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Among the multiple uncertainties surrounding the novel coronavirus disease (COVID-19) pandemic, a research letter published in The Lancet implicated drugs that antagonize the renin-angiotensin-aldosterone system (RAAS) in an unfavorable prognosis of COVID-19. This report prompted investigations to identify mechanisms by which blocking angiotensin-converting enzyme 2 (ACE2) could lead to serious consequences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The possible association between RAAS inhibitors use and unfavorable prognosis in this disease may have been biased by the presence of underlying cardiovascular diseases. As the number of COVID-19 cases has increased worldwide, it has now become possible to investigate the association between RAAS inhibitors and unfavorable prognosis in larger cohorts. Observational studies and one randomized clinical trial failed to identify any consistent association between the use of these drugs and unfavorable prognosis in COVID-19. In view of the accumulated clinical evidence, several scientific societies recommend that treatment with RAAS inhibitors should not be discontinued in patients diagnosed with COVID-19 (unless contraindicated). This recommendation should be followed by clinicians and patients.

https://doi.org/10.6061/clinics/2021/e2342 556 downloads

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study
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Bertoluci, Carolina

; Foppa, Murilo

; Santos, Angela Barreto Santiago

; Fuchs, Sandra C.

; Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Jan 2019, Volume 112 Nº 1 Páginas 87 - 90

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo A terapia de redução da pressão arterial (PA) melhora os parâmetros do ventrículo esquerdo (VE) na lesão a órgãos-alvo causada pela condição hipertensiva na hipertensão de estágio II; no entanto, se existem ou não diferenças relacionadas à classe de medicamentos nos parâmetros ecocardiográficos de pacientes com hipertensão estágio I é menos frequentemente estudado. No estudo PREVER-treatment, em que indivíduos com hipertensão estágio I foram randomizados para tratamento com diuréticos (clortalidona/amilorida) ou losartana, 110 participantes aceitaram participar de um subestudo, no qual foram realizados ecocardiogramas bidimensionais basais e após 18 meses de tratamento anti-hipertensivo. Como no estudo geral, a redução da PA sistólica foi semelhante com diuréticos ou com losartana. Os parâmetros ecocardiográficos mostraram pequenas mas significativas alterações em ambos os grupos de tratamento, com um remodelamento favorável do VE com tratamento anti-hipertensivo por 18 meses, quando a pressão arterial alvo foi atingida com clortalidona/amilorida ou com losartana como estratégia inicial de tratamento. Em conclusão, mesmo na hipertensão estágio I, a redução da pressão arterial está associada à melhora nos parâmetros ecocardiográficos tanto com o uso de diuréticos ou losartana como primeiro esquema de tratamento farmacológico.

Abstract Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.

https://doi.org/10.5935/abc.20180249 3883 downloads

Terapia de reposição hormonal: está ou não recomendada pela diretriz da SBC?
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Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Out 2010, Volume 95 Nº 5 Páginas 674 - 674

Resumo: Pt | Texto: Pt | PDF: Pt

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Reposição hormonal e doença cardiovascular: uma diretriz contrária à evidência
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Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Jul 2009, Volume 93 Nº 1 Páginas e11 - e13

Resumo: Pt | Texto: Pt | PDF: Pt

7608 downloads Citado 1 vez em SciELO

BELIEF: believe it or not
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Beck-da-Silva, Luís

; Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Ago 2008, Volume 91 Nº 2 Páginas 132 - 136

Resumo: Pt | Texto: Pt | PDF: Pt

2227 downloads

Clustering of risk factors for cardiovascular disease among women in Southern Brazil: a population-based study
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Fuchs, Sandra Costa

; Moreira, Leila Beltrami

; Camey, Susi Alves

; Moreira, Marina Beltrami

; Fuchs, Flávio Danni

Cadernos de Saúde Pública

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2008, Volume 24 Supl. 2 Páginas s285 - s293

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A associação entre agregação de fatores de risco e doença cardiovascular auto-identificada entre mulheres foi investigada em estudo transversal, utilizando amostra de base populacional, por estágios múltiplos. Entrevista domiciliar investigou diagnóstico prévio de diabetes mellitus, atividade física e padrão alimentar. Hipertensão foi definida por pressão arterial > 140/90mmHg ou uso de anti-hipertensivo. Doença cardiovascular auto-identificada foi composta por diagnósticos prévios de infarto do miocárdio, insuficiência cardíaca e acidente vascular encefálico ou realização de cirurgia de revascularização miocárdia. Estudaram-se 1.007 mulheres de Porto Alegre, Rio Grande do Sul, Brasil, predominantemente brancas (73%), com 44,8 ± 0,8 anos e 9,3 ± 0,3 anos de escolaridade. Agregação de hipertensão, diabetes mellitus, obesidade, baixo consumo de frutas e vegetais e ausência de atividade física vigorosa ou moderada associaram-se independentemente com doença cardiovascular auto-identificada. A principal agregação foi hipertensão e diabetes com razão de prevalência = 8,5 (IC95%: 4,6-49,1). A agregação de fatores de risco cardiovascular está fortemente associada com doença cardiovascular auto-identificada entre as mulheres.

The association between clustering of risk factors and self-reported cardiovascular disease among women was investigated in a cross-sectional study using a multistage population-based sample. Participants were interviewed at home about diabetes mellitus, physical activity, and diet pattern. Hypertension was defined as blood pressure > 140/90mmHg or use of anti-hypertensive medication. Cardiovascular disease included self-reported myocardial infarction, heart failure, coronary artery bypass surgery, and stroke. A sample of 1,007 women from Porto Alegre, Southern Brazil, mostly white (73%), 44.8 ± 0.8 years old, and with 9.3 ± 0.3 years of schooling was investigated. Hypertension, diabetes mellitus, obesity, low fruit and vegetable intake, and lack of vigorous or moderate physical activity were clustered into a combination of risk factors, which were independently associated with self-reported cardiovascular disease. The main cluster included hypertension and diabetes, accounting for an independent risk ratio of 8.5 (95%CI: 3.0-24.5). Clustering of cardiovascular risk factors is strongly associated with self-reported cardiovascular disease among women.

4223 downloads Citado 5 vezes em SciELO

Clustering of risk factors for cardiovascular disease among women in Southern Brazil: a population-based study
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Fuchs, Sandra Costa

; Moreira, Leila Beltrami

; Camey, Susi Alves

; Moreira, Marina Beltrami

; Fuchs, Flávio Danni

Cadernos de Saúde Pública

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2008, Volume 24 Supl. 2 Páginas s285 - s293

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

1931 downloads Citado 5 vezes em SciELO

Terapêutica na prática clínica cardiovascular: vivências e evidência
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Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Jul 2005, Volume 85 Nº 1 Páginas 72 - 75

Resumo: Pt | Texto: Pt | PDF: Pt

2221 downloads

10.

Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room
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Barbisan, Juarez Neuhaus

; Fuchs, Flávio Danni

; Schaan, Beatriz D'Agord

Sao Paulo Medical Journal

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2003, Volume 121 Nº 4 Páginas 159 - 162

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

CONTEXTO: A fibrilação atrial ocorre freqüentemente em pacientes com hipertireoidismo, enquanto que, na população adulta em geral, sua prevalência é muito baixa. A prevalência de disfunção tireoidiana em indivíduos com fibrilação atrial varia de 0% a 24%; esta grande variação sendo atribuída às diferentes metodologias aplicadas em seu diagnóstico. OBJETIVO: Neste estudo, apresentamos a prevalência de disfunção tireoidiana em pacientes adultos que se consultaram no pronto socorro cardiológico com fibrilação atrial aguda, utilizando, para seu diagnóstico, as determinações séricas de tireotrofina ultrassensível, triiodotironina (T3) e tiroxina (T4). TIPO DE ESTUDO: Estudo transversal. LOCAL: Emergência do Instituto de Cardiologia do Rio Grande do Sul. PARTICIPANTES: 72 pacientes com fibrilação atrial de até 48 horas de duração. PROCEDIMENTOS: Os participantes foram submetidos a questionário, eletrocardiograma e tiveram coletada amostra de sangue. VÁRIÁVEIS ESTUDADAS: Tireotrofina sérica, T3 e T4. RESULTADOS: Dos pacientes estudados, 16,6% tinham alteração de prova de função tireoidiana: 6,9% apresentavam hipertireoidismo, 5,6% apresentavama hipotireoidismo e 4,2% tinham apenas elevação dos níveis de T4 pelo uso de amiodarona. CONCLUSÕES: A alta prevalência de disfunção tireoidiana observada em nosso estudo, especialmente de hipertireoidismo, sugere que testes de função tireoidiana sejam realizados rotineiramente em todos os pacientes que se apresentem com fibrilação atrial aguda.

