Evaluation of systemic endothelial-dependent and endothelial-independent microvascular reactivity in metabolically healthy obesity: An observational study.

BACKGROUND: Metabolically healthy obesity (MHO), a phenotype of obesity considered to be of lower cardiovascular risk, is still a controversial concept. This study aimed to investigate the presence of subclinical systemic microvascular dysfunction in individuals with MHO. METHODS: This was a cross-sectional study in which 112 volunteers were allocated into three groups: metabolically healthy normal weight (MHNW), MHO, or metabolically unhealthy obesity (MUO). Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. MHO was defined as the absence of any component of metabolic syndrome, except waist circumference. Microvascular reactivity was evaluated using cutaneous laser speckle contrast imaging. RESULTS: Mean age was 33.2 ± 7.66 years. The median BMI in the MHNW, MHO and MUO groups was 23.6, 32.8, and 35.8 kg/m2, respectively. Baseline microvascular conductance values were lower in the MUO group (0.25 ± 0.08 APU/mmHg) than in MHO (0.30 ± 0.10 APU/mmHg) and MHNW groups (0.33 ± 0.12 APU/mmHg) (P = 0.0008). There were no significant differences regarding endothelial-dependent (acetylcholine stimulation or postocclusive reactive hyperemia) or endothelial-independent (sodium nitroprusside stimulation) microvascular reactivity among the groups. CONCLUSIONS: Individuals with MUO had lower baseline systemic microvascular flow than those with MHNW or MHO, but endothelium-dependent or endothelium-independent microvascular reactivity were not changed in any of the groups. The relatively young age of the study population, the low frequency of class III obesity, or the strict definition of MHO (absence of any metabolic syndrome criteria) might account for the lack of difference of microvascular reactivity among MHNW, MHO or MUO.

Increased systemic endothelial-dependent microvascular reactivity after ingestion of a high-carbohydrate snack in young, healthy volunteers.

OBJECTIVE: This study evaluated the acute effect of a high-carbohydrate snack (HCS) on systemic microvascular function of healthy, young volunteers, using laser speckle contrast imaging (LSCI). METHODS: Cutaneous microvascular blood flow was assessed in the forearm with LSCI coupled to iontophoresis of acetylcholine, using increasing anodal currents, before and after (25 min) the ingestion of a HCS or water (control). Twenty volunteers (10 male) received a single HCS (70 g of carbohydrates) in the fasting state in the morning. RESULTS: The area under the curve (AUC) of acetylcholine-induced microvascular vasodilation increased from 17,847 ±â€¯4539 to 20,315 ±â€¯7168 arbitrary perfusion units/s (P = 0.03) after ingestion of a HCS, but was unchanged after the ingestion of water (P = 0.22). CONCLUSION: A single snack consisting on an acute oral load of carbohydrates induced a significant increase of endothelium-dependent microvascular vasodilation in healthy, young subjects.

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)

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: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ±â€¯8.4 vs 24.7 ±â€¯8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.

Análise da prevalência dos fatores de risco cardiovascular em pacientes com fenótipo de hipercolesterolemia familiar / Analysis of prevalence of cardiovascular risk factors in patients with familial hypercholesterolemia phenotype

Comparar a prevalência dos fatores de risco para doenças cardiovasculares em pacientes com fenótipo de HF com e sem mutação. Métodos: Estudo transversal com pacientes que apresentam níveis de LDL-c ≥ 190 mg/dl e história pessoal ou familiar de hipercolesterolemia com diagnóstico genético positivo ou negativo. Foi aplicado um questionário padronizado para obtenção de informações sobre os fatores de risco cardiovascular (idade, sexo, perfil bioquímico, histórico de DCV, tabagismo, HAS, DM tipo II e estado nutricional). Também foram realizadas avaliações antropométricas e laboratoriais. Os dados foram analisados no software IBM® SPSS® Statistics versão 21 e o nível de significância estatística foi estabelecido em p < 0,05. Resultados: Foram avaliados 103 pacientes de ambos os sexos (67% mulheres) com média de idade de 55,27 ± 15,07 anos. Trinta e três pacientes tinham diagnóstico de HF. A comorbidade mais prevalente foi a hipertensão arterial sistêmica (65,05%), seguida de sobrepeso/obesidade (57,28%) e diabetes mellitus tipo II (26,21%). Conclusão: Portadores de HF apresentaram menor prevalência de FR cardiovasculares, quando comparados com pacientes sem a mutação. No entanto, eles ainda merecem atenção diferenciada e focada no manejo de FR modificáveis, uma vez que a presença de pelo menos um FR já aumenta significantemente o risco CV nessa população

To compare the prevalence of risk factors for cardiovascular disease in patients with FH phenotype with and without mutation. Methods: A cross-sectional study with patients who present LDL-c levels ≥190mg/dL and a personal or family history of hypercholesterolemia with positive or negative genetic diagnosis. We applied a standardized questionnaire to obtain information on cardiovascular risk factors (age, sex, biochemical profile, history of CVD, smoking, hypertension, type 2 diabetes mellitus and nutritional status). Anthropometric measurements and laboratory tests were also performed. The data were analyzed using version 21 of the IBM® SPSS® Statistics software and statistical significance was established as p <0.05. Results: We studied 103 patients of both sexes (67% female) with a mean age of 55.27 ± 15.07 years. Thirty-three patients had a diagnosis of FH. The most prevalent comorbidity was systemic hypertension (65.05%), followed by overweight/obesity (57.28%) and type 2 diabetes mellitus (26.21%). Conclusion: The population with FH had lower cardiovascular RF prevalence when compared with patients without the mutation. However, they still merit differentiated care focused on the management of modifiable RFs, since the presence of at least one RF already significantly increases the CV risk in this population