Assessment of lifestyle, blood pressure, and cholesterol in pharmaceutical industry professionals.

Introduction: Cardiovascular diseases are the leading cause of death worldwide. Objectives: To elucidate the lifestyle of in pharmaceutical company professionals, evaluating cardiovascular risk factors. Methods: This is an observational, longitudinal, and prospective study conducted with 1,875 individuals of both sexes. In addition to a questionnaire to identify participants' lifestyle, calculation of body mass index, blood pressure measurement, and collection of blood samples to measure serum total cholesterol and glycated hemoglobin were performed. Results: 83% of respondents had never smoked; 48.1% did not perform regular physical activity, and women tended to perform less physical activity than men; 57.6% consumed less than two servings of fruits or vegetables per day; 63.8% consumed fish less than once per week; 51.6% consumed less than one glass of sugary drinks per day, with women consuming fewer sugary drinks than men. Most participants had a body mass index from 25 to 29.9 m/kg2 or from 18.5 to 24.9 m/kg2 (43.6%), total cholesterol levels below 200 mg/dL (75.1%), glycated hemoglobin below 5.7% (86.0%), systolic blood pressure from 120 to 139 mmHg (47.6%), and diastolic blood pressure below 80 mmHg (56.1%). Conclusions: The data obtained in this study are consistent with those from the literature, demonstrating that it possible to improve habits such as smoking, diet, and physical activity.

Introdução: As doenças cardiovasculares representam a maior causa de morte em todo o mundo. Objetivos: Elucidar o estilo de vida de profissionais de uma indústria farmacêutica, avaliando os fatores de risco cardiovascular. Métodos: Tratou-se de um estudo observacional, longitudinal e prospectivo, realizado com 1.875 indivíduos de ambos os sexos. Além de questionário para identificar o estilo de vida, foram realizados cálculo do índice de massa corporal, aferição da pressão arterial e coleta de amostra de sangue para dosagem de colesterol total sérico e hemoglobina glicada. Resultados: 83% nunca tinham fumado; 48,1% não faziam atividade física regularmente e mulheres tendiam a realizar menos atividades físicas do que homens; 57,6% consumiam menos de duas porções de frutas ou verduras por dia; 63,8% consumiam peixe menos de uma vez por semana; 51,6% consumiam menos de um copo por dia de bebidas com açúcar, sendo que as mulheres consumiam menos bebidas açucaradas do que homens. A maioria dos participantes apresentou índice de massa corporal entre 25 e 29,9 m/kg2 ou entre 18,5 e 24,9 m/kg2 (43,6%), colesterol total abaixo de 200 mg/dL (75,1%), hemoglobina glicada abaixo de 5,7% (86,0%), pressão arterial sistólica entre 120-139 mmHg (47,6%), e pressão arterial diastólica menor que 80 mmHg (56,1%). Conclusões: Os dados são condizentes com informações de literatura, demonstrando que é possível melhorar hábitos como tabagismo, alimentação e prática de atividade física regularmente.

Glucose-Lowering and the Risk of Cardiovascular Events With Antidiabetic Therapies: A Systematic Review and Additive-Effects Network Meta-Analysis.

Aim: To assess the impact of the HbA1c levels achieved with antidiabetic therapies (ADTs) on the risk of MACE. Methods: A systematic search was performed in PubMed, Cochrane, and ClinicalTrials. gov for RCTs published up to March 2022 reporting the occurrence of MACE and all-cause mortality in individuals with T2DM treated with all marketed ADTs, including a sample size ≥100 individuals in each study arm and follow-up ≥24 weeks. A systematic review and additive-effects network meta-analysis with random effects and a multivariate meta-regression were utilized to assess the impact of achieved HbA1c on incident MACE. Results: We included 126 RCTs with 143 treatment arms, 270,874 individuals, and 740,295 individuals-years who were randomized to an active treatment vs. control group. Among all ADTs, only therapy with SGLT2i, GLP1-RA, or pioglitazone similarly reduced the risk of MACE compared to placebo. The achievement of HbA1c ≤ 7.0% in RCTs with the 3 drug classes in the active arm was associated with an adjusted HR of 0.91 (95% CI 0.80, 0.97; p = 0.017) compared with HbA1c>7.0%, without affecting all-cause mortality. These results, however, were not maintained among all ADTs. Conclusions: Achieving lower glucose levels with SGLT2i, GLP1-RA, or pioglitazone is linearly associated with a reduced risk of MACEs, without affecting all-cause mortality. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020213127, identifier: CRD42020213127.

Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography

OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease. METHODS: We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease. RESULTS: The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold. CONCLUSION: In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events. .

Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography.

OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease. METHODS: We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease. RESULTS: The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold. CONCLUSION: In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events.

Cilostazol e aterosclerose / Cilostazol and atherosclerosis

Embora o cilostazol seja conhecido no Japão há mais de 30 anos, somente na última década foi adotado no tratamento da aterosclerose em países ocidentais. Após 40 anos de tratamento empírico da doença arterial periférica (DAP), o cilostazol demonstrou, à luz da medicina baseada em evidências, aumentar a capacidade funcional e melhorar a claudicação intermitente e a qualidade de vida de pacientes com DAP sintomática, tornando-se o agente de primeira escolha para esse fim, de acordo com as melhores diretrizes atuais. Na doença cerebrovascular o cilostazol diminui o risco de AVC recorrente e de progressão da aterosclerose em artérias cerebrovasculares de pacientes com DAP ou em uso isolado de ácido acetilsalicílico após AVC/AIT. Após angioplastia coronária e implante de stent o cilostazol tem se mostrado uma arma promissora em reduzir o risco de reestenose, a necessidade de revascularização do vaso-alvo e a ocorrência de ECAM (evento coronário agudo maior).Este agente apresenta propriedades vasodilatadoras, antiproliferativas e antiplaquetárias e emerge como uma nova e eficiente opção no combate às graves consequências potenciais da aterosclerose.

Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil / Prevalence and risk factors associated with peripheral arterial disease in the hearts of Brazil project

FUNDAMENTO: A doença arterial obstrutiva periférica (DAOP) está associada ao maior índice de risco cardiovascular. No Brasil, faltam dados sobre sua prevalência e fatores de risco. OBJETIVO: Avaliar prevalência e fatores de risco associados à DAOP nas cidades brasileiras com > cem mil habitantes. MÉTODOS: Estudo transversal, multicêntrico, que avaliou 1.170 indivíduos (>18 anos), em 72 centros urbanos, participantes do Projeto Corações do Brasil. O diagnóstico de DAOP baseou-se na medida do índice tornozelo-braquial (ITB) < 0,90. A análise estatística utilizou teste Qui-quadrado (Pearson) corrigido para amostras complexas e intervalos de confiança. P < 0,05 foi considerado significativo. RESULTADOS: A prevalência de DAOP foi de 10,5 por cento e apenas 9 por cento dos portadores da doença apresentaram claudicação. A DAOP esteve associada à presença de diabetes, obesidade total e abdominal, acidente vascular cerebral (AVC) e doença isquêmica do coração (DIC). Houve tendência a maior prevalência de DAOP na presença de hipertensão, insuficiência cardíaca, insuficiência renal dialítica e tabagismo >20 anos/maço. Mulheres coronariopatas apresentaram risco 4,9 vezes maior de ter DAOP, do que aquelas sem coronariopatia e, entre homens diabéticos, o risco de DAOP foi 6,6 maior em comparação aos não diabéticos. CONCLUSÃO: A prevalência de DAOP foi elevada, considerando-se a baixa média de idade da população avaliada (44±14,7 anos). A minoria dos portadores apresentava claudicação, o que denota o grande contingente de indivíduos assintomáticos. Os fatores mais fortemente associados à doença foram diabetes, obesidade, AVC e DIC. Os autores concluíram que a medida do ITB deve ser considerada na avaliação de pacientes de moderado e alto risco cardiovascular.

