2012;98(1) – ABC CARDIOL

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Review Article

On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis

Ana Sofia Godinho et al. Ana Sofia Alves Alexandre José Pereira Telmo Santos Pereira

There are controversies about the possible benefits of offpump coronary artery bypass grafting (OPCABG) compared to on-pump coronary artery bypass grafting (ONCABG). For a better perspective on this important issue, we performed a meta-analysis of randomized controlled trials, comparing the two techniques. The objective of this study was to verify which technique applied in Coronary Artery Bypass Surgery, OPCABG or ONCABG, provides better results through a meta-analysis of published randomized trials comparing the two techniques. We carried out a computer-based literature search in PubMed, Embase, B-on and Science Direct from March 2009 to January 2010. The studies covered were recovered according to predetermined criteria. A systematic review of randomized clinical trials was performed in order to evaluate the differences between the two revascularization techniques (OPCABG versus ONCABG) regarding mortality and morbidity. Selected studies did not include patients at high risk and long-term longitudinal evaluations. The meta-analysis focused on nine randomized clinical trials, corresponding to a total of 75,086 patients, and compared OPCABG to ONCABG. Regarding mortality, a reduction of 18% in the risk of cardiovascular mortality (OR: 0.82, 95%CI: 0.70 to 0.98, p = 0.03) and 27% in the risk of stroke postoperatively (OR: 0.73, 95%CI: 0.63 to 0.85, p = 0.0001) were observed, both in favor of OPCABG. Concerning the occurrence of complications associated with the procedure, no significant differences were found between the two surgical techniques, particularly with regard to the occurrence of kidney complications (OR: 0.97, 95%CI: 0.84-1.14, p = 0, 74) and sepsis (OR 0.98, 95%CI: 0.64-1.51, p = 0.93, respectively). Off-pump CABG significantly reduces the occurrence of major cardiovascular events (mortality and CVA) compared to on-pump CABG surgery.

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Case Report

Atrioventricular block pathology in cardiomyopathy by desmin deposition

Luiz Alberto Benvenuti et al. Vera Dermarchi Aiello Breno Alencar Araripe Falcão Silvia Gelás Lage

Generally, restrictive cardiomyopathy due to desmin deposition is characterized by restriction to ventricular diastolic filling and different degrees of atrioventricular block (AVB). In this report, we describe the pathological changes of the cardiac conduction system related to AVB. The sinus node, the compact node, and the penetrating bundle (bundle of His) had no abnormalities, however, there was extensive fibrosis of the terminal portions of the branching bundle and the beginning of the left and right bundles at the top of the ventricular septum. The pathogenesis of this fibrous replacement is probably the same that leads to extensive fibrosis of the working ventricular myocardium, and remains to be elucidated.

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Letter to the Editor

Impact of chronic renal failure on effectiveness of drug-eluting stents

Eduardo Maffini da Rosa et al. Laís Merzoni Marcelo Nicola Branchi

LETTER TO THE EDITOR

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Atualização

Hemodynamic assessment in heart failure: role of physical examination and noninvasive methods

Gustavo Luiz Almeida Junior et al. Sérgio Salles Xavier Marcelo Iorio Garcia Nadine Clausell

Among the cardiovascular diseases, heart failure (HF) has a high rate of hospitalization, morbidity and mortality, consuming vast resources of the public health system in Brazil and other countries. The correct determination of the filling pressures of the left ventricle by noninvasive or invasive assessment is critical to the proper treatment of patients with decompensated chronic HF, considering that congestion is the main determinant of symptoms and hospitalization. Physical examination has shown to be inadequate to predict the hemodynamic pattern. Several studies have suggested that agreement on physical findings by different physicians is small and that, ultimately, adaptive physiological alterations in chronic HF mask important aspects of the physical examination. As the clinical assessment fails to predict hemodynamic aspects and because the use of Swan-Ganz catheter is not routinely recommended for this purpose in patients with HF, noninvasive hemodynamic assessment methods, such as BNP, echocardiography and cardiographic bioimpedance, are being increasingly used. The present study intends to carry out, for the clinician, a review of the role of each of these tools when defining the hemodynamic status of patients with decompensated heart failure, aiming at a more rational and individualized treatment.

