Perfil lipídico e fatores de risco para doenças cardiovasculares em idosos acompanhados na atenção primária à saúde / Lipid profile and risk factors for cardiovascular diseases in older people seen in primary health care / Perfil lipídico y factores de riesgo de enfermedades cardiovasculares en ancianos seguidos en la atención primaria de salud / Lipid profile and risk factors for cardiovascular diseases in older people seen in primary health care

Introdução: As dislipidemias estão entre os fatores de riscos mais importantes para o desenvolvimento de doenças cardiovasculares (DCV), além de estarem relacionadas a outras patologias que predispõem às DCV. Em função da elevada prevalência e da incidência de complicações associadas à cronicidade da doença, as dislipidemias representam elevados custos ao setor da saúde e da previdência social. Diante disso, ressalta-se a importância do Sistema Único de Saúde, representado pela Atenção Primária à Saúde (APS), em prover práticas de prevenção, diagnóstico e acompanhamento dos pacientes dislipidêmicos, a fim de desonerar o sistema financeiro e promover o envelhecimento saudável. Objetivo: Descrever a prevalência de perfil lipídico alterado entre os idosos. Além disso, pretendeu-se caracterizar a amostra quanto aos aspectos sociodemográficos, de saúde e de comportamento, bem como analisar os fatores associados à distribuição do perfil lipídico alterado e às características da amostra. Métodos: Estudo transversal com dados secundários, obtidos de agosto de 2021 a julho de 2022, tendo como população pacientes idosos em acompanhamento na APS do município de Marau (RS). Todos os dados foram coletados dos prontuários eletrônicos da rede de APS e, após dupla digitação e validação dos dados, a amostra foi caracterizada por meio de estatística descritiva. Foi calculada a prevalência de perfil lipídico alterado com intervalo de confiança de 95% (IC95%) e foi verificada sua distribuição conforme as variáveis de exposição, empregando-se o teste do χ2 e admitindo-se erro tipo I de 5%. Resultados: A prevalência de dislipidemia proporcional entre os sexos foi maior no feminino (33%). A cor de pele predominante foi a branca (76,7%). Cerca de 20% dos pacientes apresentavam colesterol total, colesterol HDL-c e triglicerídeos alterados, enquanto cerca de 15% apresentavam o colesterol HDL-c anormal. Constatou-se que os pacientes dislipidêmicos apresentam mais diabetes e hipertensão em relação aos não dislipidêmicos, ocorrendo a sinergia de fatores de risco para as DCV. Conclusões: A caracterização exercida neste estudo serve de base científica para a compreensão da realidade local e, também, para o direcionamento de políticas públicas na atenção primária que atuem de forma efetiva na prevenção e no controle das dislipidemias e demais fatores de risco cardiovascular.

Introduction: Dyslipidemias are among the most important risk factors for the development of cardiovascular diseases (CVD), in addition to being related to other pathologies that predispose to CVD. Because of the high prevalence and incidence of complications associated with the chronicity of the disease, dyslipidemias represent high costs for the health and social security sector. This highlights the importance of the Unified Health System, represented by primary health care (PHC), in providing prevention, diagnosis and follow-up practices for dyslipidemic patients to relieve the financial system and promote healthy aging. Objective: The study aimed to describe the prevalence of altered lipid profile among older people. In addition, we sought to characterize the sample in terms of sociodemographic, health and behavioral aspects, as well as to analyze the factors associated with the distribution of the altered lipid profile and the characteristics of the sample. Methods: We conducted a cross-sectional study with secondary data, from August 2021 to July 2022, with older patients being followed up at the PHC in the city of Marau (RS) as the study population. All data were collected from the electronic medical records of the PHC network, and after double-typing and validation, the sample was characterized using descriptive statistics. The prevalence of altered lipid profile was determined with a 95% confidence interval (95%CI), and its distribution was verified according to the exposure variables, using the chi-square test and a type I error of 5%. Results: The prevalence of proportional dyslipidemia between sexes was higher in females (33%). The predominant skin color was white (76.7%). About 20% of the patients had altered total cholesterol, HDL-C and triglycerides, while about 15% had abnormal HDL-C. It was found that more dyslipidemic patients had diabetes and hypertension than non-dyslipidemic patients, with a synergy of risk factors for CVD. Conclusions: The characterization carried out in this study serves as a scientific basis for understanding the local reality and also for directing public policies in PHC that act effectively in the prevention and control of dyslipidemia and other cardiovascular risk factors.

Introducción: las dislipidemias se encuentran entre los factores de riesgo más importantes para el desarrollo de enfermedades cardiovasculares (ECV), además de estar relacionadas con otras patologías que predisponen a ECV. Debido a la alta prevalencia e incidencia de complicaciones asociadas a la cronicidad de la enfermedad, las dislipidemias representan altos costos para los sectores de salud y seguridad social. Frente a eso, se destaca la importancia del Sistema Único de Salud, representado por la Atención Primaria de Salud (APS), en la provisión de prácticas de prevención, diagnóstico y seguimiento de pacientes dislipidémicos, con el fin de descongestionar el sistema financiero y promover el envejecimiento saludable. Objetivo: El estudio tiene como objetivo describir la prevalencia del perfil lipídico alterado entre los ancianos. Además, se pretende caracterizar la muestra en cuanto a aspectos sociodemográficos, de salud y conductuales, así como analizar los factores asociados a la distribución del perfil lipídico alterado y las características de la muestra. Métodos: estudio transversal con datos secundarios, de agosto de 2021 a julio de 2022, con pacientes ancianos en seguimiento en la APS del municipio de Marau (RS) como población. Todos los datos fueron recolectados de la historia clínica electrónica de la red de la APS y, luego de doble digitación y validación, la muestra fue caracterizada mediante estadística descriptiva. Se calculó la prevalencia de perfil lipídico alterado con un intervalo de confianza del 95% (IC95%) y se verificó su distribución según las variables de exposición, utilizando la prueba de chi-cuadrado y admitiendo un error tipo I del 5%. Resultados: la prevalencia de dislipidemia proporcional entre sexos fue mayor en el sexo femenino (33%). El color de piel predominante fue el blanco (76,7%). Alrededor del 20% de los pacientes tenían colesterol total, colesterol HDL-C y triglicéridos alterados, mientras que alrededor del 15% tenían colesterol HDL-C anormal. Se encontró que los pacientes dislipidémicos tienen más diabetes e hipertensión que los pacientes no dislipidémicos, con una sinergia de factores de riesgo para ECV. Conclusiones: la caracterización realizada en este estudio sirve de base científica para comprender la realidad local y también para orientar políticas públicas en atención primaria que actúen de manera efectiva en la prevención y control de la dislipidemia y otros factores de riesgo cardiovascular.

