Osvaldo Masoli

Eating habits, physical activity, smoking and alcohol consumption in adolescents attending school in the province of Buenos Aires

INTRODUCTION Knowledge on dietary habits, tobacco and alcohol consumption in adolescents is crucial to plan early preventive programs. The objective was to assess the eating habits, physical activity and tobacco and alcohol consumption in adolescents of Buenos Aires, in order to get information on cardiovascular risk factors. MATERIAL AND METHODS Cross-sectional observational study in adolescents aged 11-16 years of 12 urban and rural, public and private schools of the province of Buenos Aires. An anonymous survey was carried out including demographical data, eating habits, physical activity, smoking and alcohol consumption. RESULTS 1230 adolescents were surveyed, 46% of rural zones. Of them, 42.5% restrained food intake to control weight; 92% performed physical activity at least 1 h a week; 29.3% were smokers and 38.4% drank alcoholic beverages. Females restrained more food intake (46.3% vs. 37.7%; p=0.003) and were heavier smokers (32.6% vs. 25.2%; p=0.005). Alcohol consumption and smoking were associated (OR 8.27; p<0.001). Having a smoker friend increased almost 4 times the chance of smoking. Alcohol consumption by the best friend (OR 10.0; p<0.001), father o brother also increased chance in the adolescent. Adolescents of rural zones performed less physical activity (89.6% vs. 94.2%; p=0.003) and smoked more cigarettes (32.1% vs. 26.8%; p=0.04). CONCLUSIONS 42% restrained food intake to control weight, and almost all performed physical activity. Rates of smoking and alcohol consumption were 29.3% and 38.4%, and were strongly associated. Smoking was more common in females and in rural zones, and more associated to alcohol and a smoker friend.

Use of nebivolol for the treatment of endothelial dysfunction in patients with hypertension: the EDEN registry.

This aim of this study was to evaluate the presence of endothelial dysfunction in patients with primary hypertension and to determine the usefulness of nebivolol, a selective β-adrenoceptor blocking agent, as a potential treatment for endothelial dysfunction. Of 176 patients with stage I hypertension, 36 patients (20%), the majority of whom were overweight/obese, were found to have abnormal results with myocardial perfusion single-photon emission computed tomography (MP-SPECT) under cold pressor test conditions. These 36 patients were treated for 28 days with 5 mg/d nebivolol, after which only 3 (8.3%) still had abnormal MP-SPECT results. The mean ischemia score was consistent with moderate risk and decreased significantly after treatment with nebivolol. All hemodynamic variables measured (systolic and diastolic blood pressure and heart rate) were also reduced significantly by treatment with nebivolol. Endothelial dysfunction plays a key role in the pathogenesis of atherosclerosis and its reversal has considerable implications for clinical outcomes in affected patients. The cold pressor testing results of this study suggest that nebivolol may have beneficial anti-ischemic effects in the coronary arteries of patients with hypertension. However, these findings need to be confirmed in larger randomized controlled trials, ideally comparing nebivolol with other blood pressure lowering agents or NO synthase inhibitors.

Early treatment with low-dose enalapril after acute myocardial infarction: An Equilibrium radionuclide angiographic study☆

BackgroundTo further elucidate the mechanisms involved in the treatment of acute myocardial infarction (AMI) with angiotensin-converting enzyme inhibitors, we compared the effects on left ventricular volumes of early (<48 hours) versus late (45 days) administration of a fixed low dose of enalapril (10 mg) in patients with AMI. We also analyzed the changes of left ventricular volumes after withdrawal of the study drug. Reduced dilation of the left ventricle is one of the beneficial effects of angiotensin-converting enzyme inhibition after AMI. However, the nature of this effect is not completely understood.Methods and ResultsWe included 89 patients within 48 hours after onset of a first AMI and radionuclide left ventricular ejection fraction less than 45%. The study was double-blind and compared enalapril and placebo with a crossover design. All patients were randomly assigned to a sequence A (enalapril, 45 days; placebo, 45 days) or B (placebo, 45 days; enalapril, 45 days). The end point was the change of left ventricular volume at 45 and 90 days. Thrombolysis was administered to 26 patients (70%) in group A and 25 (75%) in group B. All pretreatment clinical variables were similar in both groups. Median and 95% confidence intervals (CIs) of left ventricular diastolic volumes were 46.8 ml/m2 (39 to 61 ml/m2) and 46.6 ml/m2 (39 to 60 ml/m2) for groups A and B, respectively. Baseline end systolic volumes were 28.5 ml/m2 (20 to 36 ml/m2) and 28.9 ml/m2 (23 to 28 ml/m2) in the same groups. Placebo treatment during the initial 45 days was associated with an increase of left ventricular diastolic volume of 8.75 ml/m2 (95% CI, 3.25 to 17.1 ml/m2; p<0.01) and end-systolic volume of 4.20 ml/m2 (95% CI, 0.00 to 10.1 ml/m2; p<0.05). No significant changes during other phases of the study were observed. At 45 days left ventricular diastolic volume was 11.1 ml/m2 (95% CI, 0.5 to 2.2 ml/m2), greater in placebotreated patients compared with patients receiving enalapril.ConclusionsIn patients with a first Q wave AMI and left ventricular ejection fraction less than 45%, treatment with enalapril can prevent left ventricular dilation. This protective effect involves at least partially a structural modification of the left ventricle. Hence, maximal benefit can be obtained only with early initiation of treatment.

Usefulness of radionuclide ventriculography in assessment of coronary artery spasm

Provocative tests that permit detection of coronary artery spasm are widely used in patients with ischemic syndromes. To assess the usefulness of radionuclide ventriculography combined with provocative tests for diagnosis of coronary spasm, the left ventricular (LV) response to exercise, hyperventilation and a cold pressor test was determined in 3 groups. Group I included 10 normal subjects; group II, 49 patients with typical effort angina and fixed obstructive coronary artery disease at catheterization; and group III, 19 patients suspected of having vasospastic angina based on clinical and electrocardiographic findings, each of whom had normal coronary angiographic findings. In group I, LV ejection fraction (EF) increased during hyperventilation and exercise testing in 9 of 10 subjects (90%) and failed to decrease 5% in 9 of 10 subjects (90%) during cold testing. In contrast, while 18 of 49 patients (37%) of group II showed LV dysfunction with cold testing and 8% with hyperventilation, all showed abnormal LV function during exercise. Finally, in group III, LVEF increased during exercise, mimicking the response in normal group, while dysfunction was present in 14 of 19 (74%) during hyperventilation and in 17 of 19 (89%) during cold testing. When results of hyperventilation and cold testing were combined, abnormal responses were present in all patients. Thus, radionuclide ventriculography, when performed in association with 3 forms of stress--exercise, hyperventilation and cold testing--allows accurate identification of patients likely to have coronary spasm.

Importance of patient positioning in left ventricular function assessment

We have read with great interest the papers by Elisabeth Coupez et al. and Dayong Wu et al. recently published in the Journal Nuclear Cardiology, in which ventricular function and synchronicity were assessed by D-SPECT. This novel CZT-camera allows acquisition of both supine and upright positions. From our point of view, there are a number of relevant issues worthy of consideration. It is well known that the values obtained by measuring ejection fraction and ventricular volumes depend on the patient position during acquisition. Recently Michael Tribular et al. described that volumes and ejection fraction are higher in supine compared to upright position on D-SPECT, and we have observed the same finding in our practice. In our lab, we have compared ejection fraction, ventricular volumes, and synchrony in supine and upright position in 143 consecutive patients with normal perfusion and we found that not only ejection fraction and ventricular volumes are different, but also synchrony values are twenty percent higher in upright position (p\ 0.001). We believe these findings could be explained by physiological changes such as the variation in venous return and heart rate among other unknown factors. Therefore, we consider that the assessment of the mentioned parameters should be done in supine position in order to be able to compare them with other cardiac techniques that are routinely acquired in supine position.