Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 128.296
Filtrar
2.
Medicine (Baltimore) ; 98(52): e18353, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876709

RESUMO

BACKGROUND: To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS: The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS: In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION: TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.


Assuntos
Doença das Coronárias/tratamento farmacológico , Adesão à Medicação , Sistemas de Alerta , Mensagem de Texto , Humanos
3.
Kardiologiia ; 59(11): 21-30, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849296

RESUMO

Background Long-term secondary preventive programs in coronary heart disease (CHD) are of highest efficacy but numerous logistical problems often compromise their implementation. Contemporary remote technologies have a potential to overcome these barriers. AIM: To assess  the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. METHODS: A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. RESULTS: At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are <0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values <0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values <0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р<0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values <0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (<0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. CONCLUSION: Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).


Assuntos
Doença das Coronárias , Obesidade Abdominal , Adulto , Idoso , Doença das Coronárias/complicações , Humanos , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária
4.
Kardiologiia ; 59(12): 11-19, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849306

RESUMO

BACKGROUND: Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures. AIM: To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support. METHODS: An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group I and Group II) and into Group III (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group I received this subsequent counselling via phone calls and Group II received text messages via different platforms according to patient preferences. Group III received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed. RESULTS: A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups I and II which was absent in Group III. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group I and from 40.0% to 7.5% in Group II (both р values <0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р<0.01 vs control) and from  12.5% to 0% (р<0.05 vs control), respectively. Stress level decreased in Groups I and II by 3.95±0.38 and 3.56±0.39 баллов, respectively (both р values <0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group I and by 0.98±0.13 points in Group (both р values <0.01 vs control). CONCLUSION: Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.


Assuntos
Doença das Coronárias , Obesidade Abdominal , Idoso , Doença das Coronárias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Obesidade Abdominal/complicações , Qualidade de Vida , Prevenção Secundária
5.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(12): 979-984, 2019 Dec 24.
Artigo em Chinês | MEDLINE | ID: mdl-31877594

RESUMO

Objective: To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors. Methods: This study was a single-center observational study. According to the inclusion criteria, elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled. The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Activities of daily living of the patients were assessed (including ADL and IADL) . Comorbidity of the patients was evaluated by the Charlson comorbidity index (CCI). Long-term medication use of the patients was recorded to assesse whether there was polypharmacy. The nutritional status of the patients was examined by the mini nutritional assessment-short form (MNA-SF). The full tandem stance time of the patients was evaluated. The history of falls over the previous year, urinary incontinence, and living conditions of the patients were also recorded. Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease. Results: A total of 364 patients were enrolled in the study. The patients were aged 65-96 (74.6±6.5) years and there were 218 (59.9%) male patients. There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome. The median number of long-term used medication was 7. One hundred and fifty-two (41.8%) patients were complicated with type 2 diabetes, 38 (10.4%) patients were complicated with anxiety/depression, and 98 (26.9%) patients had the history of falls over the previous year. Eighty-two (22.5%) patients were complicated with urinary incontinence, 12 patients (3.3%) were complicated with malnutrition and 33 patients (9.2%) were living alone. There were 81 (22.3%) sarcopenic patients and 283 (77.7%) non-sarcopenic patients among all the hospitalized elderly patients with coronary heart disease. The sarcopenic patients were more older, with lower body mass index(BMI)(both P<0.001), higher CCI and more long-term used medication (both P<0.05), higher proportions of malnutrition, urinary incontinence, history of falls, and living alone (all P<0.05) compared to non-sarcopenic patients. ADL and IADL scores of sarcopenic patients were significantly lower than those of non-sarcopenic patients (both P<0.001). There was also a higher proportion of unable to accomplish full tandem stance among sarcopenic patients compared to non-sarcopenic patients (P<0.001). Moreover, higher hs-CRP level (P=0.047) , lower albumin level (P=0.004) and significantly lower prealbumin level (P<0.001) were observed in sarcopenic patients compared to non-sarcopenic patients. Stepwise multivariate binomial logistic regression analysis revealed that male (OR=5.036, 95%CI 1.782-14.230, P=0.002), low BMI (OR=0.883, 95%CI 0.796-0.980, P=0.019), as well as low prealbumin level (OR=0.990, 95%CI 0.980-1.000, P=0.045) were related factors for sarcopenia among elderly patients with coronary heart disease. Conclusions: Sarcopenia is a geriatric condition commonly seen in hospitalized elderly patients with coronary heart disease. Male, low BMI, and low prealbumin level were the factors related to sarcopenia for older adults with coronary heart disease.


Assuntos
Doença das Coronárias , Sarcopenia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino
6.
J Surg Oncol ; 120(8): 1371-1378, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31696512

RESUMO

BACKGROUND: Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long-term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. METHODS: This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross-validation, and nomograms were constructed. RESULTS: The mean age was 61.3-year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2-distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. CONCLUSIONS: The overall and major morbidity models and nomograms included clinical- and surgical-related data that were very effective in predicting events, especially for high-risk patients.


Assuntos
Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Doença das Coronárias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pâncreas/cirurgia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Esplenectomia , Neoplasias Gástricas/epidemiologia
7.
Undersea Hyperb Med ; 46(5): 581-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683356

RESUMO

Introduction: We aimed to document identified cases of immersion pulmonary edema (IPE) in divers from Oceania (the Indo-Pacific region) from January 2002 to May 2018, inclusive. Method: Cases were identified using various sources, including searches of the Divers Alert Network Asia-Pacific (DAN AP) Fatality Database, published case reports, and interviews with survivors who had reported their incident to DAN AP. Where available, investigations, pathology and autopsy results were obtained. Only incidents diagnosed as IPE by diving physicians or pathologists with experience in the investigation of diving accidents were included. Individual case histories and outcomes, together with brief individual summaries of the associations and possible contributing factors were recorded. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 meters of seawater for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities. Cardiac anomalies dominated the associated or possible contributing factors. These included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusions: Previously reported associations of IPE such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, ascent or surfacing, tight wetsuit, aspiration and certain medications were identified. Cardiac conditions were frequent and included chronic disorders (valvular pathology, coronary artery disease) and transient disorders (dysrhythmias, transient myocardial dysfunction, takotsubo or stress cardiomyopathy). It is likely that the chronic cardiac disorders may have contributed to the IPE, whereas the transient cases could be either sequelae, contributors or coincidental to the IPE.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Idoso , Autopsia , Doença das Coronárias/patologia , Suscetibilidade a Doenças/etiologia , Suscetibilidade a Doenças/patologia , Evolução Fatal , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania/epidemiologia , Esforço Físico , Edema Pulmonar/diagnóstico , Edema Pulmonar/epidemiologia , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Distribuição por Sexo , Natação , Cardiomiopatia de Takotsubo/complicações , Adulto Jovem
8.
Wiad Lek ; 72(9 cz 2): 1727-1731, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622255

RESUMO

OBJECTIVE: Introduction: The anticipation of the development of thrombotic complications in coronary angioplasty patients helps to prevent this dangerous complication. Development of the available informative scales on the basis of mathematical methods taking into account the main clinical and biochemical parameters significantly simplifies the classification of patients in terms of thrombotic risk. The aim of the paper is to concentrate information on the state of hemostasis in the studied category of patients using the method of the main components and to obtain a matrix with minimal loss of information, which is convenient for analysis and the creation of a grade-ranking scale. PATIENTS AND METHODS: Materials and methods: Data of 70 patients with coronary heart disease and percutaneous coronary angioplasty were analyzed. The level of soluble fibrin, fibrinogen, D-dimer, protein C, and ratios rf/dd×100 were determined, and also the presence of diabetes mellitus and restenosis in the history was considered. RESULTS: Results: As a result of a stepwise study using the method of the main components, in the first stage two most singular matrices were obtained that describe 70% of the entire data variance (one of them is the component rf+dd, and the second one is fg+pc), which led to the first indicator of the level of thrombotic risk. At the second stage, the level of thrombotic risk was clarified, taking into consideration the presence of diabetes and history of restenosis, and it is recommended to use a second indicator for its determination (rf/dd×100). CONCLUSION: Conclusions: The presented grade-ranking scale scale allows the anticipation of the development of thrombotic complications in the studied category of patients with high probability.


Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Trombose/diagnóstico , Doença das Coronárias/complicações , Diabetes Mellitus , Humanos , Recidiva , Medição de Risco , Fatores de Risco
9.
Zhongguo Zhong Yao Za Zhi ; 44(14): 2926-2931, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31602834

RESUMO

Diemailing~® Kudiezi Injection( DKI) is widely used in the treatment of cerebral infarction,coronary heart disease and angina pectoris. Long-term clinical application and related research evidence showed that DKI has a good effect in improving the clinical symptoms of cardiovascular and cerebrovascular diseases. However,this injection has not been included in any clinical practice guideline. It has been found that the use of DKI is in wrong way in clinical practice in recent years. Therefore,clinical experts from the field of cardiovascular and cerebrovascular diseases nationwide are invited to compile this expert consensus in order to guide clinicians.GRADE system is used to grade the quality of evidence according to different outcomes according to degrading factors. Then it forms the recommendation or consensus suggestion through the nominal group method. The formation of expert consensus mainly considers six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on these six aspects,if the evidence is sufficient,a " recommendation" supported by evidence is formed,and GRADE grid voting rule is adopted. If the evidence is insufficient,a " consensus suggestions" will be formed,using the majority voting rule. In this consensus,the clinical indications,efficacy,safety evidences and related preliminary data of DKI were systematically and comprehensively summarized in a concise and clear format,which could provide valuable reference for the clinical use of DKI. This consensus has been approved by China association of Chinese medicine which is numbered GS/CACM 202-2019.


Assuntos
Angina Pectoris/tratamento farmacológico , Infarto Cerebral/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , China , Consenso , Humanos , Injeções , Medicina Tradicional Chinesa
10.
J Assoc Physicians India ; 67(10): 54-56, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571453

RESUMO

Background: Attention has increasingly turned towards the role of factors, such as inflammation in the development of atherosclerosis and CHD. C-reactive protein (CRP) has emerged as one of the most important novel inflammatory marker. Subsequent risk modification and treatment strategies of CHD keeping on pointer towards inflammation may be the appropriate approach. Aim: The aim of this study was to determine the association of CHD with CRP, a sensitive marker of inflammation. Material and Methods: This is a case control study amongst 300 subjects (150 cases and 150 controls), conducted in the Department of Cardiology at Sri Aurobindo Medical College and P.G Institute, Indore, M.P. Subjects with definite diagnosis of CHD established by coronary angiography (CAG) was taken as cases, subjects matched with age, gender with no conventional risk factor and past history of CHD from the relatives and accompanying persons were enlisted as controls. Results: Estimation of CRP reveals ≥0.6 mg/dl in 88(58.7%) subjects out of 150, compared to 26 (17.3%) control subjects out of 150 which is statistically significant (p value<0.0001) (OR=6.7). Conclusion: CRP as a noble marker of inflammation was significantly higher in subjects of CHD and thus supported adequately the hypothesis of an activation of inflammatory cascade for coronary atheromatous plaque formation and causation of CHD.


Assuntos
Proteína C-Reativa/metabolismo , Doença das Coronárias/metabolismo , Biomarcadores/metabolismo , Estudos de Casos e Controles , Humanos , Inflamação/metabolismo , Fatores de Risco
11.
Medicine (Baltimore) ; 98(42): e17106, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626081

RESUMO

BACKGROUND: Many studies investigated the association between miR-146a rs2910164 polymorphisms and risk of ischemic cardio-cerebrovascular diseases. However, the results were inconsistent. METHODS: We searched the PubMed, EMBASE, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases for appropriate studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the associations. Heterogeneity, sensitivity, and publication bias were conducted to measure the robustness of our findings.All analyses were based on previous published studies, thus, no ethical approval and patient consent are required. RESULTS: We conducted a meta-analysis to evaluate the relationship between miR-146a rs2910164 polymorphisms and risk of ischemic cardio-cerebrovascular diseases. A total of 26 related studies involving 11,602 cases and 14,016 controls were identified and included in our meta-analysis. After considering the heterogeneity of the global analysis, we inferred that rs2910164 polymorphisms were associated with a lower risk of coronary heart disease (CHD) significantly in all genetic models. In addition, it was also found that the miR-146a rs2910164 polymorphisms were associated with the low risk of ischemic cardio-cerebrovascular diseases in large sample size subgroup analysis. CONCLUSION: These results indicate that miR-146a rs2910164 polymorphisms were significantly associated with a lower risk of ischemic cardio-cerebrovascular. The miR-146a rs29101164 might be recommended as a predictor for susceptibility of ischemic cardio-cerebrovascular diseases.


