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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Edition: 25.4 - 11 Article(s)


What has changed for obtaining the title of a cardiology specialist?

O que mudou para a obtenção do título de especialista em cardiologia (TEC)?

Nelson Siqueira de Morais; Marcos Roberto Sousa

Rev Bras Cardiol. 2012;25(4):264-266


Original Article

Triglyceride/HDL-C ratio as a cardiovascular risk indicator in chronic alcoholic patients

Razão triglicerídeo/HDL-C como indicador de risco cardiovascular em alcoolistas crônicos

Maria Izabel Siqueira de Andrade; Keila Fernandes Dourado; Cybelle Rolim de Lima; Luciana Gonçalves de Orange; Roberta de Albuquerque Bento; Dannielly Alexssandra da Silva Rodrigues; Jacqueline Maria da Silva; Prissila Muniz de Moraes

Rev Bras Cardiol. 2012;25(4):267-275

Abstract PDF PORT

BACKGROUND: The consumption of large quantities of alcoholic beverages is associated with changes in the cardiovascular system. The use of the Triglyceride/HDL-C ratio (TG/HDL-C) offers a strong atherogenic marker.
OBJECTIVES: To establish the lipid profile and TG/HDL-C ratio of chronic alcoholic patients, comparing them with non-alcoholics.
METHODS: A case-control study was carried out with 50 chronic alcoholic patients and 50 non-alcoholic individuals of the same gender and similar age. The variables analyzed reflected social, economic and lifestyle conditions, anthropometry and lipid profile of both groups, and the blood pressure of the alcoholic group. With the triglyceride and HDL-C findings, it was possible to calculate the TG/HDL-C ratio.
RESULTS: In terms of the social, economic and lifestyle data, there were no differences related to physical activity and comorbidities. The anthropometry of the alcoholic group presented lower BMI values, with smaller waist circumferences and waist/height ratios. The lipid profile and TG/HDL-C ratio did not differ between the groups except for the HDL-C. The TG/HDL-C ratio was associated with the BMI and waist/height ratio in the chronic alcoholics group, and BMI, waist circumference, waist/height ratio and conicity in the non-alcoholics group.
CONCLUSION: The chronic alcoholics group presented a better biochemical profile and TG / HDL-C ratio than the non-alcoholics group.

Keywords: Alcoholism; Lipase; Triglycerides; Cholesterol, HDL; Case studies; Risk factors

Mortality analysis of hypertensive patients in a public specialized unit, Ribeirão Preto, São Paulo state, Brazil

Análise da mortalidade de pacientes hipertensos de unidade pública e especializada na cidade de Ribeirão Preto (SP)

Carolina Pinto Vieira; Daniel Valente Neves; Maria Suely Nogueira; Miyeko Hayashida; Luiz de Souza; Evandro José Cesarino

Rev Bras Cardiol. 2012;25(4):276-281

Abstract PDF PORT

BACKGROUND: A study published in 1967 analyzing annual mortality rates for hypertensive heart diseases adjusted by sex and age of 100,000 inhabitants from 1962 to 1964, listed three cities with the highest annual mortality rates due to hypertensive heart diseases (HHD): Ribeirão Preto (34.2) and São Paulo (31.7) in Brazil, and Cali (31.6) in Colombia.
OBJECTIVE: To investigate possible causes of death among hypertensive patients at a public health unit in Ribeirao Preto, SP.
METHODS: The casuistics consisted of a sample of hypertensive patients selected in compliance with the JNC VII (2003) from among the 1601 patients seen in 1999 and under follow-up monitoring at the Cardiology and Hypertension Out-Patient Clinic (CSE-FMRPUSP). The study included male and female adults over 20 years old, with pregnant women excluded. There were 155 deaths (9.68%) in the sample: 75 (48.1%) female and 80 (51.3%) male. The data were collected at the Instituto Médico Legal, Sistema de Coleta e Análise de Estatísticas Vitais in Ribeirão Preto and the Serviço de Verificação de Óbitos do Interior .
RESULTS: The most frequent causes of death were: acute myocardial infarction (12.9%); non-specified septicemia (11.6%); pneumonia (8.4%); cancer (5.8%); acute pulmonary edema (5.8%); congestive heart failure (4.5%); stroke (4.5%); cardiogenic shock (5.8%); respiratory failure (3.2%); flutter or ventricular fibrillation (2.0%).
CONCLUSION: The main causa mortis for a significant percentage of patients treated in a public specialized unit in the city of Ribeirão Preto was acute myocardial infarction.

Keywords: Cardiovascular diseases/mortality; Cardiovascular diseases/epidemiology; Hypertension; Myocardial infarction

Low dietary control risks for post-stroke patients

Riscos do baixo controle dietético de pacientes pós-AVE

Cilene Bicca Dias; Li Li Min; Luciano Bruno de Carvalho Silva; Lucia Figueiredo Mourão

Rev Bras Cardiol. 2012;25(4):282-289

Abstract PDF PORT

BACKGROUND: A cerebrovascular disease common in adults, stroke is one of the main causes of morbidity and mortality worldwide. The key risk factors for cardio-cerebrovascular diseases include food consumption.
OBJECTIVE: To analyze food consumption and the relationship between macro- / micro-nutrients and their clinical risks for post-stroke patients.
METHODS: Cross-section cohort study conducted at the Otolaryngology/Dysphagia and Vascular / Neurology out-patient clinics in a tertiary hospital, of patients with diagnosis of stroke. Data were collected between June and August 2010. A dietary intake inquiry, 24-hour recall and anamnesis were used to track food consumption; nutritional requirements were calculated. A statistical analysis was performed, with 5% significance.
RESULTS: The sample consisted of 38 patients with a mean age of 58.5 years, with 34 of them hypertensive and 19 diabetic. A high intake of macro-nutrients (carbohydrates, lipids, proteins) was noted, with a low intake of micro-nutrients (vitamins, minerals). The presence of diabetes presented a statistically significant association through the Mann Whitney test, with excessive intake of calories (p= 0.006), carbohydrates (p= 0.006) and lipids (p= 0.029). Furthermore, logistic regression analysis confirmed diabetes as a factor favoring recurrent stroke (p= 0.025).
CONCLUSION: Post-stroke patients have poor eating habits, although the ill-balanced diet of this population was not significant as a risk factor increasing the odds for the occurrence of new cardio-cerebrovascular events. However, diabetes alone proved to be a risk factor for the recurrence of stroke.

Keywords: Diet; Stroke/diet therapy; Stroke/mortality; Food consumption

Analysis of pressor response in regular physical exercise in normotensive, hypertensive and hypertensive-diabetic persons

Análise da resposta pressórica mediante exercício físico regular em indivíduos normotensos, hipertensos e hipertensos-diabéticos

Sabrina Magalhães Reis; Verônica Rosemberg França Ferreira; Felipe Lopes Prado; Aírton Martins da Costa Lopes

Rev Bras Cardiol. 2012;25(4):290-298

Abstract PDF PORT

BACKGROUND: Although the hypotensive effect of exercise has been recognized in normotensive and hypertensive individuals, this association is still not clear for coexisting hypertension and diabetes mellitus type II.
OBJECTIVE: To evaluate responses to regular aerobic exercise in normotensive, hypertensive and hypertensive-diabetic patients for the following variables: systolic blood pressure (SBP), diastolic blood pressure (DBP), capillary blood glucose, body mass index (BMI) and waist circumference.
METHODS: 75 sedentary obese individuals were studied, with a mean age of 52.3±5.2 years (men) and 52.8±4.9 years (women), divided into three groups: normotensive, hypertensive and hypertensive-diabetic. All groups followed an adapted structured exercise program for two months, three times a week on alternate days, totaling 24 sessions of aerobic exercise at 50% to 70% of maximum heart rate, lasting 60 minutes. The blood pressure and capillary blood glucose data were analyzed by nonparametric tests, using parametric tests for the anthropometric measurements, collected before and after training.
RESULTS: A significant reduction in the SBP was noted for all the groups studied. The mean variation in the DBP was not significant only in the normotensive group. The mean blood glucose values were significant only for the hypertensive-diabetic group. The BMI and waist circumference measurements were subject to significant effects by time variations in the three groups.
CONCLUSION: Regular exercise was effective for lowering blood pressure and reducing anthropometric measurements over a period of two months for all groups.

Keywords: Hypertension/epidemiology; Exercise; Diabetes mellitus, type 2; Obesity; Insulin resistance

Improvement in functional capacity exceeds that of aerobic fitness: data from 144 patients in an exercise program

Melhoria da capacidade funcional excede à da condição aeróbica: dados de 144 pacientes de programa de exercício

Gabriel Ruiz Signorelli; Carlos Vieira Duarte; Plínio Santos Ramos; Claudio Gil Soares de Araújo

Rev Bras Cardiol. 2012;25(4):299-308

Abstract PDF PORT

BACKGROUND: Patients in supervised exercise programs (SEP) have proportionally greater improvement infunctional capacity than that of aerobic fitness. However,the variables determining this difference are not welldefined.
OBJECTIVE: To discover whether changes in flexibility and muscle strength/power contribute to the difference between improvements in functional capacity (DIFA) and aerobics fitness resulting from SEP participation.
METHODS: Data was used for 144 patients (96 men), age 62±12 years old (mean±standard deviation), performing flexibility, muscle strength/power and maximal cardiopulmonary cycle ergometer tests before and after at least 3 months of SEP. The data are reported as percentages of age-predicted values obtained through specific equations.
RESULTS: After an average of 32 months of PES, flexibilityimproved in 11.6% (p<0.01) and muscle strength 14.7%(p<0.01), adjusted for age, while handgrip strength waspreserved (p=0.47). There was an inverse relationshipbetween the results of the first evaluation and theaerobic improvement (r=-0.28; p<0.01), which did not occur with the functional assessment (r=-0.09; p=0.27). Considering age-predicted values, aerobic fitness improved slightly less than aerobic fitness at 21% versus 25% (p<0.01), resulting in a mean DBIFA of 4.1%. Only improved flexibility was associated with DBIFA (r=0.24, p<0.01).
CONCLUSION: SEP attendance tends to induce slightly higher gains in functional capacity compared to aerobic fitness, with some of this difference possibly explained by greater body flexibility and probably mechanical efficiency as well, corroborating the importance of training this latter variable.

Keywords: Cardiovascular diseases; Respiratory function tests; Exercise; Physical fitness; Muscle stretching exercises

Analysis of treatment goals in secondary prevention of CAD after CABG

Análise das metas terapêuticas na prevenção secundária de DAC após CRM

Luisa Chuairi Cruz; Renato Kaufman; Vitor Manuel Pereira Azevedo; Rochelle Coppo Militão; Fábio Schneider; Fernanda Tomé Treml; Claudio Roberto Cavalcante Assumpção; Mauro Geller; Maria Eulália Thebit Pfeiffer

Rev Bras Cardiol. 2012;25(4):309-312

Abstract PDF PORT

BACKGROUND: Cardiovascular risk factor control is a major challenge for patients with coronary artery disease (CAD), especially severe cases with more stringent treatment goals.
OBJECTIVE: To assess the attainment of treatment goals and medication prescriptions among patients with CAD after coronary artery bypass grafts (CABG).
METHODS: The medical records were analyzed for 68 patients undergoing CABG in 2008 with at least a year of follow-up after surgery. Patients undergoing associated valve replacements were excluded from this analysis.
RESULTS: 45 (66.2%) of the patients were male, with a mean age of 60.3±9.1 years. The main indication for CABG surgery was unstable angina (62%), with 94% hypertensive, 28% diabetic, 50% dyslipidemic and 50% with a history of acute myocardial infarction. The mean ejection fraction was 60±13%. Damage to left main coronary artery occurred in 29% of patients and the mean number of grafts was 2.7±0.75. At one year postoperative, 73.0% of the patients were taking ACE inhibitors, 86.6% beta-blockers, 83.0% aspirin and 96.6 % statins. Postoperative risk factor control was obtained in the following proportions: SBP <140 mmHg (55.9%), DBP <90 mmHg (62.7%), glucose <100 mg% (41.1%), total cholesterol <200 mg% (70.9%), LDL <100 mg% (57.7%) or LDL <70mg% (28.8%), HDL >45 mg% (32.0%) and triglycerides <150 mg% (47.8%).
CONCLUSION: A year after CABG, patients had inadequate blood pressure, glycemic and lipid controls. The use of medications for CAD was considered adequate, except for ACE inhibitors, which could be used more.

Keywords: Coronary disease/therapy; Coronary disease/surgery; Secondary prevention; Myocardial revascularization; Risk factors

Analysis of dyslipidemia treatment drug costs in Ribeirão Preto, São Paulo state, Brazil

Análise dos custos de medicamentos no tratamento das dislipidemias em Ribeirão Preto, SP, Brasil

Ana Paula Zambuzi Cardoso Marsola; Maria Aparecida Soares Viana; Maria Suely Nogueira; Miyeko Hayashida; Luiz de Souza; Evandro José Cesarino

Rev Bras Cardiol. 2012;25(4):313-321

Abstract PDF PORT

BACKGROUND: Dyslipidemias are a major risk factor for the development of cardiovascular diseases, proven through large-scale observational studies.
OBJECTIVE: To analyze the costs of taking atorvastatin, simvastatin, bezafibrate or ciprofibrate for individuals covered by the Exceptional Medicines Program run by the Ministry of Health at the Hospital das Clínicas in Ribeirão Preto, São Paulo State, Brazil, in 2007.
METHODS: This is an observational, descriptive cross-section study with a sample consisting of 332 (31.11%) persons selected randomly from among 1067 male and female patients referred by the Unified National Health System (SUS) and private clinics, who were interviewed and their medical records were examined.
RESULTS: Of the 312 patients interviewed, 157 (51%) were male, between 15 and 63 (62.0±12.23) years old; 227 (73.22%) patients were taking statins and 54 (17.42%) were taking fibrates; 31(10%) formed the control group. The atorvastatin group presented the highest treatment cost (R$ 994.69 patient/year), while the simvastatin group (R$337.61 patient/year) spent more on laboratory examinations and supplementary tests. In the fibrates group, the drugs category resulted in higher expenditures for both groups. Patients in the ciprofibrate group needed more laboratory examinations and supplementary tests than the bezafibrate group.
CONCLUSIONS: Although treatment with atorvastatin was the most expensive, these patients presented fewer cardiovascular events and procedures, in addition to lower outlays on laboratory examinations and supplementary tests.

