Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors / Hiper-homocisteinemia como fator de risco independente para doença coronariana: comparação com fatores de risco convencionais

The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor [...].

O presente estudo foi desenhado para avaliar a força da associação da concentração elevada de homocisteína no plasma como um fator de risco para doença cardíaca coronária independente do fator de risco convencional. Foi um estudo de caso-controle realizado no Punjab Institute of Cardiology Lahore. Um total de 210 indivíduos com idade entre 25 e 60 anos, compreendendo 105 pacientes recém-admitidos de CHD como casos e 105 indivíduos saudáveis pareados por idade e sexo sem histórico de CHD como controle, foi recrutado para o estudo. Amostras de sangue em jejum foram obtidas de casos e controles. A homocisteína plasmática foi analisada pelo método de imunoensaio de polarização de fluorescência (FPIA) em analisador de imunoensaio automatizado (Abbott IMX). Colesterol total, triglicerídeos e colesterol HDL foram analisados usando métodos de kit calorimétrico. A concentração de colesterol LDL foi calculada pela fórmula de Friedewald. Os pacientes também foram avaliados para fatores de risco tradicionais, como idade, sexo, história familiar de DCV, hipertensão, tabagismo e atividade física, e foram comparados com indivíduos de controle. Os dados coletados foram inseridos no SPSS versão 24 para análise e interpretação. A média de idade nos grupos controles e experimentais foi de 43,00 ± 8,42 anos e 44,72 ± 8,59 anos com distribuição estatisticamente igual (p-valor = 0,144). A homocisteína plasmática média para os casos foi de 22,33 ± 9,22 µmol / L, enquanto no grupo controle foi de 12,59 ± 3,73 µmol / L. Diferença altamente significativa foi observada entre o nível plasmático médio de homocisteína em casos e controles (p ˂ 0,001). A regressão logística simples indica uma forte associação de doença cardíaca coronária com hiper-homocisteinemia (OR 7,45), que permaneceu significativamente associada com doença cardíaca coronária por multivariada regressão logística (OR 7,10, 95% C1 3,12-12,83, p = 0,000). O presente estudo conclui [...].

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

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

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

Conciencia de enfermedad cardiovascular y conocimiento sobre factores de riesgo y prevención cardiovascular: resultados chilenos de encuesta SIAC cono sur / Awareness of risk factors and prevention of cardiovascular disease in chile: SIAC cono sur survey

Resumen La conciencia de la enfermedad cardiovascular (ECV) en mujeres es crucial para prevenir futuros eventos cardiovasculares. En Chile, la percepción sobre ECV es baja. Objetivo: Actualizar el grado de conocimiento de las chilenas sobre ECV. Método: Estudio de corte transversal realizado a través de encuesta online a mujeres entre 20 y 70 años de edad, residentes en Chile durante marzo 2020. La invitación se efectuó a través de redes sociales. La muestra fue no probabilística, ponderándose por edad, nivel socioeconómico y región de residencia (Región Metropolitana, Coquimbo, Valparaíso, Bío-Bío). Resultados: Se obtuvieron 1227 cuestionarios validados. La muestra ponderada correspondió a 900 mujeres. La percepción de ECV como principal causa de muerte fue de 8%, menor que las correspondientes a cáncer de mama (44%) y muerte violenta / homicidio (20%). Como principal problema de salud, la opción más percibida fue cáncer general (39%), seguido de diabetes (18%). Sólo 6 % refirió la ECV como el principal problema. Los principales accesos a la información sobre ECV fueron la internet y las redes sociales (64%, mayor en <30 años), y en el consultorio (32%). La opresión o dolor en el pecho fueron los síntomas más reconocidos asociados al infarto, siendo más seleccionado por mujeres con nivel educacional alto (p< 0.05). Conclusión: Persiste una baja percepción del riesgo de la ECV como principal causa de muerte y problema de salud en mujeres chilenas, aunque tienen acceso a la información y reconocen síntomas de infarto. Es necesario adaptar las estrategias comunicacionales para incrementar la percepción de riesgo CV.

