Objective A systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases. Methods Five engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Results 21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD-7.81 mm Hg, 95% CI-9.47 to-6.15, p<0.00001) and DBP (MD-3.96 mm Hg, 95% CI-5.17 to-2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD-35.82 mmol/day, 95% CI-57.35 to-14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes. Conclusions LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes. / Wellcome Trust / Revisión por pares

Purpose: The current U.S. population exceeds three hundred million with approximately 20% living in non-urban rural areas. A higher percentage of rural residents have diagnosed heart disease and report poorer health compared to non-rural residents; however, it is not known whether risk factor modification for heart disease and health status differ based on degree of rurality. The purposes of this study were: 1) to compare differences in health status and cardiac risk factors between cardiac patients living in large and small/isolated rural areas, and 2) to compare the health status of rural cardiac patients with a national sample. Method: A secondary analysis using data from three separate studies was completed using a comparative descriptive design. The Cardiac Rehabilitation participant sample (n-191) included individuals 3 to 12 months post-cardiac event. The Arizona Heart Institute and Foundation Heart Test measured risk factors and the eight subscales of the Short-Form, Medical Outcomes study measured health status. Findings: No significant differences in health status were found; all participants rated their health moderately high. However, individuals in large rural areas reported significantly better general health than those in the normative sample. No differences in smoking, blood pressure, diabetes, or overweight/obese BMI were found between the two rural groups. Differences in exercise, and anger were present between the two groups. Significant differences were identified in waist circumference between the genders placing women at higher risk for heart disease. Conclusions: Identifying health status and cardiovascular risk factors of rural individuals informs interventions to be tested for rural residents.

Made available in DSpace on 2017-07-21T14:13:08Z (GMT). No. of bitstreams: 1 DanielleBorato.pdf: 790899 bytes, checksum: 01d3aff9b0911e734c31a2a00b5c7bdc (MD5) Previous issue date: 2011-06-17 / Atherosclerotic cardiovascular disease has become an important cause of morbidity and mortality among individuals with human immunodeficiency virus (HIV). Currently, most of these patients have access to antiretroviral drugs, which has decreasing the risk for AIDS and increasing life expectancy. Therefore, it is necessary a better monitoring of traditional cardiovascular risk factors, whose changes are often more common in individuals with HIV infection. It is considered important the laboratorial evaluation in patients infected with HIV, with or without development of Acquired Immunodeficiency Syndrome (AIDS) and the establishment of preventive health policies, through the monitoring of mortality and its risk factors. So, there is the necessity to set new trends in laboratory monitoring in patients infected with HIV, such as percentage of CD4+ T cells and early and sensitive biochemical indicators for the risk of developing cardiovascular disease, in order to diagnose life-threatening conditions of the individual, thus increasing the chance of success of treatments needed. Currently, there is growing interest in myeloperoxidase (MPO; 1.11.1.7) as a marker of cardiac risk because of the possibility of performing with high serum levels occurring in the biomolecules that are currently used for this purpose, such as ultra-sensitive C-reactive protein (hs-CRP). This study aimed to assess the levels of MPO levels in HIV-infected individuals, as a possible biomarker for early indication of cardiac risk, together with different laboratory tests for immune monitoring and evaluation of these patients. The results indicated, among others, differences in the percentages of CD4 + T lymphocytes obtained by different methodologies, which could cause conflict in clinical decisions related to treatment and care of people infected with HIV. In addition, there were significant differences in the values of ultrasensitive C-reactive protein (hs-CRP) and serum myeloperoxidase, suggesting their application as laboratory markers with predictive value for cardiovascular events in HIV-infected patients. / A doença cardiovascular aterosclerótica tem se tornado uma importante causa de morbidade e mortalidade entre indivíduos com o vírus da imunodeficiência humana (HIV). Atualmente, a maioria destes pacientes tem acesso aos medicamentos antiretrovirais, o que diminuiu o risco para a AIDS e elevou a expectativa de vida. Sendo assim, torna-se necessária uma melhor monitorização dos fatores de risco cardiovasculares tradicionais, cujas alterações são muitas vezes mais comuns em indivíduos com infecção pelo HIV. Considera-se importante a avaliação laboratorial em pacientes infectados pelo HIV, com ou sem desenvolvimento da Síndrome de Imunodeficiência Adquirida (AIDS) e o estabelecimento de políticas preventivas em saúde, por meio do monitoramento da morbimortalidade e seus fatores de risco. Há, portanto, a necessidade em se definir novas tendências no monitoramento laboratorial em pacientes infectados pelo HIV, tal como a avaliação percentual de células T CD4+ no monitoramento imunológico e indicadores bioquímicos sensíveis e precoces para o risco de desenvolvimento de doenças cardiovasculares, no sentido de se diagnosticar condições de risco de morte do indivíduo, elevando assim a chance de sucesso dos tratamentos necessários. Atualmente, observa-se o interesse crescente na mieloperoxidase (MPO; 1.11.1.7) como marcador do risco cardíaco, devido à possibilidade desta se apresentar com níveis séricos elevados precocemente em relação às biomoléculas utilizadas atualmente para tal fim, como a proteína C reativa ultrassensível (PCR-us). O presente trabalho teve por objetivo avaliar os níveis de MPO sérica em indivíduos infectados pelo HIV, como possível biomarcador para indicação precoce de risco cardíaco, em conjunto com diferentes exames laboratoriais para avaliação e o monitoramento imunológico destes pacientes. Os resultados obtidos indicaram, dentre outros, diferenças nos valores percentuais de linfócitos T Cd4+ obtidos por diferentes metodologias, o que poderia causar conflito nas decisões clínicas relacionadas ao tratamento e à assistência de pessoas infectadas pelo HIV. Além disso, observaram-se diferenças significativas nos valores de proteína C reativa ultrassensivel (PCR-us) e da mieloperoxidase sérica, sugerindo o uso como elemento laboratorial com valor preditivo de eventos cardiovasculares nos pacientes infectados pelo HIV.

Made available in DSpace on 2017-07-21T14:13:11Z (GMT). No. of bitstreams: 1 Gisele C Parabocz.pdf: 1495859 bytes, checksum: 56f08069e8fd4cf1a7e0f79f60114e3e (MD5) Previous issue date: 2013-02-18 / Fundação Araucária de Apoio ao Desenvolvimento Científico e Tecnológico do Paraná / Obesity has become epidemic in XXI century and it is estimated that there are about 1.4 billion overweight adults. The existing subclinical chronic inflammation in obesity is associated with increased risk of cardiovascular disease. Adipose tissue, in addition to its energy function, has endocrine role through the secretion of adipokines. In obesity, adipocytes become dysfunctional, producing excess proinflammatory adipokines at the expense of anti-inflammatory. This inflammatory process is the link between obesity and atherogenesis. Thus, inflammation markers are potential targets for prevention, diagnosis and treatment of atherosclerosis. Myeloperoxidase (MPO), an enzyme found primarily on neutrophils, participates on innate defense mechanisms of the body through the production of oxidizing species that have antimicrobial activity. However, these oxidants and MPO act in events that feature key role in atherogenesis, such as oxidation of LDL-cholesterol, consumption of nitric oxide and activation of proteases. Therefore, the MPO has become subject of research and many studies have shown its value as predictor of cardiac risk in certain situations. However, its usage is not yet standardized and its benchmark values are not well established for laboratory diagnosis. The aim of this study was to evaluate the levels of MPO and other biomarkers in different Body Mass Index (BMI) ranges. The results indicated significant differences between the groups in the following parameters: systolic and diastolic blood pressure, HDL-cholesterol, triglycerides/HDL rate, HDL/LDL rate and white blood cells count. Elevated levels of hs-CRP were observed in the groups with obese individuals, but no significant changes were observed to serum MPO. Therefore, serum levels of MPO did not provide information on clinically significant laboratory differentiation of groups. / A obesidade tornou-se a epidemia do século XXI, estimando-se a existência de 1,4 bilhão de adultos com excesso de peso. A inflamação crônica subclínica existente na obesidade é associada com o aumento do risco de doenças cardiovasculares. O tecido adiposo, além de sua função energética, possui papel endócrino por meio da secreção das adipocinas. Na obesidade, os adipócitos tornam-se disfuncionais, produzindo, em excesso, adipocinas pró-inflamatórias, em detrimento das anti-inflamatórias. O desencadeamento do processo inflamatório é a ligação entre a obesidade e a aterogênese. Desta forma, marcadores de inflamação são alvos em potencial para a prevenção, diagnóstico e tratamento da aterosclerose. A mieloperoxidase (MPO) é uma enzima presente principalmente em neutrófilos, participante dos mecanismos de defesa inata do organismo, através da produção de espécies oxidantes que possuem atividade antimicrobiana. Contudo, os oxidantes originados e a própria MPO participam de eventos que apresentam papel fundamental na aterogênese, tais como oxidação do LDL-colesterol, consumo de óxido nítrico e ativação de proteases. Destarte, a MPO tornou-se objeto de pesquisa e muitos estudos demonstram seu poder preditor de risco cardíaco em determinadas situações. Não obstante, seu uso ainda não está padronizado e os valores referenciais não estão bem estabelecidos para o diagnóstico laboratorial. O objetivo deste trabalho foi avaliar os níveis de MPO e outros biomarcadores em indivíduos com diferentes faixas de Índice de Massa Corporal (IMC). Os resultados obtidos indicaram diferenças significativas entre os grupos nos seguintes parâmetros: pressão arterial sistólica e diastólica, HDL colesterol, taxa triglicerídeos/HDL, taxa HDL/LDL e contagem de leucócitos. Níveis elevados de PCR-us foram observados nos grupos com indivíduos obesos, porém não se constataram alterações significativas para a MPO. Portanto, os níveis séricos de MPO não forneceram informações laboratoriais clinicamente significativas na diferenciação dos grupos estudados.

ABSTRACT ASSESSING BASELINE AND POST-DISCHARGE RISK FACTORS IN SUBJECTS WITH AND WITHOUT SLEEP APNEA UNDERGOING ENDOSCOPY WITH DEEP SEDATION Background: Outpatient procedures encompass over 60% of all surgeries in the United States, and the prevalence of obstructive sleep apnea (OSA) remains high among adult surgical ambulatory patients. Ambulatory surgery poses problems for patients with OSA because narcotics and anesthetics used during surgery can complicate the negative effects of OSA, leading to cardiac events, brain hypoxia, and even death. This study was designed to evaluate the prevalence of cardiopulmonary risk factors among post endoscopic patients with diagnosed and undiagnosed sleep apnea. Methods: The study involved a prospective, descriptive cross-sectional design and incorporated a pre-test or post-test data collection approach, using Actigraphy, pulse oximetry and 24-hour ECG monitoring via Bluetooth technology to monitor outpatients undergoing endoscopy with deep Propofol sedation. Patients were recruited pre-procedure to obtain a resting baseline ECG, and pre-procedure values were then monitored post procedure continuously for 24 hours. A p-value less than 0.05 was considered to be statistically significant. A target sample included 50 adult outpatients from a Florida suburban endoscopy center. Results: Pulse oximetry and Actigraph scores revealed no difference based on OSA. The ANOVA for oxygen desaturation events and sleep quality indices reflected no differences across groups. Sleep quality had no measurable influence on adverse events and was similar across groups; participants diagnosed with OSA slept longer than those in the untreated or no OSA group. Regressions for sleep quality indices reflected no differences among groups. Conclusions: There remains a lack of literature on cardiopulmonary and ECG indicators of cardiac risks in patients with OSA in the 24 hours following discharge from ambulatory surgery. This dissertation characterized the ECG at baseline and post-discharge among post-endoscopy outpatients with OSA and without OSA. Further research is recommended.

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