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Alves AC, Alonso R, Diaz-Diaz JL, Medeiros AM, Jannes CE, Merchan A, Vasques-Cardenas NA, Cuevas A, Chacra AP, Krieger JE, Arroyo R, Arrieta F, Schreier L, Corral P, Bañares VG, Araujo MB, Bustos P, Asenjo S, Stoll M, Dell'Oca N, Reyes M, Ressia A, Campo R, Magaña-Torres MT, Metha R, Aguilar-Salinas CA, Ceballos-Macias JJ, Morales ÁJR, Mata P, Bourbon M, Santos RD. Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica. Arterioscler Thromb Vasc Biol 2020; 40:2508-2515. [PMID: 32757650 DOI: 10.1161/atvbaha.120.313722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. Approach and Results: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). CONCLUSIONS There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect.
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Affiliation(s)
- Ana Catarina Alves
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile (R. Alonso, A.C.).,Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - José Luís Diaz-Diaz
- Department of Internal Medicine. Hospital Universitario A Coruña, Spain (J.L.D.-D.)
| | - Ana Margarida Medeiros
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Cinthia E Jannes
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Alonso Merchan
- Fundacion Clinica SHAIO, Cardiologia, Bogota, Colombia (A.M.)
| | | | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile (R. Alonso, A.C.)
| | - Ana Paula Chacra
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Jose E Krieger
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Raquel Arroyo
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - Francisco Arrieta
- Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain (F.A.)
| | - Laura Schreier
- Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Aterosclerosis, Argentina (L.S.)
| | - Pablo Corral
- Universidad FASTA, Facultad de Medicina, Cátedra Farmacología e Investigación, Mar del Plata, Argentina (P.C.)
| | - Virginia G Bañares
- Administracion Nacional de Laboratorios e Institutos de Salud "Dr Carlos G. Malbrán'', Centro Nacional de Genética Médica, Departamento de Genética Experimental, Buenos Aires, Argentina (V.G.B.)
| | - Maria B Araujo
- Hospital Nacional de Pediatria ¨Dr JP Garraham¨, Servicio de Nutrición, Buenos Aires, Argentina (M.B.A.)
| | - Paula Bustos
- Facultad de Farmacia (P.B.), Universidad de Concepción, Chile
| | - Sylvia Asenjo
- Facultad de Medicina (S.A.), Universidad de Concepción, Chile
| | - Mario Stoll
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Nicolás Dell'Oca
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Maria Reyes
- Fundación Cardiovascular de Colombia, Cardiologia, Bogotá (R.C.)
| | - Andrés Ressia
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Rafael Campo
- Fundación Cardiovascular de Colombia, Cardiologia, Bogotá (R.C.)
| | - Maria T Magaña-Torres
- Instituto Mexicano del Seguro Social, Centro de Investigación Biomédica del Occidente, Guadalajara, México (M.T.M.-T.)
| | - Roopa Metha
- Unidad de Investigación de Enfermedades Metabólicas (R.M., C.A.A.S.)
| | | | - José J Ceballos-Macias
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México. Servicio de Endocrinología, Unidad de Especialidades Médicas, Secretaría de la Defensa Nacional, Mexico (J.J.C.-M.)
| | - Álvaro J Ruiz Morales
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Javerina, Bogotá, Colombia (A.J.R.)
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - Mafalda Bourbon
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Raul D Santos
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.).,Hospital Israelita Albert Einstein, Sao Paulo, Brazil (R.D.S.)
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Araujo RL, Araujo MB, Machado RD, Braga AA, Leite BV, Oliveira JR. Evaluation of a program to overcome vitamin A and iron deficiencies in areas of poverty in Minas Gerais, Brazil. Arch Latinoam Nutr 1987; 37:9-22. [PMID: 3454623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Randon samples of children from both sexes from Belo Horizonte, the capital City, and from Turmalina, Jequitinhonha Valley, Minas Gerais, Brazil, were submitted to nutritional evaluation before and after the intervention "Program to Overcome Vitamin A and Iron Deficiencies in Areas of Poverty in Minas Gerais, Brazil". After the first examination, all the children received, with an interval of 180 days, a single oral dose of vitamin A, oral iron sulfate during 50 days, and 200 mg of Mebendazol/day for three days. Thirty days after ending administration of the third dose of medicine, the children were subjected to a new evaluation. In Belo Horizonte, the first evaluation revealed a high prevalence of deficient and low values of vitamin A in preschool children (21.5%) and school children (21.7%). A small prevalence of low hematocrit values was also observed in both groups. Deficient and low values of hemoglobin were found as well in 21.5% of preschool children and in 17.5% of school children. The second evaluation, practiced 30 days after the third dose of medicine, showed a small incidence of low vitamin A values (4.3% in preschool children and 2.9% in school children) and low hemoglobin values (6.5% in preschool children and 2.9% in school children). No deficient values of hemoglobin and vitamin A were observed. Concerning the hematocrit value, only one school child presented a low value at the second evaluation. On the other hand, in Jequitinhonha Valley, five cases of Bitot spot with conjunctival xerosis, two cases of corneal xerosis, and one case of keratomalacia were detected at the first examination. Thirty days after ending the third dose of medicine, only one corneal scar was observed. Only a small number of children with deficient and low levels of vitamin A and hemoglobin was found in the final evaluation (less than 8%), while this number was high at the first evaluation (above 38 and 12%, respectively). These results show the efficiency of the intervention Program in relation to hypovitaminosis A and iron anemia prevention. The Program is now being implemented by the Brazilian Ministry of Health.
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Affiliation(s)
- R L Araujo
- Faculdade de Ciencias Médicas de Minas Gerais, FELUMA, Belo Horizonte, Brazil
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Araujo RL, Araujo MB, Sieiro RO, Machado RD, Leite BV. [Diagnosis of hypovitaminosis A and nutritional anemia status in the population of Vale do Jequitinhonha, Minas Gerais, Brazil]. Arch Latinoam Nutr 1986; 36:642-53. [PMID: 3435214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A survey was carried out with the purpose of evaluating the nutritional status of the population of Jequitinhonha Valley in regard to vitamin A deficiency and iron-deficiency anemia. A Program--"Programa de Combate à Hipovitaminose A e à Anemia Nutricional Ferropriva em Bolsões de Probreza de Minas Gerais"--is being implanted by the Instituto Nacional de Alimentacão e Nutriçao (INAN) aiming to the prevention of such deficiencies. A random sample of 2,357 children from the towns: Turmalina, Minas Novas and Capelinha (Vale do Jequitinhonha), Minas Gerais (1,604 living in the urban and 753 in the rural areas) was submitted to an eye examination. Blood was drawn from a random subsample of these children (157 from the urban area and 107 from the rural area), in oder to detect possible nutritional problems. The following results were observed (preschool and school children, respectively): 1. Hemoglobin: 23.9% and 20% of the population in the urban area, 34.6 and 18.2% in the rural area, had low and deficient values, respectively. 2. Hematocrit: 1.5 and 2.2% of the population in the urban area, 17.3 and 5.5% in the rural area, had low values. 3. Vitamin A: 8.9 and 4.4% of the population in the urban area, 5.8 and 0% in the rural area, had deficient values (less than 10 micrograms/dl); 26.9 and 31.1% in the urban area, 26.9 and 23.6% in the rural area, had low values (10-20 micrograms/dl). These results show the occurrence of nutritional anemia and vitamin A deficiency in the observed children. As to the eye examination this was performed in 2,357 children. A high incidence of conjunctival xerosis (3.16 and 6.04% in the urban area, 7.7 and 12.6% in the rural area, in preschool and school children, respectively), was detected. Five cases of conjunctival xerosis with Bitot spot (0.2%), corneal xerosis (0.08%) and kerotomalacia (0.04%) were observed. The therapeutic effect of 200,000 UI of oral vitamin A was more efficient in preschool children (90.3% of positive reactions) than in school children (25.9% of positive reactions). The causes of the different reactions are now under study.
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Affiliation(s)
- R L Araujo
- Faculdade de Ciências Médicas de Minas Gerais da Fundação Educacional "Lucas Machado" FELUMA
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