RESUMO
OBJECTIVES: To determine the impact of moderate alcohol consumption on long term prognosis after successful coronary stenting, and whether it could be related to preprocedural plasma C reactive protein (CRP). DESIGN: Part of the prospectively designed GENERATION study which investigated the impact of several biochemical factors, including plasma CRP, on long term prognosis after coronary stenting. SETTING: Tertiary referral centre. PATIENTS: 483 consecutive patients with stable or unstable coronary artery disease who underwent successful coronary stenting and were followed for up to four years. Information about alcohol consumption was collected prospectively. INTERVENTIONS: Successful coronary stenting. MAIN OUTCOME MEASURES: The incidence of the composite end point of readmission to hospital for unstable angina, non-fatal myocardial infarction, or cardiac death, whichever occurred first. RESULTS: By the end of follow up the incidence of the composite end point was 22.8%. Patients with a baseline plasma CRP concentration of < 0.68 mg/dl (defined by ROC analysis) did not show any difference in the composite end point (p = 0.9) or its components, regardless of the amount of alcohol consumed during follow up. However, among patients with plasma CRP concentration of > or = 0.68 mg/dl, those who drank moderately had a lower incidence of the composite end point (p < 0.001) or its components. CONCLUSIONS: Moderate alcohol consumption may have a beneficial impact on the long term prognosis following successful coronary stenting. The extent of this effect is positively related to preprocedural inflammatory status. An anti-inflammatory action of moderate alcohol consumption cannot be excluded.
Assuntos
Consumo de Bebidas Alcoólicas/mortalidade , Proteína C-Reativa/análise , Doença da Artéria Coronariana/cirurgia , Stents , Consumo de Bebidas Alcoólicas/sangue , Angina Instável/sangue , Angina Instável/mortalidade , Angina Instável/cirurgia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Prognóstico , Estudos Prospectivos , Análise de SobrevidaRESUMO
Provision of health care is frequently ineffective because providers of service do not understand the culture of the ethnic groups they are treating. The aim of the program described in this article was to break down cultural and communication barriers by teaching health care personnel about the attitudes, beliefs, and behaviors of various ethnic groups.