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OBJECTIVE: The Finnish Diabetes Risk Score (FINDRISC) includes anthropometric, metabolic, and lifestyle factors that predict type 2 diabetes mellitus. The objective of this study was to evaluate the FINDRISC modified for Latin America (LA-FINDRISC) as a screening tool for persons with impaired glucose metabolism in Ciudad Bolívar, Venezuela. METHODS: Subjects aged between 18 and 70 years of both sexes without known diabetes were invited to participate. After informed consent, they were screened with the LA-FINDRISC questionnaire and then given an oral glucose tolerance test, using the American Diabetes Association criteria for diagnosis. To obtain the cutoff point of LA-FINDRISC for predicting impaired glucose regulation, a receiver operating characteristic curve was constructed. RESULTS: A total of 200 subjects were evaluated, 64.5% female, with a mean age of 35.20 ± 13.84 years. Of these, 158 (79%) did not present with carbohydrate metabolism disorder, while 42 (21%) did. Age (p = 0.0001), body mass index (p = 0.011), and waist circumference (p = 0.031) were significantly higher in subjects with impaired glucose regulation when compared to those without it. There were a significantly greater number of sedentary (p = 0.039) and hypertensive subjects (p = 0.0001), as well as those with a history of glucose >100 mg/dL (p = 0.0001), in the impaired glucose metabolism group. A cutoff LA-FINDRISC of 14 points predicted a high risk of impaired glucose regulation with a sensitivity of 45.2% and a specificity of 89.9%. CONCLUSION: A LA-FINDRISC >14 points had low sensitivity but high specificity for predicting carbohydrate metabolism disorders in this group of patients from Ciudad Bolívar.
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Diabetes Mellitus Tipo 2/diagnóstico , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Feminino , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Venezuela , Adulto JovemRESUMO
BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a tool to predict 10-year risk of type 2 diabetes mellitus (T2DM), and visceral adiposity is associated with higher cardio-metabolic risk. The objective of the study was to assess the relationship of epicardial adipose tissue (EAT) thickness with T2DM risk according to the FINDRISC tool. METHODS: The study was conducted in Ciudad Bolívar, Venezuela, and included 55 subjects of whom 37 (67.3%) were women and 18 (32.7%) men with ages between 18 and 75 years. A record was made of weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, baseline insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and EAT thickness. The FINDRISC tool, with WC cut-off points modified for Latin America (LA-FINDRISC) was used. RESULTS: BMI, WC, plasma insulin concentration, HOMA-IR index, and EAT thickness were higher (P<0.0001) in the high-risk group compared to subjects in the low-moderate risk group according to the LA-FINDRISC. LA-FINDRISC was positively correlated with BMI (r=0.513; P=0.0001), WC (r=0.524; P=0.0001), fasting blood glucose (r=0.396; P=0.003); baseline plasma insulin (r=0.483; P=0.0001); HOMA-IR index (r=0.545; P=.0.0001); and EAT thickness (r=0.702; P=0.0001). The multivariate regression analysis showed that fasting blood glucose (P=0.023) and EAT thickness (P=0.007) remained independently associated with high T2DM risk. CONCLUSIONS: LA-FINDRISC was associated with EAT thickness and insulin resistance markers. Both were independently and directly associated with high risk for diabetes in the LA-FINDRISC category.
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Tecido Adiposo/metabolismo , Adiposidade/fisiologia , Diabetes Mellitus Tipo 2/epidemiologia , Pericárdio/metabolismo , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Peso Corporal/fisiologia , Estudos Transversais , Feminino , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Venezuela , Circunferência da Cintura/fisiologia , Adulto JovemRESUMO
BACKGROUND: Menopausal transition is critical for the development of early, subclinical vascular damage. Multiple factors, such as atherosclerosis, increased epicardial fat, and endothelial dysfunction can play a role. Hence, the objective of this study was the comparison of epicardial adipose tissue and carotid intima media thickness in order to establish the best predictor of carotid stiffness in middle-aged women with endothelial dysfunction. METHODS: A total of 43 healthy women aged 40-59 years old with endothelial dysfunction previously demonstrated by flow mediated dilation were recruited to have anthropometric, biochemical, hormonal and ultrasound determinations of carotid intima media thickness and epicardial fat thickness. RESULTS: Carotid arterial stiffness parameters (local pulse wave velocity [4.7±0.7 vs 4.8±0.5 vs 5.6±0.5m/s, respectively, p<0.001], pressure strain elastic modulus [55.2±13.4 vs 59.2±11.8 vs 81.9±15.6kPa, respectively, p<0.001], arterial stiffness index ß [4.4±1.4 vs 5.0±1.1 vs 6.4±1.3, respectively, p<0.001]) and epicardial fat thickness (2.98±1.4 vs 3.28±1.9 vs 4.70±1.0mm, respectively, p=0.007) showed a significant and proportional increase in the group of late post-menopausal women when compared to early post-menopausal and pre-menopausal groups, respectively. Among body fat markers, epicardial fat was the strongest predictor of local pulse wave velocity, independent of age. CONCLUSIONS: In menopausal women with endothelial dysfunction, menopausal transition is associated with increased carotid arterial stiffness and epicardial fat thickness, independent of age. Ultrasound measured epicardial fat was a better independent predictor of arterial stiffness than carotid intima media thickness in these women.
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Tecido Adiposo/patologia , Aterosclerose/patologia , Menopausa , Pericárdio/patologia , Adulto , Antropometria , Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Estudos Transversais , Módulo de Elasticidade , Endotélio Vascular/patologia , Humanos , Pessoa de Meia-Idade , Análise de Onda de Pulso , Rigidez VascularRESUMO
OBJECTIVE: To assess the frequency and the clinical, biochemical, and molecular aspects of familial hypercholesterolemia (FH) in subjects attending an endocrinology unit. METHODS: An observational, descriptive study evaluating 3,140 subjects attending the endocrinology unit of Centro Médico Orinoco in Ciudad Bolívar, Venezuela, from 7 January 2013 to 9 December 2016. The index cases were selected using the Dutch Lipid Clinic Network criteria. Plasma lipid levels were measured, and a molecular analysis was performed by DNA sequencing of the LDLR and APOB genes. RESULTS: Ten (0.32%) of the 3,140 study patients had clinical and biochemical characteristics consistent with FH. All but one were female. Three had first-degree relatives with prior premature coronary artery; and none had a personal history of this condition. Three patients were obese; three had high blood pressure; and no one suffered from diabetes. Three patients had a history of tendon xanthomas, and one of corneal arcus. LDL-C levels ranged from 191 to 486mg/dL. Two patients were on statin therapy. The genetic causes of FH were identified in four patients, and were LDLR gene mutations in three of them and an APOB gene mutation in exon 26 in the other. CONCLUSION: Approximately, one out of every 300 people attending this endocrinology unit in those four years had FH, and LDLR gene mutations were the most prevalent cause.
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Hiperlipoproteinemia Tipo II/epidemiologia , Adolescente , Adulto , Antropometria , Apolipoproteínas B/genética , Criança , Comorbidade , Endocrinologia , Éxons/genética , Feminino , Unidades Hospitalares , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/genética , Hipertensão/epidemiologia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Pró-Proteína Convertase 9/genética , Receptores de LDL/genética , Análise de Sequência de DNA , Tendões , Venezuela/epidemiologia , Xantomatose/etiologiaRESUMO
AIM: To assess the relationship between 25-hydroxyvitamin D [25(OH)D] blood concentrations in subjects with obesity and type 2 diabetes mellitus (T2D) risk according to the Finnish Diabetes Risk Score (FINDRISC) modified for Latin America (LA-FINDRISC). METHODS: This study was conducted in Ciudad Bolívar, Venezuela. Eighty two women and 20 men (53 obese and 49 nonobese), with an average age of 42.6±12.30 years were enrolled. Weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, basal insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and 25(OH)D levels were measured. FINDRISC with WC cutoff points modified for Latin America was applied. RESULTS: No difference in 25(OH)D levels between obese and nonobese subjects was found. When anthropometric, clinical, and biochemical variables according to the 25(OH)D status were compared, the only difference detected was higher LA-FINDRISC in the insufficient/low 25(OH)D group compared to normal 25(OH)D levels group (12.75±6.62; vs 10.15±5.21; p=0.031). LA-FINDRISC was negatively correlated with plasma 25(OH)D levels (r=-0.302; p=0.002) and positively correlated with the HOMA-IR index (r=0.637; p=0.0001). CONCLUSIONS: The LA-FINDRISC significantly correlated with both 25(OH)D levels and insulin resistance markers in this group of patients.
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Diabetes Mellitus Tipo 2/etiologia , Resistência à Insulina , Obesidade/complicações , Inquéritos e Questionários , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Adulto , Biomarcadores/sangue , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Jejum/sangue , Feminino , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Venezuela , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Circunferência da CinturaRESUMO
La metreleptina es un análogo de leptina que ha sido probado en pacientes con patologías derivadas del déficit de leptina. Las lipodistrofias representan un grupo de enfermedades caracterizadas por deficiencia de leptina, y se asocian con formas severas de síndrome metabólico que incluyen hiperglucemia, hipertrigliceridemia y esteatosis hepática. Estas complicaciones metabólicas pueden posteriormente progresar a diabetes mellitus, pancreatitis aguda y cirrosis hepática. Para el manejo de estas anormalidades, usualmente se requieren diversos tratamientos, pero en estadíos avanzados tienden a ser de difícil manejo. La metreleptina es el producto farmacéutico aprobado por la Administración de Alimentos y Fármacos de los Estados Unidos (FDA) para tratar las complicaciones metabólicas de las lipodistrofias generalizadas. En este artículo, se revisa el perfil farmacólogico de metreleptina y los aspectos clínicos de las lipodistrofias generalizadas. Además, se describen algunos estudios que evaluaron la eficacia y seguridad de metreleptina en pacientes con lipodistrofias generalizadas.
Metreleptin is a synthetic leptin analog that has been trialed in patients with leptin-deficient conditions. Lipodystrophies represent a class of diseases characterized by leptin deficiency, which is associated with a severe form of the metabolic syndrome characterized by hyperglycemia, hypertriglyceridemia, and hepatic steatosis. These metabolic complications can progress to diabetes mellitus, acute pancreatitis, and hepatic cirrhosis. For the management of these abnormalities, multiple therapies are usually required, and advances stages may be progressively difficult to treat. Metreleptin is the pharmaceutical derived product that has been approved by the US Food and Drug Administration (FDA) to treat the severe metabolic abnormalities of the generalized forms of lipodystrophy. Herein, we review the pharmacological profile of metreleptin, and clinical aspects of generalized lipodystrophies. Further, we examine studies that assessed the efficacy and safety of metreleptin in generalized lipodystrophies.
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OBJECTIVE: To assess the relationship of epicardial adipose tissue (EAT) thickness with cardiometabolic risk factors (CRFs) in children and adolescents. METHODS: Seventy-seven subjects of both sexes aged 7-18 years were selected. Medical history, clinical parameters, and glucose, insulin, and lipid levels were collected. EAT thickness was measured using transthoracic echocardiography. Study subjects were divided into two groups based on whether they had less than two or two or more CRFs. RESULTS: The group with two or more CRFs had higher EAT thickness, insulin, and HOMA-IR values (P<.05). EAT thickness showed a statistically significant positive correlation with body mass index (BMI) (r=0.561, P=.0001), waist circumference (r=.549, P=.0001), systolic blood pressure (SBP) (r=.256, P=.028), insulin (r=0.408, P=.0001), and HOMA-IR (r=.325, P=.005). However, these correlations were not significant after adjustment for BMI. The cut-off point for EAT thickness as predictor of two or more CRFs was 3.17mm. The risk (odds ratio) of having two or more CRFs if EAT thickness was >3.17mm was 3.1 (95% CI: 1.174-8.022). BMI was the independent variable that most affected EAT thickness and the presence of two or more CRFs. CONCLUSION: In this group of children and adolescents, the relationship of EAT thickness with CRFs was found to be dependent on BMI.
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Tecido Adiposo/diagnóstico por imagem , Cardiopatias/epidemiologia , Doenças Metabólicas/epidemiologia , Pericárdio/diagnóstico por imagem , Adolescente , Pressão Sanguínea , Criança , Ecocardiografia , Feminino , Humanos , Insulina/sangue , Masculino , Fatores de Risco , Circunferência da CinturaRESUMO
The aim of the study was to assess the effect of sitagliptin addition on the epicardial adipose tissue (EAT) thickness in subjects with type 2 diabetes mellitus inadequately controlled on metformin monotherapy. This was a 24-week interventional pilot study in 26 consecutive type 2 diabetic patients, 14 females and 12 males average age of 43.8 ± 9.0 years, with Hemoglobin A1c (HbA1c) ≥ 7% on metformin monotherapy. Subjects who met the inclusion criteria were added on sitagliptin and started on sitagliptin/metformin combination at the dosage of 50 mg/1000 mg twice daily. EAT and visceral and total body fat were measured, respectively, with echocardiography and bioelectrical impedance analysis at baseline and after 24 weeks of sitagliptin/metformin treatment in each subject. HbA1c and plasma lipids were also measured. EAT decreased significantly from 9.98 ± 2.63 to 8.10 ± 2.11 mm, p = 0.001, accounting for a percentage of reduction (∆%) of -15% after 24 weeks of sitagliptin addition, whereas total body fat percentage, visceral fat, and body mass index (BMI), decreased by 8, 12, and 7%, respectively (p = 0.001 for all). After 6 month, EAT ∆% was significantly correlated with ∆% of visceral fat (r = 0.456; p = 0.01), whereas no correlation with either BMI ∆% (r = 0.292; p = 0.147) or HbA1c ∆% was found. The addition of Sitagliptin produced a significant and rapid reduction of EAT, marker of organ-specific visceral fat, in overweight/obese individuals with type 2 diabetes inadequately controlled on metformin monotherapy. EAT as measured with ultrasound can serve as no invasive and accurate marker of visceral fat changes during pharmaceutical interventions targeting the fat.
Assuntos
Tecido Adiposo/patologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/patologia , Hipoglicemiantes/farmacologia , Obesidade/patologia , Pericárdio/patologia , Fosfato de Sitagliptina/farmacologia , Tecido Adiposo/efeitos dos fármacos , Adiposidade , Adolescente , Adulto , Idoso , Composição Corporal/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Impedância Elétrica , Feminino , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Humanos , Lipídeos/sangue , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Obesidade/complicações , Pericárdio/efeitos dos fármacos , Projetos Piloto , Adulto JovemRESUMO
La incidencia de obesidad ha incrementado en forma significativa, constituyendo en la actualidad un grave problema de salud pública por su asociación frecuente con condiciones médicas tales como diabetes mellitus, hipertensión arterial sistémica y dislipidemias, que constituyen factores de riesgo cardiovascular. Los resultados de las intervenciones terapéuticas tradicionales (dieta, actividad física y tratamiento farmacológico), no han resultado exitosos en alcanzar y mantener la pérdida de peso, lo cual ha generado, en las últimas décadas, el desarrollo de otras modalidades terapéuticas con mejores tasas de respuesta como la cirugía bariátrica. Se requiere una adecuada selección de los posibles candidatos para cirugía bariátrica y conocimiento del manejo post-operatorio a corto y largo plazo.
The incidence of obesity has increased significantly, currently constituting a serious public health problem because of its frequent association with medical conditions such as diabetes mellitus, hypertension and dyslipidemia, which are cardiovascular risk factors. The results of traditional therapeutic interventions (diet, physical activity and drug treatment), have not been successful in achieving and maintaining weight loss, which has generated in recent decades the development of other therapeutic modalities with better response rates as bariatric surgery. Proper selection of potential candidates for bariatric surgery and post-operative knowledge of short and long-term management is required.
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The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive metabolic disorder due to an abnormal cholesterol synthesis. It was first described by Smith, Lemli and Opitz in 1964. Many cases of SLOS have been described since then, leading to the recognition as a relatively common malformation syndrome. Affected individuals have dysmorphism, microcephaly, multiple congenital malformations, mental retardation, aggressiveness and hyperactivity. The severity of physical defects correlates with the severity of the cholesterol deficiency, which is caused by an abnormally low activity of 7-dehydrocholesterol reductase, the enzyme responsible for conversion of 7-dehydrocholesterol to cholesterol. The occurrence of hypothyroidism in association with SLOS is very unusual. We describe the first Venezuelan case in which both anomalies are associated.
Assuntos
Hipotireoidismo/complicações , Síndrome de Smith-Lemli-Opitz , Pré-Escolar , Humanos , Hipotireoidismo/diagnóstico , Masculino , Fenótipo , Síndrome de Smith-Lemli-Opitz/diagnóstico , VenezuelaRESUMO
El síndrome de Smith-Lemli-Opitz (SSLO) es un desorden metabólico autosómico recesivo debido a la síntesis anormal de colesterol y fue descrito por primera vez por Smith, Lemli y Opitz en 1964. Muchos casos de SSLO han sido descritos desde entonces, siendo reconocido como un síndrome malformativo relativamente común. Los individuos afectados tienen dismorfismo, microcefalia, múltiples malformaciones congénitas, retraso mental, agresividad e hiperactividad. La severidad de los defectos físicos se correlaciona con la severidad de la deficiencia de colesterol, la cual es causada por la baja actividad de la 7-dehidrocolesterol reductasa, enzima responsable de la conversión de 7-dehidrocolesterol a colesterol. La ocurrencia de hipotiroidismo en asociación con SSLO es muy inusual. Este constituye el primer caso venezolano en el que se asocian ambas patologías.
