Prevalence of cardiometabolic risk factors in three populations from Venezuela: the VEMSOLS STUDY 2006-2010 / Prevalencia de factores de riesgo cardiometabólico en 3 poblaciones de Venezuela: estudio VEMSOLS 2006-2010

Abstract Introduction: No previous studies had reported the prevalence of cardiometabolic diseases various regions of Venezuela. Objective: To determine the prevalence of cardiometabolic risk factors in 3 populations of Venezuela. Methods: The VEMSOLS study is a sub-national, cross-sectional, population based, with bi-stage random sampling study, evaluating 751 subjects aged 20 or older from 3 selected municipalities of Venezuela. Anthropometric and biochemical measurements were obtained. ANOVA was used to continous variables and Chi-square to proportions, a p<0.05 was significant. Results: 69% were females and 81.4% from urban areas. Low HDL-c was the most prevalent disorder (63.8% [-CI- 95% 60.1-67.4]), being more common in women than in men (74.1% [69.9 -77.9] and 40.4% [33.7-43.4], respectively, p < 0.05); followed by abdominal obesity (47.4% [43.8 -51.1]) and hypertriglyceridemia (45.2% [41.5 - 49.0]). One third (30.0% [26.7-33.4]) had hypertension, 11.8% (9.5 -14.5) diabetes, 23.1% (20.2-26.3) obesity, and 20.1% (17.2-23.4) elevated LDL-cholesterol. Metabolic syndrome was present in 29.9% (26.5-33.5) of the sample. Rural population from the Andeans mountains (Páramo) presented a lower prevalence of obesity and low HDL-c (p < 0.05) comparing with urban samples. Lara's population, which had the highest Body Mass Index of the 3 municipalities, had a higher prevalence of abdominal obesity, atherogenic dyslipidemia and elevated LDL-c than the other two populations (p < 0.05). Conclusion: A high prevalence of cardiometabolic abnormalities in 3 populations of Venezuela was observed with a lower prevalence of alterations in the rural area. MÉD.UIS. 2018;31(1):15-22.

Resumen Introducción: Ningún estudio ha reportado la prevalencia de factores de riesgo cardiometabólico en varias regiones de Venezuela. Objetivo: Determinar la prevalencia de factores de riesgo cardiometabólico en 3 poblaciones de Venezuela. Materiales y Métodos: El estudio VEMSOLS es un estudio sub-nacional, transversal, poblacional, de muestreo aleatorio bi-etápico, evaluando 751 sujetos de 20 o más años de edad de 3 municipios de Venezuela. Mediciones antropométricas y bioquímicas fueron obtenidas. Analysis of Variance se utilizó para variables continuas y Chi-cuadrado para proporciones, significancia fue p<0,05. Resultados: 69% fueron mujeres y 81,4% del área urbana. Colesterol HDL bajo fue la alteración más prevalente (63,8% [Intervalo de Confianza -IC- 95%: 60,1-67,4]), siendo más común en mujeres que en hombres (74,1% [69,9 -77,9] y 40,4% [33,7-43,4], respectivamente, p< 0,05); seguidos por obesidad abdominal (47,4% [43,8 -51,1]) e hipertrigliceridemia (45,2% [41,5 - 49,0]). Un tercio (30,0% [26,7-33,4]) tenía hipertensión, 11,8% (9,5 -14,5) diabetes, 23,1% (20,2 - 26,3) obesidad y 20,1% (17,2-23,4) colesterol LDL elevado. El síndrome metabólico estuvo presente en 29,9% (26,5-33,5) de la muestra. La población rural de los Andes (Páramo) presentó una baja prevalencia de obesidad y colesterol HDL bajo comparado con las muestras urbanas (p < 0,05). La población de Lara, quien tenía el índice de masa corporal más elevado de las 3 municipalidades, mostró una alta prevalencia de obesidad abdominal, dislipidemia aterogénica y colesterol LDL elevado en comparación con las otras dos poblaciones (p< 0.05). Conclusión: Se observó una elevada prevalencia de anormalidades cardiometabólicas en 3 poblaciones de Venezuela con una menor prevalencia de alteraciones en el área rural. MÉD.UIS. 2018;31(1):15-22.

Conhecimento, atitudes e controle metabólico de diabéticos cardiopatas / Knowledge, attitudes and metabolic control of diabetic and cardiac patients

Verificar a relação do conhecimento, atitudes e controle metabólico de diabéticos cardiopatas. Métodos:estudo descritivo, exploratório e transversal que verificou conhecimento, atitudes e controle metabólico do diabetes em 46 participantes com cardiopatia. Resultados: os participantes eram predominantemente do sexo masculino, com ensino médio incompleto, que demonstraram conhecimento insatisfatório e atitudes desfavoráveis em relação à doença. Não houve diferença entre os participantes com e sem conhecimento em relação às variáveis de controle metabólico e clínico do diabetes, tampouco com atitudes frente à doença. Conclusão: o conhecimento sobre diabetes mostrou-se insatisfatório em pacientes com cardiopatia e não se relacionou a atitudes favoráveis e melhor controle da doença.

Objective: to verify the relationship between knowledge, attitudes and metabolic control in diabetic and cardiac patients. Methods: descriptive, exploratory and cross-sectional study exploring the knowledge, attitudes and diabetes metabolic control in 46 participants with heart disease. Results: participants were predominantly male with incomplete secondary education who demonstrated poor knowledge and unfavorable attitudes towards the disease. There was no difference between participants with and without knowledge on variables of metabolic and clinical control of diabetes, neither with respect to attitudes towards the disease. Conclusion: knowledge about diabetes was unsatisfactory in patients with heart disease and unrelated to favorable actions and better disease control.

Overexpression of myeloid differentiation protein 88 in mice induces mild cardiac dysfunction, but no deficit in heart morphology

Cardiac remodeling involves changes in heart shape, size, structure, and function after injury to the myocardium. The proinflammatory adaptor protein myeloid differentiation protein 88 (MyD88) contributes to cardiac remodeling. To investigate whether excessive MyD88 levels initiate spontaneous cardiac remodeling at the whole-organism level, we generated a transgenic MyD88 mouse model with a cardiac-specific promoter. MyD88 mice (male, 20-30 g, n=∼80) were born at the expected Mendelian ratio and demonstrated similar morphology of the heart and cardiomyocytes with that of wild-type controls. Although heart weight was unaffected, cardiac contractility of MyD88 hearts was mildly reduced, as shown by echocardiographic examination, compared with wild-type controls. Moreover, the cardiac dysfunction phenotype was associated with elevation of ANF and BNP expression. Collectively, our data provide novel evidence of the critical role of balanced MyD88 signaling in maintaining physiological function in the adult heart.

Interdisciplinariedade na resposta a intervenções em hábitos de vida para redução de risco cardiometabólico e a influência da depressão / Interdisciplinary approach in response to lifestyle interventions for reducing cardiometabolic risk and the influence of depression

Introdução: Doenças crônicas não transmissíveis representam as principais morbidades da atualidade, dentre estas o diabetes mellitus (DM) tipo 2 e a depressão, as quais encontram-se frequentemente associadas. Ambas contribuem para complicações cardiovasculares e mortalidade. Há evidências de que intervenções comportamentais trazem benefícios cardiometabólicos e psicológicos. Objetivos: Para avaliar intervenção no estilo de vida, este estudo incluiu: 1) revisão sistemática e metanálise destinada a investigar os efeitos de intervenções no estilo de vida na melhora da depressão em indivíduos de risco ou com diabetes mellitus tipo 2; 2) comparação do efeito de duas intervenções no estilo de vida sobre o risco cardiometabólico e na retenção dos indivíduos ao programa; 3) análise do papel da depressão na resposta cardiometabólica às intervenções, mediada pela inflamação e; 4) avaliação do efeito residual 9 meses após término das intervenções quanto às respostas de variáveis clínicas, qualidade de vida (QV) e depressão. Métodos: Para revisão sistemática os principais bancos de dados bibliográficos foram pesquisados, sendo a meta-análise conduzida por modelos de efeito aleatório. O estudo longitudinal incluiu adultos pré-diabéticos, submetidos a 18 meses de intervenção tradicional (TRD) ou interdisciplinar com psicoeducação (INT) para mudanças em hábitos de vida, sendo os dados coletados (antropometria, pressão arterial, perfil bioquímico e marcadores de inflamação PCR, TNF-, adiponectina) no momento basal, 9 e 18 meses, bem como 9 meses após o término do acompanhamento (27 meses).

Introduction: Nowadays non-communicable chronic diseases, such as diabetes mellitus and depression, are major public health problems worldwide. These conditions are commonly associated and contribute to cardiovascular complications and mortality. Previous studies showed that motivational interviews may improve cardiometabolic and psychological aspects. Objectives: In order to assess lifestyle intervention this study includes: 1) Systematic review and meta-analysis to verify effect of lifestyle interventions on depression; 2) to compare effects of two lifestyle interventions in the cardiometabolic risk and in retention of at-risk individuals; 3) to analyze influence of depression in cardiometabolic response to interventions mediated by inflammation and, 4) to assess residual effect at 9 months after completion of interventions according to clinical variables, quality of life and depression. Methods: In the systematic review major bibliographic databases were searched. Meta-analysis was conducted by random-effects model. The effect of method, duration, and frequency of the interventions were determined via subgroup analyses. Our longitudinal study includes prediabetic adults, submitted to one of two lifestyle interventions (TRD:Traditional or INT:Interdisciplinary). Data were collected (anthropometry, blood pressure, biochemical profile and inflammation markers CRP, TNF-, adiponectin) at baseline, 9th and 18th month, as well as 9 months after completion of interventions (observational phase). Diet was evaluated by 24h recalls and physical activity by IPAQ.

