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1.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 148-154, abr.-jun. 2019. graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1009485

ABSTRACT

As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil desde o final da década de 1960, a despeito da tendência de queda observada nos últimos anos. A mudança de estilo de vida relacionada à urbanização e globalização, com alta ingestão calórica e menor gasto energético, o rápido aumento da população idosa devido à maior expectativa de vida levaram à maior prevalência de obesidade e dislipidemias e, consequentemente, doenças cardiovasculares e metabólicas. Pesquisas de base populacional, estudos de coorte e de caso e de controle apontam para a importância do crescimento dos fatores de risco e diferenças regionais indicam que as políticas públicas e o atendimento médico devem priorizar intervenções de saúde tendo como objetivo a prevenção e controle dos fatores de risco mais prevalentes em nosso meio. A abordagem terapêutica da obesidade deve incluir não apenas a redução isolada do peso, e sim, atrelada à melhora metabólica ampla que se associe à diminuição do risco de complicações cardiovasculares. De um modo geral, a perda de peso é mais frequentemente alcançada ao longo dos primeiros meses ou do primeiro ano de exposição aos fármacos e embora alguns sejam mais efetivos, eventos adversos são frequentes, limitando o tratamento a longo prazo. O grande avanço e a maior segurança nos últimos anos vieram com o uso de medicamentos antiiperglicemiantes, como análogos de GLP-1, permitindo o uso a longo prazo com manutenção de resultados e adicionando benefícios cardiovasculares. A abordagem terapêutica das dislipidemias no paciente obeso é imperativa para a evolução desse perfil de pacientes, nos quais múltiplos fatores fisiológicos, bioquímicos, metabólicos e clínicos, estão interconectados e diretamente relacionados com aumentos substanciais do risco de diabetes, de doença aterosclerótica cardiovascular e mortalidade por todas as causas


Cardiovascular disease has been the no. 1 cause of death in Brazil since the late 1960s, despite the downtrend observed in recent years. Lifestyle changes related to urbanization and globalization, high calorie intake and lower energy expenditure, combined with a rapidly aging population due to increased life expectancy, have led to a greater prevalence of obesity and dyslipidemia, and consequently, cardiovascular and metabolic diseases. Population-based surveys, cohort and case-control studies underline the importance of the growth of risk factors, and regional differences indicate that public policies and medical care must prioritize health interventions in order to prevent and control the most prevalent risk factors in our country. The therapeutic approach to obesity must include not only weight reduction alone, but also in combination with comprehensive metabolic improvement, which is associated with a reduced risk of cardiovascular complications. In general, weight loss is more frequently achieved in the first few months or first year of exposure to medications, and although some drugs are more effective, adverse events are common, limiting treatment options to long-term therapy. The major advances and greater safety seen in recent years were achieved with the use of anti-hyperglycemic agents such as GLP-1 analogues, enabling long-term use with maintenance of results and adding cardiovascular benefits. The therapeutic approach to dyslipidemia in obese patients is imperative for the progress of this patient population, in which multiple physiological, biochemical, metabolic and clinical factors are interlinked and directly related to substantial increases in the risk of diabetes, atherosclerotic cardiovascular disease, and all-cause mortality


Subject(s)
Humans , Male , Female , Diet , Dyslipidemias/therapy , Obesity/prevention & control , Obesity/therapy , Time Factors , Brazil , Cardiovascular Diseases/mortality , Body Mass Index , Epidemiology , Prevalence , Risk Factors , Atherosclerosis , Overweight/complications , Life Style
2.
Motriz (Online) ; 25(1): e101982, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002699

ABSTRACT

Aim: The aim of the present study was to verify the agreement between the ventilatory method (VT) and the alternative method of heart rate deflection point (HRDP) in determining the anaerobic threshold (AT) during incremental treadmill test in dyslipidaemic patients. Methods: Twenty-seven dyslipidaemic patients (61.50 ± 10.46 years) performed an incremental treadmill test, in which the AT was determined using both methods. Bland-Altman statistics was adopted in order to verify the agreement between the methods. Results: Agreement in AT determination between the VT and HRDP methods was observed (p < 0.05) for heart rate (138.00 ± 23.80 and 136.26 ± 22.18 bpm, respectively), oxygen uptake (31.00 ± 10.33 and 31.00 ± 11.17 ml.kg−1.min−1), and treadmill velocity (7.67 ± 1.71 km.h-1and 8.00 ± 1.75 km.h-1). Conclusion: Our results suggest that the HRDP method can be adopted for the determination of the AT in dyslipidaemic patients, showing agreement with the VT method.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Anaerobic Threshold/physiology , Dyslipidemias/therapy , Heart Rate/physiology , Exercise/physiology
5.
Pesqui. vet. bras ; 36(11): 1121-1126, Nov. 2016. tab, graf, ilus
Article in Portuguese | LILACS (Americas), VETINDEX | ID: biblio-842010

ABSTRACT

O objetivo desse estudo foi avaliar os efeitos do Extrato Aquoso de Amendoim (EAA) no peso, bioquímica sérica e na histologia hepática de ratos Wistar submetidos a dietas normo e hiperlipídicas. A pesquisa foi realizada utilizando 40 ratos Wistar machos, divididos em quatro grupos (n=10): GA (dieta hiperlipídica), GB (dieta hiperlipídica +EAA), GC (dieta normolipídica) e GD (dieta normolipídica +EAA). Após 8 semanas, os animais foram eutanasiados e foram coletadas amostras sanguíneas para a avaliação de dados bioquímicos (Colesterol total e suas frações, triglicerídeos, uréia, creatinina, AST, ALT e glicemia) e fragmentos do fígado para análise histológica. Os animais do grupo GB tiveram um ganho de peso inferior quando comparados ao GA (XGB= versus XGA= p<0,05), já os grupos GC e GD não obtiveram diferenças estatísticas. Os animais que receberam o EAA tiveram uma redução nos níveis de colesterol (XGB= versus XGA= p<0,05 e XGD= versus XGA= p<0,01), dos triglicerídeos (XGB= versus XGA e XGD= versus XGA= p<0,001) e mais discretamente dos níveis de ALT. A glicemia, uréia e creatina permaneceram dentro dos valores de referência. As amostras hepáticas analisadas, dos ratos dos diferentes grupos, não apresentaram alterações histopatológicas. Conclui-se que O EAA apresentou efeitos preventivos sobre o ganho ponderal e dislipidemia.(AU)


The aim of this study was to evaluate the effect of Aqueous Extract from Peanut (EAA) in weight, serum biochemistry and liver histology of Wistar rats with normal hearing and a high fat diet. The survey was conducted using 40 male Wistar rats divided into four groups (n=0): GA (high fat diet), GB (fat diet+EAA), GC (normolipídica diet), and GD (normolipídica diet+EAA). After 8 weeks, the rats were euthanized and blood samples were collected to evaluate biochemical data (total cholesterol and its fractions, triglycerides, urea, creatinine, AST, ALT and glucose) and liver fragments for histological analysis. The animals of the GB group had a lower weight gain when compared with GA (XGB versus XGA= p<0.05), but CG and GD did not obtain statistical differences. The rats that received EAA had a reduction in cholesterol levels (XGB= versus XGA= p<0.05 vs. XGA and XGD= p<0.01), triglycerides (=XGB versus XGA and =XGD versus XGA= p<0,001) and more discreetly ALT levels. Blood glucose, urea and creatine remained within the reference values. Liver samples analyzed, the rats of different groups showed no histopathological changes. In conclusion, the EAA had preventive effects on weight gain and dyslipidemia.(AU)


Subject(s)
Animals , Rats , Arachis/chemistry , Diet, High-Fat/veterinary , Dyslipidemias/therapy , Dyslipidemias/veterinary , Weight Gain , Diet/veterinary
7.
Int. j. cardiovasc. sci. (Impr.) ; 29(3): f:210-l:217, mai.-jun. 2016. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-831783

ABSTRACT

Fundamentos: Dislipidemia e obesidade estão associadas com insuficiente consumo de frutas, verduras e legumes, e com desequilíbrio do estado antioxidante. Objetivos: Avaliar o consumo dietético das vitaminas A, E e C e dos macronutrientes, correlacionando-os com biomarcadores em dislipidêmicos com excesso de peso. Métodos: Foram selecionados indivíduos dislipidêmicos de ambos os sexos, com idade ≥ 20 anos e índice de massa corporal (IMC) ≥ 25 kg/m2. Foram excluídos aqueles em uso de medicamentos anorexígenos e/ou realizando dieta hipoenergética. Analisaram-se as variáveis antropométricas [massa corporal, estatura, circunferência da cintura (CC), IMC] e bioquímicas [colesterol total, HDL-C, LDL-C, triglicerídeos (TGs) e F2-isoprostano plasmático]. Avaliou-se o consumo alimentar pelo questionário de frequência alimentar. Testou-se a normalidade das variáveis pelo teste não paramétrico de Kolmogorov-Smirnov e realizou-se a correlação de Spearman, empregando-se o pacote estatístico SPSS18 com nível de significância de 5%.Resultados: Dos 284 participantes, 264 (93,1%) eram mulheres. As médias do IMC e da CC foram 36,0 ± 5,8 kg/m2 e 106,2 ± 12,7cm, respectivamente. O consumo de vitaminas A e C, carboidratos, proteínas, açúcar, ácidos graxos (AG) saturados e AG trans foi superior às recomendações, enquanto os consumos de vitamina E e AG poli- e monoinsaturados não alcançaram 50% das recomendações. Evidenciou-se correlação negativa entre as seguintes variáveis: vitamina E com LDL-C e colesterol total; açúcar e HDL-C; AG poli-insaturados e colesterol total e LDL-C. Observaram-se correlações positivas entre colesterol dietético, CC e IMC, e entre massa gorda e TGs. Conclusão: Observou-se inadequação no consumo dietético de vitamina E, açúcar, AG poli-insaturados e trans, o mesmo não acontecendo com as vitaminas A e C. Não houve correlação de biomarcadores e variáveis dietéticas com F2-isoprostano plasmático


Background: Insufficient consumption of fruits, vegetables and pulses is associated with dyslipidemia and obesity and with antioxidant status imbalance. Objective: To assess the dietary intake of vitamins A, E and C and of macronutrients, correlating them with biomarkers in dyslipidemic overweight individuals. Methods: Dyslipidemic individuals of both sexes, aged ≥ 20 years, with body mass index (BMI) ≥ 25 kg/m2 were selected. Individuals on anorectic drugs and/or hypocaloric diets were excluded. Anthropometric [body mass, height, waist circumference (WC), BMI] and biochemical variables [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and plasma F2-isoprostane) were assessed. Food intake was assessed using the Food Frequency Questionnaire. Statistical analyses were performed with SPSS 18. Results: Of the 284 participants, 264 (93.1%) were women. Mean BMI and WC values were 36.0 ± 5.8kg/m2 and 106.2 ± 12.7cm, respectively. The intakes of vitamins A and C, carbohydrates, proteins, sugar, saturated and trans fatty acids were above the recommended values; the intakes of vitamin E, polyunsaturated fatty acids, and monounsaturated fatty acids were below 50% of the recommended values. There was a negative correlation between the following variables: vitamin E, LDL-C and TC; sugar and HDL-C; and polyunsaturated fatty acids, TC and LDL-C. Positive correlations were observed between dietary cholesterol, WC and BMI; and between fat mass and triglycerides. Conclusion: Inappropriate intakes of vitamin E, sugar, polyunsaturated and trans fatty acids were observed, but not of vitamins A and C. No correlation of biomarkers and dietary variables was observed with plasma F2-isoprostane


Subject(s)
Humans , Male , Female , Middle Aged , Antioxidants , Cardiovascular Diseases/mortality , Cholesterol/blood , Dyslipidemias/complications , Dyslipidemias/therapy , Obesity/therapy , Vitamins , Blood Chemical Analysis/methods , Body Mass Index , Chronic Disease , Cross-Sectional Studies , Diet/methods , Statistical Analysis , Vitamin A/analysis , Vitamin E/analysis , Waist Circumference
9.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.451-465.
Monography in Portuguese | LILACS (Americas) | ID: biblio-971549
10.
Rev. cuba. plantas med ; 20(3): 290-300, jul.-set. 2015. ilus, tab
Article in Spanish | LILACS (Americas), CUMED | ID: lil-764381

ABSTRACT

INTRODUCCIÓN: la evaluación de plantas con efecto reductor en los lípidos plasmáticos, constituye una herramienta muy valiosa para el control de las dislipidemias. OBJETIVOS: comprobar la efectividad farmacológica como hipolipemiante, de Talinum triangulare (Jacq.) Willd(Talinaceae) y Abelmoschus esculentus moench (Malvaceae), en dos biomodelos de ensayo. MÉTODOS: se utilizó el fruto verde de A. esculentus y hojas frescas de Talinum triangulare. El material vegetal previo secado, se pulverizó para preparar extractos hidroalcohólicos, que una vez rotoevaporados, fueron suspendidos en agua para ser administrados a los modelos experimentales. El efecto hipolipémico de las plantas estudiadas se comprobó, en animales de experimentación, sometidos a dos modelos de inducción de hiperlipidemia; administración de solución de sacarosa al 63 % durante 16 semanas y administración vía intraperitoneal del detergente no iónico Poloxamer 338, durante 48 horas a una dosis de 0,6 g/kg. RESULTADOS: el extracto hidroalcohólico de A. esculentus (400 mg/kg) en el modelo de hiperlipemia por Dieta Rica en Sacarosa, mostró un efecto reductor de triacilglicéridos, superior al ácido nicotínico. En el modelo de hiperlipidemia por inducción con detergente no iónico, el extracto hidroalcohólico de Talinum triangulare (400 mg/kg), manifestó un efecto reductor de colesterol y triacilglicéridos, mayor que el ácido nicotínico y la atorvastatina. CONCLUSIONES: los extracto hidroalcohólicos de A. esculentus y de Talinum triangulare expresaron efectos reductores de triacilglicérios por mecanismos de acción diferentes, superiores al ácido nicotínico en cada caso. El extracto hidroalcohólico de Talinum triangulare manifestó un potente efecto reductor de colesterol mayor que el ácido nicotínico y la atorvastatina.


