RESUMEN
BACKGROUND: It remains uncertain whether continuous positive airway pressure (CPAP) therapy would significantly impact hard clinical outcomes in patients with obstructive sleep apnea (OSA). This meta-analysis aimed to assess the effects of CPAP in survival and secondary prevention of major cardiovascular events in patients with OSA and cardiovascular disease (CVD). METHODS: PubMed, Cochrane CENTRAL, LILACS, and SciElo databases (up to January 2018) were searched for randomized trials that compared CPAP with no active treatment in adults with OSA and CVD. The primary outcomes were all-cause death, cardiovascular death, acute myocardial infarction, stroke, and any major cardiovascular event. We used risk ratios (RR) and 95% confidence interval (CI) as the effect measures for dichotomous data, and weighted mean difference (WMD) and 95% CI for continuous variables. We used the random-effects method for meta-analysis. RESULTS: Nine trials involving 3314 patients contributed data for meta-analysis of at least one outcome. The duration (median) of CPAP treatment varied from one month to 56.9 months. The pooled RR (95% CI) was 0.86 (0.60-1.23, I2 = 0.0%) for all-cause death, 0.58 (0.19-1.74, I2 = 47%) for cardiovascular death, 1.11 (0.76-1.62, I2 = 0.0%) for myocardial infarction, 0.77 (0.46-1.28, I2 = 16%) for stroke, and 0.93 (0.70-1.24, I2 = 49%) for any major cardiovascular event. The quality of evidence for these outcomes was low. CONCLUSIONS: Low-quality evidence suggests that CPAP therapy does not significantly improve survival or prevent major cardiovascular events in adults with OSA and cardiovascular disease.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Presión de las Vías Aéreas Positiva Contínua , Ensayos Clínicos Controlados Aleatorios como Asunto , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/terapia , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , Causas de Muerte , Humanos , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
The purpose of this study was to determine the effects of different therapeutic 1-MHz ultrasound waveforms on endothelial function before and after cyclooxygenase (COX) inhibition. Forty-two healthy volunteers aged 27.2 ± 3.8 y underwent interventions and an evaluation for endothelial function (n = 15; with COX inhibition, n = 15; duration of the vasodilator effect, n = 12) by technique flow-mediated dilation. Continuous ultrasound therapy (0.4 W/cm(2 SATA)), pulsed ultrasound therapy (20% duty cycle, 0.08 W/cm(2 SATA)) or placebo (equipment power off) was randomly applied over the brachial artery for 5 min. COX inhibition (aspirin) was carried out 30 min before treatments. In relation to the placebo, flow-mediated dilation increased by 4.8% using continuous ultrasound and by 3.4% using pulsed ultrasound. After COX, flow-mediated dilation was enhanced by 2.1% by continuous ultrasound and 2.6% by pulsed ultrasound. This vasodilation persisted for 20 min. Continuous and pulsed therapeutic 1-MHz ultrasound waveforms improved endothelial function in humans, which provided them with anti-inflammatory vascular effects.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Arteria Braquial/fisiología , Arteria Braquial/efectos de la radiación , Endotelio Vascular/fisiología , Endotelio Vascular/efectos de la radiación , Terapia por Ultrasonido/métodos , Adulto , Aspirina/administración & dosificación , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Velocidad del Flujo Sanguíneo/efectos de la radiación , Arteria Braquial/efectos de los fármacos , Método Doble Ciego , Endotelio Vascular/efectos de los fármacos , Femenino , Humanos , Masculino , Valores de Referencia , Resultado del Tratamiento , Ondas Ultrasónicas , Vasodilatación/fisiología , Vasodilatación/efectos de la radiación , Vasodilatadores/administración & dosificación , Adulto JovenRESUMEN
OBJECTIVE: Our objective was to evaluate the association of chronic kidney dysfunction in patients with multivessel chronic coronary artery disease, preserved left ventricular function, and the possible interaction between received treatment and cardiovascular events. METHODS: The glomerular filtration rate was determined at baseline on 611 patients who were randomized into three treatment groups: medical treatment, percutaneous coronary intervention, and coronary artery bypass surgery. Incidence of myocardial infarction, angina requiring a new revascularization procedure, and death were analyzed during 5 years in each group. RESULTS: Of 611 patients, 112 (18%) were classified as having normal renal function, 349 (57%) were classified as having mild dysfunction, and 150 (25%) were classified as having moderate dysfunction. There were significant differences among the cumulative overall mortality curves among the three renal function groups. Death was observed more frequently in the moderate dysfunction group than the other two groups (P < .001). Interestingly, in patients with mild chronic kidney dysfunction, we observed that coronary artery bypass treatment presented a statistically higher percentage of event-free survival and lower percentage of mortality than did percutaneous coronary intervention or medical treatment CONCLUSIONS: Our results confirm that coronary artery disease accompanied by chronic kidney dysfunction has a worse prognosis, regardless of the therapeutic strategy for coronary artery disease, when renal function is at least mildly impaired. Additionally, our data suggest that the different treatment strategies available for stable coronary artery disease may have differential beneficial effects according to the range of glomerular filtration rate strata.