Role of Notch signaling in the mammalian heart

Notch signaling is an evolutionarily ancient, highly conserved pathway important for deciding cell fate, cellular development, differentiation, proliferation, apoptosis, adhesion, and epithelial-to-mesenchymal transition. Notch signaling is also critical in mammalian cardiogenesis, as mutations in this signaling pathway are linked to human congenital heart disease. Furthermore, Notch signaling can repair myocardial injury by promoting myocardial regeneration, protecting ischemic myocardium, inducing angiogenesis, and negatively regulating cardiac fibroblast-myofibroblast transformation. This review provides an update on the known roles of Notch signaling in the mammalian heart. The goal is to assist in developing strategies to influence Notch signaling and optimize myocardial injury repair.

Pulmonary vascular remodeling in congenital heart disease: Enhanced expression of heat shock proteins.

In congenital heart disease (CHD), mechanical wall stress by increased pulmonary artery pressure and pulmonary blood flow is believed to play a pivotal role in the pathogenesis of pulmonary plexogenic arteriopathy (PPA). The pathogenesis of this disease that involves significant pulmonary arterial remodelling, is, however, largely unknown. In the systemic circulation, upregulation of HSP-70 and HSP-27 in the arterial wall occurs in response to acute hypertension, whereas HSP-60 and increased titres of anti-HSP-60 antibodies are associated with atherosclerotic vessel disease. We looked for the involvement of HSPs in the stress response of pulmonary endothelial and vascular smooth muscle cells in different abnormal hemodynamic conditions in patients with CHDs. We analyzed the expression pattern of HSP-27, HSP-70 and HSP-60 in lung biopsies of 38 patients with CHD, using immunohistochemistry. These included 4 individuals with an essentially normal pulmonary circulation, who served as controls. Immunoreactivity against HSP-27 and also against HSP-70 was present in the pulmonary endothelium and vascular smooth muscle cells of patients and controls in a similar pattern. In contrast, expression of HSP-60 was absent in pulmonary arteries of both patients and controls. In patients with advanced PPA, cells within plexiform lesions showed strong staining for HSP-27 and HSP-70, but were again negative for HSP-60. The intensity of immunoreactivity against HSP-70 correlated inversely with medial thickness of pre-acinar arteries (r = -0.32; p = 0.04). Expression of HSP-27 and HSP-70 did not correlate with hemodynamic parameters, although immunoreactivity against HSP27 tended to be increased in cases with high pulmonary artery pressure (r = 0.37; p = 0.16) and was highest in patients with flow-associated pulmonary hypertension (p<0.01). HSP-27 and HSP-70, but not HSP-60 are engaged in the stress response of cells of small pulmonary arteries in pulmonary plexogenic arteriopathy. HSP-27 and HSP-70 are increasingly expressed in the advanced proliferative lesions of this disease.

Bone and heart abnormalities of subclinical hyperthyroidism in women below the age of 65 years / Anormalidades ósseas e cardíacas do hipertireoidismo subclínico em mulheres com menos de 65 anos

The objective of the present study was to evaluate bone and cardiac abnormalities and symptoms and signs of thyroid hormone excess in women with subclinical hyperthyroidism (SCH) aged < 65 years. Forty-eight women with SCH were evaluated. The control group consisted of 48 euthyroid volunteers. The mean symptom rating scale score was significantly higher in patients. Cardiac involvement, both morphological and affecting systolic and diastolic functions, was also observed in patients. Women with SCH showed a significant increase in serum markers of bone formation and resorption. In addition, bone mineral density (BMD) was lower in the femoral neck but not in the lumbar spine in patients before menopause, whereas a lower BMD was observed at both sites in postmenopausal patients. SCH is not completely asymptomatic in women aged < 65 years, and is associated with heart abnormalities and with increased bone turnover and reduced BMD even before menopause.

O objetivo deste estudo foi avaliar as anormalidades ósseas e cardíacas, sintomas e sinais de excesso de hormônio tireoidiano em mulheres com hipertireoidismo subclínico (HSC) e menos de 65 anos de idade. Quarenta e oito mulheres com HSC foram avaliadas. O grupo-controle consistiu de 48 voluntárias eutireoidianas. A média do escore de sintomas foi significativamente maior em pacientes que em controles. Comprometimento cardíaco, morfológico e afetando as funções sistólica e diastólica, também foi observado. Mulheres com HSC apresentaram significativo aumento dos marcadores séricos de formação e reabsorção óssea. A densidade mineral óssea (DMO) foi menor no colo de fêmur, mas não em coluna lombar em mulheres antes da menopausa; enquanto e em ambos os sítios nas mulheres pós-menopausadas. HSC não é inteiramente assintomático em mulheres com menos de 65 anos, está associado a anormalidades cardíacas morfológicas e funcionais, incremento da remodelação óssea, e menor DMO, mesmo antes da menopausa.

Cerebral and cardiac amyloidosis in autopsied elderly individuals

INTRODUÇÃO: A amiloidose em idosos pode ser uma alteração independente e própria do envelhecimento. Entretanto, as características clínicas, fisiopatológicas e bioquímicas da Amiloidose relacionada à idade ainda permanecem incertas. OBJETIVO: Verificar se o coração e o encéfalo de indivíduos acima de 60 anos apresentavam depósito amilóide. MATERIAL E MÉTODOS: Foram estudados laudos consecutivos de autópsias de indivíduos acima de 60 anos realizadas entre 1976 e 2000, que apresentavam corações sem cardiopatias, com sorologia negativa para Doença de Chagas e encéfalos sem alterações morfológicas de encefalopatias, chegando a um n de 10 casos. Lâminas de fragmentos do coração e de encéfalo foram processadas e analisadas em microscopia de luz comum e polarizada. RESULTADOS: Dos 10 casos, 3 apresentaram depósito amilóide no encéfalo e 1 no encéfalo e no coração. Em 50% dos casos, os indivíduos tinham entre 60 e 69 anos. A relação entre o peso encefálico e o peso corporal mostrou ter uma associação significativa com os casos positivos, sendo esta menor em relação aos negativos. CONCLUSÃO: A análise conjunta de depósitos amilóides em encéfalo e coração de indivíduos idosos talvez direcione para um acometimento sistêmico comum ao envelhecimento natural. Alguma alteração adicional do organismo poderia determinar a quebra de um equilíbrio natural sobre o acúmulo dessas proteínas, levando dessa forma aos contextos patológicos da amiloidose.

Senile systemic amyloidosis--a case report.

An 85 years old female presented with acute pain and weakness in left lower extremity and doppler evidence of femoropopliteal block was made which subsequently proved fatal. Necropsy revealed extensive amyloid deposition in the heart and amyloid angiopathy in rest of the organs.

Radicais livres e seu papel em cardiologia: atualizaçäo / Free radicals and its paper in cardiology: up-dating

É feita uma ampla revisão da atomística e dos aspectos químicos relacionados aos radicais livres. Discute-se ainda a influência dos radicais livres nos vários aspectos da Cardiologia e o papel potencial do uso de antioxidantes como recurso terapêutico.

Factores de riesgo para la obesidad en la infancia / Risck factors for childhood obesity

La obesidad infantil constituye un importante problema de salud, debido a su asociación con enfermedades de tipo crónico y/o degenerativo que pueden presentarse desde la infancia hasta la edad adulta. En la actualidad, se conocen los factores de riesgo asociados a este padecimiento en países desarrollados, más poco se conoce de éstos en los países en desarrollo. Este artículo presenta información relevante sobre los determinantes de la obesidad de la infancia. Por su origen, y tomando en cuenta la posibilidada de prevención, estos factores se han dividido en dos grupos. Por un lado, se realiza una síntesis de los estudios sobre los determinantes biológicos de la obesidad infantil, y por el otro, se revisan los aspectos sociales y ambientales asociados con este padecimiento. Además, se señalan aspectos de interés sobre la prevalencia de la enfermedad tanto en países en vías de desarrollo como en desarrollados, y se presentan recomendaciones sobre el tratamiento correspondiente

Effect of khamira abresham hakim arshawdwala on cardiac metabolism in experimental myocardial necrosis

Present study is an attempt to evaluate the effect of various samples of Khamira Abresham Hakim Arshadwala on myocardial metabolism after isoproterenol induced myocardial necrosis in rats. Experimental myocardial necrosis was produced according to the method of Rona et al., [1959]. The parameters included serum free fatty acids, cardiac glycogen, serum GOT, GPT, LDH, cholesterol, sodium and potassium. Khamira in the doses of 1 gm/kg showed a significant protective effect against isoproterenol induced myocardial cell damage