Abstract Awareness of cardiovascular disease (CVD) in women is crucial to prevent cardiovascular events. According to prior information the perception and knowledge about CVD in Chile is extremely low. The aim of this study was to update the information about awareness of CVD in Chilean women. Method: Cross-sectional study carried out through an online survey. Data was obtained from women between 20 and 70 years old during March 2020. Social networks were used to recruit participants. The sample was non-probabilistic, weighted by age, socio-economic level and region of residence (Metropolitan Region, Coquimbo, Valparaíso, Bío-Bío). Results: 1227 validated surveys were obtained. The weighted sample corresponded to 900 women. CVD was perceived as the main cause of death in 8% of women, compared to higher degrees of perception for breast cancer (44%) and violent death/homicide (20%). CVD was perceived as the main health problem by only 6% of women, compared to cancer (39%) and diabetes (18%). The primary source of information about CVD were the internet and social networks (64%,higher in women <30 years old), and the doctor's office (32%). Chest tightness or pain as symptoms associated with a heart attack were significantly more recognized by respondents with a high educational level (p<0.05). Conclusion: An extremely low awareness about CVD as the main cause of death and health problem is persistent in Chilean women, notwithstanding that they have access to information and recognize symptoms of a heart attack. It is necessary to modify our communication strategies to increase the perception of CV risk in Chilean women.

Secondary prevention of coronary heart disease: a cross-sectional analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT BACKGROUND: Coronary heart disease (CHD) remains a major cause of mortality worldwide and in Brazil. Use of standard medications after CHD has been proven to avoid new events and reduce early mortality. OBJECTIVES: This study aimed to analyze secondary prevention of CHD and its association with the baseline characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional analysis on ELSA-Brasil data. METHODS: Secondary prevention of CHD recommended in standard guidelines (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without angiotensin-converting enzyme inhibitors, ACEI, or angiotensin receptor blockers, ARB) was evaluated in relation to sociodemographic data and the time since the coronary event. The chi-square test, one-way analysis of variance (ANOVA) and Mann-Whitney test were performed, as necessary. RESULTS: Among 15,094 participants, 2.7% reported a previous diagnosis of CHD. Use of recommended drugs for secondary prevention was reported by almost 35% of the participants. Medication use for secondary prevention was generally more frequent among high-income participants than among low-income participants. Use of ARB and ACEI was different between participants who had private health insurance and those who only used the public healthcare system. Men were more likely to use medication than women. The frequency with which participants used the recommended drugs was similar in all time periods after CHD, but use of only one drug increased progressively across time periods. CONCLUSION: The use of medication for secondary prevention of CHD was lower than what is recommended in standardized guidelines, especially among women and lower-income participants.

Implicancia pronóstica de los estudios gated-SPECT normales en pacientes mayores de 70 años / Pronostic implication of normal gated SPECT studies in patients over 70 years old

Introducción: un resultado normal en la centellografía de perfusión miocárdica gatillada (gated-SPECT) tiene un alto valor predictivo negativo para enfermedad coronaria grave; existe un período de tiempo variable en que los pacientes permanecen con una tasa de eventos baja (menor a 1%). Sin embargo, algunas evidencias sugieren que este período de garantía (PG) no es el mismo en todos los grupos etarios. Objetivo: establecer el período de tiempo en el cual los pacientes ancianos (mayores de 70 años) mantienen una tasa de eventos cardíacos por debajo de 1%. Material y método: se estudiaron 554 pacientes mediante gated-SPECT, divididos en dos grupos: Grupo 1: (n=354) con gated-SPECT normal, y Grupo 2: (n=200) con gated-SPECT anormal. Definimos un gated-SPECT normal como aquel con score de suma en estrés (SSS) < 4 y parámetros funcionales normales. El seguimiento medio fue de 30,6 meses (rango: 12-62 meses) para la pesquisa de los eventos cardiovasculares (EC): muerte cardíaca (MC) e infarto agudo de miocardio no fatal (IAMNF), y eventos combinados (ECB): EC+ angioplastia coronaria, cirugía de revascularización miocárdica e implante de cardiodesfibrilador. Se utilizó prueba no paramétrica de Pearson y se calculó el estadístico x2, con un valor de p ?0,05 para el rechazo de la hipótesis nula (IC: 95%). Resultados: la comparación entre ambos grupos muestra diferencias en los tres primeros años para la aparición de EC (p <0,0001), MC (p <0,0001) y ECB (p <0,0001). La tasa de EC en el Grupo 1 para cada año fue de 0,56%, 0,59% y 0,50%, respectivamente, con una tasa acumulada a tres años de 1,65%. La tasa en el Grupo 2 fue de 2,50%, 1,58% y 3,84%, respectivamente (tasa acumulada: 7,92%). El período de tiempo en el cual los pacientes del Grupo 1 mantuvieron un riesgo de EC por debajo de 1% fue de 18 meses. Conclusión: el pronóstico de los pacientes ancianos que presentan un resultado normal en el gated-SPECT es muy bueno, con una tasa de EC menor a 1% por un lapso de 18 meses.

Introduction: a normal result in myocardial perfusion scintigraphy (gated-SPECT) has a high negative predictive value for severe coronary artery disease; there is a period of time in which patients remain with a low event rate (less than 1%). However, some evidence suggests that this guarantee period (PG) is not the same in all age groups. Objectives: to establish the period of time in which elderly patients (older than 70 years) maintain a rate of cardiac events below 1%. Material and methods: 554 patients were studied through gated-SPECT, divided into two groups: Group 1: (n = 354) with normal gated-SPECT, and Group 2: (n = 200) with abnormal gated-SPECT. We define a normal gated-SPECT as that with a stress sum score (SSS) <4 and normal functional parameters. The mean follow-up was 30.6 months (range: 12-62 months), for the investigation of cardiovascular events (CE): cardiac death (CD) and nonfatal infarction (NFAMI), and combined events (CBE): CE + coronary angioplasty, myocardial revascularization surgery and implanted cardiodefibrillator (ICD). Pearson's nonparametric test was used and the Χ2 statistic was calculated, with a value of p <0.05 for the rejection of the null hypothesis (CI: 95%). Results: the comparison between both groups shows differences for the appearance of CE: (p <0.0001), CD: (p <0.0001) and CBE: (p <0.0001). The CE rate in Group 1 for each year was 0.56, 0.59 and 0.50%, respectively, with a cumulative 3-year rate of 1.65%. The rate in Group 2 was 2.5, 1.58 and 3.84%, respectively (cumulative rate: 7.92%). The period in which Group 1 patients maintained a risk of CD below 1% was 18 months. Conclusion: the prognosis of elderly patients presenting a normal gated-SPECT result is very good, with a cardiac event rate of less than 1% for a period of 18 months.

Efectividad de un programa educativo en el incremento de conocimientos sobre la enfermedad coronaria en los pacientes que acuden al Programa de Hipertensión del Hospital Nacional Arzobispo Loayza Lima - 2014 / Effectiveness of an educational program in the increasing of knowledge about coronary disease in the patients who come to the Hypertension Program at the National Hospital Arzobispo Loayza - 2014

