Adults – ABC CARDIOL

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Original Article

Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients

Clarcson Plácido Conceição Santos et al. Laura Souza Lagares Sarah Rafaela Mascarenhas Santos Mariana Sousa de Pina Silva … Rodrigo Colares de Macedo Luiz Alberto Bastos de Almeida Eric Simas Bomfim

Abstract

Background

Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks.

Objective

The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association.

Methods

Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted.

Results

The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm²(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804).

Conclusions

Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

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Original Article

Association between the Phytochemical Index and Risk Factors for Cardiovascular Disease in Adults

Vanessa Zanoni Carvalhaes et al. George César Ximenes Meireles Regina Maria Catarino Rosemeire Bueno

Abstract

Background

There are few publications about the association between the phytochemical index (PI) and risk factors for cardiovascular disease.

Objective

To evaluate the association between the PI and risk factors for cardiovascular disease in adults.

Methods

This was a cross-sectional study with 141 adults, between 20 and 59 years of age. We analyzed lifestyle (physical activity), sociodemographic data (sex, age), anthropometric data (body mass index [BMI], waist circumference [WC]), biochemical data (lipid profile, blood glucose), food consumption, and phytochemical intake (expressed as PI = daily energy derived from phytochemical-rich foods ÷ total daily energy intake × 100). We performed bivariate analyses (Spearman’s correlation) and multiple linear regression adjusted for potential confounders, considering p < 0.05 as significant.

Results

The median PI was 9.80 (interquartile range: 11.45). PI was inversely correlated with BMI (rs: −0.43) and WC (rs: −0.36) and positively correlated with high-density lipoprotein cholesterol (HDL-cholesterol) (rs: 0.25), all with p < 0.05. In multiple regression analysis, PI was inversely associated with BMI (B: −0.08; 95%CI: −0.15, −0.01) after adjusting for total energy, sex, age, and physical activity; and positively associated with HDL-cholesterol (Model 1 adjusted for total energy, sex, age, and physical activity [B: 0.21; 95% CI: 0.02, 0.41]; Model 2 adjusted for BMI, sex, age, and physical activity [B: 0.21; 95% CI: 0.008, 0.40]; Model 3 adjusted for WC, sex, age, and physical activity [B: 0.20; 95%CI: 0.01, 0.40]), all with p < 0.05.

Conclusion

The results have demonstrated that higher phytochemical intake, expressed by PI, was inversely associated with BMI and positively associated with HDL-cholesterol.

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Original Article

Microalbuminuria and its Prognostic Significance in Patients with Acute Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction

Ömer Doğan Alataş et al. Murat Biteker Ahmet Demir Birdal Yıldırım … Ethem Acar Kemal Gökçek Aysel Gökçek

Abstract

Background

The prevalence and significance of microalbuminuria have not been well studied in patients with different heart failure subtypes.

Objective

The prevalence and significance of microalbuminuria have not been well studied in patients with different heart failure subtypes. Therefore, we aimed to investigate the frequency and prognostic value of microalbuminuria in patients hospitalized for acute heart failure (AHF) with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF).

Methods

All consecutive adult patients referred to the hospital due to AHF between June 2016 and June 2019 were enrolled. Microalbuminuria is defined as urinary albumin to creatinine ratio (UACR) level in the range of 30–300 mg/g. Hospital mortality was the endpoint of this study

Results

Of the 426 AHF patients (mean age 70.64 ± 10.03 years, 53.3 % female), 50% had HFrEF, 38.3% had HFpEF, and 11.7% had HFmrEF at presentation.The prevalence of microalbuminuria was 35.2%, 28.8%, and 28.0% in HFrEF, HFpEF, and HFmrEF, respectively. A total of 19 (4.5%) patients died during the in-hospital course, and in-hospital mortality was higher in HFrEF patients (6.6%) compared to patients with HFpEF (2.5%) and HFmrEF (2.0%). Multivariate analysis showed that the presence of microalbuminuria predicted in-hospital mortality in patients with HFrEF and HFmrEF but not in HFpEF.

Conclusion

Although microalbuminuria was common in all subgroups of AHF patients, it has been found to predict prognosis only in patients with HFrEF and HFmrEF.

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Original Article

Cardiovascular Risk Factors in Patients with Chronic Kidney Disease Under Conservative Treatment

Cássia Oliveira et al. Priscila Moreira de Lima Pereira Iris Teixeira Soares Melina Gabriela Monteiro … Marcus Gomes Bastos Ana Paula Carlos Cândido

Abstract

Background

Cardiovascular disease (CVD) is commonly associated with chronic kidney disease (CKD). These diseases have a significant impact on life expectancy. Individuals with CKD are more likely to die from CVD than to progress to end-stage kidney disease.

Objective

To assess cardiovascular risk factors of patients with CKD under conservative treatment.

Methods

This was an observational, cross-sectional study. Socioeconomic, anthropometric, biochemical, and physical inactivity data were assessed, and 10-year risk for CVD were estimated using the Framingham Score in patients with CKD under conservative treatment. For statistical analysis, the Student’s t-test and Pearson’s chi-square test were performed.

Results

A total of 172 individuals were evaluated, 57% of whom were male, with an average age of 68.85 ± 11.41 years. The prevalence of hypertension and diabetes were 87.2% and 53.5%, respectively; 62.2% were physically inactive; 9.9% of men were smokers and 12.8% consumed alcohol. According to BMI, 82.4% of adults <60 years old and 60.6% of those older than 60 years were overweight. High waist circumference and a high waist-hip ratio were highly prevalent in females (91.9% and 83.8%, respectively) and males (64.3% and 39.8%, respectively); 92.4% had a high body fat percentage and 73.3% high uric acid levels. According to the Framingham score, 57% have a medium or high risk of developing CVD in 10 years.

Conclusion

There was a high prevalence of cardiovascular risk factors in the population studied. The assessment of cardiovascular risk factors in patients with CKD makes it possible to guide the conduct of health professionals to prevent mortality from cardiovascular causes. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Assessing Dynamic Atrioventricular Conduction Time to RR-interval Coupling in Athletes and Sedentary Subjects

Paulo Roberto Benchimol-Barbosa et al. Olivassé Nasario Junior Jurandir Nadal

Abstract

Background

Atrioventricular conduction time ( AVCT ) is influenced by autonomic input and subject to physiological remodeling.

Objective

To evaluate beat-by-beat AVCT and RR-interval variability in athletes and healthy sedentary subjects.

Methods

Twenty adults, including 10 healthy sedentary (Controls) and 10 elite long-distance runners (Athletes), age, weight and height-adjusted, underwent maximal metabolic equivalent (MET) assessment, and 15-min supine resting ECG recording seven days later. The interval between P-wave and R-wave peaks defined the AVCT . Mean (M) and standard deviation (SD) of consecutive RR-intervals (RR) and coupled AVCT were calculated, as well as regression lines of RR vs. AVCT (RR-AVCT) . Concordant AV conduction was defined as positive RR-AVCT slope and discordant otherwise. A multivariate linear regression model was developed to explain MET based on AVCT and RR-interval variability parameters. Significance-level: 5 %.

Results

In Athletes, M-RR and SD-RR values were higher than in Controls, whereas M-AVCT and SD-AVCT were not. RR-AVCT slopes were, respectively, 0.038 ± 0.022 and 0.0034 ± 0.017 (p < 0.05). Using a cut-off value of 0.0044 (AUC 0.92 ± 0.07; p < 0.001), RR-AVCT slope showed 100% specificity and 80% sensitivity. In a multivariate model, SD-RR and RR-AVCT slope were independent explanatory variables of MET (F-ratio: 17.2; p < 0.001), showing 100% specificity and 90% sensitivity (AUC 0.99 ± 0.02; p < 0.001).

Conclusion

In elite runners, AVCT to RR -interval dynamic coupling shows spontaneous discordant AV conduction, characterized by negative AVCT vs. RR -interval regression line slope. RR -intervals standard deviation and AVCT vs. RR -interval regression line slope are independent explanatory variables of MET (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Original Article

Subclinical Thyroid Dysfunction was not Associated with Cardiac Arrhythmias in a Cross-Sectional Analysis of the ELSA-Brasil Study

Kamilla Maria Araújo Brandão Rajão et al. Antônio Luiz Pinho Ribeiro Valéria Maria Azeredo Passos Isabela Judith Martins Benseñor … Pedro Guatimosim Vidigal Cleber Pinto Camacho Maria de Fátima Haueisen Sander Diniz

Abstract

Background:

The association of subclinical thyroid dysfunction (STD) with cardiac arrhythmias remains controversial, particularly in the non-elderly population.

