Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.998
Filtrar
1.
N Engl J Med ; 382(2): 111-119, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31733181

RESUMO

BACKGROUND: The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. METHODS: In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with either an aortic jet velocity of ≥4.5 m per second or a mean transaortic gradient of ≥50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up. RESULTS: In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P = 0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years. CONCLUSIONS: Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.).


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Tratamento Conservador , Idoso , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/terapia , Doenças Assintomáticas/terapia , Doenças Cardiovasculares/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Complicações Pós-Operatórias/mortalidade
2.
BMJ ; 367: l6058, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852664

RESUMO

OBJECTIVES: To evaluate the associations between birth month, birth season, and overall and cardiovascular disease mortality, and to examine the role of familial and socioeconomic factors in these associations. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study, established in 1976, an ongoing prospective cohort study in the United States. PARTICIPANTS: Female registered nurses who reported information on date of birth at study enrolment (n=116 911, 1976-2014, followed for 38 years). EXPOSURE: Birth month and astronomical birth season (based on solstices and equinoxes as boundaries of the season categories). MAIN OUTCOME MEASURES: Age and various multivariable adjusted hazard ratios and 95% confidence intervals for the association between birth months (using November as the reference), astronomical birth season (using autumn as the reference), and overall and cardiovascular disease specific mortality were assessed using Cox proportional hazards models. RESULTS: Among study participants, 43 248 overall deaths were documented during 4 136 364 person years of follow-up since enrolment, including 8360 cardiovascular disease related deaths. In fully adjusted multivariable analyses, no significant association was observed between birth month, birth season, and overall mortality. Compared with women born in November, increased cardiovascular disease mortality was observed among those born from March to July (hazard ratio for March, 1.09, 95% confidence interval 0.98 to 1.21; April, 1.12, 1.00 to 1.24; May, 1.08, 0.98 to 1.20; June, 1.07, 0.96 to 1.19; and July 1.08, 0.98 to 1.20). Those born in April had the highest cardiovascular disease mortality, and those born in December had the lowest (December, 0.95, 0.85 to 1.06). The relative difference between the lowest and highest risk month was 17.89%. Women born in spring (1.10, 1.04 to 1.17) and summer (1.09, 1.03 to 1.16) had a higher cardiovascular disease mortality than women born in the autumn. Adjustment for familial and socioeconomic factors did not change these results. The relative difference between the lowest and highest risk season was 10.00%. CONCLUSION: Participants born in the spring and summer (especially those born in March-July) had a slight but significant increase in cardiovascular disease specific mortality. However, no seasonal birth month effect was observed among women for overall mortality. Familial and socioeconomic factors did not appear to alter these associations. Further studies are required to confirm these findings and reveal mechanisms of these seasonal birth month effects in cardiovascular disease mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Estações do Ano , Fatores de Tempo , Adulto , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos
3.
Medicine (Baltimore) ; 98(50): e18126, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852072

RESUMO

Sudden cardiac death (SCD) is a major cause of mortality in China. This study collected reference data for future programs of prevention of SCD among the ethnic Kazakh and Han populations in Xinjiang, China.From January 1, 2015 to December 31, 2015, 2 monitoring locations in northern Xinjiang China were utilized. These locations were selected based on the geographic, economic, and administrative structures of the ethnic Kazakh settlements in Xinjiang. Investigators were trained to investigate SCDs in Kazakh and Han people, a study population totaling more than 400,000. The populations were compared for SCD incidence.The average age of the Han population was significantly higher than that of the Kazakh. During the year 2015, there were 135 SCDs, specifically 67 and 68 in the Han and Kazakh populations, respectively, incidences of 37.94 and 36.2 per 100,000. After standardizing for age, the incidence in these populations was 29.36 and 51.85 per 100,000. Among those who experienced SCD, the prevalence of hypertension was higher in the Kazakh group than in the Han. The multivariate analysis of populations with SCD showed that, among the patients with coronary heart disease, the Kazakh were more likely to have SCD than the Han (odds ratio: 3.58, confidence interval: 1.18-10.95).Among the elderly, the incidence of SCD was much higher in the Kazakh population than in the Han population. Basic medical services and health education should be strengthened in the Kazakh pastoral areas.


Assuntos
Doenças Cardiovasculares/mortalidade , Morte Súbita Cardíaca/etnologia , Grupos Étnicos , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/complicações , China/epidemiologia , Estudos Transversais , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 826-832, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874472

RESUMO

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions: Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.


Assuntos
Doenças Cardiovasculares/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Morte Materna , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Causas de Morte , China/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
5.
Am J Forensic Med Pathol ; 40(4): 312-317, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688052

RESUMO

BACKGROUND: Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes. METHODS: This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012. RESULT: A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death. CONCLUSIONS: The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.


Assuntos
Morte Súbita/epidemiologia , Esquizofrenia/epidemiologia , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Médicos Legistas , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Adulto Jovem
6.
BMJ ; 367: l6055, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748235

RESUMO

OBJECTIVE: To determine the relation between age and troponin level and its prognostic implication. DESIGN: Retrospective cohort study. SETTING: Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC). PARTICIPANTS: 257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: 257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient's hospital stay. Troponin levels were standardised as a multiple of each laboratory's 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively. CONCLUSIONS: A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks. STUDY REGISTRATION: ClinicalTrials.gov NCT03507309.


Assuntos
Envelhecimento/sangue , Doenças Cardiovasculares , Troponina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Estudos de Coortes , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Reino Unido/epidemiologia
7.
J Surg Oncol ; 120(8): 1486-1496, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31602661

RESUMO

BACKGROUND AND OBJECTIVES: To investigate non-lung cancer specific mortality between stage IA non-small cell lung cancer (NSCLC) tumors less than and equal to 2 cm treated with lobectomy and sublobectomy. METHODS: Surveillance, epidemiology, and end results database was queried for patients who underwent lobectomy and sublobectomy. Propensity score matching (PSM) was used to achieve balance in clinicopathological characteristics. We used Fine-and-Gray hazard functions to analyze cause-specific mortality and risk factors. Standardized mortality ratios were calculated to describe cause specific mortality relative to the general population. RESULTS: After PSM, 3,844 patients underwent lobectomy and 1,922 patients underwent sublobectomy. Three leading causes of non-lung cancer mortality were cardiovascular disease (CVD), chronic obstructive pulmonary diseases (COPD), and other cancers. The 5-year cumulative non-lung cancer mortality of lobectomy and sublobectomy groups were 11.4% and 14.0%, respectively (P = .090). Multivariate analyses revealed that age, sex, histology, tumor size, and marital status (P < .01) were independent predictors of non-lung cancer specific mortality. In both groups, risks of CVD specific mortality were comparable to that in the general population, whereas the risk of COPD specific mortality was higher relative to the general population. CONCLUSIONS: As a significant competing event, non-lung cancer specific mortality is comparable between stage IA NSCLC tumors less than equal to 2 cm treated with lobectomy and sublobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Adulto , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Estado Civil , Análise por Pareamento , Pessoa de Meia-Idade , Análise Multivariada , Pontuação de Propensão , Programa de SEER , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
8.
BMJ ; 367: l5584, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619383

RESUMO

OBJECTIVE: To investigate the association between weight changes across adulthood and mortality. DESIGN: Prospective cohort study. SETTING: US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014. PARTICIPANTS: 36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline). MAIN OUTCOME MEASURES: All cause and cause specific mortality from baseline until 31 December 2015. RESULTS: During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality. CONCLUSIONS: Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.


Assuntos
Doenças Cardiovasculares , Causas de Morte , Mortalidade Prematura/tendências , Mortalidade/tendências , Neoplasias , Ganho de Peso , Perda de Peso , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Inquéritos Nutricionais , Obesidade/diagnóstico , Obesidade/mortalidade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Razão Cintura-Estatura
9.
Medicine (Baltimore) ; 98(42): e17544, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626117

RESUMO

The protective role of serum total bilirubin, a widely recognized antioxidant, has been approved by numerous updating studies. However, regarding the effect of high serum total bilirubin level (STBL) in arteriosclerotic cardiovascular disease (ASCVD) are conflicting in different sources of data. We, therefore, performed this meta-analysis to evaluate the influence of STBL on risk of ASCVD.Four databases were used to identify the literature with a date of search of January, 2019. Finally, a total of 20 studies had been adopted. ASCVD was defined as acute coronary syndrome, stable angina, coronary revascularization, atherosclerotic stroke or transient ischemic attack, and peripheral arterial disease (PAD). All relevant data were collected from studies meeting the inclusion criteria.A total of 20 published studies (323,891 cases) met the inclusion criteria. The meta-analysis revealed that, in studies excluding heterogeneity, STBL was significantly positively related to in-hospital cardiovascular mortality (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.83-4.36, Z = 4.69, P < .001) and major adverse cardiac events (OR 1.88, 95% CI 1.414-2.491, Z = 4.36, P < .001), also negatively associated with prognosis of acute myocardial infarction, pooled hazard ratio (HR) = 0.804 (95% CI 0.700-0.923, Z = 3.08, P = .002). The correlation similarity was also reflected in terms of patients with stroke (HR 0.78, 95% CI 0.70-0.88, Z = 4.24, P = .003). Combined analysis revealed that lower STBL was significantly associated with PAD, pooled OR = 0.91 (95% CI 0.85-0.98, Z = 2.39, P = .017). In general analysis, a conclusion can be drawn, that higher STBL was significantly negative correlated with cardiovascular disease, pooled HR = 0.83 (95% CI 0.73-0.94, Z = 3.02, P = .003).Higher STBL significantly improved the prognosis of ASCVD; furthermore, STBL was an important factor in the long-term prognosis of vascular-related disease prevention and can be used as a predictor in vascular-related disease risk prediction.


Assuntos
Aterosclerose/sangue , Bilirrubina/sangue , Doenças Cardiovasculares/sangue , Adulto , Idoso , Aterosclerose/mortalidade , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Medição de Risco/métodos , Fatores de Risco
10.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
11.
Medicine (Baltimore) ; 98(38): e17271, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568006

RESUMO

BACKGROUND: Red and (particularly) processed meats are high in cholesterol and saturated and solid fatty acids. Their consumption is considered one of the risk factors for metabolic disorders. Numerous studies demonstrated a possible association between red meat consumption and cardiovascular disease (CVD). In this protocol, we propose a systematic review of the literature to examine the associations of red meat consumption with CVD incidence and mortality, and explore the potential dose-response relationship. METHODS: We will search MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO, and Embase. We will include prospective epidemiological studies (longitudinal cohort). Risk of bias will be assessed using the Newcastle-Ottawa scale (NOS). Four independent researchers will conduct all evaluations. Disagreements will be referred to a fifth reviewer. We will summarize our findings using a narrative approach and tables to describe the characteristics of the included studies. The heterogeneity between trial results will be evaluated using a standard chi-squared test with P < .05. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). RESULTS: This review will evaluate the association between red meat consumption and incidence of CVD and mortality (primary outcome measures). The secondary outcome measure will include the dose-response effect. CONCLUSION: The findings of this systematic review will summarize the latest evidence of the association between red meat consumption and incidence of CVD and mortality and the dose-response effect through a systematic review and meta-analysis. REGISTRATION: PROSPERO CRD42019100914.


Assuntos
Doenças Cardiovasculares/etiologia , Carne Vermelha/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Humanos , Incidência , Estudos Longitudinais , Carne Vermelha/estatística & dados numéricos , Fatores de Risco
12.
Sante Publique ; Vol. 31(3): 433-441, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640331

RESUMO

OBJECTIVES: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. METHODS: We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. RESULTS: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005). CONCLUSION: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.


Assuntos
Doenças não Transmissíveis/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Humanos , Masculino , Morbidade/tendências , Mortalidade/tendências , Doenças não Transmissíveis/mortalidade , Sistema de Registros , Estudos Retrospectivos , Tunísia/epidemiologia
14.
N Engl J Med ; 381(16): 1547-1556, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31618540

RESUMO

BACKGROUND: Familial hypercholesterolemia is characterized by severely elevated low-density lipoprotein (LDL) cholesterol levels and premature cardiovascular disease. The short-term efficacy of statin therapy in children is well established, but longer follow-up studies evaluating changes in the risk of cardiovascular disease are scarce. METHODS: We report a 20-year follow-up study of statin therapy in children. A total of 214 patients with familial hypercholesterolemia (genetically confirmed in 98% of the patients), who were previously participants in a placebo-controlled trial evaluating the 2-year efficacy and safety of pravastatin, were invited for follow-up, together with their 95 unaffected siblings. Participants completed a questionnaire, provided blood samples, and underwent measurements of carotid intima-media thickness. The incidence of cardiovascular disease among the patients with familial hypercholesterolemia was compared with that among their 156 affected parents. RESULTS: Of the original cohort, 184 of 214 patients with familial hypercholesterolemia (86%) and 77 of 95 siblings (81%) were seen in follow-up; among the 214 patients, data on cardiovascular events and on death from cardiovascular causes were available for 203 (95%) and 214 (100%), respectively. The mean LDL cholesterol level in the patients had decreased from 237.3 to 160.7 mg per deciliter (from 6.13 to 4.16 mmol per liter) - a decrease of 32% from the baseline level; treatment goals (LDL cholesterol <100 mg per deciliter [2.59 mmol per liter]) were achieved in 37 patients (20%). Mean progression of carotid intima-media thickness over the entire follow-up period was 0.0056 mm per year in patients with familial hypercholesterolemia and 0.0057 mm per year in siblings (mean difference adjusted for sex, -0.0001 mm per year; 95% confidence interval, -0.0010 to 0.0008). The cumulative incidence of cardiovascular events and of death from cardiovascular causes at 39 years of age was lower among the patients with familial hypercholesterolemia than among their affected parents (1% vs. 26% and 0% vs. 7%, respectively). CONCLUSIONS: In this study, initiation of statin therapy during childhood in patients with familial hypercholesterolemia slowed the progression of carotid intima-media thickness and reduced the risk of cardiovascular disease in adulthood. (Funded by the AMC Foundation.).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Espessura Intima-Media Carotídea , Criança , LDL-Colesterol/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Hiperlipoproteinemia Tipo II/sangue , Incidência , Masculino , Intervalo Livre de Progressão , Risco , Inquéritos e Questionários , Adulto Jovem
15.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(8): 487-494, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184142

RESUMO

Introducción y objetivos: Conocemos que el exceso de grasa corporal (GC) se asocia con factores de riesgo cardiovascular, algunos tipos de cáncer y otras causas principales de muerte. Se ha definido un nuevo método antropométrico: el índice CUN-BAE (Clínica Universidad de Navarra-Estimador de Adiposidad Corporal), que se basa en el IMC, el sexo y la edad. Hemos utilizado IMC y CUN-BAE para evaluar su contribución en la asociación con mortalidad en la cohorte del Estudio Asturias. Material y métodos: El Estudio Asturias se trata de un estudio de cohortes que incluyó a 1.034 individuos de 30-75 años de edad que participaron en la primera fase del estudio (1998-1999), realizando encuesta, exploración física y sobrecarga oral de glucosa. Se registraron los fallecimientos en la cohorte tras 18 años de seguimiento. Resultados: 204 personas fallecieron: 93 mujeres y 111 varones (16,6% de las mujeres y 23,5% de los varones). Valores basales tanto de IMC como de %GC determinantes de obesidad (> 30 kg/m2 para IMC; > 25% en hombres y > 35% en mujeres para CUN-BAE) fueron mayoritarios en los datos de individuos fallecidos. Tras ajuste por DM2, HTA, ECV y tabaco, el riesgo de mortalidad por todas las causas y cardiovascular es significativamente mayor según se incrementa el CUN-BAE, sobre todo en mujeres. Conclusiones: La ecuación CUN-BAE es una herramienta útil en mujeres para detectar las que van a presentar un mayor riesgo de mortalidad, independientemente de factores de riesgo


Introduction and objectives: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. Material and methods: The Asturias study is a cohort study including 1.034 individuals aged 30-75 years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. Results: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI > 30 kg/m2 and CUN-BAE > 25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. Conclusions: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Índice de Massa Corporal , Estudos de Coortes , Fatores de Risco , Antropometria/métodos , Espanha , Indicadores de Morbimortalidade , Doenças Cardiovasculares/mortalidade , Curva ROC
16.
Expert Opin Drug Saf ; 18(11): 1043-1053, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31498687

RESUMO

Introduction: Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs worldwide. However, concerns are growing about the serious adverse events and mortality linked to their long-term use. Areas covered: The authors review the main approved clinical indications and adverse events associated with PPIs, including, among others, pneumonia, Clostridium difficile infection, cardiovascular diseases, bone fractures, kidney diseases, and several nutrient deficiencies. Recent studies have reported that patients taking PPIs displayed increased mortality, linked to cardiovascular diseases, gastrointestinal malignancies, and chronic kidney diseases. Expert opinion: PPIs represent an important advance in the medical treatment of acid-related diseases. PPIs have contributed to profound reductions in hospitalizations and mortality due to upper GI complications. However, concern is growing about the wide range of potentially serious adverse events and mortality linked to chronic PPI use. Nevertheless, the level of evidence on adverse events is low; it is based on observational studies, and most findings have not been confirmed in the limited number of clinical trials available. PPI overuse and off-label prescriptions must be eradicated, but long-term PPI use for clear indications must continue, until we have stronger evidence to support claims of serious adverse events and mortality.


Assuntos
Uso Off-Label/estatística & dados numéricos , Uso Excessivo de Medicamentos Prescritos/prevenção & controle , Inibidores da Bomba de Prótons/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/etiologia , Neoplasias Gastrointestinais/mortalidade , Humanos , Inibidores da Bomba de Prótons/administração & dosagem , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/mortalidade
17.
N Engl J Med ; 381(15): 1411-1421, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31475795

RESUMO

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).


Assuntos
Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Doenças Cardiovasculares/mortalidade , Terapia Combinada , Doença da Artéria Coronariana/complicações , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Prevenção Secundária , Stents
18.
N Engl J Med ; 381(17): 1609-1620, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31475794

RESUMO

BACKGROUND: The angiotensin receptor-neprilysin inhibitor sacubitril-valsartan led to a reduced risk of hospitalization for heart failure or death from cardiovascular causes among patients with heart failure and reduced ejection fraction. The effect of angiotensin receptor-neprilysin inhibition in patients with heart failure with preserved ejection fraction is unclear. METHODS: We randomly assigned 4822 patients with New York Heart Association (NYHA) class II to IV heart failure, ejection fraction of 45% or higher, elevated level of natriuretic peptides, and structural heart disease to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or valsartan (target dose, 160 mg twice daily). The primary outcome was a composite of total hospitalizations for heart failure and death from cardiovascular causes. Primary outcome components, secondary outcomes (including NYHA class change, worsening renal function, and change in Kansas City Cardiomyopathy Questionnaire [KCCQ] clinical summary score [scale, 0 to 100, with higher scores indicating fewer symptoms and physical limitations]), and safety were also assessed. RESULTS: There were 894 primary events in 526 patients in the sacubitril-valsartan group and 1009 primary events in 557 patients in the valsartan group (rate ratio, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The incidence of death from cardiovascular causes was 8.5% in the sacubitril-valsartan group and 8.9% in the valsartan group (hazard ratio, 0.95; 95% CI, 0.79 to 1.16); there were 690 and 797 total hospitalizations for heart failure, respectively (rate ratio, 0.85; 95% CI, 0.72 to 1.00). NYHA class improved in 15.0% of the patients in the sacubitril-valsartan group and in 12.6% of those in the valsartan group (odds ratio, 1.45; 95% CI, 1.13 to 1.86); renal function worsened in 1.4% and 2.7%, respectively (hazard ratio, 0.50; 95% CI, 0.33 to 0.77). The mean change in the KCCQ clinical summary score at 8 months was 1.0 point (95% CI, 0.0 to 2.1) higher in the sacubitril-valsartan group. Patients in the sacubitril-valsartan group had a higher incidence of hypotension and angioedema and a lower incidence of hyperkalemia. Among 12 prespecified subgroups, there was suggestion of heterogeneity with possible benefit with sacubitril-valsartan in patients with lower ejection fraction and in women. CONCLUSIONS: Sacubitril-valsartan did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among patients with heart failure and an ejection fraction of 45% or higher. (Funded by Novartis; PARAGON-HF ClinicalTrials.gov number, NCT01920711.).


Assuntos
Aminobutiratos/administração & dosagem , Antagonistas de Receptores de Angiotensina/administração & dosagem , Doenças Cardiovasculares/mortalidade , Insuficiência Cardíaca/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Neprilisina/antagonistas & inibidores , Tetrazóis/administração & dosagem , Valsartana/administração & dosagem , Idoso , Aminobutiratos/efeitos adversos , Angioedema/induzido quimicamente , Antagonistas de Receptores de Angiotensina/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Sexuais , Método Simples-Cego , Volume Sistólico , Tetrazóis/efeitos adversos , Valsartana/efeitos adversos
19.
Lancet ; 394(10204): 1169-1180, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31484629

RESUMO

BACKGROUND: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. METHODS: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). FINDINGS: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8-3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74-0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, pinteraction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78-1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75-1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48-2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36-3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74-1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75-0·95, p=0·005, in contrast to patients without PCI where it did not, pinteraction=0·012. Benefit was present irrespective of time from most recent PCI. INTERPRETATION: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk. FUNDING: AstraZeneca.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Ticagrelor/uso terapêutico , Idoso , Aspirina/uso terapêutico , Doenças Cardiovasculares/mortalidade , Angiografia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Estenose Coronária/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Hemorragia/induzido quimicamente , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea , Prevenção Secundária , Acidente Vascular Cerebral/epidemiologia
20.
Medicine (Baltimore) ; 98(37): e17095, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517834

RESUMO

BACKGROUND: The effectiveness of folic acid supplementation in stroke risk has been investigated, however, the available results are inconclusive and conflicting. The purpose of this systemic review and meta-analysis was to assess the effect of folic acid in patients with cardiovascular disease (CVD). METHODS: By searching the PubMed, EMBASE, and Cochrane library databases, we conducted a meta-analysis to evaluate effect of folic acid supplementation in patients with CVD. All-cause mortality, cardiovascular mortality, the risk of coronary heart disease (CHD) and stroke were summarized; hazard ratios (HR), the relative risk (RR) and its 95% confidence interval (CI) were also calculated. Fixed effects models were used to combine the data. A total of 12 randomized controlled trials, which involved 47,523 participants, met the inclusion criteria in this systematic review and meta-analysis. RESULTS: Our meta-analysis showed that cardiovascular patients who received folic acid therapy had significantly decreased risk of stroke (RR = 0.85, 95% CI = 0.77-0.94, Pheterogeneity = .347, I = 10.6%) compared with patients who received control treatment. However, no significant difference in all-cause mortality (HR, 0.97, 95% CI, 0.86-1.10, Pheterogeneity = .315, I = 15.4%), cardiovascular mortality (HR, 0.87, 95% CI, 0.66-1.15, Pheterogeneity = .567, I = 0) and risk of CHD (RR, 1.04, 95% CI, 0.99-1.10, Pheterogeneity = .725, I = 0) were found between the 2 groups. CONCLUSION: This meta-analysis suggested that folic acid supplementation significantly reduced the risk of stroke in patients with CVD.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Ácido Fólico/farmacologia , Doenças Cardiovasculares/mortalidade , Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Humanos , Complexo Vitamínico B/farmacologia , Complexo Vitamínico B/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA