Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017.
TL;DR: Aterosclerose, e reconhecendo a necessidade de atualizacao de sua ultima diretriz, publicada em 2013, em conformidade com as recomendacoes da SBC, reuniu um comite de especialistas, da clinica e do laboratorio clinico, a partir de janeiro de 2016, for a elaboracao deste documento as discussed by the authors.
Abstract: MENSAGEM DOS COORDENADORES Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia (SBC), acompanhando o amplo cenario de publicacoes cientificas sobre o tratamento das dislipidemias e prevencao da aterosclerose, bem como a importância de seu impacto sobre o risco cardiovascular, e reconhecendo a necessidade de atualizacao de sua ultima diretriz, publicada em 2013, em conformidade com as recomendacoes da SBC, reuniu um comite de especialistas, da clinica e do laboratorio clinico, a partir de janeiro de 2016, para a elaboracao deste [...]
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TL;DR: The TyG index was positively associated with a higher prevalence of symptomatic CAD, with metabolic and behavioral risk factors, and could be used as a marker for atherosclerosis.
Abstract: The triglyceride-glucose index (TyG index) is a tool for insulin resistance evaluation, however, little is known about its association with coronary artery disease (CAD), which is the major cardiovascular death cause, and what factors may be associated with TyG index. To evaluate the association between the TyG index and the prevalence of CAD phases, as well as cardiovascular risk factors. The baseline data of patients in secondary care in cardiology from Brazilian Cardioprotective Nutritional Program Trial (BALANCE Program Trial) were analyzed. Anthropometric, clinical, socio-demographic and food consumption data were collected by trained professionals. The TyG index was calculated by the formula: Ln (fasting triglycerides (mg/dl) × fasting blood glucose (mg/dl)/2) and regression models were used to evaluate the associations. We evaluated 2330 patients, which the majority was male (58.1%) and elderly (62.1%). The prevalence of symptomatic CAD was 1.16 times higher in patients classified in the last tertile of the TyG index (9.9 ± 0.5) compared to those in the first tertile (8.3 ± 0.3). Cardiometabolic risk factors were associated with TyG index, with the highlight for higher carbohydrate and lower lipid consumption in relation to recommendations that reduced the chance of being in the last TyG index tertile. The TyG index was positively associated with a higher prevalence of symptomatic CAD, with metabolic and behavioral risk factors, and could be used as a marker for atherosclerosis. Trial registration ClinicalTrials.gov identifier: NCT01620398. Registered 15 June, 2012
107 citations
Cites background from "Atualização da Diretriz Brasileira ..."
...Both macronutrients when consumed in excess are associated with increased serum TG [37]; however, we found that consumption below the recommended lipid level and above the recommended carbohydrate level reduced the chances of being ranked in the highest tertile of TyG index....
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TL;DR: In this article, a soybean beverage fermented with kefir grains and supplemented with inulin was developed, which had a slightly yellow color, with positive values in the b* parameter.
Abstract: The demand for the development of beverages based on fermented soybeans for the market has increased in recent years. The objective of this work was to develop a soybean beverage fermented with kefir grains and supplemented with inulin. The fermentation conditions were optimized as follows: a ratio of 4 g:100 mL of kefir grains:soymilk, a soymilk concentration of 9°Brix and a fermentation time of 12 h. This formulation was supplemented with 3.5% (m/v) inulin and evaluated at 7 °C for 28 days. The beverage had a slightly yellow color, with positive values in the b* parameter. The firmness and syneresis of the beverages were higher when inulin was used. The use of inulin also decreased sedimentation in the beverages. At 28 days of storage, the cell count (Lactococcus, Lactobacillus and yeasts) was higher than 107 CFU/mL for both treatments. Soymilk was shown to be a good substrate for fermentation using kefir grains. The addition of inulin to the fermented soymilk efficiently maintained the microorganisms and increased sensory acceptability after 14 days of storage.
52 citations
TL;DR: A CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices.
Abstract: Background: Despite being an important cardiovascular risk factor, hypertension has low control levels worldwide. Computerized clinical decision support systems (CDSSs) might be effective in reducing blood pressure with a potential impact in reducing cardiovascular risk. Objective: The goal of the research was to evaluate the feasibility, usability, and utility of a CDSS, TeleHAS (tele–hipertensao arterial sistemica, or arterial hypertension system), in the care of patients with hypertension in the context of a primary care setting in a middle-income country. Methods: The TeleHAS app consists of a platform integrating clinical and laboratory data on a particular patient, from which it performs cardiovascular risk calculation and provides evidence-based recommendations derived from Brazilian and international guidelines for the management of hypertension and cardiovascular risk. Ten family physicians from different primary care units in the city of Montes Claros, Brazil, were randomly selected to use the CDSS for the care of hypertensive patients for 6 months. After 3 and 6 months, the feasibility, usability, and utility of the CDSS in the routine care of the health team was evaluated through a standardized questionnaire and semistructured interviews. Results: Throughout the study, clinicians registered 535 patients with hypertension, at an average of 1.24 consultations per patient. Women accounted for 80% (8/10) of participant doctors, median age was 31.5 years (interquartile range 27 to 59 years). As for feasibility, 100% of medical users claimed it was possible to use the app in the primary care setting, and for 80% (8/10) of them it was easy to incorporate its use into the daily routine and home visits. Nevertheless, 70% (7/10) of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated TeleHAS as good (8/10, 80% of users), with easy completion and friendly interface (10/10, 100%) and the potential to improve patients’ treatment (10/10, 100%). A total of 90% (9/10) of physicians had access to new knowledge about cardiovascular risk and hypertension through the app recommendations and found it useful to promote prevention and optimize treatment. Conclusions: In this study, a CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices.
36 citations
Cites background from "Atualização da Diretriz Brasileira ..."
...Brazilian guidelines also recommend the systematic assessment of cardiovascular risk during hypertension management and the use of statins if needed [8]....
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...Despite Brazilian Society of Cardiology recommendations on the use of multiple risk scores to assess cardiovascular risk and advocacy of the use of a global risk assessment based in the 10-year Framingham heart score risk [8,10], Brazilian physician adherence to its use is poor [11]....
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TL;DR: Although metabolic syndrome has been studied in patients with autonomous cortisol secretion, there are limited data for those with nonfunctioning adrenal incidentaloma (NFAI).
Abstract: CONTEXT Although metabolic syndrome has been studied in patients with autonomous cortisol secretion, there are limited data for those with nonfunctioning adrenal incidentaloma (NFAI) OBJECTIVE To assess metabolic syndrome frequency in NFAI patients and controls without adrenal adenoma according to World Health Organization (WHO), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) and International Diabetes Federation (IDF) criteria DESIGN Retrospective and transversal study PATIENTS Seventy-four NFAI and 90 controls were evaluated NFAI diagnosis was established according to current guidelines The control group was selected based on normal adrenal imaging examinations MEASUREMENTS Subjects were categorized by metabolic syndrome presence according to WHO, NCEP-ATP III, AACE/ACE and IDF RESULTS Age, gender, ethnicity, body mass index, smoking, menopause, statin and fibrate use were comparable between patients and controls The frequency of prediabetes, dyslipidaemia and hypertension as well as waist circumference were significantly higher in the NFAI patients compared to the controls The metabolic syndrome frequency in the NFAI group was significantly higher compared to the normal adrenal group: WHO: 692% × 310% (P < 0001); NCEP-ATP III: 817% × 449% (P < 0001); AACE/ACE: 771% × 319% (P < 0001); IDF: 786% × 455% (P < 0001) Logistic regression analysis showed that NFAI was a predictor of metabolic syndrome according to WHO (P = 0001), NCEP-ATP III (P = 0005) and AACE/ACE (P = 0007) CONCLUSIONS Metabolic syndrome is frequently found in patients with NFAI, and this frequency is higher in NFAI patients than in those with normal adrenal imaging
34 citations
TL;DR: The results confirm that plant sterols are an effective and safe treatment of infantile dyslipidemia and are confirmed in a randomized, double blind, crossover clinical trial.
Abstract: Background and aims Despite evidence of the lipid-lowering effect of plant sterols among adults with hypercholesterolemia, data regarding phytosterol use in children are limited. In this paper, we examined the effects of daily consumption of a phytosterol-enriched milk compound on the lipid profiles of Brazilian children and adolescents with dyslipidemia. Methods and results This was a randomized, double blind, crossover clinical trial. Twenty eight dyslipidemics outpatients (aged 6–9 years) from an University Hospital were randomly allocated to control or intervention group. The intervention group received milk enriched with 1.2 g/day of plant sterol and the control group received the equivalent amount of skim milk during the period of 8 weeks. Changes from baseline in the mean lipid profile, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) concentrations. Serum lipid profiles, glucose levels, dietary and anthropometric data were determined at weeks 0, 4, 8, 16, and 20. Details regarding the safety and tolerance of phytosterol were obtained, using an open-ended questionnaire. Intention-to-treat analysis were performed, using the proc mixed procedure in SAS. After 8 weeks, the mean concentrations of TC and LDL-C were significantly reduced in the intervention group as compared to the control group with reductions of 5.9% (p = 0.09) and 10.2% (p = 0.002), respectively. In addition, TG concentrations were reduced by 19.7% (p = 0.09). No serious side effects were reported during the study. Conclusion Our results confirm that plant sterols are an effective and safe treatment of infantile dyslipidemia. Trial registration RBR-3h7f9k.
