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Resumen Las interferencias analíticas en el laboratorio clínico pueden causar errores en la interpretación de los resultados de diversas magnitudes biológicas por parte del médico peticionario. Las interferencias analíticas más frecuentemente observadas en el laboratorio clínico son la hemólisis, ictericia y lipemia. La lipemia se define como la turbidez de la muestra causada por la acumulación de lipoproteínas, principalmente lipoproteínas de muy baja densidad (VLDL) y quilomicrones. Existen diversos métodos de detección de muestras lipémicas, como por ejemplo, el índice lipémico o la determinación de triglicéridos en muestras de suero o plasma o la Concentración de Hemoglobina Corpuscular Media (CHCM) en muestras de sangre. Las empresas de diagnóstico in vitro son las responsables, según la Directiva Europea 98/79/CE, de realizar el estudio de las sustancias interferentes que pueden afectar a la medición de una magnitud. Existe una necesidad urgente de estandarizar la forma en que se realizan y se reportan los estudios de interferencia por parte de los fabricantes. La interferencia por lipemia puede ser eliminada por diferentes métodos permitiendo la determinación de magnitudes biológicas de manera exacta. El laboratorio clínico debe decidir los protocolos de actuación ante muestras lipémicas dependiendo de la magnitud biológica que se quiere analizar.

Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested.

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.

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).

Resumen Introduccion y objetivo La hipercolesterolemia familiar (HF) es el trastorno genetico mas frecuente asociado con enfermedad coronaria prematura debido a la presencia de cLDL incrementado desde el nacimiento. Se encuentra infradiagnosticada e infratratada. El objetivo primario del proyecto ARIAN es determinar el numero de pacientes diagnosticados de HF tras implantar un nuevo procedimiento de cribado desde el laboratorio. Material y metodos Este proyecto se ha disenado como un analisis retrospectivo mediante consulta al sistema informatico. Se seleccionaron de las bases de datos de laboratorio aquellas muestras de suero de pacientes ≥ 18 anos con cLDL directos o calculados > 250 mg/dl, desde el 1 de enero del 2017 hasta el 31 de diciembre del 2018. Una vez descartadas causas secundarias, se comunico al medico de Atencion Primaria solicitante la sospecha de que su paciente pudiera portar una HF y gestionar una cita prioritaria en la unidad de Lipidos. Todos aquellos pacientes con una puntuacion ≥ 6 puntos de los criterios de las Clinicas holandesas se les propuso un estudio genetico. Resultados El protocolo se presento a 55 laboratorios de forma individualizada. Hasta el dia 30 de diciembre del 2020, el numero centros que han remitido resultados es de 24. El numero de muestras analizadas hasta ese momento fue de 3.266.341, lo que representa un 34% de la poblacion atendida en esas areas de salud (9.727.434). Conclusiones La identificacion de nuevos sujetos con HF mediante esta nueva estrategia desde el laboratorio y su remision a las unidades de Lipidos debe incrementar el numero de pacientes tratados en las unidades de Lipidos y permitir iniciar cribados en cascada familiar.

Introduction The combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. Objectives To implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. Material and methods Study of the implementation of Apolipoprotein B and Lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramon Jimenez, Hospital Infanta Elena, and Hospital de Rio Tinto during 2018 and 2019. Results The four diagnostic algorithms entered into the Laboratory Information System (LIS), showed a total of 9985 patients with c-LDL >200 mg/dL. The diagnostic algorithm was extended to include Apo B, with 8182 determinations showing an Apolipoprotein B > 100 mg/dL). A total of 747 lipoprotein (a) were determined, of which 30.65% were >50 mg/dL. More than two-thirds (71.80%) showed results compatible with small and dense LDL particles. Conclusions The implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of CVD.

