The polypill: from concept and evidence to implementation

© 2022 Elsevier Ltd. All rights reserved.About 18 million deaths occur due to cardiovascular diseases each year, of which 80% are in low-income and middle-income countries, and three times as many individuals have non-fatal cardiovascular diseases. These diseases are widespread and demand global, populationwide action, but the approach to their control has been based on individualised treatment plans, leaving the majority of people at risk neglected.info:eu-repo/semantics/publishedVersio

Role of microRNAs in the regulation of cardiovascular diseases : focus on remodelling

MicroRNAs (miRNAs) are a large class of noncoding RNAs that regulate the expression of protein-coding genes at the post-transcriptional level . They are recognized as regulators of biological processes underlying cardiovascular disorders including hypertrophy, ischemic heart disease, valvular disease and arrhythmias. Particularly, circulating miRNAs are promising biomarkers of cardiovascular pathology (1). MiRNAs are small, noncoding, RNA molecules with approximately 22 nucleotides in length, which act as post-transcriptional regulators of gene expression. Individual miRNAs have been demonstrated to negatively regulate the expression of multiple gene transcripts by the cleavage or suppression of translation of a target mRNA. Conversely, the expression of individual genes can be regulated by multiple miRNAs. Since their experimental description in 1993 (2), a large number of miRNAs known by their gene-regulatory roles in different biological processes, have been catalogued. In fact, miRNAs are known to regulate approximately one third of all coding gene transcripts in mammals, showing their importance as key process modulators (3). Regarding cardiovascular diseases, miRNAs have been identified as key regulators of complex biological processes linked to several conditions as presented above, including left ventricular remodelling, atherosclerosis and myocardial infarction, heart failure, hypertension and arrhythmias (1). miRNAs are expressed in the cardiovascular system, but their role in cardiovascular diseases has not yet been entirely clarified. Moreover, since the discovery that miRNAs are present in the circulation, they have been investigated as novel biomarker as presented bellow. Only 3% of the human genome codes for proteins. Nevertheless, while noncoding RNAs will not act for coding into proteins they modulate all genomic functions. These noncoding RNAs include short miRNAs with approximately 22 nucleotides) and longer, with >200 nucleotides, long noncoding RNAs (lncRNAs) with important biological functions (4) since they are now clearly recognised to play key roles in gene regulation and may simultaneously represent diagnostic and prognostic biomarkers in cardiovascular diseases. (5,6) there are in excess of 2000 human miRNAs (catalogued in mirBase (http://www.mirbase.org) (7). Of note, the key feature of the mechanism of action of miRNAs is that a single miRNA can regulate the expression of several genes, depending on the specificity of the target sequence. On the other side, individual genes can be regulated by different miRNAs particularly if they involve complementary sequences for more than one miRNA. These factors lead to a highly complex regulatory mechanism, often difficult to understand. (8,9). In the healthy adult heart, data from a large sequencing project and other sequential studies, has identified a number of miRNAs that are highly expressed in healthy cardiac tissue and thus expected to play a key role in both normal cardiac function and disease. (10,11) These include miR-1, miR-16, miR-27b, miR-30d, miR-126, miR-133, miR-143, miR-208 and the let-7 family. However, many others have been identified and are now under study. The concept of miRNA-based therapeutics has been emerging and under development, with synthetic antagonists of miRNAs (antagomiRs or antimirs) and very promising in animal models but awaiting new advances in phase II human trials, still in its infancy (12,13). miRNAs clearly intervene in physiological and pathological processes in the cardiovascular diseases. We will review miRNA biology and its role on LV remodeling in myocardial infarction, heart failure, hypertension and aortic stenosis as additionally a note will be provided on the potential of miRNAs for therapeutics.info:eu-repo/semantics/publishedVersio

Cardiac involvement in COVID-19: a matter close to the heart, beyond the acute illness

© 2023 International Journal of Cardiovascular Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Human infection with the SARS-CoV-2 virus and COVID-19 have been ravaging the entire world since December 2019. As of February 17, 2023, records from the World Health Organization point to more than 756 million confirmed cases and approximately 6,845,000 deaths. In Brazil, until this date, approximately 36,961,000 cases have been reported, with about 698,000 deaths.Among the deaths, the main comorbidities reported are heart disease (40%), diabetes (28%), obesity (10%), neurological diseases (5%), kidney diseases (5%), and pneumopathies (5%). Furthermore, 70% of patients who died were 60 years old or older, and males were prevalent in 60% of the cases.info:eu-repo/semantics/publishedVersio

COVID-19 : a matter close to the heart

© This is an open-access article distributed under the terms of the Creative Commons Attribution License 4.0 International – CC BYThe world is facing a new challenge, the novel coronavirus disease 2019 (COVID-19), caused by a betacoronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), phylogenetically identical to the SARS-CoV (severe acute respiratory syndrome coronavirus) and the MERS-CoV (Middle East respiratory syndrome coronavirus) responsible for innumerable deaths in China in 2003 and in the Middle East in 2012, respectively.info:eu-repo/semantics/publishedVersio

