Aumento do trabalho miocárdico desperdiçado como indicador de lesão coronariana significativa / Increased wasted myocardial work as an indicator of significant coronary lesion

Introdução: A avaliação dos índices de trabalho miocárdico global em condições basais pode ser útil para a estratificação clínica de pacientes com suspeita de obstrução coronariana. Objetivo: Correlacionar o valor do índice de trabalho miocárdico global e a presença de lesões obstrutivas coronarianas significativas. Método: Estudo transversal, com pacientes encaminhados para cinecoronarioangiografia eletiva. Foi realizado ecocardiograma com obtenção das medidas para cálculo do valor do trabalho miocárdico, sendo avaliada a presença de lesões obstrutivas coronarianas significativas à cinecoronarioangiografia. Resultados: A amostra foi composta de 30 pacientes, com a idade média de 64,2±12,8 anos, sendo a maioria do sexo masculino (63,3%), dos quais 68,4% apresentaram lesões obstrutivas coronarianas significativas. O índice de trabalho miocárdico global foi de 1.876mmHg%±253,8 no grupo com lesões obstrutivas coronarianas significativas e de 2.054,2mmHg%±417,3 naqueles sem lesões significativas (p=0,089). O trabalho miocárdio construtivo global nos pacientes sem lesões obstrutivas coronarianas significativas foi maior (2.329,3mmHg%±462,9) do que naqueles com lesões obstrutivas coronarianas significativas (2.109,5mmHg%±332,3; p=0,064). O trabalho miocárdio desperdiçado global foi maior nos pacientes com lesões obstrutivas coronarianas significativas (103,7mmHg%±47,1 versus 68,3mmHg%±33,8; p=0,038). O ponto de corte de 115mmHg% foi aquele com a melhor área sob a curva (0,625), com sensibilidade de 83,3%. Conclusão: O aumento do trabalho miocárdio desperdiçado global se correlacionou com a presença de lesões obstrutivas coronarianas significativas em nossa amostra.(AU)

Introduction: The assessment of global myocardial work indices under baseline conditions may be useful for the clinical stratification of patients with suspected coronary obstruction. Objective: To correlate the value of global myocardial work indices and the presence of significant obstructive coronary lesions. Method: Cross-sectional study, with patients referred for elective coronary angiography. An echocardiogram was performed to obtain measurements to calculate the value of myocardial work and evaluated the presence or presence of significant obstructive coronary lesions at coronary angiography. Results: The sample consisted of 30 patients, with a mean age of 64.2±12.8 years, the majority being male (63.3%), of which 68.4% had significant obstructive coronary lesions. The global myocardial work indices was 1,876mmHg%±253.8 in the group with significant obstructive coronary lesions and 2,054.2mmHg%±417.3 in those without significant lesions (p=0.089). Global constructive myocardial work in patients without significant obstructive coronary lesions was higher (2,329.3mmHg%±462.9) than in those with significant obstructive coronary lesions (2,109.5mmHg%±332.3; p=0.064). Global wasted myocardial work was higher in patients with significant obstructive coronary lesions (103.7mmHg%±47.1 versus 68.3mmHg%±33.8; p=0.038). The cutoff point of 115 mmHg% was the one with the best area under the curve (0.625), with a sensitivity of 83.3%. Conclusion: The increase in global wasted myocardial work correlated with the presence of significant obstructive coronary lesions in our sample. (AU)

Metabolic syndrome, insulin resistance and other cardiovascular risk factors in university students.

