Elizabete Viana de Freitas

Importance of high-density lipoprotein-cholesterol (HDL-C) levels to the incidence of cardiovascular disease (CVD) in the elderly

Studies about the impact of HDL-C levels on the incidence of cardiovascular disease (CVD) in the elderly are scarce. We decided to evaluate the relation of clinical and laboratory variables to the incidence of CVD events in the elderly stratified according to HDL-C behavior in an 8-year follow-up. We assessed 126 elderly (mean age: 70.01±7.24 years; 33.3% were men) on two occasions (assessment 1=A1, and assessment 2=A2), with a minimum of 5-year interval. They underwent clinical and laboratory evaluation and were divided into three groups as follows: (1) GN (n=52), normal HDL-C levels on A1 and A2; (2) GL (n=36), low HDL-C levels on A1 and A2; (3) GV (n=38), HDL-C levels varying from A1 to A2. The following CVD events were observed: coronary artery disease (angina pectoris=AP, myocardial infarction=MI, percutaneous/surgical coronary intervention); stroke; transient ischemic attack=TIA; carotid disease; and heart failure=HF. The groups did not differ in age or gender at A1 and A2. Triglyceride=TG mean levels were lower in GN at A1 (p=0.007) and A2 (p<0.001) than in GL. There were 14 CVD events in GN (26.9%), 23 (63.9%) in GL, and 13 (34.2%) in GV (χ2=12.825; p=0.002). In logistic regression analysis, we observed that the higher the systolic blood pressure (SBP) (odds ratio [OR]=1.0231; p=0.0338) and the lower the HDL-C (OR=0.9363; p=0.0035), the higher the incidence of CVD events. Persistently low HDL-C levels over 8 years of follow-up were a risk factor (RF) for the development of CVD events in the elderly.

Heart failure in the elderly

The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure (HF) is a condition in which the heart can not pump enough blood to meet the bodys needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.

Study of the intima-media thickening in carotid arteries of healthy elderly with high blood pressure and elderly with high blood pressure and dyslipidemia

Objective The objective of this study was to assess the mean intima-media thickening of carotid arteries of elderly subjects, and its relationship with age, anthropometric measurements, high systolic blood pressure and dyslipidemia. Methods In this investigation, 129 subjects were enrolled between 1995 and 1998, age ranging from 29 to 94 years. They were assigned to one of 4 groups, including 2 control groups (group I, of healthy younger subjects; group II of healthy elderly subjects). Groups III and IV included those who presented with isolated systolic hypertension (ISH), and ISH and dyslipidemia, respectively. All subjects were submitted to a medical interview, lab tests with measurement of cholesterol levels, electrocardiogram, and carotid ultrasound. The ultrasound included measurement of the intima-media thickening (IMT) of the carotid arteries, the right carotid artery (RCA) and left carotid artery (LCA), and assessment of the presence of plaques. Blood fat and glucose were measured by a standard method. The results were compared among the groups through statistical tests. The tests employed were: Chi-Square, Pearson’s and Likelihood Ratio, Student’s t, Mann-Whitney; ANOVA followed by Tukey’s test, Kruskal-Wallis nonparametric test, and test for multiple comparisons and Odds Ratio determination (OR). Results In this investigation, a positive association was observed between aging and IMT. In relation to systolic hypertension, a significant association was observed with IMT (IMT-RCA p = 0.0034; IMT-LCA p = 0.0196; IMT-RLCA p = 0.0299), and with the presence of plaques (PlaqueR p = 0.0110; PlaqueL p = 0.0294; PlaqueRL p = 0.0040). Conclusion This investigation evidenced the important role of aging in IMT, and of systolic hypertension in the IMT and presence of plaque. However, further studies are needed for a better understanding of the actual role of risk factors in aging.

