AMICOR - 9 anos e Sindrome do Estado Fragilizado

Prezados amigos AMICOR,
Grato por me acompanharem até os 9 anos.
Neste ano, até completar uma década pretendo re-estudar nossos métodos de comunicação, bem como o processo em uso. Estarei aberto para sugestões e devo lhes apresentar até a próxima mensagem alguns detalhes e novas idéias.
Abaixo vai um artigo meu publicado na Zero Hora do dia 16.
Um abraço a todos.
AA
Dear friends AMICOR,
Thanks to follow me until the 9th anniversary.
From now to the 10th I wish to evaluate our communication methods, as well aour process in use. I will be open to suggestions and I will present to you until the next message some details and new ideas.
Below is an article published today in the local newspaper Zero Hora
Sincerely
AA


Síndrome do Estado fragilizado
ALOYZIO ACHUTTI/ Membro da Academia Sul-Rio-Grandense de Medicina

Recentemente tem-se nomeado com freqüência duas novas síndromes: a síndrome do status e a síndrome do Estado fraco ou fragilizado. Paralelamente à semelhança verbal das duas, podem-se encontrar também aproximações conceituais e implicações práticas cruzadas.

Síndrome refere-se a um conjunto de sintomas e sinais característicos de um estado anormal ou indesejável e se utiliza muito em medicina para designar condições mórbidas conseqüentes a causas diversas ou desconhecidas. Ambas estão relacionadas com perturbações da saúde e perda de qualidade de vida. Ambas provocam estresse, doenças crônicas e mal-estar, muito além do imaginado.

Circunstâncias responsáveis pela primeira (mais utilizada na perspectiva individual) são muito freqüentes, particularmente em sociedades com grande desigualdade social como a nossa, mas também pelo mundo afora, onde - como diz Sir Michael Marmot, em livro recente sobre o tema referindo-se a sociedades mesmo ditas igualitárias - "alguns são mais iguais do que outros...".

Com a falta ou perda da identidade, falta de alternativas e de apoio social, abandono, desinteresse e atropelo de valores humanos, a vida pode se tornar ainda mais difícil, surgem desespero e falta de motivação, só avaliáveis por quem se encontrar em situação semelhante.

A Síndrome do Estado fragilizado tem sido discutida particularmente com relação a fenômenos observados em países da antiga União das Repúblicas Socialistas Soviéticas após a queda do comunismo, mas o conceito deve ser aplicável mais extensamente, inclusive em nosso caso.

O Estado como organização política da sociedade se destina a facilitar, proteger e disciplinar a vida de seus cidadãos. O status de cidadão é sua identidade, e sua segurança radica na idoneidade e na confiabilidade de seus dirigentes. Seu projeto humano se realiza e se expressa no élan da construção social e, quando se sente ameaçado, encontra guarida em suas instituições.

A contaminação dos objetivos do bem comum pelos interesses individuais ou de grupos voltados para a sustentação artificial no poder dilacera o tecido social, corrompe os valores básicos, aumenta as cisões e se torna terreno fértil para a anarquia.

A governabilidade fica comprometida, gera enorme entropia e compromete o desenvolvimento, piorando ainda mais a desigualdade social e a sensação de desespero dos que se encontram marginalizados. Entretanto, todos sofrem, pioram até os índices de mortalidade e proliferam as doenças crônicas.

Não somente a preservação da natureza, evitando a poluição ambiental, é importante para a proteção da vida. O ambiente social e político também influi na saúde da população e deve ser arrolado entre os itens a serem considerados na prevenção de doenças e considerado pelos nossos representantes no poder.

Mais um motivo para nossa participação e escolha cuidadosa na hora da eleição.

Hypertension Day 2006

The World Hypertension League is devoted to the advancement of hypertension prevention and control through joint efforts of all national leagues and societies. With more than 15 years of achievements, the WHL seeks to promote the exchange of information among its member organizations and offers internationally applicable methods and programs for hypertension control.

Cardiovascular toolkit

Cardiovascular disease is the number one killer in the United States, for both men and women, and claims more lives each year than the next five leading causes of death combined. The Cardiovascular Dynamics effort, led by Charles A. Taylor, Ph.D. and Christopher K. Zarins, M.D., uses biosimulation to understand and help diagnose and treat this prevalent condition.

Our Physics-Based Approach

Our open source Cardiovascular ToolKit (CVTK) provides tools for constructing a virtual aorta, a cardiovascular simulation based on 3D noninvasive imaging and tailored to each individual's anatomy. The process is outlined in the diagram below: (a) acquire a contrast-enhanced magnetic resonance angiogram of the abdominal aorta; (b) determine the centerline of the vessels of interest; (c) segment vessel lumens in each 2D slice using level set methods; (d) combine the 2D segmentations into a complete 3D solid model of the aorta and its branches; (e) use the generated finite element mesh to solve equations governing blood flow in the deformable vessels.

Heart Sounds

"Research demonstrates that practice makes perfect when trying to master cardiac auscultation. Listening to these "Heart Songs" at the computer or iPod can help clinicians at every level refine their auscultation skills." - Michael J. Barrett, M.D., F.A.C.C.

programação científica do congresso Norte-Nordeste de Cardiologia

De: pfalbuquerque [mailto:pfalbuquerque@uol.com.br]
Enviada em: domingo, 30 de abril de 2006 09:53
Para: aloyzio.achutti
Assunto: Programação científica Congresso Norte-Nordeste

Caro Prof. Achutti,

Gentileza comunicar à rede que a programação científica do congresso Norte-Nordeste de Cardiologia, encontra-se no site www.cardiol.br calendário de eventos.

Muito obrigado

Pedro Albuquerque-presidente do evento.

ACC: Combination Therapy Useful In Dyslipidemia

ACC: Combination Therapy Useful In Dyslipidemia - CME Teaching Brief - MedPage Today: "ATLANTA, March 12 - Combination therapies in dyslipidemia have two roles -- to lower LDL cholesterol and to achieve non-HDL goals, according to a symposium here.

'In the absence of a lot of data on outcomes, there are some things that are absolute indications for combination therapies,' said Alan Brown, M.D., medical director of the Midwest Heart Disease Prevention Center in Napierville, Ill.

Specifically, he said, some patients won't achieve LDL goals on monotherapy, at least without going to very high doses, which increases the risk of complications, including rhabdomyalysis.

Others, whose LDL cholesterol is controlled, will need combination treatments to control other aspects of their dyslipidemia, he told a satellite symposium held in conjunction with the annual meeting of the American College of Cardiology."

Enbrel Decreases Inflammatory Markers in Metabolic Syndrome -

Enbrel Decreases Inflammatory Markers in Metabolic Syndrome - CME Teaching Brief - MedPage Today: "BOSTON, April 25 — Blocking a key protein with Enbrel (etanercept) improves several inflammatory markers in patients with metabolic syndrome, according to researchers here.

In a small randomized trial, patients treated with the agent had lower levels of C-reactive protein and higher levels of adiponectin—indications of a decrease in the inflammation thought to be a key link between the syndrome and cardiovascular risk, said Steven Grinspoon, M.D., of Massachusetts General Hospital here.

Results of the study, published in the April 25 issue of Archives of Internal Medicine, amount to 'proof of principle,' Dr. Grinspoon said in a statement, and 'sheds light on the physiology of inflammation and its relation to cardiac risk in obese patients.'"

Coffee Consumption and Coronary Heart Disease in Men and Women. A Prospective Cohort Study -- Lopez-Garcia et al., 10.1161/CIRCULATIONAHA.105.598664 -

Coffee Consumption and Coronary Heart Disease in Men and Women. A Prospective Cohort Study -- Lopez-Garcia et al., 10.1161/CIRCULATIONAHA.105.598664 -- Circulation
Esther Lopez-Garcia DrPH, Rob M. van Dam PhD, Walter C. Willett MD, DrPH, Eric B. Rimm ScD, JoAnn E. Manson MD, DrPH, Meir J. Stampfer MD, DrPH, Kathryn M. Rexrode MD, MPH, and Frank B. Hu MD, PhD^*

From the Departments of Nutrition (E.L.-G., R.M.v.D., W.C.W., E.B.R., M.J.S., F.B.H.) and Epidemiology (W.C.W., E.B.R., J.E.M., M.J.S., F.B.H.), Harvard School of Public Health; the Channing Laboratory (W.C.W., E.B.R., J.E.M., M.J.S., F.B.H.) and Division of Preventive Medicine (J.E.M., M.J.S., K.M.R.), Harvard Medical School, Boston, Mass.
^* To whom correspondence should be addressed. E-mail: nhbfh@channing.harvard.edu.

Background--We examined the association between long-term habitual coffee consumption and risk of coronary heart disease (CHD).

