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Abstract Background: This study aimed to evaluate the associations between Lipoprotein (a) ‒ Lp(a) levels and carotid Intima-Media Thickness (cIMT) and with carotid plaques in healthy subjects because of previous contradictory data. Methods: A total of 317 healthy normolipidemic subjects (20‒77 years old) were selected. The cIMT and atherosclerotic plaques were determined by B-mode ultrasonography. Mann-Whitney tests were performed to compare the groups according to Lp(a) levels and to explore the associations between Lp(a), carotid plaques, and cIMT, logistic and linear regression analyses were performed. Results: Studied population (51% females, median age 43 years old) presented carotid plaques and cIMT ≥ 0.9 mm in 23% and 18% of the participants, respectively. The group with Lp(a) levels > 30 mg/dL presented significantly higher age and atherosclerotic plaques. Indeed, multivariate linear regression analysis showed a significant association between Lp(a), age, and race. On the other hand, logistic regression analysis demonstrated that the subjects with Lp(a) > 30 mg/dL have a significantly high risk of carotid plaques. Conclusion: The data from the present study indicate that Lp(a) levels above 30 mg/dL contribute to the development of carotid plaques even in apparently healthy participants.
ABSTRACT
Introducción La insuficiencia cardíaca con función sistólica preservada es un síndrome clínico con los mismos signos y síntomas de la insuficiencia cardíaca clásica. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca en América Latina, que se asocia con miocardiopatía dilatada y deterioro progresivo de la función sistólica. No existen estudios previos que hayan evaluado pacientes con insuficiencia cardíaca y función sistólica preservada de una zona endémica en la cual la enfermedad de Chagas es la causa principal de insuficiencia cardíaca. Objetivo Comparar las características clínicas y la evolución de la insuficiencia cardíaca en pacientes con disfunción sistólica y con función sistólica preservada en una población con alta prevalencia de enfermedad de Chagas. Material y métodos Se realizó una evaluación prospectiva de los pacientes con diagnóstico clínico de insuficiencia cardíaca que ingresaron a un centro de referencia en Salvador, Bahía (Brasil). Se consideró función sistólica preservada a una fracción de eyección del ventrículo izquierdo mayor del 45% por ecocardiograma. Se realizó seguimiento al año a través de contacto telefónico o entrevista personal en el consultorio de insuficiencia cardíaca. Resultados Se incluyeron 383 pacientes durante un período de 16 meses; el 52,5% eran hombres y la edad media fue de 54,2 años. La función sistólica estuvo preservada en 138 pacientes (36%). La enfermedad de Chagas fue la principal etiología de ambos tipos de insuficiencia cardíaca (45,3% con disfunción sistólica y 44,2% con función sistólica preservada). El 93,5% (358) de los pacientes completaron un año de seguimiento. Los pacientes con enfermedad de Chagas y función sistólica preservada tuvieron menor mortalidad que los pacientes con disfunción sistólica (10% vs. 23,6%; p = 0,039). En los pacientes sin enfermedad de Chagas y función sistólica preservada, la mortalidad fue similar a la de aquellos con disfunción sistólica (10,4% vs. 15,8%; p = 0,307). Conclusiones La función sistólica preservada fue muy frecuente en nuestra población. La enfermedad de Chagas es la principal etiología de insuficiencia cardíaca independientemente de la fracción de eyección del ventrículo izquierdo. Los pacientes con enfermedad de Chagas y función sistólica preservada tienen mejor pronóstico que aquellos con disfunción sistólica, probablemente porque se encuentran en la fase inicial del compromiso cardíaco.
Background Heart failure with preserved systolic function is a clinical syndrome with the same signs and symptoms of classic heart failure. Chagas disease is a major cause of heart failure in Latin America, associated with dilated cardiomyopathy and progressive deterioration of systolic function. There are no previous assessment studies of patients with heart failure and preserved systolic function in an endemic area in which Chagas disease is the leading cause of heart failure. Objective The aim of this study was to compare clinical characteristics and evolution of heart failure in patients with systolic dysfunction and with preserved systolic function in a population with high prevalence of Chagas disease. Methods A prospective assessment was performed in patients with clinical diagnosis of heart failure admitted to a referral center in Salvador, Bahia (Brazil). Left ventricular ejection fraction > 45% by echocardiogram was considered as preserved systolic function. A one year follow-up was conducted through telephone or personal interview at the heart failure clinic. Results Three hundred and eighty three patients, 52.5% of whom were male, with an average age of 54.2 years, were included in this study over a period of 16 months. Systolic function was preserved in 138 patients (36%). Chagas disease was the main etiology of both types of heart failure (45.3% with systolic dysfunction and 44.2% with preserved systolic function). One year follow-up was completed by 93.5% (358) of patients. Patients with Chagas disease and preserved systolic function had lower mortality than patients with systolic dysfunction (10% vs. 23.6%; p=0.039). In patients without Chagas disease and preserved systolic function, mortality was similar to that of those with systolic dysfunction (10.4% vs. 15.8%; p=0.307). Conclusions Preserved systolic function was very common in our population. Chagas' disease is the leading cause of heart failure irrespective of left ventricular ejection fraction. Patients with Chagas disease and preserved systolic function have a better prognosis than those with systolic dysfunction, probably because they are in the initial phase of cardiac involvement.
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FUNDAMENTOS: Insuficiência cardíaca (IC) é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR) são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de julho de 2003 a novembro de 2006. Anemia foi definida como níveis de hemoglobina abaixo de 13 mg/dl para homens e de 12 mg/dl para mulheres. A função renal foi avaliada por meio da taxa de filtração glomerular (TFG), calculada pela fórmula simplificada do estudo MDRD (Modification of Diet in Renal Disease). RESULTADOS: Dos trezentos e quarenta e cinco pacientes incluídos neste estudo, 26,4 por cento (n = 91) tinham anemia e 29,6 por cento tinham insuficiência renal moderada a grave (TFG < 60 ml/min). A associação entre anemia e maior prevalência de insuficiência renal foi estatisticamente significante (41,8 por cento vs. 25,2 por cento; p = 0,005). Os pacientes em classe funcional III e IV apresentaram maior incidência de anemia (39,0 por cento vs. 19,4 por cento; p <0,001) e insuficiência renal (38,2 por cento vs. 24,8 por cento; p = 0,007). Não foi observada associação entre anemia ou insuficiência renal e história de hipertensão, diabetes, função sistólica ou etiologia de insuficiência cardíaca. CONCLUSÃO: A prevalência de anemia e insuficiência renal foi elevada nessa população e foi associada com a gravidade da insuficiência cardíaca (classes funcionais III e IV).
BACKGROUND: Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS: Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS: Of the 345 patients included in this study, 26.4 percent (n = 91) had anemia and 29.6 percent had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8 percent vs. 25.2 percent; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0 percent vs. 19.4 percent; p <0.001) and renal failure (38.2 percent vs. 24.8 percent; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION: The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).
FUNDAMENTO: La insuficiencia cardiaca (IC) es una enfermedad común con alta tasa de mortalidad. La anemia y la insuficiencia renal (IR), encontradas frecuentemente en portadores de IC, son asociadas a mayor severidad de la enfermedad cardiaca y peor pronóstico. OBJETIVO: Evaluar la prevalencia de anemia e insuficiencia renal, así como la asociación entre esos dos cuadros, en portadores de IC no hospitalizados. MÉTODOS: Se observaron a pacientes seguidos en la clínica de IC de un hospital universitario de julio de 2003 a noviembre de 2006. Se definió la anemia como niveles de hemoglobina abajo de 13 mg/dl para varones y de 12 mg/dl para mujeres. La función renal se evaluó por medio de la tasa de filtración glomerular (TFG), calculada por la fórmula simplificada del estudio MDRD (Modification of Diet in Renal Disease). RESULTADOS: Teniendo en cuenta los trescientos y cuarenta y cinco pacientes incluidos en este estudio, el 26,4 por ciento (n = 91) tenía anemia y el 29,6 por ciento presentaba insuficiencia renal de moderada a severa (TFG < 60 ml/min). La asociación entre anemia y mayor prevalencia de insuficiencia renal fue estadísticamente significante (el 41,8 por ciento vs el 25,2 por ciento; p = 0,005). Los pacientes en clase funcional III e IV presentaron mayor incidencia de anemia (el 39,0 por ciento vs el 19,4 por ciento; p <0,001) e insuficiencia renal (el 38,2 por ciento vs el 24,8 por ciento; p = 0,007). No se observó asociación entre anemia o insuficiencia renal e historia de hipertensión, diabetes, función sistólica o etiología de insuficiencia cardiaca. CONCLUSIÓN: La prevalencia de anemia e insuficiencia renal se elevó en esa población y se asoció con la severidad de la insuficiencia cardiaca (clases funcionales III e IV).