Utilidad de los índices aterogénicos del perfil lipídico en el diagnóstico de aterosclerosis subclínica / Utility of the atherogenic indices of the lipid profile in the diagnosis of subclinical atherosclerosis

Introducción: Los índices aterogénicos hacen referencia a un conjunto de indicadores bioquímicos que a partir de la relación entre variables lipídicas permiten predecir el riesgo de daño aterosclerótico. Objetivo: Evaluar la utilidad de los índices aterogénicos en el diagnóstico de aterosclerosis subclínica en pacientes con dislipidemia. Métodos: Se realizó un estudio descriptivo en 812 pacientes con diagnóstico clínico de dislipidemia en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el período 2015-2020. Resultados: La edad media de los pacientes fue de 56,79 ± 10,24 años, predominó el grupo de 60 y más años con un 40,9 por ciento y el sexo femenino para un 73,8 por ciento. El 61,2 por ciento de los pacientes tienen presente algún tipo de obesidad. La presencia de HTA y el consumo de tabaco afectan el 52 por ciento y 24,6 por ciento de la población estudiada. El 74,8 por ciento (607 casos) fue clasificado como riesgo cardiovascular medio según los criterios de Framingham, mientras que el 12,9 por ciento fue clasificado como riesgo alto. Se identificaron 323 (39,8 por ciento) pacientes con presencia de aterosclerosis subclínica. Las diferencias de los valores medios de los índices aterogénicos entre los grupos con presencia de aterosclerosis subclínica fueron estadísticamente significativas para los índices cCtotal/ cHDL y cLDL/cHDL (p<0,05). En el análisis multivariado los índices asociados al riesgo de presentar aterosclerosis subclínica fueron la relación cCtotal/cHDL (R=1,11) y cLDL/cHDL (R=1,12) (p<0,05). Conclusiones: Los índices aterogénicos son de utilidad en el diagnóstico de aterosclerosis subclínica, los cocientes cCtotal/cHDL y cLDL/cHDL son los que están asociados significativamente con la probabilidad de presentar daño aterosclerótico carotideo(AU)

Introduction: Atherogenic indices refer to a set of biochemical indicators that, based on the relationship between lipid variables, allow predicting the risk of atherosclerotic damage. Objective: To evaluate the usefulness of atherogenic indices in the diagnosis of subclinical atherosclerosis in patients with dyslipidemia. Methods: A descriptive study was carried out in 812 patients with clinical diagnosis of dyslipidemia at Hermanos Ameijeiras Surgical Clinical Hospital, from 2015 to 2020. Results: The mean age of the patients was 56.79 ± 10.24 years, the group of 60 and over predominated with 40.9percent and the female sex with 73.8percent. Some type of obesity was present in 61.2percent of the patients. The presence of hypertension and tobacco consumption affect 52percent and 24.6percent of the population studied, respectively. 74.8percent (607 cases) were classified as medium cardiovascular risk according to Framingham criteria, while 12.9percent were classified as high risk. Three hundred twenty three (39.8percent) patients with subclinical atherosclerosis were identified. The differences in the mean values of the atherogenic indices between the groups with subclinical atherosclerosis were statistically significant for the total C/HDLc and LDLc/HDLc indices (p<0.05). In the multivariate analysis, the indices associated with the risk of subclinical atherosclerosis were the ratio of Total C/HDLc (R=1.11) and LDLc/HDLc (R=1.12) (p<0.05). Conclusions: The atherogenic indices are useful in the diagnosis of subclinical atherosclerosis; cCtotal/cHDL and cLDL/cHDL ratios are those that are significantly associated with the probability of carotid atherosclerotic damage(AU)

Prescription of statins according to the ASCVD estimator at Pablo Arturo Suarez Hospital, March 2021 to February 2022 / Prescripción de estatinas según el estimador ASCVD en el Hospital Pablo Arturo Suárez, marzo 2021 a febrero 2022

Worldwide, the leading cause of death is cardiovascular disease. The study details the prescription of statins at the Pablo Arturo Suarez Hospital in Ecuador between March 2021 and February 2022 following the ASCVD risk scale of the American College of Cardiology and the American Heart Association. There are 563 people in this cross-sectional and retrospective study: 70% women, 30% men, 93.30% mestizos, 48.10% diabetics, 62.30% hypertensives, and 18.70% smokers. 26.10% of all patients received statins, with simvastatin being the most common (96.60%). The mean cardiovascular risk in the general population was 15.52 ± 14.51%, 44.99% of subjects had a risk lower than 7.50%, and 29% had a risk higher than 20%, with a statistically significant difference (p<0.001) according to sex. The study determined that 58.60% of the population received a statin or an inadequate dosage.

A nivel mundial, la principal causa de muerte es la enfermedad cardiovascular. El estudio detalla la prescripción de estatinas en el Hospital Pablo Arturo Suárez de Ecuador entre marzo de 2021 y febrero de 2022, siguiendo la escala de riesgo ASCVD del Colegio Americano de Cardiología y la Asociación Americana del Corazón. Son 563 personas en este estudio transversal y retrospectivo: 70% mujeres, 30% hombres, 93.30% mestizos, 48.10% diabéticos, 62.30% hipertensos y 18.70% fumadores. El 26.10% de los pacientes recibía estatinas, siendo la simvastatina la más frecuente (96.60%). El riesgo cardiovascular medio en la población general fue de 15.52 ± 14.51%, el 44.99% de los sujetos tenía un riesgo inferior al 7.50%, y el 29% tenía un riesgo superior al 20%, con una diferencia estadísticamente significativa (p<0.001) según el sexo. El estudio determinó que el 58.60% de la población recibía una estatina o una dosis inadecuada.

