Association between renal damage markers and carotid atherosclerosis in Afro-descendants with hypertension belonging to a minority ethnic group from Brazil.

Ethnicity appears to play an important role in the prevalence and severity of hypertension, renal disease, and atherosclerosis. A cross-sectional study was conducted, including 206 Afro-descendants with hypertension, living in the remaining quilombo communities. These subjects underwent a carotid intima-media thickness (CIMT) assessment. The presence of renal injury was assessed by: (1) The glomerular filtration rate (GFR) estimated by the formula CKD-EPI using creatinine and cystatin C and (2) Albuminuria (ACR ≥30 mg/g). The Poisson distribution model was set with robust variance to identify factors associated with carotid atherosclerosis. The statistical analysis was performed using the Stata 12.0 software, adopting a significance level of 5%. Most subjects were women (61.65%); the average age was 61.32 (±12.44) years. Subjects (12.62%) were identified with GFR <60 mL/min/1.73 m2 and 22.8% with albuminuria. Patients (59.22%) presented with a high CIMT. In the adjusted regression model, age ≥60 years (PR: 1.232 [CI 95%:1.091-1.390], p value = .001), ACR ≥30 mg/g (PR: 1.176 [CI 95%: 1.007-1.373], p = .040), and GFR/CKD-EPI using cystatin C (PR: 1.250 [CI 95%: 1.004-1.557], p = .045) were independently associated with carotid atherosclerosis. The occurrence of atherosclerotic lesions was high in the studied group. Age, albuminuria, and GFR (estimated by the formula CKD-EPI using cystatin C) influenced the prevalence of carotid atherosclerosis.

Sodium excretion and associated factors in urine samples of African descendants in Alcântara, Brazil: a population based study.

In most countries, salt intake has been excessive and constitutes one of the main risk factors for disease development, especially hypertension. Factors such as age, gender, sedentary lifestyle, smoking, African descent, obesity, dietary habits and family history of hypertension may be associated with high blood pressure. Studies show a positive association between the excretion of sodium and increased blood pressure. We evaluated the urinary excretion of sodium and associated factors in isolated urine samples of African descendants from remaining Quilombos. We performed a cross-sectional, population-based study with 1162 African descendants living in remaining quilombos in Alcântara, Maranhão, Brazil. Demographic, nutritional, clinical and laboratory data were analyzed. Urinary sodium excretion was estimated using the Kawasaki equation. A multivariate linear regression model was used to identify the variables related to sodium excretion. The average age was 37.6 ± 11.8 years and 51.2% were women. The prevalence of hypertension was 21.3%. The average urinary excretion of sodium was high, especially among the hypertensive (217.9 ± 90.1 vs. 199.2 ± 83.0 mmol/d; p = .002). After an adjusted analysis, only the waist circumference (odds ratios (OR) = 1.16; confidence intervals(CI)95%: 1.03-1.30), triglyceride (OR = 1.13; CI95%: 1.05-1.22), systolic blood pressure (OR = 1.19; CI95%: 1.08-1.32) and Chronic Kidney Disease Epidemiology (CKD-EPI;OR = 1.24; CI95%: 1.15-1.35) remained related to urinary sodium excretion. African descendants had a high rate of sodium excretion, especially among those who had hypertension. Abdominal adiposity, triglyceride and systolic blood pressure levels and renal function by CKD-EPI equation were associated to urinary sodium excretion.

Fatores de Risco Cardiovascular e sua Relação com o Nível de Escolaridade numa População Universitária / Cardiovascular Risk Factors and their Relationship with Educational Level in a University Population

Fundamentos: O menor grau de escolaridade na população parece estar associado com a maior prevalência dos fatoresde risco cardiovascular (FRCV). Contudo, poucos estudos avaliaram esse fato através de análise clínica e laboratorial em centros universitários. Objetivo: Avaliar a prevalência dos FRCV em servidores de universidade pública. Métodos: Estudo transversal, analítico, randomizado, com 319 participantes de uma coorte de servidores universitários. Analisou-se a prevalência dos FRCV através da medição dos níveis glicêmicos e pressóricos, perfil lipídico, índices antropométricos e foram realizadas análises comparativas de subgrupos de diferentes níveis de escolaridade. Realizou-se análise de regressão logística multivariada para avaliar a associação independente entre nível de escolaridade e presença dos FRCV. Resultados: Média de idade 46,0±10,0 anos, 52,5% mulheres, 56,0% com nível superior de escolaridade, 85,6% pertencentes às classes socioeconômicas B e C. Prevalência dos FRCV: diabetes mellitus (DM) 9,4%; hipertensão arterial sistêmica(HAS) 36,7%; dislipidemia 50,5%; tabagismo 21,9%; sobrepeso 59,6%; obesidade 13,2%; sedentarismo 27,9%. O grupo de menor nível de escolaridade se associou de forma independente com maior prevalência de DM e sedentarismo, quando comparado ao grupo dos servidores com nível superior (docentes e não docentes). DM=odds ratio 2,4(IC95% 1,05-5,5) e p=0,036; sedentarismo=odds ratio 2,2 (IC95% 1,3-3,7) e p=0,003. Os subgrupos não apresentaramdiferenças quanto às demais variáveis.

