Multiple Sclerosis and the Cardiovascular System: an overview from cardiovascular risk and clinical characteristics to treatment / Esclerose múltipla e o sistema cardiovascular: uma visão geral do risco cardiovascular e das características clínicas até o tratamento

Objective: Review the relationship between Multiple Sclerosis (MS) and the cardiovascular (CV) system, as well as the CV manifestations of the disease and the CV complications of treatment. Methods: We performed a non-systematic review of the main databases, with no time limit. Results: People with MS tend to have a different CV risk than the general population, with a higher prevalence of hypertension, hyperlipidemia, overweight, ischemic heart disease, and peripheral and cerebral artery disease. In addition, cardiac alterations can be present in any part of MS patient care. Furthermore, MS treatments are not innocuous for the CV system and require attention, especially considering fingolimod and mitoxantrone. Discussion: The findings could partially explain the higher mortality rates found in this population. Furthermore, at the onset, dysautonomia symptoms, like postural orthostatic tachycardia syndrome, can be used as a clinical marker of patients at higher risk to evolve from clinically isolated syndrome to MS. Finally, MS not only progress badly when associated with CV risk factors but are also at increased risk of CV morbidity and mortality. Conclusion: Physicians addressing MS patients should be aware of their increased cardiovascular risk and the impact that adequate control of these factors can have on disease progression, patient lifespan, and global care.

Objetivo: Analisar a relação entre a esclerose múltipla (EM) e o sistema cardiovascular (CV), bem como as manifestações CV da doença e as complicações CV do tratamento. Métodos: Foi realizada uma revisão não sistemática das principais bases de dados, sem limite de tempo. Resultados: Pessoas com EM tendem a ter um risco CV diferente da população em geral, com maior prevalência de hipertensão, hiperlipidemia, sobrepeso, cardiopatia isquêmica e doença arterial periférica e cerebral. Além disso, as alterações cardíacas podem estar presentes em qualquer parte do tratamento do paciente com EM. Além disso, os tratamentos da EM não são inócuos para o sistema CV e requerem atenção, especialmente considerando o fingolimod e a mitoxantrona. Discussão: Os achados podem explicar parcialmente as taxas de mortalidade mais altas encontradas nessa população. Além disso, no início, os sintomas de disautonomia, como a síndrome de taquicardia postural ortostática, podem ser usados como um marcador clínico de pacientes com maior risco de evoluir da síndrome clinicamente isolada para a EM. Por fim, a EM não só progride mal quando associada a fatores de risco CV, mas também apresenta um risco maior de morbidade e mortalidade CV. Conclusão: Os médicos que lidam com pacientes com EM devem estar cientes de seu risco cardiovascular aumentado e do impacto que um controle adequado desses fatores pode ter na progressão da doença, no tempo de vida do paciente e nos cuidados globais.

Desenlaces maternos y neonatales en gestantes con cardiopatía con evaluación única vs. evaluación semiestructurada por un equipo cardio-obstétrico / Maternal and neonatal outcomes in pregnant women with heart disease with single evaluation vs. semi-structured evaluation by a cardio-obstetric team

Resumen Introducción: Las enfermedades cardiovasculares en las gestantes son desafiantes, con alta morbimortalidad materna y perinatal, por lo que se recomienda un equipo cardio-obstétrico para su atención. Aun así, pocos datos evalúan el impacto de estos equipos. Por lo tanto, el presente estudio tiene como objetivo comparar los resultados obstétricos, maternos y neonatales del seguimiento semiestructurado (SSE) en una clínica cardio-obstétrica con respecto a un seguimiento usual o seguimiento no estructurado (SNE) en gestantes con enfermedad cardiaca. Métodos: Se realizó un registro prospectivo de gestantes con cardiopatías. Se compararon las pacientes con SSE por un equipo cardio-obstétrico, contra aquellas con evaluación única o SNE. Se calculó el riesgo de eventos según la clasificación de la Organización Mundial de la Salud modificado (OMSm) y la escala del Cardiac Disease in Pregnancy Study II (CARPREG-II) y se evaluaron los desenlaces cardiacos, obstétricos y neonatales. Resultados: Se evaluaron 168 pacientes, 37 con SSE y 131 con evaluación única (SNE). Los principales diagnósticos fueron cardiopatía congénita, arritmias y valvulopatías. La media del CARPREG-II en pacientes de SNE fue 2.48 (DE: 2.3) y en pacientes de SSE fue 3.37 (DE: 2.45; p = 0.041). La media de la OMSm en pacientes de SNE fue 2.1 (DE: 1.6) y con SSE fue 2.65 (DE: 0.95; p = 0.0052). No hubo diferencias significativas en los desenlaces cardiacos primarios (13.8% en SNE vs. 5.4% en SSE; p = 0.134), cardiacos secundarios (5.3 en SNE vs. 2.7 en SSE; p = 0.410), obstétricos (10% en SNE vs. 16.2% en SSE; p = 0.253) y neonatales (35.9% en SNE y 40.5% en SSE; p = 0.486) a pesar de que las pacientes con SSE tenían un riesgo mayor que las pacientes con SNE según las escalas de la OMSm y el CARPREG-II. Conclusiones: En gestantes con cardiopatía, un SSE comparado con un SNE por un equipo cardio-obstétrico no mostró diferencias estadísticamente significativas en los desenlaces cardiovasculares, obstétricos y neonatales, a pesar de que las pacientes con SSE tenían un riesgo significativamente más alto de desenlaces adversos por las escalas de la OMSm y el CARPREG-II. Esto sugiere que el SSE logra al menos equiparar los desenlaces a pesar del mayor riesgo de eventos adversos que tenían las pacientes de este grupo.

