Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention. / Adequação do Consumo de Ácidos Graxos entre Pacientes em Prevenção Cardiovascular Secundária.

BACKGROUND: Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases. OBJECTIVE: To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence. METHODS: Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis. RESULTS: No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions. CONCLUSIONS: Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.

FUNDAMENTO: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. OBJETIVO: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. MÉTODOS: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS), <7%. Na análise estatística foi considerando nível de significância de 5%. RESULTADOS: Nenhum participante aderiu a todas as recomendações de forma simultânea e mais da metade (1482 [62,9%]) não aderiu a nenhuma recomendação. A adesão exclusivamente à recomendação de AGS foi a mais prevalente, sendo cumprida por 659 (28%) dos participantes, seguida da adesão exclusivamente à recomendação de AGP (178 [7,6%]) e de AGM (5 [0,2%]). Não houve associação entre o número de comorbidades e a adesão às recomendações nutricionais (p =0,269). Os participantes da região Nordeste do país apresentaram maior proporção de adesão às recomendações para consumo de AGS (38,42%), e menor para ingestão de AGPI (3,52%) (p <0,001) em comparação às demais. CONCLUSÕES: Na amostra avaliada, evidenciou-se baixa adesão às recomendações nutricionais para consumo de ácidos graxos.

Adequação do consumo de ácidos graxos entre pacientes em prevenção cardiovascular secundária / Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention

FUNDAMENTO: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. OBJETIVO: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. MÉTODOS: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS), <7%. Na análise estatística foi considerando nível de significância de 5%. RESULTADOS: Nenhum participante aderiu a todas as recomendações de forma simultânea e mais da metade (1482 [62,9%]) não aderiu a nenhuma recomendação. A adesão exclusivamente à recomendação de AGS foi a mais prevalente, sendo cumprida por 659 (28%) dos participantes, seguida da adesão exclusivamente à recomendação de AGP (178 [7,6%]) e de AGM (5 [0,2%]). Não houve associação entre o número de comorbidades e a adesão às recomendações nutricionais (p =0,269). Os participantes da região Nordeste do país apresentaram maior proporção de adesão às recomendações para consumo de AGS (38,42%), e menor para ingestão de AGPI (3,52%) (p <0,001) em comparação às demais. CONCLUSÕES: Na amostra avaliada, evidenciou-se baixa adesão às recomendações nutricionais para consumo de ácidos graxos.

Is phase angle associated with visceral adiposity and cardiometabolic risk in cardiology outpatients?

BACKGROUND/OBJECTIVES: Phase angle (PhA) serves as a prognostic marker in various clinical scenarios, reflecting oxidative stress and cellular damage. Despite its clinical relevance, its connection with adiposity and cardiovascular risk markers remains underexplored. Hence, our study sought to investigate the relationship between PhA and metabolic, adiposity, and cardiovascular risk parameters among outpatients with cardiology diagnosis. SUBJECTS/METHODS: Adults aged between 26 and 59 years, under the care of a cardiology unit, were included. Ultrasound imaging was used to assess visceral adipose tissue (VAT). Single-frequency bioelectrical impedance analysis (BIA) [50 kHz] was employed to calculate PhA, from BIA's resistance and reactance measurements. Muscle strength, body mass index, waist circumference, and waist-to-height ratio were also evaluated. Framingham's risk score was calculated to estimate the cardiovascular risk events. Metabolic blood samples' results were obtained from medical records. RESULTS: One hundred and five participants were included in our study. Low PhA was observed in 29.5% of our sample. Higher PhA values were independently and inversely associated with both higher VAT and cardiovascular risk (adjusted OR: 0.79 [95% CI 0.69;0.91], OR: 0.74 [95% CI 0.60;0.89], respectively). Lower PhA values (≤5.59) were goodly associated with high VAT (AUC: 0.82 p < 0.001). Lower PhA values (≤5.06) were fairly associated with higher cardiovascular risk (AUC: 0.70 p = 0.003). CONCLUSION: Our study provides evidence that PhA is independently and inversely associated with elevated VAT and cardiovascular risk. These findings underscore the potential of PhA as a valuable complementary marker in assessing cardiometabolic health.

Individual differences in the effects of midazolam on anxiety-like behavior, learning, reward, and choice behavior in male mice.

Introduction: The aim of the present study was to investigate the behavioral effects of the benzodiazepine midazolam in male mice, in models of anxiolysis, learning, and abuse-related effects. Methods: In a first set of experiments, male Swiss mice were submitted to the training session of a discriminative avoidance (DA) task on the elevated plus maze to evaluate anxiety-like behavior and learning after vehicle or midazolam (1, 2 or 5 mg/kg, i.g.) administration. The same animals were submitted to a conditioned place preference (CPP) protocol with midazolam (1, 2 or 5 mg/kg, i.g.). In a second experiment, outbred (Swiss) and inbred (C57BL/6) male mice were submitted to a two-bottle choice (TBC) oral midazolam drinking procedure. Animals were exposed to one sucrose bottle and one midazolam (0.008, 0.016 or 0.032 mg/ml) plus sucrose bottle. Results: Midazolam (1 and 2 mg/kg) induced anxiolytic-like effects, and all doses of midazolam prevented animals from learning to avoid the aversive closed arm during the DA training session. Assessment of midazolam reward via the CPP procedure and choice via the TBC procedure showed notable variability. A 2-step cluster analysis for the CPP data showed that midazolam data were well-fitted to 2 separate clusters (preference vs. aversion), albeit with the majority of mice showing preference (75%). Correlational and regression analyses showed no relationship between midazolam reward and anxiolytic-like effects (time spent in the open arms in the DA test) or learning/memory. Two-step cluster analysis of the TBC data also demonstrated that, regardless of strain, mice overall fell into two clusters identified as midazolam-preferring or midazolam-avoiding groups. Both midazolam preference and avoidance were concentration-dependent in a subset of mice. Discussion: Our findings show that midazolam preference is a multifactorial behavior, and is not dependent solely on the emergence of therapeutic (anxiolytic-like) effects, learning impairments, or on genetic factors (inbred vs. outbred animals).

Evaluation of muscle loss by ultrasonography in critically ill patients.

BACKGROUND: Critically ill patients have intense muscle tissue mobilization, and attenuating protein catabolism may contribute to improved outcomes. OBJECTIVE: To evaluate short-term muscle loss in critically ill patients. METHODS: In this prospective observational study, we evaluated the thickness of the rectus femoris muscle by ultrasonography in young and older adults of both sexes admitted to a cardiological intensive care unit within 48 h of admission (baseline) and after 7 days. The results were compared and correlated with anthropometric, clinical, and biochemical parameters. The significance level for all statistical analyses was 0.05. RESULTS: The final sample comprised 88 patients with a mean age of 66.2 ± 11.8 years. There was an average 13.5% reduction in rectus femoris muscle thickness over the study period (P < 0.001), regardless of the thigh circumference maintenance (P = 0.229). This reduction occurred even with improved clinical parameters (C-reactive protein, Simplified Acute Physiology Score) and was greater in patients receiving mechanical ventilation and sedation and in those who died. Regarding nutrition status, malnourished and eutrophic individuals showed greater muscle loss than overweight individuals. There was also an inverse correlation of muscle loss (percentage) with body mass index, arm circumference, and calf circumference (P < 0.05), demonstrating that the lower these anthropometric measurements, the higher the muscle loss obtained by ultrasound. CONCLUSION: Ultrasonography assessment detected muscle mass loss in the short-term more sensitively than the anthropometric method. However, it demands caution and further studies demonstrating this analysis.

The applicability of the Visceral Adiposity Index (VAI) for predicting visceral fat / Aplicabilidade do Índice de Adiposidade Visceral (IAV) como preditor de gordura visceral

Abstract As obesity has reached epidemic proportions and given the current recognition of central adiposity as an important cardiometabolic risk factor, several researchers have focused on developing and validating predictive indexes and equations to evaluate Visceral Adipose Tissue (VAT). This study evaluates the applicability of the Visceral Adiposity Index (VAI) for predicting cardiometabolic risk in individuals treated in a hospital In the northeast region of Brazil. The VAT was evaluated by computed tomography (CT) and the VAI was calculated through specific equations for each gender. The sample involved adult and elderly patients of both genders followed up in a cardiology outpatient clinic. The following cardiometabolic parameters were collected: fasting glycemia, glycated hemoglobin, lipid profile, C-reactive protein (CRP) and uric acid. The simple linear regression was used to evaluate the explanatory power of the VAI in relation to the volume of VAT determined by CT. The predictive capacity of VAI in relation to the volume of VAT determined by CT was 25.8% (p=0.004) for males and 19.9% (p<0.001) for females. VAI correlated strongly with the triglyceride (TG) (p<0.001) and TG/high-density lipoprotein (HDL) ratio (p<0.001) and inversely correlated with HDL (p<0.001). Moreover, VAI showed low correlation with the following variables: abdominal circumference, total cholesterol, low density lipoprotein, fasting glycemia, and glycated hemoglobin (p<0.05). VAI was associated with variables considered as cardiometabolic risk factors, but exhibited a low predictive capacity regarding the volume of VAT determined by CT. Thus, caution is recommended in its use in Brazilian individuals.

Resumo Em razão de a obesidade ter alcançado proporções epidêmicas e dado ao atual reconhecimento da adiposidade central como um importante fator de risco cardiometabólico, diversos pesquisadores têm se dedicado em desenvolver e validar índices e equações preditivas para avaliar o Tecido Adiposo Visceral (TAV). Este estudo avaliou a aplicabilidade do Índice de Adiposidade Visceral (IAV) como preditor de risco cardiometabólico em indivíduos atendidos em um hospital no nordeste brasileiro. O TAV foi avaliado por tomografia computadorizada (TC) e o IAV foi calculado através de equações específicas para cada sexo. A amostra envolveu pacientes adultos e idosos de ambos os sexos acompanhados no ambulatório de cardiologia. Os seguintes parâmetros cardiometabólicos foram coletados: glicemia de jejum, hemoglobina glicada, perfil lipídico, proteína C-reativa e ácido úrico. Regressão linear simples foi empregada para avaliar o poder explicativo do IAV em relação ao volume de TAV determinado por TC. A capacidade preditiva do IAV em relação ao volume de TAV determinado pela TC foi de 25,8% (p=0,004) para o sexo masculino e 19,9% (p<0,001) para o sexo feminino. O IAV se correlacionou fortemente com as variáveis TG (r=0,916, p< 0,001) e TG/HDL (r=0,952, p<0,001) e inversamente com o HDL (r=-0,441, p<0,001), além disso, apresentou baixa correlação com as variáveis: circunferência abdominal, colesterol total, lipoproteína de baixa densidade, glicemia de jejum e hemoglobina glicada (p<0,05). O IAV associou-se com variáveis consideradas fatores de risco cardiometabólico, porém exibiu baixa capacidade preditiva em relação ao volume de TAV determinado pela TC, sendo recomendada cautela em sua utilização em indivíduos brasileiros.

Ibogaine Blocks Cue- and Drug-Induced Reinstatement of Conditioned Place Preference to Ethanol in Male Mice.

Ibogaine is a psychedelic extracted from the plant Tabernanthe iboga Baill. (Apocynaceae), natural from Africa, and has been proposed as a potential treatment for substance use disorders. In animal models, ibogaine reduces ethanol self-administration. However, no study to date has investigated the effects of ibogaine on ethanol-induced conditioned place preference (CPP). The present study aimed to investigate the effects of repeated treatment with ibogaine on the reinstatement of CPP to ethanol in male mice. The rewarding effects of ethanol (1.8 g/kg, i. p.) or ibogaine (10 or 30 mg/kg, p. o.) were investigated using the CPP model. Furthermore, we evaluated the effects of repeated treatment with ibogaine (10 or 30 mg/kg, p. o.) on the reinstatement of ethanol-induced CPP. Reinstatement was evaluated under two conditions: 1) during a priming injection re-exposure test in which animals received a priming injection of ethanol and had free access to the CPP apparatus; 2) during a drug-free test conducted 24 h after a context-paired re-exposure, in which subjects received an injection of ethanol and were confined to the compartment previously conditioned to ethanol. Our results show that ethanol, but not ibogaine, induced CPP in mice. Treatment with ibogaine after conditioning with ethanol blocked the reinstatement of ethanol-induced CPP, both during a drug priming reinstatement test and during a drug-free test conducted after re-exposure to ethanol in the ethanol-paired compartment. Our findings add to the literature suggesting that psychedelics, in particular ibogaine, may have therapeutic properties for the treatment of alcohol use disorder at doses that do not have rewarding effects per se.

The impact of visceral fat and levels of vitamin D on coronary artery calcification.

OBJECTIVE: To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS: A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS: The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5-39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4-11.7), hypertension (OR: 4.8; 95%CI 1.5-15.3), and age (OR: 10.4; 95%CI 3.9-27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS: Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.

The impact of visceral fat and levels of vitamin D on coronary artery calcification

SUMMARY OBJECTIVE: To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS: A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS: The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5-39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4-11.7), hypertension (OR: 4.8; 95%CI 1.5-15.3), and age (OR: 10.4; 95%CI 3.9-27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS: Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.

Ayahuasca blocks the reinstatement of methylphenidate-induced conditioned place preference in mice: behavioral and brain Fos expression evaluations.

RATIONALE: Accumulating evidence suggests that ayahuasca, a hallucinogenic beverage used in traditional Amazonian communities for ritualistic and curative purposes, has been associated with reduced rates of substance use disorders. However, the brain mechanisms underlying the therapeutic effects of ayahuasca have not yet been fully elucidated. OBJECTIVES: The aim of the present study was to investigate the effects of treatment with ayahuasca on the rewarding properties of the psychostimulant methylphenidate. METHODS: The rewarding properties of ayahuasca (100 mg/kg, orally) and methylphenidate (10 mg/kg, i.p.) were investigated using the conditioned place preference (CPP) model. Furthermore, we evaluated the effects of repeated treatment with ayahuasca on the reinstatement of methylphenidate-induced CPP. Fos expression was evaluated in different limbic structures (cingulate cortex-area 1, prelimbic cortex, infralimbic cortex, orbitofrontal cortex-lateral orbital area, nucleus accumbens core and shell, ventral tegmental area, dorsal striatum, and basolateral amygdala) upon each experimental phase. RESULTS: Both ayahuasca and methylphenidate induced CPP in mice. However, ayahuasca had limited effects on Fos expression, while methylphenidate altered Fos expression in several brain regions associated with the behavioral effects of drugs of abuse. Treatment with ayahuasca after conditioning with methylphenidate blocked the reinstatement of methylphenidate-induced CPP. Those behavioral effects were accompanied by changes in Fos expression patterns, with ayahuasca generally blocking the changes in Fos expression induced by conditioning with methylphenidate and/or reexposure to methylphenidate. CONCLUSIONS: Our findings suggest that ayahuasca restored normal brain function in areas associated with the long-term expression of drug wanting/seeking in animals conditioned to methylphenidate.

Glomerular filtration rate and its relationship with visceral and subcutaneous adiposity: a study with patients from Northeast Brazil / Tasa de filtración glomerular y su relación con la adiposidad visceral y subcutánea: un estudio con pacientes del noreste brasileño

ABSTRACT Objective: evaluate the relationship between visceral/subcutaneous adipose tissue (VAT/SAT) and glomerular filtration rate (GFR). Methods: A case series study was conducted with 146 male and female adult outpatients at a hospital in Northeast Brazil. VAT and SAT were quantified using computed tomography and GFR was estimated using the formula proposed by the CKD Epidemiology Collaboration. The conceptual model also considered socio-demographic, clinical, anthropometric and lifestyle variables. Results: Females accounted for 71.9% of the sample and mean age was 52.5±13.2 years. Mean body mass index indicated obesity in both sexes (men:30.4±5.9 kg/m2; women: 31.6±6.1 kg/m2). For the same mean age and BMI, men had more VAT and a higher VAT/SAT ratio. Mean GFR was similar between sexes and within the normal range. Simple linear regression analysis revealed that 21.8% of the reduction in GFR in males could be explained by the VAT/SAT ratio (p=0.002). Among females, both VAT alone and the VAT/SAT ratio were predictors of GFR reduction (r2=4.8%, p=0.025 and r2=5.3%, p=0.019, respectively). Conclusion: Mean VAT and VAT/SAT ratio were compatible with abdominal obesity in both sexes and were related to a reduction in GFR.

RESUMEN Objetivo: Evaluar la relación entre el tejido adiposo visceral (TAV) y subcutáneo (TAS) con la tasa de filtración glomerular. Métodos: Estudio tipo serie de casos, en 146 pacientes adultos de ambos sexos, atendidos en un ambulatorio de un hospital de referencia en el Nordeste brasileño. El TAV y el TAS se cuantificaron por tomografía computadorizada y la tasa de filtración glomerular (TFG) estimada por la fórmula del grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). El modelo conceptual también consideró variables sociodemográficas, clínicas, antropométricas y de estilo de vida. Resultados: Pacientes con edad promedio de 52,5 ± 13,2 años y el 71,9% de sexo femenino. El promedio del IMC en ambos sexos se encuentra en el rango de obesidad (hombres= 30,4 ± 5,9 kg/m2 vs mujeres= 31,6 ± 6,1 kg/m2). Para un mismo promedio de edad e IMC, los hombres presentaron mayor TAV y mayor razón TAV/TAS que las mujeres. El promedio de la TFG fue similar entre los sexos y se encuentra en el rango normal. A través de regresión lineal simple, se evidenció que, en el sexo masculino, la disminución de la TFG puede explicarse en el 21,8% por la razón TAV/TAS (p=0,002). En el sexo femenino, tanto el TAV aislado como la razón TAV/TAS fueron predictores de disminución de la TFG (r2= 4,8%; p=0,025 e r2= 5,3%; p=0,019), respectivamente. Conclusión: Se evidenciaron valores muy elevados de los parámetros antropométricos de obesidad abdominal y promedio de TAV y de la razón TAV/TAS compatible con obesidad visceral en ambos sexos, siendo que estos dos últimos parámetros estuvieron relacionados al descenso de la TFG.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Association between anthropometricparameters and coronary calcification / Associação entre parâmetros antropométricos e calcificação coronariana

Several studies have reported an association between obesity and the presence of coronary artery calcification (CAC), but it is still unclear which parameter would be most useful in screening for coronary calcification. This study aimed to evaluate the association between anthropometric parameters and coronary calcification. A cross-sectional study was developed involving patients attended by outpatient care, without previous diagnosis of coronary disease. The CAC was evaluated by computerized tomography, considering the coronary calcium score (CCS)> 0 as the presence of calcification and 0 as absence. The anthropometric variables studied were: body mass index, waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (Et al.), conicity index (CI), neck circumference, neck-thigh ratio, waist-thigh ratio (WThR) and body adiposity index. A total of 129 patients were evaluated, with a mean age of 55.6±11.7 years. CAC was observed in 41.9% of patients. In the male sex, the CCS had a higher correlation with the WHR (r=0.416, p=0.016) and in females, the CI and WThR (r=0.305, p=0.003 and r=0.328, p=0.001, respectively). In the logistic regression model, the only anthropometric parameter that remained associated to CAC was WC (OR=3.9). In conclusion, it was observed that several anthropometric parameters were associated with CAC, and WC was the only anthropometric parameter that remained associated to CAC in the adjusted analysis

Vários estudos têm registrado associação entre obesidade e a presença da calcificação das artérias coronárias (CAC), porém ainda não está claro qual parâmetro seria mais útil na triagem da calcificação coronariana. Este estudo teve como objetivo avaliar a associação entre parâmetros antropométricos com a calcificação coronariana. Foi realizado um estudo transversal envolvendo pacientes atendidos ambulatorialmente, sem diagnóstico prévio de doença coronariana. A CAC foi avaliada por tomografia computadorizada, considerando-se o escore de cálcio coronariano (ECC)>0 como presença de calcificação e igual a 0 como ausência. As variáveis antropométricas estudadas foram: índice de massa corpórea, circunferência abdominal (CA), razão cintura quadril (RCQ), razão cintura estatura, índice de conicidade (IC), circunferência do pescoço, razão pescoço-coxa, razão cintura-coxa (RCC) e índice de adiposidade corporal. Foram avaliados 129 pacientes, com média de idade de 55,6±11,7 anos. A CAC foi evidenciada em 41,9% dos pacientes. No sexo masculino, o ECC apresentou maior correlação com a RCQ (r=0,416; p=0,016) e no feminino, com o IC e com a RCC (r=0,305; p=0,003 e r=0,328; p=0,001, respectivamente). No modelo de regressão logística o único parâmetro antropométrico que permaneceu associado à CAC foi a CA (OR=3,9). Em conclusão, observou-se que vários parâmetros antropométricos foram associados à CAC, sendo CA o único parâmetro antropométrico que se manteve associado à CAC na analise ajustada

Tendência temporal do estado nutricional de pacientescardiopatas: resultado de 7 anos de avaliação / Temporal tendency of the nutritional status of cardiopathy patients: result of 7 years of evaluation

INTRODUÇÃO: As doenças cardiovasculares representam a principal causa de mortalidade e de incapacidade em ambos os sexos, no Brasil e no mundo. Os distúrbios nutricionais verificados nestes pacientes podem influenciar nas taxas de morbi-mortalidade. OBJETIVOS: Descrever o estado nutricional de pacientes cardiopatas hospitalizados e as tendências temporais observadas em 7 anos de avaliação e, secundariamente, analisar comparativamente o estado nutricional segundo a cardiopatia de base. MÉTODOS: Foi realizado um estudo retrospectivo, sendo coletados dados da admissão de pacientes cardiopatas internados em hospital universitário no Nordeste brasileiro, no período entre 2011-2017. A amostra foi constituída por pacientes de ambos os sexos com idade >18 anos. Foram consideradas variáveis demográficas (sexo, idade), clínicas (diagnóstico de admissão, comorbidades) e antropométrica (índice de massa corpórea). RESULTADOS: A amostra foi composta por 1785 pacientes, com mediana de idade de 60 (IQ:50-69) anos, sendo 50,6% dos pacientes coronariopatas. Verificou-se que 41,2%(IC95%: 39,0-43,6) da população apresentou excesso de peso e 15,5%(IC95%: 13,9-17,3) desnutrição. Não houve variação temporal nas prevalências de excesso de peso e desnutrição no período de 7 anos estudado (p = 0,668). A prevalência de excesso de peso foi de 49,5% nos coronariopatas, sendo 29,8% nos valvopatas e 37,1% nos miocardiopatas. A desnutrição foi identificada em cerca de 20% nos miocardiopatas e valvopatas e em 11,5% dos coronariopatas (p < 0,001). CONCLUSÕES: Esses resultados demonstram manutenção do perfil nutricional nos pacientes cardiopatas ao longo dos 7 anos do estudo. A desnutrição encontrada foi superior nos miocardiopatas e valvopatas, enquanto o excesso de peso foi maior nos pacientes coronarianos

INTRODUCTION: Cardiovascular diseases are the main cause of mortality and disability in both sexes, in Brazil and in the world. The nutritional disturbances observed in these patients may influence morbidity and mortality rates. OBJECTIVES: To describe the nutritional status of hospitalized patients with heart disease and the temporal trends observed in 7 years of evaluation and, secondarily, to analyze the nutritional status according to baseline heart disease. METHODS: A retrospective study was carried out, and data were collected on the admission of cardiac patients hospitalized in a university hospital in the Brazilian Northeast in the period between 2011-2017. The sample consisted of patients of both genders aged> 18 years. Demographic variables (sex, age), clinical (admission diagnosis, comorbidities) and anthropometric variables (body mass index) were considered. RESULTS: The sample consisted of 1785 patients, with a median age of 60 (IQ: 50-69) years being 50.6% of patients with coronary artery disease. It was verified that 41.2% (IC95%: 39.0-43.6) of the population was overweight and 15.5% (95% CI: 13.9-17.3) malnutrition. There was no temporal variation in the prevalence of overweight and malnutrition in the 7-year period studied (p = 0.668). The prevalence of overweight was 49.5% in the coronary arteries, 29.8% in the valvopathies and 37.1% in the myocardiopathy. Malnutrition was identified in about 20% in myocardiopatas and valvopas and in 11.5% of coronary heart disease patients (p <0.001). CONCLUSIONS: These results demonstrate maintenance of the nutritional profile in the patients with cardiopathy over the 7 years of the study. The malnutrition found was higher in the myocardiopatas and valvopas, while the excess weight was greater in the coronary patients

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Association between serum vitamin d levels and cardiometabolic alterations / Asociación entre los niveles séricos de vitamina D y las alteraciones cardiometabólicas

INTRODUCTION: Hypovitaminosis D has been described as an epidemic in the recent years and its association with cardiometabolic alterations such as arterial hypertension, diabetes mellitus, dyslipidemia, obesity and Metabolic Syndrome have been studied. OBJECTIVES: To evaluate the association between serum levels of vitamin D and cardiometabolic alterations. METHODS: A cross-sectional study involving patients seen outpatient in a public hospital service, reference in cardiology in Recife-PE, Brazil. Serum levels of 25 hydroxyvitamin D were measured and assessed for their relations with cardiovascular and metabolic risk parameters. RESULTS: 90 individuals were evaluated with a mean age of 57.0 ± 11.9 years, predominantly female (75.6%). Vitamin D deficiency (levels < 20 ng/ml) was observed in 12.2% of the subjects and an insufficiency (levels 20-29 ng/ml) in 35.6%. Serum vitamin D levels were higher in males (p < 0,001), in subjects with normal waist circumference (WC) (p = 0,008), and in those with elevated glycated hemoglobin (HbA1c) (p = 0,006). Inverse correlation was observed between serum levels of vitamin D and total cholesterol (TC) (r=-0,214; p = 0,045) and LDL-c (r=-0,227; p = 0,033) and direct correlation with HbA1c(r=0,211; p = 0,048). In the adjusted analysis, it was observed that patients that had central obesity had a 2.8 (IC95%: 1,1-7,7; p = 0,048) higher chance of having vitamin D deficiency when compared to patients with normal WC. It was verified that patients with high triglycerides levels had protection for vitamin D deficiency (OR=0,3; IC95%: 0,1-0,8; p = 0,023). CONCLUSIONS: Hypovitaminosis D was highly prevalent in the studied population. Low levels of vitamin D correlated with elevated levels of TC and LDL-c and central adiposity

INTRODUCCIÓN: la hipovitaminosis D se ha descrito como una epidemia en los últimos años y se ha estudiado su asociación con alteraciones cardiometabólicas como hipertensión arterial, diabetes mellitus, dislipidemia, obesidad y síndrome metabólico. OBJETIVOS: evaluar la asociación entre los niveles séricos de vitamina D y las alteraciones cardiometabólicas. MÉTODOS: Estudio transversal que incluyó pacientes atendidos de forma ambulatoria en un servicio de hospital público, referencia en cardiología en Recife-PE, Brasil. Se midieron los niveles séricos de 25 hidroxivitamina D y se evaluaron sus relaciones con los parámetros de riesgo cardiovascular y metabólico. RESULTADOS: se evaluaron 90 individuos con una edad media de 57.0 ± 11.9 años, predominantemente mujeres (75.6%). Se observó deficiencia de vitamina D (niveles <20 ng / ml) en el 12,2% de los sujetos y una insuficiencia (niveles 20-29 ng / ml) en el 35,6%. Los niveles séricos de vitamina D fueron más altos en hombres (p <0,001), en sujetos con circunferencia de cintura normal (WC) (p = 0,008) y en aquellos con hemoglobina glucosilada elevada (HbA1c) (p = 0,006). Se observó correlación inversa entre los niveles séricos de vitamina D y colesterol total (TC) (r = -0,214; p = 0,045) y LDL-c (r = -0,227; p = 0,033) y correlación directa con HbA1c (r = 0,211; p = 0,048). En el análisis ajustado, se observó que los pacientes que tenían obesidad central tenían una probabilidad mayor 2.8 (IC95%: 1,1-7,7; p = 0,048) de tener deficiencia de vitamina D en comparación con los pacientes con WC normal. Se verificó que los pacientes con niveles altos de triglicéridos tenían protección para la deficiencia de vitamina D (OR = 0,3; IC95%: 0,1-0,8; p = 0,023). CONCLUSIONES: la hipovitaminosis D fue altamente prevalente en la población estudiada. Los bajos niveles de vitamina D se correlacionan con niveles elevados de TC y LDL-c y adiposidad central

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities.

OBJECTIVES: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. SUBJECTS AND METHODS: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. RESULTS: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. CONCLUSIONS: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Effects of weight loss on adipose visceral and subcutaneous tissue in overweight adults.

BACKGROUND & AIMS: Weight loss is an important strategy for mitigating the complications of obesity. However, weight reduction does not provide detailed information on relative changes in bodily behaviors and in abdominal fat deposits (adipose visceral tissue (AVT) and adipose subcutaneous tissue (AST)). The aim of this study was to evaluate the effect of weight loss based on calorie restriction on AVT and AST in overweight individuals (1); to verify the metabolic benefits resulting from AVT reduction (2); and to the analyze the influence of covariates in AVT and AST reduction (3). METHODS: Clinical intervention study involving overweight adult patients, seen at a public hospital in the Northeast of Brazil, who underwent three months of calorie restriction. AVT and AST were quantified using computed tomography at the baseline and at the end of a follow up. RESULTS: 51 patients were evaluated (50.2 ± 11.3 years old), for whom it was verified that a 5.8(±6.2)% weight reduction in the men resulted in a 11.2(±7.9)% reduction in AVT and 6.8(±11.2)% in AST. Among the women, a 4.1(±2.5)% reduction in initial weight resulted in a 11.1(±8.8)% decrease in AVT and 5.6(±7.4)% in AST. Simple linear regression showed that a reduction in AVT caused a 54.9% reduction in triglyceride concentrations in the men and a 12.2% reduction in cholesterol and 31.4% in triglyceride levels in women. Multiple regression identified different factors that influenced the reduction in visceral and subcutaneous fat. The predictive models explained 42.9% and 54.8% of the AVT reduction in the females and males, respectively; and 39.9% and 86.7% of the AST reduction in the females and males, respectively. CONCLUSIONS: A modest 5% weight loss caused substantial AVT and AST mobilization, with potential benefits to cardiometabolic profile.

Razón entre grasa visceral y subcutánea como predictor de alteraciones cardiometabólicas / Ratio of visceral to subcutaneous fat as a predictor of cardiometabolic risk

RESUMEN La grasa visceral es una importante medida predictora de riesgo cardiometabólico, sin embargo, se ha sugerido que la razón entre los componentes visceral y subcutáneo (TAV/TAS ≥ 0,4) puede ser un indicador más apropiado para evaluar la predisposición para acumular grasa visceral (GV) y las alteraciones cardio-metabólicas. Objetivo: Evaluar la predisposición para acumular GV y su asociación con alteraciones cardio-metabólicas. Métodos: Estudio transversal con 147 individuos atendidos en un ambulatorio de un hospital en el Nordeste brasileño. Se evaluaron el TAV y el TAS por tomografía computarizada y se investigaron variables demgráficas, clínicas, antropométricas y factores de riesgo cardiometabólico. Resultados: El promedio de edad fue 52,7±13,2 años y se observó una elevada razón TAV/TAS de 0,79±0,29 en hombres y 0,54±0,22 en mujeres. Se correlacionó la razón TAV/TAS con perfil glucídico y puntuacion de calcio coronariano (PCC) (p< 0,05), mientras que el TAV aislado presentó correlación directa con colesterol no-HDL, triglicéridos (TG), razón TG/HDL, glicemia, hemoglobina glicosilada y PCC (p<0,05) e inversa con HDL-c (p= 0,001). Conclusiones: Se observó una elevada predisposición para la acumulación de TAV. La razón TAV/TAS presentó correlación con alteraciones cardiometabólicas, pero la concentración de TAV aislada se correlacionó con un número superior de parámetros, siendo en esta investigación un predictor más potente que la razón TAV/TAS para indicar esas alteraciones.

ABSTRACT Visceral fat is an important predictor of cardiometabolic risk, but evidence suggests that the ratio between visceral and subcutaneous fat (≥0.4) may be a more appropriate indicator to assess individual predisposition to accumulate visceral fat (VF) and predict cardiometabolic alterations. Objective: To evaluate the predisposition to accumulate VF and its association with cardiometabolic alterations. Methods: A cross-sectional study was conducted with 147 patients seen at a hospital in Northeast Brazil. VF and subcutaneous fat (SF) were evaluated by computed tomography and anthropometric and cardiometabolic risk factors were investigated. Results: The mean age was 52.7±13.2 years. Mean VF/SF ratio was high: 0.79±0.29 for men and 0.54±0.22 for women and was correlated with the glucose profile and coronary calcium score (CCA) (p< 0.05). VF was directly correlation with non-HDL cholesterol, triglycerides (TG), TG/HDL ratio, glycemia, glycated hemoglobin and CCA (p< 0.05) and inversely with HDL-c (p= 0.001). Conclusions: A high predisposition to VF accumulation was observed in the population. VF/SF ratio correlated with cardiometabolic alterations, but the concentration of isolated VF correlated with a higher number of parameters. In this investigation, VF alone was a more powerful predictor of cardiometabolic alterations than the ratio of VF/SF.

Predictive models for estimating visceral fat: The contribution from anthropometric parameters.

BACKGROUND: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. OBJECTIVE: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. METHODS: A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography-CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI). RESULTS: 109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R2 adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R2 adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001). CONCLUSIONS: A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.