RESUMO
OBJECTIVE: Heart fat deposition has been linked to atherosclerosis, and both accelerate after menopause. Hormone therapy (HT) may differentially slow heart fat deposition and progression of atherosclerosis, depending on the specific HT agent or its route of administration. Our objective was to evaluate the effects of different HT agents, oral and transdermal, on associations between heart fat accumulation and atherosclerosis progression, measured by carotid intima-media thickness (CIMT), in recently menopausal women from the Kronos Early Estrogen Prevention Study (KEEPS) trial. METHODS: KEEPS was a randomized, placebo-controlled trial of the effects of 0.45âmg/d oral conjugated equine estrogens (o-CEE) or 50âmcg/d transdermal 17ß-estradiol (t-E2), compared with placebo, on 48 months progression of CIMT. Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) volumes were quantified by computed tomography. RESULTS: In all, 467 women (mean age [SD] 52.7 [2.5]; 78.2% White; 30% on o-CEE, 30.8% t-E2, 39.2% placebo) with heart fat volumes and CIMT at baseline and 48 months were included. EAT and PAT changes were not associated with CIMT progression; however, the assigned treatment significantly modified the association between PAT (but not EAT) change and CIMT progression. In the o-CEE group, adjusted CIMT progression was 12.66âµm (95% confidence interval [CI] 1.80, 23.52) lower than in t-E2 group (Pâ=â0.02), and 10.09âµm (95% CI 0.79, 19.39) lower than in placebo group (Pâ=â0.03), as per 1-SD increase in PAT. CONCLUSION: Compared with t-E2, o-CEE appears to slow down the adverse effect of increasing PAT on progression of atherosclerosis. Whether this beneficial association is specific to CEE or to the oral route of CEE administration is unclear and should be assessed further.
Assuntos
Aterosclerose/prevenção & controle , Doenças das Artérias Carótidas/prevenção & controle , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Estrogênios Conjugados (USP)/administração & dosagem , Estrogênios/administração & dosagem , Administração Cutânea , Administração Oral , Aterosclerose/etiologia , Doenças das Artérias Carótidas/etiologia , Espessura Intima-Media Carotídea , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Miocárdio/patologia , Pós-Menopausa/efeitos dos fármacos , Resultado do TratamentoRESUMO
BACKGROUND: Atrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without. METHODS AND RESULTS: A nested case-control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21-6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92-5.23). CONCLUSIONS: Women with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.
Assuntos
Fibrilação Atrial/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/fisiopatologia , Pessoa de Meia-Idade , Minnesota/epidemiologia , Obesidade/epidemiologia , Gravidez , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
Entende-se por assepsia o conjunto de meios usados para impedir a penetração de microorganismos em local que não os contenha. Devido a isto, devemos ter o máximo de cuidado nas manobras operatórias para evitar futuros riscos de infecção aos pacientes. Nas cirurgias odontológicas, devemos manter a assepsia do campo operatório. Para isto, é necessário cuidados com esterilização do material e instrumental, com a antissepsia do operador, da equipe cirúrgica e do local onde será feita a intervenção no paciente e com a desinfecção da sala operatória e do equipamento. Conseguimos alcançar estes objetivos lançando mão de princípios físicos (fornos de Pasteur, autoclaves e radição ultravioleta) e de princípios químicos (desinfetantes e antissépticos)