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

Edition: 27.6 - 12 Article(s)


Advances in cardiovascular disease in 2014

Avanços da área cardiovascular no ano de 2014

Claudio Tinoco Mesquita

Rev Bras Cardiol. 2014;27(6):392-394


Original Article

Hypertriglyceridemic waist phenotype and cardiometabolic risk in dyslipidemic subjectsects

Fenótipo cintura hipertrigliceridêmica e risco cardiometabólico em indivíduos dislipidêmicos

Josilene Lopes de Oliveira; Lílian Lelis Lopes; Maria do Carmo Gouveia Pelúzio; Helen Hermana Miranda Hermsdorff

Rev Bras Cardiol. 2014;27(6):395-402

Abstract PDF PORT

BACKGROUND: Use of the hypertriglyceridemic waist phenotype (HWP) has been suggested as a low-cost tool that is simple to adopt for early identification of cardiometabolic risk.
OBJECTIVE: To evaluate a possible association between the HWP and other risk factors in dyslipidemic patients seen under the Cardiovascular Healthcare Program at Universidade Federal de Viçosa (PROCARDIO - UFV).
METHODS: This cross-sectional observational study assessed 171 subjects (102 women and 69 men) between 28 and 57 years old. Sociodemographic, anthropometric and body composition data were obtained, as well as plasma glucose concentrations, triacylglycerols, cholesterol (total and fractions) and blood pressure data were obtained from the patient records of this Program.
RESULTS: The prevalence of HWP among dyslipidemic patients was 37.6%, associated with abdominal obesity at 85.3% and hypertriglyceridemia at 46.2%. The occurrence of obesity by BMI (p=0.001), body fat (p=0.003), hyperglycemia (p=0.047) and changes in diastolic blood pressure (p=0.040) was higher in subjects with HWP.
CONCLUSIONS: The findings of this study indicate that HWP may be an early indicator of cardiometabolic risk, compared to the stand-alone use of abdominal obesity and/or dyslipidemias.

Keywords: Dyslipidemias; Waist circumference; Hypertriglyceridemia; Cardiovascular diseases

Medications taken by hypertensive patients in Rio Grande do Sul state, Brazil

Uso de medicamentos por hipertensos do estado do Rio Grande do Sul, Brasil

Christiane de Fátima Colet; Maiara Marangon; Karin Hepp Schwambach

Rev Bras Cardiol. 2014;27(6):403-408

Abstract PDF PORT

BACKGROUND: Hypertension is a major public health problem in Brazil and worldwide.
OBJECTIVES: To investigate medications taken by hypertensive patients and assess compliance with treatment.
METHODS: A cross-sectional descriptive and quantitative study of customers taking antihy pertensive medications obtained at a commercial drugstore signed up with Brazil's Farmácia Popular government- subsidized drugs program in a town in Rio Grande do Sul State. The data were collected through a structured questionnaire addressing issues related to sociodemographic characteristics and drug use.
RESULTS: 155 hypertensive patients were interviewed, mainly women. More than half of the users had blood pressure levels above 140/90mmHg. The most commonly used medications were diuretics, followed by angiotensin-converting enzyme inhibitors (ACEIs). A statistical correlation was noted between the medications taken and the blood pressure levels evaluated.
CONCLUSIONS: The findings of this study show a good level of compliance with treatment, but poor blood pressure control, suggesting a potential bias in assessing compliance and indicating a need for more effective hypertension management actions, such as physicians adjusting medications, backed by multidisciplinary teams. The main result of this study shows that hypertensive patients are being under-treated.

