Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

Lipoproteína (a) em pacientes portadores de doença arterial obstrutiva periférica e/ou diabetes mellitus tipo 2 / Lipoprotein (a) in patients with peripheral arterial obstructive disease and/or type 2 diabetes mellitus

INTRODUÇÃO: A doença arterial obstrutiva periférica (DAOP) constitui um excelente marcador para a aterosclerose sistêmica. Entre os fatores de risco para essa doença está o diabetes mellitus tipo 2 (DM2). Acredita-se que a lipoproteína (a) [Lp(a)] esteja ligada a risco aumentado de aterosclerose, embora os mecanismos que levem a esse aumento não sejam completamente conhecidos. Níveis elevados de Lp(a) parecem estar associados a risco aumentado de doença arterial coronariana (DAC), assim como DAOP e doença cerebrovascular. OBJETIVO: Avaliar os níveis plasmáticos de Lp(a) e outras variáveis lipídicas em um grupo de pacientes com DAOP e/ou DM2. MATERIAL E MÉTODOS: Níveis plasmáticos de Lp(a), colesterol total (CT), colesterol da lipoproteína de alta densidade (HDL-c), colesterol da lipoproteína de baixa densidade (LDL-c), triglicérides (TG) e apolipoproteínas A-I e B foram medidos em amostras de sangue de 12 indivíduos comprovadamente não-portadores de DAOP e DM2 (controles), 17 pacientes portadores de DAOP, 18 pacientes com DM2 e 19 pacientes portadores de DAOP e DM2 simultaneamente. Os participantes desse estudo foram selecionados buscando-se homogeneidade e semelhança estatística em relação às variáveis sexo, idade e nível socioeconômico. RESULTADOS: A Lp(a) apresentou tendência a elevação tanto no grupo de pacientes com DAOP quanto naquele com DM2 + DAOP. Foram encontradas diferenças significativas entre os grupos para as dosagens de HDL-c e Apo A-I, inclusive com correlação positiva entre esses parâmetros. A relação CT/HDL-c apresentou diferença estatística significativa entre os grupos. Foram observadas correlações positiva entre Lp(a) e LDL-c, e negativa entre o índice tornozelo-braquial (ITB) e a Lp(a). CONCLUSÃO: Para as variáveis lipídicas estudadas foram observadas diferenças estatísticas significativas apenas entre os níveis plasmáticos de HDL-c e Apo A-I. Para o parâmetro Lp(a) foram observados níveis plasmáticos mais elevados...

BACKGROUND: Peripheral arterial obstructive disease (PAOD) constitutes an excellent marker for systemic atherosclerosis and type 2 diabetes mellitus (DM2) is among the greatest risk factors for this disease. It is believed that lipoprotein (a) [Lp(a)] is linked to increased risk of atherosclerosis, although the mechanisms responsible for that are not widely known. Elevated levels of Lp(a) seem to be associated with a higher risk of coronary artery disease (CAD), as well as PAOD and cerebrovascular disease. OBJECTIVES: To assess the plasma levels of Lp(a) and other lipid parameters in patients with PAOD and/or DM2. Material and methods: Plasma levels of Lp(a), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG) and apolipoproteins A-I and B were measured in blood samples of 12 subjects carrying neither PAOD nor DM2 (control group), 17 patients with PAOD, 18 with DM2 and 19 with both PAOD and DM2. The subjects selected for this study showed homogeneity and no statistical difference for gender, age, and socioeconomic status. RESULTS: The Lp(a) showed a tendency to elevation both in groups PAOD only and PAOD + DM2 simultaneously. Significant differences were observed among the groups as to HDL-c and apolipoprotein A-I levels, with positive correlation between these two parameters. TC/HDL-c ratio showed significant difference among the groups. Positive correlation was found between Lp(a) and LDL-c, and negative one, between the ankle-arm index and LP(a). CONCLUSION: As to the lipid parameters studied, significant statistical differences were found between HDL-c and apolipoprotein A-I plasma levels only. For Lp(a) parameter, higher plasma levels were observed in PAOD and PAOD + DM2, which have also shown concomitant and significant HDL-c reduction.

Apo B/Apo A-I ratio in central and peripheral arterial diseases

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

INTRODUÇÃO: O índice apo B/apo A-I representa o balanço entre partículas de colesterol potencialmente aterogênicas ricas em apo B e partículas anti-aterogênicas ricas em apo A-I. O objetivo deste estudo foi investigar a associação entre doenças ateroscleróticas em diferentes sítios anatômicos e o índice apo B/apo A-I. MÉTODOS: Lípides, lipoproteínas e apolipoproteínas A-I e B foram quantificados em 30 indivíduos apresentando doença arterial coronariana (DAC), 26 com acidente vascular cerebral (AVC), 34 apresentando doença arterial obstrutiva periférica (DAOP) e 38 indivíduos hígidos (grupo controle). RESULTADOS: HDLc e apo A-I apresentaram-se significativamente mais baixos nos grupos DAOP e DAC, respectivamente, quando comparados com os demais grupos. Níveis de triglicérides foram significativamente mais elevados nos grupos DAC e PAOD quando comparados com o grupo controle. Apo B foi significativamente mais elevada no grupo AVC quando comparado com os grupos controle e DAOP. O índice apo B/apo A-I se mostrou significativamente elevado nos grupos DAC e AVC quando comparados com os demais (p < 0,001). CONCLUSÃO: O índice apo B/apo A-I foi importante para identificar uma tendência aumentada para aterosclerose coronariana e cerebral. No entanto, os parâmetros avaliados não podem ser considerados de forma isolada, considerando que nenhuma associação foi demonstrada quando os dados foram analisados pelo modelo de regressão logística binária.

Eletroestimulação muscular: alternativa de tratamento coadjuvante para pacientes com doença arterial obstrutiva periférica / Muscle electrostimulation: alternative adjuvant treatment to patients with peripheral arterial obstructive disease

A doença arterial periférica faz parte de um grupo de patologias vasculares que evolui de forma lenta e progressiva. A proposta deste artigo foi avaliar, por meio de revisão bibliográfica, os possíveis benefícios da eletroestimulação crônica como tratamento coadjuvante para pacientes arteriopatas. De acordo com a literatura analisada, concluímos que a eletroestimulação é capaz de provocar alterações importantes no perfil metabólico das fibras musculares, convertendo-as do tipo II para o tipo I, o que induz o crescimento capilar, a densidade capilar e o suprimento de oxigênio. Desta forma, este recurso terapêutico aumenta a capacidade aeróbica oxidativa e a resistência à fadiga dos músculos isquêmicos. Assim, a eletroestimulação é mais um recurso terapêutico capaz de melhorar a habilidade para caminhar destes pacientes, diminuindo gastos com cirurgias de revascularização e complicações maiores.

Peripheral arterial disease is included in a group of vascular diseases whose evolution is slow and progressive. This article aimed at performing a literature review to evaluate the benefits of chronic electrostimulation as adjuvant treatment for arteriopathic patients. Based on the literature, we concluded that electrostimulation can generate important changes in the metabolic profile of muscle fibers, switching them from type II to type I, which leads to capillary increase, capillary density and suppression of oxygen. Therefore, this therapeutic resource increases aerobic oxidative capacity and ischemic muscle resistance to fatigue. Thus, electrostimulation is another therapeutic option able to improve these patients' walking ability, reducing expenses related to revascularization surgeries and major complications.