Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate?

Abstract Background: ST-segment elevation acute myocardial infarction (STEMI) is a pathological process that involves cardiac muscle tissue death. Intravenous thrombolysis with fibrinolytics or primary percutaneous coronary intervention (PCI), an invasive technique, can be performed for tissue revascularization. PCI has been preferred as compared to non-invasive methods, although few studies have described its use in Brazil. Objectives: The aim of the present study was to analyze data on the use of primary PCI and investigate the relevance of hospitalizations for the treatment of STEMI in the country. Methods: A descriptive, cross-sectional analysis of data from the Brazilian Unified Health system (SUS) Department of Informatics (DATASUS) from 2010 to 2019 was conducted. Results: Hospitalizations for STEMI represented 0.6% of all hospital admissions in Brazil in the analyzed period, 0.9% of hospital costs, and 2.1% of deaths. The number of hospitalizations due to STEMI was 659,811, and 82,793 for PCIs. Length of hospital stay was 36.0% shorter and mortality rate was 53.3% lower in PCI. The mean cost of PCI was 3.5-fold higher than for treatment of STEMI. Conclusions: Data on hospitalizations for STEMI treatment in Brazil revealed high hospitalization and mortality rates, elevated costs, and long hospital stay. Although primary PCI is a more expensive and less used technique than other methods, it can reduce the length of hospital stay and mortality in the treatment of STEMI.

Variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST / Electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction

Introducción: La frecuencia de infarto agudo de miocardio sin elevación del segmento ST se está incrementando y, con ella, los resultados adversos en pacientes con enfermedad coronaria isquémica aguda. Objetivo: Identificar las variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST. Método: Se realizó un estudio transversal, de tipo correlacional, con 68 pacientes con infarto agudo de miocardio sin elevación del segmento ST atendidos en el Hospital Arnaldo Milián Castro, en la provincia de Villa Clara. Se estudiaron los hallazgos electrocardiográficos y eventos cardiacos adversos durante el ingreso. Se hicieron análisis bivariados para establecer la relación de ambas variables, utilizando el estadígrafo chi cuadrado y el riesgo relativo. Resultados: Los hallazgos electrocardiográficos más frecuentes fueron la inversión de la onda T (#8805; 2mm), depresión del segmento ST y el QT corregido largo mediante la fórmula de Bazzet. El 26,5 por ciento presentaron eventos cardiovasculares adversos. La depresión del segmento ST, el QT largo corregido y la elevación del segmento ST en aVR se asociaron significativamente con eventos adversos intrahospitalarios (p lt; 0,05). Conclusiones: La asociación de la depresión del segmento ST, la elevación del segmento ST en aVR y el QT largo corregido con la ocurrencia de eventos cardiovasculares adversos intrahospitalarios, sugiere que estos hallazgos se pueden tener en cuenta como posibles indicadores de evolución desfavorable en pacientes con infarto agudo de miocardio sin elevación del segmento ST(AU)

Introduction: The frequency of non-ST elevation acute myocardial infarction is on the increase, and so is the number of adverse results in patients with acute ischemic coronary disease. Objective: Identify the electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction. Method: A cross-sectional correlational study was conducted of 68 patients with non-ST elevation acute myocardial infarction cared for at Arnaldo Milián Castro Hospital in the province of Villa Clara. Attention was paid to electrocardiographic findings and adverse cardiac events occurring during the hospital stay. Bivariate analyses were performed to establish the relationship between the two variables, using the chi square statigram and relative risk estimation. Results: The most common electrocardiographic findings were T-wave inversion (#8805; 2 mm), ST depression and long corrected QT by Bazzet's formula. Of the total study subjects 26.5 percent had adverse cardiovascular events. ST depression, long corrected QT and ST elevation in aVR were significantly associated to in-hospital adverse events (p < 0.05). Conclusions: Association of ST depression, ST elevation in aVR and long corrected QT with the occurrence of adverse in-hospital cardiovascular events suggests that these findings may be taken into account as possible indicators of an unfavorable evolution in patients with non-ST elevation acute myocardial infarction(AU)

Variables implicadas en la enfermedad coronaria en pacientes reumáticos / Variables involved in the coronary heart disease process in rheumatic patients

Introducción: La enfermedad cardiovascular es un problema frecuente en pacientes con trastornos reumáticos sistémicos. Los pacientes pueden padecer una enfermedad asociada a afección cardiaca en el momento del diagnóstico o en una fase posterior del curso de la enfermedad reumática. Objetivo: Determinar las variables que se involucran en la enfermedad coronaria en pacientes reumáticos. Métodos: Se realizó una investigación estadístico-inferencial a partir de una variable dicotómica con variables medidas en escalas de razón y cualitativas, y el modelo de regresión logística binaria. Durante un periodo de 2 años se atendieron en consulta a 105 pacientes reumáticos del Instituto Ecuatoriano de Seguridad Social, interconsultados en cardiología. Al tratarse de una población no muy numerosa (105 pacientes), pues esta consulta se hizo solamente una vez cada seis meses, por un especio de 5 horas. Se estudiaron los factores más representativos como edad, género, peso en libras, estatura en centímetros, ingresos en dólares y el estado civil. Resultados: La tabla permitió evaluar el ajuste del modelo de regresión (hasta este momento, con un solo parámetro en la ecuación), comparando los valores predichos con los valores observados. El modelo tuvo una especificidad alta (96,2 por ciento) y una sensibilidad baja (10,3 por ciento). La ecuación logística permitió determinar si un paciente que cumplía con las características de ingresos, edad, peso y estatura determinadas, se podría considerar en el grupo que, a priori, podría padecer de enfermedad coronaria o no. El paciente evaluado con las características descritas, tuvo un 99,99 por ciento de probabilidad de padecer la enfermedad coronaria. Conclusiones: A través de una ecuación logística se logró determinar si un paciente que cumple con las características de edad e ingresos determinados, se podría considerar en el grupo que, a priori, podría padecer de enfermedad coronaria o no(AU)

Introduction: Cardiovascular disease is a frequent problem in patients with systemic rheumatic disorders. Patients may present with disease associated with heart disease at the time of diagnosis or at a later stage in the course of rheumatic disease. Objective: In the present investigation, the main objective is to determine the variables that are involved in the coronary heart disease process in rheumatic patients and the most representative factors such as: age, gender, weight in pounds, height in centimeters, income in dollars and the marital status in a group of rheumatic patients over a period of two years, treated in consultation with the Ecuadorian Social Security Institute. Methods: During a two-year period, a group of rheumatic patients from the IESS were consulted, consulted in a specialized cardiology consultation. Being a not very large population (105 patients), since this consultation was made only once every six months, for a period of 5 hours. Results: The table allows evaluating the fit of the regression model (until now, with a single parameter in the equation), comparing the predicted values with the observed values. Conclusions: Through a logistic equation, it was possible to determine if a patient who meets the characteristics of age and income determined, could be considered in the group that, a priori, could have coronary heart disease or not(AU)

Prevalência de nefropatia induzida por contraste em pacientes cardíacos de um setor de hemodinâmica / Prevalence of contrast-induced nephropathy in cardiac patients in a hemodynamic sector / Prevalencia de nefropatía inducida por contraste en pacientes cardíacos de un sector de hemodinámica

Objetivo: Determinar a prevalência da nefropatia induzida por contraste em pacientes cardiopatas submetidos a procedimentos angiográficos de diagnóstico e/ou tratamento. Método: Estudo prospectivo, quantitativo, realizado no setor de hemodinâmica de um hospital de grande porte, situado na região norte do Rio Grande do Sul, Brasil. A amostra foi constituída por 79 participantes através do cálculo de tamanho amostral. Resultados: A amostra foi formada por 52 (65,8%) homens e 27 (34,2%) mulheres. A idade média foi de 65,9 ± 9,52 anos. A incidência de nefropatia induzida por contraste foi de 30,38%, totalizando 24 pacientes. Conclusão: Foi evidenciada uma alta prevalência de nefropatia por contraste, apesar dos pacientes apresentarem poucos fatores de risco, o que ressalta a necessidade de medidas preventivas e redução do volume de contraste

Objective: To determine the prevalence of contrast-induced nephropathy in cardiac patients undergoing diagnostic and / or treatment angiographic procedures. Method: A prospective, quantitative study in the hemodynamics sector of a large hospital, located in the northern region of Rio Grande do Sul, Brazil. The sample consisted of 79 participants through the calculation of sample size. Results: The sample consisted of 52 (65.8%) men and 27 (34.2%) women. The mean age was 65.9 ± 9.52 years. The incidence of contrast-induced nephropathy was 30,38%, totaling 24 patients. Conclusion: A high prevalence of contrast nephropathy was evidenced, despite the fact that patients presented few risk factors, which highlights the need for preventive measures and reduction of contrast volume

Objetivo: Determinar la prevalencia de la nefropatía inducida por contraste en pacientes cardiopatas sometidos a procedimientos angiográficos de diagnóstico y / o tratamiento. Método: Estudio prospectivo, cuantitativo, realizado en el sector de hemodinámica de un hospital de gran porte, situado en la región norte de Rio Grande do Sul, Brasil. La muestra fue constituida por 79 participantes a través del cálculo de tamaño muestral. Resultados: La muestra fue formada por 52 (65,8%) hombres y 27 (34,2%) mujeres. La edad media fue de 65,9 ± 9,52 años. La incidencia de nefropatía inducida por contraste fue del 30,38%, totalizando 24 pacientes. Conclusión: Se evidenció una alta prevalencia de nefropatía por contraste, a pesar de que los pacientes presentaban pocos factores de riesgo, lo que resalta la necesidad de medidas preventivas y reducción del volumen de contraste

Clinical Utility of Revised Cardiac Risk Index to Predict Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery / 中国医学科学院学报

Objective To explore the predictive ability of the revised cardiac risk index(RCRI)in elderly patients with coronary heart disease(CHD)undergoing non-cardiac surgery. Methods We performed a retrospective study including a total of 2100 patients,aged≥65 with a history of CHD who underwent non-cardiac surgery form January 2013 to September 2019.The preoperative,intraoperative and postoperative clinical data were extracted from an electronic database.The RCRI and reconstructed-RCRI(R-RCRI)score of each patient were calculated.The primary end point was defined as an occurrence of perioperative MACE.Multivariate logistic regression analysis was performed to evaluate the risk factors of perioperative MACE.The area under the receiver operating characteristic(ROC)curve was used to compare the predictive value of RCRI,R-RCRI,and the new risk scoring system of the study for perioperative MACE. Results The incidence of perioperative MACE in elderly patients with CHD was 5.4%.Six independent risk factors of perioperative MACE for this population were identified:age≥80 years;female;history of heart failure;insulin-depended diabetes mellitus;preoperative ST segment abnormality;American Society of Anesthesiologists grade≥Ⅲ,and the risk index was 2,2,2,2,2 and 3 respectively.The area under ROC curve of RCRI,R-RCRI and risk scoring system in this study were 0.586,0.552 and 0.741. Conclusion The correlation between RCRI score and perioperative MACE was poor in elderly patients with CHD undergoing non-cardiac surgery,and a better cardiac risk assessment method should be established for this population.

