Uncovering the Relationship Between Statins and Muscle Problems in the ELSA-Brasil MSK Cohort.

PURPOSE: To investigate the association between statins and muscle problems in a highly diverse sample of Brazilian civil servants. METHODS: We conducted a cross-sectional data analysis at baseline of the ELSA-Brasil MSK cohort. Pain was identified through self-reported symptoms in large muscle groups (lower back and/or hips/thighs). Muscle strength was assessed using the five-times-sit-to-stand (FTSTS) and handgrip tests, with weakness defined as the lowest and highest quintiles of age- and sex-stratified handgrip strength and FTSTS performance time, respectively. Multivariable logistic regression analyses were conducted to investigate the association between statin use and muscle pain and weakness. Secondary analyses explored the impact of different types of statins and their duration of use on the response variables. RESULTS: A total of 2156 participants (mean age 55.6 ± SD 8.9, 52.8% women) were included, of whom 21.1% were taking statins and 25.1% reported muscle pain. We found no significant association between statin use and muscle problems. Secondary analysis on different types of statins revealed an association between atorvastatin and muscle weakness, as measured by the five-times-sit-to-stand test (OR 1.94, 95% CI 1.12-3.37), but not by the handgrip test (OR 0.75, 95% CI 0.29-1.42). No evidence was found to support a link between the duration of statin treatment and muscle problems. CONCLUSIONS: This study challenges previous claims of an efficacy-effectiveness gap between experimental and observational literature on statins. The findings indicate that statin use does not contribute to muscular problems.

Ultra-processed foods: Cross-sectional and longitudinal association with uric acid and hyperuricemia in ELSA-Brasil.

BACKGROUND AND AIMS: Food intake influences uric acid (UA) levels and hyperuricemia (HU), but evidence on the role of ultra-processed foods (UPFs) are scarce. The association between UPFs consumption and (1) HU prevalence and UA levels; (2) HU cumulative incidence; and (3) UA level change over a 4-year period was investigated. METHODS AND RESULTS: Cross-sectional and longitudinal analyses were performed using baseline (2008-2010, aged 35-74 years) and second visit (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants with glomerular filtration rate <60 mL/min/1.73 m2, bariatric surgery, implausible caloric intake, and using urate-lowering therapy (ULT) at baseline were excluded (all analyses). Participants with HU at baseline were excluded from longitudinal analyses. UPFs consumption was assessed using a food frequency questionnaire (FFQ) and categorized by the NOVA classification system (100 g/day). HU was defined as UA≥6.8 mg/dL. Linear, logistic, and mixed-effect linear regressions investigated the associations between UPFs consumption and UA/HU, adjusted for covariates. The final samples included 13,923 (cross-sectional) and 10,517 (longitudinal) individuals. The prevalence of HU was 18.7%, and the cumulative incidence was 4.9%. Greater UPFs consumption was associated with a greater prevalence of HU (OR:1.025 95%CI: 1.006; 1.044) and higher UA levels (ß:0.024 95%CI: 0.016; 0.032). Every additional consumption of 100 g/day of UPFs raised the 4-year cumulative incidence of HU by 5.6% (95%CI: 1.021; 1.092). However, UPFs were not associated with the pace of UA level changes during the study period. CONCLUSION: The present study shows that greater UPFs consumption is associated with another deleterious health consequence: higher UA levels and the risk of having HU.

Serum uric acid is a predictive biomarker of incident metabolic syndrome at the Brazilian longitudinal study of adult Health (ELSA - Brasil).

AIM: To investigate whether serum uric acid (SUA) levels and hyperuricemia can be predictive biomarkers of incident metabolic syndrome(MS) among different body mass index(BMI) categories, and to investigate SUA cutoffs that best discriminate individuals with incident MS. METHODS: We analyzed 7,789 participants without MS at baseline of ELSA-Brasil study. Logistic regression models were performed to evaluate associations between incident MS and SUA levels/hyperuricemia, expressed by odds ratios(ORs) and confidence intervals(95 % CI). RESULTS: We found 1,646 incident MS cases after a median follow-up of 3.8[3.5-4.1] years. Incident MS was present among 8.3 % (n = 290) of participants with normal weight, 28.3 % (n = 850) with overweight, 39.8 % (n = 506) with obesity. Among incident MS participants of total sample, 33.0 % had hyperuricemia [SUA > 6.0 mg/dL (356.9 µmol/L)]. After all adjustments, SUA was independently prognostic of incident MS: for each 1 mg/dL increase in SUA the odds of incident MS were 45 % higher (OR1.45[CI95 %1.34-1.55 p <.01]). Associations were found for those presenting normal weight, overweight and obesity (OR1.43[CI95 %1.31-1.57 p <.01; OR1.22[CI95 %1.13-1.32 p <.01]; and OR1.16[CI95 %1.04-1.29 p <.05]) respectively. Hyperuricemia was independently associated with incident MS (OR1.88[CI95 %1.49-0.2.36 p <.01]). The SUA cut point level maximizing sensitivity and specificity in the discrimination of incident MS was 5.0 mg/dL. CONCLUSIONS: SUA level is an independent predictive biomarker of incident MS at all BMI categories.

Thyrotropin level and cognitive performance: Baseline results from the ELSA-Brasil Study.

BACKGROUND AND AIMS: The role of subtle thyroid alterations, such as subclinical thyroid disease and low/high serum thyrotropin (TSH) within the normal range, on cognitive decline is controversial. The aim of this study was to evaluate the association of serum TSH and subclinical thyroid dysfunction with performance on cognitive tests in a large sample of Brazilian middle-aged adults without overt thyroid disease. METHODS: In this cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health, we excluded individuals aged 65 years and older, with overt thyroid dysfunction, prevalent stroke, in use of medications that affect thyroid function or that indicate neurologic diseases, and from Asian or indigenous ethnicity. Thyroid status was assessed by serum TSH and free thyroxine (only when the TSH was altered). Individuals were divided according to TSH tertiles and classified according to thyroid function as euthyroidism, subclinical hypothyroidism, or subclinical hyperthyroidism. Cognition was evaluated using delayed word recall test, semantic verbal fluency test, and trail making test version B. The associations of cognitive tests performance with TSH tertiles (using the middle tertile as reference) and thyroid function were investigated using linear regression models, adjusted for an extensive set of possible confounders (sociodemographic characteristics, cardiovascular risk factors, and depression). RESULTS: The mean age of the 10,362 participants was 49.5±7.4years, 52.3% women. After adjustment for confounders, the first TSH tertile was associate with worse performance on the trail making test (ß=-0.05, 95% CI=-0.09; -0.01, p=0.017). When restricting the analysis to the 9769 individuals with TSH within the normal range, the association between TSH and performance on the trail making test remained significant (ß=-0.05, 95% CI=-0.09; -0.01, p=0.020) on multiple linear regression. Subclinical thyroid disease was not associated with performance on cognitive tests. CONCLUSION: Low TSH is associated with poorer performance on an executive function test in middle-aged adults without overt thyroid dysfunction.