Insulin resistance and triglyceride/HDLc index are associated with coronary artery disease

<p>Abstract</p> <p>Background</p> <p>Insulin-resistance is associated with cardiovascular disease but it is not used as a marker for disease in clinical practice.</p> <p>Aims</p> <p>To study the association between the homeostatic model assessment (HOMA-IR) and triglyceride/HDLc ratio (TG/HDLc) with the presence of coronary artery disease in patients submitted to cardiac catheterization.</p> <p>Methods</p> <p>In a cross-sectional study, 131 patients (57.0 ± 10 years-old, 51.5% men) underwent clinical, laboratory and angiographic evaluation and were classified as No CAD (absence of coronary artery disease) or CAD (stenosis of more than 30% in at least one major coronary artery).</p> <p>Results</p> <p>Prevalence of coronary artery disease was 56.7%. HOMA-IR and TG/HDLc index were higher in the CAD <it>vs </it>No CAD group, respectively: HOMA-IR: 3.19 (1.70-5.62) vs. 2.33 (1.44-4.06), p = 0.015 and TG/HDLc: 3.20 (2.38-5.59) vs. 2.80 (1.98-4.59) p = 0.045) - median (p25-75). After a ROC curve analysis, cut-off values were selected based on the best positive predictive value for each variable: HOMA-IR = 6.0, TG/HDLc = 8.5 and [HOMA-IR×TG/HDLc] = 28. Positive predictive value for coronary artery disease for HOMA-IR>6.0 was 82.6%, for TG/HDLc>8.5 was 85.7% and for [HOMA-IR×TG/HDLc]>28 was 88.0%. Adjusted relative risk (age, gender, diabetes, body mass index, systolic blood pressure) for the presence of coronary artery disease was: for HOMA-IR>6.0, 1.47 (95.CI: 1.06-2.04, p = 0.027), for TG/HDLc>8.5, 1.46 (95% CI:1.07-1.98), p = 0.015) and for [HOMA-IR × TG/HDLc] >28, 1.64 (95%CI: 1.28-2.09), p < 0.001).</p> <p>Conclusions</p> <p>Increased HOMA-IR, TG/HDLc and their product are positively associated with angiographic coronary artery disease, and may be useful for risk stratification as a high-specificity test for coronary artery disease.</p

Subclavian Access for Transcatheter CoreValve® Aortic Prosthesis Implantation: Data from the Brazilian Registry

ABSTRACTBackgroundTransfemoral access is the preferred approach for transcatheter aortic valve implantation. However, some situations, such as the presence of peripheral vascular disease, preclude the use of such access. In these cases, subclavian access is an alternative approach for this procedure. This study aimed at evaluating the Brazilian experience using the subclavian approach for transcatheter CoreValve® prosthesis implantation.MethodsAortic valve area<1cm2, aortic valve ring≥20mm and≤27mm (26mm and 29mm CoreValve®), ascending aorta≤43mm and subclavian artery with a diameter≥6mm, without significant obstructive lesions, marked tortuosity and excess calcification were requisites for the procedure. The access through the subclavian artery was obtained by surgical dissection and, under direct vision, a subclavian artery puncture was performed. Once artery access was obtained, the standard technique was used.ResultsBetween January 2008 and April 2012, 8 patients with peripheral vascular disease underwent CoreValve® prosthesis implantation through the subclavian artery in 4 institutions. The procedure was successful in all cases with reduction of the mean transvalvular pressure gradient from 46.4±17.5mmHg to 9.3±3.6mmHg (P=0.0018) and improvement of symptoms. At 30 days and after 275±231 days of follow-up, 87.5% and 62.5% of the patients, respectively, were free from major adverse events (death, myocardial infarction, stroke and urgent cardiac suregery).ConclusionsIn the Brazilian experience, the subclavian access was a safe and effective alternative for transcatheter CoreValve® implantation

POLAR registry (Promus eluting stent registry in Latin America ):1 year follow-up results

BACKGROUND: Drug-eluting stents have been used since 2002 in different patient populations aiming to achieve high success rates with low clinical and angiographic restenosis rates. With the late thrombosis adverse events associated to the first generation sirolimus and paclitaxel-eluting stents, second-generation everolimus and zotarolimus-eluting stents has been recently developed. METHODS: The POLAR registry is a prospective, non-randomized, multicenter study, which included 988 patients, totaling 1,362 lesions treated with the everolimus-eluting stent Promus®. In order to represent the clinical practice, almost all subtypes of patients and lesions were included in this registry. Clinical follow-up was planned to be performed 1, 6, 12 and 24 months after the procedure. RESULTS: Most patients were male (69.8%), with mean age of 64.9 ± 9.4 years, 35.2% were diabetics and 55% had been treated for acute coronary syndrome. Vessel diameter was 2.95 ± 0.43 mm and lesion extension was 20.5 ± 5.6 mm. A total of 1.14 ± 0.38 stent/patient were implanted and the procedural success rate was 96.6%. Major adverse cardiac events occurred in 4.5% of patients, and stent thrombosis was observed in 5 patients (0.5%) after a clinical follow-up of 12 months. CONCLUSIONS: The present registry suggests that everolimus-eluting stents are safe and effective in daily clinical practice patients, with a low rate of major adverse cardiac events at the end of the first year of follow-up.INTRODUÇÃO: Desde 2002, os stents farmacológicos são utilizados em diversas populações de pacientes objetivando alcançar elevados índices de sucesso, com baixas taxas de reestenose angiográfica e clínica. Com os resultados adversos em relação à trombose tardia associados aos stents farmacológicos de primeira geração eluidores de sirolimus e paclitaxel, surgiram recentemente os stents farmacológicos de segunda geração eluidores de zotarolimus e everolimus. MÉTODOS: O registro POLAR é um registro prospectivo, não-randomizado, multicêntrico, que incluiu 988 pacientes totalizando 1.362 lesões tratadas com o stent Promus®. Objetivando representar a prática clínica, praticamente todos os subtipos de pacientes e lesões foram incluídos neste registro. O seguimento clínico foi planejado para ser realizado 1 mês, 6 meses, 12 meses e 24 meses após o procedimento. RESULTADOS: A maioria dos pacientes era do sexo masculino (69,8%), com média de idade de 64,9 ± 9,4 anos, 35,2% eram diabéticos e 55% tinham sido tratados na vigência de síndrome coronária aguda. O diâmetro do vaso foi de 2,95 ± 0,43 mm e a extensão da lesão, de 20,5 ± 5,6 mm. Foi implantado 1,14 ± 0,38 stent/paciente e o sucesso do procedimento foi alcançado em 96,6% dos casos. Eventos cardíacos adversos maiores ocorreram em 4,1% dos pacientes, e trombose de stent esteve presente em 5 pacientes (0,5%) após o seguimento clínico de 12 meses. CONCLUSÕES: O presente registro sugere que os stents farmacológicos eluidores de everolimus são seguros e eficazes em pacientes da prática clínica diária, com baixas taxas de eventos cardíacos adversos maiores ao término do primeiro ano de seguimento.Universidade Federal de São Paulo (UNIFESP)Instituto Dante Pazzanese de CardiologiaStatus CorHospital Israelita Albert EinsteinENCORE Hospital Lúcio RebeloReal e Benemérita Associação Portuguesa de BeneficênciaHospital Cardiológico CostantiniHemodinâmica Meridional Intercath MeridionalInstituto de Cardiologia do Espírito SantoFundação Universitária de Cardiologia Instituto de Cardiologia do Rio Grande do SulUNIFESPSciEL

'Correction:' Serum transforming growth factor beta-1 (TGF-beta-1) levels in diabetic patients are not associated with pre-existent coronary artery disease

<p>Abstract</p> <p>Background</p> <p>The association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial. No study specifically addressed patients with CAD and diabetes mellitus (DM). The association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial. No study specifically addressed patients with CAD and diabetes mellitus (DM).</p> <p>Methods</p> <p>Patients (n = 135, 30–80 years) referred for coronary angiography were submitted to clinical and laboratory evaluation, and the coronary angiograms were evaluated by two operators blinded to clinical characteristics. CAD was defined as the presence of a 70% stenosis in one major coronary artery, and DM was characterized as a fasting glycemia > 126 mg/dl or known diabetics (personal history of diabetes or previous use of anti-hyperglycemic drugs or insulin). Based on these criteria, study patients were classified into four groups: no DM and no CAD (controls, C n = 61), DM without CAD (D n = 23), CAD without DM (C-CAD n = 28), and CAD with DM (D-CAD n = 23). Baseline differences between the 4 groups were evaluated by the χ²test for trend (categorical variables) and by ANOVA (continuous variables, post-hoc Tukey). Patients were then followed-up during two years for the occurrence of MACE (cardiac death, stroke, myocardial infarction or myocardial revascularization). The association of candidate variables with the occurrence of 2-year MACE was assessed by univariate analysis.</p> <p>Results</p> <p>The mean age was 58.2 ± 0.9 years, and 51% were men. Patients with CAD had a higher mean age (p = 0.011) and a higher percentage were male (p = 0.040). There were no significant baseline differences between the 4 groups regarding hypertension, smoking status, blood pressure levels, lipid levels or inflammatory markers. TGF-β1 was similar between patients with or without CAD or DM (35.1 ×/÷ 1.3, 33.6 ×/÷ 1.6, 33.9 ×/÷ 1.4 and 31.8 ×/÷ 1.4 ng/ml in C, D, C-CAD and D-CAD, respectively, p = 0.547). In the 2-year follow-ip, independent predictors of 2-year MACE were age (p = 0.007), C-reactive protein (p = 0.048) and systolic blood pressure (p = 0.008), but not TGF-β1.</p> <p>Conclusion</p> <p>Serum TGF-β1 was not associated with CAD or MACE occurrence in patients with or without DM.</p

Tuberculose pulmonar: perfil epidemiológico do sertão Pernambucano, Brasil / Pulmonary tuberculosis: epidemiological profile of sertão Pernambucano, Brazil

Atualmente, observa-se que a tuberculose pulmonar constitui um importante problema de Saúde Pública no mundo, uma vez que esse agravo apresentou, em 2015, 10,4 milhões de casos, dos quais, mais de um milhão de pessoas vieram a óbito. Sob essa perspectiva, o presente artigo tem como objetivo traçar um perfil epidemiológico dos casos de Tuberculose Pulmonar notificados no município de Serra Talhada, entre os anos de 2007 a 2017. Foi realizado um estudo de série histórica observacional do tipo transversal, no intervalo de tempo de 2007 a 2017.  No período investigado o número de casos de tuberculose pulmonar foi de 246 casos, o local que teve a maior prevalência foi Serra Talhada, 287 por 100 mil habitantes. Diante dos dados apresentados, é imprescindível concluir, portanto, que esse estudo corrobora o perfil epidemiológico brasileiro para a Tuberculose Pulmonar, o qual indica variabilidade nos índices de acometimento durante o período analisado