Aging

IJCS

Original Article

Hypertension in Older Adults: Associations With Female Sex, Insufficient Physical Activity, Abdominal Obesity, Diabetes Mellitus, And Falls – A Cross-Sectional Study

Emylly Carlos da Silva et al. Paulo da Fonseca Valença Neto Cezar Augusto Casotti Claudio Bispo de Almeida … Débora Jesus da Silva Saulo Sacramento Meira Beatriz Cardoso Roriz Janayna Araújo Viana Vanessa Silva Souza Viana Renata de Sá Ribeiro Késia Chaves da Silva Dennis Gonçalves Novais Maiara Bernardes Marques Lunalva Aurelio Pedroso Sallet Lucas dos Santos

Abstract

Background:

Systemic Arterial Hypertension (SAH) is a major public health issue, particularly among older adults, due to its high prevalence and impact on morbidity and mortality.

Objective:

To investigate factors associated with SAH in older adults from a small municipality in northeastern Brazil.

Methods:

A population-based cross-sectional epidemiological study was conducted among 232 community-dwelling older adults. Independent variables included socioeconomic, behavioral, and health-related factors, with SAH as the outcome. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated using Poisson regression with a robust estimator. Crude models were followed by a hierarchical multiple explanatory model (Level 1: socioeconomic variables; Level 2: behavioral aspects; Level 3: health conditions). Associations were considered statistically significant at the 5% level (p < 0.05).

Results:

The prevalence of SAH was 59.1% (men: 50.0%; women: 65.4%). An increased likelihood of SAH was associated with female sex (PR: 1.33; 95% CI: 1.05–1.68), insufficient physical activity (PR: 1.24; 95% CI: 1.01–1.54), abdominal obesity (PR: 1.40; 95% CI: 1.09–1.79), diabetes mellitus (PR: 1.30; 95% CI: 1.03–1.64), and falls (PR: 1.37; 95% CI: 1.07–1.74).

Conclusion:

A high prevalence of SAH was identified, particularly among women and those with insufficient physical activity, abdominal obesity, diabetes mellitus, and a history of falls.

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IJCS

Original Article

Hypertension, Hypercholesterolemia, and Insufficient Physical Activity Associated with Diabesity in Older Adults: A Cross-Sectional Study

Gabriel Alves Godinho et al. Paulo da Fonseca Valença Neto Claudio Bispo de Almeida Saulo Sacramento Meira … Beatriz Cardoso Roriz Raquel dos Santos Barbosa Cezar Augusto Casotti Lucas dos Santos

Abstract

Background

During aging, physiological and behavioral changes occur that lead to the development of diabesity (diabetes + obesity). Hence, the hypothesis that behavioral and health aspects can increase the probability of this outcome is plausible. In this framework, it is essential to carry out health surveys to investigate the factors that increase the probability of diabesity, as this information could be used to help monitor this outcome in the older population more accurately.

Objective

To verify the factors associated with diabesity in older adults.

Methods

This is an epidemiological survey, with a cross-sectional design, conducted with 211 older adults (58.80% women) from Aiquara, Bahia, Brazil. To assess the outcome, body mass index (BMI > 27 kg/m²) and the concomitant presence of diabetes mellitus were used. In the inferential analyses, crude models and, subsequently, a multiple hierarchical explanatory model were constructed (level 1: socioeconomic variables; level 2: behavioral aspects; level 3: health conditions). This was performed using Poisson regression, with a robust estimator, calculations of prevalence ratios (PR) and their relevant 95% confidence intervals (CI).

Results

The prevalence of diabesity observed was around 9.50%. Furthermore, older adults who were insufficiently active (RP: 2.55; 95% CI: 1.20 to 6.36), those with arterial hypertension (PR: 5.32; 95% CI: 1.10 to 25.73), and those with hypercholesterolemia (PR: 2.80; 95% CI: 1.08 to 7.23) were more likely to have this outcome.

Conclusion

In the older population of Aiquara, Bahia, Brazil, the factors associated with diabesity were insufficient level of physical activity (PA), arterial hypertension, and hypercholesterolemia.

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IJCS

Original Article

The Influence of Primary Atherosclerotic Diseases on the Occurrence of Secondary Disease

Paula Monique Chiconi de Picoli et al. Creusa Sayuri Tahara Amaral Eliane Trovatti

Abstract

Background

Atherosclerosis is a condition in which fats, cholesterol, fibrin, and other substances accumulate into plaque on the arterial walls. Plaque can harden and narrow the arteries, in turn limiting the blood flow and resulting in diseases, such as acute myocardial infarction (AMI), ischemic stroke (IS), or peripheral arterial disease (PAD). There is a fairly high risk of a secondary atherosclerotic event if patients are not treated after the primary episode.

Objective

To calculate the statistical probability of developing AMI, IS, or PAD after treating the primary disease.

Methods

Data for statistical probability studies included 507,690 patients with primary atherosclerotic disease, who were in treatment during the study period and who did or did not develop a secondary atherosclerotic disease event.

Result

Statistical probability data indicate that few AMI patients can develop IS (2.99%) or PAD (2.86%) as a secondary disease. Patients with primary diagnoses of IS showed a 5.07% risk of developing PAD and a 0.95% risk of developing AMI; however, PAD patients showed a higher probability for both AMI (9.17%) and IS (8.79%).

Conclusion

Secondary atherosclerotic disease episodes after IS, AMI, and PAD were confirmed by statistical probability and are consistent with data from the literature. The study revealed that a primary PAD event leads to high rates of secondary episodes, and special attention should be given to the diagnosis and treatment of PAD in order to decrease the occurrence of secondary events.

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IJCS

Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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IJCS

Original Article

Use of Diuretics is Associated with Higher Risk of Sarcopenia in Older Adults with Hypertension

Francisco de Assis Dias Martins Junior et al. Dahany Pamela Acta Mateo Fábio Junior de Miranda Silva Samara Silva de Moura … Emerson Cruz Oliveira Daniel Barbosa Coelho Eduardo Bearzoti Kelerson Mauro de Castro Pinto Lenice Kappes Becker

Abstract

Background:

Sarcopenia is a disease that involves skeletal muscle mass loss and is highly prevalent in the older adult population. Moreover, the incidence of sarcopenia is increased in patients with hypertension.

Objectives:

The study aimed to evaluate the association between the classes of the drugs used for arterial hypertension treatment and the presence or absence of sarcopenia.

Methods:

129 older adults with hypertension were evaluated by the researchers who registered the participants medication for arterial hypertension treatment. Sarcopenia level was measured by anthropometric parameters, muscular strength, and functional capacity. The data were analyzed by one-way ANOVA followed by post-hoc test and Fisher’s exact test; statistical significance was set at 0.05.

Results:

Age was not different between women with different levels of sarcopenia, but significant differences were observed between men with absent sarcopenia (66.8±4.2 years) and men with probable sarcopenia (77.0±10.2 years). Individuals with absent sarcopenia showed higher handgrip strength (men: 33.8±7.4, women: 23.2±4.6 Kgf) in comparison with those with sarcopenia (men with probable sarcopenia: 9.5±3.3 Kgf, women with probable, confirmed, and severe sarcopenia: 11.7±2.5, 12.2±3.0, 11.8±1.8 Kgf, respectively). The analysis showed an association between the type of medication and degree of sarcopenia; diuretics were significantly associated with probable sarcopenia, and angiotensin II receptor blockers (alone or in combination with diuretics) was associated with absence of sarcopenia.

Conclusion:

In conclusion, handgrip strength was a good method to diagnose sarcopenia, and diuretics were associated with increased risk of sarcopenia in older adults with hypertension.

