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1.
BMJ ; 366: l4892, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481394

RESUMO

OBJECTIVE: To explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures. DESIGN: Retrospective cohort study. SETTING: The Health Improvement Network (THIN), a database of electronic patient records from UK primary care. PARTICIPANTS: Adult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017. EXPOSURE: TSH concentration in patients with hypothyroidism. MAIN OUTCOME MEASURES: Ischaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome. RESULTS: 162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)). CONCLUSIONS: In patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Hipotireoidismo/tratamento farmacológico , Tireotropina/sangue , Tiroxina/administração & dosagem , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Tireotropina/normas
2.
BMJ ; 366: l5125, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31562117

RESUMO

OBJECTIVE: To investigate whether fenofibrate as add-on to statin treatment reduce persistent cardiovascular risk in adults with metabolic syndrome in a real world setting. DESIGN: Propensity matched cohort study. SETTING: Population based cohort in Korea. PARTICIPANTS: 29 771 adults with metabolic syndrome (≥40 years) receiving statin treatment. 2156 participants receiving combined treatment (statin plus fenofibrate) were weighted based on propensity score in a 1:5 ratio with 8549 participants using statin only treatment. MAIN OUTCOME MEASURE: Primary outcome was composite cardiovascular events including incident coronary heart disease, ischaemic stroke, and death from cardiovascular causes. RESULTS: The incidence rate per 1000 person years of composite cardiovascular events was 17.7 (95% confidence interval 14.4 to 21.8) in the combined treatment group and 22.0 (20.1 to 24.1) in the statin group. The risk of composite cardiovascular events was significantly reduced in the combined treatment group compared with statin group (adjusted hazard ratio 0.74, 95% confidence interval 0.58 to 0.93; P=0.01). The significance was maintained in the on-treatment analysis (hazard ratio 0.63, 95% confidence interval 0.44 to 0.92; P=0.02). The risk of incident coronary heart disease, ischaemic stroke, and cardiovascular death was lower in the combined treatment group than statin group but was not significant. Participant characteristics did not appear to be associated with the low risk of composite cardiovascular events with combined treatment. CONCLUSION: In this propensity weighted cohort study of adults with metabolic syndrome, the risk of major cardiovascular events was significantly lower with fenofibrate as add-on to statin treatment than with statin treatment alone.


Assuntos
Doenças Cardiovasculares , Fenofibrato/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Síndrome Metabólica/tratamento farmacológico , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Causas de Morte , Estudos de Coortes , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Humanos , Hipolipemiantes/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Pontuação de Propensão , República da Coreia/epidemiologia , Fatores de Risco
3.
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
4.
Expert Rev Clin Pharmacol ; 12(9): 825-830, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474169

RESUMO

Introduction: 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are widely used for cardiovascular disease (CVD) prevention. Long-term use of statins has been linked to the development of diabetes mellitus (DM) which increases CVD risk. Areas covered: We discussed the reported incidence of DM in statin users, various possible mechanisms responsible for the development of DM and the clinical implications of this association on CVD risk. Relevant supporting literature was identified using MEDLINE/EMBASE search. Expert opinion: Data from available RCTs and observational studies suggest a 10-45% higher risk of new-onset DM with statin use compared to nonusers. Several cellular, molecular, and genetic mechanisms, and lifestyle changes have been studied and discussed as potential underlying mechanisms responsible for this elevated DM risk with statin therapy. The mode of the diabetogenic action of statins is still unclear and an interplay of pancreatic and peripheral effects in the pathogenesis of DM is a possibility. Despite these observations, the CVD preventative benefit of statin treatment outweighs the CVD risk associated with of development of new DM. There is a need for further research to identify the exact mechanisms involved so as to specifically target causative factors and individualize treatment.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/etiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Diabetes Mellitus/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
6.
Rev Lat Am Enfermagem ; 27: e3154, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432914

RESUMO

OBJECTIVE: to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing. METHOD: conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud. RESULTS: the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept. CONCLUSION: we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases.


Assuntos
Síndrome Metabólica/enfermagem , Enfermagem , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/enfermagem , Doenças Cardiovasculares/prevenção & controle , Humanos , Síndrome Metabólica/complicações , Fatores de Risco
7.
BMJ ; 366: l4414, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391187

RESUMO

OBJECTIVES: To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia. DESIGN: Prospective cohort study. SETTING: Civil service departments in London (Whitehall II study; study inception 1985-88). PARTICIPANTS: 7899 participants with data on the cardiovascular health score at age 50. EXPOSURES: The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health. MAIN OUTCOME MEASURE: Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. RESULTS: 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were -1.5 (95% confidence interval -2.3 to -0.7) for the group with intermediate cardiovascular health and -1.9 (-2.8 to -1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score). CONCLUSION: Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Demência/epidemiologia , Nível de Saúde , Estilo de Vida Saudável , Adulto , Idoso , Doenças Cardiovasculares/sangue , Demência/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
8.
JAMA ; 322(7): 642-650, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429895

RESUMO

Importance: The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years. Objective: To evaluate the association between years since quitting smoking and incident CVD. Design, Setting, and Participants: Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015. Exposures: Time-updated self-reported smoking status, years since quitting, and cumulative pack-years. Main Outcomes and Measures: Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years). Results: The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, -4.51 [95% CI, -5.90 to -2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, -0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]). Conclusions and Relevance: Among heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers' CVD risk remained significantly elevated beyond 5 years after smoking cessation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fumantes , Abandono do Hábito de Fumar , Adulto , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Risco , Fatores de Risco
9.
Stud Health Technol Inform ; 264: 1712-1713, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438306

RESUMO

We developed a HeartGuardian app and explored its effects supporting people with CVD on lipid control and medication adherence. Fifty-seven patients were enrolled, 29 in the intervention group and 28 in the control group. The 12-week intervention resulted in a moderate improvement in lipid level and greater improvement in medication adherence (82.14% vs 37.93%, P = 0.001). These outcomes translate into significant differences in occurrence of major adverse cardiac events (28.75% vs 72.43%, P = 0.001).


Assuntos
Doenças Cardiovasculares , Prevenção Secundária , Smartphone , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Humanos , Adesão à Medicação
10.
Pan Afr Med J ; 33: 30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384345

RESUMO

Introduction: In Ghana, there is no data regarding physical activity habits and lipid profiles of students. Therefore, the aim of this study was to investigate the relationship between physical activities, Body Mass Index (BMI) and lipid profile of students in Ghana. Methods: Cluster and systematic sampling techniques were employed to recruit 120 students, aged 18 years and above. This cross-sectional study was carried out among students from the University of Ghana. Biochemical analysis was conducted analysing total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides (TG) in serum samples. Anthropometry measurements were also taken and BMI calculated. The physical activities, undertaken over a 7-day period, by the students were assessed using the International Physical Activity Questionnaire (IPAQ). Results: 31.7% and 21.7% of the students were overweight and obese respectively. 61.5% of the obese students were engaged in high level physical activity as compared to 45.5% and 36.8% of the normal and overweight students, respectively. Normal weight students and overweight students showed significant differences in means of TC; [(4.56 ± 0.930 mmol/L) and (5.06 ± 0.93 mmol/L), respectively] and also between normal weight group (4.54 ± 0.93 mmol/L) and the obese students (5.24 ± 1.18 mmol/L). Significant correlations were also observed between TG, TC and BMI; and TC and TG, HDL and a strong correlation between LDL and TC (r=0.967). Conclusion: Strong correlations between BMI, physical activity and lipid profile indices among students in Ghana. Comprehensive efforts should be applied to reduce the incidence of CVDs among students.


Assuntos
Índice de Massa Corporal , Exercício/fisiologia , Lipídeos/sangue , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Peso Corporal/fisiologia , Doenças Cardiovasculares/prevenção & controle , Análise por Conglomerados , Estudos Transversais , Feminino , Gana , Humanos , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Universidades , Adulto Jovem
11.
Adv Exp Med Biol ; 1121: 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31392650

RESUMO

The origin of some non communicable disease (NCDs) is in early life. Evidence has shown that early life nutrition is associated with the risk of developing chronic non communicable diseases. Pregnancy and infancy are the most critical stages that influence the risks of NCDs in childhood and adult life. Prenatal maternal undernutrition and low birth weight lead to obesity and increase the risk factors of cardiovascular disease and diabetes later in life. Nutrition is one of the easily modifiable environmental factors that may affect outcome of pregnancy, trajectory of growth, and immune system of the fetus and infant. Healthy eating behaviors associate with prevention of weight disorders in pediatric, non communicable diseases, and deficiencies of micronutrient.


Assuntos
Comportamento Alimentar , Doenças não Transmissíveis , Fenômenos Fisiológicos da Nutrição , Adulto , Doenças Cardiovasculares/prevenção & controle , Criança , Feminino , Humanos , Lactente , Obesidade/prevenção & controle , Gravidez
12.
Adv Exp Med Biol ; 1121: 41-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31392651

RESUMO

AIM: The 14 years' Prevention Education Program PEP was started 1994 among first graders, their siblings and parents living in the half million city Nuremberg (Germany). The aim of prospective family-based observational study was early detection and lifestyle intervention of traditional cardiovascular risk factors. SUBJECTS AND METHODS: Out of 3370 families 24,927 adults and 23,740 children participated in the PEP Family Heart study. Anthropometric parameters including blood pressure and fasting lipids were measured. Because these variables change specifically because of natural growth and development in 3-18 years old children we had to calculate age-and gender-specific growth curves using the LMS method. Non-overweight (normal weight) is defined as BMI < 85th percentile (pctl), overweight as BMI 85th to <95th percentile, obesity as BMI ≥ 95th percentile and severe obesity as ≥ 120% of the 95th pctl. Prehypertension is categorized as the ≥90th to <95th pctl or ≥120/80 mm Hg and hypertension as ≥95th pctl on ≥3 occasions. MAIN RESULTS: 1. Cardiovascular risk (CVD) factor screening in school children predicted CVD risk in parents. 2. The growths curves for auscultatory systolic (SBP) and diastolic (DBP) blood pressure of non-overweight 8713 boys and 8138 girls nearly identical with the percentile curves of all 11,328 boys and 10,723 girls. 3. The shapes of the 10 lipid percentile curves between the 3rd and 97th pctl differ considerably by age and gender. 4. The wais-to-height ratio (WHtR) percentiles as a measure for abdominal adiposity vary substantially by age and gender 5. Among overweight and obese ≥85th pctl the percentile curves of body fat increase steeply until age 10 years and then decrease slowly in boys whereas the BF% percentile curves in girls increase continuously until age 18 years 6. The prevalence of hypertension increased strongly in severe obesity at the 99th pctl, more steeply beyond 120% of the 95th pctl to 59.1% in boys and 56% in girls. 7. The association between hypertension and normal weight, overweight and obesity increased in boys from 0,5, via 2,7 to 4,3 and in girls from 0,4 via 2,1 to 5,9. 8. Between 2000 and 2007 mean blood pressure decreased from 138.3 ± 18.5 mm Hg to 124.0 ± 13.8 mm Hg in fathers and from 119.1 ± 2.8 mm Hg to 110.4 ± 11.2 mm Hg in mothers. 9. After 1 year weighed dietary protocols demonstrate in 166 fathers a decrease of all six nutrional components like daily energy consumption from 2423 to 2307 Kcal, from 98 g to 91 g fat, from 260 g to 252 g carbohydrates, from 88 g to 84 g protein, cholesterol from 362 mg to 339 mg and alcohol from 19 g to 17 g per day and in 237 mothers from 1915 Kcal to 1830 Kcal, from 79 g to 73 g total fat, from 216 g to 212 g carbohydrates, from 66 g to 64 g protein, from 299 g to 244 mg cholesterol. 10. Sustained intensive individual and family-based lifestyle counseling in daily life in terms of healthy diet, less sedentary behavior and more leisure time physical activity slightly improved the CVD risk factor profiles in parents and their children already after 1 year.


Assuntos
Doenças Cardiovasculares , Dieta , Estilo de Vida , Adolescente , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Exercício , Família , Feminino , Alemanha , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco
13.
Rev Med Suisse ; 15(659): 1436-1441, 2019 Aug 21.
Artigo em Francês | MEDLINE | ID: mdl-31436058

RESUMO

Some sodium-glucose cotransporter type 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have proven their ability to reduce major cardiovascular events in patients with type 2 diabetes at high cardiovascular risk. Furthermore, SGLT2is reduce the risk of hospitalization for heart failure and the progression of renal disease. The 2018 ADA-EASD consensus gave the preference to either SGLT2is or GLP-1 RAs to prevent these complications. Underlying protective mechanisms are complex, differ between the two pharmacological classes and are potentially complementary, thus providing a rationale for a combination in patients at very high risk. Some studies already showed positive complementary effects on glucose control, body weight and arterial blood pressure, but not on cardiovascular and/or renal outcomes yet.


Assuntos
Diabetes Mellitus Tipo 2 , Receptor do Peptídeo Semelhante ao Glucagon 1 , Inibidores do Transportador 2 de Sódio-Glicose , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
15.
Rev Med Suisse ; 15(658): 1366-1369, 2019 Aug 14.
Artigo em Francês | MEDLINE | ID: mdl-31411823

RESUMO

Sudden cardiac death in young athletes has become a highly visible public health issue and it has been studied for the last twenty years. In this article, we analyse the most recent literature about epidemiology and aetiology of sudden cardiac death in Switzerland in comparison to international data. We cover last recommendations for pre-participation screening in athletes and we briefly describe the strategies of secondary prevention.


Assuntos
Doenças Cardiovasculares , Morte Súbita Cardíaca , Eletrocardiografia , Exercício , Atletas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Humanos , Programas de Rastreamento , Prevenção Secundária , Suíça
16.
J Agric Food Chem ; 67(33): 9121-9123, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31339705

RESUMO

As part of the 256th American Chemical Society National Meeting that was held in Boston, MA, U.S.A., in August 2018, the symposium on "Health-Promoting Food Ingredients" was organized in collaboration with Dr. Agnes Rimando (rest in peace). This symposium aimed to present the latest advances related to food ingredients (e.g., pure compounds, extracts, or additives) that potentially confer health benefits and reduce the development of lifestyle-related metabolic disorders (e.g., hypertension, obesity, cardiovascular diseases, and diabetes, among others). The studies presented included the evaluation of functional properties of bioactive compounds commonly found in foods, with an emphasis in (poly)phenols (anthocyanins, flavonols, and proanthocyanidins), and dietary fiber and their interaction with gut microbiota. Many studies were focused on whole extracts of foods and the bioactivity measured in vivo at the cellular level. The role of (poly)phenols in the prevention of cardiovascular diseases and type 2 diabetes was highlighted.


Assuntos
Ingredientes de Alimentos/análise , Alimento Funcional/análise , Animais , Doenças Cardiovasculares/dietoterapia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde , Humanos
17.
High Blood Press Cardiovasc Prev ; 26(4): 283-291, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280451

RESUMO

INTRODUCTION: The role of aspirin as a means of primary prevention remains controversial. AIM: We have conducted a meta-analysis of all randomized controlled trials (RCTs) to evaluate the role of aspirin in primary prevention. METHODS: Literature search was performed via PubMed, Embase, and the Cochrane Library for all related RCTs. All-cause mortality was the primary endpoint. Secondary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), cardiovascular mortality, cerebrovascular events, and bleeding events. We used a random effects model to report the risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Our analysis included 17 RCTs (164,862 patients; 83,309 received aspirin and 81,744 received placebo). Our study did not demonstrate any significant reduction in all-cause mortality for patients treated with aspirin when compared with placebo (RR 0.97; 95% CI 0.93-1.01; P = 0.13). Sensitivity analysis performed by excluding healthy elderly (≥ 65) showed significant reductions in all-cause mortality in the aspirin-treated patients (RR 0.94; 95% CI 0.90-0.99; P = 0.01). There were no significant differences between both groups regarding cardiovascular mortality and cerebrovascular events (P > 0.05). However, aspirin-treated patients significantly reduced MACE and MI events (RR 0.89; 95% CI 0.85-0.93; P < 0.001 and RR 0.88; 95% CI 0.78-0.98; P = 0.02, respectively), respectively. However, aspirin was associated with a significantly higher incidence of bleeding, including major bleeding and intracranial bleeding (P < 0.001). CONCLUSIONS: Aspirin use in primary prevention has resulted in a lower incidence of MACE and MI without significantly effecting cerebrovascular events. However, aspirin was associated with a higher bleeding risk. Use of aspirin as a means of primary prevention should be thoroughly discussed with patients and pursued based on the risk of cardiovascular disease while also considering bleeding risk.


Assuntos
Aspirina/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Prevenção Primária/métodos , Aspirina/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Tomada de Decisão Clínica , Hemorragia/induzido quimicamente , Humanos , Incidência , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Resultado do Tratamento
18.
High Blood Press Cardiovasc Prev ; 26(4): 263-272, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31313082

RESUMO

INTRODUCTION: Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C. AIM: The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C. METHODS: We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed. RESULTS: Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53-0.76); (2) 160-189 mg/dL: OR 0.82 (95% CI 0.75-0.89); (3) 130-159 mg/dL: OR 0.71 (95% CI 0.52-0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87-1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61-0.82); (2) 160-189 mg/dL: OR 0.91 (95% CI 0.83-0.98); (3) 130-159 mg/dL; OR 0.88 (95% CI 0.77-1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91-1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality. CONCLUSIONS: In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.


Assuntos
Doenças Cardiovasculares/prevenção & controle , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Causas de Morte , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/mortalidade , Feminino , Humanos , Masculino , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(7): 657-660, 2019 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-31288333

RESUMO

Obesity, related cardiometabolic disorders (including high blood pressure, dyslipidemia and high fasting glucose etc.) and unhealthy lifestyles are now epidemic. These cardiovascular risk factors can track from childhood into adulthood, thereby increasing risk of cardiovascular disease in adulthood. Thus, it is important and necessary to establish children cohort study, to examine the effects of childhood cardiovascular risk factors on abnormal subclinical cardiovascular structure and function in adolescence and adulthood, then to take specific and effective measures for prevention, intervention and control. This will have important public health implications for the prevention of adult cardiovascular disease.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Criança , Estudos de Coortes , Humanos , Estilo de Vida , Obesidade/epidemiologia , Fatores de Risco
20.
BMC Public Health ; 19(1): 903, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286921

RESUMO

BACKGROUND: Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN: We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24-59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM2.5) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM2.5 and indicators of cardiometabolic health. DISCUSSION: This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02658383 , posted January 18, 2016, field work completed May 2018. Official title, "Community-Based Participatory Research: A Tool to Advance Cookstove Interventions." Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Culinária/métodos , Exposição Ambiental/prevenção & controle , Utensílios Domésticos , Adulto , Poluição do Ar em Ambientes Fechados/efeitos adversos , Biomassa , Doenças Cardiovasculares/etiologia , Exposição Ambiental/efeitos adversos , Características da Família , Feminino , Honduras , Humanos , Pessoa de Meia-Idade , Material Particulado/análise , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural , Adulto Jovem
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