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1.
Br J Nutr ; 121(12): 1365-1375, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887937

RESUMO

Diabetes mellitus is a global epidemic, characterised as a heterogeneous group of metabolic disorders associated with high risk of CVD. Green banana biomass, which is composed of resistant starches (RS) and cannot be hydrolysed by amylases, delays gastric emptying and modulates insulin sensitivity, thus contributing to improve metabolic disorders. The aim of the present study was to investigate the effects of consumption of RS from green banana biomass on body composition, fasting plasma glucose, glycated Hb (HbA1c) and homeostasis model assessment of insulin resistance in subjects with pre-diabetes or type 2 diabetes on top of treatment. Middle-aged subjects (n 113) of both sexes with pre-diabetes (HbA1c: 5·7-6·4 %) or diabetes (HbA1c ≥ 6·5 %) were randomised to receive nutritional support plus green banana biomass (40 g) (RS: approximately 4·5 g, G1, n 62) or diet alone (G2, n 51) for 24 weeks. Body composition, biochemical analyses and dietary intake were evaluated at the beginning and end of the study. In the experimental group (G1), consumption of RS was associated with reduction in HbA1c (P = 0·0001), fasting glucose (P = 0·021), diastolic blood pressure (P = 0·010), body weight (P = 0·002), BMI (P = 0·006), waist and hip circumferences (P < 0·01), fat mass percentage (P = 0·001) and increase in lean mass percentage (P = 0·011). In controls (G2), reductions were observed in waist and hip circumferences (P < 0·01), HbA1c (P = 0·002) and high-density lipoprotein-cholesterol (P = 0·020). In pre-diabetes or diabetes, non-significant differences were observed in the percentage reduction in HbA1c and fasting glucose in exploratory analyses. Our results indicate that the consumption of bioactive starches is a good dietary strategy to improve metabolic control and body composition.

2.
Trials ; 18(1): 601, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258572

RESUMO

BACKGROUND: Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. METHODS/DESIGN: BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events. DISCUSSION: BATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02428374 . Registered on 28 September 2014.


Assuntos
Anti-Inflamatórios/administração & dosagem , Linfócitos B/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Mediadores da Inflamação/sangue , Inibidores da Agregação de Plaquetas/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Linfócitos T/efeitos dos fármacos , Terapia Trombolítica , Adenosina/administração & dosagem , Adenosina/análogos & derivados , Anti-Inflamatórios/efeitos adversos , Linfócitos B/imunologia , Linfócitos B/metabolismo , Biomarcadores/sangue , Brasil , Protocolos Clínicos , Clopidogrel , Angiografia Coronária , Quimioterapia Combinada , ELISPOT , Ezetimiba/administração & dosagem , Feminino , Citometria de Fluxo , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Metabolômica , Inibidores da Agregação de Plaquetas/efeitos adversos , Proteômica , Projetos de Pesquisa , Rosuvastatina Cálcica/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/imunologia , Sinvastatina/administração & dosagem , Volume Sistólico/efeitos dos fármacos , Linfócitos T/imunologia , Linfócitos T/metabolismo , Terapia Trombolítica/efeitos adversos , Ticagrelor , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivados , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos
3.
Psychiatry Res ; 258: 268-273, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28918859

RESUMO

The present study aimed at investigating possible alterations in the serum lipid profile of euthymic patients with bipolar disorder type I (BD) compared to healthy controls (HC). Thirty-five individuals from both genders were recruited, with 14 diagnosed and treated as BD patients (BD group) and 21 healthy subjects (HC group). Clinical assessment was based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Young Mania Rating Scale (YMRS), and 17-items of Hamilton Depression Rating Scale (HDRS-17) data, which were used to confirm diagnosis, to verify psychiatric comorbidities, and to estimate the severity of manic and depressive symptoms. Ultra-high performance liquid chromatography (UHPLC) coupled to high resolution mass spectrometry (HRMS) was applied to analyze the lipids extracted from all serum samples from both studied groups. In this pioneer and exploratory study, we observed different serum lipid profiles for BD and HC groups, especially regarding glycerophospholipid, glycerolipid, and sphingolipid distribution. Multivariate statistical analyses indicated that 121 lipids were significantly different between BD and HC. Phosphatidylinositols were identified as the most altered lipids in BD patient sera. The results of this preliminary study reinforce the role of lipid abnormalities in BD and offer additional methodological possibilities for investigation in the field.


Assuntos
Transtorno Bipolar/sangue , Lipídeos/sangue , Espectrometria de Massas , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Estudos de Casos e Controles , Comorbidade , Depressão/sangue , Depressão/diagnóstico , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfatidilinositóis/sangue
4.
Clin Sci (Lond) ; 131(12): 1215-1224, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28566450

RESUMO

Monocytes circulate in the blood and migrate to inflammatory tissues, but their functions can be either detrimental or beneficial, depending on their phenotypes. In humans, classical monocytes are inflammatory cluster of differentiation (CD)14++CD16-CCR2++ cells originated from the bone marrow or spleen reservoirs and comprise ≥92% of monocytes. Intermediate monocytes (CD14++CD16+CCR2+) are involved in the production of anti-inflammatory cytokines [such as interleukin (IL)-10], reactive oxygen species (ROS), and proinflammatory mediators [such as tumor necrosis factor-α (TNF-α) and IL-1ß). Nonclassical monocytes (CD14+CD16++CCR2-) are patrolling cells involved in tissue repair and debris removal from the vasculature. Many studies in both humans and animals have shown the importance of monocyte chemoattractant protein-1 (MCP-1) and its receptor [chemokine receptor of MCP-1 (CCR2)] in pathologies, such as atherosclerosis and myocardial infarction (MI). This review presents the importance of these monocyte subsets in cardiovascular diseases (CVDs), and sheds light on new strategies for the blocking of the MCP-1/CCR2 axis as a therapeutic goal for treating vascular disorders.


Assuntos
Doenças Cardiovasculares/metabolismo , Quimiocina CCL2/metabolismo , Monócitos/metabolismo , Receptores CCR2/metabolismo , Animais , Anti-Inflamatórios/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/imunologia , Quimiocina CCL2/antagonistas & inibidores , Humanos , Ligantes , Monócitos/classificação , Monócitos/efeitos dos fármacos , Monócitos/imunologia , Fenótipo , Receptores CCR2/antagonistas & inibidores , Transdução de Sinais
5.
Int J Cardiol ; 230: 204-208, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28062136

RESUMO

BACKGROUND: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. METHODS: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y12 assay at 0, 2, 6, and 24h after randomization. RESULTS: Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study. CONCLUSIONS: In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.


Assuntos
Adenosina/análogos & derivados , Cloridrato de Prasugrel/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Terapia Trombolítica/métodos , Adenosina/administração & dosagem , Angiografia Coronária , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Ticagrelor , Fatores de Tempo , Resultado do Tratamento
6.
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
7.
Trials ; 18(1): 601-601, 2017.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-36830

RESUMO

BACKGROUND: Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. METHODS/DESIGN: BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months...(AU)


Assuntos
Infarto do Miocárdio , Linfócitos B , Espectroscopia de Ressonância Magnética , Metabolômica , Proteômica
8.
Crit Rev Eukaryot Gene Expr ; 26(2): 161-2, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27480778

RESUMO

The paper summarizes the difficulties to study the rare population of endothelial progenitor cells in clinical trials, based on the experience of our group in many publications in this area.


Assuntos
Células Progenitoras Endoteliais , Transplante de Células-Tronco/métodos , Ensaios Clínicos como Assunto , Humanos
9.
Atherosclerosis ; 241(2): 342-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26071656

RESUMO

OBJECTIVE: Obstructive sleep apnea (OSA) has been linked to increased oxidative stress, lipid peroxidation and worsening atherosclerosis. This study investigated oxidized low-density lipoprotein (oxLDL) as a marker of lipid peroxidation, and total LDL cholesterol (direct LDL-C), as a marker of the lipid profile among individuals with OSA, and its association with hypertension (HYP) and dyslipidemia (DYS). The impact of one year of continuous positive airway pressure (CPAP) was also assessed. METHODS: Blood was collected after 12 h of fasting from 99 consecutive patients who were diagnosed with OSA via polysomnography, and were also diagnosed with both HYP and DYS via clinical and laboratory studies. The patients were classified into the following three groups: GI [OSA with comorbidities (HYP or DYS)], GII [OSA without comorbidities], and GIII [control]. Thirty-five patients with an apnea/hypopnea index >20 per hour of sleep were randomized to groups that received either Sham-CPAP or CPAP treatments over 12 months. RESULTS: In a binary regression controlled for sex, age, body mass index, and glycemia, model 1 which analyzed direct LDL-C, demonstrated significant levels of risk in the setting of DYS but not in the settings of HYP and OSA. In model 2, which analyzed oxLDL, DYS (p = 0.01), HYP (p = 0.032), and OSA (p = 0.039) were statistically significant. Significant alterations were observed in only the sleep parameters following one year of CPAP. CONCLUSIONS: Based on the statistical regression model, only the presence of DYS (p = 0.001) was associated with the levels of direct LDL-C. The remaining comorbidities (OSA and HYP) were not significantly related to the levels of direct LDL-C. Regarding oxLDL, OSA, HYP and DYS each added significant score values to the levels of oxLDL. These findings are suggestive of the importance of assessing oxLDL among patients presenting with OSA, both with and without comorbidities.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Dislipidemias/sangue , Hipertensão/sangue , Lipoproteínas LDL/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/terapia , Adulto , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Brasil/epidemiologia , Comorbidade , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Peroxidação de Lipídeos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
10.
Arq. bras. cardiol ; 103(4): 272-281, 10/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-725321

RESUMO

Background: Patients with diabetes are in extract higher risk for fatal cardiovascular events. Objective: To evaluate major predictors of mortality in subjects with type 2 diabetes. Methods: A cohort of 323 individuals with type 2 diabetes from several regions of Brazil was followed for a long period. Baseline electrocardiograms, clinical and laboratory data obtained were used to determine hazard ratios (HR) and confidence interval (CI) related to cardiovascular and total mortality. Results: After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular causes). Cardiovascular mortality was associated with male gender; smoking; prior myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR <60 mL/min. These factors, in addition to obesity, were predictors of total mortality. Cardiovascular mortality was adjusted for age and gender, but remained associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5; 95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p = 0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002). Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030); smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR = 3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1; p = 0.017). Conclusions: Biomarkers of simple measurement, particularly those related to target-organ lesions, were predictors of mortality in subjects with type 2 diabetes. .


Fundamento: Pacientes com diabetes apresentam-se em extrato de maior risco para eventos cardiovasculares fatais. Objetivo: Avaliar os principais preditores associados às taxas de mortalidade em pacientes com diabetes tipo 2. Métodos: Estudo de coorte composto por 323 indivíduos com diabetes mellitus do tipo 2, de várias regiões do Brasil, acompanhados em longo prazo. Dados clínicos, laboratoriais e eletrocardiográficos foram obtidos no período basal e aplicados no modelo Cox de regressão, para examinar a associação dessas variáveis com as taxas de mortalidade e determinação de hazard ratio (HR) e intervalo de confiança (IC). Resultados: Após 9,2 anos (mediana) de seguimento, 33 pacientes morreram (sendo 17 por causas cardiovasculares). A mortalidade cardiovascular foi associada a gênero masculino, tabagismo, infarto do miocárdio prévio, intervalo QTc longo, hipertrofia ventricular esquerda e taxa de filtração glomerular (TFG) <60 mL/min. Esses biomarcadores, além da obesidade, também foram preditores para mortalidade total. Após ajustes para idade e gênero, a mortalidade cardiovascular, manteve-se associada a tabagismo (HR = 3,8; IC 95% 1,3-11,8; p = 0,019), infarto prévio do miocárdio (HR = 8,5; IC 95% 1,8-39,9; p = 0,007), TFG < 60 mL/min (HR = 9,5; IC 95% 2,7-33,7; p = 0,001), intervalo QTc longo (HR = 5,1; IC 95% 1,7-15,2; p = 0,004), hipertrofia ventricular esquerda (HR = 3,5; IC 95% 1,3-9,7; p = 0,002). A mortalidade total foi associada com obesidade (HR = 2,3; IC 95% 1,1-5,1; p = 0,030), tabagismo (HR = 2,5; IC 95% 1,0-6,1; p = 0,046), infarto prévio do miocárdio (HR = 3,1; 95% CI 1,4-6,1; p = 0,005) e intervalo QTc longo (HR = 3,1; 95% CI 1,4-6,1; p = 0,017). Conclusões: Biomarcadores de simples mensuração, particularmente os que traduzem lesões de ...


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Cardiovasculares/mortalidade , /mortalidade , Brasil , Estudos de Coortes , Doenças Cardiovasculares/etiologia , /complicações , Eletrocardiografia , Taxa de Filtração Glomerular , Estimativa de Kaplan-Meier , Obesidade/complicações , Obesidade/mortalidade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Insuficiência Renal/mortalidade , Estatísticas não Paramétricas
11.
Arq Bras Cardiol ; 103(4): 272-81, 2014 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25098376

RESUMO

BACKGROUND: Patients with diabetes are in extract higher risk for fatal cardiovascular events. OBJECTIVE: To evaluate major predictors of mortality in subjects with type 2 diabetes. METHODS: A cohort of 323 individuals with type 2 diabetes from several regions of Brazil was followed for a long period. Baseline electrocardiograms, clinical and laboratory data obtained were used to determine hazard ratios (HR) and confidence interval (CI) related to cardiovascular and total mortality. RESULTS: After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular causes). Cardiovascular mortality was associated with male gender; smoking; prior myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR <60 mL/min. These factors, in addition to obesity, were predictors of total mortality. Cardiovascular mortality was adjusted for age and gender, but remained associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5; 95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p = 0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002). Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030); smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR = 3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1; p = 0.017). CONCLUSIONS: Biomarkers of simple measurement, particularly those related to target-organ lesions, were predictors of mortality in subjects with type 2 diabetes.


Assuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Idoso , Brasil , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Eletrocardiografia , Feminino , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Valor Preditivo dos Testes , Prognóstico , Insuficiência Renal/mortalidade , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas
12.
J Clin Lipidol ; 8(3): 265-72, 2014 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24793347

RESUMO

BACKGROUND: Obesity is associated with several cardiovascular risk factors, including nonalcoholic fatty liver disease (NAFLD). These risk factors can induce changes in the arteries such as an increase in the carotid intima-media thickness (cIMT), which contributes to the early development of atherosclerosis. OBJECTIVE: To determine whether NAFLD is associated with an atherogenic lipid profile, inflammatory markers, or cIMT in obese adolescents and to compare the effects of therapeutic lifestyle changes in NAFLD and non-NAFLD groups. METHODS: A total of 79 obese adolescents were divided into two groups: 33 NAFLD and 46 non-NAFLD. They were submitted to an interdisciplinary therapy involving diet exercise and psychological support during the course of 1 year. The cIMT and estimates of fat mass (liver, intra-abdominal, and subcutaneous) were determined ultrasonographically. Body composition, glucose, lipid profile, and adipokines were analyzed before and after the therapy. RESULTS: At baseline, only in the NAFLD group was the homeostasis model assessment of insulin resistance positively correlated with cIMT and triglyceride/high-density lipoprotein cholesterol ratio. Therapy was associated with an increase in adiponectin concentrations and reduced visceral fat, cIMT, leptin, and plasminogen activator inhibitor-1 concentrations, as well as the ratios of total cholesterol/high-density lipoprotein cholesterol and triglycerides/high-density lipoprotein cholesterol in both groups. Only in the non-NAFLD group did therapy result in a reduction in the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and increased high-density lipoprotein cholesterol concentration. CONCLUSIONS: In obese adolescents, NAFLD is associated with cardiovascular risk factors and inflammatory markers of atherosclerosis that were positively correlated with cIMT only in the NAFLD group. Nevertheless, the strength of the present study is that the interdisciplinary therapy effectively improved cIMT and other proinflammatory adipokines in both groups.


