Search

Aims: This study aimed to improve malnutrition in mice and elderlies with a new dairy/buriti oral dietary supplement. Background: Malnutrition is a prevalent problem in the elderly; therefore, oral dietary supplementation is an important strategy to reduce the incidence of this health problem. Objective: The present study evaluated the effects of a low-cost food supplement, made from by-products of the dairy and fruit industry in the Brazilian Cerrado (Buriti), on the nutritional status and the recovery of the metabolic profile of malnourished animals and elderly women. Methods: In the pre-clinical phase, Swiss mice were divided into six groups and subjected to malnutrition and renutrition. The clinical phase was carried out with 25 elderly women residing at a long-term institution, aged ≥ 65 years and with malnutrition or risk of malnutrition. Results: The analyzes showed improvements in anthropometric parameters and an increase in serum albumin levels, in addition to lipid profile improvement in the preclinical phase and an increase in the red blood cells and hemoglobin in the clinical phase. Conclusion: The supplement based on buriti was able to reverse malnutrition promoting improvements in anthropometric and biochemical parameters.

Objective: To analyze the association between physical fitness, cognitive function, and depressive symptoms among older adults in long-term care facilities (LTCFs). Methods: Seventy-six institutionalized male and female elderly individuals (65 years and older) living in LTCFs participated of this study. Physical fitness (aerobic capacity and strength), cognitive functions (global cognition, short-term and working and semantic memories, and executive function), and depressive symptoms were assessed. Linear regression and contingency analyses were performed. Significance was accepted at p-values ≤ 0.05. Results: Aerobic capacity predicted 32% of variance in global cognition (p < 0.01) and 25% of variance in semantic fluency/executive function (p < 0.01). Low levels of upper limb strength, lower limb strength, and aerobic capacity were associated with semantic fluency/executive function (OR = 1.38, p = 0.01, OR = 1.26, p = 0.03, and OR = 1.07, p = 0.01, respectively) and depressive symptoms (OR = 1.06, p < 0.01). Conclusion: Poor physical fitness is associated with cognition and depressive symptoms in institutionalized older adults. Low levels of strength and aerobic fitness increase the odds of presenting with impaired semantic fluency and executive function, possibly denoting an increased risk of developing dementia.

The increase in blood pressure (BP) during somatic growth might have direct determinants but also mediating factors. We investigated whether uric acid (UA) and other metabolic factors would mediate the association between body composition components and BP. A cross-sectional study was conducted in 928 children and adolescents (aged 6–18 years), in which body composition and blood biochemistry were evaluated. Structural equation modeling was performed to test the direct and indirect pathways between systolic blood pressure (SBP) and body composition parameters. Muscle mass (MM) showed a strong direct effect on BP, regardless of sex. In girls, a mediating pathway through UA was not significant, but the association between fat mass (FM) and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA, but not via the cluster of metabolic factors. The association between body composition and BP in children and adolescents has a complex design and also has a sex-specific mediating component. The increase in the UA levels may affect BP levels early in boys. Also, metabolic changes elicited by FM contribute to the increase in BP at an early age in girls. Novelty: MM showed a strong direct effect on BP, regardless of sex. In girls, the association between FM and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA.

Background: The prevalence of metabolic syndrome (MS) varies according to the different definitions available for clinical practice. The study aimed to estimate and compare the prevalence of MS according to the definitions of the American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHBI), International Diabetes Federation (IDF), and Joint Interim Statement (JIS) in a sample of climacteric women in Brazil. Methods: A population-based cross-sectional study, using a probabilistic sampling by clusters, involved 874 climacteric women. Clinical and anthropometric variables were acquired while fasting, and MS was defined according to three recommendations. To define the agreement between different definitions on MS, we calculated the sensitivity and specificity for the diagnosis of MS based on AHA/NHBI and IDF in relationship to the JIS definition. Results: The prevalence of MS was 56.9% according to the AHA/NHBI definition, 61.6% by the IDF, and 64.8% by the JIS definition, without statistical significance. When prevalence of MS was stratified by climacteric stages, the ability of the different definitions identifying MS was also similar among groups. It was observed that the MS definition proposed by AHA/NHBI identified 87.4% of MS cases from the total cases diagnosed by JIS, with agreement levels by the Kappa index of 0.835. The IDF detected 95.3% of MS cases compared to the JIS definition and the agreement level was 0.934. Conclusions: The study indicates a high prevalence of MS in climacteric women regardless of the definition used (AHA/NHBI, IDF e JIS). We did not observe significant divergences between definitions.

The gut microbiota, the ecosystem formed by a wide symbiotic community of nonpathogenic microorganisms that are present in the distal part of the human gut, plays a prominent role in the normal physiology of the organism. The gut microbiota’s imbalance, gut dysbiosis, is directly related to the origin of various processes of acute or chronic dysfunction in the host. Therefore, the ability to intervene in the gut microbiota is now emerging as a possible tactic for therapeutic intervention in various diseases. From this perspective, evidence is growing that a functional dietary intervention with probiotics, which maintain or restore beneficial bacteria of the digestive tract, represents a promising therapeutic strategy for interventions in cardiovascular diseases and also reduces the risk of their occurrence. In the present work, we review the importance of maintaining the balance of the intestinal microbiota to prevent or combat such processes as arterial hypertension or endothelial dysfunction, which underlie many cardiovascular disorders. We also review how the consumption of probiotics can improve autonomic control of cardiovascular function and provide beneficial effects in patients with heart failure. Among the known effects of probiotics is their ability to decrease the generation of reactive oxygen species and, therefore, reduce oxidative stress. Therefore, in this review, we specifically focus on this antioxidant capacity and its relationship with the beneficial cardiovascular effects described for probiotics. The authors gratefully acknowledge the Espirito Santo Research Foundation (FAPES) and the National Council for Research and Development (CNPq) for the financial support to our research project (Grant CNPq/FAPES No. 24/2018; Termo Outorga 569/2018) and CNPq Grant (Bolsa Produtividade 2015-2019) SI

Blood pressure (BP) is a strong cardiovascular risk factor, predicting cardiovascular mortality in the general population. High salt consumption is a major contributor of increased BP and hypertension. However, there is a controversy on whether BP response to salt intake would be sex-specific. Thus, we aimed to verify the changes in BP according to different salt intake in men and women in a large sample of adults. The present analysis refers to 12 813 participants (from 35 to 64 years) with a validated 12-hour overnight urine collection in which salt intake was estimated. A set of questionnaires, clinical examination, and laboratory tests were carried out during a single visit to one of the six investigation centers involved. Salt intake was 12.9 ± 5.9 g/d in men and 9.3 ± 4.3 g/d in women. BP increases as salt intake increases, regardless of using BP-lowering medication. The slope of increase in BP elicited by salt intake was significantly higher in women than in men. Thus, the increase in BP by salt intake was stepper in women even after controlling for confounders, regardless of using BP-lowering medication or being hypertensive. In conclusion, salt intake is elevated in this large sample of Brazilian adults in which only a few participants are compliant with the recommendation. Also, women have a higher responsiveness of BP according to salt intake than men, and it is not associated with age, BP level, or the use of BP-lowering medication.

