Em adultos, as informações obtidas com os modos colorido e espectral do US de artérias carótidas são importantes na detecção e na classificação da doença oclusiva carotídea e fazem parte da rotina do exame. Nestes exames, os valores de referência da análise espectral foram estabelecidos em indivíduos com placas ateroscleróticas e baseiam-se no estudo da velocidade de pico sistólico da ACI, da velocidade diastólica mínima da ACI e razão de VPS da ACI/ACC7.
A aplicabilidade do Doppler no ultrassom de carótidas na população pediátrica tem se restringido a avaliação das repercussões hemodinâmicas de desordens cardíacas e circulatórias cerebrovasculares, como nas hemorragias intraventriculares cerebrais em neonatos, asfixia neonatal e edema cerebral101,102.
O dano hemodinâmico à parede arterial é considerado o primeiro e mais importante evento que desencadeia o remodelamento patológico da parede arterial14, com consequente aumento da espessura mediointimal. Entretanto, os inúmeros estudos que demostraram aumento da EMIc em indivíduos com fatores de risco cardiovascular não incluíram avaliação de características dopplerfluxométricas.
Apenas Luo e colaboradores103 estudaram parâmetros hemodinâmicos ao Doppler hipotetizando que poderiam justificar as diferenças na EMI das artérias carótidas entre os lados direito e esquerdo. Os autores observaram que a EMI da artéria carótida comum direita se correlaciona com os parâmetros hemodinâmicos, como a velocidade média e relação sístole/diástole.
Nas principais bases de dados, não são encontrados estudos que mencionem parâmetros de normalidade para os modos colorido e espectral do US de carótidas em crianças e adolescentes. Os resultados poderiam contribuir para a compressão da etiologia do aumento da EMI nos indivíduos de risco e aprimoramento das abordagens terapêuticas.
3 OBJETIVOS
3.1 Objetivo geral
Estudar as características de normalidade do ultrassom de carótidas com Doppler em adolescentes saudáveis.
3.2 Objetivos específicos
Descrever as características do ultrassom de carótidas pelo modo B e pelo Doppler colorido e espectral em adolescentes saudáveis, sem fator de risco cardiovascular.
Correlacionar a medida da espessura da camada mediointimal das artérias carótidas com a idade, dados antropométricos e estágio puberal.
REFERÊNCIAS
1. World Health Organization. Acesso em fevereiro de 2010. Disponível em: www.who.gov.
2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2003. PloS Med 2006; 3(11):e442.
3. McTigue K, Kuller L. Cardiovascular risk factors, mortality, and overweight.
JAMA 2008; 299(11):1260-1.
4. D’Agostino RD, Vasan RS; Pencina MJ, Wolf PA, Cobaia M, Massaro JM et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117(6):743-53.
5. Nguyen-Thanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness. Am J Cardiol 2009; 104(10):1383-8.
6. Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D et al. From vulnerable plaque to vulnerable patient-Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006; 98(2A):2H-15H.
7. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI et al. Carotid artery stenosis: gray scale and Doppler US diagnosis - Society of Radiologist in Ultrasound Consensus Conference. Radiology 2003; 229(2):340- 6.
8. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER et al. Use of carotid ultrassond to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the society for Vascular Medicine. J Am. Soc Echocardiogr 2008; 21(2):93-111. 9. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical
cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115(4):459-67.
10. Groot E, Hovingh GK, Wiegman A, Duriez P, Smit AJ, Fruchart JC. Measurement of arterial wall thickness as a surrogate marker for atherosclerosis.Circulation 2004; 109(23 Suppl 1):III33-8.
11. Oren A, Vos LE, Uiterwaal CS, Grobbee DE, Bots ML. Cardiovascular risk factors and increased carotid intima media thickness in healthy young adults: the Atherosclerose Risk in Young Adults (ARYA) Study. Arch Intern Med 2003; 163(15):1787-92.
12. Kotsis V, Manios E, Pitiriga V et al. Is carotid atherosclerosis (IMT) a marker of the severity of coronary artery desease? J Hypertens 2003; 21(4): S247.
13. Barker DJ, Osmond C, Golding J, Kuh D, Wadsworth ME. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298(6673):564-7.
14. Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009; 24(4):707-19.
15. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults.The Bogalusa Heart Study. N Engl
J Med 1998; 338(23):1650-6.
16. McGill HC Jr., McMahan CA, Herderick EE, Tracy RE, Malcom GT, Zieske AW
et al. Effects of coronary heart disease risk factors on atherosclerosis of
selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Artherosclerosis in Youth. Arterioscler Thromb
Vasc Biol 2000; 20(3):836-45.
17. Strong J, Malcom GT, McMahan CA, Tracy RE, Newman WP 3rd, Herderick EE
et al. Prevalence and extent of atherosclerosis in adolescents and young adults:
implications for prevention for the Pathological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281(8):727-35.
18. Järvisalo MJ, Jartti L, Näntö-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 2001; 104(24):2943-7.
19. Järvisalo MJ, Raiakari M, Toikka JO, Putto-Laurila A, Rontu R, Laines S et al. Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes. Circulation 2004; 109(14):1750-5.
20. Sorof JM, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai D et al. Carotid ultrasonography for detection of vascular abnormalities in hypertensive children.
Pediatr Nephrol 2003; 18(10):1020-4.
21. Ayer JG, Harmer JA, Nakhla S, Xuan W, Ng MK, Raitakari OT et al. HDL- cholestereol, blood pressure, and asymmetric dimethylarginine are significantly associated with arterial wall thickness in children. Arterioscler Thromb Vasc Biol 2009; 29(6):943-9.
22. Wachtell K, Okin PM, Olsen MH, Dahlöf B, Devereux RB, Ibsen H et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death: the LIFE study.
Circulation 2007; 116(7):700-5.
23. National High Blood Pressure Education Program Working Group on High Blood pressure in Children and Adolescentes. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in childrenand adolescents.
Pediatrics 2004; 114(2 Suppl 4th Report):555-76.
24. US Preventive Services Task Force, Barton M. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics 2010; 125(2):361-7.
25. Jourdan C, Wühl E, Litwin M, Fahr K, Trelewicz J, Jobs K et al. Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 2005; 23(9):1707-15.
26. Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 2003; 290(17):2271-6.
27. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N et
al. Cardiovascular risk factors in childhood and carotid artry intima-media
thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003; 290:2277-83.
28. Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increases carotid intimal-medial thickness. J Pediatr 2005; 147(5):651-6.
29. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T et al. Heart disease and stroke statistics - 2006 update: a report from the American Heart Association Statistics Committee and Strok Estatistics Subcommittee.
Circulation 2006;113(6):e85-151.
30. Downs JR, Clearfield M, Tyroler HA, Whitney EJ, Kruyer W, Langendorfer A et
al. Air Force⁄Texas Coronary Atherosclerosis Prevention Study (AFCAPS⁄TEXCAPS): additional perspectives on tolerability of long-term treatment with lovastatin. Am J Cardiol 2001; 87(9):1074-9.
31. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24(11):987-1003.
32. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A et
al. Predicting cardiovascular risk in England and Wales: prospective derivation
and validation of QRISK2. BMJ 2008; 336(7659):1475-82.
33. Verdecchia P, Angeli F, Taddei S.At the beginning of stiffening: endothelial dysfunction meets “pulsology”. Hypertension 2006; 48(4):541-42.
34. Schoen FJ, Cotran RS. Blood Vessels. In: Cotran RS, Kumar V, Collins T, editors. Pathologic basis of disease. 6th ed. Philadelphia: W.B. Saunders, 1999. 35. Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-reactive protein and
parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation 2008; 118(22):2243-51.
36. Jacobson TA, Griffiths GG, Varas C, Gause D, Sung JC, Ballantyne CE. Impact of evidence-based “clinical judgment” on the number of American adults requiring lipid-lowering therapy based on updated NHANES III data. Arch Intern
Med 2000; 160(9):1361-9.
37. Smith SC Jr, Greenland P, Grundy SM. AHA Conference Proceedings. Prevention Conference V: Beyond Secondary Prevention: Identifying the high- risk patient for primary prevention: executive summary. American Heart Association. Circulation 2000; 101(1):111-6.
38. Tzou WS, Douglas PS, Srinivasan SR, Bond MG, Tang R, Chen W et al. Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005; 46(3):457-63.
39. Lauer MS. Primary prevention of atherosclerotic cardiovascular disease: the high public burden of low individual risk. JAMA 2007; 297(12):1376-8.
40. Kappagoda CT, Amsterdam EA. Assessment of risk for developing coronary heart disease in asymptomatic individuals. J Cardiopulm Rehabil Prev 2009; 29(4):207-19.
41. Mookadam F, Moustafa SE, Lester SJ, Warsame T. Subclinical atherosclerosis: evolving role of carotid intima-‐media thickness. Prev Cardiol 2010; 13(4):186-97. 42. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR et al. Coronary
calcium as a predictor of coronary events in four racial or ethnic groups. N Engl
J Med 2008; 358(13):1336-45.
43. Lester SJ, Eleid MF, Khandheria BK, Hurst RT. Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis.
44. Tsang TS, Barnes ME, Gersh BJ, Takemoto Y, Rosales AG, Bailey KR et al. Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol 2003; 42(7):1199-205.
45. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74(6):1399-406.
46. Stein JH, Douglas PS, Srinivasan SR, Bond MG, Tang R, Li S et al. Distribution and cross-sectional age-related increases of carotid artery intima-media thickness in young adults. Bogalusa Heart Study 2004; 35(12):2782-7.
47. Bots ML, Grobbee DE, Hofman A, Witteman JC. Common carotid intima-media thickness and risk of acute myocardial infarction: the role of lumen diameter.
Stroke 2005; 36(4):762-7.
48. Yeboah J, Burke GL, Crouse JR, Herrington DM. Relationship between brachial flow-mediated dilation and carotid intima-media thickness in an elderly cohort: the cardiovascular health study. Atherosclerosis 2008; 197(2):840-5.
49. Bots ML, Hofman A, Grobbe DE. Increased common carotid intima-media thickness. Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study. Stroke 1997; 28(12):2442-7.
50. Pearson TA, Heiss GM. Quantitative imaging, risk factors, prevalence, and change: introduction and background. Coronary atherosclerosis: A multifactorial disease. Circulation 1993; 87(3Suppl):II2.
51. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N et al. Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007; 23(1):75- 80.
52. Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E et al. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. J Am Soc Echocardiogr 2006; 19(8):943-54.
53. Salonen R., Salonen JT. Determinants of carotid intima media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med 1991; 229(3):225-31.
54. Giral P, Filitti V, Levenson J, Pithois-Merli I, Plainfosse MC, Mainardi C et al. Relation of risk factors for cardiovascular disease to early atherosclerosis detected by ultrasonography in middle-aged normotensive hypercholes terolemic men. PCV Metra Group. Atherosclerosis 1990; 85(2-3):151-9.
55. Greenland P, Smith SC Jr, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation 2001; 104(15):1863-7.
56. Molinari F, Zeng G, Suri JS. A state of the art review on intima-‐media thickness (IMT) measurement and wall segmentation techniques for carotid ultrasound. Comput
Methods Programs Biomed 2010; 100(3):201-21.
57. Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a population based ultrasonographic study. Atherosclerosis 1990; 81(1):33-40.
58. Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH et al. Prevention Conference V: Beyond secondary prevention: identifying the high- risk patient for primary prevention: noninavasive tests of atherosclerotic burden: Writing Group III. Circulation 2000; 101(1):E16-22.
59. Freire CMV, Ribeiro ALP, Barbosa FBL, Nogueira AI, Almeida MC, Barbosa MM
et al. Compararison between automated and manual measurements of carotid
intima-media thickness in clinical practice. Vasc Health and Risk Manag 2009; 5:811-7.
60. Howard G, Sharrett A, Heiss G, Evans GW, Chambless LE, Riley WA et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. Stroke 1993; 24(9):1297-304.
61. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) study, 1987-1993. Am J Epidemiol 1997; 146(6):483-94.
62. O’Leary DH, Polka JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340(1):14-22.
63. Barker DJ. In utero programming of chronic disease. Clin Sci (Lond) 1998; 95(2):115-28.
64. Vehaskari VM, Woods LL. Prenatal programming of hypertension: lessons from experimental models. J Am Soc Nephrol 2005; 16(9):2545-56.
65. Ishizu T, Ishimitsu T, Yanagi H, Seo Y, Obara K, Moriyama N et al. Effect of age on carotid arterial intima-media thickness in childhood. Heart Vessels 2004; 19(4):189-95.
66. Martyn CN, Greenwald SE. A hypothesis about mechanism for the programming of blood pressure and vascular disease in early life. Clin Exp Pharmacol Physiol 2001; 28(11):948-51.
67. Gurné O, Chenu P, Buche M, Louagie Y, Eucher P, Marchandise B et al. Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand. Heart 1999; 82(3):336-42.
68. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intima-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine study. Circulation 2001; 104(23):2815-9.
69. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version.
Pediatrics 2002; 109(1):45-60.
70. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK. Trends in blood pressure among children and adolescents. JAMA 2004; 291(17):2107-13.
71. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 1996; 128(5 Pt 1):608-15.
72. Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, Grenda R. Intima-media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol 2004; 19(7):767-74
73. Robinson RF, Batisky DL, Hayes JR, Nahata MC, Mahan JD. Body mass index in primary and secondary hypertension. Pediatr Nephrol 2004; 19(12):1379-84. 74. Flynn JT, Alderman MH. Characteristics of children with primary hypertension
seen at a referral center. Pediatr Nephrol 2005; 20(7):961-6.
75. Sorof JM, Alexandrov AV, Cardwell NG, Portman RJ. Carotid artery intima- medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 2003; 111(1):61-6.
76. Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study.
77. Litwin M, Śladowska J, Antoniewicz J, Niemirska A, Wierzbicka A, Daszkowska J et al. Metabolic abnormalities, insulin resistance and metabolic syndrome in children with primary hypertension. Am J Hypertens 2007; 20(8):875-82.
78. Toledo-Corral CM, Ventura EE, Hodis HN, Weigensberg MJ, Lane CJ, Li Y et al. Persistence of the metabolic syndrome and its influence on carotid artery intima media thickness in overweight Latino children. Atherosclerosis 2009; 206(2):594-8.
79. Groothoff JW, Gruppen MP, Offringa M, Groot E, Stok W, Bos WJ et al. Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 2002; 13(12):2953-61.
80. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002; 106(1):100-5.
81. Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K et al. Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 2005; 16(5):1494-500.
82. Mitsnefes MM, Kimball TR, Kartel J. Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 2005; 16(9):2796-803.
83. Poyrazoglu HM, Düsünsel R, Yikilmaz A, Narin N, Anarat R, Gündüz Z et al. Carotid artery thickness in children and young adults with end stage renal disease. Pediatr Nephrol 2007; 22(1):109-16.
84. Retnakaran R, Zinman B, Connelly PW, Harris SB, Hanley AJ. Nontraditional cardiovascular risk factors in pediatric metabolic syndrome. J Pediatr 2006; 148(2):176-82.
85. Meyer AA, Kundt G, Steiner M, Schuii-Werner P, Kienast W. Impaired flow- mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors. Pediatrics 2006; 117(5):1560-7.
86. Roh EJ, Lim JW, Ko KO, Cheon EJ. A useful predictor of early atherosclerosis in obese children: serum high-sensitivity C-reactive protein. J Korean Med Sci 2007; 22(2):192-7.
87. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C; Berenson GS. Body mass index, waist circumference and clustering of cardiovascular desiase risk factors in a biracial sample of children and adolescents. Pediatrics 2004; 144(2):e198-205.
88. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001; 358(9291):1400- 4.
89. Pilz S, Horejsi R, Möller R, Almer G, Scharnagl H, Stojakovic T et al. Early atherosclerosis in obese juveniles is associated with low serum levels of adiponectin. J Clin Endocrinol Metab 2005; 90(8):4792-6.
90. Beauloye V, Zech F, Tran HT, Clapuyt P, Maes M, Brichard SM. Determinants of early atherosclerosis in obese children and adolescents. J Clin Endocrinol
Metab 2007; 92(8):3025-32.
91. Rodenburg J, Vissers MN, Wiegman A, van Trotsenburg AS, van der Graaf A, Groot E et al. Statin treatment in children with familial hypercholesterolemia: the younger the better. Circulation 2007; 116(6):664-8.
92. Krantz JS, Mack WJ, Hodis HN, Liu CR, Liu CH, Kaufman FR. Early onset of subclinical atherosclerosis in young persons with type 1 diabetes. J Pediatr 2004; 145(4):452-7.
93. Singh TP, Groehn H, Kazmers A. Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus. J Am Coll Cardiol 2003; 41(4):661-5.
94. Juonala M, Magnussen CG, Venn A, Dwyer T, Burns TL, Davis PH et al. Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Circulation 2010; 122(24):2514-20.
95. Jarvisalo MJ, Harmoinen A, Hakanen M, Paakkunainen U, Viikari J, Hartiala J et
al. Elevated serum C-reactive protein levels and early arterial changes in
healthy children. Arterioscler Thromb Vasc Biol 2002; 22(8):1323-8.
96. Daniels SR, Greer FR, Committee on Nutrition. Lipid screening andcardiovascular health in childhood. Pediatrics 2008; 122(1):198-208.
97. Haney EM, Huffman LH, Bougatsos C, Freeman M, Steiner RD, Nelson HD. Screening and treatment for lipid disorders in children and adolescents:systematic evidence review for the US Preventive Services TaskForce. Pediatrics 2007; 120(1):e189-214.
98. Wachtell K, Okin PM, Olsen MH, Dahlöf B, Devereux RB, Ibsen H et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death: the LIFE study.
Circulation 2007; 116(7):700-5.
99. Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48(9):1865-70.
100. Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Jana R, Wawer ZT et al. Regression of target organ damage in children with primary hypertension. Pediatr Nephrol 2010; 25(12):2489-99.
101. Futagi Y, Otani K, Tagawa T, Yabuuchi H. Internal carotid arterial blood flow velocity in infants. Pediatr Neurol 1992; 8(3):200-4.
102. Kojo M, Ogawa T, Yamada K. Normal developmental changes in carotid arterial blood flow measured by Doppler flowmetry in children. Pediatr Neurol 1996; 14(4):313-6.
103. Luo X, Yang Y, Cao T, Li Z. Differences in left and right carotid intima-media thickness and the associated risk factors. Clin Radiol 2011; 66(5):393-8.
4 POPULAÇÃO E MÉTODOS
4.1 Casuística
Foi realizado um estudo transversal do tipo descritivo.
Os sujeitos da pesquisa foram 61 adolescentes na faixa etária entre 10 e 20 anos, de ambos os sexos, recrutados de forma aleatória entre os alunos do Instituto de Educação de Minas Gerais, escola pública localizada em área central de Belo Horizonte (MG). A coleta de dados foi realizada no período de 11/2010 a 09/2011.
Os cálculos do tamanho da amostra foram realizados de duas formas: a)