Terapêutica na prática clínica cardiovascular: vivências e evidência

Abstract

The quality of evidence in Cardiology has been intensified in the last years. By exceeding classic pharmachological and biological foundation, evidence-based methods of classic medicine, particularly randomized clinical assay, were applied to clinical scenario, allowing for discriminating among efficient, inert and injurious therapies. Classic studies, such as the one that demonstrated the inefficiency of mammary artery ligature surgery in the treatment of refractory chest angina, were predominantly carried out in cardiovascular diseases. The assimilation of methods of evidencebased medicine by corporations with corresponding investment in research and promotion, has expanded therapeutic and diagnostic possibilities quite much. However, it has been experienced a time of distortions in the relationship among corporations, academy and professionals, resulting from a strong corporate bias, which influences priorities of research, disclosure and prescription. Public cost limitations require cardiologists to strongly qualify in knowing the paradigms of evidence-based medicine, to explore the accuracy of cardiovascular therapy with a socially tolerable cost. Evidence-based medicine: origin and developmentEvidence-based medicine has been ratified as new medical paradigm. It consists of the conscious, explicit and judicious use of the best evidences available in medical literature to make decisions on patient care 1 .That definition is universal and does not deeply disagree with ethical principles of medical profession. The physician has always performed medicine by basing on the best evidence available. What has really changed in the last decades was the quality of the evidence. Scientific evidences produced in the first half of last century, predominantly by physiology and pathology, has provided medicine with a strong biological basis, by eliminating magic and fantasy. In clinical scenario, however, diagnostic and therapeutic processes were not comparatively assessed, by understanding that observation and systematized description were sufficient to distinguish between what was false and what was true. It was understood that medical intervention in men consisted in a single experiment, which was similar to the one performed in hard sciences. However, there are many reasons that may explain the evolution to the cure, being the intrinsic effect of treatment the only one.Practically every disease naturally evolves to the cure or undergoes a period of control. Such condition, associated to the art of some therapists, to placebo effect and the regression to the mean, determines the success of many therapies 2 . The use of therapies clear intrinsic effect with is the condition that separates physicians from non-scientific therapists, charlatans and others.The detection of intrinsic effect of treatments was at first done by pharmacogical experiments. In those, the intervention control was required, so it would be possible to document that the effect observed in the experiment resulted from the intrinsic activity from the medi...

Opções farmacoterapêuticas para o manejo do Diabetes Mellitus Tipo 2: revisão da literatura

“…Research, Society andDevelopment, v. 12, n. 3, e15112340605, 2023 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v12i3.40605 O fármaco de primeira escolha para indivíduos com DM2 é a metformina, pertencente à classe farmacológicas das biguanidas, capaz de reduzir a produção de glicose pelo fígado a partir substâncias não-carboidratos (aminoácidos, ácido graxo, lactato, glicerol); de aumentar a captação de glicose pelo músculo esquelético e tecido adiposo, melhorando a sensibilidade periférica da insulina; e de diminuir a captação intestinal de glicose. Portanto, trata-se de um fármaco sensibilizador de insulina (Fuchs & Wannmacher, 2017).…”

“…Contudo, o efeito secretagogo ocorre na presença ou ausência de glicose, o que eleva o risco de hipoglicemia e promove ganho de peso. Dentre as sulfonilureias, a gliclazida e a glimepirida possuem menor índice de hipoglicemia se comparado com as outras opções da classe (Fuchs & Wannmacher, 2017;Lyra et al, 2022).…”

“…A associação de uma glinida à uma sulfonilureia não é recomendada em função da sobreposição de mecanismo de ação e de efeitos adversos, dado que o aumento de insulina promovido pelas glinidas também favorece o ganho de peso e a hipoglicemia. A eficácia na redução da glicemia é menor em comparação às sulfonilureias (Fuchs & Wannmacher, 2017;Lyra et al, 2022).…”

“…Contudo, a eficácia na redução da glicemia é menos expressiva em comparação às demais classes, além de provocar importantes efeitos adversos gastrointestinais, como flatulência e diarreia. Desta forma, é menos utilizada na prática clínica (Fuchs & Wannmacher, 2017;Santos, 2021).…”

“…O atraso na intensificação do tratamento pode ocorrer tanto em termos de adição, substituição ou aumento de dose de um antidiabético oral, quanto em termos de início de insulina ou de intensificação posterior de esquemas de insulina. Se, mesmo após o uso de combinações de fármacos sensibilizadores e secretagogos de insulina, o paciente permanece hiperglicêmico, ou quando ele recebe o diagnóstico já com valores elevados de HbA1c e com sintomas e complicações da doença, torna-se necessário iniciar o tratamento com insulina basal ou associação de insulinas (Fuchs & Wannmacher, 2017).…”