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3.
Rev. Asoc. Méd. Argent ; 133(1): 4-11, mar. 2020. graf
Article in Spanish | LILACS (Americas) | ID: biblio-1097695

ABSTRACT

Desde hace varias décadas se conocen los clásicos factores de riesgo cardiovascular (género, edad, hipertensión arterial, dislipidemias, tabaquismo, obesidad, sedentarismo). También existen factores de riesgo "no convencionales", es decir situaciones no descriptas ni contenidas en la mayoría de los puntajes de riesgo tradicionales, pero de las cuales existen evidencias científicas. En esta revisión se analizan algunos de ellos, tales como factores socioeconómicos, horarios prolongados de trabajo, factores ambientales, aislamiento social, cantidad y calidad del sueño. También hay factores de "protección" cardiovascular como la dieta mediterránea. La literatura cuenta con un número muy elevado de publicaciones que abarcan estos factores. En la presente descripción se incluyeron algunas que fuesen representativas, con buen diseño experimental y que hayan realizado análisis multivariado de los resultados para controlar potenciales confundidores que invaliden las conclusiones. Finalmente, se discuten los mecanismos fisiopatológicos involucrados en la generación de los eventos cardiovasculares finales. (AU)


The classical cardiovascular risk factors have been known for several decades (gender, age, arterial hypertension, dyslipidemia, smoking, obesity, sedentary lifestyle). There also exist "non conventional" risk factors, that are those not described or not included in the majority of the traditional cardiovascular risk scores, but for whom scientific evidence is available. In this review some of them are analyzed, such as socio economic factors, prolonged work schedules, environmental factors, social isolation, sleep quantity and quality. There are also some "preventive" cardiovascular factors as the Mediterranean diet. There exist considerable amount of publications in the literature analyzing these issues. In the present paper some of them are discussed. They have been selected as they were representative of the corresponding aspect, well designed and with multivariate statistical analysis of the results, in order to control potential confounders that could invalidate the conclusions. Finally, the pathophysiological mechanisms involved are discussed. (AU)


Subject(s)
Humans , Sleep Wake Disorders , Socioeconomic Factors , Cardiovascular Diseases/etiology , Cardiovascular Diseases/epidemiology , Psychological Distress , Social Isolation , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/psychology , Risk Factors , Workload , Diet, Mediterranean , Environment
5.
Rev. chil. cardiol ; 38(1): 54-63, abr. 2019. graf
Article in Spanish | LILACS (Americas) | ID: biblio-1003638

ABSTRACT

Resumen: Las enfermedades cardiovasculares y el cáncer son enfermedades crónicas transmisibles culturalmente, y las dos causas principales de mortalidad en el mundo. Además del gran impacto sobre la mortalidad y morbilidad, estas enfermedades han mostrado un alto grado de relación entre ellas debido, entre otras razones, a que comparten factores de riesgo y mecanismos biológicos. La alta incidencia de enfermedad cardiovascular en pacientes con cáncer es un fenómeno conocido que ha orientado el desarrollo del campo interdisciplinario de la cardio-oncología. Sin embargo, en la última década han surgido evidencias que muestran el papel que desempeñan las enfermedades cardiovasculares en el desarrollo de cáncer. Un estudio reciente publicado por Meijers y cols, en agosto de 2018 en Circulation, mostró que la insuficiencia cardiaca post-infarto del miocardio contribuye significativamente al desarrollo del cáncer de colón, apoyando lo obtenido en estudios epidemiológicos anteriores. Este estudio también sugiere que el crecimiento tumoral podría producirse por factores secretados por el corazón insuficiente abriendo un amplio grupo de posibilidades de investigación en lo que sería un nuevo campo de la medicina cuyo propósito sería el desarrollo de nuevas estrategias para el seguimiento y tratamiento del cáncer en pacientes con enfermedades cardiovasculares. El presente artículo revisa los factores de riesgo, y mecanismos celulares y moleculares, que son comunes en las enfermedades cardiovasculares y el cáncer, la contribución del trabajo de Meijers y cols hacia un mayor entendimiento de la interrelación entre estas patologías y las perspectivas futuras con respecto a los nuevos hallazgos.


Abstracts: Cardiovascular diseases and cancer are culturally transmitted chronic diseases and the two main causes of death globally. In addition to their high morbidity and mortality, these diseases are closely related, due to their common risk factors and biological mechanisms. The high incidence of cardiovascular diseases in cancer patients is widely known phenomenon, which has oriented the development of the interdisciplinary field of cardio-oncology Nonetheless, there is emerging evidence in the last decade suggesting a potential role for cardiovascular diseases in the onset of cancer. A recent publication by Meijers et al in the scientific cardiovascular journal Circulation showed that heart failure significantly contributes to tumor growth, confirming previous epidemiological findings suggesting this hypothesis. Moreover, this study indicates that tumor growth may be stimulated by the secretion of factors from the failing heart, opening a wide spectrum of research areas in what may be suggested as a new field in medicine that would seek to develop new strategies to treat and prevent cancer in patients with cardiovascular diseases. This article will review shared risk factor and common cellular and molecular pathways in cardiovascular diseases and cancer, the contribution of Meijers et al to a better understanding of the connection of these diseases and future perspectives in light of the new evidence.


