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Background: Previous evidence suggests that acute treatment with statins reduce atherosclerotic complications, including periprocedural myocardial infarction, but currently, there are no large, adequately powered studies to define the effects of early, high-dose statins in patients with acute coronary syndrome (ACS) and planned invasive management., Objectives: The main goal of Statins Evaluation in Coronary procedUres and REvascularization (SECURE-PCI) Trial is to determine whether the early use of a loading dose of 80 mg of atorvastatin before an intended percutaneous coronary intervention followed by an additional dose of 80 mg 24 hours after the procedure will be able to reduce the rates of major cardiovascular events at 30 days in patients with an ACS., Design: The SECURE-PCI study is a pragmatic, multicenter, double-blind, placebo-controlled randomized trial planned to enroll around 4,200 patients in 58 different sites in Brazil. The primary outcome is the rate of major cardiovascular events at 30 days defined as a composite of all-cause mortality, nonfatal acute myocardial infarction, nonfatal stroke, and coronary revascularization., Summary: The SECURE PCI is a large randomized trial testing a strategy of early, high-dose statin in patients with ACS and will provide important information about the acute treatment of this patient population., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: This study evaluated the utility and quality-of-life year measurements for patients with coronary artery disease who underwent any of 3 therapeutic strategies with a 5-year follow-up., Methods: Quality-of-life data were obtained from the Medicine, Angioplasty, or Surgery Study II trial. To obtain utilities, the 36-Item Short-Form questionnaire was converted to a 6-Dimensional Health State Classification System., Results: Of the 611 initial patients, 579 completed the questionnaire. In all, 188 patients received the surgical treatment-194 the percutaneous, and the remaining 197 the medical. The median utility scores for the 5 years analyzed were 0.809 (95% confidence interval [CI] 0.794-0.842) for patients assigned to percutaneous coronary intervention, 0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI 0.761-0.809) for coronary artery bypass graft surgery. The difference between percutaneous coronary intervention and medical treatment was statistically significant (P < .05, Dunn test). The median cumulative quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936) for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95% CI 3.638-3.890) for surgery. Additionally, the median quality-of-life years between percutaneous and medical treatment was 0.262 (95% CI 0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI 0.036-0.413), and between surgery and percutaneous coronary intervention it was -0.038 (95% CI -0.221 to -0.146)., Conclusion: Coronary artery bypass surgery and percutaneous coronary intervention were similar regarding cumulative quality-of-life years; however, they were both superior to that of medical treatment. The results presented are valuable data for further cost-utility studies., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial., Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective., Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40 mg), intermediate dose; and above 40% (atorvastatin 20-80 mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied., Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios., Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

The aim of this study was to evaluate the cost-effectiveness of an organized breast cancer mammographic screening program implemented in Porto Alegre (Núcleo Mama Porto Alegre - NMPOA), Rio Grande do Sul State, Brazil. A Markov model was constructed to estimate the incremental cost-effectiveness ratio of NMPOA compared to current BC diagnosis and care in the Brazilian public health system, in a hypothetical cohort of women aged 40-69 years at risk of developing breast cancer. Model parameters were collected from NMPOA and the national literature. In the NMPOA strategy, effectiveness was modeled taking into account the actual observed screening adherence. Effectiveness was measured in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio in the base case was R$ 13,426 per QALY. This result was not sensitive to variation in the main model parameters in sensitivity analyses. Considering the threshold usually suggested as highly attractive in Brazil, breast cancer screening as performed in NMPOA is cost-effective in cities with high incidence of breast cancer.

The objective of this study was to provide normative SF-36 scores in a general population sample in Brazil and to describe differences in mean scores according to socio-demographic characteristics. The SF-36 questionnaire was distributed to a randomly selected sample of the general population of Porto Alegre in the State of Rio Grande do Sul. The response rate was 68% and 755 subjects were included (38% male, 62% female). Lower health status was revealed among females in the 30 to 44 year age bracket, from the lower income class, with less education and self-reported chronic medical conditions. The results and percentiles of scores of the SF-36 are reported as normative data for the general population. The SF-36 was an acceptable and practical instrument for measuring health-related quality of life in a sample of Brazilians. The results of this study can be useful for researchers using the SF-36 questionnaire in other groups to compare the scores with normative data. The SF-36 may prove a valuable tool for discovering vulnerable groups in epidemiological studies due to the ability to discriminate between different population subgroups.

Background: The benefit of statins in the reduction of cardiovascular events was demonstrated in several placebo-controlled trials. More intensive therapy seems to be associated with greater benefit. Our objective was to compare different statin doses in the reduction of cardiovascular events and deaths, combining direct and indirect evidence, through mixed treatment comparisons (MTC)., Methods: We conducted a systematic review in MEDLINE and Cochrane CENTRAL. A random-effects Bayesian MTC model was used to combine placebo-controlled and direct statin comparison trials. Intensity of statin doses was classified according to expected LDL-cholesterol reduction effect: ≤30% as low; 30-40%, intermediate, and ≥40%, high. Outcomes evaluated were non-fatal myocardial infarction (MI), stroke, coronary revascularization and coronary, cardiovascular and all-cause death. Inconsistency was assessed with split-node methodology., Results: 47 trials (11 with direct statin comparisons) were included. High doses reduced non-fatal MI by 28% (95% CI: 18%-36%) and by 14% (7%-21%) when compared to low and intermediate doses, respectively. High doses also diminished revascularization [RR versus low and intermediate doses of 0.81 (0.69-0.95) and 0.88 (0.77-0.99), respectively] and stroke [RR of 0.83 (0.68-0.99) against low doses]. Regimen intensity did not change death rates (e.g., for all-cause mortality, RRs of 0.93 (0.80-1.06) and 0.98 (0.87-1.08) for high vs. low and intermediate doses, respectively). No statistical inconsistencies were found in the analyses., Conclusions: In this study, in which all available evidence from statin trials was simultaneously analyzed, the benefit of more intensive therapy was restricted to non-fatal events., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To assess quality-of-life outcomes in patients undergoing nasal tip surgery with the vertical dome division technique using validated instruments (Rhinoplasty Outcome Evaluation [ROE] and Nasal Obstruction Symptom Evaluation [NOSE])., Study Design: Case series with planned data collection., Setting: Tertiary university center., Subject and Methods: Patients undergoing primary cosmetic and functional rhinoseptoplasty using vertical dome division were consecutively evaluated. The ROE, NOSE, and 100-mm visual analog scale (VAS) were administered pre- and postoperatively., Results: Forty-four patients were included and completed pre- and postoperative questionnaires. Their median age was 28 years, 27 (61%) were female, and the median duration of follow-up was 5 months (range, 3-9 months). Median postoperative ROE, NOSE, and VAS scores (79 [66; 87], 20 [15; 23], and 88 [61; 97], respectively) showed significant improvement compared with preoperative scores (29 [16; 41], 75 [60; 95], and 65 [46; 82], respectively; P < .001). The change in median ROE score was significantly greater in normal- and thin-skinned patients than in thick-skinned patients (54 vs 33; P = .033). Median changes in NOSE-p (-48.5 vs -68.0; P = .10) and VAS (69.0 vs 48.0; P =.083) scores did not differ between normal-/thin- and thick-skinned patients., Conclusion: Vertical dome division is a versatile technique for nasal tip refinement that resulted in significant improvement in quality-of-life outcomes related to rhinoplasty and nasal obstruction, as well as satisfaction with nasal appearance in a short-term follow-up period. The vertical dome division technique does not seem to be indicated only in patients with thick skin.

Budget impact analysis (BIA) provides operational financial forecasts to implement new technologies in healthcare systems. There were no previous specific recommendations to conduct such analyses in Brazil. This paper reviews BIA methods for health technologies and proposes BIA guidelines for the public and private Brazilian healthcare system. The following recommendations were made: adopt the budget administrator's perspective; use a timeframe of 1 to 5 years; compare reference and alternative scenarios; consider the technology's rate of incorporation; estimate the target population by either an epidemiological approach or measured demand; consider restrictions on technologies' indication or factors that increase the demand for them; consider direct and averted costs; do not adjust for inflation or discounts; preferably, integrate information on a spreadsheet; calculate the incremental budget impact between scenarios; and summarize information in a budget impact report.

