HIPERDIA

HIPERDIA
Hiperdia

Estive em Brasília numa reunião da Coordenadoria Nacional de Hpipertensão e Diabete, sob comando da Dra. Rosa Sampaio Vila-Nova, assessorada pelo Dr. Reginaldo Hollanda Albuquerque, entre vários realizações interessantes fiquei conhecendo o Programa HIPERDIA, para o registro e controle de hipertensos e diabéticos no Brasil, a partir da rede básica.
Foi implantado em 2002 pelo Dr Carlos Alberto Machado [carlos.a.machado@uol.com.br] que lá estava também presente.
São já 3 milhões e cem mill hipertensos cadastrados e 843 mil diabéticos.
Este é um programa que vale a pena ser conhecido, divulgado, aperfeiçoado e utilizado.
Se é que existem, não devem ser muitos os registros desta magnitude pelo mundo.
Alguns documentos básicos do projeto podem ser obtidos através do endereço acima, bem como outros documentos Dr. Carlos Alberto, mutio gentilmente me enviou e ficam a disposição de quem os solicitar.

As doenças do aparelho circulatório representam um importante problema de saúde pública em nosso país. Há algumas décadas são a primeira causa de morte no Brasil, segundo registros oficiais. Em 2000, corresponderam a mais de 27% do total de óbitos, ou seja, neste ano 255.585 pessoas morreram em conseqüência de doenças do aparelho circulatório.
A hipertensão arterial e o diabetes mellitus constituem os principais fatores de risco para as doenças do aparelho circulatório. Entre suas complicações mais freqüentes decorrentes encontram-se o infarto agudo do miocárdio, o acidente vascular cerebral, a insuficiência renal crônica, a insuficiência Cardíaca, as amputações de pés e pernas, a cegueira definitiva, os abortos e as mortes perinatais.

No SUS, as doenças cardiovasculares são responsáveis por 1.150.000 das internações/ano, com um custo aproximado de 475 milhões de reais, sendo que nestes números não estão inclusos os gastos com procedimentos de alta complexidade.

A identificação precoce dos casos e o estabelecimento do vínculo entre os portadores e as unidades básicas de saúde são elementos imprescindíveis para o sucesso do controle desses agravos. O acompanhamento e o controle da hipertensão arterial e do diabetes mellitus no âmbito da atenção básica poderá evitar o surgimento e a progressão das complicações, reduzindo o número de internações hospitalares, bem como a mortalidade devido a esses agravos.

O Ministério da Saúde, com o propósito de reduzir a morbimortalidade associada a essas doenças, assumiu o compromisso de executar ações em parceria com estados, municípios e Sociedade Brasileiras de Cardiologia, hipertensão, Nefrologia e Diabetes, Federações Nacionais de Portadores de hipertensão arterial e Diabetes, Conass e Conasems para apoiar a reorganização da rede de saúde, com melhoria da atenção aos portadores dessas patologias através do Plano de Reorganização da Atenção à Hipertensão Arterial e ao Diabetes Mellitus.

Nesta perspectiva, muitas ações estão sendo desenvolvidas no país. Uma delas é a disponibilização para estados e municípios de um sistema informatizado que permite o cadastramento de portadores, o seu acompanhamento, a garantia do recebimento dos medicamentos prescritos, ao mesmo tempo que, a médio prazo, poderá ser definido o perfil epidemiológico desta população, e o conseqüente desencadeamento de estratégias de saúde pública que levarão à modificação do quadro atual, a melhoria da qualidade de vida dessas pessoas e a redução do custo social.

O sistema informatizado permite cadastrar e acompanhar os portadores de hipertensão arterial e/ou diabetes mellitus, captados no Plano Nacional de Reorganização da Atenção à hipertensão arterial e ao Diabetes Mellitus, em todas as unidades ambulatoriais do Sistema Único de Saúde, gerando informações para os gerentes locais, gestores das secretarias municipais, estaduais e Ministério da Saúde.

