Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Cardiovascular disease"

Navegando por Palavras-chave "Cardiovascular disease"

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Acesso aberto (Open Access)
Análise dos polimorfismos, A637G do gene TAP1, A121C do gene ENPP1, C677T e A1298C do gene MTHFR e isoformas E2, E3 e E4 do gene APOE e de fatores de risco para doença cardiovascular em mulheres portadoras de Síndrome de Turner
(Universidade Federal de São Paulo (UNIFESP), 2010-07-28) Oliveira, Kelly Cristina de [UNIFESP]; Lipay, Monica Vannucci Nunes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background: Epidemiological studies showed a reduction of up to 13 years in life expectancy of Turner Syndrome (TS) patients compared to normal women, being the main cause of cardiovascular disease (CVD) mortality. Hypertension (SAH) diabetes mellitus (DM) and dislipidemy are important risk factors for CVD that are highly prevalent in this syndrome. TAP1, ENPP1 and APOE genes are associated with cardiovascular risk for being involved in the pathogenesis of hypertension, DM and hypercholesterolemia, respectively. The aim of this study was to analyze the frequency of polymorphism of these genes in TS patients. Methods: Seventy eight TS patients and 372 healthy individuals with no personal and familial history of CVD were assessed for polymorphisms of genes TAP1 and ENPP1 by Restriction fragment length polymorphism (RFLP). Isoforms of APOE gene were genotyped by qPCR. Results: Analysis of AA, GG and AG genotypes frequencies of A637G TAP1 polymorphism in TS patients were, respectively, 7.7%, 52.6% and 39.7%, while the control group presented 11.0%, 55.0% and 34.0% (p=0.4584). The frequency of genotypes for ENPP1 A121C polymorphism in the ST patients were: AA 42,3,0%, AC 48.7% and CC 9.0% and 45.0%, 42.0% and 12.0% in controls (p=0.5169). The frequency of genotypes of APOE gene in TS patients and controls were, respectively: E3E3 68.3% and 61.5%, E2E3 6.3% and 12,4%, E3E4 24.1% and 22,6%, E2E2 0% and 1.0%, E4E4 0% and 1.3% and E2E4 1.3% and 1.1%, (p=0,864). Conclusion: There were no correlations between the frequencies of TAP1, ENPP1 and APOE polymorphisms and CVD risk in women with TS.
Acesso aberto (Open Access)
Angiotensin II antagonists: clinical experience in the treatment of hypertension, prevention of cardiovascular outcomes and renal protection in diabetic nephropathy and proteinuria
(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Ribeiro, Artur Beltrame [UNIFESP]; Gavras, Haralambos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University School of Medicine Hypertension and Atherosclerosis Section
Angiotensin II antagonists (AIIAs) were introduced to treat hypertension about 10 years ago. During this period they were evaluated not only in terms of efficacy and safety but also in several large studies with clinical outcomes. They are efficacious in all clinical forms of hypertension and are effective also in all ethnic groups. Cardiovascular and renal protection in proteinuric diabetic nephropathy beyond blood pressure reduction was proved in major clinical studies: Losartan Intervention For Endpoint reduction in hypertension study (LIFE), Reduction of Endpoint in Non-Insulin dependent Diabetes Mellitus with the AII Antagonist Losartan (RENAAL) and Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT). Their blood pressure independent protective effect is also mentioned by the blockade of AT1 receptor. As a class AIIs have a tolerability profile similar to placebo.
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Asymptomatic Ventricular Arrhythmia and Clinical Outcomes in Chronic Kidney Disease: A Pilot Study
(Karger, 2017) Bonato, Fabiana Oliveira Bastos [UNIFESP]; Watanabe, Renato [UNIFESP]; Lemos, Marcelo Montebello [UNIFESP]; Cassiolato, Jose Luiz; Wolf, Myles; Canziani, Maria Eugênia Fernandes [UNIFESP]
Background/Aims: Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD). Methods: In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 +/- 16.1 ml/min/1.73 m(2), 57 +/- 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave. Results: We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40
Acesso aberto (Open Access)
Avaliação cardiovascular de pacientes diabéticos em ambulatório universitário
(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-03-01) Alvarenga, Marcelo A. [UNIFESP]; Oliveira, Carolina Soares Viana de [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Reis, André Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
INTRODUCTION: Type 2 diabetes is a cardiovascular disease. The morbidity and mortality among these patients are primarily due to cardiovascular diseases. There are many guidelines regarding clinical evaluation of cardiovascular disease in those patients. Implementation of these guidelines has been an argued subject. Our objective in this paper is to describe what basal cardiovascular evaluation has been carried out at a specialized university Diabetes Center. SUBJECTS AND METHODS: Data were collected from February to October 2006 of 121 type 2 diabetes individuals who were enrolled at the Diabetes Center of Federal University of São Paulo. We analyzed the type of cardiovascular disease evaluation that they had been submitted in the year that preceded the consultation. RESULTS: We have observed a high prevalence of several other cardiovascular risk factors in this population. The cardiovascular evaluations during this period has shown 36% of the patients had not been submitted to any cardiovascular test, 17% had been submitted to resting electrocardiogram and 27% of the patients had been submitted to exercise test. Rest echocardiogram, pharmacologic stress echocardiogram, myocardial perfusion scintigraphy, and coronary angiography have been carried out in a much lesser ratio. CONCLUSION: Our data has shown the variability and limitations on boarding diagnosing of DAC in university environment patients and point us the necessity of constructing defined and directed directives for the peculiarities of the Brazilian population and health system.
Acesso aberto (Open Access)
Circunferência de pescoço e sua associação com fatores de risco cardiovascular em adolescentes
(Universidade Federal de São Paulo (UNIFESP), 2015-04-17) Faria, Bruno [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Escrivão, Maria Arlete Meil Schimith [UNIFESP]; http://lattes.cnpq.br/2103953406579796; http://lattes.cnpq.br/4980474480271642; Universidade Federal de São Paulo (UNIFESP)
Introdução: O excesso de peso se tornou um problema de saúde pública em todo o mundo e sua prevalência aumentou rapidamente nas últimas décadas, atingindo cerca de 200 milhões de crianças, das quais 40 a 50 milhões são consideradas obesas. A obesidade na infância se associa com aumento da pressão arterial (PA), hipertrigliceridemia, baixo HDL-colesterol e metabolismo anormal da glicose. A adiposidade central está mais relacionada com alterações metabólicas e risco cardiovascular que a adiposidade corpórea total. A medida da circunferência do pescoço (CP) é um método de fácil realização, que pode servir como screening para identificação de adiposidade central e, consequentemente, de riscos metabólicos. Objetivos: Verificar as associações entre as medidas da CP e da circunferência abdominal (CA) com valores de PA, perfil lipídico, glicemia e insulinemia de jejum em adolescentes obesos, e verificar a reprodutibilidade da medida da CP. Métodos: 82 adolescentes entre 10 e 17 anos foram incluídos no estudo, sendo 43 (22 meninos e 21 meninas) com obesidade e 39 (20 meninos e 19 meninas) eutróficos. Foram realizados: medidas de peso, estatura, CP, CA, cálculo do índice de massa corpórea (IMC) e aferição da PA em todos os indivíduos da amostra. Perfil lipídico, HOMA-IR, glicemia e insulinemia de jejum foram avaliados no grupo dos obesos. Variáveis quantitativas foram expressas como médias e desvios padrão dos valores, enquanto as variáveis qualitativas foram expressas como frequências. Para avaliação estatística dos resultados foram feitas comparações entre os grupos, utilizando-se teste T de Student para o caso de variáveis quantitativas e teste do qui-quadrado para o caso de comparações de frequências das variáveis qualitativas. Nas análises de regressão linear, as medidas da CP e da CA foram consideradas variáveis de exposição, enquanto as medidas de risco cardiovascular como pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), perfil lipídico, glicemia, insulinemia e HOMA-IR foram consideradas variáveis de desfecho. Todos os testes foram bicaudais e em todos foi adotado o limite de 5% (p<0,05) para rejeição da hipótese de nulidade. Avaliamos a concordância entre as medidas da CP entre os diferentes observadores, pela análise de concordância entre métodos de Bland-Altman. Resultados: Foram observadas associações significantes e positivas da CP com IMC, CA, PAS e PAD, insulinemia e HOMA-IR e associação significante e negativa com o HDL colesterol. Foi encontrada discordância entre os observadores para a CP de 5,19% no total da amostra e de 10,5%, entre os obesos. DISCUSSÃO: Entre as associações encontradas com a CP, deve ser destacada a relacionada com a PA, considerando ser a hipertensão arterial um dos fatores de risco mais bem estabelecidos para os eventos cardiovasculares futuros. Tanto a CA quanto a CP se associaram com os mesmos fatores de risco, mas cabe ressaltar que a CP é uma medida muito mais fácil de ser realizada. Conclusão: Os achados desse estudo fortalecem o conhecimento atual acerca da utilização da CP como um instrumento importante para identificar indivíduos com adiposidade central e risco de hipertensão arterial sistêmica, resistência insulínica e como uma medida antropométrica adicional à CA.
Acesso aberto (Open Access)
Disfunção endotelial avaliada por dimetilarginina assimétrica e desfechos metabólicos e renais em pacientes hipertensos
(Universidade Federal de São Paulo (UNIFESP), 2018-04-26) Triches, Cristina Bergmann [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; http://lattes.cnpq.br/0797782255785305; http://lattes.cnpq.br/6481321429114103; Universidade Federal de São Paulo (UNIFESP)
Asymmetric dimethylarginine (ADMA), which is the main endogenous inhibitor of nitric oxide synthase, plays a critical role in the process of endothelial dysfunction. We evaluated the association between high plasma ADMA levels in hypertensive patients and the presence of cardiovascular risk factors, the development of type 2 diabetes mellitus (DM) and the development of cardiovascular outcomes, including death. We evaluated 191 hypertensive patients who were stratified into 2 groups according to the median value of basal ADMA: those with high levels of plasma ADMA (> 0.55 μmol/L) and low levels of plasma ADMA (≤ 0.55 μmol/L) who were prospectively evaluated over 5.8 years. High ADMA levels were seen in patients with higher weight, body mass index (BMI), waist circumference, triglycerides, uric acid, and high-sensitivity C-reactive protein (hs-CRP), and lower levels of HDL-col and in type 2 diabetic patients. There was an association between high plasma ADMA levels and the occurrence of cardiovascular death. In a subgroup of hypertensive patients free from metabolic syndrome (MS) and DM at baseline, there was an association between high ADMA levels and the development of type 2 DM. In conclusion, our study confirms the association of high plasma ADMA levels and the presence of cardiovascular risk factors in hypertensive patients and suggests a positive predictive value of high plasma ADMA levels for cardiovascular death in hypertensive patients and also for the development of type 2 DM in a subgroup of hypertensive patients free from metabolic abnormalities.
Acesso aberto (Open Access)
Doença cardiovascular no diabetes mellitus: análise dos fatores de risco clássicos e não-clássicos
(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-03-01) Siqueira, Antonela F.a.; Almeida-Pititto, Bianca de; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Cardiovascular disease, which includes coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), is the leading cause of mortality in populations, particularly in the diabetic one. Individuals with diabetes have at least a two-fold to four-fold increased risk of having cardiovascular events and a double risk of death compared with age-matched subjects without diabetes. A decline in mortality from CVD has been shown, but decline due to CHD is consistently lower in individuals with diabetes when compared with non-diabetics. The presence of several factors in diabetes leads to high occurrence of CVD such as hyperglicemia, insulin resistance, and classical and non-classical risk factors (systemic hypertension, dyslipidemia, obesity, proinflammatory condition and others). It is possible that the atherogenic role of obesity may be at least in part due to increased adipocyte production of cytokines. Considering the marked association of diabetes and CVD and unfavorable prognosis following an event, it is important to identify who is at high risk and how to screen. The American Heart Association and American Diabetes Association recommend risk stratification using diagnostic tests. However, the challenge is to accurately identify patients without a prior history of an event and those without symptoms strongly suggesting CVD, in whom additional testing would be indicated in order to achieve the most effective prevention. The benefits of glycemic control and the other risk factors have already been shown and justify optimization of the management of this high-risk population, aiming to reduce cardiovascular mortality disease and improve quality of life.
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Efeitos da terapia interdisciplinar no controle dos fatores de risco cardiovascular e marcadores inflamatórios em mulheres obesas
(Universidade Federal de São Paulo (UNIFESP), 2013-03-27) Queiroz, Giovana Goncalves Jamar de [UNIFESP]; Caranti, Danielle Arisa [UNIFESP]; http://lattes.cnpq.br/4760019839583649; http://lattes.cnpq.br/0506963975330499; Universidade Federal de São Paulo (UNIFESP)
Background: Obesity is associated with subclinical inflammation, increased cardiovascular risk factors and mortality. Because of its growing global epidemic, strategies have been proposed to control this trend and prevent coronary heart disease. Objective: To investigate the effects of an interdisciplinary therapy on inflammatory markers and cardiovascular risk factors. Methods: A total of 30 obese women (34.89 ± 3.04 kg/m 2 and 43.30 ± 5.34 years) participated in interdisciplinary therapy change of lifestyle, consisted of nutritional counseling, exercise and psychological therapy over a period of 26 weeks. The profile was obtained by anthropometric measurements and calculations of anthropometric indexes. Body composition was assessed by bioimpedance electrical and cardiorespiratory capacity analysis by ergospirometry testing. By questionnaires evaluated the habitual food intake and cardiovascular risk factors prior. Blood tests were performed for determination of metabolic parameters and adipokines. Results: After the intervention, there was significant reduction in BMI, CI, BAI, AC, NC, HC and BF, representing a weight loss of about 5%. Food consumption also decreases, while remaining within the % adequation of each nutrient. There was significant improvement in VO2máx, total cholesterol, LDL and adipokines leptin and CRP, but not enough to change BP, glucose, HDL, triglycerides and PAI-1. Conclusion: The short-term interdisciplinary therapy has shown as the first step for the obesity control to inflammation and cardiovascular risk factors.
Acesso aberto (Open Access)
Estudo sobre a associação entre doença periodontal e doença cardiovascular aterosclerótica em população nipo-brasileira
(Universidade Federal de São Paulo (UNIFESP), 2006-01-01) Silva, Alexandre Cândido da [UNIFESP]; Vivolo, Sandra Roberta Gouvea Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Periodontal disease (PD), the most prevalent oral infection, has been associated with systemic diseases. This could facilitate the bacterial dissemination into circulation and adhesion to vascular walls, favoring inflammatory response. It is speculated that such bacteria in arterial wall would accelerate atherosclerotic process. Studies investigating this relationship found contrasting results. This cross-sectional epidemiological study examined the association of PD and cardiovascular disease (CVD), adjusted for a number of variables (logistic regression), in a population at high cardiovascular risk, living in Bauru, SP. 1,146 Japanese-Brazilians aged 30 years underwent standardized questionnaires, physical examination, doppler of extremities, electrocardiogram (ECG) and oral glucose tolerance test. Diagnosis of PD was based on the community periodontal index, and CVD on the history, ankle-to-brachial pressure index and ECG. Higher prevalence of PD was found in women as compared to men (48.1% vs 40.4%, p=0.008). Stratifying according to the presence of CVD, subjects with this disease were older (63.0±12.6 vs 56.0±12.1 years, p<0.001), showed higher levels of mean blood pressure (101.1±17.5 vs 96.3±14.7 mmHg, p<0.001), post-challenge plasma glucose (194.0±52.9 vs 163.0±58.4 mg/dl, p<0.001), non-HDL cholesterol (169.0±38.4 vs 163.0±35.1 mg/dl, p=0.041) and higher frequencies of smoking (38.5% vs 29.6%, p=0,029) and PD (60.2% vs 41.8%, p<0.001). Subgroups did not differ concerning anthropometric data. In logistic regression analysis, smoking (p=0.006),age (p<0.001), mean blood pressure (p=0.024) and post-challenge plasma glucose (p=0.016) showed to be independently associated with CVD; waist circumference (p=0.077) and PD (p=0.079) reached only borderline significance. In a Japanese-Brazilian population at high cardiovascular risk, our findings confirmed the classical associations of CVD with age, smoking and elevated plasma glucose but not with PD, what could reinforce literature hypothesis of an etiopathogenetic relationship between these diseases. Methodological limitations should contribute to the lack of statistical significance. Ongoing studies may deepen the investigation on this relationship which could contribute to general and oral health promotion in this population.
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Gut Microbiome in Chronic Kidney Disease
(Springer, 2017) Armani, R. G. [UNIFESP]; Ramezani, A.; Yasir, A.; Sharama, S.; Canziani, M. E. F. [UNIFESP]; Raj, D. S.
With over 100 trillion microbial cells, the gut microbiome plays important roles in both the maintenance of health and the pathogenesis of disease. Gut microbiome dysbiosis, resulted from alteration of composition and function of the gut microbiome and disruption of gut barrier function, is commonly seen in patients with chronic kidney disease (CKD). The dysbiotic gut microbiome generates excessive amounts of uremic toxins, and the impaired intestinal barrier permits translocation of these toxins into the systemic circulation. Many of these uremic toxins have been implicated in the progression of CKD and increased cardiovascular risk. Various therapeutic interventions have been proposed that aim to restore gut microbiome symbiosis. If proven effective, these interventions will have a significant impact on the management of CKD patients. In this review, we discuss the consequences of gut microbiome dysbiosis in the context of CKD, discuss the consequences of gut dysbiosis, and highlight some of the recent interventions targeting the gut microbiome for therapeutic purposes.
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Higher prevalence of morphometric vertebral fractures in patients with recent coronary events independently of BMD measurements
(Elsevier B.V., 2013-02-01) Silva, Henrique Carriço da [UNIFESP]; Pinheiro, Marcelo M.; Genaro, Patricia S.; Castro, Charlles H. M. [UNIFESP]; Monteiro, Carlos M. C. [UNIFESP]; Fonseca, Francisco A. H. [UNIFESP]; Szejnfeld, Vera Lúcia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Cardiovascular disease and osteoporosis are important causes of morbi-mortality in the elderly and may be mutually related. Low bone mineral density (BMD) may be associated with increased risk of cardiovascular events. We investigated the prevalence of low bone mass and fractures in metabolic syndrome patients with acute coronary events. A case-control study was conducted with 150 individuals (30-80 years-old) with metabolic syndrome. Seventy-one patients had had an acute coronary syndrome episode in the last 6 months (cases) and the remaining 79 had no coronary event (controls). Cases and controls were matched for gender, BMI and age. DXA measurements and body composition were performed while spine radiographs surveyed for vertebral fractures and vascular calcification. Biochemical bone and metabolic parameters were measured in all patients. No statistically significant difference in BMD and the prevalence of osteopenia, osteoporosis and non-vertebral fractures was observed between cases and controls. the prevalence of vertebral fractures and all fractures was higher in the cases (14.1 versus 1.3%, p = 0.003 and 22.5versus7.6%, p = 0.010, respectively). Male gender (OR = 0.22 95% CI 0.58 to 0.83, p = 0.026) and daily intake of more than 3 portions of dairy products (OR = 0.19 95% CI 0.49 to 0.75, p = 0.017) were associated with lower prevalence of fractures. Cases had higher risk for fractures (OR = 4.97, 95% CI 1.17 to 30.30, p = 0.031). Bone mass and body composition parameters were not associated with cardiovascular risk factors or bone mineral metabolism. Patients with fragility fractures had higher OPG serum levels than those without fractures (p<0.001). Our findings demonstrated that patients with recent coronary events have a higher prevalence of vertebral fractures independently of BMD. (C) 2012 Elsevier Inc. All rights reserved.
Acesso aberto (Open Access)
Homocisteína
(Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2004-10-01) Neves, Lindalva Batista [UNIFESP]; Macedo, Danielle Mazziero [UNIFESP]; Lopes, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Homocysteine, formed from hepatic methionine, is metabolized through the pathways of demethylation and transsulfuration. Its plasmatic and urinary values reflect the cell synthesis. Its determination after fasting and increased infusion of methionine shows the differences of these two metabolic pathways, mainly when it is related to genetic diseases. Hyperhomocysteinemia has been associated with a higher risk of vascular thrombotic events. Several authors suggest a causal relationship between these events independently of other risk factors for vascular diseases. Decrease in plasmatic homocysteine to normal levels is followed by a significant reduction on the incidence of vascular thrombotic events. The correlation between the liver and homocysteine is becoming more important because of the recent findings that alterations of lipoproteins and methionine clearance are common in patients with hepatocellular and canalicular chronic liver disease. The treatment of hiperhomocysteinemia is based on the supplementation of folic acid and vitamins B6 and B12.
Acesso aberto (Open Access)
Impacto de dois programas de educação nutricional sobre o risco cardiovascular em pacientes hipertensos e com excesso de peso
(Pontifícia Universidade Católica de Campinas, 2009-02-01) Alvarez, Tatiana Souza [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE:To evaluate and compare the effects of two study protocols with a program of educational nutrition intervention on CARDIOVACULAR risk in overweight hypertensive patients maintained on their usual medication. Patients were followed at Hypertension and Metabology Division of Federal University of São Paulo. METHODS: Sixty tree overweight [body mass index >27 e <39kg/m²] hypertensive patients, age M=55,7 (Standard deviation - SD=6,1) years old, 12 men and 51 women, were divided into two groups according to visit intervals, either every five weeks (G35 n=25) or every two weeks (G14 n=38), during twenty weeks. The two groups were submitted to an educational program aiming to improve the quality of their diet and to promote changes in their alimentary habits. Before and at the end of the study period, all patients were submitted to blood pressure determinations, to anthopometric measurements and to laboratorial evaluation for the calculation of Framingham coronary risk. RESULTS:At the end of the study significant and similar changes in body mass index, waist circumference (102,9, SD=9,7 vs 101,8, SD=7,6 NS), systolic blood pressure (139,7, SD=12,4 vs 134,8, SD=8,2 NS), total cholesterol (192,9, SD=35,7 vs 195,2, SD=37,8 NS), energy intake (1759,5, SD=385,8 vs 1858,7, SD=452,8 NS) and Framingham coronary risk (11,1, SD=6,1 vs 9,4, SD=3,5 NS) we observed in G14 and G35 groups respectively. CONCLUSION: A short program of nutritional intervention was shown to be useful to reduce coronary risk in overweight hypertensive patients despite a very small change in body weight. A higher frequency of visits did not achieve better results, with a monthly visit being enough for positive changes although with a higher rate of drop outs.
Acesso aberto (Open Access)
Individuals with prediabetes identified by HbA1c undergoing coronary angiography have worse cardiometabolic profile than those identified by fasting glucose
(Biomed Central Ltd, 2014-12-13) Piveta, Valdecira M. [UNIFESP]; Bittencourt, Celia S. [UNIFESP]; Oliveira, Carolina S. V. [UNIFESP]; Saddi-Rosa, Pedro [UNIFESP]; Meira, Deyse M. [UNIFESP]; Giuffrida, Fernando M. A.; Reis, Andre F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Estado Bahia; Ctr Endocrinol Estado Bahia CEDEBA
Background: Type 2 diabetes mellitus has well known deleterious effects on coronary artery disease (CAD). the role of milder hyperglycemic states such as prediabetes (PD) on CAD is debatable. Glycated hemoglobin (HbA1c) has recently been advocated as a diagnostic tool for diabetes mellitus (DM) and PD. This study aims to assess the cardiometabolic risk profile and coronary lesions of patients with PD undergoing coronary angiography identified either by fasting plasma glucose (FPG) or HbA1c levels.Methods: We studied 514 individuals without previously known glucose disturbances. Their glycemic status was assessed by FPG and HbA1c (HPLC) and classified according to ADA guidelines, using each parameter independently, as having normal glucose tolerance (N), PD, or DM. CAD was defined as stenosis greater than 50% in one major coronary vessel or branch. Framingham score was calculated.Results: Subjects with PD had a similar frequency of CAD compared do N individuals by both FPG (61 vs. 59.3%) and HbA1c (55.4 vs 61.2%) (p non-significant for linear-by-linear association). PD individuals identified by FPG had worse HOMA2B (mean [95% CI] 65.4 [60.9-69.9] vs. 76.6 [71.4-81.9]) and HOMA2-IR (1.10 [0.98-1.22] vs. 0.80 [0.72-0.89]) when compared to N controls. PD individuals identified by HbA1c had higher frequency of Framingham risk above 20% (25.4 vs 11.8%), arterial hypertension (87.8 vs 72.6%), and dyslipidemia (83.8 vs 72%) compared to N individuals. PD associated with an increased number of coronary lesions only when diagnosed by HbA1c (median [interquartile interval] 2 [0-4] PD versus 1 [0-3.75] N, p = 0.03 for trend).Conclusions: HbA1c was more effective than FPG in identifying individuals with PD associated with high cardiovascular risk profile in a sample of individuals undergoing coronary angiography.
Acesso aberto (Open Access)
Interações entre síndrome da apnéia obstrutiva do sono e resistência à insulina
(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-10-01) Carneiro, Gláucia [UNIFESP]; Ribeiro Filho, Fernando Flexa [UNIFESP]; Togeiro, Sonia Maria [UNIFESP]; Tufik, Sergio [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Previous studies have shown Obstructive Sleep Apnea (OSA) as a risk factor for development of cardiovascular and cerebrovascular disease. However, controversies remain as to whether these changes are consequences of the associated obesity or OSA itself results in endocrine and metabolic changes, including impairment of insulin sensitivity, growth hormone, secretion inflammatory cytokines alterations, activation of peripheral sympathetic activity, and hipothalamic-pituitary-adrenal (HPA) axis, that may predispose to vascular disease. Furthermore many cardiovascular risk factors, such as hypertension, obesity, insulin resistance and type 2 diabetes, are strongly associated with OSA. In this article, we will review the evidence and discuss possible mechanisms underlying these links and the pathophysiology of OSA morbidities.
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Intima-Media Thickness Is Associated with Inflammation and Traditional Cardiovascular Risk Factors in Non-Dialysis-Dependent Patients with Chronic Kidney Disease
(Karger, 2010-01-01) Lemos, Marcelo M. [UNIFESP]; Jancikic, Alessandra D. B. [UNIFESP]; Sanches, Fabiana M. R. [UNIFESP]; Christofalo, Dejaldo M. [UNIFESP]; Ajzen, Sergio A. [UNIFESP]; Carvalho, Aluizio B. [UNIFESP]; Draibe, Sergio A. [UNIFESP]; Canziani, Maria Eugenia F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background: Mortality due to cardiovascular causes is high in chronic kidney disease (CKD). Intima-media thickness (IMT) and inflammation are early atherosclerosis markers, although data are lacking about their association in the CKD non-dialysis-dependent (CKD-NDD) population. the aim of the present study was to evaluate the association between IMT, inflammation and other cardiovascular risk factors in such patients. Methods: CKD-NDD patients (n = 122) were subjected to measurements of carotid IMT and inflammatory marker levels in a cross-sectional study. Results: Mean patient age was 55.2 +/- 11.3 years (61.5% males). Median C-reactive protein (CRP) was 0.28 mg/dl (0.03-14.2). the median interleukin (IL)-6 count was 4.75 pg/ml (0.7-243), the mean adiponectin was 27.8 +/- 7.3 ng/ml and the mean IMT was 0.61 +/- 0.19 mm. Four (3.3%) patients had IMT above the normal range. IMT was higher in males (p < 0.001), patients with estimated glomerular filtration rate < 60 ml/min (p = 0.030), inflammation (p = 0.005) and higher IL-6 levels (p = 0.023). IMT was correlated with age (R = 0.538; p < 0.001), waist circumference (R = 0.235; p = 0.016), CRP (R = 0.191; p = 0.035) and systolic blood pressure (R = 0.181; p = 0.048). in a multiple regression analysis, the independent determinants of IMT were age (beta = 0.512; p < 0.001) and CRP levels (beta = 0.159; p = 0.041). Conclusion: the present study demonstrated that although the IMT values were within the normal range, there was a clear association of IMT with age, as well as with inflammation in an asymptomatic CKD-NDD population. Copyright (C) 2010 S. Karger AG, Basel
Acesso aberto (Open Access)
Nefrolitíase e risco cardiovascular : avaliação da aterosclerose nos pacientes litiásicos
(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Freitas, Augustus Cesar Pinto de [UNIFESP]; Schor, Nestor [UNIFESP]; Casarini, Dulce Elena [UNIFESP]; Torres, Leuridan Cavalcante [UNIFESP]; Duarte, Maria do Carmo Menezes Bezerra; Dulce Elena Casarini : http://lattes.cnpq.br/0534906942293338; Maria do Carmo Menezes Bezerra Duarte : http://lattes.cnpq.br/4973562538598237; Leuridan Cavalcante Torres : http://lattes.cnpq.br/2047142717269426; http://lattes.cnpq.br/8276708741672261; http://lattes.cnpq.br/5318231956041552; Universidade Federal de São Paulo (UNIFESP)
Nephrolithiasis is considered a multifactorial disease, which prevalence has been increasing in the world. Many studies have been established a link between nephrolithiasis and systemic disease, including cardiovascular disease (CVD), metabolic syndrome (MS) and atherosclerosis. The main theories about the pathogenesis of early calculi’s matrix describe it like a biomineralization pathological and inflammatory process, with involvement of reactive oxygen species (ROS). Thereby, the calculi’s formation shares pathophysiological mechanisms suchlike that involved with another systemic disorders, which have high mortality and begins with atherosclerosis. Studies have shown the presence of ROS and your products in atherosclerosis, like oxidized low-density lipoprotein (LDLox), which is considered a marker of that disease. High levels of LDLox correlate significantly with CVD, including coronary and femoral artery disease. The antibody of LDLox (Ac Anti-LDLox) correlates less clearly with atherosclerosis. However, despite both, nephrolithiasis and atherosclerosis, exhibit pathophysiological mechanisms related to oxidative stress, we have not studies about LDLox in nephrolithiasis’ patients. This study aims to evaluate the serum levels of LDLox, antibory LDLox and others atherosclerosis markers in nephrolithiasis’ patients, according to the severity of the disease. It’s an translational cross-sectional study conducted between October 2015 and February 2017, involving 94 lithiasic patients, asymptomatic from the cardiovascular point of view, between 30-70 years old, watched in renal calculi clinic of Instituto de Medicina Integral Professor Fernando Figueira (IMIP) and 21 healthy controls. They were excluded when any anatomical abnormalities, chronic renal disease or cardiovascular disease were found or if they use statins. Pregnant women were also excluded. There were realized 24 hour urine measurements, serum measurements of atherosclerosis markers, like enzyme immunoassay to LDLox (Human Oxidized Low Density Lipoprotein (OxLDL) ELISA Kit; Elabscience Biotechnology Co., Wuhan, China) and Ac Anti-LDLox (OLAB IgG - Antioxidized LDL autoantibodies - ELISA Kit; Biomedica Medizinprodukte GmbH, Viena, Austria), following the manufacturer’s instructions. This study was approved by the Ethics Committee on Human Research of IMIP. Patients with nephrolithiasis were divided into group 1 (≥ 3 kidney stones) and group 2 (1-2 kidney stones). Both showed significantly higher LDLox levels (group 1: p= 0,02; group 2: 0,003) and higher LDLox/HDL (group 1: p=0,005; group 2: p=0,004) than controls. Patients in group 1 evidenced lower levels of Ac Anti-LDLox (p= 0,03) in relation to the control group. C-reactive protein were higher in patients with more severe disease (group 1; p=0,02). Our findings suggest that patients with renal stone disease have higher levels of LDLox, LDLox/HDL and PCR than healthy individuals. These findings indicate that this may be the link between nephrolithiasis, atherosclerosis and cardiovascular disease, more prevalent in patients with calculi.
Acesso aberto (Open Access)
Obesidade do peso normal e obesidade abdominal em praticantes de exercício físico: os "falsos magros" existem?
(Inst Brasileiro Pesquisa & Ensino Fisiologia Exercicio-Ibpefex, 2017) Teixeira, Cauê Vazquez La Scala [UNIFESP]; Eduardo, Claudio Zanin; Cerrone, Leticia Andrade [UNIFESP]; Konda, Kety Magalhaes; Santos, Gilberto Monteiro dos; Gomes, Ricardo José [UNIFESP]
ABSTRACT Obesity of normal weight and abdominal obesity in physical exercise practitioners: "fake lean"?Introduction: Although body mass index (BMI) eutrophy is desirable for decreasing cardiovascular and metabolic risk, recent research has attributed high risk in BMI eutrophic subjects, but with a high percentage of body fat (normal weight obesity) and abdominal obesity. Aim: to analyze the prevalence of normal weight obesity (NWO) and abdominal obesity (AO) in BMI eutrophic. Materials and methods: 204 volunteers (52.26 ± 14.18 years), 168 women (52.02 ± 14.27 years) and 36 men (53.39 ± 13.90) physical exercise practitioners underwent the following procedures divided in 3 phases: 1) all sample were initially submitted to BMI, percentage of body fat (%BF) and waist-height ratio (WHR) measurements; 2) only the BMI eutrophic subjects (n=83) were evaluated separately to identify the NWO and AO prevalence; 3) In the BMI eutrophic subjects, men and women over 61 and 55 years old, respectively, were excluded, and NWO and AO were repeated in the remaining subjects (n=52). Results: In the general sample, %BF was lower in men than women (18.61 ± 6.05 vs. 28.78 ± 5.24). For age, WHR and BMI, the statistical analysis showed no significant difference. In the BMI eutrophic subjects (N=83), 14.9% of the women presented NWO, representing 13.3% of the total. No man presented NWO. In this same sample, 44.4% of the men and 24.3% of the women had WHR over the optimal, representing 26.5% of the eutrophic subjects. Excluding the eutrophic subjects over 61 (men) and 55 years old (women) (N=52), 14.9% of the women presented NWO, representing 13.5% of the total. Conclusion: In BMI eutrophic subjects, 13 and 26% of the subjects presented NWO and AO, respectively. NWO was observed exclusively in women, whereas AO was more present in men.
Somente Metadadados
Phosphate Binder Impact on Bone Remodeling and Coronary Calcification - Results from the BRiC Study
(Karger, 2008-01-01) Barreto, Daniela Veit [UNIFESP]; Barreto, Fellype de Carvalho [UNIFESP]; Carvalho, Aluizio Barbosa de [UNIFESP]; Cuppari, Lilian [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Affonso Moyses, Rosa Maria; Neves, Katia Rodrigues; Jorgetti, Vanda; Miname, Marcio; Santos, Raul D.; Fernandes Canziani, Maria Eugenia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Background and Aims: Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. Methods: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. Results: the 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 mu m(3)/mu m(2)/day, p = 0.010 for sevelamer). Conclusions: There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups. Copyright (C) 2008 S. Karger AG, Basel
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Phytosterols and phytosterolemia: gene-diet interactions
(Springer, 2011-02-01) Izar, Maria C. [UNIFESP]; Tegani, Daniela M. [UNIFESP]; Kasmas, Soraia H. [UNIFESP]; Fonseca, Francisco A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Phytosterol intake is recommended as an adjunctive therapy for hypercholesterolemia, and plant sterols/stanols can reduce cholesterol absorption at the intestinal lumen through the Niemann-Pick C1 Like 1 (NPC1L1) transporter pathway by competitive solubilization in mixed micelles. Phytosterol absorption is of less magnitude than cholesterol and is preferably secreted in the intestinal lumen by ABCG5/G8 transporters. Therefore, plasma levels of plant sterols/stanols are negligible compared with cholesterol, under an ordinary diet. the mechanisms of cholesterol and plant sterols absorption and the whole-body pool of sterols are discussed in this chapter. There is controversy about treatment with statins inducing further increase in plasma non-cholesterol sterols raising concerns about the safety of supplementation of plant sterols to such drugs. in addition, increase in plant sterols has also been reported upon consumption of plant sterol-enriched foods, regardless of other treatments. Rare mutations on ABCG5/G8 transporters affecting cholesterol/non-cholesterol extrusion, causing sitosterolemia with xanthomas and premature atheroslerotic disease are now known, and cholesterol/plant sterols absorption inhibitor, ezetimibe, emerges as the drug that reduces phytosterolemia and promotes xanthoma regression. On the other hand, common polymorphisms affecting the NPC1L1 transporter can interfere with the action of ezetimibe. Gene-diet interactions participate in this intricate network modulating the expression of genetic variants on specific phenotypes and can also affect the individual response to the hypolipidemic treatment. These very interesting aspects promoted a great deal of research in the field.

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