CONTEXT: Atrial fibrillation occurs frequently in patients with thyrotoxicosis, while it has low prevalence in adults of the general population. The prevalence of thyroid dysfunction in subjects with atrial fibrillation is 0 to 24%, a wide variation that is attributed to the different methodologies applied. However, continuous use of amiodarone in patients with previous atrial fibrillation may interfere with these prevalence rates. OBJECTIVE: In this study, we present the prevalence of thyroid dysfunction in adult patients who presented at a cardiac emergency room with acute atrial fibrillation, using a sensitive thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3) and thyroxine (T4) determination. TYPE OF STUDY: Cross-sectional study SETTING: Emergency room of a tertiary care facility. PARTICIPANTS: A total of 72 patients with atrial fibrillation who presented at the emergency room not more than 48 hours after its onset. PROCEDURES: A standardized questionnaire and 12-lead electrocardiogram were applied, and T3, T4 and TSH were determined. MAIN MEASUREMENTS: TSH, T3 and T4 determination. RESULTS: Among these patients, 16.6% had altered thyroid function tests: 6.9% had hyperthyroidism, 5.6% hypothyroidism and 4.2% had increased T4 levels, by means of amiodarone use. CONCLUSION: The high prevalence of thyroid dysfunction in our study, especially hyperthyroidism, suggests that routine thyroid testing with sensitivethyroid-stimulating hormone assay is required in patients with acute atrial fibrillation.

3184 downloads Citado 1 vez em SciELO

11.

Establishing the prevalence of hypertension. Influence of sampling criteria
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Fuchs, Sandra Costa

; Petter, Juliano G.

; Accordi, Melissa C.

; Zen, Vanessa L.

; Pizzol-Jr, Antônio D.

; Moreira, Leila Beltrami

; Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Jun 2001, Volume 76 Nº 6 Páginas 449 - 452

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To compare the prevalence of systemic hypertension in two different populations: a representative sample of the adult urban population of Porto Alegre, and individuals who sought blood pressure measurement in a hypertension prevention and control campaign. METHODS: A cross-sectional study was carried out involving a representative sample of the adult urban population of Porto Alegre and a population sample obtained from a hypertension prevention and control campaign, which included all the individuals who sought the blood pressure assessment unit at the Hospital das Clínicas in Porto Alegre. The following parameters were investigated: history of hypertension, use of antihypertensive drugs, age, and sex. Adjustments for age and sex in the prevalence rates were performed to make them comparable. RESULTS: Hypertension prevalence, defined as values > or = 160/95mmHg or treatment with antihypertensive drugs, was higher in the campaign sample (42%) as compared with the population sample (24%). Among those who were aware of their hypertensive condition and were under medication, 54% of the campaign sample and 62% of the representative population sample maintained their pressure levels <160/90mmHg. CONCLUSION: Prevalence rates of hypertension differed a lot in the campaign sample and in the representative population sample, showing that the sampling criterion may influence assessment of risk factors and bias the association between risk factors and health aggravations.

2609 downloads Citado 6 vezes em SciELO

12.

Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic
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Busnello, Renné Gusmão

; Melchior, Raquel

; Faccin, Carlo

; Vettori, Daniela

; Petter, Juliano

; Moreira, Leila Beltrami

; Fuchs, Flávio Danni

Arquivos Brasileiros de Cardiologia

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Mai 2001, Volume 76 Nº 5 Páginas 352 - 354

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3±12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

2185 downloads Citado 4 vezes em SciELO

13.

Alcohol and atherosclerosis
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Foppa, Murilo

; Fuchs, Flávio Danni

; Duncan, Bruce B.

