HENRIQUE LANE STANIAK
Projetos de Pesquisa
Unidades Organizacionais
SCPACIN-62, Hospital Universitário
11 resultados
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- Fasting glucose levels, incident diabetes, subclinical atherosclerosis and cardiovascular events in apparently healthy adults: A 12-year longitudinal study(2016) SITNIK, Debora; SANTOS, Itamar S.; GOULART, Alessandra C.; STANIAK, Henrique L.; MANSON, JoAnn E.; LOTUFO, Paulo A.; BENSENOR, Isabela M.We aimed to study the association between fasting plasma glucose, diabetes incidence and cardiovascular burden after 10-12years. We evaluated diabetes and cardiovascular events incidences, carotid intima-media thickness and coronary artery calcium scores in ELSA-Brasil (the Brazilian Longitudinal Study of Adult Health) baseline (2008-2010) of 1536 adults without diabetes in 1998. We used regression models to estimate association with carotid intima-media thickness (in mm), coronary artery calcium scores (in Agatston points) and cardiovascular events according to fasting plasma glucose in 1998. Adjusted diabetes incidence rate was 9.8/1000 person-years (95% confidence interval: 7.7-13.6/1000 person-years). Incident diabetes was positively associated with higher fasting plasma glucose. Fasting plasma glucose levels 110-125mg/dL were associated with higher carotid intima-media thickness (=0.028; 95% confidence interval: 0.003-0.053). Excluding those with incident diabetes, there was a borderline association between higher carotid intima-media thickness and fasting plasma glucose 110-125mg/dL (=0.030; 95% confidence interval: -0.005 to 0.065). Incident diabetes was associated with higher carotid intima-media thickness (=0.034; 95% confidence interval: 0.015-0.053), coronary artery calcium scores 400 (odds ratio=2.84; 95% confidence interval: 1.17-6.91) and the combined outcome of a coronary artery calcium scores 400 or incident cardiovascular event (odds ratio=3.50; 95% confidence interval: 1.60-7.65). In conclusion, fasting plasma glucose in 1998 and incident diabetes were associated with higher cardiovascular burden.
conferenceObject Incident Diabetes, Subclinical Atherosclerosis, and Cardiovascular Events in Apparently Healthy Adults-A Longitudinal Study(2015) SITNIK, Debora; SANTOS, Itamar S.; GOULART, Alessandra C.; STANIAK, Henrique L.; LOTUFO, Paulo A.; BENSENOR, Isabela M.- High-density Lipoprotein-cholesterol Subfractions and Coronary Artery Calcium: The ELSA-Brasil Study(2019) GENEROSO, Giuliano; BENSENOR, Isabela M.; SANTOS, Raul D.; STANIAK, Henrique L.; SHAROVSKY, Rodolfo; SANTOS, Itamar S.; GOULART, Alessandra C.; JONES, Steven R.; KULKARNI, Krishnan R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.Background Although elevated high-density lipoprotein cholesterol (HDL-C) is considered protective against atherosclerotic cardiovascular disease, no causal relationship has been demonstrated. HDL-C comprises a group of different subfractions that might have different effects on atherosclerosis. Our objective was to investigate the association between HDL-C subfractions with the coronary artery calcium (CAC) score. Methods We included 3,674 (49.8 +/- 8.3 years, 54% women) participants from the ELSA-Brasil study who had no prior history of CVD and were not currently using lipid-lowering medications. We measured the fasting lipoprotein cholesterol fractions (in mmol/I) by a zonal ultracentrifugation method (VAP). We analyzed the independent predictive values of total HDL-C, HDL2-C, and HDL3-C subfractions and in the HDL2-C/HDL3-C ratio using linear regression to predict Ln(CAC+1) and logistic regression to predict the presence of CAC. Results Overall 912 (24.8%) of the participants had CAC> 0, and 294 (7.7%) had CAC> 100. The mean total HDL-C, HDL2-C, and HDL3-C were: 1.42 +/- 0.37, 0.38 +/- 0.17 and 1.03 +/- 0.21 mmol/I, respectively. Individuals with CAC> 0 had lower levels of total HDL-C as well as of each subfraction (p < 0.001). When adjusted for age, gender, smoking, hypertension, alcohol use, physical activity, and LDL-C, we observed an inverse association between HDL-C and its subfractions and CAC (p < 0.05). However, by adding triglycerides in the adjustment, neither total HDL-C nor its subfractions remained independently associated with the presence or extent of CAC. Conclusion In this cross-sectional analysis, neither the total HDL-C nor its subfractions (HDL2-C and HDL3-C, as well as HDL2-C/HDL3-C ratio) measured by VAP are independently associated with the presence or extent of coronary calcification. (C) 2019 IMSS.
- Association between psoriasis and coronary calcium score(2014) STANIAK, Henrique L.; BITTENCOURT, Marcio Sommer; SANTOS, Itamar de Souza; SHAROVSKY, Rodolfo; SABBAG, Cid; GOULART, Alessandra C.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Background: Emerging data suggests that chronic inflammatory disease, such as psoriasis, may be associated to coronary artery disease (CAD). Objective: Analyze the association between psoriasis and subclinical atherosclerosis using coronary calcium score (CAC). Methods: We investigated 221 participants with psoriasis and 718 age-and sex-matched controls without prior known CAD. All participants completed a questionnaire and underwent laboratory tests and a CAC exam. Logistic regression models adjusted for Framingham risk score (FRS) and C-reactive protein (hs-CRP) were built. CAC was included in the models as a binary variable with different cut off values. Results: Body-mass index, race, hypertension, HDL, LDL and hs-CRP were significantly associated with psoriasis presence and severity. Psoriasis severity was significantly associated with CAC (p = 0.04), particularly for very high CAC (>400) (p <0.01). The OR for severe psoriasis and CAC >400 was 2.45 (95%CI: 1.26-4.75) in unadjusted models. In a model adjusted for the FRS, this association was no longer significant, but a trend was noted (p = 0.09). No significant changes in the association were noted after the inclusion of hs-CRP in the model. Conclusion: Psoriasis is associated with higher CAC values, mainly in individuals with severe psoriasis. The current findings also suggest the potential involvement of other mechanisms beyond classical cardiovascular risk factors and inflammation in this association.
conferenceObject Association of depression and coronary heart disease in the participants from the strategy of registry in acute coronary syndrome study (the ERICO study)(2012) GOULART, Alessandra C.; SANTOS, Itamar S.; SITNIK, Debora; STANIAK, Henrique L.; BITTENCOURT, Marcio S.; FEDELI, Ligia G.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Introduction: Depression is 3 times more common in patients after acute coronary syndrome (ACS). Further, depressive symptoms and clinical depression have an unfavorable impact on mortality in these patients. The Patient Health Questtionaire-9 (PHQ-9) is a brief depression screening instrument that has been shown reasonable sensitivity and specificity in this group. Objectives: To evaluate the baseline frequency of mild-moderate depressive symptoms, major depression and, their associations to ACS among participants from the ERICO study(Strategy of Registry of Acute Coronary Syndrome). Methods: This is an ancillary study of the ERICO study, an ongoing cohort study held at the University Hospital of the Universityof São Paulo, a teaching public hospital located in São Paulo, Brazil. The ERICO study aims to verify the frequency of ACS and its subtypes, the role of potential risk factors and the long-term event rate. Besides the cardiovascular evaluation, participants are invited to answer PHQ-9 (score range 0 –27 points). The presence of mild to moderate depressive symptoms was defined as a score from 1 to 9 points. Major depression (MD) was defined as a score of 10 or more points. Results: From September 2009 to January 2011, 452 patients ( 35 years) were diagnosed as having SCA. From 218 patients (mean age 62 years) who answered PHQ-9, 130 (59%) were male. 65 (29.8%) were diagnosed as having unstable angina, 94 (43.1%) as non-ST elevation myocardial infaction (MI) and 59 (27.1%) as ST-elevation MI. Almost 90% had at least one depressive symptom and, the most common complaint was “felling tired or having little energy”. Major depression was present in 77 (35.3%) ACS patients. MD was more frequent in women than in men (59.7% vs. 40.3%, p<0.001). Almost 50% of married patients had MD (p=0.02). Other sociodemographics factors had no association with clinical depression. ACS subtypes did no nfluency the frequency of depressive symptoms or MD. Conclusion: Compared to previous studies, we found a higher frequency of MD, regardless of ACS subtypes. Follow-up study will address the impact of depressive symptoms and MD in long-term outcomes.