Severe hypercholesterolaemia is a major cardiovascular risk factor. Early detection and treatment can reduce the incidence of cardiovascular disease. Given the high prevalence of hypercholesterolaemia in Andalusia, the development of a screening strategy for its detection in Primary Care may be an efficient measure. Objective To identify patients in Primary Care with severe hypercholesterolaemia that may increase their cardiovascular risk by reviewing LDL-cholesterol results in computerised laboratory systems. Material and methods Observational, retrospective, multi-centre study in 16 hospitals in Andalusia and Ceuta. Anonymous analytical data were acquired from the different laboratory computer systems for the year 2018, and exclusively from Macarena Hospital for the year 2019. Results From a total of 1,969,035 determinations on ≥18 years old, 2791 patients (0.14%) were detected with LDL-cholesterol >250 mg/dl and from a total of 2.327.211 determinations studied in children under 18 years old, 3804 patients (0.16%) were detected with LDL-cholesterol >135 mg/dl. The highest incidence of possible genetic hypercholesterolaemia in adults corresponded to the province of Seville with 23.6 cases/1000 determinations, while in minors, the highest incidence corresponded to the province of Cadiz with 75 possible cases/1000 determinations. A geographical triangle of greater prevalence is observed between the provinces of Seville, Huelva and Cadiz. Conclusions The development of a screening strategy using a computerised review of LDL-cholesterol in Primary Care detects a large number of subjects with severe hypercholesterolaemia that could benefit from an early intervention.

Resumen La hipercolesterolemia severa es un importante factor de riesgo cardiovascular. Su deteccion precoz y tratamiento puede reducir la incidencia de las enfermedades cardiovasculares. Dada la alta prevalencia de hipercolesterolemia en Andalucia, el desarrollo de una estrategia oportunista para su deteccion en atencion primaria puede ser una medida eficiente. Objetivo Identificar pacientes en atencion primaria con hipercolesterolemias severas que puedan incrementar su riesgo cardiovascular mediante una consulta del colesterol- LDL al sistema informatico de laboratorio. Material y metodos Estudio observacional, retrospectivo, multicentrico, en 16 hospitales de Andalucia y Ceuta. Se adquirieron datos analiticos anonimizados de los diferentes sistemas informaticos de laboratorio del ano 2018 y exclusivamente del Hospital Virgen Macarena para el ano 2019. Resultados De un total de 1.969.035 determinaciones ≥ 18 anos se detectaron 2.791 pacientes (0,14%) con colesterol-LDL > 250 mg/dl, y en menores de 18 anos, sobre un total de 2.327.211 determinaciones estudiadas, se detectaron 3.804 pacientes (0,16%) con colesterol-LDL > 135 mg/dl. La mayor incidencia de posibles hipercolesterolemias geneticas en adultos correspondio a la provincia Sevilla con 23,6 casos/1.000 determinaciones, mientras que en menores la mayor incidencia correspondio a la provincia de Cadiz, con 75 posibles casos/1.000 determinaciones. Se observa un triangulo geografico de mayor prevalencia entre las provincias de Sevilla, Huelva y Cadiz. Conclusiones El desarrollo de una estrategia oportunista mediante consulta informatica del colesterol-LDL en atencion primaria detecta un gran numero de sujetos con hipercolesterolemias severas que se podrian beneficiar de una intervencion precoz.

So far, most cases of hypercholesterolaemia (60-80%) are attributed to pathogenic variants in the LDLR gene. Only 1-5% of cases are caused by variants in the APOB gene, and 0-3% by variants in the PCSK9 gene. There is a large variety in known pathogenic mutations of the LDLR gene, while for those affecting the APOB gene, the highest incidence is p.Arg3527Gln, described predominantly in Central European and North American populations. In the Iberian Peninsula the predominant gene affected is that of the LDL receptor, similar to the rest of the world, with the involvement of the APOB gene being described in individuals from the northwest, and anecdotal in the rest of the territory. A genetics analysis was performed on the population attending the first year of a lipid clinic in southwestern Spain with a 6-point score from the Dutch lipid clinics. The genetic, biochemical and clinical findings are described. The first findings show indications of a possible higher prevalence of patients with mutation in the APOB gene compared to other territories. Historical evidence is presented that could give a possible explanation to this, thus supporting the assumption.

Resumen Hasta el momento, la mayor parte de los casos de hipercolesterolemia familiar (60-80%) se atribuyen a variantes patogenicas en el gen LDLR. Solo un 1-5% de los casos se produce por variantes en el gen APOB y un 0-3% por variantes en el gen PCSK9. Existen gran variedad en mutaciones patogenicas conocidas del gen LDLR mientras que, para las que afectan al gen APOB, la de mayor incidencia es p.Arg3527Gln, descrita predominantemente en poblaciones de Centroeuropa y America del Norte. En la Peninsula Iberica el gen predominante afectado es el del receptor de LDL, similar al resto del mundo, siendo la afectacion del gen APOB descrita en individuos del noroeste y anecdotica en el resto del territorio. Analizamos geneticamente la poblacion asistida en el primer ano de una consulta de lipidos del suroeste de Espana con puntuacion ≥ 6 puntos de las clinicas de lipidos holandesas y describimos los hallazgos geneticos, bioquimicos y clinicos. Los primeros hallazgos muestran indicios de una posible mayor prevalencia de pacientes con mutacion en el gen APOB respecto a otros territorios. Encontramos hechos historicos que darian una posible explicacion a este hecho, apoyando asi dicha presuncion.

Cardiovascular diseases continue to lead the ranking of mortality in Spain. The implementation of geostatistical analysis techniques in the clinical laboratory are innovative tools that allow the design of new strategies in primary prevention of cardiovascular disease. The aim of this study was to study the prevalence and geolocation of severe dyslipidemia in the health areas under study in order to implement prevention strategies in primary care. A retrospective cohort study of low-density protein-bound cholesterol, triglyceride and lipoprotein (a) levels in the years 2019 and 2020 were carried out. In addition, a geostatistical analysis was performed including representation in choropleth maps and the detection of clustering clusters, using geographic information in zip code format included in the demographic data of each analytic.The analytical data included in the study were triglycerides (n=365,384), low density protein-bound cholesterol (n=289,594) and lipoprotein to lipoprotein (a) (n=502). Areas with the highest and lowest percentage of cases were identified for the established cut-off points of LDL-C190mg/dL and TG150mg/dL. Two clustering clusters with statistical significance were detected for cLDL190mg/dL and a total of 6 clusters for TG values150mg/dL.The detection of clusters, as well as the representation of choropleth maps, can be of great help in detecting geographic areas that require greater attention to intervene and improve cardiovascular risk.

La Sociedad Española de Arteriosclerosis tiene entre sus objetivos contribuir al mayor y mejor conocimiento de la enfermedad vascular, su prevención y su tratamiento. Es de sobra conocido que las enfermedades cardiovasculares son la primera causa de muerte en nuestro país y conllevan además un elevado grado de discapacidad y gasto sanitario. La arteriosclerosis es una enfermedad de causa multifactorial y es por ello que su prevención exige un abordaje global que contemple los distintos factores de riesgo con los que se asocia. Así, este documento resume el nivel actual de conocimientos e incluye recomendaciones y procedimientos a seguir ante el paciente que presenta enfermedad cardiovascular establecida o se encuentra con elevado riesgo vascular. En concreto, este documento revisa los principales síntomas y signos a evaluar durante la visita clínica, los procedimientos de laboratorio y de imagen a solicitar de forma rutinaria o aquellos en situaciones especiales. Igualmente, incluye la estimación del riesgo vascular, los criterios diagnósticos de las distintas entidades que son factores de riesgo cardiovascular, plantea recomendaciones generales y específicas para el tratamiento de los distintos factores de riesgo cardiovascular y sus objetivos finales. Por último, el documento recoge aspectos habitualmente poco referenciados en la literatura como son la organización de una consulta de riesgo vascular. One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation. © 2021 The Authors

Hereditary familial hypobetalipoproteinemia (FHBL) is a syndrome caused by variants in the APOB gene, that cause a defect in the secretion and mobilization of liver lipids to peripheral tissues, associated with the synthesis of truncated ApoB100 apolipoproteins. This condition causes significant reduction in total cholesterol (TC), low-density lipoproteins (LDL), very low-density proteins (VLDL) and serum triglyceride levels, with unchanged high-density lipoprotein (HDL) cholesterol levels. Herein we present the case of a middle-aged woman diagnosed with FHBL and hepatic steatosis, heterozygous for c.4698CA; (p.Tyr1566Ter) variant in APOB. The variant presented herein showed high expressiveness in the two generations of individuals analyzed and has not yet being described in the medical literature. Early diagnosis and screening for associated metabolic comorbidities such as metabolic fatty liver disease and its subsequent progression to fibrosis are the two main goals in the treatment of this condition, in order to prevent medium to long term potential complications.

