VIVIANE ZORZANELLI ROCHA GIRALDEZ

(Fonte: Lattes)
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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 159 Citação(ões) na Scopus
    Cardiovascular risk assessment in patients with diabetes
    (2017) BERTOLUCI, Marcello Casaccia; ROCHA, Viviane Zorzanelli
    Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.
  • article 3 Citação(ões) na Scopus
  • article 350 Citação(ões) na Scopus
    Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017
    (2017) FALUDI, A. A.; IZAR, M. C. O.; SARAIVA, J. F. K.; CHACRA, A. P. M.; BIANCO, H. T.; AFIUNE NETO, A.; BERTOLAMI, A.; PEREIRA, A. C.; LOTTENBERG, A. M.; SPOSITO, A. C.; CHAGAS, A. C. P.; CASELLA-FILHO, A.; SIMAO, A. F.; ALENCAR FILHO, A. C.; CARAMELLI, B.; MAGALHAES, C. C.; MAGNONI, D.; NEGRAO, C. E.; FERREIRA, C. E. S.; SCHERR, C.; FEIO, C. M. A.; KOVACS, C.; ARAUJO, D. B.; CALDERARO, D.; GUALANDRO, D. M.; MELLO JUNIOR, E. P.; ALEXANDRE, E. R. G.; SATO, I. E.; MORIGUCHI, E. H.; RACHED, F. H.; SANTOS, F. C.; CESENA, F. H. Y.; FONSECA, F. A. H.; FONSECA, H. A. R.; XAVIER, H. T.; PIMENTEL, I. C.; GIULIANO, I. C. B.; ISSA, J. S.; DIAMENT, J.; PESQUERO, J. B.; SANTOS, J. E.; FARIA NETO, J. R.; MELO FILHO, J. X.; KATO, J. T.; TORRES, K. P.; BERTOLAMI, M. C.; V, M. H. Assad; MINAME, M. H.; SCARTEZINI, M.; FORTI, N. A.; COELHO, O. R.; MARANHAO, R. C.; SANTOS FILHO, R. D.; ALVES, R. J.; CASSANI, R. L.; BETTI, R. T. B.; CARVALHO, T.; MARTINEZ, T. L. R.; GIRALDEZ, V. Z. R.; SALGADO FILHO, W.
  • conferenceObject
    Coronary artery calcification is an independent predictor of cardiovascular events in familial hypercholesterolemia
    (2017) MINAME, M. H.; SILVA, P. R. S.; ALVES, R. L. M.; MORAES, S. R.; BITTENCOURT, M. S.; ROCHA, V. Z.; MARTE, A. P.; SALGADO, W.; JANNES, C. E.; PEREIRA, A. C.; SANTOS, R. D.
  • article 0 Citação(ões) na Scopus
    Cardiovascular risk assessment in patients with diabetes (vol 9, 25, 2017)
    (2017) BERTOLUCI, Marcello Casaccia; ROCHA, Viviane Zorzanelli
  • article 28 Citação(ões) na Scopus
    Achilles tendon xanthomas are associated with the presence and burden of subclinical coronary atherosclerosis in heterozygous familial hypercholesterolemia: A pilot study
    (2017) MANGILI, Leonardo C.; MINAME, Marcio H.; SILVA, Pamela R. S.; BITTENCOURT, Marcio S.; ROCHA, Viviane Z.; MANGILI, Otavio C.; SALGADO FILHO, Wilson; CHACRA, Ana P.; JANNES, Cinthia E.; PEREIRA, Alexandre C.; SANTOS, Raul D.
