Low-Grade Chronic Inflammation: a Shared Mechanism for Chronic Diseases.

Inflammation is an important physiological response of the organism to restore homeostasis upon pathogenic or damaging stimuli. However, the persistence of the harmful trigger or a deficient resolution of the process can evolve into a state of low-grade, chronic inflammation. This condition is strongly associated with the development of several increasingly prevalent and serious chronic conditions, such as obesity, cancer, and cardiovascular diseases, elevating overall morbidity and mortality worldwide. The current pandemic of chronic diseases underscores the need to address chronic inflammation, its pathogenic mechanisms, and potential preventive measures to limit its current widespread impact. The present review discusses the current knowledge and research gaps regarding the association between low-grade chronic inflammation and chronic diseases, focusing on obesity, cardiovascular diseases, digestive diseases, and cancer. We examine the state of the art in selected aspects of the topic and propose future directions and approaches for the field.

A Clinical Tool to Relate Youth Risk Factors to Adult Cardiovascular Events and Type 2 Diabetes: The International Childhood Cardiovascular Cohort Consortium.

OBJECTIVE: To translate data relating childhood cardiovascular (CV) risk factors and adult CV disease and type 2 diabetes mellitus (T2DM) to clinically actionable values. STUDY DESIGN: This was a prospective observational study (n = 38 589) in the International Childhood Cardiovascular Cohort Consortium. Children at age 3 through 19 years were enrolled in the 1970s and 1980s and followed for more than 30 years. Five childhood CV risk factors (smoking, body mass index [BMI], systolic blood pressure, triglycerides, and total cholesterol) were related to adult CV events. Secondary analyses in a subset included low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glucose, and insulin level. Age- and sex-specific z scores were calculated for each risk factor, and a combined-risk z score was calculated by averaging z scores for the 5 key CV risk factors. Risk factor z scores were back-transformed to natural units for clinical interpretation, with hazard ratios for adult CV events presented in color-coded tables (green: no increased risk; orange: 1.4 to <2.0-fold increased risk; red: at least doubling of risk). Risk levels for development of adult T2DM on the basis of BMI, glucose, and insulin were similarly calculated and presented. RESULTS: Increased risk for CV events was observed at levels lower than currently defined abnormal clinical thresholds except for TC. Doubling of risk was observed at high normal levels just below the clinical cut point for abnormality. Risk for adult T2DM began at levels of BMI and glucose currently considered normal. CONCLUSIONS: On the basis of data showing significant relationships between childhood CV risk factors and adult CV events and T2DM, this study shows that risk in childhood begins below levels currently considered normal.

Semaglutide effects on safety and cardiovascular outcomes in patients with overweight or obesity: a systematic review and meta-analysis.

BACKGROUND: Semaglutide is a GLP-1 receptor agonist that provides a reduction in glycated hemoglobin and weight. The objective was to evaluate whether the use of semaglutide, in individuals with overweight or obesity, reduces cardiovascular outcomes and adverse effects (AE). METHODS: The data bases Pubmed, Lilacs, Scielo, Scopus, Web of Science and Cochrane Library were surveyed. RESULTS: Initially, 3333 articles were found, of which 19 articles were included. An additional search included 19 studies, totaling 38 articles. Relative risk (RR) values were significant for hospitalization due to heart failure (HF) 0.24 95% CI 0.12-0.57 (n = 2; 1045 participants; I² = 0.18), death due to cardiovascular causes 0.83 95% CI 0.71-0.98 (n = 3; 24 084 participants; I² = 0.21), death from any cause 0.79 95% CI 0.70-0.89 (n = 3; 24 084 participants; I² = 0.07), coronary revascularization 0.76 95% CI 0.69-0.85 (n = 2;20 951 participants; I² = 0.41), and non-fatal myocardial infarction 0.76 95%CI 0.66-0.88 (n = 3; 24 084 participants; I² = 0.21), with a difference between the subgroups (p = 0.05), favoring the subcutaneous administration route. The RR of stroke was 0.65 95% CI 0.44-0.97 for patients with diabetes (n = 2; 6480 participants; I² = 0.66). There was no difference between the frequency of constipation and routes of administration, as well as between doses of oral semaglutide. The RR of adverse effects was only not significant for discontinuation of treatment for oral semaglutide. CONCLUSION: The use of semaglutide reduced 76% in hospitalization due to HF, 17% deaths due to cardiovascular causes, 21% deaths due to any cause, 24% non-fatal myocardial infarction, 24% coronary revascularization and 35% stroke (in patients with diabetes). The use of semaglutide was associated with a higher relative risk and frequency of most adverse effects evaluated.

Desvendando o coração da assistência: a importância da enfermagem nos serviços de hemodinâmica / Uncovering the heart of care: the importance of nursing in hemodynamics services

INTRODUÇÃO: As doenças cardiovasculares são uma das principais causas de mortalidade em escala mundial. Dentre os tratamentos, as intervenções coronarianas percutâneas (ICP) desempenham um papel crucial oferecendo uma abordagem menos traumática e mais segura, além de promover uma recuperação mais rápida, reduzindo também os custos de assistência e a carga sobre o sistema de saúde, representando uma importante evolução e proporcionando benefícios significativos para pacientes e profissionais. No Brasil, as ICP integram uma área relativamente recente para a atuação da equipe médica e de enfermagem, demandando constante atualização e avanço científico. A atuação dos profissionais de enfermagem na hemodinâmica se faz de extrema importância para garantir a qualidade e segurança dos procedimentos, além da promoção do bem-estar dos pacientes. OBJETIVO(S): Destacar a relevância da enfermagem nos serviços de hemodinâmica no Brasil, ressaltando suas responsabilidades, métodos de atuação e impacto na assistência ao paciente. MÉTODOS: Este estudo adota uma abordagem qualitativa de revisão narrativa, adequada para explorar o estado atual do tema abordado envolvendo uma análise abrangente da literatura, sem seguir uma metodologia estritamente definida e reprodutível em termos de dados e respostas quantitativas para questões específicas, desempenhando um papel fundamental na aquisição e atualização do conhecimento. RESULTADOS: Embora seja crucial o papel do enfermeiro nos serviços de hemodinâmica, ainda há uma escassez de publicações que abordam a sua atuação. O mesmo é responsável por desempenhar múltiplos papéis nos serviços de hemodinâmica, desde o acolhimento e preparo do paciente até a assistência durante procedimentos e o cuidado após intervenção, além de assegurar a higienização adequada do ambiente, coordenar a equipe interdisciplinar e prover suporte emocional aos pacientes e familiares. CONCLUSÕES: A partir da análise bibliográfica foram encontrados apenas seis artigos que analisam e desenvolve o assunto abordado, além de destacar a importância da enfermagem nos serviços de hemodinâmica em todas as fases do cuidado e abrangendo também a gestão da unidade. Frente a isso se percebe a necessidade não somente da abordagem do tema, mas também de ações que auxiliem nas implementações e investimentos na capacitação e valorização da enfermagem para aprimorar a qualidade da assistência e contribuir para melhores desfechos clínicos e a satisfação dos pacientes.

Experiência inicial com o uso de balão farmacológico em pacientes de hospital terciário do sistema único de saúde / Initial experience with the use of drug-eluting balloons in patients at a tertiary hospital in the unified health system

INTRODUÇÃO: Os balões farmacológicos representam uma alternativa aos stents farmacológicos (SFs) a realização de intervenção coronária percutânea (ICP). São dispositivos capazes de entrega de droga anti-proliferativa na lesão-alvo de forma homogênea, com a vantagem da ausência de suporte metálico permanente no vaso coronariano. Até recentemente, as indicações para uso de balão farmacológico (BF) eram restritas a casos de reestenose intra-stent (RIS). Entretanto, sua utilização tem aumentado sobremaneira na prática diária devido aos avanços tecnológicos, maior disponibilização e novas evidências científicas. OBJETIVOS: Promover avaliação inicial da utilização e impacto de BF após sua disponibilização para tratamento de pacientes no âmbito do Sistema Único de Saúde (SUS). MÉTODOS: Trata-se de um registro prospectivo de centro único, para avaliação das indicações e desfechos maiores intra-procedimento e intra-hospitalares no emprego do BF em pacientes de hospital terciário do SUS, durante o período de Janeiro de 2023 a Março de 2024. RESULTADOS: No período, 2400 pacientes foram submetidos a ICP em nosso serviço dos quais 60 (2,5%) foram submetidos a angioplastia com BF. Destes, a média das idades era 64±9 anos, 71,6% eram do sexo masculino e 95% apresentavam quadro estável. Em 49 casos (81,6%), o BF foi utilizado para o tratamento de RIS. Em 5 casos (8,33%), o uso se deu em vaso de fino calibre; em 4 casos (6,66%), foram utilizados para tratamento de ramo lateral em bifurcação; e em 2 casos (3,33%) foram utilizados para tratamento de infarto agudo do miocárdio com supra do segmento ST (IAMCSST). Durante o procedimento (média de 1,2±0.4 vasos tratados por paciente e média de 1,6±0.9 balões farmacológicos liberadores de paclitaxel por paciente), a via de acesso radial foi utilizada em 50% e o sucesso do procedimento (estenose residual <30%, ausência de dissecção, sem necessidade de implante de stent em caráter "bail-out", ausência de eventos cardíacos adversos maiores durante a fase intra-hospitalar) foi 98,33%. A extensão e diâmetro nominais dos dispositivos eram 19.8mm e 2.91mm, respectivamente. O tempo médio de internação para realização do procedimento foi de 1,2 dias, com a maioria dos pacientes tendo alta em até 24 horas. CONCLUSÃO: Nesta experiência inicial no âmbito do SUS, a utilização do balão farmacológico mostrou-se segura e eficaz na abordagem de lesões de RIS, vaso de fino calibre, ramo lateral de bifurcação, além de dois casos em contexto de IAMCSST.

Aterosclerosis: un desafío global con raíces multifactoriales / Atherosclerosis: aglobal challenge with multifactorial roots

El interés científico que existe sobre los mecanismos involucrados en el proceso que da origen a la aterosclerosis es considerablemente notable e importante. El gran volumen de artículos y conocimiento sobre este tema cada vez es mayor, permitiendo profundizar constantemente en los mecanismos fisiopatológicos que comprende la aterosclerosis, los factores de riesgo que predisponen a la misma, y las posibles consecuencias a esperar una vez que se desencadena la patología. Ahora se sabe que el carácter multifactorial de esta situación anormal de las arterias es lo que ha llevado a la alta morbimortalidad que representan las enfermedades cardiovasculares actualmente. Objetivo: Investigar los mecanismos de la aterosclerosis: Profundizar en los procesos fisiopatológicos que conducen al desarrollo de esta enfermedad. Comprender cómo diferentes elementos, incluyendo la inmunidad, genética y microbiota, contribuyen al desarrollo de la aterosclerosis. Métodos: Se realizó una revisión de la literatura científica existente sobre el tema. Análisis de estudios que relacionan factores de riesgo (hormonales, ambientales y genéticos) con el desarrollo de la enfermedad. La investigación sobre el papel del sistema inmunológico y la microbiota en la fisiopatología de la aterosclerosis. Se ha logrado dilucidar las diferentes causas, encontrando una fuerte relación entre el desarrollo de aterosclerosis y diversos factores, para tratar de explicar el sustrato fisiopatológico al cual nos enfrentamos en la búsqueda del tratamiento más eficaz para esta condición anormal del organismo.

The scientific interest that exists in the mechanisms involved in the process that gives rise to atherosclerosis is considerably notable and important. The large volume of articles and knowledge on this topic is increasing, allowing us to constantly delve deeper into the pathophysiological mechanisms that comprise atherosclerosis, the risk factors that predispose to it, and the possible consequences to be expected once the pathology is triggered. It is now known that the multifactorial nature of this abnormal situation of the arteries is what has led to the high morbidity and mortality that cardiovascular diseases currently represent. Objective: To investigate the mechanisms of atherosclerosis: To delve deeper into the pathophysiological processes that lead to the development of this disease. To understand how different elements, including immunity, genetics and microbiota, contribute to the development of atherosclerosis. Methods: A review of the existing scientificliterature on the subject was carried out. Analysis of studies that relate risk factors (hormonal, environmental and genetic) with the development of the disease. Research on the role of the immune system and microbiota in the pathophysiology of atherosclerosis. It has been possible to elucidate the different causes, finding a strong relationship between the development of atherosclerosis and various factors, in order to try to explain the pathophysiological substrate that we face in the search for the most effective treatment for this abnormal condition of the organism.

Sexual minorities cardiovascular health disparities compared to heterosexual adults in the US: a systematic review and meta-analysis of nearly 2 million cohort patients

BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of death globally, yet disparities in CVD outcomes among sexual minorities compared to heterosexual adults are under-researched. Sexual minorities face unique stressors, discrimination, and barriers to healthcare, which may contribute to higher CVD risk. This meta-analysis synthesizes evidence on health disparities between sexual minorities and heterosexual adults. METHODS: We searched MEDLINE, Cochrane, and Embase databases for studies published between 2002 to 2024 that compared cardiovascular health disparities between sexual minorities and their heterosexual counterparts. Outcomes were CVD, Diabetes, Hypertension, and Obesity. We pooled odds ratios (OR) for binary endpoints with 95% confidence intervals (CI) using a random-effects model. Statistical analyses were performed using R software version 4.3.2. RESULTS: We included 9 Cross-sectional studies after minimizing population overlap, comprising 1,938,814 patients with a mean age of 47 years. There were no significant differences in the odds of CVD (OR 1.10; 95% CI 0.87 to 1.39; Figure 1 A), Diabetes (OR 0.88; 95% CI 0.74 to 1.04; Figure 1 B), hypertension (OR 1.07; 95% CI 0.97 to 1.19; Figure 2 A) and Obesity (OR 1.01; 95% CI 0.76 to 1.35; Figure 2 B) between groups. In subgroup analysis, there were higher odds of obesity in the sexual minority population when compared to their heterosexual counterparts (OR 1.29; 95 % CI 1.15 to 1.45) and higher hypertension odds in sexual minority men (OR 1.35; 95% CI 1.12 to 1.63). CONCLUSION: In this meta-analysis, we found no statistically significant difference in the prevalence of CVD, diabetes, and obesity between sexual minorities and heterosexuals, meaning that more studies are necessary to assess this difference. Subgroup analyses revealed sexual minority men had higher odds of hypertension and sexual minority women for obesity.