Subject(s)
Humans , Cardiovascular Diseases/epidemiology , Neoplasms/epidemiology , Risk Factors , Heart Failure/epidemiology
6.
Rev. chil. enferm. respir ; 35(1): 22-32, mar. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1003643

ABSTRACT

Introducción: La apnea obstructiva del sueño (AOS) está asociada a alta morbi-mortalidad cardiovascular. Sujetos y métodos: Se seleccionaron 3.657 sujetos entre 30 y 74 años (x: 50,1 ±12,1 DS) de la Encuesta Nacional de Salud 2010. Se estimó el riesgo de AOS mediante una regla de predicción clínica (RPC) basada en las variables del Cuestionario STOP-Bang. Según puntaje se clasificaron en Riesgo BAJO (< 3), MEDIO (3-4) y ALTO (≥ 5) de AOS. El nivel de actividad física (NAF) fue clasificado en 3 niveles: Bajo, Moderado y Alto, según los resultados autorreportados con el cuestionario GPAQ. Para estudiar la asociación entre el riesgo de AOS y NAF con el RCV Alto/Muy Alto (≥ 10%, Framingham) construimos un modelo de regresión logística ajustado por sexo, edad, IMC, diabetes tipo 2, hipertensión arterial, colesterol total elevado, colesterol HDL bajo, triglicéridos elevados, nivel educacional, tabaquismo y horas de sueño autorreportadas. Resultados: 3.098 sujetos se clasificaron como riesgo de AOS: BAJO 1.683 (54,3%), MEDIO 1.116 (36%) y ALTO 299 (9,7%). El NAF fue evaluado en 3.570 sujetos, y clasificado como: Nivel Bajo 1.093 (30,6%), Moderado 705 (19,7%), y Alto 1.772 (49,6%). El RCV fue determinado en 3.613 sujetos, y 711 (19,7%) clasificaron como riesgo Alto /Muy Alto. El modelo de regresión muestra: riesgo MEDIO un OR = 1,75 (1,05-2,90; p = 0,03), riesgo ALTO un OR = 3,86 (1,85-8,06; p < 0,001). Para el NAF Bajo un OR = 1,14 (0,75-1,74; p = 0,525), NAF Moderado un OR = 1,18 (0,73-1,92; p = 0,501). Conclusión: El riesgo MEDIO y ALTO de AOS, pero no el NAF autorreportado, constituyen un factor de riesgo independiente para riesgo cardiovascular elevado.


Introduction: Obstructive sleep apnea (OSA) is associated with high cardiovascular morbidity and mortality. Subjects and methods: 3,657 subjects between 30 and 74 years-old ( x ¯: 50.1 ± 12.1 SD) from 2010 Chilean National Health Survey were selected. Risk of OSA was estimated using a clinical prediction rule (CPR) based on the variables of the STOP-Bang Questionnaire. According to their score they were classified as LOW (< 3), MEDIUM (3-4) and HIGH (≥ 5) risk of OSA. Their physical activity level (PAL) was classified into 3 levels: Low, Moderate and High, according to the self-reported results with the GPAQ questionnaire. To study the association between the risk of OSA and PAL with High / Very High CVR (≥ 10%, Framingham) we constructed a logistic regression model adjusted for sex, age, BMI, type 2 diabetes, high blood pressure, high total cholesterol, low HDL cholesterol, high triglycerides, educational level, smoking and self-reported sleep hours. Results: 3,098 subjects were classified as OSA risk: LOW 1.683 (54.3%), MEDIUM 1.116 (36%) and HIGH 299 (9.7%). The PAL was evaluated in 3,570 subjects and classified as: Low 1,093 (30.6%), Moderate 705 (19.7%), and High 1,772 (49.6%). The CVR was determined in 3,613 subjects, and 711 (19.7%) classified as High/Very High risk. The regression model shows: MEDIUM risk an OR = 1.75 (1.05 - 2.90, p = 0.03), HIGH risk an OR = 3.86 (1.85-8.06, p < 0.001). For the PAL Low an OR = 1.14 (0.75-1.74, p = 0.525), PAL Moderate an OR = 1.18 (0.73-1.92, p = 0.501). Conclusion: The MEDIUM and HIGH risk of OSA, but not the self-reported PAL, constitute an independent risk factor for high cardiovascular risk.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Exercise/physiology , Sleep Apnea, Obstructive/complications , Cardiovascular Diseases/epidemiology , Logistic Models , Chile/epidemiology , Cross-Sectional Studies , Predictive Value of Tests , Surveys and Questionnaires , Risk Factors , ROC Curve , Risk Assessment/methods , Sleep Apnea, Obstructive/epidemiology , Self Report
7.
Rev. chil. enferm. respir ; 35(1): 33-42, mar. 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1003644

ABSTRACT

Introducción: La enfermedad respiratoria crónica determina alta morbimortalidad y frecuencia de comorbilidades cardiometabólicas. Evaluamos la asociación entre flujo espiratorio máximo (FEM) y algunas condiciones cardiometabólicas en adultos de una zona semirural, en la medición basal de la cohorte MAUCO (MAUle COhort). Material y Método: Estudio transversal (3.465 adultos, 40-74 años). Se midió el flujo espiratorio máximo (FEM) (mini-Wright, estándar ATS) utilizándose valores de Gregg y Nunn (FEM deteriorado ≤ 80% del teórico). Se obtuvo autorreporte/mediciones de hipertensión arterial (HTA), enfermedad cerebrovascular (ECV), infarto al miocardio (IAM), diabetes mellitus 2 (DM2), presión arterial, glicemia, colesterol, peso y talla. Actividad física y tabaquismo se evaluaron por encuesta, previa aprobación Ética. Se calcularon medidas de asociación, prevalencia y Odds Ratio (OR). Resultados: Muestra de 63,9% de mujeres edad media 55 (± 9) años, escolaridad media 9 (± 4) años. 84,7% tuvo exceso de peso, 81,5% inactividad física 29,4% fumadores actuales. Prevalencia de FEM bajo: 50,6% (IC 95% 48,9-52,3). El autorreporte fue: ACV 2,2% IAM 3,3, sospecha de hipertensión 24% y DM2 2,7%. Los OR crudos fueron significativos en mujeres que autorreportaron HTA, ECV, IAM y autorreporte/sospecha de DM2, y en hombres con autorreporte de ECV, sospecha de DM2 y autorreporte/sospecha de HTA. La asociación se mantuvo post-ajuste en mujeres para autorreporte de IAM y deterioro moderado (OR = 2,49) y severo del FEM (OR = 2,60) y en hombres para sospecha de DM2 y deterioro leve (OR = 5,24) y severo del FEM (OR = 6,19). Conclusiones: FEM resultó significativamente asociado con las enfermedades cardiometabólicas seleccionadas, con efecto sexo- específico para IAM (mujeres) y sospecha de DM2 (hombres). Se constata alta prevalencia de FEM alterado, y de enfermedades cardiometabólicas crónicas en la población estudiada.


