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Inicio Clínica e Investigación en Arteriosclerosis (English Edition) Clinical characterization and detection of subclinical atherosclerosis in subjec...
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Original article
Available online 28 October 2024
Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia
Caracterización clínica y detección de arteriosclerosis subclínica en sujetos con hiperalfalipoproteinemia extrema
Javier Espíldora-Hernándeza,b,
Corresponding author
javierespildora@gmail.com

Corresponding author.
, Tania Díaz-Antonioc, Jesús Olmedo-Llanesd, Jesús Zarzuela Leóne, José Riojae,b, Pedro Valdivielsoa,b,e, Miguel Ángel Sánchez-Chaparroa,b,e, María José Arizab,e
a Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, Spain
b Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, Spain
c Servicio de Radiodiagnóstico, Hospital Universitario Virgen de la Victoria, Málaga, Spain
d Servicio de Medicina Interna, Hospital de Antequera, Málaga, Spain
e Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
Received 07 February 2024. Accepted 20 March 2024
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Tables (5)
Table 1. Clinical and anthropometric characteristics of the study subjects.
Table 2. Analytical data (mg/dl).
Table 3. Radiological data.
Table 4. Variables with significant differences between patients with and without plaques.
Table 5. linear regression model for the association of covariates with the presence of subclinical atherosclerosis.
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Abstract
Introduction and objectives

The association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterise a sample of subjects with extreme hyperalphalipoproteinemia (HAE).

Material and methods

53 cases with HAE were recruited, 24 women (HDL-C > 135 mg/dl) and 29 men (HDL-C > 116 mg/dl). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis.

Results

The most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p = 0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p = 0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p < 0.05).

Conclusions

Men had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

Keywords:
Extreme hyperalphalipoproteinemia
HDL (high-density lipoproteins) cholesterol
Subclinical atherosclerosis
Vascular risk
Resumen
Introducción y objetivos

La asociación entre niveles de colesterol de HDL (C-HDL) y muerte por enfermedad cardiovascular sigue un patrón en forma de U, aumentando en los extremos. El objetivo de nuestro estudio fue caracterizar clínica y analíticamente a un grupo sujetos con hiperalfalipoproteinemia extrema, así como analizar la presencia de arteriosclerosis subclínica.

Material y métodos

Se reclutaron 53 casos con HAE, 24 mujeres (C-HDL>135 mg/dL) y 29 hombres (C-HDL>116 mg/dL). Se realizó una historia clínica detallada y se recogieron cuestionarios de adherencia a dieta mediterránea y actividad física. Se realizaron ecografías carotídeas para detectar la presencia de arteriosclerosis subclínica.

Resultados

El factor de riesgo vascular (FRCV) más prevalente fue la dislipemia (64%) sin diferencias significativas entre hombres y mujeres, al contrario que la hipertensión (21% en mujeres, versus 55% en hombres, p = 0.01) y otros FRCV, por ejemplo, la diabetes. El 7% de la serie presentó enfermedad cardiovascular previa, las mujeres tuvieron más elevado que los hombres el colesterol de LDL (p = 0.002) y el C-HDL (sin diferencias significativas). Se detectó placa en un 53% de casos, siendo más prevalente en hombres. Los pacientes con placa fueron más mayores, bebían más alcohol y fueron más fumadores (p < 0.05).

Conclusiones

Los hombres presentaron mayor prevalencia de FRCV que las mujeres, salvo la dislipemia. Hubo arteriosclerosis subclínica en más de la mitad de la serie. La edad, el consumo de alcohol y el tabaquismo se asociaron independientemente con la presencia de placa, sin embargo, nuestros datos no muestran una influencia significativa de los niveles de C-HDL.

Palabras clave:
Hiperalfalipoproteinemia extrema
Colesterol HDL (lipoproteínas de alta densidad)
Arteriosclerosis subclínica
Riesgo vascular

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