Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 155
Filter
1.
Rev. urug. cardiol ; 36(1): e36104, abr. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1252413

ABSTRACT

La diabetes mellitus es una de las principales causas de morbilidad y mortalidad a nivel mundial. Este grupo de pacientes generalmente representa una población con alto o muy alto riesgo cardiovascular, razón por la cual se realiza una estratificación precoz del riesgo, buscando enfocarse objetivamente en el abordaje farmacológico y no farmacológico con una estrategia intensiva. La enfermedad cardiovascular representa la principal causa de mortalidad, pero en los últimos años se han producido avances en la terapéutica que han demostrado reducir los eventos cardiovasculares mayores. Este artículo revisa la interacción entre diabetes, enfermedades cardiovasculares y su tratamiento.


Diabetes mellitus is one of the main causes of morbidity and mortality worldwide. This group of patients generally represents a population with high or very high cardiovascular risk, that is the reason for an early stratification of risk, seeking to objectively focus on pharmacological and non-pharmacological approach with an intensive strategy. Cardiovascular disease represents the main cause of mortality, but in recent years there have been advances in therapeutics that have been shown to reduce major cardiovascular events. This article reviews the interaction between diabetes, cardiovascular diseases and their treatment.


A diabetes mellitus é uma das principais causas de morbimortalidade em todo o mundo. Esse grupo de pacientes geralmente representa uma população com alto ou muito alto risco cardiovascular, razão pela qual se estratifica precocemente o risco, buscando enfocar objetivamente a abordagem farmacológica e não farmacológica com estratégia intensiva. A doença cardiovascular representa a principal causa de mortalidade, mas nos últimos anos houve avanços na terapêutica que mostraram reduzir os eventos cardiovasculares maiores. Este artigo analisa a interação entre diabetes, doenças cardiovasculares e seu tratamento.


Subject(s)
Humans , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Diabetes Complications , Diabetes Mellitus/diagnosis , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/adverse effects , Biomarkers , Cardiovascular Diseases/etiology , Risk Assessment , Diabetes Mellitus/epidemiology
2.
Chinese Medical Journal ; (24): 2656-2665, 2021.
Article in English | WPRIM | ID: wpr-921224

ABSTRACT

OBJECTIVE@#Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression.@*DATA SOURCES@#The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science.@*STUDY SELECTION@#Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article.@*RESULTS@#We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient.@*CONCLUSIONS@#Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Depression/drug therapy , Humans , Hypertension/drug therapy , Renin-Angiotensin System
5.
Geriatr., Gerontol. Aging (Impr.) ; 14(3): 196-202, 30-09-2020.
Article in English, Portuguese | LILACS | ID: biblio-1128391

ABSTRACT

OBJETIVO: Analisar a existência de informações, em bulas destinadas aos profissionais de saúde, sobre precaução de uso de medicamentos cardiovasculares em idosos. METODOLOGIA: Trata-se de estudo documental realizado por meio de análise de dados contidos em bulas de medicamentos. Analisou-se a existência, na bula, de informações sobre precauções no uso de medicamentos para idosos, conforme descrito no Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016. RESULTADOS: Dos 29 medicamentos pertencentes ao grupo do sistema cardiovascular que devem ser evitados por idosos e estão disponíveis no Brasil, 15 independem da condição clínica prévia do paciente para que sejam vetados para os idosos. Desses 15, apenas 3 medicamentos (20%) têm informações explícitas concordantes com o Consenso (metildopa, digoxina e espironolactona); 2 (13,33%) têm informações explícitas ausentes; 4 (26,66%) têm informações explícitas discordantes; e 6 bulas (40%) foram categorizadas como informações não explícitas. Quanto às precauções dos medicamentos de acordo com a condição clínica do paciente, incluíram-se 14 medicamentos que devem ser evitados por idosos e estão disponíveis no Brasil. Destes, 12 (85,71%) têm em suas bulas recomendações concordantes com o Consenso, porém não explícitas, e 2 (14,28%) não têm as contraindicações. CONCLUSÕES: A maioria das bulas carece de informações sobre precauções de uso de medicamentos para a população idosa.


OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.


Subject(s)
Humans , Aged , Drug Prescriptions , Cardiovascular Agents/administration & dosage , Medicine Package Inserts , Potentially Inappropriate Medication List , Cardiovascular Diseases/drug therapy , Health of the Elderly , Age Factors , Pharmacovigilance
6.
Evid. actual. práct. ambul ; 23(2): e002058, 2020. tab
Article in Spanish | LILACS | ID: biblio-1103846

ABSTRACT

Ciertos hallazgos preclínicos generaron preocupación en la comunidad científica y en la población general sobre el uso de inhibidores de la enzima convertidora de angiotensina (IECA) y los antagonistas del receptor de la angiotensina II (ARAII), y los posibles desenlaces adversos asociados con relación a la infección por el nuevo Coronavirus (SARS-Cov-2).Por este motivo, nos planteamos como objetivo proveer de recomendaciones dinámicas (living recommendations) para el tratamiento con fármacos IECA o ARA II en pacientes con riesgo o documentación de infección por SARS-CoV-2 (en todo su espectro de gravedad). Se utilizó como metodología la adaptación/adopción de guías de práctica clínica bajo el enfoque GRADE, actualizando la evidencia al 7 de abril de 2020 mediante búsquedas en múltiples bases de datos y consultando a un panel multidisciplinario libre de conflictos de interés. Como resultado de este proceso se arribó a la siguiente afirmación: se recomienda, en contexto de la pandemia de COVID-19, en personas que se encuentran en tratamiento con IECA/ARAII, mantener el tratamiento sin cambios por sobre suspenderlo o reemplazarlo por otros fármacos (Recomendación fuerte a favor - calidad de evidencia baja). (AU)


Certain preclinical findings raised concerns in the scientific community and in the general population about the use ofangiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) and the possible adverse outcomes associated with the infection with the new Coronavirus (SARS-Cov-2). For this reason, our objective is to provide living recommendations for treatment with ACEI or ARA in patients with risk or documentation of SARS-CoV-2 infection (inall its severity spectrum). The adaptation/adoption of clinical practice guidelines under the GRADE approach was used as a methodology, updating the evidence as of April 7, 2020, by searching multiple databases and consulting a multidisciplinary panel free of conflicts of interest. As a result of this process, the following statement was reached: it is recommended, in the context of the COVID-19 pandemic, in people who are undergoing treatment with ACEI/ARA, to maintain the treatment unchanged instead of its suspension or replacement with other drugs (Strong recommendation in favor - low quality ofevidence). (AU)


Subject(s)
Humans , Male , Female , Adult , Young Adult , Pneumonia, Viral/complications , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Coronavirus Infections/complications , Angiotensin II Type 2 Receptor Blockers/pharmacology , Antihypertensive Agents/pharmacology , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Cardiovascular Diseases/drug therapy , Surveys and Questionnaires , Practice Guidelines as Topic , Risk Assessment , Evidence-Based Medicine , Diabetes Mellitus/drug therapy , Renal Insufficiency, Chronic/drug therapy , Angiotensin II Type 2 Receptor Blockers/adverse effects , Pandemics , Clinical Decision-Making , Betacoronavirus/drug effects , GRADE Approach , Antihypertensive Agents/adverse effects
7.
Braz. arch. biol. technol ; 63: e20180687, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142497

ABSTRACT

Abstract Glucosamine is known as anti-inflammatory, antioxidant and as neuroprotective as well as using to treat many of diseases. This work aimed to investigate the remedial effect of glucosamine (20mg/kg b.wt) against the damage induced by a single dose of γ-radiation (8Gy) or aluminium chloride (AlCl3) (100mg/kg b.wt) in the heart and brain tissues of female rats. Serum aspartate aminotransferase (AST), cholesterol, triglycerides (TGs), LDH and creatine kinase (CPK) were measured. Moreover, gene expression of amyloid protein precursor (APP) and seladin-1 were estimated in the brain tissue. Also, acetylcholinesterase activity (AChE) and p-tau protein expression were estimated in brain homogenate. Metallothioneine (MT) was estimated in the heart and brain tissues. Heart and brain histopathological examination was performed. Irradiation significantly decreased serum AST, CPK and LDH, as well as MT levels in heart and brain tissues. Also, gene expression of seladin-1 decreased. On the other hand, irradiation significantly increased serum TGs level and brain AchE activity, tau protein, and β-amyloid percursor (APP). AlCl3 administration (21 days) induced disturbance in most of the estimated parameters, especially AST, TGs, and MT. Glucosamine treatment with irradiation or AlCl3 improved most of the measured parameters. In addition, histopathological examination confirmed the biochemical results. In conclusion: Glucosamine could be used to improve the heart and brain damages induced by γ-radiation exposure or AlCl3.


Subject(s)
Animals , Female , Rats , Brain Diseases/drug therapy , Cardiovascular Diseases/drug therapy , Radiation Exposure/adverse effects , Aluminum Chloride/adverse effects , Glucosamine/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Brain Diseases/etiology , Brain Diseases/pathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/pathology , Polymerase Chain Reaction , Rats, Wistar , Disease Models, Animal
8.
Article in English | WPRIM | ID: wpr-881036

ABSTRACT

Cardiovascular disease is the main cause of mortality and morbidity in the world, especially in developing countries. Drug therapy is one of the main ways to treat cardiovascular diseases. Among them, great progress has been made in the treatment of cardiovascular diseases with traditional Chinese medicine. In terms of experimental research, the mechanism of traditional Chinese medicine in the treatment of cardiovascular diseases has been thoroughly discussed in vitro and in vivo. In terms of clinical treatment, traditional Chinese medicine with flavonoids, saponins and alkaloids as the main effective components has a definite effect on the treatment of cardiovascular diseases such as arrhythmia, myocardial ischemia, angina pectoris and myocardial infarction, with high safety and good application prospects. With the further research on the effective ingredients, mechanism and adverse reactions of traditional Chinese medicine, it will be beneficial to the effectiveness of traditional Chinese medicine, reduce side effects and promote the modernization of traditional Chinese medicine. Calycosin and its derivatives, the main bioactive flavonoids in Astragalus membranaceus have multiple biological effects, such as antioxidant, pro-angiogenesis, anti-tumour, and anti-inflammatory effects. Based on the above biological effects, calycosin has been shown to have good potential for cardiovascular protection. The potent antioxidant effect of calycosin may play an important role in the cardiovascular protective potential. For injured cardiac myocytes, calycosin and its derivatives can alleviate the cell damage mainly marked by the release of myocardial enzymes and reduce the death level of cardiac myocytes mainly characterized by apoptosis through various mechanisms. For vascular endothelial cells, calycosin also has multiple effects and multiple mechanisms, such as promoting vascular endothelial cell proliferation, exerting vasodilating effect and directly affecting the synthesis function of endothelial cells. The present review will address the bioactivity of calycosin in cardiovascular diseases such as protective effects on cardiac myocytes and vascular endothelial cells and elucidate main mechanism of calycosin and its derivatives to exert the above biological effects.


Subject(s)
Apoptosis/drug effects , Cardiotonic Agents/pharmacology , Cardiovascular Diseases/drug therapy , Cell Proliferation/drug effects , Drugs, Chinese Herbal/pharmacology , Humans , Isoflavones/pharmacology , Medicine, Chinese Traditional , Muscle Cells/drug effects
9.
Arch. cardiol. Méx ; 89(4): 324-329, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1149090

ABSTRACT

abstract Objective: Oral antiplatelet drugs are a key to modern pharmacotherapy in cardiovascular atherothrombotic diseases. Clopidogrel (CLO) constitutes the main preventive treatment of atherothrombosis. However, a considerable inter-individual variation in CLO response has been documented, resulting in suboptimal therapy and an increased risk of recurrent adverse effects in some patients. The enzyme CYP2C19 has been reported to be the CYP isoform that activates CLO to its active metabolite. Several single nucleotide polymorphisms in the CYP2C19 gene have been identified as strong predictors of CLO-impaired pharmacological response. At least 16 variants have been associated with changes in CYP2C19 activity. Materials and Methods: The following research was composed of a total of 102 subjects with high cardiovascular risk in the northeast of Mexico, with a maintenance dose of 75 mg of CLO per day. The platelet reactivity was measured with VerifyNow P2Y12 assay, while the presence of CYP2C19*2 was identified by real-time polymerase chain reaction. Results: Patients were categorized by CYP2C19 metabolizer status based on *2 genotypes using the common consensus star allele nomenclature as normal metabolizer (G/G), intermediate metabolizer (G/A), and poor metabolizer (A/A), respectively. The phenotype frequency for CYP2C19*2 was 74.5% (G/G), 21.6% (G/A), and 3.9% (A/A). The subjects with the A allele presented ≥235 P2Y12 reaction unit levels, classifying them how poor metabolizer. The prevalence of reduced CLO effectiveness was associated with the presence of CYP2C19*2 polymorphism among Mexican patients. Conclusion: The presence of the CYP2C19*2 allele is related to resistance to the antiplatelet effect of CLO (p = 0.003).


Resumen Objetivo: Los antiplaquetarios orales son clave en la farmacoterapia moderna de las enfermedades aterotrombóticas cardiovasculares. Clopidogrel (CLO) constituye el principal tratamiento preventivo de aterotrombosis (AT). Sin embargo, se ha documentado una considerable variación interindividual en la respuesta a CLO, lo que da como resultado una terapia subóptima y mayor riesgo de efectos adversos en algunos pacientes. La enzima CYP2C19 es la isoforma CYP que activa CLO a su metabolito activo. Se han identificado varios polimorfismos de un solo nucleótido en el gen CYP2C19 como fuertes predictores de respuesta farmacológica alterada a CLO. Al menos 16 variantes se han asociado con cambios en la actividad de CYP2C19. Método: Se reclutaron un total de 102 sujetos con alto riesgo cardiovascular del noreste de México, con dosis de mantenimiento de 75 mg de CLO/día. La reactividad plaquetaria se midió con el ensayo Verify Now P2Y12, la presencia de CYP2C19*2 se identificó mediante polymerase chain reaction en tiempo real. Resultado: Los pacientes fueron clasificados por el estado metabolizador CYP2C19*2 utilizando nomenclatura consenso, como metabolizador normal (G/G), metabolizador intermedio (G/A) y metabolizador pobre (A/A), respectivamente. La frecuencia del fenotipo para CYP2C19*2 fue 74.5% (G/G), 21.6% (G/A) y 3.9% (A/A). Los sujetos con alelo A presentaron ≥235 niveles P2Y12 reaction unit, clasificándolos como metabolizadores deficientes. La prevalencia de eficacia reducida a CLO se asoció con la presencia del polimorfismo CYP2C19*2 en pacientes mexicanos. Conclusiones: La presencia del alelo CYP2C19*2 se relaciona con resistencia al efecto antiagregante plaquetario del CLO (p = 0.003).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Platelet Aggregation Inhibitors/administration & dosage , Cardiovascular Diseases/drug therapy , Cytochrome P-450 CYP2C19/genetics , Clopidogrel/administration & dosage , Drug Resistance/genetics , Platelet Aggregation Inhibitors/pharmacology , Cardiovascular Diseases/physiopathology , Risk Factors , Polymorphism, Single Nucleotide , Alleles , Clopidogrel/pharmacology , Mexico
10.
Rev. Assoc. Med. Bras. (1992) ; 65(1): 70-86, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-985001

