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3. Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE): A Prospective Cohort Study

Author

Yusuf, S., Rangarajan, S., Teo, K.K., Anand, S.S., Chow, C.K., O’Donnell, M., Smith, E., Mente, A., Leong, D., Smyth, A., Joseph, P., Duong, M., Khetan, A., Klimis, H., D’Souza, R., Miller, V., Walli-Attaei, M., Islam, S., Ramasundarahettige, C., Bangdiwala, S., Balasubramanian, K., Wong, G., Jeyachandradhas, N., Yang, X., Tang, C., Farago, L., Zarate, M., Godreault, J., Haskins, M., Jethva, M., Nguyen-Quang, D., Pineau, A., Rigitano, G., Vaghela, A., Dehghan, M., Aliberti, A., Zaki, A., Connolly, B., Agapay, D., Krol, D., Shifaly, F., Rimac, J., Di Marino, M., Jakymyshyn, M., Mushtaha, M., Kandy, N., Solano, R., Gopal, S., Ramacham, S., Shimizu, N., Tongana, T., Pare, G., McQueen, M., Bryce, T., Ditta, R., Wang, X., Dias, M., Diaz, Rafael, Orlandini, Andres D., Lamelas, Pablo, Diaz, Maria L., Pascual, Andrea L., Salvador, Mauricio, Chacon, Carolina, Dominguez, Juan M., Rahman, Mohammad O., Yusuf, Rita, Ahmed, Syed AKS., Khan, Afreen Z., Nayeem, Nazratun, Mitra, S.N., Islam, Shahidul, Pasha, Fuad, Avezum, A., Neves, P., Nunes, R., Triboni, A.H.K., Santos, L.O., Sousa, E.R.P., Silva, L.F.A., Oliveira, Gustavo BF., Teo, Hamilton- Koon, Solano, Roxanna, Donst, Aaron, Jacob, Alshey, Lim, Gene, Bideri, Belise, Connolly, Ben, Buthool, Rizwana, Trottier, Sandy, Piché, Marie-Ève, Poirier, Paul, Turbide, Ginette, Bourlaud, Anne Sophie, Auclair, Audrey, Pettigrew, Myriam, Lear, Scott A., Nocos, Rochelle A., Li, Sydney K., Wielgosz, Andreas, Coutinho, Thais, Suarez, Karen N., Abbott-Tate, Sam J., Lanas, Fernando, Serón, Pamela, Oliveros, María J., Cazor, Fairuz, Palacios, Yazmin, Hidalgo, Jessica, Acosta, Camilo, Lisheng, Liu, Wei, Li, Bo, Hu, Lu, Yin, Jun, Zhu, Yan, Liang, Yi, Sun, Yang, Wang, Qing, Deng, Xingyu, Wang, Xiaoru, Cheng, Chuangshi, Wang, Sidong, Li, Weida, Liu, Xinyue, Lang, Zhiguang, Liu, Shelly, LA Tse, Guoliang, Han, Fanghong, Lu, Yan, Hou, Xiaoyang, Liao, Di, Chen, Peng, Zhang, Ning, Li, Rensheng, Lei, Minfan, Fu, Yu, Liu, Xiaojie, Xing, Youzhu, Yang, Quanyong, Xiang, Jinhua, Tang, Zhengrong, Liu, Deren, Qiang, Aiying, Han, Jinkui, Yang, Xinbin, Wu, Chunmei, Liu, Guomin, He, Qian, Zhao, Aobulikasimu, Resalaiti, Hui, Wang, Yahong, Zhi, Yali, Wang, Haibin, Ma, Yuanting, Ma, Lihua, Hu, Li, Zhang, Guoqing, Liu, Junying, Wang, Hui, Jin, Kai, You, Tao, Peng, Jing, Su, Yingxin, Zhao, Lopez-Jaramillo, Patricio, Camacho, Paul Anthony, Perez-Mayorga, Maritza, Otero-Wandurraga, Johanna, Cure-Cure, Carlos, Accini, Jose Luis, Arcos, Edgar, Narvaez, Caludia, Sotomayoy, Aristides, Garcia, Henry, Sanchez-Vallejo, Gregorio, Cotes, Fresia, Jopez-Lopez, Jose Patricio, Espinosa, Darly, Muñoz, Maria Angelica, Bello, Olga Lucia, Chacon-Manosalva, Maria L., Vasquez-Arcila, Julieth Tatiana, Mony, Prem K., Vaz, Mario, Swaminathan, Sumathi, Bharathi, Ankalmadagu V., Shankar, Kiruba, Kurpad, Anura V., Jayachitra, Krishnaswamy G., Anthony, Raju, Murali, Karamala, Balaji, Chengi, Amaranadh, Krishnappa, Vijayalakshmi, Ponnuswamy, Monisha, Siddaraju, Harshitha, Siddayana S., Kiruba, Subramani, Sandhya, Sirana, Wooha, Mittoor, Kumar, Nitesh, Mohan, Viswanathan, Anjana, Ranjit Mohan, Deepa, Mohan, Parthiban, Kumar, Dhanasekaran, Lakshmanan, Sureshkumar, Sundaram, Nandhakumar, Manivel, Kumar, Munusamy, Kalaivani, Doss, Karthick, Elumalai, Ajith, Narendra Sai, Gupta, Rajeev, Mohan, Indu, Bhargava, Rooma, Sharma, Madhusudan, Sharma, Devendra, Velappallil, Raman Kutty, Krishnapillai, Vijayakumar, Nair, Sanjeev, Rammohan, Kamala, Sarojini, Manu Muraleedharan, Rajappan Nair, Arunlal Anitha, Veena, Veena, Santhakumari, Divya, Kamalam, Sucharitha, Sreerangan, Jith, Kumar, Rajesh, Kaur, Manmeet, Maha Lakshmi, Pinnaka Venkata, Sagar, Vivek, Mahajan, Rupali, Singh, Rupinder, Singh, Kamaljeet, Sharma, Kamaldev, Chauhan, Babita, Singh, Kamaldeep, Kelishadi, Roya, Bahonar, Ahmad, Mohammadifard, Noushin, Heidari, Hossein, Davletov, Kairat, Assembekov, Batyrbek, Amirov, Bauyrzhan, Mirrakhimov, Erkin, Abilova, Saamay, Zakirov, Umid, Toktomamatov, Ulan, Bektasheva, Erkaiym, Asanbaev, Azamat, Asanaliev, Nursultan, Mamat uulu, Rysbek, Yusoff, Khalid, Tengku Ismail, Tengku Saifuddin, Ng, Kien Keat, Devi, Ambigga Devi, Mat-Nasir, Nafiza, Ramli, Anis Safura, Nor-Ashikin, Norashikin Mohamed, Dasiman, Razif, Mazapuspavina, Yasin Md, Ariffin, Farnaza, Miskan, Maizatullifah, Abdul-Hamid, Hasidah, Abdul-Razak, Suraya, Nik Mohd-Nasir, Nik Munirah, Badlishah-Sham, Siti Fatimah, Mohamed-Yassin, Mohamed Syarif, Majid, Fadhlina, Bakar, Najmin Abu, Zainon, Nurhaliza, Salleh, Rasyidah, Ghazali, Nurshamin Mohd, Baharom, Mardhiah, Zulkifli, Hazimah, Razali, Rafezah, Ali, Sarina, Hoh, Boon Peng, Ismail, Noorhassim, Jaafar, Mohd Hasni, Tamil, Azmi Mohd, Isa, Zaleha Md, Ismail, Rosnah, Yusof, Khairul Hazdi, Saian, Noraidah, Jusoh, Nurul Afifah, Mohamed, Nur Nadia, Fauzi, Farah Adilla, Fauzi Siti Norzulikha Rahim, Fatin Azierah, Khatib, Rasha, Khammash, Umaiyeh, Giacaman, Rita, Iqbal, Romaina, Khawaja, Rehman, Kazmi, Khawar, Ali, Shehzad, Asim, Muhammad, Jumma, Mohan, Bachal, Sana, Sharif, Hina, Almas, Nighat, Miranda, Jaime, Ortiz, Antonio Bernabe, Checkley, William, Málaga, Germán, Gilman, Robert H., Carrillo-Larco, Rodrigo M., Lazo-Porras, María, Palileo-Villanueva, Lia M., Dans, Antonio L., Abat, Marc Evans M., Pudol, Louie P., Pudol, Chareece Z., Segarra, Madenn S., Romero, Mary Joy S., Abaquin, Charlene C., Manguiat, Kristaleen Mae, Malayang, Mary Stephanie, Szuba, Andrzej, Zatonska, Katarzyna, Basiak-Rasała, Alicja, Poltyn -Zaradna, Katarzyna, Wolyniec, Maria, Barbarash, Olga L., Artamonova, Galina V., Indukaeva, Elena V., Bazdyrev, Evgeny D., Polikutina, Olga M., Gruzdeva, Olga V., Tsygankova, Daria P., Vinichenko, Tamara A., Nachratova, Olga V., Agienko, Alyena S., Shot, Yulia S., AlHabib, K.F., Alshamiri, M.Q., Altaradi, H.B., Abdulrahman, M., Nouri, R., Kruger, Iolanthé M., Schutte, Aletta E., Wentzel-Viljoen, Edelweiss, Puoane, Thandi, Swart, Rina, Igumbor, Ehimario, Tsolekile, Lungiswa P., Peer, Nasheeta, Egbujie, Bonaventure A., Rosengren, A., Gustavsson, A., Andreasson, M., Johansson, J Kembro, Segerqvist, I., Lindgren, M., Yeates, Karen, Munishi, Oresto, West, Nicola, Nyakunga, Gissela, Oguz, Aytekin, Imeryuz, Nese, Altuntas, Yuksel, Temizhan, Ahmet, Karsidag, Kubilay, Calik, Burcu T., Akalin, Arzu K., Caklili, Ozge T., Keskinler, Mirac V., Guler, Kubra Yildiz, Yusufali, Afzalhussein M., Abdelmotagali, Madiha H.S., Youssef, Douaa F., Ahmad, Olfat Z.S., Ahmed, Suad H., AlOmairi, Maryam A., Khansaheb, Hamda H., Sharief, Wadeia M., Taryam, Manal O., Zidan, Marwan, El-Sayed, Eman F., Awadalla, Mai H., Hassan, Magdy M., Saleh, Nadia, Qurechi, Zahid N., Abu Kaf, Raed M., Ithappiri, Jessy P., Govindashettigar, Savithri, Adele, Lourdu J., Chifamba, Jephat, Ncube, Tatenda, Ncube, Brian, Chimhete, Casper, Manenji, Tavengwa, Gwaunza, Lennon, Joseph, Philip, Avezum, Álvaro, Ramasundarahettige, Chinthanie, Diaz, Maria Luz, Yusufali, Afzal Hussein, Gulec, Sadi, Krishnapillai, Ambigga, Rangarajan, Sumathy, and Yusuf, Salim

Published
2025
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4. Predictors of bleeding and thrombotic events among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomized clinical trial

Author

de Barros e Silva, Pedro Gabriel Melo, Furtado, Remo H. M., de Alcântara Chaud, Mariana Silveira, Macedo, Ariane Vieira Scarlatelli, Bronhara, Bruna, Damiani, Lucas Petri, Barbosa, Lilian Mazza, Suiama, Mayra Akimi, Ramacciotti, Eduardo, de Aquino Martins, Priscilla, de Oliveira, Aryadne Lyrio, Nunes, Vinicius Santana, Ritt, Luiz Eduardo Fonteles, Rocha, Ana Thereza, Tramujas, Lucas, Santos, Sueli V., Diaz, Dario Rafael Abregu, Viana, Lorena Souza, Melro, Lívia Maria Garcia, Figueiredo, Estêvão Lanna, Neuenschwander, Fernando Carvalho, Dracoulakis, Marianna Deway Andrade, Lima, Rodolfo Godinho Souza Dourado, de Souza Dantas, Vicente Cés, Fernandes, Anne Cristine Silva, Gebara, Otávio Celso Eluf, Hernandes, Mauro Esteves, Queiroz, Diego Aparecido Rios, Veiga, Viviane C., Canesin, Manoel Fernandes, de Faria, Leonardo Meira, Feitosa-Filho, Gilson Soares, Gazzana, Marcelo Basso, Liporace, Idelzuíta Leandro, de Oliveira Twardowsky, Aline, Maia, Lilia Nigro, Machado, Flávia Ribeiro, de Matos Soeiro, Alexandre, Conceição-Souza, Germano Emílio, Armaganijan, Luciana, Guimarães, Patrícia O., Rosa, Regis G., Azevedo, Luciano C. P., Alexander, John H., Avezum, Alvaro, Berwanger, Otávio, Cavalcanti, Alexandre B., and Lopes, Renato D.

Published
2024
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5. Association between low-density lipoprotein cholesterol levels and all-cause mortality in patients with coronary artery disease: a real-world analysis using data from an international network

Author

Thiago Luis Scudeler, Leandro Menezes Alves da Costa, Rafael Amorim Belo Nunes, Rafael Otto Schneidewind, Thiago Midlej Brito, Daniel Castanho Genta Pereira, Roger Pereira de Oliveira, Gabriela Chaves Santana, Helio Castello, Marcelo José de Carvalho Cantarelli, and Álvaro Avezum Junior

Subjects
Medicine, Science
Abstract

Abstract The current cholesterol guidelines recommend maintaining low levels of low-density lipoprotein cholesterol (LDL-C) in patients with coronary artery disease (CAD). However, recent studies have suggested that both very low and very high LDL-C levels may be associated with increased mortality in the general population. We utilized data from TriNetX, a global health research network, to investigate the association between LDL-C levels and all-cause mortality in patients with CAD. CAD patients were identified using the International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code and stratified into six LDL-C categories:

Published
2024
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6. Situational analysis of hypertension management at primary health care level in São Paulo, Brazil: population, healthcare professional and health system perspectives

Author

Palmeirim, Marta S., Baxter, Yara C., Silveira, Mariana, Maggion, Rafael V., Aquino, Beatriz, Avezum, Álvaro, Saric, Jasmina, Morgan, Louise, Drager, Luciano F., Bortolotto, Luiz A., Rollemberg, Suely Miya S., de Lima, Marcia M. C., Albuquerque, Edmir P. R., Jones, Olivia, Steinmann, Peter, Reiker, Theresa, and Boch, Johannes

Published
2024
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7. Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context

Author

Gustavo Bernardes de Figueiredo Oliveira, Rafael Amorim Belo Nunes, Lucas Bassolli de Oliveira Alves, Precil Diego Miranda de Menezes Neves, Victor Augusto Hamamoto Sato, Ana Heloisa Kamada Triboni, Haliton Alves de Oliveira Júnior, Priscila Raupp da Rosa, Maria Luz Díaz, Jose Patricio Lopez-Jaramillo, Fernando Lanas, Philip Joseph, and Álvaro Avezum

Subjects
Cardiovascular disease, Risk score, Risk factors, Brazil, Validation study, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Risk scores are essential tools for implementing cardiovascular disease (CVD) prevention. Validating risk scores considering regional diversities and disparities is critical for reducing the burden of CVD on global morbidity and mortality. We aimed to validate two cardiovascular risk scores (laboratory and non-laboratory-based) to predict major adverse cardiovascular events in the Brazilian cohort of the PURE study. Methods: We validated two risk scores derived from the INTERHEART study, the non-laboratory INTERHEART risk score (NL-IHRS) and the laboratory fasting cholesterol INTERHEART risk score (FC-IHRS) using data from 4623 (urban areas) and 1415 (rural areas) participants without CVD in the Brazilian cohort of the PURE study enrolled in 2004 and 2005 and followed up to September 2021. The endpoint was major cardiovascular events (MACE), defined as the composite of myocardial infarction, stroke, heart failure, or death from cardiovascular causes. We evaluated the model performance of IHRS through c-statistic and calibration methods. Findings: After a mean follow-up of 8.8 years (range, 0.28–15.1 years), there were 312 cardiovascular events, corresponding to an incidence rate of 0.58% per year (0.56% per year in urban versus 0.64% per year in rural areas). For the NL-IHRS, the c-statistic was 0.69 (95% confidence interval, CI, 0.66–0.72) in the overall cohort, 0.68 (95% CI, 0.64–0.72) in the urban cohort, and 0.72 (95% CI, 0.66–0.78) in the rural cohort. C-statistic values for the recalibrated FC-IHRS were 0.71 (95% CI, 0.67–0.74), 0.71 (95% CI, 0.67–0.75), and 0.70 (95% CI, 0.64–0.76) in the overall, urban, and rural cohorts, respectively. Interpretation: In this Brazilian community-based prospective cohort, both NL-IHRS and FC-IHRS-based models performed with reasonable discriminative accuracy on the risk estimation of long-term risk of major CVD. A non-laboratory-based CVD risk score may be instrumental in Brazilian communities with limited access to medical resources. Funding: Population Health Research Institute, Novartis Biociências S.A.

Published
2025
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8. Incidência e Preditores de Desfechos Clínicos em Pacientes com Fibrilação Atrial Valvar e Não Valvar em uso de Antagonistas da Vitamina K

Author

Idelzuita Leandro Liporace, Gustavo Bernardes F. Oliveira, Lucas Bassolli de Oliveira Alves, Nadia Marchiori Galassi, Andreia Dias Jeronimo, Fernanda Maria Lopes, Gregory Y. H. Lip, and Álvaro Avezum

Subjects
Acidente Vascular Cerebral, Tromboembolia, Hemorragia, Fibrilação Atrial, Varfarina, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Resumo Fundamento Antagonistas da vitamina K (AVK) representam uma importante estratégia terapêutica oferecida pelo Sistema Único de Saúde no Brasil aos pacientes com fibrilação atrial (FA). Entretanto, os preditores de desfechos clínicos relevantes são pouco estudados no mundo real. Objetivo Determinar a incidência e os preditores independentes de desfechos clínicos em pacientes com FA valvar e não valvar tratados com AVK. Métodos Coorte prospectivo de pacientes com FA valvar e não valvar em uso ≥ 1 ano de AVK. Desfechos primários foram morte cardiovascular, eventos tromboembólicos, sangramento maior e não maior clinicamente relevante, separadamente e como desfecho composto, e adjudicados de modo independente. Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Incluídos 1.350 pacientes, idade média de 69,2 (± 11.8) anos e 53,6% do sexo feminino, seguidos por 17 (15 - 19) meses. Incidência anual de eventos tromboembólicos e morte cardiovascular foi 4,4% e preditores foram tromboembolismo prévio (hazard ratio [HR] 2,12; intervalo de confiança [IC] de 95% 1,22 - 3,67), tempo na faixa terapêutica (TFT) < 50% (HR 1,98; IC95% 1,16 - 3,37), e taxa de filtração glomerular (TFG) < 45 mL/min/1.73 m2 (HR 2,76; IC95% 4,82 - 1,58). Taxa de sangramento maior e não maior clinicamente relevante foram 3,24% por ano (IC95% 2,47 - 4,14) e preditores foram sangramento prévio (HR 2,60; IC95% 1,47 - 4,61) e prótese mecânica (HR 1,91; IC95% 1,15 - 3,15). O desfecho composto foi 8,7% por ano e preditores foram sangramento prévio (HR 1,70; IC95% 1,07 - 2,70), TFT < 41% (HR 1,79; IC95% 1,11 - 2,86) e diâmetro do átrio esquerdo > 44 mm (HR 1,97; IC95% 3,26 - 1,19). Conclusões Tromboembolismo ou sangramento prévios, TFG e TFT reduzidos e átrio esquerdo aumentado foram preditores de desfechos clínicos em pacientes com FA tratados com AVK.

Published
2025
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9. Adiposity and Muscle Strength in Men With Prostate Cancer and Cardiovascular Outcomes

Author

Leong, Darryl P., Fradet, Vincent, Niazi, Tamim, Selvanayagam, Joseph B., Sabbagh, Robert, Higano, Celestia S., Agapay, Steven, Rangarajan, Sumathy, Mian, Rajibul, Nakashima, Carlos A.K., Mousavi, Negareh, Brown, Ian, Valle, Felipe H., Lavallée, Luke T., Shayegan, Bobby, Ng, Kelvin K.H., Gopaul, Darin D., Cavalli, Germano D., Saavedra, Sonia, Lopez-Lopez, Jose P., Freitas de Souza, Cristiano, Duceppe, Emmanuelle, Avezum Oliveira, Lívia F., Guha, Avirup, Gomez-Mesa, Juan Esteban, Eduardo Silva Móz, Luis, Violette, Philippe D., Avezum, Álvaro, Oliveira, Gustavo B.F., Kann, Ariel G., Walter, Edilson, Dusilek, Cesar O.L., Villareal Trujillo, Nicolas, Beato, Patricia, Hajjar, Ludhmila A., Luke, Patrick P.W., Schlabendorff, Eduardo, Sarid, David, and Pinthus, Jehonathan

Published
2024
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13. PERICARDIOPATIAS

Author

Mingrone, Cláudia, primary, Pereira Lemos Barbosa, Fernanda, additional, Amorim Sampaio, Gabrielli, additional, Victor Nunes, João, additional, Tereza De Oliveira Souza, Maria, additional, Fernando Avezum Do Prado, Luiz, additional, Maria Oliveira Ferreira, Ingridy, additional, Belle Moraes Gonçalves, Aline, additional, and Fernando Avezum do Prado, Luiz, additional

Published
2024
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14. Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial)Research in context

Author

Daniela Laranja Gomes Rodrigues, Gisele Silvestre Belber, Frederica Valle de Queiroz Padilha, Lucas Bassolli de Oliveira Alves, Álvaro Avezum, Marcos Aurélio Maeyama, Alexsandra Vitti, Greta Barriquel Pompermaier, Tanise Balvedi Damas, Mariana Selbach Selbach Otero, Raquel Souza de Aguiar, Renata Almeida de Andrade, Ligia Fonseca Spinel, Ana Paula Neves Marques Pinho, and Haliton Alves de Oliveira Junior

Subjects
Diabetes mellitus, Public health, Remote consultation, Telehealth, Telemedicine, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS. Methods: TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register—REBEC, under the code RBR-8gpgyd. Study status is “Completed”. Findings: This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54–68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was −0.6% (90% CI −1.0; −0.1) at 3-months and −0.5% (90% CI −0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups. Interpretation: The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic. Funding: This study was funded by the Brazilian Ministry of Health, through the Unified Health System–Institutional Development Support Program (PROADI-SUS).

Published
2024
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15. Diretriz de Tomografia Computadorizada e Ressonância Magnética Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia – 2024

Author

Tiago Augusto Magalhães, Adriano Camargo de Castro Carneiro, Valéria de Melo Moreira, Henrique Simão Trad, Marly Maria Uellendahl Lopes, Rodrigo Julio Cerci, Marcelo Souto Nacif, Paulo R. Schvartzman, Antônio Carlos Palandrini Chagas, Isabela Bispo Santos da Silva Costa, André Schmidt, Afonso Akio Shiozaki, Sérgio Tavares Montenegro, Leopoldo Soares Piegas, Marcelo Zapparoli, José Carlos Nicolau, Fabio Fernandes, Marcelo Souza Hadlich, Nabil Ghorayeb, Evandro Tinoco Mesquita, Luiz Flávio Galvão Gonçalves, Felix José Alvarez Ramires, Juliano de Lara Fernandes, Pedro Vellosa Schwartzmann, Salvador Rassi, Jorge Andion Torreão, José Carlos Pachón Mateos, Luiz Beck-da-Silva, Marly Conceição Silva, Gabriela Liberato, Gláucia Maria Moraes de Oliveira, Gilson Soares Feitosa Filho, Hilka dos Santos Moraes de Carvalho, Brivaldo Markman Filho, Ricardo Paulo de Sousa Rocha, Clerio Francisco de Azevedo Filho, Flávio Taratsoutchi, Otavio Rizzi Coelho-Filho, Roberto Kalil Filho, Ludhmila Abrahão Hajjar, Walther Yoshiharu Ishikawa, Cíntia Acosta Melo, Ieda Biscegli Jatene, Andrei Skromov de Albuquerque, Carolina de Medeiros Rimkus, Paulo Savoia Dias da Silva, Thiago Dieb Ristum Vieira, Fabio Biscegli Jatene, Guilherme Sant Anna Antunes de Azevedo, Raul D. Santos, Guilherme Urpia Monte, José Antonio Franchini Ramires, Marcio Sommer Bittencourt, Alvaro Avezum, Leonardo Sara da Silva, Alexandre Abizaid, Ilan Gottlieb, Dalton Bertolim Precoma, Gilberto Szarf, Antônio Carlos Sobral Sousa, Ibraim Masciarelli Francisco Pinto, Fábio de Morais Medeiros, Bruno Caramelli, José Rodrigues Parga Filho, Tiago Senra Garcia dos Santos, Carlos Eduardo Elias dos Prazeres, Marcelo Antonio Cartaxo Queiroga Lopes, Luiz Francisco Rodrigues de Avila, Mauricio Ibrahim Scanavacca, Luis Henrique Wolff Gowdak, Silvio Henrique Barberato, Cesar Higa Nomura, and Carlos Eduardo Rochitte

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2024
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16. Spirituality-Based Intervention in Hypertension: EFfects on Blood PrEssure and EndotheliaL Function—FEEL Trial Results

Author

Maria Emília Figueiredo Teixeira, Weimar Kunz Sebba Barroso, Andréa Araújo Brandão, Ana Luiza Lima Sousa, Roberto Esporcatte, Mário Henrique Elesbão de Borba, Ana Clara Neri Ávila Baleeiro, Beatriz Caldas Gonçalves, Enzo Inumaru, Enzo Mata de Sousa, Giovana Barros Leal, Henrique Soares de Araújo Pereira Farias, Juliana Alves de Souza, Lure Emilly Barreto da Silva, Matheus Canguçu de Paiva Queiroz, Frederico Rafael Moreira, Priscila Valverde de Oliveira Vitorino, John Eikelboom, and Álvaro Avezum

Subjects
spirituality, hypertension, pulse wave velocity, vascular endothelium, randomized controlled trial, Diseases of the circulatory (Cardiovascular) system, RC666-701, Public aspects of medicine, RA1-1270
Abstract

Background: Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide. Objectives: To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN). Methods: Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis. Results: Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (–7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (–6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM. Conclusion: A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.

Published
2025
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17. Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study

Author

Corsi, Daniel J, Marschner, Simone, Lear, Scott, Hystad, Perry, Rosengren, Annika, Ismail, Rosnah, Yeates, Karen, Swaminathan, Sumathi, Puoane, Thandi, Wang, Chuangshi, Li, Yang, Rangarajan, Sumathy, Kruger, Iolanthé M, Chifamba, Jephat, Vidhu Kumar, K, Mohan, Indu, Davletov, Kairat, Artamonov, Galina, Palileo-Villanueva, Lia M, Mat-Nasir, Nafiza, Zatonska, Katarzyna, Oguz, Aytekin, Bahonar, Ahmad, Alhabib, Khalid F, Yusufali, Afzalhussein, Lopez-Jaramillo, Patricio, Lanas, Fernando, Galatte, Agustina, Avezum, Álvaro, Mckee, Martin, Yusuf, Salim, and Chow, Clara K

Published
2024
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18. Cost effectiveness analysis of a fixed dose combination pill for primary prevention of cardiovascular disease from an individual participant data meta-analysisResearch in context

Author

Andre Lamy, Wesley Tong, Philip Joseph, Peggy Gao, Mark D. Huffman, Gholamreza Roshandel, Reza Malekzadeh, Patricio Lopez-Jaramillo, Prem Pais, Denis Xavier, Alvaro Avezum, Antonio L. Dans, Habib Gamra, and Salim Yusuf

Subjects
Cost-effectiveness, Cost implications, Polypill, Fixed dose combination, Primary prevention, Cardiovascular disease, Medicine (General), R5-920
Abstract

Summary: Background: Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis. Methods: Countries were categorized using World Bank economic groups: Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC) and High Income Countries (HIC). Country specific costs were obtained for hospitalized events, procedures, and non-study medications (2020 USD). FDC price was based on the cheapest equivalent substitute (CES) for each component. Findings: For the CES-FDC pill versus control the difference in cost was $346 (95% CI: $294–$398) per participant in Lower Middle Income Countries, $838 (95% CI: $781–$895) in Upper Middle Income Countries and $42 (95% CI: −$155 to $239) (cost-neutral) in High Income Countries. During the study period the CES-FDC pill was associated with incremental gain in quality-adjusted life years of 0.06 (95% CI: 0.04–0.08) resulting in an incremental cost-effectiveness ratio (ICER) of $5767 (95% CI: 5735–$5799), $13,937 (95% CI: $13,893–$14,041) and $700 (95% CI: $662–$738) respectively. In subgroups analyses, the highest 10 years CVD risk subgroup had ICERs of $2033, $7322 and −$6000/QALY. Interpretation: A FDC pill produced at CES costs is cost-neutral in HIC. Governments of LMI and UMI countries should assess these results based on the ICER threshold accepted in their own country and own specific health care priorities but should consider prioritizing this strategy for patients with high 10 years CVD risk as a first step. Funding: Population Health Research Institute.

Published
2024
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19. Psychological stress and cardiovascular risk among women in Brazilian communities: a cross-sectional study

Author

Antônio José C. Mattos, Alvaro Avezum, João Italo D. França, Maria Cristina O. Izar, João Fernando M. Ferreira, Luciano Ferreira Drager, José Francisco K. Saraiva, and Henrique Andrade R. Fonseca

Subjects
Psychological Stress, Cardiovascular Diseases, Women, Developing Countries, Medicine, Public aspects of medicine, RA1-1270
Abstract

Abstract: Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.

Published
2024
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21. Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study

Author

Joundi, Raed A, Hu, Bo, Rangarajan, Sumathy, Leong, Darryl P, Islam, Shofiqul, Smith, Eric E, Mirrakhimov, Erkin, Seron, Pamela, Alhabib, Khalid F, Assembekov, Batyrbek, Chifamba, Jephat, Yusuf, Rita, Khatib, Rasha, Felix, Camilo, Yusufali, Afzalhussein, Mohammadifard, Noushin, Rosengren, Annika, Oguz, Aytekin, Iqbal, Romaina, Yeates, Karen, Avezum, Alvaro, Kruger, Iolanthé, Anjana, Ranjit, PVM, Lakshmi, Gupta, Rajeev, Zatońska, Katarzyna, Barbarash, Olga, Pelliza, Eugenia, Rammohan, Kamala, Li, Mengya, Li, Xiaocong, Ismail, Rosnah, Lopez-Jaramillo, Patricio, Evans, Marc, O'Donnell, Martin, and Yusuf, Salim

Published
2024
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22. Effect of Apixaban on Clinical Outcomes in Outpatients With COVID-19: The APOLLO Randomized Clinical Trial

Author

de Barros e Silva, Pedro Gabriel Melo, Macedo, Ariane Vieira Scarlatelli, Bronhara, Bruna, Damiani, Lucas Petri, Mazza Barbosa, Lilian, Lopes, Nathália Rodrigues, Suiama, Mayra Akimi, Antunes, Murillo O., Gonçalves, Mariana Raquel, Gebara, Otávio Celso Eluf, de Aquino Martins, Priscilla, Ribeiro, Mariana Galvão, de Moura Xavier de Moraes, João Batista, Jr, Aguiar, Valéria Cristina Resende, Cavalcanti, Alexandre B., Rosa, Regis G., Berwanger, Otavio, Veiga, Viviane C., Azevedo, Luciano C.P., Ramacciotti, Eduardo, Granger, Christopher B., Alexander, John H., Avezum, Alvaro, and Lopes, Renato D.

Published
2024
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25. Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study

Author

Miller, Victoria, Jenkins, David A, Dehghan, Mahshid, Srichaikul, Kristie, Rangarajan, Sumathy, Mente, Andrew, Mohan, Viswanathan, Swaminathan, Sumathi, Ismail, Rosnah, Luz Diaz, Maria, Ravindran, Rekha M, Zatonska, Katarzyna, Bahonar, Ahmad, Altuntas, Yuksel, Khatib, Rasha, Lopez-Jaramillo, Patricio, Yusufali, Afzalhussein, Yeates, Karen, Chifamba, Jephat, Iqbal, Romaina, Yusuf, Rita, Catherina Swart, Elizabeth, Bo, Hu, Han, Guoliang, Li, Xiaocong, Alhabib, Khalid F, Rosengren, Annika, Avezum, Alvaro, Lanas, Fernando, and Yusuf, Salim

Published
2024
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26. Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study

Author

Wang, Xingyu, Liu, Xin, O’Donnell, Martin J., McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Zhang, Hongye, Lisheng, Liu, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, A., Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Nilanont, Yongchai, and Yusuf, Salim

Published
2024
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29. Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials

Author

Furtado, Remo H.M., Barros e Silva, Pedro G.M., Fonseca, Henrique A.R., Serpa-Neto, Ary, Correa, Thiago D., Guimarães, Hélio P., Pereira, Adriano J., Olivato, Guilherme B., Zampieri, Fernando G., Lisboa, Thiago, Junqueira, Debora L.M., Lapa, Maura G., Monfardini, Frederico, Damiani, Lucas P., Echenique, Leandro S., Gebara, Otavio E., Hoffman Filho, Conrado R., Polanczyk, Carisi A, Rohde, Luis E., Amazonas, Roberto, Machado, Flávia R., Avezum, Alvaro, Azevedo, Luciano C.P., Veiga, Viviane C., Rosa, Regis G., Lopes, Renato D., Cavalcanti, Alexandre B., and Berwanger, Otavio

Published
2024
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30. Safety and efficacy of factor XIa inhibition with milvexian for secondary stroke prevention (AXIOMATIC-SSP): a phase 2, international, randomised, double-blind, placebo-controlled, dose-finding trial

Author

Sharma, Mukul, Molina, Carlos A, Toyoda, Kazunori, Bereczki, Daniel, Bangdiwala, Shrikant I, Kasner, Scott E, Lutsep, Helmi L, Tsivgoulis, Georgios, Ntaios, George, Czlonkowska, Anna, Shuaib, Ashfaq, Amarenco, Pierre, Endres, Matthias, Yoon, Byung-Woo, Tanne, David, Toni, Danilo, Yperzeele, Laetitia, von Weitzel-Mudersbach, Paul, Sampaio Silva, Gisele, Avezum, Alvaro, Dawson, Jesse, Strbian, Daniel, Tatlisumak, Turgut, Eckstein, Jens, Ameriso, Sebastián F, Weber, Joerg R, Sandset, Else Charlotte, Goar Pogosova, Nana, Lavados, Pablo M, Arauz, Antonio, Gailani, David, Diener, Hans-Christoph, Bernstein, Richard A, Cordonnier, Charlotte, Kahl, Anja, Abelian, Grigor, Donovan, Mark, Pachai, Chahin, Li, Danshi, and Hankey, Graeme J

Published
2024
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31. Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study

Author

Darryl P. Leong, Mark Loeb, Prem K. Mony, Sumathy Rangarajan, Maha Mushtaha, Matthew S. Miller, Mary Dias, Sergey Yegorov, Mamatha V, Ozge Telci Caklili, Ahmet Temizhan, Andrzej Szuba, Marc Evans M. Abat, Nafiza Mat-Nasir, Maria Luz Diaz, Hamda Khansaheb, Patricio Lopez-Jaramillo, MyLinh Duong, Koon K. Teo, Paul Poirier, Gustavo Oliveira, Álvaro Avezum, and Salim Yusuf

Subjects
SARS-CoV-2, seroepidemiology, COVID-19, low-income countries, pandemic, transmission, Microbiology, QR1-502
Abstract

ABSTRACTThere are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91–0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01–1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70–0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60–0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection—especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.

Published
2024
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32. Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study

Author

Boakye, Kwadwo, Bovbjerg, Marit, Schuna, Jr, John, Branscum, Adam, Varma, Ravi Prasad, Ismail, Rosnah, Barbarash, Olga, Dominguez, Juan, Altuntas, Yuksel, Anjana, Ranjit Mohan, Yusuf, Rita, Kelishadi, Roya, Lopez-Jaramillo, Patricio, Iqbal, Romaina, Serón, Pamela, Rosengren, Annika, Poirier, Paul, Lakshmi, P. V. M., Khatib, Rasha, Zatonska, Katarzyna, Hu, Bo, Yin, Lu, Wang, Chuangshi, Yeates, Karen, Chifamba, Jephat, Alhabib, Khalid F, Avezum, Álvaro, Dans, Antonio, Lear, Scott A, Yusuf, Salim, and Hystad, Perry

Published
2023
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33. Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study

Author

Rosa, Regis Goulart, Cavalcanti, Alexandre Biasi, Azevedo, Luciano César Pontes, Veiga, Viviane Cordeiro, de Souza, Denise, dos Santos, Rosa da Rosa Minho, Schardosim, Raíne Fogliati de Carli, Rech, Gabriela Soares, Trott, Geraldine, Schneider, Daniel, Robinson, Caroline Cabral, Haubert, Tainá Aparecida, Pallaoro, Victoria Emanuele Lobo, Brognoli, Liége Gregoletto, de Souza, Ana Paula, Costa, Lauren Sezerá, Barroso, Bruna Machado, Pelliccioli, Melissa Pezzetti, Gonzaga, Janine, Studier, Nicole dos Santos, Dagnino, Ana Paula Aquistapase, Neto, Juliana de Mesquita, da Silva, Sabrina Souza, Gimenes, Bruna dos Passos, dos Santos, Vanessa Brzoskowski, Estivalete, Gabriel Pozza Muller, Pellegrino, Carolina de Moraes, Polanczyk, Carisi Anne, Kawano-Dourado, Letícia, Tomazini, Bruno Martins, Lisboa, Thiago Costa, Teixeira, Cassiano, Zampieri, Fernando Godinho, Zavascki, Alexandre Prehn, Gersh, Bernard J., Avezum, Álvaro, Machado, Flávia Ribeiro, Berwanger, Otavio, Lopes, Renato Delascio, and Falavigna, Maicon

Published
2023
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34. Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDS With Inflammatory Bowel Disease: Results From the Prospective Urban Rural Epidemiology (PURE) Study

Author

Narula, Neeraj, Wong, Emily C.L., Pray, Cara, Marshall, John K., Rangarajan, Sumathy, Islam, Shofiqul, Bahonar, Ahmad, Alhabib, Khalid F., Kontsevaya, Anna, Ariffin, Farnaza, Co, Homer U., Al Sharief, Wadeia, Szuba, Andrzej, Wielgosz, Andreas, Diaz, Maria Luz, Yusuf, Rita, Kruger, Lanthé, Soman, Biju, Li, Yang, Wang, Chuangshi, Yin, Lu, Mirrakhimov, Erkin, Lanas, Fernando, Davletov, Kairat, Rosengren, Annika, Lopez-Jaramillo, Patricio, Khatib, Rasha, Oguz, Aytekin, Iqbal, Romaina, Yeates, Karen, Avezum, Álvaro, Reinisch, Walter, Moayyedi, Paul, and Yusuf, Salim

Published
2023
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35. Rivaroxaban to prevent major clinical outcomes in non-hospitalised patients with COVID-19: the CARE – COALITION VIII randomised clinical trial

Author

Avezum, Álvaro, Oliveira Junior, Haliton Alves, Neves, Precil Diego M.M., Alves, Lucas Bassolli O., Cavalcanti, Alexandre B., Rosa, Regis G., Veiga, Viviane C., Azevedo, Luciano C.P., Zimmermann, Sérgio Luiz, Silvestre, Odilson Marcos, Seabra Prudente, Raphael Cruz, Morales Kormann, Adrian Paulo, Moreira, Frederico Rafael, Boszczowski, Icaro, de Brito Sobrinho, Edgar, da Silva e Souza, André, Seligman, Renato, de Souza Paolino, Bruno, Razuk, Alvaro, Diogenes de Magalhaes Feitosa, Audes, Monteiro Belmonte, Pedro Luiz, Freitas das Neves Gonçalves, Priscila, Hernandes, Mauro Esteves, Fagundes, Ariovaldo Leal, Sarmet Esteves, José Maria, Tognon, Alexandre Pereira, Eikelboom, John, Berwanger, Otávio, Lopes, Renato D., and Oliveira, Gustavo B.F.

Published
2023
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36. Antivirals for adult patients hospitalised with SARS-CoV-2 infection: a randomised, phase II/III, multicentre, placebo-controlled, adaptive study, with multiple arms and stages. COALITION COVID-19 BRAZIL IX – REVOLUTIOn trial

Author

Maia, Israel S., Marcadenti, Aline, Veiga, Viviane C., Miranda, Tamiris A., Gomes, Samara P.C., Carollo, Mariana B.S., Negrelli, Karina L., Gomes, Jackeline O., Tramujas, Lucas, Abreu-Silva, Erlon O., Westphal, Glauco A., Fernandes, Ruthy P., Horta, Jacques G.A., Oliveira, Deborah C., Flato, Uri A.P., Paoliello, Ricardo C.R., Fernandes, Camilo, Zandonai, Cássio L., Coelho, Juliana C., Barros, Waldemar C., Lemos, Juliana C., Bolan, Renata S., Dutra, Marcela M., Gebara, Otavio C.E., Lopes, Ana T.A., Alencar Filho, Meton S., Arraes, Jussara A., Hamamoto, Victor A., Hernandes, Mauro E., Golin, Nicole A., Santos, Tiago M., Santos, Renato H.N., Damiani, Lucas P., Zampieri, Fernando G., Gesto, João, Machado, Flávia R., Rosa, Régis G., Azevedo, Luciano C.P., Avezum, Alvaro, Lopes, Renato D., Souza, Thiago M.L., Berwanger, Otávio, and Cavalcanti, Alexandre B.

Published
2023
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38. Application of ventilator-associated events (VAE) in ventilator-associated pneumonia (VAP) notified in Brazil (IMPACTO MR-PAV): a protocol for a cohort study

Author

Alvaro Avezum, Adriano José Pereira, Viviane C Veiga, Haliton Alves De Oliveira Junior, Giovanna Marssola Nascimento, Daniela Laranja Gomes Rodrigues, Daniela Ghidetti Mangas Catarino, Filipe Teixeira Piastrelli, Maysa Yukari Cheno, Katia Cristina Camonda Braz, Lucas Bassolli Oliveira Alves, Alexandre Prehn Zavascki, Bruno Tomazini, Bruno Besen, and Ana Paula Neves Marques de Pinho

Subjects
Medicine
Abstract

Introduction Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria.Methods and analysis The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria.Ethics and dissemination This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study’s primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria.Trial registration number NCT05589727; Clinicaltrials.gov.