INTRODUCTION: assessment of plants with low plasmatic lipids effect is a power instrument to dislipidemias control. OBJECTIVES: to establish the pharmacological effectiveness as hipolipidemic agents of Talinum triangulare (Jacq.) Willd (Portulacaceae) and Abelmoschus esculentus Moench (Malvaceae) in two biomodel assays. METHODS: in the present study we have researched the hypolipemic effect of Talinum triangulare (false spinach) and A. esculentus (okra) in experimental animals subjected to two models of hyperlipidemia induction; an intake of 63 % sucrose solution for 16 weeks and an intake of Poloxamer 338 nonionic detergent via intraperitoneal for 48 hours at a dose of 0,6 g/kg. RESULTS: the hydroalcoholic extract of A. esculentus, at a dose of 400 mg/kg showed triacilglicéridos reducing effect greater than nicotinic acid in the model of hyperlipidemia induction by a sucrose-rich diet. In the model of hyperlipidemia by induction with nonionic detergent, the hydroalcoholic extract of Talinum triangulare at a dose of 400 mg/kg, showed a powerful cholesterol and triacilglicéridos lowering effect, greater than nicotinic acid and atorvastatin. CONCLUSIONS: the hydroalcoholic extract of A. esculentus and T. triangulare showed hypotriglyceridemic effect for different action mechanisms, higher than the nicotinic acid, in each case. The extract hidroalcohólico of Talinum triangulare showed a potent hipocholesterolemic effect even more than the nicotinic acid and the atorvastatin.


Subject(s)
Animals , Abelmoschus/drug effects , Plant Preparations/therapeutic use , Dyslipidemias/therapy
11.
Arq. bras. cardiol ; 104(4): 324-331, 04/2015. tab, graf
Article in English | LILACS (Americas) | ID: lil-745737

ABSTRACT

Statin treatment in association with physical exercise practice can substantially reduce cardiovascular mortality risk of dyslipidemic individuals, but this practice is associated with myopathic event exacerbation. This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises. Moderate physical training, in turn, when associated to statins does not increase creatine kinase levels or pain reports, but improves muscle and metabolic functions as a consequence of training. Therefore, it is suggested that dyslipidemic patients undergoing statin treatment should be exposed to moderate aerobic training in combination to resistance exercises three times a week, and the provision of physical training prior to drug administration is desirable, whenever possible.


A associação do tratamento medicamentoso por estatinas com a prática de exercícios físicos pode reduzir substancialmente o risco de mortalidade cardiovascular de indivíduos dislipidêmicos, porém sua realização vem sendo associada à exacerbação de quadros miopáticos. O presente trabalho teve como objetivo apresentar os resultados mais recentes da literatura específica sobre os efeitos da associação de estatinas ao exercício físico na musculatura esquelética. Para tanto, realizou-se levantamento da literatura nas bases de dados PubMed e SciELO, utilizando a combinação dos unitermos: “estatina/estatinas” AND “exercício” AND “músculo” (“statin” AND “exercise” AND “muscle”), sendo selecionados apenas artigos originais publicados entre janeiro de 1990 e novembro de 2013. Foram analisados 16 artigos que avaliaram o efeito da associação das estatinas com exercício agudo ou crônico na musculatura esquelética. Os resultados dos estudos apontaram que atletas podem experimentar efeitos deletérios na musculatura esquelética quando do uso de estatinas, visto que os quadros de exacerbação da lesão muscular pelo exercício foram mais frequentes com treinamento intenso ou exercícios agudos excêntricos e extenuantes. O treinamento físico moderado, por sua vez, quando associado às estatinas, não aumenta os relatos de dor nem os níveis de creatina quinase, além de acarretar ganhos nas funções musculares e metabólicas advindas do treinamento. Sugere-se, portanto, que pacientes dislipidêmicos em tratamento com estatinas sejam expostos ao treinamento físico aeróbio combinado a exercícios resistidos, de intensidade moderada, em três sessões semanais, sendo que a oferta do treinamento físico previamente à administração do tratamento medicamentoso, quando possível, faz-se desejável.