Risks factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes / 北京大学学报(医学版)

OBJECTIVE@#The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study.@*METHODS@#This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death.@*RESULTS@#In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min vs. 88.4 beats /min, P=0.004), shortness of breath(29.0 beats /min vs. 20.0 beats /min, P<0.001), higher neutrophil count(9.2×109/L vs. 3.8×109/L, P<0.001), lower lymphocyte count(0.5×109/L vs. 1.1×109/L, P<0.001), creatine kinase MB(CK-MB, 3.2 μg/L vs. 0.8 μg/L, P<0.001), high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ, 217.2 ng/L vs. 4.9 ng/L, P<0.001), N-terminal pro brain natriuretic peptide(NT-proBNP; 945.0 μg/L vs. 154.0 μg/L, P<0.001), inflammatory factor ferritin(770.2 μg/L vs. 622.8 μg/L , P=0.050), interleukin-2 recepter(IL-2R, 1 586.0 U/mL vs. 694.0 U/mL, P<0.001), interleukin-6(IL-6, 82.3 ng/L vs. 13.0 ng/L, P<0.001), interleukin-10(IL-10, 9.8 ng/L vs. 5.0 ng/L, P<0.001)were higher than those in the survival group. Univariate logistic regression analysis showed that the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, abnormal increase of IL 2R, IL-6, and IL-10. Multivariate regression showed that old age (OR=1.11, 95%CI=1.03-1.19, P=0.026), low non oxygen saturation(OR=0.85, 95%CI=0.72-0.99, P=0.041), and abnormal increase of IL-10(＞9.1 ng/L, OR=101.93, 95%CI=4.74-2190.71, P=0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes.@*CONCLUSION@#In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.

Capacidade funcional em populações especiais antes e após cinesioterapia passiva e alongamento / Functional capacity in special populations before and after passive kinesiotherapy and stretching / Capacidad funcional en poblaciones especiales antes y después de la kinesioterapia pasiva y el estiramiento

Objetiva-se analisar a capacidade funcional antes e depois de um tratamento com cinesioterapia passiva e alongamento em populações especiais. Estudo de caso, exploratório, retrospectivo, com uma abordagem quantitativa dos dados. A amostra da pesquisa foi constituída por homens na faixa etária entre 60 a 76 anos de idade, sedentários, com coronariopatias e co-morbidades associadas. Foram analisadas as fichas de avaliação e da reavaliação realizadas com o Senior Fitness Test entre julho a agosto de 2017. A estatística foi realizada através do software SISVAR. As co-morbidades associadas mais frequentes foram: dislipidemia e Hipertensão Arterial Sistêmica. No teste T1, houve um aumento no número de repetições nos movimentos de sentar e levantar da cadeira nos participantes 3, 7 e 10. No T2, ocorreu uma melhora no movimento de flexão do antebraço nos participantes 7 e 8. No T3, os participantes 3, 9, e 10 apresentaram uma melhora na flexibilidade dos MMII. O T4 verificou que os participantes 3 e 7 foram melhores na velocidade, agilidade e equilíbrio dinâmico. O T5 confirmou que apenas o participante 8 apresentou resultados significativos quanto à flexibilidade dos MMSS. No T6 e T7, não houve diferença significativa entre paciente x tempo quanto à resistência aeróbica e IMC respectivamente após o tratamento. Os resultados do Senior Fitness Test em populações especiais parece ser uma ferramenta capaz de analisar individualmente as necessidades de cada participante de um protocolo com reabilitação cardíaca de forma segura e prática; no entanto, se faz necessária uma amostra mais significativa.

Objective: To analyze the functional capacity before and after a treatment with passive kinesiotherapy and stretching in special populations. Method: Exploratory, retrospective case study with a quantitative data approach.The research sample consisted of men in the age group between 60 and 76 years of age, sedentary, with coronary diseases and associated comorbidities. We analyzed the evaluation and revaluation sheets made with Senior Fitness Test between July and August 2017. The statistics were performed using the SISVAR software. Results: The most frequent associated comorbidities were: dyslipidemia and Systemic Arterial Hypertension. In the T1 test, there was an increase in the number of repetitions in the sit and stand movements in the participants 3, 7 and 10. In T2 there was an improvement in the movement of forearm flexion in participants 7 and 8. In T3 participants 3, 9, and 10 presented an improvement in the flexibility of LLLs. T4 found that participants 3 and 7 were better at speed, agility, and dynamic balance. The T5 confirmed that only the participant 8 presented significant results regarding the flexibility of the MMSS. At T6 and T7, there was no significant difference between patient and time for aerobic endurance and BMI respectively after treatment. Conclusion: The results of Senior Fitness Test in special populations seem to be a tool capable of analyzing individually the needs of each participant of a protocol with cardiac rehabilitation in a safe and practical way, however a more significant sample is necessary.

El objetivo es analizar la capacidad funcional antes y después de un tratamiento con kinesioterapia pasiva y estiramiento en poblaciones especiales. Estudio de caso, exploratorio, retrospectivo, con un enfoque cuantitativo de los datos. La muestra de investigación consistió en hombres sedentarios de 60 a 76 años, con enfermedades coronarias y comorbilidades asociadas. Se analizaron los formularios de evaluación y reevaluación realizados con la Prueba de aptitud física para adultos mayores entre julio y agosto de 2017. Las estadísticas se realizaron con el software SISVAR. Las comorbilidades asociadas más frecuentes fueron: dislipidemia e hipertensión arterial sistémica. En la prueba T1, hubo un aumento en el número de repeticiones en los movimientos de sentarse y levantarse de la silla en los participantes 3, 7 y 10. En T2, hubo una mejora en la flexión del antebrazo en los participantes 7 y 8. En T3, los participantes 3, 9 y 10 mostraron una mejora en la flexibilidad de las extremidades inferiores. T4 encontró que los participantes 3 y 7 fueron mejores en velocidad, agilidad y equilibrio dinámico. T5 confirmó que solo el participante 8 presentó resultados significativos con respecto a la flexibilidad del MMSS. En T6 y T7, no hubo diferencias significativas entre el paciente x el tiempo en términos de resistencia aeróbica e IMC respectivamente después del tratamiento. Los resultados del Senior Fitness Test en poblaciones especiales parecen ser una herramienta capaz de analizar individualmente las necesidades de cada participante en un protocolo con rehabilitación cardíaca de una manera segura y práctica; sin embargo, se necesita una muestra más significativa.