Published
2023
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39. The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer: A RADICAL-PC Analysis

Author

Klimis, Harry, Pinthus, Jehonathan H., Aghel, Nazanin, Duceppe, Emmanuelle, Fradet, Vincent, Brown, Ian, Siemens, D. Robert, Shayegan, Bobby, Klotz, Laurence, Luke, Patrick P., Niazi, Tamim, Lavallee, Luke T., Mousavi, Negareh, Hamilton, Robert J., Chin, Joseph L., Gopaul, Darin, Violette, Philippe D., Davis, Margot K., Hanna, Nawar, Sabbagh, Robert, Ben Zadok, Osnat Itzhaki, Hajjar, Ludhmila Abrahão, Kann, Ariel Galapo, Mian, Rajibul, Rangarajan, Sumathy, Huei Ng, Kelvin Kuan, Iakobishvili, Zaza, Selvanayagam, Joseph B., Avezum, Alvaro, and Leong, Darryl P.

Published
2023
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40. Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): a prospective cohort study

Author

Lopez-Jaramillo, Patricio, Gomez-Arbelaez, Diego, Martinez-Bello, Daniel, Abat, Marc Evans M, Alhabib, Khalid F, Avezum, Álvaro, Barbarash, Olga, Chifamba, Jephat, Diaz, Maria L, Gulec, Sadi, Ismail, Noorhassim, Iqbal, Romaina, Kelishadi, Roya, Khatib, Rasha, Lanas, Fernando, Levitt, Naomi S, Li, Yang, Mohan, Viswanathan, Mony, Prem K, Poirier, Paul, Rosengren, Annika, Soman, Biju, Wang, Chuangshi, Wang, Yang, Yeates, Karen, Yusuf, Rita, Yusufali, Afzalhussein, Zatonska, Katarzyna, Rangarajan, Sumathy, and Yusuf, Salim

Published
2023
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41. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study

Author

Dehghan, Mahshid, Mente, Andrew, Rangarajan, Sumathy, Mohan, Viswanathan, Swaminathan, Sumathi, Avezum, Alvaro, Lear, Scott A., Rosengren, Annika, Poirier, Paul, Lanas, Fernando, Lopez-Jaramillo, Patricio, Soman, Biju, Wang, Chuangshi, Orlandini, Andrés, Mohammadifard, Noushin, AlHabib, Khalid F., Chifamba, Jephat, Yusufali, Afzal Hussein, Iqbal, Romaina, Khatib, Rasha, Yeates, Karen, Puoane, Thandi, Altuntas, Yuksel, Co, Homer Uy, Li, Sidong, Liu, Weida, Zatońska, Katarzyna, Yusuf, Rita, Ismail, Noorhassim, Miller, Victoria, and Yusuf, Salim

Published
2023
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42. Implementing a multisector public-private partnership to improve urban hypertension management in low-and middle- income countries

Author

Johannes Boch, Lakshmi Venkitachalam, Adela Santana, Olivia Jones, Theresa Reiker, Sarah Des Rosiers, Jason T. Shellaby, Jasmina Saric, Peter Steinmann, Jose M. E. Ferrer, Louise Morgan, Asha Barshilia, Edmir Peralta Rollemberg Albuquerque, Alvaro Avezum, Joseph Barboza, Yara C. Baxter, Luiz Bortolotto, Enkhtuya Byambasuren, Márcia Cerqueira, Naranjargal Dashdorj, Karina Mauro Dib, Babacar Guèye, Karim Seck, Mariana Silveira, Suely Miya Shiraishi Rollemberg, Renato W. de Oliveira, Tumurbaatar Luvsansambuu, and Ann Aerts

Subjects
Population health, Primary care, Urban health, Public private partnership, Cardiovascular risk, Hypertension, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the “CARDIO4Cities” approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). Method The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. Results Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). Conclusions This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.

Published
2022
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43. INTERBLEED: Design of an International Study of Risk Factors for Gastrointestinal Bleeding and Cardiovascular Events After Gastrointestinal Bleeding

Author

Jacqueline Bosch, PhD, Paul Moayyedi, MD, PhD, Marco Alings, MD, PhD, Alvaro Avezum, Jr., MD, PhD, Shrikant I. Bangdiwala, PhD, Alan Barkun, MD, CM, MSc, Federico Cassella, MD, Aloisio Marchi da Rocha, MD, PhD, Irfan Duzen, MD, Robert Enns, MD, Nauzer Forbes, MD, MSc, Leah Hamilton, MSc, Shofiqul Islam, PhD, Mustafa Kilickap, MD, MSc, Paul Kruger, MBBS, Yan Liang, MD, Jose C. Nicolau, MD, Rafael Nunes, MD, PhD, Martin O’Donnell, MD, PhD, Gustavo Oliveira, MD, PhD, Alejandro Rey, MD, Yihong Sun, MD, Thomas Vanassche, MD, Peter Verhamme, MD, Michael Walsh, MD, PhD, Zhenyu Wang, MD, Cynthia Wu, MD, Li Zhao, MD, Jun Zhu, MD, and John W. Eikelboom, MBBS

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Bleeding is the most common adverse event in those with cardiovascular (CV) disease receiving antithrombotic therapy, and it most commonly occurs in the gastrointestinal (GI) tract. Clinicians often dismiss bleeding as an adverse event that is reversible with effective antithrombotic therapy, but bleeding is associated with substantial morbidity and mortality, most likely mediated through an increased risk of CV events. Reducing the burden of bleeding requires knowledge of the potentially modifiable risk factors for bleeding and the potentially modifiable risk factors for adverse outcomes after bleeding. Methods: INTERBLEED is an international, multicentre, 2-component, observational study, with an incident case-control study examining the risk factors for GI bleeding, and a prospective cohort study of risk factors for CV events after GI bleeding. Cases either have CV disease and present to the hospital with GI bleeding or develop GI bleeding during hospitalization. Controls have CV disease, but no history of GI bleeding. We use a questionnaire to obtain detailed information on known and potential risk factors for GI bleeding and for CV events and outcomes after bleeding. We obtain CV and anthropometric measurements, perform functional and cognitive assessments, and follow participants at 3 months and 12 months. Results: As of April 1, 2022, the study is ongoing in 10 countries at 31 centres and has recruited 2407 cases and 1478 controls. Conclusions: Knowledge of risk factors for bleeding, and risk factors for CV events and functional decline after bleeding, will help develop strategies to prevent bleeding and subsequent complications. Résumé: Contexte: L’hémorragie est l’effet indésirable le plus fréquent chez les patients atteints de maladies cardiovasculaires (CV) qui reçoivent un traitement antithrombotique, et elle survient le plus souvent dans le tractus gastro-intestinal (GI). Les cliniciens considèrent souvent l’hémorragie comme une simple manifestation indésirable réversible par un traitement antithrombotique efficace, mais une morbidité et une mortalité considérables y sont associées, probablement en raison d’un risque accru d’événements CV. Une réduction du fardeau de l’hémorragie nécessite une connaissance des facteurs de risque potentiellement modifiables tant de l’hémorragie que des événements indésirables qui surviennent après l’hémorragie. Méthodologie: INTERBLEED est une étude internationale, observationnelle et multicentrique à deux volets; le premier volet est une étude cas-témoins incidents visant à examiner les facteurs de risque d’hémorragie GI, alors que le second volet est une étude de cohorte prospective visant à examiner les facteurs de risque d’événements CV après une hémorragie GI. Les cas sont des patients atteints de maladies CV qui consultent les services hospitaliers pour une hémorragie GI ou qui présentent une hémorragie GI en cours d’hospitalisation. Les témoins sont des patients atteints de maladies CV, mais sans antécédents d’hémorragie GI. Un questionnaire est utilisé pour obtenir des renseignements détaillés au sujet de facteurs de risque connus et potentiels d’hémorragie GI et d’événements CV et d’autres résultats de santé après une hémorragie. Des mesures cardiovasculaires et anthropométriques ainsi que des évaluations fonctionnelles et cognitives sont réalisées, et les participants sont revus après trois mois et 12 mois. Résultats: En date du 1er avril 2022, l’étude est en cours dans 10 pays et 31 établissements de santé; 2 407 cas et 1 478 témoins ont été recrutés. Conclusions: La connaissance des facteurs de risque d’hémorragie, ainsi que des facteurs de risque d’événements CV et de déclin fonctionnel à la suite d’une hémorragie, aidera à mettre en place des stratégies pour prévenir les hémorragies et les complications qui peuvent en découler.