Riesgo cardiovascular, dislipemias e indicación de estatinas en una población de obesos mórbidos

Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados ​​478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.

Efectos cardiovasculares de la exposición ocupacional a pesticidas / Cardiovascular effects of occupational exposure to pesticides

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos "agrochemicals", "myocardial infarction", "occupational exposure" y "farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Antitrombóticos: investigación y aplicaciones en la atención médica / Antithrombotics: Research and applications in healthcare

Resumen: Los antitrombóticos son fármacos que se utilizan para prevenir la formación de coágulos sanguíneos, también conocidos como trombos. Estos coágulos pueden causar graves problemas de salud, como infartos o enfermedades cerebrovasculares. En este artículo se analizan diferentes tipos de antitrombóticos, como los antiplaquetarios y los anticoagulantes, y se discuten sus mecanismos de acción. Además, se examinan los beneficios y los riesgos asociados con el uso de antitrombóticos. Por un lado, estos fármacos pueden reducir el riesgo de eventos trombóticos, lo que puede ser especialmente beneficioso en pacientes con condiciones de alto riesgo, como aquellos que han sufrido un infarto o que tienen fibrilación auricular. Por otro lado, también se discuten los posibles efectos secundarios de los antitrombóticos, como el aumento del riesgo de sangrado. Además, se proporcionan pautas para su uso seguro en diferentes escenarios clínicos. Finalmente, se abordan las estrategias de monitoreo y ajuste de la dosis de estos medicamentos para garantizar su eficacia y seguridad en los pacientes.

Abstract: Antithrombotics are drugs used to prevent the formation of blood clots, also known as thrombi. These clots can cause serious health problems, such as heart attacks or strokes. Different types of antithrombotics, such as antiplatelets and anticoagulants, are analyzed and their mechanisms of action are discussed. Additionally, the benefits and risks associated with the use of antithrombotics are examined. On the one hand, these drugs can reduce the risk of thrombotic events, which may be especially beneficial in patients with high-risk conditions, such as those who have suffered a heart attack or who have atrial fibrillation. On the other hand, the possible side effects of antithrombotics, such as the increased risk of bleeding, are also discussed and guidelines for their safe use in different clinical scenarios are provided. Additionally, monitoring and dose adjustment strategies for these medications are addressed to ensure their effectiveness and safety in patients.

Mecanismos compensatorios a nivel sistémico en pacientes con tronco arterial persistente / Systemic Compensatory Mechanisms in Patients with Persistent Truncus Arteriosus

Resumen Introducción: El tronco arterial persistente es una rara malformación cardíaca congénita que provoca diversas complicaciones en el sistema cardiovascular. Se caracteriza por la presencia de un tabique ventricular defectuoso, una única válvula troncal y un tronco arterial común entre la arteria pulmonar y aorta, conllevando a una mezcla entre la sangre arterial y venosa, debido a un cortocircuito cardíaco bidireccional predominante de izquierda a derecha que compromete el suministro de flujo sanguíneo, nutrientes y oxigenación sistémica. Las manifestaciones clínicas incluyen desaturación con cianosis, hipoxemia, taquicardia, taquipnea, alteraciones en la contractilidad cardíaca, pulsos distales anómalos, pérdida de peso, fatiga y hepatomegalia. Objetivo: El propósito de esta investigación es establecer hipótesis sobre los diversos mecanismos compensatorios que se activan a nivel sistémico para contrarrestar los efectos de esta malformación. Reflexión: Se sugiere que se producen respuestas biomoleculares similares en los sistemas cardiovascular, pulmonar y renal, reduciendo la producción de óxido nítrico y provocando respuestas vasoconstrictoras. A nivel hepático, se generan factores de crecimiento y se inician procesos de angiogénesis para aumentar la perfusión sanguínea. En el cerebro, se activan enzimas para incrementar el flujo sanguíneo y proporcionar oxígeno y nutrientes esenciales. Conclusión: A pesar de estos mecanismos compensatorios, no logran contrarrestar por completo las manifestaciones clínicas, conduciendo a una serie de problemas de salud, como hipertensión pulmonar, insuficiencia cardíaca, hepatomegalia, hipoperfusión de órganos y déficits neurológicos. Estos factores convergen para generar una compleja condición cardíaca que desencadena respuestas adaptativas en el cuerpo que terminan siendo una afección médica desafiante y potencialmente grave.

Abstract Introduction: Persistent truncus arteriosus is a rare congenital cardiac malformation that causes various complications in the cardiovascular system. It is characterized by the presence of a defective ventricular septum, a single truncal valve and a common truncus arteriosus between the pulmonary artery and aorta, leading to a mixture between arterial and venous blood, due to a predominantly left-to-right bidirectional cardiac shunt that compromises the supply of blood flow, nutrients, and systemic oxygenation. Clinical manifestations include desaturation with cyanosis, hypoxemia, tachycardia, tachypnea, alterations in cardiac contractility, abnormal distal pulses, weight loss, fatigue, and hepatomegaly. Aim: The purpose of this research is to establish hypotheses about the various compensatory mechanisms that are activated at a systemic level to counteract the effects of this malformation. Reflection: It is suggested that similar biomolecular responses occur in the cardiovascular, pulmonary, and renal systems, reducing nitric oxide production and causing vasoconstrictive responses. At the liver level, growth factors are generated and angiogenesis processes are initiated to increase blood perfusion. In the brain, enzymes are activated to increase blood flow and provide oxygen and essential nutrients. Conclusion: Despite these compensatory mechanisms, they fail to completely counteract the clinical manifestations, leading to a series of health problems such as pulmonary hypertension, heart failure, hepatomegaly, organ hypoperfusion, and neurological deficits. These factors converge to generate a complex cardiac condition that triggers adaptive responses in the body that end up being a challenging and potentially serious medical condition.

Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular / Multidimensional frailty assessment tools for use in the care of older adults with cardiovascular disease / Instrumentos de evaluación multidimensional de la fragilidad en la atención de adultos mayores con enfermedad cardiovascular

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.

Objective: to identify which tools are available for multidimensional frailty assessment of older adult with cardiovascular disease and which are potentially applicable during the Nursing Process. Method: a systematic review conducted in eight databases/portals to identify studies that presented multidimensional frailty assessment tools for older adult with cardiovascular disease and that were applicable to the nursing process. Results: a total of 19 multidimensional tools were included. The Brief Frailty Index for Coronary Artery Disease was developed for use in the cardiovascular care of older adult. The Frailty Index for Adults and the Maastricht Frailty Screening Tool for Hospitalized Patients were developed for use in the Nursing Process. Conclusion: although only one tool was developed for older adults with cardiovascular disease and only two are applicable to the nursing process, most of them have the potential to be adapted and validated for use in this population during nursing assessment.

Objetivo: identificar qué instrumentos están disponibles para la evaluación multidimensional de la fragilidad en personas mayores con enfermedad cardiovascular, que se puedan aplicar en el Proceso de Enfermería. Método: revisión sistemática realizada en ocho bases de datos/portales, para identificar estudios que presentaran instrumentos multidimensionales para la evaluación de la fragilidad en adultos mayores con enfermedad cardiovascular y que fueran aplicables al proceso de enfermería. Resultados: se incluyeron 19 instrumentos multidimensionales. El Brief Frailty Index for Coronary Artery Disease se desarrolló para usarlo en el cuidado cardiovascular de las personas mayores. El Frailty Index for Adults y la Maastricht Frailty Screening Tool for Hospitalized Patients se elaboraron para ser usados en el Proceso de Enfermería. Conclusión: aunque sólo se elaboró un instrumento para adultos mayores con enfermedad cardiovascular y sólo dos son aplicables al proceso de enfermería, la mayoría de ellos tienen el potencial para ser adaptados y validados para ser usados en esa población en la evaluación de enfermería.

Prevalencia del síndrome metabólico y factores de riesgo cardiovascular asociados en una comunidad urbana de San Luis, Argentina / Prevalence of metabolic syndrome and associated cardiovascular risk factors in an urban community of San Luis, Argentina / Prevalência da síndrome metabólica e fatores de risco cardiovascular associados em uma comunidade urbana de San Luis, Argentina

Resumen El síndrome metabólico (SM) se asocia con alteraciones metabólicas e inflamatorias que imprimen un mayor riesgo de desarrollar diabetes y enfermedades cardiovasculares y tiene como base la resistencia insulínica. La alimentación, sedentarismo, educación y distribución del ingreso pueden influir en la aparición del SM. El objetivo del estudio fue conocer la prevalencia del SM y los factores de riesgo cardiovascular asociados en una población vulnerable, adulta y urbana, que acudió voluntariamente luego de una campaña de difusión, a un hospital de atención primaria en la ciudad de San Luis, Argentina. En 451 sujetos, 205 hombres y 246 mujeres (45,5±12,4 años) se analizaron datos personales, antropométricos y biomarcadores: colesterol total, colesterol HDL (c-HDL), colesterol LDL, triglicéridos, glucosa, insulina, proteína C reactiva ultrasensible (PCRus), apolipoproteínas A y B, ácido úrico e índices subrogados de insulina. El SM se estableció empleando la definición armonizada de SM (2009). El 80% de la población no completó la educación formal. Los hombres estaban desempleados o con trabajo informal (70%). El 51,4% de la población cumplía con el criterio de SM (50,0% mujeres y 53,1% hombres). Entre los componentes del SM, la tríada más frecuente en mujeres y hombres, fue: c-HDL disminuido, circunferencia de cintura elevada e hipertrigliceridemia. El SM aumentó con la edad en los hombres. Las mujeres con SM presentaron niveles altos de PCRus. El conocimiento de la prevalencia local, tanto de la obesidad como del SM, permite valorar la magnitud del problema en cada comunidad, establecer medidas de prevención, control y compararlo con otras realidades epidemiológicas.

Abstract Metabolic syndrome (MS) is associated with metabolic and inflammatory alterations that increase the risk of developing diabetes and cardiovascular diseases, based on insulin resistance. Diet, sedentary lifestyle, education and income distribution can influence the appearance of MS. The objective of the study was to know the prevalence of MS and associated cardiovascular risk factors in a vulnerable, adult and urban population, that voluntarily attends after diffusion campaign, to a primary care hospital in the city of San Luis, Argentina. In 451 subjects, 205 men and 246 women (45.5±12.4 years), personal, anthropometric and biomarker data were analysed: total cholesterol HDL cholesterol (HDL-c), LDL cholesterol, triglycerides, glucose, insulin, ultrasensitive C-reactive protein (usCRP), apolipoproteins A and B, uric acid and insulin surrogate indices. The MS was established using the harmonised definition of MS (2009). Eighty percent of the population did not complete formal education. Men were unemployed or in informal work (70%). A total of 51.4% of the population had the MS criteria (50.0% women and 53.1% men). Among the components of MS, the most frequent triad in women and men, were: decreased HDL-c, elevated waist circumference and hypertriglyceridemia. The prevalence of MS increased with age in men. Women with MS presented high levels of usCRP. Knowledge of the local prevalence of both obesity and MS would allow enable the assessment of the magnitude of the problem in each community, establish prevention and control measures, and compare it with other epidemiological realities.

Resumo A síndrome metabólica (SM) está associada a alterações metabólicas e inflamatórias que aumentam o risco de desenvolvimento de diabetes e doenças cardiovasculares, considerando a resistência à insulina. A alimentação, o sedentarismo, a escolaridade e a distribuição de renda podem influenciar o aparecimento da SM. O objetivo do estudo foi conhecer a prevalência da SM e os fatores de risco cardiovascular associados em uma população vulnerável, adulta e urbana, que compareceu voluntariamente a um hospital de atenção primária na cidade de San Luis, Argentina, após uma campanha de divulgação. Em 451 indivíduos, 205 homens e 246 mulheres (45,5±12,4 anos), foram analisados dados pessoais, antropométricos e de biomarcadores: colesterol total, colesterol HDL (c-HDL), colesterol LDL, triglicerídeos, glicose, insulina, proteína C reativa ultrassensível (PCRus), apolipoproteínas A e B, ácido úrico e índices substitutos de insulina. A SM foi estabelecida utilizando a definição harmonizada de SM (2009). Oitenta por cento da população não concluiu a educação formal. Os homens estavam desempregados ou em trabalho informal (70%). 51,4% da população atendia os critérios da SM (50,0% mulheres e 53,1% homens). Dentre os componentes da SM, a tríade mais frequente em mulheres e homens: c-HDL diminuído, circunferência abdominal elevada e hipertrigliceridemia. SM aumentou com a idade nos homens. Mulheres com SM apresentaram níveis elevados de PCRus. O conhecimento da prevalência local da obesidade quanto da SM permite avaliar a magnitude do problema em cada comunidade, estabelecer medidas de prevenção e controle e compará-lo com outras realidades epidemiológicas.