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Editorial

The role of the Arquivos Brasileiros de Cardiologia in the new era of non-invasive cardiovascular imaging

Carlos E. Rochitte

EDITORIAL

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Brief Communication

Ankle-brachial index and ventricular hypertrophy in arterial hypertension

Pedro Ferreira de Albuquerque et al. Pedro Henrique Oliveira de Albuquerque Gustavo Oliveira de Albuquerque Denise Maria Servantes … Saskya Meneses de Carvalho Japy Angelini Oliveira Filho

The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m2 (Group I) and 150.29 ± 34.06 g/m² (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.

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Point of view

Propositional debate on biosimilar enoxaparin in Brazil

Paulo A.S. Mourão et al. Bianca F. Glauser Bruno C. Vairo Mariana S. Pereira

Some patents of low-molecular-weight heparins (LMWHs) have expired and others are about to expire. Biosimilar versions of those drugs are available for clinical use in several countries. However, skepticism persists about the possibility of obtaining preparations similar to the original drug, because of the complexity of the process to generate LMWHs. In recent years, our laboratory has analyzed biosimilar samples of enoxaparin available for clinical use in Brazil (30 different batches and 70 finished products). Those preparations were assessed regarding their chemical structure, molecular weight distribution, in vitro anticoagulant activity, and pharmacological effects in animal models of thrombosis and bleeding. Our results have clearly shown that biosimilar preparations of enoxaparin are similar to the original drug. Our results have shown that those biosimilar versions of enoxaparin are a valid therapeutic alternative, which are, however, in need of appropriate regulation to ensure compliance with regulatory requirements.

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Clinicoradiological Session

Case 1/2012: 55-year-old male with multiple coronary artery aneurysms due to Kawasaki disease

CLINICORADIOLOGICAL SESSION

Case 1/2012 – 55-year-old male with multiple coronary artery aneurysms due to Kawasaki disease

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Case Report

Recurrent myocardial infarction in a patient with papillary fibroelastoma

João Daniel Brito et al. Manuel Sousa Almeida Regina Ribeiras João Queiroz e Melo … Rosa Henriques Almeida José Aniceto Silva

This report describes a case of a 62 year-old man admitted for recurrent myocardial infarction and normal coronary arteries, caused by coronary embolism from aortic papillary fibroelastoma. Other conditions causing acute coronary syndrome and normal coronary arteries are discussed. A careful evaluation by transthoracic and transesophageal echocardiography is required in this clinical setting. Surgical excision of the tumor is safe and curative.

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Message from the Editor

Luiz Felipe P. Moreira

MESSAGE FROM THE EDITOR

Luiz Felipe P. Moreira

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Artigo Original

Ventricular hypertrophy and cardiovascular mortality in hemodialysis patients with low educational level

Rosana dos Santos e Silva Martin et al. Luis Cuadrado Martin Roberto Jorge da Silva Franco Pasqual Barretti … Jacqueline Costa Teixeira Caramori João Henrique Castro Aline de Araújo Antunes Silméia Garcia Zanati-Basan Beatriz Bojikian Matsubara Antônio Sérgio Martins

BACKGROUND: Left ventricular hypertrophy is a strong predictor of mortality in chronic kidney patients. A previous study of our group has shown that chronic kidney patients with low educational level has more severe ventricular hypertrophy. OBJECTIVE: To extend a previous study and to assess whether left ventricular hypertrophy can explain the association between schooling and cardiovascular mortality in hemodialysis patients. METHODS: This study assessed 113 patients from January 2005 to March 2008 and followed them up until October 2010. Survival curves were built to compare all-cause and cardiovascular mortality of patients with up to three years of schooling (median schooling) and those with schooling of four years and over. Cox multiple models were built and adjusted to confounding variables. RESULTS: Association between educational level and ventricular hypertrophy was observed. Statistical difference in all-cause and cardiovascular mortality between the different educational levels was observed at 5.5 years of follow-up. In the Cox model, ventricular hypertrophy and C-reactive protein associated with all-cause and cardiovascular mortality. The etiology of kidney failure associated with all-cause mortality, and creatinine associated with cardiovascular mortality. The association between educational level and mortality lost statistical significance in the adjusted model. CONCLUSION: The results of this study confirm those of a previous study. In addition, they show that the higher cardiovascular mortality observed in patients with low educational level can be explained by risk factors of biochemical and cardiac morphological origin.

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Artigo Original

Myocardial bridge associated with cardiovascular injuries in bovines adult of Canchim race

José Wilson dos Santos et al. Nader Wafae Marcelo Emílio Beletti

BACKGROUND: The influence that myocardial bridge exercises over blood stream in the course of arterial segment under the bridge has been discussed by the scientific community. OBJECTIVE: To compare ultrastructural muscle tissue of myocardial bridge and the ventricular wall; to analyze the degree of injury to the tunica intima of the arterial segments, and look for possible changes that may precede or initiate the process of atherosclerotic lesions. METHODS: Forty Canchim bovine hearts were studied regarding alterations of the tunica intima from coronary arteries on the different myocardial bridge segments. For the microscopic examination, hematoxylin-eosin and fuchsin-resorcin staining following conventional microscope techniques were made. For the electronic microscopic examination, myocardial Bridge segments from twelve Canchim bovine hearts were collected from the ventricle wall and coronary artery and were processed according to conventional techniques. RESULTS: In the light microscopy, a higher frequency of lesions on prepontine and postpontine segments of the tunica intima was observed, compared to the pontine segment. Tunica intima thickenings were followed by a disarrangement on the internal elastic limitant lamina. These cells often presented their cytoplasmas engorged by lipidic drops, making up the so-called foam cells. Electronic microscopy revealed that the muscular fibers of the myocardial bridge are usually joined in a straight and smooth way presenting lateral branches with a greater number of mitochondria in the ventricular muscle than in the bridge. CONCLUSION: There are few differences between the muscle tissues studied; intimae lesions are less frequent in pontine regions compared to pre and post-pontine regions.

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Artigo Original

Cross-cultural adaptation into Brazilian portuguese of the Dietary Sodium Restriction Questionnaire (DSRQ)

Karina Sanches Machado d'Almeida et al. Gabriela Correa Souza Eneida Rejane Rabelo

BACKGROUND: Sodium restriction is a non-pharmacological measure often recommended to patients with heart failure (HF). However, adherence is low, being among the most common causes of HF decompensation. The Dietary Sodium Restriction Questionnaire (DSRQ) aims at identifying factors that affect adherence to dietary sodium restriction by patients with HF. In Brazil, there are no instruments to assess these factors. OBJECTIVE: Perform the transcultural adaptation of DSRQ. METHODS: Methodological study that involved the following steps: translation, synthesis, back-translation, review by an expert committee, pretest of the final version and analysis of interobserver agreement. In the pretest, items and their understanding were evaluated, as well as internal consistency by Cronbach’s alpha. The instrument was simultaneously and independently administered by two researchers and the kappa test was used for agreement analysis. RESULTS: Only one question underwent major semantic and/or cultural alteration. At the pretest, Cronbach’s alpha for the total obtained was 0.77; for the Attitude, Subjective Norm and Behavioral Control scales were obtained, respectively: 0.66, 0.50 and 0.85. At the agreement step, the Kappa was calculated for 12 of the 16 questions, with values ranging from 0.62 to 1.00. In items for which the calculation was not possible, the incidence of equal responses ranged from 95% to 97.5%. CONCLUSION: Based on the transcultural adaptation of DSRQ, it was possible to propose a version of the questionnaire for further evaluation of psychometric properties.

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Artigo Original

Prognostic determinants of patients with chronic systolic heart failure secondary to systemic arterial hypertension

Dalva M.S. Rolande et al. João Paulo Fantini Augusto Cardinalli Neto José A. Cordeiro Reinaldo B. Bestetti

BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57%) were male. Thirty one (24%) patients died, 5 (4%) underwent heart transplantation, and 94 (72%) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96%, 93%, 84%, 79%, and 76%, respectively. Age (Hazard Ratio=1,05, 95% Confidence Interval 95% 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95% Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95% Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.

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Artigo Original

Interaction between serotoninergic-and β-adrenergic receptors signaling pathways in rat femoral artery

Maria Andréia Delbin et al. Alexandre Sérgio Silva Edson Antunes Angelina Zanesco

BACKGROUND: Coronary heart disease has been widely studied in cardiovascular research. However, patients with peripheral artery disease (PAD) have worst outcomes compared to those with coronary artery disease. Therefore, pharmacological studies using femoral artery are highly relevant for a better understanding of the pathophysiologic responses of the PAD. OBJECTIVE: The aim of this study was to evaluate the pharmacologic properties of the contractile and relaxing agents in rat femoral artery. METHODS: Concentration response curves to the contractile phenylephrine (PE) and serotonin (5-HT) and the relaxing agents isoproterenol (ISO) and forskolin were obtained in isolated rat femoral artery. For relaxing responses, tissues were precontracted with PE or 5-HT. RESULTS: The order rank potency in femoral artery was 5-HT > PE for contractile responses. In tissues precontracted with 5-HT, relaxing responses to isoproterenol was virtually abolished as compared to PE-contracted tissues. Forskolin, a stimulant of adenylyl cyclase, partially restored the relaxing response to ISO in 5-HT-precontracted tissues. CONCLUSION: An interaction between β-adrenergic- and serotoninergic- receptors signaling pathway occurs in femoral artery. Moreover, this study provides a new model to study serotoninergic signaling pathway under normal and pathological conditions which can help understanding clinical outcomes in the PAD.

