Bu kesitsel araştırmada 2011 yılında Sağlık Bakan- lığı tarafından yürütülen Kronik Hastalıklar ve Risk Faktörleri Sıklığı çalışması verileri kullanılmıştır. Çalışmanın yönteminin ve temel bulgularının sunul- duğu rapor daha önce yayınlanmıştır . Çalışma- da yüzde 1’lik bir prevalans (p) %0,15’lik bir sapma (d) için en küçük örnek büyüklüğü 16,622 olarak belirlenmiştir. Ancak kişilerin çalışmaya katılımının düşük olabileceği öngörülerek, örneklem belirlendi- ği sırada görev yapan 20,044 Aile Hekimi’nin ken- dilerine kayıtlı olan nüfustan 15 yaş ve üstü 2 kişiy- le görüşmesine karar verilmiştir (n=40,088). Kişiler rasgele örnekleme yöntemiyle TÜİK tarafından se- çilmiş olup, örneğe çıkan bireyler kayıtlı bulunduk- ları Aile Sağlığı Merkezi’ne davet edilmiştir. Birey- lere yapılacak çalışmayı açıklayan, verilerin gizli tutulacağını bildiren bir form okutulmuştur. Kişinin kendi rızasıyla bu işlemlerin yapılmasına izin verdi- ği yazılı ya da sözlü beyan olarak alındıktan sonra elektronik ortamda hazırlanan anket uygulanmış, gerekli fizik muayene ve laboratuvar incelemeleri gerçekleştirilmiştir. Ölçümler ve laboratuvar ince- lemeleri için örnek alımı Aile Sağlığı Merkezi’nde görevli ebe ve hemşireler tarafından yapılmıştır. Laboratuvar sonuçları yine Aile Hekimi tarafından değerlendirilmiş ve veri tabanına kaydedilmiştir.
the outpatient clinic from the Department of Rheumatology were asked to participate in the FRANCIS study. Inclusion criteria were the presence of RA and an age 70 years. Exclusion criteria were the presence of diabetes mellitus (DM) or CVD. CVD was defined as a docu- mented history of myocardial infarction, cerebrovascular event, amputation due to peripheral artery disease, intermittent claudication, or a prior percutaneus transluminal coronary angio- plasty (TCA) or coronary artery bypass graft (CABG). In addition, kidney disease defined as an MDRD< 40 was an exclusion criterium. Only patients with a CVD risk <10% according to the 2009 version of the SCORE model were randomized. Patients aged over 65 years were classified as 65 years old in order to be able to use the SCORE model. Patients with a CVD risk 10% were followed in a separate cohort (“high risk cohort”). For the current analysis, baseline data from both randomized patients and patients in the high risk cohort were used. The RA patients were treated by their own rheumatologists according to a treat-to-target principle, aiming for disease remission (DAS28<2.6). RA was defined by the ACR ‘87 criteria . Unmatched con- trol subjects were non-RA patients followed in a separate observational study (ABR no. NL29910.101.09) from our department. They were recruited from the outpatient clinic of the Diabetes and Vascular Center of the Sint Franciscus Gasthuis in Rotterdam and underwent measurements identical to the RA patients of the FRANCIS study . Exclusion criteria for the control group were also the presence of DM, CVD and/or kidney disease. All controls ful- filling the age limit of 70 years were included in this analysis. In addition, RA patients and controls who used statins and/or anti-hypertensives were excluded. Controls with a CRP >10 mg/L were excluded from the analysis. Anthropometric characteristics i.e. height, weight, waist circumference and blood pressure were obtained as well as a detailed medical history and the use of medication. All subjects provided written informed consent. The studies were approved by the independent Regional Medical Ethical Committee Rotterdam of the Maasstad Hospital, the Netherlands.
ABSTRACT: Objective: To identify areas and risk factors incardiovasculardisease (CD) mortality associated with air pollution from high exposure to vehicular traic. Methods: Cross-sectional study of CD mortality in 2,617 individuals aged 45-85 years living in the urban area of Cuiabá and Várzea Grande, Mato Grosso State, Brazil, between 2009 and 2011. We used the residential proximity of up to 150 meters to a roadway of great vehicle low as a proxy of high exposure to air pollution from vehicular traic. The association between age, gender, income, and traic intensity with vehicular traic exposure was assessed through the multiple logistic regression. We conducted stratiied analyses to observe the inluence of seasons and groups of causes. We used Bernoulli’s spatial model of probability to identify high-risk clusters. Results: Risk factors for CD mortality associated with high exposure to vehicular traic were: living in census tracts with very unequal income (OR = 1.78; 95%CI 1.36 – 2.33), heavy traic (OR = 1.20; 95%CI 1.01 – 1.43), and female gender (OR = 1.18; 95%CI 1.01 – 1.38). The CD mortality risk increases about 10% during the dry season period. We identiied nine areas ofrisk. Conclusion: High exposure to traic is associated with CD mortality in Cuiabá and Várzea Grande. Income inequality, traic intensity, and female gender presented as the main determiners for this exposure. The dry season period enhances the efects of traic exposure.
All volunteers were asked to fast for 12 h before the tests, and evaluations of serum fasting glucose, lipid proﬁle, triacylglycerols, and uric acid were carried out by conventional methods. Fasting insulinemia was measured by immuno- ﬂuorometric methods, and we adopted dosages lower than 15.0 mUI/mL as cutoff values of normality . Tests evaluated the subjects’ lipid proﬁle, including total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein choles- terol, and triacylglycerols. The analysis of these results was based on the limits put forth by the First Brazilian Guidelines for Prevention of Atherosclerosis in Child- hood and Adolescence . All tests were performed in all 95 subjects, except for the serum uric acid dosage, which was executed in 94 adolescents.
Data synthesis: After independent analyses of the studies by two reviewers, seven articles meeting the eligibility criteria, published between 2012 and 2016, remained for the review. Cross-sectional, prospective, cohort, and case-control studies were included. The importance of chemerin adipokines on the risk factors for cardiovasculardisease is demonstrated by its associationwith obesity and diabetes mellitus, as well as clinical, anthropometric, and biochemical parameters. However, the strength of evidence from these studies is relatively low, due to their heterogeneity, with several limitations such as small samples and consequent lack of representativeness, lack of standardization in dosage methods, cross-sectional design of most studies, and impossibility of extrapolating results.
ABSTRACT – Background – Evidence suggests a nutritional transition process in patients with inlammatory bowel disease. Obesity, which was once an uncommon occurrence in such patients, has grown in this population at the same prevalence rate as that found in the general population, bringing with it an increased riskofcardiovasculardisease. Objective – The aim of the present study was to determine the nutritional status and occurrence ofcardiovascularrisk factors in patients with inlammatory bowel disease. Methods – A case-series cross-sectional study was conducted involving male and female adult outpatients with inlammatory bowel disease. Data were collected on demographic, socioeconomic, clinical and anthropometric variables as well as the following cardiovascularrisk factors: sedentary lifestyle, excess weight, abdominal obesity, medications in use, comorbidities, alcohol intake and smoking habits. The signiicance level for all statistical tests was set to 5% (P < 0.05). Results – The sample comprised 80 patients with inlammatory bowel disease, 56 of whom (70.0%) had ulcerative colitis and 24 of whom (30.0%) had Crohn’s disease. Mean age was 40.3±11 years and the female genre accounted for 66.2% of the sample. High frequencies of excess weight (48.8%) and abdominal obesity (52.5%) were identiied based on the body mass index and waist circumference, respectively, in both groups, especially among those with ulcerative colitis. Muscle depletion was found in 52.5% of the sample based on arm muscle circumference, with greater depletion among patients with Crohn’s disease (P=0.008). The most frequent risk factors for cardiovasculardisease were a sedentary lifestyle (83.8%), abdominal obesity (52.5%) and excess weight (48.8%). Conclusion – The results of the complete anthropometric evaluation draw one’s attention to a nutritional paradox, with high frequencies of both - muscle depletion, as well as excess weight and abdominal obesity.
Objective: to correlate cardiovascularrisk factors of patients with kidney diseasewith elevated blood pressure levels. Methods: this is a cross-sectional study with 150 patients on hemodialysis. Two forms were used, one referring to socioeconomic factors and the other to lifestyle. Results: the sample consisted predominantly of male patients, aged over 52 years old, married and not working. Blood pressure levels were the most affected of the cardiovascularrisk factors, where 78.0% had systolic blood pressure above ideal values. A statistically significant association was found between blood pressure and age (p=0.024) and between blood pressure and ability to deal with stress (p=0.015). Conclusion: through this study, it was verified that the statistical significance between the variables indicates that high systolic blood pressure, age and ability to deal with stress favor cardiovascularrisk factors in patients with chronic kidney disease.
