Ana Marice Ladeia

Assessment of cardiovascular risk factors in a rural community in the Brazilian state of Bahia

OBJECTIVE To assess the frequency of cardiovascular risk factors in the rural community of Cavunge, in the Brazilian state of Bahia. METHODS A cross-sectional study was carried out with 160 individuals (age>19 years) randomly drawn from those listed in the population census of the Cavunge Project. The following parameters were studied: arterial hypertension, dyslipidemia, diabetes, obesity, smoking, waist-hip ratio (WHR), physical activity, and overall cardiovascular risk classified according to the Framingham score. The assessing parameters used were those established by the III Brazilian Consensus on Hypertension and the II Brazilian Consensus on Dyslipidemia. RESULTS Of the randomly drawn individuals, 126 with a mean age of 46.6 +/- 19.7 years were included in the study, 43.7% of whom were males. The frequency of arterial hypertension was 36.5%; 20.4% of the individuals had cholesterol levels > or =240 mg/dL; 31.1% of the individuals had LDL-C levels >130 mg/dL; 4% were diabetic; and 39.7% had a high-risk Framingham score. Abdominal obesity was observed in 41.3% of the population and in 57.7% of the females. High caloric-expenditure (HCE) physical activities were performed by 56.5% of the individuals. The HCE group had a greater frequency of normal triglyceride levels (63% vs 44%; P=0.05), no diabetes, and WHR tending towards normal (46% vs 27%, P=0.08) as compared with those in the low caloric-expenditure group. CONCLUSION Cardiovascular risk factors, such as hypertension and hypercholesterolemia, are frequently found in rural communities. The greatest frequency of normal triglyceride levels and normal WHR in the HCE group reinforces the association between greater caloric expenditure and a better risk profile.

C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted

Alanine Aminotransferase and High Sensitivity C-Reactive Protein: Correlates of Cardiovascular Risk Factors in Youth

OBJECTIVE The association between high-sensitivity C-reactive protein (hs-CRP) and alanine aminotransferase (ALT) with clinical/metabolic variables was evaluated in overweight Brazilian children and adolescents. STUDY DESIGN Oral glucose tolerance test was performed in 407 students (273 overweight/obese, 11.3 +/- 3.1 y). Measurements included body mass index (BMI), waist circumference (WC), blood pressure, lipids, insulin, hs-CRP, and ALT. Overweight/obese was defined using BMI z-score; insulin resistance (IR) by homeostatic model assessment: insulin resistance (HOMA-IR); and metabolic syndrome (MS) in accordance with the modified NCEP-ATPIII. RESULTS As weight increased, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), insulin, HOMA-IR, hs-CRP, ALT, ALT, hs-CRP, and AST and the number of MS components (nMSc) also increased (P </= .001 for all). Subjects with hs-CRP and ALT above the median had higher BMI z-score, WC, SBP, DBP, TG, AST, insulin, HOMA-IR, and nMSc than those with both markers below the median (P </= .002 for all). After adjustment for age, sex and ethnicity, BMI z-score (OR, 1.5; CI, 1.38 to 1.86; P < .001), WC (OR,1.3; CI, 1.19 to 1.43; P < .001) SBP (OR, 1.2; CI, 1.03 to 1.38; P = .015), DBP (OR, 1.4; CI, 1.15 to 1.69; P < .001), TG (OR, 1.8; CI, 1.29 to 2.62; P < .001), insulin (OR, 1.4; CI, 1.23 to 1.71; P < .001), HOMA-IR (OR, 1.2; CI, 1.09 to 1.29; P < .001) and nMSc (OR, 2; CI, 1.16 to 3.47; P = .012) were independently associated with high ALT and hs-CRP. For every 5-cm increase in WC and every 1-point increase in BMI z-score, there were a 1.3- and 1.5-fold greater chance of having increased ALT and hs-CRP, respectively. CONCLUSIONS Simultaneous measurements of ALT and hs-CRP should be considered as a screening test for metabolic syndrome and cardiovascular disease risk factors in overweight/obese children/adolescents.

Prognostic value of endothelial dysfunction in type 1 diabetes mellitus

Patients with diabetes mellitus are at high risk of developing atherosclerosis, associated with higher rates of micro and macro vascular involvement such as coronary artery disease and renal disease. The role of hyperglycemia to induce synthesis of reactive oxygen species by the oxidation of glucose, leading to an increased production of advanced glycosylation end products, as well as inflammation and oxidative stress has been proposed as a possible mechanism in the pathogenesis of endothelial dysfunction (ED). The interaction between C-peptide - the connecting segment of pro-insulin-and nitric oxide in vasodilation is also discussed. Therefore, endothelial dysfunction has been identified as an early marker of vascular disorder in type 1 and type 2 diabetes mellitus. In some other diseases, ED has been considered an independent predictor of vascular disease, regardless of the method used. Studies have demonstrated the importance of endothelial dysfunction as an useful tool for identifying the risk of vascular complications in patients with type 1 diabetes mellitus, particularly as regards to renal impairment. The aim of this review is to clarify the prognostic value of endothelial dysfunction as a marker of vascular disease in these subjects.

C-Reactive Protein Is Not Correlated With Endothelial Dysfunction in Overweight and Obese Women

Background Obesity is a complex and multifactorial disease, has an inflammatory pattern and is associated with higher cardiometabolic risk. There are recent reports associating an elevated C-Reactive Protein (CRP) with a microscopic endothelial dysfunction. The objective is to evaluate if there is an association between serum levels of CRP and endothelial function in women with overweight/obesity, as well as the correlation between CRP and anthropometric variables. Methods This is a cross-sectional study that analyzed secondary data from patients treated in an institution of tertiary education, as part of the weight excess and cardiometabolic disease survey. The study included patients with overweight/obesity who had CRP and endothelial function tests already made and inserted into the survey database. The endothelial function was evaluated by: reactive hyperemia test (endothelium-dependent vasodilation). All tests were recorded and later analyzed by the same echocardiographer who performed the examination. Statistical analyses were realized in the Statistical Package for the Social Sciences (SPSS) version 14. It was considered statistically significant a P value < 0.05. Results This study included 47, nonsmoker women. with a BMI of 32.37 ± 5.06 kg/m2, median of CRP of 2.59 mg/L and flow-mediated dilation (FMD) of 8.75% ± 5.22%. There was no correlation between CRP and endothelial dysfunction in this population (rs = 0.08, P = 0.64). No correlation was observed between CRP and BMI. There were no differences of endothelial dysfunction variables and CRP in groups in use or not of medications (Hypolipidemic, antihypertensives and hypoglycemic agents). Conclusion There was no association between CRP and FMD and this can suggest that it is possible that the level of eNOS dysfunction associated with increased CRP is not enough to lead to macroscopic changes and harm vasodilation.

Comparação de biomarcadores inflamatórios entre pacientes diabéticos e não-diabéticos com angina instável

Summary Background: Studies comparing inflammatory activity between diabetic and non-diabetic individuals with acute coronary syndrome are scarce, and none including only patients with unstable angina (UA) has been published to date. Objective: We compared serum C-reactive protein (CRP), and interleukin-6(IL-6) between diabetic and non-diabetic patients with unstable angina (UA) to determine if difference in inflammatory activity is responsible for a worse prognosis in diabetic patients. We also evaluated the correlation between inflammatory markers and the metabolic profile in diabetic patients and the correlation between inflammatory response and in-hospital outcomes: death, acute myocardial infarction, congestive heart failure, and length of stay in hospital. Methods: A prospective cohort study of 90 consecutive patients admitted to a chest pain unit with UA and divided into two groups, diabetic and non-diabetic. Serum CRP, IL-6, metabolic profile and leukocyte count were measured at hospital arrival.

Sensorineural hearing loss in children with sickle cell anemia and its association with endothelial dysfunction

ABSTRACT Objectives: To investigate the prevalence of sensorineural hearing loss (SNHL) in children and adolescents with sickle cell anemia (SCA) and its association with endothelial dysfunction (ED). Methods: Fifty-two participants with stable SCA and 44 apparently healthy (AA genotype) participants aged 6–18 years were evaluated for pure tone audiometry and endothelial function using ultrasonographic imaging of the brachial artery to assess flow-mediated dilation (FMD). Laboratory analysis of the lipid profile and C-reactive protein levels was performed. Results: In the SCA group, 15 (28.8%) patients presented with SNHL. The FMD values were reduced in the SCA with SNHL group compared with the SCA without SNHL and healthy groups. Logistic regression analysis showed that FMD was associated with SNHL independent of the lipid profile and SCA characteristics (odds ratio [95% confidence interval] = 0.614 [0.440–0.858]; p = 0.004). Discussion: SNHL is a common complication in SCA; furthermore, this study identified a significant association between ED and SNHL. Damage to the vascular endothelium because of inflammation in SCA reduced blood flow in the inner ear. Thus, this circulatory disorder culminates in vaso-occlusive process and induces auditory disorders, such as SNHL.

Retraction: Update to "C-reactive protein and metabolic syndrome in youth: a strong relationship?".

TO THE EDITOR: We are part of a research group on childhood obesity and made a cross-sectional study with a large sample of normal weight and overweight/obese children and adolescents that had never been studied before under these conditions. Based on the literature, C-reactive protein (CRP) and alanine aminotransferase (ALT) are defined as good markers for cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2), respectively, but separately. As obesity, CVD, and DM2 are increasing in this age group, one of our objectives was to find a reliable and readily available surrogate marker for both CVD and DM. In this way, we divided the population into four groups by BMI and these groups were further subdivided into four groups based on ALT and CRP median scores, trying to confirm our hypothesis that simultaneous measurements of ALT and CRP are better than the isolated measures as a screening test for metabolic disturbances and CVD. These conclusions we sent to a journal and after several contacts/corrections/improvements were accepted by the Journal of Pediatrics (date of submission 19 March 2007; date of decision: 6 July 2007). In the same period, we hypothesized that CRP is related to metabolic syndrome (MS). To confirm our hypothesis, we studied the same population based on the presence or absence of MS and the analyses were performed based on MS. Then, the population was divided according to CRP quartiles, in an attempt to confirm the importance of this marker in MS. As we believe that obesity is the basis of insulin resistance, and that this state is very important with regard to the development of MS, our aim was to carry out a statistical analysis of all MS components, in order to find the most important element that influences CRP levels. We concluded that obesity, in this population, never studied before, is probably the major determining factor for elevated CRP, an indication of a precocious proinflammatory state. These data were sent almost simultaneously to Journal of Pediatrics and then to Obesity and once again after much work the paper was accepted (date of submission: 24 May 2007; date of decision: 6 September 2007). These data were sent to different journals just because the focuses of the two papers are different. We realized that we had different ideas, objectives, and hypotheses, leading to different statistical analyses, results, and conclusions and we didn’t send copies of the papers to the journals (Journal of Pediatrics and Obesity) just because we didn’t know whether the data would be accepted and published. We are aware of the rules for publications and author guidelines, and would never intentionally publish the same data in two journals, for ethical reasons. If you still consider our arguments inconclusive, our team of researchers respectfully requests that you retract the publication of our article from Obesity.

Elevation of Oxidized Lipoprotein of Low Density in Users of Combined Oral Contraceptives

Background The use of combined oral contraceptive (COC) has been related to changes in glycemic, lipid metabolism, increased oxidative stress, and systemic blood pressure, which could suggest a higher oxidation of low-density lipoprotein cholesterol (LDL-cholesterol) in women on use of COC. Objective To test the hypothesis that there is a difference in the plasma values of oxidized LDL among women who use and do not use COC, as well as to evaluate the correlation between it and the lipid profile and high-sensitivity C-reactive protein (hs-CRP). Methods Forty-two women with ages between 18 and 35 years old, who were eutrophic, irregularly active, with triglycerides < 150 mg/dL, blood glucose < 100 mg/dL, and who used or did not use COC were selected. These women were allocated in the COC group, formed by 21 women on COC use for at least 1 year; and a control group (CG), consisting of 21 women who had not used any type of hormonal contraceptive for at least 1 year. A significance level of 5% was adopted for statistical analyses. Results It was observed that GCOC showed higher values of oxidized LDL than the CG, respectively 384 mU/mL versus 283 mU/mL (p < 0.01). A positive correlation between oxidized LDL and LDL-cholesterol (r = 0.3, p < 0.05), with total cholesterol (r = 0.47, p < 0.01) and with triglycerides (r = 0.32, p < 0.03) was observed, and there was no correlation with the hs-CRP. In the categorized analysis of oxidized LDL, 71.4% of GCOC women, and 28.6% of the CG remained above the established cutoff point. Conclusion Women who use COC have higher plasma levels of oxidized LDL, and there is a positive correlation between oxidized LDL and other lipid variables.

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study

Background The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process. Objectives To investigate the cardiovascular (CV) mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil. Methods We assessed the mortality of indigenous populations (≥ 30 y/o) from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states). Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:9,10 Group 1 - less urbanized tribes (Funi-ô, Pankararu, Kiriri, and Pankararé); and Group 2 - more urbanized tribes (Tuxá, Truká, and Tumbalalá). Mortality rates of highly urbanized cities (Petrolina and Juazeiro) in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05. Results There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%, respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively. Conclusions Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.