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1.
Curr Probl Cardiol ; : 100429, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31326099

RESUMO

Myocardial injury after noncardiac surgery (MINS) includes patients with traditional myocardial infarction and those with ischemic myocardial injury after surgery. This study evaluated the prognostic value of MINS on major cardiovascular events and 30-day mortality, and determined independent preoperative predictors of MINS in patients after noncardiac surgery. This multicenter prospective cohort study was part of the VISION Study. The sample consisted of 2504 patients who underwent noncardiac surgery at 2 tertiary hospitals in Brazil between September 2008 and July 2012. Troponin Ts were measured 6-12 hours, and on days 1-3 after surgery. Cox regression analyses were performed to identify independent variables of major outcomes. A total of 314 (13%) patients were diagnosed with MINS, of which 26 (8%) died. Length-of-hospital stay of MINS patients was 3 times higher (18 ± 22 days vs 5.8 ± 11 days). In multivariate analysis, 30-day mortality was significantly higher among patients with MINS (hazard ratio [HR] 3.17 (95% confidence interval [CI] 1.56-6.41)), and major bleeding (HR 5.76 (95% CI 2.75-12.05)), sepsis (HR 5.08 (95% CI 2.25-11.46)), active cancer (HR 4.22 (95% CI 1.98-8.98)), and general surgery (HR 3.11 (95% CI 1.51-6.41)). Multivariable analysis indicated a higher chance of MINS in patients ≥75 years of age, history of diabetes mellitus, hypertension, heart failure, coronary disease, and end-stage renal failure. The incidence of MINS within 30 days after noncardiac surgery is related to higher mortality. Postoperative troponin monitoring in elder patients and with risk factors for atherosclerotic disease may help reduce postoperative cardiovascular events.

2.
J Periodontol ; 90(10): 1096-1105, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31049952

RESUMO

BACKGROUND: Despite the association between cardiovascular diseases and periodontitis, there are scarce data on the impact of oral health in the dietary intake of patients with coronary artery disease (CAD). The aim of this study was to assess the association between dietary intake with periodontitis and present teeth in individuals with stable CAD. METHODS: This cross-sectional study included 115 patients with stable CAD (76 males, aged 61.0 ± 8.3 years) who were under cardiovascular care in an outpatient clinic for at least 3 months. Dietary intake was recorded applying a food frequency questionnaire previously validated. Periodontal examinations were performed by two calibrated examiners in six sites per tooth from all present teeth. Blood samples were collected to determine serum levels of lipids. Multivariable logistic and linear regression models were fitted to evaluate the association between dietary outcomes and oral health variables. RESULTS: Individuals with periodontitis had significantly higher percentage of total energy intake from fried foods, sweets, and beans, and also had lower consumption of fruits than those without periodontitis. Presence of periodontitis was associated with lower percentage of individuals who reached the nutritional recommendation of monounsaturated fatty acids and higher blood concentration of triglycerides. Having a greater number of present teeth (≥20 teeth) was associated with higher intake of fibers and total calories. CONCLUSION: In patients with stable CAD, the presence of periodontitis and tooth loss were associated with a poor dietary intake of nutrients and healthy foods, which are important for cardiovascular prevention.

3.
J Clin Periodontol ; 46(3): 321-331, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30761568

RESUMO

AIM: To assess the effect of periodontal therapy (PT) on cardiovascular blood biomarkers. MATERIALS AND METHODS: This single-blind, parallel-design, randomized controlled trial included patients with stable coronary artery disease and periodontitis. The test group (TG) received non-surgical PT, whereas the control group (CG) received one session of plaque removal. Plasma levels of C-reactive protein (CRP), glycated haemoglobin, lipids and cytokines (IL-1ß, IL-6, IL-8, IL-10, IFN-γ and TNF-α) were measured at baseline and after 3 months. RESULTS: Eighty-two patients (74.4% women, mean age 59.6 years) were analysed. TG had significantly better periodontal parameters than CG after 3 months, but no significant differences in blood markers were observed between them. In a post hoc subgroup analysis in patients with baseline CRP <3 mg/L, a significant increase in CRP was observed in CG (1.44 ± 0.82 mg/L to 4.35 ± 7.85 mg/L, p = 0.01), whereas CRP remained unchanged in TG (1.40 ± 0.96 mg/L to 1.33 ± 1.26 mg/L, p = 0.85), resulting in a significant difference between groups at 3 months. In patients with CRP ≥3 mg/L, a significant reduction in CRP was observed only in TG (11.3 ± 12.8 mg/L to 5.7 ± 4.1 mg/L, p = 0.04). Levels of IL-6 and IL-8 were significantly lower in TG than CG at 3 months. CONCLUSIONS: PT leads to lower levels of CRP, IL-6 and IL-8 in cardiovascular patients with high CRP levels.

