RESUMO
BACKGROUND: Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle-brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied. OBJECTIVE: The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients. PATIENTS AND METHODS: This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD). RESULTS: The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=-0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively). CONCLUSION: The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease.
RESUMO
BACKGROUND: The benefit of statins in the reduction of cardiovascular events was demonstrated in several placebo-controlled trials. More intensive therapy seems to be associated with greater benefit. Our objective was to compare different statin doses in the reduction of cardiovascular events and deaths, combining direct and indirect evidence, through mixed treatment comparisons (MTC). METHODS: We conducted a systematic review in MEDLINE and Cochrane CENTRAL. A random-effects Bayesian MTC model was used to combine placebo-controlled and direct statin comparison trials. Intensity of statin doses was classified according to expected LDL-cholesterol reduction effect: ≤30% as low; 30-40%, intermediate, and ≥40%, high. Outcomes evaluated were non-fatal myocardial infarction (MI), stroke, coronary revascularization and coronary, cardiovascular and all-cause death. Inconsistency was assessed with split-node methodology. RESULTS: 47 trials (11 with direct statin comparisons) were included. High doses reduced non-fatal MI by 28% (95% CI: 18%-36%) and by 14% (7%-21%) when compared to low and intermediate doses, respectively. High doses also diminished revascularization [RR versus low and intermediate doses of 0.81 (0.69-0.95) and 0.88 (0.77-0.99), respectively] and stroke [RR of 0.83 (0.68-0.99) against low doses]. Regimen intensity did not change death rates (e.g., for all-cause mortality, RRs of 0.93 (0.80-1.06) and 0.98 (0.87-1.08) for high vs. low and intermediate doses, respectively). No statistical inconsistencies were found in the analyses. CONCLUSIONS: In this study, in which all available evidence from statin trials was simultaneously analyzed, the benefit of more intensive therapy was restricted to non-fatal events.
