cardiovascular diseases – ABC CARDIOL

IJCS

Original Article

Genetic Evidence for the Association Between Sjögren's Syndrome and Cardiovascular Disease Risk

Yafang Gao et al. Guohua Wu Tianyu Jin Zhijie Shen … Nannan Zhou Xiaohong Huang

Abstract

Background:

Previous studies have indicated that patients with Sjögren’s syndrome (SS) exhibit an increased risk of cardiovascular disease (CVD). However, the causal association between SS and CVD risk remains to be elucidated.

Objectives:

This investigation explored the genetic relationship between SS and CVD risk through Mendelian randomization (MR).

Methods:

We identified the genetic association between SS and CVD incidence via two-sample MR analysis based on summary statistics from publicly available genome-wide association studies (GWAS). The inverse-variance weighting (IVW) method was used for the primary analysis in our study. Additionally, we conducted several sensitivity analyses to confirm the stability and reliability of the MR results.

Results:

MR analysis revealed that SS was not significantly associated with the risk of various CVDs, including atrial fibrillation (AF) (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.95–1.01; p = 0.22), ischemic stroke (IS) (OR = 0.99, 95% CI = 0.93–1.05; p = 0.68), heart failure (HF) (OR = 1.00, 95% CI = 0.96–1.04; p = 0.91), coronary artery disease (CAD) (OR = 0.99, 95% CI = 0.94–1.04; p = 0.60), and myocardial infaion (MI) (OR = 1.01, 95% CI = 0.97–1.06; p = 0.61).

Conclusions:

Our MR study did not provide genetic evidence supporting a causal association between SS and CVD incidence. The associations reported in prior observational studies may be due to residual confounding and reverse causality.

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Original Article

Infant Feeding Practices and Their Association with Stunting, Overweight, Obesity, and Other Cardiometabolic Risks in African Children: A Systematic Review

Jude Eteneneng Enoh et al. Roland Tiagha Akah Benedicta Ngwenchi Nkeh-Chungag

Abstract

Introduction:

Feeding patterns among infants, particularly in Africa, play a central role in shaping child growth and long-term health outcomes such as stunting, overweight, and obesity in early childhood.

Objectives:

This systematic review assessed infant feeding practices and their association with stunting, overweight, obesity, and cardiometabolic risk in children in Africa.

Methods:

PubMed, Springer Link, Web of Science, Google Scholar, and Science Direct databases were searched for articles published between 2004 and 2024. Infant feeding indicators (exclusive breastfeeding, complementary feeding, and dietary variety) and outcomes of the children (stunting, overweight, obesity, blood pressure, and lipid profiles) were retrieved.

Results:

The review identified 12 studies (7 cohort, 5 cross-sectional) involving approximately 15,620 participants. Cardiometabolic risk markers such as hypertension were identified in 2 studies, with the prevalence ranging from 9.1% to 32.7%. Obesity was reported in 5 studies, with prevalence ranging from 4.0% to 21.0%. Six studies identified stunting and overweight, with their prevalence ranging from 9.3% to 42% and 9.1% to 30.0%, respectively. Diabetes was reported in just 1 of the studies in South Africa and was observed more in males (2.6%) than females (1.9%).

Conclusion:

Stunting and early cardiometabolic risk are common in Africa and are associated with suboptimal infant feeding patterns. Inappropriate complementary feeding and early weaning of breastfeeding are linked to stunting as well as early overweight/obesity. Exclusive breastfeeding for up to 6 months is still a poorly achieved target in most settings, even though it is crucial for optimal growth.

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IJCS

Case Report

A Fixed-Dose Triple-Combination Therapy for the Initial Steps of Hypertension Treatment: Protocol for the NEXT Randomized Clinical Trial

Rogerio Orlow et al. Caroline Consuelo de Sousa Sayuri Inuzuka Audes Feitosa … Andréa Araujo Brandão Marco Mota Gomes Vanildo da Silva Guimarães Neto Elizabeth do Espírito Santo Cestario Eduardo Costa Duarte Barbosa Rodrigo Bezerra Mayara Cedrim Santos Ana Luiza Lima Sousa Sandro Rodrigues Batista Priscila Valverde de Oliveira Vitorino Weimar Kunz Sebba Barroso

Introduction

Complications from arterial hypertension account for an estimated 18 deaths per minute worldwide, establishing it as the second leading risk factor for global mortality. Between 1990 and 2019, the number of adults with arterial hypertension doubled from 650 million to 1.3 billion. Of these, only 54% are diagnosed, 42% are treated, and a mere 21% of those treated achieve adequate blood pressure (BP) control.

Although effective BP control often requires the use of multiple drugs, monotherapy remains a predominant initial approach to arterial hypertension management globally, which limits the timely achievement of therapeutic goals. This is significant because even modest reductions in systolic BP of 5 mmHg are associated with an approximate 10% reduction in the risk of major cardiovascular events, irrespective of pre-existing cardiovascular disease.

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IJCS

Letter to the Editor

Beyond the Numbers: A Critical Analysis of DATASUS on Cardiovascular Mortality

João Pedro Azevedo Lopes et al. João Emmanuel Coelho de Morais Pedro Pereira Tenório

Dear Editor,

We are writing to express our appreciation for the article “Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023” by Luiz et al. This work is of great relevance, as it provides a robust and updated epidemiological overview (2013–2023) of Cardiovascular Diseases (CVD) in Brazil, which remain one of the country’s major public health challenges. The use of a decade of DATASUS data gives the study indispensable temporal breadth for long-term trend analysis, representing one of its greatest strengths.

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IJCS

Editorial

Reflections on the Effectiveness of Cardiovascular Disease Prevention Programs in Corporate Settings

The International Journal of Cardiovascular Sciences (IJCS) publishes in this issue the original article entitled “Comparison Between Two Prevention and Control Programs for Risk Factors for Cardiovascular Diseases in an Oil Company.” This study, framed within the field of Epidemiology, addresses a question of growing relevance for public and occupational health: the effectiveness of different intervention strategies to mitigate cardiovascular risk in a specific work environment.

Cardiovascular Diseases (CVDs) remain the leading cause of morbidity and mortality globally,^– and the workplace represents a crucial area for prevention and control strategies. Workers spend a significant portion of their lives at work, and occupational factors such as stress, sedentary behavior associated with certain roles, and exposure to shifts can directly influence cardiovascular risk.^, As CVDs continue to pose a significant global health concern, analyzing interventions aimed at mitigating them in corporate environments is more relevant than ever.

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IJCS

Editorial

The Burden of Cardiovascular Disease in Brazil: Insights From a Decade of Emergency Hospital Admissions

Fernando Yue Cesena

Cardiovascular disease (CVD) remains the leading cause of death both globally and in Brazil.^, Although cancer has surpassed CVD as the top cause in some countries, projections indicate that CVD will continue to be the primary cause of mortality in Brazil for the decades to come.^,

Epidemiological analyses are essential for evaluating current public health strategies and informing future policy decisions. In this issue of the International Journal of Cardiovascular Sciences, an epidemiological study of recent emergency hospital admissions for CVD in Brazil is presented. Using data from the Department of Informatics of the Brazilian Unified Health System (DATASUS), the authors report data from over eight million hospital admissions from 2013 to 2023.

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IJCS

Original Article

Left Ventricular Hypertrophy on Electrocardiography and Chronic Kidney Disease: A Case–Control Pilot Study

Nabil Hajar et al. Nabila Nuralya Joveazhari Shofa Chasani Zulfachmi Wahab … Galih Prakasa Adhyatma Indira Aura Balqis Zeidan Ahmad Fahdalhaq Bintang Adhiyoso Wicaksono

Abstract

Background:

Chronic kidney disease (CKD) is a condition characterized by abnormalities in kidney structure or function lasting more than 3 months. CKD is known to increase the risk of cardiovascular events, which may be predicted by electrocardiography (ECG) abnormalities, such as left ventricular hypertrophy (LVH). ECG is widely used in under-resourced health care settings due to its practicality and accessibility.

Objective:

This study aimed to analyze the relationship between LVH and CKD using ECG.