Objetivo: Determinar la efectividad de un programa educativo en el incremento de conocimiento sobre la enfermedad coronaria en los pacientes que acuden al programa de hipertensión del Hospital Arzobispo Loayza. Material y Método: El estudio es de Tipo cuantitativo, nivel aplicativo, método cuasi-experimental y de corte transversal. La población estuvo conformada por 30 pacientes pertenecientes al programa de hipertensión. La técnica fue la encuesta y el instrumento un cuestionario el cual fue sometido a juicio de expertos, y aplicado antes y después de la ejecución del programa educativo. Resultados: Del 100 por ciento (30) pacientes, antes del programa educativo, 36 por ciento (11) conocen y 64 por ciento (19) no conoce sobre los principales conceptos de la enfermedad coronaria y su prevención, Después de la participación del programa, 93 por ciento (28) conoce y 7 por ciento (2) no conoce sobre los principales conceptos de la enfermedad coronaria y su prevención. Conclusiones: El programa educativo sobre la enfermedad coronaria fue efectivo en el incremento de conocimientos de los pacientes, luego de la aplicación del programa educativo, el cual fue demostrado a través de la prueba de t de Student, obteniéndose un t calc16.8, con un nivel de significancia de a: 0.05, por lo que se acepta la hipótesis de estudio y se comprueba la efectividad del programa educativo.

Objective: To determine the effectiveness of an educational program in increasing knowledge about coronary disease in patients attending the program Archbishop Loayza Hospital hypertension. Material and Methods: The study is quantitative, application level, quasi-experimental and cross-sectional method. The population consisted of 30 patients in the hypertension program. The technique was the survey instrument and a questionnaire which was submitted to expert opinion, and applied before and after the execution of the educational program. Results: Of 100 per cent (30) patients, before the educational program, 36 per cent (11) know and 64 per cent (19) does not know about the main concepts of coronary disease and its prevention, after program participation, 93 per cent (28) knows and 7 per cent (2) does not know about the main concepts of coronary disease and its prevention. Conclusions: The educational program on coronary disease was effective in increasing knowledge of patients after the implementation of the educational program, which was demonstrated through testing Student t give a t calc16.8 with a significance level a: 0.05, so the study hypothesis is accepted and the effectiveness of the educational program is checked.

Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34+ monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05) and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05). RIPre activated STAT-3 and increased CD34+ endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

Onychomatricoma: a tumor unknown to dermatologists

A sixty-one year old white female was referred to the Dermatology Department to treat an ingrown nail in the inner corner of the left hallux. Examination of the entire nail unit showed the presence of xanthonychia in the outer corner besides thickening and increase in the transverse curvature of the nail plate. Dermoscopy and nuclear magnetic resonance of the free edge of the nail plate detected characteristic signs of onychomatricoma, a diagnosis that was later confirmed by anatomopathological exam.

Nivel de conocimiento sobre autocuidados en pacientes hipertensos que acuden al CAP II de Villa Rica - EsSalud Oxapampa - Pasco 2015 / Level of knowledge about self-care in hypertensive patients attending the C.A.P. II of Villa Rica - EsSalud Oxapampa - Pasco 2015

Las enfermedades cardiovasculares en los últimos años constituyen la primera causa de muerte en países desarrollados y en muchos países del tercer mundo; la hipertensión arterial (HTA) es una de las primeras causas básicas de mortalidad y el principal factor de riesgo para el accidente cerebrovascular y la enfermedad coronaria. El presente estudio titulado "Nivel de conocimiento sobre autocuidado en pacientes hipertensos que acuden al C.A.P. II Villa Rica - 2015". Tiene como objetivo determinar el nivel de conocimiento sobre autocuidado en pacientes hipertensos. Se trata de un estudio nivel aplicativo tipo cuantitativo, método descriptivo de corte transversal. La población fue conformada por 50 pacientes que asisten a al programas de hipertensión arterial Cartera del Adulto Mayor. La técnica fue la encuesta y el instrumento un formulario tipo cuestionario. Se concluyó que la población en estudio del nivel de conocimiento sobre autocuidado en pacientes hipertensos tiene un mediano conocimiento. La hipertensión arterial disminuye la calidad de vida y la supervivencia de la población, por lo que es un reto importante para la salud pública. Para un tratamiento adecuado, es necesario determinar la prevalencia, el tratamiento y control de la hipertensión arterial en las 3 regiones del país, lo que permitirá conocer la realidad nacional y poder aplicar la prevención, método importante y económico difundido en todo el mundo, responsabilidad que pertenece a los organismos de Salud Pública del Estado...

