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1.
Bernardete, Weber; Bersch, Ferreira  C; Torreglosa, Camila R; Marcadenti, Aline; Lara, Enilda S; Silva, Jaqueline T da; Costa, Rosana P; Santos, Renato H N; Berwanger, Otavio; Bosquetti, Rosa; Pagano, Raira; Mota, Luis G S; Oliveira, Juliana D de; Soares, Rafael M; Galante, Andrea P; Silva, Suzana A da; Zampieri, Fernando G; Kovacs, Cristiane; Amparo, Fernanda C; Moreira, Priscila; Silva, Renata A da; Santos, Karina G dos; Monteiro, Aline S5,; Paiva, Catharina C J; Magnoni, Carlos D; Moreira, Annie S; Peçanha, Daniela O; Missias, Karina C S; Paula, Lais S de; Marotto, Deborah; Souza, Paula; Martins, Patricia R T; Santos, Elisa M dos; Santos, Michelle R; Silva, Luisa P; Torres, Rosileide S; Barbosa, Socorro N A A; Pinho, Priscila M de; Araujo, Suzi H A de; Veríssimo, Adriana O L; Guterres, Aldair S; Cardoso, Andrea F R; Palmeira, Moacyr M; Ataíde, Bruno R B de; Costa, Lilian P S; Marinho, Helyde A; Araújo, Celme B P de; Carvalho, Helen M S; Maquiné, Rebecca O; Caiado, Alessandra C; Matos, Cristina H de; Barretta, Claiza; Specht, Clarice M; Onofrei, Mihaela; Bertacco, Renata T A; Borges, Lucia R; Bertoldi, Eduardo G; Longo, Aline; Ribas, Bruna L P; Dobke, Fernanda; Pretto, Alessandra D B; Bachettini, Nathalia P; Gastaud, Alexandre; Necchi, Rodrigo; Souza, Gabriela C; Zuchinali, Priccila; Fracasso, Bianca M; Bobadra, Sara; Sangali, Tamirys D; Salamoni, Joyce; Garlini, Luíza M; Shirmann, Gabriela S; Los Santos, Mônica L P de; Bortonili, Vera M S; Santos, Cristiano P dos; Bragança, Guilherme C M; Ambrózio, Cíntia L; Lima, Susi B E; Schiavini, Jéssica; Napparo, Alechandra S; Boemo, Jorge L; Nagano, Francisca E Z; Modanese, Paulo V G; Cunha, Natalia M; Frehner, Caroline; Silva, Lannay F da; Formentini, Franciane S; Ramos, Maria E M; Ramos, Salvador S; Lucas, Marilia C S; Machado, Bruna G; Ruschel, Karen B; Beiersdorf, Jâneffer R; Nunes, Cristine E; Rech, Rafael L; Damiani, Mônica; Berbigier, Marina; Poloni, Soraia; Vian, Izabele; Russo, Diana S; Rodrigues, Juliane; Moraes, Maria A P de; Costa, Laura M da; Boklis, Mirena; El Kik, Raquel M; Adorne, Elaine F; Teixeira, Joise M; Trescastro, Eduardo P; Chiesa, Fernanda L; Telles, Cristina T; Pellegrini, Livia A; Reis, Lucas F; Cardoso, Roberta G M; Closs, Vera E; Feres, Noel H; Silva, Nilma F da; Silva, Neyla E; Dutra, Eliane S; Ito, Marina K; Lima, Mariana E P; Carvalho, Ana P P F; Taboada, Maria I S; Machado, Malaine M A; David, Marta M; Júnior, Délcio G S; Dourado, Camila; Fagundes, Vanessa C F O; Uehara, Rose M; Sasso, Sandramara; Vieira, Jaqueline S O; Oliveira, Bianca A S de; Pereira, Juliana L; Rodrigues, Isa G; Pinho, Claudia P S; Sousa, Antonio C S; Almeida, Andreza S; Jesus, Monique T de; Silva, Glauber B da; Alves, Lucicna V S; Nascimento, Viviane O G; Vieira, Sabrina A; Coura, Amanda G L; Dantas, Clenise F; Leda, Neuma M F S; Medeiros, Auriene L; Andrade, Ana C L; Pinheiro, Josilene M F; Lima, Luana R M de; Sabino, L S; Souza, C V S de; Vasconcelos, S M L; Costa, F A; Ferreira, R C; Cardoso, I B; Navarro, L N P; Ferreira, R B; Júnior, A E S; Silva, M B G; Almeida, K M M; Penafort, A M; Queirós, A P O de; Farias, G M N; Carlos, D M O; Cordeiro, C G N C; Vasconcelos, V B; Araújo, E M V M C de; Sahade, V; Ribeiro, C S A; Araujo, G A; Gonçalves, L B; Teixeira, C S; Silva, L M A J; Costa, L B de; Souza, T S; Jesus, S O de; Luna, A B; Rocha, B R S da; Santos, M A; Neto, J A F; Dias, L P P; Cantanhede, R C A; Morais, J M; Duarte, R C L; Barbosa, E C B; Barbosa, J M A; Sousa, R M L de; Santos, A F dos; Teixeira, A F; Moriguchi, E H; Bruscato, N M; Kesties, J; Vivian, L; Carli, W de; Shumacher, M; Izar, M C O; Asoo, M T; Kato, J T; Martins, C M; Machado, V A; Bittencourt, C R O; Freitas, T T de; Sant'Anna, V A R; Lopes, J D; Fischer, S C P M; Pinto, S L; Silva, K C; Gratão, L H A; Holzbach, L C; Backes, L M; Rodrigues, M P; Deucher, K L A L; Cantarelli, M; Bertoni, V M; Rampazzo, D; Bressan, J; Hermsdorff, H H M; Caldas, A P S; Felício, M B; Honório, C R; Silva, A da; Souza, S R; Rodrigues, P A; Meneses, T M X de; Kumbier, M C C; Barreto, A L; Cavalcanti, A B.
Am. heart j. ; 215: 187-197, Set. 2019. gráfico, tabela
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1023356

RESUMO

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)


Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Avaliação Nutricional , Alimentos, Dieta e Nutrição
2.
Am Heart J ; 215: 187-197, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31349110

RESUMO

BACKGROUND: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ±â€¯8.4 vs 24.7 ±â€¯8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.

3.
Am Heart J ; 184: 88-96, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27892891

RESUMO

Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30days. RESULTS: The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P=.46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P=.74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P=.50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P=.26), and stroke (0.9% vs 0%, P=.25). CONCLUSION: In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naïve patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naïve patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population.


Assuntos
Atorvastatina/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/prevenção & controle , Assistência Perioperatória/métodos , Modelos de Riscos Proporcionais , Medição de Risco , Troponina/sangue
5.
BMC Psychiatry ; 10: 66, 2010 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-20807429

RESUMO

BACKGROUND: Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development. METHODS/DESIGN: This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements. DISCUSSION: This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.


Assuntos
Transtornos Mentais/epidemiologia , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Atenção Primária à Saúde/métodos , Violência/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Desenvolvimento Infantil , Estudos de Coortes , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Feminino , Humanos , Recém-Nascido , Obesidade/epidemiologia , Gravidez , Trimestres da Gravidez , Prevalência , Transtornos Puerperais/epidemiologia , Violência/psicologia , Ganho de Peso/fisiologia
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