Arquivos Brasileiros de Cardiologia

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Fev 2001, Volume 76 Nº 2 Páginas 171 - 176

Resumo: En | Texto: En | PDF: En

Observational studies have attributed a protective effect to alcohol consumption on the development of atherosclerosis and cardiovascular morbidity and mortality. Alcohol intake in the amount of one to two drinks per day results in an estimated 20-40% reduction in cardiovascular events. An additional protective effect, according to major cohort studies, has been attributed to wine, probably due to antioxidant effects and platelet antiaggregation agents. On the other hand, the influence of different patterns of alcohol consumption and environmental factors may explain a great part of the additional effect of wine. Protection may be mediated by modulation of other risk factors, because alcohol increases HDL-C, produces a biphasic response on blood pressure, and modulates the endothelial function, while it neither increases body weight nor impairs glucose-insulin homeostasis. Alcohol may also have a direct effect on atherogenesis. Despite these favorable effects, the current evidence is not enough to justify prescribing alcohol to prevent cardiovascular disease.

3138 downloads

14.

Normal values of echocardiographic measurements. A population-based study
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Schvartzman, Paulo Roberto

; Fuchs, Flávio Danni

; Mello, Alex Gules

; Coli, Maikel

; Schvartzman, Mario

; Moreira, Leila Beltrami

Arquivos Brasileiros de Cardiologia

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Ago 2000, Volume 75 Nº 2 Páginas 111 - 114

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To describe echocardiographic measurements and left ventricular mass in a population sample of healthy adults inhabitants of the urban region of Porto Alegre. METHODS: An analytical, observational, population-based, cross-sectional study was done. Through a multi-stage probability sample, 114 individuals were selected to be submitted to a M-mode and two-dimensional echocardiogram with color Doppler. The analyses were restricted to healthy participants. Echocardiographic measurements were described by mean, standard deviation, 95 percentile and 95% confidence limits. RESULTS: A total of 100 healthy participants, with several characteristics similar to those from the original population, had a complete and reliable echocardiographic examination. The measurements of aorta, left atrium, interventricular septum, left ventricle in systole and diastole, left posterior wall and left ventricular mass, adjusted or not for body surface area or height, were significantly higher in males. The right ventricle size was similar among the genders. Several echocardiographic measurements were within standard normal limits. Interventricular septum, left posterior wall and left ventricular mass, adjusted or not for anthropometric measurements, and aortic dimensions had lower mean and range than the reference limits. CONCLUSION: The means and estimates of distribution for the measurements of interventricular septum, left posterior wall and left ventricular mass found in this survey were lower than those indicated by the international literature and accepted as normal limits.

149055 downloads Citado 2 vezes em SciELO

15.

O ENSINO DE FARMACOLOGIA MÉDICA DIRECIONADO À REALIDADE: EXEMPLO DE UMA EXPERIÊNCIA PIONEIRA
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Fuchs, Flávio Danni

; Wannmacher, Lenita

; Victor, Marcelo

Revista Brasileira de Educação Médica

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Ago 1988, Volume 12 Nº 2 Páginas 52 - 54

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Os autores preconizam o ensino de Farmacologia Médica voltado à realidade de prescrição em nosso meio, relatando experiências pedagógicas fundamentadas na solução de problemas. Dentre elas, que incluem solução de casos clínico-farmacológicos simulados, seminários de análise crítica da literatura original em Farmacologia aplicada e aulas expositivas, salienta-se a atividade prática da disciplina: preenchimento de fichas de avaliação da prescrição medicamentosa de pacientes internados no hospital-escola. No presente trabalho descrevem-se a metodologia dessa atividade e os resultados obtidos.

Summary The authors preconize that the teaching of Medical Pharmacology should be oriented to the most common drugs employed in Brazil and describe the experience of a discipline based on problem solving. Beside other didactic procedures used, as seminars for discussion of simulated clinical-pharmacological cases, journal clubs with original articles on applied Pharmacology, and lectures, it is pointed out in this communication the methodology and the results of the practical classes of the discipline: filling of the Pharmacological Evaluation Card, which analyzes the drug prescription of inpatients of the University affiliated hospital.

https://doi.org/10.1590/1981-5271v12.2-004 193 downloads

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