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.

COVID-19, aterosclerosis y la respuesta inflamatoria en la enfermedad reumática / COVID - 19, atherosclerosis and the inflammatory response in rheumatic disease

Introducción: La enfermedad por el coronavirus 2019 (COVID-19) es causada por el síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2). Además de la invasión tisular directa, el SARS-CoV-2 también puede provocar una respuesta inmune exagerada del huésped, que con frecuencia conduce a una tormenta de citocinas, que contribuye, significativamente, a la disfunción multiorgánica. Las enfermedades autoinmunes se caracterizan por un estado proinflamatorio, aterosclerosis acelerada e incremento de la incidencia de complicaciones vasculares por lo que en estos pacientes existe un alto riesgo de complicaciones ante la presencia del SARS-CoV-2. La alteración en la regulación del sistema inmunológico, el aumento de la demanda metabólica y la actividad procoagulante probablemente explican parte del mayor riesgo de resultados adversos en las personas con enfermedad aterosclerótica relacionada con la COVID-19. Objetivo: Actualizar los conocimientos del personal de salud en el manejo de estas enfermedades. Método: Se realizó una búsqueda de artículos en PubMed, SciELO y Google Scholar con estrategia de vocabulario controlado, de diciembre 2019 a noviembre 2020. Se seleccionaron un total de 50 artículos. Desarrollo: La elevada producción de autoanticuerpos ya sea secundaria a la enfermedad reumática o por una infección intercurrente, puede estar implicada en el desarrollo de la disfunción endotelial, la progresión y la ruptura de la placa aterosclerótica. Conclusiones: Se ha demostrado que estas enfermedades crónicas autoinmunitarias se asocian a una elevada morbimortalidad cardiovascular por lo que el médico de estos tiempos tiene que ser capaz de reconocer estos pacientes(AU)

Introduction: Coronavirus disease 2019 (Covid-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to direct tissue invasion, SARS-CoV-2 can also elicit an exaggerated host immune response, often leading to a cytokine storm, significantly contributing to multi-organ dysfunction. Autoimmune diseases are characterized by a pro-inflammatory state, accelerated atherosclerosis and an increased incidence of vascular complications, which is why there is a high risk of complications in the presence of SARS-CoV-2 in these patients. Altered immune system regulation, increased metabolic demand, and procoagulant activity likely explain part of the increased risk of adverse outcomes in people with Covid-19-related atherosclerotic disease. Objective: To update the knowledge of health personnel in the management of these diseases. Method: We reviewed articles in PubMed, SciELO and Google Scholar with a controlled vocabulary strategy, from December 2019 to November 2020. We selected a total of 50 articles. Findings: The high production of autoantibodies, whether secondary to rheumatic disease or due to intercurrent infection, may be involved in the development of endothelial dysfunction, the progression and rupture of the atherosclerotic plaque. Discussion: It has been shown that these autoimmune chronic diseases are associated with high cardiovascular morbidity and mortality, so the doctor of these times must be able to recognize these patients(AU)

Ectasia coronaria y miocardiopatía hipertrófica: una entidad infrecuente / Coronary artery ectasia and hypertrophic cardiomyopathy: case report

Resumen Se presenta el caso de un paciente de 54 años que consulta por angina de esfuerzo de 2 años de evolución en quien se identifica una dilatación ectásica del árbol coronario con lesiones ateroscleróticas críticas y miocardiopatía hipertrófica septal obstructiva. Una revisión bibliográfica revela que es una asociación infrecuente de la cual solo existen reportes de casos aislados.

Abstract We present the case of a 54-year-old patient who presented with a history of 2 years with angina. Invasive studies revealed critical coronary artery stenosis coexisting with obstructive hypertrophic miopathy. This is a rare association with only isolated case reports.

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Abstract The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I2 = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I2 = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

Profilaxis farmacológica para la prevención de la enfermedad tromboembólica en paciente con enfermedad cerebrovascular / Pharmacological prophylaxis for the prevention of thromboembolic disease in patients with cerebrovascular disease

INTRODUCCIÓN: La enfermedad cerebrovascular es un conjunto de alteraciones atribuidas a lesiones agudas y focales en el sistema nervioso central, en su mayoría secundaria a aterosclerosis DESARROLLO: En la prevención de la enfermedad cerebrovascular, existen dos grandes grupos farmacológicos, los antitromboticos y los anti plaquetarios, los cuales impactan en la calidad de vida de estos pacientes mejorando el pronóstico de los mismos. CONCLUSIONES: La enfermedad cerebrovascular comparte factores de riesgo de enfermedad tromboembólica, por lo que se recomienda iniciar profilaxis.