Methods:

This analytical observational study used a case–control design. The case group included patients diagnosed with CKD, while the control group consisted of patients presenting with signs and symptoms suggestive of CKD but without a confirmed diagnosis. Each group included 35 participants. Simple random sampling was used for the case group, and stratified random sampling for the control group. ECG examinations were performed, and measurements were taken using calipers in millimeters (mm). The Sokolow–Lyon criteria were applied to identify LVH. Data were analyzed using an independent t-test, with statistical significance set at p < 0.05.

Results:

The Sokolow–Lyon score was significantly higher in the case group than in the control group (p = 0.03).

Conclusion:

There is a significant association between LVH, as identified on ECG, and CKD. These findings may assist health professionals in resource-limited settings, where access to ECG is restricted.

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IJCS

Original Article

Comparison Between Two Prevention and Control Programs for Risk Factors for Cardiovascular Diseases in an Oil Company

Maria Lúcia Ribeiro Rocha et al. Ana Marice Teixeira Ladeia

Abstract

Background:

Cardiovascular diseases (CVDs) are the leading cause of death in the world, and companies can implement prevention and control actions aimed at reducing risk factors among their workers.

Objectives:

To verify whether the result of model A of a CVD prevention and control program was superior to model B in reducing the cardiovascular risk (CVR) of individuals from an oil company.

Methods:

Retrospective evaluation of secondary data from a restricted and fixed cohort of 670 workers, from 01/01/2016 to 12/31/2018. The workers were divided by program model into Group A (514) and Group B (156). The 2016 CVR was compared with that of 2018, within and between groups, as well as the mean and prevalence of risk factors for CVD. Statistical analysis was set at a significance level of 5%.

Results:

Group A improved the level of physical activity (PAL), consumption of fruits and vegetables, and consumption of alcohol, but the “high” CVR increased from 0.4% in 2016 to 1.4% in 2018 (p<0.01). In Group B there was no change in the workers’ health profile, but the percentage of individuals with "intermediate" CVR increased from 14.1% to 16.7% (p=0.01).

Conclusions:

The actions developed by the company had a positive impact on the way of life of workers covered by the model A program; however, they were not sufficient to reduce CVR in this group.

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IJCS

Original Article

Comparison of the Effects of Alcoholic and Non-Alcoholic Red Wine on Flow-Mediated Dilation and Brachial Artery Vasodilation

Daniel Medeiros Moreira et al. Luiza Frassetto Martins Lucca Antonini Savas Rafael Cegielka

Abstract

Background:

Cardiovascular diseases are the leading cause of mortality worldwide. Wine consumption has been associated with cardiovascular benefits, which are attributed to the presence of flavonoids.

Objectives:

To assess the effects of alcoholic and non-alcoholic red wine on endothelial function by measuring variations in brachial artery flow-mediated dilation (FMD) and analyzing changes in arterial diameter, heart rate, and blood pressure.

Methods:

A randomized, parallel, controlled clinical trial was conducted with 22 participants assessed at 2 distinct time points. Participants consumed 200 mL of red wine and, after a 7-day washout period, received 200 mL of non-alcoholic wine. Data were analyzed using Student’s t test. P values < 0.05 were considered statistically significant.

Results:

Pre-ischemia brachial artery diameter increased after both interventions: with alcoholic wine (3.21 ± 0.46 mm before versus 3.51 ± 0.53 mm after; p < 0.001) and non-alcoholic wine (3.16 ± 0.48 mm before versus 3.31 ± 0.58 mm after; p = 0.003). FMD showed a decrease after consumption of alcoholic wine (11.88% ± 8.40% before versus 5.98% ± 5.34% after; p = 0.007), whereas consumption of non-alcoholic wine did not result in significant changes (7.26% ± 6.39% before versus 6.01% ± 5.85% after; p = 0.572). Other parameters, such as heart rate and blood pressure, did not show any significant differences.

Conclusion:

Consumption of red wine, with and without alcohol, increased brachial artery diameter. However, alcoholic red wine was associated with reduced FMD, suggesting that ethanol may negatively affect endothelial function.

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IJCS

Original Article

Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023

Yago Souza Luiz et al. Vitor Moreira Alvarenga Mikaela de Miranda Lopes Lara Gomes Silva

Abstract

Introduction:

Cardiovascular diseases (CVDs) remain among the leading causes of morbidity and mortality worldwide, posing a significant public health challenge. Thus, analyzing their prevalence over time is crucial.

Objective:

To perform an epidemiological analysis of emergency hospital admissions due to CVD in Brazil between 2013 and 2023.

Methods:

This is an ecological, descriptive study based on data from the DATASUS database. Cardiovascular morbidities classified by ICD-10, along with variables such as sex and age group, were selected for analysis. Data was collected in October 2024 and organized into graphs and tables.

Results:

From January 2013 to December 2023, 8,208,282 patients were admitted for emergency cardiovascular conditions, 53.7% of whom were male, with 26% aged between 60 and 69 years. A significant reduction in hospital admissions was observed in 2020 and 2021. Ischemic heart diseases were the most frequent cause of hospitalization, accounting for 29.72% of cases. A notable increase in mortality was recorded in 2021 and 2022, with higher mortality rates among male patients and those admitted for cerebrovascular diseases.

Conclusion:

The observed increase in hospitalizations is attributed to the demographic transition occurring in the country, while the sharp decline in 2020 and 2021 appears to be a consequence of COVID-19-related measures, which is a trend also observed in other countries. These findings underscore the importance of studying the epidemiology of CVD in Brazil and reinforce the need for public investment aimed at reducing their prevalence.

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IJCS

Review Article

Strategic Use of Intravenous Medications to Protect Target Organs in Hypertensive Emergencies

Mariana Costa Silva et al. Rubens Carmo Costa Filho Vanessa Estato

Abstract

Hypertensive emergencies (HE) are life-threatening conditions triggered by sudden increases in blood pressure (BP) exceeding 180 mmHg systolic and/or 110 mmHg diastolic levels, often resulting in acute organ damage (AOD) and the risk of death. This article discusses contemporary practices in diagnosing and managing these episodes, emphasizing early recognition and immediate therapeutic intervention. It highlights the significance of a meticulous diagnostic assessment for appropriate clinical and therapeutic approaches, including detailed medical history, physical examination, and complementary investigations. Treatment focuses on the judicious use of intravenous antihypertensive agents such as sodium nitroprusside, nitroglycerin (NTG), beta-blockers, and calcium channel antagonists, stressing careful administration to prevent further harm. Individualization of treatment in HE is imperative and should be meticulously tailored to the patient’s clinical profile and main complications, notably hypertensive encephalopathy, acute pulmonary edema, acute coronary syndromes, acute aortic dissection, and preeclampsia. These conditions require differentiated approaches due to their severity. The article underscores the scarcity of randomized controlled clinical trials addressing all daily practice questions regarding managing HE. This is due to the complexity of available drugs, clinical conditions, adverse effects, and drug interactions in various scenarios. Consequently, clinical wisdom and careful observation remain pivotal in decision-making. It also addresses the complexity of accurately measuring BP in emergency settings, which can pose an additional diagnostic challenge. Finally, it emphasizes the need for new evidence to guide therapeutic practices in HE, aiming to improve patient care and clinical outcomes continuously.

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Original Article

The Relationship Between Inflammatory Markers and Supraventricular Tachycardia in Children

Sevval Durgut et al. Hikmet Kıztanır Yasin Yıldız

Abstract

Background

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases.

Objectives

This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted.

Results

There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group.

Conclusions

Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

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Original Article

Evaluation of Prevalence, Management and Recording of Risk Factors in Outpatient Patients with Coronary Artery Disease

Alexandre Felipe Pacini et al. Gerson Luiz Bredt Junior Eline da Rós Moro Alcirley de Almeida Luiz Ana Paula de Oliveira Francez

Abstract

Background

Coronary artery disease (CAD) is the leading cause of mortality worldwide. Adequate management of risk factors is directly correlated with better outcomes.

Objectives

This study aims to identify risk factors and evaluate the indicated medical treatment (both pharmacological and non-pharmacological) in patients with CAD.

Methods

Epidemiological data were collected from electronic medical records of patients treated at Cardiology outpatient clinics of a Tertiary Hospital and a descriptive analysis of the data was performed.

Results

Patients with documented CAD (n = 230) were selected for the study, with a predominance of white (60%) men (62%), most of whom were monitored following an Acute Coronary Syndrome (ACS) (63.9%). High prevalence and irregular control of risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and sedentary lifestyle were observed. Target blood pressure was achieved in 52.6% of patients, low-density lipoprotein (LDL) in 5.7%, and HbA1c in 50.8%, despite appropriate prescriptions for most patients – 100% were prescribed statins, and over 90% received antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers, and beta-blockers. Few patients were encouraged to quit smoking and engage in physical activities.

Conclusion

Significant recording errors were noted in the medical records, along with inadequate control of CAD-related risk factors. Improvements in both recording and management of these risk factors are necessary to enhance CAD outcomes. The study utilized a straightforward and cost-effective model, which effectively mapped the local population profile and managed CAD risk factors.

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Editorial

Chagas Disease and Maternal Mortality: An Overlooked Link in a Neglected Disease in Brazil

Maria Alayde Mendonça Rivera et al. Ivan Romero Rivera Glaucia Maria Moraes de Oliveira Ana G. Múnera Echeverri Walkiria Avila

Maternal mortality (MM), defined as the death of a woman during pregnancy, childbirth, or within 42 days postpartum, is a key indicator of maternal health and the quality of care provided by the health care system to prevent and manage complications during this period.

In 2020, there were 287,000 maternal deaths worldwide, resulting in a maternal mortality ratio (MMR) of 223 deaths per 100,000 live births. According to the World Health Organization (WHO), 95% of these deaths will occur in low- and middle-income countries, and 90% will be preventable.

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Viewpoint

Biomarkers and Mononuclear Inflammatory Activity in COVID-19 Survivors

Marcio Carvalho et al. Antonio Lagoeiro

Introduction

COVID-19 has globally impacted 522 million people and caused 6 million deaths, despite the administration of 12 billion vaccine doses. Beyond respiratory effects, the virus has led to complications in the cardiovascular, hematological, and nervous systems, potentially resulting in organ dysfunction and death. Individuals with pre-existing medical conditions such as hypertension, diabetes mellitus, coronary artery disease, heart failure, and chronic kidney disease are associated with worse prognoses. Increased long-term mortality risk is observed, especially in the elderly population, regardless of the acute phase severity.

COVID-19 affects multiple organs beyond the lungs, including various cardiovascular diseases such as myocarditis, acute myocardial infarction, stress cardiomyopathy, arterial and venous thromboembolism, pericarditis, and arrhythmias. The pathophysiological mechanisms include systemic inflammation (cytokine storm), coagulopathy, direct viral invasion, hypoxemia, electrolyte imbalance, and fever.

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Original Article

Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review

Liza Yurie Teruya Uchimura et al. Cintia de Freitas Oliveira Mabel Fernandes Figueiró Camila Pereira Pinto Toth … Camila Roncon de Lima Patricia Vendramim

Abstract

Introduction

Cardiovascular diseases (CVD) are a major cause of mortality in Brazil, requiring the improvement of healthcare mechanisms that can promote rapid and effective care for patients.

Objectives

To identify and characterize Brazilian policies and programs (PP) regarding urgency and emergency care in the context of CVD.

Method

The scoping review followed recommendations from the Joanna Briggs Institute (JBI). The search for studies was conducted across seven databases. The screening and eligibility steps were performed by reviewers independently, with conflicts resolved by consensus or consultation with a third reviewer. The data extraction was done in a spreadsheet and the information was analyzed and grouped by content similarity.

Results

Through the analysis of 14 studies, a systematic and contextualized understanding was gained regarding 10 PPs implemented in the urgency and emergency network (RUE) for individuals with CVDs. SAMU emerged as the most extensively studied PP, predominantly in the state of Minas Gerais. The diseases most commonly addressed in these studies included acute myocardial infarction (featured in 80% of publications), stroke, acute coronary syndrome, heart failure, and atrial fibrillation. These PP have demonstrated significant improvements in clinical outcomes, particularly in reducing morbidity and mortality rates. The studies also revealed important insights into barriers and drivers related to infrastructure, health education, and system management and coordination.

Conclusion

The evidence gathered provides significant contributions to guide future policy development and improve decision-making in clinical management for cardiologists.

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Editorial

How Can We Expand Knowledge to Improve Women's Cardiovascular Health in Latin America?

Maria Alayde Mendonça Rivera et al. Carolina María Artucio Glaucia Maria Moraes de Oliveira

Latin America (LA) is characterized by enormous cultural diversity due to its multiplicity of languages (Spanish, Portuguese, French, English, Dutch, and countless indigenous languages), ethnicities (white, black, indigenous), beliefs, climates, religions, and customs. This variability is observed between countries and within each country in the region, making them unique, even though they share a geographic area and numerous historical facts. There is evidence that the epidemiological and nutritional transition has been more heterogeneous in LA than in other areas of the world, which contributes to a significant variability between countries and their subregions not only in the prevalence of different cardiovascular (CV) risk factors (RFs), but in CV mortality as well. Currently, 51% of the 659 744 000 inhabitants (UN, 2022) are women in LA and the Caribbean.

According to the Global Burden of Diseases (GBD) 2021, the leading causes of death in Latin American women in 2021 were related to the COVID-19 pandemic, which reduced life expectancy in the region by approximately three years, more markedly in LA and the Caribbean (). Regarding noncommunicable diseases (NCD), peculiarities in the death rates per 100 000 inhabitants in LA and the Caribbean, and in Southern LA were observed in 2021. CV disease, followed by neoplasms, is responsible for the highest death rates per 100 000 inhabitants in the Caribbean, Tropical LA, and Southern LA, where this ranking is inverse in Chile. Diabetes and kidney diseases, followed by CVD, account for the highest death rates per 100 000 inhabitants in Central LA. In contrast, neoplasms, followed by mental illnesses, predominate in Andean LA.

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Original Article

Correlation of Diagnostic Components of Metabolic Syndrome with Electrocardiographic and Echocardiographic Alterations in Patients with Obesity

Alan Souza da Luz et al. João Gabriel da Costa Ramos Carolina Heitmann Mares Azevedo Ribeiro Roberto Márcio de Oliveira Júnior … Antônio Carmo da Costa Siqueira Neto Ralf Cardoso Mudesto Oliveira

Abstract

Introduction:

Metabolic syndrome (MS) and obesity are risk factors for cardiovascular diseases (CVD). However, the development of cardiovascular pathologies in obese individuals without MS is being investigated.

Objective:

To investigate whether there are similar electrocardiographic (ECG) and echocardiographic changes in individuals with obesity with and without MS.

Methodology:

A retrospective, descriptive cross-sectional study was carried out with obese patients at a university hospital in Belém, Pará, Brazil. Anthropometric, laboratory, ECG and echocardiographic data were evaluated in both populations. The chi-square test was used to describe the relationship between variables among groups; hypothesis tests with p < 0.05 were considered statistically significant values.

Results:

The study evaluated 100 individuals with obesity, 60 of whom had MS. The average age was 54 years, and the female sex was prevalent. Systolic blood pressure, HDL, and waist circumference were altered in both groups. Systemic arterial hypertension and low HDL demonstrated 4.27 times and 3.32 times greater likelihood of presenting changes in the ECG and echocardiogram for both groups. On the ECG, diffuse changes in ventricular repolarization were observed in both groups. On echocardiography, left ventricular diastolic dysfunction and left ventricular hypertrophy were present in both populations studied.

Conclusion:

Obese individuals without MS present a similar risk, requiring adequate attention to their cardiac health.

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Editorial

Lessons Learned from Cardiac Complications of COVID-19 and the Value of the Electrocardiogram

Javier César Barcos et al. Ana G. Múnera Echeverri Adrian Baranchuk

Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, much has been learned about the epidemiology, pathophysiology, clinical characteristics, and predictors of poor prognosis. Furthermore, cardiovascular implications have emerged as significant contributors to morbi-mortality. In this sense, the recently published work of Galindes-Casanova et al. reinforces existing evidence on acute COVID-19 infection, cardiac complications, and electrocardiogram (ECG) manifestations.

