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We studied the prevalence and the risk factor among the patients of gout in Mexico. Research was conducted in the National Institute of Cardiology and in our private practice. Prevalence of hiperuricemia and gout in the Institute of Cardiology was of 1% (970 out of nearly 100,000 patients). We divided those cases of two subgroups: Reumatology patients (333) and Cardiovascular patients (529). In the first group primary gout was (96.3), and (50.32% in the second. Risk factor was quite different too: nephropathy 9.9%, lithiasis 9.3%, pyelonephritis 2.7%, cardioangiosclerosis 12.9%, aortosclerosis 6.6%, coronary insufficiency 6.3%, myocardial infarction 0.9%, arterial hypertension 24.6% obesity 56.1% and diabetes 9.9% in the Reumatology group; in the Cardiovascular one, nephropathy 14.3%, lithiasis 12.2%, pyelonephritis 7.1%, cardioangiosclerosis 62.7%, aortosclerosis 31.7%, coronary insufficiency 24.9%, myocardial infarction 29%, arterial hypertension 51%, obesity 54.8% and diabetes 20.4%. Among the private practice patients prevalence was of 10.1% (961). In an early age (39 years) in men and a later one for women (53 years). Other characteristics of epidemiology and risk factor are: primary gout 89%, atherosclerosis 5%, coronary disease 4.6%, lithiasis 4.7%, nephropathy 2%, pyelonephritis 1%, obesity 43%, and diabetes 4.6%. In an small group of patients of our private practice we made an exhaustive study of risk factor and the metabolic disorder of lipids. We found the following frequency: 9.3 of nephropathy, 31.2% of lithiasis, 18.7% of pyelonephritis, 68.9% of cardioangiosclerosis, 46.8% de coronary insufficiency, 9.3% of myocardial infarction, 68.7% of arterial hypertension, 68.7% of obesity and 18.7% of diabetes. In the lipid profile we found an increase in triglicerids and prebeta lipoprotein. We have amply discussed the relation between hiperuricemia and pathology considered as a risk factor from the genetic point of view as well as the metabolic and circumstancial aspect. From all that we concluded that risk is multifactorial.
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PMID:[Various epidemiological aspects of hyperuricemia and gout in Mexico: incidence and the cardiovascular risk factor]. 72 44

Hyperlipemia is one of several risk factors for premature ischemic vascular disease. It usually represents a primary, lifelong metabolic disorder and control requires changes in life-style. These include a modification of diet (commonly caloric, cholesterol and saturated fat restriction), elimination of smoking and hypertension and, frequently, drug therapy. Drugs can attack endogenous triglyceride overproduction, lipoprotein lipase deficiency or defective remnant uptake, and can decrease cholesterol production and accelerate cholesterol degradation.
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PMID:A pathophysiologic approach to managing hyperlipemia. 94 21

The experiments we described in this paper demonstrated that the myocardiac lesions without hypertension could be produced by renal failure in rabbits; after this experimental renal failure, increase in blood urea nitrogen and various functional and morphological changes suggestive of heart lesions appeared. The main structural changes in the heart were cellular edema with dilatation of the sarcotubular system, destructive changes of the mitochondria and contractile elements, and coagulative degeneration. These myocardiac lesions are induced by renal failure, and are probably caused by electrolyte imbalance, metabolic disorder, and/or hemodynamic abnormality rather than by hypertensive or toxic factors.
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PMID:Myocardiac changes in experimental renal failure--a light and electron microscopic study. 115 92

Non-insulin-dependent (type II) diabetes mellitus is an inherited metabolic disorder characterized by hyperglycemia with resistance to ketosis. The onset is usually after age 40 years. Patients are variably symptomatic and frequently obese, hyperlipidemic and hypertensive. Clinical, pathological and biochemical evidence suggests that the disease is caused by a combined defect of insulin secretion and insulin resistance. Goals in the treatment of hyperglycemia, dyslipidemia and hypertension should be appropriate to the patient's age, the status of diabetic complications and the safety of the regimen. Nonpharmacologic management includes meal planning to achieve a suitable weight, such that carbohydrates supply 50% to 60% of the daily energy intake, with limitation of saturated fats, cholesterol and salt when indicated, and physical activity appropriate to the patient's age and cardiovascular status. Follow-up should include regular visits with the physician, access to diabetes education, self-monitoring of the blood or urine glucose level and laboratory-based measurement of the plasma levels of glucose and glycated hemoglobin. If unacceptably high plasma glucose levels (e.g., 8 mmol/L or more before meals) persist the use of orally given hypoglycemic agents (a sulfonylurea agent or metformin or both) is indicated. Temporary insulin therapy may be needed during intercurrent illness, surgery or pregnancy. Long-term insulin therapy is recommended in patients with continuing symptoms or hyperglycemia despite treatment with diet modification and orally given hypoglycemic agents. The risk of pancreatitis may be reduced by treating severe hypertriglyceridemia (fasting serum level greater than 10 mmol/L) and atherosclerotic disease through dietary and, if necessary, pharmacologic management of dyslipidemia. Antihypertensive agents are available that have fewer adverse metabolic effects than thiazides and beta-adrenergic receptor blockers. New drugs are being developed that will enhance effective insulin secretion and action and inhibit the progress of complications.
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PMID:Non-insulin-dependent (type II) diabetes mellitus. 174 94

Recent clinical and experimental studies have suggested that diabetic patients may develop myocardial dysfunction in the absence of coronary heart disease and hypertension. In this study, the correlation between histopathological changes and myocardial dysfunction was studied in experimental diabetic rat hearts. Male Wistar rats were made diabetic at 9 weeks of age with a single intravenous injection of streptozotocin 50 mg/kg. The diabetic rats were studied along with age-matched control and insulin-treated rats at 4, 8, 12 and 24 weeks after the induction of diabetes to investigate isolated papillary muscle contraction and the histopathological picture simultaneously. In the isometric contractions, resting and developed tensions were similar. Time to peak tension and time to 1/2 relaxation were prolonged and the peak rate of tension rise and tension fall was depressed. On histological examination of left ventricular walls, diameters of myocytes were similar at all disease durations. Interstitial fibrosis and disarrangement of myocytes after 12 weeks were slightly increased in the diabetic hearts. Mechanical parameters did not worsen in parallel with the duration of diabetes and histological changes, but correlated with the blood glucose level. These data suggest that short-term mechanical defects in the experimental diabetic rat heart result from the metabolic disorder itself, with histopathological changes occurring later.
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PMID:Correlation between histopathological changes and mechanical dysfunction in diabetic rat hearts. 203 40

While the incidence of essential hypertension is not increased in type 1 diabetics, it is about three times as high in type 2 diabetics. Since in 50% of the cases, hypertension is present before the metabolic disorder becomes manifest, an association between the etiologies of the two disturbances was suspected as long as 65 years ago. A new understanding of the significance of insulin resistance and hyperinsulinemia suggests that the two conditions are part of a single metabolic disorder. This is supported by the fact that normal-weight hypertensives can also manifest insulin resistance, and they more often develop a type 2 diabetes mellitus. These facts urge us to re-think our therapeutic approach to hypertension, and to employ, as far as possible, only those substances that have no negative influence on the incidence of the metabolic disorder. With the introduction of ACE-inhibitors capable of improving insulin sensitivity, we now have, for the first time, the possibility of improving the prognosis of the metabolic syndrome. Moreover, their molecular mechanism of action provides initial clues as to the possible etiology of the syndrome.
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PMID:[Essential hypertension and diabetes mellitus]. 218 85

Eating habits are deeply rooted and founded early in life. The need to change one's eating habits in order to treat a certain disease or a metabolic disorder may seem to impose a well nigh impossible task. It is therefore extremely important that the dietitian adjust the recommendations to each individual's needs, wishes and circumstances. The article translates nutritional objectives into practical advice. The desired dietary composition is essentially the same for the foods which are recommended for the treatment of diabetes, hyperlipoproteinemia and hypertension.
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PMID:[Diet treatment in clinical practice. Advice on diet--more than a knowledge of dietetics]. 225 Nov 3

The authors made a retrospective analysis of late ineffectiveness of sulphonylurea derivatives and its correlation with the age of diabetes onset, duration of the disease, sex, body mass, smoking cigarettes, diabetes history in the family, coexistence with some diabetic complications as retinopathy, ischemic heart disease, arterial hypertension and vascular diseases in lower limbs. The study was carried out in a group of 220 patients with diabetes type 2 lasting from 1 up to 25 years, aged 30-77 undergoing therapy in the Department of Gastroenterology and Metabolic Diseases in the years 1976-1987 in whom a late ineffectiveness appeared to sulphonylurea derivatives. The average time of effective therapy by means of sulphonylurea derivatives in the group examined was 8.7 +/- 4.9 years (9.2 +/- 5.2 in men and 8.3 +/- 4.6 in women). The time of effective therapy by means of the above drugs was inversely proportional to the age of patients when diabetes type 2 appeared. The time of effective therapy by means of sulphonylurea derivatives in obese men was significantly longer than in obese women. No correlation was found between the appearance of late ineffectiveness of sulphonylurea derivatives and diabetes history in the family, smoking ischemic heart disease, arterial hypertension, retinopathy and vascular diseases of lower limbs.
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PMID:[Evaluation of the late ineffectiveness of sulfonylurea derivatives in patients with diabetes mellitus hospitalized at the Gastroenterology and Metabolic Disease Clinic, Medical Academy, in Warsaw 1976-1987]. 262 49

Hypertension in patients with diabetes mellitus increases the risk of both macrovascular and microvascular complications. Such microvascular complications as diabetic nephropathy and retinopathy are accelerated in the presence of arterial hypertension. Evidence suggests that the complications of diabetes mellitus begin early in the course of the disorder as manifested by microalbuminuria and increased vascular reactivity. These findings are accompanied by changes in the renin-angiotensin-aldosterone system including reductions in plasma renin activity. These changes could be secondary to volume expansion that may be a direct consequence of elevated blood glucose, suggesting that the metabolic disorder in diabetes contributes to the etiology of hypertension in these patients. Adequate treatment of hypertension is crucial to the prevention of complications; however, many antihypertensive agents have limited usefulness in diabetes mainly because of their unfavorable side effects. Diuretics lower blood pressure in hypertensive diabetics, but their metabolic effects are especially undesirable in this population. beta-Blockers alter glucose and lipid metabolism in diabetic patients and reduce regional blood flow. Central acting agents and alpha-blockers are often associated with orthostatic hypotension, sexual dysfunction, and central nervous system side effects. Angiotensin-converting enzyme inhibitors (ACEIs) such as captopril effectively lower blood pressure in diabetic patients and have few unwanted effects. They may improve metabolic control and have favorable effects on glucose metabolism. The ACEIs also produce improved regional hemodynamics which may lead to the improvement in or prevention of the progression of diabetic nephropathy.
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PMID:Management of hypertension in the patient with diabetes mellitus. Focus on the use of angiotensin-converting enzyme inhibitors. 305 49

Hypertension occurs more frequently in diabetics and markedly exacerbates the vascular morbidity and mortality resulting from this metabolic disorder. However, the etiology of hypertension in diabetics remains poorly understood. Like aging persons, diabetics have increased systemic resistance and a probable reduction in baroreceptor sensitivity. They also have an expanded total body sodium pool and a tendency to lower levels of plasma renin activity. Some of these factors suggest that a subtle calcium deficiency could also be of etiologic importance.
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PMID:Systemic hypertension in diabetes mellitus. 328 49


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