30 citations
References
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TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Abstract: Background Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. Methods We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter and maintenance of glucose at a level between 180 and 200 mg per deciliter). Results At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The ...
8,748 citations
TL;DR: The goals of this new consensus are to provide an abbreviated document to focus on key aspects of diagnosis and management, and to update the information based on new publications and the newer guidelines, but not to add an extensive list of references.
7,099 citations
TL;DR: This document summarizes current research, plans, and recommendations for future research, as well as providing a history of the field and some of the techniques used, currently in use, at the National Institutes of Health.
Abstract: Jeffrey L. Anderson, MD, FACC, FAHA, Chair
Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect
Nancy M. Albert, PhD, RN, FAHA
Biykem Bozkurt, MD, PhD, FACC, FAHA
Ralph G. Brindis, MD, MPH, MACC
Mark A. Creager, MD, FACC, FAHA[#][1]
Lesley H. Curtis, PhD, FAHA
David DeMets, PhD[#][1]
Robert A
6,967 citations
TL;DR: Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that …
Abstract: ACCF
: American College of Cardiology Foundation
ACS
: acute coronary syndrome
AHA
: American Heart Association
CAD
: coronary artery disease
CABG
: coronary artery bypass grafting
CKMB
: creatine kinase MB isoform
cTn
: cardiac troponin
CT
: computed tomography
CV
: coefficient of variation
ECG
: electrocardiogram
ESC
: European Society of Cardiology
FDG
: fluorodeoxyglucose
h
: hour(s)
HF
: heart failure
LBBB
: left bundle branch block
LV
: left ventricle
LVH
: left ventricular hypertrophy
MI
: myocardial infarction
mIBG
: meta-iodo-benzylguanidine
min
: minute(s)
MONICA
: Multinational MONItoring of trends and determinants in CArdiovascular disease)
MPS
: myocardial perfusion scintigraphy
MRI
: magnetic resonance imaging
mV
: millivolt(s)
ng/L
: nanogram(s) per litre
Non-Q MI
: non-Q wave myocardial infarction
NSTEMI
: non-ST-elevation myocardial infarction
PCI
: percutaneous coronary intervention
PET
: positron emission tomography
pg/mL
: pictogram(s) per millilitre
Q wave MI
: Q wave myocardial infarction
RBBB
: right bundle branch block
sec
: second(s)
SPECT
: single photon emission computed tomography
STEMI
: ST elevation myocardial infarction
ST–T
: ST-segment –T wave
URL
: upper reference limit
WHF
: World Heart Federation
WHO
: World Health Organization
Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that …
6,659 citations
TL;DR: In patients with severe aortic stenosis who were not suitable candidates for surgery, TAVI, as compared with standard therapy, significantly reduced the rates of death from any cause, the composite end point of deathFrom any cause or repeat hospitalization, and cardiac symptoms, despite the higher incidence of major strokes and major vascular events.
Abstract: Background Many patients with severe aortic stenosis and coexisting conditions are not candi dates for surgical replacement of the aortic valve. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for high-risk patients with aortic stenosis. Methods We randomly assigned patients with severe aortic stenosis, whom surgeons considered not to be suitable candidates for surgery, to standard therapy (including balloon aortic valvuloplasty) or transfemoral transcatheter implantation of a balloon-expandable bovine pericardial valve. The primary end point was the rate of death from any cause. Results A total of 358 patients with aortic stenosis who were not considered to be suitable candidates for surgery underwent randomization at 21 centers (17 in the United States). At 1 year, the rate of death from any cause (Kaplan–Meier analysis) was 30.7% with TAVI, as compared with 50.7% with standard therapy (hazard ratio with TAVI, 0.55; 95% confidence interval [CI], 0.40 to 0.74; P<0.001). The rate of the composite end point of death from any cause or repeat hospitalization was 42.5% with TAVI as com pared with 71.6% with standard therapy (hazard ratio, 0.46; 95% CI, 0.35 to 0.59; P<0.001). Among survivors at 1 year, the rate of cardiac symptoms (New York Heart Association class III or IV) was lower among patients who had undergone TAVI than among those who had received standard therapy (25.2% vs. 58.0%, P<0.001). At 30 days, TAVI, as compared with standard therapy, was associated with a higher incidence of major strokes (5.0% vs. 1.1%, P = 0.06) and major vascular complications (16.2% vs. 1.1%, P<0.001). In the year after TAVI, there was no deterioration in the functioning of the bioprosthetic valve, as assessed by evidence of stenosis or regurgitation on an echocardiogram. Conclusions In patients with severe aortic stenosis who were not suitable candidates for surgery, TAVI, as compared with standard therapy, significantly reduced the rates of death from any cause, the composite end point of death from any cause or repeat hospitalization, and cardiac symptoms, despite the higher incidence of major strokes and major vascular events. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.)
6,225 citations