Introduction: Chronic respiratory diseases determine high morbimortality and cardiometabolic comorbidities. We evaluated the association between peak expiratory flow (PEF) and cardiometabolic conditions in adults in a semi-rural area, in the baseline of MAUCO cohort (MAUle COhort). Material and Method: Cross-sectional study (3,465 adults, 40-74 years). Peak expiratory flow (PEF) (mini-Wright, ATS standard) was measured (Gregg & Nunn; impaired PEF ≤ 80% predicted). Self-reported/measured hypertension (HT), cerebrovascular disease (CVD), myocardial infarction (AMI), diabetes mellitus 2 (DM2), blood pressure, glycemia, cholesterol, weight and height were obtained. Physical activity and smoking were surveyed, after Ethical approval. Association's measures, prevalence and Odds Ratio (OR) were calculated. Results: Sample of 63.9% of women, mean age 55 (± 9) years, schooling 9 (± 4) years. 84.7% had overweight, 81.5%physical inactivity 29.4% smokers. Low PEF: 50.6% (48.9-52.3). Self-reported was: CVD 2.2% AMI 3.3%, suspicion of hypertension 24% and DM2 2.7%. Crude OR`s were significant for women by self-reported hypertension, stroke, AMI and self-reported/suspicion DM2; in men for self-reported CVD, suspected DM2 and self-reported/suspected hypertension. The association remained post-adjusted in women self-reported AMI -moderate deterioration (OR = 2.49) and severe PEF (OR = 2.60) and in men suspected DM2 and mild (OR = 5.24) and severe deteriorated PEF (OR = 6.19). Conclusions: PEF was significantly associated with cardiometabolic diseases; sex- specific findings for AMI (women) and suspicion of DM2 (men). High prevalence of altered PEF and chronic cardiometabolic diseases were detected among the studied population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Respiratory Tract Diseases/epidemiology , Cardiovascular Diseases/epidemiology , Maximal Expiratory Flow Rate/physiology , Metabolic Diseases/epidemiology , Respiratory Tract Diseases/physiopathology , Cardiovascular Diseases/physiopathology , Body Mass Index , Comorbidity , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Analysis of Variance , Sex Distribution , Diabetes Mellitus, Type 2 , Dyslipidemias , Hypertension , Metabolic Diseases/physiopathology , Myocardial Infarction
8.
J. bras. nefrol ; 41(1): 29-37, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1002428

ABSTRACT

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.


RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aging/physiology , Cardiovascular Diseases/epidemiology , Renal Insufficiency, Chronic/epidemiology , Kidney Failure, Chronic/epidemiology , Portugal/epidemiology , Cardiovascular Diseases/etiology , Body Mass Index , Comorbidity , Incidence , Prevalence , Risk Factors , Follow-Up Studies , Longitudinal Studies , Creatinine/blood , Diabetes Mellitus/epidemiology , Renal Insufficiency, Chronic/complications , Dyslipidemias/epidemiology , Cognitive Dysfunction/epidemiology , Glomerular Filtration Rate , Hypertension/epidemiology , Kidney Failure, Chronic/etiology
9.
Rev. Hosp. Clin. Univ. Chile ; 30(2): 129-139, 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1052609

ABSTRACT

In the vast majority of cardiovascular diseases (CVDs), there are well-described differences between women and men in epidemiology, pathophysiology, clinical manifestations, effects of therapy, and outcomes. These differences arise on one hand from biological differences among women and men, which are called sex differences, due to differences in gene expression from the sex chromosomes and subsequent differences in sexual hormones leading to differences in gene expression and function in the CV system, In contrast, gender differences are unique to the human. They arise from sociocultural processes, such as different behaviours of women and men; exposure to specific influences of the environment; different forms of nutrition, lifestyle, or stress; or attitudes towards treatments and prevention. The scientific societies are at the forefront of implementing the knowledge in research and healthcare strategies with more proactive attitude for a feminine centered approaches may lead to a more specific and effective use of resources in CVD prevention and therapy in women. (AU)


Subject(s)
Humans , Female , Cardiovascular Diseases/prevention & control , Risk Factors , Women's Health , Cardiovascular Diseases/therapy , Cardiovascular Diseases/epidemiology
10.
Belo Horizonte; s.n; 2019. 82 p. ilus, tab.
Thesis in Portuguese | LILACS (Americas), BDENF | ID: biblio-1007079

ABSTRACT

As Doenças Cardiovasculares (DCV) se destacam como as principais causas de morte por Doenças Crônicas Não Transmissíveis (DCNT) em todo o mundo, representando um relevante problema de saúde pública. Para estimar o risco de desenvolver DCV, foram criados os chamados escores de risco e algoritmos baseados em análises de regressão de estudos populacionais, dos quais o mais comumente utilizado é o escore de 10 anos de Framingham. No entanto, a aplicabilidade de tais escores na prática clínica tem se mostrado limitada, uma vez que para os seus cálculos são exigidas mensurações de vários componentes. Dessa forma, índices antropométricos e de obesidade central mais simples de serem utilizados têm sido propostos para a identificação de participantes com alto risco cardiovascular. Trata-se de um estudo epidemiológico, de delineamento transversal e analítico conduzido com o objetivo de analisar a capacidade de índices antropométricos e de obesidade central em identificar participantes com alto risco cardiovascular em longo prazo na Coorte de Universidades Mineiras (CUME). A amostra foi constituída por 144 participantes da etapa de validação da síndrome metabólica e de seus componentes do estudo CUME, de ambos os sexos, com idade entre 30 e 59 anos, dos quais foram coletados dados demográficos, socioeconômicos, antropométricos, de estilo de vida e realizadas análises bioquímicas. O risco cardiovascular foi calculado utilizando as quatro versões do escore de Framingham de 30 anos (dois para o conjunto das DCV e dois para as DCV graves). Posteriormente, avaliou-se a capacidade do Índice de Massa Corporal (IMC), da Circunferência da Cintura (CC), do Índice de Conicidade (IC), do Índice de Adiposidade Visceral (IAV), e do Produto de Acumulação Lipídica (LAP) em identificar os indivíduos com alto risco cardiovascular. Realizou-se análise estatística, aplicando-se os testes de correlação de Pearson, de Spearman e Curva ROC, com nível de significância estatística de 5%. A maioria dos participantes foi classificada com baixo risco cardiovascular. Todos os índices antropométricos e de obesidade central apresentaram correlações positivas, moderadas (exceto o IAV) e significativas com os escores de risco de Framingham quando considerada a população total. A CC se mostrou o melhor preditor para todos os desfechos, exceto para o risco cardiovascular para DCV graves calculado com o IMC, no qual se destacou o IC. É importante que esses achados sejam considerados com o intuito de simplificar a detecção do risco cardiovascular, possibilitando o conhecimento precoce da situação de grupos populacionais sob alto risco e o estabelecimento de medidas de prevenção, controle e tratamento das DCV e, consequente, diminuição das DCNT.(AU)


Cardiovascular Diseases (CVD) stand out as the leading causes of death by Non-Communicable Diseases (NCD) worldwide, representing a relevant public health problem. To estimate the risk of developing CVD, were created the so-called risk algorithms based on regression analyzes of population studies, of which the most commonly used is the 10-year Framingham Risk Score. However, the applicability of such scores to clinical practice has been limited, as the measurements of several components are required for their calculations. Thus, simpler anthropometric and central obesity indexes have been proposed for the identification of participants with high cardiovascular risk. This is an epidemiological, cross-sectional and analytical study conducted with the objective of analyzing the ability of anthropometric and central obesity indexes to identify participants with high cardiovascular risk in a long-term perspective at the Cohort of Universities of Minas Gerais (CUME). The sample consisted of 144 participants from the validation study of metabolic syndrome and its components in the CUME study, male and female applicants aged between 30 and 59, from which were collected demographic, socioeconomic, anthropometric, and lifestyle data and performed biochemical analyzes. Cardiovascular risk was calculated using the four versions of the 30-year Framingham Score (two for general CVD and two for severe CVD). Afterwards, were evaluated the ability of Body Mass Index (BMI), Waist Circumference (WC), Conicity Index (CI), Visceral Adiposity Index (VAI) and Lipid Accumulation Product (LAP) to identify high cardiovascular risk. Statistical analysis was performed using correlation tests, such as the Pearson, Spearman and ROC curve , with a level of statistical significance of 5%. Most participants were classified with low cardiovascular risk. All anthropometric and central obesity indexes presented positive, moderate (except for VAI) and significant correlations with the Framingham Risk Score when considering the total population. WC was the best predictor for all outcomes, except for the cardiovascular risk for severe CVD calculated with the BMI, in which the CI was highlighted. It is important that these findings are considered in order to simplify the detection of cardiovascular risk, allowing early knowledge of the situation of high-risk population groups and establishing measures of prevention, control and treatment of CVD and, consequently, the reduction of NCD.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiovascular Diseases/epidemiology , Obesity, Abdominal , Socioeconomic Factors , Universities , Food Consumption , Anthropometry , Surveys and Questionnaires , Risk Factors , Academic Dissertation
12.
Rio de Janeiro; s.n; 2019. 144 f p. tab, graf.
Thesis in Portuguese | LILACS (Americas) | ID: biblio-986435

