Macrophage Depletion Improves Endothelial Insulin Resistance and Protects against Cardiovascular Injury in Salt-Sensitive Hypertension.

Vascular endothelial insulin signaling is critical for the maintenance of vascular and metabolic homeostasis. We have previously shown that in hypertensive Dahl rats, impaired vascular insulin action is linked to angiotensin II activation of the NFκB inflammatory pathway. Macrophage polarization (M1) has implicated in hypertensive and metabolic diseases. Here, we investigated the effect of macrophage depletion using liposome-encapsulated clodronate (LEC) on endothelial insulin resistance and cardiovascular remodeling in Dahl salt-sensitive (DS) rats. High salt intake (HS) for 5 weeks increased systolic blood pressure (SBP: 192 ± 5 vs. 144 ± 4 mmHg in NS, p < 0.05), aortic and cardiac hypertrophy, cardiac fibrosis, and impaired acetylcholine- and insulin-induced vasorelaxation, accompanied by impaired insulin activation of endothelial nitric oxide synthases (eNOS)/NO signaling. HS rats had a significant increase in CD68 (a monocyte/macrophage marker) expression in the aorta and the heart. LEC reduced SBP (168 ± 5 mmHg, p < 0.05) and cardiovascular injury and improved acetylcholine- and insulin-mediated vasorelaxation and insulin signaling molecules with a reduction in the macrophage infiltration in the aorta and the heart. HS rats also manifested an increase in the aortic expressions of inflammatory cytokines, including the ratio of phosphorylated inhibitory kappa B (Iκb)/Iκb, tumor necrosis factor α, and phosphorylated c-Jun N-terminal kinase (JNK) and oxidative stress, which were reduced in HS/LEC rats. Our results suggest that in salt-sensitive hypertension, macrophage may importantly contribute to endothelial insulin resistance, vascular inflammation, and injury. These findings support the idea that macrophages may be a new target for immunotherapy of vasculopathy in hypertensive and metabolic disorders.

Feasibility and Health Effects of a 15-Week Combined Exercise Programme for Sedentary Elderly: A Randomised Controlled Trial.

There is strong evidence that considerable health benefits can be achieved even with small amounts of physical activity. However, getting people to exercise regularly is a major challenge not least in the elderly population. This study investigated the feasibility and physiological health effects of a pragmatic 15-week exercise programme for sedentary elderly. In a single-blind randomised controlled trial, 45 sedentary 60-83-year-olds (25 women, 20 men) were randomly assigned (2:1 ratio) to a training group (TG, n=30) or a control group (CG, n=15). The training in TG consisted of a combination of exercise modalities (i.e., strength, aerobic fitness, stability, and flexibility training) performed once a week as supervised group-based training and a weekly home-based training for 15 weeks. Feasibility outcomes were exercise intensity, adherence, and adverse events. The primary outcome was change in aerobic fitness (VO2max/kg). Adherence was high (81%) for the supervised exercise and low (0%) for the home-based exercise. No acute injuries occurred in TG, but 4 subjects (13%) reported considerable joint pain related to training. Average heart rate (HR) during the supervised training was 104±12 beats/min (69.3±8.0%HRmax), with 3.9±7.3% of training time >90%HRmax. Intention-to-treat analyses revealed no between-group differences for aerobic fitness (P=0.790) or any secondary cardiovascular outcomes at 15-week follow-up (resting HR or blood pressure; P>0.05). Compared to CG, bodyweight (-2.3 kg, 95% CI -4.0 to -7.0; P=0.006), total fat mass (-2.0 kg, 95% CI -3.5 to -0.5; P=0.01), and total fat percentage (-1.6%, 95% CI -2.8 to -0.3; P=0.01) decreased in TG. The group-based supervised training had high adherence and moderate exercise intensity, whereas the home-based training was not feasible in this study population. This exercise programme performed once a week did not improve aerobic fitness. Thus, supervised training with more vigorous intensity control appears advisable. Clinical Study registration number is H-15016951.

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities.

