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Costa FC, Gomes LG, de Lima TM, Bortolotto LA, Hong V, Verardino R, de Souza Rocha M, Ueda SKN, de Miranda MC, de Souza HP, Latronico AC, Mendonca BB, Bachega TASS. Cardiovascular risk in women with nonclassical congenital adrenal hyperplasia. J Clin Endocrinol Metab 2024:dgae155. [PMID: 38466890 DOI: 10.1210/clinem/dgae155] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
CONTEXT The outcomes related to cardiovascular risk (CVR) in patients with nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids (GCs) or oral contraceptive pills. OBJECTIVES to analyze CVR by markers of atherosclerosis in females with nonclassical form according to therapeutic options. DESIGN AND SETTING a cross-sectional study at a tertiary center. PATIENTS AND METHODS Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into: G1 (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day); G2 (n = 19) with oral contraceptive pills; and G3 (30 matched controls). CVR was analyzed through serum lipids, HOMA-IR, inflammatory cytokines levels and quantitative image evaluations (pulse wave velocity-PWV, endothelial function by flow mediated dilatation-FMD, carotid intima media thickness-CIMT and visceral fat-VAT by abdominal tomography. RESULTS There were no statistically significant differences in BMI, HOMA-IR, HDL-cholesterol, or triglyceride levels among groups (p > 0.05). Serum interleukin-6 levels were higher in G1 than in G2 (p = 0.048), and interleukin-8 levels were higher in G1 than in G2/3 (p = 0.008). There were no statistically significant differences in VAT, PWV, FMD or CIMT among groups (p > 0.05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes. CONCLUSION Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and 8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.
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Affiliation(s)
- Fernanda Cavalieri Costa
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Garcia Gomes
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Martins de Lima
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Valeria Hong
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Renata Verardino
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Manoel de Souza Rocha
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Serli Kiyomi Nakao Ueda
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mirela Costa de Miranda
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Heraldo Possolo de Souza
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tania A S S Bachega
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Wolff Gowdak LH, Galvão De Lima JJ, Adam EL, Kirnew Abud Manta IC, Reusing JO, David-Neto E, Machado César LA, Bortolotto LA. Coronary Artery Disease Assessment and Cardiovascular Events in Middle-Aged Patients on Hemodialysis. Mayo Clin Proc 2024; 99:411-423. [PMID: 38159095 DOI: 10.1016/j.mayocp.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/03/2022] [Revised: 04/03/2023] [Accepted: 05/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To explore whether, in younger patients on dialysis with longer life expectancy, assessment of coronary artery disease (CAD) could identify individuals at higher risk of events and revascularization might improve outcomes in selected patients contrary to what had been observed in elderly patients. METHODS From August 1997 to January 2019, 2265 patients with stage 5 chronic kidney disease were prospectively referred for cardiovascular assessment. For this study, we selected 1374 asymptomatic patients aged between 18 and 64 years. After clinical risk stratification and cardiac scintigraphy by single-photon emission computed tomography, 866 patients underwent coronary angiography. The primary end point was the composite incidence of nonfatal/fatal major adverse cardiovascular events during a follow-up period of 0.1 to 189.7 months (median, 26 months). The secondary end point was all-cause mortality. RESULTS The primary end point occurred in 327 (23.8%) patients. Clinically stratified high-risk patients had a 3-fold increased risk of the primary end point. The prevalence of abnormal findings on perfusion scans was 29.2% (n=375), and significant CAD was found in 449 (51.8%) of 866 patients who underwent coronary angiography. An abnormal finding on myocardial perfusion scan and the presence of CAD were significantly associated with a 74% and 22% increased risk of cardiovascular events, respectively. In patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n=99), there was an 18% reduction in the risk of all-cause death relative to patients receiving medical treatment (P=.03). CONCLUSION In this cohort of middle-aged, asymptomatic patients on dialysis, assessment of CAD identified individuals at higher risk of events, and coronary intervention was associated with reducing the risk of death in selected patients.
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Affiliation(s)
- Luís Henrique Wolff Gowdak
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
| | - José Jayme Galvão De Lima
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo Leal Adam
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - José Otto Reusing
- Renal Transplantation Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Elias David-Neto
- Renal Transplantation Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Antonio Machado César
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Snyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V, Borghi C. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens 2024; 42:136-142. [PMID: 37728093 PMCID: PMC10712996 DOI: 10.1097/hjh.0000000000003570] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
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Affiliation(s)
- Jacques R. Snyman
- Forte Research (Pty ltd) and Private Practice South Africa, Pretoria, South Africa
| | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Valentina Perrone
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy
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Machado MF, Muela HCS, Costa-Hong VA, Panerai RB, Yassuda MS, Moraes NC, Memória CM, Bor-Seng-Shu E, Nitrini R, Bortolotto LA, Nogueira RDC. Measurement of resistance-area product by transcranial Doppler: An alternative tool for cognitive screening in hypertensive on drug treatment? Cereb Circ Cogn Behav 2023; 5:100191. [PMID: 38046105 PMCID: PMC10692755 DOI: 10.1016/j.cccb.2023.100191] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/02/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
Introduction Arterial hypertrophy and remodeling are adaptive responses present in systemic arterial hypertension that can result in silent ischemia and neurodegeneration, compromising brain connections and cognitive performance (CP). However, CP is affected differently over time, so traditional screening methods may become less sensitive in assessing certain cognitive domains. The study aimed to evaluate whether cerebrovascular hemodynamic parameters can serve as a tool for cognitive screening in hypertensive without clinically manifest cognitive decline. Methods Participants were allocated into groups: non-hypertensive (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. Measurements of blood pressure and middle cerebral artery blood flow velocity were obtained from digital plethysmography and transcranial Doppler. For the cognitive assessment, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and a broad neuropsychological battery were applied. Results Patients in groups 2 and 3 show no significant differences in most of the clinical-epidemiological variables or pulsatility index (p = 0.361), however compared to group 1 and 2, patients in group 3 had greater resistance-area product [RAP] (1.7 [±0.7] vs. 1.2 [±0.2], p < 0.001). There was a negative correlation between RAP, episodic memory (r = -0.277, p = 0.004) and cognitive processing speed (r = -0.319, p = 0.001). Conclusion RAP reflects the real cerebrovascular resistance, regardless of the direct action of antihypertensive on the microcirculation, and seems to be a potential alternative tool for cognitive screening in hypertensive.
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Affiliation(s)
- Michel Ferreira Machado
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | | | | | | | - Monica S. Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo Medical School, Brazil
| | - Natalia Cristina Moraes
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Claudia Maia Memória
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Edson Bor-Seng-Shu
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
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Paradela RS, Cabella B, Nucci MP, Ferreira NV, Torres LA, Martino LM, Consolim-Colombo FM, Bortolotto LA, da Costa DI, Irigoyen MC. Computerized working memory training for hypertensive individuals with executive function impairment: a randomized clinical trial. Front Neurosci 2023; 17:1185768. [PMID: 37483358 PMCID: PMC10361818 DOI: 10.3389/fnins.2023.1185768] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Background Hypertension is associated with working memory (WM) impairment. However, the benefits of Cogmed WM training for the hypertensive population are unknown. Therefore, we aimed to evaluate Cogmed's effects on the WM performance of hypertensive individuals with executive function (EF) impairment. Methods We included 40 hypertensive patients (aged 40-70 years, 68% female) with EF impairment. They were randomized in a 1:1 ratio to receive 10 weeks of adaptive Cogmed training or a non-adaptive control training based on online games. The primary outcome was the WM performance. The secondary outcomes were verbal memory, visuospatial ability, executive function, global cognition, and the neuronal activity measured using functional magnetic resonance imaging (fMRI) under two WM task conditions: low (memorization of 4 spatial locations) and high (memorization of 6 spatial locations). An intention-to-treat (ITT) and per-protocol (PP) analysis were performed. Results Cogmed did not show a significant effect on WM or any other cognitive outcome post-training. However, under the WM-low load and WM-high load conditions of the fMRI, respectively, the Cogmed group had an activation decrease in the right superior parietal lobe (ITT and PP analyses) and left inferior frontal lobe (PP analysis) in comparison to the control group. Conclusion The Cogmed showed no effects on the WM performance of hypertensive individuals with EF impairment. However, activation decreases were observed in frontoparietal areas related to the WM network, suggesting a more efficient neuronal activity after training.
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Affiliation(s)
- Regina Silva Paradela
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Brenno Cabella
- Institute of Theoretical Physics, São Paulo State University (IFT-UNESP), São Paulo, Brazil
| | - Mariana Penteado Nucci
- Laboratory of Medical Investigations on Magnetic Resonance Imaging (LIM-44), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Naomi Vidal Ferreira
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Research Affairs Office, Amazonia Adventist College, Benevides, Pará, Brazil
| | - Laura Aló Torres
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiza Menoni Martino
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Aparecido Bortolotto
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Danielle Irigoyen da Costa
- Brain Institute (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Claudia Irigoyen
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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6
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Borghi C, Jayagopal PB, Konradi A, Bortolotto LA, Degli Esposti L, Perrone V, Snyman JR. Adherence to Triple Single-Pill Combination of Perindopril/Indapamide/Amlodipine: Findings from Real-World Analysis in Italy. Adv Ther 2023; 40:1765-1772. [PMID: 36829102 PMCID: PMC10070199 DOI: 10.1007/s12325-023-02451-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.
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Affiliation(s)
- Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy.
| | | | - Alexandra Konradi
- Almazov National Medical Research Center, St. Petersburg, Russian Federation
| | | | - Luca Degli Esposti
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Jacques R Snyman
- Forte Research (Pty Ltd) and Private Practice, Pretoria, South Africa
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Cunha FS, Bachega TASS, Costa EMF, Brito VN, Alvares LA, Costa-Hong VA, Verardino RGS, Sircili MHP, de Mendonça BB, Bortolotto LA, Domenice S. Arterial Stiffness in Transgender Men Receiving Long-Term Testosterone Therapy. J Endocr Soc 2023; 7:bvad040. [PMID: 37063700 PMCID: PMC10096903 DOI: 10.1210/jendso/bvad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/19/2023] Open
Abstract
Abstract
Context
The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment.
Objective
To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV).
Design
A cross-sectional case-control study.
Setting
Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil.
Patients
Thirty-three TM receiving intramuscular testosterone (T) esters as regular treatment for an average time of 14 ± 8 years were compared to 111 healthy cisgender men and women controls matched for age and body mass index (BMI). Aortic stiffness was evaluated by cf-PWV measurements using the Complior® device post-testosterone therapy.
Main outcome measures
Aortic stiffness by carotid-femoral pulse wave velocity (cf-PWV) as a cardiovascular risk marker in transgender men and control group.
Results
The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range: 5.8–8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range: 3.8–9.0 m/s, p < 0.01) and cisgender women controls (6.9 ± 0.9 m/s; range: 4.8–9.1 m/s, p = 0.02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM SBP and cf-PWV in relation to cisgender women but not to cisgender men. The age, the SBP and the diagnosis of hypertension were independently associated with cf-PWV in transgender men group.
Conclusions
The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving the gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.
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Affiliation(s)
- Flávia Siqueira Cunha
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Tania Aparecida Sartori Sanchez Bachega
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Elaine Maria Frade Costa
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Vinicius Nahime Brito
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Leonardo Azevedo Alvares
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
- Centro Universitário São Camilo , São Paulo, BR
| | - Valéria Aparecida Costa-Hong
- Unidade de Hipertensão Arterial do Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Renata Gomes Sanches Verardino
- Unidade de Hipertensão Arterial do Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Maria Helena Palma Sircili
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Berenice Bilharinho de Mendonça
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Luiz Aparecido Bortolotto
- Unidade de Hipertensão Arterial do Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
| | - Sorahia Domenice
- Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo, SP, BR
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Reiker T, Des Rosiers S, Boch J, Partha G, Venkitachalam L, Santana A, Srivasatava A, Barboza J, Byambasuren E, Baxter YC, Dib KM, Dashdorj N, Anne M, de Oliveira RW, Silveira M, Ferrer JME, Morgan L, Jones O, Luvsansambuu T, Bortolotto LA, Drager L, Avezum A, Aerts A. Population health impact and economic evaluation of the CARDIO4Cities approach to improve urban hypertension management. PLOS Glob Public Health 2023; 3:e0001480. [PMID: 37040342 PMCID: PMC10089359 DOI: 10.1371/journal.pgph.0001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with 80% of that mortality occurring in low- and middle-income countries. Hypertension, its primary risk factor, can be effectively addressed through multisectoral, multi-intervention initiatives. However, evidence for the population-level impact on cardiovascular (CV) event rates and mortality, and the cost-effectiveness of such initiatives is scarce as long-term longitudinal data is often lacking. Here, we model the long-term population health impact and cost-effectiveness of a multisectoral urban population health initiative designed to reduce hypertension, conducted in Ulaanbaatar (Mongolia), Dakar (Senegal), and in the district of Itaquera in São Paulo (Brazil) in collaboration with the local governments. We based our analysis on cohort-level data among hypertensive patients on treatment and control rates from a real-world effectiveness study of the CARDIO4Cities approach (built on quality of care, early access, policy reform, data and digital, Intersectoral collaboration, and local ownership). We built a decision tree model to estimate the CV event rates during implementation (1-2 years) and a Markov model to project health outcomes over 10 years. We estimated the number of CV events averted and quality-adjusted life-years gained (QALYs through the initiative and assessed its cost-effectiveness based on the costs reported by the funder using the incremental cost effectiveness ratio (ICER) and published thresholds. A one-way sensitivity analysis was performed to assess the robustness of the results. The modelled patient cohorts included 10,075 patients treated for hypertension in Ulaanbaatar, 5,236 in Dakar, and 5,844 in São Paulo. We estimated that 3.3-12.8% of strokes and 3.0-12.0% of coronary heart disease (CHD) events were averted during 1-2 years of implementation in the three cities. We estimated that over the subsequent 10 years, 3.6-9.9% of strokes, 2.8-7.8% of CHD events, and 2.7-7.9% of premature deaths would be averted. The estimated ICER was USD 748 QALY gained in Ulaanbaatar, USD 3091 in Dakar, and USD 784 in São Paulo. With that, the intervention was estimated to be cost-effective in Ulaanbaatar and São Paulo. For Dakar, cost-effectiveness was met under WHO-CHOICE standards, but not under more conservative standards adjusted for purchasing power parity (PPP) and opportunity costs. The findings were robust to the sensitivity analysis. Our results provide evidence that the favorable impact of multisector systemic interventions designed to reduce the hypertension burden extend to long-term population-level CV health outcomes and are likely cost-effective. The CARDIO4Cities approach is predicted to be a cost-effective solution to alleviate the growing CVD burden in cities across the world.
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Affiliation(s)
| | | | | | | | | | - Adela Santana
- American Heart Association, Dallas, Texas, United States of America
| | | | | | | | | | | | | | - Malick Anne
- Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | | | | | - Jose M E Ferrer
- American Heart Association, Dallas, Texas, United States of America
| | - Louise Morgan
- American Heart Association, Dallas, Texas, United States of America
| | - Olivia Jones
- American Heart Association, Dallas, Texas, United States of America
| | | | - Luiz Aparecido Bortolotto
- Instituto do Coração (InCor), Hospital das Clinicas da Faculdade de Medicina da Brazil, São Paulo, Brazil
- Sociedade Brasileira de Hipertensão, São Paulo, Brazil
| | - Luciano Drager
- Instituto do Coração (InCor), Hospital das Clinicas da Faculdade de Medicina da Brazil, São Paulo, Brazil
- Centro de Cardiologia, Hospital Sírio Libanês, São Paulo, Brasil
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), São Paulo, Brazil
| | - Alvaro Avezum
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
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9
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Lottenberg MP, Bichuette LD, Bortolotto LA, Gowdak LHW, Darrieux FCDC, Binotto MA, Kalil R, Caramelli B. Programa de Residência Médica em Cardiologia de Adultos do InCor em 2022: 40 Anos Formando Cardiologistas para as Demandas do Brasil. Arq Bras Cardiol 2022; 119:43-51. [DOI: 10.36660/abc.20220457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
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10
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Abstract
Arterial stiffness has been investigated as part of the physiopathology of arterial hypertension since the 1970s. Its role in increasing the "pulsatile load" imposed over the Left Ventricle (LV) has been intensely studied recently and has helped in understanding the mechanisms of Atrial Fibrillation (AF) in hypertensive patients. This paper aims to review the main evidence on this issue and establish possible mechanisms involved in the development of AF in patients with arterial stiffness. A PubMed search was performed, and selected articles were searched for references focusing on this topic. In the long term, lower blood pressure levels allow for arterial wall remodeling, leading to a lower stiffness index. To this day, however, there are no available treatments that directly promote the lowering of arterial wall stiffness. Most classes of anti-hypertensive drugs ‒ with stronger evidence for beta-blockers and diuretics ‒ could be effective in reducing arterial stiffness. There is strong evidence demonstrating an association between arterial stiffness and AF. New studies focusing on arterial stiffness and pre-fibrillatory stages would strengthen this causality relation.
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Affiliation(s)
- João Gabriel Batista Lage
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Alexandre Lemos Bortolotto
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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11
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Pires Borges IB, de Oliveira DS, Misse RG, Dos Santos AM, Hong VAC, Bortolotto LA, Shinjo SK. Safety of Atorvastatin in Patients With Stable Systemic Autoimmune Myopathies: A Pilot Longitudinal Study. J Clin Rheumatol 2021; 27:S236-S241. [PMID: 31985725 DOI: 10.1097/rhu.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with systemic autoimmune myopathies (SAMs) have high prevalence of dyslipidemia and, consequently, possible endothelial dysfunction and vascular stiffness. Our objective was to evaluate the possible benefits on endothelial function and vascular stiffness, as well as adverse effects of atorvastatin in SAMs. METHODS A pilot longitudinal, double-blind, randomized, placebo-controlled study was conducted. Twenty-four of 242 patients were randomized at a 2:1 ratio to receive atorvastatin (20 mg/d) or placebo for a period of 12 weeks. Demographic data, comorbidities, and clinical and laboratory parameters, as well as endothelial function and arterial stiffness, were evaluated. RESULTS Of the 24 randomized patients, 4 patients were excluded, with remaining 20 patients (14 in the atorvastatin group and 6 in the placebo group). The mean age of the patients was 49.0 years, and 75% of the patients were female. At baseline, the demographic data, disease status, treatment, cardiovascular comorbidities, and risk factors were comparable between the atorvastatin and placebo groups. After 12 weeks of follow-up of atorvastatin therapy, no improvements were observed for endothelial function and arterial stiffness in either group (p > 0.05). As expected, a significant reduction in total and low-density lipoprotein cholesterol levels was observed. During the study, no clinical intercurrences or disease relapses were observed in either group. CONCLUSIONS The atorvastatin drug attenuated low-density lipoprotein cholesterol without worsening clinical outcomes in SAMs. No change was observed for endothelial function and arterial stiffness. Additional studies, with long-term follow-up time and different atorvastatin dosage, are needed to corroborate the results of this study.
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Affiliation(s)
| | | | - Rafael Giovani Misse
- From the Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo
| | | | - Valéria Aparecida Costa Hong
- Hypertension Unit, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Hypertension Unit, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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12
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Barbosa ECD, Feitosa AM, Bortolotto LA, Guerra GM, Filho JCAF, Cestário EES, Yugar-Toledo JC, Pimentel R, Ferrari B, Aguiar R, Barroso WKS, Eibel B, Xia X, Poulter NR, Beaney T. May Measurement Month 2019: an analysis of blood pressure screening results from Brazil. Eur Heart J Suppl 2021; 23:B30-B32. [PMID: 34054363 PMCID: PMC8153193 DOI: 10.1093/eurheartj/suab019] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study is to describe the results of the May Month Measurement (MMM) campaign implemented in Brazil, in 2019. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 13 476 individuals, 58.2% were white, 60.8% were women. The average age was 46.3 (18.6) years. Of all 13 476 participants, 6858 (50.9%) had hypertension defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg or being on anti-hypertensive medication. Of those with hypertension, 68.8% were aware of their diagnosis, 65.3% were on antihypertensive medication, and 36.1% had controlled BP (<140/90 mmHg). In addition, of 4479 participants on anti-hypertensive medication, 55.2% had controlled BP. The use of anti-hypertensive medication was associated with higher systolic (P < 0.001) and diastolic BP (P < 0.001) and having diabetes with higher systolic BP (P < 0.001). Previous hypertension in pregnancy was associated with higher systolic (P = 0.038) and diastolic BP (P = 0.003), and smoking was associated with higher systolic BP (P < 0.001). Lastly, obese and overweight individuals showed significantly higher systolic (P < 0.001) and diastolic (P < 0.001) BP. The Brazilian MMM19 data demonstrate that strategies to increase awareness of hypertension and a better control of the risk factors are still needed.
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Affiliation(s)
- Eduardo Costa Duarte Barbosa
- Serviço de Hipertensão e Cardiometabolismo Hosp, São Francisco Sta Casa Porto Alegre.,Liga Hipertensão de Porto Alegre, Porto Alegre, Brasil
| | | | | | | | | | | | | | - Rodrigo Pimentel
- Instituição: Cardioart Avaliação Clínica e Assistência Médica LTDA
| | - Bruno Ferrari
- Faculdade de Medicina de Assis, Fema Assis, São Paulo
| | - Rodrigo Aguiar
- Instituição: Universidade Federal de São Carlos/SP-UFISCAR
| | | | - Bruna Eibel
- Liga Hipertensão de Porto Alegre, Porto Alegre, Brasil.,Instituto de Cardiologia/FundaçãoUniversitária de Cardiologia, Porto Alegre/RS, Brazil.,Centro Universitário FSG, Caxias do Sul/RS, Brazil, Department of Mathematics, Imperial College London, Huxley Building, South Kensington Campus, SW7 2AZ, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
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13
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Biscotto IP, Costa Hong VA, Batista RL, Mendonca BB, Arnhold IJP, Bortolotto LA, Carvalho LRS. Vasculometabolic effects in patients with congenital growth hormone deficiency with and without GH replacement therapy during adulthood. Pituitary 2021; 24:216-228. [PMID: 33098037 DOI: 10.1007/s11102-020-01099-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluated the metabolic profiles and vascular properties in congenital growth hormone (GH) deficiency (GHD) and its replacement in adults. PATIENTS AND METHODS Cross-sectional study conducted in a single tertiary center for pituitary diseases. Eighty-one adult subjects were divided into three groups: (1) 29 GHD patients with daily subcutaneous GH replacement therapy (GHRT) during adulthood; (2) 20 GHD patients without GHRT during adulthood and (3) 32 controls. Only patients with adequate adherence to others pituitary hormone deficiencies were included. Anthropometric parameters, body composition by dual-energy X-ray absorptiometry, metabolic profiles and vascular properties (carotid intima media thickness, pulse wave velocity and flow-mediated dilation) were compared among the groups. RESULTS Waist-to-height ratio (WHR), body fat percentages and fat mass index (FMI) were lower in patients with GHRT than patients without GHRT during adulthood (0.49 ± 0.06 vs. 0.53 ± 0.06 p = 0.026, 30 ± 10 vs. 40 ± 11 p = 0.003 and 7.3 ± 4 vs. 10 ± 3.5 p = 0.041, respectively). In addition, association between longer GHRT and lower body fat percentage was observed (r = - 0.326, p = 0.04). We found higher triglyceride (113.5 ± 62 vs. 78 ± 36, p = 0.025) and lower HDL cholesterol (51 ± 17 vs. 66 ± 23, p = 0.029) levels in patients without GHRT during adulthood in comparison to controls. No statistical differences were observed for vascular properties among the groups. CONCLUSIONS No differences in vascular properties were observed in congenital GHD adult patients with or without GHRT despite patients without GHRT had an unfavorable body composition. GHRT currently remains an individualized decision in adults with GHD and these findings bring new insight into the treatment and follow-up of these patients.
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Affiliation(s)
- Isabela Peixoto Biscotto
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM42, Disciplina de Endocrinologia, Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil.
| | - Valéria Aparecida Costa Hong
- Unidade de Hipertensão, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Sao Paulo, Brazil
| | - Rafael Loch Batista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM42, Disciplina de Endocrinologia, Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM42, Disciplina de Endocrinologia, Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil
| | - Ivo Jorge Prado Arnhold
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM42, Disciplina de Endocrinologia, Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil
| | - Luiz Aparecido Bortolotto
- Unidade de Hipertensão, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Sao Paulo, Brazil
| | - Luciani Renata Silveira Carvalho
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM42, Disciplina de Endocrinologia, Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil.
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14
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Sangaleti CT, Katayama KY, De Angelis K, Lemos de Moraes T, Araújo AA, Lopes HF, Camacho C, Bortolotto LA, Michelini LC, Irigoyen MC, Olofsson PS, Barnaby DP, Tracey KJ, Pavlov VA, Consolim Colombo FM. The Cholinergic Drug Galantamine Alleviates Oxidative Stress Alongside Anti-inflammatory and Cardio-Metabolic Effects in Subjects With the Metabolic Syndrome in a Randomized Trial. Front Immunol 2021; 12:613979. [PMID: 33776997 PMCID: PMC7991724 DOI: 10.3389/fimmu.2021.613979] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The metabolic syndrome (MetS) is an obesity-associated disorder of pandemic proportions and limited treatment options. Oxidative stress, low-grade inflammation and altered neural autonomic regulation, are important components and drivers of pathogenesis. Galantamine, an acetylcholinesterase inhibitor and a cholinergic drug that is clinically-approved (for Alzheimer's disease) has been implicated in neural cholinergic regulation of inflammation in several conditions characterized with immune and metabolic derangements. Here we examined the effects of galantamine on oxidative stress in parallel with inflammatory and cardio-metabolic parameters in subjects with MetS. Trial Design and Methods: The effects of galantamine treatment, 8 mg daily for 4 weeks or placebo, followed by 16 mg daily for 8 weeks or placebo were studied in randomly assigned subjects with MetS (n = 22 per group) of both genders. Oxidative stress, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase activities, lipid and protein peroxidation, and nitrite levels were analyzed before and at the end of the treatment. In addition, plasma cytokine and adipokine levels, insulin resistance (HOMA-IR) and other relevant cardio-metabolic indices were analyzed. Autonomic regulation was also examined by heart rate variability (HRV) before treatment, and at every 4 weeks of treatment. Results: Galantamine treatment significantly increased antioxidant enzyme activities, including SOD [+1.65 USOD/mg protein, [95% CI 0.39-2.92], P = 0.004] and CAT [+0.93 nmol/mg, [95% CI 0.34-1.51], P = 0.01], decreased lipid peroxidation [thiobarbituric acid reactive substances [log scale 0.72 pmol/mg, [95% CI 0.46-1.07], P = 0.05], and systemic nitrite levels [log scale 0.83 μmol/mg protein, [95% CI 0.57-1.20], P = 0.04] compared with placebo. In addition, galantamine significantly alleviated the inflammatory state and insulin resistance, and decreased the low frequency/high frequency ratio of HRV, following 8 and 12 weeks of drug treatment. Conclusion: Low-dose galantamine alleviates oxidative stress, alongside beneficial anti-inflammatory, and metabolic effects, and modulates neural autonomic regulation in subjects with MetS. These findings are of considerable interest for further studies with the cholinergic drug galantamine to ameliorate MetS.
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Affiliation(s)
- Carine Teles Sangaleti
- Hypertension Unit, University of São Paulo (USP), São Paulo, Brazil
- Postgraduate Program in Health Science, Midwestern State University (UNICENTRO), Paraná, Brazil
| | - Keyla Yukari Katayama
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | - Kátia De Angelis
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
- Department of Physiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Tércio Lemos de Moraes
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | - Heno F. Lopes
- Hypertension Unit, University of São Paulo (USP), São Paulo, Brazil
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | - Cleber Camacho
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | - Lisete Compagno Michelini
- Biomedical Sciences Institute Department of Physiology and Biophysics, University of São Paulo (USP), São Paulo, Brazil
| | | | - Peder S. Olofsson
- Laboratory of Immunobiology, Department of Medicine, Center for Bioelectronic Medicine, Karolinska Institutet, Stockholm, Sweden
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Douglas P. Barnaby
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Fernanda Marciano Consolim Colombo
- Hypertension Unit, University of São Paulo (USP), São Paulo, Brazil
- Nursing Department Graduate Program in Nanosciences and Biosciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
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15
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Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADDM, Machado CA, Poli-de-Figueiredo CE, Amodeo C, Mion Júnior D, Barbosa ECD, Nobre F, Guimarães ICB, Vilela-Martin JF, Yugar-Toledo JC, Magalhães MEC, Neves MFT, Jardim PCBV, Miranda RD, Póvoa RMDS, Fuchs SC, Alessi A, Lucena AJGD, Avezum A, Sousa ALL, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Nogueira ADR, Dinamarco N, Eibel B, Forjaz CLDM, Zanini CRDO, Souza CBD, Souza DDSMD, Nilson EAF, Costa EFDA, Freitas EVD, Duarte EDR, Muxfeldt ES, Lima Júnior E, Campana EMG, Cesarino EJ, Marques F, Argenta F, Consolim-Colombo FM, Baptista FS, Almeida FAD, Borelli FADO, Fuchs FD, Plavnik FL, Salles GF, Feitosa GS, Silva GVD, Guerra GM, Moreno Júnior H, Finimundi HC, Back IDC, Oliveira Filho JBD, Gemelli JR, Mill JG, Ribeiro JM, Lotaif LAD, Costa LSD, Magalhães LBNC, Drager LF, Martin LC, Scala LCN, Almeida MQ, Gowdak MMG, Klein MRST, Malachias MVB, Kuschnir MCC, Pinheiro ME, Borba MHED, Moreira Filho O, Passarelli Júnior O, Coelho OR, Vitorino PVDO, Ribeiro Junior RM, Esporcatte R, Franco R, Pedrosa R, Mulinari RA, Paula RBD, Okawa RTP, Rosa RF, Amaral SLD, Ferreira-Filho SR, Kaiser SE, Jardim TDSV, Guimarães V, Koch VH, Oigman W, Nadruz W. Brazilian Guidelines of Hypertension - 2020. Arq Bras Cardiol 2021; 116:516-658. [PMID: 33909761 PMCID: PMC9949730 DOI: 10.36660/abc.20201238] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Weimar Kunz Sebba Barroso
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Andréa Araujo Brandão
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo , SP - Brasil
| | - Décio Mion Júnior
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Hospital São Francisco , Ribeirão Preto , SP - Brasil
| | | | | | | | - Maria Eliane Campos Magalhães
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro , RJ - Brasil
| | - Mário Fritsch Toros Neves
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Sandra C Fuchs
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
| | | | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | | | | | | | | | | | | | | | - Bruna Eibel
- Instituto de Cardiologia , Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre , RS - Brasil
- Centro Universitário da Serra Gaúcha (FSG), Caxias do Sul , RS - Brasil
| | | | | | | | | | | | | | - Elizabete Viana de Freitas
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Departamento de Cardiogeriatria da Sociedade Brazileira de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Emilton Lima Júnior
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba , PR - Brasil
| | - Erika Maria Gonçalves Campana
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Universidade Iguaçu (UNIG), Rio de Janeiro , RJ - Brasil
| | - Evandro José Cesarino
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Associação Ribeirãopretana de Ensino, Pesquisa e Assistência ao Hipertenso (AREPAH), Ribeirão Preto , SP - Brasil
| | - Fabiana Marques
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - Fernando Antonio de Almeida
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Frida Liane Plavnik
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | | | | | | | - Grazia Maria Guerra
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Universidade Santo Amaro (UNISA), São Paulo , SP - Brasil
| | | | | | | | | | | | - José Geraldo Mill
- Centro de Ciências da Saúde , Universidade Federal do Espírito Santo , Vitória , ES - Brasil
| | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais , Belo Horizonte , MG - Brasil
- Hospital Felício Rocho , Belo Horizonte , MG - Brasil
| | - Leda A Daud Lotaif
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital do Coração (HCor), São Paulo , SP - Brasil
| | | | | | | | | | | | - Madson Q Almeida
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | - Roberto Esporcatte
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Hospital Pró-Cradíaco , Rio de Janeiro , RJ - Brasil
| | - Roberto Franco
- Universidade Estadual Paulista (UNESP), Bauru , SP - Brasil
| | - Rodrigo Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife , PE - Brasil
| | | | | | | | | | | | | | - Sergio Emanuel Kaiser
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | - Vera H Koch
- Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | - Wille Oigman
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | - Wilson Nadruz
- Universidade Estadual de Campinas (UNICAMP), Campinas , SP - Brasil
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]. Rev Panam Salud Publica 2021; 44:e27. [PMID: 33643393 PMCID: PMC7905737 DOI: 10.26633/rpsp.2021.27] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm Rc Campbell
- Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary Alberta Canadá Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste Potchefstroom África do Sul Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste, Potchefstroom, África do Sul
| | - Cherian V Varghese
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde Washington, D.C. Estados Unidos Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto Liga de Hipertensão de Pequim Pequim China Instituto Liga de Hipertensão de Pequim, Pequim, China
| | - Taskeen Khan
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - James E Sharman
- Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart Tasmânia Austrália Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart, Tasmânia, Austrália
| | - Paul K Whelton
- Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane Nova Orleans Estados Unidos Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane, Nova Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca Milão Itália Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milão, Itália
| | - Michael A Weber
- Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn Nova York Estados Unidos Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn, Nova York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidade Nacional de Córdoba Córdoba Argentina Sanatorio Allende, y Universidade Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco Califórnia Estados Unidos Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco, Califórnia, Estados Unidos
| | - Andrew E Moran
- Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies Nova York Estados Unidos Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies, Nova York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão São Paulo Brasil Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Venkata S Ram
- Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo Hyderabad Índia Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo, Hyderabad, Índia; Universidade Macquarie, Faculdade de Medicina e Ciências da Saúde, Sydney, Austrália; Liga Mundial de Hipertensão, Escritório Regional do Sudeste Asiático, Hyderabad, Índia
| | - Michael Brainin
- Universidade do Danúbio Krems Áustria Universidade do Danúbio, Krems, Áustria
| | - Mayowa O Owolabi
- Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana Universidade de Ibadan Nigéria Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana, Universidade de Ibadan, Nigéria
| | - Agustin J Ramirez
- Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro Buenos Aires Argentina Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedade Latino-americana de Hipertensão Porto Alegre Brasil Sociedade Latino-americana de Hipertensão, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão São Paulo Brasil Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Daniel T Lackland
- Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul Charleston Estados Unidos Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul, Charleston, Estados Unidos
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]. Rev Panam Salud Publica 2021; 45:e26. [PMID: 33643404 PMCID: PMC7905751 DOI: 10.26633/rpsp.2021.26] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm RC Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de CalgaryCalgary, AlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad NoroccidentalPotchefstroomSudáfricaUnidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad Noroccidental, Potchefstroom, Sudáfrica
| | - Cherian V Varghese
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la SaludWashington, D.C.Estados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto de la Liga de Beijing contra la HipertensiónBeijingChinaInstituto de la Liga de Beijing contra la Hipertensión, Beijing, China
| | - Taskeen Khan
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - James E Sharman
- Instituto Menzies de Investigación Médica, Universidad de TasmaniaHobartTasmaniaAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Tasmania, Australia
| | - Paul K Whelton
- Departamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de TulaneNueva OrleansEstados UnidosDepartamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de Tulane, Nueva Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San LucaMilánItaliaDepartamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milán, Italia
| | - Michael A Weber
- División de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico DownstateBrooklynNueva YorkEstados UnidosDivisión de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico Downstate, Brooklyn, Nueva York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidad Nacional de CórdobaCórdobaArgentinaSanatorio Allende, y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridionalCaliforniaEstados UnidosResolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridional, California, Estados Unidos
| | - Andrew E Moran
- Control Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital StrategiesNueva YorkEstados UnidosControl Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de HipertensiónSan PabloBrasilGrupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de Hipertensión, San Pablo, Brasil)
| | - Venkata S Ram
- Escuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital ApolloHyderabadIndiaFacultad de Medicina y Ciencias de la Salud de la Universidad de MacquarieSydneyAustraliaOficina Regional de Asia Meridional de la Liga Mundial de la HipertensiónHyderabadIndiaEscuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital Apollo, Hyderabad, India; Facultad de Medicina y Ciencias de la Salud de la Universidad de Macquarie, Sydney, Australia; Oficina Regional de Asia Meridional de la Liga Mundial de la Hipertensión, Hyderabad, India
| | - Michael Brainin
- Universidad del DanubioKremsAustriaUniversidad del Danubio, Krems, Austria
| | - Mayowa O Owolabi
- Centro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no TransmisiblesUniversidad de IbadanNigeriaCentro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no Transmisibles, Universidad de Ibadan, Nigeria
| | - Agustin J Ramirez
- Unidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación FavaloroBuenos AiresArgentinaUnidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedad Latinoamericana de la Hipertensión, Artery LatamPorto AlegreBrasilSociedad Latinoamericana de la Hipertensión, Artery Latam, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de HipertensiónSan PabloBrasilHospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de Hipertensión, San Pablo, Brasil
| | - Daniel T Lackland
- División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, CharlestonCarolina del SurEstados UnidosDivisión de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston, Carolina del Sur, Estados Unidos
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Machado MF, Muela HCS, Costa-Hong VA, Yassuda MS, Moraes NC, Memória CM, Bor-Seng-Shu E, Massaro AR, Nitrini R, Bortolotto LA, Nogueira RDC. Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment. J Clin Hypertens (Greenwich) 2020; 22:2114-2120. [PMID: 32966689 DOI: 10.1111/jch.14052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
Cerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) <140 and diastolic blood pressure (DBP) <90 mm Hg (n = 54), hypertensive patients under treatment with SBP > 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 ± 11.14, P < .05) and had a lower resistance-area product (1.17 ± 0.24, P < .05), although age and greater arteriolar stiffness did not affect the CBFV mean of hypertensive patients, whether controlled or uncontrolled (62.85 × 58.49 × 58.30 cm/s, P = .29), most likely because their ARIs were not compromised (5.54 × 5.91 × 5.88, P = .6). Hypertensive patients under treatment, regardless of their BP control, have intact AR capacity.
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Affiliation(s)
- Michel Ferreira Machado
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Monica Sanches Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo Medical School, São Paulo, Brazil
| | - Natalia Cristina Moraes
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Maia Memória
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ayrton Roberto Massaro
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (Incor), University of São Paulo Medical School - Hypertension Unit, São Paulo, Brazil
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Moraes NC, Muela HCS, MemÓria CM, Costa-Hong VAD, Machado MF, Cechinhi MA, Nitrini R, Bortolotto LA, Yassuda MS. Systemic arterial hypertension and cognition in adults: effects on executive functioning. Arq Neuropsiquiatr 2020; 78:412-418. [PMID: 32627812 DOI: 10.1590/0004-282x20200039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. METHODS The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). RESULTS A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). CONCLUSION The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.
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Affiliation(s)
| | | | | | | | | | | | - Ricardo Nitrini
- Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil
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Pio de Abreu A, Trani F, Vieira G, Aparecido Bortolotto L, Ferreira Drager L. P0153IS THERE ANY VALUE FOR HOSPITALIZATION FOR CHECKING MEDICATION ADHERENCE DUE TO RESISTANT AND REFRACTORY HYPERTENSION SUSPICIOUS? IMPLICATIONS FOR MID-TERM FOR BLOOD PRESSURE CONTROL. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Resistant hypertension (RH) and refractory hypertension (RefH, an extreme phenotype of RH) are associated with increased cardiovascular events and target-organ damage. However, appropriate RH and RefH diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake during a hospital stay. Therefore, this study was aimed to evaluate whether hospitalization for confirming antihypertensive adherence in patients with RH and RefH may impact blood pressure (BP) values and BP control after hospital discharge in patients with RH or RefH suspicious at a tertiary outpatient clinic.
Method
From June 2015 to June 2017, we recruited consecutive patients with RH or RefH suspicious admitted to the Hospital for confirming treatment adherence and the respective diagnosis. We excluded patients with secondary forms of hypertension. RH was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. RefH was defined as no BP control despite using ≥5 antihypertensive drugs. During hospitalization, all patients used low sodium diet (∼3grs of salt/day) and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and RH/RefH status but also BP and number of antihypertensive drugs at hospital discharge and in the two first outpatients visits returns.
Results
We studied a total of 83 patients with suspected RH/RefH (age 53±14 years; 76% female gender; body mass index 28.8±6.2 Kg/m2; pre-hospitalization systolic 177±28mmHg and diastolic BP 106±21mmHg). Of these, 68.7% (57 patients) had suspected RefH in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of RH fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p<0.001 vs. pre-hospitalization for all comparisons). Among the RH types, RefH was confirmed in only 27 patients (32.5%). As compared to pre-hospitalization data, we noticed consistent lower number of antihypertensive drugs and lower levels of systolic and diastolic BP both at first outpatient visit post-discharge (mean returned time 2.1±1.7 months) and second outpatient visit post-discharge (mean returned time 7.1±2.6 months): First visit: 4.3±1.2 classes, systolic BP: 152±24 mmHg, diastolic BP: 89±17 mmHg; second visit: 4.5±1.3 classes, systolic BP: 150±26 mmHg, diastolic BP: 89±15 mmHg; (p<0.001 vs. pre-hospitalization for all comparisons). As a consequence, the rate of patients that reached at least 140x90mmHg increased from 0% to 35% (first visit post-discharge) and 38.5% (second visit post-discharge).
Conclusion
Supervised medication intake with controlled salt diet during hospitalization may help not only to define the RH and RefH status in uncontrolled hypertensive outpatients but also to have impact on the number of antihypertensive drugs and lower BP values in the mid-term follow-up.
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Affiliation(s)
- Andrea Pio de Abreu
- , Hypertension Unit, Renal Division, Department of Internal Medicine, University of São Paulo, Brazil
| | - Fernanda Trani
- , Hypertension Unit, Renal Division, Department of Internal Medicine, University of São Paulo, Brazil
| | - Giovanio Vieira
- , Hypertension Unit, Renal Division, Department of Internal Medicine, University of São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Hypertension Unit, Cardiology Division, Heart Institute (InCor), Department of Internal Medicine, University of São Paulo
| | - Luciano Ferreira Drager
- , Hypertension Unit, Renal Division, Department of Internal Medicine, University of São Paulo, Brazil
- Hypertension Unit, Cardiology Division, Heart Institute (InCor), Department of Internal Medicine, University of São Paulo
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Yugar-Toledo JC, Moreno Júnior H, Gus M, Rosito GBA, Scala LCN, Muxfeldt ES, Alessi A, Brandão AA, Moreira Filho O, Feitosa ADDM, Passarelli Júnior O, Souza DDSMD, Amodeo C, Barroso WKS, Gomes MAM, Paiva AMGD, Barbosa ECD, Miranda RD, Vilela-Martin JF, Nadruz Júnior W, Rodrigues CIS, Drager LF, Bortolotto LA, Consolim-Colombo FM, Sousa MGD, Borelli FADO, Kaiser SE, Salles GF, Azevedo MDFD, Magalhães LBNC, Póvoa RMDS, Malachias MVB, Nogueira ADR, Jardim PCBV, Jardim TDSV. Brazilian Position Statement on Resistant Hypertension - 2020. Arq Bras Cardiol 2020; 114:576-596. [PMID: 32267335 PMCID: PMC7792719 DOI: 10.36660/abc.20200198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Heitor Moreno Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Miguel Gus
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | | | - Elizabeth Silaid Muxfeldt
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Wilson Nadruz Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde Pontifícia Universidade Católica de são Paulo, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | | | | | | | | | - Gil Fernando Salles
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang X, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Liane Plavnik F, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. São Paulo call to action for the prevention and control of high blood pressure: 2020. J Clin Hypertens (Greenwich) 2019; 21:1744-1752. [PMID: 31769155 PMCID: PMC8030388 DOI: 10.1111/jch.13741] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health SciencesO'Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
| | - Aletta E. Schutte
- MRC Unit for Hypertension and Cardiovascular DiseaseHypertension in Africa Research Team (HART)North‐West UniversityPotchefstroomSouth Africa
| | - Cherian V. Varghese
- Department of Non‐Communicable DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Pedro Ordunez
- Department of Non‐Communicable and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | | | - Taskeen Khan
- Department of Non‐Communicable DiseasesWorld Health OrganizationGenevaSwitzerland
| | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTASAustralia
| | - Paul K. Whelton
- Departments of Epidemiology and MedicineTulane University Health Sciences CenterNew OrleansLAUSA
| | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca & Istituto Auxologico ItalianoIRCCSMilanItaly
- Department of Cardiovascular, Neural and Metabolic SciencesSan Luca HospitalMilanItaly
| | - Michael A. Weber
- Division of Cardiovascular MedicineDownstate Medical CenterState University of New YorkBrooklynNYUSA
| | - Marcelo Orías
- Department of NephrologySanatorio AllendeCórdobaArgentina
- Universidad Nacional de CórdobaCórdobaArgentina
| | - Marc G. Jaffe
- Resolve to Save Lives, An Initiative of Vital StrategiesNew YorkNYUSA
- Kaiser Permanente Northern CaliforniaSouth San FranciscoCAUSA
| | - Andrew E. Moran
- Global Hypertension ControlResolve to Save Lives, An initiative of Vital StrategiesNew YorkNYUSA
| | - Frida Liane Plavnik
- Hypertension GroupHospital Alemão Oswaldo CruzSão PauloBrazil
- Heart Institute (InCor)São PauloBrazil
- Brazilian Society of HypertensionSão PauloBrazil
| | - Venkata S. Ram
- University of Texas Southwestern Medical SchoolDallasTXUSA
- Apollo Medical College and HospitalsHyderabadIndia
- Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNSWAustralia
- World Hypertension LeagueSouth Asia Regional OfficeHyderabadIndia
| | | | - Mayowa O. Owolabi
- African Research Universities Center of Excellence for Non‐communicable DiseasesUniversity of IbadanIbadanNigeria
| | - Augstin J. Ramirez
- Arterial Hypertension an Metabolic UnitUniversity HospitalFavaloro FoundationBuenos AiresArgentina
| | - Eduardo Barbosa
- Latin American Society of HypertensionArtery LatamPorto AlegreBrazil
| | - Luiz Aparecido Bortolotto
- Director of Hypertension UnitHospital das Clínicas FMUSP‐ SPHeart Institute (InCor)São PauloBrazil
- Brazilian Society of HypertensionSão PauloBrazil
| | - Daniel T. Lackland
- Division of Translational Neurosciences and Population StudiesMedical University of South CarolinaCharlestonSCUSA
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Bortolotto LA, Bortolotto AL, Castro R, Sousa MT, Soeiro A, Pereira A. ACUTE PULMONAR EDEMA AND VENTRICULAR DYSFUNCTION DUE ADRENERGIC MYOCARDITIS ASSOCIATED TO PHEOCHROMOCYTOMA. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aparecido Bortolotto L. Mudanças Posturais e suas Influencias no Comportamento Funcional de Grandes Artérias. Arq Bras Cardiol 2019; 113:1082-1083. [PMID: 31800683 PMCID: PMC7021264 DOI: 10.36660/abc.20190691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Luiz Aparecido Bortolotto
- Unidade Clínica de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Drager LF, Lorenzi-Filho G, Cintra FD, Pedrosa RP, Bittencourt LRA, Poyares D, Carvalho CG, Moura SMGPT, Santos-Silva R, Bruin PFCD, Geovanini GR, Albuquerque FN, Oliveira WAAD, Moreira GA, Ueno LM, Nerbass FB, Rondon MUPB, Barbosa ERF, Bertolami A, Paola AAVD, Marques BBS, Rizzi CF, Negrão CE, Uchôa CHG, Maki-Nunes C, Martinez D, Fernández EA, Maroja FU, Almeida FR, Trombetta IC, Storti LJ, Bortolotto LA, Mello MTD, Borges MA, Andersen ML, Portilho NDP, Macedo P, Alves R, Tufik S, Fagondes SC, Risso TT. 1º Posicionamento Brasileiro sobre o Impacto dos Distúrbios de Sono nas Doenças
Cardiovasculares da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2018; 111:290-340. [PMID: 30335871 DOI: 10.5935/abc.20180154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Rodrigo P Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) - Universidade de Pernambuco, Recife, PE - Brasil
| | | | - Dalva Poyares
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Denis Martinez
- Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Luciana J Storti
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Paula Macedo
- Hospital de Base do Distrito Federal, Brasília, DF - Brasil.,Hospital do Coração do Brasil, Brasília, DF - Brasil
| | - Rosana Alves
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brasil
| | - Sergio Tufik
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
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Costa-Hong VA, Muela HCS, Macedo TA, Sales ARK, Bortolotto LA. Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension. BMC Cardiovasc Disord 2018; 18:123. [PMID: 29921220 PMCID: PMC6008932 DOI: 10.1186/s12872-018-0855-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 ± 9.8% vs. 20.1 ± 11.7%, p < 0.01), AIx75 (29.6 ± 6.7% vs. 18.3 ± 9.4%, p < 0.01) and central systolic blood pressure (136 ± 30 vs. 125 ± 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women. Conclusion Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status.
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Affiliation(s)
- Valeria Aparecida Costa-Hong
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
| | - Henrique Cotchi Simbo Muela
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil. .,Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola.
| | - Thiago Andrade Macedo
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
| | - Allan Robson Kluser Sales
- Heart Institute (Incor), Cardiovascular Rehabilitation and Exercise Physiology Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Heart Institute (Incor), Hypertension Unit, University of São Paulo Medical School, 2nd floor, Room 8, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, 44 - Cerqueira César, 05403-900, Brazil
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Navarro JCA, Antoniazzi L, Oki AM, Bonfim MC, Hong V, Bortolotto LA, Acosta-Cardenas P, Sandrim V, Miname MH, dos Santos Filho RD. Prevalence of Metabolic Syndrome and Framingham Risk Score in Apparently Healthy Vegetarian and Omnivorous Men. Arq Bras Cardiol 2018; 110:430-437. [PMID: 29898042 PMCID: PMC5967136 DOI: 10.5935/abc.20180073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/27/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent studies have shown a lower prevalence of metabolic syndrome (MSyn) in vegetarians (VEG) despite the inconclusive evidence from others. OBJECTIVE To verify the association between diet and other lifestyle characteristics and the prevalence of MSyn, cardiovascular risk factors (CRF), and Framingham Risk Score (FRS) in apparently healthy VEG and omnivorous (OMN) men. METHODS In this cross-sectional study, 88 apparently healthy men ≥ 35 years, 44 VEG and 44 OMN, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C-reactive protein (CRP) and FRS. To test the association between lifestyle and MSyn, Student t test, chi-square test, and multiple logistic regression model were used. A significance level of 5% was considered in all statistical analyses. RESULTS Several CRF were significantly lower in VEG than in OMN: body mass index, systolic blood pressure, diastolic blood pressure, fasting serum total cholesterol, LDL-cholesterol, apolipoprotein b, glucose, and glycated hemoglobin (all p < 0.05). The FRS mean was lower in VEG than in OMN (2.98 ± 3.7 vs 4.82 ± 4.8, p = 0.029). The percentage of individuals with MSyn was higher among OMN than among VEG (52.3 vs.15.9%) (p < 0.001). The OMN diet was associated with MSyn (OR: 6.28 95%CI 2.11-18.71) and alterations in most MSyn components in the multiple regression model independently of caloric intake, age and physical activity. CONCLUSION The VEG diet was associated with lower CRF, FRS and percentage of individuals with MSyn.
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Affiliation(s)
- Julio Cesar Acosta Navarro
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
- Hospital Regional de Ferraz de Vasconcelos - Osiris
Florindo,São Paulo, SP - Brazil
| | - Luiza Antoniazzi
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Adriana Midori Oki
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Maria Carlos Bonfim
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Valeria Hong
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Pedro Acosta-Cardenas
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Valeria Sandrim
- Departamento de Farmacologia do Instituto de Biociências de
Botucatu - Universidade Estadual Paulista (UNESP), São Paulo, SP - Brazil
| | - Marcio Hiroshi Miname
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Raul Dias dos Santos Filho
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
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Coutinho MN, Carvalho AB, Dalboni MA, Mouro MG, Higa EMS, Costa-Hong V, Bortolotto LA, Figueiredo RADO, Canziani MEF. There Is No Impact of Diabetes on the Endothelial Function of Chronic Kidney Disease Patients. J Diabetes Res 2018; 2018:7926473. [PMID: 30596103 PMCID: PMC6286770 DOI: 10.1155/2018/7926473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/02/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients. METHODS We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1α), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group). RESULTS CKD-DM group had a higher prevalence of obesity (P < 0.01), previous myocardial infarction (P = 0.02), myocardial revascularization (P = 0.04), and a trend for more peripheral artery disease (P = 0.07). Additionally, CKD-DM group had higher EPC (P = 0.001) and PWV (P < 0.001) values. On the other hand, no difference in SDF-1α and serum or urinary NO and FMD was observed between the groups. CONCLUSIONS Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.
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Affiliation(s)
| | | | | | | | | | - Valéria Costa-Hong
- Heart Institute (InCor) of the University of São Paulo Medical School, Brazil
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Nobre F, Mion Júnior D, Gomes MAM, Barbosa ECD, Rodrigues CIS, Neves MFT, Brandão AA, Alessi AA, Feitosa AM, Machado CA, Poli-de-Figueiredo CE, Amodeo C, Forjaz CLM, Giorgi DMA, Coelho EB, Lima Jr. E, Plavnik FL, Silva GV, Chaves Jr. H, Vilela-Martin JFV, Ribeiro JM, Gusmão JL, Yugar-Toledo JC, Bortolotto LA, Scala LCN, Malachias MVB, Wajngarten M, Gus M, Passarelli Jr. O, Jardim PCBV, Miranda RD, Paula RB, Ferreira-Filho SR, Andrade S, Geleilete TJM, Koch VHK, Souza WKSB, Oigman W. 6ª Diretrizes de Monitorização Ambulatorial da Pressão Arterial e 4ª Diretrizes de Monitorização Residencial da Pressão Arterial. Arq Bras Cardiol 2018. [DOI: 10.5935/abc.20180074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Macedo TA, Drager LF, Pedrosa RP, Muela HCS, Costa-Hong V, Kajita LJ, Bortolotto LA. Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography. Clinics (Sao Paulo) 2017; 72:411-414. [PMID: 28793000 PMCID: PMC5525161 DOI: 10.6061/clinics/2017(07)04] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 03/09/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.
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Affiliation(s)
- Thiago Andrade Macedo
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Luciano Ferreira Drager
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Pinto Pedrosa
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Henrique Cotchi Simbo Muela
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Valeria Costa-Hong
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Junia Kajita
- Laboratorio de Hemodinamica, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Aparecido Bortolotto
- Unidade de Hipertensao, Divisao de Cardiologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Malachias MVB, Bortolotto LA, Drager LF, Borelli FAO, Lotaif LAD, Martins LC. 7th Brazilian Guideline of Arterial Hypertension: Chapter 12 - Secondary Arterial Hypertension. Arq Bras Cardiol 2017; 107:67-74. [PMID: 27819391 PMCID: PMC5319460 DOI: 10.5935/abc.20160162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Alvim RDO, Santos PCJL, Bortolotto LA, Mill JG, Pereira ADC. Arterial Stiffness: Pathophysiological and Genetic Aspects. International Journal of Cardiovascular Sciences 2017. [DOI: 10.5935/2359-4802.20170053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Acosta-Navarro J, Antoniazzi L, Oki AM, Bonfim MC, Hong V, Acosta-Cardenas P, Strunz C, Brunoro E, Miname MH, Filho WS, Bortolotto LA, Santos RD. Reduced subclinical carotid vascular disease and arterial stiffness in vegetarian men: The CARVOS Study. Int J Cardiol 2016; 230:562-566. [PMID: 28062141 DOI: 10.1016/j.ijcard.2016.12.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 11/19/2016] [Accepted: 12/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary habits play an important role in the development of atherosclerosis, the most important cause of morbidity and mortality in the world. The objective of this study was to verify if vegetarian (VEG) diet could be related a better profile of subclinical vascular disease evaluated by arterial stiffness and functional and structural properties of carotid arteries, compared to omnivorous (OMN) diet. METHODS In this cross-sectional study, 44 VEG and 44 OMN apparently healthy men ≥35years of age, in order to not have confounding risk factors of subclinical atherosclerosis, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C reactive protein (CRP), and arterial stiffness determined by carotid-femoral pulse wave velocity (PWV). Also, carotid intima-media thickness (c-IMT) and distensibility were evaluated. RESULTS VEG men had lower body mass index, systolic and diastolic blood pressures, fasting serum total cholesterol, LDL and non-HDL-cholesterol, apolipoprotein B, glucose and glycated hemoglobin values in comparison with OMN individuals (all p values <0.05). Markers of vascular structure and function were different between VEG and OMN: PWV 7.1±0.8m/s vs. 7.7±0.9m/s (p<0.001); c-IMT 593±94 vs. 661±128μm (p=0.003); and relative carotid distensibility 6.39±1.7 vs. 5.72±1.8% (p=0.042), respectively. After a multivariate linear regression analysis, a VEG diet was independently and negatively associated with PWV (p value 0.005). CONCLUSIONS A VEG diet is associated with a more favorable cardiovascular diseases biomarker profile and better vascular structural and functional parameters.
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Affiliation(s)
- Julio Acosta-Navarro
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil; Osiris Florindo Coelho Regional Hospital of Ferraz de Vasconcelos, Brazil.
| | - Luiza Antoniazzi
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil; Paulista University (UNIP), Brazil.
| | - Adriana Midori Oki
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Maria Carlos Bonfim
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Valeria Hong
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Pedro Acosta-Cardenas
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Celia Strunz
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Eleonora Brunoro
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Marcio Hiroshi Miname
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Wilson Salgado Filho
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Luiz Aparecido Bortolotto
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
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Silva BCD, Sanjuan A, Costa-Hong V, Reis LD, Graciolli F, Consolim-Colombo F, Bortolotto LA, Moyses RMA, Elias RM. Factors associated with subendocardial ischemia risk in patients on hemodialysis. J Bras Nefrol 2016; 38:320-326. [DOI: 10.5935/0101-2800.20160049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/02/2015] [Indexed: 11/20/2022] Open
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Bernardes FM, Genta Pereira DC, Bortolotto LA, Filho GL, Drager LF. REALIDADE E DESAFIOS NO SISTEMA PÚBLICO DE SAÚDE PARA O DIAGNÓSTICO E TRATAMENTO DA APNEIA OBSTRUTIVA DO SONO EM PACIENTES HIPERTENSOS DE UM CENTRO TERCIÁRIO. Sleep Sci 2015. [DOI: 10.1016/j.slsci.2016.02.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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De Sá Perlingeiro P, Azevedo LF, Gomes-Santos IL, Bortolotto LA, Rondon MUPB, Negrão CE, De Matos LDNJ. Neurovascular Control and Cardiac Structure in Amateur Runners with Hypertension. Med Sci Sports Exerc 2015; 48:26-32. [PMID: 26258859 DOI: 10.1249/mss.0000000000000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The neurovascular mechanisms underlying hypertension are minimized by exercise training. However, it is not known whether previously trained individuals with hypertension would have deleterious repercussion of this disease. Our aim was to investigate the neurovascular control and the cardiac structure of athletes with hypertension. METHODS Muscle sympathetic nerve activity (MSNA) (microneurography), baroreflex sensitivity (intravenous infusion of phenylephrine and nitroprusside), arterial stiffness (pulse wave velocity and echotracking), and cardiac structure (echocardiography) were evaluated in 17 runners with hypertension (42 ± 1 yr) and 20 normotensive (43 ± 1 yr) amateur runners. RESULTS Runners with hypertension had higher MSNA (+24% burst frequency, P = 0.02; +24%, burst incidence, P < 0.01), left ventricular mass (+22%, P < 0.01), septum wall thickness (+9%, P = 0.04), posterior wall thickness (+11%, P = 0.04), and left atrium (+11%, P < 0.001) compared with normotensive runners. Baroreflex control of heart rate was lower in runners with hypertension during increase (P = 0.05) but not during decrease (P = 0.11) of systolic blood pressure when compared with normotensive runners. There was no difference between groups in baroreflex control of MSNA during increase (P = 0.38) and decrease (P = 0.36) of diastolic blood pressure. Pulse wave velocity (P = 0.71) and carotid variables: intima media thickness (P = 0.18), diameter (P = 0.09), and distension (P = 0.79) were similar between groups. CONCLUSIONS Sympathetic overactivity seems to be involved in the underlying mechanisms of hypertension in amateur runners. Alterations in cardiac structure and decreased baroreflex control of heart rate suggest limited protection from exercise training. However, baroreflex control of MSNA and elastic properties of artery are preserved in this population.
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Affiliation(s)
- Patricia De Sá Perlingeiro
- 1Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (Incor), Medical School of University of São Paulo, São Paulo, BRAZIL; 2Hypertension Unit, Heart Institute (Incor), Medical School of University of São Paulo, São Paulo, BRAZIL; 3School of Physical Education and Sport, University of São Paulo, São Paulo, BRAZIL; and 4Hospital Israelita Albert Einstein, São Paulo, BRAZIL
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de Oliveira Alvim R, Mourao-Junior CA, de Oliveira CM, de Faria Lima R, Horimoto ARVR, Hong VAC, Bortolotto LA, Krieger JE, Pereira AC. Glycemic control and arterial stiffness in a Brazilian rural population: Baependi Heart Study. Diabetol Metab Syndr 2015; 7:86. [PMID: 26445602 PMCID: PMC4595065 DOI: 10.1186/s13098-015-0082-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/28/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increased arterial stiffness predicts morbidity and mortality, independently of other cardiovascular risk factors, and glycemic control impairments are related to higher vascular stiffness. The aim of this study was to evaluate the association between HbA1c levels and increased arterial stiffness in a Brazilian rural population. METHODS For this study were selected 1675 individuals (both genders and aged over 18 years) resident in the municipality of Baependi, a city located in the Southeast of Brazil. HbA1c levels were determined by HPLC. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior). RESULTS HbA1c levels were associated with an increased PWV. This was more relevant for the third tertile of age. In addition, logistic regression multivariate model including age, blood pressure, gender, BMI and fasting glucose showed that the elevation of a single unit percentage of HbA1c represented an increase of 54 % in the odds of increased arterial stiffness [OR 1.54 (95 % CI 1.01-2.17)]. Both, HbA1c and fasting glucose showed higher discriminatory power in the risk assessment for increased arterial stiffness in the non-diabetic when compared to the diabetic group (AUC of HbA1c = 0.71 vs 0.57, p = 0.02; AUC of fasting glucose = 0.66 vs 0.45, p = 0.0007, respectively). CONCLUSION Our findings indicate that a increase in HbA1c levels is associated with increased arterial stiffness and that both, HbA1c and fasting glucose, presented higher discriminatory power in the risk assessment for increased arterial stiffness in the non-diabetic group as compared to diabetic individuals.
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Affiliation(s)
- Rafael de Oliveira Alvim
- />Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000 Brazil
| | - Carlos Alberto Mourao-Junior
- />Department of Physiology, Federal University of Juiz de Fora, Campus Universitário – Bairro Martelos, Juiz de Fora, Minas Gerais - MG CEP 36036-900 Brazil
| | - Camila Maciel de Oliveira
- />Department of Physiology, Federal University of Juiz de Fora, Campus Universitário – Bairro Martelos, Juiz de Fora, Minas Gerais - MG CEP 36036-900 Brazil
| | - Rerisson de Faria Lima
- />Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000 Brazil
| | - Andréa Roseli Vançan Russo Horimoto
- />Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000 Brazil
| | - Valéria Aparecida Costa Hong
- />Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, Sãos Paulo, SP CEP 05403-000 Brazil
| | - Luiz Aparecido Bortolotto
- />Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, Sãos Paulo, SP CEP 05403-000 Brazil
| | - José Eduardo Krieger
- />Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000 Brazil
| | - Alexandre Costa Pereira
- />Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000 Brazil
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Tolezani EC, Costa-Hong V, Correia G, Mansur AJ, Drager LF, Bortolotto LA. Determinants of Functional and Structural Properties of Large Arteries in Healthy Individuals. Arq Bras Cardiol 2014; 103:426-432. [PMID: 25211201 PMCID: PMC4262104 DOI: 10.5935/abc.20140124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/05/2014] [Indexed: 01/11/2023] Open
Abstract
Background Changes in the properties of large arteries correlate with higher cardiovascular
risk. Recent guidelines have included the assessment of those properties to detect
subclinical disease. Establishing reference values for the assessment methods as
well as determinants of the arterial parameters and their correlations in healthy
individuals is important to stratify patients. Objective To assess, in healthy adults, the distribution of the values of pulse wave
velocity, diameter, intima-media thickness and relative distensibility of the
carotid artery, in addition to assessing the demographic and clinical determinants
of those parameters and their correlations. Methods This study evaluated 210 individuals (54% women; mean age, 44 ± 13 years) with no
evidence of cardiovascular disease. The carotid-femoral pulse wave velocity was
measured with a Complior® device. The functional and structural
properties of the carotid artery were assessed by using radiofrequency ultrasound.
Results The means of the following parameters were: pulse wave velocity, 8.7 ± 1.5 m/s;
diameter, 6,707.9 ± 861.6 μm; intima-media thickness, 601 ± 131 μm; relative
distensibility, 5.3 ± 2.1%. No significant difference related to sex or ethnicity
was observed. On multiple linear logistic regression, the factors independently
related to the vascular parameters were: pulse wave velocity, to age (p < 0.01)
and triglycerides (p = 0.02); intima-media thickness, to age (p < 0.01);
diameter, to creatinine (p = 0.03) and age (p = 0.02); relative distensibility, to
age (p < 0.01) and systolic and diastolic blood pressures (p = 0.02 and p =
0.01, respectively). Pulse wave velocity showed a positive correlation with intima
media thickness (p < 0.01) and with relative distensibility (p < 0.01),
while diameter showed a positive correlation with distensibility (p = 0.03). Conclusion In healthy individuals, age was the major factor related to aortic stiffness,
while age and diastolic blood pressure related to the carotid functional measure.
The carotid artery structure was directly related to aortic stiffness, which was
inversely related to the carotid artery functional property.
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Affiliation(s)
- Elaine Cristina Tolezani
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valéria Costa-Hong
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gustavo Correia
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alfredo José Mansur
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luciano Ferreira Drager
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Salles Rosa Neto N, Levy-Neto M, Tolezani EC, Bonfá E, Bortolotto LA, Pereira RMR. Determinants of Arterial Stiffness in Female Patients with Takayasu Arteritis. J Rheumatol 2014; 41:1374-8. [DOI: 10.3899/jrheum.131110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.The assessment of pulse wave velocity (PWV) in Takayasu arteritis (TA) is complex because of many confounding factors. We evaluated PWV in female patients with TA and controls with comparable anthropometric and clinical variables and assessed a possible association of TA with disease variables.Methods.We evaluated 27 patients with TA consecutively. Exclusion criteria were menopause, smoking, diabetes, renal insufficiency, poorly controlled hypertension, cardiac arrhythmias, obesity, inflammatory comorbidities, pregnancy, and surgical procedures involving the aorta. Disease activity was determined by clinical and laboratory variables. As healthy controls, 27 subjects with comparable age, blood pressure, height, and weight were selected. Carotid-femoral PWV measurements were obtained using the Complior system.Results.The mean PWV in patients with TA was higher than in healthy controls (9.77 ± 3.49 vs 7.83 ± 1.06 m/s; p = 0.009). Despite our strict selection criteria, patients with TA had an average systolic blood pressure (SBP) 8 mmHg higher than controls (p = NS), and significantly higher pulse pressure values. The multivariate linear regression model shows that 93.8% of the PWV variability is explained by the variables age, mean BP, and the disease itself (adjusted R2= 0.938). Stepwise logistic analysis using the PWV cutoff value established by the receiver-operator characteristic curve (> 8.34 m/s) as dependent variable, and measures with significance in univariate analysis as independent variables revealed that TA (OR 4.69; 95% CI 1.31–16.72; p = 0.017) and mean BP (OR 1.06; 95% CI 1.00–1.12; p = 0.048) were independently associated with higher PWV. Further analysis of disease variables revealed that PWV values were not correlated with erythrocyte sedimentation rate, C-reactive protein, cumulative dose of glucocorticoid, or ejection fraction (p > 0.05).Conclusion.In our cohort of female patients with TA, the disease itself and mean BP were the strongest determinants associated with arterial stiffness.
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Wolff Gowdak LH, de Paula FJ, Cesar LAM, Bortolotto LA, de Lima JJG. PM320 Multiorgan versus single organ atherosclerotic disease as a risk factor for cardiovascular events in patients with end-stage renal disease. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bassi E, Liberman M, Martinatti MK, Bortolotto LA, Laurindo FRM. Lipoic acid, but not tempol, preserves vascular compliance and decreases medial calcification in a model of elastocalcinosis. Braz J Med Biol Res 2014; 47:119-27. [PMID: 24519127 PMCID: PMC4051185 DOI: 10.1590/1414-431x20133193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/04/2013] [Accepted: 10/07/2013] [Indexed: 01/07/2023] Open
Abstract
Vascular calcification decreases compliance and increases morbidity. Mechanisms
of this process are unclear. The role of oxidative stress and effects of
antioxidants have been poorly explored. We investigated effects of the
antioxidants lipoic acid (LA) and tempol in a model of atherosclerosis
associated with elastocalcinosis. Male New Zealand white rabbits (2.5-3.0 kg)
were fed regular chow (controls) or a 0.5% cholesterol (chol)
diet+104 IU/day vitamin D2 (vitD) for 12 weeks, and
assigned to treatment with water (vehicle, n=20), 0.12
mmol·kg-1·day-1 LA (n=11) or 0.1
mmol·kg-1·day-1 tempol (n=15). Chol+vitD-fed rabbits
developed atherosclerotic plaques associated with expansive remodeling, elastic
fiber disruption, medial calcification, and increased aortic stiffness.
Histologically, LA prevented medial calcification by ∼60% and aortic stiffening
by ∼60%. LA also preserved responsiveness to constrictor agents, while
intima-media thickening was increased. In contrast to LA, tempol was associated
with increased plaque collagen content, medial calcification and aortic
stiffness, and produced differential changes in vasoactive responses in the
chol+vitD group. Both LA and tempol prevented superoxide signals with chol+vitD.
However, only LA prevented hydrogen peroxide-related signals with chol+vitD,
while tempol enhanced them. These data suggest that LA, opposite to tempol, can
minimize calcification and compliance loss in elastocalcionosis by inhibition of
hydrogen peroxide generation.
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Affiliation(s)
- E Bassi
- Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil, Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M Liberman
- Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil, Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M K Martinatti
- Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil, Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L A Bortolotto
- Unidade de Hipertensão, Departamento de Cardiologia, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil, Unidade de Hipertensão, Departamento de Cardiologia, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - F R M Laurindo
- Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil, Laboratório de Biologia Vascular, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Bortolotto LA, Midlej-Brito T, Pisani C, Costa-Hong V, Scanavacca M. Renal denervation by ablation with innovative technique in resistant hypertension. Arq Bras Cardiol 2013; 101:e77-9. [PMID: 24217435 PMCID: PMC4062378 DOI: 10.5935/abc.20130194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Thiago Midlej-Brito
- Mailing Address: Thiago Midlej-Brito, Rua Dr. Enéas de Carvalho
Aguiar, 44, Cerqueira César. Postal Code 05403-000, São Paulo - SP - Brazil.
E-mail: ,
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Gowdak LHW, de Paula FJ, César LAM, Bortolotto LA, de Lima JJG. A new risk score model to predict the presence of significant coronary artery disease in renal transplant candidates. Transplant Res 2013; 2:18. [PMID: 24176034 PMCID: PMC3892004 DOI: 10.1186/2047-1440-2-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Renal transplant candidates are at high risk of coronary artery disease (CAD). We sought to develop a new risk score model to determine the pre-test probability of the occurrence of significant CAD in renal transplant candidates. METHODS A total of 1,060 renal transplant candidates underwent a comprehensive cardiovascular risk evaluation. Patients considered at high risk of CAD (age ≥50 years, with either diabetes mellitus (DM) or cardiovascular disease (CVD)), or having noninvasive testing suggestive of CAD were referred for coronary angiography (n = 524). Significant CAD was defined by the presence of luminal stenosis ≥70%. A binary logistic regression model was built, and the resulting logistic regression coefficient B for each variable was multiplied by 10 and rounded to the next whole number. For each patient, a corresponding risk score was calculated and the receiver operating characteristic (ROC) curve was constructed. RESULTS The final equation for the model was risk score = (age × 0.4) + (DM × 9) + (CVD × 14) and for the probability of CAD (%) = (risk score × 2) - 23. The corresponding ROC for the accuracy of the diagnosis of CAD was 0.75 (P <0.0001) in the developmental model. CONCLUSIONS We developed a simple clinical risk score to determine the pre-test probability of significant CAD in renal transplant candidates. This model may help those directly involved in the care of patients with end-stage renal disease being considered for transplantation in an attempt to reduce the rate of cardiovascular events that presently hampers the long-term prognosis of such patients.
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Affiliation(s)
- Luís Henrique Wolff Gowdak
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 44, São Paulo 05403-000, Brazil
| | - Flávio Jota de Paula
- Renal Transplant Unit, Hospital das Clínicas, University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, São Paulo 05403-000, Brazil
| | - Luiz Antônio Machado César
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 44, São Paulo 05403-000, Brazil
| | - Luiz Aparecido Bortolotto
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 44, São Paulo 05403-000, Brazil
| | - José Jayme Galvão de Lima
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 44, São Paulo 05403-000, Brazil
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de Souza SBC, Rocha JA, Cuoco MAR, Guerra GM, Ferreira-Filho JC, Borile S, Krieger EM, Bortolotto LA, Consolim-Colombo FM. High muscle sympathetic nerve activity is associated with left ventricular dysfunction in treated hypertensive patients. Am J Hypertens 2013; 26:912-7. [PMID: 23475700 DOI: 10.1093/ajh/hpt032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity. METHODS After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n = 15), impaired relaxation (LV-IR, n = 15), and pseudonormal or restrictive (LV-P/R, n = 15). An age-, sex-, and body mass index-matched control group of normotensive volunteers (N, n = 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position. RESULTS Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (33±1 and 32±1 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (26±3 and 15±2 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group. CONCLUSIONS The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
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Alessi A, Brandão AA, Coca A, Cordeiro AC, Cordeiro A, Nogueira ADR, Diógenes de Magalhães F, Feitosa A, Amodeo C, Saad Rodrigues CI, Rodrigues C, Calhoun DA, Calhoun D, Barbosa Coelho E, Barbosa E, Pimenta E, Muxfeldt E, Consolin-Colombo FM, Consolin-Colombo F, Salles G, Rosito G, Moreno H, Martin JFV, Yugar JC, Aparecido Bortolotto L, Bortolotto L, Nazário Scala LC, Scala LCN, Gonçalves de Sousa M, Souza MD, Gomes MAM, Malachias MB, Gus M, Passarelli O, Jardim PCV, Toscano PR, Sánchez RA, Sanchez R, Dischinger Miranda R, Miranda RD, Póvoa R, Barroso WKS. First Brazilian position on resistant hypertension. Arq Bras Cardiol 2013; 99:576-85. [PMID: 22948302 DOI: 10.1590/s0066-782x2012000700002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/22/2022] Open
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Simão AF, Precoma DB, Andrade JP, Correa Filho H, Saraiva JFK, Oliveira GMM, Murro ALB, Campos A, Alessi A, Avezum Junior A, Miguel ACMG, Sousa ACS, Lotemberg AMP, Lins AP, Falud AA, Brandão AA, Sanjuliani AF, Sbissa AS, Santos Filho AC, Herdy AH, Polanczyk CA, Lantieri CJ, Machado CA, Scherr C, Stoll C, Amodeo C, Araújo CGS, Saraiva D, Moriguchi EH, Mesquita ET, Cesena FHY, Fonseca FAH, Campos GP, Soares GP, Feitosa GS, Xavier HT, Castro I, Giuliano ICB, Rivera IV, Guimaraes ICB, Issa JS, Souza JRM, Faria Neto JR, Cunha LBN, Pellanda LC, Bortolotto LA, Bertolami MC, Miname MH, Gomes MAM, Tambascia M, Malachias MVB, Silva MAM, Iza MCO, Magalhães MEC, Bacellar MSC, Milani M, Wajngarten M, Ghorayeb N, Coelho OR, Villela PB, Jardim PCBV, Santos Filho RD, Stein R, Cassani RSL, D'Avila RL, Ferreira RM, Barbosa RB, Povoa RMS, Kaiser SE, Ismael SC, Carvalho T, Giraldez VZR, Coutinho W, Souza WKSB. I Diretriz Brasileira de Prevenção Cardiovascular. Arq Bras Cardiol 2013; 101:1-63. [DOI: 10.5935/abc.2013s012] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gengo e Silva RDC, Brunorio L, Giribela CRG, Bortolotto LA, Wolosker N, Consolim-Colombo FM. Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion. Rev Lat Am Enfermagem 2012; 20:251-8. [PMID: 22699724 DOI: 10.1590/s0104-11692012000200006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 09/20/2011] [Indexed: 11/22/2022] Open
Abstract
Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.
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Caldas CAM, Borba EF, Bortolotto LA, Medeiros DM, Bonfa E, Gonçalves CR. Increased arterial stiffness assessed by pulse wave velocity in Behçet's disease and its association with the lipid profile. J Eur Acad Dermatol Venereol 2012; 27:454-9. [PMID: 22329367 DOI: 10.1111/j.1468-3083.2012.04458.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the structural and functional properties of vessels in Behçet's Disease (BD) using carotid-femoral pulse wave velocity (PWV) and an echo-tracking system. METHODS BD patients without traditional cardiovascular risk factors were selected. All BD patients performed PWV and carotid ultrasound. BD patients were divided into groups based on the presence of systemic (vascular and/or ocular and/or central nervous system involvement) and vascular involvement. Healthy controls age- and sex-matched with the same exclusion criteria were selected. RESULTS A total of 23 BD patients (mean age 35.0 ± 7.6 years) had significantly higher PWV levels compared with controls (8.48 ± 1.14 vs. 7.53 ± 1.40 m/s, P = 0.017). Intima-media thickness (594.87 ± 138.61 vs. 561.08 ± 134.26 μm, P = 0.371), diastolic diameter (6383.78 ± 960.49 vs. 6447.65 ± 1159.73 μm, P = 0.840), distension (401.95 ± 117.72 vs. 337.91 ± 175.36 μm, P = 0.225) and relative distension (6.26 ± 2.83 vs. 5.42 ± 2.46 μm, P = 0.293) were similar in both groups. The systemic disease group had significantly higher levels of PWV (8.79 ± 1.21 vs. 7.88 ± 0.72 m/s, P = 0.036) compared to those with exclusive mucocutaneous manifestations. BD patients with vascular involvement had similar PWV and echo-tracking parameters compared to those without vascular involvement (P > 0.05), but had higher total and LDL cholesterol levels (P = 0.019 and P = 0.012, respectively). The multivariate linear regression analysis identified triglycerides as the most important factor in increasing PWV levels (P = 0.001) in BD. CONCLUSIONS PWV is more useful than carotid ultrasound in detecting structural and functional vascular damage in BD and emphasizes the role of the disease itself in promoting these alterations. Our findings also reinforce the need for rigorous control of all risk factors in BD, particularly lipoproteins.
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Affiliation(s)
- C A M Caldas
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Faintuch J, Bortolotto LA, Marques PC, Faintuch JJ, França JI, Cecconello I. Systemic inflammation and carotid diameter in obese patients: pilot comparative study with flaxseed powder and cassava powder. NUTR HOSP 2011; 26:208-213. [PMID: 21519749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/30/2010] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Botanical omega-3 fatty acid (alphalinolenic acid/ALA) has been shown to alleviate the prothrombotic and proinflammatory profile of metabolic syndrome, however clinical protocols are still scarce. Aiming to focus an obese population, a pilot study was designed. METHODS Morbidly obese candidates for bariatric surgery (n = 29, age 46.3 ± 5.2 years), 82.8% females (24/29), BMI 44.9 ± 5.2 kg/m², with C-reactive protein/CRP > 5 mg/L were recruited. Twenty were randomized and after exclusions, 16 were available for analysis. Flaxseed powder (60 g/day, 10 g ALA) and isocaloric roasted cassava powder (60 g/day, fat-free) were administered in a double-blind routine for 12 weeks. RESULTS During flaxseed consumption neutrophil count decreased and fibrinogen, complement C4, prothrombin time and carotid diameter remained stable, whereas placebo (cassava powder) was associated with further elevation of those measurements. CONCLUSIONS Inflammatory and coagulatory markers tended to exhibit a better outlook in the flaxseed group. Also large-artery diameter stabilized whereas further increase was noticed in controls. These findings raise the hypothesis of a less deleterious cardiovascular course in seriously obese subjects receiving a flaxseed supplement.
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Affiliation(s)
- J Faintuch
- Nutrology Residency Program, Hospital das Clinicas, São Paulo, Brazil.
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