Endocardite infecciosa: ainda mais desafios que certezas

© Sociedade Brasileira de Cardiologia - SBC. This is an open-access article distributed under the terms of the Creative Commons Attribution LicenseAfter fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.info:eu-repo/semantics/publishedVersio

Aspirin in diabetic patients at primary prevention: insights of the VITAL cohort

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose: Aspirin use among patients with diabetes in primary prevention is still a matter of debate. We aimed to evaluate the potential cardiovascular risk benefit of aspirin in primary prevention, using data from a contemporary cohort. Methods: Retrospective analysis of the VITAL cohort with > 20,000 individuals at primary prevention who were followed for a median of 5.3 years. The population was evaluated according to the baseline diabetes status, and then aspirin use was evaluated among diabetic patients. Cox regression models were used to estimate the risks of mortality and cardiovascular outcomes. The estimates were reported using adjusted hazard ratio (HR) and 95% confidence intervals (95%CI). Results: Diabetic patients (n = 3549; 13.7%) showed to increase the risk of all-cause mortality (HR 1.61, 95%CI 1.33-1.94), and major adverse cardiovascular events (MACE) (HR 1.36 95%CI 1.11-1.68) than non-diabetic population. Diabetic patients taking aspirin were older, more frequently man, hypertensive, current users of statins, and current smokers compared with diabetic patients who did not use aspirin at baseline. There was no difference between diabetic aspirin users and non-users regarding all-cause mortality (HR 0.80, 95%CI 0.59, 1.10), MACE (HR 0.92, 95%CI 0.64, 1.33), coronary heart disease (HR 0.98, 95%CI 0.67, 1.43), or stroke (HR 0.87, 95%CI 0.48, 1.58). Conclusions: The VITAL data confirmed diabetes as an important risk factor for cardiovascular events in a contemporary cohort but did not show cardiovascular benefits of aspirin in primary prevention among people with diabetes who were shown to be at higher risk of cardiovascular events.Open access funding provided by FCT|FCCN (b-on)info:eu-repo/semantics/publishedVersio

Decision-making support systems on extended hospital length of stay: validation and recalibration of a model for patients with AMI

Copyright © 2023 Xavier, Seringa, Pinto and Magalhães. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Cardiovascular diseases are still a significant cause of death and hospitalization. In 2019, circulatory diseases were responsible for 29.9% of deaths in Portugal. These diseases have a significant impact on the hospital length of stay. Length of stay predictive models is an efficient way to aid decision-making in health. This study aimed to validate a predictive model on the extended length of stay in patients with acute myocardial infarction at the time of admission. Methods: An analysis was conducted to test and recalibrate a previously developed model in the prediction of prolonged length of stay, for a new set of population. The study was conducted based on administrative and laboratory data of patients admitted for acute myocardial infarction events from a public hospital in Portugal from 2013 to 2015. Results: Comparable performance measures were observed upon the validation and recalibration of the predictive model of extended length of stay. Comorbidities such as shock, diabetes with complications, dysrhythmia, pulmonary edema, and respiratory infections were the common variables found between the previous model and the validated and recalibrated model for acute myocardial infarction. Conclusion: Predictive models for the extended length of stay can be applied in clinical practice since they are recalibrated and modeled to the relevant population characteristics.This study was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).info:eu-repo/semantics/publishedVersio

Reconstrução tridimensional dinâmica do coração através da ecocardiografia transesofágica

Copyright © 1997-99 Arquivos Brasileiros de CardiologiaObjective – To evaluate echocardiography accuracy in performing and obtaining images for dynamical threedimensional (3D) reconstruction. Methods – Three-dimensional (3D) image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. Results – Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses – 6 (2 mitral, 2 aortic and 2 mitral and aortic); mitral valve prolapse – 3; mitral and aortic disease – 2; aortic valve disease – 5; congenital heart disease – 3 (2 atrial septal defect –ASD- and 1 transposition of the great arteries -TGA); arteriovenous fistula – 1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD). Fifty five of 60 (91.6%) reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE) alone. Conclusion – 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.Objetivo - Avaliar a acuidade da ecocardiografia na realização e obtenção de imagens para reconstrução tridimensional dinâmica (3D). Métodos - Foram obtidas imagens para reconstruções 3D em 20 doentes consecutivos submetidos a ecocardiografia transesofágica. Foi utilizado um transdutor de 5 Mhz multiplanar ligado ao sistema de reconstrução 3D. Resultados – Foram estudados, consecutivamente, 20 doentes, idade média de 56±16 anos, com as seguintes doenças cardíacas: próteses valvulares - 6 (2 mitrais, 2 aórticas e 2 mitro-aórticas); prolapso da válvula mitral - 3; doença mitro-aórtica - 2; doença da válvula aórtica - 5; cardiopatia congênita - 3 (2 comunicação interatrial (CIA) e 1 transposição das grandes artérias (TGA)); fístula arteriovenosa - 1. Em 7 doentes foi também obtido fluxo por Doppler a cores e feita a reconstrução 3D do fluxo. Foram adquiridas 25 estruturas cardíacas e foram realizadas 60 reconstruções (28 de válvulas mitrais, 14 de válvulas aórticas, 4 de próteses mitrais, 7 de próteses aórticas e 7 de CIA). Das 60 (91,6%) reconstruções, 55 foram consideradas de boa qualidade por 2 observadores independentes. As 11 válvulas/próteses mitrais e 2 CIAs reconstruídas forneceram mais informações anatômicas do que apenas o ecocardiograma bidimensional. Conclusão - A ecocardiografia 3D, pela via transesofágica, é uma técnica exeqüível, que melhora o reconhecimento de detalhes anatômicos de estruturas cardíacas, particularmente a válvula mitral e o septo interatrial.info:eu-repo/semantics/publishedVersio