Objective:

To investigate whether STD was associated with cardiac arrhythmias in a cohort of middle-aged and older adults.

Methods:

Baseline data of the Longitudinal Study of Adult Health, ELSA-Brasil (35-74 years) were collected from 2008 to 2010. After exclusion of clinical hypothyroidism and hyperthyroidism, participants were categorized as euthyroidism (TSH = 0.4-4.0 µU/mL), subclinical hypothyroidism (TSH > 4.0 µU/mL; FT4 = 0.8-1.9 ng/dL), and subclinical hyperthyroidism (TSH < 0.4 µU/mL; FT4 = 0.8-1.9 ng/dL). The prevalence rates of tachycardia (HR > 100) and bradycardia (HR < 60), atrial fibrillation/flutter, conduction disorders, extrasystoles, low QRS voltage, prolonged QT intervals, and persistent supraventricular rhythms were compared between groups after adjusting for age, sex, comorbidities, lifestyle, body mass index and medications.

Results:

The HR data of 13,341 participants (52% female; median age, 51 years) and the electrocardiogram readings of 11,795 were analyzed; 698 participants (5.23%) were classified as subclinical hypothyroidism, 193 (1.45%) as subclinical hyperthyroidism, and 12,450 (93.32%) as euthyroidism. The prevalence of rhythm and conduction disorders was similar, as were HR medians, even in the subgroups with TSH 10.0 UI/mL or in older adults. Conduction disorders were less prevalent in older adults with subclinical hypothyroidism (adjusted OR = 0.44; 95% CI 0.24 to 0.80).

Conclusion:

In this large, multicenter and cross-sectional study, STD was not associated with cardiac arrhythmias, but a longitudinal assessment is necessary.

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Original Article

Hemodynamic, Metabolic and Ventilatory Responses to Exercise in Adults with Congenital Heart Disease

Pablo Marino Corrêa Nascimento et al. Daniel Arkader Kopiler Fernando Cesar de Castro e Souza Maria Carolina Terra Cola … Marina Pereira Coelho Gabriella de Oliveira Lopes Eduardo Tibiriçá

Abstract

Background:

Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF.

Objective:

To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease.

Methods:

Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed.

Results:

Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO₂) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO₂ at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg.

Conclusion:

Adults with congenital heart disease had similar responses to heart failure patients during exercise – reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure.

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Original Article

Serum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged Adults

Thaís da Silva Ferreira et al. Julia Freitas Rodrigues Fernandes Luciene da Silva Araújo Lívia de Paula Nogueira … Priscila Mansur Leal Vanessa Parada Antunes Maria de Lourdes Guimarães Rodrigues Debora Cristina Torres Valença Sergio Emanuel Kaiser Márcia Regina Simas Torres Klein

Abstract

Background:

Observational studies have highlighted an association between serum uric acid (SUA) levels and cardiovascular risk factors. Despite the growing body of evidences, several studies were conducted in older individuals or in carriers of diseases susceptible to affect SUA levels and cardiometabolic risk markers.

Objective:

To evaluate the relationship of SUA with body adiposity, metabolic profile, oxidative stress, inflammatory biomarkers, blood pressure and endothelial function in healthy young and middle-aged adults.

Methods:

149 Brazilian adults aged 20-55 years, both sexes, underwent evaluation of body adiposity, SUA, fasting glucose and insulin, lipid profile, malondialdehyde (MDA), high sensitivity C-reactive protein (hs-CRP), adiponectin, blood pressure and endothelial function. Endothelial function was assessed by the reactive hyperemia index (RHI) derived from peripheral arterial tonometry method. Participants were allocated in two groups according to SUA levels: control group (CG; n = 130; men ≤ 7 mg/dL, women ≤ 6 mg/dL) and hyperuricemia group (HG; n = 19; men > 7 mg/dL, women > 6 mg/dL). A P-value < 0.05 was considered statistically significant.