Background: The recent publication of the MADIT-CRT and RAFT trials has more than doubled the number of patients in which a direct comparison of the combination of cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) versus ICD alone was carried out. The present meta-analysis aims to assess the impact of combined CRT and ICD therapy on survival of heart failure (HF) patients., Methods and Results: Medline, Embase, and the Cochrane Library databases were searched, and all randomized controlled trials of CRT alone or combined with ICDs in HF resulting from left ventricular systolic dysfunction were included. Main outcome was all-cause mortality. Summary relative risk (RR) and 95% confidence interval (CI) were calculated employing random-effects models. Twelve studies were included, with a total of 8,284 randomized patients. For the comparison of CRT alone versus medical therapy, pooled analysis of 5 available trials demonstrated a significant reduction in all-cause mortality with CRT (RR 0.76, 95% CI: 0.64-0.9). Pooled analysis of 6 trials that compared the combination of CRT and ICD therapy to ICD alone also showed a statistically significant reduction in all-cause mortality (RR 0.83, 95% CI: 0.72-0.96). Stratified analysis showed significant mortality reductions in all New York Heart Association class subgroups, with greater effect in classes III-IV (RR 0.70; 95% CI: 0.57-0.88). Pooled estimates of implant-related risks were 0.6% for death and 8% for implant failure., Conclusion: Combined CRT and ICD therapy reduces overall mortality in HF patients when compared with ICD alone., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: among patients undergoing noncardiac surgery, our objectives were to: (1) determine the feasibility of undertaking a large international cohort study; (2) estimate the current incidence of major perioperative vascular events; (3) compare the observed event rates to the expected event rates according to the Revised Cardiac Risk Index (RCRI); and (4) provide an estimate of the proportion of myocardial infarctions without ischemic symptoms that may go undetected without perioperative troponin monitoring., Design: An international prospective cohort pilot study., Participants: Patients undergoing noncardiac surgery who were >45 years of age, receiving a general or regional anesthetic, and requiring hospital admission., Measurements: Patients had a Roche fourth-generation Elecsys troponin T measurement collected 6 to 12 hours postoperatively and on the first, second, and third days after surgery. Our primary outcome was major vascular events (a composite of vascular death [i.e., death from vascular causes], nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke) at 30 days after surgery. Our definition for perioperative myocardial infarction included: (1) an elevated troponin T measurement with at least one of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic electrocardiogram changes, coronary artery intervention, or cardiac imaging evidence of myocardial infarction; or (2) autopsy findings of acute or healing myocardial infarction., Results: We recruited 432 patients across 5 hospitals in Canada, China, Italy, Colombia, and Brazil. During the first 30 days after surgery, 6.3% (99% confidence interval 3.9-10.0) of the patients suffered a major vascular event (10 vascular deaths, 16 nonfatal myocardial infarctions, and 1 nonfatal stroke). The observed event rate was increased 6-fold compared with the event rate expected from the RCRI. Of the 18 patients who suffered a myocardial infarction, 12 (66.7%) had no ischemic symptoms to suggest myocardial infarction., Conclusions: This study suggests that major perioperative vascular events are common, that the RCRI underestimates risk, and that monitoring troponins after surgery can assist physicians to avoid missing myocardial infarction. These results underscore the need for a large international prospective cohort study.

Background: Myeloperoxidase (MPO) levels have prognostic value in cardiovascular events, but information about preanalytical variables is scarce. This study evaluated the effect of different sample types and storage conditions on MPO measurements., Methods: Plasma and serum samples [heparinized plasma (MPO-Hep), EDTA plasma (MPO-EDTA), and serum with (MPO-Gel) and without separator gel (MPO-Serum)] from 40 volunteers were assayed for MPO by ELISA (Bioxytech MPO-EIAkit). To evaluate MPO stability, samples were stored at 18-25 °C, at 2-8 °C and at -20 °C and -80 °C for predetermined periods., Results: MPO levels ranged from 16 to 69 ng/ml and were higher in patients with heart disease compared to healthy volunteers (35.0 vs. 24.9 ng/ml; P=0.03). There were no statistical differences between MPO-Hep, MPO-Gel and MPO-Serum (P>0.05), and MPO-Hep showed a good correlation with MPO-Gel and MPO-Serum (r=0.775 and r=0.792; P<0.001). No correlation between MPO-Hep and MPO-EDTA was found (r=0.21; P=0.20), and mean MPO-EDTA value was 1.8 times higher than MPO-Hep (51.4 vs. 28.7 ng/ml; P<0.001). Mean differences (ng/ml) between MPO-Hep and MPO-EDTA, MPO-Gel and MPO-Serum were 24.7 (19.5-30.0), 0.225 (-2.54-2.99), and 1.55 (-1.16-4.26), respectively., Conclusions: EDTA had a significant effect on MPO results. MPO-Hep values correlate well with MPO-Gel and MPO-Serum. MPO levels seem to be stably frozen at -20 °C or -80 °C over 6 months depending on preanalytical handling., (2010 Elsevier B.V. All rights reserved.)

Background: Depressive symptoms are associated with impaired quality of life (QOL). However, there are scarce data comparing the magnitude of depression on QOL among persons with different chronic diseases in developing countries. This study aimed to evaluate the impact of depression on QOL in patients with ischemic heart disease (IHD) and end-stage renal disease (ESRD) in hemodialysis., Methods: Cross-sectional survey conducted in 173 patients: 103 with IHD and 70 in hemodialysis. Depression was diagnosed by the Mini International Neuropsychiatric Interview-5.0 and depressive symptoms measured by Beck Depression Inventory. QOL was assessed through the Short-Form-36 (SF-36) and World Health Organization Quality of Life Instrument-brief (WHOQOL-brief). Multivariate analyses were performed to assess the association between variables and QOL., Results: Depression prevalence was 14.3% among IHD patients and 9.9% in the hemodialysis group, and depressive symptoms were present in 39 and 36%, respectively. Regardless of the chronic condition, depressed patients presented lower QOL scores than non-depressed ones in all domains, and the most affected were role emotional, mental health and social functioning of SF-36, and psychological domain of WHOQOL-brief. In linear regression analysis, depressive symptoms were predictive for lower QOL in all domains, with the highest standardized beta coefficients (ranging from -0.26 to -0.64)., Conclusion: Depression is an independent factor associated with worse QOL in IHD and ESRD patients. Among the priorities aiming at improving QOL must be evaluation and management of depressive symptoms.

Background: Many randomized clinical trials have demonstrated the effectiveness of the implantable cardioverter-defibrillator (ICDs) in death reduction of chronic heart failure (CHF) patients. Some developed countries studies have evaluated its cost-effectiveness, but these data are not applicable to Brazil., Objective: To evaluate the cost-effectiveness of ICD in CHF patients under two perspectives in Brazil: public and supplementary health systems., Methods: A Markov model was developed to analyze the incremental cost-effectiveness ratio (ICER) of ICD compared to conventional therapy in patients with CHF. Effectiveness was measured in quality-adjusted life years (QALYs). We searched the literature for data regarding effectiveness and complications. Costs were retrieved from public and health insurances reimbursement codebooks and from mean cost of admissions from a public and a private hospital. One-way sensitivity analysis was performed in all variables of the model., Results: ICER was R$ 68,318/QALY in the public and R$ 90,942/QALY in the private perspective. These values are much higher than the one suggested by the World Health Organization of 3 times the gross domestic product per head (R$ 40,545 in Brazil). The results were sensitive to the cost of the device, battery replacement interval and ICD effectiveness. In a simulation resembling MADIT-I population survival and ICD benefit, ICER was R$ R$ 23,739/QALY in the public and R$ 33,592/QALY in the private perspective., Conclusion: The ICER of ICD is elevated in the general ICC population, in either the public or private perspective. A more favorable result occurs in patients with a high sudden death risk.

Background: Congestive heart failure (CHF) is a rather prevalent condition with a high mortality rate. Levosimendan is one among the new drugs that have been tested for its management., Objective: To undertake a systematic review and meta-analysis of the morbidity and mortality reduction associated with levosimendan in the treatment of CHF., Methods: A bibliographic search was conducted in the Medline database for all randomized controlled trials (RCTs) that assessed the use of levosimendan in CHF. The outcomes were death from all causes, length of hospital stay, and hospital readmission for CHF. All RCTs with outcomes of interest were included. Methodological quality criteria, such as blinding and confidentiality of the list of allocation, were evaluated in sensitivity analysis. The main calculation was done with random effects., Results: Of the 179 articles identified, 48 were RCTs, 19 of them with outcomes of interest. In the comparison with placebo (7 trials, 1,652 patients), the relative risk (RR) for overall death was 0.87 (95% confidence interval [CI]: 0.65 to 1.18). In comparison with dobutamine (10 trials, 2,067 patients), the RR was 0.87 (95% CI: 0.75-1.02). Three studies had data on length of stay, in which levosimendan showed a decrease of 2.27 and 2.30 days compared to placebo and dobutamine, respectively (p < 0.05 for both). No article presented data on readmission alone., Conclusion: The evidence available so far has shown no benefit in terms of mortality in association with the use of levosimendan, which only showed a small benefit in the time of hospitalization.

Myeloperoxidase (MPO) is an enzyme derived of leukocytes that catalyze formation of numerous reactive oxidant species. Besides members of the innate host defense, evidences have been proving the contribution of these oxidants to tissue injury during inflammation. MPO participates in proatherogenic biological activities related to the evolution of cardiovascular disease, including initiation, propagation and acute complications of atherosclerotic process. Thereby, MPO and its inflammatory cascade represents an attractive target for prognostical investigation and therapeutics in atherosclerotic cardiovascular disease. In this review, we present the state of the art in the understanding of biological actions to clinical evidences of the relationship between MPO and coronary arterial disease. Several studies point to the independent effect of MPO levels in the evolution of disease and incidence of events in patients with acute coronary syndrome. However, the additional predictive value of MPO levels in the cardiovascular risk assessment, to incorporate it to the clinical practice as marker of plaque vulnerability, is still not consistent. Additional studies are necessary to confirm its role in the different forms of presentation of ischemic disease, besides the standardization of the assay, fundamental point for transition of this marker from research atmosphere to use in clinical routine: : from laboratory to clinical practice.

The present study evaluated the dental care plan offered to 4,000 employees of a private hospital and their respective families. The analysis covered three stages: (1) baseline (control), when dental care was provided by an outsourced company with a network of dentists paid for services, (2) a renegotiation of costs with the original dental care provider, and (3) provision of dental care by the hospital itself, through directly hired dentists on regular salaries. Monthly economic and clinical data were collected for this research. The dental plan renegotiation reduced costs by 37% in relation to baseline, and the hospital's own dental service reduced costs by 50%. Renegotiation led to a 31% reduction in clinical procedures, without altering the dental care profile; the hospital's own dental service did not reduce the total number of clinical procedures, but modified the profile of dental care, since procedures related to the causes of diseases increased and surgical/restorative procedures decreased.

Objectives: To compare the cost-effectiveness ratios of sirolimus-eluting stents (SES) with bare-metal stents (BMS) under two perspectives: the "supplementary medical system" (health plans and private patients) and the public health (SUS) system., Methods: A decision-analytic model using three different therapeutic strategies for coronary lesions: percutaneous coronary intervention (PCI) with BMS; with SES; or with BMS followed by SES to treat symptomatic restenosis. Study endpoints were one-year event-free survival and life expectancy. Decision trees were constructed using the results of published registries and clinical trials., Results: One-year restenosis-free survival was 92.7% with SES and 78.8% with BMS. Estimated life expectancy was very similar for all the strategies, ranging from 18.5 to 19 years. Under a nonpublic perspective, the cost difference in the first year between BMS and SES was R$3,816, with an incremental cost-effectiveness ratio of R$27,403 per event avoided in one year. Under the SUS perspective, the cost per event avoided in one year was R$47,529. In the sensitivity analysis, probability of restenosis, risk reduction expected with SES, the price of the stent and cost of treating restenosis were all important predictors. In the Monte Carlo simulation, data per years of life saved showed very high cost-effectiveness ratios., Conclusion: In the Brazilian model, the cost-effectiveness ratios for SES were elevated. The use of SES was more favorable for patients with high risk of restenosis, as it is associated with elevated costs in restenosis management of and under a nonpublic perspective.

Diabetes mellitus is a condition associated with cardiac complications, especially artherothrombotic disease. Several studies have demonstrated the importance of reducing cardiovascular burden on this population by adopting prevention strategies. This article revised clinical evidences on cardiovascular risk assessment and prevention actions, taking into consideration major recommendations in the field. Life-style changes with low-carbohydrate diet, weight control, and regular physical activity must be implemented. High-risk patients or with established cardiovascular disease ought to have glycemic levels<100 mg/dL and A1c<7%. It is recommended low dose of aspirin and statin for lipid management, targeting LDL<100 mg/dL, HDL>50 mg/dL and tryglycerides<150 mg/dL. Blood pressure control with non-pharmacological and antihypertensive drugs must be instituted, favoring ACE inhibitors as first option, mainly in patients with renal disease, and combined with tiazydes for the majority to achieve target blood pressure of <130/80 mmHg.

Background: Economic analyses of agents used in the treatment of AIDS and opportunistic diseases are particularly important in developing countries., Purpose: To analyze the cost-effectiveness of AIDS-related Kaposi's sarcoma (AIDS-KS) chemotherapy regimens in Brazil., Method: A decision-analysis model was developed, and effectiveness data were derived from randomized phase III trials evaluating pegylated liposomal doxorubicin (PLD), liposomal daunorubicin (DNX), and the ABV regimen (doxorubicin, bleomycin, and vincristine). Resource data on direct medical costs were obtained from local sources., Results: The cost-effectiveness estimates (defined as average costs per patient who responds completely or partially) favored PLD (US $10,272/responder) in comparison to DNX (US $16,263/responder). Regarding cost-effectiveness, the ABV regimen that is widely used in developing countries had better results when compared to both PLD (US $1,268 vs. US $10,271) and DNX (US $1,268 vs. US $16,260). The incremental cost per additional responder of using PLD instead of ABV was US $20,990. Sensitivity analyses suggest that these results hold over a wide range of assumptions., Conclusion: ABV seems to be the most reasonable treatment option for AIDS-KS patients in resource-limited countries like Brazil.

Objective: To compare the management of patients with ischemic heart disease being followed up in a general cardiology outpatient clinic with that of patients being followed up in an outpatient clinic specific for ischemic heart disease, emphasizing the lipid profile and the pharmacological treatment prescribed., Methods: Data were collected from the medical records of 52 patients consecutively treated in the outpatient clinic for ischemic heart disease (group I) and of 43 patients treated in the general cardiology outpatient clinic (group II), the anatomical diagnosis of ischemic heart disease being the basic condition for their inclusion in the study. The criteria for dyslipidemia were as follows: total cholesterol > or = 200 mg/dL or LDL-cholesterol > 100 mg/dL, or both, in patients using or not lipid-lowering drugs, and the use of lipid-lowering drugs, even when the total cholesterol or LDL-cholesterol levels were < 200 mg/dL and 100 mg/dL, respectively, or both. The Fisher exact test was used for comparing the variables, and a 2-tailed p < 0.05 was accepted as significant., Results: Demographic characteristics, risk factors for ischemic heart disease, prevalence of previous myocardial infarction, and previous revascularization procedures showed no significant differences between the patients in groups I and II. In group I, 98% of the patients received aspirin, while, in group II, 83% of the patients received that drug (p = 0.02). In regard to the use of lipid-lowering drugs, the prevalences were 60% in group I and 19% in group II (p = 0.001). The lipid profile examination was requested for 98% of group I individuals and 79% of group II individuals (p = 0.003)., Conclusion: In regard to new medical evidence, mainly prescription of aspirin and lipid-lowering drugs, the management was more reliable in the outpatient clinic specifically aimed at treating ischemic heart disease.