A cross-sectional population-based study using questionnaire and anthropometric data was conducted on 968 university students of São Luís, Brazil, from which 590 showed up for blood collection. In the statistical analysis the Student t-test, Mann-Whitney and chi-square tests were used. The prevalence of metabolic syndrome by the Joint Interim Statement (JIS) criteria was 20.5%, almost three times more prevalent in men (32.2%) than in women (13.5%) (P < 0.001). The prevalence of insulin resistance was 7.3% and the prevalence of low HDL-cholesterol was high (61.2%), both with no statistically significant differences by sex. Men showed a higher percentage of smoking, overweight, high blood pressure, high blood glucose and increased fasting hypertriglyceridemia. Women were more sedentary. University students of private institutions had higher prevalences of sedentary lifestyle, obesity, abdominal obesity, elevated triglycerides and metabolic syndrome than students from public institutions. High prevalences of metabolic syndrome, insulin resistance and other cardiovascular risk factors were found in this young population. This suggests that the burden of these diseases in the future will be increased.

Metabolic syndrome, insulin resistance and other cardiovascular risk factors in university students / Síndrome metabólica, resistência insulínica e outros fatores de risco cardiovascular em universitários

Abstract A cross-sectional population-based study using questionnaire and anthropometric data was conducted on 968 university students of São Luís, Brazil, from which 590 showed up for blood collection. In the statistical analysis the Student t-test, Mann-Whitney and chi-square tests were used. The prevalence of metabolic syndrome by the Joint Interim Statement (JIS) criteria was 20.5%, almost three times more prevalent in men (32.2%) than in women (13.5%) (P < 0.001). The prevalence of insulin resistance was 7.3% and the prevalence of low HDL-cholesterol was high (61.2%), both with no statistically significant differences by sex. Men showed a higher percentage of smoking, overweight, high blood pressure, high blood glucose and increased fasting hypertriglyceridemia. Women were more sedentary. University students of private institutions had higher prevalences of sedentary lifestyle, obesity, abdominal obesity, elevated triglycerides and metabolic syndrome than students from public institutions. High prevalences of metabolic syndrome, insulin resistance and other cardiovascular risk factors were found in this young population. This suggests that the burden of these diseases in the future will be increased.

Resumo Estudo transversal de base populacional, usando questionários e medidas antropométricas, feito em 968 universitários de São Luís, dos quais 590 realizaram também coleta de sangue. Na análise estatística foram utilizados os testes t de Student, Mann-Whitney e qui-quadrado. A prevalência de síndrome metabólica pelo critério Joint Interim Statement (JIS) foi de 20,5%, sendo quase três vezes mais prevalente nos homens (32,2%) do que nas mulheres (13,5%) (P < 0,001). A prevalência de resistência insulínica foi de 7,3% e a de HDL-colesterol diminuído foi elevada (61,2%), ambas sem diferença estatisticamente significante por sexo. Os homens apresentaram maior percentual de tabagismo, sobrepeso, hipertensão arterial, glicemia em jejum aumentada e hipertrigliceridemia. As mulheres eram mais sedentárias. Os universitários de instituições privadas tiveram maiores prevalências de sedentarismo, obesidade, obesidade abdominal, triglicerídeos aumentados e síndrome metabólica do que os alunos de instituições públicas. Prevalências elevadas de síndrome metabólica, resistência insulínica e outros fatores de risco cardiovascular foram encontradas nesta população jovem. Isto sugere que a carga destas doenças será elevada no futuro.

Gravidade da doença arterial coronariana e síndrome metabólica: exste associação? / Severity of coronary artery disease and metabolic syndrome: is there an association?

Fundamentos: A síndrome metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiovascular, usualmente relacionados à resistência à insulina.Objetivo: Avaliar a associação entre a síndrome metabólica e a gravidade da doença arterial coronariana. Métodos: Estudo transversal com 322 pacientes submetidos à cineangiocoronariografia eletiva. Avaliaram-se dados laboratoriais e fatores de risco para a doença arterial coronariana, assim como informações obtidas na cineangiocoronariografia. A síndrome metabólica foi identificada segundo os critérios doNCEP-ATPIII. Para a gravidade da doença arterial coronariana consideraram-se dois aspectos: o número de vasos acometidos e o grau de oclusão da artéria. Investigou-se a associação entre as variáveis estudada se a síndrome metabólica utilizando-se o teste do qui-quadrado; a determinação dos fatores de risco por meio do OR e associação com a gravidade pela regressão de Poisson. Considerou-se significativo p<0,05.Resultados: A prevalência da síndrome metabólica foi 58,07 %, sendo 59,13 % nos portadores de doença arterial coronariana, sem significado estatístico. A síndrome metabólica não se constituiu fator de risco independente para a presença de doença arterial coronariana. Tanto na avaliação do número de vasos acometidos quanto no grau de oclusão observou-se, nos pacientes com síndrome metabólica, tendência de maior gravidade, porém sem significância estatística. Na avaliação dos componentes da síndrome metabólica, apenas a hipertensão arterial se apresentou como fator de risco para doença arterial coronariana. Conclusão: Não se observou associação entre a síndrome metabólica e a gravidade da doença arterial coronariana.

Background: Metabolic syndrome is a complex disorder with a set of cardiovascular risk factors, usually related to insulin resistance.Objective: To assess the association between metabolic syndrome and the severity of coronary artery disease. Methods: Cross sectional study with 322 patients undergoing elective coronary angiography. Laboratory data and risk factors were evaluated for coronary artery disease, as well as information obtained during the angiography. Metabolic syndrome was diagnosed according to the NCEP ATPIII criteria, using two aspects to rate CAD severity: the number of vessels involved and the level of occlusion in the artery. The association between these variables and metabolic syndrome was investigated, using the chi-square test; risk factors were defined through the OR and the association with severity was measured through the Poisson regression, with p<0.05 considered as significant. Results: The prevalence of metabolic syndrome reached 58.07%, and 59.13% in patients with coronary artery disease, with no statistical difference. Metabolic syndrome was not an independent risk fact for the presence of coronary artery disease. When assessing occlusion levels and the number of vessels involved, a trend towards greater severity was notedin patients with metabolic syndrome, but with no statistical significance. Among the metabolic syndrome components, hypertension was the only risk factor for coronary artery disease. Conclusion: No association was noted between metabolic syndrome and the severity of coronary artery disease.

Prevalence of arterial hypertension and associated factors in adults in São Luís, state of Maranhão.

BACKGROUND: Little is known about the prevalence of arterial hypertension (AH) and its risk factors in the less developed regions of Brazil. OBJECTIVE: To estimate the prevalence of arterial hypertension and its associated factors in the population > 18 years in São Luís, state of Maranhão according to the Seventh Report of the Joint National Committee (JNC 7) criteria. METHODS: A cross-sectional study was conducted in São Luís, MA, from February to March 2003, with 835 individuals >18 years who completed a structured household questionnaire. Measurements of arterial pressure (AP), weight, height and waist circumference were taken, and other risk factors for cardiovascular disease were assessed. The Poisson regression method was used for the identification of factors associated with AH, with an estimate of the prevalence ratio (PR) and its corresponding 95% confidence interval. RESULTS: Age varied from 18 and 94 years (mean age was 39.4 years), 293 (35.1%) individuals were normotensive and 313 (37.5%) were pre-hypertensive. The AH prevalence was 27.4% (95% CI--24.4% to 30.6%), and it was higher among men (32.1%) than among women (24.2%). In the adjusted analysis, the following remained independently associated with AH: male gender (PR 1.52, 95% CI, 1.25-1.84), age > or = 30 years, with PR=6.65, 95% CI, 4.40-10.05 for > or = 60 years of age, overweight (PR 2.09 95% CI 1.64-2.68), obesity (PR 2.68, 95% CI, 2.03-3.53) and diabetes (PR 1.56, 95% CI, 1.24-1.97). CONCLUSION: These findings suggest the need to control overweight, obesity and diabetes, especially among women and individuals > or = 30 years of age in order to reduce the prevalence of arterial hypertension.

Prevalência da hipertensão arterial em adultos e fatores associados em São Luís - MA / Prevalence of arterial hypertension and associated factors in adults in São Luís, state of Maranhão

FUNDAMENTO: No Brasil, a prevalência de hipertensão arterial (HA) e seus fatores de risco são pouco conhecidos nas regiões menos desenvolvidas. OBJETIVO: Estimar a prevalência da hipertensão arterial na população > 18 anos em São Luís - MA e fatores associados, de acordo com os critérios do Seventh Report of the Joint National Committee (JNC 7). MÉTODOS: Realizou-se estudo transversal em São Luís - MA, de fevereiro a março de 2003, em 835 pessoas com idade > 18 anos que responderam a um questionário estruturado em domicílio. Foram medidos pressão arterial (PA), peso, altura e circunferência abdominal. Avaliaram-se outros fatores de risco para doença cardiovascular. Na identificação dos fatores associados à HA foi utilizado o modelo de regressão de Poisson, com estimativa da razão de prevalências (RP) e seu respectivo intervalo de confiança de 95 por cento. RESULTADOS: A idade variou entre 18 e 94 anos (média de 39,4 anos), sendo 293 (35,1 por cento) pessoas normotensas e 313 (37,5 por cento) pré-hipertensas. A prevalência de HA foi de 27,4 por cento (IC95 por cento 24,4 por cento a 30,6 por cento), maior no sexo masculino (32,1 por cento) que no feminino (24,2 por cento). Na análise ajustada permaneceram independentemente associados à HA: sexo masculino (RP 1,52 IC95 por cento 1,25-1,84), idade > 30 anos, sendo RP=6,65, IC95 por cento 4,40-10,05 para idade > 60 anos, sobrepeso (RP 2,09 IC95 por cento 1,64-2,68), obesidade (RP 2,68 IC95 por cento 2,03-3,53) e diabete (RP 1,56 IC95 por cento 1,24-1,97). CONCLUSÃO: Os resultados sugerem a necessidade de controle do sobrepeso, obesidade e diabete, sobretudo em mulheres e pessoas com idade maior ou igual a 30 anos para a redução da prevalência da hipertensão arterial.

BACKGROUND: Little is known about the prevalence of arterial hypertension (AH) and its risk factors in the less developed regions of Brazil. OBJECTIVE: To estimate the prevalence of arterial hypertension and its associated factors in the population > 18 years in São Luís, state of Maranhão according to the Seventh Report of the Joint National Committee (JNC 7) criteria. METHODS: A cross-sectional study was conducted in São Luís, MA, from February to March 2003, with 835 individuals >18 years who completed a structured household questionnaire. Measurements of arterial pressure (AP), weight, height and waist circumference were taken, and other risk factors for cardiovascular disease were assessed. The Poisson regression method was used for the identification of factors associated with AH, with an estimate of the prevalence ratio (PR) and its corresponding 95 percent confidence interval. RESULTS: Age varied from 18 and 94 years (mean age was 39.4 years), 293 (35.1 percent) individuals were normotensive and 313 (37.5 percent) were pre-hypertensive. The AH prevalence was 27.4 percent (95 percent CI - 24.4 percent to 30.6 percent), and it was higher among men (32.1 percent) than among women (24.2 percent). In the adjusted analysis, the following remained independently associated with AH: male gender (PR 1.52, 95 percent CI, 1.25-1.84), age > 30 years, with PR=6.65, 95 percent CI, 4.40-10.05 for >60 years of age, overweight (PR 2.09 95 percent CI 1.64-2.68), obesity (PR 2.68, 95 percent CI, 2.03-3.53) and diabete (PR 1.56, 95 percent CI, 1.24-1.97). CONCLUSION: These findings suggest the need to control overweight, obesity and diabete, especially among women and individuals > 30 years of age in order to reduce the prevalence of arterial hypertension.