INTRODUÇÃO: A síndrome coronariana aguda (SCA) constitui uma síndrome clínica geralmente causada por doença arterial coronariana (DAC) aterosclerótica e está associada ao infarto agudo do miocárdio (IAM) que pode muitas vezes levar a óbito. Aterosclerose é uma doença progressiva, sistêmica e de inicio precoce caracterizada pelo acúmulo de lipides e elementos fibrosos nas grandes artérias e recentemente foi considerada como uma afecção de origem inflamatória. OBJETIVO: Avaliar a frequência genotípica de E-SELECTINA, MMP9, LIGHT, LT&#945;, VCAM1, ICAM1, LGALS2 e NF&#954;B em pacientes com infarto agudo do miocárdio (IAM), angina instável (AI) e indivíduos que foram submetidos á angiocoronariografia e que apresentaram ausência de processo ateromatoso significativo. Assim como analisar a associação dos polimorfismos com a concentração sérica das formas solúveis das proteínas com a expressão gênica em leucócitos do sangue periférico, procurando estabelecer modelo de analise menos invasiva da aterosclerose. CASUÍSTICA E MÉTODOS: O estudo foi realizado em um grupo de pacientes recrutados no Instituto Dante Pazzanese de Cardiologia (IDPC) com infarto agudo do miocárdio, angina instável e indivíduos que foram submetidos á angiocoronariografia e que apresentaram ausência de processo ateromatoso significativo. Foram incluídos no estudo 93 indivíduos sendo 47 com IAM com e sem supra ST compondo o grupo IAM e 46 com AI ou que foram submetidos á angiocoronariografia e que apresentaram ausência de processo ateromatoso significativo compondo o grupo SIAM, de ambos os sexos com idades entre 45 e 90 anos. Foi realizado o estudo dos polimorfismos dos genes LIGHT (rs344560 e rs2291668), MMP9 (rs17576), LT&#945; (rs909253 e rs1041981), LGALS2 (rs7291467), VCAM1 (rs3176878), ICAM1 (rs281432), E-SELECTINA (rs5368) e NF&#954;B (rs17032705) por pirosequenciamento, a análise da expressão dos genes LIGHT, MMP9, LT&#945;, VCAM1, ICAM1 e NF&#954;B por PCR em tempo real e a dosagem das formas solúveis de VCAM1, ICAM1, E-SELECTINA e MMP9 utilizando o sistema LUMINEX. RESULTADOS: A frequência alélica e genotípica dos polimorfismos estudados (LIGHT [rs344560 e rs2291668], MMP9 [rs17576)] LT&#945; [rs909253 e rs1041981], LGALS2 [rs7291467], VCAM1 [rs3176878], ICAM1 [rs281432], E-SELECTINA [rs5368] e NF&#954;B [rs17032705]) não apresentou relação com doença arterial coronariana. Foi encontrada associação da expressão de LT&#945; com síndrome coronariana aguda (p<0,05) e relação de alguns dos polimorfismos estudados (6+3279C>T de LGALS2, 8+10029G>A de NF&#954;B, 332-3499C>G de ICAM1, Lys178Glu de LIGHT e Asp693Asp de VCAM1) com alterações na expressão gênica, formas solúveis e parâmetros bioquímicos. CONCLUSÕES: Não houve associação dos polimorfismos estudados com síndrome coronariana aguda assim como não houve associação das formas solúveis. Em relação á expressão gênica, foi encontrada associação da expressão de LT&#945; com síndrome coronariana aguda (p<0,05) e alguns dos polimorfismos estudados (6+3279C>T de LGALS2, 8+10029G>A de NF&#954;B, 332-3499C>G de ICAM1, Lys178Glu de LIGHT e Asp693Asp de VCAM1)ocasionaram alterações da expressão gênica, formas solúveis e parâmetros bioquímicos. / BACKGROUND: : Acute coronary syndrome (ACS) is a clinical syndrome usually caused by atherosclerotic coronary artery disease (CAD) and is associates with acute myocardial infarction (AMI) and sometimes can take to death. Atherosclerosis is a progressive disease characterized by the accumulation of lipides and fibrous elements in arteries and recently was considered a disease of inflammatory origin. OBJECTIVE: : Evaluated the genotypic frequency of E-SELECTIN, MMP9, LIGHT, LT&#945;, VCAM1, ICAM1, LGALS2 e NF&#954;B in patients with acute myocardial infarction, unstable angina and individuals who were submitted to coronary angiography and had absence of significant atheromathous process. As well as analyze the polymorphism association with serum concentration of protein soluble forms with gene expression in peripheral blood leukocytes trying to establish a model less invasive to analyze atherosclerosis MATERIALS AND METHODS: : Study in a group of patients recruited in Dante Pazzanese of Cardiology Institute with acute myocardial infarction, unstable angina and in individuals who showed no significant atheromatous process. The study included 93 patients (47 with acute myocardial infarction and 46 with unstable angina or individuals who showed no significant atheromatous process) of both sexes with ages between 45 and 90 years. The genes polymorphisms study was by pyrosequencing, the gene expression was by PCR real time and soluble forms was dosage by LUMINEX. RESULTS: : The allelic and genotypic polymorphisms frequency studied (LIGHT [rs344560 e rs2291668], MMP9 [rs17576)] LT&#945; [rs909253 e rs1041981], LGALS2 [rs7291467], VCAM1 [rs3176878], ICAM1 [rs281432], E-SELECTINA [rs5368] e NF&#954;B [rs17032705]) don\'t presented relation with coronary arterial disease. Was found association with LT&#945; gene expression and coronary acute syndrome (p<0,05) and relation of some polymorphism studied (6+3279C>T de LGALS2, 8+10029G>A de NF&#954;B, 332-3499C>G de ICAM1, Lys178Glu de LIGHT e Asp693Asp de VCAM1) with changes in gene expression, serum soluble forms and biochemical parameters. CONCLUSION: : Do not have association between polymorphisms studied and serum soluble forms with acute coronary syndrome. Was found association with LT&#945; gene expression and coronary acute syndrome (p<0,05) and relation of some polymorphism studied (6+3279C>T de LGALS2, 8+10029G>A de NF&#954;B, 332-3499C>G de ICAM1, Lys178Glu de LIGHT e Asp693Asp de VCAM1) with changes in gene expression, serum soluble forms and biochemical parameters.

Introduction: Scientific evidences demonstrate that Mediterranean Diet is a protective factor for several kinds of chronic non-communicable diseases, such as cardiovascular diseases. This dietary pattern is essential as preventive and treatment measure for these diseases. The accession to changes in habit is a dynamic process, challenging for both patients and healthcare professionals. Nevertheless, in Brazil there are few works that show adherence to diet in patients with Acute Coronary Syndrome. Objective: To assess the accession to a nutritional intervention based on Mediterranean Diet in patients after Acute Coronary Syndrome. Method: A nutritional intervention based on the Mediterranean Diet was performed in 282 patients after Acute Coronary Syndrome, attended at the cardiology ranked hospitals in the state of Sergipe. The intervention was carried out in two appointments, with interval of 90 days between the first and the second, through individualized nutritional care. During the consultations, the food intake frequency questionnaire was applied, anthropometric measures were checked and a dietary prescription was made based on this food pattern. Results: After nutritional intervention, patients significantly increased adherence to Mediterranean dietary patterns (p <0.001). There was no significant difference in adherence to the intervention between patients assisted by the Brazilian Unified Health System and the Supplementary Health Network. The mean of BMI, neck and waist circumferences had a significant reduction (p <0.001) in the interval between the first and the second query. / Introdução: Evidências científicas demonstram que a adesão à Dieta Mediterrânea é fator protetor para diversos tipos de doenças crônicas não transmissíveis, como as doenças cardiovasculares. Este padrão dietético é essencial como medida preventiva e de tratamento para essas doenças. A adesão às mudanças de hábito é um processo dinâmico, desafiador tanto para pacientes quanto para profissionais de saúde. Entretanto, no Brasil são escassos trabalhos que mostrem a adesão à dieta em portadores de Síndrome Coronariana Aguda. Objetivo: Avaliar a adesão à intervenção nutricional baseada na Dieta do Mediterrâneo em pacientes após Síndrome Coronariana Aguda. Casuística e Métodos: Foi realizada intervenção nutricional baseada na Dieta do Mediterrâneo em 282 pacientes após Síndrome Coronariana Aguda, atendidos nos hospitais de referência cardiológica no estado de Sergipe. A intervenção foi realizada em duas consultas, com intervalo de 90 dias entre a primeira e a segunda, por meio de atendimento nutricional individualizado. Durante as consultas aplicou-se o questionário de frequência alimentar, aferiram-se medidas antropométricas e realizou-se prescrição dietética baseada neste padrão alimentar. Resultados: Após a intervenção nutricional, os pacientes aumentaram significativamente a adesão aos padrões da Dieta do Mediterrâneo (p < 0,001). Não houve diferença significativa na adesão à intervenção entre os pacientes assistidos pelo Sistema Único de Saúde brasileiro e pela Rede Suplementar de Saúde. A média do IMC, circunferências do pescoço e da cintura tiveram redução significativa (p < 0,001) no intervalo entre a primeira e a segunda consulta. Conclusão: A intervenção nutricional baseada na dieta do Mediterrâneo obteve satisfatória adesão dos participantes, tanto da rede pública quanto privada, e resultou em significativa redução dos parâmetros antropométricos. / Aracaju, SE

Introdução: A disfunção atrial esquerda está associada a pior prognóstico em diversas situações clínicas. O método de strain bidimensional do átrio esquerdo permite avaliar de forma direta todas as fases da função atrial. Pouco se conhece sobre o comportamento das fases da função atrial esquerda em pacientes com síndrome coronariana aguda. O objetivo desse estudo foi correlacionar as funções de reservatório, conduto e contração do átrio esquerdo com desfechos adversos cardiovasculares em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST. Método: Esse estudo recrutou prospectivamente 109 pacientes com diagnóstico de infarto agudo do miocárdio sem elevação do segmento ST e de angina instável de risco moderado ou alto pelo escore GRACE para realização de ecocardiograma nas primeiras 72 horas. A função atrial foi avaliada por parâmetros ecocardiográficos convencionais e pelo strain bidimensional obtido pela média das janelas apicais 2 e 4 câmaras. O desfecho primário foi avaliado em até um ano de seguimento e foi composto pelos seguintes eventos adversos: óbito, insuficiência cardíaca nova, nova internação por síndrome coronariana aguda ou por insuficiência cardíaca, angina estável com necessidade de nova intervenção coronariana, arritmia (fibrilação atrial ou taquicardia ventricular) e acidente vascular cerebral. Os desfechos secundários foram os combinados desses eventos. Resultados: As médias do strain de reservatório, conduto e contração foram de 25% ± 8, 12% ± 5 e 12% ± 4, respectivamente. O desfecho primário teve uma incidência de 31,8% em até um ano e apresentou uma correlação significativa com o strain de reservatório (HR= 0,92; IC95% 0,88-0,96; p<0,001), de conduto (HR= 0,87; IC95% 0,81-0,94; p<0,001) e de contração (HR= 0,90; IC95% 0,84-0,98; p=0,011). Análise multivariada envolvendo variáveis clínicas e as de função atrial esquerda demonstraram que o strain de reservatório (p=0,03) e de conduto (p=0,046) se mantiveram significativos como preditores do desfecho primário. O strain de conduto se manteve significativo no desfecho combinado de óbito e insuficiência cardíaca (HR= 0,82; IC95% 0,74-0,91; p<0,001) mesmo após análise multivariada com parâmetros clínicos (p<0,001) e ecocardiográficos (p=0,049). Conclusão: A avaliação da função atrial esquerda por meio do strain bidimensional se correlacionou significativamente com desfechos adversos em pacientes com síndrome coronariana aguda sem elevação do segmento ST. O strain de reservatório e de conduto foram marcadores prognósticos independentes para o desfecho primário quando comparados às variáveis clínicas. Já para o desfecho combinado de óbito e insuficiência cardíaca, o strain de conduto foi um preditor independente mesmo após ajustado para variáveis clínicas e ecocardiográficas. / Background: Left atrial dysfunction is associated with worse prognosis in several clinical situations. The left atrial two-dimensional strain method allows direct evaluation of all phases of atrial function. There are few studies on the behavior of the various stages of left atrial function in patients with acute coronary syndrome. The aim of this study was to correlate the functions of reservoir, conduit and contraction of the left atrium with adverse cardiovascular outcomes in patients with non-ST elevation acute coronary syndrome. Method: This study prospectively recruited 109 patients with a non-ST-segment elevation myocardial infarction and unstable angina with moderate or high risk by GRACE score and echocardiography parameters were collected within the first 72 hours of admission. The atrial function was evaluated by conventional echocardiographic parameters and the two-dimensional strain obtained by the mean of the apical two- and four-chamber views. The primary endpoint was assessed during the 1 year follow-up period and was composed of theses adverse events: death, heart failure, rehospitalization for acute coronary syndrome or heart failure, stable angina requiring new coronary intervention, arrhythmia (atrial fibrillation or ventricular tachycardia) and stroke. Secondary outcomes were those combined for these events. Results: The means of reservoir, conduit and contraction strain were 25% ± 8, 12% ± 5 and 12% ± 4, respectively. The primary endpoint occurred in 31.8% patients during the 1 year follow-up period and had a statistically significant correlation with the reservoir strain (HR = 0.92, 95% CI: 0.88-0.96, p <0.001), conduit strain (HR = 0.87, 95% CI: 0.81-0.94, p <0.001) and contraction strain (HR = 0.90, 95% CI: 0.84-0.98, p = 0.011). Multivariate analysis involving clinical variables and left atrial function showed that the reservoir strain (p = 0.03) and conduit (p = 0.046) were independent predictors of endpoint primary. The conduit strain were statistically significant in the combined outcome of death and heart failure (HR = 0.82, 95% CI: 0.74-0.91, p <0.001) even after multivariate analysis with clinical (p <0.001) and echocardiography parametrs (p = 0.049). Conclusion: Evaluation of left atrial function by two-dimensional strain correlated significantly with adverse outcomes in patients with non-ST elevation acute coronary syndrome. The reservoir and conduit strain were independent prognostic markers for the primary endpoint when compared to clinical parametrs. For the combined outcome of death and heart failure, the conduit strain was an independent predictor even after adjusting for clinical and echocardiographic variables.

O tecido adiposo é considerado não somente uma fonte de energia estocável, mas principalmente um órgão endócrino que secreta várias citoquinas, as quais podem contribuir para o desenvolvimento de doenças relacionadas à obesidade, incluindo o diabetes mellitus e a doença vascular aterosclerótica. Dentre esse pool de moléculas, a adiponectina (Arcp30, AdipoQ, apM1, ou GBP28), uma nova proteína semelhante ao colágeno, foi descoberta como uma citoquina específica do adipócito. Neste estudo, realizamos a determinação dos níveis séricos da adiponectina em uma amostra de pacientes hospitalizados com SCA e, posteriormente, avaliamos a associação com os eventos cardiovasculares no seguimento clínico. Método: avaliamos 114 pacientes com SCA de ambos os sexos neste estudo de corte transversa com seguimento clínico mediano de 18 meses. Realizamos análise de regressão multivariada de Cox para identificar associação independente entre adiponectina e o risco subsequente de óbito CV, IAM não-fatal, AVE não-fatal, e rehospitalização com revascularização. Também comparamos os diversos biomarcadores metabólicos, inflamatórios, de coagulação e de necrose miocárdica por quartis de adiponectina. Resultados: Adiponectina não correlacionou-se de modo independente com o risco CV, tanto na análise univariada quanto nos modelos de Cox. Das variáveis metabólicas, a única com valor preditivo para os desfechos primário e co-primário foi a glicemia de jejum, com OR ajustado=1,06 (IC95% 1,01-1,11), p=0,016, e OR ajustado=1,10 (IC95% 1,03-1,17), p=0,003, ambos para incrementos de 10 na glicemia de jejum. Conclusões: Adiponectina não se mostrou variável independente de risco cardiovascular nesta amostra de pacientes com SCA. A glicemia de jejum foi a única variável metabólica com valor preditivo independente para os desfechos cardiovasculares. / Background: The adipose tissue is considered not only an energy resource stock, but mainly an endocrine organ that secretes several cytokines, which may contribute to the development of diseases related to obesity, including diabetes mellitus and the atherosclerotic vascular diseases. Within this pool of molecules, adiponectin (Arcp30, AdipoQ, apM1, or GBP28), a novel protein similar to collagen, was discovered as an adipocyte-specific cytokine. In this study, we determined the serum levels of adiponectin in a sample of patients hospitalized with acute coronary syndromes (ACS), and subsequently we evaluated the association with the cardiovascular events during the follow-up phase. Methods: we evaluated 114 patients with ACS of both genders in this cross-sectional study with a median follow-up of 18 months. We performed a proportional multiple regression analysis of Cox to identify independent association between adiponectina and risk of cardiovascular death, non-fatal acute MI, non-fatal CVA, and rehospitalization requiring revascularization. We also compared the various biomarkers of metabolism, inflammation, coagulation, and of myocardial necrosis divided by quartiles of adiponectin. Results: Adiponectin did not correlate independently with CV risk, either on univariate analysis or on the multiple regression models of Cox. Among the metabolic biomarkers, the only variable with predictive value for the primary and co-primary endpoints was fasting glucose, with an adjusted OR=1,06 (95%CI 1,01-1,11), p=0,016, and adjusted OR=1,10 (95%CI 1,03-1,17), p=0,003, both for increments of 10. Conclusions: Adiponectin was not an independent risk factor for cardiovascular risk in this sample of ACS patients. Fasting glucose was the only metabolic biomarker with a significant and independent predictive value for cardiovascular outcomes.

Orientadores: Roberta Cunha Matheus Rodrigues, Maria Cecilia Bueno Jayme Gallani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T21:31:16Z (GMT). No. of bitstreams: 1 Mendez_RobertoDellaRosa_M.pdf: 7384004 bytes, checksum: a5895a9ceaaad535753b2f8f2ff15232 (MD5) Previous issue date: 2008 / Mestrado / Mestre em Enfermagem

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-10-16T13:43:04Z No. of bitstreams: 1 Cláudia da Silva e Souza Candiota.pdf: 1367821 bytes, checksum: 76da1e99862549d8491527a138eb18f9 (MD5) / Made available in DSpace on 2015-10-16T13:43:04Z (GMT). No. of bitstreams: 1 Cláudia da Silva e Souza Candiota.pdf: 1367821 bytes, checksum: 76da1e99862549d8491527a138eb18f9 (MD5) Previous issue date: 2014 / Mestrado Profissional em Enfermagem Assistencial / Introdução: o estudo teve como objeto as situações-problema apresentadas por clientes hospitalizados com Síndrome Coronariana Aguda (SCA) e seus graus de complexidade – menor, média e maior. Objetivo geral: elaborar um material de ensino sobre a identificação de situações-problema e seus graus de complexidade em clientes hospitalizados com Síndrome Coronariana Aguda. Objetivos específicos: descrever situações-problema apresentadas; caracterizá-las de acordo com os graus de complexidade; identificar graus de complexidade de situações-problema, segundo os termos aliados à perspectiva diagnóstica de enfermeiros peritos; avaliar a concordância de enfermeiros peritos/experts sobre o grau de complexidade das situações-problema de clientes com SCA; discutir sobre os cuidados de enfermagem indispensáveis aos respectivos graus de complexidade identificados nas situações-problema. Método: estudo qualitativo descritivo. A coleta de dados foi realizada através de entrevista e análise documental em prontuários. O cenário foi a Unidade Coronariana de um hospital da rede pública. A análise dos dados descritiva foi composta por distribuições de frequências, cálculo das estatísticas médias e desvio padrão. Resultados: foram elaboradas 26 situações-problema dos clientes e, em seguida, foram enviadas aos enfermeiros peritos para a análise e classificação dos graus de complexidade. De acordo com a avaliação dos enfermeiros, as situações-problema dos clientes classificadas como de maior complexidade atingiram a sua maioria, em relação às de média e de menor complexidade, com ênfase na doença e seus sinais e sintomas. A organização e descrição das situações-problema foram realizadas com base em método de ensino que inclui narração inicial, enquadramento diagnóstico da problemática situacional do cliente, questões pedagógicas e narração final. Conclusão: Neste estudo, foram identificadas as situações-problema de clientes com diagnóstico de SCA em relação aos graus de complexidade – menor, média e maior, com abordagem direcionada aos problemas evidentes e não evidentes, baseados nas avaliações de enfermeiros peritos / Introduction: this study was focused on the problem-situations presented by customers hospitalized with Acute Coronary Syndrome (ACS) and its levels of complexity – smaller, medium and greater. General objective: to develop a teaching material about the identification of problem-situations and their levels of complexity in hospitalized customers with Acute Coronary Syndrome. Specific Objectives: to describe problem-situations presented; characterize them according to the levels of complexity; to identify levels of complexity of problem-situations, according to the terms linked to the diagnostic perspective of expert nurses; to evaluate the concordance of expert nurses/experts on the level of complexity of problem-situations of customers with ACS; to discuss about the nursing care essential to the respective levels of complexity identified in problem-situations. Method: this is a descriptive and qualitative study. Data collection was conducted through interviews and documentary analysis in medical charts. The scenario was the Coronary Care Unit of a public hospital. Data analysis was descriptive and comprised of distributions of frequency, calculation of average statistics and standard deviation. Results: 26 problem- situations of customers were designed and, subsequently, conveyed to expert nurses for the analysis and classification of levels of complexity. According to the evaluation of nurses, the problem-situations of customers classified as of greater complexity have reached the majority in relation to the medium and smaller complexity, with emphasis on the disease and its signs and symptoms. The organization and description of problem-situations were performed with basis on a teaching method that includes initial narration, diagnostic framework of the situational problematic of the customer, pedagogical issues and final narration. Conclusion: in this study, the problem-situations of customers diagnosed with ACS in relation to the levels of complexity were identified – smaller, medium and greater, with an approach directed to the evident and non-evident problems, based on the evaluations of expert nurses

