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1.
Clinics (Sao Paulo) ; 74: e1234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721907

RESUMO

OBJECTIVES: This prospective, randomized, open-label study aimed to compare the effects of antihypertensive treatment based on amlodipine or hydrochlorothiazide on the circulating microparticles and central blood pressure values of hypertensive patients. METHODS: The effects of treatments on circulating microparticles were assessed during monotherapy and after the consecutive addition of valsartan and rosuvastatin followed by the withdrawal of rosuvastatin. Each treatment period lasted for 30 days. Central blood pressure and pulse wave velocity were measured at the end of each period. Endothelial, monocyte, and platelet circulating microparticles were determined by flow cytometry. Central blood pressure values and pulse wave velocity were recorded at the end of each treatment period. RESULTS: No differences in brachial blood pressure were observed between the treatment groups throughout the study. Although similar central blood pressure values were observed during monotherapy, lower systolic and diastolic central blood pressure values and early and late blood pressure peaks were observed in the amlodipine arm after the addition of valsartan alone or combined with rosuvastatin. Hydrochlorothiazide-based therapy was associated with a lower number of endothelial microparticles throughout the study, whereas a higher number of platelet microparticles was observed after rosuvastatin withdrawal in the amlodipine arm. CONCLUSIONS: Despite similar brachial blood pressure values between groups throughout the study, exposure to amlodipine was associated with lower central blood pressure values after combination with valsartan, indicating a beneficial interaction. Differences between circulating microparticles were modest and were mainly influenced by rosuvastatin withdrawal in the amlodipine arm.

2.
Arq Bras Cardiol ; 113(4): 787-891, 2019 Nov 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31691761
3.
Arq. bras. cardiol ; 113(2 supl.1): 4-4, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1016802

RESUMO

INTRODUÇÃO: A reperfusão precoce é recomendada universalmente para tratamento de pacientes com infarto agudo do miocárdico com supradesnivelamento do segmento ST (IAMCST). Entretanto, apesar de rápida reperfusão com angioplastia primária ou química, alguns pacientes ainda apresentam grandes massas de fibrose miocárdica e, portanto, queda significativa da função ventricular. OBJETIVO: avaliar o papel da resposta inflamatória mediada pelos linfócitos B na massa de infarto e na função ventricular após IAMCST. Métodos: amostras de sangue venoso foram coletadas no primeiro (D1) e trigésimo dia (D30) de pacientes com IAMCST(n=120), submetidos a estratégia fármacoinvasiva.A quantificação dos linfócitos B e T foi determinada por citometria de fluxo. A secreção espontânea de imunoglobulina M (IgM) pelos linfócitos B1, foi quantificada por ELISPOT. IgM total e níveis de interleucinas (IL) plasmáticas foram determinadas por ELISA. A massa de infarto e a fração de ejeção do ventrículo esquerdo (FEVE) foram estimadas por ressonância nuclear magnética cardíaca em D30. RESULTADOS: houve queda no número absoluto (cels/mL) das subpopulações de linfócitos B1 e B2 em D30...(AU)


Assuntos
Linfócitos B , Parâmetros , Infarto do Miocárdio
4.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 242-245, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1022936

RESUMO

Os eventos isquêmicos continuam a ocorrer em pacientes com fatores de risco mal controlados, como os que têm concentrações elevadas de LDL-colesterol ou de triglicérides, nos que têm diabetes e doença aterosclerótica multivascular, a despeito do tratamento com estatinas. Além dos eventos iniciais, esses pacientes têm risco substancial de eventos recorrentes, possivelmente fatais. A avaliação dos eventos recorrentes traz a perspectiva da carga total de eventos ateroscleróticos a que esses pacientes estão expostos e não apenas dos primeiros eventos. Dois estudos com novas terapêuticas hipolipemiantes abordaram a redução de eventos cardiovasculares e também de eventos totais, de um primeiro evento e de eventos subsequentes. O evolocumabe, um inibidor da pró-proteína convertase subtilisina/quexina tipo 9 e o icosapenta etil, formulação altamente purificada de ácido graxo ômega 3 demonstraram reduções dos eventos cardiovasculares primários e secundários chave, bem como dos eventos totais, dos primeiros eventos e dos eventos subsequentes em pacientes de alto risco e risco muito alto que usam estatinas, mas com um risco elevado de novos eventos cardiovasculares. Pelos benefícios demonstrados, essas estratégias terapêuticas poderão ser incorporadas à prática clínica, desde que avaliadas num contexto de risco e benefício, e com um custo-efetividade aceitável


