MARCIO SOMMER BITTENCOURT
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30 resultados
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- Subclinical coronary atherosclerosis and cardiovascular risk stratification in heterozygous familial hypercholesterolemia patients undergoing statin treatment(2019) MINAME, Marcio H.; BITTENCOURT, Marcio S.; NASIR, Khurram; SANTOS, Raul D.Purpose of review To discuss the heterogeneity of atherosclerotic cardiovascular disease (ASCVD) risk in heterozygous familial hypercholesterolemia and evidence and limitations of clinical risk scores and subclinical coronary atherosclerosis (SCA) imaging to evaluate risk. Recent findings Risk evaluation in contemporary familial hypercholesterolemia cohorts needs to consider the cause of the familial hypercholesterolemia phenotype, for example the presence of autosomal molecular defects that impart a greater ASCVD risk than in polygenic hypercholesterolemia, prospective follow-up and the impact of statin treatment. As atherosclerosis is multifactorial, clinical scores like the Montreal familial hypercholesterolemia score and SAFEHEART risk equation have been proposed to stratify ASCVD in statintreated, molecularly defined familial hypercholesterolemia individuals. However, these scores need further validation. SCA distribution in familial hypercholesterolemia individuals undergoing conventional lipidlowering treatment is heterogeneous, with 45-50% of individuals not presenting any coronary artery calcification (CAC). One study suggests that the absence of CAC associates with no ASCVD events in asymptomatic familial hypercholesterolemia individuals undergoing statin therapy despite elevated residual LDL-cholesterol levels. In contrast, the presence of CAC was independently associated with ASCVD events. Summary ASCVD risk is heterogeneous in statin-treated familial hypercholesterolemia individuals. Further studies are necessary to determine how risk stratification, especially with SCA detection, impacts on prescription of proprotein convertase subtilisin kexin type 9 inhibitors within a cost-constrained environment.
- Coronary CTA works for preoperative risk stratification, but do we know when and how to use it?(2019) BITTENCOURT, Marcio Sommer; GUALANDRO, Danielle Menosi
- INTERPLAY BETWEEN METABOLIC HEALTH AND OBESITY AND THEIR ASSOCIATION WITH CAROTID INTIMA MEDIA THICKNESS(2019) ROMAGNOLLI, Carla; BENSENOR, Isabela; SANTOS, Itamar; LOTUFO, Paulo; BITTENCOURT, Marcio
- Heart Disease and Stroke Statistics-2019 Update A Report From the American Heart Association(2019) BENJAMIN, Emelia J.; MUNTNER, Paul; ALONSO, Alvaro; BITTENCOURT, Marcio S.; CALLAWAY, Clifton W.; CARSON, April P.; CHAMBERLAIN, Alanna M.; CHANG, Alexander R.; CHENG, Susan; DAS, Sandeep R.; DELLING, Francesca N.; DJOUSSE, Luc; ELKIND, Mitchell S. V.; FERGUSON, Jane F.; FORNAGE, Myriam; JORDAN, Lori Chaffin; KHAN, Sadiya S.; KISSELA, Brett M.; KNUTSON, Kristen L.; KWAN, Tak W.; LACKLAND, Daniel T.; LEWIS, Tene T.; LICHTMAN, Judith H.; LONGENECKER, Chris T.; LOOP, Matthew Shane; LUTSEY, Pamela L.; MARTIN, Seth S.; MATSUSHITA, Kunihiro; MORAN, Andrew E.; MUSSOLINO, Michael E.; O'FLAHERTY, Martin; PANDEY, Ambarish; PERAK, Amanda M.; ROSAMOND, Wayne D.; ROTH, Gregory A.; SAMPSON, Uchechukwu K. A.; SATOU, Gary M.; SCHROEDER, Emily B.; SHAH, Svati H.; SPARTANO, Nicole L.; STOKES, Andrew; TIRSCHWELL, David L.; TSAO, Connie W.; TURAKHIA, Mintu P.; VANWAGNER, Lisa B.; WILKINS, John T.; WONG, Sally S.; VIRANI, Salim S.Each year, the American Heart Association (AHA), in conjunction with the National Institutes of Health and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors in the AHA's My Life Check - Life's Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) produces immense health and economic burdens in the United States and globally. The Statistical Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease [CHD], heart failure [HF], valvular disease, venous disease, and peripheral arterial disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have been cited > 20 000 times in the literature. Each annual version of the Statistical Update undergoes revisions to include the newest nationally representative data, add additional relevant published scientific findings, remove older information, add new sections or chapters, and increase the number of ways to access and use the assembled information. This year-long process, which begins as soon as the previous Statistical Update is published, is performed by the AHA Statistics Committee faculty volunteers and staff and government agency partners. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, a new chapter on sleep, an enhanced focus on social determinants of health, a substantively expanded focus on the global burden of CVD, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Statistical Update.
- Coronary Artery Calcium - From Screening to a Personalized Shared Decision-Making Tool: The New American Prevention Guidelines(2019) BITTENCOURT, Marcio Sommer; BLAHA, Michael J.; NASIR, Khurram
- Coronary Computed Tomography Angiography Takes the Center Stage and Here is Why(2019) GOTTLIEB, Illan; BITTENCOURT, Marcio Sommer; ROCHITTE, Carlos Eduardo; CAVALCANTE, Joao L.
- Coronary Artery Calcium and Cardiovascular Events in Patients With Familial Hypercholesterolemia Receiving Standard Lipid-Lowering Therapy(2019) MINAME, Marcio H.; BITTENCOURT, Marcio Sommer; MORAES, Sergio R.; ALVES, Romulo I. M.; SILVA, Pamela R. S.; JANNES, Cinthia E.; PEREIRA, Alexandre C.; KRIEGER, Jose E.; NASIR, Khurram; SANTOS, Raul D.OBJECTIVES The aim of this study was to evaluate the role of coronary artery calcium (CAC) as a predictor of atherosclerotic cardiovascular disease (ASCVD) (fatal or not myocardial infarction, stroke, unstable angina requiring revascularization, and elective myocardial revascularization) events in asymptomatic primary prevention molecularly proven heterozygous familial hypercholesterolemia (FH) subjects receiving standard lipid-lowering therapy. BACKGROUND FH is associated with premature ASCVD. However, the clinical course of ASCVD in subjects with FH is heterogeneous. CAC score, a marker of subclinical atherosclerosis burden, may optimize ASCVD risk stratification in FH. METHODS Subjects with FH underwent CAC measurement and were followed prospectively. The association of CAC with ASCVD was evaluated using multivariate analysis. RESULTS A total of 206 subjects (mean age 45 +/- 14 years, 36.4% men, baseline and on-treatment low-density lipoprotein cholesterol 269 +/- 70 mg/dl and 150 +/- 56 mg/dl, respectively) were followed for a median of 3.7 years (interquartile range: 2.7 to 6.8 years). CAC was present in 105 (51%), and 15 ASCVD events (7.2%) were documented. Almost one-half of events were hard outcomes, and the others were elective myocardial revascularizations. The annualized rates of events per 1,000 patients for CAC scores of 0 (n = 101 [49%]), 1 to 100 (n = 62 [30%]) and >100 (n = 43 [21%]) were, respectively, 0, 26.4 (95% confidence interval: 12.9 to 51.8), and 44.1 (95% confidence interval, 26.0 to 104.1). In multivariate Cox regression analysis, log(CAC score 1) was independently associated with incident ASCVD events (hazard ratio: 3.33; 95% CI: 1.635 to 6.790; p = 0.001). CONCLUSIONS CAC was independently associated with ASCVD events in patients with FH receiving standard lipid-lowering therapy. This may help further stratify near-term risk in patients who might be candidates for further treatment with newer therapies. (C) 2019 by the American College of Cardiology Foundation.
- Impact of improved low-density lipoprotein cholesterol assessment on guideline classification in the modern treatment era-Results from a racially diverse Brazilian cross-sectional study(2019) PALLAZOLA, Vincent A.; SATHIYAKUMAR, Vasanth; OGUNMOROTI, Oluseye; FASHANU, Oluwaseun; JONES, Steven R.; SANTOS, Raul D.; TOTH, Peter P.; BITTENCOURT, Marcio S.; DUNCAN, Bruce B.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BLAHA, Michael J.; MARTIN, Seth S.BACKGROUND: The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-C-N) was previously demonstrated as more accurate than Friedewald LDL-C estimation (LDL-C-F) in a North American database not able to take race into account. OBJECTIVES: We hypothesized that LDL-C-N would be more accurate than LDL-C-F and correlate better with LDL particle number (LDL-P) in a racially diverse Brazilian cohort. METHODS: We performed a cross-sectional analysis of 4897 participants in the Brazilian Longitudinal Study of Adult Health, assessing LDL-C-F and LDL-C-N accuracy via overlap with ultracentrifugation-based measurement among clinical guideline LDL-C categories as well as mg/dL and percent error differences. We analyzed by triglyceride categories and correlated LDL-C estimation with LDL-P. RESULTS: LDL-C-N demonstrated improved accuracy at 70 to <100 and <70 mg/dL (P < .001), with large errors >= 20 mg/dL about 9 times more frequent in LDL-C-F at LDL-C <70 mg/dL, mainly due to underestimation. Among individuals with LDL-C <70 mg/dL and triglycerides >= 150 mg/dL, 65% vs 100% of ultracentrifugation-based low-density lipoprotein cholesterol calculation fell within appropriate categories of estimated LDL-C-F and LDL-C-N, respectively (P < .001). Similar results were observed when analyzed for age, sex, and race. Participants at LDL-C <70 and 70 to <100 mg/dL with discordantly elevated LDL-C-N vs LDL-C-F had a 58.5% and 41.5% higher LDL-P than those with concordance (P < .0001), respectively. CONCLUSIONS: In a diverse Brazilian cohort, LDL-C-N was more accurate than LDL-C-F at low LDL-C and high triglycerides. LDL-C-N may avoid underestimation of LDL-C and better reflect atherogenic lipid burden in low particle size, high particle count states.
conferenceObject INTERACTIONS BETWEEN OBSTRUCTIVE SLEEP APNEA AND SLEEP DURATION WITH SUBCLINICAL ATHEROSCLEROSIS EVALUATED BY CORONARY CALCIUM SCORE: CROSS-SECTIONAL DATA FROM ELSA-BRASIL STUDY(2019) SOUZA, S. Pereira e; BITTENCOURT, S. M.; PARISE, K. B.; SANTOS, B. R.; SILVA, A. W.; AIELO, N. A.; PADOVESI, G. S.; FILHO, L. G.; BENSENOR, M. I.; LOTUFO, A. P.; DRAGER, F. L.- Triglycerides and triglyceride-rich lipoproteins in the development and progression of atherosclerosis(2019) GENEROSO, Giuliano; JANOVSKY, Carolina C. P. S.; BITTENCOURT, Marcio S.Purpose of review In this review, we intend to show the heterogenicity of the triglyceride group, including the triglyceride-rich lipoproteins and its subparticles, apolipoproteins, and its role in atherogenesis through epidemiological and genetic studies, observing the association of these various components and subclasses with subclinical atherosclerosis and cardiovascular events. Also, we reevaluated the moment of blood collection for the triglyceride measurement and its repercussion in atherosclerosis. Finally, we present the current scenario and new insights about the pharmacologic treatment of hypertriglyceridemia. Recent findings Recent studies have been observed, a correlation between cardiovascular disease and triglyceride components (as apolipoproteins A-V, C-I, C-III) as well as proteins involved in the metabolism pathway, such as the angiopoietin-like proteins. Also, the triglyceride-rich lipoproteins, also known as remnants, were recently associated with atherogenesis. Another important topic addressed is about nonfasting triglyceride level, which has been postulated as a better predictor of cardiovascular events than fasting collection. Summary Regarding hypertriglyceridemia treatment, the drug therapy was updated, as the omega-3 polyunsaturated fatty acids were tested in primary prevention as eicosapentaenoic acid and docosahexaenoic acid combination resulted in no benefit, whereas the administration of icosapent ethyl in secondary prevention and high-risk patients showed a robust decrease of the cardiovascular outcomes.
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