Marco Vugman Wainstein

Effect of vitamins C and E on progression of transplant-associated arteriosclerosis: a randomised trial

BACKGROUND Cardiac transplantation is associated with oxidant stress, which may contribute to the development of accelerated coronary arteriosclerosis. We postulated that treatment with antioxidant vitamins C and E would retard the progression of transplant-associated arteriosclerosis. METHODS In a double-blind prospective study, 40 patients (0-2 years after cardiac transplantation) were randomly assigned vitamin C 500 mg plus vitamin E 400 IU, each twice daily (n=19), or placebo (n=21) for 1 year. The primary endpoint was the change in average intimal index (plaque area divided by vessel area) measured by intravascular ultrasonography (IVUS). Coronary endothelium-dependent vasoreactivity was assessed with intracoronary acetylcholine infusions. IVUS, coronary vasoreactivity, and vitamin C and E plasma concentrations were assessed at baseline and at 1 year follow-up. All patients received pravastatin. Analyses were by intention to treat. FINDINGS Vitamin C and E concentrations increased in the vitamin group (vitamin C 43 [SD 21] to 103 [43] mmol/L; vitamin E 24 [14] to 65 [27] mmol/L) but did not change in the placebo group (vitamin C 45 [15] vs 43 [16] mmol/L; vitamin E 27 [14] vs 27 [9] mmol/L; p<0.0001 for difference between groups). During 1 year of treatment, the intimal index increased in the placebo group by 8% (SE 2) but did not change significantly in the treatment group (0.8% [1]; p=0.008). Coronary endothelial function remained stable in both groups. INTERPRETATION Supplementation with antioxidant vitamins C and E retards the early progression of transplant-associated coronary arteriosclerosis.

Erectile Dysfunction and Coronary Artery Disease: An Association of Higher Risk in Younger Men

INTRODUCTION The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM To investigate the interaction of age in the association between ED and CAD. METHODS This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results.  Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

Custo-efetividade dos stents recobertos por rapamicina em procedimentos percutâneos coronarianos no Brasil

OBJETIVOS: Comparar as relacoes de custo-efetividade do stent recoberto (SR) por rapamicina com o stent convencional (SC), sob duas perspectivas: medicina suplementar e sistema publico (SUS). METODOS: Modelo de decisao analitico com tres estrategias de tratamento de lesao coronariana: intervencao coronaria percutânea (icP) com SC; com SR com rapamicina e SC seguido de SR para manejo de reestenose sintomatica. Os desfechos foram: sobrevida livre de eventos em um ano e expectativa de vida. As arvores de decisao foram construidas com resultados de registros e ensaios clinicos publicados. RESULTADOS: A sobrevida em um ano livre de reestenose foi de 92,7% com SR e de 78,8% com SC. A expectativa de vida estimada das estrategias foi muito semelhante, entre 18,5 e 19 anos. Sob a perspectiva nao-publica, a diferenca de custo no primeiro ano entre SC e SR foi de R

Association between myeloperoxidase polymorphisms and its plasma levels with severity of coronary artery disease.

3.816, com relacao de custo-efetividade incremental de R

Carbonyl groups: Bridging the gap between sleep disordered breathing and coronary artery disease.

27.403 por evento evitado em um ano. Sob a perspectiva do SUS, o custo por evento evitado em um ano foi de R

Atherosclerosis and acute arterial thrombosis in rabbits : a model using balloon desendothelization without dietary intervention

47.529. Na analise de sensibilidade, foram preditores relevantes a probabilidade de reestenose, a reducao de risco esperada com SR, o custo do stent e o custo do manejo da reestenose. Os dados por anos de vida demonstraram relacoes de custo-efetividade bastante elevadas na simulacao de Monte Carlo. CONCLUSAO: As relacoes de custo-efetividade do SR por rapamicina foram elevadas em modelo brasileiro. O uso de SR foi mais favoravel em pacientes de alto risco de reestenose, com elevado custo do manejo de reestenose e sob a perspectiva nao-publica.

Inflammatory and Oxidative Stress Markers after Intravenous Insulin in Percutaneous Coronary Intervention with Stent in Type 2 Diabetes Mellitus: A Randomized Controlled Trial

OBJECTIVES Myeloperoxidase (MPO) polymorphism -463 has been related to higher cardiovascular risk. This study was conducted to test whether the MPO promoter polymorphism -463A/G and MPO plasma levels are associated with coronary artery disease (CAD) severity. DESIGN AND METHODS Patients submitted to elective coronariography were enrolled, CAD severity was assessed and blood samples collected to identify the MPO polymorphism and its plasma levels. RESULTS Genotypes were determined in 118 patients. Among these patients, 12 (10%) were homozygous for AA, 69 (58%) for GG and 37 (32%) were heterozygous. Mean MPO plasma levels were 8.6+/-4.7 ng/mL for AA, 8.6+/-7.0 ng/mL for AG and 9.4+/-5.6 ng/mL for GG genotypes. The CAD severity was not associated with MPO genotypes (p=0.43), however, patients with higher CAD score presented higher MPO levels (p=0.02). CONCLUSION We found no association between MPO polymorphism and CAD severity, although a relation was observed for MPO plasma levels and extension of CAD.

