Aterosclerosis de aorta y coronarias en necropsias de fallecidos fumadores / Atherosclerosis of aorta and coronaries in necropsies of deceased smokers

Introducción: La aterosclerosis es una enfermedad que está entre las tres primeras causas básicas de muerte a nivel mundial. En la actualidad se relaciona con múltiples factores de riesgo, entre ellos el tabaquismo, que a su vez es un factor contribuyente al desarrollo de la cardiopatía isquémica. Objetivo: Caracterizar patomorfológicamente la lesión aterosclérótica de aorta y coronarias y su relación con el tabaquismo en fallecidos necropsiados. Métodos: Se realizó un estudio observacional, descriptivo y transversal; se estudiaron 431 fallecidos con autopsias clínicas, de ellos se analizaron cualitativa y cuantitativamente sus arterias coronarias y aorta mediante el sistema aterométrico. Resultados: Se presentaron mayores valores de lesiones ateroscleróticas en el grupo de fumadores con infarto de miocardio, por tanto los índices de obstrucción (Ω) y estenosis (P) tuvieron también valores más elevados. Tuvieron una superficie endarterial más afectada por placas fibrosas y graves, la arteria descendente anterior y la aorta abdominal. Conclusiones: El tabaquismo tuvo una asociación directa con el proceso aterosclerótico, se expresa por mayores valores de las lesiones en los fumadores identificados, tanto en el sector aórtico como en el coronario, además se identificó mayor susceptibilidad de la descendente y de aorta abdominal al daño aterosclerótico(AU)

Introduction: Atherosclerosis is a disease that is among the top three basic causes of death worldwide. It is currently associated with multiple risk factors, including smoking, which in turn is a contributing factor to the development of ischemic heart disease. Objective: To characterize pathomorphologically the atherosclerotic lesion of the aorta and coronary arteries and its relationship with smoking in autopsied deceased. Methods: An observational, descriptive and cross-sectional study was carried out; 431 deceased patients with clinical autopsies were studied, of which their coronary arteries and aorta were qualitatively and quantitatively analyzed using the atherometric system. Results: There were higher values ​​of atherosclerotic lesions in the group of smokers with myocardial infarction, therefore the obstruction (Ω) and stenosis (P) indices also had higher values. They had an endarterial surface more affected by fibrous and severe plaques, the anterior descending artery and the abdominal aorta. Conclusions: Smoking has a direct association with the atherosclerotic process, it is expressed by higher values ​​of the lesions in identified smokers, both in the aortic and coronary sectors, in addition, greater susceptibility of the descending and abdominal aorta to damage is identified atherosclerotic(AU)

Análise do perfil de morbimortalidade de aterosclerose no Estado de Minas Gerais comparado à Região Sudeste / A Comparative analysis of atherosclerosis-related morbidity and mortality profile in the state of Minas Gerais state and the Southeast Region

OBJETIVO: Analisar o perfil de morbimortalidade de aterosclerose em Minas Gerais em comparação ao da Região Sudeste. METODOLOGIA: Estudo epidemiológico descritivo, por meio da análise de dados do Departamento de Informática do Sistema Único de Saúde, com as variáveis número de internações, aterosclerose CID 10 (I70), faixa etária, taxa de mortalidade, sexo e etnia no período de janeiro de 2008 e janeiro de 2017. RESULTADOS: A Região Sudeste apresentou 63.713 internações por aterosclerose, sendo 22,9% de Minas Gerais. A faixa etária mais atingida do Estado foi de 60 a 69 anos (4.039 casos). O sexo masculino foi o mais acometido na Região Sudeste (55%) e em Minas Gerais (55%); já a taxa de mortalidade em ambos os casos foi maior na população feminina (Região Sudeste: 4,82; Minas Gerais: 4,31). Quanto à etnia do Estado, pardos (34,79%), brancos (26,65%) e negros (5,71%) representaram a maioria, enquanto, na Região Sudeste, brancos representaram 45,05%, pardos 24,31% e negros 5,96%. A taxa de mortalidade no Estado foi superior para negros (5,51), enquanto no Sudeste foi para brancos (4,16). A taxa de mortalidade média da Região Sudeste foi de 4,41, enquanto em Minas Gerais foi de 3,95, − a menor dentre os Estados da região. CONCLUSÃO: Embora Minas Gerais apresente a melhor taxa de mortalidade da região, faz-se necessário reduzi-la na população indígena e amarela. Já que Minas Gerais ocupa a segunda posição da região em número de internações, urge maior abrangência nas campanhas de prevenção e conscientização. (AU)

OBJECTIVE: To analyze the morbidity and mortality profile of atherosclerosis in the state of Minas Gerais in comparison to the Southeast region. METODOLOGY: This is a descriptive epidemiological study performed with analysis of data from the Department of Informatics of the Unified Health System, with the following variables: number of hospitalizations, atherosclerosis ICD 10 (I70), age group, mortality rate, gender, and ethnicity from January 2007 to January 2018. RESULTS: The Southeast region had a total of 63,713 hospitalizations for atherosclerosis, of which 22.9% were from Minas Gerais. The most affected age group in the state was of 60-69 years (4,039 cases). The male gender was the most affected in the Southeast region (55%) and in the State of Minas Gerais (55%), while the mortality rate in both cases was higher in the female population (Southeast region - 4.82, Minas Gerais - 4.31). As for the ethnicity of the state, brown (34.79%), white (26.65%), and black (5.71%) people represented the majority, while in the Southeast whites represented 45.05%; brown, 24.31%; and black, 5.96%. The mortality rate in the state was higher for black (5.51) people, while in the Southeast for white people (4.16). The Southeast mortality rate was 4.41, while in Minas Gerais it was 3.95, the lowest among the states in the region. CONCLUSION: Although Minas Gerais has the best mortality rate in the region, it is necessary to reduce it in the indigenous and yellow population. In addition, since Minas Gerais ranks second in the region in terms of the number of hospitalizations, it is more urgent to reach out to prevention and awareness campaigns. (AU)

Avaliação da Função Endotelial em Mulheres Climatéricas com Doença Arterial Coronariana / Evaluation of Endothelial Function in Pre-Menopausal Women With Coronary Arterial Disease

Fundamentos: O endotélio desempenha importante função reguladora vascular. Sua disfunção é um marcador precoce de risco cardiovascular. Entretanto, existem poucos estudos em nosso meio que avaliem a função endotelial em mulheres climatéricas. Objetivo: Avaliar a função endotelial em mulheres climatéricas na presença ou ausência de doença arterial coronariana utilizando-se um método biofísico (espessura médio-intimal das carótidas) e um método bioquímico (níveis séricos de PCR-US). Métodos: Estudo transversal que avaliou o espessamento médio-intimal da artéria carótida e níveis séricos de PCR-US de 31 mulheres climatéricas submetidas a cineangiocoronariografia, no Serviço de Hemodinâmica do Hospital Universitário da Universidade Federal do Maranhão, no período de março de 2012 a julho de 2013. Os dados foram submetidos à análise estatística. Considerou-se um nível de significância de 5%. Resultados:A amostra foi dividida em dois grupos, de acordo com presença de doença arterial coronariana (DAC): grupo com DAC (n = 13) e grupo sem DAC (n = 18). As médias de idades para os grupos foram 57,92 ± 5,17 e 51,72 ± 4,63 anos, respectivamente (p = 0,001). A EMI esteve alterada em 29,03% na população geral. A espessura médio- intimal foi de 1,55 ± 0,78 mm no grupo geral, 1,92 ± 0,94 mm no grupo com DAC e 1,18 ± 0,71 mm no grupo sem DAC (p = 0,001). As pacientes com DAC apresentaram predomínio de alteração da EMI quando comparadas aquelas sem DAC: 36,46% vs. 22,22%, respectivamente. Observou-se uma sensibilidade de 38%, especificidade de 77%, com um valor preditivo positivo de 0,55 e valor preditivo negativo de 0,63 com razão de verossimilhança para teste positivo (likelihood ratio) de 1,73. As pacientes com EMI alterado apresentaram níveis mais elevados de PCR-US, porém sem significância estatística. As pacientes com DAC apresentaram níveis mais elevados de PCR-US, porém sem significância estatística. Conclusão: Na população estudada, a avaliação da função endotelial pelo método da EMI apresentou maior sensibilidade e especificidade para o diagnóstico de DAC quando comparada a mensuração dos níveis de PCR-US em mulheres climatéricas

Background: The endothelium plays an important vascular regulatory function. Its dysfunction is an early marker of cardiovascular risk. However, there are few studies in our community that assess endothelial function in pre-menopausal women. Objective: To assess endothelial function in pre-menopausal women in the presence or absence of coronary artery disease, using a biophysical method (carotid intima media thickness) and a biochemical method (serum levels of hsCRP). Methods: Cross-sectional study that evaluated carotid intima-media thickness and serum levels of hsCRP of 31 pre-menopausal women undergoing coronary angiography at the Hemodynamics Service of Hospital Universitário da Universidade Federal do Maranhão from March 2012 to July 2013. The data were sent to statistical analysis and a statistical significance level of 5% was considered. Results: The sample was divided into two groups according to the presence of coronary artery disease (CAD): CAD group (n = 13) and group without CAD (n = 18). The average ages for the groups were 57.92 ± 5.17 and 51.72 ± 4.63 years, respectively (p = 0.001). CIMT was abnormal in 29.03% in the general population. Carotid intima-media thickness was 1.55 ± 0.78 mm in the general group, 1.92 ± 0.94 mm in the CAD group and 1.18 ± 0.71 mm in the group without CAD (p = 0.001). CAD patients had predominance of abnormal CMIT compared those without CAD: 36.46% vs. 22.22%, respectively. There was a sensitivity of 38%, specificity of 77% with a positive predictive value of 0.55 and a negative predictive value of 0.63 with likelihood ratio of 1.73. Patients with abnormal CIMT presented higher levels of hsCRP, but without statistical significance. CAD patients had higher levels of hsCRP, but without statistical significance. Conclusion: In the population studied, assessment of endothelial function using the CIMT method showed higher sensitivity and specificity for the diagnosis of CAD compared to the measurement of hsCRP levels in menopausal women

Estudo SAVEME (Salvamento Miocárdico Após Angioplastia de Resgate: Avaliação por Ressonância Magnética). Racional e desenho do estudo / SAVEME (Myocardial Salvage After Rescue Angioplasty: Evaluation by Magnetic Resonance) Study: Rationale and Study Design

Introdução: A doença aterosclerótica é responsável por um terço dos óbitos ocorridos anualmente, pois frequentemente leva a complicações como infarto do miocárdio com supradesnivelamento do segmento ST (IMCST). A intervenção coronária percutânea (ICP) de resgate é indicada caso ocorra falha da terapia trombolítica administrada neste cenário. No entanto, os benefícios, em termos de redução da taxa de mortalidade e da quantidade de miocárdio efetivamente salvo, não são bem estabelecidos. O desenvolvimento de novas ferramentas, entre elas a ressonância magnética cardíaca, para identificar a área miocárdica em risco e infartada, elevou a acurácia diagnóstica. Diferentemente do contexto da ICP primária, pouco se sabe sobre a relação entre o fluxo coronário epicárdico e microvascular após a ICP de resgate e a área de miocárdio salva. O objetivo deste estudo é avaliar se existe relação entre tais fluxos e a área de miocárdio salva identificada pela ressonância magnética. Métodos: Estudo prospectivo, aberto, unicêntrico, de intervenção. Serão selecionados 72 pacientes com IMCST que tiverem realizado ICP de resgate após falha documentada da terapia fibrinolítica transferidos para este serviço, obedecendo uma estratégia fármaco-invasiva. Conclusões: Ao término desta pesquisa, esperamos contribuir para o conhecimento sobre o fluxo coronariano e sua relação com a quantidade de músculo cardíaco salvo após a ICP de resgate. Esta é uma informação que pode ajudar a entender quais casos mais se beneficiam da ICP de resgate

