1
|
Mostaza JM, Pintó X, Armario P, Masana L, Real JT, Valdivielso P, Arrobas-Velilla T, Baeza-Trinidad R, Calmarza P, Cebollada J, Civera-Andrés M, Cuende Melero JI, Díaz-Díaz JL, Espíldora-Hernández J, Fernández Pardo J, Guijarro C, Jericó C, Laclaustra M, Lahoz C, López-Miranda J, Martínez-Hervás S, Muñiz-Grijalvo O, Páramo JA, Pascual V, Pedro-Botet J, Pérez-Martínez P, Puzo J. SEA 2024 Standards for Global Control of Vascular Risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:133-194. [PMID: 38490888 DOI: 10.1016/j.arteri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
Collapse
Affiliation(s)
- José María Mostaza
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España.
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBERobn), Fundación para la Investigación y Prevención de las Enfermedades Cardiovasculares (FIPEC), Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Pedro Armario
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Universitat Rovira i Virgili, Tarragona, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España
| | - Teresa Arrobas-Velilla
- Laboratorio de Nutrición y RCV, UGC de Bioquímica clínica, Hospital Virgen Macarena, Sevilla, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Jesús Cebollada
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Miguel Civera-Andrés
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - José I Cuende Melero
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - José L Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Javier Espíldora-Hernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España; Unidad de Lípidos y Unidad Asistencial de Hipertensión Arterial- Riesgo Vascular (HTA-RV), UGC Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Jacinto Fernández Pardo
- Servicio de Medicina Interna, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Murcia, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorón, España
| | - Carles Jericó
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Martín Laclaustra
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Lahoz
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Ovidio Muñiz-Grijalvo
- Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - José A Páramo
- Servicio de Hematología, Clínica Universidad de Navarra, Navarra, España; Laboratorio Aterotrombosis, CIMA, Universidad de Navarra, Pamplona, España
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - José Puzo
- Servicio de Bioquímica Clínica, Unidad de Lípidos, Hospital General Universitario San Jorge de Huesca, Huesca, España; Departamento de Medicina, Universidad de Zaragoza, Zaragoza, España
| |
Collapse
|
2
|
Solomon A, Negrea MO, Cipăian CR, Boicean A, Mihaila R, Rezi C, Cristinescu BA, Berghea-Neamtu CS, Popa ML, Teodoru M, Stoia O, Neamtu B. Interactions between Metabolic Syndrome, MASLD, and Arterial Stiffening: A Single-Center Cross-Sectional Study. Healthcare (Basel) 2023; 11:2696. [PMID: 37830733 PMCID: PMC10572783 DOI: 10.3390/healthcare11192696] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023] Open
Abstract
Metabolic-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), has emerged as a prominent global cause of chronic liver disease and is increasingly recognized as associated with atherosclerotic vascular illness, consolidating its position along traditional cardiovascular risk factors. Individuals with MASLD exhibit a combination of metabolic syndrome risk factors, carotid atherosclerosis, and increased arterial stiffness, hinting at shared pathogenesis. In this study, we aim to explore liver involvement and arterial stiffness within metabolic syndrome. We enrolled 75 patients (30 male and 45 female) with either liver steatosis on conventional ultrasound, altered liver function tests, or the presence of cardiometabolic risk factors after excluding liver pathology other than MASLD. Clinical evaluation, laboratory measurements, abdominal and carotid ultrasounds, vibration-controlled transient elastography (VCTE, Fibroscan), and assessment with the Arteriograph (Tensiomed) were performed. The 26 patients diagnosed with MetS had significantly higher liver involvement as quantified via the hepatic steatosis index (HSI), Fibrosis-4 (FIB4), aspartate aminotransferase to platelet ratio index (APRI) category, and VCTE measurements, as well as Agile 3+ and Agile 4 scores which use a combination of clinical and laboratory parameters together with results obtained from VCTE to reflect the probability of advanced liver fibrosis or cirrhosis. Patients with MetS also exhibited more pronounced vascular involvement as quantified via arterial stiffness measurements and CIMT (carotid intima-media thickness). We applied a two-step clustering algorithm to enhance our analysis, which gave us pertinent insight into the interplay between metabolic syndrome elements and typologies of hepatic steatosis and arterial stiffness degrees. Notably, of the three obtained clusters, the cluster showing increased levels of hepatic steatosis and arterial stiffness also exhibited the highest prevalence of metabolic syndrome and its constituting components. The results have significant clinical implications, advocating for a comprehensive diagnostic approach when MetS or MASLD is suspected.
Collapse
Affiliation(s)
- Adelaida Solomon
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Mihai Octavian Negrea
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Călin Remus Cipăian
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adrian Boicean
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Romeo Mihaila
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Cristina Rezi
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
| | | | | | - Mirela Livia Popa
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Minodora Teodoru
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Oana Stoia
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Bogdan Neamtu
- Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (A.S.); (C.R.C.); (A.B.); (R.M.); (C.R.); (M.L.P.); (M.T.); (O.S.); (B.N.)
- Department of Clinical Research, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
| |
Collapse
|
3
|
Masenga SK, Kabwe LS, Chakulya M, Kirabo A. Mechanisms of Oxidative Stress in Metabolic Syndrome. Int J Mol Sci 2023; 24:7898. [PMID: 37175603 PMCID: PMC10178199 DOI: 10.3390/ijms24097898] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Metabolic syndrome is a cluster of conditions associated with the risk of diabetes mellitus type 2 and cardiovascular diseases (CVDs). Metabolic syndrome is closely related to obesity. Increased adiposity promotes inflammation and oxidative stress, which are precursors of various complications involving metabolic syndrome components, namely insulin resistance, hypertension, and hyperlipidemia. An increasing number of studies confirm the importance of oxidative stress and chronic inflammation in the etiology of metabolic syndrome. However, few studies have reviewed the mechanisms underlying the role of oxidative stress in contributing to metabolic syndrome. In this review, we highlight mechanisms by which reactive oxygen species (ROS) increase mitochondrial dysfunction, protein damage, lipid peroxidation, and impair antioxidant function in metabolic syndrome. Biomarkers of oxidative stress can be used in disease diagnosis and evaluation of severity.
Collapse
Affiliation(s)
- Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone P.O. Box 60009, Zambia
- Department of Medicine, Room 536 Robinson Research Building, Vanderbilt University Medical Centre, Nashville, TN 37232-6602, USA
| | - Lombe S. Kabwe
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone P.O. Box 60009, Zambia
| | - Martin Chakulya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone P.O. Box 60009, Zambia
| | - Annet Kirabo
- Department of Medicine, Room 536 Robinson Research Building, Vanderbilt University Medical Centre, Nashville, TN 37232-6602, USA
| |
Collapse
|
4
|
Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Godier A, Haas T, Jacob M, Lancé MD, Llau JV, Meier J, Molnar Z, Mora L, Rahe-Meyer N, Samama CM, Scarlatescu E, Schlimp C, Wikkelsø AJ, Zacharowski K. Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. Eur J Anaesthesiol 2023; 40:226-304. [PMID: 36855941 DOI: 10.1097/eja.0000000000001803] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.
Collapse
Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University Vienna, Austria (SK), Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust (AAh), Department of Cardiovascular Sciences, University of Leicester, UK (AAh), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AAf), Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (AAf), Department of Anaesthesiology & Critical Care, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University Hospital, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery, University of Perugia, Italy (EDR), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA (DFa), University of Medicine and Pharmacy Carol Davila, Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology & Critical Care, APHP, Université Paris Cité, Paris, France (AG), Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA (TH), Department of Anaesthesiology, Intensive Care and Pain Medicine, St.-Elisabeth-Hospital Straubing, Straubing, Germany (MJ), Department of Anaesthesiology, Medical College East Africa, The Aga Khan University, Nairobi, Kenya (MDL), Department of Anaesthesiology & Post-Surgical Intensive Care, University Hospital Doctor Peset, Valencia, Spain (JVL), Department of Anaesthesiology & Intensive Care, Johannes Kepler University, Linz, Austria (JM), Department of Anesthesiology & Intensive Care, Semmelweis University, Budapest, Hungary (ZM), Department of Anaesthesiology & Post-Surgical Intensive Care, University Trauma Hospital Vall d'Hebron, Barcelona, Spain (LM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP. Centre - Université Paris Cité - Cochin Hospital, Paris, France (CMS), Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (ES), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz and Ludwig Boltzmann-Institute for Traumatology, The Research Centre in Co-operation with AUVA, Vienna, Austria (CS), Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark (AW) and Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Slouma M, Ben Ali K, Kharrat L, Zouaoui C, Ouertani H, Gharsallah I. Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:261-268. [PMID: 35641385 DOI: 10.1016/j.arteri.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome. METHODS We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc). RESULTS Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m2, p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDLc level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios). CONCLUSION Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.
Collapse
Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia
| | - Khaoula Ben Ali
- Department of Endocrinology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia
| | - Lobna Kharrat
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia.
| | - Chadia Zouaoui
- Department of Endocrinology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia
| | - Haroun Ouertani
- Department of Endocrinology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; Tunis El Manar University, Tunisia
| |
Collapse
|
6
|
SEA 2022 Standards for Global Control of Cardiovascular Risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:130-179. [PMID: 35090775 DOI: 10.1016/j.arteri.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.
Collapse
|
7
|
Teixeira JE, Bragada JA, Bragada JP, Coelho JP, Pinto IG, Reis LP, Fernandes PO, Morais JE, Magalhães PM. Structural Equation Modelling for Predicting the Relative Contribution of Each Component in the Metabolic Syndrome Status Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063384. [PMID: 35329071 PMCID: PMC8992136 DOI: 10.3390/ijerph19063384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Understanding the factor weighting in the development of metabolic syndrome (MetS) may help to predict the progression for cardiovascular and metabolic diseases. Thus, the aim of this study was to develop a confirmatory model to describe and explain the direct and indirect effect of each component in MetS status change. A total of 3581 individuals diagnosed with MetS, aged 18−102 years, were selected between January 2019 and December 2020 from a community-representative sample of Portuguese adults in a north-eastern Portuguese region to test the model’s goodness of fit. A structural equation modelling (SEM) approach and a two-way ANOVA (age × body composition) were performed to compare the relative contribution of each MetS component using joint interim statement (JIS). Waist circumference (β = 0.189−0.373, p < 0.001), fasting glucose (β = 0.168−0.199, p < 0.001) and systolic blood pressure (β = 0.140−0.162, p < 0.001) had the highest direct effect on the change in MetS status in the overall population and concerning both sexes. Moreover, diastolic blood pressure (DBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) had a low or non-significant effect. Additionally, an indirect effect was reported for age and body composition involving the change in MetS status. The findings may suggest that other components with higher specificity and sensitivity should be considered to empirically validate the harmonised definition of MetS. Current research provides the first multivariate model for predicting the relative contribution of each component in the MetS status change, specifically in Portuguese adults.
