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1.
Clin Chim Acta ; 495: 394-398, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075237

RESUMO

BACKGROUND: Metabolic syndrome (MetS) is a group of risk factors that increase the risk for heart disease. Little is known about the role of IL-10 in the severity of coronary artery disease (CAD) in patients with MetS. We investigated plasma levels of IL-10 and other pro-inflammatory cytokines in patients with MetS with or without severe CAD. METHODS: Cross-sectional study with healthy and MetS individuals. IL-10 and other pro-inflammatory interleukins were analyzed in 90 subjects divided into 3 groups: group 1 (n = 30), patients with MetS without severe CAD; group 2 (n = 30), patients with MetS and severe CAD (history of myocardial infarction or revascularization performed through surgery or percutaneous transluminal coronary angioplasty with or without stent placement); and group 3 (n = 30), healthy individuals. RESULTS: Levels of IL-12 (p = .018), TNF-α (p = .007) and IL-6 (p = .010) were significantly higher in group 1 when compared to group 3 (p = .003; p = .002; p = .001, respectively). In addition, group 1 presented significantly higher levels of IL-12 (p = .019), TNF-α (p = .026) and IL-6 (p = .020) when compared to group 2. IL-10 levels were significantly higher in group 1 (p = .003) when compared to group 2 (p = .014) and group 3 (p < .001). Only the level of IL-10 was significant to explain the presence of severe CAD, as a protective factor (OR: 0.896; 95%CI: 0.818-0.981) in the logistic regression model. CONCLUSIONS: Higher IL-10 levels in patients with MetS are associated with lower incidence of severe CAD, suggesting a protective effect through its anti-inflammatory activity even in the presence of higher levels of pro-inflammatory cytokines.

2.
PLoS One ; 14(4): e0214722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30958836

RESUMO

PURPOSE: To estimate the effect size of a serious game for cardiopulmonary resuscitation (CPR) training in comparison with a video-based on-line course in terms of learning outcomes among medical students before simulation-based CPR using a manikin. METHODS: Participants were 45 first-year medical students randomly assigned to CPR self-training using either a video-based Apple Keynote presentation (n = 22) or a serious game developed in a 3D learning environment (n = 23) for up to 20 min. Each participant was evaluated on a written, multiple-choice test (theoretical test) and then on a scenario of cardiac arrest (practical test) before and after exposure to the self-learning methods. The primary endpoint was change in theoretical and practical baseline scores during simulated CPR. This study was conducted in 2017. RESULTS: Both groups improved scores after exposure. The video group had superior performance in both the theoretical test (7.56±0.21 vs 6.51±0.21 for the game group; p = 0.001) and the practical test (9.67±0.21 vs 8.40±0.21 for the game group; p < 0.001). However, students showed a preference for using games, as suggested by the longer time they remained interested in the method (18.57±0.66 min for the game group vs 7.41±0.43 for the video group; p < 0.001). CONCLUSIONS: The self-training modality using a serious game, after a short period of exposure, resulted in inferior students' performance in both theoretical and practical CPR tests compared to the video-based self-training modality. However, students showed a clear preference for using games rather than videos as a form of self-training.

4.
Acta méd. (Porto Alegre) ; 39(1): 65-71, 2018.
Artigo em Português | LILACS | ID: biblio-910229

RESUMO

Novos fármacos para o tratamento da hipercolesterolemia foram desenvolvidos, que poderão ser incorporadas nas diretrizes, resultantes de estudos clínicos robustos que demonstraram redução de desfechos cardiovasculares adicionais aos resultados obtidos com a otimização terapêutica disponível com as estatinas. O objetivo deste artigo é atualizar o conhecimento para o tratamento das dislipidemias baseado nas melhores evidências e as novas opções terapêuticas para reduzir o risco de eventos cardiovasculares em pacientes com dislipidemia refratária à otimização do tratamento atual.


New drugs for dyslipidemia treatment have been developed in solid clinical studies, which demonstrated an additional reduction of cardiovascular outcomes compared to therapeutic treatment with statins, and might be incorporated in new treatment guidelines. The aim of this article is to update the knowledge for the treatment of dyslipidemias based on the best evidences and the new therapeutic options incorporated to reduce the risk of cardiovascular events in patients with dyslipidemia refractory to treatment optimization.


