Associação entre síndrome metabólica e rigidez arterial / Association between metabolic syndrome and arterial stiffness

Introdução: A síndrome metabólica (SM) é considerada um importante fator de risco para doenças cardiovasculares por promover mudanças biomecânicas nas paredes dos vasos que acarretam rigidez arterial (RA). Objetivo: Analisar a associação entre a síndrome metabólica e rigidez arterial. Além de descrever a população de estudo segundo características sociodemográficas e clínicas. Métodos: Estudos transversal de base populacional, na área restrita do Vale do Ogunjá, Salvador-Bahia. Foram obtidos dados sociodemográficos, por meio de questionário e dados clínicos. A VOP foi avaliada por tonometria de aplanação com o aparelho SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Austrália). Foram obtidas medidas de frequência e descritivas de central e dispersão, e o teste Qui-quadrado para análise estatística. Resultados: A VOP alterada foi mais prevalente em indivíduos que foram diagnosticados com a síndrome metabólica (37,2%), com uma razão de prevalência 2,0 vezes maiores quando comparados aos indivíduos hígidos (IC95%: 0,86 ­ 4,45). Houve também maior prevalência da RA no sexo masculino (30,4%), na faixa etária entre 40 a 74 anos (38,7%), em autodeclarados preto/pardo (27,4%), em divorciados/viúvos (38,9%) e com baixo nível de escolaridade (38,5%). As diferenças proporcionais entre os indivíduos com e sem rigidez arterial foram estatisticamente significantes entre as variáveis escolaridade (p=0,022), faixa etária (p=0,001) e hipertensão arterial (p=0,000). Por outro lado, não foram encontradas diferenças proporcionais estatisticamente significantes (p>0,05) entre as variáveis sexo, cor e estado civil, assim como para a síndrome metabólica e as variáveis que fazem parte da sua definição (hipertrigliceridemia, HDL, glicemia de jejum e obesidade abdominal), com exceção da hipertensão arterial. Conclusão: Apesar da maior prevalência de rigidez arterial em indivíduos com síndrome metabólica, não foi encontrada uma associação estatisticamente significante entre essas duas variáveis. Foi possível verificar uma associação estatisticamente significante entre a hipertensão arterial, indivíduos com idade mais avançada e com baixo nível de escolaridade e a rigidez arterial. (AU)

iomechanical changes in the walls of the vessels that cause arterial stiffness (AR). Objetive: Analyze the association between Metabolic Syndrome (MS) and arterial stiffness and to characterize the study population according to sociodemographic and clinical characteristics. Methods: Cross-sectional population-based studies, in the restricted area of Vale do Ogunjá, Salvador-Bahia. Sociodemographic data, through questionnaire and clinical data were obtained. A PWV was evaluated by applanation tonometry using the device SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Australia). Frequency and descriptive measurements of central and dispersion were obtained, and the Chi-square test to statistical analysis. Results: The altered PWV was more prevalent in individuals who were diagnosed with the metabolic syndrome (37.2%), with a prevalence ratio 2.0 times higher when compared to healthy individuals (95% CI: 0.86 - 4.45). There was also a higher prevalence of AR in males (30.4%), aged between 40 and 74 years (38.7%), in self-declared black / brown (27.4%), in divorced / widowed (38, 9%) and with a low level of education (38.5%). The proportional differences between individuals with and without arterial stiffness were statistically significant between the variables education (p = 0.022), age group (p = 0.001) and arterial hypertension (p = 0.000). On the other hand, there were no statistically significant proportional differences (p> 0.05) between the variables gender, color and marital status, as well as for the metabolic syndrome and the variables that are part of its definition (hypertriglyceridemia, HDL, blood glucose) fasting and abdominal obesity), with the exception of arterial hypertension. Conclusion: Despite the higher prevalence of arterial stiffness in individuals with metabolic syndrome, no statistically significant association was found between these two variables. It was possible to verify a statistically significant association between arterial hypertension, individuals with older age and with low level of education and arterial stiffness.

[Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population]. / Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil.

BACKGROUND: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil / Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population / Influencia del color de la piel autodeclarado en la prevalencia del síndrome metabólico en una población urbana de Brasil

Fundamento: A síndrome metabólica tem uma elevada prevalência em diferentes partes do mundo, com variações entre diferentes grupos étnicos. Objetivo: Este estudo pretende explorar a influência da cor de pele auto-referida sobre a prevalência da SM. Métodos: Estudo transversal, realizado em subgrupo populacional em Salvador, Brasil. Utilizou-se auto-definição de cor de pele (branca, parda e negra) e o critério de SM do ATP-III. Foi usado o quiquadrado para tendência a fim de analisar gradiente das prevalências entre os grupos e a regressão logística para análises de associações. Resultados: A prevalência geral da SM, ajustada por variáveis potencialmente confundidoras, não diferiu entre brancos (23,3 por cento), pardos (23,3 por cento) e negros (23,4 por cento,). A análise por sexo mostrou entre os homens redução da prevalência da SM dos brancos, 26,2 por cento IC95 por cento(20,7-31,7), em comparação aos negros, 17,5 por cento IC95 por cento (12,3-22,8), e uma prevalência intermediária entre os pardos, 21,9 por cento IC95 por cento (18,6 - 25,1), p tend= 0,002. Entre as mulheres, a tendência foi inversa, maior nas negras, 27,0 por cento IC95 por cento (22,2-31,8), e menor nas brancas, 20,5 por cento IC95 por cento(15,6-25,4), p tend= 0,02. Na análise multivariada da associação entre cor de pele e SM (branco=grupo de referência), a cor negra entre os homens foi fator de proteção, razão de prevalência (RP)= 0,60 (0,36 - 0,97), enquanto que nas mulheres tendeu a ser fator de risco, RP= 1,33 (0,94 - 1,78). Conclusão: A prevalência da SM variou em função da cor de pele de modo inverso entre homens e mulheres. Ser negro foi fator de proteção entre homens e de risco nas mulheres.

Background: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. Objective: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS. Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. Results: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3 percent), mulattos (23.3 percent) and blacks (23.4 percent). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2 percent, 95 percentCI: 20.7-31.7), in comparison to blacks (17.5 percent, 95 percentCI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9 percent, 95 percentCI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0 percent, 95 percentCI: 22.2-31.8, and lower among the whites, 20.5 percent, 95 percentCI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). Conclusion: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Fundamento: El síndrome metabólico tiene una elevada prevalencia en diferentes partes del mundo, con variaciones entre diferentes grupos étnicos. Objetivo: Este estudio pretende explorar la influencia del color de la piel autodeclarado sobre la prevalencia del SM. Métodos: ESTUDio transversal, realizado en subgrupo poblacional en Salvador, Brasil. Se utilizó la autodefinición de color de la piel (blanca, parda y negra) y el criterio de SM del ATP-III. Se usó el test chi-cuadrado para tendencia a fin de analizar gradiente de las prevalencias entre los grupos y la regresión logística para análisis de asociaciones. Resultados: La prevalencia general del SM, ajustado por variables potencialmente confusas, no difirió entre blancos (23,3 por ciento), pardos (23,3 por ciento) y negros (23,4 por ciento,). El análisis por sexo mostró entre los hombres reducción de la prevalencia del SM de los blancos, el 26,2 por ciento IC95 por ciento(20,7-31,7), en comparación con los negros, 17,5 por ciento IC95 por ciento (12,3-22,8), y una prevalencia intermedia entre los pardos, 21,9 por ciento IC95 por ciento (18,6 - 25,1), p tend= 0,002. Entre las mujeres, la tendencia fue inversa, mayor en las negras, 27,0 por ciento IC95 por ciento (22,2-31,8), y menor en las blancas, 20,5 por ciento IC95 por ciento(15,6-25,4), p tend= 0,02. En el análisis multivariado de la asociación entre color de la piel y SM (blanco=grupo de referencia), el color negro entre los hombres fue factor de protección, razón de prevalencia (RP)= 0,60 (0,36-0,97), mientras que en las mujeres tendió a ser factor de riesgo, RP= 1,33 (0,94-1,78). Conclusión: LA Prevalencia del SM varió en función del color de la piel de modo inverso entre hombres y mujeres. Ser negro fue factor de protección entre hombres y de riesgo en las mujeres.

Criteria for central obesity in a Brazilian population: impact on metabolic syndrome.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84 cm for women and 88 cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88 cm (for women) and 102 cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6-25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1-20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84 cm for women and > 88 cm for men should be tested in other Brazilian populations.

An evaluation of the Rastreometro, a new device for populational screening for high blood pressure in developing countries.

OBJECTIVE: To test a simplified blood pressure device called Rastreometro that could be used by the Health Agents. METHODS: The Rastreometro has been developed from an ordinary aneroid sphygmomanometer, in which the numeric display is covered by an adhesive with a red zone, indicating pressures equal or above 140 mmHg and a yellow zone indicating pressures below 140 mmHg. The onset of oscillations of the aneroid needle is taken as an indication of the systolic pressure value. The measurements made by the Rastreometro were compared with those made by the auscultatory method, and were carried out in 268 patients, by two operators. The influence on the results of confounding variables such as age, gender, BMI, arm length, upper arm circumference, skin colour and antihypertensive treatment were taken into consideration, as well as intra and interobserver variation. RESULTS: In the whole group, sensitivity was 95.1%, specificity was 63.1%, positive predictive value was 62.4% and negative predictive value was 95.3%. Hypertensive treatment significantly affected specificity, 32.7% as compared to 77.8% for the non-treated group. Both operators improved their results over time. CONCLUSION: This study suggests that the Rastreometro technique, as a screener for hypertension, has good sensitivity. Concerning specificity, it is acceptable, provided the patient is not on regular antihypertensive treatment. In this latter situation, it can be improved by a proper standardization of the method to read the systolic pressure by needle oscillations. Furthermore, the use of this technique requires well trained operators.

Critério de obesidade central em população brasileira: impacto sobre a síndrome metabólica / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome

OBJETIVO: Identificar e propor os melhores pontos de corte da circunferência da cintura (CCp) para diagnosticar obesidade central numa população brasileira; compará-los àqueles recomendados pelo ATPIII (CC-ATPIII) e estimar diferenças nas prevalências da síndrome metabólica (SM) usando os dois critérios. MÉTODOS: Estudo transversal, realizado em subgrupo populacional de 1.439 adultos, Salvador, Brasil. Foram construídas curvas ROC da circunferência da cintura (CC) para identificar diabete melito (DM) e obesidade. Valores >60 por cento da sensibilidade e da especificidade da curva ROC e mais próximos entre si foram usados para definir o CCp. A prevalência da SM foi estimada pelos CCp e pelos CC-ATPIII. RESULTADOS: As 829 mulheres compuseram 57,7 por cento da amostra. Os CCp selecionados foram 84 cm para mulheres e 88 cm para homens. Esses pontos detectaram DM com sensibilidade de 68,7 por cento e 70 por cento, respectivamente, e especificidade de 66,2 por cento e 68,3 por cento. Para obesidade, a sensibilidade e a especificidade foram 79,8 por cento e 77,6 por cento nas mulheres, e 64,3 por cento e 71,6 por cento nos homens. Pelos CC-ATPIII, 88 cm (mulheres) e 102 para (homens), as sensibilidades foram de 53,3 por cento e 26,5 por cento, para diagnosticar DM. Para obesidade, a sensibilidade foi 66,5 por cento (mulheres) e 28,6 por cento (homens). A prevalência da SM, pelos CCp foi 23,7 por cento, IC 95 por cento (21,6 - 25,9) e pelos CC-ATPIII de 19,0 por cento, IC 95 por cento (17,1- 20,9), 1,2 vezes maior pelo CCP. CONCLUSÃO: As CC-ATPIII foram inapropriados e subestimam a prevalência da SM nessa população, particularmente entre os homens. Sugerimos que os pontos de corte da CC de >84 cm nas mulheres e > 88 cm nos homens sejam testados em outras populações brasileiras.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60 percent and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7 percent of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7 percent and 70 percent sensitivity, and a 66.2 percent and 68.3 percent specificity, respectively. For obesity, sensitivity and specificity were 79.8 percent and 77.6 percent in women and 64.3 percent and 71.6 percent in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3 percent and 26.5 percent, respectively, to diagnose DM. For obesity, sensitivity was 66.5 percent (for women) and 28.6 percent (for men). The prevalence of MS using WCp was 23.7 percent, 95 percentCI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0 percent, 95 percentCI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

Uma avaliação do rastreômetro, um novo equipamento para triagem populacional da pressão arterial elevada, em países em desenvolvimento / An evaluation of the rastreometro, a new device for populational screening for high blood pressure in developing countries / An evaluation of the rastreometro, a new device for populational screening for high blood pressure in developing countries

OBJETIVO: Testar um novo dispositivo simplificado de medição chamado rastreômetro, que poderia ser usado pelos Agentes de Saúde. MÉTODOS: O rastreômetro foi desenvolvido a partir de um esfigmomanômetro aneróide convencional, no qual se cobriu o visor do aneróide com um adesivo, cujo desenho tem uma faixa vermelha, indicativa de pressões > 140 mmHg e uma faixa amarela, indicativa de pressões < 140 mmHg. O início das oscilações da agulha do esfigmomanômetro é considerado indicativo da pressão arterial sistólica. As medições pelo rastreômetro foram comparadas com aquelas realizadas pelo método auscultatório em 268 pacientes, por dois operadores. A influência, sobre os resultados, de variáveis que podem causar confusão, como idade, sexo, IMC, comprimento do braço, circunferência do braço, cor da pele e presença de tratamento anti-hipertensivo, foram levadas em consideração, assim como a variação intra e interobservador. RESULTADOS: No grupo como um todo, a sensibilidade foi de 95,1 por cento, a especificidade foi de 63,1 por cento, o valor preditivo positivo foi de 62,4 por cento e o valor preditivo negativo foi de 95,3 por cento. O tratamento anti-hipertensivo afetou significativamente a especificidade, de 32,7 por cento, em comparação com 77,8 por cento, no grupo não medicado. Os dois operadores melhoraram seus resultados ao longo do tempo. CONCLUSÃO: Este estudo sugere que a técnica do rastreômetro, como método de triagem para hipertensão, tem boa sensibilidade. Quanto à especificidade, ela é aceitável se os pacientes não estiverem sob tratamento anti-hipertensivo regular. Nesse último caso, pode ser melhorada pela padronização adequada da leitura da pressão sistólica pelas oscilações da agulha. Além disto, o uso dessa técnica requer operadores bem treinados.

OBJECTIVE: To test a simplified blood pressure device called Rastreometro that could be used by the Health Agents. METHODS: The Rastreometro has been developed from an ordinary aneroid sphygmomanometer, in which the numeric display is covered by an adhesive with a red zone, indicating pressures equal or above 140 mmHg and a yellow zone indicating pressures below 140 mmHg. The onset of oscillations of the aneroid needle is taken as an indication of the systolic pressure value. The measurements made by the Rastreometro were compared with those made by the auscultatory method, and were carried out in 268 patients, by two operators. The influence on the results of confounding variables such as age, gender, BMI, arm length, upper arm circunference, skin colour and antihypertensive treatment were taken into consideration, as well as intra and interobserver variation. RESULTS: In the whole group, sensitivity was 95.1 percent, specificity was 63.1 percent, positive preditive value was 62.4 percent and negative preditive value was 95.3 percent. Hypertensive treatment significantly affected specificity, 32.7 percent as compared to 77.8 percent for the non-treated group. Both operators improved their results over time. CONCLUSION: This study suggests that the Rastreometro technique, as a screener for hypertension, has good sensitivity. Concerning specificity, it is acceptable, provided the patient is not on regular antihypertensive treatment. In this latter situation, it can be improved by a proper standardization of the method to read the systolic pressure by needle oscillations. Furthermore, the use of this technique requires well trained operators.