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- ItemAcesso aberto (Open Access)Avaliacao da espessura medio-intimal em pacientes com doenca renal cronica nao dialitica: estudo prospectivo de 24 meses(Sociedade Brasileira de Nefrologia, 2014-03-01) Marcos, Andrea Gaspar; Watanabe, Renato; Lemos, Marcelo Montebello [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction:Increased carotid intima-media thickness (IMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events in general population. The prognostic value of IMT in patients with early-stage chronic kidney disease (CKD) has not been clearly established.Objective:We aimed to evaluate the association between IMT and cardiovascular (CV) events and mortality in CKD patients.Methods:A cohort of CKD patients in stage 2-4 was evaluated the occurrence of CV events and death in a 24 months follow-up. Laboratory data, carotid ultrasound and coronary computed tomography were performed at baseline.Results:A total of 117 patients (57 ± 11 years-old, 61% male) were evaluated. Mean glomerular filtration rate (eGFR) was 36 ± 17 mL/min, 96% of patients had hypertension, 23% diabetes and 27% were obese. Coronary calcification was found in 48% of the patients, with higher prevalence among CKD stage 4 (p = 0.02). The median value of IMT was 0.6 mm (0.4-0.7 mm). When compared to patients with IMT ≤ 0.6 mm, those with IMT > 0.6 mm were older (p = 0.001), had higher prevalence of male (p = 0.001) and had lower eGFR (p = 0.01). These patients also had higher prevalence of coronary calcification (p = 0.001). During the follow-up, there were no differences in the occurrence of cardiovascular events and deaths between the two groups.Conclusion:IMT in early-stage CKD patients was related to coronary calcification, but not with the occurrence of cardiovascular events or death.
- ItemRestritoDietary patterns associated with risk factors for cardiovascular disease in a Brazilian city(Pan Amer Health Organization, 2007-11-01) Neumann, Africa Isabel Cruz Perez; Martins, Ignez Salas; Marcopito, Luiz Francisco [UNIFESP]; Araujo, Eutalia Aparecida Candido; Secetaria Estado Saude São Paulo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Objective. To identify the dietary patterns of individuals living in the urban area of São Paulo, Brazil, and to investigate the association between these patterns and biological, sociodemographic, and behavioral risk factors for cardiovascular disease (CVD).Method. A cross-sectional epidemiological survey was carried out with a population-based probabilistic sample. the 2 100 participants of both sexes were from 15 to 59 years of age. A sociodemographic, behavioral clinical, and dietary survey was applied to a systematic subsample of 700 people. Dietary patterns were determined using factor analysis based on a food frequency questionnaire. Covariance analysis was used to determine the associations between dietary patterns and sociodemographic and behavioral variables, and multilinear regression to determine the association between dietary patterns and biological factors.Results. Four patterns were identified: (1) the cafeteria pattern (simple sugars and saturated fat), associated with areas of medium sociodemographic and environmental homogeneity, high school and university-level schooling, and alcohol consumption; positively associated with systolic (SAP) and diastolic (DAP) arterial pressure, body mass index (BMI) and waist-to-hip ratio (WHR); and negatively associated with HDL. (2) the traditional pattern (including cereals, beans, and infusion beverages) was predominant among women and in the age group over 50 years;associated with alcohol consumption, higher income, and areas of medium homogeneity; positively associated with glucose levels and BMI; and negatively associated with triglycerides and WHR. (3) the modern pattern (low intake of fat and simple sugars; fish) was predominant among individuals from high homogeneity areas, with higher income and university schooling;negatively associated with DAP, total cholesterol, glucose levels, and LDL. (4) the atherogenic pattern (saturated fat, addition of salt to cooked foods and alcohol consumption) was predominant among males; associated with elementary schooling, smoking, alcohol consumption, and areas of medium and low homogeneity; and positively associated with total cholesterol, triglycerides, glucose levels, BMI, and WHR.Conclusions. the results indicate an unfavorable trend in the dietary patterns of this population, since three of the four patterns identified (cafeteria, traditional, and atherogenic) are significantly associated with risk factors for CVD.
- ItemAcesso aberto (Open Access)Early traits of metabolic syndrome in pediatric post-cancer survivors: outcomes in adolescents and young adults treated for childhood medulloblastoma(Sociedade Brasileira de Endocrinologia e Metabologia, 2011-11-01) Siviero-Miachon, Adriana Aparecida [UNIFESP]; Monteiro, Carlos Manoel de Castro [UNIFESP]; Pires, Liliane Viana; Rozalem, Ana Carolina [UNIFESP]; Silva, Nasjla Saba da [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Spinola-Castro, Angela Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To analyze traits of metabolic syndrome (MetS) in medulloblastoma survivors. SUBJECTS AND METHODS: Sixteen childhood medulloblastoma survivors aged 18.0 (4.4) years, with history of craniospinal radiation therapy (RT) were compared with nine control subjects matched by age, gender, and body mass index, according to fat distribution, metabolic and cardiovascular variables. RESULTS: Medulloblastoma patients showed increases in waist circum-ference and its relationships (all p < 0.05), and HOMA1-IR (p = 0.006), which were modified by growth hormone (GH) secretion status. However, these increases were within normal range. CONCLUSIONS: Adolescent and young adult survivors of medulloblastoma showed centripetal fat deposition and decreased insulin sensitivity, associated with GH status. Pediatric brain tumor survivors following RT should be monitored for the diagnosis of MetS traits predisposing to cardiovascular disease.
- ItemAcesso aberto (Open Access)Uma estratégia para redução de risco cardiovascular em pacientes transplantados renais(Sociedade Brasileira de Cardiologia - SBC, 2010-06-01) Leite, Denise [UNIFESP]; Campos, Alexandre Holthausen [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Cardiovascular disease represents the leading cause of morbidity, mortality and graft function loss in renal transplant recipients (RTR). Aggressive treatment of risk factors is strongly advocated. However, there is a gap between recommended evidence-based therapy and effective cardiovascular management in that population. OBJECTIVE: To establish a cardiovascular risk factor control strategy for RTR. METHODS: The cardiovascular risk of 300 RTR of a renal transplant unit was assessed using the Framingham criteria. Interventions on modifiable risk factors were suggested to attending physicians by letters attached to patients' charts, including lifestyle modifications, blood pressure control and use of antiplatelet and lipid-lowering therapy. Risk factor profiles were re-evaluated after 6 and 12 months. RESULTS: Most patients were at high cardiovascular risk (58%). After 12 months, the proportion of patients on antiplatelet, antihypertensive and lipid-lowering therapy was significantly increased (29 to 51%, 83 to 92% and 3 to 46%, p < 0.001, respectively). Total cholesterol and triglyceride levels decreased (237 to 215 mg/dl, p = 0.001 and 244 to 221 mg/dl, p = 0.03). Although a non-significant reduction in LDL levels was observed (136 to 116 mg/dl, p = 0.12), patients starting statins within the first 6 months of the study presented a significant 25% reduction in LDL (159 to 119 mg/dl, p < 0.001). The proportion of patients with complete plasma lipid evaluation was also increased (27% to 49%, p < 0.001). CONCLUSION: Our results suggest that a simple, inexpensive strategy significantly improves the cardiovascular risk profile of RTR, potentially translating into marked benefits for long-term graft function and life expectancy.