HEARTS en las Américas: Marco de evaluación para la mejora continua de la calidad en los centros de atención primaria de salud

Esta publicación ha sido diseñada para apoyar a los equipos de atención primaria de salud (APS), particularmente a las instituciones del primer nivel de atención que asisten a una población-territorio definida, en el contexto del programa HEARTS en las Américas. Facilita la comprensión de la metodología y proporciona herramientas estandarizadas y prácticas para su implementación. Los principales usuarios serán los comités o grupos de calidad de los centros de atención primaria (CAP) que han adoptado HEARTS, aunque también se dirige a equipos locales responsables de la gestión clínica y administrativa de los CAP, así como a otras entidades nacionales y subnacionales para la evaluación externa de calidad. La evaluación para la mejora de la calidad de HEARTS en las Américas se centra en una valoración sistemática y estandarizada de la fidelidad, factibilidad, aceptabilidad y efectividad de las intervenciones promovidas por el programa. Busca generar una cultura de calidad entre el personal e instituciones que operan en la APS, permitiendo identificar barreras de acceso y de calidad, proponer soluciones prácticas y sostenibles, y ejecutar acciones efectivas para mejorar la calidad de los procesos y resultados en salud. El enlentecimiento en la reducción de la mortalidad por enfermedades cardiovasculares y los niveles subóptimos de control de la hipertensión sugieren que el modelo vigente de servicios de salud está agotado. Por ello, HEARTS en las Américas emerge como la adaptación regional de la iniciativa global HEARTS de la OMS, enfocándose en la mejora continua de la calidad para la gestión integrada de la hipertensión y el riesgo cardiovascular en los servicios de APS, aplicable también a otras condiciones crónicas prevalentes en la Región.

Desarrollo de capacidades en salud a través de la Iniciativa HEARTS en República Dominicana / Building Health Capacities Through the HEARTS Initiative in the Dominican Republic / Desenvolvimento de capacidades em saúde por meio da iniciativa HEARTS na República Dominicana

[RESUMEN]. La educación continua de los equipos de salud es imprescindible para garantizar resultados que tengan un efecto positivo en la salud de la comunidad. En el 2019, a través del Ministerio de Salud Pública y Asistencia Social (MISPAS), República Dominicana inició la implementación de la iniciativa HEARTS de la Organización Panamericana de la Salud (OPS). De esta manera, se alineó con las mejores prácticas mundiales para la prevención y el manejo de la hipertensión y las enfermedades cardiovasculares (ECV), y así reducir las tasas de mortalidad debida a esta enfermedad no transmisible (ENT). De hecho, la hipertensión es la principal causa de ECV, y la ECV es la ENT responsable de más muertes en el mundo. El personal médico pasante de República Dominicana tiene la enorme labor de diagnosticar y tratar de manera oportuna a las personas con presión arterial alta y diversos factores de riesgo cardiovascular. Por lo tanto, la capacitación y formación de los estudiantes de pregrado previo a ejercer funciones como médicos pasantes, representa una prioridad en el sistema de salud del país. La iniciativa HEARTS ha producido una serie de cursos virtuales de alta calidad, gratuitos y disponibles todo el año en la plataforma del Campus Virtual de Salud Pública de la OPS. Estos cursos constituyen una oportunidad singular para que las escuelas de medicina adheridas a la Asociación Dominicana de Facultades y Escuelas de Medicina (ADOFEM), a través de un acuerdo con el MISPAS, utilicen el e-learning como herramienta innovadora y poderosa de entrenamiento de los miembros del equipo de salud.

[ABSTRACT]. Continuous education of health teams is essential to ensure outcomes that have a positive impact on community health. In 2019, through an agreement with the Ministry of Public Health and Social Assistance (MISPAS), the Dominican Republic began implementing HEARTS, an initiative of the Pan American Health Organization (PAHO). This aligned MISPAS with global best practices for the prevention and management of hypertension and cardiovascular disease, with a view to reducing mortality rates due to this noncommunicable disease (NCD). Hypertension is the leading cause of cardiovascular disease, which is the NCD responsible for the most deaths worldwide. Medical interns in the Dominican Republic have the enormous task of providing timely diagnosis and treatment for people with high blood pressure and various cardiovascular risk factors. In the country's health system, therefore, it is a priority to train and educate undergraduate students before they become medical interns. The HEARTS initiative has produced a series of high-quality virtual courses that are free of charge and available year-round at PAHO's Virtual Campus for Public Health. Through an agreement with MISPAS, these courses are a unique opportunity for medical schools that are members of the Dominican Association of Medical Schools and Faculties (ADOFEM) to use e-learning as an innovative and powerful tool to train members of healthcare teams.

[RESUMO]. A formação continuada das equipes de saúde é essencial para garantir resultados que tenham um impacto positivo na saúde da comunidade. Em 2019 , através do Ministério de Saúde Pública e Assistência Social (MISPAS), a República Dominicana iniciou a implementação da iniciativa HEARTS da Organização Pan- Americana da Saúde (OPAS). Assim, se alinhou às melhores práticas mundiais de prevenção e tratamento de hipertensão arterial e doenças cardiovasculares para reduzir as taxas de mortalidade por essa doença não transmissível. De fato, a hipertensão é a principal causa de e doença cardiovascular, que, por sua vez, é a doença não transmissível responsável pelo maior número de mortes no mundo todo. Os estagiários de medicina na República Dominicana têm a enorme tarefa de diagnosticar e tratar, em tempo hábil, pessoas com pressão alta e diversos fatores de risco cardiovascular. Portanto, a capacitação e formação dos estudantes de graduação em medicina antes de se tornarem médicos estagiários é uma prioridade no sistema de saúde do país. A iniciativa HEARTS produziu uma série de cursos virtuais gratuitos de alta qualidade que estão disponíveis o ano todo na plataforma do Campus Virtual de Saúde Pública da OPAS. Esses cursos são uma oportunidade única, viabilizada por um acordo com o MISPAS, para que as escolas médicas afiliadas à Associação Dominicana de Faculdades e Escolas de Medicina (ADOFEM) utilizem o aprendizado eletrônico como uma ferramenta inovadora e poderosa de capacitação dos membros da equipe de saúde.

Safety and efficacy of moderate-intensity statin plus ezetimibe versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease: a meta-analysis

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide, poses an important healthcare challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear. PURPOSE: This meta-analysis seeks to assess the impact of moderate-intensity statin plus ezetimibe (MIS+EZT) versus high-intensity statin monotherapy (HIS) on LDL < 70mg/dl; Total Cholesterol; LDL; High Density Cholesterol (HDL) and triglycerides levels. Our goal is to synthesize the existing evidence and pinpoint areas that warrant further investigation. METHODS: A thorough literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane databases, focusing on studies that compared the effects of moderate-intensity statins plus ezetimibe with high-intensity statin monotherapy in ASCVD patients. RESULTS: In the 13 included studies, involving 8,592 patients, of which 4,525 (52.67%) received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 12 to 219 weeks, with participant ages varying from 66 to 76.5 years in the MIS+EZT group and from 67 to 75.9 years in the HIS group. Analysis revealed significant MIS+EZT-associated with greater percentages in Low Density Lipoprotein (LDL) < 70 (Odds Ratio (OR) 1.76; 95% CI [1.26; 2.45]; p=0.001; I²=73%), LDL reduction (Mean Difference (MD) -5.05 mg/dL; 95% CI [-9.02;-1.07]; p< 0.013; I²=56%;); Total Cholesterol reduction (MD -7.91 mg/ dL; 95% CI [-14.90; -0.91]; p< 0.027; I²=60%); Triglycerides reduction (MD -8.20 mg/ dL; 95% CI [-13.05; -3.35]; p< 0.001; I²=2%;); There was no statistical difference between groups in Drug Adverse reaction (Risk Ratio (RR) 1.19; 95% CI [0.79; 1.78]; p=0.404; I²=0%); and Drug intolerance (RR 0.78 ; 95% CI [0.32; 1.92]; p=0.584; I²=35%). CONCLUSIONS: This meta-analysis underscores the effectiveness of MIS+EZT in enhancing significant clinical outcomes for ASCVD patients, as evidenced by improvements in a greater percentage of patients achieved the LDL < 70 target, LDL, Total Cholesterol and Triglycerides levels . Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.

HIV and cardiovascular risk: should we use other targets for cholesterol control? Brazilian data compared to major studies

In daily clinical practice, cardiologists are confronted with patients with HIV/AIDS and this population needs special attention due to their higher cardiovascular risk. Studies show an increase in cardiovascular disease (CVD) among people with HIV/AIDS and one of the main causes of death in this group. HIV is associated with dyslipidaemia and endothelial damage, which have been proposed as a cause of the increased risk of events, and HIV replication is a determining factor in endothelial dysfunction. With antiretroviral therapy (ART) there has been a reduction in morbidity and mortality from HIV/AIDS, however, several studies have shown an increase risk factors for CVD in this population, both in individuals on ART and those not on it. Two high-impact studies related to cardiovascular risk in the HIV population are Start and Smart. Studies are important for understanding this occurrence and its relationship with the presence of the virus and the use of antiretroviral therapy in this population. In view of the higher cardiovascular risk of these patients and the question of whether they deserve a different cholesterol target from other populations. METHODS: A retrospective, observational study was carried out on a sample of HIV patients from the Brazilian STD/AIDS Reference Centre (CRT), selected by lottery using their registration number, from 1 January 2011 to February 2023, aged over 18. 148 medical records were assessed and the following were collected population characteristics. DISCUSSION: the CRT data were compared with the Start and Smart studies. The Reprieve study showed benefits earlier than expected with patients receiving a statin. An interim analysis revealed a 35 per cent reduction in serious adverse cardiovascular events in the statin group, leading to the placebo group stopping earlier. The viral load varied between the studies, with CRT having an average of 500,000 copies/ml, Start 12,759 copies/ml and Smart less than 400 copies/ml. Studies have associated HIV infection and higher viral loads with impaired endothelial function and vasodilation. Despite the data in the literature, all the patients with heart disease had undetected viral loads and CD4+ cell counts above 500 cells/mm³. Those with a high viral load in the study were not the ones with CVD. CONCLUSIONS: In CRT, the percentage of primary events attributable to serious conditions unrelated to AIDS was 1.3 per cent. Analysing biomarkers could elucidate the effects of antiretroviral therapy on arterial disease. Another fact that probably justifies the low occurrence of cardiovascular and cerebral events in CRT is the multidisciplinary care given to patients, providing intensive primary and secondary prevention through counselling and follow-up. We suggest better control of cardiovascular risk factors with multi-professional intervention and more aggressive targets for the control of comorbidities.

Fatores de risco, manejo e evolução após primeiro infarto agudo do miocárdio: Um estudo de mundo real comparando coortes de mulheres e homens na rede TriNetX / Risk Factors, Management, and Evolution after the First Acute Myocardial Infarction: A Real-World Study Comparing Cohorts of Women and Men in the TriNetX Network

FUNDAMENTO: Estudos de coorte internacionais têm consistentemente demonstrado ao longo das últimas décadas um prognóstico desfavorável em pacientes do sexo feminino após o primeiro infarto agudo do miocárdio. No entanto, dados nacionais sobre esse tema são limitados. OBJETIVOS: O presente estudo tem como objetivo comparar coortes nacionais de homens e mulheres hospitalizados devido ao primeiro infarto agudo do miocárdio (IAM), examinando os desfechos a longo prazo. MÉTODOS: Estudo retrospectivo, observacional, com dados de mundo real extraídos da plataforma global TriNetX, incluindo pacientes de ambos os sexos com diagnóstico confirmado de IAM por classificação internacional de doenças (CID), versão 11, código I21. O nível de significância estatística adotado na análise foi de 5% (0,05). O desfecho primário avaliado foi composto por óbito, nova hospitalização por IAM, procedimentos de revascularização miocárdica, ou insuficiência cardíaca após fase hospitalar e com seguimento de 5 anos. RESULTADOS: Foram avaliados dados de 29.041 pacientes, dos quais 11.284 (38,4%) eram mulheres. A idade média das populações feminina e masculina foi, respectivamente, 64,4 e 59,8 anos. O grupo de mulheres apresentou maior ocorrência do desfecho combinado de óbito, nova hospitalização por IAM, procedimentos de revascularização miocárdica, ou insuficiência cardíaca após fase hospitalar e com seguimento de 5 anos (OR 1.058; IC 1.005 - 1.113; p = 0,03). CONCLUSÃO: Nesta grande coorte brasileira, o sexo feminino foi associado a maior ocorrência de eventos cardiovasculares em período de 5 anos após a alta hospitalar.

Virtual simulation for teaching cardiology in nursing: a scoping review protocol.

INTRODUCTION: Virtual simulation (VS) can be an effective learning strategy in the context of nursing education on cardiovascular disease; however, its use in teaching cardiology in nursing is less studied. The objective of this scoping review is to map the use of VS for teaching cardiology in nursing. METHODS AND ANALYSIS: This scoping review will be conducted according to the Joanna Briggs Institute methods, and the results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Eight databases will be searched: MEDLINE (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature, Web of Science, Latin American and Caribbean Literature in Health Sciences, Spanish Bibliographic Index of Health Sciences, Database of Nursing, EMBASE and Google Scholar from inception to 31 July 2024. This study will include any existing peer-reviewed literature and grey literature. There will be no time or language restrictions. Two reviewers will screen and select the articles independently, and when there are differences, they will be resolved with a third opinion. When appropriate, broad themes and categories derived from the review questions will be accompanied by other illustrative formats (eg, tables or graphs, word clouds and infographics). ETHICS AND DISSEMINATION: This research project does not require ethical committee approval. The study is part of a cooperative research project between researchers from the Federal University of Piauí, Northeast of Brazil, and Queen's University, Ontario, Canada, to develop and seek evidence of content validity of a VS game about valvular heart disease. The protocol and review will be published in peer-reviewed journals. REGISTRATION DETAILS: Open Science Framework (https://doi.org/10.17605/OSF.IO/S3UMH).

Machine learning-based risk prediction for major adverse cardiovascular events in a Brazilian hospital: Development, external validation, and interpretability.

BACKGROUND: Studies of cardiovascular disease risk prediction by machine learning algorithms often do not assess their ability to generalize to other populations and few of them include an analysis of the interpretability of individual predictions. This manuscript addresses the development and validation, both internal and external, of predictive models for the assessment of risks of major adverse cardiovascular events (MACE). Global and local interpretability analyses of predictions were conducted towards improving MACE's model reliability and tailoring preventive interventions. METHODS: The models were trained and validated on a retrospective cohort with the use of data from Ribeirão Preto Medical School (RPMS), University of São Paulo, Brazil. Data from Beth Israel Deaconess Medical Center (BIDMC), USA, were used for external validation. A balanced sample of 6,000 MACE cases and 6,000 non-MACE cases from RPMS was created for training and internal validation and an additional one of 8,000 MACE cases and 8,000 non-MACE cases from BIDMC was employed for external validation. Eight machine learning algorithms, namely Penalized Logistic Regression, Random Forest, XGBoost, Decision Tree, Support Vector Machine, k-Nearest Neighbors, Naive Bayes, and Multi-Layer Perceptron were trained to predict a 5-year risk of major adverse cardiovascular events and their predictive performance was evaluated regarding accuracy, ROC curve (receiver operating characteristic), and AUC (area under the ROC curve). LIME and Shapley values were applied towards insights about model interpretability. FINDINGS: Random Forest showed the best predictive performance in both internal validation (AUC = 0.871 (0.859-0.882); Accuracy = 0.794 (0.782-0.808)) and external one (AUC = 0.786 (0.778-0.792); Accuracy = 0.710 (0.704-0.717)). Compared to LIME, Shapley values suggest more consistent explanations on exploratory analysis and importance of features. CONCLUSIONS: Among the machine learning algorithms evaluated, Random Forest showed the best generalization ability, both internally and externally. Shapley values for local interpretability were more informative than LIME ones, which is in line with our exploratory analysis and global interpretation of the final model. Machine learning algorithms with good generalization and accompanied by interpretability analyses are recommended for assessments of individual risks of cardiovascular diseases and development of personalized preventive actions.

