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1.
N Engl J Med ; 381(21): 1995-2008, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31535829

RESUMO

BACKGROUND: In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes. METHODS: In this phase 3, placebo-controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. RESULTS: Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371 patients (21.2%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P<0.001). A first worsening heart failure event occurred in 237 patients (10.0%) in the dapagliflozin group and in 326 patients (13.7%) in the placebo group (hazard ratio, 0.70; 95% CI, 0.59 to 0.83). Death from cardiovascular causes occurred in 227 patients (9.6%) in the dapagliflozin group and in 273 patients (11.5%) in the placebo group (hazard ratio, 0.82; 95% CI, 0.69 to 0.98); 276 patients (11.6%) and 329 patients (13.9%), respectively, died from any cause (hazard ratio, 0.83; 95% CI, 0.71 to 0.97). Findings in patients with diabetes were similar to those in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction, and hypoglycemia did not differ between treatment groups. CONCLUSIONS: Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes. (Funded by AstraZeneca; DAPA-HF ClinicalTrials.gov number, NCT03036124.).


Assuntos
Compostos Benzidrílicos/uso terapêutico , Glucosídeos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Compostos Benzidrílicos/efeitos adversos , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/mortalidade , Terapia Combinada , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Feminino , Glucosídeos/efeitos adversos , Hemoglobina A Glicada/análise , Insuficiência Cardíaca/complicações , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/tratamento farmacológico
2.
Vnitr Lek ; 65(4): 326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091955

RESUMO

Extremitovascular arterial ischemic disease (lower extremity peripheral arterial disease - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the ankle-brachial pressure index, the greater the risk of serious acute instable organovascular events (e. g. acute myocardial infarction, stroke). Complex prevention and treatment of extremitovascular arterial disease is discussed in this article. Angiology/vascular medicine is the fastest growing field of internal medicine.


Assuntos
Aterosclerose , Complicações do Diabetes , Diabetes Mellitus , Doença Arterial Periférica , Índice Tornozelo-Braço , Humanos , Extremidade Inferior , Doença Arterial Periférica/terapia , Fatores de Risco
3.
Eur J Heart Fail ; 20(3): 514-522, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29193563

RESUMO

AIMS: Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. METHODS AND RESULTS: The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1-Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2 ), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09-1.50), P = 0.003], cardiovascular death [1.44 (1.11-1.77), P = 0.001], HF hospitalization [1.37 (1.11-1.70), P = 0.004], and all-cause mortality [1.36 (1.13-1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17-0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. CONCLUSION: Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.


Assuntos
Aminobutiratos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico/efeitos dos fármacos , Tetrazóis/uso terapêutico , Ácido Úrico/sangue , Antagonistas de Receptores de Angiotensina/uso terapêutico , Biomarcadores/sangue , Método Duplo-Cego , Feminino , Seguimentos , Taxa de Filtração Glomerular/efeitos dos fármacos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Neprilisina , Prognóstico , Resultado do Tratamento
4.
Eur J Med Res ; 22(1): 43, 2017 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-29070064

RESUMO

BACKGROUND: Body weight changes are associated with significant variations in blood pressure (BP). Body mass modifications may, therefore, influence hypertension control in primary care. METHODS: Patients with a history of essential arterial hypertension were observed for 12 months. Anthropometric data and clinical BP were evaluated at the time of the recruitment and after 12 months of follow-up. The association between (body mass index) BMI change and BP control was analyzed by logistic regression. RESULTS: Sixteen thousand five hundred and sixty-four patients were recruited, while 13,631 patients (6336 men; 7295 women) finished the 1-year follow-up. In obese patients, a BMI decrease by at least 1 kg/m2 was negatively associated with uncontrolled hypertension at the end of the follow-up (men p < 0.0001, OR = 0.586, 0.481-0.713, women p < 0.001, OR = 0.732, 0.611-0.876). A similar association was observed in overweight patients (men p < 0.05, OR = 0. 804, 95% CI: 0.636-0.997, women p < 0.05, OR = 0.730, 95% CI: 0.568-0.937). A BMI increase of at least 1 kg/m2 was associated with a significantly higher odd of uncontrolled hypertension in obese (men p < 0.001, OR = 1.471, 1.087-1.991, women p < 0.001, OR = 1.422, 1.104-1.833) and overweight patients (men p < 0.0001, OR = 1.901, 95% CI: 1.463-2.470, women p < 0.0001, OR = 1.647, 95% CI: 1.304-2.080). CONCLUSIONS: Weight loss is inversely associated and weight increase is positively associated with the probability of uncontrolled hypertension in obese and overweight hypertensives.