Methods and Results--We performed a prospective cohort study with 44 005 men and 84 488 women without history of cardiovascular disease or cancer. Coffee consumption was first assessed in 1986 for men and in 1980 for women and then repeatedly every 2 to 4 years; the follow-up continued through 2000. We documented 2173 incident cases of coronary heart disease (1449 nonfatal myocardial infarctions and 724 fatal cases of CHD) among men and 2254 cases (1561 nonfatal myocardial infarctions and 693 fatal cases of CHD) among women. Among men, after adjustment for age, smoking, and other CHD risk factors, the relative risks (RRs) of CHD across categories of cumulative coffee consumption (<1> 4 cups/wk, 5 to 7 cups/wk, 2 to 3 cups/d, 4 to 5 cups/d, and 6 cups/d) were 1.0, 1.04 (95% confidence interval 0.91 to 1.17), 1.02 (0.91 to 1.15), 0.97 (0.86 to 1.11), 1.07 (0.88 to 1.31), and 0.72 (0.49 to 1.07; P for trend=0.41); among women, the RRs were 1.0, 0.97 (0.83 to 1.14), 1.02 (0.90 to 1.17), 0.84 (0.74 to 0.97), 0.99 (0.83 to 1.17), and 0.87 (0.68 to 1.11; P for trend=0.08). Stratification by smoking status, alcohol consumption, history of type 2 diabetes mellitus, and body mass index gave similar results. Similarly, we found no effect when the most recent coffee consumption was examined. RRs for quintiles of caffeine intake varied from 0.97 (0.84 to 1.10) in the second quintile to 0.97 (0.84 to 1.11) in the highest quintile (P for trend=0.82) in men and from 1.02 (0.90 to 1.16) to 0.97 (0.85 to 1.11; P for trend=0.37) in women.

Conclusions--These data do not provide any evidence that coffee consumption increases the risk of CHD.

Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Co

Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth -- Paridon et al. 113 (15): 1905 -- Circulation: "This statement is an updated report of the American Heart Association’s previous publications on exercise in children. In this statement, exercise laboratory requirements for environment, equipment, staffing, and procedures are presented. Indications and contraindications to stress testing are discussed, as are types of testing protocols and the use of pharmacological stress protocols. Current stress laboratory practices are reviewed on the basis of a survey of pediatric cardiology training programs."

Reciprocal Relationships Between Insulin Resistance and Endothelial Dysfunction: Molecular and Pathophysiological Mechanisms -- Kim et al. 113 (15): 1

Reciprocal Relationships Between Insulin Resistance and Endothelial Dysfunction: Molecular and Pathophysiological Mechanisms -- Kim et al. 113 (15): 1888 -- Circulation: "Endothelial dysfunction contributes to cardiovascular diseases, including hypertension, atherosclerosis, and coronary artery disease, which are also characterized by insulin resistance. Insulin resistance is a hallmark of metabolic disorders, including type 2 diabetes mellitus and obesity, which are also characterized by endothelial dysfunction. Metabolic actions of insulin to promote glucose disposal are augmented by vascular actions of insulin in endothelium to stimulate production of the vasodilator nitric oxide (NO). Indeed, NO-dependent increases in blood flow to skeletal muscle account for 25% to 40% of the increase in glucose uptake in response to insulin stimulation. Phosphatidylinositol 3-kinase–dependent insulin-signaling pathways in endothelium related to production of NO share striking similarities with metabolic pathways in skeletal muscle that promote glucose uptake. Other distinct nonmetabolic branches of insulin-signaling pathways regulate secretion of the vasoconstrictor endothelin-1 in endothelium. Metabolic insulin resistance is characterized by pathway-specific impairment in phosphatidylinositol 3-kinase–dependent signaling, which in endothelium may cause imbalance between production of NO and secretion of endothelin-1, leading to decreased blood flow, which worsens insu"

XXVI Congresso Norte/Nordeste de Cardiologia

XXVI Congresso Norte/Nordeste de Cardiologia
De: pfalbuquerque [mailto:pfalbuquerque@uol.com.br] Enviada em: quarta-feira, 19 de abril de 2006 13:
Gentileza divulgar o XXVICongresso Norte-Nordeste de Cardiologia, o qual estamos presidindo será em Maceió nos dias 8,9 e 10 de junho de 2006.
Site http://congresso.cardiol.br/norte-nordeste.
Muito obrigado.
Pedro Albuquerque

Heart Diseases and Stroke Statistics 2006

(Recomendado por Maria Inês Reinert Azambuja)
The American Heart Association works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Neurological Disorders and Stroke (NINDS), and other government agencies to derive the annual statistics in this update. This section describes the most important sources we use. For more details and an alphabetical list of abbreviations, see the Glossary and Abbreviation Guide.

All statistics are for the most recent year available. Prevalence, mortality and hospitalizations are computed for 2003 unless otherwise noted. Mortality as an underlying or contributing cause of death is for 2002. Economic cost estimates are for 2006. Due to late release of data, some disease mortality are not updated to 2003. Mortality for 2003 are underlying preliminary data, obtained from the NCHS publication National Vital Statistics Report: Deaths: Preliminary Data for 2003 (NVSR, 2005;53:15) and from unpublished tabulations furnished by Robert Anderson of NCHS. US and state death rates and prevalence rates are age-adjusted per 100 000 population (unless otherwise specified) using the 2000 US standard for age standardization.

Morbidity (illness) and mortality (death) data in the United States use a standard classification system—the International Classification of Diseases (ICD). About every 10–20 years, the ICD codes are revised to reflect changes over time in medical technology, diagnosis or terminology. Effective with mortality data for 1999, we’re using the tenth revision (ICD/10). It will be a few more years before the tenth revision is used for hospital discharge data.

Heart Diseases and Stroke Statistics 2006

(Recomendado por Maria Inês Reinert Azambuja)
The American Heart Association works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Neurological Disorders and Stroke (NINDS), and other government agencies to derive the annual statistics in this update. This section describes the most important sources we use. For more details and an alphabetical list of abbreviations, see the Glossary and Abbreviation Guide.

All statistics are for the most recent year available. Prevalence, mortality and hospitalizations are computed for 2003 unless otherwise noted. Mortality as an underlying or contributing cause of death is for 2002. Economic cost estimates are for 2006. Due to late release of data, some disease mortality are not updated to 2003. Mortality for 2003 are underlying preliminary data, obtained from the NCHS publication National Vital Statistics Report: Deaths: Preliminary Data for 2003 (NVSR, 2005;53:15) and from unpublished tabulations furnished by Robert Anderson of NCHS. US and state death rates and prevalence rates are age-adjusted per 100 000 population (unless otherwise specified) using the 2000 US standard for age standardization.

Morbidity (illness) and mortality (death) data in the United States use a standard classification system—the International Classification of Diseases (ICD). About every 10–20 years, the ICD codes are revised to reflect changes over time in medical technology, diagnosis or terminology. Effective with mortality data for 1999, we’re using the tenth revision (ICD/10). It will be a few more years before the tenth revision is used for hospital discharge data.

The White Man's Burden

http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673606685619.pdf
The White Man’s Burden has one basic motif: that large-scale plans to help the poor through increased foreign aid are bound to go awry.
According to William Easterly, there is too much corruption in recipient countries, unaccountability in delivery mechanisms, and sheer uncertainty about what to do. Rather than aiming big, with comprehensive and well funded strategies, Easterly thinks it is better to aim small and piecemeal, making progress one gradual step at a time—“the right plan is to have no plan”, he asserts. Aid should be as he imagines markets to be: without plans but fi lled with “searchers” looking for piecemeal progress.
Searching is, of course, needed to identify best practices for foreign aid. But so too are plans, at local, national, and international levels, to take those best practices to scale.
Easterly seems to misunderstand the historical record on aid, and, far more unfortunately, to misjudge what’s possible in the future. His main methodological error is a failure to make careful distinctions across countries and types of aid programme.
By neglecting to hone in on what has worked and failed in the past, Easterly conveys a misplaced sense of helplessness in the face of massive but solvable problems.
The critical fact is that much is known about how to help the poor. As The Lancet helped to show in its 2003 series on child mortality, the know-how and technologies exist to save lives each year by the millions, and to improve livelihoods by the tens or hundreds of millions, but only by expanding beyond piecemeal approaches and applying knowledge at scale. The same conclusions were reached in two reports that I helped to direct for WHO and the United Nations in
2001 and 2005, respectively, both of which are roundly criticised by Easterly.

WCC September - Call for papers

The Lancet:
"Coronary heart disease has the dubious distinction of being the leading cause of death worldwide, and rapid containment of this global pandemic seems unlikely. New factors, such as sociodemographic change in lower-income countries, are providing fresh challenges for prevention and treatment. The Lancet will publish a special issue to coincide with the World Congress of Cardiology in September, in Barcelona. We therefore welcome papers on any aspect of cardiology, to be submitted by May 22. We are especially interested in research that will be presented at the Congress but will also consider other articles. Submissions from the developing world are particularly welcome. Papers should be submitted online and the covering letters should state that the submission is in response to this call for papers."

Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women -- Mosca et al. 109 (5): 672 -- Circulation

Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women -- Mosca et al. 109 (5): 672 -- Circulation:
"Significant advances in our knowledge about interventions to prevent cardiovascular disease (CVD) have occurred since publication of the first female-specific recommendations for preventive cardiology in 1999.1 Despite research-based gains in the treatment of CVD, it remains the leading killer of women in the United States and in most developed areas of the world.2�3 In the United States alone, more than one half million women die of CVD each year, exceeding the number of deaths in men and the next 7 causes of death in women combined. This translates into approximately 1 death every minute.2 Coronary heart disease (CHD) accounts for the majority of CVD deaths in women, disproportionately afflicts racial and ethnic minorities, and is a prime target for prevention.1�2 Because CHD is often fatal, and because nearly two thirds of women who die suddenly have no previously recognized symptoms, it is essential to prevent CHD.2 Other forms of atherosclerotic/thrombotic CVD, such as cerebrovascular disease and peripheral arterial disease, are critically important in women. Strategies known to reduce the burden of CHD may have substantial benefits for the prevention of noncoronary atherosclerosis, although they have been studied less extensively in some of these settings.
In the wake of the reports of the Women�s Health Initiative and the Heart and Estrogen/Progestin Replacement Study (HERS), which unexpectedly showed that combination hormone therapy was associated with adverse CVD effects, there is a heightened need to critically review and document strategies to prevent CVD in women.4�7 These studies underscore the importance of evidence-based practice for chronic disease prevention. /.../"

New Cardiac Resuscitation Protocol Improves Survival - CME Teaching Brief - MedPage Today

New Cardiac Resuscitation Protocol Improves Survival - CME Teaching Brief - MedPage Today: "Review
TUSCON, Ariz., April 13 - When performed by EMS personnel, a new approach to cardiopulmonary resuscitation (CPR) substantially improves the survival rate for most patients with out-of-hospital cardiac arrest, according to researchers.
The new approach, dubbed cardiocerebral resuscitation (CCR), emphasizes fast, forceful chest compressions to get blood moving through the body over airway management, said Michael J. Kellum, M.D., of the University of Arizona College of Medicine here.
Compared with standard CPR, the new approach nearly tripled survival rates during a one-year study, Dr. Kellum and colleagues reported online in the American Journal of Medicine.
The Wisconsin Emergency Medical Services Bureau teamed with the University of Arizona researchers to test the new protocol in two Wisconsin counties during 2004 and 2005.
During the previous three-year control period, when standard CPR was used, there were 92 adult patients with witnessed cardiac arrests and an initially 'shockable' rhythm. Eighteen of these patients (20%) survived, and 14 (15%) survived neurologically intact.
After the CCR protocol was initiated, there were 33 such patients. Nineteen (57%) survived, and 16 (48%) survived neurologically intact. The differences in both total survival and neurologically normal survival were statistically significant (P=0.001).
With CCR, first responders skip the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they do not wait for the device to analyze the patient's heart rhythm, but start fast, forceful chest compressions. /.../"

Trans Fats Judged Major Villain in Cardiovascular Disease - CME Teaching Brief - MedPage Today

Trans Fats Judged Major Villain in Cardiovascular Disease - CME Teaching Brief - MedPage Today:
"When talking with patients about food choices, remind them to read labels looking for trans fatty acids amounts but also to heed the serving amounts stated on the label.
Remind patients that the unhealthy trans fats are found in deep-fried foods, bakery products, packaged snack food, margarines, and crackers, and to try to avoid these foods.

Review
BOSTON, April 13 - Consumption of trans fatty acids raised lipid levels and increases the risk of coronary heart disease, sudden death from cardiac causes, and possibly diabetes, according to a review article.
The risk of coronary heart disease increased 23%, said the review in the April 13 issue of New England Journal of Medicine. Sudden death from a cardiac event was up 47% and tripled when evaluated for certain trans-fat isomers. "/.../

ACP: Garlic, Ginseng, Ginkgo Biloba, and Ginger All Bad Actors with Warfarin - CME Teaching Brief - MedPage Today

ACP: Garlic, Ginseng, Ginkgo Biloba, and Ginger All Bad Actors with Warfarin - CME Teaching Brief - MedPage Today: "

Explain to patients who ask that vitamins as well as so-called natural substances can react with prescription drugs.
Explain to patients, who ask, that periodic review of all prescription and non-prescription drugs that they are using can reduce the risk of adverse events.
Review
PHILADELPHIA, April 9 - When it comes to adverse events associated with Coumadin (warfarin) therapy, beware of herbs and many supplements beginning with the letter G, according to a University of Washington investigator. "/.../

Ethnic groups and differences in hypertension -- 332 (7545): 0 -- BMJ

Ethnic groups and differences in hypertension -- 332 (7545): 0 -- BMJ:
(Recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
"On p 833, Brown discusses the evidence for differences between ethnic groups in terms of pathogenesis, prevalence, complications, and treatment of hypertension. Hypertension in young white people seems to be high renin (type 1) hypertension and best responds to treatment with angiotensin converting enzyme inhibitors and blockers (AB drugs). Hypertension in young black people, however, seems to be low renin (type 2) hypertension and responds better to calcium channel blockers and diuretics (CD drugs). Differences in responses to treatment are yet to be studied in most ethnic groups and are important for our understanding of hypertension, says the author. "

Statins & Heart Failure

Cardiosource: "Statin therapy may prevent the development of new-onset chronic heart failure (CHF),1 but it�s unclear whether statins are beneficial or harmful in patients who have already developed CHF. Based on autopsy data, up to one-third of the deaths in CHF patients are related to acute coronary syndromes.2 If statin therapy is safe and effective in reducing acute coronary events in patients with CHF, millions of patients who would benefit from such therapy are not currently being treated. Alternatively, if statins have adverse effects in the setting of CHF, a large number of heart failure patients are being exposed unnecessarily. Given the available data, should clinicians recommend or avoid statin therapy for patients with CHF?"

Physical Activity Cuts Stroke Risk

(Enviado por: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com] )
domingo, 2 de abril de 2006 18:12
(Disponível por solicitação)
Dr. G. Hu, Pr. J. Tuomilehto*
Helsinki, Finland
* Past-Chairman of the Working Group on Epidemiology and Prevention


Stroke remains a leading cause of severe disability and premature death in the United States and other Western countries. Effective therapies for the treatment of acute ischemic stroke only are used in a small number of patients and many stroke survivors require lengthy rehabilitation and chronic care. Thus, the identification of modifiable lifestyle factors remains critical for stroke prevention.
There is good evidence that regular physical activity reduces the risk for cardiovascular disease (1). However, the protective effect of physical activity specifically on stroke risk is less clear, and the results are inconsistent.
Study Results
Some studies (2-7), but not all (8-11) have indicated a significant inverse association between leisure-time physical activity and stroke risk.
Moreover, studies on women are sparse (4-7, 11), and only three of them have found a significant inverse association between leisure-time physical activity and stroke risk (5-7). Small sample sizes and few stroke events, especially among women, may have contributed to the inconsistent observations./.../

Cardiovascular risk factor burden has a stronger association with self-rated poor health

Taylor & Francis Group - Article
Conclusions: The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people's overall evaluation of their health into account when assessing total health risk is important.

Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery:

1.1. Purpose of the Expedited Update
Since the publication of the previous guidelines on perioperative cardiovascular evaluation for noncardiac surgery in 2002, the issue of perioperative beta blockade for non-cardiac surgery has taken on increased importance. Specifically, the Physicians Consortium for Performance Improvement and the Surgical
Care Improvement Project have both identified perioperative beta blockade as a quality measure. Given the importance of these quality measures for both public reporting and eventual pay-for-performance, and the recent series of publications on the subject, it became imperative to update the recommendations
related to beta blockade. Therefore, we have chosen to expedite the review of the literature on perioperative beta blockade in order to produce recommendations that can be used in these national quality initiatives. In general, ACC/AHA Class I and III indications for therapy identify potential
dimensions of care and processes for performance measurement; however, not all Class I and III guidelines recommendations should be selected for performance measurement (1).

