Navegando por Palavras-chave "cardiovascular disease"

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    Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis analysis
    (Librapharm, 2006-06-01) Middleton, A.; Binbrek, A. S.; Fonseca, F. A. H.; Wilpshaar, W.; Watkins, C.; Strandberg, T. E.; Fowey Surg; Rashid Hosp; Universidade Federal de São Paulo (UNIFESP); AstraZeneca; Univ Helsinki
    Background: There is an increasing body of evidence to support the benefits of reducing low-density lipoprotein cholesterol ( LDL- C) levels and this has been reflected in a lowering of LDL- C goals recommended by international guidelines. Therefore, there is a growing need for effective lipid-modifying therapies to optimise the achievement of these more stringent LDL- C goals.Objective: A meta-analysis of data pooled from five studies participating in the DISCOVERY ( DIrect Statin COmparison of LDL- C Values: an Evaluation of Rosuvastatin therapY) Programme was performed to compare the effect of rosuvastatin treatment with other statins in real-life clinical practice.Results: These studies included 6743 patients with hypercholesterolaemia from different ethnicities, countries and cultural environments. the meta-analysis showed that significantly more patients receiving rosuvastatin 10 mg achieved the 2003 European LDL- C goals compared with those who received atorvastatin 10 mg or simvastatin 20 mg ( p < 0.001 for both comparisons). A significantly greater proportion of patients receiving rosuvastatin 10 mg also achieved the 2003 European total cholesterol goal compared with those on atorvastatin 10 mg ( p < 0.001).Conclusions: the meta-analysis showed that rosuvastatin was more effective than comparator statins at lowering LDL- C levels and enabling patients to achieve lipid goals at recommended start doses. in addition, all statins studied were well tolerated and confirmed that rosuvastatin had a similar safety profile to other statins.
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    Angiotensin II antagonists - therapeutic benefits spanning the cardiovascular disease continuum from hypertension to heart failure and diabetic nephropathy
    (Librapharm, 2006-01-01) Ribeiro, A. B.; Universidade Federal de São Paulo (UNIFESP)
    Background: the cardiovascular benefits of angiotensin II antagonists (AIIAs) have been evaluated not only in terms of their ability to lower blood pressure but also on their ability to prevent strokes, cardiac events, and target organ damage. This review summarizes the body of evidence-based data demonstrating the efficacy of AIIAs across the spectrum of cardiovascular disease.Methods:A PubMed/MEDLINE search of English-language articles (1990 to September 2005) was used to identify articles describing clinical studies, particularly outcome trials, or mechanisms of therapeutic action pertinent to the therapy of cardiovascular disease or nephropathy.Findings: the antihypertensive efficacy of AIIAs is apparent across a wide spectrum of hypertensive patients, including black and Asian patients and patients with isolated systolic hypertension. More importantly, large outcome-based studies have demonstrated the efficacy of AIIAs across the continuum of cardiovascular disease, including hypertension, heart failure, post-myocardial infarction, and diabetic nephropathy. the Losartan Intervention for Endpoint reduction in hypertension study (LIFE), Reduction of Endpoints in Non-insulin-dependent Diabetes Mellitus with the All Antagonist Losartan (RENAAL), and the Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT) indicate that AIIAs confer cardiovascular and renal protective effects beyond their ability to lower blood pressure. These blood-pressure independent protective benefits of AIIAs may arise not only by blocking the deleterious effects of All mediated via the AT(1)-receptor but may also be due to beneficial molecule-specific effects. As a class, AIIAs are well tolerated with an overall adverse event profile generally comparable to placebo and superior to that typically seen with calcium channel blockers, ACE inhibitors, diuretics, and beta-blockers.Conclusions: By utilizing the body of clinical trial evidence as a guide to rational prescribing of AIIAs, practitioners can expect to deliver clinical benefits to their patients in terms of survival, prognosis, and quality of life.
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    The association between TNF-alpha and erectile dysfunction complaints
    (Wiley-Blackwell, 2013-11-01) Matos, G. [UNIFESP]; Hirotsu, C. [UNIFESP]; Alvarenga, T. A. [UNIFESP]; Cintra, F. [UNIFESP]; Bittencourt, L. [UNIFESP]; Tufik, S. [UNIFESP]; Andersen, M. L. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Inflammatory markers like tumour necrosis factor-alpha (TNF-) have been related to erectile dysfunction (ED) and may interact with other cardiovascular risk factors such as obstructive sleep apnoea syndrome (OSAS). the aim of this study was to examine the inflammatory, metabolic and hormonal profile of men with or without ED complaints and/or OSAS recruited through the Epidemiologic Sleep Study (EPISONO). A sample of 363 men completed sexual questionnaires for ED and had physical and blood examinations. OSAS was evaluated by polysomnography and clinical assessment. the blood samples were used for determination of TNF-, interleukin-6, leptin, cholesterol and fractions, triglycerides, homocysteine, glucose and hormonal levels. After controlling for confounding factors, men with ED complaints presented higher systolic blood pressure and TNF-, independent of OSAS. Significant interaction between ED and OSAS was only observed for neck circumference, which was higher in ED men with OSAS than men with OSAS without ED and men with ED without OSAS. Binary logistic regression showed that the predictor factors for ED were age >43years, myocardial infarction events, TNF- and systolic blood pressure. Finally, a receiver-operating characteristics curve suggested a cut-off point of 9.95pg/mL for TNF- with sensitivity of 60% and specificity of 59% in men with ED complaints. Furthermore, there was a significant association between high levels of TNF- (>9.95pg/mL) and the presence of ED complaints. the results showed that there was an association between TNF- levels and ED complaints in men independent of OSAS.
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    Association of Changes in Bone Remodeling and Coronary Calcification in Hemodialysis Patients: A Prospective Study
    (Elsevier B.V., 2008-12-01) 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 [UNIFESP]; Neves, Katia Rodrigues [UNIFESP]; Jorgetti, Vanda [UNIFESP]; Miname, Marcio; Santos, Raul D.; Canziani, Maria Eugenia F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Background: Vascular calcification is common and constitutes a prognostic marker of mortality in the hemodialysis population. Derangements of mineral metabolism may influence its development. the aim of this study is to prospectively evaluate the association between bone remodeling disorders and progression of coronary artery calcification (CAC) in hemodialysis patients.Study Design: Cohort study nested within a randomized controlled trial.Setting & Participants: 64 stable hemodialysis patients.Predictor: Bone-related laboratory parameters and bone histomorphometric characteristics at baseline and after 1 year of follow-up.Outcomes: Progression of CAC assessed by means of coronary multislice tomography at baseline and after 1 year of follow-up. Baseline calcification score of 30 Agatston units or greater was defined as calcification. Change in calcification score of 15% or greater was defined as progression.Results: of 64 patients, 26 (40%) had CAC at baseline and 38 (60%) did not. Participants without CAC at baseline were younger (P < 0.001), mainly men (P = 0.03) and nonwhite (P = 0.003), and had lower serum osteoprotegerin levels (P = 0.003) and higher trabecular bone volume (P = 0.001). Age (P 0.003; beta coefficient = 1.107; 95% confidence interval [Cl], 1.036 to 1.183) and trabecular bone volume (P = 0.006; beta coefficient = 0.828; 95% Cl, 0.723 to 0.948) were predictors for CAC development. of 38 participants who had calcification at baseline, 26 (68%) had CAC progression in 1 year. Progressors had lower bone-specific alkaline phosphatase (P = 0.03) and deoxypyridinoline levels (P = 0.02) on follow-up, and low turnover was mainly diagnosed at the 12-month bone biopsy (P = 0.04). Low-turnover bone status at the 12-month bone biopsy was the only independent predictor for CAC progression (P = 0.04; beta coefficient = 4.5; 95% Cl, 1.04 to 19.39). According to bone histological examination, nonprogressors with initially high turnover (n = 5) subsequently had decreased bone formation rate (P = 0.03), and those initially with low turnover (n = 7) subsequently had increased bone formation rate (P = 0.003) and osteoid volume (P = 0.001).Limitations: Relatively small population, absence of patients with severe hyperparathyroidism, short observational period.Conclusions: Lower trabecular bone volume was associated with CAC development, whereas improvement in bone turnover was associated with lower CAC progression in patients with high- and low-turnover bone disorders. Because CAC is implicated in cardiovascular mortality, bone derangements may constitute a modifiable mortality risk factor in hemodialysis patients.
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    Association of dietary fiber with temporal changes in serum cholesterol in Japanese-Brazilians
    (Center Academic Publ Japan, 2006-06-01) Gontijo de Castro, Teresa; Gimeno, Suely Godoy Agostinho [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Cardoso, Marly Augusto; Japanese-Brazilian Diabetes Study; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    To examine dietary intakes in relation to long-term serum lipoprotein changes in a prospective cohort study with 7 y of follow-up, serum lipids were analyzed by enzymatic methods, while food intake was calculated from validated food frequency questionnaires. First- and second-generation Japanese-Brazilians (n = 316) living in Bantu, São Paulo/Brazil, of both genders, aged 40 to 79 y were assessed at baseline in 1993. Multiple linear regression models were used with changes in serum lipoproteins as the dependent variable and changes in dietary intakes as the independent variables, adjusted for confounding factors. in energy-adjusted analyses, changes in serum total cholesterol were inversely associated with changes in total dietary flber, fruits/fruit juices and vegetables after adjustment for age and gender. Each increase of 10 g in the consumption of total dietary fiber was associated with a reduction of 12.5 mg/dL in the serum total cholesterol (p < 0.05). Our results highlight the importance of increased intakes of total fiber, fruits and vegetables to prevent and control dyslipidemia in Japanese migrants.
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    Ausência de dicer no tecido adiposo e possível relação na gênese de doenças cardiovasculares
    (Universidade Federal de São Paulo (UNIFESP), 2015-11-08) Tarcitano, Emilio [UNIFESP]; Mori, Marcelo Alves da Silva Mori [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The risk of cardiovascular diseases (CVDs) is increased with aging and obesity. We have previously shown that aging and obesity leads to progressive, age-dependent downregulation of Dicer, a key component of the miRNA processing pathway, in adipose tissue of mice and humans. Here we asked whether fat-specific Dicer knockout mice had premature risk of atherosclerosis by crossing them with Apoe knockout mice (Apoe-/-) and subjecting them to a Western diet. Histological analyses in the aorta after 10 weeks on the diet showed animals with greater lipid accumulation in atherosclerotic plaques in the double knockout group (called henceforth DBKO) when compared to the Apoe-/- control. DBKO also had increased Olr1 (oxidized lipoprotein receptor 1) mRNA expression in the aorta and more circulating levels of LDL and less of HDL. DBKO mice exhibited features of partial lipodystrophy and had clear signs of adipose tissue inflammation. PAI-1 was increased in the circulation of DBKO mice, confirming the pro-atherogenic status of these mice. After 20 weeks on the diet, the differences between the groups became less obvious. However, some individuals of the DBKO group tended to exhibit a more aggressive phenotype, with marked deposition of lipids covering the aortic luminal surface, increased circulating MCP-1 levels and more events of paralysis and death. Consistently, collagen deposition was decreased in the atheromas of DBKO, suggesting plaque instability. In light with our data, this study evidences a new mechanism through which aging or obesity could contribute to the pathogenesis of CVDs by reducing Dicer expression in adipose tissue.
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    Complicações cardiovasculares em usuário de cocaína: relato de caso
    (Associação de Medicina Intensiva Brasileira - AMIB, 2006-12-01) Gazoni, Fernanda Martins [UNIFESP]; Truffa, Adriano A. M.; Kawamura, Carolina [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Lopes, Renato Delascio [UNIFESP]; Sandre, Letícia Vendrame [UNIFESP]; Lopes, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade São Francisco
    BACKGROUND AND OBJECTIVES: Cocaine is the most commonly used illicit drug and its acute and chronic effects are related to a variety of physiological changes, mainly in the cardiovascular system. This study is a case report of a patient with cardiomyopathy related to cocaine use. CASE REPORT: A 19 year old men, who has been using cocaine and crack since 15 years old, was admitted to the emergency department (ED) in February 2006 with progressive dyspnea during minimal efforts and bloody expectoration. During the physical exam it was observed legs edema, jugular stasis and dyspnea at rest. The echocardiogram demonstrated left ventricular hypocinesia, a 17 mm ventricular thrombus and a 12% ejection fraction. A bleeding from the left upper lobe was identified during a pulmonary bronchoscopy which was treated with arterial embolization. After 48h of the procedure, the patient was asymptomatic and an antithrombotic treatment with warfarin and enoxaparin was started. No obstruction was found at the cineangiography and the patient was discharged after clinical improvement. The patient was admitted again to the intensive care unit in July with intense chest pain and dyspnea at rest. A new cineangiography was performed and it was observed occlusion in the anterior descendent coronary artery. CONCLUSIONS: The cocaine acute effects are commonly seen at the ED but the chronic effects, as the cardiovascular manifestations, can take longer to be correlated as a side effect of cocaine use. Its prolonged use is related to left ventricular systolic dysfunction due to hypertrophy or myocardial dilation, atherosclerosis, arrhythmias, myocyte apoptosis and sympathetic damage.
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    Construction and Validation of a Data Collection Tool for the Clinical Assessment of Human Responses of Outpatients With Chronic Cardiovascular Diseases
    (Wiley-Blackwell, 2014-10-01) Carneiro, Camila de Souza [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Herdman, Trace Heather; Lopes, Camila Takao [UNIFESP]; Bachion, Maria Marcia [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); NANDA Int Inc; Univ Wisconsin; Universidade de São Paulo (USP); Fed Univ Goias UFG
    PurposeTo develop and test the content validity of a nursing assessment tool for data collection (NATDC) based on NANDA-I for use in outpatients with chronic cardiovascular diseases.MethodsConstruction based on the literature, refinement with a pilot group of hypertensive outpatients and content validation by experts.FindingsThe NATDC questions were divided into demographic information of the patient and family, clinical data, physical examination, and interview according to NANDA-I domains.ConclusionThe NATDC was constructed and validated.Implications for Nursing PracticeThis tool can be used in patients with chronic illnesses who experience a variety of human responses seeking nursing care in an outpatient setting because it is based in human responses within a structured framework for nursing assessment.
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    Correlação entre mamografia, escore de cálcio e doença coronariana em mulheres assintomáticas de risco intermediário pelo escore de framingham
    (Universidade Federal de São Paulo (UNIFESP), 2015) Timbo, Luciana Satiro [UNIFESP]; Szarf, Gilberto Szarf [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: to correlate the presence and intensity of breast arterial calcifications (BAC) with the coronary calcium score (CCS) and the risk of developing myocardial ischemia, stroke, heart attack and death from coronary causes in five years in patients at intermediate risk by Framingham criteria. Methods: 45 patients at intermediate risk with previous indication of routine mammography, performed CCS. Each method was analyzed separately by specialist physicians without knowledge of the results. The presence and intensity of BAC were graded as follows: absent (no vascular calcifications); slight (one vascular segment), moderate (one whole vessel) and severe (two or more vessels). CCS was rated at zero, slight (1-100), moderate (101-300) and severe (greater than 300). The data were compared using appropriate statistical tools. The patients will be followed for five years. Results: the mean age was 59,6 years. The finding of BAC was diagnosed in 15 patients (4 slight, 3 moderate and 8 severe), 38, not present. The CCS was abnormal in 20 cases (10 slight, 6 moderate and 4 severe) and equal to zero in 33. There was predominance of absence of BAC and zero CCS in patients with low Framingham score. It was observed that exists a statistically significant association (p <0.05) between the presence of intramammary and coronary vascular calcifications. Intensity correlation between methods was not found. Among the risk factors evaluated for coronary artery disease, there was association statistically significant (p <0.05) between age and breast arterial calcfications, as well as age and coronary calcifications. So far, no cardiovascular event was noted. Conclusions: there is relationship between BAC and CCS in women at intermediate risk of cardiovascular disease; intensity correlation between methods was not significant; in the first 20 months of this ongoing research, no case of myocardial ischemia, stroke, heart attack and death from coronary causes was observed
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    Correlação entre mamografia, escore de cálcio e doença coronariana em mulheres assintomáticas de risco intermediário pelo escore de framingham
    (Universidade Federal de São Paulo (UNIFESP), 2013-11-29) Timbo, Luciana Satiro [UNIFESP]; Szarf, Gilberto Szarf [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: to correlate the presence and intensity of breast arterial calcifications (BAC) with the coronary calcium score (CCS) and the risk of developing myocardial ischemia, stroke, heart attack and death from coronary causes in five years in patients at intermediate risk by Framingham criteria. Methods: 45 patients at intermediate risk with previous indication of routine mammography, performed CCS. Each method was analyzed separately by specialist physicians without knowledge of the results. The presence and intensity of BAC were graded as follows: absent (no vascular calcifications); slight (one vascular segment), moderate (one whole vessel) and severe (two or more vessels). CCS was rated at zero, slight (1-100), moderate (101-300) and severe (greater than 300). The data were compared using appropriate statistical tools. The patients will be followed for five years. Results: the mean age was 59,6 years. The finding of BAC was diagnosed in 15 patients (4 slight, 3 moderate and 8 severe), 38, not present. The CCS was abnormal in 20 cases (10 slight, 6 moderate and 4 severe) and equal to zero in 33. There was predominance of absence of BAC and zero CCS in patients with low Framingham score. It was observed that exists a statistically significant association (p <0.05) between the presence of intramammary and coronary vascular calcifications. Intensity correlation between methods was not found. Among the risk factors evaluated for coronary artery disease, there was association statistically significant (p <0.05) between age and breast arterial calcfications, as well as age and coronary calcifications. So far, no cardiovascular event was noted. Conclusions: there is relationship between BAC and CCS in women at intermediate risk of cardiovascular disease; intensity correlation between methods was not significant; in the first 20 months of this ongoing research, no case of myocardial ischemia, stroke, heart attack and death from coronary causes was observed
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    The DISCOVERY PENTA study: a DIrect Statin COmparison of LDL-C value - an Evaluation of Rosuvastatin therapY compared with atorvastatin
    (Librapharm, 2005-08-01) Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Ruiz, A.; Cardona-Munoz, E. G.; Silva, J. M.; Fuenmayor, N.; Marotti, M.; DISCOVERY PENTA investigators; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Javeriana; Univ Guadalajara; Univ Coimbra; Hosp Miguel Perez Carreno; AstraZeneca
    Background. International guidelines emphasize the need to achieve recommended low-density lipoprotein cholesterol (LDL-C) levels in order to reduce morbidity and mortality associated with coronary heart disease (CHD). However, many patients with hypercholesterolemia fail to achieve LDL-C goals on treatment.Objective: the primary objective was to compare the efficacy of rosuvastatin and atorvastatin for enabling patients to achieve National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) LDL-C goals. Secondary objectives were European LDL-C goal achievement, changes in the lipid profile, and safety. Research design and methods: This 12-week, multicenter, multinational, randomized, open-label trial compared the efficacy and safety of rosuvastatin 10 mg with atorvastatin 10 mg in statin-naive and switched patients with primary hypercholesterolemia from Brazil, Colombia, Mexico, Portugal, and Venezuela.Results: A total of 1124 patients with similar baseline characteristics were randomized to the two treatment groups. After 12 weeks of treatment, a significantly greater percentage of patients receiving rosuvastatin 10mg compared with atorvastatin 10 mg achieved NCEP ATP III LDL-C goals (71.2% vs 61.4%, p < 0.001), 1998 European LDL-C goals (73.5% vs 59.2%, p < 0.001) and 2003 European LDL-C goals (58.9% vs 44.6%, p < 0.001). Rosuvastatin treatment was associated with significant reductions in LDL-C and total cholesterol (TC) and, in statin-naive patients, a significant increase in high-density lipoprotein cholesterol (HDL-C) compared with atorvastatin treatment. Both treatments were well tolerated with a similar incidence of adverse events. Clinically significant elevations in creatinine, creatine kinase or hepatic transaminases were low and similar between treatment groups.Conclusions: Rosuvastatin 10 mg is significantly more effective at achieving NCEP ATP III and European LDL-C goals, lowering LDL-C and TC in both naive and switched patients and increasing HDL-C in naive patients than atorvastatin 10 mg, with a similar safety and tolerability profile. This study also provides evidence regarding the comparative effects of rosuvastatin versus atorvastatin in Latin American and Portuguese populations.
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    Disfunção endotelial venosa em pacientes com doença de Chagas sem insuficiência cardíaca
    (Sociedade Brasileira de Cardiologia - SBC, 2006-06-01) Plentz, Rodrigo Della Méa [UNIFESP]; Irigoyen, Maria Claudia [UNIFESP]; Muller, Andreia Simone [UNIFESP]; Casarini, Dulce Elena [UNIFESP]; Rubira, Marcelo Custodio; Moreno Junior, Heitor; Mady, Charles; Ianni, Bárbara Maria; Krieger, Eduardo Moacir; Consolim-Colombo, Fernanda; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade Estadual de Campinas (UNICAMP); Universidade de Cruz Alta
    OBJECTIVE: To analyze the venous endothelial function in Chagas' disease patients without heart failure. METHODS: The Chagas' disease Group (G1) was composed by 14 women and 2 men aged 46 ± 2,7 and the Control Group (G0) by 7 women and 1 man matched by age, weight and height. Dorsal Hand Vein Compliance Technique was used to evaluate the venous endothelial function. Crescent doses of phenylephrine were infused to get a 70% pre-constriction of the vein; after that, acetylcholine and sodium nitroprusside were respectively administrated to analyze the endothelium-dependent and -independent venodilation. RESULTS: No significant systemic hemodynamic changes were observed in both groups during the experiment. The necessary phenylephrine dose to reach 70% pre-constriction of the vein was significantly higher in the G1 (1116 ± 668,2 ng/ml) compared to G0 (103 ± 28 ng/ml) p = 0,05. The endothelium-dependent venous dilation was significantly lower in G1 (65,5 ± 8%) compared to G0 (137 ± 20 %) p = 0,009. No difference was observed in the endothelium-independent venous dilatation between groups. CONCLUSION: Patients with Chagas' disease without heart failure presented venous endothelial dysfunction.
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    Freqüência de doença cardiovascular aterosclerótica e de seus fatores de risco em pacientes com lúpus eritematoso sistêmico
    (Sociedade Brasileira de Reumatologia, 2007-06-01) Telles, Rosa Weiss; Lanna, Cristina Costa Duarte; Ferreira, Gilda Aparecida [UNIFESP]; Carvalho, Marco Antonio Parreiras De; Ribeiro, Antonio Luiz; Sociedade Brasileira de Reumatologia; UFMG Faculdade de Medicina Departamento do Aparelho Locomotor; Universidade Federal de São Paulo (UNIFESP); UFMG Faculdade de Medicina Departamento de Clínica Médica
    INTRODUCTION: the pathogenesis of coronary disease in systemic lupus erythematosus patients is not completely understood. Risk factors associated with lupus or its treatment may be associated with traditional risk factors for coronary disease. Such risk factors are more common in patients with lupus. OBJECTIVE: to determine the frequency of cardiovascular disease and traditional risk factors in patients with systemic lupus erythematosus at Rheumatology Division of Hospital das Clínicas of Minas Gerais Federal University. METHODS: 172 patients with systemic lupus erythematosus were evaluated. Cardiovascular events, traditional risk factors and clinical-laboratorial findings were investigated in this cross-sectional research. RESULTS: the mean age (SD) of the patients was 38.5 years (11.2 years). 95.9% were female and 64.5% were non white. Cardiovascular disease was identified in 8 patients (4.7%), with 11 different diagnoses. Three patients had coronary insufficiency, three had stroke and five had peripheral arterial disease. Systemic arterial hypertension was the most frequent risk factor (48.8%), followed by dyslipidemia in 70 patients (40.7%) and hypertriglyceridemia in 51 patients (29.7%). LDL-c > 100 mg/dl was found in 77 patients (44.8%). Among 165 female patients, 67 (40.6%) had menopause, 43.3% of them with early menopause. CONCLUSION: the present study describes the frequency of risk factors for coronary artery disease in a Brazilian sample of lupus patients. The impact of recognition and management of those risk factors in prevention of cardiovascular events should be object of others studies.
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    Homocysteine-Lowering and Cardiovascular Disease Outcomes in Kidney Transplant Recipients Primary Results From the Folic Acid for Vascular Outcome Reduction in Transplantation Trial
    (Lippincott Williams & Wilkins, 2011-04-26) Bostom, Andrew G.; Carpenter, Myra A.; Kusek, John W.; Levey, Andrew S.; Hunsicker, Lawrence; Pfeffer, Marc A.; Selhub, Jacob; Jacques, Paul F.; Cole, Edward; Gravens-Mueller, Lisa; House, Andrew A.; Kew, Clifton; McKenney, Joyce L.; Pacheco-Silva, Alvaro [UNIFESP]; Pesavento, Todd; Pirsch, John; Smith, Stephen; Solomon, Scott; Weir, Matthew; FAVORIT Study Investigators; Rhode Isl Hosp; Univ N Carolina; NIDDK; Tufts Med Ctr; Univ Iowa; Brigham & Womens Hosp; Jean Mayer Human Nutr Res Ctr Aging; Univ Toronto; London Hlth Sci Ctr; Univ Alabama; Universidade Federal de São Paulo (UNIFESP); Ohio State Univ; Univ Wisconsin; Duke Univ; Univ Maryland
    Background-Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. Observational studies of patients with chronic kidney disease suggest increased homocysteine is a risk factor for cardiovascular disease. the impact of lowering total homocysteine levels in kidney transplant recipients is unknown.Methods and Results-In a double-blind controlled trial, we randomized 4110 stable kidney transplant recipients to a multivitamin that included either a high dose (n=2056) or low dose (n=2054) of folic acid, vitamin B6, and vitamin B12 to determine whether decreasing total homocysteine concentrations reduced the rate of the primary composite arteriosclerotic cardiovascular disease outcome (myocardial infarction, stroke, cardiovascular disease death, resuscitated sudden death, coronary artery or renal artery revascularization, lower-extremity arterial disease, carotid endarterectomy or angioplasty, or abdominal aortic aneurysm repair). Mean follow-up was 4.0 years. Treatment with the high-dose multivitamin reduced homocysteine but did not reduce the rates of the primary outcome (n=547 total events; hazards ratio [95% confidence interval]=0.99 [0.84 to 1.17]), secondary outcomes of all-cause mortality (n=431 deaths; 1.04 [0.86 to 1.26]), or dialysis-dependent kidney failure (n=343 events; 1.15 [0.93 to 1.43]) compared to the low-dose multivitamin.Conclusions-Treatment with a high-dose folic acid, B6, and B12 multivitamin in kidney transplant recipients did not reduce a composite cardiovascular disease outcome, all-cause mortality, or dialysis-dependent kidney failure despite significant reduction in homocysteine level.
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    Hyperhomocysteinemia in children and adolescents with systemic lupus erythematosus: evolutive evaluation
    (Publisaude-edicoes Medicas Lda, 2008-01-01) Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Prado, Rogerio do [UNIFESP]; Nascif, Ana Karina Soares [UNIFESP]; D'Almeida, Vania; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: One of the mechanisms implicated in the pathogenesis of coronary heart disease in patients with juvenile systemic lupus erythematosus (SLE) is the hyperhomocysteinemia. Our aim was to follow patients with juvenile SLE and to identify the presence and the persistence of hyperhomocysteinemia.Methods: We studied 18 patients with juvenile SLE (median age 13.5 y). A survey of demographic and clinic data was performed based on patients records. The plasma homocysteine concentration was performed twice with a median interval of 1.5 years (1.3-2.5), and association with nutritional status, disease activity, renal involvement and use of methotrexate was sought. The plasma homocysteine concentration was also evaluated in 59 healthy controls, sex and age-matched to the patients.Results: Of the 18 patients with juvenile SLE, 16 (88.9%) were female and 13 (72.2%) had renal involvement. Five out of 18 patients (27.8%) persisted with increased concentration of plasma homocysteine (above the 90(th) percentile of the healthy group). The elevated concentration of homocysteine did not show statistically significant association neither with renal involvement (in the first dosage, p=0.676 and in the second, p=0.500), disease activity (in the first dosage, p=0.630 and in the second, p=0.182), overweight/obesity (in the first dosage, p=0.485 and in the second, p=0.288) nor with short stature (in the first dosage, p=0.202 and in the second, P=0.500).Conclusion: This study emphasizes the persistence of elevated concentration of homocysteine in some patients with juvenile SLE and the need for evaluations of therapeutic strategies and nutritional education aiming to reduce risk factors of cardiovascular disease.
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    Lupus in Latin-American patients: lessons from the GLADEL cohort
    (Sage Publications Ltd, 2015-05-01) Pons-Estel, G. J.; Catoggio, L. J.; Cardiel, M. H.; Bonfa, E.; Caeiro, F.; Sato, E. [UNIFESP]; Massardo, L.; Molina-Restrepo, J. F.; Guibert Toledano, M.; Barile-Fabris, L. A.; Amigo, M. C.; Acevedo-Vasquez, E. M.; Abadi, Isaac; Wojdyla, D.; Alarcon-Riquelme, M. E.; Alarcon, G. S.; Pons-Estel, B. A.; GLADEL; Hosp Clin Barcelona; Hosp Italiano Buenos Aires; Fdn Dr Pedro M Catoggio Progreso Reumatol; Ctr Invest Clin Morelia SC; Universidade de São Paulo (USP); Ctr Med Cordoba; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Catolica Chile; Univ CES; Ctr Invest Med Quirurg CIMEQ; Inst Mexicano Seguro Social; Ctr Med ABC; Hosp Nacl Guillermo Almenara Irigoyen; Hosp Clin; Univ Nacl Rosario; Univ Granada; Oklahoma Med Res Fdn; Univ Alabama Birmingham; Hosp Prov Rosario
    The need for comprehensive published epidemiologic and clinical data from Latin American systemic lupus erythematosus (SLE) patients motivated the late Dr Alarcon-Segovia and other Latin American professionals taking care of these patients to spearhead the creation of the Grupo Latino Americano de Estudio del Lupus (GLADEL) cohort in 1997. This inception cohort recruited a total of 1480 multiethnic (Mestizo, African-Latin American (ALA), Caucasian and other) SLE patients diagnosed within two years from the time of enrollment from 34 Latin American centers with expertise in the diagnosis and management of this disease. in addition to the initial 2004 description of the cohort, GLADEL has contributed to improving our knowledge about the course and outcome of lupus in patients from this part of the Americas. the major findings from this cohort are highlighted in this review. They have had important clinical implications for the adequate care of SLE patients both in Latin America and worldwide where these patients may have emigrated.
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    A multinational case-control study of cardiovascular disease and steroid hormone contraceptives - Description and validation of methods
    (Elsevier B.V., 1995-12-01) Debert-Ribeiro, Myriam [UNIFESP]; Medina, E.; Artigas, J.; He, S.; Hui, Z. Y.; Zhang, D. W.; Rojas, O.; Vessey, M.; Heinemann, L.; Donnan, S.; Ho, S.; Bartfai, G.; Kisjanto, J.; Wilks, R.; Agwanda, R.; Ruiz, R.; Kozuh-Novak, M.; Dusitsin, N.; Virutamasen, P.; Phanthumchinda, K.; Demirovic, J.; Belkic, K.; Mwandila, W. S.; Mutale, C. M.; Matenga, J.; Wilson, A.; UNIV CHILE; ESCUELA MED; NATL RES INST FAMILY PLANNING; SICHUAN FAMILY PLANNING RES INST; SHANGHAI INST PLANNED PARENTHOOD RES; UNIV VALLE; UNIV OXFORD; ZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH; CHINESE UNIV HONG KONG; UNIV SZEGED; UNIV INDONESIA; UNIV W INDIES; GRP INTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REP; UNIV LJUBLJANA; CHULALONGKORN HOSP; SIRIRAJ HOSP; UNIV BELGRADE; UNIV LUSAKA; UNIV ZIMBABWE; Universidade Federal de São Paulo (UNIFESP)
    A hospital-based, case-control study of the association between current usage of oral contraceptives and first-time cases of acute myocardial infarction, stroke, or a venous thromboembolic event (deep vein thrombosis or pulmonary embolus) was carried out in 17 countries from four regions (Africa, Asia, Europe, and Latin America). A total of 3792 cases and 10,281 hospitalised controls matched for age were recruited during a 4-year period, ending in June 1993. The study was designed to have sufficient power to detect a relative risk of 2 for developing each of the three study diseases, associated with current oral contraceptive use in each of the four regions, with the exception of acute myocardial infarction (for which all non-European regions were to be combined) and for venous thromboembolic events in Asia, where these disorders are rare.This report describes the background, pilot study, methods, and the analyses carried out to validate the methods used in the study.
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    Perfil lipídico, fatores de risco cardiovascular e síndrome metabólica em um grupo de pacientes com AIDS
    (Sociedade Brasileira de Cardiologia - SBC, 2009-08-01) Silva, Érika Ferrari Rafael da [UNIFESP]; Bassichetto, Katia Cristina; Lewi, David Salomao [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Secretaria Municipal de Saúde de São Paulo
    BACKGROUND: Since the advent of AIDS, the anti-HIV therapy has developed significantly, including the highly active antiretroviral therapy (HAART) and the disease acquired a chronic characteristic. However, after the introduction of HAART, several metabolic alterations were observed, mainly related to the lipid profile. OBJECTIVES: to evaluate and compare lipid profiles, analyze cardiovascular risk, describe the prevalence of metabolic syndrome in AIDS patients with or without HAART. METHODS: Over an 18-month period, 319 patients treated at outpatient clinics in the city of São Paulo, Brazil were selected. RESULTS: The final sample included 215 patients receiving HAART and 69 HAART-naive patients. The mean age was 39.5 years, and 60.9% were males. The main cardiovascular risk factors were smoking (27%), hypertension (18%) and family history of atherosclerosis (40%). Mean total cholesterol, HDL-cholesterol, triglycerides and glucose were higher in the HAART group than in the non-HAART group (205 vs 180 mg/dl, 51 vs 43 mg/dl, 219 vs 164 mg/dl and 101 vs 93 mg/dl respectively; p < 0.001 for all). According to the Framingham risk score, the cardiovascular risk was moderate to high in 11% of the patients receiving HAART and 4% of the HAART-naïve patients. According to the Adult Treatment Panel III definition, the metabolic syndrome was observed in 13% and 12% of the patients with or without HAART, respectively. CONCLUSIONS: Although the mean values for total cholesterol, HDL-c and triglycerides were higher in the HAART group, a higher cardiovascular risk was not identified in the former. The prevalence of metabolic syndrome was comparable in both groups.
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    The progression and impact of vascular calcification in peritoneal dialysis patients
    (Multimed Inc, 2007-05-01) Ammirati, Adriano Luiz [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Cendoroglo Neto, Miguel [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Santos, Raul Dias dos; Miname, Marcio Hiroshi; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Background. Progression of coronary artery calcification (CAC) has been described in hemodialysis patients, and severe CAC has been associated with the occurrence of cardiovascular events in this population. Little information is available regarding peritoneal patients.Aim: To prospectively evaluate peritoneal dialysis patients in order to identify the variables associated with the rate of CAC progression, as well as to determine the impact that baseline CAC has on clinical outcomes over a 1-year follow-up period.Methods: Using multislice coronary tomography, calcium scores were estimated at baseline and after 12 months in 49 peritoneal dialysis patients. Patients with and without CAC progression were compared with respect to clinical characteristics and biochemical variables, including lipid profile, parameters of mineral metabolism, and markers of inflammation. Cardiovascular events, hospitalizations, and att-cause mortality were recorded.Results: At baseline, 29 patients (59%) presented CAC and a median calcium score of 234.7 (range 10.3 - 2351) Agatston units. Progression of CAC was observed in 13 patients (43%) who, in comparison with those presenting no CAC progression, were older, presented higher baseline calcium scores, and had higher mean glucose levels, lower mean high density lipoprotein cholesterol levels, and more months using low calcium peritoneal solution. We also observed a trend toward more often presenting with a history of hypertension, exhibiting more hyperphosphatemic and hyperglycemic events, and having lower albumin levels. In multiple logistic regression, only baseline calcium score was independently associated with progression of CAC. A shorter cardiovascular event-free time and a trend toward lower survival rates were observed in the group with CAC. Hospitalization event-free time did not differ between the groups.Conclusion: Determining CAC provides important prognostic data in peritoneal dialysis patients. Baseline calcium score and disturbances in glucose, mineral, and lipid metabolism were indicative of higher risk of CAC progression in this population.
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    Pulse wave velocity - a useful tool for cardiovascular surveillance in pre-dialysis patients
    (Oxford Univ Press, 2007-12-01) Lemos, Marcelo Montebello [UNIFESP]; Jancikic, Alessandra D. B. [UNIFESP]; Sanches, Fabiana M. R. [UNIFESP]; Christofalo, Dejaldo M. [UNIFESP]; Ajzen, Sergio A [UNIFESP]; Miname, Marcio H.; Santos, Raul D.; Fachini, Fernando C.; Carvalho, Aluizio B. [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Canziani, Maria Eugenia F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Ctr Diagnost Brasil
    Background. Cardiovascular mortality is high among patients with chronic kidney disease. Pulse wave velocity (PWV) is a simple method used for arterial distensibility evaluation. Few data are available concerning PWV in pre-dialysis patients. the aim of this study was to evaluate the association between PWV and cardiovascular disease in pre-dialysis.Methods. One hundred and four patients were submitted to PWV analysis, coronary artery calcium (CAC) determination with a multi-slice CT scan of the coronary arteries, echocardiogram and a carotid intima-media thickness (IMT) evaluation, with a high resolution ultrasound. the demographic characteristics and laboratory tests results were studied.Results. the mean age of those studied was 54.4 +/- 11.5 years, 60% were males and the mean creatinine clearance was 40 ml/min/1.73 m(2). the mean PWV was 12.2 +/- 3.4 m/s and it was significantly higher in males, diabetics, those with creatinine clearance <60 ml/min and proteinuria >= 1 g/24 h. PWV was correlated with systolic blood pressure, age, triglycerides, total cholesterol and 24 h proteinuria. in the multiple regression analysis, PWV was significantly associated with diabetes, age, systolic blood pressure and cholesterol. Fifty-eight patients (56%) presented coronary calcification and PWV correlated with coronary calcium score ( R = 0.48; P < 0.001) and calcium volume (R = 0.50; P < 0.001). Moreover, PWV was higher in patients with coronary calcification (13.4 +/- 3.6 m/s vs 10.7 +/- 2.4 m/s; P < 0.001). the mean left ventricular mass index (LVMI) was 106 +/- 31 g/m(2) and 24% of patients had left ventricular hypertrophy, while 19 (18.3%) patients had left ventricular dysfunction. PVW was correlated with LVMI (R = 0.25; P = 0.01) while no association could be seen between PWV and the ejection fraction or left ventricular dysfunction. A correlation between the IMT and PWV was observed (R = 0.27; P = 0.005). in addition, those with a thicker IMT had a higher PWV ( 13.2 +/- 3.4 m/s vs 11.2 +/- 3.2 m/s; P = 0.003).Conclusion. PWV is associated with cardiovascular disease in pre-dialysis patients and can be a useful tool to identify patients with increased cardiovascular risk.