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Artigo Original

Microalbuminuria is an independent prognostic marker in patients with chronic heart failure

Humberto Villacorta et al. Paula de Vilhena Ferradaes Evandro Tinoco Mesquita Antônio Cláudio Lucas da Nóbrega

BACKGROUND: Microalbuminuria has been described as a risk factor for progressive cardiovascular and renal diseases. Little is known about its prognostic value in patients (pts) with established heart failure (HF). OBJECTIVE: To assess the role of microalbuminuria as a prognostic marker in patients with chronic HF receiving standard medication. METHODS: From January 2008 through September 2009, 92 pts with chronic HF, were prospectively included. Mean age was 63.7±12.2 and 37 (40.7%) were male. Mean left ventricular ejection fraction (LVEF) was 52.5±17.5%. Pts under dialysis were excluded. Urinary albumin concentration (UAC) was determined in first morning spot sample of urine. Time to first event (HF hospitalization, emergency department visit for HF or cardiovascular death) was defined as endpoint. Mean follow-up was 11±6.1 months. RESULTS: At the time of inclusion in the study, 38 (41.3%) pts had microalbuminuria and no patient had overt albuminuria. Pts with microalbuminuria had lower left ventricular ejection fraction than the rest of the individuals (47.9±18.5 vs 54.5±17.7%, p=0.08). UAC was higher in patients with events (median 59.8 vs 18 mg/L, p=0.0005). Event-free survival was lower in pts with microalbuminuria as compared with normoalbuminuria (p<0.0001). Independent variables related to cardiac events were UAC (p<0.0001, hazard ratio=1.02, 95% CI=1.01 to 1.03 per 1-U increase of UAC), and previous myocardial infarction (p=0.025, HR=3.11, 95% CI=1.15 to 8.41). CONCLUSION: Microalbuminuria is an independent prognostic marker in pts with chronic HF. Pts with microalbuminuria had a trend for lower LVEF.

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Artigo Original

Effects of different degrees of insulin sensitivity on endothelial function in obese patients

Roberto Galvão et al. Frida Liane Plavnik Fernando Flexa Ribeiro Sérgio Aron Ajzen … Dejaldo M. de J. Christofalo Osvaldo Kohlmann Jr.

BACKGROUND: Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals. OBJECTIVE: To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components. METHODS: Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13). RESULTS: We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2±7.0 vs 18.0±7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides. CONCLUSION: Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors.

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Artigo Original

Intracoronary ultrasound-guided stenting improves outcomes: a meta-analysis of randomized trials

Graciele Sbruzzi et al. Alexandre Schaan de Quadros Rodrigo Antonini Ribeiro Aníbal Pereira Abelin … Otávio Berwanger Rodrigo Della Meã Plentz Beatriz DAgord Schann

BACKGROUND: Intracoronary ultrasound (IVUS) has been used as an adjunctive method in order to optimize implantation of stents. However, the impact of this method in some outcomes is controversial. OBJECTIVE: To systematically review the impact of routine IVUS-guided coronary stent as compared to angiographic-guided, on clinical and angiographic outcomes. METHODS: A search of databases (MEDLINE, Cochrane CENTRAL, EMBASE) and references of published studies, from 1982 to 2010, was conducted. Randomized clinical trials (RCTs) that compared angiography plus IVUS-guided (IVUS) vs. angiography alone guided (ANGIO) coronary stent implantation were included. Minimum follow-up was 6 months and the outcomes assessed were major adverse cardiac events (MACE), target lesion revascularization (TLR) and angiographic restenosis. Two reviewers independently extracted the data. Summary risk ratio and 95% confidence intervals (CI) were calculated with random-effects models. The GRADE approach was used to determine the overall quality of evidence for each outcome. RESULTS: Out of 3,631 articles identified, 8 RCTs evaluating a total of 2,341 patients were included. There was a 27% reduction in angiographic restenosis (95%CI: 3%-46%) and a 38% reduction in TLR (95%CI: 17%-53%) in favor of IVUS vs. ANGIO. However, MACE were not reduced by IVUS (RR: 0.79; 95%CI: 0.61-1.03). The MACE data represent only 47% of the optimal information size required to reliably detect a plausible treatment effect. CONCLUSIONS: We observed that IVUS-guided coronary stenting provides significant reductions in TLR and angiographic restenosis compared to angiographically-guided stenting, but it does not reduce MACE.

