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Arrobas T, Guijarro C, Campuzano R, Rodríguez Piñero M, Valderrama Marcos JF, Botana López AM, Morais López A, García Donaire JA, Obaya JC, Castilla Guerra L, Pallarés Carratalà V, Egocheaga Cabello I, Salgueira Lazo M, Castellanos Rodrigo MM, Mostaza Prieto JM, Gómez Doblas JJ, Buño Soto A. Documento de consenso para la determinación e informe del perfil lipídico en laboratorios clínicos españoles. Rev Clín Med Fam 2023. [DOI: 10.55783/rcmf.160106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular, hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.
Palabras clave: consenso, panel de lípidos, enfermedades cardiovasculares, bioquímica, colesterol, lípidos, triglicéridos, lipoproteína (a).
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Affiliation(s)
- Teresa Arrobas
- Miembro de la Sociedad Española de Medicina de Laboratorio (SEQCML). Laboratorio de Bioquímica Clínica. Hospital Universitario Virgen Macarena. Sevilla (España). Los tres autores han contribuido de manera equivalente en la redacción del documento
| | - Carlos Guijarro
- Miembro de la Sociedad Española de Arteriosclerosis (SEA). Unidad de Medicina Interna. Hospital Universitario Fundación de Alcorcón. Universidad Rey Juan Carlos. Madrid (España).Los tres autores han contribuido de manera equivalente en la redacción del documento
| | - Raquel Campuzano
- Miembro de la Sociedad Española de Cardiología (SEC). Unidad de Cardiología. Hospital Universitario Fundación de Alcorcón. Madrid (España). Los tres autores han contribuido de manera equivalente en la redacción del documento
| | - Manuel Rodríguez Piñero
- Miembro de la Sociedad Española de Angiología y Cirugía Vascular (SEACV). Unidad Intercentros Cádiz - Jerez de Angiología y Cirugía Vascular. Hospital Universitario Puerta del Mar. Cádiz (España)
| | - José Francisco Valderrama Marcos
- Miembro de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Hospital Regional Universitario de Málaga. Málaga (España)
| | - Antonio M. Botana López
- Miembro de la Sociedad Española de Endocrinología y Nutrición (SEEN). Sección de Endocrinología. Hospital Universitario Lucus Augusti de Lugo. Lugo (España)
| | - Ana Morais López
- Miembro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP). Unidad de Nutrición Infantil y Enfermedades Metabólicas. Hospital Universitario La Paz. Madrid (España)
| | - José Antonio García Donaire
- Miembro de la Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA). Unidad de Hipertensión Arterial. Hospital Clínico Universitario San Carlos. Madrid (España)
| | - Juan Carlos Obaya
- Sociedad Española de Medicina de Familia y Comunitaria (semFYC). Especialista en Medicina Familiar y Comunitaria. CS La Chopera. Alcobendas. Madrid (España)
| | - Luis Castilla Guerra
- Miembro de la Sociedad Española de Medicina Interna (SEMI). Unidad de Hipertensión, Lípidos y Riesgo Vascular. Servicio de Medicina Interna. Hospital Virgen Macarena. PCDV Departamento de Medicina. Universidad de Sevilla. Sevilla (España)
| | - Vicente Pallarés Carratalà
- Miembro de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Unidad de Vigilancia de la Salud. Unión de Mutuas. Universitat Jaume I. Castellón (España)
| | - Isabel Egocheaga Cabello
- Miembro de la Sociedad Española de Médicos Generales y de Familia (SEMG). Especialista en Medicina Familiar y Comunitaria. CS Isla de Oza. Madrid (España)
| | - Mercedes Salgueira Lazo
- Miembro de la Sociedad Española de Nefrología (SEN). Unidad de Nefrología. Hospital Universitario Virgen Macarena. Sevilla (España)
| | - María Mar Castellanos Rodrigo
- Miembro de la Sociedad Española de Neurología (SEN). Servicio de Neurología. Complejo Hospitalario Universitario A Coruña - Instituto de Investigación Biomédica A Coruña. A Coruña (España). Coordinadora del Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN
| | - José María Mostaza Prieto
- Miembro de la Sociedad Española de Arterioesclerosis (SEA). Unidad de Medicina Interna. Hospital Carlos III de Madrid. Madrid (España)
| | - Juan José Gómez Doblas
- Miembro de la Sociedad Española de Cardiología (SEC). Unidad de Cardiología del Hospital Universitario Virgen de la Victoria. Málaga (España)
| | - Antonio Buño Soto
- Miembro de la Sociedad Española de Medicina de Laboratorio. Servicio de Análisis Clínicos. Hospital Universitario la Paz. Madrid (España)
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Bea AM, Cenarro A, Marco-Bened V, Laclaustra M, Martn C, Ibarretxe D, Pint X, Arrobas T, Vials C, Civeira F, Olmos S. Diagnosis of Familial Dysbetalipoproteinemia Based on the Lipid Abnormalities Driven by APOE2/E2 Genotype. Clin Chem 2023; 69:140-148. [PMID: 36644927 DOI: 10.1093/clinchem/hvac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/14/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Familial dysbetalipoproteinemia (FDBL) is a monogenic disease due to variants in APOE with a highly variable phenotype. Current diagnostic lipid-based methods have important limitations. The objective is twofold: to define characteristics of dysbetalipoproteinemia (DBL) based on the analysis of APOE in patients from a lipid unit and in a sample from the general population, and to propose a screening algorithm for FDBL. METHODS Lipids and APOE genotype from consecutive unrelated subjects from Miguel Servet University Hospital (MSUH) (n 3603), subjects from the general population participants of the Aragon Workers Health Study (AWHS) (n 4981), and selected subjects from external lipid units (Ext) (n 390) were used to define DBL criteria and to train and validate a screening tool. RESULTS Thirty-five subjects from MSUH, 21 subjects from AWHS, and 31 subjects from Ext were APOE2/2 homozygous. The combination of non high-density lipoprotein cholesterol (non-HDLc)/apoB 1.7 plus triglycerides/apoB 1.35, in mg/dL (non-HDLc [mmol/L]/apolipoprotein B (apoB) [g/L] 4.4 and triglycerides [mmol/L]/apoB [g/L] 3.5), provided the best diagnostic performance for the identification of subjects with hyperlipidemia and APOE2/2 genotype (sensitivity 100 in the 3 cohorts, and specificity 92.8 [MSUH], 80.9 [AWHS], and 77.6 [Ext]). This improves the performance of previous algorithms. Similar sensitivity and specificity were observed in APOE2/2 subjects receiving lipid-lowering drugs. CONCLUSIONS The combination of non-HDLc/apoB and triglycerides/apoB ratios is a valuable tool to diagnose DBL in patients with hyperlipidemia with or without lipid-lowering drugs. FDBL diagnosis requires DBL and the presence of a compatible APOE genotype. Most adult APOE2/2 subjects express DBL, making FDBL as common as familial hypercholesterolemia in the population.
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Affiliation(s)
- Ana M Bea
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain
| | - Ana Cenarro
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain.,Molecular Research Laboratory, Instituto Aragones de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Victoria Marco-Bened
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain.,Departamento de Medicina, Psiquiatra y Dermatologa, Universidad de Zaragoza, Zaragoza, Spain
| | - Martn Laclaustra
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain.,Departamento de Medicina, Psiquiatra y Dermatologa, Universidad de Zaragoza, Zaragoza, Spain
| | - Csar Martn
- Fundacin Biofisika Bizkaia, Leioa, Spain.,Biofisika Institute (UPV/EHU, CSIC), Leioa, Spain.,Department of Biochemistry and Molecular Biology, Universidad del Pas Vasco UPV/EHU, Bilbao, Spain
| | - Daiana Ibarretxe
- Unitat de Medicina Vascular i Metabolisme (UVASMET) Hospital Universitari Sant Joan, IISPV, CIBERDEM, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Xavier Pint
- Unidad de Lpidos, Servicio de Medicina Interna, Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CiberObn, Barcelona, Spain
| | - Teresa Arrobas
- Laboratorio de Nutricin y RCV, Laboratorio de Bioqumica Clnica, Hospital Virgen Macarena, Sevilla, Spain
| | - Clara Vials
- Endocrinology Department, Hospital Clnic de Barcelona, Barcelona, Spain.,Institut dInvestigacions Biomdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacin Biomdica en Red Fisiopatologa de la Obesidad y Nutricin (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain.,Departamento de Medicina, Psiquiatra y Dermatologa, Universidad de Zaragoza, Zaragoza, Spain
| | - Salvador Olmos
- Hospital Universitario Miguel Servet, IIS Aragn, CIBERCV, Zaragoza, Spain.,Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Zaragoza, Spain
