José Luiz da Costa Vieira

Prevalência de síndrome metabólica em idosos de uma comunidade: comparação entre três métodos diagnósticos

FUNDAMENTO: A prevalencia de sindrome metabolica (SM), encontrada em diferentes estudos, tem apresentado ampla variacao dependendo da populacao e do criterio diagnostico utilizado, havendo uma tendencia de maior prevalencia da SM com o criterio diagnostico da International Diabetes Federation (IDF). OBJETIVO: Comparar a prevalencia da SM com diferentes criterios em idosos de uma comunidade. METODOS: Este e um estudo transversal, de base populacional, realizado na cidade de Novo Hamburgo - RS, Brasil -, do qual participaram 378 idosos com 60 anos ou mais (252 mulheres e 126 homens). A prevalencia da SM foi estimada aplicando os criterios diagnosticos do National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATPIII) (2001), do NCEP ATPIII revisado (2005) e da IDF. RESULTADOS: A prevalencia de SM aumentou progressivamente com a utilizacao dos criterios do NCEP ATP III, NCEP ATP III revisado e da IDF, apresentando valores de 50,3%, 53,4% e 56,9%, respectivamente. O aumento progressivo da prevalencia de SM com a utilizacao dos tres criterios ocorreu em ambos os sexos, com maior prevalencia entre as mulheres, com percentuais de 57,1%, 59,9% e 63,5% com os criterios do NCEP ATP III, NCEP ATP III revisado e da IDF, respectivamente. CONCLUSAO: Utilizando o criterio da IDF, encontrou-se uma maior prevalencia de SM em relacao a prevalencia encontrada com o criterio do NCEP ATP III e NCEP ATP III revisado. A prevalencia da SM foi maior entre as mulheres, independente do criterio utilizado.BACKGROUND The prevalence of the metabolic syndrome (MS) has shown wide variation in different studies, depending on the population sample and the diagnostic criteria used. The prevalence of MS tends to be higher with the diagnostic criteria of the International Diabetes Federation (IDF). OBJECTIVE To compare the prevalence of MS using different criteria in an elderly community. METHODS This was a cross-sectional population-based study conducted in the city of Novo Hamburgo - RS - Brazil, in which 378 elderly individuals, aged 60 years or over (252 women and 126 men) participated. The prevalence of MS was estimated using the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATPIII) (2001), the revised NCEP ATPIII (2005) and the IDF diagnostic criteria. RESULTS The prevalence of MS increased progressively as we used the NCEP ATP III, the revised NCEP ATP III and the IDF criteria, with values of 50.3%, 53.4% and 56.9% respectively. The progressive increase in the prevalence of MS using the three criteria occurred in both genders, with a higher prevalence among women, with rates of 57.1%, 59.9% and 63.5% with the NCEP ATP III, the revised NCEP ATP III, and the IDF criteria, respectively. CONCLUSION The use of the IDF criteria resulted in a higher prevalence of MS in comparison to the prevalence found with the NCEP ATP III criteria and the revised NCEP ATP III criteria. The prevalence of MS was higher among women, regardless of the criteria used.

Physical activity and depressive symptoms in community-dwelling elders from southern Brazil

OBJECTIVE To determine the existence of a relationship between physical activity and depressive symptoms in community-dwelling elders. METHOD This is a cross-sectional, population-based study, which included 379 community-dwelling elders from Novo Hamburgo, state of RS, Brazil. The level of physical activity was estimated using the International Physical Activity Questionnaire and depressive symptoms were diagnosed according to the Yesavage Geriatric Depression Scale. The association between the level of physical activity and depressive symptoms was analyzed by logistic regression. RESULTS A tendency towards a lower prevalence of depressive symptoms was observed in individuals with higher levels of physical activity, both in the sample as a whole as well as among men, but not among women (p for linear trend 0.04, 0.03 and 0.36, respectively). The odds ratio of the presence of depressive symptoms in the very active group as compared against that of the insufficiently active group was 0.32 (95% CI: 0.12-0.86) for men and 0.76 (95% CI: 0.39-1.46) for women. CONCLUSION In this population of aged individuals, more intense physical activity is related to a lower prevalence of depressive symptoms. As shown by gender stratification, physical activity is inversely related to depressive symptoms in men, albeit not in women.