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Abstract Sleep disordered breathing (SDB) is related to coronary artery disease (CAD), but the mechanisms are uncertain. SDB is characterized by periods of intermittent hypoxia and free radical formation. This study tested the hypothesis that carbonylation can be the link between SDB and CAD. It included 14 cases with CAD and 33 controls with <50% coronary narrowing. CAD cases have higher erythrocyte carbonyl levels than controls (p = 0.012). Positive correlation was observed between apnea-hypopnea index (AHI) and erythrocyte carbonyl concentration (ρ = 0.310; p = 0.027). To predict CAD, including as regressors: AHI, erythrocyte carbonyl, gender, age and body mass index, the significant variables in the Poisson multiple regression model were AHI and erythrocytes carbonyl. An increase of 1 pmol/gHb in erythrocyte carbonyl levels increases by 1.8% the risk of CAD and one unit of AHI increases by 3.8% the risk of CAD. The present findings represent the first evidence in humans that SDB may cause CAD through protein carbonylation.

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

Acute thrombosis can be induced in rabbits by a triggering protocol using Russells viper venom and histamine given after 8 months of a 1% cholesterol diet and balloon desendothelization. In the present study, we tested the hypothesis that aortic desendothelization performed 4 months before the triggering protocol without a high cholesterol diet is a highly effective and less expensive way of producing arterial atherosclerosis and thrombosis. Nineteen male New Zealand white rabbits on a normal diet were studied. The control group (N = 9) received no intervention during the 4-month observation period, while the other group (N = 10) was submitted to aortic balloon desendothelization using a 4F Fogarty catheter. At the end of this period, all animals were killed 48 h after receiving the first dose of the triggering treatment. Eight of 10 rabbits (80%) in the balloon-trauma group presented platelet-rich arterial thrombosis while none of the animals in the control group had thrombus formation (P < 0.01). Thus, this model, using balloon desendothelization without dietary manipulation, induces arterial atherosclerosis and thrombosis and may provide possibilities to test new therapeutic approaches.

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

CONTEXT/OBJECTIVE The objective of the study was to evaluate the effects of normalizing glycemia through iv insulin per 24 h on markers of oxidative stress and inflammation in patients with diabetes submitted to percutaneous coronary intervention (PCI) with stent. PATIENTS/METHODS This was a prospective, open-label, randomized controlled trial, comparing continuous iv insulin per 24 h targeting glycemia less than 110 mg/dl iv insulin treatment (IIT; n = 35) to standard treatment (ST; n = 35, regular insulin if glycemia was greater than 200 mg/dl). Blood samples for glycemia, glycated hemoglobin, lipids, inflammatory markers [C-reactive protein (CRP), soluble CD40 ligand, IL-6, and endothelin 1 (ET-1)] and oxidative stress (total antioxidant status, carbonyl) were collected immediately after and 24 h after PCI. RESULTS Seventy patients were included. Mean age was 60.5 ± 10 yr, 60% were men, glycated hemoglobin was 8.1 ± 1.8 (IIT) vs. 7.6 ± 1.6% (ST) (P = 0.39). The intensive insulin group had lower glycemia (P = 0.006) and higher insulinemia (P < 0.001). Insulin did not change CRP [4.5 (2.1-11.7) vs. 6.8 (2.4-10.3), P = 0.35], soluble CD40 ligand [402 (191-843) vs. 610 (230-1200), P = 0.68], IL-6 [6.21 (3.1.-10.4) vs. 10.37 (5.9-15.3), P = 0.09], and ET-1 [1.02 (0.7-1.8) vs. 1.10 (0.7-1.9), P = 0.657]. CRP, IL-6, and ET-1 increased after PCI in both groups (P < 0.05). No change was observed on protein oxidation (carbonyl, P = 0.70; total antioxidant status, P = 0.33). There was a positive correlation between CRP and glycemia (r = 0.29, P = 0.002). CONCLUSIONS Continuous iv insulin for 24 h increased insulin levels and prevented hyperglycemia. Insulin infusion did not prevent the rise in inflammatory and oxidative stress markers, and no differences were observed between IIT and ST after PCI with a stent.