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ABSTRACT: The fasting plasma glucose (FPG) test is a predictor of complications after Acute Coronary Syndrome (ACS). However, its prognostic value is not yet fully established in different age groups.
To evaluate the role of admission fasting plasma glucose (FPG) as a predictor of 30 days after ACS, and the association of hyperglycemia with major cardiovascular events (MACE): death, reinfarction and coronary artery bypass grafting, in two different age groups (<65 year and ≥65 year-old patients).
Contemporary cohort of patients hospitalized for ACS in the Institute of Cardiology of Rio Grande do Sul (Southern Brazil). In the first 24 hours of admission, patients answered a questionnaire with clinical information and had peripheral blood collected for measurement of FPG. Patients were followed up during hospitalization and for 30 days for the presence of MACE. Statistical analyses were performed using the SPSS 15.0 with the chi-square or Fisher Exact test (categorical variables) and the Student t test (numerical variables). Multivariate analysis was performed.
580 patients were included in the study. Mean age was 61.2 (±12.3) years, with 38.6% of the patients (224) ≥65 years old, and 67.7% (393) were male. Multivariable analysis showed that, after 30 days of follow-up, only FPG (OR= 1.01, 95% CI:1.00-1.01, P= 0.001) was associated with MACE in both age groups.
Admission FPG was an independent predictor for MACE in the early phase of ACS.
Arquivos brasileiros de cardiologia 03/2012; 98(3):203-10. · 1.32 Impact Factor
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ABSTRACT: Although coronary artery bypass grafting (CABG) is a good alternative therapy in severe arterial disease, it may evolve with complications, especially infections.
To determine the incidence of infection in post-CABG and its clinical predictors in a cardiology reference center in Brazil.
Cohort study. Data were collected from all patients undergoing CABG between January/2004 and February/2006, excluding emergency surgery, absent record of glucose blood levels preoperatively and infection prior to surgery. Statistical analysis: Student's t test, chi square, logistic regression.
We evaluated 717 patients, 61.9 ± 11 years old, 67.1% were men, 29.6% with diabetes, of whom 137 (19.1%) developed infection (62% respiratory, 25% superficial wound, 9.5% urinary, 3.6% deep wound). Diabetes was more prevalent in those who developed infection, as well as prolonged time of indwelling central venous catheter (79.3 ± 40.5 vs. 61.0 ± 19.3 hours, P<0.001). After multivariate analysis (model adjusted for dyslipidemia, hypertension, smoking and leukocytes), both diabetes (OR 4.18 [2.60-6.74]), prolonged central venous line (OR 1.019 [1.00-1.02] and cardiac catheterism (OR 2.03 [1.14-3.60] remained predictors of infection. While diabetes is associated with a higher percentage of infections (P <0.001), preoperative serum glucose was not associated with increased risk of infection.
Diabetes and permanence of central venous catheters were associated with development of infection in post-CABG. The preoperative blood glucose was not a predictor of risk of infection. It is probably necessary to study with greater detail glycemic control trans- and post-operatively.
Brazilian Journal of Cardiovascular Surgery 06/2011; 26(2):190-6.
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ABSTRACT: To describe clinical/laboratory features of patients undergoing coronary artery bypass graft (CABG) in a cardiology reference center.
Cohort study; data from patients undergoing CABG (January 2004 to February 2006, n = 717) were evaluated for clinical/laboratory features before, during and after surgery (infections, duration of hospital stay, deaths).
Patients were 61.9 ± 11 years old, 67.1% males, 29.6% diabetics. Intraoperatively, diabetics had a central venous catheter placed for a longer period (p < 0.001), but extracorporeal circulation, aortic clamping and total surgery times were similar to those for non-diabetics. Infection occurred in 19.1% of patients (40.1% diabetics vs. 10.3% non-diabetics, p < 0.001). The duration of hospital stay was longer for patients with diabetes vs. non-diabetic patients, but there was no difference in deaths between the two groups (p = 0.797).
Patients with diabetes undergoing CABG develop more infectious diseases and stay longer in hospital than non-diabetics.
Revista da Associação Médica Brasileira 04/2011; 57(2):200-4. · 0.77 Impact Factor
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ABSTRACT: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery.
This concurrent cohort study included patients aged ≥ 50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction.
A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels.
Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.
Clinics (São Paulo, Brazil) 01/2011; 66(5):773-6. · 1.59 Impact Factor
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ABSTRACT: Atherosclerotic cardiovascular disease begins its process in early childhood and is influenced throughout life by genetic factors and environmental exposure to potentially modifiable risk factors.
To investigate the prevalence of risk factors for atherosclerosis with emphasis on dietary habits in a predominantly Italian colonization town.
Population-based cross sectional study, involving 590 primary school students aged between 9 and 18 years, with a cluster sample. The following were collected: identification data, family history and personal history, and information regarding students' eating habits. Dietary habits considered inappropriate included: consumption of fast food, sugary snacks, sugar-sweetened beverages and animal fats four or more times a week, and fruits, green vegetables, and leguminous vegetables less than four times a week.
The prevalence of overweight among students was 24.6% (n = 145), high blood pressure, 11.1% (n = 65); passive smoking, 35.4% (n = 208); sedentary lifestyle, 52.3% (n = 306), family history of 1st degree disease: hypertension, 21.4%, obesity 36.5%. Food items eaten four or more times a week: fast food, 70.3% (n = 411); sugary snacks, 42.7% (n = 252), sugar-sweetened beverages, 71% (n = 419), and animal fats, 24.4% (n = 143). Food items eaten less than four times a week: fruits, 36.8% (n = 215), green vegetables, 49.5% (n = 292) and leguminous vegetables, 63.7% (n = 374).
Interventions are needed to promote changes in students' eating habits: higher level of consumption of fruits, green vegetables and leguminous vegetables, and increased level of physical activity.
Arquivos brasileiros de cardiologia 08/2010; 95(2):166-72. · 1.32 Impact Factor
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ABSTRACT: Several factors, which include prenatal diagnosis and availability of new therapeutic procedures, have contributed to change the profile of patients with congenital heart disease (CHD). Knowing these changes is important to a better health care.
Description of profile of patients with CHD in a reference service in the State of Rio Grande do Sul, Brazil.
It is a cross-sectional study including 684 patients with CHD in a service of pediatric cardiology from January 2007 to May 2008. We interviewed the patients (and/or their parents) and examined these patients (congenital malformations, anthropometric measures). Moreover, their charts were reviewed in order to detail heart diseases, procedures and echocardiography.
Patients were from 16 days to 66 years old, 51.8% were female, and 93.7% were Caucasian. The mean age at diagnosis was 15.8 +/- 46.8 months. Ventricular septal defect, patent ductus arteriosus and Tetralogy of Fallot were the most prevalent CHD. 59.1% of examined patients, whose average age was 44.3 +/- 71.2 months, have been undergoing therapeutic procedures; 30.4% had congenital extracardiac malformations; and 12 patients had genetic syndrome. Regarding development, 46.6% had low weight and height gain, and 13.7% had neuropsychomotor delay. Furthermore, 18.4% had family history of congenital heart disease.
Neuropsychomotor delay and low weight and height gain may be related to CHD. Establishing a profile of patients with CHD, who were treated at an institution of reference, may function as a basis in which health care of this population can be planed appropriately.
Arquivos brasileiros de cardiologia 03/2010; 94(3):313-8, 333-8. · 1.32 Impact Factor
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Arquivos brasileiros de cardiologia 09/2009; 93(3):211-2. · 1.32 Impact Factor
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ABSTRACT: Most information on the role of inflammatory markers as cardiovascular disease predictors concerns only middle-aged individuals. This review aims at evaluating the role of inflammatory markers as cardiovascular disease predictors in the elderly. The Medline (Pubmed) and Cochrane databases were used in the search, using the key words. After adding the following filters: Limits: Aged 65+ years, Humans, Randomized Controlled Trial, Meta-Analysis, Review, Clinical Trials, 554 studies were identified. Of these, 120 were selected and evaluated regarding their power of evidence (classification of the Oxford Centre for Evidence-Based Medicine). In studies with patients older than 65 years, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) showed to be good predictors of cardiovascular events. Regarding C-reactive protein (CRP), the data are inconsistent, as it appears to have lower power of prediction in the elderly when compared to middle-aged individuals. Fibrinogen levels seem to be predictors of mortality, although they are non-specific predictors, i.e., not solely of cardiovascular mortality. Additionally, the inflammatory markers are also indicative of functional decline and mortality, regardless of the presence of cardiovascular disease. The current evidence is not sufficient to allow the routine use of inflammatory markers in the elderly, as there are few studies in this age range and most of them are short-term ones with a small number of inflammatory markers. The routine request for these markers must be decided on an individual basis.
Arquivos brasileiros de cardiologia 04/2009; 92(3):221-8, 227-34. · 1.32 Impact Factor
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ABSTRACT: Glycemia and inflammatory markers were associated with clinical outcomes in patients with acute coronary syndrome (ACS).
To evaluate the role of glycemia and inflammatory markers as predictors of late cardiovascular outcomes after ACS.
One hundred and ninety-nine ACS patients of a Coronary Care Unit were included, from March to November 2002. They were reassessed clinically after approximately 3 years. Clinical variables, glycemia, CRP and fibrinogen were evaluated as event and mortality predictors. Statistical analyses included Cox multivariate analysis and survival curves (Kaplan-Meier).
At admission, 16.7% had normal glycemia. After 3 years, this proportion increased to 55.2%; the 40.6% who belonged to the borderline category decreased to 27.1%; the 42.7% with elevated glycemia decreased to 17.7%. Glycemia was not associated with the development of major cardiovascular events (MACE) and mortality at follow-up ( approximately 3 years). Considering MACE, CRP (p<0.001), but not fibrinogen, was predictive in bivariate analysis. Regarding mortality, both fibrinogen (p=0.020) and CRP (p=0.008) were predictive in bivariate analysis.
Glycemia was not associated with late mortality after ACS, but inflammatory markers were, suggesting that these are more sensitive markers to predict events in long-term. Moreover, glucose intolerance prevalence is lower in the follow-up after the ACS episode.
Diabetes Research and Clinical Practice 12/2007; 78(2):263-9. · 2.75 Impact Factor
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ABSTRACT: To associate the markers lipid profile, inflammatory profile (high-sensitivity C-reactive protein HSCRP and fibrinogen), and metabolic profile (glucose determination) with hospital and posthospital events in patients with acute ischemic syndrome (AIS) and to describe the predictors of mortality in this population.
A cohort study with 199 patients with AIS (unstable angina, acute myocardial infarction (AMI) with or without ST segment elevation) admitted to the intensive care unit (ICU) of a university cardiology Hospital, from March to November 2002. The previous diseases, the medication in use, and the coronary risk factors were recorded. The clinical events considered in the hospital were reinfarction, angina, heart failure (HF), ventricular fibrillation, and death; the posthospital events considered (30 days after hospital discharge) were reinfarction, angina, HF, death, and admittance for percutaneous procedures (PTCA) or for revascularization (MRS).
HSCRP and altered glycemia were significantly associated with hospital events (P = 0.03 and P < 0.01, respectively); however, they were not associated with posthospital events (P = 0.19 and P = 0.61, respectively). Lipid profile and fibrinogen did not have a statistically significant association in any of the times assessed. Using multiple logistic regression, age (P = 0.04), previous AMI (P = 0.04), myocardial infarction with ST segment elevation (P = 0.008) or without ST segment elevation (P = 0.048), and altered glycemia (P = 0.002) were predictors of hospital mortality.
Increased HSCRP and altered glycemia were associated with a greater number of hospital events, whereas age, previous AMI, AMI with or without ST segment elevation, and altered glycemia were predictors of hospital mortality.
Arquivos Brasileiros de Cardiologia 02/2005; 84(2):122-9. · 0.88 Impact Factor
