In this study, men with CAD had higher oestradiol and FEI levels. Additional studies are needed to clarify the direction of causality and possible underlying mechanisms.

CONTEXT AND OBJECTIVE: Metabolic syndrome consists of a set of factors that imply increased risk of cardiovascular diseases. The objective here was to evaluate the association between sex hormone-binding globulin (SHBG), sex hormones and metabolic syndrome among men. DESIGN AND SETTING: Retrospective analysis on data from the study "Endogenous oestradiol but not testosterone is related to coronary artery disease in men", conducted in a hospital in São Paulo. METHODS: Men (aged 40-70) who underwent coronary angiography were selected. The age, weight, height, waist circumference, body mass index and prevalence of dyslipidemia, hypertension and diabetes of each patient were registered. Metabolic syndrome was defined in accordance with the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII). Serum samples were collected to assess the levels of glucose, total cholesterol, HDL-cholesterol (high density lipoprotein), triglycerides, albumin, SHBG, estradiol and total testosterone (TT). The levels of LDL-cholesterol (low density lipoprotein) were calculated using Friedewald's formula and free testosterone (FT) and bioavailable testosterone (BT) using Vermeulen's formula. RESULTS: 141 patients were enrolled in the study. The prevalence of metabolic syndrome was significantly higher in the first SHBG tercile than in the second and third terciles. A statistically significant positive association between the SHBG and TT values was observed, but no such association was seen between SHBG, BT and FT. CONCLUSION: Low serum levels of SHBG are associated with higher prevalence of metabolic syndrome among male patients, but further studies are required to confirm this association. RESUMO

BackgroundThe radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention.ObjectiveTo compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route.MethodsFrom August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure.ResultsThe mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used.ConclusionsThe femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

ResumoAs doenças cardiovasculares (DCV) representam atualmente o principal grupo de causa de morte no Brasil. Os homens morrem mais de doença arterial coronariana e possuem níveis mais elevados de testosterona do que as mulheres. No entanto, estudos recentes indicam que os andrógenos podem ter efeito benéfico e/ou neutro no sistema cardiovascular masculino. Baixos níveis de testosterona endógena têm sido relacionados à presença de vários componentes da síndrome metabólica, incluindo dislipidemia, obesidade visceral, hipertensão arterial sistêmica e estados pró-trombóticos. Os dados da relação entre testosterona e reatividade vascular, aterosclerose e mortalidade cardiovascular nos homens são escassos, com os resultados de estudos disponíveis apresentando contradições. Grandes estudos randomizados e prospectivos são necessários para avaliar a função específica dos andrógenos nas DCV masculinas, para que melhores conclusões possam ser estabelecidas. AbstRActCardiovascular diseases (CVD) represent the main cause of death in Brazil. Men die more of coronary artery disease and they have higher levels of testosterone than women. However, recent studies indicate that androgens can have beneficial and/or neutral effect in the male cardiovascular system. Low levels of endogenous testosterone have been involved with the presence of some components of the metabolic syndrome including dyslipidemia, visceral obesity, hypertension and thrombus formation process. Consistent data on the relationship between testosterone and vascular reactivity, atherosclerosis and cardiovascular mortality in men are rare, with the results of available studies presenting contradictions. Large randomized and prospective trials are needed to evaluate androgen-specific function in male CVD so that better conclusions can be established. (Datasus, 2005).Existe uma divergência entre as taxas de morbidade e mortalidade por DCV entre homens e mulheres que se aproximam no período pós-menopausa. Os homens morrem duas vezes mais de doença arterial coronariana (DAC), possuem maior incidência de infarto agudo do miocárdio (IAM) e níveis mais elevados de testosterona do que as mulheres. Esse dimorfismo sexual em relação às DCV pode envolver fatores genéticos, hormonais e de estilo de vida. Uma das explicações mais utilizadas para a preponderância masculina das DCV seriam os elevados níveis de testosterona sugeridos como pró-aterogênicos e/ou a ausência do efeito protetor dos estróge-nos. Dessa forma, foi sugerido que os elevados níveis de

Background:The occurrence of acute renal failure (ARF) is associated with worse clinical outcomes after acute myocardial infarction (AMI), and its nature is multifactorial. The predictors and prognosis for ARF after primary percutaneous coronary intervention (PCI) are still not well established. Objective: To identify the predictors of ARF in patients submitted to primary PCI and to determine long term clinical evolution. Methods: This is a retrospective study which includes patients with ST-segment elevation myocardial infarction (STEMI) submitted to primary PCI from January, 2002 to January, 2007. Patients were classified with respect to ARF -an increase in creatinine ≥ 0.5 mg/dl or > 25% from baseline -during hospital stay. Follow-up data were obtained through medical records or by telephone contact to assess major events. Results: A total of 150 patients were enrolled. Mean age was 60 years old and 73% were men. Factors considered risk indicators for ARF such as diabetes mellitus (34%), Killip > 1 (27%), contrast volume and use of potential nephrotoxic drugs were also evaluated. ARF occurred in 15.3% of patients. After multivariate analyses: creatinine ≥ 1.5 mg/dl (OR 3.633 95% CI 1.047-12.613 p = 0.042), older age (OR 1.066 95% Cl 1.002-1.090, p = 0.044), p = 0.045) and the need for mechanical ventilation (OR 6.364 95% Cl 2.142-18.910, p = 0.001) were considered independent predictors for ARF. After a year of evolution, death (p = 0.001) and reinfarction (p = 0.048) had shown a significant difference between patients with and without ARF; differences were not found for revascularization (p = 0.305), dialysis (p = 0.281) or

A gênese do infarto agudo do miocárdio (IAM) está intimamente relacionada à ruptura de "placas vulneráveis". Estudos anatomopatológicos sugerem uma distribuição não-homogênea dessas placas ao longo da árvore coronária. Neste estudo, visamos a estabelecer as "zonas vulneráveis", no sentido de obter um mapa do risco de maior probabilidade de ocorrência de IAM. Método: Neste estudo, foram analisados 82 pacientes consecutivos tratados com angioplastia primária em um centro terciário de referência, no período de janeiro a setembro de 2007. Somente foram incluídos pacientes com IAM com elevação do segmento ST, com fluxo coronário TIMI 0/1. Após definir o segmento de oclusão, utilizando a segmentação coronária do Coronary Artery Surgery Study (CASS), mensuramos a distância do ponto de oclusão do vaso culpado até seu óstio, com software dedicado (CMS-Medis). O modelo de regressão de Poisson foi utilizado para determinar o risco de IAM, baseado na distância da oclusão a partir do óstio coronário. Resultados: A média das idades foi de 60 anos e 73,1% dos pacientes eram homens. A artéria descendente anterior foi o vaso culpado mais prevalente (46,3%). O diâmetro médio de referência do vaso foi de 2,8 ± 0,6 mm. Para cada segmento de 10 mm a partir do óstio do vaso-alvo, foi observada, pela regressão de Poisson, redução de 36,9% no risco de oclusão aguda do vaso. Nesta coorte notou-se distribuição nãohomogênea das placas vulneráveis, com maior prevalência nos segmentos proximais dos vasos epicárdicos. Conclusões: Os achados desta análise in vivo estão em concordância com os estudos anatomopatológicos prévios. Identificação das "zonas vulneráveis" na árvore coronária