Temperature, air pollution, and mortality from myocardial infarction in São Paulo, Brazil

An increase in daily mortality from myocardial infarction has been observed in association with meteorological factors and air pollution in several cities in the world, mainly in the northern hemisphere. The objective of the present study was to analyze the independent effects of environmental variables on daily counts of death from myocardial infarction in a subtropical region in South America. We used the robust Poisson regression to investigate associations between weather (temperature, humidity and barometric pressure), air pollution (sulfur dioxide, carbon monoxide, and inhalable particulate), and the daily death counts attributed to myocardial infarction in the city of São Paulo in Brazil, where 12,007 fatal events were observed from 1996 to 1998. The model was adjusted in a linear fashion for relative humidity and day-of-week, while nonparametric smoothing factors were used for seasonal trend and temperature. We found a significant association of daily temperature with deaths due to myocardial infarction (P < 0.001), with the lowest mortality being observed at temperatures between 21.6 and 22.6ºC. Relative humidity appeared to exert a protective effect. Sulfur dioxide concentrations correlated linearly with myocardial infarction deaths, increasing the number of fatal events by 3.4% (relative risk of 1.03; 95% confidence interval = 1.02-1.05) for each 10 µg/m³ increase. In conclusion, this study provides evidence of important associations between daily temperature and air pollution and mortality from myocardial infarction in a subtropical region, even after a comprehensive control for confounding factors

Health professional’s perception about antidepressants medication

The aim of the present study is to understand the health professional’s perception about the phenomenon of nonadherence the antidepressant medication when they are themselves patients. The participants were health professionals of a tertiary hospital in the city of São Paulo who were treated in the Ocupational Medicine Service and demonstrated nonadherence to antidepressant medication. A Qualitative clinical method was used and the collection of data was conducted through semi directed interviews. The results indicate that the participants perceived the medication as causing side effect, they expressed fear to a potential dependence to the psychoactive medication and were also afraid of being control over their mind. It s concluded that previous beliefs about their emotional problems and the use of antidepressant medication influenced the nonadherence the treatment, despite of their experience as health professionals

Relation of fasting triglyceride rich lipoprotein cholesterol to coronary artery calcium score (from the ELSA-Brasil study)

Whilst low density lipoprotein cholesterol (LDL-C) is widely accepted as the principal lipid fraction associated with atherosclerosis, emerging evidence suggests a causal relationship between lifelong elevations in triglyceride rich lipoprotein cholesterol (TRL-C) and cardiovascular disease (CVD) in genetic studies. To provide further evidence for the potential relevance of TRL-C and atherosclerosis, we have evaluated the relationship between TRL-C and coronary artery calcium score (CAC). We included 3,845 (49.9±8.4 years, 54% women) subjects who had no prior history of CVD, were not using lipid-lowering medications and underwent CAC evaluation. We assessed the relationship between increasing fasting TRL-C and the graded increase in CAC and to what extent TRL-C were independently associated with CAC over and above LDL-C using logistic regression models. Overall 973 (25%) of the participants had a CAC >0, and 308 (8%) had a CAC > 100. The median TRL-C level was 22 (IQR: 16 - 32) mg/dL. Individuals with CAC> 0 had higher TRL-C levels than those with CAC=0 (p 0 had higher levels of LDL-C, non-high density lipoprotein cholesterol (non-HDL-C), and lower HDL-C (all p0 (p=0.01). In conclusion, in a large cohort of asymptomatic individuals, TRL-C was associated with subclinical atherosclerosis supporting a potentially causal role in CVD

Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Data on the association between subclinical thyroid dysfunction and coronary artery disease (CAD) is scarce. We aimed to analyze the association between thyroid function and CAD using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (0.4-4.0 mIU/L, and normal free thyroxine, FT4, or 0.8 to 1.9 ng/dL), subclinical hypothyroidism (SCHypo; TSH>4.0 mIU/L and normal FT4), and subclinical hyperthyroidism (SCHyper; TSH4, and segment severity score (SSS) >4 of coronary arteries as the dependent variables, and quintiles of TSH and FT4 as the independent variables, adjusted for demographical data and cardiovascular risk factors. We included 767 subjects, median age 58 years (IQR=55-63), 378 (49.3%) women, 697 euthyroid (90.9%), 57 (7.4%) with SCHypo, and 13 (1.7%) with SCHyper. No association between TSH and FT4 quintiles and CAD prevalence was noted. Similarly, no association between TSH levels and the extent or severity of CAD, represented by SIS>4 and SSS>4 were seen. Restricting analysis to euthyroid subjects did not alter the results. TSH levels were not significantly associated with the presence, extent, or severity of CAD in a middle-aged healthy population