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BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. CLINICAL TRIAL REGISTRATION: NCT01620398.
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Enfermedad de la Arteria Coronaria/dietoterapia , Adiponectina/sangre , Anciano , Biomarcadores/sangre , Brasil , Proteína C-Reactiva/metabolismo , Enfermedad de la Arteria Coronaria/metabolismo , Dieta Mediterránea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenómenos Fisiológicos de la Nutrición , Estado Nutricional , Prevención Secundaria , Resultado del TratamientoRESUMEN
Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.
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Enfermedades Cardiovasculares/complicaciones , Trastornos de Deglución/etiología , Intubación Intratraqueal/efectos adversos , Desnutrición/complicaciones , Accidente Cerebrovascular/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Adulto JovenRESUMEN
INTRODUÇÃO: As doenças cardiovasculares representam a principal causa de morte no mundo. Seus fatores de risco são divididos em modificáveis e não-modificáveis. Diversos estudos clínicos vêm demonstrando a influência positiva da dieta na prevenção primária e secundária de eventos cardiovasculares. Dada a importância já documentada de uma dieta equilibrada, assim como do estado nutricional adequado na manutenção da saúde cardiovascular, este estudo objetivou avaliar a adequação da dieta habitual e do estado nutricional de pacientes submetidos a cirurgia cardíaca eletiva em hospital especializado em Cardiologia. MÉTODO: Estudo de caráter descritivo e transversal, com amostra de conveniência, composta por 38 indivíduos adultos, de ambos os sexos, encaminhados para cirurgia eletiva de revascularização do miocárdio, troca de válvula ou cirurgia combinada (revascularização do miocárdio e troca de válvula). A coleta de dados ocorreu no ambulatório de Nutrição do Instituto Dante Pazzanese de Cardiologia, anteriormente à cirurgia cardíaca, sendo realizada coleta de dados demográficos, tipo de cirurgia, antecedentes clínicos, consumo alimentar e avaliação nutricional. RESULTADOS: Na amostra avaliada, 68,42% dos pacientes estavam em sobrepeso e obesidade, segundo o índice de massa corporal. O percentual de gordura corporal apresentou valores acima da normalidade em 96,87% dos pacientes, com circunferência abdominal de risco elevado e muito elevado em 75,68%. Na avaliação habitual da dieta, a adequação no consumo de macronutrientes foi de 47,37%, 2,6% e 44,74% para carboidratos, proteínas e lipídeos respectivamente. Quanto aos ácidos graxos saturados, 36,84% dos pacientes apresentaram consumo superior ao recomendado. Foi observado baixo consumo de frutas, verduras e legumes por 89,48% dos pacientes e, consequentemente, de fibras dietéticas por 97,37%. CONCLUSÃO: Conclui-se que a amostra, composta por pacientes com excesso de peso, percentual de gordura elevado, alto risco cardiovascular e submetidos à cirurgia cardíaca eletiva, apresentou um padrão alimentar com baixo consumo de frutas, verduras, legumes e fibras dietéticas, necessitando de acompanhamento nutricional individualizado. (AU)
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Humanos , Estado Nutricional , Enfermedad Coronaria , Dieta , Procedimientos Quirúrgicos CardíacosRESUMEN
BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
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Aterosclerosis/dietoterapia , Biomarcadores/sangre , Enfermedades Cardiovasculares/prevención & control , Grasas Insaturadas en la Dieta/uso terapéutico , Ácidos Grasos Insaturados/uso terapéutico , Obesidad/dietoterapia , Sobrepeso/dietoterapia , Anciano , Anciano de 80 o más Años , Aterosclerosis/complicaciones , Grosor Intima-Media Carotídeo , Suplementos Dietéticos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/complicaciones , Obesidad/fisiopatología , Sobrepeso/sangre , Sobrepeso/complicaciones , Sobrepeso/fisiopatología , Aceites de Plantas/administración & dosificación , Factores de RiesgoRESUMEN
AIMS: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.
