Education to a Healthy Lifestyle Improves Symptoms and Cardiovascular Risk Factors – AsuRiesgo Study / Educação para um Estilo de Vida Saudável Melhora Sintomas e Fatores de Risco Cardiovasculares – Estudo AsuRiesgo

Background: Cardiovascular diseases are the current leading causes of death and disability globally. Objective: To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population. Methods: All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association’s 2020 parameters of cardiovascular health were assessed. Results: A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001) and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments. Conclusion: A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence. .

Fundamentos: As doenças cardiovasculares são, atualmente, as maiores causas de óbito e incapacitação em todo o mundo. Objetivos: Avaliar os efeitos de um programa educativo básico para prevenção cardiovascular em uma população de pacientes ambulatoriais não selecionados. Métodos: Todos os participantes frequentaram um programa educativo de mudança para um estilo de vida saudável. Foram realizadas avaliações à admissão no estudo e durante o acompanhamento. Foram avaliados sintomas, hábitos, parâmetros do ATP III para síndrome metabólica e parâmetros da American Heart Association 2020 para saúde cardiovascular. Resultados: Foram incluídos no estudo 15.073 participantes com idade ≥ 18 anos. Foi feita a análise de dados dos 3.009 pacientes que completaram a segunda avaliação. Foram documentados perda de peso (de 76,6 ± 15,3 para 76,4 ± 15,3 kg, p = 0,002), melhora da dispneia aos esforços graus II-NYHA (de 23,4% para 21,0%) e III (de 15,8% para 14,0%), e redução na proporção de fumantes ativos atuais (de 3,6% para 2,9%, p = 0,002). Houve melhora na proporção de pacientes com níveis de triglicérides > 150 mg/dL (de 46,3% para 42,4%, p < 0,001) e de colesterol LDL > 100 mg/dL (de 69,3% para 65,5%, p < 0,001). Houve melhora ≥ 20% na métrica AHA 2020 no nível classificado como ruim para tabagismo (-21,1%), alimentação (-29,8%), e nível de colesterol (23,6%). Foi documentada grande evasão como indicador substituto para baixa adesão de paciente nas primeiras 5 consultas, sendo 80% entre a primeira e a segunda avaliação, 55,6% entre a segunda e a terceira, 43,6% entre a terceira e a quarta, e 38% entre a quarta e a quinta. Conclusão: Um programa educativo básico e simples pode melhorar os sintomas e fatores de risco cardiovasculares modificáveis, mas conta com pouca adesão por parte dos pacientes. .

Education to a Healthy Lifestyle Improves Symptoms and Cardiovascular Risk Factors - AsuRiesgo Study.

BACKGROUND: Cardiovascular diseases are the current leading causes of death and disability globally. OBJECTIVE: To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population. METHODS: All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association's 2020 parameters of cardiovascular health were assessed. RESULTS: A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001) and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments. CONCLUSION: A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence.

Late gadolinium enhancement assessed by cardiac magnetic resonance imaging in heart transplant recipients with different stages of cardiac allograft vasculopathy.

AIMS: Cardiac allograft vasculopathy (CAV), which limits long-term survival after heart transplantation (HTX), is usually evaluated by coronary angiography (CA). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a non-invasive technique that can detect CAV-related myocardial infarctions. We aimed to investigate the presence of LGE infarct-typical patterns in a large sample of HTX recipients and to correlate these findings with the severity of CAV assessed by CA. METHODS AND RESULTS: LGE-CMR was performed in 132 HTX patients on a 1.5-T MRI scanner (Philips, Best, the Netherlands). Infarct-typical LGE areas were identified as bright lesions with subendocardial involvement. Infarct-atypical LGE was classified as follows: (i) right ventricle (RV) insertion, (ii) intramural, (iii) epicardial, and (iv) diffuse. CA was performed for the assessment of CAV (CAV0 = no lesion, CAV1 = mild lesions, CAV2 = moderate lesions, CAV3 = severe lesions, or mild/moderate lesions with allograft dysfunction). Infarct-typical LGE patterns were detected in 29 (22%) patients distributed in all groups and they were already present in nearly every fifth CAV0 patient, increasing significantly among CAV groups (CAV0 = 19%, CAV1 = 10%, CAV2 = 36%, and CAV3 = 71%; P < 0.01). CONCLUSION: LGE-CMR was useful to identify myocardial scar possibly related to early CAV in a significant proportion of HTX recipients, otherwise classified as low-risk patients based on CA. Therefore, LGE-CMR could be helpful to intensify CAV monitoring, medical therapy, and clinical risk stratification.

Heart transplantation in rapidly progressive end-stage heart failure associated with celiac disease.

Celiac disease is characterised by chronic immune-mediated malabsorption in genetically susceptible individuals induced by gluten proteins present in wheat, barley and rye. It occurs in adults and children at rates approaching 1% of the population. Cardiomyopathy associated with celiac disease is infrequent. The authors present here a first case of a severe progressive dilated cardiomyopathy that required heart transplantation in young woman with celiac disease.