Patient Behavior Immediately After Transient Ischemic Attack According to Clinical Characteristics, Perception of the Event, and Predicted Risk of Stroke

Patient Behavior Immediately After Transient Ischemic Attack According to Clinical Characteristics, Perception of the Event, and Predicted Risk of Stroke -- Giles et al., 10.1161/01.STR.0000217388.57851.62 -- Stroke: "Background and Purpose--Little research has been done on patients� behavior after transient ischemic attack (TIA). Recent data on the high early risk of stroke after TIA mean that emergency action after TIA is essential for effective secondary prevention. We therefore studied patients� behavior immediately after TIA according to their perceptions, clinical characteristics, and predicted stroke risk.
Methods--Consecutive patients with TIA participating in the Oxford Vascular Study or attending dedicated hospital clinics in Oxfordshire, UK, were interviewed. Predicted stroke risk was calculated using 2 validated scores.
Results--Of 241 patients, 107 (44.4%) sought medical attention within hours of the event, although only 24 of these attended the emergency department. A total of 107 (44.4%) delayed seeking medical attention for 1 day. Correct recognition of symptoms (42.2% of patients) was not associated with less delay. However, patients with motor symptoms or duration of symptoms 1 hour were more likely to seek emergency attention (hazard ratio, 2.1; 95% CI, 1.4 to 3.2; P=0.00005), as were those at higher predicted stroke risk (P=0.001). The other main correlate with delay was the day of the week on which the TIA occurred (P<0.001), with greater delays at the weekend. Delay was unrelated to age, sex, or other vascular risk factors.
Conclusions--Many patients delay seeking medical attention after a TIA irrespective of correct recognition of symptoms, although patients at higher predicted risk of stroke do act more quickly. Public education about both the urgency and"

Randomized Trials Versus the Real World

Randomized Trials Versus the Real World - CME Teaching Brief - MedPage Today:
"this study, the mean number of chronic conditions of patients in a primary care practice eligible for randomized clinical trials in the area of hypertension ranged from 5.5 - 3.3 to 11.7 - 5.3.
Explain to interested patients that the randomized controlled trials for a common condition they read about, hypertension for instance, tend to exclude or omit data on patients with co-morbid conditions. Such exclusions may make it difficult for primary care practitioners, who care for many patients with multiple conditions, to determine for whom the guidelines are relevant.
Review
SHERBROOKE, Quebec, March 28 - Randomized controlled trials are used to support clinical practice guidelines, but their results may have limited relevance to physicians in the trenches.
That's the issue studied by investigators here, who evaluated whether randomized controlled trials that may have excluded patients with co-morbidities provide useful information for clinical practice. They described their research in the March/April issue of the Annals of Family Medicine.
'With our study, we wanted to call attention to an issue of increasing relevance -- comorbidity,' wrote Martin Fortin, M.D., M.Sc., of the department of family medicine at Sherbrooke University, and colleagues.
'Results from our study suggest that randomized controlled trials targeting a chronic medical condition such as hypertension would most likely find a great many patients with co-morbid conditions during the screening process,' they wrote./.../ "

Loneliness Weighs Heavily on the Heart

Loneliness Weighs Heavily on the Heart - CME Teaching Brief - MedPage Today: "Explain to patients that this study suggests that increasing social connectedness may reduce elevated blood pressure to a similar degree as losing weight and exercising.
Point out however that the study design prevents any inferences concerning causality.
Review
CHICAGO - Loneliness may be as bad for the heart as being overweight or inactive, researchers here suggested.
Middle-age and older adults reporting the greatest degree of loneliness had blood pressure levels 10 mm Hg to 30 mm/Hg higher on average than those who were least lonely, found psychologist Louise C. Hawkley, Ph.D., of the University of Chicago, and colleagues.
The magnitude of the effect of loneliness on blood pressure is comparable to the magnitude of reduction that can be achieved through weight loss and exercise, said Dr. Hawkley and Jarett D. Berry, M.D., a cardiology fellow at Northwestern, in the March issue of Psychology and Aging. "

Recommendation to Develop Strategies to Increase the Number of ST-Segment-Elevation Myocardial Infarction Patients With Timely Access to Primary Percu

Recommendation to Develop Strategies to Increase the Number of ST-Segment-Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention. The American Heart Association's Acute Myocardial Infarction (AMI) Advisory Working Group -- Jacobs et al., 10.1161/CIRCULATIONAHA.106.174477 -- Circulation: "Abstract-- Although evidence suggests that primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in the majority of patients with ST-segment-elevation myocardial infarction (STEMI), only a minority of patients with STEMI are treated with primary PCI, and of those, only a minority receive the treatment within the recommended 90 minutes after entry into the medical system. Market research conducted by the American Heart Association revealed that those involved in the care of patients with STEMI recognize the multiple barriers that prevent the prompt delivery of primary PCI and agree that it is necessary to develop systems or centers of care that will allow STEMI patients to benefit from primary PCI. The American Heart Association will convene a group of stakeholders (representing the interests of patients, physicians, emergency medical systems, community hospitals, tertiary hospitals, and payers) and quality-of-care and outcomes experts to identify the gaps between the existing and ideal delivery of care for STEMI patients, as well as the requisite policy implications. Wor"

Oily fish and omega 3 fat supplements -- Brunner, 10.1136/bmj.38798.680185.47 -- BMJ

Oily fish and omega 3 fat supplements -- Brunner, 10.1136/bmj.38798.680185.47 -- BMJ
(recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
Seventy five years ago, long chain omega 3 fatty acids were added to the list of essential nutrients. Later in the 20th century, the properties of marine polyunsaturated oils were linked with several health benefits, including protection from cardiovascular disease. However, a high quality systematic review draws attention to uncertainties about some of the health enefits attributed to omega 3 fats.
The review shows that the evidence for a reduction in cardiovascular vents and mortality is less conclusive than we believed.
A previous meta-analysis indicates that mortality is reduced wing to fewer fatal coronary events among people ingesting mega 3 fatty acids, but the current review found no strong evidence f a reduction in combined cardiovascular events. The laim that omega 3 fats reduce the risk of cancer is not upported here or by another recent systematic review. For each ealth outcome there are too few trials with adequate allocation oncealment, and too few cohort studies in which the intake of
omega 3 fat rather than total fish intake was measured.
..............................................................

We are faced with a paradox. Health recommendations dvise increased consumption of oily fish and fish oils, within imits,9 on the grounds that intake is generally low. However, ndustrial fishing has depleted the world’s fish stocks by some 0% since 1950,11 and rising fish prices reduce affordability particularly or people with low incomes. Global production trends figure) suggest that, although fish farming is expanding rapidly, e probably do not have a sustainable supply of long chain mega 3 fats.

Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events -- Chan et al. 113 (12): 1578 -- Circulation

Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events -- Chan et al. 113 (12): 1578 -- Circulation:
"Background - Although randomized trials of cyclooxygenase-2 (COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent.
Methods and Results - We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in a prospective cohort of 70 971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1 to 21 d/mo) use of NSAIDs or acetaminophen did not experience a significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (22 d/mo) used NSAIDs had a relative risk (RR) for a cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had a RR of 1.35 (95% CI, 1.14 to 1.59). The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR=1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction=0.02). Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for a cardiovascular event among women who used 15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen.
Conclusions— Use of NSAIDs or acetaminophen at high frequency or dose is associated with a significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk. "

Grapefruit juice -

Grapefruit juice - encyclopedia article about Grapefruit juice.: "Grapefruit juice is the fruit juice coming from grapefruits. It is rich with Vitamin C. It is slightly sour. Variations include pink grapefruit juice. Pharmacological EffectsGrapefruit juice has been found to interact with some medicines. It is believed that flavonoids in the juice affect the activity of certain intestinal enzymes like CYP3A4 and CYP1A2. The flavonoid existing in highest concentration in grapefruit juice is naringin, which in humans is metabolized to naringenin. Other flavonoids exist in grapefruit juice in lower concentrations as well. [1]

These cytochrome P450 enzymes, ordinarily responsible for limiting drug metabolites from entering the bloodstream, are inhibited. As a result, more medicine reaches the bloodstream. This may result in a harmful overdose. This is particularly dangerous when the drug in question has a low therapeutic index, so that a small increase in blood concentration can be the difference between therapeutic success and toxicity.

Drugs that may be affected include midazolam (Versed), cyclosporin (Sandimmune, Neoral), lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), and caffeine, as well as a number of antihistamines including astemizole (Hismanal) and terfenadine (Seldane, Seldane-D). [2]

An easy way to tell if a medication may affected by grapefruit juice is by researching whether another known CYP3A4 inhibtor drug is already contraindicated with the drug in question. Examples of such known CYP3A4 inhibitors include cisapride (Propulsid), erythromycin, itraconazole (Sporanox), ketoconazole (Nizoral), and mibefradil (Posicor).

Orange juice does not contain naringin in as high a concentration, instead containing hesperetin. It is recommended as a substitute.
References
USDA Database of Flavonoid content of food
Pharmacological Effects

Seattle Heart Failure Model

Seattle Heart Failure Model: "The Seattle Heart Failure Model (SHFM) is a calculator of projected survival at baseline and after interventions for patients with heart failure. SHFM is designed for use by health care providers knowledgeable in cardiac medicine. Patients should only use SHFM when their healthcare providers are present, such as at a doctor�s office. Please click the option below that applies to you:"

Revisiting Rose: strategies for reducing coronary heart disease -- Manuel et al. 332 (7542): 659 -- BMJ

Revisiting Rose: strategies for reducing coronary heart disease -- Manuel et al. 332 (7542): 659 -- BMJ: "The way we assess risk of coronary heart disease has become more accurate in recent years. How does this affect the efficacy of primary and secondary prevention strategies?
Twenty years ago Geoffrey Rose used the examples of blood pressure and cholesterol to show that shifting the distribution curve of a single risk factor by a small amount in an entire population has a greater effect on death rates than does treating only people with high levels of that risk factor.1 2 Rose did not entirely discount screening and treatment, but he cautioned that it should target people at high risk of developing an adverse health outcome rather than people with a single raised risk factor such as cholesterol concentration. In the case of coronary heart disease, medical practice has evolved to include assessment of the baseline risk of disease when recommending drug treatment. Rose's argument that a population based strategy reduces more deaths from coronary heart disease than drug treatment should be re-evaluated now that the medical treatment has incorporated the high baseline risk strategy. "

Preventing coronary heart disease -- Jackson et al. 332 (7542): 617 -- BMJ

Preventing coronary heart disease -- Jackson et al. 332 (7542): 617 -- BMJ: "In this issue (p 659) Manuel and colleagues report how they estimated the effectiveness of three strategies to lower blood cholesterol concentrations in Canadians adults.1 A 'population' strategy assumed that blood cholesterol could be lowered by 2% in the whole population and deaths from coronary heart disease by 2.7%. The two other strategies were patient based, assuming that prescribing statins to subgroups of people at high risk of coronary heart disease would reduce their risk by 27%. A 'single risk factor' strategy targeted patients with blood cholesterol levels greater than 6.2 mmol/l and a 'baseline risk' strategy targeted those with a baseline risk of cardiovascular disease greater than 15% over five years, irrespective of their blood cholesterol levels. "

ACC: Salt Substitute Cuts Systolic Blood Pressure - CME Teaching Brief - MedPage Today

ACC: Salt Substitute Cuts Systolic Blood Pressure - CME Teaching Brief - MedPage Today: "# Explain to interested patients that a salt substitute consisting of sodium chloride, potassium chloride, and magnesium sulfate in a roughly 3:2:1 ratio can lower systolic blood pressure by 5.4 mm Hg without affecting diastolic pressure in a population with a very high-sodium diet.

# Be aware that most sodium in the typical American diet comes from processed foods, and cannot easily be substituted with healthier alternatives.

# This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication."

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the A

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. -- Sacco et al. 113 (10): e409 -- Circulation: "The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations."

Cobertura ACC - 2006

Cobertura ACC - 2006:
(Apud Cardioclick)
"ACC 2006: “A atenção agora deve ser direcionada ao HDL”, afirma o Dr. Eugene Braunwald.

Atlanta, 11 de Março de 2006.

No simpósio satélite especialmente dedicado ao papel do HDL no processo aterosclerótico, o Dr. Eugene Braunwald, professor de Medicina da Harvard Medical School, realizou as considerações iniciais do evento.

Segundo Dr. Braunwald, após 12 anos de vários estudos randomizados com mais de 90.000 indivíduos com doença cardiovascular e controles saudáveis, verificou-se que a redução do LDL-colesterol impacta diretamente em redução de risco cardiovascular1. Segundo o professor, os estudos mostraram que em média a redução de 1 mg/dL de LDL-colesterol reduz 1% do risco para eventos cardiovasculares.

A partir destes protocolos, mais quatro estudos (PROVE-IT TIMI 22, A to Z, TNT e o IDEAL) randomizaram mais 27.548 pacientes para comparar uma terapêutica “padrão” (pravastatina 40mg diárias, simvastatina 20 mg diárias e atorvastatina 10 mg diárias) com uma terapia “agressiva” (simvastatina 80 mg diárias e atorvastatina 80 mg diárias) para redução dos níveis de LDL.

Todos esses trials demonstraram benefícios clínicos da terapia agressiva e conseqüentemente, estabeleceu-se o consenso de que para/.../"

Community Lay Rescuer Automated External Defibrillation Programs: Key State Legislative Components and Implementation Strategies: A Summary of a Decad

Community Lay Rescuer Automated External Defibrillation Programs: Key State Legislative Components and Implementation Strategies: A Summary of a Decade of Experience for Healthcare Providers, Policymakers, Legislators, Employers, and Community Leaders From the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy -- Aufderheide et al. 113 (9): 1260 -- Circulation: "Cardiovascular disease is a leading cause of death for adults ≥40 years of age. The American Heart Association (AHA) estimates that sudden cardiac arrest is responsible for about 250 000 out-of-hospital deaths annually in the United States. Since the early 1990s, the AHA has called for innovative approaches to reduce time to cardiopulmonary resuscitation (CPR) and defibrillation and improve survival from sudden cardiac arrest. In the mid-1990s, the AHA launched a public health initiative to promote early CPR and early use of automated external defibrillators (AEDs) by trained lay responders in community (lay rescuer) AED programs. Between 1995 and 2000, all 50 states passed laws and regulations concerning lay rescuer AED programs. In addition, the Cardiac Arrest Survival Act (CASA, Public Law 106-505) was passed and signed into federal law in 2000. The variations in state and federal legislation and regulations have complicated efforts to promote lay rescuer AED programs and in some cases have/.../"

Coronary Heart Disease Risk Equivalence in Diabetes Depends on Concomitant Risk Factors -- Howard et al. 29 (2): 391 -- Diabetes Care

Coronary Heart Disease Risk Equivalence in Diabetes Depends on Concomitant Risk Factors -- Howard et al. 29 (2): 391 -- Diabetes Care: "OBJECTIVE—Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients.

RESEARCH DESIGN AND METHODS—We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n = 4,549) with a high prevalence of diabetes.

RESULTS—In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was >40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed /.../"

HeartBeat December 2005

(Lembrado por Mário Maranhão)
Please find below links to the December 2005 issue of Heartbeat, Newsletter of the World Heart Federation. In this issue, Valentin Fuster and Sidney Smith co-sign the editorial on the World Congress of Cardiology 2006, stressing the fact that this will be a special opportunity to exchange knowledge and ideas as well as to extend the hand of friendship to all who suffer from cardiovascular disease. There is a lack of global recognition of the burden linked with chronic disease and its impact. In his article “Preventing chronic disease - a vital investment”, Robert Beaglehole presents the WHO report launched in response to this situation, calling for urgent global action. For the same reason, Valentin Fuster and Janet Voûte called for the importance of including chronic diseases in the Millennium Development Goals in an article reprinted with permission from the Lancet : "MDGs: chronic diseases are not on the agenda". Articles on awareness building projects of the World Heart Federation such as World Heart Day ( "World Heart Day 2005: a resounding success" and "World Heart day wins again" ) and Go Red for Women ( "A Go Red for Women campaign for every WHF member") are also included in this issue. As usual, you will also find our list of Forthcoming Congresses & Events as well as the list of National congresses of Societies of Cardiology for 2006. Enjoy your reading! Best regards, Danielle Grizeau-Clemens Science Information Officer World Heart Federation

Immunization for Atherosclerosis: Cardiosource Cholesterol Management enews

Immunization for Atherosclerosis: Cardiosource Cholesterol Management enews: "
(Lembrado por Mário Maranhão)
• Immunization for Atherosclerosis - Interview with Prediman Shah CME CME
• Is Hypertriglyceridemia a Risk Factor in Patients With Normal Cholesterol Levels? ACCEL Online with W. Virgil Brown CME
• Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA)
• Relationship Between C-Reactive Protein and Subclinical Atherosclerosis. The Dallas Heart Study (Circulation)
• Reduction in Ventricular Tachyarrhythmias with Statins in MADIT-II (J Am Coll Cardiol)
• Myocardial blood flow and flow reserve are inversely related to Framingham risk score in adults with no clinical coronary heart disease. (J Am Coll Cardiol)
• Targeting Cholesteryl Ester Transfer Protein for the Prevention and Management of Cardiovascular Disease (J Am Coll Cardiol)
• Patients with cardiovascular disease who take a statin have a lower incidence of sepsis. (Lancet)"

Atherosclerosis immunization

Cardiosource: "Inflammation is now recognized as playing a fundamental role in atherosclerosis and its acute thrombotic complications.1 Although not necessarily the primary event, inflammation and cytokine activation during plaque formation and destabilization may represent a common final pathway to various stimuli. To the degree that inflammatory pathways play an important pathogenic mechanism in atherogenesis and plaque destabilization, a whole new approach to treating atherosclerosis is being proposed: immunomodulation.

Twenty years ago, the first reports were published showing the presence of activated immune cells in human atherosclerotic lesions.2 This was followed shortly thereafter by evidence that vascular cells can present antigen to T cells and that vascular cells can produce as well as respond to immune cytokines.3, 4 Several disease-associated antigens subsequently were identified, including oxidized low-density lipoprotein (oxLDL)5 and heat shock protein (HSP)-60.6 This led to various hypotheses regarding the role of immune/inflammatory mechanisms in atherosclerosis.

