Conglomerados espaciales de mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica en la provincia de Santiago de Cuba / Space conglomerates of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease in Santiago de Cuba province i: en

Introducción: Uno de los aspectos que más interés suscita en lo referente a la distribución geográfica de la mortalidad por cáncer es la formación de conglomerados espaciales. Objetivo: Identificar el patrón espacial de la mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica mediante la detección y descripción de conglomerados espaciales en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio ecológico exploratorio espacial de los fallecimientos por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica durante el período comprendido desde el 1 de enero hasta el 31 de diciembre de 2019 en la provincia de Santiago de Cuba, para lo cual se procedió a la detección de conglomerados espaciales de elevada y baja mortalidad por las causas antes citadas. Se empleó el método de escaneo espacial estadístico con el programa Satscan y las variables independientes fueron divididas en demográficas y clínicas. Resultados: De los 36 conglomerados espaciales de mortalidad detectados, 23 correspondieron al cáncer (65,8 %), 7 a cardiopatía isquémica (18,4 %) y 6 a enfermedad cerebrovascular isquémica (15,8 %); asimismo, 44,7 % del total eran de elevado riesgo y 55,3 % de bajo riesgo. Conclusiones: El patrón de la distribución espacial de mortalidad por cáncer de próstata, pulmón, mama, colon, esófago, cardiopatía isquémica y enfermedad cerebrovascular isquémica se caracterizó por la formación de conglomerados espaciales de elevada y baja mortalidad.

Introduction: One of the aspects that more interest raises regarding the geographical distribution of mortality due to cancer is the formation of space conglomerates. Objective: To identify the space pattern of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease by means of the detection and description of space conglomerates in Santiago de Cuba province. Methods: A space exploratory ecological study of deaths due to cancer, ischemic heart disease and ischemic cerebrovascular disease was carried out during January 1st to December 31, 2019 in Santiago de Cuba province, for which space conglomerates of high and low mortality due to the abovementioned causes were detected. The statistical space escanning method was used with the Satscan program and the independent variables were divided in demographic and clinical. Results: Of the 36 space conglomerates of mortality detected, twenty three corresponded to cancer (65.8%), seven to ischemic heart disease (18.4%) and six to ischemic cerebrovascular disease (15.8%); also, 44.7% of the total was of high risk and 55.3% of low risk. Conclusions: The space distribution pattern of mortality due to prostate, lung, breast, colon, esophagus cancer, ischemic heart disease and ischemic cerebrovascular disease was characterized by the formation of high and low mortality space conglomerates.

Comorbidities and clinical symptoms can modify myocardial function: a cross-sectional study with PET/CT / Comorbilidades y síntomas clínicos que pueden modificar la función miocárdica: estudio transversal con PET/TC

Abstract Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score ≥ 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventricular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia.

Resumen Objetivo: La asociación de comorbilidades y síntomas cardíacos que alteran la función miocárdica podría ayudar a los médicos a identificar correctamente a poblaciones de riesgo. Métodos: Se realizó un estudio transversal en población abierta de pacientes referidos a una unidad de PET/CT en la Ciudad de México para evaluación de la función miocárdica, perfusión y circulación coronaria. La isquemia se definió como una suma de diferencia de puntuación (SDS) ≥ 2. La asociación entre las comorbilidades y los síntomas cardíacos se fundamentó mediante modelos de regresión logística y análisis de tendencias. Realizamos un análisis de interacción para evaluar la adición de cualquier síntoma acompañante a condiciones comórbidas en el deterioro de la función miocárdica. Resultados: Se incluyeron 1.273 pacientes, 66,1% del sexo masculino, con una edad media de 62,4 (± 12.7) años, 360 (28,7%) con isquemia, 925 (72,7%) con al menos una comorbilidad y 676 (53,1%) con al menos una menos un síntoma cardíaco asociado. En pacientes sin isquemia, la diabetes mellitus tipo 2, la hipertensión arterial y los síntomas cardíacos adversos se asociaron con parámetros mecánicos, de perfusión y de flujo coronario adversos. Se observó una tendencia con el número acumulado de comorbilidades y síntomas cardíacos con aumento de la isquemia y disminución del flujo coronario. Solo en la disminución de la FEVI se demostró un efecto de interacción entre el aumento de las comorbilidades y los síntomas adversos. Conclusión: La alta carga de comorbilidades y síntomas en nuestra población altera la función miocárdica independientemente del nivel de isquemia.

Índice predictivo de cardiopatía isquémica en personas con diabetes mellitus

Introducción: Los individuos con diabetes mellitus tienen un riesgo de cardiopatía isquémica 2 a 4 veces superior a la observada en la población general. Objetivo: Diseñar un índice, basado en los factores de riesgo identificados, para predecir el desarrollo de cardiopatía isquémica en pacientes con diabetes mellitus. Métodos: Se realizó un estudio analítico de tipo casos y controles en 330 pacientes con diabetes mellitus. El índice se derivó del análisis de regresión logística binaria de los factores de riesgo cardiovasculares. Resultados: El índice propuesto mostró elevada morbilidad en las categorías de riesgo alto (48,9 %) y riesgo muy alto (100 %); sus valores promedio fueron significativamente mayores en los pacientes con cardiopatía isquémica, en comparación con aquellos que no la desarrollaron (7,98 x 3,67; p= 0,000). La curva COR del índice propuesto tiene buena capacidad para discriminar los pacientes que tendrán una cardiopatía isquémica de los que no desarrollarán la enfermedad (0,902; p= 0,000). Conclusiones: El índice que se propone es capaz de predecir el desarrollo de cardiopatía isquémica en pacientes con diabetes mellitus.

Introduction: Individuals with diabetes mellitus have a risk of ischemic heart disease 2 to 4 times higher than that observed in the general population. Objective: To design an index, based on the identified risk factors, to predict the development of ischemic heart disease in patients with diabetes mellitus. Methods: An analytical case-control study was carried out in 330 patients with diabetes mellitus. The index was derived from binary logistic regression analysis of cardiovascular risk factors. Results: The proposed index showed a high morbidity in the categories of high risk (48.9%) and very high risk (100%). Likewise, their mean values ​​were significantly higher in patients with ischemic heart disease compared to those who did not develop it (7.98 x 3.67; p= 0.000). The ROC curve of the proposed index has a good ability to discriminate patients who will have ischemic heart disease from those who will not develop the disease (0.902; p= 0.000). Conclusions: The proposed index is capable of predicting the development of ischemic heart disease in patients with diabetes mellitus.

Pathogenesis and Treatment of Coronary Microvascular Disease in Traditional Chinese and Western Medicine： A Review / 中国实验方剂学杂志

In recent years， coronary microvascular disease （CMVD）， a main type of ischemic heart disease with high incidence and low diagnosis rate， has become a new research hotspot and received much clinical attention. The etiology of CMVD is complex and the symptoms are various. Traditional Chinese and Western medicine have different opinions on its pathogenesis and treatment plan. Western medicine believes that CMVD is related to structural abnormalities （such as microvascular remodeling， vascular invasion， lumen obstruction， sparse vascular vessel and perivascular fibrosis） and functional abnormalities （such as endothelial dysfunction， smooth muscle cell dysfunction， microvascular constriction， microvascular spasm， inflammation and autonomic nervous dysfunction） of coronary microvascular vessels as well as the extravascular factors （such as heart rate and blood pressure）. In clinics， conventional western medicines are usually used for empirical treatment， but with undesirable effects. Traditional Chinese medicine （TCM） believes that CMVD belongs to the category of "chest impediment"， "heart pain" and "collateral disease"， and the common syndromes include Qi deficiency and blood stasis， Qi stagnation and blood stasis， Qi and Yin deficiency， congealing cold in heart vessel， heart and spleen deficiency， blood stasis obstructing collaterals， combined phlegm and blood stasis， and liver and kidney deficiency， with a variety of treatment methods. Specifically， Chinese patent medicines， self-designed prescriptions， modified classical prescriptions and TCM characteristic therapies have achieved certain effects. This review discussed the risk factors， pathological mechanism， TCM etiology and pathogenesis and traditional Chinese and Western medicine treatment of CMVD， to provide reference for the study and treatment of CMVD.

Development and validation of ischemic heart disease and stroke prognostic models using large-scale real-world data from Japan

BACKGROUND@#Previous cardiovascular risk prediction models in Japan have utilized prospective cohort studies with concise data. As the health information including health check-up records and administrative claims becomes digitalized and publicly available, application of large datasets based on such real-world data can achieve prediction accuracy and support social implementation of cardiovascular disease risk prediction models in preventive and clinical practice. In this study, classical regression and machine learning methods were explored to develop ischemic heart disease (IHD) and stroke prognostic models using real-world data.@*METHODS@#IQVIA Japan Claims Database was searched to include 691,160 individuals (predominantly corporate employees and their families working in secondary and tertiary industries) with at least one annual health check-up record during the identification period (April 2013-December 2018). The primary outcome of the study was the first recorded IHD or stroke event. Predictors were annual health check-up records at the index year-month, comprising demographic characteristics, laboratory tests, and questionnaire features. Four prediction models (Cox, Elnet-Cox, XGBoost, and Ensemble) were assessed in the present study to develop a cardiovascular disease risk prediction model for Japan.@*RESULTS@#The analysis cohort consisted of 572,971 invididuals. All prediction models showed similarly good performance. The Harrell's C-index was close to 0.9 for all IHD models, and above 0.7 for stroke models. In IHD models, age, sex, high-density lipoprotein, low-density lipoprotein, cholesterol, and systolic blood pressure had higher importance, while in stroke models systolic blood pressure and age had higher importance.@*CONCLUSION@#Our study analyzed classical regression and machine learning algorithms to develop cardiovascular disease risk prediction models for IHD and stroke in Japan that can be applied to practical use in a large population with predictive accuracy.

Intelligent Chinese Medicine: A New Direction Approach for Integrative Medicine in Diagnosis and Treatment of Cardiovascular Diseases / 中国结合医学杂志

High mortality rates from cardiovascular diseases (CVDs) persist worldwide. Older people are at a higher risk of developing these diseases. Given the current high treatment cost for CVDs, there is a need to prevent CVDs and or develop treatment alternatives. Western and Chinese medicines have been used to treat CVDs. However, several factors, such as inaccurate diagnoses, non-standard prescriptions, and poor adherence behavior, lower the benefits of the treatments by Chinese medicine (CM). Artificial intelligence (AI) is increasingly used in clinical diagnosis and treatment, especially in assessing efficacy of CM in clinical decision support systems, health management, new drug research and development, and drug efficacy evaluation. In this study, we explored the role of AI in CM in the diagnosis and treatment of CVDs, and discussed application of AI in assessing the effect of CM on CVDs.

Adherencia a tratamiento de prevención secundaria post síndrome coronario agudo, en pacientes adultos ingresados al Hospital Hernán Henríquez Aravena / Adherence to secondary prevention after acute coronary syndromes: experience in a chilean general hospital

Antecedentes: En prevención secundaria cardiovascular, el control de los factores de riesgo es deficiente y la falta de adherencia terapéutica parece ser uno de los factores causales. El cumplimiento terapéutico se asocia a un 20% de disminución del riesgo de enfermedad cardiovascular y un 38% de disminución de mortalidad por cualquier causa. Sin embargo, la adherencia a los fármacos preventivos ronda el 50% al año después del alta hospitalaria, lo que multiplica por 3 el riesgo de mortalidad. Objetivos: Describir la adherencia a mediano plazo a tratamiento de prevención secundaria post síndrome coronario agudo de los pacientes adultos ingresados al Hospital Hernán Henríquez Aravena durante el año 2018. Determinar las características clínicas y sociodemográficas de la población y explorar las posibles causas asociadas a la falta de adherencia terapéutica en este grupo de pacientes. Métodos y Resultados: Se evaluaron 396 pacientes con síndrome coronario agudo en el Hospital Hernán Henríquez Aravena de Temuco durante el año 2018. La adherencia a terapia farmacológica se evaluó mediante el cuestionario de Morisky-Green de ocho ítems, aplicado vía telefónica. Se evaluó la asociación de variables clínicas y sociodemográficas con el nivel de adherencia mediante regresión ordinal y análisis de correspondencias. Resultados: Un 41.9% de los pacientes mantuvieron adherencia a la terapia a 2 años de seguimiento. Variables sociodemográficas como el bajo nivel educacional, la ruralidad, y la presencia de 1 o 2 apellidos mapuche se asociaron con baja adherencia a terapia farmacológica. Conclusión: La adherencia a medidas de prevención secundaria después del tratamiento por un síndrome coronario aguda es baja. Los principales factores relacionados a la falta de adherencia fueron el bajo nivel educacional y la ruralidad.

Background: a lack of therapeutic adherence to secondary prevention measures after acute coronary events leads to a poor control of risk factors. Adherence to treatment is associated with a reduction of 20% in the risk of cardiovascular disease and 38% reduction in all-cause mortality long term. However, adherence to drug therapy is about 50% a year after hospital discharge, which leads to an approximately three fold increase in mortality. Objectives: to describe the medium-term adherence to secondary prevention treatment following an acute coronary syndrome in adult patients admitted to a general hospital during 2018. In addition, to relate clinical and sociodemographic characteristics related to poor adherence and also to explore possible causes associated with the lack of therapeutic adherence in this group of patients. Methods: 396 patients treated for an acute coronary syndrome were followed after being discharged from the Hernán Henríquez Aravena Hospital in Temuco (Chile) during 2018. Adherence to pharmacological therapy was evaluated using the eight-item Morisky-Green questionnaire applied via phone call. The association of clinical and sociodemographic variables with the level of adherence was evaluated using ordinal regression and correspondence analysis. Results: Only 41.9% of patients maintained adherence to therapy at 2 years of follow-up. Low educational level, rurality, and the presence of 1 or 2 mapuche surnames were associated to poor adherence to drug therapy.

Incidencia y características clínicas de los pacientes con infarto agudo de miocardio con elevación del ST sin enfermedad coronaria obstructiva (MINOCA) / Incidence and clinical characteristics of patients with ST-elevation acute myocardial infarction without obstructive coronary disease (MINOCA)

Resumen Introducción: MINOCA es un infarto agudo de miocardio sin enfermedad coronaria obstructiva, esta definición se ha incorporado recientemente a la 4° definición universal del infarto. Sin embargo, por tratarse de un síndrome coronario isquémico no convencional en la práctica clínica, su etiología es muy compleja de dilucidar y demanda un proceso de diagnósticos diferenciales para descartar otras causas de lesión cardíaca. El objetivo del presente trabajo fue caracterizar a los pacientes con infarto agudo de miocardio sin lesiones obstructivas significativas incluidos en el Registro Argentino de Infarto con Elevación del segmento ST (ARGEN-IAM-ST). Métodos: estudio prospectivo, multicéntrico de carácter nacional con inclusión de pacientes con IAMCEST dentro de las 36 horas comenzado los síntomas. Se analizaron todos los pacientes estudiados con cinecoronariografía al ingreso y se consideró MINOCA a aquellos sin lesiones obstructivas significativas de la arteria responsable y se los comparó con los pacientes con lesiones coronarias ateroscleróticas signifi cativas. Resultados: 30 pacientes con MINOCA sobre 2894 pacientes ingresados al registro (incidencia: 1%). Los pacientes con MINOCA fueron más jóvenes, proporción similar en cuanto al género, menos diabéticos y con más antecedentes de insuficiencia cardíaca. Ingresan sin falla cardíaca y fracción de eyección preservada. Mortalidad intrahospitalaria 7%, sin diferencia significativa comparado con IAM clásico. Al alta recibieron en me nor proporción inhibidores P2Y12, estatinas y betabloqueantes. Discusión: No se encontró predominancia de género femenino como otras series. La mortalidad intrahospitalaria es elevada a pesar de no tener enfermedad coronaria significativa. Se destaca la baja utilización de doble antiagregación y estatinas.

Abstract Introduction: MINOCA is an acute myocardial infarction without obstructive coronary disease, this definition was recently incorporated into the 4th universal definition of myocardial infarction. However, since it is an unconventional ischemic coronary syndrome in clinical practice, its etiology is very complex to elucidate and requires a differential diagnosis process to rule out other causes of cardiac injury. The objective of this study is to characterize patients with acute myocardial infarction without significant obstructive lesions included in the Argentine Registry of ST-segment Elevation Myocardial Infarction (ARGEN-IAM-ST). Methods: Prospective, multicenter national study including patients with STEMI within 36 hours of symptom onset. All patients studied with coronary angiography at admission were analyzed and those without significant obstructive lesions of the culprit artery were considered MINOCA. This MINOCA patients were compared with patients with significant atherosclerotic coronary lesions. Results: 30 patients with MINOCA out of 2894 patients entered in the registry (incidence: 1%). MINOCA patients were younger, had a similar proportion for gender, had fewer diabetics patients, and had a greater history of heart failure. They were admitted without heart failure and preserved ejection fraction. In-hospital mortality was 7%, with no significant difference compared to classic AMI. At discharge, they received P2Y12 inhibitors, statins, and beta-blockers in fewer proportion. Discussion: There was no predominance of the female gender as in other series. In-hospital mortality is high despite not having significant coronary disease. It is worth mentioning the low use of dual antiaggregating and statins.

Ginsenoside Rb1 promotes angiogenesis potentially by activating the JAK-STAT3 signalling pathway

Conventional revascularization strategies for ischemic heart disease (IHD) are designed to prompt reperfusion of the coronary artery to the salvaged cardiomyocytes. However, these strategies may cause myocardial reperfusion injuries. Therefore, a safe and effective strategy needs to be developed to improve the conventional strategies. Here, we investigated the pro-angiogenic effect of Ginsenoside Rb1 (Rb1) to provide the experimental basis for angiogenesis-mediated drug therapy of IHD. Thus, Human umbilical vein endothelial cells (HUVECs) were treated with either a vehicle or Rb1 at 4, 8, 12 or 16 ?M for 24 h. A model of hindlimb ischemia was established using C57BL/6J mice. In sham-operated mice, only the femoral artery was isolated without ligation whereas the other operations and supplementation control group were consistent. The mice in the supplementation group were injected with Rb1 (50 mg/kg body wt./day) for 7 days. The results indicated that Rb1 promotes cell proliferation, adhesion, migration and tube formation in the HUVECs in a dose-dependent manner. The ED50 of Rb1 to improve cell adhesion is 8 ?M. In mice, Rb1 promoted angiogenesis after the ligation of the femoral artery and ameliorated the ischemic conditions. Intriguingly, more blood flow recovery was observed in the Rb1 supplemented mice than in the vehicle-treated mice (0.85 ± 0.05 vs. 0.71±0.10 on day 3; 0.94±0.10 vs. 0.75±0.08 on day 7). In HUVECs, Rb1 increased the phosphorylation of STAT3 and JAK, which may be the mechanism through which Rb1 mitigates IHD. Moreover, our results confirmed that Rb1mitigates IHD potentially by activating the JAK-STAT3 pathway. Further clinical trials are warranted to verify the clinical implications of Rb1.

Primer choque apropiado del desfibrilador automático implantable en pacientes con cardiopatía chagásica / First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

Resumen Objetivos: Determinar si los pacientes con cardiopatía chagásica (CCh) presentaron choques apropiados del desfibrilador automático implantable (DAI) de manera más precoz que los pacientes con cardiopatía isquémica (CI). Métodos: Estudio de cohorte retrospectivo que incluyó los pacientes con CCh y CI en quienes se implantó un DAI entre los años 2009 y 2018 en un hospital de alta complejidad. El seguimiento se realizó hasta los 36 meses, evaluándose el momento del primer choque apropiado del dispositivo. Resultados: Se incluyeron 64 pacientes, 20 con CCh y 44 con CI. Se observó que una mayor proporción de pacientes con CCh presentaron choques apropiados durante el primer año (hazard ratio [HR]: 8.4; intervalo de confianza del 95% [IC95%]: 2.09-34.02; p = 0.0027) y a 3 años (HR: 4.61; IC95%: 1.51-14.07; p = 0.0072). El 100% de la población con CCh e implante del DAI como prevención secundaria de muerte súbita presentaron choques apropiados durante los primeros 26 meses de seguimiento. Conclusiones: Los pacientes con CCh presentaron choques apropiados del DAI de manera más precoz que los pacientes con CI. Todos los pacientes con CCh y DAI como prevención secundaria presentaron choques apropiados, representando una población de mayor riesgo. Esta información apoya la indicación del DAI en estos pacientes a pesar de la escasa evidencia en ensayos aleatorizados.

Abstract Objetives: To assess if patients with Chagasic heart disease (CHD) received effective automatic implantable defibrillator (AID) shocks earlier than patients with ischemic heart disease (IHD). Methods: Retrospective cohort of patients with CHD and IHD who received an implantable cardioverter defibrillator (ICD) between 2009 and 2018, in a tertiary hospital. We evaluated the time between the implant of ICD and the first effective shock in patients with CHD and compared it with the IHD control population. Results: We included a total of 64 patients, 20 with CHD and 44 with IHD. CHD patients presented earlier an effective shock than patients with IHD during the first year (hazard ratio [HR]: 8.4; 95% confidence interval [95% CI]: 2.09-34.02; p = 0.0027), and at three years (HR: 4.61; 95% CI: 1.51-14.07; p = 0.0072). 100% of CHD patients who received the ICD as secondary prevention of sudden cardiac death presented an effective shock during the first 26 months of follow-up. Conclusions: Patients with CHD received effective ICD shocks earlier than the IHD patients. All patients with CHD and ICD as secondary prevention had an appropriate ICD shock at short term, representing the highest risk population, and supporting the indication of the device in a setting where randomized clinical trials are lacking.

The effect of mobile application-based technology use on medication compliance and modification of risk factors in post PTCA cohort of patients

Mobile application-based technology was used to study medication compliance and influence on cardiovascular lifestyle in ischemic heart disease (IHD) patients who undergo percutaneous transluminal coronary angioplasty (PTCA). The Mobile-app was made available at Google play store; the app was downloaded and instructions to use were thought to patients by the research team during hospitalization in the study group. A total of two hundred patients with ischemic heart disease who underwent PTCA were enrolled into the study. The control group had telephonic follow up at periodic interval. Both groups had clinical follow ups at appropriate time intervals. Higher medication compliance, smaller number of adverse events and regular follow ups were significantly more in mobile-app group than in control group.

A Study on Prevalence, Clinical Features and Organ Damage in Systemic Lupus Erythematosus (SLE) with Special Reference to Metabolic Profile

Introduction : Systemic Lupus Erythematosus (SLE) is an Autoimmune Disorder with broad spectrum of clinical presentation and is associated with increased prevalence of Atherosclerosis and Cardiovascular events. Metabolic Abnormality, when present in SLE patients increases proinflammatory condition and increased Cardiovascular and Cerebrovascular morbidity and mortality. Objectives : The objectives of this study were to evaluate the prevalence of Metabolic Abnormality in SLE patients and to analyze the association with clinical and Demographic Factors. Methods: The study was a single center, hospital based, prospective, observational study for a span of one and a half years over one hundred patients. SLE was diagnosed by revised American Rheumatology Association Criteria for SLE and Metabolic Syndrome by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) Criteria. Data analyzed with SPSS 23.0 software. Results : The Metabolic Syndrome (MetS) was prevalent in SLE patients (56%). A statistically significant association is detected between MetS and SLE related variables - Serositis, Cutaneous manifestations, Oral Ulcer, Arthralgia, but no significant association found between MetS and QoL (Quality of Life) related variables like Age, Sex. The MetS components, Hypertension, Diabetes and Hypertriglyceridemia were significantly more prevalent in SLE. Conclusion : MetS contributes to long term Cardiovascular risk in SLE patients and thus identifying MetS can contribute to major benefit towards management of IHD risk.

Características clínicas de pacientes con diabetes mellitus complicados con cardiopatía isquémica

RESUMEN Introducción: en las personas con diabetes mellitus la cardiopatía isquémica muestra una morbilidad y una mortalidad 2-4 veces superior a la observada en la población general. Objetivo: describir las características clínicas de pacientes con diabetes mellitus complicados con cardiopatía isquémica. Métodos: se realizó un estudio descriptivo de corte transversal en 459 pacientes con diabetes mellitus, atendidos en los servicios de Endocrinología y Cardiología del Hospital General Provincial "Carlos Manuel de Céspedes" del municipio Bayamo, provincia de Granma, desde el 1ro de enero de 2015 hasta el 31 de diciembre de 2020. Estadígrafos: Chi Cuadrado y T de Student. Resultados: la frecuencia de hipertensión arterial (0,0000), hipertrofia ventricular izquierda (0,0000), tabaquismo (0,0128) y otras complicaciones vasculares de la diabetes, fue superior en los pacientes con cardiopatía isquémica con respecto a los que no poseen esta complicación. Asimismo, los casos con cardiopatía isquémica exhibieron una edad (0,0000), un tiempo de DM (0,0000) y niveles de HA1c (0,0002), colesterol (0,0266), triglicéridos (0,0432), cociente colesterol/HDL (0,0001), microalbuminuria (0,0000) y ácido úrico (0,0000), significativamente superiores que los sin cardiopatía isquémica. Conclusiones: los pacientes con diabetes complicados con cardiopatía isquémica tienen una frecuencia de factores de riesgo cardiovasculares superior a aquellos sin esta complicación. Se hace necesario otras investigaciones para determinar el papel de estos factores en el desarrollo de la enfermedad.

ABSTRACT Introduction: in people with diabetes mellitus, ischemic heart disease shows morbidity and mortality 2-4 times higher than that observed in the general population. Objective: to describe the clinical characteristics of patients with diabetes mellitus complicated by ischemic heart disease. Methods: a descriptive cross-sectional study was carried out in 459 patients with diabetes mellitus, treated at the Endocrinology and Cardiology services of the "Carlos Manuel de Céspedes" Provincial General Hospital of the Bayamo municipality, Granma province, since January 1, 2015. until December 31, 2020. Statisticians: Chi Square and Student's T. Results: the frequency of arterial hypertension (0.0000), left ventricular hypertrophy (0.0000), smoking (0.0128) and other vascular complications of diabetes was higher in patients with ischemic heart disease than in those without have this complication. Likewise, the cases with ischemic heart disease exhibited an age (0.0000), a time of DM (0.0000) and levels of HA1c (0.0002), cholesterol (0.0266), triglycerides (0.0432), ratio cholesterol/HDL (0.0001), microalbuminuria (0.0000) and uric acid (0.0000), significantly higher than those without ischemic heart disease. Conclusions: patients with diabetes complicated by ischemic heart disease have a higher frequency of cardiovascular risk factors than those without this complication. Other research is necessary to determine the role of these factors in the development of the disease.

RESUMO Introdução: em pessoas com diabetes mellitus, a cardiopatia isquêmica apresenta morbidade e mortalidade 2-4 vezes maior do que a observada na população geral. Objetivo: descrever as características clínicas de pacientes com diabetes mellitus complicado por cardiopatia isquêmica. Métodos: estudo transversal descritivo realizado em 459 pacientes com diabetes mellitus, atendidos nos serviços de Endocrinologia e Cardiologia do Hospital Geral Provincial "Carlos Manuel de Céspedes" do município de Bayamo, província de Granma, desde 1 de janeiro de 2015. até 31 de dezembro de 2020. Estatísticos: Chi Square e Student's T. Resultados: a frequência de hipertensão arterial (0,0000), hipertrofia ventricular esquerda (0,0000), tabagismo (0,0128) e outras complicações vasculares do diabetes foi maior nos pacientes com cardiopatia isquêmica do que naqueles sem essa complicação. Da mesma forma, os casos de cardiopatia isquêmica apresentaram idade (0,0000), tempo de DM (0,0000) e níveis de HA1c (0,0002), colesterol (0,0266), triglicerídeos (0,0432), relação colesterol/HDL (0,0001), microalbuminúria (0,0000) e ácido úrico (0,0000), significativamente maior do que aqueles sem cardiopatia isquêmica. Conclusões: pacientes com diabetes complicado por cardiopatia isquêmica apresentam maior frequência de fatores de risco cardiovascular do que aqueles sem essa complicação. Outras pesquisas são necessárias para determinar o papel desses fatores no desenvolvimento da doença.

Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.