Ischemic events continue to occur in patients with poorly controlled risk factors, such as those with high concentrations of LDL-cholesterol or triglycerides and those with diabetes and multivascular artherosclerotic disease, in spite of treatment with statins. These patients are at risk not only for the first, but also for recurrent ischemic events, which can be fatal. The evaluation of recurrent events brings a perspective of the total burden of artherosclerotic events to which the patient is exposed and not only of the first one. Two studies using new lipid-lowering therapies addressed the reduction of cardiovascular events and also of total events, of a first event, and of subsequent events. Evolocumab, a proprotein convertase subutilisin kexin type 9 inhibitor, and icosapent ethyl, a highly purified formulation of omega-3 fatty acid, demonstrated reductions in key primary and secondary cardiovascular events, as well as in total events, first events and subsequent events in high and very high risk patients taking statins, but with a high risk of new cardiovascular events. Based on the benefits observed, these therapeutic strategies can be incorporated into clinical practice, provided they are evaluated within a risk benefit context, with an acceptable cost-effectiveness ratio


Assuntos
Humanos , Masculino , Feminino , Dislipidemias , Prática Clínica Baseada em Evidências/métodos , Ácidos Graxos Ômega-3 , Fatores de Risco , Diabetes Mellitus , LDL-Colesterol
5.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 268-271, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1023051

RESUMO

Os estudos com estatinas envolvendo desfechos clínicos mostraram que, mesmo atingindo as metas lipídicas, os pacientes que persistem com níveis aumentados de proteína C-reativa, têm maior risco de eventos cardiovasculares. A doença aterosclerótica das coronárias também apresentou maior regressão nos estudos com estatinas, quando ocorreu além de redução efetiva de LDL-colesterol, redução da proteína-C reativa. Nos últimos anos, dois importantes estudos com terapias anti-inflamatórias mostraram resultados divergentes. O estudo CANTOS, com o anticorpo monoclonal canaquinumabe, mostrou redução do eventocombinado de morte cardiovascular, infarto ou acidente vascular cerebral não fatais, e a magnitude do benefício foi associada ao grau de diminuição de marcadores inflamatórios, como proteína C-reativa ou interleucina 6. No estudo CIRT, os pacientes que receberam o anti-inflamatório metotrexato não tiveram redução de desfechos cardiovasculares, mas tampouco tiveram redução dos mencionados marcadores inflamatórios. Esses resultados, em conjunto, sugerem que o bloqueio específico de uma via inflamatória, como a citocina, pode ser mais relevante do que efeito anti-inflamatório per se e revela um caminho para diminuição do risco inflamatório residual


Studies with statins involving clinical endpoints have shown that, in spite of achieving lipid goals, patients with high levels of C-reactive protein are at higher risk for cardiovascular events. Atherosclerotic coronary artery disease has also presented greater regression in studies with statins when, in addition to an effective reduction in LDL cholesterol, a reduction in C-reactive protein was achieved. In recent years, two important studies involving anti-inflammatory therapies reported divergent results. The CANTOS study, with the human monoclonal antibody canakinumab, showed a decrease in combined cardiovascular death, non-fatal myocardial infarction or non-fatal stroke events and the magnitude of that benefit was associated with the degree of reduction in the inflammatory markers, such as C-reactive protein and interleukin-6. In the CIRT study, patients who received the anti-inflammatory methotrexate did not have a decrease in cardiovascular outcomes, but neither was there a reduction in the inflammatory markers mentioned. Taken together, these results suggest that the specific blockade of an inflammatory pathway, such as that of cytokine,may be more relevant than the antiinflammatory effect per se and reveal a promising way to reduce the residual inflammatory risk


Assuntos
Humanos , Masculino , Feminino , Doença da Artéria Coronariana , Prática Clínica Baseada em Evidências , Inflamação , Sistema Renina-Angiotensina , Doenças Cardiovasculares , Metotrexato , Fatores de Risco , Interleucina-6 , Interleucina-1 , Inibidores de Hidroximetilglutaril-CoA Redutases , Anti-Inflamatórios
8.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 148-154, abr.-jun. 2019. graf
Artigo em Português | LILACS | ID: biblio-1009485