Abstract Introduction: Cardiovascular diseases in pregnant women are challenging, with high maternal and perinatal morbidity and mortality, so a cardio-obstetric team is recommended for their care. Even so, little data evaluates the impact of these teams. Therefore, the present study aims to compare the obstetric, maternal, and neonatal outcomes of semi-structured follow-up (SSF) in a Cardio-obstetric clinic concerning regular or unstructured follow-up (USF) in pregnant women with heart disease. Methods: A prospective registry of pregnant women with heart disease was carried out. Patients with SSF by a cardio-obstetric team were compared with those with single evaluation or USF. The risk of events was calculated according to the modified World Health Organization (mWHO) classification and the CARPREG-II scale, and cardiac, obstetric, and neonatal outcomes were evaluated. Results: One hundred sixty-eight patients were evaluated, 37 with SSF and 131 with single evaluation (USF). The primary diagnoses were congenital heart disease, arrhythmias, and valve disease. The average CARPREG-II in USF patients was 2.48 (SD 2.3); in SSF patients, it was 3.37 (SD 2.45; p = 0.041). The average of the mWHO in patients with USF was 2.1 (SD 1.6), and with SSF, it was 2.65 (SD 0.95; p = 0.0052). There were no significant differences in primary cardiac outcomes (13.8% in USF vs. 5.4% in SSF; p = 0.134), secondary cardiac (5.3% in USF vs. 2.7% in SSF; p = 0.410), obstetric (10% in USF vs. 16.2% in SSF; p = 0.253) and neonatal (35.9% in USF and 40.5% in SSF; p = 0.486) even though patients with SSF had a higher risk than patients with USF according to the mWHO and CARPREG-II scales. Conclusions: In pregnant women with heart disease, an SSF compared with a USF by a cardio-obstetric team did not show statistically significant differences in cardiovascular, obstetric, and neonatal outcomes. However, patients with SSF had a significantly higher risk of adverse outcomes due to the mWHO and CARPREG-II scales. This result suggests that the SSF achieves at least equal outcomes despite the higher risk of adverse events that patients in this group had.

Monocyte to High-Density Lipoprotein Cholesterol Ratio Decreased in Patients with Psoriasis Treated with Ixekizumab

ABSTRACT Background: Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammatory biomarker which has been associated with cardiovascular diseases. Objective: To study MHR in patients with psoriasis treated with biological agents. Methods: Between April 2019 and August 2022, MHR was retrospectively evaluated in patients with psoriasis before and 3 months after treatment with infliximab, adalimumab, etanercept, ixekizumab, secukinumab, and ustekinumab in a university hospital in Ankara, Turkey. Results: This study included 128 patients, 53 females and 75 males. 39 (30.5%) patients were treated with infliximab, 26 (20.3%) with adalimumab, 8 (6.3%) with etanercept, 18 (14.1%) with ixekizumab, 12 (9.4%) with secukinumab, and 25 (19.5%) with ustekinumab. The median MHR was 0.0127 (0.0086-0.0165) in females and 0.0146 (0.0119-0.0200) in males (p = 0.011). The median MHR decreased after treatment with adalimumab, ixekizumab, secukinumab, and ustekinumab, whereas it increased after treatment with infliximab and etanercept (p = 0.790, p = 0.015, p = 0.754, p = 0.221, p = 0.276, p = 0.889, respectively). Conclusion: MHR significantly decreased in patients with psoriasis after treatment with ixekizumab. Since high MHR levels have been associated with poor clinical outcomes in patients with cardiovascular diseases, ixekizumab might have a positive impact in the treatment of psoriasis patients who had cardiovascular diseases. We suggest that MHR may be useful both in establishing appropriate biological agent treatment and in the follow-up of patients with psoriasis treated with biological agents.

Risco cardiovascular em hipertensos e diabéticos acompanhados em uma unidade básica de saúde / Cardiovascular risk in hypertensive and diabetic patients followed up in a basic health unit

Determinar o risco cardiovascular pelo Escore de Framingham em indivíduos hipertensos e/ou diabéticos acompanhados em uma unidade de saúde. Estudo transversal com 141 indivíduos com avaliação de dados sociodemográficos, econômicos, clínicos, nutricionais e laboratoriais e aplicação do Escore de Framingham. A média de idade foi 58,5 ±10,5 anos; 67,4% foram mulheres; prevalência de hipertensão arterial, 79,4%, diabetes mellitus, 46,8%; e ambas as comorbidades, 26,2%. A análise apontou diferença por sexo: mulheres apresentaram maior índice de massa corporal (p=0,002), colesterol total (p=0,047) e lipoproteína de alta densidade (p<0,001). O risco cardiovascular foi: 27%, risco baixo; 35,4%, moderado; e 37,6%, alto. Houve maior predomínio de alto risco cardiovascular nos homens (56,5%). Na estratificação do risco cardiovascular, os fatores relacionados ao alto risco foram: maiores idades (p<0,001), maiores valores de colesterol total (p=0,002) e pressão arterial sistólica (p=0,001), maior prevalência de diabetes mellitus (p=0,041) e menores valores de lipoproteína de alta densidade (p=0,016).

To determine the cardiovascular risk using the Framingham Risk Score in hypertensive and/or diabetic individuals followed-up in a health unit. Cross-sectional study with 141 individuals evaluating sociodemographic, economic, clinical, nutritional, and laboratory data, and application of the Framingham Risk Score. Mean age was 58.5 ±10.5 years; 67.4% were women; the prevalence of hypertension was 79.4%; diabetes mellitus, 46.8%; and both comorbidities, 26.2%. The analysis pointed out difference by sex: women had higher body mass index (p=0.002), total cholesterol (p=0.047), and high-density lipoprotein (p<0.001). Cardiovascular risk was: 27%, low risk; 35.4%, moderate risk; and 37.6%, high risk. There was a higher predominance of high cardiovascular risk in men (56.5%). In the stratification of cardiovascular risk, the factors related to high risk were older age (p<0.001), higher values of total cholesterol (p=0.002) and systolic blood pressure (p=0.001), higher prevalence of diabetes mellitus (p=0.041), and lower values of high-density lipoprotein (p=0.016).

