APOLLO I: Anticoagulation control in atrial fibrillation.

INTRODUCTION AND AIMS: Anticoagulation control as assessed by time in therapeutic range (TTR) correlates positively with the safety and efficacy of thromboprophylaxis in atrial fibrillation. We set out to assess TTR in our unit and to investigate determinants of better control. METHODS: This was a case series study of atrial fibrillation patients anticoagulated with warfarin or acenocoumarol at the Family Health Unit of Fânzeres. Sociodemographic and clinical data were collected and TTR was calculated by the Rosendaal method, based on international normalized ratio tests performed in external laboratories in the preceding six months. SPSS 21.0 was used for the statistical analysis, with descriptive statistics, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Of the 106 eligible patients, 70% participated in the study. Median TTR was 65.3% (P25=48.3%, P75=86.8%). We found a positive association between this variable and duration of atrial fibrillation (ρ=0.477, p<0.001, r(2)=0.116) and with duration of anticoagulation (ρ=0.5, p<0.001, r(2)=0.087). No association was found with age, gender, educational level or existence of a caregiver (p>0.05). CONCLUSIONS: Median TTR in our unit is similar to that in southern European countries and close to the good control threshold (70%) proposed by the European Society of Cardiology. The duration of atrial fibrillation and of anticoagulation explains only a small part of the measure's variability. Other determinants of anticoagulation control must be investigated in future studies and comparative studies should be carried out in family health units monitoring anticoagulation on the premises.

Genetic polymorphisms of angiotensin-I converting enzyme, haptoglobin and angiotensinogen and oxidative stress parameters in 12 to 15-year-old adolescents.

BACKGROUND: Angiotensin-converting enzyme (ACE) I/D, haptoglobin (Hp) 1/2 and angiotensinogen (AGT) M235T gene polymorphisms have been associated with the risk of various cardiovascular conditions. Oxidative stress and reactive oxygen species have also been implicated in endothelial injury. In a randomly selected sample of healthy adolescents, we studied the relationship between these genetic polymorphisms and somatic characteristics, blood pressure and certain biochemical markers of oxidative stress. METHODS: A sample of 49 healthy adolescents were genotyped for ACE I/D, Hp 1/2 and AGT M235T polymorphisms. Anthropometric parameters, blood pressure and lipid profile were evaluated using internationally recommended methods. Serum ACE activity and oxidative stress markers were determined either by spectrophotometric methods or with commercially available kits. RESULTS: Males had higher values for ACE activity than females (p < 0.01). The haptoglobin Hp allele 1 and the ACE D allele were associated with higher ACE activity (p < 0.05 and p < 0.001). ACE activity was similar between AGT genotypes. Higher levels of MDA-LDL/Apo B were observed in individuals with both ACE DD and Hp 2-2 genotypes. Carriers of the AGT TT genotype showed higher diastolic blood pressures than other AGT genotypes. CONCLUSION: Carriers of both ACE DD and Hp 2-2 genotypes have a higher pro-oxidant status and AGT TT carriers have higher diastolic blood pressures, which may indicate a higher risk for development of hypertension in these individuals.