Dyslipidemia and blood lipid levels in patients tratied in primary care centers in east SAN JOSE

Dyslipidemia, i.e. high levels of blood lipids (cholesterol and triglycerides), is strongly related to cardiovascular disease (CVD). In order to reduce the risk of CVD at any moment in a person ́s life, it is crucial to know his/her –and the population’s– lipid profile. The aim of this study was to assess the (statistical) indicators of blood lipids and the prevalence of dyslipidemia in patients treated in the Integral Health Attention Program from Universidad de Costa Rica. A descriptive study was conducted including 10,044 patients aged 20 to 65 years, who were tested for a blood lipid profile in 2006. A total of 2,969 (29.6%) male and 7,075 (70.4%) female patients took part in the study, with an average age of 43.5 years. General averages for blood lipids were: 203.3 mg/dl for total cholesterol, 50.1 mg/dl for HDL, 120.1 mg/dl for LDL, and 165.6 mg/dl for triglycerides. Prevalence of 17.2% was determined for hypercholesterolemia (≥240 mg/dl), as well as 21.3% for low HDL levels (<40 mg/dl), 11.9% for high LDL levels (≥160 mg/dl), and 26.3% for high triglyceride levels (≥200 mg/dl). Women showed higher overall levels of dyslipidemia than men. Based on health areas, no significant differences were found in general lipid levels by age or sex. Results indicate that the general prevalence of dyslipidemia is close to half the rate reported in worldwide literature and lower than results reported in Costa Rican studies. However, general averages exceeded optimal levels for each blood lipid; consequently, it is important to develop health interventions oriented to reduce the impact of dyslipidemia in the studied population.

Prevalencia y factores de riesgo del síndrome metabólico en pacientes con tratamiento antirretroviral (ARV) que acuden a consulta en el Hospital Vicente Corral Moscoso. Cuenca, 2015

ANTECEDENTES: Desde el año 1987, el impacto y aumento del VIH/SIDA ha llevado a implementar e incrementar combinaciones de Antirretrovirales (ARV), consiguiendo una disminución de la mortalidad en un 35%; sin embargo, nos enfrentamos a otra problemática, la aparición de efectos adversos a largo plazo de estos medicamentos, englobándole al Síndrome Metabólico. OBJETIVO GENERAL: Determinar la prevalencia y factores de riego del Síndrome Metabólico en pacientes que usen Antirretrovirales en el Hospital Vicente Corral Moscoso. METODOLOGÍA: Se realizó un Estudio Analítico - Transversal de prevalencia. Se incluyó a todos los pacientes que pertenecen a la Unidad de Atención Integral para PVVS-HVCM, mayores de 18 años, que reciben tratamiento antirretroviral por más de un mes previa autorización. La información recolectada fue analizada mediante software SPSS 5. RESULTADOS: en una población de 211 pacientes, se encontró una prevalencia del Síndrome Metabólico de 30,3% (n=64) según criterios de IDF. Las variables relacionadas al síndrome metabólico fueron: Edad 42,86 (p 0,000); Sexo femenino 51.6% y masculino 48.4% (p 0,001); IMC: sobrepeso y obesidad 82,8 (p 0,000); Perímetro abdominal 100% (p 0,000); Perfil lipídico: hipertrigliceridemia 86% (p 0,000), hipercolesterolemia 53% (p 0,012), alteración de HDL 83% (p 0,000). CONCLUSIONES: Se encontró una elevada prevalencia de Síndrome Metabólico en pacientes HIV+/SIDA con tratamiento antirretroviral pero no se pudo encontrar relación estadísticamente significativa. Mientras que los factores de riesgo fueron: edad, sexo, IMC, Perímetro Abdominal y dislipidemias

Hábitos de consumo de alimentos enriquecidos com fitoesteróis

O interesse crescente pelos alimentos enriquecidos com esteróis vegetais deve-se ao fato de que estes diminuem as concentrações sanguíneas de colesterol sem efeitos adversos colaterais. Neste contexto, o enriquecimento de alimentos com esteróis vegetais poderá constituir uma ajuda importante na proteção da população contra a aterosclerose e doenças cardiovasculares. As informações sobre o comportamento alimentar são praticamente inexistentes em Portugal, pelo que se torna indispensável perceber a importância dos produtos funcionais nos hábitos de consumo. O presente trabalho pretendeu avaliar os hábitos de consumo de uma população de Viseu relativamente aos leites fermentados com baixo teor de gordura enriquecidos com esteróis vegetais e margarinas enriquecidas com fitoesteróis. Para cada produto foram feitos 577 inquéritos a indivíduos escolhidos aleatoriamente numa população que efetuava as suas compras semanais em vários hipermercados da cidade de Viseu. Inquiriu-se sobre vários parâmetros respeitantes a leites fermentados com baixo teor de gordura enriquecidos com esteróis vegetais e margarinas enriquecidas com fitoesteróis. Os resultados preliminares obtidos mostraram que, para a maioria dos inquiridos a compra dos alimentos era condicionada pelo seu custo elevado. Os indivíduos que afirmaram consumir os produtos eram maioritariamente mulheres com idade entre os 40≤65 anos. Relativamente aos parâmetros avaliados não se observam diferenças estatisticamente significativas entre ambos os sexos. Estes inquiridos ingeriam maioritariamente o alimento 1vez/dia (leites fermentados, margarina (fatia/dia)) fazendo esta escolha por apresentarem colesterol elevado ou por lhes atribuírem efeitos preventivos para a doença. Para além disso quer os que estavam sob terapêutica antidislipidémica quer os que não estavam declararam observar efeitos positivos na hipercolesterolemia. Parece evidente que são as preocupações com a saúde que influenciam a aquisição dos leites fermentados com baixo teor de gordura e margarinas enriquecidos com fitoesteróis. As declarações feitas sobre os níveis de colesterol, ingestão declarada e efeitos observados parecem sugerir uma ingestão com quantidade e frequência suficiente. Também a faixa etária que mais consome parece estar de acordo com as recomendações. A elevada taxa de não consumidores encontrada no estudo e que alega não necessidade e descrença de efeitos mesmo quando tal não acontece pode atribuir-se à escassez de informação nos rótulos e/ou custo acrescido do produto. Esclarecer sobre a importância da inclusão destes produtos na dieta sozinhos ou como coadjuvantes de terapêutica instituída poderá ser uma forma de conseguir o equilíbrio na gestão da hipercolesterolemia.

Effects of fibrosis morphology on reentrant ventricular tachycardia inducibility and simulation fidelity in patient-derived models

Myocardial fibrosis detected via delayed-enhanced magnetic resonance imaging (MRI) has been shown to be a strong indicator for ventricular tachycardia (VT) inducibility. However, little is known regarding how inducibility is affected by the details of the fibrosis extent, morphology, and border zone configuration. The objective of this article is to systematically study the arrhythmogenic effects of fibrosis geometry and extent, specifically on VT inducibility and maintenance. We present a set of methods for constructing patient-specific computational models of human ventricles using in vivo MRI data for patients suffering from hypertension, hypercholesterolemia, and chronic myocardial infarction. Additional synthesized models with morphologically varied extents of fibrosis and gray zone (GZ) distribution were derived to study the alterations in the arrhythmia induction and reentry patterns. Detailed electrophysiological simulations demonstrated that (1) VT morphology was highly dependent on the extent of fibrosis, which acts as a structural substrate, (2) reentry tended to be anchored to the fibrosis edges and showed transmural conduction of activations through narrow channels formed within fibrosis, and (3) increasing the extent of GZ within fibrosis tended to destabilize the structural reentry sites and aggravate the VT as compared to fibrotic regions of the same size and shape but with lower or no GZ. The approach and findings represent a significant step toward patient-specific cardiac modeling as a reliable tool for VT prediction and management of the patient. Sensitivities to approximation nuances in the modeling of structural pathology by image-based reconstruction techniques are also implicated.

Élucidation et identification des différents interacteurs impliqués dans le mécanisme de régulation du LDLR par la protéine PCSK9

Résumé : Les maladies cardiovasculaires représentent la principale cause de mortalité mondiale, soit le tiers des décès annuels selon l’Organisation mondiale de la Santé. L’hypercholestérolémie, caractérisée par une élévation des niveaux plasmatiques de lipoprotéines de faible densité (LDL), est l’un des facteurs de risque majeur pour les maladies cardiovasculaires. La proprotéine convertase subtilisine/kexine type 9 (PCSK9) joue un rôle essentiel dans l’homéostasie du cholestérol sanguin par la régulation des niveaux protéiques du récepteur LDL (LDLR). PCSK9 est capable de se lier au LDLR et favorise l’internalisation et la dégradation du récepteur dans les lysosomes. L’inhibition de PCSK9 s’avère une cible thérapeutique validée pour le traitement de l’hypercholestérolémie et la prévention des maladies cardiovasculaires. Par contre, plusieurs mécanismes responsables de la régulation et la dégradation du complexe PCSK9-LDLR n’ont pas encore été complètement caractérisés comme la régulation par la protéine annexin A2 (AnxA2), un inhibiteur endogène de PCSK9. De plus, plusieurs évidences suggèrent la présence d’une ou plusieurs protéines, encore inconnues, impliquées dans le mécanisme d’action de PCSK9. Celles-ci pourraient réguler l’internalisation et le transport du complexe PCSK9-LDLR vers les lysosomes. Les objectifs de cette thèse sont de mieux définir le rôle et l’impact de l’AnxA2 sur la protéine PCSK9 en plus d’identifier de nouveaux partenaires d’interactions de PCSK9 pour mieux caractériser son mécanisme d’action sur la régulation des niveaux de LDLR. Nous avons démontré que l’inhibition de PCSK9 par l’AnxA2 extracellulaire s’effectue via sa liaison aux domaines M1+M2 de la région C-terminale de PCSK9 et nous avons mis en évidence les premières preuves d’un contrôle intracellulaire de l’AnxA2 sur la traduction de l’ARNm de PCSK9. Nos résultats révèlent une liaison de l’AnxA2 à l’ARN messager de PCSK9 qui cause une répression traductionnelle. Nous avons également identifié la protéine glypican-3 (GPC3) comme un nouveau partenaire d’interaction extracellulaire avec le PCSK9 et intracellulaire avec le complexe PCSK9-LDLR dans le réticulum endoplasmique des cellules HepG2 et Huh7. Nos études démontrent que GPC3 réduit l’activité extracellulaire de PCSK9 en agissant comme un compétiteur du LDLR pour la liaison avec PCSK9. Une meilleure compréhension des mécanismes de régulation et de dégradation du complexe PCKS9-LDLR permettra de mieux évaluer l’impact et l’efficacité des inhibiteurs de la protéine PCSK9.

Determinación del comportamiento del riesgo cardiovascular en paciente postrasplante hepatico en Fundacion Cardioinfantil

El trasplante hepático es una opción terapéutica para enfermedad hepática avanzada cada vez más frecuente en Colombia. La sobrevida del 80% a 5 años conlleva a un aumento del riesgo cardiovascular y de eventos cardiovasculares, por esta razón esta investigación determina el comportamiento del riesgo cardiovascular en los pacientes con trasplante hepático de la Fundación Cardioinfantil, realizado en 3 años de seguimiento . Lo encontrado en esta investigación es que existe un aumento del riesgo cardiovascular a tres años en pacientes post trasplante hepático, estadísticamente significativo, principalmente secundario a hipertensión, diabetes e hipertrigliceridemia. El aumento es mayor a lo descrito en la población general, y similar a otros pacientes trasplantados, en un periodo de 5 años

Population’s knowledge about cerebrovascular accident (stroke) - passers of the square giraldo in Evora

Stroke is the leading cause of death in Portugal and the Alentejo region. Objective: Describe the population's knowledge about risk factors, signs and symptoms of stroke. Methodology: Quantitative and cross-sectional study. Convenience sample of 207 pedestrians with ages between 16 and 86 years old (M=38,85; SD = 18.93). Results: The pathology is known, the most frequently mentioned sources of information are television and friends. Hypercholesterolemia, heart disease and smoking are the risk factors more set out. The most well known signs are numbness and weakness in the hemisphere and dysarthria. Conclusion: It is necessary to strengthen the role of health services in education about stroke. Knowledge displays weaknesses in appreciation of advanced age and diabetes. Noteworthy is the recognition of the risk associated with tobacco consumption and persistence on it.

Sex differences in coronary artery disease severity and mortality: the impact of conventional cardiovascular risk factors

It is still unknown whether traditional risk factors may have a sex specific impact on the severity of coronary artery disease (CAD) and subsequent mortality in acute coronary syndromes (ACS). We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS-TC (NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between conventional risk factors and severity of CAD and its relationship with 30-day mortality. Risk ratios (RRs) and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Severity of disease was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD, specifically Ischemia and No Obstructive Coronary Artery disease (INOCA) and Myocardial Infarction with Non obstructive Coronary Arteries (MINOCA). The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49(95%CI,0.41–0.60) and among those with diabetes mellitus was 0.89(95% CI,0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95%CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex-related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30-day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with INOCA/MINOCA. In conclusion, obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions.

Traditional risk factors and lifetime risk of acute coronary events

Objective: To investigate the association between the four traditional coronary heart disease (CHD) risk factors (hypertension, smoking, hypercholesterolemia, and diabetes) and outcomes of first ACS. Methods: Data were drawn from the ISACS Archives. The study participants consisted of 70953 patients with first ACS, but without prior CHD. Primary outcomes were patient’ age at hospital presentation and 30-day all-cause mortality. The risk ratios for mortality among subgroups were calculated using a balancing strategy by inverse probability weighting. Trends were evaluated by Pearson's correlation coefficient (r). Results: For fatal ACS (n=6097), exposure to at least one traditional CHD-risk factor ranged from 77.6% in women to 74.5% in men. The presence of all four CHD-risk factors significantly decreased the age at time of ACS event and death by nearly half a decade compared with the absence of any traditional risk factors in both women (from 67.1±12.0 to 61.9±10.3 years; r=-0.089, P<0.001) and men (from 62.8±12.2 to 58.9±9.9 years; r=-0.096, P<0.001). By contrast, there was an inverse association between the number of traditional CHD-risk factors and 30-day mortality. The mortality rates in women ranged from 7.7% with four traditional CHD-risk factors to 16.3% with no traditional risk factors (r=0.073, P<0.001). The corresponding rates in men were 4.8% and 11.5% (r=0.078, P<0.001), respectively. The risk ratios among individuals with at least one CHD-risk factors vs. those with no traditional risk factors were 0.72 (95%CI:0.65-0.79) in women and 0.64 (95%CI:0.59-0.70) in men. This association was consistent among patient subgroups managed with guideline-recommended therapeutic options. Conclusions: The vast majority of patients who die for ACS have traditional CHD-risk factor exposure. Patients with CHD-risk factors die much earlier in life, but they have a lower relative risk of 30-day mortality than those with no traditional CHD-risk factors, even in the context of equitable evidence‐based treatments after hospital admission.