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      Lipoproteína de baja densidad pequeña y densa y riesgo cardiovascular en pacientes con lupus eritematoso sistémico Translated title: LOW DENSITY LIPOPROTEIN AND CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS.

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          Abstract

          Las enfermedades cardiovasculares (ECV) constituyen la principal causa de morbi-mortalidad en pacientes con lupus eritematoso sistémico (LES). Un factor de riesgo cardiovascular es la dislipidemia, siendo una alteración frecuente en es tos pacientes , caracterizada por incremento de lipoproteín as de b aja densidad ; cuyo fenotipo pe queñas y densas (LDLpd ) ha demostrado ser altamente aterogénico. El objetivo del presente estudio fue evaluar la presencia de LDLpd y factores clásicos de riesgo cardiovascular en pacientes con LES. La muestra estuvo constituida por 24 pacientes con LES y 24 individuos sin patología aparente (Control, CTR). Se midió la presión arterial, se determinó índice de masa corporal (IMC), í ndice cintura cadera (ICC), colesterol total y fraccionado, triglicéridos y se detectó LDLpd mediante electroforesis en gel de a garosa. Al comparar el grupo LES vs CTR se encontró diferencia estadísticamente significativa con presión arterial diastólica (77,45±7,98 mmHg vs 86,6±9,16 mmHg, p=0,00 006), ICC (0,82 ± 0,09 v s 0,86 ± 0,05, p=0,0174), IMC (25,93 ± 5,16 vs 30,15± 6,64, p=0, 036), HDL-c (47,75 ± 7,74 mg/dL vs 53,16± 5,49 mg/dL, p= 0,0134), VLDL-c (23,57 ± 13,01 vs 14,79 ± 5,47 mg/dL, p=0,0002) y triglicéridos (117,8 ± 65,08 vs 73,95 ± 27,35 mg/dL, p=0,0002). La presencia de LDLpd en ambos grupos de estudio se encontró en parámetros del perfil lipidico y/o antropométricos dentro de los valores de referencia y/o elevados. Estos resultados sugieren que un individuo con LES o no , que presente variables que constituyen el perfil lipidico y /o parámetros antropométrico s d entro de los valores de referencia, no lo excluye de desarrollar o presentar un evento cardiovascular.

          Translated abstract

          Cardiovascular diseases are the main cause of morbidity and mortality in patients with systemic lupu s erythematosus (SLE). A car diovascu lar risk factor is dyslipidemia, being a frequen t altera tion in these pa tients, characte rized by increas e of lipoprotein of low density; whose small and dense phenotype (LDLsd) has been shown to be highly athe rogenic. The aim of the prese nt study was to e valuate the presen ce of LDLsd and classic ca rdiovascu lar risk factors in patie nts with S LE. The s ample consisted of 24 patients with SLE and 24 individuals with no apparent disease. Blood pressure was me asured, body mass index (BMI), waist circumference (ICC), lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides) were determined and LDLsd was detected by agarose gel electrophoresis. When comparing the SLE vs CTR group, a statistically significant difference was found with diastolic blood pressure (77.45±7,98 mmHg vs 86.6±9,16 mmHg, p =0.00006), ICC (0.82 ± 0.09 vs 0.86 ± 0.05, p=0.0174), BMI (25.93 ± 5.16 vs 30.15± 6.64, p=0.036), HDL-c (47.75 ± 7.74 mg/ dL vs 53.16± 5.49 mg/ dL, p= 0.0134), VLDL-c (23.57 ± 13.01 vs 14.79 ± 5.47 mg/dL, p=0.0002) and triglycerides (117.8 ± 65 .08 vs 73.95 ± 27.35 mg/ dL, p=0.0002). The presence of LDLsd in both study groups was found lipidic profile and/or anthropom etrics parameters within the reference and/or elevated values. This result suggests that an individual with SLE or not, which presents variables that constitute the lipid profile and / or anthropometric parameters within the reference values, does not exclude it from developing or presenting a cardiovascular event.

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          Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk.

          In a community-based study of 301 subjects from 61 nuclear families, two distinct phenotypes (denoted A and B) were identified by nondenaturing gradient gel electrophoretic analysis of low density lipoprotein (LDL) subclasses. Phenotype A was characterized by predominance of large, buoyant LDL particles, and phenotype B consisted of a major peak of small, dense LDL particles. Previous analysis of the family data by complex segregation analysis demonstrated that these phenotypes appear to be inherited as a single-gene trait. In the present study, the phenotypes were found to be closely associated with variations in plasma levels of other lipid, lipoprotein, and apolipoprotein measurements. Specifically, phenotype B was associated with increases in plasma levels of triglyceride and apolipoprotein B, with mass of very low and intermediate density lipoproteins, and with decreases in high density lipoprotein (HDL) cholesterol, HDL2 mass, and plasma levels of apolipoprotein A-I. Thus, the proposed genetic locus responsible for LDL subclass phenotypes also results in an atherogenic lipoprotein phenotype.
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            Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study.

            Because women with systemic lupus erythematosus (SLE) are 5-8 times more likely to develop coronary heart disease (CHD) than are women in the general population, we assessed the prevalence of classic risk factors for CHD in women with SLE. Consecutive female patients with SLE who were without evidence of CHD and were attending a large lupus clinic in Toronto were studied. The control population was recruited from among age-matched subjects attending a family practice unit for an annual physical examination. The prevalence of classic CHD risk factors and the 10-year risk of a CHD-related event were determined using the Framingham risk assessment formula. Lipid subfractions, other metabolic risk factors, lifestyle variables, and demographic characteristics were also compared between the 2 groups. We studied 250 SLE patients and 250 controls whose mean +/- SD age was 44.8 +/- 12 years and 44.3 +/- 15 years, respectively. Hypertension and diabetes were significantly more common among the SLE patients. Although the SLE patients had a higher mean number of CHD risk factors per patient, the 10-year risk of a CHD-related event, using the Framingham multiple risk factor assessment, was the same in SLE patients and controls (3.2%). Compared with controls, SLE patients had higher levels of very low-density lipoprotein cholesterol and total triglycerides, and had higher levels of homocysteine despite having higher folate levels. Premature menopause, sedentary lifestyle, and an at-risk body habitus were also more prevalent in SLE patients. Women with SLE have a range of detectable coronary risk factors that are not fully reflected in the Framingham risk factor formula. These factors are likely to contribute to the loss of protection from CHD that has been observed in SLE.
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              High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review.

              Epidemiological studies have found no relationship between total cholesterol and stroke risk, but little attention has been paid to high-density lipoprotein-cholesterol (HDL-C). We performed a systematic PubMed literature search for epidemiological studies that examined the association between HDL-C level and stroke or carotid intima-media thickness (IMT). We identified 18 studies on the relationship between HDL-C and stroke risk and 37 on HDL-C and carotid IMT. Eight of ten prospective cohort studies (n=238,739) and three of eight case-control studies (n=3604 cases, 8220 controls) supported an association between elevated HDL-C level and decreased risk of stroke. Prospective cohort studies reporting on relative risk per unit increase in HDL-C showed an 11-15% decreased stroke risk per 10-mg/dl increase in HDL-C. Of 37 studies on carotid IMT, 31 reported cross-sectional, one longitudinal, and five both cross-sectional and longitudinal associations between HDL-C level and carotid IMT. Of 36 cross-sectional studies (n=51,288), 20 showed an inverse association between HDL-C level and carotid IMT. Of six longitudinal studies (n=20,065), three showed no association, one showed a weak association in a subgroup of white women and two showed a significant inverse relationship between HDL-C level and carotid IMT. Pooled estimates could not be calculated because of the variation in study designs and analysis. The weight of evidence in the literature supports an inverse association between HDL-C level and stroke or carotid atherosclerosis, but more data are needed to firmly establish this protective effect.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Role: ND
                Journal
                cs
                Comunidad y Salud
                Comunidad y Salud
                Universidad de Carabobo (Maracay, Aragua, Venezuela )
                1690-3293
                June 2017
                : 15
                : 1
                : 53-62
                Affiliations
                [01] orgnameUniversidad de Carabobo orgdiv1Unidad de Investigación de Lípidos y Lipoproteínas
                [02] orgname2 Instituto Venezolano de Investigaciones Científicas (IVIC) orgdiv1Servicio Médico Elena De Cove. Laboratorio Clínico
                Article
                S1690-32932017000100007
                4e136918-6cb5-4f0b-b40f-a29040478196

                http://creativecommons.org/licenses/by/4.0/

                History
                : 17 November 2016
                : 18 April 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 36, Pages: 10
                Product

                SciELO Venezuela


                systemic lupus erythematosus,lupus eritematoso sistémico,dislipidemia,lipoproteína de baja densidad,obesidad,dyslipidemia,lipoprotein of low density,obesity

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