Effects of conventional and sugar-free energy drinks intake in runners: a double-blind, randomized, placebo-controlled crossover clinical trial.

BACKGROUND: This study evaluated the effects of two types of energy drinks (ED) intake in trained runners. METHODS: A double-blind randomized placebo-controlled clinical trial was conducted over 6 weeks. Participants and beverages were allocated by randomization. Twelve men 23±2.6 years, 177±3.4 cm, 74.4±5.5 kg, VO2max=59.8±5.5 mL·(kg.min)-1] ingested either a conventional energy drink containing carbohydrates and 3 mg·kg-1 of caffeine, (ED1), a sugar-free energy drink 3 mg·kg-1 of caffeine (ED2), or a carbohydrate-containing, decaffeinated placebo (PL) 40-minutes before an exercise protocol. Sprint time, rate of perceived exertion (RPE), respiratory exchange ratio (RER), blood pressure (BP), heart rate and plasmatic glucose were evaluated during the experimental protocol. RESULTS: Performance improved after consuming both ED (P<0.004 ED1 and P=0.001 ED2) with lower RPE (P<0.05 for ED1 and P<0.05 for ED2) compared to PL. Consumption of ED2 decreased RER values at 0-5 minutes and 40-45 minutes (P<0.001), and ED1 increased systolic BP (P<0.05) during exercise compared to PL. There were no differences in the evaluated parameters between EDs (P>0.05). CONCLUSIONS: Consumption of conventional or sugar free ED represents a valid ergogenic strategy to improve acute performance with reduction of RPE. However, intake of a conventional ED warrants caution, mainly because the effects on systolic BP.

Physical Inactivity is Liable to the Increased Cardiovascular Risk and Impaired Cognitive Profile.

BACKGROUND: Sedentary life-style is a significant public health issue. It increases the incidence of type-2 diabetes mellitus (DM2) and systemic arterial hypertension (SAH), which in turn may impair physical and mental health. In fact, disrupted glucose metabolism is characteristic of Alzheimer's dementia, and it is often dubbed as type-3 diabetes. OBJECTIVE: The purpose of this study was to assess the level of activity, body composition, cardiovascular risk and cognitive profile of patients with DM2 and/or SAH. The study was cross-sectional design. METHOD: The sample consisted of 120 individuals which 35% men and 65% women, with an average of 64±9 years old and 60±11 years old, respectively. Various parameters were evaluated such as anthropometric variables, pedometer recordings and brief cognitive screening battery (BCSB), which assesses the immediate memory, verbal fluency, learning, late memory and recognition. Chi-square and Fisher's exact test were applied to observe possible differences between men and women. In addition to Kruskall-Wallis, in the comparison between patients with SAH; DM2 and SAH + DM2. RESULTS: A high rate of physical inactivity was found among those enrolled in this project. Females were characterized by increased body fat, whereas men displayed visceral fat excess. BCSB demonstrated reduced verbal fluency, late memory and recognition, with women presenting significantly worse results. CONCLUSION: Low level of daily physical activity is apparently correlated with obesity, elevated cardiovascular risk, and cognitive dysfunction.

High-sensitivity C-reactive protein in subjects with type 2 diabetes mellitus and/or high blood pressure.

Type 2 diabetes mellitus (DM2) and high blood pressure (HBP) may contribute to the development of cardiovascular disease, and inflammation may be an important factor in these diseases. In the present study, plasma levels of high-sensitivity C-reactive protein (hs-CRP) were measured in subjects with DM2 and/or HBP and compared to those of normal subjects. Eighty-nine subjects were analyzed for hs-CRP, including 13 normotensive patients with DM2, 17 patients with HBP, 34 hypertensive patients with DM2 (DM2+HBP) and 25 normal subjects. The plasma hs-CRP levels were significantly lower in the controls than in the HBP+DM2 group (p < 0.05). DM2 associated with HBP was also correlated with increased plasma hs-CRP levels (n = 89, r = 0.25, p = 0.0162). Only hypertensive patients with DM2 had higher levels of hs-CRP, a circulating inflammatory marker, than normal subjects. This finding suggests that patients with two associated diseases have a more active inflammatory state.

Apo B/Apo A-I ratio in central and peripheral arterial diseases.

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

Human adipose-derived stem cells stimulate neuroregeneration.

Traumatic brain injuries and degenerative neurological disorders such as Alzheimer's dementia, Parkinson's disease, amyotrophic lateral sclerosis and many others are characterized by loss of brain cells and supporting structures. Restoring microanatomy and function using stem cells is a promising therapeutic approach. Among the many various sources, adipose-derived stem cells (ADSCs) are one of the most easily harvested alternatives, they multiply rapidly, and they demonstrate low immunogenicity with an ability to differentiate into several cell types. The objective of this study was to evaluate the effect of xenotransplanted human ADSCs on post-traumatic regeneration of rat sciatic nerve. Peripheral reconstruction following complete sciatic transection and autonerve grafting was complemented by intra-operative injection of hADSCs into the proximal and distal stumps. The injury caused gliosis and apoptosis of sensory neurons in the lumbar 5 (L5) ganglia in the control rodents; however, animals treated with hADSCs demonstrated a smaller amount of cellular loss. Formation of amputation neuroma, which hinders axonal repair, was less prominent in the experimental group, and immunohistochemical analysis of myelin basic protein showed good myelination 65 days after surgery. At this point, control groups still exhibited high levels of microglia/macrophage-specific marker Iba-1 and proliferating cell nuclear antigen, the mark of an ongoing inflammation and incomplete axonal growth 2 months after the injury. This report demonstrates that hADSCs promote neuronal survival in the spinal ganglion, fuel axonal repair and stimulate the regeneration of peripheral nerves.

Transcriptional Analysis of Blood Lymphocytes and Skin Fibroblasts, Keratinocytes, and Endothelial Cells as a Potential Biomarker for Alzheimer's Disease.

Alzheimer's disease (AD) is a devastating and progressive form of dementia that is typically associated with a build-up of amyloid-ß plaques and hyperphosphorylated and misfolded tau protein in the brain. Presently, there is no single test that confirms AD; therefore, a definitive diagnosis is only made after a comprehensive medical evaluation, which includes medical history, cognitive tests, and a neurological examination and/or brain imaging. Additionally, the protracted prodromal phase of the disease makes selection of control subjects for clinical trials challenging. In this study we have utilized a gene-expression array to screen blood and skin punch biopsy (fibroblasts, keratinocytes, and endothelial cells) for transcriptional differences that may lead to a greater understanding of AD as well as identify potential biomarkers. Our analysis identified 129 differentially expressed genes from blood of dementia cases when compared to healthy individuals, and four differentially expressed punch biopsy genes between AD subjects and controls. Additionally, we identified a set of genes in both tissue compartments that showed transcriptional variation in AD but were largely stable in controls. The translational products of these variable genes are involved in the maintenance of the Golgi structure, regulation of lipid metabolism, DNA repair, and chromatin remodeling. Our analysis potentially identifies specific genes in both tissue compartments that may ultimately lead to useful biomarkers and may provide new insight into the pathophysiology of AD.

Determinantes da densidade mineral óssea na pós-menopausa / Determinants of bone mineral density in post-menopause

Pós-menopausa é período de maior perda óssea e faz-se necessário instituir medidas preventivas que amenizem sua progressão. Objetivo: correlacionar o escore da densidade mineral óssea (DMO) e seus fatores de risco, buscando determinar aqueles que mais a influenciam. Método: estudo transversal, descritivo de 62 mulheres na pós-menopausa, saudáveis, idade média de 56,82 ± 4,02 anos, avaliadas quanto aos fatores de risco para osteoporose e nível de atividade física. Absorção de dupla energia de raios-X (DXA) avaliou coluna lombar e fêmur proximal. Os grupos, DMO normal e diminuída, foram analisados pelos testes T de Student, qui-quadrado e correlações. Resultados: Mulheres com menor índice de massa corporal (IMC), maior idade e maior tempo de menopausa apresentaram menor DMO em fêmur. Raça negra e ausência de história familiar correlacionaram-se com maior DMO. Conclusão: IMC, idade, peso, história familiar de osteoporose, raça e tempo de menopausa foram os principais fatores determinantes da DMO em mulheres na pós-menopausa.

Post-menopause is the period of greatest bone loss and it is necessary to introduce preventative measures to mitigate its progression. Aim: compare the score of bone mineral density (BMD) and their risk factors and to determine those most influencing. Method: Cross-sectional, descriptive study of 62 postmenopausal women, healthy, average age 56.82 ± 4.02 years, evaluated for risk factors for osteoporosis and physical activity level. Absorption dual energy X-ray absorptiometry (DXA) evaluated lumbar spine and proximal femur. Groups, normal and reduced BMD were analyzed by Student’s t test, chisquare and correlations. Results: Women with lower body mass index (BMI), older age and longer duration of menopause had lower BMD at the femur. Black race and absence of family history correlated with higher BMD. Conclusion: BMI, age, weight, family history of osteoporosis, race, and time since menopause were the main determinants of BMD in postmenopausal women.

Altas taxas de sedentarismo e fatores de risco cardiovascular em pacientes com hipertensão arterial resistente / High rates of physical inactivity and cardiovascular risk factors in patients with resistant hypertension

A hipertensão arterial sistêmica é uma doença multifatorial, de alta prevalência na população brasileira e mundial e constitui o principal fator de risco tratável para as doenças cardiovasculares. Objetivos: Verificar a prevalência, de acordo com o sexo, dos comportamentos de risco e das comorbidades associadas à hipertensão nos pacientes atendidos no Centro Hiperdia de Viçosa, MG Métodos: Estudo transversal que avaliou 172 prontuários de hipertensos maiores de 18 anos, não diabéticos, encaminhados ao Centro Hiperdia de Viçosa. Entre os dados avaliados a partir de análise de prontuários estão os fatores e comportamentos de risco cardiovascular como sobrepeso/obesidade,dislipidemia, tabagismo, etilismo e sedentarismo, bem como condições clínicas ou comorbidades associadas à HAS. Para análise dos dados foram empregados os testes de Kolmogorov-Smirnov, o teste de Mann-Whitney e o teste de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados: Observou-se uma prevalência maior de homens entre os hipertensos analisados e as taxas de etilismo e tabagismo foram significativamente maiores neste grupo. As mulheres apresentaram uma taxa maior de obesidade. O sedentarismo e a dislipidemia estiveram presentes em 77% e 44% dos pacientes, respectivamente, sem diferença entre os sexos. Hipertensão arterial resistente foi encontrada em 71% dos pacientes. Dentre as condições clínicas relacionadas à hipertensão, houve um predomínio da hipertrofia do ventrículo esquerdo, seguida pela doença renal e pela doença cerebrovascular.Conclusões: O estudo mostrou que 71 % dos pacientes eram classificados como hipertensos resistentes e que, além desta séria condição, os mesmos ainda apresentavam uma combinação de comportamentos e fatores de risco que conferem um alto risco de complicações cardiovasculares...

Hypertension is a multifactorial disease of high prevalence in Brazil and the world’s populationand is the major treatable risk factor for cardiovascular disease.Objectives: To investigate the prevalence, according to sex, of risk behaviors and comorbidities associated with Hypertension.in the treated patients in Hiperdia Center Viçosa, MGMethods: Cross-sectional study that evaluated 172 medical records of hypertensive patients greater than 18 years, nondiabetic, referred to the center of Viçosa Hiperdia. Among the data evaluated from analysis of medical records are the factors and behaviors of cardiovascular risk as overweight / obesity,dyslipidemia, smoking, drinking and physical inactivity, as well as medical conditions or comorbidities associated with hypertension. For data analysis were used the Kolmogorov-Smirnov test, Mann-Whitney test and the Pearson correlation test. The level of significance was 5%. Results: There was a higher prevalence of men among the patients and rates of alcoholism and smoking were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were present in 77% and 44% of patients, respectively, with no difference between sexes. Resistant Hypertension was found in 71% of patients. Lower education was also very present among the hypertensive. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. Conclusions: The study showed that 71% of patients were classified as resistant Hypertension and that, beyond this serious condition, they still showed a combination of behaviors and risk factors that confer a high risk of cardiovascular complications...

Prevalência e etiologia da anemia em idosos: uma revisão integral / Prevalence and etiology of anemia in the elderly: a full review

Objetivos: Descrever a prevalência e a etiologia da anemia em idosos nos estudos originais publicados. Métodos: Revisão integrativa de artigos publicados entre 2008 e 2013, nas bases de dados eletrônicos PubMed e Science Direct. Utilização de descritores pré-determinados em inglês, abrangendo artigos que utilizassem: “anemia”, “elderly”, “etiology”, usados em combinação. Resultados: Foram encontrados 77 artigos. Após processo de filtragem selecionou-se 18 estudos que apresentavam resultados da prevalência e etiologia da anemia em idosos. Conclusão: Observou-se grande amplitude nas prevalências de anemias (5,5% a 62,6%), assim como a etiologia. Idosos hospitalizados e institucionalizados apresentaram elevadas prevalências de anemia com aumento para risco de mortalidade. Idosos não institucionalizados constituíram a maior parte da população alvo e nesses, a principal etiologia da anemia foi doença crônica e inexplicada. A etiologia da anemia encontrada nestas pesquisas contemplou as três principais causas de anemia nos idosos, quais seja por deficiências nutricionais, doenças crônicas e anemia inexplicada, confirmando a multifatorialidade desta doença...

Purpuses: to describe the prevalence and etiology of anemia in the elderly in the original studies published. Methods: systematic review of articles published between 2008 and 2013, the electronic databases PubMed and Science Direct. Using descriptors predetermined english, covering articles that used: “anemia”,“elderly”, “etiology”, used in combination. Results: was founded 77 articles. After filtering process were selected 18 studies that presented results of prevalence and etiology of anemia in the elderly. Conclusion: there was a wide range in the prevalence of anemia (5.5% to 62.6%), as well as the etiology. Hospitalized and institutionalized elderly showed a high prevalence of anemia with increased risk formortality. Non-institutionalized elderly constituted the majority of the target population and the main cause of anemia was chronic and unexplained. The etiology of anemia found in these surveys included the threemain causes of anemia in the elderly, which is by nutritional deficiencies, chronic and unexplained anemia, confirming this multifactorial disease...

Comparative study of apolipoprotein-E polymorphism and plasma lipid levels in dyslipidemic and asymptomatic subjects, and their implication in cardio/cerebro-vascular disorders.

Polymorphisms in the apolipoprotein-E (apoE) gene may modulate lipoprotein metabolism at different steps and influence total and low density lipoprotein (LDL) cholesterol (LDLc) levels, as well as other lipid features. Population studies have documented significant differences in the frequency of apoE alleles which are related to the prevalence of various cardio-vascular and neuro-psychiatric diseases. In this study, the apoE genotypes and allele frequencies were analyzed in 216 individuals (109 dyslipidemic and 107 normo-lipidic subjects), and the relative contribution of apoE polymorphism on plasma lipid and lipoprotein levels, as well as risk factors was evaluated. In normo-lipidic volunteers, the frequencies of epsilon2, epsilon3 and epsilon4 alleles were 0.042, 0.832 and 0.126, while in dyslipidemic subjects 0.046, 0.835 and 0.119, respectively. No significant difference was observed among epsilon2, epsilon3 or epsilon4 and plasma lipid-lipoprotein levels in the dyslipidemic group. In normo-lipidemics, however, total cholesterol, LDLc and non-HDLc plasma levels were significantly lower in epsilon2 subjects when compared to epsilon3 and epsilon4 individuals. The allelic frequencies of apoE epsilon2, epsilon3 and epsilon4 were similar in dyslipidemic and normo-lipemic subjects, suggesting that apoE polymorphisms have no effect on plasma lipid-lipoprotein levels in dyslipidemic subjects. In contrast, in normo-lipemic subjects the epsilon2 allele showed to be associated with lower total cholesterol and LDLc levels, the mark of a better lipid profile. Depending on other co-existing factors, the epsilon2 allele, therefore, may play either a protective or pathogenic role. This elementary knowledge is a fundamental prerequisite for a possible diagnostic application of these lipoproteins as biomarkers to predict adverse cardio-vascular and/or neuro-psychiatric maladies.

Efeitos da atividade física sobre a densidade mineral óssea de mulheres saudáveis na pré-menopausa / Physical activity effects on bone mineral density of healthy women in pre-menopause

A atividade física representa um importante estímulo ao aumento da densidade mineral óssea (DMO). Como a resistência dos ossos está associada tanto a DMO, quanto a microestrutura e propriedades do material, melhorias na massa óssea são importantes na prevenção de osteoporose na idade mais avançada. Apesar de muitos estudos sobre o tema, não existe consenso sobre qual seria o melhor tipo de atividade física, intensidade e frequência para melhorias na osteogênese e promoção do ganho de DMO. O objetivo deste estudo foi investigar os tipos de atividades físicas com melhor efeito osteogênico de aumento da DMO em mulheres saudáveis na pré-menopausa. Metodologia: Realizou-se levantamento bibliográfico de artigos científicos nas bases de dados Pubmede Direct Science publicados nos últimos dez anos. Foram selecionados estudos controlados com exercícios de alto impacto e resistido. Utilizou-se análise sistematizada dos artigos selecionados. Resultados: Foram incluídos 15 artigos nesta revisão, os quais foram separados em dois grupos, conforme o tipo de exercício. Foi realizada análise comparativa de metodologias utilizadas e resultados alcançados. Constatou-se maior eficiência do protocolo de exercício de alto impacto, mesmo em curto período de execução para aumento da DMO do fêmur proximal (colo femoral e região intertrocantérica). Em menor frequência, foi observado aumento da DMO na coluna lombar quando exercícios resistidos ou de impactos maiores foram usados. Conclusões: A maioria dos artigos executou protocolo experimental em período relativamente curto (6 meses), demonstrando que programas de exercícios simples, de fácil execução, curto período de aplicação e sem uso de aparelhos específicos são suficientes para promover remodelação óssea em sítios específicos com aumento da DMO...

Physical activity is an important stimulus to increase bone mineral density (BMD). Where by the resistance of the bone is associated with BMD, microstructure and material properties, improvements in bone mass are important to prevent osteoporosis in old ages. Despite many studies on the subject, there is no consensus on what is the best type of exercise, intensity and frequency for improvements in osteogenesis and promotion of BMD gain. This study aimed to investigate the types of physical activities that results in better osteogenic effects on increasing BMD in healthy premenopausal women. Methodology: We searched scientific articles in Pubmed and Science Direct databases published in the last ten years. We selected controlled studies which used high-impact activities or resistance training. We used systematic analysis of the selected articles. Results: Fifteen articles were included in this review, which were separated into two groups according to the type of exercise. We performed a comparative analysis of the methods used and the results achieved. There were more efficient protocols using high impact exercise even if it was a short-term program resulting in increased BMD in the proximal femur (femoral neck and intertrochanteric region). Conclusion: There were fewer studies observing increases in BMD at the lumbar spine when resistance exercise with load or high impact loads were used. Most experimental protocols performed in relatively short-term programs (6 months) demonstrated that exercise programs that were simple, easy to perform, and not using special devices are sufficient to promote bone remodeling at specific sites resultingin increased BMD...

Apo B/Apo A-I ratio in central and peripheral arterial diseases

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

INTRODUÇÃO: O índice apo B/apo A-I representa o balanço entre partículas de colesterol potencialmente aterogênicas ricas em apo B e partículas anti-aterogênicas ricas em apo A-I. O objetivo deste estudo foi investigar a associação entre doenças ateroscleróticas em diferentes sítios anatômicos e o índice apo B/apo A-I. MÉTODOS: Lípides, lipoproteínas e apolipoproteínas A-I e B foram quantificados em 30 indivíduos apresentando doença arterial coronariana (DAC), 26 com acidente vascular cerebral (AVC), 34 apresentando doença arterial obstrutiva periférica (DAOP) e 38 indivíduos hígidos (grupo controle). RESULTADOS: HDLc e apo A-I apresentaram-se significativamente mais baixos nos grupos DAOP e DAC, respectivamente, quando comparados com os demais grupos. Níveis de triglicérides foram significativamente mais elevados nos grupos DAC e PAOD quando comparados com o grupo controle. Apo B foi significativamente mais elevada no grupo AVC quando comparado com os grupos controle e DAOP. O índice apo B/apo A-I se mostrou significativamente elevado nos grupos DAC e AVC quando comparados com os demais (p < 0,001). CONCLUSÃO: O índice apo B/apo A-I foi importante para identificar uma tendência aumentada para aterosclerose coronariana e cerebral. No entanto, os parâmetros avaliados não podem ser considerados de forma isolada, considerando que nenhuma associação foi demonstrada quando os dados foram analisados pelo modelo de regressão logística binária.

High-sensitivity C-reactive protein in subjects with type 2 diabetes mellitus and/or high blood pressure

Type 2 diabetes mellitus (DM2) and high blood pressure (HBP) may contribute to the development of cardiovascular disease, and inflammation may be an important factor in these diseases. In the present study, plasma levels of high-sensitivity C-reactive protein (hs-CRP) were measured in subjects with DM2 and/or HBP and compared to those of normal subjects. Eighty-nine subjects were analyzed for hs-CRP, including 13 normotensive patients with DM2, 17 patients with HBP, 34 hypertensive patients with DM2 (DM2+HBP) and 25 normal subjects. The plasma hs-CRP levels were significantly lower in the controls than in the HBP+DM2 group (p < 0.05). DM2 associated with HBP was also correlated with increased plasma hs-CRP levels (n = 89, r = 0.25, p = 0.0162). Only hypertensive patients with DM2 had higher levels of hs-CRP, a circulating inflammatory marker, than normal subjects. This finding suggests that patients with two associated diseases have a more active inflammatory state.

Diabetes mellitus tipo 2 (DM2) e hipertensão arterial sistêmica (HAS) podem contribuir para o desenvolvimento de doenças cardiovasculares, e os processos inflamatórios relacionados a estas doenças podem ser considerados importantes fatores para o prognóstico das mesmas. O objetivo deste estudo foi determinar os níveis plasmáticos de proteína C-reativa ultra-sensível (us-PCR) em pacientes adultos com diabetes mellitus e/ou hipertensão arterial, comparando-os com indivíduos hígidos. Foram avaliadas 89 indivíduos, incluindo 13 pacientes normotensos com diabetes mellitus tipo 2 (DM2), 17 pacientes hipertensos (HAS), 34 pacientes hipertensos com diabetes mellitus tipo 2 (DM2+HAS) e 25 indivíduos hígidos. Os níveis plasmáticos de us-PCR foram significativamente mais altos no grupo DM2+HAS quando comparado com o grupo controle (p < 0,05), entretanto o mesmo não aconteceu com os grupos DM2 ou HAS. O grupo DM2+HAS também foi associado com o aumento dos níveis plasmáticos de us-PCR (r = 0,25; p < 0,05) e apresentou a maior freqüência de us-PCR > 3,0 mg/L (59 por cento). Esses dados indicam que a presença combinada de diabetes mellitus tipo 2 e hipertensão arterial promoveu uma maior expressão do estado inflamatório, refletido pelos níveis plasmáticos de us-PCR nos indivíduos avaliados.

Lipoproteína(a) e inibição da fibrinólise na doença arterial coronariana / Lipoprotein(a) and fibrinolysis inhibition in coronary artery disease

O envolvimento da lipoproteína(a) nas doenças ateroscleróticas tem sido alvo de muitos estudos que têm demonstrado que esta lipoproteína é um fator de risco independente para a doença arterial coronariana (DAC). Devido à semelhança estrutural com o plasminogênio, a Lp(a) pode competir com os sítios de ligação deste, diminuindo a geração de plasmina e inibindo a fibrinólise. O trombo formado numa placa aterosclerótica rompida dispara a maioria dos eventos cardiovasculares isquêmicos. Como o trombo é dissolvido através do sistema fibrinolítico, surgiu a hipótese de que uma diminuição da atividade fibrinolítica poderia ser um fator de risco para eventos isquêmicos. Entretanto, alguns estudos demonstraram ausência de associação entre Lp(a) e DAC, enquanto alguns atribuem o real valor preditivo à uma sub-população de Lp(a) com alta afinidade por fibrina. Essa hipótese sugere que alguns fenótipos de Lp(a) não estão associados à aterotrombose. Sendo assim, as pesquisas envolvendo Lp(a) e DAC apresentam resultados controversos, altamente dependentes da população estudada. Na população brasileira, a qual apresenta uma heterogeneidade de etnias, são raros os estudos deste tipo. Diante das notáveis controvérsias, espera-se que a presente revisão possa contribuir para suscitar ânimos no sentido da realização de estudos adicionais envolvendo a dosagem da Lp(a) em pacientes com DAC na nossa população. O conhecimento acumulado ao longo do tempo sobre a associação entre Lp(a) e DAC foi obtido através de estudos conduzidos fora do nosso meio. Assim, estudos fundamentados dentro da nossa realidade poderão trazer respostas mais fidedignas e adequadas para a nossa população.

The role of lipoprotein(a) [Lp(a)] in atherogenesis has been the target of many studies that have demonstrated that this lipoprotein is an independent risk factor for coronary artery disease (CAD). Due to the structural likeness with plasminogen, Lp(a) can compete with binding sites, reducing the plasmin generation and inhibiting fibrinolysis. Thrombus formed due to ruptured atherosclerotic plaque trigger most ischemic cardiovascular events. As the thrombus are dissolved by the fibrinolytic system, the hypothesis that a decrease in fibrinolytic activity might be a risk factor for ischemic events has been suggested. However, some studies have not demonstrated any correlation between Lp(a) and CAD while others attribute the real predictive value to a subpopulation of Lp(a) with high affinity for fibrin. This hypothesis suggests that some Lp(a) phenotypes are not associated with atherothrombosis. Furthermore, research on Lp(a) and CAD is controversial and highly dependent on the studied population. In the Brazilian population, which presents heterogeneity of the ethnic groups, studies of this type are rare. Based on the controversies, it is expected that a contribution of the present review will motivate investigators to develop studies involving the measurement of Lp(a) in patients with CAD in the Brazilian population. The accumulated knowledge on the association between Lp(a) and CAD was obtained through foreign studies. Thus, such studies must be performed in our setting in order to bring a better understanding for a more adequate management of CAD.

D-Dimer plasma levels in patients with coronary artery disease

We have previously reported that prothrombin fragment 1+2 levels were not associated to the presence or severity of coronary artery disease (CAD) and do not provide further information on subjects with CAD diagnosed by angiography. Thus, in the present study another marker of hypercoagulability was evaluated in the same subjects. This study aimed at determining D-Dimer plasma levels in a group of subjects undergoing coronary angiography to establish a likely relation between this parameter and the severity of CAD. D-Dimer plasma levels were determined in 17 subjects with no coronary atheromatosis (controls), 12 subjects with mild/moderate atheromatosis and 28 subjects with severe atheromatosis. No significant differences were observed among the three groups. Data analysis enables an inference on a tendency towards an increase in fibrinolytic activity in patients with atheromatosis, reflected by the increase in D-Dimer concentrations in the severe atheromatosis group in subjects with CAD diagnosed by coronary angiography.

Em estudo prévio, os níveis plasmáticos do fragmento 1+2 da protrombina não foram associados com a presença ou com a gravidade da doença arterial coronariana (DAC), não trazendo benefício adicional pelo menos em indivíduos com diagnóstico de DAC estabelecido por angiografia. Desta forma, neste estudo outro marcador de hipercoagulabilidade foi avaliado nos mesmos pacientes. O presente estudo teve como objetivo determinar os níveis plasmáticos do dímero D de um grupo de indivíduos submetidos à angiografia coronariana, buscando estabelecer a possível correlação entre este parâmetro e a gravidade da DAC. Os níveis plasmáticos do dímero D foram determinados em amostras de sangue de 17 indivíduos com ausência de ateromatose nas coronárias (controles), 12 indivíduos apresentando ateromatose leve/moderada e 28 indivíduos apresentando ateromatose grave. Não foram encontradas diferenças estatisticamente significativas entre as médias dos três grupos para o parâmetro avaliado. Uma análise dos dados permite inferir sobre uma tendência ao aumento da atividade fibrinolítica nos pacientes com ateromatose, refletida pela elevação da concentração de dímero D no grupo ateromatose grave em indivíduos com diagnóstico de DAC estabelecido por angiografia coronariana.

Fragmento 1+2 da protrombina em indivíduos submetidos à angiografia coronariana / Prothrombin fragment 1+2 in subjects undergoing coronary angiography

A trombina exerce um papel fundamental na conversão do fibrinogênio em fibrina, no processo de coagulação. O fator X ativado transforma a protrombina em trombina e fragmento 1+2 da protrombina (F1+2). Os níveis plasmáticos de F1+2 refletem a geração de trombina e podem ser usados como um marcador de hipercoagulabilidade in vivo, já que a trombina é uma substância instável e facilmente degradada, que não pode ser medida diretamente no plasma. O presente estudo teve como objetivo determinar os níveis plasmáticos do F1+2 de um grupo de indivíduos submetidos à angiografia coronariana, buscando estabelecer a possível correlação entre este parâmetro e a gravidade da doença arterial coronariana (DAC). Os níveis plasmáticos do F1+2 foram determinados em amostras de sangue de 17 indivíduos com ausência de ateromatose nas coronárias (controles), 12 indivíduos apresentando ateromatose leve/moderada e 28 indivíduos apresentando ateromatose grave, utilizando-se o conjunto diagnóstico Enzignost F1+2 (Behring® Diagnostics GmbH, Marburg, Germany). Não foram encontradas diferenças estatisticamente significativas entre as médias dos três grupos para o parâmetro avaliado. Portanto, as médias obtidas nos três grupos para os níveis plasmáticos de F1+2 não sinalizam para a existência de um estado de hipercoagulabilidade na população estudada. Entretanto, 73,7 por cento dos indivíduos faziam uso regular de ácido acetilsalicílico, o que pode ter influenciado nos resultados de F1+2, uma vez que este medicamento promove a inibição da enzima ciclooxigenase, diminuindo a liberação de tromboxane A2 e a agregação plaquetária. Portanto, presume-se que a redução da ativação plaquetária poderia estar contribuindo para uma menor formação de trombina e, conseqüentemente, diminuindo o potencial de hipercoagulabilidade.

Thrombin plays a basic role in the conversion of fibrinogen to fibrin in the coagulation process. Activated factor X transforms the prothrombin into thrombin and breaks up prothrombin fragment 1+2 (F1+2). F1+2 plasma levels reflect the thrombin generation and can be used as in vivo markers of hypercoagulability since the thrombin is an unstable and easily degraded substance that cannot be directly measured in the plasma. The present study aims at determining the F1+2 plasma levels of a group of subjects undergoing coronary angiography, attempting to establish a possible correlation between this parameter and the severity of the coronary artery disease. F1+2 plasma levels were determined in blood samples of 17 subjects with absence of atheromatosis in coronary arteries (controls), 12 subjects presenting mild/moderate atheromatosis and 28 subjects presenting severe atheromatosis, using the Enzignost F1+2 (Behring® Diagnostics GmbH, Marburg, Germany) diagnostic Kit. Significant differences between the averages for the three groups in respect to the evaluated parameters were not found. Therefore, F1+2 plasma level averages for the three groups did not point to a state of hypercoagulability in the studied population. However, 73.7 percent of the individuals were taking acetylsalicylic acid, which may have influenced the F1+2 plasma levels, considering that this medicine promotes the inhibition of the enzyme cyclo-oxygenase, diminishing the release of thromboxane A2 and the platelet aggregation. Therefore, it is presumed that platelet activation reduction could be contributing to a lower formation of thrombin and, consequently, diminishing the hypercoagulability potential.