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1.
Cardiovasc Diabetol ; 17(1): 33, 2018 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-29477146

RESUMEN

BACKGROUND: Long-term visit-to-visit glycemic variability is an additional measure of glycemic control. We aimed to evaluate the prognostic value of several measures of glycemic variability for the occurrence of micro- and macrovascular complications, and all-cause mortality in patients with type 2 diabetes. METHODS: 654 individuals were followed-up over a median of 9.3 years. Glycemic variability (SDs and coefficients of variation of HbA1c and fasting glycaemia) was measured during the first 12- and 24-months. Multivariate Cox analysis, adjusted for risk factors and mean HbA1c and fasting glycaemia levels, examined the associations between glycemic variability and the occurrence of microvascular (retinopathy, microalbuminuria, renal function deterioration, peripheral neuropathy) and macrovascular complications [total cardiovascular events (CVE), major adverse CVEs (MACE) and cardiovascular mortality], and of all-cause mortality. RESULTS: During follow-up, 128 patients had a CVE (96 MACE), and 158 patients died (67 from cardiovascular diseases); 152 newly-developed or worsened diabetic retinopathy, 183 achieved the renal composite outcome (89 newly developed microalbuminuria and 91 deteriorated renal function), and 96 newly-developed or worsened peripheral neuropathy. Glycemic variability, particularly the 24-month parameters either estimated by HbA1c or by fasting glycemia, predicted all endpoints, except for retinopathy and peripheral neuropathy development/progression, and was a better predictor than mean HbA1c. Glycemic variability predicted retinopathy development/progression in patients with good glycemic control (HbA1c ≤ 7.5%, 58 mmol/mol) and predicted new-incident peripheral neuropathy. CONCLUSIONS: Long-term visit-to-visit glycemic variability is an additional and frequently a better glycemic parameter than mean HbA1c levels for assessing the risk of future development of micro- and macrovascular complications in patients with type 2 diabetes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Angiopatías Diabéticas/epidemiología , Hemoglobina Glucada/metabolismo , Anciano , Albuminuria/sangre , Albuminuria/diagnóstico , Albuminuria/epidemiología , Biomarcadores/sangre , Brasil/epidemiología , Causas de Muerte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/mortalidad , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/epidemiología , Neuropatías Diabéticas/sangre , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/sangre , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
2.
Oral Dis ; 22(8): 791-796, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27470973

RESUMEN

BACKGROUND: Angiotensin-converting enzyme (ACE) downregulates the activity of bradykinin, a potent proinflammatory and immunostimulatory peptide liberated from an internal portion of kininogens. Here, we asked whether periodontitis is worsened in patients under antihypertensive treatment with ACE inhibitors. METHODS: Periodontal parameters were recorded from 30 individuals taking ACE inhibitors (case) and 35 taking a non-ACE inhibitor medication (control). Data were analyzed by nonparametric and parametric statistical tests. RESULTS: Most sociodemographic figures were similar in both groups. However, family income was statistically higher in the control group, and the percentage of sites with visible plaque (PL) was statistically higher in the case group (P = 0.043 and P = 0.005, respectively). The prevalence of individuals with chronic periodontitis varied from 31.5% in the control group to 63.4% in the case group (P = 0.001). Patients in the case group presented a 3.2-fold higher risk of having sites with pocket depth ≥5 mm and a 2.9-fold higher risk of having sites with clinical attachment loss ≥5 mm in comparison with those in the control group (P = 0.009 and P = 0.001, respectively; adjusted for family income and visible PL). CONCLUSION: Angiotensin-converting enzyme inhibitors may increase the prevalence and extent of chronic periodontitis in Brazilian patients.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Periodontitis Crónica/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Estudios de Casos y Controles , Periodontitis Crónica/patología , Femenino , Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad
3.
Diabet Med ; 29(2): 227-31, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22235986

