RESUMEN
OBJECTIVE: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. METHODS: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. RESULTS: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. CONCLUSION: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
Asunto(s)
Biomarcadores , Proteínas de Unión al Calcio , Enfermedad de la Arteria Coronaria , Proteínas de la Matriz Extracelular , Glucuronidasa , Proteínas Klotho , Proteína Gla de la Matriz , Diálisis Renal , Calcificación Vascular , alfa-2-Glicoproteína-HS , Humanos , Diálisis Renal/efectos adversos , Masculino , Femenino , Proteínas de Unión al Calcio/sangre , Persona de Mediana Edad , alfa-2-Glicoproteína-HS/análisis , alfa-2-Glicoproteína-HS/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Glucuronidasa/sangre , Proteínas de la Matriz Extracelular/sangre , Biomarcadores/sangre , Calcificación Vascular/sangre , Calcificación Vascular/diagnóstico por imagen , Anciano , Factores de Riesgo , Ensayo de Inmunoadsorción Enzimática , Adulto , Curva ROC , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Valor Predictivo de las PruebasRESUMEN
PURPOSE OF REVIEW: This review summarizes the pathophysiology of calcific aortic valve stenosis (CAVS) and surveys relevant clinical data and basic research that explain how CAVS arises. RECENT FINDINGS: Lipoprotein(a) [Lp(a)], lipoprotein-associated phospholipase A2 (Lp-PLA2), oxidized phospholipids (OxPL), autotaxin, and genetic driving forces such as mutations in LPA gene and NOTCH gene seem to play a major role in the development of CAVS. These factors might well become targets of medical therapy in the coming years. CVAS seems to be a multifactorial disease that has much in common with coronary artery disease, mainly regarding lipidic accumulation and calcium deposition. No clinical trials conducted to date have managed to answer the key question of whether Lp(a) lowering and anti-calcific therapies confer a benefit in terms of reducing incidence or progression of CAVS, although additional outcome trials are ongoing.
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Estenosis de la Válvula Aórtica/sangre , Estenosis de la Válvula Aórtica/fisiopatología , Válvula Aórtica/patología , Calcinosis/sangre , Calcinosis/fisiopatología , Calcificación Vascular/sangre , Calcificación Vascular/fisiopatología , 1-Alquil-2-acetilglicerofosfocolina Esterasa/sangre , Animales , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/genética , Calcinosis/complicaciones , Calcinosis/genética , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/genética , Enfermedad de la Arteria Coronaria/fisiopatología , Progresión de la Enfermedad , Humanos , Lipoproteína(a)/sangre , Lipoproteína(a)/genética , Mutación , Fosfolípidos/sangre , Hidrolasas Diéster Fosfóricas/sangre , Receptor Notch1/genéticaRESUMEN
Calcinosis usually represents a late manifestation of systemic sclerosis (SSc), inducing tissue damage and chronic calcifications. To analyze clinical and bone metabolism parameters associated with calcinosis in limited systemic sclerosis (lSSc), thirty-six female lSSc patients with calcinosis were compared with 36 female lSSc patients without calcinosis, matched by age, disease duration, and body mass index. Organ involvement, autoantibodies, bone density, and laboratory parameters were analyzed. Statistical significance was considered if p < 0.05. Calcinosis was significantly associated with acroosteolysis (69% vs. 22%, p < 0.001), higher modified Rodnan skin score (mRSS 4.28 ± 4.66 vs. 1.17 ± 2.50, p < 0.001), and higher 25-hydroxyvitamin D (25OHD) (24.46 ± 8.15 vs. 20.80 ± 6.60 ng/ml, p = 0.040) and phosphorus serum levels (3.81 ± 0.41 vs. 3.43 ± 0.45 mg/dl, p < 0.001). 25OHD levels > 30 ng/ml were also significantly more frequent in patients with calcinosis (p = 0.041). Regarding treatment, current use of corticosteroids was lower in patients with calcinosis compared with patients without calcinosis (8% vs. 28%, p = 0.032). On logistic regression analysis, acroosteolysis (OR = 12.04; 95% CI, 2.73-53.04; p = 0.001), mRSS (OR = 1.37; 95% CI, 1.11-1.69; p = 0.003), phosphorus serum levels (OR = 5.07; 95% CI, 1.06-24.23; p = 0.042), and lower glucocorticoid use (OR = 0.07; 95% CI, 0.007-0.66; p = 0.021) are independent risk factors for calcinosis. This study showed that limited SSc patients with calcinosis present a distinct clinic and biochemical profile when compared with a matched group without calcinosis, paired by disease duration, age and BMI. KEY POINTS: ⢠Calcinosis in patients with limited SSc was associated with acroosteolysis, higher mRSS and higher serum levels of phosphorus.
Asunto(s)
Acroosteólisis/etiología , Huesos/metabolismo , Calcinosis/etiología , Esclerodermia Limitada/complicaciones , Adulto , Anciano , Calcinosis/sangre , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Fósforo/sangre , Esclerodermia Limitada/sangreRESUMEN
Calcinosis is a frequent complication of systemic sclerosis (SSc) that is usually located in extremities but may occur across the board. The aim of our study was to identify and quantify the distribution of calcinosis in a cohort of Mexican patients with SSc and its association with clinical features and autoantibodies. A cohort of patients with SSc (2013 ACR/EULAR criteria), classified in diffuse cutaneous (dcSSc) and limited cutaneous (lcSSc) (Le Roy criteria), was studied. For their analysis, patients were allocated into those with and without calcinosis (clinical and/or radiological). The evaluation included the modified Rodnan scale for skin and Medsger disease severity scale (DSS). Calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) and antinuclear antibodies and extractable nuclear antigens were determined in serum. A total of 109 patients were included, 41 (37 %) with and 68 (63 %) without calcinosis. Calcinosis was more frequent in patients with dcSSc (55 vs 27 %). In total, we identified 354 sites with calcinosis and mean per patient of 12.0 ± 9.1; the most common sites affected were the hands (83 %), proximal upper extremity (27 %), and proximal lower extremity (22 %). Patients with calcinosis had a higher score of Rodnan scale, Mesdger DSS, and frequency of anti-nucleolar and anti-Scl-70 antibodies compared to those without calcinosis. Abnormal PTH elevation was found in 35 % of patients with calcinosis and 23 % without it. The prevalence of calcinosis is high in Mexican patients with SSc, especially in diffuse variety, and is associated with increased severity of disease.
Asunto(s)
Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Esclerodermia Sistémica/sangre , Esclerodermia Sistémica/diagnóstico por imagen , Adulto , Anticuerpos Antinucleares/sangre , Calcinosis/complicaciones , Calcinosis/etnología , Calcio/sangre , Femenino , Células Hep G2 , Humanos , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Hormona Paratiroidea/sangre , Fósforo/sangre , Prevalencia , Estudios Prospectivos , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/etnología , Vitamina D/sangreRESUMEN
BACKGROUND AND AIMS: We aimed to assess whether elevated PCSK9 and lipoprotein (a) [Lp(a)] levels associate with coronary artery calcification (CAC), a good marker of atherosclerosis burden, in asymptomatic familial hypercholesterolemia. METHODS: We selected 161 molecularly defined FH patients treated with stable doses of statins for more than a year. CAC was measured using the Agatston method and quantified as categorical variable. Fasting plasma samples were collected and analyzed for lipids and lipoproteins. PCSK9 was measured by ELISA, Lp(a) and apolipoprotein (a) concentrations by inmunoturbidimetry and LC-MS/MS, respectively. RESULTS: Circulating PCSK9 levels were significantly reduced in patients without CAC (n = 63), compared to those with CAC (n = 99). Patients with the highest CAC scores (above 100) had the highest levels of circulating PCSK9 and Lp(a). In multivariable regression analyses, the main predictors for a positive CAC score was age and sex followed by circulating PCSK9 and Lp(a) levels. CONCLUSIONS: In statin treated asymptomatic FH patients, elevated PCSK9 and Lp(a) levels are independently associated with the presence and severity of CAC, a good predictor of coronary artery disease.
Asunto(s)
Calcinosis/sangre , Vasos Coronarios/patología , Hiperlipoproteinemia Tipo II/sangre , Lipoproteína(a)/sangre , Proproteína Convertasa 9/sangre , Adulto , Anciano , Calcio/sangre , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/genética , Vasos Coronarios/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Hiperlipoproteinemia Tipo II/genética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Mutación , Fenotipo , Tomografía Computarizada por Rayos XRESUMEN
The soluble receptor for advanced glycation end-products (sRAGE) shows a close relationship with atherosclerosis. The goal of this study was to compare the levels of sRAGE in patients with and without aortic valve calcification and to investigate the relationship between them. After transthoracic echocardiographic examination, 120 male patients with aortic valve calcification and 120 age-matched male controls without aortic valve calcification were included in our study. sRAGE levels were compared between groups. The prevalence of diabetes mellitus and coronary artery disease were significantly higher in the aortic valve calcification group than in the control group (63.3 versus 45%, P = 0.01, and 65 versus 51.7%, P < 0.01, respectively). The levels of sRAGE were lower in the aortic valve calcification group than in the control group (203.8 ± 34.6 versus 324.7 ± 41.6 pg/mL, P < 0.01). In multivariate analysis, age, coronary artery disease, and sRAGE levels were independent predictors of aortic valve calcification. Our study demonstrates that sRAGE, which was proven to be a potential marker of atherosclerosis, might have a role in the development of aortic valve calcification.
Asunto(s)
Estenosis de la Válvula Aórtica/sangre , Válvula Aórtica/patología , Calcinosis/sangre , Receptor para Productos Finales de Glicación Avanzada/sangre , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
BACKGROUND: Studies have demonstrated the association of severe anatomical coronary artery disease (CAD) with postprandial triglycerides (TG) concentrations. Nevertheless the relationship between less severe atherosclerosis plaque burden and postprandial TG is less established. OBJECTIVE: to study the relationship between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA). MATERIAL AND METHODS: 130 patients who underwent an oral fat tolerance test were enrolled (85 with CAD detected by CTA and 45 without). Postprandial lipemia was studied by measuring TG from T0h to T6h with 2-h intervals, and analyzed the TG change over time using a longitudinal multivariable linear mixed effects model with the log normal of the TG as the primary outcome. RESULTS: The majority of individuals with CAD had non-obstructive disease (63.3%) Patients with CAD had a slower clearance of postprandial TG change from 4 h to 6 h (p<0.05) compared to patients without CAD. These results remained significant after adjustment for fasting TG and glucose, age, gender, body mass index, and waist circumference. However, those differences did not reach statistical significance after adjustment for fasting HDL-C. CONCLUSION: Patients with mild (<25% lumen obstruction) and moderate CAD (25-50% lumen obstruction) detected by coronary CTA had an impaired postprandial metabolism, with a delayed TG clearance, when compared to individuals with no CAD. This difference was partially explained by the lower HDL-C. Thus, though postprandial TG may contribute to the development of CAD, this association is partially related to low HDL-C.
Asunto(s)
Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Grasas de la Dieta , Periodo Posprandial/fisiología , Triglicéridos/sangre , Adulto , Anciano , Antropometría , Glucemia/análisis , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , HDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/sangre , Estenosis Coronaria/diagnóstico por imagen , Grasas de la Dieta/farmacocinética , Ayuno/sangre , Femenino , Humanos , Hipertensión/sangre , Masculino , Síndrome Metabólico/sangre , Persona de Mediana Edad , Placa Aterosclerótica/sangre , Placa Aterosclerótica/diagnóstico por imagen , Fumar/sangre , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study evaluates the relationship of blood osteoprotegerin (OPG) and receptor activator of nuclear κ-B ligand (RANKL) levels with coronary artery calcium (CAC) and cardiovascular risk factors in two studies of postmenopausal women. OPG, a marker of bone turnover, and its ligand, RANKL, may contribute to cardiovascular disease risk. METHODS: We tested the hypothesis that serum OPG and RANKL levels were associated with CAC and cardiovascular disease risk factors among postmenopausal women in the Women On the Move through Activity and Nutrition Study (WOMAN Study; n = 86; mean [SD], age 58 [2.9] y) and replicated our findings in the Healthy Women Study (HWS; n = 205; mean [SD] age, 61 [2.3] y). Serum OPG, total RANKL, and CAC were measured at baseline and 48 months in the WOMAN Study and on the eighth postmenopausal visit in the HWS. RESULTS: In the WOMAN Study, higher OPG was associated with higher CAC, and higher total RANKL was associated with lower CAC and triglycerides. In the HWS, higher total RANKL was also associated with lower CAC and triglycerides. In logistic regression models adjusted for body mass index and triglycerides, the odds ratios (95% CIs) for CAC per unit increase in OPG were 1.78 (1.17-2.73) for the WOMAN Study and 1.02 (0.84-1.24) for the HWS, and the odds ratios (95% CIs) for CAC per unit increase in log total RANKL were 0.86 (0.64-1.17) for the WOMAN Study and 0.83 (0.72-0.96) for the HWS. CONCLUSIONS: The inverse association of total RANKL with CAC and triglycerides is a new finding and may have important implications given the increasing use of drugs that modify total RANKL and its receptor, receptor activator of nuclear κ-B.
Asunto(s)
Calcinosis/sangre , Enfermedad de la Arteria Coronaria/sangre , Osteoprotegerina/sangre , Posmenopausia/sangre , Ligando RANK/sangre , Receptor Activador del Factor Nuclear kappa-B/sangre , Triglicéridos/sangre , Biomarcadores/sangre , Calcinosis/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
INTRODUCTION: Neurocysticercosis (NCC) is a parasitic infection caused by the establishment of Taenia solium cysticerci in the central nervous system. The larval stage of the parasite also affects the pig, which is the essential intermediate host for transmission. For this reason, many researchers have focused on identifying protective antigens to prevent swine cysticercosis and interrupt the transmission. These include S3Pvac vaccine antigens. Vaccine is constituted by three protective synthetic peptides: KETc1, KETc12 and GK1. AIM. To evaluate the effect of the vaccine peptides KETc1, KETc12 and GK1 in mononuclear cells of patients with neuro-cysticercosis and healthy individuals. SUBJECTS AND METHODS: Comparative, prospective, transverse study. We studied the proliferation and cytokine profile induced by the three peptides in mononuclear cells from three patients with active NCC, 16 patients by calcified NCC and 16 healthy subjects. RESULTS: KETc1 induces low levels of proliferation in cells from patients with active and controlled NCC, both in lymphocytes and in monocytes. KETc12 and GK-1 induce positive proliferation levels of monocytes in healthy subjects. CONCLUSIONS: KETc1 peptide could be used as an adjuvant in the treatment of patients with active NCC, as induced a Th2 response also GK1 peptide as stimulator of monocyte/macrophage in immunizations with other proteins.
TITLE: Efecto in vitro de la vacuna S3Pvac contra cisticercosis en celulas mononucleares humanas.Introduccion. La neurocisticercosis (NCC) es una infeccion parasitaria generada por el establecimiento de cisticercos de Taenia solium en el sistema nervioso central. La fase larvaria del parasito tambien afecta al cerdo, que es el huesped intermediario indispensable para la transmision. Por tal motivo, muchos investigadores se han enfocado en identificar antigenos protectores para prevenir la cisticercosis porcina e interrumpir la transmision. Entre ellos figuran los antigenos de la vacuna S3Pvac, constituida por tres peptidos protectores: KETc1, KETc12 y GK1. Objetivo. Evaluar el efecto de los peptidos vacunales KETc1, KETc12 y GK1 en celulas mononucleares de pacientes con NCC e individuos sanos. Sujetos y metodos. Estudio comparativo, prospectivo y transversal. Se analizo la proliferacion y el perfil de citocinas inducidos por los tres peptidos en celulas mononucleares de tres pacientes con NCC activa, 16 pacientes con NCC calcificada y 16 sujetos sanos. Resultados. KETc1 induce bajos niveles de proliferacion en las celulas de los pacientes con NCC activa y controlada, tanto en linfocitos como en monocitos. KETc12 y GK-1 inducen niveles positivos de proliferacion de monocitos en sujetos sanos. Conclusiones. El peptido KETc1 podria usarse como coadyuvante en el tratamiento de los pacientes con NCC activa, ya que indujo una respuesta Th2; y el peptido GK1, como estimulador del monocito/macrofago en inmunizaciones con otras proteinas.
Asunto(s)
Antígenos Helmínticos/inmunología , Calcinosis/inmunología , Cysticercus/inmunología , Monocitos/efectos de los fármacos , Neurocisticercosis/inmunología , Vacunas de Subunidad/farmacología , Adyuvantes Inmunológicos , Adolescente , Adulto , Anciano , Animales , Antígenos Helmínticos/análisis , Calcinosis/sangre , División Celular/efectos de los fármacos , Células Cultivadas , Estudios Transversales , Cysticercus/ultraestructura , Evaluación Preclínica de Medicamentos , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Técnicas In Vitro , Interferón gamma/metabolismo , Interleucinas/metabolismo , Linfocitos/efectos de los fármacos , Linfocitos/metabolismo , Masculino , Persona de Mediana Edad , Monocitos/metabolismo , Neurocisticercosis/sangre , Fragmentos de Péptidos/síntesis química , Fragmentos de Péptidos/inmunología , Estudios Prospectivos , Vacunas de Subunidad/inmunología , Adulto JovenRESUMEN
High serum phosphorus levels have been associated with mortality and cardiovascular events in patients with chronic kidney disease and in the general population. In addition, high phosphorus levels have been shown to induce vascular calcification and endothelial dysfunction in vitro. The aim of this study was to evaluate the relation of phosphorus and coronary calcification and atherosclerosis in the setting of normal renal function. This was a cross-sectional study involving 290 patients with suspected coronary artery disease and undergoing elective coronary angiography, with a creatinine clearance >60 ml/min/1.73 m(2). Coronary artery obstruction was assessed by the Friesinger score and coronary artery calcification by multislice computed tomography. Serum phosphorus was higher in patients with an Agatston score >10 than in those with an Agatston score ≤ 10 (3.63 ± 0.55 versus 3.49 ± 0.52 mg/dl; p = 0.02). In the patients with Friesinger scores >4, serum phosphorus was higher (3.6 ± 0.5 versus 3.5 ± 0.6 mg/dl, p = 0.04) and median intact fibroblast growth factor 23 was lower (40.3 pg/ml versus 45.7 pg/ml, p = 0.01). Each 0.1-mg/dl higher serum phosphate was associated with a 7.4% higher odds of having a Friesinger score >4 (p = 0.03) and a 6.1% greater risk of having an Agatston score >10 (p = 0.01). Fibroblast growth factor 23 was a negative predictor of Friesinger score (p = 0.002). In conclusion, phosphorus is positively associated with coronary artery calcification and obstruction in patients with suspected coronary artery disease and preserved renal function.
Asunto(s)
Calcinosis/sangre , Enfermedad de la Arteria Coronaria/sangre , Estenosis Coronaria/sangre , Vasos Coronarios/metabolismo , Riñón/metabolismo , Fósforo/sangre , Anciano , Calcinosis/mortalidad , Calcinosis/patología , Calcinosis/fisiopatología , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/fisiopatología , Estenosis Coronaria/mortalidad , Estenosis Coronaria/patología , Estenosis Coronaria/fisiopatología , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Femenino , Humanos , Riñón/patología , Riñón/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
Abstract. Epidemiological and clinical studies have shown that cardiovascular disease is associated with an increase in mortality in patients with chronic kidney disease (CKD). Vascular complications are mainly secondary to calcification and atherosclerosis. Interest in the association between uric acid levels and cardiovascular risk has been renewed in recent years. The objective of this research was to determine the relation between vascular calcification (VC) and atherosclerosis, through carotid ultrasound, with uric acid levels in patients with CKD in dialysis. VCs were observed in 56% of patients, 46% had ultrasound criteria for atherosclerosis with an overall average of 0.89 mm (SD +/- 0.28), being higher in patients with hypertension and diabetes; this group also showed increased susceptibility to VC (p = 0.01). The levels of urea (141.3 mg/dL) (p = 0.01) and uric acid (6.9 mg/dL) (p = 0.04) showed significant association with the presence of VC. Adverse cardiovascular events were observed mainly in patients with atherosclerosis and VC (p = 0.01). This investigation showed that an increase in uric acid levels above 6 mg/dL is associated with an increased risk of calcification and cardiovascular adverse events in CKD patients in dialysis.
Asunto(s)
Aterosclerosis/epidemiología , Calcinosis/epidemiología , Enfermedades Renales/epidemiología , Ácido Úrico/sangre , Adolescente , Adulto , Anciano , Calcinosis/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedad Crónica , Comorbilidad , Creatinina/sangre , Estudios Transversales , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/terapia , Susceptibilidad a Enfermedades , Femenino , Humanos , Hipertensión/epidemiología , Hiperuricemia/epidemiología , Enfermedades Renales/sangre , Enfermedades Renales/complicaciones , Enfermedades Renales/terapia , Lípidos/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diálisis Renal , Riesgo , Venezuela/epidemiología , Adulto JovenRESUMEN
Estudios clínicos y epidemiológicos han demostrado que la enfermedad cardiovascular está relacionada con un aumento en la tasa de mortalidad en los pacientes con enfermedad renal crónica (ERC). Las complicaciones vasculares son principalmente secundarias a calcificaciones y ateroesclerosis. En los últimos años se ha renovado el interés por la asociación entre niveles de ácido úrico y riesgo cardiovascular. El objetivo de esta investigación fue relacionar la presencia de calcificaciones vasculares (CV) y aterosclerosis, evaluadas mediante ecografía carotídea, con niveles de ácido úrico en pacientes con ERC estadio 5 en diálisis. Se observaron CV en 56% de los pacientes; 46% tuvo criterios ecográficos para aterosclerosis con un promedio general de 0,89 mm (DE: ± 0,28), siendo mayor en los pacientes con hipertensión arterial y diabetes mellitus; este grupo también mostró mayor predisposición para CV (p= 0,01). Los niveles de urea (141,3 mg/dL) (p= 0,01) y ácido úrico (6,9 mg/dL) (p= 0,04) mostraron asociación estadísticamente significativa con la presencia de CV. Los eventos cardiovasculares adversos predominaron en los pacientes con aterosclerosis y CV (p= 0,01). Esta investigación demostró que un incremento en los niveles de ácido úrico por encima de 6 mg/L está relacionado con mayor riesgo de presentar calcificaciones y eventos cardiovasculares adversos en pacientes con ERC.
Epidemiological and clinical studies have shown that cardiovascular disease is associated with an increase in mortality in patients with chronic kidney disease (CKD). Vascular complications are mainly secondary to calcification and atherosclerosis. Interest in the association between uric acid levels and cardiovascular risk has been renewed in recent years. The objective of this research was to determine the relation between vascular calcification (VC) and atherosclerosis, through carotid ultrasound, with uric acid levels in patients with CKD in dialysis. VCs were observed in 56% of patients, 46% had ultrasound criteria for atherosclerosis with an overall average of 0.89 mm (SD ± 0.28), being higher in patients with hypertension and diabetes; this group also showed increased susceptibility to VC (p= 0.01). The levels of urea (141.3 mg/dL) (p= 0.01) and uric acid (6.9 mg/dL) (p= 0.04) showed significant association with the presence of VC. Adverse cardiovascular events were observed mainly in patients with atherosclerosis and VC (p= 0.01). This investigation showed that an increase in uric acid levels above 6 mg/dL is associated with an increased risk of calcification and cardiovascular adverse events in CKD patients in dialysis.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Aterosclerosis/epidemiología , Calcinosis/epidemiología , Enfermedades Renales/epidemiología , Ácido Úrico/sangre , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Calcinosis/sangre , Enfermedades Cardiovasculares/epidemiología , Creatinina/sangre , Susceptibilidad a Enfermedades , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/terapia , Hipertensión/epidemiología , Hiperuricemia/epidemiología , Enfermedades Renales/sangre , Enfermedades Renales/complicaciones , Enfermedades Renales/terapia , Lípidos/sangre , Estudios Prospectivos , Diálisis Renal , Riesgo , Venezuela/epidemiologíaRESUMEN
In chronic dialysis patients, ectopic, extraosseous calcifications can cause significant morbidity. Uremic tumoral calcinosis is an uncommon and severe complication of dialysis therapy. It is defined as deposition of dense nodular calcium-containing masses surrounding the large joints of the body, generally associated with the presence of high serum calcium-and-phosphorus product. We describe a 69-year-old woman submitted to long-term chronic hemodialysis that developed painful, bilateral hip tumors. Radiographic investigation showed extensive periarticular calcifications, and a bone biopsy was suggestive of adynamic bone disease and contained substantial amounts of aluminum. The lesions were surgically excised, and the histological analysis demonstrated amorphous, calcified material associated with densely collagenized connective tissue.
Asunto(s)
Artralgia/cirugía , Calcinosis/cirugía , Fallo Renal Crónico/terapia , Neoplasias de Tejido Conjuntivo/cirugía , Diálisis Renal , Anciano , Artralgia/sangre , Artralgia/diagnóstico por imagen , Artralgia/etiología , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Calcio/sangre , Femenino , Humanos , Fallo Renal Crónico/sangre , Neoplasias de Tejido Conjuntivo/sangre , Neoplasias de Tejido Conjuntivo/diagnóstico por imagen , Fósforo/sangre , RadiografíaRESUMEN
OBJECTIVE: To verify the existence of association between plasma levels of pro- or anti-inflammatory mediators and atherosclerotic burden at coronary and carotid arteries in individuals aged of 80 or more years old. METHODS: Healthy individuals aged between 80 and 102 years old (n = 178) underwent evaluation of plasma cytokines and acute phase proteins, intima-media thickness (IMT) and presence of plaques in carotid arteries by ultrasound and coronary artery calcification (CAC) by cardiac computed tomography. RESULTS: There was no association between CAC and carotid plaques (p = 0.8), maximum (p = 0.06) or mean IMT (p = 0.2). No association was found between the presence of carotid plaques and CRP (p = 0.4), TNF-α (p = 0.8) or IL-10 (p = 0.2). Likewise, individuals in the first three quartiles for CRP, TNF-α or IL-10 had similar values of CAC, mean and maximum IMT. In contrast, individuals above the 75th percentile for CRP or for TNF-α had enhanced maximum IMT (p = 0.017 and p < 0.0001) and CAC (p = 0.026 and p = 0.01) and subjects with IL-10 levels above the 75th percentile had lower maximum IMT (p = 0.027) and CAC (p = 0.006) as compared with those below this percentile. There was no difference in mean IMT for individuals above or below the 75th percentile for CRP, TNF-α or IL-10. CONCLUSION: In very old individuals, CAC and maximum IMT were positively associated with systemic inflammatory activity only in those above the 75th percentile. The markers of atherosclerotic burden at coronary and carotid arteries were not related to each other and were distinctly associated with pro- and anti-inflammatory mediators, suggesting that atherosclerosis development is different in these vascular beds.
Asunto(s)
Envejecimiento , Calcinosis/inmunología , Enfermedades de las Arterias Carótidas/inmunología , Enfermedad de la Arteria Coronaria/inmunología , Mediadores de Inflamación/sangre , Inflamación/inmunología , Placa Aterosclerótica/inmunología , Factores de Edad , Anciano de 80 o más Años , Biomarcadores/sangre , Brasil , Proteína C-Reactiva/análisis , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Distribución de Chi-Cuadrado , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Inflamación/sangre , Interleucina-10/sangre , Masculino , Placa Aterosclerótica/sangre , Placa Aterosclerótica/diagnóstico por imagen , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Factor de Necrosis Tumoral alfa/sangre , UltrasonografíaRESUMEN
OBJECTIVE: To determine whether coronary artery calcification (CAC), elevated fasting lipids, and lipoproteins and peripheral inflammatory markers are present in insulin-dependent diabetic adolescents and young adults several years after diagnosis. STUDY DESIGN: Hispanic insulin-dependent diabetics (n = 32) diagnosed a mean of 7.8 +/- 4.5 years ago (range, 3 to 16 years), with a mean glycosylated hemoglobin concentration at the time of the study of 8.8% +/- 2.3% and a mean chronological age of 16.1 +/- 4.4 years, were evaluated. Healthy patients (n = 15) with a chronological age (CA) of 15.2 +/- 2.2 years served as control subjects. CAC was assessed by multiple slice computed tomography, and total CAC score in Agatston units was calculated. Fasting lipids, C-reactive protein, apolipoprotein (Apo) A, Apo B, and metalloproteinase-9 (MMP-9) concentrations were measured in all subjects. RESULTS: Neither adolescents with type 1 diabetes nor healthy control subjects presented with evidence of CAC. Fasting lipids, Apo A, Apo B, CRP, and MMP-9 concentrations were similar between diabetic subjects and control subjects. However, 34.4% and 25.0% of our type 1 diabetic subjects had elevated total and LDL cholesterol levels (>200 and >130 mg/dL, respectively), whereas 15.6% and 28.1% had elevated triglyceride and Apo B concentrations (>150 mg/dL and >100 mg/dL, respectively). In addition, 28.1% and 34.4% presented with elevated CRP and MMP-9 levels (>2 mg/L and >80 ng/mL, respectively). Total, LDL and HDL cholesterol, triglycerides, Apo B, CRP, and MMP-9 concentrations correlated positively with duration of the disease and with glycosylated hemoglobin levels. CONCLUSIONS: Although the study adolescents with type 1 diabetes did not present any radiologic evidence of CAC at this stage of the disease, they remain a high-risk group for the development of microvascular and macrovascular artery disease, as risk factors such as elevated lipoproteins and proinflammatory markers are already present in a significant percentage of patients studied.