Nattokinase as an adjuvant therapeutic strategy for non-communicable diseases: a review of fibrinolytic, antithrombotic, anti-inflammatory, and antioxidant effects.

INTRODUCTION: Nattokinase (NK) is the primary ingredient of natto, a traditional Asian food made from fermented soybean by Bacillus subtilis natto. Studies have shown that natto reduces the risk of cardiovascular disease (CVD) mortality due to its fibrinolytic and antithrombotic properties. A new field of studies also demonstrates that NK can mitigate molecular pathways related to inflammation and oxidative stress and can be considered an adjuvant strategy for use in many non-communicable diseases (NCDs). This paper is a narrative review of the literature. A search was conducted in PubMed and ScienceDirect up to July 2024. AREAS COVERED: This review discusses the possible effects of NK on mitigating the common complications of NCDs, such as inflammation and oxidative stress. In addition, it provides an update on the most addressed areas related to NK's fibrinolytic and antithrombotic activities. EXPERT OPINION: Due to the fibrinolytic and antithrombotic activity of nattokinase, and more recently added to the anti-inflammatory and antioxidant effects, this enzyme can be used as a new adjuvant therapeutic strategy to mitigate inflammation and oxidative stress in NCDs, including CVD.

Importance of the Hemoglobin Glycation Index for Risk of Cardiovascular and Microvascular Complications and Mortality in Individuals with Type 2 Diabetes.

BACKGRUOUND: This study investigated the prognostic importance of the hemoglobin glycation index (HGI) for macrovascular and microvascular outcomes, mortality, and hypoglycemia occurrence in a type 2 diabetes cohort and compared it to glycated hemoglobin (HbA1c). METHODS: Baseline and mean first-year HGI and HbA1c, and the variability thereof, were assessed in 687 individuals with type 2 diabetes (median follow-up, 10.6 years). Multivariable Cox regression was conducted to evaluate the associations of HGI and HbA1c parameters with macrovascular (total and major cardiovascular events) and microvascular outcomes (microalbuminuria, advanced renal failure, retinopathy, and peripheral neuropathy), mortality (all-cause and cardiovascular), and moderate/severe hypoglycemia occurrence. RESULTS: During follow-up, there were 215 total cardiovascular events (176 major) and 269 all-cause deaths (131 cardiovascular). Microalbuminuria developed in 126 patients, renal failure in 104, retinopathy in 161, and neuropathy in 177. There were 90 hypoglycemia episodes. Both HGI and HbA1c predicted all adverse outcomes, except microalbuminuria and hypoglycemia. Their adjusted risks were roughly equivalent for all outcomes. For example, the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), estimated for 1 standard deviation increments, of mean first-year HGI were 1.23 (1.05 to 1.44), 1.20 (1.03 to 1.38), 1.36 (1.11 to 1.67), 1.28 (1.09 to 1.67), and 1.29 (1.09 to 1.54), respectively, for cardiovascular events, all-cause mortality, renal failure, retinopathy, and neuropathy; whereas the respective HRs (95% CIs) of mean HbA1c were 1.31 (1.12 to 1.53), 1.28 (1.11 to 1.48), 1.36 (1.11 to 1.67), 1.33 (1.14 to 1.55), and 1.29 (1.09 to 1.53). CONCLUSION: HGI was no better than HbA1c as a predictor of adverse outcomes in individuals with type 2 diabetes, and its clinical use cannot be currently advised.

Screen time, sleep duration, leisure physical activity, obesity, and cardiometabolic risk in children and adolescents: a cross-lagged 2-year study.

BACKGROUND: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up. METHODS: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented. RESULTS: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016. CONCLUSION: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.

Cardiovascular Health Among Young Men and Women in Puerto Rico as Assessed by the Life's Essential 8 Metrics.

BACKGROUND: Cardiovascular health (CVH) in young adulthood is associated with CVD in later life, yet CVH in young adults in the United States falls below ideal levels, with noticeable sex differences. Research on CVH in young adults in Puerto Rico is scarce. This study examined CVH and sex differences in CVH in a large cohort of young adults in Puerto Rico. METHODS AND RESULTS: Data from 2162 Puerto Rican young adults aged 18 to 29 residing in PR were obtained from the PR-OUTLOOK (Puerto Rico Young Adults' Stress, Contextual, Behavioral, and Cardiometabolic Risk) study (2020-2023). Participants were recruited through various media and community outreach. CVH scores, graded on a 0 (worst) to 100 (best) scale, were derived from survey responses, physical exams, and laboratory assays. Linear regression with the margins postestimation command was used to determine adjusted means (95% CIs) for CVH scores by sex, controlling for age, marital status, education, childhood material deprivation, subjective social status, health insurance, and depressive symptoms. CVH was less than ideal (score<80) in 72.6% of the cohort (70.5% of women, 75.9% of men, P<0.05). Men had a significantly lower adjusted mean overall CVH score than women (70.7 versus 73.0) and lower adjusted mean scores for nicotine exposure (78.3 versus 86.7), non-high-density lipoprotein cholesterol (80.6 versus 86.4), and blood pressure (79.5 versus 92.2). Women had a significantly lower adjusted mean physical activity score compared with men (50.4 versus 59.5). CONCLUSIONS: Less-than-ideal CVH is notable among young adults, with men having worse CVH than women. These identified sex differences warrant further investigation and the design of interventions to enhance and preserve CVH.

The EAT-Lancet diet associated cardiovascular health parameters: evidence from a Brazilian study.

BACKGROUND: The EAT-Lancet diet is a diet aimed at promoting population and planetary health from the perspective of sustainable diets in terms of environmental and health aspects. This study aimed to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors among adults and elderly individuals in a capital city in the northeastern region of Brazil. METHODS: This is an analytical cross-sectional observational study from a population-based sample conducted between 2019 and 2020, involving 398 non-institutionalized adults and elderly people, of both sexes from "Brazilian Usual Consumption Assessment" study (Brazuca-Natal). There was a 38% response rate due to the suspension of data collection due to the covid-19 pandemic, but According to the comparative analysis of socioeconomic and demographic variables between the surveyed and non-surveyed sectors, losses were found to be random (p = 0.135, Little's MCAR test). Socioeconomic and lifestyle data, anthropometric measurements, and dietary consumption were collected. We used the Planetary Health Diet Index (PHDI) and the Cardiovascular Health Diet Index (CHDI) for cardiovascular health to assess adherence to the diet's sustainability. The evaluated cardiometabolic parameters included fasting blood glucose, triglycerides, total cholesterol, HDL-C, LDL-C, and systolic and diastolic blood pressure measurements. We also assessed the presence of type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. For the data analyses, sample weights and the effect of the study design were taken into account. Pearson's chi-square test was used to evaluate the statistical significance of frequencies. Multiple linear regression models assessed the associations between PHDI and CHDI and its components and the cardiometabolic parameters. RESULTS: The mean PHDI was 29.4 (95% CI 28.04:30.81), on a total score ranging from 0 to 150 points and the mean CHDI was 32.63 (95% CI 31.50:33.78), on a total score ranging from 0 to 110 points. PHDI showed a significant positive association with the final CHDI score and components of fruits, vegetables, and legumes, and a negative association with Ultra-processed Food (UPF) (p < 0.05). Notably, among the most consumed UPF, the following stand out: "packaged snacks, shoestring potatoes, and crackers" (16.94%), followed by margarine (14.14%). The PHDI exhibited a significant association with diabetes and dyslipidemia, as well as with systolic blood pressure, total cholesterol, and LDL-C. CONCLUSIONS: The results suggest that adopting the EAT-Lancet diet is associated with the improvement of key cardiovascular health indicators.

The decreased left ventricular ejection fraction in patients using trastuzumab deruxtecan for her2-positive breast cancer: a systematic review and meta-analysis

Breast Cancer (BC) is one of the most common cancers diagnosed in population femmale and it has several subtypes, one of them being theexpressing human epidermal growth factor receptor 2 positive (HER2 +), one of the treatments for HER2+ breast cancer consists of chemotherapy plus trastuzumab deruxtecan. Several clinical trials have shown the effectiveness and safety of trastuzumabe deruxtecano in cancer patients, however, several Adverse Events (AEs) have been described and the decrease in left ventricular ejection has been singled out for more prominent analysis. Objective: We conducted a systematic review and meta-analysis to investigate the cardiovascular effects of Trastuzumab Deruxtecano and whether it can influence the appearance of reduced left ventricular ejection fraction.. METHODS: We performed a systematic search in Embase, PubMed and Cochrane databases for randomized controlled trials (RCTs) showed a decrease in left ventricular ejection fraction in patients using trastuzumab deruxtecan against Her-2-positive breast cancer compared to patients to used another's treatments against this disease. Mean difference (MD) with 95% confidence intervals (CI) were calculated using a random effects model. The heterogeneity was examined in the I2 statistic. P-values > 0.05 were considered statistically significant. The statistical analysis was carried out using R software version 4.2.3. RESULTS: A total of 3 RCTs were included, with a total of 1656 patients evaluated, 928 patients randomized to the use of Trastuzumab Deruxtecan and 728 patients to the use of other treatments according to medical choice, follow-up ranged from 10 to 38 months. There was a visible in the decrease in left ventricular ejection fraction, with a higher incidence in the group that used trastuzumab compared to the placebo group (RR: 5.73%; 95% CI 1.51 - 21.78; I2 33% ; P= 0.010466). Another important point is the discontinuation of treatment due to grade 2 adverse events, classified as reduced LVEF, where a higher incidence is seen in the group that used Trastuzumab Deruxtecan compared to the placebo group (RR 2.11%; 95% CI 1.54 - 2.89; P = 0.000003),7. CONCLUSION: In this meta-analysis, Trastuzumab Deruxtecan showed a relationship with a decrease in left ventricular ejection fraction, displaying the need for more studies to evaluate the cardiotoxicity of trastuzumab and its effects as a whole on the cardiovascular system.