FERNANDA MARCIANO CONSOLIM COLOMBO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor e Coautores FMUSP-HC Normalizados: LUIZ APARECIDO BORTOLOTTO ×

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  • conferenceObject
    Improvement of the Adipokines Profile and Insulin Resistance in Metabolic Syndrome Patients Induced by Galantamine Activation of Cholinergic Pathway
    (2016) SANGALETI, Carine Teles; COSTA, Fernando Oliveira; MORAES, Tercio Lemos; IRIGOYEN, Maria Claudia; BORTOLOTTO, Luiz Aparecido Teles; LOPES, Heno Ferreira; PAVLOV, Valentin; TRACEY, Kevin; CONSOLIM-COLOMBO, Fernanda Marciano
  • article 17 Citação(ões) na Scopus
    High Muscle Sympathetic Nerve Activity Is Associated With Left Ventricular Dysfunction in Treated Hypertensive Patients
    (2013) SOUZA, Silvia Beatriz Cavasin de; ROCHA, Juraci Aparecida; CUOCO, Marco Antonio Romeu; GUERRA, Grazia Maria; FERREIRA-FILHO, Julio Cesar; BORILE, Suellen; KRIEGER, Eduardo Moacyr; BORTOLOTTO, Luiz Aparecido; CONSOLIM-COLOMBO, Fernanda Marciano
    The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity. After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n 15), impaired relaxation (LV-IR, n 15), and pseudonormal or restrictive (LV-P/R, n 15). An age-, sex-, and body mass indexmatched control group of normotensive volunteers (N, n 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position. Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (331 and 321 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (263 and 152 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group. The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
  • article 13 Citação(ões) na Scopus
    High Dialysate Calcium Concentration May Cause More Sympathetic Stimulus During Hemodialysis
    (2016) JIMENEZ, Zaida N. C.; SILVA, Bruno C.; REIS, Luciene dos; CASTRO, Manuel C. M.; RAMOS, Camila D.; COSTA-HONG, Valeria; BORTOLOTTO, Luiz A.; CONSOLIM-COLOMBO, Fernanda; DOMINGUEZ, Wagner V.; OLIVEIRA, Ivone B.; MOYSES, Rosa M. A.; ELIAS, Rosilene M.
    Background/Aims: Acute activation of sympathetic activation during hemodialysis is essential to maintain blood pressure (BP), albeit long-term overactivity contributes to higher mortality. Low heart rate variability (HRV), a measure of autonomic nervous system activity, and abnormal ankle-brachial index (ABI) are associated with higher mortality in patients on hemodialysis. In this study, we assessed HRV and ABI pre and post dialysis in incident patients on hemodialysis using high (1.75mmol/l) and low (1.25mmol/l) dialysate calcium concentration (DCa). Methods: HRV was measured as the ratio between low frequency and high frequency power (LF/HF). Thirty patients (age 47 16 years, 67% men) were studied in two consecutive mid-week hemodialysis sessions. Results: Mean BP variation was positive with DCa 1.75 and negative with DCa 1.25 [4.0 (-6.0, 12.2 mmHg) vs. -3.2 (-9.8, 1.3 mmHg); p=0.050]. Reduction of ABI from pre to post HD was related to higher sympathetic activity (p=0.031). The increase in LF/HF ratio was higher with DCa 1.75 (58.3% vs. 41.7% in DCa 1.75 and 1.25, respectively, RR 2.8; p=0.026). Conclusion: Although higher DCa is associated with better hemodynamic tolerability during hemodialysis, this occurs at the expense of increased sympathetic activity. Higher sympathetic activity was associated with a decrease of ABI during hemodialysis. (C) 2016 The Author(s) Published by S. Karger AG, Basel
  • article 1 Citação(ões) na Scopus
    Factors associated with subendocardial ischemia risk in patients on hemodialysis
    (2016) SILVA, Bruno Caldin da; SANJUAN, Adriano; COSTA-HONG, Valéria; REIS, Luciene dos; GRACIOLLI, Fabiana; CONSOLIM-COLOMBO, Fernanda; BORTOLOTTO, Luiz Aparecido; MOYSES, Rosa Maria Affonso; ELIAS, Rosilene Motta
    Abstract Introduction: Bone metabolism disorder (BMD) and vascular dysfunction contribute to excess cardiovascular mortality observed in hemodialysis patients. Vascular dysfunction, a new marker of atherosclerosis, can play a role in this risk. Even though associated with higher mortality in the general population, such vascular evaluation in patients on hemodialysis has not been extensively studied. Methods: In this cross-sectional study, hemodialysis patients were submitted to flow-mediated dilation, subendocardial viability ratio (SEVR) and ejection duration index assessment, in order to estimate the impact of BMD markers on vascular dysfunction. Results: A matched cohort of patients with (n = 16) and without (n = 11) severe secondary hyperparathyroidism (SHPT) was studied. Additionally, time spent under severe SHPT was also evaluated. Patients with severe SHPT had lower SEVR and higher ejection duration index, indicating higher cardiovascular risk. Lower SEVR was also associated to diastolic blood pressure (r = 0.435, p = 0.049), serum 25-Vitamin-D levels (r = 0.479, p = 0.028) and to more time spent under severe secondary hyperparathyroidism (SHPT), defined as time from PTH > 500pg/ml until parathyroidectomy surgery or end of the study (r = -0.642, p = 0.027). In stepwise multiple regression analysis between SEVR and independent variables, lower SEVR was independently associated to lower serum 25-Vitamin-D levels (p = 0.005), female sex (p = 0.012) and more time spent under severe SHPT (p = 0.001) in a model adjusted for age, serum cholesterol, and blood pressure (adjusted r² = 0.545, p = 0.001). Conclusion: Subendocardial perfusion was lower in patients with BMD, reflecting higher cardiovascular risk in this population. Whether early parathyroidectomy in the course of kidney disease could modify such results still deserves further investigation.
  • article 24 Citação(ões) na Scopus
    The Cholinergic Drug Galantamine Alleviates Oxidative Stress Alongside Anti-inflammatory and Cardio-Metabolic Effects in Subjects With the Metabolic Syndrome in a Randomized Trial
    (2021) SANGALETI, Carine Teles; KATAYAMA, Keyla Yukari; ANGELIS, Katia De; MORAES, Tercio Lemos de; ARAUJO, Amanda Aparecida; LOPES, Heno F.; CAMACHO, Cleber; BORTOLOTTO, Luiz Aparecido; MICHELINI, Lisete Compagno; IRIGOYEN, Maria Claudia; OLOFSSON, Peder S.; BARNABY, Douglas P.; TRACEY, Kevin J.; PAVLOV, Valentin A.; COLOMBO, Fernanda Marciano Consolim
    Background: The metabolic syndrome (MetS) is an obesity-associated disorder of pandemic proportions and limited treatment options. Oxidative stress, low-grade inflammation and altered neural autonomic regulation, are important components and drivers of pathogenesis. Galantamine, an acetylcholinesterase inhibitor and a cholinergic drug that is clinically-approved (for Alzheimer's disease) has been implicated in neural cholinergic regulation of inflammation in several conditions characterized with immune and metabolic derangements. Here we examined the effects of galantamine on oxidative stress in parallel with inflammatory and cardio-metabolic parameters in subjects with MetS. Trial Design and Methods: The effects of galantamine treatment, 8 mg daily for 4 weeks or placebo, followed by 16 mg daily for 8 weeks or placebo were studied in randomly assigned subjects with MetS (n = 22 per group) of both genders. Oxidative stress, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase activities, lipid and protein peroxidation, and nitrite levels were analyzed before and at the end of the treatment. In addition, plasma cytokine and adipokine levels, insulin resistance (HOMA-IR) and other relevant cardio-metabolic indices were analyzed. Autonomic regulation was also examined by heart rate variability (HRV) before treatment, and at every 4 weeks of treatment. Results: Galantamine treatment significantly increased antioxidant enzyme activities, including SOD [+1.65 USOD/mg protein, [95% CI 0.39-2.92], P = 0.004] and CAT [+0.93 nmol/mg, [95% CI 0.34-1.51], P = 0.01], decreased lipid peroxidation [thiobarbituric acid reactive substances [log scale 0.72 pmol/mg, [95% CI 0.46-1.07], P = 0.05], and systemic nitrite levels [log scale 0.83 mu mol/mg protein, [95% CI 0.57-1.20], P = 0.04] compared with placebo. In addition, galantamine significantly alleviated the inflammatory state and insulin resistance, and decreased the low frequency/high frequency ratio of HRV, following 8 and 12 weeks of drug treatment. Conclusion: Low-dose galantamine alleviates oxidative stress, alongside beneficial anti-inflammatory, and metabolic effects, and modulates neural autonomic regulation in subjects with MetS. These findings are of considerable interest for further studies with the cholinergic drug galantamine to ameliorate MetS.
  • article 0 Citação(ões) na Scopus
    Posicionamento Brasileiro sobre Hipertensao Arterial Resistente - 2020 (vol 114, pg 576, 2020)
    (2020) YUGAR-TOLEDO, Juan Carlos; MORENO JUNIOR, Heitor; GUS, Miguel; ROSITO, Guido Bernardo Aranha; SCALA, Luiz Cesar Nazario; MUXFELDT, Elizabeth Silaid; ALESSI, Alexandre; BRANDAO, Andrea Araujo; MOREIRA FILHO, Osni; FEITOSA, Audes Diogenes de Magalhaes; PASSARELLI JUNIOR, Oswaldo; SOUZA, Dilma do Socorro Moraes de; AMODEO, Celso; BARROSO, Weimar Kunz Sebba; GOMES, Marco Antonio Mota; PAIVA, Annelise Machado Gomes de; BARBOSA, Eduardo Costa Duarte; MIRANDA, Roberto Dischinger; VILELA-MARTIN, Jose Fernando; NADRUZ JUNIOR, Wilson; RODRIGUES, Cibele Isaac Saad; DRAGER, Luciano Ferreira; BORTOLOTTO, Luiz Aparecido; CONSOLIM-COLOMBO, Fernanda Marciano; SOUSA, Marcio Goncalves de; BORELLI, Flavio Antonio de Oliveira; KAISER, Sergio Emanuel; SALLES, Gil Fernando; AZEVEDO, Maria de Fatima de; MAGALHAES, Lucelia Batista Neves Cunha; POVOA, Rui Manoel dos Santos; MALACHIAS, Marcus Vinicius Bolivar; NOGUEIRA, Armando da Rocha; JARDIM, Paulo Cesar Brandao Veiga; JARDIM, Thiago de Souza Veiga
  • conferenceObject
    User embracement vs. technology based distance learning in therapy adherence in arterial hypertension
    (2016) GUERRA, G.; WEN, C. L.; VIEIRA, M.; FISTAROL, I. R. B.; TSUNEMI, M. H.; GIORGI, D. M. A.; HONG, V.; MOTTA, R. A.; KOWALSKI, I. S. G.; OLEVEIRA, J. C. De; CONSOLIM-COLOMBO, F. M.; LOPES, H. F.; BORTOLOTTO, L. A.
  • article 6 Citação(ões) na Scopus
    Statin restores cardiac autonomic response to acute hypoxia in hypercholesterolaemia
    (2013) BRASILEIRO-SANTOS, Maria S.; BARRETO-FILHO, Jose A. S.; SANTOS, Raul D.; CHACRA, Ana P. M.; SANGALETI, Carine Teles; ALVEZ, Gisele; BEZERRA, Otavio Coelho; BORTOLOTO, Luiz Aparecido; IRIGOYEN, Maria C.; CONSOLIM-COLOMBO, Fernanda M.
    BackgroundHypercholesterolaemia may alter cardiovascular autonomic function. We investigated the autonomic cardiovascular regulation during normoxia and hypoxia in familial isolated HC patients with or without statin treatment. Materials and methodsLow (LF-RR) and high (HF-RR) components of spectral analysis of RR interval and systolic arterial pressure (LF-SAP) were obtained during 5min of normoxia and isocapnic hypoxia (10% O-2) in 10 normotensive familial HC patients without medication, in seven HC patients after a 12-week treatment period with 40mg of simvastatin (HC+SVT) and in eight matched normal volunteers (CO). ResultsThe HC patients had significant impairment of cardiac autonomic modulation parameters compared with CO at normoxia, which was maintained or even accentuated during hypoxia; these parameters included lower total variance of RR, increased normalized LF-RR, decreased normalized HF-RR, increased LF-RR/HF-RR ratio, higher LF-SAP component and reduced index. However, the HC+SVT group had a significant improvement in all parameters: the LF-RR and LF-SAP decreased (indicating a decrease in cardiac and vascular sympathetic activity), the HF-RR increased (indicating an increase in parasympathetic activity) and the spontaneous baroreflex sensitivity improved. These changes were detected at normoxia and were maintained during hypoxia. ConclusionsOur data are the first to show that isolated HC is characterized by an increase in cardiac and vasomotor sympathetic drive, a decrease in cardiac vagal modulation and baroreflex impairment during normoxia and hypoxia. In addition, our data suggest that statin treatment has a potential role in restoring the physiological cardiovascular autonomic control at baseline and during cardiovascular challenge.
  • article 15 Citação(ões) na Scopus
    Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?
    (2018) FATURETO-BORGES, Fernanda; JENNER, Raimundo; COSTA-HONG, Valeria; LOPES, Heno F.; TEIXEIRA, Sandra H.; MARUM, Elias; GIORGI, Dante A. M.; CONSOLIM-COLOMBO, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; KRIEGER, Eduardo M.; DRAGER, Luciano F.
    Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55 +/- 9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mmHg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9 +/- 11.8 versus -0.3 +/- 10.3 mmHg; 18 months, -6.7 +/- 11.1 versus -1.2 +/- 10.6 mmHg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3 +/- 1.9 versus 9.2 +/- 1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.
  • article 7 Citação(ões) na Scopus
    A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial
    (2011) FUCHS, Flavio D.; FUCHS, Sandra C.; MOREIRA, Leila B.; GUS, Miguel; NOBREGA, Antonio C.; POLI-DE-FIGUEIREDO, Carlos E.; MION, Decio; BORTOLOTTO, Luiz; CONSOLIM-COLOMBO, Fernanda; NOBRE, Fernando; COELHO, Eduardo Barbosa; VILELA-MARTIN, Jose F.; MORENO JR., Heitor; CESARINO, Evandro Jose; FRANCO, Roberto; BRANDAO, Andrea Araujo; SOUSA, Marcos R. de; RIBEIRO, Antonio Luiz Pinho; JARDIM, Paulo Cesar; AFIUNE NETO, Abrahao; SCALA, Luiz Cesar N.; MOTA, Marco; CHAVES, Hilton; ALVES, Joao Guilherme; SOBRAL FILHO, Dario C.; SILVA, Ricardo Pereira e; FIGUEIREDO NETO, Jose A.; IRIGOYEN, Maria Claudia; CASTRO, Iran; STEFFENS, Andre Avelino; SCHLATTER, Rosane; MELLO, Renato Bandeira de; MOSELE, Francisca; GHIZZONI, Flavia; BERWANGER, Otavio
    Background: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil.