Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals.

BACKGROUND: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. OBJECTIVES: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. METHODS: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. RESULTS: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). CONCLUSION: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Síndrome metabólica, aterosclerose e inflamação: tríade indissociável? / Metabolic syndrome, atherosclerosis and inflammation: an inseparable triad?

Observa-se, nas populações mundiais, aumento do sedentarismo e aumento do consumo de gorduras e açúcares, sendo estes vinculados normalmente aos alimentos industrializados. A consequência disso rapidamente se manifestou no aumento do sobrepeso/obesidade e na instalação de alterações fisiológicas e metabólicas, como a Síndrome Metabólica, que é representada por alterações na glicemia, nos lipídeos e na pressão arterial. Há evidências de ligação estreita entre estas alterações e os processos inflamatórios, que também podem estar associados ao estresse oxidativo. Estas condições levam à patogênese das alterações vasculares ou intensificam os processos metabólicos que acompanham a Síndrome Metabólica. O objetivo desta revisão foi comparar as inúmeras referências literárias que mostram correlação entre os componentes da Síndrome Metabólica e o aumento dos mediadores de inflamação. Para isso, utilizou-se Pubmed, Scopus, Lilacs e Scielo como base de dados, sendo que os artigos selecionados dataram principalmente dos últimos cinco anos.

Populations all over the world are increasingly inactive and are consuming increasing quantities of fats and sugars, which is generally linked to industrially processed foods. The consequences have rapidly manifest as an increase in overweight/obesity and in physiological and metabolic changes, such as the Metabolic Syndrome, which is a series of changes in glycemia, lipids and blood pressure. There is evidence of a close relationship between these changes and inflammatory processes, which can also be linked to oxidative stress. These conditions lead to the pathogenesis of vascular abnormalities or intensify metabolic processes that accompany the metabolic syndrome. The objective of this review is to compare the large number of bibliographic references that show correlations between components of the Metabolic Syndrome and increases in the mediators of inflammation. The publications reviewed were located using the Pubmed, Scopus, Lilacs and Scielo databases and the majority of the articles selected were published within the last 5 years.

[Characterisation of factors associated with carotid stenosis in a population at high risk]. / Caracterizacion de factores asociados con estenosis carotidea en una poblacion de alto riesgo.

INTRODUCTION: Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM: To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS: We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS: The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipidemia, and smoking as factors independently associated with carotid stenosis ≥50%, and hypertension and smoking with symptomatic stenosis. The number of risk factors was strongly associated with the prevalence of carotid stenosis. Notably, neither diabetes nor obesity explained the degree of moderate to severe carotid stenosis. CONCLUSIONS: As forms of carotid atherosclerotic disease, moderate to severe stenosis is less frequent than a high burden of atherosclerotic plaques. Advanced age, smoking, dyslipidemia and hypertension are the main traditional risk factors associated with the degree of carotid stenosis.

TITLE: Caracterizacion de factores asociados con estenosis carotidea en una poblacion de alto riesgo.Introduccion. La estenosis moderada a grave es la forma de enfermedad carotidea aterosclerosa menos prevalente, pero que implica un alto riesgo de ictus isquemico. Objetivo. Caracterizar los factores asociados con la estenosis carotidea moderada a grave en una poblacion de alto riesgo. Pacientes y metodos. Realizamos un analisis de los factores de riesgo tradicionales asociados a estenosis carotidea >= 50% en 533 pacientes que recibieron evaluacion mediante ultrasonograma Doppler por historia de ictus (34%), o que contaban con al menos dos de los factores de riesgo: edad >= 55 años (86%), hipertension (65%), dislipidemia (52%), obesidad (42%), diabetes (40%) o tabaquismo (40%). Resultados. La prevalencia de estenosis carotidea >= 50% fue del 7,1%, sintomatica (asociada a ictus en territorio congruente) en el 5,6%, bilateral en el 2,1% y sintomatica bilateral en el 1,5%. Un 36,8% de los pacientes presento carga moderada a grave (>= 4) de placas de ateroma (25,9%, moderada: 4-6 placas; y 10,9%, grave: >= 7 placas). Mediante analisis multivariable se identifico la edad >= 75 años, la dislipidemia y el tabaquismo como factores asociados con estenosis >= 50%, y la hipertension arterial y el tabaquismo con estenosis sintomatica. El numero de factores de riesgo se asocio fuertemente con la prevalencia de estenosis carotidea. Notablemente, ni la diabetes ni la obesidad explicaron el grado de estenosis moderada a grave. Conclusiones. Como formas de enfermedad carotidea aterosclerosa, la frecuencia de estenosis moderada a grave es menor que una carga alta de placas de ateroma. La edad avanzada, el tabaquismo, la dislipidemia y la hipertension son los principales factores tradicionales que se asocian con el grado de estenosis carotidea.

