Showing papers by "Raul D. Santos published in 2009"
TL;DR: Prospective studies are necessary to show that reduction of uric acid levels prevent cardiovascular events, as studies have clearly shown an association between increased uric Acid concentrations with oxidative stress, endothelial dysfunction, inflammation, subclinical atherosclerosis and an increased risk of cardiovascular events.
346 citations
TL;DR: Although there is room for improvement, particularly in very-high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago.
Abstract: Background— Information about physicians’ adherence to cholesterol management guidelines remains scant. The present survey updates our knowledge of lipid management worldwide. Methods and Results— Lipid levels were determined at enrollment in dyslipidemic adult patients on stable lipid-lowering therapy in 9 countries. The primary end point was the success rate, defined as the proportion of patients achieving appropriate low-density lipoprotein cholesterol (LDL-C) goals for their given risk. The mean age of the 9955 evaluable patients was 62±12 years; 54% were male. Coronary disease and diabetes mellitus had been diagnosed in 30% and 31%, respectively, and 14% were current smokers. Current treatment consisted of a statin in 75%. The proportion of patients achieving LDL-C goals according to relevant national guidelines ranged from 47% to 84% across countries. In low-, moderate-, and high-risk groups, mean LDL-C was 119, 109, and 91 mg/dL and mean high-density lipoprotein cholesterol was 62, 49, and 50 mg/dL...
290 citations
TL;DR: A obesidade determinou uma maior chance of se detectar a dislipidemia e a hipertensao quando comparada with os demais grupos no Brasil.
54 citations
TL;DR: Assessment of subclinical atherosclerosis should be considered in persons judged to be at intermediate risk by Framingham score, because test results may influence risk stratification and, consequently, the intensity of therapeutic intervention.
51 citations
TL;DR: In this article, a coleta sistematizada of dados antropometricos (peso, altura, cintura, indice de massa corporal e niveis pressoricos) e dosagens de glicose, colesterol (total e fracoes), acido urico and apolipoproteina A e B, em uma amostra aleatoria, representativa de escolares da rede publica de Itapetininga-SP, was presented.
Abstract: FUNDAMENTO: A escassez de dados sobre a obesidade infantil e o risco cardiovascular no Brasil. OBJETIVO: Determinar a prevalencia de hipertensao, dislipidemia, obesidade e suas correlacoes em uma amostra de escolares de Itapetininga-SP. METODOS: Corte transversal com coleta sistematizada de dados antropometricos (peso, altura, cintura, indice de massa corporal e niveis pressoricos) e dosagens de glicose, colesterol (total e fracoes), acido urico e apolipoproteina A e B, em uma amostra aleatoria, representativa de escolares da rede publica de Itapetininga-SP. Analise dos dados utilizando parâmetros populacionais das curvas do NCHS(2000), categorias de pressao arterial do NHBPEP(2004) e categorias dos niveis sericos de colesterol propostos pela AHA para criancas e adolescentes(2003). RESULTADOS: Um total de 494 criancas e adolescentes participaram do estudo. Dos participantes, 11,7% apresentaram HAS, 51% apresentaram aumento do colesterol total, 40,5% apresentaram aumento do LDL-colesterol, 8,5% apresentaram aumento dos triglicerides e 6,1% tiveram valores baixos de HDL-colesterol. As medias (±desvio padrao) do CT, HDL-colesterol, LDL-colesterol e triglicerides foram respectivamente 172,1(27,9), 48,1(10,0), 105,7(23,1) e 90,9(43,8). A obesidade e o sobrepeso foram detectados em 12,8% e 9,7% da amostra, sendo que a obesidade determinou uma maior chance de se detectar a dislipidemia e a hipertensao quando comparada com os demais grupos. CONCLUSAO: Este estudo fornece subsidios para a hipotese de uma distinta prevalencia de excesso de peso entre escolares da rede publica das regioes nordeste e sudeste, maior nesta ultima. Adicionalmente, demonstra uma associacao da obesidade com a dislipidemia e a hipertensao naquele grupo. Diante da incipiencia de dados no Brasil sobre a questao estudada, o nosso trabalho fornece dados importantes para futuras comparacoes.
45 citations
TL;DR: Cholesterol treatment has improved substantially since the original L-TAP a decade ago, however, high-risk women are undertreated compared to men, and a substantial opportunity remains to reduce their cardiovascular risk.
39 citations
TL;DR: Non-HDL-C goal attainment lagged behind LDL-C goals attainment; this gap was greatest in higher-risk patients, and rates of failure were highest in Latin America.
37 citations
TL;DR: In this article, a composicao de acidos graxos of alguns alimentos industrializados disponiveis no mercado brasileiro is analyzed.
Abstract: OBJETIVO: Avaliar a composicao de acidos graxos de alguns alimentos industrializados disponiveis no mercado brasileiro nos quais houve reducao da quantidade de acidos graxos trans. Verificar tambem se estes alimentos atendem as quantidades recomendadas de consumo de gordura saturada, apos reducao de gordura trans. METODOS: Alimentos industrializados (margarina cremosa A e B, margarina com fitosterol, biscoito doce recheado, biscoito salgado sem recheio, batata frita e lanche com hamburguer de fast food multinacional com alegacao de 0% de gordura trans foram adquiridos em pontos comerciais e analisados em cromatografo gasoso. RESULTADOS: Apesar da reducao nas quantidades de acidos graxos trans, os alimentos analisados contem grandes quantidades de gorduras saturadas principalmente o acido palmitico. Alem disso, alguns dos alimentos estudados apresentam uma razao n-3/n-6 fora do recomendado para a prevencao da aterosclerose. CONCLUSAO: O consumo irrestrito desses alimentos tem forte potencial deleterio para a saude. O rotulo de ausencia de acidos graxos trans deve ser visto com cuidado e nao significa uma liberacao para o consumo irrestrito desses alimentos.
31 citations
TL;DR: It is suggested that D9N polymorphism can be a useful risk marker for myocardial infarction and that further potential candidate genes should be screened for exploratory analysis and for future therapeutic intervention in diabetes.
26 citations
TL;DR: This study supports the hypothesis of different prevalences of excess weight among school children from the public education system of the northeastern and southeastern regions of Brazil, with higher rates in the latter, and demonstrates an association of obesity with dyslipidemia and hypertension in that group.
Abstract: Background Paucity of data on childhood obesity and cardiovascular risk in Brazil. Objective To determine the prevalence of hypertension, dyslipidemia, obesity and their correlations in a sample of school children in Itapetininga, State of Sao Paulo, Brazil. Methods Cross-sectional study with systematic collection of anthropometric data (weight, height, waist circumference, BMI and blood pressure levels) and determination of glucose, total cholesterol, LDL, HDL, uric acid, and apolipoproteins A and B in a random sample representative of school children from the public education system in Itapetininga, State of Sao Paulo. For data analysis, we used population parameters from the NCHS curves (2000), blood pressure categories from NHBPEP (2004), and the serum cholesterol levels proposed by the AHA for children and adolescents (2003). Results A total of 494 children and adolescents participated in the study. Of these, 11.7% had HBP, 51% increased total cholesterol, 40.5% increased LDL-cholesterol, 8.5% increased triglycerides, and 6.1% low HDL-cholesterol levels. Mean (+/- standard deviation) TC, HDL-cholesterol, LDL-cholesterol and triglycerides were 172.1(27.9), 48.1(10.0), 105.7(23.1) and 90.9(43.8), respectively. Obesity and overweight were detected in 12.8% and 9.7% of the sample, respectively. Individuals of the obese group had a greater chance of presenting with dyslipidemia and hypertension in comparison with those of the other groups. Conclusion This study supports the hypothesis of different prevalences of excess weight among school children from the public education system of the northeastern and southeastern regions of Brazil, with higher rates in the latter. Additionally, it demonstrates an association of obesity with dyslipidemia and hypertension in that group. In light of the paucity of Brazilian data on this issue, our study provides important data for further comparisons.
26 citations
TL;DR: A post hoc analysis of the Bezafibrate Infarction Prevention trial suggests that increased SUA is an independent marker of cardiovascular disease even for subjects at an already higher risk of event recurrence.
Abstract: Many cross-sectional, retrospective and most importantly prospective studies have found a graded and continuous association between SUA with subclinical and clinical atherosclerotic disease [3–6] . However, not all studies were able to separate the effect of SUA on clinical events from confounders, such as hypertension, diuretic use, the metabolic syndrome and especially renal failure [7] . In this issue of Cardiology , Brodov et al. [8] evaluated in a post hoc analysis the association of SUA and renal dysfunction (estimated glomerular filtration rate ! 60 ml/min) with myocardial infarction and sudden cardiac death in 2,796 subjects who had previously been enrolled in the Bezafibrate Infarction Prevention (BIP) study. The BIP study was a prospective trial that tested the effects of bezafibrate on the recurrence of coronary events and death in secondary prevention subjects. The authors found that SUA levels within the fifth quintile of distribution, e.g. 1 6.76 mg/dl, were associated with approximately a 50% greater chance of dying or having a myocardial infarction after adjustment for renal function and for the components that characterize the metabolic syndrome. This subanalysis of the BIP trial suggests that increased SUA is an independent marker of cardiovascular disease even for subjects at an already higher risk of event recurrence. Brodov et al. [8] add further evidence of the link between SUA and cardiovascular disease. However, Recently, a huge wave of new laboratory and imaging biomarkers for cardiovascular disease risk prediction has swamped preventive cardiology [1, 2] . There has been a lot of discussion on whether the use of tests such as C-reactive protein, lipoprotein-associated phospholipase 2 or coronary calcium scores determined by cardiac computerized tomography add prognostic value and show costeffectiveness in comparison to clinical risk stratification. The association of serum uric acid (SUA), a biomarker known since the 19th century, with gout, cardiovascular risk factors, and coronary disease is crystal clear [3] . Historically, this relationship evolved from the classic descriptions of gout attacks to the more recent definition of the metabolic syndrome. Despite recent genome-wide studies associating SUA concentration with a few single nucleotide polymorphisms in Caucasian and black individuals that affect renal tubular handling of uric acid [4] , increased SUA concentration is frequently associated with hypertension, atherogenic dyslipidemia, diabetes, diuretic use, alcohol consumption and renal failure [3] . All the conditions previously cited, maybe with the exception of diuretic use, predispose to atherosclerosis. On the other hand, SUA may be proatherogenic per se since studies have associated SUA concentrations with increased oxidative stress, endothelial dysfunction, inflammation and hyperinsulinemia. Received: July 10, 2009 Accepted: July 10, 2009 Published online: September 23, 2009
TL;DR: Comparing the association of subclinical atherosclerosis and inflammation with 3 definitions of metabolic syndrome in 458 asymptomatic men found that MS is associated with increased subclinical coronary artery calcification and inflammation irrespective of various definitions.
Abstract: A number of metabolic syndrome (MS) definitions exist, and one's cardiovascular disease risk may depend on the definition used. The authors compared the association of subclinical atherosclerosis (coronary artery calcification [CAC] score >0] and inflammation (white blood cell [WBC] count greater than or equal to the highest quartile) with 3 definitions of MS (those of the National Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III], the American Heart Association/National Heart, Lung and Blood Institute [AHA/NHLBI], and the International Diabetes Federation [IDF]) in 458 asymptomatic men (mean age, 46+/-7 years). MS was present in 28%, 29%, and 34% according to NCEP ATP III, AHA/NHLBI, and IDF criteria, respectively. CAC was observed in 40% and high WBC count in 24%. After adjustment for age, smoking, and low-density lipoprotein cholesterol, the odds ratios for CAC scores >0 with MS by NCEP ATP III, AHA/NHLBI, and IDF definitions were 1.67 (95% confidence interval [CI], 1.02-2.72), 1.67 (95% CI, 1.03-2.70), and 1.63 (95% CI, 1.03-2.57), respectively. The multivariate odds ratios for high WBC count with MS by NCEP ATP III, AHA/NHLBI, and IDF definitions were 1.69 (95% CI, 1.04-2.73), 1.84 (95% CI, 1.14-2.95), and 1.66 (95% CI, 1.05-2.62), respectively. MS is associated with increased subclinical atherosclerosis and inflammation irrespective of various definitions.