Metabolic and cardiovascular improvements after biliopancreatic diversion in a severely obese patient

importante es saber cómo y cuándo utilizarlos y cómo combinarlos para obtener un control efectivo y eficiente del paciente hipertenso.El hipertenso es un paciente de riesgo cardiovascular en el que la elección del tratamiento viene condicionada por otras circunstancias añadidas. Actualmente 2 grandes consideraciones dominan el tratamiento antihipertensivo: por una parte, el bloqueo del sistema renina-angiotensina se erige como base de éste y, por otra parte, la utilización de combinaciones para lograr un mejor control antihipertensivo. Esta es la situación real y la práctica clínica seguida por la mayoría de los médicos españoles así lo corrobora.En resumen, consideramos que la Guía Terapéutica de la semFYC está anclada en unos planteamientos ya felizmente superados y no refleja las evidencias acumuladas sobre antihipertensivos que deben entrar en la elección de numerosos pacientes hipertensos.

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Insuficiencia renal oculta en diabéticos sin enfermedad cardiovascular conocida

Gijón-Conde

Millanes

Robledo

et al. 2009

Atención Primaria

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Upregulation of Plasma Insulin‐Like Growth Factor Binding Protein 2 Levels After Biliopancreatic Diversion in Humans

Martin

Poirier

et al. 2012

Obesity

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The biliopancreatic diversion surgery with duodenal switch (BPD‐DS) is a surgical procedure that not only induces significant weight loss, but also promotes remission of diabetes. However, the mechanism responsible for this insulin‐potentiating effect (both on sensitivity and production) is not yet clearly understood. The insulin‐like growth factor (IGF) binding protein 2 (IGFBP‐2) is a 36 kDa circulating protein that has been recently suggested to modulate insulin sensitization and fat accumulation. In humans, a low‐circulating concentration of IGFBP‐2 has been associated with obesity and insulin resistance. We thus tested the hypothesis that BPD‐DS would trigger an increase in IGFBP‐2 levels. Plasma IGFBP‐2 was quantified by enzyme‐linked immunosorbent assay in 77 severely obese men and women before and up to 1 year after BPD‐DS surgery. Baseline IGFBP‐2 levels were 159 ± 17 ng/ml. Plasma IGFBP‐2 levels increased significantly as soon as 24 h after BPD‐DS surgery and were further augmented at both 6 months and 1 year after the surgery, reaching 748 ± 65 ng/ml. Changes in IGFBP‐2 concentrations were significantly and negatively associated with blood glucose, insulin, triglycerides, and total cholesterol levels. The present findings suggest that the rise in IGFBP‐2 levels is associated with the improvements in glucose and lipid metabolism in the short‐ and long‐term after BPD‐DS. The mechanisms for the augmentation in IGFBP‐2 after BPD‐DS and its contribution to insulin sensitization remain to be elucidated.

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Effect of bariatric surgery on heart failure

Rodríguez-Flores

Salinas

Piché

et al. 2017

Expert Review of Cardiovascular Therapy

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Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.

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Metabolic and cardiovascular improvements after biliopancreatic diversion in a severely obese patient

Cited by 4 publications

References 40 publications

Insuficiencia renal oculta en diabéticos sin enfermedad cardiovascular conocida

Insuficiencia renal oculta en diabéticos sin enfermedad cardiovascular conocida

Upregulation of Plasma Insulin‐Like Growth Factor Binding Protein 2 Levels After Biliopancreatic Diversion in Humans

Effect of bariatric surgery on heart failure

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