Hipertensión arterial nocturna: análisis según su gravedad / Nocturnal Hypertension: Analysis According to its Severity

RESUMEN Introducción: En el diagnóstico y seguimiento de la hipertensión arterial (HTA) la mayoría de las guías de práctica recomiendan el monitoreo ambulatorio de la presión arterial (MAPA). En este sentido, existe cada vez más evidencia que respalda la superioridad de la hipertensión arterial nocturna (HTAN) como predictor de eventos cardiovasculares. Se sabe poco sobre la relación con los eventos cardiovasculares según la gravedad de la HTAN. Además, no está claro a partir de qué valor de presión arterial nocturna comienza a aumentar el riesgo. Objetivos: Conocer si la presencia de HTAN y sus niveles de gravedad se asocian con resultados cardiovasculares adversos durante el seguimiento. Material y métodos: Estudio observacional. Realizamos un análisis de los datos obtenidos en un centro médico de alta complejidad de Buenos Aires, recopilados a partir de estudios de MAPA de 24 horas. Examinamos las características clínicas de los pacientes, los resultados de laboratorio, los estudios de imagen y sus resultados durante el período de seguimiento. Nuestro estudio incluyó personas de 18 años o más a las que se les había diagnosticado hipertensión. Definimos HTAN como aquellos casos con valores de presión arterial ≥ 120/70 mmHg durante el periodo nocturno. Resultados: Fueron incluidos 981 pacientes en el análisis final. De ellos, el 53 % eran hombres; la edad media era de 59,4 años. Presentaban HTAN 63,6 % (n=624). Clasificamos la HTAN en cuatro estratos de gravedad para comparar, según el valor de presión arterial sistólica nocturna: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg y 160-220 mmHg. Se registraron eventos adversos cardiovasculares mayores en 8 (2,2 %), 17 (4,1 %), 8 (5,6 %) y 7 (11,3 %) sujetos, respectivamente, y esta diferencia entre grupos fue estadísticamente significativa (p=0,007). El análisis multivariado de regresión de Cox demostró que la presencia de HTAN fue un predictor independiente de eventos cardiovasculares adversos (HR 3,60; IC 95% 1,12-11,5; p=0,033), incluso al considerar la presencia de hipertensión arterial diurna. Conclusión: En esta cohorte contemporánea, la HTAN y su gravedad se asociaron independientemente con la incidencia de eventos cardiovasculares adversos.

ABSTRACT Background: In the diagnosis and follow-up of arterial hypertension (HTN) most practice guidelines recommend ambulatory blood pressure monitoring (ABPM). In this regard, there is increasing evidence supporting the superiority of nocturnal hy pertension (NHTN) as a predictor of cardiovascular events. Little is known about the relationship with cardiovascular events according to the severity of NHTN. Furthermore, it is unclear from what nighttime pressure value the risk begins to increase. Objectives: The aim of this study was to determine whether the presence of NHTN and its severity levels are associated with adverse cardiovascular outcomes during follow-up. Methods: An observational study was performed analyzing data collected from 24-hour ABPM studies obtained in a high complexity medical center in Buenos Aires. We examined patients' clinical characteristics, laboratory findings, imaging studies and their results during the follow-up period. Our study included ≥18 year-old persons who had been diagnosed with hypertension. We defined NHTN as those cases with blood pressure values ≥120/70 mmHg during the nighttime period. Results: The final analysis included 981 patients. Among these, 53% were men, mean age was 59.4 years and NHTN was present in 63.6% of cases (n=624). Nocturnal HTN was classified into four severity strata for comparison, according to the nighttime systolic blood pressure value: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg and 160-220 mmHg. Major adverse cardiovascular events were recorded in 8 (2.2%), 17 (4.1 %), 8 (5.6%) and 7 (11.3%) subjects, respectively, and this differ ence between groups was statistically significant (p=0.007). Multivariate Cox regression analysis showed that the presence of NHTN was an independent predictor of adverse cardiovascular events (HR 3.60; 95% CI 1.12-11.5; p=0.033), even when considering the presence of daytime hypertension. Conclusion: In this contemporary cohort, NHTN and its severity were independently associated with the incidence of adverse cardiovascular events.

Mais Complicações em Mulheres após Revascularização do Miocárdio Mesmo com Tempos Cirúrgicos Reduzidos: Atenção por Equidade e Melhoria da Qualidade / More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

GASTRORETENTIVE EFFERVESCENT FLOATING TABLETS (GREFT) OF DRUGS ACTING ON CARDIOVASCULAR DISEASES

Incidences of Cardio Vascular Diseases (CVDs) are increasing in an alarming proportion in India. Conventional oral dosage forms cannot be retained in the stomach for long owing to gastric emptying. Moreover, drugs which are commonly employed in management of chronic CVDs either have reduced solubility at alkaline pH, undergo colonic degradation, exhibit site-specific absorption or varying bioavailability with combination therapy. Gastro-retentive drug delivery systems (GRDDS) are designed to overcome these challenges. Since 2006, Food and Drug Administration has approved only few GRDDS for treating CVDs. The aim of the present review is to summarize the outcomes of research carried on GRRDS with drugs for CVDs since last 15 y and comprehensive analysis of limitations of such studies due to which no product has been approved or commercialized in over last 18 y. Literature survey includes single unit, multi-particulate, monolayer and bilayer dosage forms with or without effervescence-inducing agents and made of natural and/or synthetic polymers like hydroxypropylmethyl cellulose, natural gums etc. Efforts have been made to compile in vitro buoyancy data such as floating lag time, total floating time, swelling index, release profile and release kinetics. Among various studies reported on monolayer and bilayer Gastro-Retentive Effervescent Floating Tablets, only 3 involved bioavailability studies in human volunteers. Toxicity studies in animals or stability studies are totally lacking. Observation with floating-type multi-particulate GRDDS is more disappointing. lack of safety, efficacy data, stability data, in vivo imaging studies and in vitro-in vivo correlation data might be actually responsible for lack of commercialization of any GRDDS for drugs acting on CVDs in 21st century.

