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1.
Cas Lek Cesk ; 158(5): 178-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703529

RESUMO

Sleep is a condition of physiological relaxation for the cardiovascular system, and sleep-disordered breathing disturbs it. Recurrent episodes of sleep apnea disrupt the physiological interactions between sleep and the cardiovascular system. Sleep apnea can affect not only patients quality of life with cardiovascular diseases, but also their morbidity and mortality. Thus sleep apnea becomes a significant, influential risk factor in cardiology.


Assuntos
Doenças Cardiovasculares , Síndromes da Apneia do Sono , Doenças Cardiovasculares/complicações , Humanos , Qualidade de Vida , Fatores de Risco , Síndromes da Apneia do Sono/complicações
2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 402-409, ago.-sept. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182859

RESUMO

Background: This study was designed to detect the potential association of a nonfunctional adrenal incidentaloma (NFAI) with insulin resistance and associated metabolic disturbances, with a subsequent increase in cardiovascular risk factors. Methods: Eighty-three NFAI patients and 56 volunteers (controls) without any adrenal abnormalities on computed tomography (CT) were included. Fasting blood glucose (FBG), fasting insulin, lipid profiles, uric acid, homocysteine, fibrinogen, high sensitivity C-reactive protein (hs-CRP), and adiponectin levels were measured in both groups. Blood pressure (BP), waist circumference, body mass index (BMI), and carotid intima media thickness (CIMT) were evaluated in both the patients and volunteers. Results: There were no significant difference between the NFAI and control groups with respect to age, sex, BMI, waist circumference, systolic and diastolic BP, smoking, concomitant disease, and medications. Fasting insulin and glucose levels and homeostasis model of assessment-insulin resistance (HOMA-IR) scores were significantly higher in the NFAI group as compared with those in the control group (p<0.01). The frequency of metabolic syndrome in the NFAI group was higher than that in the control group (p<0.01). All the lipid fractions, except triglyceride (TG), (p<0.05), homocysteine (p=0.01), and fibrinogen levels (p<0.001), were significantly higher in the NFAI group as compared with the levels in the control group. There were no significant differences between the NFAI and control groups in terms of uric acid, hs-CRP, and adiponectin levels. The CIMT values in the NFAI group were significantly higher than those in the control group (0.74±0.14 vs. 0.53±0.09, p<0.001). The mean CIMT value showed a statistically positive correlation with age (r=0.245, p=0.004); the HOMA-IR score (r=0.490, p<0.001); and FBG (r=0.521, p<0.001), fasting insulin (r=0.432, p<0.001), total cholesterol (TC) (r=0.267, p=0.002), and fibrinogen (r=0.398, p<0.001) levels in the NFAI group. Conclusions: The results indicated that the NFAI patients had an elevated risk of insulin resistance, with metabolic syndrome and increased CIMT values. Long-term follow-up studies should be designed to evaluate postsurgical alterations in metabolic parameters and cardiovascular risk factors in NFAI patients


Antecedentes: Este estudio se diseñó para detectar la posible asociación del incidentaloma suprarrenal no funcionante (ISNF) con resistencia a la insulina y trastornos metabólicos asociados, con un incremento subsecuente en los factores de riesgo cardiovascular. Métodos: Se incluyó a 83 pacientes con ISNF y a 56 voluntarios (controles) sin anomalías suprarrenales en la tomografía computarizada (TC). Se determinaron en ambos grupos los valores de glucemia en ayunas (GA), insulina en ayunas, perfiles lipídicos, ácido úrico, homocisteína, fibrinógeno, proteína C reactiva de alta sensibilidad (PCRas) y adiponectina. Se evaluaron la presión arterial (PA), el perímetro de la cintura, el índice de masa corporal (IMC) y el grosor íntima-media carotídea (GIMC) tanto en los pacientes como en los voluntarios. Resultados: No había una diferencia significativa entre los grupos con ISNF y de control en cuanto a edad, sexo, IMC, perímetro de la cintura, PA sistólica y diastólica, tabaquismo, enfermedades concomitantes y medicamentos. Las concentraciones de insulina y glucosa en ayunas y las puntuaciones del modelo homeostático de evaluación de la resistencia a la insulina (HOMA-IR) fueron significativamente mayores en el grupo con ISNF que en el de control (p<0,01). La frecuencia de síndrome metabólico fue mayor en el grupo con ISNF que en el de control (p<0,01). Los valores de todas las fracciones lipídicas, excepto los de triglicéridos (TG) (p<0,05), homocisteína (p=0,01) y fibrinógeno (p<0,001), fueron significativamente mayores en el grupo con ISNF que en el de control. No hubo diferencias significativas entre los grupos con ISNF y de control en las concentraciones de ácido úrico, PCRas y adiponectina. Los valores del GIMC en el grupo con ISNF fueron significativamente mayores que los del grupo de control (0,74±0,14 frente a 0,53±0,09; p<0,001). El valor medio del GIMC mostró una correlación estadísticamente positiva con la edad (r=0,245; p=0,004); la puntuación del HOMA-IR (r=0,490; p<0,001), y la GA (r=0,521; p<0,001), la insulina en ayunas (r=0,432; p<0,001), el colesterol total (CT) (r=0,267; p=0,002) y el fibrinógeno (r=0,398; p<0,001) en el grupo con ISNF. Conclusión: Los resultados indicaban que los pacientes con ISNF tenían un riesgo elevado de resistencia a la insulina, con síndrome metabólico y aumento de los valores del GIMC. Deben diseñarse estudios de seguimiento a largo plazo para evaluar los cambios posquirúrgicos de los parámetros metabólicos y los factores de riesgo cardiovascular en pacientes con ISFN


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Achados Incidentais , Fatores de Risco , Neoplasias das Glândulas Suprarrenais/complicações , Doenças Cardiovasculares/metabolismo , Espessura Intima-Media Carotídea , Síndrome Metabólica/complicações , Resistência à Insulina , Glândulas Suprarrenais/patologia , Síndrome Metabólica/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Doenças Cardiovasculares/complicações , Síndrome Metabólica/fisiopatologia , Voluntários Saudáveis , Pressão Arterial , Índice de Massa Corporal , Relação Cintura-Quadril
4.
Kardiologiia ; 59(9): 20-28, 2019 Sep 20.
Artigo em Russo | MEDLINE | ID: mdl-31540573

RESUMO

AIM: to investigate relationship between arterial hypertension (AH) and risk factors / subclinical damage of target organs in patients with type 2 diabetes mellitus (DM2). METHODS: We included into this clinical epidemiological study 528 patients with DM2 (30.5 % men, 69.5 % women; mean age 54.1±0.3 years; 80.3 % with AH, 19.7 % without AH), who answered questions of the ARIC study questionnaire related to risk factors. Also, we studied features of target organ damage and laboratory indicators. RESULTS: In comparison with normotensives patients with AH more frequently had ischemic heart disease (12.7±1.6 % vs. 5.8±2.3 %, p<0.05), chronic heart failure (CHF) (30.9±2.2 % vs. 9.6±2.9 %, p<0.001), atherosclerosis of vessels of lower extremities (69.8±2.2 % vs. 53.8±4.9 %, p<0.01) and cerebral vessels (50.9±2.4 % vs. 28.8±4.4 %, p<0.001), history of stroke (5.0±1.1 % vs. 0 %, p<0.05), hypertonic angiopathy (14.5±1.8 % vs. 6.5±2.5 %, p<0.05), low level of high density lipoprotein (87.3±2.2 % vs. 74.5±6.4 %, p<0.05), electro- and echocardiographic signs of left ventricular hypertrophy (75.6±2.1 % vs. 45.4±5.1 %, p<0.001; 61.1±2.6 % vs. 24.4±4.7 %, p<0.001, respectively), lowering of left ventricular ejection fraction (12.5±1.7 % vs. 7.8±2.8 %, p<0.001), diastolic disfunction of the left ventricle (52.6±2.7 % vs. 23.2±4.7 %, p<0.001), atherosclerosis of the aorta (38.0±2.6 % vs. 20.7±4.5 %, p<0.01), lowering of the ankle-brachial index (left - 29.8±2.3 % vs. 14.9±3.5 %, p<0.01; right - 31.5±2.3 % vs. 9.9±3.0 %, p<0.001, respectively), increased intima-media thickness of the right carotid artery (84.6±5.0 % vs. 60.0±11.0 %, p<0.05). CONCLUSION: In patients with type 2 diabetes and AH, in order to develop strategy of macro- and microvascular complications prevention, it is necessary to conduct early screening of risk factors and subclinical damage of target organs.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipertensão , Doenças Cardiovasculares/complicações , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco
5.
Kardiologiia ; 59(8S): 24-36, 2019 Sep 16.
Artigo em Russo | MEDLINE | ID: mdl-31526359

RESUMO

In recent years, a greater understanding of the heterogeneity and complexity of chronic obstructive pulmonary disease (COPD) has come from the point of view of an integrated clinical assessment of severity, pathophysiology, and the relationship with other pathologies. A typical COPD patient suffers on average 4 or more concomitant diseases and every day about a third of patients take from 5 to 10 different drugs. The mechanisms of the interaction of COPD and cardiovascular disease (CVD) include the effects of systemic inflammation, hyperinflation (hyperinflation) of the lungs and bronchial obstruction. The risk of developing CVD in patients with COPD is on average 2-3 times higher than in people of a comparable age in the general population, even taking into account the risk of smoking. The prevalence of coronary heart disease, heart failure, and rhythm disturbances among COPD patients is significantly higher than in the general population. The article discusses in detail the safety of prescribing various groups of drugs for the treatment of CVD in patients with COPD. Achieving success in understanding and managing patients with COPD and CVD is possible using an integrated multidisciplinary approach.


Assuntos
Doenças Cardiovasculares , Sistema Cardiovascular , Doença Pulmonar Obstrutiva Crônica , Doenças Cardiovasculares/complicações , Comorbidade , Humanos , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Fatores de Risco
6.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 113-119, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538457

RESUMO

Cardiovascular disease (CVD) is a common cause of death, representing 29% of the mortality all over the word. Estimates for 2006 show that CVD is one of the world's main cause of death, with 17.1 million death per year. More than 70 million Americans have been diagnosed with various forms of CVD, including high blood pressure, coronary artery disease (acute myocardial infarction and angina pectoris), disorders of peripheral arteries etc. There is strong evidence that periodontal disease (PD) is associated with an increased risk of CVD. In addiction many patients with CVD are also affected by PD, which can be mild or severe. The aim of this manuscript is to investigate the effects of periodontal therapy on the management of CVD. 34 randomised controlled trials and reviews were included in this manuscript to test the effects of different periodontal therapies for patients with CVD. In conclusion, we may affirm that there is some lack of knowledge on relations between PD and CVD, however there is sufficient evidence to justify a periodontal treatment to prevent CVD, in fact PD is very prevalent in middle-aged population and can have a significant impact on the cardiovascular function.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Periodontais/terapia , Doenças Cardiovasculares/complicações , Odontólogos , Humanos , Doenças Periodontais/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
7.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 135-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538460

RESUMO

The aim of this review is to determine if there is a relationship between periodontal disease and stroke. The included case-control and cohort studies mediate the incidence of stroke and periodontal disease by analyzing different parameters. A literature review was carried out in PubMed, Scopus and Embase databases using the key word "stroke" AND "periodontal disease". An amount of 932 articles came out from our research on these three databases. These articles were selected according to PRISMA criteria. The following inclusion criteria were established: studies conducted in humans, articles published in English and published in the last ten years. Exclusion criteria were: experimental studies on animals, articles published more than 10 years ago, non-English language articles, articles of non-indexed journals, and articles not directly related to the association between stroke and periodontitis. These criteria reduced the number of articles from 932 to 399. At the end, articles that appeared to be repeated in different databases have been eliminated: 254 articles remained. All these articles titles were reviewed by the authors, who decided whether or not to include them in the review. We selected an amount of 43 articles. These studies were reviewed by reading the titles and abstracts, and by finally selecting the ones with the same topic of this review. When titles or abstracts were not clear, the complete article was read. At the end 7 articles were selected. In addition, 2 systematic reviews and 1 article, cited in the discussion, and regarding the protocol used in patients suffering from cardiovascular diseases and periodontitis, were selected. The quality of these articles was evaluated through the JADAD system. In conclusion, patients with stroke have a higher prevalence of periodontitis.


