Determination of Vascular Age in Men Using the Coronary Calcium Score and its Impact on Restratification of Cardiovascular Risk. / Determinação da Idade Vascular em Homens Através do Escore de Cálcio Coronariano e seu Impacto na Reestratificação do Risco Cardiovascular.

BACKGROUND: Identifying asymptomatic individuals at risk of developing cardiovascular disease is one of the main goals of preventive cardiology. The coronary calcium score (CCS) makes it possible to estimate vascular age, which has shown to be more reliable than chronological age for determining cardiovascular risk. OBJECTIVES: To reclassify cardiovascular risk based on arterial age and evaluate CCS progression during follow-up. METHODS: We included 150 asymptomatic men who underwent clinical and CCS evaluation in 2 evaluations with an interval of 7.6 years. We classified patients by traditional risk scores and arterial age. We evaluated which variables were associated with greater CCS progression during the period, considering a statistical significance level of 5% (p < 0.05). RESULTS: The use of arterial age in the stratification of cardiovascular risk in comparison with the Framingham risk score (FRS) reclassified 29% of individuals to a higher risk category and 37% to a lower risk category. Regarding the American Heart Association and American College of Cardiology score (ASCVD), 31% were reclassified as higher risk and 36% as lower risk. The initial classification by arterial age was directly related to the progression of CCS throughout follow-up (p < 0.001). This was not observed for the FRS (p = 0.862) or ASCVD (p = 0.153). The individual variables most associated with CCS progression were high systolic blood pressure and low HDL. CONCLUSION: Cardiovascular risk stratification using arterial age showed a better association than the FRS and ASCVD in identifying individuals with higher risk of atherosclerosis progression.

FUNDAMENTO: Identificar os indivíduos assintomáticos sob risco de desenvolver doenças cardiovasculares é um dos principais objetivos da cardiologia preventiva. O escore de cálcio coronariano (ECC) permite estimar a idade vascular, que se mostrou mais fidedigna que a idade cronológica na determinação do risco cardiovascular. OBJETIVOS: Reclassificar o risco cardiovascular com base na idade arterial e avaliar a progressão do escore de cálcio durante o seguimento. MÉTODOS: 150 homens assintomáticos foram submetidos a avaliação clínica e do ECC em 2 avaliações com intervalo de 7,6 anos. Classificamos os pacientes pelos escores de risco tradicionais e pela idade arterial. Avaliamos quais variáveis se associaram a maior progressão do ECC durante o período. O nível de significância estatística considerado foi de 5% (p < 0,05). RESULTADOS: A utilização da idade arterial na estratificação do risco cardiovascular em comparação ao escore de risco de Framingham (ERF) reclassificou 29% dos indivíduos para uma categoria de risco superior e 37% para uma categoria inferior. Em relação ao escore da AHA e ACC (ASCVD), 31% passaram para um risco maior e 36% para um risco menor. A classificação inicial pela idade arterial teve relação direta com a progressão do ECC ao longo do seguimento (p < 0,001), fato que não foi observado para o ERF (p = 0,862) e ASCVD (p = 0,153). As variáveis individuais que mais se associaram à progressão do ECC foram a pressão arterial sistólica e o HDL baixo. CONCLUSÃO: A estratificação de risco cardiovascular utilizando a idade arterial apresentou melhor associação que o ERF e ASCVD na identificação de indivíduos com maior risco de progressão da aterosclerose.

Determinação da Idade Vascular em Homens Através do Escore de Cálcio Coronariano e seu Impacto na Reestratificação do Risco Cardiovascular / Determination of Vascular Age in Men Using the Coronary Calcium Score and its Impact on Restratification of Cardiovascular Risk

Resumo Fundamento Identificar os indivíduos assintomáticos sob risco de desenvolver doenças cardiovasculares é um dos principais objetivos da cardiologia preventiva. O escore de cálcio coronariano (ECC) permite estimar a idade vascular, que se mostrou mais fidedigna que a idade cronológica na determinação do risco cardiovascular. Objetivos Reclassificar o risco cardiovascular com base na idade arterial e avaliar a progressão do escore de cálcio durante o seguimento. Métodos 150 homens assintomáticos foram submetidos a avaliação clínica e do ECC em 2 avaliações com intervalo de 7,6 anos. Classificamos os pacientes pelos escores de risco tradicionais e pela idade arterial. Avaliamos quais variáveis se associaram a maior progressão do ECC durante o período. O nível de significância estatística considerado foi de 5% (p < 0,05). Resultados A utilização da idade arterial na estratificação do risco cardiovascular em comparação ao escore de risco de Framingham (ERF) reclassificou 29% dos indivíduos para uma categoria de risco superior e 37% para uma categoria inferior. Em relação ao escore da AHA e ACC (ASCVD), 31% passaram para um risco maior e 36% para um risco menor. A classificação inicial pela idade arterial teve relação direta com a progressão do ECC ao longo do seguimento (p < 0,001), fato que não foi observado para o ERF (p = 0,862) e ASCVD (p = 0,153). As variáveis individuais que mais se associaram à progressão do ECC foram a pressão arterial sistólica e o HDL baixo. Conclusão A estratificação de risco cardiovascular utilizando a idade arterial apresentou melhor associação que o ERF e ASCVD na identificação de indivíduos com maior risco de progressão da aterosclerose.

Abstract Background Identifying asymptomatic individuals at risk of developing cardiovascular disease is one of the main goals of preventive cardiology. The coronary calcium score (CCS) makes it possible to estimate vascular age, which has shown to be more reliable than chronological age for determining cardiovascular risk. Objectives To reclassify cardiovascular risk based on arterial age and evaluate CCS progression during follow-up. Methods We included 150 asymptomatic men who underwent clinical and CCS evaluation in 2 evaluations with an interval of 7.6 years. We classified patients by traditional risk scores and arterial age. We evaluated which variables were associated with greater CCS progression during the period, considering a statistical significance level of 5% (p < 0.05). Results The use of arterial age in the stratification of cardiovascular risk in comparison with the Framingham risk score (FRS) reclassified 29% of individuals to a higher risk category and 37% to a lower risk category. Regarding the American Heart Association and American College of Cardiology score (ASCVD), 31% were reclassified as higher risk and 36% as lower risk. The initial classification by arterial age was directly related to the progression of CCS throughout follow-up (p < 0.001). This was not observed for the FRS (p = 0.862) or ASCVD (p = 0.153). The individual variables most associated with CCS progression were high systolic blood pressure and low HDL. Conclusion Cardiovascular risk stratification using arterial age showed a better association than the FRS and ASCVD in identifying individuals with higher risk of atherosclerosis progression.

Cardiopatia isquêmica e direção veicular / Ischemic heart disease in drivers

As doenças cardiovasculares são a principal causa de mortalidade em adultos, acometendo uma grande parcela da população economicamente ativa. Dentre as doenças cardiovasculares, a isquemia miocárdica se destaca pela alta prevalência e capacidade de ocasionar morbimortalidade. Muitos motoristas, sejam profissionais ou casuais, são particularmente suscetíveis, com base em alguns fatores de risco inerentes à própria função. A manifestação inicial da isquemia miocárdica durante a direção veicular representa um alto risco de acidentes de trânsito. A identificação precoce dos indivíduos de maior risco para doença arterial coronariana, especialmente através do exame médico de renovação da habilitação, e a determinação do momento correto em que aqueles que tenham sido vitimados por um evento isquêmico devem voltar a dirigir podem ser importantes armas na prevenção de acidentes automobilísticos(AU)

Cardiovascular disease is today the leading cause of death in adults, affecting a large portion of the economically active population. Among cardiovascular diseases, myocardial ischemia is distinguished by its high prevalence and ability to cause morbidity and mortality. Many drivers, whether professional or casual, are particularly susceptible, based on some risk factors inherent to driving itself. The initial manifestation of myocardial ischemia during motor vehicle driving is a high risk of traffic accidents. Early identification of individuals with higher risk for coronary artery disease, especially through the medical examination to renew the driver's license, and determining the right time when those who have been victimized by an ischemic event should return to drive, may be important weapons in the prevention of traffic accidents(AU)

Viagem com crianças: segurança "além da cadeirinha" / Traveling with children: beyond car seat safety

Resumo Objetivo Proporcionar conhecimento e instigar o profissional de saúde a fornecer uma orientação aprimorada quanto aos cuidados com crianças em viagens, além de orientar o seu transporte seguro. Fontes dos dados Revisão bibliográfica nas bases de dados Lilacs e Medline® de artigos com os termos viagem, segurança, equipamentos de proteção, criança e medicina preventiva e publicados nos últimos 21 anos. Síntese dos dados Foram analisados 93 artigos e66 atenderam aos critérios de inclusão após a leitura dos resumos. Para a construção do artigo propôs-se a definição dos subtemas: preparar a viagem com as crianças, conhecer alguns riscos do translado (transporte aéreo, transporte terrestre e aquático), explorar o destino com as crianças (exposição solar, hospedagem, altitude, alimentação, diarreia do viajante, picada de insetos) e retorno de viagem com crianças. Conclusões Ao longo dos anos houve um aumento do número de crianças que viajam pelo mundo. Entretanto, essa população não está isenta de apresentar problemas de saúde durante a viagem e pode ser até mais suscetível do que a faixa etária adulta. Esses surgem a partir de uma variedade de fatores, incluindo a exposição a organismos infecciosos, o uso de certos tipos de transporte e a participação em algumas atividades, como caminhadas para altas altitudes, entre outros. Porém, quando se viaja com crianças esses fatores de risco podem ser negligenciados e uma viagem considerada segura para um adulto pode não ser uma boa opção para os infantes. A consulta pediátrica deve ser uma boa oportunidade para aprimorar as orientações preventivas no planejamento pré-viagem.

Abstract Objective To spread knowledge and instigate the health professional to give advice on childcare during travels and on child transport safety. Sources of data Literature review through the LILACS and MEDLINE® databases, using the terms: travel, safety, protective equipment, child, preventive medicine, retrieving articles published in the last 21 years. Summary of the findings The authors analyzed 93 articles, of which 66 met the inclusion criteria after summaries were read. For drafting this article, the following sub-themes were proposed: getting ready to travel with children; knowing some of the transfer risks (air, land and water transportation) and exploring the destination with children (sun exposure, accommodations, altitude, food, traveler's diarrhea, insect bites) and return from the trip with children. Conclusions Over the years, there has been an increase in the number of children who travel around the world. However, this population is still subject to health problems while traveling and may be even more susceptible than the adult age group. These problems arise from a variety of factors, including exposure to infectious organisms, the use of certain types of transportation, and participation in some activities, such as hiking at high altitudes, among others. However, when traveling with children, these risk factors can be overlooked; a trip that is considered safe for an adult might not be a good choice for this age group. The pediatric consultation should be a good opportunity to optimize preventive guidelines at the pre-trip planning.

Bloqueio da divisão anteromedial do ramo esquerdo e coronariopatia severa: relato de caso / Left septal fascicular block and ischemic cardiomyopathy: case report

A subdivisão do sistema de condução pelo ramo esquerdo continua controversa, apesar de décadas de estudos. Rosembaum, na década de 1960, dividiu em dois fascículos, e estudos subsequentes apontaram a existência de uma terceira subdivisão, denominada anteromedial. Com critérios estabelecidos pela Sociedade Brasileira de Cardiologia e outras sociedades científi cas, o bloqueio divisional anteromedial (BDAM) é ignorado por outras entidades, que alegam não haver critérios universalmente aceitos para sua defi nição. A associação entre BDAM e cardiopatia isquêmica foi descrita algumas vezes. Relatamos um caso em que a presença de BDAM foi indicador de gravidade em um paciente com dor precordial.

The subdivision of the conduction system by the left branch remains controversial despite decades of studies. Rosenbaum, in the 1960s, split into two fascicles, and subsequent studies indicated the existence of a third subdivision, named anteromedial. With criteria established by the Brazilian Society of Cardiology and other scientifi c societies, the anteromedial divisional block (AMDB) is ignored by other groups, who claim there is no universally accepted criteria for its defi nition. The association between AMBD and ischemic cardiomyopathy has been described a few times. We describe a case in which the presence of AMBD was an indicator of severity in a patient with precordial pain.

Traveling with children: beyond car seat safety.

OBJECTIVE: To spread knowledge and instigate the health professional to give advice on childcare during travels and on child transport safety. SOURCES OF DATA: Literature review through the LILACS and MEDLINE(®) databases, using the terms: travel, safety, protective equipment, child, preventive medicine, retrieving articles published in the last 21 years. SUMMARY OF THE FINDINGS: The authors analyzed 93 articles, of which 66 met the inclusion criteria after summaries were read. For drafting this article, the following sub-themes were proposed: getting ready to travel with children; knowing some of the transfer risks (air, land and water transportation) and exploring the destination with children (sun exposure, accommodations, altitude, food, traveler's diarrhea, insect bites) and return from the trip with children. CONCLUSIONS: Over the years, there has been an increase in the number of children who travel around the world. However, this population is still subject to health problems while traveling and may be even more susceptible than the adult age group. These problems arise from a variety of factors, including exposure to infectious organisms, the use of certain types of transportation, and participation in some activities, such as hiking at high altitudes, among others. However, when traveling with children, these risk factors can be overlooked; a trip that is considered safe for an adult might not be a good choice for this age group. The pediatric consultation should be a good opportunity to optimize preventive guidelines at the pre-trip planning.

Prevalence of oral anticoagulation in atrial fibrillation.

OBJECTIVES: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment. METHODS: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it. RESULTS: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants. CONCLUSIONS: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores.

Prevalence of oral anticoagulation in atrial fibrillation

OBJECTIVES: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment. METHODS: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it. RESULTS: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants. CONCLUSIONS: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores. .