Níveis séricos de magnésio, sua associação com diabetes mellitus tipo 2 e suas complicações/comorbidades com enfâse na doença cardiovascular / Serum magnesium levels and their association with type 2 diabetes mellitus and its complications/comorbidites, especially cardiovascular disease / Niveles séricos de magnesio y su asociación con diabetes mellitus tipo 2, sus complicaciones/comorbilidades con énfasis en la enfermedad cardiovascular

O diabetes mellitus tipo 2 (DM2) é uma doença que apresenta mecanismos fisiopatológicos multifatoriais e complexos, tendo como base a resistência insulínica (RI) e como consequências as doenças cardiovasculares (DCV). A hipomagnesemia tem sido implicada tanto na RI como em complicações micro e macrovasculares, incluindo-se as DCV que são consideradas a causa mais importante de morbimortalidade no DM2. Neste contexto, o presente estudo visa avaliar níveis séricos de magnésio (Mg) em pacientes diabéticos e sua possível associação com complicações crônicas e comorbidades, tendo como ênfase as doenças cardiovasculares; e identificar possível valor do nível sérico a ser considerado em nossa população a fim de rever sua verdadeira aplicabilidade clínica. Trata-se de estudo transversal, descritivo e analítico, envolvendo 99 pacientes com DM2 de ambos os sexos, atendidos em ambulatório público na cidade de Salvador (BA). Utilizou-se como instrumentos de pesquisa questionário de dados sociodemográficos e antropométricos; recordatório alimentar de 24 horas e análise bioquímica do magnésio sérico. Também foram registradas comorbidades e complicações crônicas dos pacientes, tais como hipertensão arterial, doença arterial coronariana, doença arterial obstrutiva periférica, arritmia cardíaca, acidente vascular cerebral, dislipidemia, neuropatia sensitiva periférica, retinopatia e nefropatia diabéticas. Os dados foram expressos por tabelas de forma descritiva e analítica. Os indivíduos foram divididos em dois grupos, magnésio baixo e normal/alto, e suas variáveis foram comparadas por meio de testes de hipóteses. Nossos achados evidenciaram nível sérico médio de magnésio de 1,97 mg% (IC 1,69 a 2,25 mg%) no total da amostra. Entre aqueles com magnésio baixo, níveis subclínicos estavam presentes em 29 sujeitos (29,3%), e níveis de hipomagnesemia em 34 indivíduos (34,3%). O nível médio do Mg no total da amostra diferiu significativamente (p<0,001) do valor normal ideal, mas não diferiu do considerado subclínico (p 0,311). No grupo com hipomagnesemia houve predomínio do sexo feminino e de pacientes com maior escolaridade. Glicemia de jejum foi mais elevada no grupo Mg baixo, e hemoglobina glicada no grupo Mg normal/alto, mas ambos sem diferença estatística. Níveis baixos de vitamina B12 foram encontrados em 12 pacientes (12,1%) e os níveis mais baixos de magnésio estavam presentes nos pacientes com deficiência de vitamina B12 (1,81±0,24 versus 2,01±0,29) com p=0,027. Antidiabéticos orais foram mais utilizados no grupo com Mg baixo. Não houve diferença entre magnésio sérico, ingestão calórica e magnésio e cálcio alimentares. Pacientes com DCV tiveram média de 2,01 mg% (IC 1,69-2,33 mg%) para o Mg. A doença cardiovascular esteve presente em 47,5% da amostra e pacientes com esta morbidade apresentaram 29,8% de prevalência de hipomagnesemia; infarto agudo do miocárdio (IAM) foi mais frequente no grupo com Mg normal/alto. Nossos dados apontam que hipomagnesemia em pacientes diabéticos deve ser considerada em níveis clínicos e subclínicos. Níveis baixos de Mg também estiveram associados à vitamina B12 baixa. Pacientes que apresentaram doenças cardiovasculares associadas também tiveram importante prevalência de hipomagnesemia incluindo níveis subclínicos, com exceção nos casos de IAM, em que níveis do magnésio sérico mantiveram-se no intervalo considerado normal ideal evidenciado por significativa diferença estatística (p<0,005).

Diabetes mellitus type 2 (DM2) is a multifactorial disease with complex physiopathological mechanisms, in which insulin resistance (IR) and its consequences, such as cardiovascular diseases (CVD), form its basis. Hypomagnesemia has been implicated in IR and micro and macrovascular complications, including CVD, which is considered the most important cause of morbidity and mortality in DM2. This study aims to evaluate serum magnesium (Mg) levels in diabetic patients and its possible association with chronic complications and comorbidities (especially cardiovascular diseases) and to find a possible serum level value to be considered in its population to review its true clinical applicability. This cross-sectional, descriptive, and analytical study involved 99 DM2 patients of all sexes who were served in a public outpatient clinic in Salvador-Ba. A sociodemographic and anthropometric data questionnaire, a 24-hour food recall, and serum magnesium analysis were used as research instruments. The comorbidities and chronic complications of patients, such as hypertension, coronary artery disease, peripheral arterial obstructive disease, cardiac arrhythmia, cerebrovascular accident, dyslipidemia, peripheral sensory neuropathy, diabetic retinopathy, and nephropathy, were also recorded. The data were expressed in descriptive and analytical tables. The individuals were divided into two groups, low and normal/high magnesium, and their variables were compared using hypothesis tests. Our findings showed an average serum magnesium level of 1.97 mg% (IC 1.69 to 2.25 mg%) in the whole sample. In those with low magnesium, subclinical levels occurred in 29 subjects (29.3%)and hypomagnesemia, in 34 individuals (34.3%). The median Mg level in the total sample significantly differed (p<0.001) from the ideal normal value, but failed to do in relation to the subclinical value (p=0.311). The hypomagnesemia group showed a predominance of women and patients with higher education. Fasting glucose was higher in the low Mg group and glycated hemoglobin in the normal/high Mg group, both without statistical differences. Low levels of vitamin B12 occurred in 12 patients (12.1%) and the lowest magnesium levels, in patients with vitamin B12 deficiency (1.81±0.24 versus 2.01±0.29) (p=0.027). Oral antidiabetics were more used in the group with low Mg. Serum magnesium, caloric intake, and dietetic magnesium and calcium showed no differences. Patients with CVD had an Mg average of 2.01 mg% (IC 1.69-2.33 mg%). Cardiovascular disease occurred in 47.5% of the sample. Patients with this morbidity had a 29.8% prevalence of hypomagnesemia. Moreover, myocardial infarction occurred more often in the normal/high Mg group. Data suggest that hypomagnesemia in diabetic patients should be considered at clinical and subclinical levels. Low Mg levels were also associated with low vitamin B12. Patients who showed cardiovascular diseases also had a high prevalence of hypomagnesemia, including subclinical levels, except in cases of myocardial infarction, in which serum magnesium levels remained within the normal ideal range, as evinced by its significant statistical difference (p<0.005).

