Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Síndrome metabólica, aterosclerose e inflamação: tríade indissociável? / Metabolic syndrome, atherosclerosis and inflammation: an inseparable triad?

Observa-se, nas populações mundiais, aumento do sedentarismo e aumento do consumo de gorduras e açúcares, sendo estes vinculados normalmente aos alimentos industrializados. A consequência disso rapidamente se manifestou no aumento do sobrepeso/obesidade e na instalação de alterações fisiológicas e metabólicas, como a Síndrome Metabólica, que é representada por alterações na glicemia, nos lipídeos e na pressão arterial. Há evidências de ligação estreita entre estas alterações e os processos inflamatórios, que também podem estar associados ao estresse oxidativo. Estas condições levam à patogênese das alterações vasculares ou intensificam os processos metabólicos que acompanham a Síndrome Metabólica. O objetivo desta revisão foi comparar as inúmeras referências literárias que mostram correlação entre os componentes da Síndrome Metabólica e o aumento dos mediadores de inflamação. Para isso, utilizou-se Pubmed, Scopus, Lilacs e Scielo como base de dados, sendo que os artigos selecionados dataram principalmente dos últimos cinco anos.

Populations all over the world are increasingly inactive and are consuming increasing quantities of fats and sugars, which is generally linked to industrially processed foods. The consequences have rapidly manifest as an increase in overweight/obesity and in physiological and metabolic changes, such as the Metabolic Syndrome, which is a series of changes in glycemia, lipids and blood pressure. There is evidence of a close relationship between these changes and inflammatory processes, which can also be linked to oxidative stress. These conditions lead to the pathogenesis of vascular abnormalities or intensify metabolic processes that accompany the metabolic syndrome. The objective of this review is to compare the large number of bibliographic references that show correlations between components of the Metabolic Syndrome and increases in the mediators of inflammation. The publications reviewed were located using the Pubmed, Scopus, Lilacs and Scielo databases and the majority of the articles selected were published within the last 5 years.

Fatores de risco cardiovascular em adolescentes de município do sul do Brasil: prevalência e associações com variáveis sociodemográficas / Cardiovacular risk factors in adolescents from a town in the Brazilian South: prevalence and association with sociodemographic variables

OBJETIVO: Determinar a prevalência de fatores de risco cardiovascular e analisar sua associação com variáveis sociodemográficas em adolescentes do município de Três de Maio/RS. MÉTODOS: Estudo transversal de base escolar com amostra probabilística, estratificada por sexo e nível econômico, composta por 660 adolescentes de 14 a 19 anos, 343 moças (52 por cento). Foram investigadas as prevalências dos fatores de risco comportamentais (sedentarismo, dieta aterogênica, tabagismo) e biológicos (excesso de peso, excesso de adiposidade abdominal, pré-hipertensão/hipertensão arterial, hiperglicemia e dislipidemias) e sua associação com variáveis sociodemográficas (sexo, idade e nível econômico). As associações foram testadas por meio do teste qui-quadrado e razão de prevalência (intervalo de confiança de 95 por cento) entre os fatores de risco e as variáveis sociodemográficas. RESULTADOS: Os fatores de risco mais prevalentes foram: dieta aterogênica (98,3 por cento), sedentarismo (61,2 por cento), excesso de adiposidade abdominal (32,6 por cento), baixos níveis de lipoproteína de alta densidade (25,9 por cento) e colesterol total elevado (20,3 por cento). Foram encontradas associações significativas entre sexo feminino, sedentarismo [razão de prevalência (RP) = 1,33 (1,17 - 1,50)], excesso de adiposidade abdominal [RP = 2,44 (1,89 - 3,16)] e colesterol total elevado [RP = 1,89 (1,36 - 2,62)]; e, entre o sexo masculino, baixos níveis de lipoproteína de alta densidade [RP = 2,22 (1,67 - 2,94)] e pré-hipertensão/hipertensão arterial [RP = 4,87 (1,67 - 14,23)]. Verificou-se também,associação entre a idade de 17 a 19 anos e o tabagismo [RP = 1,84 (1,05 - 3,22)] e pré-hipertensão/hipertensão arterial [RP = 3,36 (1,43 - 7,90)]. O nível econômico não foi associado aos fatores de risco cardiovascular na amostra estudada. CONCLUSÃO: Os resultados indicam a necessidade de intervenções que promovam um estilo de vida saudável, com ênfase à adoção de hábitos alimentares adequados...