Real World Evidence of Bempedoic Acid on Efficacy and Safety in Patients with Uncontrolled LDL-c and at High Risk of CVD

Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

Abstract Background: Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades. Objectives: To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events. Methods: This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests. Results: The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001). Conclusions: A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

High Cardiorespiratory Optimal Point Values Are Related to Cardiovascular Mortality in Men Aged 46 to 70 Years: a Prospective Cohort Study

Abstract Background: Several hemodynamic and respiratory variables measured during cardiopulmonary exercise testing (CPX) have been shown to predict survival. One such measure is the cardiorespiratory optimal point (COP) that reflects the best possible circulation-respiration interaction, but there are still limited data on its relationship with adverse outcomes. Objective: To assess the association between COP and cardiovascular mortality in men aged 46 to 70 years. Methods: A sample of 2201 men who had anthropometric, clinical, and COP data obtained during cycling CPX between 1995 and 2022 was extracted from the CLINIMEX Exercise cohort. COP was identified as the minimal minute-to-minute VE/VO2 during CPX. Vital data were censored on October 31, 2022 for ICD-10-identified cardiovascular deaths. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results: The mean ± standard deviation age was 57 ± 6 years and the median COP value was 24 (interquartile range = 21.2 to 27.4). During a mean follow-up of 4688 ± 2416 days, 129 (5.6%) patients died from cardiovascular causes. The death rates for low (< 28), high (28 to 30), and very high (> 30) categories of COP were 3.2%, 9.6%, and 18.7%, respectively. Following adjustment for age, history of myocardial infarction, diagnosis of coronary artery disease, and diabetes mellitus, the HR (95% CI) for cardiovascular mortality comparing very high versus low COP was 2.76 (1.87 to 4.07; p < 0.001). Conclusions: Our data indicate that, for a general population-based sample of men, COP > 30 represents a considerably higher risk for cardiovascular death. Information on COP could assist cardiovascular risk assessment in men.

Health Literacy, Patient Knowledge and Adherence to Oral Anticoagulation in Primary Care

Abstract Background Warfarin is the only oral anticoagulant available in the Brazilian public health system. Health knowledge and treatment are essential to achieving the desirable therapeutic effect. However, data on these aspects among primary care patients are still lacking. Objective To assess health literacy, patient knowledge, and adherence to oral anticoagulation with warfarin, as well as the medication regimen complexity in primary health units in the municipality of Divinópolis, Minas Gerais, Brazil. Methods This cross-sectional study included patients using warfarin from primary care settings. Sociodemographic and clinical data were collected from medical records. Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), Oral Anticoagulation Knowledge (OAK), adaptation of the Measure of Adherence to Treatment (MAT-adapted) to oral anticoagulation, and Medication Regimen Complexity Index (MRCI) were applied, and the time in therapeutic range (TTR) was calculated. Patients were stratified in two groups (TTR < 60% and TTR ≥ 60%) and compared using Fisher's exact test at a significance level of p < 0.050. Results Analysis included 162 patients (64.8 ± 12.7 years old, 55.6% women). Nonvalvular atrial fibrillation (26.5%) and venous thromboembolism (24.1%) were the main indications for warfarin, and 67.9%, 88.3%, and 16.7% of the patients had inadequate health literacy, insufficient knowledge regarding anticoagulant therapy, and non-adherence to warfarin therapy, respectively. There was no significant association of these parameters in relation to TTR. MRCI showed high pharmacotherapy complexity between the drug prescriptions. Conclusion This study showed alarming insufficient knowledge about warfarin therapy and low health literacy in primary care patients.

Depression and Physical activity among cardiac patients undergone cardiac events: a correlational study / Depresión y actividad física entre pacientes sometidos a eventos cardiacos: un estudio correlacional / Depressão e atividade física em pacientes submetidos a eventos cardíacos: um estudo correlacional

Objective. To assess prevalence of depression and its relationship with physical activity among individuals who have experienced a cardiac event. Methods. This descriptive study involved 196 cardiac patients receiving treatment at selected cardiac hospitals of Punjab (India). Subjects were chosen using purposive sampling technique. After getting informed written consents from the participants the data was collected using International Physical Activity Questionnaire (IPAQ) and Beck Depression Inventory-II (BDI-II). Results. The results showed that majority (62.2%) of the cardiac patients had moderate clinical depression and 11.2% of patients had severe depression. 86.7% of the patients had low level of physical activity (<600 MET min/week). There was also a significant negative correlation between the depression and physical activity depicting the higher the physical activity, lower was the depression score and vice-versa (p<0.05). Moreover, study results revealed that physical activity was significantly associated with age and educational status; whereas, depression was not associated with selected demographic variables. Conclusion. The current investigation has brought to light that a vast majority of individuals suffering from cardiac issues exhibited signs of moderate to severe depressive symptoms. Additionally, the findings indicate an inverse relationship between depression and physical activity. Consequently, it is crucial for nurses to concentrate on identifying early indicators of depression and physical inactivity so that individualized care plans can be developed to enhance the overall health of cardiac patients.

