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Bahia L, Mello KF, Lemos LLP, Costa NL, Mulinari E, Malerbi DA. Cost-effectiveness of continuous glucose monitoring with FreeStyle Libre ® in Brazilian insulin-treated patients with types 1 and 2 diabetes mellitus. Diabetol Metab Syndr 2023; 15:242. [PMID: 38001509 PMCID: PMC10675900 DOI: 10.1186/s13098-023-01208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Hypoglycemia is a barrier to optimal glucose control in the treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Blood glucose monitoring is essential in diabetes management. Inappropriate glucose management is associated with high mortality and morbidity. FreeStyle Libre® (FSL) is a continuous glucose monitoring (CGM) system that provides effective, safe, and convenient glucose monitoring, without routine finger pricking. This study aims to estimate the incremental cost-effectiveness ratio (ICER) of the FSL system in comparison to conventional Self-monitoring of blood glucose (SMBG) in T1DM and T2DM patients that require intensive insulin therapy. METHODS A decision-tree model was developed to compare the cost-effectiveness ratio between FSL and conventional SMBG from the perspective of the Brazilian Public Healthcare System (SUS). The model captures the cumulative rates of acute complications such as severe hypoglicemia and diabetic ketoacidosis, per-event costs, and quality-adjusted life-years (QALYs) gained over a 1-year time horizon in adult and pediatric patients (≥ 4 years old) with T1DM or T2DM. Inputs from the Brazilian health databases, clinical trials, and real-world data were used in the study. RESULTS The results demonstrated that, regarding solely severe hypoglicemia and diabetic ketoacidosis events, T1DM have a QALY difference of 0.276, a cost difference of R$ 7.255, and an ICER of R$ 26,267.69 per QALY gained for CGM with FSL, when compared to conventional SMBG. T2DM results demonstrated equally a QALY difference of 0.184, a cost difference of R$ 7290, and an ICER of R$ 39,692.67 per QALY gained, in favour of CGM with FSL. CONCLUSION Our findings demonstrated that FSL is cost-effective in T1DM and T2DM for acute diabetic complications, from a SUS perspective. CGM with FSL can promote safe, convenient, and cost-effective glucose monitoring, therefore contributing to the improvement of the incidence of complications and quality of life.
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta-analysis on prevention and treatment of childhood obesity. J Pediatr (Rio J) 2019; 95:385-400. [PMID: 30121174 DOI: 10.1016/j.jped.2018.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.
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Affiliation(s)
- Luciana Bahia
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Medicina Interna, Rio de Janeiro, RJ, Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil
| | - Camila Wohlgemuth Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Karen Sparrenberger
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil.
| | - Gabriela de Azevedo Abreu
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Laura Augusta Barufaldi
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Brasília, DF, Brazil
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Medicina Interna, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta‐analysis on prevention and treatment of childhood obesity. Jornal de Pediatria (Versão em Português) 2019. [DOI: 10.1016/j.jpedp.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Sparrenberger K, Sbaraini M, Cureau FV, Teló GH, Bahia L, Schaan BD. Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents. Diabetol Metab Syndr 2019; 11:40. [PMID: 31149031 PMCID: PMC6534928 DOI: 10.1186/s13098-019-0435-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/15/2019] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. METHODS Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12-17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents ("ERICA"), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. RESULTS Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. CONCLUSION Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.
