Jornal SBC 192 | Julho 2018

Taqui News Brasileiros assinam editorial de publicação da ESC Viviane Rocha e Raul Dias dos Santos foram convidados e escreve- ram editorial publicado na edição do European Journal of Preventive Cardiology da European Society of Cardiology (ESC). O texto, com o título “ Cholesterol and inflammation: The lesser the better in athero- thrombosis ”, comenta a recente diretriz publicada por um grupo de especialistas daquela sociedade sobre a influência do colesterol e da inflamação como causas da aterosclerose e suas complicações. O editorial faz um resumo da evidência disponível, comenta al- guns pontos polêmicos e aborda as soluções bem-sucedidas para evitar a aterotrombose, destacando a comprovação do conceito da chamada dupla meta: ou seja redução da LDL-colesterol e da inflamação para prevenção adequada da doença cardiovascular. A íntegra do artigo pode ser lida no link : http://journals.sagepub. com/doi/full/10.1177/2047487318772936 Homenageados no Salão Nobre da APM Lopes e Chagas com a homenagem a Oscar Dutra Invited editorial Cholesterol and inflammation: The lesser the better in atherothrombosis Viviane Z Rocha 1 and Raul D Santos 1,2 For decades, longitudinal studies have supported the multifactorial nature of atherosclerosis. Indeed, unless in exceptional cases, there is no single cause that is fun- damental or sufficient by itself for the development of atherosclerotic disease. Overall, a variable combination of the so-called risk factors initiates the atherosclerosis process,andmaycontributetoitsevolution,andultim- ately to its complications. Interestingly, since the use of themedicalterm‘‘riskfactor’’byKanneletal. 1 wholed the way for the widely recognized Framingham Heart Study, the list of potential risk factors for cardiovascu- lar disease has dramatically increased. In addition to traditional risk factors such as hypercholesterolemia, for which the pivotal influence on the development of coronary heart disease has been established since the 1960s, several different plasma ‘‘markers’’, causal or not, emerged several years ago with the promise to helpidentifying those persons whoareprone toprema- ture atherothrombosis. 2–4 Among the distinct bio- markers, those reflecting a low-grade inflammatory status gathered most of the attention of scientific com- munity, not only because of their power of prediction of cardiovascular events observed in large-scale epide- miologic studies (high-sensitivity C-reactive protein (hsCRP) being the best example), 2 but also due to a well-recognized role of inflammation in atherosclerosis from experimental studies in the last three decades. 5 In this issue of European Journal of Preventive Cardiology , a Working Group of Atherosclerosis and Vascular Biology of the European Society of Cardiology addresses the close connections between these two risk factors, hypercholesterolemia and inflammation, concerning their synergistic biological contributions to atherosclerosis, and also their specific therapies, which nowseemcomplementaryapproachestoreducecardio- vascular risk (Table 1). 6 Cholesterol and inflammation – ‘‘partners in crime’’ As described in this Consensus paper, cholesterol and inflammation are biologically interrelated in their impact on atherosclerosis. 6 The entry and retention of low-density lipoprotein (LDL) particles within the arterial wall trigger several inflammatory signals, cul- minatingintheexpressionofadhesionmoleculesbythe endothelium and the local secretion of cytokines and chemokines, which ultimately contribute to accu- mulation of macrophages and other inflammatory cellsinthesubendothelialspace. 5,7 Thislipid-inflamma- tion interface reunites enough elements for setting up a proper soil for atherosclerosis initiation and often times, atherosclerosis progression. Beyond the well-known biological plausibility behind cholesterol’s role in atherogenesis, the causal relationship between low-density lipoprotein choles- terol (LDL-C) and atherosclerotic coronary heart dis- ease is currently unequivocal, with consistent and robust evidence from prospective epidemiologic cohort studies, 8 Mendelian randomization studies, 9,10 and randomized trials ofdifferentLDL-lowering thera- pies 10–12 that act by enhancing the LDL receptor- mediated apolipoprotein B containing lipoprotein clearance pathway. Cumulative data, including over 20m person-years of follow-up, have supported a dose-dependent, log-linear association between the magnitude of exposure to LDL-C and risk of athero- sclerotic cardiovascular disease (ASCVD). 10 The recent studies of outcomes of a new class of potent LDL- C-lowering agents, the monoclonal antibodies against proprotein convertase subtilisin kexin type 9 (PCSK9), reinforced this causal association. The Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial, 13 the combined Studies of PCSK9 Inhibition and the Reduction of Vascular Events (SPIRE) trials, 14 and the recently presented Evaluation of Cardiovascular Outcomes After an 1 LipidClinicHeartInstitute(InCor),UniversityofSaoPauloMedical SchoolHospital,Brazil 2 HospitalIsraelitaAlbertEinstein,Brazil Correspondingauthor: RaulDSantos,UnidadeClinicadeLipidesInCor-HCFMUSP,Av.DrEneas C.Aguiar44,Cep05403-900,SaoPaulo,SP,Brazil. Email :Raul.santos@incor.usp.br EuropeanJournalofPreventive Cardiology 0(00)1–4 ! TheEuropeanSocietyof Cardiology2018 Reprintsandpermissions: sagepub.co.uk/journalsPermissions.nav DOI:10.1177/2047487318772936 journals.sagepub.com/home/ejpc Oscar Dutra é homenageado pela Sociedade de Clínica Médica A Sociedade Brasileira de Clínica Médica, em virtude das comemorações dos seus 30 anos de fundação, realizou no final do mês de maio uma Sessão Solene no Salão Nobre da Associação Paulista de Medicina para entregar Meda- lhas de Mérito e Amigo da SBCM. O presidente da SBC, Oscar Dutra, foi condecorado pelo trabalho em favor da clínica médica no Brasil. Dutra foi representado na home- nagem pelo presidente da SBC (gestão 2008/2009) e atual diretor científico da AMB, Antônio Carlos Palandri Chagas, que recebeu o diploma do presidente da SBCM, Antônio Carlos Lopes. Fotos: Divulgação 14