BACKGROUND Among several lipid ratios available, the triglyceride/HDL-cholesterol (TG/HDL-C) may detect individuals at risk of cardiometabolic diseases. However, its reference values for different ethnicities are not well established. OBJECTIVE To define sex- and ethnicity-specific reference values for TG/HDL-C ratio in a large sample of healthy multiethnic adults and test its association with cardiometabolic conditions. METHODS An apparently healthy sample (n = 2,472), aged 35–74, free of major cardiovascular risk factors, was used to generate the reference values for the TG/HDL-C. Exclusion criteria were diabetes, elevated blood pressure, obesity, hypercholesterolemia, severe hypertriglyceridemia, and smoking history. Cut-offs based on the reference values were tested in the whole ELSA Brasil study (n = 13,245), stratified by sex and ethnicity, to identify cardiometabolic conditions. RESULTS TG/HDL-C ratio was higher in men than women, and did not change significantly with age, regardless of sex and ethnicity. Also, black individuals showed lower levels of TG/HDL-C as compared to other ethnic groups. ROC curve showed that the cut-off based on the 75th percentile displayed better sensitivities and specificities for men and women, regardless of ethnicity. Also, the sex- and ethnicity-specific cut-offs based on the 75th percentile were significantly associated with all tested cardiometabolic conditions (hypertension, diabetes, obesity, metabolic syndrome, and insulin resistance). Also, we observed that the use of a single sex-specific cut-off (men: 2.6; women: 1.7) could be used for the different ethnicities with good reliability. CONCLUSION The defined TG/HDL-C cut-offs (men: 2.6; women: 1.7) are reliable and showed good clinical applicability to detect cardiometabolic conditions in a multiethnic population.

Studies have shown that lean mass must be an important determinant of blood pressure value in children and adolescents. The absence of adjustment for the collinearity between lean and fat mass (FM), restricted age span, and lack of separate analysis by sex leave a gap in the literature. This study determined direct and indirect effects of the somatic growth indicators linked to the association between age and systolic blood pressure (SBP) in boys and girls. This is a cross-sectional study comprising 1,510 participants (6-18 years). Path analysis was used to test a model in which the association between age and SBP would have a direct and independent component, but also indirect mediating paths through muscle mass (MM), FM, and height. There was no significant association between age and SBP (unstandardized β ± SE) for both girls (0.072 ± 0.236, P = .761) and boys (0.238 ± 0.264, P = .368). Height was not a mediator for the association between age and SBP in both girls (-0.291 ± 0.156, P = .062) and boys (-0.015 ± 0.187, P = .935). Mediating effect of MM was significant for both girls (0.909 ± 0.137, P

Ethnicity is an important determinant of blood pressure levels, being black individuals affected more than any other ethnic group. Arterial stiffening, an independent risk factor for hypertension, is also influenced by ethnicity. However, whether black individuals from different continents would have different patterns of arterial stiffening is still unknown. Thus, the authors aimed to compare pulse wave velocity (PWV) in black subjects living in Angola and Brazil. A total of 677 black individuals from two independent cross-sectional studies conducted in Brazil and Angola were included in this analysis. Carotid-to-femoral PWV was measured following the same protocols for both studies, as well as clinical and anthropometric variables. Adjusted PWV was higher in Brazilian blacks than in Angolans, regardless of sex (men from Brazil: 10.7 ± 1.8 vs men from Angola: 9.9 ± 1.8 m/s, P < .001; women from Brazil: 10.3 ± 1.5 vs women from Angola: 9.2 ± 1.3 m/s, P < .001). Although the cf-PWV was higher in Brazilian blacks, the age-related increase in cf-PWV was higher in Angolan men compared to Brazilians, but not in women. SBP showed the strongest association with cf-PWV, regardless of sex and country. However, age was associated with cf-PWV in all groups, except in Brazilian men. Our results clearly show a difference in PWV between two black populations, and highlight for sex differences in the hemodynamic parameters that might affect blood pressure levels in these populations.

Subendocardial viability ratio (SEVR) is a reliable index of myocardial supply-workload balance. This study sought to investigate whether overweight/obese children and adolescents have altered SEVR and to identify which are the associated factors. This cross-sectional study involved 789 individuals. Central haemodynamic was measured by radial applanation tonometry. Diastolic time was shorter (496 ± 122 vs 537 ± 140 ms, P = .014) and diastolic pressure-time index was lower (2681 ± 412 vs 2814 ± 423 mm Hg seconds, P = .024) in overweight/obese compared with eutrophic girls. SEVR was lower in girls than in boys (1.34 ± 0.39 vs 1.48 ± 0.41, P = .018) but only among overweight/obese. SEVR may be affected by small variations in the temporal determinants of cardiac cycle.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Oral Mucositis (OM) is a common adverse effect of head and neck squamous cell carcinoma (HNSCC) treatment. The purpose of this study was to investigate the significance of early changes in tissue electrical parameters (TEPs) in predicting the development of OM in HNSCC patients receiving radiation therapy (RT). The current study combined two study designs. The first was a case-control study. The control group comprised of RT patients who did not receive head and neck RT, and patients with HNSCC who received RT comprised the case group. In the second part of the study, the case group was included in a parallel cohort. A total of 320 patients were assessed for eligibility, and 135 patients were enrolled. Double blinding was performed, and neither the patients nor the care providers knew the measured parameters. The primary outcome was the detection of between-group changes in local TEPs over the follow-up period. The secondary outcome was the appearance of OM grades II, III, or IV and the predictive value of local TEPs in determining the incidence of OM after RT. The variables, impedance module, resistance, reactance, phase angle, and capacitance, were analyzed by the receiver operator curves (ROC). The case and control groups did not differ in demographic and clinical characteristics. Radiation therapy increased the local impedance module, resistance, reactance, and phase angle and reduced the local tissue capacitance in both groups. Evaluation of TEPs in the first week of RT correlated with the development of OM lesions during cancer therapy. ROC analysis showed that local impedance module and resistance presented higher specificity than did other parameters in predicting OM. In conclusion, local tissue electrical parameters measured at the first RT week can be useful tools to predict oral mucositis.

High salt intake is known to increase blood pressure (BP) and also to be associated with carotid-femoral pulse wave velocity (cf-PWV). However, recent data showed a sex-specific pattern in the salt-induced rise of BP. Thus, we aimed to investigate whether the association between salt intake and arterial stiffness also has a sex-specific pattern. A total of 7755 normotensive participants with a validated 12-h overnight urine collection in which daily salt intake was estimated were included. cf-PWV, as well as clinical and anthropometric parameters, was measured. Salt intake positively correlated with cf-PWV, in which the linear regression was steeper in women than in men (0.0199 ± 0.0045 vs 0.0326 ± 0.0052 m/s per gram of salt, P < .05). cf-PWV increases over the salt quartiles in men and women. However, after adjustment for confounders, the association remained significant only for men. In the path analysis, the direct path (men: 0.048 P < .001, women: 0.029 P = .028) was higher in men while that mediated by SBP (men: 0.020 P < .001, women: 0.034 P < .001) was higher in women. We clearly demonstrated that high salt intake has a direct and independent effect increasing arterial stiffness regardless of sex. Also, the association between salt intake and arterial stiffness is more dependent on BP in normotensive women than it is in normotensive men. These results highlight the need for a sex-specific approach in the evaluation of cardiovascular risk associated with dietary habits.