Objetivo. Evaluar la prevalencia de la depresión y su relación con la actividad física entre las personas con que han presentado un evento cardíaco. Métodos. Este estudio descriptivo involucró a 196 pacientes cardíacos que recibieron tratamiento en hospitales cardíovasculares seleccionados de Punjab (India). Los sujetos fueron elegidos utilizando la técnica de muestreo intencional. Después de obtener los consentimientos informados por escrito de los participantes, los datos se recopilaron utilizando el Cuestionario Internacional de Actividad Física (IPAQ, por sus siglas en inglés) y el Inventario de Depresión de Beck-II (BDI-II). Resultados. La mayoría (62.2%) de los pacientes cardíacos tenían depresión clínica moderada y otro 11.2% tenían depresión severa. El 86.7% de los participantes tenía bajo nivel de actividad física (<600 MET min/semana). Se encontró una correlación negativa significativa entre la depresión y la actividad física, ya que cuanto mayor era la actividad física, menor era la puntuación de depresión y viceversa (p<0.05). Además, los resultados del estudio revelaron que la actividad física se asoció estadísticamente con la edad y el nivel educativo; mientras que no se encontró que la depresión estuviera estadísticamente asociada con variables demográficas seleccionadas. Conclusión. El presente estudio reveló que la mayoría de los pacientes cardíacos tenían síntomas depresivos moderados o severos. Los resultados también mostraron que la depresión y la actividad física estaban inversamente correlacionadas. Por lo tanto, el enfoque en la detección de síntomas tempranos de depresión e inactividad física por parte de los enfermeros es crucial para la formulación de un plan de atención individualizado para promover el bienestar de estos pacientes cardíacos.

Objetivo. Avaliar a prevalência de depressão e sua relação com a atividade física em cardiopatas. Métodos. Este estudo descritivo envolveu 196 pacientes cardíacos recebendo tratamento em hospitais cardíacos selecionados em Punjab, Índia. Os indivíduos foram escolhidos usando a técnica de amostragem intencional. Após obter o consentimento informado por escrito dos participantes, os dados foram coletados por meio do Questionário Internacional de Atividade Física (IPAQ) e do Inventário de Depressão de Beck-II (BDI-II). Resultados. A maioria (62.2%) dos cardiopatas apresentava depressão clínica moderada e outros 11.2% apresentavam depressão grave. 86.7% dos participantes apresentavam baixo nível de atividade física (<600 MET min/semana). Foi encontrada correlação negativa significativa entre depressão e atividade física, pois quanto maior a atividade física, menor o escore de depressão e vice-versa (p<0.05). Além disso, os resultados do estudo revelaram que a atividade física esteve estatisticamente associada à idade e escolaridade; enquanto a depressão não foi estatisticamente associada com variáveis demográficas selecionadas. Conclusão. O presente estudo revelou que a maioria dos cardiopatas apresentava sintomas depressivos moderados ou graves. Os resultados também mostraram que depressão e atividade física foram inversamente correlacionadas. Portanto, o foco na detecção precoce de sintomas de depressão e sedentarismo pelos enfermeiros é crucial para a formulação de um plano de cuidados individualizado para promover o bem-estar desses cardiopatas.

Diagnósticos e intervenções de enfermagem frente aos riscos cardiovasculares originados pelo estresse na população em situação de rua / Diagnoses and nursing interventions against cardiovascular risks caused by stress in the homeless population

ntrodução: O estresse está relacionado às doenças cardiovasculares, que são responsáveis por 27% das mortes no Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao estresse persistente e potencialmente fatal. Objetivo: Estabelecer diagnósticos e intervenções de enfermagem, relacionando estresse e DCV nesta população. Métodos e procedimento: Este é um estudo exploratório, transversal e quantitativo, realizado na área central de São Paulo com 119 voluntários selecionados por conveniência entre novembro de 2021 e julho de 2022, aprovado pelo CEP: 036417, CAAE:21519413.40000.5511. Resultado: 35% dos 119 entrevistados afirmam sentir muito estresse ou que isso afeta sua rotina. Valores de pressão arterial e frequência cardíaca estão acima do recomendado. A escala de Likert mostra 32% com proteção ineficaz, risco cardiovascular prejudicado e síndrome do estresse de realocação. Conclusão: Estratégias de saúde são cruciais para atender às necessidades humanas básicas da população em situação de rua, incluindo conscientização sobre riscos cardiovasculares e acesso a cuidados básicos de saúde. A implementação do processo de enfermagem pode ajudar a abordar essas necessidades. (AU)

Stress is related to cardiovascular diseases, which are responsible for 27% of deaths in Brazil. The homeless population is exposed to risk factors, requiring health evaluation and monitoring due to living conditions that lead to persistent and potentially fatal stress. Objective: To establish nursing diagnoses and interventions, relating stress and CVD in this population. Methods and procedure: This is an exploratory, cross-sectional, and quantitative study conducted in downtown São Paulo with 119 volunteers selected by convenience between November 2021 and July 2022, approved by CEP: 036417, CAAE:21519413.40000.5511. Result: 35% of 119 respondents report feeling high stress or that it affects their routine. Blood pressure and heart rate values are above recommended levels. The Likert scale shows 32% with ineffective protection, impaired cardiovascular risk, and relocation stress syndrome. Conclusion: Health strategies are crucial to meet the basic human needs of the homeless population, including awareness of cardiovascular risks and access to basic health care. The implementation of the nursing process can help address these needs.(AU)

El estrés está relacionado con las enfermedades cardiovasculares, que son responsables del 27% de las muertes en Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao stress persistente e potencialmente fatal. Objetivo: Establecer diagnósticos e intervenciones de enfermagem, relacionando estresse e DCV nesta população. Método y procedimiento: Se trata de un estudio exploratorio, transversal y cuantitativo, realizado en el área central de São Paulo con 119 voluntarios seleccionados por conveniencia entre noviembre de 2021 y julio de 2022, aprobado por CEP: 036417, CAAE:21519413.40000.5511. Resultados: 35% de los 119 encuestados afirman sentir mucho estrés o que éste afecta su rutina. Los valores de presión arterial y frecuencia cardíaca están por encima de lo recomendado. Escala de Likert muestra 32% con protección ineficaz, riesgo cardiovascular alterado y síndrome de estrés de reubicación. Conclusión: Las estrategias de salud son cruciales para satisfacer las necesidades humanas básicas de las personas sin hogar, incluyendo la concienciación sobre los riesgos cardiovasculares y el acceso a la atención sanitaria básica. La aplicación del proceso de enfermería puede ayudar a abordar estas necesidades.(AU)