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Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/etiología , Brasil , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/patología , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Clase SocialRESUMEN
RESUMO O objetivo deste estudo foi identificar e analisar, por meio de levantamento bibliográfico, a atuação fonoaudiológica em Unidades de Terapia Intensiva Neonatal (UTINs) em casos de cardiopatia congênita. Como fonte de dados foram utilizadas as seguintes plataformas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Scielo e o serviço de pesquisa da National Library of Medicine nas bases de dados Pubmed, sistema de procura do Google Acadêmico (HTTP//scholar.google.com.br). Foram pesquisados trinta e dois trabalhos, sendo a atuação fonoaudiológica em UTINs descrita em vinte e oito deles, os quais apresentam como procedimentos avaliação e estimulação do sistema sensório-motor-oral, com uso de técnicas de sucção não-nutritiva e nutritiva, além de triagem auditiva. Porém, as características dos neonatos com cardiopatia congênita e a inserção do fonoaudiólogo em UTIN cardíaca não são citadas, pouco se caracterizando os objetivos e a prática desse profissional. Apenas uma publicação obedeceu aos critérios de inclusão do presente estudo. Trata-se de um trabalho que descreve a transição da alimentação enteral direta para o seio materno em recém-nascidos pré-termo cardiopatas, com idade corrigida, em um centro de terapia intensiva neonatal. Foi possível constatar então a escassez de trabalhos publicados sobre intervenção fonoaudiológica com RN cardiopatas, o que indica a necessidade de novos estudos sobre o tema, já que a atenção a esses pacientes deve ser diferenciada, visto que apresentam particularidades que podem comprometer o desempenho na alimentação.
ABSTRACT The purpose of this study is to identify and analyze, through bibliographical survey, the use of speech therapy care in Neonatal Intensive Care Unit (NICU) in cases of newborns with congenital heart disease. The source data is from Latin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), SciELO and the search engine of the National Library of Medicine in the databases PubMed, also the Google Scholar search system (http // scholar.google.com.br). Thirty two works were studied and the use of speech therapy in NICU´s was described in twenty eight of them which presented as procedures the assessment and stimulation of the sensory-motor-oral system, using nonnutritive and nutritive sucking and hearing screening techniques. However, the characteristics of newborns with congenital heart disease and the insertion of the speech therapist into cardiac neonatal ICU are not mentioned, not even the description of the objectives and practice of such professional. The care of patients with congenital heart disease should be differentiated as it has particular features that can undermine the performance concerning feeding. Only one publication followed the inclusion criteria of the present survey. It describes the transition of the direct gastric feeding to breast feeding in preterm newborns with heart disease, with age corrected, in a newborn intensive care unit. It was possible to verify the lack of works published on speech therapy intervention with newborns with heart disease, which indicates the need of new studies on the theme, as the care of such patients should be differentiated once they present particularities that could undermine the performance of feeding.
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Resumo:OBJETIVO:determinar a prevalência de disfagia orofaríngea em indivíduos submetidos à cirurgia cardíaca e que evoluíram com Acidente Vascular Cerebral em Hospital Público de Referência.MÉTODOS:estudo clínico descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos de avaliação clínica da deglutição orofaríngea, no período de novembro de 2010 á novembro de 2011. Foram incluídos os 25 protocolos de avaliação clínica para disfagia orofaríngea de indivíduos que fizeram cirurgia cardíaca e evoluíram com Acidente Vascular Cerebral no pós-operatório, durante o período estudado, e que foram assistidos pela equipe de Fonoaudiologia. A avaliação clinica da deglutição foi baseada em instrumento clinico e a deglutição classificada como normal, disfagia leve, moderada e grave.RESULTADOS:dos 25 (100%) indivíduos, 24 (96%) apresentaram algum grau de disfagia orofaríngea na avaliação clínica. (95% [IC]: 79,6- 99,9). Constatou-se que 41,66% apresentaram disfagia grave, 33,66% disfagia moderada e 25% disfagia leve.CONCLUSÃO:é alta a prevalência de disfagia orofaríngea em indivíduos com Acidente Vascular Cerebral após cirurgia cardíaca.
Abstract:PURPOSE:to determine the prevalence of oropharyngeal dysphagia in patients undergoing cardiac surgery and who developed stroke in a public referral hospital.METHODS:a retrospective descriptive clinical cross-sectional study conducted by collecting data on clinical assessment protocols of oropharyngeal swallowing in the period November 2010 to November 2011, including the protocols of 25 individuals for clinical evaluation of oropharyngeal dysphagia with post-operative stroke during the study period who were assisted by the Speech-Language Pathology team. Clinical swallowing assessment was based on clinical tools and swallowing classified as normal, mild, moderate and severe dysphagia.RESULTS:of the twenty-five (100%) patients, 24 (96%) presented dysphagia in clinical evaluation and 1 (4%) did not (95% [IC]: 79.6- 99.9). It was found that 41.66% had severe dysphagia, 33.66% moderate and 25% mild dysphagia.CONCLUSION:there was a high prevalence of oropharyngeal dysphagia in patients with stroke after cardiac surgery.
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Servicios Médicos de Urgencia/métodos , Infarto del Miocardio/terapia , Biomarcadores/sangre , Brasil , Cardiología , Electrocardiografía , Humanos , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/prevención & control , Medición de Riesgo , Factores de Riesgo , Prevención Secundaria , Sociedades Médicas , Terapia Trombolítica/métodosRESUMEN
OBJETIVO: associar o grau de disfagia orofaríngea e o tempo de intubação orotraqueal no indivíduo pós-acidente vascular encefálico após cirurgia cardíaca. MÉTODOS: estudo clínico transversal descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos e registros de prontuário, durante seis meses, em Hospital Público de Referência em Cardiologia. Foram analisados 25 protocolos e prontuários de indivíduos submetidos à cirurgia cardíaca, que evoluíram com acidente vascular encefálico e foram assistidos pela equipe de Fonoaudiologia. Os indivíduos foram divididos em dois grupos. O Grupo I (GI) constou de 10 indivíduos com intubação orotraqueal menor que 24 horas e o Grupo II (GII) de 15 indivíduos com intubação orotraqueal maior que 24 horas. Realizada avaliação clínica da deglutição e analisada a associação entre a classificação clínica do grau de comprometimento para disfagia e o tempo de intubação orotraqueal. RESULTADOS: verificou-se que no GI 40% apresentaram disfagia leve, 30% moderada e 20% grave. No GII 13,3% apresentaram disfagia leve, 33,3% moderada e 53,33% grave. Verificou-se associação linear significante entre o grau de disfagia e o tempo de IOT (p= 0,031), indicando que o número de indivíduos com disfagia moderada e grave foi maior no grupo com mais tempo de intubaçao. CONCLUSÕES: constatou-se que o tempo de intubação orotraqueal maior que 24 horas aumentou o grau da disfagia orofaríngea nesta população. .
PURPOSE: to associate the degree of oropharyngeal dysphagia and orotracheal intubation time in post stroke individuals after cardiac surgery. METHODS: a cross-sectional retrospective descriptive clinical study carried out by means of protocols data collection and chart records during six months in a public hospital of reference in cardiology. We analyzed 25 protocols and medical records of individuals undergoing cardiac surgery who evolved with stroke and were assisted by a team of speech and language pathology. The subjects were divided into two groups. Group I (GI) consisted of 10 individuals with orotracheal intubation less than 24 hours and Group II (GII) of 15 individuals with orotracheal intubation more than 24 hours. After performing swallowing clinical evaluation and analyzing the association between the clinical classification of degree of commitment for dysphagia and orotracheal intubation time. RESULTS: it was found that 40% of the individuals in GI presented mild dysphagia, 30% moderate and 20% severe. In GII, 13.3 % presented mild dysphagia, 33.3% moderate and 53.33% severe. There was a significant linear association between the degree of dysphagia and the duration of intubation (p = 0.031), indicating that the number of individuals with moderate and severe dysphagia was higher in the group with a longer intubation. CONCLUSIONS: we could observe that time of orotracheal intubation more than 24 hours increases the degree of oropharyngeal dysphagia in this population. .
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Introdução: A síndrome metabólica (SM) é caracterizada poralterações fisiopatológicas que aumentam o risco de doenças cardiovasculares.Objetivo: Avaliar a frequência de síndrome metabólicaem adultos de acordo com critérios diagnósticos e analisar qualparâmetro a identificou melhor. Método: Estudo de 124 pacientesdo ambulatório de nutrição clínica de um Instituto de Cardiologia deSão Paulo. O diagnóstico de síndrome metabólica foi determinadode acordo com os critérios do National Cholesterol Education Program- Adult Treatment Panel III (NCEP/ATPIII) e da InternationalDiabetes Federation (IDF) para todos os pacientes. Utilizou-se testequi-quadrado para análise das diferenças entre as variáveis categóricas.A média das variáveis numéricas foi comparada por teste deMann Whitney para amostras independentes com nível de significânciade 0,05 ou 5%. Para testar a concordância entre os critérios,utilizou-se o coeficiente Kappa. Resultados: Participaram do estudo61 homens e 63 mulheres. O grupo apresentou percentuais elevadosde pré-obesidade (31,5%), obesidade (64,5%) e alterações do perfilglicídico (62,9%). Diferenças estatísticas significantes entre os sexosforam encontradas nas frequências de hipertensão arterial (p = 0,01)e circunferência elevada (p = 0,00). A concordância geral entre oscritérios foi muito boa (Kappa = 0,897; p = 0,000). Observou-seque 92,6% dos pacientes que foram diagnosticados com SM peloATPIII também o foram pela IDF. Conclusão: A concordância entreos critérios para diagnósticos da SM indicou que ambos podem serutilizados na prática clínica.
Introduction: Metabolic Syndrome (MS) is characterized by pathophysiologicalchanges that increase the risk of cardiovascular disease.Objective: To evaluate the frequency of metabolic syndrome inadults according to criteria diagnoses and analyze which parameterbest identified it. Method: The study of 124 patients from the ClinicalNutrition Institute of Cardiology in São Paulo. The diagnosis ofmetabolic syndrome was determined according to the criteria of theNational Cholesterol Education Program - Adult Treatment Panel III(NCEP/ATPIII) and International Diabetes Federation (IDF) for allpatients. The chi-square analysis of differences between categoricalvariables was used. The average numerical variables were comparedby Mann-Whitney test for independent samples with significancelevel of 0.05 or 5%. The Kappa coefficient was used to evaluate theconcordance between both criteria. Results: The study included 61men and 63 women. The group had high percentages of pre-obesity(31.5%), obesity (64.5%) and abnormal glucose profile (62.9%).Statistically significant differences between sexes were found inthe frequencies of hypertension (p = 0.01) and high circumference(p = 0.00). The overall agreement between the criteria was verygood (Kappa = 0.897, p = 0.000). It was observed that 92.6% ofpatients who were diagnosed with MS by ATPIII were also by IDF.Conclusion: The agreement between the criteria for diagnosis ofMS indicated that both can be used in clinical practice.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/metabolismo , Síndrome Metabólico/patología , Grasa Abdominal , Estudios Transversales/métodos , Obesidad Abdominal , Factores de RiesgoAsunto(s)
Trastornos de Deglución/terapia , Ingestión de Alimentos/fisiología , Aditivos Alimentarios/uso terapéutico , Sodio en la Dieta/administración & dosificación , Trastornos de Deglución/etiología , Aditivos Alimentarios/química , Humanos , Terapia Nutricional , Factores de Riesgo , ViscosidadRESUMEN
As cardiopatias congênitas são anomalias estruturais e/ou funcionais do coração ou dos grandes vasos. A morbidade nesta população também está relacionada a problemas de alimentação: em alguns casos, essas dificuldades podem estar associadas à disfagia orofaríngea, distúrbio de deglutição que pode trazer complicações como desnutrição, desidratação, alterações pulmonares e pode levar à morte. As causas da disfagia nessa população são múltiplas como: fadiga, que pode levar à incoordenação entre sucção, deglutição e respiração; intubação orotraqueal prolongada; síndromes associadas às cardiopatias; comprometimentos neurológicos; a até mesmo atraso no desenvolvimento neurocomportametal devido ao tempo prolongado de internação, comum nessa população. O objetivo da fonoterapia é a eficácia da fase oral, coordenação entre sucção, deglutição e respiração e transição laringotraqueal. O objetivo do estudo foi descrever a intervenção fonoaudiológica em uma criança no pós-operatório da cirurgia cardíaca que evoluiu com disfagia orofaríngea, Neste caso, a fonoterapia possibilitou a reabilitação da deglutição e transição alimentar da via alternativa para via oral exclusiva, minimizando riscos de aspiração laringotraqueal.
Congenital heart defects are structural abnormalitiesand/or functional heart or great vessels. The morbity in this population is also related to feeding problems in some cases these difficulties may be associated with oropharyngeal dysphagia, a swallwing disorder that can cause complications such as malnutrition, dehydration, pulmonar disorders and can lead to death. The causes of dysphagia in this population are manifold such as fadigue which can lead to incoordination of sucking, swallowing and breathing, prolonged intubation, syndromes associated with heart disease, neurological damage and even neurobehavior development delay due to prolonged hospitalization common in this population. The goal of speech therapy is the efficiency of the oral coordination of sucking , swallowing and breathing and transition to oral feeding minimizing risk of tracheal aspiration. The aim of the study was to describe the speech therapy in a postoperative cardiac surgery child who developed oropharyngeal dysphagia. In this case, speech therapy enabled the rehabilitation of swallowing and feeding transition alternative pathway for oral exclusive, minimizing the risk of tracheal aspiration.
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Humanos , Femenino , Niño , Cardiopatías Congénitas/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Fonoaudiología/métodos , Trastornos de Deglución/complicaciones , Trastornos de Deglución/terapia , Grupo de Atención al Paciente , Factores de Riesgo , Cirugía TorácicaRESUMEN
BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.
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Atención Ambulatoria/normas , Fármacos Cardiovasculares/uso terapéutico , Enfermedades Cardiovasculares/terapia , Medicina Basada en la Evidencia/normas , Estilo de Vida , Guías de Práctica Clínica como Asunto/normas , Anciano , Brasil , Fármacos Cardiovasculares/clasificación , Métodos Epidemiológicos , Medicina Basada en la Evidencia/métodos , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
FUNDAMENTO: Dados de atendimento ambulatorial ao paciente de alto risco cardiovascular no Brasil são insuficientes. OBJETIVO: Descrever o perfil e documentar a prática clínica do atendimento ambulatorial de pacientes de alto risco cardiovascular no Brasil, no que diz respeito à prescrição de terapias baseadas em evidências. MÉTODOS: Registro prospectivo que documentou a prática clínica ambulatorial de indivíduos de alto risco cardiovascular, que foi definido como a presença de um dos seguintes fatores: doença arterial coronariana, cerebrovascular e vascular periférica; diabetes; ou aqueles com pelo menos três dos seguintes fatores: hipertensão arterial, tabagismo, dislipidemia, maiores 70 anos, histórico familiar de doença arterial coronariana, nefropatia crônica ou doença carotídea assintomática. Foram avaliadas características basais e a taxa de prescrição das intervenções medicamentosas e não medicamentosas. RESULTADOS: Foram incluídos 2.364 pacientes consecutivos, sendo 52,2% do gênero masculino, idade média de 66,0 anos (± 10,1). Dentre os pacientes incluídos, 78,3% utilizavam antiplaquetários, 77,0% estatinas e, dos pacientes com história de infarto do miocárdio, 58,0% receberam betabloqueadores. O uso concomitante destas três classes foi de 34%. Não atingiram as metas preconizadas pelas diretrizes 50,9% dos hipertensos, 67% dos diabéticos e 25,7% dos dislipidêmicos. Os principais preditores de prescrição de terapias com benefício comprovado foram centro com cardiologista e histórico de doença arterial coronariana. CONCLUSÃO: Este registro nacional e representativo identificou hiatos importantes na incorporação de terapias com benefício comprovado, oferecendo um panorama real dos pacientes de alto risco cardiovascular.
BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.
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Anciano , Femenino , Humanos , Masculino , Atención Ambulatoria/normas , Fármacos Cardiovasculares/uso terapéutico , Enfermedades Cardiovasculares/terapia , Medicina Basada en la Evidencia/normas , Estilo de Vida , Guías de Práctica Clínica como Asunto/normas , Brasil , Fármacos Cardiovasculares/clasificación , Métodos Epidemiológicos , Medicina Basada en la Evidencia/métodos , Factores de RiesgoRESUMEN
A qualidade dos lípides na alimentação é um dos principaisfundamentos na prevenção e mortalidade por doenças crônicasnão transmissíveis. Ensaios anteriores já estabeleceramos benefícios das gorduras insaturadas ante as saturadas,principalmente em relação ao ômega 3 (w-3). Mais recentemente,os estudos têm buscado avaliar os efeitos metabólicosde diversos óleos, tanto de forma isolada como associados.Como parte da dieta Mediterrânea, o óleo de oliva pareceexercer papel efetivo na diminuição plasmática de colesterol,especialmente na lipoproteína de baixa densidade (LDL). Entreos óleos ricos em ácidos polinsaturados, o de girassol e o delinhaça estão sendo analisados quanto às suas ações e sobre anecessidade de se estabelecer uma relação de consumo. Esteartigo revisa os conceitos da estrutura química dos óleos deoliva, girassol e linhaça e os efeitos que exercem sobre a saúdecardiovascular.
The importance of lipids in our nutrition is a major corner stone in the prevention and mortality from chronic diseases, both in their quantity, and quality. Previous trials have already establishedthe benefits of unsaturated fats compared to saturated, especially in relation to omega 3 (w-3). More recently, several studies try to evaluate the metabolic effects of different oils,either alone or associated. As part of the Mediterranean diet, olive oil seems to play an effective role in reducing plasmacholesterol, especially in low-density lipoprotein (LDL). Among the oils rich in polyunsaturated acids, the sunflowerand flax seed oils are being analyzed for their actions and the need to establish a consumer relationship. This article reviews the concept of the chemical structure of olive oil, sunflower oil and flaxseed oil, and their effects on cardiovascular health.
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Humanos , Enfermedades Cardiovasculares/complicaciones , Grasas Insaturadas/análisis , Ácidos Grasos/análisis , Aceite de Linaza/análisis , Enfermedad Crónica/prevención & controlRESUMEN
There is compelling evidence that bariatric weight loss reduces cardiovascular complications; however, these still tend to be the most common cause of late death after surgical intervention. In a prospective cohort study, correlations of dietary nutrients with indexes of vascular health were sought, with emphasis on vitamin D and calcium. Clinically stable obese outpatient subjects (>60 years old, N = 44) were interviewed about dietary macro and micronutrients. Nutritional assessment targeted anthropometric and bioimpedance analysis (BIA), hematologic counts, lipid profile, glucose homeostasis, and inflammatory markers. Carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD), along with related vascular measurements, were documented, and results were correlated by uni- and multivariate analysis, corrected for known risk factors. IMT, FMD, and also brachial basal flow were positively influenced by vitamin D (P < 0.001). Calcium appeared beneficial for brachial basal flow only (P = 0.010). No association with IMT occurred, and a negative result for FMD was elicited. Also, vitamins A and B12 were advantageous for FMD, whereas iron was deleterious for IMT. Intake of many micronutrients including calcium and vitamin D did not meet recommendations. Vitamin D displayed a beneficial profile regarding vascular health, and more attention to this nutrient should be given, especially concerning obese patients with cardiometabolic risk. Calcium exhibited less straightforward results but deserves focus as well, along with antioxidant vitamin A as well as the B-complex which were mostly deficient in this experience.
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Compuestos de Calcio/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Vitamina A/uso terapéutico , Vitamina D/uso terapéutico , Densidad Ósea/efectos de los fármacos , Compuestos de Calcio/metabolismo , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/metabolismo , Estudios de Cohortes , Femenino , Humanos , Masculino , Síndrome Metabólico/metabolismo , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Obesidad/metabolismo , Obesidad/fisiopatología , Estudios Prospectivos , Encuestas y Cuestionarios , Vitamina A/metabolismoRESUMEN
O objetivo deste trabalho foi avaliar o estado nutricional e a história familiar para doença cardiovascular (DVC) e seus fatores de risco em escolares. Foi um estudo transversal de 384 crianças de seis a dez anos de escolas públicas da cidade de São Paulo. Avaliou-se o estado nutricional das crianças e seus pais de acordo com padrões internacionais. Os pais foram questionados quanto à presença de (DVC) e fatores de risco entre familiares da criança. Para análise estatística utilizou-se teste qui-quadrado. Os maiores percentuais de hipertensão (53,8 por cento), dislipidemia (26,4 por cento), diabetes (34 por cento), infarto agudo do miocárdio (21,7 por cento) e acidente vascular cerebral (14,6 por cento) foram observados entre os avós maternos das crianças com excesso de peso. Os pais (p=0,01), mães (p=0,02) e irmãos (p=0,04) das crianças com excesso de peso apresentaram maiores percentuais de obesidade em relação às eutróficas e às com baixo peso. O tabagismo foi maior entre os pais das crianças com excesso de peso (p=0,02). A presença de alcoolismo foi maior entre entre os avós paternos (p=0,00) e maternos (p=0,04) das crianças com baixo peso...
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Humanos , Masculino , Femenino , Niño , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Estado Nutricional , Grasa Abdominal , Sobrepeso/complicaciones , Factores de RiesgoRESUMEN
INTRODUÇÃO: Estudos recentes incluindo pacientes portadores de doença coronária estável sugerem ausência de benefício clínico da estratégia inicial de intervenção coronária percutânea com stents não-farmacológicos associada a terapia medicamentosa otimizada vs. terapia medicamentosa otimizada isolada. No entanto, o tratamento ideal para pacientes com doença coronária estável no mundo real permanece controverso. Reportamos o impacto dos stents farmacológicos (SF) em pacientes portadores de doença coronária estável tratados na prática clínica diária. Método: Entre maio de 2002 e novembro de 2009, 1814 pacientes portadores de doença coronária estável (angina estável ou isquemia silenciosa) foram prospectivamente incluídos no Registro DESIRE, e o seguimento clínico de até 8 anos (média de 3,9 +- 2 anos) foi realizado em 98 por cento desses pacientes. Resultados: A média das idades era de 64,2 +- 10,8 anos, 28 por cento tinham diabetes melito, 21 por cento tinham infarto do miocárdio prévio e 51,7 por cento, revascularização prévia. A artéria descendente anterior foi o vaso-alvo mais tratado (42 por cento) e, considerando-se o total de lesões (n= 2.701), 66,3 por cento delas eram de elevada complexidade (tipos B2/C). Ao final do procedimento, o sucesso angiográfico...
BACKGROUND: Recent studies in patients with stable coronary artery disease suggest there is no clinical benefit of the initial strategy of percutaneous coronary intervention with bare metal stents associated to optimal medical therapy (OMT) vs OMT alone. However, the best therapeutic option for patients with stable coronary artery disease in the real world remains controversial. We report the impact of drug eluting stents (DES) in patients with stable coronary artery disease treated in the daily clinical practice. METHOD: From May 2002 to November 2009, 1,814 patients with stable coronary artery disease (stable angina or silent ischemia) were prospectively included in the DESIRE Registry and 98% of the patients were followed up to 8 years (mean 3.9 ± 2 years). RESULTS: Mean age was 64.2 ± 10.8 years, 28% had diabetes mellitus, 21% had a prior myocardial infarction and 51.7% had a prior revascularization. Left anterior descending artery was treated in 42% of the patients. When all of the lesions (n = 2,701) were taken into consideration, 66.3% were classified as complex B2/C lesions. Angiographic success was 99%. The cumulative rate of adverse events in the late clinical follow-up was: cardiac death, 3.4%; myocardial infarction, 5.5%; target-lesion revascularization (TLR), 4.8%; and stent thrombosis, 0.8%. CONCLUSION: The use of DES in stable coronary artery disease was associated to excellent late clinical follow-up including a cumulative TLR rate < 5% and stent thrombosis < 1%. When compared to historical data, such findings show a great benefit of DES in this population, suggesting that percutaneous coronary intervention with DES is a safe and effective initial strategy in patients with stable coronary artery disease.