Results:

After adjustment for confounders, participants in HG compared with those in CG displayed higher body mass index (BMI): 34.15(33.36-37.19) vs.31.80 (26.26-34.42) kg/m²,p = 0.008, higher MDA: 4.67(4.03-5.30) vs. 3.53(3.10-4.07) ng/mL, p < 0.0001 and lower RHI: 1.68 ± 0.30 vs. 2.05 ± 0.46, p = 0.03). In correlation analysis adjusted for confounders, SUA was positively associated (p < 0.05) with BMI, waist circumference, LDL-cholesterol, triglycerides and MDA, and negatively associated (p < 0.05) with HDL-cholesterol, adiponectin and RHI.

Conclusions:

This study suggests that in healthy young and middle-aged adults higher SUA levels are associated with higher body adiposity, unfavorable lipid and inflammatory phenotype, higher oxidative stress and impaired endothelial function.

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Original Article

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries

Juliana Maria Dantas Mendonça Borges et al. Pamella de Assis Almeida Mariana Martins Gonzaga do Nascimento José Augusto Soares Barreto Filho … Mario Borges Rosa Antonio Carlos Sobral Sousa

Abstract

Background:

The current guidelines dispose recommendations to manage antiplatelet agents in the perioperative period; however, the daily medical practices lack standardization.

Objectives:

To asses factors associated with inadequate management of antiplatelet agents in the perioperative period of non-cardiac surgeries.

Methods:

Cross-sectional Study conducted in hospital from October 2014 to October 2016. The study dependent variable was a therapy that did not comply with the recommendations in the Brazilian Association of Cardiology (SBC) guidelines. The independent variables included some characteristics, the people in charge of the management and causes of lack of adherence to those guidelines. Variables were included in the multivariate model. Analysis was based on the odds ratio (OR) value and its respective 95% confidence interval (CI) estimated by means of logistic regression with 5% significance level.

Results:

The sample was composed of adult patients submitted to non-cardiac surgeries and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161). The management failed to comply with the recommendations in the guidelines in 80.75% of the sample. Surgeons had the highest number of noncomplying orientations (n = 63). After multivariate analysis it was observed that patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and those with a previous episode of acute myocardial infarction (AMI) (OR = 0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying with the guidelines.

Conclusion:

Positive association between patients’ schooling level, or those with a history of previous AMI, with management of the use of aspirin and clopidogrel in the perioperative period of non-cardiac surgeries. However, diverging conducts stress the need of having internal protocol defined.

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Original Article

Is Lipid Accumulation Product Associated with an Atherogenic Lipoprotein Profile in Brazilian Subjects?

Flavia De Conti Cartolano et al. Caroline Pappiani Maria Camila Prupper de Freitas Antonio M. Figueiredo Neto … Antônio Augusto Ferreira Carioca Nágila Raquel Teixeira Damasceno

Abstract

Background:

Lipid accumulation product (LAP), a simple and low-cost tool, is a novel biomarker of central lipid accumulation and represents a potential surrogate marker for atherogenic lipoprotein profile. However, its association with lipoprotein subfractions has not been described in the literature.

Objective:

To determine whether LAP index could be used as a marker of low- and high-density lipoprotein (LDL and HDL) size in Brazilian individuals.

Methods:

This cross-sectional study included patients (n = 351) of both sexes and age between 30-74 years. Clinical and sociodemographic data and family history of diseases were evaluated. Lipoprotein size, and levels of total cholesterol (TC), lipoproteins, apolipoprotein AI and B (APO AI/APO B), glucose, insulin, insulin resistance index (HOMA-IR) and non-esterified fatty acids (NEFA) were assessed in blood samples. LAP was calculated by the formulas [(waist circumference_[cm]-58) × (triglycerides_[mmol/L]) for women and (waist circumference _[cm]-65) × (triglycerides _[mmol/L]) for men]. The association between LAP and metabolic parameters were tested by linear trend (general linear model, GLM test) before and after multiple adjustments for potential confounders (sex, age, smoking, statin, fibrate, and hypoglycemic drugs) at significant level p < 0.05.

Results:

LAP was positively associated with TC, APO B, NEFA, glucose, insulin and HOMA-IR values, and negatively associated with HDL-C. Higher central lipid accumulation was corelated with higher percentage of intermediate HDL and of small LDL and HDL and less amount of large HDL. LDL size was also reduced in greater LAP index values. The negative impact of LAP was maintained after adjustment for multiple variables.

Conclusion:

LAP was robustly associated with atherogenic profile of lipoprotein subfractions, independently of multiple confounders.

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Review Article

Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review

Fernanda Porto et al. Yuri Saho Sakamoto Cristina Salles

Abstract

Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS –Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: ‘obstructive sleep apnea’ AND ‘polysomnography’ AND ‘myocardial infarction’ AND ‘adults NOT ‘treatment.’ The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.

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Original Article

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease

Viviane Castello-Simões et al. Vinicius Minatel Marlus Karsten Rodrigo Polaquini Simões … Natália Maria Perseguini Juliana Cristina Milan Ross Arena Laura Maria Tomazi Neves Audrey Borghi-Silva Aparecida Maria Catai

Background:

Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure.

Objective:

To characterize both indices in patients with CAD compared with healthy controls.

Methods:

Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO₂), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO₂/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO₂ x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency).

Results:

The CAD group had significantly lower values for peak VO₂ (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R² = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R² = 0.46, p < 0.001).

Conclusion:

The indices CP and VP were lower in men with CAD than healthy controls.

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Artigo Original

Body mass index and hypertension in adult subjects in Brazil's Midwest

Nadia Mohamed Amer et al. Sonia Silva Marcon Rosangela Getirana Santana

BACKGROUND: Overweight and obesity are an important public health problem in society, due to the growth in all age groups and their association with various chronic diseases, especially hypertension OBJECTIVE: To investigate possible factors associated with changes in body mass index (BMI). METHODS: Study developed in the city of Nova Andradina, State of Mato Grosso do Sul, with 369 subjects registered in the Family Health Strategy Program in 2007. Data were collected at the subjects’ homes, by using a semi-structured interview and by an anthropometric assessment. In the analysis of data, we used the Chi-square and Mantel Haenszel tests, for categorical responses, and ANOVA and Tukey tests, for continuous responses. RESULTS: The prevalence of overweight and obesity was 33.3% and 23.0%, respectively. Most of the individuals had the following characteristics: they were female (85.4%), physically inactive (89.7%), their waist-hip ratio (WHR) was inadequate (83.7%) and they had some chronic health problem (31.9%), especially hypertension. Risk factors for overweight and obesity may be linked to variables such as widowed status, inadequate WHR, lower income and health problems. On the other hand, high blood pressure may be linked only to obesity. CONCLUSION: The percentage of people that were overweight and those who did not do exercises in Nova Andradina indicates that these issues are also an important challenge for the health sector in smaller cities. Therefore, it is urgent that multidisciplinary intervention programs be implemented in primary health care.

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Artigo Original

Relationship between leisure-time physical activity and blood pressure in adults

Francisco José Gondim Pitanga et al. Ines Lessa

BACKGROUND: High blood pressure (BP) is found at epidemic levels in adults of industrialized societies, thereby favoring an increase in the risk of development of numerous cardiovascular pathologies. OBJECTIVE: To investigate the relationship between leisure-time physical activity (LTPA) and high systolic blood pressure (SBP)/diastolic blood pressure (DBP) in adults, in the city of Salvador, state of Bahia. METHODS: A cross-sectional study was conducted with a sample of 2,292 adults of both sexes, aged > 20 years. Those who engaged in physical activity during their leisure time were considered to be active in their free time. We used logistic regression analysis to estimate the odds ratio (OR), with confidence interval of 95%. RESULTS: After the adjustment for age and stratification by sex, the relationships between LTPA and SBP/DBP were: SBP = 0.86 (0.85 to 0.87) for females and 0.65 (0.64 to 0.66) for males; DBP = 0.94 (0.92 to 0.95) for females and 0.64 (0.63 to 0.65) for males. CONCLUSION: The results of this study are important to public health and they must be used to raise awareness of the relevance of LTPA to prevent high levels of SBP/DBP.

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Artigo Original

Influence of prior nutritional status on the development of the metabolic syndrome in adults

Renata Maria Souza Oliveira et al. Sylvia do Carmo Castro Franceschini Gilberto Paixão Rosado Silvia Eloiza Priore

BACKGROUND: The increase in the prevalence of excess weight among people of increasingly younger age groups may lead to the early development of cardiovascular risks. OBJECTIVE: To investigate the prevalence of the metabolic syndrome among young adults and the impact of birth conditions and nutritional status during adolescence on this disorder. METHODS: One hundred individuals were evaluated at three different stages of life. By consulting the database of people enlisted in the army reserve military service, data were collected on weight, height, and waist circumference of all draftees of 1996, 1997, and 1999 in order to analyze their nutritional status during adolescence. Using the same database, information was sought at the maternity on their birth conditions and the adult individuals were identified. Anthropometric and biochemical data were obtained from these adults. The Metabolic Syndrome (MS) was classified according to ATP III NCEP. Body fat percentage was assessed with bioelectrical impedance and the statistical analysis was performed using the Sigma Stat 2.0 software. RESULTS: Prevalence of the MS was detected in 13% of the individuals. The birth conditions showed no relationship with the syndrome. In adolescence, those individuals diagnosed with MS had greater values for weight (11 kg; p =<0.001), WC (8 cm; p < 0.001), and BMI (2.5 kg/m²; p= 0.002). CONCLUSION: A significant part of the risk factors for cardiovascular conditions starts during childhood and adolescence, and is likely to persist throughout life; therefore, primary prevention measures are critical in the context of cardiovascular disease.

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Artigo Original

Association between hyertension and overweight in adults in Belém, state of Pará (Brazil), 2005

Hilma Paixão Borges et al. Nilma do Carmo Cruz Erly Catarina Moura

BACKGROUND: Hypertension is a major public health issue affecting 20 to 25% of the global population of adults, and 12 to 35 % of Brazilians. OBJECTIVE: To evaluate the association between hypertension and overweight. METHODS: A cross-sectional study was conducted in 2005 with a probabilistic sampling of the population >18 years of age in Belém, capital of the state of Pará, in the Northern region of Brazil, using the telephone surveillance system for chronic diseases (SIMTEL). The dependent variable was hypertension, the explanatory variable was overweight and the confounding variables were age, level of education and lifestyle characteristics. The variables associated with hypertension were run through the regression logistic model and odds ratios were calculated for each variable. RESULTS: Hypertension affected 16.2% of men and 18.3% of women, and overweight affected 49.2% of men and 34.1% of women. The prevalence of hypertension was directly associated with age and overweight in both genders. Among men, hypertension was associated with intake of vegetables and low intake of beans (similar to kidney- and pinto-type beans); as for women, hypertension was associated with marital status (widow or separated), and inversely to education level. The risk of hypertension increased directly with weight for both genders (p<0.001), and it was 6.33 times higher among obese men and 3.33 among obese women as compared to normal-weight subjects. CONCLUSION: Overweight was associated with hypertension. However, variables such as age, education, and food consumption interfere in this relationship, creating circumstances favorable to reducing or increasing that risk.

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Artigo Original

Cardiovascular health profile of an adult population from the metropolitan region of São Paulo

Renata Furlan Viebig et al. Maria Pastor Valero Fernando Araújo Alice Tatsuko Yamada Alfredo José Mansur

OBJECTIVE: To describe the cardiovascular health profile of an adult population from the metropolitan region of São Paulo, according to the European Society of Cardiology (ESC) criteria. METHODS: Two hundred volunteers of both sexes enrolled in the “Cardiac Evaluation” project of a general outpatient clinic were studied. Data collected included socioeconomic status, cigarette smoking, alcohol consumption, anthropometric measurements, diet, physical activity, serum lipids, blood glucose and blood pressure. Average intake of dietary cholesterol and total lipids was estimated from a 24-hour dietary recall. Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ-8) and exercise stress tests. RESULTS: Sample population composition was 61.5% female and 38.5% male, mean age 41.7 (median = 42.6) and 41.0 (median = 43.0%). Prevalence of smoking (22%) and daily alcohol consumption (14% males; no females) was low. The overweight prevalence was 47% (12% being obese), in addition to high levels of serum total cholesterol (> 190 mg/dl) in 56% and LDL-cholesterol (> 115 mg/dl) in 61%. The IPAQ-8 results showed that 6% were sedentary. CONCLUSION: The study population showed greater risk of cardiovascular diseases, according to ESC criteria, due especially to the high prevalence of overweight and hypercholesterolemia.

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