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IJCS

Editorial

Chagas Disease – Past and Future

Aurea Lúcia Alves de Azevedo Grippa de Souza et al. Claudio Tinoco Mesquita

After 111 years of its discovery, Chagas disease remains a major public health challenge in Brazil and in other Latin American countries, reason why it continues to be a relevant topic in discussion panels worldwide. The disease was first described in 1909 by Carlos Justiniano Ribeiro das Chagas after his observations during an expedition to eradicate malaria in the rural areas of the state of Minas Gerais, in the city of Lassance. Carlos Chagas’ magnificent life journey makes him a unique figure in the history of medicine, as he alone described all the stages of a new infectious disease: pathological findings, means of transmission (Triatoma infestans), etiology, clinical manifestations, and epidemiology. For this reason, he was one of the few Brazilians to be nominated for a Nobel Prize, which, unfortunately, he did not win. This issue of the International Journal of Cardiovascular Sciences (IJCS) focuses on Chagas disease and its repercussions on the cardiovascular system.

Carlos Chagas graduated in 1904 in Rio de Janeiro and began his professional life in the city of Niterói as a physician of the Public Hygiene Committee at Santa Isabel Maritime Hospital, after declining Oswaldo Cruz’s invitation to work at Manguinhos. The Maritime Hospital, a beautiful architectural complex () built during the 19th century from an old farm, was considered a reference for the treatment of infectious diseases until the end of the 4th decade of the 20th century. Sailors, immigrants and local residents with bubonic plague, yellow fever or tuberculosis were treated at the institution. In this hospital, the Italian physician Camillo Terni, from the Serum Therapy Institute of Messina, conducted pioneering studies on a plague vaccine (). After working for 1 year at the Maritime Hospital, Chagas left to Manguinhos, where he began his journey to eradicate yellow fever and malaria, which led him to discover the disease caused by the insect known as barbeiro (kissing bug).

[…]

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IJCS

Original Article

Correlation between Epicardial Fat Thickness and Clinical and Anthropometric Variables in an Elderly Population

Joaquim Castanheira et al. Cristiana Nunes Telmo Pereira

Abstract

Background

Epicardial fat (EF) thickness is a marker of visceral adiposity and consequently considered an important predictive marker of cardiovascular and metabolic risk.

Objective

To describe echocardiographic features of the heart in an elderly population and to study the correlation between EF thickness and clinical and anthropometric variables.

Methods

A sample of 34 individuals (25 women) aged between 65 and 92 years, who attended a private institution in the central region of Continental Portugal, was analyzed. A standardized sociodemographic questionnaire was applied, and anthropometric assessment, echocardiography and blood pressure measurement were performed in all subjects. A correlational analysis of EF thickness with anthropometric and clinical parameters was performed. The association between variables was tested by Pearson’s correlation and point-biserial correlation. A value of p < 0.05 was defined as statistically significant.

Results

EF thickness was higher in males (6.0 ± 1.4 mm vs 5.2 ± 0.9 mm in females), and ranged from 4 to 9 mm. There were statistically significant correlations between EF thickness and weight (r = 0.4; p = 0.02), body surface area (r = 0.4; p = 0.02), lean mass (r = 0.4; p = 0.03), calf circumference (r = 0.5; p = 0.01) and left ventricular end-diastolic diameter (r = 0.3; p = 0.04).

Conclusion

EF thickness was higher in males and was significantly correlated with anthropometric parameters of adiposity and left ventricular end-diastolic diameter. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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IJCS

Original Article

Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul

Carolina Zenilda Nicolao et al. Juliana Bischoff Ferreira Adriana Aparecida Paz Graciele Fernanda da Costa Linch … Marciane Rover Emiliane Nogueira de Souza

Abstract

Background:

Heart failure (HF) is the final pathway of most cardiac diseases. Although the prevalence of HF has increased, due to the ageing of the population, more comprehensive data have shown a reduction in the percentage of HF hospital admissions over the last years.

Objective:

Assess the morbidity and mortality of HF patients in Brazil, Rio Grande do Sul and Porto Alegre.

Method:

The study is a retrospective analysis of data from the Brazilian Unified Health System’s (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). We evaluated the incidence of HF hospital admissions, the average length of stay, hospital costs and sex ratio, during a ten-year period (2007 to 2016). Due to availability of the system, mortality rate and age range, the total duration of the study was nine years.

Results:

Within this period, the percentage of hospitalizations for HF decreased. On the other hand, the length of stay increased in all regions studied. Mortality rates were in decline in all regions. Hospital costs showed an increase of 110.8%. HF was more prevalent in patients between the seventh and eighth decades of life, with men being more affected than women, except in Rio Grande do Sul.

Conclusion:

We conclude that, in spite of the high costs of HF to healthcare providers, hospitalizations and mortality rates have shown a significant decline over the last years, which results from the advances in the treatment of this disease, through initiatives to improve patient education, engagement and planning in health care and self-care.

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IJCS

Original Article

Correlation between Exercise Stress Test and Echocardiographic Parameters in Elderly Individuals

Liz Andréa Villela Baroncini et al. Camila Varotto Baroncini Juliana Ferreira Leal

Abstract

Background:

Maximum oxygen consumption (VO₂ max) in healthy individuals decreases approximately 10% per decade of life, and such decrease is more pronounced after the seventh decade.

Objectives:

To assess functional capacity of individuals aged 75 years or older, submitted to ergometric test and transthoracic echocardiogram exam, by means of metabolic equivalent (MET) and VO₂ max measurements.

Methods:

A total of 381 patients (205 women; 79 ± 3.7 years) were evaluated. Exclusion criteria were: presence of left ventricular (LV) systolic dysfunction, LV diastolic dysfunction grade II and III, significant valve disease, or coronary artery disease with systolic LV dysfunction or dilatation. Associations between quantitative variables were analyzed by Pearson and Spearman correlation coefficients, and comparisons of quantitative data by Student’s t-test for independent samples.

Results:

Increasing age was associated with a progressive decrease in the distance covered (p = 0.021), in the expected increase in HR (p < 0.001), in VO₂ max (p < 0.001), and METs (p < 0.001) in both genders. There was no correlation of exercise test parameters with the echocardiographic parameters.

Conclusions:

Relatively healthy older individuals, with global systolic and diastolic functions of the left ventricle preserved, presented a progressive decrease in their functional capacity due to their natural aging process, comorbidities related to their age range and physical deconditioning.

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IJCS

Original Article

Protective Effects of Accumulated Aerobic Exercise in Infarcted Old Rats

Daniele Jardim Feriani et al. Hélio José Coelho-Júnior Maria Cláudia Irigoyen Bruno Rodrigues

Abstract

Background:

Aerobic exercise exerts cardioprotective effects on myocardial infarction. However, there is lack of information about the possible protective effects of continuous or accumulated aerobic exercise performed prior to myocardial infarction in aging.

Objective:

To evaluate the preventive effects of continuous or accumulated aerobic exercise on physical capacity, pulmonary congestion and ventricular weight in rats submitted to myocardial infarction.

Methods:

Old male Wistar rats were divided into four groups: sham control, sedentary infarcted, continuous aerobic exercise submitted to myocardial infarction, and accumulated aerobic exercise submitted to myocardial infarction. Body weight and maximum speed were evaluated at the beginning and at the end of the protocol. Trained groups performed continuous (1 h a day) or accumulated (30 minutes in the morning and 30 minutes in the afternoon) exercise. All groups, except the sham control, were submitted to myocardial infarction surgery at the end of the protocol. Heart, skeletal muscles, as well as wet and dry lung were weighed. The significance level in statistical analysis was established at p < 0.05.

Results:

Both continuous and accumulated exercise caused an increase in physical capacity in rats, as well as prevented its further impairment after myocardial infarction, and in the accumulated exercise group this prevention was greater. The continuous exercise group demonstrated an increase in lung water content, while the accumulated exercise group presented a reduction in body weight and an increase in left ventricle relative weight.

Conclusion:

In conclusion, the data of the present study indicate that accumulated aerobic exercise present a better protective effect than continuous aerobic training in the context of myocardial infarction and aging.

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