Investindo em Educação e Saúde

Investindo em educaão e saúde
Caros amigos,
Desejo-lhes um Feliz ano novo, com muita esperança, amor e sucesso.
Abiaxo vai artigo meu que Zero Hora publicou no dia de hoje.
A inspiração veio da Dra. Valderês e do livro do Vinod Thomas, ex diretor do Banco Mundial no Brasil, cuja referência está na materia postada imediatamente antes. "O Brasil Visto por Dentro"
Um abraço a todos.
ALOYZIO ACHUTTI: Membro da Academia Sul-Rio-Grandense de Medicina

Superávit primário, dívida externa, dívida social, cotação do dólar, risco Brasil, salário mínimo, bolsa de valores, produto interno bruto, ajuste fiscal, reforma da previdência...
Estes e outros temas são assunto de todo o dia, de manchetes, de discussões acaloradas e objeto de propaganda política, nem sempre bem intencionada.
Tudo isso, e muito mais, diz respeito à gente que vive neste país, corresponde aos nossos 185 milhões de concidadãos. Tem a ver com o que produzimos, consumimos, gastamos, exportamos, desperdiçamos e investimos, dentro desta enorme e rica propriedade natural nem sempre bem conservada e gerida.
Proponho medir parte de nossa riqueza, com unidades não convencionais e monetárias, mas aproximando-nos um pouco mais do valor potencial vivo de nosso capital humano. Pelos padrões atualmente existentes poderíamos estimá-lo em cerca de 13.210.436.478 anos potenciais de vida.
Quantidades, entretanto, não expressam toda a realidade; ou melhor, muitas vezes escondem parte importante e inconveniente dela. Nos adaptamos a manipulações deste tipo, especialmente quando querem nos mostrar que a economia vai bem, apesar de toda a corrupção, desperdício e malversação de recursos. Os números, especialmente quando mostrados setorialmente, são facilmente manipuláveis, e servem também para ocultar graves defeitos de qualidade.
Do conceito de saúde, entretanto, a qualidade de vida é parte indissociável. Não nos conformamos com somente maior número de anos vividos. Trata-se de capitalizar anos de vida saudáveis.
Estudando informações relativas à saúde de nossa população com dados de 1998 foi possível estimar em 37.518.239 o número de anos de vida saudáveis perdidos a cada ano no Brasil, por todas as causas de doença, violências, incapacidade ou morte precoce. Estendendo este cálculo para nosso capital humano global, chega-se a um desperdício – por problemas em grande parte evitáveis - de 20% a 30% dos anos potenciais de vida saudável responsáveis pela produção e conservação de nossas riquezas.
Avaliando a saúde de nossa sociedade, através da equidade na distribuição das riquezas, também se chega a uma proporção semelhante (dependendo do critério utilizado) de pessoas socialmente excluídas que poderiam estar contribuindo para o processo produtivo, aumentando nossa riqueza, aliviando a carga das doenças, participando no controle social e reduzindo conflitos oriundos da desigualdade exagerada.
Marcos de mudança nos ciclos temporais, são ocasiões para reflexão, balanço e bons propósitos. Redefinições políticas são essenciais, mas a incorporação das mudanças na cultura, e na consciência de cada cidadão, implica num processo educacional sério e sustentado.
A fórmula mais eficaz para sanar nossa economia global - deixando ela a desejar quantitativa e qualitativamente - está na participação efetiva na administração de nossos recursos, e na mobilização de nosso capital físico, nosso capital humano e no trabalho produtivo. Assim, somente como ganho em anos potenciais de vida saudáveis de nossa população, podemos esperar rendimentos em torno de 30%.
Pode haver melhor investimento do que em educação e saúde?

O Brasil Visto por Dentro

Grupo Banco Mundial: "Foi lançado neste mês o livro O Brasil visto por dentro " O desenvolvimento em uma terra de contrastes, do ex-diretor do Banco Mundial para o Brasil, Vinod Thomas. Os eventos ocorreram no Rio de Janeiro, São Paulo e Brasília, com a participação de autoridades, pesquisadores e outros interessados..
O Brasil tem um dos maiores potenciais do mundo em desenvolvimento para atingir o progresso sustentado, mas esta realização depende de ações incisivas e urgentes. Esta é a perspectiva do livro, que já está à venda nas melhores livrarias."

The Pandemic of Lifestyle Diseases

The Pandemic of Lifestyle Diseases
The WHO estimates that atherosclerosis and diabetes (90% of the Type 2 variety) kill about 16 million people every year, more than are killed by war, famine and malaria combined, and more than might concievably be killed in a single pandemic of bird flu. Half of these deaths occur in people under 70 years old and at least 80% are preventable with simple lifestyle changes.

The ancient Greeks were very perceptive. They gave their god of medicine, Asclepius, two daughters, Panaceia, the goddess of the quick fix and Hygeia, the goddess of prevention and treatment of disease by healthy lifestyle. We have developed this site will prove to you that lifestyle change, Hygeia, is the only way to prevent and treat these diseases. The classic description of the principles of Hygeia was given by Hippocrates about 430 BC.

Drugs and procedures, Panaceia, only treat symptoms and will not decrease total mortality. There is increasing evidence that Panaceia will actually kill more people than it could possibly save.

The bas-relief in the header of Hygeia with her sacred snake was done in 1955 by Armand Filion. It can be seen above the Cedar Avenue entrance to Livingstone Hall, the former nurses' residence at the Montreal General Hospital in Montr�al, Qu�bec, Canada

NHLBI, DASH Eating Plan

NHLBI, DASH Eating Plan: "I give a copy of this to all my hypertensive patients, and have received good feedback. They have found it informative and easy to understand.' -M. Keen, MD Toledo, OH
Get with the plan that is clinically proven to significantly reduce blood pressure. It's not enough to tell hypertensive and prehypertensive patients to, 'Watch your diet.' Give them a week's worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the 'Dietary Approaches to Stop Hypertension' clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping. Facts About the DASH Eating Plan 24 pages. NIH Publication No. 03-4082."

Fundação do Incor deve R$ 200 milhões

De: Isaac roitman [mailto:iroitman@imagelink.com.br]
Enviada em: quarta-feira, 28 de dezembro de 2005 23:46
Assunto: Fw: incor

Publicado na Folha de SP
Demorou p/ aparecer as evidências.
Fundação do Incor deve R$ 200 milhões

FABIANE LEITE
da Folha de S.Paulo
A dívida da Fundação Zerbini, entidade privada que administra o maior instituto público de cardiologia da América Latina, o Incor de São Paulo, chega hoje a R$ 200 milhões, diante de um orçamento de R$ 230 milhões anuais.

O quadro foi apresentado ontem pelo conselho deliberativo do Hospital das Clínicas da USP, ao qual o Incor está ligado, e pela própria fundação. As duas instituições estão em guerra por causa do endividamento, mas ambas cobraram ações do governo Geraldo Alckmin (PSDB) para a solução do problema.

O hospital quer um auxílio financeiro para o pagamento. Já a fundação cobra verbas que não teriam sido repassadas pelo governador. O instituto faz hoje um total de 250 mil consultas por ano, em média, 13 mil internações, 5.000 cirurgias e 2 milhões de exames diagnósticos. Problemas no atendimento não estão descartados, a longo prazo, caso a situação não se resolva.

A Zerbini foi criada com anuência do HC para melhorar a estrutura do Incor, como acelerar as contratações e viabilizar mais rapidamente os investimentos, justamente por não ter as amarras de um órgão estatal.

O conselho do hospital atribui o endividamento a uma má gestão de verbas pelo hoje presidente do Incor e do conselho curador da fundação, José Ramires, e tentou afastá-lo do cargo.

"A fundação está tecnicamente falida, pois não tem patrimônio para pagar a dívida", afirma Marcos Boulos, integrante do conselho deliberativo do hospital.

Ontem, o HC apresentou resultados de uma auditoria independente que aponta controles inadequados das compras e estoques da fundação.
Segundo o órgão, a situação "é grave".

Já Paulo Bonadies, advogado de José Ramires, acusou ontem o governo Alckmin de "tungar", nos últimos cinco anos, R$ 100 milhões destinados à entidade que defende, isso principalmente em razão de repasses não realizados pelo governador e aportes feitos pelo governo federal, mas não direcionados pelo Estado à Zerbini, de acordo com sua versão.

Ainda segundo Bonadies, Alckmin não teria honrado compromisso do ex-governador Mário Covas de pagar empréstimo de R$ 40 milhões do BNDES (Banco Nacional de Desenvolvimento Econômico e Social), dívida de longo prazo assumida pela fundação e que chega a R$ 120 milhões.

"A fundação arca com dois terços do custeio do Incor, hoje de R$ 230 milhões", afirmou o advogado da Zerbini. "Há um clima de beligerância, disputa de egos. Eles [o conselho] estão matando a galinha dos ovos de ouro do hospital, do Incor [a fundação], e diminuindo a oportunidade de se tratar em um centro de excelência",
continuou, classificando em seguida o conselho do hospital como "uma turba", que estaria causando, com as acusações, dificuldades para a fundação obter novos empréstimos no sistema financeiro e recursos de doações. Bonadies nega a falência.

Segundo o advogado, a fundação vem pagando 1.600 funcionários que deveriam estar sob responsabilidade do governo do Estado. O hospital informou que recentemente Alckmin assumiu os salários de mais de 900 funcionários, o que melhorará a situação financeira da Fundação Zerbini.

Alckmin trata a polêmica como um desentendimento entre as duas instituições e informou que vem destinando adequadamente recursos ao Incor.

A Fundação Zerbini também está em pé de guerra com o Ministério Público do Estado de São Paulo, que acompanha o desempenho da instituição.

Ontem o advogado da entidade chamou o promotor que cuida do setor, Paulo José de Palma, de "pústula", em razão de Palma, supostamente, não ter apresentado provas de que a entidade está sob investigação do órgão público.

"Vou levar o caso à Corregedoria [do Ministério Público]", ameaçou. O promotor afirma não ter dado acesso às investigações porque o advogado não teria procuração da Zerbini para trabalhar em nome da instituição. Ele não quis comentar o xingamento do advogado e destacou que seu trabalho é técnico. Segundo Palma, há seis investigações sigilosas na Promotoria sobre a fundação.

Outro lado

Nota emitida ontem pela Secretaria de Estado da Saúde diz que as afirmações do cardiologista José Ramires, hoje presidente do Incor de São Paulo, "são inverídicas".

"De maneira nenhuma há dívida entre a Fundação Zerbini e a Secretaria de Estado da Saúde", diz o texto, ao comentar a informação dos advogados do médico de que o governo não teria feito os repasses para a fundação.

"Como afirmou o conselho deliberativo do Hospital das Clínicas, ao qual o Incor é subordinado, a secretaria repassou R$ 600 milhões ao Incor em dez anos, ou seja, R$ 60 milhões por ano", destaca o texto da pasta.

A secretaria também negou que tenha existido um compromisso do ex-governador Mário Covas de pagar um empréstimo assumido pela Fundação Zerbini com o BNDES.

No texto, o governo destaca ainda que o atendimento não será afetado. "Vale ressaltar que a secretaria acredita que as divergências entre HC e Incor serão resolvidas o mais breve possível. A pasta acompanha o caso [...] e confia nas informações do HC de que não há a menor possibilidade do atendimento à população ser prejudicado", diz a nota.

Em entrevista ontem, o HC informou que o governo autorizou a criação de mais de 900 cargos públicos no Incor, em substituição às vagas privadas, que entravam nos gastos da Zerbini. Assim, diz acreditar o conselho deliberativo, a fundação terá folga para saldar a dívida com o BNDES.

O advogado da fundação, Paulo Bonadies, diz que hoje um total de 3.000 funcionários do Incor têm salários pagos pela fundação.

American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke

American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke: "AHA News
12/21/2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association 2005 year-end report:
DALLAS, Dec. 21 - Cell recycling - using a person's own bone marrow - to repair the heart; a gene that may make it possible to predict which patients may benefit from a particular therapy, and a drug that may help smokers reduce their cravings for nicotine, are among the American Heart Association's top 10 research advances in heart disease and stroke for 2005, said Robert Eckel, M.D., president of the American Heart Association.
Other major milestones include hot and cold therapy for stroke rehabilitation, and a study that extended the range of patients that might benefit from prophylactic implantable defibrillators.
The American Heart Association's Top 10 list was created in 1996. Each year's list highlights major gains in heart disease and stroke research.
This year's achievements include:
1. Cell recycling regenerates ailing hearts. Heart attack survivors infused with stem-like cells from their own bone marrow had nearly twice the improvement in their heart's pumping ability as patients given a placebo. Reporting on the 'Intracoronary Infusion of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction: A Randomized, Double-Blind, Placebo Controlled Multicenter Trial (REPAIR),' German researchers said the study is a landmark trial that demonstrates the potential of progenitor therapy for restoring heart function. A second study by another group of German researchers showed that implanting bone marrow cells into blood-starved legs can help people with peripheral "/.../

Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ

Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ: "The panels that the Mexican muralist Diego Rivera created for the Mexican National Institute of Cardiology in the 1940s evince a populist concern and celebrate medical technology
The murals Diego Rivera executed for the National Institute of Cardiology in Mexico City (figures 1 and 2) are a testament to his talents as a painter as well as to his prodigious energy. The History of Cardiology consists of two panels of 6 m by 4 m and were completed in time for the inauguration of the new institute building on 18 April 1944. "

Erectile Dysfunction a Sign of Looming Heart Risks -

Erectile Dysfunction a Sign of Looming Heart Risks - CME Teaching Brief - MedPage Today: "When patients present with erectile dysfunction, even if no cardiac symptoms are currently present, be aware of the increased risk of future cardiovascular disease, assess risk factors, and intervene as appropriate. "

Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of

Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of Care and Outcomes Research Interdisciplinary Writing Group. Cosponsored by the Council on Epidemiology and Prevention and the Stroke Council Endorsed by the American College of Cardiology Foundation

Abstract--With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.

Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation

Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation:
"Background? Although the mechanisms are unknown, it has been suggested that transient exposure to traffic-derived air pollution may be a trigger for acute myocardial infarction. The study aim was to investigate the effects of diesel exhaust inhalation on vascular and endothelial function in humans.
Methods and Results? In a double-blind, randomized, cross-over study, 30 healthy men were exposed to diluted diesel exhaust (300 ?g/m3 particulate concentration) or air for 1 hour during intermittent exercise. Bilateral forearm blood flow and inflammatory factors were measured before and during unilateral intrabrachial bradykinin (100 to 1000 pmol/min), acetylcholine (5 to 20 ?g/min), sodium nitroprusside (2 to 8 ?g/min), and verapamil (10 to 100 ?g/min) infusions 2 and 6 hours after exposure. There were no differences in resting forearm blood flow or inflammatory markers after exposure to diesel exhaust or air. Although there was a dose-dependent increase in blood flow with each vasodilator (P<0.0001 for all), this response was attenuated with bradykinin (P<0.05), acetylcholine (P<0.05), and sodium nitroprusside (P<0.001) infusions 2 hours after exposure to diesel exhaust, which persisted at 6 hours. Bradykinin caused a dose-dependent increase in plasma tissue plasminogen activator (P<0.0001) that was suppressed 6 hours after exposure to diesel (P<0.001; area under the curve decreased by 34%).
Conclusions? At levels encountered in an urban environment, inhalation of dilute diesel exhaust impairs 2 important and complementary aspects of vascular function in humans: the regulation of vascular tone and endogenous fibrinolysis. Thes"

Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use:

Twenty-Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use: The Minnesota Heart Survey, 1980-1982 to 2000-2002 -- Arnett et al. 112 (25): 3884 -- Circulation: "Background� Although US cholesterol concentrations have dropped, &50% of adults have total cholesterol concentrations 5.18 mmol/L, putting them at 'borderline-high risk' for heart disease. Whether the decline has continued into the 21st century is unknown. We assessed 20-year trends in cholesterol, hypercholesterolemia, lipid-lowering drug use, and cholesterol awareness, treatment, and control from Minnesota Heart Survey (MHS) data.
Methods and Results� Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis�St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and contro"

Standardized Cardiovascular Disease Mortality from 1980 to 1999 - Brazil

Balanced Cardiovascular Disease Mortality from 1980 to 1999 - Brazil
Gl�ucia Maria Moraes Oliveira, Nelson Albuquerque Souza e Silva, Carlos Henrique Klein Universidade Federal do Rio de Janeiro, Escola Nacional de Sa�de P�blica e Secretaria de Estado de Sa�de do Rio de Janeiro - Rio de Janeiro, RJ - BrazilOBJECTIVE
To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), S�o Paulo (SP) and Rio Grande do Sul (RS) and respective capitals, from 1980 to 1999.
METHODS
Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro?s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions.
RESULTS
Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively.
CONCLUSION
A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.

Indicadores de Saúde no Brasil

Indicadores de Saúde no Brasil
Aloyzio Cechella Achutti
Health Indicators in Brazil
In the circulatory diseases chapter of this issue of Arquivos Brasileiros de Cardiologia, Dr. Gláucia M.M.Oliveira analyzes mortality data in the states of Rio de Janeiro, São Paulo, Rio Grande do Sul and their respective capitals, during the period of 1980-19991./.../

Nesta edição dos Arquivos Brasileiros de Cardiologia, a Dra. Gláucia M. M. Oliveira publica uma análise sobre dados de mortalidade, no capítulo das doenças do aparelho circulatório, para os estados do Rio de Janeiro, São Paulo, Rio Grande do Sul e suas capitais, no período de 1980-19991./.../

Determinantes Sociais e Econômicos de Saúde e Doença

Caros amigos,

Enviei para toda a lista AMICOR uma mensagem com copia anexa de um documento preliminar sobre uma proposta para formar um grupo virtual de estudos e de trabalho sobre Determinantes Sociais e Econômicos de Saúde e Doença.

Sugestões, críticas e adesões serão sempre benvindas.

A proposta será discutida com quem tiver condições de comparecer na reunião ordinária do Servilo de Cardiologia do Hospital Moinhos de Vento, no próximo dia 15, 5a. feira, das 7:30 às 8:30 da manhã.

Quem não o tiver recebido pode solicitar para meu endereço.

Um abraço a todos

AA

Lown Fellowship in Cardiovascular Disease in the Developing World

ProCOR: "Lown Fellowship in Cardiovascular Disease in the Developing World
The Lown Fellowship in Cardiovascular Disease in the Developing World offers:
- Emphasis on clinical and community research
- One-year training period
- No ECFMG certificate requirement

The Fellowship was developed in 2002 by the Lown Cardiovascular Center (www.lowncenter.org), which promotes a non-invasive, patient-focused model of cardiovascular care that is particularly applicable in low-resource settings as well as in countries like the US. This model of care has been practiced at the Lown Cardiovascular Center for more than 40 years with demonstrated efficacy ('Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease' Am J Cardiol 2004;93:294-299.)

We invite inquiries and applications from promising candidates who meet the specified criteria outlined below.
Shmuel Ravid, MD, MPH
Director
Lown Fellowship in Cardiovascular Disease in the Developing World
Lown Cardiovascular Research Foundation"

The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ

The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ: "The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031, but the number of people aged under 65 will change little during this period (table). The increase in the number of older people will likely lead to an increase in the number of people who have chronic diseases, including cardiovascular disease. This will impose further workload and financial pressures on the NHS. We examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation."

Peripheral Arterial Disease Guidelines Push Early Diagnosis -

Peripheral Arterial Disease Guidelines Push Early Diagnosis - CME Teaching Brief - MedPage Today: "Be aware that the new peripheral arterial disease guidelines recommend the use of targeted questions to identify patients.


Explain to patients that the guidelines, issued by the major cardiovascular professional societies, emphasize the relationship between coronary artery disease and peripheral arterial disease. "/.../

Avoiding heart attacks and strokes: Don't be a victim, protect yourself

WHO | Avoiding heart attacks and strokes:
Don't be a victim, protect yourself:
"Cardiovascular diseases are killing more and more people around the world, striking rich and poor alike. Those who survive a heart attack or stroke often need to take long-term medical treatment. If you have ever had a heart attack or stroke, or had to care for someone who has, you will know that these diseases can seriously affect the life of both the patient and his or her family. The effects can even reach beyond the family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you should read this booklet. It explains why heart attacks and strokes happen and how you can avoid them. It tells you what you should do to avoid becoming a victim. This publication is available for free download, hard copies can be ordered from WHO Press.
Short summary [pdf 34kb]
Part 1. What you should know [pdf 1.52Mb]
Part 2. What you can do [pdf 776kb]
Full report [pdf 2.16Mb]

guidelines to raise HDL levels

Today in Cardiology: "Cardiologists and other experts at Johns Hopkins University have issued interim guidelines for physicians on how best to treat low levels of HDL cholesterol and help keep arteries clear from LDL buildup.
In an article published online in the New England Journal of Medicine, the researchers reported that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol."

Coffe and hypertension

Caro Prof. Dr AAchutti, sugiro a leitura aos que se dedicam a pesquisa, prevenção e tratamento da hipertensao arterial dos artigos anexos e da Carta Medica - pags 5 e 6- anexos.
Breve esperamos colocar no mercado uma patente resultante de nossas pesquisas - um fitoterapico de cafe - , em parceria com uma industria farmaceutica nacional ( patente mundial obtida).
Saudacoes
Darcy Lima
Darcy Roberto Lima [drlima@cafeesaude.com.br]

Context Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain.

Objective To examine the association between caffeine intake and incident hypertension in women.
Design, Setting, and Participants Prospective cohort study conducted in the Nurses’ Health Studies (NHSs) I and II of 155 594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires.
We also tested the associations with types of caffeinated beverages.
Main Outcome Measure Incident physician-diagnosed hypertension.
Results During follow-up, 19 541 incident cases of physician-diagnosed hypertension
were reported in NHS I and 13 536 in NHS II. In both cohorts, no linear association
between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend=.29; NHS II, P for trend=.53). Using
categorical analysis, an inverse U-shaped association between caffeine consumption
and incident hypertension was found. Compared with participants in the lowest uintile
of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I,8%-18%;in NHSII, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001).
Conclusion No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted.
JAMA. 2005;294:2330-2335 www.jama.com

C-reactive protein and its role in metabolic syndrome

The Lancet 2005; 366:1954-1959
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]
DOI:10.1016/S0140-6736(05)67786-0

C-reactive protein and its role in metabolic syndrome: mendelian randomisation study
Nicholas J Timpson a , Debbie A Lawlor a, Roger M Harbord a, Tom R Gaunt b, Ian NM Day a b, Lyle J Palmer a c, Andrew T Hattersley d, Shah Ebrahim a, Gordon DO Lowe e, Ann Rumley e and George Davey Smith a

Summary
Background
Circulating C-reactive protein (CRP) is associated with the metabolic syndrome and might be causally linked to it. Our aim was to generate estimates of the association between plasma CRP and metabolic syndrome phenotypes that were free from confounding and reverse causation, to assess the causal role of this protein.

Methods
We examined associations between serum CRP concentration and metabolic syndrome phenotypes in the British Women's Heart and Health Study. We then compared these estimates with those derived from a mendelian randomised framework with common CRP gene haplotypes to generate unconfounded and unbiased estimates of any causal associations.

Findings
In a sample of British women, body-mass index (BMI), systolic blood pressure, waist-to-hip ratio, serum concentrations of HDL cholesterol and triglycerides, and insulin resistance were all associated with plasma CRP concentration. CRP haplotypes were associated with plasma CRP concentration (p<0·0001). With instrumental variable analyses, there was no association between plasma CRP concentration and any of the metabolic syndrome phenotypes analysed. There was strong evidence that linear regression and mendelian randomisation based estimation gave conflicting results for the CRP–BMI association (p=0·0002), and some evidence of conflicting results for the association of CRP with the score for insulin resistance (p=0·0139), triglycerides (p=0·0313), and HDL cholesterol (p=0·0688).

Interpretation
Disparity between estimates of the association between plasma CRP and phenotypes comprising the metabolic syndrome derived from conventional analyses and those from a mendelian randomisation approach suggests that there is no causal association between CRP and the metabolic syndrome phenotypes.

Affiliations

a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK
b Human Genetics Division, School of Medicine, University of Southampton, Southampton, UK
c Laboratory for Genetic Epidemiology, Western Australian Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
d Peninsular Medical School, University of Exeter, Exeter, UK
e Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

2nd International Conference on Women, Heart Disease & Stroke

2nd International Conference on Women, Heart Disease & Stroke

Risk of High Blood Pressure Among Young Men Increases With the Degree of Immaturity at Birth -- Johansson et al. 112 (22): 3430 -- Circulation

Risk of High Blood Pressure Among Young Men Increases With the Degree of Immaturity at Birth -- Johansson et al. 112 (22): 3430 -- Circulation: "Background� Survivors of preterm birth constitute a new generation of young adults, but little is known about their long-term health. We investigated the association between gestational age (GA) and risk of high blood pressure (HBP) in young Swedish men and whether GA modified the risk of HBP; ie, whether HBP was related to being born small for gestational age (SGA).
Methods and Results� This population-based cohort study included 329 495 Swedish men born in 1973 to 1981 who were conscripted for military service in 1993 to 2001. Multivariate linear- and logistic-regression analyses were performed. Main outcome measures were systolic and diastolic BPs at conscription. Linear-regression analyses showed that systolic BP increased with decreasing GA (regression coefficient �0.31 mm Hg/wk, P<0.001). Systolic and diastolic BPs both increased with decreasing birth weight for GA, but the association with systolic BP was most evident (regression coefficient �0.67 mm Hg per SD score in birth weight for GA, P<0.001). Compared with men born at term (GA, 37 to 41 weeks), the adjusted odd ratios (95% confidence intervals [CIs]) for high systolic BP (140 mm Hg) were as follows: moderately preterm (33 to 36 weeks), 1.25 (1.19 to 1.30); very preterm (29 to 32 weeks), 1.48 (1.30 to 1.68); and extremely preterm (24 to 28 weeks), 1.93 (1.34 to 2.76). Being SGA was associated only with an increased risk of high systolic BP among men born at 33 weeks or later. The risk estimates for high diastolic BP (90 mm Hg) increased with decreasing GA, but the risk reached significance only among men born moderately preterm.
Conclusions� Preterm bir"

Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting

PLoS Medicine: Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting: "A clinical trial is a research study in which human volunteers are treated and observed to an-swer a particular biomedical question. Clinical trials are one of the most valuable sources of evidence to determine which therapies are safe and effective. However, instances of selective re-porting of results to benefit proprietary interests rather than public health have recently come to light. For example, in 2004, GlaxoSmithKline settled a US$2.5 million lawsuit for suppressing trial results showing that its antidepressant paroxetine (Paxil) increased suicidal ideation in children [1]. More re-cently, Merck and Pfizer have been criticized for with-holding results showing increased risk of heart disease from COX-2 drugs such as rofecoxib (Vioxx) [2�4], which was withdrawn from the market because of these risks.
A complete public register of trials and the subsequent release of all results are crucially impor-tant to prevent drug and device makers from skewing the public record on the effectiveness of therapies. However, even when local laws require that trials be registered, compliance has been incomplete. In the United States, the Food and Drug Administration Modernization Act [5] requires that all trials on life-threatening diseases be registered into ClinicalTrials.gov (a register maintained by the National Institutes of Health), yet only 48% of industry-sponsored trials were registered during the initial period of the law's implementation [6]. Moreover, trials are sometimes registered with uninformative data (e.g., not giving the name of the tested drug) [7], thus subverting the central purpose of registration, which is to increase transparency."/.../

Cardiopulmonar Resuscitation - Part 1: Introduction

Part 1: Introduction -- , 10.1161/CIRCULATIONAHA.105.166550 -- Circulation
This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American
Heart Association in Dallas, Texas, January 23–30, 2005.These guidelines supersede the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care./.../

Several other chapters follow on the same issue. The addresses to *.pdf are to open access.

Part 2: Ethical Issues
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166551
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166551v1?etoc

Part 3: Overview of CPR
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166552
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166552v1?etoc

Part 4: Adult Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166553
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166553v1?etoc

Part 5: Electrical Therapies. Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166554
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166554v1?etoc

Part 6: CPR Techniques and Devices
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166555
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166555v1?etoc

Part 7.1: Adjuncts for Airway Control and Ventilation
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166556
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166556v1?etoc

Part 7.2: Management of Cardiac Arrest
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166557
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166557v1?etoc

Part 7.3: Management of Symptomatic Bradycardia and Tachycardia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166558
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166558v1?etoc

Part 7.4: Monitoring and Medications
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166559
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166559v1?etoc

Part 7.5: Postresuscitation Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166560
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166560v1?etoc

Part 8: Stabilization of the Patient With Acute Coronary Syndromes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166561
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166561v1?etoc

Part 9: Adult Stroke
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166562
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166562v1?etoc

Part 10.1: Life-Threatening Electrolyte Abnormalities
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166563
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166563v1?etoc

Part 10.2: Toxicology in ECC
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166564
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166564v1?etoc

Part 10.3: Drowning
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166565
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166565v1?etoc

Part 10.4: Hypothermia
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166566
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166566v1?etoc

Part 10.5: Near-Fatal Asthma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166567
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166567v1?etoc

Part 10.6: Anaphylaxis
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166568
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166568v1?etoc


Part 10.7: Cardiac Arrest Associated With Trauma
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166569
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166569v1?etoc

Part 10.8: Cardiac Arrest Associated With Pregnancy
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166570
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166570v1?etoc

Part 10.9: Electric Shock and Lightning Strikes
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166571
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166571v1?etoc

Part 11: Pediatric Basic Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166572
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166572v1?etoc

Part 12: Pediatric Advanced Life Support
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166573
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166573v1?etoc

Part 13: Neonatal Resuscitation Guidelines
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166574
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166574v1?etoc

Part 14: First Aid
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.166575
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.166575v1?etoc

Major Changes in the 2005 AHA Guidelines for CPR and ECC. Reaching the Tipping Point for Change
Mary Fran Hazinski, Vinay M. Nadkarni, Robert W. Hickey, Robert Connor, Lance B. Becker, and Arno Zaritsky
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170809
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170809v1?etoc

Management of Conflict of Interest Issues in the Activities of the American Heart Association Emergency Cardiovascular Care Committee, 2000-2005
John E. Billi, Brian Eigel, William H. Montgomery, Vinay M. Nadkarni, and Mary Fran Hazinski
Circulation published 28 November 2005, 10.1161/CIRCULATIONAHA.105.170810
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.105.170810v1?etoc

Men Born Preterm at Increased Risk for High Blood Pressure -

Men Born Preterm at Increased Risk for High Blood Pressure - CME Teaching Brief - MedPage Today: "Men Born Preterm at Increased Risk for High Blood Pressure

By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: ABC News, Forbes
MedPage Today Action Points


Explain to patients with a history if premature birth that this study showed a direct and proportional association between an increase in systolic blood pressure and decreased gestational age. There was also an association between diastolic blood pressure and premature birth. "

Stress Can Cause Rising Cholesterol Levels -

Stress Can Cause Rising Cholesterol Levels - CME Teaching Brief - MedPage Today: "Stress Can Cause Rising Cholesterol Levels

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 23, 2005
Also covered by: BBC News
MedPage Today Action Points

Understand that in this study, participants who initially responded with high levels of stress to a psychological challenge test had the highest levels of cholesterol three years later.

Review
LONDON, Nov. 23 - Stress can cause cholesterol levels to climb, researchers here have found.
A study of 199 men and women here found that 'a person's reaction to stress is one mechanism through which higher lipid levels may develop,' said epidemiologist Andrew Steptoe, D.Sc., of University College London.
He and colleague Lena Brydon, Ph.D., reported in the November issue of Health Psychology that people who showed high levels of stress responses on a test designed to evoke them had more unfavorable lipid profiles three years later than did people who took the same test but managed it without stressful responses.
The participants were 199 men and women who were part of the Whitehall II study. Three years earlier it assessed demographic, psychosocial, and biological risk factors for coronary artery disease in more than 10,000 British civil servants.
The investigators measured cardiovascular, inflammatory, and hemostatic responses as participants performed moderately stressful behavioral tasks involving color and word matching on a computer screen, and tracing an image seen in a mirror.
They were evaluated for stress-induced changes in total cholesterol, LDL cholesterol concentration, HDL /.../"

Noisy Environment Linked to Heart Attack Risk - CME Teaching Brief - MedPage Today

Noisy Environment Linked to Heart Attack Risk - CME Teaching Brief - MedPage Today

Advise patients who ask that long-term exposure to high noise levels can damage hearing and recommend ear protection.

Note that this study finds a link between chronic exposure to noise and the risk of myocardial infarction, even after other risk factors are taken into account.

BERLIN, Nov. 23 - Too much noise may increase the risk of heart attack, European researchers say.
In a large case-control study, chronic exposure to environmental noise was associated with an increased risk of myocardial infarction in both men and women, according to Stefan Willich, M.D., of the Charité University Medical Center here./.../

Edital Residencias: Instituto Cardiologia-FUC-RS

De: Ruschel [mailto:chaveruschel@cpovo.net]
Enviada em: segunda-feira, 21 de novembro de 2005 21:52
1.1) ENFERMAGEM: (2 ANOS) ...................... 06 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.2) FISIOTERAPIA: (2 ANOS) ....................... 04 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.3) NUTRIÇÃO: (2 ANOS) ........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.4) PSICOLOGIA: (2ANOS)........................... 02 vagas
(Pré-requisito: Curso de graduação na área correspondente, registro no devido conselho regional)
1.5) MEDICINA: Cardiologia (13 vagas), Área de Atuação Cardiologia Pediátrica (2 vagas), Cirurgia Cardiovascular (2 vagas), Radiologia e Diagnóstico Por Imagem (2 vagas), ver Edital específico a ser publicado em 28 de outubro de 2005 no Jornal Zero Hora e no site www.cardiologia.org.br

Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery -- Zacharias et al. 112 (21): 3247 -- Circulation

Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery -- Zacharias et al. 112 (21): 3247 -- Circulation: "Conclusions Obesity is an important determinant of new-onset AF after cardiac surgery. Future postoperative AF risk models should incorporate BMI or obesity levels. Studies examining the efficacy of AF-minimizing prophylactic interventions in high-BMI patients, particularly in the elderly, may be warranted. "

5o. Simp�sio Internacional de Cardiologia Invasiva para Clínicos

5o. Simpósio Internacional de Cardiologia Invasiva para Clínicos

Metabolic syndrome -- Khunti and Davies 331 (7526): 1153 -- BMJ

Metabolic syndrome -- Khunti and Davies 331 (7526): 1153 -- BMJ
Independently raises cardiovascular risk and should be picked up in primary care


Metabolic syndrome is characterised by hyper-insulinaemia, low glucose tolerance, dyslipidaemia, hypertension, and obesity. This cluster of factors has been recognised for many years, but the syndrome was not formally labelled until Reaven did so in 1988 and suggested that insulin resistance was its central characteristic.1 Insulin resistance seems to be the main underlying factor leading to the increased risk of mortality from coronary heart disease among people with the syndrome.2 Strategies to combat the forecast epidemic of type 2 diabetes and its vascular complications should focus on preventing and intervening early in metabolic syndrome./.../

It is becoming increasingly clear that a proinflammatory state is a common feature of the syndrome and of atheromatous disease. A recent randomised controlled trial showed that insulin resistance and measurements of C reactive protein were significantly lower at two year follow-up in patients with metabolic syndrome who had been allocated to a Mediterranean diet than in those who continued their normal diets.12 Although large intervention studies have shown that intensive modification of lifestyle delays the onset of diabetes in patients with impaired glucose tolerance,w9 no similar trials have aimed at reducing all the cardiovascular disease risk factors among people with metabolic syndrome.

Japanese study: small LDL reductions = big CHD

De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: sexta-feira, 18 de novembro de 2005 22:09
Para: undisclosed-recipients:
Assunto: MEGA (AHA News)

MEGA: Japanese study finds small LDL reductions translate into big CHD
protection

Nov 16, 2005. Michael O'Riordan
Dallas, TX - The addition of a low-dose statin to a low-fat diet rich in
fish reduced the risk of coronary heart disease in a Japanese study of
individuals with moderately elevated cholesterol levels. Investigators
report that the combination of diet and pravastatin 10 mg reduced the risk
of CHD by 33%, approximately the same reduction observed in US and European
primary-prevention trials that have used larger statin doses.


The results of the Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese (MEGA) study were presented today at the
American Heart Association Scientific Sessions 2005. Lead investigator Dr
Haruo Nakamura (National Defense Medical College, Saitama, Japan) said the
purpose of the Japanese study was to examine whether the addition of a
low-dose statin to a diet rich in omega-3 fatty acids could reduce the risk
of CHD. In Japan, the incidence of coronary disease is about one third lower
than the US and Europe, where most of the statin trials have been conducted,
but the risk of stroke and cancer is higher.

Dr Daniel Rader (University of Pennsylvania School of Medicine,
Philadelphia), who commented on the study during the late-breaking
clinical-trials session, called the MEGA study a landmark primary-prevention
trial for the Asian population, not unlike the West of Scotland Coronary
Prevention Study (WOSCOPS) and the Air Force/Texas Coronary Atherosclerosis
Prevention Study (AFCAPS/TexCAPS). He said the results support the concept
that a modest shift in population cholesterol distribution can have a major
impact on the incidence of coronary disease and will spur debate about the
role low-dose statin therapy might have in achieving such a shift.

"The MEGA study will undoubtedly have a major impact on the treatment of
hypercholesterolemia in Asia, as it provides reassurance of safety and proof
of benefit of low-dose statin therapy," said Rader. "It should have impact
in the West, as well. These results suggest that the potential for the
broader use of low-dose statin therapy make it important to utilize
available approaches to identify that subset of healthy individuals who are
at high risk and may merit statin therapy despite only modestly elevated LDL
cholesterol."

Relatively low risk patients

The MEGA study was a prospective, randomized, open-label trial comparing
diet and pravastatin 10 mg with diet alone for the reduction of
first-occurrence CHD in 7832 patients. Of those randomized to statin
therapy, approximately 25% were uptitrated to the 20-mg dose of pravastatin.
The diet followed by patients was low in total cholesterol, low in saturated
fat, and included at least three servings of fish per week.

Average baseline LDL cholesterol levels were 156 mg/dL in both study arms
before treatment. Mean HDL-cholesterol levels were relatively high,
measuring 57 mg/dL in both treatment groups. During a mean follow-up of 5.3
years, treatment with pravastatin 10 mg significantly decreased total- and
LDL-cholesterol levels, 11.5% and 18%, respectively.

The MEGA investigators report that treatment with pravastatin reduced the
risk of CHD 33% compared with patients randomized to diet alone. Although
the absolute benefit was small, a little over a 1% absolute reduction in
risk, the number needed to treat to prevent one additional CHD event was
119.

MEGA: Primary and secondary end points

End point
Hazard ratio (95% CI)

Coronary heart disease (a composite end point of fatal/nonfatal MI, angina,
cardiovascular death, need for revascularization)
0.67 (0.49-0.91)

Coronary heart disease and cerebral infarction
0.70 (0.54-0.90)

Stroke
0.83 (0.57-1.21)

Total mortality
0.72 (0.51-1.01)

Speaking with heartwire, Nakamura said that the relatively small reduction
in LDL-cholesterol levels translated into a statistically significant
reduction in CHD risk, a reduction similar to those observed in the major
lipid-lowering studies. Asked why the 10- to 20-mg dose of pravastatin
yielded benefit that was previously achieved with 20- to 40-mg doses of
pravastatin in the US and Europe, he said he suspects that the traditional
Japanese diet and baseline HDL-cholesterol levels were cardioprotective.

"We understand that LDL cholesterol is very important for developing
coronary heart disease, but not only LDL is important. Levels of HDL are
also important, and there are many studies that have showed a protective
benefit of HDL cholesterol against coronary heart disease. In general,
Japanese people usually have high HDL cholesterol, about 10 mg/dL higher
than people in the US, so this might have provided some protective benefit
that allowed us to reduce the dose of statin in this trial."

Cartilha do Coração para Crianças

Acaba de ser concluída a cartilha brasileira de prevenção das doenças cardiovasculares em crianças e adolescentes. É a primeira vez que se estabelece quais os parâmetros ideais para a população infanto-juvenil controlar os fatores de risco para infartos e derrames. Com divulgação prevista para esta semana, durante um congresso da Sociedade Brasileira de Cardiologia, o documento traz recomendações sobre peso, pressão arterial, colesterol, atividades físicas, alimentação e níveis de açúcar no sangue. Até agora, alguns médicos aplicavam aos jovens as mesmas diretrizes destinadas aos adultos. Outros adotavam normas estrangeiras – que podiam ser tanto americanas quanto dinamarquesas ou canadenses. A falta de consenso comprometia o diagnóstico e o tratamento dos males que predispõem a infartos e derrames. "A partir de agora, os médicos brasileiros contam com uma ferramenta bastante precisa para preservar a saúde cardiovascular futura dos meninos e meninas de hoje", diz o cardiologista Bruno Caramelli, diretor do departamento de aterosclerose da Sociedade Brasileira de Cardiologia e um dos autores da cartilha.

Criado pelas sociedades brasileiras de cardiologia, pediatria, endocrinologia pediátrica e hipertensão, o documento tem por objetivo conter o avanço de distúrbios tipicamente adultos entre meninos e meninas. A vida sedentária, as dietas gordurosas, a obesidade e o stress estão fazendo com que males como a hipertensão, o colesterol alto e o diabetes comecem a manifestar-se ainda na infância. "Se não controlarmos esse quadro, em menos de três décadas não haverá hospital disponível para abrigar tantos infartados", diz a pediatra Isabela Giuliano, pesquisadora do Instituto do Coração, em São Paulo. Estudos baseados na necropsia de crianças vítimas de morte inesperada mostram que, apesar da idade, algumas apresentavam artérias repletas de estrias, sinal da agressão sofrida pelos vasos sanguíneos e indício de problemas cardiovasculares no futuro. Um desses estudos, publicado na revista científica The New England Journal of Medicine, em 1998, revelou que quase 30% dos meninos e meninas de 2 a 15 anos já tinham as artérias coronárias e a aorta comprometidas.

Estabelecer os níveis ideais de glicemia, colesterol, pressão arterial ou peso para crianças e adolescentes não é tarefa simples. Um bom exemplo é o colesterol. O perfil lipídico de um homem de 40 anos, por exemplo, pode ser muito semelhante ao de outro vinte anos mais velho. O mesmo não acontece, porém, entre um garoto de 1 ano e outro de 5. Até os 2 anos, o colesterol tende a ser abundante na circulação, já que é matéria-prima para a produção de GH, o hormônio do crescimento, e para a maturação dos neurônios (veja quadro). Embora seja mais fácil mudar hábitos de vida de crianças e adolescentes, pelo fato de que ainda não estão tão arraigados, isso exige estratégias de convencimento e educação que devem envolver pais, educadores e médicos. "Não basta dizer a uma criança que o consumo exagerado de gordura pode fazer mal às suas artérias", diz a pediatra. "Mesmo que ela se convença, é provável que se sinta constrangida ao chegar à escola com um sanduíche natural."

Há cerca de dois anos, quando Djeneffer Cris Antero, hoje com 13 anos, recebeu o diagnóstico de colesterol alto, sua mãe até tentou mostrar-lhe o perigo que isso representava. Em vão. A garota continuou preferindo doces e frituras a frutas e verduras. Também não se incomodou em se engajar numa atividade física. Recentemente, Djeneffer descobriu que também sofre de diabetes tipo 2. "Agora eu me assustei de verdade. É muito chato não poder comer o que quero, quando quero, mas vou fazer de tudo para me cuidar." Vale a pena, em nome de um coração saudável por muitos anos.

Managing Abnormal Blood Lipids: A Collaborative Approach -- Fletcher et al. 112 (20): 3184 -- Circulation

Managing Abnormal Blood Lipids: A Collaborative Approach -- Fletcher et al. 112 (20): 3184 -- Circulation

Abstract—Current data and guidelines recommend treating abnormal blood lipids (ABL) to goal. This is a complex process and requires involvement from various healthcare professionals with a wide range of expertise. The model of a multidisciplinary case management approach for patients with ABL is well documented and described. This collaborative approach encompasses primary and secondary prevention across the lifespan, incorporates nutritional and exercise management as a significant component, defines the importance and indications for pharmacological therapy, and emphasizes the importance of adherence. Use of this collaborative approach for the treatment of ABL ultimately will improve cardiovascular and cerebrovascular morbidity and mortality. (Circulation. 2005;112:3184-3209.)

Cardiovascular Disease Mortality in Men

Cardiosource: "Revised Adult Treatment Panel III Guidelines and Cardiovascular Disease Mortality in Men Attending a Preventive Medical Clinic
Topic: Prevention/Vascular
Date Posted: 11/5/2005
Author(s): Ardern CI, Katzmarzyk PT, Janssen I, Church TS, Blair SN.
Citation: Circulation. 2005;112:1478-1485.

Study Question: What is the relative contribution of cardiovascular fitness (CardFit) and the metabolic syndrome on cardiovascular disease (CVD) mortality within each intervention window, as defined by the revised Adult Treatment Panel (ATP) III guidelines (ATP III-R)?
Methods: Risk factor and CardFit data from 19,125 men (aged 20-79 years) who attended a preventive medical clinic between 1979 and 1995 were used. Mortality follow-up was completed until December 31, 1996. Five classic risk factors were considered: age =45 years, family history, current smoker, hypertension, and low high-density lipoprotein cholesterol (HDL-C). Participants were assigned to one of four ATP III-R groups (high risk as coronary heart disease [CHD] or CHD risk equivalent, moderate risk as 2+ risk factors or 10-year Framingham risk of 10-20%, moderate risk 10-year risk <10%, and low risk 0-1 risk factor). The ATP III-R group was then used to assign one of the groups: LDL-C at goal, therapeutic lifestyle change (TLC) initiation, and drug consideration. Unfit was defined as in the lowest age-adjusted lowest quintile. The risk of CVD mortality was assessed by Cox proportional hazards regression.
Results: Mean age was 45 years; 58% were classified as being at the LDL goal, whereas 18% were eligible for TLC initiation and 24% for drug treatment. There were 179 CVD deaths over an average 10.2 years of follow-up. Compared with those with LDL-"

Guidelines, Lighthouses, and a Toe in the Water

Artigos na �ntegra - Merck Sharp & Dohme: "Guidelines, Lighthouses, and a Toe in the Water
[Editorial]
Holmes, David R. Jr MD; Hodgson, Patricia BA; Singh, Mandeep MD
From Mayo Clinic (D.R.H., M.S.), Rochester, Minn, and Duke Clinical Research Institute (P.H.), Durham, NC.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Mandeep Singh, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
A guideline tells you how to get someplace, whereas a lighthouse keeps you off the rocks; both can shepherd you on a safe journey toward your goal. The American College of Cardiology (ACC), in concert with the American Heart Association (AHA), has been at the forefront of developing guidelines for percutaneous coronary interventions (PCI).1 In an era in which there are multiple data sets to draw from, guidelines help to sort out optimal from less optimal evidence-based approaches. Application of these guidelines makes intuitive sense as we counsel our individual patients about the risk/benefit ratio of PCI and as we develop treatment strategies for healthcare delivery systems to employ."/.../

Putting theory into practice: First survey to show that following guidelines improves outcomes
Nov 1, 2005 Lisa Nainggolan

Houston, TX - The first survey of its kind—involving more than 400 000 patients—has shown that following evidence-based guidelines for cardiac care can improve patient outcomes [1]. The results are published online before print October 31, 2005 in Circulation.

This is a reminder that guidelines can work and be useful.

"This research shows that carefully crafted guidelines can be used to improve quality of care and outcomes. This has not been shown before," lead author Dr H Vernon Anderson (University of Texas Health Science Center, Houston) commented to heartwire.

Anderson said that previous studies have revealed that adoption of effective clinical practices can be scattered, inconsistent, and haphazard, and there can be a tendency for doctors to feel "guideline fatigue" when new recommendations are issued. "But this is a reminder that guidelines can work and be useful," he stressed.

Physicians heeding guidelines
Anderson and colleagues say that the US National Cardiovascular Data Registry (NCDR) was established several years ago to provide an objective mechanism to assess guidelines-based practice. This is the first look at outcomes from the NCDR, which will be used by the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines Committee to periodically reassess and revise clinical practice guidelines.

Using the NCDR, the researchers analyzed the impact of the 2001 ACC/AHA recommendations for selecting patients most likely to benefit from percutaneous coronary interventions [2]. (Procedures for ST-elevation MI were excluded.) They examined patient records from 363 hospitals during the 39 months after the 2001 guidelines were released: 412 617 patients underwent PCI and could be classified according to the recommendations.

The data show that physicians in the participating hospitals (94% community hospitals and 6% university hospitals) seemed to be heeding the guidelines when selecting patients for PCI.

Of all the procedures performed on patients, 64% were designated (according to the guidelines) as class I (medical evidence for and/or general agreement that the procedure is useful and effective) and 21% were class IIa (weight of evidence is in favor of the usefulness).

Of the PCIs, 7% of the procedures conducted were class IIb (usefulness/efficacy is less well established) and 8% were class III (medical evidence and/or general agreement that the procedure is not useful or effective and in some cases may be harmful).

Clinical success declined from almost 93% of class I procedures to 85% of class III procedures. Adverse events (MI, CABG, and death) were generally lower in the class I procedures and highest in class III procedures (with the exception of CABG in class III, which was thought by the researchers to be due to the high percentage of previous CABG in these patients).

Adherence to guidelines associated with better outcomes
The review found a relationship among procedure indications, clinical success, and adverse events, and discovered that a small number of procedures are being carried out against recommendations.

"We observed that most PCI procedures were done for class I indications and that only a small fraction were done against recommendations," the researchers say. "This finding suggests that PCI practice conforms to the guidelines to a large extent, [and] adherence to the recommended indications for PCI was associated with better outcomes.

"A more careful consideration of procedures with class IIb and III indications might improve clinical outcomes and, by extension, the quality of patient care," they note. However, they add that understanding the reasons PCIs are done against recommendations "may provide valuable clues . . . into new or developing approaches."

"Over time, the evidence and the guidelines will change, as they should, and there will always be special cases, but overall, the quality of patient care will be improved by a conscious effort to adhere to guideline recommendations," Anderson concludes.

Sources

Anderson HV, Shaw RE, Brindis RG, et al. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force Guidelines. Circulation 2005; DOI: 10.1161/CIRCULATIONAHA.105.553727. Available at http://circ.ahajournals.org.
Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001; 37:2215-2239.

WHO Study on Prevention of Recurrences of Myocardial Infarction and Stroke

820.pdf (application/pdf Object)
This work on Secondary Prevention of Cronary and Cerebro Vascular Disease, has the contribution of at least three members of th AMICOR list: Shanti Mendis, Jefferson G. Fernandes and E. Moriguchi.

MDGs: chronic diseases are not on the agenda

The Lancet:
Valentin Fuster and Janet Voûte

"2005 marks the fifth anniversary of the adoption of the UN's Millennium Declaration, signed by 189 countries and translated into eight Millennium Development Goals (MDGs) to be accomplished by the year 2015. The medical and public-health communities should rejoice that these eight goals include three specifically focused on health. There is a growing recognition worldwide that the time has come to fulfil the long-standing pledge to make health services available for all.1 The three explicit health goals elaborated in 2000 were: to reduce child mortality by two-thirds relative to 1990; to improve maternal health, including reducing maternal mortality by three-quarters relative to 1990; and to prevent the spread of HIV/AIDS, malaria, and other diseases. But, in 2000, and again during a ten-taskforce review in 2005, cardiovascular disease (CVD) and other chronic diseases are not mentioned. This omission can, and must, be rectified."/.../

Forum HIPERDIA

De: Carlos Alberto Machado [mailto:carlos.a.machado@uol.com.br]
Enviada em: quinta-feira, 27 de outubro de 2005 22:26
Assunto: Fw: Fórum Hiperdia

Por favor, divulguem.

Carlos Alberto Machado
----- Original Message -----
From: "Patricia Serapião Coimbra"
To:
Sent: Wednesday, October 26, 2005 3:07 PM
Subject: Fórum Hiperdia

Prezados membros da Comunidade Hiperdia:

Um dos mais freqüentes desejos dos técnicos e usuários do
Sistema Hiperdia tem sido a solicitação para a formação de um espaço
destinado à troca de experiências, críticas e sugestões.

Rotineiramente, a equipe de desenvolvimento e manutenção do
*Sistema Hiperdia* recebe mensagens e ligações dos muitos usuários, ora
fazendo consultas, ora elogiando o produto, ora apresentando
dificuldades, ora sugerindo modificações... enfim, um grande número de
pessoas que formam a Comunidade de Usuários do Hiperdia!

Assim sendo, nós, da Equipe Hiperdia, estamos comunicando a
criação de um FÓRUM para a discussão de assuntos ligados à Hipertensão e
Diabetes.

Para acessar, clique aqui: *Fórum do Hiperdia*


Este espaço terá dois canais, assim dispostos:

O primeiro objetiva permitir a troca de informações sobre o
Programa (CNHD):
http://forum.datasus.gov.br/viewforum.php?f=73 - dúvidas sobre
medicamentos, acompanhamentos, fichas, adesão, etc...

O outro será indicado aos usuários e operadores do Sistema
hiperdia:
http://forum.datasus.gov.br/viewforum.php?f=74 - consultas sobre
backup, importação, transmissão, etc...


É nosso desejo que o *Fórum do Hiperdia*
se torne um importante
canal de comunicação envolvendo todos aqueles que se debruçam sobre esta
importante causa...


Obs.: Para utilizar o Fórum é necessário cadastrar-se através do botão
Registrar, localizado no menu de opções da página principal do
/forum.datasus.gov.br/ ou clicando no endereço abaixo:

http://forum.datasus.gov.br/profile.php?ode=register&sid=f79526408290ffef31ccfc0a9ff9c046

http://forum.datasus.gov.br/profile.php?mode=register&sid=f79526408290ffef3
1ccfc0a9ff9c046>

Atenciosamente,

Equipe Hiperdia
MS\Datasus-RJ

The Forgotten Majority. Unfinished Business in Cardiovascular Risk Reduction

The Forgotten Majority. Unfinished Business in Cardiovascular Risk Reduction
Peter Libby, MD
Boston, Massachusetts
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]Available on request.
Despite meaningful progress in the identification of risk factors and the development of highly effective clinical tools, deaths from cardiovascular disease continue to increase worldwide. Sparked by an obesity epidemic, the metabolic syndrome and the rising incidence of type 2 diabetes have led to an upsurge of cardiovascular risk. Although pharmacologic treatments with the statin class of drugs have reduced cholesterol levels and lowered mortality rates, several large controlled clinical trials, including the Scandinavian Simvastatin Survival Study, the Cholesterol and Recurrent Events trial, the Air Force/Texas Coronary Atherosclerosis Prevention studies, and Long-term Intervention with Pravastatin in Ischemic Disease study, have indicated that cardiovascular events continue to occur in two thirds of all patients. Follow-up studies, such as the Heart Protection Study and the Pravastatin or Atorvastatin Evaluation and Infection Therapy/Thrombolysis In Myocardial Infarction-22 trials, reinforced these earlier results. Although therapy with gemfibrozil, a fibric acid derivative, showed reduced occurrence of cardiovascular events in the Helsinki Heart Study and the Veterans Affairs HDL Intervention Trial, results of other studies, e.g., the Bezafibrate Intervention Program and the Diabetes Atherosclerosis Intervention study, showed less encouraging results. Although lifestyle modifications, such as improved diet and increased exercise levels, benefit general health and the metabolic syndrome and insulin resistance in particular, most people continue to resist changes in their daily routines. Thus, physicians must continue to educate their patients regarding an optimal balance of drug therapy and personal behavior. (J Am Coll Cardiol 2005;46:1225– 8) © 2005 by the American College of Cardiology Foundation

Quotes: Geoffrey Rose

Quotes: Geoffrey Rose:
"It makes little sense to expect individuals to behave differently from their peers; it is more appropriate to seek a general change in behavioural norms and in the circumstances which facilitate their adoption.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 102
Measures to improve public health, relating as they do to such obvious and mundane matters as housing, smoking, and food, may lack the glamour of high-technology medicine, but what they lack in excitement they gain in their potential impact on health, precisely because they deal with the major causes of common disease and disabilities.
Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992, here: 101"

Stockholm Challenge

Stockholm Challenge: "The Stockholm Challenge Award 2006
THE STOCKHOLM CHALLENGE AWARD 2006 invites excellent ICT projects from all over the world to compete for the prestigious Challenge trophies. The Challenge is searching for the best initiatives that accelerate the use of information technology for the social and economic benefit of citizens and communities. The objective is to help local entrepreneurs, who work to close the digital divide, by bringing in research communities, development organisations and strong corporate initiatives.
THE AWARDS WILL BE HANDED OUT IN SIX CATEGORIES in the City Hall - on May 11, 2006. Special focus will be on projects in countries and regions with the greatest needs. There will also be an international Challenge conference in Stockholm on issues related to the role of ICTs in global development work.
THE AWARD IS OPEN FOR ENTRIES until December 31st 2005. The application form is easily accessible on the home page.
The Stockholm Challenge is headquartered at the IT University - a joint initiative by KTH (The Royal Institute of Technology) and Stockholm University. It is managed by a consortium that also includes the City of Stockholm, Ericsson and Sida, the Swedish International Development Cooperation Agency.
For more information, please contact:
Project Manager
Ulla Skid�n
ulla.skiden@stockholmchallenge.se
Telephone: + 46 8 7904469
Cell: +46 70 678 72 82
www.stockholmchallenge.se"

TIME Magazine - Global Health Conference

TIME Magazine - Global Health Conference: "TIME MAGAZINE TO CONVENE LEADERS TO DEVELOP SOLUTIONS TO GLOBAL HEALTH CHALLENGES

Speakers Include Bill Gates, Richard Branson, Lee Jong-wook, Ted Turner, Ann Veneman, Paul Farmer, Madeleine Albright, Paul Wolfowitz, Agnes Binagwaho, Rick Warren, Julie Gerberding and Bono

New York - TIME magazine will focus America's attention on global health during the TIME Global Health Summit, November 1-3, 2005, in New York City. Supported by the Bill & Melinda Gates Foundation, the TIME Summit will convene leaders in medicine, government, business, public policy and the arts to develop actions and solutions to health crises.

TIME is partnering with PBS, as well as ABC News, to reach a broad audience. On Monday, October 31, a TIME special issue on global health will hit newsstands, reaching more than 27 million readers around the world. On Nov. 1-3 from 9-11 pm (check local listings), PBS will premiere Rx for Survival "A Global Health Challenge, a six-part documentary series narrated by Brad Pitt. The series is co-produced by the WGBH/NOVA Science Unit and Vulcan Productions. Also this fall, ABC News will provide expanded coverage of global health issues. The TIME Summit will be on-the-record and open to credentialed media for news coverage.

'The developed nations of the world can no longer ignore the health crisis faced by millions of people every day,' said Jim Kelly, managing editor of TIME magazine. 'With the rapid spread of so many diseases that can be treated "and in many cases prevented " with simple interventions, TIME hopes this summit will inspire American leaders and the general public to commit the necessary resources to stop the needless deaths. This is not an insurmountable task. We have the drugs, the vaccines and the medical knowledge. "

Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina

Clayton et al. 331 (7521): 869 -- BMJ"Results 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables (in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings (if available), lipid lowering treatment, QT interval, systolic blood pressure 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event (death in 39%, myocardial infarction in 46%, and disabling stroke in 15%) or the incidence of angiography or revascularisation, which occurred in 29% of patients. Conclusion This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials. "/.../

Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patient

Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients -- Clayton et al. 331 (7521): 869 -- BMJ: "Results 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables (in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings (if available), lipid lowering treatment, QT interval, systolic blood pressure 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event (death in 39%, myocardial infarction in 46%, and disabling stroke in 15%) or the incidence of angiography or revascularisation, which occurred in 29% of patients. Conclusion This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials. "/.../

Evolution of the Heart from Bacteria to Man

Evolution of the Heart from Bacteria to Man -- BISHOPRIC 1047 (1): 13 -- Annals of the New York Academy of Sciences: "Evolution of the Heart from Bacteria to Man
NANETTE H. BISHOPRIC

This review provides an overview of the evolutionary path to the mammalian heart from the beginnings of life (about four billion years ago ) to the present. Essential tools for cellular homeostasis and for extracting and burning energy are still in use and essentially unchanged since the appearance of the eukaryotes. The primitive coelom, characteristic of early multicellular organisms (800 million years ago), is lined by endoderm and is a passive receptacle for gas exchange, feeding, and sexual reproduction. The cells around this structure express genes homologous to NKX2.5/tinman, and gradual specialization of this 'gastroderm' results in the appearance of mesoderm in the phylum Bilateria, which will produce the first primitive cardiac myocytes. Investment of the coelom by these mesodermal cells forms a 'gastrovascular' structure. Further evolution of this structure in the bilaterian branches Ecdysoa (Drosophila) and Deuterostoma (amphioxus) culminate in a peristaltic tubular heart, without valves, without blood vessels or blood, but featuring a single layer of contracting mesoderm. The appearance of Chordata and subsequently the vertebrates is accompanied by a rapid structural diversification of this primitive li"/.../

ASCOT: a tale of two treatment regimens

(referred by Marcelo Gustavo Colominas [mgcolominas@gigared.com])
ASCOT: a tale of two treatment regimens Better blood pressure, fewer deaths, and less diabetes with newer antihypertensive agents
Each year in the United Kingdom alone there are 20 000 preventable deaths from cardiovascular disease attributable to hypertension. Much of the excess mortality and associated morbidity arises from poor control of blood pressure among people known to have hypertension. For the past two years in the United Kingdom, general practitioners have had the prime responsibility for tackling this problem, along with financial incentives to meet targets for detecting and controlling high blood pressure. Yet, despite many clinical trials and guidelines, they may be unsure about which antihypertensive drug to use first and how to combine treatments.
In 2004 the National Institute for Health and Clinical Excellence (NICE) recommended thiazide or thiazide-like diuretics as the first line treatment for most patients, with the addition of blockers as the next step.w1 This echoed the advice given in the US Joint National Committee's guidelines the previous year.w2 Near simultaneous guidance from the British Hypertension Society, however, recommended for the first time drugs acting on the renin-angiotensin system—angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers—as first line treatment for "younger, non-black" patients. In effect, the resulting confusion endorsed earlier European guidelines which advocated leaving the choice of drug to individual practitioners./.../

El corralito aumentó nueve veces el riesgo de eventos vasculares |

Fabiola Czubaj
El corralito aumentó nueve veces el riesgo de eventos vasculares | LA NACION LINE: "Apenas estalló en el país la crisis de 2001, muchos argentinos trataron de buscar ayuda psicológica y médica para proteger su salud ante el malestar que produce la sensación de estar a la deriva social. A otros, en cambio, el afán de recuperar sus ahorros los empujó a descuidar el equilibrio que su psiquis necesitaba para seguir adelante.

Esto motivó a un grupo de investigadores argentinos, dirigidos por los doctores Fernando Taragano, profesor titular de psiquiatría, y Ricardo Allegri, profesor de neurología, ambos investigadores principales del Cemic, a estudiar desde fines de 2001 las consecuencias clínicas de ambas conductas. Luego de 31 meses de seguimiento, el equipo halló que el riesgo de daño cardíaco o cerebral era nueve veces mayor en los argentinos que habían sufrido de gran ansiedad y no habían aceptado ayuda. "

La crisis económica causó 20.000 muertes cardíacas

LA NACION LINE:
"La crisis económica causó 20.000 muertes cardíacas
(enviado por Marcelo Gustavo Colominas [mgcolominas@gigared.com])
Se debió al deterioro de los recursos hospitalarios; hubo 10.000 infartos no fatales por estrés

La crisis que produjo la última recesión y que llevó a la Argentina a una de las etapas más dramáticas de su historia no sólo provocó muertes en las calles en diciembre de 2001. En silencio, el deterioro hospitalario causado por el derrumbe de la economía local produjo 20.000 muertes cardíacas más que lo habitual, entre abril de 1999 y diciembre de 2002, período en el que el estrés y la depresión sin contención social provocaron 10.000 infartos más, pero no fatales.
Así lo demuestra el primer estudio que relaciona mortalidad y crisis no provocada por guerras, ataques terroristas o desastres naturales, realizado por investigadores de la Fundación Favaloro y de la Universidad de Massachussetts, Estados Unidos.
"Esta es la primera información epidemiológica oficial mundial de una crisis financiera, social y econômica que se asocia a mayor mortalidad e infarto. Hubo argentinos que sufrieron infarto por torpeza en el manejo de la cosa pública. Una proyección nacional haría presumir que hubo 20.000 muertes coronarias más entre 1999 y 2002. Esto debería servirnos de advertencia, ya que, si vuelve a pasar, los responsables de tomar las decisiones estarían provocando un genocidio', afirmó a LA NACION el doctor Enrique Gurfinkel, jefe de la Unidad Coronaria de la Fundación Favaloro y autor principal del estudio. "

WHO calls for 2% reduction a year in chronic disease mortality -- Zarocostas 331 (7520): 798 -- BMJ

WHO calls for 2% reduction a year in chronic disease mortality -- Zarocostas 331 (7520): 798 -- BMJ: "WHO calls for 2% reduction a year in chronic disease mortality
Geneva John Zarocostas
The World Health Organization has called on governments to mount a serious response to the looming 'invisible' global epidemic of chronic disease.
To ensure that sustained actions are taken worldwide, WHO has set out, in a report published this week, a new target to reduce the death rate from chronic disease by 2% each year until 2015.
This would prevent 36 million deaths "mostly in poor and middle income countries" from chronic diseases such as heart disease, stroke, cancer, respiratory diseases, and diabetes.
Of the estimated 58 million people who will die in 2005 about 35 million (60%) will die from chronic disease, the report says, and it cautions that the percentage will rise by a further 17% in the next 10 years unless urgent action is taken.
In the meantime, the number of deaths from infectious diseases is projected to decline by 3% over the next 10 years, it notes.
'This is a very serious situation, both for public health and for the societies and economies affected,' said Lee Jong-wook, WHO's director general. He added, 'The cost of inaction is clear and unacceptable.'
The report, which draws on the latest findings in nine countries (Brazil, Canada, China, India, Nigeria, Pakistan, Russia, the United Kingdom, and Tanzania), says, 'It is vitally important that the impending chronic disease pandemic is recognized, understood and acted on urgently.'
Anbumani Ramadoss, India's minister of health and family welfare, said, 'The scale of the problem we face is clear, with the projected number of deaths in India attributable to chronic diseases r"

CVD Calendar

ProCOR - Home Page:
"ProCOR's CVD Calendar compiles events taking place globally that are relevant to the prevention of cardiovascular disease in developing countries.
To submit information about an event to the calendar, email details to info@procor.org.

CVD Calendar
� 2005
� 2006
� Links for additional events "

Investing in Children's health: economic benefits

This paper argues that investing in children’s health is a sound economic decision for governments to take, even if the moral justifications for such programmes are not considered. The paper also outlines dimensions that are often neglected when public investment decisions are taken. The conclusion that can be drawn from the literature studying the relationship between children’s health and the economy is that children’s health is a potentially valuable economic investment.

The literature shows that making greater investments in children’s health results in better educated and more productive adults, sets in motion favourable demographic changes, and shows that safeguarding health during childhood is more important than at any other age because poor health during children’s early years is likely to permanently impair them over the course of their life.

In addition, the literature confirms that more attention should be paid to poor health as a mechanism for the intergenerational transmission of poverty. Children born into poor families have poorer health as children, receive lower investments in human capital, and have poorer health as adults. As a result, they will earn lower wages as adults, which will affect the next generation of children who will thus be born into poorer families.

Atherothrombosis -

NPG web focus: Atherothrombosis - Focus home: "Nature Reviews Drug Discovery is pleased to present a collection of reviews on atherothrombosis, the leading cause of morbidity and mortality. As discussed in these articles, recent progress in the understanding of the pathogenesis of atherothrombosis, and in the application of approaches to assess disease progression, has provided new impetus to the discovery and development of novel drugs for this condition."

Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome: Myocardial Ischemia Reduction with Statins

Entrez PubMed: "Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome: An analysis of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial.

Schwartz GG, Olsson AG, Szarek M, Sasiela WJ.

OBJECTIVE: We examined relations between characteristics of the metabolic syndrome, early cardiovascular risk, and effect of early, intensive statin therapy after acute coronary syndrome. RESEARCH DESIGN AND METHODS: A total of 3,038 patients in the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial were characterized by the presence or absence of a history of diabetes, a history of hypertension and/or blood pressure >/=130/>/=85, BMI >30 kg/m(2), HDL cholesterol <40 mg/dl (men) or <50 mg/dl (women), and triglycerides >/=150 mg/dl. Patients with three or more of these characteristics were categorized as having metabolic syndrome. RESULTS: A total of 38% of patients (n = 1,161) met criteria for metabolic syndrome as defined in this study and had a 19% incidence of a primary end point event (death, nonfatal myocardial infarction, cardiac arrest, or recurrent unstable myocardial ischemia) during the 16-week trial. Patients with two or fewer characteristics (n = 1,877) were classified as not having metabolic syndrome and had a 14% incidence of a primary end point event. In univariate analysis, the individual characteristics that bore a significant relation to risk were diabetes and low HDL cholesterol. In a multivariable model including age, sex, and randomized treatment ass"

The neglected epidemic of chronic disease

The Lancet: "Lancet Editor Richard Horton introduces the Chronic Diseases Series: 'Without concerted and coordinated political action, the gains achieved in reducing the burden of infectious disease will be washed away as a new wave of preventable illness engulfs those least able to protect themselves. Let this series be part of a new international commitment to deny that outcome.'
Horton R - (DOI: 10.1016/S0140-6736(05)67454-5)"

Parâmetros da boa saúde estão mais rígidos

O Globo On Line


05/10/2005 - 13h24m
Parâmetros da boa saúde estão mais rígidos

Cintia Parcias, do Globo Online
RIO - Alarmadas principalmente com o avanço da síndrome metabólica - que hoje atinge de 25% a 35% dos brasileiros e é caracterizada por alterações nos níveis de colesterol, triglicerídeos, glicose e pressão sanguínea, somadas a uma medida elevada da cintura - associações médicas vêm adotando novos padrões de avaliação e reformulando recomendações. Nos últimos anos, muita coisa mudou; mas nem todo mundo se deu conta. Abaixo, conheça a regras e parâmetros mais atualizados para garantir uma saúde de ferro e adotar um estilo mais saudável de vida.

Medidas corporais

Um dos critérios de avaliação de risco cardiovascular e de diagnóstico da síndrome metabólica é a medida da cintura. Até o início deste ano, considerava-se como limite uma circunferência de até 88 centímetros para as mulheres e 104 centímetros para os homens. Mas a partir do 65º Congresso da Associação Americana de Diabetes, realizado em junho, essas medidas baixaram.

- Ficou oficialmente estabelecido que, para se manterem na lista de pessoas saudáveis, as mulheres devem ter cintura inferior a 80 centímetros e os homens, inferior a 94 centímetros - conta o endocrinologista Walmir Coutinho, que vai presidir do 6º Congresso Latino-Americano de Obesidade, a partir do dia 25, no Rio de Janeiro. Para verificar o peso, continua valendo o cálculo do índice de massa corporal (IMC), que considera obesa a pessoa cujo resultado for superior a 30. ( Calcule o seu IMC na capa do Viver Melhor )

Alimentação

A pirâmide alimentar usada desde 1992 por profissionais e instituições de saúde para prescrever a alimentação mais adequada a cada pessoa sofreu alterações para se adaptar às Diretrizes Alimentares para os Americanos, de 2005. A nova pirâmide é resultado de diversas pesquisas realizadas pelo Departamento de Agricultura dos Estados Unidos (USDA).

- As mudanças são a tradução das descobertas científicas destes últimos anos. Entre as novidades, podemos citar a maior ênfase nos vegetais e nas frutas, a preferência por laticínios desnatados ou semi-desnatados, por grãos integrais, por frutas em vez de sucos e por gorduras líquidas em vez de sólidas. Foi ressaltada também a importância da atividade física. Antes a pirâmide nem falava nisso - explica a nutricionista Bia Rique, representante oficial no Brasil da Associação Dietética Americana no Exterior.

As divisões da atual pirâmide são verticais. Cada tira representa grupos de alimentos e têm uma largura diferente, conforme a recomendação de ingestão daqueles itens.

Atividade física

De acordo com as recomendações do Colégio Americano de Medicina, da Associação Americana do Coração e outros órgão oficiais de saúde, todos devem fazer no mínimo 30 minutos diários de atividade física moderada (como caminhada), para sair da lista de sedentários.

- Isso não garante um emagrecimento eficaz nem uma forma física invejável, mas é o básico para a pessoa ser minimamente ativa - comenta a professora de educação física Ana Paula Silva, que faz parte do Centro de Estudo do Laboratório de Aptidão Física de São Caetano do Sul (Celafiscs).

Estes 30 minutos podem ser divididos em três sessões de 10 minutos ou duas de 15. O importante é manter a freqüência.

- Será um primeiro movimento para incluir a prática de exercício no dia-a-dia. Mas a partir daí a pessoa deverá adotar um programa mais elaborado e especificamente voltado para as suas necessidades, seja perder peso, diminuir o colesterol ou fortalecer a musculatura - ressalta Ana Paula.

Pressão

A hipertensão é um importante fator de risco para diversas doenças. Mas a pressão de 140 por 90, comumente usada para caracterizar a hipertensão, já não satisfaz mais a classe médica.

- Agora trabalhamos com um limite de 130 por 80, principalmente se o paciente apresenta outros fatores de risco para a síndrome metabólica - esclarece Walmir Coutinho.

Colesterol

Há alguns anos a taxa de colesterol máxima recomendável no sangue diminuiu de 260 para 200. Atualmente, porém, o colesterol total vem perdendo importância na análise geral do risco do paciente. Hoje se observam com mais atenção os níveis do bom e do mau colesterol isoladamente. Ainda não há consenso sobre a quantidade ideal de cada um. Tampouco sobre o que teria maior impacto para melhorar a saúde: aumentar o bom ou diminuir o ruim. Estes pontos serão, inclusive, tema de debate no próximo Congresso de Obesidade. Mesmo assim, a maior parte dos médicos está trabalhando com o seguinte padrão: HDL (colesterol bom) igual ou maior que 40 e LDL (o ruim) igual ou menor que 120.

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