La diabetes mellitus tipo 2 (DM2) es una enfermedad con mecanismos fisiopatológicos multifactoriales y complejos caracterizada por la resistencia a la insulina (RI) y sus consecuencias, como las enfermedades cardiovasculares (ECV). La hipomagnesemia está asociada con la RI y las complicaciones micro y macrovasculares, incluyendo las ECV, que se consideran la principal causa de morbimortalidad por la DM2. En este contexto, este estudio tiene como objetivo evaluar los niveles séricos de magnesio (Mg) en pacientes diabéticos y la posible asociación con complicaciones crónicas y comorbilidades, con énfasis en las enfermedades cardiovasculares; e identificar un posible valor de nivel sérico para considerar en esta población con el fin de revisar su verdadera aplicabilidad clínica. Se trata de un estudio transversal, descriptivo y analítico, en el cual participaron 99 pacientes con DM2 de ambos sexos, atendidos en un centro ambulatorio público en la ciudad de Salvador (Bahía, Brasil). Se utilizaron un cuestionario de datos sociodemográficos y antropométricos, un recordatorio alimentario de 24 horas y un análisis bioquímico del magnesio sérico. También se registraron las comorbilidades y complicaciones crónicas de los pacientes, como hipertensión arterial, enfermedad arterial coronaria, enfermedad arterial obstructiva periférica, arritmia cardíaca, accidente cerebrovascular, dislipidemia, neuropatía sensorial periférica, retinopatía y nefropatía diabética. Los datos se dispusieron en tablas para su análisis y descripción. Los individuos se separaron en dos grupos: bajo magnesio y normal/alto magnesio, y se compararon sus variables mediante pruebas de hipótesis. Los hallazgos evidenciaron un nivel sérico medio de magnesio de 1,97 mg% (IC 1,69 a 2,25 mg%) en el total de la muestra. Los bajos niveles subclínicos de magnesio estaban presentes en 29 sujetos (29,3%), y la hipomagnesemia en 34 individuos (34,3%). El nivel medio de Mg en el total de la muestra tuvo una diferencia significativa (p<0,001) del valor normal ideal, pero no difirió del valor subclínico (p=0,311). En el grupo con hipomagnesemia hubo predominio del sexo femenino y de pacientes con mayor nivel de estudios. La glucemia en ayunas fue más alta en el grupo de bajo Mg, y la hemoglobina glucosilada en el grupo de normal/alto Mg, pero en ninguno de los dos se encontró diferencia estadística. Los bajos niveles de vitamina B12 se encontraron en 12 pacientes (12,1%), y los niveles más bajos de magnesio estaban presentes en los pacientes con deficiencia de vitamina B12 (1,81±0,24 versus 2,01±0,29) con p=0,027. Los antidiabéticos orales se utilizaron más en el grupo con bajo Mg. No hubo diferencia entre el magnesio sérico, la ingesta calórica, el magnesio y el calcio en la dieta. Los pacientes con ECV tuvieron una media de 2,01 mg% (IC 1,69-2,33 mg%) para Mg. La enfermedad cardiovascular estuvo presente en el 47,5% de la muestra, y los pacientes con esta morbilidad tuvieron una prevalencia del 29,8% de hipomagnesemia; el infarto agudo de miocardio (IAM) fue más frecuente en el grupo con normal/alto Mg. Los resultados demuestran que la hipomagnesemia en los pacientes diabéticos debe considerarse en los niveles clínicos y subclínicos. Los bajos niveles de Mg también estuvieron asociados a bajos niveles de vitamina B12. Los pacientes que presentaron enfermedades cardiovasculares asociadas también tuvieron una alta prevalencia de hipomagnesemia, incluidos los niveles subclínicos, con excepción de los casos de IAM en los que los niveles séricos de magnesio se mantuvieron dentro del intervalo considerado normal ideal, evidenciado por una diferencia estadísticamente significativa (p<0,005).

A review on cardiovascular risk in rheumatoid arthritis

A systemic inflammatory disease known as rheumatoid arthritis (RA) is distinguished by excessive cardiovascular disease (CVD) morbidity and death. Traditional CV risk factors may partially contribute to CV disease in RA. Shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, changes in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction are some of the mechanisms that link RA and CVD. The detailed pathogenetic pathway by which this association between RA and CVD might be explained is still not entirely known. It is crucial for controlling cardiovascular risk in people with RA. Optimizing care of traditional risk factors in addition to those inherent to RA is necessary to lessen the burden caused by CVD. The potential effect of planned Cardiac risk management in these individuals is highlighted by findings for under diagnosis and inadequate treatment of conventional CVD risk factors in RA. Present cardiovascular standards suggest RA patients to be examined for and treated for CVD risk factors without appropriate treatment goals. Utilizing potent anti-rheumatic medications that can reduce disease activity and treating the conventional CV risk factors should both be part of the therapy of CV risk in RA. There is currently insufficient scientific data to develop therapy targets for RA-related CVD risk factors. Thus, more study is required on the traditional CVD risk factor screening and management in RA patients.