OBJECTIVE: To determine the prevalence of cardiovascular risk factors and analyze their association with sociodemographic variables among adolescents from the town Três de Maio, state of Rio Grande do Sul. METHODS: Cross-sectional and school-based study with a probabilistic sample method, stratified by sex and economic level, comprised of 660 14 to 19 year-old adolescents, 343 girls (52%). We investigated behavioral (inactivity, atherogenic diet, smoking) and biological (overweight and excess abdominal adiposity, prehypertension/hypertension, hyperglycemia and dyslipidemias) risk factors and their association with sociodemographic variables (gender, age and economic level). Associations were tested using the chi-square test and prevalence ratio (95% confidence interval) among risk factors and sociodemographic variables.RESULTS: The most prevalent cardiovascular risk factors were: atherogenic diet (98.3%), inactivity (61.2%), increased abdominal adiposity (32.6%), low high-density lipoprotein (25.9%), and increased total cholesterol (20.3%). Significant associations were found between being female and sedentary [prevalence ratio (PR) = 1.33 (1.17 - 1.50)], excess abdominal fat [PR = 2.44 (1.89 - 3.16)] and high total cholesterol [RP = 1.89 (1.36 - 2.62)]; and, between males and low levels of high density lipoprotein [RP = 2.22 (1.67 - 2.94)] and prehypertension/hypertension [RP = 4.87 (1.67 - 14.23)]. There was also an association between the 17 to 19 age group and smoking [OR = 1.84 (1.05 - 3.22)] and blood prehypertension/hypertension [RP = 3.36 (1.43 - 7.90)]. Economic level was not associated with cardiovascular risk factors in our sample. CONCLUSION: The results indicate the need for interventions that promote a healthy lifestyle, with emphasis on adopting a healthy diet and increasing levels of physical activity.

Fatores de risco cardiovascular em adolescentes: prevalência e associação com fatores sociodemográficos / Cardiovascular risk factors for adolescents: prevalence and association with sociodemographic factors

OBJETIVOS: Determinar a prevalência de fatores de risco cardiovascular (individual e co-ocorrência); e investigar a relação entre esses fatores e indicadores sociodemográficos em adolescentes. MÉTODOS: A amostra, selecionada por conglomerados em dois estágios (escolas, turmas), foi constituída de 782 adolescentes (14-17 anos de idade, 54,9 por cento do sexo feminino) do ensino médio no município de João Pessoa - PB, Brasil. As variáveis independentes foram sexo, idade e condição econômica. Os desfechos investigados foram: níveis insuficientes de atividade física, hábitos alimentares inadequados, pressão arterial elevada, etilismo, excesso de peso corporal e tabagismo. RESULTADOS: Níveis insuficientes de atividade física (59,5 por cento) e hábitos alimentares inadequados (49,5 por cento) foram os fatores de risco cardiovascular mais prevalentes. Pressão arterial elevada, etilismo e excesso de peso foram mais prevalentes no sexo masculino, e níveis insuficientes de atividade física no sexo feminino. Cerca de 10 por cento dos adolescentes não apresentaram nenhum fator de risco, e 51,4 por cento apresentaram dois ou mais fatores de forma simultânea. Os adolescentes do sexo masculino (OR = 1,89; 1,35 - 2,65) e aqueles que pertenciam aos estratos econômicos mais pobres tiveram maiores chances de apresentar um ou mais fatores de risco biológicos (OR = 1,69; IC95 por cento = 1,16 - 2,47). CONCLUSÃO: A prevalência de fatores de risco cardiovascular foi elevada, com destaque para a exposição simultânea a múltiplos fatores de risco. Os adolescentes do sexo masculino e os mais pobres foram os subgrupos com maior exposição a fatores de risco biológicos de forma simultânea.