Off-Pump coronary revascularization using bilateral internal thoracic arteries in a patient with paroxysmal nocturnal hemoglobinuria: a case report

Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.

Impact of anxiety and depression on morbidity and mortality of patients with coronary syndrome / Impacto de la ansiedad y depresión en la morbimortalidad de pacientes con síndrome coronaria / Impacto da ansiedade e depressão na morbimortalidade de pacientes com síndrome coronariana

ABSTRACT Objective: Evaluate the impact of anxiety and depression on morbidity and mortality of patients with acute coronary syndrome. Method: Retrospective cohort study, with follow-up of two years, conducted with 94 patients. The morbidity and mortality (readmission, myocardial revascularization, and death) was evaluated immediately after discharge and after one and two years. Anxiety and depression were evaluated by the State-Trait Anxiety Inventory and by Beck's Depression Inventory. The Kaplan-Meier estimator and the Logrank test were used. The significance level adopted was 0.05. Results: We observed that 76.6% of the patients did not present symptoms of depression or had mild signs, while 78.8% had low to moderate anxiety. The symptoms of depression and anxiety were not related to morbidity (need for MR p=0.098 and 0.56, respectively; readmission p=0.962 and 0.369, respectively) and mortality (p=0.434 and 0.077, respectively). Conclusion: No relationship was found between levels of anxiety and depression with the morbidity and mortality of patients.

RESUMEN Objetivo: Evaluar el impacto de la ansiedad y de la depresión en la morbimortalidad de pacientes con síndrome coronaria aguda. Método: Estudio de cohorte retrospectivo, con seguimiento de dos años, ha sido realizado con 94 pacientes. La morbimortalidad (la readmisión, la revascularización del miocardio y del óbito) ha sido evaluada inmediatamente después del alta hospitalaria y después de uno y dos años. La ansiedad y la depresión han sido evaluadas por el Inventario de Ansiedad Trazo y por el Inventario de Depresión de Beck. Se ha utilizado de los gráficos de Kaplan-Meier y de la prueba Logrank. El nivel de significancia que ha sido adoptado ha sido de 0,05. Resultados: Se ha observado que el 76,6% de los pacientes no presentaban síntomas de depresión o presentaban señales leves y el 78,8% tenían ansiedad de baja a moderada. Los síntomas de depresión y de ansiedad no se han relacionado a la morbilidad (necesidad de RM p=0,098 y 0,56, respectivamente; readmisión p=0,962 y 0,369, respectivamente) y a la mortandad (p=0,434 y 0,077, respectivamente). Conclusión: No hubo relación entre niveles de ansiedad y depresión con la morbimortalidad de los pacientes.

RESUMO Objetivo: Avaliar o impacto da ansiedade e depressão na morbimortalidade de pacientes com síndrome coronariana aguda. Método: Estudo de coorte retrospectivo, com seguimento de dois anos, realizado com 94 pacientes. A morbimortalidade (readmissão, revascularização do miocárdio e óbito) foi avaliada imediatamente após a alta hospitalar e depois de um e dois anos. A ansiedade e a depressão foram avaliadas pelo Inventário de Ansiedade Traço e pelo Inventário de Depressão de Beck. Utilizou-se dos gráficos de Kaplan-Meier e do teste Logrank. O nível de significância adotado foi de 0,05. Resultados: Observou-se que 76,6% dos pacientes não apresentavam sintomas de depressão ou apresentavam sinais leves e 78,8% tinham ansiedade baixa a moderada. Os sintomas de depressão e ansiedade não se relacionaram à morbidade (necessidade de RM p=0,098 e 0,56, respectivamente; readmissão p=0,962 e 0,369, respectivamente) e à mortalidade (p=0,434 e 0,077, respectivamente). Conclusão: Não houve relação entre níveis de ansiedade e depressão com a morbimortalidade dos pacientes.

Metabolismo e função das lipoproteínas de alta densidade (HDL) em indivíduos idosos: efeito da presença de diabetes mellitustipo 2 e doença coronária obstrutiva / Metabolism and function of high density lipoprotein (HDL) in the elderly: effects of type 2 diabetes mellitus and coronary artery disease

Introdução: A doença arterial coronária (DAC) decorrente da aterosclerose é uma das principais causas de comprometimento do envelhecimento saudável e sobrevida do idoso.Entre os principais fatores de risco da DAC estão o diabetes mellitus tipo 2 (DM) e as dislipidemias. O HDL-colesterol baixo é fator de risco importante, mas aspectos funcionais e metabólicos da HDL devem ser avaliados, já que esta lipoproteína tem várias ações anti-aterogênicas. Neste sentido, a transferência de lípides de outras lipoproteínas para a HDL, mediada pela proteína de transferência de ésteres de colesterol (CETP), é passo importante na formação e metabolismo da HDL e está relacionada com a presença de DAC. Objetivo: Avaliar o impacto da idade nas transferências de lípides para HDL e outros parâmetros relacionados com o metabolismo da HDL em indivíduos idosos e as mudanças nesses parâmetros em idosos com DAC e com DAC e DM. Métodos: Foram estudados 25 jovens (JOV), 35 idosos sem DAC e sem DM (IDS), 35 idosos com DAC (IDS-DAC) e 34 idosos com DAC e DM (IDS-DAC-DM). Foram determinados perfil lipídico e apolipoproteínas plasmáticas, concentração plasmática da CETP e da lecitina-colesterol aciltransferase (LCAT), composição lipídica e diâmetro da HDL e marcadores inflamatórios. A transferência de colesterol esterificado e livre, fosfolípides e triglicérides para a HDL foi realizada por ensaio "in vitro" com uma nanopartícula marcada com lípides radioativos como partícula doadora de lípides. Após a precipitação química das outras lipoproteínas e da nanopartícula doadora, o sobrenadante contendo HDL foi separadoe medida a radioatividade. Resultados: IDS apresentou IMC maior que JOV. LDL-colesterol e não-HDL-colesterol, IL-6 e IL-8 foram mais altos, IL-1ß mais baixo e a transferência de fosfolípides para a HDL foi maior em IDS do que em JOV, mas as diferenças desapareceram quando corrigidas pelo IMC. Entre IDS-DAC e IDS não houve diferenças nos lípides plasmáticos, mas no IDS-DAC a transferência de colesterol livre, triglicérides e fosfolípides foi menor e a de colesterol esterificado foi maior. A concentração de CETP foi maior no IDS-DAC, onde houve maior % de colesterol esterificado e triglicérides e menor % de fosfolípides na HDL. Em IDS-DAC-DM, apoB foi maior que em IDS-DAC, mas LDL-colesterol foi igual. Houve menor transferência de colesterol esterificado em IDS-DAC-DM comparado a IDS-DAC e maior de fosfolípides. IDS-DAC-DM teve CETP mais baixa e LCAT mais alta do que IDS-DAC. Em IDS-DAC-DM houve menor proporção de colesterol esterificado e livre e maior de fosfolípides na HDL. Marcadores inflamatórios não diferiram entre IDS-DAC-DM e IDS-DAC. Conclusões: As alterações nos parâmetros de transferência de lípides sinalizaram tanto a presença de DAC nos idosos quanto diferenciaram idosos com DAC associada a DM daqueles apenas com DAC. A redução da transferência de colesterol livre nos idosos com DAC é aterogênica, como foi mostrado em trabalho anteriorem indivíduos de 40-50 anos com DAC precoce. Esses dados podem ter aplicação tanto na prevenção quanto na terapêutica da DAC, por meio de medicamentos que modulem a transferência de lípides para a HDL e assim melhorem a função anti-aterogênica desta lipoproteína

Introduction: Coronary artery disease (CAD) resulting from atherosclerosis is one of the main causes of compromised healthy aging and lifespan in elderly people. Amongst the main risk factors for CAD are type 2 diabetes mellitus (DM) and dyslipidemias. Low HDL-cholesterol is an important risk factor, but functional and metabolic aspects of HDL must be evaluated, since this lipoprotein has several anti-atherogenic actions. In this regard, lipid transfer from other lipoproteins to HDL, mediated by cholesteryl ester transfer protein (CETP), is an important step towards the formation and metabolism of HDL and is related to the presence of CAD. Objective: To evaluate the impact of age in lipid transfer to HDL and other parameters related to HDL metabolism in elderly individuals and the changes in these parameters in elderly individuals with CAD and with CAD and DM. Methods: 25 young (YOUNG), 35 elderly without CAD and DM (ELDERLY), 35 elderly with CAD (ELDERLY-CAD) and 34 elderly with CAD and DM (ELDERLY-CAD-DM) subjects were studied. The lipid profile, the apolipoprotein, CETP and lecithin-cholesterol acyltransferase (LCAT) plasma concentration,theHDL lipid composition and diameter and inflammatory markers were evaluated.The transfer of esterified and free cholesterol, phospholipids and triglycerides to HDL was assayed in vitro with a donor lipid nanoparticle labeled with radioactive lipids.After chemical precipitation of the other lipoproteins and the donor lipid nanoparticle, the supernatant containing HDL was separated and the radioactivity was measured. Results: ELDERLY presented greater BMI than YOUNG. LDL-cholesterol and non-HDL-cholesterol, IL-6 and IL-8 were higher, IL-1ß was lower and phospholipid transfer to HDL was higher in ELDERLY than in YOUNG, but the differences disappeared when corrected by BMI. There were no differences in plasmatic lipids between ELDERLY-CAD and ELDERLY, but in ELDERLY-CAD the transfer of free cholesterol, triglycerides and phospholipids was lower and of esterified cholesterol was higher. CETP concentration was higher in ELDERLY-CAD, where there was higher % of esterified cholesterol and triglycerides and lower % of phospholipids in HDL. In ELDERLY-CAD-DM, apo B was higher than in ELDERLY-CAD, but LDL-cholesterol was equal. There was lower transfer of esterified cholesterol in ELDERLY-CAD-DM compared to ELDERLY-CAD and higher transfer of phospholipids. ELDERLY-CAD-DM had lower CETP and higher LCAT than ELDERLY-CAD. In ELDERLY-CAD-DM there was a smaller proportion of esterified and free cholesterol and greater proportion of phospholipids in HDL. Inflammatory markers did not differ between ELDERLY-CAD-DM and ELDERLY-CAD. Conclusions: The alterations in the parameters of lipid transfer not only signalled the presence of CAD in the elderly but also differentiated the elderly with CAD and DM from those with CAD only. The reduction of free cholesterol transfer in the elderly with CAD is atherogenic, as shown in a previous work on individuals of 40-50 years of agewith precocious CAD. This data may be applied both to the prevention and the therapeutics of CAD, by means of medicines that modulate lipid transfer to HDL and thus improve the anti-atherogenic function of this lipoprotein

Avaliação da medida central da pressão e rigidez arterial em participantes de caminhada de longa distância / Assessment of central Blood pressure and arterial stiffness in practicing long-distance walking race

Fundamento: A Caminhada Ecológica que ocorre anualmente no Brasil, é um evento único por sua distância (310 Km) e dinâmica de realização (média de 62 km/dia por 5 dias, com ritmo médio de 7,6 km/h). Embora os efeitos benéficos de exercícios de intensidade moderada sejam bem conhecidos, os efeitos do exercício intenso e de longa duração ainda requerem estudo. Objetivo: Avaliar os efeitos da modalidade mista caminhada/corrida em vários parâmetros de pressão arterial (PA) 30 dias antes (A0) do evento, e ao final dos dias 2 (A2), 3 (A3) e 4 (A4) da caminhada. Métodos: Foram medidas PA sistólica e diastólica central (cPAS e cPAD, respectivamente), PA sistólica e diastólica periférica (pPAS e pPAD, respectivamente), pressão de pulso central (cPP), pressão de pulso periférica (pPP), pressão de pulso amplificada (aPP), augmentation index ajustado (AIx75%) e velocidade da onda de pulso (VOP) com Mobil-O-Graph ® (IEM, Stolberg, Alemanha) em 25 atletas do sexo masculino (idade média, 45,3 ± 9,1 anos). Foi considerado significativo valor de p < 0,05. Resultados: Houve redução de cPAS de A0 para A2 (109,5 para 118,1 mmHg) e de A0 para A3 (109,5 para 102,5 mmHg); redução de pPP de A0 para A2 (49,2 para 38,2 mmHg) e de A0 para A4 (49,2 para 41,2 mmHg); redução de aPP de A0 para A1 (15,6 para 9,5 mmHg), de A0 para A2 (15,6 para 8,0 mmHg) e de A0 para A3 (15,6 para 11,2 mmHg). VOP correlacionou-se com idade. Conclusões: A PA caiu nos primeiros dias da caminhada de longa distância, retornando a níveis próximos aos basais no final, e a VOP correlacionou-se fortemente com idade. Esse tipo de exercício promove efeitos na PA e na VOP similares aos vistos em esportes de longa duração e alta intensidade. Tais mudanças em indivíduos saudáveis e treinados não parecem aumentar os riscos cardiovasculares. Este foi o primeiro estudo a avaliar os efeitos desse tipo de exercício no sistema cardiovascular

Background: An ecological hiking occurs yearly in Brazil. It is a unique event because of its distance (310 km) and dynamics (mean of 62 km/day for 5 days with mean pace of 7.6 km/h). Although beneficial effects of moderate-intensity exercises are well-known, the effects of intense and long-duration exercise still require study. Objective: To evaluate the effects of mixed walking/running race on various blood pressure (BP) parameters 30 days before (A0), on the 2 nd (A2), 3 rd (A3), and 4 th (A4) days after completing the day's stage. Methods: Central systolic (cSBP) and diastolic BP (cDBP), peripheral systolic (pSBP) and diastolic BP (pDBP), central pulse pressure (cPP), peripheral pulse pressure (pPP), amplified pulse pressure (aPP), corrected augmentation index (AIx75%) and pulse wave velocity (PWV) were measured using an oscillometric Mobil-O-Graph ® (IEM, Stolberg, Germany) in 25 male athletes (mean age of 45.3 ± 9.1 years). A p value < 0.05 was considered a statistically-significant difference. Results: cSBP decreased from A0 to A2 (109.5 to 118.1 mmHg) and from A0 to A3 (109.5 to 102.5 mmHg); pPP decrease from A0 to A2 (49.2 to 38.2 mmHg) and from A0 to A4 (49.2 to 41.2 mmHg); aPP decrease from A0 to A1 (15.6 to 9.5 mmHg), from A0 to A2 (15.6 to 8.0 mmHg) and from A0 to A3 (15.6 to 11.2 mmHg). PWV correlated with age. Conclusions: Blood pressure dropped on the first days of the race and returned to close to baseline values at the end. PWV correlates strongly with age. This type of exercise promotes effects on BP and PWV similar to those seen in long-duration, high-intensity sports. These changes in trained healthy individuals do not seem to increase cardiovascular risks. This was the first study to assess the effects of this type of exercise on the cardiovascular system

Radioterapia e cardiotoxicidade / Radiotherapy and cardiotoxicity

Os avanços da radioterapia aumentaram a taxa de sobrevida dos pacientes em tratamento oncológico em até 90% em alguns casos. A prevalência acumulada de doença cardíaca relacionada com a radioterapia é estimada em 10% a 30% de 5 a 10 anos após o tratamento e é dose-dependente. A dose acumulada e seu fracionamento podem determinar os efeitos cardíacos agudos e crônicos da radioterapia. Além disso, a progressão da doença cardíaca induzida pela radiação a curto e longo prazo em cada paciente ainda não é completamente compreendida. Sabe-se que o dano cardíaco está relacionado com o dano endotelial que acomete a micro e a macrovasculatura, e o acompanhamento dos pacientes expostos deve seguir recomendações.

Advances in radiotherapy have increased the survival rate of cancer patients by up to 90% in some cases. The cumulative prevalence of radiotherapy-related heart disease is estimated at 10% to 30% five to ten years after treatment, and is dose-dependent. The accumulated dose and its fractionation may result in acute and chronic cardiac effects of radiotherapy. In addition, the progression of short- and long-term radiation-induced heart disease in each patient is still not fully understood. It is known that heart damage is related to endothelial damage, which affects the micro and macro vasculature, and the follow-up to these exposed patients should follow the recommendations

Crenças, valores e atitudes dos familiares conviventes com pacientes coronariopatas / Beliefs, values and attitudes of cohabiting relatives of coronary artery disease patients / Creencias, valores y actitudes de familiares de pacientes con coronariopatía