Keywords: Hypertension; Antihypertensive agents; Community pharmacy services

Acute myocardial infarction from the standpoint of the Brazilian population

Infarto agudo do miocárdio sob a ótica da população brasileira

Bruna Grici Cascaldi; Felipe Mendonça Lacerda; Alexandre Rodrigues; Gustavo Viani Arruda

Rev Bras Cardiol. 2014;27(6):409-417

Abstract PDF PORT

BACKGROUND: Acute myocardial infarction is one of the leading causes of morbidity, mortality and disability in Brazil and the world, offering a public health challenge. Knowledge of the symptoms of infarction among the population contributes to early diagnosis and speed in seeking treatment, improving patient prognoses.
OBJECTIVE: To identify the level of knowledge of a population group about acute myocardial infarction and alerting emergency services.
METHODS: Cross-sectional study conducted with passers-by in several public places in the town of Marilia, São Paulo State, Brazil. Based on the presentation of a typical clinical case of acute myocardial infarction, respondents completed a structured questionnaire in order to demonstrate their knowledge about myocardial infarction and alerting emergency services, in addition to collecting social and demographic information.
RESULTS: 303 subjects were interviewed (61.72% women) with a mean age of 39.75 ± 15.39 years), with 38.94% not recognizing the case symptoms as resulting from infarction. Although most (70.63%) of the respondents said that they would call the emergency service in the presented situation, 40.59% could not state the emergency service number in Brazil. Higher educational levels, age less than 40 years and absence of any history of hypertension were associated with correct identification of the emergency service number p=0.035; p<0.001; p=0.020, respectively) and its activation (p=0.025; p=0.006; p=0.003, respectively).
CONCLUSIONS: The study showed that a significant proportion of the respondents did not know the emergency service number in Brazil and had little knowledge about acute myocardial infarction.

Keywords: Myocardial infarction; Emergency medical services; Risk factors

Evaluation of risk factors and treatment targets in patients with coronary artery disease

Avaliação de fatores de risco e metas terapêuticas em pacientes com doença arterial coronariana

Rodrigo Mazzarone Gomes de Sá; Rodrigo Rodrigues Batista; Vitor Manuel Pereira Azevedo; Renato Kaufman

Rev Bras Cardiol. 2014;27(6):418-422

Abstract PDF PORT

BACKGROUND: Coronary artery disease (CAD) is a major cause of hospitalization in Brazil's Unified National Health System (SUS) and an important risk factor for ventricular dysfunction. CAD patients are rated as high cardiovascular risks, with increasingly tighter treatment targets.
OBJECTIVE: To assess traditional CAD risk factor controls and treatment targets among CAD patients.
METHODS: A retrospective analysis was conducted of the medical records of patients seen at the residency outpatient clinic at a tertiary healthcare facility that is a cardiology reference center in the SUS from April 2013 to April 2014. The inclusion criteria were met by 110 patients.
RESULTS: Among the included patients, 68.1% were male, with an average age of 60.1±9.2 years; 90.9% were diagnosed with hypertension; 42.7% with DM, 81.8% with dyslipidemia (DLP), 25.4% were smokers and 32.7% had positive family histories of CAD. Most (61%) received surgical and clinical treatment, followed by clinical and percutaneous treatment (20.9%) and finally clinical treatment only (18.1%). Regarding target controls, 78.1% had controlled blood pressure (SBP <140 mmHg and DBP <90 mmHg), 65.4% with TG <150 mg/dL; 87.2% with TC <200 mg/dL; HDL with 29.1%> 45 mg/dL; 65.4% with LDL <100 mg/dL; LDL and 27.2% with <70 mg/dL.
CONCLUSION: Despite being high-complexity and high-risk patients, a good response was obtained only for blood pressure control, while the dyslipidemia control findings were unsatisfactory, which may be partly explained by the treatment options available in the SUS.

Keywords: Coronary angiography; Diabetes mellitus; Dyslipidemias; Coronary artery disease; Hypertension; Smoking

Comparison of clinical and epidemiological profiles among men and women with acute coronary syndrome

Comparação do perfil clínico-epidemiológico entre homens e mulheres na síndrome coronariana aguda

Maria Celita de Almeida; Carlos Eduardo Lucena Montenegro; Camila Sarteschi; Gabriela Lucena Montenegro; Patricia Bezerra Rocha Montenegro; Jesus Reyes Livera; Silvia Maria Lucena Montenegro; Sergio Tavares Montenegro; Odwaldo Barbosa e Silva; Eduardo Maia Freese de Carvalho

Rev Bras Cardiol. 2014;27(6):423-429

Abstract PDF PORT

BACKGROUND: Ischemic heart disease is the leading cause of death among men and women in Brazil and in several countries on different continents. A sharp upsurge in mortality rates has been noted in the developing countries, today constituting a major public health issue.
OBJECTIVE: To analyze and compare the clinical and epidemiological profiles of men and women with acute coronary syndrome.
METHODS: We studied 927 patients (60.0% men) with an average age of 67.0±12.0 years diagnosed with acute coronary syndrome (ACS) and admitted to the coronary unit of a cardiology reference hospital in the supplementary healthcare network between September 2009 and December 2012 in the city of Recife, Pernambuco State, Brazil.
RESULTS: Among the risk factors, hypertension and sedentary lifestyles were more frequent among women (p=0.001), while smoking and alcoholism were more frequent among men (p=0.01). Men also had more frequent acute myocardial infarctions with elevation of the ST segment or previous coronary artery bypass grafting (p=0.011) and higher troponin levels (p=0.006). During hospitalization, adverse outcomes and deaths were more frequent among women (p=0.177).
CONCLUSION: Women with ACS present higher rates for hypertension and sedentary lifestyles, with more adverse outcomes among women underscoring the need for earlier intervention and encouragement for controlling risk factors, in order to lower in-hospital mortality rates with fewer complications.

Keywords: Epidemiology; Coronary artery disease; Acute coronary syndrome.

Point of View

Myocardial perfusion imaging: why, how and who?

Cintilografia de perfusão miocárdica de estresse-isolado: por que, como e em quem?

Aline Ribeiro Nogueira de Oliveira; Jader Cunha de Azevedo; Anderson Oliveira; Claudio Tinoco Mesquita

Rev Bras Cardiol. 2014;27(6):430-433

Abstract PDF PORT

At various stages during the development of a technique, it is necessary to reassess what to do and how this can provide more clinical information, thus becoming more effective in daily practice. In myocardial perfusion imaging, new protocols have appeared, with trimmer test times, less patient exposure to radiation and lower overall costs, while ensuring the same accuracy as established protocols. The stress-only protocol has shown particular relevance for Emergency Room patients rated as low and medium risk for coronary artery disease, requiring fast, safe and accurate diagnoses.

Keywords: Radionuclide imaging; Myocardial ischemia; Emergency medical services

Are angiotensin II receptor blockers linked to cancer?

Os bloqueadores dos receptores de angiotensina II estão relacionados à ocorrência de câncer?

Fábio Santiago Figueredo; Andréa Araujo Brandão

Rev Bras Cardiol. 2014;27(6):434-436

Abstract PDF PORT

The association between angiotensin receptor blockers (ARBs) and cancer has shown conflicting results in clinical studies and meta-analyses. Subsequent meta-analyses with larger numbers of clinical trials and patients taking ARBs and other anti-hypertensives have not been able to demonstrate increased risk and mortality from cancer. Prospective studies show that high blood pressure alone, or related factors such as age and obesity, are associated with cancer and mortality. Thus, ARBs have been considered as safe and effective drugs for anti-hypertensive treatment.

Keywords: Antihypertensive agents; Carcinoma; Angiotensin II type 2 receptor blockers

Review Article

Centenarian hearts

O Coração do centenário

Glauco Franco Santana; Nancy Luz Andrade; Odilon Gariglio Alvarenga de Freitas

Rev Bras Cardiol. 2014;27(6):437-444

Abstract PDF PORT

Studies show that lower cardiovascular risk factor rates among centenarians are decisive for successfully achieving extreme longevity, together with genetic and environmental factors. Despite cardio-protective factors, these individuals present a non-negligible prevalence of cardiovascular diseases, particularly coronary artery disease, heart failure and atrial fibrillation, which should prompt the scientific community to seek a better understanding of the health / disease processes of this population. This purpose of this review is to explore the prevalence of major cardiovascular risk factors and identify the main cardiovascular diseases in the centenarian population.

