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

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

Abordagem da dislipidemia na síndrome dos ovários policísticos / Management of dyslipidemia in polycystic ovary syndrome

A dislipidemia é um distúrbio metabólico frequente na síndrome dos ovários policísticos (SOP) e, possivelmente, contribui para um aumento do risco de doenças cardiovasculares. A avaliação do risco cardiovascular de cada paciente define as metas lipídicas a serem atingidas por meio da terapêutica recomendada para a correção da dislipidemia. Alimentação saudável, perda de peso e implementação de um programa regular de atividade física contribuem para a melhora do perfil lipídico. A terapia farmacológica deve ser reservada para as pacientes que não atingiram as metas lipídicas após modificações na dieta e regularização da atividade física ou nas pacientes com alto risco cardiometabólico.(AU)

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

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

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea.

OBJECTIVE: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Increasing the chances of natural conception: opinion statement from the the brazilian federation of gynecology and obstetrics associations - FEBRASGO committee of gynecological endocrinology / Aumentando as chances de concepção natural: parecer da comissão nacional de ginecologia endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia

Abstract Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.

Resumo Uma vez que mitos e equívocos sobre a procriação natural se espalham rapidamente na era do fácil acesso à informação e às redes sociais, o aconselhamento adequado sobre a fertilidade natural e a concepção espontânea deve ser encorajado em qualquer tipo de assistência à saúde. Apesar do fato de não haver evidências fortes sobre qualquer dos aspectos relacionados à fertilidade natural, existe literatura sobre como aumentar as chances de uma gravidez espontânea. No presente artigo, a Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) oferece sugestões para otimizar o aconselhamento a pessoas que tentam a concepção espontânea, na ausência do diagnóstico de infertilidade.

Increasing the Chances of Natural Conception: Opinion Statement from the the Brazilian Federation of Gynecology and Obstetrics Associations - FEBRASGO - Committee of Gynecological Endocrinology.

Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.

Uma vez que mitos e equívocos sobre a procriação natural se espalham rapidamente na era do fácil acesso à informação e às redes sociais, o aconselhamento adequado sobre a fertilidade natural e a concepção espontânea deve ser encorajado em qualquer tipo de assistência à saúde. Apesar do fato de não haver evidências fortes sobre qualquer dos aspectos relacionados à fertilidade natural, existe literatura sobre como aumentar as chances de uma gravidez espontânea. No presente artigo, a Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) oferece sugestões para otimizar o aconselhamento a pessoas que tentam a concepção espontânea, na ausência do diagnóstico de infertilidade.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

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

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

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

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

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

Avaliação da reserva ovariana na predição do mau prognóstico reprodutivo: quando e como investigar / Ovarian reserve evaluation in the prediction of poor reproductive prognosis: when and how to investigate?

Muitas vezes, torna-se um grande desafio para o ginecologista a identificação daquelas com maior ou menor chance de concepção. Vários marcadores laboratoriais e ultrassonográficos, conhecidos conjuntamente como testes de avaliação da reserva ovariana, são estudados há décadas com a intenção de se buscar uma ferramenta para a predição do potencial reprodutivo. E, embora ainda se busquem os marcadores ideais para aplicação clínica, mais difícil do que os definir é definir quando eles estão indicados. Este artigo de atualização, assinado pela Comissão Nacional Especializada em Ginecologia Endócrina da Febrasgo, pretende oferecer ao leitor as ferramentas necessárias para o uso racional dos testes de avaliação da reserva ovariana no cotidiano.(AU)

Often, it becomes a great challenge for the gynecologist to identify women with a greater or lesser chance of conception. Several laboratory and ultrasound markers, known jointly as ovarian reserve evaluation tests, have been studied for decades with the intention of seeking a tool for the prediction of reproductive potential. And, while the ideal markers for clinical application are still sought, defining them is as harder as defining when they are indicated. This update article, signed by the National Specialized Committee on Gynecologic Endocrinology, Febrasgo, intends to offer the reader the necessary tools for the rational use of ovarian reserve evaluation tests in daily practice.(AU)

Prevention of peritoneal adhesion using a bacterial cellulose hydrogel, in experimental study.

PURPOSE: To analyze the effectiveness of bacterial cellulose hydrogel as a barrier in preventing postoperative peritoneal adhesion in rat model. METHODS: Experimental study with 45 Wistar rats (Rattus norvegicus) that were divided into three groups for the following treatments: A. Saline, B. Oxidized Regenerated Cellulose (ORC) barrier, and C Bacterial Cellulose Hydrogel (BCH) barrier. After 45 days of the surgery the adhesions were classified and graded according to the qualitative score. The histological parameters were evaluated using a modified semi-quantitative scale to rate the extent of fibrosis, inflammatory reaction and vascular proliferation. RESULTS: Compared with the saline group (A), the treatments with ORC barrier (B) and BHC barrier (C) resulted in a smaller number of adhesions (p=0.019 and p=0.003 on Fisher's exact test, respectively). Data from inflammation and neovascularization showed no statistically significant difference between the groups BHC and ORC (p=0.426 and 0.446 on chi-square test, respectively). CONCLUSION: Bacterial cellulose hydrogel is effective as a bio-re-absorbable barrier for preventing postoperative peritoneal adhesions.

Prevention of peritoneal adhesion using a bacterial cellulose hydrogel, in experimental study

PURPOSE: To analyze the effectiveness of bacterial cellulose hydrogel as a barrier in preventing postoperative peritoneal adhesion in rat model. METHODS: Experimental study with 45 Wistar rats (Rattus norvegicus) that were divided into three groups for the following treatments: A. Saline, B. Oxidized Regenerated Cellulose (ORC) barrier, and C Bacterial Cellulose Hydrogel (BCH) barrier. After 45 days of the surgery the adhesions were classified and graded according to the qualitative score. The histological parameters were evaluated using a modified semi-quantitative scale to rate the extent of fibrosis, inflammatory reaction and vascular proliferation. RESULTS: Compared with the saline group (A), the treatments with ORC barrier (B) and BHC barrier (C) resulted in a smaller number of adhesions (p=0.019 and p=0.003 on Fisher's exact test, respectively). Data from inflammation and neovascularization showed no statistically significant difference between the groups BHC and ORC (p=0.426 and 0.446 on chi-square test, respectively). CONCLUSION: Bacterial cellulose hydrogel is effective as a bio-re-absorbable barrier for preventing postoperative peritoneal adhesions. .

Qualidade do sono e tolerância ao esforço em portadores de apneia obstrutiva do sono / Sleep quality and stress tolerance in patients with obstructive sleep apnea / Calidad del sueño y la tolerancia al estrés en pacientes con apnea obstructiva del sueño

INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente associada com piores indicadores de saúde. A qualidade do sono pode ser medida objetiva e subjetivamente por métodos como a polissonografia, que é o padrão de referência, ou por meio de testes e questionários, como o índice de qualidade de sono de Pittsburgh (IQSP). OBJETIVO: Correlacionar a qualidade do sono com a tolerância ao esforço em pacientes portadores da síndrome da apneia/hipopneia obstrutiva do sono (SAHOS). MÉTODOS: Participaram do estudo 63 indivíduos (57 mulheres e seis homens), média de idade de 51,7 ± 6,6 anos; índice de massa corpórea (IMC) média de 28,2 ± 5,0 kg/m2); índice de apneia/hipopneia (IAH) médio de 7,3 ± 10,50 eventos/hora, verificado através da polissonografia. Para a avaliação da qualidade do sono, os participantes responderam ao IQSP, e para a avaliação da tolerância ao esforço, realizaram o teste de caminhada de 6 minutos (TC6M). RESULTADOS: Não houve correlação entre o IQSP e o TC6M (Rs = -0,103620, p = 0,419), assim como entre o IAH e o TC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que a qualidade do sono e a gravidade da SAHOS não afetam a tolerância ao esforço dos indivíduos com SAHOS. CONCLUSÃO: Estudos com uma amostra maior, levando-se em consideração a estratificação pela gravidade da SAHOS e utilizando métodos mais acurados de avaliação da capacidade funcional, devem ser realizados, a fim de que resultados mais abrangentes possam ser obtidos. .

INTRODUCTION: Sleep is a natural and recurring state, in which important neurobiological processes take place. Poor quality of sleep is directly associated with worse health indicators. Sleep quality can be measured objectively and subjectively by methods such as polysomnography, which is the gold standard, or tests and questionnaires as the Sleep Quality Index in Pittsburgh (PSQI). OBJECTIVE: To correlate the quality of sleep with exercise tolerance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: The study included 63 subjects (57 women and 6 men) aged 51.7 ± 6.6 years, with body mass index (BMI) 28.2 ± 5.0 kg/m2,apnea/hypopnea index (AHI) 7.3±10:50 events/hour, assessed by polysomnography. To assess the quality of sleep, participants responded the PSQI instrument and were submitted to the exercise tolerance test through the 6-minute walk test (6MWT). RESULTS: There was no correlation between the PSQI and the 6MWT (Rs = -0.103620, p = 0.419), and between the 6MWT and the AHI (R = -0, 000984, p = 0.9939). According to the results of this work, we suggest that the quality of sleep and the severity of OSAHS did not affect the exercise tolerance of individuals with OSAHS. CONCLUSION: Studies with a larger sample, taking into account the stratification by severity of OSAHS and using more accurate methods of functional capacity evaluation should be conducted, so that more comprehensive results can be obtained. .

INTRODUCCIÓN: El sueño es un estado natural y recurrente durante el cual acontecen procesos neurobiológicos importantes. La mala calidad del sueño está asociada directamente con peores indicadores de salud. La calidad del sueño puede ser medida objetiva y subjetivamente mediante métodos como la polisomnografía,, que es el estándar de referencia, o pruebas y cuestionarios como el índice de calidad de sueño de Pittsburgh (ICSP), OBJETIVO: Correlacionar la calidad del sueño con la tolerancia al esfuerzo en pacientes portadores del síndrome de la apnea/hipopnea obstructiva del sueño (SAHOS). MÉTODOS: Participaron en el estudio 63 individuos (57 mujeres y seis hombres), edad promedio de 51,7 ± 6,6 años; índice de masa corpórea (IMC) 28,2 ± 5,0 kg/m2); índice de apnea/hipopnea (IAH) 7,3 ± 10,50 eventos/hora, verificado por medio de la polisomnografía. Para la evaluación de la calidad del sueño, los participantes respondieron al ICSP y para la evaluación de la tolerancia al esfuerzo, realizaron la prueba de caminata de 6 minutos (PC6M). RESULTADOS: No hubo correlación entre el ICSP y la PC6M (Rs = -0,103620, p = 0,419), ni entre el IAH y la PC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que la calidad del sueño y la gravedad del SAHOS no afectan a la tolerancia al esfuerzo de los individuos con SAHOS. CONCLUSIÓN: Se deben realizar los estudios con una muestra mayor, teniéndose en consideración la estratificación según la gravedad del SAHOS y utilizándose métodos más precisos para evaluación de la capacidad funcional, a fin de que se puedan obtener resultados de más alcance. .