High fitness is associated with a better cardiovascular risk profile in patients with type 2 diabetes mellitus.

Novel cardiovascular risk markers, such as ambulatory blood pressure (BP) and aortic stiffness, have been proposed. The aim of this study was to investigate the relationship between physical fitness and some of these risk markers in 575 type 2 diabetic patients. In a cross-sectional design, clinical, laboratory, echocardiographic, aortic pulse wave velocity and 24-h ambulatory BP monitoring data were obtained. Fitness was self-reported using a standard questionnaire of daily activities, and then assessed as belonging to one of the three categories: low (<4 metabolic equivalents (METs)), moderate (≥ 4 to <7 METs) and high fitness (≤ 7 METs). In a random sub-sample of 265 patients, self-reported fitness was confirmed by a standard treadmill test. Statistical analysis was carried out, using tests including bivariate tests among the three categories and multivariate logistic regression. Agreement between self-reported and measured fitness was substantial (weighted κ: 0.63). High fitness patients were younger, frequently male, had a decreased prevalence of degenerative complications, lower office and ambulatory BP levels, particularly during the night and had an increased prevalence of the normal nocturnal dipping pattern. High fitness patients also had lower hemoglobin A1c and C-reactive protein levels, a decreased prevalence of left ventricular hypertrophy and increased aortic stiffness. On multiple logistic regression, after adjustments for several confounders, high fitness was independently associated with a higher likelihood of having low C-reactive protein (odds ratio (OR): 2.3, 95% confidence interval (CI): 1.3-3.9), controlled nighttime BP (OR: 2.3, 95% CI: 1.4-3.8), normal dipping pattern (OR: 2.1, 95% CI: 1.2-3.5) and low aortic stiffness (OR: 2.5, 95% CI: 1.3-4.8). Patients with moderate fitness had intermediate OR. In conclusion, a moderate to high level of physical fitness was independently associated with several favorable intermediate cardiovascular risk markers, which may contribute to decreasing the burden of morbi-mortality in patients with type 2 diabetes.

Perceived health status of women with overt and subclinical hypothyroidism.

OBJECTIVE: The objective of this study was to investigate the health status of women with overt and subclinical hypothyroidism and relate it to the presence of clinical signs and symptoms of the disease. SUBJECTS AND METHODS: A cross-sectional study was conducted on 232 women divided into 3 groups: overt hypothyroidism (n = 14); subclinical hypothyroidism (n = 152), and controls (n = 66). Health status was evaluated by the questionnaire SF-36, and the clinical signs and symptoms of hypothyroidism were assessed with the Billewicz scale modified by Zulewski. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction was applied to compare continuous variables between the groups. To assess the relationship between SF-36 domains and the clinical score, as well as SF-36 domains and serum thyroid-stimulating hormone levels, the Spearman correlation coefficient was calculated. RESULTS: Patients with overt hypothyroidism presented systematically lower scores in all SF-36 domains (p < 0.05), both in relation to subclinical hypothyroidism patients and controls. This indicates a great dissatisfaction with health status in this group. Patients with subclinical hypothyroidism presented statistically lower scores in relation to controls with the exception of the role-emotional and bodily pain domains, where although they were not statistically significant, scores were clinically different. Highly negative correlations between SF-36 domains and the clinical score were observed in overt hypothyroidism (physical function r = -0.80, p < 0.01; bodily pain r = -0.74, p < 0.01). CONCLUSION: Overt hypothyroidism seemed to be associated with worse perception of health status, negatively associated with clinical score.