1
|
Marcadenti A, Machado RHV, Santos RHN, Kasai CCDS, Kovacs C, Bello A, de Matos CH, Bertacco RTA, Souza GC, Schirmann GDS, Nagano FEZ, Poloni S, Kik RME, Feres NH, Rodrigues IG, Sousa ACS, Pinheiro JMF, Vasconcelos SML, Carlos DMDO, Souza VS, Gomes AB, Figueiredo Neto JAD, Moriguchi EH, Izar MC, Pinto SL, Bressan J, de Souza SR, Kumbier MC, de Araújo CBP, Torreglosa CR, Weber B, Bersch-Ferreira ÂC. Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention. Arq Bras Cardiol 2024; 121:e20230487. [PMID: 38597553 DOI: 10.36660/abc.20230487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/13/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases. OBJECTIVE To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence. METHODS Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis. RESULTS No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions. CONCLUSIONS Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.
Collapse
Affiliation(s)
| | | | | | | | - Cristiane Kovacs
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - Annie Bello
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | | | | | - Gabriela C Souza
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | - Soraia Poloni
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
| | - Raquel Milani El Kik
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | - Isa G Rodrigues
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife, PE - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Magali C Kumbier
- Consultoria Terapia Nutricional - COTENUT, Porto Alegre, RS - Brasil
| | | | | | - Bernardete Weber
- Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, SP - Brasil
| | | |
Collapse
|
2
|
Fonseca HAR, Bittencourt CR, Monteiro AM, Fonseca FA, Sanches LR, Ferreira CEDS, Neto AMF, Gidlund M, Izar MC. Immunometabolic and Vascular Health Responses among High Endurance Trained Subjects. Int J Sports Med 2024; 45:245-252. [PMID: 37793434 DOI: 10.1055/a-2186-2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
In this study, we aimed to examine the impact of high endurance training on vascular health parameters and immune-endocrine responses against modified low-density lipoprotein (LDL) particles. This observational, cross-sectional study included high endurance-trained and healthy non-trained subjects. Vascular ultrasound was used to assess vascular health parameters based on carotid intima-media thickness and endothelial function (flow-mediated dilation). Enzyme-linked immunosorbent assays were used to measure interleukin (IL)-8 and IL-10, autoantibody isotypes anti-oxidized LDL (oxLDL) and anti-apolipoprotein B (ApoB-D) peptide. Plasma levels of the corticosterone and 17 α-hydroxyprogesterone hormones were analyzed by mass spectrometry. This study enrolled 96 subjects, of whom 44 were high endurance trained and 52 were healthy non-trained individuals. Smaller carotid intima-media thickness values were observed in the high-endurance trained than in the healthy non-trained males, while no differences were observed between female groups. Flow-mediated dilation measurements did not differ by training or sex. The humoral immune responses to IgG anti-oxLDL and IgM anti-ApoB-D autoantibodies showed an isotype imbalance between the high-endurance trained and the non-trained groups. Immunoendocrine parameters showed inverse correlations between 17 α-hydroxyprogesterone concentrations and carotid intima-media thickness measurements. Direct correlations were found between IL-10 concentrations and flow-mediated dilation measurements. Chronic high-endurance exercise modulates immune-endocrine and vascular health parameters, in a sex-dependent manner.
Collapse
Affiliation(s)
- Henrique A R Fonseca
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
- Department of Immunology, Institute Biomedical Science IV, University of Sao Paulo, São Paulo, SP, Brazil
- National Institute of Technology in Complex Fluids, Physics Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Celia Regina Bittencourt
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Andrea Moreira Monteiro
- Department of Immunology, Institute Biomedical Science IV, University of Sao Paulo, São Paulo, SP, Brazil
- National Institute of Technology in Complex Fluids, Physics Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | - Francisco Antonio Fonseca
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
- National Institute of Technology in Complex Fluids, Physics Institute, University of Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | - Magnus Gidlund
- Department of Immunology, Institute Biomedical Science IV, University of Sao Paulo, São Paulo, SP, Brazil
| | - Maria Cristina Izar
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
- National Institute of Technology in Complex Fluids, Physics Institute, University of Sao Paulo, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Alves JM, Germano DB, Kim YJ, Fonseca FAH, Izar MC, Tuleta ID, Nagai R, Novo NF, Juliano Y, Neves LM, Pallos D, França CN. Modulation of monocyte subtypes in diabetes after non-surgical periodontal treatment. Clin Oral Investig 2023; 27:6847-6854. [PMID: 37843636 DOI: 10.1007/s00784-023-05299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES The current study aims to evaluate the effect of non-surgical periodontal treatment on the modulation of monocyte phenotype, in the presence or absence of diabetes. MATERIALS AND METHODS The identification, quantification, and phenotypic characterization of monocyte subtypes (classical, intermediate, and non-classical) were performed by flow cytometry, at baseline and 1 month after the end of non-surgical periodontal treatment, in patients with periodontitis, associated or not with diabetes. RESULTS There was an increase in non-classical monocytes after treatment and a reduction in intermediate monocytes, without differences for the classical subtype, regardless of the diabetes status. Furthermore, there was a reduction in intermediate monocytes and an increase in non-classical and classical monocytes after treatment in the diabetes group, while no significant differences were observed for classical, intermediate, and non-classical monocytes in the group without diabetes. Comparisons between the two groups showed significant differences for classical, intermediate, and non-classical monocytes at baseline; these differences were not found one month after treatment. CONCLUSIONS Non-surgical periodontal treatment leads to modulation of monocytes to a less inflammatory phenotype, especially in individuals with diabetes. CLINICAL RELEVANCE A better understanding of the role of these biomarkers in the periodontitis contex may constitute a new strategic target for a better treatment of patiens with diabetes associated to periodontitis. CLINICAL TRIAL REGISTRATION Brazilian Registry of Clinical Trials-RBR-35szwc. Jhefferson Miranda Alves and Danielle Borges Germano contributed equality to this study and should be considered first authors.
Collapse
Affiliation(s)
- Jhefferson Miranda Alves
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil
| | - Danielle Borges Germano
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil
| | - Yeon Jung Kim
- Post Graduation Program in Odontology, Santo Amaro University, Sao Paulo, Brazil
| | | | - Maria Cristina Izar
- Department of Medicine, Federal University of Sao Paulo, Cardiology Division, Sao Paulo, Brazil
| | | | - Rogério Nagai
- Post Graduation Program in Odontology, Santo Amaro University, Sao Paulo, Brazil
| | - Neil Ferreira Novo
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil
| | - Yára Juliano
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil
| | - Lucas Melo Neves
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil
| | - Débora Pallos
- Post Graduation Program in Odontology, Santo Amaro University, Sao Paulo, Brazil
| | - Carolina Nunes França
- Post Graduation Program in Health Sciences, Santo Amaro University, Professor Eneas de Siqueira Neto Street, 340, Jardim das Imbuias, Sao Paulo, SP, 04829-300, Brazil.
| |
Collapse
|
4
|
Palmeira NGF, Bianco HT, Bombig MTN, Povoa FF, Fonseca FAH, Izar MC, Thalenberg JM, Luna B, Marui F, Fischer SM, Amodeo C, de Souza DDSM, Povoa R. Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients. Arq Bras Cardiol 2023; 120:e20230050. [PMID: 37820172 PMCID: PMC10519347 DOI: 10.36660/abc.20230050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. OBJECTIVE To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. METHODS A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. RESULTS A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. CONCLUSION High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.
Collapse
Affiliation(s)
- Natascha Gonçalves Francisco Palmeira
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Henrique Tria Bianco
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | | | - Fernando Focaccia Povoa
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Francisco A. H. Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - José Marcos Thalenberg
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Braulio Luna
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Fabiane Marui
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Simone Matheus Fischer
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Celso Amodeo
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | | | - Rui Povoa
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| |
Collapse
|
5
|
Brito L, Sahade V, Weber B, Bersch-Ferreira ÂC, Marcadenti A, Torreglosa C, Kovacs C, Moreira ASB, Torres RDS, Marinho H, Matos C, Abib R, Souza GC, Shirmann GDS, Nagano FEZ, Ramos MEM, Poloni S, El Kik RM, Feres NH, Dutra ES, Ferreira Carvalho APP, David MM, Galvão I, Sousa ACS, Dantas CDF, Gonçalves A, Pinheiro JMF, Vasconcelos SML, Penafort A, de Oliveira Carlos DM, Luna A, Neto JADF, Dias L, Moriguchi EH, Bruscato N, Izar MC, Lopes S, Backes LM, Bressan J, Raimondi S, Kumbier M, Daltro C. Factors associated with diet quality among Brazilian individuals with cardiovascular diseases. J Hum Nutr Diet 2023; 36:1713-1726. [PMID: 37283442 DOI: 10.1111/jhn.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
Collapse
Affiliation(s)
- Luciana Brito
- Programa de Pós-Graduação em Medicina e Saúde da UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Empresa Brasileira de Serviços Hospitalares (EBSERH), Salvador, Bahia, Brazil
| | - Viviane Sahade
- Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazil
| | | | | | | | | | | | - Annie Seixas Bello Moreira
- Instituto Nacional de Cardiologia (INC), Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Helyde Marinho
- Instituto Nacional de Pesquisas da Amazônia, Hospital Universitário Francisca Mendes, Manaus, Amazonas, Brazil
| | - Cristina Matos
- Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Renata Abib
- Hospital Escola da Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | | | - Soraia Poloni
- Instituto de Cardiologia-Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil
| | - Raquel Milani El Kik
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Eliane Said Dutra
- Hospital Universitário de Brasília, Brasília, Distrito Federal, Brazil
| | | | - Marta Marques David
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Isa Galvão
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Amanda Gonçalves
- Hospital Universitário Alcides Carneiro, Campina Grande, Paraíba, Brazil
| | | | | | - Andreza Penafort
- Universidade de Fortaleza (UNIFOR) and Núcleo de Atenção Médica Integrada (NAMI) da Fundação Edson Queiroz, Fortaleza, Ceará, Brazil
| | | | - Adriana Luna
- Hospital Universitário da Fundação da Universidade Federal de Sergipe (FUFSE), Aracaju, Sergipe, Brazil
| | | | - Luciana Dias
- Hospital Universitário Presidente Dutra do Maranhão, Universidade Federal, São Luiz, Maranhão, Brazil
| | | | - Neide Bruscato
- Associação Veranense de Assistência em Saúde, Veranópolis, Rio Grande do Sul, Brazil
| | - Maria Cristina Izar
- Ambulatório de Lípides, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sonia Lopes
- Universidade Federal Tocantins, Palmas, Tocantins, Brazil
| | | | | | - Simone Raimondi
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, Brazil
| | | | - Carla Daltro
- Programa de Pós-Graduação em Medicina e Saúde da UFBA, Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazil
| |
Collapse
|
6
|
Fonseca FAH, Izar MC. Could Patients At Low Cardiovascular Risk Be Better Stratified? Arq Bras Cardiol 2023; 120:e20230310. [PMID: 37466491 PMCID: PMC10364996 DOI: 10.36660/abc.20230310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Francisco Antonio Helfenstein Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo – Medicina, São Paulo, SP – Brasil
| |
Collapse
|
7
|
Bacchin AS, Fonseca FAH, Povoa R, Szarf G, Pinto IM, Caixeta AM, Teixeira D, Maugeri IL, Ishimura ME, Coste MER, Bianco HT, França CN, Izar MC. Pharmacoinvasive Strategy in Elderly Up to 75 Years or Non-Elderly: Analysis of Biochemical and Cardiac Magnetic Resonance Imaging Parameters. Arq Bras Cardiol 2022; 120:e20220177. [PMID: 36629600 PMCID: PMC9833293 DOI: 10.36660/abc.20220177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pharmacoinvasive strategy is an alternative when primary percutaneous coronary intervention (PCI) is not feasible. OBJECTIVES This study aimed to evaluate the effects of early pharmacoinvasive strategy on the infarct size and left ventricular ejection fraction in elderly and non-elderly patients. The role of inflammatory markers was also examined. METHODS Patients (n=223) with ST segment elevation myocardial infarction (STEMI) were prospectively included and submitted to pharmacological thrombolysis in the first six hours, and underwent coronary angiogram and PCI when necessary, in the first 24 hours. Blood samples were collected in the first day (D1) and after 30 days (D30). Cardiac magnetic resonance imaging (cMRI) was performed at D30. Significance was set at p<0.05. RESULTS Elderly and non-elderly patients showed similar percentage of infarcted mass (13.7 [6.9-17.0] vs. 14.0 [7.3-26.0], respectively, p=0.13) (median [interquartile range]). However, elderly patients had better left ventricular ejection fraction (53 [45-62] vs. 49 [39-58], p=0.025). Titers of interleukin (IL)1beta, IL-4, IL-6, and IL-10 did not differ between D1 and D30, but elderly patients had higher titers for IL-18 at D1 and D30. Absolute numbers of B and T lymphocytes were similar in both groups at D1 and D30, but elderly patients had higher neutrophil/lymphocyte ratio at D30. Multivariate linear regression analysis of cMRI outcomes in the whole population showed that the independent predictors were not different between elderly and non-elderly patients. CONCLUSION Pharmacoinvasive strategy in elderly patients was associated with small differences in inflammatory parameters, similar infarct size and better left ventricular function than non-elderly patients.
Collapse
Affiliation(s)
- Amanda S. Bacchin
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Francisco A. H. Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSantana de ParnaíbaSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo, Santana de Parnaíba, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Gilberto Szarf
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Ibraim Masciarelli Pinto
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia – Cardiovascular CT/MR, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Daniela Teixeira
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Ieda Longo Maugeri
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Mayari E. Ishimura
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Maria E. R. Coste
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Henrique Tria Bianco
- Escola Paulista de MedicinaUniversidade Federal de São PauloSantana de ParnaíbaSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo, Santana de Parnaíba, SP – Brasil
| | - Carolina N. França
- Universidade de Santo AmaroSão PauloSPBrasilUniversidade de Santo Amaro – Pós-Graduação, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| |
Collapse
|
8
|
Bianco HT, Povoa R, Izar MC, Alves CMR, Barbosa AHP, Bombig MTN, Gonçalves I, Luna B, Aguirre AC, Moraes PIDM, Almeida D, Moreira FT, Povoa FF, Stefanini E, Caixeta AM, Bacchin AS, Moisés VA, Fonseca FA. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol 2022; 119:691-702. [PMID: 36453760 PMCID: PMC9750212 DOI: 10.36660/abc.20211055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/15/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. OBJECTIVES To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. METHODS Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. RESULTS Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. CONCLUSION Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.
