Índices para avaliar dietas sustentáveis e promotoras de saúde cardiovascular: desenvolvimento, validação e aplicação / Indices for evaluating sustainable and cardiovascular health-promoting diets: development, validation, and application

Introdução: Índices de avaliação da dieta são instrumentos úteis para identificar a qualidade global da dieta e verificar se a adesão às recomendações dietéticas possui efeitos benéficos na saúde. Em 2019, a Comissão EAT-Lancet propôs um modelo de dieta sustentável, enquanto que a American Heart Association (AHA) possui recomendações dietéticas para promoção da saúde cardiovascular. No entanto, não existem índices baseados nestas recomendações. Objetivo: Desenvolver e validar dois índices de avaliação da dieta baseados na dieta sustentável do EAT-Lancet e nas recomendações dietéticas da AHA e sua aplicação na análise de associação com aterosclerose subclínica. Métodos: Foram utilizados dados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), uma coorte multicêntrica que acompanha 15.105 funcionários de seis instituições públicas de ensino e pesquisa. O consumo alimentar foi avaliado através de um Questionário de Frequência Alimentar (QFA). A aterosclerose subclínica foi avaliada através do escore de calcificação arterial coronariano (CAC) na linha de base (2008-2010) e na segunda onda (2012-2014) e a espessura médio-intimal das carótidas (IMT) na linha de base e na terceira onda (2017-2019). Para o desenvolvimento do Planetary Health Diet Index (PHDI), foram utilizadas as recomendações da Comissão EAT-Lancet e para o desenvolvimento do Cardiovascular Health Diet Index (CHDI), foram utilizadas as recomendações dietéticas da American Heart Association. Após o desenvolvimento dos índices, técnicas de validade e confiabilidade interna foram empregadas. Para avaliar os fatores associados aos índices, foram empregados modelos de regressão linear simples e múltiplos. Modelos de Poisson com variância robusta foram construídos para avaliar a associação entre os índices e a incidência e progressão do CAC, enquanto modelos lineares mistos foram construídos para avaliar os índices e as mudanças no IMT. Resultados: A população apresentou uma média de 60,4 pontos no PHDI (de uma variação possível de 0 - 150 pontos) e de 57,1 pontos no CHDI (de uma variação possível de 0 - 110 pontos). Análises de validade relativa e confiabilidade demonstraram que ambos os índices possuem desempenho satisfatórios, demonstrando boa validade e confiabilidade interna. Observou-se que as mulheres, os idosos, pessoas com maior renda per capita, prática de atividade física moderada e vigorosa apresentaram, em média, maiores pontuações. Ao passo que, os fumantes e as pessoas com sobrepeso e obesidade apresentaram, em média, menores pontuações em ambos os índices. Não foram observadas associações significantes entre o PHDI com CAC e IMT. No entanto, após um período médio de acompanhamento de 8 anos, um aumento de 10 pontos no CHDI foi associado a uma diminuição de 0,0023 mm (IC 95% -0,0045; -0,0002) no IMT. Nenhuma associação foi observada entre o escore CHDI e a incidência e progressão de CAC após um período de acompanhamento de 4 anos. Conclusões: Os resultados demonstram a validade dos índices propostos como ferramentas adequadas para avaliação da dieta. Foi possível observar que a adesão as recomendações de dieta sustentável e promotoras da saúde cardiovascular estão associadas com condições sociodemográficas e de estilo de vida. Além disso, maior adesão à uma dieta cardioprotetora está inversamente associada com um marcador de aterosclerose subclínica.

Introduction: Dietary indices are useful tools to identify the overall dietary quality and to verify whether adherence to dietary recommendations has beneficial effects on health. In 2019, the EAT-Lancet Commission proposed a sustainable diet model, while the American Heart Association (AHA) has dietary recommendations for promoting cardiovascular health. However, there are no indices based on these recommendations. Objective: To develop and validate two dietary indices based on the EAT-Lancet sustainable diet and AHA dietary recommendations and their application in analyzing associations with subclinical atherosclerosis. Methods: Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort following 15,105 employees from six public teaching and research institutions, were used. Dietary intake was assessed through a Food Frequency Questionnaire (FFQ). Subclinical atherosclerosis was assessed through coronary artery calcification score (CAC) at baseline (2008-2010) and the second wave (2012-2014) and carotid intima media thickness (IMT) at baseline and the third wave (2017-2019). For the development of the Planetary Health Diet Index (PHDI), the recommendations of the EAT-Lancet Commission were used, and for the development of the Cardiovascular Health Diet Index (CHDI), the dietary recommendations of the American Heart Association were used. After index development, techniques of validity and internal reliability were employed. To assess factors associated with the indices, simple and multiple linear regression models were used. Poisson models with robust variance were constructed to assess the association between the indices and the incidence and progression of CAC, while mixed linear models were constructed to assess the indices and changes in IMT. Results: The population had a mean score of 60.4 points on the PHDI (out of a possible range of 0-150 points) and 57.1 points on the CHDI (out of a possible range of 0-110 points). Relative validity and reliability analyses demonstrated that both indices performed satisfactorily, showing good internal validity and reliability. It was observed that women, the elderly, individuals with higher per capita income, moderate and vigorous physical activity, on average, had higher scores. Conversely, smokers and overweight and obese individuals, on average, had lower scores on both indices. No significant associations were observed between the PHDI and CAC and IMT. However, after a mean follow-up period of 8 years, a 10-point increase in the CHDI was associated with a decrease of 0.0023 mm (95% CI -0.0045; -0.0002) in IMT. No association was observed between the CHDI score and the incidence and progression of CAC after a 4-year follow-up period. Conclusions: The results demonstrate the validity of the proposed indices as suitable tools for dietary assessment. It was possible to observe that adherence to sustainable diet and cardiovascular health-promoting recommendations is associated with sociodemographic and lifestyle conditions. Additionally, greater adherence to a cardioprotective diet is inversely associated with a marker of subclinical atherosclerosis.

