Beyond the GRACE ACS Score: Do We Need a Different Model for Men and Women after STEMI? / Além do Escore GRACE SCA: É Necessário um Modelo Diferente para Homens e Mulheres após IAMCSST?

BACKGROUND: Women, in comparison to men, experience worse outcomes after acute coronary syndrome (ACS). However, whether the female sex per se is an independent predictor of such adverse events remains unclear. OBJECTIVE: This study aims to assess the association between the female sex and in-hospital mortality after ST-elevation myocardial infarction (STEMI). METHODS: We conducted a retrospective cohort study by enrolling consecutive STEMI patients admitted to a tertiary hospital from January 2018 to February 2019. All patients were treated per current guideline recommendations. Multivariable logistic regression models were applied to evaluate in-hospital mortality using GRACE variables. Model accuracy was evaluated using c-index. A p-value < 0.05 was statistically significant. RESULTS: Out of the 1678 ACS patients, 709 presented with STEMI. The population consisted of 36% women, and the median age was 61 years. Women were older (63.13 years vs. 60.53 years, p = 0.011); more often presented with hypertension (75.1% vs. 62.4%, p = 0.001), diabetes (42.2% vs. 27.8%, p < 0.001), and hyperlipidemia (34.1% vs. 23.9%, p = 0.004); and were less likely to undergo percutaneous coronary intervention (PCI) via radial access (23.7% vs. 46.1%, p < 0.001). In-hospital mortality rate was significantly higher in women (13.2% vs. 5.6%, p = 0.001), and the female sex remained at higher risk for in-hospital mortality (OR 2.79, 95% CI 1.15-6.76, p = 0.023). A multivariate model including age, sex, systolic blood pressure, cardiac arrest, and Killip class was 94.1% accurate in predicting in-hospital mortality, and the c-index was 0.85 (95% CI 0.77-0.93). CONCLUSION: After adjusting for the risk factors in the GRACE prediction model, women remain at higher risk for in-hospital mortality.

FUNDAMENTO: As mulheres, em comparação aos homens, apresentam piores resultados após a síndrome coronariana aguda (SCA). No entanto, ainda não está claro se o sexo feminino em si é um preditor independente de tais eventos adversos. OBJETIVO: Este estudo tem como objetivo avaliar a associação entre o sexo feminino e a mortalidade hospitalar após infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). MÉTODOS: Conduzimos um estudo de coorte retrospectivo, recrutando pacientes consecutivos com IAMCSST, internados em um hospital terciário de janeiro de 2018 a fevereiro de 2019. Todos os pacientes foram tratados de acordo com as recomendações das diretrizes atuais. Modelos de regressão logística multivariada foram aplicados para avaliar a mortalidade hospitalar utilizando variáveis de GRACE. A precisão do modelo foi avaliada usando o índice c. Um valor de p < 0,05 foi estatisticamente significativo. RESULTADOS: Dos 1.678 pacientes com SCA, 709 apresentaram IAMCSST. A população era composta por 36% de mulheres e a idade média era de 61 anos. As mulheres tinham maior idade (63,13 anos vs. 60,53 anos, p = 0,011); apresentavam hipertensão (75,1% vs. 62,4%, p = 0,001), diabetes (42,2% vs. 27,8%, p < 0,001) e hiperlipidemia (34,1% vs. 23,9%, p = 0,004) mais frequentemente; e apresentaram menor probabilidade de serem submetidas a intervenção coronária percutânea (ICP) por acesso radial (23,7% vs. 46,1%, p < 0,001). A taxa de mortalidade hospitalar foi significativamente maior em mulheres (13,2% vs. 5,6%, p = 0,001), e o sexo feminino permaneceu em maior risco de mortalidade hospitalar (OR 2,79, IC de 95% 1,15­6,76, p = 0,023). Um modelo multivariado incluindo idade, sexo, pressão arterial sistólica, parada cardíaca e classe de Killip atingiu 94,1% de precisão na previsão de mortalidade hospitalar, e o índice c foi de 0,85 (IC de 95% 0,77­0,93). CONCLUSÃO: Após ajuste para os fatores de risco no modelo de previsão do GRACE, as mulheres continuam em maior risco de mortalidade hospitalar.

Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women

Abstract Background Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable. Objective To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers. Methods This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05). Results According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (<5%), intermediate (5-10%), and high (>10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity <85% (22.2%), coronary calcium score >0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score. Conclusion Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea.

OBJECTIVE: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Migraine and Markers of Carotid Atherosclerosis in Middle-Aged Women: A Cross-Sectional Study.

OBJECTIVE: This study evaluated the association between migraine and the markers of carotid artery disease. BACKGROUND: Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. METHODS: In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. RESULTS: The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. CONCLUSION: Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.

Aterosclerose de carótidas em mulheres na pré e pós-menopausa com antecedentes de hipertensão na gestação: estudo de caso-controle / Carotid atherosclerosis in pre-and-post-menopausal women with a history of pregnancy-induced hypertension: case-control study

A mortalidade por doença cardiovascular entre as mulheres permanece elevada. Estudos observacionais são controversos sobre a participação dos antecedentes de distúrbio hipertensivo gestacional no risco cardiovascular. Verificar a associação entre aterosclerose de carótidas em mulheres no climatério que tiveram hipertensão na gestação. Estudo de caso-controle, sendo os casos compostos por mulheres com aterosclerose de carótida, definida como espessura íntima-média carotídea > 1 mm e/ou presença de placas de carótidas; os controles não apresentavam estas alterações. Adotou-se nível de significância de 95%. Foram avaliadas 504 mulheres sem doença cardiovascular prévia, sendo 126 casos e 378 controles. Eram hipertensas 67% delas; 76% eram dislipidêmicas; e 16%, diabéticas. Cerca de 10% referiram antecedentes de hipertensão na gestação. As mulheres com aterosclerose de carótidas apresentaram valores maiores dos níveis de pressão arterial sistólica (134,18 mmHg vs. 128,59 mmHg; p = 0,008) e de LDL-colesterol (156,52 mg% vs. 139,97 mg%; p = 0,0005). Não foi encontrada diferença estatística em relação à presença de aterosclerose de carótidas e ao antecedente de hipertensão na gestação (OR 1,672; IC 95% 0,893-3,131). O antecedente de hipertensão na gestação não foi associado à aterosclerose subclínica de carótidas em mulheres na pré e pós-menopausa. No entanto, verificou-se a associação entre a aterosclerose de carótida e os fatores de risco clássicos, como pressão arterial sistólica elevada e altos níveis de LDL-colesterol

Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk. To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension. Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%. A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol(156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131). The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels

Qualidade do sono e tolerância ao esforço em portadores de apneia obstrutiva do sono / Sleep quality and stress tolerance in patients with obstructive sleep apnea / Calidad del sueño y la tolerancia al estrés en pacientes con apnea obstructiva del sueño

INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente associada com piores indicadores de saúde. A qualidade do sono pode ser medida objetiva e subjetivamente por métodos como a polissonografia, que é o padrão de referência, ou por meio de testes e questionários, como o índice de qualidade de sono de Pittsburgh (IQSP). OBJETIVO: Correlacionar a qualidade do sono com a tolerância ao esforço em pacientes portadores da síndrome da apneia/hipopneia obstrutiva do sono (SAHOS). MÉTODOS: Participaram do estudo 63 indivíduos (57 mulheres e seis homens), média de idade de 51,7 ± 6,6 anos; índice de massa corpórea (IMC) média de 28,2 ± 5,0 kg/m2); índice de apneia/hipopneia (IAH) médio de 7,3 ± 10,50 eventos/hora, verificado através da polissonografia. Para a avaliação da qualidade do sono, os participantes responderam ao IQSP, e para a avaliação da tolerância ao esforço, realizaram o teste de caminhada de 6 minutos (TC6M). RESULTADOS: Não houve correlação entre o IQSP e o TC6M (Rs = -0,103620, p = 0,419), assim como entre o IAH e o TC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que a qualidade do sono e a gravidade da SAHOS não afetam a tolerância ao esforço dos indivíduos com SAHOS. CONCLUSÃO: Estudos com uma amostra maior, levando-se em consideração a estratificação pela gravidade da SAHOS e utilizando métodos mais acurados de avaliação da capacidade funcional, devem ser realizados, a fim de que resultados mais abrangentes possam ser obtidos. .