OBJECTIVE: The objective of this study was to determine the prevalence of cardiovascular risk factors (individual and co-occurrence); and to analyze their relationship with demographic and socioeconomic variables in adolescents.METHODS: A two-stage cluster sampling process was used (school and class). The sample was made up of 782 adolescents (14 to 17 years old, 54.9% female), from high schools in the city of João Pessoa - PB, Brazil. Independent variables were: sex, age, and socioeconomic status. Outcomes were cardiovascular risk factors (insufficient levels of physical activity, poor dietary habits, high blood pressure, alcoholism, overweight, and smoking). RESULTS: Insufficient levels of physical activity (59.5%) and poor dietary habits (49.5%) were the most prevalent cardiovascular risk factors. High blood pressure, alcoholism, and overweight were higher among males than females, and insufficient levels of physical activity were more prevalent among females. Around 10% of these adolescents did not exhibit risk factors, while 51.4% had two or more cardiovascular risk factors. The odds of co-occurrence of biological risk factors were 1.89 (1.35 - 2.65) times greater for male adolescents and 1.69 (95% CI= 1.16 - 2.47) greater for those in the lowest socioeconomic strata.CONCLUSIONS: There was a high prevalence of cardiovascular risk factors, with a predominance of co-occurrence of exposure to more than one risk factor. Male and underprivileged adolescents were more likely to suffer co-occurrence of exposure to biological risk factors.

Modificación del grosor intima-media carotídeo según factores de riesgo clásicos y síndrome metabólico con o sin inflamación / Relation of intima-media thickness, traditional risk factors and metabolic syndrome in subjects with or without inflammation

El grosor intima-media carotideo (CIMT) es un marcador de aterosclerosis subclinica y eventos isquémicos cerebrales y coronarios. Si bien los valores normales promedio en Chile, han sido publicados, no existen datos locales de cómo se modifica el CIMT según la carga de factores de riesgo (FR) cardiovascular. Objetivos: Analizar la modificación del CIMT según la carga de FR clásicos, presencia de síndrome metabólico (SMET) y SMET más inflamación. Métodos: Hombres y mujeres de Santiago sin antecedente de eventos isquémicos previos, nivel socio económico medio, medio bajo y medio alto. En todos se realizó encuesta sobre antecedentes demográficos, FR cardiovascular, y medición de PA, IMC, cintura, y perfil lipídico, glicemia y proteína C-reactiva ultrasensible (ePCR) en ayuno. Para diagnóstico de SMET se usó NCEP ATPIII (2001), y para inflamación, ePCR> 2 mg/L (valor de corte de > riesgo porAHA). El CIMT se midió en carótida común derecha e izquierda con software MATH®. Resultados: Se incluyeron en el análisis 999 sujetos (508 hombres), edad promedio 43.8 +/- 11 años. La prevalencia de HTA fue 30 por ciento, dislipidemia 68 por ciento, tabaquismo 47 por ciento, y SMET 24 por ciento. El CIMT medio promedio fue 0.61 +/- 0.1 mm y la ePCR promedio 2.22 mg/L. La modificación del CIMT medio (mm) según número de FR (edad>45/55 hombre/mujer, diabetes, HTA, colesterol total > 200, HDL < 40/50, tabaquismo e historia familiar), fue la siguiente: 0 FR= 0.55 +/- 0.08; 1-2 FR= 0.59 +/- 0.091; > 3 FR= 0.67 +/- 0.12 (p < 0.0001). Asimismo, el CIMT aumentó según el puntaje de Framingham: < 5 por ciento = 0.58 +/- 0.09; 5-10 por ciento= 0.66 +/- 0.11; > 10-20 por ciento= 0.68 +/- 0.11; >20 por ciento > o = 0.76 +/- 0.14 (p < 0.0001). El CIMT fue significativamente mayor en los sujetos con SMET, y se incrementa en forma significativa cuando se adiciona ePCR>2 mg/L. En el modelo de regresión múltiple, el CIMT se asocia en forma conjunta a Framingham (p < 0.0001) y SMET+ePCR>2...

Carotid intima-media thickness (CIMT) is a marker for cerebral and coronary ischemic events. Normal values for CIMT in Chile have been published but the relation of CIMT to level of risk factors (RF) is unknown. Aim. To analyze the relation of CIMT to level of traditional RF and the presence of metabolic syndrome (MS), with or without inflammation. Methods. Males and females living in Santiago, Chile, with no prior history of ischemic events, of a low, medium or high socio-economic level, were studied. Demographic data, and presence of RF were obtained. Blood pressure, BMI, waist, blood lipids, blood glucose and US-CRP were measured in the fasting state. The presence of MS was defined by the NCEP-ATP III (2001) criteria. Inflammation was defined as US-CRP >2mg/L (the cut off point for increased risk, according to the AHA). CIMT was measure in both carotid arteries using the MATH® software. Results. 999 subjects (508 males), aged 43 +/- 11 years old. The prevalence of hypertension (HT) was 30 percent, dyslipidemia 68 percent, tobacco use 41 percent and MS 24 percent. Mean CIMT was 0.61 +/- 0.1 mm and US-PCR was 2.22 mg/L. CIMT according to number of RF - age > 45/55 (male/female), diabetes, HT, total cholesterol > 200 mg/dl, HDL < 40/50 mg/dl, tobacco use and family history- were: 0 RF: 0.55 +/- 0.08; 1-2 RF: 0.59 +/- 0.091; >3 RF: 0.67 +/- 0.12 (p < 0.0001). CIMT according to Framingham scores was: < 5 percent: 0.58 +/- 0.09; 5 - 10 percent: 0.66 +/- 0.11; 10 - 20 percent: 0.68 +/- 0.11 and > 20 percent: 0.76 +/- 0.14 (p < 0.0001). CIMT was significantly greater in subjects with MS and more in the group with US-PCR > 2mg/L. In multiple regression analysis, CIMT was jointly associated to Framingham score (p < 0.0001) and presence of MS + US-PCR >2 mg/L (p=0.01) (r2=0.19 for the model). Conclusion. CIMT increases in relation to traditional RF load and the presence of MS. An increased atherosclerotic risk in subjects with MS+inflammation (US-PCR > 2 mg/L)...

Assessment of atherosclerosis by carotid intimomedial thickness in patients with rheumatoid arthritis.

OBJECTIVES: To determine the prevalence of subclinical (asymptomatic) atherosclerosis in patients with rheumatoid arthritis (RA) and to study the variables affecting such an occurrence. METHODS: Case control study which included 100 patients with RA having disease duration more than 5 years and 100 healthy age and sex matched controls. Cases and controls symptomatic for atherosclerosis or having traditional risk factors for atherosclerosis were excluded. Both cases and controls were subjected to carotid ultrasound examination in addition to detailed history and physical examination. RESULTS: The study population (both cases and controls) included 94 females and 6 males. The mean age of cases and controls was similar (44.06 +/- 11.32 years and 44.1 +/- 11.52 years). The mean disease duration was 155.04 +/- 48.8 months. The mean carotid intimo-medial thickness (CIMT) of the RA patients (0.519 +/- 0.18 mm) was significantly greater than the controls (0.387 +/- 0.085). Age and disease duration were the only factors found to significantly affect CCIMT. RA patients had higher prevalence of carotid plaques (21%) compared to controls (1%). Erosions on hand radiographs were the only significant predictor of plaques in patients with RA. CONCLUSION: Patients with RA exhibit premature atherosclerosis by way of increased CIMT and carotid plaques when compared to age and sex matched controls.

