Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

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Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil

Background: Peripheral arterial disease (PAD) is associated with increased cardiovascular risk. In Brazil, data on PAD prevalence and risk factors are scarce.Objective: To assess prevalence and risk factors related to PAD in Brazilian urban centers with more than 100,000 inhabitants.Methods: National, multicenter, cross-sectional study of 1,170 individuals (>= 18years), from 72 major Brazilian urban centers participating in the Hearts of Brazil Project. PAD diagnosis was based on ankle-brachial index (ABI) <= 0.90. The statistical analysis used the corrected Chi-square (Pearson) test for complex samples and confidence intervals. P< 0.05 was considered statitically significant.Results: PAD prevalence was 10.5%. Intermittent claudication (IC) was present in only 9% of PAD patients. A significant association was found between PAD and the following factors: diabetes, total and abdominal obesity, stroke and ischemic heart disease (IHD). There was a trend of higher PAD prevalence among individuals with hypertension, heart failure, chronic renal failure on dialysis, as well as those who had smoked over 20 pack-years. For females, presence of IHD was associated with a 4.9-fold greater risk of PAD. Among males, a 6.6-fold increased risk of PAD was found for diabetic in comparison to non-diabetic individuals.Conclusion: PAD prevalence was markedly high, considering the low mean age of the studied population (44 +/- 14.7 yrs). IC was detected in a minority of PAD subjects, indicating a considerable number of asymptomatic individuals. Diabetes, obesity, stroke and IHD were the stronger predictors of PAD. The authors concluded that ABI measurement should be considered in the evaluation of moderate to high cardiovascular risk patients. (Arq Bras Cardiol 2008; 91(6): 370-382)Libbs PharmaceuticalsAstraZenecaBiosinteticaBiolabNovartisSanofi-AventisOmronRoche DiagnosticosCentrais Eletricas FurnasMinistry of Health and Conselho Nacional de Secretarios Municipais de Saude (Conasems)Hosp Israelita Albert Einstein, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Sao Paulo Incor USP, Fac Med, Inst Coracao, Sao Paulo, BrazilFac Ciencias Med, Belo Horizonte, MG, BrazilInst Dante Pazzanese Cardiol, Sao Paulo, BrazilUniv Fed Ouro Preto, Dept Ciencias Med, Ouro Preto, MG, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events