Atherothrombotic disease, traditional risk factors, and 4-year mortality in a Latin American population: the REACH Registry.

BACKGROUND: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk. HYPOTHESIS: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort. METHODS: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry. RESULTS: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index <20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥ 65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥ 30 (HR: 0.58) were associated with a reduced risk. CONCLUSIONS: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin American cohort. Nearly one-third of the population with 3 symptomatic vascular-disease locations died at 4-year follow-up.

Fatores de risco cardiovascular em adolescentes de município do sul do Brasil: prevalência e associações com variáveis sociodemográficas / Cardiovacular risk factors in adolescents from a town in the Brazilian South: prevalence and association with sociodemographic variables

OBJETIVO: Determinar a prevalência de fatores de risco cardiovascular e analisar sua associação com variáveis sociodemográficas em adolescentes do município de Três de Maio/RS. MÉTODOS: Estudo transversal de base escolar com amostra probabilística, estratificada por sexo e nível econômico, composta por 660 adolescentes de 14 a 19 anos, 343 moças (52 por cento). Foram investigadas as prevalências dos fatores de risco comportamentais (sedentarismo, dieta aterogênica, tabagismo) e biológicos (excesso de peso, excesso de adiposidade abdominal, pré-hipertensão/hipertensão arterial, hiperglicemia e dislipidemias) e sua associação com variáveis sociodemográficas (sexo, idade e nível econômico). As associações foram testadas por meio do teste qui-quadrado e razão de prevalência (intervalo de confiança de 95 por cento) entre os fatores de risco e as variáveis sociodemográficas. RESULTADOS: Os fatores de risco mais prevalentes foram: dieta aterogênica (98,3 por cento), sedentarismo (61,2 por cento), excesso de adiposidade abdominal (32,6 por cento), baixos níveis de lipoproteína de alta densidade (25,9 por cento) e colesterol total elevado (20,3 por cento). Foram encontradas associações significativas entre sexo feminino, sedentarismo [razão de prevalência (RP) = 1,33 (1,17 - 1,50)], excesso de adiposidade abdominal [RP = 2,44 (1,89 - 3,16)] e colesterol total elevado [RP = 1,89 (1,36 - 2,62)]; e, entre o sexo masculino, baixos níveis de lipoproteína de alta densidade [RP = 2,22 (1,67 - 2,94)] e pré-hipertensão/hipertensão arterial [RP = 4,87 (1,67 - 14,23)]. Verificou-se também,associação entre a idade de 17 a 19 anos e o tabagismo [RP = 1,84 (1,05 - 3,22)] e pré-hipertensão/hipertensão arterial [RP = 3,36 (1,43 - 7,90)]. O nível econômico não foi associado aos fatores de risco cardiovascular na amostra estudada. CONCLUSÃO: Os resultados indicam a necessidade de intervenções que promovam um estilo de vida saudável, com ênfase à adoção de hábitos alimentares adequados...

OBJECTIVE: To determine the prevalence of cardiovascular risk factors and analyze their association with sociodemographic variables among adolescents from the town Três de Maio, state of Rio Grande do Sul. METHODS: Cross-sectional and school-based study with a probabilistic sample method, stratified by sex and economic level, comprised of 660 14 to 19 year-old adolescents, 343 girls (52%). We investigated behavioral (inactivity, atherogenic diet, smoking) and biological (overweight and excess abdominal adiposity, prehypertension/hypertension, hyperglycemia and dyslipidemias) risk factors and their association with sociodemographic variables (gender, age and economic level). Associations were tested using the chi-square test and prevalence ratio (95% confidence interval) among risk factors and sociodemographic variables.RESULTS: The most prevalent cardiovascular risk factors were: atherogenic diet (98.3%), inactivity (61.2%), increased abdominal adiposity (32.6%), low high-density lipoprotein (25.9%), and increased total cholesterol (20.3%). Significant associations were found between being female and sedentary [prevalence ratio (PR) = 1.33 (1.17 - 1.50)], excess abdominal fat [PR = 2.44 (1.89 - 3.16)] and high total cholesterol [RP = 1.89 (1.36 - 2.62)]; and, between males and low levels of high density lipoprotein [RP = 2.22 (1.67 - 2.94)] and prehypertension/hypertension [RP = 4.87 (1.67 - 14.23)]. There was also an association between the 17 to 19 age group and smoking [OR = 1.84 (1.05 - 3.22)] and blood prehypertension/hypertension [RP = 3.36 (1.43 - 7.90)]. Economic level was not associated with cardiovascular risk factors in our sample. CONCLUSION: The results indicate the need for interventions that promote a healthy lifestyle, with emphasis on adopting a healthy diet and increasing levels of physical activity.

Fatores de risco cardiovascular em adolescentes: prevalência e associação com fatores sociodemográficos / Cardiovascular risk factors for adolescents: prevalence and association with sociodemographic factors

OBJETIVOS: Determinar a prevalência de fatores de risco cardiovascular (individual e co-ocorrência); e investigar a relação entre esses fatores e indicadores sociodemográficos em adolescentes. MÉTODOS: A amostra, selecionada por conglomerados em dois estágios (escolas, turmas), foi constituída de 782 adolescentes (14-17 anos de idade, 54,9 por cento do sexo feminino) do ensino médio no município de João Pessoa - PB, Brasil. As variáveis independentes foram sexo, idade e condição econômica. Os desfechos investigados foram: níveis insuficientes de atividade física, hábitos alimentares inadequados, pressão arterial elevada, etilismo, excesso de peso corporal e tabagismo. RESULTADOS: Níveis insuficientes de atividade física (59,5 por cento) e hábitos alimentares inadequados (49,5 por cento) foram os fatores de risco cardiovascular mais prevalentes. Pressão arterial elevada, etilismo e excesso de peso foram mais prevalentes no sexo masculino, e níveis insuficientes de atividade física no sexo feminino. Cerca de 10 por cento dos adolescentes não apresentaram nenhum fator de risco, e 51,4 por cento apresentaram dois ou mais fatores de forma simultânea. Os adolescentes do sexo masculino (OR = 1,89; 1,35 - 2,65) e aqueles que pertenciam aos estratos econômicos mais pobres tiveram maiores chances de apresentar um ou mais fatores de risco biológicos (OR = 1,69; IC95 por cento = 1,16 - 2,47). CONCLUSÃO: A prevalência de fatores de risco cardiovascular foi elevada, com destaque para a exposição simultânea a múltiplos fatores de risco. Os adolescentes do sexo masculino e os mais pobres foram os subgrupos com maior exposição a fatores de risco biológicos de forma simultânea.

OBJECTIVE: The objective of this study was to determine the prevalence of cardiovascular risk factors (individual and co-occurrence); and to analyze their relationship with demographic and socioeconomic variables in adolescents.METHODS: A two-stage cluster sampling process was used (school and class). The sample was made up of 782 adolescents (14 to 17 years old, 54.9% female), from high schools in the city of João Pessoa - PB, Brazil. Independent variables were: sex, age, and socioeconomic status. Outcomes were cardiovascular risk factors (insufficient levels of physical activity, poor dietary habits, high blood pressure, alcoholism, overweight, and smoking). RESULTS: Insufficient levels of physical activity (59.5%) and poor dietary habits (49.5%) were the most prevalent cardiovascular risk factors. High blood pressure, alcoholism, and overweight were higher among males than females, and insufficient levels of physical activity were more prevalent among females. Around 10% of these adolescents did not exhibit risk factors, while 51.4% had two or more cardiovascular risk factors. The odds of co-occurrence of biological risk factors were 1.89 (1.35 - 2.65) times greater for male adolescents and 1.69 (95% CI= 1.16 - 2.47) greater for those in the lowest socioeconomic strata.CONCLUSIONS: There was a high prevalence of cardiovascular risk factors, with a predominance of co-occurrence of exposure to more than one risk factor. Male and underprivileged adolescents were more likely to suffer co-occurrence of exposure to biological risk factors.

Modificación del grosor intima-media carotídeo según factores de riesgo clásicos y síndrome metabólico con o sin inflamación / Relation of intima-media thickness, traditional risk factors and metabolic syndrome in subjects with or without inflammation

El grosor intima-media carotideo (CIMT) es un marcador de aterosclerosis subclinica y eventos isquémicos cerebrales y coronarios. Si bien los valores normales promedio en Chile, han sido publicados, no existen datos locales de cómo se modifica el CIMT según la carga de factores de riesgo (FR) cardiovascular. Objetivos: Analizar la modificación del CIMT según la carga de FR clásicos, presencia de síndrome metabólico (SMET) y SMET más inflamación. Métodos: Hombres y mujeres de Santiago sin antecedente de eventos isquémicos previos, nivel socio económico medio, medio bajo y medio alto. En todos se realizó encuesta sobre antecedentes demográficos, FR cardiovascular, y medición de PA, IMC, cintura, y perfil lipídico, glicemia y proteína C-reactiva ultrasensible (ePCR) en ayuno. Para diagnóstico de SMET se usó NCEP ATPIII (2001), y para inflamación, ePCR> 2 mg/L (valor de corte de > riesgo porAHA). El CIMT se midió en carótida común derecha e izquierda con software MATH®. Resultados: Se incluyeron en el análisis 999 sujetos (508 hombres), edad promedio 43.8 +/- 11 años. La prevalencia de HTA fue 30 por ciento, dislipidemia 68 por ciento, tabaquismo 47 por ciento, y SMET 24 por ciento. El CIMT medio promedio fue 0.61 +/- 0.1 mm y la ePCR promedio 2.22 mg/L. La modificación del CIMT medio (mm) según número de FR (edad>45/55 hombre/mujer, diabetes, HTA, colesterol total > 200, HDL < 40/50, tabaquismo e historia familiar), fue la siguiente: 0 FR= 0.55 +/- 0.08; 1-2 FR= 0.59 +/- 0.091; > 3 FR= 0.67 +/- 0.12 (p < 0.0001). Asimismo, el CIMT aumentó según el puntaje de Framingham: < 5 por ciento = 0.58 +/- 0.09; 5-10 por ciento= 0.66 +/- 0.11; > 10-20 por ciento= 0.68 +/- 0.11; >20 por ciento > o = 0.76 +/- 0.14 (p < 0.0001). El CIMT fue significativamente mayor en los sujetos con SMET, y se incrementa en forma significativa cuando se adiciona ePCR>2 mg/L. En el modelo de regresión múltiple, el CIMT se asocia en forma conjunta a Framingham (p < 0.0001) y SMET+ePCR>2...

Carotid intima-media thickness (CIMT) is a marker for cerebral and coronary ischemic events. Normal values for CIMT in Chile have been published but the relation of CIMT to level of risk factors (RF) is unknown. Aim. To analyze the relation of CIMT to level of traditional RF and the presence of metabolic syndrome (MS), with or without inflammation. Methods. Males and females living in Santiago, Chile, with no prior history of ischemic events, of a low, medium or high socio-economic level, were studied. Demographic data, and presence of RF were obtained. Blood pressure, BMI, waist, blood lipids, blood glucose and US-CRP were measured in the fasting state. The presence of MS was defined by the NCEP-ATP III (2001) criteria. Inflammation was defined as US-CRP >2mg/L (the cut off point for increased risk, according to the AHA). CIMT was measure in both carotid arteries using the MATH® software. Results. 999 subjects (508 males), aged 43 +/- 11 years old. The prevalence of hypertension (HT) was 30 percent, dyslipidemia 68 percent, tobacco use 41 percent and MS 24 percent. Mean CIMT was 0.61 +/- 0.1 mm and US-PCR was 2.22 mg/L. CIMT according to number of RF - age > 45/55 (male/female), diabetes, HT, total cholesterol > 200 mg/dl, HDL < 40/50 mg/dl, tobacco use and family history- were: 0 RF: 0.55 +/- 0.08; 1-2 RF: 0.59 +/- 0.091; >3 RF: 0.67 +/- 0.12 (p < 0.0001). CIMT according to Framingham scores was: < 5 percent: 0.58 +/- 0.09; 5 - 10 percent: 0.66 +/- 0.11; 10 - 20 percent: 0.68 +/- 0.11 and > 20 percent: 0.76 +/- 0.14 (p < 0.0001). CIMT was significantly greater in subjects with MS and more in the group with US-PCR > 2mg/L. In multiple regression analysis, CIMT was jointly associated to Framingham score (p < 0.0001) and presence of MS + US-PCR >2 mg/L (p=0.01) (r2=0.19 for the model). Conclusion. CIMT increases in relation to traditional RF load and the presence of MS. An increased atherosclerotic risk in subjects with MS+inflammation (US-PCR > 2 mg/L)...

[Obesity in schoolchildren from Merida, Venezuela: association with cardiovascular risk factors]. / Obesidad en escolares de Mérida, Venezuela: asociación con factores de riesgo cardiovascular.

OBJECTIVE: To investigate the prevalence of obesity and associated cardiovascular risk factors in schoolchildren in our city, given the influence of these factors on the development of atherosclerosis. METHODS: We studied a representative sample of second grade students composed of 370 children aged 7.82+/-0.62 years (47.8% girls and 52.2% boys); 52.4% were from public schools and 47.6% were from private schools. Surveys were performed and anthropometric measurements, blood pressure (BP) values and glucose and lipid profiles in capillary blood were determined. RESULTS: A total of 9.7% (36 schoolchildren) were obese and 13.8% were overweight. There were no differences according to sex or school system. Abdominal obesity was observed in 69.4% (p<0.0001), normal-high BP (90-97th percentile) in 27.8% (p<0.0001), dyslipidemia in 66.7% (p<0.05) and metabolic syndrome in 38.9% (p<0.0001) of the obese children compared with 1.3%, 5.1%, 48.9% and 0.4% of the children with normal weight, respectively. No association was found between fasting hyperglycemia and obesity. There were no cases of hypertension or diabetes mellitus. The risk (odds ratio) for normal-high BP, dyslipidemia, abdominal obesity and metabolic syndrome was 6.3, 2.2, 60.9, and 70.2 times higher in obese children than in non-obese children, respectively. A positive and significant correlation was found between waist circumference and body mass index with BP and the atherogenic indexes triglycerides/high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C (p=0.0001). CONCLUSIONS: Compared with cities in other countries, the city of Mérida, Venezuela, has an intermediate prevalence of overweight and obesity in schoolchildren. The high frequency of cardiovascular risk factors in the obese and its positive correlation with adiposity highlights the need to implement population-based strategies for its prevention in childhood.

Arterioesclerosis subclínica, factores de riesgo cardiovascular clásicos y emergentes en niños obesos chilenos / Subclinical atherosclerosis: classic and emerging cardiovascular risk factors in Chilean obese children

La arteriosclerosis puede comenzar en la niñez y desarrollarse crónicamente dependiendo de la carga de factores de riesgo (FR) cardiovascular. Objetivo: Comparar niños obesos con eutróficos en cuanto a FR clásicos, emergentes (Proteína C Reactiva ultrasensible: PCRus) y arteriosclerosis subclínica, mediante dos nuevas técnicas no invasivas: dilatación mediada por flujo de la arteria braquial (DMF) y grosor de la íntima-media carotídea (IMT). Método: Se estudiaron 26 niños obesos (IMC ³ Pc95) y 57 eutróficos (IMC: Pc10 - Pc85). Se evaluó antropometría, presión arterial (PA), DMF, IMT, y se determinó de PCRus, perfil lipídico y glicemia de ayunas. Resultados: El 50 por ciento fueron mujeres y 41 por ciento prepúberes. Con edad de 9,9 + - 1,6 y 9,8 + - 1,8 años (ns), zIMC: 2,0 + - 0 2 y 1,7 + - 0,6, perímetro de cintura (por ciento Media): 133,5 + - 16 y 100,5 + -1 0 por ciento en obesos y eutróficos respectivamente. Los obesos tuvieron mayor Colesterol Total, CLDL, Triglicéridos, PCRus y menor CHDL (p < 0,005). No hubo diferencia significativa en DMF: 9,03 + - 5,2 por ciento vs 9,3 + - 4,2 por ciento, IMT: 0,49 + - 0,03 vs 0,50 + - 0,03 mm, glicemia ni PA. Conclusión: Este grupo de niños obesos chilenos presenta mayor carga de FR clásicos y nivel de PCRus que los eutróficos, pero no se encontró diferencia significativa en marcadores sustitutos de arteriosclerosis subclínica.

Doença aterosclerótica da artéria renal / Atherosclerotic Illness of the Renal Artery

Neste artigo, os autores discutem aspectos relacionados ao diagnóstico e ao tratamento da doença aterosclerótica da artéria renal. Destacam-se, também, as indicações para a revascularização de pacientes com estenose significativa da artéria renal...

In the present article, the authors address aspects related to the diagnosis and the management of renal artery atherosclerotic disease. The authors also point out the indications for the revascularization of patients with significant stenosis in renal artery.

Sex-dependent variables in the modulation of postalimentary lipemia.

OBJECTIVE: To quantify in young adults the sex-dependent differences in lipemic responses to a fat meal, we measured the association of these responses with markers of atherosclerosis and determined their metabolic regulators. METHODS: Forty-nine normolipidemic volunteers, 25 women and 24 men, were matched according to age, body mass index, waist circumference, diet, physical activity, and apolipoprotein-E phenotyping. After receiving a standardized fat meal (40 g of fat/m2 of body surface area), serial blood samples were drawn for laboratory analysis. Common carotid intima-media thickness was measured. RESULTS: The lipemic responses were much greater in men than in women for plasma triacylglycerol (TAG), cholesterol, and TAG in TAG-rich lipoproteins, non-esterified fatty acids, phospholipids, and apolipoprotein-B100. Men presented with increased blood pressure, carotid intima-media thickness, TAG, hepatic lipase, and insulin and lower high-density lipoprotein cholesterol, apolipoprotein-AI, and non-esterified fatty acid concentrations. Only in men did carotid intima-media thickness correlate marginally with titers of autoantibodies to epitopes of oxidized low-density lipoprotein; in addition, phospholipids and cholesteryl esters were negatively related to autoantibodies. Multivariate analysis indicated that age (R2 = 45%), waist circumference (R2 = 19%), phospholipids (R2 = 39%), non-esterified fatty acids (R2 = 29%), insulin (R2 = 17%), lipoprotein lipase activity (R2 = 16%), and cholesteryl ester transfer protein (an exploratory variable; R2 = 6%) are strong determinants of postalimentary lipemia in women and that only insulin (R2 = 55%) and phospholipids (R2 = 37%) are determinants in men. CONCLUSIONS: We have provided data explaining that postalimentary lipemia is differently regulated by sex. Several risk factors for coronary heart disease and significant associations with atherosclerosis biomarkers were found only in men.

Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.

Identifying individuals at high risk for diabetes: The Atherosclerosis Risk in Communities study.

OBJECTIVE: To develop and evaluate clinical rules to predict risk for diabetes in middle-aged adults. RESEARCH DESIGN AND METHODS: The Atherosclerosis Risk in Communities is a cohort study conducted from 1987-1989 to 1996-1998. We studied 7,915 participants 45-64 years of age, free of diabetes at baseline, and ascertained 1,292 incident cases of diabetes by clinical diagnosis or oral glucose tolerance testing. RESULTS: We derived risk functions to predict diabetes using logistic regression in a random half of the sample. Rules based on these risk functions were evaluated in the other half. A risk function based on waist, height, hypertension, blood pressure, family history of diabetes, ethnicity, and age was performed similarly to one based on fasting glucose (area under the receiver-operating characteristic curve [AUC] 0.71 and 0.74, respectively; P = 0.2). Risk functions composed of the clinical variables plus fasting glucose (AUC 0.78) and additionally including triglycerides and HDL cholesterol (AUC 0.80) performed better (P < 0.001). Evaluation of scores based on the metabolic syndrome as defined by the National Cholesterol Education Program or with slight variations showed AUCs of 0.75 and 0.78, respectively. Rules based on all these approaches, while identifying 20-56% of the sample as screen positive, achieved sensitivities of 40-87% and specificities of 50-86%. CONCLUSIONS: Rules derived from clinical information, alone or combined with simple laboratory measures, can characterize degrees of diabetes risk in middle-aged adults, permitting preventive actions of appropriate intensity. Rules based on the metabolic syndrome are reasonable alternatives to rules derived from risk functions.

Lipoprotein composition in children and adolescents with type 1 diabetes mellitus.

Atherosclerotic cardiovascular diseases are the major causes of morbidity and mortality in patients with diabetes mellitus. Both quantitative and qualitative abnormalities of lipo-proteins are associated with the development of atherogenesis. In this study, the prevalence of dyslipidemia and the relative levels of glycosylated lipoproteins in 20 children and adolescents with type 1 diabetes mellitus were determined. Lipid profile, apolipoproteins A-I and B, Lp(a) and LpA-I in plasma were assayed. LpB and glycosylated HDL and LDL were evaluated by ELISA. Diabetic patients and controls had normal lipid profiles, but the diabetic group showed significantly higher LpA-I and lower LpA-I:A-II concentrations than controls. The diabetic group showed a significantly higher glycosylation level of HDL than controls and did not show a statistical difference for glycosylated LDL. No significant correlation between glycosylated lipoproteins, glycemia or HbA1c was found. In conclusion, these results suggest that type 1 diabetic patients develop important qualitative lipid abnormalities.

Evaluation of risk for atherosclerosis in Alagille syndrome and progressive familial intrahepatic cholestasis: two congenital cholestatic diseases with different lipoprotein metabolisms.

OBJECTIVES: To evaluate the risk for atherosclerosis in Alagille syndrome (AGS) and progressive familial intrahepatic cholestasis (PFIC) on the basis of lipoprotein metabolism and by ultrasonography. STUDY DESIGN: Five patients with AGS and 5 with PFIC, ages 3 to 4 years, were enrolled. Intimal-medial thickness and wall stiffness of the common carotid artery were examined by ultrasonography. Serum levels of lipids and lipoproteins were determined. Further, the chemical composition of LDL and its ability to transform macrophages into foam cells were determined. RESULTS: Intimal-medial thickness and wall stiffness were increased in patients with PFIC but not in patients with AGS. Total cholesterol, LDL cholesterol, HDL cholesterol, and lipoprotein X were remarkably increased in patients with AGS, whereas in patients with PFIC, an increase in triglyceride and a decrease in HDL cholesterol were the prominent findings. However, despite the normal LDL cholesterol level, oxidized LDL level was strikingly high in patients with PFIC. LDLs from patients with PFIC had high TG contents and exhibited high abilities to transform macrophages into foam cells. CONCLUSIONS: These findings suggest that patients with PFIC are at high risk for cardiovascular disorders involving atherosclerosis.

Papel da inflamação na etiopatogenia da doença arterial coronária / Paper of inflammation in the etiopathogeny of heart disease

Estudos experimentais e clínicos epidemiológicos comprovaram que a aterosclerose é uma doença multifatorial. Os fatores que aumentam a sua prevalência, que aceleram sua evolução e que preenchem os critérios de casualidade são denominados fatores de risco. Os fatores que não preenchem os critérios de casualidade, mas podem ter importância para a maior inicidência de eventos clínicos, são designados maracdores de risco. A teoria inflamatória postula que que as citocians participam do mecanismo fisiopatológico da aterosclerose. Neste levantamento bibliográfico, avaliou-se a importância de váris marcadores inflamatórios: interleucinas, fator de necrose tumoral alfa, proteína C-reativa e proteína amilóide A...