Factores contextuales de las señales ateroscleróticas tempranas en adolescentes aparentemente sanos / Contextual factors of early atherosclerotic signals in apparently healthy adolescents

Introducción: La exploración e identificación de los factores contextuales del proceso aterosclerótico desde las edades tempranas presenta vacío de conocimiento en términos de mecanismos y causas. En la atención primaria de salud existen las condiciones requeridas para la identificación de los adolescentes con factores de riesgo aterogénico y en la cual resulta más fácil comprender el contexto de la enfermedad. Objetivo: Determinar la influencia de los factores contextuales sobre la presencia de señales ateroescleróticas tempranas en adolescente aparentemente sanos. Métodos: Estudio descriptivo de corte transversal. Se utilizaron estadísticas descriptivas. Se aplicó análisis de correlaciones canónicas y se elaboraron árboles de decisión. Resultados: Los factores de riesgo aterosclerótico que predominaron para ambos sexos fueron el bajo consumo de frutas y vegetales, la circunferencia de la cintura > 90 p y ser fumador pasivo. En el sexo femenino se destaca el sedentarismo. En ambos sexos predominaron los adolescentes con dos o tres señales (masculino 77 [48,4 por ciento] y femenino 71 [48,0 por ciento]). El conjunto de factores contextuales explica hasta el 33 por ciento de la variabilidad en las señales ateroscleróticas tempranas. El árbol de clasificación mostró una mayor frecuencia de adolescentes con señales ateroescleróticas tempranas para la percepción de la situación económica regular o mala y para el nivel educacional mayor de secundaria básica. Conclusiones: Los factores contextuales influyen en la presencia de señales ateroscleróticas tempranas en adolescentes aparentemente sanos, pero explican parcialmente sus variabilidades(AU)

Introduction: The exploration and identification of the contextual factors of the atherosclerotic process from an early age present a knowledge gap in terms of mechanisms and causes. In primary health care, there are the conditions required for the identification of adolescents with atherogenic risk factors and in which it is easier to understand the context of the disease. Objective: Determine the influence of contextual factors on the presence of early atherosclerotic signals in apparently healthy adolescents. Methods: Descriptive cross-sectional study. Descriptive statistics were used. Analysis of canonical correlations was applied and decision trees were elaborated. Results: The atherosclerotic risk factors that predominated for both sexes were low consumption of fruits and vegetables, waist circumference > 90 p and being a passive smoker. In the female sex, a sedentary lifestyle stands out. In both sexes, adolescents with two or three signs predominated (male 77 [48.4percent] and female 71 [48.0percent]). The set of contextual factors explains up to 33percent of the variability in early atherosclerotic signals. The classification tree showed a higher frequency of adolescents with early atherosclerotic signals for the perception of the regular or bad economic situation and for the higher educational level of basic secondary school. Conclusions: Contextual factors influence the presence of early atherosclerotic signals in apparently healthy adolescents, but partially explain their variabilities(AU)

Metabolitos bioactivos generados por la disbiosis intestinal y sus implicaciones fisiopatológicas en la enfermedad cardiovascular / Bioactive metabolites generated by intestinal dysbiosis and their pathophysiological implications in cardiovascular disease

Introducción: La disbiosis conocida como la alteración de la relación simbiótica entre la microbiota intestinal y el huésped están implicados en la patogenia de la enfermedad cardiovascular aterosclerótica. Objetivo: Realizar una revisión documental sobre los mecanismos fisiopatológicos que relacionan los metabolitos bioactivos generados por la disbiosis intestinal con el desarrollo y progresión de la enfermedad cardiovascular aterosclerótica. Métodos: Se utilizó el motor de búsqueda Google Académico y se consultaron artículos de libre acceso en las bases de datos Pubmed, SciELO, Lilacs, Cumed y Hinari desde septiembre 2020 hasta el mes de marzo 2021. Las palabras clave utilizadas para esta revisión fueron:microbioma, microbiota intestinal, disbiosis, aterosclerosis, enfermedad cardiovascular y sus equivalentes en inglés, según el descriptor de Ciencias de la Salud (DeCS). Se consideraron artículos originales, de revisión, revisiones sistemáticas y metaanálisis posteriores al año 2015. Se revisaron un total de 73 artículos. Desarrollo: Las relaciones fisiopatológicas entre la disbiosis intestinal y las enfermedades cardiovasculares son complejas, ya que se influyen mutuamente a través de los sus toxinas endógenas (metabolitos bioactivos), el sistema circulatorio, las respuestas inmunitarias y los cambios metabólicos. Las investigaciones futuras deberían centrarse en dilucidar los actores moleculares subyacentes e identificar si las vías que interconectan la disbiosis intestinal con la ECA son causales, correlacionales o consecuentes. Conclusiones: La evidencia acumulada sostiene que la disbiosis de la microbiota intestinal está involucrada en la síntesis de metabolitos proaterogénicos los cuales modulan los mecanismos implicados en la fisiopatología de la ECA(AU)

Introduction: Dysbiosis is known as the alteration of the symbiotic relationship between the intestinal microbiota and the host is involved in the pathogenesis of atherosclerotic cardiovascular disease. Objective: To carry out a documentary review on the pathophysiological mechanisms that relate the bioactive metabolites generated by intestinal dysbiosis with the development and progression of atherosclerotic cardiovascular disease. Methods: The Google Scholar search engine was used and free access articles were consulted in Pubmed, SciELO, Lilacs, Cumed and Hinari databases from September 2020 to March 2021. The keywords used for this review were microbiome, gut microbiota, dysbiosis, atherosclerosis, cardiovascular disease and their English equivalents, according to the Health Sciences (DeCS) descriptor. Original articles, review articles, systematic reviews and meta-analyses after 2015 were considered. A total of 73 articles were reviewed. Findings: The pathophysiological relationships between intestinal dysbiosis and cardiovascular diseases are complex, since they influence each other through their endogenous toxins (bioactive metabolites), the circulatory system, immune responses and metabolic changes. Future research should focus on elucidating the underlying molecular players and on identifying whether the pathways that interconnect gut dysbiosis with ACE are causal, correlational, or consequential. Conclusions: The accumulated evidence supports that the dysbiosis of the intestinal microbiota is involved in the synthesis of proatherogenic metabolites which modulate the mechanisms involved in the pathophysiology of ACE(AU)

Atherosclerosis Complications in the Brazilian Population: An Ecological Time Series Study

Abstract Background: Atherosclerosis is a serious health problem, and several factors contribute to its occurrence. Longitudinal and qualified monitoring of primary health care (PHC) may contribute to the management of atherosclerosis and reduction of avoidable hospital admissions. Objectives: To estimate the trend in hospitalizations for atherosclerosis and the impact of PHC coverage on its evolution from 2008 to 2018 in Brazil. Methods: An ecological time series analytical study based on the outcomes of hospital admissions for atherosclerosis in Brazil. Time in years, PHC coverage, and Family Health Strategy (FHS) services were considered independent variables. A Prais-Winsten model was used to estimate the outcome trend, and α < 0.05 was adopted. Results: We observed a mean increase of 1.81 hospitalizations for atherosclerosis per 100 000 inhabitants annually (p = 0.002) in Brazil. This growth was evidenced in the Northeast (p < 0.001), Southeast (p = 0.003), and South (p < 0.001) regions, being stable in the North (p = 0.057) and Midwest (p = 0.62) regions. Men presented twice the growth in hospitalizations from the fifth decade of life on (p < 0.01). An inversely proportional relationship was observed for PHC coverage (B = -0.71; p < 0.001) and the proportion of FHS services (B = -0.59; p < 0.001) with the rate of admissions due to atherosclerosis in Brazil. Conclusions: Although hospitalizations for atherosclerotic complications are increasing in Brazil, they present regional and individual gender and age discrepancies, as well as a mitigating effect exerted by PHC coverage.

Factores contextuales, familia y factores de riesgo y enfermedades consecuentes de la aterosclerosis / Contextual, family factors and risk factors and consequential diseases of atherosclerosis

Introducción: Se realizó una compilación de investigaciones que abordan el tema de la influencia de los factores contextuales en familias con factores de riesgo y enfermedades consecuentes de la aterosclerosis. Objetivo: Mostrar la influencia de los factores contextuales en familias con factores de riesgo y enfermedades consecuentes de la aterosclerosis. Métodos: Se analizaron algunas investigaciones realizadas en el periodo 2012-2018, se seleccionaron cuatro artículos y cuatro tesis. Se analizó la arterosclerosis con un enfoque social en donde el objeto de investigación fueron la familia y el contexto en que ella vive y se desarrolla, se estimó la contribución relativa de dichos espacios sobre la salud individual y familiar. Resultados: Se identificaron y caracterizaron subpoblaciones con niveles más altos de concentración de la carga de morbilidad y con perfiles de riesgo propio. El contexto influye sobre la salud individual. El patrón de asociaciones entre ciertos factores individuales y las enfermedades consecuentes de la aterosclerosis cambia de un policlínico a otro. El análisis de la correlación canónica entre las variables contextuales y los factores de riesgo permite explicar la variabilidad en los factores de riesgos y enfermedades consecuentes. Conclusiones: El análisis contextual de la situación de salud permitirá continuar el perfeccionamiento de las soluciones diseñadas para enfrentar los problemas de salud, eliminado o disminuyendo las causas que le dieron origen, desde sus raíces, con mayores posibilidades de influir, tanto en el individuo como en la familia y la comunidad, con acciones adecuadas para cada contexto(AU)

Introduction: A compilation of researches was carried out that addresses the issue of the influence of contextual factors in families with risk factors and diseases consequential to atherosclerosis. Objective: Show the influence of contextual factors in families with risk factors and diseases consequential to atherosclerosis. Methods: Some researches carried out in the period 2012-2018 were analyzed; four articles and four theses were selected. Atherosclerosis was analyzed with a social approach where the object of research was the family and the context in which it lives and develops. The relative contribution of these spaces on individual and family health was estimated. Results: Sub-populations with higher levels of concentration of the disease burden and with their own risk profiles were identified and characterized. Context influences individual health. The pattern of associations between certain individual factors and the consequential diseases of atherosclerosis changes from one polyclinic to another. The analysis of the canonical correlation between contextual variables and risk factors allows to explain the variability in risk factors and consequential diseases. Conclusions: The contextual analysis of the health situation will allow to continue the improvement of the solutions designed to face the health problems, eliminating or reducing the causes that gave rise to it, from its roots, with greater possibilities of influencing, both in the individual and in the family and the community, with appropriate actions for each context(AU)

Agrupamentos de fatores de risco cardiometabólicos e sua associação com aterosclerose e inflamação crônica em adultos e idosos em florianópolis, Sul do Brasil / Clusters of cardiometabolic risk factors and their association with atherosclerosis and chronic inflammation among adults and elderly in florianópolis, Southern Brazil

Resumo Fundamento O aumento significativo de doenças cardiovasculares em países em desenvolvimento alerta sobre seu impacto em populações carentes. Objetivo Identificar a relação de agrupamentos de componentes da síndrome metabólica (SM) com aterosclerose e inflamação crônica em adultos e idosos. Métodos Análise transversal usando dados de dois estudos populacionais de tipo coorte realizados em Florianópolis, sul do Brasil (EpiFloripa Adult Cohort Study, n = 862, 39,9±11,5 anos; EpiFloripa Aging Cohort Study, n = 1197, 69,7±7,1 anos). Pressão arterial (PA), circunferência da cintura (CC), e níveis plasmáticos de lipídio e glicose foram analisados como fatores individuais ou como agrupamentos de componentes da SM (como número de componentes presentes em um indivíduo ou como combinações). Os desfechos incluíram espessura intima-media carotídea (EIMC), placas ateroscleróticas, e níveis de proteína C reativa (CRP). Regressão linear múltipla e regressão logística, ajustadas quanto aos fatores de confusão, foram usadas para análise. O nível de significância adotado foi de 5%. Resultados Indivíduos com PA e CC elevadas, dislipidemia e hiperglicemia (61,5%) apresentaram maiores valores de EIMC e PCR que aqueles que não apresentaram componentes de SM. CC elevada foi um determinante comum de inflamação sistêmica, ao passo que a coexistência de PA elevada e CC elevada (agrupamentos de dois ou três fatores) associou-se com maior EIMC (β entre +3,2 e +6,1 x 10-2 mm; p < 0,05) e PCR (EXPβ entre 2,18 e 2,77; p < 0,05). Conclusão A coexistência de PA e CC elevadas associou-se com maiores valores de EIMC e níveis de PCR. A obesidade central, isolada ou em combinação com outros fatores de risco, teve efeito sobre a inflamação sistêmica.

Abstract Background The significant increase in cardiovascular diseases in developing countries alerts about their impact on underprivileged populations. Objective To identify the relationship of clusters of metabolic syndrome (MS) components with atherosclerosis and chronic inflammation among adults and elderly. Methods Cross-sectional analysis using data from two population-based cohort studies in Florianópolis, Southern Brazil (EpiFloripa Adult Cohort Study, n = 862, 39.9±11.5 years; EpiFloripa Aging Cohort Study, n = 1197, 69.7±7.1 years). Blood pressure (BP), waist circumference (WC), and lipid and glucose levels were analyzed as individual factors or as clusters (either as the number of components present in an individual or as combinations of components). Outcomes included carotid intima-media thickness (IMT), atherosclerotic plaques, and C-reactive protein (CRP) levels. Multiple linear and logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results Individuals with high BP, elevated WC, dyslipidemia and hyperglycemia (6.1% of the sample) showed higher IMT and CRP than those negatives for all MetS components. Elevated WC was a common determinant of systemic inflammation, while the coexistence of high BP and elevated WC (clusters of two or three factors) was associated with higher IMT (β between +3.2 and +6.1 x 10-2 mm; p value < 0.05) and CRP (EXPβ between 2.18 and 2.77; p value < 0.05). Conclusion The coexistence of high BP and elevated WC was associated with increased IMT and CRP levels, but central obesity affected systemic inflammation either alone or in combination with other risk factors.

Association between height-related polymorphism rs17081935 and reduced handgrip strength in relation to status of atherosclerosis: a cross-sectional study

BACKGROUND@#Aging is a process that increases oxidative stress. Increased oxidative stress leads to the development of atherosclerosis and mitochondrial dysfunction. Mitochondria contribute to energy production that might have a beneficial influence on maintaining muscle strength. Therefore, the height-related single nucleotide polymorphism (SNP) rs17081935, which is also reported to be associated with mitochondrial metabolism, might be associated with reduced muscle strength and this association might be affected by atherosclerosis status. To clarify those associations, a cross-sectional study of 1374 elderly Japanese individuals aged 60-89 years was conducted.@*METHODS@#Logistic regression was used to clarify the association between rs17081935 and reduced handgrip strength. Since atherosclerosis might affect handgrip strength, participants were stratified by atherosclerosis status. Reduced handgrip strength was defined as being in the lowest quintile of handgrip strength (< 25.6 kg for men and < 16.1 kg for women).@*RESULTS@#No significant associations were found between a minor allele of rs17081935 and reduced handgrip strength among elderly participants without atherosclerosis. A significant inverse association was observed among elderly participants with atherosclerosis. After adjusting for known cardiovascular risk factors and height, the adjusted odd ratio (OR) and 95% confidence interval (CI) for reduced handgrip strength and a minor allele of rs17081935 were 1.13 (0.86, 1.43) for elderly participants without atherosclerosis and 0.55 (0.36, 0.86) for those with atherosclerosis, respectively.@*CONCLUSION@#A minor allele of the height-related SNP rs17081935 was significantly inversely associated with reduced handgrip strength among older individuals with atherosclerosis, but not among those without atherosclerosis.

Señales ateroscleróticas tempranas en adolescentes entre 10 y 19 años aparentemente sanos / Early Atherosclerotic Signs in Apparently Healthy Adolescents Aged 10-19 Years

Introducción: La aterosclerosis es un proceso gradual que va progresando desde la primera o segunda década de la vida hasta la aparición de manifestaciones clínicas en décadas posteriores. Las investigaciones dirigidas a la identificación de los factores de riesgo aterogénico en niños y adolescentes demuestran que los hechos precursores de las enfermedades consecuentes de la aterosclerosis en el adulto se establecen desde edades tempranas de la vida. Objetivo: Identificar la presencia de señales ateroscleróticas tempranas en adolescentes entre 10 y 19 años aparentemente sanos. Método: Se realizó un estudio de corte transversal entre los meses de octubre de 2016 a junio de 2017 en tres Consultorios del Médico y la Enfermera de la Familia, pertenecientes a los Policlínicos Raúl Gómez García, Turcios Lima y Louis Pasteur. Se estudiaron 307 adolescentes. Resultados: Los factores de riesgo aterosclerótico que más predominaron fueron el bajo consumo de frutas: en el sexo masculino 53,5 por ciento y en el femenino 59,5 por ciento; el bajo consumo de vegetales: en el sexo masculino 47,8 por cfiento y en el femenino 52,02 por ciento y ser fumador pasivo: en el sexo masculino 51,6 por ciento y en el femenino 56,08 por ciento. En el sexo femenino se destacó también el sedentarismo. En ambos sexos predominaron los adolescentes con dos o tres señales ateroscleróticas tempranas: en el sexo masculino 77 para 48,4 por ciento y para el femenino 71 para 47,9 por ciento. Conclusiones: Predominaron adolescentes con dos o tres señales ateroscleróticas tempranas(AU)

