DEBORA SITNIK
Projetos de Pesquisa
Unidades Organizacionais
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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- One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study(2015) SANTOS, Itamar Souza; GOULART, Alessandra Carvalho; BRANDAO, Rodrigo Martins; SANTOS, Rafael Caire de Oliveira; BITTENCOURT, Marcio Sommer; SITNIK, Debora; PEREIRA, Alexandre Costa; PASTORE, Carlos Alberto; SAMESIMA, Nelson; LOTUFO, Paulo Andrade; BENSENOR, Isabela MartinsBackground: Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers. Objectives: To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors. Methods: We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality. Results: We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95% CI) = 1.75-2.38], non-ST elevation myocardial infarction (HR = 3.82; 95% CI = 2.21-6.60) or ST elevation myocardial infarction (HR = 2.59; 95% CI = 1.38-4.89) diagnoses, and diabetes (HR = 1.78; 95% CI = 1.20-2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95% CI = 1.04-2.50), but not for cardiovascular mortality. Conclusions: We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in Sao Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one-year survival for overall and cardiovascular-related causes.
- 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 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.- Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study(2016) SANTOS, Rafael Caire de Oliveira dos; GOULART, Alessandra Carvalho; KISUKURI, Alan Loureiro Xavier; BRANDAO, Rodrigo Martins; SITNIK, Debora; STANIAK, Henrique Lane; BITTENCOURT, Marcio Sommer; LOTUFO, Paulo Andrade; BENSENOR, Isabela Martins; SANTOS, Itamar de SouzaBackground: To the best of our knowledge, there are no studies evaluating the influence of the unit of the first contact on the frequency and time of pharmacological treatment during an acute coronary syndrome (ACS) event. Objectives: The main objective was to investigate if the unit of first contact influenced the frequency and time of aspirin treatment in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods: We analyzed the pharmacological treatment time in 830 ERICO participants - 700 individuals for whom the hospital was the unit of first contact and 130 who initially sought primary care units. We built logistic regression models to study whether the unit of first contact was associated with a treatment time of less than three hours. Results: Individuals who went to primary care units received the first aspirin dose in those units in 75.6% of the cases. The remaining 24.4% received aspirin at the hospital. Despite this finding, individuals from primary care still had aspirin administered within three hours more frequently than those who went to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for non ST-elevation ACS and ST-elevation myocardial infarction, respectively). In adjusted models, individuals coming from primary care were more likely to receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval: 2.06-6.51). Conclusions: In our setting, individuals from primary care were more likely to receive aspirin earlier. Enhancing the ability of primary care units to provide early treatment and safe transportation may be beneficial in similar settings.
- 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 Design and baseline characteristics of a coronary heart disease prospective cohort: 2-year experience from the strategy of registry of acute coronary syndrome study (ERICO study)(2012) SANTOS, Itamar S.; GOULART, Alessandra C.; SITNIK, Debora; STANIAK, Henrique L.; FEDELI, Ligia G.; BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Introduction: Acute coronary syndrome (ACS) is an important cause of hospitalization. Although most patients are treated at local hospitals, the vast majority of registry studies are set in tertiary facilities. The ERICO study (Strategy of Registry of Acute Coronary Syndrome) was created to verify the frequency of ACS and its subtypes, the role of known or potential risk factors and long-term event rate in a community teaching hospital in the southeastern region of Brazil. Objectives: To describe the design and baseline characteristics during the two initial years of ERICO enrollment. Methods: The ERICO study is an ongoing prospective cohort. It is conducted at a secondary general hospital in Sao Paulo, Brazil. All consecutive patients, 35 years-old or older, with a diagnosis of ACS who agree to participate are enrolled in the study. Sociodemographics, medical history, clinical exam and information about hospital treatment are obtained. A brief depression questionnaire is also applied for an ancillary study. Blood samples are drawn at admission and stored. In 30-day follow-up visit, data on medical history and occurence of depressive symptoms are updated and additional blood and urinary samples are collected. Retinography, carotid intima-media thickness, heart rate variability and pulse wave velocity are performed. Questionnaires about food frequency, physical activity and sleep apnea are applied. At six months, and annually after acute event, participants are followed by phone. Results: From February 2009 to January 2011, 570 patients were enrolled. Of these, 156 (27.4%) had ST-elevation myocardial infarction (STEMI), 233 (40.9%) non ST-elevation myocardial infarction (NSTEMI) and 181 (31.7%) unstable angina (UA). Median age was 62 (interquartile interval: 54–73) years. 332 (58.2%) were men and 451 (79.1%) had 8 years or less of education. Most common primary cardiovascular risk factors were hypertension and sedentarism. Among 455 individuals who could adequately inform about previous coronary disease, only 126 (27.7%) had a prior positive history. Compared to the subgroup with STEMI, individuals with UA and NSTEMI had a higher frequency of known hypertension (p<0.01), dyslipidemia (p=0.01), sedentarism (p=0.01), prior coronary heart disease (CHD, p heart failure (p<0.01). Conclusion: In contrast to studies performed in tertiary hospitals, this community-hospital based sample has a less frequent prior history of CHD, which possibly reflects more closely a community-based setting.