OBJECTIVES: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. SUBJECTS AND METHODS: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. RESULTS: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. CONCLUSIONS: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Especificaciones del servicio de medición y control de la presión arterial mediante MAFC, AMPA y MAPA / Specifications of the arterial pressure measurement and testing service using one-off measurement in community pharmacies, arterial pressure self-measurement and outpatient arterial pressure monitoring

En abril de 2013, la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC) presentó su propuesta sobre servicios profesionales farmacéuticos (SPF) cuyo fin es cubrir las necesidades relacionadas tanto con la atención de los pacientes que utilizan medicamentos, como con la salud pública. Esta propuesta ofrece un planteamiento sobre la implantación y desarrollo de los SPF con el objetivo de impulsar su prestación por las farmacias comunitarias en los próximos años. De acuerdo con dicha propuesta todos los SPF que constituyen el catálogo de servicios contarán con un documento de especificaciones. El objeto de este documento de especificaciones es definir y caracterizar el servicio de medición y control de la presión arterial con un doble objeto: • Ayudar al farmacéutico comunitario y a sus representantes en el ofrecimiento, prestación, difusión, financiación y concertación de este servicio. • Servir de guía a los farmacéuticos comunitarios que desean implantar este servicio en la farmacia o elaborar un procedimiento normalizado de trabajo para su realización. Este documento se complementa con la Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV). Documento de consenso GIAF-UGR, SEFAC y SEH-LELHA y con el programa impacHta: formación de SEFAC y SEH-LELHA en hipertensión y riesgo vascular (AU)

In April 2013, the Spanish Family and Community Pharmacy Society (Sociedad Española de Farmacia Familiar y Comunitaria - SEFAC) issued a proposal for professional pharmacy services, with an aim to cover both the needs relating to care for patients on medication and to public health. This proposal put forward an approach for the implementation and development of professional pharmacy services with an aim to roll out this service in community pharmacies in the next few years. In accordance with this proposal, all professional pharmacy services that offer these services will be supported by a specifications document. The purpose of this specifications document is to define and characterize the arterial pressure measurement and testing service with two aims: • To help community pharmacists and their representatives in the offer, provision, promotion, financing and arrangement of this service. • To serve as a guide for community pharmacists who want to implement this service in the pharmacy or to provide a standardized working procedure to do so. This document is accompanied by the procedural guide for community pharmacists for patients with arterial hypertension and cardiovascular risk (Guía de actuación para el farmacéutico comunitario en pacientes con HTA y riesgo cardiovascular (RCV)). Consensus document of GIAF-UGR, SEFAC and SEH-LELHA and the impacHta program: SEFAC and SEH-LELHA training in hypertension and vascular risk (AU)

Recomendaciones para la actividad deportiva en atletas con cardiopatías congénitas en el adulto / Recommendations for adult sport athletes with congenital heart diseases

La seguridad de la actividad física y deportiva en pacientes adultos con cardiopatías congénitas aún no está bien establecida. Las recomendaciones sobre el ejercicio físico en estos pacientes suele ser bastante restrictiva sin que haya clara evidencia para ello, a pesar de que el deporte haya demostrado importantes beneficios cardiovasculares tanto en la población general como en estos pacientes. La prevalencia y la supervivencia de esta población ha aumentado considerablemente en las últimas décadas debido a un diagnóstico precoz, una sustancial mejora de las medidas terapéuticas, tanto en técnicas quirúrgicas como percutáneas, así como en los cuidados posteriores y un seguimiento clínico estricto a largo plazo. Es por ello que cada vez es más frecuente encontrarnos con pacientes asintomáticos con buen grado funcional y con numerosas dudas sobre sus posibilidades en la práctica deportiva. Así mismo, surgen dudas entre los profesionales a la hora de establecer las mejores recomendaciones en relación a la actividad deportiva. En los últimos años ha cobrado especial relevancia el estudio de los beneficios y la seguridad de este tipo de actividades en este subgrupo de pacientes. Las investigaciones se centran fundamentalmente en la seguridad de la actividad física en pacientes con cardiopatías congénitas, y el temor a que la práctica de actividad física a nivel competitivo pueda aumentar significativamente el riesgo de eventos adversos, especialmente de eventos arrítmicos y muerte súbita. En esta revisión, analizamos numerosos estudios y las guías de práctica clínica actuales, con el fin de establecer las recomendaciones de actividad física, así como sus restricciones en función de los diferentes tipos de cardiopatías congénitas

Safety of sport and physical activity in adult patients with congenital heart disease is still not well established. Recommendations on exercise in this subgroup of patients are usually pretty restrictive without having clear evidence for this, even though sport has shown significant cardiovascular benefits in both the general population and in patients with cardiovascular problems. Prevalence and survival of this population has increased considerably in recent decades due to early diagnosis, a substantial improvement in therapeutic measures, both surgical techniques and percutaneous, as well as aftercare and strict long term clinical monitoring. This is why it is increasingly common to find asymptomatic patients with good performance status and many doubts about their chances in sports. Doubts among professionals in establishing the best recommendations in relation to sport also arise. In the last years, it has become particularly relevant the study of the benefits and safety of these types of activities in this subgroup of patients. Researches focuses mainly on the safety of physical activity in patients with congenital heart disease, and fear that the practice of physical activity on a competitive level can significantly increase the risk of adverse events, especially arrhythmic events and sudden death. In this review, we analyzed numerous studies and current clinical practice guidelines, in order to establish recommendations for physical activity and its restrictions in terms of the different types of congenital heart disease

[Some Aspects of Medical Activities to Overcome Consequences of Chernobyl Accident].

The results of the long term work of the Russian Scientific Centre of Roentgenology and Radiology on me- dical investigation of the participants in the liquidation of the consequences of Chernobyl power plant acci- dent have been summarized. It has been stated that circulatory system and tumor diseases occupy the leading position in the disease rate among the affected liquidators. The important role of cytogenetic investigation was pointed out. It allows us not only to determine the efficient impact on the human body but also to evaluate the effective dose of radiation, the information about which allows us to predict the development of distant post-irradiation pathology. The results of cytogenetic investigations testify to the interrelation between the level of chromosomal abnormalities and cardiovascular diseases and confirm the clinical data on the non- neoplastic.pathology among the liquidators of the accident.

Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports.

OBJECTIVE: To follow up on previously reported associations between periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and specific birth defects using an expanded dataset from the National Birth Defects Prevention Study. DESIGN: Bayesian analysis combining results from independent published analyses with data from a multicenter population based case-control study of birth defects. SETTING: 10 centers in the United States. PARTICIPANTS: 17,952 mothers of infants with birth defects and 9857 mothers of infants without birth defects, identified through birth certificates or birth hospitals, with estimated dates of delivery between 1997 and 2009. EXPOSURES: Citalopram, escitalopram, fluoxetine, paroxetine, or sertraline use in the month before through the third month of pregnancy. Posterior odds ratio estimates were adjusted to account for maternal race/ethnicity, education, smoking, and prepregnancy obesity. MAIN OUTCOME MEASURE: 14 birth defects categories that had associations with SSRIs reported in the literature. RESULTS: Sertraline was the most commonly reported SSRI, but none of the five previously reported birth defects associations with sertraline was confirmed. For nine previously reported associations between maternal SSRI use and birth defect in infants, findings were consistent with no association. High posterior odds ratios excluding the null value were observed for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.6 to 6.2; atrial septal defects 1.8, 1.1 to 3.0; right ventricular outflow tract obstruction defects 2.4, 1.4 to 3.9; gastroschisis 2.5, 1.2 to 4.8; and omphalocele 3.5, 1.3 to 8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4 to 3.1 and craniosynostosis 1.9, 1.1 to 3.0). CONCLUSIONS: These data provide reassuring evidence for some SSRIs but suggest that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy.

Diferenças regionais na transição da mortalidade por doenças cardiovasculares no Brasil, 1980 a 2012 / Regional differences in cardiovascular mortality transition in Brazil, 1980 to 2012

Objetivo. Estimar a tendência temporal da mortalidade por doenças cardiovasculares no Brasil no período de 1980 a 2012. Método. Realizamos um estudo ecológico de série temporal das taxas de mortalidade por doenças cardiovasculares no Brasil. Os dados sobre óbitos foram provenientes do Sistema de Informações de Mortalidade e divididos em dois grupos: óbitos por doenças isquêmicas do coração (DIC) e por doenças cerebrovasculares (DCBV). Resultados. No Brasil, houve variação de -34,73% dos coeficientes padronizados de mortalidade para as DIC; aumento de 117,98% no Nordeste e de 10,26% no Centro-Oeste; e redução no Sudeste (-53,08%), Sul (-44,56%) e Norte (-4,39%). As DCBV apresentaram uma variação de -48,05%. A maioria das regiões apresentou redução nas taxas de mortalidade: -61,99% no Sudeste, -55,49% no Sul, -26,91% no Centro-Oeste e -20,78% no Norte. Só o Nordeste apresentou aumento (13,77%). Conclusões. Observamos uma tendência geral de queda dos coeficientes de mortalidade por DIC e DCBV no Brasil de 1980 a 2012, com marcadas variações regionais, sendo que as regiões Sudeste e Sul apresentaram os maiores coeficientes para os dois grupos de doenças e as regiões Norte e Nordeste, os menores. É importante considerar, nos planos de vigilância, as desigualdades no perfil epidemiológico entre as regiões do país.

Objective. To estimate the time trend of cardiovascular mortality from 1980 to 2012. Methods. We performed an ecological time series study of cardiovascular mortality in Brazil. Data regarding deaths were obtained from the Mortality Information System and divided into two groups: deaths from ischemic heart disease (IHD) and deaths from cerebrovascular disorders (CBVD). Results. A -34.73% variation in IHD standardized mortality rates was recorded for Brazil. Concerning specific regions, an increase was observed in the Northeast (117.98%%) and the Midwest (10.26%). IHD mortality rates fell in the Southeast (-53.08%), South (-44.56%) and North (-4.39%). For CBVD, the overall variation was -48.10%. Mortality rates were reduced in most regions: -61.99% in the Southeast, -55.49% in the South, -26.91% in the Midwest, and -20.78% in the North. Only the Northeast recorded an increase in CBVD mortality (13.77%). Conclusions. We observed an overall declining trend for IHD and CBVD mortality in Brazil from 1980 to 2012, with strong regional variation. Mortality rates were highest in the Southeast and South for both groups of disorders, and lowest in the North and Northeast. Surveillance efforts should take into account the regional differences in epidemiological profile.

Sec2015- El congreso de las enfermedades cardiovasculares / No disponible

No disponible

Proceso de atención de enfermería a un escolar con disminución del oxígeno en sangre por malformación cardíaca aplicando el modelo de Henderson / Nursing process to a school child with decreased blood oxygen by heart malformation using the Henderson model", "_i": "

En la actualidad, el cuidado de enfermería en su práctica diaria se basa en una metodología que le permite desarrollar intervenciones eficientes y de calidad, las cuales se fortalecen con la evidencia generada a través de la realización de estudios de caso. El estudio de caso es un método de investigación cualitativa que involucra el proceso de atención enfermería y las teorías de enfermería. Este artículo expone un estudio de un caso bajo el modelo de Virginia Henderson a un escolar con Tetralogía de Fallot con el objetivo de individualizar los cuidados para lograr la independencia de la persona. Se realizó durante la etapa pre, trans y postquirúrgica de la persona. Una vez obtenidos los datos de las valoraciones, se analizaron y jerarquizaron las necesidades y se aplicó la escala propuesta por Margot Phaneuf, se elaboraron diagnósticos de enfermería y planes de cuidados correspondientes a las principales alteraciones detectadas, para los cuales se buscó la evidencia científica que respaldara algunas de las intervenciones, con la finalidad de brindar mayor sustento a las mismas. Los resultados se enfocaron hacia la recuperación del niño mejorando su calidad de vida y la de su cuidador primario.

At the present time nursing care in their practice is based on a methodology that lets you develop effective interventions and quality which are strengthened on evidence generated through the case studies. The case study is a qualitative research method that involves Nursing Attention Process and nursing theories. This paper describes a case study using Virginia Henderson’s model: A school child with tetralogy of Fallot. The main objective is to individualize cares to achieve personal independence from the primary caretaker. The study was carried out throughout the preoperative, during surgery, and postoperative stages of the person. After obtaining the valuations data were analyzed and nested the needs and applied the scale proposed by Margot Phaneuf. Are developed nursing diagnoses and care plans corresponding to the main alterations detected, for which it research in the scientific evidence to support some interventions, with the purpose of provide greater sustenance to them. The results focus to the child’s recovery by improving their quality of life and his primary caregiver.

Proceso enfermero en lactante mayor con pentalogía de Cantrell con el enfoque de Virginia Henderson / Nursing process in the older infant with pentalogy of Cantrell with the approach of Virginia Henderson", "_i": "

Introducción: La pentalogía de Cantrell es un síndrome caracterizado por disrupción del esternón bajo, defectos cardíacos, diafragmáticos y abdominales, además de onfalocele y ectopia cordis parcial o total. El índice de mortalidad es alto y ocurre en los primeros meses; su principal complicación es la sepsis. Objetivo: Desarrollar un proceso enfermero aplicado a un lactante mayor con pentalogía de Cantrell con el enfoque de Virginia Henderson. Metodología: Estudio de caso clínico en un lactante mayor masculino. Se realizó un estudio descriptivo, prospectivo y longitudinal durante dos meses, basado en el Proceso de Atención de Enfermería, con el enfoque conceptual de Virginia Henderson. Se abordaron las 14 necesidades humanas con un instrumento de valoración validado y se establecieron los diagnósticos de enfermería; las intervenciones están basadas en evidencia científica; se incluyó una evaluación integral y un plan de alta. Resultados: Necesidades más alteradas: oxigenación, seguridad, movilidad y postura. Se encontraron cuatro diagnósticos reales, seis de riesgo y dos de bienestar; se generaron 63 intervenciones con niveles de recomendación científica desde la A hasta IV C. Se evitaron complicaciones al otorgar atención de calidad. Conclusión: El proceso enfermero es fundamental para otorgar cuidados de calidad, aunque no permitió disminuir la dependencia del lactante o la suplencia total de enfermería, no hubo complicaciones y se orientó al familiar. La literatura no reporta cuidados específicos para esta población dada su baja incidencia y alta mortalidad.

Introduction: Cantrell’s pentalogy is a syndrome characterized by defects in the lower part of the sternum, heart, diaphragmatic and abdominal defects. In addition, omphalocele and partial or complete ectopia cordis. The mortality rate is high and takes place in the first months of life; its main complication is septicemia. Objective: To develop a nursing procedure applied to infant higher with Cantrell’s pentalogy with the focus of Virginia Henderson. Methodology: Study of a clinical case of an elder infant. It was a descriptive, prospective and longitudinal study carried out during two months, based on the process of care, nursing, with the conceptual approach of Virginia Henderson. Fourteen human needs with validated assessment tool to establishes nursing diagnosis; the interventions were based on scientific evidence including comprehensive assessment and discharge plan. Results: The most altered aspects were: oxygenation, safety, mobility and posture. We found four real diagnostics, six at risk and two without risk; generated sixty-three interventions with degrees of scientific recommendation from A to IV C. complications were avoided by implementing quality care. Conclusion: The nursing process is fundamental to implementing quality care, even if it was not allowed to reduce the dependence of the infant to a total substitution nursing. There were no complications and the family was oriented. The literature does not report specific care for this population due to its low incidence and mortality.

Challenging the FDA black box warning for high aspirin dose with ticagrelor in patients with diabetes.

Ticagrelor, a novel reversible antiplatelet agent, has a Food and Drug Administration (FDA) black box warning to avoid maintenance doses of aspirin (ASA) >100 mg/daily. This restriction is based on the hypothesis that ASA doses >100 mg somehow decreased ticagrelor's benefit in the Platelet Inhibition and Patient Outcomes (PLATO) U.S. cohort. However, these data are highly postrandomized, come from a very small subgroup in PLATO (57% of patients in the U.S. site), and make no biological sense. Moreover, the ticagrelor-ASA interaction was not significant by any multivariate Cox regression analyses. The Complete Response Review for ticagrelor indicates that for U.S. PLATO patients, an ASA dose >300 mg was not a significant interaction for vascular outcomes. In the ticagrelor-ASA >300 mg cohort, all-cause and vascular mortality were not significantly increased (hazard ratio [HR] 1.27 [95% CI 0.84-1.93], P = 0.262 and 1.39 [0.87-2.2], P = 0.170), respectively. Furthermore, for major adverse cardiovascular events (MACEs), 30-day all-cause mortality, and 30-day vascular mortality, the strongest interaction is the diabetes-ASA interaction. That is, patients who had diabetes had significantly fewer MACEs through study end (0.49 [0.34-0.63], P < 0.0001), significantly less 30-day all-cause mortality (0.33 [0.20-0.56], P < 0.0001), and significantly less 30-day vascular mortality (0.35 [0.22-0.55], P < 0.0001), respectively, when given high-dose (300-325 mg) ASA, regardless of treatment (clopidogrel or ticagrelor) assignment. The black box warning for the use of maintenance ASA doses >100 mg with ticagrelor is inappropriate for patients with diabetes and not evidence based.

Determinación del riesgo cardiovascular en la población española / Determining cardiovascular risk in the Spanish population

La medición del riesgo cardiovascular en un mismo grupo de personas del área mediterránea española arroja resultados diferentes según la herramienta que se elija, incluso aunque las herramientas empleadas utilicen los mismos parámetros para determinar el riesgo.

Determinación del riesgo cardiovascular en la población española / Determining cardiovascular risk in the Spanish population

La medición del riesgo cardiovascular en un mismo grupo de personas del área mediterránea española arroja resultados diferentes según la herramienta que se elija, incluso aunque las herramientas empleadas utilicen los mismos parámetros para determinar el riesgo. (AU)

Periconceptional folic acid-containing multivitamin supplementation for the prevention of neural tube defects and cardiovascular malformations.

The prevention of neural tube defects with periconceptional folic acid or folic acid-containing multivitamin supplementation is accepted by the scientific community; here the possible prevention of cardiovascular malformations is discussed. The aim of this presentation is to show the main findings of trials and studies that resulted in the prevention of neural tube defects and particularly cardiovascular malformations by folic acid-containing multivitamins or folic acid supplementation in order to stimulate the incorporation of folic acid-containing multivitamins or folic acid in the prevention of cardiovascular malformations.

Effectiveness of deferiprone in transfusion-independent beta-thalassemia/HbE patients.

Beta-thalassemia/HbE (beta-thal/HbE) is a thalassemia intermedia (TI) which encompasses a broad spectrum of severity. Here, we used deferiprone (DFP) as an iron chelating agent in TI patients receiving intermittent blood transfusion who are asymptomatic for cardiovascular disease in order to evaluate the effectiveness in iron overload and reduce the possibility of cardiovascular complications. Thirty transfusion-independent beta-thal/HbE patients with iron overload were treated with DFP for 1 year. Hematological, biochemical, oxidative stress and echocardiographic parameters were determined. Serum ferritin, non-transferrin-bound iron, and malondialdehyde decreased significantly (P<0·05) after 1-year treatment with DFP. For echocardiographic results, mean pulmonary arterial pressure and pulmonary vascular resistance were diminished significantly (P<0·05). All those parameters were still improved after subgroup analysis was done for the high ferritin group (>2500 ng/ml). DFP therapy alone improved iron overload and oxidative stress and compliance was good. We propose that prevention of pulmonary hypertension is also possible for TI undergoing intermittent blood transfusion.

Vitamin supply in pregnancy for prevention of congenital birth defects.

PURPOSE OF REVIEW: After the short summary of history of primary prevention of neural tube defects by folic acid or folic acid-containing multivitamin supplementation during the periconception period, the three main unsolved problems are highlighted. RECENT FINDINGS: Both intervention trials and observational studies confirmed that this new primary preventive method is effective - beyond the prevention of neural-tube defects - in the reduction of the most common structural birth defects: congenital cardiovascular abnormalities. Nevertheless, this important progress in the field of congenital abnormalities is not appreciated appropriately. The periconception supplementation of both folic acid alone and folic acid-containing multivitamin is useful; however, the available data indicate the higher efficacy of multivitamins in the primary prevention of neural-tube defects and congenital cardiovascular abnormalities. The optimal dose of folic acid is not known though this knowledge would be necessary from both a scientific and practical aspect. SUMMARY: Periconception folic acid or folic acid-containing multivitamin supplementation has resulted in a breakthrough in the primary prevention of neural-tube defects, cardiovascular abnormalities and probably some other defects; however, extra efforts are necessary to eliminate folic acid or folic acid-containing multivitamin preventable congenital abnormalities.

Disfunção precoce no controle autonômico cardiovascular em filhos de hipertensos: papel do exercício físico / Early detection on the autonomic control in offspring of hypertensive parents: role of physical exercise

A Hipertensão arterial (HA) afeta milhões de pessoas em todo o mundo, sendo que no Brasil atinge entre 22 e 44% da população urbana adulta, chegando a 65% nos indivíduos idosos. Ainda que os indivíduos apresentem pressão arterial (PA) dentro da faixa dita de normalidade, é possível notar uma correlação positiva entre os níveis de PA e a incidência de doenças cardiovasculares, renais e mortalidade. Dessa forma, acredita-se que detecções precoces da elevação da PA, e a interação desta condição com outros tantos fatores de risco genéticos pode ser muito importante no futuro para o manejo clínico de um paciente. Diversos estudos familiares vêm demonstrando a agregação familiar da HA, tanto entre irmãos, quanto entre pais e filhos. Trabalhos demonstraram que jovens normotensos, filhos de hipertensos, apresentam aumento da PA, dos níveis séricos de catecolaminas, redução da resposta barorreflexa, e anormalidades metabólicas e endócrinas quando comparados a jovens filhos de normotensos. Baseado nos estudos da literatura pode-se sugerir que pesquisas envolvendo jovens normotensos com história familiar positiva de hipertensão são modelos muito atrativos para detecção de modificações precoces e possíveis marcadores biológicos de HA. Entretanto, até o presente momento, poucos são os estudos sobre anormalidades nas respostas cardiovasculares à situação de estresse e/ou sobrecarga fisiológica, como o exercício físico, em descendentes de hipertensos. Nesta revisão serão abordadas as alterações fisiológicas observadas em indivíduos jovens com história familiar positiva de HA, bem como serão discutidas os possíveis efeitos benéficos do exercício físico nesta população.

The incidence of hypertension is high in Brazil and in the whole world. In Brazil, this disease affects 22-44% of adult urban population, and 65% of older subjects. Despite the subjects have arterial pressure (AP) inside of normality range, is interesting perceive that exist a positive correlation between AP levels and cardiovascular and kidney disease, and mortality incidence. In this way, it is possible that early detections of AP levels increase, and the interactions of this condition with other genetics risk factors can be very important in the future to clinical management of this patient. Studies were demonstrating familiar aggregation of hypertension, between brothers as well as between father and sons. Other studies demonstrated that normotensive young offspring of hypertensive parents present AP and plasmatic levels of catecholamine increase, and baroreflex responses reduction, as well as endocrine and metabolic abnormalities as compared to offspring of normotensive parents. Based in these studies it is clearly that research involving normotensive young subjects with positive family history of hypertension are very attractive models to detection of early modifications and possible biological markers of hypertension. However, until the present time, there are few studies about cardiovascular responses abnormalities to stress tests and/or to physiological situation, as physical exercise, in offspring of hypertensive parents. In this article physiological we reviewed alterations observed in young subjects with positive family history of hypertension and the possible benefits of physical exercise in this population are discussed.