Método indirecto para la verificación del intervalo de referencia del perfil lipídico / Indirect method for the verification of the lipid profile reference range

Introducción: La dislipidemia es uno de los problemas más frecuentes en los niños y adolescentes y su estudio es importante debido a su fuerte correlación con la enfermedad cardiovascular aterosclerótica en adultos. Muchos países desarrollaron valores de referencia nacionales investigando los lípidos séricos utilizando datos basados en la población nacional propia. Nuestro objetivo fue verificar el intervalo de referencia del perfil lipídico calculando las curvas de percentiles a través del método indirecto en nuestra población pediátrica. Materiales y métodos: Se analizaron los resultados de nuestra base de datos utilizando el método indirecto. Luego de aplicar filtros y criterios de exclusión se calcularon los percentiles 25, 50, 75, 95 y 99 para colesterol total (CT), colesterol HDL (C-HDL), colesterol no HDL (C-no-HDL), triglicéridos (TG) y colesterol LDL (C-LDL) y para el C-HDL además se calculó el percentil 10. El valor de referencia para el cambio (RCV) se utilizó para determinar si existía diferencia clínicamente significativa entre los valores de percentiles obtenidos y los utilizados en el consenso de la SAP. Resultados: No se evidenció diferencia clínicamente significativa contra los valores propuesto por la SAP, excepto para los TG para las edades 1,5,7 años en el percentil 95 y para la edad de 8 años en el percentil 75 y 95; para el C-HDL en el percentil 10 para las edades 1,16 y 17 años. Discusión: Se obtuvieron los percentiles de los lípidos y se compararon con los valores de referencia utilizados por el consenso en el que están basados las guías (AU)

Introduction: Dyslipidemia is one of the most common problems in children and adolescents and its study is important because of its strong correlation with atherosclerotic cardiovascular disease in adulthood. Many countries have developed national reference values investigating serum lipids using data based on their own national population. Our aim was to verify the lipid profile reference range by calculating percentile curves through the indirect method in our pediatric population. Materials and methods: The results of our database were analyzed using the indirect method. After applying filters and exclusion criteria, the 25th, 50th, 75th, 95th, and 99th percentiles were calculated for total cholesterol (TC), HDL cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), triglycerides (TG), and LDL cholesterol (LDL-C); for HDL-C, the 10th percentile was also calculated. The reference change values (RCV) were used to determine whether there was a clinically significant difference between the percentile values obtained and those used in the consensus of the Argentine Association of Pediatrics (SAP). Results: There was no clinically significant difference with the values proposed by the SAP, except for TG for ages 1, 5, and 7 years at the 95th percentile and for age 8 years at the 75th and 95th percentile; and for HDL-C at the 10th percentile for ages 1, 16, and 17 years. Discussion: Lipid percentiles were obtained and compared with the reference values used by the consensus on which the guidelines are based (AU)

Early Use of Handgrip Exercise Associated with Dobutamine Stress Echocardiography in Women

Abstract Background Coronary artery disease (CAD) is an important cause of morbidity and mortality in women and requires early diagnosis for defining the appropriate treatment. Objective To identify the positive predictive value (PPV) and safety of the early use of handgrip exercise in pharmacological stress echocardiography using dobutamine (early-ECHO) in women. Methods Positive ischemic early-ECHO records from 111 women were evaluated from January 2012 to March 2018. Subsequently, the hospital medical records were verified to locate patients who underwent conventional coronary angiography (CCA), and we analyzed the medical conduct adopted for these patients. Statistical analyses were performed using SPSS employing one-way analysis of variance (ANOVA), Fisher's exact test, or Pearson's chi-square test. The level of statistical significance was set at p < 0.05 for all analyses. Results Four patients (4.4%) presented serious complications during the examination. Out of 90 patients who underwent CCA, 71 (78.9%) had CAD. Among these 71 patients, 58 (81.7%) had severe lesions and 13 (18.3%) presented moderate CAD. Moreover, CCA did not demonstrate relevant coronary lesions in 19 of the 90 patients (21.1%). Among patients with severe CAD, 16 (27.6%) underwent myocardial revascularization surgery; 34 (58.6%) underwent percutaneous coronary angioplasty; and 08 (13.7%) had their clinical treatments intensified. The PPV for early-ECHO was 78.9%. Conclusions Early-ECHO showed a high PPV for diagnosing myocardial ischemia in women. It presented a low complication rate and provided rapid disease identification, allowing the early treatment of injuries and potentially preventing CAD complications.

