Aged – ABC CARDIOL

IJCS

Editorial

From Right to Left Radial Access in Older Patients: Are We Witnessing the Next Procedural Shift?

Sandro Cadaval Gonçalves

The steady rise in percutaneous coronary interventions performed in older patients reflects not only demographic trends but also the growing body of evidence supporting the effectiveness of invasive strategies in this population. Three decades ago, the femoral approach was the undisputed standard. Early reports of transradial access in the early 1990s were met with skepticism, mainly due to concerns about procedural complexity and unfamiliarity with the required technical adjustments. Over time, radial access became the preferred approach. The transition from radial to femoral access offered elderly patients a clear reduction in bleeding and vascular complications. Operators naturally shifted from right femoral to right radial access, remaining on the same side of the patient and often overlooking the more distant left side. As a result, right radial access (RRA) became the default. The choice between RRA and left radial access (LRA) is often driven by habit, operator ergonomics, equipment availability, and catheterization laboratory setup. Emerging evidence suggests this decision warrants closer consideration. In older patients, atherosclerotic and tortuous changes in the subclavian and brachiocephalic arteries are disproportionately more common on the right side. A left radial approach may reduce technical challenges, potentially shortening procedure time and lowering radiation exposure and contrast volume.^,

In this issue of the International Journal of Cardiovascular Sciences, Gonçalves et al. shed light on this important topic. In an elegant and technically well-performed systematic review and meta-analysis, including 1,094 patients from three randomized trials and one observational study, the authors provide compelling evidence to reconsider the choice of radial access in elderly patients. While numerous previous reviews have compared LRA and RRA, this study is unique in its exclusive focus on the elderly population. The analysis included studies involving patients aged ≥70 years undergoing diagnostic or therapeutic coronary procedures, comparing RRA and LRA, and reporting at least one of three outcomes: fluoroscopy time, contrast volume, and procedural difficulty.

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Original Article

Left Versus Right Radial Access in Elderly Patients for Coronary Procedures: A Systematic Review and Meta-Analysis

Anna Loise da Cruz Gonçalves et al. Deivyd Vieira Silva Cavalcante Brenda de Adonai Rodrigues Martins Caroline de Oliveira Fischer Bacca … Júlia Gonçalves Gadelha Suelen Queiroz Gabriel Erzinger Octávio Drummond Guina

Abstract

Background:

Radial artery access is widely used in coronary procedures, but the optimal choice between left (LRA) and right (RRA) radial access remains controversial, especially in older patients.

Objective:

Compare LRA and RRA in patients ≥ 70 years undergoing coronary procedures.

Methods:

This study conducted a systematic review and meta-analysis of observational studies and randomized clinical trials (RCTs), adopting a significance level of 5% for all statistical analyses. We searched PubMed, Embase, and Cochrane Central for studies comparing LRA and RRA in patients aged ≥ 70 years. The main outcomes were fluoroscopy time, contrast volume, and procedure difficulty.

Results:

We included 1,094 patients from 4 studies, of which 3 were RCTs. Among them, 821 (75%) patients underwent the procedure via RRA. The LRA group showed a significantly shorter fluoroscopy time (standard mean difference [MD]: −0.41; 95% confidence interval [CI]: −0.67 to −0.42; p < 0.01; I² = 80%), and there was a significant reduction in the contrast volume between the groups, favoring LRA (MD: −13.04 milliliters; 95% CI: −18.0 to −8.20; p < 0.01; I² = 0%). However, there was no significant difference in the perceived difficulty level between the groups (risk ratio [RR]: 1.03; 95% CI: 0.61 to 1.73; p = 0.92; I² = 0%).

Conclusion:

LRA is associated with a significantly shorter fluoroscopy time, suggesting a greater efficiency in terms of radiation exposure. These findings imply that, while LRA may offer some efficiency benefits, the choice between LRA and RRA should consider other clinical and technical factors, such as operator preference and experience.

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Original Article

Analysis of the Prevalence of Metabolic Syndrome and NCEP ATP III Criteria in Older People

João Pedro de Sousa Palmeira et al. Mateus Cardoso Oliveira Emille Silva Santos Renata Sigler … Lorena Andrade Nunes Cézar Augusto Casotti

Abstract

Background:

Metabolic syndrome (MS) is a cluster of conditions, including hypertension, dyslipidemia, and abdominal obesity, associated with increased cardiovascular risk. In the elderly population, the prevalence of MS varies widely depending on region, lifestyle, and diagnostic criteria. Understanding the components that contribute most to MS can aid in targeted health interventions.

Objective:

This study aimed to investigate the prevalence of MS and identify which components most influence its diagnosis among older adults.

Methods:

This is an epidemiological, cross-sectional study conducted from January to December 2022, with people aged 60 or over, of both sexes. Data were obtained in three steps (interviews, clinical examinations, and laboratory tests). Data were entered in duplicate and analyzed using PAST software. The criteria and cutoff points adopted to diagnose MS were those proposed by NCEP ATP III.

Results:

This study evaluated 127 older people, 63% female. The prevalence of MS was 40%, and the most prevalent component was arterial hypertension. Hypertriglyceridemia, waist circumference, and high blood glucose were the components of MS that contributed to 68.2% of the diagnosis of this condition.

Conclusions:

The prevalence of MS was high in the population assessed. Hypertension was the most prevalent component, and hypertriglyceridemia was the component that most explained it.

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IJCS

Original Article

Percutaneous Patent Foramen Ovale Occlusion in Patients Over 60 Years of Age with History of Stroke

Marcelo Sabedotti et al. Luciano da Silva Selistre Agda Mezzomo Fabio Eduardo Camazzola … Ramiro Caldas Degrazia Bibiana Guimarães Maggi Sara Voltolini

Abstract

Background:

The prevalence of patent foramen ovale (PFO) is 27%. PFO is related to paradoxical embolism, which can cause ischemic stroke. Ischemic stroke without an identifiable cause is common, accounting for up to 40% of cases, and PFO is frequently found in these patients. The prevalence of PFO is almost 3 times higher in elderly patients with ischemic stroke without identified etiology, suggesting that these patients may also benefit from PFO closure.

Objectives:

The primary objective was to assess the recurrence of ischemic stroke or transient ischemic attack during clinical follow-up. The secondary objective was to assess the occurrence of procedural complications, onset of atrial fibrillation, and reduced anticoagulant use.

Methods:

This retrospective cohort study included 36 patients over 60 years of age with prior ischemic stroke who underwent PFO closure. Survival analysis was performed using the Kaplan-Meier model. Independence tests between categorical variables were performed using the chi-square test and Fisher’s exact test, adopting a significance level of 0.05.

Results:

The patients’ mean age was 69.6 ± 6.5 years, and 55.5% were men. No complications occurred during the procedures. Echocardiography was performed 30 days after the intervention, showing no residual shunts. During the follow-up of 58.9 ± 42.7 months, there were no cases of ischemic stroke, transient ischemic attack, or atrial fibrillation related to the procedure. The use of anticoagulants decreased from 41.7% to 5.6% (p = 0.03).

Conclusions:

Percutaneous PFO occlusion for the prevention of cerebrovascular events in individuals over 60 years of age with prior ischemic stroke is effective and safe, with a low risk of complications, and it can reduce the risk of bleeding by reducing the use of anticoagulants.

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Original Article

Agreement Between a Portable Cholesterol Device and Laboratory-Based Testing in Older Adults

Odilon Abrahin et al. Naicha Stefanie Félix Souza Rejane P. Abrahin Alex Harley Crisp

Abstract

Background:

It is crucial to monitor blood lipid levels accurately in older adults to assess cardiovascular risk. Although several portable strip-based devices are commercially available, their accuracy has not been well established.

Objective:

To evaluate the agreement of the Mission Cholesterol device and standard laboratory method results, using samples from older adults.

Methods:

Forty-nine patients (42 females) with an average age of 70 ± 8 years were included. The participants were instructed to fast for 12 hours before undergoing venous and capillary blood sampling for lipid analysis (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglyceride [TG] levels). The agreement between the Mission Cholesterol device and laboratory test results was assessed using the concordance correlation coefficient (CCC) and Bland–Altman plots. The accuracy levels were assessed based on the percentage bias recommended by the National Cholesterol Education Program (NCEP).

