Daniel P. Capingana

Gender Distribution of Serum Uric Acid and Cardiovascular Risk Factors: Population Based Study

FUNDAMENTO: Nao ha dados relativos a epidemiologia da hiperuricemia em estudos brasileiros de base populacional. OBJETIVO: Investigar a distribuicao de acido urico serico e sua relacao com variaveis demograficas e cardiovasculares. METODOS: Estudamos 1.346 individuos. A hiperuricemia foi definida como > 6,8 e > 5,4 mg/dL para homens e mulheres, respectivamente. A sindrome metabolica (SM) foi definida utilizando-se os criterios NCEP ATP III. RESULTADOS: A prevalencia de hiperuricemia foi de 13,2%. A associacao de acido urico serico (AUS) com fatores de risco cardiovasculares foi especifica para o genero: em mulheres, maiores niveis de AUS estiveram associados com IMC elevado, mesmo apos ajustes da pressao arterial sistolica para idade (PAS). Em homens, a relacao do AUS com o colesterol HDL esteve mediada pelo IMC, enquanto em mulheres, o AUS mostrou-se semelhante e dependente do IMC, independentemente dos niveis glicose e presenca de hipertensao. Nos homens, os triglicerideos, a circunferencia abdominal (CA) e a PAS explicaram 11%, 4% e 1% da variabilidade do AUS, respectivamente. Nas mulheres, a circunferencia abdominal e os triglicerideos explicaram 9% e 1% da variabilidade de AUS, respectivamente. Em comparacao com o primeiro quartil, homens e mulheres no quarto quartil apresentavam 3,29 e 4,18 vezes mais de aumento de risco de SM, respectivamente. As mulheres apresentaram uma prevalencia quase tres vezes maior de diabetes melito. Homens normotensos com MS apresentaram maiores niveis de AUS, independente do IMC. CONCLUSAO: Nossos resultados parecem justificar a necessidade de uma avaliacao baseada no genero em relacao a associacao do AUS com fatores de risco cardiovasculares, que se mostraram mais acentuados em mulheres. A SM esteve positivamente associada com AUS elevado, independentemente do genero. A obesidade abdominal e a hipertrigliceridemia foram os principais fatores associados com a hiperuricemia mesmo em individuos normotensos, o que pode adicionar maior risco para a hipertensao.BACKGROUND There is no data concerning the epidemiology of hyperuricemia in Brazilian population-based studies. OBJECTIVE To investigate the distribution of serum uric acid and its relationship with demographics and cardiovascular variables. METHODS We studied 1,346 individuals. Hyperuricemia was defined as ≥ 6.8 and ≥ 5.4 mg/dL for men and women, respectively. Metabolic syndrome (MS) was defined with NCEP ATP III criteria. RESULTS The prevalence of hyperuricemia was 13.2%. The association of serum uric acid (SUA) with cardiovascular risk factors was gender-specific: in women, higher SUA was associated with increasing BMI, even after adjustments for age-systolic blood pressure (SBP). In men, the relationship of SUA with HDLc was mediated by BMI, whereas in women, SUA was similar and dependent on BMI, regardless of glucose levels and presence of hypertension. In men, triglycerides, waist circumference (WC) and SBP explained 11%, 4% and 1% of SUA variability, respectively. In women, WC and triglycerides explained 9% and 1% of SUA variability, respectively. Compared to the first quartile, men and women in the fourth quartile had a 3.29 fold and 4.18 fold increase of MS risk, respectively. Women had almost three fold higher prevalence of diabetes mellitus. Normotensive men with MS presented higher SUA, regardless of BMI. CONCLUSION Our results seem to justify the need for gender-based evaluation regarding the association of SUA with cardiovascular risk factors, which was more pronounced in women. MS was positively associated with increasing SUA, regardless of gender. Abdominal obesity and hypertriglyceridemia were the main factors associated with hyperuricemia even in normotensive individuals, which may add a higher risk for hypertension.

Prevalence of cardiovascular risk factors and socioeconomic level among public-sector workers in Angola