Assuntos
Hipertensão/epidemiologia , Ganho de Peso , Perda de Peso , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Wien Klin Wochenschr ; 129(21-22): 793-798, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28913629

RESUMO

BACKGROUND: The blood concentrations of total cholesterol and low-density lipoprotein (LDL) do not predict survival in patients older than 60 years. The atherogenic index of plasma (AIP) is a logarithm of the triacylglycerol to high-density lipoprotein (HDL) ratio and a surrogate for the concentration of small dense LDL. It might be a better reflection of the risk of all-cause death in elderly patients. METHODS: We conducted a prospective observational study of patients with arterial hypertension older than 60 years. The concentrations of total cholesterol, LDL, HDL and triacylglycerol were measured at the time of the recruitment and the patients were observed for 10 years. Cox regression analysis was performed to assess the effects of lipoproteins and AIP on survival. RESULTS: A total of 500 patients were recruited and 473 of them (226 men, 247 women) either died or successfully completed the 10-year follow-up and were included in the analysis. The AIP was positively associated, while HDL concentration was negatively associated with the risk of all-cause death adjusted for age, smoking habits, statin use, history of diabetes mellitus, myocardial infarction, stroke and peripheral artery occlusive disease (PAOD) in elderly women but not in men. The LDL, total cholesterol, triacylglycerol and non-HDL concentrations were not associated with the risk of death in both sexes. CONCLUSIONS: The AIP is positively associated with the risk of all-cause death in elderly women with arterial hypertension independent of age, smoking habits, statin therapy and comorbidities.


Assuntos
Aterosclerose/sangue , Aterosclerose/mortalidade , Colesterol/sangue , Lipoproteínas LDL/sangue , Idoso , Algoritmos , LDL-Colesterol/sangue , Feminino , Humanos , Hipertensão/sangue , Hipertensão/mortalidade , Lipoproteínas HDL/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Eslováquia , Triglicerídeos/sangue
6.
Vnitr Lek ; 63(2): 124-132, 2017.
Artigo em Tcheco | MEDLINE | ID: mdl-28334544

RESUMO

Antiplatelet therapy by acetylsalicylic acid (ASA, aspirin) provided pivotal advances in the prevention and treatment of organovascular (angiovascular, cardiovascular, cerebrovascular, extremitovascular, renovascular, genitovascular, mesenteriointestinokolonovascular, bronchopulmovascular, oculovascular, otovascular and other) arterial ischemic diseases. Currently available antiplatelet drugs have some limitations which might be overcomed by improved dosing regimens, use of combination of agents affecting different platelet functions and, in particular, by the new antiplatelet drugs (new arterial antithrombotics) with distinct pharmacodynamic properties offering new advantages, including faster onset of action, greater potency, and reversibility of effects.Key words: arteriothromboprophylaxis - arterial thrombosis - classic antiplatelet drugs - new antiplatelet agents - organovascular arterial diseases.


Assuntos
Aspirina/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Trombose/prevenção & controle , Doenças Vasculares/prevenção & controle , Humanos , Ativação Plaquetária , Testes de Função Plaquetária , Doenças Vasculares/tratamento farmacológico
7.
Vnitr Lek ; 62(9): 746-750, 2016.
Artigo em Tcheco | MEDLINE | ID: mdl-27715076

RESUMO

Until recently, vitamin K antagonists (VKA; predominantly warfarin) were the only oral anticoagulants for primary and secondary prevention of venous thromboembolism. Prevention and therapy with novel, direct, non-VKA oral anticoagulant agents (NOACs; DOACs: dabigatran, rivaroxaban, apixaban, edoxaban), have recently become available as an alternative to VKA. NOACs have been shown to be non-inferior or superior to VKA in clinical trials. Available results suggest that real world safety of NOACs is mostly consistent with results observed in clinical trials. The most effective method is triple simultaneous prevention of venous thromboembolism (pharmaco kinezio mechano phlebothromboemboloprophylaxis).Key words: oral anticoagulants - NOAC/DOAC - thromboprophylaxis - venous thromboembolism - VKA.


Assuntos
Anticoagulantes/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Administração Oral , Humanos , Tromboembolia Venosa/etiologia
8.
Undersea Hyperb Med ; 43(2): 123-34, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27265989

RESUMO

OBJECTIVES: To investigate vasomotion in diabetic patients who underwent sessions of hyperbaric oxygen (HBO2) therapy. MATERIALS AND METHODS: Seventy-one patients with diabetes Type 2 and lower-extremity neuropathy were enrolled in a prospective matched case-control study. A total of 39 patients underwent 15 sessions of HBO2 therapy consisting of 90 minutes of breathing 100% oxygen at 2.5 atmospheres; 32 were included in the control group without exposure to hyperbaric oxygen. We used laser Doppler flowmetry for measurement of flowmotion. Spectral analysis of laser Doppler flowmetry signals was performed using the Fast Fourier transform algorithm. The total spectral activity was divided into the subgroup of endothelium, adrenergic, intrinsic smooth muscle, respiratory and cardiac spectral activity. The lateral ankle and the dorsum of the foot were chosen for this study. Heating provocation test was performed on both sites. The measurement was performed 24 hours before the first HBO2 session and 24 hours after the last (15th) session of therapy. RESULTS: We observed a significant increase in respiratory, cardiac and total spectral activity of flowmotion on the ankle as well as a significant increase in cardiac and total spectral activity on the dorsum of the foot in patients without a foot ulcer. In the subgroup of patients with a diabetic ulcer, a decrease of total spectral activity of flowmotion on the dorsum of the foot was observed. CONCLUSION: Flowmotion (indirectly vasomotion) measured by laser Doppler flowmetry changed significantly after HBO2 therapy. Flowmotion dynamics may partly explain the positive effect of HBO2 on the healing process of a diabetic ulcer.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/fisiopatologia , Oxigenação Hiperbárica , Fluxometria por Laser-Doppler/métodos , Microcirculação , Área Sob a Curva , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Pé Diabético/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Sistema Vasomotor/fisiopatologia , Cicatrização
9.
High Blood Press Cardiovasc Prev ; 23(2): 133-40, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27160718

RESUMO

INTRODUCTION: Impaired baroreflex function is associated with a shift in autonomic balance towards sympathetic dominance, which may play important role in the development of arterial hypertension and consequent target organ damage. AIM: To determine the effect of treatment on the cardiovascular autonomic modulation expressed by baroreflex sensitivity (BRS) in hypertensives. METHODS: A total of one hundred fourteen hypertensive patients (58 male/56 female, 65 ± 13 years of age, BMI 30 ± 3.4 kg/m(2)) were enrolled. Control group of 20 subjects with normal blood pressure (BP) (ten male/ten female, 59 ± 8 years of age, body mass index 28.3 ± 2.5 kg/m(2)) without any treatment was also studied. BRS and BRSf were determined by the sequence and spectral method: a 5-min on-invasive beat-to-beat recording of blood pressure and R-R interval with use of Collin CBM-7000 monitor, controlled breathing at a frequency of 0.1 Hz. RESULTS: Significant negative correlation between spontaneous BRS and BP was present in hypertensives (r = -0.52, p < 0.001). All cohort of hypertensive patients had significantly lower BRS than subjects with normal blood pressure (p < 0.05). The greatest decline in BRS values was in hypertensive patients with metabolic syndrome, who had BRS values <5 ms/mmHg. Hypertensives with hypercholesterolaemia on low dose statin therapy (atrovastatin 20 mg) had higher BRS/BRSf values than statin free patients (p < 0.05). Only BRSf not BRS was significantly increased in hypertensives with beta-blockers. CONCLUSION: An inverse correlation between blood pressure and BRS is present in hypertensives. BRS and BRSf is higher in low dose statin-treated patients with essential hypertension.