INTRODUCTION: Sleep is a natural and recurring state, in which important neurobiological processes take place. Poor quality of sleep is directly associated with worse health indicators. Sleep quality can be measured objectively and subjectively by methods such as polysomnography, which is the gold standard, or tests and questionnaires as the Sleep Quality Index in Pittsburgh (PSQI). OBJECTIVE: To correlate the quality of sleep with exercise tolerance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: The study included 63 subjects (57 women and 6 men) aged 51.7 ± 6.6 years, with body mass index (BMI) 28.2 ± 5.0 kg/m2,apnea/hypopnea index (AHI) 7.3±10:50 events/hour, assessed by polysomnography. To assess the quality of sleep, participants responded the PSQI instrument and were submitted to the exercise tolerance test through the 6-minute walk test (6MWT). RESULTS: There was no correlation between the PSQI and the 6MWT (Rs = -0.103620, p = 0.419), and between the 6MWT and the AHI (R = -0, 000984, p = 0.9939). According to the results of this work, we suggest that the quality of sleep and the severity of OSAHS did not affect the exercise tolerance of individuals with OSAHS. CONCLUSION: Studies with a larger sample, taking into account the stratification by severity of OSAHS and using more accurate methods of functional capacity evaluation should be conducted, so that more comprehensive results can be obtained. .

INTRODUCCIÓN: El sueño es un estado natural y recurrente durante el cual acontecen procesos neurobiológicos importantes. La mala calidad del sueño está asociada directamente con peores indicadores de salud. La calidad del sueño puede ser medida objetiva y subjetivamente mediante métodos como la polisomnografía,, que es el estándar de referencia, o pruebas y cuestionarios como el índice de calidad de sueño de Pittsburgh (ICSP), OBJETIVO: Correlacionar la calidad del sueño con la tolerancia al esfuerzo en pacientes portadores del síndrome de la apnea/hipopnea obstructiva del sueño (SAHOS). MÉTODOS: Participaron en el estudio 63 individuos (57 mujeres y seis hombres), edad promedio de 51,7 ± 6,6 años; índice de masa corpórea (IMC) 28,2 ± 5,0 kg/m2); índice de apnea/hipopnea (IAH) 7,3 ± 10,50 eventos/hora, verificado por medio de la polisomnografía. Para la evaluación de la calidad del sueño, los participantes respondieron al ICSP y para la evaluación de la tolerancia al esfuerzo, realizaron la prueba de caminata de 6 minutos (PC6M). RESULTADOS: No hubo correlación entre el ICSP y la PC6M (Rs = -0,103620, p = 0,419), ni entre el IAH y la PC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que la calidad del sueño y la gravedad del SAHOS no afectan a la tolerancia al esfuerzo de los individuos con SAHOS. CONCLUSIÓN: Se deben realizar los estudios con una muestra mayor, teniéndose en consideración la estratificación según la gravedad del SAHOS y utilizándose métodos más precisos para evaluación de la capacidad funcional, a fin de que se puedan obtener resultados de más alcance. .

Prevalência de aterosclerose de carótida e fatores associados em mulheres a partir do climatério / Prevalence and predictors of carotid atherosclerosis in pre- and post-menopausal women

Introdução: As doenças cardiovasculares permanecem como a principal causa de morbimortalidade entre as mulheres no Brasil e no mundo. Estratégias de prevenção primária baseadas na detecção dos fatores de risco tradicionais para aterosclerose, têm sido pouco eficazes para reduzir as altas taxas de mortalidade nessa população. O presente estudo tem como objetivo primário detectar e quantificar a presença de aterosclerose na sua fase subclínica, em mulheres climatéricas e pós-menopausadas. Métodos: Foram estudadas 823 mulheres de 45 a 65 anos de idade (idade média 54,3 ± 5,3 anos), no período peri e pós-menopausa, sem doença cardiovascular conhecida, ou em uso de terapia de reposição hormonal, residentes em Recife, Nordeste do Brasil. Todas foram submetidas a avaliação clínica e dosagens bioquímicas, que incluíram os níveis de glicose, lipídios, proteína C-reativa, hormônio folículo-estimulante, adiponectina e aldosterona. Ultrassonografia modo B foi utilizada na avaliação carotídea; medidas da espessura íntima média carotídea (EIMC) foram determinadas na parede posterior da artéria carótida comum (ACC) utilizando-se um "software" de leitura automatizada; aterosclerose carotídea foi definida quando da presença de placa carotídea e/ou EIMC > 1mm. Resultados: De 823 mulheres, 10,2% eram fumantes, 58% tinham hipertensão e 9,9% eram diabéticas. A prevalência de doença aterosclerótica subclínica entre a população analisada foi de 12,7%, e a média da EIMC foi de 0,645 ± 0,124 milímetros. Na análise univariada, foram detectadas associações significativas entre presença de aterosclerose carotídea e: a idade (p < 0,001), o fumo (p=0,014), a hipertensão (p=0,002), a pressão arterial sistólica (p=0,003), o colesterol total (p=0,001) e o LDL-colesterol (p=0,001). No modelo ajustado, a idade (p < 0,001), o fumo (p=0,001), a pressão arterial sistólica (p=0,030) e o colesterol total (p=0,008) se correlacionaram de forma significativa e independente com a aterosclerose...

Aims: Cardiovascular diseases continue to be the main cause of morbidity and mortality among women in Brazil and worldwide. Strategies of primary prevention, based on the detection of traditional risk factors for atherosclerosis, have had a small impact in reducing the high rates of mortality in this population. Therefore, the main purpose of this study was to analyse the prevalence of subclinical carotid atherosclerosis in peri- and postmenopausal women. Methods: We studied 823 peri- and postmenopausal women, 45 to 65 years-old (mean age 54.3±5.3 years), from Recife city, without known cardiovascular disease and hormone therapy utilization. All of them were submitted to a careful medical evaluation, and biochemical analyses that included glucose and lipids levels, C-reactive protein, follicle-stimulating hormone, adiponectin and aldosterone. B-mode ultrasound was utilized for carotid evaluations; intima-media thickness (IMT) measures were determined on the far wall common carotid artery (CCA) with automated reading software; presence of carotid atherosclerosis was defined as either the presence of plaque and/or IMT >= 1.00mm. Results: Of the 823 women, 10.2% were current smokers, 58% had hypertension and 9.9% were diabetics. The prevalence of subclinical atherosclerotic disease among the analyzed population was 12.7%, and the mean CCA-IMT was 0.645±0.124 mm. By univariate analyses, a positive and statistically significant correlation was found between carotid atherosclerosis and age (p < 0.001), current smoker (p=0.014), hypertension (p=0.002), systolic blood pressure (p=0.003), total cholesterol (p=0.001) and LDL cholesterol (p=0.001). In the adjusted model, age (p < 0.001), current smoker (p=0.001), systolic blood pressure (p=0.030) and total cholesterol (p=0.008), remained correlating significantly and independently with carotid atherosclerosis. Conclusion: Our study showed a high prevalence of carotid atherosclerosis among asymptomatic...