this analysis was to evaluate the Lp(a)-TG association in patients treated at the lipid units included in the registry of the Spanish Society of Atherosclerosis (SEA) by comparing the different dyslipidemias. PATIENTS AND METHODS: Five thousand two hundred and seventy-five subjects ≥18 years of age registered in the registry before March 31, 2023, with Lp(a) concentration data and complete lipid profile information without treatment were included. RESULTS: The mean age was 53.0 ± 14.0 years, with 48% women. The 9.5% of subjects (n = 502) had diabetes and the 22.4% (n = 1184) were obese. The median TG level was 130 mg/dL (IQR 88.0-210) and Lp(a) 55.0 nmol/L (IQR 17.9-156). Lp(a) concentration showed a negative association with TG concentration when TG values exceeded 300 mg/dL. Subjects with TG > 1000 mg/dL showed the lowest level of Lp(a), 17.9 nmol/L, and subjects with TG < 300 mg/dL had a mean Lp(a) concentration of 60.1 nmol/L. In subjects without diabetes or obesity, the inverse association of Lp(a)-TG was especially important (p < 0.001). The median Lp(a) was 58.3 nmol/L in those with TG < 300 mg/dL and 22.0 nmol/L if TG > 1000 mg/dL. No association was found between TG and Lp(a) in subjects with diabetes and obesity, nor in subjects with familial hypercholesterolemia. In subjects with multifactorial combined hyperlipemia with TG < 300 mg/dL, Lp(a) was 64.6 nmol/L; in the range of 300-399 mg/dL of TG, Lp(a) decreased to 38. 8 nmol/L, and up to 22.3 nmol/L when TG > 1000 mg/dL. CONCLUSIONS: Our results show an inverse Lp(a)-TG relationship in TG concentrations > 300 mg/dL in subjects without diabetes, obesity and without familial hypercholesterolemia. Our results suggest that, in those hypertriglyceridemias due to hepatic overproduction of VLDL, the formation of Lp(a) is reduced, unlike those in which the peripheral catabolism of TG-rich lipoproteins is reduced.

Riesgo cardiovascular en pacientes con esclerosis sistémica / Cardiovascular Risk in Patients with Systemic Sclerosis

Introducción: El riesgo cardiovascular es importante en la evaluación de los pacientes con esclerosis sistémica. Objetivo: Determinar el riesgo cardiovascular en pacientes con esclerosis sistémica. Métodos: Se realizó un estudio transversal y descriptivo en pacientes protocolizados del Servicio de Reumatología, en el período de enero 2020 a enero 2022. Se recogieron variables demográficas, clínicas, y se aplicó la calculadora de riesgo cardiovascular Framingham. Resultados: Se incluyeron 105 pacientes con edad media de 48,6 ± 15,3 años, el grupo más frecuente de 50 a 59 años (36,2 por ciento), predominó el sexo femenino 92,2 por ciento el color de piel blanca (74,3 por ciento), el tiempo de evolución fue mayor a 5 años (66,7 por ciento) con una media de 10,5 ± 9,3. El valor promedio de la escala de gravedad modificada de Medsger fue 5,1 ± 2,7 y el 72,4 por ciento con afectación leve. El fenómeno de Raynaud y la fibrosis pulmonar fueron más frecuentes con un 89,5 por ciento y 55,2 por ciento. El índice de Rodnan en promedio fue de 13,1 ± 8,0 y los reactantes de fase aguda normales en la mayoría. Los factores de riesgo cardiovascular más frecuentes fueron la HTA (30,2 por ciento) y dislipidemia (19,9 por ciento). El índice de masa corporal que predominó fue de peso adecuado (54,3 por ciento). Predominó el riesgo cardiovascular bajo según score de Framingham (86 por ciento). Existieron diferencias significativas entre las medias del tiempo de evolución y el riesgo cardiovascular (10 ± 6,9 frente a 9,6 ± 8,8 frente a 16,9 ± 10,8; p = 0,032). Conclusiones: El riesgo cardiovascular en los pacientes con esclerosis sistémica fue bajo(AU)