Assuntos
Anti-Hipertensivos/administração & dosagem , Pressão Arterial/efeitos dos fármacos , Atorvastatina/administração & dosagem , Sistema Nervoso Autônomo/efeitos dos fármacos , Barorreflexo/efeitos dos fármacos , Sistema Cardiovascular/inervação , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Hipertensão/tratamento farmacológico , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Feminino , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/fisiopatologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
10.
Circ Heart Fail ; 9(3): e002744, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26915374

RESUMO

BACKGROUND: The angiotensin receptor neprilysin inhibitor sacubitril/valsartan (LCZ696) reduced cardiovascular morbidity and mortality compared with enalapril in patients with heart failure (HF) and reduced ejection fraction (EF) in the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. We evaluated the influence of EF on clinical outcomes and on the effectiveness of sacubitril/valsartan compared with enalapril. METHODS AND RESULTS: Eight thousand three hundred ninety-nine patients with New York Heart Association class II to IV HF with reduced EF [left ventricular EF (LVEF) ≤40%] were randomized to sacubitril/valsartan 97/103 mg twice daily versus enalapril 10 mg twice daily and followed for a median of 27 months. The primary study end point was cardiovascular death or HF hospitalization. LVEF was assessed at the sites and recorded on case report forms. We related LVEF to study outcomes and assessed the effectiveness of sacubitril/valsartan across the LVEF spectrum. The mean LVEF in PARADIGM-HF, reported by sites, was 29.5 (interquartile range, 25-34). The risk of all outcomes increased with decreasing LVEF. Each 5-point reduction in LVEF was associated with a 9% increased risk of cardiovascular death or HF hospitalization (hazard ratio, 1.09; 95% confidence interval, 1.05-1.13; P<0.001), a 9% increased risk for CV death (hazard ratio, 1.09; 95% confidence interval, 1.04-1.14), a 9% increased risk in HF hospitalization (hazard ratio, 1.09; 95% confidence interval, 1.04-1.14) and a 7% increased risk in all-cause mortality (hazard ratio, 1.07; 95% confidence interval, 1.03-1.12) in adjusted analyses. Sacubitril/valsartan was effective across the LVEF spectrum, with no evidence of heterogeneity, when modeled either in tertiles (P interaction=0.87) or continuously (P interaction=0.95). CONCLUSIONS: In patients with HF and reduced EF enrolled in PARADIGM-HF, LVEF was a significant and independent predictor of all outcomes. Sacubitril/valsartan was effective at reducing cardiovascular death and HF hospitalization throughout the LVEF spectrum. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.


Assuntos
Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Enalapril/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Neprilisina/antagonistas & inibidores , Inibidores de Proteases/uso terapêutico , Volume Sistólico/efeitos dos fármacos , Tetrazóis/uso terapêutico , Função Ventricular Esquerda/efeitos dos fármacos , Idoso , Aminobutiratos/efeitos adversos , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Causas de Morte , Enalapril/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/enzimologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Neprilisina/metabolismo , Modelos de Riscos Proporcionais , Estudos Prospectivos , Inibidores de Proteases/efeitos adversos , Recuperação de Função Fisiológica , Tetrazóis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
11.
J Diabetes Complications ; 30(1): 67-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26412028

RESUMO

INTRODUCTION: Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension. OBJECTIVES: To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality. DESIGN AND METHODS: We retrospectively analyzed 187 patients with diabetes mellitus (60 patients with diabetes type 1 and 127 patients with diabetes type 2). Patients were divided into groups according to presence or absence of OH and type of diabetes. Association of OH with macrovascular and microvascular complications was evaluated and the effect of OH on 10-year all-cause mortality was also assessed. RESULTS: OH was present in 31.7% of patients with diabetes type 1 (DM1) and in 32.3% of patients with diabetes type 2 (DM2). OH was positively associated with the prevalence of myocardial infarction in DM1 (OR=10.67) and with prevalence of stroke in DM2 (OR=3.33). There was also a strong association of OH and the prevalence of peripheral artery disease in both DM1 (OR=14.18) and DM2 (OR=3.26). Patients with both types of diabetes and OH had significantly higher prevalence of nephropathy (DM1 OR=8.68, DM2 OR=3.24), retinopathy (DM1 OR=8.09, DM2 OR=4.08) and peripheral neuropathy (DM1 OR=17.14, DM2 OR=7.51) Overall 10year mortality rate was higher in diabetic patients with OH. CONCLUSIONS: Presence of OH in diabetics is associated with higher prevalence of macrovascular and microvascular complications of diabetes mellitus and also with higher 10-year mortality.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/epidemiologia , Neuropatias Diabéticas/epidemiologia , Hipotensão Ortostática/epidemiologia , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Cardiomiopatias Diabéticas/complicações , Cardiomiopatias Diabéticas/epidemiologia , Cardiomiopatias Diabéticas/mortalidade , Cardiomiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/mortalidade , Neuropatias Diabéticas/fisiopatologia , Seguimentos , Hospitais Universitários , Humanos , Hipotensão Ortostática/complicações , Hipotensão Ortostática/mortalidade , Hipotensão Ortostática/fisiopatologia , Pessoa de Meia-Idade , Mortalidade , Ambulatório Hospitalar , Prevalência , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Eslováquia/epidemiologia
12.
Lipids Health Dis ; 14: 151, 2015 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-26607422

RESUMO

BACKGROUND: Our goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile. METHODS: Healthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75-80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile. RESULTS: 4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest. CONCLUSION: Just 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.


Assuntos
Colesterol/sangue , Jejum/sangue , Lipoproteínas/sangue , Triglicerídeos/sangue , Adulto , Exercício , Humanos , Masculino , Período Pós-Prandial , Comportamento Sedentário , Adulto Jovem
13.
Undersea Hyperb Med ; 42(5): 399-407, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26591979

RESUMO

OBJECTIVES: Favorable metabolic changes have been observed in many in vitro and animal studies after application of hyperbaric oxygen (HBO2). Metabolic changes after hyperbaric oxygen therapy, especially focused on lipoprotein subfractions, have not been described in humans. Our aim was to investigate possible alteration in concentration of lipoprotein subfractions in diabetic patients after hyperbaric oxygen therapy. METHODS: 58 Type 2 diabetic patients were enrolled in a prospective matched case-control study. A total of 31 underwent hyperbaric oxygen therapy, and 27 were included in the control group without HBO2 exposure. Fasting concentrations of lipoprotein subfractions were measured by electrophoresis in polyacrylamide gel 24 hours before and 24 hours after hyperbaric sessions performed at 2.5 atmospheres absolute for 15 days. Homeostatic model assessment of insulin resistance, C-peptide and glycemic variability were assessed before and after therapy. RESULTS: We observed decreased subfractions of very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL 3), LDL 1, LDL 2 and LDL 3-7 after hyperbaric oxygen treatment. In addition, the IDL 1 subfraction, as well as the concentration of C-peptide, increased significantly in the treatment arm. Glycemic variability improved after therapy. No differences were observed in the control group. CONCLUSION: Hyperbaric oxygen therapy is connected with antiatherogenic metabolic changes. This study demonstrates that hyperbaric oxygen therapy may hold potential for inducing metabolic changes in diabetic patients that may decrease their cardiovascular risk.


Assuntos
Peptídeo C/sangue , VLDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Oxigenação Hiperbárica , Lipoproteínas IDL/sangue , Estudos de Casos e Controles , LDL-Colesterol/sangue , Pé Diabético/sangue , Pé Diabético/terapia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/terapia , Jejum/sangue , Feminino , Índice Glicêmico , Humanos , Oxigenação Hiperbárica/métodos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
14.
Vasa ; 44(6): 458-65, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26515223

RESUMO

BACKGROUND: The aim of this study was to evaluate the vasodilatation and vasomotion response to local heating in the cutaneous microcirculation of the ankle, dorsum of foot and forearm. Recently, it has been suggested that this response differs between the forearm and the leg. PROBANDS AND METHODS: Twenty-nine young healthy adults were recruited. They underwent measurement by laser Doppler flowmetry (LDF) in three sites of the body (ankle, dorsum of foot, forearm). Percentage change of the median flow of the skin before and after provocation and normalised perfusion flow to maximal dilation (cutaneous vascular conductance--CVC % Max) during short provocation test were monitored. Spectral analysis of laser Doppler flowmetry signals was performed using the fast Fourier transform algorithm. RESULTS: Significant differences were found in CVC % Max between ankle/dorsum (45.18±6.38% Max vs. 51.24±6.87% Max, respectively; p<0.05) and between ankle/forearm (45.18±6.38% Max vs. 54.49±5.37% Max, respectively; p<0.05). Percentage change of flux after provocation has revealed significant differences between ankle/dorsum (394.1±204.5% vs. 577.4±273.5%, respectively; p<0.05) and ankle/forearm (394.1±204.5% vs. 637.1±324.7%, respectively; p<0.05). Total spectral activity of vasomotion has differed between ankle/dorsum and ankle/forearm: 69.59 [49.58-96.04] vs. 93.01 [73.15-121.8] (p<0.05) and 69.59 [49.58-96.04] vs. 107.5 [80.55-155.8] (p<0.05), respectively. CONCLUSIONS: Cutaneous microcirculation exhibits regional differences. Significant variability of function between ankle and dorsum of foot suggests that leg microcirculation is not uniform.


Assuntos
Hipertermia Induzida , Microcirculação , Microvasos/fisiologia , Temperatura Cutânea , Pele/irrigação sanguínea , Vasodilatação , Adulto , Algoritmos , Velocidade do Fluxo Sanguíneo , Feminino , , Antebraço , Análise de Fourier , Voluntários Saudáveis , Humanos , Fluxometria por Laser-Doppler , Masculino , Fluxo Sanguíneo Regional , Fatores de Tempo , Adulto Jovem
15.
Vnitr Lek ; 61(7-8): 660-9, 2015.
Artigo em Tcheco | MEDLINE | ID: mdl-26375693

RESUMO

Erectile dysfunction is a highly prevalent and progressive condition affecting the quality of life of man and his sexual partner. Evidence is accumulating in favour of erectile dysfunction as a sign of a genitovascular disease (GVD) in the majority of patients. Erectile dysfunction may be considered as the clinical manifestation of a organovascular disease affecting penis (male genitovascular disease - MGVD) as well as angina pectoris is the typical manifestation of a vascular disease affecting coronary arteries of a heart (cardiovascular disease - CVD). Several studies confirm the assumption that erectile dysfunction symptoms were found to come prior to cardiovascular disease symptoms in 60-95 % of CVD patients with mean interval of 2-3 years and likewise of all organovascular diseases (OVD). Four potent selective PDE5Is have been approved by the EMA for the treatment of erectile dysfunction. Physicians should systematically look for erectile dysfunction in any male with vascular risk factors.


Assuntos
Arteriopatias Oclusivas/complicações , Disfunção Erétil/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Arteriopatias Oclusivas/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/epidemiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Inibidores da Fosfodiesterase 5/uso terapêutico , Qualidade de Vida , Fatores de Risco , Doenças Vasculares/epidemiologia
16.
Vnitr Lek ; 61(5): 398-400, 2015 May.
Artigo em Tcheco | MEDLINE | ID: mdl-26075846

RESUMO

Despite significant improvement in the diagnosis and therapy of cardiovascular diseases their global risk and proportion of their clinical forms remains very high. Still the large part of the patients cannot reach the estimated target lipid levels despite statin therapy. Low adherence to preventive programmes with physical training and diet leads to progression of the pathological process of atherothrombosis. One possible therapeutic approach could be the combined hypolipidemic treatment. In this context we followed-up the size of lipoprotein particles among very high risk patients on statin monotherapy, where phytosterole was added. Lipoprotein profile among very high risk patients during combined therapy lead to improvement and therefore may contribute to lowering of their residual risk.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipoproteínas/sangue , Fitosteróis/uso terapêutico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Quimioterapia Combinada , Saúde Global , Humanos , Incidência , Lipoproteínas/efeitos dos fármacos , Fatores de Risco
17.
Vnitr Lek ; 61(3): 244-50, 2015 Mar.
Artigo em Tcheco | MEDLINE | ID: mdl-25873121

RESUMO

Pelvic congestion syndrome: chronic symptoms, which may include pelvic pain, perineal heaviness, urgency of micturition, and post-coital pain, caused by ovarian and/or pelvic vein reflux and/or obstruction, and which may be associated with vulvar, perineal, and/or lower extremity varices. The VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology. Project Vessels of AS SMC.


