Sedentary Lifestyle – ABC CARDIOL

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Original Article

The Relationship between Lifestyle and Costs Related to Medicine Use in Adults

Romulo Araujo Fernandes et al. Alessandra Madia Mantovani Jamile Sanches Codogno Bruna Camilo Turi-Lynch … Subhash Pokhrel Nana Anokye

Abstract

Background:

The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses.

Objective:

To examine the interrelationship between the costs of medicine use and lifestyle behaviors.

Methods:

A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05.

Results:

In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs.

Conclusion:

Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact.

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Original Article

Dyslipidemia in Adolescents Seen in a University Hospital in the city of Rio de Janeiro/Brazil: Prevalence and Association

Nathalia Pereira Vizentin et al. Paula Mendonça Santos Cardoso Camila Aparecida Gomes Maia Isabela Perez Alves … Gabriel Lunardi Aranha Denise Tavares Giannini

Abstract

Background:

Early exposure to obesity favors greater risks of cardiovascular factors such as dyslipidemia.

Objectives:

To establish the prevalence of dyslipidemia, and to evaluate its association with nutritional status of the adolescents attended at the ambulatory of the Adolescent Health Studies Center of the University Hospital Pedro Ernesto.

Methods:

This is a cross-sectional, observational study, the sample of which was of convenience, consisting of adolescents from 12 to 18 years old of both genders. The lipid profile was evaluated, along with its association with the anthropometric indicators: body mass index and waist circumference. For statistical analysis, a significance level of 5% was used.

Results:

A total of 239 adolescents, 104 boys (43.5%) and 135 girls (56.5%) were evaluated and, of these, 52 (21.8%) were eutrophic, 60 (25.1%) overweight, and 127 (53.1%) obese. Obeseadolescents had significantly lower mean values of HDL-cholesterol (44.7 mg/dl vs 53.9 mg/dl; p < 0.001) and higher triglycerides (109.6 mg/dl vs 87.3 mg/dl; p = 0.01). The changes with higher prevalence were low HDL-cholesterol (50.6%), hypercholesterolemia (35.1%), and hypertriglyceridemia (18.4%). A negative association of HDL-cholesterol with body mass index and a positive association of triglycerides with body mass index could be observed, even after adjustment for gender and skin color.

Conclusion:

This study demonstrated high prevalence of dyslipidemia among adolescents. In view of the significant association between lower levels of HDL-cholesterol and increased triglycerides with overweight, the control of these factors should receive attention, with the precocious diagnosis of the dyslipidemia being important, mainly if it is associated with another cardiovascular risk, to develop effective intervention strategies.

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Original Article

Association of Multiple Genetic Variants with the Extension and Severity of Coronary Artery Disease

Simone Cristina Pinto Matheus Fischer et al. Simone Pires Pinto Lívia Campos do Amaral Silva Lins Henrique Tria Bianco … Carlos Manoel de Castro Monteiro Luiz Fernando Muniz Pinheiro Francisco Antonio Helfenstein Fonseca Maria Cristina de Oliveira Izar

Abstract

Background:

Metabolic syndrome (MS) is a condition that, when associated with ischemic heart disease and cardiovascular events, can be influenced by genetic variants and determine more severe coronary atherosclerosis.

Objectives:

To examine the contribution of genetic polymorphisms to the extension and severity of coronary disease in subjects with MS and recent acute coronary syndrome (ACS).

Methods:

Patients (n = 116, 68% males) aged 56 (9) years, with criteria for MS, were prospectively enrolled to the study during the hospitalization period after an ACS. Clinical and laboratory parameters, high-sensitivity C-reactive protein, thiobarbituric acid reactive substances, adiponectin, endothelial function, and the Gensini score were assessed. Polymorphisms of paraoxonase-1 (PON-1), methylenotetrahydrofolate reductase (MTHFR), endothelial nitric oxide synthase (ENOS), angiotensin-converting enzyme (ACE), angiotensin II type 1 receptor (AT1R), apolipoprotein C3 (APOC3), lipoprotein lipase (LPL) were analysed by polymerase chain reaction (PCR) technique, followed by the identification of restriction fragment length polymorphisms (RFLP, and a genetic score was calculated. Parametric and non-parametric tests were used, as appropriate. Significance was set at p < 0.05.

Results:

Polymorphisms of PON-1, MTHFR and ENOS were not in the Hardy-Weinberg equilibrium. The DD genotype of LPL was associated with higher severity and greater extension of coronary lesions. Genetic score tended to be higher in patients with Gensini score < P50 (13.7 ± 1.5 vs. 13.0 ± 1.6, p = 0.066), with an inverse correlation between genetic and Gensini scores (R = -0.194, p = 0.078).

Conclusions:

The LPL polymorphism contributed to the severity of coronary disease in patients with MS and recent ACS. Combined polymorphisms were associated with the extension of coronary disease, and the lower the genetic score the more severe the disease.

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Original Article

Cardiovascular Risk Factors in Climacteric Women with Coronary Artery Disease

Jorgileia Braga de Melo et al. Roberta Cristina Almeida Campos Philippe Costa Carvalho Mariana Ferreira Meireles … Maria Valneide Gomes Andrade Tânia Pavão Oliveira Rocha Wilma Karlla dos Santos Farias Maria Jozelia Diniz Moraes Josete Costa dos Santos José Albuquerque de Figueiredo Neto

Abstract

Background:

The increased incidence of cardiovascular disease in women occurs during the climacteric period, especially after menopause.

Objective:

The aim of this study was to identify risk factors among climacteric women with and without coronary artery disease (CAD).

Method:

This cross-sectional study was performed in the Catheterization Laboratory at the Federal University Hospital of Maranhão, in the Northeast region of Brazil, between March 2012 and July 2013. We included 31 climacteric women who went to the care center for cardiac catheterization. They were divided into groups after catheterization results: Group I (with DAC) and Group II (without CAD). Statistical analysis: Categorical variables were described by means of frequencies and percentages, numerical variables by mean ± standard deviation or median (Quartile.3 – Quartile.1); the Shapiro-Wilk test was used to verify the normality of quantitative data. Fisher’s exact test was used for categorical data comparisons. For continuous data, we used Student’s test or the Mann-Whitney for unpaired samples; statistical significance was set at p < 0.05.

Results:

We evaluated groups with CAD (n = 13) and without CAD (n = 18). The results showed a mean age between the groups of 57.92 ± 5.15 and 51.72 ± 4.63 years, respectively. Among the cardiovascular risk factors, the most prevalent among women with CAD were menopause (84.62%), systemic arterial hypertension (SAH) (69.23%) and sedentary life style (69.23%).

Conclusion:

We concluded that, in addition to menopause itself, SAH and sedentary lifestyle were the most prevalent cardiovascular risk factors among women with CAD.

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Original Article

Minute-Ventilation Variability during Cardiopulmonary Exercise Test is Higher in Sedentary Men Than in Athletes

Renata Rodrigues Teixeira de Castro et al. Sabrina Pedrosa Lima Allan Robson Kluser Sales Antonio Claudio Lucas da Nóbrega

Abstract

Background:

The occurrence of minute-ventilation oscillations during exercise, named periodic breathing, exhibits important prognostic information in heart failure. Considering that exercise training could influence the fluctuation of ventilatory components during exercise, we hypothesized that ventilatory variability during exercise would be greater in sedentary men than athletes.

Objective:

To compare time-domain variability of ventilatory components of sedentary healthy men and athletes during a progressive maximal exercise test, evaluating their relationship to other variables usually obtained during a cardiopulmonary exercise test.

Methods:

Analysis of time-domain variability (SD/n and RMSSD/n) of minute-ventilation (Ve), respiratory rate (RR) and tidal volume (Vt) during a maximal cardiopulmonary exercise test of 9 athletes and 9 sedentary men was performed. Data was compared by two-tailed Student T test and Pearson´s correlations test.

Results:

Sedentary men exhibited greater Vt (SD/n: 1.6 ± 0.3 vs. 0.9 ± 0.3 mL/breaths; p < 0.001) and Ve (SD/n: 97.5 ± 23.1 vs. 71.6 ± 4.8 mL/min x breaths; p = 0.038) variabilities than athletes. VE/VCO₂ correlated to Vt variability (RMSSD/n) in both groups.

Conclusions:

Time-domain variability of Vt and Ve during exercise is greater in sedentary than athletes, with a positive relationship between VE/VCO₂ pointing to a possible influence of ventilation-perfusion ratio on ventilatory variability during exercise in healthy volunteers.

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Original Article

Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome

Juliana de Goes Jorge et al. Marcos Antonio Almeida Santos José Augusto Soares Barreto Filho Joselina Luzia Menezes Oliveira … Enaldo Vieira de Melo Norma Alves de Oliveira Gustavo Baptista de Almeida Faro Antônio Carlos Sobral Sousa

Abstract

Background:

Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established.

Objective:

To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS.

Methods:

Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records.

Results:

The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure.

Conclusion:

A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS.

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Artigo Original

Reference values for cardiopulmonary exercise testing for sedentary and active men and women

Artur Haddad Herdy et al. Dorian Uhlendorf

BACKGROUND: The reference values for cardiopulmonary exercise testing (CPET) available in Brazil were derived from a cycle ergometer in a sedentary and relatively small population. OBJECTIVE: Provide reference values for CPET in Brazilians of both sexes, either sedentary or active. METHODS: From 2006 to 2008, 3,992 CEPT of healthy individuals were selected from our laboratory. Athletes, smokers, patients with any known pathology, users of continuous medication and obese patients were excluded. Peak VO2 was considered max VO2. We also analyzed the anaerobic threshold VO2, maximum ventilation and oxygen pulse according to sex, age, sedentary and active patients. Age groups were divided as follows: G1 (15-24), G2 (25-34), G3 (35-44), G4 (45-54), G5 (55-64) and G6 (65-74). RESULTS: According to age groups, the mean values of VO2 in ml/kg/min with their standard deviations were: Active man: G1-50.6 ± 7.3, G2-47, 4 ± 7.4, G3-45, 4 ± 6.8, G4-40.5 ± 6.5; G5-35.3 ± 6.2; G6-30.0 ± 6.1. Active woman: G1-38.9 ± 5.7; G2-38.1 ± 6.6; G3-34.9 ± 5.9; G4-31.1 ± 5.4; G5-28.6 ± 6.1; G6-25.1 ± 4.4. Sedentary man: G1-47.4 ± 7.9; G2-41.9 ± 7.2; G3-39.0 ± 6.8; G4-35.6 ± 7.7; G5-30.0 ± 6.3; G6-23.1 ± 6.3. Sedentary woman: G1-35.6 ± 5.7; G2-34.0 ± 4.8; G3-30.0 ± 5.4; G4-27.2 ± 5.0; G5-23.9 ± 4.2; G6-21.2 ± 3.4. CONCLUSION: This article provides reference values of max VO2, among other parameters, in the Cardiopulmonary Exercise Testing performed on the treadmill in individuals of both sexes, either active and sedentary.

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Artigo Original

Physical inactivity, TV-watching hours and body composition in children and adolescents

Ivan Romero Rivera et al. Maria Alayde Mendonça da Silva Renata D'Andrada Tenório Almeida Silva Bruno Almeida Viana de Oliveira Antonio Carlos Camargo Carvalho

BACKGROUND: Physical inactivity is a predisposing factor to the onset/worsening of other cardiovascular risk factors, particularly obesity. OBJECTIVE: To determine physical activity level (PAL) and daily number of hours of TV (HTV) and the association and/or correlation of these variables with age, gender, economic class, public/private school, overweight and obesity in children and adolescents. METHODS: Cross sectional study, school-based population, public and private education, primary and secondary education. The sample was calculated based on the minimum expected prevalence of several variables, including physical inactivity. Cluster sampling. Protocol: structured questionnaire, including Physical Activity for Older Children Questionnaire (PAQ-C) measurements of weight, height, body mass index (BMI) and triceps skinfold (TSF). Statistical analysis: Chi-square, linear correlation. RESULTS: Among the 1,253 students, averaging 12.4 ± 2.9 years old, of which 549 were male, there was a prevalence of inactivity in 93.5%, more commonly found in female adolescents and there was no association between PAL and excess weight or body fat, soccer and dance were the most frequent activities in boys and girls, respectively; 60% of students did not have physical education classes. Average and median HTV were respectively 3.6 and 3 hours; there was a significant association between HTV and obesity and significant correlation between PAL and age (negative) and between BMI and TSF (positive). CONCLUSION: Physical inactivity is present in 93.5% of children and adolescents from Maceió. It is more commonly found among teenagers and females, with no association or correlation of this variable with excess weight or body fat; obesity was associated with > 3 HTV.

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