O Sistema de cadastramento e acompanhamento dos portadores, Sistema HiperDia, é uma ferramenta útil para profissionais da rede básica e para gestores do SUS no enfrentamento destas doenças.

Drug for heart failure increases mortality -- Spurgeon 330 (7498): 981 -- BMJ

Drug for heart failure increases mortality -- Spurgeon 330 (7498): 981 -- BMJ: "Drug for heart failure increases mortality
David Spurgeon


Patients with heart failure who were treated with the drug nesiritide to help them survive a crisis were 80% more likely to die in the month after treatment than were patients who had received traditional drugs for symptoms of acute heart failure. This was the finding of a US study published last week in JAMA ( 2005;293: 1900-5)[Abstract/Free Full Text].

The drug's manufacturer Scios, which is part of Johnson & Johnson, released a statement a day after the JAMA study appeared, saying 'labelling has been revised to include an expanded analysis of the mortality rates seen in pivotal trials of the congestive heart failure agent."

Deaths linked to heart drugs - Sunday Times -

Deaths linked to heart drugs - Sunday Times - Times Online: "Deaths linked to heart drugs
(Recommended by Maria Inês Reinert Azambuja)
Lois Rogers, Medical Editor
EXPERTS are calling for a complete safety review of heart drugs taken by millions of Britons. Government figures released last week show that 92 deaths have been linked to the statin drugs developed to lower cholesterol.

It is believed that the death toll could be higher because doctors are reluctant to blame drugs they prescribe for harming patients.

More than 37 of the deaths were attributed to a formulation called simvastatin which is now being sold over the counter in low doses under the brand name Zocor.

Many specialists are concerned that the drug, produced by Merck, should be available without a prescription. A statin called Lipitor, made by Pfizer, was associated with 36 of the deaths."

What Is the Best Strategy for Reducing Deaths from Heart Disease?

PLoS Medicine: What Is the Best Strategy for Reducing Deaths from Heart Disease?: "What Is the Best Strategy for Reducing Deaths from Heart Disease?

Michael E. Makover, Shah Ebrahim

Background to the debate: Coronary artery disease is a major cause of death worldwide. Two very different approaches have been proposed as a way of reducing these deaths. The “high risk” approach uses tools such as risk factor scoring and carotid ultrasound to try and identify those at highest risk, and then treats them aggressively. The “population” approach aims to shift the distribution of risk factors across a population in a beneficial direction with the goal of reducing heart disease in the whole population."

Aortic wall thickeness in newborn & IU growth restriction

The Journal : Current Issue: "Much epidemiological evidence has linked low birthweight with late cardiovascular risk. We measured aortic wall thickness (a marker of early atherosclerosis) by ultrasonography in 25 newborn babies with intrauterine growth restriction and 25 with normal birthweight. Maximum aortic thicknesses were significantly higher in the babies with intrauterine growth restriction (810 um [SD 113]) than in those without (743 um [76], p=0.02), more so after adjustment for birthweight (300 um/kg [45] vs 199 um/kg [29], p<0.0001). Newborn babies with growth restriction have significant aortic thickening, suggesting that prenatal events might predispose to later cardiovascular risk."

Heart Statistics UK

Homepage: "

Welcome to the heartstats site

This is the British Heart Foundation's statistics website - the most comprehensive and up-to-date source of statistics on the burden, prevention, treatment and causes of heart disease in the UK.

We regularly update information on the site as new statistics become available.

Available to download are the British Heart Foundation's Statistics publications, including the compendium Coronary Heart Disease Statistics. This is published annually, and contains a selection of key statistics available online.

If you have any comments or feedback, please get in touch."

