Muerte súbita cardíaca. Comportamiento en las áreas de salud municipio Arroyo Naranjo. Ciudad de la Habana 2000-2004 / Sudden cardiac death. Behaviorin the Arroyo Naranjo communities in Havana City during the period 2000-2004

Problema científico: ¿Cómo se ha comportado la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000-2004? Propósito: Describir el comportamiento de la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000- 2004. Material y Método: Se realiza un estudio epidemiológico en una población de 210000 habitantes en las áreas de salud de la municipalidad de Arroyo Naranjo (Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), con un seguimiento de 5 años. Participaron el Grupo Cubano para el Estudio de la Muerte Súbita Cardíaca (GEMSC), el Centro de Investigaciones y Referencias de Aterosclerosis de La Habana (CIRAH) y la Universidad de Ciencias Médicas "Julio Trigo López". El estudio SUCADES I (SUdden CArdiac DEath Study) incluyó 5 098 fallecidos de muerte natural, a quienes se les aplicó los criterios de Muerte Súbita Cardiaca (MSC) de la Organización Mundial de la Salud (OMS). Resultados: El 9.3 % de las muertes estudiadas acontecieron de forma súbita. El 50.6 % de los eventos se manifestó en el sexo masculino, en edades de 60-74 años. La localidad de Párraga resultó la más afectada (23.4 %). El domicilio de la víctima fue el lugar de ocurrencia de 35.0 % de los eventos. El Infarto agudo del miocardio (IAM) se corroboró en 58.4 %. Conclusiones: Existió un predominio de la Muerte Súbita Cardíaca en el sexo masculino, en el grupo de 60-74 años, en el área de salud de Párraga, documentándose con mayor frecuencia en el medio extrahospitalario (domicilio de la víctima). El Infarto agudo del miocardio, los trastornos del ritmo cardíaco y la disfunción miocárdica ventricular izquierda constituyeron los principales diagnósticos definitivos.

Scientific Problem: How has the Sudden Cardiac Death behaved on the Clinical-Pathological bases in Arroyo Naranjo communities, in Havana City during the period 2000-2004?Objective:To describe the Sudden Cardiac Death behavior in the Arroyo Naranjo communities, in Havana City during the period 2000-2004. Material and method: An epidemiologic study was carried out in a population of 210000 inhabitant in the health areas of the Arroyo Naranjo municipality (Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), followed for 5 years. The Cuban Group for the Sudden Cardiac Death Study (GEMSC), The Research and Reference Center for Aterosclerosis from Havana (CIRAH) and the Medical Sciences Faculty "Julio Trigo López" took part. The SUCADES I study (SUdden CArdiac DEath Study) included 5098 dead of natural causes, to which the criteria of Sudden Cardiac Death (MSC) from the World Health Organization (OMS) were applied. Results:The 9.3 % of the deaths studied happened in a sudden way. The 50.6 % of the events occurred in the male sex, in ages between 60-74 years old. Párraga was the most affected area (23.4 %).The victim's house was the place where the 35.0% of the events happened. The acute myocardial infarct (AMI) was corroborated in the 58.4 %. Conclusions: Sudden Cardiac Death was predominant in the male sex, in the group between 60-74 years old, in Párraga's health area, most frequently documented in the extra hospital media (victim's house). The acute myocardial Infarct, the cardiac rhythm troubles and the left ventricular myocardial dysfunction constituted the main definitive diagnosis.

Intervenção nos hábitos de vida em instituição pública / Life-habit intervention in a public institution

FUNDAMENTO: A doença coronariana é a maior causa mortis mundial, segundo a Organização Mundial de Saúde (OMS), e a segunda no Brasil. Morte súbita ocorre de 4 a 6 vezes mais nos que já sofreram um infarto agudo do miocárdio (IAM); em 6 anos, 18 por cento dos homens e 35 por cento das mulheres terão novo IAM. A prevenção secundária, cuja eficácia já foi demonstrada, é de fundamental importância. OBJETIVO: Testar a efetividade de um programa multiprofissional que visa a modificar fatores de risco para aterosclerose no sistema público. MÉTODOS: Dos 2.337 coronariopatas em tratamento ambulatorial, 513 com estudo coronariográfico concordaram em participar deste estudo, que utilizou como arma terapêutica palestras de como e por que controlar os fatores de risco. Análise estatística: variação significativa pré e pós-intervenção; teste t de Student emparelhado ou o teste de Wilcoxon; existência de diferença significativa entre dois grupos; teste t de Student para amostras independentes ou o teste de Mann-Whitney. Comparação entre três grupos: análise de variância (ANOVA) ou Kruskal-Wallis. RESULTADOS: Colesterol, LDL, triglicérides, índice de massa corpórea, índices de Castelli I e II e medida da cintura apresentaram diminuição significativa, mesmo nos pacientes sem hipolipemiante. Na avaliação do impacto em relação à dieta, verificou-se que 72 por cento dos que não faziam dieta passaram a fazê-la. Atividade física: dos 55 por cento sedentários, 71 por cento passaram a exercitar-se três ou mais vezes/semana. Tabagismo: dos fumantes, 60 por cento (9 por cento do total) interromperam este hábito e 32 por cento o diminuíram. CONCLUSÃO: Esses resultados demonstram a eficácia de programas para melhorar hábitos de vida, aplicados em unidades do sistema público de saúde.

BACKGROUND: Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18 percent of the men and 35 percent of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE: To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS: Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. Statistical analysis: significant variation pre and post-intervention; paired Student's t test or Wilcoxon's test ; existence of a significant difference between the two groups; Student's t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS: Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72 percent of the patients that did not follow a diet, started to do so. Physical activity: of the 55 percent sedentary patients, 71 percent started to exercise three or more times a week. Smoking: of the smokers, 60 percent (9 percent of the total) stopped smoking and 32 percent decreased the number of cigarettes. CONCLUSION: These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system.

Effect of Xuefuzhuyutang and Erchentang on Bulbar Conjunctival Microcirculation in Experimental Atherosclerosis Rabbits / 中国中医药信息杂志

Objective To observe the influence of Xuefuzhuyutang and Erchentang on bulbar conjunctival microcirculation in experimental atherosclerosis rabbits and distinguish the differences of the two recipes. Methods 28 rabbits were randomly divided into 4 groups (control group, hypercholesterol group, Erchentang group, Xuefuzhuyutang group). The models were developed by fed high cholesterol diet, the changes of bulbar conjunctival microcirculation were detected at 10 weeks. Results Xuefuzhuyutang decreased the score values of the capsular dilatation, the diameter of microvein, the red blood cell aggregation (P

Changes of Platelet Activation and Clinical Outcome in Acute Atherosclerotic Cerebral Infarction Treated with Clopidogrel Loading Dose (300 mg)

BACKGROUND: Platelet activation has an important role in progression of atherosclerotic vascular events. To know the beneficial effects of clopidogrel loading dose about changes of platelet activation and clinical outcome in acute stage of atherosclerotic infarction, we performed a prospective randominized study. METHODS: Patients with large artery atherosclerotic infarction were randomized to clopidogrel loading dose (n=24) or intravenous heparin with low dose aspirin (n=28) during 7 days. We measured the surface expression of CD63 on platelets and the platelet aggregability for 7 days. The National Institute of Health Stroke Scale (NIHSS) score was recorded at 24 hours, 72 hours, and 7 days after stroke. Three-month outcome was recorded by the modified Barthel index (BI). RESULTS: As compared with intravenous heparin, the loading dose of clopidogrel was associated with significant reduction of the surface expression of CD63 on platelets, platelet aggregability, and NIHSS score. The clopidogrel loading dose-treated patients were more likely to have a very favorable outcome on BI index at 3 months. CONCLUSIONS: Our results showed that the clopidogrel loading dose has beneficial effects of clinical outcome of acute stage of large artery atherosclerotic infarction may be mediated by the platelet hyperactivity in these patients. Thus, this loading dose trial deserves further evaluation in clinical trial for treatment in large artery atherosclerotic infarction.

Aterosclerose coronariana e infarto do miocárdio em chagásicos crônicos / Coronary arteriosclerosis and myocardial infarction in chronic Chagas' disease

PURPOSE--To evaluate both the frequency of myocardial infarction and coronary atherosclerosis as well as the pathology of the later in necropsied chronic chagasic individuals. METHODS--Systematized gross and light microscopy were performed in hearts, especially at the three main coronary arteries. Eighty-nine hearts were studied, 35 chronic chagasics and 54 nonchagasics, all from males. Statistical tests were used for frequency analysis. RESULTS--Myocardial infarction occurred in 8.6 chagasics and in 7.4 nonchagasics. Coronary atherosclerosis was detected in 71.4 of chagasics and in 74.1 of nonchagasics. Its morphology was similar for both groups and indistinguishable from the classical descriptions of atherosclerosis. There were no cases showing lesions compatible with accelerated coronary atherosclerosis. CONCLUSION--The frequency of myocardial infarction and coronary atherosclerosis was the same for both chagasics and nonchagasic individuals. The morphological findings for the studied arteriopathy were identical for the two considered groups. However, it seems that the frequency of myocardial infarction is higher in chagasics with normal coronary arteries (with or without minimal atherosclerotic lesions), as compared with nonchagasics.

Objetivo - Determinar a freqüência de infarto do miocárdio e da aterosclerose coronariana, bem como as características anatomopatológicas desta última em chagásicos crônicos necropsiados. Métodos - Estudaram-se 89 corações, sendo 35 de chagásicos crônicos e 54 de não-chagásicos, todos provenientes de homens e foram analisados de modo sistematizado, macro e microscopicamente, o coração e, particularmente, os principais troncos coronarianos. Empregaram-se testes estatísticos para análise das freqüências. Resultados -Infarto do miocárdio ocorreu em 8,6% dos chagásicos e em 7,4% dos não-chagásicos. A aterosclerose coronariana foi diagnosticada em 71,4% dos tripanossomóticos e em 74,1% dos nãotripanossomóticos e suas características morfológicas foram semelhantes nos dois grupos considerados e superponiveis àquelas, classicamente, descritas na arteriopatia. Em nenhum caso se observaram lesões daarteriosclerose coronariana acelerada. Conclusão - A freqüência de infarto do miocárdio e de aterosclerose coronariana foi a mesma em chagásicos e não-chagásicos. Quanto às características morfológicas da arteriopatia em estudo foram idênticas nos dois grupos considerados. Entretanto, a freqüência de infarto do miocárdio, em chagásicos com coronárias pérvias, sem ou com lesões ateroscleróticas mínimas, parece maior que a observada em não-chagásicos.