Background Socio-economic disparities account for changes in the lipid profile in developing countries. We aimed to investigate the association between blood lipids and socio-economic and educational strata in adults not taking lipid-lowering medications. Methods A cross-sectional, population-based study enrolled 1614 individuals not taking lipid-lowering medications. Sociodemographic characteristics, monthly income, education level and the number of consumer goods available at home were obtained and individuals were classified into five socio-economic categories. Blood lipids were obtained in fasting participants. Results In men, the higher the socio-economic or educational stratum, the higher the total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels and the lower the high-density lipoprotein cholesterol (HDL-c), after controlling for age, body mass index, hypertension, smoking habit and physical activity. In women, the higher socio-economic strata were associated with elevated total cholesterol and HDL-c, while lower total cholesterol, LDL-c and TG levels were found in those with higher education levels. Also, individuals in the upper socio-economic strata had higher levels of total cholesterol and LDL-c, showing more than two times higher odds of having multiple alterations in blood lipids (men: OR 2.99 [95% CI 1.23 to 5.07]; women: OR 2.31 [95% CI 1.09 to 5.83]). Conclusions Dyslipidemia is highly prevalent in developing countries. Individuals in the highest socio-economic category are the ones at higher risk for dyslipidemia. This phenomenon calls for strategies to stimulate healthy diet habits and a physically active lifestyle to minimize health problems.

While infectious diseases constituted the most serious global health issue until the middle of the 20th century [1]; nowadays, the cardiovascular and metabolic diseases are the largest contributors to global morbimortality [2]. Interestingly, if in the past centuries, bacteria were considered a potential threat to health, currently, it is well known that in normal conditions in some body compartments, such as the gut, there is a pool of microbe that is majorly composed of nonpathogenic microorganisms (“nice guys”) that are relevant to oppose the progression of several chronic diseases. Moreover, recent studies have revealed that diseases related with dysbiosis of the gut microbiota are linked with an exacerbated oxidative stress [3]. Recent data have revealed that the healthy bacteria of gut microbiota may promote a physiological cross-talk with other systems such as the brain, cardiovascular organs, and metabolic-related tissues, helping to avoid and fight hypertension and metabolic syndrome progression [3]. In parallel, other studies demonstrated that the disturbance of gut microbiota (triggered and caused by urban diets and sedentary lifestyle) may result in excessive bioavailability of reactive oxygen species (ROS) and contribute to the increase of oxidative stress [4]. Therefore, the three terms used in the title of this special issue: gut microbiota, diet, and chronic diseases, that have sounded so discrepant until the last century begin to have a stronger meaning in the present century, as illustrated in Figure 1. However, a further and wide investigation is still necessary to reach a better understanding about the interactions either through the influence of microbiota and diet or through pharmacological strategies. Open in a separate window Figure 1 Follow-up of a decade of published papers related with the association between the three keywords: gut microbiota, diet, and chronic diseases, based on PubMed indexation. Data source: https://www.ncbi.nlm.nih.gov/pubmed/.

Background: Stress test is used to detect coronary artery disease (CAD). The QTc interval dispersion (dQTc) is an electrocardiographic index of ventricular repolarization heterogeneity. Some researchers have linked transient myocardial ischemia induced by physical exertion with increased heterogeneity of ventricular repolarization measured by dQTc. Objectives: To study the patterns of dQT in patients with and without chronic obstructive CAD and to define a reliable cutoff point for dQT that could become a diagnostic criterion for myocardial ischemia. Methods: We retrospectively analyzed the electrocardiogram in resting and in exercise of 63 patients submitted to exercise test and cardiac catheterization. We divided the patients into three groups: true negative (VN), true positive (VP) and false positive (FP). VN: patients with coronary lesion lower than 70% and exercise test without myocardial ischemia; VP: individuals with stenosis greater than 70% in coronary arteries and a test suggestive of myocardial ischemia; FP: people with stenosis lower than 70% in the coronary arteries and stress test with ischemia criteria. Values of p < 0.05 were considered statistically significant. Results: Resting dQTc was not different among the three groups. However, for the dispersion of the QTc interval in exercise was, respectively, 47 ± 17 ms, 72 ± 42 ms, and 61 ± 31 ms for VN, VP and FP (p = 0.003). Conclusions: Obstructive chronic coronary disease patients have an increase in dQTc during exercise. Measurement of dQTc may be helpful in the diagnosis of myocardial ischemia in the stress test.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Objective: the increased prevalence of obesity and associated comorbidities, such as cardiovascular and metabolic diseases, has gained attention worldwide, and the renin-angiotensin system (RAS) has been pointed out as a possible link. Thus, the present study aimed to verify the possible association between angiotensinogen (AGT) or angiotensin-converting enzyme (ACE) polymorphisms with overweight and obesity in adults. Subjects and methods: the present investigation was a population-based cross-sectional study including 1,567 individuals from an urban area in Brazil. Anthropometric, clinical and biochemical parameters were evaluated, and all individuals were genotyped for the ACE I/D and AGT M/T polymorphisms. Results: the prevalence of overweight was higher among men, whereas obesity was more prevalent among women. However, the frequency of ACE or AGT polymorphisms was similar among body mass index (BMI) categories. In addition, the mean age-adjusted BMI averages did not change significantly for ACE or AGT polymorphisms, regardless of sex or BMI category. The age-adjusted BMI average for the combination of ACE and AGT genotypes evidenced no significant differences regardless of sex or BMI categories. Results were similar when BMI was replaced by waist circumference (WC). Conclusions: we were not able to find any associations between BMI and WC (overweight/obesity) and ACE and AGT polymorphisms, indicating that the RAS system might not be involved in overweight and obesity, at least based on genetic backgrounds. However, further studies must measure RAS components to elucidate this question.

RESUMO: Objetivo: Comparar a prevalência de fatores de risco cardiovascular na população de Vitória (ES) em pesquisa autorreferida por contato telefônico (VIGITEL) ou por exames clínicos e laboratoriais realizados na Pesquisa Nacional de Saúde (PNS). Método: Os inquéritos foram realizados na população adulta de Vitória (≥18anos). No VIGITEL foram entrevistados 1996 indivíduos (homens = 38%). Na PNS foi feita visita domiciliar seguida de exames clínicos e laboratoriais em 318 indivíduos (homens = 48%) selecionados em 20setores censitários da cidade. Nos dois inquéritos, as prevalências foram ajustadas para a estrutura populacional estimada para o ano de 2013. Os dados são fornecidos como porcentagens e intervalo de confiança de 95% (IC95%). Resultados: Foram encontradas prevalências similares no VIGITEL e na PNS, respectivamente, para tabagismo (8,2%; IC95% 6,7 - 9,7% versus 10,0; IC95% 6,4 - 13,6%) e hipertensão (24,8%; IC95% 22,6- 27,0% versus 27,2%; IC95% 21,8 - 32,5%). Houve diferença estatística (p < 0,01) entre o VIGITEL e a PNS, respectivamente, para as prevalências de obesidade (16,8%; IC95% 14,1 - 18,1% versus 25,7%; IC95% 20,4- 30,9%) e colesterol elevado (≥ 200mg/dL) no sangue (20,6%; IC95% 18,6 - 22,6% versus 42,3%; IC95% 36,9- 47,7%). A prevalência de diabetes também foi maior (p < 0,05) na PNS (6,7 versus 10,7%). Conclusão: A prevalência populacional de hipertensão e tabagismo foi estimada adequadamente no VIGITEL. Isso não ocorreu com a obesidade por provável viés de informação do peso corporal no VIGITEL. Os dados mostram a necessidade de melhorar a cobertura diagnóstica das dislipidemias em vista da importância do controle desse fator de risco na prevenção primária das doenças cardiovasculares.

