Pedro Magalhães

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.

Distribuição por gênero de ácido úrico sérico e fatores de risco cardiovascular: estudo populacional

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.

Relationship between treatment delay and type of reperfusion therapy and mechanical complications of acute myocardial infarction

Objectives: The incidence of mechanical complications after acute myocardial infarction has markedly declined with the advent of reperfusion. Nevertheless there is some controversy about the equal effectiveness of the different reperfusion therapies in preventing these complications. We aimed to analyse how reperfusion therapy and treatment delay relate to the incidence of mechanical complications in a population of ST-elevation myocardial infarction (STEMI) patients. Methods: We analysed all STEMI patients included in the second phase of the Portuguese Registry on Acute Coronary Syndromes, between October 2010 and July 2015. We compared both conservative medical treatment with reperfusion therapy and thrombolysis with primary percutaneous coronary intervention for mechanical complications. We also evaluated the impact of treatment delay on mechanical complications. Results: Among 5230 STEMIs we observed 77 mechanical complications (1.5%). These were significantly more frequent in the non-reperfused patients (3.3% vs. 1.1%, P<0.001) and they were numerically higher in thrombolysis than in primary percutaneous coronary intervention patients (1.6% vs. 1.0%, respectively, P=0.282). Patients with mechanical complications had higher times from symptom onset to hospitalisation and to reperfusion. In multivariate analysis performing reperfusion therapy (odds ratio 0.52, 95% confidence interval 0.29–0.93) and a time from symptom onset to hospitalisation ⩾6 hours (odds ratio 2.44, 95% confidence interval 1.37–4.33) were independent predictors of mechanical complications. The type of reperfusion did not influence the occurrence of mechanical complications. Conclusion: A longer time from symptom onset to hospitalisation was associated with an increased number of mechanical complications. Timely reperfusion therapy prevented mechanical complications and no significant difference was found between thrombolysis and primary percutaneous coronary intervention.

Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

Background Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy. Objective To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy. Methods The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased. Results A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation. Conclusion In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5).

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.