Collapse
Affiliation(s)
- José E. Teixeira
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
- Correspondence:
| | - José A. Bragada
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - João P. Bragada
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Joana P. Coelho
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Isabel G. Pinto
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Luís P. Reis
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Paula O. Fernandes
- Applied Management Research Unit (UNIAG), Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - Jorge E. Morais
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - Pedro M. Magalhães
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| |
Collapse
|
8
|
Silva-Boghossian CM, Dezonne RS. What Are the Clinical and Systemic Results of Periodontitis Treatment in Obese Individuals? ACTA ACUST UNITED AC 2021; 8:48-65. [PMID: 34367878 PMCID: PMC8327900 DOI: 10.1007/s40496-021-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Purpose of Review Periodontitis and obesity are characterized by a dysregulated inflammatory state. Obese individuals have a higher chance of presenting periodontitis. Clinical studies in different populations demonstrate that individuals with obesity have worse periodontal conditions. This current review aims to explore recent literature to understand what the impacts of obesity on periodontal treatment outcomes are and to learn whether periodontal treatment can improve systemic biomarkers in obese individuals. Recent Findings Short- and long-term evaluations demonstrated that non-surgical periodontal treatment could improve clinical parameters in obese individuals, represented as the reduction in mean probing depth, sites with probing depth ≥ 4 mm, and extension of bleeding on probing. However, obese individuals may have less clinical improvement when compared to normal-weight individuals with a similar periodontal profile. Additionally, periodontal treatment may contribute to a reduction in systemic levels of retinol-binding protein 4 and leptin, while promoting an increase in systemic levels of adiponectin. Summary Overall, obese individuals with periodontitis can significantly benefit from non-surgical periodontal treatment. However, clinical improvements seem to be less prominent in obese individuals with periodontitis compared to non-obese individuals with similar periodontal status. Nevertheless, periodontal treatment may impact significantly on the reduction of several biochemical biomarkers of obesity with or without weight reduction. Further investigations are needed to improve our comprehension of the mechanisms underlying those findings.
Collapse
Affiliation(s)
- Carina M. Silva-Boghossian
- Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325, Cidade Universitaria, Rio de Janeiro, RJ CEP 21941-617 Brazil
| | - Romulo S. Dezonne
- Postgraduate Program in Translational Biomedicine, University of Grande Rio, Duque de Caxias, RJ Brazil
| |
Collapse
|
9
|
Núñez-Cortés JM, Pedro-Botet J. Dislipemia aterogénica: la otra pandemia, asociada a la diabesidad. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS 2021; 33:30-32. [PMID: 33455724 PMCID: PMC7833629 DOI: 10.1016/j.arteri.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|
10
|
Escalante-Araiza F, Gutiérrez-Salmeán G. Traditional Mexican foods as functional agents in the treatment of cardiometabolic risk factors. Crit Rev Food Sci Nutr 2020; 61:1353-1364. [PMID: 32338032 DOI: 10.1080/10408398.2020.1758028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Major cardiometabolic risk phenotypes include insulin resistance (IR), hyperinsulinemia, overweight, obesity and dyslipidemia, which contribute to the current prevalent chronic disease pandemia worldwide. Among traditional treatments, dietary habits represent one of the most difficult and controversial aspects to implement in handling metabolic disturbances. The use of herbal remedies by latinos and hispanics, as part of self-care of metabolic diseases has been well documented in several studies, mainly because they are "natural", consistent with their culture, family-related, accessible, and affordable. Phytochemicals are present in fruits, vegetables and various plants, and constitute nonessential nutrients such as vitamins or minerals, many of them being consumed in a popular way or used as herbal remedies or dietary supplements. In this narrative review, we present evidence on traditional endemic Mexican foods such as cacao, corn, common bean, prickle pear, chili, avocado and salba-chia as functional agents to improve the metabolic status in risk phenotypes.