Introduction: Atherosclerotic disease accounts for one-third of deaths annually, as it often leads to complications such as ST-elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (PCI) is indicated in case of thrombolytic therapy failure administered in this scenario. However, the benefits regarding mortality rate reduction and the amount of myocardium that is actually salvaged are not well established. The development of new tools, including cardiac magnetic resonance imaging, to identify the myocardium at risk and the infarcted area has increased diagnostic accuracy. Differently from the context of primary PCI, little is known about the association between epicardial and microvascular coronary flow following rescue PCI and the salvaged myocardial area. The aim of this study is to evaluate whether there is an association between coronary flow and the salvaged myocardial area identified by magnetic resonance imaging. Methods: This will be a prospective, open, single-center, intervention study. A total of 72 patients with STEMI who underwent rescue PCI after documented failure of the fibrinolytic therapy, and were transferred to our institution, will be selected, observing a pharmacoinvasive strategy

Prognóstico da coronariopatia aterosclerótica não significativa detectada pela tomografia de coronárias / Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

Introdução: Embora os estudos tenham demonstrado elevada acurácia diagnóstica da tomografia de coronárias (TC)na detecção de doença arterial coronariana (DAC), os dados sobre o valor prognóstico desse método em pacientes com obstrução coronariana não significativa são limitados.Objetivo: Avaliar o valor da TC na predição de eventos adversos em pacientes com suspeita de DAC e obstrução coronária não significativa. Métodos: Foram avaliados prospectivamente 440 pacientes entre janeiro de 2008 e julho de 2013 pela TCMD, diagnosticados com obstrução não significativa ou sem obstrução aterosclerótica coronariana e com seguimento médio de 33 meses. Os desfechos avaliados foram: morte de origem cardíaca, infarto do miocárdio, angina instável associado à hospitalização ou revascularização do miocárdio. Resultados: Dos 440 pacientes estudados, 295 (67%) eram homens, com idade média de 55,9 ± 12,0 anos. Foi encontrada obstrução não significativa em 152 (35%) dos pacientes e ocorreram 49 (11%) desfechos. Na análise multivariada, utilizando-se modelo de regressão de Cox, os preditores de desfechos clínicos foram obstrução não significativa à TC(hazard ratio 3,51; IC 95% 1,73 – 7,8; p < 0,01), idade e hipertensão arterial sistêmica. A obstrução não significativa à TC apresentou associação com desfechos clíncos adversos, e a análise de sobrevida mostrou diferença significativa (log-rank 24,6; p < 0,01) na predição desses desfechos. Conclusão: A detecção de obstrução aterosclerótica não significativa pela TC mostrou associação com a presença de eventos adversos em pacientes com suspeita de DAC, podendo se mostrar útil na estratificação de risco desses pacientes.

Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD),data on the prognostic value of this method in patients with no significant coronary obstruction are limited.Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting.Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes werenon-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 — 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT wasassociated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes.Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients withsuspected CAD, which may prove useful in the risk stratification of these patients.

Study of coronary artery atherosclerosis in sudden deaths and its medico-legal relevance.

The coronary artery diseases can play a crucial medico- legal role to decide the cause of sudden death whether natural or unnatural. There are certain occasions, when a person dies on the operating table or soon after surgery, and a coronary attack is probably the cause of death. A final coronary episode may sometimes be associated with an operative procedure supposedly due to hypotensive state. During driving or piloting a person may goes into a state of confusion because heart attack. In this state he may lose control and an accident can happen. These conditions indicate that intervention of Forensic Pathologist is significant to decide the actual cause of death apart from injury or disease of vital organs. We examine coronary arteries for atherosclerotic changes in 50 cases of sudden deaths. We observed that there were marked intimal thickening with luminal narrowing ≤ 75% of luminal diameter in 20 cases (40%) in total hearts. In natural deaths 17 cases (48.57%) showed luminal narrowing ≤ 75% of luminal diameter. These findings are suggestive of medico legal intervention to clarify the mode of death in some instances.

Correlation of risk factors with coronary atherosclerosis.

The prevalence of any disease among individuals likely to cause tissue or organ injury is related to a number of factors. The risk factors that predispose to atherosclerosis have been identified by a number of studies. This study was undertaken to correlate risk factors with the occurrence & severity of coronary atherosclerosis. The study duration was of 2 years from October 2006 to October 2008 & it includes 120 medicolegal autopsies conducted at MGIMS, over a period of 2 years. Data (age, sex, occupation, education, alcoholism, smoking, dietary habits etc) was recorded from the short history. Major coronaries were sectioned transversely by sharp knife at intervals of 0.3 cm and also longitudinally. The morphological lesions were noted in proforma and then they were sent for histopathology. The data was evaluated statistically. The study shows definite correlation between the risk factors and atherosclerosis. Certain life style modifications can decrease the incidence of atherosclerosis in the population.

Análise crítica da estratificação de risco cardiovascular / Critical analysis of cardiovascular risk stratification

A doença aterosclerótica cardiovascular é a principal causa de morte em todo o mundo e em muitos dos casos o evento fatal é sua primeira manifestação. Educar mudança de hábitos à população e identificar e tratar precocemente os indivíduos de alto risco é a única forma de reagir. Nesse contexto, diversos escores marcadores de risco têm sido desenvolvidos para auxiliar a identificação e orientar a terapêutica preventiva. A complexidade da aterogênese e sua multiplicidade de fatores de risco limitam, no entanto, a eficácia destas ferramentas e impõem estratégias sequenciais de investigação. Nesta revisão, serão apresentadas as principais características e limitações dos escores clínicos, com que frequência eles podem falhar em indivíduos de alto risco na população brasileira e que estratégias estão sendo usadas para atenuar estas limitações.

Atherosclerotic cardiovascular disease is the leading cause of death worldwide and in many cases the fatal event is its first appearance. Educating the population to change of habits and lifestyle identifying and promptly treating the high-risk individuals are ways of fighting against this disease. In this context, several risk markers and scores have been developed to help identify and guide preventive therapy. Their effectiveness, however, is affected by the complex interactions among multiple risk factors involved in atherogenesis and strategies involving the combined use of clinical scores and laboratory or imaging tests are necessary. This review will cover the main features and limitations of clinical scores, which often can fail in high-risk individuals in our population, and in strategies which are being used to mitigate these limitations.

Além dos lípides: o que valorizar a prevenção? / Beyond lipids what should be done to improve cardiovascular prevention?

Além da obtenção de níveis ideais de lipídios, com base na estratificação de risco, outros fatores de risco clássicos, como a hipertensão arterial, diabetes mellitus e tabagismo devem ser abordados e receber a terapia mais apropriada. Na decisão da melhor estratégia terapêutica, a presença de comorbidades, como insuficiência renal, hepatopatias, doenças gastrointestinais e pulmonares, também constituem aspectos decisivos na prescrição médica mais adequada. Outro quesito que não deve ser negligenciado é o sinergismo entre os fármacos para atenuação de mecanismos da aterosclerose. De forma universal, o estilo de vida saudável deve receber adequada recomendação e, com base nas características individuais do paciente, sugeridas as opções mais apropriadas. Finalmente, deve ser programado o seguimento do paciente com base em testes diagnósticos e funcionais, periodicidade de exames de biomarcadores laboratoriais, aqueles destinados para a segurança, além de futuros exames de imagens.

Beyond the achievement of appropriate lipid levels based on the cardiovascular risk stratification, other classic risk factors, such as hypertension, diabetes mellitus and smoking should also receive adequate therapy. For the best therapeutic decision, other comorbidities, e.g. renal failure, liver disease, gastrointestinal and lung diseases should be taken into account, as they constitute important aspects for medical decision. Another aspect that should not be neglected is the synergism between drugs for the attenuation of mechanisms related to atherosclerosis. As a general recommendation, an appropriate lifestyle should be emphasized, respecting the characteristics of each patient. Finally, a reliable chronogram during the follow up should be discussed with the patient regarding laboratory tests (biomarkers, image), including safety or diagnosis.

Tratamento da hipercolesterolemia: quais os mais importantes produtos de pesquisa? / Hypercholesteromia the most important products being researched?

As estatinas são produtos farmacêuticos de grande sucesso em todo mundo. Entretanto, muitos pacientes, ou por não as tolerarem adequadamente, ou por necessitarem de taxas mais baixas de LDL-colesterol estabelecidas como metas, poderão ter benefícios clínicos com o emprego de novos medicamentos. Numerosas linhas de pesquisa encontram-se em evolução, avaliando produtos com atuação em diferentes vias moleculares: inibidores de síntese da apolipoproteína B, inibidores da DGAT2, da ACAT2, da MTP, da esqualeno sintase, tireoidemiméticos e inibidores da PCSK9. Espera-se, para futuro próximo, a introdução no mercado desses medicamentos, que poderão auxiliar ainda mais na prevenção primária e secundária da doença aterosclerótica coronária, flagelo deste novo século.

Statins are pharmaceutical products that obtained worldwide success. However, some patients with inadequate tolerability to these medications and the need of achieving lower LDL-cholesterol levels as recommended targets, may receive clinical benefits with the use of new drugs. Many research lines have been in evolution evaluating products that act in different molecular pathways: inhibitors of apoliprotein B synthesis, inhibitors of DGAT2, ACAT2, MTP, squalene synthase, thyromimetics, and inhibitors of PCSK9. It is a hope that the future introduction of many of these products on the market will help furthermore primary and secondary prevention of coronary heart disease, a scourge of this new century.

Novel cardiovascular drugs in clinical trials.

Cardiovascular diseases remain a major cause of morbidity and mortality worldwide, regardless of the recent advances in medical and surgical treatment, for as life expectancy in the developed countries increases, cardiovascular conditions affecting the elderly also rises. Atherosclerosis and cardiovascular diseases take a huge toll on the society, making them the leading cause of death in developed countries. Phenomenal advances in the pathophysiology of cardiovascular disease and the molecular signaling pathways has revealed the role of endothelial dysfunction involved therein and thus has raised the possibility of novel therapeutic targets. Such potential cellular targets include the vascular smooth muscle cells, monocyte/macrophage cell lines, platelets, and endothelial cells. Certain studies affirm that antiplatelet agents, antioxidant therapies, amino acid supplementation, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers may prevent or slow the progression of the disease process. The race is on for new medicines that can treat and prevent heart attacks and strokes, arising out of atherosclerosis, which kills nearly 1 million people a year in the U.S.A alone.

Aterosclerose carotídea avaliada pelo eco-Doppler: associação com fatores de risco e doenças arteriais sistêmicas / Carotid atherosclerosis evaluated by Doppler ultrasound: association with risk factors and systemic arterial disease

