Maria Cristina Oliveira Izar | Universidade Federal de São Paulo (UNIFESP) (original) (raw)

Papers by Maria Cristina Oliveira Izar

Scientific reports, May 15, 2024

Geriatrics & Gerontology International, Jul 31, 2023

Hypertension and dyslipidemia Hypertension and atherosclerosis are two important and related risk... more Hypertension and dyslipidemia Hypertension and atherosclerosis are two important and related risk factors associated with the morbidity and mortality of patients with chronic renal failure. Increased prevalence of hypertensive nephropathy as a major cause of end stage renal disease has been reported in USA and Europe. Among these patients, the cardiovascular morbidity is estimated around 10 to 20 times that observed in the general population and may be present in half of patients under dyalisis.

Revista da Sociedade de Cardiologia do Estado de São Paulo, Jun 30, 2023

A doença cardiovascular permanece como a primeira causa de morte em homens e mulheres. Dados do G... more A doença cardiovascular permanece como a primeira causa de morte em homens e mulheres. Dados do Global Burden of Disease 2019 destacam como principais fatores de risco para a mulher brasileira a elevação da pressão arterial sistólica, índice de massa corpórea elevado, riscos alimentares, LDL-colesterol elevado, tabagismo e glicemia de jejum elevada. Com relação ao risco de doença aterosclerótica cardiovascular, as mulheres compartilham alguns fatores de risco tradicionais com o sexo masculino, enquanto outros fatores de risco são sub-reconhecidos entre as mulheres e há ainda fatores de risco específicos do sexo/gênero feminino. Esses fatores ativam mecanismos pró-inflamatórios, causam disfunção endotelial, levando à aterosclerose sub-clínica, disfunção autonômica, e do sistema imune, que culminam no desenvolvimento da doença cardiovascular (infarto do miocárdio, acidente vascular cerebral, insuficiência cardíaca, morte súbita cardíaca, fibrilação atrial e demência). O reconhecimento de fatores de risco tradicionais e seu dife-rente impacto nas mulheres, bem como de fatores emergentes e não tradicionais únicos ou mais frequentes nas mulheres, contribui para o novo entendimento dos mecanismos que levam aos piores desfechos nas mulheres. Nesse artigo, destacamos a contribuição de cada um desses fatores de risco e as principais recomendações para seu controle.

Arquivos Brasileiros De Cardiologia, 2022

BBA clinical, Jun 1, 2015

were associated to the presence of high cIMT. ROC curve analyses show that among those with high ... more were associated to the presence of high cIMT. ROC curve analyses show that among those with high CRP the area under the curve (AUC) for 10-year ASCVD Risk was 0.746 and for Lifetime ASCVD Risk was 0.658. In those with low CRP, the AUC were respectively 0.727 and 0.443. Conclusion: The present study suggests that plasma CRP can be used as a screening tool to select among low-risk individuals those in whom a detailed investigation of biomarkers may be useful to identify risk factors associated with their atherosclerotic burden.

Arquivos Brasileiros De Cardiologia, Jun 1, 2023

Global heart, 2023

Background: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especia... more Background: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low-and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resourcerelated factors. Objective: This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. Methods: The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and ≥18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. Results: A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. Conclusion: In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations. 2 Fonseca et al.

Investigative Ophthalmology & Visual Science, May 14, 2008

Fundamento: Pacientes com síndrome metabólica (SM) têm alto risco coronariano e a disfunção da cé... more Fundamento: Pacientes com síndrome metabólica (SM) têm alto risco coronariano e a disfunção da célula beta ou resistência à insulina pode prever um risco adicional de eventos cardiovasculares precoces. Objetivo: Avaliar as alterações glicometabólicas precoces em pacientes com SM, mas sem diagnóstico de diabete tipo 2, após síndrome coronariana aguda. Métodos: Um total de 114 pacientes foi submetido ao teste oral de tolerância à glicose (TOTG), 1-3 dias da alta hospitalar, após infarto agudo do miocárdio ou angina instável. Baseado no TOTG, definimos três grupos de pacientes: tolerância normal à glicose (TNG; n=26), tolerância alterada à glicose (TAG; n=39) ou diabetes mellitus (DM; n=49). O Modelo de Avaliação da Homeostase (HOMA-IR) foi usado para estimar a resistência à insulina; a responsividade da célula beta foi avaliada através do índice insulinogênico de 30 minutos (∆I30/∆G30). Resultados: Baseado no HOMA-IR, os pacientes com DM eram mais insulino-resistentes do que aqueles com TNG ou TAG (p<0,001). De acordo com o índice insulinogênico, a responsividade da célula beta também estava alterada em indivíduos com DM (p<0,001 vs TNG ou TAG). Conclusão: Altas taxas de alterações glicometabólicas foram encontradas após síndrome coronariana aguda em pacientes com SM. Como essas anormalidades acentuadamente aumentam o risco de desfechos adversos, o TOTG precoce pode ser utilizado em pacientes com SM para identificar aqueles que apresentam maior risco coronariano. (Arq Bras Cardiol 2009;92(2):94-99) Palavras-chave: Resistência à insulina, síndrome metabólica, síndrome coronariana aguda, diabetes mellitus tipo 2, células secretoras de insulina.

European Journal of Preventive Cardiology, Nov 4, 2020

JAMA Cardiology, May 1, 2019

IMPORTANCE Studies have found that patients at high cardiovascular risk often fail to receive evi... more IMPORTANCE Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. OBJECTIVE To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. DESIGN, SETTING, AND PARTICIPANTS In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. INTERVENTIONS Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. MAIN OUTCOMES AND MEASURES The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. RESULTS Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in interventionclustersweremorelikelytoreceiveaprescriptionofevidence-basedtherapiesthanthose in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control(ie,hyperlipidemia,hypertension,ordiabetes).Ratesofeducationforsmokingcessationwere higheramongcurrentsmokersintheinterventiongroupthaninthecontrolgroup(51.9%[364of701] vs18.2%[153of840];oddsratio , 11.24;95%CI,2.20-57.43).Therateofcardiovascularmortality,acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). CONCLUSIONS AND RELEVANCE Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies.

Arquivos Brasileiros de Cardiologia

Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médi... more Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

European Journal of Internal Medicine

Journal of Human Nutrition and Dietetics

BackgroundAn individual's dietary pattern contributes in different ways to the prevention and... more BackgroundAn individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors.MethodsThis is a cross‐sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann–Whitney or Pearson's chi‐squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal–Wallis was used. For the confounding ana...

Arquivos Brasileiros de Cardiologia

Oliveira et al. Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 Posicionamento sobr... more Oliveira et al. Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 O relatório abaixo lista as declarações de interesse conforme relatadas à SBC pelos especialistas durante o período de desenvolvimento deste posicionamento, 2022 Especialista Tipo de relacionamento com a indústria Alexandra Oliveira de Mesquita Nada a ser declarado Alexandre Jorge Gomes de Lucena Nada a ser declarado Andréa Araujo Brandão Declaração financeira A-Pagamento de qualquer espécie e desde que economicamente apreciáveis, feitos a (i) você, (ii) ao seu cônjuge/ companheiro ou a qualquer outro membro que resida com você, (iii) a qualquer pessoa jurídica em que qualquer destes seja controlador, sócio, acionista ou participante, de forma direta ou indireta, recebimento por palestras, aulas, atuação como proctor de treinamentos, remunerações, honorários pagos por participações em conselhos consultivos, de investigadores, ou outros comitês, etc. Provenientes da indústria farmacêutica, de órteses, próteses, equipamentos e implantes, brasileiras ou estrangeiras:-Servier: Acertil, Acertalix, Acertanlo, Triplixan. Outros relacionamentos Financiamento de atividades de educação médica continuada, incluindo viagens, hospedagens e inscrições para congressos e cursos, provenientes da indústria farmacêutica, de órteses, próteses, equipamentos e implantes, brasileiras ou estrangeiras:-Servier: Acertil, Acertalix, Acertanlo, Triplixan.

Arquivos Brasileiros de Cardiologia

Fundamento: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialment... more Fundamento: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. Objetivo: Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. Método: Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOLbrief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. Resultados: Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. Conclusão: O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis. Palavras-chave: Mulheres Médicas; Burnout; Pandemia de COVID-19; Brasil.

Arquivos Brasileiros de Cardiologia

Nutrition, Metabolism and Cardiovascular Diseases, 2021

BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholester... more BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS AND RESULTS This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC. CONCLUSIONS In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.

Scientific reports, May 15, 2024

Geriatrics & Gerontology International, Jul 31, 2023

Hypertension and dyslipidemia Hypertension and atherosclerosis are two important and related risk... more Hypertension and dyslipidemia Hypertension and atherosclerosis are two important and related risk factors associated with the morbidity and mortality of patients with chronic renal failure. Increased prevalence of hypertensive nephropathy as a major cause of end stage renal disease has been reported in USA and Europe. Among these patients, the cardiovascular morbidity is estimated around 10 to 20 times that observed in the general population and may be present in half of patients under dyalisis.

Revista da Sociedade de Cardiologia do Estado de São Paulo, Jun 30, 2023

A doença cardiovascular permanece como a primeira causa de morte em homens e mulheres. Dados do G... more A doença cardiovascular permanece como a primeira causa de morte em homens e mulheres. Dados do Global Burden of Disease 2019 destacam como principais fatores de risco para a mulher brasileira a elevação da pressão arterial sistólica, índice de massa corpórea elevado, riscos alimentares, LDL-colesterol elevado, tabagismo e glicemia de jejum elevada. Com relação ao risco de doença aterosclerótica cardiovascular, as mulheres compartilham alguns fatores de risco tradicionais com o sexo masculino, enquanto outros fatores de risco são sub-reconhecidos entre as mulheres e há ainda fatores de risco específicos do sexo/gênero feminino. Esses fatores ativam mecanismos pró-inflamatórios, causam disfunção endotelial, levando à aterosclerose sub-clínica, disfunção autonômica, e do sistema imune, que culminam no desenvolvimento da doença cardiovascular (infarto do miocárdio, acidente vascular cerebral, insuficiência cardíaca, morte súbita cardíaca, fibrilação atrial e demência). O reconhecimento de fatores de risco tradicionais e seu dife-rente impacto nas mulheres, bem como de fatores emergentes e não tradicionais únicos ou mais frequentes nas mulheres, contribui para o novo entendimento dos mecanismos que levam aos piores desfechos nas mulheres. Nesse artigo, destacamos a contribuição de cada um desses fatores de risco e as principais recomendações para seu controle.

Arquivos Brasileiros De Cardiologia, 2022

BBA clinical, Jun 1, 2015

were associated to the presence of high cIMT. ROC curve analyses show that among those with high ... more were associated to the presence of high cIMT. ROC curve analyses show that among those with high CRP the area under the curve (AUC) for 10-year ASCVD Risk was 0.746 and for Lifetime ASCVD Risk was 0.658. In those with low CRP, the AUC were respectively 0.727 and 0.443. Conclusion: The present study suggests that plasma CRP can be used as a screening tool to select among low-risk individuals those in whom a detailed investigation of biomarkers may be useful to identify risk factors associated with their atherosclerotic burden.

Arquivos Brasileiros De Cardiologia, Jun 1, 2023

Global heart, 2023

Background: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especia... more Background: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low-and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resourcerelated factors. Objective: This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. Methods: The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and ≥18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. Results: A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. Conclusion: In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations. 2 Fonseca et al.

Investigative Ophthalmology & Visual Science, May 14, 2008

Fundamento: Pacientes com síndrome metabólica (SM) têm alto risco coronariano e a disfunção da cé... more Fundamento: Pacientes com síndrome metabólica (SM) têm alto risco coronariano e a disfunção da célula beta ou resistência à insulina pode prever um risco adicional de eventos cardiovasculares precoces. Objetivo: Avaliar as alterações glicometabólicas precoces em pacientes com SM, mas sem diagnóstico de diabete tipo 2, após síndrome coronariana aguda. Métodos: Um total de 114 pacientes foi submetido ao teste oral de tolerância à glicose (TOTG), 1-3 dias da alta hospitalar, após infarto agudo do miocárdio ou angina instável. Baseado no TOTG, definimos três grupos de pacientes: tolerância normal à glicose (TNG; n=26), tolerância alterada à glicose (TAG; n=39) ou diabetes mellitus (DM; n=49). O Modelo de Avaliação da Homeostase (HOMA-IR) foi usado para estimar a resistência à insulina; a responsividade da célula beta foi avaliada através do índice insulinogênico de 30 minutos (∆I30/∆G30). Resultados: Baseado no HOMA-IR, os pacientes com DM eram mais insulino-resistentes do que aqueles com TNG ou TAG (p<0,001). De acordo com o índice insulinogênico, a responsividade da célula beta também estava alterada em indivíduos com DM (p<0,001 vs TNG ou TAG). Conclusão: Altas taxas de alterações glicometabólicas foram encontradas após síndrome coronariana aguda em pacientes com SM. Como essas anormalidades acentuadamente aumentam o risco de desfechos adversos, o TOTG precoce pode ser utilizado em pacientes com SM para identificar aqueles que apresentam maior risco coronariano. (Arq Bras Cardiol 2009;92(2):94-99) Palavras-chave: Resistência à insulina, síndrome metabólica, síndrome coronariana aguda, diabetes mellitus tipo 2, células secretoras de insulina.

European Journal of Preventive Cardiology, Nov 4, 2020

JAMA Cardiology, May 1, 2019

IMPORTANCE Studies have found that patients at high cardiovascular risk often fail to receive evi... more IMPORTANCE Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. OBJECTIVE To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. DESIGN, SETTING, AND PARTICIPANTS In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. INTERVENTIONS Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. MAIN OUTCOMES AND MEASURES The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. RESULTS Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in interventionclustersweremorelikelytoreceiveaprescriptionofevidence-basedtherapiesthanthose in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control(ie,hyperlipidemia,hypertension,ordiabetes).Ratesofeducationforsmokingcessationwere higheramongcurrentsmokersintheinterventiongroupthaninthecontrolgroup(51.9%[364of701] vs18.2%[153of840];oddsratio , 11.24;95%CI,2.20-57.43).Therateofcardiovascularmortality,acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). CONCLUSIONS AND RELEVANCE Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies.

Arquivos Brasileiros de Cardiologia

Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médi... more Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

European Journal of Internal Medicine

Journal of Human Nutrition and Dietetics

BackgroundAn individual's dietary pattern contributes in different ways to the prevention and... more BackgroundAn individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors.MethodsThis is a cross‐sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann–Whitney or Pearson's chi‐squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal–Wallis was used. For the confounding ana...

Arquivos Brasileiros de Cardiologia

Oliveira et al. Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 Posicionamento sobr... more Oliveira et al. Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 Posicionamento sobre a Saúde Cardiovascular nas Mulheres-2022 O relatório abaixo lista as declarações de interesse conforme relatadas à SBC pelos especialistas durante o período de desenvolvimento deste posicionamento, 2022 Especialista Tipo de relacionamento com a indústria Alexandra Oliveira de Mesquita Nada a ser declarado Alexandre Jorge Gomes de Lucena Nada a ser declarado Andréa Araujo Brandão Declaração financeira A-Pagamento de qualquer espécie e desde que economicamente apreciáveis, feitos a (i) você, (ii) ao seu cônjuge/ companheiro ou a qualquer outro membro que resida com você, (iii) a qualquer pessoa jurídica em que qualquer destes seja controlador, sócio, acionista ou participante, de forma direta ou indireta, recebimento por palestras, aulas, atuação como proctor de treinamentos, remunerações, honorários pagos por participações em conselhos consultivos, de investigadores, ou outros comitês, etc. Provenientes da indústria farmacêutica, de órteses, próteses, equipamentos e implantes, brasileiras ou estrangeiras:-Servier: Acertil, Acertalix, Acertanlo, Triplixan. Outros relacionamentos Financiamento de atividades de educação médica continuada, incluindo viagens, hospedagens e inscrições para congressos e cursos, provenientes da indústria farmacêutica, de órteses, próteses, equipamentos e implantes, brasileiras ou estrangeiras:-Servier: Acertil, Acertalix, Acertanlo, Triplixan.

Arquivos Brasileiros de Cardiologia

Fundamento: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialment... more Fundamento: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. Objetivo: Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. Método: Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOLbrief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. Resultados: Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. Conclusão: O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis. Palavras-chave: Mulheres Médicas; Burnout; Pandemia de COVID-19; Brasil.

Arquivos Brasileiros de Cardiologia

Nutrition, Metabolism and Cardiovascular Diseases, 2021

BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholester... more BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS AND RESULTS This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC. CONCLUSIONS In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.