Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment)

ABSTRACT: The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy.

Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment).

The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort / Bronquiolite viral aguda e risco de asma em escolares: análise de coorte de recém-nascidos brasileiros

Abstract Objective: To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma. Methods: Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72 h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model. Results: Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p = 0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma. Conclusion: Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Resumo Objetivo: Verificar se a ocorrência de bronquiolite viral aguda (BVA) no primeiro ano de vida constitui fator de risco para asma aos seis anos considerando a história parental de asma. Métodos: Estudo de corte transversal aninhado a uma coorte de nascidos vivos. O questionário padronizado do International Study of Asthma and Allergies in Children (ISAAC) foi aplicado às mães para identificar asma nas crianças de seis anos. O diagnóstico de BVA foi feito por relato materno de diagnóstico médico e/ou presença de sintomas de coriza acompanhados de tosse, taquipneia e dispneia quando os participantes tinham três, seis, nove e 12 meses. Dados socioeconômicos, ambientais, história parental de asma e referentes à gestação foram coletados nas primeiras 72 horas de vida do recém-nascido e em visitas domiciliares prospectivas por entrevistadores treinados. Associação entre BVA e asma foi avaliada por análise de regressão logística e potencial efeito modificador da história parental verificado pela introdução do termo de interação no modelo de regressão logística ajustada. Resultados: A prevalência de BVA no primeiro ano de vida foi 68,6% (461). A ocorrência de BVA foi fator de risco para asma aos seis anos em crianças com história parental de asma OR: 2,66 (1,10-6,40), efeito modificador p = 0,002. História parental de asma OR: 2,07 IC95% (1,29-3,30) e sexo masculino OR: 1,69 IC95% (1,06-2,69) foram outros fatores de risco identificados para asma. Conclusão: BVA no primeiro ano de vida é fator de risco para asma em crianças com história parental de asma.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort.

OBJECTIVE: To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma. METHODS: Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model. RESULTS: Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma. CONCLUSION: Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis.

The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This was a prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (cohort A) to those treated with standard-of-care (SOC) antibiotics (cohort B). The primary outcome was in-hospital mortality. Time to clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed. There were 29 and 149 patients included in cohort A and cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg of body weight/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In cohort A, median time to clearance of methicillin-resistant S. aureus (MRSA) bacteremia was 1.0 day, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance compared to SOC (1.0 versus 5.0 days; P < 0.01). Regimens with higher daptomycin doses were not associated with increased incidence of AEs. In conclusion, higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens.

[Determinants of C-reactive protein in individuals with very low socioeconomic status].

BACKGROUND: Low socioeconomic (SE) status has been associated to inflammation and predictors of C-reactive protein (CRP) have been investigated by studies performed in developed countries. This study aimed to identify predictors of CRP in individuals of very low SE level in a developing country and evaluate whether CRP is related to SE status in this scenario. OBJECTIVE: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. METHODS: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. RESULTS: In the low SE individuals, independent predictors of CRP were body mass index > 25 Kg/m(2) (P<0.001), smoking (P=0.005) and acute infection conditions (P=0.049). The low SE group (median=2.02 mg/l; interquartile range 0.92 - 4.95 mg/dl) had higher CRP levels compared to the high SE group (1.16 mg/l, interquartile range 0.55 - 2.50 mg/dl, P=0.03). Body mass index tended to be higher (27 +/- 4.9 kg/m(2) vs 25.5 +/- 3.2 kg/m(2); P=0.07) and the prevalence of acute infection greater (32% vs 3%, P=0.002) in the low SE group. After overweight individuals and those with infectious conditions were excluded, the CRP levels were similar between the groups with low and high SE levels (0.93 mg/l vs 1.08 mg/l, P=0.28). CONCLUSION: Adiposity, infection conditions and smoking are predictors of CRP in individuals with very low SE level. The first two factors determine greater level of inflammation in low SE individuals when compared to the high SE counterparts.

Determinantes do valor da proteína C-reativa em indivíduos de nível sócio-econômico muito baixo / Determinantes del valor de la proteína C reactiva en individuos de nivel socioeconómico muy bajo / Determinants of C-reactive protein in individuals with very low socioeconomic status

FUNDAMENTO: Inflamação sistêmica exacerbada tem sido descrita em indivíduos de baixo nível sócio-econômico, porém estudos sobre determinantes dos valores de proteína C-reativa foram realizados apenas em países desenvolvidos. OBJETIVO: Identificar preditores de PCR em indivíduos de baixo nível SE em um país em desenvolvimento e avaliar se a PCR está relacionada ao nível SE nesse cenário. MÉTODOS: Oitenta e oito indivíduos de nível SE muito baixo foram recrutados de uma comunidade pobre, semi-rural no Brasil; 32 indivíduos de nível SE alto foram utilizados como amostra de comparação. A PCR de alta sensibilidade foi medida por nefelometria. RESULTADOS: Entre os indivíduos de baixo nível SE, os preditores independentes de PCR foram índice de massa corporal > 25 kg/m² (P<0,001), hábito de fumar (P=0,005) e condições infecciosas agudas (P=0,049). O grupo com baixo nível SE (mediana=2,02 mg/l; variação interquartil: 0,92 - 4,95 mg/dl) apresentou níveis mais altos de PCR quando comparado com o grupo de alto nível SE (1,16 mg/l, variação interquartil: 0,55 - 2,50 mg/dl, P=0,03). O índice de massa corporal foi mais alto (27 ± 4,9 kg/m² vs 25,5 ± 3,2 kg/m²; P=0,07) e a prevalência de infecção aguda foi maior (32 por cento vs 3 por cento, P=0,002) no grupo com baixo nível SE. Após exclusão de indivíduos com sobrepeso ou condições infecciosas, os valores de PCR foram similares entre os grupos com baixo e alto nível SE (0,93 mg/l vs 1,08 mg/l, P=0,28). CONCLUSÃO: Adiposidade, condições infecciosas e fumo são preditores de PCR em indivíduos com nível SE muito baixo. Os primeiros dois fatores são os determinantes da exacerbação da inflamação em indivíduos de muito baixo nível SE.

BACKGROUND: Low socioeconomic (SE) status has been associated to inflammation and predictors of C-reactive protein (CRP) have been investigated by studies performed in developed countries. This study aimed to identify predictors of CRP in individuals of very low SE level in a developing country and evaluate whether CRP is related to SE status in this scenario. OBJECTIVE: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. METHODS: Eight-two individuals of very low SE level were recruited from a poor, semi-rural community in Brazil. Thirty-two individuals of high socioeconomic level comprised a comparison sample. High-sensitivity CRP was measured by nephelometry. RESULTS: In the low SE individuals, independent predictors of CRP were body mass index > 25 Kg/m² (P<0.001), smoking (P=0.005) and acute infection conditions (P=0.049). The low SE group (median=2.02 mg/l; interquartile range 0.92 - 4.95 mg/dl) had higher CRP levels compared to the high SE group (1.16 mg/l, interquartile range 0.55 - 2.50 mg/dl, P=0.03). Body mass index tended to be higher (27 ± 4.9 kg/m² vs 25.5 ± 3.2 kg/m²; P=0.07) and the prevalence of acute infection greater (32 percent vs 3 percent, P=0.002) in the low SE group. After overweight individuals and those with infectious conditions were excluded, the CRP levels were similar between the groups with low and high SE levels (0.93 mg/l vs 1.08 mg/l, P=0.28). CONCLUSION: Adiposity, infection conditions and smoking are predictors of CRP in individuals with very low SE level. The first two factors determine greater level of inflammation in low SE individuals when compared to the high SE counterparts.

FUNDAMENTO: Se ha descrito inflamación sistémica exacerbada en individuos de bajo nivel socioeconómico, con todo, estudios sobre determinantes de los valores de proteína C reactiva sólo se han realizado en países desarrollo. OBJETIVO: Identificar predictores de PCR en individuos de bajo nivel SE en un país en desarrollo y evaluar si la PCR está relacionada al nivel SE en ese escenario. MÉTODOS: Se reclutaron ochenta y ocho individuos de nivel SE muy bajo de un comunidad pobre, semi-rural en Brasil, se utilizaron 32 individuos de nivel SE alto como muestra de comparación. La PCR de alta sensibilidad se midió por nefelometría. RESULTADOS: Entre los individuos de bajo nivel SE, los predictores independientes de PCR fueron índice de masa corporal > 25 kg/m² (P<0,001), hábito de fumar (P=0,005) y condiciones infecciosas agudas (P=0,049). El grupo con bajo nivel SE (mediana=2,02 mg/l; variación intercuartil: 0,92 - 4,95 mg/dl) presentó niveles más altos de PCR al compararlo con el grupo de alto nivel SE (1,16 mg/l, variación intercuartil: 0,55 - 2,50 mg/dl, P=0,03). El índice de masa corporal fue más alto (27 ± 4,9 kg/m² vs 25,5 ± 3,2 kg/m²; P=0,07) y la prevalencia de infección aguda fue mayor (32 por ciento vs 3 por ciento, P=0,002) en el grupo con bajo nivel SE. Tras la exclusión de individuos con sobrepeso o condiciones infecciosas, los valores de PCR fueron similares entre los grupos con bajo y alto nivel SE (0,93 mg/l vs 1,08 mg/l, P=0,28). CONCLUSIÓN: Adiposidad, condiciones infecciosas y tabaco son predictores de PCR en individuos con nivel SE muy bajo. Los primeros dos factores son los determinantes de la exacerbación de la inflamación en individuos de muy bajo nivel SE.

Valor Prognóstico da relação E/E' em pacientes com insuficiência renal crônica em início de hemodiálise / Prognostic value of E/E' ratio in patients with chronic kidney disease beginning hemodialysis

Fundamentos e objetivos: Doença cardiovascular é a principal causa de morte de pacientes com insuficiência renal crônica (IRC). Embora a taxa de mortalidade seja muito alta, não são todos os pacientes que morrem durante o período de acompanhamento. Variáveis do Doppler Tecidual parecem sofrer pouca influência das variáveis de precarga, observadas nos pacientes que fazem hemodiálise. A relação E/E' é capaz de predizer pressão capilar pulmonar e surge como preditor independentemente de morte em algumas situações clínicas. O objetivo deste estudo foi verificar se a relação E/E' seria preditora de morte nos pacientes com IRC, em fase inicial de tratamento com hemodiálise (HD). Métodos: Foram estudados 50 pacientes com IRC, em uremia e com indicação imediata...

Uso racional do ecocardiograma na avaliação da função diastólica do ventrículo esquerdo / Rational use of echocardiography for assessing left ventricular diastolic function

Fundamento e Objetivo: No estudo da função diastólica do ventrículo esquerdo (FDVE) com o ecocardiograma, analisa-se o fluxo mitral (FM) e o fluxo em veia pulmonar com o Doppler tecidual e a velocidade de programação do FM com o Doppler colorido modo-M (VPF). A análise conjunta dessas 5 modalidades ecocardiográficas proporciona a melhor análise da FDVE. Entretanto, nem sempre é possível utilizar todos esses métodos no mesmo paciente. O objetivo deste estudo foi verificar qual a forma de avaliação que apresenta a maior equivalência diagnóstica, com o resultado obtido pela análise em conjunto dos 5 métodos ecocardiográficos de avaliação da FDVE. Método: Estudo seccional em que foi avaliada a FDVE, nos pacientes encaminhados para a realização de ecocardiograma de rotina. Em todos eles, foram utilizadas as 5 formas de avaliação da FDVE. Resultados: Foram estudados 85 pacientes, com média etária 57 + - 14,7 anos de idade, 39 homens. Os pacientes foram distribuídos em 4 grupos, de acordo com a análise conjunta das 5 formas de avaliação da FDVE: G1 - padrão normal de FDVE (n=39); G2 - padrão de alteração do relaxamento do VE (n=22); G3 - padrão pseudonormal (n=11) e G4 - padrão restritivo (n=13). As taxas de concordância de cada método...

Optimizing the treatment of hypertension in the primary care setting.

OBJECTIVE: To assess the result of the care provided by an interdisciplinary team on the control of hypertension. METHODS: In a Health Unit, 88 patients were treated by an interdisciplinary team for 12 months. Visits to the physician or nurse occurred every one to three months, and to the nutritionist whenever necessary. Educational lectures were delivered regularly. Total cholesterol and fasting plasma glucose levels were determined at baseline and at 12 months. Clinical and laboratory data were analyzed and blood pressure was compared at baseline and at six and 12 months, and total cholesterol and plasma glucose were compared at baseline and at 12 months. RESULTS: Females accounted for 79.41% of the sample and the mean age was 58+/-9.90 years. Median blood pressure (BP) was 166.00/96.5 mmHg at baseline, 146.75/85.25 mmHg at 6 months (p<0,000) and 134.00/80.00 mmHg at 12 months (p<0.000). The rate of BP< or =140/90 mmHg increased from 10.23% to 48.81% (p<0.000). Median total cholesterol decreased from 217 mg/dl to 194.00 mg/dl (p<0.004) and median blood glucose from 101 mg/dl to 95 mg/dl (NS). At baseline, 50% of the patients received two antihypertensive drugs, 25% received three, and 5.68% received four, whereas at 12 months these percentages were 21.18%, 29.41% and 32.94%, respectively. CONCLUSION: The care provided by an interdisciplinary team may significantly improve the control of hypertension and of associated cardiovascular risk factors.

Otimização de recursos no cuidado primário da hipertensão arterial / Optimizing the treatment of hypertension in the primary care setting

OBJETIVO: Avaliar o resultado da atuação de uma equipe interdisciplinar no controle da hipertensão. MÉTODOS: Numa Unidade de Saúde, 88 pacientes foram assistidos por uma equipe interdisciplinar, por 12 meses. As visitas ao médico e à enfermeira ocorreram cada um a três meses, e à nutricionista, quando necessário. Palestras educacionais foram ministradas, regularmente. O colesterol total e a glicemia de jejum foram medidos, na admissão e aos 12 meses do estudo. Foram analisados dados clínicos e laboratoriais e comparados à pressão arterial, na admissão e aos 6 e 12 meses do estudo, e o colesterol total e glicemia, na admissão e aos 12 meses. RESULTADOS: Havia 79,41 por cento de mulheres e a idade média era 58±9,90 anos. A mediana da pressão arterial foi 166,00/96,5 mmHg, na admissão, 146,75/85,25 mmHg, aos seis meses (p<0,000) e 134,00/80,00 mmHg aos 12 meses (p<0,000). A taxa de PA<140/90 mmHg subiu de 10,23 por cento para 48,81 por cento (p<0,000). A mediana do colesterol total diminuiu de 217 mg/dl para 194,00 mg/dl (p<0,004), e da glicemia, de 101 mg/dl para 95 mg/dl (NS). Na admissão, 50 por cento dos pacientes usavam dois anti-hipertensivos; 25 por cento, três; e 5,68 por cento, quatro; enquanto aos 12 meses esses percentuais passaram a 21,18 por cento, 29,41 por cento e 32,94 por cento, respectivamente. CONCLUSÃO: A assistência por equipe interdisciplinar pode melhorar, significativamente, o controle da hipertensão e de fatores de risco cardiovascular associados.

OBJECTIVE: To assess the result of the care provided by an interdisciplinary team on the control of hypertension. METHODS: In a Health Unit, 88 patients were treated by an interdisciplinary team for 12 months. Visits to the physician or nurse occurred every one to three months, and to the nutritionist whenever necessary. Educational lectures were delivered regularly. Total cholesterol and fasting plasma glucose levels were determined at baseline and at 12 months. Clinical and laboratory data were analyzed and blood pressure was compared at baseline and at six and 12 months, and total cholesterol and plasma glucose were compared at baseline and at 12 months. RESULTS: Females accounted for 79.41 percent of the sample and the mean age was 58±9.90 years. Median blood pressure (BP) was 166.00/96.5mmHg at baseline, 146.75/85.25mmHg at 6 months (p<0,000) and 134.00/80.00mmHg at 12 months (p<0.000). The rate of BP<140/90mmHg increased from 10.23 percent to 48.81 percent (p<0.000). Median total cholesterol decreased from 217mg/dl to 194.00mg/dl (p<0.004) and median blood glucose from 101mg/dl to 95mg/dl (NS). At baseline, 50 percent of the patients received two antihypertensive drugs, 25 percent received three, and 5.68 percent received four, whereas at 12 months these percentages were 21.18 percent, 29.41 percent and 32.94 percent, respectively. CONCLUSION: The care provided by an interdisciplinary team may significantly improve the control of hypertension and of associated cardiovascular risk factors.

Síndrome metabólica na infância e adolescência: um fator maior de risco cardiovascular / Metabolic syndrome in children and adolescents: a major cardiovascular risk factor

A Síndrome Metabólica (SM), transtorno complexo representado por um conjunto de fatores de risco de doença cardiovascular aterosclerótica com elevada incidência e prevalência no adulto, tem início na infância e a sua evolução clínica no adulto é modulada por fatores hereditários e ambientais. O objetivo deste artigo é rever os principais aspectos etiopatogênicos, epidemiológicos, clínicos, terapêuticos e preventivos da síndrome metabólica, com enfoque na infância e adolescência. Os dados foram coletados no Medline, período de 1988 a 2005 - seleção de estudos anátomopatológicos, epidemiológicos, clínicos e de diretrizes, e permitiram a seguinte síntese: o conhecimento da síndrome metabólica na população pediátrica está em evolução; o sobrepeso/obesidade na infância e adolescência é o principal fator de risco predisponente para o desenvolvimento de doenças cardiovasculares na vida adulta, por facilitar o aparecimento de hiperinsulinemia, dislipidemia e hipertensão arterial; a identificação precoce e a implementação de medidas para o controle do sobrepeso/obesidade deve representar a principal forma de atuação do pediatra. Concluiu-se que a intervenção precoce sobre o estilo de vida de crianças e adolescentes é fundamental para prevenir complicações metabólicas e cardiovasculares na vida adulta.

Lipid profile correlates with glycemic control in young patients with type 1 diabetes mellitus.

Data on dyslipidemia in type 1 diabetes is scarce. The authors aimed to evaluate the lipid profile in patients with type 1 diabetes and its correlation to glycemic control. Ninety-four subjects (53.2% males), aged 15.4+/-4.7 (3.6-21.9 years), with disease duration of 5.0+/-3.6 years (0.3-17 years) were evaluated for heart rate, blood pressure, height, and weight. Laboratory data included total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs), glycemia, glycosylated hemoglobin (HbA1c), creatinine, thyroid-stimulating hormone, antithyroid antibodies, and 24-hour microalbuminuria. Correlations were performed by the Spearman rank correlation test, and the significance level was <0.05. Mean values were TC, 168.6+/-46.6 mg/d; HDL, 43.1+/-15.3 mg/dL; LDL, 110.9+/-40.6 mg/dL; TGs, 78.3+/-48.6 mg/dL; glycemia, 204.6+/-116.7 mg/dL; and HbA1c, 11.2%+/-2.9%. High TC (43.9% vs. 10.7%; p<0.002) and LDL (51.5% vs. 10.7%; p<0.01) were more prevalent in patients 19 years and younger (n=66). HbA1c correlated with TC (r=0.30; p=0.004), LDL (r=0.28; p=0.008), TG (r=0.31; p=0.003), and TG/HDL ratio (r=0.25; p=0.01). Duration of diabetes correlated with LDL (r=0.21; p=0.04) and insulin daily doses with TG (r=0.23; p=0.04) and body mass index expressed as z scores (r=-0.28; p=0.007). There was a high prevalence of hypercholesterolemia (54.6%) in these diabetic patients, and lipid fraction levels were correlated with HbA1c. Good management of diabetes seems to be of paramount importance in controlling dyslipidemia.

Prevalence of cardiovascular risk factors in selected samples of schoolchildren--socioeconomic influence.

Few data are available regarding the prevalence of cardiovascular risk factors in schoolchildren in Brazil. Weight, height, body mass index, blood pressure, and serum cholesterol were determined in 366 students, from 6-12 years of age, 209 (57.1%) from a private school and 157 (41.9%) from a public school, 187 (51.1%) female, aged 8.4+/-1.7 years. Prevalence of the risk of being overweight was 14.8%, being overweight/obese 13.1%, and presenting with elevated cholesterol (>/=170 mg/dL) was 28.1%, particularly at the private school: 21.5% vs. 5.7% for the risk of being overweight (p<0.001), 17.2% vs. 7.6% for being overweight/obese (p<0.01), 41.8% vs. 10.2% for cholesterol >/=170 mg/dL (p<0.001), and 14.8% vs. 1.3% for cholesterol >/=200 mg/dL (p<0.001), respectively. The results showed a high prevalence of risk factors among these school children, especially among private students.

Assessment of risk factors in coronary patients being followed by cardiologists: control of risk factors in coronary patients.

Control of risk factors for coronary heart disease secondary prevention is still very unsatisfactory. This study assessed 104 patients referred by cardiologists to discover how carefully National Cholesterol Education Program II recommendations were being followed. Average age of the cohort was 60.9+/-10.8 years, and 67.3% were men. A total of 57(54.8%) experienced a previous myocardial infarction and 83 (80.3%) a revascularization procedure. They saw their doctors 4.4+/-2.9 times a year and had blood tests 2.8+/-1.7 times a year. Blood pressure was >/=140/90 mm Hg in 57.8%, body mass index >/=25 kg/m2 in 62.5%, and the weight-to-hip ratio >/=0.95 in 42.9% of men, and >/=0.85 in 47.0% of women. Total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride values were 222.9+/-47.3 mg/dL, 144.9 mg/dL, 44.8+/-11.5 mg/dL, and 176+/-119.41 mg/dL, respectively. Low-density lipoprotein cholesterol was <100 mg/dL in 8.1%, and <130 mg/dL in 47.1%; the total cholesterol/high-density lipoprotein cholesterol ratio was 5.1+/-1.5 (>/=5 in 51%). In these patients, the control of major risk factors like high blood pressure, overweight, and high low-density lipoprotein cholesterol was poor.