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Affiliation(s)
- Karen Sparrenberger
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul-Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Mariana Sbaraini
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Vogt Cureau
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul-Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Heiden Teló
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul-Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Luciana Bahia
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D. Schaan
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul-Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Bahia L, Kupfer R, Momesso D, Cabral DAP, Tschiedel B, Puñales M, Lavigne S, Façanha CFS, Forti AC, Mendes ADN, Tura BR. Health-related quality of life and utility values associated to hypoglycemia in patients with type 1 diabetes mellitus treated in the Brazilian Public Health System: a multicenter study. Diabetol Metab Syndr 2017; 9:9. [PMID: 28149328 PMCID: PMC5273819 DOI: 10.1186/s13098-017-0206-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affect the quality of life of diabetic patients. The aim of the study was to evaluate the health-related quality of life and calculate utilities values associated with hypoglycemia in patients with type 1 diabetes mellitus (T1DM). METHODS A multicenter, cross-sectional and observational study with T1DM patients from reference centers of the Brazilian public health system was conducted in three cities. Demographic and clinical data were collected, besides details on the frequency and severity of hypoglycemia. Health-related quality of life was assessed using EQ-5D instrument and utility values generated. RESULTS 221 patients (107 women, 114 men), aged 29.8 ± 11.6 and disease duration of 14.2 ± 9.1 years were included. Most patients (n = 214, 96.8%) reported at least one symptomatic hypoglycemia in the last three months, 68% (n = 150) reported nocturnal episodes and 34.8% (n = 77) reported severe episodes. High frequency (daily or weekly) was observed in 38.6 and 26% of those reporting nocturnal or severe hypoglycemia, respectively. The median visual analog scale was 70 [60-85] for all patients, with differences between those with and without severe hypoglycemia (70 [60-80] vs 80 [61-90]; p = 0.006) and those with high and low frequency (62.5 [50-72.25] vs 70 [60-80]; p = 0.007). The median utility values was 0.801 [0.756-1.000] for all patients, with difference between those with high and low frequency of severe episodes (0.737 [0.628-1.000] vs 0.801 [0.756-1.000]; p = 0.02). CONCLUSIONS This study shows the high frequency of hypoglycemia in a sample of T1DM patients treated in three reference centers of the Brazilian public health system and the impact of severe episodes on health-related quality of life. Utility values were generated and can be used in economic analysis for treatments that could decrease hypoglycemia and consequently improve quality of life.
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Affiliation(s)
- Luciana Bahia
- Universidade do Estado do Rio de Janeiro-UERJ, Rio de Janeiro, Brazil
- Visconde de Pirajá 547/501 Ipanema, Rio de Janeiro, 22410-003 Brazil
| | - Rosane Kupfer
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Denise Momesso
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Debora A. P. Cabral
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Balduino Tschiedel
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | - Marcia Puñales
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | - Suzana Lavigne
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | | | - Adriana C. Forti
- Centro de Diabetes e Hipertensão de Fortaleza-CIDH, Fortaleza, Brazil
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Coutinho ESF, Bahia L, Barufaldi LA, Abreu GDA, Malhão TA, Pepe CR, Araujo DV. Cost of diseases related to alcohol consumption in the Brazilian Unified Health System. Rev Saude Publica 2017; 50:S0034-89102016000100218. [PMID: 27305403 PMCID: PMC4902658 DOI: 10.1590/s1518-8787.2016050005741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/20/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.
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Affiliation(s)
- Evandro Silva Freire Coutinho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro RJ , Brasil, Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Luciana Bahia
- Universidade do Estado do Rio de Janeiro, Departamento de Medicina Interna, Universidade do Estado do Rio de Janeiro, Rio de Janeiro RJ , Brasil, Departamento de Medicina Interna. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Laura Augusta Barufaldi
- Ministério da Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília DF , Brasil, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília, DF, Brasil
| | - Gabriela de Azevedo Abreu
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ , Brasil, Instituto de Estudos em Saúde Coletiva. Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Thainá Alves Malhão
- Instituto Nacional do Câncer, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro RJ , Brasil, Unidade Técnica de Alimentação, Nutrição e Câncer. Coordenação de Prevenção e Vigilância. Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro, RJ, Brasil
| | - Camila Ribeiro Pepe
- Medinsight Decisions in Health Care, São Paulo SP , Brasil, Medinsight Decisions in Health Care. São Paulo, SP, Brasil
| | - Denizar Vianna Araujo
- Universidade do Estado do Rio de Janeiro, Departamento de Medicina Interna, Universidade do Estado do Rio de Janeiro, Rio de Janeiro RJ , Brasil, Departamento de Medicina Interna. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
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Takemoto MLS, Bahia L, Toscano CM, Araujo DV. Systematic review of studies on rotavirus disease cost-of-illness and productivity loss in Latin America and the Caribbean. Vaccine 2014; 31 Suppl 3:C45-57. [PMID: 23777691 DOI: 10.1016/j.vaccine.2013.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 04/12/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rotavirus is the most common cause of severe acute diarrhea among children in both developed and developing countries. Vaccination can reduce the disease burden and its incorporation into health care systems should consider future costs and benefits. OBJECTIVES To systematically review studies on costs due to rotavirus infection in Latin America and Caribbean (LAC) region, considering their methods and results. METHODS A search of relevant databases including the Cochrane Central Register of Controlled Trials, Embase, MEDLINE via PubMed, the Latin American and Caribbean Health Sciences Literature database (LILACS), and the Brazilian Thesis Databank was performed. Inclusion criteria for studies were: (a) economic evaluation or cost-of-illness studies; (b) conducted in the LAC region; (c) assess economic burden of rotavirus disease or the economic impact of rotavirus vaccination programs. Two authors independently screened the studies for eligibility. RESULTS Of 444 studies initially retrieved, 21 met the eligibility criteria and were included (14 cost-effectiveness analyses of vaccination programs and 7 cost-of-illness studies). Direct medical costs were assessed in all 21 studies, but only 10 also investigated indirect and non-medical direct costs. The most commonly observed methods for cost estimation were retrospective database analysis and hospital-based surveillance study. Only one study was a household-based survey.A wide cost range was identified (e.g., inpatient care US$79.91 to US$858.40 and outpatient care US$13.06 to US$64.10), depending on the methods, study perspective, and type of costs included. CONCLUSION Rotavirus-associated costs were assessed in 21 studies across the Latin America and Caribbean region. The majority of studies were made alongside economic evaluations of vaccination programs. Methods are broadly different among studies but administrative databases seem to be the most employed source of data.
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Bahia L, Toscano CM, Takemoto MLS, Araujo DV. Systematic review of pneumococcal disease costs and productivity loss studies in Latin America and the Caribbean. Vaccine 2014; 31 Suppl 3:C33-44. [PMID: 23777689 DOI: 10.1016/j.vaccine.2013.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 01/31/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pneumococcal disease is an important cause of morbidity and mortality associated with significant economic burden for healthcare systems and society. OBJECTIVES To systematically review pneumococcal disease cost of illness and productivity loss studies in the Latin America and Caribbean (LAC) region. METHODS A search of relevant databases was performed till November 2011. A broad and sensitive search strategy was used consisting of medical subject headings (MeSH) terms for pneumococcal disease, healthcare costs and productivity loss studies. No language restriction was applied. Only papers from LAC region and child population were analyzed. Additional exclusion criteria included duplicate studies, and insufficient information about methods. RESULTS A total of 1241 citations were retrieved. After applying the exclusion criteria, only 16 studies remained for analysis. There were 4 papers from Brazil, 3 from Argentina, 2 from Colombia, 2 from Mexico, 1 from Uruguay, 1 from Chile, and 3 analyzing a group of LAC countries. Only 4 were cost-of-illness studies, 11 were cost-effectiveness studies of pneumococcal vaccine and 1 study of the pneumococcal burden of disease. Methods used for quantifying health resource utilization and costing methods varied significantly among studies, as well as data sources considered. Productivity losses were considered in 8 studies, all of which used the human capital approach method. Pneumococcal disease cost estimates varied significantly depending on the pneumococcal syndromes considered, methods used, study perspective and type of costs included. CONCLUSION This systematic review reinforced the importance of standardization of methods for cost studies that can allow comparison and reproducibility in other settings. These estimates can be useful for future economic analysis conducted to support the decision making process on the introduction of new vaccines in LAC. However, caution must be taken, as methodological aspects of studies will result in estimates with varying levels of accuracy and external validity.
