Avaliação de resistência à insulina e fatores de risco para doenças cardiovasculares em pacientes com vitiligo / Evaluation of insulin resistance and risk factors for cardiovascular diseases in patients with vitiligo

Introdução: A relação entre doença cardiovascular, resistência à insulina e vitiligo tem sido avaliada em estudos. No entanto, ainda não há consenso sobre o assunto. Objetivos: Avaliar a relação entre resistência à insulina e vitiligo, além da prevalência de fatores de risco para doença cardiovascular em adultos com vitiligo quando comparados ao grupo controle. Métodos: Estudo transversal com grupo controle. Foi utilizada uma amostra de conveniência de pacientes consecutivos com 14 anos ou mais. Pacientes e controles foram investigados com exames laboratoriais e medidas antropométricas. Foram calculados os índices LAP, HOMA-IR, e HOMAß. Resultados: Foram incluídos 130 pacientes, 73 com diagnóstico de vitiligo e 57 controles. Não houve diferença significativa entre os grupos quando avaliadas as medidas do LAP, HOMA-IR, e HOMAß. Dentre os fatores de risco para doença cardiovascular, a pressão arterial sistólica foi significativamente maior nos pacientes com vitiligo. Conclusões: Não foi observada maior prevalência de resistência à insulina entre pacientes com vitiligo. Quanto aos fatores de risco para doenças cardiovasculares, apenas a pressão arterial sistólica foi maior nos pacientes com vitiligo. Novos estudos são necessários para elucidar a prevalência de resistência à insulina e fatores de risco cardiovascular em pacientes com vitiligo.

Introduction: The relationship between cardiovascular disease, insulin resistance and vitiligo has been evaluated in studies. However, there is still no consensus on the subject. Objectives: To evaluate the relationship between insulin resistance and vitiligo, in addition to the prevalence of risk factors for cardiovascular disease, in adults with vitiligo when compared to the control group. Methods: Cross-sectional study with a control group. A convenience sample of consecutive patients aged 14 years and over was used. Patients and controls were assessed with laboratory tests and anthropometric measurements. The LAP, HOMA-IR, and HOMAß indices were calculated. Results: We included 130 patients, 73 with a diagnosis of vitiligo and 57 controls. There were no significant differences between groups when LAP, HOMA-IR, and HOMAß were evaluated. Among the risk factors for cardiovascular disease, systolic blood pressure was significantly higher in patients with vitiligo. Conclusions: There was no higher prevalence of insulin resistance among patients with vitiligo. Regarding the risk factors for cardiovascular diseases, only systolic blood pressure was higher in patients with vitiligo. Further studies are needed to elucidate the prevalence of insulin resistance and cardiovascular risk factors in patients with vitiligo.

Effectiveness of physical exercise to reduce cardiovascular risk factors in youths: a randomized clinical trial.

BACKGROUND: The aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents. METHODS: A randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home. RESULTS: A total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14. CONCLUSION: A low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors.