M Fiuza

Hospital de Santa Maria, Lisboa, Lisbon, Portugal

Are you M Fiuza?

Claim your profile

Publications (48)102.74 Total impact


  • No preview · Article · Nov 2014 · Value in Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Insights from the “-omics” science have recently emphasized the need to implement an overall strategy in medical research. Here, the development of Systems Medicine has been indicated as a potential tool for clinical translation of basic research discoveries. Systems Medicine also gives the opportunity of improving different steps in medical practice, from diagnosis to healthcare management, including clinical research. The development of Systems Medicine is still hampered however by several challenges, the main one being the development of computational tools adequate to record, analyze and share a large amount of disparate data. In addition, available informatics tools appear not yet fully suitable for the challenge because they are not standardized, not universally available, or with ethical/legal concerns. Cardiovascular diseases (CVD) are a very promising area for translating Systems Medicine into clinical practice. By developing clinically applied technologies, the collection and analysis of data may improve CV risk stratification and prediction. Standardized models for data recording and analysis can also greatly broaden data exchange, thus promoting a uniform management of CVD patients also useful for clinical research. This advance however requires a great organizational effort by both physicians and health institutions, as well as the overcoming of ethical problems. This narrative review aims at providing an update on the state-of-art knowledge in the area of Systems Medicine as applied to CVD, focusing on current critical issues, providing a road map for its practical implementation.
    Full-text · Article · Oct 2014 · European Journal of Internal Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objetivo Caracterizar a distribuição dos níveis de colesterol total (CT), colesterol LDL (C-LDL), colesterol HDL (C-HDL) e triglicéridos nos utentes dos cuidados de saúde primários em Portugal. Métodos Estudo transversal envolvendo 719 médicos de família, segundo distribuição estratificada e proporcional à densidade populacional de cada região. Os primeiros dois utentes adultos de cada dia de consulta foram convidados a participar independentemente do motivo de consulta. Foi utilizado um inquérito para recolha de dados sociodemográficos, clínicos e laboratoriais, incluindo o perfil lipídico avaliado nos 12 meses precedentes. Resultados Foram avaliados 16.856 indivíduos (61,6% do sexo feminino, 58 ± 15 anos), dispondo-se da determinação de CT, C-LDL, C-HDL e triglicéridos em 95,9% (N = 16.159), 59,1% (N = 9.956), 95,4% (N = 16.074) e 97,9% (N = 16.494), respetivamente. Detetou-se hipercolesterolemia (≥ 200 mg/dl) em 47% e níveis aumentados de C-LDL (≥ 130 mg/dl) em 38,4%. A hipertrigliceridemia (≥ 200 mg/dl) e o C-HDL diminuído (< 40 mg/dl) foram menos prevalentes, afetando 13% da população. A dislipidemia foi mais frequente nos homens entre os 30-60 anos e nas mulheres pós-menopausa. Considerando a população com idade ≥ 40 anos, 54,1% dos indivíduos cumpriam critérios de elegibilidade para terapêutica hipolipidemiante e 44,7% estavam medicados com estatinas (mas apenas 16,0% desses apresentavam CT ≤ 175 mg/dl). Conclusões A prevalência de dislipidemia é elevada entre os utentes adultos dos cuidados de saúde primários em Portugal. Além disso, é particularmente frequente nos homens entre os 30-60 anos e nas mulheres após a menopausa, que deverão constituir grupos-alvo nas estratégias preventivas de saúde pública.
    Full-text · Article · Jan 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim To characterize the distribution of total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides in primary health care users. Methods We performed a cross-sectional study in a primary care setting, involving 719 general practitioners based on stratified distribution proportional to the population density of each region of Portugal. The first two adult patients scheduled for an appointment on a given day were invited to participate. A questionnaire was applied to assess sociodemographic, clinical and laboratory data including lipid profile. Results The study included 16 856 individuals (mean age 58.1±15.1 years; 61.6% women). Data on TC, LDL-C, HDL-C and triglycerides were available for 95.9% (n=16 159), 59.1% (n=9956), 95.4% (n=16 074) and 97.9% (n=16 494) of the population, respectively. Hypercholesterolemia (TC ≥200 mg/dl) was detected in 47%, and 38.4% had high levels of LDL-C (≥130 mg/dl). Hypertriglyceridemia (≥200 mg/dl) and low HDL-C (<40 mg/dl) were less prevalent, affecting roughly 13% of the population. Dyslipidemia was more common in middle-aged men and in post-menopausal women. Of the population aged over 40, 54.1% met eligibility criteria for lipid-lowering therapy and 44.7% were medicated with statins, but only 16.0% of these had TC ≤175 mg/dl. Conclusions Dyslipidemia is highly prevalent in primary health care users in Portugal. It is particularly common in middle-aged men and post-menopausal women, who should be considered target groups for preventive public health measures.
    Preview · Article · Dec 2013 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
  • Source

    Full-text · Article · Nov 2013 · Value in Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To evaluate N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a risk marker for intrahospital death and/or cardiogenic shock in patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: Prospective study in which 172 patients (62% men, mean age 65,3±12,5 years) with STEMI that underwent primary angioplasty were studied. Blood was drawn prior to the primary angioplasty and the plasma concentration of NT-proBNP was determined. The Killip-Kimball (KK) classification was used to assess the hemodynamic repercussion of the infarction. An echocardiographic study was performed 24-72 hours after the myocardial revascularization and the left ventricular ejection fraction (LVEF) was determined by biplane Simpson's method. We then correlated the NT-proBNP level with the KK classification, LVEF and determined its predictive value for intrahospital death and/or cardiogenic shock events (receiver operator curve). Results: NT-proBNP average serum level (pg/ml): 1034±2596. NT-proBNP (pg/ml) distribution according to the KK classification: KK I: 804±2280, KK II: 1498±1407, KK III: 3840±3814, KK IV: 2172±4675 (p<0,022) and LVEF: LVEF >40%: 730±2194, LVEF ≤40%: 2215±3554 (p<0,001). The area under the curve for intrahospital death and/or cardiogenic shock was 0,837 (p<0,001) and the best prognostic accuracy for NT-proBNP was 1310 pg/ml. This cutoff value showed a 75% sensitivity and 86,5% specificity for the occurrence of such events. Discussion: We evaluated NT-proBNP prior to the revascularization procedure in order to assess which patients with STEMI have a higher short-term risk of morbidity and mortality. An increased blood level of NT-proBNP was associated with a lower LVEF, a higher KK classification and a more likely occurrence of adverse events following a STEMI, which is in agreement with previous studies. NT-proBNP proved to be a useful hemodynamic stress marker for the evaluation of patients with STEMI and a strong predictor for the occurrence of adverse events in the short-term, therefore allowing the development of optimized risk stratification strategies, better healthcare and more efficient management of the available resources. Conclusions: An increased concentration of NT-proBNP in patients with STEMI is associated with higher short-term risk of mortality and/or cardiogenic shock. The NT-proBNP concentration should be measured in all patients presenting with STEMI at their initial assessment.
    Full-text · Article · Aug 2013 · European Heart Journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the influence of metabolic syndrome in the effectiveness of antihypertensive treatment and to compare it using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2001 and 2004), International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung and Blood Institute (AHA-NHLBI) definitions. The VALSIM (Estudo de Prevalência da Síndrome Metabólica) survey was designed as an observational cross-sectional study performed in a primary healthcare setting in Portugal. The first two adult patients scheduled for an appointment on a given day were invited to participate. The treatment effectiveness was evaluated by the occurrence of uncontrolled hypertension (≥140/90 mmHg) in patients taking antihypertensive drugs. Logistic regression analysis was used to determine the association between uncontrolled hypertension and metabolic risk factors, with adjustments for age, sex, and pattern of antihypertensive treatment. Among the 16 856 individuals evaluated, 8925-treated hypertensive patients were identified. Only 35.8% of them had controlled hypertension. The risk of poor blood pressure control increased with age, waist circumference, serum levels of triglycerides and HDL-cholesterol. Among treatable risk factors, metabolic syndrome as defined by NCEP-ATP III 2001 diagnostic criteria was the strongest independent predictor of uncontrolled hypertension (odds ratio: 1.23; 95% CI: 1.08-1.41; P = 0.002). In opposition, the IDF or AHA-NHLBI definitions of metabolic syndrome failed to identify patients at risk of poor blood pressure control. Metabolic syndrome is associated with lower effectiveness of antihypertensive therapy and the NCEP-ATP III 2001 definition of metabolic syndrome is the one that better identifies patients at risk of poor blood pressure control.
    Full-text · Article · Jun 2013 · Journal of Hypertension
  • Source
    Manuela Fiuza

    Preview · Article · Dec 2012 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
  • Manuela Fiuza

    No preview · Article · Nov 2012 · 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 · Conference Paper · May 2012
  • Manuela Fiúza · Andreia Magalhães

    No preview · Chapter · Mar 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cystatin C is a marker of renal dysfunction, and preliminary studies have suggested it might have a role as a prognostic marker in patients with coronary artery disease. The aim of the present study was to evaluate the usefulness of cystatin C for risk stratification of patients with ST-segment elevation myocardial infarction, regarding in-hospital and long-term outcomes. We included 153 consecutive patients with ST-segment elevation myocardial infarction treated by primary angioplasty. The baseline cystatin C level was measured at coronary angiography. The in-hospital outcome was determined as progression to cardiogenic shock or in-hospital death, and the long-term outcome was assessed, considering the following end points: (1) death and (2) death or reinfarction. Of the 153 patients evaluated (age 61 ± 12 years; 75.6% men), 15 (14.4%) progressed to cardiogenic shock and 4 (2.7%) died during hospitalization. The patients who progressed to cardiogenic shock or died during hospitalization had significantly greater cystatin C levels (1.02 ± 0.44 vs 0.69 ± 0.24 mg/L; p = 0.001). Long-term follow-up was available for 130 patients (583 ± 163 days). Among them, 11 patients died and 7 had reinfarction. A high baseline cystatin C level was associated with an increased risk of death (hazard ratio 8.5; p = 0.009) and death or reinfarction (hazard ratio 3.89; p = 0.021). Furthermore, only high baseline cystatin C levels and left ventricular ejection fraction ≤40% were independent predictors of the long-term risk of death, with synergistic interaction between the 2. In conclusion, cystatin C is a new biomarker with significant added prognostic value for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, predicting both short- and long-term outcomes.
    Full-text · Article · Feb 2012 · The American journal of cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Transoesophageal echocardiography (TOE) is a widely used imaging modality in ambulatory patients, with a reportedly low complication rate. TOE is frequently performed under conscious sedation. It is the imaging modality of choice for assessment of aortic valve morphology and size prior to trans-catheter aortic valve implantation (TAVI). However, the population of patients undergoing workup for TAVI differs from the general TOE population, as they have been turned down for conventional surgery due to high operative risk. Therefore, we sought to establish whether the complication rate for patients undergoing TOE as part of TAVI work-up is higher than the risk for the general TOE population. Methods: We reviewed the registry of all patients who underwent TAVI work up at our institution and identified patients who underwent TOE as part of TAVI work up. TOE was performed by a cardiologist assisted by a nurse and an echocardiographer. When sedation was used, it was administered by the cardiologist. We calculated logistic Euroscore as a measure of patient risk and reviewed the TOE records for sedation use and major complications (failed procedure, arrhythmia, desaturation, laryngospasm, reversal of sedation, major upper GI bleeding or trauma, death). Minor complications such as sore throat were not recorded. Where there was doubt as to outcome or a complication was documented, a full review of the medical record was performed. Results: We identified 77 patients who underwent TOE during TAVI workup between November 2007 and May 2011. Mean patient age was 83.3 ±6.6 years and 37 (48.1%) patients were aged ≥85y. Median Euroscore was 23.0% (Range 6-69%). Mean FEV1/FVC was 64±12.3%. 44 (57.1%) patients had moderate or severe COPD, defined as FEV1/FVC ratio <70%. 82% of patients underwent TOE under conscious sedation. Median dose of Midazolam administered was 2mg. The TOE probe could not be inserted in 2 (2.6%) patients. No other complications occurred. Conclusion: TOE may safely be performed under sedation in high risk patients undergoing TAVI work up.
    Full-text · Article · Dec 2011 · European Heart Journal – Cardiovascular Imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introdução: Os doentes com disfunção renal e síndrome coronária aguda têm pior prognóstico, não só pela elevada prevalência de factores de risco cardiovasculares, como também pela subutilização das terapêuticas cardioprotectoras, maior toxicidade dos fármacos e anomalias da biologia vascular. A cistatina C é um marcador indirecto da função renal que se admite que tenha melhor valor prognóstico. Objectivo: Avaliar o valor prognóstico da cistatina C em doentes (dts) internados com enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAM-EST). Métodos: Em dts consecutivos admitidos por EAM-EST e submetidos a angioplastia primária, doseou-se a cistatina C numa amostra de sangue colhida aquando do início do cateterismo coronário. Foi definida uma variável composta constituída por evolução em choque cardiogénico ou morte intra-hospitalar e a avaliação do valor prognóstico da cistatina C relativamente a esta variável foi determinado pela área sob a curva (AUC) ROC. Resultados: Foram estudados 172 dts (75,6% do sexo masculino; 61±12 anos), com doença de 1, 2 e 3 vasos em 55%, 30% e 12%, respectivamente. Setenta por cento dos dts tinham hipertensão arterial, 60% tinham dislipidémia e 29% diabetes tipo 2. A artéria responsável pelo EAM foi a descendente anterior, coronária direita e circunflexa em 45%, 40% e 16%, respectivamente. A concentração sérica de cistatina C foi de 0,73±0,28 μg/dL e correlacionou-se directamente com a concentração de creatinina (r=0,66; p<0,001), com os valores de NT-proBNP (r=0,49; p<0,001) e indirectamente com os valores de tensão arterial média no serviço de urgência (r=-0,023; p<0,007). Durante o internamento, 22 dts evoluíram em choque cardiogénico ou morte. Os valores de cistatina C foram significativamente superiores nestes dts (0,95±0,47 μg/dL versus 0,70±0,24 μg/dL), correlacionando-se com o prognóstico adverso com uma AUC de 0.693 (IC 95% 0.546-0.841; p 0,008). Conclusão: A cistatina C, doseada aquando do cateterismo coronário de urgência, é um predictor independente de evolução para choque cardiogénico ou morte intra-hospitalar, em doentes internados com EAM-EST.
    Full-text · Conference Paper · Apr 2011
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare definitions of metabolic syndrome (MS) in relation to their association with coronary artery disease (CAD) and stroke. We performed a cross-sectional study in a primary care setting, involving 719 general practitioners and based on stratified distribution proportional to the population density. The first two adult patients scheduled for an appointment on a given day were invited to participate, irrespective of the reason for the consultation. A questionnaire was applied to record sociodemographic, clinical and laboratory data. A diagnosis of MS was defined according to NCEP-ATP III 2001, NCEP-ATP III 2004, IDF and AHA/NHLBI criteria. Multivariate logistic regression analysis was used to assess the risk of CAD and stroke according to gender, age, body mass index, waist circumference, HDL cholesterol, triglycerides, hypertension, diabetes and MS according to each definition. The study included 16,856 individuals (age 58.1 +/- 15.1 years). The prevalence of MS adjusted for gender, age and region size according to the 2001 and 2004 NCEP-ATP III, IDF and AHA/NHLBI definitions was 28.4%, 32.8%, 65.5% and 69.4%, respectively. The degree of agreement according to k statistics was modest and only 60.3% simultaneously fulfilled the criteria of all definitions. Hypertension was the treatable risk factor most strongly associated with CAD and stroke. Only the IDF and AHA/NHLBI definitions of MS were independently associated with CAD (OR: 1.74 and 2.26, respectively). Regarding stroke, only the AHA/NHLBI criteria showed a statistically significant association (OR: 1.85). MS as defined according to the AHA/NHLBI criteria appears to be the best predictor of CAD and stroke in the Portuguese population, and remains an independent risk factor for CAD and stroke after adjustment for its individual components.
    Full-text · Article · Feb 2011 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Serum uric acid (SUA) is a relevant marker for cardiovascular disease in patients with hypertension and it has been implicated in target organ damage (TOD). However, the causative role has not been confirmed. Inflammation plays a pivotal role in TOD seen in essential hypertensive patients, while numerous studies confirm its interrelation with arterial stiffening. Thus, the purpose of the present study was to assess any possible links between SUA, inflammatory markers and arterial stiffness indices in never-treated essential hypertensive patients. Design and Methods: The study included 450 newly diagnosed patients, with stage I-II essential hypertension who referred to our outpatient clinic within a period of 24 months. All patients underwent full clinical and laboratory evaluation, while BP levels were assessed by 24-h ambulatory blood pressure monitoring (ABPM). Levels of hsCRP were measured using a validated high-sensitivity assay, while adiponectin was evaluated by a sandwich ELISA system. Finally, arterial stiffness assessment was made by carotid-femoral pulse wave velocity (PWVc-f), using the Complior devise. Results: On the basis of the median uric acid levels (5.3 mg/dl) the study population was divided into subjects with low (n = 149) and with high (n = 143) SUA values. In the entire study population, SUA was positively associated with 24-h BP (r = 0.297, p < 0.0001), hsCRP (r = 0.204, p = 0.001) and PWVc-f (r = 0.165, p = 0.009), while it was negatively related to adiponectin (r = -0.218, p < 0.0001). In multiple regression analysis SUA was independently associated with hsCRP [beta (SE) = 0.142(0.116), p = 0.02], adiponectine [beta(SE) = -0.154(0.005), p = 0.03] and 24-h BP [beta(SE) = 0.246(0.008), p = 0.001], while PWVc-f failed to present such an association(p = NS). Conclusions: There is a strong independent interrelation between SUA, CRP, 24h-BP and adiponectin levels in essential hypertensive patients, while no such association was confirmed for arterial stiffness. Further studies should be conducted so as to clarify the possible causative background of these interrelations.
    No preview · Article · Jun 2010 · Journal of Hypertension

  • No preview · Article · Jun 2010 · Journal of Hypertension
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introdução: Estudos preliminares sugerem que os marcadores inflamatórios se elevam precocemente na evolução do enfarte agudo do miocárdio (EAM), mas não está caracterizada a evolução temporal dos seus níveis séricos e a correlação dos mesmos com a repercussão estrutural cardíaca e hemodinâmica do EAM. Objectivo: Avaliar a evolução temporal dos parâmetros inflamatórios e correlacioná-los com a gravidade do compromisso estrutural do EAM e sua repercussão hemodinâmica. Métodos: Em doentes com EAM com elevação de ST submetidos a angioplastia coronária de urgência, procedeu-se a colheita de sangue aquando do início do cateterismo coronário (tempo basal) e após 8h, 16h, 24h, 48h e 72h. Foi doseada a interleucina (IL) 6 no tempo basal em todos os doentes. Numa amostra de 23 doentes, estratificada para a fracção de ejecção (FEj), efectuou-se a determinação da IL-6 e IL-10 em todos os tempos. Foi realizado estudo ecocardiográfico 24 a 72h após a angioplastia e a FEj foi determinada pelo método de Simpson biplano. Definiu-se função ventricular esquerda compromida (FVEc) por FEj ≤40%. A distribuição dos níveis de IL-6 em função da FEj e classe Killip máxima (KKm) foi avaliada com os testes de Kruskal-Wallis e de Mann-Whitney, e a sua correlação com a proteína C-reactiva (PCR), homocisteína e NT-proBNP foi avaliada pelo teste de Pearson. Resultados: Foram avaliados 159 doentes (76% do sexo masculino; 61±12 anos), com doença de 1, 2 e 3 vasos em 45%, 40% e 15%, respectivamente. A FEj foi de 52±12% (inferior a 40% em 18% dos doentes) e a KKm foi ?III em 9%. Os valores de IL-6 variaram de forma significativa com a KKm (p=0,021) e os doentes que evoluíram para FVEc já apresentavam, aquando do cateterismo, IL-6 aumentada (9,0±10,0 vs 5,9±9,5 pg/mL; p=0,006). Além disso, os níveis sérios de IL-6 aumentaram mais significativamente até às 24h neste grupo de doentes (p=0,001). Em termos globais, a IL-6 correlacionou-se com a PCR (R2=0,36; p<0,001), homocisteina (R2=0,33; p=0,004) e NT-proBNP(R2=0,31; p=0,008). Pelo contrário, a concentração basal de IL-10 (17,4±15,7 pg/mL) não variou com a Fej ou KKm. Conclusão: A intensidade da resposta inflamatória no EAM com elevação de ST varia em função do tempo e é mais intensa nos doentes com compromisso estrutural mais extenso. A IL-6 poderá eventualmente identificar, aquando do cateterismo coronário, o subgrupo de doentes que evolui com compromisso grave da função sistólica global ventricular esquerda.
    Full-text · Conference Paper · Apr 2010
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the prevalence, treatment and control of diabetes mellitus (DM) in primary health care users, to characterize associated cardiovascular (CV) risk factors and effectiveness of their treatment, and to estimate the clinical impact of DM on the occurrence of coronary artery disease (CAD) and stroke. The VALSIM Study was performed in a primary care setting and involved 719 general practitioners (GPs), based on stratified distribution and proportional to the population density of each region of mainland Portugal and the islands of Madeira and the Azores. A questionnaire on sociodemographic and clinical data (previous diagnosis of DM, CAD or stroke, antidiabetic and antihypertensive medication and statins) and laboratory tests (lipids and HbA1C) was applied by participating GPs to the first two adult patients scheduled for an appointment on a given day, and blood pressure (BP) was measured. DM was defined as fasting glucose of > or = 126 mg/dl or use of antidiabetic agents. The study included 16,856 individuals (mean age 58.1 +/- 15.1 years; 61.6% women), of whom 3215 were identified as diabetic. The prevalence of DM adjusted for gender and age in primary health care users was 14.9%, higher in men (M: 16.8%; F: 13.2%), and increased with age. Among the diabetic population, 90.2% were being treated with antidiabetic drugs and 51.7% had HbA1C lower than 7%. Around 91% had high BP (> or = 130/80 mmHg or were taking antihypertensive medication), 39.5% were overweight, 45.1% were obese, 69.3% had abdominal obesity, 71.8% had metabolic syndrome (ATP III criteria), 12% presented CAD and 5% had past history of stroke. The association between these CV risk factors and DM was stronger in women, and the impact of DM on occurrence of CAD and stroke was also higher in women. Among diabetic hypertensives, 78.4% were being treated with antihypertensive drugs, but only 9.3% had BP < 130/80 mmHg (M: 9.5%; F: 9.1%). Of diabetic patients with CAD, 94.2% were taking antihypertensive medication, but only 9.8% had controlled BP (M: 13.7%; F: 6.1%). Although 59% of the diabetic population were being treated with statins, only 6.7% had total cholesterol < 200 mg/dl, triglycerides < 150 mg/dl and HDL-cholesterol > 60 mg/dl. Of diabetic patients with CAD, 76.5% were being treated with statins, but only 29.4% had total cholesterol < 175 mg/dl (M: 34.2%; F: 24.1%). The management of DM in a primary care setting in Portugal can and should be improved, since 9.8% of patients are not treated and 48.3% are not controlled. DM has a considerable clinical impact due to its strong association with CAD and stroke. The risk of stroke and CAD is much higher in diabetic women, due firstly to a stronger association of DM with other risk factors in women, and secondly to less aggressive treatment.
    Full-text · Article · Apr 2010 · Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
  • Manuela Fiúza
    [Show abstract] [Hide abstract]
    ABSTRACT: Although having high clinical efficacy in the treatment of human epidermal growth factor receptor-2 (HER2+) metastatic breast cancer, trastuzumab has been associated with cardiotoxicity, and the etiology and pathogenesis of this condition is currently under investigation. This paper reviews the cardiotoxicity, associated with trastuzumab use and discusses the risk assessment and management of cardiac dysfunction. The increased risk of cardiotoxicity is lower when trastuzumab is given as monotherapy (3%-7%) compared with anthracyclines + trastuzumab therapy (27%). Type II cardiac changes occur in trastuzumab-treated patients, which do not appear to be dose-related, are not associated with histological changes, and are generally reversible. Several risk factors for cardiac events have been identified and assessing levels of troponin I and N-terminal pro-brain B-type natriuretic peptide before and after treatment with trastuzumab may allow early detection of cardiotoxicity. A symptomatic and functional evaluation scheme for patients indicated for treatment with trastuzumab has also been proposed to work alongside therapeutic options for the treatment of heart failure. The risk of cardiac dysfunction associated with trastuzumab can be justified given the increase in overall survival. This risk is lower when trastuzumab is given as monotherapy. The paradigm for cardiologists remains the same: treat the cancer effectively whilst preventing cardiotoxicity.
    No preview · Article · Jul 2009 · Advances in Therapy