Prevalence of cardiovascular risk factors among truck drivers in the South of Brazil.

BACKGROUND: Truck drivers work under conditions that predispose them to a high prevalence of risk factors for the development of cardiovascular disease (CVD); however, these factors have not been fully evaluated and are not usually considered to be within the scope of health or labor services. METHODS: An observational cross-sectional study was conducted on 250 long-distance truck drivers; the drivers were all male and were aged 18-60 years. The clinical evaluation consisted of an assessment of social habits and demographic data and an evaluation of risk factors for CVD at 3 time points separated by a one-week interval. To assess the associations with risk factors were used univariate and multivariate analysis. The suitability of the final model fit was assessed via the Hosmer-Lemeshow test. The significance level was set at 5%. RESULTS: Among all of the subjects, the prevalence of physical inactivity was 72.8%; consumption of alcoholic beverages, 66.8%; routine use of some type of stimulant during work activities, 19.2%; and smoking, 29%. Only 20.8% had a healthy weight, and 58.2% had an abdominal circumference greater than 102 cm. A diagnosis of arterial hypertension was confirmed in 45.2%, and abnormal glucose levels were detected in 16.4%. Although some of the truck drivers were aware of these conditions, most were not taking specific medications. The logistic regression analysis shows that the odds of hypertension and abnormal glucose levels were increased in truck drivers with abdominal obesity. Age and the family history of premature CVD also increased the chances of hypertension and the abnormal blood glucose levels were related to II or III grade obesity. CONCLUSION: Long-distance truck drivers showed a high prevalence of a cluster of cardiovascular risk factors; these risk factors make the drivers highly susceptible to the development of CVD. The associated risk factors, low compliance with drug treatment, and unique features of this profession suggest that traditional precautions are not sufficient to change this scenario.

Falso diagnóstico de miocardiopatia hipertrófica em feocromocitoma / A false dignosis of hypertrophic myocardiopathy in pheochromocytoma

A 24 year-old man was admitted with hypertensive crises and diagnosis hypothesis of neurofibromathosis and pheochromocytoma with blood pressure of 150 x 110mmHg and in use of anti-hypertensive drugs. The electrocardiogram (EKG) showed left ventricle hypertrophy. An echocardiogram showed interventricular septum (IVS) thickness of 16mm, posterior wall (PW) thickness of 11mm (ratio IVS/PW was 1.4). Diastolic ventricular diameter was 39mm with gradient of 52mmHg and mild mitral-valve murmur by pulsate Doppler. Increased vanillylmandelic acid and metanephrines in a 24-hour sample of urine has confirmed diagnosis of pheochromocytoma within was localized by 131I metaiodobenzyl-guanidine scan and computerized axial tomography. The patient was submitted to right adrenalectomy. Blood pressure was normalized. Evaluation an year later revealed a healthy man with normal laboratory exams, EKG and echocardiogram. It seems that the hypertrophy was consequence of the hypertension and pheochromocytoma, was not hypertrophic cardiomyopathy.

Homem de 24 anos foi admitido com hipótese diagnóstica de neurofibromatose e feocromocitoma, com pressão arterial (PA) de 150 x 110 mmHg e em uso de medicação anti-hipertensiva. O eletrocardiograma mostrava sobrecarga de ventrículo esquerda. O ecocardiograma relatado com diagnóstico de miocardiopatia hipertrófica assimétrica, mostrava a espessura de septo interventricular de 16mm, parede posterior de 11mm, diâmetro diastólico de 39mm, com gradiente intra-ventricular de 52mmHg e discreta regurgitação proto-sistólica valvar mitral ao doppler pulsátil. As dosagens de ácido vanilmandélico e de metanefrina urinárias confirmaram a suspeita clínica de feocromocitoma, localizado através da cintilografia com metaiodobenzilguanidina e tomografia axial computadorizada. Um ano após adrenalectomia direita se encontra assintomático, com PA, alterações laboratoriais, eletrocardiográficas e ecocardiográficas normais, evidenciando assim, que a hipertrofia de ventrículo esquerdo (HVE) era conseqüência da hipertensão arterial do feocromocitoma e não da miocardiopatia hipertrófica. Esta regressão da HVE excluiu, assim, o falso diagnóstico de micardiopatia hipertrófica