BACKGROUND: Peripheral arterial disease (PAD) is associated with increased cardiovascular risk. In Brazil, data on PAD prevalence and risk factors are scarce. OBJECTIVE: To assess prevalence and risk factors related to PAD in Brazilian urban centers with more than 100,000 inhabitants. METHODS: National, multicenter, cross-sectional study of 1,170 individuals (>18 years), from 72 major Brazilian urban centers participating in the "Hearts of Brazil Project". PAD diagnosis was based on ankle-brachial index (ABI) < 0.90. The statistical analysis used the corrected Chi-square (Pearson) test for complex samples and confidence intervals. P< 0.05 was considered statitically significant. RESULTS: PAD prevalence was 10.5 percent. Intermittent claudication (IC) was present in only 9 percent of PAD patients. A significant association was found between PAD and the following factors: diabetes, total and abdominal obesity, stroke and ischemic heart disease (IHD). There was a trend of higher PAD prevalence among individuals with hypertension, heart failure, chronic renal failure on dialysis, as well as those who had smoked over 20 pack-years. For females, presence of IHD was associated with a 4.9-fold greater risk of PAD. Among males, a 6.6-fold increased risk of PAD was found for diabetic in comparison to non-diabetic individuals. CONCLUSION: PAD prevalence was markedly high, considering the low mean age of the studied population (44±14.7 yrs). IC was detected in a minority of PAD subjects, indicating a considerable number of asymptomatic individuals. Diabetes, obesity, stroke and IHD were the stronger predictors of PAD. The authors concluded that ABI measurement should be considered in the evaluation of moderate to high cardiovascular risk patients.

Prevalence and risk factors associated with peripheral arterial disease in the Hearts of Brazil Project.

BACKGROUND: Peripheral arterial disease (PAD) is associated with increased cardiovascular risk. In Brazil, data on PAD prevalence and risk factors are scarce. OBJECTIVE: To assess prevalence and risk factors related to PAD in Brazilian urban centers with more than 100,000 inhabitants. METHODS: National, multicenter, cross-sectional study of 1,170 individuals (>18 years), from 72 major Brazilian urban centers participating in the "Hearts of Brazil Project". PAD diagnosis was based on ankle-brachial index (ABI)

Insuficiência cardíaca no idoso: qual a diferença? / Heart failure in the elderly: what's the difference?

A insuficiência cardíaca é síndrome grave, de natureza progressiva e, em geral, irreversível, pouco freqüente na população geral, mas comum entre os idosos. É associada a baixos índices de qualidade de vida, freqüente necessidade de hospitalização e elevada taxa de mortalidade. O processo natural de envelhecimento está associado a importantes modificações cardiovasculares que, quando combinadas com processos patológicos, particularmente doença coronária e hipertensão arterial, propiciam maior suscetibilidade do idoso em desenvolver insuficiência cardíaca. Além disso, tais alterações influenciam a fisiopatologia da insuficiência cardíaca e modificam as propriedades farmacológicas da maioria dos agentes terapêuticos, dificultando o diagnóstico clínico e complicando o tratamento...

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire.

OBJECTIVE: Translation, cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire (ECQ) a specific tool to assess intermittent claudication. METHODS: The Brazilian Portuguese version of the ECQ was developed after authorization by the University of Edinburgh. It was applied to 217 individuals: São Paulo Capital District residents with complaints of leg pain. Individuals under research were invited through mass communication media to participate in the I Campaign to Fight Peripheral Arterial Disease (PAD). In stage 1, participants filled out the ECQ and another questionnaire on risk factors and cardiovascular history. In stage 2, participants had anthropometric measures and ankle-brachial index (ABI) at rest measured by vascular Doppler. In case of doubt, vascular treadmill test was applied (VTT). PAD condition was defined by ABI < or = 0.90 and/or positive VTT and/or documented PAD. Statistical analysis--which included performance assessment and the comparison between proportions and means--was performed using SAS software, version 8.2. RESULTS: Mean age of participants was 60+/-11.5 years, female sex predominated in the sample studied (53.4%). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85%, 93%, 80%, 95% and 91%, respectively. No differences in performance were found between elderly (> or = 65 years) and non-elderly subjects. CONCLUSION: The Brazilian Portuguese version of the Edinburgh claudication questionnaire maintained good sensitivity and specificity and can be recommended for screening of PAD in clinical practice and epidemiological research in Brazil.

Versão em português, adaptação transcultural e validação do Questionário de Claudicação de Edimburgo / Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire

OBJETIVO: Traduzir, adaptar culturalmente e validar a versão em português do Questionário de Claudicação de Edimburgo, específico para avaliar a presença de claudicação intermitente. MÉTODOS: A versão em português do Questionário de Claudicação de Edimburgo foi desenvolvida, após autorização da Universidade de Edimburgo, e aplicada em 217 indivíduos residentes no município de São Paulo, com queixas de dor nas pernas, convidados pelos meios de comunicação de massa a participar da I Campanha de Combate à Doença Arterial Obstrutiva Periférica (DAOP). Na primeira etapa, eles responderam ao Questionário de Claudicação de Edimburgo e a um questionário sobre fatores de risco e antecedentes cardiovasculares. Na segunda etapa, realizaram medidas antropométricas e do índice tornozelo-braquial (ITB) de repouso com Doppler vascular e, nos casos duvidosos, teste de esforço vascular em esteira (TEV). A presença de DAOP foi definida por ITB < 0,90 e/ou por TEV positivo e/ou por DAOP documentada. A análise estatística, que incluiu avaliação de desempenho e comparações das proporções e médias, foi realizada utilizando-se o programa SAS versão 8.2. RESULTADOS: A média de idade dos participantes foi de 60 ± 11,5 anos, com predomínio do sexo feminino (53,4 por cento). A análise de desempenho da versão em língua portuguesa mostrou sensibilidade de 85 por cento, especificidade de 93 por cento, valor preditivo positivo de 80 por cento, valor preditivo negativo de 95 por cento e acurácia de 91 por cento. Não houve diferença no desempenho entre idosos (> 65 anos) e não-idosos. CONCLUSÃO: A versão em português do Questionário de Claudicação de Edimburgo manteve níveis adequados de sensibilidade e especificidade, podendo ser recomendado para o rastreamento de DAOP na prática clínica e em estudos epidemiológicos realizados no Brasil.

OBJECTIVE: Translation, cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire (ECQ) a specific tool to assess intermittent claudication. METHODS: The Brazilian Portuguese version of the ECQ was developed after authorization by the University of Edinburgh. It was applied to 217 individuals: São Paulo Capital District residents with complaints of leg pain. Individuals under research were invited through mass communication media to participate in the I Campaign to Fight Peripheral Arterial Disease (PAD). In stage 1, participants filled out the ECQ and another questionnaire on risk factors and cardiovascular history. In stage 2, participants had anthropometric measures and ankle-brachial index (ABI) at rest measured by vascular Doppler. In case of doubt, vascular treadmill test was applied (VTT). PAD condition was defined by ABI < 0.90 and/or positive VTT and/or documented PAD. Statistical analysis - which included performance assessment and the comparison between proportions and means - was performed using SAS software, version 8.2. RESULTS: Mean age of participants was 60±11.5 years, female sex predominated in the sample studied (53.4 percent). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85 percent, 93 percent, 80 percent, 95 percent and 91 percent, respectively. No differences in performance were found between elderly (>65 years) and non-elderly subjects. CONCLUSION: The Brazilian Portuguese version of the Edinburgh claudication questionnaire maintained good sensitivity and specificity and can be recommended for screening of PAD in clinical practice and epidemiological research in Brazil.

Combinação de fármacos na abordagem das dislipidemias: associação entre estatinas e niacina / Combination of drugs: statins and niacin

A combinação de estatinas com niacina se apresenta como uma atraente associação, na presença de dislipidemia mista com níveis de HDL baixo, quando monoterapia é insuficiente para o alcance das metas lipídicas. Benefícios clínicos foram observados com a combinação de estatinas com niacina nos estudos FATS, HATS e ARBITER 2, mostrando atenuação no desenvolvimento da aterosclerose e/ou redução de eventos coronários, acompanhados de alterações lipídicas favoráveis. Em geral, esta combinação é bem tolerada. Recomenda-se monitoração adequada das enzimas hepáticas e muscular e, ainda, titulação cuidadosa de cada uma das drogas combinadas.