Mauricio Pimentel

Associação entre diferentes indicadores de obesidade e prevalência de hipertensão arterial

PURPOSE To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil. METHODS In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure > or = 160 mmHg or diastolic > or = 90 mmHg, and were considered obese if they had BMI > or = 27 kg/m2, or had a waist-hip-ratio > or = 0.95 cm (men) or 0.80 (women) or had a waist circumference > or = 96 (men) or 92 (women). RESULTS Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0-3.2 in men; RR 2.2, CI 1.3-3.8 in women). The other indices were significantly associated with hypertension just in women. CONCLUSION BMI > or = 27.0 kg/m2 was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.PURPOSE: To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil. METHODS: In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure ³160mmHg or diastolic³90mmHg, and were considered obese if they had BMI ³27kg/m2, or had a waist-hip-ratio ³0.95cm (men) or 0.80 (women) or had a waist circumference ³96 (men) or 92 (women). RESULTS: Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0 - 3.2 in men; RR 2.2, CI 1.3 - 3.8 in women). The other indices were significantly associated with hypertension just in women. CONCLUSION: BMI ³ 27.0kg/m2 was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.

Transcoronary gradient of plasma microRNA 423-5p in heart failure: evidence of altered myocardial expression

Abstract Context: Elevated plasmatic microRNAs (miRs) are observed in heart failure (HF). However, the cardiac origin of these miRs remains unclear. Objective: We calculated transcoronary gradients of miR-29b, miR-133a and miR-423-5p in 17 outpatients with stable systolic HF and in controls without structural cardiac disease. Materials and methods: MicroRNAs were measured by quantitative real-time polymerase chain reaction. Results: Positive transcoronary miR gradients were observed in patients with HF but not in controls (p = 0.03). B-type natriuretic peptide (BNP) moderately correlated with the transcoronary gradients of miR-133a and miR-423-5p. Discussion and conclusions: The difference in transcoronary gradients between HF outpatients and controls suggests that miR-423-5p has a cardiac origin. The positive correlation between miR-423-5p and BNP transcoronary gradients supports this hypothesis.

Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Brazil: Primary Prevention Analysis in the Public Sector

BACKGROUND Several studies have demonstrated the effectiveness and cost-effectiveness of implantable cardioverter-defibrillators (ICDs) in chronic heart failure (CHF) patients. Despite its widespread use in developing countries, limited data exist on its cost-effectiveness in these settings. OBJECTIVE To evaluate the cost-effectiveness of ICD in CHF patients under the perspective of the Brazilian Public Healthcare System (PHS). METHODS We developed a Markov model to evaluate the incremental cost-effectiveness ratio (ICER) of ICD compared with conventional therapy in patients with CHF and New York Heart Association class II and III. Effectiveness was evaluated in quality-adjusted life years (QALYs) and time horizon was 20 years. We searched MEDLINE for clinical trials and cohort studies to estimate data from effectiveness, complications, mortality, and utilities. Costs from the PHS were retrieved from national administrative databases. The models robustness was assessed through Monte Carlo simulation and one-way sensitivity analysis. Costs were expressed as international dollars, applying the purchasing power parity conversion rate (PPP US

Custo-efetividade de cardiodesfibriladores implantáveis no Brasil nos setores público e privado

). RESULTS ICD therapy was more costly and more effective, with incremental cost-effectiveness estimates of PPP US

Genetic polymorphisms of the adrenergic system and implantable cardioverter-defibrillator therapies in patients with heart failure

50,345/QALY. Results were more sensitive to costs related to the device, generator replacement frequency and ICD effectiveness. In a simulation resembling the MADIT-I population survival and ICD benefit, the ICER was PPP US

Short-term Effects of High-Dose Caffeine on Cardiac Arrhythmias in Patients With Heart Failure: A Randomized Clinical Trial

17,494/QALY and PPP US

Anestesia venosa total com infusão alvo-controlada de remifentanil e propofol para ablação de fibrilação atrial

15,394/life years. CONCLUSIONS In a Brazilian scenario, where ICD cost is proportionally more elevated than in developed countries, ICD therapy was associated with a high cost-effectiveness ratio. The results were more favorable for a patient subgroup at increased risk of sudden death.

Total intravenous anesthesia with target-controlled infusion of remifetanil and propofol for ablation of atrial fibrillation

BACKGROUND: Many randomized clinical trials have demonstrated the effectiveness of the implantable cardioverter-defibrillator (ICDs) in death reduction of chronic heart failure (CHF) patients. Some developed countries studies have evaluated its cost-effectiveness, but these data are not applicable to Brazil. OBJECTIVE: To evaluate the cost-effectiveness of ICD in CHF patients under two perspectives in Brazil: public and supplementary health systems. METHODS: A Markov model was developed to analyze the incremental cost-effectiveness ratio (ICER) of ICD compared to conventional therapy in patients with CHF. Effectiveness was measured in quality-adjusted life years (QALYs). We searched the literature for data regarding effectiveness and complications. Costs were retrieved from public and health insurances reimbursement codebooks and from mean cost of admissions from a public and a private hospital. One-way sensitivity analysis was performed in all variables of the model. RESULTS: ICER was R

Early improvement of pacing threshold following primary right coronary angioplasty

68,318/QALY in the public and R

Sudden cardiac death markers in non-ischemic cardiomyopathy

90,942/QALY in the private perspective. These values are much higher than the one suggested by the World Health Organization of 3 times the gross domestic product per head (R