Subject(s)
Humans , Dyslipidemias/therapy , Exercise Therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Muscle, Skeletal/drug effects , Muscular Diseases/chemically induced , Creatine Kinase/physiology , Exercise/physiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Muscle, Skeletal/injuries , Musculoskeletal Pain/chemically induced
12.
Rev. cuba. plantas med ; 20(1): 38-47, ene.-mar. 2015. tab
Article in English | LILACS (Americas), CUMED | ID: lil-753003

ABSTRACT

INTRODUCTION: knowing patients 'believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations. OBJECTIVE: to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among patients with peripheral vascular diseases. METHODS: a survey was performed among patients of the National Institute of Angiology and Vascular Surgery from February through April 2007. The characteristics of the use of plants as medicinal remedies and the names of species considered useful for the treatment of diabetes, arterial hypertension and dyslipidemia were recorded. RESULTS: two hundred and forty five both sex adult volunteers (142 female/103 male), aged 44 to 72 years) were included in the study. More than 80 % of them used medicinal plants at least occasionally and confided on their efficacy to treat different illnesses Fifteen species, mainly Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq.., Morinda citrifolia L., Ocinum sanctum L and Salvia officinalis L, from 11 botanical families, were mentioned by participants. Most patients' claims about plants´ properties have been scientifically supported in some extent, nevertheless, the majority of the pharmacological evidence relays on pre-clinical studies and results of clinical trials are not conclusive. The lack of standardized plant preparations with identified active principles and demonstrated clinical effectiveness are limitations for recommending their therapeutic use. CONCLUSION: this study has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and confirmed that physicians should be aware about the possibility of herb-drug interactions that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice.


INTRODUCCIÓN: el conocimiento tradicional de los pacientes sobre la utilidad de las plantas medicinales puede servir de base para su educación en el uso racional de las preparaciones herbarias. OBJETIVO: caracterizar las plantas que los pacientes con enfermedades vasculares consideran útiles para el tratamiento de la diabetes, la hipertensión y como hipolipemiante. MÉTODOS: se realizó una encuesta a los pacientes del Instituto Nacional de Angiología y Cirugía Vascular entre febrero y abril de 2007. Las características del empleo de las plantas con fines medicinales y los nombres de las especies consideradas útiles para tratar la diabetes, la hipertensión arterial y la dislipidemia fueron tabulados. RESULTADOS: doscientos cuarenta y cinco adultos voluntarios de ambos sexos (142 femeninos/103 masculinos, edad 44 a 72 años) fueron incluidos en el estudio. Más del 80 % de ellos utilizaban las plantas medicinales al menos ocasionalmente y confiaban en su eficacia para tratar diferentes enfermedades. Quince especies, fundamentalmente Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq., Morinda citrifolia L., Ocinum sanctum L. y Salvia officinalis L., pertenecientes a 11 familias botánicas, fueron mencionadas por los participantes en la encuesta. La mayoría de los planteamientos de los pacientes sobre las propiedades de estas plantas tienen algún fundamento científico, sin embargo, las evidencias farmacológicas disponibles son fundamentalmente de tipo pre-clínico y los resultados de los ensayos clínicos efectuados no son concluyentes. La carencia de preparaciones derivadas de plantas estandarizadas, con principios activos identificados y efectividad clínica demostrada, son limitaciones para recomendar su utilización terapéutica. CONCLUSIONES: esta es la primera caracterización del uso de productos de plantas con fines medicinales por pacientes con enfermedades vasculares periféricas, y confirma que los facultativos deben conocer sobre la posibilidad de interacciones planta-medicamento que deben ser diagnosticadas. Esta información ayudaría a la integración de la Fitoterapia a la práctica clínica sustentada científicamente.


Subject(s)
Humans , Plants, Medicinal/drug effects , Peripheral Vascular Diseases/therapy , Dyslipidemias/therapy
13.
Rev. bras. cardiol. (Impr.) ; 27(6): 418-422, nov.-dez. 2014. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-752231

ABSTRACT

Fundamentos: A doença arterial coronariana (DAC) é uma das principais causas de internação no SUS e importante fator de risco para a disfunção ventricular. Os pacientes portadores de DAC são classificados como de alto risco cardiovascular, apresentando metas terapêuticas cada vez mais rigorosas.Objetivo: Avaliar o controle dos fatores de risco tradicionais e metas terapêuticas em pacientes com DAC.Métodos: Foi realizada análise retrospectiva de prontuários de pacientes atendidos no ambulatório da residência médica de uma unidade terciária de saúde, hospital referência em cardiologia na rede pública, no período de abril de 2013 a abril de 2014. Preencheram os critérios de inclusão 110 pacientes.Resultados: Dentre os pacientes incluídos, 68,1% eram do sexo masculino. A média de idade foi 60,1±9,2 anos. Tinham diagnóstico de HAS, 90,9% dos pacientes; 42,7% de DM, 81,8% de dislipidemia (DLP), 25,4% eram tabagistas e 32,7% apresentavam história familiar positiva para DAC. A maior parte (61%) recebeu tratamento clínico mais cirúrgico, seguindo-se o tratamento clínico mais percutâneo (20,9%) e por último o tratamento clínico exclusivo (18,1%). Em relação ao controle de metas, 78,1% estavam com pressão arterial controlada (PAS <140 mmHg e PAD <90 mmHg), 65,4% com TG <150 mg/dL; 87,2% com CT <200 mg/dL; 29,1% com HDL >45 mg/dL; 65,4% com LDL <100 mg/dL; e 27,2% com LDL <70 mg/dL.Conclusão: Apesar de serem pacientes de alta complexidade e alto risco, obteve-se boa resposta no controle pressórico, enquanto no controle da dislipidemia os resultados foram insatisfatórios, o que pode em parte ser explicado pelas opções terapêuticas disponíveis na rede pública de saúde.


Background: Coronary artery disease (CAD) is a major cause of hospitalization in Brazil’s Unified National Health System (SUS) and an important risk factor for ventricular dysfunction. CAD patients are rated as high cardiovascular risks, with increasingly tighter treatment targets.Objective: To assess traditional CAD risk factor controls and treatment targets among CAD patients.Methods: A retrospective analysis was conducted of the medical records of patients seen at the residency outpatient clinic at a tertiary healthcare facility that is a cardiology reference center in the SUS from April 2013 to April 2014. The inclusion criteria were met by 110 patients.Results: Among the included patients, 68.1% were male, with an average age of 60.1±9.2 years; 90.9% were diagnosed with hypertension; 42.7% with DM, 81.8% with dyslipidemia (DLP), 25.4% were smokers and 32.7% had positive family histories of CAD. Most (61%) received surgical and clinical treatment, followed by clinical and percutaneous treatment (20.9%) and finally clinical treatment only (18.1%). Regarding target controls, 78.1% had controlled blood pressure (SBP <140 mmHg and DBP <90 mmHg), 65.4% with TG <150 mg/dL; 87.2% with TC <200 mg/dL; HDL with 29.1%> 45 mg/dL; 65.4% with LDL <100 mg/dL; LDL and 27.2% with <70 mg/dL.Conclusion: Despite being high-complexity and high-risk patients, a good response was obtained only for blood pressure control, while the dyslipidemia control findings were unsatisfactory, which may be partly explained by the treatment options available in the SUS.


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Artery Disease/complications , Coronary Artery Disease/therapy , Risk Factors , Therapeutics/methods , Coronary Angiography/methods , Diabetes Mellitus/therapy , Dyslipidemias/therapy , Epidemiologic Factors , Hypertension/therapy , Observational Study , Tertiary Care Centers
14.
Rev. chil. pediatr ; 85(3): 367-377, jun. 2014. ilus, tab
Article in Spanish | LILACS (Americas) | ID: lil-719145

ABSTRACT

La prevalencia de dislipidemias ha aumentado en niños y adolescentes, muchas de ellas asociadas al incremento de la obesidad. Puesto que constituyen un factor de riesgo cardiovascular futuro, deben conocerse las bases de su tratamiento. En la gran mayoría de los pacientes, éste consiste en cambios de estilo de vida, con dieta específica y aumento de la actividad física, presentando habitualmente una respuesta favorable. Solo una minoría requiere tratamiento medicamentoso, el que debe ser realizado por especialista en el contexto de una evaluación completa del perfil de riesgo cardiovascular, con la inclusión del paciente y su familia. Sin embargo, la prevención de los factores de riesgo cardiovascular debe ser realizada por todos los miembros del equipo de salud. Este artículo presenta las recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría para el diagnóstico, tamizaje y tratamiento de las dislipidemias en la niñez.


The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.


