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Vnitr Lek ; 67(1): 37-40, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33752389


Treatment of dyslipidemia and hypertension is a key step for reducing the risk of atherosclerotic cardiovascular disease. Dyslipidemia and hypertension often occur in one patient at the same time, so both of these risk factors need to be addressed at the same time. It is better to start therapy before the patient is at high risk of a fatal cardiovascular event. To improve the patients prognosis, it is important not only to achieve the target LDL-cholesterol value and the optimal blood pressure value, but it is also very important (and often more difficult) to maintain the patients good and long-term adherence to established combination pharmacotherapy. For better adherence to long-term therapy also contributes reduction the number of tablets, which can be achieved through the use of a fixed combination of statins and antihypertensive agents.

Doenças Cardiovasculares , Dislipidemias , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertensão , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/tratamento farmacológico , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico
Eur J Endocrinol ; 184(4): 587-596, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606661


Objective: To investigate the prevalence and risks factors associated with the presence of liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D). Design and methods: This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18-75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography. Results: Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia both for the cut-off point of LSM ≥8.0 kPa (45% vs 24% P = 0.002) and ≥13 kPa (13% vs 4% P = 0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects. Conclusions: Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D NAFLD and atherogenic dyslipidemia.

Aterosclerose/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Adulto , Idoso , Aterosclerose/etiologia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/complicações , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Hiperglicemia/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Adulto Jovem
Chem Biol Interact ; 338: 109427, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33639173


Oxidative stress and inflammation are implicated in the occurrence and progression of diabetic nephropathy (DN). Diphenyl diselenide (DPDS) is a stable and simple diaryl diselenide with anti-hyperglycemic, anti-inflammatory, and antioxidant activities. However, the effects of DPDS on DN are still unclear to date. Herein, we aimed to explore whether DPDS could improve renal dysfunction in streptozotocin (STZ)-induced diabetic rats and its underlying mechanisms. STZ-induced DN rats were administered with DPDS (5 or 15 mg/kg) or metformin (200 mg/kg) once daily by intragastric gavage for 12 weeks. DPDS supplementation significantly improved hyperglycemia, glucose intolerance, dyslipidemia, and the renal pathological abnormalities, concurrent with significantly reduced serum levels of creatinine, urea nitrogen, urine volume, and urinary levels of micro-albumin, ß2-microglobulin and N-acetyl-glucosaminidase activities. Moreover, DPDS effectively promoted the activities of antioxidant enzymes, and reduced the levels of MDA and pro-inflammatory factors in serum and the kidney. Furthermore, DPDS supplementation activated the renal Nrf2/Keap1 signaling pathway, but attenuated the high phosphorylation levels of NFκB, JNK, p38 and ERK1/2. Altogether, the current study indicated for the first time that DPDS ameliorated STZ-induced renal dysfunction in rats, and its mechanism of action may be attributable to suppressing oxidative stress via activating the renal Nrf2/Keap1 signaling pathway and mitigating inflammation by suppressing the renal NFκB/MAPK signaling pathways, suggesting a potential therapeutic approach for DN.

Derivados de Benzeno/uso terapêutico , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/patologia , Nefropatias Diabéticas/tratamento farmacológico , Inflamação/tratamento farmacológico , Compostos Organosselênicos/uso terapêutico , Estresse Oxidativo , Animais , Antioxidantes/metabolismo , Derivados de Benzeno/farmacologia , Citocinas/metabolismo , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/fisiopatologia , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/fisiopatologia , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Dislipidemias/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/metabolismo , Inflamação/complicações , Inflamação/genética , Proteína 1 Associada a ECH Semelhante a Kelch/metabolismo , Rim/patologia , Rim/fisiopatologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Masculino , Modelos Biológicos , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , Compostos Organosselênicos/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Ratos Sprague-Dawley , Estreptozocina
Nat Commun ; 12(1): 213, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431899


High-fat diet (HFD) decreases insulin sensitivity. How high-fat diet causes insulin resistance is largely unknown. Here, we show that lean mice become insulin resistant after being administered exosomes isolated from the feces of obese mice fed a HFD or from patients with type II diabetes. HFD altered the lipid composition of exosomes from predominantly phosphatidylethanolamine (PE) in exosomes from lean animals (L-Exo) to phosphatidylcholine (PC) in exosomes from obese animals (H-Exo). Mechanistically, we show that intestinal H-Exo is taken up by macrophages and hepatocytes, leading to inhibition of the insulin signaling pathway. Moreover, exosome-derived PC binds to and activates AhR, leading to inhibition of the expression of genes essential for activation of the insulin signaling pathway, including IRS-2, and its downstream genes PI3K and Akt. Together, our results reveal HFD-induced exosomes as potential contributors to the development of insulin resistance. Intestinal exosomes thus have potential as broad therapeutic targets.

Dieta Hiperlipídica , Exossomos/metabolismo , Resistência à Insulina/genética , Fosfatidilcolinas/metabolismo , Regulação para Cima/genética , Tecido Adiposo/metabolismo , Animais , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Dislipidemias/complicações , Dislipidemias/genética , Dislipidemias/patologia , Células Epiteliais/metabolismo , Fígado Gorduroso/complicações , Fígado Gorduroso/genética , Fígado Gorduroso/patologia , Fezes , Regulação da Expressão Gênica , Intolerância à Glucose , Proteínas de Fluorescência Verde/metabolismo , Humanos , Insulina/metabolismo , Interleucina-6/sangue , Intestinos/citologia , Lipídeos/química , Fígado/metabolismo , Fígado/patologia , Ativação de Macrófagos , Camundongos Endogâmicos C57BL , Receptores de Hidrocarboneto Arílico/metabolismo , Transdução de Sinais , Tetraspanina 30/metabolismo , Fator de Necrose Tumoral alfa/sangue
Int J Mol Sci ; 22(2)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33440821


Cardiovascular disease (CVD) is the leading cause of death worldwide and is the clinical manifestation of the atherosclerosis. Elevated LDL-cholesterol levels are the first line of therapy but the increasing prevalence in type 2 diabetes mellitus (T2DM) has positioned the cardiometabolic risk as the most relevant parameter for treatment. Therefore, the control of this risk, characterized by dyslipidemia, hypertension, obesity, and insulin resistance, has become a major goal in many experimental and clinical studies in the context of CVD. In the present review, we summarized experimental studies and clinical trials of recent anti-diabetic and lipid-lowering therapies targeted to reduce CVD. Specifically, incretin-based therapies, sodium-glucose co-transporter 2 inhibitors, and proprotein convertase subtilisin kexin 9 inactivating therapies are described. Moreover, the novel molecular mechanisms explaining the CVD protection of the drugs reviewed here indicate major effects on vascular cells, inflammatory cells, and cardiomyocytes, beyond their expected anti-diabetic and lipid-lowering control. The revealed key mechanism is a prevention of acute cardiovascular events by restraining atherosclerosis at early stages, with decreased leukocyte adhesion, recruitment, and foam cell formation, and increased plaque stability and diminished necrotic core in advanced plaques. These emergent cardiometabolic therapies have a promising future to reduce CVD burden.

Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Diabetes Mellitus Tipo 2/complicações , Suscetibilidade a Doenças , Dislipidemias/complicações , Animais , Biomarcadores , Doenças Cardiovasculares/metabolismo , Estudos Clínicos como Assunto , Diabetes Mellitus Tipo 2/metabolismo , Gerenciamento Clínico , Desenho de Fármacos , Desenvolvimento de Medicamentos , Avaliação Pré-Clínica de Medicamentos , Dislipidemias/metabolismo , Humanos , Incretinas/metabolismo , Metabolismo dos Lipídeos/efeitos dos fármacos , Terapia de Alvo Molecular , Pró-Proteína Convertase 9/antagonistas & inibidores , Medição de Risco , Fatores de Risco
Artigo em Inglês | MEDLINE | ID: mdl-33401577


The purpose of the current study is to evaluate the incidence of age-related macular degeneration (AMD) in dyslipidemia-related diseases with or without the use of fibrate. Patients were defined as dyslipidemia-related diseases according to the diagnostic code and lab exam arrangement, then the population was divided into those with fibrate application and those without via 1:2 ratios of propensity-score matching. The primary outcome is the development of AMD after dyslipidemia-related diseases by the Cox proportional hazard regression. Besides, the relationship between the medical compliance of fibrate, presented as medical possession ratio (MPR), and the AMD development was also analyzed. A total of 22,917 patients and 45,834 individuals were enrolled in the study and control groups. There were 572 and 1181 events of any AMD development in the study and control groups which showed identical risk of AMD (aHR: 0.94, 95% CI: 0.85-1.04). However, a reduced risk of any AMD was found in those patients reached a baseline MPR more than 20% (aHR: 0.729, 95% CI: 0.599-0.887, p = 0.0016) and overall MPR more than 5% three years after the diagnosis of dyslipidemia-related diseases (aHR: 0.712, 95% CI: 0.557-0.909, p = 0.0065). Besides, a lower risk of dry-AMD was also found in those patients with the above conditions (aHR: 0.736, 95% CI: 0.599-0.906, p = 0.0038 and aHR: 0.721, 95% CI: 0.557-0.934, p = 0.0133, respectively). In conclusion, the use of fibrate with fair initial medical compliance will decrease the incidence of AMD in patients with dyslipidemia-related diseases, especially for the development of dry-AMD.

Dislipidemias , Ácidos Fíbricos , Degeneração Macular , Adesão à Medicação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dislipidemias/complicações , Feminino , Ácidos Fíbricos/uso terapêutico , Humanos , Incidência , Degeneração Macular/epidemiologia , Degeneração Macular/prevenção & controle , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
Arterioscler Thromb Vasc Biol ; 41(3): 1229-1238, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33504178


OBJECTIVE: The aim of this study was to comprehensively assess the association of multiple lipid measures with incident peripheral artery disease (PAD). Approach and Results: We used Cox proportional hazards models to characterize the associations of each of the fasting lipid measures (total cholesterol, LDL-C [low-density lipoprotein cholesterol], HDL-C [high-density lipoprotein cholesterol], triglycerides, RLP-C [remnant lipoprotein cholesterol], LDL-TG [LDL-triglycerides], sdLDL-C [small dense LDL-C], and Apo-E-HDL [Apo-E-containing HDL-C]) with incident PAD identified by pertinent International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge codes (eg, 440.2) among 8330 Black and White ARIC (Atherosclerosis Risk in Communities) participants (mean age 62.8 [SD 5.6] years) free of PAD at baseline (1996-1998) through 2015. Since lipid traits are biologically correlated to each other, we also conducted principal component analysis to identify underlying components for PAD risk. There were 246 incident PAD cases with a median follow-up of 17 years. After accounting for potential confounders, the following lipid measures were significantly associated with PAD (hazard ratio per 1-SD increment [decrement for HDL-C and Apo-E-HDL]): triglycerides, 1.21 (95% CI, 1.08-1.36); RLP-C, 1.18 (1.08-1.29); LDL-TG, 1.18 (1.05-1.33); HDL-C, 1.39 (1.16-1.67); and Apo-E-HDL, 1.27 (1.07-1.51). The principal component analysis identified 3 components (1: mainly loaded by triglycerides, RLP-C, LDL-TG, and sdLDL-C; 2: by HDL-C and Apo-E-HDL; and 3: by LDL-C and RLP-C). Components 1 and 2 showed independent associations with incident PAD. CONCLUSIONS: Triglyceride-related and HDL-related lipids were independently associated with incident PAD, which has implications on preventive strategies for PAD. However, none of the novel lipid measures outperformed conventional ones. Graphic Abstract: A graphic abstract is available for this article.

Lipídeos/sangue , Doença Arterial Periférica/sangue , Idoso , Idoso de 80 Anos ou mais , Apolipoproteínas E/sangue , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Dislipidemias/sangue , Dislipidemias/complicações , Feminino , Humanos , Lipoproteínas/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Masculino , Doença Arterial Periférica/etiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Triglicerídeos/sangue
Rev. cuba. med ; 59(4): e1633, oct.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144501


Introducción: La aterosclerosis subclínica es predictora de eventos vasculares futuros y es diagnosticada por imágenes y biomarcadores sin que existan manifestaciones clínicas. Objetivo: Identificar los factores pronósticos asociados con la aterosclerosis subclínica en pacientes dislipidémicos. Método: Se realizó un estudio de cohorte en el Hospital Hermanos Ameijeiras en 1028 pacientes en el periodo de 2016 al 2019. Resultados: La existencia de placa de ateroma fue de 26,9 por ciento. Existieron diferencias significativas relacionadas al tabaquismo (30,0 por ciento vs 23,7 por ciento). En las variables lipídicas, el promedio de los valores de la LDLc fue superior en los pacientes con placa de ateroma y la relación CT/LDL fue mayor en los que no tienen esta alteración. La frecuencia de engrosamiento del complejo íntima-media mayor de 1,0 mm fue de 37,1 por ciento. Existieron diferencias significativas relacionadas al tabaquismo (30,4 por ciento vs 22,4 por ciento) y la presencia de HTA (56,7 por ciento vs 48,8 por ciento ) en las variables lipídicas el promedio de los valores de la HDLc fue superior en los pacientes sin aumento del grosor del complejo íntima-media y la elevación CT/HDL fue mayor en los que presentan dicha alteración. Conclusiones: Los factores que influyen de manera independiente en la probabilidad de formación de las placas de ateroma son la LDLc (elevada), la edad, los triglicéridos y el sexo masculino y los que influyen en la probabilidad para el engrosamiento del complejo íntima-media son la HDLc (baja), el tabaquismo, y la hipertensión arterial(AU)