Prevalence of metabolic syndrome in an elderly community: comparison between three diagnostic methods

FUNDAMENTO: A prevalencia de sindrome metabolica (SM), encontrada em diferentes estudos, tem apresentado ampla variacao dependendo da populacao e do criterio diagnostico utilizado, havendo uma tendencia de maior prevalencia da SM com o criterio diagnostico da International Diabetes Federation (IDF). OBJETIVO: Comparar a prevalencia da SM com diferentes criterios em idosos de uma comunidade. METODOS: Este e um estudo transversal, de base populacional, realizado na cidade de Novo Hamburgo - RS, Brasil -, do qual participaram 378 idosos com 60 anos ou mais (252 mulheres e 126 homens). A prevalencia da SM foi estimada aplicando os criterios diagnosticos do National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATPIII) (2001), do NCEP ATPIII revisado (2005) e da IDF. RESULTADOS: A prevalencia de SM aumentou progressivamente com a utilizacao dos criterios do NCEP ATP III, NCEP ATP III revisado e da IDF, apresentando valores de 50,3%, 53,4% e 56,9%, respectivamente. O aumento progressivo da prevalencia de SM com a utilizacao dos tres criterios ocorreu em ambos os sexos, com maior prevalencia entre as mulheres, com percentuais de 57,1%, 59,9% e 63,5% com os criterios do NCEP ATP III, NCEP ATP III revisado e da IDF, respectivamente. CONCLUSAO: Utilizando o criterio da IDF, encontrou-se uma maior prevalencia de SM em relacao a prevalencia encontrada com o criterio do NCEP ATP III e NCEP ATP III revisado. A prevalencia da SM foi maior entre as mulheres, independente do criterio utilizado.BACKGROUND The prevalence of the metabolic syndrome (MS) has shown wide variation in different studies, depending on the population sample and the diagnostic criteria used. The prevalence of MS tends to be higher with the diagnostic criteria of the International Diabetes Federation (IDF). OBJECTIVE To compare the prevalence of MS using different criteria in an elderly community. METHODS This was a cross-sectional population-based study conducted in the city of Novo Hamburgo - RS - Brazil, in which 378 elderly individuals, aged 60 years or over (252 women and 126 men) participated. The prevalence of MS was estimated using the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATPIII) (2001), the revised NCEP ATPIII (2005) and the IDF diagnostic criteria. RESULTS The prevalence of MS increased progressively as we used the NCEP ATP III, the revised NCEP ATP III and the IDF criteria, with values of 50.3%, 53.4% and 56.9% respectively. The progressive increase in the prevalence of MS using the three criteria occurred in both genders, with a higher prevalence among women, with rates of 57.1%, 59.9% and 63.5% with the NCEP ATP III, the revised NCEP ATP III, and the IDF criteria, respectively. CONCLUSION The use of the IDF criteria resulted in a higher prevalence of MS in comparison to the prevalence found with the NCEP ATP III criteria and the revised NCEP ATP III criteria. The prevalence of MS was higher among women, regardless of the criteria used.

Impact of statin dose on major cardiovascular events: a mixed treatment comparison meta-analysis involving more than 175,000 patients.

BACKGROUND The benefit of statins in the reduction of cardiovascular events was demonstrated in several placebo-controlled trials. More intensive therapy seems to be associated with greater benefit. Our objective was to compare different statin doses in the reduction of cardiovascular events and deaths, combining direct and indirect evidence, through mixed treatment comparisons (MTC). METHODS We conducted a systematic review in MEDLINE and Cochrane CENTRAL. A random-effects Bayesian MTC model was used to combine placebo-controlled and direct statin comparison trials. Intensity of statin doses was classified according to expected LDL-cholesterol reduction effect: ≤30% as low; 30-40%, intermediate, and ≥40%, high. Outcomes evaluated were non-fatal myocardial infarction (MI), stroke, coronary revascularization and coronary, cardiovascular and all-cause death. Inconsistency was assessed with split-node methodology. RESULTS 47 trials (11 with direct statin comparisons) were included. High doses reduced non-fatal MI by 28% (95% CI: 18%-36%) and by 14% (7%-21%) when compared to low and intermediate doses, respectively. High doses also diminished revascularization [RR versus low and intermediate doses of 0.81 (0.69-0.95) and 0.88 (0.77-0.99), respectively] and stroke [RR of 0.83 (0.68-0.99) against low doses]. Regimen intensity did not change death rates (e.g., for all-cause mortality, RRs of 0.93 (0.80-1.06) and 0.98 (0.87-1.08) for high vs. low and intermediate doses, respectively). No statistical inconsistencies were found in the analyses. CONCLUSIONS In this study, in which all available evidence from statin trials was simultaneously analyzed, the benefit of more intensive therapy was restricted to non-fatal events.

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Background Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. Methods We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int

Dietary intake is not associated to the metabolic syndrome in elderly women.

). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int

Prevalencia de síndrome metabólico en adultos mayores: comparación entre tres métodos diagnósticos

11,770) was applied. Results Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int

Changes in the profile of lipoprotein subfractions associated with hormone replacement therapy

10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int

Percutaneous Intervention in ST-Elevation Myocardial Infarction: Culprit-only or Complete Revascularization?

27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int

Risk-Benefit Assessment of Carotid Revascularization

9,000-20,000 per QALY in all scenarios. Conclusions Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.