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OBJECTIVE: To evaluate the impact of physical activity on the use of the health system and the quality of life in sedentary elderly. METHODS: A prospective interventional study was carried out between March 2010 and February 2011 with 100 subjects (60-90 years of age,) divided into active group (AG) and control group (CG). During this period, AG performed physical exercise twice a week in 60-minute sessions and the CG remained sedentary with observation of their activities. Before and after the study, all subjects were clinically evaluated and completed a quality of life questionnaire. RESULTS: Eighty-nine subjects (AG = 44; CG = 45) were analyzed. AG had fewer visits to emergency room (p = 0.0056), hospitalizations (p = 0.0011), length of hospital stay (p = 0.0012) and fewer subsidiary tests (p = 0.0236) compared to the CG. The quality of life score analyzed before and after physical activity increased in AG compared to CG (p < 0.0001) and among subjects in AG (p < 0.0001), with no change in the CG. CONCLUSION: The intervention of a physical activity program for sedentary elderly can contribute to reduce the use of the health system and improve the quality of life. Level of evidence II, Therapeutics Studies. Prospective comparative study.
OBJETIVO: Avaliar o impacto da atividade física sobre o uso do sistema de saúde e a qualidade de vida em idosos sedentários. MÉTODOS: Estudo prospectivo intervencionista (março/2010 a fevereiro/2011) com 100 indivíduos (mín. 60 e máx. 90 anos de idade), divididos em grupo ativo (GA) e grupo controle (GC). Nesse período, o GA realizou exercício físico duas vezes por semana, em sessões de 60 minutos e o GC permaneceu sedentário, com observação de suas atividades. Antes e depois do estudo, todos os indivíduos foram avaliados clinicamente e responderam a um questionário de qualidade de vida. RESULTADOS: Foram analisados 89 indivíduos (44 no GA, e 45 no GC). O GA teve menor número de visitas ao pronto-socorro (p = 0,0056), internações (p = 0,0011), tempo de internação (p = 0,0012) e de exames subsidiários realizados (p = 0,0236) comparado com o GC. O escore de qualidade de vida, analisado pré e pós-atividade física apresentou aumento no GA em comparação com o GC (p < 0,0001) e entre os indivíduos do próprio GA (p < 0,0001), não havendo alteração no GC. CONCLUSÃO: A intervenção de um programa de atividade física para idosos sedentários pode contribuir para reduzir a utilização do sistema de saúde e melhorar a qualidade de vida. Nível de Evidência II, Estudos terapêuticos. Estudo prospectivo comparativo.
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ABSTRACT Objective: To evaluate the impact of physical activity on the use of the health system and the quality of life in sedentary elderly. Methods: A prospective interventional study was carried out between March 2010 and February 2011 with 100 subjects (60-90 years of age,) divided into active group (AG) and control group (CG). During this period, AG performed physical exercise twice a week in 60-minute sessions and the CG remained sedentary with observation of their activities. Before and after the study, all subjects were clinically evaluated and completed a quality of life questionnaire. Results: Eighty-nine subjects (AG = 44; CG = 45) were analyzed. AG had fewer visits to emergency room (p = 0.0056), hospitalizations (p = 0.0011), length of hospital stay (p = 0.0012) and fewer subsidiary tests (p = 0.0236) compared to the CG. The quality of life score analyzed before and after physical activity increased in AG compared to CG (p < 0.0001) and among subjects in AG (p < 0.0001), with no change in the CG. Conclusion: The intervention of a physical activity program for sedentary elderly can contribute to reduce the use of the health system and improve the quality of life. Level of evidence II, Therapeutics Studies. Prospective comparative study.