Arterioesclerosis subclínica, factores de riesgo cardiovascular clásicos y emergentes en niños obesos chilenos / Subclinical atherosclerosis: classic and emerging cardiovascular risk factors in Chilean obese children

La arteriosclerosis puede comenzar en la niñez y desarrollarse crónicamente dependiendo de la carga de factores de riesgo (FR) cardiovascular. Objetivo: Comparar niños obesos con eutróficos en cuanto a FR clásicos, emergentes (Proteína C Reactiva ultrasensible: PCRus) y arteriosclerosis subclínica, mediante dos nuevas técnicas no invasivas: dilatación mediada por flujo de la arteria braquial (DMF) y grosor de la íntima-media carotídea (IMT). Método: Se estudiaron 26 niños obesos (IMC ³ Pc95) y 57 eutróficos (IMC: Pc10 - Pc85). Se evaluó antropometría, presión arterial (PA), DMF, IMT, y se determinó de PCRus, perfil lipídico y glicemia de ayunas. Resultados: El 50 por ciento fueron mujeres y 41 por ciento prepúberes. Con edad de 9,9 + - 1,6 y 9,8 + - 1,8 años (ns), zIMC: 2,0 + - 0 2 y 1,7 + - 0,6, perímetro de cintura (por ciento Media): 133,5 + - 16 y 100,5 + -1 0 por ciento en obesos y eutróficos respectivamente. Los obesos tuvieron mayor Colesterol Total, CLDL, Triglicéridos, PCRus y menor CHDL (p < 0,005). No hubo diferencia significativa en DMF: 9,03 + - 5,2 por ciento vs 9,3 + - 4,2 por ciento, IMT: 0,49 + - 0,03 vs 0,50 + - 0,03 mm, glicemia ni PA. Conclusión: Este grupo de niños obesos chilenos presenta mayor carga de FR clásicos y nivel de PCRus que los eutróficos, pero no se encontró diferencia significativa en marcadores sustitutos de arteriosclerosis subclínica.

Doença aterosclerótica da artéria renal / Atherosclerotic Illness of the Renal Artery

Neste artigo, os autores discutem aspectos relacionados ao diagnóstico e ao tratamento da doença aterosclerótica da artéria renal. Destacam-se, também, as indicações para a revascularização de pacientes com estenose significativa da artéria renal...

In the present article, the authors address aspects related to the diagnosis and the management of renal artery atherosclerotic disease. The authors also point out the indications for the revascularization of patients with significant stenosis in renal artery.

Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.

Fisiopatologia e aspectos inflamatórios da aterosclerose / Physiopathology and inflammatory aspects of atherosclerosis

O objetivo deste trabalho foi apresentar e avaliar o que tem se descoberto recentemente sobre fisiopatologia, epidemiologia e aspectos inflamatórios envolvidos na aterosclerose dentro de uma pespectiva multidisciplinar. Foram realizadas compilações bibliográficas sobre artigos científicos originais e de revisão em revistas indexadas no Medline no período de 1970 ao atual que envolvesse assuntos relacionados à aterosclerose. A revisão sugere que a aterosclerose é uma doença multifatorial com forte componente genético, ambiental e de resposta inflamatória, associada ao envelhecimento. No entanto, ainda a sua etiologia não está completamente esclarecida. O entendimento da biologia básica da inflamação na aterosclerose proporcionaria um melhor suporte clínico que poderia alterar o caminho da prática da medicina preventiva e propiciar benefícios para a saúde pública.

Papel da inflamação na etiopatogenia da doença arterial coronária / Paper of inflammation in the etiopathogeny of heart disease

Estudos experimentais e clínicos epidemiológicos comprovaram que a aterosclerose é uma doença multifatorial. Os fatores que aumentam a sua prevalência, que aceleram sua evolução e que preenchem os critérios de casualidade são denominados fatores de risco. Os fatores que não preenchem os critérios de casualidade, mas podem ter importância para a maior inicidência de eventos clínicos, são designados maracdores de risco. A teoria inflamatória postula que que as citocians participam do mecanismo fisiopatológico da aterosclerose. Neste levantamento bibliográfico, avaliou-se a importância de váris marcadores inflamatórios: interleucinas, fator de necrose tumoral alfa, proteína C-reativa e proteína amilóide A...

An autopsy study of atherosclerosis in aorta, common carotid arteries and circle of Willis.

