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Evaluation of the relationship between atherosclerosis and Helicobacter pylori infection with measurement of growth differentiation factor 15 and atherosclerosis indicators in adults with no comorbidity 在没有合并症的成年人中,通过测量生长分化因子15和动脉粥样硬化指标来评估动脉粥样硬化与幽门螺杆菌感染之间的关系。
IF 1.6 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.arteri.2023.09.002
Osman Başpinar , Ayça Elibol , Derya Koçer , Turgut Tursem Tokmak , Serkan Doğan , Oğuzhan Sıtkı Dizdar

Background

The aim of this study was to investigate presence of subclinical atherosclerosis by measuring carotid intima-media thickness (CIMT) in patients with Helicobacter pylori (HP) and to assess effects of HP on atherosclerosis by evaluating markers of atherosclerosis and blood growth differentiation factor (GDF-15) levels.

Materials and methods

This cross-sectional study included 59 patients without comorbid disease who had HP and 30 healthy controls without HP in upper endoscopic biopsy. In order to assess atherosclerosis, the CIMT measurement was performed by sonography. Serum GDF-15 level was measured by ELISA method. In all patients, atherosclerosis markers were recorded. Atherogenic indices were calculated, including Castelli risk index I and II (TG/HDL-c and LDL-c/HDL-c, respectively), plasma atherogenic index (PAI; log TG/HDL-c), non-HDL-c (TH-HDL-c) and atherogenic coefficient (AC; non-HDL-HDL-c).

Results

The GDF-15 level and CIMT were significantly higher in HP-positive group when compared to HP-negative group (p  0.001). There was a significant correlation between serum GDF-15 level and CIMT (r = 0.445; p  0.001). There was no correlation between other atherosclerosis markers and serum GDF-15 level or CIMT. The bacterial intensity on endoscopic specimen was only correlated with CIMT (p < 0.001). Vitamin B12 and D levels were comparable among groups.

Conclusion

This study suggested that there was a correlation between GDF-15 level and subclinical atherosclerosis development in patients with HP. However, GDF-15 level, which was found to be elevated while atherogenic indices were normal, can be an earlier marker for subclinical atherosclerosis.

背景:本研究的目的是通过测量幽门螺杆菌(HP)患者的颈动脉内膜-中膜厚度(CIMT)来研究亚临床动脉粥样硬化的存在,并通过评估动脉粥样硬化标志物和血液生长分化因子(GDF-15)水平来评估HP对动脉粥样硬化的影响。材料和方法:这项横断面研究包括59名患有HP的无合并症患者和30名未患有HP的健康对照者进行上内镜活检。为了评估动脉粥样硬化,通过超声进行CIMT测量。ELISA法测定血清GDF-15水平。所有患者均记录了动脉粥样硬化标志物。计算动脉粥样硬化指数,包括Castelli风险指数I和II(分别为TG/HDL-c和LDL-c/HDL-c)、血浆动脉粥样硬化指数(PAI;log-TG/HDL-c),结果:HP阳性组的GDF-15水平和CIMT显著高于HP阴性组(p≤0.001),血清GDF-15与CIMT之间存在显著相关性(r=0.445;p≤0.001;其他动脉粥样硬化标志物与血清GDF15水平或CIMT之间无相关性。内镜标本上的细菌强度仅与CIMT相关(P结论:本研究表明,HP患者的GDF-15水平与亚临床动脉粥样硬化发展之间存在相关性。然而,在动脉粥样硬化指数正常的情况下,GDF-15的水平升高,可能是亚临床动脉粥样硬化的早期标志。
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引用次数: 0
Influencia de la concentración de triglicéridos en la lipoproteína(a) en función de la dislipidemia 脂蛋白(a)中甘油三酯浓度对血脂异常的影响。
IF 1.6 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.arteri.2023.11.005
Victoria Marco-Benedí , Ana Cenarro , Martín Laclaustra , Pilar Calmarza , Ana M. Bea , Àlex Vila , Carlos Morillas-Ariño , José Puzo , Juan Diego Mediavilla Garcia , Amalia Inmaculada Fernández Alamán , Manuel Suárez Tembra , Fernando Civeira

Background

Recently, an inverse relationship between the blood concentration of lipoprotein(a) (Lp(a)) and triglycerides (TG) has been demonstrated. The larger the VLDL particle size, the greater the presence of VLDL rich in apoliprotein E and in subjects with the apoE2/E2 genotype, the lower Lp(a) concentration. The mechanism of this inverse association is unknown. The objective of this analysis was to evaluate the Lp(a)–TG association in patients treated at the lipid units included in the registry of the Spanish Society of Atherosclerosis (SEA) by comparing the different dyslipidemias.

Patients and methods

Five thousand two hundred and seventy-five subjects ≥18 years of age registered in the registry before March 31, 2023, with Lp(a) concentration data and complete lipid profile information without treatment were included.

Results

The mean age was 53.0 ± 14.0 years, with 48% women. The 9.5% of subjects (n = 502) had diabetes and the 22.4% (n = 1184) were obese. The median TG level was 130 mg/dL (IQR 88.0–210) and Lp(a) 55.0 nmol/L (IQR 17.9–156). Lp(a) concentration showed a negative association with TG concentration when TG values exceeded 300 mg/dL. Subjects with TG > 1000 mg/dL showed the lowest level of Lp(a), 17.9 nmol/L, and subjects with TG < 300 mg/dL had a mean Lp(a) concentration of 60.1 nmol/L. In subjects without diabetes or obesity, the inverse association of Lp(a)–TG was especially important (p < 0.001). The median Lp(a) was 58.3 nmol/L in those with TG < 300 mg/dL and 22.0 nmol/L if TG > 1000 mg/dL. No association was found between TG and Lp(a) in subjects with diabetes and obesity, nor in subjects with familial hypercholesterolemia. In subjects with multifactorial combined hyperlipemia with TG < 300 mg/dL, Lp(a) was 64.6 nmol/L; in the range of 300–399 mg/dL of TG, Lp(a) decreased to 38. 8 nmol/L, and up to 22.3 nmol/L when TG > 1000 mg/dL.

Conclusions

Our results show an inverse Lp(a)–TG relationship in TG concentrations > 300 mg/dL in subjects without diabetes, obesity and without familial hypercholesterolemia. Our results suggest that, in those hypertriglyceridemias due to hepatic overproduction of VLDL, the formation of Lp(a) is reduced, unlike those in which the peripheral catabolism of TG-rich lipoproteins is reduced.

背景:最近,血液中脂蛋白(a)(Lp(a))浓度与甘油三酯(TG)之间的反比关系已被证实。VLDL 粒径越大,富含脂蛋白 E 的 VLDL 就越多,而在具有 apoE2/E2 基因型的受试者中,脂蛋白(a)的浓度就越低。这种反向关联的机制尚不清楚。这项分析的目的是通过比较不同的血脂异常,评估在西班牙动脉粥样硬化协会(SEA)登记册中的血脂单位接受治疗的患者的脂蛋白(a)-TG 关联性:研究对象: 在2023年3月31日前登记在册的5275名年龄≥18岁的受试者,这些受试者具有脂蛋白(a)浓度数据和完整的血脂概况信息,且未接受过治疗:平均年龄为(53.0 ± 14.0)岁,女性占 48%。9.5%的受试者(502 人)患有糖尿病,22.4%的受试者(1184 人)肥胖。TG 水平中位数为 130 mg/dL (IQR 88.0-210),Lp(a) 为 55.0 nmol/L (IQR 17.9-156)。当 TG 值超过 300 mg/dL 时,脂蛋白(a)浓度与 TG 浓度呈负相关。TG > 1000 mg/dL 的受试者脂蛋白(a)水平最低,为 17.9 nmol/L,而 TG < 300 mg/dL 的受试者脂蛋白(a)平均浓度为 60.1 nmol/L。在没有糖尿病或肥胖症的受试者中,脂蛋白(a)与总胆固醇的反比关系尤为重要(p < 0.001)。TG < 300 mg/dL 的 Lp(a) 中位数为 58.3 nmol/L,TG > 1000 mg/dL 的 Lp(a) 中位数为 22.0 nmol/L。糖尿病和肥胖症患者以及家族性高胆固醇血症患者的总胆固醇和脂蛋白(a)之间没有关联。在 TG < 300 mg/dL 的多因素合并高脂血症受试者中,脂蛋白(a)为 64.6 nmol/L;在 TG 300-399 mg/dL 的范围内,脂蛋白(a)降至 38.8 nmol/L,当 TG > 1000 mg/dL 时,脂蛋白(a)降至 22.3 nmol/L:我们的研究结果表明,在没有糖尿病、肥胖症和家族性高胆固醇血症的受试者中,当 TG 浓度大于 300 mg/dL 时,Lp(a)-TG 呈反比关系。我们的研究结果表明,与富含 TG 的脂蛋白的外周分解代谢减少的情况不同,由于肝脏过度产生 VLDL 而导致的高甘油三酯血症中,Lp(a) 的形成会减少。
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引用次数: 0
Is Helicobacter pylori a new kid on the block? 幽门螺杆菌是新来的吗?
IF 1.6 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.arteri.2024.02.002
Manuel Vázquez-Carrera
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引用次数: 0
High-fat diet promotes coagulation and endothelial activation in Sprague Dawley rats: Short-term effects of combined oral contraceptives 高脂饮食促进Sprague-Dawley大鼠凝血和内皮细胞活化:联合口服避孕药的短期效果。
IF 1.6 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.arteri.2023.10.001
Oyesanmi A. Fabunmi , Phiwayinkosi V. Dludla , Bongani B. Nkambule