Introduction: Cardiovascular risk is important in the evaluation of patients with systemic sclerosis. Objective: To determine the cardiovascular risk in patients with systemic sclerosis. Methods: A cross-sectional and descriptive study was carried out in protocolized patients of Rheumatology Service, from January 2020 to January 2022. Demographic and clinical variables were collected, and Framingham cardiovascular risk calculator was used. Results: One hundred five patients were included with a mean age of 48.6 ± 15.3 years, the most frequent group was 50 to 59 years (36.2percent), female sex (92.2percent) predominated, as well as white skin color (74.3percent). The evolution time was greater than 5 years (66.7percent) with a mean of 10.5 ± 9.3. The average value of modified Medsger severity scale was 5.1 ± 2.7 and 72.4percent had mild involvement. Raynaud's phenomenon and pulmonary fibrosis were more common at 89.5percent and 55.2percent. Rodnan index on average was 13.1 ± 8.0 and the acute phase reactants were normal in the majority. The most frequent cardiovascular risk factors were HBP (30.2percent) and dyslipidemia (19.9percent). The predominant body mass index was adequate weight (54.3percent). Low cardiovascular risk according to Framingham score prevailed (86percent). There were significant differences between the mean duration of evolution and cardiovascular risk (10 ± 6.9 vs. 9.6 ± 8.8 vs. 16.9 ± 10.8; p = 0.032). Conclusions: The cardiovascular risk in patients with systemic sclerosis was low(AU)

Enfermedades asociadas e indicadores metabólicos en personas con esquizofrenia

La esquizofrenia es una enfermedad que está caracterizada por su complejidad psicopatológica agravada por una frecuente asociación de enfermedades físicas como la obesidad, la intolerancia a la glucosa, la diabetes y la dislipidemia. Además, indicadores metabólicos como la glucemia, el colesterol y los triglicéridos en sangre, así como la obesidad, tienen relevancia en estos pacientes, según lo planteado en la literatura especializada sobre el tema. Por otra parte, las enfermedades físicas asociadas como los indicadores metabólicos, tienen su impacto en el sistema nervioso central con independencia de la esquizofrenia. La suma de los trastornos mentales y físicos implica la necesidad de atender ambos problemas simultáneamente y se recomienda la intervención interdisciplinaria. El protocolo de actuación para la atención de los pacientes con esquizofrenia y psicosis relacionadas en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" es un ejemplo del abordaje señalado.

Schizophrenia is a disease characterized by a psychopathological complexity, aggravated by frequent association of physical diseases such as obesity, glucose intolerance, diabetes and dyslipidemia. In addition, there are other metabolic indicators such as blood glucose, cholesterol and triglycerides which are relevant in these patients, and the international literature has been suggested so. On the other hand, both associated physical diseases and metabolic indicators have their impact on the central nervous system in addition to schizophrenia. The sum of mental and physical disorders implies the need to address both problems simultaneously, which is why interdisciplinary intervention is recommended. Hermanos Ameijeiras Clinical Surgical Hospital is an example of the action protocol for patients with schizophrenia and psychosis.

Impacto pronóstico de los factores de riesgo cardiovascular en pacientes ingresados por síndrome coronario agudo / Prognostic impact of cardiovascular risk factors in patients admitted for acute coronary syndrome

Introducción y objetivos: Las medidas de prevención cardiovascular hacen hincapié en la importancia del control de factores de riesgo cardiovascular (FRCV). Sin embargo, los estudios más recientes arrojan datos desalentadores cuyo impacto está por determinar. El objetivo de este estudio fue analizar la repercusión que los distintos FRCV y su grado de control tienen sobre el pronóstico de los pacientes tras un síndrome coronario agudo. Pacientes y métodos: Se recogieron datos epidemiológicos, farmacológicos y sobre el control de FRCV de 1.689 pacientes consecutivos que ingresaron durante 2018-2020 por síndrome coronario agudo en un hospital de tercer nivel. Finalmente, se calculó la tasa de eventos adversos cardiovasculares mayores. Resultados: Los pacientes que ingresaron por síndrome coronario agudo fueron predominantemente hombres, con índice de masa corporal>25kg/m2, fumadores (o exfumadores) y con un deficiente control de FRCV (50% para hipertensión y diabetes, y 35% en dislipidemia), especialmente aquellos pacientes con antecedentes personales de cardiopatía isquémica. Se encontró una infrautilización de fármacos útiles para dicho control. Se observó una relación directamente proporcional entre el número de FRCV (o su mal control) con la incidencia de eventos adversos cardiovasculares mayores a 2 años, siendo la hipertensión el factor con mayor repercusión cardiovascular. El confinamiento por SARS-CoV-2 empeoró el grado de control de FRCV y el pronóstico cardiovascular. Conclusión: Hay un importante margen de mejora en el control de los FRCV, que se traduciría en un beneficio pronóstico de los pacientes con cardiopatía isquémica. Es preciso intensificar las medidas de prevención y promoción de salud cardiovascular. (AU)

Introduction and objectives: Cardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome. Patients and methods: Epidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated. Results: The patients admitted for acute coronary syndrome were predominantly men, with body mass index>25Kg/m2, smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis. Conclusion: There is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential. (AU)

Is dyslipidemia a risk factor for trastuzumab-induced cardiotoxicity in breast cancer patients? A systematic review and meta-analysis.