Today, it is clear that immune cells dominate early atherosclerotic lesions and their effector molecules accelerate lesion progression, ultimately leading to inflammation that can elicit acute coronary syndromes. Thus, inflammation and immunity play a key role in a number of specific cardiovascular diseases (Slide 1), presenting a long list of po"

Governo: maior pesquisa sobre hipertensão e diabetes da América Latina

http://portal.saude.gov.br/portal/aplicacoes/noticias/noticias_detalhe.cfm?co_seq_noticia=22714
Um consórcio formado por sete conceituadas instituições de ensino superior foi selecionado - por meio de chamada pública - para o desenvolvimento daquela que será a maior pesquisa da América Latina voltada à investigação das reais causas da hipertensão e diabetes no Brasil. As universidades federais de Minas Gerais (UFMG), da Bahia (UFBA), do Espírito Santo (UFES), do Rio Grande do Sul (UFRGS), além da Universidade Estadual do Rio de Janeiro (UERJ), a Universidade de São Paulo (USP) e Fundação Oswaldo Cruz (Fiocruz), começam, no próximo mês, o Estudo Multicêntrico Longitudinal em Doenças Cardiovasculares e Diabetes Mellitus (EMLDCD), também conhecido como Estudo Longitudinal de Saúde do Adulto (Elsa/Brasil).O objetivo do EMLDCD é fazer um retrato da população brasileira a partir do monitoramento de aproximadamente 15 mil pessoas pesquisadas. Elas serão recrutadas pelas instituições de pesquisa a partir de janeiro e acompanhados por 20 ou até 30 anos. A cada ano, os pacientes serão convocados para reexame da saúde. Para tanto, o governo federal - por meio dos ministérios da Saúde e da Ciência e Tecnologia, e também da Financiadora de Estudos e Projetos (Finep) - investirá R$ 22,6 milhões na pesquisa, recursos que serão suficientes para o financiamento dos estudos nos anos de 2006, 2007 e 2008. Metade desses recursos vem do Fundo Nacional de Saúde (FNS) e a outra parte do Fundo Setorial CT-Saúde.

EPIDAT

EPIDAT: "Epidat 3.1: Análise epidemiolóxico de datos tabulados
Novidade: Epidat 3.1 disponible dende o 19 de xaneiro de 2006! Esta versión corrixe certos erros detectados na versión 3.0, e está disponible en varios idiomas.
Programa desenvolvido polo Servizo de Epidemioloxía da Dirección Xeral de Saúde Pública da Consellería de Sanidade (Xunta de Galicia) en colaboración coa Unidad de Análisis de Salud y Sistemas de Información Sanitaria da Organización Panamericana de la Salud (OPS-OMS), a través da carta de entendemento existente entre a Consellería de Sanidade e a OPS-OMS.


Nota
Epidat 3.1 és un programa de libre distribución, polo que, non só se permite, senon que se agradece a sua difusión e calquer tipo de crítica ou comentario que axude a mellorar futuras versions. "

CVD Risk reduction in Diabetes

This is a call for applications for Proposal Development Grants (PDGs) in the area of research related to cardiovascular risk reduction in diabetes, to be conducted in developing country settings. The Initiative for Cardiovascular Health Research in Developing Countries (IC Health) will provide upto 5 grants of USD 10,000 each to developing country investigators for developing detailed research project proposals, in prioritized areas indicated in the call for applications. These applications have to be submitted by 31st January 2006, in the format prescribed by IC Health.

Blood Glucose Predictive Role

Contribution from: Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
American Journal of Epidemiology 2006;163(4):342-351
The Predictive Role of Blood Glucose for Mortality in Subjects with Cardiovascular Disease
Sidney C. Port1,2, Noel G. Boyle3, Willa A. Hsueh4, Manuel J. Quiñones4, Robert I. Jennrich2 and Mark O. Goodarzi5

Using the Framingham Heart Study data (United States, 1948–1978), the authors examined the association of blood glucose with 2-year all-cause, cardiovascular, and noncardiovascular mortality in subjects with documented cardiovascular disease. After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality. However, the relations for men and women were qualitatively different. For men, adjusted mortality risk increased very rapidly through the normal range (from 4.12% at 3.89 mmol/liter (70 mg/dl) to 12.26% at 5.55 mmol/liter (100 mg/dl)) and was flat at 12.26% thereafter. For women, risk was flat at 3.65% through the normal range and then increased rapidly, reaching 8.34% at 6.99 mmol/liter (126 mg/d), but increased much more slowly thereafter. Exactly analogous relations held for cardiovascular mortality.
For men and women combined, noncardiovascular mortality increased from 1.82% at 3.89 mmol/liter to 2.06% at 5.55 mmol/liter to 2.29% at 6.99 mmol/liter (p for trend = 0.009). These findings suggest that although 5.55 mmol/liter (normal) may be a useful mortality risk division (albeit with different implications for the two sexes), 6.99 mmol/liter (diabetic) is not, especially for men.
blood glucose; cardiovascular diseases; mortality; risk factors
--------------------------------------------------------------------------------
Abbreviations: AIC, Akaike's Information Criterion; CVD, cardiovascular disease
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco

Death from Acute Rheumatic Fever in Rural Ethiopia

The Lancet: "In their Seminar, Jonathan Carapetis and colleagues (July 9, p 155)1 identify the need for more and better data on acute rheumatic fever (ARF) and rheumatic heart disease (RHD), particularly in low-income and middle-income countries. In rural Ethiopia, the prevalence of RHD in schoolchildren is about 4.6 per 10002 and recent research showed a mean age at death of 25.9 years in hospital inpatients.3
Secondary prophylaxis with a regular injection of penicillin every 3 or 4 weeks is a proven and the most cost-effective approach to the control of ARF and RHD, since primary prophylaxis is difficult to establish and vaccine development is still years away. At Dabat Health Centre in the North Gondar Administrative Zone, Ethiopia, patients with ARF and RHD have been enrolled in a follow-up and secondary prevention programme since 1998. Patients are included after seeking health care because of symptomatic ARF or RHD."

Cardiovascular Diseases Calendar

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

CVD Calendar
� 2006
� 2007
� Links for additional events "

Early detection of cardiovascular disease - the future of cardiology?

E-Journal - Volume 4 - vol4n19: "Early detection of cardiovascular disease - the future of cardiology?
Prof. D. Duprez . Minneapolis, United States of America. Past-Chairman of the ESC Working Group on Peripheral Circulation
Recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
Our goal is to improve the precision for early detection and treatment of cardiovascular disease by identifying markers for early disease and the response to therapy. The traditional approach to cardiovascular disease prevention involves identifying risk factors that are statistically but not necessarily biologically related to disease. Health care expenditures are overwhelming national and corporate budgets, predominantly because of the escalating costs of advanced disease. Therefore there is an urgent need for early detection and treatment of asymptomatic cardiovascular disease."/.../

Early Invasive versus Selectively Invasive Management

Recomendado por Nelson Robson & Carmem [nelcarmem@uol.com.br]
(Full document available on request)
n engl j med 353;11 www.nejm.org september 15, 2005
Background
Current guidelines recommend an early invasive strategy for patients who have acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level. However, randomized trials have not shown an overall reduction in mortality, and the reduction in the rate of myocardial infarction in previous trials has varied depending on the definition of myocardial infarction.
methods
We randomly assigned 1200 patients with acute coronary syndrome without ST-segment elevation who had chest pain, an elevated cardiac troponin T level (≥0.03μg per liter), and either electrocardiographic evidence of ischemia at admission or a documented history of coronary disease to an early invasive strategy or to a more conservative (selectively invasive) strategy. Patients received aspirin daily, enoxaparin for 48 hours, and abciximab at the time of percutaneous coronary intervention. The use of clopidogrel and intensive lipid-lowering therapy was recommended. The primary end point was a composite of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms within one year after randomization.
results
The estimated cumulative rate of the primary end point was 22.7 percent in the group assigned to early invasive management and 21.2 percent in the group assigned to selectively invasive management (relative risk, 1.07; 95 percent confidence interval, 0.87 to 1.33; P=0.33). The mortality rate was the same in the two groups (2.5 percent).
Myocardial infarction was significantly more frequent in the group assigned to early invasive management (15.0 percent vs. 10.0 percent, P=0.005), but rehospitalization was less frequent in that group (7.4 percent vs. 10.9 percent, P=0.04).
conclusions
We could not demonstrate that, given optimized medical therapy, an early invasive strategy was superior to a selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level.

Erectile Dysfunction Predicts Coronary Heart Disease - CME Teaching Brief - MedPage Today

Erectile Dysfunction Predicts Coronary Heart Disease - CME Teaching Brief - MedPage Today:
Min JK et al. Prediction of Coronary Heart Disease by Erectile Dysfunction in Men Referred for Nuclear Stress Testing. Arch Intern Med. 2006;166:201-206.
"Consider questioning men about sexual function when treating them for suspected coronary heart disease, noting that this study implies erectile dysfunction is an independent predictor of severe disease, at least among men referred for stress testing.

Advise patients that erectile dysfunction has been demonstrated to share a common profile of risk factors with coronary artery disease that includes diabetes, hypertension, cigarette smoking, and hyperlipidemia.

Note that further studies are needed to establish whether patients with erectile dysfunction but no cardiac symptoms should be screened for overt coronary heart disease. /.../"

In Coronary Surgery, Spare the Aorta to Save the Brain - CME Teaching Brief - MedPage Today

In Coronary Surgery, Spare the Aorta to Save the Brain - CME Teaching Brief - MedPage Today: "
By Peggy Peck, Managing Editor, MedPage Today
Be aware that this study suggests that it is surgical technique, not the use of a cardiopulmonary bypass pump, that increases the risk of cognitive impairment following heart surgery.

Explain to patients who ask that these findings are limited by the significant age differences between the traditional surgery arm and the two comparator groups."

Cardiovascular Risks of Ethos and Pathos at the Movies - CME Teaching Brief - MedPage Today

Cardiovascular Risks of Ethos and Pathos at the Movies - CME Teaching Brief - MedPage Today:
"Understand that this small study suggests that laughter can have a beneficial effect on the cardiovascular system by inducing relaxation of arterial endothelium, thereby improving circulation.
Advise patients that a good laugh has never been known to be harmful. "/.../

Cardiovascular Disease and Associated Risk Factors

Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]. Full tex available on request
Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there.
Methods. We reviewed Cuban public health statistics, surveys, and reports of health services.
Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors.
Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. (Am J Public Health. 2006;96:94–101. doi:10.2105/AJPH.2004.051417)

International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.

International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.Authors: Bhatt DL, et al. Reviewed by: Joaquin Barnoya, MD, MPH (ProCOR)
Context
Atherothrombosis is the leading cause of cardiovascular morbidity and mortality around the globe. To date, no single international database has characterized the atherosclerosis risk factor profile or treatment intensity of individuals with atherothrombosis.
ObjectiveTo determine whether atherosclerosis risk factor prevalence and treatment would demonstrate comparable patterns in many countries around the world.
Design, Setting, and Participants
The Reduction of Atherothrombosis for Continued Health (REACH) Registry collected data on atherosclerosis risk factors and treatment. A total of 67 888 patients aged 45 years or older from 5473 physician practices in 44 countries had either established arterial disease (coronary artery disease [CAD], n = 40 258; cerebrovascular disease, n = 18843; peripheral arterial disease, n = 8273) or 3 or more risk factors for atherothrombosis (n = 12 389) between 2003 and 2004.
Main Outcome Measures
Baseline prevalence of atherosclerosis risk factors, medication use, and degree of risk factor control.
ResultsAtherothrombotic patients throughout the world had similar risk factor profiles: a high proportion with hypertension (81.8%), hypercholesterolemia (72.4%), and diabetes (44.3%). The prevalence of overweight (39.8%), obesity (26.6%), and morbid obesity (3.6%) were similar in most geographic locales, but was highest in North America (overweight: 37.1%, obese: 36.5%, and morbidly obese: 5.8%; P< .001 vs other regions). Patients were generally undertreated with statins (69.4% overall; range: 56.4% for cerebrovascular disease to 76.2% for CAD), antiplatelet agents (78.6% overall; range: 53.9% for 3 risk factors to 85.6% for CAD), and other evidence-based risk reduction therapies. Current tobacco use in patients with established vascular disease was substantial (14.4%). Undertreated hypertension (50.0% with elevated blood pressure at baseline), undiagnosed hyperglycemia (4.9%), and impaired fasting glucose (36.5% in those not known to be diabetic) were common. Among those with symptomatic atherothrombosis, 15.9% had symptomatic polyvascular disease. Conclusion
This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.JAMA. 2006;295:180-189

www.jama.com

Chronic Stable Angina and Asymptomatic CAD

Referred by: Marcelo Gustavo Colominas [mgcolominas@gigared.com]
Full text available on request.
Primary Care Management of Chronic Stable Angina and Asymptomatic Suspected or Known Coronary Artery Disease: A Clinical Practice Guideline from the American College of Physicians
Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, MPH; for the American College of Physicians/American College of Cardiology Chronic Stable Angina Panel*
In 1999, the American College of Physicians (ACP), then the American College of Physicians–American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization
procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.
Ann Intern Med. 2004;141:562-567.

XXVI Congresso Norte/Nordeste de Cardiologia

XXVI Congresso Norte/Nordeste de Cardiologia:

De: Pedro Albuquerque [mailto:pfalbuquerque@uol.com.br] Enviada em: sábado, 7 de janeiro de 2006 01:24
Gostaria que fosse divulgado aos amigos da AMICOR que o XXVI Congresso Norte-Nordeste de Cardiologia e XXVIII Congresso de Ciruurgia Cardiovascular do Note-Nordeste será realizado em Maceió nos dia 8,9 e 10 de junho de 20006.
O site do congresso é http://congresso.cardiol.br/norte-nordeste, inscrições de TL online http:///tl.cardiol.br.
P.S - veja o anexo.
Muito Obrigado.
Pedro Albuquerque - presidente do congresso.
"Caros colegas cardiologistas,
Há meses as comissões Organizadoras do XXVI Congresso Norte/Nordeste de Cardiologia e do XXVIII Congresso de Cirurgia Cardiovascular Norte/Nordeste, encontram-se plenamente empenhadas no esforço de manter o alto padrão que sempre caracterizou esse megaevento, principal encontro da Cardiologia e da Cirurgia Cardiovascular dos norte/nordestinos.

Maceió prepara-se para, nos dias 8, 9 e 10 de junho de 2006, no Centro Cultural e de Exposições (Centro de Convenções), recebê-los de forma especial, mantendo-os fraternalmente acolhidos."

The John Snow Society

The John Snow Society: "The John Snow Society aims to promote the life and works of Dr John Snow, the pioneer of epidemiological method and celebrated anaesthetist.
As outlined in the Constitution, the Society has a serious intent, publishing news, collecting facts and dates related to the life and works of John Snow and organising the Annual Pumphandle Lecture Series, but it also aims to provide a communication network for epidemiologists and those trained in the Snow tradition throughout the world.
The Society currently has over 1,000 members worldwide, many of them eminent specialists in their fields. "/.../

Heart Disease and Dementia

Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@gigared.com] chaco@fac.org.arAssunto: Heart Disease and Dementia
American Journal of Epidemiology 2006 163(2):135-141
Heart Disease and Dementia: A Population-based Study
Francesca Bursi1, Walter A. Rocca2,3, Jill M. Killian2, Susan A. Weston2, David S. Knopman3, Steven J. Jacobsen2 and Véronique L. Roger1,2
1 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN2 Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN3 Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
Correspondence to Dr. Véronique L. Roger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905 (e-mail: roger.veronique@mayo.edu).
There are conflicting reports on the possible positive association between coronary disease and dementia. The objectives of this study were to examine the association between coronary disease, as measured by myocardial infarction and cardiac death, and dementia in a population-based study. By use of the record-linkage system of the Rochester Epidemiology Project, 916 cases of dementia and 916 age (±1 year)- and sex-matched controls were identified in Rochester, Minnesota, between 1985 and 1994. From the same population, the authors identified all subjects who experienced a myocardial infarction (defined using standardized criteria) during the period 1979–1998. For myocardial infarction occurring prior to the index year of dementia, the authors used conditional logistic regression (case-control analysis), while for myocardial infarction and death occurring after the index year, they used competing risk survival analysis to account for informative censoring (cohort analysis). Before the index year, the odds ratio for myocardial infarction among cases with dementia compared with controls was 1.00 (95% confidence interval (CI): 0.62, 1.62; p = 1.00). After the index year, patients with dementia had a 46% decreased risk of subsequent myocardial infarction (hazard ratio = 0.54, 95% CI: 0.36, 0.82; p = 0.004) and an 18% decreased risk of cardiac death (hazard ratio = 0.82, 95% CI: 0.70, 0.95; p = 0.010). There was no evidence of a positive association between dementia and preceding myocardial infarction, while there was a decreased risk of myocardial infarction and cardiac death following dementia.
case-control studies; cohort studies; death; dementia; myocardial infarction; odds ratio; survival analysis

ACC/AHA Clinical Performance Measures

Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multi-faceted strategy to facilitate the process of improving clinical care. The initial phase of this effort was to create clinical practice guidelines that carefully review and synthesize available evidence to better guide patient care. Such guidelines are written in a spirit of suggesting diagnostic or therapeutic interventions for patients in most circumstances. Accordingly, significant judgment by clinicians is required to adapt these guidelines to the care of individual patients, and these guidelines can be generated with varying degrees of confidence based upon available evidence.
Occasionally, the evidence supporting a particular structural aspect or process of care is so strong that failure to perform such actions reduces the likelihood that optimal patient outcomes will occur. Creating a mechanism for quantifying these opportunities to improve the outcomes of care is an important and pressing challenge/.../

New diureticHeart Failure

NovaCardia - Product Focus - Drugs in Development: "KW-3902: An Innovative Therapy for CHF
In-licensed from Kyowa Hakko in August 2003, KW-3902 (intravenous) is currently in Phase II development for Congestive Heart Failure (CHF) patients undergoing diuresis. This proprietary small molecule acts as an adenosine-A1 receptor antagonist. Current therapies for CHF introduce significant medical liabilities to patients, most notably the risk of worsening kidney function, a predictor of poor outcome. KW-3902, with its novel mechanism of action, has the potential to significantly improve the management of CHF, particularly in patients with renal dysfunction."

Periodic Breathing in Heart Failure: Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory

Artigos na Íntegra - Merck Sharp & Dohme: Editorial do CIRCULATION de um AMICOR
"Periodic Breathing in Heart Failure: Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory [Editorial]
Ribeiro, Jorge P. MD, ScD
From the Cardiology Division, Hospital de Clínicas de Porto Alegre and Department of Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
Correspondence to Jorge P. Ribeiro, MD, ScD, Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 90035 - 007, Porto Alegre, RS Brazil. E-mail jpribeiro@cpovo.net
In the 19th century, Cheyne 1 and Stokes 2 described a pattern of periodic breathing in patients with heart failure, but over the past few decades, particular attention has been given to the occurrence of periodic breathing during sleep.3,4 Central sleep apnea, also referred to as Cheyne-Stokes respiration, is an abnormal periodic breathing pattern in which central apneas and hypopneas alternate with periods of hyperventilation that have a waxing-waning pattern of tidal volume that classically has been associated with severe decompensated heart failure.4 Up to 37% of patients with heart failure may present obstructive sleep apnea,5 in which there is complete or partial collapse of a narrowed pharynx; as many as 40% of heart failure patients may present central sleep apnea,6 in which there is reduction in central inspiratory drive. Despite the fact that obstructive sleep apnea and central sleep apnea have different mechanisms, both are associated with increased sympathetic activity at night and during daytime that results in vasoconstriction, an increased peripheral vascular resistance.3,4 Moreover, small cohort studies had previously demonstrated that the presence of central sleep apnea is associated with increased mortality in heart failure.7,8"/.../

Preconditioning: A New Concept About the Benefit of Exercise -- Domenech 113 (1): e1 -- Circulation

Preconditioning: A New Concept About the Benefit of Exercise -- Domenech 113 (1): e1 -- Circulation:
"Clinicians have learned about the beneficial effects of several factors that may prevent a myocardial infarction (MI), including avoidance of smoking; treatment of high blood pressure, diabetes, dyslipidemia, and obesity; and regular performance of exercise. This last factor is based on epidemiological observations such as a decrease in the incidence of MI in men who perform heavy work1,2; however, it is only in the last few years that the beneficial effect of exercise has obtained plausible explanations of its own, that is, apart from its effect on other risk factors. There are at least 3 distinct mechanisms for this benefit: (1) Improvement of endothelial function, thereby preventing atherosclerosis and coronary occlusion3; (2) prevention of remodeling after MI through the expression of oxidative metabolism-related genes4; and (3) delaying acute ischemic injury after a coronary occlusion by preconditioning. "

The Year in Cardiology, 2005 - CME Teaching Brief - MedPage Today

The Year in Cardiology, 2005 - CME Teaching Brief - MedPage Today: DALLAS, Dec. 30 - In 2005 heart disease killed more Americans than cancer, accidents or HIV infection, and it did so despite continued advances in heart disease diagnosis and treatment.
Those advances have made a dent in mortality, which declined from 322 per 100,000 in 1990 to 241 per 100,000 in 2002, but heart disease is unlikely to lose its No. 1 killer title any time soon.
The reason, authorities say, is that prevention is an elusive goal, not yet within the grasp of the cardiology's considerable reach.
For example, according to the CDC's National Center for Health Statistics, about half of America's aging baby boomers have hypertension and almost 40% are obese-a combination that is likely to spell cardiovascular mortality for many.
And yet another study found that nearly one in five Americans from the age of 12 through 49 -- an estimated 16 million -- can't pass a simple physical fitness treadmill test.
Nearing Medicare, Boomers Need Diets and Blood Pressure Control
Americans in Droves Flunk Fitness Test
While the diet-and-fitness message continues to be ignored by many Americans, researchers have been investigating mechanisms of heart disease progression as way to develop secondary prevention strategies.
Inflammation is considered a major contributor to plaque instability, which led many researchers to suggest that infection may be a trigger for cardiovascular events. And if infection could trigger an event, then antibiotics might prevent events.
That was the theory anyway, and 2005 was the year that it was debunked.
In a National Heart, Lung, and Blood Institute (NHLBI) trial, patients with stable coronary artery disease who underwent a year-long course of weekly azithromycin therapy were no less likely to have a heart attack or stroke than patients taking placebo.
Likewise, in a study sponsored by Bristol-Myers Squibb and Sankyo, acute coronary syndrome patients treated with Tequin (gatifloxacin) for a mean of two years had no reduction in cardiac events compared to patients randomized to placebo.
In announcing the negative results, NHLBI Director Elizabeth G. Nabel, M.D., said it was clear the antibiotics did not work, and it is time to focus prevention efforts on "the controllable risk factors for preventing coronary events."
No Role for Antibiotics in Cardiovascular Secondary Prevention
Another popular theory, that aggressive lipid lowering with high-dose Lipitor (atorvastatin) is better than standard therapy with Zocor (simvastatin) or other less potent statins, retained its adherents even though it was not confirmed in one major study.
That study, Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) trial, found that high dose Lipitor did not achieve a statistically significant benefit compared with usual-dose treatment with Zocor (simvastatin) in patients with a history of acute myocardial infarction.
Patients randomized to 80 mg of Lipitor had an 11% relative reduction in major coronary events versus patients randomized to 20 mg of Zocor (P=0.07).
Moreover the aggressive treatment failed to achieve a significant benefit even though high-dose Lipitor lowered LDL to 81 mg/dL versus 104 mg/dL in the Zocor group. There were no significant differences in either cardiovascular or all-cause mortality.
But those results did little to dampen the enthusiasm of many cardiologists who said they will stick to high=dose Lipitor regimens, and they have solid evidence to back up that clinical decision. In the Treating to New Targets (TNT) trial, which enrolled 10,001 patients with stable coronary disease, treatment with high-dose Lipitor to mean LDL levels of 77 mg/dL was associated with a 22% reduction in risk of major cardiovascular events compared with patients treated to a mean LDL of 101 mg/dL.
When he reported the TNT findings at the American College of Cardiology meeting in March, principal investigator John C. LaRosa, M.D., of the State University of New York Health Science Center in Brooklyn said, "We have entered a new era in the treatment of established coronary disease from starting at an LDL of 100."
AHA: High-Dose Lipitor Does Not Outdo Standard-Dose Zocor
ACC: LDL Cholesterol of Less than 80 mg/dL Reduces Risk of Heart Attack and Stroke
But a big-stick statin may not always be the safest treatment choice, according to an analysis of post-marketing safety reports from patients using Crestor (rosuvastatin), a super-potent statin, Lipitor (atorvastatin), Zocor (simvastatin), or Pravachol (pravastatin).
Patients taking Crestor were eight times more likely to develop rhabdomyolysis, nephropathy, renal failure or proteinuria than patients taking Pravachol, and 6.5 times more likely to develop those complications than patients taking Lipitor.
Richard H. Karas, M.D., Ph.D., director of preventive cardiology and the Woman's Heart Center at Tuft-New England Medical Center, noted that the absolute risk remains low: 28 events per million prescriptions for Crestor, versus 13 per million for Zocor, 3.5 per million for Pravachol, and 4.3 per million for Lipitor.
Safety and efficacy of devices was also a big issue this year, and most of the news for Guidant was bad. The device maker was forced to recall 170,000 pacemakers and implantable defibrillators, which was more than half of the company's devices. Moreover, Guidant's problems triggered a months' long series of events that included a demand by cardiologists for a reworking of device safety alerts and recalls and a two-day FDA conference on device safety.

Implantable Devices Take a Licking but Don't Always Keep on Ticking
Cardiologists Urge Changes in Safety Regs and Guidelines for ICD Use
Crestor Called Less Safe Than Other Statins
But while the year was a rocky one for the heart-device industry, it was another boom year for drug-eluting stents. These stents-Cypher, which delivers sirolimus to the endothelium and Taxus, which carries a payload of paclitaxol-now are the stents of choice for most interventionists. What remains, of course, is heavy competition between the two.
In this head-to-head race, Cypher came away as the winner in trials reported this year.
ACC: Cypher Stent Edges Ahead of Taxus in Head-to-Head Trials
ACC: Cypher Bests Taxus in All Comers Comparison Study
Just as Cypher was the odds-on-favorite in the world of stents, Plavix (clopidogrel) was this year's winner for the drug reporting the most positive trial results. It was difficult to find a cardiology journal, or a cardiology conference that didn't feature a positive Plavix study. The take home message was clear: give it early and often.
ACC: Adding Plavix to Clot-Busting Regimen Saves Lives
ESC: Pretreatment with Plavix Reduces MI, Stroke, and Death Before and After Stenting
Plavix-Aspirin Combo Reduces Acute Heart Attack Deaths
Finally, a pair of low-tech but significant observations: dyspnea is not a benign symptom, and for men heart rate reveals volumes.
First, a study of almost 18,000 patients referred for cardiac stress testing found that people with no known coronary artery disease who report a history of dyspnea are four times more likely to die from heart disease than asymptomatic patients.
Second, a study of 5,713 French men found that when a man's heart rate is too fast at rest, he had a 3.5-fold increase in risk of sudden cardiac death. Moreover, if a man had less than an optimum increase in heart rate during exercise, his risk of sudden death was 20% higher than men whose hearts speeded up appropriately during exercise.
Dyspnea Is Predictive of Cardiac and All-Cause Mortality
Sudden Death in Healthy Men Can Be Predicted by Heart Rate

Investindo em Educação e Saúde

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

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

O Brasil Visto por Dentro

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

The Pandemic of Lifestyle Diseases

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

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

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

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