34 results on '"Pesaro AE"'
Search Results
2. Cluster of climatic and pollutant characteristics increases admissions for acute myocardial infarction: Analysis of 30,423 patients in the metropolitan area of Sao Paulo.
- Author
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Ribeiro MH, Grossi A, Caixeta A, Franken M, Katz M, Seleme V, Ribeiro E, Pesaro AE, Fabri J Jr, Mehta S, and Campos CM
- Subjects
- Brazil epidemiology, Hospitalization, Humans, Particulate Matter adverse effects, Seasons, Air Pollutants adverse effects, Air Pollution adverse effects, Air Pollution analysis, Environmental Pollutants, Myocardial Infarction epidemiology
- Abstract
Background: The impact of simultaneous adverse climate conditions in the risk of myocardial infarction (MI) was not tested before. The aim of the present study was to investigate the impact of the combination of climate and air pollution features in the number of admissions and mortality due to acute myocardial infarction in 39 municipalities of São Paulo from 2012 to 2015., Methods: Data about MI admissions were obtained from the Brazilian public health system (DataSUS). Daily information on weather were accessed from the Meteorological Database for Teaching and Research. Additionally, daily information on air pollution were obtained from the Environmental Company of the State of São Paulo. A hierarchical cluster analysis was applied for temperature, rainfall patterns, relative air humidity, nitrogen dioxide, particulate matter 2.5 and particulate matter 10. MI admissions and in-hospital mortality were compared among the clusters., Results: Data analysis produced 3 clusters: High temperature variation-Low humidity-high pollution (n=218 days); Intermediate temperature variation/high humidity/intermediate pollution (n=751 days) and low temperature variation/intermediate humidity-low pollution (n=123 days). All environmental variables were significantly different among clusters. The combination of high temperature variation, dry weather and high pollution resulted in a significant 9% increase in hospital admissions for MI [30.5 (IQR 25.0-36.0)]; patients/day; P<0.01). The differences in weather and pollution did not have impact on in-hospital mortality (P=0.88)., Conclusion: The combination of atmospheric conditions with high temperature variation, lower temperature, dryer weather and increased inhalable particles was associated with a marked increase of hospital admissions due to MI., Competing Interests: Declaration of Competing Interests None of the authors have conflicts of interest to declare, (Copyright © 2020. Published by Elsevier Inc.)
- Published
- 2021
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3. The Finnish Diabetes Risk Score (FINDRISC), incident diabetes and low-grade inflammation.
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Pesaro AE, Bittencourt MS, Franken M, Carvalho JAM, Bernardes D, Tuomilehto J, and Santos RD
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- Adult, Cross-Sectional Studies, Female, Finland, Humans, Incidence, Male, Risk Factors, Diabetes Mellitus, Type 2 epidemiology, Inflammation complications
- Abstract
Aims: The FINDRISC was created to predict the development of type 2 diabetes mellitus (T2DM). Since T2DM associates with inflammation we evaluated if the FINDRISC could predict either current or incident T2DM, and elevated high sensitivity C-reactive protein (hs-CRP)., Methods: 41,880 people (age 41.9 ± 9.7 years; 31% female) evaluated between 2008 and 2016 were included. First, the cross-sectional association between the FINDRISC with presence of either T2DM or hs-CRP ≥ 2.0 mg/L was tested. After a 5 ± 3 years follow-up we tested the score predictive value for incident T2DM and inflammation in respectively 10,559 individuals without diabetes and in a subset of 2,816 individuals having no elevated hs-CRP at baseline., Results: In the cross sectional analysis the FINDRISC was associated with both T2DM (OR 1.24, 95% CI: 1.23-1.26, P < 0.001) and inflammation (OR 1.10, 95% CI: 1.09-1.11, P < 0.001) per FINDRISC unit, as well as in longitudinal analyses (OR 1.17, 95% CI: 1.14-1.20, P < 0.001; and OR 1.04, 95% CI: 1.02-1.07, P < 0.001; respectively, per FINDRISC unit). The C-statistic for incident T2DM and inflammation was 0.79 (95% CI 0.77-0.82) and 0.55 (95% CI 0.53-0.58), respectively., Conclusion: The FINDRISC shows good discrimination for incident T2DM but less for inflammation., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2021
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4. Short- and Midterm Adherence to Platelet P2Y12 Receptor Inhibitors After Percutaneous Coronary Intervention With Drug-Eluting Stents.
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Morita F, Wajngarten M, Katz M, Fernandes-Silva MM, Caixeta A, Franken M, Lemos PA, and Pesaro AE
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- Aged, Aged, 80 and over, Comorbidity, Coronary Thrombosis mortality, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Platelet Aggregation Inhibitors adverse effects, Prospective Studies, Purinergic P2Y Receptor Antagonists adverse effects, Risk Factors, Smokers, Smoking adverse effects, Time Factors, Treatment Outcome, Coronary Thrombosis prevention & control, Drug-Eluting Stents, Medication Adherence, Percutaneous Coronary Intervention instrumentation, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use
- Abstract
Introduction/objectives: In patients who have undergone recent percutaneous coronary intervention (PCI), poor adhesion to antiplatelet agents may increase the risk of stent thrombosis and death. We aimed to investigate the adherence to different P2Y12 receptor inhibitors after PCI with drug-eluting stent in stable and unstable patients and to evaluate the factors associated with low adherence., Method: In a prospective study conducted between 2014 and 2018, the 8-item Morisky scale was applied at 30 days and 6 months post-PCI to measure P2Y12 receptor inhibitors adherence. Also, we describe the characteristics of patients using different platelet receptor P2Y12 inhibitors. Regression models were used to identify predictors of poor adherence., Results: A total of 214 patients were included (65 ± 12 years, 81% man, 61% acute coronary syndromes). Patients in the clopidogrel group were older than those in the prasugrel (68 ± 12 vs 59 ± 11 years, P < .01, respectively) or ticagrelor group (68 ± 12 vs 62 ± 12 years, P < .01). Patients with low/moderate adherence at 30 days and 6 months represented, respectively, 19.8% and 27.5% of our sample. Current smokers and preexisting cardiovascular disease at presentation were associated with lower adherence at 30 days., Conclusions: We found substantial rates of moderate and low adherence to P2Y12 receptor inhibitors early after PCI. Current smokers and preexisting cardiovascular disease at presentation were associated with a lower likelihood of adherence. These results highlight the need of monitoring adherence to medical treatment after PCI.
- Published
- 2020
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5. Circulating osteogenic proteins are associated with coronary artery calcification and increase after myocardial infarction.
- Author
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Pesaro AE, Katz M, Liberman M, Pereira C, Mangueira CLP, de Carvalho AEZ, Carvalho KS, Nomura CH, Franken M, and Serrano CV Jr
- Subjects
- Adult, Aged, Biomarkers blood, C-Reactive Protein metabolism, Coronary Artery Disease blood, Coronary Artery Disease complications, Female, Humans, Lipoproteins, LDL blood, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction etiology, Transforming Growth Factor beta1 blood, Tumor Necrosis Factor-alpha blood, alpha-2-HS-Glycoprotein metabolism, Matrix Gla Protein, Calcium-Binding Proteins blood, Coronary Artery Disease metabolism, Extracellular Matrix Proteins blood, Myocardial Infarction metabolism, Osteoprotegerin blood, RANK Ligand blood
- Abstract
Background: Coronary artery calcification (CAC) and atherosclerotic inflammation associate with increased risk of myocardial infarction (MI). Vascular calcification is regulated by osteogenic proteins (OPs). It is unknown whether an association exists between CAC and plasma OPs and if they are affected by atherothrombotic inflammation. We tested the association of osteogenic and inflammatory proteins with CAC and assessed these biomarkers after MI., Methods: Circulating OPs (osteoprotegerin, RANKL, fetuin-A, Matrix Gla protein [MGP]) and inflammatory proteins (C-reactive protein, oxidized-LDL, tumoral necrosis factor-α, transforming growth factor [TGF]-β1) were compared between stable patients with CAC (CAC ≥ 100 AU, n = 100) and controls (CAC = 0 AU, n = 30). The association between biomarkers and CAC was tested by multivariate analysis. In patients with MI (n = 40), biomarkers were compared between acute phase and 1-2 months post-MI, using controls as a baseline., Results: MGP and fetuin-A levels were higher within individuals with CAC. Higher levels of MGP and RANKL were associated with CAC (OR 3.12 [95% CI 1.20-8.11], p = 0.02; and OR 1.75 [95% CI 1.04-2.94] respectively, p = 0.035). After MI, C-reactive protein, OPG and oxidized-LDL levels increased in the acute phase, whereas MGP and TGF-β1 increased 1-2 months post-MI., Conclusions: Higher MGP and RANKL levels associate with CAC. These findings highlight the potential role of these proteins as modulators and markers of CAC. In addition, the post-MI increase in OPG and MGP, as well as of inflammatory proteins suggest that the regulation of these OPs is affected by atherothrombotic inflammation., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
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6. Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America.
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Levin RK, Katz M, Saldiva PHN, Caixeta A, Franken M, Pereira C, Coslovsky SV, and Pesaro AE
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- Adult, Age Factors, Aged, Aged, 80 and over, Brazil epidemiology, Cities, Female, Heart Failure therapy, Hospitals, Public, Humans, Male, Middle Aged, Myocardial Infarction therapy, Prospective Studies, Retrospective Studies, Sex Factors, Young Adult, Heart Failure epidemiology, Hospitalization trends, Myocardial Infarction epidemiology, Seasons, Temperature
- Abstract
Background: In high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America., Methods: This was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates., Findings: The highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p<0.001; and AMI: 678 vs. 586 per month, p<0.001). Monthly average temperatures were moderately lower during winter than other seasons and they were not associated with hospitalizations for HF and AMI., Interpretation: The winter season was associated with a greater number of hospitalizations for both HF and AMI. This increase was not associated with seasonal oscillations in temperature, which were modest. Our study suggests that the prevention of cardiovascular disease decompensation should be emphasized during winter even in low to middle-income countries with tropical and subtropical climates.
- Published
- 2018
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7. P2Y 12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: Analysis from the SAMPA randomized trial.
- Author
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Guimarães LF, Généreux P, Silveira D, Pesaro AE, Falcão F, Barbosa BR, de Souza CF, Fonseca FA, Alves CM, Carvalho AC, Stone GW, and Caixeta A
- Subjects
- Adenosine administration & dosage, Coronary Angiography, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors administration & dosage, Prospective Studies, Purinergic P2Y Receptor Antagonists administration & dosage, ST Elevation Myocardial Infarction diagnosis, Ticagrelor, Time Factors, Treatment Outcome, Adenosine analogs & derivatives, Prasugrel Hydrochloride administration & dosage, ST Elevation Myocardial Infarction drug therapy, Thrombolytic Therapy methods
- Abstract
Background: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed., Methods: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y
12 assay at 0, 2, 6, and 24h after randomization., Results: Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study., Conclusions: In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y12 receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)- Published
- 2017
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8. A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade.
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Katz M, Bosworth HB, Lopes RD, Dupre ME, Morita F, Pereira C, Franco FG, Prado RR, Pesaro AE, and Wajngarten M
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- Adult, Aged, Brazil epidemiology, Female, Hospitalization trends, Humans, Interrupted Time Series Analysis methods, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction economics, Socioeconomic Factors, Stroke diagnosis, Stroke economics, Interrupted Time Series Analysis trends, Myocardial Infarction epidemiology, Patient Admission trends, Stroke epidemiology, Unemployment trends
- Abstract
Background: The effect of socioeconomic stressors on the incidence of cardiovascular disease (CVD) is currently open to debate. Using time-series analysis, our study aimed to evaluate the relationship between unemployment rate and hospital admission for acute myocardial infarction (AMI) and stroke in Brazil over a recent 11-year span., Methods and Results: Data on monthly hospital admissions for AMI and stroke from March 2002 to December 2013 were extracted from the Brazilian Public Health System Database. The monthly unemployment rate was obtained from the Brazilian Institute for Applied Economic Research, during the same period. The autoregressive integrated moving average (ARIMA) model was used to test the association of temporal series. Statistical significance was set at p<0.05. From March 2002 to December 2013, 778,263 admissions for AMI and 1,581,675 for stroke were recorded. During this time period, the unemployment rate decreased from 12.9% in 2002 to 4.3% in 2013, while admissions due to AMI and stroke increased. However, the adjusted ARIMA model showed a positive association between the unemployment rate and admissions for AMI but not for stroke (estimate coefficient=2.81±0.93; p=0.003 and estimate coefficient=2.40±4.34; p=0.58, respectively)., Conclusions: From 2002 to 2013, hospital admissions for AMI and stroke increased, whereas the unemployment rate decreased. However, the adjusted ARIMA model showed a positive association between unemployment rate and admissions due to AMI but not for stroke. Further studies are warranted to validate our findings and to better explore the mechanisms by which socioeconomic stressors, such as unemployment, might impact on the incidence of CVD., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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9. Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study.