INTRODUCTION: Cerebrovascular disease is a group of alterations attributed to acute and focal lesions in the central nervous system, mostly secondary to atherosclerosis. DEVELOPMENT: In the prevention of cerebrovascular disease, there are two major pharmacological groups, antithrombotics and antiplatelet drugs. , which impact the quality of life of these patients, improving their prognosis. CONCLUSIONS: Cerebrovascular disease shares risk factors for thromboembolic disease, so it is recommended to start prophylaxis.

The association between Hba1c and arterial stiffness among non-diabetic patients with chronic kidney disease / Associação entre Hba1c e rigidez arterial entre pacientes sem diabetes com doença renal crônica

Abstract Background Cardiovascular events are seen more frequently after the age of 60 and they are a significant cause of morbidity and mortality. Arterial stiffness is a property that can be expressed by pulse wave velocity and this value is assumed to be a predictor of cardiovascular events. Patients with chronic kidney disease and dysregulated blood sugar have increased atherosclerosis and arterial stiffness, but the relationship between physiological levels of Hba1c and arterial stiffness is less clear in chronic kidney disease patients without diabetes mellitus. Objectives Here, we aimed to investigate the degree of arterial stiffness among non-diabetic, non-dialysis dependent chronic kidney disease patients with physiological HbA1c levels. Methods We enrolled 51 patients who were followed up at Ege University Hospital Nephrology Department between February and June 2015. Non-diabetic, non-dialysis dependent chronic kidney disease patients were included in the study. Blood pressure and pulse wave velocity were measured with an applanation tonometry device (Sphygmocor Vx Software Atcor Medical, Australia). Correlations between pulse wave velocity and the aforementioned parameters were investigated (see below). Results We detected a significant correlation between pulse wave velocity and systolic blood pressure (p=0.0001) and Hba1c (p=0.044) separately. There was an inverse correlation with creatinine clearance (p=0.04). We also detected a significant correlation with serum phosphorus level (p=0.0077) and furosemide use (p=0.014). No correlations were found among the other parameters. Conclusions Arterial stiffness is an important predictor of cardiovascular events and measuring it is an inexpensive method for estimating morbidity and mortality. Our study supports the importance of measuring arterial stiffness and of controlling blood glucose levels, even at physiological Hba1c values, especially for chronic kidney disease patients.

Resumo Contexto Os eventos cardiovasculares são mais frequentes em pessoas com mais de 60 anos, e sugere-se que sejam causas significativas de morbidade e mortalidade. A rigidez arterial é expressa pela velocidade da onda de pulso, e presume-se que esse valor seja um preditor de eventos cardiovasculares. Os pacientes com doença renal crônica e desregulação do açúcar no sangue têm aterosclerose e rigidez arterial aumentadas. No entanto, a relação entre os níveis fisiológicos de Hba1c e a rigidez arterial entre pacientes com doença renal crônica sem diabetes melito é menos clara. Objetivos Buscamos investigar o grau de rigidez entre os pacientes sem diabetes e portadores de doença renal crônica sem dependência de diálise com níveis fisiológicos de HbA1c. Métodos Incluímos 51 pacientes, sem diabetes e com doença renal crônica sem dependência de diálise, que estavam em acompanhamento no Departamento de Nefrologia do Ege University Hospital entre fevereiro e junho de 2015. A pressão sanguínea e a velocidade da onda do pulso foram medidas com um dispositivo de tonometria de aplanação (Sphygmocor Vx Software Atcor Medical, Austrália). A correlação entre a velocidade da onda de pulso e os parâmetros mencionados anteriormente foi investigada. Resultados Detectamos correlação significativa entre a velocidade da onda de pulso e a pressão arterial sistólica (p = 0,0001) e Hba1c (p = 0,044) separadamente. Foi constatada correlação inversa com a depuração de creatinina (p = 0,04). Também detectamos correlação significativa com o nível de fósforo sérico (p = 0,0077) e o uso de furosemida (p = 0,014). Não foi encontrada correlação entre outros parâmetros. Conclusões A rigidez arterial é um preditor importante de eventos cardiovasculares, e a sua medição é um método de baixo custo para estimar a morbidade e mortalidade. Nosso estudo corrobora a importância da medição da rigidez arterial e do controle dos níveis de glicemia sanguínea mesmo em valores de Hba1c fisiológicos, principalmente para pacientes portadores de doença renal crônica.

