MAURICIO WAJNGARTEN
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- I Brazilian Guidelines On Cardiovascular Prevention(2013) SIMAO, A. F.; PRECOMA, D. B.; ANDRADE, J. P.; CORREA FILHO, H.; SARAIVA, J. F. K.; OLIVEIRA, G. M. M.; MURRO, A. L. B.; CAMPOS, A.; ALESSI, A.; AVEZUM JUNIOR, A.; ACHUTTI, A. C.; MIGUEL, A. C. M. G.; SOUSA, A. C. S.; LOTEMBERG, A. M. P.; LINS, A. P.; FALUD, A. A.; BRANDAO, A. A.; SANJULIANI, A. F.; SBISSA, A. S.; ALENCAR FILHO, A. C.; HERDY, A. H.; POLANCZYK, C. A.; LANTIERI, C. J.; MACHADO, C. A.; SCHERR, C.; STOLL, C.; AMODEO, C.; ARAUJO, C. G. S.; SARAIVA, D.; MORIGUCHI, E. H.; MESQUITA, E. T.; CESENA, F. H. Y.; FONSECA, F. A. H.; CAMPOS, G. P.; SOARES, G. P.; FEITOSA, G. S.; XAVIER, H. T.; CASTRO, I; GIULIANO, I. C. B.; V, I. Rivera; GUIMARAES, I. C. B.; ISSA, J. S.; SOUZA, J. R. M.; FARIA NETO, J. R.; CUNHA, L. B. N.; PELLANDA, L. C.; BORTOLOTTO, L. A.; BERTOLAMI, M. C.; MINAME, M. H.; GOMES, M. A. M.; TAMBASCIA, M.; MALACHIAS, M. V. B.; SILVA, M. A. M.; IZA, M. C. O.; MAGALHAES, M. E. C.; BACELLAR, M. S. C.; MILANI, M.; WAJNGARTEN, M.; GHORAYEB, N.; COELHO, O. R.; VILLELA, P. B.; V, P. C. B. Jardim; SANTOS FILHO, R. D.; STEIN, R.; CASSANI, R. S. L.; D'AVILA, R. L.; FERREIRA, R. M.; BARBOSA, R. B.; POVOA, R. M. S.; KAISER, S. E.; ISMAEL, S. C.; CARVALHO, T.; GIRALDEZ, V. Z. R.; COUTINHO, W.; SOUZA, W. K. S. B.
- Cardiovascular risk in cognitively preserved elderlies is associated with glucose hypometabolism in the posterior cingulate cortex and precuneus regardless of brain atrophy and apolipoprotein gene variations(2013) TAMASHIRO-DURAN, Jaqueline Hatsuko; SQUARZONI, Paula; DURAN, Fabio Luis de Souza; CURIATI, Pedro Kallas; VALLADA, Homero Pinto; BUCHPIGUEL, Carlos Alberto; LOTUFO, Paulo Andrade; WAJNGARTEN, Mauricio; MENEZES, Paulo Rossi; SCAZUFCA, Marcia; ALVES, Tania Correa de Toledo Ferraz; BUSATTO, Geraldo FilhoCardiovascular risk factors (CVRF) possibly contribute to the emergence of Alzheimer's disease (AD). Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been widely used to demonstrate specific patterns of reduced cerebral metabolic rates of glucose (CMRgl) in subjects with AD and in non-demented carriers of the apolipoprotein epsilon 4 (APOE epsilon 4) allele, the major genetic risk factor for AD. However, functional neuroimaging studies investigating the impact of CVRF on cerebral metabolism have been scarce to date. The present FDG-PET study investigated 59 cognitively preserved elderlies divided into three groups according to their cardiovascular risk based on the Framingham 10-year risk Coronary Heart Disease Risk Profile (low-, medium-, and high-risk) to examine whether different levels of CVRF would be associated with reduced CMRgl, involving the same brain regions affected in early stages of AD. Functional imaging data were corrected for partial volume effects to avoid confounding effects due to regional brain atrophy, and all analyses included the presence of the APOE epsilon 4 allele as a confounding covariate. Significant cerebral metabolism reductions were detected in the high-risk group when compared to the low-risk group in the left precuneus and posterior cingulate gyrus. This suggests that findings of brain hypometabolism similar to those seen in subjects with AD can be detected in association with the severity of cardiovascular risk in cognitively preserved individuals. Thus, a greater knowledge about how such factors influence brain functioning in healthy subjects over time may provide important insigths for the future development of strategies aimed at delaying or preventing the vascular-related triggering of pathologic brain changes in the AD.