Introduction: Subclinical atherosclerosis is a predictor of future vascular events and is diagnosed by imaging and biomarkers without any clinical manifestations. Objective: To identify the prognostic factors that are associated with subclinical atherosclerosis in dyslipidemic patients. Method: A cohort study was carried out at the Hermanos Ameijeiras Hospital in 1028 patients in the period from 2016 to 2019. Results: The existence of atheroma plaque was 26.9 percent. There were significant differences related to smoking (30.0 percent vs 23.7 percent). In the lipid variables, the average of the LDLc values ​​is higher in patients with atheroma plaque and the CT/LDL ratio is higher in those without this alteration. Regarding the frequency of thickening of the intima-media complex greater than 1.0 mm, it was 37.1 percent. There were significant differences related to smoking (30.4 percent vs 22.4 percent) and the presence of HTA (56.7 percent vs 48.8 percent in the lipid variables, the average of the HDLc values ​​is higher in the patients without an increase in the thickness of the intima-media complex and the CT/HDL elevation is greater in those with said alteration. Conclusions: The factors that independently influence the probability of atheroma plaque formation are LDLc (elevated), age, triglycerides and male sex, and those that influence the probability of thickening of the intima-media complex. They are HDLc (low), smoking, and high blood pressure(AU)

Humanos , Masculino , Feminino , Prognóstico , Aterosclerose/diagnóstico por imagem , Dislipidemias/complicações , Placa Aterosclerótica/prevenção & controle , Estudos de Coortes
Arch. Soc. Esp. Oftalmol ; 95(12): 615-618, dic. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-197762


La obstrucción venosa retiniana (OVR) se ha relacionado fundamentalmente con los factores de riesgo vascular y con el glaucoma; sin embargo, existen pocos estudios de la OVR en pacientes con trasplante de órgano sólido. Se analizó una serie de 331 pacientes que presentaron OVR (de rama en 226 casos y central en 105 casos) a lo largo de 10 años y se compararon las características entre los 4 pacientes con antecedente de trasplante de órgano sólido (hepático, renal o bipulmonar) que presentaron una OVR y el resto. En nuestra serie la OVR en los trasplantados comenzó a edades más tempranas que en el resto de pacientes con OVR (58 vs. 68 años, respectivamente), afectó a la vena central de la retina (100% vs. 32%) y se asoció con la diabetes mellitus (75% vs. 25%) y con los tratamientos esteroideo (100% vs. 1%) e inmunosupresor (tacrolimus 75% vs. 0%)

Although retinal venous obstruction (RVO) has been primarily related to vascular risk factors and glaucoma, there are a few studies of RVO in patients with solid organ transplants. An analysis was performed on total of 331 patients who presented with RVO (branch RVO in 226 cases and central RVO in 105 cases) over a 10 year period, and the characteristics were compared with the 4 patients with a history of solid organ transplant (liver, renal, or bipulmonary) who presented with RVO. In this series, the onset of RVO in transplant patients occurred at earlier ages than in other patients with RVO (58 vs. 68 years, respectively), affected the central vein of the retina (100% vs. 32%), and was associated with diabetes mellitus (75% vs. 25%), as well as with steroidal (100% vs. 1%) and immunosuppressive (tacrolimus 75% vs. 0%) treatments

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Oclusão da Veia Retiniana/etiologia , Transplante de Órgãos/efeitos adversos , Complicações do Diabetes , Dislipidemias/complicações , Hipertensão/complicações , Fatores de Risco
Cir. Esp. (Ed. impr.) ; 98(10): 591-597, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199451


INTRODUCCIÓN: Entre las estrategias diseñadas para optimizar el número de injertos hepáticos existentes para trasplante, la implementación del proceso de valoración de injertos constituye una de las menos exploradas. El objetivo principal es identificar los factores de riesgo que presentan los donantes hepáticos para la «NO validez». Secundariamente analizamos la coincidencia entre la valoración del cirujano y la del anatomopatólogo en los donantes NO válidos. MATERIAL Y MÉTODO: Estudio retrospectivo realizado a partir de una base de datos prospectiva que analiza 190 donantes hepáticos, 95 válidos y 95 NO válidos. Se estudian las variables de cada uno de ellos correspondientes al protocolo de donación de la Organización Nacional de Trasplantes. Mediante el estudio multivariante determinamos los factores de riesgo independientes de NO validez. Cotejamos las causas de NO validez argumentadas con los hallazgos histopatológicos de dichos injertos. RESULTADOS: Los factores de riesgo independientes de NO validez en el estudio multivariante (p < 0,05) fueron: dislipemia, antecedentes personales médicos distintos a factores de riesgo cardiovascular y quirúrgicos abdominales, GGT, BrT, y el resultado de la ecografía hepática previa. Las dos causas más frecuentes de NO validez fueron: esteatosis y fibrosis. El 78% de las biopsias confirmaron la NO validez del injerto (en 57,9% del total coincidían los hallazgos histológicos con los descritos por el cirujano). El 22% restante de las biopsias no presentaban hallazgos patológicos. CONCLUSIONES: La determinación de los factores de riesgo de NO validez contribuirá al diseño de futuros scores de valoración que constituyan herramientas útiles en el proceso de valoración de injertos hepáticos

INTRODUCTION: Among the strategies designed to optimize the number of existing liver grafts for transplantation, the implementation of the graft assessment process is one of the least explored. The main objective is to identify the risk factors presented by liver donors for «NO validity». Secondly, we analyzed the coincidence between the surgeon's assessment and that of the anatomo-pathologist in the invalid donors. MATERIAL AND METHOD: Retrospective study conducted from a prospective database that analyzes 190 liver donors, 95 valid and 95 NOT valid. The variables of each of them corresponding to the donation protocol of the National Transplant Organization are studied. Through a multivariate study we determine the independent risk factors of NO validity. We checked the causes of NO validity argued with the histopathological findings of these grafts. RESULTS: The independent risk factors of non-validity in the multivariate study (P < .05) were: dyslipidemia, personal medical history other than cardiovascular and abdominal surgical risk factors, GGT, BrT, and the result of previous liver ultrasound. The 3 most frequent causes of NO validity were: steatosis, fibrosis and macroscopic appearance of the organ. 78% of the biopsies confirmed the NO validity of the graft (in 57.9% of the cases the histological findings coincided with those described by the surgeon). The 22.1% of the biopsies hadńt pathological findings. CONCLUSIONS: The determination of the risk factors of NO validity will contribute to the design of future assessment scores that are useful tools in the process of liver graft assessment)

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doadores Vivos , Transplante de Fígado/métodos , Medição de Risco/métodos , Estudos Retrospectivos , Fatores de Risco , Fígado/patologia , Biópsia , Dislipidemias/complicações , Doenças Cardiovasculares/complicações , gama-Glutamiltransferase/sangue
Cir. Esp. (Ed. impr.) ; 98(9): 540-546, nov. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198480


INTRODUCCIÓN: El síndrome metabólico (SM) se asocia con un aumento del riesgo de diabetes mellitus (DM) y cardiopatía coronaria. El SM también puede estar asociado con un aumento del riesgo de algunos cánceres frecuentes. El objetivo de este estudio fue determinar la relación entre el SM y el cáncer de mama en mujeres posmenopáusicas. MÉTODOS: Estudio de cohortes prospectivo de mujeres posmenopáusicas. Dicha cohorte se dividió en dos grupos: el «grupo con un diagnóstico benigno», formado por mujeres a las cuales se les realizó un seguimiento por cribado del cáncer de mama, y el «grupo con un tumor maligno», formado por pacientes con cáncer de mama diagnosticado por biopsia. Se analizaron como variables a estudio la edad, peso, altura, índice de masa corporal (IMC), perímetro abdominal, glucosa sérica, LDL, HDL y niveles de insulina. Se utilizó la fórmula del modelo homeostático HOMA-IR para evaluar la resistencia a la insulina. Las diferencias se consideraron estadísticamente significativas cuando p < 0,05. RESULTADOS: Doscientas mujeres con una media de edad de 61,5 ± 9,6 años (rango: 37-93) se inscribieron en el estudio que consta de 150 (75%) pacientes en el grupo con un diagnóstico benigno y 50 (25%) pacientes en el grupo con un tumor maligno. El IMC y el perímetro abdominal fueron mayores en el grupo con un tumor maligno (p < 0,05). La incidencia de DM y SM fue mayor en el grupo con un tumor maligno (p < 0,005). En el grupo con un tumor maligno se detectaron incidencias mucho más altas en relación con los niveles glucémicos en ayunas > 100 mg/dl, los niveles de insulina > 10 mUI/l y puntuaciones en el HOMA-IR > 2,7 (p < 0,05). CONCLUSIONES: Existe relación entre el SM y el cáncer de mama posmenopáusico. Son necesarios más estudios para establecer métodos de protección para la prevención del cáncer de mama en mujeres con SM

INTRODUCTION: Metabolic syndrome is associated with an increased risk of diabetes mellitus (DM) and coronary heart disease. It may also be associated with a higher risk of some common cancers. The objective of this study was to determine the relationship between metabolic syndrome and breast cancer in postmenopausal women. METHODS: We present a prospective cohort study of postmenopausal women. This cohort was divided into two groups: the «benign diagnosis group», including women who were studied after breast cancer screening; and the «malignant tumor group», including patients with breast cancer that had been diagnosed by biopsy. Age, weight, height, body mass index (BMI), abdominal perimeter, serum glucose, LDL, HDL and insulin levels were analyzed as variables under study. The HOMA-IR homeostatic model formula was used to assess insulin resistance. The differences were considered statistically significant when P < .05. RESULTS: Two hundred women with a mean age of 61.5±9.6 (range: 37-93) were enrolled in the study, consisting of 150 (75%) patients with a benign diagnosis and 50 (25%) patients with a malignant tumor. BMI and abdominal perimeter were higher in the group with a malignant tumor (P < .05). The incidence of DM and metabolic syndrome was higher in the malignant tumor group (P < .005). In the malignant tumor group, much higher incidences correlated with fasting glycemic levels > 100 mg/dL, insulin levels > 10 mIU/L and HOMA-IR scores > 2.7 (P < .05). CONCLUSIONS: There is a relationship between metabolic syndrome and postmenopausal breast cancer. More studies are needed to establish methods for the prevention of breast cancer in women with metabolic syndrome

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Metabólica/complicações , Neoplasias da Mama/etiologia , Pós-Menopausa/metabolismo , Estudos Prospectivos , Neoplasias da Mama/metabolismo , Fatores de Risco , Complicações do Diabetes , Dislipidemias/complicações , Obesidade Abdominal/complicações , Resistência à Insulina , Antropometria
Sci Rep ; 10(1): 17458, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060704


We aim to study the association of hyperlipidemia and statin use with COVID-19 severity. We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤ 94% requiring supplemental oxygen, intensive-care unit (ICU) admission, invasive mechanical-ventilation and death. Patients on long term dyslipidaemia medications (statins, fibrates or ezetimibe) were considered to have dyslipidaemia. Logistic regression models were used to study the association between dyslipidaemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined, in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05. One hundred fifty-six (21.8%) patients had dyslipidaemia and 97% of these were on statins. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: Coeff (risk difference): - 0.12 (- 0.23, - 0.01); p = 0.028). There were no other significant differences in other outcomes. Statin use was independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

Infecções por Coronavirus/patologia , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pneumonia Viral/patologia , Idoso , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Dislipidemias/complicações , Dislipidemias/patologia , Feminino , Humanos , Imunidade Inata , Unidades de Terapia Intensiva , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença
Vnitr Lek ; 66(5): 275-281, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32942864


The worldwide population is burdened with chronic kidney disease (CKD) from 10-13 %. Patients with CKD subsequently die to cardiovascular disease (CVD) and their complications. In the Czech population, in 2016, the number of patients with end stage renal disease (ESRD) on regular dialytic treatment was 6 739, or 674/1 000 000 inhabitants. Overall mortality in regular dialysis treatment patients was 18.4 % in 2016, of which 43 % died of cardiovascular complications. In view of this fact, a number of expert groups are concerned, among other things, with the problems of lipid metabolism disorders, with the aim of finding a common predictive marker (preferably also therapeutically qualifiable) to stratify patients dialyzed or potentially indicating hypolipidemic therapy. The aim of possible interventions is to minimize cardiovascular risk and subsequent complications resulting from cardiovascular disease (CVD), thus improving the quality of life of regular dialysis treatment patients.

Doenças Cardiovasculares , Dislipidemias , Falência Renal Crônica , Insuficiência Renal Crônica , Doenças Cardiovasculares/etiologia , Dislipidemias/complicações , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia
Metas enferm ; 23(7): 16-23, sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196458


OBJETIVO: con enfermedad renal crónica (ERC) así como explorar la influencia del sexo y la diabetes mellitus (DM) en dicho riesgo. MÉTODO: estudio descriptivo transversal en pacientes con ERC del Área Básica de Salud Balaguer (n= 1.852). Variables analizadas: sexo, DM, cHDL-cLDL-triglicéridos (cTG)-colesterol total (CT), índices: CT/cHDL, cLDL/cHDL, TG/cHDL, No-cHDL. Análisis estadístico mediante Chi cuadrado/U-Mann-Whitney con el programa SPSS. RESULTADOS: un total de 1.834 pacientes cumplían los criterios de inclusión. Se observaron valores óptimos de control lipídico (62,6% con CT< 200 mg/dl), aunque prevalencias elevadas de RA alto (73,3% según cociente CT/cHDL). Las mujeres (con o sin DM) presentaron valores lipídicos más altos que los hombres: CT 190 mg/dL (DE: 41,3) con DM y 198 mg/dl (DE: 39,1) sin DM, frente a 175 mg/dl (DE: 37,2) con DM y 183 mg/dl (DE: 38,9) sin DM (p< 0,001). El cálculo del RA para las mujeres fue superior en todos los cocientes excepto cTG/cHDL. Las personas no diabéticas presentaron una mayor prevalencia de RA elevado en comparación con las diabéticas; fue superior en cLDL/cHDL (44,4% sin DM frente a 39,8% con DM) y No-cHDL (68,0% sin DM frente a 59,3% con DM), pero inferior en cTG/cHDL (57,7% sin DM frente a 76,6% con DM) y CT/cHDL (72,7% sin DM frente a 74,4% con DM). CONCLUSIONES: parece que tanto los valores de RA como el control lipídico (CT, cLDL) son mejores en personas con DM (posible intensidad terapéutica) y peores en mujeres. Destaca el No-cHDL como mejor predictor entre todos los índices de cálculo del RA

OBJECTIVE: to determine the atherogenic risk in patients with chronic kidney disease (CKD), as well as to explore the influence of gender and diabetes mellitus (DM) in said risk. METHOD: a descriptive cross-sectional study in CKD patients from the Balaguer Basic Health Area (n= 1.852). Variables analyzed: gender, DM, HDLc-LDLc-triglycerides (TGc)-total cholesterol (TC); indexes: TC/HDLc, LDLc/HDLc, TG/HDLc, No-HDLc. Statistical analysis through Chi square-Mann-Whitney U with the SPSS program. RESULTS: in total, 1,834 patients met the inclusion criteria. Optimal values of lipid control were observed (62.6% with TC< 200 mg/dl), though there was a high prevalence of elevated AR (73.3% according to the TC/HDLc ratio). Women (with or without DM) presented higher lipid values than men: TC 190 mg/dL (SD: 41.3) with DM and 198 mg/dl (SD: 39.1) without DM, vs. 175 mg/dl (SD: 37.2) with DM and 183 mg/dl (SD: 38.9) without DM (p< 0.001). The estimation of AR for women was superior in all ratios except for TGc/HDLc. Non-diabetic persons presented a higher prevalence of high AR vs. diabetic persons; it was higher in LDLc/HDLc (44.4% without DM vs. 39.8% with DM), and No-HDLc (68.0% without DM vs. 59.3% with DM), but lower in TGc/HDLc (57.7% without DM vs. 76.6% with DM) and TC/HDLc (72.7% without DM vs. 74.4% with DM). CONCLUSIONS: it seems that both AR values and lipid control (TC, LDLc) are better in persons with DM (potential treatment intensity), and worse in women. No-HDLc stands out as the best predictor among all indexes for calculating AR

Humanos , Masculino , Feminino , Idoso , Aterosclerose/complicações , Doenças Cardiovasculares/etiologia , Dislipidemias/complicações , Insuficiência Renal Crônica/complicações , Complicações do Diabetes , Prática Avançada de Enfermagem/métodos , Biomarcadores , Estudos Transversais , Estatísticas não Paramétricas , Hipercolesterolemia/complicações , Prevenção Primária , Fatores de Risco
Diabetes Metab Syndr ; 14(5): 1463-1465, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32771919


BACKGROUND AND AIMS: The number of positive and death cases from coronavirus disease 2019 (COVID-19) is still increasing. The identification of risk factors for severe outcomes is important. Dyslipidemia has been shown as a long-known risk factor for cardiovascular disease. The aim of this study is to analyze the potential association between dyslipidemia and the severity of COVID-19 infection. METHODS: We systematically searched the PubMed database using specific keywords related to our aims until July 9th, 2020. All articles published on COVID-19 and dyslipidemia were retrieved. Statistical analysis was done using Review Manager 5.4 software. RESULTS: A total of 7 studies with a total of 6922 patients were included in our analysis. Our meta-analysis showed that dyslipidemia is associated with severe COVID-19 infections [RR 1.39 (95% CI 1.03-1.87), p = 0.03, I2 = 57%, random-effect modelling]. CONCLUSION: Dyslipidemia increases the risk of the development of severe outcomes from COVID-19 infections. Patients with dyslipidemia should be monitored closely to minimize the risk of COVID-19.

Infecções por Coronavirus/complicações , Dislipidemias/complicações , Pneumonia Viral/complicações , Betacoronavirus , Humanos , Pandemias
Medicine (Baltimore) ; 99(30): e21289, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791710


This study investigated the impacts of renin-angiotensin system inhibitors (RASIs) on 2-year clinical outcomes in diabetes and dyslipidemic acute myocardial infarction (AMI) patients after a successful percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DESs).A total of 16,997 AMI patients were enrolled, and divided into four groups based on the presence or absence of diabetes and dyslipidemia as follows: diabetes -/dyslipidemia -(group A, 11,132 patients), diabetes +/dyslipidemia - (group B, 3,860 patients), diabetes -/dyslipidemia + (group C, 1,328 patients), and diabetes +/dyslipidemia + (group D, 677 patients). The clinical endpoint was the occurrence of major adverse cardiac events (MACEs), the composite of total death, recurrent myocardial infarction (re-MI), and any repeat revascularization, including target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR).After RASIs therapy, the cumulative incidences of MACEs (adjusted hazard ratio [aHR], 1.330; 95% confidence interval [CI], 1.022-1.732; P = .034), any repeat revascularization (aHR, 1.584; 95% CI, 1.092-2.298; P = .015), TLR, and TVR were significantly higher in group B than group C. However, the cumulative incidences of all-cause death, cardiac death, re-MI, and non-TVR were similar in groups B and C.In this study, under the newer-generation DESs era, repeat revascularization rate reduction benefit of RASIs therapy in diabetic AMI patients was lesser than that in dyslipidemic AMI patients. However, larger randomized controlled studies are needed to confirm these results in the future.

Antagonistas de Receptores de Angiotensina/uso terapêutico , Stents Farmacológicos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/fisiopatologia , Dislipidemias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Sistema de Registros , República da Coreia
BMC Public Health ; 20(1): 1069, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631300


BACKGROUND: Achieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood, especially in the developing countries. Therefore, this study comprehensively examined the prevalence and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa. METHODS: In this cross-sectional study, 329 individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg in accordance with the South African Hypertension Society guideline (2014). Multiple logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension. RESULTS: The majority of the participants were 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n = 187) with no significant difference between sexes, 57.38% male versus 56.88% female, respectively. In the multiple logistic regression model analysis after adjusting for confounding variables, obesity (AOR = 2.90; 95% CI 1.66-5.05), physical activity (AOR = 4.79; 95% CI 2.15-10.65) and HDL-C (AOR = 5.66; 95% CI 3.33-9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort. CONCLUSION: The high prevalence of uncontrolled hypertension in the study setting can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.

Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Hipertensão/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea/fisiologia , Cidades/epidemiologia , Estudos de Coortes , Efeitos Psicossociais da Doença , Estudos Transversais , Dislipidemias/complicações , Dislipidemias/epidemiologia , Exercício Físico , Feminino , Humanos , Hipertensão/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , África do Sul/epidemiologia