Background: The lower level of education in the population appears to be associated with a higher prevalence of cardiovascular risk factors(CVRF). However, few studies have assessed this fact by means of clinical and laboratory analysis in universities. Objective: To evaluate the prevalence of cardiovascular risk factors in public servants at a public university.Methods: Cross-sectional, analytical and randomized study, with 319 participants of a cohort composed of university public servants.CVRF prevalence was assessed by measuring blood glucose and blood pressure levels, lipid profile and anthropometric indices, and comparative analyses were made of subgroups with different education levels. A multivariate logistic regression analysis was used to assess the independentassociation between education level and presence of CVRF.Results: Mean age 46.0±10.0 years old, 52.5% women, 56.0% with higher education level, 85.6% belonging to B and C socioeconomic classes. Prevalence of CVRF: diabetes mellitus (DM) - 9.4%; systemic hypertension (SH) - 36.7%; dyslipidemia - 50.5%; smoking - 21.9%;overweight - 59.6%; obesity - 13.2%; sedentary lifestyle - 27.9%. The group with the lowest level of education had an independent association,with higher prevalence of DM and sedentary lifestyle, as compared to the group of public servants with higher level of education (teachersand non-teachers). DM=odds ratio 2.4 (95% CI 1.05 to 5.5) and p=0.036; sedentary lifestyle=odds ratio 2.2 (95% CI 1.3 to 3.7) andp=0.003. The subgroups showed no differences regarding the other variables. Conclusion: In this study, individuals with higher levels of education showed lower prevalence of diabetes and sedentary lifestyle.

Deficiência de vitamina D: um novo fator de risco cardiovascular? / Vitamin D deficiency: a new cardiovascular risk factor?

O papel da vitamina D na regulação do metabolismo ósseo já está bem estabelecido. Entretanto, nos últimosanos, vários estudos evidenciam que a função da vitamina D se estende muito além da saúde óssea, incluindo a regulação do sistema imunológico e efeitos antiproliferativos nas células, podendo ainda desempenhar papel importante na fisiologia do sistemacardiovascular. Evidências crescentes demonstram forte associação entre hipovitaminose D e hipertensão arterialsistêmica (HAS), síndrome metabólica (SM), diabetes mellitus (DM) e aterosclerose, podendo representar, pois,um fator de risco cardiovascular emergente. Os mecanismos pelos quais a vitamina D exerceria seus efeitos cardio e vasculoprotetores ainda não estão completamente esclarecidos, mas há inúmeras evidências de que ela possa exercer importantes papéis na regulaçãodo sistema renina-angiotensina (SRA), nos mecanismos de secreção e sensibilidade à insulina e na atuação dascitocinas inflamatórias, além de ações cardíacas e vasculares diretas. Nesta revisão, são apresentados vários estudos associando deficiência de vitamina D com marcadores de aterosclerose e risco cardiometabólico,assim como pequenos ensaios randomizados que avaliaram os efeitos cardiovasculares de sua suplementação. No entanto, embora seja plausívelconsiderar a suplementação dessa vitamina como um meio promissor de interferir favoravelmente no riscocardiovascular, grandes estudos randomizados e controlados com placebo, com poder estatísticoadequado para avaliação de desfechos pesados ainda são necessários para que se possa estabelecer definitivamente seu papel na prevenção e tratamento dadoença cardiovascular.(DCV)

The role of vitamin D in bone metabolism regulation is already well established. However, during the past fewyears, several studies have shown that the function of vitamin D extends well beyond bone health, including immune system regulation and antiproliferative effects in cells, while also playing an important role in cardiovascular system physiology. Growing evidence is demonstrating strong associations between hypovitaminosis D and hypertension, metabolic syndrome, diabetes and atherosclerosis, thus possibly indicating an emergent cardiovascular risk factor. Themechanisms through which vitamin D exerts its protective cardiovascular effects are not yet fully elucidated, but there is ample evidence that it may playimportant roles in renin-angiotensin system regulation, as well as insulin secretion and sensitivity mechanismsand the actions of inflammatory cytokines, in addition to direct cardiac and vascular actions. This reviewpresents several studies associating vitamin D deficiency with cardiometabolic risk and atherosclerosis markers,as well as some minor randomized clinical trials assessing the cardiovascular effects of vitamin Dsupplements. However, although it is plausible to consider vitamin D supplementation as a promisingway of intervening favorably in cardiovascular risk, major randomized placebo-controlled trials, with adequate statistical power for evaluating hardendpoints, are still needed in order to definitively confirm its role in the prevention and treatment ofcardiovascular diseases.

