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1.
BMJ ; 371: m3109, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046451

RESUMO

Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.


Assuntos
Gerenciamento Clínico , Hipertrigliceridemia/terapia , Adulto , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/genética , Hipolipemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pancreatite/etiologia , Pancreatite/prevenção & controle , Fatores de Risco , Triglicerídeos/sangue
2.
Cir Cir ; 88(5): 569-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064694

RESUMO

Objective: To describe the clinical characteristics and management of severe COVID-19 patients. Method: Observational, descriptive, longitudinal, and retrospective study. Results: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). Conclusion: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Terapia Combinada , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Universitários/organização & administração , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Respiração Artificial , Avaliação de Sintomas
3.
Cir Cir ; 88(5): 654-663, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064698

RESUMO

The disease caused by a new coronavirus, which started in 2019, was named COVID-19 and declared a pandemic on March 11, 2020 by the World Health Organization. Although it is true that the first reports emphasized the respiratory manifestations of this disease as an initial clinical presentation, little by little cases with different initial manifestations began to appear, involving other systems. In cases where central nervous system involvement was identified, the most frequent findings were dizziness, headache, and alteration of alertness. Regarding the cardiovascular system, elevation of cardiac biomarkers and myocarditis are one of the most frequent findings. The main gastrointestinal symptoms described so far are: anorexia, nausea, vomiting, diarrhea, abdominal pain and/or discomfort. Venous thromboembolism is a frequent complication and a public health problem. Skin manifestations remain a field of investigation. Maculopapular rashes, reticular livedo, acral gangrene, among others, have been identified. Health personnel must be updated on new clinical findings and the forms of presentation of this partially known disease, which will make it possible to make more accurate and timely diagnoses, thus impacting the prognosis of these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Doenças Cardiovasculares/etiologia , Doenças do Sistema Nervoso Central/etiologia , Síndrome da Liberação de Citocina/etiologia , Gastroenteropatias/etiologia , Humanos , Nefropatias/etiologia , Dermatopatias/etiologia
4.
Medicine (Baltimore) ; 99(41): e22660, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031329

RESUMO

BACKGROUND: Dapagliflozin, a novel inhibitor of renal sodium-glucose cotransporter 2, allows an insulin-independent approach to improve type 2 diabetes hyperglycemia. This current research is a double blinded, randomized, and prospective trial to determine the effect of dapagliflozin on cardiovascular outcomes in type 2 diabetes. METHODS: This randomized controlled, double-blinded, single center trial is carried out according to the principles of Declaration of Helsinki. This present study was approved in institutional review committee of the Lianyungang Hospital affiliated to Xuzhou Medical University (LW-20200901001). All the patients received the informed consent. Diabetic patients were randomized equally to receive 28-week treatment with dapagliflozin or matching placebo. The major outcome of our current study was the change in the level of hemoglobin A1c (HbA1c) from the baseline to week 28. Secondary outcome measures contained the levels of fasting blood glucose, the mean change in seated systolic and diastolic blood pressure, body weight, and the mean change in calculated average daily insulin dose in patients treated with insulin at baseline, the other laboratory variables, and self-reported adverse events. The P < .05 was regarded as statistically significant. RESULTS: We assumed that the dapagliflozin administration in patients with type 2 diabetes would reduce HbA1c, body weight, systolic blood pressure, and achieve the goal of glycemic control, without adversely impacting cardiovascular risk. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5987).


Assuntos
Compostos Benzidrílicos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Método Duplo-Cego , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Medicine (Baltimore) ; 99(37): e21730, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925715

RESUMO

Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6-9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.


Assuntos
Aorta Abdominal/patologia , Doenças da Aorta/mortalidade , Doenças Cardiovasculares/mortalidade , Diálise Peritoneal/mortalidade , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Calcificação Vascular/mortalidade , Idoso , Doenças da Aorta/complicações , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Valores de Referência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Fatores de Risco , Calcificação Vascular/complicações
8.
Medicine (Baltimore) ; 99(33): e21623, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872020