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Pesaro AE, Katz M, Katz JN, Barbas CS, Makdisse MR, Correa AG, Franken M, Pereira C, Serrano CV Jr, and Lopes RD
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- Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Myocardial Infarction mortality, Prognosis, Respiratory Insufficiency mortality, Retrospective Studies, Treatment Outcome, Myocardial Infarction therapy, Respiration, Artificial, Respiratory Insufficiency therapy
- Abstract
Purpose: Patients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV., Methods: This was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models., Results: Mechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8-6.2), 13 (11.2-4.7), and 28 (18.0-37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40-1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79-5.26, P<0.001)., Conclusions: In AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.
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- 2016
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10. Reduction of ischemic events in Improved Reduction of Outcomes: Vytorin Efficacy International Trial: Intensive cholesterol lowering or ezetimibe antithrombotic effects?
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Pesaro AE, Granger CB, and Lopes RD
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- Acute Coronary Syndrome blood, Acute Coronary Syndrome epidemiology, Anticholesteremic Agents administration & dosage, Brazil epidemiology, Dose-Response Relationship, Drug, Humans, Incidence, Treatment Outcome, Acute Coronary Syndrome drug therapy, Cholesterol blood, Ezetimibe administration & dosage, Ezetimibe, Simvastatin Drug Combination administration & dosage, Randomized Controlled Trials as Topic
- Published
- 2016
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11. Preprocedural statin therapy, inflammation, and myocardial injury in low-risk stable coronary artery disease patients submitted to coronary stent implantation.
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Greque GV, Serrano CV Jr, Strunz CM, Soeiro A, Santos M, Pivateli F, Jacob JL, Pesaro AE, Nicolau JC, and Kalil-Filho R
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- Aged, Biomarkers blood, C-Reactive Protein metabolism, Coronary Artery Disease diagnosis, Creatine Kinase, MB Form blood, Female, Humans, Interleukin-6 blood, Male, Middle Aged, Myocardium pathology, Necrosis, Percutaneous Coronary Intervention adverse effects, Prospective Studies, Risk Factors, Treatment Outcome, Troponin I blood, Anti-Inflammatory Agents therapeutic use, Coronary Artery Disease therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Inflammation Mediators blood, Myocardium metabolism, Percutaneous Coronary Intervention instrumentation, Stents
- Abstract
Objective: Evaluate if statin therapy prior to elective coronary stent implantation (CSI) reduces the plasma levels of markers of inflammation and of myocardial necrosis in low-risk stable coronary artery disease patients (CAD)., Background: The elevation of markers of inflammation and of myocardial necrosis after percutaneous coronary intervention may interfere with clinical outcome. Among acute coronary syndrome patients, statins improve clinical outcomes when used before CSI-mostly due to reduction of CSI-related myocardial infarction. However, little is known concerning preprocedural statin therapy on the reduction of these markers in stable patients at low-risk., Methods: In this prospective, observational study, 100 patients (n = 50 on statin therapy vs. n = 50 not on statin) with stable coronary artery disease underwent elective CSI. Inflammatory (C-reactive protein [CRP], interleukin [IL]-6, tumor necrosis factor-α and matrix metalloproteinase-9) and myocardial necrosis markers (troponin I and CK-MB) were determined before and 24 hr after CSI., Results: All patients presented a significant increase of CRP and IL-6 after CSI. However, this increase was attenuated in patients on statin therapy prior to CSI than those without statin therapy: 75% vs. 150% (P < 0.001) and 192% vs. 300% (P < 0.01). The other pro-inflammatory markers were similar for both sets of patients. Troponin I and CK-MB did not change after CSI regardless of previous statin therapy or not., Conclusions: Pretreatment with statin attenuates procedural inflammation, denoted by markedly lower increases of CRP and IL-6 levels, in elective CSI within low-risk stable CAD patients. Periprocedural myocardial injury was irrelevant and was not affected by preprocedural statin therapy in this population., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2016
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12. Peripheral arterial disease in heterozygous familial hypercholesterolemia.
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Pereira C, Miname MH, Makdisse MR, Watanabe C, Pesaro AE, Jannes CE, Kalil Filho R, Pereira AC, and Santos RD
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- Adult, Age Factors, Ankle Brachial Index, Brazil epidemiology, Case-Control Studies, Chi-Square Distribution, Comorbidity, Cross-Sectional Studies, Female, Genetic Markers, Genetic Predisposition to Disease, Humans, Hyperlipoproteinemia Type II diagnosis, Logistic Models, Male, Middle Aged, Odds Ratio, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease physiopathology, Prevalence, Propensity Score, Prospective Studies, Registries, Risk Assessment, Risk Factors, Smoking adverse effects, Smoking epidemiology, Heterozygote, Hyperlipoproteinemia Type II epidemiology, Hyperlipoproteinemia Type II genetics, Peripheral Arterial Disease epidemiology
- Abstract
Background: Familial hypercholesterolemia is characterized by elevated plasma cholesterol and early coronary arterial disease onset. However, few studies investigated the association of heterozygous familial hypercholesterolemia with peripheral arterial disease., Methods: In a cross sectional study 202 heterozygous familial hypercholesterolemia patients (91% confirmed by molecular diagnosis) were compared to 524 normolipidemic controls. Peripheral arterial disease was diagnosed by ankle-brachial index values ≤0.90., Results: Compared with controls, familial hypercholesterolemia patients were older, more often female, with higher rates of hypertension, diabetes, previous coronary disease and higher total cholesterol levels. Smoking (previous and former) was more common among controls. The prevalence of peripheral arterial disease was 17.3 and 2.3% respectively in familial hypercholesterolemia and controls (p < 0.001). Results persisted after matching familial hypercholesterolemia and controls by a propensity score. Regression analyses demonstrated that age (odds ratio- OR = 1.03 95% CI 1.00-1.05, p = 0.033), previous cardiovascular disease (OR = 3.12 CI 95% 1.56-6.25, p = 0.001) and familial hypercholesterolemia diagnosis (OR = 5.55 CI 95% 2.69-11.44, p< 0.001) were independently associated with peripheral arterial disease. Among familial hypercholesterolemia patients, age (OR 1.05, 95% CI 1.02-1.09, p = 0.005), intermittent claudication (OR 6.32, 95% CI 2.60-15.33, p< 0.001) and smoking (OR 2.44, 95% CI 1.08-5.52, p = 0.032) were associated with peripheral arterial disease., Conclusions: Peripheral arterial disease is more frequent in familial hypercholesterolemia than in normolipidemic subjects and it should routine screened in these individuals even if asymptomatic. However, its role as predictor of cardiovascular events needs to be ascertained prospectively., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
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13. Heart failure with preserved left ventricular ejection fraction in patients with acute myocardial infarction.
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Antonelli L, Katz M, Bacal F, Makdisse MR, Correa AG, Pereira C, Franken M, Fava AN, Serrano Junior CV, and Pesaro AE
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- Aged, Aged, 80 and over, Brazil epidemiology, Diastole physiology, Epidemiologic Methods, Female, Hospitalization, Humans, Male, Middle Aged, Prognosis, Systole physiology, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left physiology, Heart Failure epidemiology, Heart Failure physiopathology, Myocardial Infarction epidemiology, Myocardial Infarction physiopathology, Stroke Volume physiology
- Abstract
Background: The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated., Objective: To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality., Methods: Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models., Results: Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35-6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality., Conclusion: One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.
- Published
- 2015
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14. Calculated and perceived cardiovascular risk in asymptomatic subjects submitted to a routine medical evaluation: The perception gap.
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Katz M, Laurinavicius AG, Franco FG, Conceicao RD, Carvalho JA, Pesaro AE, Wajngarten M, and Santos RD
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- Adult, Asymptomatic Diseases, Brazil epidemiology, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Comorbidity, Cross-Sectional Studies, Decision Support Techniques, Female, Humans, Life Style, Male, Middle Aged, Risk Assessment, Risk Factors, Risk Reduction Behavior, Surveys and Questionnaires, Cardiovascular Diseases psychology, Health Knowledge, Attitudes, Practice, Perception
- Abstract
Background: Poor adherence to medical treatment represents a major health problem. A subject's misperception of his own cardiovascular risk has been indicated as a key driver for low compliance with preventive measures. This study analysed the relationship between objectively calculated short- and long-term cardiovascular risk and its subjective perception., Design: Cross-sectional study in asymptomatic Brazilian subjects., Methods: Individuals (N = 6544, mean age 49.1 ± 7 years, 22.2% female) who underwent a routine mandatory health evaluation were studied. A questionnaire in which each individual rated his own cardiovascular risk as low, intermediate or high according to his own perception was used. The 10-year and lifetime cardiovascular risk were calculated respectively using the Framingham risk (FRS) and Lifetime risk (LRS) scores. Individuals were classified as hypo-perceivers (i.e. perceived risk lower than estimated risk), normo-perceivers (i.e. perceived risk coincident with estimated risk) and hyper-perceivers (i.e. perceived risk higher than estimated risk)., Results: Cardiovascular risk, using the FRS, was low in 77.9% (N = 5071), intermediate in 14.4% (N = 939) and high in 7.7% (N = 499) of subjects. Cardiovascular risk, using the LRS, was low in 7.6% (N = 492), intermediate in 43.1% (N = 2787) and high in 49.3% (N = 3184) of the study population. The prevalence of normo-perceivers was 57.6% using the FRS and only 20.6% using the LRS. Using the LRS, 72.3% of the intermediate and 91.2% of the high-risk subjects were hypo-perceivers., Conclusions: In a large sample of asymptomatic individuals, there was a gap between calculated and perceived cardiovascular risk. Using a long-term risk score, most of the intermediate- and high-risk subjects were hypo-perceivers., (© The European Society of Cardiology 2014.)
- Published
- 2015
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15. Acute management of unstable angina and non-ST segment elevation myocardial infarction.
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Silva FM, Pesaro AE, Franken M, and Wajngarten M
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- Acute Coronary Syndrome diagnosis, Angina, Unstable diagnosis, Anticoagulants therapeutic use, Cineangiography, Evidence-Based Medicine methods, Humans, Myocardial Infarction diagnosis, Platelet Aggregation Inhibitors therapeutic use, Acute Coronary Syndrome drug therapy, Angina, Unstable drug therapy, Critical Care, Myocardial Infarction drug therapy
- Abstract
Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.
- Published
- 2015
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16. Prognostic value of serial brain natriuretic Peptide measurements in patients with acute myocardial infarction.
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Pesaro AE, Katz M, Caixeta A, Makdisse MR, Correia AG, Pereira C, Franken M, Fava AN, and Serrano CV Jr
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- Aged, Biomarkers metabolism, Female, Hospital Mortality, Humans, Length of Stay, Male, Myocardial Infarction blood, Prognosis, ROC Curve, Retrospective Studies, Myocardial Infarction mortality, Natriuretic Peptide, Brain metabolism
- Abstract
Objectives: Elevated B-type natriuretic peptide (BNP) levels following acute myocardial infarction (AMI) are associated with adverse outcomes. The role of serial BNP monitoring after AMI has been poorly investigated. We aimed to evaluate the prognostic value of in-hospital serial BNP measurements in AMI patients., Methods: Patients with AMI (n=1,924) were retrospectively evaluated. We selected patients with at least 2 in-hospital BNP measurements. The association between in-hospital mortality and BNP measurements (earliest, highest follow-up and the variation between measurements) were tested in multivariate models., Results: Serial BNP levels were determined in 176 patients. Compared to the rest of the population, these patients were older and had higher mortality rates. In the adjusted models, only the highest follow-up BNP remained associated with in-hospital death (odds ratio 1.06; 95% confidence interval, CI, 1.01-1.15; p=0.014). Receiver-operating characteristic curve analysis demonstrated that the highest follow-up BNP was the best predictor of in-hospital death (area under the curve=0.75; 95% CI 0.64-0.86)., Conclusions: Serial BNP monitoring was performed in a high-risk subgroup of AMI patients. The highest follow-up BNP was a better predictor of short-term death than the baseline and in-hospital variation values. In AMI patients, a later in-hospital BNP assessment may be more useful than an early measurement., (© 2015 S. Karger AG, Basel.)
- Published
- 2015
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17. Diabetes and cardiovascular disease: from evidence to clinical practice - position statement 2014 of Brazilian Diabetes Society.
- Author
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Bertoluci MC, Pimazoni-Netto A, Pires AC, Pesaro AE, Schaan BD, Caramelli B, Polanczyk CA, Júnior CV, Gualandro DM, Malerbi DA, Moriguchi E, Borelli FA, Salles JE, Júnior JM, Rohde LE, Canani LH, Cesar LA, Tambascia M, Zanella MT, Gus M, Scheffel RS, and Dos Santos RD
- Abstract
There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology.
- Published
- 2014
- Full Text
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18. [Brazilian guidelines on platelet antiaggregants and anticoagulants in cardiology].
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Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum A Jr, Marques AC, Franci A, Manica AL, Volschan A, De Paola AA, Greco AI, Ferreira AC, Sousa AC, Pesaro AE, Simão AF, Lopes AS, Timerman A, Ramos AI, Alves BR, Caramelli B, Mendes BA, Polanczyk CA, Montenegro CE, Barbosa CJ, Serrano CV Jr, Melo CC, Pinho C, Moreira DA, Calderaro D, Gualandro DM, Armaganijan D, Machado Neto EA, Bocchi EA, Paiva EF, Stefanini E, D'Amico E, Evaristo EF, Silva EE, Fernandes F, Brito FS Jr, Bacal F, Ganem F, Gomes FL, Mattos FR, Moraes Neto FR, Tarasoutchi F, Darrieux FC, Feitosa GS, Fenelon G, Morais GR, Correa Filho H, Castro I, Gonçalves I Jr, Atié J, Souza Neto JD, Ferreira JF, Nicolau JC, Faria Neto JR, Annichino-Bizzacchi JM, Zimerman LI, Piegas LS, Pires LJ, Baracioli LM, Silva LB, Mattos LA, Lisboa LA, Magalhães LP, Lopes MA, Montera MW, Figueiredo MJ, Malachias MV, Gaz MV, Andrade MD, Bacellar MS, Barbosa MR, Clausell NO, Dutra OP, Coelho OR, Yu PC, Lavítola PL, Lemos Neto PA, Andrade PB, Farsky PS, Franco RA, Kalil RA, Lopes RD, Esporcatte R, Heinisch RH, Kalil Filho R, Giraldez RR, Alves RC, Leite RE, Gagliardi RJ, Ramos RF, Montenegro ST, Accorsi TA, Jardim TS, Scudeler TL, Moisés VA, and Portal VL
- Subjects
- Acute Coronary Syndrome drug therapy, Atrial Fibrillation drug therapy, Brazil, Chagas Disease drug therapy, Female, Heart Failure drug therapy, Humans, Ischemic Attack, Transient drug therapy, Myocardial Infarction drug therapy, Perioperative Period, Societies, Medical, Stroke drug therapy, Venous Thromboembolism drug therapy, Anticoagulants therapeutic use, Cardiovascular Diseases drug therapy, Platelet Aggregation Inhibitors therapeutic use
- Published
- 2013
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19. Increasing doses of simvastatin versus combined ezetimibe/simvastatin: effect on circulating endothelial progenitor cells.
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Pesaro AE, Serrano CV Jr, Katz M, Marti L, Fernandes JL, Parra PR, and Campos AH
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- Aged, Anticholesteremic Agents administration & dosage, Anticholesteremic Agents pharmacology, Azetidines administration & dosage, Azetidines pharmacology, Cholesterol, LDL blood, Cholesterol, LDL drug effects, Coronary Artery Disease physiopathology, Dose-Response Relationship, Drug, Drug Combinations, Endothelial Cells drug effects, Endothelial Cells metabolism, Ezetimibe, Simvastatin Drug Combination, Female, Flow Cytometry, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacology, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypercholesterolemia complications, Male, Middle Aged, Simvastatin administration & dosage, Simvastatin pharmacology, Stem Cells drug effects, Stem Cells metabolism, Anticholesteremic Agents therapeutic use, Azetidines therapeutic use, Coronary Artery Disease drug therapy, Hypercholesterolemia drug therapy, Simvastatin therapeutic use
- Abstract
Background: Patients with coronary artery disease (CAD) should be treated with statins to attain very low cholesterol levels, in order to reduce cardiovascular adverse events. More than 70% of these patients do not reach the appropriate cholesterol goal despite moderate statin doses. However, it is not known whether therapeutic uptitration with different lipid-lowering strategies has a similar "pleiotropic" effect on atherosclerotic endothelial dysfunction evaluated by measurement of endothelial progenitor cells (EPCs)., Objective: We sought to compare, in patients with stable CAD and with a low-density lipoprotein cholesterol (LDL-C) >70 mg/dL on treatment with simvastatin 20 mg, the effects on EPCs by increasing simvastatin to 80 mg versus adding ezetimibe 10 mg., Methods: Patients (n = 68, 63 ± 9 years, 39% men) were randomly allocated to receive ezetimibe 10/simvastatin 20 mg or simvastatin 80 mg for 6 weeks. Circulating EPCs were measured by flow cytometry before and after the treatment., Results: Both strategies presented similar effects on metabolic parameters. The LDLs were equally reduced by ezetimibe 10/simvastatin 20 mg and simvastatin 80 mg (28.9% ± 13% vs 21.1% ± 33%; P = .46, respectively). The levels of EPCs were unaffected by ezetimibe 10/simvastatin 20 mg (median [25th, 75th]: pre- vs posttreatment, 7.0 [2.3; 13.3] vs 3.1 [0.1; 13.2] EPCs/10(4) mononuclear cells; P = .43) or simvastatin 80 mg (pre- vs posttreatment, 6.1 [2.9; 15.2] vs 4.0 [1.4; 10.7] EPCs/10(4) mononuclear cells; P = .5), and there were no differences between the groups on treatment effects (P = .9)., Conclusions: Among stable patients with CAD and with an LDL-C >70 mg/dL on simvastatin 20 mg, increasing simvastatin dose to 80 mg or adding ezetimibe 10 mg promoted similar further cholesterol reduction but did not have incremental effects on circulating EPCs. These data suggest that the effects of simvastatin moderate doses on EPCs are not increased by intensive lipid-lowering strategies (clinicaltrials.gov: NCT00474123).
- Published
- 2013
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20. Effect of implementing an acute myocardial infarction guideline on quality indicators.
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Makdisse M, Katz M, Corrêa Ada G, Forlenza LM, Perin MA, de Brito Júnior FS, Nascimento TC, Gomes IM, Franken M, Knobel M, Pesaro AE, dos Santos OF, Cendoroglo Neto M, and Lottenberg CL
- Subjects
- Female, Hospital Mortality, Humans, Male, Middle Aged, Quality Indicators, Health Care statistics & numerical data, Treatment Outcome, Emergency Service, Hospital standards, Guideline Adherence statistics & numerical data, Myocardial Infarction therapy, Quality Indicators, Health Care standards
- Abstract
Objective: To evaluate the compliance rates to quality of care indicators along the implementation of an acute myocardial infarction clinical practice guideline., Methods: A clinical guideline for acute myocardial infarction was introduced on March 1st, 2005. Patients admitted for acute myocardial infarction from March 1st, 2005 to December 31st, 2012 (n=1,431) were compared to patients admitted for acute myocardial infarction before the implementation of the protocol (n=306). Compliance rates to quality of care indicators (ASA prescription on hospital admission and discharge, betablockers on discharge and door-to-balloon time) as well as the length of hospital stay and in-hospital mortality were compared before and after the implementation of the clinical guideline., Results: The rates of ASA prescription on admission, on discharge and of betablockers were higher after guideline implementation: 99.6% versus 95.8% (p<0.001); 99.1% versus 95.8% (p<0.001); and 95.9% versus 81.7% (p<0.001), respectively. ASA prescription rate increased over time, reaching 100% from 2009 to 2012. Door-to-balloon time after versus before implementation was of 86(32) minutes versus 93(51) (p=0.20). The length of hospital stay after the implementation versus before was of 6(6) days versus 6(4) days (p=0.34). In-hospital mortality was 7.6% (before the implementation), 8.7% between 2005 and 2008, and 5.3% between 2009 and 2012, (p=0.04)., Conclusion: The implementation of an acute myocardial infarction clinical practice guideline was associated with an increase in compliance to quality of care indicators.
- Published
- 2013
- Full Text
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21. Vascular calcification: pathophysiology and clinical implications.
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Liberman M, Pesaro AE, Carmo LS, and Serrano CV Jr
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- Animals, Atherosclerosis metabolism, Disease Models, Animal, Humans, Osteoblasts metabolism, Osteoclasts metabolism, Risk Factors, Vascular Calcification etiology, Vascular Calcification metabolism, Atherosclerosis complications, Vascular Calcification physiopathology
- Abstract
Vascular calcification in coronary artery disease is gaining importance, both in scientific research and in clinical and imaging applications. The calcified plaque is considered the most relevant form of atherosclerosis within the coronary artery tree and is frequently a challenge for percutaneous intervention. Recent studies showed that plaque calcification is dynamic and is strictly related to the degree of vascular inflammation. Several inflammatory factors produced during the different phases of atherosclerosis induce the expression and activation of osteoblastic cells located within the arterial wall, which, in turn, promote the deposit of calcium. The vascular smooth muscle cells have an extraordinary capacity to undergo osteoblastic phenotypical differentiation. There is no doubt that the role of these factors, as well as the elements of genomics and proteomics, could be a vital strategic point in prevention and treatment. Within this context, we conducted an updating review on coronary calcification focused on pathophysiology, experimental models, and clinical implications of vascular calcification.
- Published
- 2013
- Full Text
- View/download PDF
22. Inflammation and circulating endothelial progenitor cells in patients with coronary artery disease and residual platelet reactivity.
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Pesaro AE, Serrano CV Jr, Katz M, Campos AH, Lopes RD, Marti LC, Martins HS, Sunahara RS, Maranhão RC, and Nicolau JC
- Subjects
- Aged, Aspirin therapeutic use, Biomarkers, C-Reactive Protein analysis, Coronary Artery Disease blood, Coronary Artery Disease pathology, Female, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Platelet Function Tests, Statistics, Nonparametric, Time Factors, Coronary Artery Disease drug therapy, Endothelial Cells, Inflammation Mediators blood, Platelet Activation physiology, Stem Cells
- Published
- 2012
- Full Text
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23. Pleiotropic effects of ezetimibe/simvastatin vs. high dose simvastatin.
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Pesaro AE, Serrano CV Jr, Fernandes JL, Cavalcanti AB, Campos AH, Martins HS, Maranhão RC, de Lemos JA, Souza HP, and Nicolau JC
- Subjects
- Aged, Apolipoproteins B blood, Biomarkers blood, Cholesterol, LDL blood, Coronary Artery Disease blood, Dose-Response Relationship, Drug, Drug Synergism, Ezetimibe, Female, Humans, Hypercholesterolemia blood, Lipoproteins, LDL blood, Male, Middle Aged, Platelet Aggregation drug effects, Anticholesteremic Agents administration & dosage, Azetidines administration & dosage, Coronary Artery Disease drug therapy, Hypercholesterolemia drug therapy, Simvastatin administration & dosage
- Abstract
Background: In the setting of stable coronary artery disease (CAD), it is not known if the pleiotropic effects of cholesterol reduction differ between combined ezetimibe/simvastatin and high-dose simvastatin alone., Objective: We sought to compare the anti-inflammatory and antiplatelet effects of ezetimibe 10mg/simvastatin 20mg (E10/S20) with simvastatin 80 mg (S80)., Methods and Results: CAD patients (n=83, 63 ± 9 years, 57% men) receiving S20, were randomly allocated to receive E10/S20 or S80, for 6 weeks. Lipids, inflammatory markers (C-reactive protein, interleukin-6, monocyte chemoattractant protein-1, soluble CD40 ligand and oxidized LDL), and platelet aggregation (platelet function analyzer [PFA]-100) changes were determined. Baseline lipids, inflammatory markers and PFA-100 were similar between groups. After treatment, E10/S20 and S80 patients presented, respectively: (1) similar reduction in LDL-C (29 ± 13% vs. 28 ± 30%, p=0.46), apo-B (18 ± 17% vs. 22 ± 15%, p=0.22) and oxidized LDL (15 ± 33% vs. 18 ± 47%, p=0.30); (2) no changes in inflammatory markers; and, (3) a higher increase of the PFA-100 with E10/S20 than with S80 (27 ± 43% vs. 8 ± 33%, p=0.02)., Conclusions: These data suggest that among stable CAD patients treated with S20, (1) both E10/S20 and S80 were equally effective in further reducing LDL-C; (2) neither treatment had any further significant anti-inflammatory effects; and (3) E10/S20 was more effective than S80 in inhibiting platelet aggregation. Thus, despite similar lipid lowering and doses 4× less of simvastatin, E10/S20 induced a greater platelet inhibitory effect than S80., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
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24. Natriuretic peptides and long-term mortality in patients with severe aortic stenosis.
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Katz M, Tarasoutchi F, Pesaro AE, Lopes RD, Spina GS, Vieira ML, and Grinberg M
- Subjects
- Aged, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Biomarkers, Disease Management, Echocardiography methods, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prognosis, Severity of Illness Index, Survival Rate, Survivors, Aortic Valve metabolism, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis metabolism, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Natriuretic Peptide, Brain metabolism, Peptide Fragments metabolism
- Abstract
Background and Aim of the Study: The natriuretic peptides, brain natriuretic peptide (BNP) and its N-terminal prohormone (NT-proBNP), can be used as diagnostic and prognostic markers for aortic stenosis (AS). However, the association between BNP, NT-proBNP, and long-term clinical outcomes in patients with severe AS remains uncertain., Methods: A total of 64 patients with severe AS was prospectively enrolled into the study, and underwent clinical and echocardiographic assessments at baseline. Blood samples were drawn for plasma BNP and NT-proBNP analyses. The primary outcome was death from any cause, through a six-year follow up period. Cox proportional hazards modeling was used to examine the association between natriuretic peptides and long-term mortality, adjusting for important clinical factors., Results: During a mean period of 1,520 +/- 681 days, 51 patients (80%) were submitted to aortic valve replacement, and 13 patients (20%) were medically managed without surgical interventions. Mortality rates were 13.7% in the surgical group and 62% in the medically managed group (p < 0.001). Patients with higher plasma BNP (> 135 pg/ml) and NT-proBNP (> 1,150 pg/ml) levels at baseline had a greater risk of long-term mortality (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.1; HR 4.3, 95% CI 1.4-13.5, respectively). After adjusting for important covariates, both BNP and NT-proBNP remained independently associated with long-term mortality (HR 2.9, 95% CI 1.5-5.7; HR 1.8, 95% CI 1.1-3.1, respectively)., Conclusion: In patients with severe AS, plasma BNP and NT-proBNP levels were associated with long-term mortality. The use of these biomarkers to guide treatment might represent an interesting approach that deserves further evaluation.
- Published
- 2012
25. Effect of beta-blockers on the risk of atrial fibrillation in patients with acute myocardial infarction.
- Author
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Pesaro AE, de Matos Soeiro A, Serrano CV, Giraldez RR, Ladeira RT, and Nicolau JC
- Subjects
- Adrenergic beta-Antagonists adverse effects, Aged, Atrial Fibrillation epidemiology, Atrial Fibrillation mortality, Epidemiologic Methods, Female, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction mortality, Treatment Outcome, Adrenergic beta-Antagonists therapeutic use, Atrial Fibrillation prevention & control, Myocardial Infarction drug therapy
- Abstract
Introduction: Oral beta-blockers improve the prognosis of patients with acute myocardial infarction, while atrial fibrillation worsens the prognosis of this population. The reduction of atrial fibrillation incidence in patients treated with beta-blockers could at least in part explain the benefits of this drug., Objective: To investigate the effect of beta-blockers on the incidence of atrial fibrillation in patients with acute myocardial infarction., Methods: We analyzed 1401 patients with acute myocardial infarction and evaluated the occurrence or absence of atrial fibrillation, the use of oral beta-blockers and mortality during the first 24 hours., Results: a) The use of beta-blockers was inversely correlated with the presence of atrial fibrillation (rho = 0.004; OR = 0.54). b) Correlations with mortality were as follows: 31.5% in patients with atrial fibrillation, 9.2% in those without atrial fibrillation (rho < 0.001; Odds Ratio = 4.52), and 17.5% in patients not treated with beta-blockers and 6.7% in those who received the drug (rho < 0.001; OR = 0.34). c) Adjusted Models: The presence of atrial fibrillation was independently correlated with mortality (OR = 2.48, rho = 0.002). The use of beta-blockers was inversely and independently correlated with mortality (OR = 0.53; rho = 0.002). The patients who used beta-blockers showed a lower risk of atrial fibrillation (OR = 0.59; rho = 0.029) in the adjusted model., Conclusion: The presence of atrial fibrillation and the absence of oral beta-blockers increased in-hospital mortality in patients with acute myocardial infarction. Oral beta-blockers reduced the incidence of atrial fibrillation, which might be at least partially responsible for the drug's benefit.
- Published
- 2010
- Full Text
- View/download PDF
26. Native LDL-cholesterol mediated monocyte adhesion molecule overexpression is blocked by simvastatin.
- Author
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Serrano CV Jr, Pesaro AE, de Lemos JA, Rached F, Segre CA, Gomes F, Ribeiro AF, Nicolau JC, Yoshida VM, and Monteiro HP
- Subjects
- Anticholesteremic Agents therapeutic use, CD11b Antigen blood, Cell Adhesion Molecules blood, Coronary Artery Disease blood, Coronary Artery Disease complications, Female, Humans, Hypercholesterolemia blood, Hypercholesterolemia complications, Hypercholesterolemia drug therapy, L-Selectin blood, Lipopolysaccharide Receptors blood, Male, Middle Aged, Monocytes metabolism, Simvastatin therapeutic use, Anticholesteremic Agents pharmacology, Cell Adhesion Molecules antagonists & inhibitors, Cholesterol, LDL blood, Monocytes drug effects, Simvastatin pharmacology
- Abstract
Aim of the Study: This study sought to evaluate the effect of nLDL concentrations on monocyte adhesion molecule expression in hypercholesterolemic patients with stable coronary artery disease (CAD) and to determine whether lipid-lowering therapy with simvastatin would change this effect., Methods: Blood samples from patients with hypercholesterolemia (mean LDL 152 mg/dL) and CAD (HC, n = 23) were collected before and after a 12-week treatment with 40 mg of simvastatin. Healthy individuals (mean LDL 111 mg/dL) were used as controls (CT, n = 15). Isolated nLDL, at a fixed concentration of 100 mg/dL, was added to monocyte suspensions obtained before and after the simvastatin treatment. Monocyte activation was determined by changes in cellular adhesion molecule expression., Results: In response to nLDL, CD11b and CD14 adhesion molecule expression was higher in HC patients than in CT patients before treatment (174.2 +/- 8.4 vs 102.2 +/- 6.3, P < 0.03 and 140.4 +/- 5.0 vs 90.4 +/- 6.7, P < 0.04). After simvastatin treatment, CD11b expression decreased to 116.9 +/- 12.5 (P < 0.03) and CD14 expression to 107.5 +/- 6.2 (P < 0.04). Alternatively, L-selectin expression was lower in HC patients than in CT patients before therapy (46.0 +/- 3.5 vs 62.1 +/- 5.5, P < 0.04), and it increased markedly after lipid reduction to 58.7 +/- 5.0 (P < 0.04 vs baseline). After simvastatin treatment, LDL was reduced to mean 101.5 mg/dL., Conclusions: These data demonstrate that monocytes from HC patients are more prone to marked nLDL-mediated changes of adhesion molecule expression than monocytes from controls. Simvastatin is capable of inhibiting such nLDL effects. This proinflammatory response to nLDL may have a role in the early onset of atherosclerosis.
- Published
- 2009
- Full Text
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27. Influence of leukocytes and glycemia on the prognosis of patients with acute myocardial infarction.
- Author
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Pesaro AE, Nicolau JC, Serrano CV Jr, Truffa R, Gaz MV, Karbstein R, Giraldez RR, Kalil Filho R, and Ramires JA
- Subjects
- Biomarkers blood, Blood Glucose analysis, Brazil epidemiology, Epidemiologic Methods, Female, Humans, Hyperglycemia complications, Hyperglycemia mortality, Leukocyte Count, Leukocytosis blood, Male, Middle Aged, Myocardial Infarction blood, Prognosis, Hospital Mortality, Leukocytosis mortality, Myocardial Infarction mortality
- Abstract
Background: 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<0.001, 95%CI = 19.4 - 52.6), respectively. b) With the adjusted mode, the same pattern was observed [p values: 0.002 (t-ratio 3.05), 0.04 (t-ratio 2.06), respectively]. c) Long-term follow-up: the univariate analysis showed P values of 0.001 (t-ratio 3.3), <0.001 (t-ratio 4.16), respectively. The multivariate analysis showed P=0.001 (t-ratio 3.35), 0.08 (t-ratio 1.75), respectively. (d) After the exclusion of the intrahospital deaths, the leukocyte (P=0.989) and glucose levels (P=0.144) did not remain significantly correlated with mortality. The same result was observed at the multivariate analysis., Conclusion: The levels of glucose and leukocytes at the hospital admission of patients with AMI are excellent predictors of intrahospital mortality and poor predictors of long-term death.
- Published
- 2009
- Full Text
- View/download PDF
28. Coronary artery bypass surgery, angioplasty and long term anti-platelet treatment in a type B hemophilia patient.
- Author
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Pesaro AE, Gaz MV, Karbstein R, Perin M, Serrano CV, and Damico E
- Subjects
- Adult, Humans, Male, Angioplasty, Balloon, Coronary, Coronary Artery Bypass, Factor IX therapeutic use, Hemophilia B therapy
- Published
- 2009
- Full Text
- View/download PDF
29. Acute coronary syndromes: treatment and risk stratification.
- Author
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Pesaro AE, Campos PC, Katz M, Corrêa TD, and Knobel E
- Abstract
Background and Objectives: Acute coronary syndromes result from a disruption of a vulnerable coronary plaque complicated by intraluminal thrombus formation, embolisation, and variable degrees of coronary obstruction. Patients with total occlusion may present with acute ST Elevation Myocardial Infarction (STEMI). Partial vessel obstruction may result in Non-ST-Elevation Acute Myocardial Infarction (NSTEMI) or unstable angina (UA). Clinical symptoms and electrocardiographic changes are the main components of identification of ACS. The rapid and effective triage of such patients regarding presence or absence of ST-segment elevation is critical to dictate further therapeutic strategies. The objective of this chapter was to review current evidence and recommendations for the evaluation and early treatment of acute coronary syndromes., Contents: We performed a clinical review using the electronic databases MedLine and LILACS from January 1990 to September 2007., Conclusions: Reperfusion of the infarct-related artery is the cornerstone of therapy for STEMI. Fibrinolysis and percutaneous coronary intervention are both well established as effective options. Management of UA/NSTEMI patients requires early risk stratification. High-risk patients should undergo an early invasive strategy that consists in performance of cardiac catheterization in the first 24 to 48 hours of presentation.
- Published
- 2008
30. Dengue: cardiac manifestations and implications in antithrombotic treatment.
- Author
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Pesaro AE, D'Amico E, and Aranha LF
- Subjects
- Dengue diagnosis, Heart Diseases drug therapy, Humans, Risk Factors, Thrombolytic Therapy, Thrombosis etiology, Time Factors, Anticoagulants administration & dosage, Dengue complications, Fibrinolytic Agents administration & dosage, Heart Diseases etiology, Thrombosis prevention & control
- Published
- 2007
- Full Text
- View/download PDF
31. Coronary artery disease in women: a review on prevention, pathophysiology, diagnosis, and treatment.
- Author
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Araujo LF, de Matos Soeiro A, Fernandes JL, Pesaro AE, and Serrano CV Jr
- Subjects
- Acute Disease, Female, Heart Diseases diagnosis, Heart Diseases etiology, Humans, Male, Practice Guidelines as Topic, Risk Factors, Sex Factors, Syndrome, Coronary Artery Disease diagnosis, Coronary Artery Disease etiology, Coronary Artery Disease physiopathology, Coronary Artery Disease prevention & control, Coronary Artery Disease therapy, Women's Health
- Abstract
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.
- Published
- 2006
- Full Text
- View/download PDF
32. [Negative sestamibi-dipyridamole perfusion imaging in severe coronary artery disease in the preoperative period of correction of abdominal aortic aneurysm].
- Author
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Halpern H, Miyoshi E, Pesaro AE, Serrano CV Jr, and Wolosker N
- Subjects
- Aged, Dipyridamole, Humans, Male, Radionuclide Imaging, Radiopharmaceuticals, Severity of Illness Index, Technetium Tc 99m Sestamibi, Aortic Aneurysm, Abdominal surgery, Coronary Artery Disease diagnostic imaging, Preoperative Care
- Abstract
We report the case of a 73-year-old male patient who was a candidate for correction of an abdominal aortic aneurysm without abnormalities in his first cardiological evaluation. The surgery was postponed because of the need for treatment of epididymitis. Two weeks later, the patient returned to the hospital with thoracic pain, when the angiography showed obstructions in 2 coronary arteries, which were successfully treated with percutaneous transluminal angioplasty and stent implantation. After 45 days, the patient underwent surgery for correction of the abdominal aortic aneurysm under peridural and general anesthesia. The patient evolved without complications.
- Published
- 2005
- Full Text
- View/download PDF
33. [Case 2/2004--fever, chest pain, dyspnea and edema in a 42-year-old man].
- Author
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Pesaro AE and Gutierrez PS
- Subjects
- AIDS-Related Opportunistic Infections complications, Adult, Chest Pain diagnosis, Chest Pain etiology, Edema diagnosis, Edema etiology, Extremities, Fatal Outcome, Fever diagnosis, Fever etiology, Humans, Male, Pericarditis, Tuberculous complications, AIDS-Related Opportunistic Infections diagnosis, Pericarditis, Tuberculous diagnosis
- Published
- 2004
- Full Text
- View/download PDF
34. [Acute myocardial infarction -- acute coronary syndrome with ST-segment elevation].
- Author
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Pesaro AE, Serrano CV Jr, and Nicolau JC
- Subjects
- Angioplasty, Fibrinolytic Agents therapeutic use, Humans, Prognosis, Syndrome, Thrombolytic Therapy, Myocardial Infarction diagnosis, Myocardial Infarction drug therapy, Myocardial Infarction therapy
- Abstract
Cardiovascular diseases continue to be the first cause of death in Brazil -- responsible for almost 32% of all deaths. In addition, they are the third major cause of admission in the country. Among them, acute myocardial infarction is still one of the major causes of morbidity and mortality. Despite of the last decade's therapeutic advances, acute myocardial infarction still shows remarkable rates of mortality, and great part of the patients do not receive the adequate treatment. The opening of the Coronary Care Units and the introduction of reperfusion treatment with fibrinolytics or primary angioplasty were fundamental to reduce mortality and complications related to myocardial infarction. Important beneficial effects to the current treatment include less ventricular dysfunction and better control of ventricular arrhythmias. The need of early reperfusion is crucial for the good prognosis after a myocardial infarction. The objective of this review is to emphasize the modern basic concepts of the pathophysiology, diagnosis and treatment of acute myocardial infarction, according to national and international guidelines.
- Published
- 2004
- Full Text
- View/download PDF
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