Gláucia Maria Moraes de Oliveira

I Latin American Guidelines for the diagnosis and treatment of Chagas' heart disease: executive summary.

Jadelson Pinheiro de Andrade, Jose Antonio Marin Neto, Angelo Amato Vincenzo de Paola, Fábio Vilas-Boas, Glaucia Maria Moraes Oliveira, Fernando Bacal, Edimar Alcides Bocchi, Dirceu Rodrigues Almeida, Abilio Augusto Fragata Filho, Maria da Consolação Vieira Moreira, Sergio Salles Xavier, Wilson Alves de Oliveira Junior, João Carlos Pinto Dias et al Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ Brasil

Mortalidade por doenças cardiovasculares em três estados do Brasil de 1980 a 2002

OBJETIVO: Avaliar e comparar a mortalidade de adultos por doencas do aparelho circulatorio (DAC), especialmente doencas isquemicas do coracao (DIC) e doencas cerebrovasculares (DCBV), no periodo de 1980 a 2002 nos Estados do Rio de Janeiro, Rio Grande do Sul e Sao Paulo e em suas capitais, levando em consideracao o impacto dos obitos por causas mal definidas nas taxas de mortalidade. METODOS: Foram estimadas as taxas de mortalidade (brutas e ajustadas por sexo e idade) por DAC, DIC e DCBV em individuos com 20 ou mais anos. Essas taxas foram compensadas com parte dos obitos por causas mal definidas, na mesma proporcao dos obitos por DAC, DIC ou DCBV em relacao a todos os obitos, excluidos os mal definidos. Tambem foram estimadas as medias e diferencas anuais das taxas de mortalidade compensadas e ajustadas com modelos de regressao linear. A populacao padrao foi a do Estado do Rio de Janeiro em 2000. RESULTADOS: O declinio anual das taxas compensadas e ajustadas de mortalidade por DAC em 100 000 habitantes variou de -13,1 a -8,7 no Estado do Rio de Janeiro e no Municipio de Sao Paulo, respectivamente. Nas DIC, o declinio anual foi maior no Municipio e no Estado do Rio de Janeiro (-5,0 e -4,5, respectivamente), e menor no Estado do Rio Grande do Sul e no Municipio de Sao Paulo (-2,8 e -2,7, respectivamente). Nas DCBV, a variacao observada foi de -6,5 a -2,9 no Estado do Rio de Janeiro e em Porto Alegre, respectivamente. CONCLUSAO: Tendo em vista que o declinio nas taxas de mortalidade compensadas e ajustadas por DAC, DIC e DCBV ocorreu depois de 1980, e pouco provavel que tenha resultado do controle dos fatores de risco e implementacao da revascularizacao do miocardio. Essa queda poderia estar relacionada ao desenvolvimento economico acentuado que a precedeu, com consequente melhoria das condicoes de vida e reducao da exposicao a infeccoes no periodo perinatal e na infância.

Mortalidade compensada por doenças cardiovasculares no período de 1980 a 1999 - Brasil

OBJECTIVE To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), São Paulo (SP) and Rio Grande do Sul (RS) and respective capitals from 1980 to 1999. METHODS Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiros population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions. RESULTS Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively. CONCLUSION A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.

Impairment of systemic microvascular endothelial and smooth muscle function in individuals with early-onset coronary artery disease: studies with laser speckle contrast imaging.

ObjectivesThe assessment of systemic microvascular reactivity is currently considered to be critical in the stratification of cardiovascular risk. In the present study, we compared skin microvascular function in individuals with early-onset (premature) coronary artery disease (EOCAD, n=30) with that of age-matched and sex-matched healthy individuals (n=30). Materials and methodsUsing laser speckle contrast imaging, cutaneous blood flow was assessed in the forearm at rest and during reactivity tests, including postocclusive reactive hyperemia and the iontophoresis of acetylcholine or sodium nitroprusside with increasing currents of 30, 60, 90, 120, 150, and 180 &mgr;A for 10-s intervals spaced 1 min apart. Carotid intima–media thickness was evaluated using an ultrasound system and a 7.5 MHz ultrasound transducer. ResultsThe endothelium-dependent skin microvascular vasodilator responses that were induced by both acetylcholine and postocclusive reactive hyperemia were significantly reduced in patients with EOCAD compared with healthy individuals. The vasodilator responses that were induced by sodium nitroprusside were also significantly reduced in individuals with EOCAD. These systemic microvascular alterations were concurrent with increased carotid intima–media thickness in these patients. ConclusionLaser speckle contrast imaging identifies endothelial-dependent and endothelial-independent microvascular dysfunction in individuals presenting with EOCAD, and thus could be valuable as an early peripheral marker of atherothrombotic disease.

A COCONUT EXTRA VIRGIN OIL-RICH DIET INCREASES HDL CHOLESTEROL AND DECREASES WAIST CIRCUMFERENCE AND BODY MASS IN CORONARY ARTERY DISEASE PATIENTS.

INTRODUCTION saturated fat restriction has been recommended for coronary arterial disease, but the role of coconut oil (Cocos nucifera L.) extra virgin, lauric acid source in the management of lipid profile remains unclear. OBJECTIVE to evaluate the effect of nutritional treatment associated with the consumption of extra virgin coconut oil in anthropometric parameters and lipid profile. METHODS we conducted a longitudinal study of 116 adults of both sexes presenting CAD. Patients were followed in two stages: the first stage (basal-3 months), intensive nutritional treatment. In the second stage (3-6 months), the subjects were divided into two groups: diet group associated with extra virgin coconut oil consumption (GDOC) and diet group (DG). Held monthly anthropometric measurements: body mass, waist circumference (WC), neck circumference (PP), body mass index (BMI). Gauged to collected blood pressure and blood samples were fasted for 12 hours, for total cholesterol analysis and fractions apoproteins (Apo A-1 and B), glucose, glycated hemoglobin (HbA1C), insulin (I). Comparing the averages at the beginning and end of the study employing the paired Student t-independent. And set the diastolic blood pressure by BMI using ANOVA. Analyses were performed using the SPSS statistical package, being significant p < 0.05. RESULTS the mean age of the population was 62.4 ± 7.7 years, 63.2% male, 70% elderly, 77.6% infarcted, 52.6% with angina, hypertension and dyslipidemia 100%. In the first stage the nutritional treatment reduced body weight, WC, BMI and PP and insulin concentrations, HbA1C, HOMA-IR and QUICK, without changing the other parameters. In the second stage of the study, it was observed that the GDOC maintained the reduction of body mass, BMI, WC, with a significant difference between groups for DC (-2.1 ± 2,7 cm; p < 0.01). In addition, there was an increase in HDL-C concentrations, Apo A, with significant difference in GD, only for HDL-C (3.1 ± 7.4 mg/dL; p = 0.02). CONCLUSION it was observed that the nutritional treatment associated with extra virgin coconut oil consumption reduced the CC and increased HDL-C levels in patients with CAD.

Letalidade por doenças isquêmicas do coração no Estado do Rio de Janeiro no período de 1999 a 2003

OBJECTIVE To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System/Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).

I Diretriz de Prevenção Cardiovascular da Sociedade Brasileira de Cardiologia - Resumo Executivo

Brazil currently faces a major health challenge: the pandemic scenario of cardiovascular morbidity and mortality. According to Brazilian Health Ministry data, 326,000 deaths due to cardiovascular diseases (CVD) occurred in 2010, corresponding to approximately 1,000 deaths/day, 200,000 deaths due exclusively to ischemic heart and cerebrovascular diseases, reflecting a gloomy scenario far from the minimally acceptable control.

Aplicação do EuroSCORE na cirurgia de revascularização miocárdica em hospitais públicos do Rio de Janeiro

BACKGROUND Risk stratification models are used to assess the risk of death in surgery. OBJECTIVE To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003. METHODS Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve. RESULTS 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%- 10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. CONCLUSION The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.

Reduced systemic microvascular density and reactivity in individuals with early onset coronary artery disease

OBJECTIVE This study sought to test whether patients with early-onset coronary artery disease (EOCAD, n=30) showed systemic microvascular rarefaction and endothelial dysfunction in comparison to age- and sex-matched healthy controls (CTL, n=30), as evaluated by skin video-capillaroscopy. METHODS Functional capillary density (FCD) was defined as the number of spontaneously perfused capillaries per square millimeter of skin area and assessed by high-resolution intra-vital color microscopy in the dorsum of the middle phalanx. Capillary recruitment (capillary reserve) was evaluated using post-occlusive reactive hyperemia (PORH) after arm ischemia for 3min. RESULTS The mean capillary density at rest was significantly reduced in patients with EOCAD compared to controls (CTL 95±20 and EOCAD 80±18capillaries/mm(2), P=0.0040). During PORH, capillary density was also markedly reduced in EOCAD patients (CTL 96±18 and EOCAD 71±20capillaries/mm(2), P<0.0001). Moreover, the capillary density in EOCAD patients was significantly reduced during PORH (EOCAD at rest 80±19 and EOCAD during PORH 71±20capillaries/mm(2), P=0.0073). CONCLUSIONS Patients with EOCAD presented systemic capillary rarefaction and impaired microvascular endothelial function. Thus, the early detection of these microvascular alterations in young adults at an increased risk of coronary artery disease could be useful as a surrogate marker of subclinical atherosclerosis.

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.