Hipolipemiantes e câncer / Lipid-lowering drugs and cancer

Os hipolipemiantes são medicamentos de eficácia comprovada no tratamento dos distúrbios do metabolismo dos lipídeos. Essas drogas reduzem a morbidade e a mortalidde em eventos cardiovasculares de forma notória. A suspeita de que esses agentes podem aumentar o risco de câncer tem sido questionada desde o início de seu uso, gerando intensos debates e reanálises de ensaios clínicos sobre o assunto. Recentemente, os resultados do estudo Sinvastatin and Ezetimibe in Aortic Stenosis (SEAS) despertaram novo interesse por esse tema, pois os pacientes submetidos a terapia hipolipemiante intensiva tiveram número aumentado de câncer em comparação com o grupo controle. Este artigo visa a revisar os estudos em busca de evidência sobre associação do uso de hipolipemiantes e baixos níveis de colesterol com incidência de câncer. Até o momento não há evidências concretas de meta-análises, seja com estatinas ou, mais recentemente, com ezetimiba, que indiquem que esses medicamentos induzam o aparecimento de neoplasias ou que elevem o risco de mortalidade pelo câncer.

The efficacy of lipid-lowering agents in the treatment of lipid metabolism disorders is well established. These drugs markedly reduce morbidity and mortality in cardiovascular events. The hypothesis that lipid-lowering drugs might increase the risk of cancer has been questioned from the very beginning of their use and has been subject of intense debate and several attempts to reanalyze clinical trial data. Recently, the results of the Simvastatin and Ezetimibe in Aortic Stenosis Study (SEAS) has sparked new interest on this issue, since patients undergoing intense lipid-lowering therapy had a higher rate of cancer than the control group. This article gives an overview of the clinical evidence on the association of lipid-lowering drugs and low cholesterol levels with the incidence of cancer. So far there are no clear evidences from metanalyses, whether with statins or more recently with ezetimibe, indicating that these drugs induce the development of cancer or increase the risk of mortality due to cancer.

Estratificação de risco de doença coronária em mulheres / Cardiovascular disease in women: risk stratification

As doenças cardiovasculares representam a principal causa de morte nas mulheres. Apesar de os fatores de risco como dislipidemia, hipertensão, diabetes, tabagismo e história familiar serem os mesmos para ambos os sexos, a estratificação de risco com mulheres apresenta algumas peculiaridades. O escore de Framingham, classicamente utilizado para avaliação de risco cardiovascular, apresenta várias limitações no que se refere às mulheres, pois raramente uma mulher é classificada como de alto risco com o uso dessa escala. Para melhor estratificação, é preciso considerar que a presença de pelo menos um fator de risco para aterosclerose já pode indicar maior risco no longo prazo. Marcadores de aterosclerose subclínica e proteína C-reativa ultra-sensível podem ser úteis para melhor acurácia na estratificação de risco da mulher.

Efeito hipertensäo e normotensäo do avental branco na liga de hipertensäo do Hospital das Clínicas, FMUSP. Prevalência, características clínicas e demográficas / White-coat hypertension and normotension in the league of hypertension of the Hospital das Clínicas, FMUSP. Prevalence, clinical and demographic characteristics

OBJECTIVE: To assess the prevalence of white-coat normortension, white-coat hypertension, and white-coat effect. METHODS: We assessed 670 medical records of patients from the League of Hypertension of the Hospital das Clínicas of the Medical School of the University of Säo Paulo. White-coat hypertension (blood pressure at the medical office: mean of 3 measurements with the oscillometric device ³140 or ³90 mmHg, or both, and ambulatory blood pressure monitoring mean during wakefulness < 135/85) and white-coat normotension (office blood pressure < 140/90 and blood pressure during wakefulness on ambulatory blood pressure monitoring ³ 135/85) were analyzed in 183 patients taking no medication. The white-coat effect (difference between office and ambulatory blood pressure > 20 mmHg for systolic and 10 mmHg for diastolic) was analyzed in 487 patients on treatment, 374 of whom underwent multivariate analysis to identify the variables that better explain the white-coat effect. RESULTS: Prevalence of white-coat normotension was 12 percent, prevalence of white-coat hypertension was 20 percent, and prevalence of the white-coat effect was 27 percent. A significant correlation (p<0.05) was observed between white-coat hypertension and familial history of hypertension, and between the white-coat effect and sex, severity of the office diastolic blood pressure, and thickness of left ventricular posterior wall. CONCLUSION: White-coat hypertension, white-coat normotension, and white-coat effect should be considered in the diagnosis of hypertension