Results:

The TC measurement had a better accuracy level (bias = 10.91%; CCC = 0.89) than other lipid measurements. However, none of them met the NCEP’s acceptable standards for bias and concordance (CCC ≥ 0.90). Furthermore, the device demonstrated modest overall agreement in classifying lipid risk according to clinical reference values (agreement rates: TC, 67.3%; HDL-C, 65.3%; LDL-C, 49.0%; and TG, 61.2%).

Conclusion:

The Mission Cholesterol device exhibited insufficient agreement levels for effective lipid profile monitoring and screening in older adults.

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IJCS

Original Article

Feasibility of the Two-Minute Walk Test in Elderly Patients After Acute Myocardial Infarction: A Cross-Sectional Study

André Luiz Lisboa Cordeiro et al. Luiz Anselmo Santos Lucas Oliveira Ana Cristina Almeida … Damaris Alves Hanna Beatriz de Melo Moraes e Silva Fernanda Francisco Souza André Raimundo França Guimarães

Abstract

Background

Pathologies involving the heart are still the main causes of death, and acute myocardial infarction (AMI) is consistently present in this index. The two-minute walk test (2MWT) is ideal for assessing the functional capacity of this patient.

Objective

To describe the feasibility of the 2MWT in older people after AMI.

Methods

This is a cross-sectional study. At hospital discharge, patients were invited to perform the 2MWT. Before starting the test, systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SpO₂), heart rate (HR) and the Double Product (DP) were checked. After checking the vital signs, the patients were accompanied by an examiner, who was positioned laterally to ensure safety and verbally encouraged during the test; after the completion of the test, all vital signs were reassessed in two moments, at the immediate end and after 20 minutes of rest. ANOVA was used for the comparison of pre and post-test and pre and recovery. A p<0.05 was considered significant.

Results

We evaluated 51 patients, 4 (80%) males with a mean age of 67±8 years. The distance walked on the 2MWT had a mean of 157 ± 22 meters. The SBPmmHg Pre-Test 112±21 vs 131±15 Post-Test (p=0.24) and 119±22 at Recovery (p = 0.34) and HR (bpm) Pre-Test 75±15 vs 89±19 Post-Test (p=0.15) and 79±15 at Recovery (p = 0.59). After a rest, all variables analyzed followed the same pattern, returning to values close to the pre-test moment.

Conclusion

The performance of the 2MWT in the hospital environment presents good feasibility in the evaluation of submaximal capacity in elderly patients after AMI.

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IJCS

Original Article

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Luan George Xavier et al. Renato Sampaio Mello Neto Marcos Henrique de Oliveira Morais Pedro Jorge Cronemberger … Maria do Carmo Carvalho Martins Marta Rosal

Abstract

Background

In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH).

Objective

To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease.

Methods

A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05.

Results

Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters.

Conclusions

This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

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IJCS

Viewpoint

Frailty in Patients With Valve Disease: How to Assess?

David Provenzale Titinger et al. Vitor Emer Egypto Rosa Marcelo Eidi Ochiai Tarso Augusto Accorsi … João Ricardo Cordeiro Fernandes Roney Orismar Sampaio Flávio Tarasoutchi

Introduction

Valvular heart disease contributes to an important portion of hospital admissions. It can progress to heart failure and death, and it ranks eighth among the causes of mortality due to cardiovascular diseases in Brazil. From the moment that a valve disease becomes anatomically important and has clinical repercussions, only interventional treatment (conventional surgery or transcatheter technique) is able to alter the natural course of the disease.^, The choice of intervention leads to the need for individualized evaluation of the patient, exposing associated clinical conditions that may impact the final result, such as frailty.^,

Frailty, as a clinical syndrome, is characterized by decreased physiological reserve and reduced capacity after a stressor event, causing vulnerability to diseases. It is related to decreased muscle strength, resistance, and functionality, resulting in greater dependence for daily activities and increased mortality. Some commonly associated conditions include sarcopenia, malnutrition, and hormonal disorders.