Assuntos
LDL-Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia/tratamento farmacológico
5.
Circ Heart Fail ; 10(11)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29141857

RESUMO

BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies. METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher. CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies. CLINICAL TRIAL REGISTRATION: PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Cardiomiopatia Chagásica/complicações , Insuficiência Cardíaca/tratamento farmacológico , Idoso , Amidas/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Fármacos Cardiovasculares/efeitos adversos , Cardiomiopatia Chagásica/mortalidade , Cardiomiopatia Chagásica/virologia , Feminino , Fumaratos/uso terapêutico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/virologia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , América Latina , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos
6.
Arq. bras. cardiol ; 108(1): 60-69, Jan. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-838677

RESUMO

Abstract Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.


Resumo Fundamento: Programas de intervenção em estilo de vida podem reduzir a prevalência de síndrome metabólica (SM) e, portanto, diminuir o risco de doença cardíaca, um dos principais problemas de saúde pública da atualidade. Objetivo: Comparar os efeitos de três tipos de abordagem para programas de mudança no estilo de vida visando à redução dos parâmetros metabólicos, assim como identificar seu impacto na qualidade de vida (QV) de indivíduos com SM. Métodos: Estudo randomizado controlado incluindo 72 indivíduos com SM com idade de 30 a 59 anos, que foram randomizados em três grupos de intervenção multidisciplinar [Intervenção Padrão (IP) - grupo controle; Intervenção em Grupo (IG); e Intervenção Individual (II)] por 12 semanas. O desfecho primário foi a mudança nos parâmetros metabólicos, e o secundário, a melhora nas medidas de QV em três momentos: condição basal, aos 3 e aos 9 meses. Resultados: As intervenções IG e II resultaram em uma significativa redução em índice de massa corporal, circunferência abdominal e pressão arterial sistólica, e em melhoras da QV aos 3 meses, embora significativamente associadas com o domínio 'capacidade funcional'. Tais mudanças, entretanto, não permaneceram 6 meses após o final da intervenção. Depressão e ansiedade associaram-se significativamente com pior QV, embora sem efeito na resposta à intervenção. Conclusão: A intervenção multidisciplinar, em especial em grupo, pode ser uma estratégia efetiva e economicamente possível para controlar os parâmetros metabólicos de SM e melhorar a QV quando comparada à IP, mesmo em uma relação de dose-efeito.

7.
Curr Med Res Opin ; 33(2): 239-251, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27776432

RESUMO

In the last two decades, statin therapy has proved to be the most potent isolated therapy for attenuation of cardiovascular risk. Its frequent use has been seen as one of the most important elements for the reduction of cardiovascular mortality in developed countries. However, the recurrent incidence of muscle symptoms in statin users raised the possibility of causal association, leading to a disease entity known as statin associated muscle symptoms (SAMS). Mechanistic studies and clinical trials, specifically designed for the study of SAMS have allowed a deeper understanding of the natural history and accurate incidence. This set of information becomes essential to avoid an unnecessary risk of severe forms of SAMS. At the same time, this concrete understanding of SAMS prevents overdiagnosis and an inadequate suspension of one of the most powerful prevention strategies of our times. In this context, the Luso-Latin American Consortium gathered all available information on the subject and presents them in detail in this document as the basis for the identification and management of SAMS.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Fatores de Risco
8.
Arq Bras Cardiol ; 108(1): 60-69, 2017 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-27982160

RESUMO

BACKGROUND: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. OBJECTIVE: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. METHODS: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. RESULTS: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. CONCLUSION: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.


Assuntos
Estilo de Vida , Síndrome Metabólica/terapia , Qualidade de Vida , Comportamento de Redução do Risco , Adulto , Antropometria , Ansiedade/fisiopatologia , Pressão Sanguínea/fisiologia , Depressão/fisiopatologia , Dietoterapia/métodos , Escolaridade , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Estado Civil , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Rev Lat Am Enfermagem ; 24: e2848, 2016 11 28.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-27901223

RESUMO

Objectives: to present currently available evidence to verify the association between metabolic syndrome and quality of life. Method: Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. Results: a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. Conclusion: although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.


