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OBJECTIVES: The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. METHODS: We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). RESULTS: ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. CONCLUSIONS: Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.
Assuntos
Síndrome Coronariana Aguda/epidemiologia , Pacientes Ambulatoriais , Doença Arterial Periférica/epidemiologia , Trombose/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Doenças Assintomáticas , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Prevalência , Prognóstico , Sistema de Registros , Medição de Risco , Trombose/diagnóstico , Trombose/mortalidade , Fatores de Tempo , Adulto JovemRESUMO
Introducción: La detección y la cuantificación de la carga aterosclerótica por técnicas de imagen no invasiva es un marcador cada vez más usado en la evaluación y reestratificación del riesgo cardiovascular. La cuantificación de la carga de aterosclerosis para la evaluación del riesgo cardiovascular requiere por tanto una herramienta precisa, ya que el riesgo aumenta de manera proporcional a la carga de enfermedad subclínica. Objetivo: Profundizar en las técnicas de imagen no invasivas que permiten la cuantificación imaginológica de la carga aterosclerótica global en su fase subclínica y su importancia en la reevaluación precoz del riesgo cardiovascular. Desarrollo: Entre todas las modalidades de imagen, la puntuación de calcio coronario por tomografía axial computarizada y la cuantificación de la carga de aterosclerosis por ecografía vascular tridimensional han demostrado mejorar la valoración del riesgo cardiovascular individual por encima de las escalas de riesgo convencionales basadas en la presencia de factores de riesgo tradicionales, pues identifica directamente la enfermedad y reclasifica a los individuos de riesgo bajo e intermedio de manera más efectiva. Conclusiones: La cuantificación imaginológica no invasiva de la carga aterosclerótica mejora de manera significativa la exactitud y precisión en la predicción de las escalas de estimación del riesgo cardiovascular global universalmente validadas, pues incrementa su capacidad de discriminación y reclasificación de la población con riesgo de enfermedad cardiovascular(AU)
Introduction: The detection and quantification of the atherosclerotic burden by non-invasive imaging techniques is a marker increasingly used in the evaluation and re-stratification of cardiovascular risk. The quantification of the atherosclerosis burden for the assessment of cardiovascular risk therefore requires a precise tool, since the risk increases proportionally to the burden of subclinical disease. Objective: To deepen the non-invasive imaging techniques that allow the imaginological quantification of the global atherosclerotic burden in its subclinical phase and its importance in the early reassessment of cardiovascular risk. Development: Among all imaging modalities, the coronary calcium score by computed tomography and the quantification of the atherosclerosis burden by three-dimensional vascular ultrasound have been shown to improve the assessment of individual cardiovascular risk above conventional risk scales based on presence of traditional risk factors, since it directly identifies the disease and reclassifies individuals at low and intermediate risk more effectively. Conclusions: The non-invasive imaginological quantification of the atherosclerotic burden significantly improves the accuracy and precision in the prediction of the globally validated global cardiovascular risk estimation scales, as it increases their discrimination and reclassification capacity of the population at risk of cardiovascular disease(AU)
Assuntos
Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Fatores de RiscoRESUMO
The population is now living longer during the period classified as "elderly" (60 years and older), exhibiting multimorbidity associated to the lengthening of the average life span. The dietary intake of phenolic compounds (PC) may affect the physiology, disease development and progression during the aging process, reducing risk factors of age related diseases. The aim of this review is to briefly describe some of the possible effects of a series of PC on the reduction of risk factors of the onset of cardiovascular diseases, considering their potential mechanisms of action. The main actions described for PC are associated with reduced platelet activity, anti-inflammatory effects, and the protection from oxidation to reduce LDL and the generation of advanced glycation end products. Preclinical and clinical evidence of the physiological effects of various PC is presented, as well as the health claims approved by regulatory agencies.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Fenóis/farmacologia , Envelhecimento/efeitos dos fármacos , Envelhecimento/metabolismo , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Antioxidantes/química , Antioxidantes/farmacologia , Disponibilidade Biológica , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Suplementos Nutricionais , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Benefícios do Seguro , Fenóis/química , Inibidores da Agregação Plaquetária/química , Inibidores da Agregação Plaquetária/farmacologia , Fatores de RiscoRESUMO
The objective of the study was to identify risk factors for atherothrombosis in patients with chronic obstructive pulmonary disease on oxygen therapy. 62 patients of the UFU-HC Home Care program were included. COPD was diagnosed through clinical aspects added with an altered spirometry (FEV1/FVC ≤ 0.7 post BD). The following risk factors for atherothrombosis were evaluated: body composition (body weight, BMI, WCI), fasting glucose, plasmatic lipid profile (TC, LDL-C, HDL-C and triglycerides), tobacco use disorder, sedentarism, rest blood pressure, 6-minute walk test, CRP, FEV1, rest HR, hypoxemia and Framingham score. The mean weight (kg) was 59.3 ± 15.3 with a BMI of 24.4 ± 5.5 and WHR of 1.0 ± 0.1. The risk factors: TC, LDL-C, triglycerides, fasting glucose, systemic BP and tobacco use disorder were equally distributed between the groups and only HDL-C was significantly lower in men. The Framingham score was higher and with statistically significant variation in men. The other variables were also equally distributed between men and women, except the FEV1, which was lower in men. It was concluded that men with COPD on oxygen therapy have a higher Framingham score than women. The lower HDL-C and FEV1 in men represents an elevated risk for atherothrombosis. Lower FEV1, higher CRP and hypoxemia were found in the studied population and represent risk factors for atherothrombosis.
O objetivo do estudo foi identificar fatores de risco para aterotrombose em pacientes com DPOC em oxigenoterapia. Foram incluídos 62 pacientes do programa de Assistência Domiciliar HC - UFU. A DPOC foi diagnosticada através da clínica com alteração na espirometria (VEF1/CVF ≤ 0.7 pós BD). Foram avaliados os fatores de risco para aterotrombose: composição corporal (peso corporal, IMC e ICQ), glicemia de jejum, perfil lipídico plasmático (CT, LDL-C, HDL-C e triglicérides), tabagismo e carga tabágica, sedentarismo, pressão arterial sistêmica de repouso, teste de caminhada de 6 minutos, PCR, VEF1, FC repouso, hipoxemia e escore de Framingham. A média de peso (kg) foi 59,3 ± 15,3 com IMC de 24,4 ± 5,5 e ICQ de 1,0 ± 0,1. Os fatores de risco: elevação de TG, CT, LDL-C, glicemia de jejum, pressão arterial sistêmica e o tabagismo estavam, igualmente, distribuídos entre os grupos, sendo que, apenas o HDL-C foi significativamente mais baixo no homem. O escore de Framingham foi maior e com diferença estatisticamente significante no sexo masculino. As demais variáveis estudadas também estavam distribuídas entre homens e mulheres, igualmente, exceto quanto ao VEF1, que foi mais baixo no homem. Concluiu-se que homens com DPOC e em oxigenioterapia apresentam escore de Framingham mais elevado do que as mulheres. A redução de HDL-C e VEF1 em homens representa um acréscimo no risco para aterotrombose. O VEF1 reduzido, PCR aumentada e hipoxemia foram características encontradas em toda a população estudada e, também, representam fatores de risco para aterotrombose.
Assuntos
Humanos , Masculino , Feminino , Oxigenoterapia , Espirometria , Doença Pulmonar Obstrutiva Crônica , Sexo , Tabagismo , Diabetes Mellitus , Comportamento Sedentário , HipertensãoRESUMO
Introducción: La eriptosis se ha descrito como el proceso de muerte celular programada en el eritrocito antes de la senectud. Puede desencadenarse en situaciones como: el estrés osmótico, el estrés oxidativo, la exposición a metales pesados, entre otros factores. Diversos estudios sugieren que los eritrocitos pueden desempeñar un papel activo en la hemostasia normal o anormal en ciertas condiciones en las que se produce perturbación de la membrana de estas células. Objetivo: Describir los mecanismos involucrados en la eriptosis y su estrecha relación con los procesos de adhesión a la pared vascular que conllevan a la enfermedad trombótica. Método: Se hizo una revisión narrativa a partir de la literatura encontrada en las bases de datos PubMed y Science Direct utilizando las palabras claves. Se seleccionaron 51 artículos originales, 20 revisiones de la literatura y un estudio de casos, que se ajustaban a las exigencias del objetivo. Se revisaron los resúmenes de forma separada e independiente. Seguidamente se buscaron las publicaciones en el texto completo para la revisión. Conclusiones: La eriptosis se caracteriza por la disminución del volumen celular, la vesiculación y la translocación del fosfatidil serina hacia la superficie externa de la membrana plasmática. Las alteraciones en la distribución de los fosfolípidos favorecen los procesos de adhesión celular a la pared vascular, conllevando al deterioro de la microcirculación, lo cual puede ocasionar importantes trastornos a nivel cardiovascular. La comprensión y el esclarecimiento de la eriptosis pueden ser esenciales para la búsqueda de nuevas dianas terapéuticas, encaminadas a ofrecer otras alternativas farmacológicas en el tratamiento de la enfermedad cardiovascular.