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IJCS

Editorial

Correlation of Diuretic use and Sarcopenia in Elderly Patients with Hypertension

Lídia Zytynski Moura et al. Camila Hartmann

Hypertension is a chronic disease with high prevalence in Brazil and worldwide. It is estimated that approximately 31% of the world population has blood pressure levels ≥ 140/90 mmHg or uses antihypertensive medication. Hypertension is also the main risk factor with an independent, linear, and continuous association for cardiovascular diseases. Cardiovascular diseases, in turn, are the leading cause of death, hospitalizations, and outpatient care worldwide, including in developing countries such as Brazil.

With aging, hypertension becomes an even more significant health problem. Around 61% of individuals over 60 years old have hypertension. In Brazil, the epidemiological transition with the increase in the number of elderly people (≥ 60 years) in the next decades will lead to a substantial increase in the prevalence of hypertension and its complications. Aging is still associated with other health disorders, including sarcopenia. As with hypertension, the prevalence of sarcopenia is higher in the elderly. It varies from 5% to 13% in people between 60 and 70 years of age, and from 11% to 50% in people ≥ 80 years of age.

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Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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Original Article

Cognitive Alterations in Elderly Patients with Heart Failure’

Fernanda Guedes Afiune et al. Salvador Rassi Abrahão Afiune Neto

Abstract

Background:

Among the various pathologies that affect the elderly, Heart Failure (HF) stands out. Recently, an attempt has been made to verify the existence of cognitive impairment associated with HF.

Objectives:

To compare the cognitive performance of elderly people with heart failure with that of age-matched individuals without this pathology. Check the existence of marked impairment in some cognitive functions in the clinical group.

Methods:

The sample consisted of 78 elderly people, whose inclusion criterion was the presence of HF and no HF (control group); age over 60 years, both sexes, and any level of education. The control group consisted of 37 individuals (with a median age of 68 years – Interquartile range of 12) and the HF group, with 41 individuals (with a median age of 67 years – Interquartile range of 11). The subjects were matched in terms of education level, with a predominance of elderly people with 0 to 4 years of education (65.9% in the Clinical Group and 59.5% in the Control Group). Eleven neuropsychological tests covering cognitive functions were used: attention, language, memory, mood, and executive function. Statistical analysis was performed using SPSS software, version 23, with a significance level of 5%. The Chi-square test and the Mann-Whitney test were applied.

Results:

The results showed significant differences between the groups, mainly in executive functions, which include the ability to plan, switch, and recall previously stored information.

Conclusion:

Our study showed differences between the cognitive performance of elderly people with HF and elderly people without HF. The main alteration was found in the so-called executive functions, attention, and memory.

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Editorial

Epicardial Fat Thickness: a Promising Cardiovascular Risk Factor that Requires in-Depth Studies

Roberto M. Saraiva et al. Andréa Rodrigues da Costa

This issue of the International Journal of Cardiovascular Sciences presents a paper by Castanheira et al. that addresses epicardial fat (EF) thickness in an elderly Portuguese population. They describe the mean values of EF thickness and its correlation with anthropometric, echocardiographic, and clinical variables in these individuals.

EF is the visceral adipose tissue located between the myocardium and the visceral pericardium, and commonly found in the atrioventricular and interventricular grooves. EF has several physiological roles, including local effects on the heart, in a paracrine manner.^– EF can be measured non-invasively by echocardiography, and the measurement of EF thickness by 2D echocardiography has been proposed as a surrogate for visceral fat, since it is easier to perform as compared with direct measures such as computed tomography and magnetic resonance imaging (MRI). In addition, a significant correlation between EF and visceral fat measurements by MRI was demonstrated.

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Editorial

Mortality in the Elderly Due to Cerebrovascular Disease

Marco Antônio Mota Gomes et al. Annelise Machado Gomes de Paiva

Cardiovascular Diseases (CVD) are the main cause of death, hospitalization and outpatient care worldwide, including in developing countries like Brazil. More than 75% of deaths from these causes occur in low- or middle-income countries, and about 80% of deaths are due to acute myocardial infarction (AMI) and stroke. Vilela, PB et al. observed that mortality from cerebrovascular disease in Brazil is influenced by socioeconomic factors.

Although the aging process is not necessarily related to diseases and disabilities, elderly people have a high prevalence of chronic non-communicable diseases (NCDs). In the period from 2010 to 2050, the number of strokes is expected to more than double, with most of the increase among the elderly (≥75 years of age) and minority groups. Greater attention is needed to promote optimal cardiovascular health and healthy aging throughout life.

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IJCS

Review Article

Transcatheter Aortic Valve Implantation: Where are we in 2020?

Rogerio Sarmento-Leite et al. Gilberto Eder de Oliveira Junior

Abstract

Aortic stenosis is an insidious disease of rapid progression after the onset of symptoms. Aortic valve replacement surgery is a well-established therapy that reduces symptoms and increases survival rates. However, the procedure may be associated with high operative mortality rates and promote comorbidity. Depending on the local reality, the prevalence of patients considered inoperable (due to medical comorbidities and age) may achieve 30%. For these patients, transcatheter aortic valve implantation (TAVI) was initially indicated; over time, the method has advanced technologically and been simplified, and become an alternative therapy for patients at low and intermediate surgical risk also, and considered one of the major advances of modern medicine.

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Editorial

Vascular Aging and Arterial Stiffness in Older Adults

Erika Maria Gonçalves Campana et al. Sayuri Inuzuka

Deaths from cardiovascular disease, according to the WHO, are projected to reach around 14 million by 2030. The global population is aging at an accelerated rate and the prevalence of arterial hypertension (AH) increases with advancing age. Aging is the common denominator in several cardiovascular diseases. Arterial stiffness and increased pulse wave velocity (PWV), as well as central systolic pressure are major predictors of cardiovascular events. ( )

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IJCS

Editorial

Antiplatelet Therapy for Elderly Patients: When Less May Be More

Roberto Esporcatte et al. Fernando Oswaldo Dias Rangel

In the last two decades, double antiplatelet therapy, together with percutaneous coronary intervention (PCI), has become a cornerstone of acute coronary syndrome (ACS) treatment and its use is recommended as early as possible, although there are many unanswered questions about the efficacy and safety of loading dose (LD), best moment of administration, clinical scenarios and, especially, its use in elderly patients. Despite the fact that elderly patients represent approximately 30% of the population admitted for ACS, they are virtually excluded from large clinical trials, receive fewer diagnostic and therapeutic approaches and have more ischemic and hemorrhagic complications.

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Review Article

Physical Exercise in the Management of Erectile Dysfunction in Patients with Heart Failure

Ana Gonzáles et al. Tales de Carvalho Leonardo Andreato Sabrina Sties Anelise Sonza

Abstract

Erectile dysfunction (ED) is a highly prevalent problem that affects the quality of life, prognosis and survival of patients with heart failure (HF). In the management of ED, physical exercise is a therapeutic strategy that reduces disease-related symptoms and optimizes drug use. However, the repercussions of physical exercise on ED in individuals with HF still need to be elucidated. In this sense, the objective of this study was to evaluate the effects of physical exercise on erectile function (EF) in HF patients. This was a systematic review conducted according to PRISMA guidelines. Patients with HF, male and ejection fraction ≤ 45% were submitted to physical exercise of different modalities. The search for scientific articles was conducted in the electronic databases (PubMed, LILACS, Cochrane-Library, Science Direct) from the inception until October 2018, according to the MeSH dictionary descriptors, which were suitable for all databases. Results: Three studies were analyzed, includinng 99 male subjects, age ranging from 53 years (± 7.48) to 58 years (± 12). Seventy subjects were submitted to a physical exercise program and 29 were in the control group. In all studies, physical exercise showed positive results in the management of ED regardless of erectile dysfunction (ED) classification status and intensity of exercise used. It was concluded that physical exercise of different intensities was considered an effective therapeutic intervention to improve EF in individuals with HF and ED.

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Original Article

Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?

Alexandre de Matos Soeiro et al. Guilherme Casale Maria Antonieta Albanez Albuquerque de Medeiros Lopes Lucas Colombo Godoy … Aline Siqueira Bossa Bruno Biselli Tatiana de Carvalho Andreucci Torres Leal Maria Carolina Feres de Almeida Soeiro Carlos V Serrano Jr. Múcio Tavares Oliveira Jr.

Abstract

Background:

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population.

Objective:

This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age.

Methods:

Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05.

Results:

Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 – 0.614, p = 0.007).

Conclusion:

A loading dose of 300 mg or more of clopidogrel.

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Original Article

Moderate-Intensity Walking Training Improves Depressive Symptoms and Pain in Older Adults with Good Quality of Life: A Controlled Randomized Trial

Silvio Lopes Alabarse et al. Hélio José Coelho Júnior Ricardo Yukio Asano Braulio Luna Filho … Wagner Correa Santos Japy Angelini Oliveira Filho

Abstract

Background:

Walking training can be an adequate choice to improve physical and psychological conditions in the elderly. Studies have reported positive changes in the quality of life, depressive symptoms and pain. However, baseline characteristics of volunteers have been controlled, and some of previous studies have not investigated these parameters concomitantly.

Objectives:

To assess the effects of moderate-intensity walking on quality of life, depressive symptoms and physical pain in physically active elderly individuals.

Methods:

Sixty-nine subjects were recruited and allocated into two groups: training group (n = 40) and control group (n = 29). All were evaluated for quality of life, depressive symptoms and pain. Training group underwent 40 minutes of walking (50-70% of maximum heart rate), 3 days a week for 12 weeks. For statistical analysis, we used the Kolmogorov-Smirnov test, Student’s t-test and Split-Plot ANOVA with Bonferroni post hoc, Pearson correlation. Significance level was set at 5%.

Results:

After 12 weeks of training, depressive symptoms and physical pain significantly reduced in the training group (2.7 ± 2.4 to 1.9 ± 1.8 and 4.3 ± 3.1 to 2.8 ± 2.9, respectively) compared with baseline values, and remained unchanged in the control group. There was a positive, moderate correlation between depressive symptoms and pain (r = 0.30).

Conclusion:

physically active elderly individuals with good quality of life show improved depressive symptoms after a short-term moderate-intensity walking training program.

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Review Article

Risk Factor Differences in Acute Myocardial Infarction between Young and Older People: A Systematic Review and Meta-Analysis

Liu Lei et al. Zeng Bin

Abstract

Acute myocardial infarction (AMI) is less frequent in young individuals (≤ 45 years) than in older ones (> 45 years). Young AMI patients differ from older AMI patients in different ways. This article aims to assess the differences between young and older AMI patients. A search was made in the database of Cochrane Library, PubMed, BioMed Central and Embase, sence their establishment to December 2016, using the key words: risk factors, clinical characteristics, acute myocardial infarction and young. Meta-analysis was performed by using the Review Manager 5.3 software, pooled odds ratios and 95% confidence intervals were used to assess the strength of differences. Eight studies with fairly quality, enrolling 13,358 patients in the analysis. Compared with older AMI patients, young AMI patients had a higher rate of smoking and obesity (OR = 2.71,95%CI:1.87 to 3.92; OR = 1.76,95%CI:1.13 to 2.74), higher rate of family history of coronary artery disease and alcohol consumption (OR = 2.36,95%CI:1.22 to 4.59; OR = 1.76,95%CI:1.04 to 2.97). Moreover, Young AMI patients had a lower rate of hypertension and diabetes mellitus (OR = 0.52,95%CI:0.37 to 0.73; OR = 0.58,95%CI:0.50 to 0.67). No significant differences were observed in hyperlipidemia, a subgroup data-analysis showed a higher total cholesterol, triglyceride lipase, and low-density lipoprotein levels (p < 0.05), and lower levels of high-density lipoprotein (p < 0.01) in young AMI patients. Smoking, family history of coronary artery disease, obesity and alcohol consumption are the most main risk factors of AMI among young individuals, and young AMI patients have better prognosis than older ones.

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