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Artigo Original

Gender distribution of serum uric acid and cardiovascular risk factors: population based study

Sérgio Lamego Rodrigues et al. Marcelo Perim Baldo Pires Capingana Pedro Magalhães … Eduardo Miranda Dantas Maria del Carmen Bisi Molina Luciane Bresciani Salaroli Renato Lário Morelato José Geraldo Mill

BACKGROUND: There is no data concerning the epidemiology of hyperuricemia in Brazilian population-based studies. OBJECTIVE: To investigate the distribution of serum uric acid and its relationship with demographics and cardiovascular variables. MEHTODS: We studied 1,346 individuals. Hyperuricemia was defined as > 6.8 and > 5.4 mg/dL for men and women, respectively. Metabolic syndrome (MS) was defined with NCEP ATP III criteria. RESULTS: The prevalence of hyperuricemia was 13.2%. The association of serum uric acid (SUA) with cardiovascular risk factors was gender-specific: in women, higher SUA was associated with increasing BMI, even after adjustments for age-systolic blood pressure (SBP). In men, the relationship of SUA with HDLc was mediated by BMI, whereas in women, SUA was similar and dependent on BMI, regardless of glucose levels and presence of hypertension. In men, triglycerides, waist circumference (WC) and SBP explained 11%, 4% and 1% of SUA variability, respectively. In women, WC and triglycerides explained 9% and 1% of SUA variability, respectively. Compared to the first quartile, men and women in the fourth quartile had a 3.29 fold and 4.18 fold increase of MS risk, respectively. Women had almost three fold higher prevalence of diabetes mellitus. Normotensive men with MS presented higher SUA, regardless of BMI. CONCLUSION: Our results seem to justify the need for gender-based evaluation regarding the association of SUA with cardiovascular risk factors, which was more pronounced in women. MS was positively associated with increasing SUA, regardless of gender. Abdominal obesity and hypertriglyceridemia were the main factors associated with hyperuricemia even in normotensive individuals, which may add a higher risk for hypertension.

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Artigo Original

Mild stunting is associated with higher blood pressure in overweight adolescents

Ana Paula Grotti Clemente et al. Carla Danusa Santos Ana Amelia Benedito Silva Vinicius Jose Martins … Anna Carolina Marchesano Mariana Belluca Fernandes Maria Paula Albuquerque Ana Lydia Sawaya

BACKGROUND: Studies have shown that pre/postnatal undernutrition leads to higher risk of non communicable diseases such as diabetes, hypertension and obesity in adulthood. OBJECTIVE: To determine whether overweight adolescents with mild stunting [height-for-age Z scores (HAZ) in the range -2] have higher blood pressure than overweight individuals with normal stature (HAZ >-1). MEHTODS: Participants were classified as mildly stunted or of normal stature, and further stratified according to body mass index-for-age percentiles as overweight, normal or underweight. Systolic (SBP) and diastolic (DPB) blood pressures were determined according to guidelines, and abdominal fat was analyzed by dual energy X-ray absorptiometry. RESULTS: Mild stunted overweight individuals showed higher DBP values (p=0.001) than their underweight counterparts (69.75 ± 12.03 and 54.46±11.24 mmHg, respectively), but similar to those of normal BMI. No differences were found in DBP values of normal, overweight and underweight individuals among the normal stature groups. An increase in SBP (p=0.01) among mild stunted individuals was found when those with overweight were compared to their underweight and normal BMI counterparts (114.70 ± 15.46, 97.38 ± 10.87 and 104.72 ± 12.24 mmHg, respectively). Although no differences were observed in the means of SBP between mild stunting and normal stature groups, a significant intercept was found (p=0.01), revealing higher SBP among stunted individuals. There was a correlation between SBP and abdominal fat (r=0.42, ρ=0.02) in the stunted group. CONCLUSION: Stunted individuals with overweight showed higher SBP than those of normal stature and overweight. These findings confirm that mild stunting increase the risk of future hypertension and alterations are evident at early age.

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