Exposição a agrotóxicos ou práticas agroecológicas: ideação suicida entre camponeses do semiárido no Brasil / Exposure to pesticides or agroecological practices: suicidal ideation among peasant farmers in Brazil's semi-arid region

Resumo Diferentes práticas agrícolas estão associadas a diferentes riscos para a saúde de camponeses. Objetivou-se analisar a associação entre ideação suicida e exposição a agrotóxicos, comparando camponeses vivendo sob exposição ambiental a agrotóxicos em relação a camponeses envolvidos com práticas agroecológicas, sem o uso de agrotóxicos, no semiárido norte mineiro. As famílias avaliadas foram amostradas, por conveniência, a partir da prática agrícola a qual estavam vinculadas, e os dados coletados por meio de entrevistas com instrumento previamente validado. Foram realizadas análises bivariadas seguidas de regressão logística. Foram entrevistados 547 camponeses, de ambos os sexos, sendo 311 sob exposição a agrotóxicos. Os camponeses expostos a agrotóxicos, em relação a camponeses envolvidos com práticas agroecológicas, tiveram maiores chances para ideação suicida (OR=2,30; IC95% 1,16-4,56), consumo problemático de álcool (OR=2,30; IC95% 1,18-4,48) e episódios prévios de intoxicação aguda por agrotóxicos (OR=8,58; IC95% 2,98-24,72).Conclui-se que as práticas agrícolas que implicam em exposição crônica a agrotóxicos se associam a maiores chances de ideação suicida, independentemente de episódios prévios de intoxicação aguda por agrotóxicos ou do uso problemático do álcool.

Abstract Health risks faced by peasant farmers may vary depending on the type of agriculture they practice. This study examined the association between suicide ideation and exposure to pesticides by comparing two groups of peasant farmers of both sexes living in the semi-arid region of the north of Minas Gerais, Brazil: exposed to pesticides and adopting agroecological practices without the use of pesticides. Group participants were selected using convenience sampling and data was collected using a previously validated questionnaire administered through face-to-face interviews. Bivariate analysis was performed, followed by logistic regression. A total of 547 peasant farmers were interviewed (311 in the group exposed to pesticides and 236 in the group adopting agroecological practices). Respondents from the group exposed to pesticides were more likely to report suicidal ideation (OR=2.30; 95%CI 1.16-4.56), harmful alcohol consumption (OR=2.30; 95%CI 1.18-4.48), and lifetime acute pesticide poisoning (OR=8.58; 95%CI 2.98-24.72). The findings suggest that agricultural practices that lead to chronic pesticide exposure are associated with a greater likelihood of suicide ideation, regardless of previous episodes of acute pesticide poisoning or harmful alcohol consumption.

QT Interval Dispersion Behavior in Patients With and Without Obstructive Coronary Artery Disease Undergoing Exercise Test

Abstract Background: Stress test is used to detect coronary artery disease (CAD). The QTc interval dispersion (dQTc) is an electrocardiographic index of ventricular repolarization heterogeneity. Some researchers have linked transient myocardial ischemia induced by physical exertion with increased heterogeneity of ventricular repolarization measured by dQTc. Objectives: To study the patterns of dQT in patients with and without chronic obstructive CAD and to define a reliable cutoff point for dQT that could become a diagnostic criterion for myocardial ischemia. Methods: We retrospectively analyzed the electrocardiogram in resting and in exercise of 63 patients submitted to exercise test and cardiac catheterization. We divided the patients into three groups: true negative (VN), true positive (VP) and false positive (FP). VN: patients with coronary lesion lower than 70% and exercise test without myocardial ischemia; VP: individuals with stenosis greater than 70% in coronary arteries and a test suggestive of myocardial ischemia; FP: people with stenosis lower than 70% in the coronary arteries and stress test with ischemia criteria. Values of p < 0.05 were considered statistically significant. Results: Resting dQTc was not different among the three groups. However, for the dispersion of the QTc interval in exercise was, respectively, 47 ± 17 ms, 72 ± 42 ms, and 61 ± 31 ms for VN, VP and FP (p = 0.003). Conclusions: Obstructive chronic coronary disease patients have an increase in dQTc during exercise. Measurement of dQTc may be helpful in the diagnosis of myocardial ischemia in the stress test.

Polymorphisms of the renin-angiotensin system are not associated with overweight and obesity in a general adult population

ABSTRACT Objective The increased prevalence of obesity and associated comorbidities, such as cardiovascular and metabolic diseases, has gained attention worldwide, and the renin-angiotensin system (RAS) has been pointed out as a possible link. Thus, the present study aimed to verify the possible association between angiotensinogen (AGT) or angiotensin-converting enzyme (ACE) polymorphisms with overweight and obesity in adults. Subjects and methods The present investigation was a population-based cross-sectional study including 1,567 individuals from an urban area in Brazil. Anthropometric, clinical and biochemical parameters were evaluated, and all individuals were genotyped for the ACE I/D and AGT M/T polymorphisms. Results The prevalence of overweight was higher among men, whereas obesity was more prevalent among women. However, the frequency of ACE or AGT polymorphisms was similar among body mass index (BMI) categories. In addition, the mean age-adjusted BMI averages did not change significantly for ACE or AGT polymorphisms, regardless of sex or BMI category. The age-adjusted BMI average for the combination of ACE and AGT genotypes evidenced no significant differences regardless of sex or BMI categories. Results were similar when BMI was replaced by waist circumference (WC). Conclusions We were not able to find any associations between BMI and WC (overweight/obesity) and ACE and AGT polymorphisms, indicating that the RAS system might not be involved in overweight and obesity, at least based on genetic backgrounds. However, further studies must measure RAS components to elucidate this question.

Distúrbio de movimento por conta de estado hiperosmolar não cetótico em idosa: relato de caso / Movement disorder caused by hyperosmolar hyperglycemic state in an older adult: a case report

O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.

Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichorea­hemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.

Prevalência de fatores de risco cardiovascular na população de Vitória segundo dados do VIGITEL e da Pesquisa Nacional de Saúde de 2013 / Prevalence of cardiovascular risk factors in the population of Vitória according to data from VIGITEL and the National Health Interview Survey of 2013

RESUMO: Objetivo: Comparar a prevalência de fatores de risco cardiovascular na população de Vitória (ES) em pesquisa autorreferida por contato telefônico (VIGITEL) ou por exames clínicos e laboratoriais realizados na Pesquisa Nacional de Saúde (PNS). Método: Os inquéritos foram realizados na população adulta de Vitória (≥18anos). No VIGITEL foram entrevistados 1996 indivíduos (homens = 38%). Na PNS foi feita visita domiciliar seguida de exames clínicos e laboratoriais em 318 indivíduos (homens = 48%) selecionados em 20setores censitários da cidade. Nos dois inquéritos, as prevalências foram ajustadas para a estrutura populacional estimada para o ano de 2013. Os dados são fornecidos como porcentagens e intervalo de confiança de 95% (IC95%). Resultados: Foram encontradas prevalências similares no VIGITEL e na PNS, respectivamente, para tabagismo (8,2%; IC95% 6,7 - 9,7% versus 10,0; IC95% 6,4 - 13,6%) e hipertensão (24,8%; IC95% 22,6- 27,0% versus 27,2%; IC95% 21,8 - 32,5%). Houve diferença estatística (p < 0,01) entre o VIGITEL e a PNS, respectivamente, para as prevalências de obesidade (16,8%; IC95% 14,1 - 18,1% versus 25,7%; IC95% 20,4- 30,9%) e colesterol elevado (≥ 200mg/dL) no sangue (20,6%; IC95% 18,6 - 22,6% versus 42,3%; IC95% 36,9- 47,7%). A prevalência de diabetes também foi maior (p < 0,05) na PNS (6,7 versus 10,7%). Conclusão: A prevalência populacional de hipertensão e tabagismo foi estimada adequadamente no VIGITEL. Isso não ocorreu com a obesidade por provável viés de informação do peso corporal no VIGITEL. Os dados mostram a necessidade de melhorar a cobertura diagnóstica das dislipidemias em vista da importância do controle desse fator de risco na prevenção primária das doenças cardiovasculares.

ABSTRACT: Objective: To compare the prevalence of cardiovascular risk factors in the adult population of Vitória, Espírito Santo, Brazil, in two surveys conducted by telephone interview (VIGITEL) or by clinic and laboratory exams during the National Health Interview Survey (NHIS). Method: Data were collected from adults (≥ 18 years). In VIGITEL, 1,996 subjects (males = 38%) were interviewed. In NHIS, home visit followed by clinical and laboratory tests was made with 318 individuals (males = 48%) selected in 20 census tracts of the city. The prevalence of risk factors was adjusted to the estimated population of the city in 2013. Data are shown as prevalence and 95% confidence interval (95%CI). Results: Similar values of prevalence were found in VIGITEL and NHIS, respectively, for smoking (8.2%; 95%CI 6.7-9.7% vs 10.0; 95%CI 6.4 - 13.6%) and hypertension (24.8%; 95%CI 22.6 - 27.0% vs 27.2%; 95%CI 21.8 - 32.5%). Statistical differences between surveys (p < 0.01) were found for diabetes (6.7%; 95%CI 5.6 - 7.9% vs 10.7%; 95%CI 7.1 - 14.5%), obesity (16.8%; 95%CI 14.1 - 18.1% vs 25.7%; 95%CI 20.4 - 30.9%) and high cholesterol (≥ 200mg/dL) (20.6%; 95%CI 18.6- 22.6% vs 42.3%; 95%CI 36.9 - 47.7%). The prevalence of diabetes was also higher (p < 0.01) in NHIS (6.7 vs 10.7%). Conclusion: Prevalence of smoking and hypertension, but not obesity, was adequately detected in VIGITEL, because there might have been information bias related to body weight during telephone interviews. Datashow the necessity to improve the diagnosis of dyslipidemias in primary care services, as the control of this risk factor is of utmost importance to prevent cardiovascular diseases.

Lipid disorders among Black Africans non-users of lipid-lowering medication

ABSTRACT Objective: Angola is a sub-Saharan African country where the population has scarce access to lipidlowering medication. We sought to determine the frequency of lipid disorders among Angolan nonusers of lipid-lowering medication. Material and methods: A cross-sectional descriptive study was carried out in a sample of 604 workers from the public sector. Blood pressure and anthropometric data were measured along with biochemical parameters including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). LDL-C to HDL-C ratio (LDL-C/HDL-C) was obtained from LDL-C and HDL-C levels. Results: High frequencies of elevated blood pressure (44.8%), metabolic syndrome (20.2%), increased TC (39.2%) and increased LDL-C (19.3%) were found. Low HDL-C was more frequent in women (62.4% vs. 36.1%, p < 0.001). Isolated hypercholesterolemia was more frequent in men (9.6% vs. 2.5%, p < 0.001). Among men TC, TG, LDL-C and LDL-C/HDL-C ratio were higher and HDL-C was lower in obese than in low-weight and normal-weight participants. Among women TC, TG, LDL-C and LDL-C/HDL-C ratio were higher in obese than in normal-weight participants. Significant linear trend of increasing TC and LDL-C levels as age increased was detected for both genders (p for trend < 0.05). Conclusion: The results of our study showed a high frequency of lipid disorders in Angolan non-users of lipid-lowering medication.

Estudo de validação das equações de Tanaka e de Kawasaki para estimar a excreção diária de sódio através da coleta da urina casual / Validation study of the Tanaka and Kawasaki equations to estimate the daily sodium excretion by a spot urine sample

RESUMO: Objetivo: Validar as fórmulas de Tanaka e Kawasaki para cálculo do consumo de sal pela relação sódio/creatinina na urina casual. Métodos: Foram estudados 272 adultos (20 - 69 anos, 52,6% de mulheres) com coleta urinária de 24 h e duas coletas casuais no mesmo dia (em jejum - casual 1 - e fora do jejum - casual 2). Antropometria, pressão arterial e coleta de sangue foram obtidos no mesmo dia. A concordância entre o consumo de sal estimado pela urina de 24 h e pela urina casual foi feita por Pearson (r) e Bland & Altman. Resultados: O consumo médio de sal medido pela urina de 24 h foi de 10,4 ± 5,3 g/dia. A correlação entre a excreção de sódio na urina de 24 h e a estimada pela urina casual 1 ou 2, respectivamente, foi apenas moderada, tanto por Tanaka (r = 0,51 e r = 0,55; p < 0,001) como por Kawasaki (r = 0,52 e r = 0,54; p < 0,001). Observa-se subestimação crescente dos valores estimados em relação ao medido com o aumento do consumo de sal pela fórmula de Tanaka e, ao contrário, superestimação ao usar a fórmula de Kawasaki. As fórmulas estimam adequadamente o consumo diário de sal (diferença entre sal medido e estimado de, no máximo, 1 g/dia) somente com consumo entre 9 - 12 g/dia (Tanaka) e 12 - 18 g/dia (Kawasaki). Conclusão: A coleta de urina casual estima adequadamente o consumo de sal apenas nos indivíduos próximos à média populacional.

ABSTRACT: Objective: To validate Tanaka and Kawasaki's formulas to calculate the salt intake by the sodium/creatinine ratio in spot of urine. Methods: Two hundred and seventy two adults (20 - 69 years old; 52.6% women) with 24 h urine collection and two urinary spots collected on the same day (while fasting - spot 1 - or not fasting - spot 2). Anthropometry, blood pressure and fasting blood were measured on the same day. The analysis of agreement between salt consumption measured in the 24 h urine test and urinary spots were determined by the Pearson's correlation (r) and the Bland & Altman method. Results: The mean salt consumption measured by the 24 h sodium excretion was 10.4 ± 5.3 g/day. The correlation between the measured 24 h sodium excretion and the estimation based on spots 1 and 2, respectively, was only moderated according to Tanaka (r = 0.51 and r = 0.55; p < 0.001) and to Kawasaki (r = 0.52 and r = 0.54; p < 0.001). We observed an increasing underestimation of salt consumption by Tanaka to increasing salt consumption and conversely, an overestimation of consumption by the Kawasaki formula. The estimation of salt consumption (difference between measured and calculated salt consumption lower than 1 g/day) was adequate only when the consumption was between 9 - 12 g/day (Tanaka) and 12 - 18 g/day (Kawasaki). Conclusion: Spot urine sampling is adequate to estimate salt consumption only among individuals with an actual consumption near the population mean.

Relação entre volume do átrio esquerdo e disfunção diastólica em 500 casos de uma população brasileira / Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients

FUNDAMENTO: O aumento do Volume do Átrio Esquerdo Indexado (VAEi) tem sido associado à Disfunção Diastólica (DD) do Ventrículo Esquerdo (VE), considerado marcador de eventos cardiovasculares (fibrilação atrial, acidente vascular cerebral, insuficiência cardíaca, e óbito). OBJETIVO: Avaliar a relação entre VAEi e diferentes graus de DD em pacientes brasileiros submetidos ao ecocardiograma, estudando os determinantes do aumento do VAEi nesta amostra. MÉTODOS: Selecionamos 500 pacientes ambulatoriais submetidos a ecocardiografia, após exclusão de arritmia, cardiopatia valvar ou congênita, marca-passo permanente ou janela ecocardiográfica inadequada. O VAEi foi obtido pelo método de Simpson; classificou-se a DD segundo diretrizes atuais. Variáveis clínicas e ecocardiográficas foram submetidas a análise multivariada de regressão linear. RESULTADOS: A idade média foi de 52 ± 15 anos, 53% do sexo masculino, 55% hipertensos, 9% coronariopatas, 8% diabéticos, 24% obesos, 47% com hipertrofia VE, fração de ejeção média do VE: 69,6 ± 7,2%. A prevalência de DD na amostra foi de 33,8% (grau I: 66%, grau II: 29% e grau III: 5%). Houve aumento progressivo das dimensões do VAEi conforme o grau de DD: 21 ± 4 mL/m² (ausente), 26 ± 7 mL/m² (grau I), 33 ± 5 mL/m² (grau II), 50 ± 5 mL/m2 (grau III) (p < 0,001). Os preditores independentes de aumento do VAEi nesta amostra foram idade, massa ventricular esquerda, espessura relativa de parede, fração de ejeção do VE e relação E/e'. CONCLUSÃO: A DD contribui para o remodelamento atrial esquerdo. O aumento do VAEi expressa a gravidade da DD e está associado de forma independente com idade, hipertrofia ventricular esquerda, disfunção sistólica e aumento das pressões de enchimento do VE.

BACKGROUND: Left atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. RESULTS: Mean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m² (absent), 26 ± 7 mL/m² (grade I), 33 ± 5 mL/m² (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. CONCLUSION: DD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

OBJECTIVES: The present study was performed to investigate 1) whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2) whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM), sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p<0.05). RESULTS: Myocardial infarctions in exercise-trained animals resulted in a smaller myocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. CONCLUSION: Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties. .

Distribuição por gênero de ácido úrico sérico e fatores de risco cardiovascular: estudo populacional / Gender distribution of serum uric acid and cardiovascular risk factors: population based study / Distribución por género del ácido úrico sérico y factores de riesgo cardiovascular: estudio poblacional

FUNDAMENTO: Não há dados relativos à epidemiologia da hiperuricemia em estudos brasileiros de base populacional. OBJETIVO: Investigar a distribuição de ácido úrico sérico e sua relação com variáveis demográficas e cardiovasculares. MÉTODOS: Estudamos 1.346 indivíduos. A hiperuricemia foi definida como > 6,8 e > 5,4 mg/dL para homens e mulheres, respectivamente. A síndrome metabólica (SM) foi definida utilizando-se os critérios NCEP ATP III. RESULTADOS: A prevalência de hiperuricemia foi de 13,2 por cento. A associação de ácido úrico sérico (AUS) com fatores de risco cardiovasculares foi específica para o gênero: em mulheres, maiores níveis de AUS estiveram associados com IMC elevado, mesmo após ajustes da pressão arterial sistólica para idade (PAS). Em homens, a relação do AUS com o colesterol HDL esteve mediada pelo IMC, enquanto em mulheres, o AUS mostrou-se semelhante e dependente do IMC, independentemente dos níveis glicose e presença de hipertensão. Nos homens, os triglicerídeos, a circunferência abdominal (CA) e a PAS explicaram 11 por cento, 4 por cento e 1 por cento da variabilidade do AUS, respectivamente. Nas mulheres, a circunferência abdominal e os triglicerídeos explicaram 9 por cento e 1 por cento da variabilidade de AUS, respectivamente. Em comparação com o primeiro quartil, homens e mulheres no quarto quartil apresentavam 3,29 e 4,18 vezes mais de aumento de risco de SM, respectivamente. As mulheres apresentaram uma prevalência quase três vezes maior de diabetes melito. Homens normotensos com MS apresentaram maiores níveis de AUS, independente do IMC. CONCLUSÃO: Nossos resultados parecem justificar a necessidade de uma avaliação baseada no gênero em relação à associação do AUS com fatores de risco cardiovasculares, que se mostraram mais acentuados em mulheres. A SM esteve positivamente associada com AUS elevado, independentemente do gênero. A obesidade abdominal e a hipertrigliceridemia foram os principais fatores associados com a hiperuricemia mesmo em indivíduos normotensos, o que pode adicionar maior risco para a hipertensão.

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 percent. 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 percent, 4 percent and 1 percent of SUA variability, respectively. In women, WC and triglycerides explained 9 percent and 1 percent 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.

RFUNDAMENTO: No existen datos relativos a la epidemiología de la hiperuricemia en los estudios brasileros de base poblacional. OBJETIVO: Investigar la distribución del ácido úrico sérico y su relación con las variables demográficas y cardiovasculares. MÉTODOS: Estudiamos 1.346 individuos. La hiperuricemia se definió como > 6,8 y > 5,4 mg/dL para hombres y mujeres, respectivamente. El síndrome metabólico (SM) fue definido utilizando los criterios NCEP ATP III. RESULTADOS: La prevalencia de hiperuricemia fue de un 13,2 por ciento. La asociación del ácido úrico sérico (AUS), con los factores de riesgo cardiovasculares fue específica para el género: en las mujeres, mayores niveles de AUS estuvieron asociados con un IMC elevado, incluso después de los ajustes para la presión arterial sistólica (PAS) y edad . En los hombres, la relación del AUS con el colesterol HDL fue mediada por el IMC, mientras que en las mujeres, el AUS demostró ser parecido y dependiente del IMC, independientemente de los niveles de glucosa y de la presencia de hipertensión. En los hombres, los triglicéridos, la circunferencia abdominal (CA) y la PAS, explicaron el 11 por ciento, 4 por ciento y el 1 por ciento de la variabilidad del AUS, respectivamente. En las mujeres, la circunferencia abdominal y los triglicéridos explicaron el 9 por ciento y el 1 por ciento de la variabilidad de AUS, respectivamente. En comparación con el primer cuartil, los hombres y las mujeres, en el cuarto cuartil, tenían 3,29 y 4,18 veces más aumento de riesgo de SM, respectivamente. Las mujeres tenían una prevalencia casi tres veces mayor de diabetes mellitus. Los hombres normotensos con MS tenían mayores niveles de AUS, independiente del IMC. CONCLUSIONES: Nuestros resultados parecen justificar la necesidad de una evaluación con base en el género, respecto de la asociación del AUS con los factores de riesgo cardiovasculares, que demostraron ser más acentuados en las mujeres. La SM estuvo positivamente asociada con el AUS elevado, independientemente del género. La obesidad abdominal y la hipertrigliceridemia fueron los principales factores asociados con la hiperuricemia incluso en los individuos normotensos, lo que puede añadirle un riesgo mayor a la hipertensión.

Effects of spironolactone in spontaneously hypertensive adult rats subjected to high salt intake

OBJECTIVE: To evaluate the effect of spironolactone on ventricular stiffness in spontaneously hypertensive adult rats subjected to high salt intake. INTRODUCTION: High salt intake leads to cardiac hypertrophy, collagen accumulation and diastolic dysfunction. These effects are partially mediated by cardiac activation of the renin-angiotensin-aldosterone system. METHODS: Male spontaneously hypertensive rats (SHRs, 32 weeks) received drinking water (SHR), a 1 percent NaCl solution (SHR-Salt), or a 1 percent NaCl solution with a daily subcutaneous injection of spironolactone (80 mg.kg-1) (SHRSalt- S). Age-matched normotensive Wistar rats were used as a control. Eight weeks later, the animals were anesthetized and catheterized to evaluate left ventricular and arterial blood pressure. After cardiac arrest, a doublelumen catheter was inserted into the left ventricle through the aorta to obtain in situ left ventricular pressurevolume curves. RESULTS: The blood pressures of all the SHR groups were similar to each other but were different from the normotensive controls (Wistar = 109±2; SHR = 118±2; SHR-Salt = 117±2; SHR-Salt-S = 116±2 mmHg; P<0.05). The cardiac hypertrophy observed in the SHR was enhanced by salt overload and abated by spironolactone (Wistar = 2.90±0.06; SHR = 3.44±0.07; SHR-Salt = 3.68±0.07; SHR-Salt-S = 3.46±0.05 mg/g; P<0.05). Myocardial relaxation, as evaluated by left ventricular dP/dt, was impaired by salt overload and improved by spironolactone (Wistar = -3698±92; SHR = -3729±125; SHR-Salt = -3342±80; SHR-Salt-S = -3647±104 mmHg/s; P<0.05). Ventricular stiffness was not altered by salt overload, but spironolactone treatment reduced the ventricular stiffness to levels observed in the normotensive controls (Wistar = 1.40±0.04; SHR = 1.60±0.05; SHR-Salt = 1.67±0.12; SHR-Salt- S = 1.45±0.03 mmHg/ml; P<0.05). CONCLUSION: Spironolactone reduces left ventricular hypertrophy secondary to high salt intake and ventricular stiffness in adult SHRs.

Impacto da atividade física sobre o risco cardiovascular na população adulta de Vitória-ES / Impact of physical activity on cardiovascular risk in adults from Vitória-ES

A atividade física (AF) regular é considerada hábito de vida saudável por reduzir o risco de doenças cardiovasculares. Entretanto, há poucos estudos neste sentido realizados em amostras populacionais. Avaliar o impacto da AF de lazer (AFL), ocupacional (AFO) e mista (AFLO) sobre o risco cardiovascular mensurado pelo escore de Framingham (EF) na população adulta (25-64 anos) de Vitória-ES. Estudo transversal em amostra probabilística (N=1.663; ambos os sexos). Os dados foram coletados por meio de questionário, avaliação clínica e laboratorial (coleta de sangue). A estimativa de gasto calórico semanal em AFL, AFO e AFLO foi feita por meio de entrevista e, dessa forma, 4 grupos foram constituídos: Sedentário (S), AFL, AFO e AFLO. Análises de variância e covariância, bem como testes qui-quadrado e Mantel-Haenszel, foram usados para análise estatística. O grupo AFO apresentou valores inferiores para % gordura (%G), colesterol total (CT) e LDL se comparado ao grupo S. A prevalência de tabagismo foi menor nos grupos AFL (11,5%) e AFLO (10,2%), e maior nos grupos S (26,4%) e AFO(30,2%). O EF e o risco (%) de desenvolvimento de doença arterial coronariana em 10 anos (risco DAC), não ajustados, apresentaram-se menores no grupo AFO (EF= 3; 2,65±6,20; risco DAC= 4; 6,79±6,68%;mediana; média±DP ) se comparado ao grupo S (EF= 5; 3,85±7,07; risco DAC= 6; 8,41±7,74%). Entretanto, após ajuste para idade e CT, o EF e o risco DAC foram menores no grupo AFL (EF:2,54±4,18; risco DAC: 6,55±5,29%; média±DP) se comparado aos grupos S (EF: 3,50±4,17; risco DAC:8,05±5,33%) e AFO (EF: 4,09±4,19; risco DAC: 8,08±5,35%), evidenciando, assim, que as variáveis CT e idade foram as principais determinantes das diferenças iniciais em favor do grupo AFO. O estudo denota impacto positivo da AF de lazer ou laboral na redução do risco cardiovascular populacional.

Regular physical activity (PA) has been considered a healthy habit to reduce thecardiovascular risk. However, there are few studies to determine this association in population-based studies. To evaluate the contribution of leisure-time (LPA), occupational (OPA) and combined physical activity (LOPA) on the cardiovascular risk computed by Framingham score (FS) on the adult population (25-64 y) of Vitória, Brazil. Cross-sectional study in a probabilistic sample (N=1,661; both sexes). Datawere collected by questionnaires and clinical and laboratorial (blood collection) exams. Estimation of week caloric expenditure in LPA, OPA and LOPA were obtained by interview and 4 groups were designed accordingly: Sedentary, LPA, OPA and LOPA. Analysis of variance and covariance, qui-squareand Mantel-Haenszel tests were used for statistical analysis. Before and after adjustment to age, the OPA group showed lower values of body fat, total cholesterol (TC) and LDL-cholesterol compared to the sedentary group. The smoking prevalence was smaller in LPA (11.5%) and LOPA (10.2%) than insedentary (26.4%) and OPA (30.2%) groups. The unadjusted FS and the 10-year risk for coronary heart disease (CHD-risk) were smaller in the OPA (FRS= 3; 2.65±6.20; CHD-risk= 4; 6.79±6.68%; median; mean±SD) compared to the sedentary group (FRS= 5; 3.85±7.07; CHD-risk= 6; 8.41±7.74%). However, after adjustment for age and TC, the FRS and CHD-risk were smaller in the LPA (FR: 2.54±4.18; CHDrisk: 6.55±5.29%; mean±SD) than in the sedentary (FR: 3.50±4.17; CHD-risk: 8.05±5.33%) and OPA (FR: 4.09±4.19; CHD-risk: 8.08±5.35%) groups, showing that age and TC were the main responsible tosupport the initial differences to the OPA group. The study shows positive impact of leisure-time and occupational physical activity to reduce the global cardiovascular risk in the studied population.

Associação entre a razão cintura-estatura e hipertensão e síndrome metabólica: estudo de base populacional / Association of waist-stature ratio with hypertension and metabolic syndrome: population-based study

FUNDAMENTO: Hipertensão e síndrome metabólica são fatores de risco cardiovascular associados com o aumento da adiposidade. Em um estudo anterior, a razão cintura-estatura (RCE) foi identificada como o melhor índice de obesidade associado com hipertrofia do ventrículo esquerdo. OBJETIVO: Comparar a capacidade desse índice na identificação da hipertensão e síndrome metabólica com outros índices de obesidade (índice de massa corporal - IMC; circunferência da cintura - CC e razão cintura-quadril - RCQ) através da análise de curvas ROC (receiver operator characteristics). MÉTODOS: 1.655 (45,8 por cento homens) participantes do Projeto MONICA-WHO/Vitória, com idade média de 45 ± 11 anos foram investigados. A prevalência de síndrome metabólica (critérios ATP-III) foi de 32,9 por cento, hipertensão de 42,4 por cento e obesidade de 19,2 por cento. RESULTADOS: Em relação à capacidade de identificar a hipertensão, houve uma superioridade significante da RCE em relação ao IMC e CC (p < 0,05), independentemente do sexo, mas não em relação à RCQ (p > 0,05). Em relação à capacidade de identificar a síndrome metabólica, houve uma superioridade significante da RCE em relação à RCQ em homens (p < 0,001), mas não em relação ao IMC e à CC (p = 0,16 e p = 0,9 respectivamente). Entretanto, em mulheres, a RCE foi significativamente superior em relação à RCQ (p < 0,001) e IMC (p = 0,025), mas não em relação à CC (p = 0,8). Os pontos de corte são 0,52 e 0,53 para hipertensão e 0,53 e 0,54 para síndrome metabólica, para homens e mulheres, respectivamente. CONCLUSÃO: A obesidade abdominal identificada pela RCE, ao invés da obesidade geral identificada pelo IMC, é o índice mais simples e melhor aplicável, associado à hipertensão e síndrome metabólica, em nossa população.

BACKGROUND: Hypertension and metabolic syndrome are cardiovascular risk factors associated with increased adiposity. In a previous study, waist-to-stature ratio (WSR) was identified as the best obesity index associated with left ventricular hypertrophy. OBJECTIVE: In this study we compared the ability of this index to identify hypertension and metabolic syndrome with other obesity indexes (body mass index - BMI; waist circumference - WC; and waist-to-hip ratio - WHR) by receiver operating characteristic (ROC) curve analyses. METHODS: 1,655 (45.8 percent men) participants of the MONICA-WHO/Vitoria Project, mean age 45 ± 11 y were investigated. Metabolic syndrome prevalence (ATP-III criteria) was 32.9 percent, hypertension was 42.4 percent and obesity was 19.2 percent. RESULTS: Regarding the ability to identify hypertension, there was a significant WSR superiority in relation to BMI and WC (p < 0.05) regardless of gender, but WHR (p > 0.05). In relation to the ability to identify metabolic syndrome, there was a significant WSR superiority in relation to WHR in men (p < 0.001), but BMI and WC (p = 0.16 and p = 0.9), respectively. However, in women WSR was significantly superior in relation to WHR (p < 0.001) and BMI (p = 0.025), but WC (p = 0.8). The optimal WSR cutoffs are 0.52 and 0.53 for hypertension and 0.53 and 0.54 for metabolic syndrome, for men and women, respectively. CONCLUSION: Abdominal obesity, identified by WSR as a surrogate, and not overall obesity (BMI as surrogate), is the simplest and best applicable obesity index associated to hypertension and metabolic syndrome in our population.

Correlação entre a depuração plasmática de creatinina utilizando urina coletada durante 24 horas e 12 horas / Correlation between the creatinine clearance in the urine collected during 24 hours and 12 hours

INTRODUÇÃO: A concentração da creatinina no plasma é usada para avaliar a função renal, mas a depuração da creatinina plasmática (DCP) constitui método mais sensível para essa finalidade. OBJETIVO : Correlacionar a DCP em coleta urinária de 12 horas noturna com a de 24 horas. MÉTODOS: Noventa e cinco voluntários (34-64 anos) coletaram urina durante 24 horas em dois frascos: diurno (das 7h às 19h) e noturno (das 19h às 7h do dia seguinte). A coleta de sangue se deu em jejum para medidas bioquímicas. A correlação entre as variáveis foi feita pelo teste Pearson (r) e a concordância de medidas, pelo teste de Bland-Altman. RESULTADOS: Urinas de quatro indivíduos foram recusadas por erro de coleta. Na amostra final (n = 91; 42 homens), havia 23 hipertensos e cinco diabéticos. A DCP (mL/min/1,73 m²) foi menor no período noturno em mulheres (77,8 ± 22,7 versus 88,4 ± 23,6; p < 0,05) e similar em homens (91,2 ± 22,9 versus 97,3 ± 30,9; p > 0,05). As correlações entre a DCP na urina de 12 horas noturna ou diurna e a de 24 horas foram fortes (r = 0,85 e 0,83, respectivamente). Em 85 e 83 dos 91 indivíduos, a medida da DCP noturna e diurna, respectivamente, foi concordante com a de 24 horas. CONCLUSÃO: A urina de 12 horas, sobretudo quando coletada à noite, fornece valores de DCP similares àqueles obtidos em coleta de 24 horas. Como essa coleta é mais fácil de ser feita em pacientes ambulatoriais à noite, esse período deveria ser preferido para a medida da filtração glomerular.

INTRODUCTION: Creatinine concentration in plasma has been used to evaluate renal function. However, the endogenous creatinine clearance (CrCl) is more sensitive to this goal. OBJECTIVE : Correlate the CrCl calculated from urinary collects of 12 h and 24 h. METHODS: Ninety five volunteers (34-64 y) collected the urine for 24 h into two bottles: night, from 7 am to 7 pm and day, from 6 am to 7 pm. A fasting blood sample was used to measure plasma creatinine. Correlation between variables was determined by Pearson method (r) and the agreement between night and 24 h CrCl was determined by the Bland-Altman plot. RESULTS: Urines of 4 individuals were discarded because of collect errors. In the final sample (n = 91; 42 males), hypertension was found in 23 and diabetic in 5. The CrCl (mL/min/1.73 m²) was slightly lower in females in the night (77.8 ± 22.7 versus 88.4 ± 23.6; p < 0.05) and similar in males (91.2 ± 22.9 versus 97.3 ± 30.9; p > 0.05). Strong correlations were observed between the CrCl calculated from the night and day urines and the 24 h (r = 0.85 and 0.83; respectively). Agreement between the CrCl calculated from night or day urine and the 24 h urine was observed, respectively, to 85 and 83 individuals. CONCLUSION: The 12 h urine, mainly obtained at night, gives CrCl values similar to those obtained in the 24 h collect. Since urine collect is easier to outpatients at night, this period should be chosen in the clinical evaluation of the glomerular filtration rate.