Resumen Las dislipidemias son alteraciones del metabolismo lipidico que cursan con concentraciones de lipidos alteradas, tanto por exceso como por defecto. Estas alteraciones estan fuertemente asociadas con el proceso aterosclerotico, y se ha demostrado que el control de dichas alteraciones consigue disminuir la incidencia de episodios de origen isquemico. Diagnosticar las dislipidemias desde un punto de vista etiologico es muy importante, ya que el riesgo cardiovascular al que predispone cada una de ellas es diferente, dependiendo del tipo de lipoproteina que este alterada y de su concentracion. Por ello es de gran utilidad disponer de algoritmos diagnosticos sencillos que incluyan magnitudes del metabolismo lipidico disponibles en la mayoria de los laboratorios clinicos, con el fin de realizar el diagnostico inicial del tipo de dislipidemia, en caso de poseer las herramientas diagnosticas adecuadas identificarla y, en caso contrario, disponer de la informacion apropiada para recomendar la ampliacion del estudio en otro centro que disponga de los recursos necesarios para establecer el diagnostico.

One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation.

Resumen Este documento describe recomendaciones para la estandarizacion de la medida de las magnitudes lipidicas, puesto que resultan criticas para la toma de decisiones clinicas. Deben emplearse metodos recomendados validados frente a un metodo de referencia o definitivo, y materiales de control que cumplan con la Directiva Europea sobre Diagnostico in vitro; deben cumplir tambien los objetivos recomendados por el National Cholesterol Education Program (NCEP) y la Sociedad Espanola de Medicina del Laboratorio (SEQCML). La determinacion de colesterol de HDL por metodos homogeneos en equipos automatizados se considera aceptable para la practica rutinaria, y la formula de Friedewald utilizable para estimar la concentracion de colesterol de LDL siempre que las concentraciones de trigliceridos sean iguales o inferiores a 200 mg/dL (2,3 mmol/L); en otro caso, se recomienda utilizar la concentracion de colesterol-no-HDL. La cuantificacion rutinaria de apolipoproteinas A1 y B, y lipoproteina (a), puede efectuarse por metodos de inmunonefelometria e inmunoturbidimetria, con calibradores trazables a materiales de referencia.

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.

Severe hypercholesterolaemia is a major cardiovascular risk factor. Early detection and treatment can reduce the incidence of cardiovascular disease. Given the high prevalence of hypercholesterolaemia in Andalusia, the development of a screening strategy for its detection in Primary Care may be an efficient measure.To identify patients in Primary Care with severe hypercholesterolaemia that may increase their cardiovascular risk by reviewing LDL-cholesterol results in computerised laboratory systems.Observational, retrospective, multi-centre study in 16 hospitals in Andalusia and Ceuta. Anonymous analytical data were acquired from the different laboratory computer systems for the year 2018, and exclusively from Macarena Hospital for the year 2019.From a total of 1,969,035 determinations on≥18 years old, 2,791 patients (0.14%) were detected with LDL-cholesterol250mg/dl and from a total of 2.327.211 determinations studied in children under 18 years old, 3,804 patients (0.16%) were detected with LDL-cholesterol135mg/dL. The highest incidence of possible genetic hypercholesterolaemia in adults corresponded to the province of Seville with 23.6 cases/1,000 determinations, while in minors, the highest incidence corresponded to the province of Cadiz with 75 possible cases/1,000 determinations. A geographical triangle of greater prevalence is observed between the provinces of Seville, Huelva and Cadiz.The development of a screening strategy using a computerised review of LDL-cholesterol in Primary Care detects a large number of subjects with severe hypercholesterolaemia that could benefit from an early intervention.

A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.

A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.

Resumen La hipercolesterolemia familiar (HF) es una de las enfermedades hereditarias mas frecuentes, afectando a unas 10 millones de personas en todo el mundo. Se caracteriza por niveles elevados de c-LDL y por una elevada prevalencia de enfermedad cardiovascular prematura. La HF se origina por mutaciones en el gen que codifica el receptor de c-LDL. Presentamos el caso de un nino de 6 anos que es remitido al laboratorio de Riesgo Cardiovascular (RCV) por sospecha de hipercolesterolemia familiar. Se le realiza una bioquimica general y un perfil de RCV, donde se observa un colesterol total y un c-LDL elevado, con el resto de los parametros dentro de los rangos de normalidad. Se procede a la confirmacion de la HF heterocigota mediante la determinacion de la mutacion del receptor de c-LDL (Lipochip®) mediante analisis genetico.

