S. Gomes

North Lisbon Hospital Center, Lisboa, Lisbon, Portugal

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Publications (24)126.34 Total impact

  • Article: PP.01.17
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    ABSTRACT: Objective: High blood pressure (HTA) and diabetes mellitus (DM) confer a greater risk of developing coronary heart disease. It is intended to assess the impact of HTA on the in-hospital morbidity and mortality of diabetic patients diagnosed with acute coronary syndrome without ST segment elevation (ACS NSTEMI). Design and method: Prospective study of 240 diabetic patients (pts) diagnosed with ACS NSTEMI, between October 2009 and September 2014. They were divided into two groups- diabetic pts with a history of hypertension (Group I: n = 214, 89.17%, 55.1% men) and diabetic pts without a history of hypertension (Group II: n = 26, 10.83%, 76.9% men) - and compared for in-hospital mortality and for the primary composite endpoint (PCE) -nonfatal myocardial reinfarction, stroke and total mortality. Results: Group I was older [I: 71.35 (interq (iq) = 13.75) vs II: 66.57 (IQ = 14.74), p < 0.05], had higher body mass index [I: 28.32 (IQ = 6.75) vs II: 26.04 (iQ = 5.76), p < 0.05] and a higher prevalence of previous stroke [I: 14.5% vs II: 0.0%, p < 0.05]. No statistical difference in relation to other previous cardiovascular history. On admission, there was no difference in the Killip classes, nor in the analytical parameters (blood glucose, creatinine, BNP). During hospitalization, there was no difference in regard with the adopted risk stratification strategy, or the in-hospital medication, except for ACE inhibitors [I: 68.7% vs II: 4.6%, p < 0.01%] and diuretics [I: 47.2% vs II: 23.1%, p < 0.05] that were most frequently used in group I. There was also no difference for in-hospital complications, nor mortality [I: 6.1% vs II: 15.4%, p = ns] nor PCE [I: 10.7% vs II: 19.2%, p = NS] between the two groups. No difference in the secondary prevention strategy between the two groups. Conclusions: Although there was a high prevalence of hypertension in diabetic patients with ACS NSTEMI, this was not associated with increased in-hospital morbidity and mortality in this population. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.33.04
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    ABSTRACT: Objective: Measurement of femoral-carotid pulse wave velocity (PWV) is recognized as a simple and practical method for assessing arterial stiffness. We determined whether the PWV of asymtomatic population with no detectable Coronary artery disease is affected by obesity and its associated metabolic risk variables. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.33.03
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    ABSTRACT: Objective: Body Mass Index (BMI) is widely used to assess the impact of obesity on cardiometabolic risk but it does not always relate to central obesity. The WHtR (waist/height), is a contant anthropometric marker of central adiposity, has been advocated as a superior indicator of cardiometabolic risk. Design and method: Cross-sectional cardiometabolic risk factor variables on 2555 adults (23.6% female and 76.4% male), 30-65 years of age were used. Based on BMI, the population was classified as obese if BMI was > 30 (n = 1759, 68.8%) and non obese if BMI < 30 (n = 796, 31.2%). The risk profiles of each group based on the WHtR (<0.6, no central obesity versus > = 0.6, central obesity) were compared. Results: 24.9% of the non obese group were centrally obese (WHtR > = 0.6) and 10.1% among the obese were not (WHtR < 0.6). 32.2% of the non Obese with Central Obesity group had Type 2 Diabetes, as compared to 15.7% of the non Obese without Central Obesity (P < 0.0001). 74.7% of the non Obese with Central Obesity had metabolic syndrome as compared to 36.7% of the non Obese without Central Obesity (p < 0.0001). On multivariate analysis the non obese with central adiposity were 1.78, 1.4, and more likely to have significant adverse levels of tryglicerides, glucose and 0.55 less times to have higher HDL, respectively. In the obese group, those without central obesity were 3.49 times likely to have significant adverse levels of HDL cholesterol (p < 0.0001), as compared to those with central obesity. Conclusions: In our population WHtR was found to further stratify cardiometabolic risk factor levels beyond BMI percentile category alone. It not only detects central obesity and related adverse cardiometabolic risk among non obese population, but also identifies those with predisposition to Glucose metabolism impairment, which has implications for primary care practice. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.28.03
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    ABSTRACT: Objective: Approximately 15% of patients who develop coronary artery disease (CAD) have reduced stratified cardiovascular risk by existing predictive models. It is estimated that, for CAD, the genetic variation explains 40-55% of this variability. Characterize the genetic profile of a representative sample of the Portuguese population, including genetic polymorphisms associated with traditional cardiovascular risk factors (TCRF) and Coronary Atherosclerosis. Design and method: A case-control study included 1321 patients with documented CAD (mean age 53.4 +/- 8.1 years, 78.8% male) and 1148 controls, selected from our database in order to be similar to cases in terms of gender and age. We evaluated the TCRF and 29 genes variants: ACE I/D, AGT235 M/T, ATIR A/C, MTHFR C/T and 1298 A/C, PON192 Q/R and 55 L/M, LPA T/C, APO E, Locus 9p21.3 (rs1333049), CDKN2B (rs4977574), GJA4 C/T, PCSK9 A/G, TAS2R50 A/G, KIF6 C/T, IGF2BP2 G/T, ADAMTS7 A/G, MC4R T/C, PPARG Pro12 Ala, ZNF259 C/G, SMAD3 C/T, MIA3 C/A, MTHFD1L A/G, SLC30A8 C/T, TCF7L2 C/T, HNF4 C/G, FTO A/C and ADIPOQ C/G. A score was created based on the risk multiplication (Odds Ratio) of each genotype of the 29 variants. A logistic regression was performed to estimate the CAD risk according to the score deciles. The decile, which included the median of the genetic score of the study population, was considered as the reference class. Results: The genetic Score ranged between 0.04 and 6.7 and the median of the population was 0.369. Low values of genetic Score were significantly protective (first 2 deciles, OR = 0.464 p < 0.570 and OR < 0.0001 p = 0.002, respectively). On the other hand, high score values showed a significant CAD risk (last 2 deciles, OR = 1.455 p = 0.042 and OR = 1.620 p = 0.009, respectively), while intermediate values were not significant. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
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    ABSTRACT: Genes associated with coronary artery disease (CAD) and traditional cardiovascular risk factors (TCRF) present a limited individual predictive value. It is expected that the inclusion in global scores may increase the predictive ability. In genetic terms, there are no validated risk scores to predict the occurrence of cardiovascular disease or its complications. Evaluate the ability of a multifactorial genetic risk score (GRS) be able to add predictive power, for the development of CAD, to the model developed only with TCRF. A case-control study was performed with 1321 consecutive coronary patients (mean age 53.4 ± 8.1 years, 78.8% male) and 1148 controls selected to be similar to cases in terms of gender and age. Traditional risk factors (hypertension, diabetes, dyslipidemia, smoking, obesity, sedentary lifestyle, family history) were evaluated according to the International criteria. The genetic variants were analyzed with specific primers and the GRS was determined in the entire population, based on 29 genetic polymorphisms previously associated with atherosclerotic disease in general and, in particular, with CAD. A multiplicative model was then used based on risk multiplication (odds ratio - OR) of each genotype of the 29 studied genes. Subsequently, a multivariate analysis was done with the TCRF only or the TCRF with the GRS and a ROC curve was constructed for both situations. After multivariate analysis, the GRS was found to be an independent predictor for CAD (OR = 2.1; CI: 1.7-2.5; p < 0.0001). The AUC increased from 0.71 to 0.74 after the inclusion of GRS to the TCRF in the multivariate analysis (Figure).(Figure is included in full-text article.) CONCLUSIONS:: In our population, the multiplicative GRS was an independent predictor for CAD. When analyzed together with traditional risk factors, it adds little predictive value. Its usefulness, in clinical practice, may be directed to the intermediate risk group, in which a possible risk reclassification can have different therapeutic measures.
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.42.02
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    ABSTRACT: Objective: Arterial hypertension (AHT) is a multifactorial disease in which the genetic contribution is particularly important. It is estimated that about 30% of the blood pressure values are genetically determined. Multiple genes have been associated to AHT, but sometimes without statistical significance. Create a score with genes pathophysiologically associated with AHT determine the risk of developing this disease. Design and method: Case-control study which included 1063 individuals, 487 patients with AHT (mean age 51.8 +/- 7.6; 48.7% male) and 576 controls (mean age 51.1 +/- 7.4; 46.5% male). We selected 12 gene variants associated with hypertension namely, those of the Renin Angiotensin Aldosterone System (AGT 174 M/T; AGT 235 T/M; ACE I/D; ACE 8 A/G; AT1R 1166 A/C; CYP11B2 -344 C/T, CYP17A1 T/C); the balance of sodium and water (SNN1G A -173 G, ADD1 Gly460Trp); the sympathetic adrenergic system ([beta]1 Adrenergic R389G, [beta]2 adrenergic R16G); and other candidate genes as ATP2 B1 A/G and the Sub Unit [beta]3 Protein G C825T. The odds ratio (OR) for each of the genetic variants was calculated and the multiplicative score was then determined based on the risk multiplication (OR) of each genotype of the 12 studied variants. This score was divided into tertiles, considering the 1st tertile of OR as the reference class and compared with the 3rd tertile in terms of AHT development. Results: The genetic score generated by using 12 genetic polymorphisms presented an AHT risk of 2.07 (CI: 1.53 to 2.80; p < 0.0001), comparing the 3rd tertile with the 1st tertile (Table). Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.16.02
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    ABSTRACT: Objective: Obesity is associated with diabetes mellitus, hypertension, dyslipidemia and increased cardiovascular disease (CVD) risk. Anthropometric indeces, such body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), were evaluated as predictors of the presence of CVD risk factors in Portuguese adults. Design and method: The study contained a 2555 representative sample of Portuguese adults 1952 male aged 52.5 +/- 8.2 years and 603 female aged 53.5 +/- 8.8 years. All anthropometric indices correlated significantly with fasting glucose level, systolic and diastolic Blood Pressure, Tryglicerides and inversely with the high-density lipoprotein (HDL-C) level (p < 0.0001). Results: The WHtR showed higher correlation with CVD risk factors than WC and BMI in both men (p < 0.0001, r correlation of 0.21, 0.20, 0.18, 0.15 and -0.2 respectively) and female (P < 0.0001, 0.28, 0.27, 0.24 0.3, -0.37). Regarding Diabetes, Hypertension and Low HDL-C the area under the receiver (AUCs) operating characteristic (ROC) curve for WHtR was higher than that for WC or BMI in the male group. In female group the ROC curve increased from the BMI to WC, beeing highest for WHtR. WC was a better predictor for High cholesterol and LDL in men. The AUCs for WHtR were highest for Diabetes (AUC = 0.74 and Hypertension (AUC = 0.74) in female group and male group (AUC = 0.66 and AUC = 0.68). The WHtR cut-off value to predict diabetes mellitus, hypertension, and dyslipidemia was approximately 0.57 in men and 0.58-0.62 in women. The WC cut-offs varied from 92 to 101 cm in men and from 88 to 97 cm in women. The optimal BMI cut-off point varied from 21.7 to 29.1 kg/m2 in women and from 26 to 29 Kg/m2 in men. Conclusions: WC or WHtR were better predictors of CVD risk factors than BMI in Portuguese Adult Population. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
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    ABSTRACT: Type 2 diabetes mellitus (T2DM) constitutes a worldwide health problem associated with strong cardiovascular risk. There are environmental factors that contribute for the development of this disease, such as obesity or sedentary life. However, individuals with normal weight can have T2DM and, on the other hand, many of the obese individuals will not develop diabetes, suggesting that it is compelling. the evaluation of other variables, such as genetic factors. Objective: Our study aims to investigate genetic polymorphisms associated with the T2DM onset in a Portuguese population. Methods: We performed a case-control study with 1938 Caucasians which 548 were diabetic type 2 patients (classified as diabetic according to the European Association for the Study of Diabetes) and 1390 were controls, with no significant difference in age. Blood samples for genetic analysis were collected, from both groups, in order to evaluate 18 genetic variants previously described as being associated to hypertension, obesity, diabetes or coronary disease as PON1 Q192R and PON1 L55M, KIF6 T/A, HNF4A C/G, FTO A/C, TAS2R50 A/G, PCSK9 G/A, GJA4 C/T, TCF7L2 C/T, ACE I/D, AGT M235T, AT1R A1166C, MTHFR C677T e MTHFR A1298C, 9P21 locus (rs1333049 G/C) and APOE (ɛ2, ɛ3, ɛ4). Data are presented by mean ± SD. Continuous variables are evaluated by Student t test and categorical variables by Chi Square tests. The power of the association was expressed by the Odds Ratio (OR) and 95% confidence intervals. Multivariate logistic regression is performed to determinate which polymorphic variants were significantly and independently associated with T2DM. A p-value less than 0.05 was considered statistically significant. Results: The polymorphisms that showed association with T2DM, in the univariate analysis were: TCF7L2 TT (OR=1.69; p=0.0002) and AT1R CC (OR=1.58; p=0.021). After logistic regression, with all the genetic variants investigated and the environmental factors, only the TCF7L2 TT (OR=1.99; p<0.0001) remained in the equation showing to be significantly and independently associated with T2DM emergence. Conclusions: This study suggests that there is in our population a genetic polymorphism that independently contributes to the development of T2DM. Since diabetes is associated with a very strong cardiovascular risk, the patients carrying this polymorphism should be approached with early preventive measures, in order to counteract their genetic tendency to develop diabetes.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: The Arterial Hypertension (AH) is associated with an increase of cardiovascular mortality and morbidity. This study aims to evaluate the prevalence of hypertension and its impact on in-hospital morbidity and mortality in Acute Myocardial Infarction (AMI). Methods: Retrospective study of 817 consecutively enrolled patients admitted for AMI between October 2009 and October 2012. AH was defined according to the European Society of Hypertension classification: systolic blood pressure ≫140 mmHg or diastolic blood pressure ≫90 mmHg. It was divided in 2 groups: patients with prior AH (Group H: n=550, 67.3%; 64.0% men) and patients without prior AH (Group NH: n=267, 32.7%; 79.0% men). We compare them regarding primary composite endpoint (cardiovascular death, non-fatal MI or stroke). Results: The prevalence of hypertension in patients admitted for AMI was 67.3%. There were no differences in the composite primary endpoint (H=8.4% vs NH=7.9%; p=0.808). Group H had higher age [H=69.0 (interq=17) vs NH=58.0 (interq=19); p<0.001] and bone mass index [H=27.55 (interq=6.08) vs NH=25.95 (interq=4.26); p<0.001]. They had higher history of angina (H=30.2% vs NH=14.2%; p<0.001), myocardial infarction (H=24.2% vs NH=12.7%; p<0.001), stoke (H=10.2% vs NH=2.6%; p<0.001), cardiac failure (H=7.1% vs NH=3.4%; p=0.034), Diabetes Mellitus (H=36.7% vs NH=10.9%; p<0.001), dyslipidemia (H=59.6% vs NH=32.2%; p<0.001) and chronic renal disease (H=10.4% vs NH=1.9%; p<0.001). Group H presented Killip >1 at the admission (H=23.6% vs NH=14.6%; p<0.05) and at 72h (H=27.4% vs NH=20.0%; p<0.05), higher values of blood glucose [H=147 (interq=105) vs NH=125 (interq=61); p<0.001], creatinine [H=1.135 (interq=0.60) vs NH=0.99 (interq=0.36); p<0.001] and BNP [H=334 (interq=658) vs NH=181.5 (interq=391); p<0.001]. They had less 1-vessel disease (H=28.35 vs NH=43.9%; p<0.001) and no differences at multivessel disease. No significant differences were found at the duration of hospital stay in Cardiology service [H=6 (interq=4) vs NH=6 (interq=3); p=0.281]. Conclusions: AH was not associated with an increase of mortality and morbidity in AMI or the duration of hospitalization. However, there was an association between hypertension with other cardiovascular risk factors.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: Chronic Kidney Disease (CKD) is a frequent morbidity in patients admitted for acute coronary syndrome (ACS). Several equations to correctly identify patients with CKD through glomerular filtration rate (GFR) exist, but it is still not consensual which one is the most appropriate in the setting on ACS. We aimed to compare which of the 3 more commonly used formulas - Cockcroft-Gault [CG]; Modification of Diet in Renal Disease [MDRD] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] – is more effective in predicting a worse outcome at 1-year follow up. Methods: Retrospective study of 560 consecutive patients [age 66.01±12.96; 65.9% men; 0.18% black; 30.7% diabetics; 69.1% hypertensive] admitted to our coronary intensive care unit of a tertiary hospital for ACS between October 2009 and October 2011. GFR estimates from CG, MDRD and CKD-EPI were compared in terms of prediction of mortality risk and of a composite primary endpoint (re-infarction, stroke and mortality) at 1-year follow up. Results: Prevalence of GFR <60 ml/min/1.73m2 was 43.1% using CG, 46.1% with MDRD and 41.8% with CKD-EPI. All 3 formulas showed good results in predicting 1-year composite primary endpoint with CG proving to be the best formula by ROC curve analysis [AUC (CG): 0.747 vs AUC (MDRD): 0.711 vs AUC (CKD-EPI): 0.725]. All formulas were valuable in predicting 1-year total mortality with CG showing the best results. [AUC (CG): 0.78 vs AUC (MDRD): 0.735 vs AUC (CKD-EPI): 0.751].
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Despite preventive efforts, coronary artery disease (CAD) remains the leading cause of death in developed countries and a major cause of disability. After the diagnosis of acute CAD, cardiovascular complications are frequent despite the best therapeutic interventions. Apart from the obvious causes, such as poor adherence to therapy or disease severity, little is known about the clinical, laboratory and genetic factors that are associated with late vascular complications. Objective: In this study we intend to evaluate the traditional, clinical, biochemical and genetic factors that can predict vascular complications after the diagnosis of CAD in a Portuguese population. Material and methods: The study included 1090 coronary patients (855 men and 235 women, mean age 53.1±7.9 years) consecutively admitted in a cardiology unit. After a mean follow-up of 3 years and 9 months, all patients were interviewed and the clinical history, as well as all the major adverse cardiovascular events (MACE), were reviewed. Patients with MACE (myocardial infarction, stroke, heart failure, need for new angioplasty or surgery and cardiovascular death) were compared with those without MACE. Univariate analysis and multivariate logistic regression analysis were performed. SPSS for Windows version19.0 was used and a threshold of p<0.05 was accepted as significant. Results: After the follow-up period, 31% of patients developed at least one cardiovascular complication. Comparing patients with and without MACE, significant differences were found in sedentary life (OR=1.94, p<0.0001), leukocytosis (p=0.004), Lp(a) (p=0.01), ApoB (p=0.001) and glucose levels (p=0.02). In genetic terms, HNF4A CC genotype (OR=1.50; p=0.006) and PCSK9 GG variant (OR=1.30; p=0.047) showed significant increased risk for onset of complication. After logistic regression the two genetic variants remained in the equation: HNF4A CC (OR=3.90; p=0.031) and PCSK9 GG (OR=1.95; p=0.017) with sedentary life (OR=1.71; p<0.0001). Conclusion: According to these results, there are risk factors such as sedentary life and some genetic variants (HNF4A and PCSK9) that are significantly and independently associated with MACE occurrence and allow us to predict vascular complications after CAD diagnosis. If patients have one or more of these conditions, a particularly careful secondary prevention should be ensured.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Arterial hypertension (AHT) is a well-known risk factor for the development of vascular disease, namely stroke or coronary artery disease (CAD). In the worldwide population, multiple genetic polymorphisms have been associated with CAD, though with contradictory results. The genetic factors that contribute to hypertensive patients will develop CAD are still unknown Objective: Evaluate the genetic factors associated with the development of CAD in hypertensive patients. Methods: A case-control study was performed with 1402 hypertensive caucasians patients, of which 799 were consecutive coronary patients admitted to the Hospital with mean age of 54.3±7.6 years,75.8% males and 603 controls without CAD (mean age of 55.2±6.8 years, 82.3% males). In a blinded study, we evaluated several polymorphisms in 14 genes previously reported as being associated with CAD: PON1 Q192R and L55M, KIF6 T/A, HNF4A C/G, FTO A/C, TAS2R50 A/G, PCSK9 G/A, GJA4 C/T, TCF7L2 C/T, ACE I/D, AGT M235T, AT1R A1166C, MTHFR C677T and A1298C, 9P21 locus (rs1333049 G/C) and APOE (ɛ2, ɛ3, ɛ4). The coronary risk associated with each genotype was determined by using a univariate analysis (3x2) and the respective Odds Ratio (OR) and 95% confidence intervals (CI). Results: The polymorphisms that showed an increased risk for CAD in hypertensive patients were: ACE DD (OR=1.30; p=0.019); locus 9p21 CC (OR= 1.29; p=0.033) and AT1R CC (OR=1.53; p=0.050). View this table:Enlarge table
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Introduction The prevalence of malnutrition in ambulatory patients with heart failure is difficult to determine, depending on the timing and methodology. Objective To determine the nutritional status of outpatients with systolic heart failure with the Mini Nutritional Assessment (MNA) full and short-form versions, and evaluate its relationship with the short-term prognosis, biomarkers and quality of life. Methods Fifty consecutive (70% male), geriatric (74.3+ 6.2years old) stable outpatient with heart failure (NYHA class II 68%, III 32%) and left ventricular ejection fraction of 26.7 +11.5% were included and followed during 12 months. At a routine visit to the heart failure clinic, the MNA, the Minnesota Living with Heart Failure questionnaire (MLHFQ) were applied. According to the MNA screening score the nutritional status was classified using the MNA full (MNA-F) and the short-form (MNA-F) versions of the questionnaire. The recorded events were death and hospitalization. Statistics: The-survival and hospitalizations curves were evaluated with the Log-Rank test and Cox Regression analysis. The association between parameters was analyzed with the Pearson and Spearmann correlation coefficient. Results (1) The mortality and hospitalization rates were 12% and 42%, respectively. (2) With the MNA-SF 7.6% of the patients had malnutrition and 20% were at risk of malnutrition. There was a good agreement (90%) between the MNA-SF and the MNA-F classifications. (3) There was a significant relationship between the MNA screening score and the MLHFQ (rs= −0.592 p<0.00l), Nt-ProBNP (rs= −0.49 p<0.001) and total plasma protein (r= 0.672 p=0.006); (3) The-MNA-SF nutritional classification was associated with the 12 months survival (Log-Rank p=0.044) and hospitalization (Log-Rank p=0.005) curves. (4) Those patients with malnutrition by the MNA-SF were at greater risk of death (HR= 8.0 p=0.059) and hospitalization (HR 8.1 p=0.008). Conclusion The MNA is useful for the evaluation of the nutritional status of elderly outpatients with systolic heart failure. It is a good predictor of the short-term outcome and is also associated with the quality of life and Nt-ProBNP.
    No preview · Article · Apr 2013 · The Journal of Nutrition Health and Aging
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    ABSTRACT: Various studies have compared coronary artery disease (CAD) patients with controls in order to determine which polymorphisms are associated with a higher risk of disease. The results have often been contradictory. Moreover, these studies evaluated polymorphisms in isolation and not in association, which is the way they occur in nature. Our purpose was to evaluate the risk of CAD in patients with associated polymorphisms in the same gene or in differen genes. We evaluated the risk associated with ACE DD, ACE 8 CC, ACT 174MM, AGT 235TT, MTHFR 677TT, MTHFR 1298AA, PON1 192RR and PON1 55MM in 298 CAD patients and 298 healthy individuals. We then evaluated the risk of associated polymorphisms in the same gene (ACE DD + ACE 8GG; AGT 174MM + AGT 235TT; MTHFR 677TT + MTHFR 1298AA). Finally, for the isolated polymorphisms which were significant, we evaluated the risk of polymorphism associations at different functional levels (ACE + AGT; ACE + MTHFR; ACE + PON1). Multiple logistic regression was used to identify independent risk factors for CAD. Isolated polymorphisms including ACE DD(p < 0.0001), ACE 8 gg (p=0.023), and MTHFR 1298AA (p = 0.049) presented with a significantly higher frequency in the CAD group. An association of polymorphisms in the same gene did not have an additive or synergistic effect, nor did it increase the risk of CAD. Polymorphic associations in different genes increased the risk of CAD, compared with the isolated polymorphisms. The association of ACE DD or ACE 8 GG with PON1 192RR increased the risk of CA fourfold (1.8 to 4.2). After logistic regression analysis, current smoking, family history, fibrinogen, diabetes, and the ACE DD or ACE 8 GG + MTHFR 1298AA and ACE DD or ACE 8 GG + PON1 192RR associations remained in the, model and proved to be independent predictors of CAD. The association of polymorphisms in the same gene did not increase the risk of the isolated polymorphism. The association of polymorphisms in genes belonging to different enzyme systems was always linked to increased risk compared to the isolated polymorphisms. This study may contribute to a better understanding of overall genetic risk for CAD rather than that associated with each polymorphism in isolation.
    No preview · Article · Apr 2009 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
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    ABSTRACT: Arterial compliance or stiffness is an important determinant of cardiovascular disease and there is considerable interest in its noninvasive measurement. Pulse wave velocity (PWV) is widely used as an index of arterial stiffness. To determine whether PWV is useful for risk stratification in both healthy individuals and coronary patients. Control subjects, n=510, aged 46.1 +/- 11 years, with no history of coronary disease, were selected from electoral rolls, and coronary patients, n=301, aged 53.7 +/- 10 years, were selected from hospital patients with a history of coronary artery disease (CAD) confirmed by coronary angiogram (at least 75% obstruction of one of the main coronary vessels). The asymptomatic subjects without CAD formed Group A, and were subdivided into A1 (without hypertension, dyslipidemia and/or diabetes) and A2 (with hypertension, dyslipidemia and/or diabetes). The coronary patients formed Group B, who were also subdivided into B1, without these classic risk factors, and B2 with hypertension, dyslipidemia and/or diabetes. We used the Student's t test to compare continuous variables and the chi-square test to compare categorical data. The strength of correlation between continuous variables was tested by Pearson's linear correlation. Independent variables predictive of CAD were determined by backward logistic regression analysis. The statistical analysis was performed using SPSS for Windows version 11.0 and data were expressed as means +/- SD; a p value of 0.05 was considered significant. Comparing the two groups A1 and A2, mean PWV was significantly lower in group A1. Comparing B1 and B2, mean PWV was also significantly lower in group B1. In group A1, PWV was significantly and positively correlated with age, body mass index, waist-to-hip ratio, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean blood pressure (BP), blood glucose, apo B, triglycerides, and high-sensitivity C-reactive protein, unlike HDL which was inversely correlated (Pearson's coefficient). In group A2, PWV was significantly and positively correlated with age, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean BP, blood glucose and pulse pressure (PP), but not HDL, which was inversely correlated with PWV. In group B1, PWV was only significantly and positively correlated with age, systolic, mean, and diastolic BP and PP, and presented a significant inverse correlation with ejection fraction. However, in the high-risk coronary population (group B2), there was a positive correlation with age, waist-to-hip ratio, systolic and mean BP, PP and homocysteine. After stepwise logistic regression, PWV remained in the model and proved to be a significant and independent risk factor for CAD. The results of our study show that PWV is higher in high-risk groups and significantly correlated with many classic and new CAD risk markers, suggesting that there is a cumulative influence of risk factors in the development of arterial stiffness. We believe that PWV is a useful index of vascular status and hence cardiovascular risk and that it may be useful for risk stratification in both asymptomatic and coronary patients.
    No preview · Article · Mar 2009 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
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    ABSTRACT: Complex diseases such as coronary artery disease (CAD), hypertension and diabetes are usually caused by individual susceptibility to multiple genes, environmental factors, and the interaction between them. The paraoxonase 1 (PON1) enzyme has been implicated in the pathogenesis of atherosclerosis and CAD. Two common polymorphisms in the coding region of the PON1 gene, which lead to a glutamine (Q)/arginine (R) substitution at position 192 and a leucine (L)/methionine (M) substitution at position 55, influence PON1 activity. Studies have investigated the association between these polymorphisms and CAD, but with conflicting results. 1) To evaluate the association between PON1 polymorphisms and CAD risk; and 2) to study the interaction between PON1 polymorphisms and others in different candidate genes. We evaluated the risk of CAD associated with PON1 Q192R and L55M polymorphisms in 298 CAD patients and 298 healthy individuals. We then evaluated the risk associated with the interaction of the PON1 polymorphisms with ACE DD, ACE 8 GG and MTHFR 1298AA. Finally, using a logistic regression model, we evaluated which variables (genetic, biochemical and environmental) were linked significantly and independently with CAD. We found that the PON1 55MM genotype was more common in the CAD population, but this did not reach statistical significance as a risk factor for CAD, while PON1 192RR presented an 80% higher relative risk compared to the population without this polymorphism. The interaction between PON1 192RR and MTHFR 1298AA, sited in different genes, increased the risk for CAD, compared with the polymorphisms in isolation (OR=2.76; 95% CI=1.20-6.47; p=0.009), as did the association of PON1 192RR with ACE DD, which presented a 337% higher risk compared to the population without this polymorphic association (OR=4.37; 95% CI=1.47-13.87; p=0.002). Similarly, the association between PON1 192RR and ACE 8 GG was linked to an even higher risk (OR=6.23; 95% CI=1.67-27.37; p<0.001). After logistic regression, smoking, family history, fibrinogen, diabetes, Lp(a) and the association of PON1 192RR + ACE 8 GG remained in the regression model and proved to be significant and independent risk factors for CAD. In the regression model the latter association had OR=14.113; p=0.018. When analyzed separately, the PON1 192RR genotype presented a relative risk for CAD 80% higher than in the population without this genotype. Its association with other genetic polymorphisms sited in different genes, coding for different enzymes and belonging to different physiological systems, always increased the risk for CAD. After correction for other conventional and biochemical risk factors, the PON1 192RR + ACE 8 GG association remained a significant and independent risk factor for CAD.
    No preview · Article · Dec 2008 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology

  • No preview · Article · May 2008 · European Journal of Internal Medicine

  • No preview · Article · May 2008 · European Journal of Internal Medicine

  • No preview · Article · Jun 2005 · European Journal of Heart Failure Supplements
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    ABSTRACT: The recent introduction of new diagnostic criteria for acute myocardial infarction (AMI), with troponin measurement, has increased the number of patients admitted with this diagnosis. To evaluate the epidemiologic and prognostic implications of the new diagnostic criteria for AMI. This was a retrospective study of 586 patients admitted for acute coronary syndrome (ACS) to the coronary care unit of our hospital, between 2002 and 2003. Data were collected from RECIMA, the Madeira Ischemic Heart Disease Registry. The population was analyzed following two different definitions of ACS: 1 - old criteria (Group I): AMI with ST elevation (typical symptoms or ECG with ST-segment elevation and raised CK-MB >2x), AMI without ST elevation (typical symptoms or ECG without ST elevation and raised CK-MB >2x) and unstable angina (UA) (symptoms or ECG indicative of ischemia, with normal CK-MB, regardless of troponin status); 2 - new criteria (Group II): AMI with ST elevation (typical symptoms or ECG with segment ST elevation and raised CK-MB >2x or troponin), AMI without ST elevation (typical symptoms or ECG without ST-segment elevation and raised CK-MB >2x or troponin) and UA (symptoms or ECG indicative of ischemia, with normal enzymes). We evaluated whether this change in criteria had any influence on in-hospital mortality. The new criteria significantly (by 11.9 %) increased the total number of patients admitted with AMI. This was due to an increase in AMI without ST elevation (p < 0.001) and a decrease in patients with UA (p < 0.001), with no changes in AMI with ST elevation. In-hospital mortality was lower in patients with AMI diagnosed by the new criteria and in those with UA. The overall increase in AMI resulting from the new diagnostic classification was accompanied by a decrease, although not statistically significant, of in-hospital mortality, probably due to the lower risk of the population analyzed.
    No preview · Article · Feb 2005 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology