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Estatinas: Características y Efectos sobre el Control Lipídico en el Niño y Adolescente Obeso Translated title: Statins: Characteristics and Effects on lipid control in obese children and adolescents

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      Abstract

      La obesidad en niños y adolescentes representa un problema emergente de salud pública, siendo el trastorno nutricional y metabólico más prevalente en los países desarrollados. Paralelo a este incremento de obesidad, han hecho su aparición dislipemias a edades cada vez más tempranas. En la última década se han producido novedosos avances en el tratamiento de estas alteraciones lipídicas, fundamentalmente debido a la introducción de las estatinas en su terapia. Su utilidad y eficacia ampliamente demostrada en adultos parece ser igualmente aplicable en el tratamiento de las hipercolesterolemias durante la infancia. En la actualidad son seis ya las estatinas utilizadas en población infantil, habiendo sido analizada su actividad en niños y jóvenes a través de ensayos clínicos, en los que se concluye su eficacia y seguridad para reducir las concentraciones tanto de colesterol total como de colesterol en lipoproteínas de baja densidad (c-LDL) en sangre. El objetivo de este trabajo ha sido ofrecer una revisión actualizada sobre las características de éstas y sus efectos en la mejora clínica de los niveles de lípidos en sangre en niños y adolescentes con sobrepeso y obesidad.

      Translated abstract

      Obesity in children and adolescents is an emerging public health problem, with nutritional and metabolic disorder being most prevalent in developed countries. Parallel to this increase in obesity, dyslipidemia is occurring at increasingly early ages. The last decade has seen advances in novel treatments for these lipid abnormalities, mainly due to the introduction of statin therapy. Its utility and effectiveness amply demonstrated in adults appears to be equally applicable in the treatment of hypercholesterolemia in childhood. Currently there are six statins used in children. Their activity in children and adolescents has been studied in clinical trials, which determined their efficacy and safety to reduce both total cholesterol and low density lipoprotein cholesterol (LDL-c) levels. The aim of this study was to provide an update on the characteristics of these statins and their effects on clinical improvement of blood lipid levels in overweight and in obese children and adolescents.

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      Most cited references 73

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      Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis

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        Structural mechanism for statin inhibition of HMG-CoA reductase.

        HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase (HMGR) catalyzes the committed step in cholesterol biosynthesis. Statins are HMGR inhibitors with inhibition constant values in the nanomolar range that effectively lower serum cholesterol levels and are widely prescribed in the treatment of hypercholesterolemia. We have determined structures of the catalytic portion of human HMGR complexed with six different statins. The statins occupy a portion of the binding site of HMG-CoA, thus blocking access of this substrate to the active site. Near the carboxyl terminus of HMGR, several catalytically relevant residues are disordered in the enzyme-statin complexes. If these residues were not flexible, they would sterically hinder statin binding.
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          Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study.

          Carotid artery intima-media thickness (IMT) is associated with cardiovascular risk factors and is recognized as an important predictive measure of clinical coronary atherosclerosis events in middle-aged and elderly populations. However, information on the association of carotid IMT in young adults with different risk factors measured in childhood, adulthood, or as a cumulative burden of each of the risk factors measured serially from childhood to adulthood is limited. To examine the association between carotid IMT in young adults and traditional cardiovascular risk factors measured since childhood. A cohort study of 486 adults aged 25 to 37 years from a semirural black and white community in Bogalusa, La (71% white, 39% men), who had at least 3 measurements of traditional risk factors since childhood, conducted between September 1973 and December 1996. Association of carotid IMT with risk factors, including systolic blood pressure, lipoprotein levels, and body mass index. Male vs female (0.757 mm vs 0.719 mm) and black vs white (0.760 mm vs 0.723 mm) participants had increased carotid IMT (P<.001 for both). In multivariable analyses, significant predictors for being in top vs lower 3 quartiles of carotid IMT in young adults were childhood measures of low-density lipoprotein cholesterol (LDL-C) level (odds ratio [OR], 1.42, corresponding to 1-SD change specific for age, race, and sex; 95% confidence interval [CI], 1.14-1.78) and body mass index (BMI; OR, 1.25; 95% CI, 1.01-1.54); adulthood measures of LDL-C level (OR, 1.46; 95% CI, 1.16-1.82), high-density lipoprotein cholesterol (HDL-C) level (OR, 0.67; 95% CI, 0.51-0.88), and systolic blood pressure (OR, 1.36; 95% CI, 1.08-1.72); and long-term cumulative burden of LDL-C (OR, 1.58; 95% CI, 1.24-2.01) and HDL-C (OR, 0.75; 95% CI, 0.58-0.97) levels measured serially from childhood to adulthood. An increasing trend in carotid IMT across quartiles of LDL-C level measured in childhood was observed, with a mean value of 0.761 mm (95% CI, 0.743-0.780 mm) for those at the top quartile vs 0.724 mm (95% CI, 0.715-0.734 mm) for those in the lower 3 quartiles (P<.001). Childhood measures of LDL-C level and BMI predict carotid IMT in young adults. The prevention implications of these findings remains to be explored.
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            Author and article information

            Affiliations
            Granada orgnameHospital Universitario San Rafael orgdiv1Unidad de Hospitalización Crónica España
            Granada orgnameUniversidad de Granada orgdiv1Facultad de Ciencias de la Salud orgdiv2Departamento de Enfermería España
            Contributors
            Role: ND
            Role: ND
            Journal
            albacete
            Revista Clínica de Medicina de Familia
            Rev Clin Med Fam
            Sociedad Castellano-Manchega de Medicina de Familia y Comunitaria (Cuenca, Castilla La Mancha, Spain )
            1699-695X
            February 2011
            : 4
            : 1
            : 69-75
            S1699-695X2011000100010

            This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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            Figures: 0, Tables: 0, Equations: 0, References: 42, Pages: 7
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            Product Information: SciELO Spain

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