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Rioja J, Ariza MJ, García-Casares N, Coca-Prieto I, Arrobas T, Muñiz-Grijalvo O, Mangas A, Ibarretxe D, Sánchez-Chaparro MÁ, Valdivielso P. Evaluation of the chylomicron-TG to VLDL-TG ratio for type I hyperlipoproteinemia diagnostic. Eur J Clin Invest 2020; 50:e13345. [PMID: 32649781 DOI: 10.1111/eci.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study is to confirm the diagnostic performance of the Chylomicron to very low-density lipoproteins triglycerides (CM/VLDL-TG) ratio, the triglycerides to cholesterol ratio (TG/TC) and a dichotomic rule including the tryglycerides to apolipoprotein B (TG/APOB) ratio for the presence of Type I hyperlipoproteinemia (HPLI) in patients with severe hypertriglyceridemia (sHTG) that were at high risk for familial chylomicronemia syndrome (FCS). METHODS Two cohorts (derivation and validation) of patients with sHTG were included in the study. Anthropometric, clinical, biochemical and genetic data were obtained. The CM/VLDL-TG, TG/TC and TG/APOB ratios were calculated. Finally, a diagnostic performance study was developed to establish sensitivity, specificity and cut-offs by a ROC curve analysis in the derivation cohort as well as agreement and predictive values in the validation cohort. RESULTS Patients with FCS in both cohorts showed an earlier presence in pancreatitis, greater number of acute pancreatitis episodes and lower BMI. FCS patients also showed higher ratios of CM/VLDL-TG, TG/TC and TG/APOB ratios, whereas their HDL-C, LDL-C and APOB levels were lower than in non-FCS patients. Sensitivity and agreement were low for both the TG/TC and TG/APOB ratios, although predictive values were good. The CM/VLDL-TG ratio showed greatest sensitivity, specificity, agreement and predictive values for cut-off of 3.8 and 4.5. CONCLUSIONS Our results suggest that in subjects at high risk of FCS a total serum TG/TC ratio or TG/APOB ratio are feasible to initially screen for HLPI; however, a CM/VLDL-TG ratio ≥4.5 is a better diagnostic criterion for HPLI.
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Affiliation(s)
- José Rioja
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - María-José Ariza
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | - Teresa Arrobas
- Clinical Chemistry Unit, Virgen Macarena Hospital, Sevilla, Spain
| | - Ovidio Muñiz-Grijalvo
- Internal Medicine Department, UCERV-UCAMI, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Alipio Mangas
- Internal Medicine Department, School of Medicine, Institute of Research and Innovation in Biomedical Sciences (INiBICA), University Hospital Puerta del Mar, University of Cadiz, Cádiz, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,Lipid Unit, University Hospital Virgen de la Victoria, Málaga, Spain
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Melguizo E, Navarro V, Hernández B, Santos K, Arrobas T, Domínguez C, Navarro F, González C. Diagnostic utility of oxidative damage markers for early rheumatoid arthritis in non-smokers and negative anti-CCP patients. An Sist Sanit Navar 2014; 37:109-15. [PMID: 24871116 DOI: 10.4321/s1137-66272014000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Besides the development of new markers and diagnostic criteria for rheumatoid arthritis (RA), many patients are still diagnosed after several years of symptoms. Oxidative stress markers are already increased at an early stage of RA. Our aim was to evaluate the additional diagnostic value of these markers. METHODS A case-control study was performed. Patients met the 1987 RA ACR criteria, less than 2 years of symptoms and no previous treatment with disease-modifying anti-rheumatic drugs (DMARD), steroids or vitamin E. Controls were selected from patient's relatives and matched (1:1) by gender, age, and current smoking habit. Oxidative damage markers were malonyldialdehyde (MDA), Lipid hydroperoxides (LOOH) and Carbonyl proteins (CP). Statistical analysis was performed in agreement with the STARD initiative. RESULTS Sixty-five RA patients without treatment and 65 healthy controls were included. LOOH, CP, antibodies against citrullinated peptides (anti-CCP) and rheumatoid factor (RF) were significantly higher in patients, and MDA higher in controls. The same results were obtained in the subgroups of patients who smoke or not, and in anti-CCP positive or negative. The diagnosis performance of traditional markers showed good specificity but low sensitivity. The addition of LOOH and CP increased the sensitivity and the area under the receiving operating characteristic (ROC) curve especially in non-smoking (66%) and negative anti-CCP (51%) patients. CONCLUSIONS The separate or combined addition of LOOH or CP to the traditional disease markers improved the diagnosis of RA, especially in non-smoking or negative anti-CCP patients.
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Affiliation(s)
- E Melguizo
- Clinical Biochemistry Department, University Hospital Virgen Macarena, Sevilla, 41071, Spain.
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