Assuntos
Doenças Cardiovasculares/complicações , Periodontite/complicações , Acidente Vascular Cerebral/complicações , Humanos , Fatores de Risco
9.
Life Sci ; 235: 116843, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31494172

RESUMO

Polycystic ovary syndrome (PCOS) is a multifactorial disease, which is resulted from the three common features, hyperandrogenism (HA), ovulatory dysfunction (OD), and polycystic ovarian morphology (PCOM). The environmental inducers (like diet, lifestyle, chemicals, drugs, and ageing) and cardiometabolic risk factors (such as insulin resistance, metabolic syndrome, and obesity) are involved in pathogenesis of PCOS. The growing body of evidence has been shown that there exist endothelial cell dysfunction (ECD) in women with PCOS independent of age, weight and metabolic abnormalities. It has been shown that a broad spectrum of cardiovascular risk markers are involved in ECD- induced cardiovascular disease. It is well described that there are no worldwide treatments for PCOS and all of pharmacological treatments are off -label without any approval. MNAM is one of potential therapeutic factor, which produced by nicotinamide N-methyltransferase (NNMT) via consumption of S-adenosyl methionine (SAM) and nicotinamide. Only one study has shown higher expression of its producer enzyme, NNMT, in the cumulus cells of women with PCOS. Therefore, we reviewed beneficial effects of MNAM on modulation of cardiometabolic risk factors, which are associated to PCOS and try to describe possible mode of action of MNAM in the regulation of these markers.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Niacinamida/análogos & derivados , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Sintomas Prodrômicos , Biomarcadores/sangue , Feminino , Humanos , Niacinamida/farmacologia , Niacinamida/uso terapêutico , Fatores de Risco
10.
Clín. investig. arterioscler. (Ed. impr.) ; 31(4): 178-185, jul.-ago. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-182712

RESUMO

La enfermedad cardiovascular sigue siendo la primera causa de mortalidad en los países occidentales. Se necesitan nuevas estrategias para la prevención y el control de esta enfermedad. Al mismo tiempo, la incidencia de factores de riesgo que conducen al desarrollo de esta afección, como la obesidad, la hipertensión y la diabetes, sigue aumentando. Por lo tanto, la búsqueda de nuevos marcadores o mediadores es una prioridad en la mayoría de los programas de prevención cardiovascular. El estudio de la microbiota intestinal está surgiendo porque se sabe que los microorganismos intestinales actúan colectivamente como un órgano integrado, regulando múltiples funciones biológicas que pueden modular los factores de riesgo cardiovascular y los mecanismos patógenos de este proceso. Esta revisión considera la situación actual con respecto a la influencia de la microbiota intestinal en la enfermedad cardiovascular y, en particular, su influencia en los principales factores de riesgo tradicionales que conducen a la enfermedad cardiovascular, como la obesidad, la diabetes, la hipertensión y los lípidos


Cardiovascular disease remains the first cause of mortality in Western countries. New strategies for prevention and control of cardiovascular disease are needed. At the same time, the incidence of risk factors that lead to the development of this disease, such as obesity, hypertension and diabetes, continues to rise. Therefore, the search for new markers or mediators is a priority in most cardiovascular prevention programs. The study of the intestinal microbiota is emerging because it is known that intestinal microorganisms act collectively as an integrated organ, regulating multiple biological functions that can modulate cardiovascular risk factors and the pathogenic mechanisms of this process. This review considers the current situation regarding the influence of gut microbiota on cardiovascular disease and particularly, its influence on the main traditional risk factors that lead to cardiovascular disease, such as obesity, diabetes, hypertension and lipids


Assuntos
Humanos , Microbioma Gastrointestinal , Fatores de Risco , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/complicações , Arteriosclerose/complicações , Arteriosclerose/prevenção & controle , Obesidade/epidemiologia
11.
Med. clín (Ed. impr.) ; 153(3): 100-105, ago. 2019. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183431

RESUMO

Introducción y objetivos: Actualmente en España, la quema del carbón sigue siendo una de las fuentes principales de electricidad. Su combustión genera la emisión de múltiples sustancias nocivas, entre ellas, las partículas PM2,5 que se han relacionado con incrementos en morbimortalidad cardiovascular. Los objetivos del estudio son: 1) determinar la distribución geográfica nacional de dichas partículas y su posible asociación con la proximidad a las centrales térmicas de carbón y 2) estimar el impacto sobre la salud cardiovascular derivado de las emisiones de partículas PM2,5 de las centrales térmicas de carbón en España durante el año 2014. Métodos: Para realizar el estudio de dispersión de los contaminantes atmosféricos procedentes de las centrales térmicas se empleó el modelo matemático CALPUFF. Los datos demográficos y epidemiológicos se obtuvieron del Instituto Nacional de Estadística. Se emplearon metodologías validadas en el ámbito internacional para valorar la asociación contaminante-respuesta. Resultados: El número total de defunciones atribuibles al carbón fue de 709 casos, de los cuales 586 (82,6%) se relacionaron con las partículas PM2,5. La mayor parte de ellas fueron debidas a infartos, ictus fatales y a insuficiencia cardiaca, que constituyeron un total de 170 de las muertes por PM2,5 (29%). Las tasas de incidencia más elevadas se observaron en Asturias y Castilla y León. Conclusiones: Este estudio describe un aumento de morbimortalidad cardiovascular en España relacionada con las emisiones procedentes de la quema de carbón. Refleja como aquellas comunidades con mayor presencia de centrales térmicas (Asturias y Castilla y León) fueron las más afectadas y extrapola que sus habitantes tienen un mayor riesgo de mortalidad por exposición a partículas PM2,5


Introduction and objectives: One of the main sources of energy in Spain is still coal combustion. It releases multiple pollutants into the atmosphere, such as PM2.5, that has been linked to an increase in cardiovascular morbidity and mortality. The objectives of this paper are: 1) to determine the national distribution of these particles and their proximity to coal plants, 2) to estimate the cardiovascular impact of PM2.5 particles in Spain in 2014. Methods: In order to complete the national pollutant dispersion study, we used the CALPUFF model. The epidemiologic and demographic data were obtained from the National Statistics Institute. The associations «pollutant-effect» were obtained by internationally validated methodologies. Results: The total number of deaths due to coal pollutants were 709, from which 586 (82.6%) were related to PM2.5 particles. Most of them were due to myocardial infarctions, fatal strokes and heart failure, adding up to 170 cases of mortality related to PM2.5 (29%). The greatest densities were found in the regions of Asturias and Castilla y León. Conclusions: This study describes an increase in cardiovascular mortality and morbidity in Spain, due to coal combustion pollutants. It finds a greater impact in the provinces of Asturias and Castilla León, where a higher presence of coal power plants can be found. This reflects that the people that live in those areas have a greater risk of cardiovascular death due to PM2.5 pollutant exposure from coal


Assuntos
Humanos , Poluição do Ar/efeitos adversos , Poluição Ambiental/efeitos adversos , Centrais Termelétricas , Carvão Mineral/efeitos adversos , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Centrais Elétricas , Indicadores de Morbimortalidade , Exposição Ambiental/efeitos adversos
12.
Interv. psicosoc. (Internet) ; 28(2): 83-90, ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183649

RESUMO

Childhood overweight and obesity is a continued problem. Children above the 90th percentile for BMI are particularly susceptible to cardiovascular health risks. There remains a minimal understanding of theory-based psychological predictors of physical activity and weight change in children. This research incorporated data from a subsample of after-school care enrollees above the 90th BMI percentile (Mage=10.1 years) who participated in either 4-day/week (n = 21) or 3-day/week (n = 24) versions of a 45 min/session, cognitive-behaviorally based physical activity/health behavior-change program over a full school year, or a control condition of usual care (n = 14). For the cognitive-behavioral groups only, significant improvements were found in self-regulation, mood, and physical activity. Their BMI increases of 0.12 and 0.11 kg/m2, respectively, were significantly less than the 0.90 kg/m2 rise expected through maturation. Theory-based regression models uniformly confirmed significant associations of changes in self-regulation and physical activity (R2s = .22-.25). However, within separate analyses, entry of changes in (a) self-efficacy and mood into a multiple regression equation, (b) self-efficacy as a mediator, and (c) mood as a moderator, did not increase predictive accuracies. The significant association of changes in physical activity and BMI was stronger in the heavier children. Findings will be useful for large-scale intervention applications and refinements


El sobrepeso y la obesidad infantil suponen un problema continuo. Los niños que superan el percentil 90 de índice de masa corporal (IMC) son especialmente propensos a riesgos en la salud cardiovascular. Apenas se conocen los predictores teóricos de la actividad física y del cambio de peso en los niños. Esta investigación incorpora datos de una submuestra de niños inscritos en atención extraescolar que superan el percentil 90 en IMC (media de edad de 10.1 años), que participaron en dos modalidades de un programa cognitivo-conductual de cambio en comportamiento de la actividad física y la salud de una duración de un año escolar con sesiones de 45 minutos 4 días por semana (n = 21) o 3 días por semana (n = 24). Además, se incluía un grupo control de cuidados habituales (n = 14). Únicamente se hallaron avances significativos en los grupos cognitivo-conductuales en autorregulación, estado de ánimo y actividad física. El aumento de su IMC de 0.12 y 0.11 kg/m2 respectivamente era menor (de modo significativo) que el aumento de 0.90 kg/m2 que se espera en virtud de la maduración. Los modelos de regresión confirmaron de forma consistente una asociación significativa de los cambios en autorregulación y actividad física (R2 = .22-.25). No obstante, en análisis separados, la introducción de cambios en a) autoeficacia y estado de ánimo en la ecuación de regresión múltiple, b) autoeficacia como mediador y c) el estado de ánimo como moderador no aumentaron la precisión predictiva. La asociación significativa de los cambios en la actividad física y el IMC era más estrecha en los niños con más peso. Los resultados serán de utilidad en las aplicaciones y el perfeccionamiento de la intervención a gran escala


Assuntos
Humanos , Criança , Masculino , Feminino , Atividade Motora/fisiologia , Composição Corporal , Índice de Massa Corporal , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Terapia Cognitivo-Comportamental/organização & administração , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/prevenção & controle , Sistemas de Apoio Psicossocial , Análise de Dados , Análise de Variância
13.
Expert Rev Cardiovasc Ther ; 17(8): 625-632, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31403364

RESUMO

Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities. Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosis, and stroke. The transapical approach currently remains the main pathway for TMVR but is associated with high risk of major bleeding and residual apical myocardial scarring. Complication prediction and prevention seem possible. Device-related complication prediction is based on pre-operative imaging including multi-slice computed tomography with 3-dimensional reconstructions and echocardiography which allow LVOT obstruction prediction and appropriate sizing aiming at avoiding dislocation. Industry should aim at the development of transfemoral delivery systems. Nevertheless, several recent feasibility observational studies suggested acceptable safety and efficacy of transcatheter mitral valve replacement. Expert opinion: TMVR complications and transapical delivery are some of the main setbacks which need to be addressed for TMVR to be adopted for broad clinical use.


Assuntos
Doenças Cardiovasculares/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico por imagem , Feminino , Humanos , Masculino , Valva Mitral/cirurgia , Prognóstico
14.
Am J Dent ; 32(4): 191-200, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31436940

RESUMO

PURPOSE: To review the literature on the effects of non-surgical periodontal treatment on surrogate markers of cardiovascular diseases (CVDs) and to clarify the impact of periodontal disease on systemic inflammation. METHODS: PRISMA guidelines for systematic reviews and meta-analyses have been adopted. An electronic search in PubMed up to December 2018 was performed using the following search terms and keywords alone or in combination: non surgical periodontal therapy, atherosclerotic vascular disease (AVD), operative surgical procedures, CVD, IL-6, CRP, cholesterol, LDL, oxidized low density lipoprotein, HDL, endothelial dysfunction, dependent dilatation, carotid intima media thickness, periodontitis, tunica intima. RESULTS: The electronic search resulted in the inclusion of 28 articles that were grouped and discussed based on the investigated surrogate markers. Meta-analysis was not carried out due to the heterogeneity of the results. The included studies demonstrated that periodontal treatments contribute to the resolution of oral inflammation and in turn might positively modulate the levels of systemic inflammatory markers. The initial phase of periodontal therapy has a positive impact on the short-term reduction of a series of systemic markers that are considered as surrogate markers of AVD. CLINICAL SIGNIFICANCE: The non-surgical therapy of periodontal disease would positively reduce the levels of systemic inflammation markers, decreasing the vascular risk and the possibility of developing CVD or the subclinical progression of the disease.


Assuntos
Biomarcadores , Doenças Cardiovasculares , Doenças Periodontais , Periodontite , Biomarcadores/análise , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Espessura Intima-Media Carotídea , Humanos , Doenças Periodontais/complicações , Doenças Periodontais/terapia , Periodontite/complicações , Periodontite/terapia
15.
Herz ; 44(7): 611-629, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31468075

RESUMO

There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2, treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective randomized studies on the management of heart failure and coronary artery disease are needed, which should specifically focus on the growing number of patients with advanced renal functional impairment.


Assuntos
Doenças Cardiovasculares , Falência Renal Crônica , Revascularização Miocárdica , Insuficiência Renal Crônica , Insuficiência Renal , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/cirurgia , Taxa de Filtração Glomerular , Humanos , Estudos Prospectivos , Insuficiência Renal Crônica/complicações
16.
Isr Med Assoc J ; 21(6): 408-411, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280511

RESUMO

BACKGROUND: Erectile dysfunction (ED) is a syndrome associated with endothelial dysfunction, which may predict cardiovascular events in men presenting with this syndrome. It has been shown to be associated with a higher rate of acute myocardial infarction and cardiovascular mortality, vascular inflammation, and impaired endothelial function. In this review we present the literature findings and describe the mechanistic pathways that are known to be involved in this syndrome and its related clinical consequences.


Assuntos
Doenças Cardiovasculares/complicações , Endotélio Vascular/fisiopatologia , Disfunção Erétil/complicações , Transtornos do Sono-Vigília/complicações , Adulto , Animais , Doenças Cardiovasculares/fisiopatologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Transtornos do Sono-Vigília/fisiopatologia
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(6): 385-392, jun.-jul. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-182855

RESUMO

Purpose: Gender affirming hormone therapy (HT) in transgender men both improves and impairs several surrogate cardiovascular risk markers. However, few prospective works with long follow-up and control group are available. In this context, this work aimed to assess the changes in the metabolic and cardiovascular risk pattern after 12 months of HT in transgender men. Furthermore, we aimed to investigate early effects on target tissues that may reflect an initial vascular damage. Methods: Prospective observational study, including 20 transgender men, attended in the Gender Identity Unit (UIG) of the Hospital Clinic from July 2013 to November 2015. Anthropometric and body composition by dual-energy X-ray absorptiometry (DXA), hormonal, metabolic and coagulation parameters, endothelial dysfunction by flow-mediated dilation (FMD) and intima-media thickness (IMT) by carotid ultrasound, were assessed at baseline, at 6 and 12 months of HT. Results: We observed an impairment of lipid profile, and increase of homocysteine and leucocytes count, as well as changes in body composition with increased total lean mass together with decreased total fat mass. In addition, higher mean-maximum common IMT was observed after 12 months of HT. Conclusion: Our work shows changes in metabolic and inflammatory parameters after HT after short-medium follow-up, which could increase cardiovascular risk in this setting, together with initial evidence of vascular changes


Objetivo: En los transexuales masculinos (FtM) el tratamiento hormonal (TH) cruzado produce cambios tanto positivos como negativos en diversos marcadores subrogados de riesgo cardiovascular. Por otro lado, existen pocos estudios prospectivos con un grupo control y con un seguimiento prolongado que valoren los cambios en el perfil del riesgo cardiovascular. En este contexto, nuestro trabajo tiene como objetivo evaluar los cambios en el patrón de riesgo metabólico y cardiovascular tras 12 meses de TH en transexuales masculinos. Además, estudiamos los cambios tempranos en tejidos diana que puedan reflejar un daño vascular inicial. Metodología: Estudio observacional prospectivo en 20 transexuales masculinos atendidos en la unidad de identidad de género (UIG) del Hospital Clínic desde julio de 2013 a noviembre de 2015. Se valoraron los cambios antropométricos y de composición corporal mediante una absorciometría de rayos X de doble energía (DXA), así como las variaciones en los parámetros metabólicos y trombóticos. La disfunción endotelial fue evaluada mediante la dilatación mediada por flujo (FMD), y el grosor de íntima-media carotídea (IMT) a través de una ecografía carotídea, a los 6 y 12 meses del TH. Resultados: Observamos un deterioro en el perfil lipídico, y un aumento de los niveles de homocisteína y del recuento de leucocitos, así como cambios en la composición corporal con aumento de la masa magra y disminución de la masa grasa. Además, se observó un incremento en el grosor de la IMT tras 12 meses del TH. Conclusión: En un seguimiento a mediano-corto plazo tras TH, nuestro trabajo muestra cambios en los parámetros metabólicos inflamatorios que podrían incrementar el riesgo cardiovascular en los transexuales masculinos, sumado a la evidencia de cambios vasculares incipientes


Assuntos
Humanos , Masculino , Hormônios Esteroides Gonadais/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Pessoas Transgênero , Hormônios Esteroides Gonadais/efeitos adversos , Doenças Cardiovasculares/complicações , Estudos Prospectivos , Antropometria , Composição Corporal/efeitos dos fármacos , Absorciometria de Fóton
18.
Egypt J Immunol ; 26(1): 129-139, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333003

RESUMO

T regulatory cells (Tregs) are a cornerstone regulator for immune responses and inflammatory reactions. Abnormal number or function of Tregs causes deranged immune response that increases the autoimmune disorders and inflammatory conditions. Type 1 diabetes mellitus is an autoimmune disease associated with many complications, of which, Cardiovascular complications are fundamental and responsible for profound morbidity and mortality. Understanding the immunopathogenesis of these disorders allows early diagnosis and better management by innovating new therapeutic targets. In this study, we aimed to detect the association between CD4+CD8+FOX3+ Tregs, T1DM, and associated cardiovascular complications. The study included 144 individuals divided into three groups, group 1 included 48 patients suffering from T1DM without cardiovascular complications, group II: included 48 type T1DM patients with cardiovascular complications. Group III: included 48 healthy control subjects. For all participants, markers for inflammation, and cardiovascular involvement were assessed. The percentage of CD4+ CD25+ FOXP3+ Regulatory T- cells (Tregs) was measured by flow cytometry using peripheral blood samples. The level of Treg was lowest in group II and highest in group III, the difference was highly significant P < 0.001. Treg in group I significantly correlated with age (r= 0.58, P=0.004), CK-mb (r= 0.61, P=0.04) and LDL (r= -.61, P=0.4). While in group II, it correlated with triglyceride level, (r= 0.65 and a P =- 0.02). In conclusion, Lower levels of Tregs are associated with cardiovascular complications in TIDM patients.


Assuntos
Doenças Cardiovasculares/complicações , Diabetes Mellitus Tipo 1/complicações , Linfócitos T Reguladores/citologia , Biomarcadores , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/imunologia , Citometria de Fluxo , Fatores de Transcrição Forkhead/metabolismo , Humanos , Subunidade alfa de Receptor de Interleucina-2
20.
Clín. investig. arterioscler. (Ed. impr.) ; 31(3): 101-110, mayo-jun. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182703

RESUMO

Introduction: Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. Methods: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. Results: The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. Conclusions: SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years


Introducción: Existen pocos estudios realizados en atención primaria sobre prevalencias ajustadas por edad de la disfunción eréctil (ED, por sus siglas en inglés). Los objetivos del estudio SIMETAP-ED fueron determinar las prevalencias crudas y ajustadas por edad del diagnóstico de la ED, comparar estas tasas con otros estudios similares, y comparar las prevalencias de factores de riesgo cardiovasculares (FRCV), enfermedades cardiovasculares (ECV), enfermedades metabólicas y enfermedad renal crónica (ERC) entre las poblaciones con y sin ED. Métodos: Estudio observacional transversal realizado en atención primaria. Muestra aleatoria base poblacional: 2.934 varones adultos. Tasa de respuesta: 66%. Se realizó una entrevista clínica para diagnosticar ED mediante una pregunta derivada de la definición de ED. Se revisaron las historias clínicas de los pacientes para identificar sus FRCV y enfermedades asociadas con la ED. Los ajustes de tasas se estandarizaron con respecto a la población española. Resultados: Las prevalencias de enfermedades metabólicas, ECV, FRCV y ERC en la población con ED fueron más altas que en la población sin ED, destacando las ECV. La prevalencia cruda de la ED fue del 17,21% (intervalo de confianza del 95%: 15,86-18,63). Las tasas de prevalencia ajustadas por edad de la ED fueron del 0,71% en menores de 40 años, del 12,4% en mayores de 18 años, del 10,8% en varones entre 40 y 69 años, del 18,9% en mayores de 40 años y del 48,6% en mayores de 70 años. Conclusiones: El estudio SIMETAP-ED mostró asociación de la ED con las enfermedades metabólicas, ERC, FRCV y, sobre todo, con ECV. La prevalencia ajustada por edad de la ED fue del 12,4% en varones adultos, del 19% en mayores de 40 años y casi del 50% en mayores de 70 años


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Doenças Metabólicas/complicações , Insuficiência Renal Crônica/complicações , Estudos Transversais
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