Introduction: Atherosclerosis is a gradual process that progresses from the first or second decade of life until the onset of clinical manifestations in further decades. Research aimed at identifying atherogenic risk factors in children and adolescents shows that the events previous to consequent diseases in atherosclerosis in adults are established from an early age of life. Objective: To identify the presence of early atherosclerotic signs in apparently healthy adolescents between 10 and 19 years of age. Method: A cross-sectional study was carried out between the months of October 2016 and June 2017 in three family medicine offices belonging to Raúl Gómez García, Turcios Lima, and Louis Pasteur Polyclinics. 307 adolescents were studied. Results: The most prevalent atherosclerotic risk factors were low fruit consumption (53.5 percent in males, 59.5 percent in females), low vegetable consumption (47.8 percent in males, 52.02 percent in females), and being a passive smoker (51.6 percent in males, 56.08 percent in females). A sedentary lifestyle was also highlighted in the female sex. Adolescents with two or three early atherosclerotic signs predominated in both sexes (77 males, accounting for 48.4 percent, and 71 females, accounting for 47.9 percent). Conclusions: There was a predominance of adolescents with two or three early atherosclerotic signs(AU)

Comparación de puntajes de riesgo para predecir aterosclerosis subclínica / Comparison of risk scores to predict subclinical atherosclerosis

La aterosclerosis subclínica es un potente predictor de eventos cardiovasculares, aunque se desconoce cuál de los puntajes de riesgo es más eficaz para predecir su presencia en una población latinoamericana. El objetivo fué comparar la performance de los puntajes de riesgo: Framingham, Regicor y Atherosclerotic Cardiovascular Disease Risk Estimator para predecir la existencia de aterosclerosis subclínica en pacientes asintomáticos sin enfermedad cardiovascular conocida; así como determinar la prevalencia y distribución en los distintos lechos vasculares. Desde 2014 a 2017 se evaluaron pacientes de 35 a 75 años asintomáticos y sin enfermedad cardiovascular conocida, a quienes se les realizó una eco Doppler carotídea y femoral, y score de calcio. Se definió como aterosclerosis subclínica a la presencia de placas en las arterias carótidas y/o femorales o a la presencia de calcio en las coronarias (score de Agatston > 0). Se estudiaron así 212 pacientes, edad media 53 ± 7 años, de los cuales el 60% (128) eran varones. La prevalencia de aterosclerosis subclínica fue 62% (131 casos). De esos 131 con placa en alguno de los territorios, el Atherosclerotic Cardiovascular Disease Risk Estimator fue el que identificó el mayor número de casos con riesgo cardiovascular elevado (39%), Framingham detectó 20%, y Regicor 0% (p < 0.01). La reclasificación neta fue del 41%, 50% y 60% respectivamente (< 0.01). La prevalencia de aterosclerosis subclínica en sujetos asintomáticos sin antecedentes de enfermedad cardiovascular fue 62%. El calculador Atherosclerotic Cardiovascular Disease Risk Estimator fue el más efectivo para predecir aterosclerosis subclínica en esta población.

Subclinical atherosclerosis is a powerful predictor of cardiovascular events, although it is unknown which of the risk scores is more useful to predict its presence in a Latin American population. The objective was to compare the performance of the risk scores: Framingham, Regicor and Atherosclerotic Cardiovascular Disease Risk Estimator to predict the presence of subclinical atherosclerosis in asymptomatic persons without known cardiovascular disease; as well as determining its prevalence and distribution in the different vascular beds. From 2014 to 2017, patients from 35 to 75 years, asymptomatic and without known cardiovascular disease who underwent a carotid and femoral Doppler echo and calcium score were evaluated. Subclinical atherosclerosis was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score > 0). A total of 212 patients were included. The mean age was 53 ± 7 years, of which 60% (128) were male. The prevalence of subclinical atherosclerosis was 62% (131 cases). Of these 131 subjects with a plaque in any of the territories, the Atherosclerotic Cardiovascular Disease Risk Estimator was the one that identified the highest number of cases with high cardiovascular risk (39%), Framingham detected 20%, and Regicor 0% (p < 0.01). The net reclassification was 41%, 50% and 60% respectively (< 0.01). The prevalence of subclinical atherosclerosis in asymptomatic persons without a history of cardiovascular disease was 62%. The Atherosclerotic Cardiovascular Disease Risk Estimator was the most effective predictor of subclinical atherosclerosis in this population.

High prevalence of obesity in rheumatoid arthritis patients: association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study

Abstract Introduction: Rheumatoid arthritis (RA) is a well-documented independent risk factor for cardiovascular disease. Obesity may provide an additional link between inflammation and accelerated atherosclerosis in RA. Objective: To evaluate the association between obesity and disease parameters and cardiovascular risk factors in RA patients. Method: Cross-sectional study of a cohort of RA patients from three Brazilian teaching hospitals. Information on demographics, clinical parameters and the presence of cardiovascular risk factors was collected. Blood pressure, weight, height and waist circumference (WC) were measured during the first consultation. Laboratory data were retrieved from medical records. Obesity was defined according to the NCEP/ATPIII and IDF guidelines. The prevalence of obesity was determined cross-sectionally. Disease activity was evaluated using the DAS28 system (remission < 2.6; low 2.6—3.1; moderate 3.2-5.0; high >5.1). Results: The sample consisted of 791 RA patients aged 54.7 ± 12.0 years, of whom 86.9% were women and 59.9% were Caucasian. The mean disease duration was 12.8 ± 8.9 years. Three quarters were rheumatoid factor-positive, the mean body mass index (BMI) was 27.1 ±4.9, and the mean WC was 93.5 ± 12.5 cm. The observed risk factors included dyslipidemia (34.3%), type-2 diabetes (15%), hypertension (49.2%) and family history of premature cardiovascular disease (16.5%). BMI-defined obesity was highly prevalent (26.9%) and associated with age, hypertension and dyslipidemia. Increased WC was associated with diabetes, hypertension, dyslipidemia and disease activity. Conclusion: Obesity was highly prevalent in RA patients and associated with disease activity.

Análise do perfil de morbimortalidade de aterosclerose no Estado de Minas Gerais comparado à Região Sudeste / A Comparative analysis of atherosclerosis-related morbidity and mortality profile in the state of Minas Gerais state and the Southeast Region

OBJETIVO: Analisar o perfil de morbimortalidade de aterosclerose em Minas Gerais em comparação ao da Região Sudeste. METODOLOGIA: Estudo epidemiológico descritivo, por meio da análise de dados do Departamento de Informática do Sistema Único de Saúde, com as variáveis número de internações, aterosclerose CID 10 (I70), faixa etária, taxa de mortalidade, sexo e etnia no período de janeiro de 2008 e janeiro de 2017. RESULTADOS: A Região Sudeste apresentou 63.713 internações por aterosclerose, sendo 22,9% de Minas Gerais. A faixa etária mais atingida do Estado foi de 60 a 69 anos (4.039 casos). O sexo masculino foi o mais acometido na Região Sudeste (55%) e em Minas Gerais (55%); já a taxa de mortalidade em ambos os casos foi maior na população feminina (Região Sudeste: 4,82; Minas Gerais: 4,31). Quanto à etnia do Estado, pardos (34,79%), brancos (26,65%) e negros (5,71%) representaram a maioria, enquanto, na Região Sudeste, brancos representaram 45,05%, pardos 24,31% e negros 5,96%. A taxa de mortalidade no Estado foi superior para negros (5,51), enquanto no Sudeste foi para brancos (4,16). A taxa de mortalidade média da Região Sudeste foi de 4,41, enquanto em Minas Gerais foi de 3,95, − a menor dentre os Estados da região. CONCLUSÃO: Embora Minas Gerais apresente a melhor taxa de mortalidade da região, faz-se necessário reduzi-la na população indígena e amarela. Já que Minas Gerais ocupa a segunda posição da região em número de internações, urge maior abrangência nas campanhas de prevenção e conscientização. (AU)

OBJECTIVE: To analyze the morbidity and mortality profile of atherosclerosis in the state of Minas Gerais in comparison to the Southeast region. METODOLOGY: This is a descriptive epidemiological study performed with analysis of data from the Department of Informatics of the Unified Health System, with the following variables: number of hospitalizations, atherosclerosis ICD 10 (I70), age group, mortality rate, gender, and ethnicity from January 2007 to January 2018. RESULTS: The Southeast region had a total of 63,713 hospitalizations for atherosclerosis, of which 22.9% were from Minas Gerais. The most affected age group in the state was of 60-69 years (4,039 cases). The male gender was the most affected in the Southeast region (55%) and in the State of Minas Gerais (55%), while the mortality rate in both cases was higher in the female population (Southeast region - 4.82, Minas Gerais - 4.31). As for the ethnicity of the state, brown (34.79%), white (26.65%), and black (5.71%) people represented the majority, while in the Southeast whites represented 45.05%; brown, 24.31%; and black, 5.96%. The mortality rate in the state was higher for black (5.51) people, while in the Southeast for white people (4.16). The Southeast mortality rate was 4.41, while in Minas Gerais it was 3.95, the lowest among the states in the region. CONCLUSION: Although Minas Gerais has the best mortality rate in the region, it is necessary to reduce it in the indigenous and yellow population. In addition, since Minas Gerais ranks second in the region in terms of the number of hospitalizations, it is more urgent to reach out to prevention and awareness campaigns. (AU)

Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients / Frequência de Aterosclerose Subclínica em Brasileiros Infectados pelo HIV

Abstract Background: AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. Objectives: To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Methods: Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p < 0.05. Results: Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001). Furthermore, carotid intima-media thickness was higher in the HIV group than in controls (p < 0.001). Patients with carotid plaque had higher fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those without plaques. The presence of HIV, adjusted for age, overweight/obesity, and smoking increased by almost fivefold the risk of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001). Exposure to protease inhibitors did not influence carotid intima-media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). Conclusions: HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.

Resumo Fundamento: Aterosclerose e AIDS são importantes problemas de saúde pública. A maior sobrevida de indivíduos infectados pelo HIV acha-se associada com maior número de eventos cardiovasculares nessa população, mas tal associação ainda não foi completamente esclarecida. Objetivos: Identificar a frequência de aterosclerose subclínica em pacientes infectados pelo HIV em comparação a controles; analisar as associações entre aterosclerose e variáveis clínicas e laboratoriais, fatores de risco cardiovascular e escore de risco de Framingham (ERF) para doença coronariana. Métodos: Estudo prospectivo transversal caso-controle avaliando a presença de aterosclerose subclínica em 264 pacientes infectados pelo HIV e 279 controles. A avaliação clínica incluiu ultrassonografia das artérias carótidas, análise da rigidez arterial através da velocidade de onda de pulso (VOP) e augmentation index (AIx), exames laboratoriais do sangue periférico e determinação do risco cardiovascular segundo os critérios do ERF. O nível de significância adotado na análise estatística foi p < 0,05. Resultados: Placas foram identificadas em 37% do grupo infectado pelo HIV e em 4% dos controles (p < 0,001). A espessura médio-intimal carotídea foi maior no grupo HIV do que nos controles (p < 0,001). Pacientes com placa carotídea apresentaram maiores níveis de glicemia de jejum, colesterol total, colesterol da lipoproteína de baixa densidade e triglicérides do que aqueles sem placas. A presença do HIV, ajustada por idade, sobrepeso/obesidade e tabagismo aumentou em quase cinco vezes o risco de placa aterosclerótica carotídea (OR: 4,9; IC95%: 2,5-9,9; p < 0,001). Exposição aos inibidores da protease não influenciou a espessura médio-intimal carotídea, não se associou com frequência de placa carotídea e não alterou as características mecânicas do sistema arterial (VOP e AIx). Conclusões: Pacientes infectados pelo HIV apresentam maior risco de aterosclerose na associação com os clássicos fatores de risco cardiovascular. Tratamento com os inibidores da protease não promove alterações funcionais nas artérias, nem se associa com maior frequência de placas ateroscleróticas carotídeas. O ERF pode ser inadequado para essa população.

Doenças cardiometabólicas / Cardiometabolic diseases

RESUMO: Introdução: Doenças cardiometabólicas são prevalentes nas populações, estando entre as principais causas de morte. Objetivos: Este subestudo do Saúde, Bem-Estar e Envelhecimento (Sabe) descreve as prevalências autorreferidas de hipertensão, diabete mellitus (DM) e doença cardiovascular aterosclerótica (DCV) nas suas três ondas (2000, 2006 e 2010) e analisa a associação com fatores de risco selecionados. Métodos: Empregou-se regressão logística. Resultados: O predomínio de mulheres e a idade (68 anos) foram mantidos nas três ondas. No período, verificou-se tendência geral de aumento nas prevalências de hipertensão (53,1 a 66,7%), DM (16,7 a 25%) e DCV (23,0 a 27,2%) - estabilização da prevalência de DCV apenas de 2006 a 2010. Indivíduos do sexo feminino, com índice de massa corporal (IMC) > 27 kg/m2 e ex-fumantes tenderam consistentemente à maior probabilidade de hipertensão autorreferida ao longo das ondas. Apresentar IMC > 27 kg/m2 associou-se à maior probabilidade de referir DM nas três ondas, enquanto com ex-fumantes isso aconteceu apenas em 2010. Ter sido fumante também se associou à DCV nas ondas, mas não o excesso de peso. Averiguando-se pares de ondas para testar alterações nas prevalências, viu-se que em geral houve elevação significativa nos percentuais das doenças com o tempo. Conclusão: Em suma, DM, hipertensão e DCV autorreferidos ocorreram com elevadas prevalências nos participantes do Sabe em São Paulo. A associação de IMC elevado com doenças cardiometabólicas sugere que adiposidade corporal pode favorecê-las, embora esta análise não permita assegurar relação causa × efeito. É possível que o aumento dos percentuais de doentes da primeira para a terceira onda reflita melhora nas condições de diagnóstico e/ou no controle dessas doenças no período.

ABSTRACT: Introduction: Cardiometabolic diseases are prevalent in populations and are among the leading causes of death. Objective: This sub-study of the Health, Well-being and Aging (SABE) study describes the self-reported prevalence of diabetes mellitus (DM), hypertension, and atherosclerotic cardiovascular disease (CVD) for its three waves (2000, 2006, and 2010). It also analyses the associations with selected risk factors. Methods: Logistic regression models were performed. Results: Predominance of women and average age (68 years) were maintained in all the waves. During the period, there was a general tendency of increasing prevalence of hypertension (53.1 to 66.7%), DM (16.7 to 25.0%), and CVD (23.0 to 27.2%); and stabilization of the CVD prevalence rate occurred only from 2006 to 2010. Women, with body mass index (BMI) > 27 kg/m2, and ex-smokers had consistently higher risk of self-reported hypertension across the three waves. BMI >27kg/m2 was also associated with a higher probability of DM in the three waves, whereas with ex-smokers this occurred only in 2010. Ex-smokers presented higher risk of CVD in all the waves, but not excess weight. Wave pairs were analyzed to test changes in prevalence, and it was found a significant increase in diseases rates across the years. Conclusion: In summary, self-reported DM, hypertension, and CVD had high prevalence rates for participants of SABE Study, in São Paulo. The association of elevated BMI with cardiometabolic diseases suggests that body adiposity might favor their occurrence, although the study design does not guarantee a cause and effect relationship. Increased rates of affected individuals from the first to the third wave may reflect improvement in diagnostic conditions and/or control of these diseases' mortality during that period.

Aterosclerosis subclínica y disminución de la densidad mineral ósea en mujeres de edad mediana / Subclinical atherosclerosis and decreasing in bone´s mineral density in middle-aged women

Introducción: la aterosclerosis y la osteoporosis son enfermedades con una alta incidencia. Diversos estudios epidemiológicos han mostrado una asociación entre ambos procesos. Objetivo: describir la posible asociación entre la aterosclerosis subclínica y la disminución de la densidad mineral ósea, así como la relación de estos procesos con variables de la esfera reproductiva en mujeres de edad mediana. Métodos: se realizó un estudio descriptivo transversal con 103 mujeres que asistieron a la consulta de climaterio y osteoporosis del Instituto Nacional de Endocrinología. La aterosclerosis subclínica se diagnosticó a través del ultrasonido doppler carotídeo, y la densidad mineral ósea mediante la absorciometría dual de rayos x en columna lumbar. El test chi cuadrado de independencia, el coeficiente de correlación lineal de Pearson, la prueba t de comparación de medias y Anova, permitieron realizar el análisis estadístico. Resultados: la aterosclerosis subclínica se diagnosticó en 28 de las mujeres de edad mediana (27 por ciento), y 48 pacientes (46,6 por ciento) presentaron densidad mineral ósea disminuida (osteopenia u osteoporosis). El 57,1 por ciento de las pacientes con aterosclerosis subclínica tuvieron una densidad mineral ósea disminuida. El 70,4 por ciento de las pacientes con aterosclerosis subclínica estaban en posmenopausia; el 66,7 por ciento de las que tenían osteopenia, y el 75 por ciento de las que presentaron osteoporosis, pertenecían a la etapa posmenopáusica. Conclusiones: las mujeres de edad mediana con aterosclerosis subclínica tienen mayor frecuencia de osteopenia u osteoporosis. En aquellas con aterosclerosis subclínica y densidad mineral ósea disminuida predomina la posmenopausia. El tipo de menopausia y el tiempo de vida reproductiva no se relacionan con la aterosclerosis subclínica y la disminución de la densidad mineral ósea. Se evidencia una asociación inversa entre tiempo de posmenopausia y densidad mineral ósea(AU)

Introduction: atherosclerosis and osteoporosis are diseases with a high incidence. Several epidemiological studies have shown a relation among both processes. Objective: to describe the possible relation among subclinical atherosclerosis and the decrease of bone´s mineral density, as well as the relations of these processes with reproductive variables in middle-aged women. Methods: a cross-sectional descriptive study was conducted with 103 women who attended to the Climacteric and Osteoporosis Consultation in the National Institute of Endocrinology. Subclinical atherosclerosis was diagnosed through carotid doppler ultrasound, and bone´s mineral density by performing a dual x-ray absorptiometry in the lumbar spine. The chi square test of independence, the Pearson linear correlation coefficient, the t test for comparison of averages and Anova allowed the performance of the statistical analysis. Results: subclinical atherosclerosis was diagnosed in 28 of the middle-aged women in the study (27 percent), and 48 of them (46.6 percent) had decreased bone´s mineral density (osteopenia or osteoporosis). 57.1 percent of the patients with subclinical atherosclerosis had a decreased bone´s mineral density. 70.4 percent of the patients with subclinical atherosclerosis were in the postmenopause stage; 66.7 percent of those with osteopenia, and 75 percent of those with osteoporosis were in the postmenopausal stage. Conclusions: middle-aged women with subclinical atherosclerosis have more incidence of osteopenia or osteoporosis. In those with subclinical atherosclerosis and low bone´s mineral density, postmenopause is predominant. The type of menopause and the reproductive lifetime are not related to subclinical atherosclerosis and low bone´s mineral density. An inverse association among the postmenopausal time and bone´s mineral density is evidenced(AU)

Factores de riesgo ateroscleróticos en pacientes con artritis reumatoide / Atherosclerotic risk factors in patients with rheumatoid arthritis

Introducción: la artritis reumatoide es una enfermedad inflamatoria crónica y progresiva caracterizada por la inflamación de articulaciones sinoviales y manifestaciones sistémicas. Objetivo: describir las características de algunos factores de riesgo de ateroesclerosis en pacientes con artritis reumatoide. Métodos: se realizó un estudio descriptivo, de corte transversal, en 112 pacientes con diagnóstico de artritis reumatoide. Para el diagnóstico positivo se tuvieron en cuenta los criterios del American College of Rheumatology. Se aplicó un cuestionario creado para la investigación y se realizaron exámenes complementarios y determinación de medidas antropométricas para explorar la presencia de factores de riesgo de ateroesclerosis. Resultados: promedio de edad de 56,3 años, con predominio del grupo menor de 49 años, sexo femenino (81,3 por ciento); el 76,3 por ciento de los pacientes presentaron factores de riesgo aterosclerótico con predominio para el hábito de fumar (41,1 por ciento), hipertensión arterial (24,1 por ciento) y elevación del índice de masa corporal (18,8 por ciento). Conclusiones: existe alta incidencia de factores de riesgo aterosclerótico en los pacientes con artritis reumatoidea, siendo los de mayor incidencia, el hábito de fumar, la hipertensión arterial y la elevación del índice de masa corporal; el metotrexato y los esteroides, son los medicamentos que más se utilizan en el control de la artritis reumatoidea y al parecer, en las dosis usualmente utilizadas, tienen un papel protector sobre el endotelio vascular(AU)

Introduction: Rheumatoid arthritis is a chronic and progressive inflammatory disease characterized by inflammation of synovial joints and systemic manifestations. Objective: To describe some risk factors for atherosclerosis in patients with rheumatoid arthritis. Methods: A descriptive, cross-sectional study was performed in 112 patients diagnosed with rheumatoid arthritis. For the positive diagnosis the criteria of the American College of Rheumatology were taken into account. A questionnaire created for the investigation was applied and laboratory examinations and determination of anthropometric measurements were carried out to determine the presence of risk factors for atherosclerosis. Results: Mean age of 56.3 years, with predominance of age group under 49 years, female (81.3 percent); 76.3 percent of the patients had atherosclerotic risk factors with a predominance of smoking (41.1 percent), hypertension (24.1 percent) and body mass index (18.8 percent). Conclusions: There is a high incidence of atherosclerotic risk factors in rheumatoid arthritis patients, with the highest incidence of smoking, hypertension and elevation of body mass index; methotrexate and steroids are the drugs most commonly used in the control of rheumatoid arthritis and it seems that in doses usually used, they play a protective role on the vascular endothelium(AU)

Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica: posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria / Adherence to pharmacologic treatment in secondary prevention of cardiovascular disease

This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.