A alta incidência e prevalência da doença coronariana é evidente no Brasil e no mundo. A concepção de saúde e enfermidade influencia nas atitudes e condutas dos indivíduos diante do processo saúde doença e afeta o desempenho e o desenvolvimento do núcleo familiar. O objetivo foi analisar crenças, valores e atitudes dos familiares conviventes com pacientes com síndrome coronariana aguda sobre a doença coronariana. Trata-se de estudo transversal com abordagem qualitativa realizado em um Hospital Universitário. A amostra foi composta de nove familiares, mediante uma entrevista semi estruturada. Os dados foram coletados por meio de instrumentos com questões elaboradas tendo como base as premissas do referencial teórico e avaliados segundo o Modelo de Crença em Saúde. Os familiares tinham entre 26 e 66 anos. As categorias suscetibilidade, severidade, benefícios e barreiras percebidas derivadas do Modelo de Crença em Saúde, assim como a categoria conscientização e mudança, mostraram que os familiares possuem conhecimento sobre os aspectos preventivos e de controle das consequências da doença coronariana, porém as crenças e valores adquiridos ao longo de suas vidas, influenciados pelo contexto cultural, social, econômico, emocional e principalmente familiar, interferem nos comportamentos preventivos da doença e promotores de saúde. A despeito do conhecimento que os familiares conviventes possuem sobre a doença, o enfermeiro precisa adequar o processo educacional para minimizar os conflitos decorrentes de crenças, valores e contexto do ambiente familiar, facilitar e promover a incorporação de novos hábitos.

The high incidence and prevalence of coronary heart disease is evident in Brazil and worldwide. The concept that individuals have on health andillness influences their attitudes and behaviors before the health-disease process and affects the performance and development of the familynucleus. The objective was to analyze beliefs, values and attitudes of family members that live with patients with acute coronary syndrome ofcoronary heart disease. This is a cross-sectional study with qualitative approach conducted at a university hospital. The sample consisted ofnine relatives of patient. Semi-structured interviews were applied. Data were collected through instruments with questions prepared upon theassumptions of the theoretical framework. Data were evaluated according to the Health Belief Model. Family members were aged between 26 and66 years. The categories susceptibility, severity, benefits and perceived barriers derived from Health Belief Model, as well as the categories awarenessand change, showed that family members have knowledge about the prevention and control aspects of the consequences of coronary heart disease.However, the beliefs and values acquired throughout their lives, influenced by cultural, social, economic, emotional and especially family context,hinder behaviors with preventive and health promoter character. Despite the knowledge that family member of coronary patients have about thedisease, nurses need to tailor the educational process aiming to minimize conflicts arising from beliefs, values and family environment context, aswell as facilitate and promote the incorporation of new habits.

La elevada incidencia y prevalencia de la enfermedad coronaria en Brasil y en el mundo es evidente. El concepto de salud y enfermedad influye en las actitudesy comportamientos de los individuos en el proceso de salud-enfermedad y afecta el rendimiento y desarrollo del núcleo familiar. El objetivo del presenteestudio fue analizar las creencias, valores y actitudes de familiares que conviven con pacientes con síndrome coronario agudo de la enfermedad arterialcoronaria. Se trata de un estudio cualitativo transversal realizado en un hospital universitario. La muestra estaba compuesta por nueve familiares. Los datosfueron recogidos en entrevistas semiestructuradas a través de instrumentos con preguntas preparadas en base a los supuestos del marco teórico según elModelo de Creencias en Salud. Los familiares tenían entre 26 y 66 años. Las categorías “susceptibilidad”, “gravedad”, “beneficios” y “barreras” percibidasderivadas del modelo Creencias en Salud, así como la categoría “concienciación y cambio”, mostraron que los familiares tienen conocimiento sobre losaspectos de prevención y control de las consecuencias de la enfermedad cardíaca coronaria. Sin embargo, las creencias y valores adquiridos durante toda lavida, influenciados por el contexto cultural, social, económico y emocional de la familia interfieren con los comportamientos preventivos de la enfermedad ypromotores de la salud. A pesar del conocimiento que los familiares tienen sobre la enfermedad, los enfermeros precisan adecuar el proceso educativo paraminimizar los conflictos resultantes de las creencias, valores y contexto familiar para facilitar y promover la incorporación de nuevos hábitos.

Caracterización de pacientes en posoperatorio de revascularización miocárdica según eventos clínicos de cuidado de enfermería / Characterization of patients in postoperative period of myocardial revascularization according to clinical nursing care events", "_e": "n

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.

Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.

Comparison of polyurethane with cyanoacrylate in hemostasis of vascular injury in guinea pigs / Comparação do poliuretano com cianoacrilato na hemostasia de injúria vascular em cobaias

Objective: To evaluate the behavior of castor oil-derived polyurethane as a hemostatic agent and tissue response after abdominal aortic injury and to compare it with 2-octyl-cyanoacrylate. Methods: Twenty-four Guinea Pigs were randomly divided into three groups of eight animals (I, II, and III). The infrarenal abdominal aorta was dissected, clamped proximally and distally to the vascular puncture site. In group I (control), hemostasis was achieved with digital pressure; in group II (polyurethane) castor oil-derived polyurethane was applied, and in group III (cyanoacrylate), 2-octyl-cyanoacrylate was used. Group II was subdivided into IIA and IIB according to the time of preparation of the hemostatic agent. Results: Mean blood loss in groups IIA, IIB and III was 0.002 grams (g), 0.008 g, and 0.170 g, with standard deviation of 0.005 g, 0.005 g, and 0.424 g, respectively (P=0.069). The drying time for cyanoacrylate averaged 81.5 seconds (s) (standard deviation: 51.5 seconds) and 126.1 s (standard deviation: 23.0 s) for polyurethane B (P=0.046). However, there was a trend (P=0.069) for cyanoacrylate to dry more slowly than polyurethane A (mean: 40.5 s; SD: 8.6 s). Furthermore, polyurethane A had a shorter drying time than polyurethane B (P=0.003), mean IIA of 40.5 s (standard deviation: 8.6 s). In group III, 100% of the animals had mild/severe fibrosis, while in group II only 12.5% showed this degree of fibrosis (P=0.001). Conclusion: Polyurethane derived from castor oil showed similar hemostatic behavior to octyl-2-cyanoacrylate. There was less perivascular tissue response with polyurethane when compared with cyanoacrylate. .

