Em todo o mundo, são realizadas mais de 230 milhões de operações por ano e as complicações cardíacas são as causas mais comuns de morbidade e mortalidade pós-operatórias. Com o aumento da expectativa ...de vida da população mundial, um número crescente de pacientes com múltiplas comorbidades tem sido submetido a operações não cardíacas. Em consequência, é esperado um aumento de complicações cardiovasculares associadas a tais procedimentos e o infarto agudo do miocárdio (IAM) perioperatório poderá se tornar um problema frequente. No Brasil, o número de operações não cardíacas também está aumentando, sendo realizadas aproximadamente três milhões de cirurgias por ano. Apesar dos avanços nas técnicas cirúrgicas e anestésicas, a mortalidade e o custo relacionados a estes procedimentos também estão aumentando, sendo fundamental o desenvolvimento de estratégias para a redução da mortalidade. A ocorrência de um IAM perioperatório prolonga a necessidade de terapia intensiva, a estadia hospitalar, aumenta o custo da internação e diminui a sobrevida a longo prazo. Esta revisão aborda a fisiopatologia, a incidência, o diagnóstico e o tratamento do IAM perioperatório, baseado nas evidências atuais.
People with HIV (PWH) are at an increased risk of atherosclerotic cardiovascular disease. Suboptimal responses to statin therapy in PWH may result from antiretroviral therapies (ARTs). This ...open-label extension study aimed to evaluate the long-term safety and efficacy of evolocumab up to 52 weeks in PWH.
This final analysis of a multinational, placebo-controlled, double-blind, randomized phase 3 trial evaluated the effect of monthly subcutaneous evolocumab 420 mg on low-density lipoprotein cholesterol (LDL-C) during the open-label period (OLP) following 24 weeks of double-blind period in PWH with hypercholesterolemia/mixed dyslipidemia. All participants enrolled had elevated LDL-C or nonhigh-density lipoprotein cholesterol (non-HDL-C) and were on stable maximally tolerated statin and stable ART.
Efficacy was assessed by percentage change from baseline in LDL-C, triglycerides, and atherogenic lipoproteins. Treatment-emergent adverse events (TEAEs) were examined.
Of the 467 participants randomized in the double-blind period, 451 (96.6%) received at least one dose of evolocumab during the OLP (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). By the end of the 52-week OLP, the overall mean (SD) percentage change in LDL-C from baseline was -57.8% (22.8%). Evolocumab also reduced triglycerides, atherogenic lipid parameters (non-HDL-C, apolipoprotein B, total cholesterol, very-low-density lipoprotein cholesterol, and lipoproteina), and increased HDL-C. TEAEs were similar between placebo and evolocumab during the OLP.
Long-term administration of evolocumab lowered LDL-C and non-HDL-C, allowing more PWH to achieve recommended lipid goals with no serious adverse events.
NCT02833844.
http://links.lww.com/QAD/C441.
Purpose
To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D).
Methods
...This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m
2
and < 35 kg/m
2
, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months.
Results
At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%,
P
= < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%,
P
= NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m
2
versus 30.9 ± 2.5 kg/m
2
;
P
= < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL,
P
< 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL;
P
= 0.001).
Conclusions
SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
•To determine the prognostic value of perioperative hs-TnI in addition to traditional cardiac risk tools in patients undergoing elective major orthopedic surgery.•To evaluate the incidence of ...perioperative myocardial injury through systematic hs-TnI monitoring in a tertiary orthopedic center in Brazil.•Assessing mortality and cardiovascular complications in the short- and long-term periods after elective major orthopedic surgery.
The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval 95 % CI 1.3–19.3). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7–96.5) and 7.7 (95 % CI 2.2–26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio HR = 3.97, 95 % CI 1.13–13.89 and HR = 5.80, 95 % CI 1.93–17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
The advances in surgical technique were notable and now allow procedures in a broader population including high-risk patients. ...there has been a steep increase in the number of major surgical ...procedures performed in these high-risk patients, raising the perioperative cardiovascular event rates.
In this review, we present the contributions to nutrition science from Latin American native peoples and scientists, appreciated from a historic point of view since pre-historic times to the modern ...age. Additionally, we present epidemiological and clinical studies on the area of plant-based diets and their relation with the prevention and treatment of cardiovascular diseases conducted in recent decades, and we discuss challenges and perspectives regarding aspects of nutrition in the region.
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