Adolescent – ABC CARDIOL

IJCS

Review Article

One Size Does Not Fit All: The Need to Rethink the Metabolic Syndrome in Women

Maria Cristina Costa de Almeida et al. Marildes Luiza Castro Larissa Espíndola Neto Luciana Nicolau Aranha … Thaís Salim Gláucia Maria Moraes de Oliveira

Abstract

Metabolic syndrome (MetS) is increasing at epidemic proportions worldwide. MetS and its components are frequent among Brazilian women (41.8%). Women are affected by changes in adipose tissue distribution, lipid profile, insulin resistance (IR), and vascular remodeling during their lives. These changes result from the lack of estrogen after menopause. There have been various attempts to propose a uniform origin for the clustering of the MetS components, including genetics, IR, obesity, lifestyle, sleep disturbances, inflammation, fetal and neonatal programming, and disturbed circadian rhythm of the body functions. The proinflammatory and prothrombotic state in MetS is well-defined. Socioeconomic and lifestyle-related factors are also essential triggers of MetS, which is associated with a higher risk for coronary artery diseases (CAD) and stroke in women. Population measures in health and community medicine, such as continuing education on the importance of lifestyle change to reduce cardiovascular risks from early childhood, are fundamental strategies. Statins reduce high-sensitivity C-reactive protein blood levels and treat high cholesterol. According to the patient, hypoglycemic agents, such as dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1(GLP-1a), and sodium-glucose transport protein 2 (SGLT2) inhibitors, in addition to metformin, have their indication due to their beneficial cardiometabolic and vascular effects. Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) should be the first choice to treat hypertension in postmenopausal womem. The recognition of the different gender- and age-specific risk factors, allowing for specific and targeted interventions, is fundamental, especially for women.

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IJCS

Editorial

Family Functioning and Congenital Heart Disease

Klébia Magalhães Pereira Castello Branco et al. Maria Verônica Câmara dos Santos

In the last decades, we have been watching a remarkable increase in survival of children with congenital heart disease (CHD), due to advances in surgical and medical management, leading to a significant growth in the number of adolescents and young adults with the disease. In developed countries, the number of adults with CHD surpasses the number of children with CHD.

Unfortunately, prolonged survival has been achieved at a high cost, as an expressive number of patients continue to suffer from significant medical, psychological and social issues. The knowledge that CHD brings an individual burden is not a new concept. In 1964, Glaser concluded that “Despite benefits derived from these remarkable therapeutic gains, children with CHD face many difficulties in their efforts toward social and emotional adjustment.”

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IJCS

Editorial

Daily Consumption of Soft Drinks and Cardiovascular Risk in Adolescents

Karine Brito Beck da Silva

Cardiovascular disease (CVD) includes a group of diseases that affect the heart. These are considered a major public health problem and remain one of the main diseases of the 21st century due to their high morbidity and mortality. CVDs have also been appearing themselves more often even in childhood and adolescence.

Among the factors associated with the increase in the prevalence of CVD are the increase in physical inactivity and reduced physical activity, as well as inadequate eating habits, such as a high intake of ultraprocessed foods, long intervals between meals, and a low consumption of fruits and vegetables, common especially among adolescents. The short and long-term effects of such behaviors are worrisome, as they contribute to fat mass gain, risk factors for Chronic Noncommunicable Diseases (NCDs), responsible for 70% of annual deaths, representing an important cause of morbidity during adolescence.

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IJCS

Editorial

Why is Physical Activity Important to Study in Childhood and Adolescence?

Klebia Castello Branco et al. Isabela de Carlos Back

One of the most important concerns of pediatrician in this pandemic/post-pandemic period is the damage caused by COVID-19 on children’s daily habits, especially physical activity. Children and teenagers were kept indoors during these 2 years, living their lives through digital interactions and becoming forcefully sedentary.

Studies conducted worldwide have shown that the average daily screen time of children and adolescents was greater than 2 hours a day, with the vast majority of them having a higher time than that recommended for any age.

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IJCS

Original Article

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Matheus Alves Pacheco et al. Silvia Meyer Cardoso Michele Honicky Yara Maria Franco Moreno … Luiz Rodrigo Augustemak de Lima Camila Souza Marcos Isabela de Carlos Back

Abstract

Background

Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity.

Objectives

To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease.

Methods

Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the “undesirable” levels, consisting of the sum of “borderline” and “low” values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant.

Results

Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c.

Conclusion

In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

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Original Article

Association between Cardiovascular Risk in Adolescents and Daily Consumption of Soft Drinks: a Brazilian National Study

Ana Flávia Gomes de Britto Neves et al. Rodrigo Pinheiro de Toledo Vianna Marina Travassos Lopes

Abstract

Background:

Cardiovascular risk in adolescence is a public health problem that has grown along with the increase in soft drink consumption.

Objective:

To investigate the association between cardiovascular risk factors and daily consumption of soft drinks in Brazilian adolescents.

Methods:

We conducted a cross-sectional, national, school-based study of 36,956 Brazilian adolescents aged 12 to 17 years. Daily soft drink consumption was estimated using a 24-hour dietary recall. Cardiovascular risk was categorized as overweight, obesity, hypertension, hyperglycemia, and dyslipidemia. The survey command of Stata 14.0® was used to analyze data from a complex sample. The chi-square test was used to assess differences in soft drink consumption and other variables in the descriptive analysis. The odds ratio of cardiovascular risk factors and their respective 95% confidence intervals were estimated, considering sociodemographic and behavioral variables in the Mantel-Haenszel model. Statistical significance was set at p < 0.05.

Results:

Daily consumption of soft drinks was common among adolescents. A daily serving ≥ 450 mL was significantly associated with overweight and hypertension. Results associated with the consumption of regular soft drinks show the possibility of reverse causality. Consumption of diet soft drinks in adolescence should be considered a cardiovascular risk factor.

Conclusion:

Daily consumption of soft drinks can be understood as a relevant risk factor in the epidemiological scenario. Improper eating habits are multifactorial in nature and need to be better understood in the context of adolescent health and further explored in national surveys.

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Original Article

Analysis of Diastolic Left Ventricular Function in Adolescents with Juvenile Systemic Lupus Erythematosus

Talita Nolasco Loureiro et al. Cristina Ortiz Sobrinho Valete Marcia Bueno Castier Maria de Fatima Monteiro Leite Flavio Roberto Sztajnbok

Abstract

Background

Juvenile systemic lupus erythematosus (JSLE) is a chronic inflammatory disease that affects the heart in 50% of cases. The behavior of diastolic function in adolescents and the predictors of its occurrence by conventional echocardiography are poorly established.

Objectives

This study aimed to evaluate diastolic function in adolescents with JSLE and to identify possible predictors of its occurrence by conventional echocardiography.

Methods

Cross-sectional, observational, control group study in a tertiary hospital of 49 adolescents with JSLE and 49 controls, using the EACVI 2016 guideline classification. Statistical methods used were Fisher and Mann-Whitney tests. Multivariate logistic regression models were constructed. A significance level of 5% was adopted.

Results

Among 98 patients, the JSLE group had higher indexed left atrial volume (p <0.001), lower lateral E' value (p<0.001) and lower E/A ratio value (p<0.001). The diagnosis of JSLE was associated with a higher chance of increased left atrial index volume (OR 3.3; p value 0.03).

Conclusions

Based on the 2016 guideline, no diastolic dysfunction was found in JSLE. However, differences in the analyzed echocardiographic parameters were found in these adolescents.

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Viewpoint

Home Physical Activity Programs for Children and Adolescents as a Healthy Strategy During Social Isolation Caused by COVID-19: viewpoint

Rafaela Catherine da Silva Cunha de Medeiros et al. Isis Kelly dos Santos Jason Azevedo de Medeiros Ricardo Ney Cobucci … Tatiane Andreza Lima da Silva Juliany de Souza Araujo Phelipe Wilde de Alcântara Varela Breno Guilherme de Araújo Tinoco Cabral Paulo Moreira Silva Dantas

Background

The recent outbreak of coronavirus disease (COVID-19) is considered a global health emergency. The global impact of this viral infection is of great concern to everyone. As the COVID-19 outbreak continues to appear unstoppable, preventive and hygiene measures have been implemented to safeguard against infection. Among these precautions, social isolation is considered to have the greatest potential for reducing contagion, at least until a vaccine becomes available. This isolation measure works as a kind of “necessary evil” for preventing a wide-reaching disaster. Thus, social distancing and staying home remain the most effective restrictive measures to prevent the exponential increase in contagion.

One of the crucial focal points of this strategy was oriented toward the closure of schools, thus affecting thousands of children and adolescents, who comprise approximately half of the global student population. The closure of educational institutions could have a significant impact on their lives, requiring them to adapt to new routines. Considering that they are now being confined to their homes due to the new situation generated by the pandemic, this cohort may experience moments of stress.

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Original Article

Family Functioning of Adolescents with Congenital Cardiopathy in a Sample from Public Schools in Porto Alegre – RS

Ângela Piccoli et al. Lucas Neiva-Silva Lucia Campos Pellanda

Abstract

Background

The impact of chronic diseases on the patient and the family ranges from minimal to severe distress. Family functioning has been often investigated as a psychosocial measure having an essential role for social adjustment in chronic diseases.

Objectives

To compare family functioning among families of adolescents with congenital heart disease (CHD) and healthy controls (H) in relation to cohesion, adaptability, and family risk.

Method

Cross-sectional exposed-control study with 2 groups of adolescents (12 -18 years). The exposed group included adolescents with congenital heart disease (CHD), from a specialized public health system hospital (SUS), and adolescents from 7 public schools, considered healthy, composed the control group. In the hospital, the data collection was individual, before the medical consultation. In schools, the collection took place in groups. Adolescents and parents responded to the FACES III scale. The following statistical tests were used: Pearson’s chi-square, Fisher’s test, T-test for independent samples, Poisson multivariate regression analysis with 95% reliability, significance established at 5% and a statistical power at 99% (ß = 0.01).

Results

A total of 161 (41.6%) adolescents with CHD and 226 (58.4%) healthy adolescents participated. There was greater family cohesion among adolescents with CHD, with a higher frequency of connected families, while among healthy adolescents, there are more families of the disengaged type. Regarding adaptability, a higher proportion of families of the chaotic type were found among healthy adolescents compared to adolescents with CHD. A higher frequency of high-risk families was identified among healthy adolescents (16.8%).

Conclusion

The families of the adolescents with CHD have a more balanced functioning and low risk when compared to the families of healthy adolescents; with greater cohesion between the members and greater adaptability. Congenital heart disease was not an independent factor for high-risk family. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0).

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Editorial

Identification of Preclinical Markers Related to Hereditary Diseases: Expanding the Horizons of the Study of Cardiac Autonomic Modulation

Nágela Nunes et al. Paulo R. Benchimol-Barbosa

The Autonomic Nervous System (ANS) consists of two opposite pathways (sympathetic and parasympathetic) that have action both on the atrial and ventricular myocardium, as well as on atrioventricular and sinus nodes, thus exerting influence on the variation of heart rate (HR). The increase in HR is a consequence of the greater action of the sympathetic pathway and the lower parasympathetic activity (vagal inhibition), while its reduction basically depends on predominance of vagal activity. The influence of ANS on the heart is dependent on information that departs, among others, from baroceptors, chemoreceptors, changes in the respiratory system, vasomotor system, renin-angiotensin-aldosterone system and thermoregulatory system.

The discovery of the relationship between ANS and mortality from cardiovascular diseases has led to several studies, which have proven the existence of reduced parasympathetic and increased sympathetic activity in several pathologies of the cardiovascular system. These findings made it necessary to develop quantitative markers of cardiac autonomic activity, and heart rate variability (HRV) is the most promising autonomic marker . Historically, their clinical interest arose in 1965, when Hon and Lee demonstrated a well-defined clinical application of HRV in the area of fetal distress monitoring. In 1977, Wolf et al., showed an association between low HRV and higher risk of mortality after acute myocardial infarction and Kleiger et al., in 1987, confirmed that HRV was a potent and independent predictor of mortality after acute myocardial infarction. In 1996, in an age-stratified cross-sectional study, Barbosa et al., reported >18 % per decade reduction in HRV in healthy adults and >25 % per decade reduction in subjects two years post-myocardial infarction with persevered left ventricular systolic function. Additionally, the authors observed that aging related HRV decrease was mainly related to reduction in spontaneous vagal activity. In 2002, Nunes studied HRV variability in preschool healthy children, defining normality ranges for HRV variables in this population.

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Original Article

Influence of Family History of Diabetes on Cardiac Autonomic Dysfunction of Adolescents

Carlos Alberto Alves Dias-Filho et al. Nivaldo de Jesus Soares Jr Carlos José Dias Andressa Coelho Ferreira … Carlan da Silva Sena Janaína de Oliveira Brito-Monzani Rafael Martins Andrade Adeilson Serra Mendes Vieira Leandro Moraes Pinto Wellington Roberto G. de Carvalho Cristiano Teixeira Mostarda

Abstract

Background

To evaluate cardiac autonomic modulation of adolescents with a family history of diabetic parents.

Objective

This study aims to evaluate the influence of a family history of diabetes on cardiac autonomic modulation.

Methods

This is an analytical and cross-sectional study on adolescents between 11 and 18 years of age, of both genders, who were divided into group with a family history of diabetes and a control group without a family history of diabetes. The study protocol consisted of the analysis of heart rate variability, blood pressure, anthropometric measurements, and body composition. Also, by using questionnaires, level of physical activity, sexual maturation, and sleep quality were evaluated. Normality of data distribution was tested using the Kolmogorov-Smirnov test. Then, statistical significance was evaluated using the Student’s t-test, and the Cohen’s teste was used for calculation of the effect size. The level of significance adopted in the statistical analysis was 5%.

Results

When the group of individuals with a family history of diabetes was compared with the control group, statistically significant differences were observed in the variables the standard deviation of the NN time series interval (SDNN) (43.9 ± 2.2 vs. 53.5 ± 2.6 ms), the square root of the quadratic differences (RMSSD) (41.9 ± 3.3 vs. 52.4 ± 3.2 ms), standard deviation of beat-to-beat instantaneous variability (SD1) (29.7 ± 2.3 vs. 37.1 ± 2.3 ms), long-term standard deviation of continuous RR intervals (SD2) (. 54.1 ± 2.6 vs. 66.66 ± 3.5 ms), and in low frequency (LF) (496.0 ± 49.5 vs. 728 ± 71.6 ms²) and high frequency (HF) (1050.0 ± 120.4 vs. 737.4 ± 98.5 ms²) in the frequency domain.

Conclusions

Global autonomic modulation is decreased in adolescents with a family history of diabetes. We also observed a decrease in vagal activity in this group. So, sympathetic autonomic modulation is predominant in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Original Article

Comparative Analysis of Direct and Indirect Methods for the Determination of Maximal Oxygen Uptake in Sedentary Young Adults

Alfredo Moreira da Rocha Neto et al. Artur Haddad Herdy Pablo de Souza

Abstract

Background:

Maximal oxygen uptake is a powerful prognostic indicator and a reliable measure of physical conditioning. It can be measured directly by cardiopulmonary exercise testing (CPET) or indirectly by formulas derived from conventional protocols.

Objective:

We compared the VO₂ max obtained by formula using exercise testing with Bruce protocol (BP) with the VO₂ max obtained by CPET on the treadmill.

Methods:

We selected 41 healthy, non-obese, physically inactive young volunteers, aged between 21 and 50 years, residents of Florianópolis, Brazil.

Results:

Twenty-one women (52%) with mean age of 35.62 ± 8.83 years, and 20 males, with mean age of 32.5 ± 7.18 years participated in the study. Statistically significant differences were found for VO₂ max between the two methods (BP – 42.31 ± 5.21 ml/kg.min vs. CPET – 30.46 ± 5.50 ml/kg.min., p < 0.0001). The Bruce formula overestimated the result by 34.1% (BP – 45.95 ± 3.94 ml/kg.min vs. CPX – 34.27 ± 4.20 ml/kg.min, p < 0.0001) for men, and by 44.8% (BP – 38.84 ± 3.72 ml/kg.min vs. CPX – 26.83 ± 3.90, p < 0.0001) for women. A moderate correlation was observed between the methods (r = 0.65). When classifying the results according to the table of aerobic capacity of the American Heart Association, the agreement was null (kappa = 0.0034; Pearson chi2 = 0.001).

Conclusion:

VO₂ estimated by BP is not capable of demonstrating the true aerobic capacity in these individuals, while CPET is an important tool for early detection of diminished functional capacity in sedentary young men and women.

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