By the end of 2023, COVID-19 had already caused more than 770 million confirmed cases and 7 million deaths worldwide. The disease is characterized by an acute phase that lasts up to 4 weeks. Symptoms and complications could occasionally extend up to several months, called post-acute COVID-19. The main clinical manifestations are fever and respiratory symptoms. Less commonly, extrapulmonary involvement can also occur, involving different organs and systems secondary to direct and indirect viral damage, the latter through the dysregulation of the immune system, a hyperinflammatory state, endothelial dysfunction, coagulopathy, a prothrombotic state, and an imbalance of the renin-angiotensin-aldosterone system. These complex mechanisms, added to the injury of different organs and the adverse effects of COVID-19 treatments, favor the development of cardiac complications ().

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Editorial

Breast Cancer, Cardiotoxicity and Cardiovascular Disease Prevention: Where Are We in this Knowledge?

Maria Alayde Mendonça Rivera et al. Ivan Romero Rivera Glaucia Maria Moraes de Oliveira

In recent decades, significant advances have been made in the early detection and treatment of different types of cancer, which have led to a significant worldwide increase in the number of survivors of this group of diseases, with estimates that two-thirds of all survivors would be 65 years old or older in 2020.

There are currently more than 32 million cancer survivors worldwide and this number is expected to continue growing, due to efficient screening for the disease and increased patient life expectancy after definitive treatment, as well as increased life expectancy of populations, which increases the incidence of numerous neoplasms and is currently around 73.4 years worldwide for both sexes (70.8 years for men and 76 years for women).

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Editorial

Risk Stratification in Patients Hospitalized With Infective Endocarditis Undergoing Cardiac Surgery: How Sharp Are We?

Ana Margarida Martins et al. Catarina Sousa

Infective endocarditis (IE) is an infrequent yet life-threatening and disabling condition, with an estimated incidence between 3 and 12 cases per 100,000 subjects per year.^, Recent epidemiological studies have suggested a rising trend in the incidence of IE, potentially attributable to factors such as an aging population and a growing group of susceptible patients with congenital heart disease, intracardiac prosthesis or devices, and chronic renal failure on dialysis. Limited information is available concerning Brazil’s temporal trends on IE incidence and clinical outcomes. The primary source of evidence regarding the IE scenario in Brazil stems from single or multicenter observational studies.^– Analyzing available data, it appears that IE predominantly affects younger male patients in Brazil. The most prevalent microbial culprits are Staphylococcus, followed by Enterococcus and Streptococcus species; rheumatic heart disease is an important underlying heart condition as well.

The diverse clinical spectrum of IE, coupled with the substantial risk of complications and the limited availability of randomized clinical trials on IE, justify that it continues to be a prognostic challenge. Despite the unquestionable diagnostic and therapeutic advances in the management of IE in recent decades, its prognosis is still marked by high rates of complications and significant in-hospital mortality. In developed countries, IE is associated with mortality rates of approximately 20%,^,, whereas in low- and middle-income countries, the mortality of IE ranges from 15% to 30%. The predominant focus in studies on IE has been the evaluation of clinical factors that may influence the course of the disease. In one of these studies, a machine learning-based analysis identified peripheral stigmata, nosocomial IE, the absence of vegetation, and surgery in the presence of neurologic complications as characteristics associated with higher in-hospital mortality.

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Editorial

Challenges and Perspectives for Cardiology in the Developing World: Joint Views from Africa and Latin America

Mauer A. A. Gonçalves et al. Humberto Morais Gláucia Maria Moraes de Oliveira Cláudio Tinoco Mesquita

How to face challenges and promote improvements?

In 2017, a survey revealed that 18% of the 33 participating African countries had no registered cardiologists.^, Across Africa, there are approximately 2000 registered cardiologists for a population of 1.2 billion inhabitants. There is a scarcity of cardiac surgery and interventional cardiology services, with around 22 cardiothoracic centers in Africa, and 30% of African countries lack artificial cardiac stimulation therapies and cardiac electrophysiology.^– The lack of qualified human resources is a critical obstacle. The region faces a shortage of health professionals equipped to handle CVD. The specialized training process is lengthy and inadequate, contributing to this gap.^, Compared to Africa, Latin America has a great number of estimated cardiologists: 25000 to 30000. According to the 2023 Brazilian Medical Demographics study, the cardiology field has 20324 licensed professionals. Angola, an African low- to middle-income country with an estimated population of 34.0 million inhabitants, has made notable efforts in training specialists in cardiology and cardiac surgery. There are currently around 100 registered cardiologists, including 4 interventional cardiologists and 5 cardiologists who autonomously implant cardiac stimulation devices. There are also 10 cardiac surgeons, all of whom were trained abroad.

Reducing the burden of CVD in Latin America and Africa requires a multi-faceted approach that addresses various factors. For instance, collaboration with middle- and high-income countries plays a crucial role in establishing specialized centers and training professionals. However, the sustainability of these centers is challenged by economic fluctuations and political instabilities, affecting the continuity of these services.^, Inclusive health policies are crucial to ensure equitable access to medical services and medications for CVD. Expanding health insurance coverage and providing accessible therapies are fundamental steps in this direction. Partnerships between countries, both North-South and South-South, are essential to strengthen specialized workforces and improve cardiovascular care.^,,

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Original Article

Evaluation of the Profile and Quality of Sphygmomanometers Available at a Health Education Institution in Belo Horizonte

Matheus Evangelista da Costa et al. Sarah Mattos Moraes Kleisson Antonio Pontes Maia

Abstract

Background

Arterial hypertension affects around 30% of the Brazilian adult population, showing a direct and progressive relationship with an increased risk of cardiovascular diseases (CVDs). In this context, adjustments in the calibration and physical constitution of sphygmomanometers are essential conditions for obtaining correct blood pressure (BP) measurements.

Objectives

Analyze the profile and quality of sphygmomanometers used in various sectors of a health education institution in Belo Horizonte, Minas Gerais.

Methods

The present study conducted a cross-sectional, observational, and non-interventional study to assess adherence to various quality parameters of the sphygmomanometers available in the outpatient clinic, emergency department, and ward of an educational institution in the municipality of Belo Horizonte.

Results

We analyzed 78 devices, in which high rates of adherence were identified for velcro/pins, 93.5% (73/78); bulbs/rubbers, 92.1% (70/76); valves, 93.4% (71/76); the seal of the National Institute of Metrology, Quality, and Technology (INMETRO), 97.4% (76/78); and the clock, 92.1% (70/76). However, these parameters showed no statistical significance. Institutions (hospital/outpatient clinic) recorded higher calibration rates, 75% (39/52, p<0.001), in accordance with the deadlines stipulated by INMETRO, and the cuff/equipment compatibility showed its highest value (52%) among students (32/61, p = 0.004).

Conclusion

Our study showed that 38.4% (30/78) of the devices did not presented some type of inadequacy, with outpatient-owned devices had the highest compliance rate (p = 0.015). These findings are worrisome, as they can lead to inaccurate BP measurements.

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IJCS

Editorial

Firefighters Fighting Cardiovascular Death

Cardiovascular diseases are the primary cause of death worldwide. Chronic stress and obesity are important risk factors for the development of all cardiovascular diseases. Studies have shown that firefighters seem to be at higher risk of cardiovascular death, and one possible explanation is high levels of chronic stress in addition to a routine in favour of fat weight gain. An autonomic imbalance in favour of sympathetic activation to the detriment of vagal modulation might be an underlying mechanism for increased cardiovascular risk. This could trigger an acute event in a susceptible population, for instance, firefighters who undergo major stress.

Mendes et al. (2023) tested firefighters’ autonomic response during acute mental stress (3 minutes of Stroop colour word test) and its relationship to adipose tissue. The authors sought to investigate possible physiological parameters which would impact the heart rate response to mental stress. In their study, mental stress decreased vagal modulation (RMSSD) and increased heart rate and blood pressure. Therefore, the group of participants was separated into three subgroups according to heart rate response. Even with different heart rate and RMSSD responses, blood pressure increased similarly between the subgroups. However, the subgroup with lower body fat responded with higher heart rate during mental stress. This result was confirmed using multiple linear regression.

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