Simultaneous transfer of cholesterol, triglycerides, and phospholipids to high-density lipoprotein in aging subjects with or without coronary artery disease

OBJECTIVE: To verify whether the capacity of high-density lipoprotein (HDL) to simultaneously receive nonesterified cholesterol, triglycerides, cholesteryl esters, and phospholipids changes with aging and the presence of coronary artery disease. DESIGN: Cross-sectional study with biochemical analyses. SUBJECTS: Eleven elderly patients with coronary artery disease (74±5 years) were compared with the following groups of non-coronary artery disease subjects (referred to as "healthy"): 25 young (25±5 years), 25 middle-aged (42± years), and 25 elderly subjects (75±8 years). METHODS: Plasma samples were incubated with a nanoemulsion labeled with radioactive lipids; the transfer of the lipids from the nanoemulsion to the HDL was measured in chemically precipitated HDL. HDL size and paraoxonase-1 activity were also determined. RESULTS: The transfer of cholesteryl esters and phospholipids to high-density lipoprotein was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. Non-esterified cholesterol and triglyceride transfer was not different among these three groups. The HDL size was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. The paraoxonase-1 activity was similar among the groups. Compared with healthy elderly subjects, coronary artery disease elderly subjects had significantly less (p<0.05) transfer of non-esterified cholesterol, triglycerides, and cholesteryl esters to the HDL and a significantly smaller (p<0.05) HDL size. CONCLUSION: Because lipid transfer is enhanced in healthy elderly subjects but not in those with coronary artery disease, increasing lipid transfer to HDL may be a protective mechanism against the disease

Hormone replacement therapy increases levels of antibodies against heat shock protein 65 and certain species of oxidized low density lipoprotein

Hormone replacement therapy (HRT) reduces cardiovascular risks, although the initiation of therapy may be associated with transient adverse ischemic and thrombotic events. Antibodies against heat shock protein (Hsp) and oxidized low density lipoprotein (LDL) have been found in atherosclerotic lesions and plasma of patients with coronary artery disease and may play an important role in the pathogenesis of atherosclerosis. The aim of the present study was to assess the effects of HRT on the immune response by measuring plasma levels of antibodies against Hsp 65 and LDL with a low and high degree of copper-mediated oxidative modification of 20 postmenopausal women before and 90 days after receiving orally 0.625 mg equine conjugate estrogen plus 2.5 mg medroxyprogesterone acetate per day. HRT significantly increased antibodies against Hsp 65 (0.316 ± 0.03 vs 0.558 ± 0.11) and against LDL with a low degree of oxidative modification (0.100 ± 0.01 vs 0.217 ± 0.02) (P<0.05 and P<0.001, respectively, ANOVA). The hormone-mediated immune response may trigger an inflammatory response within the vessel wall and potentially increase plaque burden. Whether or not this immune response is temporary or sustained and deleterious requires further investigation.Universidade de São Paulo Faculdade de Medicina Instituto do CoraçãoUniversidade Federal de São Paulo (UNIFESP) Departamento de BiofísicaUniversidade de São Paulo Instituto de Ciências Biomédicas IV Departamento de Imunologia and Instituto de Medicina Tropical da Universidade de São PauloUNIFESP, Depto. de BiofísicaSciEL

Mycoplasma pneumoniae and Chlamydia pneumoniae in calcified nodules of aortic stenotic valves

Estenose da Valva Aórtica (EVA) tem sido considerada como um processo aterosclerótico das valvas pois elas freqüentemente exibem alterações inflamatórias com acúmulo de macrófagos e linfócitos T, bem como infiltração de lípides. O presente estudo investigou se as bactérias Chlamydia pneumoniae (CP) e Mycoplasma pneumoniae (MP), detectadas previamente em placas ateroscleróticas, estavam presentes na EVA. Dez valvas removidas cirúrgicamente de pacientes com EVA foram analisadas pela imunohistoquímica, hibridização in situ e microscopia eletrônica. A média e desvio padrão das porcentagens de área ocupadas por antígenos de CP e de DNA do MP foram respectivamente de 6,21 +/- 5,41 e 2,27 +/- 2,06 nos focos de calcificação; 2,8 +/- 3,33 e 1,78+/- 3,063 nas áreas de fibrose ao redor e 0,21 +/- 0,17 e 0,12 +/- 0,13 nas regiões menos lesadas da válvula. Houve uma maior quantidade de CP e MP nos focos de calcificação e na fibrose ao redor do que nas regiões valvulares mais preservadas. Em conclusão, o fato de haver maior quantidade de CP e MP nos focos de calcificação da EVA favorece a hipótese de que a estenose aórtica não é um processo degenerativo inevitável devido a idade, mas sim uma resposta inflamatória à presença dessas bactérias, em uma morfologia semelhante à detectada na injúria aterosclerótica.Aortic Valve Stenosis (AVS) has been explained as an atherosclerotic process of the valve as they often exhibit inflammatory changes with infiltration of macrophages, T lymphocytes and lipid infiltration. The present study investigated whether the bacteria Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP), detected previously in atherosclerotic plaques, are also present in AVS. Ten valves surgically removed from patients with AVS were analyzed by immunohistochemistry, in situ hybridization, and electron microscopy. The mean and standard deviation of the percentage areas occupied by CP antigens and MP - DNA were respectively 6.21 +/- 5.41 and 2.27 +/- 2.06 in calcified foci; 2.8 +/- 3.33 and 1.78+/- 3.63 in surrounding fibrotic areas, and 0.21 +/- 0.17 and 0.12 +/- 0.13 in less injured parts of the valve. There was higher amount of CP and MP in the calcified foci and in the surrounded fibrosis than in more preserved valvular regions. In conclusion, the fact that there were greater amounts of CP and MP in calcification foci of AVS favors the hypothesis that AS is not an inevitable degenerative process due to aging, but rather that it may be a response to the presence of these bacteria, similarly to the morphology detected in atherosclerosis damage

The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients

Multicenter study of elderly patients in outpatient clinics of cardiology and geriatric brazilian institutions

OBJETIVO: Avaliar aspectos epidemiológicos, clínicos e terapêuticos de idosos com doenças cardiovasculares (DCV), no Brasil. MÉTODOS: Idosos com DCV, atendidos em 36 serviços de Cardiologia e Geriatria do Brasil, foram investigados através de questionário aplicado aos que tinham consulta marcada para o período analisado (um mês). RESULTADOS: Estudados 2196 idosos de 65 a 96 anos, sendo 60% mulheres e analisados os fatores de risco: sedentarismo (74%), pressão arterial (PA) elevada (53%), LDL colesterol aumentado (33%), colesterol total aumentado (30%), obesidade (30%), HDL-colesterol diminuído (15%), diabetes (13%) e tabagismo (6%). Observou-se maior prevalência nas mulheres, com três ou mais fatores de risco. O principal motivo de consulta foi a PA elevada (48%). Teste ergométrico e cinecoronariografia, foram mais solicitados para os homens. Os diagnósticos mais comuns foram hipertensão arterial sistêmica (HAS) (67%) e insuficiência coronária (ICo) (29%). Os medicamentos mais utilizados foram diuréticos (42%). CONCLUSÃO: Foi observada alta prevalência de fatores de risco (93%), principalmente nas mulheres; sedentarismo, como fator de risco mais freqüente, aumentando de prevalência com a idade; HAS, como principal motivo de consulta e diagnóstico; menor investigação e diagnóstico de ICo em mulheres; diuréticos, como os fármacos mais freqüentemente prescritos; insuficiência cardíaca como principal doença associada a internação (31%) e atendimento de emergência (10%). _________________________________________________________________________________________ ABSTRACT: PURPOSE: To evaluate epidemiological, clinical and therapeutic aspects of elderly patients with cardiovascular disease in Brazil. METHODS: Elderly patients with cardiovascular disease treated in 36 centers of cardiology and geriatrics were investigated through a questionnaire applied to those who had an appointment during the analyzed period . RESULTS: 2196 elderly patients ranging from 65 to 96 years of age were analyzed, 60% of which were females. The main risk factors were: sedentarism (74%); high blood pressure (53%), high LDL-cholesterol (33%), high total cholesterol (30%), obesity (30%), low HDL-cholesterol (15%), diabetes (13%) and smoking (6%). A higher prevalence of females existed among those with > 3 risk factors. The main reason for the medical appointment was high blood pressure (48%). Stress test and coronariography were requested more often in males. The most common diagnoses were hypertension (67%), and coronary disease (29%). The most often used medications were diuretics (42%). CONCLUSION: There was high prevalence of risk factors (93%), mainly in females; sedentarism was the most common risk factor and prevalence increased with age; hypertension was the most common reason for a medical appointment . Diuretics were the most used drugs; congestive heart failure was the main disease associated to hospitalization (31%) and emergencies (10%)

II Diretrizes em Cardiogeriatria da Sociedade Brasileira de Cardiologia

O diagnóstico e tratamento de pacientes idosos com doença cardiovascular apresentam distinções importantes em relação aos pacientes adultos não idosos. A anamnese pode ser dificultada por diminuição de sensibilidade dolorosa, déficit de memória e de audição, dificultando a compreensão das questões formuladas pelo médico, com menor precisão das informações e consequente erro diagnóstico. A omissão ou desvalorização ou hipervalorização dos sintomas contribuem para aumentar essas dificuldades. Além disso, o exame físico pode confundir. A estase jugular, característica de ICC, pode ser ocasionada por vasos tortuosos e ateroscleróticos ou por compressão venosa pelo arco aórtico alongado. Estertores pulmonares podem ser ocasionados por atelectasia ou doença pulmonar obstrutiva crônica; a hepatomegalia, por diafragma rebaixado secundário à doença pulmonar obstrutiva crônica; e o edema, por insuficiência venosa, ação gravitacional ou compressão extrínseca por tumor. O tratamento deve ser conduzido com cuidado. As transformações que ocorrem com o envelhecimento modificam a farmacocinética e a farmacodinâmica dos fármacos, com alterações em sua distribuição, metabolização e eliminação, além de repercutirem em sua ação e efeito no organismo do idoso. Esses fatos demandam adequação das doses dos medicamentos. A presença de comorbidades e aparecimento das doenças degenerativas associada ao processo de envelhecimento levam ao uso de maior número de fármacos e, consequentemente, de interações medicamentosas, exigindo atenção na prescrição terapêutica

I Diretrizes do Grupo de Estudos em Cardiogeriatria da Sociedade Brasileira de Cardiologia

O idoso apresenta características próprias na manifestação das doenças, na resposta à terapêutica e no efeito colateral dos medicamentos. Constitui um grupo de maior risco para o aparecimento das doenças degenerativas, em geral, e cardiovasculares, em particular, além de apresentar maior número de comorbidades