Introduction: Eryptosis has been described as programmed process of cellular death in erythrocytes before old age. It can be triggered, among other factors, by situations such as osmotic stress, oxidative stress or exposure to heavy metals. Several studies suggest that erythrocytes can play an active role in normal or abnormal haemostasis in certain conditions where the membrane of these cells is perturbed. Objetive: To describe the mechanisms involved in eryptosis and their close relationship with the processes of adhesion to the vascular wall that entail the thrombotic disease. Methods: A narrative review was carried out from the literature found in data base PubMed and Science Direct by using the key words. 51 original articles, 20 literature reviews and one case study complying with the requirements were selected. Abstracts were reviewed separately and independently. Complete publications were then located for review. Conclusions: Eryptosis is characterised by the decrease in cell volume, the vesiculation and the translocation of phosphatidylserine towards the outer surface of the plasma membrane. Disorders in the distribution of the phospholipids favour processes of cell adhesion to the vascular wall, causing impairment of microcirculation, which can result in important cardiovascular diseases. Understanding and clarifying eryptosis could be essential for finding new therapeutic targets, aimed at offering other pharmacological alternatives for the treatment of cardiovascular diseases.
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Humanos , Apoptose , Células Sanguíneas , Doenças Cardiovasculares , Eriptose , LipídeosRESUMO
Thrombosis is the main outcome of many cardiovascular diseases. Current treatments to prevent thrombotic events involve the long-term use of antiplatelet drugs. However, this therapy has several limitations, thereby justifying the development of new drugs. A series of N-oxide derivatives (furoxan and benzofuroxan) were synthesized and characterized as potential antiplatelet/antithrombotic compounds. All compounds (3a,b, 4a,b, 8a,b, 9a,b, 13a,b and 14a,b) inhibited platelet aggregation induced by adenosine-5-diphosphate, collagen, and arachidonic acid. All compounds protected mice from pulmonary thromboembolism induced by a mixture of collagen and epinephrine; however, benzofuroxan derivatives (13a,b and 14a,b) were the most active compounds, reducing thromboembolic events by up to 80%. N-oxide derivative 14a did not induce genotoxicity in vivo. In conclusion, 14a has emerged as a new antiplatelet/antithrombotic prototype useful for the prevention of atherothrombotic events.
Assuntos
Benzoxazóis/síntese química , Benzoxazóis/farmacologia , Oxidiazóis/síntese química , Oxidiazóis/farmacologia , Inibidores da Agregação Plaquetária/síntese química , Embolia Pulmonar/prevenção & controle , Animais , Benzoxazóis/química , Colágeno/efeitos adversos , Modelos Animais de Doenças , Epinefrina/efeitos adversos , Humanos , Camundongos , Simulação de Acoplamento Molecular , Estrutura Molecular , Oxidiazóis/química , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/química , Inibidores da Agregação Plaquetária/farmacologia , Embolia Pulmonar/induzido quimicamenteRESUMO
INTRODUCTION: knowing patients 'believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations. OBJECTIVE: to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among patients with peripheral vascular diseases. METHODS: a survey was performed among patients of the National Institute of Angiology and Vascular Surgery from February through April 2007. The characteristics of the use of plants as medicinal remedies and the names of species considered useful for the treatment of diabetes, arterial hypertension and dyslipidemia were recorded. RESULTS: two hundred and forty five both sex adult volunteers (142 female/103 male), aged 44 to 72 years) were included in the study. More than 80 % of them used medicinal plants at least occasionally and confided on their efficacy to treat different illnesses Fifteen species, mainly Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq.., Morinda citrifolia L., Ocinum sanctum L and Salvia officinalis L, from 11 botanical families, were mentioned by participants. Most patients' claims about plants´ properties have been scientifically supported in some extent, nevertheless, the majority of the pharmacological evidence relays on pre-clinical studies and results of clinical trials are not conclusive. The lack of standardized plant preparations with identified active principles and demonstrated clinical effectiveness are limitations for recommending their therapeutic use. CONCLUSION: this study has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and confirmed that physicians should be aware about the possibility of herb-drug interactions that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice.
INTRODUCCIÓN: el conocimiento tradicional de los pacientes sobre la utilidad de las plantas medicinales puede servir de base para su educación en el uso racional de las preparaciones herbarias. OBJETIVO: caracterizar las plantas que los pacientes con enfermedades vasculares consideran útiles para el tratamiento de la diabetes, la hipertensión y como hipolipemiante. MÉTODOS: se realizó una encuesta a los pacientes del Instituto Nacional de Angiología y Cirugía Vascular entre febrero y abril de 2007. Las características del empleo de las plantas con fines medicinales y los nombres de las especies consideradas útiles para tratar la diabetes, la hipertensión arterial y la dislipidemia fueron tabulados. RESULTADOS: doscientos cuarenta y cinco adultos voluntarios de ambos sexos (142 femeninos/103 masculinos, edad 44 a 72 años) fueron incluidos en el estudio. Más del 80 % de ellos utilizaban las plantas medicinales al menos ocasionalmente y confiaban en su eficacia para tratar diferentes enfermedades. Quince especies, fundamentalmente Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq., Morinda citrifolia L., Ocinum sanctum L. y Salvia officinalis L., pertenecientes a 11 familias botánicas, fueron mencionadas por los participantes en la encuesta. La mayoría de los planteamientos de los pacientes sobre las propiedades de estas plantas tienen algún fundamento científico, sin embargo, las evidencias farmacológicas disponibles son fundamentalmente de tipo pre-clínico y los resultados de los ensayos clínicos efectuados no son concluyentes. La carencia de preparaciones derivadas de plantas estandarizadas, con principios activos identificados y efectividad clínica demostrada, son limitaciones para recomendar su utilización terapéutica. CONCLUSIONES: esta es la primera caracterización del uso de productos de plantas con fines medicinales por pacientes con enfermedades vasculares periféricas, y confirma que los facultativos deben conocer sobre la posibilidad de interacciones planta-medicamento que deben ser diagnosticadas. Esta información ayudaría a la integración de la Fitoterapia a la práctica clínica sustentada científicamente.
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Humanos , Plantas Medicinais/efeitos dos fármacos , Doenças Vasculares Periféricas/terapia , Dislipidemias/terapiaRESUMO
A aterotrombose é uma doença do sistema circulatório cujas manifestações clínicas mais significativas (infarto do miocárdio e acidente vascular encefálico) representam atualmente as principais causas de mortalidade, com expectativa de que sua incidência aumente nos próximos anos. O uso clínico de antiagregantes plaquetários encontra-se firmemente consolidado como terapia de escolha na prevenção primária e secundária de eventos clínicos relacionados à aterotrombose. A presente revisão tem como objetivo realizar uma descrição dos aspectos gerais da aterotrombose e dos principais fármacos antiagregantes plaquetários, com uma descrição breve de seus aspectos farmacodinâmicos e farmacocinéticos.
Atherothrombosis is a circulatory system disease whose most significant clinical manifestations (myocardial infarction and stroke) are today the leading causes of death worldwide, expected to increase over the coming years. The clinical use of antiplatelet agents is firmly established as the therapy of choice in primary and secondary prevention of clinical events related to atherothrombosis. This review offers a description of the general aspects of atherothrombosis and the main antiplatelet drugs,with a brief outline of their pharmacodynamic and pharmacokinetic aspects.