Correlação entre atividade física e variáveis de pacientes com infarto agudo do miocárdio / Correlation between physical activity and clinical variables in patients with acute myocardial infarction

Fundamentos: A atividade física reduz o risco de doença coronariana, uma das principais causas de morte no mundo. Objetivos: Este estudo pretende correlacionar as atividades físicas com variáveis clínicas de pacientes internados em hospitais públicos de Santa Catarina após o primeiro infarto agudo do miocárdio. Métodos: Os pacientes selecionados foram submetidos a questionário que engloba diferentes variáveis clínicas. A atividade física foi mensurada através do Escore de Baecke. Os dados obtidos foram tabulados e analisados através do software SPSS 13.0 for Windows. A avaliação da normalidade foi realizada pelo teste de Kolmogorov-Smirnov. A correlação entre duas variáveis quantitativas foi avaliada pela Correlação de Pearson. Foram considerados significativos valores de p < 0,05. Resultados: O estudo evidenciou uma correlação positiva fraca entre o escore de Baecke e anos de escolaridade com r = 0,361 (p = 0,001). Houve uma correlação negativa fraca entre o escore de Baecke e o escore de depressão PHQ9 com r = -0,252 (p = 0,009). O estudo também apresentou correlação negativa fraca entre o escore de depressão PHQ9 e o Mini Mental com r = -0,258 (p = 0,007), assim como uma correlação negativa fraca entre o PHQ9 e os anos de escolaridade com r = -0,199 (p = 0,039). Conclusões: Existe uma correlação positiva entre atividade física e anos de escolaridade em pacientes internados com o primeiro infarto agudo do miocárdio. Há também uma correlação negativa entre atividade física e depressão nesses pacientes, assim como uma correlação negativa entre depressão e o Mini-Mental, e depressão e anos de escolaridade

Background: Physical activity reduces the risk of coronary heart disease, one of the leading causes of death in the world. Objectives: This study intends to correlate physical activity and clinical variables of the patients hospitalized in public hospitals of Santa Catarina after the first acute myocardial infarction. Methods: The selected patients answered a questionnaire on different clinical variables. Physical activity was measured using the Baecke's questionnaire. Data were tabulated and analyzed using the SPSS 13.0 for Windows software. Normality was assessed using the Kolmogorov­Smirnov test. Correlations between two quantitative variables were evaluated by Pearson's correlation. Values of p < 0.05 were considered statistically significant. Results: The study showed a weak positive correlation between the Baecke score and years of schooling (r = 0.361; p = 0.001). There was a weak negative correlation between the Baecke score and the PHQ9 depression score (r = ­0.252; p = 0.009). The study also showed a weak negative correlation between the PHQ9 depression score and the Mini Mental score (r = ­0.258; p = 0.007), as well as a weak negative correlation between PHQ9 and schooling years with (r = ­0.199, p = 0.039). Conclusions: There is a positive correlation between physical activity and years of schooling in hospitalized patients with first acute myocardial infarction. Negative correlations were found between physical activity and depression, between depression and the Mini­Mental State Examination, and between depression and years of schooling in these patients

Attenuation of atherogenic apo B-48-dependent hyperlipidemia and high density lipoprotein remodeling induced by vitamin C and E combination and their beneficial effect on lethal ischemic heart disease in mice

BACKGROUND AND AIMS: Atherosclerotic cardiovascular disease is highly prevalent and its underlying pathogenesis involves dyslipidemia including pro-atherogenic high density lipoprotein (HDL) remodeling. Vitamins C and E have been proposed as atheroprotective agents for cardiovascular disease management. However, their effects and benefits on high density lipoprotein function and remodeling are unknown. In this study, we evaluated the role of vitamin C and E on non HDL lipoproteins as well as HDL function and remodeling, along with their effects on inflammation/ oxidation biomarkers and atherosclerosis in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. METHODS AND RESULTS: Mice were pre-treated for 5 weeks before and during atherogenic diet feeding with vitamin C and E added to water and diet, respectively. Compared to a control group, combined vitamin C and E administration reduced serum total cholesterol and triglyceride levels by decreasing apo B-48-containing lipoproteins, remodeled HDL particles by reducing phospholipid as well as increasing PON1 and apo D content, and diminished PLTP activity and levels. Vitamin supplementation improved HDL antioxidant function and lowered serum TNF-α levels. Vitamin C and E combination attenuated atherogenesis and increased lifespan in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. CONCLUSIONS: Vitamin C and E administration showed significant lipid metabolism regulating effects, including HDL remodeling and decreased levels of apoB-containing lipoproteins, in mice. In addition, this vitamin supplementation generated a cardioprotective effect in a murine model of severe and lethal atherosclerotic ischemic heart disease.

Red wine consumption, coronary calcification, and long-term clinical evolution

Coronary artery calcification (CAC) is associated with atherosclerotic complications. However, elevated CAC may not always imply a worse prognosis. Herein, we report the clinical evolution of long-term red wine (RW) drinkers in relation to CAC. We followed 200 healthy male habitual RW drinkers and compared them to 154 abstainers for a period of 5.5 years. The initial evaluation included coronary computed tomography angiography (CTA), clinical, demographics, and laboratory data. CAC was quantified by the Agatston score. The follow-up process was conducted by telephone calls and/or hospital record review. The composite end-point of total death, acute myocardial infarction (AMI), or coronary revascularization (or major adverse cardiac event - MACE) was assessed. The RW drinkers ingested 28.9±15 g of alcohol/day for 23.4±12.3 years. They had higher high-density lipoprotein and low-density lipoprotein, but lower C-reactive protein than abstainers. Age, total cholesterol, triglycerides, glucose, and liver enzymes were similar. History of diabetes was lower among drinkers, but other risk factors were similar. However, drinkers had higher CAC than abstainers; the mean value was 131.5±362 in drinkers vs 40.5±320 in abstainers (P<0.001). The median and interquartile range were 15 (0.0-131.5) in RW drinkers and 1 (0.0-40.5) in abstainers (P=0.003). During the follow-up, MACE was significantly lower in drinkers than in abstainers, despite their higher CAC. The difference was driven mainly by AMI (0 vs 6; P<0.03). Greater CAC values in this setting did not predict worse prognosis. A possible underlying mechanism is lesion calcification, which leads to plaque stabilization and less clinical events.

Impact of Diltiazem Alone versus Diltiazem with Nitrate on Five-Year Clinical Outcomes in Patients with Significant Coronary Artery Spasm

PURPOSE: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. MATERIALS AND METHODS: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. RESULTS: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. CONCLUSION: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab / Redução da Progressão da Doença Vascular do Enxerto Cardíaco com o Uso Rotineiro da Terapia de Indução com Basiliximab

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

ResumoFundamento:A doença vascular do enxerto (DVE) constitui uma grande limitação de sobrevida a longo prazo de pacientes submetidos a transplante cardíaco (TxC). Alguns imunossupressores diminuem o aparecimento da DVE.Objetivos:O principal objetivo foi avaliar, através de ultrassonografia intracoronária (USIC), a variação do crescimento volumétrico da camada íntima e comparar, após um ano, o grupo que recebeu basiliximab com um grupo de controle.Métodos:Treze pacientes de um único centro foram analisados retrospectivamente de 2007 a 2009. As análises foram feitas através de USIC, medindo-se o volume de um segmento coronariano nos primeiros 30 dias e um ano após o TxC. A vasculopatia foi caracterizada pelo volume da camada íntima do vaso.Resultados:O estudo incluiu 13 pacientes (7 no grupo com o basiliximab e 6 no grupo de controle). A análise por USIC revelou que o grupo de controle apresentou maior crescimento volumétrico do vaso (131,32 a 127,77 mm3 x 120 a 185,43 mm3 p = 0,051). O crescimento da camada íntima (CCI) também foi maior no grupo de controle [Basiliximab: 20,23 a 26,69 mm3 (∆ 33%); Controle: 27,30 a 49,15 mm3(∆ 80% p = 0,015)]. De acordo com a regressão univariada, o volume da placa aterosclerótica prévia do doador não teve relação com o crescimento da íntima (r = 0,15, p = 0,96), enquanto que o remodelamento positivo do vaso foi diretamente proporcional ao crescimento da íntima (r = 0,85, p < 0,001).Conclusão:A terapia de indução de rotina com basiliximab está associada à redução do crescimento da camada íntima do vaso no primeiro ano após o transplante cardíaco.

Does Dual Antiplatelet Therapy Increase the Risk of Peptic Ulcer Disease? / 대한소화기학회지

No abstract available.

Clinical Impact of Dual Antiplatelet Therapy on Peptic Ulcer Disease / 대한소화기학회지

BACKGROUND/AIMS: Increased incidence of coronary artery disease has led to the increased use of dual antiplatelet therapy composed of aspirin and clopidogrel. We investigated the incidence of gastrointestinal complications in patients who received single or dual antiplatelet therapy and analyzed their clinical characteristics in order to predict the prognostic factors. METHODS: Between January 2009 and December 2011, we retrospectively reviewed the medical records of patients who underwent coronary angiography at Chung-Ang University Hospital (Seoul, Korea). One hundred and ninety-four patients were classified into two groups: aspirin alone group and dual antiplatelet group. Clinical characteristics, past medical history, and presence of peptic ulcer were analyzed. RESULTS: During the follow-up period, 11 patients had duodenal ulcer; the event rate was 2.02% in the aspirin alone group and 9.47% in the dual antiplatelet group (hazard ratio [HR] 5.24, 95% CI 1.03-26.55, p<0.05). There was no significant difference in the rate of significant upper gastrointestinal bleeding: 0% vs. 4.2% (p=0.78). In patients who received proton pump inhibitor (PPI), 24 patients had gastric ulcer; the event rate was significantly different between the two groups: 4.87% vs. 22.98% (HR 3.40, 95% CI 1.02-11.27, p<0.05). CONCLUSIONS: Dual antiplatelet groups had a higher incidence of duodenal ulcers without significant bleeding compared with the aspirin alone group. In patients who received PPI, the dual antiplatelet therapy group had a higher incidence of gastric ulcers without significant bleeding compared with the aspirin alone group. Therefore, physicians must pay attention to high risk groups who receive dual antiplatelet therapy and aggressive diagnostic endoscopy should also be considered.

Prevenção cardiovascular - infância e adolescência / Cardiovascular prevention - childhood and adolescence

A doença aterosclerótica coronariana (DAC) constitui um importante problema de saúde pública, fortemente relacionada à presença de determinadas condições, os fatores de risco (FR) cardiovasculares modificáveis, além do fator hereditário decorrente de familiares de primeiro grau. São propostas ações preventivas para FR e doenças cardiovasculares, em idades cada vez mais jovens. Os efeitos de múltiplos FR para DAC são encontrados já na faixa etária pediátrica. Medidas de prevenção e intervenção precoces relacionadas aos FR modificáveis: 1 - evitar iniciação do tabagismo, 2 - controle de peso; 3 - incentivo à prática de atividades físicas; 4 - dieta saudável e balanceada retardariam o desenvolvimento da DAC. O exercício físico é importante ferramenta na prevenção das DCV já na infância e adolescência. Abordaremos o impacto da prática regular de atividade física e esportiva na hipertensão arterial, dislipidemia, obesidade e no sedentarismo. Crianças e adolescentes devem ser encorajados a participar desde cedo e diariamente de atividades físicas variadas, adequadas ao seu desenvolvimento e que sejam divertidas e seguras. Devem se lúdicas, ou organizadas, no contexto da família, escola e comunidade, 1 - Os padrões de atividade física estabelecidos na infância persistem na vida adulta. 2 - Atividades físicas aeróbicas regulares de moderada/alta intensidade, estão associadas à redução de pressão arterial, gordura corporal melhora do perfil lipídico/metabólico. 3 - Existe limitada, mais forte e consistente evidência, de que diferentes modalidades de intervenção, associadas à prática de atividades físicas, melhoram alterações subclínicas da doença aterosclerótica em crianças e adolescentes. 4 - Limitar o tempo gasto em TV e jogos eletrônicos a, no máximo duas horas por dia.

