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Master's Dissertation
DOI
https://doi.org/10.11606/D.6.1990.tde-21052021-140642
Document
Author
Full name
Marcelo Chiara Bertolami
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 1990
Supervisor
Committee
Andrade, Januário de (President)
Martinez, Tania Leme da Rocha
Quintão, Eder Carlos Rocha
Title in Portuguese
Comparação da fórmula de Friedewald com a ultracentrifugação analítica durante o tratamento das dislipidemias
Keywords in Portuguese
Doenças Nutricionais e Metabólicas
Hiperlipidemias
Medicina Preventiva
Ultracentrifugação
Abstract in Portuguese
A fórmula de Friedewald para cálculo do LDL-colesterol tem sido usada largamente, como método simplificado, em substituição ao método caro e sofisticado da dosagem do colesterol da LDL separada por ultracentrifugação preparativa ou analítica. Apesar de diversos trabalhos compararem estas duas metodologias, não foram encontrados estudos que as comparassem na vigência de medidas terapêuticas dietéticas ou medicamentosas. Neste estudo foram submetidos a análise 86 pacientes hiperlipidêmicos e confrontaram-se os dados obtidos pela fórmula de Friedewald, com os da ultracentrifugação analítica, antes e após período de dieta e/ou medicamentos, específicamente Lovastatina, Clofibrate ou Bezafibrate. Os valores obtidos pelos dois procedimentos: (LDL-colesterol calculado e Sf 0-20 da ultracentrífuga analítica) mostraram boa correlação antes e depois da terapêutica em dois grupos de pacientes, a saber: 1) Grupo que realizou apenas restrições alimentares. 2) Grupo em que além da dieta, foram utilizadas drogas, como a Lovastatina, Bezafibrate ou Clofibrate. Entretanto, analisando-se os pacientes conforme os níveis da trigliceridemia, observou-se que havia boa correlação entre os dois métodos apenas quando estes valores eram observados em conjunto. Subdividindo-se os pacientes em 3 grupos conforme os níveis de triglicérides séricos, a saber: 1) abaixo de 150mg/dl; 2) entre 150 e 250 mg/dl e 3) acima 250 mg/dl (embora abaixo de 400 mg/dl, como recomendado para utilização da fórmula), observou-se que a correlação entre os métodos foi boa apenas nos grupos 1 e 2 (naqueles com trigliceridemia abaixo de 250 mg/dl), não tendo sido boa no grupo 3 (com triglicérides acima de 250 mg/dl). Neste grupo, após período de tratamento, com dieta ou Fibrates, que levou à redução dos níveis de triglicérides, para abaixo de 250 mg/dl (exceto em 1 paciente que apresentou após tratamento dietético trigliceridemia de 276 mg/dl), observou-se que a correlação entre o LDL-colesterol calculado e as Sf 0-20 da ultracentrifugação passou a ser boa. Em conclusão, a fórmula de Friedewald é válida nas trigliceridemias até 250 mg/dl, e acima deste valor, o tratamento dietético e/ou medicamentoso, com redução dos níveis de triglicérides, faz com que a correlação entre os dois métodos passe a ser boa.
Title in English
Comparative study of the Friendewald formula with the analytical ultracentifugative during the treatment of the hyperlipidemia
Keywords in English
Hyperlipidemias
Nutritional and Metabolic Diseases
Preventive Medicine
Ultracentrifugation
Abstract in English
The Friedewald formula has been widely used as a simplified method to calculate the LDL-cholesterol, substituting the expensive and sophisticated method of the cholesterol content dosage of the serum LDL fraction isolated by preparative ultracentrifugation. Despite many studies comparing these two methodologies, there is none that made that during therapeutic measures based on diet or drugs. This study compares the data obtained by the Friedewald formula with those from the analytical ultracentrifugation, before and after a period of diet and/or medication such as Lovastatln, Clofibrate or Bezafibrate. Eighty-six hyperlipidemic patients were studied through these two methods, and the correlations between them were obtained. The correlation between the two procedures was good before and after the therapeutic in two patient groups: 1) Group that made only alimentary restrictions. 2) Group that utilized Lovastatin, Bezafibrate or Clofibrate beside the diet. When the levels of triglycerides were analised, it was observed that the good correlation between the two methods was good only when all the specter of those lipids were seen enterely. However, when the cases were divided in 3 groups according to the triglycerides levels like: 1) below 150 mg/dl; 2) between 150 and 250 mg/dl and 3) above 250 mg/dl (however below 400 mg/dl, like is recommended for the utilization of the formula), it was observed that there was a good correlation between the two methods only in the groups 1 and 2 (those with triglyceride levels below 250 mg/dl). There was no good correlation in the group 3 (with triglyceridemia above 250 mg/dl). In this group, after a treatment period with diet or Fibrates, that drove to a reduction of triglyceride levels below 250 mg/dl (except one patient that presented 276 mg/dl after the diet period), it was observed that the correlation between the calculated LDL-cholesterol and the Sf 0-20 of the analytical ultracentrifugation turned to a good one. It was concluded that the Friedewald formula is valid for the triglyceridemias up to 250 mg/dl. Above this value, the reduction of triglycerides levels by the treatment based on diet and/or drugs, turns the correlation between the two methods in a good one.
 
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2021-05-21
 
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