RESUMO

BACKGROUND: Prediabetes is an abnormal metabolic state that develops prior to the onset of diabetes with proven to common comorbid states of coronary artery disease. However, whether prediabetes worsens prognosis after percutaneous coronary intervention remains controversial. The aim of this study is to summarize previous cohort studies and to specify the impact of prediabetes on the long-term outcomes after percutaneous coronary intervention. METHODS: This meta-analysis will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines for conducting and reporting meta-analysis data. Pubmed, Embase and Google scholar will be systematically searched, and supplemented with manual searches of the included reference lists to identify cohort studies. Pooled effects on the discontinuous variables will be expressed by adjusted hazard ratios with 95% confidence intervals. All analyses will be performed with Stata 15.0 (StataCorp LP, College Station, TX). RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This systematic review will provide new information and help enhance clinical decision-making on management of these patients. REGISTRATION NUMBER: INPLASY202060079.


Assuntos
Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estado Pré-Diabético/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Humanos , Estado Pré-Diabético/mortalidade , Prognóstico , Projetos de Pesquisa , Fatores de Risco
9.
Int J Mol Sci ; 21(18)2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32947927

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19), an infectious disease with severe acute respiratory syndrome, has now become a worldwide pandemic. Despite the respiratory complication, COVID-19 is also associated with significant multiple organ dysfunction, including severe cardiac impairment. Emerging evidence reveals a direct interplay between COVID-19 and dire cardiovascular complications, including myocardial injury, heart failure, heart attack, myocarditis, arrhythmias as well as blood clots, which are accompanied with elevated risk and adverse outcome among infected patients, even sudden death. The proposed pathophysiological mechanisms of myocardial impairment include invasion of SARS-CoV-2 virus via angiotensin-converting enzyme 2 to cardiovascular cells/tissue, which leads to endothelial inflammation and dysfunction, de-stabilization of vulnerable atherosclerotic plaques, stent thrombosis, cardiac stress due to diminish oxygen supply and cardiac muscle damage, and myocardial infarction. Several promising therapeutics are under investigation to the overall prognosis of COVID-19 patients with high risk of cardiovascular impairment, nevertheless to date, none have shown proven clinical efficacy. In this comprehensive review, we aimed to highlight the current integrated therapeutic approaches for COVID-19 and we summarized the potential therapeutic options, currently under clinical trials, with their mechanisms of action and associated adverse cardiac events in highly infectious COVID-19 patients.


Assuntos
Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Antivirais/farmacologia , Antivirais/uso terapêutico , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Doenças Cardiovasculares/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Genoma Viral , Humanos , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Pneumopatias/mortalidade , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Sistema Renina-Angiotensina , Replicação Viral/efeitos dos fármacos
10.
PLoS One ; 15(9): e0236277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877424

RESUMO

Patients with high serum ferritin and low transferrin saturation (TSAT) levels could be considered as presenting with dysutilization of iron for erythropoiesis. However, the long-term safety of iron administration in these patients has not been well established. An observational multicenter study was performed over 3 years. In 805 patients undergoing maintenance hemodialysis (MHD), we defined dysutilization of iron for erythropoiesis in patients with lower TSAT (<20%) and higher ferritin (≥100 ng/mL) levels. A time-dependent Cox hazard model was used for the evaluation of the association between dysutilization of iron for erythropoiesis and adverse events and survival. Patients with low TSAT levels showed an increased risk of cerebrovascular and cardiovascular disease (CCVD) and death compared to patients with normal or higher TSAT levels. Patients with low ferritin and high TSAT levels had a significantly lower risk of CCVD and death compared with patients with high ferritin and low TSAT levels. Higher TSAT levels were associated with male gender, age, the absence of diabetes, low levels of high-sensitivity CRP, and low ß2 microglobulin levels, but not with intravenous iron administration or ferritin levels. Although patients with low TSAT levels had a significantly higher risk of CCVD or death, high TSAT levels were not linked with iron administration. Patients, who were suspected of dysutilization of iron for erythropoiesis, had a higher risk of CCVD and death. The administration of iron should be performed cautiously for improving TSAT levels, as iron administration could sustain TSAT levels for a short term.


Assuntos
Doenças Cardiovasculares/sangue , Transtornos Cerebrovasculares/sangue , Ferritinas/sangue , Diálise Renal , Transferrina/análise , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/etiologia , Feminino , Humanos , Ferro/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Fatores de Risco
11.
N Engl J Med ; 383(15): 1436-1446, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32970396

RESUMO

BACKGROUND: Patients with chronic kidney disease have a high risk of adverse kidney and cardiovascular outcomes. The effect of dapagliflozin in patients with chronic kidney disease, with or without type 2 diabetes, is not known. METHODS: We randomly assigned 4304 participants with an estimated glomerular filtration rate (GFR) of 25 to 75 ml per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 200 to 5000 to receive dapagliflozin (10 mg once daily) or placebo. The primary outcome was a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes. RESULTS: The independent data monitoring committee recommended stopping the trial because of efficacy. Over a median of 2.4 years, a primary outcome event occurred in 197 of 2152 participants (9.2%) in the dapagliflozin group and 312 of 2152 participants (14.5%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.51 to 0.72; P<0.001; number needed to treat to prevent one primary outcome event, 19 [95% CI, 15 to 27]). The hazard ratio for the composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal causes was 0.56 (95% CI, 0.45 to 0.68; P<0.001), and the hazard ratio for the composite of death from cardiovascular causes or hospitalization for heart failure was 0.71 (95% CI, 0.55 to 0.92; P = 0.009). Death occurred in 101 participants (4.7%) in the dapagliflozin group and 146 participants (6.8%) in the placebo group (hazard ratio, 0.69; 95% CI, 0.53 to 0.88; P = 0.004). The effects of dapagliflozin were similar in participants with type 2 diabetes and in those without type 2 diabetes. The known safety profile of dapagliflozin was confirmed. CONCLUSIONS: Among patients with chronic kidney disease, regardless of the presence or absence of diabetes, the risk of a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes was significantly lower with dapagliflozin than with placebo. (Funded by AstraZeneca; DAPA-CKD ClinicalTrials.gov number, NCT03036150.).


Assuntos
Compostos Benzidrílicos/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Glucosídeos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/farmacologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Feminino , Glucosídeos/efeitos adversos , Glucosídeos/farmacologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Insuficiência Renal Crônica/complicações , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia
12.
Int J Mol Sci ; 21(18)2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899833

RESUMO

Coronavirus disease 2019 (COVID-19) is usually more severe and associated with worst outcomes in individuals with pre-existing cardiovascular pathologies, including hypertension or atherothrombosis. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can differentially infect multiple tissues (i.e., lung, vessel, heart, liver) in different stages of disease, and in an age- and sex-dependent manner. In particular, cardiovascular (CV) cells (e.g., endothelial cells, cardiomyocytes) could be directly infected and indirectly disturbed by systemic alterations, leading to hyperinflammatory, apoptotic, thrombotic, and vasoconstrictive responses. Until now, hundreds of clinical trials are testing antivirals and immunomodulators to decrease SARS-CoV-2 infection or related systemic anomalies. However, new therapies targeting the CV system might reduce the severity and lethality of disease. In this line, activation of the non-canonical pathway of the renin-angiotensin-aldosterone system (RAAS) could improve CV homeostasis under COVID-19. In particular, treatments with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) may help to reduce hyperinflammation and viral propagation, while infusion of soluble ACE2 may trap plasma viral particles and increase cardioprotective Ang-(1-9) and Ang-(1-7) peptides. The association of specific ACE2 polymorphisms with increased susceptibility of infection and related CV pathologies suggests potential genetic therapies. Moreover, specific agonists of Ang-(1-7) receptor could counter-regulate the hypertensive, hyperinflammatory, and hypercoagulable responses. Interestingly, sex hormones could also regulate all these RAAS components. Therefore, while waiting for an efficient vaccine, we suggest further investigations on the non-canonical RAAS pathway to reduce cardiovascular damage and mortality in COVID-19 patients.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Cardiotônicos/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Sistema Renina-Angiotensina , Animais , Doenças Cardiovasculares/etiologia , Infecções por Coronavirus/complicações , Humanos , Pandemias , Pneumonia Viral/complicações
13.
PLoS One ; 15(8): e0236021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745082

RESUMO

BACKGROUND: The National Lung Screening Trial (NLST) demonstrated that annual screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. Nonetheless, the leading cause of mortality in the study was from cardiovascular diseases. PURPOSE: To determine whether the used machine learning automatic algorithms assessing coronary calcium score (CCS), level of liver steatosis and emphysema percentage in the lungs are good predictors of cardiovascular disease (CVD) mortality and incidence when applied on low dose CT scans. MATERIALS AND METHODS: Three fully automated machine learning algorithms were used to assess CCS, level of liver steatosis and emphysema percentage in the lung. The algorithms were used on low-dose computed tomography scans acquired from 12,332 participants in NLST. RESULTS: In a multivariate analysis, association between the three algorithm scores and CVD mortality have shown an OR of 1.72 (p = 0.003), 2.62 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively, and an OR of 1.12 (p = 0.044) for level of liver steatosis. Similar results were shown for the incidence of CVD, OR of 1.96 (p < 0.0001), 4.94 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively. Also, emphysema percentage demonstrated an OR of 0.89 (p < 0.0001). Similar results are shown for univariate analyses of the algorithms. CONCLUSION: The three automated machine learning algorithms could help physicians to assess the incidence and risk of CVD mortality in this specific population. Application of these algorithms to existing LDCT scans can provide valuable health care information and assist in future research.


Assuntos
Doenças Cardiovasculares/mortalidade , Aprendizado de Máquina , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Fumar Cigarros/efeitos adversos , Fumar Cigarros/epidemiologia , Ensaios Clínicos Fase III como Assunto , Vasos Coronários/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Enfisema/diagnóstico , Enfisema/epidemiologia , Enfisema/etiologia , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Feminino , Humanos , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/mortalidade , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , National Cancer Institute (U.S.) , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Estados Unidos/epidemiologia
14.
Medicine (Baltimore) ; 99(30): e20176, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791656

RESUMO

There may be differences in optimal anthropometric cut-offs for diagnosing obesity among different regions of China. However, there has been little studies about choosing effective obesity indicators in Han People of low-income Chinese adults in southwest China. The purpose of this study was to compare and evaluate the associations between different obesity indicators and cardiovascular disease risk factors (CVDRF) and choose the optimal cut-off values.A cross-sectional study was carried out in southwest of China, with multi-stage sampling enrolling 2112 subjects aged 20 to 80 years old. Anthropometric measurements included Body mass index (BMI), waist circumference (WC), Hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). We measured the percentage of body fat (PBF) by bioelectrical impedance analyzer to assess the body composition. The validity of different obesity indicators in assessing CVDRF risk were assessed through comparison area under curve of different indicators in assessing CVDRF risk in different gender. Logistic regression models were used to evaluate the association between the obesity indicators and CVDRF.When both male and female were considered, the optimal indicators were WHtR and percentage of body fat PBF for hypertension, WHR and WHtR for dyslipidemia. Both WC and WHtR were optimal indicators in assessing metabolic syndrome risk for both genders. When both disease and gender were considered, WHtR was the best associated indicators with various CVDRF. The cut-off of BMI and WC were consistent to the definition of obesity in Working Group of China. The WHtR positively correlated with the CVDRF. The cut-off of WHtR to do what was approximately 0.50 for adults in both genders in southwest of China.WHtR may be the best associated indicators for obesity-related CVDRF among the others (BMI, WC, Hip circumference, PBF, and WHR) in southwest of China. The cut-off of WHtR was approximately 0.50 for adults in both genders in southwest of China.


Assuntos
Doenças Cardiovasculares/etiologia , Obesidade/diagnóstico , Razão Cintura-Estatura , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Fatores de Risco
15.
Medicine (Baltimore) ; 99(30): e20923, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791673

RESUMO

Overweight and obesity in childhood are associated with early cardiovascular dysfunction and promote heightened risk of cardiovascular morbidity and mortality in adulthood. Waist circumference (WC) correlates with visceral obesity, which is why obese children with elevated WC need to be carefully monitored to prevent long-term cardio-metabolic complications. The purpose of our study was to establish if WC could be a predictor of cardiovascular complications in children.The authors conducted a retrospective study that included 160 overweight and obese children and adolescents, aged 6 to 18 years. Patients were evaluated completely anthropometrically, biologically, and imagistic. The anthropometric data tracked were height, weight, WC, and body mass index. Echocardiography evaluated the following parameters: the interventricular septum, left ventricular mass, the relative thickness of the ventricular wall, the pathological epicardial fat.Our results confirm that the presence of visceral obesity was significantly associated (χ = 11.72, P = .0006) with pathological epicardial fat. In children, visceral obesity is not a risk factor for vascular or cardiac impairment, but in adolescents, the results showed that visceral obesity is an important predictive factor for the occurrence of vascular (AUC = 0.669, P = .021) and cardiac (AUC = 0.697, P = .037) impairment. Concentric left ventricular (LV) hypertrophy is significantly influenced by the presence of visceral obesity (AUC = 0.664, P = .013 children; AUC = 0.716, P = .026 adolescents).WC above the 90th percentile is a predictive factor for increased LVM index and concentric hypertrophy in both children and adolescents.


Assuntos
Doenças Cardiovasculares/etiologia , Obesidade Abdominal/complicações , Obesidade Pediátrica/complicações , Circunferência da Cintura , Adolescente , Doenças Cardiovasculares/diagnóstico por imagem , Criança , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 99(31): e20462, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756074

RESUMO

INTRODUCTION: Subclinical hypothyroidism (SH) is serum thyrotropin (TSH) slightly increased, while serum free thyroxine (FT4) levels are normal, and patients may have no abnormal symptoms, or only slight hypothyroidism, there are many studies proving that SH does increase cardiovascular risk in adults. However, there are few studies in children and adolescents. In order to explore whether children with subclinical hypothyroidism have a higher cardiovascular risk, we designed this meta-analysis. METHODS: The protocol of this systematic review and meta-analysis was registered on the NPLASY (No. 202040182). The following electronic databases will be searched from the inception through the present to find studies that live up to our standard: PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. And we will include case-control studies, cohort studies, and cross-sectional studies. For including study, we will use the Newcastle-Ottawa Scale to evaluate their quality. Then 2 researchers will independently extract the required information. I statistics and subgroups will be used to analyze heterogeneity. We conduct a sensitivity analysis by excluding literature successively. When the system review contains >10 articles, Egger test will be conducted to evaluate publication bias. RESULTS: From this study, we will assess the cardiovascular risk of children and adolescents with SH from multiple perspectives. CONCLUSION: The conclusion of this paper will provide evidence for cardiovascular risk of SH children and provide basis for prevention and treatment of SH. ETHICS AND DISSEMINATION: This meta-analysis does not collect personal primary data, so there is no need for formal moral recognition. The results of the system review will be presented to national and international conferences for publication.


Assuntos
Doenças Cardiovasculares/etiologia , Hipotireoidismo/complicações , Adolescente , Fatores Etários , Doenças Assintomáticas , Criança , Humanos , Fatores de Risco
17.
Pathol Res Pract ; 216(9): 153086, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32825954

RESUMO

A novel coronavirus SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) with cardiovascular and multiple organ failure till death. The main mechanisms of virus internalization and interaction with the host are down-regulation or upregulation of the ACE2 receptor, the surface glycoprotein competition mechanism for the binding of porphyrin to iron in heme formation as well as interference with the immune system. The interference on renin-angiotensin-aldosterone system (RAAS) activation, heme formation, and the immune response is responsible for infection diffusion, endothelial dysfunction, vasoconstriction, oxidative damage and releasing of inflammatory mediators. The main pathological findings are bilateral interstitial pneumonia with diffuse alveolar damage (DAD). Because ACE receptor is also present in the endothelium of other districts as well as in different cell types, and as porphyrins are transporters in the blood and other biological liquids of iron forming heme, which is important in the assembly of the hemoglobin, myoglobin and the cytochromes, multiorgan damage occurs both primitive and secondary to lung damage. More relevantly, myocarditis, acute myocardial infarction, thromboembolism, and disseminated intravasal coagulation (DIC) are described as complications in patients with poor outcome. Here, we investigated the role of SARSCoV-2 on the cardiovascular system and in patients with cardiovascular comorbidities, and possible drug interference on the heart.


Assuntos
Betacoronavirus/patogenicidade , Doenças Cardiovasculares/etiologia , Infecções por Coronavirus/virologia , Pulmão/virologia , Pneumonia Viral/virologia , Doenças Cardiovasculares/metabolismo , Sistema Cardiovascular/virologia , Infecções por Coronavirus/complicações , Humanos , Pulmão/metabolismo , Pandemias , Pneumonia Viral/complicações , Sistema Renina-Angiotensina/fisiologia
18.
PLoS One ; 15(8): e0236667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756570

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. METHODS: In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. RESULTS: Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. CONCLUSION: PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Rigidez Vascular/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia
19.
Environ Health Prev Med ; 25(1): 42, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32825824

RESUMO

OBJECTIVE: To verify the association between sleep duration and television time with cardiometabolic risk and the moderating role of age, gender, and skin color/ethnicity in this relationship among adolescents. METHODS: Cross-sectional study with 1411 adolescents (800 girls) aged 10 to 17 years. Television time, sleep duration, age, gender, and skin color/ethnicity were obtained by self-reported questionnaire. Cardiometabolic risk was evaluated using the continuous metabolic risk score, by the sum of the standard z-score values for each risk factor: high-density lipoprotein cholesterol, triglycerides, glycemia, cardiorespiratory fitness, systolic blood pressure, and waist circumference. Generalized linear regression models were used. RESULTS: There was an association between television time and cardiometabolic risk (ß, 0.002; 95% CI, 0.001; 0.003). Short sleep duration (ß, 0.422; 95% CI, 0.012; 0.833) was positively associated with cardiometabolic risk. Additionally, age moderated the relationship between television time and cardiometabolic risk (ß, - 0.009; 95% CI, - 0.002; - 0.001), suggesting that this relationship was stronger at ages 11 and 13 years (ß, 0.004; 95% CI, 0.001; 0.006) compared to 13 to 15 years (ß, 0.002; 95% CI, 0.001; 0.004). No association was found in older adolescents (ß, 0.001; 95% CI, - 0.002; 0.002). CONCLUSIONS: Television time and sleep duration are associated with cardiometabolic risk; adolescents with short sleep have higher cardiometabolic risk. In addition, age plays a moderating role in the relationship between TV time and cardiometabolic risk, indicating that in younger adolescents the relationship is stronger compared to older ones.


Assuntos
Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Comportamento Sedentário , Sono , Televisão/estatística & dados numéricos , Fatores Etários , Brasil/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Síndrome Metabólica/etnologia , Síndrome Metabólica/etiologia , Prevalência , Fatores de Risco , Comportamento Sedentário/etnologia , Fatores Sexuais
20.
PLoS One ; 15(8): e0238082, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822436

RESUMO

BACKGROUND: The association between daily changes in ambient fine particulate matter (PM2.5) and cardiovascular diseases have been well established in mechanistic, epidemiologic and exposure studies. Only a few studies examined the effect of hourly variations in air pollution on triggering cardiovascular events. Whether the current PM2.5 standards can protect vulnerable individuals with chronic cardiovascular diseases remain uncertain. METHODS: we conducted a time-stratified, case-crossover study to assess the associations between hourly changes in PM2.5 levels and the vascular disease onset in residents of Tainan City, Taiwan, visiting Emergency Room of Chi Mei Medical Center between January 2006 and December 2016. There were 26,749 cases including 10,310 females (38.5%) and 16,439 males (61.5%) identified. The time of emergency visit was identified as the onset for each case and control cases were selected as the same times on other days, on the same day of the week in the same month and year respectively. Residential address was used to identify the ambient air pollution exposure concentrations from the closest station. Conditional logistic regression with the stepwise selection method was used to estimate adjusted odds ratios (ORs) for the association. RESULTS: When we only included cases occurring at PM2.5>10 µg/m3 and PM2.5>25 µg/m3, very significant ORs could be observed for 10 µg/m3 increases in PM2.5 at 0 and 1 hour, implying fine particulate exposure could promptly trigger vascular disease events. Moreover, a very clear increase in risk could be observed with cumulative exposure from 0 to 48 hours, especially in those cases where PM2.5>25 µg/m3. CONCLUSIONS: Our study demonstrated that transient and low concentrations of ambient PM2.5 trigger adult vascular disease events, especially cerebrovascular disease, regardless of age, sex, and exposure timing. Warning and delivery systems should be setup to protect people from these prompt adverse health impacts.


Assuntos
Poluentes Atmosféricos/análise , Doenças Cardiovasculares/diagnóstico , Material Particulado/análise , Idoso , Poluentes Atmosféricos/toxicidade , Doenças Cardiovasculares/etiologia , Estudos Cross-Over , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Material Particulado/toxicidade , Fatores de Risco , Taiwan
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