Collapse
Affiliation(s)
- Henrique Tria Bianco
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Claudia Maria Rodrigues Alves
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Henrique Pereira Barbosa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Maria Teresa Nogueira Bombig
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Iran Gonçalves
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Bráulio Luna
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Ana Caroline Aguirre
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Pedro Ivo de Marqui Moraes
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Dirceu Almeida
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Flávio Tocci Moreira
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Fernando Focaccia Povoa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Edson Stefanini
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Amanda S. Bacchin
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Valdir Ambrósio Moisés
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Francisco A.H. Fonseca
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| |
Collapse
|
9
|
Izar MC, Fonseca FAH. Blood Pressure Variability and Cardiovascular Risk in ELSA-Brasil: A Potential Surrogate Marker for Predicting Mortality and Cardiovascular Outcomes? Arq Bras Cardiol 2022; 119:512-513. [PMID: 36287406 PMCID: PMC9563885 DOI: 10.36660/abc.20220525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de Medicina , São Paulo , SP - Brasil
| | - Francisco A H Fonseca
- Universidade Federal de São Paulo Escola Paulista de Medicina , São Paulo , SP - Brasil
| |
Collapse
|
10
|
Santos RD, Lorenzatti A, Corral P, Nogueira JP, Cafferata AM, Aimone D, Lourenço CM, Izar MC, Lima JG, Lottenberg AM, Alonso R, Garay K, Morales AR, Vargas-Uricoechea H, Peña CAC, Roman-González A. Challenges in familial chylomicronemia syndrome diagnosis and management across Latin American countries: An expert panel discussion. J Clin Lipidol 2021; 15:620-624. [PMID: 34920815 DOI: 10.1016/j.jacl.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 02/08/2023]
Abstract
Familial chylomicronemia syndrome (FCS) is a rare genetic disorder characterized by extremely high triglyceride levels due to impaired clearance of chylomicrons from plasma. This paper is the result of a panel discussion with Latin American specialists who raised the main issues on diagnosis and management of FCS in their countries. Overall FCS is diagnosed late on the course of the disease, is characterized by heterogeneity on the occurrence of pancreatitis, and remains a long time in care of different specialists until reaching a lipidologist. Pancreatitis and secondary diabetes are frequently seen, often due to late diagnosis and inadequate care. Molecular diagnosis is unusual; however, loss of function variants on the lipoprotein lipase gene are apparently the most frequent etiology. A founder effect of the glycosylphosphatidylinositol anchored high density lipoprotein binding protein 1 gene has been described in the northeast of Brazil. Low awareness of the disease amongst health professionals contributes to inadequate care and an inadequate patient journey.
Collapse
Affiliation(s)
- Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Avenida Dr. Eneas de Carvalho Aguiar, 44-05403-900, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Alberto Lorenzatti
- Rusculleda Foundation for Research, DAMIC Medical Institute, Cordoba, Argentina
| | - Pablo Corral
- Pharmacology Department, FASTA University, School of Medicine, Mar del Plata, Argentina
| | | | | | | | - Charles M Lourenço
- Centro Universitario Estacio de Ribeirao Preto, Ribeirao Preto, Sao Paulo, Brazil
| | - Maria Cristina Izar
- Lipids, Atherosclerosis, and Vascular Biology Section, Cardiology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Josivan G Lima
- Hospital Universitario Onofre Lopes (HUOL), Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ana Maria Lottenberg
- Laboratorio de Lipides (LIM-10), Hospital das Clínicas (HCFMUSP) da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
| | - Karla Garay
- Hospital Carlos Andrade Marin and Hospital Alianza, Quito, Ecuador
| | - Alvaro Ruiz Morales
- Departments of Internal Medicine and of Clinical Epidemiology, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayán, Colombia
| | - Christian A Colón Peña
- Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes, Universidad El Bosque, D.C., Bogotá, Colombia
| | | |
Collapse
|
11
|
Affiliation(s)
- Maria Cristina Izar
- Lipids, Atherosclerosis and Vascular Biology Section, Cardiology Division, Department of Medicine, Universidade Federal de Sao Paulo, Rua Loefgren, 1350-Vila Clementino, Sao Paulo, SP 04040-001, Brazil
| |
Collapse
|
12
|
Bianco HT, Povoa R, Izar MC, Luna Filho B, Moreira FT, Stefanini E, Fonseca HA, Barbosa AHP, Alves CMR, Caixeta AM, Gonçalves I, Moraes PIDM, Lopes RD, Paola AAVD, Almeida D, Moises VA, Fonseca FAH. Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive Approach. Arq Bras Cardiol 2021; 117:15-25. [PMID: 34320062 PMCID: PMC8294746 DOI: 10.36660/abc.20200241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Fundamento A intervenção coronária percutânea primária é considerada o “padrão-ouro” para reperfusão coronária. Entretanto, quando não disponível, a estratégia fármaco-invasiva é método alternativo, e o eletrocardiograma (ECG) tem sido utilizado para identificar sucesso na reperfusão. Objetivos Nosso estudo teve como objetivo examinar alterações no segmento-ST pós-lise e seu poder de prever a recanalização, usando os escores angiográficos TIMI e blush miocárdio (MBG) como critério de reperfusão ideal. Métodos Foram estudados 2.215 pacientes com infarto agudo do miocárdio com supra-ST submetidos à fibrinólise [(Tenecteplase)-TNK] e encaminhados para angiografia coronária em até 24 h pós-fibrinólise ou imediatamente encaminhados à terapia de resgate. O ECG foi realizado pré-TNK e 60 min-pós. Os pacientes foram categorizados em dois grupos: aqueles com reperfusão ideal (TIMI-3 e MBG-3) e aqueles com reperfusão inadequada (fluxo TIMI <3). Foi definido o critério de reperfusão do ECG pela redução do segmento ST >50%. Consideramos p-valor <0,05 para as análises, com testes bicaudais. Resultados O critério de reperfusão pelo ECG apresentou valor preditivo positivo de 56%; valor preditivo negativo de 66%; sensibilidade de 79%; e especificidade de 40%. Houve fraca correlação positiva entre a redução do segmento-ST e os dados angiográficos de reperfusão ideal (r = 0,21; p <0,001) e baixa precisão diagnóstica, com AUC de 0,60 (IC-95%; 0,57-0,62). Conclusão Em nossos resultados, a redução do segmento-ST não conseguiu identificar com precisão os pacientes com reperfusão angiográfica apropriada. Portanto, mesmo pacientes com reperfusão aparentemente bem-sucedida devem ser encaminhados à angiografia brevemente, a fim de garantir fluxo coronário macro e microvascular adequados.
Collapse
Affiliation(s)
- Henrique Tria Bianco
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | | | - Flavio Tocci Moreira
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | | | - Adriano Mendes Caixeta
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Iran Gonçalves
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | - Renato Delascio Lopes
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Duke University Hospital, Durham, North Carolina - EUA
| | | | - Dirceu Almeida
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | - Valdir Ambrosio Moises
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | |
Collapse
|
13
|
Klassen A, Faccio AT, Picossi CRC, Derogis PBMC, Dos Santos Ferreira CE, Lopes AS, Sussulini A, Cruz ECS, Bastos RT, Fontoura SC, Neto AMF, Tavares MFM, Izar MC, Fonseca FAH. Evaluation of two highly effective lipid-lowering therapies in subjects with acute myocardial infarction. Sci Rep 2021; 11:15973. [PMID: 34354179 PMCID: PMC8342504 DOI: 10.1038/s41598-021-95455-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 07/23/2021] [Indexed: 01/07/2023] Open
Abstract
For cardiovascular disease prevention, statins alone or combined with ezetimibe have been recommended to achieve low-density lipoprotein cholesterol targets, but their effects on other lipids are less reported. This study was designed to examine lipid changes in subjects with ST-segment elevation myocardial infarction (STEMI) after two highly effective lipid-lowering therapies. Twenty patients with STEMI were randomized to be treated with rosuvastatin 20 mg QD or simvastatin 40 mg combined with ezetimibe 10 mg QD for 30 days. Fasting blood samples were collected on the first day (D1) and after 30 days (D30). Lipidomic analysis was performed using the Lipidyzer platform. Similar classic lipid profile was obtained in both groups of lipid-lowering therapies. However, differences with the lipidomic analysis were observed between D30 and D1 for most of the analyzed classes. Differences were noted with lipid-lowering therapies for lipids such as FA, LPC, PC, PE, CE, Cer, and SM, notably in patients treated with rosuvastatin. Correlation studies between classic lipid profiles and lipidomic results showed different information. These findings seem relevant, due to the involvement of these lipid classes in crucial mechanisms of atherosclerosis, and may account for residual cardiovascular risk. Randomized clinical trial: ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.
Collapse
Affiliation(s)
- Aline Klassen
- Department of Chemistry, Federal University of Sao Paulo (UNIFESP), Diadema, SP, Brazil.
| | - Andrea Tedesco Faccio
- Center for Multiplatform Metabolomics Studies (CEMM), Institute of Chemistry, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Carolina Raissa Costa Picossi
- Center for Multiplatform Metabolomics Studies (CEMM), Institute of Chemistry, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | | | | | - Aline Soriano Lopes
- Department of Chemistry, Federal University of Sao Paulo (UNIFESP), Diadema, SP, Brazil
| | - Alessandra Sussulini
- Department of Analytical Chemistry, Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, Campinas, SP, 13083-970, Brazil
| | - Elisa Castañeda Santa Cruz
- Department of Analytical Chemistry, Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, Campinas, SP, 13083-970, Brazil
| | - Rafaela Tudela Bastos
- Department of Chemistry, Federal University of Sao Paulo (UNIFESP), Diadema, SP, Brazil
| | | | | | - Marina Franco Maggi Tavares
- Center for Multiplatform Metabolomics Studies (CEMM), Institute of Chemistry, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Maria Cristina Izar
- Division of Cardiology, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Loefgren 1350, São Paulo, SP, CEP 04040-001, Brazil
| | | |
Collapse
|
14
|
Pereira TS, Fonseca FAH, Fonseca MIH, Martins CM, Fonseca HAR, Fonzar WT, Goulart AC, Bensenor IM, Lotufo PA, Izar MC. Phytosterol consumption and markers of subclinical atherosclerosis: Cross-sectional results from ELSA-Brasil. Nutr Metab Cardiovasc Dis 2021; 31:1756-1766. [PMID: 33965299 DOI: 10.1016/j.numecd.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/16/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS AND RESULTS This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC. CONCLUSIONS In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.
Collapse
Affiliation(s)
- Tuany S Pereira
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Francisco A H Fonseca
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | | | - Celma M Martins
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Henrique A R Fonseca
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Waleria T Fonzar
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Maria Cristina Izar
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
| |
Collapse
|
15
|
Fonseca HAR, Gidlund M, Sant'Anna VR, Fernandes ER, Fonseca FAH, Izar MC. HIV-Infected Naïve Patients Exhibit Endothelial Dysfunction Concomitant with Decreased Natural Antibodies Against Defined Apolipoprotein B Autoantigens. Arq Bras Cardiol 2021; 116:844-849. [PMID: 33886738 PMCID: PMC8121411 DOI: 10.36660/abc.20200062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022] Open
Abstract
Fundamento: Fatores de risco definidos para HIV e tradicionais podem estar associados a um aumento de eventos cardiovasculares. Estudos recentes sugerem que a resposta imune humoral à LDL modificada pode estar associada ao processo de aterosclerose. Objetivos: Avaliar a presença de anti-LDL oxidada e de peptídeos derivados da Apolipoproteína B no sangue, bem como sua associação à função endotelial na infecção por HIV. Métodos: Este estudo incluiu consecutivamente sujeitos com idade, sexo e dados demográficos correspondentes em dois grupos: (1) indivíduos infectados com HIV e naïve para terapia antiviral e (2) indivíduos não infectados. A aterosclerose subclínica foi avaliada pela espessura íntima-média, utilizando-se a ultrassonografia das artérias carótidas. A função endotelial foi determinada pela dilatação mediada por fluxo (DMF) da artéria braquial por ultrassonografia. Os níveis de autoanticorpos (IgM, IgG) de lipoproteínas de baixa densidade antioxidadas (LDL-ox), fragmentos de peptídeos antiapolipoproteína B (peptídeos ApoB-D e 0033G-Cys), e citocina foram avaliados por meio de ELISA. Resultados: Os resultados deste estudo não mostraram diferenças na aterosclerose subclínica entre os grupos. Entretanto, os sujeitos infectados com HIV apresentaram uma DMF mais baixa, em comparação com os sujeitos não infectados. Portanto, os sujeitos infectados com HIV apresentaram níveis mais altos de citocinas inflamatórias, títulos de IgG anti-LDL-ox, e IgG anti-ApoB-D. Em contraste, títulos de IgM anti-ApoB-D foram mais baixos em indivíduos infectados com HIV e associados a funções endoteliais diminuídas. Conclusões: Os resultados deste estudo mostram que a infecção por HIV, em sujeitos naïve, está associada à disfunção endotelial e à diminuição de anticorpos naturais para antígenos Apo-B.
Collapse
Affiliation(s)
- Henrique Andrade R Fonseca
- Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP - Brasil.,Universidade de Sao Paulo, São Paulo, SP - Brasil
| | | | - Viviane Rodrigues Sant'Anna
- Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP - Brasil.,Universidade de Sao Paulo, São Paulo, SP - Brasil
| | - Esteferson Rodrigues Fernandes
- Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP - Brasil.,Universidade de Sao Paulo, São Paulo, SP - Brasil
| | - Francisco A H Fonseca
- Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP - Brasil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP - Brasil
| |
Collapse
|
16
|
Fonseca F, Ballerini AP, Izar MC, Kato J, Ferreira CE, Fonzar W, do Amaral J, Rezende P, Machado-Santelli G, França C. Advanced chronic kidney disease is associated with higher serum concentration of monocyte microparticles. Life Sci 2020; 260:118295. [PMID: 32822720 DOI: 10.1016/j.lfs.2020.118295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022]
Abstract
Advanced chronic kidney disease is associated with high rates of cardiovascular disease. Considering the crucial role of capillaries in renal function, our study aimed to evaluate microparticles related to vascular physiology examining the link between stages of chronic kidney disease with circulating endothelial (EMP), platelet (PMP) and monocytic (MMP) microparticles. Cross-sectional study with blinded endpoints included subjects of both sexes, aged 40-75 years (n = 247), with established cardiovascular disease (coronary heart disease, ischemic stroke, or peripheral artery disease). They were stratified 1:1 by the presence or absence of decreased glomerular filtration rate (GFR < 60 mL/min/1.73 m2) estimated by the CKD-EPI criteria, and according to the stages of CKD. Microparticles were quantified by flow-cytometry using specific antibodies to identify endothelial, platelet, and monocytic derived microparticles. Higher percentages of circulating MMP (p = 0.036), but not for EMP or PMP, were observed in subjects with reduced GFR. Circulating MMP were also related to the stages of chronic kidney disease (trend analysis across renal stages, p = 0.038). Higher percentages of circulating MMP were found in subjects with reduced GFR, and their percentages were progressively higher according to the stage of chronic renal function.
Collapse
Affiliation(s)
| | | | | | - Juliana Kato
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Waléria Fonzar
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
17
|
Coste MER, França CN, Izar MC, Teixeira D, Ishimura ME, Longo-Maugeri I, Bacchin AS, Bianco HT, Moreira FT, Pinto IM, Szarf G, Caixeta AM, Berwanger O, Gonçalves I, Fonseca FAH. Early Changes in Circulating Interleukins and Residual Inflammatory Risk After Acute Myocardial Infarction. Arq Bras Cardiol 2020; 115:1104-1111. [PMID: 32876202 PMCID: PMC8133737 DOI: 10.36660/abc.20190567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023] Open
Abstract
Fundamento Pacientes com infarto agudo do miocárdio podem apresentar uma grande área infartada e disfunção ventricular mesmo com trombólise e revascularização precoces. Objetivo Investigar o comportamento das citocinas circulantes em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) e a relação delas com a função ventricular. Métodos No estudo BATTLE-AMI (Avaliação dos Linfócitos Tipos B e T no Infarto Agudo do Miocárdio), os pacientes com IAMCSST foram tratados com uma estratégia farmacoinvasiva. Os níveis de citocinas (IL-1β, IL-4, IL-6, IL-10 e IL-18) no plasma foram testados através de ensaio de imunoadsorção enzimática (ELISA) no início do estudo e após 30 dias. A massa infartada e a fração de ejeção ventricular esquerda (FEVE) foram examinadas por ressonância magnética cardíaca 3-T. Valores de p menores que 0,05 foram considerados significativos. Resultados Na comparação com o início do estudo, níveis mais baixos foram detectados para IL-1β (p = 0,028) e IL-18 (p < 0,0001) após 30 dias do IAMCSST, enquanto níveis mais altos foram observados para IL-4 (p = 0,001) e IL-10 (p < 0,0001) no mesmo momento. Em contrapartida, nenhuma mudança foi detectada nos níveis de IL-6 (p = 0,63). Os níveis da proteína C-reativa de alta sensibilidade e de IL-6 se correlacionaram no início do estudo (rho = 0,45, p < 0,0001) e 30 dias após o IAMCSST (rho = 0,29, p = 0,009). No início do estudo, a correlação entre os níveis de IL-6 e FEVE também foi observada (rho = -0,50, p = 0,004). Conclusões Durante o primeiro mês pós-infarto agudo do miocárdio, observamos uma melhora significativa no balanço das citocinas pró e anti-inflamatórias, exceto da IL-6. Esses achados sugerem risco inflamatório residual. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Gilberto Szarf
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | - Iran Gonçalves
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | |
Collapse
|
18
|
Lotfollahi Z, Mello APDQ, Costa ES, Oliveira CLP, Damasceno NRT, Izar MC, Neto AMF. Green-banana biomass consumption by diabetic patients improves plasma low-density lipoprotein particle functionality. Sci Rep 2020; 10:12269. [PMID: 32704082 PMCID: PMC7378544 DOI: 10.1038/s41598-020-69288-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 07/09/2020] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to investigate the effects of 6-months consumption of green-banana biomass on the LDL particle functionality in subjects with type 2 diabetes. Subjects (n = 39, mean age 65 years old) of both sexes with diabetes (HbA1c ≥ 6·5%) were randomized to receive nutritional support plus green-banana biomass (40 g) (n = 21) or diet alone (n = 18) for 6-months. Non-linear optical responses of LDL solutions from these participants were studied by Z-scan technique. UV-visible spectrophotometer was used to measure the absorbance of the LDL samples. Small Angle X-ray Scattering and Dynamic Light Scattering experiments were used to look for any structural changes in LDL samples and to determine their size distribution. The Lipoprint test was used to determine the LDL sub-fractions in terms of distribution and size. Consumption of green-banana biomass, reduced total- (p = 0.010), non-HDL-cholesterol (p = 0.043), glucose (p = 0.028) and HbA1c (p = 0.0007), and also improved the protection of the LDL particle against oxidation, by the increase in carotenoids content in the particles (p = 0.007). This higher protection against modifications may decrease the risk of developing cardiovascular disease. These benefits of the green-banana biomass encourage the use of resistant starches with potential clinical applications in individuals with pre-diabetes and diabetes.
Collapse
Affiliation(s)
- Zahra Lotfollahi
- Complex Fluids Group, Instituto de Física, Universidade de São Paulo, Rua Do Matão, 1371, Butantã, São Paulo, SP, CEP: 05508-090, Brazil
| | | | - Edna S Costa
- Federal University of São Paulo, São Paulo, Brazil
| | - Cristiano L P Oliveira
- Complex Fluids Group, Instituto de Física, Universidade de São Paulo, Rua Do Matão, 1371, Butantã, São Paulo, SP, CEP: 05508-090, Brazil
| | | | | | - Antonio Martins Figueiredo Neto
- Complex Fluids Group, Instituto de Física, Universidade de São Paulo, Rua Do Matão, 1371, Butantã, São Paulo, SP, CEP: 05508-090, Brazil.
| |
Collapse
|
19
|
Machline-Carrion MJ, Soares RM, Damiani LP, Campos VB, Sampaio B, Fonseca FH, Izar MC, Amodeo C, Pontes-Neto OM, Santos JY, Gomes SPDC, Saraiva JFK, Ramacciotti E, Barros E Silva PGDM, Lopes RD, Brandão da Silva N, Guimarães HP, Piegas L, Stein AT, Berwanger O. Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Evidence-Based Treatment in Patients at High Cardiovascular Risk in Brazil: The BRIDGE Cardiovascular Prevention Cluster Randomized Clinical Trial. JAMA Cardiol 2020; 4:408-417. [PMID: 30942842 DOI: 10.1001/jamacardio.2019.0649] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. Objective To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. Design, Setting, and Participants In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. Interventions Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. Main Outcomes and Measures The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. Results Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). Conclusions and Relevance Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02851732.
Collapse
Affiliation(s)
| | | | | | | | - Bruna Sampaio
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
| | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, São Paulo, Brazil.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Nilton Brandão da Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Airton T Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Otávio Berwanger
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
| | | |
Collapse
|
20
|
Souza DDSMD, Oliveira CLBD, Maciel BG, Figueiredo MT, Bianco HT, Fonseca FAH, Izar MC, Póvoa RMS. Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection. Arq Bras Cardiol 2020; 114:711-715. [PMID: 32491012 DOI: 10.36660/abc.20190143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715).
Collapse
Affiliation(s)
| | | | | | | | - Henrique Tria Bianco
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Francisco A H Fonseca
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Maria Cristina Izar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M S Póvoa
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
21
|
Machline-Carrion MJ, Soares RM, Damiani LP, Campos VB, Sampaio B, Yamashita J, Fonseca FH, Izar MC, Amodeo C, Pontes-Neto OM, de Melo Barros PG, Lopes RD, Brandão da Silva N, Guimarães HP, Piegas L, Stein AT, Berwanger O. Rationale and design for a cluster randomized quality-improvement trial to increase the uptake of evidence-based therapies for patients at high cardiovascular risk: The BRIDGE-Cardiovascular Prevention trial. Am Heart J 2019; 207:40-48. [PMID: 30415082 DOI: 10.1016/j.ahj.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Translating evidence into clinical practice in the management of high cardiovascular risk patients is challenging. Few quality improvement interventions have rigorously evaluated their impact on both patient care and clinical outcomes. OBJECTIVES The main objectives are to evaluate the impact of a multifaceted educational intervention on adherence to local guidelines for the prescription of statins, antiplatelets and angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for high cardiovascular risk patients, as well as on the incidence of major cardiovascular events. DESIGN We designed a pragmatic two arm cluster randomized trial involving 40 clusters. Clusters are randomized to receive a multifaceted quality improvement intervention or to routine practice (control). The multifaceted intervention includes: reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint is the adherence to combined evidence-based therapies (statins, antiplatelet therapy and angiotensin converting enzyme inhibitors or angiotensin receptor blockers) at 12 months after the intervention period in patients without contra-indications for these medications. All analyses follow the intention-to-treat principle and take the cluster design into account using linear mixed logistic regression modeling. SUMMARY If proven effective, this multifaceted intervention would have wide utility as a means of promoting optimal usage of evidence-based interventions for the management of high cardiovascular risk patients.
Collapse
|
22
|
Cieslarova Z, Magaldi M, Barros LA, do Lago CL, Oliveira DR, Fonseca FAH, Izar MC, Lopes AS, Tavares MFM, Klassen A. Capillary electrophoresis with dual diode array detection and tandem mass spectrometry to access cardiovascular biomarkers candidates in human urine: Trimethylamine-N-Oxide and l-carnitine. J Chromatogr A 2019; 1583:136-142. [DOI: 10.1016/j.chroma.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 02/06/2023]
|
23
|
Izar MC, Fonzar WT, Silva TP, Franca CN, Fonseca HAR, Teixeira D, Maugeri IML, Coste MER, Bianco HT, Pesquero JB, Rodrigues AAE, Carvalho ACC, Fonseca FAH. P5388Role of the immune-inflammatory biomarkers and atherosclerosis development in subjects with familial hypercholesterolemia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Izar
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - W T Fonzar
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - T P Silva
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - C N Franca
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - D Teixeira
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - M E R Coste
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - H T Bianco
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - J B Pesquero
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | |
Collapse
|
24
|
Fonseca FAH, Izar MC, Maugeri IML, Berwanger O, Damiani LP, Pinto IM, Szarf G, França CN, Bianco HT, Moreira FT, Caixeta A, Alves CMR, Soriano Lopes A, Klassen A, Tavares MFM, Fonseca HA, Carvalho ACC. Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial. Trials 2017; 18:601. [PMID: 29258572 PMCID: PMC5735810 DOI: 10.1186/s13063-017-2361-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. Methods/design BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events. Discussion BATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation. Trial registration ClinicalTrials.gov, NCT02428374. Registered on 28 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2361-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Francisco A H Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil.
| | - Maria Cristina Izar
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Ieda M L Maugeri
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Lucas P Damiani
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Ibraim M Pinto
- Instituto Dante Pazzanese de Cardiologia, Avenida Dante Pazzanese 500, São Paulo, Brazil
| | - Gilberto Szarf
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Carolina N França
- Universidade Santo Amaro, Rua Professor Enéas de Siqueira 340, São Paulo, Brazil
| | - Henrique T Bianco
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Flavio T Moreira
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Adriano Caixeta
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Claudia M R Alves
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Soriano Lopes
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Klassen
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Marina F M Tavares
- Universidade de São Paulo, Avenida Professor Lineu Prestes, 748, São Paulo, Brazil
| | - Henrique A Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Antonio C C Carvalho
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | | |
Collapse
|
25
|
Bertoluci MC, Moreira RO, Faludi A, Izar MC, Schaan BD, Valerio CM, Bertolami MC, Chacra AP, Malachias MVB, Vencio S, Saraiva JFK, Betti R, Turatti L, Fonseca FAH, Bianco HT, Sulzbach M, Bertolami A, Salles JEN, Hohl A, Trujilho F, Lima EG, Miname MH, Zanella MT, Lamounier R, Sá JR, Amodeo C, Pires AC, Santos RD. Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM). Diabetol Metab Syndr 2017; 9:53. [PMID: 28725272 PMCID: PMC5512820 DOI: 10.1186/s13098-017-0251-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/30/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. MAIN BODY The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy. CONCLUSIONS Diabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk.
Collapse
Affiliation(s)
- Marcello Casaccia Bertoluci
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003 Brazil
- Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil
| | - Rodrigo Oliveira Moreira
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rua Moncorvo Filho, 90, Rio de Janeiro, RJ 20211-340 Brazil
- Faculdade de Medicina de Valença (FMV), Rua Sebastião Dantas Moreira, 40, Valença, RJ 27600-000 Brazil
- Faculdade de Medicina da Universidade Presidente Antônio Carlos (FAME/UNIPAC), Av. Juiz de Fora, 1100, Juiz De Fora, MG 36048-000 Brazil
| | - André Faludi
- Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo (UNIFESP), Rua Loefgren, 1350, São Paulo, SP 04040-001 Brazil
| | | | - Cynthia Melissa Valerio
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rua Moncorvo Filho, 90, Rio de Janeiro, RJ 20211-340 Brazil
| | - Marcelo Chiara Bertolami
- Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil
| | - Ana Paula Chacra
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| | | | - Sérgio Vencio
- Universidade Federal de Goiás (UFG), 1ª Avenida, s/n, Setor Leste Universitário, Goiânia, GO 74605-020 Brazil
| | - José Francisco Kerr Saraiva
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Av. John Boyd Dunlop, s/n, Campinas, SP 13059-900 Brazil
| | - Roberto Betti
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| | - Luiz Turatti
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| | | | - Henrique Tria Bianco
- Universidade Federal de São Paulo (UNIFESP), Rua Loefgren, 1350, São Paulo, SP 04040-001 Brazil
| | - Marta Sulzbach
- Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil
| | - Adriana Bertolami
- Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil
| | - João Eduardo Nunes Salles
- Faculdade de Ciências, Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr, 112, São Paulo, SP 01221-020 Brazil
| | - Alexandre Hohl
- Universidade Federal de Santa Catarina (UFSC), Rua Profa. Maria Flora Pausewang, s/n, Florianópolis, SC 88040-970 Brazil
| | - Fábio Trujilho
- Clínica de Endocrinologia e Metabologia, Av. Tancredo Neves, 1632/708, Salvador, BA 41820-020 Brazil
| | - Eduardo Gomes Lima
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| | - Marcio Hiroshi Miname
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| | | | - Rodrigo Lamounier
- Centro de Diabetes de Belo Horizonte, Rua Niquel, 31, Belo Horizonte, MG 30220-280 Brazil
| | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia, Av. Dante Pazzanese, 500, São Paulo, SP 04012-180 Brazil
| | - Antonio Carlos Pires
- Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - Raul D. Santos
- Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP 05403-000 Brazil
| |
Collapse
|
26
|
Bianco HT, Izar MC, Fonseca HA, Póvoa RM, Saraiva JF, Forti A, Jardim PCBV, Introcaso L, Yugar-Toledo J, Xavier HT, Faludi AA, Fonseca FAH. Relevance of target-organ lesions as predictors of mortality in patients with diabetes mellitus. Arq Bras Cardiol 2014; 103:272-81. [PMID: 25098376 PMCID: PMC4206357 DOI: 10.5935/abc.20140112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/09/2014] [Indexed: 11/28/2022] Open
Abstract
Background Patients with diabetes are in extract higher risk for fatal cardiovascular
events. Objective To evaluate major predictors of mortality in subjects with type 2 diabetes. Methods A cohort of 323 individuals with type 2 diabetes from several regions of Brazil
was followed for a long period. Baseline electrocardiograms, clinical and
laboratory data obtained were used to determine hazard ratios (HR) and confidence
interval (CI) related to cardiovascular and total mortality. Results After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular
causes). Cardiovascular mortality was associated with male gender; smoking; prior
myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR
<60 mL/min. These factors, in addition to obesity, were predictors of total
mortality. Cardiovascular mortality was adjusted for age and gender, but remained
associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial
infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5;
95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p =
0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002).
Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030);
smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR =
3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1;
p = 0.017). Conclusions Biomarkers of simple measurement, particularly those related to target-organ
lesions, were predictors of mortality in subjects with type 2 diabetes.
Collapse
Affiliation(s)
| | | | | | | | | | - Adriana Forti
- Centro de Diabetes e Hipertensão de Fortaleza, Fortaleza, CE, Brazil
| | | | - Luis Introcaso
- Centro de Investigação Clínica de Brasília, Brasília, DF, Brazil
| | - Juan Yugar-Toledo
- Escola de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | | | | |
Collapse
|
27
|
Camargo LM, França CN, Izar MC, Bianco HT, Lins LS, Barbosa SP, Pinheiro LF, Fonseca FAH. Effects of simvastatin/ezetimibe on microparticles, endothelial progenitor cells and platelet aggregation in subjects with coronary heart disease under antiplatelet therapy. ACTA ACUST UNITED AC 2014; 47:432-7. [PMID: 24760119 PMCID: PMC4075313 DOI: 10.1590/1414-431x20143628] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/20/2014] [Indexed: 01/14/2023]
Abstract
It is not known whether the addition of ezetimibe to statins adds cardiovascular
protection beyond the expected changes in lipid levels. Subjects with coronary heart
disease were treated with four consecutive 1-week courses of therapy (T) and
evaluations. The courses were: T1, 100 mg aspirin alone; T2, 100 mg aspirin and 40 mg
simvastatin/10 mg ezetimibe; T3, 40 mg simvastatin/10 mg ezetimibe, and 75 mg
clopidogrel (300 mg initial loading dose); T4, 75 mg clopidogrel alone. Platelet
aggregation was examined in whole blood. Endothelial microparticles (CD51), platelet
microparticles (CD42/CD31), and endothelial progenitor cells (CD34/CD133;
CDKDR/CD133, or CD34/KDR) were quantified by flow cytometry. Endothelial function was
examined by flow-mediated dilation. Comparisons between therapies revealed
differences in lipids (T2 and T3<T1 and T4 for total cholesterol, LDL-C, and
triglycerides; P<0.002 for all), as well as for endothelial function (T2>T1 and
T4, P=0.001). Decreased platelet aggregation was observed after aspirin (arachidonic
acid, T1<T3 and T4, P=0.034) and clopidogrel (adenosine, T3 and T4<T1 and T2,
P<0.0001) therapy. Simvastatin/ezetimibe diphosphate did not change platelet
aggregation, the amount of circulating endothelial and platelet microparticles, or
endothelial progenitor cells. Cardiovascular protection following therapy with
simvastatin/ezetimibe seems restricted to lipid changes and improvement of
endothelial function not affecting the release of microparticles, mobilization of
endothelial progenitor cells or decreased platelet aggregation.
Collapse
Affiliation(s)
- L M Camargo
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - C N França
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M C Izar
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - H T Bianco
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L S Lins
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - S P Barbosa
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - L F Pinheiro
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - F A H Fonseca
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
28
|
Alessi A, Bonfim AV, Brandão AA, Feitosa A, Amodeo C, Alves CR, Brasil DP, Souza DDSM, Barbosa E, Consolim-Colombo FM, Borelli F, Fonseca FH, Lopes HF, Chaves H, Bortolotto LA, Martin LC, Scala LCN, Mota-Gomes MA, Malachias MVB, Izar MC, Fonseca MIH, Neves MFT, Morais NS, Passarelli O, Jardim PCV, Toscano PR, Miranda RD, Franco R, Betti RTB, Pedrosa RP, Povoa R, Carneiro SB, Jardim T, Barroso WKS. I Brazilian position statement on arterial hypertension and diabetes mellitus. Arq Bras Cardiol 2014; 100:491-501. [PMID: 23842875 DOI: 10.5935/abc.20130123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
29
|
Moreira FT, Ramos SC, Monteiro AM, Helfenstein T, Gidlund M, Damasceno NRT, Neto AMF, Izar MC, Fonseca FAH. Effects of two lipid lowering therapies on immune responses in hyperlipidemic subjects. Life Sci 2014; 98:83-7. [PMID: 24447629 DOI: 10.1016/j.lfs.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/23/2013] [Accepted: 01/06/2014] [Indexed: 01/05/2023]
Abstract
AIMS To compare the effects of two of the most effective lipid-lowering therapies with similar LDL-cholesterol reduction capacity on the innate and adaptive immune responses through the evaluation of autoantibodies anti-oxidized LDL (anti-oxLDL Abs) and electronegative LDL [LDL(-)] levels. MAIN METHODS We performed a prospective, randomized, open label study, with parallel arms and blinded endpoints. One hundred and twelve subjects completed the study protocol and received rosuvastatin 40 mg or ezetimibe/simvastatin 10/40 mg for 12 weeks. Lipids, apolipoproteins, LDL(-), and anti-oxLDL Abs (IgG) were assayed at baseline and end of study. KEY FINDINGS Main clinical and laboratory characteristics were comparable at baseline. Lipid modifications were similar in both treatment arms, however, a significant raise in anti-oxLDL Abs levels was observed in subjects treated with rosuvastatin (p=0.026 vs. baseline), but not in those receiving simvastatin/ezetimibe. (p=0.233 vs. baseline), thus suggesting modulation of adaptive immunity by a potent statin. Titers of LDL(-) were not modified by the treatments. SIGNIFICANCE Considering atherosclerosis as an immune disease, this study adds new information, showing that under similar LDL-cholesterol reduction, the choice of lipid-lowering therapy can differently modulate adaptive immune responses.
Collapse
Affiliation(s)
| | | | - Andrea Moreira Monteiro
- Complex Fluids Laboratory, Institute of Physics, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Tatiana Helfenstein
- Department of Medicine, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | - Magnus Gidlund
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Maria Cristina Izar
- Department of Medicine, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | | |
Collapse
|
30
|
Santos RD, Gagliardi ACM, Xavier HT, Casella Filho A, Araújo DB, Cesena FY, Alves RJ, Pereira AC, Lottemberg AMP, Chacra APM, Faludi AA, Sposito AC, Ribeiro Filho FF, Helfenstein Fonseca FA, de Carlos Back Giuliano I, Catani LH, Bertolami MC, Hiroshi Miname M, Izar MC, Monte O, Maranhão RC, Martinez TLR, Arruda Machado V, Zorzanelli Rocha V, Salgado Filho W. [First Brazilian Guidelines for Familial Hypercholesterolemia]. Arq Bras Cardiol 2013; 99:1-28. [PMID: 23532256 DOI: 10.5935/abc.20120202] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
31
|
Martins CM, Fonseca FA, Ballus CA, Figueiredo-Neto AM, Meinhart AD, de Godoy HT, Izar MC. Common sources and composition of phytosterols and their estimated intake by the population in the city of São Paulo, Brazil. Nutrition 2013; 29:865-71. [DOI: 10.1016/j.nut.2012.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 12/05/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
|
32
|
Santos RD, Gagliardi ACM, Xavier HT, Magnoni CD, Cassani R, Lottenberg AM, Arpadi Faludi A, Geloneze B, Scherr C, Kovacs C, Tomazzela C, Carla C, Barrera-Arellano D, Cintra D, Quintão E, Nakandakare ER, Fonseca FAH, Pimentel I, Ernesto dos Santos J, Bertolami MC, Rogero M, Izar MC, Nakasato M, Teixeira Damasceno NR, Maranhão R, Cassani RSL, Perim R, Ramos S. [First guidelines on fat consumption and cardiovascular health]. Arq Bras Cardiol 2013; 100:1-40. [PMID: 23598539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
|
33
|
Kasmas SH, Izar MC, França CN, Ramos SC, Moreira FT, Helfenstein T, Moreno RA, Borges NC, Figueiredo-Neto AM, Fonseca FA. Differences in synthesis and absorption of cholesterol of two effective lipid-lowering therapies. Braz J Med Biol Res 2012; 45:1095-101. [PMID: 22801416 PMCID: PMC3854149 DOI: 10.1590/s0100-879x2012007500118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/10/2012] [Indexed: 12/13/2022] Open
Abstract
Effective statin therapy is associated with a marked reduction of cardiovascular events. However, the explanation for full benefits obtained for LDL cholesterol targets by combined lipid-lowering therapy is controversial. Our study compared the effects of two equally effective lipid-lowering strategies on markers of cholesterol synthesis and absorption. A prospective, open label, randomized, parallel design study, with blinded endpoints, included 116 subjects. We compared the effects of a 12-week treatment with 40 mg rosuvastatin or the combination of 40 mg simvastatin/10 mg ezetimibe on markers of cholesterol absorption (campesterol and β-sitosterol), synthesis (desmosterol), and their ratios to cholesterol. Both therapies similarly decreased total and LDL cholesterol, triglycerides and apolipoprotein B, and increased apolipoprotein A1 (P < 0.05 vs baseline for all). Simvastatin/ezetimibe increased plasma desmosterol (P = 0.012 vs baseline), and decreased campesterol and β-sitosterol (P < 0.0001 vs baseline for both), with higher desmosterol (P = 0.007) and lower campesterol and β-sitosterol compared to rosuvastatin, (P < 0.0001, for both). In addition, rosuvastatin increased the ratios of these markers to cholesterol (P < 0.002 vs baseline for all), whereas simvastatin/ezetimibe significantly decreased the campesterol/cholesterol ratio (P = 0.008 vs baseline) and tripled the desmosterol/cholesterol ratio (P < 0.0001 vs baseline). The campesterol/cholesterol and β-sitosterol/cholesterol ratios were lower, whereas the desmosterol/cholesterol ratio was higher in patients receiving simvastatin/ezetimibe (P < 0.0001 vs rosuvastatin, for all). Pronounced differences in markers of cholesterol absorption and synthesis were observed between two equally effective lipid-lowering strategies.
Collapse
Affiliation(s)
- S H Kasmas
- Divisão de Cardiologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Izar MC, Pinheiro L, Franca CN, Barbosa SP, Kasmas SH, Bianco HT, Povoa RM, Fonseca F. PHARMACOKINETIC INTERACTIONS BETWEEN CLOPIDOGREL AND ROSUVASTATIN: EFFECTS ON VASCULAR PROTECTION IN SUBJECTS WITH CORONARY HEART DISEASE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61539-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Marui FRRH, Bombig MTN, Francisco YA, Thalenberg JM, Fonseca FAH, Souza DD, Costa FDA, Izar MC, Carvalho ACDC, Póvoa R. Avaliação da hipertensão arterial resistente pela monitorização residencial da pressão arterial. Arq Bras Cardiol 2010; 95:536-40. [DOI: 10.1590/s0066-782x2010005000120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/15/2010] [Indexed: 11/22/2022] Open
|
36
|
Izar MC, Brandao SA, Fischer SC, Povoa RM, Monteiro CM, Monteiro AM, Gidlund M, Neto AMF, Carvalho AC, Fonseca FA. EARLY INCREASE IN CIRCULATING AUTOANTIBODIES AGAINST HUMAN OXIDIZED LOW-DENSITY LIPOPROTEIN IN HYPERTENSIVE PATIENTS AFTER BLOOD PRESSURE CONTROL. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
37
|
Sposito AC, Caramelli B, Fonseca FAH, Bertolami MC, Afiune Neto A, Souza AD, Lottenberg AMP, Chacra AP, Faludi AA, Loures-Vale AA, Carvalho AC, Duncan B, Gelonese B, Polanczyk C, Rodrigues Sobrinho CRM, Scherr C, Karla C, Armaganijan D, Moriguchi E, Saraiva F, Pichetti G, Xavier HT, Chaves H, Borges JL, Diament J, Guimarães JI, Nicolau JC, dos Santos JE, de Lima JJG, Vieira JL, Novazzi JP, Faria Neto JR, Torres KP, Pinto LDA, Bricarello L, Bodanese LC, Introcaso L, Malachias MVB, Izar MC, Magalhães MEC, Schmidt MI, Scartezini M, Nobre M, Foppa M, Forti NA, Berwanger O, Gebara OCE, Coelho OR, Maranhão RC, dos Santos Filho RD, Costa RP, Barreto S, Kaiser S, Ihara S, Carvalho TD, Martinez TLR, Relvas WGM, Salgado W. [IV Brazilian Guideline for Dyslipidemia and Atherosclerosis prevention: Department of Atherosclerosis of Brazilian Society of Cardiology]. Arq Bras Cardiol 2007; 88 Suppl 1:2-19. [PMID: 17515982 DOI: 10.1590/s0066-782x2007000700002] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
38
|
Izar MC, Fonseca FAH, Ihara SSM, Kasinski N, Sang WH, Lopes IEL, Pinto LDESDA, Relvas WGM, Lourenço D, Tufik S, de Paola AAV, Carvalho ACC. Risk Factors, biochemical markers, and genetic polymorphisms in early coronary artery disease. Arq Bras Cardiol 2003; 80:379-95. [PMID: 12754559 DOI: 10.1590/s0066-782x2003000400003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the risk factors, lipid and apolipoprotein profile, hemostasis variables, and polymorphisms of the apolipoprotein AI-CIII gene in early coronary artery disease (CAD). METHODS Case-control study with 112 patients in each group controlled by sex and age. After clinical evaluation and nutritional instruction, blood samples were collected for biochemical assays and genetic study. RESULTS Familial history of early CAD (64 vs 39%), arterial hypertension (69 vs 36%), diabetes mellitus (25 vs 3%), and previous smoking (71 vs 46%) were more prevalent in the case group (p<0.001). Hypertension and diabetes were independent risk factors. Early CAD was characterized by higher serum levels of total cholesterol (235 +/-6 vs 209 +/- 4 mg/dL), of LDL-c (154 +/- 5 vs 135 +/- 4 mg/dL), triglycerides (205 +/- 12 vs 143 +/- 9 mg/dL), and apolipoprotein B (129 +/- 3 vs 105 +/- 3 mg/dL), and lower serum levels of HDL-c (40 +/- 1 vs 46 +/- 1 mg/dL) and apolipoprotein AI (134 +/- 2 vs 146 +/- 2mg/dL) [p<0.01], in addition to an elevation in fibrinogen and D-dimer (p<0.02). The simultaneous presence of the rare alleles of the APO AI-CIII genes in early CAD are associated with hypertriglyceridemia (p=0.03). CONCLUSION Of the classical risk factors, hypertension and diabetes mellitus were independently associated with early CAD. In addition to an unfavorable lipid profile, an increase in the thrombotic risk was identified in this population. An additive effect of the APO AI-CIII genes was observed in triglyceride levels.
Collapse
Affiliation(s)
- Maria Cristina Izar
- Disciplina de Cardiologia, UNIFESP/EPM, Universidade Federal de São Paulo, Sao Paulo, SP.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Fonseca FA, Izar MC, Fuster V, Gallo R, Padurean A, Fallon JT, Schachter EN, Chesebro JH, Badimon JJ. Chronic endothelial dysfunction after oversized coronary balloon angioplasty in pigs: a 12-week follow-up of coronary vasoreactivity in vivo and in vitro. Atherosclerosis 2001; 154:61-9. [PMID: 11137083 DOI: 10.1016/s0021-9150(00)00458-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previous studies have reported the development of vasoconstriction immediately after invasive coronary interventions. Other studies in animals have demonstrated that using oversized balloon angioplasty, vasospasm can be suppressed, even in the presence of endothelial denudation due to important structural alteration in vascular smooth muscle. The regenerated endothelium also appears to be impaired chronically by selective attenuation of in vitro endothelial dependent relaxation related to pertussis toxin-sensitive G proteins. The purpose of this investigation was to verify in vivo and in vitro vasoreactivity to bradykinin (BK) and serotonin (5-hydroxytryptamine; 5-HT) (endothelial dependent agonists) as well as to nitroglycerin (NTG) (exogenous nitric oxide donor) at different times after oversized balloon angioplasty intervention ranging from 1 h to 12 weeks, in normal porcine coronary arteries. BK-induced vasodilatation in vivo was impaired acutely, but it was restored after 4 weeks. Serotonin caused vasoconstriction in vivo that was significantly augmented after 12 weeks. Conversely, endothelium-dependent vasodilatation in vitro to BK and 5-HT remained attenuated during the whole period of follow-up. Finally, relaxation elicited by NTG was reduced in the in vivo experiment until the first week after the procedure. Histological analysis showed severe arterial injury, and complete recovery of endothelial coverage after 4 weeks. In conclusion, this experiment supports evidence for the occurrence of the acute attenuation of vasoresponsiveness and chronic endothelial dysfunction following overstretching coronary balloon angioplasty. Abnormal remodeling associated with the severity of injury may contribute to chronic endothelial dysfunction. Differences found between in vivo and in vitro studies also suggest that multiple endogenous influences present in the former can attenuate the greater endothelial dysfunction demonstrated by endothelial assessment in vitro.
Collapse
Affiliation(s)
- F A Fonseca
- Cardiovascular Biology Research Laboratory, Cardiovascular Institute (Box 1030), Annenberg Building 24, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA
| | | | | | | | | | | | | | | | | |
Collapse
|