Combination therapy for hypertension management: insights from the Indian experts

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

Association of plasma fibrinogen level with the severity of obstructive sleep apnoea patients in a tertiary care hospital

Background: Obstructive sleep apnoea syndrome (OSAS) is a common sleep-related breathing disorder of multi-risk factorial pathogenesis and is characterized by recurrent, partial or complete upper airway obstruction resulting in intermittent hypoxia during sleep. It has been implicated in both cardiovascular and cerebrovascular diseases. Objective of the study was to determine the association of Plasma Fibrinogen levels with the severity of OSA patients in a tertiary care hospital. Methods: This cross-sectional observational study with group comparison was conducted among all the patients attending in the Department of Respiratory Medicine, BSMMU with suspicion of OSA within one year after the clearance of institutional review board (IRB) using STOP-BANG questionnaire and Epworth sleepiness scale (ESS) and confirmed by polysomnography. Plasma fibrinogen was measured in all OSA and non-OSA patients. Data were analyzed with the help of statistical package for the social sciences (SPSS) version 26. Results: Sociodemographic analysis found no significant differences in age, gender, area, occupation, or smoking between OSA and non-OSA groups (p>0.05). However, witnessed apnoea (p=0.002), breathlessness (p=0.005), higher ESS (p<0.001), and STOP-Bang scores (p<0.001) were associated with OSA. Plasma fibrinogen levels were significantly higher in OSA (319.2±63.7 mg/dl versus 242.5±20.33 mg/dl, p<0.001), positively correlating with AHI (r=+0.876, p=0.001). Positive correlations were also found between fibrinogen levels and daytime sleepiness (r= +0.393, p=0.002), waist circumference (r =+0.346, p=0.007), and BMI (r =+0.297, p=0.021) in OSA patients. Conclusions: In conclusion, this study establishes a notable connection between plasma fibrinogen levels and the severity of OSA. Elevated fibrinogen levels correlate with increased OSA severity, indicating a link between OSA, inflammation and coagulation.

Digital therapeutics for cardiovascular diseases in India- a low-middle income country’s perspective: a systematic review

Cardiovascular disease acts as a predominant cause for death in India. Digital technology has shown great potential in delivering cardiac rehabilitation remotely to patients with minimal cost implications. The main aim of this study was to analyze the comprehensiveness and effectiveness of digital cardiac rehabilitation intervention for cardiovascular patients on the Indian Cardiology Continuum. A comprehensive literature search was performed in Pubmed, Springer-link, Elsevier, Embase and Google Scholar. The selected tenure for this review was 10 years (16 January 2014 to 16 January 2024). Authors separately conducted the assessment of the selected studies by using the quality assessment of diagnostic accuracy studies. Microsoft excel 2020 was used for statistical analysis and graphical designs. A total of 3 articles were included in the review. The median sample size of the included studies is 153 (30-304), mean study timeline is 7.67 months (3-17), and median follow-up period is 6 months (3-12). Digital therapeutics showed significant reduction in Systolic Blood Pressure (34.67 mmHg) and Diastolic Blood Pressure (21.97 mmHg) in stage III hypertensive patients. Medication adherence of patients using digital therapeutics was 90%, while 10% patients remained non-adherent/dropped out of the trial. Digital therapeutics builds a lucrative bridge to help cardiovascular patients cross over into improved QoL, in place of traditional face-to-face CR regimes. Further research is required to improve comprehensiveness and clinical effectiveness of the digital cardiac rehab programs on a long-term basis in India.

Antiplatelet Therapy and Kidney Function in Non-Dialysis Chronic Kidney Disease: A Two-Centre Observational Study in Nigeria

Antiplatelet therapy used in preventing cardiovascular events in chronic kidney disease may be associated with higher risks of bleeding, low efficacy from fewer occlusive atherosclerotic disease), attenuation of the inflammatory process, and changes in the haemogram. We prospectively determined the kidney function, the haemogram, and the lipid profile of participants with and without antiplatelet therapy. The population with a mean age of 69.21 ± 11.73 years, had more women (65.88%), p=0.001. Participants' age was positively correlated with the CKD stage, p<0.001. Bleeding was more common with clopidogrel than aspirin and, less common with advancing CKD. Cardiovascular events were more common in CKD stage 5. The men had higher eGFR but lower platelet count and platelet neutrophil ratio (PNR) than the women, p=0.004, p<0.001, and p<0.001 respectively. The eGFR, bicarbonate, and HDL cholesterol were higher with versus without antiplatelets, p=0.04, p<0.001, and p=0.001 respectively. The platelet count and PNR were higher with antiplatelet therapy and with higher CKD stage, p<0.001 and p<0.001 and, p<0.001 and p<0.001 respectively. Higher platelet count (OR-0.410, 95% CI-0.02-1.04), lower uric acid levels (OR-0.550, 95% CI-0.271-0.948), higher HDL-C (OR-0.486, 95% CI-0.093-1.013), lower LDL-C (OR-0.572, 95% CI-0.082-1.002) and lower triglycerides (OR-1.274, 95% CI-0.755-1.493) were independently associated with antiplatelet therapy. The benefits of antiplatelet therapy in CKD are anchored on its anti-inflammatory, lipid-lowering, and kidney function-improving effects, these synergistically lead to lower cardiovascular events. The increased risk and consequences of bleeding, and reductions in leucocytes and erythrocytes population should be borne in mind to prevent heightening morbidity and mortality rates.

Pulse methylprednisolone therapy triggered sinus bradycardia in two children

Intravenous methylprednisolone is an important therapeutic modality in many conditions, owing to their anti-inflammatory and immune-modulating properties. Along with other side-effects of corticosteroids, cardiovascular side-effects are also seen in varying degree in children. Sinus bradycardia is reported uncommonly in children following high dose intravenous methylprednisolone. We report two paediatric cases without any underlying cardiac problems with asymptomatic bradycardia following high dose intravenous methylprednisolone. Heart rate reduction was seen from 30-40% compared to the baseline heart rate, which returned to its normal value after 24-36 hours of stoppage of the offending drug. A high index of suspicion along with strict cardiovascular monitoring is necessary in patients receiving high dose of methylprednisolone.

Padrão de Atividade Física "Guerreiros de Fim de Semana": Risco ou Benefício para a Saúde? / "Weekend Warriors" Physical Activity Pattern: Health Risk or Benefit?

A vida frenética, principalmente nos grandes centros urbanos, dificulta, para algumas pessoas, a realização de atividade física de forma regular (3-5 vezes por semana). Todavia, a possibilidade de realizar essas atividades em um ou dois dias da semana pode ser uma alternativa bastante interessante, uma vez que este padrão de atividade física tem sido associado a menor mortalidade por todas as causas, cardiovasculares e câncer. Nesta breve revisão narrativa, abordaremos os principais estudos científicos sobre os "Guerreiros de Fim de Semana" e sua relação com os benefícios e riscos à saúde. Certamente, a incorporação desse padrão de atividade física nas recomendações e orientações futuras promoverá melhora das condições de saúde e auxiliará o poder público a adequar as estratégias de combate ao sedentarismo.

