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@ Q   %;  P+sZCU 4  3@)$=c6N3!Rl +; M.+ - =3a a      a  $" &r<dH  5$'?98\ <s   :~L / S   T ,>+ I,#       <-#F7   ;;CZy!"m#e>  I( ;#$  &'()Opb$s#ڿE`"  Tb$$>I$ Tb$-gB4nyө* T"$ˏqv[9tT"$IvS$X>0Tb$nhx=_Wk$T"$zCU>hx jT"$SL#>j7]koNb1=T"$.43xhO ]2nT$T$T"$g"' K]4 T"$^َ`q1vUx )6T n0e0e     A5% 8c8c     ?A)BCD|E||S" @$'+ʚ;>7ʚ;g4BdBdv 0(pp<4!d!d` 0L6D<4dddd` 0L6D <4dddd 0Lhg4=d=dv 0.p po2*___PPT9 %hlpL.[>_>c>g>"?&?*?2?3?z? %O =`UcLos niveles de triglicridos postprandiales son un factor de riesgo para la cardiopata isqumica?ddfff8  AntecedentesLa relacin entre la hipertrigliceridemia y el riesgo cardiovascular es controvertida. Recientemente se ha propuesto que los remanentes de quilomicrones y de VLDL presentes en el suero postprandial podran jugar un papel en el desarrollo de la aterosclerosis. Sin embargo, estas partculas se reflejan en los anlisis habituales, puesto que habitualmente se recomienda que estos se hagan en ayunas. >b   Objetivos|Someter a prueba a hiptesis de que los triglicridos postprandiales predicen el riesgo de sufrir una cardiopata isqumica.59 Diseo (1)WEstudio de cohortes (Copenhagen City Heart Study): estudio prospectivo de base poblacional, se inici en 1976, incluy ms de 14.000 personas de 20-80 aos. Al 72% de los participantes se les determinaron los triglicridos en una muestra que no se recogi en ayunas. Los participantes han sido seguidos hasta 2004 en el 100% de los casos.X3ZmZZm( Diseo (2)La variable de resultado principal fue la presencia de un infarto de miocardio (IM) o de otras manifestaciones de cardiopata isqumica (CI). Otras variables analizadas fueron: HTA, tabaquismo, consumo de alcohol, ejercicio fsico de tiempo libre, menopausia y tratamiento hormonal sustitutivo. En una submuestra de 66 pacientes se llev a cabo una prueba de sobrecarga grasa. BZ{ZSZ{S3 B]*Resultados (1)Se incluyeron 13.981 participantes. El porcentaje de pacientes que tomaban hpolipemiantes no super el 2%. Los que se encontraban en los cuartiles superiores: tenan un mayor IMC, fumaban ms, hacan menos ejercicio y tenan ms HTA y diabetes. .Z[Z[,J0 hG'Resultados (2) P(Resultados (3) [)Resultados (4)bLa relacin fue ms fuerte para: las personas <55 aos y las que beban alcohol >2 veces/semana. &!B!BT ConclusionesLos autores concluyen que en esta cohorte de la poblacin general, los niveles de triglicridos postprandiales se relacionan con el riesgo de infarto de miocardio, cardiopata isqumica y muerte._VgComentario (1)La relacin entre la hipertrigliceridemia y el riesgo de padecer una cardiopata isqumica es un tema controvertido, a pesar de haberse encontrado una relacin entre ellos: la frecuente relacin entre los niveles de triglicridos y otros factores de riesgo cardiovascular (colesterol HDL bajo, diabetes, obesidad, etc.) han oscurecido su contribucin neta. La hipertrigliceridemia parece ser un cajn de sastre en el que coinciden varios cuadros clnicos que pueden tener diferentes riesgos cardiovasculares. *RR,@TComentario (2)En la actualidad se tiende a considerar que la hipertrigliceridemia es un factor de riesgo independiente, pero de una menor potencia que el colesterol LDL. Otro factor que puede influir en la interpretacin del valor de la hipertrigliceridemia como factor de riesgo cardiovascular es que la mayor parte de las determinaciones se llevan a cabo en ayunas, mientras que las personas pasan una parte muy importante del da en una situacin postprandial. En concreto, se ha propuesto que los remanentes de VLDL y de los quilomicrones,partculas presentes en el suero postprandial, sonfcilmente captadas por el endotelio vascular y por lo tanto pueden estar implicadas en la etiopatogenia de la aterosclerosis. Zt. C" `rComentario (3)Los resultados de este estudio parecen ir en esta direccin. Se ha detectado una relacin entre los niveles de triglicridos (especialmente evidente para los niveles de triglicridos ms elevados y en mujeres) con el riesgo de desarrollar una cardiopata isqumica que se mantena en el anlisis multivariante. En otro estudio llevado a cabo en mujeres publicado en el mismo nmero de la revista se llegaba a las mismas conclusiones. La asociacin entre la CI y los triglicridos que se apreciaba en el anlisis crudo: desapareca en el anlisis multivariante para los triglicridos en ayunas, se mantena para los triglicridos postprandiales. 2    P=F8#Comentario (4)La trascendencia clnica de esta relacin est pendiente de determinar: El hecho de que tenga que hacerse una determinacin de triglicridos postprandial complica su determinacin y es posible que haya que establecer unas condiciones estndar para incorporarla a la prctica habitual. Habr que llevar a cabo estudios de intervencin que demuestren que tratar estos pacientes produce una reduccin de la cardiiopata isqumica.6H0 Ze0 ZHe,   /3456> ? 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Antecedentes Objetivos Diseo (1) Diseo (2)Resultados (1)Resultados (2)Resultados (3)Resultados (4) ConclusionesComentario (1)Comentario (2)Comentario (3)Comentario (4) Fuentes usadasPlantilla de diseoServidores OLE incrustadosTtulos de diapositivaD  8@ _PID_HLINKSA `http://www.apaldia.com/;http://www.apaldia.com/resumenes/resumen.php?idresumen=151;http://www.apaldia.com/resumenes/resumen.php?idresumen=303/http://www.annals.org/cgi/content/full/145/1/1;http://www.apaldia.com/resumenes/resumen.php?idresumen=307;http://www.apaldia.com/resumenes/resumen.php?idresumen=307;http://www.apaldia.com/resumenes/resumen.php?idresumen=4200http://www.annals.org/cgi/content/full/147/1/41+http://www.annals.org/cgi/reprint/147/1/41;http://www.apaldia.com/resumenes/resumen.php?idresumen=486;http://www.apaldia.com/resumenes/resumen.php?idresumen=4878http://jama.ama-assn.org/cgi/content/abstract/298/3/2994http://jama.ama-assn.org/cgi/content/full/298/3/299/http://jama.ama-assn.org/cgi/reprint/298/3/299;http://www.apaldia.com/resumenes/resumen.php?idresumen=488;http://www.apaldia.com/resumenes/resumen.php?idresumen=488-_vManuel Iglesias RodalManuel Iglesias Rodal  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesVCurrent UserSummaryInformation(RPowerPoint Document(DocumentSummaryInformation8