ABSTRACT

As doenças cardiovasculares (DCV) são a primeira causa de mortes no Brasil e no mundo. Sua relação com a temperatura ambiente tem sido evidenciada por estudos epidemiológicos. No contexto das mudanças climáticas, de acordo com as projeções de aquecimento e da maior frequência de eventos extremos, é esperado um aumento dos impactos do clima na saúde, como a elevação da mortalidade por DCV atribuída à temperatura. O Brasil está em uma das regiões do globo que mais tem apresentado aquecimento, e as projeções apontam aumentos de até 8-9°C, segundo cenário de nenhuma mitigação. No entanto, há pouca evidência sobre os efeitos da temperatura na mortalidade por DCV e dos impactos associados às mudanças climáticas no Brasil e na América Latina. Neste sentido, o objetivo desta tese foi investigar o efeito da temperatura na mortalidade por DCV no presente e estimar os impactos futuros da temperatura na mortalidade por DCV, segundo diferentes cenários de mudanças climáticas no Brasil. Foram estimados os efeitos da temperatura na mortalidade por DCV nas capitais brasileiras e combinado para todo o Brasil e suas regiões por meio de estudos de séries temporais. Foram incluídos dados diários de óbitos por DCV, temperatura e umidade relativa médias durante o período de estudo que variou de 2000 a 2015. As análises utilizaram modelos lineares generalizados, combinados com os distributed lag non-linear models, com 21 dias de defasagem. A heterogeneidade dos efeitos entre as cidades, segundo características geográficas, socioeconômicas, demográficas e infraestruturais, foi investigada por meio de modelos de metarregressão. A projeção dos impactos das mudanças climáticas na mortalidade por DCV até 2100, foi estimada em termos dos óbitos atribuíveis ao frio e ao calor, conforme temperaturas simuladas segundos os cenários de emissão RCP4.5 e RCP8.5, utilizando dois modelos climáticos regionalizados (Eta-HadGEM2-ES e Eta-MIROC5). Os resultados mostraram o efeito da temperatura ambiente na mortalidade por DCV na maioria das capitais, e o efeito combinado para todo o Brasil e para as regiões Centro-Oeste, Norte, Sudeste e Sul. Foi observada relação exposição-resposta em forma de U e os efeitos foram mais acentuados entre os locais com maior amplitude térmica. Em relação aos impactos das mudanças climáticas, foi observada uma tendência de redução dos óbitos atribuíveis ao frio em todas as capitais brasileiras, e de elevação dos óbitos atribuíveis ao calor e totais na maioria das capitais. Esse aumento é mais intenso segundo o cenário RCP8.5 que não prevê nenhuma estratégia de mitigação das emissões de CO2. Os achados desse estudo são importantes para prover informações para a comunicação do risco, visando a promoção de políticas de saúde e o planejamento de estratégias de enfrentamento e adaptação às transformações do clima


Cardiovascular diseases (CVD) are the leading cause of death in Brazil and worldwide. Its relationship with ambient temperature has been evidenced by epidemiological studies. In the context of climate change, according to warming projections and the greater frequency of extreme events, an increase in impacts of climate in health, such as the rise in CVD mortality attributed to temperature, is expected. Brazil is located in one of the regions in the world that has experienced the most warming, and the projections indicate increases of up to 8-9°C, under scenario of no mitigation. However, there is little evidence on the effects of temperature on CVD mortality and the impacts associated to climate change in Brazil and Latin America. The objective of this work was to investigate the effect of temperature on CVD mortality in the present and to estimate the future impacts of temperature on CVD mortality under different climate change scenarios in Brazil. The effects of temperature on CVD mortality in Brazilian capitals were estimated and pooled for the whole country and its regions using time series studies. Daily data on CVD deaths, average temperature, and relative humidity were included during the study period, which ranged from 2000 to 2015. The analysis used generalized linear models, combined with distributed lag non-linear models, with 21 days of lag. The heterogeneity of effects among cities, according to geographic, socioeconomic, demographic and infrastructural characteristics, was investigated through meta-regression models. The projection of the impacts of climate change on CVD mortality by 2100 was estimated in terms of deaths attributable to cold and heat, with temperature series simulated under RCP4.5 and RCP8.5 using two regionalized climate models (Eta- HadGEM2-ES and Eta-MIROC5). The results showed the effect of ambient temperature on CVD mortality in most cities, and the pooled effect for all Brazil and the Midwest, North, Southeast, and South regions. the effects were more intense among the cities with greater thermal amplitude. In relation to the impacts of climate change, there was a tendency to reduce deaths attributable to cold, in all Brazilian cities, and to increase total deaths and those attributable to heat, in most analyzed cities. This increase is more intense under the RCP8.5 scenario, which does not consider any mitigation strategy for CO2 emissions. The findings of this study are important to provide information for the communication of the risks aiming at the promotion of health policies and the planning of strategies for adaptation to climate change


Subject(s)
Humans , Temperature , Climate Change/mortality , Brazil/epidemiology , Cardiovascular Diseases/epidemiology , Time Series Studies , Epidemiology
13.
Article in Portuguese | LILACS (Americas) | ID: biblio-998602

ABSTRACT

Epidemiologia clínica é o campo de conhecimento que estuda as melhores práticas assistenciais, com foco nos interesses do paciente de compartilhar as decisões com os médicos e demais profissionais de saúde que realizam o atendimento ou prestam cuida-dos. Vale-se da mesma metodologia usada pela epidemiologia tradicional para qualificar e desenvolver a pesquisa aplicada à prática clínica. A vacinação contra a febre amarela, mostra bem a diferença entre os interesses da epidemiologia clínica e os da epidemiologia tradicional. A estratégia populacional pode trazer muitos benefícios para a coletividade que, no geral, apresenta baixo risco e muitos malefícios para um grupo muito menor de indivíduos de alto risco. Os padrões de ações preventivas modificam-se de acordo com a evolução no tempo. Além da prevenção primordial, primária, secundária e terciária este texto discute a prevenção quaternária por meio de ações que visam evitar os danos associados ao uso excessivo de procedimentos diagnósticos e terapêuticos. O diálogo sobre saúde é um contraponto entre o saber científico e o saber popular, a informação dada a partir do conhecimento prévio do indivíduo e da comunidade deve respeitar seus valores, como exemplificado por trabalhos realizados em escolas de ensino fundamental.


