Tuesday, October 31, 2006
Gostaria de perguntar sobre alguma informação ou tema sobre o impacto da Prática da Atividade na reunião do SBC?
Encaminho a agenda dos programas que estamos colaborando com a TV Cultura em SP nessa sexta-feira será discutido a AF x Infarto.
Um grande abraço.
dia 03/11 – pgm 15 – AF X prevenção do infarto do miocárdio ( Claudia Forjaz / Dr. Nabil Ghaorayeb / Dr. José Aguilar Cortez)
dia 10/11 – pgm 16 – caminhada + promoção saúde ( Timóteo Araújo / Erinaldo Andrade)
dia 17/11 – pgm 17 – atividade física no setor privado (Dr. Márcio Marega)
dia 24/11 – pgm 18 – atividade física e hipertensão (Dr. Celso Amadeo)
dia 01/12 – pgm 19 – atividade física no setor públici de saúde (Dra. Marizete Medeiros)
dia 08/12 – pgm 20 – atividade física nas Ongs (Dr. Mário Albanese)
Prof. Timóteo Araújo
Monday, October 30, 2006
Entre tantas oportunidades de contato e troca de conhecimento e experiências que podem ser visitados no endereço da SBC e no Congresso Virtual, gostaria de registrar com satisfação a premiação de membros da lista AMICOR: Geniberto Paiva Campos, Carisi Polanckzyc, Nadine Clasusell juntamente com o esposo da Dra. Carisi, Dr. Rohde.
Também gostaria de assinalar que entre os candidatos à presidência da SBC constam ilustres AMICOR: Abrahão Afiune Neto, Flávio Danni Fuchs, Jorge Ilha Guimarães e Paulo César B. Jardim.
Juntamente com vários outros membros de nossa lista tive a satisfação de participar de três atividades:
- Abrindo com uma palestra a primeira sessão de temas livres sobre Epidemiologia, abordando "Ultrapassando o Setor Saúde"
- Coordenando e traçando retrato do tabagismo no BR no simpósio sobre "Tabagismo: Doença Negligenciada" com Analice Gigliotti, Jacqueline Issa e José Miguel Chatkin
- Participando de Sessão Especial sobre Tabagismo Passivo, juntamente com Aristóteles Comte de Alencar Fo. Jacqueline Scholz Issa e Silvia Maria Cury Ismael.
(Recebido de Fábio Vilas-Boas, Editor dos Arquivos Brasileiros de Cardiologia)
"A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE gradually has broadened its concerns to include ethical principles related to publication in biomedical journals./.../"
Tuesday, October 17, 2006
So what are the implications of the results of this study for clinical practice? Primarily, these data confirm that older adults with diabetes are at very high absolute risk of death from cardiovascular causes (four to five percent per year). Thus, strategies aimed at reducing these risks should be aggressively pursued among such individuals, wherever possible.
Fortunately, a range of preventive treatments of proven efficacy are at our disposal, including blood pressure lowering  and the use of statins . Intensive glucose lowering in type 2 diabetes has been shown to reduce microvascular (retinal and renal) events. However, the balance of risks and benefits of lowering haemoglobin A1c levels below seven percent (as recommended by many current guidelines), particularly with respect to macrovascular events such as myocardial infarction and stroke, remains uncertain. At least two large-scale randomised clinical trials evaluating this question are ongoing, one of which has no upper age restriction  while the other includes participants aged up to 80 years at randomisation . Importantly, to reach such targets for intensive glucose lowering, insulin therapy will be frequently required. Should the trials demonstrate that the benefits of intensive glucose lowering outweigh the risks, these data, rather than observational data suggesting possible harm associated with the use of insulin, should take precedence in guiding clinical practice."
In a pooled analysis of two phase 3 clinical trials, vernakalant (RSD1235) converted atrial fibrillation to a sinus rhythm in a median 10 minutes, and nearly all patients who converted had a persistent sinus rhythm over 24 hours, reported Ian Stiell, M.D., from the University of Ottawa, in Ontario, and colleagues.
Vernakalant is a frequency-dependent Na+ and early-activating K+ channel blocker that 'selectively prolongs the atrial refractory period without significantly altering ventricular refractoriness,' the authors said in a poster presentation at the American College of Emergency Physicians meeting.
The randomized, double-blind, placebo controlled ACT (Atrial Arrhythmia Conversion Trials) I and III studies were designed to study the efficacy and safety of vernakalant in patients using concomitant rate- or rhythm-control medications. /.../"
Friday, October 13, 2006
Additional cardiovascular risk factors associated with excess weigth in children and adolescents: the Belo Horizonte heart study
"Robespierre Q. C. Ribeiro; Paulo A. Lotufo; Joel A. Lamounier; Reynaldo G. Oliveira; José Francisco Soares; Denise Aparecida Botter
Universidade de São Paulo e Universidade Federal de Minas Gerais - São Paulo, SP - Minas Gerais, MG
OBJETIVO: Examinar a associação de sobrepeso e obesidade com perfis de atividade física, pressão arterial (PA) e lípides séricos. MÉTODOS: Inquérito epidemiológico com 1.450 estudantes – seis a dezoito anos, em Belo Horizonte-MG. Dados: peso, altura, PA, espessura de pregas cutâneas, circunferência das cinturas, atividade física, colesterol total (CT), LDL-c, HDL-c, e hábitos alimentares. RESULTADOS:Prevalências de sobrepeso e obesidade foram 8,4% e 3,1%. Em relação aos estudantes situados no quartil inferior (Q1) da distribuição da prega subescapular, os estudantes do quartil superior (Q4) apresentaram um risco (odds ratio) 3,7 vezes maior de ter um CT aumentado. Os estudantes com sobrepeso e obesos tiveram 3,6 vezes mais risco de apresentar PA sistólica aumentada, e 2,7 vezes para PA diastólica aumentada, em relação aos estudantes com peso normal. Os estudantes menos ativos, no Q1 da distribuição de MET, apresentaram 3,8 vezes mais riscos de terem CT aumentado comparados com os mais ativos (Q4). CONCLUSÃO: Estudantes com sobrepeso ou obesos ou nos quartis superiores para outras variáveis de adiposidade, assim como os estudantes com baixos níveis de atividade física ou sedentários apresentaram níveis mais elevados de PA e perfil lipídico de risco aumentado para o desenvolvimento de aterosclerose"
Wednesday, October 11, 2006
MedPage Today Action Points
Explain to interested patients that walnuts contain alpha-linoleic acid (a plant-based omega-3 fatty acid) and other "cardioprotective constituents" such as L-arginine and antioxidants.
Caution patients that the study looked at the effect of walnuts or olive oil added to a fatty meal in individuals on an otherwise healthy Mediterranean diet, rather than the effect on individuals who repeatedly ate high fat content meals, and did not deal with weight gain.
BARCELONA, Spain, Oct. 10 -- Walnuts may be heart-healthy nuts, suggest Spanish researchers.
While both raw walnuts and olive oil decreased the sudden onset of arterial inflammation and oxidation after an unhealthy meal, the walnuts were better at keeping arteries flexible, they found.
But patients should not take this as an excuse to regularly eat fat-filled meals, followed by a handful of walnuts, said Emilio Ros, M.D., Ph.D., of the Lipid Clinic at Hospital Clínico here, and colleagues, in the Oct. 17 Journal of the American College of Cardiology.
The study, they pointed out, was small, and it looked at the effect of a single meal on individuals whose regular fare was a healthy Mediterranean diet.
Yet study participants had better arterial elasticity after a walnut-containing meal than an olive oil-containing meal. For those with moderately high cholesterol, postprandial flow-mediated dilation of the brachial artery was:
Improved by 24% when they ate walnuts with their high-fat meal (4.1% dilation before meal to 5.1% after), but
Impaired by 36% when they ate olive oil with the meal instead (3.6% dilation before meal to 2.3% after).
For individuals with normal cholesterol levels, the postprandial flow-mediated dilation was:
Unchanged in participants with normal cholesterol levels when they ate walnuts with the meal (4.2% dilation before meal to 4.2% after),
But impaired by 17% after they ate the olive oil-containing meal (4.7% dilation before meal to 3.9% after). /.../"
Encourage psoriasis patients to aggressively control their modifiable cardiovascular risk factors.
Younger patients, 30 to 40 years old, with severe psoriasis had almost twice the risk of an MI compared with similar patients without psoriasis. By contrast, 60-year-old patients with severe disease had only a 36% increased MI risk, reported Joel Gelfand, M.D., of the University of Pennsylvania here, and colleagues in the Oct. 11 issue of the Journal of the American Medical Association.
These findings came from a prospective, population-based cohort study in the United Kingdom comparing 556,995 controls and 127,139 patients with mild psoriasis and 3,837 with severe disease, in which the researchers controlled for major cardiovascular risk factors. The data have been used widely in epidemiological studies. "
Tuesday, October 10, 2006
(Referred by Marcelo Colominas
Cardiovascular disease is the leading cause of morbidity and mortality in Australia. It is therefore important that all medical practitioners are familiar with the well documented risk factors for cardiovascular disease, as well as the outcome benefits of pharmacological and other interventions.
The large and ever-increasing body of clinical evidence, the range of patient groups at risk and the plethora of recommended interventions all make it increasingly difficult for busy doctors to adopt an integrated approach to prevention of vascular events. While absolute risk calculators, such as the Framingham Heart Study Prediction Score Sheets (www.nhlbi.nih.gov/about/framingham/riskabs.htm) or the New Zealand Cardiovascular Risk Factor Calculator (www.racp.edu.au/bp/resources/EBM_cardio.pdf), enable doctors to assign overall risk, guidelines for management are usually focused on single interventions. Moreover, the continual emergence of new data on vascular risk management redefines risk categories and approaches to risk management.
Prevention of cardiovascular disease: an evidence-based clinical aid was developed by a multidisciplinary group of physicians to address this issue and was first published by the MJA in July 2003. We have revised and updated our evaluation of current best practice based on a rigorous analysis of available published evidence to March 2004, and formulated a concise and up-to-date guide for the prevention of cardiovascular disease. This consensus of opinions is summarised in this document (see Clinical aid, page F12) and provided as a single-page chart for use in clinical practice as a desktop reference.
Patients were classified as being either at high or low risk of cardiovascular events (Box 1). It is widely considered that high-risk patients are those with clinically evident vascular disease, renal disease, diabetes or other risk factors conferring an annual risk of a future event of 2%–3% or greater. Risk can be calculated using an absolute risk-factor calculator (see above)."
Wednesday, October 04, 2006
Coronary artery disease (CAD) and other acquired and congenital cardiac diseases are major medical and socioeconomic problems. CAD affects 13.2 million Americans and was responsible for 502 189 deaths in 2001. In 2004, the direct and indirect economic impact of CAD was in excess of $120 billion, which was about one-third of the total costs attributable to cardiovascular diseases (1).
Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease, beginning with chest radiography and fluoroscopy and progressing to coronary angiography and cardiac catheterization, ultrasonography (echocardiography), and nuclear medicine. All of these modalities have a well-established role in patient care. Computed tomography (CT), with multidetector CT and electron-beam technology, and magnetic resonance (MR) imaging, with appropriately equipped imagers, now can image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and can help assess cardiac function. Thus, CT and MR imaging will have an increasing role in comprehensive cardiac imaging./.../