TNFalfa e mortalidade por Insuficiência Cardíaca

Circulation. 2008;118:625-631

Tumor Necrosis Factor- and Mortality in Heart Failure
A Community Study Shannon M. Dunlay, MD; Susan A. Weston, MS; Margaret M. Redfield, MD; Jill M. Killian, BS; Véronique L. Roger, MD, MPH
E-mail roger.veronique@mayo.edu
Background— Tumor necrosis factor- (TNF), an inflammatory cytokine, was reported to be elevated in trials of heart failure (HF) with reduced ejection fraction (EF) and associated with mortality. Whether this is true for HF with preserved EF is unknown, and community data are lacking. We evaluated the distribution of TNF, its association with baseline characteristics and mortality, and its benefit in assessing risk in community HF patients.
Methods and Results— Olmsted County residents with active HF from July 2004 to March 2007 (n=486; mean age, 76.7 years; EF 50%, 55%) were prospectively recruited. Clinical characteristics and TNF were measured. Elevated TNF (more than the assay limit of normal of 2.8 pg/mL) was present in 143 (29%). Higher TNF was associated with decreased creatinine clearance, nonsmoking status, anemia, and greater comorbidity (Ptrend<0.05 for all). Mortality increased with increasing TNF (P=0.016), with 1-year mortality estimates of 16%, 18%, 23%, and 32% from the lowest to highest quartile, respectively. After adjustment for age, sex, and EF, the hazard ratios for death were 1.24, 1.37, and 1.90 from the second to the highest TNF quartile, respectively (Ptrend=0.007). TNF contributed to risk assessment as indicated by increases in the area under the receiver operating characteristic curves in all models examined (P<0.05 for all). Results did not differ by EF (P=0.60 interaction term of TNF and EF).
Conclusions— TNF was elevated in a large portion of community HF patients, was associated with a large decrease in survival, and provided a significant incremental increase in risk assessment above established indicators. TNF is useful for risk assessment in HF patients with preserved and reduced EF

Qualidade de vida no portador de doença coronariana

Patient-Reported Health Status in Coronary Heart Disease in the United States
Age, Sex, Racial, and Ethnic Differences Circulation. 2008;118:491-497

Jipan Xie, MD, PhD; Eric Q. Wu, PhD; Zhi-Jie Zheng, MD, PhD; Patrick W. Sullivan, PhD; Lin Zhan, MS; Darwin R. Labarthe, MD, MPH, PhD
E-mail jipan.xie@gmail.com
Background— Coronary heart disease (CHD) affects 15.8 million Americans. However, data on the national impact of CHD on health-related quality of life, particularly among people of different age, sex, racial, and ethnic groups, are limited.
Methods and Results— Using data from the 2000 and 2002 Medical Expenditure Panel Survey, we examined various measures of patient-reported health status, including health-related quality of life, in the CHD and non-CHD populations and differences in the measures among demographic subgroups. These measures included short-form generic measures (Short Form 12; Mental Component Summary-12 and Physical Component Summary-12) and EuroQol Group measures (EQ-5D index and EQ visual analog scale). Ordinary least-squares regressions were used to adjust for sociodemographic characteristics, risk factors, comorbidities, and proxy report. The adjusted difference between the CHD and non-CHD populations was –1.2 for Mental Component Summary-12 (2.4% of the score in the non-CHD population), –4.6 for Physical Component Summary-12 (9.2%), –0.04 for EQ-5D (4.6%), and –7.3 for EQ visual analog scale (9.0%) (all P<0.05).>

Adiposidade e Sobrevida pós Infarto do Miocárdio

Circulation. 2008;118:482-490

Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial Infarction

Marianne Zeller, PhD; Philippe Gabriel Steg, MD, PhD; Jack Ravisy, MD; Luc Lorgis, MD; Yves Laurent, MD; Pierre Sicard, PhD; Luc Janin-Manificat, MD; Jean-Claude Beer, MD; Hamid Makki, MD; Anne-Cécile Lagrost, MSc; Luc Rochette, PharmD, PhD; Yves Cottin, MD, PhD, for the RICO Survey Working Group
Background— An elevated body mass index (BMI) has been reported to be associated with a lower rate of death after acute myocardial infarction (AMI). However, waist circumference (WC) may be a better marker of cardiovascular risk than BMI. We used data from a contemporary French population-based cohort of patients with AMI to analyze the impact of WC and BMI on death rates.
Methods and Results— We evaluated 2229 consecutive patients with AMI. Patients were classified according to BMI as normal, overweight, obese, and very obese (BMI <25,>35 kg/m2, respectively) and as increased waistline (WC >88/102 cm for women/men) or normal. Half of the patients were overweight (n=1044), and one quarter were obese (n=397) or very obese (n=128). Increased WC was present in half of the patients (n=1110). Increased BMI was associated with a reduced death rate, with a 5% risk reduction for each unit increase in BMI (hazard ratio, 0.95; 95% CI, 0.93 to 0.98; P<0.001). In contrast, WC as a continuous variable had no impact on all-cause death (P=0.20). After adjustment for baseline predictors of death, BMI was not independently predictive of death. The group of patients with high WC but low BMI had increased 1-year death rate.
Conclusions— Neither BMI nor WC independently predicts death after AMI. Much of the inverse relationship between BMI and the rate of death after AMI is due to confounding by characteristics associated with survival. This study emphasizes the need to measure both BMI and WC because patients with a high WC and low BMI are at high risk of death.