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

Edition: 28.1 - 11 Article(s)


To estimate or not to estimate cardiovascular risk? That is the question

Estimar ou não o risco cardiovascular? Eis a questão

Gláucia Maria Moraes de Oliveira

Int J Cardiovasc Sci. 2015;28(1):1-3


Original Article

Predictive value of the Framingham risk score in identifying high cardiovascular risk

Valor preditivo do escore de Framingham na identificação de alto risco cardiovascular

Priscila Valente Fernandes; Marcelo Machado de Castro; Alexandre Fuchs; Marcos Calzada da Rocha Machado; Fernanda Diniz de Oliveira; Lívia Botelho Silva; Lorraine Furlani Rosa; Vitor Manuel Pereira Azevedo; Mauro Geller; Renato Kaufman

Int J Cardiovasc Sci. 2015;28(1):4-8


BACKGROUND: Cardiovascular risk stratification is essential for an adequate approach to primary prevention. However, the current risk scores have no satisfactory accuracy in predicting cardiovascular events.
OBJECTIVE: To evaluate whether the two risk scores recommended by the major cardiology societies have predictive value in identifying patients with an established high cardiovascular risk.
METHODS: The study included 72 patients classified as high risk based on independent factors as recommended by the Brazilian Society of Cardiology. At the first appointment, the Framingham score and the SCORE risk were calculated in order to evaluate the ability to identify high-risk individuals.
RESULTS: Of 72 patients, 39 (53.4%) patients were male with a mean age of 59.0±9.5 years, mean 129.0±22 mmHg and 78.0±14 mmHg systolic and diastolic blood pressure, respectively. In the sample, 91.8% were hypertensive, 46.5% had diabetes, 36.9% were current smokers and 72.6% were patients with coronary artery disease, of which 56.1% had previous myocardial infarction. Among these patients, 32 (44.4%) were considered at low cardiovascular risk, 27 (37.5%) intermediate-risk and 13 (18.1%) high-risk by the Framingham score; and 26 (36.1%) patients were considered at high risk by the SCORE risk.
CONCLUSION: Based on the high-risk population, neither the Framingham score nor the SCORE risk were considered good identifiers of patients at high cardiovascular risk.

Keywords: Cardiovascular diseases; Risk factors; Diabetes mellitus; Dyslipidemias; Smoking; Atherosclerosis

C-Reactive protein in the initial phase of postprandial lipemia in subjects with central obesity

Proteína C-Reativa na fase inicial da lipemia pós-prandial em indivíduos com obesidade central

Djeyne Silveira Wagmacker; Jefferson Petto; Fabiano Leichsenring Silva; Alan Carlos Nery dos Santos; Ana Marice Teixeira Ladeia

Int J Cardiovasc Sci. 2015;28(1):9-15


BACKGROUND: Studies indicate that during postprandial lipemia (PPL), free radical formation occurs, stimulating the endothelium to secrete cytokines that mediate inflammatory responses. Excess adipose tissue, especially in the abdominal region, is positively correlated with C-reactive protein (CRP) values. However, little is known about CRP variations during the initial phase of PPL, especially among obese individuals.
OBJECTIVE: To determine if there are variations in CRP plasma concentrations among individuals with central obesity during the initial phase of PPL.
METHODS: This study assessed forty sedentary men and women with no alterations to fasting lipid profiles and waist circumferences above the normal cutoff point, measuring their CRP levels after fasting for twelve hours and three hours after ingesting 50g of fat.
RESULTS: The mean CRP values after fasting and three hours after lipids intake were 0.6 mg/L (0.2 to 1.8 mg/L) and 0.4 mg/L (0.2 to 1.8 mg/L) (p=1.000) respectively.
CONCLUSION: In this study, the initial phase of PPL did not present any variations in CRP concentrations among subjects with central obesity.

Keywords: Inflammation; Metabolism; Lipids

Association between homocysteine and polymorphisms in MTHFR in Brazilian obese women

Associação entre a homocisteína e os polimorfismos do gene da MTHFR em mulheres brasileiras obesas

Mauara Scorsatto; Ronir Raggio Luiz; Glaucia Maria Moraes de Oliveira; Cíntia Barros Santos-Rebouças; Márcia Mattos Gonçalves Pimentel; Glorimar Rosa