Etiología y evolución de la anemia en pacientes sometidos a cirugía cardiovascular / Etiology and evolution of anemia in patients submitted to cardiovascular surgery

Resumen Objetivo: El objetivo del presente estudio es evaluar en nuestro medio la prevalencia de anemia en el preoperatorio de la cirugía cardiovascular, su incidencia postoperatoria y su evolución durante el primer mes. Métodos: Se realizó un estudio de cohorte prospectivo en el que se incluyeron todos los pacientes sometidos a cirugía cardiovascular central intervenidos durante el periodo del 01/09/2021 al 01/09/2022 en un hospital universitario. Se realizó seguimiento clínico y de laboratorio previo a la cirugía, al quinto y al día treinta del postoperatorio. Se comparó a los grupos con y sin anemia preoperatoria. Resultados: La prevalencia de anemia en el preoperatorio fue del 32.1%. La incidencia de anemia en el postoperatorio fue del 96% en el grupo de pacientes sin anemia previa. Al mes de la cirugía un 73 y un 90% de los pacientes, con y sin anemia preoperatoria respectivamente, persistían anémicos. Los pacientes con anemia preoperatoria tuvieron una menor recuperación de sus valores de hemoglobina al mes. Se observó una tendencia a mayor mortalidad y una mayor necesidad de derivación a centros de rehabilitación postegreso hospitalario en aquellos con anemia preoperatoria. Conclusiones: En este trabajo se evidenció una alta prevalencia e incidencia de anemia en el perioperatorio de las cirugías cardiovasculares. Así como su subtratamiento y elevada persistencia durante el mes posterior a la cirugía.

Abstract Objective: The aim of this study is to evaluate the prevalence of anemia in the preoperative period of cardiovascular surgery, its postoperative incidence and its evolution during the first month in our setting. Methods: A prospective cohort study was carried out in which all patients undergoing central cardiovascular surgery operated during the period 09/01/2021-09/01/2022 in a university hospital were included. Clinical and laboratory follow-up was carried out prior to surgery, on the fifth and on the 30th postoperative day. Groups with and without preoperative anemia were compared. Results: The prevalence of anemia in the preoperative period was 32.1%. The incidence of anemia in the postoperative period was 96% in the group of patients without previous anemia. One month after surgery, 73 and 90% of the patients, with and without preoperative anemia, respectively, remained anemic. Patients with preoperative anemia had less recovery of their hemoglobin values at one month. A trend towards higher mortality and a greater need for referral to post-hospital discharge rehabilitation centers was observed in those with preoperative anemia. Conclusions: In this work, a high prevalence and incidence of anemia in the perioperative period of cardiovascular surgeries was evidenced. As well as its subtreatment and high persistence during the month after surgery.

Apnea obstructiva del sueño en la práctica clínica cardiológica. Epidemiología, diagnóstico y tratamiento. Estudio observacional, retrospectivo y transversal / Obstructive sleep apnea in cardiology clinical practice. Epidemiology, diagnosis, and treatment. Observational, cross-sectional, and retrospective study

Resumen Objetivo: Determinar las características clínico-epidemiológicas, viabilidad diagnóstica de la poligrafía respiratoria domiciliaria y el tratamiento de pacientes con sospecha de apnea obstructiva del sueño (AOS) en riesgo cardiovascular. Métodos: Se realizó estudio observacional, transversal, descriptivo en pacientes atendidos en un servicio de consulta externa de cardiología con sospecha de AOS, de enero de 2015 a diciembre de 2019. La información se obtuvo de los expedientes médicos, se aplicó análisis estadístico descriptivo. Resultados: Se examinaron 138 expedientes, de las poligrafías respiratorias domiciliarias fueron descartadas solo el 8% por no cumplir con los estándares de calidad requeridos. Se demostró que el 89% padecían AOS, un 60% moderada a severa; predominó en hombres después de los 50 años. El principal ractores de riesgo cardiovascular fue hipertensión (89%). La cardiopatía más prevalente fue la hipertensiva (52%). Se optimizó tratamiento farmacológico cardiovascular en el 82% de los casos. Rehabilitación cardiaca en el 30%, ventilación mecánica no invasiva 41%, modalidad fija 33% y autoajustable 9%, todos con telemetría. Conclusiones: La prevalencia y severidad de la AOS es mayor en presencia de riesgo o enfermedad cardiovascular establecida. Ante la sospecha clínica es factible confirmar el diagnóstico con poligrafía respiratoria domiciliaria por el nivel de precisión y la menor infraestructura requerida. Es necesaria una mayor participación del cardiólogo en el diagnóstico y tratamiento de este trastorno por el riesgo significativo de enfermedad cardiovascular que representa.

Abstract Objective: To determine the clinical-epidemiological characteristics, diagnostic feasibility of home respiratory polygraphy and treatment of patients with suspected obstructive sleep apnea (OSA) at cardiovascular risk. Methods: An observational, cross-sectional, descriptive study was conducted in patients seen in a cardiology outpatient service with suspected OSA, from January 2015 to December 2019. The information was obtained from medical records, and a descriptive statistical analysis was applied to this information. Results: 138 files were reviewed; only 8% of the home respiratory polygraphs were discarded, because they did not meet the required quality standards. It was demonstrated that 89% suffered from OSA, 60% moderate to severe; in men after 50 years of age. The main cardiovascular risk factors was hypertension (89%). The most prevalent heart disease was hypertension (52%). Cardiovascular pharmacological treatment was improved in 82% of the cases. Cardiac rehabilitation in 30%, noninvasive mechanical ventilation 41%, fixed modality 33%, and self-adjustable 9%, all with telemetry. Conclusions: The prevalence and severity of OSA is higher in the presence of risk or established cardiovascular disease. In the presence of clinical suspicion, it is feasible to confirm the diagnosis with home respiratory poligrafy due to the level of precision and the lower infrastructure required. Greater involvement of the cardiologist in the diagnosis and treatment of this disorder is necessary due to the significant risk of cardiovascular disease it represents.