A. Becerra

Lipoprotein(a) and other lipoproteins in hypothyroid patients before and after thyroid replacement therapy

AIMS To analyse the influence of thyroid hormones on serum lipoprotein(a) (Lp(a)) concentration and other lipid parameters, and hence potentially on coronary artery disease (CAD) risk. METHODS Thirty-six patients with hypothyroidism and 165 age-matched control euthyroid subjects were evaluated in a cross- sectional study, determining thyroid function tests and fasting serum lipids and lipoproteins. In a follow-up study for those hypothyroid patients the same determinations were repeated after normalization of thyroid state by levothyroxine (L-T(4)) replacement therapy. Patients needing other treatments were excluded. At baseline, patients with hypothyroidism had significantly higher levels of Lp(a), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A-I and apo B, and a higher TC/high-density lipoprotein cholesterol (HDL-C) ratio than control subjects. RESULTS Severity of the hypothyroid state, expressed by serum thyroid-stimulating hormone, was correlated with serum levels of Lp(a), LDL-C, and TC (r= 0.64, 0.52, 0.49, P= 0.005, P= 0.033, P= 0. 048, respectively). The pretreatment Lp(a) levels were also correlated with those of posttreatment Lp(a)(r= 0.68, P= 0.002). All patients, who presented basal Lp(a) levels higher than 30 mg/dl, showed a decrease in Lp(a) concentrations by L-T(4)therapy, and these normalized in eight cases (22.2%). Euthyroid state gave rise to a significant reduction of serum Lp(a) by 32.3%, of LDL-C by 22. 8%, of TC by 17%, of apo A-I by 9.6%, and of apo B by 9.3%. After L-T(4)therapy, CAD risk, expressed as TC/HDL-C ratio, decreased by 19.9%. CONCLUSIONS These results show that hypothyroidism is associated not only with elevated serum levels of LDL-C but also with elevated serum Lp(a) concentrations. Lp(a) levels may be at least partially modulated by thyroid hormone-dependent mechanisms, thus increasing the risk of developing premature atherosclerosis in hypothyroid state, that might be reduced by L-T(4)therapy.

A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients

Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 μg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.

Índices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población española

INTRODUCTION The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.

Estudio de prevalencia de Helicobacter pylori y Chlamydia pneumoniae en placas de ateroma de pacientes diabéticos y no diabéticos con arteriosclerosis

Fundamento La arteriosclerosis se comporta como un proceso inflamatorio cronico. Algunos estudios han sugerido que Chlamydia pneumoniae y Helicobacter pylori pueden representar un papel en la patogenia de la arteriosclerosis en pacientes diabeticos y no diabeticos. EL objetivo del estudio fue determinar mediante cultivo y reaccion en cadena de la polimerasa (PCR), la presencia de C. pneumoniae y H. pylori en arterias de pacientes con arteriosclerosis. Metodos y resultados El estudio presenta un diseno transversal, con 40 pacientes (22 diabeticos y 18 no diabeticos) sometidos a una intervencion de revascularizacion. Se recogieron muestras de ateroma y se utilizaron los siguientes metodos de deteccion de la infeccion: PCR y cultivo de las placas de ateroma para detectar C. pneumoniae y H. pylori. Se utilizo la serologia para determinar el contacto previo del paciente con el germen. En el grupo total, 29 pacientes (72,5%) presentaban serologia positiva a H. pylori y 20 (50%) a C. pneumoniae (p Conclusion En este estudio se demuestra la nula presencia de H. pylori y escasa de C. pneumoniae en placas de ateroma. La relacion entre arteriosclerosis e infeccion por C. pneumoniae, pero no por H. pylori, podria explicarse por infeccion directa de la pared arterial.

OriginalÍndices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población españolaAnthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population

INTRODUCTION The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.

Effect of metformin on cardiovascular risk factors in obese type 2 diabetic patients

Background Obese patients with type 2 diabetes mellitus often are in poor glycaemic control. Weight gain, hyperlipidemia and hypertension accompain insulin therapy in these patients. Objective The aim of our study was to evaluate the effect of metformin on these parameters in obese type 2 diabetic patients previously treated with other therapies. Design A group of 78 type 2 diabetic outpatients in poor glycaemic control (HbA 1c > 7.5%) and overweight (BMI > 25) were analyzed prospectively. All patients were treated with metformin during three months in a step up dosage schedule. Anti-hypertensive and anti-lipid therapy remained unchanged during the study. All patients remained with the same dietary intake (1.500 calories) and exercise. Results A decrease in basal glucose (24.8%) (173 ± 29.8 mg/dl vs 134.8 ± 21.4 mg/dl; p 1c levels (15.4%) (8.5 ± 1.4% vs 7.2 ± 1.1%; p 1c Conclusions In summary, the addition of metformin improved glycaemic, lipid and blood pressure control in obese diabetic type 2 patients in por glycemic control with a low incidence of side effects.