- Predictors of the risk of falls among elderly with chronic atrial fibrillation(2012) SANTOS, Angela Cristina Silva dos; NOBRE, Moacyr Roberto Cuce; NUSSBACHER, Amit; RODRIGUES, Giselle Helena de Paula; GEBARA, Otavio Celso Eluf; AZUL, Joao Batista Carvalho Serro; WAJNGARTEN, MauricioOBJECTIVES: Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed. METHODS: From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, 107 took part in this study. Their age was 77.9 +/- 6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied. RESULTS: At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that self-reported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%. CONCLUSION: In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests.
- Endothelial Alterations in Aging(2018) WAJNGARTEN, M.; NUSSBACHER, A.; DOURADO, P. M. M.; CHAGAS, A. C. P.Age is an important modifying factor of endothelial structure and function in humans. Mechanisms involved in the reduction of age-related endothelium-dependent vasodilation are caused mainly by a primary alteration in the l-arginine-NO pathway. Oxidative stress in the arterial wall plays an important role in the elderly, as it compromises NO bioavailability. The compromise of endothelium-dependent vasodilation in hypertension appears to represent an acceleration of the changes seen in aging. Endothelial dysfunction contributes to making vascular aging a strong risk factor for the development of cardiovascular diseases. On the other hand, experimental evidence suggests that dietary restriction stimulates preservation of vascular function through several mechanisms such as sirtuins, AMP kinase, insulin/insulin-like growth factor 1, and TOR kinase protein. However, controversies still remain as to how caloric restriction improves mitochondrial performance and whether this is sufficient to delay cell and age-dependent decline of the organism. © 2018 Elsevier Inc. All rights reserved.
bookPart Alterações endoteliais no envelhecimento(2016) WAJNGARTEN, Mauricio; NUSSBACHER, Amit; DOURADO, Paulo Magno Martins; CHAGAS, Antonio Carlos Palandri- Acute management of unstable angina and non-ST segment elevation myocardial infarction(2015) SILVA, Fernando Morita Fernandes; PESARO, Antonio Eduardo Pereira; FRANKEN, Marcelo; WAJNGARTEN, MauricioNon-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.
- Behavioral Cardiology: Cardiology's New Frontier of Action(2015) KATZ, Marcelo; WAJNGARTEN, Mauricio
- Prefrontal-Parietal White Matter Volumes in Healthy Elderlies Are Decreased in Proportion to the Degree of Cardiovascular Risk and Related to Inhibitory Control Deficits(2017) SANTOS, Pedro P.; SILVEIRA, Paula S. Da; SOUZA-DURAN, Fabio L.; TAMASHIRO-DURAN, Jaqueline H.; SCAZUFCA, Marcia; MENEZES, Paulo R.; LEITE, Claudia Da Costa; LOTUFO, Paulo A.; VALLADA, Homero; WAJNGARTEN, Mauricio; ALVES, Tania C. De Toledo Ferraz; RZEZAK, Patricia; BUSATTO, Geraldo F.Cardiovascular risk (CVR) factors may be associated with poor cognitive functioning in elderlies and impairments in brain structure. Using MRI and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of individuals aged 65-75 years (n = 156), subdivided in three CVR subgroups using the Framingham Risk Score. Cognition was assessed using the Short Cognitive Performance Test. In high-risk subjects, we detected significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low and intermediate CVR subgroups. Findings remained significant after accounting for the presence of the APOE epsilon 4 allele. Inhibitory control performance was negatively related to right prefrontal WM volume, proportionally to the degree of CVR. Significantly reduced deep parietal WM was also detected bilaterally in the high CVR subgroup. This is the first large study documenting the topography of CVR-related WM brain volume deficits. The significant association regarding poor response inhibition indicates that prefrontal WM deficits related to CVR are clinically meaningful, since inhibitory control is known to rely on prefrontal integrity.
- Calculated and perceived cardiovascular risk in asymptomatic subjects submitted to a routine medical evaluation: The perception gap(2015) KATZ, Marcelo; LAURINAVICIUS, Antonio G.; FRANCO, Fabio G. M.; CONCEICAO, Raquel D.; CARVALHO, Jose A. M.; PESARO, Antonio E. P.; WAJNGARTEN, Mauricio; SANTOS, Raul D.Background Poor adherence to medical treatment represents a major health problem. A subject's misperception of his own cardiovascular risk has been indicated as a key driver for low compliance with preventive measures. This study analysed the relationship between objectively calculated short- and long-term cardiovascular risk and its subjective perception. Design Cross-sectional study in asymptomatic Brazilian subjects. Methods Individuals (N=6544, mean age 49.17 years, 22.2% female) who underwent a routine mandatory health evaluation were studied. A questionnaire in which each individual rated his own cardiovascular risk as low, intermediate or high according to his own perception was used. The 10-year and lifetime cardiovascular risk were calculated respectively using the Framingham risk (FRS) and Lifetime risk (LRS) scores. Individuals were classified as hypo-perceivers (i.e. perceived risk lower than estimated risk), normo-perceivers (i.e. perceived risk coincident with estimated risk) and hyper-perceivers (i.e. perceived risk higher than estimated risk). Results Cardiovascular risk, using the FRS, was low in 77.9% (N=5071), intermediate in 14.4% (N=939) and high in 7.7% (N=499) of subjects. Cardiovascular risk, using the LRS, was low in 7.6% (N=492), intermediate in 43.1% (N=2787) and high in 49.3% (N=3184) of the study population. The prevalence of normo-perceivers was 57.6% using the FRS and only 20.6% using the LRS. Using the LRS, 72.3% of the intermediate and 91.2% of the high-risk subjects were hypo-perceivers. Conclusions In a large sample of asymptomatic individuals, there was a gap between calculated and perceived cardiovascular risk. Using a long-term risk score, most of the intermediate- and high-risk subjects were hypo-perceivers.
- Simultaneous transfer of cholesterol, triglycerides, and phospholipids to high-density lipoprotein in aging subjects with or without coronary artery disease(2011) AZEVEDO, Carolina H. M.; WAJNGARTEN, Mauricio; PRETE, Ana C. Lo; DIAMENT, Jayme; MARANHAO, Raul C.OBJECTIVE: To verify whether the capacity of high-density lipoprotein (HDL) to simultaneously receive non-esterified cholesterol, triglycerides, cholesteryl esters, and phospholipids changes with aging and the presence of coronary artery disease. DESIGN: Cross-sectional study with biochemical analyses. SUBJECTS: Eleven elderly patients with coronary artery disease (74 +/- 5 years) were compared with the following groups of non-coronary artery disease subjects (referred to as ""healthy""): 25 young (25 +/- 5 years), 25 middle-aged (42 +/- 6 years), and 25 elderly subjects (75 +/- 8 years). METHODS: Plasma samples were incubated with a nanoemulsion labeled with radioactive lipids; the transfer of the lipids from the nanoemulsion to the HDL was measured in chemically precipitated HDL. HDL size and paraoxonase-1 activity were also determined. RESULTS: The transfer of cholesteryl esters and phospholipids to high-density lipoprotein was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. Non-esterified cholesterol and triglyceride transfer was not different among these three groups. The HDL size was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. The paraoxonase-1 activity was similar among the groups. Compared with healthy elderly subjects, coronary artery disease elderly subjects had significantly less (p<0.05) transfer of non-esterified cholesterol, triglycerides, and cholesteryl esters to the HDL and a significantly smaller (p<0.05) HDL size. CONCLUSION: Because lipid transfer is enhanced in healthy elderly subjects but not in those with coronary artery disease, increasing lipid transfer to HDL may be a protective mechanism against the disease.
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