Background cardiovascular risk factors in patients of metastatic prostate cancer on androgen deprivation therapy: A retrospective observational study from a tertiary care hospital of Eastern India

Background: Androgen deprivation therapy (ADT) is indispensable part of treatment for metastatic prostate cancer (MPC) patients. There is documented association between ADT and adverse cardiovascular (CV) events, with variability between the different modes. However, there is dearth of evidence on the background CV risk factors of these group of patients at diagnosis. Aims and Objectives: We envisaged this retrospective observational study in the department of oncology to document the background CV risk factors of MPC patients at diagnosis, to help us better select the available ADTs based on their CV risks. Materials and Methods: Over a period of 2 years, all patients registered for treatment with a diagnosis of MPC, indicated for ADT, and available detailed history and background cardiological evaluation at presentation, were included in the study. As indirect indicators of CV risks, history of smoking, presence and treatment of dyslipidemia, and type 2 diabetes mellitus (T2DM), were documented. As direct indicators of CV risks, presence and treatment of hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF), ECG, and echocardiography changes suggesting cardiac morbidity were documented and the data were analyzed using descriptive statistical methods. Results: Indirect indicators: dyslipidemia, habit of smoking, and T2DM were found in 74%, 29.3%, and 13.3% patients, respectively. Direct indicators: Presence of hypertension, IHD, CCF, abnormalities in ECG, and echocardiography were found in 38.7%, 10.6%, 4%, 28%, and 34.6% patients, respectively. ST-T changes on ECG, low EF, and IHD on echocardiography were seen in 28.5%, 23%, and 26.9%, respectively. Conclusions: MPC patients have a substantial pre-existing CV risk at diagnosis. Our findings warrant a meticulous screening of all MPC patients for CV risk factors, to help in judicious selection of their ADT.

Clustering of cardiovascular disease risk factors among first-year students at the University of Ibadan, Nigeria: a cross-sectional study

ABSTRACT BACKGROUND: Cardiovascular disease (CVD) is the second leading cause of death in sub-Saharan Africa. Globally, there is substantial evidence that modifiable risk factors for CVD are increasing in adolescents. Unfortunately, there is a paucity of information on the prevalence and clustering of these risk factors in adolescents. OBJECTIVES: This study explores the modifiable risk factors for CVD among first-year students at the University of Ibadan, Nigeria. DESIGN AND SETTING: This cross-sectional study was conducted at the University of Ibadan, Nigeria. METHODS: A total of 546 newly admitted students at the University of Ibadan, Nigeria, were recruited using stratified random sampling. An interviewer-administered questionnaire was used to obtain information from study participants between January and February 2016. RESULTS: The mean age of respondents was 19 ± 2.2 years with a male-to-female ratio of 1:1. The reported risk factors for CVD were smoking (1.6%), abdominal obesity (3.3%), alcohol consumption (3.7%), overweight/obesity (20.7%), unhealthy diet (85.3%), and physical inactivity (94.5%). Clustering of ≥ 2 risk factors was reported in 23.4% of students. Female students were twice as probably overweight/obese as male students (adjusted odds ratio [AOR] = 2.2; confidence interval [CI] = 1.41-3.43). Students whose fathers were skilled workers were 3.5 times more likely to be physically inactive (AOR = 1.7; CI = 0.97-2.96). The clustering of ≥ 2 risk factors was significantly higher among women and Muslims in bivariate analysis, whereas no significant association was found in multivariate analysis. CONCLUSIONS: Public health strategies to prevent CVD risk factors should begin in schools and extend to the entire community.

Relationship between vitamin B12 levels and insulin resistance in postmenopausal women from Colombia Caribbean / Relação entre níveis de vitamina B12 e resistência à insulina em mulheres na pós-menopausa da Colômbia Caribe

Introduction: The high prevalence of low vitamin B12 serum levels has been recognized as a public health problem in Latin America; however, the current magnitude of this deficiency in Colombia is uncertain. Low levels of vitamin B12 can induce clinical and subclinical hematological and neurological disorders. Epidemiological studies have demonstrated a relationship between vitamin B12 deficiency and cardiovascular diseases (CVDs). However, the role of vitamin B12 in insulin resistance has been poorly studied. Objective: This study aimed to evaluate the relationship between vitamin B12 serum levels and biochemical and anthropometric markers related to CVDs and insulin resistance in postmenopausal women from Colombia Caribbean. Methods: Correlational, descriptive study. By convenience sampling, 182 postmenopausal women from the medical consultation service of a health institution were linked. Serum vitamin B12 levels, anthropometric variables (body mass index, abdominal perimeter), and biochemical variables (glycemia, insulin, lipid profile, HOMA IR) were evaluated. Results: The average value of the vitamin B12 serum level was 312.5 ± 122.5 pg/mL (230.6 ± 90.4 pmol/L); 46.7% of the women had less than adequate levels of 300 pg/mL (> 221 pmol/L), and 9. 9% were deficient, with levels of less than 200 pg/mL (148 pmol/L). The women with metabolic syndrome were 63.7%, and according to HOMA IR, 52.7 % had insulin resistance. A significant inverse relationship was shown between serum vitamin B12 levels with basal glycemic (P =0.002) and HOMA-IR (P =0.040). Conclusions: A significant inverse relationship between vitamin B12 levels and basal glycemia and HOMA-IR was observed. These findings highlight vitamin B12 deficiency in postmenopausal women and suggest nutritional supplementation.Keywords: Vitamin B12, Insulin resistance, Diet, Postmenopause, Cardiovascular diseases (AU).

Introdução: A alta prevalência de baixos níveis séricos de vitamina B12 foi reconhecida como um problema de saúde pública na América Latina, mas a magnitude atual dessa deficiência na Colômbia é incerta. Baixos níveis de vitamina B12 podem induzir distúrbios hematológicos e neurológicos clínicos e subclínicos. Na verdade, estudos epidemiológicos demonstram uma relação entre deficiência de vitamina B12 e doenças cardiovasculares (DCVs). No entanto, o papel da vitamina B12 na resistência à insulina tem sido pouco estudado. Objetivo: O objetivo deste estudo foi avaliar a relação entre os níveis séricos de vitamina B12 e marcadores bioquímicos e antropométricos relacionados com doenças cardiovasculares e resistência à insulina em mulheres pós-menopáusicas da Colômbia Caribe. Métodos: Estudo correlacional, descritivo. Por amostragem de conveniência, foram vinculadas 182 mulheres na pós-menopausa do serviço de consulta médica de uma instituição de saúde. Níveis séricos de vitamina B12, variáveis antropométricas (índice de massa corporal, perímetro abdominal) e variáveis bioquímicas (glicemia, insulina, perfil lipídico, HOMA IR) foram avaliadas. Resultados: O valor médio do nível sérico de vitamina B12 foi de 312,5 ± 122,5 pg/mL (230,6 ± 90,4 pmol/L); 46,7% das mulheres tinham níveis abaixo do adequado de 300 pg/mL (> 221 pmol/L), e 9,9% eram deficientes, com níveis abaixo de 200 pg/mL (148 pmol/L).As mulheres com síndrome metabólica foram 63,7% e, segundo o HOMA IR, 52,7% apresentavam resistência à insulina. Uma relação inversa significativa entre os níveis séricos de vitamina B12 com glicemia basal (P = 0,002) e HOMA-IR (P = 0,040) foi mostrada. Conclusões: Foi observada uma relação inversa significativa entre os níveis de vitamina B12 e glicemia basal e HOMA-IR. Esses achados destacam a deficiência de vitamina B12 em mulheres na pós-menopausa e sugerem suplementação nutricional (AU).

A review of the SARS-CoV-2 viral genome mutation and its effects

The pandemic-starting SARS-CoV-2 novel coronavirus was found in Wuhan, China. WHO declared this pandemic, which began in late 2019, in March 2020. Experts say this was the first SARS-CoV-2 outbreak. It was the first of many. This virus constantly mutates in response to its replication environment, causing waves, the deadliest of which was the delta variant-caused second wave, which killed millions worldwide. This review examines viral genome alterations and their global effects. We used references from previous research articles on this or similar issues to make our review more data-driven. We found that the virus’ mutation has caused major health problems in humans, including deaths. The viruses changed genome, proteins, local food, sanitation, immunity, and milieu may be involved. We also found that while some of the impacted variations are milder and less contagious, some have had record-breaking peaks and significant death rates in a short time. This analysis examines COVID-19’s impact on diabetes, cardiovascular disease, asthma, aging, and community hygiene. SARS-CoV-2 increases stress and blood glucose in diabetics. Clinical investigations have linked COVID-19 to cardiovascular disease, although the mechanism is uncertain. Asthmatics are more vulnerable to respiratory infections. Its effects change as one age. Cleanliness campaigns are needed to put an end to the epidemic.

Infarto agudo do miocárdio: Tempo é músculo / Acute myocardial infarction: Time is muscle

Objetivo: descrever a impotância de uma detecção precoce do Infarto Agudo do Miocárdio (IAM) por meio da equipe multidisciplinar de saúde e expor se o tempo interfere ou não na piora da lesão miocárdica. Método:Trata-se de uma revisão integrativa da literatura com artigos de 2015 e 2020. As bases utilizadas foram LILACS, MEDLINE, SCIELO, BDEFN e Google Acadêmico. Resulatdos: O tempo porta-balão <90 minutos é eficiente no manejo do paciente com IAM, pois quanto mais rápido atendimento melhor o prognóstico, mas ainda existem muitas dificuldades na realização desse manejo, pois muitos sintomas não são detectados precocemente, a busca pelo atendimento é demorada e as instituições não seguem os protocolos corretamente. Conclusão: Diante deste cenário a telemedicina surge como um aliado no prevenção, diagnóstico e tratamento e principalmente o menor tempo para o atendimento, pois trará mais saúde para o miocárdio e consequentemente para o paciente.(AU)

Objetivo: describir la importancia de la detección precoz del Infarto Agudo de Miocardio (IAM) a través del equipo multidisciplinario de salud y exponer si el tiempo interfiere o no en el empeoramiento de la lesión miocárdica. Método: Se trata de una revisión integrativa de la literatura con artículos de 2015 y 2020. Las bases de datos utilizadas fueron LILACS, MEDLINE, SCIELO, BDEFN y Google Scholar. Resultados: El tiempo puerta-balón < 90 minutos es eficiente en el manejo de los pacientes con IAM, pues cuanto más rápido el tratamiento, mejor el pronóstico, pero aún existen muchas dificultades para realizar este manejo, ya que muchos síntomas no se resuelven. detectada a tiempo, la búsqueda de atención lleva mucho tiempo y las instituciones no siguen correctamente los protocolos. Conclusión: Ante este escenario, la telemedicina surge como un aliado en la prevención, diagnóstico y tratamiento y sobre todo en el menor tiempo de atención, ya que traerá más salud al miocardio y consecuentemente al paciente.(AU)