Collapse
Affiliation(s)
- Fabiola Escalante-Araiza
- Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| | - Gabriela Gutiérrez-Salmeán
- Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, México
| |
Collapse
|
11
|
Pedro-Botet J, Ascaso JF, Blasco M, Brea Á, Díaz Á, Hernández-Mijares A, Pintó X, Millán J. Triglycerides, HDL cholesterol and atherogenic dyslipidaemia in the 2019 European guidelines for the management of dyslipidaemias. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:209-218. [PMID: 32037300 DOI: 10.1016/j.arteri.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022]
Abstract
In general, both European and American clinical guidelines have addressed the management of atherogenic dyslipidaemia in an unconvincing and even superficial way, largely because of the available therapeutic limitations. Consequently, this type of dyslipidaemia is underdiagnosed, under-treated, and under-controlled. Given the recent presentation of the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology on the management of dyslipidaemias, it seems appropriate to examine its position with respect to atherogenic dyslipidaemia and/or its main components, the increase in triglyceride-rich lipoproteins, and the decrease of high-density lipoprotein cholesterol.
Collapse
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Juan F Ascaso
- Departamento de Medicina, Universitat de València, CIBERDEM ISCIII, Valencia, España
| | - Mariano Blasco
- Área Sanitaria de Delicias, Atención Primaria, Zaragoza, España
| | - Ángel Brea
- Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | - Ángel Díaz
- Centro de Salud de Bembibre, Bembibre, León, España
| | - Antonio Hernández-Mijares
- Fundación para la Investigación Sanitaria y Biomédica de la Comunidad Valenciana FISABIO; Departamento de Medicina, Universitat de València, Valencia, España
| | - Xavier Pintó
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Universitat de Barcelona, CIBERobn-ISCIII, Barcelona, España
| | - Jesús Millán
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
| | | |
Collapse
|
12
|
Cui F, Hu HF, Guo J, Sun J, Shi M. The Effect of Autophagy on Chronic Intermittent Hypobaric Hypoxia Ameliorating Liver Damage in Metabolic Syndrome Rats. Front Physiol 2020; 11:13. [PMID: 32082187 PMCID: PMC7002389 DOI: 10.3389/fphys.2020.00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022] Open
Abstract
Aim Our previous study demonstrated that chronic intermittent hypobaric hypoxia (CIHH) can confer hepatic protection by reducing endoplasmic reticulum stress (ERS) in high-fat-high-fructose induced metabolic syndrome (MS) rats. It is known that there is a functional coupling between autophagy and ERS. This study aimed to investigate the effect of CIHH on autophagy function and adenosine mono-phosphate-activated protein kinase-mammalian target of rapamycin (AMPKα-mTOR) signaling pathway in hepatic tissue of MS rats. Main Methods 6-week old male Sprague-Dawley rats were randomly divided into: control (CON), CIHH (treated with hypobaric hypoxia simulating 5000-m altitude for 28 days, 6 h daily), MS (induced by 16-week high fat diet and 10% fructose water feeding), and MS + CIHH groups (exposed to CIHH after 16-week MS model). Food and water intakes, body weight, Lee's index, fat coefficient, systolic arterial pressure, blood biochemicals, and histopathology of liver were measured, the expression of phosphorylated (p)-AMPK, p-mTOR, autophagy-related and ERS-related proteins were assayed in hepatic tissue. Key Findings The MS rats displayed obesity, hypertension, polydipsia, glucose and lipids metabolism disorders, increased inflammatory cytokine, hepatic tissue morphological and functional damage, and the up-regulated expressions of ERS-related, autophagy-related proteins and p-mTOR, and the down-regulated expression of p-AMPKα. All aforementioned abnormalities in MS rats were ameliorated in MS + CIHH rats. Significance In conclusion CIHH confers hepatic protection through activating AMPK-mTOR signaling pathway and the autophagy function, thus inhibiting ERS in hepatic tissue.
Collapse
Affiliation(s)
- Fang Cui
- Department of Electron Microscope Laboratory Centre, Hebei Medical University, Shijiazhuang, China
| | - Hao Fei Hu
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Guo
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie Sun
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Shi
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
13
|
Précoma DB, Oliveira GMMD, Simão AF, Dutra OP, Coelho OR, Izar MCDO, Póvoa RMDS, Giuliano IDCB, Alencar Filho ACD, Machado CA, Scherr C, Fonseca FAH, Santos Filho RDD, Carvalho TD, Avezum Á, Esporcatte R, Nascimento BR, Brasil DDP, Soares GP, Villela PB, Ferreira RM, Martins WDA, Sposito AC, Halpern B, Saraiva JFK, Carvalho LSF, Tambascia MA, Coelho-Filho OR, Bertolami A, Correa Filho H, Xavier HT, Faria-Neto JR, Bertolami MC, Giraldez VZR, Brandão AA, Feitosa ADDM, Amodeo C, Souza DDSMD, Barbosa ECD, Malachias MVB, Souza WKSBD, Costa FAAD, Rivera IR, Pellanda LC, Silva MAMD, Achutti AC, Langowiski AR, Lantieri CJB, Scholz JR, Ismael SMC, Ayoub JCA, Scala LCN, Neves MF, Jardim PCBV, Fuchs SCPC, Jardim TDSV, Moriguchi EH, Schneider JC, Assad MHV, Kaiser SE, Lottenberg AM, Magnoni CD, Miname MH, Lara RS, Herdy AH, Araújo CGSD, Milani M, Silva MMFD, Stein R, Lucchese FA, Nobre F, Griz HB, Magalhães LBNC, Borba MHED, Pontes MRN, Mourilhe-Rocha R. Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 113:787-891. [PMID: 31691761 PMCID: PMC7020870 DOI: 10.5935/abc.20190204] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Dalton Bertolim Précoma
- Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR - Brazil
- Sociedade Hospitalar Angelina Caron, Campina Grande do Sul, PR - Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Raul Dias Dos Santos Filho
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brazileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Álvaro Avezum
- Hospital Alemão Oswaldo Cruz, São Paulo, SP - Brazil
| | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
| | - David de Pádua Brasil
- Faculdade de Ciências Médicas de Minas Gerias (CMMG) da Fundação Educacional Lucas Machado (FELUMA), Belo Horizonte, MG - Brazil
- Hospital Universitário Ciências Médicas (HUCM), Belo Horizonte, MG - Brazil
- Universidade Federal de Lavas (UFLA), Lavras, MG - Brazil
| | - Gabriel Porto Soares
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Universidade de Vassouras, Vassouras, RJ - Brazil
| | - Paolo Blanco Villela
- Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | - Wolney de Andrade Martins
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
- Complexo Hospitalar de Niterói, Niterói, RJ - Brazil
| | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campina, SP - Brazil
| | - Bruno Halpern
- Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | | | | | | | - Viviane Zorzanelli Rocha Giraldez
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | - Lucia Campos Pellanda
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS - Brazil
- Fundação Universitária de cardiologia do RS (ICFUC), Porto Alegre, RS - Brazil
| | | | | | | | | | - Jaqueline Ribeiro Scholz
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - José Carlos Aidar Ayoub
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP - Brazil
- Instituto de Moléstias Cardiovasculares, São José do Rio Preto, SP - Brazil
| | | | - Mario Fritsch Neves
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Jamil Cherem Schneider
- SOS Cardio, Florianópolis, SC - Brazil
- Universidade do Sul de SC (Unisul), Florianópolis, SC - Brazil
| | | | | | - Ana Maria Lottenberg
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
- Laboratório de Lípides (LIM10), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, SP - Brazil
| | | | - Marcio Hiroshi Miname
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Roberta Soares Lara
- Instituto de Nutrição Roberta Lara, Itu, SP - Brazil
- Diadia Nutrição e Gastronomia, Itu, SP - Brazil
| | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, São José, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | | | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | | | | | - Hermilo Borba Griz
- Hospital Santa Joana Recife, Recife, PE - Brazil
- Hospital Agamenon Magalhães, Recife, PE - Brazil
| | | | | | - Mauro Ricardo Nunes Pontes
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
- Hospital São Francisco, Porto Alegre, RS - Brazil
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
| |
Collapse
|