Assuntos
Síndrome Metabólica , Qualidade de Vida , Humanos
10.
Sci. med. (Porto Alegre, Online) ; 26(3): ID23184, jul-set 2016.
Artigo em Inglês | LILACS-Express | ID: biblio-846583

RESUMO

AIMS: Despite all progress made in understanding and treating metabolic syndrome, the study of its impact on quality of life is still controversial and not well understood. The aim of this study was to test the hypothesis that metabolic syndrome can be associated with a worse quality of life. MESTHODS: A controlled cross-sectional study included individuals with metabolic syndrome, from the sub-analysis of a randomized clinical trial about lifestyle modification and cardiovascular risk factors, as well as individuals with no metabolic syndrome, attended as outpatients in several clinics at a general university hospital in Southern Brazil. Measurements were made in individual interviews and included data collection, laboratory tests, and application of general scales such as Mini-Mental State Examination and Medical Outcomes Study Short Form, General Health Survey (SF-36). Comparisons of quantitative data used the Student's t test, followed by analysis of covariance or multiple linear regression for adjustment, and correlation coefficient. For categorical data, the Chi-square or Fisher's exact test were used. RESULTS: The study included 229 individuals, 118 metabolic syndrome and 111 no metabolic syndrome. In univariate analysis, metabolic syndrome was significantly associated with lower scores in the social functioning (p<0.001) and role emotional (p=0.019) quality of life domains, and with the Mental Component Summary score of the SF-36 (p=0.013). However, after adjustments for confounding factors, especially body mass index, the significance of these associations was lost. The only significant association between metabolic syndrome and quality of life that has remained after the adjustments was with worse QOL in the role emotional domain, but only in men (p=0.049). CONCLUSIONS: After adjusting for multiple variables, metabolic syndrome was significantly associated with decreased quality of life scores in men in the role emotional domain.


OBJETIVOS: Apesar dos avanços no entendimento e tratamento da síndrome metabólica, o estudo do seu impacto sobre a qualidade de vida é ainda controverso e inconclusivo. O objetivo deste estudo foi testar a hipótese de que a síndrome metabólica estaria associada à piora da qualidade de vida. MÉTODOS: Um estudo transversal controlado incluiu indivíduos com síndrome metabólica, advindos da subanálise de um estudo controlado randomizado sobre modificação de estilo de vida e fatores de risco cardiovascular; e indivíduos sem síndrome metabólica, provenientes de diversos ambulatórios de um hospital geral no sul do Brasil. As medidas foram realizadas em entrevistas individuais, que incluíram coleta de dados demográficos, testes laboratoriais e aplicação do Exame do Estado Mental e o Medical Outcome Study Short Form, General Health Survey (SF-36). Para comparações entre dados quantitativos, foram utilizados teste t de Student, análise de covariância ou regressão linear múltipla para os ajustes dos fatores confundidores, e coeficiente de correlação. Para dados categóricos foi utilizado o qui quadrado ou o Exato de Fisher quando necessário. RESULTADOS: O estudo incluiu 229 indivíduos, sendo 118 com síndrome metabólica e 111 sem síndrome metabólica. A síndrome metabólica foi significativamente associada com baixos escores de qualidade de vida nos domínios funcionamento social (p<0,001) e aspectos emocionais (p=0,019); e com baixos escores no Componente Sumário da Saúde Mental do SF-36 (p=0,013). Entretanto, após ajustes para os fatores confundidores, especialmente índice de massa corporal, a significância dessas associações foi perdida. A única associação significativa que foi mantida entre síndrome metabólica e qualidade de vida após a análise ajustada foi com o domínio aspectos emocionais, embora somente em homens (p=0,049). CONCLUSÕES: Após o ajuste para múltiplas variáveis, a síndrome metabólica foi significativamente associada com diminuição da pontuação para qualidade de vida em homens, no domínio aspectos emocionais.

11.
Sci. med. (Porto Alegre, Online) ; 26(2): ID22964, abr-jun 2016.
Artigo em Português | LILACS-Express | ID: biblio-846433

RESUMO

OBJETIVOS: Avaliar o perfil lipídico e parâmetros inflamatórios de pacientes com doença de Crohn e retocolite ulcerativa, e correlacionar com os níveis de atividade das doenças. MÉTODOS: Estudo transversal com pacientes acompanhados no Ambulatório de Doença Inflamatória Intestinal do Hospital São Lucas da PUCRS. Foram avaliadas as características demográficas, antropométricas e metabólicas dos pacientes com doença inflamatória intestinal crônica. Avaliaram-se parâmetros lipídios e inflamatórios e analisou-se a correlação entre a gravidade da doença inflamatória e os parâmetros metabólicos, na doença de Crohn pelo índice de Harvey-Bradshaw e na retocolite ulcerativa pelo método de Truelove e Witts. RESULTADOS: Participaram do estudo 122 pacientes de ambos os sexos com doença inflamatória intestinal, estratificados em: doença de Crohn (n=64) e retocolite ulcerativa (n=58). As mulheres representaram 54,1% da amostra, a média de idade foi de 41,6±12,6 anos e a média de índice de massa corporal foi de 25 ± 4,4kg/m2 . O colesterol ligado à lipoproteína de baixa densidade (LDL-c) mostrou-se significativamente mais elevado nos pacientes com retocolite ulcerativa comparando-se aos pacientes com doença de Crohn (p=0,006). A proteína C reativa aumentada esteve associada com maior gravidade do processo inflamatório em pacientes com doença de Crohn (p=0,027), quando analisada pelo índice de Harvey-Bradshaw. Na retocolite ulcerativa, conforme o índice de Truelove e Witts, houve correlação fraca entre atividade da doença e colesterol ligado à lipoproteína de alta densidade (HDL-c) (rs =-0,29; p=0,036) e entre atividade da doença e colesterol total (rs =-0,30; p=0,028). Cerca de dois terços dos pacientes (67,6%) apresentaram o HDL-c abaixo dos valores recomendados. CONCLUSÕES: O LDL-c mostrou-se significativamente mais elevado nos pacientes com retocolite ulcerativa comparados aos pacientes com doença de Crohn. O HDL-c apresentou níveis reduzidos em pacientes com doença inflamatória mais grave na retocolite ulcerativa. A proteína C reativa aumentada em pacientes com doença de Crohn esteve associada com a gravidade do processo inflamatório determinada pelo índice de Harvey-Bradshaw. A detecção dessas alterações metabólicas pode auxiliar na identificação de indivíduos com potencial risco para eventos cardiovasculares.


AIMS: To evaluate the lipid profile and inflammatory parameters in patients with Crohn's disease (CD), and ulcerative colitis (UC) and correlate them with disease activity levels. METHODS: Cross-sectional study of patients followed up at the Inflammatory Bowel Disease Outpatient Clinic of São Lucas Hospital at Pontifícia Universidade Católica do Rio Grande do Sul, Brazil. The demographic, anthropometric, and metabolic characteristics of patients with chronic inflammatory disease were evaluated. Lipids and inflammatory parameters were evaluated as well as the correlation between the severity of inflammatory disease and metabolic parameters using the Harvey-Bradshaw index for CD and Truelove and Witts' method for UC. RESULTS: The study included 122 male and female patients with inflammatory bowel disease classified into CD (n=64) and UC (n=58). Women accounted for 54.1% of the sample, with a mean age of 41.6±12.6 years and a BMI of 25±4.4kg/m2 . Low-density lipoprotein cholesterol (LDL-c) was significantly higher in UC than in CD (p=0.006). Higher C-reactive protein levels were associated with a more severe inflammatory process in CD patients (p=0.027) according to the Harvey-Bradshaw index. In UC, there was a weak correlation between disease activity and high-density lipoprotein cholesterol (HDL-c) (rs =-0.29; p=0.036) and between disease activity and total cholesterol (rs =-0.30; p=0.028) according to Truelove and Witts' index. The HDL-c of about two thirds of the patients (67.6%) was below the recommended values. CONCLUSIONS: LDL-c was significantly higher in patients with UC than in those with CD. HDL-c was lower in patients with more severe inflammatory disease triggered by UC. Increased C-reactive protein levels in CD patients were associated with severity of the inflammatory process determined by the Harvey-Bradshaw index. The detection of these metabolic changes may help identify individuals with potential risk for cardiovascular events.

12.
Rev. latinoam. enferm. (Online) ; 24: e2848, 2016. graf
Artigo em Inglês | LILACS | ID: biblio-960917

RESUMO

ABSTRACT Objectives: to present currently available evidence to verify the association between metabolic syndrome and quality of life. Method: Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. Results: a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. Conclusion: although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.


RESUMO Objetivos: apresentar as evidências disponíveis atuais para verificar a associação entre síndrome metabólica e qualidade de vida. Métodos: Cochrane Library, EMBASE, Medline e LILACS foram as bases de dados consultadas na identificação de todos os estudos que investigavam a associação entre síndrome metabólica e qualidade de vida. Dois revisores de forma independente e cegados extraíram os dados e, em caso de dúvidas, um outro revisor foi escolhido. Resultados: um total de 30 estudos foram incluídos, considerando os critérios de inclusão e exclusão, os quais envolveram 62.063 pacientes. A maioria dos estudos sugerem que a síndrome metabólica é significativamente associada à piora da qualidade de vida. Alguns, no entanto, demonstram associação apenas em mulheres, ou somente se associadas à depressão ou índice de massa corporal. Entretanto, um estudo não demonstrou tal associação, após ajuste para os fatores confundidores. Conclusão: apesar de dispormos de poucos estudos a respeito da relação entre síndrome metabólica e qualidade de vida, um número crescente de evidências tem demonstrado uma significativa associação entre a síndrome metabólica e o prejuízo na qualidade de vida. Entretanto, é necessário que sejam conduzidos estudos longitudinais com objetivo de confirmar esta associação e, determinar se esta relação é linear ou somente um fator de associação.


RESUMEN Objetivo: presentar las evidencias actualmente disponibles para verificar la asociación entre el síndrome metabólico y la calidad de vida. Métodos: se consultaron las bases de datos Cochrane Library, EMBASE, Medline y LILACS para la identificación de todos los estudios que investigaban la asociación entre síndrome metabólico y calidad de vida. Dos revisores de tipo ciego extrajeron los datos y en caso de dudas se eligió un revisor adicional. Resultados: un total de 30 estudios fueron incluidos, llevando en consideración los criterios de inclusión y exclusión, totalizando 62.063 pacientes. La mayoría de los estudios sugieren que el síndrome metabólico esta significativamente asociado al empeoramiento de la calidad de vida. Algunos, sin embargo muestran asociación solamente en mujeres, o sólo asociados a depresión o índice de masa corporal. También un estudio no mostró esta asociación después de ajustar por los factores confundentes. Conclusión: a pesar de tener a disposición pocos estudios en referencia a la relación entre síndrome metabólico y calidad de vida, un número creciente de evidencias ha demostrado una asociación significativa entre síndrome metabólico y perjuicio de la calidad de vida. Sin embargo es necesario que se realicen estudios longitudinales con el objetivo de confirmar esta asociación y determinar si esta relación es linear o solamente un factor de asociación.


Assuntos
Humanos , Qualidade de Vida , Síndrome Metabólica
13.
Artigo em Português | LILACS | ID: biblio-883010

RESUMO

O infarto agudo do miocárdio apresenta incidência crescente no mundo nos últimos anos. A isquemia aguda do miocárdio pode levar a necrose miocárdica e a complicações sistêmicas, até mesmo a morte. O adequado manejo dos pacientes com suspeita de infarto baseia-se na tentativa de reestabelecer o fluxo sanguíneo ao tecido isquêmico, visando interromper o mecanismo de lesão. Ao médico emergencista cabe o total domínio dos algoritmos indicados no caso de IAM, visando a abordagem precoce do paciente e redução de desfechos cardiovasculares.


Myocardial infarction's incidence has been presenting an increasing worldwide in the last years. Acute myocardial ischemia can lead to myocardial necrosis and systemic complications, even death. The adequate management of patients suspected of infarction is based in trying to reestablish the blood flow to the ischemic tissue, owing to interrupt the mechanism of lesion. It is the emergency physician responsibility to have total domain of the myocardial infarction algorithms, looking forward to a quick patient approach and to minimize cardiovascular events.


Assuntos
Doenças Cardiovasculares , Infarto do Miocárdio , Emergências
14.
Arq Bras Cardiol ; 104(5 Suppl 1): 1-26, 2015 Jun.
Artigo em Português | MEDLINE | ID: mdl-26039716
15.
Int. j. cardiovasc. sci. (Impr.) ; 28(2): 101-106, mar.-abr. 2015. tab
Artigo em Inglês, Português | LILACS | ID: lil-762450