Panoramic radiography for detection of bilateral carotid calcified atheroma: an unusual case report / Radiografía panorámica para la detección de ateroma calcificado carotídeo bilateral: reporte de un caso inusual

Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Introducción: La aterosclerosis es una enfermedad inflamatoria progresiva que puede desencadenar graves consecuencias médicas como infarto agudo de miocardio o accidente cerebrovascular. Case Report: El propósito de este estudio es reportar un caso inusual de hallazgo de placas ateromatosas calcificadas en las arterias carótidas de forma bilateral mediante una radiografía panorámica. Mujer de 75 años con antecedentes mórbidos, acude a la Clínica Odontológica Docente de la Pontificia Universidad Católica con exámenes complementarios. La radiografía panorámica mostró estructuras radiopacas bien definidas adyacentes a C4. Mediante ecografía Doppler se confirmó la presencia de ateromas calcificados en las arterias carótidas derecha e izquierda. El paciente fue informado de estos hallazgos y actualmente se encuentra en seguimiento médico. Conclusión: La radiografía panorámica es un recurso complementario útil en la detección de placas ateroscleróticas de la región carotídea superior.

Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application

Abstract Although low-density lipoprotein cholesterol is central to the development and progression of atherosclerosis, the role of inflammation in the atherosclerotic process is becoming better understood and appreciated. Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis, HIV infection, and inflammatory bowel disease have all been shown to be associated with an increased blood levels of inflammatory biomarkers and increased risk of cardiovascular events. Evidence from observational studies suggests that anti-inflammatory therapy decreases this risk in these conditions. Clinical trials of anti-inflammatory drugs in patients with coronary disease have yielded mixed results. Drugs that have failed in recent trials include the P38 MAP kinase inhibitor losmapimod, the phospholipase A2 inhibitors darapladib and varespladib, and methotrexate. Canakinumab, an interleukin-1β inhibitor, reduced cardiovascular events in patients with coronary disease in the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS). Canakinumab increased the rate of fatal infections in CANTOS and is very expensive; it is thus unlikely to be widely used for risk reduction in cardiology. On the other hand, colchicine is a safe and inexpensive anti-inflammatory drug. In the Colchicine Cardiovascular Outcomes Trial (COLCOT), where patients within 30 days of a myocardial infarction were randomized to low-dose colchicine or placebo and followed for a median of almost 2 years, colchicine treatment was associated with a 23% reduction (p=0.02) in cardiovascular events. Newer studies with anti-inflammatory drugs have the potential to improve outcomes of patients with atherosclerosis, just as low-density lipoprotein cholesterol-lowering drugs have done over the past two decades.

COVID-19 grave: entenda o papel da imunidade, do endotélio e da coagulação na prática clínica / Severe COVID-19: understanding the role of immunity, endothelium, and coagulation in clinical practice

Resumo O SARS-CoV-2 é o responsável pela pandemia da COVID-19. O sistema imunológico é fator determinante no combate à infecção viral e, quando atua equilibrada e eficientemente, a doença é autolimitada e benigna. Uma parcela significativa da população, porém, apresenta resposta imune exacerbada. Os indivíduos diabéticos, hipertensos, obesos e com doenças cardiovasculares, infectados pelo vírus, apresentam maior chance de progredir para formas graves. Essas doenças estão relacionadas a processos inflamatórios crônicos e disfunção endotelial. Os receptores do tipo Toll estão presentes nas células de defesa e participam da imunopatologia de doenças cardiovasculares e metabólicas, levando à produção de citocinas pró-inflamatórias quando ativados. Devido à ação viral e à hiperativação do sistema imune, estados de hiperinflamação, hiperativação plaquetária, disfunção endotelial e hipercoagulabilidade são desenvolvidos, predispondo a tromboses venosas e arteriais. Discutiremos sobre a interação entre a COVID-19, a imunidade, o endotélio e a coagulação, como também sobre as possíveis causas de doenças cardiometabólicas impactarem negativamente na evolução da COVID-19.

Abstract SARS-CoV-2 is responsible for the COVID-19 pandemic. The immune system is a determinant factor in defense against viral infections. Thus, when it acts in a balanced and effective manner the disease is self-limited and benign. Nevertheless, in a significant proportion of the population, the immune response is exaggerated. When infected, patients with diabetes, hypertension, obesity, and cardiovascular disease are more likely to progress to severe forms. These diseases are related to chronic inflammation and endothelial dysfunction. Toll-like receptors are expressed on immune cells and play an important role in the physiopathology of cardiovascular and metabolic diseases. When activated, they can induce release of inflammatory cytokines. Hypercoagulability, hyperinflammation, platelet hyperresponsiveness, and endothelial dysfunction occur in immune system hyperactivity caused by viral activity, thereby increasing the risk of arterial and venous thrombosis. We discuss the interactions between COVID-19, immunity, the endothelium, and coagulation, as well as why cardiometabolic diseases have a negative impact on COVID-19 prognosis.

Factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide / Risk factors for the development of atherosclerosis in patients with rheumatoid arthritis

Introducción: la artritis reumatoide es una enfermedad sistémica, de etiología desconocida, caracterizada por provocar inflamación crónica, cursa con manifestaciones articulares, extrarticulares y comportamiento clínico variable. Objetivo: caracterizar los factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide e identificar su relación con el tiempo de diagnóstico, actividad inflamatoria y tratamiento. Método: se realizó estudio descriptivo transversal, en pacientes con artritis reumatoide atendidos en el Centro de Reumatología del Hospital Docente Clínico Quirúrgico 10 de Octubre entre febrero 2016 y junio 2017. Resultados: la mayor frecuencia fue para el sexo femenino, el rango etario 45-54 años. Se observó placa ateromatosa en 37.2 por ciento y engrosamiento complejo íntima media en el 15.4 por ciento. Los factores de riesgo que mostraron asociación con la presencia de placa fueron: hipertrigliceridemia (p= 0.000), hipercolesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) y los niveles elevados de proteína C Reactiva (p= 0.003). Conclusiones: los factores de riesgo tradicionales que presentaron significación estadística fueron la hipercolesterolemia, hipertrigliceridemia y la Diabetes Mellitus. La presencia de más de un factor elevó la frecuencia de alteraciones en el eco doppler; existió asociación entre la elevación de los niveles de PCR y la presencia de alteraciones del eco doppler. Se constató en aquellos pacientes con alteraciones eco doppler carotídeo relación con el tiempo de evolución, actividad de la enfermedad y dosis acumulada de esteroides(AU)

Introduction: rheumatoid arthritis is a systemic disease, of unknown etiology, characterized by chronic inflammation; It presents with joint, extra-articular manifestations and variable clinical behavior. Objective: to characterize the risk factors for the appearance of atherosclerosis in patients with rheumatoid arthritis and to identify their relationship with the time of diagnosis, inflammatory activity and treatment. Method: a cross-sectional, descriptive study was conducted in patients with rheumatoid arthritis treated at the Rheumatology Center of the Surgical Clinical Teaching Hospital 10 de Octubre in the period between February 2016 and June 2017. Results: the highest frequency was for the female sex, the age range 45-54 years. Atheromatous plaque was observed in 37.2 percent and intimal complex thickening in 15.4 percent. The risk factors that showed association with the presence of plaque were: hypertriglyceridemia (p= 0.000), hypercholesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) and high levels of C-reactive protein (p= 0.003) Conclusions: the traditional risk factors that presented statistical significance were hypercholesterolemia, hypertriglyceridemia and Diabetes Mellitus. The presence of more than one traditional risk factor increased the frequency of alterations in Doppler echo; There was an association between the elevation of C-Reactive Protein levels and the presence of Doppler echo alterations. It was found in those patients with carotid echo Doppler alterations, relationship with the time of evolution, activity of the disease and cumulative dose of steroids(AU)

Intervención educativa para la prevención de complicaciones en pacientes con dislipidemia / Educational intervention for the prevention of complications in patients with dyslipidemia

RESUMEN Introducción: actualmente, la enfermedad ateroesclerótica está entre las principales causas de muerte, incapacidad y demencia en adultos mayores. Su causalidad es multifactorial, pero es indiscutible la relación de la dislipidemia con los riesgos de eventos cardiovasculares. Objetivo: dotar de información necesaria a pacientes, para modificar estilos de vida y lograr un impacto positivo en la reducción de la morbimortalidad, producida por enfermedades ateroescleróticas. Materiales y métodos: se aplicó un proyecto de intervención a través de acciones educativas a un grupo de pacientes adultos (n=234) con dislipidemia. Atendidos en la Unidad de Salud Oziel Montecristo, por el equipo I (blanco) del municipio de Campinas, Departamento de São Paulo. Entre enero a julio del 2016. Los participantes fueron sometidos a una encuesta antes y después de recibir la información. Resultados: el grupo etáreo que predominó fue entre 20-50 años con 55,5 %. La escolaridad primaria fue más significativa en el 41 %. Otros factores de riesgo reportados fue obesidad, 46,5 %; fumadores, 9,4 %; con etilismo crónico, 8,5 % y sedentarismo 71,7 %. Las enfermedades crónicas presentes fueron: hipertensión arterial, 53,4 %; diabetes mellitus, 40,5 %; cardiopatía isquémica y enfermedad renal crónica el 20,9 % y 9,4 %, respectivamente. Se lograron resultados positivos en el auditorio, un número importante de pacientes continuaron en los grupos terapéuticos. Conclusiones: los pacientes se apropiaron de conocimientos importantes sobre la dislipidemia, para practicar estilos de vida saludables, que disminuyan el riesgo de eventos cardiovasculares (AU).

ABSTRACT Introduction: currently, atherosclerotic disease is among the main causes of death, disability and dementia in elder people. It is caused by multiple factors, but it is indisputable the relation of dyslipidemia with the risk of cardiovascular events. Objective: to provide the necessary information to patients for them to modify life styles and achieving a positive impact in the reduction of the morbidity and mortality caused by atherosclerotic diseases. Materials and methods: an intervention project was applied through educative actions in a group of adult patients (n=234) with dyslipidemia, treated in the Health Unit ¨Oziel Montecristo¨, by the team I (white), of the municipality Campinas, São Paulo Department, from January to July 2016. The participants answered an inquiry before and after receiving the information. Results: the predominant age group was the 20-50 years one, with 55.5 %. Primary scholarship was the most significant (41 %). Other reported factors were obesity, 46.5 %; smoking, 9.4 %; chronic alcoholism, 8.5 %; and sedentary life style, 71.7 %. The chronic diseases found were: arterial hypertension, 53.4 %; diabetes mellitus, 40.5 %; ischemic heart disease, 20.9 %; and chronic renal disease, 9.4 %. Positive results were achieved in the audience; an important number of patients continued in therapeutic groups. Conclusions: the patients assimilated important knowledge on dyslipidemia, to practice healthy life styles decreasing the risk of cardiovascular events (AU).

Clinical Characteristics and Adverse Events in Acute Coronary Syndrome Patients with a History of Peripheral Arterial Disease / Características Clínicas e Eventos Adversos em Pacientes com Síndrome Coronariana Aguda e História de Doença Arterial Periférica

Abstract Background: In clinical observation, patients with acute coronary syndrome complicated with peripheral artery disease have poor prognosis, so the relationship between the diseases and clinical characteristics need to be further explored. Objective: This study aims to investigate clinical characteristics and independent risk factors for in-hospital adverse events in acute coronary syndrome patients with a history of peripheral arterial disease (PAD). Methods: A total of 5,682 patients with acute coronary syndrome were included into this study. These patients were divided into two groups according to the presence or absence of a history of PAD: PAD group (n = 188), and non-PAD (control) group (n = 5,494). Then, the clinical characteristics and incidence of in-hospital adverse events were analyzed; p < 0.05 was considered statistically significant. Results: The age of PAD patients was higher than that in the control group (65.5 ± 10.3 years vs. 58.6 ± 11 years, p < 0.001), and the proportion of PAD patients with diabetes history and stroke history was higher than that in the control group (73 [39%] vs. 1472 [26.8%], p = 0.018; 36 [19.3%] vs. 396 [7.2%], p < 0.001). The multivariate logistic regression analysis between groups based on in-hospital adverse events revealed that a history of PAD (OR = 1.791, p = 0.01), a history of diabetes (OR = 1.223, p = 0.001), and age of > 65 years old (OR = 4.670, p < 0.001) were independent risk factors for in-hospital adverse events. Conclusion: A history of PAD, advanced age, and a history of diabetes are independent risk factors for in-hospital adverse events in patients with acute coronary syndrome.

Resumo Fundamento: Na observação clínica, os pacientes com síndrome coronariana aguda com doença arterial periférica têm prognóstico ruim, portanto, a relação entre as doenças e as características clínicas precisa ser mais explorada. Objetivos: Este estudo tem o objetivo de investigar características clínicas e fatores de risco independentes para eventos adversos hospitalares em pacientes com síndrome coronariana aguda e história de doença arterial periférica (DAP). Métodos: Foram incluídos no estudo 5682 pacientes com síndrome coronariana aguda. Os pacientes foram divididos em dois grupos de acordo com a presença ou ausência de DAP prévia: grupo DAP (n = 188) e grupo sem DAP (n = 5494, grupo controle). Em seguida, foram analisadas características clínicas e a incidência de eventos adversos hospitalares nesses grupos; um p < 0,05 foi considerado estatisticamente significativo. Resultados: A idade dos pacientes com DAP foi maior que a idade do grupo controle (65,5 ± 10,3 anos vs. 58,6 ± 11 anos, p < 0,001), e a proporção de pacientes com história de diabetes ou acidente vascular cerebral foi maior no grupo DAP que no grupo controle [73 (39%) vs. 1472 (26,8%), p = 0,018; 36 (19,3%) vs. 396 (7,2%), p < 0,001). A análise de regressão logística multivariada para eventos adversos hospitalares mostrou que história de DAP (OR = 1,791, p = 0,01), história de diabetes (OR = 1,223, p = 0,001), e idade >65 anos de idade (OR = 4,670, p < 0,001) foram fatores de risco independentes para eventos adversos hospitalares. Conclusão: DAP prévia, idade avançada, e história de diabetes são fatores de risco independentes para eventos adversos hospitalares em pacientes com síndrome coronariana aguda.

An atypical presentation of a severe and massive atheroembolic disease / Uma apresentação atípica de doença ateroembólica grave

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.

Síndrome de Turner: nuestra experiencia en la creación del Registro Institucional y de la Unidad Interdisciplinaria en el Hospital Italiano de Buenos Aires: un primer paso para el mejor seguimiento / Turner syndrome: our experience in the creation of the Registry Institutional and Interdisciplinary Unit at the Italian Hospital of Buenos Aires: a first step to the best follow-up

El síndrome de Turner (ST) resulta de la ausencia completa o parcial del segundo cromosoma sexual en fenotipos femeninos. Tiene una incidencia de 1:2000- 2500 nacidas vivas. Recién en la última década se ha puesto atención a la salud de las adultas con ST. La mortalidad es 3 veces superior respecto de la población general debido al riesgo de disección aórtica por anomalías cardiovasculares estructurales y aterosclerosis vinculada a hipertensión arterial, diabetes, dislipidemia y obesidad. También presentan elevada prevalencia de enfermedades autoinmunitarias. Objetivo: evaluar la calidad del seguimiento clínico de pacientes adultas con ST, comparando los controles de salud preconformación y posconformación del Registro y de la Unidad Interdisciplinaria. En el año 2017 fuimos convocados para integrar el Programa de Enfermedades Raras del Hospital Italiano de Buenos Aires. A partir de la creación del Registro Institucional y del equipo multidisciplinario obtuvimos mejoría significativa en los controles por las especialidades de cardiología, endocrinología y otorrinolaringología, en los controles bioquímicos del metabolismo lipídico, hidrocarbonado, hepatograma, TSH y anticuerpos para celiaquía e imágenes cardiovasculares y densitometría ósea. En conclusión, el seguimiento sistematizado e institucional, mediante el Registro y la creación de la Unidad Interdisciplinaria de Síndrome de Turner, permitió encontrar las falencias del sistema de atención y optimizar el seguimiento de esta población. (AU)

Turner syndrome (TS) results from the complete or partial absence of the second sex chromosome in female phenotypes. It has an incidence of 1: 2000-2500 girls born alive. Only in the last decade has been paid attention to the health of adults women with TS. Mortality is 3 times higher than in the general population due to the risk of aortic dissection cause to structural cardiovascular anomalies and atherosclerosis related to hypertension, diabetes, dyslipidemia and obesity. They also have a high prevalence of autoimmune diseases. Until nowadays in Argentina do not exist a national registry of this disease that complies with the international follow-up recommendations for these patients. We proposed to develop the institutional register at 2014 and a multidisciplinary team was created to care and follow up girls and women with TS during 2015. It was indexed to Italian Hospital of Buenos Aires' Rare Diseases Program since 2017. After the creation of the institutional registry and the multidisciplinary team we obtained a significant improvement in cardiology, endocrinology and otorhinolaryngology schedule visits, in lipids and hydrocarbon metabolism, liver, thyroid and celiac diseases biochemical controls and in the performance of cardiovascular MNR and bone densitometry. In conclusion, the systematized and institutional follow-up, through the registry and the creation of the Interdisciplinary Unit of Turner Syndrome, allowed us to find the flaws of the care system and to optimize the follow up of this population. (AU)

Aterosclerosis carotídea en el infarto cerebral aterotrombótico del territorio vascular homónimo / Carotid atherosclerosis in atherothrombotic cerebral infarction of the homonymous vascular territory

Introducción: El eco-Doppler carotídeo es la prueba de elección en el estudio inicial y de seguimiento del ictus aterotrombótico. Objetivo: Describir los hallazgos ecográficos en ambos ejes carotídeos en pacientes con infarto cerebral aterotrombótico del territorio vascular homónimo. Métodos: Se realizó una investigación observacional con todos los pacientes (63), que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay", entre octubre del 2012 y septiembre del 2013, con diagnóstico clínico y tomográfico de infarto cerebral aterotrombótico de territorio anterior, a los que se les realizó eco-Doppler carotídeo. Resultados: Se contabilizaron mayor cantidad de placas de ateromas en el eje carotídeo homolateral al ictus aterotrombótico (54,3 por ciento) y la gran mayoría de estos fueron inestables (98,4 por ciento). La placa tipo III (50 por ciento), la irregularidad del contorno (54,1 por ciento) y la estenosis menor del 49 por ciento (57,6 por ciento) fueron los hallazgos ecográficos que dominaron en el eje contralateral al infarto. En ambas carótidas también fueron las placas tipo III (47,1 por ciento), la irregularidad de los contornos (51,6 por ciento), las estenosis no significativas (54,3 por ciento) y la inestabilidad de estas (94,4 por ciento), las que predominaron. Conclusiones: La aterosclerosis carotídea en el ictus aterotrombótico describe mayoritariamente placas tipo III irregulares, que provocan estenosis menores del 49 por ciento en ambos ejes carotídeos y la inestabilidad es casi constante, con una incidencia ligeramente mayor en el eje carotídeo homolateral al infarto. La frecuencia del resto de las cualidades de las placas de ateromas enunciadas, domina levemente en el eje carotídeo contralateral(AU)

Introduction: Carotid echo-Doppler is the test of choice in the initial and follow-up study of atherothrombotic stroke. Objective: To describe echographic findings in both carotid axes in patients with atherothrombotic cerebral infarction of the homonymous vascular territory. Methods: Sixty-three patients underwent an observational and cross-sectional investigation at Dr. Carlos J. Finlay Central Military Hospital from October 2012 to September 2013. They have a clinical and tomographic diagnosis of atherothrombotic cerebral infarct from the previous territory and the underwent a carotid echo-Doppler. Results: We recorded higher number of atheromatous plaques in the homolateral carotid axis at atherothrombotic stroke (54.3 percent) and the majority was unstable (98.4 percent). Type III plate (50 percent), irregularity of the contour (54.1 percent) and less than 49 percent stenosis (57.6 percent) were the echographic findings that dominated the axis contralateral to the infarction. In both carotids, type III plaques (47.1 percent), irregularity of the contours (51.6 percent), non-significant stenosis (54.3 percent) and instability (94.4 percent) predominated. Conclusions: Carotid atherosclerosis in atherothrombotic stroke mostly describes the presence of irregular, type III plaques that cause stenosis of less than 49 percent in both carotid axes. The instability of them is almost constant, with a slightly higher incidence in the homolateral carotid axis to infarction. The frequency of the rest of the qualities of the listed atheromatous plaques slightly dominates in the contralateral carotid axis(AU)

Lesión aterosclerótica en arterias coronarias de fallecidos por muerte violenta en edad pediátrica / Atherosclerotic coronary arteries lesion in pediatric violent deaths

Introducción: La aterosclerosis es una enfermedad que comienza con la unión del óvulo y el espermatozoide, se desarrolla con el paso del tiempo en estrecha relación con estilos de vida, y está entre las primeras causas básicas de muerte a nivel mundial. Hay que conocerla desde sus inicios para poder prevenir y enfrentar sus temibles consecuencias. Objetivo: Caracterizar la lesión aterosclerótica en las arterias coronarias de fallecidos por muerte violenta en edad pediátrica. Métodos: Se realizó un estudio observacional, transversal de 32 fallecidos en edad pediátrica, con autopsias médico legales, de ellos se analizaron cualitativa y cuantitativamente sus arterias coronarias mediante el sistema aterométrico. Resultados: Se presentaron estrías adiposas y placas fibrosas de los tres sectores coronarios principales en 32 sujetos. Las placas graves no estuvieron presentes en el estudio en ninguno de los grupos. Las estrías adiposas, se constataron desde edades tempranas y alcanzaron mayores valores según aumentó la edad. De los tres sectores arteriales, el que más estrías adiposas y placas fibrosas presentó fue la descendente anterior. Conclusiones: Desde etapas muy tempranas de la vida se encuentran evidencias irrefutables de lesiones ateroscleróticas, que se intensifican a medida que avanza la edad. La arteria más afectada resultó ser la descendente anterior(AU)

Introduction: Atherosclerosis is a disease that begins with the union of the ovum and sperm. It develops over time in close relationship with lifestyles, and it is among the first basic causes of death worldwide. In order to prevent and face its terrible consequences it is necessary to learn about it from the beginning. Objective: To characterize the atherosclerotic coronary arteries in pediatric violent death. Methods: This is an observational, cross-sectional study focused on 32 pediatric deaths. We reviewed the legal medical autopsies. The coronary arteries were analyzed qualitatively and quantitatively by the atheometric system. Results: Adipose striae and fibrous plaques of the three main coronary sectors were presented in these 32 subjects. The severe plaques were not present in the study in any of the groups. We found adipose striae from an early age and reached higher values as age increased. The anterior descending arterial sector had the most fat streaks and fibrous plaques. Conclusions: This study found irrefutable evidence of atherosclerotic lesions from very early stages of life, which intensify as age advances. The most affected artery was the anterior descending artery(AU)

Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry / Associação entre isquemia crítica do membro e rigidez arterial medida por oscilometria da artéria braquial

Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis

A rigidez arterial aumentada está associada ao aumento da mortalidade cardiovascular. A relação entre rigidez arterial e isquemia crítica do membro (IC) não está bem estabelecida. Objetivos O objetivo deste estudo é analisar a relação entre índices de rigidez arterial e o grau de isquemia de membro medido pelo índice tornozelo-braço (ITB). Métodos Foi feito um estudo transversal em pacientes com IC e controles. A rigidez arterial foi medida usando a oscilometria da artéria braquial. Os índices de rigidez arterial mensurados foram a velocidade de onda de pulso (VOP) e o índice de aumentação corrigido para a frequência cardíaca de 75 batimentos/min (AIx@75). Regressão linear múltipla foi aplicada para identificar preditores dos índices de rigidez arterial. Resultados Pacientes do grupo IC tiveram VOP (12,1±1,9 m/s vs. 10,1±1,9 m/s, p < 0,01) e AIx@75 (31,8±7,8% vs. 17,5±10,8%, p < 0,01) maiores que controles. Pressão sistólica central foi maior no grupo IC (129,2±18,4 mmHg vs. 115,2±13,1 mmHg, p < 0,01). Houve uma relação inversa entre o AIx@75 e o ITB (coeficiente de Pearson = 0,19, p = 0,12). A análise de regressão múltipla mostrou que o ITB reduzido foi um preditor de elevação do AIx@75 (β = -25,02, p < 0,01). Conclusões Pacientes com IC têm elevada rigidez arterial medida por oscilometria da artéria braquial. O grau de isquemia do membro, medido pelo ITB, é um preditor do AIx@75 elevado. O aumento do AIx@75 na IC pode ter implicações de prognóstico no grupo de pacientes com aterosclerose avançada

Impacto del tabaquismo en la aterosclerosis coronaria de fallecidos por muerte violenta / Impact of smoking in coronary atherosclerosis of deceased due to violent death

Introducción: Las enfermedades cardiovasculares son una de las principales causas de muerte en Cuba y el mundo. Entre ellas se encuentra el infarto agudo de miocardio, que se produce principalmente, por aterosclerosis de las arterias coronarias. Esta enfermedad coronaria, está ligada a varios factores de riesgo, de manera fundamental al hábito de fumar, que se ha incrementado en la actualidad. Objetivo: Determinar el desarrollo del proceso aterosclerótico en fallecidos por muerte violenta y los efectos del hábito de fumar, sobre este proceso. Métodos: Se realizó un estudio descriptivo de 245 fallecidos por muerte violenta, mediante la utilización del sistema aterométrico, se analizaron cualitativa y cuantitativamente las arterias coronarias. Resultados: Se presentaron mayores valores de lesiones en el grupo de alto nivel aterosclerótico, de ambos sexos, las superficies arteriales ocupadas por estrías adiposas, placas fibrosas y placas graves fueron desde valores negativos a positivos. Al introducir el efecto del tabaco, los valores aumentaron con gran rapidez, también en el grupo de alto nivel aterosclerótico. Conclusiones: Se define la existencia de un proceso de conversión de un tipo de lesión aterosclerótica en otra, desde las menos graves a las más graves, con mayor severidad del proceso en el grupo de alto nivel aterosclerótico. El tabaquismo acelera la producción de la aterosclerosis(AU)

Introduction: Cardiovascular diseases are one of the main causes of death in Cuba and the world and among them, acute myocardial infarction that is produced mostly by atherosclerosis of the coronary arteries, the latter entity is linked to several factors of risk, in a fundamental way to the smoking habit (smoking) which has had a great increase at present. Objective: To determine the development of the atherosclerotic process in deaths due to violent death and the effect on smoking. Methods: An observational, analytical and cross-sectional study of 245 deaths due to violent death was performed, using the atheometric system, the coronary arteries were analyzed qualitatively and quantitatively. Results: There were higher values of arterial lesions in the group of high atherosclerotic level, either male or female, where the arterial surfaces occupied by adipose striae, fibrous plaques and severe plaques were from negative to positive values, thus showing its rapid conversion . When the habit of smoking was added, the values increased very rapidly, also in the high-atherosclerotic group. Conclusions: It is defined the existence of a process of conversion of one type of atherosclerotic lesion in another, from the least serious to the most serious; with greater severity of the process in the group of high atherosclerotic level. Smoking accelerates the production of atherosclerosis(AU)