Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women

Abstract Background Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable. Objective To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers. Methods This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05). Results According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (<5%), intermediate (5-10%), and high (>10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity <85% (22.2%), coronary calcium score >0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score. Conclusion Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

Non Electrocardiographic alterations in exercise testing in asymptomatic women. Associations with cardiovascular risk factors

OBJECTIVES: To estimate the prevalence of exercise testing alterations in middle-aged women without symptoms of heart disease and to verify the associations of functional capacity and heart rate behavior during and after exercise with cardiovascular risk factors. METHODS: A cross-sectional study was conducted with 509 asymptomatic women aged between 46 and 65 years who underwent clinical evaluations and exercise testing (Bruce protocol). The heart rate behavior was evaluated by the maximal predicted heart rate achieved, chronotropic index and recovery heart rate. RESULTS: The mean age was 56.4±4.8 years, and 13.4% of the patients had a Framingham risk score above 10%. In the exercise treadmill testing, 58.0% presented one or more of the following alterations (listed in order of ascending prevalence): symptoms (angina, dyspnea, and dizziness), ST-segment depression, arrhythmia, reduction in recovery heart rate of ≤12 bpm at 1 minute, altered maximal predicted heart rate achieved, abnormal blood pressure, functional capacity deficiency, and altered chronotropic index. In the multivariate analysis, the following associations (odds ratio) were observed for these alterations: chronotropic index was associated with obesity (2.08) and smoking (4.47); maximal predicted heart rate achieved was associated with smoking (6.45); reduction in the recovery heart rate at 1 minute was associated with age (1.09) and obesity (2.78); functional capacity was associated with age (0.92), an overweight status (2.29) and obesity (6.51). CONCLUSIONS: More than half of middle-aged women without cardiovascular symptoms present alterations in one or more exercise testing parameters. Alterations in the functional capacity or heart rate behavior, as verified by exercise testing, are associated with age, smoking, an overweight status and obesity.

Aterosclerose de carótidas em mulheres na pré e pós-menopausa com antecedentes de hipertensão na gestação: estudo de caso-controle / Carotid atherosclerosis in pre-and-post-menopausal women with a history of pregnancy-induced hypertension: case-control study

A mortalidade por doença cardiovascular entre as mulheres permanece elevada. Estudos observacionais são controversos sobre a participação dos antecedentes de distúrbio hipertensivo gestacional no risco cardiovascular. Verificar a associação entre aterosclerose de carótidas em mulheres no climatério que tiveram hipertensão na gestação. Estudo de caso-controle, sendo os casos compostos por mulheres com aterosclerose de carótida, definida como espessura íntima-média carotídea > 1 mm e/ou presença de placas de carótidas; os controles não apresentavam estas alterações. Adotou-se nível de significância de 95%. Foram avaliadas 504 mulheres sem doença cardiovascular prévia, sendo 126 casos e 378 controles. Eram hipertensas 67% delas; 76% eram dislipidêmicas; e 16%, diabéticas. Cerca de 10% referiram antecedentes de hipertensão na gestação. As mulheres com aterosclerose de carótidas apresentaram valores maiores dos níveis de pressão arterial sistólica (134,18 mmHg vs. 128,59 mmHg; p = 0,008) e de LDL-colesterol (156,52 mg% vs. 139,97 mg%; p = 0,0005). Não foi encontrada diferença estatística em relação à presença de aterosclerose de carótidas e ao antecedente de hipertensão na gestação (OR 1,672; IC 95% 0,893-3,131). O antecedente de hipertensão na gestação não foi associado à aterosclerose subclínica de carótidas em mulheres na pré e pós-menopausa. No entanto, verificou-se a associação entre a aterosclerose de carótida e os fatores de risco clássicos, como pressão arterial sistólica elevada e altos níveis de LDL-colesterol

Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk. To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension. Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%. A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol(156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131). The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels

Efeitos de diferentes intensidades de treinamento aeróbio sobre a lipemia de adolescentes obesos / Effects of different intensities of aerobic training on lipemia in obese adolescents

O objetivo do presente estudo foi verificar o efeito de diferentes intensidades de treinamento físico aeróbio sobre a lipemia de adolescentes obesos submetidos à intervenção multidisciplinar. Quarenta e três adolescentes (idade= 15,25±1,26) obesos (índice de massa corporal [IMC] acima do percentil 95 (CDC) (IMC= 34,48±3,88 kg/m2) de ambos os gêneros foram alocados aleatoriamente em dois grupos: treinamento de alta intensidade (TAI) ? limiar ventilatório I (LVI); e treinamento de baixa intensidade (TBI) - 20% abaixo do LVI. As sessões de exercício (3x/semana) foram isocalóricas (350 kcal). Todos os adolescentes receberam a mesma intervenção nutricional, psicológica e clínica durante 24 semanas. Foram determinados os níveis de triglicerídeos, colesterol total e frações, antes e após a intervenção. Para comparações entre os grupos e momentos utilizou-se ANOVA two-way com Post-hoc de Fisher. Após 24 semanas observou-se redução no colesterol total (9% - p<0,05) e LDL (17,7% - p<0,05) e elevação do HDL (22,8% - p<0,05) em resposta ao TBI. O TAI foi efetivo na redução do LDL (14,3% - p<0,05) e aumento no HDL (28,1% - p<0,05). As razões lipídicas Colesterol Total/HDL-colesterol, LDL-colesterol/HDL-colesterol (Índices de Castelli I e II), reduziram em ambos os grupos: TBI (-24,81% Castelli I), (-33,59% Castelli II); TAI (- 24,45% Castelli I), (-31,83% Castelli II). Os resultados sugerem que ambas intensidades de treinamento físico são capazes de promover alterações positivas na lipemia de adolescentes obesos submetidos a intervenção multidisciplinar, entretanto, quando comparado ao treinamento de alta intensidade, o treinamento de baixa intensidade é mais efetivo na redução do colesterol total...

The aim of this study was to investigate the effect of different intensities of aerobic exercise on lipemia in obese adolescents submitted to a multidisciplinary intervention. Forty-three obese (body mass index [BMI] higher than 95th percentile (CDC) (BMI = 34.48 ± 3.88 kg/m2) adolescents (age = 15.25 ± 1.26) from both genders were randomly allocated into two groups: high intensity training (HIT) - ventilatory threshold (LVI), and low intensity training (LIT) - 20 % below the LVI. Exercise sessions (3x/week) were isocaloric (350 kcal). All adolescents received the same nutritional, psychological and clinical counseling for 24 weeks. Were determined levels of triglycerides, total cholesterol and fractions, before and after the intervention. Comparisons between groups and times were made by two-way ANOVA with Fisher as Post-hoc. After 24 weeks there was a reduction in total cholesterol (9 % - p < 0.05) and LDL (17.7% - p < 0.05) and increasing in HDL (22.8 % - .p < 0.05) in response to LIT. HIT was effective to decrease LDL (14.3% - p < 0.05) and increase HDL (28.1 % - .p < 0.05). The lipid ratios: total cholesterol / HDL ? cholesterol; LDL-colesterol/HDL-colesterol (Castelli Indices I and II), decreased in both groups: LIT (-24.81 % Castelli I), ( II -33.59 % Castelli); (HIT - 24.45% Castelli I), (-31,83 % Castelli II). The results suggest that both intensities of exercise training can promote positive changes in lipid profile in obese adolescents submitted to a multidisciplinary intervention, however when compared to high-intensity training, low intensity training is more effective in reducing total cholesterol...

Reasons and Barriers to Lose Weight: Obese Adolescents’ Point of View.

Aims: To identify the reasons why obese adolescents seek weight loss therapy and what barriers they face in losing weight. Study Design: Cross-sectional study. Place and Duration of Study: Department of Physical Education and School Medical Science, University of Pernambuco 2009-11. Methodology: The study was conducted with 128 obese adolescents (76 girls [BMI=35.46±3.92] and 52 boys [BMI=33.70±2.88]), aged between 12 to 18 years old Personal reasons for seeking weight loss treatment and barriers to losing weight were obtained by an individual semi-structured interview (8 questions) conducted by a psychologist. All individual interviews lasted approximately 20 min and were performed in a quiet room. Adolescents’ answers were semi-transcribed by the researcher and the content was anonymously analyzed in order to categorize the data. Results: The main reason for girls to start a weight loss program was to become healthy (39.47%), followed by to fit in clothes (30.26%), personal appearance (30.26%), and bullying (28.95%). Physical fitness (40.38%) was the most important reason to seek weight loss for boys, followed by to become healthy (36.54%), and bullying (25%). For both genders, the main barriers described were lack of self-control (47.37% - 36.54%), lack of social support (27.63% - 30.77%), and self-motivation (22.37% - 21.15%). Conclusion: Obese adolescents had several reasons for seeing weight loss. Overall, becoming healthy was the main motivation for weight loss and lack of self-control was the main barrier. This information can be used to help develop more effective weight loss strategies for obese adolescents.