RESUMO Objetivo: Avaliar o impacto da atividade física sobre o uso do sistema de saúde e a qualidade de vida em idosos sedentários. Métodos: Estudo prospectivo intervencionista (março/2010 a fevereiro/2011) com 100 indivíduos (mín. 60 e máx. 90 anos de idade), divididos em grupo ativo (GA) e grupo controle (GC). Nesse período, o GA realizou exercício físico duas vezes por semana, em sessões de 60 minutos e o GC permaneceu sedentário, com observação de suas atividades. Antes e depois do estudo, todos os indivíduos foram avaliados clinicamente e responderam a um questionário de qualidade de vida. Resultados: Foram analisados 89 indivíduos (44 no GA, e 45 no GC). O GA teve menor número de visitas ao pronto-socorro (p = 0,0056), internações (p = 0,0011), tempo de internação (p = 0,0012) e de exames subsidiários realizados (p = 0,0236) comparado com o GC. O escore de qualidade de vida, analisado pré e pós-atividade física apresentou aumento no GA em comparação com o GC (p < 0,0001) e entre os indivíduos do próprio GA (p < 0,0001), não havendo alteração no GC. Conclusão: A intervenção de um programa de atividade física para idosos sedentários pode contribuir para reduzir a utilização do sistema de saúde e melhorar a qualidade de vida. Nível de Evidência II, Estudos terapêuticos. Estudo prospectivo comparativo.
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As doenças cardiovasculares (DCV) são as principais causas de morbidade e mortalidade no Brasil. Consubstanciam-se a hipertensão (HAS), a diabetes mellitus (DM), a dislipidemia (DLP) e o tabagismo como fatores de risco cardiovasculares de maior importância. Indaga-se a relação entre a fisiopatologia da aterosclerose e os principais fatores de risco. A HAS, em sua fisiopatologia, relaciona-se com a DM; intrinsecamente, HAS e DM atuam na resistência vascular periférica (RVP). A obesidade, avaliada pelo índice de massa corpórea, têm relação linear com a ingestão de gorduras, que promove hiperinsulinemia, aumentando o risco de DM (principalmente em mulheres); a obesidade visceral, avaliada pela cintura abdominal, aumenta o risco de desenvolver a HAS, principalmente em homens. Afisiopatologia da HAS, relativa a esses marcadores, é descrita também por sua ação no sistema nervoso central (SNC) com hiperatividade simpática, atuando nos receptores tipo1 da angiotensina II e no acometimento na doença microvascular na DM principalmente com proteinúria. O endotélio, na gênese e formação da aterosclerose, modifica-se tanto na HAS quanto na DM, com o efeito vasodilatador (mediado pelo óxido nítrico). Aação antiaterogênica da insulina usualmente se dá por meio da liberação de oxido nítrico e pela via de ativação da proteína cinase (AKT). No entanto, na presença da resistência insulínica, ocorre a ativação da via da proteína ativada-rasmitogênio (ras-MAP cinase), consubstanciando-se a via pró-aterogênica. Embora esses mecanismos, intrinsecamente ligados, se sobreponham em pacientes com HAS, DM e DLP, o adequado controle de um desses fatores de risco, mesmo em menor escala, promoverá redução da morbimortalidade e, consequentemente, a adesão ao tratamento.
The cardiovascular diseases (CVD) are major causes of morbidity and mortality in Brazil. The major cardiovascular risk factors are hypertension (HYS), diabetes mellitus(DM), dyslipidemia (DYS) and smoking. There are inquires between the pathophysiology of atherosclerosis and the major risk factors. The HYS, in its pathophysiology, is related to DM; both of them inherently act in peripheral vascular resistance (RVP). Obesity, evaluated by body mass index, have linear relation to fat intake, which promotes hyperinsulinemia, increasing the risk of DM (mostly in women); the visceral obesity evaluated by waist circumference, increases the risk of developing HYS, mainly in men. The HYS pathophysiology, related to these markers, is also described by its action on the central nervous system (CNS) with sympathetic hyperactivity, acting on the angiotensin II type 1 receptor and in the involvement of DM microvascular disease, mostly with proteinuria. The endothelium in the genesis and formation of atherosclerosis is modified in HYS and DM, with a vasodilatation effect (mediated by nitric oxide). The antiatherogenic action of insulin usually takes place through releasing nitric oxide and via activation of protein kinase (AKT). Nevertheless, in the occurrence of insulin resistance, the protein-activated rasmitogen (ras-MAP kinase) is activated, resulting in the pro-atherogenic route. Even though these mechanisms intrinsically linked overlap in patients with HYS, DM and DYS, the appropriate control of these risk factors, even on a smaller scale, shall promote reduction of morbidity and mortality, and, consequently, treatment adherence.
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Humanos , Diabetes Mellitus , Dislipidemias , HipertensãoRESUMO
OBJECTIVE: In familial hypercholesterolemia (FH), the metabolism and anti-atherogenic functions of HDL can be affected by the continuous interactions with excess LDL amounts. Here, lipid transfers to HDL, an important step for HDL intravascular metabolism and for HDL role in reverse cholesterol transport (RCT) were investigated in FH patients. METHODS: Seventy-one FH patients (39 ± 15 years, LDL-cholesterol=274 ± 101; HDL-cholesterol=50 ± 14 mg/dl) and 66 normolipidemic subjects (NL) (38 ± 11 years, LDL-cholesterol=105 ± 27; HDL-cholesterol=52 ± 12 mg/dl) were studied. In vitro, lipid transfers were evaluated by incubation of plasma samples (37°C, 1h) with a donor lipid nanoemulsion labeled with 3H-triglycerides (TG) and 14C-unesterified cholesterol (UC) or with 3H-cholesteryl ester (EC) and 14C-phospholipids (PL). Radioactivity was counted at the HDL fraction after chemical precipitation of apolipoprotein (apo) B-containing lipoproteins and the nanoemulsion. Data are % of total radioactivity measured in the HDL fraction. RESULTS: Transfer of UC to HDL was lower in FH than in NL (5.6 ± 2.1 vs 6.7 ± 2.0%, p=0.0005) whereas TG (5.5 ± 3.1 vs 3.7 ± 0.9%, p=0.018) and PL (20.9 ± 4.6 vs 18.2 ± 3.7 %, p=0.023) transfers were higher in FH. EC transfer was equal. By multivariate analysis, transfers of all four lipids correlated with HDL-cholesterol and with apo A-I. CONCLUSION: FH elicited marked changes in three of the four tested lipid transfers to HDL. The entry of UC into HDL for subsequent esterification is an important driving force for RCT and reduction of UC transfer to HDL was previously associated to precocious coronary heart disease. Therefore, in FH, HDL functions can be lessened, which can also contribute to atherogenesis.
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Hiperlipoproteinemia Tipo II/metabolismo , Metabolismo dos Lipídeos/genética , Lipoproteínas HDL/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apolipoproteínas B/metabolismo , Colesterol/sangue , Colesterol/metabolismo , Ésteres do Colesterol/metabolismo , Feminino , Humanos , Hiperlipoproteinemia Tipo II/genética , Lipoproteínas HDL/genética , Lipoproteínas LDL/genética , Lipoproteínas LDL/metabolismo , Masculino , Pessoa de Meia-Idade , Fosfolipídeos/metabolismo , Triglicerídeos/metabolismo , Adulto JovemRESUMO
BACKGROUND: This pilot study evaluates the association of severe periodontitis with pulse wave velocity (PWV), carotid artery intima-medial thickness (IMT), and clinical, metabolic, and atherogenic inflammatory markers in 79 subjects with heterozygous familial hypercholesterolemia (hFH). All subjects were free of previous vascular disease manifestations. METHODS: The body mass index (in kilograms per square meter), plasma lipids, glucose, C-reactive protein, and white blood cell counts were evaluated. After full-mouth periodontal examinations, patients were categorized into the severe periodontitis group (SPG) or non-severe periodontitis group (NSPG). RESULTS: The SPG showed significantly higher values of cholesterol-year scores, triglycerides, glucose, PWV, IMT, and diastolic blood pressure (DBP) (P ≤0.05) than the NSPG. After adjustment for traditional risk factors for atherosclerosis, only the association between severe periodontitis and DBP (odds ratio: 3.1; 95% CI: 1.1 to 8.5; P = 0.03) was confirmed. CONCLUSION: In individuals with hFH, severe periodontitis was associated with a higher DBP, which suggests that severe periodontitis, itself, may contribute to the increased cardiovascular risk profile in this population.
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Hiperlipoproteinemia Tipo II/complicações , Hipertensão/complicações , Periodontite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda do Osso Alveolar/classificação , Aterosclerose/patologia , Biomarcadores/análise , Velocidade do Fluxo Sanguíneo/fisiologia , Glicemia/análise , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Proteína C-Reativa/análise , Artéria Carótida Primitiva/patologia , Colesterol/sangue , Feminino , Heterozigoto , Humanos , Hiperlipoproteinemia Tipo II/genética , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Bolsa Periodontal/classificação , Projetos Piloto , Triglicerídeos/sangue , Túnica Íntima/patologia , Túnica Média/patologia , Adulto JovemRESUMO
BACKGROUND: Increasing age and cholesterol levels, male gender, and family history of early coronary heart disease (CHD) are associated with early onset of CHD in familial hypercholesterolemia (FH). OBJECTIVE: Assess subclinical atherosclerosis by computed tomography coronary angiography (CTCA) and its association with clinical and laboratorial parameters in asymptomatic FH subjects. METHODS: 102 FH subjects (36% male, 45 ± 13 years, LDL-c 280 ± 54 mg/dL) and 35 controls (40% male, 46 ± 12 years, LDL-c 103 ± 18 mg/dL) were submitted to CTCA. Plaques were divided into calcified, mixed and non-calcified; luminal stenosis was characterized as >50% obstruction. RESULTS: FH had a greater atherosclerotic burden represented by higher number of patients with: plaques (48% vs. 14%, p=0.0005), stenosis (19% vs. 3%, p=0.015), segments with plaques (2.05 ± 2.85 vs.0.43 ± 1.33, p=0.0016) and calcium scores (55 ± 129 vs. 38 ± 140, p=0.0028). After multivariate analysis, determinants of plaque presence were increasing age (OR=2.06, for age change of 10 years, CI95%: 1.38-3.07, p<0.001) and total cholesterol (OR=1.86, for cholesterol change by 1 standard deviation, CI95%: 1.09-3.15, p=0.027). Coronary calcium score was associated with the presence of stenosis (OR=1.54; CI95%: 1.27-1.86, p<0.001, for doubling the calcium score). Male gender was directly associated with the presence of non-calcified plaques (OR: 15.45, CI95% 1.72-138.23, p=0.014) and inversely with calcified plaques (OR=0.21, CI95%: 0.05-0.84, p=0.027). Family history of early CHD was associated with the presence of mixed plaques (OR=4.90, CI95%: 1.32-18.21, p=0.018). CONCLUSIONS: Patients with FH had an increased burden of coronary atherosclerosis by CTCA. The burden of atherosclerosis and individual plaque subtypes differed with the presence of other associated risk factors, with age and cholesterol being most important. A coronary calcium score of zero ruled out obstructive disease in this higher risk population.
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Calcinose/complicações , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Hiperlipoproteinemia Tipo II/complicações , Adulto , Fatores Etários , Calcinose/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
Our purpose was to study the determinants of coronary and carotid subclinical atherosclerosis, aortic stiffness and their relation with inflammatory biomarkers in familial hypercholesterolemia (FH) subjects. Furthermore, we evaluated the agreement degree of imaging and inflammatory markers' severity used for coronary heart disease (CHD) prediction. Coronary calcium scores (CCS), carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV), C reactive protein (CRP) and white blood cells count (WBC) were determined in 89 FH patients (39+/-14 years, mean LDL-C=279 mg/dl) and in 31 normal subjects (NL). The following values were considered as imaging and biomarkers' severity: CCS>75th% for age and sex, IMT>900 microm, PWV>12 m/s, and CRP>3mg/l. Coronary artery calcification (CAC) prevalence and severity, IMT, PWV and WBC values were higher in FH than in NL (all parameters, p<0.05). After multivariate analysis, the following variables were considered independent determinants of (1) IMT: systolic blood pressure, 10-year CHD risk by Framingham risk scores (FRS) and apolipoprotein B (r(2)=0.33); (2) PWV: age (r(2)=0.35); (3) CAC as a continuous variable: male gender and LDL-cholesterol year score (LYS) (r(2)=0.32); (4) presence of CAC as dichotomous variable: FRS (p=0.0027) and LYS (p=0.0228). With the exception of a moderate agreement degree between IMT and PWV severity (kappa=0.5) all other markers had only a slight agreement level (kappa<0.1). In conclusion, clinical parameters poorly explained IMT, CAC and PWV variability in FH subjects. Furthermore, imaging markers and inflammatory biomarkers presented a poor agreement degree of their severity for CHD prediction.
