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OBJECTIVE: To define an echocardiographically-assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects. METHODS: Fifty-two subjects aged 20-65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography. RESULTS: No significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (P=.0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (P=.0001), total cholesterol (P=.002), LDL-C (P=.007), non-HDL-C (P=.0001), triglycerides (P=.0001), Tg-HDL-C ratio (P=.0001), and lower HDL-C levels (P=.0001) as compared to the control group. EAT thickness (P=.0001) and left ventricular mass (P=.017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (P=.0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95%CI: 71.9-93.1) and a specificity of 71.11% (95%CI: 55.7-83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥ 5 mm was 8.25 (95%CI: 3.15-21.56; P=.0001). CONCLUSION: An EAT value ≥ 5 mm has good sensitivity and specificity for predicting MS in the Venezuelan population.
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Tejido Adiposo/anatomía & histología , Síndrome Metabólico/epidemiología , Pericardio/anatomía & histología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Venezuela , Adulto JovenRESUMEN
OBJECTIVE: To assess the association between epicardial adipose tissue thickness (EAT) and plasma adrenomedullin plasma levels in patients with metabolic syndrome (MS). METHODS: Twenty-one patients (12 females and 9 males) with MS according to the International Diabetes Federation guidelines, aged 22-58 years, were enrolled into the study and compared to 19 age-matched control subjects without MS. Plasma glucose, lipid, and adrenomedullin levels were assessed. EAT, left ventricular mass, and carotid intima-media thickness were evaluated by transthoracic two-dimensional echocardiography. RESULTS: No statistically significant differences were found between the groups in age, sex, and height. Body weight, abdominal circumference (AC), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly higher (p=0.0001) in MS patients; this group also showed significantly higher glucose (p=0.001), total cholesterol (p=0.01), LDL-C (p=0.03), VLDL-C (p=0.005), triglyceride (p=0.002), Tg/HDL ratio (p=0.0001), and plasma adrenomedullin (3.49±1.21 vs 1.69±0.92 ng/mL; p=0.0001) levels and lower HDL-C (p=0.02) levels as compared to the control group. EAT was significantly thicker in MS patients compared to the control group (8.45±3.14 vs 5.43±0.96; p=0.0001), showed a positive correlation to BMI (r=0.347; p=0.02), AC (r=0.350; p=0.02), DBP (r=0.346; p=0.02), and adrenomedullin levels (r=0.741; p=0.0001). In multiple linear regression analysis, adrenomedullin was the only parameter associated to EAT (R(2)=0.550; p=0.0001). CONCLUSION: In this small patient group, a statistically significant association was found between EAT and plasma adrenomedullin levels, which may be considered as a potential biomarker of MS.
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Tejido Adiposo/patología , Adrenomedulina/sangre , Síndrome Metabólico/sangre , Síndrome Metabólico/patología , Pericardio/patología , Adipocitos/metabolismo , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/metabolismo , Adrenomedulina/biosíntesis , Adulto , Antropometría , Aterosclerosis/patología , Biomarcadores , Glucemia/análisis , Arterias Carótidas/diagnóstico por imagen , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etiología , Lípidos/sangre , Masculino , Persona de Mediana Edad , Pericardio/diagnóstico por imagen , Pericardio/metabolismo , Células del Estroma/metabolismo , Ultrasonografía , Adulto JovenRESUMEN
La adrenomedulina es un péptido vasodilatador, presente en el sistema cardiovascular, riñón, pulmón, glándula adrenal y en el adipocito. Este péptido ha venido adquiriendo una importancia creciente en los últimos años, ya que se han descrito niveles elevados del mismo en patologías como el síndrome metabólico, diabetes mellitus tipo 2, hipertensión arterial y en aterosclerosis, lo cual pone de manifiesto su relevancia en la fisiopatología de estos trastornos y su posible uso como marcador de riesgo cardiometabólico. A nivel cardíaco, el efecto inotrópico positivo de este péptido parece estar mediado por un aumento del calcio citosólico, independiente de AMP cíclico; reduce la hipertrofia de los miocardiocitos y en la insuficiencia cardíaca los niveles plasmáticos de adrenomedulina están incrementados. La adrenomedulina tiene efecto vasodilatador sistémico y pulmonar y se encuentra incrementada en el plasma de sujetos con hipertensión arterial esencial y en hipertensos con hiperaldosteronismo primario. En riñón, la adrenomedulina induce efecto diurético y natriurético, aumento de la filtración glomerular y disminución de la reabsorción tubular distal de sodio; sus niveles están elevados en la insuficiencia renal crónica. La adrenomedulina está elevada en pacientes diabéticos con mal control metabólico, pero su papel patogénico en la enfermedad no está claro.
Adrenomedullin is a vasodilatory peptide found in the cardiovascular system, kidneys, lungs, adrenal glands and adipocytes. This peptide has been rising interest during the last years because increased plasma levels of it have been found in several pathological conditions such as the metabolic syndrome, type 2 diabetes mellitus, arterial hypertension and atherosclerosis, pointing to a possible physiopathologic role in these diseases and the potential use as a clinical cardiometabolic marker. In the heart, adrenomedullin has a positive inotropic action, probably mediated through cytosolic increase of calcium concentration, independent of cyclic AMP; it also can reduce cardiomyocites hypertrophy. In heart failure, adrenomedullin levels are increased and show systemic and pulmonar vasodilator effect; its plasma levels are increased in patients with essential arterial hypertension and hypertensives with primary hyperaldosteronism. In the kidneys, adrenomedullin is natriuretic and diuretic, it elevates glomerular filtration rate and reduce distal tubules sodium reabsorption; in patients with renal failure, adrenomedullin levels are increased. In diabetic patients, adrenomedullin plasma levels are increased; however, its pathogenic role in this disease is not yet clear.
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En años recientes el concepto clásico del sistema renina angiotensina ha experimentado cambios sustanciales. La identificación de los nuevos componentes del sistema renina angiotensina ha contribuido a modificar nuestro entendimiento acerca de su función en condiciones fisiológicas así como en diversas enfermedades. En este artículo de revisión nos enfocaremos en el papel de este sistema endocrino en el riesgo cardiometabólico.
In the past few years the classical concept of the reninangiotensin system has experienced substantial changes. The identification of the new components of the reninangiotensin system have contributed to switch our understanding about its function in physiological situations and in several diseases. In this review we will focus on the role of this endocrine system in the cardiometabolic risk.
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Con el objetivo de evaluar la asociación de la insulina y el factor de crecimiento insulino similar tipo 1 (IGF-1) en pacientes con cáncer de mama, se eligió una muestra de 15 pacientes con diagnóstico histopatológico de cáncer de mama durante el período enero-agosto de 2008, y se determinaron los niveles de glicemia en ayunas, insulina basal e IGF-1. Se evaluó el grado de insulino-sensibilidad mediante el método HOMA en esta muestra, comparándose posteriormente con pacientes sin cáncer y de edades similares. Encontramos que la concentración plasmática de insulina en las pacientes con cáncer fue de 11,53 ± 1,91 µU/mL; mientras que los controles presentaron 5,1 ± 0,98 µU/mL, lo cual resultó estadísticamente significativo (P<0,01). Además, las pacientes con cáncer de mama exhibieron glicemia de 108,57 ± 12,33 mg/dL, en comparación con los controles quienes obtuvieron 80,92 ± 1,40 mg/dL. Con estos resultados se calculó el HOMA, obteniendo valores de 3,15 y 1,00 respectivamente. Adicionalmente, al determinar IGF-1 observamos niveles de 219,64 ± 17,03 ng/mL en las pacientes con cáncer y de 178,47 ± 12,78 ng/mL en controles. Se concluye que las pacientes con cáncer de mama presentan el fenómeno de resistencia a la insulina, el cual de manera sinérgica con el IGF-1 promueve la proliferación y diferenciación de células mamarias
Samples from 15 patients who had been diagnosed with breast cancer during January-August 2008 were assayed for the purpose of evaluating the association of insulin and insulin-like growth factor-1 (IGF-1) in women with this type of cancer. Assays were performed to measure fasting blood glucose, basal insulin, and IGF-1. A homeostatic model assessment test (HOMA) was also performed to assess insulin sensitivity, and the results were matched against those of healthy women of the same age group. Insulin plasma concentration in the former group was 11.53 ± 1.91 µU/mL whereas that of the control group was 5.1 ± 0.98 µU/mL, a statistically significant finding. (P<0.01). In addition, the glucose level in the sick women was 108.57 ± 12.33 mg/dL as compared to 80.92 ± 1.40 mg/dL in those without cancer. HOMA was 3.15 and 1.00, and IGF.1 levels were 219.64 ± 17.03 ng/mL and 178.47 ± 12.78 ng/mL for sick and healthy women, respectively. It is thus concluded that women with cancer develop insulin resistance, which in synergy with IGF-1, promotes breast cell proliferation and differentiation