Nelson Albuquerque de Souza e Silva

Prevalência dos fatores de risco para doença cardiovascular em funcionários do Centro de Pesquisas da Petrobras

OBJECTIVE: To determine the prevalence of risk factors for cardiovascular diseases in employees of the research center at Petrobras. METHODS: In a cross-sectional study, employees of the research center at Petrobras were assessed clinically and by laboratory testing from March 2000 and February 2001. Those who did not attend the periodical annual medical examination of 2000 were excluded from the study. The percentage of risk factor occurrence and the mean standard deviation of the biochemical variables, blood pressure, and body mass index were calculated. RESULTS: Of 1,911 employees, 970 were studied, 75.4% were men and 24.6% were women with a mean age of 42.2 years old. The risk factors were lack of exercise (67.3%), cholesterol > 200 mg/dL (56.6%), overweight (42%), obesity (17%), blood hypertension (18.2%), smoking (12.4%), and diabetes mellitus (2.5%). CONCLUSION: The high prevalence of risk factors for cardiovascular disease in young individuals draws attention to the need for the adoption of workplace programs to encourage healthy lifestyles and to prevent diseases.

Mortalidade por doenças cardiovasculares em três estados do Brasil de 1980 a 2002

OBJETIVO: Avaliar e comparar a mortalidade de adultos por doencas do aparelho circulatorio (DAC), especialmente doencas isquemicas do coracao (DIC) e doencas cerebrovasculares (DCBV), no periodo de 1980 a 2002 nos Estados do Rio de Janeiro, Rio Grande do Sul e Sao Paulo e em suas capitais, levando em consideracao o impacto dos obitos por causas mal definidas nas taxas de mortalidade. METODOS: Foram estimadas as taxas de mortalidade (brutas e ajustadas por sexo e idade) por DAC, DIC e DCBV em individuos com 20 ou mais anos. Essas taxas foram compensadas com parte dos obitos por causas mal definidas, na mesma proporcao dos obitos por DAC, DIC ou DCBV em relacao a todos os obitos, excluidos os mal definidos. Tambem foram estimadas as medias e diferencas anuais das taxas de mortalidade compensadas e ajustadas com modelos de regressao linear. A populacao padrao foi a do Estado do Rio de Janeiro em 2000. RESULTADOS: O declinio anual das taxas compensadas e ajustadas de mortalidade por DAC em 100 000 habitantes variou de -13,1 a -8,7 no Estado do Rio de Janeiro e no Municipio de Sao Paulo, respectivamente. Nas DIC, o declinio anual foi maior no Municipio e no Estado do Rio de Janeiro (-5,0 e -4,5, respectivamente), e menor no Estado do Rio Grande do Sul e no Municipio de Sao Paulo (-2,8 e -2,7, respectivamente). Nas DCBV, a variacao observada foi de -6,5 a -2,9 no Estado do Rio de Janeiro e em Porto Alegre, respectivamente. CONCLUSAO: Tendo em vista que o declinio nas taxas de mortalidade compensadas e ajustadas por DAC, DIC e DCBV ocorreu depois de 1980, e pouco provavel que tenha resultado do controle dos fatores de risco e implementacao da revascularizacao do miocardio. Essa queda poderia estar relacionada ao desenvolvimento economico acentuado que a precedeu, com consequente melhoria das condicoes de vida e reducao da exposicao a infeccoes no periodo perinatal e na infância.

Mortalidade compensada por doenças cardiovasculares no período de 1980 a 1999 - Brasil

OBJECTIVE To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), São Paulo (SP) and Rio Grande do Sul (RS) and respective capitals from 1980 to 1999. METHODS Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiros population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions. RESULTS Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively. CONCLUSION A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.