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Calcinose/patologia , Doenças das Artérias Carótidas/patologia , Doença da Artéria Coronariana/patologia , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/patologia , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Pulsátil , Tomografia Computadorizada por Raios X , Túnica Íntima/patologia , Túnica Média/patologiaRESUMO
Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector row computed tomographic coronary angiography (CTCA). We studied five HoFH patients (three females, two males, mean age 19.8+/-2.9 years, age range 15-23 years, with a mean low density lipoprotein (LDL) cholesterol 618+/-211 mg/dL) using 64 slice CTCA. None of the patients showed evidence of ischemia with standard exercise testing. Calcified and mixed atherosclerotic plaques adjacent to or compromising the coronary artery ostia were found in all study subjects. Coronary plaques causing significant obstruction were found in one patient, who had previously undergone coronary artery bypass surgery and aortic valve replacement. Two other patients were noted to have non-obstructive calcified, mixed and non-calcified coronary artery plaques. Our data suggest that CTCA could be a useful non-invasive method for detection of early aortic and coronary atherosclerosis specifically affecting the coronary ostia in HoFH subjects.
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Aortografia/métodos , Calcinose/diagnóstico por imagem , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Hiperlipoproteinemia Tipo II/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adolescente , Adulto , Aorta/patologia , Aortografia/instrumentação , Vasos Coronários/patologia , Feminino , Humanos , Hiperlipoproteinemia Tipo II/complicações , Processamento de Imagem Assistida por Computador , Masculino , Tomografia Computadorizada Espiral/instrumentaçãoRESUMO
Our aim was to characterize HDL subspecies and fat-soluble vitamin levels in a kindred with familial apolipoprotein A-I (apoA-I) deficiency. Sequencing of the APOA1 gene revealed a nonsense mutation at codon -2, Q[-2]X, with two documented homozygotes, eight heterozygotes, and two normal subjects in the kindred. Homozygotes presented markedly decreased HDL cholesterol levels, undetectable plasma apoA-1, tuboeruptive and planar xanthomas, mild corneal arcus and opacification, and severe premature coronary artery disease. In both homozygotes, analysis of HDL particles by two-dimensional gel electrophoresis revealed undetectable apoA-I, decreased amounts of small alpha-3 migrating apoA-II particles, and only modestly decreased normal amounts of slow alpha migrating apoA-IV- and apoE-containing HDL, while in the eight heterozygotes, there was loss of large alpha-1 HDL particles. There were no significant decreases in plasma fat-soluble vitamin levels noted in either homozygotes or heterozygotes compared with normal control subjects. Our data indicate that isolated apoA-I deficiency results in marked HDL deficiency with very low apoA-II alpha-3 HDL particles, modest reductions in the separate and distinct plasma apoA-IV and apoE HDL particles, tuboeruptive xanthomas, premature coronary atherosclerosis, and no evidence of fat malabsorption.
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Apolipoproteína A-I/deficiência , Apolipoproteína A-I/genética , Hipolipoproteinemias/genética , Hipolipoproteinemias/metabolismo , Lipoproteínas HDL/química , Adulto , Idoso , Apolipoproteína A-I/sangue , Criança , Pré-Escolar , HDL-Colesterol/sangue , Feminino , Humanos , Hipolipoproteinemias/sangue , Lipoproteínas HDL/sangue , Masculino , Tamanho da Partícula , Linhagem , Xantomatose/metabolismoRESUMO
Our purpose is to provide a framework for diagnosing the inherited causes of marked high-density lipoprotein (HDL) deficiency (HDL cholesterol levels <10 mg/dL in the absence of severe hypertriglyceridemia or liver disease) and to provide information about coronary heart disease (CHD) risk for such cases. Published articles in the literature on severe HDL deficiencies were used as sources. If apolipoprotein (Apo) A-I is not present in plasma, then three forms of ApoA-I deficiency, all with premature CHD,and normal low-density lipoprotein (LDL) cholesterol levels have been described: ApoA-I/C-III/A-IV deficiency with fat malabsorption, ApoA-I/C-III deficiency with planar xanthomas, and ApoA-I deficiency with planar and tubero-eruptive xanthomas (pictured in this review for the first time). If ApoA-I is present in plasma at a concentration <10 mg/dL, with LDL cholesterol that is about 50% of normal and mild hypertriglyceridemia, a possible diagnosis is Tangier disease due to mutations at the adenosine triphosphate binding cassette protein A1 (ABCA1) gene locus. These patients may develop premature CHD and peripheral neuropathy, and have evidence of cholesteryl ester-laden macrophages in their liver, spleen, tonsils, and Schwann cells, as well as other tissues. The third form of severe HDL deficiency is characterized by plasma ApoA-I levels <40 mg/dL, moderate hypertriglyceridemia, and decreased LDL cholesterol, and the finding that most of the cholesterol in plasma is in the free rather than the esterified form, due to a deficiency in lecithin:cholesterol acyltransferase activity. These patients have marked corneal opacification and splenomegaly, and are at increased risk of developing renal failure, but have no clear evidence of premature CHD. Marked HDL deficiency has different etiologies and is generally associated with early CHD risk.
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A Hipercolesterolemia Familiar (HF) é uma doença caracterizada por aterosclerose precoce. Contudo, o curso clínico da doença coronária na HF é variável. A detecção da aterosclerose subclínica, pela espessura íntima média (IMT) carotídea, calcificação da artéria coronariana (CAC) e da rigidez arterial pela velocidade de onda de pulso (VOP) em portadores de HF pode ser útil na estratificação do risco cardiovascular. O objetivo primário deste estudo foi avaliar se existe correlação da CAC, IMT e VOP em portadores de HF. Como objetivos secundários, comparar estes marcadores de aterosclerose subclínica nos HF em relação a controles pareados por idade e sexo (CTRL) e avaliar quais são os principais fatores que influenciam a VOP carotídeo-femoral a IMT carotídea e a CAC, em pacientes com HF. Material e Métodos: Analisamos 89 HF (39±14 anos, 38% homens, LDL-c médio de 279 mg/dL) e 31 controles pareados para sexo e idade (CTRL) (LDL-c médio de 102mg/dL). Determinamos o IMT pela ultra-sonografia de alta definição tipo "echotracking" (Wall-Track System2), a VOP pelo método Complior®, CAC pela tomografia de múltiplos detectores, perfil lipídico e variáveis bioquímicas como Lp(a), PCR as, apoA1 e apoB. Foram calculados respectivamente o risco de DAC em 10 anos e a carga de exposição ao colesterol pelos escore de Framingham (ERF) e pelo índice LDL-c x idade (LYS). Resultados: Os HF apresentaram maior ERF (%) (7 ± 3 vs. 3 ± 3, p=0,002), maior prevalência de CAC (34% vs. 12%, p=0,024), maior IMT (micra m) (653 ± 160 vs 593 ±111, p=0,027), maior VOP (m/s) (9,2 ±1,5 vs. 8,5 ± 0,9, p=0.007) e glóbulos brancos mais elevados (x109 células/L) (7,2 ± 2,0 vs 6,4 ± 1,5, p=0,046) do que CTRL. Não foram observadas diferenças de PCR as respectivamente 1,7 (0,2-3,4 mg/L) e 1,3...
Familial hypercholesterolemia (FH) is associated with early onset of coronary heart disease (CHD). Detection of subclinical atherosclerosis (SCA) could be useful for risk stratification in FH subjects. The relationship among carotid, aortic and coronary SCA was not yet explored in FH. We studied the correlation among common carotid intima-media thickness (IMT), coronary artery calcification (CAC) and arterial stiffness (carotid-femoral pulse wave velocity-PWV) and their determinants in FH subjects. Methods: 89 FH subjects (39±14 Years, 38% male, median LDL-c = 279 mg/dL) and in 31 normal matched controls (NL) (median LDL-c 102mg/dL) were studied. IMT was determined by the Wall-Track System2, aortic stiffness (PWV) with the Complier® method, CAC prevalence and severity were measured by multidetector computed tomography. Clinical and laboratory variables (lipids, apolipoprotein AI and B, Lp(a), glucose, hsCRP and WBC) were determined. The 10-year CHD risk was calculated by Framingham scores (FRS) and the age-cholesterol burden by the LDL-cholesterol year score (LYS=LDL-c x age). Results: FH subjects had a greater FRS (%) (7 ± 3 vs. 3 ± 3, p=0.002), higher prevalence of CAC (34% vs. 12%, p=0.024), greater IMT values (micra m) (653 ± 160 vs 593 ±111, p=0.027), higher PWV (m/s) (9.2 ±1.5 vs. 8.5 ± 0.9, p=0.007) and white blood cels (x109 cels/L) (7.2 ± 2.0 vs 6.4 ± 1.5, p=0.046) than NL. No difference were found in median hsCRP levels (mg/L) respectively 1.7 (0.2-3.4) and 1.3 (0.2-8.0) p=n.s. for FH and NL. By multivariate analyses the following variables were independent determinants of: 1)IMT: systolic blood pressure (r2=0.36, p=0.045), FRS (r2=0.26, p=0.0001) and apolipoprotein B (r2=0.32, p=0.02). 2)PWV: age (r2=0.37, p=0.0001). 3)CAC as a continuous variable: male gender...
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Humanos , Masculino , Aterosclerose , Doenças das Artérias Carótidas , Hiperlipoproteinemia Tipo II , Artérias/fisiopatologia , Dislipidemias , TomografiaRESUMO
Although there are specific guidelines regarding the treatment of dyslipidemia in highly risk patients, these recommendations are usually inadequately followed. The aim of this study is to investigate risk factors in patients with increased cardiovascular risk currently treated in Brazil and Venezuela. Medical charts of 412 patients were selected in 4 institutions. Patients were divided into groups according to the use of lipid-lowering drugs (LLD), particularly statins. Patients who did not use LLD showed higher levels of total cholesterol (p< 0.001), LDL cholesterol (p< 0,001) and HDL cholesterol (p< 0.001), besides lower levels of triglycerides (p< 0.001). The use of statins was associated with a decrease in levels of total cholesterol (from 251.0 +/- 40.0 to 196.0 +/- 46.0), LDL cholesterol (from 168.0 +/- 36.0 to 116.0 +/- 39.0), HDL cholesterol (from 51.0 +/- 46.0 to 46.0 +/- 12.0) and triglycerides (from 181.0 +/- 120.0 to 160.0 +/-79.0). Finally, only a small percentage of patients, even those under treatment with LLD, showed cholesterol levels according to currently available guidelines. Therefore, although the guidelines for the treatment of dyslipidemia are widely known, only a small percentage of patients achieve adequate levels of cholesterol. It is necessary to decrease lipid levels of these patients by increasing the dose of the statins or using a second drug.
Assuntos
Doenças Cardiovasculares/etiologia , Hiperlipidemias/metabolismo , Lipídeos/sangue , Índice de Massa Corporal , Brasil , Doenças Cardiovasculares/diagnóstico , Colesterol/sangue , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/metabolismo , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Hipolipemiantes/metabolismo , Hipolipemiantes/uso terapêutico , Masculino , Estudos Retrospectivos , Fatores de Risco , VenezuelaRESUMO
Embora existam recomendações especificas envolvendo o tratamento das dislipidemias em pacientes com alto risco, estas recomendações dificilmente são seguidas adequadamente. O objetivo deste estudo é investigar fatores de risco em pacientes com alto risco cardiovascular acompanhados ambulatorialmente no Brasil e Venezuela. Os prontuários de 412 pacientes foram selecionados em 4 instituições. Os pacientes foram divididos conforme a utilização de hipolipemiantes. Pacientes sem hipolipemiantes apresentavam níveis mais elevados de colesterol total (p< 0,001), LDL colesterol (p< 0,001) e HDL colesterol (p< 0,001), além de menores níveis de triglicérides (p< 0,001). O uso de hipolipemiantes foi associado à diminuição dos níveis de colesterol total (251,0 ± 40,0 para 196,0 ± 46,0), LDL colesterol (168,0 ± 36,0 para 116,0 ± 39,0), HDL colesterol (51,0 ± 46,0 para 46,0 ± 12,0) e triglicérides (181,0 ± 120,0 para 160,0 ± 79,0). Concluímos que apenas um pequeno percentual de pacientes, mesmo em uso de estatinas, apresenta níveis de colesterol compatível com os atualmente recomendados. Desta forma, embora as recomendações para tratamento das dislipidemias sejam bem conhecidas, um pequeno percentual de pacientes atinge os valores desejados de colesterol. É necessário um melhor controle dos níveis lipídicos dos pacientes, tanto através da utilização de doses maiores de estatinas como da utilização da associação de hipolipemiantes.