MAURICIO WAJNGARTEN
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- 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.
- 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- 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.
article 15 Citação(ões) na Scopus Minimally Supervised Multimodal Exercise to Reduce Falls Risk in Economically and Educationally Disadvantaged Older Adults(2013) ALMEIDA, Tais L.; ALEXANDER, Neil B.; NYQUIST, Linda V.; MONTAGNINI, Marcos L.; SANTOS, Angela C. S.; RODRIGUES, Giselle H. P.; NEGRAO, Carlos E.; TROMBETTA, Ivani C.; WAJNGARTEN, MauricioFew studies have evaluated the benefit of providing exercise to underprivileged older adults at risk for falls. Economically and educationally disadvantaged older adults with previous falls (mean age 79.06, SD = 4.55) were randomized to 4 mo of multimodal exercise provided as fully supervised center-based (FS, n = 45), minimally supervised home-based (MS, n = 42), or to nonexercise controls (C, n = 32). Comparing groups on the mean change in fall-relevant mobility task performance between baseline and 4 mo and compared with the change in C, both FS and MS had significantly greater reduction in timed up-and-go, F(2,73) = 5.82, p = .004, eta(2)(p) = .14, and increase in tandem-walk speed, F(2,73) = 7.71, p < .001 eta(2)(p) = .17. Change in performance did not statistically differ between FS and MS. In community-dwelling economically and educationally disadvantaged older adults with a history of falls, minimally supervised home-based and fully supervised center-based exercise programs may be equally effective in improving fall-relevant functional mobility.conferenceObject 17beta-estradiol reduces endothelin-1 release in women with ischaemic left ventricular dysfunction(2016) ROSANO, G. M. C. Giuseppe M. C.; GEBARA, O.; WAJNGARTEN, M.; ALDRIGHI, J. C.; RAMIRES, J. A. F.bookPart Caso clínico baseado em diretriz: Como usar a imagem para complementar a consulta(2017) PINTO, Ibraim Masciarelli; WAJNGARTEN, Mauricio; DOUGLAS, Roberto Andrés Gomes; SMANIO, Paola Emanuel Poggio- Silent Atrial Fibrillation in Elderly Pacemaker Users: A Randomized Trial Using Home Monitoring(2016) LIMA, C. E. B.; MARTINELLI, M.; PEIXOTO, G. L.; SIQUEIRA, S. F.; WAJNGARTEN, Mauricio; SILVA, Rodrigo Tavares; COSTA, Roberto; FILHO, Roberto; RAMIRES, Jose Antonio FranchiniBackground: Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detection. The aims of this study were to evaluate the incidence of silent AF, the role of PRM, and to determine predictors of silent AF occurrence. Methods: Three hundred elderly patients with permanent pacemaker (PPM) were randomly assigned to the remote group (RG) or control group (CG). All patients received PPM with remote monitoring capabilities. Primary end point was AF occurrence rate and the secondary end points were time to AF detection and number of days with AF. Results: During the average follow-up of 15.7 +/- 7.7 months, AF episodes were detected in 21.6% (RG = 24% vs CG = 19.3%, P = 0.36]. There was no difference in the time to detect the first AF episode. However, the median time to detect AF recurrence in the RG was lower than that in the CG (54 days vs 100 days, P = 0.004). The average number of days with AF was 16.0 and 51.2 in the RG and CG, respectively (P = 0.028). Predictors of silent AF were left atrial diameter (odds ratio [OR] 1.2; 95% CI = 1.1-1.3; P < 0.001) and diastolic dysfunction (OR 4.8; 95% CI = 1.6-14.0; P = 0.005). Conclusions: The incidence of silent AF is high in elderly patients with pacemaker; left atrial diameter and diastolic dysfunction were predictors of its occurrence. AF monitoring by means of pacemaker is a valuable tool for silent AF detection and continuous remote monitoring allows early AF recurrence detection and reduces the number of days with AF.
bookPart Insuficiência cardíaca no idosos - características e tratamento(2016) NUSSBACHER, Amit; WAJNGARTEN, Mauricio