Marco Aurélio Lumertz Saffi

Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: A randomized clinical trial

Background: Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk. Aim: The purpose of this study was to evaluate the effect of systematic, nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease (CAD). Methods: This was a randomized clinical trial of CAD patients treated at a tertiary referral hospital. The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year, starting three months after hospital discharge. Exercise and dietary goals were set for each patient and monitored at each session. The control group received standard medical advice. Patients were stratified by Framingham risk score and compared at the end of the follow-up period. Results: The final sample comprised 74 patients, 38 in the intervention group and 36 in the control group. Mean age was 58±9 years; 74% of patients were male. A 1.7 point (−13.6%) reduction in risk score was recorded in the intervention group, vs a 1.2 point increase in risk score (+11%) in the control group (p=0.011). Significant between-group differences were detected for weight (intervention, 78±14 kg at baseline vs 77±14 kg at study end; control, 78±15 kg vs 79±15 kg; p=0.04), systolic blood pressure (intervention, 136±22 mm Hg vs 124±15 mm Hg; control, 126±15 mm Hg vs 129±16 mm Hg; p=0.005), and diastolic blood pressure (intervention, 82±10 mm Hg vs 77±09 mm Hg; control, 79±09 mm Hg vs 80±10 mm Hg; p=0.02). Conclusion: Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial

BackgroundScarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months.Methods/designThis is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1β, IL-6, TNFα, fibrinogen, ICAM-1, VCAM-1 and E-selectin. These outcomes will be assessed at all time points over 12 months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6 months after periodontal therapy.DiscussionThis trial will provide new evidence regarding the effect of periodontal treatment on risk markers for recurrence of cardiovascular events in stable coronary artery disease patients.Trial registration numberClinicalTrials.gov Identifier, NCT01609725

Validity and reliability of a questionnaire on knowledge of cardiovascular risk factors for use in Brazil

Using a sample of patients with coronary artery disease, this methodological study aimed to conduct a cross-cultural adaptation and validation of a questionnaire on knowledge of cardiovascular risk factors (Q-FARCS), lifestyle changes, and treatment adherence for use in Brazil. The questionnaire has three scales: general knowledge of risk factors (RFs); specific knowledge of these RFs; and lifestyle changes achieved. Cross-cultural adaptation included translation, synthesis, back-translation, expert committee review, and pretesting. Face and content validity, reliability, and construct validity were measured. Cronbachs alpha for the total sample (n = 240) was 0.75. Assessment of psychometric properties revealed adequate face and content validity, and the construct revealed seven components. It was concluded that the Brazilian version of Q-FARCS had adequate reliability and validity for the assessment of knowledge of cardiovascular RFs.

Fatores precipitantes de descompensação da insuficiência cardíaca relacionados a adesão ao tratamento: estudo multicêntrico-EMBRACE

OBJECTIVE To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment. METHODS Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment. RESULTS A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment. CONCLUSION The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.Objetivo: Descrever os fatores precipitantes de descompensacao da insuficiencia cardiaca entre pacientes aderentes e nao aderentes ao tratamento. Metodos: Estudo transversal de uma coorte multicentrica. Pacientes acima de 18 anos com insuficiencia cardiaca descompensada (classe funcional III/IV) foram elegiveis. Para a coleta dos dados foi utilizado um questionario estruturado avaliando os motivos da descompensacao. O uso irregular de medicacao previo a internacao, controle inadequado de sal e liquidos foram considerados como grupo de ma adesao ao tratamento. Resultados: Foram incluidos 556 pacientes, com idade media de 61±14 anos, 362(65%) homens. O principal fator de descompensacao foi a ma adesao, representando 55% da amostra. Os pacientes que referiram o uso irregular das medicacoes na ultima semana apresentaram 22% mais risco de internacao por ma adesao quando comparados aos pacientes aderentes. Conclusao: O estudo EMBRACE demonstrou que em pacientes com insuficiencia cardiaca, a ma adesao mostrou-se como o principal fator de exacerbacao. Palavras-chave: Insuficiencia cardiaca. Estudo multicentrico. Fatores desencadeantes.