Resumen La sobrecarga oral de glucosa (SOG) es una prueba habitual en los laboratorios clinicos. Determina el estado de diabetes o intolerancia a la glucosa. Pacientes con una SOG alterada, mas uno de los dos criterios siguientes: perimetro de cintura patologico (> 102 cm en hombres o > 88 cm en mujeres) o sobrepeso/obesidad (indice de masa corporal [IMC] ≥ 25 kg/m 2 o IMC ≥ 30 kg/m 2 ) con una alta probabilidad van a presentar otros factores de riesgo cardiovascular (FRCV) asociados, que supondran un elevado riesgo cardiovascular (RCV) global para la persona que los padece. Proponemos la SOG como prueba capaz de identificar pacientes con moderado/alto RCV que es necesario evaluar.

Resumen La lipoproteina (a) (Lp[a]) es una lipoproteina esferica, rica en esteres de colesterol y fosfolipidos con una apolipoproteina a que se asemeja estructuralmente a la molecula de lipoproteinas de baja densidad (LDL). Los valores elevados de Lp(a) se asocian a ataques cardiacos, apoplejias, estrechamiento de las arterias y reestenosis de vasos despues de haber establecido quirurgicamente un puente coronario. El hecho que la concentracion de Lp(a) no pueda modificarse con los hipolipemiantes habituales influye en el cumplimiento terapeutico de los pacientes, ya que el porcentaje de colesterol transportado por la Lp(a) es inmodificable, y este puede llegar a concentraciones de hasta 80-90 mg/dl. Objetivos Estudiar si los valores de Lp(a) influyen en la consecucion de los objetivos terapeuticos y, en caso afirmativo, analizar las posibles alternativas. Pacientes y metodos Se selecciono a una poblacion de 100 pacientes intervenidos de bypass aortocoronario. Todos los pacientes fueron pesados y tallados, se les tomo la presion arterial y el perimetro de cintura, se les determino un hemograma, coagulacion, perfil tiroideo, bioquimica general y un perfil de riesgo cardiovascular. Resultados Dividimos a los pacientes en funcion de la concentracion de Lp(a) al ano de seguimiento. Segun los valores de Lp(a) el cumplimiento es del 46,55% para Lp(a) 30 mg/dl. Si aplicamos el LDL corregido (colesterol unido a LDL – colesterol unido a Lp[a]) el cumplimiento en el grupo de mayor riesgo se incrementa en un 39,89%, pasando al 75,60%. Conclusiones Confirmamos que la consecucion de los objetivos terapeuticos de los pacientes puede mejorarse con un seguimiento de estos de manera mas intensiva y que esta consecucion esta influida por la elevacion de las concentraciones de Lp(a), con lo que se confirma un cumplimiento mas bajo en los pacientes con riesgo mayor en funcion de sus concentraciones de Lp(a).

Introduccion La revascularizacion miocardica es una intervencion terapeutica perfectamente establecida en pacientes con enfermedad coronaria. El objetivo del presente estudio es el de comprobar el cumplimiento terapeutico de los objetivos marcados por el Adult Treatment Panel (ATP) III para una poblacion de muy alto riesgo cardiovascular y la evolucion de los principales factores de riesgo cardiovascular. Material y metodos Se han estudiado un total de 131 pacientes intervenidos de bypass aortocoronario. Para la evaluacion de su riesgo y posterior tratamiento, fueron atendidos a los 3, 6 y 12 meses tras la intervencion. Independientemente de otros datos necesarios para la historia clinica, a todos se les determino los valores de presion arterial, perimetro de cintura, peso, talla e indice de masa corporal, habito tabaquico y hemograma, un perfil bioquimico y un perfil de riesgo cardiovascular que incluye, ademas de los habituales, una ultracentrifugacion para la separacion de las lipoproteinas, los valores de apolipoproteina (apo) A-I y B-100 y diversos marcadores de riesgo e inflamacion como la lipoproteina(a) (Lp[a]), proteina C reactiva ultrasensible (PCR), el fibrinogeno y la homocisteina. Resultados Los valores de colesterol unido a lipoproteinas de baja densidad (cLDL) descendieron desde 142 a 108 mg/dl y los de apo B desde 101 a 79 mg/dl. El 44% de los pacientes cumplio los objetivos marcados por el ATP III, es decir, cLDL 102 cm, presente en el 50% de los pacientes, descendio al 19,64%, y los fumadores, que abarcaban el 58% de los pacientes, abandonaron en su totalidad el habito tabaquico. Conclusiones Tras el tratamiento con estatinas y/o estatinas-ezetimiba y modificacion de los habitos de vida, los pacientes experimentan una reduccion significativa de los principales factores de riesgo a excepcion de la homocisteina y de la Lp(a); el 44% de los pacientes estudiados cumple los objetivos marcados por el ATP III. Por otro lado, el tratamiento combinado estatina-ezetimiba parece producir mayores beneficios que el tratamiento con estatinas en monoterapia.

[EN] The “flipped classroom” is a new teaching methodology model that seeks to reverse the way learning contents are delivered to students in order to promote the subject understanding by working at home. The aim of the study is to analyze whether the implementation with “flipped classroom” is useful as a teaching tool to improve academic performance and if it is dependent on the sex of participants. We have a sample of 75 kinesiology students (55% male and 46% female) and 98 of obstetrics (94% women and 4% men), between 20-24 years. They performed three tests in the academic semester: 1st test, control group N = 164; 2nd test, introduction from class to class on paper; 3 test, introduction of web platform. The average score of the first test was 3.86 ± 0.78 and confidence interval (3.74-3.99), second test average score was 4.12 ± 0.87 and confidence interval (3.99-4.26) and third test average score was 4.92 ± 0.94 and interval confidence (4.77- 5.05). An analysis of variance was done obtai, [ES] El flipped classroom es un nuevo modelo metodológico docente que trata de invertir la forma en que los contenidos de aprendizaje se entregan a los alumnos para favorecer el entendimiento de la materia mediante un trabajo en casa .El objetivo del estudio es analizar si la implantación del ”flippedd classroom” es útil como herramienta docente para mejorar el rendimiento académico y si este es dependiente del sexo. Contamos con una cohorte de 75 alumnos de kinesiología (55% hombres y 46% mujeres) y 98 de obstetricia (94%mujeres y 4% hombres) de ambos sexos entre los 20-24 años. Se les realizo tres pruebas en el semestre académico, 1ºprueba, grupo control N=164, 2 prueba, introducción de clase a clase en papel, 3 pruebas, introducción de plataforma web. La nota media de la primera prueba fue 3,86± 0.78 e intervalo de confianza (3.74-3.99) la de la segunda prueba fue 4.12± 0.87 intervalo de confianza (3.99-4.26) y de la tercera prueba 4.92±0.94 e intervalo de confianza (4.77- 5.05.) Se real

Iodine is an essential trace element implicated in synthesis of thyroid hormones. Iodine requirements vary throughout life. This iodine requirement is increased during pregnancy and breastfeeding. In a previous study carried out by our group in 2008, we detected an iodine-deficient area in the province of Huelva, specially in district Sierra de Huelva-Andévalo by means of neonatal TSH determinations.To reinforce the iodine supplementation campaign and its impact on their newborns in order to assess nutrition iodine status in pregnant women using questionnaire and ioduria determination.This study has been jointly carried out by Congenital Hypothyroidism Unit of the Clinical Biochemistry Department of the Virgen Macarena University Hospital (Seville) and the Gynecology and Clinical Analysis Unit of the Río Tinto Hospital (Huelva) during two years. We studied 313 pregnant women. All of them filled out a personal questionnaire to know the iodine nutritional status in their area. Ioduria was determinated by high-resolution liquid chromatography. Data from pregnant women and results of the studied variables were analyzed with SPSS v13.0.Pregnant women from the sanitary district Sierra de Huelva-Andévalo present a median for ioduria which corresponds to an insufficient iodine intake according to the WHO classification. The questionnaires suggest that this iodine deficiency is consequence of an insufficient iodine intake and a low adherence to the treatment.