Camila Giro

β-adrenergic receptor polymorphisms in susceptibility, response to treatment and prognosis in heart failure: Implication of ethnicity

Common functional polymorphisms in β-adrenergic receptor (βAR) genes have been associated with heart failure (HF) phenotypes and pharmacogenetic interactions with βAR blockers. This study evaluated the association between βAR polymorphisms and carvedilol drug response and prognosis in patients with HF. In this prospective cohort controlled study, 326 volunteers were enrolled [146 HF patients (ejection fraction (EF)<50% by Simpson) and 180 healthy controls]. Drug response was evaluated by echocardiography and outcomes were mortality and hospitalization. DNA was extracted from peripheral blood leukocytes, fragments were amplified by the polymerase reaction and genotyped by restriction fragment length polymorphism (RFLP) for Ser49Gly and Arg389Gly βAR-1 polymorphisms and Gln27Glu and Arg16Gly βAR-2 polymorphisms. The study population was in Hardy‑Weinberg equilibrium. The survival rate was adjusted using the Kaplan-Meier method. HF patients showed the following characteristics: EF 35±9%, 69.9% male, age 59±13 years, 50.7% self-identified as black, 46% had ischemic etiology. The mean follow-up of 23 months showed 18 mortalities and 46 hospitalizations. The genotypes Glu27Glu (24.7 vs. 6.1%, p=0.0004) and Arg16Arg (72.6 vs. 22.8, p<0.0001) of βAR2 polymorphisms and Gly49Gly (33.6 vs. 4.3%, p<0.0001) of the βAR1 polymorphism were higher in HF patients compared with controls. Patients with hospital admission showed a significantly higher Gly389 allelic frequency (54.9 vs. 42.1%, p=0.039), and the trend prevailed among patients who succumbed to the disease (61.1%, p=0.047). Black patients with the Ser49Ser genotype showed a reduced survival compared with the Gly49Gly or Ser49Gly genotypes (p=0.028). There was no association between improved LVEF >20% and βAR polymorphisms. HF patients with β-blocker therapy and the Gly389 allele have reduced event-free survival compared to those carrying the Arg389 allele. Additionally, systolic HF outpatients undergoing β-blocker therapy, self‑identified as black and homozygous for Ser49Ser may have reduced event-free survival, while Glu27Glu, Arg16Arg and Gly49Gly genotypes may be associated with risk for HF.

Analysis of mortality and hospitalization for cardiovascular diseases in Niterói, between 1998 and 2007

BACKGROUND The reduction in mortality from cardiovascular disease has been observed in Brazil for years, attributed to a fall in risk factors, improved treatment and reduced hospital mortality. OBJECTIVE To compare the mortality, the rate of hospitalization and hospital mortality in hospitals belonging to the Brazilian Public Health System, for ischemic heart disease (IHD), cerebrovascular diseases (CVD) and heart failure (HF), in Niterói, between 1998 and 2007. METHODS We used the number of deaths and hospitalizations and mortality of residents in Niterói for Chapter IX of ICD10 and specific causes available in Datasus, in population aged 30 and older. The difference between the magnitude of the indicators was calculated for men and women taking the average of the first three year period less the average of the second three year period. RESULTS There was drop in population mortality rates in men and women for all age groups, in three groups of causes and for Chapter IX. The falling trend of rates decreased with age. For IHD there was a decrease in hospital mortality. For CVD and HF, there was an increase. The rates of hospitalization from IHD decreased, with exception of some ranges. CONCLUSION This study has clarified some aspects of cardiovascular morbidity and mortality in Niterói. The reduction in population and hospital mortality from IHD indicates that there is a better approach in this condition. Increased mortality rate from cerebrovascular diseases and HF points to the need to give greater attention to the quality of hospital care for these groups of diseases.FUNDAMENTO: A reducao da mortalidade por doencas cardiovasculares e observada no Brasil ha anos, atribuida a queda nos fatores de risco, melhora na terapeutica e diminuicao da mortalidade hospitalar. OBJETIVO: Comparar a mortalidade populacional, o coeficiente de internacao e a mortalidade hospitalar em unidades do Sistema Unico de Saude, para doenca isquemica do coracao (DIC), doencas cerebrovasculares (DCBV) e insuficiencia cardiaca (IC), no municipio de Niteroi, entre 1998 e 2007. METODOS: Foram utilizados o numero de obitos e o de internacoes e mortalidade hospitalar de residentes em Niteroi para o capitulo IX do CID10 e causas especificas disponiveis no Datasus, na populacao de 30 anos e mais. A diferenca entre a magnitude dos indicadores foi calculada para homens e mulheres considerando a media do primeiro trienio menos a media do segundo trienio. RESULTADOS: Houve queda dos coeficientes de mortalidade populacional em homens e mulheres, para todas as faixas etarias, nos tres grupos de causas e para o capitulo IX. A tendencia a queda dos coeficientes diminuiu com a idade. Para DIC houve queda na mortalidade hospitalar. Para DCBV e IC, aumento. Os coeficientes de internacao hospitalar por DIC diminuiram, com excecao de algumas faixas. CONCLUSAO: O presente estudo permitiu esclarecer alguns aspectos da morbimortalidade cardiovascular em Niteroi. A reducao da mortalidade populacional e hospitalar por DIC indica haver melhor qualidade na abordagem dessa condicao. O aumento da mortalidade hospitalar por DCBV e IC aponta para a necessidade de se dar maior atencao a qualidade do cuidado hospitalar para esses grupos de doencas.

Análise da mortalidade e das internações por doenças cardiovasculares em Niterói, entre 1998 e 2007

BACKGROUND The reduction in mortality from cardiovascular disease has been observed in Brazil for years, attributed to a fall in risk factors, improved treatment and reduced hospital mortality. OBJECTIVE To compare the mortality, the rate of hospitalization and hospital mortality in hospitals belonging to the Brazilian Public Health System, for ischemic heart disease (IHD), cerebrovascular diseases (CVD) and heart failure (HF), in Niterói, between 1998 and 2007. METHODS We used the number of deaths and hospitalizations and mortality of residents in Niterói for Chapter IX of ICD10 and specific causes available in Datasus, in population aged 30 and older. The difference between the magnitude of the indicators was calculated for men and women taking the average of the first three year period less the average of the second three year period. RESULTS There was drop in population mortality rates in men and women for all age groups, in three groups of causes and for Chapter IX. The falling trend of rates decreased with age. For IHD there was a decrease in hospital mortality. For CVD and HF, there was an increase. The rates of hospitalization from IHD decreased, with exception of some ranges. CONCLUSION This study has clarified some aspects of cardiovascular morbidity and mortality in Niterói. The reduction in population and hospital mortality from IHD indicates that there is a better approach in this condition. Increased mortality rate from cerebrovascular diseases and HF points to the need to give greater attention to the quality of hospital care for these groups of diseases.FUNDAMENTO: A reducao da mortalidade por doencas cardiovasculares e observada no Brasil ha anos, atribuida a queda nos fatores de risco, melhora na terapeutica e diminuicao da mortalidade hospitalar. OBJETIVO: Comparar a mortalidade populacional, o coeficiente de internacao e a mortalidade hospitalar em unidades do Sistema Unico de Saude, para doenca isquemica do coracao (DIC), doencas cerebrovasculares (DCBV) e insuficiencia cardiaca (IC), no municipio de Niteroi, entre 1998 e 2007. METODOS: Foram utilizados o numero de obitos e o de internacoes e mortalidade hospitalar de residentes em Niteroi para o capitulo IX do CID10 e causas especificas disponiveis no Datasus, na populacao de 30 anos e mais. A diferenca entre a magnitude dos indicadores foi calculada para homens e mulheres considerando a media do primeiro trienio menos a media do segundo trienio. RESULTADOS: Houve queda dos coeficientes de mortalidade populacional em homens e mulheres, para todas as faixas etarias, nos tres grupos de causas e para o capitulo IX. A tendencia a queda dos coeficientes diminuiu com a idade. Para DIC houve queda na mortalidade hospitalar. Para DCBV e IC, aumento. Os coeficientes de internacao hospitalar por DIC diminuiram, com excecao de algumas faixas. CONCLUSAO: O presente estudo permitiu esclarecer alguns aspectos da morbimortalidade cardiovascular em Niteroi. A reducao da mortalidade populacional e hospitalar por DIC indica haver melhor qualidade na abordagem dessa condicao. O aumento da mortalidade hospitalar por DCBV e IC aponta para a necessidade de se dar maior atencao a qualidade do cuidado hospitalar para esses grupos de doencas.

Os polimorfismos dos receptores adrenérgicos na insuficiência cardíaca: o que a genética explica?

Heart failure (HF) is a complex disease, which involves several physiopathological mechanisms and different genetic polymorphisms. The adrenergic system is directly related to this pathology, as it participates in cardiovascular autoregulation and has a crucial role in the deterioration of cardiac function. The beta-blockers appeared as a great advance in cardiology for the treatment of HF; however, the drug response varies according to each patient, as several factors are associated, such as the genetic one. This review aims at assessing the genetic involvement in the development of HF, the drug response and the prognosis.

Genetic polymorphism G894T and the prognosis of heart failure outpatients

Background Previous studies have analyzed the role of the genetic polymorphism of endothelial nitric oxide synthase on heart failure prognosis. However, there are no studies relating the G894T and heart failure in Brazil. Objective To evaluate the association between G894T GP and the prognosis of a sample of Brazilian outpatients with heart failure. Methods Cohort study included 145 patients with systolic heart failure, followed for up to 40 months (mean = 22), at two university hospitals, in the State of Rio de Janeiro. We evaluated the relationship between G894T and the following outcomes: reverse remodeling, improvement in functional class (NYHA), and mortality and hospitalization rates. The diameters of the left atrium and ventricle, as well as the ejection fraction of the left ventricle, were evaluated at baseline and at 6 months to assess reverse remodeling. The improvement in functional class was evaluated after 6 months, and mortality rate and hospitalization were evaluated during follow-up. Race was self-declared. G894T polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Results The genotypic frequencies were GG (40%), GT (48.3%) and TT (11.7%). The allele frequency was guanine (64.1%) and thiamine (35.8%). There were no differences between the genotype or allelic frequencies according to self declared race, either as baseline characteristics. There was no relationship between genotype or allele frequency and the outcome measures. Conclusion No association was observed between the G894T polymorphism (Glu298Asp) and prognosis in this sample of Brazilian outpatients with systolic heart failure.

Análisis de la mortalidad y de las hospitalizaciones por enfermedades cardiovasculares en Niterói, entre 1998 y 2007

BACKGROUND The reduction in mortality from cardiovascular disease has been observed in Brazil for years, attributed to a fall in risk factors, improved treatment and reduced hospital mortality. OBJECTIVE To compare the mortality, the rate of hospitalization and hospital mortality in hospitals belonging to the Brazilian Public Health System, for ischemic heart disease (IHD), cerebrovascular diseases (CVD) and heart failure (HF), in Niterói, between 1998 and 2007. METHODS We used the number of deaths and hospitalizations and mortality of residents in Niterói for Chapter IX of ICD10 and specific causes available in Datasus, in population aged 30 and older. The difference between the magnitude of the indicators was calculated for men and women taking the average of the first three year period less the average of the second three year period. RESULTS There was drop in population mortality rates in men and women for all age groups, in three groups of causes and for Chapter IX. The falling trend of rates decreased with age. For IHD there was a decrease in hospital mortality. For CVD and HF, there was an increase. The rates of hospitalization from IHD decreased, with exception of some ranges. CONCLUSION This study has clarified some aspects of cardiovascular morbidity and mortality in Niterói. The reduction in population and hospital mortality from IHD indicates that there is a better approach in this condition. Increased mortality rate from cerebrovascular diseases and HF points to the need to give greater attention to the quality of hospital care for these groups of diseases.FUNDAMENTO: A reducao da mortalidade por doencas cardiovasculares e observada no Brasil ha anos, atribuida a queda nos fatores de risco, melhora na terapeutica e diminuicao da mortalidade hospitalar. OBJETIVO: Comparar a mortalidade populacional, o coeficiente de internacao e a mortalidade hospitalar em unidades do Sistema Unico de Saude, para doenca isquemica do coracao (DIC), doencas cerebrovasculares (DCBV) e insuficiencia cardiaca (IC), no municipio de Niteroi, entre 1998 e 2007. METODOS: Foram utilizados o numero de obitos e o de internacoes e mortalidade hospitalar de residentes em Niteroi para o capitulo IX do CID10 e causas especificas disponiveis no Datasus, na populacao de 30 anos e mais. A diferenca entre a magnitude dos indicadores foi calculada para homens e mulheres considerando a media do primeiro trienio menos a media do segundo trienio. RESULTADOS: Houve queda dos coeficientes de mortalidade populacional em homens e mulheres, para todas as faixas etarias, nos tres grupos de causas e para o capitulo IX. A tendencia a queda dos coeficientes diminuiu com a idade. Para DIC houve queda na mortalidade hospitalar. Para DCBV e IC, aumento. Os coeficientes de internacao hospitalar por DIC diminuiram, com excecao de algumas faixas. CONCLUSAO: O presente estudo permitiu esclarecer alguns aspectos da morbimortalidade cardiovascular em Niteroi. A reducao da mortalidade populacional e hospitalar por DIC indica haver melhor qualidade na abordagem dessa condicao. O aumento da mortalidade hospitalar por DCBV e IC aponta para a necessidade de se dar maior atencao a qualidade do cuidado hospitalar para esses grupos de doencas.