HENRIQUE LANE STANIAK
Projetos de Pesquisa
Unidades Organizacionais
SCPACIN-62, Hospital Universitário
16 resultados
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- Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2020) CARDOSO, Rhanderson; GENEROSO, Giuliano; STANIAK, Henrique L.; FOPPA, Murilo; DUNCAN, Bruce B.; PEREIRA, Alexandre C.; BLAHA, Michael J.; BLANKSTEIN, Ron; NASIR, Khurram; BENSENOR, Isabela M.; LOTUFO, Paulo A.; BITTENCOURT, Marcio S.Background and aims: There are limited data on serial coronary artery calcium (CAC) assessments outside North American and European populations. We sought to investigate risk factors for CAC incidence and progression in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: We included individuals with no prior cardiovascular disease and two CAC measurements in ELSA-Brasil. Incident CAC was defined as a baseline CAC of 0 followed by CAC > 0 on the second study. CAC progression was defined according to multiple published criteria. We performed logistic and linear regression to identify risk factors for CAC incidence and progression. We also examined risk factor effect modification by baseline CAC (0 vs. > 0). Results: A total of 2707 individuals were included (57% women, age 48.6 +/- 7.7 years). Participants self-identified as white (55%), brown (24%), black (16%), Asian (4%) and Indigenous (1%). The mean period between CAC assessments was 5.1 +/- 0.9 years. CAC incidence occurred in 282 (13.3%) of 2127 individuals with baseline CAC of 0. CAC progression occurred in 319 (55%) of 580 participants with baseline CAC > 0. Risk factors for CAC incidence included older age, male sex, white race, hypertension, diabetes, higher BMI, smoking, lower HDL-C, higher LDL-C and triglycerides, and metabolic syndrome. Older age and elevated LDL-C were associated with CAC incidence, but not progression. Risk factors consistently associated with CAC progression were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome. On interaction testing, these four risk factors were more strongly associated with CAC progression as compared to CAC incidence. Conclusions: CAC incidence was associated with multiple traditional risk factors, whereas the only risk factors associated with progression of CAC were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome.
- 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.conferenceObject Clinical Prediction Risk Scores Systematically Underestimate the Presence and Extent of Subclinical Atherosclerosis in Brazilian Women: The Brazilian Study of Longitudinal Health (ELSA-Brasil)(2014) BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; STANIAK, Henrique L.; SHAROVSKY, Rodolfo; GOMEZ, Luz Marina; MENDES, Vytor Hugo; BLANKSTEIN, Ron; NASIR, Khurram; BENSENOR, Isabela; LOTUFO, Paulo A.conferenceObject Thyroid-stimulating Hormone Levels and Coronary Artery Calcium Score. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2017) PEIXOTO-MIRANDA, Erique J.; BITTENCOURT, Marcio S.; STANIAK, Henrique L.; PEREIRA, Alexandre C.; FOPPA, Murilo; SANTOS, Itamar S.; 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.
conferenceObject Zero calcium scores is not reliable to rule out coronary artery disease in the emergency room(2012) STANIAK, Henrique L.; BITTENCOURT, Marcio S.; SHAROVSKY, Rodolfo; BENSENOR, Isabela; GOULART, Alessandra; CASTRO, Claudio C.; SANTOS, Itamar; OLMOS, Rodrigo; LOTUFO, PauloIntroduction: Several diagnostic tools have been proposed to investigate patients with acute chest pain in the emergency room. Recently, coronary computed angiotomography (CTA) has been studied for this purpose. Since CTA has some limitations including the use of ionizing radiation, iodine contrast and the need of drugs such as beta blockers and nitrates to achieve good image quality some authors have suggested that a negative calcium score would yield those patients with very low risk in which CTA could be safely avoided. Objectives: Evaluate the diagnostic accuracy of a negative calcium score when compared with CTA in the acute setting and subsequent downstream evaluation Methods: 65 patients (32 female) with acute chest pain, normal eletrocardiogram and cardiac biomarkers who underwent calcium score and CTA which had a negative calcium score were included. The exams were performed in a 64 detectors CT device with standard settings, and the CTA was performed using prospective acquisition, after beta blocker and nitrate unless contraindicated. The calcium score exams were compared to the CTA results. The CTA was considered positive if any lesion 50% was identified. Results: 65 patients were evaluated from February to August 2011. The mean age was 53.8 14.7 years and mean heart rate was 62 bpm. 2 of these zero calcium scores had non obstructive disease (50%), 3 of these zero calcium scores had obstructive disease and 1 patient had an invaluable CTA due to motion artifacts. These last 4 patients were furtherstratified with invasive coronary angiography and all 4 underwent coronary angioplasty. Conclusion: 8.2% of the patients with coronary artery disease would be misdiagnosed if coronary calcium score was used as the sole imaging strategy in this sample. Not only that, 4 patients which had an intervention performed would remain untreated.- 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.