Background

Combined oral contraceptives (COCs), use in individuals are associated with increased risk of thrombotic events. This highlights the significance of assessing the impact of COC on promoting coagulation and endothelial activation in high-fat diet (HFD)-fed Sprague Dawley rats.

Methods

Twenty (20) five-weeks-old female Sprague Dawley rats weighing between 150 and 200 g were subjected to both LFD and HFD-feeding for 8-weeks to determine its influence on basic metabolic status, hemostatic profile, hemodynamic parameters (blood pressure and heart rate), as well as selected biomarkers of coagulation (tissue factor and D-dimer) and endothelial activation (Von Willebrand factor and nitric oxide). Thereafter HFD-fed animals were treated with receive high dose combined oral contraceptive (HCOC) and low dose combine oral contraceptive (LCOC) for 6 weeks.

Results

Our results showed that beyond weight gain, HFD-feeding was associated with hyperglycemia, increased mean arterial pressure, and reduced nitric oxide levels when compared with LFD group (p < 0.05). Interestingly, treatment with high dose of COC for 6-weeks did not significantly alter atherothrombotic markers (p > 0.05). However, this study is not without limitation as regulation of these markers remains to be confirmed within the cardiac tissues or endothelial cells of these animals.

Conclusion

HFD-feeding orchestrate the concomitant release of pro-coagulants and endothelial activation markers in rats leading to haemostatic imbalance and endothelial dysfunction. Short-term treatment with COC shows no detrimental effects in these HFD-fed rats. Although in terms of clinical relevance, our findings depict the notion that the risk of CVD in association with COC may depend on the dosage and duration of use among other factors especially in certain conditions. However, additional studies are required to confirm these findings, especially long-term effects of this treatment within the cardiac tissues or endothelial cells of these animals in certain conditions relating to postmenopausal state.

背景:联合口服避孕药(COCs)在个体中的使用与血栓形成事件的风险增加有关。这突出了评估COC对高脂肪饮食(HFD)喂养的Sprague-Dawley大鼠促进凝血和内皮激活的影响的重要性。方法:20只体重在150至200g之间的5周龄雌性Sprague-Dawley大鼠同时接受LFD和HFD喂养8周,以确定其对基础代谢状态、止血特性、血液动力学参数(血压和心率)的影响,以及凝血(组织因子和D-二聚体)和内皮激活(Von Willebrand因子和一氧化氮)的选定生物标志物。此后,HFD喂养的动物接受高剂量联合口服避孕药(HCOC)和低剂量联合口服避孕药具(LCOC)治疗6周。结果:与LFD组相比,除了体重增加外,HFD喂养还与高血糖、平均动脉压升高和一氧化氮水平降低有关(p0.05)。然而,本研究并非没有限制,因为这些标志物在这些动物的心脏组织或内皮细胞中的调节仍有待证实。结论:HFD喂养协调了大鼠促凝血因子和内皮激活标志物的同时释放,导致止血失衡和内皮功能障碍。COC的短期治疗在这些HFD喂养的大鼠中没有显示出有害影响。尽管就临床相关性而言,我们的研究结果表明,CVD与COC相关的风险可能取决于剂量和使用持续时间以及其他因素,尤其是在某些情况下。然而,还需要更多的研究来证实这些发现,特别是在与绝经后状态相关的某些条件下,这种治疗对这些动物的心脏组织或内皮细胞的长期影响。
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引用次数: 0
Multizonal observational study conducted by clinical practitioners on Repatha® use in patients with hyperlipidemia (ZERBINI): Colombian results 由临床医师开展的关于高脂血症患者使用 Repatha® 的多区域观察研究(ZERBINI):哥伦比亚的结果
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2023.06.001
Heidy M. Roncancio , Julián R. Lugo-Peña , Ángel A. García , Janeth Leal , Carlos A. Hoyos , Johnny A. Beltrán , César L. Cruz , Carol Paez-Cano , Mariana Pineda-Posada , Eduardo Contreras

Background

Cardiovascular disease (CVD) represents the primary cause of death and disability globally, with elevated cholesterol as one of the leading risk factors for CVD. We describe the clinical characteristics, treatment patterns, and effectiveness of evolocumab in treating hyperlipidemia.

Methods

Observational study conducted through a chart review of patients with hyperlipidemia receiving evolocumab as part of clinical management in Colombia.

Results

This study included 115 patients treated with evolocumab. A total of 101 patients (87.8%) had a history of CVD, 13 (11.3%) familial hypercholesterolemia (FH), and 23 (20%) type 2 diabetes. Thirty-nine patients reported intolerance to any statin (33.9%). The median value of LDL-C before initiation of evolocumab was 147 mg/dL (IQR: 122.5–183.7 mg/dL). Within the first 3 months of treatment, LDL-C value dropped to a median value of 53 mg/dL (IQR: 34.0–95.5 mg/dL), showing a reduction of 63.9%. The median LDL-C values remained below 45 mg/dL until the end of follow-up. Among the patients with available data, up to 61% achieved an LDL-C level below 55 mg/dL at the 10–12-month follow-up. A total of 72% of patients were persistent with treatment. Safety results showed a low frequency of hospitalizations (≤2%) and treatment-emergent adverse drug reactions (5.2%). No serious adverse events were reported.

Conclusions

Evolocumab was associated with reductions in LDL-C levels, with a relative decrease of 63.9% within the first 3 months of treatment. Low rates of interruptions due to adverse events and adequate medication persistence was reported.

背景心血管疾病(CVD)是导致全球死亡和残疾的主要原因,而胆固醇升高是导致心血管疾病的主要危险因素之一。我们描述了 evolocumab 治疗高脂血症的临床特征、治疗模式和有效性。方法通过对哥伦比亚接受 evolocumab 作为临床治疗一部分的高脂血症患者进行病历回顾,开展了一项观察性研究。共有 101 名患者(87.8%)有心血管疾病史,13 名患者(11.3%)有家族性高胆固醇血症(FH),23 名患者(20%)有 2 型糖尿病。39名患者(33.9%)表示对任何他汀类药物不耐受。开始使用 evolocumab 前,低密度脂蛋白胆固醇的中位值为 147 mg/dL(IQR:122.5-183.7 mg/dL)。在治疗的前 3 个月,低密度脂蛋白胆固醇的中位值降至 53 毫克/分升(IQR:34.0-95.5 毫克/分升),降幅达 63.9%。直到随访结束,低密度脂蛋白胆固醇的中位值一直保持在 45 毫克/分升以下。在有数据可查的患者中,高达61%的患者在10-12个月的随访中将低密度脂蛋白胆固醇水平降至55毫克/分升以下。共有72%的患者坚持治疗。安全性结果显示,住院率(≤2%)和治疗引发的药物不良反应发生率(5.2%)较低。结论Evolocumab可降低LDL-C水平,在治疗的前3个月内相对降幅达63.9%。因不良事件而中断治疗的比例较低,且有足够的用药持续性。
{"title":"Multizonal observational study conducted by clinical practitioners on Repatha® use in patients with hyperlipidemia (ZERBINI): Colombian results","authors":"Heidy M. Roncancio ,&nbsp;Julián R. Lugo-Peña ,&nbsp;Ángel A. García ,&nbsp;Janeth Leal ,&nbsp;Carlos A. Hoyos ,&nbsp;Johnny A. Beltrán ,&nbsp;César L. Cruz ,&nbsp;Carol Paez-Cano ,&nbsp;Mariana Pineda-Posada ,&nbsp;Eduardo Contreras","doi":"10.1016/j.arteri.2023.06.001","DOIUrl":"10.1016/j.arteri.2023.06.001","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular disease (CVD) represents the primary cause of death and disability globally, with elevated cholesterol as one of the leading risk factors for CVD. We describe the clinical characteristics, treatment patterns, and effectiveness of evolocumab in treating hyperlipidemia.</p></div><div><h3>Methods</h3><p>Observational study conducted through a chart review of patients with hyperlipidemia receiving evolocumab as part of clinical management in Colombia.</p></div><div><h3>Results</h3><p>This study included 115 patients treated with evolocumab. A total of 101 patients (87.8%) had a history of CVD, 13 (11.3%) familial hypercholesterolemia (FH), and 23 (20%) type 2 diabetes. Thirty-nine patients reported intolerance to any statin (33.9%). The median value of LDL-C before initiation of evolocumab was 147<!--> <!-->mg/dL (IQR: 122.5–183.7<!--> <!-->mg/dL). Within the first 3 months of treatment, LDL-C value dropped to a median value of 53<!--> <!-->mg/dL (IQR: 34.0–95.5<!--> <!-->mg/dL), showing a reduction of 63.9%. The median LDL-C values remained below 45<!--> <!-->mg/dL until the end of follow-up. Among the patients with available data, up to 61% achieved an LDL-C level below 55<!--> <!-->mg/dL at the 10–12-month follow-up. A total of 72% of patients were persistent with treatment. Safety results showed a low frequency of hospitalizations (≤2%) and treatment-emergent adverse drug reactions (5.2%). No serious adverse events were reported.</p></div><div><h3>Conclusions</h3><p>Evolocumab was associated with reductions in LDL-C levels, with a relative decrease of 63.9% within the first 3 months of treatment. Low rates of interruptions due to adverse events and adequate medication persistence was reported.</p></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0214916823000517/pdfft?md5=6ea6bc5dc42de8e64538f70e91a0cee9&pid=1-s2.0-S0214916823000517-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9776691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Valoración del riesgo aterogénico. ¿Lo podemos mejorar? 致动脉粥样硬化风险评估--我们能改进它吗?
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2024.01.001
José Puzo Foncillas
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引用次数: 0
Widespread xanthomas regression by personalized lipid lowering therapy in heterozygous familial hypercholesterolemia 个体化降脂治疗在杂合子家族性高胆固醇血症中广泛的黄瘤消退。
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2023.11.002
Francesco Sbrana, Beatrice Dal Pino, Federico Bigazzi, Tiziana Sampietro

“The lower, the better” is the recommended approach in the management of high LDL cholesterol. Unfortunately, this does not always achieve as in the case of a 69-year-old woman referred to our Institute for her lipid profile (LDL cholesterol 412 mg/dl), bilateral xanthelasma and cutaneous xanthomas. With a maximized and personalized lipid-lowering therapies (rosuvastatin, ezetimibe, PCSK9i and lipoprotein apheresis), after only six months, the patient showed an impressive regression in her cutaneous xanthomas.

“越低越好”是治疗高LDL胆固醇的推荐方法。不幸的是,这并不总是能够实现,例如一位69岁的女性因其脂质谱(低密度脂蛋白胆固醇412mg/dl)、双侧黄斑瘤和皮肤黄斑瘤而来到我们研究所。通过最大化和个性化的降脂治疗(瑞舒伐他汀、依泽替米贝、PCSK9i和脂蛋白分离),仅仅6个月后,患者的皮肤黄瘤出现了令人印象深刻的消退。
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引用次数: 0
Nuevo índice aterogénico para la predicción de aterosclerosis carotídea basado en la ratio proteína C reactiva no ultrasensible/HDL 基于非超敏 C 反应蛋白/高密度脂蛋白比值的新动脉粥样硬化预测指数
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2023.07.002
Óscar Fabregat-Andrés , Pilar Pérez-de-Lucía , Victor E. Vallejo-García , Pablo Vera-Ivars , Alfonso A. Valverde-Navarro , José María Tormos

Introduction

Current guidelines recommend cardiovascular risk assessment as a preventive measure for cardiovascular diseases, whose fundamental etiology is arteriosclerosis. One of the tools used to estimate risk in clinical practice are atherogenic indices (AI), ratios between lipid fractions with well-established reference ranges. Despite its widespread use, there is still limited information on its clinical utility. In recent years, some research has reinforced the role of inflammation in the etiology and chronicity of the atherosclerotic process. The inclusion of inflammatory parameters in the AI calculation could improve its diagnostic performance in the detection of arteriosclerosis. We sought to evaluate a new AI as a ratio between C-reactive protein (CRP) values and high-density lipoprotein cholesterol (HDL) values.

Methods

A total of 282 asymptomatic patients with no history of cardiovascular disease were included in the study. Laboratory tests with lipid profile and CRP, and carotid ultrasound to assess the presence of atheromatosis were performed in all of them. The new AI is established as the ratio between non-ultrasensitive CRP value in mg/dL (multiplied by 100) and HDL value in mg/dL. It was compared with the Castelli I and II indices, and the plasma atherogenic index. The optimal cut-off point of the new AI was value = 1 as determined by ROC curve, with an area under the curve of 0.678 (95% CI 0.60-0.75; p < 0.001).

Results

Mean age of patients was 60.4 ± 14.5 years. A total of 118 patients (41.8% of total) had carotid arteriosclerosis. When evaluating the diagnostic performance of different AIs, we found that CRP·100/HDL ratio showed the highest values of sensitivity and positive predictive value (0.73 and 0.68, respectively) compared to the Castelli I and II indices, and the plasma atherogenic index. It was also the only predictor of carotid atheromatosis both when considering its values quantitatively (with OR 1.4 [95% CI 1.1-1.7]; p = 0.005), and qualitatively (with OR 2.9 [95% CI 1.5-5.5]; p < 0.001) in patients with a CRP·100/HDL ratio > 1.

Conclusions

The new PCR·100/HDL index showed the best diagnostic performance in the detection of carotid atheromatosis compared to other classic AIs in this Spanish population of asymptomatic patients.

导言:现行指南建议将心血管风险评估作为心血管疾病的预防措施,而心血管疾病的根本病因是动脉硬化。在临床实践中,用于评估风险的工具之一是致动脉粥样硬化指数(AI),即具有明确参考范围的脂质组分之间的比率。尽管其应用广泛,但有关其临床实用性的信息仍然有限。近年来,一些研究强化了炎症在动脉粥样硬化病因和慢性过程中的作用。将炎症参数纳入 AI 计算可提高其在动脉硬化检测中的诊断性能。我们试图评估一种新的 AI,即 C 反应蛋白(CRP)值与高密度脂蛋白胆固醇(HDL)值之间的比值。研究共纳入 282 名无症状、无心血管疾病史的患者,对他们全部进行了血脂和 CRP 实验室检测,并进行了颈动脉超声检查以评估是否存在动脉粥样硬化。新的 AI 值是以毫克/分升为单位的非超敏 CRP 值(乘以 100)与以毫克/分升为单位的 HDL 值之间的比值。它与卡斯特里 I 和 II 指数以及血浆致动脉粥样硬化指数进行了比较。结果 患者平均年龄为(60.4 ± 14.5)岁。共有 118 名患者(占总数的 41.8%)患有颈动脉硬化。在评估不同 AI 的诊断性能时,我们发现 CRP-100/HDL 比值的敏感性和阳性预测值(分别为 0.73 和 0.68)与 Castelli I 和 II 指数以及血浆致动脉粥样硬化指数相比最高。从定量(OR 1.4 [95% CI 1.1-1.7];P = 0.005)和定性(OR 2.9 [95% CI 1.5-5.5];P < 0.结论在西班牙无症状患者群体中,与其他经典 AI 相比,新的 PCR-100/HDL 指数在检测颈动脉粥样硬化方面显示出最佳诊断性能。
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引用次数: 0
Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria 156000名初级保健成人严重高胆固醇血症的临床特征。
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2023.08.002
Teresa Gijón-Conde , Carolina Ferré Sánchez , Isabel Ibáñez Delgado , Berenice Rodríguez Jiménez , José R. Banegas

Objective

To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM).

Material and methods

Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥ 300 mg/dL or LDL-cholesterol ≥ 220 mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥ 240 mg/dL (≥ 160 mg/dL if lipid-lowering treatment) with triglycerides < 200 mg/dL and TSH < 5 μIU/mL.

Results

156,082 adults ≥ 18 years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95% CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8 years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol < 55, < 70 and < 100 mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95% CI: 1.03%, 0.98-1.08%).

Conclusions

Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

目的:在马德里社区(CAM)的一个大型卫生区的初级保健环境中,检查严重高胆固醇血症(HS)的频率及其临床特征和家族性高胆固醇血症的表型。材料和方法:对69个卫生中心(西北/CAM区)的健康卡受试者进行多中心研究。在任何分析中,HS被定义为胆固醇≥300mg/dL或LDL胆固醇≥220mg/dL(2018年1月1日至2021年12月30日);FH表型为c-LDL≥240mg/dL(如果降脂治疗,则≥160mg/dL)和甘油三酯。6187名受试者患有HS(占所研究实验室测试的3.96%,95%CI:3.87-4.06%)。计算机临床记录中诊断高脂血症的平均演变时间为10.8年,36.5%患有高血压,9.5%患有糖尿病,62.9%超重/肥胖。83.7%的患者服用降脂药物(65.7%为低强度/中等强度,28.6%为高强度/极高强度)。6.1%患有心血管疾病(94.2%接受降脂药物治疗),伴有低密度脂蛋白胆固醇。结论:在初级保健分析的100名患者中,有4名患有HS,治疗水平高,但强度不足,治疗目标实现率低。每100人中就有1人具有FH表型。通过计算机记录识别这两种血脂异常将使其能够更准确、早期地检测,并制定心血管预防策略。
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引用次数: 0
Sueño y riesgo cardiometabólico. Revisión narrativa 睡眠与心脏代谢风险叙述性综述
IF 1.6 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.arteri.2023.08.001
J. Ildefonzo Arocha Rodulfo , Gestne Aure Fariñez , Fernando Carrera

Objectives

Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various chronic diseases, including cardiometabolic, neurodegenerative, and autoimmune diseases.

Material and methods

This is a narrative review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century.

Results

The relationship between sleep disorders and metabolic dysregulation has been clearly established, mainly in the setting of modern epidemic of cardiometabolic disease, a cluster of conditions include obesity, insulin resistance, arterial hypertension, and dyslipidaemia, all of them considered as main risk factor for atherosclerotic cardiovascular disease (ACVD) and its clinical expression such as ischemic ictus, myocardial infarction and type 2 diabetes. Clinically viable tools to measure sleep duration and quality are needed for routine screening and intervention.

Conclusions

In view of what has been exposed in this review, it is evident that the timing, amount, and quality of sleep are critical to reduce the burden of risk factors for several chronic disease, including ACVD and type 2 diabetes, and most relevant in young people. Future research studies should elucidate the effectiveness of multimodal interventions to counteract the risk of short sleep for optimal patient outcomes across the healthcare continuum, especially in young people.

目的睡眠障碍(包括睡眠中断和睡眠时间短)的发病率很高,而且与各种慢性疾病(包括心脏代谢疾病、神经退行性疾病和自身免疫性疾病)的发病风险增加密切相关。结果睡眠障碍与新陈代谢失调之间的关系已得到明确证实,这主要是在现代心血管代谢疾病流行的背景下发生的,这些疾病包括肥胖、胰岛素抵抗、动脉高血压和血脂异常,它们都被认为是动脉粥样硬化性心血管疾病(ACVD)及其临床表现(如缺血性心肌梗塞、心肌梗死和 2 型糖尿病)的主要危险因素。结论 综上所述,睡眠的时间、数量和质量对于减轻包括 ACVD 和 2 型糖尿病在内的多种慢性疾病的风险因素负担至关重要,这一点在年轻人中尤为突出。未来的研究应阐明多模式干预措施的有效性,以抵消睡眠时间过短的风险,从而在整个医疗保健过程中为患者(尤其是年轻人)提供最佳治疗效果。
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Clinica e Investigacion en Arteriosclerosis
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