The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive metabolic disorder due to an abnormal cholesterol synthesis. It was first described by Smith, Lemli and Opitz in 1964. Many cases of SLOS have been described since then, leading to the recognition as a relatively common malformation syndrome. Affected individuals have dysmorphism, microcephaly, multiple congenital malformations, mental retardation, aggressiveness and hyperactivity. The severity of physical defects correlates with the severity of the cholesterol deficiency, which is caused by an abnormally low activity of 7-dehydrocholesterol reductase, the enzyme responsible for conversion of 7-dehydrocholesterol to cholesterol. The occurrence of hypothyroidism in association with SLOS is very unusual. We describe the first Venezuelan case in which both anomalies are associated.
Assuntos
Pré-Escolar , Humanos , Masculino , Hipotireoidismo/complicações , Síndrome de Smith-Lemli-Opitz , Hipotireoidismo/diagnóstico , Fenótipo , Síndrome de Smith-Lemli-Opitz/diagnóstico , VenezuelaRESUMO
OBJECTIVE: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. SUBJECTS AND METHODS: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. RESULTS: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). CONCLUSION: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease.
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Adiponectina/sangue , Tecido Adiposo/patologia , Síndrome Metabólica/patologia , Pericárdio/patologia , Adulto , Função do Átrio Esquerdo , Glicemia/análise , Índice de Massa Corporal , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Modelos Lineares , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Tamanho do Órgão , Volume Sistólico , Triglicerídeos/sangue , Venezuela , Função Ventricular EsquerdaRESUMO
Objective: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. Subjects and methods: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. Results: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). Conclusion: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease. .
Objetivo: Estudar a relação entre a espessura do tecido adiposo epicárdico (TAE) e os níveis plasmáticos de adiponectina em pacientes venezuelanos. Sujeitos e métodos: Foram selecionados 31 pacientes com diagnóstico de síndrome metabólica (SM) (grupo de estudo) e 27 controles. Foram medidos a glicose, os lipídios e a adiponectina. Foram determinados a espessura do TAE, a fração de ejeção, a função diastólica, a massa ventricular esquerda (MVE) e o volume atrial esquerdo (VAI) pela ecocardiografia transtorácica. Resultados: A espessura do TAE foi maior em pacientes com SM (5,69 ± 1,12 contra 3,52 ± 0,80 mm; p = 0,0001) com uma correlação positiva com o índice de massa corporal (IMC) (r = 0,661; p = 0,0001), circunferência da cintura (CC) (r = 0,664; p = 0,0001), pressão arterial sistólica (PAS) (r = 0,607; p = 0,0001), diastólica (PAD) (r = 0,447; p = 0,0001), insulina (r = 0,505; p = 0,0001), com a relação TG/HDL-C (r = 0,447; p = 0,0001), com o colesterol HDL (r = 0,353; p = 0,007), VAI (r = 0,432; p = 0,001) e MVI (r = 0,469; p = 0,0001). A espessura do TAE se correlacionou negativamente com a adiponectina (r = -0,499; p = 0,0001). Conclusão: Existe uma relação significativa entre a espessura do TAE, os componentes do SM e a concentração plasmática de adiponectina, o que poderia ser utilizado como um biomarcador para essa doença. .
