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Abstract Background Androgen deprivation therapy (ADT) is widely used in the treatment of testosterone-dependent prostate carcinomas. ADT often increases plasma LDL and HDL cholesterol and triglycerides. The aim was to test whether ADT changes the transfer of lipids to HDL, an important aspect of this metabolism and HDL protective functions, and related parameters. Methods Sixteen volunteers with advanced prostate carcinoma submitted to pharmacological ADT or orchiectomy had plasma collected shortly before and after 6 months of ADT. In vitro transfer of lipids to HDL was performed by incubating plasma with donor emulsion containing radioactive lipids by 1 h at 37 °C. After chemical precipitation of apolipoprotein B-containing lipoprotein, the radioactivity of HDL fraction was counted. Results ADT reduced testosterone to nearly undetectable levels and markedly diminished PSA. ADT increased the body weight but glycemia, triglycerides, LDL and HDL cholesterol, HDL lipid composition and CETP concentration were unchanged. However, ADT increased the plasma unesterified cholesterol concentration (48 ± 12 vs 56 ± 12 mg/dL, p = 0.019) and LCAT concentration (7.15 ± 1.81 vs 8.01 ± 1.55μg/mL, p = 0.020). Transfer of unesterified (7.32 ± 1.09 vs 8.18 ± 1.52%, p

Abstract Background: Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented. Objective: To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis. Methods: This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months. Results: The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events. Conclusion: Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Insertion of inferior vena cava filters has been well established in literature, reducing occurrence of pulmonary embolism after an episode of deep venous thrombosis in patients with contraindication to anticoagulation. There are a small number of complications related to procedure and embolization is rare. In this context, we described a case of intracardiac embolization associated with cardiac tamponade.

Resumo: O interesse em doenças auto-imunes vem crescendo a cada ano, principalmente a inter-relação com as doenças cardiovasculares. Especificamente, a artrite reumatoide vem sendo considerada um fator de risco independente para doença arterial coronária nos últimos anos. Diversos estudos foram realizados recentemente com o objetivo de esclarecer pontos cruciais na estratificação de risco desses pacientes e no seu respetivo tratamento medicamentoso adequado. Novas terapias específicas da doença reumatoide ainda estão em estudo, e prometem reduzir o risco cardiovascular a longo prazo. Desse modo, realizamos uma revisão bibliográfica ampla, utilizando as principais bases de dados nacionais e internacionais, com o objetivo de salientar a importância de mecanismos ateroscleróticos e inflamatórios sobre a doença arterial coronária. Além disso, frente às atuais evidências, sugerimos estratégias de estratificação de risco e tratamento da doença arterial coronária em pacientes com artrite reumatoide. Abstract: There is increasing interest in autoimmune diseases, especially their relationship with cardiovascular disease. Rheumatoid arthritis in particular has been considered an independent risk factor for coronary artery disease in recent years. Various studies have aimed to clarify important aspects of risk stratification and treatment options in patients with rheumatoid arthritis, and specific therapies are being studied that promise to reduce their long-term cardiovascular risk. We performed a wide-ranging review of the literature to highlight the importance of atherosclerotic and inflammatory mechanisms in coronary artery disease. We also suggest strategies for risk stratification and treatment of cardiovascular disease in patients with rheumatoid arthritis. Palavras-chave: Artrite reumatoide, Doença cardiovascular, Inflamação, Keywords: Rheumatoid arthritis, Cardiovascular disease, Inflammation

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group - EG), and 1040 were

FUNDAMENTO: Estudos prévios demonstraram que a leucocitose e a hiperglicemia verificadas à admissão de pacientes com IAM (infarto agudo do miocárdio), estão correlacionadas com a mortalidade intra-hospitalar. Entretanto, pouco é sabido sobre o impacto desses marcadores a longo prazo. OBJETIVO: Avaliar a curto e longo prazos, a influência dos níveis de glicose e leucócitos no prognóstico de pacientes com IAM. MÉTODOS: Foram analisados, retrospectivamente, 809 pacientes (idade média 63,2 ± 12,87 anos) com IAM, incluídos de forma prospectiva e consecutiva em banco de dados específico. RESULTADOS: a) Na fase intra-hospitalar os valores médios aferidos foram comparados entre pacientes que morreram ou sobreviveram: Leucocitose 12156±5977 vs 10337±3528 (p=0.004, 95% IC= 976-2663); Glicose 176±105 mg/dl vs 140±72 mg/dl (pFUNDAMENTO: Estudios previos demostraron que tanto la leucocitosis como la hiperglucemia verificadas cuando de la admisión de pacientes con infarto agudo de miocardio (IAM), están correlacionadas con la mortalidad intrahospitalaria. Sin embargo, poco se sabe acerca del impacto de esos marcadores a largo plazo. OBJETIVO: Evaluar, a corto y largo plazos, la influencia de los niveles de glucosa y leucocitos en el pronóstico de pacientes con IAM. MÉTODOS: Se analizaron, retrospectivamente, a 809 pacientes (edad promedio 63,2 ± 12,87 años) con IAM, incluidos de forma prospectiva y consecutiva en banco de datos específico. RESULTADOS: a) En la fase intrahospitalaria se compararon los valores promedio obtenidos entre pacientes que murieron o supervivieron: leucocitosis 12.156±5.977 vs 10.337±3.528 (p=0.004, 95% IC= 976-2663); glucosa 176±105 mg/dl vs 140±72 mg/dl (pBACKGROUND: Previous studies have demonstrated that leukocytosis and hyperglycemia verified at the admission of patients with acute myocardial infarction (AMI) are associated with intrahospital mortality. However, little is known on the long-term impact of these markers. OBJECTIVE: To evaluate the short-and long-term influence of the levels of glucose and leukocytes on the prognosis of patients with AMI. METHODS: A total of 809 patients with AMI were retrospectively assessed (mean age: 63.2 ± 12.87 yrs) and prospectively and consecutively included in a specific database. RESULTS: a) At the intrahospital phase, the mean values were compared between patients that died and those who survived: Leukocytosis: 12156±5977 vs 10337±3528 (p=0.004, 95%CI = 976-2663); Glucose 176±105 mg/dl vs 140±72 mg/dl (p

Aim: High-density lipoprotein (HDL) particles in ST-segment elevation myocardial infarction (STEMI) are deficient in their anti-atherogenic function. Molecular determinants of such deficiency remain obscure. Methods: Five major HDL subpopulations were isolated using density-gradient ultracentrifugation from STEMI patients (n = 12) and healthy age- and sex-matched controls (n = 12), and 160 species of phosphatidylcholine, lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylglycerol, phosphatidylserine, phosphatidic acid, sphingomyelin and ceramide were quantified by LC-MS/MS. Results: Multiple minor species of proinflammatory phosphatidic acid and lysophosphatidylcholine were enriched by 1.7–27.2-fold throughout the majority of HDL subpopulations in STEMI. In contrast, minor phosphatidylcholine, phosphatidylglycerol, phosphatidylinositol, phosphatidylethanolamine, sphingomyelin and ceramide species were typically depleted up to 3-fold in STEMI vs. control HDLs, while abundances of their major species did not differ between the groups. Intermediate-to-long-chain phosphatidylcholine, phosphatidylinositol and phosphatidylglycerol species were more affected by STEMI than their short-chain counterparts, resulting in positive correlations between their fold decrease and the carbon chain length. Additionally, fold decreases in the abundances of multiple lipid species were positively correlated with the double bond number in their carbon chains. Finally, abundances of several phospholipid and ceramide species were positively correlated with cholesterol efflux capacity and antioxidative activity of HDL subpopulations, both reduced in STEMI vs controls. KEGG pathway analysis tied these species to altered glycerophospholipid and linoleic acid metabolism. Conclusions: Minor unsaturated intermediate-to-long-chain phospholipid and sphingolipid species in HDL subpopulations are most affected by STEMI, reflecting alterations in glycerophospholipid and linoleic acid metabolism with the accumulation of proinflammatory lysolipids and maintenance of homeostasis of major phospholipid species.

Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH ≤ 4 mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding.

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p

To evaluate functional and compositional properties of HDL in subjects from a kindred of genetic apoA-I deficiency, two homozygotes and six heterozygotes, with a nonsense mutation at APOA1 codon -2, Q[-2]X, were recruited together with age- and sex-matched healthy controls (n = 11). Homozygotes displayed undetectable plasma levels of apoA-I and reduced levels of HDL-cholesterol (HDL-C) and apoC-III (5.4% and 42.6% of controls, respectively). Heterozygotes displayed low HDL-C (21 ± 9 mg/dl), low apoA-I (79 ± 24 mg/dl), normal LDL-cholesterol (132 ± 25 mg/dl), and elevated TG (130 ± 45 mg/dl) levels. Cholesterol efflux capacity of ultracentrifugally isolated HDL subpopulations was reduced (up to −25%, P < 0.01, on a glycerophospholipid [GP] basis) in heterozygotes versus controls. Small, dense HDL3 and total HDL from heterozygotes exhibited diminished antioxidative activity (up to −48%, P < 0.001 on a total mass basis) versus controls. HDL subpopulations from both homozygotes and heterozygotes displayed altered chemical composition, with depletion in apoA-I, GP, and cholesteryl ester; enrichment in apoA-II, free cholesterol, and TG; and altered phosphosphingolipidome. The defective atheroprotective activities of HDL were correlated with altered lipid and apo composition. These data reveal that atheroprotective activities of HDL particles are impaired in homozygous and heterozygous apoA-I deficiency and are intimately related to marked alterations in protein and lipid composition.

Resumo: Introdução: A monitorização da atividade da doença e o melhor esquema terapêutico ainda têm sido um desafio em pacientes com arterite de Takayasu (AT). Em síndromes coronárias agudas (SCA) a melhor forma de tratamento intervencionista mantém-se indefinida. Dessa forma, descrevemos as características basais, as manifestações clínicas, os achados angiográficos, o tratamento definitivo adotado e a evolução a longo prazo de pacientes com AT que apresentaram SCA. Métodos: Entre 2004 e 2010, foram analisados retrospetivamente oito pacientes com AT que apresentaram SCA. Foram obtidas as seguintes informações: idade, sexo, manifestações clínicas e eletrocardiográficas, estado hemodinâmico, fatores de risco para SCA, marcadores de necrose miocárdica, clearance de creatinina, fração de ejeção de ventrículo esquerdo, marcadores inflamatórios, medicações utilizadas, achados angiográficos, tratamento definitivo adotado e evolução a longo prazo. Resultados: Os 8 pacientes eram mulheres. A mediana de idade foi de 49 anos. A dor precordial típica esteve presente em 37,5%. Cerca de 85,7% apresentaram aumento de velocidade de hemossedimentação. O seguimento mais acometido foi o tronco da coronária esquerda em 62,5%. Em três casos optou-se pela revascularização cirúrgica, em dois pacientes realizou-se uma angioplastia com stent convencional, num outro com stent farmacológico e em dois doentes manteve-se o tratamento clínico. Registou-se uma mortalidade intra-hospitalar de 25% e em seguimento médio de 30 meses não houve mortes. Conclusão: Em pacientes que sobreviveram ao quadro agudo e receberam alta hospitalar, foram obtidos bons resultados a longo prazo, principalmente com tratamento clínico ou cirúrgico. A velocidade de hemossedimentação parece estar mais relacionada com a ocorrência de quadros de SCA em pacientes com AT. Abstract: Introduction: Monitoring of disease activity and the best therapeutic approach are a challenge in Takayasu arteritis (TA). When associated with acute coronary syndromes (ACS), the best interventional treatment has not been established. The objective of this study was to describe the baseline characteristics, clinical manifestations, treatment and long-term outcome of patients with TA and ACS. Methods: We retrospectively analyzed eight patients between 2004 and 2010. The following data were obtained: age, gender, clinical and electrocardiographic manifestations, Killip class, risk factors for ACS, markers of myocardial necrosis (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate [ESR]), medication during hospital stay, angiographic findings, treatment (medical, percutaneous or surgical) and long-term outcome. Statistical data were expressed as percentages and absolute values. Results: All eight patients were women, median age 49 years. Typical chest pain was present in 37.5%. Elevated ESR was observed in 85.7%. Three patients underwent coronary artery bypass grafting, three underwent percutaneous coronary angioplasty (two with bare-metal stents and one with a drug-eluting stent) and two were treated medically. In-hospital mortality was 25%. There were no deaths during a mean follow-up of 30 months. Conclusions: In our study, patients who were discharged home had good outcomes in long-term follow-up with medical, percutaneous or surgical treatment. ESR appears to be associated with ACS in TA. Palavras-chave: Arterite de Takayasu, Síndrome coronária aguda, Angioplastia coronária, Inflamação, Keywords: Takayasu arteritis, Acute coronary syndromes, Coronary angioplasty, Inflammation

OBJECTIVES: Acute respiratory failure is present in 5% of patients with acute myocardial infarction and is responsible for 20% to 30% of the fatal post-acute myocardial infarction. The role of inflammation associated with pulmonary edema as a cause of acute respiratory failure post-acute myocardial infarction remains to be determined. We aimed to describe the demographics, etiologic data and histological pulmonary findings obtained through autopsies of patients who died during the period from 1990 to 2008 due to acute respiratory failure with no diagnosis of acute myocardial infarction during life. METHODS: This study considers 4,223 autopsies of patients who died of acute respiratory failure that was not preceded by any particular diagnosis while they were alive. The diagnosis of acute myocardial infarction was given in 218 (4.63%) patients. The age, sex and major associated diseases were recorded for each patient. Pulmonary histopathology was categorized as follows: diffuse alveolar damage, pulmonary edema, alveolar hemorrhage and lymphoplasmacytic interstitial pneumonia. The odds ratio of acute myocardial infarction associated with specific histopathology was determined by logistic regression. RESULTS: In total, 147 men were included in the study. The mean age at the time of death was 64 years. Pulmonary histopathology revealed pulmonary edema as well as the presence of diffuse alveolar damage in 72.9% of patients. Bacterial bronchopneumonia was present in 11.9% of patients, systemic arterial hypertension in 10.1% and dilated cardiomyopathy in 6.9%. A multivariate analysis demonstrated a significant positive association between acute myocardial infarction with diffuse alveolar damage and pulmonary edema. CONCLUSIONS: For the first time, we demonstrated that in autopsies of patients with acute respiratory failure as the cause of death, 5% were diagnosed with acute myocardial infarction. Pulmonary histology revealed a significant inflammatory response, which has not previously been reported.

Leila Fernandes Araujo, Alexandre de Matos Soeiro, Juliano Lara Fernandes, Antônio Eduardo Pesaro, Carlos V Serrano JrHeart Institute (InCor), University of São Paulo, School of Medicine, BrazilAbstract: Despite numerous studies on women’s cardiac health throughout the past decade, the number of female deaths caused by cardiovascular disease still rises and remains the leading cause of death in women in most areas of the world. Novel studies have demonstrated that cardiovascular disease, and more specifically coronary artery disease presentations in women, are different than those in men. In addition, pathology and pathophysiology of the disease present significant gender differences, which leads to difficulties concerning diagnosis, treatment and outcome of the female population. The reason for this disparity is all steps for female cardiovascular disease evaluation, treatment and prevention are not well elucidated; and an area for future research. This review brings together the most recent studies published in the field of coronary artery disease in women and points out new directions for future investigation on some of the important issues. Keywords: coronary artery disease, women, risk factors, prevention, diagnosis, treatment.