Contexte : Il y a très peu de données sur l’utilisation et la sécurité CV du paracétamol et des AINS à faible dose en l’automédication. Objectifs : établir les caractéristiques des utilisateurs, évaluer et comparer le risque de syndrome coronarien aigu (SCA), associé au paracétamol (P) et à l'ibuprofène à dose antalgique (IDA). Méthodes : Études d'utilisation, études de cohorte auto-contrôlées (self-controlled cohort - SCC), étude de cohorte appariée sur le score de propension et étude cas-témoin nichée (CTN) ont été réalisé dans l’Echantillon Généraliste Bénéficiaires (EGB) en incluant les épisodes de traitement d’IDA et de P chez les adultes entre 2009 et 2014. Des risques de SCA ont été estimés par les rapports de taux d'événement (RTE) ou les hazard ratios (HRs) avec l’IC à 95%. Résultats : L’utilisation d’OSI et de P concerne surtout des jeunes pour des courtes durées de traitement. Les études SCC ont inclu 316265 et 1025877 épisodes d’IDA et P respectivement chez 168407 et 342494 utilisateurs. Chez les utilisateurs d'aspirine à faible dose (AFD) (3,5% et 5,3% des épisodes d’IDA et de P), le risque de SCA a augmenté après la dispensation d’IDA (RTE 1,52 [1.07 à 2.16]) mais diminué après la dispensation de P (HR 0,39 [0,32 à 0,47]). Chez les non-utilisateurs d’AFD (96,5% d’IDA et 94,7% de P), le risque de SCA n’a augmenté qu’après P (1,32 [1,16 à 1,49]). Dans l'étude de cohorte appariée (age moyen 45 ans), il n'y avait pas de différence entre le P et l’IDA sur la durée totale du suivi (HR 0,97 [0,71 à 1,32]), en dépit d'une augmentation plus élevée avec l’IDA dans les 2 premières semaines (1,75 [1,08 à 2,82]). Dans l'étude CTN (age moyen 67), le risque n’a augmenté qu’avec P, pas avec l’IDA (P : 1,36 [1,23 à 1,50]; IDA : 1,16 [0,78 à 1,72]). 11. Conclusion : Le risque de SCA associé à l’IDA ou au P varie en fonction du statut d’utilisation d’AFD et de l'âge. Pour l’IDA, le risque n'a augmenté que chez les utilisateurs d’AFD. Au contraire, pour P, le risque a augmenté seulement chez les non-utilisateurs d’AFD. Chez les jeunes non-utilisateurs d’AFD, il n'y avait pas de différence entre l’IDA et le P (étude de cohorte apparié). Chez les patients âgés (étude CTN), P semble être associé à un risque plus élevé. / Background : There is little data about the CV safety of Paracetamol (P) and OTC NSAIDs. Objectives : Describe usage patterns, to evaluate and compare the risk of acute coronary syndrome (ACS) associated with P and OTC-Strength ibuprofen (OSI). Methods : Drug utilisation, self-controlled cohort (SCC), propensity score- (PS) matched cohort, nested case-control (NCC) studies were conducted in the Echantillon Généraliste Bénéficiaires (EGB). Studies included P and OSI treatment episodes in adults in 2009-2014. Risks were quantified by event rate ratios (ERRs) or hazard ratio (HRs) with 95% CI. Results : Use of OSI and P concerning mostly young persons for short durations. The SCC studies included 316265 OSI and 1025877 P episodes in 168407 and 342494 users. In low-dose aspirin (LDA) users (3.5% OSI and 5% P episodes), ACS risk increased after OSI dispensing (ERR 1.52 [1.07-2.16]) but decreased after P (HR 0.39 [0.32-0.47]). In LDA nonusers, ACS risk increased after P (1.32 [1.16-1.49]), but not after OSI (1.22 [0.63-2.36]). In the PS-matched study (mean age 45), there was no difference between P and OSI over the total follow-up (HR 0.97 [0.71-1.32]), despite a higher increase with OSI in the first 2 weeks (1.75 [1.08-2.82]). In the NCC study (mean age 67), the risk increased with P but not with OSI (P: 1.36 [1.23-1.50]; OSI: 1.16 [0.78-1.72]). Conclusion : ACS risk associated with OSI or P vary according to LDA use and age. For OSI, ACS risk increased only in LDA users. Conversely, for P, ACS risk increased only in LDA nonusers. In young LDA 9 nonusers, there was no difference between OSI and P (PS-matched study). In older patients (NCC study), P appeared to be associated with a higher risk.

Les monocytes jouent un rôle procoagulant majeur au cours du Syndrome Coronaire Aigu (SCA). Ils expriment à leur surface le Facteur Tissulaire (FT), initiateur majeur de la génération de la thrombine et sont à l’origine de la génération de icroparticules (MPs) procoagulantes exprimant également le FT. L’inhibition de la génération de thrombine et/ou de la génération des MPs monocytaires est ainsi d’un grand intérêt dans le contexte coronaire. Dans la première partie de ce travail, nous avons effectué une étude fondamentale évaluant, in vitro, l’effet d’anticoagulants utilisés dans le SCA, particulièrement le fondaparinux, ainsi que l’effet de l’interleukine-10 (IL-10), une cytokine anti-inflammatoire dotée des propriétés anti-athéromateuses. Ces deux types de molécules ont été analysées seules ou de façon combinée dans des modèles de génération de thrombine et de microvésiculation monocytaire. Ainsi, nous démontrons 1- que l’IL-10 inhibe lamicrovésiculation monocytaire, 2- que les molécules anticoagulantes inhibent d’avantage la génération de thrombine médiée par la MP monocytaire que celle médiée par le monocyte activé 3- que l’IL-10 potentialise l’effet anticoagulant du fondaparinux. Dans la mesure où la production de l’IL-10 est contrôlée génétiquement, nous avons évalué, dans la seconde partie de ce travail, l’association possible entre 5 polymorphismes génétiques de l’IL-10 et lerisque de pathologie coronaire aigue, et ce, dans une population tunisienne (291 patients/291témoins sains). Nous rapportons une association positive entre les variants polymorphes, IL-10 -592A (Odds ratio : 1,82) et IL-10R3 (Odds ratio : 1,46), et la pathologie coronaire. De façon intéressante, la littérature rapporte que ces deux variants polymorphes sont associés à une synthèse faible d’IL-10. En conclusion, nos résultats ne nous autorisent pas à proposer l’étude systématique des polymorphismes de l’IL-10 dans l’appréciation du risque coronaire aigu chez le patient. En revanche, nos résultats suggèrent que l’IL-10 pourrait constituer une molécule prometteuse dans l’arsenal des thérapeutiques anti-thrombotiques. / Procoagulant monocytes play a major role in the pathogeny of the acute coronary syndrome(ACS). Indeed, they express Tissue Factor (TF), the main trigger of thrombin generation, and generate highly procoagulant TF-bearing microparticles (MPs). It is therefore a major issue to control MPassociated thrombin generation in SCA. This led us to evaluate, in the first part of this work, the effect of anticoagulant molecules used in the management of ACS (including fondaparinux) but also of IL-10, an anti-inflammatory cytokine, which can modulate the progression of atheroma. Both types of molecules were evaluated separately or incombination, in a in vitro model of thrombin generation and monocytic MP generation. Ours results show that: 1- IL-10 inhibits monocytic-MP generation; 2- anticoagulants inhibit more potently MP-induced thrombin generation than activated monocyte-induced thrombin generation; 3- IL-10 potentiates fondaparinux inhibitory effect on thrombin generation.As IL-10 production is genetically controlled, we evaluated the possible influence of 5 well-described IL- 10 polymorphisms on the risk of ACS among Tunisians (291 patients/291 healthy controls). Results show that two polymorphic variants of IL-10 i.e. SNP-592A (Odds ratio: 1,82) and microsatellite IL-10R3 Odds ratio: 1,46) are significantly associated with the risk of SCA. Interestingly, the literature reports that these two polymorphic variants are associated with low levels of IL-10 production. In conclusion: Our results do not allow us to recommend the analysis of IL-10 polymorphisms in the assessment of ACS risk. However, our data suggest that IL-10 is a promising antithrombotic pharmacological agent, in this clinical situation.

En hälsosam kosthållning minskar risken för kardiovaskulär sjukdom och bidrar till en minskad risk för akut koronart syndrom. De nordiska näringsrekommendationerna innehåller riktlinjer för att förebygga kardiovaskulär sjukdom, och dessa har vidare kvantifierats av Livsmedelsverket. Trots de stora hälsofördelar som en sådan kosthållning medför når få svenskar de uppsatta målen och kunskapen om hur kostvanorna ser ut hos gruppen av personer som genomgått akut koronar händelse är begränsad. Syftet var att undersöka hur kosthållningen hos patienter som vårdades för akut koronart syndrom stämmer överens med de nordiska näringsrekommendationerna. För att svara på syftet användes en kvantitativ metod i form av en enkätstudie. Fyrtiotvå personer som genomgått akut koronart syndrom rekryterades genom konsekutivt urval på tre hjärtmottagningar i södra Sverige. Svarsfrekvensen var 76 procent, vilket antyder att studien har god generaliserbarhet. Samband undersöktes genom Students t-test test och Fishers exakta test. Resultatet visade att enbart två procent av patienterna nådde kostrekommendationerna gällande frukt och grönsaker, och lika stor andel nådde det rekommenderade intaget av fullkornsprodukter. För konsumtion av rött kött och charkuteriprodukter åt 88 procent i enlighet med näringsrekommendationerna. Tjugosex procent åt den rekommenderade mängden nötter och frön medan 64 procent av studiedeltagarna nådde det uppsatta målet för intag av fisk. Enbart en liten andel av studiedeltagarna hade helt uteslutit feta mejeriprodukter och smörbaserade matfetter från sin kost i enlighet med rekommendationerna. Slutsatsen kunde dras att patienter som genomgått akut koronar händelse har en kosthållning som i liten grad överensstämmer med de Nordiska Näringsrekommendationerna. Med ökad kunskap om kostintagets betydelse finns det förbättringspotential för denna grupp patienters kostförändringar och hur personcentrerade kostinterventioner kan bidra till ökad kardiovaskulär hälsa. / Adhering to a healthy diet reduces the risk of cardiovascular disease and contributes to a lower risk of acute coronary syndrome. The Nordic Nutrition Recommendations includes a set of nutritional guidelines aimed at preventing cardiovascular disease and these have been further quantified by the Swedish National Food Agency. Despite the big health improvements that such a diet entails, few Swedes meet the recommended daily intakes. Little is known about how the dietary patterns of the specific subgroup of people who have experienced an acute coronary event compares to the Nordic Nutrition Recommendations. The aim was to investigate to what extent patients whom have been treated for acute coronary syndrome adhere to the latest nutritional guidelines given by the Nordic Nutrition Recommendations 2012. To answer the aim of the study a quantitative method was used through a survey study. Forty-two people were enrolled by consecutive sampling from three different heart polyclinics in southern Sweden. The study had a response rate of 76 percent, which suggests that the study had a high generalisability. Correlations between independent variables were controlled with Student’s t-test and Fisher’s exact test. The results showed that only two percent of the patients reached the guidelines dietary reference level when it comes to fruits and vegetables. The same result was shown when it comes to wholegrain dietary intake among this population, only two percent reached the recommended level. Looking at the dietary intake of red meat the result showed that 88 percent eat according to The Nordic Nutrition Recommendations. Looking at the intake of nuts and seeds, 26 percent of the patients ate as suggested in the guidelines. Sixty-four percent of this studies participants reached the recommended intake of fish per week. Only a low rate of the patients had completely excluded fat dairy products and butter-based products. The conclusion was made that patients who went through an acute coronary event have a dietary consumption that to a low extent correspond to The Nordic Nutrition Recommendations. There are room for improvement in this area. With the help of further studies in this subject would illuminate greater understanding about the dietary patterns among this patient group and how patient participatory dietary interventions could contribute to cardiovascular health.

I bakgrunden beskrivs att akut koronart syndrom (AKS) kan vara relaterad till en osund livsstil och skulle kunna förebyggas genom att avstå rökning, äta balanserad kost, vara fysiskt aktiv och måttlig alkoholkonsumtion. Livsstilsförändring anses som en bidragande faktor till minskning av kardiovaskulär morbiditet och mortalitet samt återinsjuknande av AKS. Målet i vården är att förhindra sjukdomsprocessen, återge livskvalitet till patienterna, motivera till livsstilsförändring samt förhindra återinsjuknande. Patientens engagemang till livsstilsförändring kan påverkas beroende på hur patienten uppfattar allvarlighetsgrad av sinsjukdom, vilket förtydligas med hjälp av health belief model’s (HBM) teori. Studien behövsför att identifiera vilka faktorer som kan hindra eller främja patienter till livsstilsförändring. Sjuksköterskor behöver en ökad kunskap för att stödja patienterna till att uppnå en livsstilsförändring som är hållbar utifrån deras förmågor. Syftet med studien var att identifiera interna och externa faktorer som kan hindra eller främja livsstilsförändring hos patienter efter att ha drabbats av AKS. Metoden som valdes var litteraturstudie för att besvara syftet. Studier publicerade under åren 2008-2018 inkluderades och artikelsökningarna gjordes i databaserna Cinahl Complete, PubMed samt manuell sökning. Datainsamlingen resulterade i 16 vetenskapliga artiklar med både kvalitativ och kvantitativ metod. Kvalitetsgranskningen gjordes utifrån Sophiahemmet Högskolas bedömningsunderlag för kvalitetsgranskning. Dataanalysen gjordes utifrån en integrerad analys. I resultat framkom fem kategorier, respektive med åtta underkategorier. Huvudkategorierna var fysiska faktorer, psykologiska faktorer, vilka var interna faktorer samt sociala faktorer, socioekonomiska faktorer och vårdrelaterade faktorer, som var externa faktorer. Familjen och nära anhöriga hade en stor inverkan och skapade motivation genom att stötta patienterna. Patienter med högre utbildning och god ekonomi var mer benägna att leva mer hälsosamt. Hindrande faktorer till livsstilsförändring var hög ålder, komorbiditet och fysiska funktionsnedsättningar. Nedstämdhet och chock av att drabbas av AKS hindrade patienter att göra förändringar, att inte acceptera sjukdomen begränsade patienterna. Familjekonflikter och brist på stöd hindrade en sund livsstil. Patienter med kunskapsbrist som inte insåg sambandet mellan AKS och livsstilsförändring, hade svårigheter att förändra livsstilen. Bristfälligt professionellt stöd och bristfällig uppföljning hindrade en hälsosam livsstil. Slutsatsen av studien var att interna och externa faktorer kan både hindra och främja patienter att göra livsstilsförändringar efter AKS. Det behövs både kunskap och medvetenhet om riskfaktorer till AKS för att kunna främja hälsa och motverka ohälsa. Patientens egna förmåga är beroende av den sociala omgivningen, familj och av vårdpersonalen som har en viktig påverkan i förändringsprocessen. Sjuksköterskan kan tillsammans med patienten skapa individuella förutsättningar att göra livsstilsförändringar, vilket kan leda till ökad livskvalitet och minska risken för återinsjuknande.