Preventing cancer, cardiovascular disease, and diabetes

The Journal : Current Issue: "Preventing cancer, cardiovascular disease, and diabetes
Andrew G Renehan, Anthony Howell
Collectively, cardiovascular disease (including stroke), diabetes, and cancer account for over 60% of all deaths in the USA and UK, and are major burdens on health resources and costs (table).1-11 Traditionally, the approaches to prevention of these three broad disease groups have operated separately. But increasingly it is recognised that major risk factors--ie, smoking, obesity, and physical inactivity--are common to all three diseases, and that current prevention strategies fail to capitalise on existing knowledge. As trends in the prevalence rates of these risk factors increase in many countries, with few examples of them abating, there are potentially greater problems in the future.12 Two new initiatives--one in the USA,13 one in the UK14--now address these issues."

Global NCD InfoBase

-----Mensagem original-----
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Bonita, Ruth Beaglehole
Enviada em: quarta-feira, 20 de abril de 2005 10:35
Para: procor@usa.healthnet.org
Assunto: [ProCOR] Invitation to review your country level CVD risk factor data

Dear Colleagues,

You may remember the launch of SuRF Report 1 in May 2003 (see www.who.int/ncd_surveillance/infobase/en ). This report was based on the Global NCD InfoBase, a partnership with, and expansion of, the CVD InfoBase.

The InfoBase collates, in one place, all details on country specific data on 8 major risk factors including survey, source, and measure of the uncertainty around estimates of age specific prevalence and means.
Much progress has been made since then. In particular, using existing data, comparable country estimates have been made for mean blood pressure, overweight and obesity.

You are invited to visit the development web site
http://www.who.int/ncd_surveillance/infobase/web/NCDInfoBase/CountryProf
iles/ListCountries.aspx
to view the relevant pages for your particular country (or any with which you are familiar). Please provide feedback and comment to the manager of the WHO InfoBase, Dr K Strong (strongk@who.int ) on the following:

*Content (and confirmation that this is the best data for your country - ie most recent, nationally representative)
*Format and display
*Navigation

If you are having problems accessing the web, please send a message requesting a PDF of the files for the country of interest.

We are interested in your feedback, which is crucial to the overall quality and completeness.

Your efforts and time are recognised and appreciated.

With thanks
Ruth

Dr Ruth Bonita

Member of ProCOR International Advisory Council and Director, Surveillance
Office of the Assistant Director-General (ADGO)
Evidence for Information and Policy (EIP)
World Health Organization

WHO Global InfoBase: InfoBase Online

WHO Global InfoBase: InfoBase Online
InfoBase Online

The WHO Global InfoBase, and the SuRF report that comes from it, represent the first steps in building better quality NCD risk factor data by displaying the country-level data that currently exists. The next step is to use this data to develop estimates of national prevalence for each risk factor and Member State. Member States with national health statistics reporting systems (that include risk factor information) have already produced these estimates for their countries. For other countries with sub-national surveys, and sometimes more than one survey, a data harmonization process can be used.

The collection of NCD risk factor data is continuing in many countries and the InfoBase will need to reflect this new work as it becomes available. In fact, for those countries that have embarked on a STEPS survey, a method for direct transfer of aggregate, core risk factor data to the NCD InfoBase has been developed. The development of the NCD InfoBase is meant to support the process of data collection and to hold the collection in a central place. At the same time, the current collections need to be used to transform the data into a useful, comparative tool for advocacy, policy and research.

There are two different ways to search for information on the NCD InfoBase Online. The Country Profiles (hyperlink) search allows the user to define the country and risk factor of interest. This will return a list of all information in the database related to the chosen country and risk factor. A more refined search is available, the Advanced Search, (hyperlink) which allows users to refine the search to their specifications. Users can search by specific criteria related to their needs, such as selecting only national studies.

We are currently running a user feasibility study about our web site. If you would like to participate please email Linsey de Guzman (deguzmanl@who.int).

Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults, Gregg et al.