CONTEXTO: A aterosclerose carotídea apresenta alta prevalência populacional e associação com vários fatores de risco, contribuindo para altos índices de morbidade e mortalidade. OBJETIVO: Pesquisar a freqüência e associação da aterosclerose de carótidas extracranianas com: idade, sexo, hipertensão arterial, doença coronária isquêmica, tabagismo, diabetes melito tipo 2, obesidade, doença arterial oclusiva periférica, acidente vascular cerebral, oclusão carotídea, espessamento médio-intimal e acotovelamento. MÉTODOS: Foram avaliadas as artérias carótidas extracranianas, bilateralmente, de 367 indivíduos (132 homens e 235 mulheres) com idade média de 63 anos (35 a 91 anos) por anamnese, semiologia clínica e ultra-sonografia. A possibilidade da associação entre aterosclerose carotídea representada por placas ateromatosas inespecíficas com estenose > 10 por cento, ateromatose discreta e difusa com estenose < 10 por cento e os fatores de risco enunciados foi analisada estatisticamente pelo odds ratio e seus intervalos de confiança de 95 por cento. RESULTADOS: A freqüência da aterosclerose carotídea foi de 52 por cento, e do espessamento médio-intimal, de 30,2 por cento. Houve associação entre a aterosclerose (ateromatose discreta e difusa e placas ateromatosas inespecíficas) com idade > 64 anos, acidente vascular cerebral, obesidade e tabagismo. Considerando-se somente estenoses carotídeas > 60 por cento, houve associação com idade > 64 anos, oclusão carotídea e doença coronária. O espessamento médio-intimal apresentou associação com idade > 64 anos, acotovelamento, oclusão carotídea, hipertensão arterial e índice tornozelo-braquial < 0,9. CONCLUSÃO: A aterosclerose carotídea apresentou alta freqüência populacional (52 por cento) e associação com idade, obesidade, acidente vascular cerebral, coronariopatia e tabagismo.

BACKGROUND: A high prevalence of carotid atherosclerosis in the population and its frequent association with several risk factors contribute to high morbidity and mortality rates. OBJECTIVE: To investigate frequency and association of extracranial carotid atherosclerosis with age, sex, hypertension, ischemic coronary disease, smoking, type 2 diabetes mellitus, obesity, peripheral arterial disease, stroke, carotid occlusion, intima-media thickness and kinking. METHODS: The carotid and bilateral extracranial arteries of 367 individuals (132 males and 235 females), with a mean of 63 years of age (35-91 years) were evaluated via anamnesis, clinical semiology and ultrasonography. The possible association between carotid atherosclerosis, represented by unspecific atheromatous plaques with stenosis > 10 percent or discrete and diffuse atheromatosis with stenosis < 10 percent and the risk factors listed above was statistically analyzed by the odds ratio with a confidence interval of 95 percent. RESULTS: The frequency of carotid atherosclerosis and intima-media thickness was, respectively, 52 and 30.2 percent. There was an association between atherosclerosis types and age (> 64 years), stroke, obesity and smoking. When only carotid stenosis > 60 percent was considered, there was an association with age (> 64 years), carotid occlusion and coronary disease. Intima-media thickness was associated with age (> 64 years), kinking, carotid occlusion, hypertension and ankle-brachial index < 0.9. CONCLUSION: Carotid atherosclerosis is highly prevalent in the population (52 percent) and is associated with age, obesity, stroke, coronary disease, and smoking.

Plasma homocysteine level in cardiac syndrome X and its relation with duke treadmill score

To investigate the plasma homocysteine level and the relationship between plasma homocysteine level and duke treadmill score DTS in cardiac syndrome X CSX patients. Seventy-nine patients 36 male, 43 female, mean age: 50 +/- 8.8 years admitted to Gazi University Hospital, Ankara, Turkey with typical effort angina, positive stress test, and angiographically normal coronary arteries between January and September 2006 were included in this prospective and controlled study. Thirty asymptomatic patients 11 male, 19 female, mean age: 47.6 +/- 8.3 years with 2 cardiovascular risk factors were chosen as a control group. Plasma homocysteine level was measured in both groups and DTS was calculated in the CSX group. Plasma homocysteine was measured with the AxSYM homocysteine immunoassay method in both groups. Plasma homocysteine level was higher in the CSX group compared to the control group 16.5 +/- 4.9 ?mol/L, n=79, versus 12.4 +/- 4.1 ?mol/L, n=30, p<0.001. The DTS was -2.7 +/- 5.3 in the CSX group. There was a negative correlation between the DTS and homocysteine levels in the CSX group. r=-0.506, p<0.001. Plasma homocysteine level, which is known to cause endothelial dysfunction and microvascular ischemia were higher in CSX patients. Also, this increase in homocysteine level inversely correlated with the DTS, which represents the magnitude of ischemia

Mortalidad por cardiopatía isquémica en Cuba: relación con la dieta y el colesterol sérico / Death from ischemic heart disease in Cuba and its relationship with diet and serum cholesterol

Numerosos estudios han demostrado la asociación entre la dieta elevada en grasas saturadas, el colesterol total en el suero y la mortalidad por enfermedades aterosclerosas. La curva de mortalidad por cardiopatía isquémica en nuestro país ascendió hasta 1990, en que comenzó un descenso que alcanza el 25 porciento del pico máximo. La etapa de ascenso se relaciona con un consumo elevado en grasas saturadas evidenciado por un aumento concomitante del colesterol sérico, mientras que el descenso comienza con el inicio del llamado período especial, caracterizado por una disminución de la ingestión de grasas, una reducción del sedentarismo y de la obesidad en nuestra población. La reducción de la mortalidad por cardiopatía isquémica es menor de la esperada de acuerdo con la reducción en las cifras de colesterol total en la población. Esto podría estar motivado por la presencia de otros factores de riesgo de aterosclerosis aún no estudiados en nuestro medio

Dislipidemias / Dyslipidemias

En este aporte hemos hecho una breve reseña de las ideas actuales sobre este tema, en especial los estudios que prueban la validez de la terapéutica hipolipemiante para disminuir eventos y mortalidad por enfermedades ateroscleróticas. Recalcamos asimismo la importancia para nuestro medio del 2º Consenso Uruguayo sobre dislipemias de agosto de 1998.

Vitamin use and atherosclerotic heart disease mortality: a matched case-control study in Maryland

The effect of any vitamin use was assessed in 175 subjects who died of atherosclerotic heart disease [ASHD] and 350 age and sex matched controls recruited from Washington county, Maryland, between May through November 1989. Vitamin use was inversely associated with the risk of death from ASHD [crude relative odds 0.83 [95% C.I. 0.53 to 1.29; p = 0.413]]. After adjustment for multiple cardiovascular risk factors using conditional logistic regression, the protective effect of vitamins in lowering the risk of ASHD was enhanced, [adjusted relative odds 0.61 [95% C.l. 0.37 to 0.99 p= 0.047]]. Other significant risk factors for ASHD were current cigarette smoking [adjusted relative odds 2.63 [95% C.l. 1.46 to 4.7; p = 0.001]], taking two or more medications concurrently [other than antihypertensive and antihyperlipidemic drugs] [adjusted relative odds 2.28 [95% C.l. 1.46 to 3.55; p= 0.001]] and being on antihypertensive treatment [adjusted relative odds 1.63 [95% C.l. 1.06 to 2.49; p = 0.025]]. Systolic and diastolic blood pressure, blood cholesterol, education and body mass index were found not to be significantly associated with ASHD after adjusting for current treatment for hypertension, current cigarette smoking and taking more than two medications

Diabetes y enfermedad coronaria / Diabetes and coronary heart disease

La enfermedad aterosclerótica constituye la mayor causa de morbimortalidad en pacientes diabéticos. El infarto de miocardio es más prevalente, su curso más tórpido y su pronóstico peor, especialmente en mujeres. Se plantea un enfoque epidemiológico de la relación entre diabetes y enfermedad coronaria considerando tanto los efectos de la primera en los factores de riesgo coronario, cuanto los efectos directos de la diabetes, la hiperglucemia y la hiperinsulinemia en el desarrollo aterosclerótico y trombótico, ya que el exceso de enfermedad vascular en estos pacientes no se explica totalmente por la mayor prevalencia de los factores de riesgo coronario