Luciana Savoy Fornari

Alterações eletrocardiográficas e sua relação com os fatores de risco para doença isquêmica do coração em população da área metropolitana de São Paulo

OBJETIVO: A doenca isquemica do coracao apresenta altas taxas de mortalidade e e a mais prevalente entre as doencas cardiovasculares. E uma doenca multifatorial, cuja prevencao depende do controle dos fatores de risco. O eletrocardiograma de repouso pode ser utilizado para detectar manifestacoes da doenca isquemica do coracao quando o individuo ainda e assintomatico. O objetivo do estudo foi o de analisar a relacao entre as anormalidades eletrocardiograficas e os fatores de risco para doenca isquemica do coracao em uma populacao adulta residente na area metropolitana de Sao Paulo. METODOS: Realizou-se um estudo transversal com populacao do municipio de Cotia (SP). A amostra constou de 1067 individuos com idade acima de 20 anos, de ambos os sexos. Os dados foram obtidos por meio de entrevista com utilizacao de um questionario padronizado. As variaveis estudadas foram: sexo, idade, tabagismo, atividade fisica, indice de massa corporea, relacao cintura/quadril, pressao arterial, diabetes melito, dislipidemia (colesterol total, LDL-colesterol, HDL-colesterol e triglicerides) e alteracoes eletrocardiograficas. As alteracoes eletrocardiograficas foram agrupadas em tres categorias: alteracoes de repolarizacao ventricular (ARV), sobrecarga do ventriculo esquerdo (SVE) e alteracoes nao relacionadas a isquemia miocardia ou sem alteracoes (NRI). RESULTADOS: A populacao de estudo era predominantemente jovem, sendo 79% abaixo de 50 anos, com idade de 39,8 anos ± 13,2 anos. Cerca de 59,3% dos individuos eram do sexo feminino. O eletrocardiograma mostrou que 9,5% da populacao apresentava ARV e 3,3% apresentava SVE. O sexo feminino, a idade de risco (acima de 65 anos para mulheres e acima de 55 anos para homens), a presenca de diabetes, hipertensao arterial, colesterol total ³ a 200 mg/dl, LDL-colesterol ³ a 130 mg/dl, triglicerides acima de 200 mg/dl, indice de massa corporea indicativo de sobrepeso ou obesidade (³25 Kg/m2),relacao cintura/quadril alterada correlacionaram-se positivamente com ARV. O sexo masculino, diabetes, hipertensao arterial e o tabagismo foram correlacionados positivamente com SVE. Na presenca de ARV no ECG encontramos uma razao de chance de 3,54 para a ocorrencia do diagnostico de hipertensao sistolica e de 1,83 para colesterol total ³ a 200 mg/dl. Na presenca de SVE no ECG, a razao de chance para a ocorrencia do diagnostico de hipertensao sistolica observada foi de 5,92. Dos tres fatores de risco correlacionados as alteracoes eletrocardiograficas associadas a isquemia miocardia, dois sao controlaveis e ligados a condicoes nutricionais (hipertensao e colesterol ³ a 200 mg/dl), o que demonstra a importância da sua deteccao precoce. Em estudos epidemiologicos e de intervencao nutricional, o eletrocardiograma, metodo simples e de baixo custo, pode auxiliar na identificacao de fatores de risco cardiovascular. Seria importante que estas informacoes fossem confirmadas por estudos prospectivos que incluissem a determinacao dos valores preditivos do ECG nesta situacao.

Children First Study: how an educational program in cardiovascular prevention at school can improve parents’ cardiovascular risk

Aim: To evaluate whether a multidisciplinary educational program (EP) in cardiovascular prevention (CVP) for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year. Methods and results: This was a prospective community-based study in Brazil during 2010 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents, and children were exposed to a weekly EP in CVP with a multidisciplinary health team. At onset and end of the study, we collected data from parents and children (weight, height, arterial blood pressure, and laboratory tests). We studied 197 children and 323 parents. Analyzing the parents’ FCR we found that 9.3% of the control group and 6.8% of the intervention group had more than a 10% year risk of cardiovascular heart disease (CHD) over the next 10 years. After the children’s EP for the year, the intervention group had a reduction of 91% in the intermediate/high FCR group compared with a 13% reduction in the control group, p = 0.002). In the same way, analyzing the FCR of all parents, there was a reduction of the average risk in the intervention group (3.6% to 2.8% respectively, p < 0.001) compared with the control group (4.4% to 4.4%, p = 0.98). Conclusion: An educational program in cardiovascular prevention directed at school-age children can reduce the FCR risk of their parents, especially in the intermediate/high risk categories.

Secular trends in a population with ischemic heart disease admitted to the Instituto do Coração in São Paulo.

OBJECTIVE To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4 +/- 11.5 to 59.9 +/- 12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9 +/- 15.2 and 57.7 +/- 11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3 +/- 8.6 to 60.5 +/- 9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1 +/- 9.1 and 62.1 +/- 7.9 years, P=0.0001). CONCLUSION The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.

Anticoagulants and antiplatelet drugs during cataract surgery

Patients undergoing cataract surgery are generally elderly, and many take drugs with systemic effects. The surgeon must be aware of the risks of continuing or discontinuing such medications perioperatively. Antiplatelet drugs and anticoagulants, prescribed to reduce the incidence of thromboembolic events, are often used in this population. This paper aims to review the perioperative use of antiplatelet and anticoagulant drugs in the setting of cataract surgery. Topical or intracameral anesthesia is preferred over anesthesia injected with needles. Aspirin can be safely continued in patients undergoing cataract surgery. Warfarin has been extensively studied, and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range. Only a few studies of direct oral anticoagulants are available, and therefore no definite recommendations regarding those agents can be made at this time. Anesthesia in cataract surgery carries a low risk, even for patients taking anticoagulant or antiplatelet drugs. The discontinuation of this class of drugs before cataract surgery may increase the risk of thromboembolism.

CHILDREN FIRST STUDY II: HOW AN EDUCATIONAL PROGRAM IN CARDIOVASCULAR PREVENTION AT PUBLIC SCHOOLS CAN IMPROVE PARENTS’ CARDIOVASCULAR RISK

Objective: To evaluate whether a multidisciplinary educational program in cardiovascular prevention for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year, in public schools in Brazil. Methods: We performed a prospective community-based study in Brazil during 2013 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents and children were exposed to a weekly educational program in cardiovascular prevention with a multidisciplinary health team. At onset and end of the study we collected data from parents and children (clinical information, weigh, height, arterial blood pressure and laboratorial tests). Results: We studied 265 children and 419 parents. Analyzing the parents’ FCR we found that 9% of the control group and 13% of the intervention g...

Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coração of the Medical School of USP from 1986 to 1995

OBJECTIVE To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > or =40% were analyzed. RESULTS We studied 18,221 patients and observed a significant increase in the number of females (22.8% to 25.2%, P=0.001) and an increase in age (57.1 +/- 29.3 to 60.4 +/- 10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2% and 64.5%) and among the older patients (59.8 +/- 9.8 and 56.8 +/- 10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2% vs 69.2% and 33.8% vs 30.5%, respectively, P<0.0001). CONCLUSION A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis.