GIULIANO GENEROSO

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  • article 3 Citação(ões) na Scopus
    Anomalous Coronary Arteries: When to Follow-up, Risk Stratify, and Plan Intervention
    (2021) ADAM, Eduardo Leal; GENEROSO, Giuliano; BITTENCOURT, Marcio Sommer
    Purpose of Review Coronary artery anomalies are a diverse group of entities, ranging from benign variations of normal anatomy to life-threatening conditions. There is, however, no universal consensus in their classification, risk stratification, and management. The aim of this review is to develop a straightforward clinical approach for the assessment and care of patients with anomalous coronary arteries. Recent Findings Autopsy series and population screening studies have recently provided useful clinical data on the prevalence and outcomes of coronary anomalies. Also, findings on coronary computed tomography angiography, magnetic resonance imaging, and invasive angiography, enriched with fractional flow reserve and intravascular ultrasound, have allowed identification of several high-risk features associated with specific coronary anomalies. Management of patients with anomalous coronary arteries requires an individualized approach based on clinical, physiological, and anatomic features. High-quality studies are paramount for further development of this fascinating field.
  • conferenceObject
    TRIGLYCERIDE-RICH LIPOPROTEINS-CHOLESTEROL IS STRONGLY ASSOCIATED WITH COGNITIVE PERFORMANCE WHILE TRIGLYCERIDES NOT: A CROSS-SECTIONAL ANALYSIS
    (2020) GENEROSO, Giuliano; SUEMOTO, Claudia K.; BENSENOR, Isabela; SANTOS, Raul; JONES, Steven R.; KULKARNI, Krishnaji; BLAHA, Michael; TOTH, Peter; LOTUFO, Paulo; BITTENCOURT, Marcio
  • article 15 Citação(ões) na Scopus
    Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
    (2020) CARDOSO, Rhanderson; GENEROSO, Giuliano; STANIAK, Henrique L.; FOPPA, Murilo; DUNCAN, Bruce B.; PEREIRA, Alexandre C.; BLAHA, Michael J.; BLANKSTEIN, Ron; NASIR, Khurram; BENSENOR, Isabela M.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.
    Background and aims: There are limited data on serial coronary artery calcium (CAC) assessments outside North American and European populations. We sought to investigate risk factors for CAC incidence and progression in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: We included individuals with no prior cardiovascular disease and two CAC measurements in ELSA-Brasil. Incident CAC was defined as a baseline CAC of 0 followed by CAC > 0 on the second study. CAC progression was defined according to multiple published criteria. We performed logistic and linear regression to identify risk factors for CAC incidence and progression. We also examined risk factor effect modification by baseline CAC (0 vs. > 0). Results: A total of 2707 individuals were included (57% women, age 48.6 +/- 7.7 years). Participants self-identified as white (55%), brown (24%), black (16%), Asian (4%) and Indigenous (1%). The mean period between CAC assessments was 5.1 +/- 0.9 years. CAC incidence occurred in 282 (13.3%) of 2127 individuals with baseline CAC of 0. CAC progression occurred in 319 (55%) of 580 participants with baseline CAC > 0. Risk factors for CAC incidence included older age, male sex, white race, hypertension, diabetes, higher BMI, smoking, lower HDL-C, higher LDL-C and triglycerides, and metabolic syndrome. Older age and elevated LDL-C were associated with CAC incidence, but not progression. Risk factors consistently associated with CAC progression were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome. On interaction testing, these four risk factors were more strongly associated with CAC progression as compared to CAC incidence. Conclusions: CAC incidence was associated with multiple traditional risk factors, whereas the only risk factors associated with progression of CAC were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome.
  • conferenceObject
    High-density Lipoprotein Subfractions Are Associated With Low-grade Inflammation, Insulin Resistance and Metabolic Syndrome Components. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
    (2018) GENEROSO, Giuliano; BENSENOR, Isabela J.; SANTOS, Raul D.; SANTOS, Itamar S.; GOULART, Alessandra C.; JONES, Steven R.; KULKARNI, Krishnaji R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.
  • conferenceObject
    Association Between HDL-P Subfractions and Intima-Media Carotid Thickness.
    (2018) GENEROSO, Giuliano; BENSENOR, Isabela M.; SANTOS, Raul D.; SANTOS, Itamar S.; JONES, Steven R.; OTVOS, James D.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.
  • article 3 Citação(ões) na Scopus
    The association between triglyceride-rich lipoproteins, circulating leukocytes, and low-grade inflammation: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
    (2023) CESENA, Fernando Yue; GENEROSO, Giuliano; SANTOS, Raul D.; PEREIRA, Alexandre Costa; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio Sommer; BENSENOR, Isabela M.
    Background: Experimental studies have linked triglyceride-rich lipoproteins (TRLs) to inflamma-tion, but the extent of this phenomenon in vivo has not been completely elucidated.Objective: We investigated the association between TRL subparticles and inflammatory markers (circulating leukocytes, plasma high-sensitivity C-reactive protein [hs-CRP], and GlycA) in the general population.Methods: This was a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TRLs (number of particles per unit volume) and GlycA were measured by nuclear mag-netic resonance spectroscopy. The association between TRLs and inflammatory mark ers w as determined by multiple linear regression models adjusted for demographic data, metabolic conditions, and lifestyle factors. Standardized regression coefficients (beta) with 95% confidence intervals are reported. Results: The study population comprised 4,001 individuals (54% females, age 50 +/- 9 years). TRLs, especially medium and large subparticles, were associated with GlycA (beta 0.202 [0.168, 0.235], p < 0.001 for total TRLs). There was no association between TRLs and hs-CRP (beta 0.022 [-0.011, 0.056], p = 0.190). Medium, large, and very large TRLs were associated with leukocytes, with stronger connections with neutrophils and lymphocytes than monocytes. When TRL subclasses were analyzed as the proportion of the total pool of TRL particles, medium and large TRLs were positively related to leukocytes and GlycA, whereas smaller particles were inversely associated.Conclusions: There are different patterns of association between TRL subparticles and inflammatory markers. The findings support the hypothesis that TRLs (especially medium and larger subparticles) may induce a low-grade inflammatory environment that involves leukocyte activation and is captured by GlycA, but not hs-CRP.(c) 2023 National Lipid Association.
  • article 1 Citação(ões) na Scopus
    Dietary patterns and subclinical atherosclerosis incidence and progression: Results from ELSA-Brasil
    (2023) ALVES, Mariane de A.; MIRANDA, Andreia M.; CACAU, Leandro T.; LEVY, Jessica; GENEROSO, Giuliano; BITTENCOURT, Marcio S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; MARCHIONI, Dirce M.
    Background and aims: Cardiovascular disease (CVD) is the main cause of disease burden worldwide. Coronary artery calcification (CAC) score is a subclinical atherosclerosis marker able to predict the risk of CVD in asymptomatic patients, and few studies have investigated the association between dietary patterns (DP) and CAC score prospectively. Thus, the aim of this study was to estimate the association between baseline DP and CAC score incidence and progression on the ELSA-Brasil cohort. Methods and results: This study is a longitudinal prospective analysis of the ELSA-Brasil participants who underwent a CAC exam on baseline and follow-up (n = 2,824). CAC incidence was defined as a baseline CAC score equal to zero (n = 2,131) and subsequent follow-up CAC score greater than zero. CAC progression was defined according to the Hokanson method for the individuals who presented a CAC score greater than zero at the baseline (n = 639). Dietary data were assessed at the baseline using a food frequency questionnaire (FFQ), and factor analysis was applied to identify DP. Poisson regression models with robust variance and linear regression models were applied to estimate the association between baseline DP and CAC incidence and progression. The incidence of CAC was 14.6%, while 60.3% of the individuals presented CAC progression. Three DP were identified: convenience, Brazilian traditional, and prudent. We did not find a significant association between baseline DP and CAC incidence or progression. Conclusion: Our findings from this longitudinal prospective analysis showed that baseline DP are not associated with CAC incidence or progression. & COPY; 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University.
  • article 2 Citação(ões) na Scopus
    Polypills in Cardiovascular Disease Prevention: Mass-Strategy Approach, Precision Medicine, or an Essential Intertwine Between Them?
    (2021) GENEROSO, Giuliano; BITTENCOURT, Marcio Sommer
    Purpose of ReviewThis review considers the framework of high-risk vs. population approaches as proposed in the Rose's axiom within the context of cardiovascular diseases, including its benefits and limitations. We also contextualize the use of precision medicine in primary prevention therapy and contrast that with population approach.Recent FindingsAlthough the high-risk strategy aims at individualized care, the complexity of pharmacologic regimens and other limitations reduces its real-life impact. On the other hand, broad population strategies include treatment of a substantial number of low-risk individuals who are unlikely to benefit from treatment. The use of additional strategies to identify those low-risk individuals, instead of targeting at identifying the high-risk population, is and alternative strategy to be considered. Evidence of the potential use of coronary artery calcium score and polypills for this strategy is discussed.SummaryA more targeted population approach to primary prevention in cardiovascular diseases with the use of polypills and coronary artery calcium score might be considered in a structured mass-strategy approach to risk reduction.
  • article 14 Citação(ões) na Scopus
    High-density Lipoprotein-cholesterol Subfractions and Coronary Artery Calcium: The ELSA-Brasil Study
    (2019) GENEROSO, Giuliano; BENSENOR, Isabela M.; SANTOS, Raul D.; STANIAK, Henrique L.; SHAROVSKY, Rodolfo; SANTOS, Itamar S.; GOULART, Alessandra C.; JONES, Steven R.; KULKARNI, Krishnan R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.
    Background Although elevated high-density lipoprotein cholesterol (HDL-C) is considered protective against atherosclerotic cardiovascular disease, no causal relationship has been demonstrated. HDL-C comprises a group of different subfractions that might have different effects on atherosclerosis. Our objective was to investigate the association between HDL-C subfractions with the coronary artery calcium (CAC) score. Methods We included 3,674 (49.8 +/- 8.3 years, 54% women) participants from the ELSA-Brasil study who had no prior history of CVD and were not currently using lipid-lowering medications. We measured the fasting lipoprotein cholesterol fractions (in mmol/I) by a zonal ultracentrifugation method (VAP). We analyzed the independent predictive values of total HDL-C, HDL2-C, and HDL3-C subfractions and in the HDL2-C/HDL3-C ratio using linear regression to predict Ln(CAC+1) and logistic regression to predict the presence of CAC. Results Overall 912 (24.8%) of the participants had CAC> 0, and 294 (7.7%) had CAC> 100. The mean total HDL-C, HDL2-C, and HDL3-C were: 1.42 +/- 0.37, 0.38 +/- 0.17 and 1.03 +/- 0.21 mmol/I, respectively. Individuals with CAC> 0 had lower levels of total HDL-C as well as of each subfraction (p < 0.001). When adjusted for age, gender, smoking, hypertension, alcohol use, physical activity, and LDL-C, we observed an inverse association between HDL-C and its subfractions and CAC (p < 0.05). However, by adding triglycerides in the adjustment, neither total HDL-C nor its subfractions remained independently associated with the presence or extent of CAC. Conclusion In this cross-sectional analysis, neither the total HDL-C nor its subfractions (HDL2-C and HDL3-C, as well as HDL2-C/HDL3-C ratio) measured by VAP are independently associated with the presence or extent of coronary calcification. (C) 2019 IMSS.
  • conferenceObject
    Diabetes Alters the Association Between High-density Lipoprotein Subtractions and Carotid Intima-media Thickness: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
    (2018) GENEROSO, Giuliano; BENSENOR, Isabela J.; SANTOS, Itamar S.; SANTOS, Raul D.; GOULART, Alessandra C.; JONES, Steven R.; KULKARNI, Krishnaji R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.