Browsing by Author "Aguiar, C"
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- CODAP: a Multidisciplinary Consensus Among Portuguese Experts on the Definition, Detection and Management of Atherogenic DyslipidemiaPublication . Mello e Silva, A; Aguiar, C; Sequeira Duarte, J; Couto, L; Teixeira Veríssimo, M; Marques da Silva, PIntroduction and aims: Atherogenic dyslipidemia is an important contributor to residual cardiovascular (CV) risk, but it is underdiagnosed and undertreated. This study aimed to assess the opinion of Portuguese experts to generate a consensus concerning the diagnosis and treatment of atherogenic dyslipidemia, as well as to contribute toward standardization of clinical practice in this disorder. Methods: The study consisted in the application of a questionnaire to an expert panel, following a modified Delphi methodology. Results: The majority (88.4%) of the proposed items were found to be consensual. The expert panel recognized the importance of the atherogenic dyslipidemia phenotype, the role played by low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol as risk markers and therapeutic targets, the choice of statins as first-line lipid-lowering drugs, and the value of associating statins with fenofibrate as a means to reduce residual CV risk. However, the role played by triglycerides in CV risk and the therapeutic value of fibrates lacked consensus. Taking into consideration the state of the art and the opinions expressed in this study, the scientific committee developed a treatment algorithm aimed to improve the perception and treatment of atherogenic dyslipidemia. Conclusions: The experts involved in this study were shown to be familiar with the concept and the importance of atherogenic dyslipidemia. The few situations in which a consensus could not be found were mainly related to the interpretation and/or relevance of the available evidence.
- Cuidados Intensivos Cardíacos em Portugal: Projetar a MudançaPublication . Monteiro, S; Timóteo, AT; Caeiro, D; Silva, M; Tralhão, A; Guerreiro, C; Silva, D; Aguiar, C; Santos, J; Monteiro, P; Gil, V; Morais, JIn recent years, the number of patients requiring acute cardiac care has increased, with progressively more complex cardiovascular conditions, often complicated by acute or chronic non-cardiovascular comorbidities, which affects the management and prognosis of these patients. Coronary care units have evolved into cardiac intensive care units, which provide highly specialized health care for the critical heart patient. In view of the limited human and technical resources in this area, we consider that there is an urgent need for an in-depth analysis of the organizational model for acute cardiac care, including the definition of the level of care, the composition and training of the team, and the creation of referral networks. It is also crucial to establish protocols and to adopt safe clinical practices to improve levels of quality and safety in the treatment of patients. Considering that acute cardiac care involves conditions with very different severity and prognosis, it is essential to define the level of care to be provided for each type of acute cardiovascular condition in terms of the team, available techniques and infrastructure. This will lead to improvements in the quality of care and patient prognosis, and will also enable more efficient allocation of resources.
- Effect of Empagliflozin Beyond Glycemic Control: Cardiovascular Benefit in Patients with Type 2 Diabetes and Established Cardiovascular DiseasePublication . Monteiro, P; Aguiar, C; Matos, P; Silva-Nunes, J; Birne, R; Branco, P; Calado, J; Melo, M; Polónia, JThe prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D. This article explores the various trials already performed and under development in this field, with particular focus on the EMPA-REG OUTCOME trial. In this trial, empagliflozin, a sodium-glucose co-transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations. With this reduction in risk for major CV events in patients with T2D, the EMPA-REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities.
- Empagliflozina e a Nova Era no Tratamento da Diabetes Tipo 2: Para Além do Controlo GlicémicoPublication . Silva Nunes, J; Aguiar, C; Birne, R; Branco, P; Calado, J; Matos, P; Melo, M; Monteiro, P; Polónia, JA diabetes mellitus tipo 2 (DMT2) tem associado um risco aumentado de mortalidade, principalmente, por doença cardiovascular (DCV). Interessa ter disponíveis opções terapêuticas que permitam o controlo glicémico mas que considerem, igualmente, a atuação sobre fatores de risco cardiovascular e a redução de eventos micro e macrovasculares. Nos últimos anos foram desenvolvidos vários inibidores do transporte renal de glicose via cotransporte de sódio/glicose (iSGLT), nomeadamente a empagliflozina, para promover a excreção urinária de glicose filtrada pelo rim. A empagliflozina é um inibidor competitivo, reversível, altamente potente e seletivo dos SGLT2, indicada no tratamento da hiperglicemia da DMT2. O EMPA-REG OUTCOME®, um ensaio clínico de resultados cardiovasculares aleatorizado, em dupla ocultação, controlado com placebo, que incluiu 7020 indivíduos com DMT2 e DCV estabelecida, avaliou o efeito da empagliflozina versus placebo, associado ao tratamento standard, na ocorrência de um compósito de 3 pontos MACE (Major Adverse Cardiovascular Events) - morte por causa cardiovascular, acidente vascular cerebral não fatal ou enfarte agudo de miocárdio não fatal. Com os resultados do EMPA-REG OUTCOME®, a empagliflozina foi o primeiro iSGLT2 a demonstrar uma redução de morbilidade cardiovascular em indivíduos com DMT2 com elevado risco cardiovascular, adicionando a proteção cardiovascular ao efeito anti-hiperglicémico do fármaco e abrindo uma nova era no tratamento e gestão da DMT2.
- Gastric MANECs: a Casuistic of a Portuguese CentrePublication . Aguiar, C; Caldeira Fradique, A; Quaresma, L; Matias, R; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Oliveira, M; Cabrita, F; Mateus Marques, R; Esteves, J; Costa, L; Fernandez, G; Guedes da Silva
- Lifestyle and Impact on Cardiovascular Risk Factor Control in Coronary Patients Across 27 Countries: Results From the European Society of Cardiology ESC-EORP EUROASPIRE V RegistryPublication . Kotseva, K; De Backer, G; De Bacquer, D; Rydén, L; Hoes, A; Grobbee, D; Maggioni, A; Marques-Vidal, P; Jennings, C; Abreu, A; Aguiar, C; Badariene, J; Bruthans, J; Castro Conde, A; Cifkova, R; Crowley, J; Davletov, K; Deckers, J; De Smedt, D; De Sutter, J; Dilic, M; Dolzhenko, M; Dzerve, V; Erglis, A; Fras, Z; Gaita, D; Gotcheva, N; Heuschmann, P; Hasan-Ali, H; Jankowski, P; Lalic, N; Lehto, S; Lovic, D; Mancas, S; Mellbin, L; Milicic, D; Mirrakhimov, E; Oganov, R; Pogosova, N; Reiner, Z; Stöerk, S; Tokgözoğlu, L; Tsioufis, C; Vulic, D; Wood, DAims: The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design: A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods: Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results: A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion: A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.
- Lifestyle and Risk Factor Management in People at High Risk of Cardiovascular Disease. A Report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV Cross-Sectional Survey in 14 European RegionsPublication . Kotseva, K; De Bacquer, D; De Backer, G; Rydén, L; Jennings, C; Gyberg, V; Abreu, A; Aguiar, C; Conde, Almudena C; Davletov, K; Dilic, M; Dolzhenko, M; Gaita, D; Georgiev, B; Gotcheva, N; Lalic, N; Laucevicius, A; Lovic, D; Mancas, S; Miličić, D; Oganov, R; Pajak, A; Pogosova, N; Reiner, Ž; Vulic, D; Wood, D; The Euroaspire InvestigatorsBACKGROUND: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV in primary care was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2014-2015 in 71 centres from 14 European countries. The main objective was to determine whether the 2012 Joint European Societies' guidelines on cardiovascular disease (CVD) prevention in people at high CVD risk have been followed in clinical practice. METHODS: Patients without a history of atherosclerotic disease started on either blood pressure and/or lipid and/or glucose-lowering treatments were identified and interviewed at least six months after the start of medication. RESULTS: Medical notes of 6700 patients were reviewed, and 4579 patients (58.7% women; mean age 58.8 (standard deviation (SD) 11.3) years) interviewed (interview rate 68.3%). Overall, 16.6% were smokers, 39.9% were overweight (body mass index (BMI)≥25 and <30 kg/m2), 43.5% obese (BMI ≥30 kg/m2) and 63.9% centrally obese (waist circumference of ≥88 cm for women, ≥102 cm for men). The medical risk factor control was very poor, with less than half (42.8%) of the patients on blood pressure lowering medication reaching the target of <140/90 mm Hg (<140/80 mm Hg in people with self-reported diabetes). Among treated dyslipidaemic patients only 32.7% attained the low-density lipoprotein (LDL)-cholesterol target of <2.5 mmol/l. Among people treated for type 2 diabetes mellitus, 58.5% achieved the glycated haemoglobin (HbA1c) target of <7.0%. CONCLUSION: The EUROASPIRE IV survey shows that large proportions of patients at high CVD risk have unhealthy lifestyle habits and uncontrolled blood pressure, lipids and diabetes. The present data make it clear that more efforts must be taken to improve cardiovascular prevention in people at high CVD risk.