Objectives This study compared serum cystatin C (CysC) with conventional biomarkers of renal function in terms of their ability to predict illness severity in patients in a mixed intensive care unit (ICU). The present study also tested the hypothesis that increased CysC could predict illness severity in different clinical conditions in adult patients admitted to the ICU. Design and methods The performance of serum creatinine, urea and CysC, as well as the Glomerular Filtration Rate (GFR) estimates (Cockcroft–Gault/MDRD/Larsson and CKD-EPI Equations) in predicting illness severity was compared in 60 critically ill patients. Adult patients admitted to the hospital were screened for eligibility in this prospective and observational study. The mean patient age was 52 ± 19 years. The average APACHE II score was 9.5 ± 6 for the entire sample. The patients were assigned to two different degrees of severity, and the internally derived cut off value was an APACHE II score Results Both serum CysC and urea showed significant correlations with APACHE II, even after controlling for age. Urea and CysC levels, as well as the GFR estimated by the method of Larsson and Cockcroft–Gault, remained significantly increased in patients in the APACHEII ≥ 10 group. The ROC curve analyses indicated that both urea and CysC levels have high sensitivity and specificity in the prediction of illness severity using the APACHE II as a gold standard prognostic stratification system. Furthermore, CysC was more accurate than the Larsson, CKD-EPI CysC, CKD-EPI Cr-CysC, Cockcroft–Gault and CKD-EPI Cr CFR estimation methods compared with the MDRD method. Additionally, CysC was a good predictor in both young and old patients, whereas urea was not predictive of illness severity. Conclusions Our findings suggest that CysC and GFR estimates (Larsson or CKD-EPI CysC methods) are good predictors of illness severity in adult patients hospitalized in a mixed ICU.

It is known that dietary habits have a strong influence on body metabolism. In the last decades, the dietary habits have changed worldwide, and the consumption of fructose, especially in sugar-sweetened beverages, increased significantly. In this perspective, the present review aimed to summarize the effects of fructose on different cardiometabolic conditions. Clinical, experimental, and epidemiological studies evidenced that fructose can exert several deleterious effects when its consumption is above the recommended amounts. The increased fructose consumption decreases satiety, favoring a positive energy balance, increases adipogenesis, leading to visceral fat accumulation, induces ectopic fat accumulation, especially in the skeletal muscle and liver, leading to insulin resistance, inflammation, and lipid metabolism impairment, increases arterial blood pressure and causes vascular damage. Therefore, increased fructose consumption is linked to the development of alarming cardiometabolic conditions, such as obesity, insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular diseases, through several different mechanisms. Further clinical and experimental studies are still necessary to elucidate additional signaling pathways and mechanisms by which fructose is involved in all the mentioned cardiometabolic disorders. Also, the reported findings raise the need for the creation of public health policies aimed to prevent diet-associated cardiometabolic disorders, thus improving the population quality of life.

African–Americans present higher prevalence of left ventricular hypertrophy (LVH) when compared with white populations. However, there is a lack of information about the prevalence and determinants of LVH in black individuals living in Africa. A cross-sectional study was performed with a non-probabilistic sample comprised of 609 University workers from Angola/Africa, describing the prevalence of LVH and the determinants of left ventricular mass. Echocardiographic measurements were performed and left ventricular mass was indexed to body surface area. Systolic and diastolic blood pressures were measured, along with anthropometric and clinical variables. Chamber diameter and wall thickness were higher in men compared to women. Additionally, LVM was higher in men (114.2 ± 36 vs 98.4 ± 31.9, P

Background Aging declines essential physiological functions, and the vascular system is strongly affected by artery stiffening. We intended to define the age- and sex-specific reference values for carotid-to-femoral pulse wave velocity (cf-PWV) in a sample free of major risk factors. Methods and results The ELSA-Brasil study enrolled 15,105 participants aged 35–74years. The healthy sample was achieved by excluding diabetics, those over the optimal and normal blood pressure levels, body mass index ≤18.5 or ≥25kg/m 2 , current and former smokers, and those with self-report of previous cardiovascular disease. After exclusions, the sample consisted of 2158 healthy adults (1412 women). Although cf-PWV predictors were similar between sex (age, mean arterial pressure (MAP) and heart rate), cf-PWV was higher in men (8.74±1.15 vs. 8.31±1.13m/s; adjusted for age and MAP, P n =15,105) increased by twice the age-related slope of cf-PWV growth, regardless of sex (0.0919±0.182 vs. 0.0504±0.153m/s per year for men, 0.0960±0.173 vs. 0.0606±0.139m/s per year for women). Conclusions cf-PWV is different between men and women and even in an optimal and normal range of MAP and free of other classical risk factors for arterial stiffness, reference values for cf-PWV should take into account MAP levels. Also, the presence of major risk factors in the general population doubles the age-related rise in cf-PWV.

Carotid‐femoral pulse wave velocity (PWV) has been used as the gold standard method to estimate arterial stiffness. However, its use in clinical practice is still limited because reference values for specific groups, such as black children, remain unknown. The authors aimed to investigate predictors and to propose preliminary reference values of PWV in this population. Prepubertal schoolchildren (N=157; mean age, 9.36±1.41 year) from Luanda (Angola) with normal blood pressure values and without obesity were included. Mean PWV was 5.73±0.68 m/s, with no difference between the sexes. Univariate regression analysis showed a significant (P

RESUMO: Objetivo: Validar as fórmulas de Tanaka e Kawasaki para cálculo do consumo de sal pela relação sódio/creatinina na urina casual. Métodos: Foram estudados 272 adultos (20 - 69 anos, 52,6% de mulheres) com coleta urinária de 24 h e duas coletas casuais no mesmo dia (em jejum - casual 1 - e fora do jejum - casual 2). Antropometria, pressão arterial e coleta de sangue foram obtidos no mesmo dia. A concordância entre o consumo de sal estimado pela urina de 24 h e pela urina casual foi feita por Pearson (r) e Bland & Altman. Resultados: O consumo médio de sal medido pela urina de 24 h foi de 10,4 ± 5,3 g/dia. A correlação entre a excreção de sódio na urina de 24 h e a estimada pela urina casual 1 ou 2, respectivamente, foi apenas moderada, tanto por Tanaka (r = 0,51 e r = 0,55; p < 0,001) como por Kawasaki (r = 0,52 e r = 0,54; p < 0,001). Observa-se subestimação crescente dos valores estimados em relação ao medido com o aumento do consumo de sal pela fórmula de Tanaka e, ao contrário, superestimação ao usar a fórmula de Kawasaki. As fórmulas estimam adequadamente o consumo diário de sal (diferença entre sal medido e estimado de, no máximo, 1 g/dia) somente com consumo entre 9 - 12 g/dia (Tanaka) e 12 - 18 g/dia (Kawasaki). Conclusão: A coleta de urina casual estima adequadamente o consumo de sal apenas nos indivíduos próximos à média populacional. ABSTRACT: Objective: To validate Tanaka and Kawasaki's formulas to calculate the salt intake by the sodium/creatinine ratio in spot of urine. Methods: Two hundred and seventy two adults (20 - 69 years old; 52.6% women) with 24 h urine collection and two urinary spots collected on the same day (while fasting - spot 1 - or not fasting - spot 2). Anthropometry, blood pressure and fasting blood were measured on the same day. The analysis of agreement between salt consumption measured in the 24 h urine test and urinary spots were determined by the Pearson's correlation (r) and the Bland & Altman method. Results: The mean salt consumption measured by the 24 h sodium excretion was 10.4 ± 5.3 g/day. The correlation between the measured 24 h sodium excretion and the estimation based on spots 1 and 2, respectively, was only moderated according to Tanaka (r = 0.51 and r = 0.55; p < 0.001) and to Kawasaki (r = 0.52 and r = 0.54; p < 0.001). We observed an increasing underestimation of salt consumption by Tanaka to increasing salt consumption and conversely, an overestimation of consumption by the Kawasaki formula. The estimation of salt consumption (difference between measured and calculated salt consumption lower than 1 g/day) was adequate only when the consumption was between 9 - 12 g/day (Tanaka) and 12 - 18 g/day (Kawasaki). Conclusion: Spot urine sampling is adequate to estimate salt consumption only among individuals with an actual consumption near the population mean.

High salt intake is related to an increase in blood pressure and development of hypertension. However, currently, there are no national representative data in Brazil using the gold standard method of 24-h urine collection to measure sodium consumption. This study aimed to determine salt intake based on 24-h urine collection in a sample of 272 adults of both genders and to correlate it with blood pressure levels. We used a rigorous protocol to assure an empty bladder prior to initiating urine collection. We excluded subjects with a urine volume

The dietary–sodium restriction is a standard approach following an acute myocardial infarction (MI). We examined the hypothesis in which the use of a high or low–sodium diet would worsen post–infarction left ventricular remodeling in rats and facilitate the development of heart failure. Left coronary artery ligation or sham–operated (SO) was produced in male Wistar rats (250–290 g). After surgery, animals were assigned to one of the three diets: standard amount of sodium (0.3% NaCl, SO and MI groups), a high–sodium diet (0.6% NaCl, SO–High and MI–High groups), or a low–sodium diet (0.03% NaCl, SO–Low and MI–Low groups). Diets were provided for 8 weeks post–surgery. Mortality rate was elevated in high–salt group (MI–Low, 21.4%; MI, 35.3%; MI–High, 47.6%). Contractility parameter was seen to be impaired in MI–Low animals (3195 ± 211 mm Hg/s) compared with MI (3751 ± 200 mm Hg/s). Low–salt diet did not prevent myocardial collagen deposition (MI–Low, 5.2 ± 0.5%; MI, 5.0 ± 0.4%) nor myocyte hypertrophy (MI–Low, 608 ± 41μ 2 ; MI, 712 ± 53 μm 2 ) in left ventricle after MI. High–salt intake increases collagen volume fraction (SO, 3.3 ± 0.4%; SO–High, 4.7 ± 0.4%) in animals sham, but no major changes after MI. Our results show that ventricular remodeling was not altered by immediate introduction of low sodium after MI, and it may be a safe strategy as a therapeutic intervention to avoid volume retention. However, high sodium can be harmful, accelerating the post–infaction ventricular remodeling.

Background Black people have a higher risk of developing hypertension and presenting higher vascular stiffening. Our aim was to investigate whether the association between race and aortic stiffness could be explained by differences in the primary risk factors. Methods and Results We analyzed data from 11 472 adults (mean age, 51.9±8.9; 53.8% female) self‐reported as white (n=6173), brown (n=3364), or black (n=1935). Their carotid‐to‐femoral pulse wave velocity (cf‐PWV) as well as clinical and anthropometric parameters were measured. cf‐PWV was higher in blacks than in whites or browns (men: white, 9.63±1.81; brown, 9.63±1.88; black, 9.98±1.99; women: white, 8.84±1.64; brown, 9.02±1.68; black, 9.34±1.91; P P >0.05). The association between race and arterial stiffness was significant for brown and black women in the highest cf‐PWV quartile, even after controlling for covariates. There were no differences in the age‐related increase in cf‐PWV among the racial groups after adjustment, confirming the strong effect of age and mean arterial pressure on cf‐PWV revealed by the multiple linear regression. Conclusions Racial differences in cf‐PWV were mainly attributed to differences in mean arterial pressure and age, although they cannot fully explain the association between race and cf‐PWV in women in the highest cf‐PWV values. This suggests that therapeutic approaches to overcome the effects of aging on the vascular system should focus on blood pressure control, especially in the black population.

Summary Non-invasive assessment of central arterial pulse wave augmentation has been proved to be useful in predicting cardiovascular adverse events. Previous studies have shown that prepubescent girls had greater central augmentation pressure compared with height-matched boys. This study sought to investigate which factors contribute to the body height-independent sexual differences in central arterial wave reflection observed in childhood. This cross-sectional study involved 819 children and adolescents (6-18 years of age) of both sexes. Phenotypes of central haemodynamic were obtained by radial applanation tonometry. Heart rate corrected augmentation index (Aix@75) was greater in girls compared with boys (2.9 ± 10.7 vs. -1.7 ± 12.9%, p

Myocardial infarction (MI) is a major risk for ventricular arrhythmia. Pause-triggered ventricular arrhythmia can be caused by increased myofilament Ca binding due to sarcomeric mutations or Ca-sensitizing compounds. Myofilament Ca sensitivity is also increased after MI. Here we hypothesize that MI increases risk for pause-triggered ventricular arrhythmias, which can be prevented by myofilament Ca-desensitization and contractile uncoupling. To test this hypothesis, we generated a murine chronic MI model using male B6SJLF1/J mice (n=40) that underwent permanent ligation of the left anterior descending coronary artery. 4 weeks post MI, cardiac structure, function and myofilament Ca sensitivity were evaluated. Pause-dependent arrhythmia susceptibility was quantified in isolated hearts with pacing trains of increasing frequency, followed by a pause and an extra stimulus. Coronary ligation resulted in a mean infarct size of 39.6±5.7%LV and fractional shortening on echocardiography was reduced by 40% compared to non-infarcted controls. Myofilament Ca sensitivity was significantly increased in post MI hearts (pCa50: Control=5.66±0.03; MI=5.84±0.05; p

OBJECTIVES: The present study was performed to investigate 1) whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2) whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM), sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p

Hyperuricemia is associated with cardiovascular disease and its prevalence is unknown in black Africans. This study reports hyperuricemia distribution and its association with cardiovascular risk factors in a selected Angolan population. A cross-sectional study in 585 black Africans was performed. Hyperuricemia was defined as uric acid >7.0 mg/dL in men or >5.7 mg/dL in women. Overall prevalence was 25%. Hyperuricemia was associated with hypertension (odds ratio [OR], 2.20; confidence interval [CI], 95% 1.41-3.47), high waist circumference (OR, 1.67; CI, 95% 1.05-2.65), and metabolic syndrome (OR, 1.66; CI, 95% 1.07-2.57). Compared to those with uric acid levels in the first quartile, individuals in the fourth quartile showed higher body mass index, waist circumference, systolic blood pressure, and plasma levels of creatinine and triglycerides. Hypertension, high waist circumference, and metabolic syndrome were the major cardiovascular risk factors associated with hyperuricemia.

BACKGROUND Obesity has been described as a predictor of cardiovascular mortality, and some studies have reported an association with obesity and increased aortic stiffness. Other studies have not identified obesity to be an independent risk factor. Therefore, the purpose of our study was to determine the association between aortic stiffness and obesity in the Brazilian population. METHODS A cross-sectional study recruited 1,662 individuals aged 25-64 years from the population of Vitoria, Brazil following the guidelines of the MONICA-WHO Project. Anthropometric, clinical, and hemodynamic measurements and analyses of aortic stiffness (using carotid-femoral pulse wave velocity

A high salt diet is a known risk factor for cardiovascular diseases that leads to cardiac hypertrophy and creates a substrate for arrhythmias and sudden death. However, acute arrhythmogenesis after infarction has not been studied. Male Wistar rats (21 days) received drinking water (MI) or 1% NaCl solution (MI-Salt-C) for 4 weeks. Water was given to another group for 4 weeks, and on the day before surgery, animals received a 1% NaCl solution (MI-Salt-A). Non-invasive systolic blood pressure (SBP) was obtained before surgery. Myocardial infarction (MI) was produced by permanent occlusion of the left coronary artery. Electrocardiogram was monitored during the first 30 min post-occlusion to evaluate arrhythmias. Although SBP was not altered by salt intake (SHAM: 114±2, MI: 112±2, MI-Salt-C: 115±2, MI-Salt-A: 116±4 mm Hg), ventricular hypertrophy was observed in the animals receiving chronic salt diet (SHAM: 0.22±0.008, MI: 0.23±0.007, MI-Salt-C: 0.28±0.01; MI-Salt-A: 0.23±0.01 g/cm; P0.05). Ventricular premature beats increased in both salt-loaded groups compared to MI group (MI: 805±81, MI-Salt-C: 1145±98; MI-Salt-A: 1023±77; P0.05). Atrioventricular blockade was only observed in animals subjected to high salt intake (MI-Salt-C: 38.9%; MI-Salt-A: 42.1%). High salt intake was associated with increased post-infarct arrhythmias; however, this effect was unrelated to ventricular hypertrophy.

Objectives: To evaluate the acute effects of colony-stimulating factor (G-CSF) on ventricular arrhythmias after coronary occlusion in rats. Materials and Methods: Male Wistar rats (10 weeks) received G-CSF (100 μg.kg-1) or vehicle. Thirty minutes later, animals were infarcted by coronary occlusion under artificial respiration. Electrocardiogram was monitored for 30 min to evaluate ventricular arrhythmias. Results: G-CSF treatment reduced the number of premature ventricular beats and the number and duration of ventricular tachycardia. The incidence of ventricular fibrillation was significantly reduced by G-CSF (MI-Cont: 11.2 ± 2.4 vs. MI-GCSF: 5.4 ± 1 events; P < 0.05). However, total duration of ventricular fibrillation was not altered (MI-Cont: 84 ± 16 vs. MI-GCSF: 76 ± 13 sec). Conclusions: Acute administration of G-CSF before coronary ligature in rats reduces the incidence of ventricular premature beats and ventricular tachycardia, suggesting a possible direct electrophysiological effect of this cytokine independently of its genomic effects. However, the data suggest that G-CSF treatment may affect the spontaneous recovery from ventricular fibrillation. Acute G-CSF administration acts directly on cardiac electrophysiology, different from chronic treatment.

G-CSF is a critical regulator of hematopoietic cell proliferation, differentiation and survival. It has been reported that G-CSF attenuates renal injury during acute ischemia-reperfusion. In this study we evaluated the effects of G-CSF on the renal and cardiovascular systems of 2K1C hypertensive mice.Male C57BL/6 mice were subjected to left renal artery clipping (2K1C) or sham operation and were then administered G-CSF (100 μg/kg/day) or vehicle for 14 days.Arterial pressure was higher in 2K1C + vehicle animals than in 2K1C + G-CSF (150±5 vs. 129±2 mmHg, p0.01, n=8). Plasma angiotensin I, II and 1-7 concentrations were significantly increased in 2K1C + Vehicle when compared to the normotensive Sham group. G-CSF prevented the increase of these vasoactive peptides. The clipped kidney/contralateral kidney weight ratio showed a less atrophy of the ischemic kidney in the treated group (0.50±0.02 vs. 0.66±0.01, p0.05). The infarction area in the clipped kidney was completely prevented in 7 out of 8 2K1C + G-CSF mice. Administration of G-CSF protected the clipped kidney from apoptosis.Our data indicate that G-CSF prevents kidney infarction and markedly attenuates the increases in plasma angiotensin levels and hypertension in 2K1C mice, reinforcing the protective effect of G-CSF on kidney ischemia.

FUNDAMENTO: Não há dados relativos à epidemiologia da hiperuricemia em estudos brasileiros de base populacional. OBJETIVO: Investigar a distribuição de ácido úrico sérico e sua relação com variáveis demográficas e cardiovasculares. MÉTODOS: Estudamos 1.346 indivíduos. A hiperuricemia foi definida como > 6,8 e > 5,4 mg/dL para homens e mulheres, respectivamente. A síndrome metabólica (SM) foi definida utilizando-se os critérios NCEP ATP III. RESULTADOS: A prevalência de hiperuricemia foi de 13,2%. A associação de ácido úrico sérico (AUS) com fatores de risco cardiovasculares foi específica para o gênero: em mulheres, maiores níveis de AUS estiveram associados com IMC elevado, mesmo após ajustes da pressão arterial sistólica para idade (PAS). Em homens, a relação do AUS com o colesterol HDL esteve mediada pelo IMC, enquanto em mulheres, o AUS mostrou-se semelhante e dependente do IMC, independentemente dos níveis glicose e presença de hipertensão. Nos homens, os triglicerídeos, a circunferência abdominal (CA) e a PAS explicaram 11%, 4% e 1% da variabilidade do AUS, respectivamente. Nas mulheres, a circunferência abdominal e os triglicerídeos explicaram 9% e 1% da variabilidade de AUS, respectivamente. Em comparação com o primeiro quartil, homens e mulheres no quarto quartil apresentavam 3,29 e 4,18 vezes mais de aumento de risco de SM, respectivamente. As mulheres apresentaram uma prevalência quase três vezes maior de diabetes melito. Homens normotensos com MS apresentaram maiores níveis de AUS, independente do IMC. CONCLUSÃO: Nossos resultados parecem justificar a necessidade de uma avaliação baseada no gênero em relação à associação do AUS com fatores de risco cardiovasculares, que se mostraram mais acentuados em mulheres. A SM esteve positivamente associada com AUS elevado, independentemente do gênero. A obesidade abdominal e a hipertrigliceridemia foram os principais fatores associados com a hiperuricemia mesmo em indivíduos normotensos, o que pode adicionar maior risco para a hipertensão. BACKGROUND: There is no data concerning the epidemiology of hyperuricemia in Brazilian population-based studies. OBJECTIVE: To investigate the distribution of serum uric acid and its relationship with demographics and cardiovascular variables. MEHTODS: We studied 1,346 individuals. Hyperuricemia was defined as > 6.8 and > 5.4 mg/dL for men and women, respectively. Metabolic syndrome (MS) was defined with NCEP ATP III criteria. RESULTS: The prevalence of hyperuricemia was 13.2%. The association of serum uric acid (SUA) with cardiovascular risk factors was gender-specific: in women, higher SUA was associated with increasing BMI, even after adjustments for age-systolic blood pressure (SBP). In men, the relationship of SUA with HDLc was mediated by BMI, whereas in women, SUA was similar and dependent on BMI, regardless of glucose levels and presence of hypertension. In men, triglycerides, waist circumference (WC) and SBP explained 11%, 4% and 1% of SUA variability, respectively. In women, WC and triglycerides explained 9% and 1% of SUA variability, respectively. Compared to the first quartile, men and women in the fourth quartile had a 3.29 fold and 4.18 fold increase of MS risk, respectively. Women had almost three fold higher prevalence of diabetes mellitus. Normotensive men with MS presented higher SUA, regardless of BMI. CONCLUSION: Our results seem to justify the need for gender-based evaluation regarding the association of SUA with cardiovascular risk factors, which was more pronounced in women. MS was positively associated with increasing SUA, regardless of gender. Abdominal obesity and hypertriglyceridemia were the main factors associated with hyperuricemia even in normotensive individuals, which may add a higher risk for hypertension. RFUNDAMENTO: No existen datos relativos a la epidemiología de la hiperuricemia en los estudios brasileros de base poblacional. OBJETIVO: Investigar la distribución del ácido úrico sérico y su relación con las variables demográficas y cardiovasculares. MÉTODOS: Estudiamos 1.346 individuos. La hiperuricemia se definió como > 6,8 y > 5,4 mg/dL para hombres y mujeres, respectivamente. El síndrome metabólico (SM) fue definido utilizando los criterios NCEP ATP III. RESULTADOS: La prevalencia de hiperuricemia fue de un 13,2%. La asociación del ácido úrico sérico (AUS), con los factores de riesgo cardiovasculares fue específica para el género: en las mujeres, mayores niveles de AUS estuvieron asociados con un IMC elevado, incluso después de los ajustes para la presión arterial sistólica (PAS) y edad . En los hombres, la relación del AUS con el colesterol HDL fue mediada por el IMC, mientras que en las mujeres, el AUS demostró ser parecido y dependiente del IMC, independientemente de los niveles de glucosa y de la presencia de hipertensión. En los hombres, los triglicéridos, la circunferencia abdominal (CA) y la PAS, explicaron el 11%, 4% y el 1% de la variabilidad del AUS, respectivamente. En las mujeres, la circunferencia abdominal y los triglicéridos explicaron el 9% y el 1% de la variabilidad de AUS, respectivamente. En comparación con el primer cuartil, los hombres y las mujeres, en el cuarto cuartil, tenían 3,29 y 4,18 veces más aumento de riesgo de SM, respectivamente. Las mujeres tenían una prevalencia casi tres veces mayor de diabetes mellitus. Los hombres normotensos con MS tenían mayores niveles de AUS, independiente del IMC. CONCLUSIONES: Nuestros resultados parecen justificar la necesidad de una evaluación con base en el género, respecto de la asociación del AUS con los factores de riesgo cardiovasculares, que demostraron ser más acentuados en las mujeres. La SM estuvo positivamente asociada con el AUS elevado, independientemente del género. La obesidad abdominal y la hipertrigliceridemia fueron los principales factores asociados con la hiperuricemia incluso en los individuos normotensos, lo que puede añadirle un riesgo mayor a la hipertensión.

Coronary artery disease is the leading cause of death in the developed world and in developing countries. Acute mortality from acute myocardial infarction (MI) has decreased in the last decades. However, the incidence of heart failure (HF) in patients with healed infarcted areas is increasing. Therefore, HF prevention is a major challenge to the health system in order to reduce healthcare costs and to provide a better quality of life. Animal models of ischemia and infarction have been essential in providing precise information regarding cardiac remodeling. Several of these changes are maladaptive, and they progressively lead to ventricular dilatation and predispose to the development of arrhythmias, HF and death. These events depend on cell death due to necrosis and apoptosis and on activation of the inflammatory response soon after MI. Systemic and local neurohumoral activation has also been associated with maladaptive cardiac remodeling, predisposing to HF. In this review, we provide a timely description of the cardiovascular alterations that occur after MI at the cellular, neurohumoral and electrical level and discuss the repercussions of these alterations on electrical, mechanical and structural dysfunction of the heart. We also identify several areas where insufficient knowledge limits the adoption of better strategies to prevent HF development in chronically infarcted individuals.

The aim of the present study was to evaluate the effect of low-dose spironolactone initiated during the early stages of hypertension development and to assess the effects of chronic pressure overload on ventricular remodeling in rats. Male spontaneously hypertensive rats (SHRs) (4 weeks) were randomized to receive daily spironolactone (20 mg/kg) or vehicle (mineral oil) from 4 weeks to 8 months of age. Systolic blood pressure was measured non-invasively by tail-cuff pletysmography at baseline, 4 and 8 months. Hemodynamic assessment was performed at the end of treatment by arterial and ventricular catheterization. An in situ left ventricular pressure-volume curve was created to evaluate dilatation and wall stiffness. Systolic blood pressure at 1 month of age was higher in SHRs than in the Wistar group; it increased throughout the follow-up period and remained elevated with treatment (Wistar: 136 ± 2, SHR: 197 ± 6.8, SHR-Spiro: 207 ± 7.1 mmHg; p0.05). Spironolactone reduced cardiac hypertrophy (Wistar: 1.25 ± 0.03 SHR: 1.00 ± 0.03, SHR-Spiro: 0.86 ± 0.02 g; p0.05) and left ventricular mass normalized to body weight (Wistar: 2.51 ± 0.06, SHR: 2.70 ± 0.08, 2.53 ± 0.07 mg/g; p0.05). Moreover, the left ventricular wall stiffness that was higher in SHRs was partially reduced by spironolactone treatment (Wistar: 0.370 ± 0.032; SHR: 0.825 ± 0.058; SHR-Spiro: 0.650 ± 0.023 mmHg/ml; p0.05). Our results show that long-term spironolactone treatment initiated at the early stage of hypertension development reduces left ventricular hypertrophy and wall stiffness in SHRs.

OBJECTIVE: To evaluate the effect of spironolactone on ventricular stiffness in spontaneously hypertensive adult rats subjected to high salt intake. INTRODUCTION: High salt intake leads to cardiac hypertrophy, collagen accumulation and diastolic dysfunction. These effects are partially mediated by cardiac activation of the renin-angiotensin-aldosterone system. METHODS: Male spontaneously hypertensive rats (SHRs, 32 weeks) received drinking water (SHR), a 1% NaCl solution (SHR-Salt), or a 1% NaCl solution with a daily subcutaneous injection of spironolactone (80 mg.kg-1) (SHR-Salt-S). Age-matched normotensive Wistar rats were used as a control. Eight weeks later, the animals were anesthetized and catheterized to evaluate left ventricular and arterial blood pressure. After cardiac arrest, a double-lumen catheter was inserted into the left ventricle through the aorta to obtain in situ left ventricular pressure-volume curves. RESULTS: The blood pressures of all the SHR groups were similar to each other but were different from the normotensive controls (Wistar = 109±2; SHR = 118±2; SHR-Salt = 117±2; SHR-Salt-S = 116±2 mmHg; P

Our aim was to evaluate the effects of granulocyte colony-stimulating factor (G-CSF) on early cardiac arrhythmias after myocardial infarction (MI) and the impact on survival. Male Wistar rats received repeated doses of 50 μg/kg G-CSF (MI-GCSF group) or vehicle (MI group) at 7, 3, and 1 days before surgery. MI was induced by permanent occlusion of left coronary artery. The electrocardiogram was obtained before occlusion and then for 30 minutes after surgery. Events and duration of ventricular arrhythmias were analyzed. The levels of connexin43 (Cx43) were measured by Western blot immediately before MI production. Survival was significantly increased in MI-GCSF pretreated group (74% versus 52.9% MI, P < 0.05). G-CSF pretreatment also significantly reduced the ventricular premature beats when compared with the untreated-MI group (201 ± 47 versus 679 ± 117, P < 0.05). The number and the duration of ventricular tachycardia were smaller in the MI-G-CSF group, as well as the number of ventricular fibrillation episodes (10% versus 69% in MI, P < 0.05). Cx43 levels were significantly increased by G-CSF treatment (1.27 ± 0.13 versus 0.86 ± 0.11; P < 0.05). The MI size 24 hours after occlusion was reduced by G-CSF pretreatment (36 ± 3% versus 44 ± 2% of left ventricle in MI group; P < 0.05). The increase of Cx43 expression in the heart may explain the reduced incidence in ventricular arrhythmias in the early phases after coronary artery occlusion in rats, thus increasing survival after MI.

Background The growing epidemic of metabolic syndrome has been related to the increased use of fructose by the food industry. In fact, the use of fructose as an ingredient has increased in sweetened beverages, such as sodas and juices. We thus hypothesized that fructose intake by hypertensive rats would have a worse prognosis in developing metabolic disorder and non-alcoholic fatty liver disease. Methods Male Wistar and SHR rats aged 6 weeks were given water or fructose (10%) for 6 weeks. Blood glucose was measured every two weeks, and insulin and glucose sensitivity tests were assessed at the end of the follow-up. Systolic blood pressure was measure by plethysmography. Lean mass and abdominal fat mass were collected and weighed. Liver tissue was analyzed to determine interstitial fat deposition and fibrosis. Results Fasting glucose increased in animals that underwent a high fructose intake, independent of blood pressure levels. Also, insulin resistance was observed in normotensive and mostly in hypertensive rats after fructose intake. Fructose intake caused a 2.5-fold increase in triglycerides levels in both groups. Fructose intake did not change lean mass. However, we found that fructose intake significantly increased abdominal fat mass deposition in normotensive but not in hypertensive rats. Nevertheless, chronic fructose intake only increased fat deposition and fibrosis in the liver in hypertensive rats. Conclusions We demonstrated that, in normotensive and hypertensive rats, fructose intake increased triglycerides and abdominal fat deposition, and caused insulin resistance. However, hypertensive rats that underwent fructose intake also developed interstitial fat deposition and fibrosis in liver.

Scientists worldwide have disseminated the idea that increased dietary salt increases blood pressure. Currently, salt intake in the general population is ten times higher than that consumed in the past and at least two times higher than the current recommendation. Indeed, a salt-rich diet increases cardiovascular morbidity and mortality. For a long time, however, the deleterious effects associated with high salt consumption were only related to the effect of salt on blood pressure. Currently, several other effects have been reported. In some cases, the deleterious effects of high salt consumption are independently associated with other common risk factors. In this article, we gather data on the effects of increased salt intake on the cardiovascular system, from infancy to adulthood, to describe the route by which increased salt intake leads to cardiovascular diseases. We have reviewed the cellular and molecular mechanisms through which a high intake of salt acts on the cardiovascular system to lead to the progressive failure of a healthy heart.

BACKGROUND: Left atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. RESULTS: Mean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m2 (absent), 26 ± 7 mL/m2 (grade I), 33 ± 5 mL/m2 (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. CONCLUSION: DD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Because diabetes mellitus (DM) is a multifactorial metabolic disease, its prevention and treatment has been a constant challenge for basic and clinical investigators focused on translating their discoveries into clinical treatment of this complex disorder. In this review, we highlight recent experimental and clinical evidences of potential coadjuvants in the management of DM, such as polyphenols (quercetin, resveratrol and silymarin), cultured probiotic microorganisms and drugs acting through direct/indirect or pleiotropic effects on glycemic control in DM. Among several options, we highlight new promising therapeutic coadjuvants, including chemical scavengers, the probiotic kefir and the phosphodiesterase 5 inhibitors, which besides the reduction of hyperglycemia and ameliorate insulin resistance, they reduce oxidative stress and improve endothelial dysfunction in the systemic vascular circulation. In the near future, experimental studies are expected to clear the intracellular pathways involving coadjuvants. The design of clinical trials may also contribute to new strategies with coadjuvants against the harmful effects of diabetic complications.

According to hypertension guidelines, the recommended electrocardiographic (ECG) diagnostic criteria for left ventricular hypertrophy (LVH) are the Sokolow–Lyon and Cornel voltage criteria, both with general acceptance by primary care physicians. However, it was recently reported that the R-wave voltage in lead aVL (RaVL) was as good as other more complicated and time-consuming ECG criteria to detect LVH in hypertensive patients. Therefore, our aim was to investigate if the ability of the RaVL to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) could be translated to the general population, a more realistic assessment of its utility in a nonreferral setting. 682 participants (43.5 % males), aged between 27 and 72 years from the urban population of Vitoria, ES, Brazil, were enrolled. We investigated the association of ECHO-LVH (LV mass >51 g/Ht2.7) with several ECG voltage measurements: Sokolow–Lyon and Cornel criteria, S-wave voltage in lead V3 (SV3) and RaVL. The RaVL showed the best positive correlation with LV mass indexed to Ht2.7, superior to both Cornell and Sokolow–Lyon criteria and was not influenced by gender. Analysis of the ROC curves showed that the RaVL depicted a significant superior performance in relation to all the other measurements in the ability to detect ECHO-LVH. SV3 was not correlated with LV mass. Thus, it seems that most of Cornell’s performance depends on its simplified version, that is, RaVL. We have shown that the simple and single assessment of RaVL presented a greater diagnostic ability in detecting ECHO-LVH in the general population, signaling its value mainly as a screening tool.

The effect of a salt-based diet on the coronary responsiveness in aged hypertensive rats (SHR) still is unclear. We investigated the effects of high salt intake on the relaxation properties of coronary arteries of aged SHRs. Male SHR (32 week-old) received drinking water (SHR) or 1% NaCl solution (SHR-Salt) for 8 weeks. Isolated coronary segments were subjected to concentration–response curves to acetylcholine (ACh) in the presence or absence of L-NAME (100 μM), enalaprilate (10 μM), losartan (10 μM), and spironolactone (100 μM). Salt intake did not increase blood pressure in old SHRs, but caused ventricular hypertrophy. The endothelium-dependent relaxation in SHRs was lower than in Wistar rats. However, salt intake did not add further impairment. Both enalaprilate and losartan reduced the vasodilator response in coronary arteries from Wistar, but did not affect SHR-salt rats. Conversely, losartan attenuated the impaired ACh relaxation observed in SHR. Spironolactone reduced the relaxation induced by ACh in coronary arteries from Wistar rats but not in SHR. The renin–angiotensin–aldosterone system participates in the impaired coronary relaxation in aged SHR, but does not partake in this deleterious effect under increased salt intake, indicating that age could differentiate the effects of high sodium intake in coronary arteries of SHR.

Low-sodium and high-potassium diets have been recommended as an adjunct to prevention and treatment of hypertension. Analysis of these nutrients in 24-h urine has been considered the reference method to estimate daily intake of these minerals. However, 24-h urine collection is difficult in epidemiological studies, since urine must be collected and stored in job environments. Therefore, strategies for shorter durations of urine collection at home have been proposed. We have previously reported that collecting urine during a 12-h period (overnight) is more feasible and that creatinine clearance correlated strongly with that detected in 24-h samples. In the present study, we collected urine for 24 h divided into two 12-h periods (from 7:00 am to 7:00 pm and from 7:00 pm to 7:00 am next day). A sample of 109 apparently healthy volunteers aged 30 to 74 years of both genders working in a University institution was investigated. Subjects with previous myocardial infarction, stroke, renal insufficiency, and pregnant women were not included. Significant (P < 0.001) Spearman correlation coefficients (r s) were found between the total amount of sodium and potassium excreted in the urine collected at night and in the 24-h period (r s = 0.76 and 0.74, respectively). Additionally, the 12-h sodium and potassium excretions (means ± SD, 95% confidence interval) corresponded to 47.3 ± 11.2%, 95%CI = 45.3-49.3, and 39.3 ± 4.6%, 95%CI = 37.3-41.3, respectively, of the 24-h excretion of these ions. Therefore, these findings support the assumption that 12-h urine collected at night can be used as a reliable tool to estimate 24-h intake/excretion of sodium and potassium.