Cardiovascular disease in recent years are the leading cause of death in developed countries and in many third world countries; high blood pressure (hypertension) is one of the first root causes of mortality and major risk factor for stroke and coronary heart disease. This study entitled "Knowledge about self-care in hypertensive patients attending the C.A.P. II Villa Rica - 2015". It aims to determine the level of awareness of self in hypertensive patients. This is a quantitative application level, descriptive method of cross section study. The population was composed of 50 patients attending the hypertension program Portfolio Elderly. The technique was the survey and a questionnaire type instrument form. It was concluded that the study population's level of knowledge about self-care in patients with hypertension have a medium knowledge. Blood pressure diminishes the quality of life and survival of the population, so it is an important public health challenge. For proper treatment, it is necessary to determine the prevalence, treatment and control of hypertension in the 3 regions, which will reveal the national reality and to implement prevention, important and economical method spread worldwide, responsibility organisms belonging to the State Public Health...

Uso oportuno de inmunoglobulinas intravenosas y riesgo de alteraciones coronarias en pacientes con enfermedad de Kawasaki / Early use of immunoglobulin and risk of coronary abnormalities in patients with Kawasaki's disease

La enfermedad de Kawasaki es una vasculitis sistémica de vasos de mediano calibre, que afecta principalmente a las arterias coronarias, provocando dilatación y aneurismas coronarios en un 15 - 25% de los casos no tratados. El tratamiento recomendado actualmente es el uso de inmunoglobulina intravenosa antes del décimo día de enfermedad, lo cual reduce el riesgo de aneurismas coronarios de un 20% a un 4%. Objetivos: Determinar la relación entre el tratamiento oportuno con inmunoglobulina y el riesgo de presentar alteración coronaria en la ecocardi ografía en pacientes con Enfermedad de Kawasaki. Métodos: Se revisó la base de datos de Cardiología Infantil del hospital, identificando 66 pacientes que presentaron la enfermedad entre los años 1994 y 2014. Se determinó el momento en que se inició el tratamiento con inmunoglobulina y se analizó el hallazgo ecocardiográfico de alteraciones coronarias durante el período de hospitalización. Resultados: 52 niños (79%) recibieron tratamiento precoz, antes de 10 días del comienzo de la enfermedad; en el resto el tratamiento fue tardío. El tratamiento precoz se asoció a un menor riesgo de presentar aneurismas coronarios (5.8% vs 50% de los casos, p<0.01). Conclusión: En la enfermedad de Kawasaki es de suma importancia el diagnóstico y tratamiento oportuno con inmunoglobulina intravenosa para reducir el riesgo de formación de aneurismas coronarios.

Kawasaki’s disease is a systemic vasculitis of the mediumsized blood vessels, primarily affecting the coronary arteries, causing coronary dilation and aneurysms in 15 - 25% of untreated children. Use of Intravenous immunoglobulin within the first 10 days of illness is the recommended treatment, redugin the risk of coronary artery aneurysm develo-pment from 20% to 4%. Objective: To determine the association of early treatment to risk of echocardiographic coronary changes on patients with the disease. Methods and Results: A review of the institutional Pediatric Cardiology Database, allowed the identification of 66 patients who had Kawasaki’s disease between 1994 and 2014. The echocardiographic findings at follow up were related to the time of treatment initiation in relation to the beginning of the disease. Treatment with im-munoglobulin within 10 days was associated to coronary artery aneurysms in 5.8% of patients, as opposed to 50% in those with a delayed initiation of therapy. Conclusión: Early treatment with immunoglobulins (within 10 days of illness) significantly reduces the short term risk of developing coronary aneurysms in patients with Kawasaki’s disease.

