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Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention. At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap. The literature review showed that the cholesterol burden in Portugal is high and especially uncontrolled in those with the highest CV risk. An infographic scorecard was built to include in the WHF collection, for a clear idea about CV risk and cholesterol burden in Portugal, which would also be useful for health policy advocacy. The expert discussion and preventive strategies proposal followed the five pillars of the WHF document: awareness improvement; population-based approaches for CV risk and cholesterol; risk assessment/population screening; system-level approaches; surveillance of cholesterol and ASCVD outcomes. These strategies were debated by all the expert participants, with the goal of creating a national cholesterol roadmap to be used for advocacy and as a guide for CV prevention. Several key recommendations were outlined: include all stakeholders in a multidisciplinary national program; create a structured activities plan to increase awareness in the population; improve the quality of continuous CV health education; increase the interaction between different health professionals and non-health professionals; increment the referral of patients to cardiac rehabilitation; screen cholesterol levels in the general population, especially high-risk groups; promote patient self-care, engage with patients' associations; use specific social networks to spread information widely; create a national database of cholesterol levels with systematic registry of CV events; redefine strategies based on the evaluation of results; create and involve more patients' associations - invert the pyramid order. In conclusion, ASCVD and the cholesterol burden remain a strong global issue in Portugal, requiring the involvement of multiple stakeholders in prevention. The Portuguese cholesterol roadmap can provide some solutions to help urgently mitigate the problem. Population-based approaches to improve awareness and CV risk assessment and surveillance of cholesterol and ASCVD outcomes are key factors in this change. A call to action is clearly needed to fight hypercholesterolemia and ASCVD burden., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Introduction and Objectives: Vascular endothelial growth factor (VEGF) inhibitors are widely used in oncology and ophthalmology. Although these agents have been shown to increase the risk of cardiovascular events in systemic use, the effect of local applications is unclear. In our study, we aimed to investigate the effects of anti-VEGF agents on left heart functions after intravitreal injection using speckle tracking echocardiography., Methods: In this prospectively designed study, 44 patients who were going to start intravitreal anti-VEGF treatment were included in the study. Patients were evaluated with speckle tracking echocardiography before the first anti-VEGF administration and at three months of anti-VEGF treatment., Results: Global longitudinal strain (GLS) values at three months were lower in the patients who participated in the study and this was statistically significant (-18.77±2.17, -18.60±2.01, p=0.001). Also, there was a statistically significant decrease in the mean values of GLS (GLS4CH) obtained from apical four space image, GLS (GLSAPLAX) obtained from apical long axis image and GLS (GLS2CH) obtained from apical 2 space image at month 0 and month 3 (-19.08±2.39, -18.93±2.26, p=0.004; -18.81±2.29, -18.60±2.12, p=0.001; -18.44±2.31, -18.27±2.12, p=0.013, respectively)., Conclusion: The slight decrease in GLS in our study suggests that the use of intravitreal anti-VEGF agents may have cardiac effects., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events (ASCVE). The ESC/EAS risk SCORE was updated by SCORE2, which estimates 10-year risk of fatal and non-fatal CVD in European populations aged 40-69 years without established CVD or diabetes. Our aim was to compare the two ESC/EAS risk scores and to validate SCORE2 in our population., Methods: A total of 1071 individuals (age 57.2±6.1 years; 75.2% male) without CVD or diabetes, from GENEMACOR study controls, were analyzed over 5.4±3.9 years. The population was stratified into risk categories according to the two scores, and the area under the ROC curve (AUC) and Harrell's C-index assessed the scores' performance. Calibration was performed using the goodness-of-fit test, and occurrence of the first event assessed by Cox regression. Kaplan-Meier analysis estimated SCORE2 survival., Results: SCORE stratified subjects into four risk categories: low (7.4%), moderate (46.5%), high (25.3%) and very high (20.8%), and SCORE2 into three: low-to-moderate (24.7%), high (59.0%) and very high (16.2%). SCORE presented good discrimination for CV mortality (AUC=0.838; C-index=0.834, 95% CI: 0.728-0.940), as did SCORE2 for total CV events (AUC=0.744; C-index=0.728, 95% CI: 0.648-0.808). Calibration did not show a disparity between observed and expected ASCVE. The probability of ASCVE was eight times higher in very-high-risk SCORE2 (p=0.001), and three times in the high-risk group (p=0.049). Event-free survival was 99%, 90% and 72% in the low-to-moderate, high and very-high-risk categories, respectively (p<0.0001)., Conclusions: SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The association between exercise and coronary atherosclerosis still remains unclarified. We aimed to analyze the prevalence of high coronary atherosclerotic burden in veteran athletes, considering cardiovascular (CV) risk and volume of exercise., Methods: A total of 105 asymptomatic male veteran athletes (48±5.6 years old) were studied. A high coronary atherosclerotic burden was defined as one of the following characteristics in coronary computed tomography angiography: calcium score >100, >75th percentile, obstructive plaques, involving left main, three-vessels or two-vessels including proximal anterior descending artery, segment involvement score >5 or CT-adapted Leaman score ≥5. CV risk was stratified by SCORE2 and volume of exercise by metabolic equivalent task score., Results: Most athletes (n=88) were engaged in endurance sports for 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] metabolic equivalent of tasks/hour/week. The mean Systematic Coronary Risk Evaluation 2 was 2.8±1.5%; 76.9% of athletes had a low-moderate risk and none a very high risk. High coronary atherosclerotic burden was present in 25.7% athletes. Athletes with high cardiovascular risk and high exercise volume (above the median) showed significantly high coronary atherosclerotic burden compared to those with low-moderate risk and high volume (50.0% vs. 15.6%; p=0.017). Among athletes with low to moderate risk, a high volume of exercise tended to be protective, while in those with low volume, there was similar rate of high coronary atherosclerotic burden, regardless of CV risk., Conclusions: A combination of higher volume of exercise and high cardiovascular risk revealed the worst association with coronary atherosclerosis in veteran athletes. The relationship between these variables is controversial, but integrating exercise characteristics and risk assessment into preparticipation evaluation is essential., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Portugal is a country with a high prevalence of type 2 diabetes (T2D) and cardiovascular disease (CVD). The prevalence of CVD and cardiovascular (CV) risk factors among T2D patients followed in hospitals in Portugal is not known. The primary objective of this study was to assess the prevalence of CVD and CV risk factors among T2D patients in a hospital setting in Portugal. The clinical management of CVD in the hospital setting was also assessed., Methods: We performed a non-interventional, multicenter, cross-sectional study with a retrospective phase. T2D patients were consecutively invited to participate. Data were collected retrospectively., Results: A total of 715 patients were included in the study. Mean age and diabetes duration were 66.6 and 17.4 years, respectively. Of these, 286 patients (40.0%) had been diagnosed with CVD, mostly ischemic heart disease (50.4%). All patients had at least one CV risk factor. CVD was significantly associated with hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia and smoking. During the three years prior to study inclusion, the incidence of hyperglycemic episodes and T2D complications increased among patients with established CVD, but the numbers of hospitalization episodes and specialist appointments remained stable. An improvement was observed in key cardiometabolic risk factors., Conclusions: Our study revealed a high prevalence of CVD and CV risk factors among a sample of T2D patients in a hospital setting. Patients with established CVD seem to be adequately managed but further efforts are needed at the prevention stage for better control of risk factors and morbidity., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Introduction: Cardiovascular disease is one of the main causes of morbidity and mortality worldwide. Control of its risk factors, particularly diabetes and dyslipidemia, through reduction of LDL cholesterol, is crucial to reduce cardiovascular risk. This work aims to assess and improve the medical approach to dyslipidemia in diabetic patients., Methods: This is a quality improvement study aimed at family doctors. It included patients with diabetics and dyslipidemia enrolled in the primary health care units of Além D'Ouro, S. Miguel and Oceanos. A quality standard was defined for each of the criteria assessed, and the results were compared using the chi-square test with p-value<0.05. Data analysis was performed using Microsoft Excel 2010® and IBM SPSS®., Results: Comparing the first and second assessments, 14.6% vs. 22.2% (p=0.016) of the patients, respectively, achieved the LDL cholesterol target level of <70 mg/dl. Of those who did not meet the target level, 11.0% vs. 13.6% (p=0.395) had their pharmacological therapy changed and 4.6% vs. 3.3% (p=0.448) had their lipid profile reassessed within three months., Conclusions: Control of dyslipidemia in patients with diabetes continues to be a major factor in the health of these patients, but it is carried out in an unsatisfactory way in the three health units studied. It is essential to increase the literacy of family doctors and to encourage the search for the best possible lipid control, in order to reduce cardiovascular risk, as well as to raise awareness among patients to increase adherence to therapy., (Copyright © 2021 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

For many years psoriasis was considered an inflammatory condition restricted to the skin. However, nowadays it is considered an immune-mediated, systemic inflammatory condition associated with numerous medical comorbidities, particularly cardiometabolic diseases, and overall cardiovascular mortality. Several studies have suggested that psoriasis may be an independent risk factor for atherosclerosis, indicating that psoriasis itself poses an intrinsic risk for cardiovascular disease, probably due to the disease's inflammatory burden. However, other causes beyond systemic inflammation and traditional cardiovascular risk factors may be implicated in cardiovascular disease in psoriasis. Recently, epicardial adipose tissue, an emerging cardiovascular risk factor, has been shown to be increased in psoriasis patients and to be associated with subclinical atherosclerosis, providing another possible link between psoriasis and atherosclerosis. The reason for the increase in epicardial adipose tissue in patients with psoriasis is unknown, but it is probably multifactorial, with genetic, immune-mediated and behavioral factors having a role. Thus, along with the increased prevalence of cardiometabolic risk factors and systemic inflammation in psoriasis, epicardial adipose tissue is probably another important contributor to the higher cardiovascular risk observed in psoriasis., (Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Introduction: Obesity and hypertension have been identified as independent risk factors for cardiovascular disease. Nevertheless, the role of obesity in the development and progression of target-organ disease in hypertensive patients is controversial. The objective of this study was to assess the impact of body weight on cardiovascular risk factors, target-organ disease and global cardiovascular risk in hypertensive patients in a primary care setting., Methods: A cross-sectional observational study was carried in Vila Nova de Gaia, Portugal (n=150). A detailed medical and personal history was obtained and a physical examination was performed. Venous blood and 24-hour urine samples were collected, and an electrocardiogram was performed. Cardiovascular risk was assessed using the Framingham score. The statistical analysis was performed using SPSS(®). A p-value <0.05 was considered statistically significant., Results: The sample was 71.8% female, with a mean age of 74.3 ± 10.8 years. The prevalence of obesity was 29.5%. Overweight/obese subjects presented lower mean HDL cholesterol (51.2 ± 13.9 mg/dl vs. 65.4 ± 35.2, p<0.005), higher triglycerides (137.8 ± 70.4 mg/dl vs. 111.5 ± 68.8 mg/dl, p<0.001), higher fasting glucose (111.9 ± 32.8 mg/dl vs. 98.4 ± 13.1 mg/dl, p<0.011) and more frequent mild valve disease (57.9% vs. 29.6%, p=0.021). Global cardiovascular risk was also significantly higher (10.9 ± 7.7 vs. 6.5 ± 5.7, p<0.001)., Conclusion: Overweight and obesity appear to be related to a less favorable lipid and blood glucose profile and higher cardiovascular risk in hypertensive patients. On the basis of our findings we suggest strict metabolic monitoring and improved education on weight reduction and control at primary health care clinics., (Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Background and Objective: The high prevalence and natural history of atherosclerosis make young people important targets for cardiovascular prevention. This study aimed to analyze changes over time in the cardiovascular risk profile of a population of healthy young adults., Methods: We studied 923 Portuguese Air Force applicants between 1991 and 2007, divided into two-year periods. In addition to cardiovascular risk factors, the Framingham score and HeartScore were calculated for age 65. Cochran-Armitage and Jonckheere-Terpstra tests for trend were used for categorical and continuous variables, respectively., Results: Mean age was 19.2 ± 2.3 years (p = 0.34) and 55 applicants (6%) were female (p = 0.56). Mean body mass index was 22.4 ± 2.5 kg (p for trend 0.35). The number of smokers decreased over the study period (11.6 vs. 7.0%, p for trend 0.02). Of the total number of applicants, 122 (13.2%) were classified as hypertensive. Mean systolic blood pressure was 127 ± 12 mmHg and increased significantly over time (122 ± 13 vs. 128 ± 11 mmHg, p for trend <0.001). Hypercholesterolemia was found in 108 applicants (11.7%) and total cholesterol showed an improvement (170 ± 35 vs. 155 ± 26 mg/dl, p for trend <0.001). The mean modified Framingham score was 12.6 ± 5.1 and improved over the study period (12.9 ± 5.9% vs. 11.9 ± 4.7%, p for trend 0.006). The mean modified HeartScore was 3.2 ± 1.4 and remained unchanged (p for trend 0.10)., Conclusions: In our population, except for an increase in systolic blood pressure values, there was an overall improvement in cardiovascular risk from 1991 to 2007. Further studies are needed to better assess the situation in Portugal and help devise preventive strategies in young people., (Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)