INTRODUCTION: Breast cancer patients undergoing trastuzumab therapy have greater risk of cardiovascular disease. Risk factors for this effect have been proposed. However, the role of dyslipidemia is not completely understood. This systematic review aimed to explore the role of dyslipidemia in trastuzumab-induced cardiotoxicity. METHODS: The investigators searched MEDLINE, Scopus, and Web of Science up to October 25, 2020. A random-effects model was used to determine pooled estimates of the results. The primary endpoint was trastuzumab-induced cardiotoxicity in patients with and without dyslipidemia. RESULTS: A total of 39 studies were selected for inclusion in our systematic review assessing 21079 patients. One study demonstrated a statistically significant association between dyslipidemia and cardiotoxicity (OR=2.28, 95% CI 1.22-4.26, p=0.01). In all other studies, no such association was observed. Twenty-one studies including 6135 patients were eligible for meta-analysis. In this meta-analysis of unadjusted data, dyslipidemia was significantly associated with cardiotoxicity (OR=1.25, 95% CI 1.01-1.53, p=0.04, I2=0%), however, a subgroup analysis of studies reporting adjusted measures did not demonstrate a significant association (OR=0.89, 95% CI 0.73-1.10, p=0.28, I2=0%). CONCLUSION: This systematic review and meta-analysis did not demonstrate a significant association between dyslipidemia alone and the development of cardiotoxicity. In the absence of other relevant cardiovascular risk factors, review of lipid profile may not be obligatory, and management of patients could be performed without referral for cardio-oncology assessment. Further investigation of risk factors for trastuzumab-induced cardiotoxicity is required to confirm these results.

Association of rs662799 and rs5070 genetic polymorphisms with hypertriglyceridemia and atherogenic dyslipidemia in pediatric patients in Southeast Mexico / Asociación de los polimorfismos genéticos rs662799 y rs5070 con hipertrigliceridemia y dislipidemia aterogénica en pacientes pediátricos del sureste de México

Background and aims: Triglycerides are the initiators of the metabolic changes that lead to atherogenic dyslipidemia (AD). The APOA5 and APOA1 genes are involved in the response and metabolism of serum lipids and lipoproteins, where single nucleotide polymorphisms (SNP) rs662799 (promoter region) and rs5070 (intronic region) have been associated with the susceptibility to dyslipidemia. Until now, few studies evaluate the association of these polymorphisms with the presentation of hypertriglyceridemia and AD among Mexican children. Therefore, the objective was to determine the association between rs662799 and rs5070 with hypertriglyceridemia and AD in a pediatric population of southeastern Mexico. Materials and methods: A case–control analysis was performed including 268 infants aged 2–16 years, anthropometric, clinical variables, and serum lipid profiles were analyzed. DNA was extracted from blood samples and genotyping of polymorphisms was executed with the TaqMan SNP genotyping assay. Allele and genotypic frequencies were calculated. For genetic association analysis, logistic regression models were fitted according to models of inheritance. Results: The SNP rs662799 (C) was significantly associated with hypertriglyceridemia in the overdominant model (OR=3.89, p=0.001) and AD in the dominant model (OR=4.01, p=0.001). The SNP rs5070 (T) has a protective effect against hypertriglyceridemia in the additive risk model (OR=0.68, p=0.03). Conclusion: Polymorphism rs662799 was significantly associated with cases of hypertriglyceridemia and AD in minors in southeastern Mexico. On the other hand, rs5070 polymorphism was not associated with cases of hypertriglyceridemia or AD.(AU)

Antecedentes y objetivos: Los triglicéridos son los iniciadores de los cambios metabólicos que conducen a la dislipidemia aterogénica (DA). Los genes APOA5 y APOA1 están implicados en la respuesta y metabolismo de lípidos séricos y lipoproteínas, donde los polimorfismos de nucleótido único (SNP) rs662799 (región promotora) y rs5070 (región intrónica) se han asociado con la susceptibilidad a la dislipidemia. Hasta ahora, pocos estudios evalúan la relación de estos polimorfismos con la presentación de hipertrigliceridemia y DA entre los niños mexicanos. Por lo tanto, el objetivo fue determinar la asociación entre rs662799 y rs5070 con hipertrigliceridemia y DA en una población pediátrica del sureste de México. Materiales y métodos: Se realizó un análisis de casos y controles con 268 niños de 2 a 16 años, se analizaron variables antropométricas, clínicas y perfiles de lípidos séricos. Se extrajo ADN de muestras de sangre y se realizó genotipado de polimorfismos con el ensayo de genotipado TaqMan SNP. Se calcularon las frecuencias alélicas y genotípicas. Para el análisis de asociación genética, los modelos de regresión logística se ajustaron según los modelos de herencia. Resultados: El SNP rs662799 se asoció significativamente con hipertrigliceridemia en el modelo sobredosis (OR=3,89, p=0,001) y DA en el modelo dominante (OR=4,01, p=0,001). El SNP rs5070 tiene un efecto protector contra la hipertrigliceridemia en el modelo de riesgo aditivo (OR=0,68, p=0,03). Conclusión: El polimorfismo rs662799 se asoció significativamente con casos de hipertrigliceridemia y DA en menores del sureste de México. Por otro lado, el polimorfismo rs5070 no se asoció con casos de hipertrigliceridemia o DA en esta población.(AU)

Management of hypertension and dyslipidemia in Mexico: evidence, gaps, and approach / Manejo de la hipertensión y dislipidemia en México: evidencia, brechas y aproximaciones

Abstract Hypertension and dyslipidemia are key risk factors for cardiovascular disorders and mortality worldwide. To understand the local health system challenges faced in the management of the two conditions, a semi-systematic approach was adopted for quantifying stages of the journey of care of adult Mexican patients, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured literature search was conducted for articles published in English from 2010 to 2019 in EMBASE and MEDLINE databases. The articles restricted to patient subgroups, or not having national representativeness, thesis abstracts, letters to the editor, editorials, or case studies were excluded. In addition, an unstructured unrestricted literature search was conducted, on websites of Incidence and Prevalence Database, World Health Organization, Country's Ministry of Health, and Google. Last search was run on 28 August 2020 for Hypertension and 12 November 2019 for Dyslipidemia. Weighted or simple means were calculated for the pooled data. Seven articles of 647 retrievals for hypertension and 11 articles of 1265 retrievals for dyslipidemia were included in the review. The prevalence of hypertension was estimated to be 24.1%, while 59.9% of patients had awareness, 97.5% underwent screening, 18.4% had diagnosis, 50% received treatment, 50% were adherent to treatment, and 49.9% had disease control. Prevalence of dyslipidemia was estimated as 36.7%, while 8.6% of patients had awareness, 48.1% underwent screening, 28% had diagnosis, 68.9% received treatment, 50% were adherent to treatment, and 30% had disease control. The study suggested that addressing the synergistic effect of hypertension and dyslipidemia could reduce cardiovascular risk associated with these conditions.

Resumen La hipertensión y la dislipidemia -especialmente la hipercolesterolemia- son factores de riesgo cardiovascular que impactan directamente en la prevalencia e incidencia de enfermedades cardiovasculares en todo el mundo y México no es la excepción. Para comprender los desafíos que enfrenta el sistema de salud de nuestro país, especialmente en lo relacionado con el diagnóstico, tratamiento y control de los factores de riesgo cardiovascular mencionados, realizamos un análisis semi-sistemático de la literatura con el objetivo de evaluar las fases del proceso de atención de pacientes adultos mexicanos en lo relacionado con el conocimiento, detección, diagnóstico, tratamiento, adherencia y control de hipertensión y dislipidemia. Se llevó a cabo una investigación bibliográfica semi-sistemática de los artículos publicados en inglés del año 2010 al año 2019; las bases de datos exploradas fueron EMBASE y MEDLINE. Se excluyeron del análisis los artículos sin representatividad nacional, así como los resúmenes de tesis, cartas al editor, editoriales o estudios de casos. Además, se realizó una búsqueda bibliográfica sin restricciones, en los sitios Web de las bases de datos sobre Incidencia y Prevalencia, Organización Mundial de la Salud, Secretaría de Salud de México y Google. La última búsqueda sobre hipertensión se realizó el 28 de agosto del 2020 y sobre dislipidemia el 12 de noviembre del 2019. Se calcularon las medias ponderadas o simples para la recolección de datos. En la revisión, se incluyeron 7 artículos de 647 sobre hipertensión y 11 artículos de 1,265 sobre dislipidemia. Se estimó que la prevalencia de hipertensión en México es de 24.1%; 97.5% de la población reportó haber sido sometida a alguna prueba de detección; 59.9% tuvo conocimiento del diagnóstico; 18.4 % se reconocen con hipertensión; 50% reciben tratamiento; 50% es adherente al mismo, y finalmente solo un 49.9 % tienen control de la hipertensión. Se estimó que la prevalencia de dislipidemia en México es de 36.7%; 48.1% de la población reportó haber sido sometida a alguna prueba de detección; 8.6% tuvo conocimiento del diagnóstico; 28% se conocen con dislipidemia; 68.9% reciben tratamiento; 50% es adherente al mismo, y finalmente solo 30% tuvo control de la dislipidemia. La evidencia revisada hace evidente una gran área de oportunidad para mejorar los índices de diagnóstico, tratamiento y control de estos dos factores sinérgicos para el riesgo de enfermedades cardiovasculares.

Prevalencia de glucosa alterada en ayuno y dislipidemia entre pacientes mexicanos con VIH naïve a tratamiento antirretroviral.

BACKGROUND: Metabolic complications have become more relevant in the care of patients with HIV. However, little is known about the incidence and risk factors for these disorders among HIV-infected antiretroviral treatment naïve (ARTn) patients. OBJECTIVE: To recognize the prevalence of Impaired Fasting Glucose (IFG) and dyslipidemia among HIV-infected ARTn Mexican individuals and identify associated risk factors. METHOD: A retrospective study was conducted in HIV-1-infected ART-N patients, referred for attention to a general hospital in Mexico City, between 2009 and 2019. We collected information for anthropometric, clinical, biochemical and HIV status variables. RESULTS: We included 221 patients, 97% were males, mean age 30 years (interquartile range [IQR]: 25-38); median CD4 count was 250 cells/mm3 (IQR: 120.25-391) and median log10 HIV viral load was 4.69 HIV-1 RNA copies/ml (IQR: 3.64-5.25). Prevalence of IFG was 22.6% and was associated with overweight-obesity (odds ratio [OR]: 2.75; 95% confidence interval [95% CI]: 1.36-5.55; p-value < 0.05). Hypoalphalipoproteinemia was the most frequent dyslipidemia: 69.46%. An association between count CD4 < 250 and lower HDL cholesterol levels was found (OR: 3.23; 95CI%: 1.61-6.5; p-value < 0.05). CONCLUSIONS: IFG and dyslipidemia are highly prevalent among HIV-infected ART-naïve Mexican patients, therefore, screening for glucose and lipids abnormalities always should be considered among ARTn patients.

ANTECEDENTES: Las alteraciones metabólicas se han vuelto más relevantes en el cuidado de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Existe poca información sobre estas alteraciones en pacientes naïve a tratamiento antirretroviral (nTAR). OBJETIVO: Identificar la prevalencia de glucosa alterada en ayuno y dislipidemia entre individuos mexicanos con VIH nTAR e identificar los factores asociados. MÉTODO: Estudio retrospectivo en pacientes con VIH nTAR valorados en un hospital general de la Ciudad de México de 2009 a 2019. Se recabaron datos antropométricos, clínicos, bioquímicos y relacionados con el estado del VIH. RESULTADOS: Se incluyeron 221 pacientes, el 97% hombres, con mediana de edad 30 años (rango intercuartil [RIC]: 25-38), cuenta de linfocitos CD4 250 células/mm3 (RIC: 120.25-391) y carga viral log10 4.69 copias/ml (RIC: 3.64-5.25) de VIH-1 ARN. La prevalencia de glucosa alterada en ayuno fue del 22.6% y presentó asociación con sobrepeso-obesidad (razón de momios [RM]: 2.75; intervalo de confianza del 95% [IC95%]: 1.36-5.55; p < 0.05). La dislipidemia más frecuente fue la hipoalfalipoproteinemia (69.46%), asociada con CD4 < 250 (RM: 3.23; IC95%: 1.61-6.5; p < 0.05). CONCLUSIONES: Las alteraciones en el metabolismo de los lípidos y de la glucosa son frecuentes entre individuos mexicanos con VIH nTAR; por lo tanto, es importante una adecuada evaluación antes de iniciar el tratamiento.

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C / Efectos cardiometabólicos de los antivirales de acción directa en pacientes con hepatitis C

El virus de la hepatitis C (VHC) se ha asociado durante mucho tiempo a varias manifestaciones extrahepáticas, entre ellas el aumento del riesgo cardiovascular. La aparición de los antivirales de acción directa (AAD) ha permitido evaluar la posible reversión de estas manifestaciones tras un tratamiento exitoso. Así, muchos estudios han aportado datos significativos sobre el efecto positivo del tratamiento con AAD en la resistencia a la insulina, la diabetes mellitus de tipo 2, la enfermedad cardiovascular y la aterosclerosis. Por el contrario, los estudios han mostrado efectos perjudiciales sobre el metabolismo de los lípidos y resultados indeterminados respecto a la función renal y el metabolismo del ácido úrico. No obstante, a medida que un mayor número de pacientes logre una respuesta virológica sostenida, se estudiarán ampliamente los efectos de la erradicación del VHC sobre los procesos cardiometabólicos, lo que permitirá obtener conclusiones más fiables sobre el alcance de los resultados extrahepáticos.(AU)

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.(AU)

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C.

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.

[Prognostic impact of cardiovascular risk factors in patients admitted for acute coronary syndrome]. / Impacto pronóstico de los factores de riesgo cardiovascular en pacientes ingresados por síndrome coronario agudo.

INTRODUCTION AND OBJECTIVES: Cardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome. PATIENTS AND METHODS: Epidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated. RESULTS: The patients admitted for acute coronary syndrome were predominantly men, with body mass index>25Kg/m2, smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis. CONCLUSION: There is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential.

Association of rs662799 and rs5070 genetic polymorphisms with hypertriglyceridemia and atherogenic dyslipidemia in pediatric patients in Southeast Mexico.

BACKGROUND AND AIMS: Triglycerides are the initiators of the metabolic changes that lead to atherogenic dyslipidemia (AD). The APOA5 and APOA1 genes are involved in the response and metabolism of serum lipids and lipoproteins, where single nucleotide polymorphisms (SNP) rs662799 (promoter region) and rs5070 (intronic region) have been associated with the susceptibility to dyslipidemia. Until now, few studies evaluate the association of these polymorphisms with the presentation of hypertriglyceridemia and AD among Mexican children. Therefore, the objective was to determine the association between rs662799 and rs5070 with hypertriglyceridemia and AD in a pediatric population of southeastern Mexico. MATERIALS AND METHODS: A case-control analysis was performed including 268 infants aged 2-16 years, anthropometric, clinical variables, and serum lipid profiles were analyzed. DNA was extracted from blood samples and genotyping of polymorphisms was executed with the TaqMan SNP genotyping assay. Allele and genotypic frequencies were calculated. For genetic association analysis, logistic regression models were fitted according to models of inheritance. RESULTS: The SNP rs662799 (C) was significantly associated with hypertriglyceridemia in the overdominant model (OR=3.89, p=0.001) and AD in the dominant model (OR=4.01, p=0.001). The SNP rs5070 (T) has a protective effect against hypertriglyceridemia in the additive risk model (OR=0.68, p=0.03). CONCLUSION: Polymorphism rs662799 was significantly associated with cases of hypertriglyceridemia and AD in minors in southeastern Mexico. On the other hand, rs5070 polymorphism was not associated with cases of hypertriglyceridemia or AD.

Riscos de infecção por SARS-CoV-2 e COVID-19 em mulheres com síndrome dos ovários policísticos / Risks of SARS-CoV-2 and COVID-19 infection in women with polycystic ovary syndrome

Esta revisão narrativa teve como objetivo avaliar possíveis riscos da associação entre a infecção por SARS-CoV-2 (causa da COVID-19) e as características metabólicas e endócrinas frequentemente encontradas em mulheres com a síndrome dos ovários policísticos (SOP). A COVID-19 é mais grave em indivíduos com obesidade, diabetes mellitus, dislipidemia e hipertensão arterial. Como essas condições são comorbidades comumente associadas à SOP, foi hipotetizado que mulheres com SOP teriam maior risco de adquirir COVID-19 e desenvolver formas clínicas mais graves da doença. Considerando vários estudos epidemiológicos, a presente revisão mostra que mulheres com SOP têm risco 28% a 50% maior de serem infectadas pelo vírus SARS-CoV-2 em todas as idades e que, nessas mulheres, a COVID-19 está associada a maiores taxas de hospitalização, morbidade e mortalidade, especialmente naquelas com alterações no metabolismo de carboidratos e lipídios, hiperandrogenemia e aumento do tecido adiposo visceral. Os mecanismos que explicam o maior risco de infecção por COVID-19 em mulheres com SOP são considerados.(AU)