Socioeconomic aspects of spousal concordance for hypertension, obesity, and smoking in a community of Rio de Janeiro, Brazil

OBJECTIVE The present study aims to evaluate the environmental role in the distribution of hypertension, obesity, and smoking and spousal concordance for the presence/absence of these 3 cardiovascular risk factors. METHODS A cross-sectional study was conducted in a community in Rio de Janeiro, Brazil. The households were randomly selected. Odds ratios were estimated to measure spousal concordance, across socioeconomic levels. RESULTS Overall a significant aggregation of all 3 risk factors was present. The crude odds ratio for hypertension was 1.78 (95%CI=1.02-3.08); for obesity, it was 1.80 (95%CI=1.09-2.96); and for smoking, it was 3.40 (95% CI=2.07-5.61). The spousal concordance for hypertension decreased significantly (p<0.001) from the lower to the higher educational level. In the case of obesity and smoking, the opposite was observed, although p-values for the linear trend were 0.10 and 0.08, respectively. CONCLUSION In lower socioeconomic levels, couples are more concordant for hypertension and discordant for smoking. For hypertension and smoking, education seems to be a discriminant stronger than income, but for obesity the 2 socioeconomic indicators seem to represent different aspects of the environmental determinants of risk factor distribution.

Letalidade por doenças isquêmicas do coração no Estado do Rio de Janeiro no período de 1999 a 2003

OBJECTIVE To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System/Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).

Aplicação do EuroSCORE na cirurgia de revascularização miocárdica em hospitais públicos do Rio de Janeiro

BACKGROUND Risk stratification models are used to assess the risk of death in surgery. OBJECTIVE To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003. METHODS Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve. RESULTS 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%- 10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. CONCLUSION The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.

Mortalidade por todas as causas e por doenças cardiovasculares em três estados do Brasil, 1980 a 2006

OBJECTIVE to evaluate mortality from all causes, diseases of the circulatory system (DCS), ischemic heart disease (IHD), and cerebrovascular diseases (CVD) from 1980 to 2006 in Rio de Janeiro, Rio Grande do Sul, São Paulo, and their capitals, taking into consideration the impact of deaths due to ill-defined causes. METHODS population and mortality data were obtained from the Unified Health Systems Data Bank (DATASUS). Mortality from the diseases of interest and from ill-defined causes was adjusted by the direct method for adults older than 20 years of age. Since the mortality rates from ill-defined causes increased markedly after 1990, proportional mortality rates from ill-defined causes were calculated. Linear regression models were used for analysis of trends. RESULTS a relevant decline in all-cause mortality was observed in the three states and capitals. Rio de Janeiro and its capital had the highest rates of all-cause mortality. DCS mortality declined more than all-cause mortality. Proportional mortality from ill-defined causes in Rio de Janeiro and its capital was higher than in all other states and capitals starting in 1990. CVD mortality fell in the study period, especially in Rio de Janeiro and its capital. The state of Rio de Janeiro also had the highest IHD mortality rates until 1993. Among the capitals, São Paulo presented the highest IHD mortality rates starting in 1992. CONCLUSIONS the decline in all-cause mortality resulted mainly from the decline in DCS mortality. In turn, the decline in DCS mortality was partly due to the reduction in CVD mortality, especially in the state of Rio de Janeiro.

Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.

Doença arterial coronariana em pacientes com valvopatia reumática e não-reumática acompanhados em hospital público do Rio de Janeiro

OBJECTIVE to estimate the prevalence of coronary artery disease (CAD) in valvular heart disease of rheumatic (RVHD) and non-rheumatic (NVHD) etiology, assessing possible predictive factors for the presence of CAD. METHODS This is a cross-sectional study of a series of cases obtained from a pre-defined population, wherein 1,412 patients referred for heart surgery of any etiology were evaluated. Of these, 294 primary heart disease patients aged > or =40 submitted to cinecoronary arteriography (CA) were identified and studied. RESULTS patients with RVHD presented lower prevalence of CAD (4%) when compared to NVHD (33.61%), p<0.0001. The logistic regression analysis showed that age, typical angina-like chest pain (TACP), systemic arterial hypertension (SAH), diabetes and dyslipidemia were significantly related to CAD, and that the rheumatic etiology was not a disease determinant. Smoking and gender were clinically important in CAD, although not statistically significant. In the whole group, the Log-linear analysis showed that, regardless of the etiology, gender, age > or =55, SAH, TACP, diabetes and dyslipidemia were all related directly to CAD, with the latter three being the most important variables for the disease. CONCLUSION the prevalence of CAD among RVHD patients is low, whereas it is high among NVHD patients; the rheumatic etiology does not seem to have any beneficial effects on the prevalence of CAD; gender, age, SAH, TACP, dyslipidemia and diabetes were identified as being strongly associated with the presence of CAD. It is possible to define the criteria that indicate the need for pre-surgical CA in heart valve replacements, so that the standard indication after the age of 40 years can be avoided.