Clinical Epidemiology is the field of knowledge that studies the best care practices, focusing on the patient's interest in sharing decisions with physicians and other health professionals who provide treatment or health care. It employs the same methodology used by traditional epidemiology to qualify and develop research applied to clinical practice. Vaccination against yellow fever clearly shows the difference between the interests of clinical epidemiology and those of traditional epidemiology. Population strategy can produce many benefits for society as a whole, which generally involves a lower risk, to the detriment of a much smaller group of high-risk individuals. Preventive care patterns change according to temporal evolution. In addition to primordial, primary, secondary and tertiary prevention, this text also discusses quaternary prevention through actions aimed at avoiding the damage associated with the excessive use of diagnostic and therapeutic procedures. The dialogue on health is a counterpoint between scientific knowledge and common knowledge. Information produced from the prior knowledge of the individual and the community must respect their values, as exemplified by work carried out in elementary schools


Subject(s)
Humans , Male , Female , Preventive Health Services/economics , Practice Patterns, Physicians'/history , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/epidemiology
14.
Article in Portuguese | LILACS (Americas) | ID: biblio-998680

ABSTRACT

A infância e a adolescência são períodos que compreendem a transição para a vida adulta, no qual ocorrem mudanças no âmbito físico, psicológico, emocional e social. Nesse período tão crucial para o desenvolvimento, fatores ambientais e doenças aos quais os jovens estão expostos podem refletir na vida adulta, gerando maiores chances de desenvolvimento de doenças crônicas, incluindo a doença cardiovascular (DCV). A principal etiologia das doenças cardiovasculares é a aterosclerose, que tem seu início na infância. Dessa forma, é reconhecido atualmente que a prevenção cardiovascular primordial deve iniciar precocemente, na infância e adolescência, antes da instalação da doença de fato, de modo a diminuir a prevalência e incidência das DCV na idade adulta.


Childhood and adolescence constitute the transition to adult life, where changes occur in the physical, psychological, emotional and social spheres. In such a crucial period of deve-lopment, environmental factors and diseases to which young people are exposed may have repercussions in adulthood, increasing the chances of developing chronic diseases, including cardiovascular disease (CVD). The main etiology of cardiovascular diseases is atheroscle-rosis, which has its onset in childhood. Accordingly, it is currently recognized that primordial prevention of cardiovascular disease should begin early, i.e. in childhood and adolescence, prior to its actual onset, in order to reduce the prevalence and incidence of CVD in adulthood.


Subject(s)
Humans , Child , Adolescent , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/epidemiology , Atherosclerosis/etiology , Obesity/congenital , Chronic Disease , Diet, Food, and Nutrition
15.
Article in Portuguese | LILACS (Americas) | ID: biblio-998771

ABSTRACT

A prevenção cardiovascular é tema fundamental, pois as doenças cardiovasculares que têm como substrato a aterosclerose, têm grande impacto na morbidade e mortalidade cardiovascular no Brasil e no mundo. Estima-se que 80% dos casos de doença arterial co-ronariana resultam da presença isolada ou em associação a fatores como as dislipidemias, tabagismo, hipertensão arterial, diabetes entre outros. Além disso, biomarcadores como história familiar de aterosclerose precoce, marcadores de inflamação de baixo grau como a proteína C reativa (PCR) e imagem da placa de ateroma (escore de cálcio coronário) ajudam a identificar e reclassificar o risco de doença cardiovascular. Estratégias como check-up cardiovascular ou os dos escores de risco são utilizadas na identificação do indivíduo assintomático com maior risco de desenvolver um evento agudo. O check-upcardiovascular, além de identificar os fatores de risco, inclui exames laboratoriais, testes funcionais e de imagem, o que pode implicar em custos excessivos dos exames que não agregarão valor discriminatório ou de reclassificação do risco cardiovascular. Apesar da escassez de dados, meta-análise recente não observou qualquer diferença na mortali-dade por todas as causas e cardiovascular, quanto à realização ou não dos exames de check-up de rotina. A partir da medicina baseada em evidência, diversos algoritmos foram criados para estratificação, de acordo com a presença dos fatores de risco e calibrados para a população estudada. Esses algoritmos são de simples realização e de baixo custo.A Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose ­ 2017 mantém a recomendação do uso do Escore Global de Risco na avalição inicial de indiví-duos assintomáticos. A revisão sistemática realizada pelo grupo Cochrane, observou que o uso dos escores de risco na prevenção primária tiveram modesto impacto na redução de eventos cardiovasculares, comparados com a não utilização. Além disso, o uso dos escores clínicos reduziu fatores de risco como colesterol elevado e hipertensão arterial, aumentou a prescrição de hipolipemiantes, anti-hipertensivos e AAS, sem evidência de danos e diminuiu a prevalência de tabagismo. Atualmente, ainda há controvérsias sobre quando e como deve ser feita a avaliação do risco cardiovascular. A literatura é clara em dizer que o uso de testes de forma indiscriminada na população não tem boa relação de custo-eficácia. Entretanto, a avaliação do risco cardiovascular pelos escores clínicos de risco pode identificar indivíduos de maior risco que serão beneficiados pela implementação de tratamentos preventivos.


Cardiovascular disease prevention is a key topic as cases with atherosclerosis as an underlying cause have a considerable impact on cardiovascular morbidity and mortality in Brazil and the rest of the world. It is estimated that 80% of coronary artery disease cases result from the individual presence or combination of factors such as dyslipidemias, smo-king, hypertension, diabetes, and others. In addition, biomarkers such as family history of early atherosclerosis, low-grade inflammatory markers such as C-reactive protein (CRP), and atheromatous plaque imaging (coronary calcium score) help identify and reclassify the risk of cardiovascular disease. Strategies such as cardiovascular check-ups or the use of risk scores are used to identify the asymptomatic patient with a higher risk of developing an acute event. Besides identifying risk factors, the cardiovascular check-up also includes laboratory, functional and imaging tests, which may involve excessive costs that will not add discriminatory value or allow the cardiovascular risk to be reclassified. Despite the lack of data, a recent meta-analysis found no difference in all-cause and cardiovascular mortality, whether or not routine check-ups were performed. According to evidence-based medicine, several algorithms have been created for stratification, depending on the presence of risk factors and calibrated for a particular study population. These algorithms are both simple and inexpensive. The Update of the Brazilian Guideline on Dyslipidemia and Atherosclerosis Prevention - 2017 recommends using the Global Risk Score in the initial assessment of asymptomatic individuals. A systematic review conducted by the Cochrane group found that the use of risk scores in primary prevention had a modest impact on the reduction of cardiovascular events compared to non-use. Furthermore, the use of clinical scores reduced risk factors such as high cholesterol and high blood pressure, increased lipid-lowering/antihypertensive drug and aspirin prescriptions, with no evidence of harmful side effects, and reduced the prevalence of smoking. There is still controversy as to when and how to assess cardiovascular risk. The literature is clear in stating that the use of indiscriminate testing in the population is not cost effective. However, the evaluation of cardiovascular risk using clinical risk scores can identify higher risk individuals who will benefit from the implementation of preventive treatments.


Subject(s)
Humans , Primary Prevention/education , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/epidemiology , Atherosclerosis/physiopathology , Carotid Arteries/diagnostic imaging , Electrocardiography/nursing
16.
J. bras. nefrol ; 40(4): 388-402, Out.-Dec. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-984581

ABSTRACT

ABSTRACT There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.


RESUMO Existem importantes diferenças na doença renal crônica entre caucasianos e afrodescendentes. Foi amplamente aceito que isso ocorreu devido a fatores socioeconômicos, mas estudos recentes mostraram que as variantes gênicas da apolipoproteína L-1 (APOL1) estão fortemente associadas à glomeruloesclerose segmentar e focal, nefropatia associada ao HIV, nefroesclerose hipertensiva e nefrite lúpica na população afrodescendente. Essas variantes chegaram à América do Sul através do tráfico intercontinental de escravos, e proporcionaram uma vantagem evolutiva aos portadores, protegendo contra formas de tripanossomíase, mas à custa de um maior risco de doença renal. O efeito das variantes não parece estar relacionado à sua concentração sérica, mas sim à sua ação local sobre os podócitos. Variantes de risco também são importantes no transplante renal, já que enxertos de doadores com variantes de risco apresentam pior sobrevida.


Subject(s)
Humans , Renal Insufficiency, Chronic/genetics , Apolipoprotein L1/genetics , Polymorphism, Genetic , Genetic Variation , African Americans/genetics , Cardiovascular Diseases/etiology , Cardiovascular Diseases/epidemiology , Prevalence , Risk Factors , Podocytes , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/epidemiology , Apolipoprotein L1/physiology
17.
Int. j. cardiovasc. sci. (Impr.) ; 31(6): 619-629, nov.- dez. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-979922

ABSTRACT

Background: Virtual reality is an alternative therapeutic resource to be inserted into cardiovascular rehabilitation, stimulating the practice of physical activity through man-machine interaction. Objective: To compare the effects of conventional and virtual reality cardiac rehabilitation on body composition and functional capacity in patients with heart disease. Methods: Randomized clinical trial with 27 cardiac patients divided into conventional rehabilitation group (CRG) and virtual reality rehabilitation group (VRG). They underwent a rehabilitation program with 60-minute training sessions twice a week for eight weeks. The VRG training consisted of exercises from the Xbox 360® with Kinect™, using YourShape™ and Dance Central 3™ games. The CRG used conventional treadmills for aerobic exercise and free weights for resistance exercise. Bioimpedance and 6-minute walk test (6MWT) were evaluated at baseline and after training. For main outcome analysis, Student t and Mann Whitney tests were used with a 5% significance level. Results: The VRG showed a significant increase in body fat percentage and fat weight when compared to the CRG, and a smaller amount of total water. There was a significant improvement in functional capacity evidenced by the increase in the distance covered in the 6MWT (54.00 m and 32.25 m in the CRG and VRG, respectively), but the gains did not differ between the groups. Conclusion: The two rehabilitation modalities had no effect on the body composition of the groups. In addition, the improvement in functional capacity was similar in both groups


Subject(s)
Humans , Male , Female , Adult , Body Composition , Cardiovascular Diseases/mortality , Cardiovascular Diseases/epidemiology , Physical Therapy Modalities , Virtual Reality Exposure Therapy/methods , Cardiac Rehabilitation , Virtual Reality , Blood Glucose , Blood Pressure , Brazil/epidemiology , Exercise , Body Mass Index , Anthropometry , Statistical Analysis , Protocols , Diabetes Mellitus , Waist Circumference , Hypertension
18.
Rev. salud pública ; 20(5): 568-573, oct.-nov. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1004470

ABSTRACT

ABSTRACT Objective High sodium consumption is associated with cardiovascular disease (CVD). CVD is the leading cause of mortality in Ecuador, which may be caused in part by unhealthy eating habits. Currently, there are no data on the consumption of sodium using 24-hr urine samples. The aims of the study were to provide preliminary data of sodium intake in an urban population sample consisting of adults between 25 and 64 years old, and to explore the feasibility to conduct a population-level sodium intake determination by using 24-hr urine samples. Methods A cross-sectional study was conducted in a sample of 129 adults living in an urban setting. 24-hr urinary samples were collected and the WHO STEPS instrument was used to collect the socio-demographic and clinical characteristics of participants. A reference value of 2.0 g/day was used to differentiate between normal and high sodium intake groups. Results Participants' median age was 39 years, 91% of them identified themselves as belonging to the mestizo race, and 60% were female. The average sodium intake was 2 655(±1 185) mg/d (range: 1 725 to 3 404), which is equivalent to a salt intake of 6.8 g/d (range: 4.4 to 8.7). Sodium intake was significantly higher in males than in females: 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectively, (p<.01). Conclusions Sodium consumption in two-thirds of the participants was higher than the WHO recommended level. These results should help to support the execution of a national sodium intake survey that, in turn, would provide information to guide and plan public health strategies seeking to decrease cardiovascular diseases occurrence rates in Ecuador.(AU)


RESUMEN Objetivo Un exceso de sodio dietético se asocia con enfermedades cardiovasculares (ECV). Las ECV son la principal causa de mortalidad en el Ecuador, tal vez por patrones dietéticos no saludables en su población. Al momento no existe información del consumo de sodio usando orina de 24-hr. Los objetivos del estudio fueron proveer información preliminar de la ingesta de sodio en una muestra urbana de adultos de 25-64 años, y explorar la factibilidad de realizar un estudio a nivel nacional. Métodos Estudio de corte-transversal de 129 adultos residentes en un entorno urbano. Se recolectó muestras urinarias de 24-hr y se recolectaron características socio-demográficas y clínicas usando los cuestionarios STEPS de la OMS. Un valor de referencia de 2.0 g/día fue utilizado para discriminar entre consumidores normales y altos de sodio. Resultados La mediana de edad de la población estudiada fue de 39 años, 91% se autodefinió de raza mestiza, y 60% fueron femeninas. La ingesta promedio de sodio fue de 2 655(±1 185) mg/d (rango: 1 725 to 3 404), que es equivalente a una ingesta de sal de 6.8 g/d (rango: 4.4 to 8.7). La ingesta masculina fue significativamente mayor que el de las mujeres 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectivamente, (p<.01). Conclusiones Dos tercios de la población estudiada consume sodio mayor al recomendado por la OMS. Estos resultados apoyan la ejecución de un estudio nacional que guíe la planificación en salud pública e informe estrategias para mejorar la salud cardiovascular en el Ecuador.(AU)


Subject(s)
Humans , Sodium, Dietary/adverse effects , Cardiovascular Diseases/epidemiology , Urine/chemistry , Cross-Sectional Studies/instrumentation , Cohort Studies , Ecuador/epidemiology
19.
Rev. chil. cardiol ; 37(2): 126-133, ago. 2018. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-959351

ABSTRACT

Introducción : En la actualidad, la Minería de Datos es cada vez más popular en el campo de la salud porque existe una necesidad de eficiencia metodológica y analítica para detectar información desconocida y valiosa en datos de salud. Objetivo : Desarrollar un modelo predictivo utilizando técnicas de minería de datos, específicamente Arboles de Decisión, para pesquisar pacientes con propensión a desarrollar Diabetes Tipo II (DM II), Hipertensión Arterial (HTA) o Dislipidemia (DLP). Método : Se analizó el problema de los Factores de Riesgo Cardiovascular Mayores desde una perspectiva de procesos y se estudiaron las técnicas que permiten descubrir el conocimiento del fenómeno almacenado en las bases de datos de Examen de Medicina Preventiva del Adulto (EMPA) de la Población en Control Cardiovascular que presenta DM II, HTA o DLP Resultados : El Algoritmo C5, presenta un mayor poder predictivo, respecto de otros algoritmos de Árbol de Decisión. Se comprobó que las variables Edad y Circunferencia de Cintura fueron las de mayor poder de discriminación en el padecimiento de DM2, HTA o DLP. El algoritmo C5 alcanzó una precisión global de un 83,01% en la partición de prueba, luego en la misma partición el modelo logra discriminar un paciente con algunas de las patologías en el 85,25% de los casos, y uno que no presenta alguna de las patologías en un 80,27% de las oportunidades. Conclusión : La Minería de Datos y en este caso, específicamente los Modelos de Árboles de Decisión son una alternativa válida para la pesquisa cardiovascular temprana.


Introduction : Data Mining is increasingly popular in the health field because there is a need for an efficient analytical methodology to detect unknown and valuable information of health data. Objective : To develop a predictive model using data mining techniques, specifically Decision Trees, to investigate patients with a propensity to develop Type II Diabetes, Arterial Hypertension or Dyslipidemia. The data of adult patients presenting Type II diabetes, Hypertension or Dyslipidemia being followed in a preventive cardiovascular control program were analyzed with the aim of unveiling phenomena that could help develop the prediction of these risk factors. Results : With respect to other decision tree algorithms, Algorithm C 5, showed a greater predictive power. The variables age and waist circumference had the greatest power of discrimination for DM2, HTA or DLP. The C 5 algorithm reached a global precision of 83.01% in the test partition. Then, in the same partition the model managed to discriminate a patient with some of the risk factors in 85.25% of cases, and to rule out any of them in 80.27% of cases. Conclusion : Data Mining, specifically decisión tree models, is a valid alternative for early detection of cardiovascular of risk factors.


Subject(s)
Humans , Male , Female , Cardiovascular Diseases/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Dyslipidemias/diagnosis , Data Mining , Hypertension/diagnosis , Prognosis , Decision Trees , Cardiovascular Diseases/epidemiology , Risk Assessment , Early Diagnosis , Diabetes Mellitus, Type 2/epidemiology , Dyslipidemias/epidemiology , Hypertension/epidemiology
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