Objective: to describe the importance of an early detection of Acute Myocardial Infarction (AMI) through the multidisciplinary health team and expose whether or not time interferes in the worsening of the myocardial injury. Method: This is an integrative literature review with articles from 2015 and 2020. The databases used were LILACS, MEDLINE, SCIELO, BDEFN and Google Scholar. Results: The door- to-balloon time <90 minutes is efficient in the management of patients with AMI, because the faster the treatment, the better the prognosis, but there are still many difficulties in carrying out this management, since many symptoms are not detected early, the search for care it is time consuming and institutions do not follow protocols correctly. Conclusion: Given this scenario, telemedicine emerges as an ally in prevention, diagnosis and treatment and especially the shortest time for care, as it will bring more health to the myocardium and consequently to the patient.(AU)

Estilo de vida sedentário em pacientes hospitalizados com afecções cardiovasculares / Sedentary lifestyle in hospitalized patients with cardiovascular diseases

Objetivo: analisar a prevalência e a relação entre o diagnóstico de enfermagem estilo de vida sedentário, seus componentes diagnósticos e as características sociodemográficas e clínicas em pacientes hospitalizados com afecções cardiovasculares. Método: Estudo transversal, realizado com pacientes hospitalizados com afeccções cardiovasculares. A coleta de dados se deu por um instrumento contendo dados sociodemográficos, clínicos e componentes do diagnóstico, os quais foram analisados por testes estatísticos. Resultados: Inferiu-se prevalência do diagnóstico em 84,1% da amostra, com as características definidoras: falta de condicionamento físico (93,2%), média de atividade física diária inferior à recomendada para idade e sexo (86,4%) e preferência por atividade com pouca atividade física (59,1%) e fatores relacionados: treinamento insuficiente para fazer exercício físico (45,5%) e interesse insuficiente para a atividade física (43,2%). Conclusão: O sedentarismo é prevalente em pacientes com afecções cardiovasculares e pode ser desencadeado pelo baixo interesse na realização de atividade física(AU)

Objective: to analyze the prevalence and relationship between the nursing diagnosis sedentary lifestyle, its diagnostic components and sociodemographic and clinical characteristics in hospitalized patients with cardiovascular conditions. Method: Cross-sectional study, carried out with patients hospitalized with cardiovascular conditions. Data were collected using an instrument containing sociodemographic and clinical data and diagnostic components, which were analyzed using statistical tests. Results: Prevalence of the diagnosis was inferred in 84.1% of the sample, with the defining characteristics: lack of physical conditioning (93.2%), average daily physical activity lower than recommended for age and gender (86.4%) and preference for activity with little physical activity (59.1%) and related factors: insufficient training to do physical exercise (45.5%) and insufficient interest in physical activity (43.2%). Conclusion: Sedentary lifestyle is prevalent in patients with cardiovascular diseases and can be triggered by low interest in performing physical activity(AU)

Objetivo: analizar la prevalencia y la relación entre el diagnóstico de enfermería sedentarismo, sus componentes diagnósticos y las características sociodemográficas y clínicas en pacientes hospitalizados con condiciones cardiovasculares. Método: Estudio transversal, realizado con pacientes hospitalizados con condiciones cardiovasculares. Los datos fueron recolectados a través de un instrumento que contenía datos sociodemográficos, clínicos y componentes diagnósticos, que fueron analizados mediante pruebas estadísticas. Resultados: Se infirió prevalencia del diagnóstico en el 84,1% de la muestra, con las características definidoras: falta de acondicionamiento físico (93,2%), actividad física diaria promedio inferior a la recomendada para edad y sexo (86,4%) y preferencia por actividad con poca actividad física (59,1%) y factores relacionados: insuficiente formación para hacer ejercicio físico (45,5%) e insuficiente interés por la actividad física (43,2%). Conclusión: El sedentarismo es prevalente en pacientes con enfermedades cardiovasculares y puede ser desencadenado por el bajo interés por realizar actividad física(AU)

Estimación del riesgo cardiovascular global en hipertensos de la Universidad de Ciencias Médicas de Cienfuegos

Fundamento: a pesar de la importancia del cálculo del riesgo cardiovascular global en hipertensos y los beneficios de su implementación en la Atención Primaria de Salud, en la Universidad de Ciencias Médicas de Cienfuegos son insuficientes los estudios sobre su estimación. Objetivo: determinar el riesgo cardiovascular global en hipertensos de la Universidad de Ciencias Médicas de Cienfuegos en el año 2021. Métodos: se realizó un estudio descriptivo, transversal y correlacional. La muestra estuvo conformada por 105 hipertensos entre 40-80 años de la Universidad de Ciencias Médicas de Cienfuegos en el 2021. Las variables estudiadas fueron: edad, género, colesterol total, tabaquismo, presión arterial sistólica, diabetes mellitus diagnosticada y el riesgo cardiovascular global. Se calcularon la frecuencia absoluta y relativa de las variables y se aplicó la Chi cuadrado de Pearson en la asociación de las variables y el riesgo cardiovascular bajo con un nivel de significación p=0,05. Los resultados se presentaron en tablas. Resultados: predominó el género femenino, el grupo etáreo de 50-69 años, los no diabéticos y los no fumadores, con colesterol normal y prehipertensos. El 93,3 % presentó riesgo cardiovascular global bajo y el 6,7 % de moderado a crítico. Los pacientes no diabéticos y con presión arterial sistólica normal presentaron asociación significativa con el riesgo cardiovascular bajo. Conclusiones: los hipertensos de la Universidad de Ciencias Médicas de Cienfuegos presentan un riesgo cardiovascular global bajo, se mostró una correlación entre el riesgo cardiovascular bajo y la presión arterial sistólica normal y los antecedentes de no diabetes, lo que condicionaría protección a eventos cardiovasculares y cerebrovasculares en el futuro.