Assuntos
Hiperemia/diagnóstico , Hiperemia/terapia , Extremidade Inferior/irrigação sanguínea , Consenso , Humanos , Hiperemia/complicações , Dor Pélvica/complicações , Dor Pélvica/diagnóstico , Dor Pélvica/terapia , Guias de Prática Clínica como Assunto , Síndrome , Varizes/complicações , Varizes/diagnóstico , Varizes/terapia
18.
Vnitr Lek ; 61(2): 106-13, 2015 Feb.
Artigo em Tcheco | MEDLINE | ID: mdl-25813252

RESUMO

Monitoring of transcutaneous perfusion pressure of tissue oxygen (tcpO2) is a simple, non-invasive method performed in diagnostic process of chronic diabetic complications. Primary, tcpO2is used as an indicator of microcirculatory function. Properly placed and fixed Clark electrode is able to detect with high accuracy partial oxygen pressure on the skin surface by polarographic system of dissolved oxygen from capillary bed through tissues to upper layers of the skin. The microcirculation function is influenced by macrocirculation, thus, tcpO2is a suitable parameter in diagnosis of peripheral arterial obliterative disease or other vascular pathologies. Combination of tcpO2monitoring and skin perfusion pressure by laser Doppler technique gives us information not only about nutritive capillary flow, but also about vessels which precede capillary bed. The article discusses current guidelines for measurement of tcpO2and evaluation of the results. Also reviews the results of recent studies which are interested in the use of tcpO2in diabetic patients.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos , Complicações do Diabetes/diagnóstico , Doença Arterial Periférica/diagnóstico , Humanos , Microcirculação/fisiologia
19.
Vnitr Lek ; 61(2): 151-6, 2015 Feb.
Artigo em Tcheco | MEDLINE | ID: mdl-25813260

RESUMO

The prevalence and the incidence of chronic and acute venous vascular disease has been shown to be globally very high, in both industrialized and developing countries. Chronic venous diseases of lower extremities are being an integral part of the third millennium's deadly angiopandemy, at the present time. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1 %) as has been assumed so far. Among venoactive drugs (VAD), micronized purified flavonoid fraction (MPFF) of diosmin hesperidin remains the agent with the highest degree of recommendation and it also indicated to pharmacotherapeutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compressive sclerotherapy, liquid or foam, is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants (DOAC) represent one of the therapeutic and preventive options of deep venous thrombosis (DVT) and of venous thromboembolism (VTE) with a limitation in patients with malignant conditions and in pregnancy. The most effective is triple simultaneous pharmaco-kinezio-mechano-phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are indicated to anticoagulant therapy too.


Assuntos
Varizes/terapia , Insuficiência Venosa/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Doença Crônica , Humanos , Extremidade Inferior/irrigação sanguínea , Escleroterapia , Cicatrização
20.
Blood Press ; 24(2): 103-10, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25652796

RESUMO

BACKGROUND AND AIMS: Arterial hypertension doubles the risk of coronary heart disease, heart and kidney failure, and peripheral arterial disease. Less variation in diurnal ambulatory blood pressure monitoring (ABPM) patterns may affect mortality outcome. Therefore, as hypertension occurs in over 95% of older subjects, the prognostic value of dipping status in older hypertensive patients will be assessed. METHOD: The retrospective study group consisted of 170 hypertensive patients, aged 75-84 years, enrolled in the years 2005 to 2007. Baseline measures included 24-h ABPM. Diurnal index and dipping status was calculated and stratified the group into dippers (40 patients, 23.5%), non-dippers (65 patients, 38.2%) and reverse-dippers (65 patients, 38.2%). RESULTS: During a 5-year observation, after baseline we have observed 69 deaths (40.9%) from the whole group of 170 patients with 23 (35.4%) being non-dippers and 36 (55.4%) reverse-dippers. There were significant differences between the groups divided according to diurnal dipping status in survival time, number of recorded deaths and night mean blood pressure. We have identified and confirmed risk factors for the all-cause mortality: age, mean systolic and diastolic blood pressure, diurnal index and dipping status (dipping, non-dipping or reverse-dipping). CONCLUSION: Reverse-dippers and non-dippers revealed worse prognosis compared with dippers.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
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