The incidence, extent and degree of atherosclerosis was studied in descending aorta, common carotid arteries and circle of Willis obtained from 50 cadavers above the age of 30 years. Specimens were stained grossly with Sudan IV and the total atherosclerotic area was measured and atherosclerotic index was calculated. The co-efficient of correlation between extent of atherosclerosis with age and nutritional status was calculated. The incidence of atherosclerosis was 100.0% in the aorta and common carotid arteries in all the specimens. In case of circle of Willis, it was 76.5% in the fourth decade and 87.5% in the fifth decade, rising to 100.0% thereafter. The atherosclerotic index increased with age at all the three locations. However, at any given age, the atherosclerotic index in circle of Willis was much less as compared to the aorta or common carotid arteries. The most prominent lesion in all the three groups of vessels in the fourth and fifth decades was the presence of a fatty streak. There was a sudden spurt in the extent of fibrous plaques in the aorta, carotid arteries and circle of Willis in the sixth decade. Complicated lesions also appeared in this decade, and became more marked after sixty years of age. The correlation between the extent and degree of atherosclerosis with age was found to be highly significant statistically (p < 0.001). A significant correlation (p < 0.001) was also found between the nutritional status and extent and degree of atherosclerosis. No conclusion could be derived regarding differences in the extent and degree of the disease in the two sexes.

Hiper-homocisteinemia na doença arterial periférica / Hyperhomocysteinemia in peripheral arterial disease

Estudos recentes indicam que um nível plasmático elevado de homocisteína é um fator de risco importante e prevalente para doença vascular aterosclerótica coronariana, cerebral e periférica. A homocisteína é um aminoácido sulfurado utilizado em diversas vias metabólicas. A hiper-homocisteinemia pode ser atribuída à ocorrência de defeitos genéticos de algumas enzimas do metabolismo da homocisteína ou a deficiências nutricionais das vitaminas B6, B12 e folato, ou pode, ainda, estar relacionada a outros fatores de risco para aterosclerose. Foram sugeridos alguns mecanismos biologicamente plausíveis de dano vascular causado pela hiper-homocisteinemia, em especial a oxidação das lipoproteínas de baixa densidade (LDL). Em contrapartida, diversos estudos demonstram que a suplementação de ácido fólico resulta em redução eficiente da concentração de homocisteína no plasma. Nesta revisão, serão abordados o metabolismo da homocisteína e sua relação com a doença arterial periférica, e serão discutidas as causas, os mecanismos patogênicos e as perspectivas de tratamento da hiper-homocisteinemia.

Riesgo vascular global (primera parte) / Global vascular risk (first part)

En esta primera entrega de Evidencia se hace hincapié en el nuevo paradigma de evaluación del riesgo global para tomar decisiones en la prevención y el tratamiento de la enfermedad cardiovascular; se relativizan los conceptos de prevención primaria y secundaria; se describen datos epidemiológicos de Argentina así como la herramienta más difundida para la estimación del riesgo cardiovascular (el puntaje de Framingham) y se resume la principal evidencia que sustenta las intervenciones farmacológicas disponibles para el manejo de estos pacientes

Ankle brachial index as a predictor of generalized atherosclerosis.

OBJECTIVE: To assess ankle brachial index (ABI) as a screening method to target subclinical atherosclerosis in middle aged individuals. MATERIAL AND METHODS: Total 160 patients over the age of 40 years were included in the study for a period of 16 months. Their ABI was determined either by colour Doppler method (30 patients) and/or sphygmomanometry (all 160 patients). A value of < 0.9 was taken as cutoff point for significant stenosis. RESULTS: Total 69 patients out of total of 160 had significantly low ABI value (43.12%) which shows that there is a very high incidence of low ABI in the community. Overall > 50% of the patients were largely asymptomatic and had presence of two or more risk factors. ABI < 0.9 was a good screening test to detect such individuals at an earlier stage (sub-clinical). CONCLUSION: A significantly low (< 0.9) ABI value can detect subclinical atherosclerotic vascular involvement and predict future occurrence of preventable major vascular event.