Adverse anthropometric risk profile in biochemically controlled acromegalic patients: comparison with an age- and gender-matched primary care population

GH and IGF-1 play an important role in the regulation of metabolism and body composition. In patients with uncontrolled acromegaly, cardiovascular morbidity and mortality are increased but are supposed to be normalised after biochemical control is achieved. We aimed at comparing body composition and the cardiovascular risk profile in patients with controlled acromegaly and controls. A cross-sectional study. We evaluated anthropometric parameters (height, weight, body mass index (BMI), waist and hip circumference, waist to height ratio) and, additionally, cardiovascular risk biomarkers (fasting plasma glucose, HbA1c, triglycerides, total cholesterol, HDL, LDL, and lipoprotein (a), in 81 acromegalic patients (58% cured) compared to 320 age- and gender-matched controls (ratio 1:4), sampled from the primary care patient cohort DETECT. The whole group of 81 acromegalic patients presented with significantly higher anthropometric parameters, such as weight, BMI, waist and hip circumference, but with more favourable cardiovascular risk biomarkers, such as fasting plasma glucose, total cholesterol, triglycerides and HDL levels, in comparison to their respective controls. Biochemically controlled acromegalic patients again showed significantly higher measurements of obesity, mainly visceral adiposity, than age- and gender-matched control patients (BMI 29.5 ± 5.9 vs. 27.3 ± 5.8 kg/m2; P = 0.020; waist circumference 100.9 ± 16.8 vs. 94.8 ± 15.5 cm; P = 0.031; hip circumference 110.7 ± 9.9 vs. 105.0 ± 11.7 cm; P = 0.001). No differences in the classical cardiovascular biomarkers were detected except for fasting plasma glucose and triglycerides. This effect could not be attributed to a higher prevalence of type 2 diabetes mellitus in the acromegalic patient group, since stratified analyses between the subgroup of patients with acromegaly and controls, both with type 2 diabetes mellitus, revealed that there were no significant differences in the anthropometric measurements. Biochemically cured acromegalic patients pertain an adverse anthropometric risk profile, mainly because of elevated adiposity measurements, such as BMI, waist and hip circumference, compared to an age- and gender-matched primary care population

Factores de riesgo cardiovascular entre pacientes con síndrome de Cushing, curados y no curados con respecto a un grupo control

Objetivos: Describir los factores de riesgo cardiovascular que se presentan en el paciente con Síndrome de Cushing (SC), para establecer programas educativos adaptados a este grupo de pacientes. Método: El ámbito de estudio se desarrolló en el Hospital de Sant Pau, en el Servicio de Endocrinología. Se extrajeron datos de las Historias Clínicas de los pacientes que fueron visitados en consultas con diagnóstico de SC en el 2005, realizándose una recogida retrospectiva. No se excluyó ningún paciente, independientemente de los años de duración de la patología, de las opciones terapéuticas o del tratamiento farmacológico recibido, incluyendo todos los pacientes con SC. Elaboramos una hoja de recogida de datos demográficos, clínicos (peso, índice de masa corporal, tensión arterial, perímetro abdominal) y analíticos (lípidos, glicemia); para el tratamiento informático se utilizó el programa SPSS. Resultados: El perímetro abdominal fue mayor en pacientes no curados (100.8 ±13.9cm) que en controles (89±12.8cm) (p<0.05). Respecto al peso no se encontraron diferencias significativas entre controles (69,9±13,3Kg), curados (69,9±16,5Kg) y no curados (76,4±16,5Kg). El IMC tampoco reflejó diferencias en los tres grupos en estudio: control (26,5±5,2), curados (27,8±6,4) y no curados (29,3±3,8). El colesterol fue más alto en los pacientes curados (5.90±0.92mmol/L) que en controles (5.38±1.07mmol/L) (p<0.05), al igual que los triglicéridos (1.20±0.51mmol/L versus controles 1.05±0.56mmol/L; p<0.05). Ambos grupos de pacientes presentaron presión sistólica mayor que los controles (curados,128.3±16.7mmHg p<0.05; no curados,134.1±13mmHg, p<0.001). Los no curados (78.6±9.2mmHg) presentaron además presión diastólica mayor que los controles (72.3±8.6, p<0.05) Fig.3. No observamos diferencias en la glicemia basal entre los 3 grupos de pacientes. Conclusiones: Los pacientes con SC, curados de su hipercortisolismo y con enfermedad activa presentan mayor riesgo cardiovascular y metabólico, comparados con el grupo control. La enfermera educadora deberá contemplar e incluir en los programas de prevención secundaria a dichos pacientes, para promocionar hábitos saludables, prevenir y controlar sus factores de riesgo. Palabras Clave Síndrome Cushing, educación sanitaria, factores de riesgo cardiovascular

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Refining estimates of availability bias to improve assessments of the conservation status of an endangered dolphin.

Estimation of visibility bias is critical to accurately compute abundance of wild populations. The franciscana, Pontoporia blainvillei, is considered the most threatened small cetacean in the southwestern Atlantic Ocean. Aerial surveys are considered the most effective method to estimate abundance of this species, but many existing estimates have been considered unreliable because they lack proper estimation of correction factors for visibility bias. In this study, helicopter surveys were conducted to determine surfacing-diving intervals of franciscanas and to estimate availability for aerial platforms. Fifteen hours were flown and 101 groups of 1 to 7 franciscanas were monitored, resulting in a sample of 248 surface-dive cycles. The mean surfacing interval and diving interval times were 16.10 seconds (SE = 9.74) and 39.77 seconds (SE = 29.06), respectively. Availability was estimated at 0.39 (SE = 0.01), a value 16-46% greater than estimates computed from diving parameters obtained from boats or from land. Generalized mixed-effects models were used to investigate the influence of biological and environmental predictors on the proportion of time franciscana groups are visually available to be seen from an aerial platform. These models revealed that group size was the main factor influencing the proportion at surface. The use of negatively biased estimates of availability results in overestimation of abundance, leads to overly optimistic assessments of extinction probabilities and to potentially ineffective management actions. This study demonstrates that estimates of availability must be computed from suitable platforms to ensure proper conservation decisions are implemented to protect threatened species such as the franciscana

Refining estimates of availability bias to improve assessments of the conservation status of an endangered dolphin - Fig 3

<p>Histograms of surfacing (A, solid line represents the mean and the median) and dive (B, solid line represents the mean, and dashed line the median) times of franciscana (<i>Pontoporia blainvillei</i>) groups recorded from helicopter surveys in Babitonga Bay, southern Brazil.</p

Comparison between estimates of availability obtained with dive parameters from land/boat based surveys (Pr[surface], 20, 22, 24) and those computed with data provided in this study (Pr[aerial]) for aerial surveys conducted in three different FMAs.

<p>Comparison between estimates of availability obtained with dive parameters from land/boat based surveys (Pr[surface], 20, 22, 24) and those computed with data provided in this study (Pr[aerial]) for aerial surveys conducted in three different FMAs.</p

Availability of franciscana (<i>Pontoporia blainvillei</i>) groups estimated for all groups together and for small and large groups separately assuming a window of time (<i>w</i>[<i>x</i>]) equal to 6 seconds.

<p>Availability of franciscana (<i>Pontoporia blainvillei</i>) groups estimated for all groups together and for small and large groups separately assuming a window of time (<i>w</i>[<i>x</i>]) equal to 6 seconds.</p

Study area.

<p>Map of Babitonga Bay, State of Santa Catarina (red), southern Brazil. The inset shows the realized trackline effort and franciscana (<i>Pontoporia blainvillei</i>) sightings from helicopter surveys.</p

Model-averaged predictor coefficients and relative importance (RI).

<p>Model-averaged predictor coefficients and relative importance (RI).</p

Mean (SE in parenthesis) surfacing (<i>E</i>(<i>s</i>)) and diving (<i>E</i>(<i>d</i>)) times of franciscana groups recorded from different observation platforms (S = surface [land/boat], A = aerial [helicopter]).

<p>Mean (SE in parenthesis) surfacing (<i>E</i>(<i>s</i>)) and diving (<i>E</i>(<i>d</i>)) times of franciscana groups recorded from different observation platforms (S = surface [land/boat], A = aerial [helicopter]).</p