Influência da menopausa, idade, etnia e do sexo sobre as lipoproteínas e suas subfrações nas três fases da vida (adolescentes, adultos e idosos) / Influence of menopause, age, ethnicity and sex on lipoproteins and their subfractions in the three stages of life (adolescents, adults and the elderly)

Introdução: A prevalência de doenças cardiovasculares tem crescido em todo o mundo. Além da hipercolesterolemia, fatores como o envelhecimento, menopausa, diferenças no metabolismo do colesterol entre homens e mulheres e entre etnias, provavelmente contribuem para as prevalências dessas doenças. Objetivo: Avaliar a influência da menopausa, da idade (adolescentes, adultos e idosos), do sexo e da etnia sobre as subfrações lipoproteicas aterogênicas. Métodos: Trata-se de um estudo transversal, de base populacional e amostra probabilística de residentes da cidade de São Paulo. Foram utilizados dados de participantes "ISA-CAPITAL 2015" que tiveram coleta de dados bioquímicos. Foram realizadas análises de partículas de LDL e HDL respectivamente, em 827 amostras. O tamanho das partículas de LDL e HDL foi determinado pelo sistema Lipoprint® System (Quantimetrix Corporation. Todos os testes estatísticos foram realizados com o auxílio do programa SPSS 16. Foi considerado significativo p<0,05. Resultados: As análises com adolescentes mostraram que as meninas apesar de possuírem maior IMC, CC e concentração de TG, apresentaram melhor perfil de subfrações de LDL (LDL grande% 17,8; LDL pequena% 1,7) do que os meninos (LDL grande% 13,5; LDL pequena% 3,4) p<0,001 e p=0,002, respectivamente. Entre os indivíduos adultos, foi identificado um perfil mais aterogênico entre homens, com maior percentual de LDL pequena, quando comparados às mulheres (4,9% vs 2,7%; p<0,001, respectivamente). Com relação à população idosa, os resultados demonstraram que apesar do avanço da idade, as idosas quando comparadas aos idosos possuíam maior concentração LDL grande (32,5mg/dL vs 28,5mg/dL; p=0,007 respectivamente). As mulheres idosas tiveram uma piora das subfrações lipoproteicas se comparadas com as mulheres adultas (razão de LDL mg/dL=12,3 mulheres adultas vs 10,7 mulheres idosas; p=0,002) se aproximando ao perfil mais aterogênico encontrado entre os homens (razão de LDLmg/dL=9,9 homens adultos vs 9,0 homens idosos; p=0,027). Entretanto, quando pareadas por homens de mesma idade, as mulheres idosas, ainda assim, demonstraram um perfil menos aterogênico do que os homens idosos (razão de LDL mg/dL=10,7 mulheres idosas vs 9,0 homens idosos; p=0,001). Ao analisar a presença de menopausa, foi identificado que as mulheres no período pós menopausa tiveram piora do perfil lipídico clássico com aumento do IMC (p=0,025), CC (p<0,001), glicose (p<0,001), PAS (p<0,001), PAD (p=0,005) e TG (p<0,001), assim como tiveram piora do perfil lipoproteico com diminuição de LDL grande% quando comparadas com as mulheres no período pré menopausa (17,6% vs 14,6%; p=0,001). Quanto à etnia, foi identificado que os indivíduos brancos apresentaram valores maiores para IMC (p=0,005), CC (p=0,001), glicose (p=0,015) e TG (p=0,010). Após ajustes para etnia, idade e IMC, houve associação positiva com HDL grande (=0,122; R2=0,013; p=0,001), demonstrando maior aterogenicidade entre os indivíduos brancos. Conclusão: Em todas as faixas etárias o sexo feminino apresentou perfil menos aterogênico quando comparado ao masculino. A presença de menopausa e da etnia branca demonstrou um perfil lipídico clássico e lipoproteico mais aterogênico.

Introduction: The prevalence of cardiovascular diseases has increased throughout the world. In addition to hypercholesterolemia, factors such as aging, menopause, differences in cholesterol metabolism between men and women and between ethnicities probably contribute to the prevalence of these diseases. Objective: To evaluate the influence of menopause, age (adolescents, adults and elderly), sex and ethnicity on atherogenic lipoprotein subfractions. Methods: This is a cross-sectional, population-based study with a probabilistic sample of residents of the city of São Paulo. Data from "ISA-CAPITAL 2015" participants who had biochemical data collected were used. LDL and HDL particle analyzes were carried out respectively in 827 samples. The size of LDL and HDL particles was determined using the Lipoprint® System (Quantimetrix Corporation. All statistical tests were performed with the aid of the SPSS 16 program. Was considered significant p<0.05. Results: Analyzes with adolescents showed that girls, despite having higher BMI, WC and TG concentration, presented a better profile of LDL subfractions (LDL large% 17.8; LDL small% 1.7) than boys (LDL large% 13.5; LDL small% 3.4) p<0.001 and p=0.002, respectively. Among adult individuals, a more atherogenic profile was identified among men, with a higher percentage of LDL small, when compared to women (4.9% vs 2.7%; p<0.001, respectively). Regarding the elderly population, the results demonstrated that despite advancing age, elderly women, when compared to elderly men, had a higher large LDL concentration (32.5mg/dL vs 28.5mg/dL; p=0.007 respectively). Elderly women had a worsening of lipoprotein subfractions compared to adult women (LDL ratio mg/dL=12.3 adult women vs 10.7 elderly women; p=0.002) approaching the more atherogenic profile found among men (LDLmg/dL ratio=9.9 adult men vs 9.0 elderly men; p=0.027). However, when paired with men of the same age, elderly women still demonstrated a less atherogenic profile than elderly men (LDL ratio mg/dL=10.7 elderly women vs 9.0 elderly men; p=0.001). When analyzing the presence of menopause, it was identified that women in the postmenopausal period had a worsening of the classic lipid profile with an increase in BMI (p=0.025), WC (p<0.001), glucose (p<0.001), SBP (p< 0.001), DBP (p=0.005) and TG (p<0.001), as well as a worsening of the lipoprotein profile with a reduction in LDL large when compared to women in the premenopausal period (17.6% vs 14.6%; p=0.001). Regarding ethnicity, it was identified that white individuals presented higher values for BMI (p=0.005), WC (p=0.001), glucose (p=0.015) and TG (p=0.010). After adjustments for ethnicity, age and BMI, there was a positive association with HDL large (=0.122; R2=0.013; p=0.001), demonstrating greater atherogenicity among white individuals. Conclusion: In all age groups, females presented a less atherogenic profile when compared to males. The presence of menopause and white ethnicity demonstrated a more atherogenic classic lipid and lipoprotein profile.