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Affiliation(s)
- Luciana Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Ferrazoli EG, Blanco MM, Bittencourt S, Bachi ALL, Bahia L, Soares MBP, Ribeiro-Dos-Santos R, Mello LE, Longo BM. Anticonvulsant activity of bone marrow cells in electroconvulsive seizures in mice. BMC Neurosci 2013; 14:97. [PMID: 24011127 PMCID: PMC3846761 DOI: 10.1186/1471-2202-14-97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 09/03/2013] [Indexed: 11/16/2022] Open
Abstract
Background Bone marrow is an accessible source of progenitor cells, which have been investigated as treatment for neurological diseases in a number of clinical trials. Here we evaluated the potential benefit of bone marrow cells in protecting against convulsive seizures induced by maximum electroconvulsive shock (MES), a widely used model for screening of anti-epileptic drugs. Behavioral and inflammatory responses were measured after MES induction in order to verify the effects promoted by transplantation of bone marrow cells. To assess the anticonvulsant effects of bone marrow cell transplantation, we measured the frequency and duration of tonic seizure, the mortality rate, the microglial expression and the blood levels of cytokine IL-1, IL-6, IL-10 and TNF-α after MES induction. We hypothesized that these behavioral and inflammatory responses to a strong stimulus such as a convulsive seizure could be modified by the transplantation of bone marrow cells. Results Bone marrow transplanted cells altered the convulsive threshold and showed anticonvulsant effect by protecting from tonic seizures. Bone marrow cells modified the microglial expression in the analyzed brain areas, increased the IL-10 and attenuate IL-6 levels. Conclusions Bone marrow cells exert protective effects by blocking the course of electroconvulsive seizures. Additionally, electroconvulsive seizures induced acute inflammatory responses by altering the pattern of microglia expression, as well as in IL-6 and IL-10 levels. Our findings also indicated that the anticonvulsant effects of these cells can be tested with the MES model following the same paradigm used for drug testing in pharmacological screening. Studies on the inflammatory reaction in response to acute seizures in the presence of transplanted bone marrow cells might open a wide range of discussions on the mechanisms relevant to the pathophysiology of epilepsies.
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Affiliation(s)
- Enéas Galdini Ferrazoli
- Laboratório de Neurofisiologia, Departamento de Fisiologia, Federal University of São Paulo - UNIFESP, R, Botucatu, 862 5 andar, V, Clementino - CEP, 04023-066, São Paulo, Brazil.
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Bahia L, Coutinho ESF, Barufaldi LA, de Azevedo Abreu G, Malhão TA, Ribeiro de Souza CP, Araujo DV. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study. BMC Public Health 2012; 12:440. [PMID: 22713624 PMCID: PMC3416687 DOI: 10.1186/1471-2458-12-440] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/16/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS). METHODS Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥ 1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥ 18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010). RESULTS The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. CONCLUSION The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.
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Affiliation(s)
- Luciana Bahia
- Internal Medicine Department, State University of Rio de Janeiro (UERJ) and National Institute of Science and Technology for Health Technology Assessment (IATS) – CNPq/Brazil, Blv. 28 de Setembro 77 – 3rd floor – room 329, Vila Isabel, ZIP 20551-030, Rio de Janeiro/RJ, Brazil
| | - Evandro Silva Freire Coutinho
- National School of Public Health, Oswaldo Cruz Foundation (Fiocruz), Leopoldo Bulhões Street, 1480, Manguinhos, ZIP 21041-210, Rio de Janeiro/RJ, Brazil
| | - Laura Augusta Barufaldi
- Institute for Studies in Public Health, Federal University of Rio de Janeiro (UFRJ), Blv. Horácio Macedo, No number - Fundão Island, University City, ZIP 21941-598, Rio de Janeiro/RJ, Brazil
| | - Gabriela de Azevedo Abreu
- Institute for Studies in Public Health, Federal University of Rio de Janeiro (UFRJ), Blv. Horácio Macedo, No number - Fundão Island, University City, ZIP 21941-598, Rio de Janeiro/RJ, Brazil
| | - Thainá Alves Malhão
- City Department of Health and Civil Defense of Rio de Janeiro (SMSDC-RJ), Afonso Cavalcanti Street, 455, 8th floor, room 801, New Town, ZIP 20211-110, Rio de Janeiro/RJ, Brazil
| | | | - Denizar Vianna Araujo
- Internal Medicine Department, State University of Rio de Janeiro (UERJ) and National Institute of Science and Technology for Health Technology Assessment (IATS) – CNPq/Brazil, Blv. 28 de Setembro 77 – 3rd floor – room 329, Vila Isabel, ZIP 20551-030, Rio de Janeiro/RJ, Brazil
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Longo B, Romariz S, Blanco MM, Vasconcelos JF, Bahia L, Soares MBP, Mello LE, Ribeiro-dos-Santos R. Distribution and proliferation of bone marrow cells in the brain after pilocarpine-induced status epilepticus in mice. Epilepsia 2010; 51:1628-32. [PMID: 20384764 DOI: 10.1111/j.1528-1167.2010.02570.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The distribution of bone marrow cells in brain areas during the acute period after pilocarpine-induced status epiepticus (SE) was investigated here. To achieve this, we generated chimeric mice by engrafting bone marrow cells from enhanced green fluorescent protein (eGFP) transgenic mice. GFP(+) bone marrow-derived cells were found throughout the brain, predominantly in the hippocampus. As expected, these cells exhibited the characteristics of microglia. The pattern of distribution, proliferation, and differentiation of GFP(+)cells changes as a function of intensity and time following SE. This pattern is also a consequence of the inflammatory response, which is followed by the progressive neuronal damage that is characteristic of the pilocarpine model.
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Affiliation(s)
- Beatriz Longo
- Laboratório de Engenharia Tecidual e Imunofarmacologia, CPqGM/FIOCRUZ, Bahia, Brazil
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Bahia L, Aguiar LGK, Villela N, Bottino D, Godoy-Matos AF, Geloneze B, Tambascia M, Bouskela E. Adiponectin is associated with improvement of endothelial function after rosiglitazone treatment in non-diabetic individuals with metabolic syndrome. Atherosclerosis 2007; 195:138-46. [PMID: 17084402 DOI: 10.1016/j.atherosclerosis.2006.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 08/10/2006] [Accepted: 09/06/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The risks of metabolic syndrome (MetSyn) rely on the interaction between insulin resistance, metabolic abnormalities, inflammation and vascular dysfunction. Insulin sensitizers counteract some of these abnormalities. The objective of this study was to evaluate the effects of rosiglitazone (ROSI) on vascular reactivity, adipokines and inflammatory markers in a group of non-diabetic subjects with MetSyn. METHODS AND RESULTS Thirty subjects with NCEP-ATPIII criteria for MetSyn and eight healthy subjects were studied at baseline and 18 subjects with MetSyn were treated with ROSI 8 mg/day for 24 weeks. Venous occlusion plethysmography exams before and during intra-arterial infusions of acetylcholine and sodium nitroprusside were performed to assess endothelial-dependent and independent vasodilation. Forearm blood flow (FBF) and vascular resistance (VR) responses were analyzed. Treatment with ROSI improved endothelial function (235% increment in FBF; p<0.01 and 56% decrement in VR; p=0.01), adiponectin (7.3[3.6-17.9] versus 37.9[19.3-42.4]; p<0.01), HOMA-IR (3.5+/-1.2 versus 2.7+/-1.6; p<0.05), C-reactive protein (CRP) (1.05[0.57-2.07] versus 0.3[0.2-0.8]; p<0.01) and fibrinogen (3.1+/-0.73 versus 2.62+/-0.64; p<0.05) levels. The difference between groups on endothelial-dependent vasodilation, adiponectin and CRP levels disappeared after treatment and the improvement of endothelial function was associated with the increment of adiponectin levels. CONCLUSION ROSI treatment restored endothelial function in MetSyn subjects, probably through an adiponectin-mediated process.
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Affiliation(s)
- Luciana Bahia
- Laboratório de Pesquisas em Microcirculação (LPM), Department of Physiological Sciences, Institute of Biology Roberto Alcântara Gomes, State University of Rio de Janeiro, Brazil.
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Kraemer de Aguiar LG, Laflor CM, Bahia L, Villela NR, Wiernsperger N, Bottino DA, Bouskela E. Metformin improves skin capillary reactivity in normoglycaemic subjects with the metabolic syndrome. Diabet Med 2007; 24:272-9. [PMID: 17263761 DOI: 10.1111/j.1464-5491.2007.02082.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Insulin resistance and a parental history of diabetes mellitus are independently associated with endothelial dysfunction. Oxidative stress has a pivotal role in the pathophysiology of vascular injury. Metformin, in addition to its glucose-lowering properties, has vasculoprotective effects. We investigated whether metformin has beneficial effects on the nutritive skin capillary circulation and deceases oxidative stress in a group at high risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease. METHODS Thirty normoglycaemic subjects with the metabolic syndrome (MS),who had first-degree relatives with T2DM, participated. The mean age was 39.1 +/- 8.4 years and body mass index (BMI) 35.7 +/- 4.8 kg/m2 (mean +/- SD). SUBJECTS were randomized 1 : 1 to receive placebo (n=14) or metformin (n=16; 1700 mg/day) in a double-blind study. At baseline and post treatment, blood and urine samples were collected for biochemical and 8-epi-prostaglandin F2alpha (8-epi-PGF2alpha) analysis, respectively. Microcirculation was assessed by nailfold videocapillaroscopy, analysing afferent (AF), efferent (EF) and apical (AP) diameters of capillary loops, functional capillary density (FCD), red blood cell velocity at rest (RBCV), after 1 min arterial occlusion (RBCVmax) and time (TRBCVmax)taken to reach it. RESULTS Groups did not differ significantly in anthropometric, clinical, laboratory or microvascular measurements at baseline. In the metformin group, weight,BMI, systolic blood pressure and fasting plasma glucose fell, and lipid profile and microcirculatory parameters FCD, AF, EF, AP, RBCVmaxand TRBCVmax improved (all P<0.01). No relationship between clinico-laboratory parameters and microvascular reactivity was observed, except for changes in total and low density lipoprotein-cholesterol and RBCVmax* 8-epi-PGF2alpha did not change significantly in either group. CONCLUSIONS Metformin improved skin capillary reactivity in normoglycaemic MS subjects independently of significant changes in 8-epi-PGF2alpha levels.
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Affiliation(s)
- L G Kraemer de Aguiar
- Department of Physiological Sciences, Laboratóriode Pesquisas em Microcirculação, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Bahia L, Aguiar LG, Villela N, Bottino D, Godoy-Matos AF, Geloneze B, Tambascia M, Bouskela E. Relationship between adipokines, inflammation, and vascular reactivity in lean controls and obese subjects with metabolic syndrome. Clinics (Sao Paulo) 2006; 61:433-40. [PMID: 17072441 DOI: 10.1590/s1807-59322006000500010] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 07/18/2006] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Metabolic syndrome is an important risk factor for cardiovascular disease. Adipokines interfere with insulin action and endothelial cell function. We investigated the relationship among adipokines, metabolic factors, inflammatory markers, and vascular reactivity in obese subjects with metabolic syndrome and lean controls. METHODS Cross-sectional study of 19 obese subjects with metabolic syndrome and 8 lean volunteers evaluated as controls. Vascular reactivity was assessed by venous occlusion pletysmography measuring braquial forearm blood flow (FBF) and vascular resistance (VR) responses to intra-arterial infusions of endothelium-dependent (acetylcholine-Ach) and independent (sodium nitroprusside-SNP) vasodilators. Blood samples were obtained to evaluate C reactive protein (CRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, adiponectin, resistin, and lipid profile. Patients were classified with regard to insulin resistance through the HOMA-IR index. RESULTS PAI-1, CRP and fibrinogen were higher and adiponectin was lower in metabolic syndrome subjects compared to controls. Metabolic syndrome subjects had impaired vascular reactivity. Adiponectin and PAI-1 were associated with insulin, HOMA-IR, triglycerides, and HDLc; and resistin with CRP. Adiponectin was associated with VR after Ach in the pooled group and resistin with D FBF after Ach in the metabolic syndrome group. CONCLUSION Metabolic syndrome subjects exhibited low levels of adiponectin and high levels of CRP, fibrinogen, and PAI-1. Adiponectin and PAI-1 correlated with insulin resistance markers. Adiponectin and resistin correlated with vascular reactivity parameters. An adipocyte-endothelium interaction might be an important mechanism of inflammation and vascular dysfunction.
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Affiliation(s)
- Luciana Bahia
- Department of Physiological Sciences, Institute of Biology Roberto Alcântara Gomes, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Bahia L, Aguiar LGK, Villela N, Bottino D, Godoy-Matos AF, Bouskela E. Efeitos da rosiglitazona sobre a função endotelial em indivíduos não-diabéticos com síndrome metabólica. Arq Bras Cardiol 2006; 86:366-73. [PMID: 16751941 DOI: 10.1590/s0066-782x2006000500007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effects of rosiglitazone (ROSI), an insulin-sensitizer, on endothelial function and endothelial activation markers in a group of non-diabetic subjects with metabolic syndrome. METHODS A group of eighteen subjects (12 women, 6 men), mean age 41.2 +/- 9.7 and BMI 37.8 +/- 6.1 Kg/m2, was treated with rosiglitazone 8 mg/day for 12 weeks. Another group of nine healthy subjects, mean age 26.1 +/- 4.4 and BMI 21.7 +/- 1.7 Kg/m2, was studied at baseline to compare vasodilator response. Endothelial function was evaluated by venous occlusion plethysmography after intra-arterial infusions of acetylcholine (Ach) and sodium nitroprusside (SNP). The following were measured: glucose, insulin, lipids, fibrinogen, and high-sensitivity C-reactive protein (CRP). HOMA and Quicki indexes were calculated to quantify insulin resistance (IR). RESULTS There was an improvement in insulin resistance, as evidenced by lower HOMA-R and higher QUICKI index, as well as a decrease in CRP and fibrinogen levels. Endothelium-dependent vasodilation also improved, as evidenced by greater increment in blood flow after Ach and greater decrement in vascular resistance. No difference in endothelium-independent vasodilation was noted. CONCLUSION Rosiglitazone treatment reduced insulin resistance, fibrinogen, and CRP levels and improved endothelial function in non-diabetic subjects with metabolic syndrome. These data suggest that rosiglitazone plays a role in the regulation of endothelial function in patients at high cardiovascular risk.
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Affiliation(s)
- Luciana Bahia
- Laboratório de Pesquisas em Microcirculação, Universidade do Estado do Rio de Janeiro, RJ.
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Abstract
O endotélio é responsável pela manutenção da homeostase vascular. Em condições fisiológicas, mantém o tônus vascular, o fluxo sangüíneo laminar, a fluidez da membrana plasmática, o equilíbrio entre coagulação e fibrinólise, a inibição da proliferação e da migração celulares e o controle da resposta inflamatória. A disfunção endotelial é definida como uma alteração do relaxamento vascular por diminuição da biodisponibilidade de fatores de relaxamento derivados do endotélio, principalmente o óxido nítrico (NO). Estas respostas vasomotoras anormais ocorrem na presença de inúmeros fatores de risco para a aterosclerose. A síndrome metabólica é considerada um estado de inflamação crônica que se acompanha de disfunção endotelial e ocasiona aumento na incidência de eventos isquêmicos cardiovasculares e elevada mortalidade. Essa revisão abordará o processo fisiológico de regulação da função vascular pelo endotélio, os métodos disponíveis para avaliação in vivo da disfunção endotelial e as terapias capazes de melhorar a função vascular e conseqüentemente minimizar o risco cardiovascular dessa síndrome tão prevalente no nosso meio.
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Affiliation(s)
- Luciana Bahia
- Laboratório de Pesquisas em Microcirculação, Universidade do Estado do Rio de Janeiro/UERJ [corrected]
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Villela NR, Aguiar LGK, Bahia L, Bottino D, Bouskela E. Does endothelial dysfunction correlate better with waist-to-hip ratio than with body mass index or waist circumference among obese patients? Clinics (Sao Paulo) 2006; 61:53-8. [PMID: 16532226 DOI: 10.1590/s1807-59322006000100010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Obesity is associated with cardiovascular disease, affecting large arteries and the microcirculation. Waist circumference and body mass index are routinely employed as measures for assessing obesity-related health risk, whereas waist-to-hip ratio is not. We aimed to investigate the association between brachial vascular reactivity and body mass index, waist circumference, and waist-to-hip ratio. METHODS Eighty-five volunteers (21 men/66 women), aged between 20 and 55 years, underwent determination of waist circumference, body mass index, waist-to-hip ratio, and endothelial function by venous occlusion plethysmography. Forearm blood flow was measured in response to intrabrachial artery infusions of 3 different concentrations of endothelium-dependent (acetylcholine 7.5, 15, and 30 mg/min) and endothelium-independent (sodium nitroprusside 2, 4, and 8 mg/min) vasodilators. RESULTS There was an inverse correlation of body mass index and waist circumference with forearm blood flow increments after acetylcholine and sodium nitroprusside infusions, while waist-to-hip ratio showed an inverse correlation with forearm blood flow increments only after acetylcholine. When subjects older than 40 years (n = 25) were excluded from the analysis, the inverse correlation of body mass index with forearm blood flow increments after acetylcholine infusion no longer existed, while waist circumference and waist-to-hip ratio showed the same results observed before. CONCLUSION The waist-to-hip ratio is probably a better estimator of endothelial dysfunction and possibly of cardiovascular risk than body mass index. These findings underscore the importance of routinely collecting hip circumference as an obesity index and risk estimator.
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Affiliation(s)
- Nivaldo Ribeiro Villela
- Laboratório de Pesquisas em Microcirculação, Universidade do Estado do Rio de Janeiro, RJ, Brazil
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Bahia L, Gomes MB, da Cruz P di M, Gonçalves MDF. Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus. Arq Bras Cardiol 1999; 73:11-22. [PMID: 10684138 DOI: 10.1590/s0066-782x1999000700002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the frequency of coronary artery disease, microalbuminuria and the relation to lipid profile disorders, blood pressure and clinical and metabolic features. METHODS Fifty-five type 2 diabetic patients (32 females, 23 males), aged 59.9 +/- 9 years and with known diabetes duration of 11 +/- 7.3 years were studied. Coronary artery disease (CAD) was defined as a positive history of myocardial infarction, typical angina, myocardial revascularization or a positive stress testing. Microalbuminuria was defined when two out of three overnight urine samples had a urinary albumin excretion ranging 20-200 micrograms/min. RESULTS CAD was present in 24 patients (43.6%). High blood pressure (HBP) present in 32 patients (58.2%) and was more frequent in CAD group (p = 0.05) HBP. Increased the risk of CAD 3.7 times (CI[1.14-12]). Microalbuminuria was present in 25 patients (45.5%) and tended to associate with higher systolic blood pressure (SBP) (p = 0.06), presence of hypertension (p = 0.06) and known diabetes duration (p = 0.08). In the stepwise multiple logistic regression the systolic blood pressure was the only variable that influenced UAE (r = 0.39, r2 = 0.14, p = 0.01). The hypertensive patients had higher cholesterol levels (p = 0.04). CONCLUSION In our sample the frequency of microalbuminuria, hypertension, hypercholesterolemia and CHD was high. Since diabetes is an independent risk factor for cardiovascular disease, the association of others risk factors suggest the need for an intensive therapeutic intervention in primary and in secundary prevention.
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Affiliation(s)
- L Bahia
- Internal Medicine Department, UERJ, Brazil
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