Climatério e lúpus eritematoso sistêmico / Climacteric and systemic lupus erythematosus

O lúpus eritematoso sistêmico é uma doença crônica, complexa e multifatorial que apresenta manifestações em vários órgãos. O seu acometimento ocorre 10 vezes mais no sexo feminino do que no masculino. É uma doença com uma clínica variada e com graus variados de gravidade, causando fadiga, manifestações cutâneas, como rash malar, fotossensibilidade, queda de cabelo e manifestações musculoesqueléticas, como artralgia, mialgia e atrite. Podem ocorrer flares (crises), que se caracterizam por aumento mensurável na atividade da doença. No climatério, no período da pré-menopausa, o lúpus eritematoso sistêmico ocorre com mais frequência, podendo ocorrer também na pós-menopausa. Algumas doenças são mais frequentes na fase do climatério, e a presença do lúpus pode influenciar na sua evolução, como a doença cardiovascular, osteoporose e tromboembolismo venoso. A terapia hormonal oral determina aumento do risco de tromboembolismo venoso no climatério, e na paciente com lúpus eritematoso sistêmico há aumento dos riscos de flares e de trombose. Em vista disso, a terapia hormonal é recomendada apenas para pacientes com lúpus eritematoso sistêmico estável ou inativo, sem história de síndrome antifosfolípides e com anticorpos antifosfolípides negativa, devendo-se dar preferência para a terapia estrogênica transdérmica, em menor dose e de uso contínuo. Na paciente com lúpus eritematoso sistêmico ativo ou com história de síndrome antifosfolípides ou com anticorpos antifosfolípides positiva, recomenda-se a terapia não hormonal, como os antidepressivos. (AU)

Systemic lupus erythematosus is a chronic, complex, multifactorial disease that manifests in several organs. Its involvement occurs 10 times more in females than in males. It is a disease with a varied clinic and varying degrees of severity, causing fatigue, skin manifestations such as malar rash, photosensitivity, hair loss and musculoskeletal manifestations such as arthralgia, myalgia and arthritis. Flare may occur, which are characterized by measurable increase in disease activity. In the climacteric, in the premenopausal period, systemic lupus erythematosus occurs more frequently, and may also occur in the postmenopausal period. Some diseases are more frequent in the Climacteric phase and the presence of lupus can influence its evolution, such as cardiovascular disease, osteoporosis and venous thromboembolism. Oral hormone therapy determines an increased risk of venous thromboembolism in the climacteric and in patients with systemic lupus erythematosus there is an increased risk of flares and thrombosis. In view of this, hormone therapy is only recommended for patients with stable or inactive systemic lupus erythematosus, without a history of antiphospholipid syndrome and with antiphospholipid antibodies, giving preference to transdermal estrogen therapy, at a lower dose and for continuous use. In patients with active systemic lupus erythematosus or with a history of antiphospholipid syndrome or positive antiphospholipid antibodies, non-hormonal therapy, such as antidepressants, is recommended. (AU)

Caracterización epidemiológica de pacientes diabéticos e hipertensos en consultorio en Quinta Normal, 2018-2019 / Epidemiological features of patients ascribed to a primary care cardiovascular health program in Santiago, Chile

BACKGROUND: Hypertension and diabetes are highly prevalent conditions in Chilean adults. AIM: To describe the demographic and clinical profiles, risk factors and complications associated with arterial hypertension (AH) and diabetes mellitus (DM) in patients ascribed to a cardiovascular health program at a public primary health care center in Santiago. MATERIAL AND METHODS: Review of medical records of 583 patients aged 37 to 95 years (56% women). Gender, age, smoking habits, blood pressure, glycated hemoglobin levels, LDL cholesterol and triglycerides levels, nutritional status in the last control carried out, and associated cardiovascular complications were recorded. RESULTS: Thirty four percent (201 participants) and 36% (210 participants) had a decompensated DM and AH, respectively. Dyslipidemia was the main associated cardiovascular risk factor. The prevalence of obesity was 43% (249 participants). Twenty percent had chronic kidney disease and 13% had diabetic retinopathy. CONCLUSIONS: These patients have a high frequency of obesity, dyslipidemia, and chronic kidney disease.

Association between socioeconomic and nutritional factors and height of Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents / Associação entre fatores socioeconômicos e nutricionais e altura de adolescentes brasileiros: resultados do Estudo de Riscos Cardiovasculares em Adolescentes / Asociación entre los factores socioeconómicos y nutricionales y la estatura de los adolescentes brasileños: resultados del Estudio de Riesgo Cardiovascular en Adolescentes

This study aims to describe the mean height of adolescents from the five regions of Brazil and to evaluate socioeconomic and nutritional factors associated with normal growth. This is a cross-sectional study conducted in the Brazilian urban and rural areas with students aged 12 to 17 years (n = 71,553). Anthropometry, socioeconomic variables, physical activity, and diet were evaluated. Height-for-age z-scores were calculated and multiple linear regression models were used to investigate the association of exposure variables with height (outcome) by sex and age (12-13, 14-15, and 16-17 years). We observed a lower mean height in adolescents from the North Region and in individuals with low socioeconomic status. At 17 years of age, the closest to the final height in this sample, mean heights for girls and boys were 160.9 ± 0.1cm and 173.7 ± 0.3cm, respectively. In multiple linear regression analysis, physical activity (girls β = 0.119, 95%CI: 0.035; 0.202; boys β = 0.092, 95%CI: 0.012; 0.172) and high level of maternal education (girls β = 0.103, 95%CI: 0.001; 0.204; boys β = 0.39, 95%CI: 0.245; 0.534) were positively associated with height-for-age z-score in 16- to 17-year-old boys and girls. Other factors positively associated with height-for-age z-score in older students include higher protein consumption (β = 0.022, 95%CI: 0.010; 0.035) and obesity (β = 0.217, 95%CI: 0.084; 0.350) for boys, and low weight (β = 0.205, 95%CI: 0.028, 0.382) for girls. We observed differences in the mean height among adolescents from the five Brazilian regions. Normal growth, especially among older adolescents, was associated with high maternal education, practice of physical activity, protein consumption, and body mass index (BMI) categories.

Buscou-se descrever a altura média dos adolescentes das cinco regiões do Brasil e avaliar os fatores socioeconômicos e nutricionais que estejam associados ao seu crescimento normal. Este é um estudo transversal realizado em ambientes urbanos e rurais no Brasil com estudantes de 12 a 17 anos (n = 71.553). Avaliamos antropometria, variáveis socioeconômicas, atividade física e dieta. Calculou-se os escores-z por idade e investigou-se a associação das variáveis de exposição com altura (desfecho) por sexo e idade (12-13, 14-15 e 16-17 anos) através de múltiplos modelos de regressão linear. Observou-se menor altura média em adolescentes da região Norte e em baixos níveis socioeconômicos. Aos 17 anos, o mais próximo da altura final nesta amostra, as alturas médias para meninas e meninos foram de 160,9 ± 0,1cm e 173,7 ± 0,3cm, respectivamente. Na análise de regressão linear múltipla, atividade física (meninas β = 0,119, IC95%: 0,035; 0,202; meninos β = 0,092, IC95%: 0,012; 0,172) e Ensino Médio materno (meninas β = 0,103, IC95%: 0,201; 0,204; meninos β = 0,39, IC95%: 0,245; 0,534) estiveram positivamente associados ao escore-z de altura por idade em meninos e meninas de 16-17 anos. Maior consumo de proteína (β = 0,022, IC95%: 0,010; 0,035) e obesidade (β = 0,217, IC95%: 0,084; 0,350) estiveram positivamente associados ao escore-z de altura para a idade meninos mais velhos, enquanto a variável associada às meninas foi baixo peso (β = 0,205, IC95%: 0,028; 0,382). Observou-se diferenças na altura média de adolescentes das cinco regiões brasileiras. O crescimento normal, especialmente entre adolescentes mais velhos, esteve associado à escolaridade materna, à prática de atividade física, ao consumo de proteínas e às categorias de índice de massa corporal (IMC).

Los objetivos fueron describir la estatura media de los adolescentes de las cinco regiones de Brasil y evaluar los factores socioeconómicos y nutricionales asociados al crecimiento normal. Estudio transversal realizado en entornos urbanos y rurales de Brasil con estudiantes de 12 a 17 años (n = 71.553). Se evaluaron la antropometría, las variables socioeconómicas, la actividad física y la dieta. Se calculó la puntuación Z de la altura para la edad y se utilizaron modelos de regresión lineal múltiple para investigar la asociación de las variables de exposición con la altura (resultado) por sexo y edad (12-13, 14-15 y 16-17 años). Se observó una estatura media más baja en los adolescentes de la región norte y en los de nivel socioeconómico bajo. A los 17 años, la edad más cercana a la estatura final en esta muestra, las estaturas medias de las chicas y los chicos eran de 160,9 ± 0,1cm y 173,7 ± 0,3cm, respectivamente. En el análisis de regresión lineal múltiple, la actividad física (chicas β = 0,119, IC95%: 0,035; 0,202; chicos β = 0,092, IC95%: 0,012; 0,172) y la madre con educación secundaria (chicas β = 0,103, IC95%: 0,001; 0,204; chicos β = 0,39, IC95%: 0,245; 0,534) se asociaron positivamente con la puntuación z de la altura para la edad en chicos y chicas de 16-17 años. En el caso de los chicos, el mayor consumo de proteínas (β = 0,022, IC95%: 0,010; 0,035) y la obesidad (β = 0,217, IC95%: 0,084; 0,350), mientras que, en el caso de las chicas, el bajo peso (β = 0,205, IC95%: 0,028; 0,382) también se asociaron positivamente con la puntuación z de la altura para la edad en los estudiantes mayores. Se observaron diferencias en la estatura media entre los adolescentes de las cinco regiones brasileñas. El crecimiento normal, especialmente entre los adolescentes de mayor edad, se asoció con la alta escolaridad de la madre, la práctica de actividad física, el consumo de proteínas y las categorías de índice de masa corporal (IMC).

High ankle-brachial index predicts cardiovascular events and mortality in hemodialysis patients with severe secondary hyperparathyroidism / Índice tornozelo-braquial elevado prediz eventos e mortalidade cardiovasculares nos pacientes em hemodiálise com hiperparatireoidismo secundário grave

Abstract Introduction: Vascular calcification related to severe secondary hyperparathyroidism (SHPT) is an important cause of cardiovascular and bone complications, leading to high morbidity and mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). The present study aimed to analyze whether ankle-brachial index (ABI), a non-invasive diagnostic tool, is able to predict cardiovascular outcomes in this population. Methods: We selected 88 adult patients on HD for at least 6 months, with serum iPTH>1,000pg/mL. We collected clinical data, biochemical and hormonal parameters, and ABI (sonar-Doppler). Calcification was assessed by lateral radiography of the abdomen and by simple vascular calcification score (SVCS). This cohort was monitored prospectively between 2012 and 2019 for cardiovascular outcomes (death, myocardial infarction (MI), stroke, and calciphylaxis) to estimate the accuracy of ABI in this setting. Results: The baseline values were: iPTH: 1770±689pg/mL, P: 5.8±1.2 mg/dL, corrected Ca: 9.7±0.8mg/dL, 25(OH)vit D: 25.1±10.9ng/mL. Sixty-five percent of patients had ABI>1.3 (ranging from 0.6 to 3.2); 66% had SVCS≥3, and 45% aortic calcification (Kauppila≥8). The prospective evaluation (51.6±24.0 months), provided the following cardiovascular outcomes: 11% of deaths, 17% of nonfatal MI, one stroke, and 3% of calciphylaxis. After adjustments, patients with ABI≥1.6 had 8.9-fold higher risk of cardiovascular events (p=0.035), and ABI≥1.8 had 12.2-fold higher risk of cardiovascular mortality (p=0.019). Conclusion: The presence of vascular calcifications and arterial stiffness was highly prevalent in our population. We suggest that ABI, a simple and cost-effective diagnostic tool, could be used at an outpatient basis to predict cardiovascular events in patients with severe SHPT undergoing HD.

Resumo Introdução: A calcificação vascular relacionada ao hiperparatireoidismo secundário (HPTS) grave é uma causa importante de complicações cardiovasculares e ósseas, levando a alta morbidade e mortalidade em pacientes com doença renal crônica (DRC) em hemodiálise (HD). O presente estudo objetivou analisar se o índice tornozelo-braquial (ITB), uma ferramenta diagnóstica não invasiva, pode predizer desfechos cardiovasculares nesta população. Métodos: Selecionamos 88 adultos em HD há pelo menos 6 meses, com PTHi sérico>1.000pg/mL. Coletamos dados clínicos, parâmetros bioquímicos e hormonais, e ITB (sonar-Doppler). A calcificação foi avaliada por radiografia lateral do abdome e por escore de calcificação vascular simples (ECVS). Esta coorte foi monitorada prospectivamente entre 2012 e 2019 para desfechos cardiovasculares (óbito, infarto do miocárdio (IM), acidente vascular cerebral e calcifilaxia) para estimar a precisão do ITB neste cenário. Resultados: Os valores basais foram: PTHi: 1770±689pg/mL, P: 5,8±1,2 mg/dL, Ca corrigido: 9,7±0,8mg/dL, 25(OH)vit D: 25,1±10,9ng/Ml; 65% dos pacientes apresentaram ITB>1,3 (variando de 0,6 a 3,2); 66% tiveram ECVS≥3, e 45% calcificação da aorta (Kauppila≥8). A avaliação prospectiva (51,6±24,0 meses) forneceu os seguintes desfechos cardiovasculares: 11% de óbitos, 17% de IM não fatal, um AVC, 3% de calcifilaxia. Após ajustes, pacientes com ITB≥1,6 tiveram risco 8,9 vezes maior de eventos cardiovasculares (p=0,035), e ITB≥1,8 apresentaram risco 12,2 vezes maior de mortalidade cardiovascular (p=0,019). Conclusão: A presença de calcificações vasculares e rigidez arterial foi altamente prevalente em nossa população. Sugerimos o ITB, uma ferramenta diagnóstica simples e econômica, para ser usada em ambulatório para prever eventos cardiovasculares em pacientes com HPTS grave em HD.

Principales alimentos con azúcares añadidos y su variación geográfica y sociodemográfica: estudio latinoamericano de nutrición y salud (ELANS) / Main foods with added sugars and their geographic and sociodemographic variation: Latin American study of nutrition and health (ELANS)

Diversos estudios epidemiológicos y de intervención apuntan a una asociación fuerte y consistente entre la ingesta excesiva de azúcares y el riesgo de desarrollar caries dentales y enfermedades crónicas no transmisibles. El objetivo fue describir los 10 principales alimentos que contribuyen a la ingesta de azúcares añadidos en muestras representativas de poblaciones urbanas de ocho países latinoamericanos, y considerar diferencias por país, sexo, nivel socioeconómico (NSE) y grupo de edad. Se realizó una encuesta transversal multinacional en hogares de Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela (N=9218; 15­65 años). La contribución porcentual a la ingesta total del nutriente sirvió para identificar los alimentos aportadores. Los datos se estratificaron por país, sexo, NSE y grupo de edad y se compararon los gramos por día. Excepto en Perú y en el grupo de 50 a 65 años, los refrescos figuraron como el principal contribuyente a la ingesta de azúcares añadidos. Las bebidas caseras y las industrializadas también destacaron. Argentina fue el país con mayor ingesta de azúcares añadidos aportados por bebidas industrializadas, y Chile el país con menor frecuencia de bebidas como fuentes. Entre los 10 contribuyentes, la ingesta de azúcares añadidos fue mayor en el sexo masculino, excepto para sacarosa y pasteles dulces. Mayores ingestas de azúcares provenientes del jugo de fruta natural y sacarosa fueron observadas en el NSE más bajo. Las mayores y menores ingestas en los grupos de edad cambian de acuerdo con la fuente alimentaria. En conclusión, las bebidas azucaradas fueron los principales contribuyentes a la ingesta de azúcares añadidos, y la ingesta varió según la ubicación geográfica y los factores sociodemográficos(AU)

This study aimed to describe the top 10 foods that contribute to added sugars intake in representative samples of urban populations in eight Latin American countries, and consider differences by country, sex, socioeconomic level (SEL), and age group. A household-based, multinational, cross-sectional survey was conducted in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (N=9218; 15­65 years). Contributors to added sugars were identified and listed based on the percentage of contribution to total intake of this nutrient. Data were stratified by country, sex, SEL, and age group, and the grams per day compared. Except in Peru and in the 50 to 65 years age group, soft drinks were the leading contributor to added sugar intake. Homemade beverages together industrialized beverages have been a prominent position on ranking. In general, the highest intake of added sugars by industrialized beverages was from Argentina, and the lowest frequency of beverages as sources of added sugars was observed in Chile. Among the top 10 contributors, male sex had highest added sugar intake, except for sucrose and sweet cakes. Higher intakes of sugars from natural fruit juice and sucrose were observed in the lower SEL. The highest and lowest intakes in the age groups change according to the food source. In conclusion, sugar-sweetened beverages were main contributors to added sugar intake, and the intake vary with geographical location and sociodemographic factors(AU)

Lipoprotein(a) levels in children and adolescents: Ouro Preto Study

Abstract Background Lipoprotein (a) is a cardiovascular risk factor in adult. Studies have shown the presence of this emergent risk factor in school children, which may contribute to the development of atherosclerosis in adulthood. Objective To evaluate the association between lipoprotein (a) and cardiovascular risk factors in school children. Methods Lipoprotein (a) levels were measured in 320 school children (6-14 years) selected from a population survey carried out in Ouro Preto (southeast of Brazil). Demographic (sex and age), biochemical (total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, and glucose), anthropometric (body mass index, waist circumference, body fat percentage), clinical (arterial blood pressure, pubertal stage and birth weight) and economic (family income) parameters, as well as family history (obese and/or hypertensive parents) were analyzed. Non-parametric analysis was used to evaluate lipoprotein (a) levels in each subgroup. Variables with p≤0.20 in the univariate analysis were included in binary regression logistic model. Differences with p < 0.05 were considered significant. Results Lipoprotein (a) levels were associated with total cholesterol (p=0.04), body fat (p=0.009), and mother´s systolic (p=0.02) and diastolic blood pressure (p=0.04). In a logistic regression analysis, children with high lipoprotein (a) levels and body fat, and children born from hypertensive mothers were, respectively, at 3.2(p=0.01) and 1.4 (p=0.03) times higher risk than other children. In clustering these factors, elevated lipoprotein (a) was 2.6 times more likely to be seen in school children with high body fat and born hypertensive mothers. Conclusions Lipoprotein (a) was correlated with cardiovascular risk factors in children and adolescents. Persistence of these risk factors in childhood suggests a contribution of elevated lipoprotein (a) to future cardiovascular disease. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Impacto do consumo de alimentos ultraprocessados na saúde de crianças, adolescentes e adultos: revisão de escopo / Impacto del consumo de alimentos ultraprocesados en la salud de niños, adolescentes y adultos: revisión de alcances / Impact of the consumption of ultra-processed foods on children, adolescents and adults' health: scope review

O objetivo deste trabalho foi realizar uma revisão de escopo da literatura acerca da associação entre o consumo de alimentos ultraprocessados e desfechos em saúde. A busca foi realizada nas bases PubMed, Web of Science e LILACS. Foram elegíveis os estudos que avaliaram a associação entre o consumo de alimentos ultraprocessados identificados com base na classificação NOVA e os desfechos em saúde. O processo de revisão resultou na seleção de 63 estudos, os quais foram analisados em termos de qualidade com base em ferramenta do Instituto Nacional de Saúde dos Estados Unidos. Os desfechos encontrados incluíram indicadores de obesidade, marcadores de risco metabólico, diabetes, doenças cardiovasculares, câncer, asma, depressão, fragilidade, doenças gastrointestinais e mortalidade. A evidência foi particularmente consistente para obesidade (ou indicadores relacionados a ela) em adultos, cuja associação com o consumo de ultraprocessados foi demonstrada, com efeito dose-resposta, em estudos transversais com amostras representativas de cinco países, em quatro grandes estudos de coorte e em um ensaio clínico randomizado. Grandes estudos de coorte também encontraram associação significativa entre o consumo de alimentos ultraprocessados e o risco de doenças cardiovasculares, diabetes e câncer, mesmo após ajuste para obesidade. Dois estudos de coorte demonstraram associação do consumo de alimentos ultraprocessados com depressão e quatro estudos de coorte com mortalidade por todas as causas. Esta revisão sumarizou os resultados de trabalhos que descreveram a associação entre o consumo de alimentos ultraprocessados e as diversas doenças crônicas não transmissíveis e seus fatores de risco, o que traz importantes implicações para a saúde pública.

El objetivo de este estudio fue realizar una revisión de alcance de la literatura sobre la asociación entre el consumo de alimentos ultraprocesados y los resultados de salud. La búsqueda se realizó en las bases de datos PubMed, Web of Science y LILACS. Fueron elegibles los estudios que evaluaron la asociación entre el consumo de alimentos ultraprocesados identificados según la clasificación NOVA y los resultados de salud. El proceso de revisión resultó en la selección de 63 estudios, cuya calidad se analizó con base en una herramienta delo Instituto Nacional de Salud de Estados Unidos Los resultados encontrados incluyeron indicadores de obesidad, marcadores de riesgo metabólico, diabetes, enfermedad cardiovascular, cáncer, asma, depresión, fragilidad, enfermedad gastrointestinal y mortalidad. La evidencia fue particularmente consistente para la obesidad (o indicadores relacionados con ella) en adultos, cuya asociación con el consumo de alimentos ultraprocesados se demostró, con un efecto dosis-respuesta, en estudios transversales con muestras representativas de cinco países, en cuatro grandes estudios de cohortes y en un ensayo clínico aleatorizado. Grandes estudios de cohortes también encontraron una asociación significativa entre el consumo de alimentos ultraprocesados y el riesgo de enfermedades cardiovasculares, diabetes y cáncer, incluso después de ajustar la obesidad. Dos estudios de cohortes mostraron una asociación entre el consumo de alimentos ultraprocesados y la depresión y cuatro estudios de cohortes con mortalidad por todas las causas. Esta revisión resumió los resultados de estudios que describieron la asociación entre el consumo de alimentos ultraprocesados y las diversas enfermedades crónicas no transmisibles y sus factores de riesgo, lo que tiene importantes implicaciones para la salud pública.

The aim of this study was to conduct a literature scope review of the association between the consumption of ultra-processed foods and health outcomes. The search was carried out in the PubMed, Web of Science and LILACS databases. Studies that assessed the association between the consumption of ultra-processed foods, identified on the NOVA classification, and health outcomes were eligible. The review process resulted in the selection of 63 studies, which were analyzed in terms of quality using a tool from the National Institutes of Health. The outcomes found included obesity, metabolic risk markers, diabetes, cardiovascular diseases, cancer, asthma, depression, frailty, gastrointestinal diseases and mortality indicators. The evidence was particularly consistent for obesity (or indicators related to it) in adults, whose association with the consumption of ultra-processed foods was demonstrated, with dose-response effect, in cross-sectional studies with representative samples from five countries, in four large cohort studies and in a randomized clinical trial. Large cohort studies have also found a significant association between the consumption of ultra-processed foods and the risk of cardiovascular diseases, diabetes and cancer - even after adjusting for obesity. Two cohort studies have shown an association of ultra-processed foods consumption with depression and four cohort studies with all-cause mortality. This review summarized the studies' results that described the association between the consumption of ultra-processed foods and various non-communicable diseases and their risk factors, which has important implications for public health.

Fatores de risco comportamentais para doenças cardiovasculares entre adolescentes da zona rural de um município do Sul do Brasil / Behavioral risk factors for cardiovascular diseases in adolescents from the rural area of a municipality in Southern Brazil / Factores de riesgo comportamentales para enfermedades cardiovasculares entre adolescentes de la zona rural de un municipio del sur de Brasil

O estudo objetivou estimar a prevalência de fatores de risco comportamentais para doenças cardiovasculares (DCV) e fatores associados ao seu acúmulo entre adolescentes da zona rural do Município de Pelotas, Rio Grande do Sul, Brasil. Estudo transversal, do tipo censo de base escolar, com amostra de 515 estudantes matriculados do 6º ao 9º ano do Ensino Fundamental das 21 escolas municipais rurais de Pelotas. Os fatores de risco comportamentais investigados foram: inatividade física; consumo irregular de frutas, legumes e verduras; experimentação de álcool e tabaco; e adição de sal à comida. O desfecho do estudo foi o escore de aglomeração de fatores de risco comportamentais variando de 0 a 3: nenhum fator de risco comportamental para DCV ou exposição a 1, 2 ou ≥ 3 fatores de risco comportamentais. Realizou-se regressão logística ordinal para avaliar o efeito ajustado das características individuais sobre o acúmulo de fatores de risco comportamentais, tendo como categoria de referência os indivíduos sem qualquer fator de risco. A inatividade física foi o fator de risco mais prevalente (74,8%), seguido do consumo irregular de frutas, legumes e verduras (56,2%). Aproximadamente 42% dos adolescentes apresentaram dois fatores de risco comportamentais, sendo a combinação inatividade física e consumo irregular de frutas, legumes e verduras a mais prevalente (23%). As chances de acumular dois ou mais fatores de risco comportamentais aumentou com a idade. A presença de fatores de risco comportamentais, bem como a simultaneidade destes é bastante elevada entre os adolescentes da zona rural do Município de Pelotas, evidenciando que eles estão expostos ao desenvolvimento de DCV. São necessárias intervenções preventivas de ocorrência simultânea desses fatores.

The study aimed to estimate the prevalence of behavioral risk factors for cardiovascular diseases (CVDs) and factors associated with their accumulation in adolescents from the rural area of a municipality in Pelotas, Rio Grande do Sul State, Brazil. This was a cross-sectional school-based census-type study with a sample of 515 sixth to nineth-grade schoolchildren in 21 rural public schools in Pelotas. The target behavioral risk factors were: physical inactivity; irregular consumption of fruits, vegetables, and greens; initiation to alcohol consumption and smoking; and addition of salt to foods. The study outcome was the cluster score of behavioral risk factors, varying from 0 to 3: no behavioral risk factors for CVD or exposure to 1, 2, or ≥ 3 behavioral risk factors. Ordinal logistic regression was performed to assess the effect adjusted for individual characteristics on the accumulation of behavioral risk factors, using as the reference category individuals without any risk factor. Physical inactivity was the most prevalent risk factor (74.8%), followed by irregular consumption of fruits, vegetables, and greens (56.2%). Approximately 42% of the adolescents presented two behavioral risk factors, the most prevalent combination of which was physical inactivity and irregular consumption of fruits, vegetables, and greens (23%). The odds of accumulating two or more behavioral risk factors increased with age. The presence and simultaneity of behavioral risk factors is quite high among adolescents from the rural area of Pelotas, showing that they are exposed to the development of CVD. Interventions are needed to prevent the simultaneous occurrence of these risk factors.

El objetivo del estudio fue estimar la prevalencia de factores de riesgo comportamentales para enfermedades cardiovasculares (DCV por sus siglas en portugués) y factores asociados a su acumulación entre adolescentes de la zona rural del Municipio de Pelotas, Rio Grande do Sul, Brasil. Estudio transversal, tipo censo de base escolar, con muestra de 515 escolares matriculados del 6º al 9º año de Enseñanza Fundamental de las 21 escuelas municipales rurales de Pelotas. Los factores de riesgo comportamentales investigados fueron: inactividad física; consumo irregular de frutas, legumbres y verduras; experimentación de alcohol y tabaco y adición de sal a la comida. El resultado del estudio fue la puntuación de aglomeración de factores de riesgo comportamentales, variando de 0 a 3: ningún factores de riesgo comportamentales para DCV o exposición a 1, 2 o ≥ 3 factores de riesgo comportamentales. Se realizó regresión logística ordinal, para evaluar el efecto ajustado de las características individuales sobre el acúmulo de factores de riesgo comportamentales, teniendo como categoría de referencia los individuos sin cualquier factor de riesgo. La inactividad física fue el factor de riesgo más prevalente (74,8%), seguido del consumo irregular de frutas, legumbres y verduras (56,2%). Aproximadamente un 42% de los adolescentes presentaron dos factores de riesgo comportamentales, siendo la combinación inactividad física y consumo irregular de frutas, legumbres y verduras la más prevalente (23%). Las oportunidades de acumular dos o más factores de riesgo comportamentales aumentaron con la edad. La presencia de factores de riesgo comportamentales, así como la simultaneidad de estos es bastante elevada entre los adolescentes de la zona rural del Municipio de Pelotas, evidenciando que ellos están expuestos al desarrollo de DCV. Son necesarias intervenciones preventivas para la ocurrencia simultánea de estos factores.

Prevalencia de lesiones ateroscleróticas carotídeas en radiografía panorámica y su relación con factores de riesgo cardiovascular en brasileños / Prevalence of atherosclerotic carotid lesions on panoramic radiography and relationship with cardiovascular risk factors in Brazilians

RESUMEN: Aunque la radiografía panorámica no es una prueba de diagnóstico inicial para detectar la aterosclerosis carotídea, no podemos ignorar su valor al ver estas lesiones como hallazgos incidentales que pueden ser grandes aliados en el diagnóstico temprano y la prevención de eventos vasculares graves. El objetivo de este estudio fue evaluar la prevalencia de calcificaciones en la bifurcación de la arteria carótida en las radiografías panorámicas de rutina como principio diagnóstico, así como su relación con los factores de riesgo cardiovascular en individuos brasileños. Se analizaron 449 exámenes de radiografía panorámica de la base de datos del Departamento de Radiología de la Facultad de Odontología de Piracicaba, UNICAMP, São Paulo, Brasil. Después de obtener mediciones de la presión arterial e información sobre el tabaquismo y las enfermedades sistémicas, fue buscado en la radiografía panorámica la presencia o ausencia de la masa radiopaca en las regiones de las vértebras cervicales C3-C4. En el caso de una imagen sugestiva de ateroma, se realizó una radiografía anteroposterior para confirmar el diagnóstico. Aplicamos la prueba estadística de Chi-cuadrado con distribución normal y muestras independientes y aleatorias con un intervalo de confianza del 95 %. La confirmación de calcificaciones carotideas se produjo en el 8,5 % de la población de estudio (38 casos). No encontramos ninguna relación entre la presencia de calcificaciones con el tabaquismo, con el sexo o con datos previos de antecedentes familiares. Sin embargo 49,1 % de los casos estaban por encima de sesenta años y tenía asociación significativa con la hipertensión (P = 0,006). El mayor riesgo se presenta en pacientes ancianos hipertensos y, por lo tanto, hacemos hincapié en la importancia de una observación minuciosa de las radiografías panorámicas en la búsqueda de cualquier alteración de la anatomía normal y si es así, proceder con la derivación lo antes posible para un diagnóstico concluyente por parte de un especialista, pudiendo así ayudar en la prevención de episodios vasculares graves.

SUMMARY: Although panoramic radiography is not an initial diagnostic test for detecting carotid atherosclerosis, we cannot ignore its value in viewing these lesions as incidental findings that can be great allies in early diagnosis and prevention of serious vascular events. The aim was to evaluate the prevalence of calcifications in the bifurcation of the carotid artery on routine panoramic radiographs as a diagnostic principle, as well as its relationship with cardiovascular risk factors in Brazilians. We analyzed 449 panoramic radiography exams from the database of the Department of Radiology of the Faculty of Dentistry of Piracicaba, UNICAMP, São Paulo, Brazil. After obtaining blood pressure measurements and information on smoking and systemic diseases, the researcher observed on the panoramic radiograph, the presence or absence of the radiopaque mass in the regions of the cervical vertebrae C3-C4. In the case of a suggestive image of atheroma, an anteroposterior radiography was performed to confirm the diagnosis. The Chi-square test of normal distribution for independent and random samples with a 95 % confidence interval was applied to the data. Confirmation of carotid calcifications occurred in 8.5 % of the study population (38 cases). We did not find any relationship between the presence of calcifications with smoking, sex or previous family history. However, 49.1 % of cases occurred above sixty years old and there was a significant relationship with hypertension (P = 0.006). The greatest risk was presented in elderly and hypertensive patients, so we highlight the importance of a thorough observation by the dentist of panoramic radiographs to detect any alteration of the normal anatomy and in the positive case, proceed with the referral as soon as possible for a conclusive diagnosis by a specialist, being able to thus assist in the prevention of severe vascular episodes.

Efecto del tratamiento periodontal no quirúrgico sobre la función endotelial / Effect of the non-quirurgical periodontal treatment over the endotelial function

RESUMEN Introducción: La periodontitis se caracteriza por ser una inflamación mediada por el huésped y asociada a microbios que producen la pérdida de la adherencia periodontal. Una infección focal localizada como la enfermedad periodontal podría conducir a una inflamación sistémica. La disfunción endotelial vascular se ha asociado con una variedad de enfermedades y factores de riesgo para la aterosclerosis, que incluyen la edad, hipertensión arterial, dislipidemias, diabetes, tabaquismo, enfermedades cardiovasculares específicas como arteriopatía coronaria, cerebral y procesos infecciosos e inflamatorios como enfermedad periodontal. Objetivo: Evaluar los efectos del tratamiento periodontal no quirúrgico sobre la función endotelial de los pacientes con periodontitis crónica mediante una revisión de ensayos clínicos aleatorizados. Métodos: Se utilizó una estrategia de búsqueda primaria en combinación de vocabulario controlado y términos de texto libre para la elaboración de una estrategia de búsqueda en MEDLINE a través de PubMed, mediante el PubMed Advanced Search Builder el 5 de julio de 2019. Análisis e integración de la información: Fueron seleccionados 29 artículos de 2214. Para la elección se tuvo en cuenta que fueran estudios en humanos donde estuvieran relacionadas las variables de estudio. Del 100 por ciento de los artículos seleccionados se encontró que el 37,9 por ciento pertenecían a estudios de casos y controles, el 31 por ciento pertenecían a estudios transversales, el 10,34 por ciento a estudios de cohorte y solo 20,6 por ciento fueros estudios de ensayos clínicos, de los cuales solo 3 artículos (10 por ciento) fueron seleccionados para esta revisión. Conclusiones: La terapia periodontal no presenta un efecto sobre la función endotelial en un periodo de 3 meses, sin embargo, a los 6 meses se reporta una mejoría en la función endotelial(AU)

ABSTRACT Introduction: Periodontitis is characterized by being an inflammation mediated by the host and associated with microbes that produce, the loss of periodontal adhesion. A localized focal infection such as periodontal disease could lead to systemic inflammation. Vascular endothelial dysfunction has been associated with a variety of pathologies and risk factors for atherosclerosis, including age, hypertension, dyslipidemias, diabetes, smoking, specific cardiovascular pathologies such as coronary artery disease, cerebral, inflammatory, and infectious processes such as periodontal disease. Objective: Assess the effects of non-surgical periodontal treatment on the endothelial function of patients with chronic periodontitis through a review of randomized clinical trials. Methods: We used a primary search strategy using a combination of controlled vocabulary and free text terms based on the MEDLINE search strategy through PubMed using the PubMed Advanced Search Builder on July 05, 2019. Analysis and integration of the information: 29 articles of 2214 were selected because they are human studies where the study variables are related. 100 percent of the selected articles found that 37.9 percent belonged to case-control studies, 31 percent belonged to cross-sectional studies, 10.34 percent to cohort studies and only 20.6 percent were clinical trial studies, of which only 3 articles (10 percent) were selected for this review. Conclusions: Periodontal therapy does not have an effect on endothelial function in a period of 3 months, however at 6 months an improvement in endothelial function was reported(AU)

Proteína C reactiva ultrasensible y riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 / Ultrasensitive reactive C protein and cardiovascular risk in patients with type 2 diabetes mellitus

Objetivo: describir el riesgo cardiovascular de pacientes con diabetes mellitus tipo 2 (DM2), según los valores de proteína C reactiva ultrasensible (PCR-us). Material y métodos: estudio descriptivo transversal, realizado en el Patronato del Diabético de zona 1, Ciudad de Guatemala, en el cual participaron 196 pacientes mayores de 50 años de edad, obteniéndose características sociodemográficas, medidas antropométricas. Además, se tomaron muestras de sangre que fueron procesadas en iCroma ll para determinar los valores de Proteína C reactiva ultrasensible (PCR-us). Resultados: los pacientes que aceptaron formar parte del estudio, tuvieron una media de edad de 62±8.62 DE; 74.4% (146) fueron del sexo femenino; 54% (106) eran católicos y el 82.1% (161), residían en la Ciudad de Guatemala. El estado nutricional fue normal en el 26% (50), el 11% (21) tenía sobrepeso y 63% (125), obesidad. Para índice cintura cadera (ICC) con respecto al sexo femenino, se obtuvo una media de 0.89±0.05 DE y una media 0.97±0.05 DE del sexo masculino. Respecto al riesgo cardiovascular, se obtuvo una media en valores de PCR-us de 2.9±2.8 DE, con 76% (148) de los pacientes en riesgo cardiovascular moderado/alto. Conclusiones: los valores de PCR-us tuvieron una media de 2.9±2.8 DE y 8 de cada 10 pacientes están en riesgo moderado/alto. De los pacientes estudiados, 7 de cada 10 fueron mujeres, con una media para a edad de 62 años. Se encontraron 7 de cada 10 con sobrepeso u obesidad, con una media para índice cintura cadera con respecto al sexo elevado.

Objective: to describe the cardiovascular risk of patients with type 2 diabetes mellitus, according to the values of ultrasensitive C-reactive protein (PCR-us). Material and methods: descriptive cross-sectional study, carried out on 196 patients over 50 years of age, from the Diabetic Board of Trustees in Zone 1, Guatemala. Data on sociodemographic characteristics, anthropometric measurements and blood were obtained. The blood samples were processed in iCroma ll to determine the values of ultrasensitive reactive Protein C (PCR-us). Results: the patients who accepted to be part of the study had a mean age of 62 ± 8.62 SD years; 74.4% (146) were female; 54% (106) were catholic, and 82.1% (161) resided in Guatemala City. Nutritional status was normal in 50 patients (26%), 21, overweight (11%) and 125, obese (63%). For the waisthip index, with respect to the female, an average of 0.89 ± 0.05 SD and for males, an average 0.97 ± 0.05 SD were obtained. Regarding cardiovascular risk, an average in PCR-us values of 2.9 ± 2.8 SD was obtained; 76% (148) of patient were at moderate / high cardiovascular risk.

Factores de riesgo cardiovascular no convencionales / Unconventional cardiovascular risk factor

Desde hace varias décadas se conocen los clásicos factores de riesgo cardiovascular (género, edad, hipertensión arterial, dislipidemias, tabaquismo, obesidad, sedentarismo). También existen factores de riesgo "no convencionales", es decir situaciones no descriptas ni contenidas en la mayoría de los puntajes de riesgo tradicionales, pero de las cuales existen evidencias científicas. En esta revisión se analizan algunos de ellos, tales como factores socioeconómicos, horarios prolongados de trabajo, factores ambientales, aislamiento social, cantidad y calidad del sueño. También hay factores de "protección" cardiovascular como la dieta mediterránea. La literatura cuenta con un número muy elevado de publicaciones que abarcan estos factores. En la presente descripción se incluyeron algunas que fuesen representativas, con buen diseño experimental y que hayan realizado análisis multivariado de los resultados para controlar potenciales confundidores que invaliden las conclusiones. Finalmente, se discuten los mecanismos fisiopatológicos involucrados en la generación de los eventos cardiovasculares finales. (AU)

The classical cardiovascular risk factors have been known for several decades (gender, age, arterial hypertension, dyslipidemia, smoking, obesity, sedentary lifestyle). There also exist "non conventional" risk factors, that are those not described or not included in the majority of the traditional cardiovascular risk scores, but for whom scientific evidence is available. In this review some of them are analyzed, such as socio economic factors, prolonged work schedules, environmental factors, social isolation, sleep quantity and quality. There are also some "preventive" cardiovascular factors as the Mediterranean diet. There exist considerable amount of publications in the literature analyzing these issues. In the present paper some of them are discussed. They have been selected as they were representative of the corresponding aspect, well designed and with multivariate statistical analysis of the results, in order to control potential confounders that could invalidate the conclusions. Finally, the pathophysiological mechanisms involved are discussed. (AU)

Factores de riesgo cardiovascular en Estados Unidos y México: comparación de los estudios HABLE y ENASEM / Cardiovascular risk factors in Mexico and the United States: a comparative cross-sectional study between the HABLE and MHAS participants

Resumen Introducción: En Estados Unidos se dispone de información acerca de la población mexicoamericana por el Estudio de Salud y Envejecimiento del Cerebro en Latinos Mayores (HABLE); en México se dispone de los resultados del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Objetivo: Comparar la prevalencia de factores de riesgo cardiovascular entre hombres y mujeres de HABLE y ENASEM. Método: Se analizó transversalmente la prevalencia de hipertensión, diabetes, hipercolesterolemia y obesidad abdominal en 559 participantes de HABLE y se comparó con datos de 13 663 participantes del ENASEM. La comparación se realizó mediante t de Student y chi cuadrada, según el tipo de variable. Resultados: El análisis demostró que la prevalencia de hipertensión (50 %, IC 95 % = 41.8-51.8), diabetes (35.5 %, IC 95 % = 27.6-43.8) y obesidad abdominal (59.3 %, IC 95 % = 50.5-68.1) fueron significativamente mayores en hombres del HABLE, mientras que las mujeres presentaron una prevalencia más elevada de diabetes (36.8 %, IC 95 % = 32.2-41.5) y obesidad abdominal (89.6 %, IC 95 % = 86.6-92.5). La hipercolesterolemia tuvo una prevalencia más elevada en mujeres del ENASEM (53.3 %, IC 95 % = 50.3-56.2). Conclusión: La prevalencia de factores de riesgo cardiovascular fue mayor en mexicoamericanos participantes del HABLE, que en mexicanos participantes del ENASEM.

Abstract Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.

Socioeconomic status and cardiovascular risk factors in young adults: a cross-sectional analysis of a Brazilian birth cohort / Situação socioeconômica e fatores de risco cardiovascular em jovens: uma análise transversal de uma coorte de nascimentos brasileira

ABSTRACT: Introduction: In high-income countries, persons of high socioeconomic status (SES) have a lower cardiovascular risk. However, in middle and low-income countries, the results are controversial. Objective: To evaluate the association between family income and cardiovascular risk factors in young adults. Methods: A total of 2,063 individuals of a birth cohort initiated in 1978/79 in the city of Ribeirão Preto, Brazil, were evaluated at age of 23/25 years. Cardiovascular risk factors (hypertension, sedentary lifestyle, smoking, low high-density lipoprotein (HDL)-cholesterol, high low-density lipoprotein (LDL)-cholesterol, high fibrinogen, insulin resistance, diabetes, abdominal and total obesity, and metabolic syndrome) were evaluated according to family income. Income was assessed in multiples of the minimum wage. Simple Poisson regression models were used to estimate the prevalence ratios (PR) with robust estimation of the variance. Results: High-income women showed lower prevalences of low HDL-cholesterol (PR = 0.47), total obesity (PR = 0.22), abdominal obesity (PR = 0.28), high blood pressure (PR = 0.28), insulin resistance (PR = 0.57), sedentary lifestyle (PR = 0.47), metabolic syndrome (PR = 0.24), and high caloric intake (PR = 0.71) (p < 0.05). High-income men showed lower prevalences of low HDL-cholesterol (PR = 0.73) and sedentarism (PR = 0.81) (p < 0.05). These results may be explained by the fact that high-income women pay more attention to healthy habits and those with the lowest family income are least likely to access health services resources and treatments. Conclusion: Women were in the final phase of the epidemiologic transition, whereas men were in the middle phase.

RESUMO: Introdução: Em países de alta renda, indivíduos de situação socioeconômica elevada apresentam menor risco cardiovascular. Em países de média e baixa rendas, os resultados são controversos. Objetivo: Avaliar a associação entre renda familiar e fatores de risco cardiovascular em adultos jovens. Metodologia: Estudo seccional em que foram avaliados 2.063 indivíduos aos 23/25 anos de uma coorte de nascimento iniciada em 1978/79 na cidade de Ribeirão Preto, Brasil. Avaliaram-se fatores de risco cardiovascular (hipertensão arterial, sedentarismo, tabagismo, HDL - colesterol baixo, LDL - colesterol elevado, fibrinogênio alto, resistência insulínica, diabetes, obesidade abdominal e total e síndrome metabólica) de acordo com renda familiar. A renda foi avaliada em múltiplos do salário mínimo. As razões de prevalências (RP) foram estimadas em modelos de regressão de Poisson simples, com estimativa robusta da variância. Resultados: Mulheres de maior renda apresentaram menores prevalências de HDL - colesterol baixo (RP = 0,47), obesidade total (RP = 0,22) e abdominal (RP = 0,28), resistência insulínica (RP = 0,57), pressão arterial elevada (RP = 0,28), sedentarismo (RP = 0,47), síndrome metabólica (RP = 0,24) e alta ingestão calórica (RP = 0,71) (p < 0,05). Os homens de maior renda apresentaram menores prevalências de HDL - colesterol baixo (RP = 0,73) e sedentarismo (RP = 0,81) (p < 0,05). Pode ser que mulheres de alta renda prestem mais atenção aos hábitos saudáveis e aquelas com menor renda têm menor probabilidade de acessar recursos e tratamentos de serviços de saúde. Conclusão: As mulheres encontravam-se na fase final da transição epidemiológica, enquanto os homens, na fase intermediária.

SGLT-2 inhibitors in diabetes: a focus on renoprotection

SUMMARY Type 2 diabetes mellitus is an important public health problem, with a significant impact on cardiovascular morbidity and mortality and an important risk factor for chronic kidney disease. Various hypoglycemic therapies have proved to be beneficial to clinical outcomes, while others have failed to provide an improvement in cardiovascular and renal failure, only reducing blood glucose levels. Recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors, represented by the empagliflozin, dapagliflozin, and canagliflozin, have been showing satisfactory and strong results in several clinical trials, especially regarding the reduction of cardiovascular mortality, reduction of hospitalization due to heart failure, reduction of albuminuria, and long-term maintenance of the glomerular filtration rate. The benefit from SGLT2 inhibitors stems from its main mechanism of action, which occurs in the proximal tubule of the nephron, causing glycosuria, and a consequent increase in natriuresis. This leads to increased sodium intake by the juxtaglomerular apparatus, activating the tubule glomerular-feedback and, finally, reducing intraglomerular hypertension, a frequent physiopathological condition in kidney disease caused by diabetes. In addition, this class of medication presents an appropriate safety profile, and its most frequently reported complication is an increase in the incidence of genital infections. Thus, these hypoglycemic agents gained space in practical recommendations for the management of type 2 diabetes mellitus and should be part of the initial therapeutic approach to provide, in addition to glycemic control, cardiovascular outcomes, and the renoprotection in the long term.

Polycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers / Hidrocarburos policíclicos aromáticos y desarrollo de enfermedades respiratorias y cardiovasculares en trabajadores / Hidrocarbonetos policíclicos aromáticos e desenvolvimento de doenças respiratórias e cardiovasculares em trabalhadores

ABSTRACT Objectives: to identify the scientific evidence on the development of cardiovascular and respiratory diseases due to workplace contamination by polycyclic aromatic hydrocarbons. Methods: integrative literature review. The search for primary articles was held in October 2017 in the Medical Literature Analysis and Retrieval System Online (through Pubmed), Web of Science and Latin American and Caribbean Literature in Health Sciences (LILACS). Results: the 16 studies analyzed showed that exposure to polycyclic aromatic hydrocarbons was associated with cardiovascular diseases, such as increased blood pressure, heart rate variation, and ischemic heart disease; and respiratory disorders, such as decreased lung function, chronic obstructive pulmonary disease, asthma, wheeze, coughing, pulmonary wheezing, chest tightness, effort dyspnea, and sore throat. Conclusions: polycyclic aromatic hydrocarbons cause deleterious effects on the cardiovascular and respiratory systems through mutations and cellular inflammation, being a risk to exposed individuals.

RESUMEN Objetivos: identificar las evidencias científicas sobre el desarrollo de enfermedades cardiovasculares y respiratorias debido a la contaminación en el ambiente de trabajo por hidrocarburos policíclicos aromáticos. Métodos: revisión integrativa de la literatura. La búsqueda de los artículos primarios se realizó en octubre de 2017 en: Medical Literature Analysis and Retrieval System Online (vía PubMed), Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud. Resultados: los 16 estudios analizados mostraron que la exposición a los hidrocarburos policíclicos aromáticos estuvo asociada a las enfermedades cardiovasculares, como aumento de la presión arterial, variación de la frecuencia cardíaca y enfermedad cardiaca isquémica; y a la respiración, como disminución de la función pulmonar, enfermedad pulmonar obstructiva crónica, asma, silbido, tos, sibilancia pulmonar, opresión en el pecho, disnea al esfuerzo y dolor de garganta. Conclusiones: los hidrocarburos policíclicos aromáticos causan efecto deletéreo en el sistema cardiovascular y respiratorio por medio de mutaciones e inflamaciones celulares, siendo un riesgo al individuo expuesto.

RESUMO Objetivos: identificar as evidências científicas sobre o desenvolvimento de doenças cardiovasculares e respiratórias devido à contaminação no ambiente de trabalho por hidrocarbonetos policíclicos aromáticos. Métodos: revisão integrativa da literatura. A busca dos artigos primários foi realizada em outubro de 2017 na Medical Literature Analysis and Retrieval System Online (via Pubmed), Web of Science e Literatura Latino-Americana e do Caribe em Ciências da Saúde. Resultados: os 16 estudos analisados mostraram que a exposição aos hidrocarbonetos policíclicos aromáticos esteve associada a doenças cardiovasculares como aumento da pressão arterial, variação da frequência cardíaca e doença cardíaca isquêmica; e respiratórias como diminuição da função pulmonar, doença pulmonar obstrutiva crônica, asma, chiado, tosse, sibilância pulmonar, opressão no peito, dispneia ao esforço e dor de garganta. Conclusões: os hidrocarbonetos policíclicos aromáticos causam efeito deletério no sistema cardiovascular e respiratório por meio de mutações e de inflamações celulares, sendo um risco ao indivíduo exposto.

Should all patients with psoriasis receive statins? Analysis according to different strategies

Abstract Background: Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis. Objective: To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy. Methods: A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed. Results: A total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1-27.0%) and 1.9% (IQR 0.4-5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively. Study limitations: This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis. Conclusion: This population with psoriasis was mostly classified at moderate-high risk and the statin therapy indication was similar when applying the two strategies evaluated.