Higher Income and Integration into the Workforce Are the Main Factors Associated with Quality of Life in Acromegalic Patients in Northeastern Brazil.

OBJECTIVE: To identify the factors associated with quality of life in patients with acromegaly with follow-up at the referral service in neuroendocrinology of the state of Maranhão, northeast Brazil. METHODS: The Acromegaly Quality of Life Questionnaire (Acro-QoL) was used. Factors independently associated with quality of life were identified using multivariate linear regression, with p values < 0.05 considered significant. RESULTS: The multivariate linear regression analysis indicated a positive association between being integrated into the job market and quality of life scores in the overall domain (ß = 0.288, p = 0.003), psychological domain (ß = 0.291, p = 0.032), and personal relationship domain (ß = 0.314, p = 0.019). We also observed a positive association with income and the quality of life scores in all domains as follows: overall domain (ß = 0.037, p = 0.003), physical domain (ß = 0.988, p = 0.001), psychological domain (ß = 0.342, p = 0.008), physical appearance domain (ß = 0.270, p = 0.049), and personal relationship domain (ß = 0.315, p = 0.012). CONCLUSION: For patients with acromegaly living in one of the least developed regions of Brazil, integration into the job market and a higher income were associated with a better quality of life.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents.

OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents.

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

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.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

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...

Acromegalic cardiomyopathy in an extensively admixed population: is there a role for GH/IGF-I axis?

BACKGROUND: A specific acromegaly-related cardiomyopathy has been described in the literature, largely in Caucasians, which is independent of other risk factors, mainly hypertension. OBJECTIVE: This study assessed the cardiac changes in acromegalics of significant ethnic diversity and also the relevance of the aetiopathogenic factors involved, such as disease activity and hypertension. DESIGN: It is a cross-sectional study with a comparative control group. PATIENTS AND METHODS: In this study, 37 acromegalic patients (20 Intermediate-skinned (IS), 14 Dark-skinned (DS) and three Light-skinned (LS) individuals) and 74 controls matched by age, gender and hypertension were evaluated. Cardiac morphology and function were addressed using echocardiography parameters. RESULTS: The mean age of patients was 46.9 ± 12.8 years, with 67.6% being women and 43.2% hypertensive. The prevalence of left ventricular hypertrophy (LVH) between acromegalics was 56.8% vs 10.8% in the controls (P < 0.001). About 86% of patients with LVH had active disease (P = 0.023). Logistic regression revealed that disease activity presented a stronger association (OR = 5.925; CI = 1.085-32.351; P = 0.040) with LVH than hypertension (OR = 3.237; CI = 0.702-14.924; P = 0.132). When DS acromegalics were compared with IS ones, no statistically significant differences were observed. CONCLUSION: Chronically hyperactive somatotropic axis remains as an independent and determining factor in the development of left ventricular hypertrophy, as it is more associated with this condition than hypertension in a largely admixed population with a high degree of African ancestry.

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil

INTRODUCTION: Hepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%. OBJECTIVE: The aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís. Methods: Demographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA. RESULTS: 40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples. CONCLUSIONS: The prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil.

INTRODUCTION: Hepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%. OBJECTIVE: The aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís. METHODS: Demographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA. RESULTS: 40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples. CONCLUSIONS: The prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.

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.

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.

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.

Prevalence of true hypertensive crises and appropriateness of the medical management in patients with high blood pressure seen in a general emergency room.

BACKGROUND: High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated. OBJECTIVE: To analyze the cases of patients seen in a general emergency room because of high blood pressure as for meeting the criteria for the diagnosis of hypertensive crisis and the appropriateness of medical management. METHODS: Of the 1012 patients consecutively seen in a private referral general emergency room in the city of São Luís, State of Maranhão, between August and November 2003, 198 (19.56%) had a main diagnosis of high blood pressure in that visit. Of these, proper information could only be obtained from the patient charts of 169 patients; 54.4% of them were females with a mean age of 53.3 +/- 15.2 years. Data regarding patients and the attendant physicians were collected, and each case was classified as an urgency, emergency or pseudohypertensive crisis; the medical management was classified as appropriate or inappropriate. We also sought to identify the factors associated with the medical management and with the use of antihypertensive medication. RESULTS: Criteria for the characterization of a hypertensive crisis were present in only 27 patients (16%), and all were classified as urgencies. Medical management was considered appropriate in 72 cases (42.6%), and was neither influenced by specialty (p=0.5) nor by the physician's experience (p=0.9). Blood pressure levels, but not the presence or absence of symptoms, were predictive of the use of antihypertensive medication (p<0.001). CONCLUSION: In the population analyzed, less than one fifth of the patients seen in an emergency room with a presumed hypertensive crisis met defined criteria for this diagnosis. Medical management was considered appropriate in less than half of the occurrences.

Prevalência de verdadeiras crises hipertensivas e adequação da conduta médica em pacientes atendidos em um pronto-socorro geral com pressão arterial elevada / Prevalence of true hypertensive crises and appropriateness of the medical management in patients with high blood pressure seen in a general emergency room

FUNDAMENTO: Pressão arterial elevada é motivo freqüente de procura por pronto-socorro, sendo possível que muitos pacientes recebam erroneamente um diagnóstico de crise hipertensiva e, conseqüentemente, um tratamento inapropriado. OBJETIVO: Analisar os casos de pacientes com pressão arterial elevada atendidos em um pronto-socorro geral, quanto ao preenchimento de critérios para o diagnóstico de crise hipertensiva e a adequação da conduta médica. MÉTODOS: Dos 1.012 pacientes atendidos consecutivamente em um pronto-socorro geral privado de referência, em São Luís, Maranhão, entre agosto e novembro de 2003, 198 (19,56 por cento) tiveram como diagnóstico principal do atendimento pressão arterial elevada. Destes, de apenas 169 pacientes foi possível obter informação adequada nos boletins de atendimento, sendo 54,4 por cento do sexo feminino, com média de idade de 53,3 ± 15,2 anos. Coletaram-se dados referentes aos pacientes e aos médicos atendentes, a fim de classificar cada caso como urgência, emergência ou pseudocrise hipertensiva, e a conduta médica como adequada ou inadequada. Procurou-se ainda identificar os fatores associados à conduta e ao uso de medicação anti-hipertensiva. RESULTADOS: Em apenas 27 pacientes (16 por cento) houve critérios para caracterização de uma crise hipertensiva, sendo todos estes classificados como urgências. A conduta médica foi considerada adequada em 72 casos (42,6 por cento), não sofrendo influência da especialidade (p = 0,5) nem da experiência do médico (p = 0,9). Níveis tensionais, e não a presença ou ausência de sintomas, foram preditivos do uso de medicação anti-hipertensiva (p < 0,001). CONCLUSÃO: Na população analisada, menos de 1/5 dos pacientes atendidos em um pronto-socorro com suposta crise hipertensiva apresentou critérios definidos para tal diagnóstico. A conduta médica foi considerada adequada em menos da metade dos atendimentos.

BACKGROUND: High blood pressure is a common reason for patients to seek an emergency room, and many of them may possibly be wrongly diagnosed with hypertensive crisis and, consequently, be inappropriately treated. OBJECTIVE: To analyze the cases of patients seen in a general emergency room because of high blood pressure as for meeting the criteria for the diagnosis of hypertensive crisis and the appropriateness of medical management. METHODS: Of the 1012 patients consecutively seen in a private referral general emergency room in the city of São Luís, State of Maranhão, between August and November 2003, 198 (19.56 percent) had a main diagnosis of high blood pressure in that visit. Of these, proper information could only be obtained from the patient charts of 169 patients; 54.4 percent of them were females with a mean age of 53.3 ± 15.2 years. Data regarding patients and the attendant physicians were collected, and each case was classified as an urgency, emergency or pseudohypertensive crisis; the medical management was classified as appropriate or inappropriate. We also sought to identify the factors associated with the medical management and with the use of antihypertensive medication. RESULTS: Criteria for the characterization of a hypertensive crisis were present in only 27 patients (16 percent), and all were classified as urgencies. Medical management was considered appropriate in 72 cases (42.6 percent), and was neither influenced by specialty (p=0.5) nor by the physician's experience (p=0.9). Blood pressure levels, but not the presence or absence of symptoms, were predictive of the use of antihypertensive medication (p<0.001). CONCLUSION: In the population analyzed, less than one fifth of the patients seen in an emergency room with a presumed hypertensive crisis met defined criteria for this diagnosis. Medical management was considered appropriate in less than half of the occurrences.

Prevalence of coronary risk factors and myocardial perfusion scintigraphy abnormalities in asymptomatic diabetic outpatients.

OBJECTIVE: To determine the prevalence of coronary artery disease (CAD) risk factors (RF) and myocardial ischemia in a sample of asymptomatic diabetic patients treated on an outpatient basis. METHODS: From 80 type 2 diabetic patients initially recruited at an university outpatient endocrinology clinic, with no symptoms and/or CAD diagnosis, only 61 patients completed the study protocol, being 52,5% females, with a mean age of 56.3 +/- 10.9 years. The patients were interviewed searching for RF and underwent electrocardiogram, echocardiogram and perfusional myocardial scintigraphy (PMS) at rest and under stress. According to the PMS results they were divided into two groups: an ischemic and a normal one . RESULTS: The RF identified were: male gender (48%), age > or = 55 years (51%), family history of premature atherosclerotic disease (16%), history of smoking (46%), hypertension (44%), sedentary lifestyle (62%), overweight/obesity (67%), HDL- cholesterol < 45 mg/dl (69%), LDL- cholesterol > or = 100 mg/dl (85%) and triglycerides > or = 150 mg/dl (54%). Ischemic MPS were diagnosed in 15% of the patients. The variables associated with this diagnosis were: male gender (p=0.007), low HDL levels (p=0.046), history of smoking (p=0.038), left ventricular hypertrophy (LVH) (p=0.043) and left ventricle ejection fraction (LVEF) < 60% (p=0.01). CONCLUSION: A high prevalence of associated RF was observed, as well as a significant prevalence of 15% for myocardial ischemia. The variables identified as predictors of a myocardial ischemia diagnosis were: male gender, low HDL-cholesterol, past smoking, LVH and LVEF < 60%.