Research progress of the effect of flavonoids on cardiovascular and cerebrovascular ischemic diseases / 药学实践杂志

Flavonoids are secondary metabolites that widely existing in traditional Chinese medicine. They have many biological activities and pharmacological effects. In recent years, studies have found that flavonoids can play an effective protective role in the treatments of ischemic stroke and ischemic heart disease through various ways. The mechanisms of their protective effects have been systematically explained in detail. For example, flavonoids can affect pathophysiological mechanisms such as antioxidant, inhibition of inflammatory response, apoptosis and autophagy pathway. This paper reviews the protective effect and mechanisms of the treatments of flavonoids on cardiovascular and cerebrovascular ischemic diseases by referring to relevant literatures. The purpose is to provide reference for future research and development of drugs for the treatments of cardiovascular and cerebrovascular diseases.

A study of the prevalence and risk factors of ischemic heart disease / Эрүүл мэндийн лаборатори

Аbstract@#Ischemic heart disease (IHD) remains one of the most important disorders associated with disability and mortality worldwide, and is one of the major causes of cardiovascular diseases in Mongolia. The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia.</br> We conducted a nationwide cross-sectional survey between March and September, 2009. General participants were recruited from urban to rural regions in a multistage random cluster sampling method. The diagnosis of IHD was based on the Rose questionnaire and electrocardiographic findings. A total of 369 (16.2%) subjects with IHD were diagnosed among 2280 participants. The prevalence of subjects with IHD was significantly increased by age: from 9.9% in individuals age 40-44 years compared to 17.7% in those over 60 years. Smoking habits (former and current) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men, while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women. </br> IHD was found to be prevalent, especially among people aged over 40 years, in Mongolia. Statistical factors related to IHD were found to be significantly different based on sex. The current data may provide relevant information to prevent IHD in the Mongolian population.

Research progress of hypoxia-inducible factor-prolyl hydroxylase inhibitors in the treatment of renal anemia and ischemic heart disease / 中国综合临床

The hypoxia-inducible factor is a significant regulator of adaptive transcriptional response in hypoxia or hypoxia. Hypoxia-inducible factor (hypoXIA-inducible factor) loses its activity after hydroxylation by proline hydroxylase in a normoxic environment. Proline hydroxylase inhibitor is a kind of new small molecule oral preparation by inhibiting the proline hydroxylase, reducing the degradation of HIF, activating the hypoxia-induced way, adjusting including stimulates erythropoiesis, iron absorption and mobilization, angiogenesis, lipid, and glucose metabolism, inflammation, energy metabolism, cell growth and differentiation, and other physiological reaction, Showed more clinical benefits. In recent years, the application of proline hydroxylase inhibitors in the field of renal anemia has achieved apparent efficacy, and the research in the field of ischemic heart disease has also made significant progress in the future in the treatment of ischemic heart disease and other aspects of good application prospects.

Major Chinese Ethnic Medicines for Prevention and Treatment of Ischemic Heart Diseases： A Review / 中国实验方剂学杂志

In China， the incidence of ischemic heart disease （IHD） is increasing year by year， which brings enormous burden to families and society. It is urgent to find preferable treatment methods and medical therapies. The Chinese ethnic minority medicine has gradually developed unique theoretical systems and therapeutic characteristics on the basis of clinical experience and thinking modes including image-number thinking and the holistic perspective. Consequently， it possesses huge application capacity and research value in prevention and treatment of IHD. Belonging to the medical system based on the view of nature and life， the Tibetan medicine， Mongolian medicine， and Dai medicine have respectively formed theories like "three elements" "three life-sustaining energies" "four elements and five skandhas （aggregates）" ， have put forward unique understandings of IHD and have formed corresponding therapeutic principles and methods， generating plentiful classic prescriptions represented by Sanwei Tanxiang powder， Bawei Chenxiang powder， Roukou Wuwei pills and Yajiao Hadun powder. They also contain characteristic ethnic medicine resources such as Choerospondiatis Fructus， Rhodiola Rosea and Draconis Sanguis. Aiming to provide enlightenment and reference for the clinical application and development of the Chinese ethnic minority medicine for the prevention and treatment of IHD， the authors try to summarize the related researches represented by Tibetan and Mongolian medicines， and then discuss the opportunities and challenges faced by such researches.

