Assuntos
Dislipidemias , Adolescente , Brasil , Criança , Estudos Transversais , Humanos , Lipídeos , PrevalênciaAssuntos
Humanos , Criança , Adolescente , Dislipidemias , Brasil , Prevalência , Estudos Transversais , LipídeosRESUMO
Background: By observing the high prevalence of failures in the surgical treatment of myocardial revascularization (MR), with the use of the Left Internal Thoracic Artery (LITA) as a graft, evidenced by the international literature, it was sought to demonstrate the prevalence of lesions that would not allow the use of LITA as a graft in myocardial revascularization surgery, with possible alteration in the surgical management performed by the cardiac surgeon, and reduction of the morbimortality of these patients. Objectives: To evaluate the prevalence of atherosclerotic lesions of the LITA, through selective preoperative angiography, in patients submitted to coronary angiography and indicated for myocardial revascularization. We also analyzed other lesions that made the use of LITA unfeasible as a main graft in cases of myocardial revascularization surgery (MRS). Methods: This was a cross-sectional, prevalence study that evaluated, through selective angiography, the LITA of 39 patients with a median age of 63 years, submitted to coronary angiography, with indication of Coronary Artery Bypass Graft (CABG). Categorical variables were compared by chi-square test and Fisher's exact test. The single continuous variable, age, was tested for normality by the Kolmogorov-Smirnov test, described in median (P25; P75) and the groups compared with the Mann-Whitney test. The level of statistical significance adopted was p < 0.05. The analyzes were performed in SPSS ® software version 20. Results: It was identified the presence of 7.7% of disorders in the LITA that made it unfeasible to be used. In all of the patients there was no specific symptomatology evidencing the lesion. No variable was shown as a predictor for the occurrence of the outcomes. Conclusion: The prevalence of the lesions found in the study was significant, indicating that a preoperative evaluation of LITA could bring future benefits to the patients submitted to CABG
Fundamento: Pela observação da alta prevalência de falhas no tratamento cirúrgico da revascularização do miocárdio (RM), com o uso da Artéria Torácica Interna Esquerda (ATIE) como enxerto, evidenciadas pela literatura internacional, buscou-se demonstrar a prevalência de lesões que inviabilizem o uso da ATIE como enxerto na cirurgia de revascularização do miocárdio, com possível alteração na conduta cirúrgica tomada pelo cirurgião cardíaco, e redução da morbimortalidade destes pacientes. Objetivos: Avaliar a prevalência de lesões ateroscleróticas da ATIE, por meio da angiografia seletiva, pré - operatória, em pacientes submetidos à cinecoronariografia e com indicação de revascularização cirúrgica do miocárdio. Também foram analisadas outras lesões que inviabilizam o uso da ATIE como enxerto principal em casos de necessidade da cirurgia de revascularização do miocárdio (CRM). Métodos: Estudo analítico, transversal, de prevalência, que avaliou por meio da angiografia seletiva, a ATIE de 39 pacientes com mediana de idade de 63 anos, submetidos ao exame de cinecoronariografia, com indicação de CRM. As variáveis categóricas foram comparadas pelo teste do qui-quadrado e exato de Fisher. A única variável contínua, a idade, foi testada para normalidade pelo teste de Kolmogorov-Smirnov, descrita em mediana (P25; P75) e os grupos comparados com teste de Mann-Whitney. O nível de significância estatística adotado foi p < 0,05. As análises foram realizadas no software SPSS ® versão 20. Resultados: Foi identificada a presença de 7,7% de alterações na ATIE que inviabilizam sua utilização. Em todos os pacientes inexistiu a presença de qualquer sintomatologia especifica que evidencia a lesão. Nenhuma variável se mostrou como fator preditor para ocorrência dos desfechos. Conclusão: A prevalência das lesões encontradas no estudo mostrou-se significativa, indicando que uma avaliação pré-operatória de ATIE possa trazer benefícios futuros aos pacientes submetido à CRM
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Aterosclerose/complicações , Angiografia Coronária/métodos , Artéria Torácica Interna , Prevalência , Doença da Artéria Coronariana/complicações , Diabetes Mellitus/diagnóstico , Diagnóstico por Imagem/métodos , Revascularização Miocárdica/métodos , Fatores de Risco , Comportamento Sedentário , Interpretação Estatística de Dados , Tabagismo/complicaçõesRESUMO
BACKGROUND AND AIMS: Achilles tendon xanthomas (ATX) are a sign of long-term exposure to high blood cholesterol in familial hypercholesterolemia (FH) patients, which have been associated with cardiovascular disease. We evaluated the ATX association with the presence and extent of subclinical coronary atherosclerosis in heterozygous FH patients. METHODS: 102 FH patients diagnosed by US-MEDPED criteria (67% with genetically proven FH), with median LDL-C 279 mg/dL (interquartile range: 240; 313), asymptomatic for cardiovascular disease, underwent computed tomography angiography and coronary artery calcium (CAC) quantification. Subclinical coronary atherosclerosis was quantified by CAC, segment-stenosis (SSS) and segment-involvement (SIS) scores. Adjusted Poisson regression was used to assess the association of ATX with subclinical atherosclerosis burden as continuous variables. RESULTS: Patients with ATX (n = 21, 21%) had higher LDL-C and lipoprotein(a) [Lp(a)] concentrations as well as greater CAC scores, SIS and SSS (p < 0.05). After adjusting for age, sex, smoking, hypertension, previous statin use, HDL-C, LDL-C and Lp(a) concentrations, there was an independent positive association of ATX presence with CAC scores (ß = 1.017, p < 0.001), SSS (ß = 0.809, p < 0.001) and SIS (ß = 0.640, p < 0.001). CONCLUSIONS: ATX are independently associated with the extension of subclinical coronary atherosclerosis quantified by tomographic scores in FH patients.
Assuntos
Tendão do Calcâneo , Apolipoproteína B-100/genética , Doença da Artéria Coronariana/etiologia , Heterozigoto , Hiperlipoproteinemia Tipo II/genética , Mutação , Receptores de LDL/genética , Xantomatose/etiologia , Tendão do Calcâneo/diagnóstico por imagem , Adulto , Doenças Assintomáticas , Biomarcadores/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Feminino , Predisposição Genética para Doença , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/complicações , Hiperlipoproteinemia Tipo II/diagnóstico , Lipoproteína(a)/sangue , Masculino , Pessoa de Meia-Idade , Fenótipo , Projetos Piloto , Índice de Gravidade de Doença , Xantomatose/diagnóstico por imagemRESUMO
BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated blood cholesterol, increased prevalence of subclinical atherosclerosis and high risk of premature coronary heart disease. However, this risk is not explained solely by elevated LDL-cholesterol concentrations, and other factors may influence atherosclerosis development. There is evidence that increased adiposity may predispose to atherosclerosis in FH. Epicardial fat has been associated with subclinical coronary atherosclerosis in the general population. This study evaluated the association of epicardial fat (EFV) volume with the presence and extent of subclinical coronary atherosclerosis detected by computed tomography angiography in FH patients. METHODS: Ninety-seven FH subjects (35% male, mean age 45 ± 13 years, LDL-C 281 ± 56 mg/dL, 67% with proven molecular defects) underwent computed tomography angiography and coronary artery calcium (CAC) scoring. EFV was measured in non-contrast images using a semi-automated method. Segment-stenosis score (SSS) and segment-involvement score (SIS) were calculated. Multivariate Poisson regression was utilized to assess an independent association of EFV with coronary atherosclerotic burden. RESULTS: EFV was positively associated with age, body mass index, waist circumference, blood glucose, the presence of the metabolic syndrome components, but not with LDL-C. After adjusting for confounders and abdominal circumference, an independent association (shown as ß coefficients and 95% confidence intervals) of EVF with CAC scores [ß = 0.263 (0.234; 0.292), p=0.000], SIS [ß = 0.304 (0.141; 0.465) p=0.000] and SSS [ß = 0.296 (0.121; 0.471), p=0.001] was found. CONCLUSIONS: In FH, EFV was independently associated with coronary atherosclerotic presence and severity.
Assuntos
Adiposidade , Doença da Artéria Coronariana/complicações , Hiperlipoproteinemia Tipo II/complicações , Pericárdio/patologia , Tecido Adiposo/patologia , Adulto , Aterosclerose/sangue , Colesterol/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Inquéritos e Questionários , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND AIMS: Regular intake of phytosterols (PS) is proven to dose-dependently lower LDL-cholesterol (LDL-C). Whether PS consumption can also impact low-grade inflammation is unclear. Considering the low feasibility of outcomes studies involving PS consumption, investigation of surrogate markers of atherosclerosis represents a valuable approach. This study assessed the anti-inflammatory effect of PS consumption, according to inflammatory biomarkers, mainly C-reactive protein (CRP). METHODS AND RESULTS: A systematic search of Medline, Cab Abstracts, and Food Science & Technology Abstracts was conducted through January 2015. Our study selection included randomized controlled trials (RCT), involving intake of PS-enriched foods as active treatment, and measurement of plasma inflammatory biomarkers. Random-effects meta-analyses were performed using average baseline and end-of-intervention concentrations and control-adjusted absolute changes in CRP and blood lipids. There were 20 eligible RCTs including a total of 1308 subjects. The absolute change of plasma CRP levels with PS consumption was -0.10 mg/L (95%CI -0.26; 0.05), a non-significant change, and heterogeneity had borderline significance (I(2) = 29.1; p-value = 0.073). The absolute reduction of LDL-C was -14.3 mg/dL (95%CI -17.3; -11.3). Meta-regression analyses showed that both the dose and duration of PS intake significantly influenced the absolute changes in plasma CRP (ß = -0.35, p = 0.0255 and ß = -0.03, p = 0.0209, respectively). CONCLUSIONS: In this meta-analysis, regular intake of PS-enriched foods did not significantly change CRP, whilst LDL-C concentrations were significantly reduced. Further studies with higher PS doses may provide more definite conclusions on a potential anti-inflammatory effect of PS intake.
Assuntos
Biomarcadores/metabolismo , Inflamação/metabolismo , Fitosteróis/química , Anti-Inflamatórios/química , Colesterol/sangue , LDL-Colesterol/metabolismo , Humanos , Lipídeos/sangue , Plantas/química , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão , Triglicerídeos/sangueRESUMO
OBJECTIVE: Reductions on the clearance from plasma of chylomicrons are associated with atherosclerosis. Statins improve the removal from plasma of chylomicrons in a dose dependent manner. There is controversy whether ezetimibe modifies the plasma clearance of chylomicrons. Effects of ezetimibe alone or in combination with simvastatin were compared with low and high dose of the latter, upon the kinetics of a chylomicron-like emulsion in coronary heart disease (CHD) patients. METHODS: 25 CHD patients were randomized for treatment with ezetimibe 10 mg (group 1) or simvastatin 20 mg (group 2) with progression to ezetimibe + simvastatin 10/20 mg or simvastatin 80 mg, respectively. Kinetic studies were performed at baseline and after each treatment period of 6 weeks. The fractional catabolic rates (FCR) of the emulsion labeled with (14)C-CE and (3)H-TG, that represent respectively chylomicron remnant and triglyceride removal, were calculated. Comparisons were made by ANOVA. RESULTS: The (14)CE-FCR in group 1 were 0.005 ± 0.004, 0.011 ± 0.008 and 0.018 ± 0.005 min(-1) and in group 2 were 0.004 ± 0.003, 0.011 ± 0.008 and 0.019 ± 0.007 min(-1) respectively at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). The (3)H-TG-FCR in group 1 were 0.017 ± 0.011, 0.024 ± 0.011 and 0.042 ± 0.013 min(-1) and in group 2 were 0.016 ± 0.009, 0.022 ± 0.009 and 0.037 ± 0.012 min(-1) at baseline, after 6 and 12 weeks (p < 0.05 vs. baseline, and 6 vs. 12 weeks). There were no differences between groups in time. CONCLUSION: Both treatments increased similarly the removal from plasma of chylomicron and remnants in CHD patients.
Assuntos
Azetidinas/administração & dosagem , Quilomícrons/metabolismo , Doença das Coronárias/tratamento farmacológico , Sinvastatina/administração & dosagem , Idoso , Ésteres do Colesterol/metabolismo , Remanescentes de Quilomícrons/metabolismo , Quilomícrons/sangue , Doença das Coronárias/sangue , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Trioleína/metabolismoAssuntos
Infarto Miocárdico de Parede Anterior/patologia , Vasos Coronários/patologia , Miocárdio/patologia , Idoso , Infarto Miocárdico de Parede Anterior/complicações , Colecistite/patologia , Colecistite Aguda/etiologia , Dispneia/etiologia , Evolução Fatal , Feminino , Hemorragia/patologia , Humanos , Poliarterite Nodosa/complicações , Poliarterite Nodosa/patologia , Alvéolos Pulmonares/irrigação sanguínea , Edema Pulmonar/patologiaAssuntos
Idoso , Feminino , Humanos , Infarto Miocárdico de Parede Anterior/patologia , Vasos Coronários/patologia , Miocárdio/patologia , Infarto Miocárdico de Parede Anterior/complicações , Colecistite Aguda/etiologia , Colecistite/patologia , Dispneia/etiologia , Evolução Fatal , Hemorragia/patologia , Poliarterite Nodosa/complicações , Poliarterite Nodosa/patologia , Alvéolos Pulmonares/irrigação sanguínea , Edema Pulmonar/patologiaRESUMO
Adolescentes experimentam cada vez mais precocemente contatos sexuais. A falta de uma orientação sexual adequada torna tais experiências um risco ao futuro desses jovens. Este estudo traça um perfil sexual de adolescentes entre 12 e 18 anos, estudantes de Londrina, com o intuito de conhecer melhor sua realidade. Cerca de 43por cento deles já iniciaram vida sexual, sendo a estrutura familiar um fator ínfluenciador para tal. Cerca de 73 por cento dos entrevistados afirmam desejar mais informações sobre sexo. A televisão é a principal fonte de informação sexual destes jovens e eles optaram pela escola e pais como fontes confiáveís. Dentre as sexualmente ativas, 47por cento consideraram suas primeiras experiências sexuais horríveis ou piores do que esperavam, Também é entre as adolescentes a maior incidência de DSTS, embora 95 por cento dos entrevistados afirmem ser a camisinha o método contraceptívo preferido. Os profissionais da saúde atuam pouco na orientação de adolescentes, sendo esta uma fase em que a iniciação sexual é freqüente, porém de risco, principalmente, para as meninas.(au)