Cardiovascular Sciences

Due to the rare occurrence of myocardial infarction (MI) in young people, chest pain in young adults poses a unique diagnostic challenge, increasing the risk of misdiagnosis. This case underscores the importance of considering acute MI in any patient with chest pain, regardless of age. Cardiac imaging is essential for confirming and guiding the diagnosis. We present a case of a very young adult with acute myocardial infarction with nonobstructive coronary artery (MINOCA). Furthermore, after investigation, we identified 7 genetic mutations predisposing the patient to coronary artery thrombosis. MI has a complex etiology involving a combination of genetic factors and internal and external environmental risk factors. It is a leading cause of death globally and has a rare incidence among teenagers and young adults.

No previous study has evaluated the prevalence of metabolic syndrome (MS) in more than one region in Venezuela. Objective: To determine the prevalence of MS in three Venezuelan regions. From 2006 to 2010, a total of 1,320 subjects aged ≥ 20 years were selected by multistage stratified random sampling from the regions of Lara State (western region), Mérida State (the Andean region), and Capital District (Capital Region). Anthropometric measurements, blood pressure, and biochemical analysis were obtained from each participant. MS was defined according to the harmonized Joint Interim Statement (2009) definition. Results: Mean age was 44.8 ± 0.39 years and 68.5% of the participants were female. The overall prevalence of MS was 35.7% (95% confidence interval 32.2 -39.2%), while the prevalence was 42.5% (95% CI 38.8 -46.1%) among men and 32.6% (95% CI 29.1 -36.0%) among women (p < 0.001). In women, the prevalence of MS increased at almost every decade of life, while in men, the prevalence was similar from the age of 30 years onwards. The most prevalent abnormalities were low HDL-c levels (58.6%, 95% CI 54.9 -62.1%), abdominal obesity (52.0%, 95% CI 48.4 -55.7%), and elevated triglycerides levels (39.7%, 95% CI 36.1 -43.2%). The prevalence of MS increased with increasing body mass index categories. In Venezuela, MS is a highly prevalent condition, which increases the risk of type 2 diabetes and cardiovascular disease in a large number of subjects. (Int

Background: Atherosclerosis is a serious health problem, and several factors contribute to its occurrence. Longitudinal and qualified monitoring of primary health care (PHC) may contribute to the management of atherosclerosis and reduction of avoidable hospital admissions. Objective: To estimate the trend in hospitalizations for atherosclerosis and the impact of PHC coverage on its evolution from 2008 to 2018 in Brazil. Method: An ecological time series analytical study based on the outcomes of hospital admissions for atherosclerosis in Brazil. Time in years, PHC coverage, and Family Health Strategy (FHS) services were considered independent variables. A Prais-Winsten model was used to estimate the outcome trend, and α < 0.05 was adopted. We observed a mean increase of 1.81 hospitalizations for atherosclerosis per 100 000 inhabitants annually (p = 0.002) in Brazil. This growth was evidenced in the Northeast (p < 0.001), Southeast (p = 0.003), and South (p < 0.001) regions, being stable in the North (p = 0.057) and Midwest (p = 0.62) regions. Men presented twice the growth in hospitalizations from the fifth decade of life on (p < 0.01). An inversely proportional relationship was observed for PHC coverage (B = -0.71; p < 0.001) and the proportion of FHS services (B = -0.59; p < 0.001) with the rate of admissions due to atherosclerosis in Brazil. Although hospitalizations for atherosclerotic complications are increasing in Brazil, they present regional and individual gender and age discrepancies, as well as a mitigating effect exerted by PHC coverage.

Introdução
A amiloidose cardíaca resulta da deposição de fibrilas amiloides no espaço extracelular do coração. Esta doença crônica e progressiva reduz significativamente a qualidade de vida e carrega uma alta taxa de mortalidade se não for diagnosticada e tratada precocemente. O dano miocárdico ocorre devido à lesão direta por peptídeos sanguíneos, bem como à distorção arquitetônica causada pelo infiltrado extracelular, levando principalmente à disfunção ventricular diastólica, mas também à disfunção sistólica, à medida que a doença progride e surgem arritmias cardíacas. Os subtipos mais comuns incluem peptídeos transtirretina anormais (ATTR) e cadeia leve de imunoglobulina (AL), com AL tendo um prognóstico pior e o transplante cardíaco sendo uma opção potencial de tratamento. Nos Estados Unidos, a incidência estimada de cardiomiopatia por amiloidose de cadeia leve é ​​de 1 em 100.000 indivíduos. , O principal fator de risco para o desenvolvimento de amiloidose de cadeia leve é ​​um histórico pessoal de gamopatia monoclonal.

As manifestações cardíacas geralmente envolvem hipotensão ortostática, arritmias, hipertrofia ventricular inconsistente com regiões eletricamente inativas no eletrocardiograma e insuficiência cardíaca com fração de ejeção predominantemente preservada, embora fração de ejeção reduzida possa ocorrer em casos avançados.

Introducing an innovative drug to the market requires not only large amounts of money, but also time. Therefore, the process of repositioning, i.e., finding new indications for drugs already in use, is becoming more and more frequent. In 2020, chloroquine (CQ) and hydroxychloroquine (HCQ) were approved for the treatment of severe COVID-19 infection. However, studies have shown that the adverse effects of these drugs are too serious and the approval was revoked. The most serious and most frequently reported adverse effects were cardiotoxicity and neurotoxicity. For this reason, the study investigates the possible mechanism of cardiotoxicity and neurotoxicity of CQ and HCQ using in silico computational methods. The results of this study were found to be consistent with the literature.

Congenital heart defects are the most common birth defects and the leading cause of mortality in the first year of life. It is well known that the 22q11 deletion syndrome (22q11DS) is the most common microdeletion syndrome in humans and that congenial heart diseases (CHDs) are one of the most common phenotypic manifestations. However, it should be noted that the 22q11 deletion was also found in a significant number of patients with isolated CHD. The 22q11DS phenotype may include cardiovascular anomalies, palatal abnormalities, nasal voice, immune deficiency, endocrine dysfunctions, a varying degree of cognitive deficits and intellectual disabilities, velopharyngeal insufficiency, and characteristic craniofacial dysmorphism. This condition affects about 1 in 4,000 live births, making 22q11DS the most common microdeletion syndrome in humans. Here we describe the cases of three children who were referred to the clinical hospital center with the diagnosis of CHD, but with no direct signs of 22q11DS. Investigation of familial data led us to suspect that the mothers could be carriers of 22q11DS. The multiplex ligation-dependent probe amplification (MLPA) testing confirmed that the patients and mothers exhibited 3 Mb 22q11 deletions, which justified the clinical signs in the mothers and the CHD in children. In the presence of a few characteristics that are common of a spectrum of some known syndromes, a familial examination can provide clues to a definitive diagnosis, as well as to the prevention of diseases and genetic counseling of these patients.

Science is a tireless systematic pursuit of knowledge, where researchers, using established methods, invest their time and dedication to contribute to a better world. 1 Scientific communication is a precious way to disseminate the knowledge acquired by researchers to others interested in the subject and must be done in a clear, concise manner that conveys the authors' intentions to the article's readers. One of the most important ways to share the results of the quest for knowledge is through the publication of articles, which are scientific documents that describe research through the discussion of ideas, innovative methodologies, techniques, processes, and results in various areas of knowledge. 2 Data from the Bori Agency indicate that Brazil, although it continues to hold fourteenth position in the ranking of the highest number of scientific article publications, experienced a decrease of 7.4% in article publications in 2022 compared to 2021. One of the main reasons for this reduction is the impact of the COVID-19 pandemic; however, Brazil was the country that experienced the most significant decline in article publications. Thus, it is crucial to understand the processes involved in the preparation and submission of articles and to contribute to higher acceptance rates.

Background: Children and adolescents should be encouraged to participate in sports; however, physicians should screen for cardiac abnormalities that can lead to sudden death. The European Society of Cardiology, the Brazilian Society of Cardiology and the Brazilian Society of Sports Medicine indicate performing an electrocardiogram (ECG) in evaluating athletes, while the American Heart Association indicates complementary exams only when there is a personal or family history of cardiovascular diseases or changes in clinical examination. Objectives: To evaluate the need for an ECG in evaluating children and adolescents before starting physical activities. We recruited 983 children and adolescents who practiced physical activities for anthropometric assessment, clinical examination and conventional ECG at rest. Variables were analysed using the Goodman test with a significance level of 5%. Results: Participants had a higher incidence of overweight, obesity and severe obesity compared to standard World Health Organization (WHO) values. The most common finding in clinical examination was heart murmur (18.5% of participants). Electrocardiographic changes were found in 3.3% of participants, including paroxysmal supraventricular tachycardia and pre-excitation syndrome, which may be responsible for sudden death, even in asymptomatic individuals with no personal or family history of heart disease and no abnormality on clinical examination. Conclusions: ECG revealed arrhythmias that were not detected by clinical examination and may precede sudden death in individuals subjected to physical exertion, indicating its role in the assessment of children and adolescents before starting regular physical exercise .

Introduction Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks. – Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions [...]

The gradual loss of ovarian function with concomitant decrease in estrogen levels, characteristic of the climacteric period, leads to several metabolic changes and symptoms. Significant effects on the health and quality of life of women occur, and vasomotor symptoms during this transitional period are almost universally recognized. Among physical symptoms, hot flushes and night sweats are very prevalent and may be very disturbing.

Introdução: Diabetes mellitus (DM) é uma condição prevalente na população em geral, que parece aumentar o risco de insuficiência cardíaca (IC). Entretanto, a prevalência de DM tipo 2 em pacientes brasileiros com insuficiência cardíaca não é conhecida, e o impacto do DM no tratamento da IC ainda não está claro. Objetivo: Avaliar a prevalência de DM tipo 2 em pacientes ambulatoriais com insuficiência cardíaca, e sua correlação com características clínicas e com o tratamento da IC. Métodos: Foram incluídos 402 pacientes com IC em acompanhamento ambulatorial entre agosto de 2008 e setembro de 2009. os pacientes foram comparados com relação às características clínicas, remodelamento cardíaco e tratamento da IC. Resultados: A prevalência de DM tipo 2 na amostra estudada foi de 31%. Os pacientes com DM tinham idade maior (65±10 vs. 60±14 anos; p<0,001) e maior prevalência etiologia isquêmica em comparação aos não diabéticos (52% vs. 30%, respectivamente). Os parâmetros ecocardiográficos não diferiram entre os grupos, mas a pressão sistólica da artéria pulmonar (PSAP) foi maior nos pacientes diabéticos (50±14 vs. 43±14 mmHg; p=0,001). O tratamento da insuficiência cardíaca foi similar entre pacientes com e sem DM. Entre os com DM, cerca da metade dos pacientes tinha controle glicêmico adequado, e os principais tratamentos utilizados foram as drogas metformina e insulina. Conclusões: A prevalência de DM foi elevada nesta população de pacientes ambulatoriais com insuficiência cardíaca, sendo associada a etiologia isquêmica e comorbidades. Apesar de não haver associação com outras características de gravidade da doença, remodelamento cardíaco ou com o IC, pacientes com DM tinham níveis mais elevados de PSAP. A repercussão clínica e prognóstica destes achados merece ser avaliada em estudos prospectivos futuros.

Background: Coronary artery disease (CAD) has high morbidity and mortality rates. Coronary angioplasty and antiplatelet therapy with acetylsalicylic acid (ASA) are critical in treating CAD patients. Elective angioplasty lacks studies on the factors associated with resistance to ASA. Objective: To evaluate the prevalence and ASA resistance related factors in patients undergoing elective angioplasty. Methods: Retrospective cohort study of 198 patients undergoing elective angioplasty, evaluated for resistance to ASA by optical aggregometry with arachidonic acid as agonist. Results: Resistance to ASA in 6.56% of the cohort (13/198). C-reactive protein (CRP) levels indicated association with resistance to ASA (p=0.02). Conclusions: Low prevalence of ASA resistance in patients undergoing elective angioplasty; C-reactive protein high levels are related to greater frequency of this resistance.

Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and function (i.e., muscle power, muscle strength, and physical performance). 1-5 Since 2016, it has been recognized as a disease. 6 People aged 50 years and older lose 1% of skeletal muscle mass, 2% of gait speed, and 1.9 to 5.0% of handgrip strength per year, 7,8 and these variables have been used for the assessment of sarcopenia by renowned organizations. 9 However, the cause and pathogenesis of sarcopenia are not fully understood; the target in sarcopenia treatment is to improve patient survival and quality of life. Sarcopenia is highly prevalent in older adults, 10 and the incidence of arterial hypertension is over 70% in this population. Data from population studies have shown that the prevalence of hypertension is increased in patients with sarcopenia. 11 Hypertension pharmacotherapy usually consists of single therapy or a combination of different medications.

The concepts of Religiosity and Spirituality (R/S) are broad and heterogeneous. In summary, R/S can be understood as a set of feelings, thoughts, experiences, and behavioral factors motivated by the search for the "sacred". 1 Religiosity has an organizational dimension, related to participation in collective ceremonies in churches, temples, or other religious services, and a nonorganizational dimension, related to the individual practice of prayers, religious readings, and consumption of religious programs on their own. 2 Religiosity can also be classified as intrinsic, which refers to subjective and individual aspects, and extrinsic, which refers to social aspects and religious association. 3 In this context, the concepts of religion and religiosity are different: while the former refers to a construct formed by beliefs, behaviors, dogmas, rituals, and ceremonies derived from traditions established throughout history, 4 the latter refers to how much an individual believes, follows, and practices a religion. 2

Background The implementation of intensive therapy protocols increases the probability of adverse events in patients with breast cancer (BC). Components of metabolic syndrome (MS) are among these events. Objective To verify the prevalence of MS and cardiovascular disease (CVD) risk in female BC survivors. Materials and Methods This is a descriptive, observational, cross-sectional study. Our sample comprised 60 women without BC (G1) and 60 women who had survived BC (G2). We collected sociodemographic, anthropometric, tumor, and clinical data. After variable analysis, the participants received positive or negative MS diagnoses and a 10-year CVD risk stratification. The significance level adopted for the analyses was 5% ( p &lt; 0.05) and the confidence interval (CI) was 95%. For comparing categorical data, we used the chi-squared, Fisher’s exact, or G tests; for comparing continuous data, we used the parametric Student’s t-test and the non-parametric Mann-Whitney test. Results Both gr...

COVID-19, caused by the coronavirus family SARS-CoV-2 and declared a pandemic in March 2020, continues to spread. Its enormous and unprecedented impact on our society has evidenced the huge social inequity of our modern society, in which the most vulnerable individuals have been pushed into even worse socioeconomic situations, struggling to survive. As the pandemic continues, we witness the huge suffering of the most marginalized populations around the globe, even in developed, high-income latitudes, such as North America and Europe. That is even worse in low-income regions, such as Brazil, where the public healthcare infrastructure had already been struggling before the pandemic. Cities with even more evident social inequity have been impacted the most, leaving the most socioeconomically disadvantaged ones, such as slum residents and black people, continuously inflating the statistics of COVID-19 sufferers. Poverty, marginalization, and inequity have been well-known risk factors for morbidity and mortality from other diseases. However, COVID-19 has deepened our society's wound. It is up to us to heal it up. If we really care for the others and want to survive as a species, we must fight social inequity.

After 18 years of the classic pathophysiological characterization of what we currently call "heart failure (HF) with preserved ejection fraction (HFpEF)", its diagnostic criteria remain questionable and evolving. 1 Even with historically different diagnostic criteria, establishing its prevalence and assessing its prognosis is an increasing challenge in primary care. In 2016, the European Society of Cardiology (ESC) established the following as criteria for HFpEF: the presence of signs and or symptoms of HF; left ventricle ejection fraction (LVEF) greater than or equal to 50%; elevation of natriuretic peptides; and the presence of cardiac structural or functional alteration. 2 In general, primary care physicians find it difficult to deal with patients with multiple comorbidities, signs and symptoms of HF and preserved LVEF and, in such cases, easily accessible tools that assist the physician in diagnosis and prognosis can be extremely useful. Recently, a scoring system called the H 2 FPEF score 3 was proposed to estimate the diagnostic probability of HFpEF in patients assisted in a specialized HF unit. However, the prognostic utility of this score remains 666

Cardiovascular health in developing countries, notably in the regions of Africa and Latin America, poses unique challenges that warrant in-depth analysis and an interdisciplinary approach. The medical landscape in these contexts is marked by a complex intersection of factors, including structural limitations, restricted financial resources, and a diversity of cultural and socioeconomic conditions. 1 This editorial aims to explore the pressing challenges and promising prospects for Cardiology in these two continents, providing a joint perspective that seeks to highlight similarities, disparities, and opportunities to improve cardiovascular health in communities at different stages of development. Africa has the poorest countries in a single continent. Of the top 30 poorest countries in the world, 23 are in Africa, representing 76.6% of the total countries on the list, with almost 1.1 billion people in poverty, as per the report of the 2023 Multidimensional Poverty Index (MPI), which measures the acute deprivations in health, education, and living standards that people face simultaneously. 2 Africa, the least developed continent, faces a complex intersection of economic and public health challenges. Despite modest economic growth, the highest proportion of the world's poor, 54.8%, are from Africa, which holds significant inequalities and vulnerabilities. 1,3 Poverty disproportionately affects low-income countries and regions, 57.3% and 639 million people, and Sub-Saharan Africa has a higher average poverty rate, 41.1%, than Latin America and the Caribbean, 37.9%. Also, endemic diseases such as malaria, HIV/AIDS, and tuberculosis persist, while noncommunicable diseases, such as cardiovascular disease (CVD), are growing as public health concerns in Africa and Latin America. It is essential to mention that the leading causes of agestandardized deaths worldwide were the same from 1990 to 2019: ischemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infection, in descending order. However, in 2021, COVID-19 replaced stroke as the second leading standardized cause of death. In 2021, the highest age-standardized death rates from COVID-19 occurred in Sub-Saharan Africa, Latin America, and the Caribbean, and mortality from COVID-19 exceeded deaths from CVD in these regions. Few countries had MPI data consolidated during the COVID-19 pandemic, and the impacts of the COVID-19 pandemic on poverty and inequalities will likely be more significant in the coming years. There will likely be a substantial reduction in life expectancy in these regions in subsequent years, interrupting the cycle of incremental gains observed previously (Figure 1). 4 There is a significant intersection between the COVID-19 pandemic and CVD globally, especially in Latin America, the Caribbean, North Africa, and Sub-Saharan Africa. It is worth highlighting the impact of SARS-CoV-2 on the cardiovascular system and patients with CVD, the competition for health resources, and mitigation policies that compromised CVD care, partially

Background: The consumption of functional foods (FF), as oat and linseed, is a safe and efficient strategy for reducing the risk of non-transmissible chronic diseases (NTCD). Objective: Analyzing the effect of food supplementation with brown linseed flour or oat in flakes on the body mass index (BMI), on the waist circumference (WC) and on the lipid profile of elderly. Methods: Longitudinal controlled, randomized study, with duration of eight weeks, made with 60 senior individuals (age > 60 years), evaluated at three moments: baseline (T0), four weeks (T1) and eight weeks (T2) after the study started. Weight, height and WC were measured and blood samples were collected. Volunteers were randomly divided into control group (CG), linseed group (LG) and oat group (OG). Results: BMI and WC have not changed significantly throughout the study in any group. OG showed reduction of 18.4% in the total cholesterol (TC) levels in the plasma compared to LG in the end of the study period (p<0.05). OG showed also, at T2, values 30.4% lower for LDL cholesterol than LG and CG (p<0.05). On the other hand, LG showed increase of 12.0% in the triglycerides levels from T0 to T2 (p<0.05). Conclusion: The supplementation with functional foods was beneficial for reducing the TC and LDL cholesterol.

Background: The consumption of functional foods (FF), as oat and linseed, is a safe and efficient strategy for reducing the risk of non-transmissible chronic diseases (NTCD). Objective: Analyzing the effect of food supplementation with brown linseed flour or oat in flakes on the body mass index (BMI), on the waist circumference (WC) and on the lipid profile of elderly. Methods: Longitudinal controlled, randomized study, with duration of eight weeks, made with 60 senior individuals (age > 60 years), evaluated at three moments: baseline (T0), four weeks (T1) and eight weeks (T2) after the study started. Weight, height and WC were measured and blood samples were collected. Volunteers were randomly divided into control group (CG), linseed group (LG) and oat group (OG). Results: BMI and WC have not changed significantly throughout the study in any group. OG showed reduction of 18.4% in the total cholesterol (TC) levels in the plasma compared to LG in the end of the study period (p<0.05). OG showed also, at T2, values 30.4% lower for LDL cholesterol than LG and CG (p<0.05). On the other hand, LG showed increase of 12.0% in the triglycerides levels from T0 to T2 (p<0.05). Conclusion: The supplementation with functional foods was beneficial for reducing the TC and LDL cholesterol.

Aortic stenosis is an insidious disease with a long-term period of latency. It progresses rapidly after symptoms appear, esulting in a high mortality rate (approximately 50% in the first 2 years) in untreated symptomatic patients, 1 with sudden death being common in these individuals. Approximately 30% of the patients aged 75 years or over are not candidates for surgical procedure 2 due to their advanced age, female sex, functional class, operatory emergency, ventricular dysfunction, pulmonary hypertension, previous heart surgery, associated coronary artery disease, among others. In the age range of patients in their 80s, those who remain in clinical treatment have a survival rate of 65.8% in the first year and 41.8% in the second year of follow-up. 3

Background: Sudden cardiac death is the main lethal mechanism associated with Chagas cardiomyopathy. Studies suggest that dysautonomia may represent a relevant, intense, independent, and early phenomenon in the natural history of the disease, even when ventricular systolic function is preserved, and may also be the mechanism that triggers malignant ventricular arrhythmias. Objective: To evaluate the degree of dysautonomia and its possible association with ventricular arrhythmias in patients with Chagas cardiomyopathy, according to different categories of mortality risk, as defined by the score proposed by Rassi, used as a surrogate outcome for death. A cross-sectional study involving 43 patients with Chagas cardiomyopathy stratified into risk categories based on the Rassi score, with 23 being classified as low risk and 20 as intermediate-to-high risk. Heart rate variability (HRV) was assessed using Holter monitoring for long-term recordings of 24 hours (time domain) and for short-term recordings of 5 minutes (frequency domain) at rest and after autonomic tests: deep breathing and Valsalva maneuver. The HRV variables were compared between the groups using the Student's t-test and α=0.05. Comparison of the results between the risk stratification groups showed no differences in HRV indexes, either in the time or frequency domain. However, results showed a significant increase in the number of arrhythmias as a function of increased risk (p=0.02). There was no association between the degree of dysautonomia, evaluated by Holter monitoring, and the categories of mortality risk, despite a direct association between the rate of arrhythmias and the higher risk group.

Type 2 diabetes mellitus is currently an important risk factor for cardiovascular diseases. Therefore, diabetic patients considered at high risk should receive more aggressive preventive treatment. The intensity and severity of micro and macrovascular conditions associated with diabetes mellitus are the focus of investigation of the genetic, molecular and clinical mechanisms involved. One of the most important characteristics is that the time window for the development of atherosclerosis is smaller, showing more clearly the clinical outcomes and a potential therapeutic response. The best treatment for diabetic patients is interdisciplinary treatment through which the cardiologist and the endocrinologist investigate the consequences of the disease, any possible drug interactions and their adverse effects. The creation of a language and a common agenda for these two medical specialties can bring huge gains for the patient. The purpose of this review is to update the concepts related to the treatment and prevention of diabetes complications for non-endocrinologists.

Drug-induced QT prolongation with T wave inversion is a complex regulatory and clinical problem due to the rarity of this potentially fatal adverse incident. A 68-year-old female patient was receiving piperacillin/tazobactam therapy for a complicated urinary tract infection. She has had normal ECG findings before the antibacterial therapy. After the treatment, the patient worsens due to long QT which is predisposed to torsades de pointes. As a result of the researches, it was understood that the cause of long QT was piperacillin/tazobactam. We aimed to present a rare case in which we detected drug-induced QTc prolongation with piperacillin/tazobactam in clinical practice.

Background: Cardiovascular diseases are the leading cause of death in Brazil, and systemic hypertension is one of the main risk factors. In this sense, adherence to treatment is critical for controlling hypertension and prevention of its complications. Objectives: To determine and compare non-adherence rates to hypertension treatment by using different methods and blood pressure control, and determine the factors associated with non-adherence of hypertensive patients in Estratégia Saúde da Família (Family Health Strategy), in the city of São Luís, state of Maranhão. Methods: The cross-sectional study, conducted in São Luís, State of Maranhão, with 502 users of Estratégia Saúde da Família (Family Health Strategy-FHS). In order for adherence to be assessed, we used the Morisky and Green Test (MGT), Qualiaids team's Medication Adherence Questionnaire (QAM-Q) and Haynes' Questionnaire. To check the relation between adherence to treatment and sociodemographic and clinical variables, either Fisher's exact test or Chi-Square Test was used. Results: Non-adherence prevalence rate measured by MGT, MAQ-Q and Haynes was, respectively, 29.28%, 60.16% and 13.15%. Concordance between Haynes─MAQ-Q tests (kappa=80.68%) was substantial, while those between MAQ-Q─Morisky (kappa=48.61%) and Morisky─Haynes (kappa=55.58%) were moderate. Variables such as patient's smoking habit and return to physician for a follow-up visit have been shown, in all three tests, to be associated with non-adherence to treatment. Conclusions: Tests under evaluation have been shown to have good concordance. Non-adherence rate was high when measured by MAQ-Q, but low when measured by MGT and Haynes. Considering the control of blood pressure, MAQ-Q and Haynes presented statistical significance; MAQ-Q identified the greatest number of individuals with non-controlled blood pressure among those who do not adhere. The variables smoking and showing up to return visits were associated with non-adhesion in the three questionnaires.

Fundament: Telemedicine for follow-up in heart failure (HF) patients is effective in reducing hospitalizations, total and cardiovascular mortality. However, few studies were conducted in low and middle income, where lower access to technology and illiteracy could impact the results. Objective: To assess the effectiveness of associating telemedicine strategies, when compared to usual care, in reducing hospitalizations related to HF in patients discharged from the hospital due to HF. Methods: Controlled, randomized, multicenter, parallel-arm clinical trial, with an allocation ratio of 1:1, blinded to outcome evaluation, in which 340 patients who were discharged from public hospitals in Belo Horizonte due to HF will be randomized. Patients will be followed for 6 months and the intervention group will receive, in addition to the usual care, Structured Telephone Support (STS) from a nurse, a doctor, and an educational program. Counseling will be according to a clinical decision tree. The level of significance in the statistical analysis will be 5%. Expected results: Reduction in the number of hospital readmissions and/or in hospitalization time, in addition to developing a software with a clinical decision tree for remote follow-up and patient education about HF adapted to local culture. Conclusions: The intention of this study is to develop a telemedicine strategy and assess whether or not, in addition to the usual care, it is effective in reducing hospitalizations and mortality from HF. If effective, the aforementioned strategy could reduce costs and hospital needs in the Unified Health System (SUS, in Portuguese) for patients with HF. These results will be even more relevant considering the pandemic of COVID-19.

Background: Grapes and its derivatives (wines and juices) are rich in polyphenols that have high antioxidant and vasodilator capacity. These biological activities may vary in the juices marketed and produced in different regions of Brazil. Objectives: To determine the antioxidant and vasorelaxant effects of grape juice samples produced in different regions of Brazil. Methods: The content of phenolic compounds and antioxidant capacity were evaluated by the methods of Folin-Ciocalteau, DPPH, ABTS and a new electroanalytical approach (differential pulse voltammetry-DPV). Vasodilator effects were analyzed in isolated aorta from rats in an organ bath. Results: The samples from RJ and SP presented respectively the higher and lower phenolic content and also antioxidant capacity by the methods used (ABTS and DPPH). The results of the electrochemical index corroborate to the other tests, with the best results to RJ (21.69 ± 3.15 µA/V) and worse to the SP sample (11.30 ± 0.52 µA/V). In the vascular reactivity studies, the relaxation induced by each sample presented more distinct differences, following the order: RJ (87.9 ± 4.8%) > RS1 (71.6 ± 8.6%) > GO (56.2 ± 7.2%) > SP (39.9 ± 7.8%) > PR (39.4 ± 9.5%) > RS2 (19.5 ± 6.2%). Inhibition of endothelial NO practically abolished (p < 0.001) the relaxation for all samples, except one. Conclusion: The phenolic content and antioxidant capacity vary greatly among samples. The results obtained for the order of antioxidant activity were: RJ > RS1 > GO > RS2 > PR > SP. The juices were able to induce vascular relaxation at quite varied levels, and the RJ sample the most effective. The L-NAME practically blocked all samples except one (RS2).

Modern lifestyle is marked with unhealthy habits, including a sedentary behavior characterized by several hours of low energy expenditure, such as prolonged uninterrupted sitting. 1 Sedentary lifestyle is a worldwide public health problem, 2 primarily due to its association with increased risk of chronic diseases, such as type 2 diabetes, cancer, osteoporosis and cardiovascular disease (CVD). 3-5 In addition, prolonged sitting decreases cerebral blood flow (CBF) and function, 6 and may also impair affective and cognitive measures related to mood, affect, and alertness. 7

Cardiovascular diseases (CVD) are the main cause of death worldwide, which is a major concern for governmental leaders, research institutes, and health professionals alike. Hypertension and diabetes mellitus (DM) are recognized as major modifiable risk factors for CVD, and understanding the contribution of these risk factors to disease burden has motivated a wide range of studies and health promotion strategies. 1,2 Around 1 in 10 individuals aged 20 to 79 in the world has diabetes, a total of approximately 537 million people. It is estimated that, by 2045, this number will increase to 784 million. The majority of cases are in developing countries, where the greatest increase in rates is expected in the coming

Hypertension is a combination of genetic, environmental, and social factors, defined by blood pressure levels in which the benefits of treatment outweigh the risks. 1 The global prevalence of hypertension is approximately 1.3 billion adults. 2 The blood pressure control rates in developing countries in 2019 were 23% in women and 18% in men. 2

Deaths from cardiovascular disease, according to the WHO, are projected to reach around 14 million by 2030. The global population is aging at an accelerated rate and the prevalence of arterial hypertension (AH) increases with advancing age. 1 Aging is the common denominator in several cardiovascular diseases. Arterial stiffness and increased pulse wave velocity (PWV), as well as central systolic pressure are major predictors of cardiovascular events.

Background: An ecological hiking occurs yearly in Brazil. It is a unique event because of its distance (310 km) and dynamics (mean of 62 km/day for 5 days with mean pace of 7.6 km/h). Although beneficial effects of moderate-intensity exercises are well-known, the effects of intense and long-duration exercise still require study. Objective: To evaluate the effects of mixed walking/running race on various blood pressure (BP) parameters 30 days before (A0), on the 2 nd (A2), 3 rd (A3), and 4 th (A4) days after completing the day's stage. Methods: Central systolic (cSBP) and diastolic BP (cDBP), peripheral systolic (pSBP) and diastolic BP (pDBP), central pulse pressure (cPP), peripheral pulse pressure (pPP), amplified pulse pressure (aPP), corrected augmentation index (AIx75%) and pulse wave velocity (PWV) were measured using an oscillometric Mobil-O-Graph ® (IEM, Stolberg, Germany) in 25 male athletes (mean age of 45.3 ± 9.1 years). A p value < 0.05 was considered a statistically-significant difference. Results: cSBP decreased from A0 to A2 (109.5 to 118.1 mmHg) and from A0 to A3 (109.5 to 102.5 mmHg); pPP decrease from A0 to A2 (49.2 to 38.2 mmHg) and from A0 to A4 (49.2 to 41.2 mmHg); aPP decrease from A0 to A1 (15.6 to 9.5 mmHg), from A0 to A2 (15.6 to 8.0 mmHg) and from A0 to A3 (15.6 to 11.2 mmHg). PWV correlated with age. Conclusions: Blood pressure dropped on the first days of the race and returned to close to baseline values at the end. PWV correlates strongly with age. This type of exercise promotes effects on BP and PWV similar to those seen in long-duration, high-intensity sports. These changes in trained healthy individuals do not seem to increase cardiovascular risks. This was the first study to assess the effects of this type of exercise on the cardiovascular system.

Even before the SARS-COV2 pandemic had been declared by the World Health Organization (WHO), professional and recreational sportive events had already been cancelled worldwide. For the first time since the World War II, the Tokyo 2020 Olympic Games is at the top of this long list. 1 Not only was competitive athletic life compromised, but the adoption of social distancing as countermeasure for SARS-COV2 spread, deeply affecting their availability to train due to the closing of indoors sport facilities and, in some places, even the prohibition of any kind of outdoor workout. 2,3 While this paper is being written, the total number of COVID-19 cases worldwide has already surpassed 274

Background: In pandemic times, social isolation is of utmost importance to minimize the spread of the SARS-Cov-2 virus. At times like these, home fitness becomes extremely necessary to avoid sedentarism and decompensation in chronic disease patients. Objectives: Evaluate the engagement of rehabilitation patients to a tele-oriented exercise program at home (TOEP). Materials and Methods: 66 of 94 patients (63.8% males; 65.5±14 years old; 5.2±2.6 months in rehabilitation) agreed to take part. Subjects were grouped in three levels of functionality to guide the exercise prescription. Weekly Training Rates (WTR) were compared using the Friedman test and corrected by Dunn's test. A multivariate logistic model was designed to determine independent predictors in program engagement. Statistical significance was determined by a p<0.05. Results: TOEP provided WTR similar to the pre-quarantine values of 2.8/week (p>0.05), and 91.8% of patients took part until the end of those 5 weeks. The presence of diabetes was a predicted factor for low engagement to TOEP with relative risk of 0.41 (CI95%: 0.25 to 0.66). Conclusion: TOEP provided satisfactory engagement in rehabilitation patients. Most of them increased WTR during quarantine. Patients with diabetes displayed lower engagement to the minimum standard frequency.

Background: In pandemic times, social isolation is of utmost importance to minimize the spread of the SARS-Cov-2 virus. At times like these, home fitness becomes extremely necessary to avoid sedentarism and decompensation in chronic disease patients. Objectives: Evaluate the engagement of rehabilitation patients to a tele-oriented exercise program at home (TOEP). Materials and Methods: 66 of 94 patients (63.8% males; 65.5±14 years old; 5.2±2.6 months in rehabilitation) agreed to take part. Subjects were grouped in three levels of functionality to guide the exercise prescription. Weekly Training Rates (WTR) were compared using the Friedman test and corrected by Dunn's test. A multivariate logistic model was designed to determine independent predictors in program engagement. Statistical significance was determined by a p<0.05. Results: TOEP provided WTR similar to the pre-quarantine values of 2.8/week (p>0.05), and 91.8% of patients took part until the end of those 5 weeks. The presence of diabetes was a predicted factor for low engagement to TOEP with relative risk of 0.41 (CI95%: 0.25 to 0.66). Conclusion: TOEP provided satisfactory engagement in rehabilitation patients. Most of them increased WTR during quarantine. Patients with diabetes displayed lower engagement to the minimum standard frequency.

Even before the SARS-COV2 pandemic had been declared by the World Health Organization (WHO), professional and recreational sportive events had already been cancelled worldwide. For the first time since the World War II, the Tokyo 2020 Olympic Games is at the top of this long list. 1 Not only was competitive athletic life compromised, but the adoption of social distancing as countermeasure for SARS-COV2 spread, deeply affecting their availability to train due to the closing of indoors sport facilities and, in some places, even the prohibition of any kind of outdoor workout. 2,3 While this paper is being written, the total number of COVID-19 cases worldwide has already surpassed 274

Background: Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking. Objectives: To evaluate the association between RfH and stroke. Methods: We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke. Results: We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06). Conclusion: RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

Background: Cardiovascular and pulmonary complications often occur in the immediate post-surgery period and may be prevented and/or treated with lung expansion techniques. Objective: To evaluate the efficacy of lung expansion techniques in serum arterial lactate levels and oxygenation in patients in this surgical recovery phase. Method: A prospective and analytical study was carried out in postoperative cardiac surgery patients, hemodynamically stable. Measurements of artery lactate levels and partial pressure of oxygen were obtained from arterial blood samples drawn before and after lung expansion techniques, including alveolar recruiting maneuver and intermittent positive pressure breathing. Results: 40 patients with average age of 51.1 ± 14.9 years, 55% female, were included. It is possible to observe the statistically significant difference (p < 0.05) in the comparison between values of baseline and post-operative arterial lactate, oxygen level, oxygen saturation/fraction of inspired oxygen in both procedures. In relation to the outcome of oxygen blood pressure, only the group on intermittent positive pressure breathing achieved significant improvement. Conclusion: The lung expansion techniques used have contributed with the reduction of lactate level, improvement in oxygenation and oxygen saturation in this population, but did not alter intensive care unit length of stay. (Int J

Background: Resistance training (RT) is a strategy that decreases blood pressure (BP) in patients with stage 1 hypertension and attenuates BP progression in hypertensive rats (stage 3). The influence of RT in cardiac remodeling in uncontrolled hypertension is not yet established. Objective: The aim of this study was to evaluate the long-term effects of RT in moderate intensity in cardiac remodeling in spontaneously hypertensive rats (SHRs) without treatment. Methods: Ten male SHRs with stage 3 hypertension (systolic BP ≥ 180 mmHg) and five normotensive Wistar-Kyoto (WKY) rats (systolic BP < 120 mmHg) were divided into three groups: sedentary normotensive (SED-WKY), sedentary hypertensive (SED-SHR), and RT hypertensive (RT-SHR). The RT was conducted in a vertical ladder (3 days/week for 12 weeks, on nonconsecutive days) at 70% of the maximum load. BP and heart rate were recorded. At the end of the protocol, the animals were euthanized and had their left ventricles sectioned for histological analysis (hematoxylin and eosin and picrosirius red). Results: RT did not attenuate the absolute and relative weight gains of the heart and left ventricle in the RT-SHR group compared with the sedentary group (SED-SHR). There was no difference in nuclear cardiomyocyte volume and collagen content between groups. However, RT decreased the number of nuclei in the cardiomyocytes and attenuated the increase in systolic BP in the RT-SHR when compared with the SED-SHR group. The Δ of the rate-pressure product was lower in the RT-SHR group compared with the groups SED-WKY and SED-SHR. Conclusions: The data obtained demonstrate that RT did not attenuate the cardiac hypertrophy, but reduced the nuclear proliferation in cardiomyocytes and the BP progression in SHRs with severe hypertension.

Background: It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool. Objective: To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN). Methods: This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level. Results: Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474). Conclusion: Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

The concepts of Religiosity and Spirituality (R/S) are broad and heterogeneous. In summary, R/S can be understood as a set of feelings, thoughts, experiences, and behavioral factors motivated by the search for the "sacred". 1 Religiosity has an organizational dimension, related to participation in collective ceremonies in churches, temples, or other religious services, and a nonorganizational dimension, related to the individual practice of prayers, religious readings, and consumption of religious programs on their own. 2 Religiosity can also be classified as intrinsic, which refers to subjective and individual aspects, and extrinsic, which refers to social aspects and religious association. 3 In this context, the concepts of religion and religiosity are different: while the former refers to a construct formed by beliefs, behaviors, dogmas, rituals, and ceremonies derived from traditions established throughout history, 4 the latter refers to how much an individual believes, follows, and practices a religion. 2

Although most chemotherapy agents have adverse side effects, the most feared, due to its morbidity and mortality, is cardiotoxicity. Its main etiological agents are anthracyclines and trastuzumab, both of which are widely used in breast cancer treatment. 1-3 Several methods have been proposed to diagnose and assess cardiotoxicity secondary to cancer treatment. Currently, determining left ventricular ejection fraction (LVEF) by echocardiography has been recommended. 4-9 However, studies have shown that LVEF, despite being a robust predictor of cardiac events in general, has low sensitivity for detecting changes in LV function, 9 with a detectable drop in LVEF occurring only after damage to a large amount of myocardial tissue. 5 Large studies have found myocardial strain to be an ideal parameter of myocardial deformation for early detection of subclinical systolic dysfunction, ie, even before cardiotoxicity is diagnosed through a drop in

Background: Myocardial ischemia may occur in asymptomatic patients without a history of coronary artery disease (CAD). Stress echocardiography (SE) is a method with good diagnostic accuracy, while coronary cineangiography (CCA) is the gold standard method to detect obstructive CAD. However, many patients with ischemia on functional tests show nonobstructive lesions on CCA. Objective: To assess the presence of predictors of obstructive atherosclerotic plaques in asymptomatic individuals with an SE positive for myocardial ischemia. Methods: Cross-sectional study with 278 asymptomatic individuals who underwent SE and CCA, divided into groups G1 (obstructive atherosclerotic lesions ≥ 50%) and G2 (plaques below 50% or nonexistent). Quantitative variables were compared with Student's t test or Mann-Whitney test for independent groups, according to the normality of the sample. For categorical variables, we used the chi-square test or Fisher's exact test, as appropriate. Logistic regression was used to identify independent predictors of atherosclerotic lesions. Results: The numbers of patients in G1 and G2 were 233 (83.3%) and 45 (16.2%), respectively. The mean age was higher in G1 (60.9 ± 9.56 years versus 51.8 ± 10.05 years, p < 0.001). G1, when compared with G2, had more patients with hypertension (65.2% versus 48.9%, respectively, p = 0.03) and dyslipidemia (77.3% versus 57.8%, respectively, p = 0.006). G2, when compared with G1, had a higher frequency of mild obesity (33.3% versus 14.2%, respectively, p = 0.002), which emerged as a protective factor for atherosclerotic lesions. Conclusion: The predictors of atherosclerotic plaques in asymptomatic patients with ischemia on SE were age, male gender, and fixed ischemia.

Background: The impact of gender on the outcome of patients hospitalized with infective endocarditis (IE) is not fully understood. Objective: To verify the association between gender and the clinical profile of patients hospitalized with IE, treatment strategies, and clinical outcomes. Methods: This is a retrospective nationwide study of patients hospitalized with IE, based on hospital admissions between 2010 and 2018 in Portugal. Descriptive statistics were used to present variables. An inferential analysis was performed using multiple logistic regression. A 95% confidence interval and a 5% significance level were considered. Results: In total, 3266 (43.1%) women and 4308 (56.9%) men were hospitalized with IE. The women were older (76 vs 69 years old, p&lt;0.001), more frequently presented arterial hypertension (39.8% vs 35.4%, p&lt;0.001) and atrial fibrillation (29.5% vs 21.2%, p&lt;0.001), and had less cardiovascular comorbidities. Acute heart failure was more common in women (3...

Snakes, scorpions, spiders, wasps, and fish have evolved independent venom systems with complex mixtures in their chemical arsenals. Envenomation after a snakebite is a neglected public health issue responsible for substantial illness and death in impoverished populations living in rural and tropical Africa, Asia, Oceania, and Latin America.