Anel Gómez-García

Rosuvastatina y metformina reducen la inflamación y el estrés oxidativo en pacientes con hipertensión y dislipemia

Introduccion y objetivos La hipertension arterial (HTA) y la dislipemia incrementan el riesgo de enfermedad cardiovascular a traves de los efectos proinflamatorios y el estres oxidativo. Nuestro objetivo fue estimar el efecto de la rosuvastatina y la metformina en la inflamacion y el estres oxidativo en pacientes con HTA y dislipemia. Metodos En un ensayo clinico abierto paralelo, se estudio a 48 pacientes con HTA y dislipemia. Se trato a 16 pacientes con rosuvastatina 10 mg/dia, 16 con metformina 1.700 mg/dia y 16 con 10 mg de almidon como control. Las variables analizadas durante el estudio fueron edad, peso, indice de masa corporal (IMC), presion arterial, glucosa, colesterol total (CT), de las lipoproteinas de baja densidad (cLDL) y de las lipoproteinas de alta densidad (cHDL), trigliceridos (TG), interleucina 6 (IL-6), factor de necrosis tumoral alfa (TNFα), glutation reductasa (GSH), glutation peroxidasa (GPx) y superoxido dismutasa (SOD). Resultados Con 10 mg/dia de rosuvastatina, disminuyeron el CT (41,7%), el cLDL (63%) y los TG (10,7%) y se incremento el cHDL (6,3%). Despues del tratamiento farmacologico con rosuvastatina o metformina, se encontro disminucion e interaccion entre grupos en la IL-6, el TNFα, la GSH y la GPx e incremento en la SOD. Conclusiones La rosuvastatina mejoro el perfil de lipidos. Ambos farmacos reducen la inflamacion y el estres oxidativo. Estos resultados demuestran un efecto adicional cardioprotector, como un mecanismo de accion direc-to o a traves de sus efectos pleiotropicos. Son necesarios estudios adicionales a largo plazo para determinar si la rosuvastatina o la metformina seran farmacos utiles para disminuir el riesgo cardiovascular causado por el estres oxidativo y la inflamacion.

Association between angiotensin-1 converting enzyme gene polymorphism and the metabolic syndrome in a Mexican population

Metabolic Syndrome (MS) is recognized as a cluster of cardiovascular risk factors. All components of MS have a genetic base. Genes of the renin angiotensin system are potential candidate genes for MS. We investigated whether angiotensin converting enzyme (ACE) gene polymorphism increases susceptibility to MS as an entity in a Mexican population. In a cross-sectional study, 514 individuals were studied including 245 patients with MS and 269 subjects without MS criteria. ACE gene polymorphism was detected using PCR. MS was defined according to The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria, except that the raised fasting plasma glucose ≥ 100 mg/dl criterion for identification of intolerance fasting glucose was modified in accordance with the suggestion of the American Diabetes Association. Patients with MS were significantly different from subjects without MS in relation to mean body mass index (BMI), waist circumference (WC), systolic blood pressure, diastolic blood pressure, glucose, total cholesterol (C), triglycerides, HDL-C, and LDL-C (P<0.0001). The differences in the mean BMI, WC, glucose, total cholesterol, triglycerides, LDL-C, and HDL-C were maintained in patients with the MS and DD genotypes (P<0.01). The DD genotype was strongly associated with MS (adjusted OR=5.48, 95% CI 3.20-9.38, P<0.0001). We concluded that the DD genotype increases susceptibility to MS in a Mexican population. These results indicate that pharmacological and non-pharmacological treatment and a reduction in body fat will have important therapeutic implications in this disease.

[Effect of oral zinc administration on insulin sensitivity, leptin and androgens in obese males].

BACKGROUND Zinc is important for insulin synthesis, storage and secretion. When zinc concentration decrease, there is a concomitant reduction in insulin secretion and peripheral insulin sensitivity. AIM To assess the effects of zinc sulfate on insulin sensitivity, leptin and androgens in obese individuals. MATERIAL AND METHODS A randomized, double-blind, placebo-controlled clinical trial was performed in 14 obese volunteers between 21 and 30 years old, with body mass index (BMI) (3) 27 kg/m2. During one month, seven subjects received 100 mg/day of zinc sulfate orally (ZnG) and the other seven received placebo, as control group (CG). At baseline and after the intervention, insulin sensitivity was measured using a euglycemic-hyperinsulinemic clamp technique. Blood glucose, serum lipids, zinc, androgens and leptin were also measured in a fasting blood sample. RESULTS After the intervention, a rise in zinc concentrations from 11.8 to 16.9 umol/L; p=0.001 and in leptin levels from 15.2 to 27.7 ng/mL; p=0.029, was observed in the ZnG. No changes were observed in the CG. There were no significant changes in insulin sensitivity and androgens after the intervention with zinc sulfate. CONCLUSIONS Zinc increased the leptin concentrations in obese individuals, but did not modify insulin sensitivity and androgens.

Hiperleptinemia como factor de riesgo en hipertensión arterial asociada a obesidad

FUNDAMENTO Y OBJETIVO Algunas observaciones otorgan un papel relevante al hongo Alternaria alternata como desencadenante de crisis de asma de riesgo vital (ARV). El objetivo de este trabajo fue determinar si las crisis de ARV de los pacientes sensibilizados a Alternaria cursan con un perfil clinico diferencial. Pacientes y metodo Estudio descriptivo y multicentrico (33 hospitales espanoles) de 194 pacientes incluidos de forma prospectiva por padecer una crisis de ARV. Se recogieron las caracteristicas y el curso clinico de la crisis, y cuando alcanzaron la estabilidad clinica se les practicaron una espirometria, pruebas cutaneas de alergia y determinacion de IgE a Alternaria. Se establecio la sensibilizacion a Alternaria cuando la prueba cutanea o bien la IgE especifica resultaron positivas. Resultados En 20 de los pacientes (10%) se pudo constatar sensibilizacion a Alternaria. En comparacion con el grupo de pacientes no sensibilizados, los sensibilizados a Alternaria resultaron ser significativamente mas jovenes, con una media (DE) de edad de 35 (15) frente a 50 (21) anos (p Conclusiones Las caracteristicas clinicas constatadas en las crisis de ARV de los pacientes sensibilizados a Alternaria parecen distinguirlos como fenotipo particular. Una conducta de evitacion especifica podria comportar efectos beneficiosos al prevenir crisis de ARV en los pacientes sensibilizados.

Efecto de la pentoxifilina sobre la evolución de la nefropatía diabética

BACKGROUND AND OBJECTIVE Diabetic nephropathy (DN) is the principal cause of end-chronic kidney disease. Metabolic and hemodynamic components are directly involved. However, convincing data have shown that inflammation participates in the diabetic complications. The aim of this study was to investigate whether the inhibition of the inflammation and pro-inflammatory cytokines with pentoxifylline (PXF) attenuate the progression of the DN. SUBJECTS AND METHOD In a prospective, randomized, double-blind, placebo- controlled study, we evaluated the effect of PXF (1200 mg daily) during 12 months, in 34 patients with incipient or established DN. Evaluated parameters were inflammation, pro-inflammatory cytokines and urinary albumin excretion (UAE). RESULTS PXF treatment had a reno-protective effect determined by a significant reduction in the UAE in both incipient and established (p<0,01) DN patient. This effect was attributed to a reduction in the C-reactive protein, interleukin-6, tumor necrosis factor-alpha and leptin serum levels (p<0,01). CONCLUSIONS PXF treatment caused regression and prevented the progression of renal damage. Thus, PXF should be used in the preventive treatment of DN. These results showed that inflammation and pro-inflammatory cytokines are related to the progression of diabetic nephropathy.

OriginalEfecto de la pentoxifilina sobre la evolución de la nefropatía diabéticaEffect of pentoxifylline on the evolution of diabetic nephropathy

BACKGROUND AND OBJECTIVE Diabetic nephropathy (DN) is the principal cause of end-chronic kidney disease. Metabolic and hemodynamic components are directly involved. However, convincing data have shown that inflammation participates in the diabetic complications. The aim of this study was to investigate whether the inhibition of the inflammation and pro-inflammatory cytokines with pentoxifylline (PXF) attenuate the progression of the DN. SUBJECTS AND METHOD In a prospective, randomized, double-blind, placebo- controlled study, we evaluated the effect of PXF (1200 mg daily) during 12 months, in 34 patients with incipient or established DN. Evaluated parameters were inflammation, pro-inflammatory cytokines and urinary albumin excretion (UAE). RESULTS PXF treatment had a reno-protective effect determined by a significant reduction in the UAE in both incipient and established (p<0,01) DN patient. This effect was attributed to a reduction in the C-reactive protein, interleukin-6, tumor necrosis factor-alpha and leptin serum levels (p<0,01). CONCLUSIONS PXF treatment caused regression and prevented the progression of renal damage. Thus, PXF should be used in the preventive treatment of DN. These results showed that inflammation and pro-inflammatory cytokines are related to the progression of diabetic nephropathy.