- ItemAcesso aberto (Open Access)Estudo prospectivo de 2151 pacientes com doença renal crônica em tratamento conservador com abordagem multidisciplinar no Vale do Paraíba, SP(Sociedade Brasileira de Nefrologia, 2012-09-01) Luciano, Eduardo de Paiva; Luconi, Paulo Sérgio [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Melaragno, Claudio Santiago [UNIFESP]; Abreu, Patricia Ferreira [UNIFESP]; Reis, Sandra Ferreira Stanisck; Furtado, Rejane Maria Spindola; Ruivo, Gilson Fernandes; Centro Estadual para Tratamento de Doenças Renais do Vale do Paraíba; Universidade Federal de São Paulo (UNIFESP); Universidade de TaubatéINTRODUCTION: Chronic Kidney Disease (CKD) is common, severe and treatable. Its detection involves low cost tests. AIM: To evaluate the effect of a multidisciplinary (nephrologist, social worker, nurse, nutritionist, and psychologist) intervention comparing clinical and laboratory parameters in patients with CKD. METHODS: A prospective study with 2,151 patients attended at the State Center for Kidney Diseases of the Vale do Paraiba, São Paulo, from February 2008 to March 2011. The kidney function was measured using albuminuria and estimated glomerular filtration rate (eGRF) using the MDRD formula The clinical outcomes were the occurrence of cardiovascular disease (CAD), hospitalization episodes, need of renal replacement therapy (RRT) and death. RESULTS: Participants had a mean (range) age of 62 years (14-101), a mean follow-up of 546 days (90-1540) and the majority was in the stage 3 of CKD (59%). The most common primary diagnoses were hypertension (41.2%) and diabetes (32.4%). Mean blood pressure values at the beginning and at the end of treatment were 143 ± 26 mmHg x 87 ± 14 mmHg and 123 ± 16 mmHg x 79 ± 9 mmHg, respectively (p < 0.001); the eGRF decreased from 58.5 ± 31 ml/min. to 56.3 ± 23 ml/min (p < 0.01). Mean value of proteinuria decreased from 1.04 ± 1.44 g/day to 0.61 ± 1.12 g/day, p < 0.001, and the fasting glicemia decreased from 137 ± 73 mg/dl to 116 ± 42 mg/dl. One hundred and twenty-two patients (5.7%) had a CAD episode, the hospitalization rate was 6.6% (n = 143 patients), 7.3% patients died (n = 156), and 1.1% (n = 23) patients needed to start RRT. The risk of cardiovascular events, hospitalization, or death was inversely related to eGRF, and the rates of these events were low compared with the international literature. CONCLUSION: The multidisciplinary care with well defined targets is effective for the preservation of renal function and reduction in morbidity and mortality of CKD patients.
- ItemAcesso aberto (Open Access)Neuropatia autonômica cardiovascular diabética: fatores de risco, impacto clínico e diagnóstico precoce(Sociedade Brasileira de Cardiologia - SBC, 2008-04-01) Rolim, Luiz Clemente de Souza Pereira [UNIFESP]; Sá, João Roberto de [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Cardiovascular autonomic neuropathy (CAN) is one of the most clinically significant complications of diabetes mellitus (DM), but one of the least frequently diagnosed. In this review, we discuss the major risk factors for the development and progression of CAN in patients with DM, the natural history of autonomic neuropathy and its impact on cardiovascular disease in DM, as well as the tests for the early diagnosis and staging of CAN in the clinical practice. The bibliographic research was based on two databases: Medline and Tripdatabase, with the following descriptors: diabetic cardiovascular autonomic neuropathy and cardiovascular autonomic neuropathy and diabetes. We selected English and German articles, written between 1998 and 2007. In its initial stages (early and intermediate), CAN may be diagnosed and reversed. However, in advanced cases (severe stage), the only treatment that remains is a symptomatic one. CAN is associated with higher cardiovascular morbidity and mortality rates and poor quality of life in diabetic individuals.
- ItemSomente MetadadadosNoncoding RNA Profiles in Tobacco- and Alcohol-Associated Diseases(Mdpi Ag, 2017) do Amaral, Nayra Soares; Melo, Natalia Cruz e [UNIFESP]; Maia, Beatriz de Melo; Rocha, Rafael Malagoli [UNIFESP]Tobacco and alcohol are the leading environmental risk factors in the development of human diseases, such as cancer, cardiovascular disease, and liver injury. Despite the copious amount of research on this topic, by 2030, 8.3 million deaths are projected to occur worldwide due to tobacco use. The expression of noncoding RNAs, primarily microRNAs (miRNAs) and long noncoding RNAs (lncRNAs), is modulated by tobacco and alcohol consumption. Drinking alcohol and smoking cigarettes can modulate the expression of miRNAs and lncRNAs through various signaling pathways, such as apoptosis, angiogenesis, and inflammatory pathways-primarily interleukin 6 (IL-6)/signal transducer and activator of transcription 3 (STAT3), which seems to play a major role in the development of diseases associated with these risk factors. Since they may be predictive and prognostic biomarkers, they can be used both as predictors of the response to therapy and as a targeted therapy. Further, circulating miRNAs might be valuable noninvasive tools that can be used to examine diseases that are related to the use of tobacco and alcohol. This review discusses the function of noncoding RNAs in cancer and other human tobacco- and alcohol-associated diseases.
- ItemAcesso aberto (Open Access)Positive Association between Tinnitus and Arterial Hypertension(Frontiers Media Sa, 2016) Figueiredo, Ricardo Rodrigues [UNIFESP]; Azevedo, Andreia Aparecida [UNIFESP]; Penido, Norma de Oliveira [UNIFESP]Introduction: Tinnitus is the perception of noise in the absence of an external source and is considered by most authors as a multifactorial symptom. A systematic review concerning the association of tinnitus and systemic arterial hypertension retrieved suggestions of a positive association, but the articles included failed to perform a detailed analysis on the theme. Purpose: To analyze the presence of arterial hypertension in tinnitus and non-tinnitus patients, to analyze differences between tinnitus impact and psychoacoustic measurements in hypertensive and normotensive patients, and to evaluate the association between the presence of tinnitus and the diverse antihypertensive drugs employed. Materials and methods: This includes cross-sectional transversal study, comparing two groups of subjects (144 in the study group with tinnitus and 140 in the control group without tinnitus). Clinical, demographical, audiometrical, and psychoacoustics characteristics of the subjects were compared. Results: Hypertension prevalence in tinnitus subjects was 44.4% against 31.4% in subjects without tinnitus (p = 0.024). Positive associations with tinnitus were found with hypertension treatment with angiotensin-converting enzyme (ACE) inhibitors (p = 0.006), tiazidic diuretics (p < 0.0001), potassium-sparing diuretics (p = 0.016), and calcium channels blockers (p = 0.004). Conclusion: There is an association between tinnitus and arterial hypertension. This association is particularly strong in older patients. Hypertension treatment with diuretics, ACE inhibitors, and calcium channels blockers were more prevalent in tinnitus patients, suggesting that an eventual ototoxicity of these drugs may be involved in tinnitus pathophysiology, a hypothesis that should be evaluated in further studies.
- ItemSomente MetadadadosReinnervation of Renal Afferent and Efferent Nerves at 5.5 and 11 Months After Catheter-Based Radiofrequency Renal Denervation in Sheep(Lippincott Williams & Wilkins, 2015-02-01) Booth, Lindsea C.; Nishi, Erika E. [UNIFESP]; Yao, Song T.; Ramchandra, Rohit; Lambert, Gavin W.; Schlaich, Markus P.; May, Clive N.; Univ Melbourne; Monash Univ; Universidade Federal de São Paulo (UNIFESP)Previous studies indicate that catheter-based renal denervation reduces blood pressure and renal norepinephrine spillover in human resistant hypertension. the effects of this procedure on afferent sensory and efferent sympathetic renal nerves, and the subsequent degree of reinnervation, have not been investigated. We therefore examined the level of functional and anatomic reinnervation at 5.5 and 11 months after renal denervation using the Symplicity Flex catheter. in normotensive anesthetized sheep (n=6), electric stimulation of intact renal nerves increased arterial pressure from 99 +/- 3 to 107 +/- 3 mm Hg (afferent response) and reduced renal blood flow from 198 +/- 16 to 85 +/- 20 mL/min (efferent response). in a further group (n=6), immediately after denervation, renal sympathetic nerve activity was absent and the responses to electric stimulation were abolished. At 11 months after denervation (n=5), renal sympathetic nerve activity and the responses to electric stimulation were at normal levels. Immunohistochemical staining for renal efferent (tyrosine hydroxylase) and renal afferent nerves (calcitonin gene-related peptide), as well as renal norepinephrine levels, was normal 11 months after denervation. Findings at 5.5 months after denervation were similar (n=5). in summary, catheter-based renal denervation effectively ablated the renal afferent and efferent nerves in normotensive sheep. By 11 months after denervation the functional afferent and efferent responses to electric stimulation were normal. Reinnervation at 11 months after denervation was supported by normal anatomic distribution of afferent and efferent renal nerves. in view of this evidence, the mechanisms underlying the prolonged hypotensive effect of catheter-based renal denervation in human resistant hypertension need to be reassessed.
- ItemSomente MetadadadosStress influence on genesis, onset and maintenance of cardiovascular diseases: literature review(Blackwell Publishing Ltd, 2003-09-01) Franco, Gianfabio P. [UNIFESP]; Barros, Alba LBL de [UNIFESP]; Nogueira-Martins, Luiz A. [UNIFESP]; Michel, Jeanne LM [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. Recent mortality profiles in Brazil show that circulatory diseases are the leading cause of death in Brazil. These disorders contribute to 34% of deaths, with 50% of those deaths occurring in people under 50 years of age, that is, in people who are still active in the workforce. We assume that the growing incidence of cardiovascular diseases has occurred as the globalization of Brazil continues and brings with it the associated health risk factors of modern lifestyles, including stress.Aim. This paper reports the. evidence on the influence of stress in the development, onset and progress of cardiovascular diseases. We aim to define the concept of stress and to point systematically to the interrelationships between its emotional and bodily manifestations through a discussion of the history and study of stress. We then suggest that factors leading to the experience of stress in Brazil are no different than in any other modern nation. We further offer a perspective on nursing interventions currently undertaken in Brazil in both hospital and community settings, with their more recent emphasis on health. promotion and prevention.Methods. An extensive literature review was undertaken. the data presented here were selected from reviews and clinical studies described in MEDLINE, LILACS, SciELO databases, as well as in the classical literature. We also refer to the current Brazilian literature on the prevalence of cardiovascular diseases and their associated risk factors.Conclusions. the incidence of cardiovascular diseases in Brazil is rising. Because of the globalization of Brazilian society, with its consequent competitiveness and accelerated modern lifestyles, Brazilians are no less immune,to the usual health risk factors associated with cardiovascular diseases. Stresses associated with a modern lifestyle, however, are emerging as a new and major risk for developing cardiovascular diseases in Brazil.
- ItemAcesso aberto (Open Access)Testosterona sérica e doença cardiovascular em homens(Sociedade Brasileira de Endocrinologia e Metabologia, 2009-11-01) Callou, Emmanuela Quental [UNIFESP]; Sá, Francisco Carleial Feijó de; Guedes, Alexis Dourado [UNIFESP]; Verreschi, Ieda Therezinha do Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Dante Pazzanese de CardiologiaCardiovascular diseases (CVD) represent the main cause of death in Brazil. Men die more of coronary artery disease and they have higher levels of testosterone than women. However, recent studies indicate that androgens can have beneficial and/or neutral effect in the male cardiovascular system. Low levels of endogenous testosterone have been involved with the presence of some components of the metabolic syndrome including dyslipidemia, visceral obesity, hypertension and thrombus formation process. Consistent data on the relationship between testosterone and vascular reactivity, atherosclerosis and cardiovascular mortality in men are rare, with the results of available studies presenting contradictions. Large randomized and prospective trials are needed to evaluate androgen-specific function in male CVD so that better conclusions can be established.
- ItemSomente MetadadadosUltrasonography for the evaluation of visceral fat and cardiovascular risk(Lippincott Williams & Wilkins, 2001-09-01) Ribeiro-Filho, Fernando Flexa [UNIFESP]; Faria, Alessandra Nunes [UNIFESP]; Kohlmann Junior, Osvaldo [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Ribeiro, Artur Beltrame [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.5 +/- 7.7 years with a body mass index of 39.2 +/- 5.4 kg/m(2), were submitted to ultrasonograph and CT scans. Visceral fat measured by ultrasonography, I cm above the umbilical knot, showed a high correlation with CT-determined visceral fat (r=0.67, P <0.0001). The ultrasonograph method showed good reproducibility with an intra-observer variation coefficient of <2%. Both ultrasonograph and CT visceral fat values were correlated with fasting insulin (r=0.29 and r=0.27, P <0.01) and plasma glucose 2 hours after oral glucose load (r=0.22 and r=0.34, P <0.05), indicating that ultrasonography is a useful method to evaluate cardiovascular risk. A significant correlation was also found between visceral fat by CT and serum sodium (r=0.18, P <0.05). A ultrasonograph-determined visceral-to-subcutaneous fat ratio of 2.50 was established as a cutoff value to define patients with abdominal visceral obesity. This value also identified patients with higher levels of plasma glucose, serum insulin and triglycerides and lower levels of HDL-cholesterol, which are metabolic abnormalities characteristic of the metabolic syndrome. Our data demonstrate that ultrasonography is a precise and reliable method for evaluation of visceral fat and identification of patients with adverse metabolic profile.