O peso da endocardite infeciosa em Portugal nos últimos 30 anos : uma revisão sistemática de estudos observacionais

© 2021 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. Este é um artigo Open Access sob uma licença CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction: Infective endocarditis affects cardiac valves or devices and has a potentially uncertain prognosis. Little information is available on the epidemiology of this disease in Portugal. Objective: A systematic review of all evidence published in the last 30 years to assess epidemiological data in patients hospitalized with infective endocarditis in Portuguese hospital centers. Methods: Extensive search of all published evidence using Medline, Scopus, general search databases and in addition Portuguese medical journals was performed. All relevant studies in Portuguese or English that reported short- or long-term mortality were included. Results: Eighteen retrospective cohort studies (15 medical and three surgical series) were included with a total of 1872 patients assessed. The medical series included 1279 patients. Older males with predominant native left heart valve involvement were identified. Staphylococcus and streptococcus were the most frequent reported pathogens. Surgical intervention was performed on average in 29.8% of cases. The short-term mortality rate ranged from three to 37.2% (average 21.9%). Surgical cases involved older males with affected native left heart valves, emergent/urgent indication was dominant and short-term mortality ranged from 13.6 to 16%. Conclusions: The current study provides a descriptive analysis of the published series of infective endocarditis in Portugal over the last 30 years. Therefore, it may serve as a starting point for the development and implementation of a multicentric prospective registry on infective endocarditis patients in Portugal that will allow a better and more accurate characterization of this special patient population.Introdução: A endocardite infeciosa afeta válvulas ou dispositivos cardíacos e tem um prognóstico potencialmente incerto. Pouca informação está disponível sobre a sua epidemiologia em Portugal. Objetivo: Revisão sistemática de todos os estudos publicados nos últimos 30 anos que avaliaram dados epidemiológicos em pacientes hospitalizados com endocardite infeciosa em centros hospitalares portugueses. Métodos: Uma pesquisa detalhada de todos os estudos publicados, usando a Medline, Scopus, motores de busca generalistas e também revistas médicas portuguesas, foi realizada. Todos os estudos relevantes em português ou inglês que relataram mortalidade em curto ou longo prazo foram incluídos. Resultados: Dezoito estudos de coorte retrospetivos (15 séries médicas e 3 cirúrgicas) foram incluídos com um total de 1872 pacientes avaliados. As séries médicas incluíram 1279 doentes. Identificaram-se homens mais velhos com envolvimento predominante de válvulas cardíacas esquerdas nativas. Staphylococcus e Streptococcus foram os agentes envolvidos mais frequentemente. A intervenção cirúrgica foi realizada em 29,8% dos casos (valor médio). A taxa de mortalidade em curto prazo variou entre 3 e 37,2% (média 21,9%). Os casos cirúrgicos incluíram homens mais velhos com envolvimento das válvulas esquerdas nativas, a indicação emergente/urgente dominou e a mortalidade em curto prazo variou entre 13,6 e 16%. Conclusões: O estudo atual fornece uma análise descritiva de todas as séries de endocardite infeciosa publicadas em Portugal nos últimos 30 anos. Pode servir como ponto de partida para o desenvolvimento de um registo prospetivo multicêntrico em pacientes com endocardite infeciosa em Portugal, que permitirá uma caracterização mais rigorosa desta população específica de doentes.info:eu-repo/semantics/publishedVersio

Trends of case-fatality rate by acute coronary syndrome in Portugal : impact of a fast track to the coronary unit

© The Author(s) 2019. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Introduction: Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system. Methods: We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fasttrack system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions. Results: After 2007 case-fatality by acute coronary syndrome decreased (b¼1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%. Conclusions: Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.info:eu-repo/semantics/publishedVersio