[Prevalence of subclinical atherosclerosis and cardiovascular risk reclassification by measure of carotid intima-media thickness in ambulatory hypertensive patients]. / Prevalência de aterosclerose subclínica e reclassificação de risco cardiovascular pela medida da espessura íntimo-medial carotídea em pacientes hipertensos ambulatoriais.

INTRODUCTION AND OBJECTIVES: Although carotid intima-media thickness (CIMT) is considered a surrogate marker of subclinical atherosclerosis, with known value in risk stratification, its routine use in hypertensive patients is not recommended. The aim of this study was to determine the prevalence of subclinical atherosclerosis through measurement of CIMT and its impact on reclassification of risk in hypertensive patients. METHODS: This was a cross-sectional study of 94 middle-aged (56.99±11.89 years) hypertensive outpatients without overt cardiovascular disease, 68.1% female. All participants underwent clinical examination, biochemical tests, echocardiogram and measurement of CIMT by high-resolution ultrasound. RESULTS: Although the majority of patients were stratified as low (63.5%) or intermediate risk (23%) according to their Framingham score, a high prevalence (75.3%) of increased CIMT was observed in the overall sample, including in the low (61%) and intermediate risk groups (93.8%). CIMT measurement resulted in risk reclassification of 70.31% of the patients, 61% of those at low risk being reclassified as intermediate risk and 93.8% of those at intermediate risk being reclassified as high risk. CONCLUSION: In these hypertensive outpatients, predominantly middle-aged and female, CIMT measurement revealed a high prevalence of subclinical atherosclerosis and resulted in risk reclassification in the majority of cases.

Correlação entre o índice de massa ventricular esquerda e a função endotelial em pacientes hipertensos / Correlation between left ventricular mass index and endothelial function in hypertensive patients

Fundamentos: Tanto a hipertrofia ventricular esquerda (HVE) como a disfunção endotelial representam importantes fatores de risco cardiovascular. No entanto, a correlação entre HVE e disfunção endotelial tem sido pouco explorada e ainda é motivo de controvérsias. Objetivo: Investigar a correlação entre o índice de massa do ventrículo esquerdo (IMVE) e a dilatação mediada por fluxo de artéria braquial (DMF), adotada como estimativa da função endotelial, em indivíduos hipertensos. Materiais e Métodos: Trata-se de estudo transversal envolvendo 94 hipertensos sem doença cardiovascular manifesta, com média de idade de 56,99 ± 11,89 anos, sendo 68,1% do sexo feminino. Todos os participantes foram submetidos a exame clínico, pesquisa de fatores de risco cardiovascular, dosagens bioquímicas, ecodopplercardiografia para determinação do IMVE e pesquisa da DMF por ultra-sonografia de alta resolução. Utilizouse a regressão linear múltipla para pesquisa da associação entre IMVE e DMF. Resultados: A média do IMVE foi de 104,4 ± 26,2 g/m2 e a da DMF, de 5,2 ± 5,7%. Na análise de regressão linear simples, observou-se uma correlação inversa significativa entre o IMVE e a DMF (ß = -0,389, p = 0,007). Após análise de regressão multivariada, a associação persistiu independentemente da pressão arterial, tanto sistólica quanto diastólica, proteína C reativa ultrassensível (PCR-US) e de outros fatores de risco cardiovascular. Conclusão: Observou-se correlação inversa significativa entre IMVE e DMF em hipertensos sem doença cardiovascular manifesta, independentemente da pressão arterial e do status inflamatório.

Background: Both left ventricular hypertrophy (LVH) and endothelial dysfunction represent important cardiovascular risk factors. However, the correlation between LVH and endothelial dysfunction has been little explored and is still a matter of controversies. Objective: To investigate the correlation between left ventricular mass index (LVMI) and flow-mediated dilation (FMD) of brachial artery , used as an estimative measure of endothelial dysfunction, in hypertensive patients. Materials and Methods: This is a cross-sectional study involving 94 middle-aged (56,99 ± 11,89 years) hypertensive outpatients without overt cardiovascular disease, being 68,1% female. All the participants underwent clinical examination, biochemical analyses, search for cardiovascular risk factors, transthoracic echocardiography for the determination of LVMI and assessment of FMD using a high-resolution Doppler B-mode ultrasound equipment. A multiple linear regression model was used to analyse the association between LVMI and DMF. Results: Mean LVMI was 104,4 ± 26,2 g/m2 and mean DMF, 5,2 ± 5,7%. Using simple linear regression, it was observed a significant inverse correlation between LVMI and FMD (ß = -0,389, p =0,007). This association remained significant even after adjustment for systolic and diastolic blood pressure, high sensitivity C-reactive protein (hs-CRP) and many other cardiovascular risk factors. Conclusions: In these hypertensive patients without overt cardiovascular disease, it was observed a significant inverse correlation between LVMI and FMD, which was independent of blood pressure and inflammatory status.

