RESUMO
Determination of different forms of 25-OHD (total, free and bioavailable) in healthy young women does not offer additional advantages over standard 25-OHDT for evaluating vitamin D deficiency. In these subjects 25-OHDT values <15 ng/ml would be more appropriate for defining this deficiency. INTRODUCTION: Determination of 25-OH vitamin D serum levels (25-OHD) constitutes the method of choice for evaluating vitamin D deficiency. However, vitamin D-binding protein (DBP) may modulate its bioavailability thereby affecting correct evaluation of 25-OHD status. We analysed the impact of the determination of 25-OHD (total, free and bioavailable) on the evaluation its biologic activity (estimated by serum PTH determination) in healthy young women. METHODS: 173 premenopausal women (aged 35-45 yrs.) were included. We analysed serum values of total 25-OHD (25-OHDT), DBP, albumin, PTH and bone formation (PINP,OC) and resorption (NTx,CTx) markers. Free(25-OHDF) and bioavailable (25-OHDB) serum 25-OHD levels were estimated by DBP and albumin determinations and also directly by ELISA (25-OHDF-2). We analysed threshold PTH values for the different forms of 25-OHD and the correlations and differences according to 25-OHDT levels <20 ng/ml. RESULTS: 62% of subjects had 25-OHD values <20 ng/ml and also had significantly lower 25-OHDF and 25-OHDB values, with no significant differences in bone markers and PTH values. The PTH threshold value was similar for all forms of 25-OHD (â¼70 pg/ml). Women with PTH values >70 had lower 25-OHDT (15.4 ± 1.4 vs. 18.3 ± 2.7, p < 0.05) and 25OHDB values (1.7 ± 0.2 vs. 2.2 ± 0.09, p < 0.05). The different forms of 25OHD were significantly intercorrelated, with marginal correlations between PTH and 25-OHDT (r = -0.136, p = 0.082). CONCLUSIONS: Determination of different forms of 25-OHD in healthy young women does not offer additional advantages over standard 25-OHDT for evaluating vitamin D deficiency. In these subjects 25-OHDT values <15 ng/ml would be more appropriate for defining this deficiency.
Assuntos
Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Adulto , Disponibilidade Biológica , Biomarcadores/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Pré-Menopausa/sangue , Vitamina D/sangueRESUMO
INTRODUCTION: Cerebrovascular disease (CVD) is responsible for the majority of disability-adjusted life years and is a leading cause of mortality. This impact justifies having up-to-date data on its incidence. PATIENTS AND METHODS: We conducted a systematic review of the studies published since 2010 that provided information on the crude incidence rate (CIR) and adjusted incidence rate of CVD during the second decade of the 21st century. RESULTS: Thirty-five articles were identified. Twenty-eight provided information on the overall incidence of CVD, 19 on the incidence of ischaemic stroke (IS), 19 on the incidence of haemorrhagic stroke (HS) and 10 on the incidence of subarachnoid haemorrhage (SAH). The incidence was heterogeneous across countries. Thus, the median CIR was 149.5 - confidence interval 95% (CI 95%): 122-256 - cases per 100,000 inhabitants for CVD; 155 (CI 95%: 95.6-246.12) for SI; 29 (CI 95%: 19-43) for HS; and 6.5 (CI 95%: 4.8-13.5) for SAH. The incidence for both CVD and IS and HS was higher in men than in women in most studies, with the exception of some Asian, European and North American studies. The majority of studies showed a decreasing or stabilising trend in incidence, with the exception of studies conducted in China, Singapore, France and Australia. CONCLUSION: There are few studies that analyse the incidence of CVD and even fewer that analyse its evolution. The overall median remains high, although the figures are heterogeneous across studies. Worldwide the trend is towards its decrease, and there are geographical areas, especially in Asia, with an alarming upward trend.
TITLE: Epidemiología del ictus en la última década: revisión sistemática.Introducción. La enfermedad cerebrovascular (ECV) es la responsable de la mayoría de los años de vida ajustados por discapacidad y una de las principales causas de mortalidad. Dicho impacto justifica disponer de datos actualizados sobre su incidencia. Pacientes y métodos. Se realizó una revisión sistemática de los estudios publicados desde 2010 hasta la actualidad que aportaran información sobre la tasa de incidencia cruda (TIC) y la tasa de incidencia ajustada de la ECV durante la segunda década del siglo xxi. Resultados. Se identificaron 35 artículos. Veintiocho ofrecieron información sobre la incidencia global de ECV, 19 sobre la incidencia de ictus isquémico (IcI), 19 sobre la de ictus hemorrágico (IH) y 10 sobre la de hemorragia subaracnoidea (HSA). La incidencia fue heterogénea entre países. Así, la mediana de la TIC fue de 149,5 intervalo de confianza al 95% (IC 95%): 122-256 casos por cada 100.000 habitantes para la ECV; 155 (IC 95%: 95,6-246,12) para el IcI; 29 (IC 95%: 19-43) para el IH; y 6,5 (IC 95%: 4,8-13,5) para la HSA. La incidencia tanto para la ECV como para el IcI y el IH fue mayor en los hombres que en las mujeres en la mayoría de los estudios, a excepción de algunos estudios asiáticos, europeos y norteamericanos. En la mayoría de los estudios se registró una tendencia al descenso o la estabilización en la incidencia, a excepción de estudios realizados en China, Singapur, Francia y Australia. Conclusión. Existen pocos estudios que analicen la incidencia y aún menos la evolución de la ECV. La mediana global continúa siendo elevada, aunque las cifras son heterogéneas entre los estudios. Existe una tendencia mundial a su decremento, y hay áreas geográficas, sobre todo en el continente asiático, con una preocupante tendencia al incremento.