Objetivo: Avaliar o comportamento hemostático e a reação tecidual do poliuretano, derivado da mamona, após injúria da aorta abdominal de cobaias e compará-lo com o 2-octil-cianoacrilato. Métodos: Vinte e quatro cobaias foram divididas aleatoriamente em três grupos de oito animais (I, II e III). A aorta abdominal infrarrenal foi dissecada, pinçada proximal e distalmente ao local que se procedeu à punção vascular. No grupo I (controle), a hemostasia foi feita com digitopressão; no grupo II (poliuretano), aplicou-se o selante vegetal e, no grupo III (cianoacrilato), aplicou-se o 2-octil-cianoacrilato. O grupo II foi subdividido em IIA e IIB, conforme o tempo de preparo do poliuretano. Resultados: A média de perda sanguínea nos grupos IIA, IIB e III foi 0,002 g, 0,008 g e 0,170 g, com desvios padrões de 0,005 g, 0,005 g e 0,424 g, respectivamente (P=0,069). O tempo de secagem do selante cianoacrilato foi em média 81,5 segundos (s) (desvio padrão: 51,5 s), enquanto o poliuretano B levou 126,1 segundos (desvio padrão: 23,0 s) (P=0,046). Entretanto, houve tendência (P=0,069) do cianoacrilato apresentar um tempo maior de secagem que o poliuretano A. Além disso, o poliuretano A teve um tempo de secagem menor que o poliuretano B (P=0,003), com média para o IIA de 40,5 segundos (desvio padrão: 8,6 s). No grupo III, 100% dos animais tiveram fibrose moderada/acentuada, enquanto no grupo II apenas 12,5% (P=0,001). Conclusão: O poliuretano derivado da mamona apresentou comportamento hemostático semelhante ao 2-octil-cianoacrilato. A cola vegetal demonstrou menor reação tecidual perivascular. .

Pathological Features of Myocardial Contraction Band Necrosis in Sudden Cardiac Death / 法医学杂志

OBJECTIVE@#To investigate the pathological features and significance of myocardial contraction band necrosis in sudden cardiac death.@*METHODS@#Using HE and PTAH staining, the distribution sites and pathological features of myocardial contraction band necrosis were observed. The data were analyzed according to the extent of necrosis.@*RESULTS@#The locations, pathological features and the extent of necrosis were similar in different sudden death cases. The locations were related with sites of myocardial damage. The papillary muscles of left ventricular were most occurred, followed by the anterior wall of left ventricular. In the sudden death cases caused by stress cardiomyopathy, the extent of myocardial contraction band necrosis was lighter than the others. Most cases were predominantly level 1, the others were level 2.@*CONCLUSION@#Used as the diagnosis basis of acute myocardial ischemia, the myocardial contraction band necrosis has important significance to determination of death.

Paro cardiorespiratorio secundario a hematoma coronario intramural en arteria descendente anterior / Cardiac arrest associated to intramural hematoma of the anterior descending coronary artery

Background: A 43 year old woman presented with chest pain followed by cardiac arrest recovered after defibrillation. Coronary angiography revealed a narrowed anterior descending coronary artery but no intraluminal thrombi. Optic coherence tomography showed intramural hematoma and the patient was treated medically with aspirin, clopidogrel and atorvastatin. Two weeks later the pain recurred and coronary angiography revealed similar findings. After medical treatment with heparin followed by aspirin and clopidogrel she has remained stable.

Anticorpos monoclonais anti PCSK9 / Anti-PCSK9 monoclonal antibodies

Inibição da PCSK9 constitui um dos mais promissores avanços para o tratamento da hipercolesterolemia nos últimos anos. Esta pró-proteína convertase ao interagir com a LDL e seu receptor hepático determina a degradação do receptor. Por meio de anticorpos monoclonais, esta ação é inibida na corrente circulatória e, desta forma, o receptor após captar a LDL pode ser reciclado muitas vezes, permitindo eficiente redução do LDL-colesterol. Estes fármacos se mostraram surpreendentemente bem tolerados, com perfil de segurança similar ao placebo e produziram reduções no LDL-C ao redorde 60%, independentemente de terapia prévia com outros hipolipemiantes como estatinas ou ezetimiba. Além disso,reduzem também a lipoproteína Lp (a), uma ação que não se observa com as estatinas. Estudos prospectivos destinado sao exame do impacto em desfechos cardiovasculares estão atualmente em curso e poderão ampliar as indicações hoje previstas, como seu uso para hipercolesterolemias primárias graves ou intolerância a estatinas.

Inhibition of PCSK9 constitutes one of the most promising advances for the treatment of hypercholesterolemia in thelast years. This proprotein convertase interacts with LDLand its receptor determining degradation of the receptor.Through the use of monoclonal antibodies, this effectis inhibited in the bloodstream, and thus, after the LDL capture, the receptor can be recycled many times, promotingan effective LDL-C decrease. Surprisingly, these drugsshowed safety profile similar to placebo and were very well tolerated, achieving LDL-C lowering around 60%, beyond previous therapies with statins or ezetimibe. In addition, these drugs also decrease lipoprotein Lp (a), an effect not observed with statins. Prospective studies aimedto evaluate the impact of treatment on cardiovascular eventsare currently ongoing and they may increase the possible indications recognized today, such as severe primary hypercholesterolemias or statin intolerance.