BackgroundCardiovascular diseases are the leading cause of death in the majority of developed and developing countries. African countries are currently facing an increase in both cardiovascular and transmitted diseases. In addition, cardiovascular risk varies among different socioeconomic groups. Thus, we determined the prevalence of modifiable cardiovascular risk factors in apparently healthy public-sector workers and investigated possible relationships with socioeconomic status.MethodsWe employed a cross-sectional study comprising 42.2% (n = 615) of the public-sector workers at Agostinho Neto University, 48% (n = 294) male and 52% (n= 321) female, with ages between 20 and 72 years and from various socioeconomic groups. The study was conducted from February 2009 to December 2010. Personal, anthropometric, biochemical, hemodynamic, socioeconomic, and physical activity data were collected.ResultsThe prevalence rates of cardiovascular risk factors were as follows: hypertension, 45.2% (men 46.3%, women 44.2%, P > 0.05); hypercholesterolemia, 11.1% (men 10.5%, women 11.5%, P > 0.05); low high-density lipoprotein (HDL) cholesterol, 50.1% (men 36.9%, women 62.3%; P < 0.05); hypertriglyceridemia, 10.6% (men 12.6%, women 8.7%, P > 0.05); smoking, 7.2% (men 10.2%, women 4.4%; P < 0.05); diabetes, 5.7% (men 5.5%, women 5.9%, P > 0.05); overweight, 29.3% (men 27.3%, women 31.2%, P > 0.05); obesity, 19.6% (men 9.2%, women 29.0%; P < 0.05); sedentary lifestyle, 87.2% (men 83.0%, women 91,0%, P < 0.05); and left ventricular hypertrophy, 20% (men 32.0%, women 9.0%; P < 0.05). At least one risk factor was present in 27.7% of the sample; 15.2% had two risk factors, and 31.4% had three or more risk factors. Among the individuals with low socioeconomic status, 41.0% had three or more risk factors.ConclusionsThe results of this study suggest the existence of a high prevalence of multiple risk factors for cardiovascular disease in apparently healthy public-sector workers in Angola. The workers in lower socioeconomic groups had higher incidences of hypertension, smoking, and left ventricular hypertrophy.

Prevalence of the metabolic syndrome and determination of optimal cut-off values of waist circumference in university employees from Angola : cardiovascular topic

Summary Background Estimates of the prevalence of the metabolic syndrome in Africans may be inconsistent due to lack of African-specific cut-off values of waist circumference (WC). This study determined the prevalence of the metabolic syndrome and defined optimal values of WC in Africans. Methods This cross-sectional study collected demographic, anthropometric and clinical data of 615 Universitary employees, in Luanda, Angola. The metabolic syndrome was defined using the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII) and the Joint Interim Statement (JIS) criteria. Receiver operating characteristics curves were constructed to assess cut-off values of WC. Results The crude prevalence of the metabolic syndrome was higher with the JIS definition (27.8%, age-standardised 14.1%) than with the ATP III definition (17.6%, age-standardised 8.7%). Optimal cut-off values of WC were 87.5 and 80.5 cm in men and women, respectively. Conclusions There was a high prevalence of the metabolic syndrome among our African subjects. Our data suggest different WC cut-off values for Africans in relation to other populations.

Head Lice Among Primary School Children in Viana, Angola: Prevalence and Relevant Teachers’ Knowledge

Background: A high rate of Pediculosis capitis in school children has been reported in some African countries. However, systematic information on ectoparasitosis among school children from Angola is not available. The aim of this research was to determine the prevalence of head lice among school children and ascertain relevant teachers’ knowledge about head lice infestation. Methods: This cross-sectional study was conducted in 171 randomly selected children attending school in Viana. The children were examined for presence of head lice by visual inspection. In addition, a questionnaire was used to assess teachers’ and children’s’ knowledge about this ectoparasite. Results: The overall prevalence of head lice was 42.1%, with a significance difference between the genders (girls [95.8%] versus boys [4.2%,] P < 0.001). Self-reported history of being in contact with another person infested with head lice was the main risk factor for becoming infested. Conclusion: A high rate of head lice infestation was demonstrated. Female gender and history of contact with someone already infested were the main risk factors. Teachers demonstrated a knowledge of the biology and clinical signs of head lice, but did not have adequate knowledge about its treatment, suggesting a need for increased competence on the part of teachers to be able to teach children about preventative measures. However, further systematic epidemiological studies are required to increase our understanding of ectoparasitosis in Angola.

Distribution of Serum Uric Acid in Black Africans and Its Association With Cardiovascular Risk Factors

Hyperuricemia is associated with cardiovascular disease and its prevalence is unknown in black Africans. This study reports hyperuricemia distribution and its association with cardiovascular risk factors in a selected Angolan population. A cross‐sectional study in 585 black Africans was performed. Hyperuricemia was defined as uric acid >7.0 mg/dL in men or >5.7 mg/dL in women. Overall prevalence was 25%. Hyperuricemia was associated with hypertension (odds ratio [OR], 2.20; confidence interval [CI], 95% 1.41–3.47), high waist circumference (OR, 1.67; CI, 95% 1.05–2.65), and metabolic syndrome (OR, 1.66; CI, 95% 1.07–2.57). Compared to those with uric acid levels in the first quartile, individuals in the fourth quartile showed higher body mass index, waist circumference, systolic blood pressure, and plasma levels of creatinine and triglycerides. Hypertension, high waist circumference, and metabolic syndrome were the major cardiovascular risk factors associated with hyperuricemia.

Arterial Stiffness in Lower Limb Amputees

Background A high carotid-femoral pulse wave velocity (PWV) has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively). This difference remained even after adjusting for confounding factors. Conclusion A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees.

Predictors and Reference Values of Pulse Wave Velocity in Prepubertal Angolan Children.

Carotid‐femoral pulse wave velocity (PWV) has been used as the gold standard method to estimate arterial stiffness. However, its use in clinical practice is still limited because reference values for specific groups, such as black children, remain unknown. The authors aimed to investigate predictors and to propose preliminary reference values of PWV in this population. Prepubertal schoolchildren (N=157; mean age, 9.36±1.41 year) from Luanda (Angola) with normal blood pressure values and without obesity were included. Mean PWV was 5.73±0.68 m/s, with no difference between the sexes. Univariate regression analysis showed a significant (P<.05) positive correlation between PWV and height, age, body weight, lean body weight, and blood pressure. In multivariate analysis, however, only height remained an independent predictor of PWV [PWV=0.018×height (cm)+3.230]. Curves of PWV percentiles as a function of height are proposed, thus identifying normal PWV in black children.

Gender-specific determinants of blood pressure elevation in Angolan adults

Abstract Background: Hypertension affects African–American adults more than any other ethnic group in the US. However, some of the black populations living outside Africa are well adapted to food and lifestyle. We aimed to describe the clinical characteristics underlying the gender-specific determinants of BP and the risk of hypertension in public-sector workers living in Angola. Materials and methods: 609 volunteers (48% men) were included in this cross-sectional and descriptive study. Demographic, socioeconomic and life style data were collected during an interview. Systolic BP (SBP) and diastolic BP (DBP) were measured, along with some anthropometric and clinical variables. Results: The prevalence of hypertension is 45.2% without difference between genders. Obesity was more prevalent in women (29.2% vs. 8.9%, p < 0.05). The age-related increment in SBP is higher in women (14.2 ± 1.1 vs 9.5 ± 1.3 mmHg/decade, p < 0.05). In men, age, BMI, cholesterol and LDLc/HDLc explained 21, 4, 2.5 and 2.9% of SBP variability, respectively. In women, age, BMI and HC explain 27, 2 and 1% of SBP variability, respectively. The risk for hypertension is 5 × high among men aged ≥45 years, and 3.5× in those having BMI ≥25. Women aged 45 years or older have 8 × risk of hypertension and 2× the risk by having BMI ≥25. Conclusions: We found that advanced age (≥45) and overweight/obesity (BMI ≥25) are the main risk factors for hypertension in adults from Angola. However, our data suggest that age and BMI may have different influence on increasing BP in men and women.

Prevalence and Clinical Correlates of Left Ventricular Hypertrophy in Black Africans

IntroductionAfrican–Americans present higher prevalence of left ventricular hypertrophy (LVH) when compared with white populations. However, there is a lack of information about the prevalence and determinants of LVH in black individuals living in Africa.MethodsA cross-sectional study was performed with a non-probabilistic sample comprised of 609 University workers from Angola/Africa, describing the prevalence of LVH and the determinants of left ventricular mass. Echocardiographic measurements were performed and left ventricular mass was indexed to body surface area. Systolic and diastolic blood pressures were measured, along with anthropometric and clinical variables.ResultsChamber diameter and wall thickness were higher in men compared to women. Additionally, LVM was higher in men (114.2 ± 36 vs 98.4 ± 31.9, P < 0.001), and the overall prevalence of LVH in black Angolans was 41.1%, which tended to be higher in women (44.5 vs 37.4%, P = 0.096). In men, systolic blood pressure and BMI were independently associated with LVM, while age, systolic blood pressure and waist circumference were associated with LVM in women.ConclusionsIn summary, blood pressure levels were the main determinants of LVH in black Africans, although different anthropometric variables showed mild influence in LVM. Our data suggests that LVH prevalence and determinants in black Africans are similar to that reported for African–Americans.

2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries

Arq Bras Cardiol. 2017; 109(5):389-396 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries Gláucia Maria Moraes de Oliveira,1 Miguel Mendes,2 Marcus Vinícius Bolívar Malachias,3,4 João Morais,5 Osni Moreira Filho,6 Armando Serra Coelho,7 Daniel Pires Capingana,8 Vanda Azevedo,9 Irenita Soares,9 Alda Menete,10,11 Beatriz Ferreira,10,11 Miryan Bandeira dos Prazeres Cassandra Soares,12 Mário Fernandes13 Universidade Federal do Rio de Janeiro (UFRJ),1 Rio de Janeiro, RJ Brazil; Centro Hospitalar de Lisboa Ocidental, E.P.E. Hospital de Santa Cruz,2 Carnaxide Portugal; Faculdade Ciências Médicas de Minas Gerais;3 Fundação Educacional Lucas Machado (FCMMG/FELUMA),4 Belo Horizonte, MG Brazil; Centro Hospitalar de Leiria Hospital de Santo André,5 Leiria Portugal; Pontifícia Universidade Católica do Paraná,6 Curitiba, PR Brazil; Clínica Santos Dumont,7 Lisboa Portugal; Instituto Superior de Ciências de Saúde do Cuando Cubango de Angola8 Angola; Colégio da Especialidade de Cardiologia da Ordem dos Médicos de Cabo Verde9 Cabo Verde; Instituto do Coração de Moçambique10 Moçambique; Colégio da Especialidade de Cardiologia da Ordem dos Médicos de Moçambique11 Moçambique; Hospital Dr. Ayres de Menezes,12 São Tomé São Tomé e Príncipe; Hospital Américo Boavida,13 Luanda Angola