Assuntos
Transtornos Cerebrovasculares/genética , Doença das Coronárias/genética , Predisposição Genética para Doença , MicroRNAs/genética , Humanos , Isquemia , Polimorfismo de Nucleotídeo Único , Fatores de Risco
12.
Artigo em Russo | MEDLINE | ID: mdl-31626154

RESUMO

AIM: To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF). SUBJECTS AND METHODS: Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry. RESULTS: The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure. CONCLUSION: ECP is an effective, non-invasive treatment in patients with heart failure.


Assuntos
Doença das Coronárias/cirurgia , Contrapulsação , Insuficiência Cardíaca/complicações , Microcirculação/fisiologia , Idoso , Doença das Coronárias/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Zhonghua Yi Xue Za Zhi ; 99(35): 2750-2755, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550797

RESUMO

Objective: To assess whether acute-phase plasma PCSK9 levels predict recurrent cardiovascular (CV) events in acute myocardial infarction (AMI) patients without receiving reperfusion therapy. Methods: Plasma PCSK9 levels were measured during the acute phase (≤24 hours) in 882 patients who did not undergo reperfusion therapy from the China PEACE-Prospective AMI Study (2012-2014). Associations of acute-phase PCSK9 tertiles with patient characteristics and recurrent CV events at 1 year were assessed using multivariable logistic and Cox proportional hazards regression models. Results: Female gender (odds ratio [OR] 2.86, 95% confidence interval [CI] 1.36-5.98), premature coronary heart disease (CHD) (OR 2.82, 95%CI 1.43-5.53), higher high-sensitivity C-reactive protein (OR 1.69, 95%CI 1.35-2.13), and higher triglycerides (OR 1.93, 95%CI 1.10-3.38) were associated with higher baseline PCSK9 levels. Patients with PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events (HR 0.77, 95%CI 0.44-1.34). Conclusion: Acute-phase plasma PCSK9 levels are associated with levels of inflammation and triglycerides, premature CHD, and gender in AMI patients without reperfusion therapy, however it do not predict recurrent CV events at 1 year.


Assuntos
Infarto do Miocárdio/sangue , Pró-Proteína Convertase 9/sangue , China , Doença das Coronárias/epidemiologia , Feminino , Humanos , Inflamação , Masculino , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Fatores Sexuais , Triglicerídeos/sangue
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 457-463, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484606

RESUMO

To systematically evaluate the risks of cardiocerebral vascular events in patients with primary biliary cholangitis(PBC). Methods We carried out a Meta analysis by RevMan 5.3 software to investigate literatureon the risk of cardiocerebral vascular events in patients with PBC and controls. Results Compared with non-PBC controls,PBC patients had significantly higher risk of coronary events(RR=1.56,P=0.0002);however,the risk of cerebrovascular events showed no significant difference between these two groups(RR=1.01,P=0.94).Subgroup analysis demonstrated a significantly lower risk of transient ischemic attack or carotid stenosis in PBC patients(RR=0.63,P=0.03);however,there was no significant difference in the risk of stroke(RR=1.11,P=0.40). Conclusion Patients with PBC have an increased risk of coronary events but may have a lower risk of transient ischemic attack or carotid stenosis.


Assuntos
Colangite/complicações , Doença das Coronárias/etiologia , Cirrose Hepática Biliar/complicações , Estenose das Carótidas/etiologia , Humanos , Ataque Isquêmico Transitório/etiologia , Fatores de Risco , Acidente Vascular Cerebral/etiologia
15.
Br J Radiol ; 92(1103): 20180309, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31502858

RESUMO

Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and "smart" contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.


Assuntos
Aterosclerose/diagnóstico , Diagnóstico por Imagem/tendências , Doenças da Aorta/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Meios de Contraste , Doença das Coronárias/diagnóstico , Humanos , Angiografia por Ressonância Magnética/tendências , Espectroscopia de Ressonância Magnética , Nanopartículas de Magnetita , Imagem Molecular/tendências , Espectrofotometria Infravermelho/tendências , Tomografia de Coerência Óptica/tendências , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia de Intervenção/tendências , Calcificação Vascular/diagnóstico
16.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 73-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538452

RESUMO

The aim of present study is to evaluate the greater risk of periodontal disease in subjects affected by cardiovascular disease. The statistical study includes 200 patients equally divided into a test and a control group. The test group is made up of hospitalized patients from the cardiology division of the S. Salvatore hospital of L'Aquila and the second made up of subjects that frequented a dental clinic. All patients were subject to anamnesis and clinical evaluation for periodontal disease. The index used for this clinical examination were CPTIN index (Community Periodontal Index for Treatment Needs), pocket depth index (PPD), probing bleeding index (PBI), and plaque index (Silness, Loe). All data were collected and a comparative analysis was done of the results obtained from the two groups. Analysing the data concerning the average of lost and present teeth in the oral cavity and the damage of periodontal attachment we notice that cardiopathic subjects had a loss of periodontal attachment 2 times greater than in the control group and major condition of edentulism. A frequency test called the "chi-square test" showed that cardiopathic patients had a greater frequency of periodontal disease. The development of periodontal disease in subject suffering from coronary heart disease is faster and more aggressive than in healthy subjects. Therefore, the prevention of periodontal disease is simple and effective way to reduce the risk of cardiovascular disease.


Assuntos
Doença das Coronárias/complicações , Doenças Periodontais/complicações , Índice de Placa Dentária , Humanos , Itália
17.
N Engl J Med ; 381(12): 1103-1113, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31475793

RESUMO

BACKGROUND: There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease. METHODS: In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrial fibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had angiographically confirmed coronary artery disease not requiring revascularization to receive monotherapy with rivaroxaban (a non-vitamin K antagonist oral anticoagulant) or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause; this end point was analyzed for noninferiority with a noninferiority margin of 1.46. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority. RESULTS: The trial was stopped early because of increased mortality in the combination-therapy group. Rivaroxaban monotherapy was noninferior to combination therapy for the primary efficacy end point, with event rates of 4.14% and 5.75% per patient-year, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01 for superiority). CONCLUSIONS: As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrial fibrillation and stable coronary artery disease. (Funded by the Japan Cardiovascular Research Foundation; AFIRE UMIN Clinical Trials Registry number, UMIN000016612; and ClinicalTrials.gov number, NCT02642419.).


Assuntos
Fibrilação Atrial/tratamento farmacológico , Doença das Coronárias/terapia , Inibidores do Fator Xa/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Rivaroxabana/uso terapêutico , Idoso , Aspirina/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Ponte de Artéria Coronária , Doença das Coronárias/complicações , Quimioterapia Combinada/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/efeitos adversos , Modelos de Riscos Proporcionais , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Rivaroxabana/efeitos adversos
18.
N Engl J Med ; 381(21): 2032-2042, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31556978

RESUMO

BACKGROUND: Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI). METHODS: In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin of 1.6 percentage points. RESULTS: We enrolled 9006 patients, and 7119 underwent randomization after 3 months. Between randomization and 1 year, the incidence of the primary end point was 4.0% among patients randomly assigned to receive ticagrelor plus placebo and 7.1% among patients assigned to receive ticagrelor plus aspirin (hazard ratio, 0.56; 95% confidence interval [CI], 0.45 to 0.68; P<0.001). The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, -0.06 percentage points; 95% CI, -0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority). CONCLUSIONS: Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke. (Funded by AstraZeneca; TWILIGHT ClinicalTrials.gov number, NCT02270242.).


Assuntos
Aspirina/uso terapêutico , Doença das Coronárias/terapia , Hemorragia/induzido quimicamente , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Ticagrelor/uso terapêutico , Idoso , Aspirina/efeitos adversos , Doença das Coronárias/tratamento farmacológico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Ticagrelor/efeitos adversos
19.
Arq. bras. cardiol ; 113(2 supl.1): 29-29, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1016869

RESUMO

A Doença Arterial Coronariana (DAC) é a maior causa global de morte. No Brasil, em 2011, 8,8% dos óbitos cardiovasculares ocorreram devido à DAC. Os estudos indicam que 20-40% dos pacientes com DAC apresentam transtorno depressivo e, nesses casos, sua mortalidade é aumentada em 1,6 vezes. Atualmente, a Intervenção Coronariana Percutânea (ICP) é a modalidade terapêutica mais utilizada para DAC. OBJETIVO: Avaliar a prevalência da depressão e intenção suicida nos pacientes portadores de DAC submetidos à ICP, correlacionando-a às suas características biopsicossociais e à dosagem de mediadores neuroendócrinos. MÉTODO: Estudo retrospectivo, com inclusão consecutiva de pacientes com DAC submetidos a ICP eletiva no Instituto Dante Pazzanese de Cardiologia entre Maio e Dezembro de 2013. Para detectar e classificar o transtorno depressivo, aplicouse o Questionário de Saúde do Paciente (PHQ-9) e Questionário de Beck (BDI). RESULTADOS: Foram incluídos 206 pacientes. Destes, 59,7% apresentaram depressão, de acordo com o PHQ-9. Utilizando o BDI, foi detectado o transtorno em 37,4% dos casos. 6,8% reportaram intenção suicida. A Tabela 1 demonstra as características físicas e dosagem sérica de mediadores neuroendócrinos de pacientes com e sem depressão. A divergência entre os resultados obtidos pelo BDI e PHQ-9 é uma das limitações do estudo, possivelmente ocorrida devido à diferente classificação do transtorno em cada questionário. Ainda, o desenho retrospectivo do estudo não permite saber a ordem de aplicação dos questionários, o que pode interferir no resultado. CONCLUSÃO: A depressão e a DAC apresentam evidente associação. Seu reconhecimento precoce, além da maior interação entre cardiologistas e psiquiatras, pode ser benéfica e impactar positivamente na morbimortalidade destes agravos. (AU)


Assuntos
Humanos , Doença das Coronárias , Transtorno Depressivo , Intervenção Coronária Percutânea
20.
Arq. bras. cardiol ; 113(2 supl.1): 48-48, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1016895

RESUMO

INTRODUÇÃO: Devido ao envelhecimento populacional, a presença de octogenários nas salas de hemodinâmica para realização de intervenções coronárias percutâneas (ICP) tem sido cada vez mais frequente. Estes pacientes apresentam doença coronariana mais avançada, lesões complexas e múltiplas comorbidades, que podem influenciar negativamente o sucesso dessas intervenções. Este trabalho visa avaliar o perfil de apresentação clínica e hemodinâmica de octogenários, segundo sexo, submetidos a ICP. METODOS: Estudo retrospectivo, descritivo, observacional e consecutivo, realizado de janeiro de 2013 a dezembro de 2017. As variáveis quantitativas foram analisadas por média e desvio padrão e variáveis qualitativas por valores absolutos e/ou percentuais e diferenças de tratamento foram calculadas por teste exato de Fisher e Qui-quadrado, considerado P-valor significativo P < 0,05. RESULTADOS: De 166 octogenários, com idade média de 82,4 (+-3,71), 41% eram mulheres e 59% eram homens. Entre as 69 mulheres, a idade média foi 82,6 anos (±3,69), a Taxa de Filtração Glomerular estimada (TGF Crockcroft-Gault) de 53,55mLmin, a Fração de Ejeção (FE) média de 59% e lesão em tronco de coronária esquerda (TCE) de 21%. Quanto à forma de apresentação, 22% apresentaram Angina Estável (AE), 12% Angina Instável (AI), 33% Infarto agudo do miocárdio sem supradesnivelamento de ST (IAMSST) e 7% Infarto agudo do miocárdio com supradesnivelamento do ST (IAMCST). Houve 4% de óbitos. Entre os 96 homens, a idade média foi 83,09 anos (±3,68), TFG de 54,3mLmin, FE média de 53% e lesão de TCE em 40%. Cerca de 33% apresentaram AE, 10% AI, 29% IAMSST, 17% IAMCST e 5% faleceram. CONCLUSÃO: Observou-se predomínio de IAMCCST em homens octogenários, com maior tendência a lesão de TCE (p=0,0069) e queda da fração de ejeção (p=0,003). Não houve diferença de mortalidade quanto ao sexo e demais variáveis analisadas. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Idoso de 80 Anos ou mais , Doença das Coronárias , Intervenção Coronária Percutânea
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA