Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) in breathing during sleep due to airway collapse in the pharyngeal region. ...OSA and its cardiovascular consequences have been widely explored in observational and prospective studies. Most evidence verifies the positive relationship between OSA and hypertension, coronary artery disease, atrial fibrillation, stroke and heart failure. However, more studies are needed to better assess the impact of OSA, and possible benefit of treatment with continuous positive airway pressure (CPAP) on dyslipidemia, type 2 diabetes, insulin resistance and cardiovascular mortality. The leading pathophysiological mechanisms involved in the changes triggered by OSA, include intermittent hypoxemia and re-oxygenation, arousals and changes in intrathoracic pressure. Hypertension is strongly related with activation of the sympathetic nervous system, stimulation of the renin-angiotensin-aldosterone system and impairment of endothelial function. The high prevalence of OSA in the general population, hypertensive patients and especially obese individuals and patients resistant to antihypertensive therapy, highlights the need for effective screening, diagnosis and treatment of OSA to decrease cardiovascular risk.
Abstract
Background/Introduction
With increasing evidence of LDL-cholesterol (LDL-c) lowering and a subsequent reduction in cardiovascular events, guidelines of different parts of the world aim for ...lower LDL-c goals by risk stratification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition has been able to reduce up to 60% LDL-c levels, with further reduction in cardiovascular outcomes.
Purpose
Our aim was to evaluate the proportion of very high risk patients in a tertiary cardiology center that met LDL-c goal of less than 50mg/dL proposed by the Brazilian Society of Cardiology (BSC) guidelines. Furthermore, we assessed the number of patients that were receiving adequate statin intensity therapy and could benefit from PCSK9 inhibition by the FOURIER/ODYSSEY and by the National Institute for Health and Care Excellence (NICE) criteria.
Methods
We screened 2180 consecutive patients from March, 2018 to February, 2019 for cardiovascular risk factors, cholesterol and glycemic levels, and current medical therapy at use. Patients were stratified by level of risk, and compliance to recommended statin therapy was evaluated. We then analyzed how many of the very high risk patients, that were in use of high intensity statin therapy, met the inclusion LDL-c levels of the FOURIER/ODYSSEY trials (≥70mg/dL) and the NICE recommendations (≥140mg/dL) for the introduction of PCSK9 inhibitors.
Results
Of the 2180 patients enrolled to our study, 1225 (56.2%) patients were at very high cardiovascular risk level. Of these patients, 136 (11.1%) met LDL-c BSC guideline levels. Using the LDL-c target of 70mg/dL, an additional 320 (26.1%) patients were below target range. When analyzing statin therapy at use, 913 (74,5%) were receiving adequate statin therapy. Of the very high risk patients in adequate statin treatment, 617 (65.9%) by the FOURIER/ODYSSEY criteria and 88 (9.4%) patients by the NICE criteria would benefit from PCSK9 inhibitors.
Conclusions
With lower LDL-c goals, achievement of optimal LDL-c levels is now a challenge for current clinical practice. Even though many patients are receiving adequate guideline-based statin therapy, difficulty remains in achieving optimal treatment, especially in the higher risk stratum. These patients would benefit from PCSK9 inhibition, being the NICE criteria, a more cost-effective strategy, still applicable in a substantial portion of our patients.
Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA) is a common but still underestimated condition. OSA often coexists and ...interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed. Keywords: obstructive sleep apnea, hypertension, cardiac function
Análisis de espectros biológicos ponderados en pampas del sudeste de la provincia de Chubut Bertolami, Miguel A.(Universidad Nacional de la Patagonia San Juan Bosco Facultad de Ciencias Naturales); Rueter, B. L.(Universidad Nacional de la Patagonia San Juan Bosco Facultad de Ciencias Naturales); Benítez, M.(Universidad Nacional de la Patagonia San Juan Bosco Facultad de Ciencias Naturales)
Multequina,
12/2008, Letnik:
17, Številka:
2
Journal Article
Odprti dostop
La fisonomía dominante en las mesetas o "pampas" del sudeste de la provincia de Chubut es la Estepa Subarbustivo-herbácea en Pampa Vaca (Distrito Central) y Estepa Herbáceo-arbustiva en Pampa ...Salamanca (Distrito del Golfo San Jorge), con proporciones variables de especies subarbustivas, arbustivas y gramíneas. Los objetivos de este trabajo fueron: 1) conocer el Espectro Biológico en ambas "pampas" y 2) evaluar las fluctuaciones estacionales de la biomasa verde, seca y muerta, por cada forma de vida. Se utilizó el test de Chi cuadrado (α²) para comparar los espectros obtenidos con el Espectro Biológico Normal de Raunkiaer. Finalmente los espectros obtenidos se relacionaron con el clima del área de estudio. En Pampa Vaca se encontraron 28 especies distribuidas en 10 familias de las cuales, las familias Poaceae y Asteraceae fueron mayoritarias. Las formas de vida dominantes fueron Caméfitas (subarbustos) y Hemicriptófitas (gramíneas). Se obtuvo diferencias significativas (α < 0,05) cuando se comparó el especto biológico observado con el teórico. La fluctuación estacional mostró que la biomasa verde de las especies Caméfitas estuvo relacionada con los años húmedos. En tanto que en Pampa Salamanca se encontraron 80 especies distribuidas en 25 familias de las cuales, al igual que en Pampa Vaca, las familias Poaceae y Asteraceae fueron las más ricas. La forma de vida dominante fueron las Nanofanerófitas, siguiéndoles las Caméfitas y Hemicriptófitas. Se obtuvo una diferencia altamente significativa entre las Nanofanerófitas y Caméfitas al comparar el espectro biológico observado con el teórico. Según la fluctuación estacional observada en los datos de biomasa, la biomasa verde de las Hemicriptófitas mostró una mejor respuesta a la vegetación que el resto de las formas de vida.
Dwarf shrubs and herbaceous steppes are the dominant physiognomic types in Pampa Vaca (Central District), southeastern Chubut, while shrubs and herbaceous steppes dominate in Pampa Salamanca (San Jorge Gulf District), but the latter with variable proportions of dwarf shrubs, shrubs and grasses. The aims of this study were 1) to describe the life forms spectra in both "pampas" and 2) to report the seasonal fluctuations in green, dry and dead biomass sorted into life forms. Chi squared test (X²) was used to compare the spectra obtained with the Normal Biologic Spectrum of Raunkiaer. Finally the spectra obtained were related to the climate of the area. A total of 28 species, belonging to 10 families, were recorded in Pampa Vaca; most of the species were Poaceae and Asteraceae. The dominant life forms were Chamaephytes (dwarf shrubs) and Hemicryptophytes (graminoids). Significant differences (α< 0,05) were obtained when the observed and theoretical biologic spectra were compared. The seasonal fluctuation showed that the Chamaephytes green biomass was related to wet years. In Pampa Salamanca a total of 80 species, distributed in 25 families, was found and similarly to Pampa Vaca, the Poaceae and Asteraceae were the richest families. The dominant life form was the Nanophanerophytes (shrubs), followed by the Chamaephytes and Hemicryptophytes. Highly significant differences were observed for Nanophanerophytes and Chamaephytes when the observed and theoretical biologic spectra were compared. According to the seasonal fluctuation observed in the biomasa data, it is assumed that the Hemicryptophytes green biomass had a better response to the rain.
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