Lipidograma y metabolismo óseo, estudio clínico y analítico en la cohorte “CARMEN”

La Organización Mundial de Sanidad (OMS) atribuye a la enfermedad cardiovascular (ECV) la principal causa de muerte en el mundo, con 15 millones de fallecimientos por dicha patología según los últimos datos de 2016. La incidencia de ECV aumenta con la edad como también lo hace la incidencia de osteoporosis, una patología esquelética que representa la principal causa de morbilidad en la población anciana. Ambas patologías tienen un importante incremento a partir de la menopausia, de hecho, en España, el 26% de las mujeres mayores de 50 años presentan osteoporosis. La patogénesis de la ECV y de la osteoporosis ha sido ampliamente estudiada. Así, se ha encontrado que la arteriosclerosis representa el principal precursor de la ECV y la dislipemia una de las condiciones predisponentes más importante. Con respecto a la osteoporosis el envejecimiento es el principal factor de riesgo. Tanto la ECV como la osteoporosis son enfermedades multifactoriales, indicando que ambas están gobernadas tanto por factores ambientales como genéticos. Por otra parte, ambas coexisten en la mayoría de las mujeres postmenopáusicas por lo tanto en los últimos años se ha especulado acerca de una relación entre ambas patologías, postulando la existencia de varias alteraciones comunes a ambas enfermedades. Entre estas, varios investigadores han apostado por la dislipemia como base y conexión entre la enfermedad cardiovascular y la osteoporosis. Sin embargo, los estudios realizados para establecer la relación entre valores del perfil lipídico y la densidad mineral ósea (DMO) han sido, hasta la fecha, inconcluyentes. El propósito de la presente tesis doctoral ha sido el de investigar la relación entre dislipemia y perfil óseo en una población de mujeres posmenopáusicas e intentar establecer los parámetros puente entre los dos estados metabólicos por su posible uso en la prevención de estas enfermedades que poseen gran repercusión clínica y socioeconómica en la salud de la población a nivel mundial. Se incluyeron en nuestra investigación 667 mujeres postmenopáusicas de la Comunidad Valenciana a las cuales se les realizaron una anamnesis, una exploración física, una analítica (lipidograma con colesterol total, triglicéridos, HDL y LDL; marcadores del metabolismo óseo completos de betaCTX, OPG, calcio, fosforo y FA; perfil hormonal con FSH, LH y estradiol; glucosa y vitamina D) y una densitometría ósea de cadera y de columna. Los resultados de nuestro estudio demostraron que la pérdida de mineralización ósea en nuestra cohorte era significativa a partir de los 62 años de edad y que la DMO a nivel de cadera se relacionaba con el perfil lipídico y en particular correlacionaba positivamente con los niveles de colesterol total, de HDL y de LDL. En el análisis multivariante el IMC y el colesterol entraron en la ecuación como factores protectores para la osteoporosis/osteopenia a nivel de cadera mientras que, los años transcurridos desde el inicio de la menopausia se asociaron a un mayor riesgo de enfermedad. En la columna, los años de menopausia representaron un factor de riesgo y el IMC un factor protector para la comparsa de osteoporosis/osteopenia.The World Health Organization (WHO) consider cardiovascular disease (CVD) as the leading cause of death in the world, with 15 million deaths from this disease according to the latest data from 2016. The incidence of CVD increases with age as well as it is the incidence of osteoporosis, a skeletal pathology that represents the main cause of morbidity in the elderly population. Both pathologies have a significant increase since the menopause, in fact, in Spain, 26% of women over 50 have osteoporosis. The pathogenesis of CVD and osteoporosis has been widely studied. Thus, it has been found that arteriosclerosis represents the main precursor of CVD and dyslipidemia is one of the most important predisposing conditions. With respect to osteoporosis, aging is the main risk factor. Both CVD and osteoporosis are multifactorial diseases, indicating that both are governed by both environmental and genetic factors. On the other hand, both coexist in the majority of postmenopausal women; therefore, in recent years there has been speculation about a relationship between both pathologies, postulating the existence of several alterations common to both diseases. Among these, several researchers have opted for dyslipidemia as a basis and connection between cardiovascular disease and osteoporosis. However, the studies conducted to establish the relationship between lipid profile values ​​and bone mineral density (BMD) have been, to date, inconclusive. The purpose of this doctoral thesis has been to investigate the relationship between dyslipidemia and bone profile in a population of postmenopausal women and try to establish bridging parameters between the two metabolic states for their possible use in the prevention of these diseases that have great impact and socioeconomic health in the population worldwide. We included 667 postmenopausal women from the Valencian Community who underwent an anamnesis, a physical examination, an analytical (lipidogram with total cholesterol, triglycerides, HDL and LDL, markers of complete bone metabolism of betaCTX, OPG, calcium , phosphorus and FA, hormonal profile with FSH, LH and estradiol, glucose and vitamin D) and bone densitometry of the hip and spine. The results of our study showed that the loss of bone mineralization in our cohort was significant after 62 years of age and that BMD at the hip level was related to the lipid profile and in particular correlated positively with total cholesterol levels , HDL and LDL. In the multivariate analysis, BMI and cholesterol entered the equation as protective factors for osteoporosis / osteopenia at the hip level, while the years since the beginning of menopause were associated with an increased risk of disease. In the column, the menopause years represented a risk factor and the BMI a protective factor for osteoporosis / osteopenia

Comparison of IOTA three-step strategy and logistic regression model LR2 for discriminating between benign and malignant adnexal masses

Aims: To compare the diagnostic performance of two ultrasound-based diagnostic systems for the classification of benign or malignant adnexal masses, the three-step strategy and the predictive logistic regression model LR2, both proposed by the International Ovarian Tumour Analysis (IOTA) Group. Material and methods: Prospective observational study at a single centre that included patients diagnosed with a persistent adnexal mass by transvaginal ultrasound over a period of two years. They were evaluated by a non-expert sonographer by applying the three-step diagnostic strategy and the LR2 predictive model to classify the masses as benign or malignant. Patients were treated surgically or followed up for at least one year, taking as the standard reference for benignity or malignancy the histological diagnosis of the lesion or ultrasound changes suggestive of malignancy during the follow-up period. Sensitivity, specificity, positive and negative likelihood ratios and overall accuracy of both systems was calculated and compared. Results: One hundred patients were included, with a mean age of 50.6 years (range 18-87). Surgery was performed on 62 (62%) patients and 38 (38%) were managed expectantly. Eighty-three (83%) lesions were benign and 17 (17%) were malignant. The IOTA three-step strategy presented sensitivity of 94.1% (95%CI, 86.7-98.3%) and specificity 97.6% (95%CI, 94.8-99%). The LR2 logistic regression model showed sensitivity 94.1% (95%CI, 73-98.9%) and specificity 81.9% (95%CI 72.3-88.7%). Comparison of the two systems showed a statistically significant dif-ference in specificity in favour of the three-step strategy. Conclusions: The IOTA three-step strategy, in addition to being sim-ple to use in clinical practice, has a high diagnostic accuracy for the classification of benignity and malignancy of the adnexal masses, overtaking that of other predictive models such as the LR2 logistic regression model

The mediterranean diet and menopausal health: An EMAS position statement

Introduction: Globally, 985 million women are aged 50 and over, leading to increasing concerns about chronic conditions such as cardiovascular disease, osteoporosis, dementia, and cognitive decline, which can adversely affect quality of life and independent living.Aim: To evaluate the evidence from observational studies and randomized trials on the effects of the Mediterranean diet on short- and long-term menopausal health: estrogen deficiency symptoms, cardiovascular disease, osteoporosis, cognitive and mental health, breast cancer, and all-cause mortality.Materials and methods: Literature review and consensus of expert opinion.Summary recommendations: The Mediterranean diet is a non-restrictive dietary pattern common in the olive-growing areas of the Mediterranean basin. It may improve vasomotor symptoms, cardiovascular risk factors such as blood pressure, cholesterol and blood glucose levels, as well as mood and symptoms of depression. Long-term adherence may: improve cardiovascular risk and events, and death; improve bone mineral density; prevent cognitive decline; and reduce the risk of breast cancer and all-cause mortality.Sistema de Investigacion y Desarrollo (SINDE) of the Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador ; Vice-Rectorado de Investigacion & Postgrado (VRIP) of the Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuado