What is the deadliest disease in the world?

WHO | What is the deadliest disease in the world?
Q: What is the deadliest disease in the world?

A: The results of ranking the leading causes of death are subject to the cause categories used. The broader the cause categories used, the more likely they will rank among the top leading causes of death.

According to the estimates in The world health report 2004, there were 57 million deaths in the world in 2002. The broad category of all "noncommunicable diseases" killed 33.5 million people; communicable diseases, maternal and perinatal conditions, and nutritional conditions killed 18.3 million people worldwide; and external causes of injuries killed 5.2 million people.

When analysing at disaggregated level, the following are the leading causes of death:

Pathophysiology of Coronary Artery Disease -- Libby and Theroux 111 (25): 3481 -- Circulation

Pathophysiology of Coronary Artery Disease -- Libby and Theroux 111 (25): 3481 -- Circulation:
(Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]

"During the past decade, our understanding of the pathophysiology of coronary artery disease (CAD) has undergone a remarkable evolution. We review here how these advances have altered our concepts of and clinical approaches to both the chronic and acute phases of CAD. Previously considered a cholesterol storage disease, we currently view atherosclerosis as an inflammatory disorder. The appreciation of arterial remodeling (compensatory enlargement) has expanded attention beyond stenoses evident by angiography to encompass the biology of nonstenotic plaques. Revascularization effectively relieves ischemia, but we now recognize the need to attend to nonobstructive lesions as well. Aggressive management of modifiable risk factors reduces cardiovascular events and should accompany appropriate revascularization. We now recognize that disruption of plaques that may not produce critical stenoses causes many acute coronary syndromes (ACS). The disrupted plaque represents a 'solid-state' stimulus to thrombosis. Alterations in circulating prothrombotic or antifibrinolytic mediators in the 'fluid phase' of the blood can also predispose toward ACS. Recent results have established the multiplicity of 'high-risk' plaques and the widespread nature of inflammation in patients prone to develop ACS. These findings challenge our traditional view of coronary atherosclerosis as a segmental or localized disease. Thus, treatment of ACS should involve 2 overlapping phases: first, addressing the culprit lesion, and second, aiming at rapid 'stabilization' of other plaques that may produce recurrent events. The concept of 'interventional cardiology' must expand beyond mechanical revascularization to embrace preventive interventions that forestall future events.

"

Most Doctors Favor Annual Check-Ups, Evidence Notwithstanding -

Most Doctors Favor Annual Check-Ups, Evidence Notwithstanding - CME Teaching Brief - MedPage Today

# Understand the limitations of the annual physical examination and the reasons that national guidelines currently recommend against their routine practice.

# Consider the potential value of the annual physical exam as a means of strengthening the physician-patient bond.

Thresholds for normal blood pressure and serum cholesterol -- Westin and Heath 330 (7506): 1461 -- BMJ

Thresholds for normal blood pressure and serum cholesterol -- Westin and Heath 330 (7506): 1461 -- BMJ

Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: segunda-feira, 27 de junho de 2005 17:18
Assunto: Thresholds for normal blood pressure and serum cholesterol
BMJ 2005;330:1461-1462
Thresholds for normal blood pressure and serum cholesterol Lower thresholds mean that 90% of people over 50 years are identified as patients

WMA: recognition of the essential role of health professionals in tobacco control

WMA - Policy:
"WMA Council Resolution on implementation of the WHO Framework Convention on tobacco control
De: Dr. Ronald Davis [mailto:davis@globalink.org]
Enviada em: segunda-feira, 27 de junho de 2005 12:45
Assunto: WMA urges natl medical associations to support FCTC
At its meeting last month, the World Medical Association, a consortium of approximately 80 National Medical Associations, adopted the policy copied below regarding the FCTC.
Best wishes,
Ron Davis

http://www.wma.net/e/policy/cr_4.htm

Adopted at the 170th WMA Council Session, Divonne-les-Bains, France, 15 May 2005

The World Medical Association Welcomes the recognition of the essential role of health professionals in tobacco control as the focus of World No Tobacco Day, 31 May 2005;
Recognises the importance of the WHO Framework Convention on Tobacco Control (FCTC) in furthering the campaign to protect people from exposure and addiction to tobacco;
Encourages national medical associations to work assiduously and energetically to get their governments to ratify and implement the FCTC;
Urges governments to introduce regulation and other measures as set out in the FCTC. Governments should also introduce a ban on smoking in enclosed public places and work places as an urgent public health intervention;
Recognises the vital role of health professionals in public health education and in support for smoking cessation;
Commits, with the other members of the World Health Professions Alliance, to mobilise health professionals in the fight to implement the FCTC and to reduce the human cost of tobacco.

"

Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery? -- Jin et al. 111 (25): 3359 -- Circulation

Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery? -- Jin et al. 111 (25): 3359 -- Circulation
Body size is not a significant risk factor for CABG mortality, but the lowest mortality is found in the high-normal and overweight subgroups compared with obese and underweight.

Stroke epidemiology in Latin America

De: Ines Lessa [mailto:ines@lessa.org]
Enviada em: sábado, 25 de junho de 2005 17:11
Para: aloyzio.achutti
Assunto: Re: Stroke epidemiology in the developing world

Caro Dr. Achutti,
...............
Mandei e-mail para os autores que disseram não haver
qualquer informação sobre incidência de AVE na América Latina. Em 1983 o
meu foi publicado em ingles no PAHO Bulletin, embora descritivo, pois na
época as análises não eram sofisticadas como atualmente. Também existe
um estudo de incidência do AVE para a cidade de Joinville, publicado no
Brasil, mas em revista indexada. Foi um e-mail educado, só parabenizando
e dando a informação.
No proprio Lancet foi publicada uma carta que enviei, sobre os casos
encontrados de AVE por leptospirose(isso eu não referi). Esse meu
artigo foi usado por um pesquisador de Boston com mais 16 estudos com
metodologia semelhante em estudo de revisão (não foi metanálise) e
publicado. Depois que ele padronizou todos com uma mesma população
padrão, Salvador saiu com a maior incidência entre os países ocidentais.
Abraço,
Ines

Stroke epidemiology in the developing world

The Lancet
Feigin VL
One of the major problems of stroke epidemiology is the lack of good-quality epidemiological studies in developing countries. Despite over two-thirds of stroke deaths worldwide occurring in developing countries, there have been few population-based incidence studies of stroke in these populations, and none from Latin America.

A study of stroke incidence and outcomes by Pablo Lavados and colleagues in Iquique, Chile (the PISCIS Project), in today's Lancet helps to fill this gap in our knowledge. This is the first study of population-based incidence of stroke in Latin America that meets not only the standard1 but also the most rigorous criteria for an ideal study of stroke incidence.2 Completeness of case ascertainment with multiple overlapping sources of information in a relatively large study area, a high level of early verification of stroke subtypes by CT (91%), and comprehensiveness of the report are impressive and leave no doubts about the methodological soundness of the study. The key findings are that stroke outcomes and incidence rates in the predominantly Hispanic-Mestizo population of Iquique are similar to incidence rates in other populations, but the proportion of intracerebral haemorrhage was somewhat higher.

CARDIOLOGISTAS DE TODO O BRASIL CONSTERNADOS PELA MORTE DE EDSON SAAD

Sócios: Notícias
(Fonte ABC)
O falecimento, no dia 3 de junho, do professor Edson A. Saad, sensibilizou os cardiologistas do Brasil inteiro, muitos dos quais se iniciaram na profissão através dos seus ensinamentos. A SBC convida a todos para a missa de sétimo dia, que será celebrada nesta sexta-feira, 10 de junho, às 18 horas, na igreja de São José, à avenida Borges de Medeiros, 2.735, na lagoa Rodrigo de Freitas.

Saad, que nasceu em Igarapava, no Estado de São Paulo, prestou inestimáveis serviços à SBC, principalmente no setor da Educação Continuada, e seus artigos sobre hipertensão arterial e aterosclerose, sempre muito didáticos, ajudaram o desenvolvimento de centenas de cardiologistas.

Professor de duas Universidades, a Federal do Rio de Janeiro e a UFF, de Niterói, Edson Saad era membro da Academia Nacional de Medicina.

Casado com d. Mônica Benchimol Saad há quase 43 anos, deixa três filhos, um dos quais, Eduardo, seguiu os passos do pai e tornou-se cardiologista, especializando-se em arritmias. Edson Saad deixa também oito netos.

PLAC Test – The Test for Lp-PLA2 – Website

PLAC Test – The Test for Lp-PLA2 – Website
Focus on Prevention

The PLACTM test can help physicians identify patients at high risk for ischemic stroke or coronary heart disease. When used in conjunction with clinical evaluation and traditional risk assessment, the PLAC test can provide more accurate ischemic stroke and cardiac risk estimates to aid in determining the most appropriate treatment strategies to prevent stroke and heart disease.
The PLAC Test Advances Stroke and CHD Prevention

* The PLAC test is the only FDA-cleared blood test to aid in determining the risk for ischemic stroke associated with atherosclerosis
* Elevated Lp-PLA2 doubles an individual's risk of experiencing an ischemic stroke or coronary event, independent of traditional risk factors
* Lp-PLA2 is additive to blood pressure in predicting future incident ischemic stroke
* Major clinical studies have shown Lp-PLA2 to be highly predictive of cardiovascular risk
* The PLAC test provides accurate, reliable results that you can trust to identify your patients who may be at an elevated risk for a future ischemic stroke or coronary event

With a clear picture of your patient's cardiovascular risk, you can more accurately determine what type of goals and treatment programs your patient will need to minimize the risk of having a major cardiovascular event.

The Lancet call for papers on the global burden of chronic diseases

Greetings,
The June 4 issue of The Lancet issued a call for papers on the global burden of chronic diseases (see "Comment" reprinted below). I invite members of the ProCOR network to submit original research papers on the following
themes:
--Consequences of the unchecked increase in chronic disease for individuals and societies. --The case for urgent national and global action to prevent and control the rising burden of chronic disease. --Effective and feasible interventions within the context of an incremental, integrated approach to chronic disease prevention and control. --Work from China and India on their challenges and progress towards the prevention and control of chronic diseases.

I encourage members of the ProCOR network to submit contributions in order to strengthen this special series.

The deadline for submission of research articles is Aug 1, 2005. For more information visit www.thelancet.com or email editorial@thelancet.com

Richard Horton, Editor, The Lancet
Member, ProCOR International Advisory Council

---------------------------------
The Lancet
Volume 365, Issue 9475 , 4 June 2005-10 June 2005, Pages 1913-1914
Comment: Chronic diseases of adults-a call for papers

Robert Beaglehole (a), and Richard Horton (b)

(a)Chronic Diseases and Health Promotion, WHO, CH-1211 Geneva 27, Switzerland (b)The Lancet, London NW1 7BY, UK

This week The Lancet issues a call for papers on the global burden of chronic diseases. The Millennium Development Goals have rightly focused attention on the plight of the world's poorest children and mothers, and on select infectious disease epidemics. By contrast, chronic diseases-the leading cause of adult mortality in all regions of the world-are not yet on the international health agenda.

This year there will be about 60 million deaths worldwide. Approximately 35 million (60% of the total) will be due to chronic diseases of adults, principally heart disease, stroke, cancer, and diabetes. Approximately 16 million will occur in people younger than 70 years of age. These diseases are responsible for about 30% of the global burden of disease as measured by disability adjusted life years lost.

Many countries that have limited financial resources and poor health systems are facing an upsurge of chronic diseases. Four out of five chronic disease deaths occur in low-income and middle-income countries; one third of all cardiovascular disease deaths occur in India and China. Alarmingly, in transition countries such as Russia, chronic disease death rates are especially high in middle-aged people, causing major adverse consequences to the economies of families and societies.1

The chronic disease epidemics are driven by population ageing and social and environmental changes that increase the prevalence of common risk factors. Major initiatives are achieving some success in tobacco control, including the ratification of the WHO Framework Convention on Tobacco Control. The effects of these measures will be felt progressively, but for now, tobacco-induced epidemics are uncontrolled in most low-income and middle-income countries. The rapid transition in urbanising societies to diets that are high in fat, sugar, and salt, together with decreasing physical activity as the norm, have led to the global obesity pandemic. Obesity is driving the rapid rise in diabetes and may threaten future gains in life expectancy.2

To date, our response to these epidemics has been woefully inadequate. In several high-income countries, interventions have led to major improvements in the life expectancy and quality of life of middle-aged and older people. For example, death rates from coronary heart disease have fallen by up to 70% in the past three decades in Australia, New Zealand, the USA, and the UK. The challenge is to ensure that all populations, especially the most disadvantaged, benefit from effective preventive and treatment interventions.

The explanation for the global neglect of chronic disease is not straightforward but several misconceptions have contributed. Chronic diseases are held by some to be an unavoidable side-effect of social and economic development, diseases of affluence not warranting the attention of those seeking to provide aid to improve health. Others see them as the fault of individuals who make self-injurious choices, as though these were independent of society and entirely volitional. Yet others see chronic disease as an affliction of older men in high-income countries; and that the control of infectious disease epidemics should take priority in low-income and middle-income countries. All of these misconceptions can be rebutted with indisputable evidence-a third of deaths due to cardiovascular disease in the developing world occur in men and women of working age, mostly among the poor. They seriously distort the establishment of a balanced global health agenda.

The Lancet has commissioned a series of four papers on chronic diseases, to be published later this year. This series will demonstrate that the misconceptions we have described are not only fundamentally wrong but, if left unchecked, will produce dangerous results for individuals and societies alike. The series will make the case for urgent national and global action to prevent and control the rising burden of chronic disease and present a guide to effective and feasible interventions within the context of a stepwise, integrated approach to chronic disease prevention and control. In addition, this series will showcase work from China and India on their challenges and progress towards the prevention and control of chronic diseases.

We want to strengthen this series by publishing original research papers in each of the four issues devoted to the commissioned reviews. The deadline for submission of research articles is Aug 1, 2005.

We declare that we have no conflict of interest.
References
1 S Leeder, S Raymond and H Greenberg, A Race Against Time, Columbia University, New York (2004). 2 SJ Olshansky, DJ Passaro and RC Hershow et al., A potential decline in life expectancy on the United States in the 21st century, N Engl J Med 352 (2005), pp. 1138-45.

_____________________________________________________________________

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Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults -- Sutton-Tyrrell

Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults -- Sutton-Tyrrell et al., 10.1161/CIRCULATIONAHA.104.483628 -- Circulation: "Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults
Kim Sutton-Tyrrell DrPH*, Samer S. Najjar MD, Robert M. Boudreau PhD, Lakshmi Venkitachalam MPhil, Varant Kupelian MS, Eleanor M. Simonsick PhD, Richard Havlik MD, Edward G. Lakatta MD, Harold Spurgeon PhD, Stephen Kritchevsky MD, Marco Pahor MD, Douglas Bauer PhD, Anne Newman MD, for the Health ABC Study

From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (K.S.-T., R.M.B., L.V., V.K., A.N.); Gerontology Research Center (S.S.N., E.M.S., E.G.L., H.S.) and Laboratory of Epidemiology, Demography and Biometry (R.H.), National Institute on Aging, Bethesda, Md; University of Tennessee, Memphis (S.K.); Wake Forest University School of Medicine, Winston-Salem, NC (M.P.); and Prevention Sciences Group, University of California, San Francisco (D.B.).

* To whom correspondence should be addressed. E-mail: Tyrrell@edc.pitt.edu.

Background--Aging results in vascular stiffening and an increase in the velocity of the pressure wave as it travels down the aorta. Increased aortic pulse wave velocity (aPWV) has been associated with mortality in clinical but not general populations. The objective of this investigation was to determine whether aPWV is associated with total and cardiovascular (CV) mortality and CV events in a community-dwelling sample of older adults.

Methods and Results--aPWV was measured at baseline in 2488 participants from the Health, Aging and Body Composition (Health ABC) study. Vital status, cause of death and coronary heart disease (CHD), stroke, and congestive heart failure were determined from medical records. Over 4.6 years, 265 deaths occurred, 111 as a result of cardiovascular causes. There were 341 CHD events, 94 stroke events, and 181 cases of congestive heart failure. Results are presented by quartiles because of a threshold effect between the first and second aPWV quartiles. Higher aPWV was associated with both total mortality (relative risk, 1.5, 1.6, and 1.7 for aPWV quartiles 2, 3, and 4 versus 1; P=0.019) and cardiovascular mortality (relative risk, 2.1, 3.0, and 2.3 for quartiles 2, 3, and 4 versus 1; P=0.004). aPWV quartile was also significantly associated with CHD (P=0.007) and stroke (P=0.001). These associations remained after adjustment for age, gender, race, systolic blood pressure, known CV disease, and other variables related to events.

Conclusions--Among generally healthy, community-dwelling older adults, aPWV, a marker of arterial stiffness, is associated with higher CV mortality, CHD, and stroke.

Key words: aging • elasticity • epidemiology • mortality • risk factor"

Guidant Recalls 38,000 Defibrillators

Teaching Brief - MedPage Today
INDIANAPOLIS, June 17-The Guidant Corp. here has agreed with the FDA to recall 38,000 potentially flawed implanted heart defibrillators, the company said today.

The recalled models are the Prizm 2 DR, the Contak Renewal and Contak Renewal 2, the Ventak Prizm AVT, Vitality AVT, Renewal 3 AVT and Renewal 4 AVT ICDs.

The company said that it was voluntarily advising physicians "about important safety information regarding certain devices." These actions the FDA defined as recalls, Guidant said.

Common Stomach Bug May Affect Heart Rhythm, Study Finds

Bloomberg.com: U.K.
(Recommended by Mario Maranhao)
June 16 (Bloomberg) -- A stomach bug that affects about half of the people over the age of 60 in the U.S. may trigger an irregular heart rhythm, according to a study in the medical journal Heart, the first time such a link has been made.

Patients with an irregular heart beat, or atrial fibrillation, were 20 times more likely to test positive for Helicobacter pylori bacteria and had five times higher levels of gastric inflammation than healthy volunteers, the study of 104 people found.

Cardiosource

Cardiosource
(Recommended by Mario Maranhao)
Cardiovascular Diseases News from the American College of Cardiology

Heart Drug for Blacks Endorsed

Heart Drug for Blacks Endorsed
By Rob Stein Washington Post Staff Writer Friday, June 17, 2005; A01
(Recommended by Darcy R. Lima & Mario C. Maranhao)

Federal health advisers yesterday endorsed the approval of a drug to treat heart failure in African Americans, which would make the controversial pill the first medicine targeted at a specific racial group.

The Food and Drug Administration advisory panel voted unanimously to recommend that the agency approve a request by NitroMed Inc. of Lexington, Mass., to sell the drug BiDil for patients with severe heart failure, and a majority agreed with the company that its label should say it is specifically intended for African Americans. The agency is not bound by the panel's decision but usually follows the advice.

The closely watched vote marked a crucial step for the drug, which has triggered intense debate, coming amid intensifying efforts to tailor "personalized" treatments to the genetic makeup of individual patients and groups of patients. Supporters say the drug would represent one of the first steps in that direction, offering an urgently needed treatment to a group that suffers more from many health problems and has been long neglected by medical research. (more)

Doctors fight over drug firm influence - The Boston Globe

Doctors fight over drug firm influence - The Boston Globe - Boston.com - Business
By Christopher Rowland, Globe Staff | June 16, 2005 crowland@globe.com
(Recommended by Mario Maranhao)

A fierce, behind-the-scenes battle over how much influence drug companies exert on doctors is raising the blood pressure at the American Society of Hypertension.

The society's cofounder and longtime editor of the prestigious American Journal of Hypertension, Dr. John H. Laragh, has accused ''academic physician/businessmen" who accept industry speaking and consulting fees of improperly coloring the group's activities.

''The lines separating marketing from education have been fractured," Laragh wrote in an e-mail message to physicians in the 3,000-member society.
The episode is a stark example of a broader debate taking place within the nation's medical societies, which represent physicians in virtually every medical specialty. Recently, many of the groups have become more sensitive to the potential for conflicts of interest relating to pharmaceutical industry grants.

Disagreements have flared over industry money used to support the hypertension society's educational programs, as well as the propriety of direct industry payments to physicians who serve as lecturers and consultants. The hypertension organization requires doctors participating in speaking programs to reveal the payments, but does not require them to disclose amounts.

Critics say the payments help companies put a patina of scientific and medical legitimacy on what is otherwise an attempt to increase market share.

''The society is seen as sort of a marketing tool by industry. There is a lot of money to go around," said Dr. Curt D. Furberg, a former member of its executive council and a professor of public health sciences at Wake Forest University in North Carolina.

The stakes for the drug companies are especially high in disease areas like hypertension, where the potential markets are huge (about 60 million Americans have high blood pressure) and where doctors can prescribe among a variety of competing brand-name drugs with similar characteristics.

''Every society that I know of is doing a lot of soul-searching in the area of conflict of interest and ethical responsibilities," said Paul Pomerantz, president of the American Association of Medical Society Executives.

Laragh leveled his charges a week before the society's annual gathering May 14-18 in San Francisco. The move by Laragh, a respected pioneer in hypertension research and a professor at Cornell University's Weill Medical College in New York, highlighted a split in the organization between a group of physicians that expresses wariness about industry participation and a newer faction that embraces it.

The dispute has now spread from the American Society of Hypertension to its official journal, the American Journal of Hypertension, which Laragh controls. He has closed the journal's office, which was located in the same Manhattan office suite as the society, and moved it to a sympathetic colleague's office at the Albert Einstein College of Medicine of Yeshiva University in the Bronx.

The society's president, Dr. Thomas Giles, a professor of medicine at Louisiana State University, said he hopes to repair the rift between the journal and the society. He denied Laragh's charge that drug companies have improperly influenced the society's activities under his watch.

Industry sponsorships of meetings and their payments to doctors, Giles said, are part of a ''partnership" between physicians, corporations, and government and can be managed with appropriate disclosure rules. The society estimates that about $1.5 million of its $4.4 million annual budget is met by ''unrestricted educational grants" by drug companies. Among the large sponsors of this year's annual meeting in San Francisco were Novartis AG, AstraZeneca Pharmaceuticals LP, and Pfizer Inc.

''We will not put ourselves in the position where were are going to function as the marketing arm for anybody," Giles said. ''All academicians who are prominent are asked to give talks. To characterize their efforts as marketing is clearly not correct."

The drug companies say they spend money on grants to medical societies because it helps get news out to doctors about medical advances.

''We think it is important for scientific organizations to continue to provide forums in which important information and research is shared," said Carla Burigatto, a spokeswoman at AstraZeneca.

The disagreement has taken on the characteristics of a political mud fight. Laragh's enemies have questioned the size of his American Journal of Hypertension salary -- $229,000 in 2003 -- and whether he engineered the selection of his wife, Jean E. Sealey, as the society's president-elect. Sealey is a leading hypertension researcher, but she is not a medical doctor. Giles formed a committee last year that investigated the salary level and found that it ''substantially exceeded" the salaries paid by other medical journals, but he declined to discuss the issue in an interview.

Laragh, responding for himself and his wife, dismissed those issues as ''low blows." He said this week that the real issue was the drug companies' presence and participation at the society's meeting in San Francisco, which he said reached levels never seen in the history of the 19-year-old society. Previously, industry-sponsored education sessions were confined to ''satellite" sessions before and after the society's events. This year, Laragh said, the sessions were intertwined with the rest of the program. The main speaking sessions each day, he said, were sponsored by different drug companies, also for the first time.

Among the doctors he singled out for criticism in his e-mail, alleging that personal business interests were intermingled with society proceedings, was Dr. Michael A. Weber, a leading figure and past president of the society. Weber once conducted research with Laragh and is a professor at the Downstate College of Medicine at the State University of New York.

Weber also is a founding partner of a company in New York, Integrium LLC, which administers clinical trials under contract with pharmaceutical companies. Individual researchers were once limited to one speaking opportunity at the annual meeting, Laragh said, but this year Weber and physicians affiliated with Integrium were given seven chances to speak. At one session, an Integrium physician chaired a meeting to discuss results of a clinical trial of Avapro that Integrium administered. Avapro is a hypertension drug marketed jointly by Bristol-Myers Squibb Co. and Sanofi-Aventis SA.

Weber defended the role that Integrium, Bristol-Myers Squibb, and Sanofi-Aventis played. He said the physicians associated with Integrium did not interpret or disseminate results of the trial.

All medical societies rely heavily on industry sponsorship, Weber said. ''Otherwise we wouldn't exist," he said.

Should everyone over 50 take aspirin prophylaxis? -- 330 (7505): 0 -- BMJ

Should everyone over 50 take aspirin prophylaxis? -- 330 (7505): 0 -- BMJ
(Recommended by:: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com] )
On pages 1440 and 1442, two sides of the argument are presented on whether aspirin should be used for primary prevention of vascular disease in all people over a certain age, and what that age should be. Elwood and colleagues believe that evidence shows that aspirin should be taken from around 50 years of age, but they also argue that the topic should be widely discussed and that the final decision should lie with each individual person. Baigent is not convinced by the available evidence and argues that such practice could result in net harm.

Lambl's Excrescences

Echocardiography
Lambl (Wein Med Wschr vi, 1856, 244) described small filiform processes on the aortic valve. Margerey (J Path Bact 1949; 61:203-208) studied 250 mitral valves and postulated that the mechanism of formation is intimal damage due to mechanical trauma at the leaflet coaptation.

The damaged area is covered by fibrin, which subsequently becomes uplifted, or partially detached from the valve surface. A layer of intimal cells covers the surface of the fibrin deposit. The enclosed fibrin becomes condensed and hyaline constituting the excrescence. Organized hyaline substance is later replaced by fibrous and elastic tissue.

Heart Valve Society of America

Heart Valve Society of America
HVSA (including the Heart Valve Trialists Society) was founded by a group of nationally and internationally recognized American experts in heart valve diseases to advance recognition and knowledge of the field.

HVSA will:

* promote research;
* educate medical professionals about the evaluation and treatment of heart valve diseases;
* serve as an informational resource for government, private industry, healthcare providers, the media and public; and,
* encourage and facilitate education of future heart valve disease specialists.

Cardiologists/Cardiothoracic Surgeons Form Medical Society Focusing on Heart Valve Disease

The Heart Valve Society of America (HVSA) - including the Heart Valve Trialists Society - has been formed by a founding board of nationally and internationally prominent cardiologists and cardiothoracic surgeons in the heart valve disease field.

The mission of the Society is to:
- promote research
- educate medical professionals about the evaluation and treatment of heart valve diseases;
- serve as an informational resource for government, private industry, healthcare providers, the media and public; and,
- encourage and facilitate education of future heart valve disease specialists

"Heart valve diseases can be considered 'mystery killers,'" said Jeffrey S. Borer, MD of Weill Medical College of Cornell University, president of the Society. "Too often, they progress slowly and imperceptibly, yet are capable of causing sudden and unexpected death. The founding board believes a vehicle is needed to bring cardiologists, cardiothoracic surgeons, anesthesiologists, pathologists, internists, basic scientists, other medical and allied health professionals together, in order to further research and educate caregivers and patients about this important public health problem."

Please visit our site at heartvalvesocietyofamerica.org

N-Acetylcysteine Does Not Prevent Contrast-Induced Nephropathy

N-Acetylcysteine Does Not Prevent Contrast-Induced Nephropathy: "N-Acetylcysteine Does Not Prevent Contrast-Induced Nephropathy
(Recommended by the AMICOR Paulo Caramori [caramori.p@plugin.com.br])

NEW YORK (Reuters Health) Jun 03 - N-acetylcysteine administration does not reduce the likelihood of contrast-induced nephropathy (CIN) after cardiac catheterization in patients at low to moderate risk of developing the complication, a new study shows.

CIN is a fairly common complication of cardiac procedures, Dr. Paulo Caramori of the Hospital Sao Lucas-PUCRS in Porto Alegre, Brazil, and colleagues note, and while hydration and use of low osmolality contrast media have been shown to help prevent it, the exact mechanisms at work remain unclear.

Based on the hypothesis that such injury is due to renal vasoconstriction and free radical release, the researchers set out to determine whether N-acetylcysteine, which has both vasodilating and antioxidant properties, might help prevent it. Past studies have shown conflicting results.

The researchers randomized 156 patients undergoing coronary procedures and considered to be at risk of developing CIN to 600 mg of N-acetylcysteine orally twice daily for 2 days or placebo, beginning the day before the procedure.

Patients were scheduled for coronary angiography or percutaneous coronary intervention, and all either had serum creatinine of 106.08 micromole/L or greater, creatinine clearance below 50 mL/ min or diabetes mellitus. Ionic low osmolality contrast medium was used in all patients.

CIN, defined as an increase of 44.2 micromoles/L in creatinine over a 48-hour period, occurred in 10.4% of the patients given N-acetylcysteine and 10.1% of those given placebo, which was not a significant difference, the researchers found.

'On the basis of these findings, we believe that the use of N-acetylcysteine in preventing CIN in patients undergoing cardiac catheterization should not be encouraged,' the researchers conclude.

'The recommended measures for preventing CIN continue to be appropriate hydration and the use of a small volume of contrast in patients at low to moderate risk of CIN undergoing cardiac catheterization with a low osmolality contrast medium.'

Heart 2005;91:774-778."

The New Cholesterol Targets -- A Nursing Perspective

The New Cholesterol Targets -- A Nursing Perspective: "The New Cholesterol Targets: What Are They and What Are Their Practical Implications? -- A Nursing Perspective
Lynne T. Braun, PhD, RN, CNP
Recommended by Carlos Alberto Machado [carlos.a.machado@uol.com.br]


Even when hypercholesterolemia is identified and treated, many patients fail to meet their cholesterol target levels as defined by national guidelines. Most concerning is that less than 20% of high-risk patients (those with known CHD) meet their LDL-C goal... Ultimately, lowering LDL-C levels to well below currently recommended levels in these high-risk patients [to a target of 75 mg/dL instead of 100 mg/dL, using a high-dose 'second generation' statin] was shown to have clinical benefit with a relative risk reduction for cardiovascular and cerebrovascular events of 20% to 25%."

IV Congresso de Insuficiência Cardíaca

IV Congresso de Insuficiência Cardíaca:
" MENSAGEM DO PRESIDENTE

O Grupo de Estudos de Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia vem crescendo progressivamente desde a sua criação em 2001.
As atividades promovidas pelo GEIC, incluindo eventos científicos e desenvolvimento de diretrizes, têm proporcionado à comunidade de cardiologistas generalistas e a especialistas em insuficiência cardíaca meios de aprimorar conhecimentos na área, com o objetivo de qualificar a assistência aos pacientes e também estimular a produção intelectual de grupos com vocação científica.
O carro-chefe das nossas atividades é o Congresso Brasileiro de Insuficiência Cardíaca, com sua quarta edição em 2005.
Este evento vem ganhando prestígio pela qualificada e diversificada programação científica e tem contado com apoio da indústria farmacêutica e de produtos na área cardiológica, o que tem contribuído para sua continuada viabilização estreitando parcerias e possibilitando o convívio entre vários profissionais da área.
Contamos com a sua presença em Gramado no Hotel Serrano em 2005, colaborando para mais uma realização de sucesso para todos!

Dra. Nadine Clausell
Presidente do IV Congresso Brasileiro de Insuficiência Cardíaca

6th ICPC: Conferency Commentaries (more...)

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Barbara Roberts
Enviada em: terça-feira, 14 de junho de 2005 09:19
Assunto: [ProCOR] Conference commentary: 6th ICPC

The 6th International Conference on Preventive Cardiology in Iguassu Falls,Brazil provided ProCOR's representatives (Brian Bilchik, Catherine Colemanand myself), an opportunity to learn, to reconnect with old friends and makenew ones, and to share information about ProCOR and the Lown model of care.

With as many as nine concurrent sessions on some days, it was impossible toattend all the talks we would have liked. While many presentations weredevoted to cardiovascular disease in women, there was still little mention
of the lack of evidence-based data on which to base treatment decisions inwomen. There was a session devoted to a "polypill" for prevention whichwould contain (among other drugs) a statin and aspirin - this despite the fact that statins have not been shown to lower women's event rates in thetwo primary prevention trials which included them and that aspirin hasrecently been shown not to protect healthy women underage 65 against heart attack.

Many papers addressed the cardiovascular disease burden in

developing countries and countries in economic transition, from rural populations in Iran to urban populations in Romania. Speaker after speaker discussed the social and economic factors which influence health behaviors and health systems. In this regard, the conference contributed to a change to my way of thinking about cardiovascular disease prevention. Just as the cholera, yellow fever and typhoid fever epidemics of prior centuries were not controlled until governments, from the community to the national level, instituted sewerage systems, safe water supplies and insect control programs, the current cardiovascular disease epidemic will also require governments at all levels to take a more active role. The cardiovascular disease epidemic will not be averted solely by appeals to people to lead healthier lifestyles. Government action will be required to rein in the tobacco and food industries and to provide safe environments so that people can incorporate exercise into their daily lives.

As Sylvie Stachenko pointed out in her excellent valedictory address, an aging population, technology, urbanization and globalization are powerful forces driving the chronic disease epidemic. To counter these, public health in the 21st century must move the prevention of chronic diseases from a global priority to a global reality. This will require changes in public policy that will no doubt be opposed by sectors in the food and tobacco
industries. She imparted a memorable quote from Bismarck: "Two things you should never watch being made: sausages and public policy." However, averting our gaze from public policy is not an option. Unless the medical
community can influence public policy in meaningful ways, the cardiovascular disease epidemic will overwhelm the scarce health care resources of the developing world and continue to rob their economies of people in their mostproductive years.

I welcome comments from our readers on how we, as medical professionals, can best interact with policy makers to ensure that choosing healthy diets and lifestyles becomes not only possible but easy for people whether they live in Boston or Isfahan.

Barbara H. Roberts, MD, FACC
Contributing Editor, Women's Heart Health, ProCOR
Director, The Women's Cardiac Center at The Miriam Hospital

Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee

Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association--Executive Summary: Endorsed by the Infectious Diseases Society of America -- Baddour et al. 111 (23): 3167 -- Circulation: "Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.

Methods and Results— This work represents the third iteration of an infective endocarditis 'treatment' document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This executive summary addresses the major points detailed in the larger document that contains more extensive background information and pertinent references. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.

Conclusions— The recommendations outlined in this summary should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management."

Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee

Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America -- Baddour et al. 111 (23): e394 -- Circulation
Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.

Methods and Results— This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.

Conclusions— The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.

Outcomes Research in Cardiovascular Disease -- Krumholz et al. 111 (23): 3158

Report of the National Heart, Lung, and Blood Institute Working Group on Outcomes Research in Cardiovascular Disease -- Krumholz et al. 111 (23): 3158 -- Circulation
The National Heart, Lung, and Blood Institute convened a working group on outcomes research in cardiovascular disease (CVD). The working group sought to provide guidance on research priorities in outcomes research related to CVD. For the purposes of this document, "outcomes research" is defined as investigative endeavors that generate knowledge to improve clinical decision making and healthcare delivery to optimize patient outcomes. The working group identified the following priority areas: (1) national surveillance projects for high-prevalence CV conditions; (2) patient-centered care; (3) translation of the best science into clinical practice; and (4) studies that place the cost of interventions in the context of their real-world effectiveness. Within each of these topics, the working group described examples of initiatives that could serve the Institute and the public. In addition, the group identified the following areas that are important to the field: (1) promotion of the use of existing data; (2) facilitation of collaborations with other federal agencies; (3) investigations into the basic science of outcomes research, with an emphasis on methodological advances; (4) strengthening of appropriate study sections with individuals who have expertise in outcomes research; and (5) expansion of opportunities to train new outcomes research investigators. The working group concluded that a dedicated investment in CV outcomes research could directly improve the care delivered in the United States.

Heart Drug Intended for One Race

The New York Times > Business > U.S. to Review Heart Drug Intended for One Race
By STEPHANIE SAUL (recommended by Maria Ines Reinert Azambuja)
In 1997, a new heart failure treatment called BiDil appeared dead on arrival. The Food and Drug Administration rejected the drug, saying that studies supporting it were inconclusive.

Then, proponents of BiDil refocused their strategy. This Thursday, eight years after the drug was rejected for use in the general public, an F.D.A. panel will consider whether BiDil should become the first drug intended for one racial group, in this case, African-Americans.

A study of 1,050 African-American heart failure patients showed that BiDil significantly reduced death and hospitalization, prompting the American Heart Association to call BiDil one of the top developments of 2004. BiDil increases levels of nitric oxide, which widens blood vessels.

The drug's maker, NitroMed Inc., says its decision to test and market BiDil as a drug for African-Americans is based on solid science. But BiDil's application has engendered controversy, with many scientists convinced that race is too broad and ill-defined a category to be relevant in determining a drug's approval, especially since geneticists have failed to identify a biological divide separating one race from another.

Effect of Treatment of Gestational Diabetes Mellitus

NEJMoa042973v1.pdf (application/pdf Object)
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy outcomes
Caroline A. Crowther, et al.
The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women’s mood and quality of
life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group.
conclusions Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’s health-related quality of life.

Gestational Diabetes Mellitus — Time to Treat

NEJMe058100v1.pdf (application/pdf Object)
Gestational Diabetes Mellitus — Time to Treat
Michael F. Greene, M.D., and Caren G. Solomon, M.D., M.P.H.
Gestational diabetes mellitus, broadly defined as carbohydrate intolerance beginning or first recognized during pregnancy, was originally described
decades ago and has since been the subject of extensive research. Yet the most recent guidelines of the U.S. Preventive Services Task Force, noting the absence of data to establish a clear link between screening and improved outcomes of affected pregnancies, concluded that “the evidence is insufficient to recommend for or against routine screening for gestational diabetes.”

The American College of Obstetricians and Gynecologists officially recommends screening for and treatment of gestational diabetes but acknowledges that these recommendations are based on “limited or inconsistent scientific evidence.”

Sociedad Sudamericana de Cardiologia

Sociedad Sudamericana de Cardiologia
Dear coleagues of the South-American Society of Cardiology

It is indeed a great pleasure to see the startup of our SSC home page www.sscardio.org .
I believe it will become an important tool for our better knowledge of our potential and difficulties and , thus, enable us to adjust better to the reality that surround us and in this way , to further enhance our development and opportunities in the field of our professional realms, the practice of Cardiology, to better serve our people, all with our own southamerican stile.

We were built in the midst of a more recent struggle to discover realities of a new world than most part of the remainder world.

These 500 years, nevertheless, are enough for us to have a History that portray us as good honest, progressive, good-natured people, doted with a clear humanitarian notion of the Universe, which leads to understanding, compassion and an in tense energy to achieve our dreams.

This is a reality that makes us proud and clearly full of attributes that are well aligned with those of the profession we are involved with, the Medical profession, and, in this particular regard, as cardiologists.

Therefore lets get it to work!

This homepage has the aim of becoming evermore a place for communication among the distinct Societies that comprise our South-American Society of Cardiology (SSC), and shall be a commonplace for Scientific and Cultural manifestations of all.
For that purpose a window is being prepared for a biweekly publication, under the responsibility of each society, in an alphabetical order, for articles on scientific or societal subjects that they wish to bring to everyone’s attention.

It has been appointed to the Argentinian Society of Cardiology the task of initiating the publications which they did by sending us an interesting article by Drs. Carlos D. Tajer and Hernán C. Doval, on the controversy of Coxibs.
Subsequently we will have themes coming from Bolivia, Brazil, Chile, Colombia, Equator, Paraguay, Peru, Uruguay and Venezuela. According to previous agreements and a calendar already distributed.

In the beginning the homepage will present windows written in Portuguese, but shortly they will be available also in Spanish.

The article can be in Spanish or Portuguese although it would be desirable, considering the current globalization of the scientific world, whenever possible, to have it also translated to the English which will enable us to have in the future a place in the indexation agencies.

Besides this homepage will be make it possible a concection with each Society and thus facilitate communication among the for announcement of their activities.
It would be highly desirable by the same token to have also the homepage of SSC in the homepage of each society.

The SSC homepage will be an editorial responsibility of the President of the Society and will be hosted by his corresponding national society, till the end of his tenure when it will move on to the next president.

A propos I shall thank heartfully to the support that has been provided to this endeavor by the Brazilian Society of Cardiology, under the leadership of Dr. Antonio Felipe Simão and the most efficacious technical support derived from the informatics session of the aforementioned society under the personal supervision of Mr. Orlando Castro, who has been giving invaluable help for this purpose.

Suggestions are quite welcome!

Sincerely yours,

Dr. Gilson S. Feitosa
President of the South-American Society of Cardiology

Age, Cohort and Period Effects in the Mortality by Ischemic Heart Diseases and Ill-Defined Causes of Death

art01.pdf (application/pdf Object)
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores são membros da lista AMICOR e Dra. Gláucia é editora da Revista da SOCERJ
Objective: To analyze the mortality due to ischemic heart diseases (IHD) and ill-defined causes (IDC) in the Brazilian states of Rio de Janeiro (RJ), São Paulo (SP), and Rio Grande do Sul (RS) Brazil, according to the age-cohort-period model, in 1980, 1990, and 2000.
Methods: Mortality due to IHD and IDC from 8 birth cohorts, 1901-10, 1911-20, 1921-30, 1931-40, 1941-50, 1951-60, 1961-80 and 1971-80, were estimated for 6 age groups (20- 29; 30-39; 40-49; 50 -59; 60 -69; 70-79 years), in 1980, 1990 and 2000, in RJ, SP, and RS for both sexes.
The annual deaths data were collected from DATASUS, while the population data were collected from IBGE. The HD mortality was balanced for the ill-defined deaths.
Results: Mortality due to IHD was higher in RJ for both sexes in 1980 and 1990 except for the 70-79 women’s age group. In the year of 2000 the IHD
mortality was also higher in RJ for the male 20-29 and 40-49 age groups and in nearly all female age groups. It has decreased in all Brazilian states for the 30-79 age groups in the past few years. The age effect on IHD and IDC mortality was present in all Brazilian states and age groups. The cohort effect on IHD mortality rates was observed in SP and RS for both sexes from the 30-39 age group with lower magnitude in RJ. The period effect occurred in RJ with a decline in mortality due to IHD in 2000, and with an increase due to IDC in 1990 and 2000, and in RS there was a drop in both
mortality rates.
Conclusions: In RJ mortality due to IHD apparently dropped while mortality due to IDC increased sharply in 2000; however, in RS mortality due to IHD and IDC declined in 1990 and 2000. Hypotheses was raised to explain these findings. Efeitos de Idade, Geração e Período na Mortalidade por
Doenças Isquêmicas do Coração e por Causas Mal Definidas nos Estados do Rio de Janeiro, São Paulo e Rio Grande do Sul nos Anos de 1980, 1990 e 2000 - Brasil Age, Cohort and Period Effects in the Mortality by Ischemic Heart Diseases and Ill-Defined Causes of Death in the States of Rio de Janeiro, São Paulo, and Rio Grande do Sul In 1980, 1990, and 2000 - Brazil

Ischemic Heart Diseases, Cerebrovascular Diseases and Ill Defined Causes of Death

art01.pdf (application/pdf Object)
Ischemic Heart Diseases, Cerebrovascular Diseases and Ill Defined Causes of Death
in Health Districts of Rio de Janeiro State from 1980 to 2000 - Brazil
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores fazem parte da lista AMICOR e Dra. Gláucia é a editora da Revista da SOCERJ
Objective: To analyze trends in mortality due to Ischemic Heart Diseases (IHD), Cerebrovascular Diseases (CRVD) and Ill Defined Causes (IDC) of death in adults from regions within the State of Rio de Janeiro, RJ, Brazil, between 1980 and 2000.
Methods: Death data were obtained from DATASUS/MS and population data were obtained from IBGE. Ten regions were then defined: Cinturão Metropolitano (Metropolitan area), City of Rio de Janeiro, Niterói, Médio-Paraíba, Serrana (Mountain), Norte (North), Baixada Litorânea (Coastal lowland), Noroeste (Northwest), Centro-Sul (Southeast) e Baía da Ilha Grande (Ilha Grande Bay). Rates of mortality caused by IDC, IHD, and CRVD were adjusted according to gender and age through the direct method. Standards were based on the Rio de Janeiro population aged 20 or over in the 2000 Census. Due to a considerable increase in IDC mortality rates in RJ from 1990 on, a compensation maneuver was effected. Trends were analyzed by linear regression models.
Results: A steady decline in compensated and adjusted CRVD mortality rates was observed in all regions (medium annual decline of 2,9% in Rio de Janeiro) from 1980 on, while the decline of IHD mortality was remarkable from the 1990s on in almost all regions with a simultaneous increase in
IDC mortality in the Metropolitan area.
Conclusions: CRVD trends prevailed in all regions except in Niterói and in the City of Rio de Janeiro. Annual CRVD trends were higher than IHD trends in all regions.

Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery -- Baumgartner et al. 111 (22):

Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery -- Baumgartner et al. 111 (22): 3007 -- Circulation: "Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery
William A. Baumgartner, MD; Stephanie Burrows, PhD; Pedro J. del Nido, MD; Timothy J. Gardner, MD; Suzanne Goldberg, RN, MSN; Robert C. Gorman, MD; George V. Letsou, MD; Alice Mascette, MD; Robert E. Michler, MD; John D. Puskas, MD; Eric A. Rose, MD; Todd K. Rosengart, MD; Frank W. Sellke, MD; Sara J. Shumway, MD; Norbert Wilke, MD

From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

Correspondence to William A. Baumgartner, MD, Vincent L. Gott Professor of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Blalock 618, Baltimore, MD 21287-4618. E-mail wbaumgar@csurg.jhmi.jhu.edu

Received December 16, 2004; revision received February 15, 2005; accepted March 2, 2005.

New surgical procedures, imaging modalities, and medical devices have improved therapy for many patients and made treatment possible for others who have had few options in the past. In February 2004, the National Heart, Lung, and Blood Institute’s (NHLBI) Advisory Council proposed that the institute evaluate the status and future directions in cardiac surgery. In response to this recommendation, the NHLBI convened a working group of cardiac surgeons on May 7 and 8, 2004, to assess the state of cardiac surgery research, identify critical gaps in current knowledge, determine areas of opportunity, and obtain specific recommendations for future research activities. The working group discussed surgical revascularization, novel surgical approaches, valvular research directions, biotechnology and cell-based therapy, heart failure, imaging modalities, and barriers to clinical research and presents its recommendations here.

"

Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged >=70

Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged >=70 -- Nelson et al. 330 (7503): 1306 -- BMJ:

"Results The proportional benefit gained from the use of low dose aspirin by the prevention of myocardial infarctions (-389 in men, -321 in women) and ischaemic stroke (-19 in men and -35 in women) is offset by excess gastrointestinal (499 in men, 572 in women) and intracranial (76 in men, 54 in women) bleeding. The results in health adjusted years of life lived (which take into account length and quality of life) are equivocal for aspirin causing net harm or net benefit.

Conclusion Epidemiological modelling suggests that any benefits of low dose aspirin on risk of cardiovascular disease in people aged ≥ 70 are offset by adverse events. These findings are tempered by wide confidence intervals, indicating that the overall outcome could be beneficial or adverse."

Epidemiological transition and the study of burden of disease in Brazil

Destaque102.pdf (application/pdf Object)
(Sent by Maria Inês Reinart Azambuja)
Joyce Mendes de Andrade Schramm, Andreia Ferreira de Oliveira, Iúri da Costa Leite, Joaquim Gonçalves Valente, Ângela Maria Jourdan Gadelha,
Margareth Crisóstomo Portela, Mônica Rodrigues Campos.
Abstract In Brazil, the epidemiological transition has not followed the model experienced by most developed countries. There is coexistence of old and new health problems, where despite the predominance of the chronical and degenerative diseases, the communicable ones still play an important role. In this study the differentials in relation to the epidemiological pattern are described not only for the country as a whole, but also for its major regions, using the Disability Adjusted Life Years (DALY), the health indicator of the studies of burden of disease. Amongst the main results found we stand out that the group of chronical and degenerative diseases is responsible for 66,3% of the national burden of disease; 23,5% are responded by the communicable diseases, perinatal and maternal conditions and nutritional deficiencies; and 10,2% is due to the injuries. The use of DALY permits the identification of health priorities based on the epidemiological profile, making easier the process of decision make and the use of resources by the managers.
Key words Epidemiological transition, Burden of disease, DALY, Non-communicable diseases Resumo No Brasil, a transição epidemiológica não tem ocorrido de acordo com o modelo experimentado pela maioria dos países desenvolvidos. Velhos e novos problemas em saúde coexistem, com predominância das doenças crônico-degenerativas, embora as doenças transmissíveis ainda desempenhem um papel importante. Neste estudo,
os diferenciais, em relação ao padrão epidemiológico, são descritos para o Brasil e grandes regiões, para o indicador de saúde dos estudos da carga de doença, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doenças não-transmissíveis, Infecciosas/parasitárias/maternas/perinatais/ nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doença estimada. A utilização do indicador DALY propicia a identificação de prioridades em função do perfil epidemiológico, facilitando a tomada de decisões e destinação adequada de recursos por parte dos gestores. Palavras-chave Transição epidemiológica, Carga de doença, DALY, Doenças não-transmissíveis

[ProCOR] Case for Prevention: Porto Alegre, Brazil

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:38
Para: procor@healthnet.org
Assunto: [ProCOR] Case for Prevention: Porto Alegre, Brazil

Porto Alegre, Brazil demonstrates a model of multi-sectoral partnerships and multi-level approaches to promote cardiovascular health. Other cities and countries are encouraged to share their models through ProCOR in order to inform and inspire the efforts of others.

________________

Nurses and nutritionists, epidemiologists and neurologists, cardiologists and communicators, primary care physicians and public health professionals, government officials and staff of NGOs, recently convened in Porto Alegre, Brazil, to discuss the city's model of CVD prevention and control. The participants represented a microcosm of the sectors of society that contribute to health. In Porto Alegre, multi-sectoral partnerships bring together diverse groups to promote health in multidisciplinary ways and on multiple levels.
National policy, community interventions, and medical care-family medicine, primary care, specialists, and emergency-are working together to develop a range of innovative programs that serve the poorest pockets of Porto Alegre and the richest.

The International Meeting on Cardiovascular and Cerebrovascular Disorders Prevention and Control in Porto Alegre, Brazil on May 19 was convened by Dr. Aloyzio Achutti, Amicor, and Dr. Jefferson Gomes Fernandes, Director, Institute of Education and Prevention, Hospital Moinhos de Ventos. Participants from World Health Organization; Brazil's Ministry of Health; Hospital Moinhos de Ventos in Porto Alegre, the Institute of Research and Prevention, AMICOR, and ProCOR demonstrated the power of linking health care with social change.

Underlying Porto's Alegre's activities is the support of the Ministry of Health. On the national level, Brazil is putting in place legislation and policies that provide impetus to efforts to create healthy environments. Brazil has the largest public health system in the world. Brazil's national health policy is currently in final review by its Health Assembly, and free nicotine replacement therapy has just become become part of the public health system. On May 25, a national day promoting physical activity and nutrition was celebrated across the country.

A "quality of life" map of each of the more than 2300 census blocks in Porto Alegre guides the city's planning. Indicators such as age, literacy, employment, electricity, number of inhabitants, access to sewage disposal and garbage pickup, presence of health care facilities and their capacity to meet demand, are analyzed and assigned to each census block in values ranging from 1 (worst) to 5 (best). The census blocks can be reviewed individually, providing an immense amount of detail, or can be aggregated into clusters. Indicators also can be overlaid onto one another in various combinations.

The outcomes of this planning target the specific needs of each area of the city. For example:
* On an outlying island, programs to provide water treatment, sewage disposal, and electricity accompany a family medicine clinic's services, which include home visits to each resident by a trained member of the clinic staff.
* The hospital is building its new laundry facility in a poor area of the city. Although the facility is several miles away from the hospital, the location was chosen because it will create more than 300 jobs for nearby residents and the hospital realizes that health benefits will follow when more employment is available.
* A 24-hour emergency clinic recently was established in an empty building in an area of Porto Alegre that experiences a high incidence of violence and injuries. The Institute of Education and Prevention has developed a one-year program for individuals planning to enter medical school which includes an orientation to community health and a patient-focused approach to their future profession.
* Primary care, dental care, and a wellness clinic are available in a hospital branch located in an upscale shopping, increasing ease of access to preventive services by including health care among residents' everyday errands.
I was struck by the balance I saw at Hospital Moinhos de Vento between their successful strategy of creating a "hotel" atmosphere in their private hospital facility and their success in providing the same level of care at the public hospital. Many cardiologists with whom I spoke emphasized the importance of balancing an emphasis on the use of clinical skills and multi-disciplinary medical management of cardiovascular disease while incorporating the latest technology in appropriate ways. The "rush to refer" that is overtaking much of American medicine did not seem to dominate the model of care described at Hospital Moinhos de Vento. One physician asked, "Why should we prescribe the latest, more effective, most marketed drug when older medications work better, are cheaper, and have a longer track record." Another physician said, "We need to recognize the important role of non-physicians. And we need to learn in new areas that were not part of our training, like how to counsel a patient on physician activity or nutrition." While the philosophy and vision at this hospital is not representative of all medical institutions in the region or the country, I was told that it is not the only Brazilian example of successful
integration of clinical care and community, of technology and the "art of healing."

Prior to the conference, on May 17, I celebrated the 8th anniversary of AMICOR with Dr. Achutti and his wife, Dr. Valderes Robinson, also a cardiologist. Dr.Achutti founded AMICOR in 1997 to establish a network of cardiologists, physicians, and health workers from Brazil, Latin America, and other countries.
Daily he links them to locally relevant information from Latin American and international sources. Information is presented in Portuguese, Spanish, or English. Dr. Achutti is currently exploring the potential of blogs to transfer
information among networks and he maintains an extensive email distribution list. ProCOR and AMICOR are part of an increasingly linked "network of networks" around the globe, in which interpersonal, institutional, regional, national, and global networks intersect with each other at common points of interest to proliferate the sharing of knowledge and connections among people.

Thank you to the many Brazilian colleagues who made me feel welcome, patiently explained what was unfamiliar and enthusiastically explored what was possible. I especially thank Dr. Achutti for his faith in all kinds of connections and his ability to make them happen.
_____________________________________________________________________

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Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study

Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study
Wolffenbuttel BH, Franken AA, Vincent HH; THE DUTCH CORALL STUDY GROUP.

University Medical Centre, Groningen, the Netherlands.

Abstract. Wolffenbuttel BHR, Franken AAM, Vincent HH on behalf of the Dutch CORALL Study Group (University Medical Centre, Groningen; Isala Clinics, Zwolle; and Antonius Hospital, Nieuwegein, the Netherlands). Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study. J Intern Med 2005; 257: 531-539.Objectives. To compare the efficacy of the newest cholesterol-lowering drug, rosuvastatin (RSV) with atorvastatin (ATV) in subjects with type 2 diabetes. Design. A 24-week, open-label, randomized, parallel-group, phase IIIb, multicentre study. Setting. Diabetes outpatient clinics of 26 hospitals in the Netherlands. Subjects. A total of 263 patients with type 2 diabetes treated with oral agents or insulin, age (mean +/- SD) 60 +/- 10 years, body mass index (BMI) 31.4 +/- 6.1 kg m(-2), 46% males. Intervention. After a 6-week dietary lead-in period, patients were randomized to RSV (n = 131) or ATV (n = 132) treatment in a dose escalation scheme (RSV: 10, 20 and 40 mg or ATV: 20, 40 and 80 mg for 6 weeks each sequentially). Main outcome measures. Primary outcome was the change in apolipoprotein B (apoB) and apoB/apolipoprotein A1 (apoA1) ratio, which has been suggested a better predictor for cardiovascular events than total (TC) or low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were the changes in other lipid parameters. Results. Baseline LDL-C in the RSV and ATV groups was 4.23 +/- 0.98 mmol L(-1) and 4.43 +/-0.99 mmol L(-1), whilst apoB/apoA1 was 0.86 +/-0.22 and 0.92 +/- 0.35, respectively. A greater reduction in apoB/apoA1 was seen with RSV (-34.9%, -39.2% and -40.5%) than with ATV (-32.4%, -34.7% and -35.8%, P < 0.05 at weeks 12 and 18). Significantly greater reductions in LDL-C were also seen with RSV (-45.9%, -50.6% and -53.6%) than with ATV (-41.3%, -45.6% and -47.8%, all P < 0.05). The American Diabetes Association (ADA) LDL-C goal of <2.6 mmol L(-1) was reached by 82%, 84% and 92% of patients with RSV and 74%, 79% and 81% with ATV. Triglyceride reductions ranged from 16 to 24% and were not different between treatments. Both treatments were well-tolerated: nine patients in the RSV and 11 in the ATV group withdrew from treatment because of adverse events after randomization. Conclusion. In subjects with type 2 diabetes, greater improvements of apoB/apoA1 and across the lipid profile were observed with RSV compared with ATV.

PMID: 15910557 [PubMed - in process]

Noninvasive Coronary Angiography

Noninvasive Coronary Angiography
(Full text available on request)
Hype or New Paradigm?
Mario J. Garcia, MD
When Sones Inadvertentely performed the first coronary angiogram in 1958, he could not anticipate the profound future implications of that event. Four years later, when he reported his experience with more than 1000 procedures, the technique was still considered experimental and was dismissed by many leading authorities in cardiovascular medicine.
Yet, the introduction of coronary angiography started a new era, leading to the rapid development of coronary artery bypass graft surgery and percutaneous revascularization for the routine management of ischemic heart disease.
Four decades later, more than 2 million angiographic procedures are performed annually in the United States alone. Although invasive coronary angiography clearly has led to improved outcomes, it also has contributed to greater expenses in health care cost, limiting its potential to become more widely available. This has led to a growing interest in the scientific community in the development of less expensive, noninvasive alternative methods for evaluating coronary anatomy.

[ProCOR] Conference report: 6th ICPC "Protecting the heart ofglobal development"

-----Mensagem original-----
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:37
[ProCOR] Conference report: 6th ICPC "Protecting the heart ofglobal development"

(from Catherine Coleman)
The 6th International Conference on Preventive Cardiology convened more than 700 international participants to discuss how clinical practice, community intervention, and policy development can promote global heart health. At those who attended head home, we must ask ourselves:
What did we learn? What next steps will we take? What concrete actions will result? What will have changed in four years, at the next conference? We invite all of our global colleagues to utilize ProCOR as a forum in which to continue and expand the conference, and to discuss these important questions.
________

"Protecting the heart of global development" was the theme of the 6th International Conference on Preventive Cardiology in Foz do Iguassu, Brazil (May 21-25, 2005). The scientific program ranged from genomics to public health, and demonstrated a broad concept of preventive cardiology that extended beyond medical care to include community interventions and policy development. No single risk factor, subset of countries, sector of society, or preventive approach holds the key to global heart health. Rather, everyone, working together in complementary ways and integrated into cooperative efforts, is necessary in order to address the global burden of cardiovascular disease.

Only half of the world's countries have surveillance systems. "We can't guide the development of policy, and we can't make wise decisions about the allocation of scarce health resources, unless we track trends in health status," said Ruth Bonita, WHO. "Using this information, we can develop appropriate and effective interventions and evaluate them." WHO's STEPwise approach assists countries in collecting information about NCD risk factors in their unique settings (www.who.int/chp/steps> or email rileyl@who.int)
Surveillance data paves the way for policy development. Less than 50% of countries have a national NCD policy; less than 30% have a CVD plan, and less than 40% have a tobacco plan. Surveillance data can be incorporated into successful strategies that place heart health on the political agenda. Sylvie Stachenko, Canada, reminded attendees that "we need to communicate with policy makers in plain language that helps them understand the urgency. Tell them the stories. Use reports and important documents. Engage the media in publicizing the problem. Link the heart health agenda to other policy agendas. Make the economic case--show how policies will translate to reduced burden on health care.But always insist that economics are not more important than health." Dr. Stachenko emphasized the roles of government, the private sector, industry, NGOs, and civil society advocates. "By educating the public, we can build consumer demand, which in turn can drive policy development. Health ministries need to take a stewardship role in rallying other players, but a heart-healthy society is a shared effort."

While policy creates environmental change, successful population approaches are delivered in partnership with communities. Working with communities requires knowing and valuing their cultures, contexts, and dynamics. Multi-factoral approaches work better than single approaches; a program addressing physical activity and nutrition will produce more benefit than a physical activity program alone. Engaging a range of sites--home, workplace, schools--further increases change.

Brian O'Connor, Canada, outlined strategies for population-based programs, including community mobilization and education, social marketing and media, health promotion programs, alliances and partnerships, and involvement of the community in policy making. Examples of interventions from the world can be reviewed online at www.internationalhearthealth.org. The social determinants of health--risk conditions in which people live--are an important component of community health programming. Dr. O'Connor pointed out that "many of the tools we develop are sophisticated and can't reach people living on the margin.
Approaches should be tailored to take this into consideration.
Partnerships with communities produce benefits beyond improved health status.Communities that participate in planning develop a sense of ownership that increases the likelihood of success and sustainability. Leadership and other community capacity such as advocacy and planning skills can be transferred to

other areas and contribute to a healthier environment. But building an infrastructure requires a sustained and committed effort and willingness to share control of the agenda. "The community is not a laboratory," Dr. O'Connor warned. "Don't take the data and depart. Don't patronize them. Engage them in the process."
Darwin Labarthe, USA, examined the role of physicians and the choices that they face: "Rescue the individual, report accumulated cases, or respond to community needs. All are essential." Physicians can influence health on many levels--by promoting health for all, encouraging healthy lifestyles for their patients, identifying and treating underlying conditions, diagnosing and treating CVD, preventing occurrences, and enhancing quality of life for those with CVD."

This shift in the physician's role calls for a redefinition of primary care, noted David MacLean, Canada. "Primary care is multidisciplinary and assumes an active role in chronic disease prevention. Physicians can enhance preventive practice by utilizing multiple approaches." Noting that for many physicians "their idea of preventive medicine is vaccination," Dr. MacLean described a Russian polyclinic where doctors with minimal resources nevertheless were able to successfully manage their patients' CVD risk.

It is encouraging that this international conference on preventive cardiology addressed issues that extended far beyond the physician's examination room or the hospital's catheterization lab.

But questions remain. What have we learned during these days of discussions?What next steps will each of us take to translate what we learned into action? In four years, at the next conference, what will have changed?

Aloyzio Achutti, Brazil, reminded participants that "Our scientific meetings must be permanent. It is important for us to stay connected through a virtual community. The technical resources are already available and accessible.
Regional networks can be connected into a global network. Sharing information creates a connection that leads to mutual support and empowerment, for example the development of multi-centric research opportunities. There are many potential friends hidden by traditional communication barriers and institutional, economic, social, cultural and political restraints."
It is our hope that those who attended the conference and those who did not will use ProCOR, AMICOR, and other electronic networks as a way to continue and expand the conversation, introduce new topics, challenge one another, stay connected, and continue the global dialogue until we have achieved our goals.

Catherine Coleman
Editor in Chief, ProCOR
__________________________________________________________________

Contribute to ProCOR's Global Dialogue by replying to this message or sending an email to .
Engage others in the discussion by forwarding this message to colleagues.
We welcome new participants! Subscribing is free--simply send an email to .
Questions, comments? Send feedback to Catherine Coleman, Editor in Chief, ProCOR
.
ProCOR (www.procor.org) is a program of the Lown Cardiovascular Research Foundation. ProCOR's email discussion is hosted by SATELLIFE (www.healthnet.org), The Global Health Information Network.