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Calcinosis/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Lípidos/sangre , Adolescente , Adulto , Apolipoproteínas B/sangre , Proteína C-Reactiva/metabolismo , Calcinosis/sangre , Calcinosis/etiología , Estudios de Casos y Controles , Niño , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/etiología , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Humanos , Masculino , Metaloproteinasa 9 de la Matriz/sangre , RadiografíaRESUMEN
BACKGROUND AND OBJECTIVE: Coronary heart disease (CHD) is the leading cause of death worldwide including Brazil. Improved precision in detecting early coronary disease may aid in more targeted preventive therapy. The National Cholesterol Education Program (NCEP) provides guidelines for determining the aggressiveness of primary prevention strategies including lipid lowering based on Framingham risk equation. Identification of subclinical atherosclerosis and coronary plaque burden is a step towards identifying high-risk individuals. This investigation was designed to determine how the updated NCEP guidelines classify asymptomatic individuals with presence of any as well as advanced CACS (coronary artery calcium score), a powerful intermediary for CHD events, in asymptomatic Brazilian men. METHODS AND RESULTS: Five hundred forty-six asymptomatic Brazilian men (mean age: 46+/-7 years) presented to a single electron beam tomography (EBT) facility in Sao Paulo. The study population was categorized into low risk (0-1 risk factors, n=166, 30%), intermediate risk (> or = 2 risk factors but < 10% risk of CHD over 10 years, n=150, 27%), moderately high risk (2 risk factors and 10-20% risk of hard CHD events in 10 years, n=147, 28%) and high-risk (> or = 2 risk factors and > 20% risk of hard CHD events in 10 years, n=83, 15%), respectively. In our study population, overall no CACS, mild CACS (1-99.9), moderate-severe CACS (> or = 100) were observed in 317 (58%), 160 (29%) and 69 (13%) men, respectively. Advanced calcification (CACS > or = 75th percentile for age) was present in 19% (n=104) men. Based on the LDL-C cutoffs recommended by the NCEP guidelines for initiation of lipid lowering, overall only 55% with CACS > or = 100 and 42% men with CACS > or = 75th percentile qualified for pharmacotherapy. As a result nearly half of individuals with CACS > or = 100 (45%) and CACS > or = 75th percentile (48%) missed eligibility for drug therapy. CONCLUSION: Our findings reveal the potential limitation of NCEP guidelines in identifying asymptomatic Brazilian men with significant coronary atherosclerosis who are potential candidates for aggressive primary prevention. Assessment of CACS may provide incremental value to global risk assessment in high-risk Brazilian men.
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Calcinosis/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/prevención & control , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Biomarcadores/sangre , Brasil , Calcinosis/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Estudios Transversales , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevención Primaria/métodos , Medición de Riesgo , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Triglicéridos/sangreRESUMEN
OBJECTIVE: Takayasu arteritis (TA) is a chronic inflammatory disorder affecting the aorta and its branches. Vascular calcification has been described in 29-54% of cases of TA, although its aetiology remains unknown. Recently the osteoprotegerin/RANKL/RANK system has emerged as an important contributing factor to atherogenesis and osteogenesis. Our aim is to investigate the association between vascular calcification, bone mineral density (BMD) and the osteoprotegerin/RANK/RANKL system in TA. METHODS: Thirty pre-menopausal female TA patients and 30 age- and sex-matched controls were studied. BMD was measured by dual X-ray absorptiometry. Arterial calcification in TA patients was analysed by computed tomography in thoracic and abdominal sites. Serum levels of osteoprotegerin and soluble receptor activator of nuclear factor kappaB ligand (sRANKL) were quantified by enzyme-linked immunosorbent assay. RESULTS: Patients with severe arterial calcification showed lower BMD values than controls in lumbar spine (0.965 +/- 0.055 vs 1.126 +/- 0.153 g/cm2, P = 0.009) and total body (0.993 +/- 0.065 vs 1.085 +/- 0.082 g/cm2, P = 0.019). In contrast, TA patients without calcification presented BMD values similar to controls (P > 0.05). Interestingly, lower serum levels of sRANKL (1.89 +/- 2.35 vs 2.80 +/- 2.23 pg/ml, P = 0.031) and a longer disease duration (12.20 +/- 6.61 vs 3.56 +/- 5.33 yr, P = 0.004) were observed in TA patients with severe calcification compared with patients without calcification. CONCLUSIONS: Severe arterial calcification in TA is associated with low values of BMD and sRANKL, reinforcing the possible link between bone and vascular disease.
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Enfermedades de la Aorta/etiología , Enfermedades Óseas Metabólicas/complicaciones , Calcinosis/etiología , Proteínas Portadoras/sangre , Glicoproteínas de Membrana/sangre , Arteritis de Takayasu/complicaciones , Adulto , Enfermedades de la Aorta/sangre , Enfermedades de la Aorta/fisiopatología , Densidad Ósea , Enfermedades Óseas Metabólicas/sangre , Enfermedades Óseas Metabólicas/fisiopatología , Calcinosis/sangre , Calcinosis/fisiopatología , Femenino , Glicoproteínas/sangre , Humanos , Vértebras Lumbares/fisiopatología , Osteoprotegerina , Premenopausia , Ligando RANK , Receptor Activador del Factor Nuclear kappa-B , Receptores Citoplasmáticos y Nucleares/sangre , Receptores del Factor de Necrosis Tumoral/sangre , Arteritis de Takayasu/sangre , Arteritis de Takayasu/fisiopatologíaRESUMEN
Hyperphosphatemia is an important risk factor of secondary hyperparathyroidism and extraosseous calcifications in chronic renal failure patients. In this study our hypothesis is that physicians misconception of adequate phosphatemia is a risk factor for hyperphosphatemia. In 1999 GEMOR sent a renal osteodystrophy inquiry to different hemodialysis centers in Argentina. It included 80 dialysis centers in 17 Argentinian provinces. The enquire had 33 questions about renal osteodystrophy. Here we report the section related to phosphorous metabolism. We obtained responses from 80 dialysis centers (4,512 dialysis patients), which represents about 24% of Argentinian dialysis centers. Physicians considered phosphorous levels between 4.5 to 5.5 mg/dl in 83.5% of centers as adequate, and between 5.5 to 6.5 mg/dl in 10.1%. Five out of 77 centers reported that they had no patients with hyperphosphatemia. The percentage of hemodialysis patients that had more than 6 mg/dl in each center was 28.8 +/- 15.9%. Those centers that aimed for phosphatemia between 5.5 and 6.5 mg/dl, had a higher percentage of patients with phosphatemia above 6 mg/dl than those aiming for between 4.5 and 5.5 mg/dl (42.8 +/- 16.7 vs 27.1 +/- 15.2% respectively, p = 0.007), and had higher mean of phosphatemia (6.4 +/- 0.7 vs 5.3 +/- 0.7 mg/dl respectively, p = 0.0001), than the last group. In conclusion, a higher mean phosphate level was obtained in hemodialysis centers where physicians considered higher pre-dialysis target levels. Some centers had no patients with hyperphosphatemia (neglect or good control?).
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Actitud del Personal de Salud , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/prevención & control , Fosfatos/sangre , Médicos/psicología , Argentina , Análisis Químico de la Sangre/estadística & datos numéricos , Calcinosis/sangre , Calcinosis/etiología , Calcio/sangre , Terapia por Quelación/estadística & datos numéricos , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/sangre , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Cultura , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Encuestas Epidemiológicas , Unidades de Hemodiálisis en Hospital/estadística & datos numéricos , Humanos , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/tratamiento farmacológico , Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Fósforo/sangre , Pautas de la Práctica en Medicina/estadística & datos numéricos , Valores de Referencia , Diálisis Renal/efectos adversos , Factores de Riesgo , Vitamina D/uso terapéuticoRESUMEN
The present paper aims to assess radiographic vascular and soft parts calcifications occurrence and its correlation with biochemical profiles. The study was performed in 47 patients (ten diabetic patients), 49 years old, who had been on dialysis for a period of 51 months. Vascular calcifications (VCs) were classified as proximal, distal and soft tissues. In addition, Ca, P, CaxP values in the six months prior to the recruitment period, PTH, FAL and calcium carbonate, calcium acetate, and vitamin D3 intake were determined. A higher frequency of VCs was observed in diabetics, yielding a significant association with proximal 60% (p = 0.05) and almost significant with distal calcifications 70% (p = 0.07). Likewise, a lower CaxP was noted for diabetic VCs in comparison to that seen in non-diabetic VCs (p < 0.05). Proximal and distal VCs in the non-diabetics population were 25% and 20%, respectively; and tissue calcifications were 24%. Age was correlated with proximal and distal VCs (p < 0.01). A higher CaxP was observed in patients with VCs and it yielded an even higher value for tissue calcifications. Lastly, calcium acetate and overall calcium intake was higher in patients with tissue calcifications (p = 0.05). VCs were more frequent in diabetics and they also showed a lower CaxP. VCs in non-diabetics were correlated with CaxP values, whereas tissue calcifications were associated with calcium intake. Therefore, the management of renal osteodystrophy should be changed in order to prevent calcifications as well as to decrease morbidity in hemodialysis patients.
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Calcinosis/etiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Fallo Renal Crónico/complicaciones , Diálisis Renal/efectos adversos , Enfermedades Vasculares/etiología , Acetatos/administración & dosificación , Acetatos/análisis , Adulto , Anciano , Argentina/epidemiología , Calcinosis/sangre , Calcinosis/diagnóstico por imagen , Calcio/sangre , Compuestos de Calcio , Calcio de la Dieta/efectos adversos , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/prevención & control , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/terapia , Femenino , Soluciones para Hemodiálisis/efectos adversos , Soluciones para Hemodiálisis/química , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Especificidad de Órganos , Fósforo/sangre , Radiografía , Enfermedades Vasculares/sangre , Enfermedades Vasculares/diagnóstico por imagenRESUMEN
1. Ageing induces calcium accumulation in the vascular system. The simplest experimental way of producing high degrees of arterial calcium overload is by administration of an overdose of vitamin D(3) to rats. The aim of the present study was to evaluate the pharmacokinetics of organic anions in rats with arterial calcinosis induced by an overdose of vitamin D(3). 2. We used bromosulfophthalein (BSP) and sulfanilamide (SA) as models of organic anions with preferential biliary and renal excretion, respectively. 3. Increases in the clearance and elimination rate constant of BSP were observed in treated rats. The clearance and the elimination rate constant for SA were also increased in rats with arterial calcinosis. 4. Variations in arterial hepatic blood flow, aspartate aminotransferase activity and liver calcium accumulation were not observed in treated rats. In contrast, treated rats had a lower renal blood flow and increased renal calcium levels. 5. In summary, rats with arterial calcinosis showed an increase in total body clearance of both BSP and SA, probably associated with modifications in their metabolism and/or in organ extraction. Alterations to hepatic and renal blood flow do not account for these phenomena.