Atherosclerotic coronary artery disease (CAD) is a major public health problem strongly related to the presence of certain conditions, the modifiable cardiovascular risk factors (RF), besides the hereditary fator due to first degree relatives. Preventive actions are proposed for RF and cardiovascular disease in increasingly younger ages. The effects of multiple risk factors for CAD are already found in the pediatric age group. Prevention and early intervention related to modifiable RF are the following; 1 - preventing smoking initiation; 2 - weight control; 3 - encouraging physical activity; 4 - A healthy balanced diet. These would probably retard the development of CAD. Physical exercise is na importante tool in the prevention of CVD in childhood and adolescence. The impact of the regular practice of physical activity and sports on hypertension, dyslipidemia, obesity and sedentary life style will be discussed here. Chiçdren and adolescentes should be encouraged to participate varied and daily physical activities, appropriate to their development and that are fun and safe. These activities should be playful and organized n the contexto of Family, school and community. 1 - The physical activity patterns in childhood presist into adulthood; 2 - Regular aerobic physical activities of moderate or high intensity are associted with reduced blood pressure, body fat, improved lipid - metabolic profile, 3 - There is limited but strong and consistente evidence that diferente forms of intervention associated with physical activity improves subclinical alterations of the atherosclerotic disease in children and adolescentes. 4 - Time spent watching TV and play vídeo games should be limited to no more than two hours per day.

Crenças e comportamentos de pessoas com doença arterial coronária / Beliefs and behavior patterns of individuals with coronary artery disease

O estudo descreveu crenças e comportamentos sobre causas e medidas de controle da doença arterial coronária (DAC). Cem adultos foram entrevistados em ambulatório público, em Salvador (BA). Os resultados foram analisados em percentuais, médias e por técnica de análise de dados qualitativos. Predominaram homens, idade < 60 anos, cor negra, baixas escolaridade e renda, casados e sem ocupação. A média de crenças para a causa da DAC foi de 1,53 por participante incluindo fatores comportamentais, biológicos, relacionais e religiosos e representaram sobretudo acúmulo de excessos quanto às tensões cotidianas e alimentação. A maioria dos participantes não considerou a enfermidade de caráter crônico acreditando que o tratamento não duraria a vida toda e na cura da doença. A média de crenças para medidas de controle foi de 1,45 prevalecendo seguimento do regime alimentar e uso das medicações. Predominou sedentarismo, redução do tabagismo e consumo de bebida alcoólica, preparo de alimentos com menos sal e gordura saturada, maior consumo de carnes brancas, alimentos cozidos e industrializados. Apenas 66% cumpriam a receita médica. O entendimento insatisfatório sobre causas e medidas de controle da DAC torna essencial a implementação de cuidados contemplando as distintas condições de vida e saúde e projetos para o cuidar de si.

The study described beliefs and behavior patterns related to causes and control measures of coronary artery disease (CAD). A hundred adults in an outpatient clinic in Salvador in the state of Bahia were interviewed. The results were analyzed via the qualitative analysis technique. It predominantly involved married and unemployed black men, aged <60 years, with low schooling and income. The average beliefs on the cause of CAD was 1.53 per participant and blamed behavioral, biological, relational and religious factors, and represented excesses related to day-to-day tensions and eating habits. Most of the participants did not consider the disease to be chronic and believed that treatment would be temporary and they would be cured. The average beliefs for control measures were of 1.45, with dietary measures and medication. A sedentary lifestyle was the norm and reducing smoking and alcohol, using less salt and saturated fat in the preparation of meals, consuming white meat, cooked and industrialized food was seen as the answer. Only 66% complied with medical prescriptions. Lack of understanding of the causes and control measures of CAD makes the implementation of medical care, better living and health conditions and self-care essential.

Improving cardiovascular prevention through patient awareness / Melhora da prevenção cardiovascular pelo conhecimento do paciente

OBJECTIVE: Patients with peripheral artery disease (PAD) or coronary artery disease (CAD) must have their risk factors rigorously controlled, but there is a gap between practice and ideal. This study aimed to demonstrate how cardiovascular prevention is performed for these patients in a Brazilian university hospital, and to identify predictors of good practice. METHODS: 192 patients with CAD or PAD were included in this transversal study. Six prevention goals were analyzed: 1) systolic blood pressure < 140 mmHg; 2) diastolic blood pressure < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL for men/ > 50 mg/dL for women; 5) not smoking; 6) regular practice of aerobic exercise. RESULTS: The mean age of the patients was 65.7 years, and 60% were men. The percentage of patients that achieved goals 1 to 6 was 57.3%, 67.2%, 40.1%, 27.6%, 88.5%, and 25%, respectively. The average number of goals achieved by patients was 3.06 ± 1.31. When asked about the reason for being treated, 182(94.8%) patients claimed to know about their disease, but when the diagnosis reported by the patients with the physician's diagnosis were compared, it was discordant in 12% of cases. The average number of goals achieved by patients was 2.67 and 3.46 for the PAD and the CAD group, respectively. The independent predictors of a higher number of goals/patient were: male gender (p = 0.011), hospitalization (p < 0.0001), CAD diagnosis (p = 0.011), knowing the reason for treatment (p = 0.028), and receiving prescription of β -blocker (p = 0.011). CONCLUSION: Even in an university hospital, prevention is far from ideal. Efforts to increase patients' awareness should be stimulated, and can possibly improve the effectiveness of preventive measures.

OBJETIVO: Pacientes com doença arterial periférica (DAP) ou doença arterial coronariana (DAC) necessitam de um controle rigoroso dos seus fatores de risco, mas essa prática ainda está muito aquém da ideal. O objetivo deste estudo foi verificar como é feita a prevenção cardiovascular nesses pacientes em um hospital universitário no Brasil e identificar os preditores de melhor prevenção secundária. MÉTODOS: Trata-se de estudo transversal, com 192 pacientes portadores de DAC ou DAP. Foram analisadas seis metas a serem atingidas: 1) pressão arterial sistólica < 140 mmHg; 2) pressão arterial diastólica < 90 mmHg; 3) LDL < 100 mg/dL; 4) HDL > 40 mg/dL para homens/> 50 mg/dL para mulheres; 5) não fumar; 6) prática de exercício físico aeróbico regular. RESULTADOS: A idade média dos pacientes é 65,7 anos e 60% são do sexo masculino. A porcentagem dos pacientes que atingiram de 1 a 6 metas foi 57,3%; 67,2%; 40,1%; 27,6%; 88,5% e 25%, respectivamente. O número médio de metas atingidas por paciente foi 2,67 e 3,46 para os pacientes com DAP e DAC, respectivamente. Os preditores independentes de maior número de metas/paciente foram: sexo masculino (p = 0,011), estar internado (p < 0,001), diagnóstico de DAC (p = 0,011), saber o motivo do tratamento (p = 0,028) e receber prescrição de β-bloqueador (p = 0,011). CONCLUSÃO: Mesmo em um hospital universitário, a prevenção encontra-se longe da ideal. Esforços para aumentar a conscientização do paciente devem ser estimulados e podem possivelmente melhorar a efetividade das medidas preventivas.

Levels of apolipoproteins as risk factors for coronary artery disease / Níveis de apolipoproteínas como fatores de risco para doença arterial coronariana

INTRODUCTION: The Saudi population is renowned for their unhealthy diet and physical inactivity. OBJECTIVE:To investigate apolipoproteins B (apo B), A-I (apo A-I) and B/A-I as risk factors that might be associated with increased incidence of the coronary artery disease. METHODS: Two hundred and twenty subjects suspected of having the coronary artery disease underwent coronary angiography and blood draw following a 12-hour fast. Apolipoproteins B and A-I were both measured by turbidimetric methods. RESULTS: One hundred and forty subjects were positive and 80 subjects were negative for the coronary artery disease. Both apolipoproteins were found to be statistically significant as risk factors for the coronary artery disease: apolipoprotein B (105.33±29.22 versus 94.56±24.35 mg/dL, p<0.003), apolipoprotein A-I (123.98±25.6 versus 133.5±24.1 mg/dL, p<0.004) and apolipoproteins B/A-I (0.88±0.28 versus 0.72±0.2, p<0.0001). CONCLUSIONS:Measurements of apolipoproteins B, A-I and calculation of apolipoproteins B/A-I ratio either instead of or in addition to the customary measurements of lipoprotein cholesterol may significantly add to predicting and assessing the coronary risk factors in the Saudi population.