Keywords: Drug Costs; Anticholesteremic agents/economics; Dyslipidemias/therapy; Health economics

Knowledge about systemic hypertension and compliance with antihypertensive treatment among elderly patients

Conhecimento sobre hipertensão arterial sistêmica e adesão ao tratamento anti-hipertensivo em idosos

Nicole Pucci; Márcia Regina Pereira; Daniele Botelho Vinholes; Paolla Pucci; Naique Dellai Campos

Rev Bras Cardiol. 2012;25(4):322-329

Abstract PDF PORT

BACKGROUND: Patients fail to comply with antihypertensive treatment for many reasons. One explanation for this high non-compliance rate is that many of them do not understand their disease, with the asymptomatic course of hypertension contributing to this lack of understanding.
OBJECTIVE: To evaluate the influence of knowledge about hypertension on compliance with antihypertensive treatment among elderly hypertensive patients.
METHODS: A cross-sectional study using a questionnaire was administered to elderly hypertensive patients at three Family Health Clinics (Becker PSF, Sais PSF and Caic PSF), as well as specialized outpatient units at the University of Southern Santa Catarina (AME and AMEI) in the town of Tubarão, Santa Catarina State, Brazil, between December 2010 and February 2011.
RESULTS: It was noted that among the 260 patients studied, 42.3% were compliant with treatment, while the blood pressure of only 48.5% of these elderly patients was controlled. There was a statistically significant link between compliance with treatment and the cost of antihypertensive medications. The level of their knowledge about hypertension was satisfactory in the compliant and non-compliant groups, with only one question about their knowledge of the disease being associated significantly to their compliance with treatment.
CONCLUSION: Despite adequate knowledge among hypertensive patients, questions about their knowledge of the disease were clearly not sufficient to influence their compliance with treatment.

Keywords: Hypertension/therapy; Medication adherence; Antihypertensive agents; Aged

Review Article

Lower limb Ischemia: current outlook for cell therapy and gene therapy

Isquemia de membros inferiores: perspectiva atual da terapia celular e terapia gênica

Paulo Eduardo Ocke Reis; Irlandia Figueira Ocke Reis; Daniel Queiroz Neves; Priscila Keiko Matsumoto; Sang Won Han; Radovan Borojevic

Rev Bras Cardiol. 2012;25(4):330-339

Abstract PDF PORT

The severity of the symptoms presented by a patient with lower limb ischemia dictates the type of treatment. Despite known therapies, some of these patients are not candidates for surgical intervention or remain in pain even after treatment, adversely affecting their quality of life. Awareness of the molecular mechanisms involved in vascular development paves the way for respecting and understanding the benefits and limits of molecular therapies for treating lower limb ischemic diseases. This paper describes the current status of cell therapy and gene therapy for the treatment of critical lower limb ischemia.

Keywords: Ischemia/physiopathology; Peripheral artery disease; Lower extremity; Tissue therapy; Gene therapy

Antiplatelet therapy and platelet reactivity tests in the era of coronary stents

Antiagregantes plaquetários e testes de função plaquetária na era dos stents coronarianos

Aline Sterque Villacorta; Humberto Villacorta Jr

Rev Bras Cardiol. 2012;25(4):340-349

Abstract PDF PORT

Patients treated with coronary stents must follow dual antiplatelet treatment with ASA and clopidogrel. A considerable number of stented patients taking clopidogrel present high platelet reactivity, indicating inadequate responses to this drug. These patients are at higher risk not only for stent thrombosis, but also cardiovascular death, acute myocardial infarction and intra-stent restenosis. Double-dose clopidogrel treatment has not been an effective strategy. The use of more powerful drugs such as prasugrel or ticagrelor seems to be more valid, particularly in a context of acute coronary syndrome, but there are no studies confirming the benefits for stable patients. For chronic patients taking clopidogre l , there are no recommendations in the literature on routine platelet function assessment tests, but they may be performed in selected cases.

Keywords: Drug-eluting stents/adverse effects; Platelet aggregation inhibitors; platelet aggregation, Platelet function tests