Intima-Media Thickness is Associated With Non-Traditional Risk Factors and Ischemic Heart Disease in Hemodialysis Patients

Dear Editor, Cardiovascular disease (CVD) is the principal cause of morbidity and mortality in chronic kidney disease (CKD). Uremic patients have a risk of death due to CVD that is 10–20 times higher than the general population (1). Several noninvasive imaging techniques to identify and quantify the atherosclerotic process have evolved in recent decades. One of the methods is the measurement of the intima-media thickness of the common carotid arteries (IMT– CCA). In this paper, we present the results obtained from the investigation of the association of age, serum albumin,high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-a, and calcium ¥ phosphorus product (Ca ¥ P) with the IMT–CCA and ischemic heart disease in 48 regular hemodialysis patients and 54 healthy volunteers randomized by sex, age, weight and body mass index.The group of hemodialysis patients was subdivided both with and without ischemic heart disease. IMT-CCA, hs-CRP, IL-6, TNF-a, phosphorus, and Ca ¥ P values were higher, whereas serum albumin levels were lower in hemodialysis patients than those in the control group. These differences were at the expense of the subgroup of hemodialysis patients with ischemic heart disease. IMT–CCA (1.2 0.2 vs. 0.80 0.1 mm, P < 0.0001), hs-CRP (8.8 3.3 vs. 2.7 3.0 mg/mL, P < 0.0001), IL-6 (8.4 3.5 vs. 4.4 2.9 ng/mL, P < 0.0001), TNF-a (9.6 3.2 vs. 4.5 2.5 ng/mL, P < 0.0001), and Ca ¥ P (56.8 11.0 vs. 40.8 12.4 mg/dL, P < 0.01) were higher and serum albumin levels (3.1 0.3 vs. 3.9 0.5 g/dL, P < 0.0001) were lower in the subgroup of hemodialysis patients with ischemic heart disease. Pearson’s correlation shows a positive correlation between IMT-CCA and age, hs-CRP, IL-6, TNF-a and Ca ¥ P, and an inverse correlation with serum albumin values in the studied population. The results are shown in Figure 1. In the stepwise regression analysis, serum IL-6 and Ca ¥ P are independently associated with IMT–CCA. The main finding in our study is that IMT–CCA, serum albumin, hs-CRP, IL-6, TNF-a, and Ca ¥ P differed between hemodialysis patients, with and without ischemic heart disease, and normal individuals. Pearson’s correlation suggests a relationship between age, malnutrition, inflammation, and alterations in mineral metabolism with the development of atherosclerosis both in the general population and in hemodialysis patients. Previous studies have reported that hypoalbuminemia was associated with morbidity and mortality from CVD in patients with end-stage renal disease (2) and with earliest stages of CKD (3), suggesting a possible link between malnutrition, inflammation, and atherosclerosis with CVD morbidity and mortality. In addition, hyperphosphatemia, for its effects on vascular dynamics and in parathyroid hormone levels, significantly increases the risk of morbidity and mortality from CVD in hemodialysis patients (4). Due to the characteristics of our study, we can only establish a relationship between malnutrition, inflammation and abnormalities in the mineral metabolism with CVD morbidity. Longitudinal prospective studies are needed to determine the impact of these risk factors in CVD mortality in our population. In conclusion, this study reports the importance of some non-traditional risk factors and suggests a possible link between malnutrition, inflammation and atherosclerosis with CVD. The hyperphosphatemia and/or Ca ¥ P could be considered as an indirect predictor of atherosclerosis and ischemic heart disease in hemodialysis patients. These are modifiable risk factors; therefore, it will be necessary to implement non-pharmacological and pharmacological strategies for preventing the development and/or progression of renal damage and its cardiovascular complications in at-risk populations.