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.

Impacto do hipotireoidismo subclínico na resposta cárdio-pulmonar em esforço e na recuperação / Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery

No intuito de identificar as manifestações clínicas do hipotireoidismo subclínico (HS) durante o estresse físico e na recuperação, foram comparadas 15 portadoras de HS com 16 mulheres saudáveis através de um teste cárdio-pulmonar em esteira ergométrica. Análise das médias obtidas através do Mann-Whitney U Test. As pacientes obtiveram valores menores no pico do exercício para fração expirada de O2 (14,90 ± 1,05 x 16 ± 1,14 por cento; p = 0,014); na variação da pressão arterial sistólica (34,33 ± 17,92 x 52,50 ± 17,22; p = 0,009); na duração do exercício (8,83 ± 2,91 x 14,5 ± 5,63 min; p = 0,0005), na carga máxima de teste (11,6 ± 4,22 x 18,94 ± 5,45 por cento; p = 0,0004), além de tendências na razão de trocas gasosas e na freqüência cardíaca de pico. Entre o primeiro e o terceiro minutos de recuperação, houve uma redução média de 0,71 mmHg na pressão arterial diastólica para essas pacientes, comparado a 5,33 mmHg das mulheres saudáveis (p = 0,0009) (recuperação mais lenta). Pode-se inferir que o HS é capaz de causar disfunções cárdio-pulmonares, com maior sensibilidade para os parâmetros previamente citados.

In order to identify the characteristics of subclinical hypothyroidism (SH) during physical stress and its recovery, 15 SH patients and 16 healthy women were compared by a treadmill cardiopulmonary test. Means of variables were analyzed by the Mann-Whitney U test. Patients obtained lower values for peak expired fraction of O2 (14.90 ± 1.05 x 16 ± 1.14 percent; p = 0.014); systolic blood pressure variation (34.33 ± 17.92 x 52.50 ± 17.22; p = 0.009); exercise duration (8.83 ± 2.91 x 14.5 ± 5.63 min; p = 0.0005), maximal test load (11.6 ± 4.22 x 18.94 ± 5.45 percent; p = 0.0004), as well as tendencies in gas exchange ratio and peak heart rate. Between the first and the third recovery minutes, there was a reduction of only 0.71 mmHg in the diastolic blood pressure, whereas there was a 5.33-mmHg reduction to control group (p = 0.0009) (slower recovery of patients). It is presumable that SH may cause cardiopulmonary dysfunctions, with higher sensibility to the parameters previously cited.

[Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery]. / Impacto do hipotireoidismo subclínico na resposta cárdio-pulmonar em esforço e na recuperação.

In order to identify the characteristics of subclinical hypothyroidism (SH) during physical stress and its recovery, 15 SH patients and 16 healthy women were compared by a treadmill cardiopulmonary test. Means of variables were analyzed by the Mann-Whitney U test. Patients obtained lower values for peak expired fraction of O2 (14.90+/-1.05 x 16+/-1.14%; p = 0.014); systolic blood pressure variation (34.33+/-17.92 x 52.50+/-17.22; p = 0.009); exercise duration (8.83+/-2.91 x 14.5+/-5.63 min; p = 0.0005), maximal test load (11.6+/-4.22 x 18.94+/-5.45%; p = 0.0004), as well as tendencies in gas exchange ratio and peak heart rate. Between the first and the third recovery minutes, there was a reduction of only 0.71 mmHg in the diastolic blood pressure, whereas there was a 5.33-mmHg reduction to control group (p = 0.0009) (slower recovery of patients). It is presumable that SH may cause cardiopulmonary dysfunctions, with higher sensibility to the parameters previously cited.