RESUMO

Fundamentos: A doença cardiovascular (DCV) é a principal causa de morte nos países em desenvolvimento. Os indivíduos com síndrome metabólica (SM) apresentam risco elevado para DCV. Os fatores de risco tradicionais em conjunto, não explicam todos os eventos cardiovasculares. O fator von Willebrand (FvW), envolvido na agregação plaquetária e trombose, tem sido investigado nesse contexto. Objetivo: Investigar a relação entre FvW e DCV, em pacientes portadores de SM, com e sem eventos cardiovasculares prévios. Métodos: Estudados 77 pacientes ambulatoriais, ≥18 anos, portadores de SM de acordo com os critérios estabelecidos pela NCEP-ATP III. Mediu-se o nível plasmático do FvW e comparou-se os valores médios entre os grupos com DCV prévia (n=30) e sem DCV documentada (n=47). Resultados: Da população estudada, 66,0% eram do sexo feminino, 78,0% de etnia branca, média de idade 63,7±8,9 anos, peso médio 82,9±14,9 kg e índice de massa corpórea 32,2±4,8 kg/m2. O nível plasmático médio do FvW foi similar nos pacientes com e sem DCV prévia, com valores de 154,5±52,1 e 155,47±41,4, respectivamente. Observou-se associação entre o diabetes mellitus (DM) e DCV estabelecida, que permaneceu significativa após ajuste para as demais variáveis incluídas no modelo multivariado. Conclusões: Não houve diferença no nível plasmático médio do FvW entre os pacientes portadores de SM, com e sem DCV documentada. A presença de DM, entretanto, esteve associada de forma independente com DCV nesta população.


Background: Cardiovascular disease (CVD) is the leading cause of death in developing countries. Individuals with metabolic syndrome (MS) are at increased risk for CVD. The traditional risk factors, altogether, do not explain all cardiovascular events. The von Willebrand factor (vWF), involved in platelet aggregation and thrombosis, has been investigated in this context. Objective: To investigate the relationship between the vWF and CVD in patients with MS, with and without previous cardiovascular events. Methods: The study included 77 outpatients, ≥18 years, with MS, according to the criteria established by NCEP-ATP III. The plasma level of vWF was measured and the mean values were compared between the groups with prior CVD (n=30) and without documented CVD (n=47). Results: In the study population, 66.0% were female, 78.0% were white, mean age 63.7±8.9, mean weight 82.9±14.9 kg, and body mass index 32.2±4.8 kg/m2. The average plasma level of vWF was similar in patients with and without previous CVD, with values of 154.5±52.1 and 155.47±41.4, respectively. There was an association between diabetes mellitus (DM) and established CVD, which remained significant after adjusting for other variables included in the multivariate model. Conclusions: There was no difference in the mean plasma level of vWF among patients with MS, with and without documented CVD. The presence of DM, however, was independently associated with CVD in this population.


Assuntos
Humanos , Masculino , Feminino , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Hemostáticos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Fator de von Willebrand , Brasil/epidemiologia , Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Infarto do Miocárdio , Estudo Observacional , Pacientes Ambulatoriais , Fatores de Risco , Fatores Sexuais , Análise Estatística
16.
Artigo em Português | LILACS | ID: biblio-879584

RESUMO

A Hipertensão Arterial Sistêmica é uma das situações mais frequentes na prática clínica, sendo obrigatório para o médico o conhecimento a respeito da sua apresentação e tratamento, independente da especialidade. Este artigo irá revisar as últimas diretrizes de tratamento Hipertensão Arterial Sistêmica em adultos (18 anos ou mais).


High Blood pressure is one of the most frequently situations in the clinical practice, so that it is mandatory to the physician having the knowledge about the presentation and treatment of this pathology irrespective of the medical specialization. This article will review the latest guidelines about the treatment of High Blood Pressure in adults.


Assuntos
Hipertensão , Hipertensão/terapia
17.
Thrombosis ; 2014: 753780, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25349734

RESUMO

Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/- 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.

18.
Rev Bras Cir Cardiovasc ; 29(2): 140-7, 2014 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25140462

RESUMO

OBJECTIVE: To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery. METHODS: A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05. RESULTS: The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001). CONCLUSION: The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Adulto Jovem
19.
Oxid Med Cell Longev ; 2014: 587083, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24967004

RESUMO

OBJECTIVE: The main goal of the present study was to investigate the xanthine oxidase (XO) activity in metabolic syndrome in subjects submitted to a single exercise session. We also investigated parameters of oxidative and inflammatory status. MATERIALS/METHODS: A case-control study (9 healthy and 8 MS volunteers) was performed to measure XO, superoxide dismutase (SOD), glutathione peroxidase activities, lipid peroxidation, high-sensitivity C-reactive protein (hsCRP) content, glucose levels, and lipid profile. Body mass indices, abdominal circumference, systolic and diastolic blood pressure, and TG levels were also determined. The exercise session consisted of 3 minutes of stretching, 3 minutes of warm-up, 30 minutes at a constant dynamic workload at a moderate intensity, and 3 minutes at a low speed. The blood samples were collected before and 15 minutes after the exercise session. RESULTS: Serum XO activity was higher in MS group compared to control group. SOD activity was lower in MS subjects. XO activity was correlated with SOD, abdominal circumference, body mass indices, and hsCRP. The single exercise session reduced the SOD activity in the control group. CONCLUSIONS: Our data support the association between oxidative stress and risk factors for cardiovascular diseases and suggest XO is present in the pathogenesis of metabolic syndrome.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/enzimologia , Exercício , Inflamação/patologia , Síndrome Metabólica/sangue , Síndrome Metabólica/enzimologia , Xantina Oxidase/sangue , Doenças Cardiovasculares/complicações , Feminino , Glutationa Peroxidase/metabolismo , Humanos , Peroxidação de Lipídeos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Oxirredução , Fatores de Risco , Superóxido Dismutase/metabolismo , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo
20.
Arch. latinoam. nutr ; 64(2): 91-98, jun. 2014. ilus, tab
Artigo em Inglês | LILACS | ID: lil-752679

RESUMO

Metabolic Syndrome is a complex clinical condition that brings together a set of cardiovascular risk factors. Lifestyle changes, such as eating habit improvements, are first-choice therapies for the treatment of this clinical condition. This study aimed to evaluate the effect of short-term nutritional counseling, on the diet quality and total energetic value (TEV) in individuals with Metabolic Syndrome. Eighty subjects (men and women) aged 30 to 60 years with metabolic syndrome were followed over three months. The Healthy Eating Index tool adapted to the Brazilian population was used for the evaluation of diet quality. Mean age was 51 + 6 years, and 68.6% were women. The mean score of the dietary quality of the population studied increased significantly from 53.02 to 61.65 after intervention. The amount of individuals classified as Inappropriate Diet decreased significantly six-fold, the amount of individuals classified as Healthy Diet increased four-fold, and the percent of diets classified as Diet that Needs Change decreased by 25% when compared to the beginning of the study. Adequate intake of vegetables was inversely associated to abdominal circumference, as well as adequate intake of sodium and fasting serum insulin. The amount of TEV presented a significant reduction (p <0.000) after intervention. The short-term nutritional counseling showed to be efficient to improve dietary quality. Associations between dietary quality and variables studied highlight the importance of nutritional intervention in individuals with metabolic syndrome.


A Síndrome Metabólica é uma condição clínica complexa que reúne um conjunto de fatores que aumentam o risco cardiovascular. Mudanças no estilo de vida como a melhora dos hábitos alimentares são consideradas terapia de primeira escolha nesta condição clínica. Este estudo tem como objetivo avaliar o efeito de uma intervenção nutricional de curta duração sobre a qualidade da dieta e o valor energético total (VET) em indivíduos com Síndrome Metabólica. Oitenta indivíduos (homens e mulheres) com idades entre 30 a 60 anos, com síndrome metabólica foram acompanhados ao longo de três meses. Para avaliar a qualidade da dieta foi utilizado o instrumento Índice de Alimentação Saudável adaptado para a população brasileira. A média de idade foi de 51 + 6 anos e 68,6% eram mulheres. A pontuação média da qualidade da dieta da população estudada aumentou significativamente de 53,02 para 61,65 após a intervenção. A quantidade de indivíduos classificados como dieta inadequada diminuiu significativamente em seis vezes, a quantidade de indivíduos classificados como dieta saudável aumentou quatro vezes, e a percentagem de dietas classificadas como dieta que necessita modificação diminuiu 25% em relação ao início do estudo. A ingestão adequada de vegetais foi inversamente associada à circunferência abdominal, bem como a ingestão adequada de sódio e insulina sérica de jejum. O VET apresentou uma redução significativa (p <0,000) após a intervenção. O aconselhamento nutricional de curta duração mostrou-se eficiente para melhorar a qualidade da dieta. As associações entre a qualidade da dieta e as variáveis estudadas destacam a importância da intervenção nutricional em indivíduos com síndrome metabólica.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Metabólica/dietoterapia , Terapia Nutricional/métodos , Brasil , Pressão Sanguínea/fisiologia , Aconselhamento , Doenças Cardiovasculares/etiologia , Ingestão de Energia/fisiologia , Comportamento Alimentar/fisiologia , Estilo de Vida , Modelos Lineares , Síndrome Metabólica/complicações , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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