    Background and aims: Achilles tendon xanthomas (ATX) are a sign of long-term exposure to high blood cholesterol in familial hypercholesterolemia (FH) patients, which have been associated with cardiovascular disease. We evaluated the ATX association with the presence and extent of subclinical coronary atherosclerosis in heterozygous FH patients. Methods: 102 FH patients diagnosed by US-MEDPED criteria (67% with genetically proven FH), with median LDL-C 279 mg/dL (interquartile range: 240; 313), asymptomatic for cardiovascular disease, underwent computed tomography angiography and coronary artery calcium (CAC) quantification. Subclinical coronary atherosclerosis was quantified by CAC, segment-stenosis (SSS) and segment-involvement (SIS) scores. Adjusted Poisson regression was used to assess the association of ATX with subclinical atherosclerosis burden as continuous variables. Results: Patients with ATX (n = 21, 21%) had higher LDL-C and lipoprotein(a) [Lp(a)] concentrations as well as greater CAC scores, SIS and SSS (p < 0.05). After adjusting for age, sex, smoking, hypertension, previous statin use, HDL-C, LDL-C and Lp(a) concentrations, there was an independent positive association of ATX presence with CAC scores (beta = 1.017, p < 0.001), SSS (beta = 0.809, p < 0.001) and SIS (beta = 0.640, p < 0.001). Conclusions: ATX are independently associated with the extension of subclinical coronary atherosclerosis quantified by tomographic scores in FH patients.
  • conferenceObject
    STATIN-INDUCED HEPATITIS IN A SECONDARY PREVENTION PATIENT WITH SEVERE HYPERCHOLESTEROLEMIA
    (2017) BETTEGA, Marcelo; MINAME, Marcio Hiroshi; ROCHA, Viviane Zorzanelli; SANTOS FILHO, Raul Dias dos; RIZERIO, Brenno
  • conferenceObject
    Familial Hypercholesterolemia in Children and Safety of Early Lipid-Lowering Treatment
    (2017) BELLUNGHI, Maria Sol; MINAME, Marcio; JANNES, Cinthia E.; SILVA, Pamela R.; PEREIRA, Alexandre; CHACRA, Ana Paula; SALGADO, Wilson; SANTOS, Raul D.; ROCHA, Viviane Z.
  • article 24 Citação(ões) na Scopus
    Evaluation of clinical and laboratory parameters used in the identification of index cases for genetic screening of familial hypercholesterolemia in Brazil
    (2017) SILVA, Pamela R. S.; JANNES, Cinthia E.; OLIVEIRA, Theo G. M.; MINAME, Marcio H.; ROCHA, Viviane Z.; CHACRA, Ana Paula; GURGEL, Maria Helane C.; MONTENEGRO, Renan M.; RODRIGUES SOBRINHO, Carlos Roberto M.; MOREIRA, Annie Seixas Bello; ASSAD, Marcelo H. V.; PINTO, Marina R. C.; TADA, Mauricio Teruo; SANTOS, Raul D.; PEREIRA, Alexandre C.; KRIEGER, Jose E.
    Background and aims: There is controversy on the accuracy of different diagnostic criteria for familial hypercholesterolemia (FH). The aim of this study is to assess the performance of different clinical criteria used to identify individuals for FH genetic cascade screening in Brazil. Methods: All index cases (IC) registered in the Hipercol Brasil program between 2011 and 2016 were analyzed. Inclusion criteria were age > 18 years and elevated LDL-cholesterol (LDL-C) levels, with a conclusive result in the genetic test, whether positive or negative. Initially, we tested the multivariable association between clinical and laboratory markers and the presence of an FH causing mutation. Then, we analyzed sensitivity, specificity, positive and negative predictive values for the LDL-C quartile distribution, LDL-C as a continuous variable, as well as the performance measures for the Dutch Lipid Clinic Network (DLCN) score to identify a mutation. Results: Overall, 753 ICs were included and an FH causing mutation was found in 34% (n = 257) of the subjects. After multivariable analysis, LDL-C as a continuous variable, tendon xanthomas and corneal arcus were independently associated with the presence of FH mutations. LDL-C values >= 230 mg/dL (5.9 mmol/L) had the best tradeoff between sensitivity and specificity to diagnose a mutation. The DLCN score presented a better performance than LDL-C to identify a mutation, area under the ROC curve were 0.744 (95% CI: 0.704-0.784) and 0.730 (95% CI: 0.687-0.774), respectively, p = 0.014. Conclusions: In our population, LDL >= 230 mg/dL is a feasible criterion to indicate ICs to genetic testing. (C) 2017 Published by Elsevier Ireland Ltd.