Diabetes Mellitus – ABC CARDIOL

ABC

Special Article

Cardiovascular Statistics – Brazil 2026

Gláucia Maria Moraes de Oliveira et al. Luisa Campos Caldeira Brant Carisi Anne Polanczyk Deborah Carvalho Malta … Andreia Biolo Bruno Ramos Nascimento Maria de Fatima Marinho de Souza Andrea Rocha De Lorenzo Antonio Aurélio de Paiva Fagundes Júnior Arthur Gus Manfro Beatriz D. Schaan Christina Grüne de Souza e Silva Fábio Morato de Castilho Fernando Henpin Yue Cesena Gabriel Porto Soares Gesner Francisco Xavier Junior Jose Augusto Soares Barreto Filho Lucia Campos Pellanda Luciana Nicolau Aranha Luis Eduardo Paim Rohde Luiz Guilherme Passaglia Marcelo Martins Pinto-Filho M. Julia Machline-Carrion Marcio Sommer Bittencourt Octavio M. Pontes Neto Paolo Blanco Villela Paulo Henrique Godoy Renato Azeredo Teixeira Ricardo Stein Roney Orismar Sampaio Thais Rocha Salim Thomas A. Gaziano Pablo Perel Gregory A. Roth Antonio Luiz Pinho Ribeiro

Cardiovascular Statistics – Brazil was established to provide a periodic, comprehensive, evidence-based assessment of cardiovascular health in Brazil and to support clinical practice, research, public health planning, and policy development. Developed under the auspices of the Brazilian Society of Cardiology, the initiative brings together a multidisciplinary network of investigators from academic institutions across the country who are responsible for reviewing, analyzing, and interpreting data from multiple complementary sources. Since its first edition in 2020, Cardiovascular Statistics – Brazil has sought not only to quantify the burden of cardiovascular diseases (CVDs) and their risk factors but also to identify temporal trends, regional disparities, gaps in care, and emerging challenges for the Brazilian health system. The project is modeled on international initiatives such as the American Heart Association’s Heart Disease and Stroke Statistics Update, while incorporating data sources and perspectives that reflect Brazil’s unique epidemiological, demographic, and healthcare characteristics.

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IJCS

Original Article

Innovative Health Education Strategies: Training Professionals in Hypertension and Diabetes Care in Primary Health Care

Thiago Barbabela de Castro Soares et al. Priscila Lenita Candida dos Santos Regina Márcia Faria de Moura Daisy Motta-Santos … Reginaldo Gonçalves Polianna Delfino Pereira Daniella Nunes Pereira Clara Rodrigues Alves de Oliveira Lilian Cristina Rezende Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and behavioral changes are a cornerstone of their prevention and treatment. However, implementing such changes can be challenging, and the use of validated protocols may support this process.

Objectives:

To develop, implement, and evaluate a continuing education protocol for primary care professionals focused on creating and monitoring action plans for the care of patients with arterial hypertension (AH) and diabetes mellitus (DM).

Methods:

The strategy involved 20 hours of in-person workshops and 15 hours of online training, based on Ministry of Health guidelines and covering topics such as physical activity, nutrition, and lifestyle. Evaluation was conducted through the development of team-based action plans and the administration of a satisfaction questionnaire.

Results:

The model was implemented in five municipalities, with 166 healthcare professionals participating in the in-person workshops. All teams developed action plans to implement the covered topics within their local contexts. The workshops on physical activity, nutrition, and lifestyle change were mostly rated as “good,” “very good,” or “excellent.” The most frequently mentioned terms in the qualitative assessments were “content,” “knowledge,” and “practices.” The strategy proved feasible, and partnerships with local public institutions enabled the active involvement of health professionals in proposing solutions to identified issues ().

Conclusion:

The action plans were tailored to local realities and reflected a high level of satisfaction with both the content and the hands-on approach of the sessions.

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ABC

Editorial

The ELSA-BRASIL Study and Physical Activity in Protecting Against the Development of Type 2 Diabetes

Rodrigo Delevatti et al. Larissa dos Santos Leonel Leandro Franzoni

Type 2 diabetes mellitus (T2DM) is a highly prevalent disease, considered a major public health problem, which implies personal costs, as well as representing a significant financial burden on health services.^, In its preventive and therapeutic approach, the protective role of physical education has been established, but the optimization of its benefits, especially analyzing the relationship between characteristics inherent to the practice of physical activity and the development of DMT2, is still open.

In this scenario, the article “Dose-Response Association between Leisure-Time Physical Activity Intensity Trajectories and Diabetes among Men and Women in ELSA-Brasil” collaborates significantly, following a significant sample of individuals from different locations in Brazil, testing the association between different doses of leisure-time physical activity and pre-diabetes and T2DM in adults and older adults. The exposure is based on the different activity profiles, considered here as doses (the product of frequency, duration, and intensity), classified as low, moderate, and high, terms that refer to the intensity of the effort.

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ABCHF

Review Article

The Use of Sodium-Glucose Cotransporter2 (SGLT2) Inhibitors in Patients with Reduced Ejection Fraction: An Integrative Review

Irving Gabriel Araújo Bispo et al. Guilherme Martins Chaves Mariana Gonçalves Fernandes Larissa Hiromi Yamamoto Giulia Amorim Almeida

Abstract

Heart failure (HF) is characterized as a clinical syndrome comprised of different etiologies. HF can be classified according to the left ventricular ejection fraction (LVEF) in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Studies have shown that sodium-glucose cotransporter2 (SGLT2) inhibitors can collaborate in the treatment of HF. To conduct a bibliographic survey in the form of an integrative qualitative review on the use of SGLT2 inhibitors in the treatment of heart failure. This study was carried out through the elaboration of an integrative literature review. Articles published in the last five years were selected from the PubMed, SciELO, LILACS, and Cochrane Library databases, using the following descriptors: “Diabetes Mellitus”, “Heart Failure”, “Heart Failure with Reduced Ejection Fraction” and “Sodium-Glucose Transporter 2 Inhibitors” A total of 1,504 articles, published in the PubMed, SciELO, Cochrane Library, and LILACS databases, were found. After analysis, in accordance with the inclusion and exclusion criteria; reading of the abstracts or full text; and exclusion of duplicate articles, 17 studies were selected, In the past five years, there has been a lack of conclusive studies on the use of SGLT2 inhibitors. Studies, such as DAPA-HF, have shown that dapagliflozin reduces hospitalizations and cardiovascular deaths in patients with HF, regardless of their glycemic status. Recent guidelines have already incorporated SGLT2 inhibitors for the treatment of HFrEF due to strong scientific evidence.

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ABCIC

Original Article

Left Ventricular Global Longitudinal Strain: an Early Marker of Diabetic Cardiomyopathy

Ana Carolina Saran et al. Stephanie Corradini Tormin Jennifer Vogel Rogério Krakauer João Eduardo Nunes Salles

Abstract

Background:

Diabetic cardiomyopathy (DCM) leads to abnormal myocardial structure and function in the absence of cardiac risk factors. Screening in the pre-clinical phase is not well established. Global longitudinal strain (GLS) has been measured as an important echocardiography parameter in asymptomatic patients.

Objective:

To describe the presence of early parameters of DCM in patients with type 2 diabetes (T2DM) without cardiovascular disease and to compare results against 2 control groups (CT groups).

Methods:

A total of 58 patients were divided into the following 3 groups: T2DM (n = 20); heart failure (HF) with preserved ejection fraction (HFpEF) without T2DM (n = 19); and control without T2DM or HFpEF (n = 19). Patients with cardiovascular disease and those using SGLT2 inhibitors, pioglitazone or saxagliptin were excluded.

Results:

The mean overall prevalence of GLS was 16% (standard deviation [SD] ± 2.9), and 41% of participants had abnormal values, comprising 10 (50%) patients from the T2DM, 11 (58%) from the HFpEF, and 3 (16%) from the CT groups (p = 0.019). Mean GLS values in the T2DM, HFpEF, and CT groups were 16.1%, 14.8%, and 17.5%, respectively (p = 0.015). There was a negative moderate association between HbA1c levels and GLS values in the T2DM group (p = 0.043).

Conclusions:

GLS proved to be a potential early marker of left ventricular (LV) cardiac changes in patients with T2DM, given the similarity between this patient group and the HFpEF group studied.

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ABC

Editorial

Aiming for Health Equity: Why Does Diversity in Brazilian Medical Research Matter?

Christina Grüne de Souza e Silva

Over 35 years ago, Brazilian citizens earned their constitutional right to health. Guided by the fundamental principles of universality and equity, health access and actions provided by the Brazilian Unified Health System (Sistema Único de Saúde – SUS) are ever-since responsibilities of the State and should be, therefore, guaranteed by economic and social policies.

Since its creation, SUS has experienced significant improvements in disease prevention and health promotion. A dramatic drop in infant mortality and a significant increase in life expectancy are a couple of major outcomes that reflect the expansion in Brazilians’ population access to comprehensive health care. However, disparities across geographical regions and income groups persist, especially for vulnerable populations such as the quilombolas.

