Metabolic Syndrome and Subclinical Hypothyroidism: A Type 2 Diabetes-Dependent Association

Introduction. Subclinical hypothyroidism (ScH) is an endocrine alteration that is related to cardiovascular risk factors, including those categorized as components of the Metabolic Syndrome (MS). However, findings in prior reports regarding an association between these alterations are inconsistent. The purpose of this study was to determine the relationship between both entities in adult subjects from Maracaibo City, Venezuela. Materials and Methods. The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multistage sampling. In this substudy, 391 individuals of both genders were selected and TSH, free T3, and free T4 tests were performed as well as a complete lipid profile, fasting glycaemia, and insulin blood values. ScH was defined according to the National Health and Nutrition Examination Survey (NHANES) criteria: high TSH (≥4.12mUI/L) and normal free T4 (0.9-1,9 ng/dL) in subjects without personal history of thyroid disease. MS components were defined according to IDF/AHA/NHLBI/WHF/IAS/IASO-2009 criteria. A multiple logistic regression analysis was used to assess the relationship between MS components and ScH diagnosis. Results. Of the evaluated population, 10.5% (n=41) was diagnosed with ScH, with a higher prevalence in women (female: 13.6% versus male: 7.7%; χ2=3.56, p=0.05). Likewise, 56.1% (n=23) of the subjects with ScH were diagnosed with MS (χ2=4.85; p=0.03), being hyperglycemia the main associated criterion (χ2=11.7; p=0.001). In multivariable analysis, it was observed that the relationship was exclusive with the presence of type 2 diabetes mellitus (T2DM) OR: 3.22 (1.14-9.14); p=0.03. Conclusion. The relationship between ScH and MS in our population is dependent on the presence of hyperglycemia, specifically T2DM diagnosis, findings that vary from those previously reported in Latin American subjects

Advanced Glycation End Products: New Clinical and Molecular Perspectives

Diabetes mellitus (DM) is considered one of the most massive epidemics of the twenty-first century due to its high mortality rates caused mainly due to its complications; therefore, the early identification of such complications becomes a race against time to establish a prompt diagnosis. The research of complications of DM over the years has allowed the development of numerous alternatives for diagnosis. Among these emerge the quantification of advanced glycation end products (AGEs) given their increased levels due to chronic hyperglycemia, while also being related to the induction of different stress-associated cellular responses and proinflammatory mechanisms involved in the progression of chronic complications of DM. Additionally, the investigation for more valuable and safe techniques has led to developing a newer, noninvasive, and effective tool, termed skin fluorescence (SAF). Hence, this study aimed to establish an update about the molecular mechanisms induced by AGEs during the evolution of chronic complications of DM and describe the newer measurement techniques available, highlighting SAF as a possible tool to measure the risk of developing DM chronic complications

Niveles séricos de óxido nítrico en pacientes con crisis hipertensiva

Con el propósito de determinar la concentración sérica de óxido nítrico (ON) en pacientes con crisis hipertensiva (CH) se diseñó un estudio prospectivo en el que participaron 10 pacientes normotensos y/o prehipertensos (grupo A), 9 con Hipertensión Arterial (HTA) estadíos 1 y/o 2 (grupo B), 9 con CH tipo urgencia hipertensiva (grupo C). Se registró presión arterial (PA) diastólica y sistólica y se midió el ON por el método de Diazotización en todos los individuos. Se encontraron niveles de ON significativamente bajos con respecto al grupo A en los grupo B y C (p<0.001), pero al compararse estos últimos no hubo diferencias estadísticamente significativas (p>0.05). Los valores de ON se correlacionaron negativamente con la presión arterial sistólica y diastólica, corroborándose que el nivel de ON fue bajo en aquellos individuos con hipertensión arterial. La sobreproducción repentina de vasoconstrictores podría explicar el aumento súbito de PA en CH.A prospective clinical study was designed with the purpose to measure nitric oxide (NO), in patients with hypertensive crises (HC). Blood samples were collected from 10 normotense and/or pre-hypertensive individuals (group A), 9 with hypertension (AHT) stages 1 and/or 2 (group B), and 9 with HC but with hypertensive urgency (group C). Systolic and diastolic blood pressure (BP) was recorded by Dynamap and NO was measured by diazotization assay. NO values in group B and C were lower than A group (p<0.001), however, when B and C groups were compared, there was no significant differences between both groups. NO levels were negative correlated with systolic and diastolic BP. We concluded that NO is low in hypertension and HC, but the association between NO and HC with respect to AHT stages 1and 2 was not corroborated. Further researches are needed to identify vasoconstrictor factors that may lead the suddenly elevation of BP levels founded in HC

The sick adipose tissue : new insights into defective signaling and crosstalk with the myocardium

Adipose tissue (AT) biology is linked to cardiovascular health since obesity is associated with cardiovascular disease (CVD) and positively correlated with excessive visceral fat accumulation. AT signaling to myocardial cells through soluble factors known as adipokines, cardiokines, branched-chain amino acids and small molecules like microRNAs, undoubtedly influence myocardial cells and AT function via the endocrine-paracrine mechanisms of action. Unfortunately, abnormal total and visceral adiposity can alter this harmonious signaling network, resulting in tissue hypoxia and monocyte/macrophage adipose infiltration occurring alongside expanded intra-abdominal and epicardial fat depots seen in the human obese phenotype. These processes promote an abnormal adipocyte proteomic reprogramming, whereby these cells become a source of abnormal signals, affecting vascular and myocardial tissues, leading to meta-inflammation, atrial fibrillation, coronary artery disease, heart hypertrophy, heart failure and myocardial infarction. This review first discusses the pathophysiology and consequences of adipose tissue expansion, particularly their association with meta-inflammation and microbiota dysbiosis. We also explore the precise mechanisms involved in metabolic reprogramming in AT that represent plausible causative factors for CVD. Finally, we clarify how lifestyle changes could promote improvement in myocardiocyte function in the context of changes in AT proteomics and a better gut microbiome profile to develop effective, non-pharmacologic approaches to CVD

Actividad física y enfermedad cardiovascular

Las enfermedades cardiovasculares representanla principal causa de morbi-mortalidad en el mundo occidental. Existen múltiples factoresde riesgo involucrados en la aparición de eventos cardiovascularesagudos como los niveles de LDLc elevados, HDLc baja, la hipertensión arterial, el hábito tabáquico y el sedentarismo o bajo nivel de actividad física. Se han realizado numerosas investigaciones que han dilucidado las adaptaciones del organismo durante el ejercicio y los beneficios derivados de su práctica corriente en los diferentessistemas y vías metabólicas.En las últimas décadas se han desarrollado numerosos cuestionarios para medir la actividad física y aproximarse en algún grado a la cuantificación del nivel de riesgo para enfermedad cardiovascular de la persona sedentaria. Muchosde estos instrumentos están validados internacionalmentemostrando ser fáciles de aplicar y perfectamente accesibles a través de internet, pero a pesar de esto no se usan de forma extensa debido quizás al desconocimiento de su existencia. La actividad física constituye un engranajeesencial en la salud bio-psico-social del ser humano pudiéndose convertir en la base de un cambio en el estilo de vida dirigido a la reducción del riesgo de padecer enfermedadescrónico-degenerativas y en la optimización de la calidad de vida.Coronary artery diseases (CAD) are main cause of morbidity and mortality in western world. Multiple risk factors are involved in CAD, among them, a sedentary life style or low physical activity level is a well-recognized modifiable risk factor. Numerous investigations had explained both, organism adaptations during the exercise and benefits in different system and metabolic routes of the body.Throughout the last decades, some questionnaires have been developed with the aim to measure physical degree practice and to indicate CAD risk level in a sedentary person.Many of these instruments are validated internationally showing to be easily applicable and perfectly accessible to scientist, which does not justify its low current exploit, because perhaps by ignorance of their existence. Physical activity constitutes an essential gear in bio-psycho-social human health; this one can become the base of lifestyle change aimed to CAD risk  &nbsp

High-sensitivity c-reactive protein epidemiological behavior in adult individuals from Maracaibo, Venezuela

Objectives: High-sensitivity C-Reactive Protein (hs-CRP) is one of the most applied inflammation markers; therefore, the main objective of this research is to evaluate its epidemiological behavior in adult subjects of the Maracaibo City, Venezuela. Materials and Methods: A total of 1,422 subjects, 704 women (49.5%) and 718 men (50.5%), were enrolled in the Maracaibo City Metabolic Syndrome Prevalence Study. The results were expressed as medians and inter-quartile ranges (p25-p75). Differences were determined through the Mann-Whitney U test and one-way ANOVA test with the Bonferroni adjustment. A multiple logistic regression model was designed for the analysis of the main factors associated with high serum hs-CRP levels. Results: Overall hs-CRP median was 0,.372 mg/L (0.126- 0.765 mg/L), 0,382 mg/L (0.122-0.829 mg/L) for women and 0.365 mg/L (0.133-0.712 mg/L) for men; p=0.616. An increasing pattern was observed in hs-CRP concentrations through age, BMI, waist circumference and HOMA2-IR categories. After adjusting for independent variables, a greater risk for elevated hs-CRP levels was observed with female gender, hypertriacylglyceridemia, obesity, diagnosis of metabolic syndrome and very large waist circumference values. Conclusions: Elevated hs-CRP levels are related to the metabolic syndrome but not with each of their separate components, being a greater waist circumference one of the more important risk factors, but only at values much higher than those proposed for our population.&nbsp

Valores de referencia de las hormonas tiroideas y TSH en individuos adultos de Maracaibo, Venezuela

Introducción: A nivel mundial, nacional o regional no existe un consenso ampliamente aceptado para los valores de referencia de hormonas tiroideas. Por ello, el objetivo de este estudio fue determinar los valores de referencia de TSH, FT3 libre y FT4 libre en individuos adultos del Municipio Maracaibo, Estado Zulia. Materiales y Métodos: Se realizó historia clínica completa y se determinó la concentración plasmática de TSH, T3L, T4L y anticuerpos anti-tiroideos a 425 individuos seleccionados al azar del Estudio de Prevalencia de Síndrome Metabólico en la ciudad de Maracaibo, un estudio descriptivo, transversal, con muestreo aleatorio multietápico que cuenta con una muestra de 2.230 individuos mayores de 18 años de ambos sexos. Para obtener la población de referencia (n=266) y establecer los intervalos de referencia se excluyeron individuos con antecedentes personales y familiares de enfermedad tiroidea, anticuerpos antitiroideos positivos (anti-tiroglobulina y anti-peroxidasa tiroidea), antecedentes personales de enfermedades cardiovasculares o autoinmunes, diabetes mellitus y uso de medicamentos tales como betabloqueantes, esteroides, anticonceptivos orales, amiodarona y levotiroxina. Resultados: Los valores de referencia de TSH, T3L y T4L  fueron establecidos mediante los percentiles 2,5 y 97,5 para establecer el límite inferior y superior en la población de referencia. De esta manera se obtuvieron los siguientes resultados TSH 0,70-5,52 mUI/L, T3L 1,80-4,40 pg/mL, T4L 0,80-1,80 ng/dL. Conclusiones: Los valores de referencia obtenidos en nuestra población difieren a los reportados en otros países, siendo necesario determinar valores de referencia en cada población con la finalidad de diagnosticar de forma adecuada las patologías relacionadas con hipo e hiperfunción tiroidea.Introduction: Currently there is no consensus regarding reference values for thyroid hormone profile. The purpose of this study was to determine the references values of TSH, Free T3 and Free T4 in adults from the Maracaibo Municipality, Zulia State. Materials and Methods: the Maracaibo city Metabolic Syndrome Prevalence Study is a cross-sectional study which enrolled 2.230 individuals of both sexes over 18 years of age, out of which 425 were selected due to medical history and availability of thyroid function quantification. The reference population subsample was obtained (n=266) by excluding those with personal and family history of thyroid disease, positive anti-thyroid antibodies, cardiovascular or autoimmune diseases, diabetes mellitus and medication usage. Results: the references values for TSH, FT3 and FT4 are between 2.5th and 97.5th to establish an upper and lower limit respectively: TSH 0.70-5.52 mIU/L, FT3 1.80-4.40 pg/ mL, FT4 0.80-1.80 ng/dL. Conclusions: the reference values obtained for our population differ from previous reports from other countries, strengthening the notion that each populace needs their own threshold values, facilitating a proper and efficient diagnosis tool to detect thyroid abnormalities&nbsp

Niveles séricos de Lp(a) y su comportamiento en el estado Zulia: 10 años de investigación

La Lipoproteína Lp(a) es considerada uno de los factores de riesgo independientes más importantes para el desarrollo de las enfermedades cardiovasculares. La mayoría de los estudios prospectivos realizados hasta la fecha han demostrado que la Lp(a) es un predictor útil del desarrollo de la enfermedad arterial coronaria y en consecuencia, del infarto de miocardio. Los primeros estudios realizados en Venezuela sobre la Lp(a) han sido llevados a cabo en el Estado Zulia y es durante estos 10 años de investigación que se ha logrado profundizar en el comportamiento epidemiológico de esta lipoproteína, comprobando que existen diferentes factores que pueden alterar la concentración de Lp(a) más allá de lo que frecuentemente se documenta en la mayoría de los estudios publicados hasta la fecha, donde se recalca que la concentración sérica de esta lipoproteína está en su mayor parte genéticamente determinada. En nuestra población, factores como el grado de actividad física, la raza, ciertos antecedentes familiares en niños y adolescentes, y la deprivación estrogénica están probablemente involucrados en la modificación de los niveles séricos de Lp(a).Lipoprotein Lp(a) is considered one of the most important independent risk factors for atherosclerotic cardiovascular disease. Most prospective studies to date have shown that Lp(a) is a useful predictor for the development of coronary artery disease and as result myocardial infarction. Early studies in Venezuela on the Lp(a) have been conducted in the state of Zulia and it is during these years of research that has been made to deep the epidemiological behavior of this lipoprotein, checking that there are different factors that can affect the Lp (a) concentration beyond what is often documented in most published studies, which stresses that the serum concentration of this lipoprotein is largely genetically determined. In our population, factors such as levels of physical activity, race, family history in children and adolescents, and estrogen deprivation has been involved in a significant change in serum levels of Lp (a)

Comportamiento epidemiológico del hipotiroidismo subclínico y su asociación con factores de riesgo cardiometabólicos en individuos adultos del Municipio Maracaibo, Venezuela

Introducción: La relación entre el hipotiroidismo subclínico (HSC) y diversos factores de riesgo cardiovascular es controversial. El objetivo de este estudio es analizar el comportamiento de dichos factores en adultos con HSC del municipio Maracaibo, estado Zulia, Venezuela. Materiales y Métodos: Se seleccionaron 425 individuos de la base de datos del estudio de Prevalencia de Síndrome Metabólico de Maracaibo, en base a historia clínica y determinación de TSH, T3, T4, anticuerpos anti-tiroideos, glicemia, insulina basal y perfil lipídico. Las variables cualitativas fueron expresadas como frecuencias absolutas y relativas y las variables cuantitativas como media aritmética ± DE, se realizó un modelo de regresión logística múltiple para determinar la relación entre los factores de riesgo con respecto al diagnóstico de HSC. Resultados: La prevalencia del HSC fue 9,6% (n=41), presentando elevación de la glicemia, colesterol total, triacilglicéridos y VLDL, y disminución de T3 (p=0,017). La presencia de HSC es directamente proporcional a la edad y presenta una asociación significativa con anticuerpos anti-tiroideos positivos. El HSC mostró incrementar el riesgo para enfermedades cardio-metabólicas como Diabetes Mellitus tipo 2 y enfermedad cardiovascular. Conclusiones: La prevalencia de HSC es similar a la mostrada en reportes previos, estando asociado con la presencia de varios factores cardio-metabólicos. Es necesaria la determinación oportuna del perfil tiroideo, especialmente adultos mayores, para un diagnóstico precoz y adecuado seguimiento de este grupo de pacientes.&nbsp