Background: despite the importance of calculating global cardiovascular risk in hypertensive patients and the benefits of its implementation in Primary Health Care, studies on its estimation are insufficient at the University of Medical Sciences of Cienfuegos. Objective: to determine the global cardiovascular risk in hypertensive patients at the University of Medical Sciences of Cienfuegos in the year 2021. Methods: a descriptive, cross-sectional and correlational study was carried out. The sample consisted of 105 hypertensive patients between 40-80 years of age from the University of Medical Sciences of Cienfuegos in 2021. The variables studied were: age, gender, total cholesterol, smoking, systolic blood pressure, diagnosed diabetes mellitus, and global cardiovascular risk. The absolute and relative frequency of the variables were calculated and Pearson's Chi square was applied in the association of the variables and low cardiovascular risk with a significance level of p=0.05. The results were presented in tables. Results: the female gender, the age group of 50-69 years, non-diabetics and non-smokers, with normal cholesterol and prehypertensive predominated. 93.3 % presented low overall cardiovascular risk and 6.7 % moderate to critical. Non-diabetic patients with normal systolic blood pressure presented a significant association with low cardiovascular risk. Conclusions: hypertensive patients at the University of Medical Sciences of Cienfuegos have a low overall cardiovascular risk, a correlation was shown between low cardiovascular risk and normal systolic blood pressure and a history of non-diabetes, which would determine protection against cardiovascular and cerebrovascular events in the future

Metabolismo de los esfingolípidos y su relación con las enfermedades cardiovasculares, renales y metabólicas / Sphingolipid metabolism and its relationship with cardiovascular, renal and metabolic diseases

Resumen Los esfingolípidos (esfingomielina, glucolípidos y gangliósidos) se localizan en las membranas celulares, el plasma y las lipoproteínas. En pacientes con enfermedades cardiovasculares, renales y metabólicas, el perfil de los esfingolípidos y sus metabolitos (ceramida, esfingosina y esfingosina-1-fosfato) se modifica, y estos cambios pueden explicar las alteraciones en algunas respuestas celulares, como la apoptosis. Además, se ha sugerido que la esfingosina y la esfingosina-1-fosfato previenen la COVID-19. En esta revisión también se mencionan brevemente las técnicas que permiten el estudio de los esfingolípidos y sus metabolitos.

Abstract Sphingolipids (sphingomyelin, glycolipids, gangliosides) are located in cell membranes, plasma, and lipoproteins. In patients with cardiovascular, renal, and metabolic diseases, the profile of sphingolipids and their metabolites (ceramide, sphingosine, and sphingosine-1-phosphate) is modified, and these changes may explain the alterations in some cellular responses such as apoptosis. Furthermore, sphingosine and sphingosine-1-phosphate have been suggested to prevent COVID-19. This review also briefly mentions the techniques that allow us to study sphingolipids and their metabolites.

Brief review of pathophysiological disorders as consequence of psychological stress / Breve revisión de los trastornos fisiopatológicos como consecuencia del estrés psicológico

Background: Psychological stress is a reaction to an unexpected situation that favours adaptation and response to the event. However, when psychological stress is chronic or very intense, it can induce changes in various systems and tissues, causing diseases or aggravating existing ones. Objective: To briefly analyse the pathophysiological conditions caused by psychological stress. Method: A narrative review of the scientific literature on pathophysiological conditions as a consequence of psychological stress was performed. Results: Psychological stress can induce various conditions at the gastrointestinal, immune and cardiovascular levels. This is mainly due to the neurobiological and endocrine response because when faced with a stressful stimulus, a deregulated release of glucocorticoids and catecholamines is generated, altering the normal physiology of the organism. Gastrointestinal disorders are mainly due to goblet cell dysfunction, resulting in intestinal hyperpermeability, inflammation and infection. Changes at the immune level lead to an increase in inflammatory responses but a decrease in the protective activities of the immune system. Finally, cardiovascular conditions include atherosclerosis, increased blood pressure and stroke. Conclusion: Psychological stress can induce real physiological pathologies and, in some cases, fatal ones. Some of the molecular mechanisms involved in these pathologies have already been studied and identified. Knowledge of these molecular mechanisms can help clinicians and therapists to improve the treatment and therapy of patients.

Introducción: El estrés psicológico es una respuesta a una situación inesperada que favorece la adaptación y la respuesta ante dicho evento. Sin embargo, cuando el estrés psicológico es crónico o muy intenso, se pueden desencadenar afecciones en diversos sistemas y tejidos, generando enfermedades o empeorando las ya existentes. Objetivo: Analizar brevemente las afecciones fisiopatológicas causadas por el estrés psicológico. Método: Se realizó una revisión narrativa con la literatura científica sobre las afecciones fisiopatológicas debidas al estrés psicológico. Resultados: El estrés psicológico puede desencadenar diversas afecciones a nivel gastrointestinal, inmunitario y cardiovascular. Esto se debe principalmente a la respuesta neurobiológica y endócrina, ya que ante estímulos estresores, se genera una liberación desregulada de glucocorticoides y catecolaminas que alteran la fisiología normal del organismo. Las afecciones a nivel gastrointestinal se deben principalmente a la disfunción de las células caliciformes, dando como consecuencia hiperpermeabilidad intestinal, inflamación e infecciones. Las alteraciones a nivel inmunitario generan un aumento en las respuestas inflamatorias pero una reducción en las actividades protectoras del sistema inmune. Por último, las afecciones cardiovasculares incluyen ateroesclerosis, aumento de la presión arterial y derrames cerebrales, entre otros. Conclusión: El estrés psicológico puede causar patologías fisiológicas reales y, en algunos casos, mortales. Algunos de los mecanismos moleculares implicados en estas patologías ya han sido estudiados y establecidos. Conocer estos mecanismos moleculares puede ayudar a los médicos y terapeutas a mejorar el tratamiento y la terapia del paciente.