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ABC

Original Article

Cluster of Physical Inactivity and Other Risk Factors and Diabesity in Quilombol Adults

Poliana Pereira Santana et al. Clarice Alves dos Santos Ricardo Franklin de Freitas Mussi Hector Luiz Rodrigues Munaro Saulo Vasconcelos Rocha

ABSTRACT

Background:

Diabesity is a condition characterized by the coexistence of type 02 diabetes and obesity. The causes are multifactorial, resulting from a complex interaction of genetic and behavioral factors. Among the behavioral factors, there are physical inactivity, inadequate eating habits and excessive consumption of alcohol and tobacco.

Objective:

To investigate the clustering of physical inactivity and other risk factors and the association between risk factor combinations and the presence of diabesity in quilombola adults.

Methods:

Cross-sectional study involving a sample of 332 middle-aged and older adults (≥ 50 years) selected among participants in the “Epidemiological Profile of Quilombolas in Bahia” study. Data were collected by interview and anthropometric assessment. Descriptive statistics, cluster analysis, and multinomial logistic regression procedures were used for data analysis.

Results:

The highest prevalence of clustering was identified for the combinations of regular alcohol consumption in the absence of the other factors (O/E=14.2; 95%CI 0.87-1.15), followed by regular alcohol and tobacco consumption (O/E=10.3; 95%CI 0.64-0.95) and regular consumption of alcohol, tobacco and foods high in sugar and fat (O/E=6.8; 95%CI= 1.31-1.75). Unadjusted analysis revealed an association between physical inactivity in the absence of the other factors (OR=0.82; 95%CI 0.78-0.86) and diabesity.

Conclusion:

Alcohol consumption was the most prevalent factor among the largest combinations evaluated. Furthermore, the presence of physical inactivity without the other behaviors analyzed and the absence of all behaviors were associated with diabesity only in unadjusted analysis.

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IJCS

Original Article

Development and Implementation of a Computerized Decision Support System for Screening Hypertension and Diabetes in a Resource-Constrained Region

Laura Defensor Ribeiro de Melo et al. Antonio Luiz Pinho Ribeiro João Antonio de Queiroz Oliveira Junia Xavier Maia … Thábata Queiroz Vivas de Sá Vânia Soares de Oliveira e Almeida Pinto Marcia Maria Oliveira Lima Patrick Wander Enlich Leonardo Bonisson Ribeiro Christiane Correa Rodrigues Cimini Milena Soriano Marcolino

Abstract

Background

Strategies aimed at improving the diagnosis and treatment of cardiovascular diseases (CVD) are of utmost importance. Clinical decision support systems (CDSS) are guided by updated guidelines and may be capable of benefiting screening and early diagnosis initiatives in remote regions.

Objective

To develop a CDSS for screening hypertension and diabetes mellitus (DM), as well as to assess its feasibility and usability in the context of a primary care setting in a resource-constrained region.

Methods

This research focused on the strategy of screening hypertension and DM based on CDSS. A software was developed and implemented in 10 municipalities in the Northeast of the state of Minas Gerais, Brazil, from April 2017 to October 2018. Patients of 30 to 69 years of age were attended by primary care practitioners using the software. A Likert-scale questionnaire with 15 questions to assess usability (System Usability Scale) and satisfaction was applied to the professionals at the end of study. Groups were compared by applying the chi-squared test for categorical variables. Statistical significance was considered as p < 0.05.

Results

In the field study, 13,775 individuals were assessed; 185 patients were diagnosed with hypertension; 35 were diagnosed with DM, and 5 were diagnosed with both diseases. For the usability and satisfaction assessment, 258 healthcare professionals participated. Fifty-one percent considered their prior knowledge for the use of technologies to be good; 53.7% reported a desire to use the application frequently, and 78.4% would recommend the platform.

Conclusion

The implementation of a CDSS developed to assist in the screening of hypertension and DM was feasible in the context of a primary care setting in a resource-constrained region, with good user satisfaction.

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ABC

Special Article

Cardiovascular Statistics – Brazil 2023

Gláucia Maria Moraes de Oliveira et al. Luisa Campos Caldeira Brant Carisi Anne Polanczyk Deborah Carvalho Malta … Andreia Biolo Bruno Ramos Nascimento Maria de Fatima Marinho de Souza Andrea Rocha De Lorenzo Antonio Aurélio de Paiva Fagundes Júnior Beatriz D. Schaan Christina Grüne de Souza e Silva Fábio Morato de Castilho Fernando Henpin Yue Cesena Gabriel Porto Soares Gesner Francisco Xavier Junior Jose Augusto Soares Barreto Filho Luiz Guilherme Passaglia Marcelo Martins Pinto Filho M. Julia Machline-Carrion Marcio Sommer Bittencourt Octavio M. Pontes Neto Paolo Blanco Villela Renato Azeredo Teixeira Ricardo Stein Roney Orismar Sampaio Thomaz A. Gaziano Pablo Perel Gregory A. Roth Antonio Luiz Pinho Ribeiro

ABOUT THESE STATISTICS

The publication Cardiovascular Statistics – Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil. The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke. Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Networkand an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG).

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IJCS

Editorial

Increased Circulating Fetuin-A Levels in Patients With Atrial Fibrillation: Are We Really There?

Claudia da Silva Fragata

Fetuin-A is a protein almost exclusively secreted by the liver. Circulating fetuin-A levels are elevated in humans with metabolic syndrome and insulin resistance, conditions that are associated with increased risk of cardiovascular disease. Fetuin-A is a natural inhibitor of the insulin-stimulated insulin receptor tyrosine kinase and was shown to induce insulin resistance in rodents.^, Studies in humans have demonstrated that circulating fetuin-A levels are positively associated with fat accumulation in the liver, insulin resistance, and metabolic syndrome. To our knowledge, the potential association between fetuin-A and atrial fibrillation (AF) has not been studied to date. Therefore, the present study aimed to determine circulating fetuin-A levels in AF patients and revealed that higher plasma fetuin-A levels were associated with AF after adjustments for some confounding factors.

Fetuin-A seems to be involved in many normal and pathological processes, such as in response to systemic inflammation, hepatocyte-growth-factor activity and regulation of insulin activity, inhibition of unwanted mineralization, osteogenesis, and bone resorption.

[…]

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ABCHF

Review Article

Diabetic Cardiomyopathy and Heart Failure

Antonio José Lagoeiro Jorge et al. Marcio Roberto Moraes de Carvalho

Introduction

The global prevalence of diabetes, especially type 2 diabetes mellitus (T2DM), has been on a concerning upward trend over the years. The most recent estimates published in the International Diabetes Federation Diabetes Atlas account for more than 450 million adults with diabetes worldwide, with 693 million persons estimated to have T2DM by the year 2045. This diabetes pandemic will impose a significant burden on society, both in terms of substantial costs to the healthcare system and poor health outcomes for T2DM patients.

The Framingham Heart Study demonstrated the epidemiological linkage between diabetes and increased risk of heart failure (HF). It is well established that diabetes not only increases the risk of HF, but also increases its incidence by approximately 2.5-fold regardless of age or other comorbidities. Diabetic patients now represent up to one-third of participants in HF clinical trials, with diabetes being an independent predictor of poor outcome^, and a leading driver of the worldwide HF epidemic.

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ABC

Letter to the Editor

Analysis of low-density lipoprotein in diabetic patients using the Martin/Hopkins and Sampson equations

Cristian Rodrigues do Nascimento et al. Rodrigo Mendes Carlos Alberto de Lima Botelho Filho Romero Henrique de Almeida Barbosa Pedro Pereira Tenório

Dear Editor,

We read with great interest the article: Comparison of Novel Martin/Hopkins and Sampson Equations for Calculation of Low-Density Lipoprotein Cholesterol in Diabetic Patients. The study compared the Martin/Hopkins (LDL-Cmh), Sampson (LDL-Cs), and Friedewald (LDL-Cf) equations with directly obtained low-density lipoprotein (LDL-Cd). The aim was to analyze which would have a greater agreement with LDL-Cd in diabetic patients and investigate how these new equations could change clinical decision-making compared to LDL-Cf.

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IJCS

Original Article

Prevalence of Surgical Myocardial Revascularization in Diabetics and Non-diabetics After Acute Myocardial Infarction

Ariane Maggi Coelho Schwanck et al. Iara Schardosin Bayma de Menezes Marina Casagrande Canto

Abstract

Background

Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia. The main cause of death among diabetics is cardiovascular disease (CVD), which is a precursor to acute myocardial infarction (AMI). Approximately 30% of diabetic patients with AMI require myocardial revascularization surgery (MRS).

Objective

To evaluate the prevalence of MRS in diabetic and non-diabetic patients after AMI in a hospital in the city Criciúma, Brazil, during the period from 2016 to 2019.

Methods

A cross-sectional study was carried out with secondary data collection, with analysis of 215 medical records of diabetic and non-diabetic patients with AMI, submitted or not to MRS during the study period. For statistical analysis, the Shapiro-Wilk test, Pearson’s chi-square test and Fisher’s exact test were used, with a significance level of α = 0.05.

Results

The frequency of diabetic AMI patients with hypertension (88.1%) was significantly higher (p<0.01) than of diabetic AMI patients without hypertension. Although no statistically significant differences were found in the other variables between the groups, smoking, hypertension and dyslipidemia were more prevalent in diabetic than in non-diabetic patients with AMI undergoing MRS.

Conclusion

The prevalence of MRS after AMI in diabetic patients was higher than in non-diabetic patients.

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IJCS

Original Article

Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review

Ariane Petronilho et al. Mariana de Oliveira Gois Camila Sakaguchi Maria Cecília Moraes Frade … Meliza Goi Roscani Aparecida Maria Catai

Abstract

Background

The incidence of diabetes mellitus in younger adults is rising over the years. The diabetic population has an increased risk of developing heart failure, and diabetic individuals with heart failure have four times greater mortality rate. Studies results about exercise effect on left ventricular function in type 2 diabetes mellitus are heterogenous.

Objective

This review aimed to analyze the effects of physical exercise on left ventricular dysfunction in type 2 diabetes mellitus (T2DM).

Methods

Only randomized clinical trials with humans published in English were included. Inclusion criteria were studies with type 2 diabetes patients, physical exercise, control group and left ventricular function. Exclusion criteria were studies with animals, children, teenagers, elderly individuals and athletes, presence of diet intervention, and patients with type 1 diabetes, cancer, cardiac, pulmonary, or neurological diseases. Electronic databases PubMed, Web of Science, Cochrane, and Scopus were last searched in September 2021. Risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale.

Results

Five studies were included, representing 314 diabetic individuals submitted to resistance and aerobic exercise training. Of the variables analyzed, physical exercise improved peak torsion (PTo), global longitudinal strain, global strain rate (GSR), time to peak untwist rate (PUTR), early diastolic filling rate (EDFR) and peak early diastolic strain rate (PEDSR).

Conclusion

To our knowledge, this is the first systematic review on the effects of exercise on left ventricular function in T2DM including only randomized clinical trials with humans. Physical exercise seems to improve systolic and diastolic strain, twist, and torsion. High intensity exercise was reported to be superior to moderate intensity exercise in one study. This review was limited by the small number of studies and their heterogeneity regarding exercise protocols, follow-up period, exercise supervision and left ventricular function variables analyzed. This review was registered in PROSPERO (CRD42021234964).

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Original Article

Effects of High-Intensity Interval Training and Continuous Training on Exercise Capacity, Heart Rate Variability and Isolated Hearts in Diabetic Rats

Eduardo Gomes de Souza Neto et al. João Victor Capelli Peixoto Claucio Rank Filho Ricardo Rasmussen Petterle … Rosalvo Tadeu Hochmuller Fogaça Beata Maria Wolska Fernando Augusto Lavezzo Dias

Abstract

Background

High-intensity interval training (HIIT) has been suggested as an alternative for continuous training (CT) in people with diabetes mellitus (DM) due to its short duration and potential to improve adherence to exercise. However, data on its impact on heart rate variability (HRV) are scarce.

Objectives

To assess and compare the effects of HIIT and CT on exercise capacity, HRV and isolated hearts in diabetic rats.

Methods

DM (intravenous streptozotocin, 45 mg.kg ^-1 ) and control (C) animals performed 20 sessions (5 days/week, 50 min, for 4 weeks) of CT on a treadmill (70% of maximal exercise capacity) or HIIT (cycles of 1:1min at 50% and 90% of maximal exercise capacity). HRV was assessed by continuous electrocardiogram, and cardiac function assessed in isolated perfused hearts. For data analysis, we used the framework of the multivariate covariance generalized linear model or one-way ANOVA followed by Tukey’s test, considering p<0.05 as significant.

Results

Higher exercise capacity (m/min) was achieved in HIIT (DM-HIIT: 36.5 [IQR 30.0-41.3]; C-HIIT: 41.5 [37.8-44.5], both n=10) compared to CT (DM-CT: 29.0 [23.8-33.0]; C-CT: 32.0 [29.5-37.0], both n=10) (p<0.001). Heart rate (bpm) was lower in DM compared to controls (p<0.001) both in vivo (DM-HIIT:348±51, C-HIIT:441±66, DM-CT:361±70, C-CT:437±38) and in isolated hearts. There were no differences in HRV between the groups. Maximum and minimal dP/dt were reduced in DM, except +dP/dt in DM-HIIT vs. C-HIIT (mean difference: 595.5±250.3, p=0.190).

Conclusion

Short-term HIIT promotes greater improvement in exercise performance compared to CT, including in DM, without causing significant changes in HRV.

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ABC

Editorial

Endothelial Biomarkers and Translational Medicine: Still a Challenge

Renato Jorge Alves

The article “Can the Serum Endocan Level Be Used as a Biomarker to Predict Subclinical Atherosclerosis in Patients with Prediabetes?” addressed a topic of the greatest relevance and originality, the diagnostic investigation of subclinical atherosclerosis in pre-diabetic patients. Therefore, the study evaluated the endothelial cell-specific molecule-1 (ESM-1) endocan concentration in pre-diabetic patients to verify the role of serum endocan levels in detecting subclinical atherosclerosis, aided by measuring the intima-media layer of the carotid arteries thickness (IMT).

Due to the global epidemic of obesity, there is an increasing number of patients diagnosed with type 2 diabetes. However, preceding this morbidity, an even greater contingent of individuals is hidden, those in the pre-diabetic or insulin resistance phase.

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IJCS

Original Article

Diet Quality and Associated Factors in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes at a Specialized Outpatient Clinic in the City of Pelotas, Brazil

Fernanda Vighi Dobke et al. Aline Longo Bruna Luiza Paulina Ribas Bernardete Weber … Eduardo Gehling Bertoldi Lúcia Rota Borges Renata Torres Abib Bertacco

Abstract

Background

In most cases, atherosclerotic cardiovascular disease (ACVD) is preventable through primary prevention and control of traditional risk factors, such as smoking cessation, regular physical activity, and adherence to healthy dietary patterns. The assessment of diet quality of ACVD patients would be important for a dietary intervention.

Objectives

This study aimed to evaluate diet quality of ACVD patients and its association with clinical conditions.

Methods

This cross-sectional study was nested within a randomized clinical trial entitled “Programa Alimentar Cardioprotetor Brasileiro.” Baseline data of 80 patients from Pelotas, Brazil, were obtained. Food consumption was assessed using 24-h food recall and the Revised Diet Quality Index (IQD-R). Data on smoking status and comorbidities were reported by the patients during medical history taking. To analyze the associations between IQD-R and clinical variables, unpaired Student’s t-test or the analysis of variance was performed. The significance level was 5%.

Results

Most of the sample consisted of men (66.5%), elderly individuals (52.50%), patients with hypertension (78.75%), dyslipidemia (58.75%), and overweight (73.75%). The average IQD-R score was 56.7 ± 12.6 points. Better quality of diet was observed for patients with diabetes compared to those without diabetes (61.1 ± 11.8 versus 54.0 ± 12.6 points; p=0.014).

Conclusion

There is a need to improve diet quality of ACVD patients. Patients ACVD and diabetes had better diet quality compared to those without diabetes.

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IJCS

Original Article

The Influence of Primary Atherosclerotic Diseases on the Occurrence of Secondary Disease

Paula Monique Chiconi de Picoli et al. Creusa Sayuri Tahara Amaral Eliane Trovatti

Abstract

Background

Atherosclerosis is a condition in which fats, cholesterol, fibrin, and other substances accumulate into plaque on the arterial walls. Plaque can harden and narrow the arteries, in turn limiting the blood flow and resulting in diseases, such as acute myocardial infarction (AMI), ischemic stroke (IS), or peripheral arterial disease (PAD). There is a fairly high risk of a secondary atherosclerotic event if patients are not treated after the primary episode.

Objective

To calculate the statistical probability of developing AMI, IS, or PAD after treating the primary disease.

Methods

Data for statistical probability studies included 507,690 patients with primary atherosclerotic disease, who were in treatment during the study period and who did or did not develop a secondary atherosclerotic disease event.

Result

Statistical probability data indicate that few AMI patients can develop IS (2.99%) or PAD (2.86%) as a secondary disease. Patients with primary diagnoses of IS showed a 5.07% risk of developing PAD and a 0.95% risk of developing AMI; however, PAD patients showed a higher probability for both AMI (9.17%) and IS (8.79%).

Conclusion

Secondary atherosclerotic disease episodes after IS, AMI, and PAD were confirmed by statistical probability and are consistent with data from the literature. The study revealed that a primary PAD event leads to high rates of secondary episodes, and special attention should be given to the diagnosis and treatment of PAD in order to decrease the occurrence of secondary events.

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Original Article

Comparison of Novel Martin/Hopkins and Sampson Equations for Calculation of Low-Density Lipoprotein Cholesterol in Diabetic Patients

Abdulrahman Naser et al. Khagani Isgandarov Tolga Sinan Güvenç Rengin Çetin Güvenç Müslüm Şahin

Abstract

Background

The accurate determination of low-density lipoprotein cholesterol (LDL-C) is important to reach guideline-recommended LDL-C concentrations and to reduce adverse cardiovascular outcomes in diabetic patients. The commonly used Friedewald equation (LDL-Cf), gives inaccurate results in diabetic patients due to accompanying diabetic dyslipidemia. Recently two new equations – Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) – were developed to improve the accuracy of LDL-C estimation, but data are insufficient to suggest the superiority of one equation over the other one.

Objective

The present study compared the accuracy and clinical usefulness of novel Martin/Hopkins and Sampson equations in diabetic patients.

Methods

This study included 402 patients with diabetes. Patients’ cardiovascular risk and LDL-C targets were calculated per European guidelines. Calculated LDL-Cmh, LDL-Cs, and LDL-Cf concentrations were compared with direct LDL-C concentration (LDL-Cd) to test agreement between these equations and LDL-Cd. A p-value <0.05 was accepted as statistically significant.

Results

Both LDL-Cmh and LDL-Cs had a better agreement with LDL-Cd as compared to LDL-Cf, but no statistical differences were found among novel equations for agreement with LDL-Cd (Cronbach’s alpha 0.955 for both, p=1). Likewise, LDL-Cmh and LDL-Cs showed a similar degree of agreement with LDL-Cd in determining whether a patient was in a guideline-recommended LDL-C target (96.3% for LDL-Cmh and 96.0% for LDL-Cs), which were marginally better than LDL-Cf (94.6%). In patients with a triglyceride concentration >400 mg/dl, agreement with LDL-Cd was poor, regardless of the method used.

Conclusion

Martin/Hopkins and Sampson’s equations show a similar accuracy for calculating LDL-C concentrations in patients with diabetes, and both equations were marginally better than the Friedewald equation.

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ABCIC

Review Article

Role of Strain in the Early Diagnosis of Diabetic Cardiomyopathy

Thais Rossoni Weber da Silva et al. Roberto Léo da Silva Adriana Ferraz Martins Jefferson Luiz Brum Marques

Abstract

Background

Advanced echocardiography using two- and three-dimensional myocardial strain proposes to identify subclinical systolic dysfunction in different clinical conditions. Strain assessment plays an important role in the early diagnosis of diabetic cardiomyopathy in diabetes mellitus (DM). However, the findings of published articles are heterogeneous. Here we conducted a systematic review to analyze the current role of strain assessment in patients with DM.

Methods

This systematic review of five databases identified 19 studies that used two-dimensional strain and 8 studies that used three-dimensional strain.

Results

The studies of two-dimensional strain included 1,774 DM patients (mean age, 57.1 years; median age, 55 years; 47.5% women), while those of three-dimensional strain included 488 DM patients (mean age, 55.7 years; median age, 63 years; 51% women). Global longitudinal strain was the myocardial deformation marker that differed most frequently between the DM and control groups.

Conclusion

Myocardial strain imaging by two- and three-dimensional speckle tracking echocardiography allows the identification of subclinical systolic dysfunction in DM patients, and differences become more marked when associated with risk factors and ventricular remodeling.

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ABC

Letter to the Editor

Statin Use Improves Cardiometabolic Protection Promoted By Physical Training in an Aquatic Environment: A Randomized Clinical Trial

Carla Paixão Miranda et al. Fernando Botoni Manoel Rocha

Reply

On 09/29/21 we received notification of a Letter to the Editor of the Arquivos Brasileiros de Cardiologia journal with some criticisms to our article entitled “Statin Use Improves Cardiometabolic Protection Promoted By Physical Training in an Aquatic Environment: A Randomized Clinical Trial”. We would like to thank the editors for the opportunity to respond and would like to clarify some points mentioned in the aforementioned Letter, which, according to our understanding, has serious problems in the interpretation of the scientific methodology processes used in our article.

The authors of the Letter report that a healthy control group was not added to the study. In fact, it was not and we report below the reasons why we made this methodological decision. The objective of the study was to analyze the influence of simvastatin use on the lipid profile adaptations resulting from aerobic and resistance training in aquatic environments in elderly women with dyslipidemia. Considering that the literature is already vast concerning studies of physical training interventions with a healthy population and evaluation of lipid parameters, the focus of our experiment was to study their effects on individuals with dyslipidemia, thus bringing a new result focused on those who need therapeutic interventions the most, aiming at improving the lipid profile. In this context, we did not see the justification for the inclusion of a healthy group. Another reason is the complete lack of intention to compare the effects of using a lipid-lowering medication in healthy individuals versus dyslipidemia patients. Therefore, we did not find any justification for the use of this medication in a healthy population.

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Original Article

Achievement of LDL-Cholesterol Goals after Acute Myocardial Infarction: Real-World Data from the City of Curitiba Public Health System

André Bernardi et al. Marcia Olandoski Lucas Olandoski Erbano Luiz Cesar Guarita-Souza … Cristina Pellegrino Baena José Rocha Faria-Neto

Abstract

Background

Reduction of LDL-cholesterol (LDL-c) levels is the cornerstone in risk reduction, but many high-risk patients are not achieving the recommended lipid goals, even in high-income countries.

Objective

To evaluate whether patients seen in the city of Curitiba public health system are reaching LDL-c goals after an acute myocardial infarction (AMI).

Methods

This retrospective cohort explored the data of patients admitted with AMI between 2008 and 2015 in public hospitals from the city of Curitiba. In order to evaluate the attainment of the LDL-c target, we have used the last value registered in the database for each patient up to 2016. For those who had at least one LDL-c registered in the year before AMI, percentage of reduction was calculated. The level of significance adopted for statistical analysis was p<0.05.

Results

Of 7,066 patients admitted for AMI, 1,451 were followed up in an out-patient setting and had at least one evaluation of LDL-c. Mean age was 60.8±11.4 years and 35.8%, 35.2%, 21.5%, and 7.4% of patients had LDL-c levels ≥100, 70–99, 50–69 and <50 mg/dL, respectively. Of these, 377 patients also had at least one LDL-c evaluation before the AMI. Mean LDL-c concentrations were 128.0 and 92.2 mg/dL before and after AMI, with a mean reduction of 24.3% (35.7 mg/dL). LDL-c levels were reduced by more than 50% in only 18.3% of the cases.

Conclusion

In the city of Curitiba public health system patients, after myocardial infarction, are not achieving adequate LDL-c levels after AMI.

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Original Article

Factors Associated With Abnormalities On Myocardial Perfusion Scintigraphy In Diabetic Patients

Alfredo Lírio da Cruz et al. Álisson Carvalho de Freitas Bianca Naomi Sada Watanabe Helena Bigarella Nascimento … Heloisa Porath Luiz Antonio Fruet Bettini Luciane Moreira Marcos Germano Dopheide

Abstract

Diabetes mellitus (DM) is the greatest risk factor for coronary artery disease. In addition to a long duration of diabetes, the presence of peripheral arterial disease and smoking are strong predictors of abnormalities on myocardial perfusion scintigraphy (MPS). This study aimed to assess the impact of risk factors in diabetic patients on MPS results and compare them with those of non-diabetic patients in a nuclear medicine clinic. A retrospective cross-sectional study was performed through the analysis of the medical records of patients who underwent MPS in 2010–2019. A total of 34,736 medical records were evaluated. Analyzing the stress phase of MPS, DM patients required two-fold more pharmacological stimulation than non-diabetic patients for MPS. Factors that negatively impact the MPS results were also evaluated, and DM (33.6%), insulin therapy (18.1%), systemic arterial hypertension (69.9%), dyslipidemia (53%), sedentary lifestyle (83.1%), use of pharmacological stress (50.6%), typical chest pain (8.5%), and limiting angina during the test (1.7%) were significantly associated (p < 0.001) with test abnormalities.

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Research Letter

Medical Residency in Brazil in the Era of Chronic Diseases: The Need for Cardiometabolic Medicine Residency

Eduardo Thadeu de Oliveira Correia et al. Letícia Mara dos Santos Barbetta Mayara Gabriele Toledo Evandro Tinoco Mesquita Jeffrey I. Mechanick

Introduction

Cardiovascular diseases (CVD) are the leading cause of death in Brazil, significantly decreasing life expectancy, impairing quality of life, and causing a great impact on the Brazilian Unified Health System. However, it is important to highlight the enormous progress in cardiovascular research and in Brazilian cardiology over the past 6 decades, which have contributed to the increase in life expectancy from 54. years in 1960 to 75.6 years in 2018.

Whereas in the last century, cardiology waged a major battle against acute diseases, such as endocarditis and acute myocardial infarction, medical research has made breakthrough advancements in the management of these conditions. Nonetheless, at the same time, the era of chronic diseases emerged, in which primary drivers (e.g., genetics, environment, and behavior), metabolic drivers (e.g., obesity, diabetes, high cholesterol, and hypertension), co-morbidities (e.g., non-alcoholic fatty liver disease and chronic kidney disease [CKD]), and clinical endpoints (e.g., coronary heart disease, heart failure, and atrial fibrillation) were modeled to improve patient outcomes. As an effort to improve this concept, Mechanick et al.^, introduced the Cardiometabolic-Based Chronic Disease (CMBCD) model, which focused on the impact of primary and metabolic drivers on the development of CVD, identifying key targets to reduce progression from risk (Stage 1 CMBCD) to pre-disease (Stage 2 CMBCD), disease (Stage 3 CMBCD), and complications (Stage 4 CMBCD). This classification is depicted in and marks a new era in the care of cardiometabolic diseases.

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