- Peritoneum Patch Repair in Oncologic Major Resections – An Autolog AlternativePublication . Aguiar, C; Vigia, E; Nobre, AM; Bicho, L; Filipe, E; Paulino, J
- Prevalence of Microalbuminuria in Hypertensive Patients With or Without Type 2 Diabetes in a Portuguese Primary Care Setting: The RACE (MicRoAlbumin sCreening survEy) StudyPublication . Marques da Silva, P; Carvalho, D; Nazaré, J; Martins, L; Aguiar, C; Manso, MC; Carqueja, T; Polónia, JIntrodução e objetivos: Determinar a prevalência de microalbuminúria (MAU) em doentes hipertensos (HTA) e/ou diabéticos tipo 2 (DM2) e em normotensos não diabéticos (grupo controlo). Como objetivos secundários, analisar as diferenças de distribuição da MAU nas quatro subpopulações e observar a associação de variáveis clínicas e epidemiológicas diversas com a MAU. Métodos: O RACE (micRoAlbuminsCreeningsurvEy) é um estudo epidemiológico descritivo, observacional de corte transversal, multicêntrico, que incluiu doentes acompanhados nos Cuidados de Saúde Primários (CSP) em Portugal. Os doentes com causas potenciais de falsos positivos para MAU foram excluídos. As avaliações principais foram a frequência da MAU, determinada pelo teste da tira reativa Micral-Test®, a pressão arterial (PA), as variáveis demográficas, as doenças concomitantes, a medicação cardiovascular e antidiabética e as variáveis bioquímicas. Resultados: Um total de 9198 participantes (3769 hipertensos, 3100 diabéticos tipo 2 hipertensos, 423 diabéticos normotensos e 1906 controlos), 54,7% do sexo feminino, foram incluídos na análise primária. A prevalência de MAU foi de 58% nos doentes com HTA + DM2, 51% nos doentes com DM2, 43% nos doentes com HTA e de 12% no grupo controlo ( 2: p < 0,001 para todos os subgrupos). Numa análise multivariada, os preditores de MAU foram presenc¸a de DM2 ou de HTA, a HbA1c, o sexo masculino, a idade, a PA sistólica e o colesterol total. Conclusões: A MAU é extremamente frequente nos doentes em CSP com diabetes e/ou hipertensão, particularmente em doentes com HTA e DM2 com risco cardiovascular elevado. O rastreio da MAU poderá facilitar a identificação de indivíduos em risco e aumenta a atenção para a doença renal e as lesões nos órgãos alvo.
- Prosthetic Mitral Valve Thrombosis in Pregnancy: From Thrombolysis to AnticoagulationPublication . Cardoso, G; Aguiar, C; Andrade, MJ; Patrício, L; Freire, I; Serrano, F; Anjos, R; Mendes, MINTRODUCTION: Pregnant women with mechanical prosthetic heart valves are at increased risk for valve thrombosis. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss. Bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns. CASE REPORT: We report a case of mitral prosthetic valve thrombosis in early pregnancy, which was successfully treated with streptokinase. Ten years later, the same patient had an uneventful pregnancy, throughout which acenocoumarol was maintained. CONCLUSION: With this case we review the prevention (with oral anticoagulant therapy) and treatment of prosthetic valve thrombosis during pregnancy, which is important for both obstetrician and cardiologist.