- Impacto do Alto Risco para Apneia Obstrutiva do Sono na Sobrevida após Síndrome Coronariana Aguda: Achados do Registro ERICO(2017) MAIA, Flavia C.; GOULART, Alessandra C.; DRAGER, Luciano F.; STANIAK, Henrique L.; SANTOS, Itamar de Souza; LOTUFO, Paulo Andrade; BENSENOR, Isabela M.Background: Obstructive sleep apnea (OSA) is a very often clinical condition that can be associated with high mortality risk, particularly in coronary heart disease (CHD). The diagnosis of OSA is not always accessible via the gold-standard method polysomnography. Objective: To evaluate long-term influence of the high risk for OSA on fatal and non-fatal outcomes after acute coronary syndrome (ACS) in the Acute Coronary Syndrome Registry Strategy (ERICO) Study using the Berlin questionnaire as a surrogate. Methods: Berlin questionnaire, a screening questionnaire for OSA, was applied in 639 cases of ACS 30 days after the index event. Cox regression proportional-hazards model was used to calculate the hazard ratio (HR) of all-cause, cardiovascular and CHD (myocardial infarction) mortality, as well as, the combined endpoint of fatal or recurrent non-fatal CHD. Results: The high-risk group for OSA had higher frequencies of previous personal/family history of CHD and diabetes, in addition to a poorer event-free survival, as compared to the low-risk group (p-log-rank=0.03). The HR for fatal or recurrent non-fatal CHD was 4.26 (95% confidence interval, 1.18-15.36) in patients at high risk for OSA compared to those at low risk for OSA after a 2.6-year mean follow-up. Conclusions: Using Berlin questionnaire, we were able to identify high risk for OSA as an independent predictor of non-fatal reinfarction or CHD mortality in post-ACS individuals in a long-term follow-up.
- Elevated High-Sensitivity Troponin I in the Stabilized Phase after an Acute Coronary Syndrome Predicts All-Cause and Cardiovascular Mortality in a Highly Admixed Population: A 7-Year Cohort(2019) CASTRO, Leandro Teixeira de; SANTOS, Itamar de Souza; GOULART, Alessandra C.; PEREIRA, Alexandre da Costa; STANIAK, Henrique Lane; BITTENCOURT, Marcio Sommer; LOTUFO, Paulo Andrade; BENSENOR, Isabela MartinsBackground: High-sensitivity cardiac troponin I (hs-cTnl) has played an important role in the risk stratification of patients during the in-hospital phase of acute coronary syndrome (ACS), but few studies have determined its role as a long-term prognostic marker in the outpatient setting. Obiective : To investigate the association between levels of hs-cTnl measured in the subacute phase after an ACS event and long-term prognosis in a highly admixed population. Methods: We measured levels of hs-cTnl in 525 patients 25 to 90 days after admission for an ACS event; these patients were then divided into tertiles according to hs-cTnl levels and followed for up to 7 years. We compared all-cause and cardiovascular mortality using Cox proportional hazards models and adopting a significance level of 5%. Results: After a median follow-up of 51 months, patients in the highest tertile had a greater hazard ratio (HR) for all-cause mortality after adjustment for age, sex, known cardiovascular risk factors, medication use, and demographic factors (HR: 3.84, 95% Cl: 1.92-8.12). These findings persisted after further adjustment for estimated glomerular filtration rate < 60 ml/min/1.73 m(2) and left ventricular ejection fraction < 0.40 (HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly higher in the highest tertile after adjustment for age and sex (HR: 5.65, 95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27). Conclusions: Elevated hs-cTnl levels measured in the stabilized phase after an ACS event are independent predictors of all-cause and cardiovascular mortality in a highly admixed population.
- Design and baseline characteristics of a coronary heart disease prospective cohort: two-year experience from the strategy of registry of acute coronary syndrome study (ERICO study)(2013) GOULART, Alessandra C.; SANTOS, Itamar S.; SITNIK, Debora; STANIAK, Henrique L.; FEDELI, Ligia M.; PASTORE, Carlos Alberto; SAMESIMA, Nelson; BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; LOTUFO, Paulo A.; BENSENOR, Isabela M.OBJECTIVES: To describe the ERICO study (Strategy of Registry of Acute Coronary Syndrome), a prospective cohort to investigate the epidemiology of acute coronary syndrome. METHODS: The ERICO study, which is being performed at a secondary general hospital in Sao Paulo, Brazil, is enrolling consecutive acute coronary syndrome patients who are 35 years old or older. The sociodemographic information, medical assessments, treatment data and blood samples are collected at admission. After 30 days, the medical history is updated, and additional blood and urinary samples are collected. In addition, a retinography, carotid intima-media thickness, heart rate variability and pulse-wave velocity are performed. Questionnaires about food frequency, physical activity, sleep apnea and depression are also applied. At six months and annually after an acute event, information is collected by telephone. RESULTS: From February 2009 to September 2011, 738 patients with a diagnosis of an acute coronary syndrome were enrolled. Of these, 208 (28.2%) had ST-elevation myocardial infarction (STEMI), 288 (39.0%) had non-ST-elevation myocardial infarction (NSTEMI) and 242 (32.8%) had unstable angina (UA). The mean age was 62.7 years, 58.5% were men and 77.4% had 8 years or less of education. The most common cardiovascular risk factors were hypertension (76%) and sedentarism (73.4%). Only 29.2% had a prior history of coronary heart disease. Compared with the ST-elevation myocardial infarction subgroup, the unstable angina and non-ST-elevation myocardial infarction patients had higher frequencies of hypertension, diabetes, prior coronary heart disease (p < 0.001) and dyslipidemia (p = 0.03). Smoking was more frequent in the ST-elevation myocardial infarction patients (p = 0.006). CONCLUSIONS: Compared with other hospital registries, our findings revealed a higher burden of CV risk factors and less frequent prior CHD history.
conferenceObject HIGH-DENSITY LIPOPROTEIN SUBFRACTIONS ARE NOT INDEPENDENTLY ASSOCIATED WITH CORONARY ARTERY CALCIUM: A CROSS-SECTION ANALYSIS(2018) BITTENCOURT, Marcio; GENEROSO, Giuliano; BENSENOR, Isabela; SANTOS, Itamar S.; SANTOS, Raul D.; GOULART, Alessandra C.; STANIAK, Henrique L.; SHAROVSKY, Rodolfo; JONES, Steven; KULKAMI, Krishnaji R.; BLAHA, Michael J.; TOTH, Peter P.; LOTUFO, Paulo A.- ST-segment abnormalities are associated with long-term prognosis in non-ST-segment elevation acute coronary syndromes: The ERICO-ECG study(2016) BRANDAO, Rodrigo M.; SAMESIMA, Nelson; PASTORE, Carlos A.; STANIAK, Henrique L.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.; SANTOS, Itamar S.Introduction: We aimed to identify whether ST-segment abnormalities, in the admission or during in-hospital stay, are associated with survival and/or new incident myocardial infarction (MI) in 623 non-ST-elevation acute coronary syndrome participants of the Strategy of Registry of Acute Coronary Syndrome (ERICO) study: Materials and methods: ERICO is conducted in a community-based hospital. ST-segment analysis was based on the Minnesota Code. We built Cox regression models to study whether ECG was an independent predictor for clinical outcomes. Results: Median follow-up was 3 years. We found higher risk of death due to MI in individuals with ST-segment abnormalities in the final ECG (adjusted hazard ratio: 2.68; 95% confidence interval: 1.14-6.28). Individuals with ST-segment abnormalities in any tracing had a non-significant trend toward a higher risk of fatal or new non-fatal MI (p = 0.088). Conclusions: ST-segment abnormalities after the initial tracing added long-term prognostic information.