Adequação das indicações da intervenção percutânea na doença coronariana estável e preditores do seu emprego inapropriado em um hospital de ensino / Appropriateness of percutaneous intervention indications in stble coronary disease and inappropriate use predictors at a teaching hospital

Fundamentos: A intervenção coronariana percutânea(ICP) promove melhora sintomática e menor necessidade de antianginosos na doença coronariana estável, masnão reduz a incidência de infarto do miocárdio e morte. Objetivo: Avaliar a adequação das indicações de ICPem pacientes com doença coronariana estável em um hospital universitário.Métodos: Foram estudados 102 pacientes com doença coronariana estável submetidos consecutivamentea ICP em um hospital universitário, com média de idade de 65,9±10,7 anos, sendo 67,3 % homens. Coletaram-se informações referentes ao paciente(dados clínico-epidemiológicos, resultados de testes provocativos de isquemia e uso de antianginosos) e aomédico solicitante (tempo de formação e especialidade). Considerou-se adequada a indicação de ICP a pacientes com angina do peito refratária ao tratamento clínico ou a pacientes assintomáticos apresentando grande área de isquemia miocárdica em testes provocativos.Resultados: A indicação de ICP foi considerada adequada em 34 (33,3 %) pacientes, inadequada em 2 e incerta nos 66 restantes. À análise univariada,mostraram-se significativamente associadas à indicação de ICP inadequada/incerta as variáveis: idade mais elevada (p=0,001), aposentadoria (p=0,006) e ausência de tabagismo (p=0,041) e de dislipidemia(p=0,039), observando-se tendência à significância em relação a sedentarismo (p=0,094), renda mais baixa(p=0,013) e tempo de formação do médico solicitante ≥10 anos (p=0,094). Após análise de regressão logística,apenas idade mais elevada (OR=1,10 [1,06-11,1]; p=0,048), renda mais baixa (OR=2,84 [1,5-7,6]; p=0,039)e maior tempo de formação do médico solicitante...

Background: Percutaneous coronary intervention (PCI) results in improved symptoms and less need forantianginal medications for stable coronary artery disease, but does not reduce myocardial infarction and death rates. Objective: To assess the appropriateness of PCIindications in patients with stable coronary artery disease at a university hospital. Methods: The study involved 102 patients with stable coronary artery disease consecutively undergoing PCIat a university hospital, with a mean age of 65.9 ± 10.7 years and 67.3% male. Information was collected on the patient (clinical and epidemiological data,ischemia provocation test results and antianginal drug use) and the requesting physician (time since graduation and speciality). PCI indications wereconsidered appropriate for patients with angina pectoris to clinical treatment, or for asymptomatic patients presenting large areas of myocardial ischemia in provocation tests. Results: PCI indications were consideredappropriate for 34 (33.3%) patients, inappropriate for two others, and uncertain for the remaining 66.In the univariate analysis, the following variables were significantly associated with inappropriate/uncertain ICP indications: older (p=0.001), retired(p=0.006), non-smoker (p=0.041) and dyslipidemia (p=0.039), noting a trend towards sedentary lifestyles (p=0.094), lower income (p=0.013) and≥10 years time since graduation (p=0.094). After the logistic regression analysis, only the older (OR=1.10 [1.06-11.1]; p=0.048), lower income(OR=2.84[1.5-7.6]; p=0.039) and longer time since...

Correlação entre a cistatina C sérica e marcadores de aterosclerose subclínica em pacientes hipertensos / Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients

FUNDAMENTO: A cistatina C sérica (s-CC), um marcador endógeno da função renal, tem sido proposta também como um marcador de risco cardiovascular. No entanto, ainda não está estabelecido se se trata de um marcador direto de aterosclerose, independentemente da função renal. OBJETIVO: O objetivo deste estudo foi correlacionar a s-CC com dois marcadores substitutos de aterosclerose subclínica. MÉTODOS: Trata-se de um estudo transversal envolvendo 103 pacientes hipertensos ambulatoriais, de meia idade (57,49 ± 11,7 anos), sendo 60 do sexo feminino (58,25%) e a maioria com função renal preservada. A s-CC foi correlacionada com a espessura mediointimal carotídea (EMIc) e a dilatação mediada por fluxo de artéria braquial (DMF), ambas avaliadas por ultrassonografia, bem como com o clearance de creatinina medido e fatores de risco cardiovascular estabelecidos. RESULTADOS: A s-CC não se correlacionou significativamente nem com a EMIc (r = -0,024, p = 0,84) nem com a DMF (r = -0,050 e p = 0,687), e não foi observada também associação significativa com fatores de risco convencionais nem marcadores inflamatórios. Na análise univariada, a s-CC se correlacionou com o clearance de creatinina medido (r = - 0,498, p < 0,001), idade (r = 0,408, p < 0,001), microalbuminúria (r = 0,291, p = 0,014), ácido úrico (r = 0,391, p < 0,001), relação E/e' (r = 0,242, p = 0,049) e escore de Framingham (r = 0,359, p = 0,001). No entanto, após análise de regressão múltipla, apenas a associação com o clearance de creatinina medido permaneceu significativa (r = -0,491, p <0,001). CONCLUSÃO: Em pacientes hipertensos ambulatoriais de meia idade, a s-CC se correlacionou com o clearance de creatinina medido,como esperado, mas não foi observada associação com marcadores de aterosclerose nem com fatores de risco cardiovascular estabelecidos.

BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.

Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients.

BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.

Parâmetros ecocardiográficos como preditores de eventos cardiovasculares em pacientes em hemodiálise / Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients

FUNDAMENTO: Pacientes com doença renal crônica (DRC) em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o valor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV), fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005) e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042) foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise.

BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.

Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients.

BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.

Effect of kidney transplantation on cardiac morphology and function.

Cardiac involvement is very frequent in patients with chronic kidney disease on dialysis. Kidney transplantation results in reducing morbidity and mortality compared to patients on dialysis. The objective of this review was to address the effect of renal transplantation in cardiac structure and function assessed by echocardiography. Since the 1980s, studies have demonstrated a trend towards improvement in cardiac parameters after kidney transplantation. With the improvement of the Doppler imaging methods, the new studies, although with conflicting results, demonstrated improvement in systolic and diastolic function and reduction of left ventricular mass, especially in the first two years after renal transplantation with stabilization of the parameters in subsequent years. Overall, the body of evidence has demonstrated significant impact of renal transplantation on left ventricular hypertrophy, systolic and diastolic function, but the results are not uniform.

Efeito do transplante renal na morfologia e função cardíaca / Effect of kidney transplantation on cardiac morphology and function

O envolvimento cardíaco é muito frequente nos portadores de doença renal crônica em diálise. O transplante renal resulta em redução da morbidade e mortalidade em relação aos pacientes em diálise. O objetivo desta revisão foi abordar o efeito do transplante renal na estrutura e função cardíaca avaliada pela ecodopplercardiografia. Desde a década de 1980, os estudos já demonstravam tendência à melhora nos parâmetros cardíacos após o transplante renal. Com a melhora dos métodos de imagens ao ecodopplercardiograma, os estudos, apesar de alguns resultados conflitantes, demonstravam melhora na função sistólica e diastólica e redução da massa ventricular esquerda, principalmente nos primeiros dois anos após o transplante renal com estabilização dos parâmetros nos anos subsequentes. De forma geral, o corpo das evidências tem demonstrado impacto importante do transplante renal na hipertrofia ventricular esquerda, função sistólica e diastólica, porém os resultados não são uniformes.

Cardiac involvement is very frequent in patients with chronic kidney disease on dialysis. Kidney transplantation results in reducing morbidity and mortality compared to patients on dialysis. The objective of this review was to address the effect of renal transplantation in cardiac structure and function assessed by echocardiography. Since the 1980s, studies have demonstrated a trend towards improvement in cardiac parameters after kidney transplantation. With the improvement of the Doppler imaging methods, the new studies, although with conflicting results, demonstrated improvement in systolic and diastolic function and reduction of left ventricular mass, especially in the first two years after renal transplantation with stabilization of the parameters in subsequent years. Overall, the body of evidence has demonstrated significant impact of renal transplantation on left ventricular hypertrophy, systolic and diastolic function, but the results are not uniform.

[Metabolic syndrome in outpatient cardiology clinics]. / Síndrome metabólica em ambulatório cardiológico.

BACKGROUND: In Brazil, the prevalence of the metabolic syndrome (MS) is little known in several regions. OBJECTIVE: To analyze the prevalence of MS, its components and the agreement between two diagnostic definitions in a population aged > 13 years. METHODS: Cross-sectional study conducted from June to October 2007 in 719 patients of outpatient cardiology clinics in the city of São Luis, State of Maranhão, Brazil. Blood pressure (BP), weight, height, waist circumference and lipid profile were measured. Risk factors for MS were evaluated according to the International Diabetes Federation (IDF) definition. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression. RESULTS: The prevalence of MS was higher in both genders when using IDF definition (62.3% in men and 64.6% in women) than when using that of the National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48.9% in men and 59% in women). The most prevalent MS components were: hypertension (87.2% and 86%); hypertriglyceridemia (84.4% and 82.5%); increased waist circumference (77.8% and 100%); low HDL-c (58.1% and 49.9%); and high blood glucose (59.9% and 51.9%), using NCEP ATPIII and IDF definitions, respectively. In the adjusted analysis, age > 60 years and body mass index (BMI) > 30 were associated with a higher risk of MS (p<0.001). CONCLUSION: The prevalence of MS was much higher than in the overall population, and hypertension was the most prevalent component. There was good agreement between the two definitions, very good in the female gender and moderate in the male gender.

Síndrome metabólica em ambulatório cardiológico / Metabolic syndrome in outpatient cardiology clinics / Síndrome metabólico en ambulatorio cardiológico

Fundamento: No Brasil, a prevalência de síndrome metabólica (SM) é pouco conhecida em várias regiões. Objetivo: Analisar a prevalência da SM, seus componentes e a concordância entre dois critérios diagnósticos numa população com idade > 13 anos. Métodos: Estudo transversal, realizado de junho a outubro de 2007, em 719 pacientes, em ambulatórios cardiológicos de São Luís, MA. Mediu-se a pressão arterial (PA), peso, altura, circunferência abdominal e perfil lipídico. Avaliaram-se os fatores de risco para a SM segundo o critério da International Diabetes Federation (IDF). Razões de prevalência e intervalos de confiança de 95 por cento foram estimados pela regressão de Poisson. Resultados: A prevalência da SM foi maior em ambos os sexos pelo conceito da IDF (62,3 por cento em homens e 64,6 por cento em mulheres), em relação ao do National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48,9 por cento em homens e 59 por cento em mulheres). Os componentes da SM mais prevalentes foram: hipertensão arterial sistêmica HAS (87,2 por cento e 86 por cento); hipertrigliceridemia (84,4 por cento e 82,5 por cento); circunferência abdominal alterada (77,8 por cento e 100 por cento); HDL-c baixo (58,1 por cento e 49,9 por cento); e glicemia alterada (59,9 por cento e 51,9 por cento), pelos conceitos NCEP ATPIII e IDF, respectivamente. Após análise ajustada, idade > 60 anos e índice de massa corporal (IMC) > 30 foram associados a um maior risco de SM (p < 0,001). Conclusão: A prevalência da SM foi bem maior que a população geral; a (HAS) foi o componente mais prevalente. Houve boa concordância entre os dois critérios, sendo ótima no sexo feminino e regular no masculino.

Background: In Brazil, the prevalence of the metabolic syndrome (MS) is little known in several regions. Objective: To analyze the prevalence of MS, its components and the agreement between two diagnostic definitions in a population aged > 13 years. Methods: Cross-sectional study conducted from June to October 2007 in 719 patients of outpatient cardiology clinics in the city of São Luis, State of Maranhão, Brazil. Blood pressure (BP), weight, height, waist circumference and lipid profile were measured. Risk factors for MS were evaluated according to the International Diabetes Federation (IDF) definition. Prevalence ratios and 95 percent confidence intervals were estimated using Poisson regression. Results: The prevalence of MS was higher in both genders when using IDF definition (62.3 percent in men and 64.6 percent in women) than when using that of the National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48.9 percent in men and 59 percent in women). The most prevalent MS components were: hypertension (87.2 percent and 86 percent); hypertriglyceridemia (84.4 percent and 82.5 percent); increased waist circumference (77.8 percent and 100 percent); low HDL-c (58.1 percent and 49.9 percent); and high blood glucose (59.9 percent and 51.9 percent), using NCEP ATPIII and IDF definitions, respectively. In the adjusted analysis, age > 60 years and body mass index (BMI) > 30 were associated with a higher risk of MS (p<0.001). Conclusion: The prevalence of MS was much higher than in the overall population, and hypertension was the most prevalent component. There was good agreement between the two definitions, very good in the female gender and moderate in the male gender.

Fundamento: En Brasil, la prevalencia de síndrome metabólico (SM) es poco conocida en varias regiones. Objetivo: Analizar la prevalencia del SM, sus componentes y la concordancia entre dos criterios diagnósticos en una población con edad > 13 años. Métodos: Estudio transversal, realizado de junio a octubre de 2007, en 719 pacientes, en ambulatorios cardiológicos de São Luís, MA. Se midió la presión arterial (PA), peso, altura, circunferencia abdominal y perfil lipídico. Se evaluaron los factores de riesgo para el SM según el criterio de la International Diabetes Federation (IDF). Razones de prevalencia de intervalos de confianza del 95 por ciento se estimaron por la regresión de Poisson. Resultados: La prevalencia de SM fue mayor en ambos sexos por el concepto de la IDF (62,3 por ciento en hombres y 64,6 por ciento en mujeres), con relación al del National Cholesterol Education Program - Adult Treatment Prevention (NCEP ATPIII) (48,9 por ciento en hombres y 59 por ciento en mujeres). Los componentes del SM más prevalentes fueron: hipertensión arterial sistémica - HAS (87,2 por ciento y 86 por ciento); hipertrigliceridemia (84,4 por ciento y 82,5 por ciento); circunferencia abdominal alterada (77,8 por ciento y 100 por ciento); HDL-c bajo (58,1 por ciento y 49,9 por ciento); y glucemia alterada (59,9 por ciento y 51,9 por ciento), por los conceptos NCEP ATPIII y IDF, respectivamente. Después del análisis ajustado, edad > 60 años e índice de masa corporal (IMC) > 30 se asociaron a un mayor riesgo de SM (p < 0,001). Conclusión: La prevalencia de SM fue mucho mayor que la población general; la HAS fue el componente más prevalente. Hubo buena concordancia entre los dos criterios, siendo óptima en el sexo femenino y regular en el masculino.

Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome.

BACKGROUND: Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE: The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS: Thirty-five (35) patients who underwent surgical Roux's Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5% were female, with a mean age at the time of surgery of 37.8+/-11.1 years and a mean BMI of 45.0+/-6.2 Kg/m(2). During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS: Prior to surgery, MS was diagnosed in 27 patients (77.1%). When those patients were reevaluated 34.4+/-15 months after surgery, a reduction of mean BMI to 28.3+/-5.0 Kg/m(2) and MS was identified in only two patients (5.7%) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8%, 83%, 87.5%, 57.13% and 94% respectively. CONCLUSION: MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.

[Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil]. / Aspectos relacionados à escolha do tipo de parto: um estudo comparativo entre uma maternidade pública e outra privada, em São Luís, Maranhão, Brasil.

This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

Aspectos relacionados à escolha do tipo de parto: um estudo comparativo entre uma maternidade pública e outra privada, em São Luís, Maranhão, Brasil / Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil

Esta pesquisa objetivou analisar aspectos relacionados à escolha do tipo de parto em uma maternidade do serviço público e outra do serviço privado, em São Luís, Maranhão, Brasil. Trata-se de um estudo transversal abordando comparativamente 163 primíparas de uma maternidade pública e 89 de maternidade privada, com médias de idade de 21,63 ± 5,24 e 28,8 ± 5,41 anos, respectivamente. Preferiam o parto vaginal 79,1 por cento das gestantes da maternidade pública, e a cesariana 67,4 por cento das da maternidade privada (p < 0,0001). O parto cesáreo foi realizado em 46 por cento das mulheres da maternidade pública e em 97,8 por cento das da maternidade privada (p < 0,0001). A satisfação das parturientes foi elevada com as duas vias de parto, porém o desejo de repetir foi mais freqüentemente referido por aquelas submetidas ao parto vaginal (71,6 por cento vs. 41,3 por cento na maternidade pública e 100 por cento vs. 65,5 por cento na privada). Na maternidade pública, o subgrupo cesariana apresentava mais mulheres brancas e de melhor renda. A taxa de cesarianas foi, portanto, elevada nas duas maternidades, sendo significativamente maior no maternidade privada, observando-se ainda preferência pelo parto vaginal na pública e pela cesariana na maternidade privada.

This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 ± 5.24 and 28.8 ± 5.41 years, respectively. In the public hospital, 79.1 percent of the women reported preferring vaginal deliveries, while in the private hospital 67.4 percent of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46 percent of the women in the public maternity hospital and 97.8 percent of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6 percent vs. 41.3 percent in the public maternity hospital and 100 percent vs. 65.5 percent in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

Efeito da perda ponderal induzida pela cirurgia bariátrica sobre a prevalência de síndrome metabólica / Efecto de la pérdida ponderal inducida por la cirugía bariátrica sobre la prevalencia de síndrome metabólico / Effects of weight loss induced by bariatric surgery on the prevalence of metabolic syndrome

