Determinants of Stroke in Brazil: A Cross-Sectional Multivariate Approach from the National Health Survey.

OBJECTIVE: The objective of this study was to investigate the association between biological-health, socioeconomics, and behavioral determinants and stroke by evaluating the risk of stroke in the presence of each or all determinants grouped in a multivariate model. METHODS: This study is a transversal secondary data analysis of the Brazilian National Health Survey, released by the Brazilian Institute of Geography and Statistics. The prevalence, prevalence ratios, and confidence intervals were calculated for the main outcome. A multivariate regression model was applied, with the stroke as outcome and all other variables with a P value of .20 or lower in the univariate analysis included as explanatory variables to adjust for potential confounders and effect modifiers. RESULTS: The mean age was 43.3 ± 16.6 years, ranging from 18 to 101 years. The prevalence of hypertension was 21.4%, and with regard to lifestyle habits, it was observed that 20.0% had smoked but stopped and 29.7% practiced physical activity in the last 30 days. The regression model showed that the odds ratio in the final model was weighted, with low schooling, smoking habit, overweight, low physical activity practice, diabetes, and hypertension being significantly associated with stroke. CONCLUSION: The multivariate model showed that the chance of stroke is high, both combined or isolated.

Relationship between diabetes mellitus and heart rate variability in community-dwelling elders.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is one of the most common non-communicable diseases (NCDs) and may influence the autonomic nervous system. This study aims to analyze the autonomic control, through heart rate variability (HRV), from community-dwelling elders with (DM+) and without diabetes mellitus (DM-). MATERIALS AND METHODS: This cross-sectional study, in which 205 elders (≥ 60 years old), from the urban area of Aiquara municipality gave their written consent to participate. HRV data was collected through a Polar RS800CX monitor with a 5-min initial record at rest, followed by the command to quickly stand up. RESULTS: The mean age was 71 years (SD, 7.32). The population was mostly made up of women 121 (59%), with low or no schooling 123 (60%), and low income 166 (81%). HRV analysis in a frequency domain showed no difference when comparing the two groups of DM+ and DM-. Henceforth in a time domain, the rMSSD showed a median value of 16.09 (interquartile range, 9.91-30.68); pNN50 median of 0.79 (interquartile range, 0.00-6.62), with a statistical significance between the group of DM+ and DM-. CONCLUSIONS: There is a difference between the studied groups principally in what concerns the time domain, which reflects the parasympathetic activity, suggesting that elders with diabetes mellitus may have a worse parasympathetic control.

Daily sodium intake influences the relationship between angiotensin-converting enzyme gene insertion/deletion polymorphism and hypertension in older adults.

The angiotensin-converting enzyme insertion/deletion (I/D) gene polymorphism has been widely reported as being associated with hypertension; however, most studies do not consider environmental/behavioral factors. This study aimed to investigate the relationship among angiotensin-converting enzyme insertion/deletion gene polymorphism, environmental/behavioral factors, and hypertension in community-dwelling elderly individuals. All community-dwelling older adults from Aiquara, Bahia, Brazil, were invited to take part in this study. After exclusions, 234 elderly participants were submitted to a data collection, which included sociodemographics, lifestyle and health status questionnaires, clinical assessment, and blood withdrawal. From the blood samples, the gene polymorphism was identified through polymerase chain reaction and patients grouped as II or D allele carriers (ID and DD genotypes). Hypertension was defined by self-report of the condition and confirmed by antihypertensive drug treatment. Chi-square test was used to identify differences in the proportions distributed between groups of each dependent variable (ie, genotype, diagnosis of hypertension, and blood pressure state from medicated patients with hypertension). The prevalence of hypertension was 59.3% and was associated with diabetes mellitus and obesity, but not with angiotensin-converting enzyme insertion/deletion gene polymorphism. However, carriers of the II genotype, a salt-sensitivity genotype, exhibited a significantly greater estimated sodium intake. In addition, among medicated elderly patients with hypertension, II genotype carriers exhibited poor blood pressure control, despite similar antihypertensive drug treatment in D allele carriers, while exhibiting a greater estimated sodium intake. Our results provide new evidence regarding the interaction of genetic and environmental/behavioral factors in the genesis of hypertension among elderly patients, as well as in blood pressure control in medicated elderly patients with hypertension.

The D allele of angiotensin-converting enzyme gene is associated with greater hemodynamic response to resistance exercises.

HYPOTHESIS/INTRODUCTION: The association of ACE I/D polymorphism and hemodynamic response to exercise have been limited to primarily aerobic exercises. We hypothesized that D allele carriers would show greater hemodynamic response to resistance exercise, as has been observed with aerobic. This study aimed to investigate the association of ACE I/D polymorphism and hemodynamic (blood pressure (BP), heart rate (HR) and rate-pressure product (RPP)) response to resistance exercise in young healthy subjects. MATERIALS AND METHODS: ACE I/D polymorphisms were studied by PCR analysis from 75 healthy men. Subjects completed a resistance exercise session of three sets of 10 knee extension repetitions with loads of 50, 75 and 100% of 10RM and two-minute rest intervals. Hemodynamic measures were recorded before and immediately after each set. Analysis of variance was used to identify significant differences among ACE genotypes. RESULTS: ACE I/D polymorphism is associated with hemodynamic response to resistance exercise, as healthy subjects with ACE D allele were prone to higher responses. In addition, this phenotypic difference seems to be a load-dependent trend. CONCLUSION: ACE DD carriers exhibit greater heart work during resistance exercise. Future studies should focus on the influence of resistance training period with different workloads on the hemodynamic response in healthy individuals with different ACE genotypes.