Assuntos
Aterosclerose/epidemiologia , Artérias Carótidas/patologia , Dietoterapia , Terapia por Exercício , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/epidemiologia , Obesidade/terapia , Adiponectina/metabolismo , Adolescente , Adulto , Índice de Massa Corporal , Artérias Carótidas/diagnóstico por imagem , Seguimentos , Humanos , Comunicação Interdisciplinar , Lipídeos/sangue , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/complicações , Fatores de Risco , Comportamento de Redução do Risco , Apoio Social , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
13.
Inflammation ; 37(1): 35-43, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23928876

RESUMO

The low-grade systemic inflammation seen in obesity may affect the actions of some adipose tissue-derived adipokines that are involved in the regulation of vascular function. We sought to verify whether hyperleptinemia may influence the inflammatory and atherogenic responses in obese adolescents undergoing interdisciplinary therapy. Thirty-four obese adolescents underwent interdisciplinary therapy for 1 year. Subjects were considered hyperleptinemic if they had baseline values of leptin above 20 ng/mL for boys and 24 ng/mL for girls. Both groups showed an improvement in body composition and a reduction in carotid intima-media thickness. However, only subjects in the non-hyperleptinemic group showed an increase in adiponectin concentration after therapy. Moreover, leptin concentration was positively correlated with adiponectin and inversely correlated with PAI-1 in this group. Hyperleptinemic state may impair the attenuation of inflammation in obese adolescents undergoing interdisciplinary therapy, particularly by impeding the increase in adiponectin concentration, which is directly involved in vascular protection.


Assuntos
Adiponectina/sangue , Inflamação/sangue , Leptina/sangue , Obesidade/sangue , Inibidor 1 de Ativador de Plasminogênio/sangue , Tecido Adiposo/patologia , Adiposidade , Adolescente , Glicemia , Espessura Intima-Media Carotídea , Feminino , Humanos , Inflamação/imunologia , Resistência à Insulina , Estilo de Vida , Masculino , Obesidade/imunologia , Programas de Redução de Peso
14.
Arq. bras. cardiol ; 112(1): 1-10, 2014.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-29981

RESUMO

Fundamento: Pacientes com diabetes apresentam-se em extrato de maior risco para eventos cardiovasculares fatais.Objetivo: Avaliar os principais preditores associados às taxas de mortalidade em pacientes com diabetes tipo 2.Métodos: Estudo de coorte composto por 323 indivíduos com diabetes mellitus do tipo 2, de várias regiões do Brasil,acompanhados em longo prazo. Dados clínicos, laboratoriais e eletrocardiográficos foram obtidos no período basale aplicados no modelo Cox de regressão, para examinar a associação dessas variáveis com as taxas de mortalidade edeterminação de hazard ratio (HR) e intervalo de confiança (IC).Resultados: Após 9,2 anos (mediana) de seguimento, 33 pacientes morreram (sendo 17 por causas cardiovasculares).A mortalidade cardiovascular foi associada a gênero masculino, tabagismo, infarto do miocárdio prévio, intervaloQTc longo, hipertrofia ventricular esquerda e taxa de filtração glomerular (TFG) <60 mL/min. Esses biomarcadores,além da obesidade, também foram preditores para mortalidade total. Após ajustes para idade e gênero, a mortalidadecardiovascular, manteve-se associada a tabagismo (HR = 3,8; IC 95% 1,3-11,8; p = 0,019), infarto prévio do miocárdio(HR = 8,5; IC 95% 1,8-39,9; p = 0,007), TFG < 60 mL/min (HR = 9,5; IC 95% 2,7-33,7; p = 0,001), intervalo QTclongo (HR = 5,1; IC 95% 1,7-15,2; p = 0,004), hipertrofia ventricular esquerda (HR = 3,5; IC 95% 1,3-9,7; p = 0,002).A mortalidade total foi associada com obesidade (HR = 2,3; IC 95% 1,1-5,1; p = 0,030), tabagismo (HR = 2,5;IC 95% 1,0-6,1; p = 0,046), infarto prévio do miocárdio (HR = 3,1; 95% CI 1,4-6,1; p = 0,005) e intervalo QTc longo(HR = 3,1; 95% CI 1,4-6,1; p = 0,017).Conclusões: Biomarcadores de simples mensuração, particularmente os que traduzem lesões de órgãos-alvo, forampreditores de mortalidade em pacientes com diabetes tipo 2. (AU)


Assuntos
Diabetes Mellitus Tipo 2 , Epidemiologia , Hipertensão
15.
Arq. bras. cardiol ; 103(04): 272-281, 2014. ilus
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-30146

RESUMO

Fundamento: Pacientes com diabetes apresentam-se em extrato de maior risco para eventos cardiovasculares fatais.Objetivo: Avaliar os principais preditores associados às taxas de mortalidade em pacientes com diabetes tipo 2.Métodos: Estudo de coorte composto por 323 indivíduos com diabetes mellitus do tipo 2, de várias regiões do Brasil,acompanhados em longo prazo. Dados clínicos, laboratoriais e eletrocardiográficos foram obtidos no período basale aplicados no modelo Cox de regressão, para examinar a associação dessas variáveis com as taxas de mortalidade edeterminação de hazard ratio (HR) e intervalo de confiança (IC).Resultados: Após 9,2 anos (mediana) de seguimento, 33 pacientes morreram (sendo 17 por causas cardiovasculares).A mortalidade cardiovascular foi associada a gênero masculino, tabagismo, infarto do miocárdio prévio, intervaloQTc longo, hipertrofia ventricular esquerda e taxa de filtração glomerular (TFG) <60 mL/min. Esses biomarcadores,além da obesidade, também foram preditores para mortalidade total. Após ajustes para idade e gênero, a mortalidadecardiovascular, manteve-se associada a tabagismo (HR = 3,8; IC 95% 1,3-11,8; p = 0,019), infarto prévio do miocárdio(HR = 8,5; IC 95% 1,8-39,9; p = 0,007), TFG < 60 mL/min (HR = 9,5; IC 95% 2,7-33,7; p = 0,001), intervalo QTclongo (HR = 5,1; IC 95% 1,7-15,2; p = 0,004), hipertrofia ventricular esquerda (HR = 3,5; IC 95% 1,3-9,7; p = 0,002).A mortalidade total foi associada com obesidade (HR = 2,3; IC 95% 1,1-5,1; p = 0,030), tabagismo (HR = 2,5;IC 95% 1,0-6,1; p = 0,046), infarto prévio do miocárdio (HR = 3,1; 95% CI 1,4-6,1; p = 0,005) e intervalo QTc longo(HR = 3,1; 95% CI 1,4-6,1; p = 0,017).Conclusões: Biomarcadores de simples mensuração, particularmente os que traduzem lesões de órgãos-alvo, forampreditores de mortalidade em pacientes com diabetes tipo 2. (AU)


Assuntos
Diabetes Mellitus , Mortalidade , Epidemiologia
18.
Bone ; 52(2): 562-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23142805

RESUMO

Cardiovascular disease and osteoporosis are important causes of morbi-mortality in the elderly and may be mutually related. Low bone mineral density (BMD) may be associated with increased risk of cardiovascular events. We investigated the prevalence of low bone mass and fractures in metabolic syndrome patients with acute coronary events. A case-control study was conducted with 150 individuals (30-80years-old) with metabolic syndrome. Seventy-one patients had had an acute coronary syndrome episode in the last 6months (cases) and the remaining 79 had no coronary event (controls). Cases and controls were matched for gender, BMI and age. DXA measurements and body composition were performed while spine radiographs surveyed for vertebral fractures and vascular calcification. Biochemical bone and metabolic parameters were measured in all patients. No statistically significant difference in BMD and the prevalence of osteopenia, osteoporosis and non-vertebral fractures was observed between cases and controls. The prevalence of vertebral fractures and all fractures was higher in the cases (14.1 versus 1.3%, p=0.003 and 22.5versus7.6%, p=0.010, respectively). Male gender (OR=0.22 95% CI 0.58 to 0.83, p=0.026) and daily intake of more than 3 portions of dairy products (OR=0.19 95% CI 0.49 to 0.75, p=0.017) were associated with lower prevalence of fractures. Cases had higher risk for fractures (OR=4.97, 95% CI 1.17 to 30.30, p=0.031). Bone mass and body composition parameters were not associated with cardiovascular risk factors or bone mineral metabolism. Patients with fragility fractures had higher OPG serum levels than those without fractures (p<0.001). Our findings demonstrated that patients with recent coronary events have a higher prevalence of vertebral fractures independently of BMD.


Assuntos
Densidade Óssea , Doenças Cardiovasculares/complicações , Vértebras Lombares/patologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Composição Corporal , Brasil/epidemiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Lipídeos/sangue , Modelos Logísticos , Vértebras Lombares/fisiopatologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Osteoprotegerina/sangue , Prevalência , Fraturas da Coluna Vertebral/sangue , Fraturas da Coluna Vertebral/fisiopatologia
20.
Circ J ; 76(3): 729-36, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22214900

RESUMO

BACKGROUND: Increased numbers of endothelial (EMP) and platelet (PMP) microparticles have been related to cardiovascular risk factors and coronary artery disease. Little is known about the early effects of statins and clopidogrel on these new biomarkers of vascular homeostasis. The aim of the present study was to evaluate pharmacokinetic interactions between atorvastatin and clopidogrel and their effects, alone or combined, on EMP, PMP, and endothelial progenitor cells (EPC). METHODS AND RESULTS: A prospective open-label study enrolled subjects with stable coronary disease (n=26). Drugs were given daily for 3 weeks (atorvastatin 80 mg, visits 1-3; clopidogrel 75 mg, visits 2-4). Counts of EPC (CD34+/CD133+/KDR+), EMP (CD51+) and PMP (CD42+/CD31+), and pharmacokinetic parameters over 24h were assessed at each visit. Atorvastatin plasma concentrations were increased by concomitant therapy with clopidogrel (maximum serum concentration [C(max)], P=0.002; area under the clopidogrel or atorvastatin plasma concentration vs. time curve from 0 to the last detectable concentration [AUC(last)], P=0.03). After atorvastatin withdrawal there was an increase in clopidogrel plasma concentrations (C(max), P=0.009; AUC(last), P=0.039). PMP were inversely correlated with clopidogrel C(max) on visit 3 (rho=-0.57, P=0.006) and on visit 4 (rho=-0.54, P=0.01), and with clopidogrel AUC(last) on visit 3 (rho=-0.44, P=0.04), and on visit 4 (rho=-0.57, P=0.005). In addition, clopidogrel C(max) was correlated with EPC (CD133+/KDR+) on visit 4 (rho=0.48, P=0.025). No correlations of atorvastatin and MP or EPC were found. CONCLUSIONS: The balance between platelet MP release and EPC mobilization seems influenced by clopidogrel plasma levels, suggesting a protective mechanism on coronary artery disease.


Assuntos
Plaquetas/patologia , Doença da Artéria Coronariana/tratamento farmacológico , Células Endoteliais/patologia , Células-Tronco/patologia , Ticlopidina/análogos & derivados , Adulto , Idoso , Movimento Celular , Micropartículas Derivadas de Células/efeitos dos fármacos , Clopidogrel , Doença da Artéria Coronariana/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas , Substâncias Protetoras , Antagonistas do Receptor Purinérgico P2Y , Ticlopidina/sangue , Ticlopidina/farmacologia
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