4.
Oral Dis ; 24(7): 1349-1357, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29873864

RESUMO

OBJECTIVE: To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS: A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS: The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION: Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Periodontite/terapia , Idoso , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Molécula 1 de Adesão Intercelular/sangue , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Selectina-P/sangue , Educação de Pacientes como Assunto , Periodontite/complicações , Aplainamento Radicular , Método Simples-Cego , Molécula 1 de Adesão de Célula Vascular/sangue , Vasodilatação/fisiologia
5.
J Appl Oral Sci ; 24(4): 352-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27556206

RESUMO

MATERIAL AND METHODS: This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1ß, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. RESULTS: CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). CONCLUSION: Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.


Assuntos
Doença da Artéria Coronariana/sangue , Interferon gama/sangue , Interleucinas/sangue , Doenças Periodontais/sangue , Fator de Necrose Tumoral alfa/sangue , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal , Doenças Periodontais/fisiopatologia , Índice Periodontal , Valor Preditivo dos Testes , Valores de Referência , Fatores de Risco , Fumar/efeitos adversos , Inquéritos e Questionários
6.
J. appl. oral sci ; 24(4): 352-358, July-Aug. 2016. tab
Artigo em Inglês | LILACS | ID: lil-792599

RESUMO

ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças Periodontais/sangue , Doença da Artéria Coronariana/sangue , Interleucinas/sangue , Interferon gama/sangue , Fator de Necrose Tumoral alfa/sangue , Doenças Periodontais/fisiopatologia , Valores de Referência , Doença da Artéria Coronariana/fisiopatologia , Biomarcadores/sangue , Fumar/efeitos adversos , Modelos Lineares , Índice Periodontal , Estudos Transversais , Valor Preditivo dos Testes , Inquéritos e Questionários , Fatores de Risco , Perda da Inserção Periodontal
7.
Int. j. cardiovasc. sci. (Impr.) ; 29(4): f:270-l:279, jul.-ago. 2016. tab, graf
Artigo em Português | LILACS | ID: biblio-831824

RESUMO

Fundamento: A inflamação tem sido reconhecida como um importante fator de risco para as doenças cardiovasculares. A doença periodontal pode acarretar alterações de alguns marcadores plasmáticos envolvidos no processo aterogênico. Objetivo: Avaliar a associação entre a doença periodontal e os níveis lipídicos ao longo do tempo em pacientes com doença arterial coronariana crônica. Métodos: Este estudo de coorte retrospectivo incluiu uma amostra de pacientes cardiopatas crônicos recebendo atendimento em um ambulatório de atenção terciária de cardiopatia isquêmica. Dos 239 pacientes elegíveis, foram incluídos 80 que apresentavam dados retrospectivos de perfil lipídico entre 2009 e 2011. Foram realizados exames periodontais de todos os dentes presentes em 2011. Modelos múltiplos de equações de estimação generalizada foram aplicados para avaliar a associação entre parâmetros periodontais e alterações ao longo do tempo nos seguintes desfechos: triglicerídeos, colesterol total, LDL-colesterol e HDL-colesterol, com ajustes para idade, índice de massa corporal, fumo, uso de hipoglicemiante oral e tempo de acompanhamento. Resultados: Durante um tempo médio de acompanhamento de 713 dias, não houve mudanças significativas nas concentrações de triglicerídeos, colesterol total e LDL-colesterol. Um aumento significativo de 31,6% nos níveis de HDL-colesterol foi observado entre 2009 e 2011. Observamos uma associação negativa e significativa entre a média individual de perda de inserção periodontal e nível de HDL-colesterol, indicando que quanto maior a perda de inserção, mais baixos os níveis de HDL-colesterol ao longo do tempo. Conclusão: A doença periodontal destrutiva pode estar relacionada com um pior controle lipídico, particularmente relacionado a níveis de HDL-colesterol, em pacientes cardiopatas crônicos


Background: Inflammation has been recognized as an important risk factor for cardiovascular diseases. Periodontal disease may alter some plasma markers involved in the atherogenic process. Objective: To assess the association between periodontal disease and lipid levels over time in patients with chronic coronary artery disease.Methods: This retrospective cohort study included a sample of patients with chronic heart disease receiving care in an outpatient tertiary care for ischemic heart disease. Of 239 patients eligible for the study, we included 80 patients who had available retrospective data of lipid profile between 2009 and 2011. We performed periodontal examinations of all teeth present in 2011. Multiple models of generalized estimating equations were applied to assess the association between periodontal parameters and changes over time in the following outcomes: triglycerides, total cholesterol, LDL-cholesterol, and HDL-cholesterol levels adjusted for age, body mass index, smoking, use of oral hypoglycemic, and follow-up duration. Results: During a mean follow-up time of 713 days, there were no significant changes in the concentrations of triglycerides, total cholesterol, and LDL-cholesterol. A significant 31.6% increase in HDL-cholesterol levels was observed between 2009 and 2011. We observed a significant negative association between mean individual periodontal attachment loss and HDL- cholesterol levels, indicating that the greater the attachment loss, the lower the HDL-cholesterol level over time. Conclusion: Destructive periodontal disease may be related to a worse lipid control, specifically regarding HDL-cholesterol levels, in chronic cardiac patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/fisiopatologia , Lipídeos/análise , Lipídeos/sangue , Doenças Periodontais/complicações , Centros de Atenção Terciária/normas , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Doença Crônica , Entrevistas como Assunto/métodos , Estudos Observacionais como Assunto , Periodontite/complicações , Periodontite/diagnóstico , Fatores de Risco , Análise Estatística , Resultado do Tratamento
8.
Acad Emerg Med ; 21(1): 40-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24552523

RESUMO

BACKGROUND: Emergency department (ED) care for acute vascular diseases faces the challenge of overcrowding. A vascular unit is a specialized, protocol-oriented unit in the ED with a team trained to manage acute vascular disorders, including stroke, coronary syndromes, pulmonary embolism (PE), and aortic diseases. OBJECTIVES: The objective was to compare case fatality rates for selected cardiovascular conditions before and after the implementation of a vascular unit. METHODS: Patients with the selected diagnoses admitted to the ED in two different time periods, 2002 through 2005 (before unit opening) and 2007 to 2010 (after vascular unit opening), were identified by ICD-10 codes, and their electronic records were reviewed. Case fatality rates were calculated and compared for both time periods. RESULTS: The period prior to unit implementation (2002 through 2005) included 4,164 patients, and the vascular unit period (2007 to 2010) included 6,280 patients. Overall, the case fatality rate for acute vascular conditions decreased from 9% to 7.3% with vascular unit implementation (p = 0.002). The in-hospital mortality rates for acute coronary syndrome (ACS) dropped from 6% to 3.8% (p = 0.003), and for acute PE dropped from 32.1% to 10.8% (p < 0.001). The stroke case-fatality rate did not decrease despite improvements in the quality of stroke health care indicators. CONCLUSIONS: The vascular unit strategy has the potential to reduce overall mortality for most acute vascular conditions.


Assuntos
Doenças Cardiovasculares/mortalidade , Serviço Hospitalar de Emergência/organização & administração , Mortalidade Hospitalar , Unidades Hospitalares/organização & administração , Brasil , Doenças Cardiovasculares/terapia , Aglomeração , Serviços Médicos de Emergência , Feminino , Hospitais Públicos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Centros de Atenção Terciária/organização & administração
9.
J Periodontol ; 85(4): 545-53, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23805809

RESUMO

BACKGROUND: There are scarce data on the impact of the periodontal condition in the control of biomarkers in patients with cardiovascular disease (CVD). The aim of this study is to assess whether periodontal inflammation and tissue breakdown are associated with C-reactive protein (CRP) and lipids in patients with stable heart disease. METHODS: This cross-sectional study included 93 patients with stable coronary artery disease (57 males; mean age: 63.5 ± 9.8 years) who were in outpatient care for at least 6 months. After applying a structured questionnaire, periodontal examinations were performed by two calibrated periodontists in six sites per tooth at all teeth. Blood samples were collected from patients on the day of periodontal examination to determine levels of CRP, lipids, and glycated hemoglobin. Multiple linear regression models were fitted to evaluate the association among different periodontal and blood parameters controlling for sex, body mass index, glycated hemoglobin, use of oral hypoglycemic drugs, and smoking. RESULTS: Overall, the sample presented high levels of periodontal inflammation and tissue breakdown. Unadjusted mean concentrations of triglycerides (TGs), very-low-density lipoprotein cholesterol, and glucose were significantly higher in individuals with severe periodontitis. When multiple linear regression models were applied, number of teeth with clinical attachment loss ≥6 mm and presence of severe periodontitis were significantly associated with higher CRP concentrations. Bleeding on probing was significantly associated with TGs, total cholesterol, and non-high-density lipoprotein cholesterol. CONCLUSION: In this sample of patients with stable CVD, current periodontal inflammation and tissue breakdown are associated with cardiovascular inflammatory markers, such as CRP and lipid profile.


Assuntos
Proteína C-Reativa/análise , Doença da Artéria Coronariana/terapia , Lipídeos/sangue , Índice Periodontal , Periodontite/sangue , Adulto , Assistência Ambulatorial , Biomarcadores/sangue , Glicemia/análise , Índice de Massa Corporal , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Estudos Transversais , Feminino , Hemorragia Gengival/sangue , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/terapia , Perda da Inserção Periodontal/sangue , Fumar , Triglicerídeos/sangue
10.
J Emerg Med ; 40(5): 557-64, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20022199

RESUMO

BACKGROUND: Different strategies have been described to increase promptness and efficiency in the assessment and management of patients with acute chest pain and acute coronary syndrome (ACS) in the emergency department (ED). OBJECTIVE: The objective of this study is to evaluate the results of implementing a Chest Pain Unit (CPU) to assist patients with ACS, and to determine its impact on quality of health care indexes and clinical outcomes. METHODS: A study was conducted with a prospective cohort of patients admitted to the ED with a chief complaint of acute chest pain or suspected ACS at two different time periods: before (n = 663) and after (n = 450) introducing a CPU as part of the ED. Quality-of-care indexes analyzed in this study were adherence to a critical pathway, length of hospital stay, and hospital mortality. RESULTS: There was increased adherence to a critical pathway during the CPU period compared to the period with no designated CPU area, including compliance with prescribing aspirin, beta-blockers, and angiotensin-converting enzyme inhibitor, and performing coronary angiography in high-risk patients. After adjustment to baseline characteristics, admissions to a CPU resulted in a 65% reduction in mortality (odds ratio 0.35; 95% confidence interval 0.14-0.88; p = 0.03). There was no difference in median length of hospital stay, 7 days (interquartile range [IQR] 4-12) before CPU and 6 days (IQR 4-11) after introducing the CPU (p = 0.10). CONCLUSION: In the scenario of a crowded ED, implementation of a CPU was associated with greater adherence to a critical pathway for patients with ACS, with a concomitant reduction in mortality rates.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Unidades Hospitalares/organização & administração , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Algoritmos , Dor no Peito/mortalidade , Dor no Peito/terapia , Procedimentos Clínicos , Feminino , Fidelidade a Diretrizes , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Qualidade da Assistência à Saúde , Estatísticas não Paramétricas , Inquéritos e Questionários
13.
Blood Press ; 12(3): 145-8, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12875475

RESUMO

The association between epistaxis and hypertension is still disputed. In a cross-sectional study, we evaluated this association in a sample of 1174 individuals older than 18 years, representative of inhabitants of Porto Alegre, RS, Brazil. Epistaxis was defined as any episode of non-traumatic nosebleeding after 18 years of age. Hypertension was defined as the mean of two blood pressure readings > or = 160/95 mmHg or the use of antihypertensive drugs. The prevalence of epistaxis and hypertension were 14.7% (95% confidence interval, CI 12.7-16.7) and 24.1% (95% CI 21.7-26.6), respectively. History of epistaxis in the adulthood (risk ratio = 1.24, 95% CI 0.83-1.85), and in the previous 6 months (risk ratio 0.79, 95% CI 0.40-1.56; p = 0.510) were not associated with hypertension after controlling for gender, age, race, history of allergic rhinitis or nasal abnormalities, alcohol abuse, smoking and years of study. History of epistaxis was positively associated with history of allergic rhinitis and inversely associated with years at school. In conclusion, we demonstrated that hypertension is not associated with history of epistaxis in the adulthood in free-living individuals.


Assuntos
Epistaxe/etiologia , Hipertensão/complicações , Adulto , Brasil/epidemiologia , Estudos Transversais , Epistaxe/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Medição de Risco
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