FUNDAMENTO: A síndrome metabólica (SM) está frequentemente ligada ao excesso de peso e melhora com a perda ponderal, sendo esperado que essa melhora seja proporcional à intensidade dessa perda. OBJETIVO: Avaliar o impacto da perda ponderal induzida pela cirurgia bariátrica (CB) sobre a prevalência da SM, em médio prazo. MÉTODOS: Foram analisados 35 pacientes submetidos à cirurgia de by-pass gastrojejunal em Y de Roux, no período de outubro de 2001 a outubro de 2005, em nosso HU, sendo 88,5 por cento do sexo feminino, com uma média de idade de 37,8±11,1 anos e um IMC médio de 45,0±6,2 kg/m². Na primeira etapa da pesquisa, foram obtidos dados demográficos e clínico-antropométricos antes da realização da CB, incluindo os critérios para o diagnóstico da SM, de acordo com as diretrizes do NCEP dos Estados Unidos. Na segunda etapa, os pacientes operados foram reavaliados ambulatorialmente quanto à prevalência da SM. RESULTADOS:Antes da cirurgia, a SM foi diagnosticada em 27 pacientes (77,1 por cento). Em reavaliação 34,4±15 meses após a cirurgia, observou-se uma queda do IMC médio para 28,3±5,0 kg/m² e a SM foi detectada em apenas dois pacientes (5,7 por cento) (p<0,001). A prevalência dos critérios cintura abdominal, glicemia, pressão arterial, HDL-colesterol e triglicerídeos foi reduzida em, respectivamente, 45,8 por cento, 83 por cento, 87,5 por cento, 57,13 por cento e 94 por cento. CONCLUSÃO: A SM é ocorrência comum em obesos candidatos à CB e esse procedimento se mostrou extremamente eficaz na indução da regressão da síndrome, verificando-se redução expressiva da prevalência de todos os critérios do NCEP.

BACKGROUND: Metabolic Syndrome (MS) is often linked to overweight/obesity and can improve after weight loss, such improvement is expected to be proportional to the intensity of weight loss. OBJECTIVE: The aim of this study was to evaluate the impact of weight loss induced by bariatric surgery (BS) on the prevalence of MS in a middle-term period. METHODS: Thirty-five (35) patients who underwent surgical Roux's Y gastrojejunal by-pass from October 2001 until October 2005 in our University Hospital were evaluated. 88.5 percent were female, with a mean age at the time of surgery of 37.8±11.1 years and a mean BMI of 45.0±6.2 Kg/m². During the first stage of our study demographic and clinical-anthropomorphic data were collected prior to the BC procedure, including those criteria needed for the diagnosis of MS, according to the guidelines of the US NCEP. The second stage consisted of reevaluation of those patients in the post-surgical period in order to determine the prevalence of MS in an outpatient setting. RESULTS: Prior to surgery, MS was diagnosed in 27 patients (77.1 percent). When those patients were reevaluated 34.4±15 months after surgery, a reduction of mean BMI to 28.3±5.0 Kg/m² and MS was identified in only two patients (5.7 percent) (p<0.001). Prevalence of individual criteria such as abdominal circumference, fasting glucose levels, arterial blood pressure, HDL-cholesterol and triglycerides had a reduction of 45.8 percent, 83 percent, 87.5 percent, 57.13 percent and 94 percent respectively. CONCLUSION: MS is a rather common feature in obese patients enrolled for BS and this procedure has been proved to be extremely efficient reversing the metabolic syndrome, with an expressive reduction of prevalence of each and all of the NCEP criteria.

FUNDAMENTO: El síndrome metabólico (SM) frecuentemente está vinculado al exceso de peso y mejora con la pérdida ponderal, esperándose que esta mejora sea proporcional a la intensidad de esa pérdida. OBJETIVO: Evaluar el impacto de la pérdida ponderal inducida por la cirugía bariátrica (CB) sobre la prevalencia de la SM, a medio plazo. MÉTODOS: Se estudiaron 35 pacientes sometidos a cirugía de bypass gastroyeyunal en Y de Roux, en el período de octubre de 2001 a octubre de 2005, en nuestro HU, siendo el 88,5 por ciento del sexo femenino, con un promedio de edades de 37,8±11,1 años y un IMC promedio de 45,0±6,2 Kg/m². En la primera etapa de la investigación, se obtuvieron datos demográficos y clínico antropométricos antes de la realización de la CB, incluyendo los criterios para el diagnóstico de la SM, de acuerdo con las directrices del NCEP de los Estados Unidos. En la segunda etapa, los pacientes operados se reevaluaron ambulatoriamente con relación a la prevalencia de la SM. RESULTADOS: Antes de la cirugía, fue diagnostica la SM en 27 pacientes (77,1 por ciento). En la reevaluación 34,4±15 meses después de la cirugía, se observó una disminución del IMC promedio para 28,3±5,0 Kg/m² y se detecto la SM sólo en dos pacientes (5,7 por ciento) (p<0,001). La prevalencia de los criterios cintura abdominal, glicemia, presión arterial, HDL-colesterol y triglicéridos, se redujeron respectivamente en: 45,8 por ciento, 83 por ciento, 87,5 por ciento, 57,13 por ciento y 94 por ciento. CONCLUSIÓN: La SM es común en obsesos candidatos a CB y este procedimiento se mostró extremadamente eficaz en la inducción de la regresión del síndrome, verificándose una reducción expresiva de la prevalencia de todos los criterios del NCEP.