Isabel Palma

Influence of a Regular, Standardized Meal on Lipid Profile of People withDiabetes

Aims: The need to fast before lipid screening has been questioned in the past years. The aim of this study was to determine the influence of a light meal on the lipid profile in people with diabetes. Methods: 115 participants with type 2 diabetes were recruited between April/2013-August/2014 from our Outpatient Diabetes Education Clinic. Clinical and analytical evaluation took place in 2 moments (8-hour fasting=t0; 2h after a light standardized meal=t1), with measurements of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. Results: Triglycerides concentration increased between the 2 moments (median difference t1-t0=0.07 mmol/L, p=0.002) but the total cholesterol, LDL-cholesterol, HDL-cholesterol and non HDL- cholesterol did not change significantly. Performing an analysis according to the LDL-cholesterol therapeutic goals proposed by Adult Treatment Panel III, we found an agreement between fasting and postprandial assessments of 91.1% for the goal of 2.6 mmol/L (102/112), and of 97.3% for the goal of 1.8 mmol/L (109/112). The same analysis was performed for the secondary goal, non HDL-cholesterol. Conclusion: The data presented suggest that the nonfasting lipid profile can be an alternative to the fasting lipid profile in selected patients. Larger studies are needed to confirm these results and demonstrate an association of nonfasting lipemia and cardiovascular risk in individuals with diabetes.

Lipoprotein apheresis in the management of severe hypercholesterolemia and hyperlipoproteinemia(a)—The Portuguese experience

BACKGROUND Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) are established causal risk factors for cardiovascular disease (CVD). Lipoprotein apheresis is often required for treatment of patients with a high risk for CVD due to hypercholesterolemia and/or hyperlipoproteinemia(a). AIM To describe our experience with lipoprotein apheresis in patients with severe hypercholesterolemia or with hyperlipoproteinemia(a). METHODS We retrospectively investigated patients treated with Lipoprotein apheresis using direct adsorption of lipoproteins (DALI) technique, between December 2008 and March 2018, in our center. Adverse events, acute and long term reductions in lipid parameters were analyzed. RESULTS Between December 2008 and March 2018, a total of 950 treatments were performed in five patients, four with heterozygous familial hypercholesterolemia (HeFH), all on maximally tolerated cholesterol-lowering drug therapy and in one patient with hyperlipoproteinemia(a) and progressive CVD. In the four patients with HeFH we obtained mean acute reductions in LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) of 62.0 ± 7.8% and 60.4 ± 6.8%, respectively. Regarding long-term efficacy we achieved a mean reduction of 43.1% in LDL-C and of 41.2% in non-HDL-C. In the patient with hyperlipoproteinemia(a) we attained mean acute reductions of 60.4 ± 6.4% in Lp(a) and of 75.4 ± 7.3% in LDL-C per session and long term reductions in Lp(a) and LDL-C of 67.4% and 40.5%, respectively. Adverse events were recorded in only 1.2% of treatments. CONCLUSION Lipoprotein apheresis is an efficient and safe treatment in severely hypercholesterolemic patients who are refractory to conservative lipid-lowering therapy or with hyperlipoproteinemia(a) and progressive CVD.

Screening Tests for Hypercortisolism in Patients With Adrenal Incidentaloma

Background: To compare the diagnostic performance of different first-line screening tests for subclinical hypercortisolism (SH) in patients with adrenal incidentaloma (AI). Methods: We studied a series of patients with AI, with no clinical evidence of hormonal hypersecretion. For screening for SH, all patients performed 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC) and 24-h urinary free cortisol (UFC). A control group of patients with confirmed Cushing’s syndrome (CS) was used to calculate the diagnostic performance of the screening tests. Results: In the 83 patients with AI, morning cortisol after 1-mg DST was ? 1.8 ?g/dL in 69.9%, 1.9 to 5 ?g/dL in 26.5% and > 5 ?g/dL in 3.6%. LNSC was elevated in 20.5% and all patients had normal UFC levels. In the control group, composed of 50 patients with confirmed CS, all patients who underwent 1-mg DST had cortisol levels > 1.8 ?g/dL (1.9 to 5 ?g/dL in 16.2% and > 5 ?g/dL in 83.3%); LNSC was elevated in 93.8% and the UFC was increased in 85.4% of patients tested. Overall, for the screening of SH, the 1-mg DST presented a sensitivity and specificity of 100% and 69.9% with its lowest threshold (? 1.8 ?g/dL) and 83.3% and 96.4% with its highest threshold (< 5 ?g/dL). LNSC showed a sensitivity and specificity of 93.8% and 79.5% and the UFC of 85.4% and 100%, respectively. Conclusions: The 1-mg DST at its lowest threshold presented the highest sensitivity in identifying SH, but its low specificity encourages us to consider UFC levels, to reduce false-positive test results. J Endocrinol Metab. 2018;8(4):62-68 doi: https://doi.org/10.14740/jem510w

LDL‐aférese no tratamento de hipercolesterolemia familiar: experiência do Hospital Santo António

INTRODUCTION High plasma levels of low-density lipoprotein (LDL) cholesterol are a risk factor for the development of premature atherosclerosis. Direct adsorption of lipoproteins (DALI) is an apheresis technique by which LDL cholesterol is selectively removed from whole blood. OBJECTIVE The present study describes our experience with DALI LDL apheresis in severely hypercholesterolemic patients. METHODS Three hypercholesterolemic patients suffering from atherosclerotic complications were treated fortnightly by DALI apheresis, in a total of 308 sessions between December 2008 and January 2013. All patients were on the highest tolerated dose of statins and other lipid-lowering drugs. RESULTS The sessions were essentially uneventful, adverse events being recorded in only 3.6% of them. A mean 63.3% acute reduction in LDL cholesterol was obtained. CONCLUSION DALI apheresis proved to be a simple, safe and efficient method of lipid apheresis in hypercholesterolemic patients refractory to conservative lipid-lowering therapy.

Influence of normal food intake on the lipid profile of diabetic patients

The need to fast for the determination of lipid profile has been discussed in the past years, for several reasons: 1) Most of the day time is spent in a postprandial state; 2) The lipid concentrations seem to be only slightly affected by a normal meal; 3) Both fasting and postprandial testing can predict cardiovascular risk.  Recruitment of patients: April/2013 August/2014, Outpatient Diabetes Education Program of Hospital de Santo António