Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients

INTRODUCTION: Decreased heart rate variability (HRV) in patients with end stage renal disease (ESRD) undergoing hemodialysis is predictive of cardiac death, especially due to sudden death. OBJECTIVE: To evaluate the effects of aerobic training during hemodialysis on HRV and left ventricular function in ESRD patients. METHODS: Twenty two patients were randomized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and control (n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were submitted to aerobic training, performed during the first two hours of hemodialysis, three times weekly, for 12 weeks. HRV and left ventricular function were assessed by 24 hours Holter monitoring and echocardiography, respectively. RESULTS: After 12 weeks of protocol, no significant differences were observed in time and frequency domains measures of HRV in both groups. The ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%). CONCLUSION: A 12-week aerobic training program performed during hemodialysis did not modify HRV and did not significantly improve the left ventricular function.INTRODUÇÃO: Pacientes com doenca renal crônica (DRC) sob tratamento hemodialítico apresentam diminuicao da variabilidade da frequência cardíaca (VFC) que representa um fator de risco independente para a mortalidade cardíaca, especialmente a morte súbita. OBJETIVO: Avaliar o efeito do exercício aeróbico, realizado durante as sessões de hemodiálise, na VFC e na funcao ventricular esquerda de pacientes portadores de DRC. MÉTODOS: Foram avaliados 22 pacientes randomizados em dois grupos: exercício (n = 11; 49,6 ± 10,6 anos; 4 homens) e controle (n = 11; 43,5 ± 12,8; 4 homens). Os pacientes do grupoexercício foram submetidos a três sessões semanais de exercício aeróbico, realizado nas duas horas iniciais da hemodiálise, durante 12 semanas. Para a análise da VFC e da funcao ventricular esquerda, todos os pacientes foram submetidos aos exames de Holter de 24 horas e ecocardiograma, respectivamente. RESULTADOS: Após 12 semanas de protocolo, nao foi observada diferenca significante em nenhum dos parámetros da VFC nos domínios do tempo e da frequência em ambos os grupos. A fração de ejeção aumentou de modo nao significante nos pacientes do grupo-exercício (67,5 ± 12,6% vs. 70,4 ± 12%) e diminuiu nao significantemente nos pacientes do grupo-controle (73,6 ± 8,4% vs. 71,4 ± 7,6%). CONCLUSÃO: A realizacao de 12 semanas de exercício aeróbico, durante as sessões de hemodiálise, nao modificou a VFC e nao promoveu melhora significante na funcao ventricular esquerda.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas GeraisUniversidade Federal de Juiz de Fora Departamento de Clínica MédicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUFJFUNIFESP, EPMSciEL

Ciprofibrate therapy in patients with hypertriglyceridemia and low high density lipoprotein (HDL)-cholesterol: greater reduction of non-HDL cholesterol in subjects with excess body weight (The CIPROAMLAT study)

BACKGROUND: Hypertriglyceridemia in combination with low HDL cholesterol levels is a risk factor for cardiovascular disease. Our objective was to evaluate the efficacy of ciprofibrate for the treatment of this form of dyslipidemia and to identify factors associated with better treatment response. METHODS: Multicenter, international, open-label study. Four hundred and thirty seven patients were included. The plasma lipid levels at inclusion were fasting triglyceride concentrations between 1.6–3.9 mM/l and HDL cholesterol ≤ 1.05 mM/l for women and ≤ 0.9 mM/l for men. The LDL cholesterol was below 4.2 mM/l. All patients received ciprofibrate 100 mg/d. Efficacy and safety parameters were assessed at baseline and at the end of the treatment. The primary efficacy parameter of the study was percentage change in triglycerides from baseline. RESULTS: After 4 months, plasma triglyceride concentrations were decreased by 44% (p < 0.001). HDL cholesterol concentrations were increased by 10% (p < 0.001). Non-HDL cholesterol was decreased by 19%. A greater HDL cholesterol response was observed in lean patients (body mass index < 25 kg/m(2)) compared to the rest of the population (8.2 vs 19.7%, p < 0.001). In contrast, cases with excess body weight had a larger decrease in non-HDL cholesterol levels (-20.8 vs -10.8%, p < 0.001). There were no significant complications resulting from treatment with ciprofibrate. CONCLUSIONS: Ciprofibrate is efficacious for the correction of hypertriglyceridemia / low HDL cholesterol. A greater decrease in non-HDL cholesterol was found among cases with excess body weight. The mechanism of action of ciprofibrate may be influenced by the pathophysiology of the disorder being treated

Dieta e dislipidemia: visão antropológica e recomendações atuais

In the therapy and prevention of the cardiovascular diseases little emphasis if gives to the non-pharmacological treatment and changes in the life style. Usually preference to the medicine treatment is given, more easily than to try to change the habits of the individuals, which demand time and patients of the two sides. In this monograph a revision of the importance of the diet in the reduction of plasmatic lipids is carried through. It is compared diet of our ancestor ones with the current one and where if to intervene to get benefits. To long of the evolution the human being, it had development of the profile economizer, to survive the times of shortage, what it became an upheaval in the current days, increasing the incidence of cardiovascular illnesses, obesity and diabetes. The diet has little power in reducing the plasmatic cholesterol levels, however exactly with modest reductions in the plasmatic cholesterol levels, significant reduction of the number of cardiovascular events exists; It is to have of the doctor to implement measured dietary as therapy of first line in the reduction of cardiovascular events. Diverse other diseases are related to the inadequate diet. The stimulation the changes of the life style is practical holistic in the exercise of the medicine.Na terapia e prevenção das moléstias cardiovasculares, pouca ênfase se dá ao tratamento não farmacológico e mudanças no estilo de vida. Usualmente, dá-se preferência ao tratamento medicamentoso, mais fácil que tentar mudar os hábitos dos indivíduos, o que demanda tempo e paciência dos dois lados. Nesta monografia, uma revisão da importância da dieta na redução dos lípides plasmáticos é realizada. Compara-se a dieta de nossos ancestrais com a atual e mostra-se em que intervir para obter benefícios. Ao longo da evolução humana, houve desenvolvimento do perfil poupador, para sobreviver a épocas de penúria, o que tornou um transtorno nos dias atuais, aumentando a incidência de doenças cardiovasculares, obesidade e diabetes. A dieta tem pouco poder em reduzir os níveis séricos de colesterol, porém, mesmo com reduções modestas nestes, existe redução significativa do número de eventos cardiovasculares; é dever do médico implementar medidas dietéticas como terapia de primeira linha na redução de eventos cardiovasculares. Diversas outras moléstias estão relacionadas à dieta inadequada. O estímulo a mudanças do estilo de vida é prática holística no exercício da medicina