Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Introduction We aimed to identify predictors of morbidity and mortality in patients undergoing isolated mitral valve replacement. Methods This is a retrospective cohort study with 164 patients who underwent isolated mitral valve replacement at a referral hospital for cardiovascular diseases, which were performed from January 2011 to December 2016. Data were obtained from medical records, including preoperative, intraoperative, and postoperative information. Statistical analysis was performed to calculate odds ratio (OR), unpaired Student's t -test, and binary logistic regression. P -values < 0.05 were considered significant. Results A total of 69.5% (n=114) of the patients had a diagnosis of rheumatic disease prior to surgery. Mortality rate was 6.7% (n=11). The most observed complication was the occurrence of postoperative arrhythmias (19.5%). On average, patients remained 5.34 days in the intensive care unit. There was a statistically significant enhanced risk of death among patients with previous diagnosis of endocarditis (OR 5.22, 95% confidence interval [CI] 1,368-19,915; P =0.008), reduced ejection fraction (EF) (< 50%) (OR 9.46, 95% CI 2,61-34,35; P <0.001), and mitral regurgitation (MR) (OR 7.7, 95% CI 1.576-37.545; P =0.004). Patients who died were older than those who survived surgery ( P <0.001) and had lower preoperative serum hemoglobin levels ( P =0.018). Logistic regression showed age and reduced EF at preoperative evaluation as predictors of death. Conclusion Older age, reduced serum hemoglobin levels, preoperative diagnosis of endocarditis, reduced EF, and MR were associated with postoperative mortality. Age and reduced EF were predictors of death.

Cardiovascular disease (CVD) is the leading cause of death in developed countries 1 and, in Brazil, despite regional differences, CVD kills more than any other cause. 2 CVD is also the leading cause of death among women, and usually occurs 7-10 years later than men. 1 However, the prevalence of this disease increases in the postmenopausal period, possibly due to the decrease in estrogen hormone levels.There are few data in the literature about the assessment of risk factors and treatment of CVDs in women, as compared to men, including in Brazil. This leads to a delay in the institution of appropriate therapies, so that women often receive less aggressive treatments and are less likely than their male counterparts to be managed following recommended guidelines. 3 Mitral valve disease is the most common valvular heart disease. In developing countries, the main cause of mitral valve stenosis is rheumatic fever, and mitral valve replacement is currently one of the most common

Cardiovascular disease (CVD) is the leading cause of death worldwide. For many years, it was believed that CVD was much more prevalent in men, probably due to the lack of studies that addressed this issue in women and their risk factors, according to their biological particularities. 1 Cardiovascular risk factors common to both genders have been identified. However, some studies have shown that these factors are associated with worse outcomes in women in comparison to men. [2][3][4] In general, women usually develop CVD 10 years later than men, so that the prevalence of CVD increases in the postmenopausal period, probably due to the decline in estrogen hormone levels. 5

Systemic hypertension (SH) is an important risk factor for cardiovascular events, especially stroke, which justifies the relevance of its proper management. In a meta-analysis conducted by Sarki et al., 1 the results showed a prevalence of 32.3% of SH, and Latin America was as one of the regions with the highest estimates (39.1%). 1 According to data from the American Heart Association, specifically in the African-American population, the prevalence of SH reaches 44.9% for black men, and 46.1% for black women. 2 A higher prevalence of SH in blacks was also identified in Brazilian studies. 3-5 Despite this high prevalence, pressure control is achieved in most cases with the appropriate choice of antihypertensive drugs. 6 However, still 9-18% of individuals with SH have blood pressure levels resistant to pharmacological treatment, which characterizes resistant hypertension (RH). 6-8