ABSTRACT

SUMMARY The prevalence of type 2 diabetes mellitus (T2DM) in the elderly grew sharply over the last decade. Reduced insulin sensitivity and secretory capacity, weight gain, sarcopenia, and elevated adiposity are all common metabolic and body changes in the aging population that favor an increased risk of hypoglycemia, frailty syndrome, falls, and cognitive dysfunction. First line antidiabetic therapy is frequently not safe in older individuals because of its high risk of hypoglycemia and prevalent co-morbid diseases, such as chronic kidney disease, osteoporosis, cardiovascular disease, and obesity. Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a new class of antidiabetic therapy that inhibits glucose and sodium reabsorption on renal proximal convoluted tubule. Its effect is well demonstrated in various clinical scenarios in the younger population. This review and metanalysis describe particularities of the SGLT2i on the elderly, with mechanistic insights of the potential benefit and remaining challenges about the use of these drugs in this important age group. Further, we will present a meta-analysis of the main effects of SGLT2i reported in post-hoc studies in which the median age of the subgroups analyzed was over 60 years. Despite the absence of specific clinical trials for this population, our findings suggest that SGLT2i therapy on older individuals is effective to lower glucose and maintain its effect on systolic blood pressure and body weight.


RESUMO A prevalência da diabetes mellitus tipo 2 em idosos cresceu muito na última década. A redução na sensibilidade à insulina e na capacidade secretora, ganho de peso, sarcopenia e adiposidade elevada são todas alterações metabólicas e corporais comuns entre a população idosa. Essas mudanças críticas favorecem o aumento no risco de hipoglicemia, síndrome de fragilidade, quedas e disfunções cognitivas. A primeira linha de tratamento contra a diabete muitas vezes não é segura para indivíduos mais velhos devido ao alto risco de hipoglicemia e a prevalência de comorbidades patogênicas, como doença renal crônica, osteoporose, doença cardiovascular e obesidade. Os inibidores do cotransportador sódio-glicose 2 (SGLT2) são uma nova classe de tratamento contra a diabete que inibe reabsorção de glicose e sódio na parte convoluta do túbulo proximal. Seu efeito é claramente demonstrado em diversos cenários clínicos em populações mais jovens. Esta revisão e meta-análise descreve as particularidades dos SGLT2 na população idosa, abordando os mecanismos dos potenciais benefícios e desafios ainda presentes do uso destes medicamentos nesse grupo etário tão importante. Além disso, apresentaremos uma meta-análise dos principais efeitos dos SGLT2 encontrados em estudos post-hoc nos quais a idade média dos subgrupos analisados foi acima de 60 anos. Apesar da ausência de ensaios clínicos que incluem essa população, os dados encontrados sugerem que o tratamento com SGLT2 em idosos é eficaz para diminuir os níveis de glicose e tem efeitos na pressão arterial sistólica e no peso corporal.


Subject(s)
Humans , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Hypoglycemic Agents/therapeutic use , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/drug therapy , Risk Factors , Frail Elderly , Diabetes Mellitus, Type 2/metabolism , Insulin/metabolism , Middle Aged
12.
São Paulo; s.n; s.n; 2019. 236 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1007591

ABSTRACT

INTRODUÇÃO: As doenças cardiovasculares (DCV) aparecem em primeiro lugar entre as principais causas de mortalidade no mundo, representando 46,2% do total de mortes, número muito próximo aos encontrados no Brasil, impactando os gastos com saúde. A prevenção baseia-se em estilo de vida saudável, contudo, uma vez instaladas, é consenso o tratamento medicamentoso com estatinas. Alguns tratamentos alternativos vêm sendo estudados como o ômega-3 (w-3) na prevenção das DCV. Apesar das evidências clínicas favoráveis, não existem muitos estudos acerca da viabilidade econômica de tais tratamentos. OBJETIVO: Avaliar o custo-efetividade das intervenções com w-3 isolado ou associado às estatinas na redução dos fatores de risco cardiovascular sob a perspectiva do Sistema Único de Saúde (SUS). MATERIAL E MÉTODOS: Para avaliar a efetividade do w-3 isolado e combinado com estatina foram utilizados os dados secundários do ensaio clínico CARDIONUTRI no momento basal e após 8 semanas. A amostra foi composta por 186 indivíduos com idade entre 30 e 74 anos divididos entre aqueles que não tomavam medicação e os que tomavam estatinas. Aleatoriamente, uma parcela deles recebeu cápsulas de 1 g de w-3 (37% de ácido eicosapentaenoico e 23% de docosaexaenoico) ou cápsulas de placebo. A recomendação era de que todos deveriam tomar 3 cápsulas ao dia, totalizando 3g/dia (de w-3 ou placebo) durante 8 semanas. Ao final, obteve-se quatro grupos: a) w-3; b) placebo; c) w-3 + estatina; e d) estatina. Para a avaliação do impacto foi usado o método Diferenças em Diferenças com a adição de variáveis de controle: densidade calórica do consumo alimentar, Índice de Massa Corporal (IMC), prática de atividade física, idade, sexo, raça, hábito tabagista, escolaridade e grau de adesão. Os custos dos tratamentos foram estimados com base no custo médio ponderado pelas probabilidades das eventuais intercorrências relacionadas a efeitos adversos e de sucesso e fracasso por meio do método da árvore de decisão. Foi considerado para fins do cômputo dos custos o período de 2 meses de tratamento. RESULTADOS: Nos quatro grupos, a maioria eram mulheres, obesas e com escore de risco muito alto para DCV. Os grupos w-3 e placebo possuíam maior escolaridade e renda comparadas a aqueles que tomavam estatinas. Todas as variáveis de controle foram estatisticamente significantes em pelo menos um dos modelos, exceto raça. A suplementação com w-3 associada às estatinas mostrou efetividade sobre HDLPEQUENA, com diminuição de 2,211 mg/dL e custo-efetividade de R$ 109,31 por redução em mg/dl da lipoproteína em 2 meses de tratamento. CONCLUSÃO: O tratamento com 1,8g de óleo de peixe isolado ou associado às estatinas em intervenção primária não evidenciou efeitos significativos nas mudanças dos parâmetros lipídicos, exceto no caso da HDLPEQUENA com o tratamento associado, mostrando não ser custo-efetivo na redução dos fatores de risco cardiovascular em geral. Em virtude da existência de controvérsias acerca de seus potenciais efeitos, sugere-se que os ensaios clínicos utilizem métodos estatísticos mais robustos para avaliar o impacto líquido da suplementação


INTRODUCTION: Cardiovascular diseases (CVD) are among the leading causes of death worldwide, accounting for 46.2% of all cases, very close to those found in Brazil, impacting health expenses. Current prevention is based on a healthy lifestyle, and once a CVD diagnosis is made, the current consensus is drug treatments with statins. Some alternative treatments such as omega-3 (w-3) have been studied in the prevention of these diseases. However, despite favorable clinical evidence, there are not many studies of economic viability of this treatment. OBJECTIVE: To evaluate the cost-effectiveness of interventions with w-3 alone or associated with statins in reducing cardiovascular risk factors from the perspective of the Unified Health System (SUS). METHODS: To assess the effectiveness of w-3 alone and its combination with statin, the secondary data of the classic lipid profile and lipoprotein size of the CARDIONUTRI clinical trial were used at baseline and after 8 weeks. The sample consisted of 186 subjects aged 30 to 74 years randomly received capsules containing 3g of w-3 per day (37% of eicosapentaenoic acid and 23% of docosahexaenoic acid) or 3g of mineral oil (placebo). Capsules were randomly assigned to individuals who were not taking medication or were already taking statins, separated into four groups: a) w-3; b) placebo; c) w-3 associated with statins; d) statins. Data analysis was conducted using the Difference in Differences statistical method with the addition of control variables: caloric density of food consumption, Body Mass Index (BMI), physical activity practice, age, sex, race, smoking, educational level and adherence to the treatment. The treatment costs were estimated based on the weighted average cost by the probabilities of the eventual intercurrences related to adverse effects and of success and failure by means of the decision tree method elapsed in 2 months of treatment. RESULTS: In all four groups, the majority were women, obese and with a very high-risk score for CVD. W-3 and placebo groups had higher educational level and income compared to those who were already taking statins. All control variables were statistically significant in at least one of the models except race. W-3 supplementation showed efficacy on HDLSMALL among those who consumed w-3 + statins with a reduction of 2,211 mg /dL and cost-effectiveness R$ 109.31 per mg/dL for 2 months of treatment. CONCLUSION: The treatment with 1.8g of fish oil isolated or associated with statins in primary intervention did not show significant effects on changes in lipid parameters except HDLSMALL of interventions associated with statins. Therefore it was not cost-effective in reducing cardiovascular risk factors. Due to the existence of controversies about its potential effects, it is suggested that clinical trials use more robust statistical methods to assess the net impact of supplementation


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cardiovascular Diseases/drug therapy , Fatty Acids, Omega-3/analysis , Cost-Benefit Analysis , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology
14.
Revista Digital de Postgrado ; 8(3): e181, 2019. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1094886

ABSTRACT

La Insuficiencia Cardíaca (IC) es una entidad clínica de gran importancia, por su elevada incidencia y mortalidad, por ende la inquietud de realizar constantes y actualizadas revisiones para optimizar su tratamiento y así impactar la morbimortalidad de los pacientes. Objetivo: analizar críticamente la literatura médica, en el tratamiento farmacológico de la insuficiencia cardíaca para ofrecer una mejor calidad de vida al paciente. Métodos: investigación documental a través de la revisión sistemática de artículos primarios en revistas científicas en bases de datos bibliográficas en ciencias de la salud: Pub Med, Google Académico, Elsevier, ScienceDirect, Biblioteca Virtual en Salud (BVS) OPS y Scielo, entre los años de 2014 y 2018, para ello se determinaron los siguientes descriptores: insuficiencia cardiaca, tratamiento, desafíos, calidad de vida. Se revisaron 28 artículos digitales actualizados y cotejados. Resultados: En el tratamiento actual de la insuficiencia cardiaca, prevalece la combinación Sacubitril/Valsartán, ya que disminuye el riesgo de muerte cardiovascular en un 20% y de hospitalización en 21%; además, disminuye los efectos adversos en relación al tratamiento convencional con (IECA). Conclusión: Las nuevas terapias farmacológicas en insuficiencia cardíaca, permiten sustituir las terapias convencionales y optimizar calidad de vida(AU)


Heart Failure (HF) is a clinical entity of great importance, due to its high incidence and mortality, therefore the concern of conducting constant and updated reviews to optimize their treatment and thus impact the morbidity and mortality of patients. Objective: to critically analyze the medical literature, in the pharmacological treatment of heart failure to offer a better quality of life to the patient. Methods: documentary research through the systematic review of primary articles in scientific journals in bibliographic databases in health sciences: Pub Med, Google Scholar, Elsevier, ScienceDirect, Virtual Health Library (VHL) PAHO and Scielo, among the years of 2014 and 2018, for this the following descriptors were determined: heart failure, treatment, challenges, quality of life. 28 updated and collated digital articles were reviewed. Results: In the current treatment of heart failure, the Sacubitril / Valsartan combination prevails, since it reduces the risk of cardiovascular death by 20% and hospitalization by 21%; In addition, it reduces adverse effects in relation to conventional treatment with (ACEI). Conclusion: the new pharmacological therapies in heart failure, allow to replace conventional therapies and optimizing quality of life(AU)


Subject(s)
Humans , Cardiovascular Diseases/mortality , Cardiovascular Diseases/drug therapy , Heart Failure/mortality , Heart Failure/drug therapy , Quality of Life/psychology , Echocardiography/methods , Risk Factors
15.
Säo Paulo med. j ; 136(6): 557-570, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-991692

ABSTRACT

ABSTRACT BACKGROUND: Risks regarding hospital admission due to adverse drug reactions and drug interactions from use of omeprazole have been reported. The question guiding the present review was "Which adverse events occur in patients using omeprazole in a Food and Drug Administration-approved and/or off-label manner?" It was also proposed to evaluate the safety of use of omeprazole. DESIGN AND SETTING: Qualitative narrative review with critical evaluation, in a public university. METHODS: The PubMed, SCOPUS, LILACS, SciELO, EMBASE and EBSCO databases were searched on July 31, 2018. Studies evaluating adverse events were screened. RESULTS: 72 articles were included, among which 58 reported on adverse drug events (47, adverse drug reactions; 5, drug interactions; and 6, situations of ineffectiveness). 28 adverse drug reactions not described in compendia and drug leaflets were described in these studies: myocardial infarction (6); stroke (2); spontaneous abortion (1); proliferative changes (1); chills (1); heart failure (1); thrombosis (2); and dementia (1), among others. Severe adverse reactions, for instance cardiac problems, Steven-Johnson syndrome and proliferative changes, were identified. The antiplatelet effects of drugs such as clopidogrel, in patients who underwent heart-related surgery, increased the risk of developing cardiac problems, such as cardiovascular death, myocardial infarction and stroke. In newly transplanted patients, decreased absorption of mycophenolate mofetil occurred, thus leading to rejection of transplanted organs. CONCLUSION: Use of omeprazole should be monitored primarily in patients with heart disorders using antiplatelet agents concomitantly, and in newly transplanted patients using mycophenolic acid, in order to avoid serious adverse reactions.


Subject(s)
Humans , Peptic Ulcer/drug therapy , Omeprazole/adverse effects , Proton Pump Inhibitors/adverse effects , Platelet Aggregation Inhibitors , Cardiovascular Diseases/drug therapy , Case-Control Studies , Randomized Controlled Trials as Topic , Cross-Sectional Studies , Cohort Studies , Treatment Outcome , Risk Assessment , Drug Interactions
18.
Gac. méd. boliv ; 41(1): 71-74, jun. 2018. ilus, graf, map, tab
Article in Spanish | LILACS, LIBOCS | ID: biblio-953627

ABSTRACT

La cardiomiopatía inducida por estrés o Síndrome de Takotsubo se caracteriza por una disfunción aguda del ventrículo izquierdo caracterizado por acinesia o discinesia apical con hipercinesia basal a menudo reversible, en ausencia de obstrucción coronaria en la angiografía. La presentación clínica se asemeja al del Infarto Agudo de Miocardio; con un inicio súbito caracterizado por dolor precordial de tipo isquémico, disnea, palpitaciones, cambios electrocardiográficos, elevación de biomarcadores de necrosis miocárdica y en casos más graves y raros shock cardiogénico; el estrés emocional y físico severo suelen ser desencadenantes. Con el presente caso clínico, revisamos las características clínicas, diagnósticas y terapéuticas de ésta entidad poco frecuente que representa cerca del 1% de todos los pacientes con sospecha de síndrome coronario agudo.


Cardiomyopathy induced by stress or Takotsubo Syndrome is characterized by an acute dysfunction of the left ventricle characterized by apical akinesia or dyskinesia with often reversible basal hyperkinesia, in the absence of coronary occlusion on angiography. The clinical presentation resembles the Acute Myocardial Infarction, with a sudden onset characterized by a chest pain angina type, dyspnea, palpitations, electrocardiographic changes, elevation of cardiac biomarkers and cardiogenic shock in more serious and rare cases; the severe emotional and physical stress tend to be triggers. With this clinical case, we reviewed the clinical, diagnostic and therapeutic features of this rare entity which represents about 1% of all patients with suspected acute coronary syndrome.


Subject(s)
Humans , Stress, Psychological , Takotsubo Cardiomyopathy/diagnosis , Cardiovascular Diseases/drug therapy
SELECTION OF CITATIONS
SEARCH DETAIL