Association between uric acid and cardiovascular risk variables in a non-hospitalized population

FUNDAMENTO: A associacao entre acido urico (AU) e as variaveis de risco cardiovascular permanece controversa em estudos epidemiologicos. OBJETIVO: Avaliar a associacao entre o AU, pressao arterial (PA), indices antropometricos e variaveis metabolicas em populacao nao hospitalar estratificada por quintis de AU. METODOS: Em estudo observacional transversal, foram avaliados 756 individuos (369M), com idade de 50,3 ± 16,12 anos, divididos em quintis de AU. Foram obtidos PA, indice de massa corporal (IMC), circunferencia abdominal (CA), AU, glicose, insulina, HOMA-IR, colesterol (CT), LDL-c, HDL-c, triglicerideos (TG), creatinina (C). Foi calculada a taxa de filtracao glomerular estimada (TFGE) e considerada hipertensao arterial (HA) quando a PA > 140x90 mmHg, sobrepeso/obesidade (S/O) quando IMC > 25 kg/m2 e sindrome metabolica (SM) de acordo com a I Diretriz Brasileira de SM. RESULTADOS: 1) Nao houve diferenca entre os grupos na distribuicao por sexo e faixa etaria; 2) Os maiores quintis de AU apresentaram maiores medias de idade (p < 0,01), IMC, CA (p < 0,01), PAS, PAD (p < 0,001), CT, LDL-c, TG (p < 0,01), C e TFGE (p < 0,001) e menor media de HDL-c (p < 0,001); 3) O grupo com maior quintil de AU mostrou maiores prevalencias de HA, S/O e SM (p < 0,001); 4) Maiores percentuais dos menores quintis de insulina (p < 0,02) e de HOMA-IR (p < 0,01) foram encontrados nos menores quintis de AU; 5) Em analise de regressao logistica, o AU e as variaveis que compoem a SM apresentaram-se associados a ocorrencia de SM (p < 0,01). CONCLUSAO: Maiores quintis de acido urico associaram-se a pior perfil de risco cardiovascular e a pior perfil de funcao renal na amostra populacional nao hospitalar estudada.BACKGROUND The association between uric acid (UA) and cardiovascular risk variables remains a controversial issue in epidemiological studies. OBJECTIVE To evaluate the association between UA, blood pressure (BP), anthropometric indices and metabolic variables in a non-hospitalized population stratified by UA quintiles. METHODS A cross-sectional observational study evaluated 756 individuals (369 males), aged 50.3 ± 16.12 years, divided in UA quintiles. BP, body mass index (BMI), abdominal circumference (AC), UA, glucose, insulin, HOMA-IR, total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG) and creatinine (C) levels were obtained. The estimated glomerular filtration rate (eGFR) was calculated and arterial hypertension (AH) was considered when BP > 140x90 mmHg, overweight/obesity (OW/O) was considered when BMI > 25 kg/m² and metabolic syndrome (MS) was established according to the I Brazilian Guideline of MS. RESULTS 1) There was no difference between the groups regarding the distribution by sex and age range; 2) The highest UA quintiles presented higher mean age (p < 0.01), BMI, AC (p < 0.01), SBP, DBP (p < 0.001), TC, LDL-c, TG (p < 0.01), C and eGFR (p < 0.001) and lower mean HDL-c (p < 0.001); 3) The group with the highest UA quintile showed higher prevalence of AH, OW/O and MS (p < 0.001); 4) Higher percentages of the lowest quintiles of insulin (p < 0.02) and HOMA-IR (p < 0.01) were observed with the lowest quintiles of UA; 5) A logistic regression analysis showed that UA and the variables that compose MS were associated with the occurrence of MS (p < 0.01). CONCLUSION Higher quintiles of uric acid were associated with a worse cardiovascular risk profile and a worse kidney function profile in the non-hospitalized population sample studied.

Associação entre ácido úrico e variáveis de risco cardiovascular em uma população não hospitalar

FUNDAMENTO: A associacao entre acido urico (AU) e as variaveis de risco cardiovascular permanece controversa em estudos epidemiologicos. OBJETIVO: Avaliar a associacao entre o AU, pressao arterial (PA), indices antropometricos e variaveis metabolicas em populacao nao hospitalar estratificada por quintis de AU. METODOS: Em estudo observacional transversal, foram avaliados 756 individuos (369M), com idade de 50,3 ± 16,12 anos, divididos em quintis de AU. Foram obtidos PA, indice de massa corporal (IMC), circunferencia abdominal (CA), AU, glicose, insulina, HOMA-IR, colesterol (CT), LDL-c, HDL-c, triglicerideos (TG), creatinina (C). Foi calculada a taxa de filtracao glomerular estimada (TFGE) e considerada hipertensao arterial (HA) quando a PA > 140x90 mmHg, sobrepeso/obesidade (S/O) quando IMC > 25 kg/m2 e sindrome metabolica (SM) de acordo com a I Diretriz Brasileira de SM. RESULTADOS: 1) Nao houve diferenca entre os grupos na distribuicao por sexo e faixa etaria; 2) Os maiores quintis de AU apresentaram maiores medias de idade (p < 0,01), IMC, CA (p < 0,01), PAS, PAD (p < 0,001), CT, LDL-c, TG (p < 0,01), C e TFGE (p < 0,001) e menor media de HDL-c (p < 0,001); 3) O grupo com maior quintil de AU mostrou maiores prevalencias de HA, S/O e SM (p < 0,001); 4) Maiores percentuais dos menores quintis de insulina (p < 0,02) e de HOMA-IR (p < 0,01) foram encontrados nos menores quintis de AU; 5) Em analise de regressao logistica, o AU e as variaveis que compoem a SM apresentaram-se associados a ocorrencia de SM (p < 0,01). CONCLUSAO: Maiores quintis de acido urico associaram-se a pior perfil de risco cardiovascular e a pior perfil de funcao renal na amostra populacional nao hospitalar estudada.BACKGROUND The association between uric acid (UA) and cardiovascular risk variables remains a controversial issue in epidemiological studies. OBJECTIVE To evaluate the association between UA, blood pressure (BP), anthropometric indices and metabolic variables in a non-hospitalized population stratified by UA quintiles. METHODS A cross-sectional observational study evaluated 756 individuals (369 males), aged 50.3 ± 16.12 years, divided in UA quintiles. BP, body mass index (BMI), abdominal circumference (AC), UA, glucose, insulin, HOMA-IR, total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG) and creatinine (C) levels were obtained. The estimated glomerular filtration rate (eGFR) was calculated and arterial hypertension (AH) was considered when BP > 140x90 mmHg, overweight/obesity (OW/O) was considered when BMI > 25 kg/m² and metabolic syndrome (MS) was established according to the I Brazilian Guideline of MS. RESULTS 1) There was no difference between the groups regarding the distribution by sex and age range; 2) The highest UA quintiles presented higher mean age (p < 0.01), BMI, AC (p < 0.01), SBP, DBP (p < 0.001), TC, LDL-c, TG (p < 0.01), C and eGFR (p < 0.001) and lower mean HDL-c (p < 0.001); 3) The group with the highest UA quintile showed higher prevalence of AH, OW/O and MS (p < 0.001); 4) Higher percentages of the lowest quintiles of insulin (p < 0.02) and HOMA-IR (p < 0.01) were observed with the lowest quintiles of UA; 5) A logistic regression analysis showed that UA and the variables that compose MS were associated with the occurrence of MS (p < 0.01). CONCLUSION Higher quintiles of uric acid were associated with a worse cardiovascular risk profile and a worse kidney function profile in the non-hospitalized population sample studied.

Pressão Arterial em jovens como marcador de risco cardiovascular. Estudo do Rio de Janeiro

BACKGROUND: The study of the cardiovascular risk variables in young populations is fundamental to establish primary prevention strategies. OBJECTIVE: To evaluate the blood pressure (BP), anthropometric and metabolic profile in young individuals from The Rio de Janeiro Study, followed by 17 years. METHODS: A total of 115 individuals (64 males) were evaluated at three different moments (follow-up: 212.23±16.0 months): A1 (12.97±1.48 years), A2 (21.90±1.71 years) and A3 (30.65±2.00 years) and divided in two groups: NG (n=84) with at least two normal BP measurements at the three assessments; HG (n=31) with at least two abnormal BP measurements at the three assessments. BP and body mass index (BMI) were obtained at the three assessments. Levels of glucose, triglycerides, total cholesterol and fractions were obtained at A2 and A3. Abdominal circumference (AC) was obtained only at A3. RESULTS: 1) The means of BP, BMI and AC (p<0.0001) as well as the prevalence of systemic arterial hypertension (SAH) and overweight/obesity (O/O) (p<0.003) were higher in the HG at the three assessments; 2) The means of LDL-c and glycemia (p<0.05) at A2 and the prevalence of metabolic syndrome (MS) at A3 were higher in the HG; 3) the association SAH+O/O was more prevalent in the HG, whereas the association NBP+NBMI was more prevalent in the NG (p<0.0001) at the three assessments; 4) SAH at A1 (RR=5.20 = 5.20; p<0.0007), male gender (RR=5.26 = 5.26; p<0.0019) and OO at A1 (RR=3.40 = 3.40; p<0.0278) determined an increased risk for AH at the young adult life (A3). CONCLUSION: After 17 years of follow-up, the BP of young individuals showed a significant association with the cardiovascular risk variables and the occurrence of MS at the young adult life.BACKGROUND The study of the cardiovascular risk variables in young populations is fundamental to establish primary prevention strategies. OBJECTIVE To evaluate the blood pressure (BP), anthropometric and metabolic profile in young individuals from The Rio de Janeiro Study, followed by 17 years. METHODS A total of 115 individuals (64 males) were evaluated at three different moments (follow-up: 212.23+/-16.0 months): A1 (12.97+/-1.48 years), A2 (21.90+/-1.71 years) and A3 (30.65+/-2.00 years) and divided in two groups: NG (n=84) with at least two normal BP measurements at the three assessments; HG (n=31) with at least two abnormal BP measurements at the three assessments. BP and body mass index (BMI) were obtained at the three assessments. Levels of glucose, triglycerides, total cholesterol and fractions were obtained at A2 and A3. Abdominal circumference (AC) was obtained only at A3. RESULTS 1) The means of BP, BMI and AC (p<0.0001) as well as the prevalence of systemic arterial hypertension (SAH) and overweight/obesity (O/O) (p<0.003) were higher in the HG at the three assessments; 2) The means of LDL-c and glycemia (p<0.05) at A2 and the prevalence of metabolic syndrome (MS) at A3 were higher in the HG; 3) the association SAH+O/O was more prevalent in the HG, whereas the association NBP+NBMI was more prevalent in the NG (p<0.0001) at the three assessments; 4) SAH at A1 (RR=5.20 = 5.20; p<0.0007), male gender (RR=5.26 = 5.26; p<0.0019) and OO at A1 (RR=3.40 = 3.40; p<0.0278) determined an increased risk for AH at the young adult life (A3). CONCLUSION After 17 years of follow-up, the BP of young individuals showed a significant association with the cardiovascular risk variables and the occurrence of MS at the young adult life.

Blood pressure in young individuals as a cardiovascular risk marker. The Rio de Janeiro study

BACKGROUND: The study of the cardiovascular risk variables in young populations is fundamental to establish primary prevention strategies. OBJECTIVE: To evaluate the blood pressure (BP), anthropometric and metabolic profile in young individuals from The Rio de Janeiro Study, followed by 17 years. METHODS: A total of 115 individuals (64 males) were evaluated at three different moments (follow-up: 212.23±16.0 months): A1 (12.97±1.48 years), A2 (21.90±1.71 years) and A3 (30.65±2.00 years) and divided in two groups: NG (n=84) with at least two normal BP measurements at the three assessments; HG (n=31) with at least two abnormal BP measurements at the three assessments. BP and body mass index (BMI) were obtained at the three assessments. Levels of glucose, triglycerides, total cholesterol and fractions were obtained at A2 and A3. Abdominal circumference (AC) was obtained only at A3. RESULTS: 1) The means of BP, BMI and AC (p<0.0001) as well as the prevalence of systemic arterial hypertension (SAH) and overweight/obesity (O/O) (p<0.003) were higher in the HG at the three assessments; 2) The means of LDL-c and glycemia (p<0.05) at A2 and the prevalence of metabolic syndrome (MS) at A3 were higher in the HG; 3) the association SAH+O/O was more prevalent in the HG, whereas the association NBP+NBMI was more prevalent in the NG (p<0.0001) at the three assessments; 4) SAH at A1 (RR=5.20 = 5.20; p<0.0007), male gender (RR=5.26 = 5.26; p<0.0019) and OO at A1 (RR=3.40 = 3.40; p<0.0278) determined an increased risk for AH at the young adult life (A3). CONCLUSION: After 17 years of follow-up, the BP of young individuals showed a significant association with the cardiovascular risk variables and the occurrence of MS at the young adult life.BACKGROUND The study of the cardiovascular risk variables in young populations is fundamental to establish primary prevention strategies. OBJECTIVE To evaluate the blood pressure (BP), anthropometric and metabolic profile in young individuals from The Rio de Janeiro Study, followed by 17 years. METHODS A total of 115 individuals (64 males) were evaluated at three different moments (follow-up: 212.23+/-16.0 months): A1 (12.97+/-1.48 years), A2 (21.90+/-1.71 years) and A3 (30.65+/-2.00 years) and divided in two groups: NG (n=84) with at least two normal BP measurements at the three assessments; HG (n=31) with at least two abnormal BP measurements at the three assessments. BP and body mass index (BMI) were obtained at the three assessments. Levels of glucose, triglycerides, total cholesterol and fractions were obtained at A2 and A3. Abdominal circumference (AC) was obtained only at A3. RESULTS 1) The means of BP, BMI and AC (p<0.0001) as well as the prevalence of systemic arterial hypertension (SAH) and overweight/obesity (O/O) (p<0.003) were higher in the HG at the three assessments; 2) The means of LDL-c and glycemia (p<0.05) at A2 and the prevalence of metabolic syndrome (MS) at A3 were higher in the HG; 3) the association SAH+O/O was more prevalent in the HG, whereas the association NBP+NBMI was more prevalent in the NG (p<0.0001) at the three assessments; 4) SAH at A1 (RR=5.20 = 5.20; p<0.0007), male gender (RR=5.26 = 5.26; p<0.0019) and OO at A1 (RR=3.40 = 3.40; p<0.0278) determined an increased risk for AH at the young adult life (A3). CONCLUSION After 17 years of follow-up, the BP of young individuals showed a significant association with the cardiovascular risk variables and the occurrence of MS at the young adult life.

Importância da HDL-c para a ocorrência de doença cardiovascular no idoso

BACKGROUND Studies on the impact of HDL-c and the occurrence of cardiovascular disease (CV) in the elderly are scarce. OBJECTIVE To evaluate the clinical and laboratory variables and the occurrence of CV events in elderly patients stratified according to the behavior of HDL-c during an eight-year follow up. METHODS We evaluated 81 elderly patients, mean age of 68.51 +/- 6.32 years (38.2% male), in two stages (A1 and A2), with a minimum interval of five years. The subjects were divided into 3 groups according to HDL-c levels: normal HDL-c in both assessments (NG) (n = 31), low HDL-c in both assessments (LG) (n = 21) and variable HDL-c in A1 and A2 (VG) (n = 29). Main CV events were recorded: coronary heart disease (angina, myocardial infarction, percutaneous / surgical myocardial revascularization), stroke, transient ischemic attack, carotid disease, dementia and heart failure. RESULTS The groups did not differ in gender and age in A1 and A2. Mean triglyceride levels were lower in the NG in A1 (p = 0.027) and A2 (p = 0.016) than in the LG. The distribution of CV events was as follows: 13 events in the NG (41.9%), 16 (76.2%) in the LG, and 12 (41.4%) in the VG (chi2 = 7.149, p = 0.024). The logistic regression analysis showed that the older the patient (OR = 1.187, p = 0.0230) and the lower the HDL-c (OR = 0.9372, p = 0.0102), the greater the occurrence of events CV. CONCLUSION Permanently low HDL-c during eight years of monitoring is a risk factor for the development of CV events in the elderly.FUNDAMENTO: Estudios sobre el impacto del HDL-c y ocurrencia de enfermedad cardiovascular (CV) en adultos mayores son raros. OBJETIVO: Evaluar las variables clinicas y laboratoriales y la ocurrencia de eventos CV en adultos mayores estratificados segun el comportamiento del HDL-c en seguimiento de ocho anos. METODOS: Se evaluaron, en dos momentos (A1 y A2), con espacio minimo de cinco anos, a 81 adultos mayores, con edad promedio de 68,51 ± 6,32 (el 38,2% del sexo masculino). Los individuos fueron divididos en 3 grupos de acuerdo con el nivel de HDL-c: HDL-c normal en las dos evaluaciones (GN) (n=31); HDL-c bajo en las dos evaluaciones (GB) (n=21); y HDL-c variable de A1 para A2 (GV) (n=29). Se registraron los eventos CV mayores: enfermedad coronaria (angina, infarto miocardio, revascularizacion miocardica percutanea/quirurgica), accidente vascular encefalico, accidente isquemico transitorio, enfermedad carotidea, demencia e insuficiencia cardiaca. RESULTADOS: Los grupos no difirieron en cuanto su edad y el sexo en A1 y A2. Los promedios de los trigliceridos fueron menores en el GN en A1 (p=0,027) y A2 (p=0,016) que en el GB. Sin embargo la distribucion de eventos CV fue de 13 en el GN (41,9%), 16 (76,2%) en el GB y de 12 (41,4%) en el GV (χ2=7,149, p=0,024). En el analisis de regresion logistica se pudo observar que cuanto mayor la edad (OR=1,187, p=0,0230) y cuanto menor el HDL-c (OR=0,9372, p=0,0102), mayor la ocurrencia de eventos CV. CONCLUSION: El HDL-c permanentemente bajo a lo largo de ocho anos de seguimiento fue el factor de riesgo para desarrollo de eventos CV en adultos mayores.

Pulse wave vocity in young adults: study of Rio de Janeiro

BACKGROUND Pulse wave velocity (PWV) can be a marker of cardiovascular impairment, but there are few studies in young adults. OBJECTIVE To evaluate the association between blood pressure (BP), current anthropometric and metabolic variables and those obtained 13 years earlier, in childhood and adolescence, with PWV. METHODS Sixty individuals were followed longitudinally and split into two groups according to the percentile of blood pressure (BP) obtained 13 years earlier: Group 1 (G1): BP percentile < 50 (n = 25, 11M, 26.4 years old) and Group 2 (G2): BP > 95 percentile (n = 35, 19M, 25.4 years old). The individuals underwent clinical evaluation, laboratory analysis and measurements of PWV through the Complior method. RESULTS G1 showed higher mean age; G2 showed greater mean weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), PWV and blood glucose, and lower mean HDL-cholesterol. SBP, MAP and heart rate (HR) obtained during childhood and adolescence significantly correlated with PWV. Current weight, height, waist-hip ratio, SBP, DBP, pulse pressure (PP), MAP and creatinine presented a positive and significant correlation with PWV. A comparison of the average PWV adjusted for SBP, DBP, SBP and DBP, MAP and PP showed no statistically significant difference between groups. CONCLUSION The percentile of BP in childhood/adolescence related to arterial distensibility assessed by PWV 13 years later. Changes in PWV can be identified in young individuals suggesting that early vascular impairment may be present in this age group, also related to blood pressure, anthropometric and metabolic variables.FUNDAMENTO: A velocidade da onda de pulso (VOP) pode ser marcador de comprometimento cardiovascular, porem existem poucos estudos em adultos jovens. OBJETIVO: Avaliar a associacao da pressao arterial (PA), variaveis antropometricas e metabolicas, atuais e obtidas 13 anos antes, na infância e adolescencia, com a VOP. METODOS: Sessenta individuos foram acompanhados longitudinalmente e estratificados em dois grupos segundo o percentil da pressao arterial (PA) obtido 13 anos antes: Grupo 1 (G1): percentil da PA 95 (n = 35, 19M, 25,4 anos). Foram submetidos a avaliacao clinica, analise laboratorial e medidas da VOP pelo metodo Complior. RESULTADOS: G1 apresentou maior media de idade; G2 exibiu maior media de: peso, PA sistolica (PAS), PA diastolica (PAD), PA media (PAM), VOP e glicemia, e menor media de HDL-colesterol. PAS, PAM e frequencia cardiaca (FC) obtidas na infância e adolescencia apresentaram correlacao significativa com a VOP. Peso, altura, cintura, relacao cintura/quadril, PAS, PAD, pressao de pulso (PP), PAM e creatinina atuais apresentaram correlacao positiva e significativa com a VOP. A comparacao das medias de VOP ajustadas pela PAS, PAD, PAS e PAD, PAM e PP nao mostrou diferenca estatisticamente significativa entre os grupos. CONCLUSAO: O percentil da PA na infância/adolescencia mostrou-se relacionado a distensibilidade arterial, avaliada pela VOP, 13 anos apos. Alteracoes da VOP podem ser identificadas em individuos jovens, sugerindo que o comprometimento vascular precoce pode estar presente nessa faixa etaria, relacionado tambem a pressao arterial, variaveis antropometricas e metabolicas.

Importance of HDL-c for the occurrence of cardiovascular disease in the elderly

BACKGROUND Studies on the impact of HDL-c and the occurrence of cardiovascular disease (CV) in the elderly are scarce. OBJECTIVE To evaluate the clinical and laboratory variables and the occurrence of CV events in elderly patients stratified according to the behavior of HDL-c during an eight-year follow up. METHODS We evaluated 81 elderly patients, mean age of 68.51 +/- 6.32 years (38.2% male), in two stages (A1 and A2), with a minimum interval of five years. The subjects were divided into 3 groups according to HDL-c levels: normal HDL-c in both assessments (NG) (n = 31), low HDL-c in both assessments (LG) (n = 21) and variable HDL-c in A1 and A2 (VG) (n = 29). Main CV events were recorded: coronary heart disease (angina, myocardial infarction, percutaneous / surgical myocardial revascularization), stroke, transient ischemic attack, carotid disease, dementia and heart failure. RESULTS The groups did not differ in gender and age in A1 and A2. Mean triglyceride levels were lower in the NG in A1 (p = 0.027) and A2 (p = 0.016) than in the LG. The distribution of CV events was as follows: 13 events in the NG (41.9%), 16 (76.2%) in the LG, and 12 (41.4%) in the VG (chi2 = 7.149, p = 0.024). The logistic regression analysis showed that the older the patient (OR = 1.187, p = 0.0230) and the lower the HDL-c (OR = 0.9372, p = 0.0102), the greater the occurrence of events CV. CONCLUSION Permanently low HDL-c during eight years of monitoring is a risk factor for the development of CV events in the elderly.FUNDAMENTO: Estudios sobre el impacto del HDL-c y ocurrencia de enfermedad cardiovascular (CV) en adultos mayores son raros. OBJETIVO: Evaluar las variables clinicas y laboratoriales y la ocurrencia de eventos CV en adultos mayores estratificados segun el comportamiento del HDL-c en seguimiento de ocho anos. METODOS: Se evaluaron, en dos momentos (A1 y A2), con espacio minimo de cinco anos, a 81 adultos mayores, con edad promedio de 68,51 ± 6,32 (el 38,2% del sexo masculino). Los individuos fueron divididos en 3 grupos de acuerdo con el nivel de HDL-c: HDL-c normal en las dos evaluaciones (GN) (n=31); HDL-c bajo en las dos evaluaciones (GB) (n=21); y HDL-c variable de A1 para A2 (GV) (n=29). Se registraron los eventos CV mayores: enfermedad coronaria (angina, infarto miocardio, revascularizacion miocardica percutanea/quirurgica), accidente vascular encefalico, accidente isquemico transitorio, enfermedad carotidea, demencia e insuficiencia cardiaca. RESULTADOS: Los grupos no difirieron en cuanto su edad y el sexo en A1 y A2. Los promedios de los trigliceridos fueron menores en el GN en A1 (p=0,027) y A2 (p=0,016) que en el GB. Sin embargo la distribucion de eventos CV fue de 13 en el GN (41,9%), 16 (76,2%) en el GB y de 12 (41,4%) en el GV (χ2=7,149, p=0,024). En el analisis de regresion logistica se pudo observar que cuanto mayor la edad (OR=1,187, p=0,0230) y cuanto menor el HDL-c (OR=0,9372, p=0,0102), mayor la ocurrencia de eventos CV. CONCLUSION: El HDL-c permanentemente bajo a lo largo de ocho anos de seguimiento fue el factor de riesgo para desarrollo de eventos CV en adultos mayores.