Int J Cardiovasc Sci. 2015;28(1):16-24


BACKGROUND: Brazilian national surveys have indicated a rise in obesity and cardiovascular disease in women.
OBJECTIVE: To determine the frequency of 677C>T and 1 298A>C polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene in obese Brazilian women and to assess the potential association of these polymorphisms with serum concentrations of homocysteine (Hcy), folate and cobalamin after fortification of wheat and corn flour with folic acid in Brazil.
METHODS: A cross-sectional study was conducted from 2008 to 2009 with 133 obese women. Commercial kits were employed to perform laboratory analyses including measurement of lipids and glucose using enzymatic methods, total Hcy and serum folate using a competitive immunoassay and cobalamin based on chemiluminescence. Genotyping was performed by PCR, followed by restriction fragment length polymorphism analysis.
RESULTS: The average age of participants was 39.0±4.4 years and mean body mass index was 32.5±2.1 kg/m2. The distributions of the genotypes were CC (47%), CT (44%), and TT (9%) for the position MTHFR 677 and AA (60%), AC (35%), and CC (5%) for the position 1 298. Hcy levels correlated negatively with serum folate in the group displaying the 677CT, 1 298AC, or 1 298CC genotypes (r=-0.554, p<0.01).
CONCLUSION: Our findings suggest that obese Brazilian women with genotypes 677TT have higher Hcy concentrations than those carrying the genotypes 677CT and 677CC. Additionally, genotypes 1 298CC are associated with higher Hcy concentrations than genotypes 1 298AC and 1 298AA.

Keywords: Hyperhomocysteinemia; Obesity; Folic acid; Methylenetetrahydrofolate reductase (NADPH2)

Effect of resistance training with different intensities on blood pressure in hypertensive patients

Efeito do treinamento resistido com diferentes intensidades na pressão arterial em hipertensos

João Paulo Cardoso dos Reis; Klebson da Silva Almeida; Rosilene Amaral da Silva Souza; Moisés Simão Santa Rosa de Sousa

Int J Cardiovasc Sci. 2015;28(1):25-34


BACKGROUND: The effect of resistance training (RT) on the behavior of blood pressure (BP), heart rate (HR) and double product (DP) is strongly related to the characteristics of exercise and is inconsistent with hypertensive individuals.
OBJECTIVES: To compare the acute and late cardiovascular response in sessions of 50% and 75% of maximum estimated repetition in grade-1 hypertensive individuals.
METHODS: For 24 hours, the study analyzed systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 14 mild hypertensive men, trained (TG) and untrained (UG), under protocols of 75% and 50% on maximum estimated repetition. The level of cardiovascular stress in eight exercises for the two intensities mentioned was concomitantly observed.
RESULTS: In the TG, the variable SBP showed differences between the protocol of lower intensity compared to the other, 50% with control (p=0.028) and 50% to 75% (p=0.022), and DBP differed only in the protocols of 50% with control (p=0.024). In the UG, the difference occurred in all protocols, as well in SBP [50% and control (p=<0.0001); 75% and control (p=0.039); and 50% and 75% (p=0.001)] as in DBP [50% and control (p=0.002); 75% and control (p=0.002); and 50% and 75% (p=0.002)]. On cardiovascular stress, the exercises seated row, leg press in the TG and high row, leg curl and abdominal crunch in the UG differed in both protocols.
CONCLUSION: The results indicate safety in RT in mild hypertension men. It became evident that the lower intensity protocol showed higher efficiency in promoting post-exercise hypotension.

Keywords: Hypertension; Monitoring ambulatory; Resistance training; Exercise

Profile of chagasic patients with implantable cardioverter defibrillators (ICD)

Perfil dos pacientes chagásicos portadores de cardioversor - desfibrilador implantável (CDI)

Valéria Vieira da Silva; Antônio Malan Cavalcanti Lima; Maria Luiza Costa; Isabela Pereira Gomes

Int J Cardiovasc Sci. 2015;28(1):35-41


BACKGROUND: Sudden death accounts for 55-65% of the deaths from Chagas disease, and the implantable cardioverter-defibrillator (ICD) is the most effective therapy to prevent sudden death in patients with ventricular tachyarrhythmias.
OBJECTIVE: To describe the clinical profile of patients with chronic Chagas disease with ICD admitted to a referral hospital.
METHODS: 75 chagasic patients with ICD, admitted to Santa Casa de Misericórdia de Goiânia, from January 2011 to December 2013, were evaluated by means of medical record review.
RESULTS: The sample (n=75) was composed of 57 (76.0%) male patients and 18 (24.0%) female patients. Clinical admissions accounted for 60.0% of the sample, while surgical ones accounted for 40.0%. Out of all clinical admissions, 40 (89.0%) were due to heart problems: heart failure (HF), with 13 (32.0%) patients, and electrical storm (ES), with 12 (30.0%) patients. Out of the 30 surgical admissions, 17 (56.66%) were due to battery depletion.
CONCLUSION: The clinical profile of patients with chronic Chagas disease with CDI is characterized as follows: male, aged 51-60, presence of dual-chamber devices, appropriate use of antiarrhythmic drugs and beta-blockers, presence of systemic hypertension (SH), left ventricular ejection fraction (LVEF) of 35-45%, clinical admissions due to heart problems (particularly HF and ES), and zero to three post-implantation admissions.

Keywords: Implantable defibrillators; Sudden death; Chagas disease; Cardiac arrhythmias

Aging and cardiac, biochemical, molecular and functional changes: an experimental study

Envelhecimento e alterações cardíacas, bioquímicas, moleculares e funcionais: estudo experimental

Emiliana Barbosa Marques; Rogério Barbosa de Magalhães Barros; Nazareth de Novaes Rocha; Christianne Bretas Vieira Scaramello

Int J Cardiovasc Sci. 2015;28(1):42-50


BACKGROUND: Aging involves physical and psychological changes that reduce the elderly's ability to adapt themselves to society, which is the leading risk factor for cardiovascular diseases.
OBJECTIVE: To investigate changes in the cardiovascular system resulting from the aging process in rats.
METHODS: Murinometric/nutritional, echocardiographic and hemodynamic parameters were determined in 1, 5 and 12-month aged male rats. The expression of proteins that are critical to intracellular calcium dynamics and leptin signaling, as well as cardiac ATPase activity, was investigated in cardiac homogenates of rats. Data were expressed as mean ± standard error and analyzed by ANOVA one-way test (* p <0.05 vs. one month and #p <0.05 vs. 5 months).
RESULTS: Whereas the body mass index increased (0.46±0.01 g/cm2; 0.75±0.01 g/cm2*,0.78±0.01 g/cm2*), the food efficiency ratio (0.431±0.013; 0.035±0.003*; 0.003±0.001*#), maximum speed during maximal exercise stress testing (3.36±0.34 km/h; 1.38±0.04 km/h*; 1.20±0.13 km/h*) and heart rate (410.2±5.9 bpm; 375.9±7.6 bpm*; 376.6±3,3 bpm*) decreased with age. Left ventricular hypertrophy and diastolic dysfunction along with reduced leptin receptor expression (2.1±0.4; 1.9±0.2; 0.8±0.2*#) and SERCA-type calcium pump activity (1981±77 nmol Pi/mg protein/h; 2 385±205 nmol Pi/mg protein/h; 1 148±152 nmol Pi/mg protein/h#) were observed in the hearts.
CONCLUSIONS: Aging process is related to cardiometabolic risk, with cardiac leptin receptor downregulation and reduced cardiac SERCA2 calcium pump activity presumably being mechanisms underlying the left ventricular diastolic dysfunction and consequent exercise intolerance.

Keywords: Aging; Left ventricular dysfunction; Calcium signaling; Anthropometry; Nutritional physiological phenomena

Mortality from coronary artery disease during dengue epidemics

Mortalidade por doença arterial coronariana durante epidemias de dengue

Marcio Lassance Martins de Oliveira; Marco Antonio Mattos; Marisa Santos; Bernardo Rangel Tura

Int J Cardiovasc Sci. 2015;28(1):51-60


BACKGROUND: The possibility of increased mortality from coronary artery disease (CAD) during dengue epidemics is frequently taken into account to create extra cardiologic beds.
OBJECTIVE: Describe a possible association between the mortality from CAD and the reported cases of dengue virus infections in the state of Rio de Janeiro.
METHODS: Two time series were developed. The first series of CAD mortality comprised 313,503 patients between January 1996 and December 2010. The disease codes used were all from I20 to I25 (ICD-10). The second series comprised 275,227 cases of dengue fever reported between January 1994 and December 2010. The Box-Jenkins methodology was employed for modeling the series; and both cross correlation and intervention analysis were used to evaluate such association.
RESULTS: The time series of CAD mortality best fits into the model SARIMA (1,1,1) x (1,0,1)365, where annual seasonality is reflected by an increase in the number of cases in winter months. The intervention analysis showed absence of influence of cases of dengue fever in CAD mortality with a correlation coefficient of 0.0018.
CONCLUSIONS: There is no correlation between CAD mortality and the number of dengue fever cases. CAD mortality is higher in winter.

Keywords: Time series studies; Dengue; Coronary disease

Betaine and choline intakes are related to total plasma homocysteine: health survey of São Paulo, Brazil

Betaína e colina dietéticas relacionadas à homocisteína plasmática: estudo de base populacional, São Paulo, Brasil

Raíssa do Vale Cardoso Lopes; Michelle Alessandra de Castro; Valéria Troncoso Baltar; Dirce Maria Lobo Marchioni; Regina Mara Fisberg

Int J Cardiovasc Sci. 2015;28(1):61-69


BACKGROUND: High concentrations of plasma homocysteine (Hcyp) have been associated with increased risk of cardiovascular diseases. Hcyp can be decreased by remethylation to methionine, which uses folate or betaine as a donor of the methyl group.
OBJECTIVES: To evaluate the intake of betaine and choline and its relation to homocysteine in residents of the city of São Paulo.
METHODS: Data from 584 individual, of both sexes, from the population-based study ISA-SP 2008. Geometric averages of Hcyp were analyzed according to choline and betaine intake tertiles and trend test was applied.
RESULTS: The study analyzed 584 individuals: 222 (38.0%) men and 362 (62.0%) women, mean age 55.0 ± 19.0 years. The prevalence of hyperhomocysteinemia was higher among men (28.0%), the elderly (21.0%) and those with lower household income (21.0%). Approximately 31.0% of individual with hyperhomocysteinemia presented folate deficiency (<7.5 nmol/L) and 26.0% presented vitamin B12 deficiency (<200 pmol/L). There was a decrease in the geometric means of homocysteine according to an increase in betaine tertiles in both sexes, adults, normal and in all categories of education. Choline was related to Hcyp in both sexes, higher household income individuals, non-smokers and alcohol consumers.
CONCLUSIONS: This study suggests the importance of betaine intake due to its inverse relationship with the concentration of Hcyp in adults and elderly in the city of São Paulo. Choline played a protective role in specific subgroups of the population.

Keywords: Betaine; Choline; Homocysteine; Diet; Cardiovascular diseases

Safety of the six-minute walk test in hospitalized cardiac patients

Segurança do teste de caminhada de seis minutos em cardiopatas hospitalizados

Pryscilla Alves Ferreira; Palmireno Pinheiro Ferreira; Anne Karine Menezes Santos Batista; Fernanda Warken Rosa

Int J Cardiovasc Sci. 2015;28(1):70-77


BACKGROUND: There is no evidence in the literature to attest the safety of the six-minute walk test (6MWT) in hospitalized cardiac patients.
OBJECTIVE: To identify adverse events during the course of the 6MWT in hospitalized cardiac patients.
METHODS: This is an observational, cross-sectional, conducted in 30 patients with heart disease who were hospitalized. Two 6MWT practices were carried along a 20-meter corridor. The distance traveled, the cardiorespiratory parameters and signs of intolerance to physical exertion were collected. The adverse effects identified in both practices were classified as non-cardiopulmonary and cardiopulmonary, and in the latter group, divided into non-serious and serious.
RESULTS: Adverse effects were observed in both 6MWT practices in 15 (50.0%) patients, and the following were identified: lower limb (LL) arthralgia, palpitation, dyspnea, desaturation, dizziness, nausea, hypotension, bradycardia, and numbness in the left arm. Of the 30 patients, 4 (13.3%) patients presented severely adverse effects. All of the 4 (100%) patients had hypertension (SAH) and 3 (75%) were diagnosed with coronary artery disease (ICO) and dyslipidemia (DLP).
CONCLUSION: In the 6MWT, a low frequency of serious adverse events was found in cardiac patients hospitalized two days after admission.

Keywords: Patient safety; Heart diseases; Walking

Review Article

The paradigm of systems biology applied to cardiovascular diseases

O paradigma da biologia de sistemas aplicado às doenças cardiovasculares

Evandro Tinoco Mesquita; Eduardo Nani Silva; Antonio José Lagoeiro Jorge; Bruna de Melo Mariano; João Paulo Pedroza Cassino; Celso Vale Souza Junior; Michelle Araujo Mesquita; Ruíza Gonçalves Rocha

Int J Cardiovasc Sci. 2015;28(1):78-86


Based on individual analyses of the functional components of an organism, the Oslerian method shows signs of depletion when attempting to explain the pathophysiology of complex syndromes such as cancer and cardiovascular diseases. This is why it is gradually being supplanted by a new paradigm: the methodology of biological systems. This new model strives to integrate knowledge in different modern research areas with the omics sciences and bioinformatics, in order to develop biological networks leading to a better understanding of these complex syndromes. The purpose of this review is to introduce clinical cardiologists and cardiovascular researchers a new tool called systems biology, showing how it integrates data from the omics sciences and its contribution to a new approach to cardiovascular disease. To date, a search of the Medline database has been conducted with the following key words in Portuguese and English: "biologia de sistemas", "insuficiência cardíaca", "síndrome metabólica" e "arritmias cardíacas"; "systems biology", "heart failure", "metabolic syndrome" and "cardiac arrhythmias". This led to the conclusion that systems biology must be used to an increasing extent for a better understanding of complex cardiovascular diseases such as metabolic syndrome, atherosclerosis, hypertension, heart failure and cardiac arrhythmias. Cardiologists, cardiovascular researchers, other healthcare practitioners and basic researchers in other fields of knowledge will build up closer links in a quest to identify health and disease network models that are now called network medicine.

Keywords: Systems biology; Cardiovascular diseases; Heart failure