Erlon Oliveira de Abreu-Silva

Nutrition and Physical Activity in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and it is associated with other medical conditions such as diabetes mellitus, metabolic syndrome, and obesity. The mechanisms of the underlying disease development and progression are not completely established and there is no consensus concerning the pharmacological treatment. In the gold standard treatment for NAFLD weight loss, dietary therapy, and physical activity are included. However, little scientific evidence is available on diet and/or physical activity and NAFLD specifically. Many dietary approaches such as Mediterranean and DASH diet are used for treatment of other cardiometabolic risk factors such as insulin resistance and type-2 diabetes mellitus (T2DM), but on the basis of its components their role in NAFLD has been discussed. In this review, the implications of current dietary and exercise approaches, including Brazilian and other guidelines, are discussed, with a focus on determining the optimal nonpharmacological treatment to prescribe for NAFLD.

Stents farmacológicos liberadores de Everolimus XienceTM V no tratamento de pacientes com lesões coronárias complexas na prática diária: resultados iniciais do registro brasileiro BRAVO

BACKGROUND: The XienceTM V everolimus-eluting stent (Abbott Vascular, Santa Clara, USA), a second-generation drug-eluting stent (DES) has demonstrated sustained efficacy and safety in the treatment of selected patients with coronary lesions. However, the impact of the XienceTM V stent in populations from daily clinical practice with complex lesions has not yet been fully determined. METHODS: The BRAVO Registry was a prospective, non-randomized, multicenter study that evaluated the late clinical outcomes of minimally selected patients treated with XienceTM V DES in the Brazilian daily clinical practice. Overall, 535 patients were included in 25 clinical sites between September/2008 and September/2010. Major adverse cardiac events (MACE) were defined as cardiac death, acute myocardial infarction (AMI) and target vessel revascularization (TVR). RESULTS: Mean age was 62.7 + 11.1 years, 40% had diabetes, 24.9% had a previous AMI and 41.9% presented with acute coronary syndrome. About two thirds of the patients had type B2/C lesions and 46.1% treated the left anterior descending artery. Multiple stenting procedures were performed in 13.8% of cases and angiographic success was > 99%. During hospitalization, periprocedural AMI rate was 1.9%. At the 6-month follow-up, cumulative rates of cardiac death, AMI and TVR were 1.1%, 2.2% and 1.3%, respectively (MACE rate: 4.3%). There were 4 cases of stent thrombosis (defined according to the Academic Research Consortium ARC) reported within 6 months, representing an event rate of 0.75% (0.4% definite/probable). CONCLUSIONS: In this Registry including complex patients and lesions treated at multiple sites in Brazil, the XienceTM V second generation DES demonstrated excellent immediate results and sustained clinical efficacy and safety at mid-term follow-up (6 months). Long-term results are expected.

Different adipose tissue depots: Metabolic implications and effects of surgical removal

Increased adiposity has been associated to worse metabolic profile, cardiovascular disease, and mortality. There are two main adipose tissue depots in the body, subcutaneous and visceral adipose tissue, which differ in anatomical location. A large body of evidence has shown the metabolic activity of adipose tissue; lipectomy and/or liposuction therefore appear to be alternatives for improving metabolic profile through rapid loss of adipose tissue. However, surgical removal of adipose tissue may be detrimental for metabolism, because subcutaneous adipose tissue has not been associated to metabolic disorders such as insulin resistance and type 2 diabetes mellitus. In addition, animal studies have shown a compensatory growth of adipose tissue in response to lipectomy. This review summarizes the implications of obesity-induced metabolic dysfunction, its relationship with the different adipose tissue depots, and the effects of lipectomy on cardiometabolic risk factors.

Seguimento angiográfico e clínico tardio do novo stent farmacológico não-polimérico liberador de paclitaxel para o tratamento de lesões coronárias de novo: resultados do estudo PAX-B

BACKGROUND: The non-polymeric paclitaxel-eluting sent Amazonia® PAX did not show differences in the occurrence of coronary restenosis or clinical events after 4 months of follow-up when compared with the Taxus® stent. However, the performance of the Amazonia® PAX stent in more complex cases and with longer angiographic follow-up has not been demonstrated. METHODS: The PAX-B study was a prospective, non-randomized, multicenter study assessing the late follow-up of patients treated with the Amazonia® PAX stent. The primary outcome was in-stent late lumen loss. RESULTS: One hundred and three patients with mean age of 61.3 ± 11.4 years were included, 26.2% were diabetics, 24.3% had acute coronary syndromes and 71.6% had type B2/C lesions. Multiple stents were performed in 4.7% of the cases and angiographic success was 100%. During hospitalization, the periprocedural acute myocardial infarction rate was 3.9% and one of these events led to target lesion revascularization (TLR). At 9-month angiographic follow-up, the median in-stent late lumen loss was 0.91 [0.50; 1.21] mm. The cumulative rates of major adverse cardiac events at the 6-month, 9-month and 12-month follow-up were 7.8%, 18.5% and 21.3%, respectively, mostly due to TLR. There was no death or stent thrombosis at 12 months. CONCLUSIONS: The stent Amazonia® PAX demonstrated excellent immediate results and high safety profile. However, angiographic recurrence rates were relatively high, due to low efficacy in inhibition of neointimal hyperplasia.

Diet and Inflammation: Effects of Macronutrients and Dietary Patterns

Cardiovascular disease (CVD) has already been demonstrated to be related to a chronic and complex inflammatory process, in which the loss of endothelial protective properties - the so-called endothelial dysfunction - plays a central role. A number of different approaches, both pharmacological and non-pharmacological, have been tested with inconclusive results so far. One field of special interest is the impact of the different macronutrients and dietary patterns in the inflammatory response that, ultimately, leads to endothelial dysfunction and increased cardio-metabolic risk. Although apparently simple, interventions regarding dietary habits have complex implications and involve a number of covariates that may interfere in the final results. To date, results about the protective effects of diet - in general - regarding cardio-metabolic risk remain to be fully proven.

Effects of Physical Activity on The Inflammatory Process Related to Insulin Resistance and Obesity

Atherosclerosis, the pathophysiological substrate for cardiovascular disease (CVD), is the final stage of an inflammatory cascade. During the process, endothelial dysfunction ensues and the inflammatory state is perpetuated. A number of traditional risk factors, as obesity and insulin resistance/type 2 diabetes, are characterized by a proinflammatory state as well, with increased levels of cytokines, interleukins, vasoactive peptides and enhanced expression of specific cellular receptors. The anti-inflammatory properties of physical exercise and its positive effects as a strategy for obesity and insulin resistance have already been shown in terms of cardiovascular protection and survival.

Dissecção causando estenose de artéria de rim transplantado: diagnóstico por angiografia rotacional tridimensional

A 47-year-old man diagnosed with stage 5 chronic kidney disease due to polycystic kidneys and on dialysis for five years was submitted to kidney transplantation. During the post-operative period the patient presented with graft dysfunction and uncontrolled hypertension, requiring reintroduction of dialysis. Doppler ultrasound suggested stenosis of the transplant renal artery, which was confirmed by CT angiography. On the 49th day after surgery, 3D rotational angiography of the renal graft artery was performed, showing dissection causing severe stenosis. Angioplasty and stent implantation were successfully performed and the patient no longer requires dialysis and has evolved well in the past six months. Transplant renal artery stenosis is a common complication, and is secondary to atherosclerotic plaque in most of the cases. Screening with Doppler ultrasound and diagnostic confirmation by angiography are the recommended strategies for intervention. Dissection is a possible cause of transplant renal artery stenosis.