INTRODUÇÃO: A população da Arábia Saudita é conhecida por sua dieta não-saudável e inatividade física. OBJETIVO: Investigar as apolipoproteínas B (apo B), AI (apo AI) e B/AI como fatores de risco que podem estar associados ao aumento da incidência da doença arterial coronariana. MÉTODOS: Duzentos e vinte pacientes com suspeita de doença art RESULTADOS: Cenerial coronariana foram submetidos à angiografia coronária e extração de sangue após jejum de 12 horas. As apolipoproteínas B e AI foram medidas por métodos turbidímetros.to e quarenta pacientes foram positivos e 80 foram negativos para a doença arterial coronariana. Ambas apolipoproteínas foram estatisticamente significativas como fatores de risco para doença arterial coronariana: apolipoproteínas B (105,33±29,22 versus 94,56±24,35 mg/dL, p<0,003), AI (123,98±25,6 versus 133,5±24,1, p<0,004) e B/A-I (0,88±0,28 versus 0,72±0,2, p<0,0001). CONCLUSÕES: As medidas das apolipoproteínas B, AI e o cálculo da relação B/AI tanto por ou em adição às medidas habituais de colesterol das lipoproteínas podem aumentar significativamente a previsão e avaliação dos fatores de risco coronariano na população saudita.

Drugs and lifestyle for the treatment and prevention of coronary artery disease: comparative analysis of the scientific basis

In this article, we compare two strategies for atherosclerosis treatment: drugs and healthy lifestyle. Statins are the principal drugs used for the treatment of atherosclerosis. Several secondary prevention studies have demonstrated that statins can significantly reduce cardiovascular events including coronary death, the need for surgical revascularization, stroke, total mortality, as well as fatal and non-fatal myocardial infarction. These results were observed in both men and women, the elderly, smokers and non-smokers, diabetics and hypertensives. Primary prevention studies yielded similar results, although total mortality was not affected. Statins also induce atheroma regression and do not cause cancer. However, many unresolved issues remain, such as partial risk reduction, costs, several potential side effects, and long-term use by young patients. Statins act mainly as lipid-lowering drugs but pleiotropic actions are also present. Healthy lifestyle, on the other hand, is effective and inexpensive and has no harmful effects. Five items are associated with lower cardiac risk: non-smoking, BMI ≤25, regular exercise (30 min/day), healthy diet (fruits, vegetables, low-saturated fat, and 5-30 g alcohol/day). Nevertheless, there are difficulties in implementing these measures both at the individual and population levels. Changes in behavior require multidisciplinary care, including medical, nutritional, and psychological counseling. Participation of the entire society is required for such implementation, i.e., universities, schools, media, government, and medical societies. Although these efforts represent a major challenge, such a task must be faced in order to halt the atherosclerosis epidemic that threatens the world.

Absence of arteriosclerosis in intramyocardial coronary arteries: a mystery to be solved? / Ausência de arteriosclerose na porção intramiocárdica das artérias coronárias: um mistério a ser resolvido?

Several studies show that portions of intramyocardial coronary arteries are spared of arteriosclerosis, involving morphological, embryological, biochemical and pathophysiological aspects. Endothelial function is significantly affected in the segment of transition, as estimated by the vasoactive response to Ach. These findings suggest that myocardial bridge can provide protection against arteriosclerosis by counteracting the negative effects of endothelial dysfunction. The intramyocardial portion's protection phenomenon deserves further scientific research on all research fronts. Improved morphological, biomechanical and especially physiological and embryological knowledge may be the key to a future window of opportunity for chronic arterial disease therapy and prevention. In addition, this review discusses possible therapeutic approaches for symptomatic coronary ischemia caused by myocardial bridges.

Diversos estudos demonstram que as porções intramiocárdicas das artérias coronárias são poupadas da arteriosclerose, envolvendo aspectos morfológicos, embriológicos, biomecânicos e aspectos fisiopatológicos. A função endotelial é significativamente afetada no segmento de transição, tal como estimado pela resposta vasoativa para acetilcolina (Ach). Esses achados sugerem que ponte miocárdica pode fornecer proteção contra a arteriosclerose, por contrariar os efeitos negativos da disfunção endotelial. O fenômeno dessa proteção da porção intramiocárdica merece maior investigação científica em todas as frentes de pesquisa. Maiores conhecimentos sobre os aspectos morfológicos, biomecânicos e, principalmente, fisiológicos e embriológicos podem ser a chave para uma futura janela de oportunidades de terapia e prevenção da doença arterial crônica. Nessa revisão, discutem-se, também, possíveis abordagens terapêuticas para fenômenos coronarianos isquêmicos causados por pontes miocárdicas.