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Familial hypercholesterolemia (FH) remains underdiagnosed and undertreated.Report the results of the first years (2017-2019) of the Mexican FH registry.There are 60 investigators, representing 28 federal states, participating in the registry. The variables included are in accordance with the European Atherosclerosis Society (EAS) FH recommendations.To date, 709 patients have been registered, only 336 patients with complete data fields are presented. The mean age is 50 (36-62) years and the average time since diagnosis is 4 (IQR: 2-16) years. Genetic testing is recorded in 26.9%. Tendon xanthomas are present in 43.2%. The prevalence of type 2 diabetes is 11.3% and that of premature CAD is 9.8%. Index cases, male gender, hypertension and smoking were associated with premature CAD. The median lipoprotein (a) level is 30.5 (IQR 10.8-80.7) mg/dl. Statins and co-administration with ezetimibe were recorded in 88.1% and 35.7% respectively. A combined treatment target (50% reduction in LDL-C and an LDL-C100 mg/dl) was achieved by 13.7%. Associated factors were index case (OR 3.6, 95%CI 1.69-8.73, P = .002), combination therapy (OR 2.4, 95%CI 1.23-4.90, P = .011), type 2 diabetes (OR 2.8, 95%CI 1.03-7.59, P = .036) and age (OR 1.023, 95%CI 1.01-1.05, P = .033).The results confirm late diagnosis, a lower than expected prevalence and risk of ASCVD, a higher than expected prevalence of type 2 diabetes and undertreatment, with relatively few patients reaching goals. Recommendations include, the use of combination lipid lowering therapy, control of comorbid conditions and more frequent genetic testing in the future.

espanolAntecedentes: Irisin es una proteina escindida de la proteina 5 que contiene el dominio de fibronectina tipo III y se ha implicado en los efectos beneficiosos del ejercicio. Sin embargo, se desconoce que factores contribuyen al incremento de irisina despues del ejercicio intensivo en humanos. Este estudio tuvo como objetivo evaluar factores independientes relacionados con la irisina serica despues de 2 semanas de actividad fisica supervisada en mujeres jovenes sedentarias sanas. Diseno y metodos: desarrollamos un estudio comparativo, intervencionista, longitudinal y prospectivo en un centro de salud especializado de tercer nivel. Entre marzo de 2010 y agosto de 2011, se reclutaron 82 mujeres adultas jovenes sedentarias, sin enfermedades cronicas o tratamientos medicos regulares. Un total de 38 mujeres cumplieron los criterios de seleccion, y las concentraciones de irisina se cuantificaron antes y despues de la intervencion. Se evaluaron factores independientes relacionados con el incremento de irisina de acuerdo con la intensidad de actividad fisica leve a moderada y vigorosa. Se realizo una prueba supervisada de ejercicio en la cinta de correr siguiendo el protocolo de Bruce de lunes a viernes durante 2 semanas. Ademas, se tomaron medidas antropometricas y se midieron el factor de crecimiento de fibroblastos 21 (FGF21), glucosa, insulina y transaminasas hepaticas. Resultados: la intensidad del ejercicio se relaciono directamente conlos niveles sericos deirisina ( p = 0.02) y FGF21 ( p = 0.01). Sin embargo, no se confirmo una relacion independiente y significativa entre FGF21 e irisina. Se encontro una nueva asociacion entre alanina aminotransferasa (ALT) e irisina, que muestra una correlacion positiva y significativa ( r = 0.37, p = 0.02). La asociacion fue particularmente fuerte con una mayor intensidad de ejercicio aerobico ( r = 0.64, p = 0.01). El modelo de regresion lineal ajustado por glucosa e indice de masa corporal confirmo una asociacion independiente entre ALT e irisina y tambien entre insulina e irisina (R² ajustado = 0,12, p= 0.04). Dicha asociacion aumento despues de agrupar en intensidad de actividad fisica moderada a vigorosa (R² ajustado = 0.46, F = 4.7, p = 0.03). Conclusiones: los niveles sericos de irisina y FGF21 aumentaron significativamente despues de 2 semanas de actividad fisica supervisada. Sin embargo, solo la insulina en ayunas y ALT, pero no FGF21, fueron parametros independientes que explican el incremento de irisina, principalmente despues de un ejercicio moderado a vigoroso. EnglishBackground: Irisin is a protein cleaved from fibronectin type III domain-containing protein 5 and has been implicated in the beneficial effects of exercise. However, it is unknown which factors contribute to irisin increment after intensive exercising in humans. This study aimed to assess independent factors related with serum irisin after 2 weeks of supervised physical activity in young sedentary healthy women. Design and Methods: We developed a comparative, interventional, longitudinal, and prospective study at a third-level specialty health center. Between March 2010 and August 2011, 82 sedentary young adult women, without chronic diseases or regular medical treatments, were recruited. A total of 38 women fulfilled selection criteria, and irisin concentrations were quantified before and after the intervention. Independent factors related with irisin increment were evaluated according to mild to moderate and vigorous intensity of physical activity. A supervised treadmill exercise test following the Bruce’s protocol was conducted from Monday to Friday during 2 weeks. In addition, anthropometric measurements were taken, and fibroblast growth factor 21 (FGF21), glucose, insulin, and liver transaminases were measured. Results: Intensity of exercising was directly related to irisin (p = 0.02) and FGF21 (p = 0.01) serum levels. However, an independent and significant relationship between FGF21 and irisin was not confirmed. A novel association was found between alanine aminotransferase (ALT) and irisin, showing a positive and significant correlation (r = 0.37, p = 0.02). The association was particularly strong with higher intensity of aerobic exercising (r = 0.64, p = 0.01). Linear regression model adjusted for glucose and body mass index confirmed an independent association between ALT and irisin and also between insulin and irisin (adjusted R² = 0.12, p = 0.04). Such association increased after grouping in moderate to vigorous physical activity intensity (adjusted R² = 0.46, F = 4.7, p = 0.03). Conclusions: Serum irisin and FGF21 levels significantly increased after 2 weeks of supervised physical activity. However, only fasting insulin and ALT, but not FGF21, were independent parameters explaining irisin increment, mainly after moderate to vigorous exercising. (REV INVEST CLIN. 2019;71:133-40)

Type 2 Diabetes Mellitus (T2DM) is a chronic illness with high prevalence in Mexico, Latin- America, and the world and is associated to high morbidity, disability, and mortality rate, especially in developing countries. T2DM physiopathology is very complex; insulin resistance in the muscle, liver, and adipose tissue, a reduction in the production of incretins (mainly GLP-1) in the intestine, increased glucagon synthesis, an insufficient response of insulin generation, and increased glucose reabsorption in the kidney lead all together to an hyperglycemic state, which has been closely associated with the development of micro and macrovascular complications. Sodium Glucose Linked Transporter 2 inhibitors (SGLT2i) are the most recent therapeutic class available for treating T2DM. SGLT2i central effect is a glycosuric action, and they can reverse the deleterious effect of tubular reabsorption of glucose in the diabetic patient resulting in greater hyperglycemia. Because their mechanism of action is completely different to current drugs, they can be considered as monotherapy or in combination with any other oral or parenteral medication, including different types of insulin or its analogues. This therapeutic synergy accomplishes a greater percentage of patients achieving glycemic control goals.

La diabetes mellitus es un problema de salud publica en constante ascenso en la mayor parte del mundo. Latino-America (LA) presenta una prevalencia elevada de diabetes mellitus tipo 2 (DM2), en la poblacion mayor de 20 anos y fluctua entre 8 y 10%. Esta prevalencia se ha incrementado acorde con el patron epidemiologico mundial; sin embargo, es particularmente elevada en LA por las caracteristicas geneticas de la poblacion, habitos de alimentacion inadecuados y sedentarismo que, vinculados con el sindrome metabolico, han encontrado un ambiente favorable para su expresion con nuestro estilo de vida actual. La DM2 es una enfermedad cronica, degenerativa, progresiva pero controlable. En la actualidad se conocen algunos mecanismos fisiopatologicos que se manifiestan en diferentes etapas de su historia natural. Dentro de este marco de referencia se desprende que la gran mayoria de los casos de DM2 se presentan en individuos que, durante un periodo variable de anos, posiblemente decadas, han cursado con alteraciones metabolicas que preceden y acompanan al estado de hiperglucemia persistente. En LA, la DM2 tiene un gran impacto en la economia del sistema de salud. Los pacientes con DM2 tienen hospitalizaciones mas prolongadas y es la segunda causa de mortalidad en pacientes hospitalizados