Keywords: Cardiovascular diseases; Aged 80 years and over; Risk factors

Step tests for assessing exercise capacity among patients with heart diseases: literature review

Testes de degrau para avaliação da capacidade de exercício em pacientes com doenças cardíacas: revisão de literatura

Cristiane de Fátima Travensolo; Marcos Doederlein Polito

Rev Bras Cardiol. 2014;27(6):445-453

Abstract PDF PORT

Although step tests are used frequently for healthy people and patients with lung diseases, this type of test is still quite rare for patients with heart diseases. The purpose of this paper is to conduct a review of literature on the use of step tests for assessing exercise capacity among patients with heart diseases. Through consulting the Medline / PubMed, LILACS and SciELO databases, 305 papers were found, with eleven included in this review: nine on patients with heart failure and two with coronary artery disease. The protocols used were the two-minute step test and the Master two-step test. Four studies compared step test performance to the metabolic equivalent, accelerometer, cycle ergometer and cardiopulmonary treadmill tests, with seven studies presenting comparisons with the performance of cognitive tasks, daily living activities, quality of life and depression. The step test seems to be a simple, fast and safe strategy for patients with heart diseases, although further studies are required for better physical fitness estimates, comparing step test exercise capacities with cardiopulmonary exercise test results.

Keywords: Stress test; Heart diseases; Exercise tolerance

Cardiovascular Image

Multiple muscular ventricular septal defects seen in cardiac CT angiography

Múltiplas comunicações interventriculares musculares visualizadas em angiotomografia do coração

Fernanda Mello Erthal Cerbino; Filipe Penna de Carvalho; Ilan Gottlieb

Rev Bras Cardiol. 2014;27(6):454-456

Abstract PDF PORT

A female patient (80 years old) with atypical chest pain and a normal echocardiogram underwent cardiac computed tomography angiography. No obstructive coronary arterial disease was found. However, multiple deep crypts were detected on the muscular portion of the ventricular septum, some running between the ventricles. Cardiac Magnetic Resonance was then performed and, despite detecting some of the crypts, it was unable do identify any interventricular connection. The Qp/Qs was 0.98, indicating the absence of detectable shunts. This case report shows that the high spatial resolution of the cardiac computed tomography angiography, together with volumetric tridimensional acquisition can detect minor anatomical alterations to the heart.

Keywords: Interventricular connection; Heart; Multidetector computed tomography

Preliminary Communication

Brazilian samba: an innovative proposal for cardiac rehabilitation programs

Samba brasileiro como proposta inovadora em programas de reabilitação cardíaca

Ana Inês Gonzáles; Sabrina Weiss Sties; Helena de Oliveira Braga; Lourenço Sampaio de Mara. Almir Schmitt Netto; Tales de Carvalho

Rev Bras Cardiol. 2014;27(6):457-460

Abstract PDF PORT

BACKGROUND: As samba requires very active movements, it is plausible to expect benefits for the cardiovascular system.
OBJECTIVE: To evaluate the effects of Brazilian samba as exercise for heart patients participating in a cardiac rehabilitation program.
METHODS: Fifteen patients with stable coronary artery disease and a mean age of 60.74±5.96 years underwent cardiopulmonary testing. For three classes, they performed seventeen samba steps at three different tempos, in order to ascertain perceived exertion and heart rate (HR) behavior. A descriptive analysis of the data was followed by the Wilcoxon test, comparing HR behavior, with a 5% significance level.
RESULTS: The patients spent more than 76% of the total time in the ideal exercise target zone, with HR between the first and second ventilatory thresholds and mild to moderate perceived exertion.
CONCLUSION: The Brazilian samba protocol allowed patients with cardiovascular disease to remain within the desired exercise target zone.

Keywords: Exercise; Dance therapy; Cardiovascular diseases