RESUMO

As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil desde o final da década de 1960, a despeito da tendência de queda observada nos últimos anos. A mudança de estilo de vida relacionada à urbanização e globalização, com alta ingestão calórica e menor gasto energético, o rápido aumento da população idosa devido à maior expectativa de vida levaram à maior prevalência de obesidade e dislipidemias e, consequentemente, doenças cardiovasculares e metabólicas. Pesquisas de base populacional, estudos de coorte e de caso e de controle apontam para a importância do crescimento dos fatores de risco e diferenças regionais indicam que as políticas públicas e o atendimento médico devem priorizar intervenções de saúde tendo como objetivo a prevenção e controle dos fatores de risco mais prevalentes em nosso meio. A abordagem terapêutica da obesidade deve incluir não apenas a redução isolada do peso, e sim, atrelada à melhora metabólica ampla que se associe à diminuição do risco de complicações cardiovasculares. De um modo geral, a perda de peso é mais frequentemente alcançada ao longo dos primeiros meses ou do primeiro ano de exposição aos fármacos e embora alguns sejam mais efetivos, eventos adversos são frequentes, limitando o tratamento a longo prazo. O grande avanço e a maior segurança nos últimos anos vieram com o uso de medicamentos antiiperglicemiantes, como análogos de GLP-1, permitindo o uso a longo prazo com manutenção de resultados e adicionando benefícios cardiovasculares. A abordagem terapêutica das dislipidemias no paciente obeso é imperativa para a evolução desse perfil de pacientes, nos quais múltiplos fatores fisiológicos, bioquímicos, metabólicos e clínicos, estão interconectados e diretamente relacionados com aumentos substanciais do risco de diabetes, de doença aterosclerótica cardiovascular e mortalidade por todas as causas


Cardiovascular disease has been the no. 1 cause of death in Brazil since the late 1960s, despite the downtrend observed in recent years. Lifestyle changes related to urbanization and globalization, high calorie intake and lower energy expenditure, combined with a rapidly aging population due to increased life expectancy, have led to a greater prevalence of obesity and dyslipidemia, and consequently, cardiovascular and metabolic diseases. Population-based surveys, cohort and case-control studies underline the importance of the growth of risk factors, and regional differences indicate that public policies and medical care must prioritize health interventions in order to prevent and control the most prevalent risk factors in our country. The therapeutic approach to obesity must include not only weight reduction alone, but also in combination with comprehensive metabolic improvement, which is associated with a reduced risk of cardiovascular complications. In general, weight loss is more frequently achieved in the first few months or first year of exposure to medications, and although some drugs are more effective, adverse events are common, limiting treatment options to long-term therapy. The major advances and greater safety seen in recent years were achieved with the use of anti-hyperglycemic agents such as GLP-1 analogues, enabling long-term use with maintenance of results and adding cardiovascular benefits. The therapeutic approach to dyslipidemia in obese patients is imperative for the progress of this patient population, in which multiple physiological, biochemical, metabolic and clinical factors are interlinked and directly related to substantial increases in the risk of diabetes, atherosclerotic cardiovascular disease, and all-cause mortality


Assuntos
Humanos , Masculino , Feminino , Dieta , Dislipidemias/terapia , Obesidade/prevenção & controle , Obesidade/terapia , Fatores de Tempo , Brasil , Doenças Cardiovasculares/mortalidade , Índice de Massa Corporal , Epidemiologia , Prevalência , Fatores de Risco , Aterosclerose , Sobrepeso/complicações , Estilo de Vida
9.
JAMA Cardiol ; 4(5): 408-417, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30942842

RESUMO

Importance: Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. Objective: To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. Design, Setting, and Participants: In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. Interventions: Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. Main Outcomes and Measures: The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. Results: Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). Conclusions and Relevance: Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. Trial Registration: ClinicalTrials.gov identifier: NCT02851732.

10.
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.

11.
Arq. bras. cardiol ; 112(1): 20-29, Jan. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-973836

RESUMO

Abstract Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. Results: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.


Resumo Fundamento: Pacientes com infarto do miocárdico com elevação do segmento-ST atendidos em centros de atendimento primário e tratados de acordo com a estratégia fármaco-invasiva são submetidos à fibrinólise seguida de coronariografia em período de 2-24h. Neste cenário, o conhecimento de marcadores de reperfusão como a redução em 50% do segmento-ST é fundamental. Objetivo: Analisar o desempenho da dispersão do intervalo QT em adição aos critérios clássicos, como marcador precoce de reperfusão pós-terapia trombolítica. Métodos: Estudo observacional com a inclusão de 104 pacientes tratados com tenecteplase (TNKase) e referenciados a hospital de atendimento terciário. A análise dos eletrocardiogramas (ECG) consistiu em mensuração do intervalo QT e sua dispersão nas 12 derivações, e também apenas na região com supradesnivelamento-ST antes e 60min pós-TNKase. A angiografia foi realizada em todos os pacientes com obtenção do fluxo TIMI e Blush da artéria culpada. Foram considerados significantes valores de p < 0,05. Resultados: Observamos aumento da dispersão do intervalo QT, corrigido pela frequência cardíaca, regional (dQTcR) 60min pós-lise (p = 0,006) em infartos de parede anterior nos casos com fluxo TIMI 3 e Blush 3 [T3B3(+)]. Adicionando a dQTcR ao critério ECG (redução do ST > 50%) de reperfusão, a área sob a curva aumentou para 0,87 [(0,78-0,96), IC95%, p < 0,001] em pacientes com fluxo coronário T3B3(+). Nos pacientes com critério de ECG para reperfusão e dQTcR > 13 ms a sensibilidade e especificidade foram 93% e 71%, respectivamente, para reperfusão em T3B3(+), possibilitando reclassificar 6% dos pacientes com sucesso de reperfusão. Conclusão: Os dados sugerem a dQTcR como instrumento promissor na identificação não invasiva de reperfusão na artéria coronária culpada, 60min pós-trombólise.

12.
Am. heart j. ; 207: 40-48, Jan. 2019. gráfico, ilustração
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1023779

RESUMO

BACKGROUND: Translating evidence into clinical practice in the management of high cardiovascular risk patients is challenging. Few quality improvement interventions have rigorously evaluated their impact on both patient care and clinical outcomes. OBJECTIVES: The main objectives are to evaluate the impact of a multifaceted educational intervention on adherence to local guidelines for the prescription of statins, antiplatelets and angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for high cardiovascular risk patients, as well as on the incidence of major cardiovascular events. DESIGN: We designed a pragmatic two arm cluster randomized trial involving 40 clusters. Clusters are randomized to receive a multifaceted quality improvement intervention or to routine practice (control). The multifaceted intervention includes: reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint is the adherence to combined evidence-based therapies (statins, antiplatelet therapy and angiotensin converting enzyme inhibitors or angiotensin receptor blockers) at 12 months after the intervention period in patients without contra-indications for these medications. All analyses follow the intention-to-treat principle and take the cluster design into account using linear mixed logistic regression modeling. SUMMARY: If proven effective, this multifaceted intervention would have wide utility as a means of promoting optimal usage of evidence-based interventions for the management of high cardiovascular risk patients. (AU)


Assuntos
Humanos , Inibidores da Agregação de Plaquetas , Medicina Baseada em Evidências/estatística & dados numéricos , Adesão à Medicação
14.
Artigo em Português | LILACS | ID: biblio-998688

RESUMO

As doenças cardiovasculares estão entre as principais causas de mortalidade no mundo e não afligem apenas os adultos. Muitos trabalhos têm demonstrado que elas já podem ser vistas na infância. Entre os fatores de risco para a doença cardiovascular, pode-se destacar a dislipidemia, o baixo peso ao nascer e a obesidade infantil. A detecção de dislipidemia na infância é crucial, por ser considerada a fase estratégica para a implementação de medidas de prevenção da aterosclerose no âmbito populacional. Embora as causas ambientais ou poligênicas sejam as mais frequentes, é importante a identificação de formas genéticas como a hipercolesterolemia familiar e hipertrigliceridemias de base genética, pois medidas relacionadas aos hábitos de vida e terapêutica medicamentosa devem ser iniciadas preco-cemente, evitando-se complicações e mudando a história natural dos desfechos clínicos. Outros estudos têm demonstrado que o baixo peso ao nascer também contribui para o desenvolvimento tardio de hipertensão arterial, doença coronariana e disfunção endotelial. Possivelmente, por conta das agressões ao sistema vascular em desenvolvimento. No en-tanto, os mecanismos ainda são incertos. Evidências sugerem que alguns biomarcadores, tais como os níveis de ácido úrico e homocisteína e a baixa concentração de óxido nítrico observados em crianças com baixo peso ao nascer, podem estar associados a alterações deletérias na vida adulta. Por fim, o terceiro fator que deve ser considerado é a obesidade infantil. Essa desordem tem causa multifatorial e pode favorecer o surgimento das etapas iniciais da aterosclerose, como a disfunção endotelial, já na infância. Porém, é um fator de risco modificável, e as estratégias de prevenção e intervenção baseiam-se, na maioria dos casos, em mudanças do estilo de vida, como alimentação saudável e exercício físico.


Cardiovascular disease is one of the leading causes of mortality in the world and does not affect adults alone. Many papers have shown that it can already be seen in childhood. The most significant risk factors for cardiovascular disease include dyslipidemia, low birth weight and childhood obesity. Screening for dyslipidemia in childhood is crucial as this is considered a strategic phase for the implementation of measures aimed at preventing atherosclerosis in the population setting. Although environment or polygenic causes are the most common, it is important to identify genetic forms such as familial hypercholesterolemia and hypertriglyceridemia, since measures related to lifestyle and pharmacotherapy must be initiated early in life to avoid complications and change the natural history of clinical outcomes. Other studies have shown that low birth weight also contributes to the late development of hypertension, coronary artery disease and endothelial dysfunction, possible due to injury to the developing vascular system. However, the mechanisms are still uncertain, and evidence suggests that some biomarkers, such as uric acid and homocysteine levels, and the low concentration of nitric oxide observed in low birthweight children, may be associated with deleterious changes in adulthood. Finally, the third factor to be considered is childhood obesity. This disorder has a multifactorial etiology and may favor the onset of the first stages of atherosclerosis, such as endothelial dysfunction, in young children. However, it is a modifiable risk factor, and prevention and intervention strategies are largely based on lifestyle changes such as healthy diet and exercise


Assuntos
Humanos , Criança , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/diagnóstico por imagem , Aterosclerose/etiologia , Dislipidemias/genética , Dieta Saudável/enfermagem
15.
Arq Bras Cardiol ; 112(1): 20-29, 2019 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30570061

RESUMO

BACKGROUND: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. OBJECTIVE: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. METHODS: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. RESULTS: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. CONCLUSION: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.

16.
J Chromatogr A ; 2018 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-30509618

RESUMO

A capillary electrophoresis with diode array and tandem mass spectrometry detection (CE-UV-MS/MS) method has been developed for the targeted assessment of cardiovascular biomarkers candidates, trimethylamine-N-Oxide (TMAO) and l-carnitine, and creatinine in human urine samples. The dual detection was applied due to the high concentration of creatinine (monitored by UV detection at 200 nm) in relation to TMAO and l-carnitine (quantified by selected reaction monitoring (SRM) mass spectrometry), in human urine. All instrumental parameters, sheath liquid (SHL) and background electrolyte (BGE) compositions were optimized with a pool of urine provided by adult healthy volunteers and evaluated by signal-to-noise ratio (SNR) and peak shape of TMAO. The compositions for the optimized BGE was formic acid at concentration of 0.10 mol L-1, and for SHL was 70:30 MeOH:H2O containing 0.05% (v/v) formic acid, delivered at a flow rate of 5 µL min-1. Limits of detection for TMAO, l-carnitine and creatinine were 0.76, 0.54 and 303 µmol L-1, respectively. Limits of quantification were 2.5, 1.8 and 1000 µmol L-1, respectively. Linearity was evaluated by ANOVA and presented R2 from 0.993 to 0.997. Precision and accuracy were evaluated at three concentration levels. Coefficients of variation (CV) from 1 to 21% were obtained for the intra-day precision evaluation and from 2 to 16% for the inter-day precision evaluation. The recovery ranged from 75 to 116%. Quantitation of TMAO and l-carnitine in infarcted patients urine in comparison to healthy individuals indicated a 2.2 fold increase of TMAO and a 7.0 fold increase of l-carnitine. These results showed the potential applicability of the proposed method for the evaluation of TMAO and l-carnitine in urine within a panel of candidate metabolites in targeted metabolomics studies of cardiovascular diseases among other conditions.

19.
Am Heart J ; 207: 40-48, 2018 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-30415082

RESUMO

BACKGROUND: Translating evidence into clinical practice in the management of high cardiovascular risk patients is challenging. Few quality improvement interventions have rigorously evaluated their impact on both patient care and clinical outcomes. OBJECTIVES: The main objectives are to evaluate the impact of a multifaceted educational intervention on adherence to local guidelines for the prescription of statins, antiplatelets and angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for high cardiovascular risk patients, as well as on the incidence of major cardiovascular events. DESIGN: We designed a pragmatic two arm cluster randomized trial involving 40 clusters. Clusters are randomized to receive a multifaceted quality improvement intervention or to routine practice (control). The multifaceted intervention includes: reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint is the adherence to combined evidence-based therapies (statins, antiplatelet therapy and angiotensin converting enzyme inhibitors or angiotensin receptor blockers) at 12 months after the intervention period in patients without contra-indications for these medications. All analyses follow the intention-to-treat principle and take the cluster design into account using linear mixed logistic regression modeling. SUMMARY: If proven effective, this multifaceted intervention would have wide utility as a means of promoting optimal usage of evidence-based interventions for the management of high cardiovascular risk patients.

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