Physical Activity and Public Health in Older Adults
Recommendation From the American College of Sports Medicine and the
American Heart Association
Miriam E. Nelson, PhD, FACSM; W. Jack Rejeski, PhD; Steven N. Blair, PED, FACSM, FAHA; Pamela W. Duncan, PhD; James O. Judge, MD; Abby C. King, PhD, FACSM, FAHA;
Carol A. Macera, PhD, FACSM; Carmen Castaneda-Sceppa, MD, PhDObjective—To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
Participants—A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
Evidence—The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing
drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
Summary—The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older
adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving
recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing
sedentary behavior, and risk management. (Circulation. 2007;116:1094-1105.)
Key Words: older adults physical activity benefits risks heal
Tuesday, August 28, 2007
Physical Activity and Public Health: Updated Recommendation for Adults From
De: Timoteo [mailto:timoteo@celafiscs.org.br]
Enviada em: segunda-feira, 27 de agosto de 2007 12:26
Olá Prof. Achutti!!
Recentemente a Circulation publicações os artigos de Reavaliação das Recomndações de AF x Saúde Pública (Adultos e idoso).
Physical Activity and Public Health
Updated Recommendation for Adults From the American College of
Sports Medicine and the American Heart Association
William L. Haskell, PhD, FAHA; I-Min Lee, MD, ScD; Russell R. Pate, PhD, FAHA; Kenneth E. Powell, MD, MPH; Steven N. Blair, PED, FACSM, FAHA; Barry A. Franklin, PhD, FAHA; Caroline A. Macera, PhD, FACSM; Gregory W. Heath, DSc, MPH, FAHA; Paul D. Thompson, MD; Adrian Bauman, PhD, MD Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and
clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical
activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and
circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for
a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice
during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical
activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)] (Circulation. 2007;116:1081-1093.)
Key Words: benefits risks physical activity dose physical activity intensity
Enviada em: segunda-feira, 27 de agosto de 2007 12:26
Olá Prof. Achutti!!
Recentemente a Circulation publicações os artigos de Reavaliação das Recomndações de AF x Saúde Pública (Adultos e idoso).
Physical Activity and Public Health
Updated Recommendation for Adults From the American College of
Sports Medicine and the American Heart Association
William L. Haskell, PhD, FAHA; I-Min Lee, MD, ScD; Russell R. Pate, PhD, FAHA; Kenneth E. Powell, MD, MPH; Steven N. Blair, PED, FACSM, FAHA; Barry A. Franklin, PhD, FAHA; Caroline A. Macera, PhD, FACSM; Gregory W. Heath, DSc, MPH, FAHA; Paul D. Thompson, MD; Adrian Bauman, PhD, MD Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and
clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical
activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and
circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for
a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice
during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical
activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)] (Circulation. 2007;116:1081-1093.)
Key Words: benefits risks physical activity dose physical activity intensity
Sunday, August 26, 2007
2361 - AMICOR10 - 26/08/2007
Caríssimos AMICOR,
Um dos motivos para demora de mais de um mês da última mensagem, é devida em parte à busca de um formato mais adequado para nossa comunicação.
As postagens nos BLOGs AMICOR, continuam e podem ser acessados diretamente como sempre ou assinando gratuitamente Feedblitz ou ourto sistema SSR
Dear AMICOR,
The delay (more than one month) from the last message was due to the search for a more appropriate format for our communication.
The regular posts in the AMICOR BLOGs, follow as ever, and may be accessed directly or signing (free) Feedblitz or other SSR systems.
Here are the latest updates for achutti@gmail.com
"AMICOR" - 1 new article
World Health Report 2007
More Recent Articles
Search AMICOR
World Health Report 2007
The world health report 2007: A safer future23 August 2007 -- More than ever before, global public health security depends on international cooperation and the willingness of all countries to take steps to tackle new and emerging threats. That is the message of this year's World health report entitled A safer future: global public health security in the 21st century, which is launched today.
Read the news release
The world health report 2007
• Email to a friend • Article Search • Related •
More Recent Articles
US Death Rate Hits All-Time Low
History, principles and practice of health and human rights
Trabalhador está acima do peso
Pierre Levy : Inteligência Colectiva
Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis
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Um dos motivos para demora de mais de um mês da última mensagem, é devida em parte à busca de um formato mais adequado para nossa comunicação.
As postagens nos BLOGs AMICOR, continuam e podem ser acessados diretamente como sempre ou assinando gratuitamente Feedblitz ou ourto sistema SSR
Dear AMICOR,
The delay (more than one month) from the last message was due to the search for a more appropriate format for our communication.
The regular posts in the AMICOR BLOGs, follow as ever, and may be accessed directly or signing (free) Feedblitz or other SSR systems.
Here are the latest updates for achutti@gmail.com
"AMICOR" - 1 new article
World Health Report 2007
More Recent Articles
Search AMICOR
World Health Report 2007
The world health report 2007: A safer future23 August 2007 -- More than ever before, global public health security depends on international cooperation and the willingness of all countries to take steps to tackle new and emerging threats. That is the message of this year's World health report entitled A safer future: global public health security in the 21st century, which is launched today.
Read the news release
The world health report 2007
• Email to a friend • Article Search • Related •
More Recent Articles
US Death Rate Hits All-Time Low
History, principles and practice of health and human rights
Trabalhador está acima do peso
Pierre Levy : Inteligência Colectiva
Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis
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AMICOR na presidência da SBC 2010-2011
Resultado Eleição Presidente da SBC 2010/2011
Candidato
Votos
Chapa 2 - Jorge Ilha
1132
Chapa 1 - Cláudio P. Cunha
884
Brancos
12
Nulos
16
TOTAL
2044
Candidato
Votos
Chapa 2 - Jorge Ilha
1132
Chapa 1 - Cláudio P. Cunha
884
Brancos
12
Nulos
16
TOTAL
2044
Saturday, August 25, 2007
World Health Report 2007
The world health report 2007: A safer future23 August 2007 -- More than ever before, global public health security depends on international cooperation and the willingness of all countries to take steps to tackle new and emerging threats. That is the message of this year's World health report entitled A safer future: global public health security in the 21st century, which is launched today.Read the news release The world health report 2007
Thursday, August 23, 2007
US Death Rate Hits All-Time Low
U.S. Death Rate Hits All-Time Low
By Michael Smith, Senior Staff Writer, MedPage Today August 22, 2007
Add Your Knowledge™
Additional Public Health Coverage HYATTSVILLE, Md., Aug. 22 -- The U.S. death rate fell to a historic low in 2004 and the life expectancy at birth hit a record high, according to the National Center for Vital Statistics here.
Final totals for the year show 2,397,615 deaths and an age-adjusted death rate of 800.8 deaths per 100,000 people.
That was 50,673 fewer deaths than in 2003 and represented the largest single-year decline in raw death counts since 1938, when deaths fell by 69,036 from the previous year.
At the same time, life expectancy at birth hit 77.8 years, continuing an increasing trend in the population as a whole and among both blacks and whites, according to the agency, part of the CDC.
By Michael Smith, Senior Staff Writer, MedPage Today August 22, 2007
Add Your Knowledge™
Additional Public Health Coverage HYATTSVILLE, Md., Aug. 22 -- The U.S. death rate fell to a historic low in 2004 and the life expectancy at birth hit a record high, according to the National Center for Vital Statistics here.
Final totals for the year show 2,397,615 deaths and an age-adjusted death rate of 800.8 deaths per 100,000 people.
That was 50,673 fewer deaths than in 2003 and represented the largest single-year decline in raw death counts since 1938, when deaths fell by 69,036 from the previous year.
At the same time, life expectancy at birth hit 77.8 years, continuing an increasing trend in the population as a whole and among both blacks and whites, according to the agency, part of the CDC.
Tuesday, August 21, 2007
History, principles and practice of health and human rights
Series, Health and Human Rights
History, principles, and practice of health and human rights
Sofia Gruskin JD a , Edward J Mills PhD b and Daniel Tarantola MD c
See CommentSee CommentSee World ReportSee World ReportSee PerspectivesSee Perspectives
Summary
Introduction
A brief history of health and human rights
Human rights and health policy
Applying human rights to health
Concerns for the future
Steps forward
References
Summary
Individuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action.Back to top
This is the first in a Series of four papers about health and human rights
Introduction
Blatant violation of human rights affecting the health of both individuals and populations continues. Examples include the torture of detainees in Abu-Ghraib prison in Iraq;1 systematic rapes and murders in the Balkans,2 Rwanda,3 Chechnya,4 and Darfur;5 physician involvement in torture,6 botched executions;7 inhumane experimentation;8 and questionable interrogation techniques in the so-called war on terror.1,9,10 Such violations of human rights can be engineered by or endorsed by governments, institutions of power, and individuals. These deplorable violations exist alongside more subtle activities that also have severe and longlasting effects on health and human rights such as absence of basic health-care systems;11 policies keeping medicines unaffordable;12 and tolerance of discrimination against groups such as injecting drug users,13 people with mental-health disorders,14,15 illegal immigrants,16 or homeless people.17 The continuing and foreseeable absence of access to effective care for most people living with most diseases in poor countries can also be viewed as a violation of human rights.18 Therefore human rights should be imperative in delivery of care and implementation of public-health programmes.
Three main relations between health and human rights exist: the positive and negative effects on health of promotion, neglect, or violation of human rights; the effect of health on the delivery of human rights; and the effects of public-health policies and programmes on human rights.19 Despite the advances in the study and advocacy of health and human rights we still do not fully understand the nature of these relationships, how they interact, or their value to medicine and public-health practice. In this article we address the public health aspects of these relations, and highlight where further research and action are needed./.../
History, principles, and practice of health and human rights
Sofia Gruskin JD a , Edward J Mills PhD b and Daniel Tarantola MD c
See CommentSee CommentSee World ReportSee World ReportSee PerspectivesSee Perspectives
Summary
Introduction
A brief history of health and human rights
Human rights and health policy
Applying human rights to health
Concerns for the future
Steps forward
References
Summary
Individuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action.Back to top
This is the first in a Series of four papers about health and human rights
Introduction
Blatant violation of human rights affecting the health of both individuals and populations continues. Examples include the torture of detainees in Abu-Ghraib prison in Iraq;1 systematic rapes and murders in the Balkans,2 Rwanda,3 Chechnya,4 and Darfur;5 physician involvement in torture,6 botched executions;7 inhumane experimentation;8 and questionable interrogation techniques in the so-called war on terror.1,9,10 Such violations of human rights can be engineered by or endorsed by governments, institutions of power, and individuals. These deplorable violations exist alongside more subtle activities that also have severe and longlasting effects on health and human rights such as absence of basic health-care systems;11 policies keeping medicines unaffordable;12 and tolerance of discrimination against groups such as injecting drug users,13 people with mental-health disorders,14,15 illegal immigrants,16 or homeless people.17 The continuing and foreseeable absence of access to effective care for most people living with most diseases in poor countries can also be viewed as a violation of human rights.18 Therefore human rights should be imperative in delivery of care and implementation of public-health programmes.
Three main relations between health and human rights exist: the positive and negative effects on health of promotion, neglect, or violation of human rights; the effect of health on the delivery of human rights; and the effects of public-health policies and programmes on human rights.19 Despite the advances in the study and advocacy of health and human rights we still do not fully understand the nature of these relationships, how they interact, or their value to medicine and public-health practice. In this article we address the public health aspects of these relations, and highlight where further research and action are needed./.../
Monday, August 20, 2007
Trabalhador está acima do peso
Resultado de pesquisa da AMICOR Dra. Sandra Fuchs
Trabalhador está acima do peso
MARCELA DONINI
Acima do peso adequado e comendo mal, grande parte dos industriários do país deve mudar seus hábitos se quiser evitar doenças cardiovasculares.A recomendação é resultado do Estudo Sesi - Perfil Epidemiológico de Fatores de Risco para Doenças Não-transmissíveis em Trabalhadores da Indústria do Brasil, apresentado no sábado, durante o 15° Congresso Brasileiro de Hipertensão, em Recife (PE).O excesso de peso é a característica mais preocupante entre os 4.818 trabalhadores entrevistados, segundo a epidemiologista da pesquisa e professora da Universidade Federal do Rio Grande do Sul (UFRGS) Sandra Fuchs. Comparável ao índice referente à população geral dos Estados Unidos, país com maior número de obesos no mundo, os 49,7% dos industriários de mal com a balança surpreenderam os pesquisadores.- Os trabalhadores deveriam ser mais saudáveis do que o restante da população justamente por terem saúde para trabalhar - observa.Estudo deve mudar rotina nas empresasSegundo o Estudo Sesi, 51,3% dos homens industriários e 45,1% das mulheres estão acima do peso ideal. A hipertensão arterial, outro fator de alto risco para doenças do coração, foi registrada em 26,3% dos entrevistados. Com o excesso de peso, o padrão alimentar inadequado forma uma péssima combinação. A pesquisa revelou que 46,1% dos homens e 34,5% das mulheres não comem nenhuma porção de frutas ou legumes por dia, quando a recomendação da Organização Mundial da Saúde é de cinco porções diárias para prevenir alguns tipos de câncer e doenças do coração. Após a coleta de informações, os entrevistados foram submetidos a intervenções, como palestras de conscientização sobre a redução de peso, atividades físicas e dieta balanceada. O objetivo é ampliar as ações a todos industriários do Brasil.Em fase de correção, o estudo se iniciou em 2001 e foi desenvolvido pelo Serviço Social da Indústria, em parceria com a Sociedade Brasileira de Cardiologia, a Organização Pan-americana de Saúde e o Ministério da Saúde. O texto deve ser publicado este ano e apresentado à Confederação Nacional das Indústrias para que, definido o perfil dos trabalhadores, seja possível mudar algumas rotinas nas empresas.( mailto:%20marcela.donini@zerohora.com.br )
Trabalhador está acima do peso
MARCELA DONINI
Acima do peso adequado e comendo mal, grande parte dos industriários do país deve mudar seus hábitos se quiser evitar doenças cardiovasculares.A recomendação é resultado do Estudo Sesi - Perfil Epidemiológico de Fatores de Risco para Doenças Não-transmissíveis em Trabalhadores da Indústria do Brasil, apresentado no sábado, durante o 15° Congresso Brasileiro de Hipertensão, em Recife (PE).O excesso de peso é a característica mais preocupante entre os 4.818 trabalhadores entrevistados, segundo a epidemiologista da pesquisa e professora da Universidade Federal do Rio Grande do Sul (UFRGS) Sandra Fuchs. Comparável ao índice referente à população geral dos Estados Unidos, país com maior número de obesos no mundo, os 49,7% dos industriários de mal com a balança surpreenderam os pesquisadores.- Os trabalhadores deveriam ser mais saudáveis do que o restante da população justamente por terem saúde para trabalhar - observa.Estudo deve mudar rotina nas empresasSegundo o Estudo Sesi, 51,3% dos homens industriários e 45,1% das mulheres estão acima do peso ideal. A hipertensão arterial, outro fator de alto risco para doenças do coração, foi registrada em 26,3% dos entrevistados. Com o excesso de peso, o padrão alimentar inadequado forma uma péssima combinação. A pesquisa revelou que 46,1% dos homens e 34,5% das mulheres não comem nenhuma porção de frutas ou legumes por dia, quando a recomendação da Organização Mundial da Saúde é de cinco porções diárias para prevenir alguns tipos de câncer e doenças do coração. Após a coleta de informações, os entrevistados foram submetidos a intervenções, como palestras de conscientização sobre a redução de peso, atividades físicas e dieta balanceada. O objetivo é ampliar as ações a todos industriários do Brasil.Em fase de correção, o estudo se iniciou em 2001 e foi desenvolvido pelo Serviço Social da Indústria, em parceria com a Sociedade Brasileira de Cardiologia, a Organização Pan-americana de Saúde e o Ministério da Saúde. O texto deve ser publicado este ano e apresentado à Confederação Nacional das Indústrias para que, definido o perfil dos trabalhadores, seja possível mudar algumas rotinas nas empresas.( mailto:%20marcela.donini@zerohora.com.br )
Wednesday, August 15, 2007
Pierre Levy : Inteligência Colectiva
Assistimos (Valderês e eu) hoje uma conferência de Pierre Levy na Série de "Fronteiras do Pensamento"
http://www.fronteirasdopensamento.com.br/?menu=conferencistas&act=25#25
Ao chegar em casa, casualmente Maria Inês Reinert Azambuja havia nos enviado esta referência de um livro seu traduzido pela OPAS.
Ela dizia em sua mensagem: Parece que isto é o futuro...
Penso que precisamos ver como baseados no presente, podemos alcançar este futuro.
Segundo ele já temos muitos instrumentos e uma rede em franco desenvolvimento (sendo que a maior taxa de crescimento da rede no último ano se deu na China, na Índia e no Brasil).
Vejamos como juntos podemos caminhar neste sentido...
************************************
Es con gran satisfacción que la Organización Panamericana de la Salud, a través de la Unidad de Promoción y Desarrollo de la Investigación y el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME), pone a la disposición de los usuarios de la BVS/Ciencia y Salud (BVS/CyS) la versión electrónica en español del consagrado libro de Pierre Lévy “La inteligencia colectiva”. La traducción a partir del original francés fue hecha por el Centro Nacional de Información de Ciencias Médicas (INFOMED) de Cuba y Pierre Lévy autorizó la traducción y publicación de su libro sin costo alguno.
http://www.fronteirasdopensamento.com.br/?menu=conferencistas&act=25#25
Ao chegar em casa, casualmente Maria Inês Reinert Azambuja havia nos enviado esta referência de um livro seu traduzido pela OPAS.
Ela dizia em sua mensagem: Parece que isto é o futuro...
Penso que precisamos ver como baseados no presente, podemos alcançar este futuro.
Segundo ele já temos muitos instrumentos e uma rede em franco desenvolvimento (sendo que a maior taxa de crescimento da rede no último ano se deu na China, na Índia e no Brasil).
Vejamos como juntos podemos caminhar neste sentido...
************************************
Es con gran satisfacción que la Organización Panamericana de la Salud, a través de la Unidad de Promoción y Desarrollo de la Investigación y el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME), pone a la disposición de los usuarios de la BVS/Ciencia y Salud (BVS/CyS) la versión electrónica en español del consagrado libro de Pierre Lévy “La inteligencia colectiva”. La traducción a partir del original francés fue hecha por el Centro Nacional de Información de Ciencias Médicas (INFOMED) de Cuba y Pierre Lévy autorizó la traducción y publicación de su libro sin costo alguno.
Tuesday, August 14, 2007
Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis
Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis
By Charles Bankhead, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco August 13, 2007
Add Your Knowledge™
Additional Coronary Artery Disease Coverage
Amit Khera, M.D., M.Sc.Southwestern Medical
DALLAS, Aug. 13 -- For assessing obesity's impact on atherosclerosis risk, the waist-to-hip ratio tops body mass index and waist
By Charles Bankhead, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco August 13, 2007
Add Your Knowledge™
Additional Coronary Artery Disease Coverage
Amit Khera, M.D., M.Sc.Southwestern Medical
DALLAS, Aug. 13 -- For assessing obesity's impact on atherosclerosis risk, the waist-to-hip ratio tops body mass index and waist
Wednesday, August 08, 2007
Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack
Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack
Souvik Sen MD, MS*, Alan Hinderliter MD, Pranab K. Sen PhD, Jennifer Simmons BSW, James Beck PhD, Steven Offenbacher DDS, PhD, MMSc, E. Magnus Ohman MD, and Stephen M. Oppenheimer MD, PhD
Background—It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA).
Methods and Results—AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA. Of these, 125 consented to a follow-up transesophageal echocardiogram at 12 months. Adequate paired AA images were obtained in 117 (78 with strokes, 39 with TIAs), which allowed detailed measurements of plaques. On admission for their index stroke or TIA, patients were assessed for stroke risk factors, stroke subtypes, baseline AA plaque characteristics, and laboratory parameters. Progression of AA atheroma was observed in 33 patients (28%) on 12-month follow-up transesophageal echocardiogram. It was determined that the progression group had significantly higher adjusted homocysteine levels (P<0.0001) and neutrophil counts (P<0.0001) than the no-progression group. These patients were followed up for a median of 1.7 years from the index stroke/TIA (range 0.5 to 4.5 years) for vascular events including stroke, TIA, myocardial infarction, and death due to vascular causes. Kaplan-Meier curves showed fewer patients with AA atheroma progression remained free of the composite vascular end point (49% compared with 89% in the no-progression group; P<0.0001). AA atheroma progression was associated with composite vascular events (hazard ratio 5.8, 95% confidence interval 2.3 to 14.5, P=0.0002) after adjustment for a propensity score based on confounders.
Conclusions—In this preliminary study of stroke/TIA patients with AA atheroma on transesophageal echocardiogram, AA atheroma progression was associated with recurrent vascular events.
Key words: aorta • atherosclerosis • disease progression • echocardiography • stroke
Souvik Sen MD, MS*, Alan Hinderliter MD, Pranab K. Sen PhD, Jennifer Simmons BSW, James Beck PhD, Steven Offenbacher DDS, PhD, MMSc, E. Magnus Ohman MD, and Stephen M. Oppenheimer MD, PhD
Background—It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA).
Methods and Results—AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA. Of these, 125 consented to a follow-up transesophageal echocardiogram at 12 months. Adequate paired AA images were obtained in 117 (78 with strokes, 39 with TIAs), which allowed detailed measurements of plaques. On admission for their index stroke or TIA, patients were assessed for stroke risk factors, stroke subtypes, baseline AA plaque characteristics, and laboratory parameters. Progression of AA atheroma was observed in 33 patients (28%) on 12-month follow-up transesophageal echocardiogram. It was determined that the progression group had significantly higher adjusted homocysteine levels (P<0.0001) and neutrophil counts (P<0.0001) than the no-progression group. These patients were followed up for a median of 1.7 years from the index stroke/TIA (range 0.5 to 4.5 years) for vascular events including stroke, TIA, myocardial infarction, and death due to vascular causes. Kaplan-Meier curves showed fewer patients with AA atheroma progression remained free of the composite vascular end point (49% compared with 89% in the no-progression group; P<0.0001). AA atheroma progression was associated with composite vascular events (hazard ratio 5.8, 95% confidence interval 2.3 to 14.5, P=0.0002) after adjustment for a propensity score based on confounders.
Conclusions—In this preliminary study of stroke/TIA patients with AA atheroma on transesophageal echocardiogram, AA atheroma progression was associated with recurrent vascular events.
Key words: aorta • atherosclerosis • disease progression • echocardiography • stroke
Monday, August 06, 2007
Family History of Premature Coronary Heart Disease and Coronary Artery Calcification
Background— A family history of premature coronary heart disease (CHD) is a known risk factor for CHD events. The purpose of this study was to assess the strength of the association between a family history of premature CHD and coronary artery calcification (CAC) in a multiethnic cohort of asymptomatic individuals. We also sought to determine whether individuals with a reported family history of premature CHD have an increased atherosclerotic burden among those classified as being at low to intermediate risk on the basis of the conventional Framingham risk score.
Methods and Results— The association of family history of premature CHD with CAC was assessed in 5347 asymptomatic individuals (47% men; mean age 62±10 years) in the Multi-Ethnic Study of Atherosclerosis (MESA). The demographics (age, gender, and race)–adjusted OR for CAC >0 with versus without a family history of premature CHD was 1.94 (95% CI, 1.64 to 2.29). On adjustment for CHD risk factors, the association was slightly attenuated to an OR of 1.84 (95% CI, 1.55 to 2.19). Family history of premature CHD was significantly associated with CAC in all ethnic groups. The age-, gender-, and race-adjusted prevalence of CAC >0 was significantly higher with presence of any family history of premature CHD than for those with no family history of premature CHD among individuals classified as low risk (35% versus 23%, P<0.0001) and among those at intermediate risk (70% versus 60%, P=0.01). Similarly, the prevalence of age-gender-race–based CAC 75th percentile in low-risk (24% versus 14%, P=0.0003) and intermediate-risk (34% versus 20%, P<0.001) individuals was also higher among those with a family history of premature CHD. Compared with those without a family history of premature CHD, the association with the presence of CAC was strongest in participants reporting such history in both a parent and a sibling (odds ratio, 2.74; 95% CI, 1.64 to 4.59), followed by those reporting a family history in a sibling only (odds ratio, 2.06; 95% CI, 1.64 to 2.58) and those reporting a family history of premature CHD only in a parent (odds ratio, 1.52; 95% CI, 1.19 to 1.93).
Conclusions— An association between family history of premature CHD and the presence of any CAC, as well as advanced CAC, was observed in the present population-based multiethnic study. The relationship was independent of other risk factors and Framingham risk score, which supports the utility of including information on family history of premature CHD in current methods of global risk assessment and practice guidelines.
Methods and Results— The association of family history of premature CHD with CAC was assessed in 5347 asymptomatic individuals (47% men; mean age 62±10 years) in the Multi-Ethnic Study of Atherosclerosis (MESA). The demographics (age, gender, and race)–adjusted OR for CAC >0 with versus without a family history of premature CHD was 1.94 (95% CI, 1.64 to 2.29). On adjustment for CHD risk factors, the association was slightly attenuated to an OR of 1.84 (95% CI, 1.55 to 2.19). Family history of premature CHD was significantly associated with CAC in all ethnic groups. The age-, gender-, and race-adjusted prevalence of CAC >0 was significantly higher with presence of any family history of premature CHD than for those with no family history of premature CHD among individuals classified as low risk (35% versus 23%, P<0.0001) and among those at intermediate risk (70% versus 60%, P=0.01). Similarly, the prevalence of age-gender-race–based CAC 75th percentile in low-risk (24% versus 14%, P=0.0003) and intermediate-risk (34% versus 20%, P<0.001) individuals was also higher among those with a family history of premature CHD. Compared with those without a family history of premature CHD, the association with the presence of CAC was strongest in participants reporting such history in both a parent and a sibling (odds ratio, 2.74; 95% CI, 1.64 to 4.59), followed by those reporting a family history in a sibling only (odds ratio, 2.06; 95% CI, 1.64 to 2.58) and those reporting a family history of premature CHD only in a parent (odds ratio, 1.52; 95% CI, 1.19 to 1.93).
Conclusions— An association between family history of premature CHD and the presence of any CAC, as well as advanced CAC, was observed in the present population-based multiethnic study. The relationship was independent of other risk factors and Framingham risk score, which supports the utility of including information on family history of premature CHD in current methods of global risk assessment and practice guidelines.
Unstable Angina
ACC/AHA 2007 Guidelines for the Management of
Patients With Unstable Angina/Non–ST-Elevation
Myocardial Infarction
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction)
Developed in Collaboration with the American College of Emergency Physicians, the Society for
Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Patients With Unstable Angina/Non–ST-Elevation
Myocardial Infarction
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction)
Developed in Collaboration with the American College of Emergency Physicians, the Society for
Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Wednesday, August 01, 2007
Physical Activity and Public Health in Older Adults. Recommendation From the American College of Sports Medicine and the American Heart Association -- Nelson et al., 10.1161/CIRCULATIONAHA.107.185650 -- Circulation
Physical Activity and Public Health in Older Adults. Recommendation From the American College of Sports Medicine and the American Heart Association -- Nelson et al., 10.1161/CIRCULATIONAHA.107.185650 -- Circulation:
"Summary—The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management."
"Summary—The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management."
Physical Activity and Public Health. Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association -- Haskell et al., 10.1161/CIRCULATIONAHA.107.185649 -- Circulation
Physical Activity and Public Health. Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association -- Haskell et al., 10.1161/CIRCULATIONAHA.107.185649 -- Circulation:
"Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity."/.../
"Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity."/.../
Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening
NEJM -- Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening:
Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermajer, Ph.D., F.R.A.C.P., Beatriz Ferreira, M.D., Ph.D., Ana Olga Mocumbi, M.D., Dinesh Jani, M.D., Christophe Paquet, M.D., M.P.H., Sophie Jacob, Ph.D., Daniel Sidi, M.D., Ph.D., and Xavier Jouven, M.D., Ph.D.
"Background Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease.
Methods Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and Mozambique were screened for rheumatic heart disease according to standard clinical and echocardiographic criteria.
Results Clinical examination detected rheumatic heart disease that was confirmed by echocardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozambique; the corresponding prevalence rates and 95% confidence intervals (CIs) were 2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79 cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corresponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique).
Conclusions Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications. "/.../
Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermajer, Ph.D., F.R.A.C.P., Beatriz Ferreira, M.D., Ph.D., Ana Olga Mocumbi, M.D., Dinesh Jani, M.D., Christophe Paquet, M.D., M.P.H., Sophie Jacob, Ph.D., Daniel Sidi, M.D., Ph.D., and Xavier Jouven, M.D., Ph.D.
"Background Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease.
Methods Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and Mozambique were screened for rheumatic heart disease according to standard clinical and echocardiographic criteria.
Results Clinical examination detected rheumatic heart disease that was confirmed by echocardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozambique; the corresponding prevalence rates and 95% confidence intervals (CIs) were 2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79 cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corresponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique).
Conclusions Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications. "/.../
Rheumatic Heart Disease in Developing Countries
Jonathan R. Carapetis, Ph.D., F.R.A.C.P.
Only 30 or 40 years ago, rheumatic fever was a common topic in the Journal. A PubMed search for articles on rheumatic fever published between 1967 and 1976 returned 55 New England Journal of Medicine articles — fewer than for endocarditis (77) but more than for stroke and syphilis (24 entries each). A similar PubMed search for the decade 1997 through 2006 yielded just eight entries for rheumatic fever. This trend holds for all Medline-indexed journals: an average of 516 articles on rheumatic fever per year from 1967 through 1976, but only 172 per year from 1997 through 2006. Most observers would probably consider this decrease to be a reasonable reflection of the waning incidence of the disease. After all, in the mid-20th century, children with rheumatic fever occupied many of the beds in pediatric wards in industrialized countries — indeed, entire hospitals were dedicated to the treatment of, and rehabilitation from, rheumatic fever. But in the latter half of the 20th century, rheumatic fever receded as an important health problem in almost all wealthy countries. Today, most physicians in these countries are unlikely ever to see a case of acute rheumatic fever, and their experience with rheumatic heart disease will be limited to heart-valve lesions in older patients who had rheumatic fever in their youth.
The reality, however, is that the decrease in publications reflects only the waning burden of disease among the less than 20% of the world's population living in high-income countries. For everyone else, rheumatic fever and rheumatic heart disease are bigger problems than ever. It was estimated recently that worldwide 15.6 million people have rheumatic heart disease and that there are 470,000 new cases of rheumatic fever and 233,000 deaths attributable to rheumatic fever or rheumatic heart disease each year.1 These are conservative estimates — the actual figures are likely to be substantially higher. Almost all these cases and deaths occur in developing countries.
Only 30 or 40 years ago, rheumatic fever was a common topic in the Journal. A PubMed search for articles on rheumatic fever published between 1967 and 1976 returned 55 New England Journal of Medicine articles — fewer than for endocarditis (77) but more than for stroke and syphilis (24 entries each). A similar PubMed search for the decade 1997 through 2006 yielded just eight entries for rheumatic fever. This trend holds for all Medline-indexed journals: an average of 516 articles on rheumatic fever per year from 1967 through 1976, but only 172 per year from 1997 through 2006. Most observers would probably consider this decrease to be a reasonable reflection of the waning incidence of the disease. After all, in the mid-20th century, children with rheumatic fever occupied many of the beds in pediatric wards in industrialized countries — indeed, entire hospitals were dedicated to the treatment of, and rehabilitation from, rheumatic fever. But in the latter half of the 20th century, rheumatic fever receded as an important health problem in almost all wealthy countries. Today, most physicians in these countries are unlikely ever to see a case of acute rheumatic fever, and their experience with rheumatic heart disease will be limited to heart-valve lesions in older patients who had rheumatic fever in their youth.
The reality, however, is that the decrease in publications reflects only the waning burden of disease among the less than 20% of the world's population living in high-income countries. For everyone else, rheumatic fever and rheumatic heart disease are bigger problems than ever. It was estimated recently that worldwide 15.6 million people have rheumatic heart disease and that there are 470,000 new cases of rheumatic fever and 233,000 deaths attributable to rheumatic fever or rheumatic heart disease each year.1 These are conservative estimates — the actual figures are likely to be substantially higher. Almost all these cases and deaths occur in developing countries.
Ten Years ProCOR
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org]
Em nome de Bernard Lown, MD
Enviada em: sexta-feira, 27 de julho de 2007 15:53
Para: procor@healthnet.org
Assunto: [ProCOR] Dr. Vikas Saini joins Lown Cardiovascular Research Foundation
Dear ProCor colleagues,
At this important point in ProCor's history--celebrating our tenth anniversary, launching the Ashanti-ProCor project to advance our understanding of how we can meet CVD information needs in Ghana and globally, and preparing to announce the first Louise Lown Heart Hero Award recipient, I am pleased to share with you the exciting and important news that Dr. Vikas Saini has been recruited as President of the Lown Cardiovascular Research Foundation. As President, Dr. Saini will work with ProCOR and the Lown Foundation's other programs and will participate in the Lown Group's cardiovascular practice.
When ProCOR was founded a decade ago, the primary intent was to rouse awareness of the mounting cardiovascular epidemic emerging in developing countries as well as to focus on prevention as the only effective remedy. A promissory note for success was the cresting information revolution worldwide. Another element we hoped would make our approach unique was bringing the Lown model of cardiovascular care to global attention by sharing the decades of experience of the Lown Group. The Lown Group, by individualizing care and placing a premium on listening to the patient, has minimized costly interventions, empowered patients to take control of their own health and encouraged them to more readily adopt healthy lifestyles.
Now the right individual has joined with us to address this challenge. Dr. Saini brings extraordinary credentials to this role. Born in Hoshiarpur, a small town in Punjab, India, Dr. Saini came to the US at the age of four. His educational background includes a scholarship to Upper Canada College, and at the extraordinarily young age of 16 he was accepted to Princeton University. Dr. Saini graduated with honors from medical school at Dalhousie University in Halifax, Nova Scotia, Canada, and completed his medical residency at Baltimore City Hospitals, a program of Johns Hopkins University School of Medicine.
With a strong interest in researching the physiology of mind-body interactions, Dr. Saini expressed the desire to study investigative techniques at our research lab in Boston. I offered him a fellowship at the Lown Laboratory at the Harvard School of Public Health, and he immersed himself in the research and clinical activities of the group. He later went on to co-found Aspect Medical Systems, Inc., where he served as its first Vice President of Research & Development and on its Board of Directors. As a founding partner of The Cardiovascular Specialists in Hyannis, Massachusetts, USA, Dr. Saini's experience includes a clinical cardiology practice specializing in conservative cardiovascular alternatives to invasive management. As Vice President of Primary Care, LLC, the largest network of independent primary care providers in Massachusetts, Dr. Saini worked with health plans to improve health care delivery within the network and to assess and develop the group's incorporation of health information technology.
Dr. Saini's research includes developing a hypothesis that anesthetic depth alters the body's inflammatory tone long term, which is currently being tested in clinical trials. Other research includes a clinical trial looking at post-operative inflammation and a project assessing the potential of certain dietary plant poly-phenols for cardiovascular prevention.
Dr. Saini complements all those who have helped sustain our vision over the years. Joining us is a vote of confidence; an affirmation of the Lown Group's potential.
Bernard Lown, MD
Founder and Chair, ProCor
Em nome de Bernard Lown, MD
Enviada em: sexta-feira, 27 de julho de 2007 15:53
Para: procor@healthnet.org
Assunto: [ProCOR] Dr. Vikas Saini joins Lown Cardiovascular Research Foundation
Dear ProCor colleagues,
At this important point in ProCor's history--celebrating our tenth anniversary, launching the Ashanti-ProCor project to advance our understanding of how we can meet CVD information needs in Ghana and globally, and preparing to announce the first Louise Lown Heart Hero Award recipient, I am pleased to share with you the exciting and important news that Dr. Vikas Saini has been recruited as President of the Lown Cardiovascular Research Foundation. As President, Dr. Saini will work with ProCOR and the Lown Foundation's other programs and will participate in the Lown Group's cardiovascular practice.
When ProCOR was founded a decade ago, the primary intent was to rouse awareness of the mounting cardiovascular epidemic emerging in developing countries as well as to focus on prevention as the only effective remedy. A promissory note for success was the cresting information revolution worldwide. Another element we hoped would make our approach unique was bringing the Lown model of cardiovascular care to global attention by sharing the decades of experience of the Lown Group. The Lown Group, by individualizing care and placing a premium on listening to the patient, has minimized costly interventions, empowered patients to take control of their own health and encouraged them to more readily adopt healthy lifestyles.
Now the right individual has joined with us to address this challenge. Dr. Saini brings extraordinary credentials to this role. Born in Hoshiarpur, a small town in Punjab, India, Dr. Saini came to the US at the age of four. His educational background includes a scholarship to Upper Canada College, and at the extraordinarily young age of 16 he was accepted to Princeton University. Dr. Saini graduated with honors from medical school at Dalhousie University in Halifax, Nova Scotia, Canada, and completed his medical residency at Baltimore City Hospitals, a program of Johns Hopkins University School of Medicine.
With a strong interest in researching the physiology of mind-body interactions, Dr. Saini expressed the desire to study investigative techniques at our research lab in Boston. I offered him a fellowship at the Lown Laboratory at the Harvard School of Public Health, and he immersed himself in the research and clinical activities of the group. He later went on to co-found Aspect Medical Systems, Inc., where he served as its first Vice President of Research & Development and on its Board of Directors. As a founding partner of The Cardiovascular Specialists in Hyannis, Massachusetts, USA, Dr. Saini's experience includes a clinical cardiology practice specializing in conservative cardiovascular alternatives to invasive management. As Vice President of Primary Care, LLC, the largest network of independent primary care providers in Massachusetts, Dr. Saini worked with health plans to improve health care delivery within the network and to assess and develop the group's incorporation of health information technology.
Dr. Saini's research includes developing a hypothesis that anesthetic depth alters the body's inflammatory tone long term, which is currently being tested in clinical trials. Other research includes a clinical trial looking at post-operative inflammation and a project assessing the potential of certain dietary plant poly-phenols for cardiovascular prevention.
Dr. Saini complements all those who have helped sustain our vision over the years. Joining us is a vote of confidence; an affirmation of the Lown Group's potential.
Bernard Lown, MD
Founder and Chair, ProCor
Tuesday, July 31, 2007
Mãe Brasileira
(Artigo Publicado em ZH dia 31 julho 2007)
Mãe brasileira
ALOYZIO ACHUTTI/ Médico
Com a devida licença dos discípulos de Freud e Lacan, e de nossas respeitáveis mães (a expressão popular aqui tem acepção simbólica), algumas considerações apresentadas numa conferência recente de Jean-Pierre Lebrun (na série Fronteiras do Pensamento), também expressas em seu livro Um Mundo sem Limite, podem servir para explicar nossa realidade.Tantas notícias e fatos a nos deixar perplexos cada dia podem ter suas raízes bem mais profundas, plantadas na dinâmica populacional da "grande família brasileira".O filho inicialmente se sente como continuidade da própria mãe, não tendo, portanto, identidade própria e consciência de limite. A figura do pai, apresentando ao filho a noção do outro que não a mãe/filho, é que o traz para a realidade, possibilitando-lhe a descoberta de sua identidade própria, do limite e da responsabilidade.Saímos de uma experiência traumática de autoritarismo (característica mais própria do pai) e caímos numa fase de permissividade e de aparente onipotência porque tudo nos é concedido pelo governo central, num "maternalismo" sem limites (bolsa-família, medicamentos de graça, invasão de propriedades etc.).Voltamos à condição mais primitiva, na qual não se necessita fazer nenhum esforço, nem para conquistar o alimento, eternamente dependentes e deitados em berço esplêndido.É possível que o desenvolvimento de tal filosofia política tenha se baseado na boa-fé, na ingenuidade e até ignorância de muitos de nossos governantes, guindados ao poder por nós mesmos, na presunção de resolver nossos problemas através de uma regressão ao colo ou ao ventre de uma grande "mãe brasileira". - Que fique bem claro: esta expressão é bastante popular e não foi inventada.Caindo na realidade, já é tempo de cada cidadão reconhecer sua própria identidade e ser responsável pelo próprio destino, deixando de ser apenas massa sujeita às manobras.Neste cenário podem-se distinguir três conjuntos bem distintos de atores: um que passivamente aceita e se deleita com a condição primitiva a lhe trazer algumas benesses e ilusões. Outra esperta (explorando a função materna), dela se aproveitando e a sustentando, pela conveniente falta de limites. A terceira (em nosso esquema, no papel do outro) - intencionalmente ignorada ou escondida - utilizada para prover os recursos necessários, que não caem do céu.O governo precisa se aproximar mais da figura paterna se quiser que a população se desenvolva, deixando de ser mero objeto e assumindo a posição de sujeito. Só assim, em nossa pátria amada Brasil, será possível delimitar as responsabilidades, terminar com a impunidade dos aproveitadores, mesmo quando travestidos nas vestes e com gestos de mãe gentil.
Mãe brasileira
ALOYZIO ACHUTTI/ Médico
Com a devida licença dos discípulos de Freud e Lacan, e de nossas respeitáveis mães (a expressão popular aqui tem acepção simbólica), algumas considerações apresentadas numa conferência recente de Jean-Pierre Lebrun (na série Fronteiras do Pensamento), também expressas em seu livro Um Mundo sem Limite, podem servir para explicar nossa realidade.Tantas notícias e fatos a nos deixar perplexos cada dia podem ter suas raízes bem mais profundas, plantadas na dinâmica populacional da "grande família brasileira".O filho inicialmente se sente como continuidade da própria mãe, não tendo, portanto, identidade própria e consciência de limite. A figura do pai, apresentando ao filho a noção do outro que não a mãe/filho, é que o traz para a realidade, possibilitando-lhe a descoberta de sua identidade própria, do limite e da responsabilidade.Saímos de uma experiência traumática de autoritarismo (característica mais própria do pai) e caímos numa fase de permissividade e de aparente onipotência porque tudo nos é concedido pelo governo central, num "maternalismo" sem limites (bolsa-família, medicamentos de graça, invasão de propriedades etc.).Voltamos à condição mais primitiva, na qual não se necessita fazer nenhum esforço, nem para conquistar o alimento, eternamente dependentes e deitados em berço esplêndido.É possível que o desenvolvimento de tal filosofia política tenha se baseado na boa-fé, na ingenuidade e até ignorância de muitos de nossos governantes, guindados ao poder por nós mesmos, na presunção de resolver nossos problemas através de uma regressão ao colo ou ao ventre de uma grande "mãe brasileira". - Que fique bem claro: esta expressão é bastante popular e não foi inventada.Caindo na realidade, já é tempo de cada cidadão reconhecer sua própria identidade e ser responsável pelo próprio destino, deixando de ser apenas massa sujeita às manobras.Neste cenário podem-se distinguir três conjuntos bem distintos de atores: um que passivamente aceita e se deleita com a condição primitiva a lhe trazer algumas benesses e ilusões. Outra esperta (explorando a função materna), dela se aproveitando e a sustentando, pela conveniente falta de limites. A terceira (em nosso esquema, no papel do outro) - intencionalmente ignorada ou escondida - utilizada para prover os recursos necessários, que não caem do céu.O governo precisa se aproximar mais da figura paterna se quiser que a população se desenvolva, deixando de ser mero objeto e assumindo a posição de sujeito. Só assim, em nossa pátria amada Brasil, será possível delimitar as responsabilidades, terminar com a impunidade dos aproveitadores, mesmo quando travestidos nas vestes e com gestos de mãe gentil.
Monday, July 30, 2007
Diesel Fumes Team Up With Cholesterol for Atherosclerosis
Diesel fumes synergistically link up with cholesterol to activate genes that turn up atherosclerosis and vessel inflammation, according to Andre Nel, M.B.Ch.B., Ph.D., of the University of California, Los Angeles, and colleagues.
In vitro and mouse studies revealed that a low dose of diesel exhaust particles combined with oxidized phospholipids generated in LDL cholesterol upregulated 1,555 genes, of which the most upregulated clusters were in pathways related to vascular inflammation and atherosclerosis, they reported in the July 26 issue of Genome Biology.
Of the upregulated genes, 43% exhibited synergy when the diesel particles and oxidized phospholipids were combined.
"Our gene-expression
In vitro and mouse studies revealed that a low dose of diesel exhaust particles combined with oxidized phospholipids generated in LDL cholesterol upregulated 1,555 genes, of which the most upregulated clusters were in pathways related to vascular inflammation and atherosclerosis, they reported in the July 26 issue of Genome Biology.
Of the upregulated genes, 43% exhibited synergy when the diesel particles and oxidized phospholipids were combined.
"Our gene-expression
Sunday, July 29, 2007
CV Risk Scores - Bonneux: BMJ, Volume 335(7611).July 21, 2007.107-108
Ovid: Bonneux: BMJ, Volume 335(7611).July 21, 2007.107-108: "Risk scores based on the Framingham heart study reflect the higher risks of cardiovascular disease in the 1970s and 1980s and tend to overpredict current risks. They do not include family history, body mass index, use of antihypertensive drugs, or measures of social class. Omitting socioeconomic status as a predictor increases the health gap between rich and poor: the risks in poor people are underestimated and under-treated, and risks in rich people are overestimated and overtreated.
In this week’s BMJ Hippisley-Cox and colleagues derive a new cardiovascular disease risk score (QRISK) for the United Kingdom and validate its performance against the Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN). 1 They found that QRISK provided more appropriate risk estimates to help identify high risk patients on the basis of age, sex, and social deprivation. The QRISK score indicates that in the United Kingdom about 3.2 million men and women aged 35–74 are likely to be at high risk, compared with 4.7 million predicted by Framingham and 5.1 million with ASSIGN." /.../
In this week’s BMJ Hippisley-Cox and colleagues derive a new cardiovascular disease risk score (QRISK) for the United Kingdom and validate its performance against the Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN). 1 They found that QRISK provided more appropriate risk estimates to help identify high risk patients on the basis of age, sex, and social deprivation. The QRISK score indicates that in the United Kingdom about 3.2 million men and women aged 35–74 are likely to be at high risk, compared with 4.7 million predicted by Framingham and 5.1 million with ASSIGN." /.../
Wednesday, July 25, 2007
Atherothrombosis - Wave Goodbye to Combined Anticoagulation and Antiplatelet Therapy?
Atherothrombosis - Wave Goodbye to Combined Anticoagulation and Antiplatelet Therapy? [Editorial]
Mohler, Emile R. III.
From the Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia.
Atherothrombosis describes the occurrence of both atherosclerosis and thrombosis in an artery, a common feature of peripheral arterial disease. [1] It is estimated that 1 in 16 U.S. residents who were at least 40 years of age in 2000 (approximately 8.5 million persons) had peripheral arterial disease. [2] Although claudication is frequent in and seriously limits the lifestyle of patients with peripheral arterial disease, the most common cause of death in these patients is from coexisting atherothrombosis in the coronary or carotid arteries, resulting in a risk of myocardial infarction or stroke that is three times as high as the risk in patients without peripheral arterial disease. [3] It is estimated that half of patients with peripheral arterial disease have concomitant coronary artery disease. [4] The Reduction of Atherothrombosis for Continued Health (known as REACH) Registry, which follows a cohort of approximately 68,000 patients, showed that the annual rate of myocardial infarction, stroke, or death from cardiovascular causes for patients with peripheral arterial disease was 5%./.../
Mohler, Emile R. III.
From the Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia.
Atherothrombosis describes the occurrence of both atherosclerosis and thrombosis in an artery, a common feature of peripheral arterial disease. [1] It is estimated that 1 in 16 U.S. residents who were at least 40 years of age in 2000 (approximately 8.5 million persons) had peripheral arterial disease. [2] Although claudication is frequent in and seriously limits the lifestyle of patients with peripheral arterial disease, the most common cause of death in these patients is from coexisting atherothrombosis in the coronary or carotid arteries, resulting in a risk of myocardial infarction or stroke that is three times as high as the risk in patients without peripheral arterial disease. [3] It is estimated that half of patients with peripheral arterial disease have concomitant coronary artery disease. [4] The Reduction of Atherothrombosis for Continued Health (known as REACH) Registry, which follows a cohort of approximately 68,000 patients, showed that the annual rate of myocardial infarction, stroke, or death from cardiovascular causes for patients with peripheral arterial disease was 5%./.../
Perguntar não ofende...
PERGUNTAR NÃO OFENDE
Aloyzio Achutti. Médico.
(Enviado para publicação no jornal ZH)
Sem entrar no mérito da questão, ao ler a notícia sobre a retirada de um casal de um vôo por uma pergunta considerada ofensiva sobre os freios da aeronave, imaginam-se outras pessoas com mais perguntas engasgadas. É uma ofensa ou um direito perguntar? Sobre a qualidade de um produto antes de comprar? Sobre o risco de uma cirurgia, ou efeitos colaterais de um remédio? Sobre a competência e a corriola de um candidato antes de votar? Sobre os riscos de viajar?
Qual a diferença para a segurança de um vôo ter o “transponder” desligado (motivo para responsabilizar os pilotos do Legacy) e “pinar” ou travar o “reversor” de uma turbina e seguir voando? A crônica confusão em terra não pode ser sintoma de doença muito mais grave e generalizada colocando em risco a segurança de voar? Como é possível oferecer tarifas abaixo do custo operacional sem comprometer a qualidade e a segurança do serviço? É mera coincidência o caos aéreo e a permissão de novas políticas e estratégias comerciais, com a quebra e a saída do mercado de uma companhia cotada como das melhores e mais seguras do mundo?
Não se trata de julgamento precipitado. Por isso mesmo são perguntas esperando por respostas. Um evento por demais doloroso como o recém ocorrido suscita novos questionamentos que os verdadeiros responsáveis (aqueles que têm que responder por algo) já deveriam ter-se feito. A insegurança contamina também outros setores.
Para começar pela saúde: há gente que adoece e morre por falta de recursos? A distribuição das prioridades inter-setoriais levam em conta a importância e as necessidades da saúde humana e saúde ambiental? A alocação de recursos para a saúde como despesa sem reconhecer seu valor como investimento no capital humano não a põe em inferioridade frente ao setor dito produtivo, do qual se serve os poder econômico e também o político? Há falta de material e deficiências nas condições de trabalho dos serviços de saúde? Reutiliza-se material descartável? Quanto recebe um médico do serviço público e outros profissionais da saúde para atender com qualidade cada paciente? E mesmo através dos chamados planos de saúde? A formação médica e a educação continuada são isentas de influência externa, ou podem estar distorcidas pelos interesses de intermediários, da indústria farmacêutica e de equipamentos médicos?
Não é preciso perguntar aos políticos, senadores, deputados e seus auxiliares, bem como ao pessoal do judiciário, se estão satisfeitos com seus salários e prerrogativas de que dispõe, mas pode-se perguntar quanto recebe um professor do ensino fundamental ou médio para formar cada cidadão? E na universidade os professores e pesquisadores estão tranqüilos com a proporcionalidade entre o que se lhes paga e a responsabilidade da formação profissional e do desenvolvimento científico, tecnológico, artístico e cultural?
Será um problema de gestão, de incompetência ou de irresponsabilidade a má distribuição dos bilhões de uma das proporcionalmente maiores arrecadações tributárias do mundo?
O que ofende mesmo não é a pergunta, mas a falta de resposta. Ser responsável é dar resposta, informando clara e prontamente às perguntas do cidadão perplexo pelas manobras dissuasivas. A ocultação da verdade, a falta de respeito frente ao evidente descalabro, ou a demonstração de desconhecimento e menos caso pela segurança, são um desrespeito aos direitos fundamentais do cidadão, e terminam retirando qualquer esperança de uma resposta traduzida em atos efetivos.
Aloyzio Achutti. Médico.
(Enviado para publicação no jornal ZH)
Sem entrar no mérito da questão, ao ler a notícia sobre a retirada de um casal de um vôo por uma pergunta considerada ofensiva sobre os freios da aeronave, imaginam-se outras pessoas com mais perguntas engasgadas. É uma ofensa ou um direito perguntar? Sobre a qualidade de um produto antes de comprar? Sobre o risco de uma cirurgia, ou efeitos colaterais de um remédio? Sobre a competência e a corriola de um candidato antes de votar? Sobre os riscos de viajar?
Qual a diferença para a segurança de um vôo ter o “transponder” desligado (motivo para responsabilizar os pilotos do Legacy) e “pinar” ou travar o “reversor” de uma turbina e seguir voando? A crônica confusão em terra não pode ser sintoma de doença muito mais grave e generalizada colocando em risco a segurança de voar? Como é possível oferecer tarifas abaixo do custo operacional sem comprometer a qualidade e a segurança do serviço? É mera coincidência o caos aéreo e a permissão de novas políticas e estratégias comerciais, com a quebra e a saída do mercado de uma companhia cotada como das melhores e mais seguras do mundo?
Não se trata de julgamento precipitado. Por isso mesmo são perguntas esperando por respostas. Um evento por demais doloroso como o recém ocorrido suscita novos questionamentos que os verdadeiros responsáveis (aqueles que têm que responder por algo) já deveriam ter-se feito. A insegurança contamina também outros setores.
Para começar pela saúde: há gente que adoece e morre por falta de recursos? A distribuição das prioridades inter-setoriais levam em conta a importância e as necessidades da saúde humana e saúde ambiental? A alocação de recursos para a saúde como despesa sem reconhecer seu valor como investimento no capital humano não a põe em inferioridade frente ao setor dito produtivo, do qual se serve os poder econômico e também o político? Há falta de material e deficiências nas condições de trabalho dos serviços de saúde? Reutiliza-se material descartável? Quanto recebe um médico do serviço público e outros profissionais da saúde para atender com qualidade cada paciente? E mesmo através dos chamados planos de saúde? A formação médica e a educação continuada são isentas de influência externa, ou podem estar distorcidas pelos interesses de intermediários, da indústria farmacêutica e de equipamentos médicos?
Não é preciso perguntar aos políticos, senadores, deputados e seus auxiliares, bem como ao pessoal do judiciário, se estão satisfeitos com seus salários e prerrogativas de que dispõe, mas pode-se perguntar quanto recebe um professor do ensino fundamental ou médio para formar cada cidadão? E na universidade os professores e pesquisadores estão tranqüilos com a proporcionalidade entre o que se lhes paga e a responsabilidade da formação profissional e do desenvolvimento científico, tecnológico, artístico e cultural?
Será um problema de gestão, de incompetência ou de irresponsabilidade a má distribuição dos bilhões de uma das proporcionalmente maiores arrecadações tributárias do mundo?
O que ofende mesmo não é a pergunta, mas a falta de resposta. Ser responsável é dar resposta, informando clara e prontamente às perguntas do cidadão perplexo pelas manobras dissuasivas. A ocultação da verdade, a falta de respeito frente ao evidente descalabro, ou a demonstração de desconhecimento e menos caso pela segurança, são um desrespeito aos direitos fundamentais do cidadão, e terminam retirando qualquer esperança de uma resposta traduzida em atos efetivos.
Saturday, July 21, 2007
Clopidogrel-Statin interaction?
Lack of Evidence of a Clopidogrel–Statin Interaction in the CHARISMA Trial Jacqueline Saw, MD*, Danielle M. Brennan, MS, Steven R. Steinhubl, MD, Deepak L. Bhatt, MD, Koon-Hou Mak, MD, Keith Fox, MB, ChB, Eric J. Topol, MD#,* on behalf of the CHARISMA Investigators
* Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky Gleneagles Medical Center, Singapore University and Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom# Department of Cardiovascular Diseases, Scripps Clinic, La Jolla, California.
Manuscript received November 7, 2006; revised manuscript received January 19, 2007, accepted January 22, 2007.
* Reprint requests and correspondence: Dr. Eric J. Topol, Director, Scripps Translational Science Institute, Chief Academic Officer, Scripps Health, Professor of Translational Genomics, The Scripps Research Institute, Scripps Clinic, Division of Cardiovascular Diseases, 10666 North Torey Pines Road, Mail Drop SW206, La Jolla, California 92037. (Email: etopol@scripps.edu)
Objectives: The purpose of this study was to evaluate the potential impact of clopidogrel and statin interaction in a randomized, placebo-controlled trial with long-term follow-up.
Background: There are conflicting data regarding whether statins predominantly metabolized by CYP3A4 reduce the metabolism of clopidogrel to its active metabolite and diminish its clinical efficacy.
Methods: The CHARISMA trial was a randomized trial comparing long-term 75 mg/day clopidogrel versus placebo in patients with cardiovascular disease or multiple risk factors on aspirin. The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death at median follow-up of 28 months. We performed a secondary analysis evaluating the interaction of clopidogrel versus placebo with statin administration, categorizing baseline statin use to those predominantly CYP3A4 metabolized (atorvastatin, lovastatin, simvastatin; CYP3A4-MET) or others (pravastatin, fluvastatin; non–CYP3A4-MET).
Results: Of 15,603 patients enrolled, 10,078 received a statin at baseline (8,245 CYP3A4-MET, 1,748 non–CYP3A4-MET) and 5,496 did not. For the overall population, the primary end point was 6.8% with clopidogrel and 7.3% with placebo (hazard ratio [HR] 0.93; p = 0.22). This was similar among patients on CYP3A4-MET (5.9% clopidogrel, 6.6% placebo, HR 0.89; p = 0.18) or non–CYP3A4-MET statin (5.7% clopidogrel, 7.2% placebo, HR 0.78; p = 0.19). There was no interaction between statin types and randomized treatment (p = 0.69). Patients on atorvastatin (n = 4,127) (5.7% clopidogrel, 7.1% placebo, HR 0.80; p = 0.06) or pravastatin (n = 1,440) (5.1% clopidogrel, 7.0% placebo, HR 0.72; p = 0.13) had similar event rates.
Conclusions: Despite theoretic concerns and ex vivo testing suggesting a potential negative interaction with concomitant clopidogrel and CYP3A4-MET statin administration, there was no evidence of an interaction clinically in a large placebo-controlled trial with long-term follow-up.
* Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky Gleneagles Medical Center, Singapore University and Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom# Department of Cardiovascular Diseases, Scripps Clinic, La Jolla, California.
Manuscript received November 7, 2006; revised manuscript received January 19, 2007, accepted January 22, 2007.
* Reprint requests and correspondence: Dr. Eric J. Topol, Director, Scripps Translational Science Institute, Chief Academic Officer, Scripps Health, Professor of Translational Genomics, The Scripps Research Institute, Scripps Clinic, Division of Cardiovascular Diseases, 10666 North Torey Pines Road, Mail Drop SW206, La Jolla, California 92037. (Email: etopol@scripps.edu)
Objectives: The purpose of this study was to evaluate the potential impact of clopidogrel and statin interaction in a randomized, placebo-controlled trial with long-term follow-up.
Background: There are conflicting data regarding whether statins predominantly metabolized by CYP3A4 reduce the metabolism of clopidogrel to its active metabolite and diminish its clinical efficacy.
Methods: The CHARISMA trial was a randomized trial comparing long-term 75 mg/day clopidogrel versus placebo in patients with cardiovascular disease or multiple risk factors on aspirin. The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death at median follow-up of 28 months. We performed a secondary analysis evaluating the interaction of clopidogrel versus placebo with statin administration, categorizing baseline statin use to those predominantly CYP3A4 metabolized (atorvastatin, lovastatin, simvastatin; CYP3A4-MET) or others (pravastatin, fluvastatin; non–CYP3A4-MET).
Results: Of 15,603 patients enrolled, 10,078 received a statin at baseline (8,245 CYP3A4-MET, 1,748 non–CYP3A4-MET) and 5,496 did not. For the overall population, the primary end point was 6.8% with clopidogrel and 7.3% with placebo (hazard ratio [HR] 0.93; p = 0.22). This was similar among patients on CYP3A4-MET (5.9% clopidogrel, 6.6% placebo, HR 0.89; p = 0.18) or non–CYP3A4-MET statin (5.7% clopidogrel, 7.2% placebo, HR 0.78; p = 0.19). There was no interaction between statin types and randomized treatment (p = 0.69). Patients on atorvastatin (n = 4,127) (5.7% clopidogrel, 7.1% placebo, HR 0.80; p = 0.06) or pravastatin (n = 1,440) (5.1% clopidogrel, 7.0% placebo, HR 0.72; p = 0.13) had similar event rates.
Conclusions: Despite theoretic concerns and ex vivo testing suggesting a potential negative interaction with concomitant clopidogrel and CYP3A4-MET statin administration, there was no evidence of an interaction clinically in a large placebo-controlled trial with long-term follow-up.
Thursday, July 19, 2007
Desastre da TAM: solidariedade de um AMICOR Argentino.
De: Dr.Alejandro Wajner [mailto:ahwajner@gmail.com]
Enviada em: quinta-feira, 19 de julho de 2007 06:03
Para: aloyzio.achutti@terra.com.br
Assunto: mi solidaridad con ustedes por la catastrofe aerea previsible
Dr. Mi solidaridad con este desastre evitable.
Los 200 muertos son ejemplo de la corrupción de los políticos. La pista de aterrizaje estaba mal construida.
Todos lo sabían!
El gobierno es responsable directo y debe ser juzgado por los familiares.
El que maneja la línea aérea debe ir a prision.
En mi país pasa lo mismo y nadie va a prisión.
La justicia no existe.
Sólo para los que la compran.
Mi corazón está con ustedes!
Un médico amigo
Enviada em: quinta-feira, 19 de julho de 2007 06:03
Para: aloyzio.achutti@terra.com.br
Assunto: mi solidaridad con ustedes por la catastrofe aerea previsible
Dr. Mi solidaridad con este desastre evitable.
Los 200 muertos son ejemplo de la corrupción de los políticos. La pista de aterrizaje estaba mal construida.
Todos lo sabían!
El gobierno es responsable directo y debe ser juzgado por los familiares.
El que maneja la línea aérea debe ir a prision.
En mi país pasa lo mismo y nadie va a prisión.
La justicia no existe.
Sólo para los que la compran.
Mi corazón está con ustedes!
Un médico amigo
RISCO E LIMITE
RISCO E LIMITE
Aloyzio Achutti. Médico.
(publicado no Jornal Zero Hora, no dia 20/07/2007)
Prevenir significa evitar danos, antecipando-se ao desastre. O conceito de risco e o conhecimento de sua presença são fundamentais para poder prevenir e chegar antes que o mal aconteça. A sabedoria popular já nos ensina: “é preferível prevenir que remediar”, “antes que o mal cresça, corte-se-lhe a cabeça”, porém não basta o conhecimento. Uma atitude favorável é necessária, e mais do que isso, uma cultura de proteção aos bens e valores fundamentais.
Dizem que nossa cultura é da catástrofe, que só nos movemos depois que um grande mal acontece, e não nos choca mais o comportamento paradoxal de massa, atraída para a contemplação e a comunicação do desastre e da violência, esperando pelo herói do último minuto...
Tudo pode estar relacionado com o desejo de onipotência, com o impulso de ignorar limites, a voracidade de acumular, e o mito da eternidade. As conquistas e o desenvolvimento da ciência contribuem para estimular estas fantasias, reforçadas pela propaganda, corrupção política, e interesses de mercado.
Estamos vivendo momentos de competição desportiva, onde bater recordes é a meta, distorcendo o valor do exercício físico para a saúde. Se a atividade física faz bem, ninguém provou até hoje que seu extremo traga benefícios, a não ser para os interessados na mobilização de multidões e nos negócios daí resultantes.
O limite está geralmente associado a risco e deve ser abordado com muita cautela, somente quando necessário, e com redobrada segurança. Entretanto nossa cultura foi construída cultuando o mais alto, o mais rico, o mais poderoso, o mais veloz, o mais violento, o som mais forte, os esportes radicais e a droga mais excitante, o que é capaz de comer e beber mais, quem mais se arrisca.
A virtude está no meio porque o abuso do limite se encontra nos extremos, em geral por irresponsabilidade, loucura ou incompetência. Também operar no limite inferior ou abaixo dos custos, pagar mal pelo serviço, por clientelismo, por lucratividade, ou para desviar recursos, só pode aumentar o risco de acidentes ou de má prática e deteriorar a qualidade. Na saúde, ou em qualquer outro setor de serviço, no transporte, na indústria, no comércio e na agricultura, é preciso observar os limites e cuidar dos riscos, planejar e avaliar constantemente, investir em manutenção, suporte e infra-estrutura.
A lei é o estabelecimento de limites visando o bem comum. Uma cultura que não respeita os limites, ou que cultua a transgressão em busca de vantagens ou situações de estresse e de risco, favorece a criminalidade e a corrupção.
A final, tudo tem limites e tem riscos, até nossa existência e o meio ambiente no qual vivemos. Para preservá-los, para gozá-los por mais tempo, para não sofrer danos é preciso respeitar os limites e agir dentro de uma margem razoável de segurança. Os extremos são para uso excepcional e a consciência de limite deve-nos servir antes como alarme de alto risco e estímulo na busca de soluções e alternativas melhores, raramente como provocação a ser enfrentada.
Aloyzio Achutti. Médico.
(publicado no Jornal Zero Hora, no dia 20/07/2007)
Prevenir significa evitar danos, antecipando-se ao desastre. O conceito de risco e o conhecimento de sua presença são fundamentais para poder prevenir e chegar antes que o mal aconteça. A sabedoria popular já nos ensina: “é preferível prevenir que remediar”, “antes que o mal cresça, corte-se-lhe a cabeça”, porém não basta o conhecimento. Uma atitude favorável é necessária, e mais do que isso, uma cultura de proteção aos bens e valores fundamentais.
Dizem que nossa cultura é da catástrofe, que só nos movemos depois que um grande mal acontece, e não nos choca mais o comportamento paradoxal de massa, atraída para a contemplação e a comunicação do desastre e da violência, esperando pelo herói do último minuto...
Tudo pode estar relacionado com o desejo de onipotência, com o impulso de ignorar limites, a voracidade de acumular, e o mito da eternidade. As conquistas e o desenvolvimento da ciência contribuem para estimular estas fantasias, reforçadas pela propaganda, corrupção política, e interesses de mercado.
Estamos vivendo momentos de competição desportiva, onde bater recordes é a meta, distorcendo o valor do exercício físico para a saúde. Se a atividade física faz bem, ninguém provou até hoje que seu extremo traga benefícios, a não ser para os interessados na mobilização de multidões e nos negócios daí resultantes.
O limite está geralmente associado a risco e deve ser abordado com muita cautela, somente quando necessário, e com redobrada segurança. Entretanto nossa cultura foi construída cultuando o mais alto, o mais rico, o mais poderoso, o mais veloz, o mais violento, o som mais forte, os esportes radicais e a droga mais excitante, o que é capaz de comer e beber mais, quem mais se arrisca.
A virtude está no meio porque o abuso do limite se encontra nos extremos, em geral por irresponsabilidade, loucura ou incompetência. Também operar no limite inferior ou abaixo dos custos, pagar mal pelo serviço, por clientelismo, por lucratividade, ou para desviar recursos, só pode aumentar o risco de acidentes ou de má prática e deteriorar a qualidade. Na saúde, ou em qualquer outro setor de serviço, no transporte, na indústria, no comércio e na agricultura, é preciso observar os limites e cuidar dos riscos, planejar e avaliar constantemente, investir em manutenção, suporte e infra-estrutura.
A lei é o estabelecimento de limites visando o bem comum. Uma cultura que não respeita os limites, ou que cultua a transgressão em busca de vantagens ou situações de estresse e de risco, favorece a criminalidade e a corrupção.
A final, tudo tem limites e tem riscos, até nossa existência e o meio ambiente no qual vivemos. Para preservá-los, para gozá-los por mais tempo, para não sofrer danos é preciso respeitar os limites e agir dentro de uma margem razoável de segurança. Os extremos são para uso excepcional e a consciência de limite deve-nos servir antes como alarme de alto risco e estímulo na busca de soluções e alternativas melhores, raramente como provocação a ser enfrentada.
Wednesday, July 18, 2007
Scanning the Genome for Coronary Risk
Anthony Rosenzweig, M.D.
Coronary artery disease remains an enormous clinical problem, affecting more than 15 million people in the United States alone, where it is the most common cause of death (accounting for one in three deaths).1 The prevalence of coronary heart disease is increasing at a particularly alarming rate in developing nations, which are ill equipped to shoulder the associated economic burden.2,3 The clinical need this represents underscores the importance of understanding the causes of coronary disease and identifying persons at risk.
Much progress has been made toward these goals. We now recognize many clinical risk factors — such as hyperlipidemia and diabetes — and realize that they can induce an inflammatory cascade marked by endothelial dysfunction, leukocyte recruitment, and proliferation of smooth-muscle cells, ultimately culminating in plaque formation.4 The addition of thrombosis, plaque rupture, or hemorrhage can lead to plaque instability and acute coronary syndromes. This suggests that risk factors could, in theory, affect primarily plaque formation or stability and in turn, measures of plaque burden (such as coronary calcification) or clinical events (such as myocardial infarction), respectively. However, most factors identified to date have qualitatively similar effects on both aspects of atherosclerosis
Coronary artery disease remains an enormous clinical problem, affecting more than 15 million people in the United States alone, where it is the most common cause of death (accounting for one in three deaths).1 The prevalence of coronary heart disease is increasing at a particularly alarming rate in developing nations, which are ill equipped to shoulder the associated economic burden.2,3 The clinical need this represents underscores the importance of understanding the causes of coronary disease and identifying persons at risk.
Much progress has been made toward these goals. We now recognize many clinical risk factors — such as hyperlipidemia and diabetes — and realize that they can induce an inflammatory cascade marked by endothelial dysfunction, leukocyte recruitment, and proliferation of smooth-muscle cells, ultimately culminating in plaque formation.4 The addition of thrombosis, plaque rupture, or hemorrhage can lead to plaque instability and acute coronary syndromes. This suggests that risk factors could, in theory, affect primarily plaque formation or stability and in turn, measures of plaque burden (such as coronary calcification) or clinical events (such as myocardial infarction), respectively. However, most factors identified to date have qualitatively similar effects on both aspects of atherosclerosis
World Heart Federation : Rheumatic Heart Disease Network
World Heart Federation : Rheumatic Heart Disease Network: "The World Heart Federation's web site for rheumatic heart disease control is an international resource developed primarily for clinicians, health practitioners and policy-makers in developing countries where the disease is still common. Its purpose is to promote rheumatic fever and rheumatic heart disease control through the use of register-based secondary prevention.
The Centre provides register databases, as well as the latest rheumatic fever/rheumatic heart disease guidelines, educational and training materials, available free of charge. It also provides an email contact for asking questions and sharing information and experience on rheumatic heart disease control.
The World Heart Federation also invites users to submit local rheumatic heart disease programme and training materials to this site through the email contact. Materials can be included on the site for use by others around the world.
World Heart Federation resources and training materials >
Other international resources and training materials >
The Centre provides register databases, as well as the latest rheumatic fever/rheumatic heart disease guidelines, educational and training materials, available free of charge. It also provides an email contact for asking questions and sharing information and experience on rheumatic heart disease control.
The World Heart Federation also invites users to submit local rheumatic heart disease programme and training materials to this site through the email contact. Materials can be included on the site for use by others around the world.
World Heart Federation resources and training materials >
Other international resources and training materials >
Nonfasting Triglyceride Levels Linked to Increased Cardiovascular Risk
Nonfasting Triglyceride Levels Linked to Increased Cardiovascular Risk - Breaking Medical News + CME Teaching Brief® - MedPage Today: "HERLEV, Denmark, July 17 -- Elevated nonfasting triglycerides are associated with increased risk of fatal and nonfatal cardiac events, according to results of two large, long-term, prospective cohort studies."/.../
Stroke prevalence US 2005
Stroke is the third most common cause of death in the United States.1 Stroke also results in substantial health-care expenditures; the mean lifetime cost resulting from an ischemic stroke is estimated at $140,000 per patient.1 Nationwide, costs related to stroke are expected to reach an estimated $62.7 billion in 2007.1 Stroke death rates are higher in the southeastern United States, compared with other regions of the country; blacks, American Indians/Alaska Natives (AI/ANs), Asians/Pacific Islanders, and Hispanics die from stroke at younger ages than whites.1-3 Regional and national data on self-reported stroke prevalence have been published previously1, 4; however, state-specific prevalence data for persons with a history of stroke have not. To provide national-level stroke prevalence estimates by age group, sex, race/ethnicity, and education level and overall prevalence estimates for each of the 50 states, the U.S. Virgin Islands (USVI), the District of Columbia (DC), and Puerto Rico, CDC analyzed data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis and provides the first state-based prevalence estimates of stroke. The results indicated that, in 2005, substantial differences existed in the prevalence of stroke by state/territory, race/ethnicity, age group, and education level. To lower the incidence of stroke and meet the Healthy People 2010 objective* to reduce stroke deaths (objective no. 12-7) and the overall goal to eliminate health disparities, public health programs should augment stroke risk-factor prevention and educational measures in disproportionately affected regions and populations.
Monday, July 16, 2007
Assessment of Functional Capacity in Clinical and Research Settings
The assessment of functional capacity reflects the ability to perform activities of daily living that require sustained aerobic metabolism. The integrated efforts and health of the pulmonary, cardiovascular, and skeletal muscle systems dictate an individual’s functional capacity. Numerous investigations have demonstrated that the assessment of functional capacity provides important diagnostic and prognostic information in a wide variety of clinical and research settings. This scientific statement, an update of the previously published American Heart Association (AHA) document, highlights the major clinical and research applications of functional capacity assessment. For a comprehensive review of exercise testing, the reader is referred to the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing./.../
Sunday, July 15, 2007
[2360 - AMICOR10 - 15/07/2007]
[2360 - AMICOR10 - 15/07/2007]
This week Highlights/Realces desta semana
Among several references sellected since the last massege the following must be highlightedEntre as várias referencias selecionadas desde a última mensagem as seguintes merecem ser salientadas:
http://amicor.blogspot.com/
Influenza e Ateroesclerose
Reportagem no Jornal da Universidade sobre artigo em revista internacional da AMICOR Maria Inês Reinert Azambuja
THE HEALTH BENEFITS OF PALEOCUISINE
Swedish men with diabetes showed a dramatic drop in their blood sugar after 3 months on a "Paleolithic" diet, according to researchers in Sweden, who found that a diet free of grains and dairy products worked better than the oft-recommended "Mediterranean" diet.
Global Burden of Disease 2005: call for collaborators
Christopher JL Murray a, Alan D Lopez b, Robert Black c, Colin D Mathers d, Kenji Shibuya d, Majid Ezzati e, Joshua A Salomon e, Catherine M Michaud e, Neff Walker c and Theo Vos bThe Global Burden of Disease (GBD) Study was commissioned by the World Bank in 1991 to provide a comprehensive assessment of disease burden in 1990 for 107 diseases and injuries and ten selected risk factors for the world and eight major regions. The methods and findings of the original GBD have been widely published and have stimulated numerous national studies of burden of disease
AMICOR - HONcode certificate extended
HONcode, Health On the Net Foundation's initiative to improve the quality of the medical Internet. As part of our subsequent monitoring process, we revisited your Web site and reviewed it for its HONcode compliance. Upon this process we certify its full compliance with all HONcode principles. We are therefore very pleased to herewith inform you that your HONcode certificate has been extended for the following year.
http://amicor_preserve.blogspot.com/
'The Governance Indicators
"'The Governance Indicators put to rest the tired assertion that these issues cannot be robustly measured and the lessons drawn cannot be put to subsequent positive use by governments, the development community, civil society and the media.'
Environmental Burden of Disease: Country profiles
For the first time, WHO presents country data on the burden of disease that is preventable through healthier environments. These estimates provide the stepping stone for informed policy making in disease prevention.
Informações sobre como melhor utilizar os Blogs AMICOR estarão permanentemente disponíveis no endereço abaixo:
Information on how to use the AMICOR Blogs are permenently available in the following address:
http://amicor10.blogspot.com/
É possível assinar gratuitamente para receber informação automática dos Blogs AMICOR ou de outros através de programas como Bloglines ou FeedBlitz, basta acessar o endereço e fazer sua inscrição dando os endereços desejados;
http://www.bloglines.com/public/achutti
http://www.feedblitz.com/
This week Highlights/Realces desta semana
Among several references sellected since the last massege the following must be highlightedEntre as várias referencias selecionadas desde a última mensagem as seguintes merecem ser salientadas:
http://amicor.blogspot.com/
Influenza e Ateroesclerose
Reportagem no Jornal da Universidade sobre artigo em revista internacional da AMICOR Maria Inês Reinert Azambuja
THE HEALTH BENEFITS OF PALEOCUISINE
Swedish men with diabetes showed a dramatic drop in their blood sugar after 3 months on a "Paleolithic" diet, according to researchers in Sweden, who found that a diet free of grains and dairy products worked better than the oft-recommended "Mediterranean" diet.
Global Burden of Disease 2005: call for collaborators
Christopher JL Murray a, Alan D Lopez b, Robert Black c, Colin D Mathers d, Kenji Shibuya d, Majid Ezzati e, Joshua A Salomon e, Catherine M Michaud e, Neff Walker c and Theo Vos bThe Global Burden of Disease (GBD) Study was commissioned by the World Bank in 1991 to provide a comprehensive assessment of disease burden in 1990 for 107 diseases and injuries and ten selected risk factors for the world and eight major regions. The methods and findings of the original GBD have been widely published and have stimulated numerous national studies of burden of disease
AMICOR - HONcode certificate extended
HONcode, Health On the Net Foundation's initiative to improve the quality of the medical Internet. As part of our subsequent monitoring process, we revisited your Web site and reviewed it for its HONcode compliance. Upon this process we certify its full compliance with all HONcode principles. We are therefore very pleased to herewith inform you that your HONcode certificate has been extended for the following year.
http://amicor_preserve.blogspot.com/
'The Governance Indicators
"'The Governance Indicators put to rest the tired assertion that these issues cannot be robustly measured and the lessons drawn cannot be put to subsequent positive use by governments, the development community, civil society and the media.'
Environmental Burden of Disease: Country profiles
For the first time, WHO presents country data on the burden of disease that is preventable through healthier environments. These estimates provide the stepping stone for informed policy making in disease prevention.
Informações sobre como melhor utilizar os Blogs AMICOR estarão permanentemente disponíveis no endereço abaixo:
Information on how to use the AMICOR Blogs are permenently available in the following address:
http://amicor10.blogspot.com/
É possível assinar gratuitamente para receber informação automática dos Blogs AMICOR ou de outros através de programas como Bloglines ou FeedBlitz, basta acessar o endereço e fazer sua inscrição dando os endereços desejados;
http://www.bloglines.com/public/achutti
http://www.feedblitz.com/
Influenza e Ateroesclerose
Reportagem no Jornal da Universidade sobre artigo em revista internacional da AMICOR Maria Inês Reinert Azambuja
CIÊNCIA
Para Maria Inês Reinelt Azambuja, professora da Faculdade de Medicina da UFRGS, há uma relação direta entre a ocorrência da pandemia de influenza em 1918 e o alto índice de infartos do miocárdio registrado nos Estados Unidos nas décadas de 60 e 70.
Em artigo publicado na edição de abril da revista Perspectives in Biology and Medicine da universidade norte-americana Johns Hopkins, em colaboração com o professor de epidemiologia populacional da universidade de Harvard, Richard Levins, a médica afirma que aquelas mortes não ocorreram por doença isquêmica. A causa real teria sido a infecção pelo vírus da influenza, que gerou uma resposta imunopatológica e resultou em trombose coronária, seguida por morte súbita. “Em outras palavras, aquelas mortes deveriam estar no cômputo geral da gripe espanhola, mas foram creditadas a outras causas por suas manifestações clínicas.”
A professora, que atua junto ao Departamento de Medicina Social, dedica-se ao estudo dos problemas do coração desde 1982, quando trabalhou na Secretaria Estadual da Saúde na prevenção das doenças cardiovasculares. Com mestrado em epidemiologia nos EUA, ela atualmente presta atendimento no Ambulatório de Doenças do Trabalho situado no posto de saúde do bairro IAPI.
“O modo como enxergamos um determinado problema depende muito do momento histórico que estamos vivendo. Quando me formei, em 1976, tive a sorte de acompanhar o período em que a mortalidade por doença isquêmica do coração, que tinha sido muito elevada durante os últimos 30 anos, começava a diminuir”, diz a professora. Por conta disso, Maria Inês acha que pôde levantar questões que a maioria de seus colegas, que desenvolveram seus estudos durante uma fase de aumento desse índice, não teve condições de fazer. “Naturalmente, os médicos daquela época associaram a alta taxa de mortalidade por problemas do coração a fatores como estilo de vida, desenvolvimento da economia e todas as mudanças que acompanharam o aumento da urbanização nos países desenvolvidos. O que fiz foi olhar para esse fenômeno como um evento, comparando-o a uma epidemia, na tentativa de entender não o que provocou a doença em si, mas o que causou essa curva epidêmica.”
Curva decrescente – Na década de 70, quando o número de mortes baixou abruptamente, a epidemiologista passou a perguntar-se o que teria causado tal mudança, uma vez que não houve uma desaceleração dos fatores tidos como causadores do problema. “No primeiro mundo, tentou-se explicar essa queda pela redução dos fatores de risco, como se as pessoas estivessem sendo mais bem tratadas de problemas como pressão alta, consumissem menos gordura, ou recebessem melhor atendimento médico. Porém, minha experiência como especialista em saúde pública me dizia que as intervenções médicas têm pouco impacto sobre o conjunto da população. Mesmo medidas mais amplas, como uma mudança da dieta alimentar não produzem impactos assim tão marcantes a ponto de serem percebidos em termos populacionais.”
Dados da Organização Mundial da Saúde revelam que, em 30 anos, houve uma queda de 60% na mortalidade por doença isquêmica do coração nos Estados Unidos. Atualmente, apesar de a população norte-americana ter envelhecido muito, esse índice segue baixo. E, no Brasil, conforme o Ministério da Saúde, o número de óbitos também está caindo.
A médica explica que, no início de suas pesquisas buscou as causas para o aumento do índice de mortes por problemas cardíacos no ambiente externo, mas terminou concluindo que era preciso considerar a vulnerabilidade da própria população. “Testei várias hipóteses: a qualidade da população poderia ter sido alterada em função da Primeira Guerra Mundial, que ocasionou a morte dos indivíduos mais saudáveis e a sobrevivência dos não tão fortes. A possibilidade de uma infecção estar relacionada às mortes por doença isquêmica do coração não passava pela minha cabeça. Um dia, deparei-me com um artigo antigo que levantava a possibilidade de infecção na arteriosclerose e percebi que uma infecção poderia ser a causa daqueles índices elevados dos anos 60. Por isso, digo que nossa capacidade de pensar é totalmente determinada pelo momento que estamos vivendo. As coisas podem estar diante de nosso nariz, mas não conseguimos enxergá-las. O paradigma degenerativo era tão forte que ninguém, naquela época, imaginaria pensar em infecção.”
Ao estudar que evento poderia ter sido tão grande a ponto de causar tamanho impacto na mortalidade cardiovascular, a epidemiologista deparou-se com a pandemia de 1918, causada pelo vírus da influenza e popularmente conhecida como gripe espanhola. Na comparação entre as informações daquele período e os dados referentes às mortes nos anos 60, algumas coisas ficaram claras: os sobreviventes do vírus da influenza, que tinham entre 20 e 40 anos em 1918, morreram predominantemente nas décadas de 1950 e 1960 de doença isquêmica do coração.
No artigo que publicou, a médica sustenta que, de alguma maneira, o grupo populacional que sobreviveu à primeira pandemia de influenza em 1918 ficou vulnerável e veio a falecer durante outras epidemias de influenza. “Nas epidemias que se seguiram à pandemia de 1918, houve muitas mortes por doença isquêmica do coração”, conclui.
Doenças do coração estão associadas a velhas crenças
Pandemia deixou vestígios
CIÊNCIA
Para Maria Inês Reinelt Azambuja, professora da Faculdade de Medicina da UFRGS, há uma relação direta entre a ocorrência da pandemia de influenza em 1918 e o alto índice de infartos do miocárdio registrado nos Estados Unidos nas décadas de 60 e 70.
Em artigo publicado na edição de abril da revista Perspectives in Biology and Medicine da universidade norte-americana Johns Hopkins, em colaboração com o professor de epidemiologia populacional da universidade de Harvard, Richard Levins, a médica afirma que aquelas mortes não ocorreram por doença isquêmica. A causa real teria sido a infecção pelo vírus da influenza, que gerou uma resposta imunopatológica e resultou em trombose coronária, seguida por morte súbita. “Em outras palavras, aquelas mortes deveriam estar no cômputo geral da gripe espanhola, mas foram creditadas a outras causas por suas manifestações clínicas.”
A professora, que atua junto ao Departamento de Medicina Social, dedica-se ao estudo dos problemas do coração desde 1982, quando trabalhou na Secretaria Estadual da Saúde na prevenção das doenças cardiovasculares. Com mestrado em epidemiologia nos EUA, ela atualmente presta atendimento no Ambulatório de Doenças do Trabalho situado no posto de saúde do bairro IAPI.
“O modo como enxergamos um determinado problema depende muito do momento histórico que estamos vivendo. Quando me formei, em 1976, tive a sorte de acompanhar o período em que a mortalidade por doença isquêmica do coração, que tinha sido muito elevada durante os últimos 30 anos, começava a diminuir”, diz a professora. Por conta disso, Maria Inês acha que pôde levantar questões que a maioria de seus colegas, que desenvolveram seus estudos durante uma fase de aumento desse índice, não teve condições de fazer. “Naturalmente, os médicos daquela época associaram a alta taxa de mortalidade por problemas do coração a fatores como estilo de vida, desenvolvimento da economia e todas as mudanças que acompanharam o aumento da urbanização nos países desenvolvidos. O que fiz foi olhar para esse fenômeno como um evento, comparando-o a uma epidemia, na tentativa de entender não o que provocou a doença em si, mas o que causou essa curva epidêmica.”
Curva decrescente – Na década de 70, quando o número de mortes baixou abruptamente, a epidemiologista passou a perguntar-se o que teria causado tal mudança, uma vez que não houve uma desaceleração dos fatores tidos como causadores do problema. “No primeiro mundo, tentou-se explicar essa queda pela redução dos fatores de risco, como se as pessoas estivessem sendo mais bem tratadas de problemas como pressão alta, consumissem menos gordura, ou recebessem melhor atendimento médico. Porém, minha experiência como especialista em saúde pública me dizia que as intervenções médicas têm pouco impacto sobre o conjunto da população. Mesmo medidas mais amplas, como uma mudança da dieta alimentar não produzem impactos assim tão marcantes a ponto de serem percebidos em termos populacionais.”
Dados da Organização Mundial da Saúde revelam que, em 30 anos, houve uma queda de 60% na mortalidade por doença isquêmica do coração nos Estados Unidos. Atualmente, apesar de a população norte-americana ter envelhecido muito, esse índice segue baixo. E, no Brasil, conforme o Ministério da Saúde, o número de óbitos também está caindo.
A médica explica que, no início de suas pesquisas buscou as causas para o aumento do índice de mortes por problemas cardíacos no ambiente externo, mas terminou concluindo que era preciso considerar a vulnerabilidade da própria população. “Testei várias hipóteses: a qualidade da população poderia ter sido alterada em função da Primeira Guerra Mundial, que ocasionou a morte dos indivíduos mais saudáveis e a sobrevivência dos não tão fortes. A possibilidade de uma infecção estar relacionada às mortes por doença isquêmica do coração não passava pela minha cabeça. Um dia, deparei-me com um artigo antigo que levantava a possibilidade de infecção na arteriosclerose e percebi que uma infecção poderia ser a causa daqueles índices elevados dos anos 60. Por isso, digo que nossa capacidade de pensar é totalmente determinada pelo momento que estamos vivendo. As coisas podem estar diante de nosso nariz, mas não conseguimos enxergá-las. O paradigma degenerativo era tão forte que ninguém, naquela época, imaginaria pensar em infecção.”
Ao estudar que evento poderia ter sido tão grande a ponto de causar tamanho impacto na mortalidade cardiovascular, a epidemiologista deparou-se com a pandemia de 1918, causada pelo vírus da influenza e popularmente conhecida como gripe espanhola. Na comparação entre as informações daquele período e os dados referentes às mortes nos anos 60, algumas coisas ficaram claras: os sobreviventes do vírus da influenza, que tinham entre 20 e 40 anos em 1918, morreram predominantemente nas décadas de 1950 e 1960 de doença isquêmica do coração.
No artigo que publicou, a médica sustenta que, de alguma maneira, o grupo populacional que sobreviveu à primeira pandemia de influenza em 1918 ficou vulnerável e veio a falecer durante outras epidemias de influenza. “Nas epidemias que se seguiram à pandemia de 1918, houve muitas mortes por doença isquêmica do coração”, conclui.
Doenças do coração estão associadas a velhas crenças
Pandemia deixou vestígios
Clinical Utilization of Cardiac Biomarker Testing in Heart Failure
National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Utilization of Cardiac Biomarker Testing in Heart Failure
WRITING GROUP MEMBERS , W. H. Wilson Tang MD, Gary S. Francis MD, David A. Morrow MD, MPH, L. Kristin Newby MD, MHS, Christopher P. Cannon MD, Robert L. Jesse MD, PhD, Alan B Storrow MD, Robert H. Christenson PhD, COMMITTEE MEMBERS , Robert H. Christenson PhD, Chair, Fred S. Apple , Christopher P. Cannon , Gary S. Francis , Robert L. Jesse , David A. Morrow , L. Kristin Newby , Jan Ravkilde , Alan B. Storrow , W.H. Wilson Tang , and Alan H.B. Tang
WRITING GROUP MEMBERS , W. H. Wilson Tang MD, Gary S. Francis MD, David A. Morrow MD, MPH, L. Kristin Newby MD, MHS, Christopher P. Cannon MD, Robert L. Jesse MD, PhD, Alan B Storrow MD, Robert H. Christenson PhD, COMMITTEE MEMBERS , Robert H. Christenson PhD, Chair, Fred S. Apple , Christopher P. Cannon , Gary S. Francis , Robert L. Jesse , David A. Morrow , L. Kristin Newby , Jan Ravkilde , Alan B. Storrow , W.H. Wilson Tang , and Alan H.B. Tang
Friday, July 13, 2007
THE HEALTH BENEFITS OF PALEOCUISINE
THE HEALTH BENEFITS OF PALEOCUISINE
Swedish men with diabetes showed a dramatic drop in their blood sugar after 3 months on a "Paleolithic" diet, according to researchers in Sweden, who found that a diet free of grains and dairy products worked better than the oft-recommended "Mediterranean" diet.
Of 29 men with heart disease and diabetic conditions, 14 showed blood sugar returning to normal after restricting themselves to lean meat, fish, fruits, root vegetables, eggs, and nuts. What's more, their glucose tolerance improved by 26%, as shown when glucose levels were tested after they ate sugars. But the 15 men on the Mediterranean diet, whose intake included grains and dairy products, showed only a 7% improvement in glucose tolerance, according to Lund University physician Staffan Lindeberg, whose study was published online this month in Diabetologia. Lindeberg says the study was inspired when he learned in the 1990s that Papua New Guinea's Trobriand islanders, who live on a "preagricultural" diet, had no heart disease or diabetes.
Lindeberg speculates that a Stone Age diet may owe its success with diabetics to the absence of "bioactive substances," such as the casein protein in milk and lectin in grains, which may impair glucose tolerance--as they do in studies of rats.
Evolutionary nutritionist Loren Cordain of Colorado State University in Fort Collins says the study is "significant" because "it represents one of the first well-controlled trials of a modern paleolike diet to ever have been conducted."/.../
Swedish men with diabetes showed a dramatic drop in their blood sugar after 3 months on a "Paleolithic" diet, according to researchers in Sweden, who found that a diet free of grains and dairy products worked better than the oft-recommended "Mediterranean" diet.
Of 29 men with heart disease and diabetic conditions, 14 showed blood sugar returning to normal after restricting themselves to lean meat, fish, fruits, root vegetables, eggs, and nuts. What's more, their glucose tolerance improved by 26%, as shown when glucose levels were tested after they ate sugars. But the 15 men on the Mediterranean diet, whose intake included grains and dairy products, showed only a 7% improvement in glucose tolerance, according to Lund University physician Staffan Lindeberg, whose study was published online this month in Diabetologia. Lindeberg says the study was inspired when he learned in the 1990s that Papua New Guinea's Trobriand islanders, who live on a "preagricultural" diet, had no heart disease or diabetes.
Lindeberg speculates that a Stone Age diet may owe its success with diabetics to the absence of "bioactive substances," such as the casein protein in milk and lectin in grains, which may impair glucose tolerance--as they do in studies of rats.
Evolutionary nutritionist Loren Cordain of Colorado State University in Fort Collins says the study is "significant" because "it represents one of the first well-controlled trials of a modern paleolike diet to ever have been conducted."/.../
Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study -- Hippisley-Cox et al., 10.1136/bmj.39261.471806.55 -- BMJ
Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study -- Hippisley-Cox et al., 10.1136/bmj.39261.471806.55 -- BMJ: "Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study
Julia Hippisley-Cox, professor of clinical epidemiology and general practice1, Carol Coupland, senior lecturer in medical statistics1, Yana Vinogradova, research fellow in medical statistics1, John Robson, senior lecturer in general practice2, Margaret May, research fellow in medical statistics3, Peter Brindle, research and development strategy lead4
1 Tower Building, University Park, Nottingham NG2 7RD, 2 Centre for Health Sciences, Queen Mary's School of Medicine and Dentistry, London, 3 Department of Social Medicine, University of Bristol, 4 Avon Primary Care Research Collaborative, Bristol Primary Care Trust
Objective To derive a new cardiovascular disease risk score (QRISK) for the United Kingdom and to validate its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN).
Design Prospective open cohort study using routinely collected data from general practice.
Setting UK practices contributing to the QRESEARCH database.
Participants The derivation cohort consisted of 1.28 million patients, aged 35-74 years, registered at 318 practices between 1 January 1995 and 1 April 2007 and who were free of diabetes and existing cardiovascular disease. The validation cohort consisted of 0.61 million patients from 160 practices. "/.../
Julia Hippisley-Cox, professor of clinical epidemiology and general practice1, Carol Coupland, senior lecturer in medical statistics1, Yana Vinogradova, research fellow in medical statistics1, John Robson, senior lecturer in general practice2, Margaret May, research fellow in medical statistics3, Peter Brindle, research and development strategy lead4
1 Tower Building, University Park, Nottingham NG2 7RD, 2 Centre for Health Sciences, Queen Mary's School of Medicine and Dentistry, London, 3 Department of Social Medicine, University of Bristol, 4 Avon Primary Care Research Collaborative, Bristol Primary Care Trust
Objective To derive a new cardiovascular disease risk score (QRISK) for the United Kingdom and to validate its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN).
Design Prospective open cohort study using routinely collected data from general practice.
Setting UK practices contributing to the QRESEARCH database.
Participants The derivation cohort consisted of 1.28 million patients, aged 35-74 years, registered at 318 practices between 1 January 1995 and 1 April 2007 and who were free of diabetes and existing cardiovascular disease. The validation cohort consisted of 0.61 million patients from 160 practices. "/.../
Global Burden of Disease 2005: call for collaborators
Global Burden of Disease 2005: call for collaborators
Christopher JL Murray a, Alan D Lopez b, Robert Black c, Colin D Mathers d, Kenji Shibuya d, Majid Ezzati e, Joshua A Salomon e, Catherine M Michaud e, Neff Walker c and Theo Vos b
The Global Burden of Disease (GBD) Study was commissioned by the World Bank in 1991 to provide a comprehensive assessment of disease burden in 1990 for 107 diseases and injuries and ten selected risk factors for the world and eight major regions.1 The methods and findings of the original GBD have been widely published2,3 and have stimulated numerous national studies of burden of disease.4–8
The basic philosophy guiding the burden of disease approach is that best estimates of incidence, prevalence, and mortality can be generated through the careful analysis and correction for bias of all available sources of information in a country or region. To assess burden of disease, a time-based measure that combined years of life lost due to premature mortality and years of life lost due to time lived in health states less than ideal health—the disability-adjusted life year, or DALY—was developed. The initial GBD Study represented a major step in the global and regional quantification of the effects of diseases, injuries, and risk factors on population health. Results from the GBD Study have been widely used by governments and non-governmental agencies to inform debates on priorities for research, development, and policy responses./.../
Christopher JL Murray a, Alan D Lopez b, Robert Black c, Colin D Mathers d, Kenji Shibuya d, Majid Ezzati e, Joshua A Salomon e, Catherine M Michaud e, Neff Walker c and Theo Vos b
The Global Burden of Disease (GBD) Study was commissioned by the World Bank in 1991 to provide a comprehensive assessment of disease burden in 1990 for 107 diseases and injuries and ten selected risk factors for the world and eight major regions.1 The methods and findings of the original GBD have been widely published2,3 and have stimulated numerous national studies of burden of disease.4–8
The basic philosophy guiding the burden of disease approach is that best estimates of incidence, prevalence, and mortality can be generated through the careful analysis and correction for bias of all available sources of information in a country or region. To assess burden of disease, a time-based measure that combined years of life lost due to premature mortality and years of life lost due to time lived in health states less than ideal health—the disability-adjusted life year, or DALY—was developed. The initial GBD Study represented a major step in the global and regional quantification of the effects of diseases, injuries, and risk factors on population health. Results from the GBD Study have been widely used by governments and non-governmental agencies to inform debates on priorities for research, development, and policy responses./.../
Wednesday, July 11, 2007
AMICOR - HONcode certificate extended
De: honcode-en@healthonnet.org [mailto:honcode-en@healthonnet.org]
Enviada em: terça-feira, 10 de julho de 2007 18:18
Para: aloyzio.achutti@terra.com.br
Assunto: Extension of certification + Thanks HONcode
Dear Information provider,
Thank you for showing your support for the HONcode, Health On the Net Foundation's initiative to improve the quality of the medical Internet. As part of our subsequent monitoring process, we revisited your Web site and reviewed it for its HONcode compliance.
Upon this process we certify its full compliance with all HONcode principles. We are therefore very pleased to herewith inform you that your HONcode certificate has been extended for the following year.
.................
The HONcode team
------------------------------------------------------------------
Code of Conduct Department | HONcode:
http://www.hon.ch/Conduct.html
Health On the Net (HON) | HON: http://www.hon.ch/
Geneva University Hospital - DIM | My electronic mail is
CH-1211 Geneva 14, Switzerland | HONcode@healthonnet.org
Phone/Fax:(41 22)372 6250/8885 |
Enviada em: terça-feira, 10 de julho de 2007 18:18
Para: aloyzio.achutti@terra.com.br
Assunto: Extension of certification + Thanks HONcode
Dear Information provider,
Thank you for showing your support for the HONcode, Health On the Net Foundation's initiative to improve the quality of the medical Internet. As part of our subsequent monitoring process, we revisited your Web site and reviewed it for its HONcode compliance.
Upon this process we certify its full compliance with all HONcode principles. We are therefore very pleased to herewith inform you that your HONcode certificate has been extended for the following year.
.................
The HONcode team
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Code of Conduct Department | HONcode:
http://www.hon.ch/Conduct.html
Health On the Net (HON) | HON: http://www.hon.ch/
Geneva University Hospital - DIM | My electronic mail is
CH-1211 Geneva 14, Switzerland | HONcode@healthonnet.org
Phone/Fax:(41 22)372 6250/8885 |
Monday, July 02, 2007
Cardiovascular Biomarkers: Added Value With an Integrated Approach?
Cardiovascular Biomarkers: Added Value With an Integrated Approach?
[Editorial]
Koenig, Wolfgang MD, FRCP, FESC
From the Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Ulm, Germany.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Wolfgang Koenig, MD, Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Robert-Koch Str 8, D-89081 Ulm, Germany. E-mail wolfgang.koenig@uniklinik-ulm.de
In primary prevention, traditional risk factors are a useful first step in t
he determination of who could be at risk for cardiovascular events. In the era of “global risk assessment” scores such as the Framingham score, the Prospective Cardiovascular Münster (PROCAM) score, or the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE), which are derived from multivariable statistical models, should be used.1 However, it has been noted that a considerable number of at-risk patients cannot be identified on the basis of traditional risk factors alone.2 This has prompted the search for novel markers of cardiovascular risk to help improve risk prediction.3 Such markers could either represent various blood biomarkers relevant to the pathophysiology of atherothrombosis (eg, markers of the inflammatory response, coagulation markers, markers of platelet aggregation, lipoproteins, or lipid-related variables), genetic markers, or markers of subclinical disease, which may also aid in improved risk prediction. Determination of global risk on the basis of traditional risk factors allows categorization into high (10-year risk, >20%), low (10-year risk, <10%), or intermediate risk (10-year risk, 10% to 20%). Subjects at high risk should be recommended lifestyle changes or prescribed a statin. Subjects at low risk would be reevaluated 3 to 5 years later. Those at intermediate risk, however, who comprise up to 40% of the population at risk,4 would be candidates for additional testing to increase or decrease their actual risk. A large panel of blood biomarkers are available for this purpose, but most of them are not yet applicable in clinical practice for various reasons
[Editorial]
Koenig, Wolfgang MD, FRCP, FESC
From the Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Ulm, Germany.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Wolfgang Koenig, MD, Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Robert-Koch Str 8, D-89081 Ulm, Germany. E-mail wolfgang.koenig@uniklinik-ulm.de
In primary prevention, traditional risk factors are a useful first step in t
he determination of who could be at risk for cardiovascular events. In the era of “global risk assessment” scores such as the Framingham score, the Prospective Cardiovascular Münster (PROCAM) score, or the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE), which are derived from multivariable statistical models, should be used.1 However, it has been noted that a considerable number of at-risk patients cannot be identified on the basis of traditional risk factors alone.2 This has prompted the search for novel markers of cardiovascular risk to help improve risk prediction.3 Such markers could either represent various blood biomarkers relevant to the pathophysiology of atherothrombosis (eg, markers of the inflammatory response, coagulation markers, markers of platelet aggregation, lipoproteins, or lipid-related variables), genetic markers, or markers of subclinical disease, which may also aid in improved risk prediction. Determination of global risk on the basis of traditional risk factors allows categorization into high (10-year risk, >20%), low (10-year risk, <10%), or intermediate risk (10-year risk, 10% to 20%). Subjects at high risk should be recommended lifestyle changes or prescribed a statin. Subjects at low risk would be reevaluated 3 to 5 years later. Those at intermediate risk, however, who comprise up to 40% of the population at risk,4 would be candidates for additional testing to increase or decrease their actual risk. A large panel of blood biomarkers are available for this purpose, but most of them are not yet applicable in clinical practice for various reasons
The Brain Heart Connection
Neurocardiology has many dimensions, but it may be conceptualized as divided into 3 major categories: the heart’s effects on the brain (eg, cardiac source embolic stroke), the brain’s effects on the heart (eg, neurogenic heart disease), and neurocardiac syndromes (eg, Friedreich disease). The present review deals with the nervous system’s capacity to injure the heart. This subject is inherently important
but also represents an example of a much more widespread and conceptually fascinating area of neurovisceral damage in general.
but also represents an example of a much more widespread and conceptually fascinating area of neurovisceral damage in general.
Saturday, June 30, 2007
Public policy & the challenge of chronic noncommunicable diseases
De: Ruggiero, Mrs. Ana Lucia (WDC)
Enviada em: quinta-feira, 28 de junho de 2007 12:25
Public policy & the challenge of chronic noncommunicable diseases
Olusoji Adeyi, OwenSmith, Sylvia Robles
The International Bank for Reconstruction and Development / The World Bank, June 2007
"....A new World Bank report launched June 27 warns that poor countries are catching up with wealthier nations in terms of cancer, diabetes, obesity, and heart disease, and that by 2015, these chronic illnesses will be the leading cause of death in developing countries. The report calls for actions to slow down the trend, and to prepare for subsequent heavy demand on health care budgets.
According to the new report, life expectancy for all age groups, lower fertility rates, better control of infectious diseases, and changing lifestyles with more smoking, bad diets and lack of exercise, mean that poor countries face a future where non-communicable diseases (NCDs) become a major problem. The report says that countries need to promote healthy aging and avoid premature deaths. They will also need to adapt their health systems to cope with the growing numbers of elderly people who will require long-term care and request expensive treatment.
The report says that in Indonesia, for example, private healthcare spending is projected to more than double by 2020, compared to 2005, as its elderly population grows in size, and needs treatment for chronic diseases...."
Enviada em: quinta-feira, 28 de junho de 2007 12:25
Public policy & the challenge of chronic noncommunicable diseases
Olusoji Adeyi, OwenSmith, Sylvia Robles
The International Bank for Reconstruction and Development / The World Bank, June 2007
"....A new World Bank report launched June 27 warns that poor countries are catching up with wealthier nations in terms of cancer, diabetes, obesity, and heart disease, and that by 2015, these chronic illnesses will be the leading cause of death in developing countries. The report calls for actions to slow down the trend, and to prepare for subsequent heavy demand on health care budgets.
According to the new report, life expectancy for all age groups, lower fertility rates, better control of infectious diseases, and changing lifestyles with more smoking, bad diets and lack of exercise, mean that poor countries face a future where non-communicable diseases (NCDs) become a major problem. The report says that countries need to promote healthy aging and avoid premature deaths. They will also need to adapt their health systems to cope with the growing numbers of elderly people who will require long-term care and request expensive treatment.
The report says that in Indonesia, for example, private healthcare spending is projected to more than double by 2020, compared to 2005, as its elderly population grows in size, and needs treatment for chronic diseases...."
Saturday, June 23, 2007
[2358 - AMICOR10 - 23/06/2007]
[2358 - AMICOR10 - 23/06/2007]
Do grupo antigo de mais de 300, manifestaram interesse em continuar na AMICOR10 os 121 abaixo listados:
From the more then 300 members, the following 121expressed interest in to follow in the AMICOR10:
Airton Stein, Albertino Damasceno, Alberto C. Duque, Alberto José Niituma Ogata, Alberto Stein, Alejandro Wajner, Alexander Daudt, Aloyzio Achutti, Amanda Sousa, Ana Lúcia Robinson Achutti, Ana Menezes, Andréa Silveira Gomes, André Steffens, Antônio Pedro Mirra, Ari Timerman, Aristóteles Comte de Alencar Fo.,Beatriz Amaral, Blau Souza, Bruce B. Duncan, Bruno Caramelli, Carisi Polanczyk, Carlos Alberto Machado, Carlos H. Klein, Carlos Marcílio de Souza, Catia Teixeira, Cesar G Victora, Claudia Caminha Escosteguy, Claudio A. Bandeira Medina, Catherine Coleman, Dalfran Maciel, Darcy Lima, Denis Martinez, Edi e Ponciano Vieira, Eduardo A Costa, Éffrem Maranhão, Elisabeth Nader, Emilio Moriguchi, Eney Fernandes, Fernando Lucchese, Flavio Danni Fuchs, Flávio Kanter, Geniberto Paiva Campos, Gilberto Barcellos, Gilberto Brodt, Gilson Feitosa, Giuseppe Repetto, Gláucia M. Oliveira, Helder Reis, Henrique Barata, Ines Lessa, Isaac Roitman, Isabela Giuliano, Iseu Gus, Izabella Rohlfs, Jaqueline Scholz Issa, Jefferson Fernandes, João Carlos F. Braga, João Giongo, Joel Barcellos, Jorge Dable, Jorge Ilha Guimarães, Jorge Ossanai, José Miguel Chatkin, José Roberto Goldim, José da Silva Moreira; Juliana Nunes, Kleber Gaspar, Leo A. e Clara Trombka, Leopoldo Soares Piegas, Lucélia Magalhães, Lucia Pellanda, Luciana Fornari, Luciano Loos, Lucio Bakos, Luis Paulo Melione, Luis Soares Halty, Luiz Carlos Corrêa da Silva, Luiz Scala, Manoel A. P. P. Albuquerque, Marcelo Gustavo Colominas, Margarita Diaz, Maria Inês Azambuja, Mariana Lourenço de Lima Carneiro, Mario Becker, Mario F. C. Maranhão, Mario Wiehe, Marta Filippi, Maura Malcon, Mendel Rabin, Moacyr Saffer, Montezuma Ferreira, Murilo Foppa, Nelson Souza e Silva, Nilton Brandão da Silva, Orlando C. B. Wender, Patrícia Pereira Ruschel, Paulo Cesar Jardim, Paulo Henkin, Paulo Opitz, Paulo Roberto Prates, Pedro Albuquerque, Pedro van Zeller, Reginaldo Albuquerque, Romero Bezerra, Romildo Andrade, Rosa Maria Sampaio Vilanova de Carvalho, Salvador Serra, Sandra C. Fuchs, Sérgio Haussen, Sérgio Luiz Bassanesi, Sérgio V. Perrone, Silvia Maria Cury Ismael, Silvia Nanfara y Crespin César, Tânia Braga, Tänia Maria Cavalcante ,Telmo Bonamigo, Timóteo Leandro de Araújo, Ueli Grüninger, Ulisses Coelho, Valderês Robinson Achutti, Waldir Castro,
This week Highlights
Entre vários assuntos publicados desde a última postagem chamo atenção para:
About The Literature, Arts & Medicine Database
http://amicor.blogspot.com ,
Custo da violência no Brasil 2004 e
Escalas do Universo: Nikon no
http://amicor_preserve.blogspot.com
É possível assinar gratuitamente para receber informação automática dos Blogs AMICOR ou de outros através de programas como Bloglines ou FeedBlitz, basta acessar o endereço e fazer sua inscrição dando os endereços desejados;
http://www.bloglines.com/public/achutti
http://www.feedblitz.com
Do grupo antigo de mais de 300, manifestaram interesse em continuar na AMICOR10 os 121 abaixo listados:
From the more then 300 members, the following 121expressed interest in to follow in the AMICOR10:
Airton Stein, Albertino Damasceno, Alberto C. Duque, Alberto José Niituma Ogata, Alberto Stein, Alejandro Wajner, Alexander Daudt, Aloyzio Achutti, Amanda Sousa, Ana Lúcia Robinson Achutti, Ana Menezes, Andréa Silveira Gomes, André Steffens, Antônio Pedro Mirra, Ari Timerman, Aristóteles Comte de Alencar Fo.,Beatriz Amaral, Blau Souza, Bruce B. Duncan, Bruno Caramelli, Carisi Polanczyk, Carlos Alberto Machado, Carlos H. Klein, Carlos Marcílio de Souza, Catia Teixeira, Cesar G Victora, Claudia Caminha Escosteguy, Claudio A. Bandeira Medina, Catherine Coleman, Dalfran Maciel, Darcy Lima, Denis Martinez, Edi e Ponciano Vieira, Eduardo A Costa, Éffrem Maranhão, Elisabeth Nader, Emilio Moriguchi, Eney Fernandes, Fernando Lucchese, Flavio Danni Fuchs, Flávio Kanter, Geniberto Paiva Campos, Gilberto Barcellos, Gilberto Brodt, Gilson Feitosa, Giuseppe Repetto, Gláucia M. Oliveira, Helder Reis, Henrique Barata, Ines Lessa, Isaac Roitman, Isabela Giuliano, Iseu Gus, Izabella Rohlfs, Jaqueline Scholz Issa, Jefferson Fernandes, João Carlos F. Braga, João Giongo, Joel Barcellos, Jorge Dable, Jorge Ilha Guimarães, Jorge Ossanai, José Miguel Chatkin, José Roberto Goldim, José da Silva Moreira; Juliana Nunes, Kleber Gaspar, Leo A. e Clara Trombka, Leopoldo Soares Piegas, Lucélia Magalhães, Lucia Pellanda, Luciana Fornari, Luciano Loos, Lucio Bakos, Luis Paulo Melione, Luis Soares Halty, Luiz Carlos Corrêa da Silva, Luiz Scala, Manoel A. P. P. Albuquerque, Marcelo Gustavo Colominas, Margarita Diaz, Maria Inês Azambuja, Mariana Lourenço de Lima Carneiro, Mario Becker, Mario F. C. Maranhão, Mario Wiehe, Marta Filippi, Maura Malcon, Mendel Rabin, Moacyr Saffer, Montezuma Ferreira, Murilo Foppa, Nelson Souza e Silva, Nilton Brandão da Silva, Orlando C. B. Wender, Patrícia Pereira Ruschel, Paulo Cesar Jardim, Paulo Henkin, Paulo Opitz, Paulo Roberto Prates, Pedro Albuquerque, Pedro van Zeller, Reginaldo Albuquerque, Romero Bezerra, Romildo Andrade, Rosa Maria Sampaio Vilanova de Carvalho, Salvador Serra, Sandra C. Fuchs, Sérgio Haussen, Sérgio Luiz Bassanesi, Sérgio V. Perrone, Silvia Maria Cury Ismael, Silvia Nanfara y Crespin César, Tânia Braga, Tänia Maria Cavalcante ,Telmo Bonamigo, Timóteo Leandro de Araújo, Ueli Grüninger, Ulisses Coelho, Valderês Robinson Achutti, Waldir Castro,
This week Highlights
Entre vários assuntos publicados desde a última postagem chamo atenção para:
About The Literature, Arts & Medicine Database
http://amicor.blogspot.com ,
Custo da violência no Brasil 2004 e
Escalas do Universo: Nikon no
http://amicor_preserve.blogspot.com
É possível assinar gratuitamente para receber informação automática dos Blogs AMICOR ou de outros através de programas como Bloglines ou FeedBlitz, basta acessar o endereço e fazer sua inscrição dando os endereços desejados;
http://www.bloglines.com/public/achutti
http://www.feedblitz.com
About The Literature, Arts & Medicine Database
About The Literature, Arts & Medicine Database
This site is to be visited many times. It contains material we are needing nowadays while we use to limit medicine to the realm of sciences.
The Literature, Arts, & Medicine Database is an annotated multimedia listing of prose, poetry, film, video and art that was developed to be a dynamic, accessible, comprehensive resource for teaching and research in MEDICAL HUMANITIES, and for use in health/pre-health, graduate and undergraduate liberal arts and social science settings. It is a multi-institutional project (see Editorial Board) that was initiated by faculty of the New York University School of Medicine, Felice Aull, Martin Nachbar, Karen Brewer; programming specialist Roy Smith; and then-medical student Irene Chen, '96. The on-line database began in Gopher Internet format in the summer of 1993 and was converted to Web format in 1994 by Martin Nachbar and Roy Smith. In 2006 Yoo Kyung Chang, Eunbong Sohn and William Holloway re-designed the database to a dynamic Web format. This Web site is produced and maintained by Division of Educational Informatics (DEI), formerly the Hippocrates Project-- the multi-disciplinary development laboratory for application of information technologies to medical education at New York University School of Medicine.
This site is to be visited many times. It contains material we are needing nowadays while we use to limit medicine to the realm of sciences.
The Literature, Arts, & Medicine Database is an annotated multimedia listing of prose, poetry, film, video and art that was developed to be a dynamic, accessible, comprehensive resource for teaching and research in MEDICAL HUMANITIES, and for use in health/pre-health, graduate and undergraduate liberal arts and social science settings. It is a multi-institutional project (see Editorial Board) that was initiated by faculty of the New York University School of Medicine, Felice Aull, Martin Nachbar, Karen Brewer; programming specialist Roy Smith; and then-medical student Irene Chen, '96. The on-line database began in Gopher Internet format in the summer of 1993 and was converted to Web format in 1994 by Martin Nachbar and Roy Smith. In 2006 Yoo Kyung Chang, Eunbong Sohn and William Holloway re-designed the database to a dynamic Web format. This Web site is produced and maintained by Division of Educational Informatics (DEI), formerly the Hippocrates Project-- the multi-disciplinary development laboratory for application of information technologies to medical education at New York University School of Medicine.
Wednesday, June 20, 2007
ezetimibe/simvastatin versus simvastatin versus atorvastatin
1: Am J Cardiol. 2007 Jun 15;99(12):1706-1713. Epub 2007 May 2. Related Articles, Links
Comparison of effects of ezetimibe/simvastatin versus simvastatin versus atorvastatin in reducing C-reactive protein and low-density lipoprotein cholesterol levels.
Pearson T, Ballantyne C, Sisk C, Shah A, Veltri E, Maccubbin D.
University of Rochester School of Medicine and Dentistry, Rochester, New York.
The lowering effects of ezetimibe/simvastatin combination therapy on low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein (CRP) were compared with those of simvastatin or atorvastatin monotherapy in a large cohort of patients with primary hypercholesterolemia. To compare ezetimibe/simvastatin with simvastatin, data were combined from 3 identical, prospective 12-week trials in which patients were randomized to receive placebo; ezetimibe 10 mg; ezetimibe 10 mg added to simvastatin 10, 20, 40, or 80 mg; or simvastatin 10, 20, 40, or 80 mg. To compare ezetimibe/simvastatin with atorvastatin, data were analyzed from a phase III double-blind, active-controlled study in which patients were randomized equally to receive ezetimibe/simvastatin 10/10, 10/20, 10/40, or 10/80 mg or atorvastatin 10, 20, 40, or 80 mg for 6 weeks. When averaged across doses, ezetimibe/simvastatin produced significantly greater reductions compared with simvastatin alone in LDL cholesterol (52.5% vs 38.0%, respectively) and CRP levels (31.0% vs 14.3%, respectively). At each individual simvastatin dose, co-administration with ezetimibe produced significant further CRP reductions versus simvastatin alone. Ezetimibe/simvastatin was significantly more effective at lowering LDL cholesterol than atorvastatin when pooled across doses (53.4% vs 45.3%, respectively) and in each milligram-equivalent dose comparison. Reductions in CRP of similar magnitude were observed with ezetimibe/simvastatin and atorvastatin when averaged across doses and at each milligram-equivalent statin dose comparison. In conclusion, the lipid-modulating and anti-inflammatory effects of ezetimibe/simvastatin provide additional benefits not realized by statin monotherapy alone.
PMID: 17560879 [PubMed - in process]
Comparison of effects of ezetimibe/simvastatin versus simvastatin versus atorvastatin in reducing C-reactive protein and low-density lipoprotein cholesterol levels.
Pearson T, Ballantyne C, Sisk C, Shah A, Veltri E, Maccubbin D.
University of Rochester School of Medicine and Dentistry, Rochester, New York.
The lowering effects of ezetimibe/simvastatin combination therapy on low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein (CRP) were compared with those of simvastatin or atorvastatin monotherapy in a large cohort of patients with primary hypercholesterolemia. To compare ezetimibe/simvastatin with simvastatin, data were combined from 3 identical, prospective 12-week trials in which patients were randomized to receive placebo; ezetimibe 10 mg; ezetimibe 10 mg added to simvastatin 10, 20, 40, or 80 mg; or simvastatin 10, 20, 40, or 80 mg. To compare ezetimibe/simvastatin with atorvastatin, data were analyzed from a phase III double-blind, active-controlled study in which patients were randomized equally to receive ezetimibe/simvastatin 10/10, 10/20, 10/40, or 10/80 mg or atorvastatin 10, 20, 40, or 80 mg for 6 weeks. When averaged across doses, ezetimibe/simvastatin produced significantly greater reductions compared with simvastatin alone in LDL cholesterol (52.5% vs 38.0%, respectively) and CRP levels (31.0% vs 14.3%, respectively). At each individual simvastatin dose, co-administration with ezetimibe produced significant further CRP reductions versus simvastatin alone. Ezetimibe/simvastatin was significantly more effective at lowering LDL cholesterol than atorvastatin when pooled across doses (53.4% vs 45.3%, respectively) and in each milligram-equivalent dose comparison. Reductions in CRP of similar magnitude were observed with ezetimibe/simvastatin and atorvastatin when averaged across doses and at each milligram-equivalent statin dose comparison. In conclusion, the lipid-modulating and anti-inflammatory effects of ezetimibe/simvastatin provide additional benefits not realized by statin monotherapy alone.
PMID: 17560879 [PubMed - in process]
Calcified plaque x estrogens
JoAnn E. Manson, M.D., et al NEJM
Background Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.
Methods In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.
Results The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.
Conclusions Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611 [ClinicalTrials.gov] .)
Background Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.
Methods In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.
Results The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.
Conclusions Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611 [ClinicalTrials.gov] .)
Razão Apo B/Apo A-I e Predição de Risco
Apo B/Apo A-I Ratio and Cardiovascular Risk Prediction
Luciana Moreira Lima, Maria das Graças Carvalho, Marinez Oliveira Sousa
Universidade Federal de Minas Gerais - Belo Horizonte, MG - Brasil
ConclusãoCom base nas recentes evidências das vantagens do uso das apolipoproteínas A-I e B como marcadores de risco cardiovascular, o índice apo B/apo A-I emerge como importante parâmetro complementar para avaliação desse risco, especialmente em indivíduos normolipêmicos, com
potencial importância para aplicação na monitoração de pacientes de alto risco em terapia com agentes hipolipemiantes no futuro.
Luciana Moreira Lima, Maria das Graças Carvalho, Marinez Oliveira Sousa
Universidade Federal de Minas Gerais - Belo Horizonte, MG - Brasil
ConclusãoCom base nas recentes evidências das vantagens do uso das apolipoproteínas A-I e B como marcadores de risco cardiovascular, o índice apo B/apo A-I emerge como importante parâmetro complementar para avaliação desse risco, especialmente em indivíduos normolipêmicos, com
potencial importância para aplicação na monitoração de pacientes de alto risco em terapia com agentes hipolipemiantes no futuro.
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