Biocellulose-based hydrogel dressing as a strategy for the management of chronic arterial wounds

Purpose: To evaluate using a biocellulose-based hydrogel as an adjuvant in the healing process of arterial ulcers. Methods: A prospective single group quasi-experimental study was carried out with chronic lower limb arterial ulcer patients. These patients received biocellulose-based hydrogel dressings and outpatient guidance on dressing and periodic reassessments. The primary outcomes were the ulcer-healing rate and product safety, which were assessed by ulcer area measured in photographic records of pre-treatment and posttreatment after 7, 30, and 60 days. Secondary outcomes were related to clinical assessment by the quality-of-life scores (SF-36 and EQ-5D) and pain, evaluated by the visual analogue scale (VAS). Results: Seventeen participants were included, and one of them was excluded. Six patients (37%) had complete wound healing, and all patients had a significant reduction in the ulcer area during follow-up (233.6mm2 versus 2.7mm2) and reduction on the score PUSH 3.0 (p < 0.0001). The analysis of the SF-36 and EQ-5D questionnaires showed a statistically significant improvement in almost all parameters analyzed and with a reduction of pain assessed by the VAS. Conclusions: The biocellulose-based hydrogel was safe and showed a good perspective to promoting the necessary conditions to facilitate partial or complete healing of chronic arterial ulcers within a 60-day follow-up. Quality of life and pain were positively affected by the treatment.

Satisfacción con los cursos a distancia de la maestría Investigación en Aterosclerosis durante la COVID-19 / Satisfaction with the Distance Courses of a master's degree in Atherosclerosis Research during COVID-19

Introducción: La satisfacción de los estudiantes con respecto a la educación que reciben es un elemento clave en la valoración de la calidad de la educación. La enfermedad causada por el nuevo coronavirus SARS-CoV-2 representó una emergencia sanitaria que generó preocupación a nivel mundial por su impacto en la salud, la economía y la educación. Objetivo: Evaluar la satisfacción de los estudiantes con los cursos a distancia del primer ciclo de la maestría Investigación en Aterosclerosis durante la COVID-19. Métodos: Se hizo un estudio descriptivo de corte transversal. Se utilizó una encuesta, que estuvo disponible, al finalizar cada curso, en el Aula Virtual de Salud. Los datos de la encuesta se obtuvieron del AVS, se introdujeron en una base de datos en Excel, y se procesaron con el paquete estadístico SPSS versión 20.0 para Windows. Resultados: Para todos los cursos los horarios que predominaron fueron en horario extralaboral y los fines de semana y durante la jornada laboral, en horario extralaboral y los fines de semana. Como vías de conexión más utilizadas estuvieron Infomed y los datos móviles. El curso mejor orientado resultó La aterosclerosis, un problema epidemiológico. La evaluación de los aspectos relacionados con el profesor, los contenidos, el material bibliográfico, la comunicación y el aseguramiento tecnológico fue satisfactoria. La computadora y el celular representaron los dispositivos tecnológicos más empleados. Las respuestas en relación con la satisfacción con los cursos se encontraron entre satisfecho y muy satisfecho. Conclusiones: La mayor parte de los aspectos evaluados recibieron calificaciones satisfactorias. Como aspecto positivo se destaca el empleo del aula virtual; como negativos, la dificultad con los dispositivos tecnológicos y la conectividad; y como interesantes, la adquisición y el perfeccionamiento de habilidades con los cursos a distancia y mejorar la calidad de la conectividad(AU)

Introduction: Student satisfaction with the education that they receive is a key element for education quality assessment. The disease caused by the new SARS-CoV-2 coronavirus represented a health emergency that generated worldwide concern due to its impact on health, economy and education. Objective: To assess student satisfaction with the distance courses of the first cycle of a master's degree in atherosclerosis research during COVID-19. Methods: A descriptive and cross-sectional study was carried out. A survey was used, available in the virtual health classroom at the end of each course. The survey's data were obtained from the virtual health classroom, entered into an Excel database, and processed with the statistical package SPSS (version 20.0) for Windows. Results: For all the courses, the predominant schedules were during out-of-work hours and on weekends and during the working day, during out-of-work hours and on weekends. The most frequently used means of connection were Infomed and mobile data. The best oriented course was Atherosclerosis, an epidemiological problem. The assessment of aspects related to the professor, the contents, the bibliographic material, communication and technological assurance were satisfactory. The computer and the cell phone were the most frequently used technological devices. The responses regarding satisfaction with the courses ranged between satisfied and very satisfied. Conclusions: Most of the assessed aspects received satisfactory ratings. As a positive aspect, the use of the virtual classroom stands out; as a negative one, the difficulty with technological devices and connectivity; and as interesting ones, the acquisition and improvement of skills with distance courses, as well as improving the quality of connectivity(AU)

Miocardiopatía hipertrófica, anomalía coronaria, enfermedad aterosclerótica y arritmia ventricular coexistiendo en un mismo paciente / Joint presence of hypertrophic cardiomyopathy, anomalous origin of the circumflex coronary artery and ventricular arrhythmia

Presentamos el caso de un paciente quien presentó un evento presincopal en el que destacan 3 patologías asociadas a muerte súbita de forma independiente: miocardiopatía hipertrófica, origen anómalo coronario y enfermedad arterial coronaria epicárdica; diagnósticos coexistentes. Se describe las patologías, diagnóstico, manejo médico y terapéutico y se revisa la literatura.

A patient presented with a presyncopal event. Three conditions independently associated with sudden death, hypertrophic cardiomyopathy, anomalous origin of coronary arteries and epicardial coronary artery disease were found. Diagnosis, and medical management are described, followed by a review of the literature.

Factores predictivos de mortalidad por cardiopatía ateroesclerótica en ancianos / Predictive factors of mortality due to atherosclerotic heart disease in elderly: en

Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y el mundo. Objetivo: Identificar los factores predictivos de defunciones por enfermedad cardiovascular aterosclerótica en personas de edad avanzada. Métodos: Se realizó un estudio analítico, de tipo caso-control, que incluyó a 237 pacientes fallecidos a causa de cardiopatía ateroesclerótica (casos) y 711 ancianos vivos (controles), pertenecientes a 3 áreas de salud del municipio de Santiago de Cuba, desde enero hasta diciembre de 2021. Resultados: Los factores predictivos que formaron parte del modelo fueron el tabaquismo, la dieta poco saludable, el sedentarismo, la diabetes mellitus, la enfermedad renal crónica, la fragilidad, el deterioro cognitivo y la multimorbilidad. Conclusiones: Los factores de riesgo tradicionales seleccionados en este estudio, combinados con otras condiciones potenciales, mejoraron la predicción de la mortalidad por cardiopatías en ancianos y facilitaron la orientación de las intervenciones preventivas en este grupo poblacional.

Introduction: Cardiovascular diseases constitute the first death cause in Cuba and the world. Objective: To identify the predictive factors of deaths due to atherosclerotic cardiovascular disease in elderly people. Methods: An analytic case-control type study was carried out that included 237 dead patients due to atherosclerotic heart disease (cases) and 711 living elderly (control), belonging to 3 health areas of Santiago de Cuba municipality, from January to December, 2021. Results: The predictive factors that were part of the model were nicotine addiction, not very healthy diet, physical inactivity, diabetes mellitus, chronic renal disease, fragility, cognitive deterioration and multimorbidity. Conclusions: The traditional risk factors selected in this study, combined with other potential conditions, improved the prediction of mortality due to heart disease in elderly and facilitated the orientation of preventive interventions in this population group.

Prevalence and association of mycoplasma infection in the development of coronary artery disease / Prevalência e associação de infecção por micoplasma no desenvolvimento de doença arterial coronariana

Coronary heart disease (CHD) has been associated with significant morbidity and mortality worldwide. Although remain controversial, several studies have demonstrated the association of M. pneumoniae infections with atherosclerosis. We evaluated the possible association of mycoplasma infections in patients diagnosed with atherosclerosis by ELISA and PCR methods. Atherosclerotic tissue samples and blood samples were collected for the detection of mycoplasma antibodies (IgA) by ELISA from the 97 patients with coronary artery disease (CAD). M. pneumoniae specific IgA, IgG and IgM were measured by using the Anti-M. pneumoniae IgA/IgG/IgM ELISA. Detection of M. pneumoniae targeting the P1 adhesion gene was performed by PCR Acute infection of M. pneumoniae was diagnosed in 43.3% (42) of patients by PCR. The M. pneumoniae specific antibodies were detected in 36.1% (35) of patients. Twenty-five (25.8%) cases had IgG antibodies, 15 (15.5%) cases had IgM antibodies, 3 (3.1%) cases had IgA antibodies, 10 (10.3%) cases had both IgM + IgG antibodies and 1 (1%) case of each had IgM + IgA and IgG + IgA antibodies. None of the cases was positive for all three antibodies. A Pearson correlation coefficient analysis revealed an excellent correlation between the PCR and the serological results (r=0.921, p70 years of age. Our study reported an unusually higher prevalence of M. pneumoniae by serological tests (36.1%) and PCR (43.3%). Although the hypothesis of the association of M. pneumoniae and CAD is yet to be proven, the unusually high prevalence of M. pneumoniae in CAD patients indicates an association, if not, in the development of atherosclerosis.

A doença coronariana (DCC) tem sido associada a significativa morbidade e mortalidade em todo o mundo. Embora ainda sejam controversos, vários estudos têm demonstrado a associação de infecções por M. pneumoniae com aterosclerose. Avaliamos a possível associação de infecções por micoplasma em pacientes com diagnóstico de aterosclerose pelos métodos ELISA e PCR. Amostras de tecido aterosclerótico e amostras de sangue foram coletadas para a detecção de anticorpos contra micoplasma (IgA) por ELISA de 97 pacientes com doença arterial coronariana (DAC). IgA, IgG e IgM específicos para M. pneumoniae foram medidos usando o Anti-M. pneumoniae IgA / IgG / IgM ELISA. A detecção de M. pneumoniae visando o gene de adesão P1 foi realizada por PCR. A infecção aguda por M. pneumoniae foi diagnosticada em 43,3% (42) dos pacientes pela PCR. Os anticorpos específicos para M. pneumoniae foram detectados em 36,1% (35) dos pacientes. Vinte e cinco (25,8%) casos tinham anticorpos IgG, 15 (15,5%) casos tinham anticorpos IgM, 3 (3,1%) casos tinham anticorpos IgA, 10 (10,3%) casos tinham anticorpos IgM + IgG e 1 (1%) caso de cada um tinha anticorpos IgM + IgA e IgG + IgA. Nenhum dos casos foi positivo para os três anticorpos. A análise do coeficiente de correlação de Pearson revelou uma excelente correlação entre o PCR e os resultados sorológicos (r = 0,921, p 70 anos de idade. Nosso estudo relatou uma prevalência incomumente maior de M. pneumoniae por testes sorológicos (36,1%) e PCR (43,3%). Embora a hipótese da associação de M. pneumoniae e DAC ainda não tenha sido comprovada, a prevalência incomumente alta de M. pneumoniae em pacientes com DAC indica uma associação, se não, no desenvolvimento de aterosclerose.

Clinical relevance of oxidative stress biomarkers in cardiovascular prevention / Relevância clínica de biomarcadores de estresse oxidativo na prevenção cardiovascular

Cardiovascular diseases involve hyperlipidemia, inflammation and oxidative stress. Although this relationship is well established, only biomarkers associated with hyperlipidemia and inflammation are currently in clinical practice for diagnosis and evaluation of patient treatment. Our hypothesis is that oxidative stress biomarkers may be an independent risk factor and may assist in cardiovascular risk stratification and contribute to improving current scores. Thus, the objective of this study was to investigate which are the biomarkers and methodologies were used in clinical studies in humans with different health conditions. With the results obtained in the first part, we selected studies conducted in healthy individuals and in individuals under primary and secondary cardiovascular prevention in order to evaluate the most frequent biomarkers, the results obtained according to the individual's profile and the methodology used, and correlate with different health conditions. We observed that malondialdehyde (MDA) was the most frequent lipid biomarker of oxidative stress applied in the studies, but it presented significant variability in the results and a weak correlation with clinical outcomes. The result of this study demonstrates the importance of carrying out a multicentric study to validate the MDA values in individuals with different health conditions and the standardization of the methodology based on high performance liquid chromatographyy (HPLC)

As doenças cardiovasculares envolvem hiperlipidemia, inflamação e estresse oxidativo. Embora essa relação esteja bem estabelecida, apenas biomarcadores associados à hiperlipidemia e inflamação são atuais na prática clínica para diagnóstico e avaliação do tratamento do paciente. Nossa hipótese é que biomarcadores de estresse oxidativo podem ser um fator de risco independente e podem auxiliar na estratificação de risco cardiovascular e contribuir para melhorar os escores atuais. Assim, o objetivo deste estudo foi investigar primeiramente quais são os biomarcadores e metodologias utilizados nos estudos clínicos em humanos em diferentes condições de saúde. Com os resultados obtidos na primeira etapa, selecionamos os estudos conduzidos em indivíduos saudáveis e em prevenção cardiovascular primária e secundária a fim de avaliar os biomarcadores mais utilizados, os resultados obtidos conforme o perfil do indivíduo e a metodologia utilizada e finalmente correlacionar com as diferentes condições de saúde. Observamos que o malondialdeído (MDA) foi o biomarcador lipídico de estresse oxidativo mais frequente nos estudos, porém apresentou importante variabilidade nos resultados e fraca correlação com desfechos clínicos. O resultado desse estudo demonstra a importância da realização de um estudo multicentrico para validação dos valores de MDA nos diferentes perfis de indivíduos e a padronização metodológica baseada na cromatografia líquida de alta eficiência (HPLC)

Enfermedades consecuentes de la aterosclerosis en población atendida por cuatro consultorios médicos / Resulting diseases due to atherosclerosis in population treated by four medical offices

Introducción: La aterosclerosis es una enfermedad compleja, tan antigua como el hombre, a quien acompaña desde la concepción hasta su muerte. Objetivo: Describir el comportamiento de las enfermedades consecuentes de la aterosclerosis. Métodos: Se realizó un estudio descriptivo de corte transversal durante el período comprendido entre 2016 a 2019. Resultados: Predominaron las enfermedades del corazón, 175 (22,6 por ciento) de los encuestados estaban diagnosticados con algún tipo de ellas. El 54,3 por ciento (95 pacientes) tenían diagnóstico de cardiopatía. Predominó también el antecedente familiar de enfermedad arterial periférica (243 para el 31,4 por ciento). Las enfermedades cardiovasculares tuvieron el mayor riesgo asociado con la hipertensión arterial, la diabetes mellitus tipo 2, la dislipidemia como factores de riesgo y en relación a las otras enfermedades consecuentes, todas tuvieron un alto riesgo asociado, así como con el antecedente familiar de enfermedad cardiovascular. Conclusiones: Se describió el comportamiento de las enfermedades consecuentes de la aterosclerosis. Las enfermedades cardiovasculares presentaron un alto riesgo asociado con la mayoría de los factores de riesgos(AU)

Introduction: Atherosclerosis is a complex disease, as old as man, whom it accompanies from conception to death. Objective: To describe the behavior of diseases resulting from atherosclerosis. Methods: A descriptive cross-sectional study was conducted from 2016 to 2019. Results: Heart diseases predominated, 175 (22.6 percent) of the surveyed individuals were diagnosed with some type of them. 54.3 percent (95 patients) had been diagnosed with heart disease. A family history of peripheral arterial disease also predominated (243 for 31.4 percent). Cardiovascular diseases had the highest risk associated with arterial hypertension, type 2 diabetes mellitus, dyslipidemia as risk factors and in relation to the other resulting diseases, all had a high associated risk, as well as with family history of cardiovascular disease. Conclusions: The behavior of the resulting diseases due to atherosclerosis was described. Cardiovascular diseases presented a high risk associated with most of the risk factors(AU)

Prevalencia de hipotiroidismo subclínico y biomarcadores de riesgo cardiovascular en pacientes del Hospital General de Riobamba / Prevalence of subclinical hypothyroidism and biomarkers of cardiovascular risk in patients of the General Hospital of Riobamba

El Hipotiroidismo subclínico (HSC) es definido bioquímicamente por una elevación en la concentración sérica de la hormona TSH con niveles normales de T4 libre. El objetivo de este estudio fue determinar la prevalencia de HSC en los pacientes que asistieron a la consulta de medicina interna del Hospital General IESS de Riobamba. Así como, analizar la correlación entre los parámetros hormonales y ciertos marcadores bioquímicos asociados con el incremento de riesgo cardiovascular. Se realizó una investigación de tipo descriptiva, observacional, con un diseño no experimental de corte transversal, que abarcó el periodo comprendido desde enero de 2019 hasta septiembre de 2021. 245 pacientes fueron diagnosticados con HSC, lo cual representó el 10.58 % del universo poblacional estudiado, 61.2% eran del sexo femenino, mientras que el 38.8% del sexo masculino. El mayor número de casos (59.61 %) se observó en el grupo etario mayor de 65 años, distribuidos de la siguiente manera: (22.86% hombres y 36.75% mujeres), también se encontró que el HSC está asociado con un perfil lipídico aterogénico, caracterizado por un incremento en la concentración de colesterol total y LDL los cuales se correlacionaron positivamente con las concentraciones de TSH.

Subclinical hypothyroidism (SH) is biochemically defined by an elevation in the serum concentration of TSH hormone with normal levels of free T4. The aim of this study was to determine the prevalence of SH in patients attending the internal medicine clinic of the General Hospital IESS of Riobamba. Also, to analyze the correlation between hormonal parameters and certain biochemical markers associated with increased cardiovascular risk. A descriptive, observational, non-experimental cross-sectional design was performed, covering the period from January 2019 to September 2021. 245 patients were diagnosed with SH, which represented 10.58 % of the population universe studied, 61.2% were female, while 38.8% were male. The highest number of cases (59.61 %) was observed in the age group over 65 years, distributed as follows: (22.86% men and 36.75% women), it was also found that SH is associated with an atherogenic lipid profile, characterized by an increase in the concentration of total cholesterol and LDL which correlated positively with TSH concentrations.

Prescription of statins according to the ASCVD estimator at Pablo Arturo Suarez Hospital, March 2021 to February 2022 / Prescripción de estatinas según el estimador ASCVD en el Hospital Pablo Arturo Suárez, marzo 2021 a febrero 2022

Worldwide, the leading cause of death is cardiovascular disease. The study details the prescription of statins at the Pablo Arturo Suarez Hospital in Ecuador between March 2021 and February 2022 following the ASCVD risk scale of the American College of Cardiology and the American Heart Association. There are 563 people in this cross-sectional and retrospective study: 70% women, 30% men, 93.30% mestizos, 48.10% diabetics, 62.30% hypertensives, and 18.70% smokers. 26.10% of all patients received statins, with simvastatin being the most common (96.60%). The mean cardiovascular risk in the general population was 15.52 ± 14.51%, 44.99% of subjects had a risk lower than 7.50%, and 29% had a risk higher than 20%, with a statistically significant difference (p<0.001) according to sex. The study determined that 58.60% of the population received a statin or an inadequate dosage.

A nivel mundial, la principal causa de muerte es la enfermedad cardiovascular. El estudio detalla la prescripción de estatinas en el Hospital Pablo Arturo Suárez de Ecuador entre marzo de 2021 y febrero de 2022, siguiendo la escala de riesgo ASCVD del Colegio Americano de Cardiología y la Asociación Americana del Corazón. Son 563 personas en este estudio transversal y retrospectivo: 70% mujeres, 30% hombres, 93.30% mestizos, 48.10% diabéticos, 62.30% hipertensos y 18.70% fumadores. El 26.10% de los pacientes recibía estatinas, siendo la simvastatina la más frecuente (96.60%). El riesgo cardiovascular medio en la población general fue de 15.52 ± 14.51%, el 44.99% de los sujetos tenía un riesgo inferior al 7.50%, y el 29% tenía un riesgo superior al 20%, con una diferencia estadísticamente significativa (p<0.001) según el sexo. El estudio determinó que el 58.60% de la población recibía una estatina o una dosis inadecuada.

Utilidad de los índices aterogénicos del perfil lipídico en el diagnóstico de aterosclerosis subclínica / Utility of the atherogenic indices of the lipid profile in the diagnosis of subclinical atherosclerosis

Introducción: Los índices aterogénicos hacen referencia a un conjunto de indicadores bioquímicos que a partir de la relación entre variables lipídicas permiten predecir el riesgo de daño aterosclerótico. Objetivo: Evaluar la utilidad de los índices aterogénicos en el diagnóstico de aterosclerosis subclínica en pacientes con dislipidemia. Métodos: Se realizó un estudio descriptivo en 812 pacientes con diagnóstico clínico de dislipidemia en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el período 2015-2020. Resultados: La edad media de los pacientes fue de 56,79 ± 10,24 años, predominó el grupo de 60 y más años con un 40,9 por ciento y el sexo femenino para un 73,8 por ciento. El 61,2 por ciento de los pacientes tienen presente algún tipo de obesidad. La presencia de HTA y el consumo de tabaco afectan el 52 por ciento y 24,6 por ciento de la población estudiada. El 74,8 por ciento (607 casos) fue clasificado como riesgo cardiovascular medio según los criterios de Framingham, mientras que el 12,9 por ciento fue clasificado como riesgo alto. Se identificaron 323 (39,8 por ciento) pacientes con presencia de aterosclerosis subclínica. Las diferencias de los valores medios de los índices aterogénicos entre los grupos con presencia de aterosclerosis subclínica fueron estadísticamente significativas para los índices cCtotal/ cHDL y cLDL/cHDL (p<0,05). En el análisis multivariado los índices asociados al riesgo de presentar aterosclerosis subclínica fueron la relación cCtotal/cHDL (R=1,11) y cLDL/cHDL (R=1,12) (p<0,05). Conclusiones: Los índices aterogénicos son de utilidad en el diagnóstico de aterosclerosis subclínica, los cocientes cCtotal/cHDL y cLDL/cHDL son los que están asociados significativamente con la probabilidad de presentar daño aterosclerótico carotideo(AU)

Introduction: Atherogenic indices refer to a set of biochemical indicators that, based on the relationship between lipid variables, allow predicting the risk of atherosclerotic damage. Objective: To evaluate the usefulness of atherogenic indices in the diagnosis of subclinical atherosclerosis in patients with dyslipidemia. Methods: A descriptive study was carried out in 812 patients with clinical diagnosis of dyslipidemia at Hermanos Ameijeiras Surgical Clinical Hospital, from 2015 to 2020. Results: The mean age of the patients was 56.79 ± 10.24 years, the group of 60 and over predominated with 40.9percent and the female sex with 73.8percent. Some type of obesity was present in 61.2percent of the patients. The presence of hypertension and tobacco consumption affect 52percent and 24.6percent of the population studied, respectively. 74.8percent (607 cases) were classified as medium cardiovascular risk according to Framingham criteria, while 12.9percent were classified as high risk. Three hundred twenty three (39.8percent) patients with subclinical atherosclerosis were identified. The differences in the mean values of the atherogenic indices between the groups with subclinical atherosclerosis were statistically significant for the total C/HDLc and LDLc/HDLc indices (p<0.05). In the multivariate analysis, the indices associated with the risk of subclinical atherosclerosis were the ratio of Total C/HDLc (R=1.11) and LDLc/HDLc (R=1.12) (p<0.05). Conclusions: The atherogenic indices are useful in the diagnosis of subclinical atherosclerosis; cCtotal/cHDL and cLDL/cHDL ratios are those that are significantly associated with the probability of carotid atherosclerotic damage(AU)

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Abstract Background: The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition. Objective: To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC. Methods: Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 . Results: Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the "moments" of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO2max. Conclusion: The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

Ácidos grasos omega-3 y función endotelial en pacientes con síndrome coronario agudo / Omega-3 fatty acids and endothelial function in patients with acute coronary syndrome

Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial, manifestándose principalmente como enfermedad isquémica coronaria. El pronóstico y desenlace del Síndrome Coronario Agudo (SCA) depende en gran proporción de la disfunción endotelial asociado a este cuadro. Objetivo:Evaluar el efecto de los ácidos grasos omega­3, sobre la función endotelial en el Síndrome Coronario Agudo (SCA). Métodos: Se realizó estudio con 16 pacientes con síndrome coronario agudo (SCA) tratados con Omega-3 a dosis de 3 gramos/día+Terapia Convencional (O3+Tc) durante 30 días. Se les realizó a las 12 horas del ingreso y los a 30 días, perfil lipídico, proteína C reactiva ultrasensible (PCRus), Endotelina 1 (ET-1), y Péptido Natriurético cerebral (NTproBNP). Resultados: Durante 4 semanas de seguimiento, el uso de 3 gramos/día de ácidos grasos omega-3, añadido a la terapia convencional en el Síndrome Coronario Agudo, mostró una reducción significativa de la concentración plasmática de NTproBNP (p = 0,000), PCRus (p =0,000) y triglicéridos (p = 0,004). Conclusión: Tres gramos al día de ácidos grasos omega-3 contribuye a la reducción de la concentración plasmática de Triglicéridos y NTproBNP en pacientes con síndrome coronario agudo(AU)

Mainly as coronary ischemic disease. the prognosis and outcome of Acute Coronary Syndrome (ACS) depend largely on the endothelial dysfunction associated with this condition. Objective: To evaluate the effect of omega-3 fatty acids on endothelial function in Acute Coronary Syndrome (ACS). Method: A study was conducted with 16 patients with acute coronary syndrome (ACS) treated with Omega-3 at a dose of 3 grams/day+Conventional erapy (O3+Tc) for 30 days. Lipid profile, ultrasensitive C-reactive protein (usCRP), Endothelin 1 (ET-1), and Brain Natriuretic Peptide (NTproBNP) were performed 12 hours aer admission and 30 days later. Results: During 4 weeks of follow-up, the use of 3 grams/day of omega-3 fatty acids, added to conventional therapy in Acute Coronary Syndrome, showed a significant reduction in the plasma concentration of NTproBNP (p = 0.000), hsCRP (p =0.000) and Triglycerides (p = 0.004). Conclusion: three grams a day of omega-3 fatty acids contributes to the reduction of the plasmatic concentration of Triglycerides and NTproBNP in patients with acute coronary syndrome(AU)

Factores contextuales de las señales ateroscleróticas tempranas en adolescentes aparentemente sanos / Contextual factors of early atherosclerotic signals in apparently healthy adolescents

Introducción: La exploración e identificación de los factores contextuales del proceso aterosclerótico desde las edades tempranas presenta vacío de conocimiento en términos de mecanismos y causas. En la atención primaria de salud existen las condiciones requeridas para la identificación de los adolescentes con factores de riesgo aterogénico y en la cual resulta más fácil comprender el contexto de la enfermedad. Objetivo: Determinar la influencia de los factores contextuales sobre la presencia de señales ateroescleróticas tempranas en adolescente aparentemente sanos. Métodos: Estudio descriptivo de corte transversal. Se utilizaron estadísticas descriptivas. Se aplicó análisis de correlaciones canónicas y se elaboraron árboles de decisión. Resultados: Los factores de riesgo aterosclerótico que predominaron para ambos sexos fueron el bajo consumo de frutas y vegetales, la circunferencia de la cintura > 90 p y ser fumador pasivo. En el sexo femenino se destaca el sedentarismo. En ambos sexos predominaron los adolescentes con dos o tres señales (masculino 77 [48,4 por ciento] y femenino 71 [48,0 por ciento]). El conjunto de factores contextuales explica hasta el 33 por ciento de la variabilidad en las señales ateroscleróticas tempranas. El árbol de clasificación mostró una mayor frecuencia de adolescentes con señales ateroescleróticas tempranas para la percepción de la situación económica regular o mala y para el nivel educacional mayor de secundaria básica. Conclusiones: Los factores contextuales influyen en la presencia de señales ateroscleróticas tempranas en adolescentes aparentemente sanos, pero explican parcialmente sus variabilidades(AU)

Introduction: The exploration and identification of the contextual factors of the atherosclerotic process from an early age present a knowledge gap in terms of mechanisms and causes. In primary health care, there are the conditions required for the identification of adolescents with atherogenic risk factors and in which it is easier to understand the context of the disease. Objective: Determine the influence of contextual factors on the presence of early atherosclerotic signals in apparently healthy adolescents. Methods: Descriptive cross-sectional study. Descriptive statistics were used. Analysis of canonical correlations was applied and decision trees were elaborated. Results: The atherosclerotic risk factors that predominated for both sexes were low consumption of fruits and vegetables, waist circumference > 90 p and being a passive smoker. In the female sex, a sedentary lifestyle stands out. In both sexes, adolescents with two or three signs predominated (male 77 [48.4percent] and female 71 [48.0percent]). The set of contextual factors explains up to 33percent of the variability in early atherosclerotic signals. The classification tree showed a higher frequency of adolescents with early atherosclerotic signals for the perception of the regular or bad economic situation and for the higher educational level of basic secondary school. Conclusions: Contextual factors influence the presence of early atherosclerotic signals in apparently healthy adolescents, but partially explain their variabilities(AU)

Encuestas para evaluar satisfacción con los cursos a distancia de la maestría Investigación en Aterosclerosis / Surveys for assessing satisfaction with the distance learning courses of the Master's Degree in Atherosclerosis Research

Introducción: La COVID-19 provocó que el Ministerio de Educación Superior indicara la suspensión de las actividades docentes de forma presencial. Por esta razón, la maestría Investigación en Aterosclerosis tuvo que pasar a la virtualidad. Objetivo: Validar el diseño de encuestas para la evaluación de la satisfacción de los maestrantes y profesores con los cursos virtuales de la maestría Investigación en Aterosclerosis. Métodos: Se realizó una investigación cualitativa que consistió en la revisión de la literatura publicada para analizar la teoría fundamentada en el diseño y la validación de encuesta. Se revisaron las publicaciones a partir de 2017 mediante el motor de búsqueda diseño y validación de instrumentos para evaluar la satisfacción con los cursos virtuales. También se hizo un análisis documental para analizar conceptos clave, ideas sobre los métodos utilizados para la elaboración de este tipo de instrumento; considerar problemáticas y retos de este diseño en otros estudios; y conocer las diferentes maneras de abordar el problema de investigación. Para el diseño de los instrumentos se llevó a cabo un estudio piloto con determinados estudiantes y profesores. Resultados: La encuesta para los estudiantes constó de 12 preguntas; y para los profesores, de 10, los cuales consideraron como satisfactoria su calidad. En el análisis de los resultados por los autores y la valoración global de ambas encuestas realizadas por el grupo de investigación surgieron dos recomendaciones para su perfeccionamiento, que se incluyeron para confeccionar la versión final de cada instrumento. Conclusiones: Ambas encuestas son fácilmente adaptables para utilizarse en otros cursos virtuales y en diferentes entornos virtuales de aprendizaje. Los dos instrumentos aportan datos generales, información sobre el profesor, contenido del curso, bibliografía y aseguramiento tecnológico(AU)

Introduction: COVID-19 caused the Ministry of Higher Education to indicate the interruption of face-to-face teaching activities. Subsequently, the master's degree in Atherosclerosis Research had to continue in the virtual modality. Objective: To validate survey design for assessing the satisfaction of master's degree students and professors with the virtual courses of the master's degree in Atherosclerosis Research. Methods: A qualitative research was conducted consisting of a review of the published literature to analyze the grounded theory in survey design and validation. Publications from 2017 were reviewed using the search, in which the following text chain was entered: design and validation of instruments to assess satisfaction with virtual courses. A documentary analysis was also conducted to analyze key concepts and ideas about the methods used for the development of this type of instrument, to consider problem situations and challenges of this design in other studies, as well as to learn about the different ways of approaching the research problem. For the design of the instruments, a pilot study was carried out with selected students and teachers. Results: The survey for the students consisted of twelve questions, while the professors had ten. The latter ones considered its quality as satisfactory. In the analysis of the results by authors and the overall assessment of both surveys carried out by the research group, two recommendations for improvement emerged, then included to make the final version of each instrument. Conclusions: Both surveys are easily adaptable for use in other virtual courses and in different virtual learning environments. Both instruments provide general data, information about the teacher, course content, bibliography and technological assurance(AU)

Metabolitos bioactivos generados por la disbiosis intestinal y sus implicaciones fisiopatológicas en la enfermedad cardiovascular / Bioactive metabolites generated by intestinal dysbiosis and their pathophysiological implications in cardiovascular disease

Introducción: La disbiosis conocida como la alteración de la relación simbiótica entre la microbiota intestinal y el huésped están implicados en la patogenia de la enfermedad cardiovascular aterosclerótica. Objetivo: Realizar una revisión documental sobre los mecanismos fisiopatológicos que relacionan los metabolitos bioactivos generados por la disbiosis intestinal con el desarrollo y progresión de la enfermedad cardiovascular aterosclerótica. Métodos: Se utilizó el motor de búsqueda Google Académico y se consultaron artículos de libre acceso en las bases de datos Pubmed, SciELO, Lilacs, Cumed y Hinari desde septiembre 2020 hasta el mes de marzo 2021. Las palabras clave utilizadas para esta revisión fueron:microbioma, microbiota intestinal, disbiosis, aterosclerosis, enfermedad cardiovascular y sus equivalentes en inglés, según el descriptor de Ciencias de la Salud (DeCS). Se consideraron artículos originales, de revisión, revisiones sistemáticas y metaanálisis posteriores al año 2015. Se revisaron un total de 73 artículos. Desarrollo: Las relaciones fisiopatológicas entre la disbiosis intestinal y las enfermedades cardiovasculares son complejas, ya que se influyen mutuamente a través de los sus toxinas endógenas (metabolitos bioactivos), el sistema circulatorio, las respuestas inmunitarias y los cambios metabólicos. Las investigaciones futuras deberían centrarse en dilucidar los actores moleculares subyacentes e identificar si las vías que interconectan la disbiosis intestinal con la ECA son causales, correlacionales o consecuentes. Conclusiones: La evidencia acumulada sostiene que la disbiosis de la microbiota intestinal está involucrada en la síntesis de metabolitos proaterogénicos los cuales modulan los mecanismos implicados en la fisiopatología de la ECA(AU)

Introduction: Dysbiosis is known as the alteration of the symbiotic relationship between the intestinal microbiota and the host is involved in the pathogenesis of atherosclerotic cardiovascular disease. Objective: To carry out a documentary review on the pathophysiological mechanisms that relate the bioactive metabolites generated by intestinal dysbiosis with the development and progression of atherosclerotic cardiovascular disease. Methods: The Google Scholar search engine was used and free access articles were consulted in Pubmed, SciELO, Lilacs, Cumed and Hinari databases from September 2020 to March 2021. The keywords used for this review were microbiome, gut microbiota, dysbiosis, atherosclerosis, cardiovascular disease and their English equivalents, according to the Health Sciences (DeCS) descriptor. Original articles, review articles, systematic reviews and meta-analyses after 2015 were considered. A total of 73 articles were reviewed. Findings: The pathophysiological relationships between intestinal dysbiosis and cardiovascular diseases are complex, since they influence each other through their endogenous toxins (bioactive metabolites), the circulatory system, immune responses and metabolic changes. Future research should focus on elucidating the underlying molecular players and on identifying whether the pathways that interconnect gut dysbiosis with ACE are causal, correlational, or consequential. Conclusions: The accumulated evidence supports that the dysbiosis of the intestinal microbiota is involved in the synthesis of proatherogenic metabolites which modulate the mechanisms involved in the pathophysiology of ACE(AU)

Atherosclerosis Complications in the Brazilian Population: An Ecological Time Series Study

Abstract Background: Atherosclerosis is a serious health problem, and several factors contribute to its occurrence. Longitudinal and qualified monitoring of primary health care (PHC) may contribute to the management of atherosclerosis and reduction of avoidable hospital admissions. Objectives: To estimate the trend in hospitalizations for atherosclerosis and the impact of PHC coverage on its evolution from 2008 to 2018 in Brazil. Methods: An ecological time series analytical study based on the outcomes of hospital admissions for atherosclerosis in Brazil. Time in years, PHC coverage, and Family Health Strategy (FHS) services were considered independent variables. A Prais-Winsten model was used to estimate the outcome trend, and α < 0.05 was adopted. Results: We observed a mean increase of 1.81 hospitalizations for atherosclerosis per 100 000 inhabitants annually (p = 0.002) in Brazil. This growth was evidenced in the Northeast (p < 0.001), Southeast (p = 0.003), and South (p < 0.001) regions, being stable in the North (p = 0.057) and Midwest (p = 0.62) regions. Men presented twice the growth in hospitalizations from the fifth decade of life on (p < 0.01). An inversely proportional relationship was observed for PHC coverage (B = -0.71; p < 0.001) and the proportion of FHS services (B = -0.59; p < 0.001) with the rate of admissions due to atherosclerosis in Brazil. Conclusions: Although hospitalizations for atherosclerotic complications are increasing in Brazil, they present regional and individual gender and age discrepancies, as well as a mitigating effect exerted by PHC coverage.

El volumen medioplaquetario: su importancia en la práctica clínica / Mean platelet volume: its importance in clinical practice

Las plaquetas son fragmentos citoplasmáticos anucleados derivados de los megacariocitos que presentan función central, tanto en procesos fisiológicos como la hemostasia, así como también en procesos patológicos como la inflamación, la ateroesclerosis. El tamaño de las plaquetas, medido como volumen medio de plaquetas, es un marcador de reactividad plaquetaria, que proporciona información importante sobre el curso y pronóstico de una variedad de afecciones inflamatorias. El estudio de este marcador se ha utilizado como pronóstico en enfermedades cardiovasculares, preeclampsia y en la púrpura trombocitopénica. El objetivo de este trabajo es revisar los conceptos actuales basados en la evidencia científica relacionados con el volumen plaquetario medio e insistir en su evaluación y significado en la práctica clínica cotidiana(AU)

Platelets are enucleated cytoplasmic fragments derived from megakaryocytes, which have a central function, both in physiological processes such as hemostasis, as well as in pathological processes such as inflammation, atherosclerosis. Platelet size, measured as mean volume of platelets, is a marker of platelet reactivity, providing important information on the course and prognosis of a variety of inflammatory conditions. The study of this marker has been used as a prognostic in cardiovascular diseases, preeclampsia and in thrombocytopenic purpura. The objective of this paper is to review the current concepts based on scientific evidence related to the mean platelet volume and to insist on its evaluation and meaning in daily clinical practice(AU)

Aterosclerosis en puente venoso aorto-coronario: hallazgos del OFDI: caso clínico / Findings of optical coherence tomography in saphenous grafts failure: report of one case

Atherosclerosis is the main cause of late saphenous vein graft (SVG) failure. Intracoronary images using optical coherence tomography (OCT) in addition to angiography allow a detailed analysis of the lesion beyond the degree of stenosis. We report a 67 years old diabetic male who underwent coronary surgery in 2009, consulting for an acute coronary syndrome. Angiography showed two different lesions on one aortocoronary venous grafts. OCT demonstrates atherosclerosis in different stages identifying the culprit lesion. Stent placement were successfully carried out.