Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators.

OBJECTIVE: There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. METHODS: A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. RESULTS: The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. CONCLUSION: The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators

ABSTRACT Objective There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. Subjects and methods A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. Results The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. Conclusion The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Altered left ventricular twist is associated with clinical severity in adults and adolescents with homozygous sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk. METHODS: Forty patients with SCA (mean age, 23.5 ± 9.3 years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed. RESULTS: There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.4 ± 1.2° vs 10.7 ± 1.8°; P < .0001). Several variables were strongly related to LV twist, including the clinical severity index (ρ = -0.97, Z score = -6.05, P < .0001), E/e' ratio (r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure (r = 0.72, P < .0001). CONCLUSIONS: LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e' ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk.

Altered Left Ventricular Twist Is Associatedwith Clinical Severity in Adults and Adolescentswith Homozygous Sickle Cell Anemia

Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aimsof this study were to identify early markers of cardiac dysfunction through ventricular strain and ventriculartwist and determine the relationships between these measures and other markers of cardiovascular risk.Methods: Forty patients with SCA (mean age, 23.5 6 9.3 years; 24 male patients) and 40 age- and sexmatchedhealthy individuals were compared. All subjects participated in structured interviews, and bloodsamples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular(LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensionalspeckle-tracking echocardiography were performed.Results: There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, andradial), and global right ventricular longitudinal strain between patients and controls; however, LV twist wassignificantly lower in the patient group (mean, 7.4 6 1.2 vs 10.7 6 1.8 ; P < .0001). Several variables werestrongly related to LV twist, including the clinical severity index (r = 0.97, Z score = 6.05, P < .0001), E/e0 ratio(r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure(r = 0.72, P < .0001).Conclusions: LV twist is altered in patients with SCA. There were strong correlations between left ventriculartwist and clinical severity index, E/e0 ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure.These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greatercardiac risk.

Effects of intense and prolonged exercise on insulin sensitivity and glycogen metabolism in hypertensive subjects.

BACKGROUND: The information that insulin sensitivity and glycogen synthesis are reduced in hypertension arises primarily from studies using insulin infusions. Whether glycogen metabolism is actually altered in a physiological condition, such as during and after prolonged exercise, is currently unknown. METHODS AND RESULTS: To examine this issue, 9 hypertensive and 11 normotensive subjects were evaluated on a rest day and after intense and prolonged exercise on a separate day. Insulin sensitivity and hemodynamic variables were measured on both days. On the exercise day, whole-body substrate utilization was assessed and muscle biopsies were taken in the leg at baseline, immediately after exercise, and 2.5 and 4 hours after exercise. Insulin sensitivity at rest was lower in hypertensive than normotensive subjects (P<0.05) and increased after exercise in normotensive (P<0.01) but not in hypertensive (P=NS) subjects. Leg blood flow increased after exercise in both groups but to a lesser extent in hypertensive than normotensive subjects. Baseline glycogen content and maximal glycogen synthase activity were higher in hypertensive than normotensive subjects (P<0.001). Glycogen concentration decreased relatively less (-35 versus -66%) and returned to baseline levels faster in hypertensive subjects after exercise. Hypertensive subjects used approximately 40% less carbohydrates during exercise (P<0.001) at the expense of greater free fatty acid oxidation. CONCLUSIONS: It is concluded that increased intramuscular glycogen storage and resynthesis in hypertension are independent of blood flow and may represent compensatory mechanisms for the reduced insulin sensitivity and carbohydrate metabolism in this condition.

[Effect of environmental stress on blood pressure during the work shift]. / Efeito de estresse ambiental sobre a pressão arterial de trabalhadores.

OBJECTIVE: To evaluate blood pressure (BP) and heart rate (HR) behavior in individuals during the working journey in two environments with different work stressors. METHODS: The study comprised 46 male individuals working in a wood processing factory in Botucatu, Brazil. Twenty seven (27.4+/-5.4 yrs, mean+/-SD) worked in the production line performing intense physical activity (G1) at high room temperatures and noise levels. Nineteen (33.2+/-7.6 yrs old) performed managerial tasks mostly comfortably seated at low noise, air-conditioned offices (G2). After anthropometric measurements (obesity, total and local adiposity) and blood biochemistry analyses (glucose, triglycerides and cholesterol), their BP and HR were registered during three consecutive days at 3 different time of the day: in the beginning, in the middle and at the end of the working journey. RESULTS: There were similar BP and HR changes during the journey for G1 and G2, but G1 showed higher rates. Due to the wide variability of BP responses within each group, participants were divided in two subgroups: responders (GR1 and GR2) with BP increase >10%, and non-responders (GN1 and GN2). Both subgroups showed similar anthropometric and biochemical patterns differing only in their BP response and, in the case of GR1,family history for hypertension. GR1 showed higher BP and HR than GR2. CONCLUSIONS: Individual changes of BP and HR responses to environmental stressors during the working journey indicates that these factors should be considered while evaluating BP measurements and might be considered as potential factors for hypertension.