Published
2022
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44. Influência do Bem-estar Espiritual na Pressão Arterial, Hemodinâmica Central e Função Endotelial

Author

Maria Emília Figueiredo Teixeira, Priscila Valverde de Oliveira Vitorino, Andrea A. Brandão, Ana Luiza Lima Souza, Talles Marcelo Gonçalves de Andrade Barbosa, Roberto Esporcatte, Mário Henrique Elesbão de Borba, Álvaro Avezum, and Weimar Kunz Sebba Barroso

Subjects
Espiritualidade, Religião e Medicina, Pressão Arterial, Hemodinâmica, Endotélio/fisiologia, Valores Sociais, Valor da Vida, Qualidade de Vida, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2022
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45. Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

Author

Eikelboom, John W, Jolly, Sanjit S, Belley-Cote, Emilie P, Whitlock, Richard P, Rangarajan, Sumathy, Xu, Lizhen, Heenan, Laura, Bangdiwala, Shrikant I, Tarhuni, Wadea M, Hassany, Mohamed, Kontsevaya, Anna, Harper, William, Sharma, Sanjib Kumar, Lopez-Jaramillo, Patricio, Dans, Antonio L, Palileo-Villanueva, Lia M, Avezum, Alvaro, Pais, Prem, Xavier, Denis, Felix, Camilo, Yusufali, Afzalhussein, Lopes, Renato D, Berwanger, Otavio, Ali, Zeeshan, Wasserman, Sean, Anand, Sonia S, Bosch, Jackie, Choudhri, Shurjeel, Farkouh, Michael E, Loeb, Mark, and Yusuf, Salim

Published
2022
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46. Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

Author

Eikelboom, John W, Jolly, Sanjit S, Belley-Cote, Emilie P, Whitlock, Richard P, Rangarajan, Sumathy, Xu, Lizhen, Heenan, Laura, Bangdiwala, Shrikant I, Luz Diaz, Maria, Diaz, Rafael, Yusufali, Afzalhussein, Kumar Sharma, Sanjib, Tarhuni, Wadea M, Hassany, Mohamed, Avezum, Alvaro, Harper, William, Wasserman, Sean, Almas, Aysha, Drapkina, Oxana, Felix, Camilo, Lopes, Renato D, Berwanger, Otavio, Lopez-Jaramillo, Patricio, Anand, Sonia S, Bosch, Jackie, Choudhri, Shurjeel, Farkouh, Michael E, Loeb, Mark, and Yusuf, Salim

Published
2022
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48. A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes

Author

Hertzel C. Gerstein, Chinthanie Ramasundarahettige, Alvero Avezum, Jan Basile, Ignacio Conget, William C. Cushman, Gilles R. Dagenais, Edward Franek, Mark Lakshmanan, Fernando Lanas, Lawrence A. Leiter, Nana Pogosova, Jeffrey Probstfield, Peter J. Raubenheimer, Matthew Riddle, Jonathan Shaw, Wayne H.-H. Sheu, Theodora Temelkova-Kurktschiev, Ibrahim Turfanda, and Denis Xavier

Subjects
Risk Factor, Kidney, Albuminuria, Cardiovascular Outcomes, Kidney Outcomes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline were included in this post hoc epidemiologic analysis. The hazard of higher baseline levels of 1/eGFR and natural log transformed ACR (calculated as ln [ACR × 100] to eliminate negative values) and their interaction for incident major adverse cardiovascular events (MACE), kidney outcomes, and deaths was estimated. The hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI) was also assessed. Results A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome. There was also a negative interaction between these two risk factors with respect to MACE and death. Conversely, a linear relationship was noted between the KDI and all three outcomes. People in the highest KDI fifth experienced the highest incidence of MACE, death, and the kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively). C statistics for the KDI were similar to those for eGFR and albuminuria. Conclusions The KDI combines the baseline eGFR and ACR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in people with diabetes and additional CV risk factors. Trial Registration clinicaltrials.gov NCT01394952.

Published
2022
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49. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study

Author

Walli-Attaei, Marjan, Rosengren, Annika, Rangarajan, Sumathy, Breet, Yolandi, Abdul-Razak, Suraya, Sharief, Wadeia Al, Alhabib, Khalid F, Avezum, Alvaro, Chifamba, Jephat, Diaz, Rafael, Gupta, Rajeev, Hu, Bo, Iqbal, Romaina, Ismail, Rosnah, Kelishadi, Roya, Khatib, Rasha, Lang, Xinyue, Li, Sidong, Lopez-Jaramillo, Patricio, Mohan, Viswanathan, Oguz, Aytekin, Palileo-Villanueva, Lia M, Poltyn-Zaradna, Katarzyna, R, Sreelakshmi P, Pinnaka, Lakshmi V M, Serón, Pamela, Teo, Koon, Verghese, Sejil T, Wielgosz, Andreas, Yeates, Karen, Yusuf, Rita, Anand, Sonia S, and Yusuf, Salim

Published
2022
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50. Hydroxychloroquine versus placebo in the treatment of non-hospitalised patients with COVID-19 (COPE – Coalition V): A double-blind, multicentre, randomised, controlled trial

Author

Avezum, Álvaro, Oliveira, Gustavo B F, Oliveira, Haliton, Lucchetta, Rosa C, Pereira, Valéria F A, Dabarian, André L, D´O Vieira, Ricardo, Silva, Daniel V, Kormann, Adrian P M, Tognon, Alexandre P, De Gasperi, Ricardo, Hernandes, Mauro E, Feitosa, Audes D M, Piscopo, Agnaldo, Souza, André S, Miguel, Carlos H, Nogueira, Vinicius O, Minelli, César, Magalhães, Carlos C, Morejon, Karen M L, Bicudo, Letícia S, Souza, Germano E C, Gomes, Marco A M, Fo, José J F Raposo, Schwarzbold, Alexandre V, Zilli, Alexandre, Amazonas, Roberto B, Moreira, Frederico R, Alves, Lucas B O, Assis, Silvia R L, Neves, Precil D M M, Matuoka, Jessica Y, Boszczowski, Icaro, Catarino, Daniela G M, Veiga, Viviane C, Azevedo, Luciano C P, Rosa, Regis G, Lopes, Renato D, Cavalcanti, Alexandre B, and Berwanger, Otavio

Published
2022
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