Efeito da intervenção multidisciplinar sobre a insatisfação da imagem corporal em adolescentes obesos / Effects of a multidisciplinary intervention on body image dissatisfaction in obese adolescents

O objetivo do presente estudo foi analisar os efeitos da intervenção multidisciplinar sobre a insatisfação da imagem corporal em adolescentes obesos. Trinta e quatro adolescentes obesos com idade entre 12 a 19 anos, IMC?95th e púberes, foram submetidos à intervenção multidisciplinar composta por acompanhamento nutricional, psicológico, clínico e sessões de exercício físico. A insatisfação com a imagem corporal foi verificada através do Body Shape Questionnaire (BSQ). As avaliações foram realizadas antes e após 12 semanas de intervenção. Os efeitos da intervenção sobre a insatisfação da imagem corporal foram verificados utilizando-se o Qui-quadrado. Todas as análises foram realizadas com auxílio do software SPSS 10.0, p<0,05. Verificou-se no início da intervenção que 80,95% dos adolescentes apresentavam insatisfação com a imagem corporal, e após as 12 semanas de intervenção houve uma redução para 60,90% dos adolescentes com algum grau de insatisfação com a imagem corporal (p=0,05). Conclui-se que a intervenção multidisciplinar é uma importante estratégia para reduzir a insatisfação com a imagem corporal de adolescentes obesos.

The aim of this study was to analyze the effects of a multidisciplinary intervention on body image dissatisfaction (BID) in obese adolescents. Thirty four obese adolescents aged between 12 to 19 years, BMI?95 percentile and pubescent, were submitted to a multidisciplinary intervention composed by nutritional, psychological and clinical counseling and exercise sessions. BDI was determined assessed through by Body Shape Questionnaire (BSQ). Evaluations were performed before and after 12 weeks of intervention. The results are presented as mean (X) +standard deviation (SD) and distribution of absolute and relative frequency. The effects of the intervention on BDI were verified using chi-square test. All the analyses were performed using the software SPSS 10.0, p<0.05. A the beginning of intervention 80.95% of the adolescents were dissatisfied with their body image, after 12 weeks this value was reduced to 60.90% (p=0.05). The multidisciplinary intervention is an important strategy to reduce the dissatisfaction with body image of obese adolescents.

Efeitos de diferentes intensidades de treinamento físico aeróbio sobre a concentração circulante de leucócitos em adolescentes obesos submetidos à intervenção multidisciplinar / Effects of different aerobic training intensity on leukocyte in obese adolescents submitted to a multidisciplinary therapy

O objetivo do presente estudo foi comparar os efeitos do treinamento aeróbio de alta intensidade (TAI) com o de baixa intensidade (TBI) sobre a concentração circulante de leucócitos em adolescentes obesos. Quarenta e três adolescentes obesos (34,4±4,3 kg/m²) de ambos os gêneros (13 meninos e 30 meninas), com idade entre 13 e 18 anos, foram submetidos de forma aleatória ao TAI (intensidade correspondente ao limiar ventilatório I; N=20) ou TBI (intensidade correspondente a 20% abaixo do limiar ventilatório I; N=23) durante 12 semanas. Todos os voluntários receberam o mesmo acompanhamento clínico, psicológico e nutricional. Para ambos os grupos as sessões de exercício foram isocalóricas (350Kcal). A concentração total de leucócitos e subpopulações (monócitos, linfócitos e neutrófilos) foram determinadas por citometria de fluxo fluorescente antes (pré) e após (pós) a intervenção. Para a análise entre grupos e momentos foi utilizada ANOVA two way para medidas repetidas, com post-hoc de Fisher. Correlações entre as variáveis foram analisadas por meio da correlação de Pearson. Os resultados demonstraram redução na concentração circulante de monócitos tanto no TAI (pré: 0,63+0,10; pós: 0,3+0,10 ? p<0,001) quanto no TBI (pré: 0,73+0,27; pós: 0,39+0,19 ? p<0,001), sem diferença entre os grupos. Adicionalmente o foi verificado elevação dos neutrófilos apenas no grupo TAI (p=0,008). Dessa forma, podemos concluir que treinamento físico aeróbio, independente da intensidade, é efetivo no controle do estado inflamatório em adolescentes obesos, via redução da concentração circulante de monócitos.

The aim of this study was to compare the effects of a high intensity (HIT) vs. a low intensity (LIT) aerobic exercise training on leukocytes levels in obese adolescents. Forty-three obese (34.4 +4.3 kg/m²) from both genders (13 boys and 30 girls) aged between 13 and 18 years underwent randomically to HIT (intensity corresponding to ventilatory threshold I, N=20) or LIT (intensity corresponding to 20% below ventilatory threshold I, N=23) during 12 weeks. All volunteers accomplish the clinical follow-up (1x/month), psychological and nutritional counseling (1x/week). For both groups exercise sessions were isocaloric (150Kcal). Total leukocytes and subpopulations (monocytes, lymphocytes and neutrophils) were determined by fluorescence flow cytometry before and after intervention. For analysis between groups and time were used two-way ANOVA for repeated measures with Fisher as post-hoc. Correlations between variables were analyzed by Pearson´s correlation. The results showed reduction on circulating levels of monocytes in TAI (pre: 0.63+0.10; post: 0.3+0.10 ? p<0.001) as well as in TBI (pre: 0.73+0.27; post: 0.39+0.19 ? p<0.001), without groups differences. In addition it was verified a rise in neutrophils values (p=0.008). Thus we can conclude that aerobic exercise, regardless of intensity, is effective in controlling the inflammatory status in obese adolescents by reducing monocytes circulating levels.

Modificações da qualidade de vida sexual de obesos submetidos à cirurgia de Fobi-Capella / Changes the sexual quality of life of the obeses submitted Fobi-Capella gastroplasty surgery

OBJETIVO: Analisar as modificações na qualidade de vida sexual de obesos, proporcionadas pela redução do peso corpóreo, após a realização da gastroplastia à Fobi-Capella. MÉTODOS: Estudo quantitativo, prospectivo e longitudinal com cortes transversais, realizado entre março de 2005 e março de 2007, com 21 obesos mórbidos. Critérios de inclusão: idade de 20 a 50 anos, índice de massa corpórea (IMC) =40 Kg/m² e insucesso em tentativas de tratamento clínico para obesidade nos últimos dois anos. Coleta de dados clínicos em prontuários e aplicação de questionário específico com questões relativas à função sexual, realizadas antes e seis meses após a cirurgia. Os escores obtidos foram analisados com o auxilio do programa Epi-Info6, empregando o teste T de student para amostras pareadas. RESULTADOS: O valor total aumentou seis meses após a cirurgia em 76,19 por cento, permaneceu inalterado em 14,29 por cento e diminuiu em 9,52 por cento. Os domínios referentes a função erétil e a relação sexual aumentaram em 71,42 por cento, ao desejo sexual em 52,38 por cento e ao orgasmo em 28,57 por cento. A satisfação sexual aumentou em 57,14 por cento. As médias do valor total e dos seus domínios antes e seis meses após a cirurgia, exceto aquelas referentes ao orgasmo e ao desejo sexual, apresentam diferenças estatisticamente significativas. CONCLUSÃO: A qualidade de vida sexual em homens obesos melhora após a realização da gastroplastia à Fobi-Capella. Evidenciaram-se modificações favoráveis na função sexual desses indivíduos após a perda de peso.

OBJECTIVES: Examine changes in the quality of sexual life of men with morbid obesity offered by a reduction in body weight following Fobi-Capella gastroplasty. METHOD: A quantitative, prospective, longitudinal, cross-sectional study was carried out on 21 men with morbid obesity between March 2005 and March 2007. Inclusion criteria were: aged 20 to 50 years, body mass index (BMI) = 40 kg/m² and failure in attempts of clinical treatment for obesity in the previous two years. Data collection from clinical records and the administering of a specific questionnaire on issues relating to sexual function was performed prior to and six months following surgery. Scores were analyzed with the help of the Epi-Info 6 program, using the Student's t-test for paired samples. RESULTS: The total score increased at the six-month post operative in 76.19 percent; remained unaltered in 14.29 percent; and decreased in 9.52 percent. Scores in areas related to erectile function and sexual relations increased in 71.42 percent; sexual desire increased in 52.38 percent; and orgasms increased in 28.57 percent. General sexual satisfaction increased in 57.14 percent. The average total score and scores on the domains of the questionnaire prior to and six months following surgery revealed statistically significant differences, except those relating to sexual desire and orgasm. CONCLUSION: The quality of sexual life in morbid obese men improves following Fobi-Capella surgery. Favorable changes occurred in sexual function after these individuals underwent this type of bariatric surgery.

Onicomicose: prevenção do pé em risco nos portadores de diabetes tipo 2 / Onychomycosis: preventing the foot at risk in type 2 diabetes bearers

O objetivo do estudo foi avaliar a incidência e os fatores desencadeantes de onicomicose nos pacientes diabéticos atendidos no Programa de Diabetes de um Hospital Universitário do Recife. Tratou-se de um estudo exploratório, quantitativo, realizado com 63 pacientes portadores de diabetes atendidos no programa durante um ano. O estudo mostrou a presença de onicomicose em 40% (25) dos pacientes, sugerindo a necessidade de um programa preventivo-promocional, com enfoque no auto-cuidado, dirigido aos pacientes diabéticos.

Transtorno da compulsão alimentar periódica em uma população de obesos mórbidos candidatos a cirurgia bariátrica do Hospital Universitário Oswaldo Cruz, em Recife - PE / Binge eating disorder in a population of morbid obese candidates to bariatric surgery at the Oswaldo Cruz University Hospital in Recife, PE / Binge eating disorder in a population of morbid obese candidates to bariatric surgery at the Oswaldo Cruz University Hospital in Recife, PE

OBJETIVOS: Avaliar a freqüência de transtorno da compulsão alimentar periódica (TCAP) e dos principais transtornos psiquiátricos associados à obesidade mórbida em indivíduos à espera de cirurgia bariátrica. MÉTODOS: Estudo de corte transversal. Foram entrevistados pacientes do programa de cirurgia da obesidade do Hospital Universitário Oswaldo Cruz e avaliados o perfil sócio-demográfico, a qualidade de vida (escala SF-36), o TCAP (Binge Eating Scale ­ BES) e os transtornos psiquiátricos (Mini International Neuropsychiatry Interview ­ M.I.N.I./DSM-IV). RESULTADOS: Dos 400 pacientes inscritos no programa, 67 (16,8 por cento) foram entrevistados. O IMC variou de 36,1 a 81,8 kg/m² (média 48,5 ± 8,8). Todos os entrevistados apresentavam doenças associadas, sendo a HAS, os distúrbios do sono e as osteopatias as mais freqüentes. Os transtornos psiquiátricos mais freqüentes foram: 47,8 por cento transtorno de ansiedade generalizada; 29,9 por cento depressão atual e 34,3 por cento depressão no passado. Verificou-se TCAP em 56,7 por cento dos pacientes (25,4 por cento TCAP moderado e 31,3 por cento, grave) e esses apresentaram os piores escores em todos os domínios de qualidade de vida da escala SF-36. CONCLUSÕES: Constatou-se elevada prevalência de TCAP. Grupo com TCAP apresentou maior número de tratamentos realizados com objetivo de perder peso, elevada prevalência de depressão maior no momento da avaliação, piores escores em todos os domínios da escala de qualidade de vida SF-36. Visto que os portadores de TCAP apresentam vasta psicopatologia e maior probabilidade de comprometimento nos resultados da cirurgia, deve-se aprimorar a detecção desses distúrbios a fim de proporcionar-lhes o tratamento adequado.

OBJECTIVES: To analyze the frequency of binge eating disorder (BED) and of the main psychiatric disorders associated with morbid obesity in individuals on the waiting list for bariatric surgery. METHOD: Cross sectional study. Interviews with patients from the Surgery for Obesity Program of Oswaldo Cruz University Hospital were conducted evaluating socio-demographic profile, quality of life (SF-36 scale), BED (Binge Eating Scale ­ BES) and psychiatric disorders (M.I.N.I./DSM-IV). RESULTS: 67 out of 400 patients enrolled in the program were interviewed (16.8 percent). The BMI varied from 36.1 to 81.8 kg/m² (average 48.5 ± 8.8). All have associated diseases, the most frequent being systemic arterial hypertension, sleeping disorders and osteopathies. The most frequent psychiatric disorders were: 47.8 percent generalized anxiety disorder, 29.9 percent major depressive disorder, single episode, 34.3 percent recurrent major depressive disorder. In this group 56.7 percent showed BED (25.4 percent moderate and 31.3 percent severe) and the worse scores in all the domains of quality of life (SF-36 scale). CONCLUSIONS: High prevalence of BED. The compulsive eaters showed a higher number of obesity treatments, higher prevalence of actual major depression, and the worse scores in all the domains of the SF-36 scale. Considering the ample range of psychopathology associated with BED and the greater probability of jeopardizing the surgery results it is very important to improve the detection of these disorders in order to provide adequate treatment.