categorical variables (p<0.05). Results: The majority of the parameters assessed (44%) showed slight (k=0.21 to 0.40) and/or poor agreement (k<0.20), with low values of negative specific agreement. The best agreement was observed between waist circumference and waist- to-height ratio both for the general population (k=0.88) and between sexes (k=0.93 to 0.86). There was a significant association (p<0.001) between the riskofcardiovascular diseases and females when using waist circumference and conicity index, and with males when using neck circumference. This resulted in a wide variation in the prevalence ofcardiovasculardiseaserisk (5.5%-36.5%), depending on the parameter and the sex that was assessed. Conclusion: The results indicate variability in agreement in assessing risk for cardiovascular diseases, based on anthropometric parameters, and which also seems to be influenced by sex. Further studies in the Brazilian population are required to better understand this issue.
Demographic data in a sample representative of the United States from the Third National Health and Nutrition Examination Survey revealed that 25(OH) D levels are associated with important cardiovasculardiseaserisk factors. The prevalence of diabetes mellitus (odds ratio 1.98), obesity (odds ratio 2.29), increased levels of triglycerides (odds ratio 1.47) and arterial hypertension (odds ratio 1.30) were all signiicantly greater in the lower quartiles of the 25(OH)D serum levels than in the higher quartiles (< 0.001 for all) (47). Pilz and cols. found an associationof vitamin D deiciency with heart failure and sudden cardiac death (SCD) in a large cross-sectional study of patients referred for coronary angiography. After adjustment for cardiovascularrisk factors, the hazard ratios (with 95% conidence intervals) for death due to heart failure and for SCD were 2.84 (1.20-6.74) and 5.05 (2.13-11.97), respectively, when comparing patients with severe vitamin D deiciency [25(OH)D < 10 ng/mL] with persons in the optimal range [25(OH)D > 30 ng/mL] (48). On the other hand, a systematic review and meta- analysis found (51 eligible trials of moderate quality) that 25(OH)D was associated with nonsigniicant effects on the patient-important outcomes of death [RR, 0.96; 95% conidence interval (CI), 0.93, 1.00; P = 0.08], myocardial infarction (RR, 1.02; 95% CI, 0.93, 1.13; P = 0.64), and stroke (RR, 1.05;95%CI, 0.88, 1.25; P = 0.59) (49).
genéticos. Este estudo teve como objetivo avaliar a associação entre fatores de risco cardiovascular e os níveis de danos ao DNA em crianças e adolescentes. Antropometria, dieta e fatores de risco para DCV foram avaliados através de procedimentos padrão. Níveis de danos no DNA foram avaliados através do ensaio cometa (eletroforese de célula única; EC) e do teste de micronúcleos em leucócitos. Um total de 34 crianças e adolescentes, selecionados a partir de uma amostra populacional, foram divididos em três grupos, de acordo com seu nível de risco de DCV. Indivíduos com níveis moderado e alto risco para DCV apresentaram de forma significativa maiores níveis de gordura corporal e de marcadores séricos de risco cardiovascular que indivíduos de baixo risco (P <0,05). Indivíduos de alto risco também mostraram um aumento significativo de danos ao DNA, de acordo com o EC, mas não de acordo com o teste de micronúcleos, do que indivíduos de risco baixo e moderado. A vitamina C consumida foi inversamente correlacionada com os danos ao DNA avaliados pelo EC, e o número de micronúcleos foi inversamente correlacionado com a ingestão de ácido fólico. Os resultados obtidos indicam um aumento de danos no DNA que pode ser consequente do estresse oxidativo em indivíduos jovens com fatores de risco para DCV, indicando que o nível de danos no DNA pode auxiliar na avaliação do risco de DCV.
Anthropometric parameters (weight, height, BMI), systolic and diastolic blood pressure, body fat percentage, basal meta- bolic rate, laboratory markers (fasting insulin, fasting glucose, quantitative index of insulin sensitivity [QUICKI], homeo- stasis assessment model of insulin resistance [HOMA-IR)], total cholesterol, HDL-cholesterol and LDL- cholesterol were studied. Some sonographic parameters were also evaluated (flow-mediated dilation (FMD), a variation of the pulsatil- ity index (PI- C) and basal diameter of the brachial artery). The examinations were performed in the morning (7-9 am) after 15 minutes of rest in dorsal decubitus, in a room with temperature control (20–23ºC). All individuals were fasting for a minimum of 12 hours and had rested the night before for at least 8 hours. Initially, blood pressure was taken in the left arm with a standard mercury sphygmomanometer, establish- ing systolic blood pressure (SBP) and diastolic blood pressure (DBP). Weight and height were used to determine the BMI. The percentage of body fat and the basal metabolic rate were assessed by bioelectrical impedance analyzer (BIA), equipment BF-906 (Maltron ®
Objetivo: estratificar el riesgo cardiovascular de adultos jovenes através de la escala del riesgo Framingham (ERF) y relacionarlo a la presión arterial, datos antropométricos y bioquímicos. Método: estúdio cuantitaivo, realizado con 351, escolares adultos jovenes de 12 escuelas públicas en la ciudad de Juazeiro do Norte –Ceará, seleccionadas de forma aleatória estratificados por escuela y turno. Los datos sociodemográficos, fueron recogidos por preguntas seguidas de su verificación objetiva de la presión arterial y la circunferência abdominal (CA). La colecta de material, analisis bioquímico, medida de peso y altura se realizaron en un laboratório contratado anticipadamente. Resultados: se comprobó que se tiene la mayoria femenina, mestiza, conciliando estúdio y trabajo. Fue mínimo el riesgo de los adultos jovenes por el ERF, sin embargo fue estadisticamente significativo, entre ERF, presión arterial diastólica, CA, indice de masa corporal y colesterol HDL, LDL y trigliceridos. Conclusión: cuantificar los riesgos cardiovasculares en adultos jovenes puede subsidiar acciones relevantes de enfermería en la promoción de la salud cardiovascular. Descriptores: enfermedades cardiovasculares, riesgo, enfermería, adulto joven, estudiantes.
13. Flegal KM, Kit BK, Orpana H, Graubard BI. Associationof All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA. 2013;309(1):71-82. 14. Piegas LS, Avezum A, Pereira JCR, Rossi Neto JM, Hoepfner C, Farran JA, et al. Risk factors for myocardial infarction in Brazil. Am Heart J. 2003;146(2):331-8. 15. Avezum A, Piegas LS, Pereira JCR. Risk Factors Associated With Acute Myocardial Infarction in the São Paulo Metropolitan Region. A Developed Region in a Developing Country. Arq Bras Cardiol. 2005; 84(3):206-13.
In a cross-sectional study, 930 homes were randomly selected out of 33 city districts on a simple sample basis. Proportionality of population density within each district was systematically considered throughout the selection process. On each sampled home, an individual aging 15 years or more whose birthday was nearby the interview date was selected to study inclusion. Participation in the study was voluntary, and a signed informed consent was obtained from all par- ticipants. Blood pressure was measured at home and socio- demographic information as gender, age, ethnicity, education and economical class were obtained upon personal inter- view. Behavior parameters as smoking, ingestion of alcoholic drinks and physical inactivity were also acquired. Subse- quently, agreeable volunteers were encouraged to present themselves at the health service of Federal University of Ouro Preto (UFOP) for collection of blood samples, anthro- pometric measurements and recording of electrocardiograms (ECG).
In this study, it was used the updated NCEP-ATP III criteria as a useful, simple and inexpensive guideline for MS diagnosis, to describe the prevalence of MS in adults according with age, gender, socioeconomic status, educational levels, BMI, HOMA index and physical activity . Another classification usually utilized for definition of MS is based in The International Diabetes Federation (IDF) criteria; however, IDF and ATPIII criteria show a good agreement, reason why was used the updated ATP III classification, without comparisons between them . The population prevalence of MS (22.7%) was very similar to that seen in the American study NHANES (23.7%) , maybe because it adopted similar criteria for age distribution and included the urban population only. In Brazil, a systematic review showed a mean prevalence of MS of 29.6% (range: 14.9%–65.3%) . However, the studies were performed in little population samples . Despite the methodological differences (half of these studies used the definition proposed by NCEP-ATP III) and the lack of consensus on criteria for MS diagnosis, this review indicated a high prevalence of MS in the healthy Brazilian adult population. As mentioned in the literature, increased prevalence of MS with age [24,26] was also observed in the present study.
Objective The aim of this study was to demonstrate a correlation between the overall risk for CV events, and low bone density in postmenopausal women, and its impact on the incidence of serious CV events. Methods Our prospective study involved 300 postmenopausal women. All the examinees were divided into three groups based on their measured bone density: Group I – 84 examinees with osteoporosis; Group II – 115 examinees with osteopenia; and Group III – 101 examinees with normal bone density. In all examinees the overall ten-year risk for a fatal CV event was calculated using the SCORE system tables. Results After a 36-month follow-up, CV events occurred in 19 (6.3%) examinees. Significant differences in the incidence of CV events were demonstrated between the patients with osteoporosis, osteopenia, and normal bone density (χ 2 =28.7; p<0.001), as well as between those with a high and low CV risk (χ 2 =22.6;
Juvenile idiopathic arthritis (JIA) is the most prevalent chronic arthropathy in childhood and adolescence. The prevalence of metabolic syndrome, as well as obesity, is increasing rapidly in all age groups, including children. Metabolic syndrome is deined as a cluster ofrisk factors for cardiovasculardisease and type 2 diabetes mellitus, including abdominal obesity, insulin resistance, dyslipidemia and hypertension. Besides those components, inlammation has been increasingly con- sidered as a signiicant component of metabolic syndrome and obesity, and patients with diseases characterized by the presence of chronic inlammation, such as JIA, could represent special risk groups. Glucocorticoids are used routinely in the management of the inlammation of JIA, in high doses and long-term. Long-term use of the glucocorticoids can cause to insulin resistance, hypertension, and obesity, increasing the riskof metabolic syndrome. The aim of this study is to review the literature on the prevalence of different components of metabolic syndrome in patients with JIA. We observed that the data on metabolic syndrome and its components in those patients are very scarce and more studies needed, in view of the potential increased riskofcardiovasculardisease.
In decompensated heart failure, of 1,212 individuals, patients with a higher tertile of NLR, showing a mean of 9.6, had an increase in the mortality rate during an average follow-up of 26 months. Nevertheless, the highest tertile of NLR was associated with older age, systemic arterial hypertension, diabetes mellitus, history of coronary artery disease and arterial fibrillation. In the blood sample analyses, the highest NLR tertile was associated with the increase in B-type natriuretic peptide, urea, serum creatinine and hemoglobin levels. Consequently, the chest x-ray examination showed that the highest tertile of the NLR was associated with a higher incidence of cardiomegaly, pleural effusion and interstitial edema. 36
Factors associated with increased SUA were investigated by multivariate stepwise regression analysis, stratified by gender. In men, triglycerides (ß= 0.23, p<0.001), waist circumference (ß= 0.21, p<0.001) and systolic blood pressure (ß= 0.11, p=0.004) explained 11%, 4% and 1% of the SUA variability, respectively. In women, waist circumference (ß= 0.26, p<0.001) and triglycerides (ß= 0.09, p=0.02) explained 9% and 1% of the SUA variability, respectively. Age was excluded from the model in both genders. Indeed, the prevalence of hyperuricemia did not change in relation to age categories. However, in women but not in men, SUA was significantly higher above the age of 54 (25-54 years: 5.22±1.14 mg/dL and 3.92±1.19 mg/dL; 55-65 years: 5.45±1.37 mg/dl and 4.36±1.11 mg/dl, in men and women, respectively). Table 5 shows the areas under the ROC curves (AURC) and the optimal cut-off points (according to the highest sensitivity and specificity) of SUA associated with MS. The best cut offs were 5.3 mg/dL for men and 4.0 mg/dL for women, that are roughly in the 75 th percentile of the SUA distribution curve of
clinic, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, were sequentially invited to participate in this study. Patients with other autoimmune diseases, except secondary Sjogren’s syndrome, were excluded. The study began in January 2013 and ended in December 2013 and the data collection was made with a cross-sectional design in the same period. A total of 110 patients was studied. Demo- graphic (gender, age, race, education level) and clinical data related to RA (disease duration since diagnosis, the presence of extra-articular manifestations, rheumatoid factor, cyclic citrullinated peptide antibody [anti-CCP], medications used, bone erosions) and the presence ofcardiovascularrisk factors (hypertension, diabetes mellitus, dyslipidemia, heart disease, smoking) were collected from clinical records. Given that data on smoking are often not recorded properly in the clinical records, information about smoking was directly asked for the patient at the assessment day: never smoked, smoked in the past, currently smoking, number of cigarettes/day and smok- ing time. The patient was considered as a smoker if he/she had smoked or still was smoking for at least 6 months any number of cigarettes. Pack-years of smoking was calculated as the average number of cigarettes per day multiplied by years as a smoker, divided by 20. A history of >20 packs/year was considered as heavy smoking. 32 Information about dose and