RESUMEN

AIMS: Gestational diabetes mellitus may precede development of Type 2 diabetes and may be related to cardiovascular disease. Pulse wave velocity measurement is the gold-standard method to evaluate arterial stiffness, a preclinical cardiovascular risk marker. However, the relationship between aortic stiffness and gestational diabetes is unclear. The aim of this study was to evaluate aortic pulse wave velocity in women with gestational diabetes in comparison with a matched control group of healthy pregnant women. METHODS: This case-control study included 24 women with gestational diabetes and 27 matched control subjects. Clinical, demographic and laboratory variables were obtained and aortic pulse wave velocity were measured. RESULTS: Both groups had similar age, gestational age, BMI, ethnicity, smoking status and blood pressure levels. Women with gestational diabetes had aortic pulse wave velocity comparable with control subjects: 7.2 ± 0.9 vs. 7.3 ± 1.2 m/s (P = 0.79). When categorized according to the median value of pulse wave velocity (7.3 m/s), age (P < 0.001), diastolic blood pressure (P = 0.03) and heart rate (P = 0.02) were associated with increased arterial stiffness. In the group with gestational diabetes, there was a non-significant trend towards higher 1-h postprandial glycaemia in patients with higher (above the median) pulse wave velocity (6.5 ± 0.8 vs. 7.1 ± 1.3 mmol/l, P = 0.22) and a lower prevalence of patients with good glycaemic control (38.5 vs. 72.7%, P = 0.09). CONCLUSIONS: Although gestational diabetes may be a risk factor for development of cardiovascular disease, women with gestational diabetes do not have higher aortic stiffness than healthy pregnant women. Time of exposure to hyperglycaemia may have been insufficient to increase central arterial stiffness in women with gestational diabetes.


Asunto(s)
Aorta/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Diabetes Gestacional/fisiopatología , Angiopatías Diabéticas/fisiopatología , Hiperglucemia/fisiopatología , Rigidez Vascular , Adulto , Glucemia/metabolismo , Presión Sanguínea , Índice de Masa Corporal , Brasil/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/epidemiología , Angiopatías Diabéticas/epidemiología , Femenino , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/epidemiología , Embarazo , Flujo Pulsátil , Factores de Tiempo , Resistencia Vascular
4.
Diabetol Metab Syndr ; 12: 85, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33042229

RESUMEN

BACKGROUND: HbA1c variability has been linked to retinopathy, renal disease and autonomic neuropathy in patients with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D). Although the same relationship has been demonstrated for diabetic peripheral neuropathy (DPN) in patients with T2D, data for T1D are still lacking. METHODS: Patients older than 17 years of age with ≥ 10 years of T1D duration and follow-up were included. All patients underwent nerve conduction studies and neurological examination. Laboratorial data was retrospectively extracted from chart review. Mean HbA1c (mHbA1c) over 10 years was calculated, as well as HbA1c variability estimated by standard deviation (HbA1c-SD) and coefficient of variation (HbA1c-CV). RESULTS: Fifty patients with T1D were included (30 females and 21 non-caucasians), with mean age and T1D duration of 25.6 ± 5.0 and 17.9 ± 6.1 years, respectively. The frequency of DPN was 24%. Higher mHbA1c (10.4 ± % vs 8.1 ± %; p < 0.001), HbA1c-SD (1.8 ± 0.8 vs 0.9 ± 0.4; p < 0.001), and HbA1c-CV (1.7 ± 0.8 vs 1.2 ± 1.1; p = 0.006) were observed in patients with DPN compared to others. SD-HbA1c and HbA1c-CV were associated with DPN, diagnosed by either clinical or NCS criteria, independent of mHbA1c, age and gender. CONCLUSIONS: Not only long-term glycemic control, but also its variability is associated with DPN in patients with T1D. Larger studies are required to confirm this finding.

5.
J Hum Hypertens ; 19(3): 241-9, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15660120

RESUMEN

QT-interval parameters are potential indicators of increased cardiovascular risk. We evaluated prospectively their prognostic value, in relation to other risk markers, for cardiovascular fatal and nonfatal events in a cohort of 271 hypertensive type 2 diabetic outpatients. QT intervals were measured from 12-lead standard ECGs obtained on admission and maximum rate-corrected QT-interval duration and QT-interval dispersion (QTd) calculated. Clinical and laboratory data and 2-D echocardiograms (available in 126 patients) were recorded. Survival analyses included Kaplan-Meier survival curves, uni and multivariate Cox proportional-hazards models. After a median follow-up of 55 months (range 2-84), 68 total fatal or nonfatal cardiovascular events and 34 cardiovascular deaths (24 of them from cardiac causes) were observed. In multivariate Cox analysis, QTd was an independent predictor for total cardiovascular events (HR: 1.16, 95% CI: 1.01-1.34, for each 10 ms increments) and for cardiac deaths (HR: 1.28, 95% CI: 1.01-1.60). Other independent risk indicators for cardiovascular morbidity and mortality were echocardiographic left ventricular hypertrophy (Echo-LVH), serum triglycerides, presence of pre-existing cardiac and peripheral arterial disease, age, diabetes duration, heart rate and the presence of frequent ventricular premature contractions on ECG. The combination of QTd and Echo-LVH improved cardiovascular risk stratification compared with either alone, the presence of both prolonged QTd (>65 ms) and Echo-LVH was associated with a 3.2-fold (95% CI: 1.7-6.1) increased risk of a first cardiovascular event and a 5.9-fold (95% CI: 2.1-16.4) increased risk of cardiovascular death. Thus, QT provided additive prognostic information for cardiovascular morbidity and mortality beyond that obtained from conventional risk markers, including Echo-LVH, in type 2 diabetic patients with arterial hypertension.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Electrocardiografía , Frecuencia Cardíaca/fisiología , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/fisiopatología , Adulto , Anciano , Presión Sanguínea/fisiología , Causas de Muerte , Diabetes Mellitus Tipo 2/fisiopatología , Ecocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia
6.
Eur J Pharmacol ; 86(3-4): 385-91, 1983 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-6832216

RESUMEN

Verapamil was given to 18 anesthetized dogs (alpha-chloralose 100 mg/kg) as a bolus injection (200 micrograms/kg) followed by constant rate infusion (10 micrograms/kg per min). Hemodynamic parameters were evaluated before and during verapamil administration. After a suitable period of time for complete reversal of hemodynamic effects, verapamil administration as well as hemodynamic measurements were repeated during graded aortic occlusion. This technique stabilized central aortic pressure so that the level of reflex baroreceptor stimulation could be kept constant. Atrio-ventricular conduction disturbances observed in 5 dogs during balloon occlusion are attributed to lack of sympathetic stimulation. Without balloon occlusion, verapamil produced significant decreases in peripheral systemic vascular resistance and pressure and marked increases in cardiac output. Heart rate, pulmonary arterial and pulmonary wedge pressures did not change significantly. During graded aortic occlusion, systemic resistance and cardiac output were less markedly affected but there was an increase in both pulmonary arterial and wedge pressures.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Sistema Nervioso Simpático/fisiología , Verapamilo/farmacología , Animales , Aorta/fisiología , Gasto Cardíaco/efectos de los fármacos , Perros , Presión Esfenoidal Pulmonar/efectos de los fármacos
7.
J Hum Hypertens ; 17(8): 561-7, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12874614

RESUMEN

The aim of the study was to assess the determinants of increased QT interval parameters in diabetic patients with arterial hypertension and, in particular, the strength of their relationships to echocardiographically derived left ventricular mass (LVM) and geometric patterns. In a cross-sectional study with 289 hypertensive type 2 diabetic outpatients, maximal QT and QTc (heart rate-corrected) intervals, and QT, QTc, and number-of-leads-adjusted QT interval dispersions were manually measured from standard baseline 12-lead ECGs. Electrocardiographic criteria for left ventricular hypertrophy (LVH) were either Sokolow-Lyon or Cornell sex-specific voltages. LVM and geometric patterns were determined by 2D echocardiography. Statistical analyses involved bivariate tests (Mann-Whitney, chi2, Spearman's correlation coefficients, ANOVA and receiver-operating-characteristic (ROC) curve analyses) and multivariate tests (multiple linear and logistic regressions). QT dispersion measurements showed significant correlations with echocardiographic LVM (r=0.26-0.27). ROC curves demonstrated a poor isolated predictive performance of all QT parameters for detection of LVH (areas under curve: 0.58-0.59), comparable to that of electrocardiographic voltage criteria. Only patients with concentric hypertrophy had significantly increased QT dispersion (QTd) when compared to those with normal geometries (64.24+/-21.09 vs 53.20+/-15.35, P<0.05). In multivariate analyses, both electrocardiographic and echocardiographic LVH were independent predictors of increased QTd, as well as only QTd and gender were determinants of LVM. In conclusion, increased QT interval dispersion is associated with LVM and concentric hypertrophy geometric pattern in diabetic hypertensive patients, although in isolation neither QTd nor any QT parameter presents enough predictive performance to be recommended as screening procedures for detection of LVH.


Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Hipertensión/etiología , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/fisiopatología , Anciano , Análisis de Varianza , Presión Sanguínea , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Hipertensión/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etiología , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC
8.
J Hum Hypertens ; 27(11): 657-62, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23636008

RESUMEN

Resistant hypertension (RH) is defined as an uncontrolled office blood pressure (BP) despite the use of at least three antihypertensive drugs. With an increasing prevalence, RH implies in a very high cardiovascular risk and needs a careful clinical approach, aiming to control BP and to reduce its morbidity and mortality. The initial diagnostic approach involves drug adherence checking and the evaluation of antihypertensive scheme, emphasizing the use of diuretics and adequate combination and dosages of the two other drugs, which preferentially reduces cardiovascular risk and promotes prevention/regression of target organ damages. Because of an exaggerated white-coat effect, ambulatory BP monitoring (ABPM) at baseline is mandatory to classify patients into true RH (uncontrolled ambulatory BPs) and white-coat RH (controlled ambulatory BPs), and define initial therapeutic approach. Ideally, the objective is ambulatory BP control, so the treatment follow-up shall be based on ABPM measurements. The treatment involves lifestyle changes and use of adequate combinations of antihypertensive agents from different classes. In this way, patients with true RH need to intensify antihypertensive treatment by adding aldosterone antagonists as the fourth drug and also changing antihypertensive treatment to bedtime. Otherwise, in patients with controlled ambulatory BP, the therapeutic scheme should be maintained and ABPM or home BP monitoring repeated serially. Despite pharmacological interventions, ambulatory BP control in RH patients remains challenging and new interventional procedures have been recently proposed, as renal denervation and baroreflex activation therapy. Currently, these procedures shall be reserved to true RH patients in whom other alternatives have failed.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Resistencia a Medicamentos , Hipertensión/tratamiento farmacológico , Determinación de la Presión Sanguínea , Quimioterapia Combinada , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Selección de Paciente , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , Simpatectomía , Insuficiencia del Tratamiento , Hipertensión de la Bata Blanca/diagnóstico , Hipertensión de la Bata Blanca/tratamiento farmacológico , Hipertensión de la Bata Blanca/fisiopatología
11.
Braz J Med Biol Res ; 41(8): 674-80, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18797700

RESUMEN

Increased proteinuria is recognized as a risk predictor for all-cause and cardiovascular mortality in diabetic patients; however, no study has evaluated these relationships in Brazilian patients. The aim of this study was to investigate the prognostic value of gross proteinuria for all-cause and cardiovascular mortalities and for cardiovascular morbidity in a cohort study of 471 type 2 diabetic individuals followed for up to 7 years. Several clinical, laboratory and electrocardiographic variables were obtained at baseline. The relative risks for all-cause, cardiovascular and cardiac mortalities and for cardiovascular and cardiac events associated with the presence of overt proteinuria (>0.5 g/24 h) were assessed by Kaplan-Meier survival curves and by multivariate Cox regression model. During a median follow-up of 57 months (range 2-84 months), 121 patients (25.7%) died, 44 from cardiovascular and 30 from cardiac causes, and 106 fatal or non-fatal cardiovascular events occurred. Gross proteinuria was an independent risk predictor of all-cause, cardiovascular and cardiac mortalities and of cardiovascular morbidity with adjusted relative risks ranging from 1.96 to 4.38 for the different endpoints. This increased risk remained significant after exclusion of patients with prior cardiovascular disease at baseline from the multivariate analysis. In conclusion, gross proteinuria was a strong predictor of all-cause, cardiovascular and cardiac mortalities and also of cardiovascular morbidity in a Brazilian cohort of type 2 diabetic patients. Intervention studies are necessary to determine whether the reduction of proteinuria can decrease morbidity and mortality of type 2 diabetes in Brazil.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Proteinuria/complicaciones , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/orina , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/orina , Electrocardiografía , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico
12.
Lupus ; 17(11): 1042-8, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18852231

RESUMEN

The aim of this study was to investigate whether initial and accrued organ damage measured by Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI) predicts mortality in cohort of Brazilian patients with systemic lupus erythematosus (SLE). One hundred and five outpatients with SLE were enrolled from July 2000 to March 2001; their demographics, disease manifestations, interventions and quantified disease activity (SLEDAI) were obtained. SDI was measured at baseline and at the end of follow-up. Initial and accrued SDI prognostic values for mortality were investigated by multivariate Cox survival analysis and Kaplan-Meyer survival curves. After a median follow-up of 6.3 years, 19 patients died due to disease activity, end-organ failure, cardiovascular events, cancer and infection. Deceased patients had longer disease duration and greater initial and final SDI than survivors had. After adjustment for age, sex and disease duration, both initial and final SDI >/= 3 points were independent predictors of mortality, with hazard ratios (HRs) of 3.0 (1.1-8.2) and 4.7 (1.6-14.5), respectively. Damage accrual during follow-up was the strongest predictor of death (HR: 5.1, 2.0-13.0). Renal and pulmonary damages were the main predictors of increased mortality risk. In conclusion, baseline and accrued damage increase mortality risk in Brazilian patients with SLE. Measures to prevent damage development and progression are urgent to reduce the mortality of patients with SLE.


Asunto(s)
Lupus Eritematoso Sistémico/mortalidad , Adulto , Brasil/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
13.
Lupus ; 14(10): 846-52, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16302681

RESUMEN

Systemic lupus erythematosus (SLE) patients have increased cardiovascular morbidity and mortality. QT-interval parameters are presumed markers of cardiovascular risk and have not been previously evaluated in SLE. Standard 12-lead ECGs were obtained from 140 female SLE outpatients and 37 age and body mass index-matched controls. QT interval was measured in each lead and heart rate-corrected maximum QT-interval duration (QTcmax) and QT-interval dispersion (QTd) were calculated. Risk factors for cardiovascular disease and lupus clinical features, disease treatment, disease activity and damage index were recorded. SLE patients have increased QT-interval parameters when compared to controls (QTcmax: 427.91 +/- 31.53 ms(1/2) versus 410.05 +/- 15.45 ms(1/2), P < 0.001; QTd: 52.38 +/- 22.21 ms versus 37.12 +/- 12.88 ms, P < 0.001). These differences persisted after excluding those patients with arterial hypertension, diabetes and with ECG abnormalities (QTcmax: 419.90 +/- 28.78 ms(1/2) versus 409.15 +/- 15.85 ms(1/2), P = 0.041; QTd: 54.74 +/- 26.00 ms versus 37.96 +/- 13.05 ms, P = 0.001). Multivariate linear regression for factors associated with QTcmax selected the presence of electrocardiographic left ventricular hypertrophy (ECG-LVH) (P = 0.003), nonspecific ST-T-wave abnormalities (P = 0.022) and left atrial enlargement (P = 0.044). Multivariate associates with QTd were age (P = 0.018), ECG-LVH (P = 0.022) and ST-T abnormalities (P = 0.031). In conclusion, SLE patients have increased QT interval parameters when compared to controls. This prolongation may lead to an increased cardiovascular risk. This finding might be due to subclinical atherosclerotic cardiovascular disease.


Asunto(s)
Síndrome de QT Prolongado/etiología , Lupus Eritematoso Sistémico/complicaciones , Adulto , Función del Atrio Izquierdo/fisiología , Ecocardiografía , Femenino , Atrios Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/fisiopatología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/fisiopatología , Factores de Riesgo
14.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;41(8): 674-680, Aug. 2008. graf, tab
Artículo en Inglés | LILACS | ID: lil-491923

RESUMEN

Increased proteinuria is recognized as a risk predictor for all-cause and cardiovascular mortality in diabetic patients; however, no study has evaluated these relationships in Brazilian patients. The aim of this study was to investigate the prognostic value of gross proteinuria for all-cause and cardiovascular mortalities and for cardiovascular morbidity in a cohort study of 471 type 2 diabetic individuals followed for up to 7 years. Several clinical, laboratory and electrocardiographic variables were obtained at baseline. The relative risks for all-cause, cardiovascular and cardiac mortalities and for cardiovascular and cardiac events associated with the presence of overt proteinuria (>0.5 g/24 h) were assessed by Kaplan-Meier survival curves and by multivariate Cox regression model. During a median follow-up of 57 months (range 2-84 months), 121 patients (25.7 percent) died, 44 from cardiovascular and 30 from cardiac causes, and 106 fatal or non-fatal cardiovascular events occurred. Gross proteinuria was an independent risk predictor of all-cause, cardiovascular and cardiac mortalities and of cardiovascular morbidity with adjusted relative risks ranging from 1.96 to 4.38 for the different endpoints. This increased risk remained significant after exclusion of patients with prior cardiovascular disease at baseline from the multivariate analysis. In conclusion, gross proteinuria was a strong predictor of all-cause, cardiovascular and cardiac mortalities and also of cardiovascular morbidity in a Brazilian cohort of type 2 diabetic patients. Intervention studies are necessary to determine whether the reduction of proteinuria can decrease morbidity and mortality of type 2 diabetes in Brazil.


Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Cardiovasculares/mortalidad , /mortalidad , Proteinuria/complicaciones , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/orina , /complicaciones , /orina , Electrocardiografía , Métodos Epidemiológicos , Valor Predictivo de las Pruebas , Pronóstico
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