Subject(s)
Humans , Adolescent , Child , Adolescent Nutrition , Child Nutrition , Dyslipidemias/diagnosis , Dyslipidemias/prevention & control , Algorithms , Dyslipidemias/therapy , Cardiovascular Diseases/prevention & control , Hypercholesterolemia , Hypertriglyceridemia , Mass Screening
15.
Rev. peru. med. exp. salud publica ; 31(1): 143-150, ene.-mar. 2014. ilus
Article in Spanish | LILACS (Americas) | ID: lil-705974

ABSTRACT

Recientemente se han publicado en el “Octavo reporte del Joint National Commitee”; la “Guía de hipertensión arterial” y la “Guía de manejo de dislipidemia”. Ambas son basadas en la evidencia y han guiado sus recomendaciones exclusivamente en resultados de ensayos clínicos, dejando de lado, en lo posible, recomendaciones formuladas por expertos. Ambas han introducido cambios metodológicos importantes, en la forma de catalogación y al resumir la evidencia utilizada. La “Guía de hipertensión arterial” ha sido realizada para hacer de ella una guía confiable, tiene como característica resaltante la simplificación de recomendaciones y, la guía misma, es un documento simple, de fácil implementación. Un cambio potencialmente interesante en la guía de dislipidemia constituye el abandono de la meta terapéutica numérica para emplear la modificación del nivel de riesgo, que podría promover una discusión sobre la intensidad del tratamiento, tomando en cuenta las preferencias, y así impulsarr la toma de una decisión compartida.


Updates to the Guidelines for the Management of High Blood Pressure and the Guidelines for the Management of Dyslipidemia have been recently published in the eighth report of the Joint National Committee. Both are evidence-based and rely on clinical trial results, leaving aside, when possible, recommendations made by experts. Both have introduced important methodological changes in the form of cataloging and summarizing the evidence used. The High Blood Pressure Guideline is considered to be a reliable guide; it has simplified recommendations and is easy to implement. A potentially interesting change in the Dyslipidemia Guideline is the abandonment of the numerical therapeutic target in order to use the modification of the level of risk, which could promote a discussion about the intensity of treatment, and initiate shared decision-making.


Subject(s)
Humans , Dyslipidemias/therapy , Hypertension/therapy , Practice Guidelines as Topic/standards
17.
Rev. bras. cir. cardiovasc ; 28(2): 238-247, abr.-jun. 2013. tab
Article in Portuguese | LILACS (Americas), SES-SP | ID: lil-682435

ABSTRACT

OBJETIVO: Demonstrar a eficácia de um programa de otimização da prática clínica em pacientes com doença arterial coronária para prescrição de medicamentos e documentar a prática clínica vigente quanto aos medicamentos e medidas para a mudança do estilo de vida. MÉTODOS: Estudo de corte transversal, seguido de componente longitudinal. Foram incluídos 710 pacientes consecutivos (Fase 1). Após aplicação de ferramentas para melhoria da prática clínica, foram incluídos, após seis meses, 705 pacientes com coleta dos mesmos dados (Fase 2). Foram selecionados aleatoriamente, a partir do primeiro grupo, 318 prontuários para comparação desses mesmos pacientes (Fase 3). RESULTADOS: Comparação entre as Fases 1 e 2: melhora em relação a tabagismo (P=0,019), dislipidemia (P<0,001), hipertensão arterial e atividade física regular (P<0,001). Diferença significativa para inibidores da enzima de conversão da angiotensina - IECA (67,2% vs. 56,8%, P<0,001); antagonistas do receptor da angiotensina II - ARA II (25,4% vs. 32,9%, P=0,002) e betabloqueador (88,7% vs. 91,9%, P=0,047). Comparação entre as Fases 1 e 3: houve redução do peso (P=0,044) e pressão arterial (P<0,001). Em relação à prescrição de medicamentos recomendados, diferença para IECA (64,8% vs. 61,6%, P=0,011) e ARA II (27,0% vs. 31,3%, P=0,035). CONCLUSÃO: Não houve mudança significativa na utilização de medicamentos; entretanto, observou-se melhora significativa em relação ao tabagismo e atividade física na Fase 2; melhora substancial nos níveis de pressão arterial, na comparação tanto entre as Fases 1 e 2 como entre as Fases 1 e 3. A inclusão de enfermeiro treinado para gerenciar o processo foi fundamental. Programas abrangentes de melhoria de qualidade assistencial, provavelmente, devem ser continuados por período de seguimento maior.


OBJECTIVE: To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling. METHODS: Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3). RESULTS: Phase 1 to Phase 2: there were improvement on smoking cessation (P=0.019), dyslipidemia (P<0.001), hypertension and physical activity (P<0.001). There was significant difference on angiotensin converting enzyme inhibitors - ACEI (67.2% vs. 56.8%, P<0.001); angiotensin II receptor blockers - ARB II (25.4% vs. 32.9%, P=0.002) and beta-blocker (88.7% vs. 91.9%, P=0.047). Phase 1 to Phase 3: there was both weight (P=0.044), and blood pressure reduction (P<0.001). There was statistical significant difference on ACEI (64.8% vs. 61.6%, P=0.011) and ARB II (27.0% vs. 31.3%, P=0.035). CONCLUSION: There was no significant change on the evidence-based pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy. Comprehensive programs for clinical practice should be pursued for longer follow-up period.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Disease/prevention & control , Guideline Adherence , Life Style , Secondary Prevention/methods , Cardiovascular Agents/therapeutic use , Coronary Disease/etiology , Cross-Sectional Studies , Dyslipidemias/therapy , Hypertension/drug therapy , Reproducibility of Results , Risk Factors , Smoking Cessation , Time Factors , Treatment Outcome
18.
Medicina (Ribeiräo Preto) ; 46(1)jan.-mar. 2013.
Article in Portuguese | LILACS (Americas) | ID: lil-674890

ABSTRACT

Modelo do Estudo: Estudo retrospectivo. Objetivo do Estudo: Caracterizar as condutas frente às alterações lipídicas e efeitos colaterais durante o tratamento com estatinas em unidades básicas de saúde. Metodologia: Foram analisados os prontuários médicos de mulheres atendidas em uma unidade básica de saúde, dos quais foram obtidos: presença de doenças, medicamentos em uso, tipo e dose de estatina, resultados de exames bioquímicos, queixas osteomusculares, e cessação do uso da estatina, retroagindo as anotações até a consulta médica da prescrição inicial. Resultados: As estatinas prescritas foram sinvastatina e atorvastatina em doses baixas (10-20 mg). As modificações da dose(48,4%) e/ou do tipo (25,4%) ocorreram para adequação do perfil lipídico. Houve redução dos níveis lipídicos sem elevação dos valores de creatina quinase. A cessação de uso do medicamento (30,6%) foi prioritariamente por conta própria (74%), a qual apresentou forte associação com os relatos de desconfortos osteomusculares (Odds Ratio: 6,40[1,53-26,78]). Conclusão: A terapêutica com estatina foi eficaz para redução dos níveis séricos de lipídeos, e os autorrelatos de dor foram subestimados, caracterizando-se como o maior fator limitante da aderência ao tratamento.


Study Model: Retrospective study. Study Objective: To characterize statin treatment management due to lipid alterations and side effects throughout statin treatment in basic healthcare unit. Methods: Medical reports of women from a basic healthcare unit were analyzed, obtaining: disease presence, regular medication prescription, statin type and dosage, biochemical exams results, musculoskeletal complaints, and statin use cessation, going back the information until the medical consultation of first prescription. Results: Prescribed statins were Simvastatin and Atorvastatin at low doses (10-20 mg). Dose(48,4%) and/or type (25,4%) alterations occurred for lipid profile adequacy. Lipid levels were reducedc without creatine kinase elevation. Treatment with drawn (30,6%) was mainly due to their own decision(74%), which was strongly associated with records of musculoskeletal complaints (Odds Ratio: 6,40[1,53-26,78]). Conclusion: Statin treatment was effective in reducing serum lipid levels and self-reported pain was underestimated, characterizing the major limiting factor for treatment adherence.


Subject(s)
Humans , Female , Dyslipidemias/therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Medication Therapy Management , Public Health
19.
Einstein (Säo Paulo) ; 10(4): 526-527, Oct.-Dec. 2012. tab
Article in English | LILACS (Americas) | ID: lil-662482

ABSTRACT

This is a remarkable progress; since the finding of statins, there was no new way of reducing, significantly, cholesterol and LDL fraction. It is also clear that this decrease, by statins, is related to future cardiovascular lesions, being useful in its primary and secondary prophylaxis. The authors presented studies on research to promote the falling of blood cholesterol by means of antibodies, which inhibit the pro-protein PCSK9, as well as agents that act performing the RNA interference. We had two advantages immediately: for patients with myopathy associated with statins, and the fact of being injected every 15 days, that may contribute to better treatment adherence.


Este é um progresso sensível; desde a descoberta das estatinas, não havia novas maneiras de diminuir, de maneira significativa, o colesterol e a fração LDL. Também está claro que essa redução, pelas estatinas, tem relação com futuras lesões cardiovasculares, sendo útil na profilaxia primária e secundária destas. Os autores apresentaram estudos sobre pesquisas para promover a queda do colesterol sanguíneo por meio de anticorpos que inibem a pró-proteína PCSK9, bem como agentes que atuam realizando a interferência no RNA. Duas vantagens se afiguram imediatamente: para pacientes que têm a miopatia relacionada às estatinas e por ser droga injetável a cada 15 dias, o que pode colaborar para maior adesão ao tratamento.


Subject(s)
Humans , Dyslipidemias/therapy , Proprotein Convertases/immunology , Serine Endopeptidases/immunology , Antibodies, Monoclonal/administration & dosage , Clinical Trials as Topic , Cholesterol, LDL/blood , RNA Interference
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