Recuperando la función endotelial / Recovering endothelial function

La enfermedad ateroesclerótica comienza a temprana edad. La presencia de factores de riesgo, como la hipertensión arterial, tabaquismo, dislipidemia y diabetes mellitus, a lo que hoy se suman la obesidad y el síndrome metabólico, originan desde el inicio disfunción endotelial, incremento del estrés oxidativo e inflamación, con aparición temprana de células espumosas, estrías grasas y placas de ateroma. Placas que en algunos de los casos son consideradas vulnerables, con un riesgo de sufrir erosión y rotura, el fenómeno aterotrombótico y un evento vascular agudo, como el síndrome coronario agudo y el accidente cerebrovascular. Al manejar y tratar los factores de riesgo cardiovasculares, síndrome metabólico, marcadores precoces del riesgo cardiovascular, se podría enlentecer o retardar el envejecimiento (injuria endotelial) de los órganos blanco, probablemente sin reducción de la mortalidad, pero logrando tres enfoques fundamentales con la detección temprana de la aterotrombosis subclínica: prevenir eventos cardiovasculares, brindar protección de los órganos blanco y mejorar la calidad de vida...

Atherosclerosis starts early in life. The presence of risk factors like hypertension, smoking, dyslipidemia and diabetes as well as obesity and metabolic syndrome accelerates its progress. These factors generate endothelial dysfunction, oxidative stress and inflammation, with early appearance of foamy cells, fatty streaks and atheromatous plaques. These plaques are vulnerable to erosion and rupture, the so called atherothrombotic phenomenon, leading to acute vascular events like acute coronary or cerebrovascular syndromes. Managing and treating the metabolic syndrome, early markers of cardiovascular risk, could slow down end organ aging and damage, probably without reduction of mortality but focusing on three fundamental aspects of early detection of subclinical atherothrombosis: prevention of cardiovascular events, protection of end organs, and improvement of quality of life...

South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation / Diretriz Sul-Americana de Prevenção e Reabilitação Cardiovascular

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Com este documento, o Comitê Interamericano de Prevenção e Reabilitação Cardiovascular, em posição conjunta com a Sociedade Sul-Americana de Cardiologia, mostra seu interesse no desenvolvimento de estratégias, medidas e intervenções para a prevenção e a reabilitação cardiovascular. Com o objetivo de implementar na América Latina uma política de saúde regional e nacional dos países membros, tem-se o objetivo de promover a saúde cardiovascular e, consequentemente, diminuir a morbimortalidade. O grupo de estudos em Reabilitação Cardiopulmonar e Metabólica do Departamento de Exercício, Ergometria e Reabilitação Cardiovascular de Sociedade Brasileira de Cardiologia (DERC/SBC) criou uma comissão de experts para revisar a versão em português e adaptá-la à realidade nacional. Este documento tem como missão principal auxiliar os profissionais de saúde a alcançarem medidas efetivas de prevenção e reabilitação cardiovascular (RCV) na prática clínica diária. Com a difusão deste documento, bem como com a sua implementação de forma mais abrangente, contribuiremos com a meta da Organização Mundial de Saúde de diminuir a mortalidade cardiovascular no mundo em 25% até o ano de 2025. As prioridades deste grupo de trabalho são: • Enfatizar o caráter prioritário da RCV como instrumento de prevenção secundária com importante impacto na morbimortalidade cardiovascular; • Unir esforços para melhorar o conhecimento da RCV, sua difusão e aplicação na maioria dos centros e institutos cardiovasculares da América do Sul, priorizando a utilização de um método de prevenção cardiovascular integral, prático, de fácil aplicação e de custo/benefício comprovado; • Melhorar a educação do pessoal da saúde e dos pacientes por meio de programas educativos dirigidos, que permitam envolver diretamente os sistemas de saúde, pessoal médico, pacientes e líderes comunitários sobre a importância dos serviços de RCV, a fim de diminuir as barreiras para a sua implantação.

Doença cardíaca na mulher: porque é diferente? / Woman´s heart - differences that make a difference

Neste artigo, analisamos as diferenças entre mulheres e homens no cenário da doença arterial coronariana. A principal questão é se as mulheres têm o mesmo risco cardiovascular que os homens. Ao longo da história, as diferenças entre homens e mulheres - na doença e na saúde - têm fascinado pesquisadores e médicos. O gênero feminino (XX) e o masculino (XY) diferem em sua genética. Assim, a influência de um cromossomo isolado afeta a expressão da doença, as características e o comportamento psicossociais, podendo proteger ou aumentar a suscetibilidade a doenças cardíacas. Existem muitos mitos sobre a aterosclerose, como, por exemplo, tratar-se de doença de rico, doença de velho ou de homens. Hoje, as doenças cardiovasculares são as principais causas de morte entre as mulheres americanas. Uma em cada três mulheres morre de doenças do coração. É a primeira causa de morte em mulheres, independentemente de raça ou etnia. Elas também ocorrem em idades mais jovens do que a maioria das pessoas pensam, e o risco aumenta na meia-idade. Adicionalmente, dois terços das mulheres que têm ataques cardíacos não se recuperaram totalmente. A incidência de doença cardíaca é dependente da idade em homens e mulheres. Apesar dos avanços no tratamento da aterosclerose e de vários estudos de prevenção secundária terem demonstrado que as drogas, principalmente as estatinas, podem reduzir significativamente os eventos cardiovasculares, incluindo morte coronária, necessidade de revascularização cirúrgica, acidente vascular cerebral, mortalidade total, bem como o infarto do miocárdio fatal e não fatal. Também os estudos de prevenção primária produziram resultados semelhantes, embora a mortalidade total não tenha sido afetada. Adicionalmente, as estatinas também induzem à regressão do ateroma e não causam câncer. No entanto, muitas questões permanecem não resolvidas, como a redução parcial de riscos, custos, vários efeitos colaterais, e uso a longo prazo para os pacientes jovens...

In this article, we analyze the differences between women and men in the setting of coronary artery disease. The main question is whether women are at the same cardiac heart risk as men. Throughout history, the differences between men and women- in sickness and in health - have fascinated researchers and doctors. Female (XX) and male (XY) differ in their genetics. Thus, the influence of an isolated chromosome affects the expression of disease, psychosocial characteristics and behavior, and can protect or increase susceptibility to cardiac heart disease(CHD). There are lots of myths about atherosclerosis, such as that it is a disease of the wealthy, a disease of the elderly or men´s disease. Nowadays, cardiovascular diseases are leading causes of death for American women. One in three women dies from heart disease. It´s the number 1 killer of women, regardles of race or ethnicity. It also strikes women at younger ages than most people think, and the risk rises in middle age. In addition,two-thirds of women who have heart attacks never fully recover. Incidence of cardiac heart disease is age-dependent, in men and women. Despite the advances in treatment of atherosclerosis, several secondary prevention studies have demonstrated that drugs, mainly statins, can significantly reduce cardiovascularevents, including coronary death, the need for surgical revascularization, stroke, total mortality, as well as fatal and non-fatal myocardial infarction. 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...

Medicamentos de ação metabólica: Estatinas, fibratos e antidiabéticos orais / Drugs of metabolic action: Statins, fibrates and oral antidiabetics

A polifarmácia na prática clínica atualmente é necessária paraa obtenção de metas de tratamento mais rigorosas impostas porestudos que vêm demonstrando seus benefícios. O pacienteque apresenta alterações metabólicas está mais suscetível aouso de medicamentos hipolipemiantes e antidiabéticos orais.A interação medicamentosa entre esses e outros fármacosfaz com que devamos nos atentar aos mecanismos de ação,metabolização e excreção dessas drogas...

Multiple drugs used in clinical practice are required to obtain morestrict treatment goals determined by studies that have demonstratedtheir benefits. Metabolic alterations in patients are more likelyto be treated with lipid lowering drugs and oral antidiabetics.We should pay close attention to their rnechanisms of action,metabolism and excretion, due to their interaction with otherdrugs...