Efeito de estresse ambiental sobre a pressäo arterial de trabalhadores / Effect of environmental stress on blood pressure during the working journey

OBJETIVO: Analisar o comportamento de pressäo arterial (PA) e a freqüência cardíaca (Fc) de indivíduos ao longo da jornada de trabalho em dois ambientes com estresses ambientais distintos. MÉTODOS: Foram avaliados 46 funcionários, trabalhadores de uma indústria processadora de madeira, de Botucatu, SP, sendo 27 funcionários da linha de produçäo (esforço físico moderado-intenso, altas temperaturas e elevados níveis de ruído) (G1), e 19 da administraçäo (sem esforço físico, salas aclimatadas, baixos níveis de ruído) (G2). Todos foram submetidos a avaliaçäo antropométrica da composiçäo corporal (obesidade e adiposidade) e bioquímica do sangue (lipidemia) e, adicionalmente, o registro da PA e da Fc em três momentos do turno de serviço: início, meio e fim. RESULTADOS: Houve semelhança na variaçäo da PA entre G1 e G2, mas com maiores elevaçöes de PA e Fc em G1. Os resultados mostraram grande variabilidade na resposta da PA, levando à subdivisäo dos grupos G1 e G2 em respondedores (GR, aumento maior de 10 por cento na PA média) e näo respondedores (GN). Os subgrupos GR e GN apresentaram semelhanças nos padröes antropométrico e bioquímico diferindo apenas na resposta pressórica e no caso do GR1 na história familiar de hipertensäo. Comparando os subgrupos GR1 e GR2, foi constatado que os primeiros apresentaram maiores variaçöes de PA e Fc que os segundos. CONCLUSOES: A variaçäo individual da resposta pressórica e da Fc conforme o tipo de estresse ambiental indica ser este um fator adicional a ser considerado na avaliaçäo da pressäo arterial e, talvez, na gênese da hipertensäo arterial de operários

Efeito de diferentes protocolos de atividade física sobre a pressäo arterial e capacidade aeróbica de indivíduos adultos do sexo masculino: relaçäo com variáveis nutricionais, bioquímicas e hormonais / Effect of different protocols of physical activity on the arterial pressure and aerobic capacity of male adult subjects: relation with nutritional, biochemical and hormonal variables

Este trabalho foi realizado no período de março de 1991 a dezembro de 1993, tendo como objetivo avaliar o efeito de diferentes protocolos de atividade física sobre a pressäo arterial e capacidade aeróbia de indivíduos adultos do sexo masculino, com idade média de 56 ñ 5 anos, previamente sedentários. Para tanto, foram analisadas variáveis cardio-circulatórias (frequência cardíaca, pressäo arterial, desempenho em esteira ergométrica), nutricionais (ingestäo alimentar + antropometria), bioquímicas (colesterol), triglicérides, glicemia, ácido úrico, potássio, creatinina, cálcio e sódio urinário) e hormonais (catecolaminas, cortisol, insulina e peptídeo C), observadas antes e após 18 semanas de participaçäo nos protocolos de atividade física. Os indivíduos participantes dos protocolos de atividade aeróbia foram agrupados de acordo com a frequência semanal e tipo de seguimento ao programa em: GI (maior ou igual 3x/semana, supervisionado), GII (menor e maior ou igual 2x/semana) e GIII (maior ou igual 3x/semana, näo supervisionado). Os indivíduos do GIV participaram de um programa de relaxamento-alongamento por 12 semanas. A reduçäo da pressäo arterial foi associada à assiduidade, supervisäo pela equipe multiprofissional, diminuiçäo da adiposidade, da descarga adrenérgica, da insulinemia e dos níveis séricos de peptídeo C e cortisol. Estas adaptaçöes ao treinamento aeróbio foram encontradas somente no GI. A ingestäo alimentar näo variou em nenhum dos grupos. Houve variaçäo significativa, do ponto de vista biológico, da colesterolemia e calcemia somente no GI. A reduçäo de pressäo arterial, tanto sistólica como diastólica, observada no GI, foi significativamente maior que aquela observada no GIV e suficiente para aumentar a proporçäo de normotensos naquele grupo. Näo houve modificaçäo pressórica nos GII e GIII. O fato da reduçäo pressórica ter sido observada no mesmo grupo em que ocorreram adaptaçöes antropométricas e hormonais (GI), decorrentes do treinamento físico, indica que este tipo de protocolo pode ser utilizado como arma terapêutica eficaz no tratamento näo farmacológico da hipertensäo arterial.