Estado periodontal de pacientes con cardiopatía isquémica / Periodontal state of patients with ischemic heart disease

Introducción: En numerosos estudios realizados en las últimas 3 décadas, se ha tratado de atribuir una relación causal a la enfermedad periodontal en la fisiopatología de la cardiopatía isquémica. Objetivo: Caracterizar el estado periodontal de pacientes con cardiopatía isquémica y algunos factores de riesgo cardiovascular. Métodos: Se realizó un estudio transversal de 50 pacientes, atendidos en la sala de cuidados coronarios del Hospital Provincial Vladimir Ilich Lenin de Holguín, desde septiembre de 2019 hasta enero de 2020. Se evaluó el estado periodontal mediante el Índice Periodontal de Russell simplificado. Se exploraron algunos factores de riesgo de la cardiopatía isquémica y se emplearon métodos teóricos, empíricos, así como la estadística descriptiva. Resultados: En la serie predominó el grupo de 60-69 años de edad (23 para 46,0 %); 56,0 % de los pacientes presentó infarto agudo de miocardio y 62,0 % periodontitis avanzada. Entre los factores de riesgo cardiovascular más frecuentes figuraron: hipertensión arterial (74,0 %) y tabaquismo (70,0 %). Conclusiones: En este estudio se halló, en gran medida, la periodontitis crónica en pacientes con cardiopatía isquémica, lo cual sirve de pauta para la toma de decisiones de médicos y estomatólogos.

Introduction: In numerous studies carried out in the last 3 decades, it has been tried to attribute a causal relationship to the periodontal disease in the pathophysiology of the ischemic heart disease. Objective: To characterize the periodontal state of patients with ischemic heart disease and some cardiovascular risk factors. Methods: A cross-sectional study of 50 patients, assisted in the Coronary Cares Service of Vladimir Ilich Lenin Provincial Hospital in Holguín, was carried out from September, 2019 to January, 2020. The periodontal state was evaluated by means of the Russell Periodontal Index simplified. Some risk factors of the ischemic heart disease were explored and theoretical, empiric methods were used, as well as the descriptive statistic. Results: In the series there was a prevalence of the 60-69 age group (23 for 46 %); 56.0 % of the patients presented acute myocardial infarction and 62.0 % presented advanced periodontitis. Among the most frequent cardiovascular risk factors we can mention: hypertension (74.0 %) and nicotine addiction (70.0 %). Conclusions: In this study it was found, in great measure, the chronic periodontitis in patients with ischemic heart disease, which serves as rule for the decisions making of doctors and dentists.

Periodontitis, asociación con enfermedad cardiovascular isquémica / Periodontitis, association with ischemic cardiovascular disease

Objetivo. Determinar la asociación de la periodontitis con la enfermedad cardiovascular isquémica. Métodos. Estudio transversal, analítico de casos y controles. Del universo de 9 350 individuos, entre 35 y 70 años de ambos sexos, residentes en el municipio Plaza de la Revolución, que presentaban como mínimo seis dientes en boca y en su historia clínica médica resultados de análisis complementarios para detectar dislipidemia en los últimos seis meses. La muestra de 1 200 individuos se obtuvo de forma aleatoria simple, que otorgaron su consentimiento para participar. El grupo casos estuvo formado por 600 sujetos con diagnóstico médico de enfermedad cardiovascular isquémica durante los cinco años anteriores a la investigación y el grupo control por igual número de sujetos, sin este antecedente. Se parearon los grupos en relación a edad y sexo. Las variables estudiadas fueron: antecedentes de enfermedad cardiovascular isquémica en los últimos cinco años, presencia y gravedad de periodontitis, dientes perdidos por periodontitis y pérdida de inserción periodontal. La asociación entre la presencia de periodontitis con enfermedad cardiovascular isquémica, se empleó la odds ratio (OR), con intervalos de confianza al 95%. Se aplicó, además, el Ji cuadrado de independencia con un nivel de significación de 0,05. Resultados. Se observa una alta intensidad de asociación con la periodontitis (OR=4,07). en los casos, no así en los controles. Los casos también pre-sentaron mayor gravedad, dientes perdidos y pérdida de inserción que los controles. Conclusiones. Se detectó una fuerte asociación entre la periodontitis y la enfermedad cardiovascular isquémica.

Objective. Determine the association between periodontitis and ischemic heart disease.Methods. Cross-sectional, analytical case-control study. From the universe of 9,350 individuals between the ages of 35 and 70 years of both sexes, residents in the Plaza de la Revolution municipality, who had at least six teeth in the mouth and in their medical history the results of complementary tests to detect dyslipidemia In the last six months, a sample of 1,200 individuals who gave their consent to participate was selected by the simple random method. The case group consisted of 600 subjects with a medical diagnosis of ischemic cardiovascular disease during the five years prior to the investigation and the control group for the same number of subjects, without this antecedent. The groups were matched in relation to age and sex. The variables studied were: history of ischemic cardiovascular disease in the last five years, presence and severity of periodontitis, teeth lost due to periodontitis and loss of periodontal attachment. The association between the presence of periodontitis and ischemic cardiovascular disease, the odds ratio (OR) was used, with its corresponding 95% confidence intervals. In addition, the Chi square of independence was applied with a significance level of 0.05. Results. A high intensity of association with periodontitis is observed (OR = 4.07). in the cases, not so in the controls. The cases also presented greater severity, missing teeth and loss of attachment than the controls. Conclusions. A strong association between periodontitis and ischemic cardiovascular disease was detected in this study.