Dia: 29 de outubro de 2010

Escolha sua bicicleta e use sem moderação

Beto Matos-Souza

The Role of Ischemic Mitral Regurgitation in the Pathogenesis of Acute Pulmonary Edema

The New England Journal of Medicine
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Exercise Echocardiography
  

Symptom-limited, graded, bicycle exercise testing was performed with the patients in a semisupine position on a tilting exercise table. Beta-blockers were given neither on the day before the test nor on the morning of the test. After an initial workload of 25 W maintained for six minutes, the workload was increased every two minutes by 25 W. Every two minutes, blood pressure was measured and a 12-lead electrocardiogram was obtained. Two-dimensional and Doppler echocardiographic recordings were obtained throughout the test.
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Conclusions: In patients with left ventricular systolic dysfunction, acute pulmonary edema is associated with the dynamic changes in ischemic mitral regurgitation and the resulting increase in pulmonary vascular pressure.
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Estudo brilhante que analisou as mudanças na regurgitação mitral que provocam o edema pulmonar.
(During exercise, regurgitant volume and the effective regurgitant orifice area increased (by 26+/-14 ml and 16+/-10 mm(2)), respectively).
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O entra e sai da parede arterial

Beto Matos-Souza

Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness

The New England Journal of Medicine
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CONCLUSIONS

This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima–media thickness when combined with a statin and that niacin is superior to ezetimibe.

Estudo publicado em 2009 mostra diferença significativa na medida da camada íntima-média após o uso de estatina combinada com Ezetimiba ou Niacina em pacientes com iníco de tratamento já com LDL abaixo de 100. 
Apesar de promover uma queda adicional de quase 20% no LDL, a adição de Ezetimiba mostrou tendência a elevação da IMT.
Já a Niacina foi capaz de elevar o HDL.
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No balanço do entra e sai da parede arterial, será que a saída foi aumentada pelo HDL elevado pela Niacina?
O que motiva a mobilização do LDL depositado na parede?
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De novo, pesquisas que mostram redução na parede arterial são vinculadas não só ao aumento do HDL, queda do LDL mas, consistentemente, queda do Triglicérides!
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