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adiponectina/sangue , Tecido Adiposo/patologia , Síndrome Metabólica/patologia , Pericárdio/patologia , Função do Átrio Esquerdo , Índice de Massa Corporal , Glicemia/análise , Estudos Transversais , HDL-Colesterol/sangue , Colesterol/sangue , Ecocardiografia , Modelos Lineares , Síndrome Metabólica/sangue , Tamanho do Órgão , Volume Sistólico , Triglicerídeos/sangue , Venezuela , Função Ventricular EsquerdaRESUMO
Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality. Epicardial adipose tissue (EAT) thickness may act as a therapeutic target during treatments with drugs modulating the adipose tissue. We evaluate EAT thickness in RA patients treated with biological and nonbiological disease-modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted with a cohort of 34 female RA patients and 16 controls matched for age and body mass index (BMI). Plasma glucose, basal insulin, plasma lipids, and high-sensitivity C-reactive protein (hs-CRP) were assessed. EAT thickness and left ventricular mass (LVM) were measured by echocardiography. No significant differences in waist circumference (WC), blood pressure, fasting blood glucose, basal insulin, and lipid parameters were found between the groups. The control group showed lower concentrations (P = 0.033) of hs-CRP and LVM (P = 0.0001) than those of the two RA groups. Patients treated with TNF-α inhibitors showed significantly lower EAT thickness than those treated with nonbiological DMARDs (8.56 ± 1.90 mm versus 9.71 ± 1.45 mm; P = 0.04). Women with no RA revealed reduced EAT thickness (5.39 ± 1.52 mm) as compared to all RA patients (P = 0.001). Results suggest that RA patients have greater EAT thickness than controls regardless of BMI and WC.
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El exceso crónico de glucocorticoides se acompaña de una amplia variedad de signos y síntomas conocidos como síndrome de Cushing. Esta condición, ocurre con mayor frecuencia por causas iatrogénicas cuando los glucocorticoides son usados como terapia antiinflamatoria por tiempo prolongado. El mecanismo patogénico del Cushing endógeno puede dividirse en dependiente o independiente de ACTH. A pesar de los avances en el diagnóstico y tratamiento de esta patología, el síndrome de Cushing continúa siendo un reto para el clínico. En este artículo, basado en niveles de evidencia científica y en la experiencia clínica de la Unidad de Endocrinología del IAHULA, se presenta el protocolo de manejo del Síndrome de Cushing, el cual incluye criterios diagnósticos, manejo clínico y tratamiento de esta condición.
Chronic glucocorticoid excess is accompanied by a wide range of signs and symptoms known as Cushings syndrome. This condition most commonly arises from iatrogenic causes when glucocorticoids have been used as anti-inflammatory treatment for a long time. The pathogenetic mechanism of endogenous Cushings syndrome can be divided into ACTH dependent and ACTH independent. Despite major advances in diagnosis and therapy, Cushings syndrome is frequently a challenge for the clinician. In this paper, based on levels of scientific evidence and clinical experience in the Unit of Endocrinology, IAHULA, we present the protocol for the management of Cushings syndrome, which includes: diagnostic criteria, clinical management and treatment of this condition.
RESUMO
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.
Assuntos
Tecido Adiposo/anatomia & histologia , Síndrome Metabólica/epidemiologia , Pericárdio/anatomia & histologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valor Preditivo dos Testes , Venezuela , Adulto JovemRESUMO
La acromegalia es una enfermedad caracterizada por un exceso de secreción de hormona de crecimiento (GH) y concentraciones circulantes elevadas del factor de crecimiento semejante a la insulina tipo 1 (IGF-1). Esta enfermedad presenta una elevada morbilidad y mortalidad asociada a complicaciones cardiovasculares, respiratorias y metabólicas. El aspecto facial es característico e incluye ensanchamiento y engrosamiento de la nariz, pómulos prominentes, abultamiento frontal y prognatismo. El diagnóstico clínico es confirmado por un incremento en los niveles séricos de GH e IGF-1. El objetivo terapéutico es disminuir dichos niveles y aminorar los síntomas del paciente. Las opciones terapéuticas incluyen cirugía, tratamiento médico y radioterapia. En el presente artículo, basados en niveles de evidencia científica y en la experiencia clínica de la Unidad de Endocrinología del IAHULA, se presenta el protocolo para el manejo de la acromegalia, el cual consta de los criterios diagnósticos, el manejo clínico, el tratamiento y seguimiento de esta condición.
Acromegaly is a disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. This disease has an increased morbidity and mortality associated with cardiovascular, respiratory, and metabolic complications. The facial aspect is characteristic and includes a widened and thickened nose, prominent cheekbones, forehead bulges, and prognathism. The clinical diagnosis is confirmed by an increased serum GH and IGF-1 concentration. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels and ameliorating patients symptoms. The therapeutic options include surgery, medical therapies, and radiotherapy. In this paper, based on levels of scientific evidence and clinical experience in the Unit of Endocrinology, IAHULA, we present the protocol for the management of acromegaly, which includes: diagnostic criteria, clinical management, treatment and surveillance of this condition.