JAMA -- Abstract: Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults, April 20, 2005, Gregg et al. 293 (15): 1868:
"Results The prevalence of all risk factors except diabetes decreased over time across all BMI groups, with the greatest reductions observed among overweight and obese groups. Compared with obese persons in 1960-1962, obese persons in 1999-2000 had a 21-percentage-point lower prevalence of high cholesterol level (39% in 1960-1962 vs 18% in 1999-2000), an 18-percentage-point lower prevalence of high blood pressure (from 42% to 24%), and a 12-percentage-point lower smoking prevalence (from 32% to 20%). Survey x BMI group interaction terms indicated that compared with the first survey, the prevalence of high cholesterol in the fifth survey had fallen more in obese and overweight persons than in lean persons (P<.05). Survey x BMI changes in blood pressure and smoking were not statistically significant. Changes in risk factors were accompanied by increases in lipid-lowering and antihypertensive medication use, particularly among obese persons. Total diabetes prevalence was stable within BMI groups over time, as nonsignificant 1- to 2-percentage-point increases occurred between 1976-1980 and 1999-2000.

Conclusions Except for diabetes, CVD risk factors have declined considerably over the past 40 years in all BMI groups. Although obese persons still have higher risk factor levels than lean persons, the levels of these risk factors are much lower than in previous decades."

Metabolic Syndrome

The Journal : Current Issue
Robert H Eckel, Scott M Grundy, Paul Z Zimmet
(recommended by Maria Inês Reinert Azambuja)
Defining the metabolic syndrome
Prevalence
Relation to predictability of diabetes and cardiovascular disease
Mechanisms underlying the metabolic syndrome
Beyond insulin resistance
Management of metabolic syndrome

The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology seems to be largely attributable to insulin resistance with excessive flux of fatty acids implicated. A proinflammatory state probably contributes to the syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. The fundamental approach is weight reduction and increased physical activity; however, drug treatment could be appropriate for diabetes and cardiovascular disease risk reduction.

6th International Conference on Preventive Cardiology

World Heart Federation: "The Sixth International Conference on Preventive Cardiology (ICPC) is organized by the World Heart Federation through its Council of Epidemiology and Prevention (click on the image for more information)"

Overweight in Children and Adolescents: Pathophysiology, Consequences, Prevention, and Treatment -- Daniels et al. 111 (15): 1999 -- Circulation

Overweight in Children and Adolescents: Pathophysiology, Consequences, Prevention, and Treatment -- Daniels et al. 111 (15): 1999 -- Circulation: "The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns."

Epidemiology 2: Compared to what? Finding controls for case-control studies

The Journal : Current Issue: "Epidemiology 2: Compared to what? Finding controls for case-control studies"
Use of control (comparison) groups is a powerful research tool. In case-control studies, controls estimate the frequency of an exposure in the population under study. Controls can be taken from known or unknown study populations. A known group consists of a defined population observed over a period, such as passengers on a cruise ship. When the study group is known, a sample of the population can be used as controls. If no population roster exists, then techniques such as random-digit dialling can be used. Sometimes, however, the study group is unknown, for example, motor-vehicle crash victims brought to an emergency department, who may come from far away. In this situation, hospital controls, neighbourhood controls, and friend, associate, or relative controls can be used. In general, one well-selected control group is better than two or more. When the number of cases is small, the ratio of controls to cases can be raised to improve the ability to find important differences. Although no ideal control group exists, readers need to think carefully about how representative the controls are. Poor choice of controls can lead to both wrong results and possible medical harm.

Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience

The Journal : Current Issue: "Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study"

Reducing mortality in myocardial infarction -- Townend and Doshi 330 (7496): 856 -- BMJ

Reducing mortality in myocardial infarction -- Townend and Doshi 330 (7496): 856 -- BMJ: "Treatment in specialised angioplasty centres should follow rapid prehospital thrombolysis

Restoring blood flow promptly in an occluded coronary artery by either thrombolysis or angioplasty reduces mortality in myocardial infarction with ST elevation. With both treatments, the faster reperfusion is achieved, the greater the reduction in mortality.1 2 The relative merits of thrombolysis in hospital and angioplasty have recently been debated in this journal,3 4 but in most developed countries the debate is largely over. Meta-analysis of trials comparing the two treatments showed a reduction in reinfarction and stroke and a small reduction in mortality in favour of angioplasty. 5 Guidelines from the European Society of Cardiology now state that primary angioplasty is the preferred therapeutic option when it can be performed 'within 90 minutes after the first medical contact.'6

In the United Kingdom no special funding exists for primary angioplasty: thrombolysis in hospital remains the standard treatment. Things may be about to change, however. The Department of Health has earmarked 1m ($1.89m; {euro}1.46m) 'to pilot the possibility of providing a national 24/7 primary angioplasty service,' even though such a service would require enormous reorganisation of services and considerable additional investment. Patients with acute myocardial infarction would bypass their local hospitals and go to specialist centres providing a 24 hour angioplasty service. This proposal entails daunting logistical and financial challenges, and the prospect of large numbers of emergency procedures, many of them performed out of hours, raises questions about the quality of such a service."

Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of

American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of
Cardiovascular Care
John A. Spertus, MD, MPH, FACC; Kim A. Eagle, MD, FACC, FAHA; Harlan M. Krumholz, MD, FACC, FAHA; Kristi R. Mitchell, MPH; Sharon-Lise T. Normand, PhD, MSc, FACC; for the American College of Cardiology and the American Heart Association Task Force on Performance Measures Abstract—The ability to quantify the quality of cardiovascular care critically depends on the translation of recommendations for high-quality care into the measurement of that care. As payers and regulatory agencies increasingly seek to quantify healthcare quality, the implications of the measurement process on practicing physicians are likely to grow.
This statement describes the methodology by which the American College of Cardiology and the American Heart Association approach creating performance measures and evising techniques for quantifying those aspects of care thatdirectly reflect the quality of cardiovascular care. Methods for defining target populations, identifying dimensions of care, synthesizing the literature, and operationalizing the process of selecting measures are proposed. It is hoped that new sets of measures will be created through the implementation of this approach, and consequently, through the use of such measurement sets in the context of quality improvement efforts, the quality of cardiovascular care will improve.
(Circulation. 2005;111:1703-1712.)

Effects of Exercise and Stress Management

Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients With Ischemic Heart Disease A Randomized Controlled Trial
James A. Blumenthal, PhD et al.
JAMA, April 6, 2005—Vol 293, No. 13
Results Patients in the exercise and stress management groups had lower mean (SE)
BDI scores (exercise: 8.2 [0.6]; stress management: 8.2 [0.6]) vs usual care (10.1 [0.6]; P = .02); reduced distress by GHQ scores (exercise: 56.3 [0.9]; stress management: 56.8 [0.9]) vs usual care (53.6 [0.9]; P = .02); and smaller reductions in LVEF during mental stress testing (exercise: −0.54% [0.44%]; stress management: −0.34% [0.45%]) vs usual care (−1.69% [0.46%]; P = .03). Exercise and stress management were associated with lower mean (SE) WMA rating scores (exercise: 0.20 [0.07]; stress management: 0.10 [0.07]) in a subset of patients with significant stress-induced WMA at baseline vs usual care (0.36 [0.07]; P = .02). Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation (exercise: mean [SD], 5.6% [0.45%]; stress management: 5.2% [0.47%]) vs usual care patients (4.1% [0.48%]; P = .03). In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity (8.2 [0.8] ms/mm Hg) vs usual care (5.1 [0.9] ms/mm Hg; P = .02) and significant increases in heart rate variability (193.7 [19.6] ms) vs usual care (132.1 [21.5] ms; P = .04).
Conclusion For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.
JAMA. 2005;293:1626-1634 www.jama.com

Aspirin more effective than warfarin for some patients ...

AMNews: April 18, 2005. Aspirin more effective than warfarin for some patients ... American Medical News: "Aspirin more effective than warfarin for some patients
A new clinical trial concludes that aspirin is the preferred treatment for intracranial stenosis, although warfarin is still the top choice for certain stroke-related conditions.

By Susan J. Landers, AMNews staff. April 18, 2005.

Washington -- A new study comparing treatments to reduce the risk of stroke due to blockage of the brain's arteries may tip the balance toward using aspirin and away from the more expensive and complex warfarin regimen.

Results of a double-blind, randomized clinical trial published in the March 31 New England Journal of Medicine found that aspirin is safer than warfarin and just as effective for treating intracranial stenosis.

ACC/AHA/HRS Key Data Elements and Definitions for Electrophysiological Studies and Procedures A Report of the American College of Cardiology Task Forc

EPDataStandardsPublicCommentVersion.pdf (application/pdf Object)

2005 Evidence Evaluation Worksheets in Resuscitation

C2005 Evidence Evaluation Worksheets
International Liaison Committee on Resuscitation 2005 Consensus on ECC & CPR Science and Treatment Recommendations

Instruction: To view the ILCOR worksheets, select one of the disciplines and click on the link.

Readers are cautioned that the information contained in each worksheet is preliminary and does not represent any task force or resuscitation council recommendation. more

Basic Life Support (BLS)

Basic Life Support (BLS): "This is a complete list of topics that were reviewed during the C2005 conference. Worksheets that have completed the review process are linked below. Please check back often as additional links become available.

Readers are cautioned that additional new science published after Jan. 2005 is not included as the worksheets will not be updated once the conference is completed"

Type 2 diabetes: principles of pathogenesis and therapy

pdfdownload (application/pdf Object)
Michael Stumvoll, Barry J Goldstein, Timon W van Haeften
(Referred by Maria Inês Reinert Azambuja)
Type 2 diabetes mellitus has become an epidemic, and virtually no physician is without patients who have the disease. Whereas insulin insensitivity is an early phenomenon partly related to obesity, pancreas beta-cell function declines gradually over time already before the onset of clinical hyperglycaemia. Several mechanisms have been proposed, including increased non-esterified fatty acids, inflammatory cytokines, adipokines, and mitochondrial dysfunction for insulin resistance, and glucotoxicity, lipotoxicity, and amyloid formation for beta-cell dysfunction.
Moreover, the disease has a strong genetic component, but only a handful of genes have been identified so far: genes for calpain 10, potassium inward-rectifier 6.2, peroxisome proliferator-activated receptor gama insulin receptor substrate-1, and others. Management includes not only diet and exercise, but also combinations of antihyperglycaemic drug treatment with lipid-lowering, antihypertensive, and anti platelet therapy.

Misleading use of risk ratios

The Journal : Current Issue
Bruce V Stadel, Eric Colman, Todd Sahlroot
Risk ratios are widely misused in ways that exaggerate both the benefits and harms of drugs. This is especially true when a risk ratio is called "relative risk".

Relative risk does not measure "risk" at all, because risk has dimensions, such as observed deaths per 100 or 1000 people. However, a risk ratio has no dimensions because they cancel in calculating the ratio. Thus, if a drug changes risk from two deaths per 100 people to one death per 100 people, the risk ratio (0·5) is the same as if the drug changes risk from two deaths per 1000 people to one death per 1000 people. It is wrong to call these changes a "50% decreased risk"--the change from two deaths per 100 people to one death per 100 people is a 1% decreased risk, and the change from two deaths per 1000 people to one death per 1000 people is a 0·1% decreased risk.

Cardiovascular risk assessment

The Journal : Current Issue
In their article in your Treating Individuals Series on the usefulness of cardiovascular risk calculators, Rod Jackson and colleagues (Jan 29, p 434)1 make some interesting points about cardiovascular risk estimation. However, they underestimate the effects of the number of parameters used and of biological variation.

Novel Device for High Blood Pressure Implanted -

Novel Device for High Blood Pressure Implanted - MedGadget - www.medgadget.com
(referred by Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com])
WROC-TV 8 in Rochester, NY reports that 36 year old Annette Lawrence of Rochester has made history yesterday when she became the first patient in the world to be implanted with the Rheos Baroreflex Hypertension System. The system, designed for treatment of drug refractory hypertension, works through the activation of baroreceptors--"pressure sensors" located inside the carotid sinus that are partially responsible for blood pressure regulation.

American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Q

American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of Cardiovascular Care -- Spertus et al. 111 (13): 1703 -- Circulation
The ability to quantify the quality of cardiovascular care critically depends on the translation of recommendations for high-quality care into the measurement of that care. As payers and regulatory agencies increasingly seek to quantify healthcare quality, the implications of the measurement process on practicing physicians are likely to grow. This statement describes the methodology by which the American College of Cardiology and the American Heart Association approach creating performance measures and devising techniques for quantifying those aspects of care that directly reflect the quality of cardiovascular care. Methods for defining target populations, identifying dimensions of care, synthesizing the literature, and operationalizing the process of selecting measures are proposed. It is hoped that new sets of measures will be created through the implementation of this approach, and consequently, through the use of such measurement sets in the context of quality improvement efforts, the quality of cardiovascular care will improve.

IV Congresso Brasileiro de Insuficiência Cardíaca

23 a 25 de Junho 2005 em GRAMADO RS
Presidente a AMICOR NADINE CLAUSELL
Esta é uma das áreas mais sensíveis da Cardiologia atual: Controvérsias, novos conceitos, novos recursos de diagnóstico e tratamento com drogas e equipamentos, e novas confusões...
A Nadine promete sacudir o assunto. Vale a pena considerar uma visita a Gramado, bem no início do inverno.

Reporting of trial outcomes is incomplete and biased

The medical literature represents a selective and biased subset of study outcomes. Chan and Altman (p 753) analysed all journal articles of randomised trials indexed in PubMed whose primary publication occurred in December 2000. They identified unreported outcomes as those mentioned in the methods but not the results and also by asking authors. In 519 trials with 553 publications and 10 557 reported outcomes, over 20% of the measured outcomes were incompletely reported, and non-reporting was associated with statistical non-significance. Non-significant outcomes of both efficacy and harm were, on average, twice as likely not to be fully reported than were statistically significant outcomes. Protocols of trials should be made publicly available, the authors say.

Relative Contributions of Genes, Environment, and Interactions to Blood Lipid Concentrations in a General Adult Population -- Costanza et al. 161 (8):

Relative Contributions of Genes, Environment, and Interactions to Blood Lipid Concentrations in a General Adult Population -- Costanza et al. 161 (8): 714 -- American Journal of Epidemiology
(Referred by Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
The authors evaluated the contributions of nine genetic (G) variants (selected from 275 single nucleotide polymorphisms in 11 reverse cholesterol transport pathway genes), five environmental (E) factors (selected from 10), and G x G, E x E, and G x E interactions in explaining population variance of blood lipid concentrations. Total cholesterol, triglycerides, and high density lipoprotein (HDL) cholesterol were measured, and low density lipoprotein (LDL) cholesterol and HDL cholesterol/LDL cholesterol ratio were calculated in a population-based random sample of 1,543 men and women in Geneva, Switzerland, aged 35–74 years in 1999–2001. Explained variances (R2) for HDL cholesterol/LDL cholesterol ratio, HDL cholesterol, and LDL cholesterol, respectively, were 34%, 33%, and 19%, decomposed into main effects of G (6%, 4%, and 5%) and E (25%, 28%, and 11%), with just 3%, 2%, and 3% due to G x G, E x E, and G x E interactions, respectively. Risk factor clustering was only moderate: 70% of study subjects had 3 variants, 75% had 2 environmental exposures, and 69% had 5 of both types of factors. Multiple genes with weak associations, together with more dominating environmental factors, are involved in determining blood lipid concentrations. Interactions added little explained variance. Increasing trends in hypercholesterolemia are attributable to environmental changes affecting populations as a whole. Reducing obesity and smoking and moderating alcohol intake in entire opulations should remain the primary strategies for lipid control.