Prevalence of Risk Factors for Coronary Artery Disease in the Brazilian State of Rio Grande do Sul

OBJECTIVE - To determine the risk factors prevalence for coronary artery disease in the State of Rio Grande do Sul, Brazil and to identify their relation with the age bracket. METHODS - We carried out an observational, cross-sectional study of 1,066 adults older than 20 years in the Brazilian State of Rio Grande do Sul. We investigated the risk factors: familial antecedents, systemic arterial hypertension, high levels of cholesterol and glycemia, overweight/obesity, smoking and sedentary lifestyle. A standardized questionnaire completed at the patients' dwellings by health agents were used; the data were stored in an EPI-INFO software database. The results were expressed with a 95% confidence interval. RESULTS - The sample composition was of 51.8% females. The risk factors prevalences were: 1) sedentary lifestyle 71.3%; 2) familial antecedents: 57.3%; 3) overweight/obesity (body mass index >25): 54.7%; 4) smokers: 33.9%; 5) hypertension: 31.6% (considering >140/90mmHg) and 14.4% (considering >160/95mmHg); 6) high glycemia (>126 mg/dL): 7%; 7) high cholesterol >240 mg/dL): 5.6%. CONCLUSION - The prevalence of the major risk factors for coronary artery disease in the Brazilian state of Rio Grande do Sul could be determined in a study that integrated public and private institutions.

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

OBJECTIVE: To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. METHODS: We retrospectively analyzed the in-hospital and late evolution of 189 patients with multivessel coronary disease, who underwent percutaneous coronary stent placement. These patients were divided into 2 groups as follows: group I (GI) - 59 patients with involvement of the proximal segment of the anterior descending coronary artery; and group II (GII) - 130 patients without involvement of the proximal segment of the anterior descending coronary artery. RESULTS: No significant difference was observed in the success rate of the procedure (91.5% versus 97.6%, p=0.86), nor in the occurrence of major adverse cardiac events (5.1% versus 1.5%, p=0.38), nor in the occurrence of major vascular complications (1.7% versus 0%, p=0.69) in the in-hospital phase. In the late follow-up, the incidence of major adverse cardiac events (15.4% versus 13.7%, p=0.73) and the need for new revascularization (13.5% versus 10.3%, p=0.71) were similar for both groups. CONCLUSION: The in-hospital and late evolution of patients with multivessel coronary disease with and without involvement of the proximal segment of the anterior descending coronary artery treated with coronary stent placement did not differ. This suggests that this revascularization method is an effective procedure and a valuable option for treating these types of patients.

Medical care and deaths due to coronary artery disease in Brazil, 1980-1999

OBJECTIVE: To estimate the frequency of medical care preceding deaths due to coronary artery diseases (CAD) in different Brazilian regions and capitals and to describe trends in medical care from 1980 to 1999. METHODS: Information on medical care preceding deaths due to coronary artery diseases/acute myocardial infarction in adults > 20 years from 1980 to 1999 was collected in the DATASUS, the databank of the Brazilian Health Ministry. Sex, states, and capitals selected for 1999 were analyzed in the study. Medical care was stratified as follows: with, without, and ignored medical care. The descriptive analysis comprised frequencies, ratios of frequency, test for proportions, and increments or reductions in frequencies. RESULTS: Acute myocardial infarction (AMI) represented 75 to 85% of the CAD in the period; the frequency of deaths with medical care ranged from 48.9 to 63%, and that of ignored medical care ranged from 27.2 to 41.5%. The frequency of other CAD with medical care ranged from 56 to 76%. The frequency of deaths preceded by medical care decreased by 17.8%, and that with ignored medical care increased by 36.5% (RF=2). The values for the other CAD were -20.2% and +64.6% (RF=44.4). Deaths preceded by medical care were more frequent in females at all ages and in all Brazilian regions. CONCLUSION: The results show a high frequency of sudden death and suggest errors in diagnosis or codification and overestimation of the statistics about mortality. Validation of the death certificate diagnosis and frequent surveillance are required.

Quantifying the risk of coronary artery disease in a community: The Bambuí Project

OBJECTIVE: To determine the coronary risk profile in adults and elderly in a community. METHODS: The study comprised a sample of adults (30-59 years, n=547) and the entire elderly population (60-74 years, n=1165) residing in Bambuí town, Brazil. The Framingham score based on sex, age, smoking, diabetes mellitus, systolic and diastolic blood pressure, total cholesterol, and HDL-C was used. The score based on age and sex was defined as "expected" and compared with the mean score obtained by the sum of all risk factors in each age group and sex (score "observed"). RESULTS: The difference between the scores "observed" and "expected" increased with aging in both sexes. Smoking increased the difference from 30 years of age onwards, in both sexes, and hypertension was important in men above the age of 30 years and in women above the age of 50 years. Diabetes and elevated total cholesterol increased the risk of the disease above the age of 50 years in both sexes. A higher level of HDL-C reduced the risk among men above the age of 30 years, with no significant difference among women. Less schooling (< 4 years versus ³ 4 years) was associated with a higher score in adults of both sexes, but not among the elderly. CONCLUSION: Based on these results, in the community studied, the risk of coronary artery disease may be reduced up to 44% in men and 38% in women.

Mapeo de QTL para Mal de Río Cuarto en maíz. QTL mapping for tolerance to Mal de Río Cuarto disease in maize.

El Mal de Río Cuarto (MRC) es una enfermedad del maíz (Zea mays L.), endémica de ciertas zonas de la Argentina y constituye la patología más importante de este cultivo por la severidad de los daños y por la creciente difusión del área geográfica afectada. El empleo de la resistencia genética bajo un manejo integrado de la enfermedad, constituye la estrategia más económica y ambientalmente sustentable para lograr el incremento y la estabilidad en la producción de los cultivos de maíz, reduciendo el uso nocivo de agroquímicos. La reacción a la enfermedad MRC se encuentra influida por una fuerte interacción genotipo-ambiente que dificulta el mejoramiento genético. En los ensayos multiambientales la inconsistencia de la respuesta y la inestabilidad de los genotipos ensayados hace dificultoso llevar a cabo una buena selección basada en los síntomas de la enfermedad. Para contribuir a aumentar la eficacia de los métodos de mejoramiento es posible implementar programas en los que se incluyan herramientas biotecnológicas como los marcadores moleculares, que permiten reducir el efecto ambiental y contribuyen a soslayar, al menos en parte, los inconvenientes planteados por los efectos de la interacción genotipo-ambiente facilitando la identificación de los genotipos buscados. La selección fenotípica realizada convencionalmente, puede ser complementada con la selección asistida por marcadores (marker-assisted selection MAS) consistente en utilizar la información genética que brindan marcadores moleculares de ADN, tales como los SSR, asociados a loci o segmentos cromosómicos (quantitative trait loci QTL) que confieran resistencia a MRC. Si bien los resultados preliminares obtenidos por nuestro grupo de trabajo señalan la presencia de posibles QTLs e informan que la reacción frente a la enfermedad tiene una moderada heredabilidad y una substancial variación debida a la interacción genotipo-ambiente, es necesario confirmar los resultados relativos a los parámetros poblacionales y obtener una mejor delimitación de las regiones genómicas identificadas. Con la finalidad de aumentar la eficiencia de los programas de mejoramiento en el desarrollo de genotipos tolerantes mediante la selección asistida por marcadores utilizando una población de mapeo F2 con un fondo genético diferente y líneas endocriadas recombinantes evaluadas en ensayos multiambientales, se proponen los siguientes objetivos (i) estudiar la forma de herencia de la reacción frente a MRC, (ii) identificar nuevos QTLs asociados a este carácter y (iii) verificar la consistencia de los QTLs identificados previamente.

Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011

Background:Circulatory system diseases are the first cause of death in Brazil.Objective:To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast), from 1996 to 2011.Methods:Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011.Results:Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005.Conclusions:Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes.

Prevalence of Rheumatic Heart Disease in a Public School of Belo Horizonte

Background: Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals. Objectives: To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography. Methods: This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR) and/or aortic regurgitation (AR) were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG) to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible. Results: Of the 267 students, 1 (0.37%) had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF) and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%). Of these, 16 (6%) underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student. Conclusion: In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000) than on clinical evaluation (3.7/1000-95% CI).

Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

AbstractBackground:Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy.Objective:To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy.Methods:The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased.Results:A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation.Conclusion:In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5).

Variations in the Prevalence of Risk Factors for Coronary Artery Disease in Rio Grande do Sul-Brazil: A Comparative Analysis between 2002 and 2014

Abstract Background: Due to the importance of coronary artery disease (CAD), continuous investigation of the risk factors (RFs) is needed. Objective: To evaluate the prevalence of RFs for CAD in cities in Rio Grande do Sul State, and compare it with that reported in a similar study conducted in the same cities in 2002. Methods: Cross-sectional study on 1,056 healthy adults, investigating the prevalence and absolute and relative frequencies of the following RFs for CAD: obesity, systemic arterial hypertension (SAH), dyslipidemias, smoking, sedentary lifestyle, diabetes mellitus, and family history, as well as age and sex. Data was collected in 19 cities, host of the Offices of the Regional Coordinators of Health, as in the 2002 study. Results: Twenty-six percent of the sample consisted of older adults and 57% were women. The prevalence of sedentary lifestyle was 44%, history family 50%, smoking 23%, overweight/obesity 68%, dyslipidemia (high cholesterol levels) 43%, SAH 40%, and diabetes 11%. When compared to the 2002 study, the prevalence of active smoking and sedentary behavior decreased, whereas the prevalence of hypertension, dyslipidemia and obesity increased. Obesity is the most prevalent RF in women, and SAH the most prevalent in men. Conclusions: The prevalence of RFs for CAD in Rio Grande do Sul State remains high. Hypertension, obesity and dyslipidemia are still prevalent and require major prevention programs. Smoking and physical inactivity have decreased in the state, suggesting the efficacy of related campaigns.

Early Markers of Atherosclerotic Disease in Individuals with Excess Weight and Dyslipidemia

Abstract Background: Excessive weight is a cardiovascular risk factor since it generates a chronic inflammatory process that aggravates the endothelial function. Objective: To evaluate the endothelial function in individuals with excess weight and mild dyslipidemia using brachial artery flow-mediated dilation (BAFMD), and the association of endothelial function with anthropometric and biochemical variables. Methods: Cross-sectional study that included 74 individuals and evaluated anthropometric variables (body mass index [BMI], waist-hip ratio [WHR], waist circumference [AC], and percentage of body fat [PBF]), biochemical (blood glucose, insulinemia, ultrasensitive C-reactive protein, fibrinogen, total cholesterol, HDL-cholesterol, triglycerides, and LDL-cholesterol) and endothelial function (BAFMD, evaluated by ultrasound). The statistical analysis was performed with SPSS, version 16.0. To study the association between the variables, we used chi-square, Student's t and Mann-Whitney tests, and Pearson's correlation. Logistic regression analyzed the independent influence of the factors. Values of p < 0.05 were considered significant. Results: The participants had a mean age of 50.8 years, and 57% were female. BMI, WC, WHR, and PBF showed no significant association with BAFMD. The male gender (p = 0.02) and higher serum levels of fibrinogen (p = 0.02) were significantly and independently associated with a BAFMD below 8%. Conclusions: In individuals with excess weight and mild untreated dyslipidemia, male gender and higher levels of fibrinogen were independently associated with worse BAFMD.

Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012

Abstract Background: Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. Objective: to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. Results: there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). Conclusion: Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.

Chagas' disease in the Amazon Basin: V. Periurban palms as habitats of Rhodnius robustus and Rhodnius pictipes - triatomine vectors of Chagas' disease

Trypanosoma cruzi infected Rhodnius robustus and/or Rhodnius pictipes were commonly found, in large numbers, in the Brazilian Amazonian palms Maximiliana regia ("inajá"), Acrocomia sclerocarpa ("mucajá") and Orbignya speciosa ("babaçu"). The common opossum, Didelphis marsupialis, was the animal most frequently associated with triatomine infested palms. R. pictipes, frequently light-attracted into houses from palm trees, was the probable source of an acute case of Chagas' disease in the vicinity of Belém. It is considered that triatomine infested palms are likely to cause some cases of acute Chagas' disease in the States of Amazonas and Rondônia. Possible control methods are suggested.

Epidemiology and prevention of cardiovascular disease in the Seychelles Islands (Indian Ocean)

This article presents selected findings and lessons from a cardiovascular research and prevention program initiated in 1989 in the Republic of Seychelles, a country in demographic and epidemiological transition. Rapid and sustained aging of the population (e.g., two-fold increase of people aged 30-39 from 1979 to 1995) implies, over the next few decades, further dramatic increase of the burden of chronic diseases, particularly cardiovascular disease (CVD). Epidemiological surveillance shows high age-specific rates of CVD (particularly stroke), high prevalence of peripheral atherosclerosis (plaques in carotid and femoral arteries), high prevalence of classical modifiable risk factors in the adult population (particularly hypertension), and substantial proportions of children with overweight. Stagnant life expectancy in men and an increase in women have been observed over the last two decades; this occurred despite largely improved health services and reduced infant mortality rates, and may reflect the large CVD burden found in middle-aged men (less so in middle-aged women). A national program of prevention of CVD has been initiated since 1991, which includes a mix of interventions to reduce risk factors in the general population and in high-risk individuals. Substantial research to back the prevention program indeed shows, at the moment, epidemiological patterns in Seychelles similar to those observed in Western countries (e.g., an association between peripheral atherosclerosis [as a proxy of CVD] and low density lipoprotein-cholesterol, smoking, diabetes, and [inversely] walking). This clearly supports the view that promotion of healthy lifestyles and control of conventional risk factors should be the main targets for CVD prevention and control.