Navegando por Palavras-chave "Cardiovascular risk"

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    Associação do polimorfismo G894T do gene da óxido nítrico sintase endotelial (eNOS) com alteração do intervalo QTc e marcadores de risco cardiovascular em pacientes dialíticos
    (Universidade Federal de São Paulo (UNIFESP), 2016-02-29) Andrade, Jessica Liara Felicio de [UNIFESP]; Higa, Elisa Mieko Suemitsu [UNIFESP]; http://lattes.cnpq.br/8578252701813423; http://lattes.cnpq.br/3880410597697153; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The chronic kidney disease (CKD) occurs due to traditional (hypertension, diabetes, dyslipidemia) and non-traditional risk factors (inflammatory processes and oxidative stress). In addition, the CKD can collaborate with major cardiac changes such as QTc prolongation, contributing to the cardiovascular disease (CVD) risk and premature death. The endothelial nitric oxide synthase (eNOS) - which can be inhibited by asymmetric dimethylarginine (ADMA) - is an enzyme of great importance for cardiovascular system homeostasis, and one of the responsible for nitric oxide (NO) production, which is a potent vasodilator. There are three eNOS polymorphisms, among them, the G894T polymorphism resulting from the replacement of nitrogenous base guanine for thymine at position 894 of exon 7, and it is correlated with cardiac complications and mortality in this population. Aim: To evaluate the association of G894T polymorphism with QTc prolongation and cardiovascular risk markers in dialysis patients. Methods: Predialysis blood samples were collected for biochemical and genetic analysis and was the 12-lead electrocardiogram performed. The genotype distribution of eNOS G894T polymorphism was analyzed by polymerase chain reaction (PCR), followed by digestion with Ban II restriction enzyme. Cardiovascular risk factors were assessed by NO, TBARS, ADMA and total antioxidant plasma levels. Results: The study showed that GG genotype was predominant, with 54%, followed by 41% GT and 6% TT and this genotype distribution was not associated with QTc prolongation; however, women with TT genotype presented a trend tendency to this change and patients with T allele had increased levels of lipid peroxidation, L-arginine and ADMA and reduced synthesis of NO and antioxidant. Conclusion: Our study showed that, although there was no association between eNOS polymorphisms and QTc, patients with T allele had significant risk factors for the development among them, increased oxidative stress, decreased NO bioavailability and redox imbalance, which contribute to the development of endothelial dysfunction and therefore for future cardiovascular complications.
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    Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population
    (Elsevier B.V., 2013-04-01) Moraes, Walter André dos Santos [UNIFESP]; Poyares, Dalva [UNIFESP]; Zimberg, Ioná Zalcman [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Sleep duration has been associated with overweight individuals in many epidemiological studies; however, few studies have assessed sleep using objective methods. Our study was designed to evaluate the association between body mass index (BMI) and sleep duration measured by actigraphy (Acti), polysomnography (PSG) and the Pittsburgh Sleep Quality Index questionnaire (PSQIO). Furthermore, we evaluated other biochemical and polysomnographic parameters.Methods: A representative sample of 1042 individuals from São Paulo, Brazil, including both genders (20-80 yrs), participated in our protocol. Weight and other anthropometric parameters were measured at the onset of the study. Sleep duration was calculated by Acti, PSG, and the PSQIQ. the population was sorted by sleep duration, body, slow wave sleep (SWS) and REM sleep (REMS) duration subsets. in addition, other biochemical and polysomnographic parameters were analyzed. Differences between population subsets were analyzed by one-way analysis of variance (ANOVA). Linear regression analysis was performed between sleep and anthropometric parameters.Results: Shorter sleep duration was associated with higher BMI and waist and neck circumference when measured by Acti and PSG (p < 0.05). Lower leptin levels were associated with short sleep in normal-weight (BMI > 18 and <= 25) individuals (p < 0.01). the association between short sleep duration Acti and higher BMI was present when apnea-hypopnea index (AHI) was less than 15 (p = 0.049). Shorter REMS and SWS also were associated with higher BMI (p < 0.01). Normal-weight individuals tended to sleep longer, have higher sleep efficiency and longer SWS and REMS than obese individuals (Acti, PSG; p = 0.05). Sleep duration was negatively correlated with BMI (Acti, PSG; p < 0.05). Short SWS and REMS were associated with higher cardiovascular risk factors (p < 0.05).Conclusion: Shorter sleep, SWS, and REMS duration were associated with higher BMI, central adiposity measurements, and cardiovascular risk factors when measured by objective methods. (c) 2012 Elsevier B.V. All rights reserved.
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    Association of Carotid Intima-media Thickness and Cardiovascular Risk Factors in Women Pre- and Post-bariatric Surgery
    (Springer, 2009-03-01) Sarmento, P. L. F. A. [UNIFESP]; Plavnik, F. L. [UNIFESP]; Zanella, M. T. [UNIFESP]; Pinto, P. E.; Miranda, R. B.; Ajzen, S. A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Servidor Publ Estadual; Hosp Serv Publ Estadual São Paulo
    Obesity is associated with cardiovascular risk factors (CVRFs), such as hypertension, hypertriglyceridemia, and low levels of high-density cholesterol (HDL-C). in obese patients with a body mass index (BMI) of a parts per thousand yen40 kg/m(2) or 35-40 kg/m(2) associated with CVRFs, weight loss may be achieved more effectively by bariatric surgery on reducing several CVRFs. Carotid intima-media thickness (C-IMT) is an indicator of early atherosclerosis, and may be correlated with CVRFs. Our objective was to correlate C-IMT with CVRFs before (baseline data) and after surgery, and to observe whether weight loss is followed by a regression of C-IMT.Eighteen women who had undergone bariatric surgery participated in this study. Assessments were carried out on the baseline date, and 3, 6, and 12 months after surgery. Some of the CVRFs analyzed were: total cholesterol (TC) levels, HDL-C, triglycerides to HDL-C ratio (TG/HDL-C) and fasting plasma glucose. C-IMT was measured by B-mode ultrasound.A positive correlation was found between C-IMT and age and triglyceride level (p = 0.002 and p = 0.02, respectively). Six months after surgery, we found a significant reduction in C-IMT (p < 0.05), which was significantly correlated with TG level and systolic pressure (p < 0.05).The weight loss achieved with bariatric surgery resulted in regression of C-IMT. This regression could be observed 6 months following surgery, with an additional benefit at 12 months. Also, this finding was correlated with a reduction in triglyceride levels and systolic blood pressure.
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    Classificação da aptidão cardiorrespiratória e seu papel mediador na saúde cardiometabólica e respiratória de adultos: resultados transversal do estudo EPIMOV
    (Universidade Federal de São Paulo, 2019-12-05) Dourado, Victor Zuniga [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/1919368500743497; Universidade Federal de São Paulo (UNIFESP)
    RESUMO PARTE 1: CLASSIFICAÇÃO DA APTIDÃO CARDIORRESPIRATÓRIA INTRODUÇÃO: A American Heart Association recomendou em 2016 que a avaliação da aptidão cardiorrespiratória (ACR) seja considerada um sinal vital na prática clínica devido à sua importância na triagem do risco cardiometabólico. Entretanto, a avaliação da ACR ainda não tem sido incorporada como estratégia de rotina. Tabelas de normalidade e equações de predição do consumo máximo de O2 (V ̇O2max), principalmente utilizando testes mais simples como o teste de caminhada de seis minutos (TC6), poderiam facilitar o uso da avaliação da ACR na prática clínica e na saúde pública. OBJETIVOS: Avaliar a ACR e suas alterações relacionadas ao sexo e idade, bem como oferecer tabelas de normalidade para a distância percorrida no TC6 (DTC6) em adultos com base na classificação obtida por avaliação direta da ACR (i.e., V ̇O2max). MÉTODOS: Avaliamos os resultados de 1295 participantes adultos entre 18 e 80 anos (60% mulheres) que realizaram a primeira avaliação no Estudo Epidemiológico do Movimento Humano (EPIMOV). O V ̇O2max foi avaliado diretamente durante teste de exercício cardiorrespiratório máximo realizado em esteira sob protocolo de rampa. O TC6 foi aplicado conforme padronização internacional. Peso, estatura foram mensurados e o índice de massa corporal (IMC) foi calculado. A ACR foi classificada para sexo e faixa etária de acordo com os percentis (p) como se segue: muito fraca (< p5%), fraca (p5% - p25%), regular (p26% - p50%), boa (p51% - p75%), excelente (p76% - p95%) e superior (> p95%), tanto para o V ̇O2max quanto para o TC6. As alterações do V ̇O2max e da DTC6 relacionadas ao sexo e idade foram avaliadas e calculamos o declínio por década (18-29, 30-39, 40-49, 50-59, 60-80 anos). A correlação entre a DTC6 e o V ̇O2max foi inspecionada e uma equação foi desenvolvida para estimativa do V ̇O2max com base na DTC6. De acordo com a classificação do V ̇O2max (i.e., padrão ouro), investigamos a DTC6 em percentual do predito com maior combinação de sensibilidade e especificidade para identificar cada uma das classificações do V ̇O2max utilizando curvas ROC. RESULTADOS: O V ̇O2max declinou em homens e mulheres, ambos em média em 8,7% por década. A DTC6, em média, declinou 9,3% por década nas mulheres e 9,5% por década nos homens. A DTC6 apresentou correlação significativa exponencial com o V ̇O2max (V ̇O2max(mL/min/kg) = 4,910 x exp (0,003 x DTC6(m)); R2 = 0,548). Produzimos tabelas de classificação da ACR nas faixas etárias 18-27, 28-34, 35-42, 43-51, 52-59 e 60-80 anos. Considerando a classificação da ACR obtida por meio do V ̇O2max como critério padrão ouro, a DTC6, em percentual do predito, apresentou excelente capacidade para identificar a ACR muito fraca (DTC6 ≤ 96%; AUC = 0,819). Apresentou boa capacidade para identificar a ACR fraca (DTC6 = 97 – 103%; AUC = 0,735), excelente (DTC6 = 107 – 109%; AUC = 0,715) e superior (DTC6 > 109%; AUC = 0,790). Entretanto, não foi capaz de diferenciar a ACR regular e boa. CONCLUSÕES: A classificação da ACR por meio da DTC6 é válida em comparação à ACR diretamente avaliada pelo V ̇O2max e poderia ser utilizada na prática clínica e na saúde pública para a triagem e monitoramento do risco cardiometabólico e respiratório de adultos da população em geral. RESUMO PARTE 2: PAPEL MEDIADOR DA APTIDÃO CARDIORRESPIRATÓRIA INTRODUÇÃO: Estudos de grande dimensão identificaram os baixos níveis de atividade física moderada a vigorosa (AFMV) e aptidão cardiorrespiratória (ACR) como causadores independentes de problemas cardiometabólicos e respiratórios em adultos. Entretanto, a influência combinada desses atributos tem sido investigada inapropriadamente, considerando a ACR como um confundidor. Levantamos a hipótese de que a ACR desempenha papel mediador significativo na relação entre a AFMV e tais desfechos de saúde indesejáveis. OBJETIVO: Investigar o papel mediador da ACR na correlação entre a AFMV e atributos cardiometabólicos e respiratórios em adultos assintomáticos. MÉTODOS: Avaliamos 1295 adultos entre 18 e 80 anos (60% mulheres) que utilizaram um acelerômetro triaxial acima do quadril dominante durante sete dias para avaliação da AFMV. O consumo máximo de O2 (V ̇O2max) foi avaliado diretamente durante teste de exercício cardiorrespiratório realizado em esteira. Fizemos três medidas da pressão arterial sistólica (PAS) e diastólica (PAD) em repouso. A variabilidade da frequência cardíaca (VFC) foi avaliada durante 10 minutos de repouso na posição supina por um monitor de frequ6encia cardíaca. A glicemia, colesterol total e triglicérides foram avaliados em jejum. A composição corporal foi avaliada por impedância bioelétrica tetrapolar. Realizamos espirometria para registrar a capacidade vital forçada (CVF) e o volume expiratório forçado em 1 s (VEF1). O papel mediador do V ̇O2max na relação entre AFMV (variável independente) e as variáveis cardiometabólicas e respiratórias (variáveis dependentes) foi investigado por meio de equações estruturais com cálculo dos efeitos totais (c), indiretos (ab) (i.e., mediados) e diretos (c’). O teste Sobel-Goodman foi utilizado para calcular a proporção de efeitos totais mediados. As análises de mediação foram ajustadas pela idade, sexo e escore de risco cardiovascular e, no caso do VEF1 e CVF, também para a estatura. RESULTADOS: Observamos papel mediador completo da ACR na gordura corporal e na taxa metabólica basal, com 97% e 98% dos efeitos totais mediados, respectivamente. O papel mediador do V ̇O2max foi completo também para a função pulmonar quando considerada a CVF como desfecho, com efeitos totais mediados entre 81% (CVF em L) e 93% (CVF em %pred.). Para as variáveis metabólicas o papel mediador do V ̇O2max foi significativo apenas para os triglicérides, com 77,7% do efeito total mediado. Os efeitos totais mediados pelo V ̇O2max foram significativos para quase todas as variáveis de VFC, com proporções dos efeitos totais mediados entre 36% e 64%. A AFMV não apresentou efeito total significativo na PAS ou na PAD. Diferentemente, o V ̇O2max influenciou significativamente as medidas de pressão arterial. Observamos mediação inconsistente, com a ACR atuando como variável supressora neste caso. CONCLUSÕES: A influência da AFMV na saúde cardiometabólica e respiratória de adultos é amplamente mediada pela ACR, o que demanda o delineamento de estratégias preventivas mais focadas na atividade física com intensidade suficiente para aumentar a ACR. Portanto, o presente estudo reforça as recomendações atuais no sentido de adicionar a avaliação da ACR realmente como um sinal vital na prática clínica e na saúde pública.
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    Diversity of apolipoprotein E genetic polymorphism significance on cardiovascular risk is determined by the presence of metabolic syndrome among hypertensive patients
    (Biomed Central Ltd, 2014-11-20) Teixeira, Andrei Alkmim [UNIFESP]; Marrocos, Mauro Sergio [UNIFESP]; Quinto, Beata Marie Redublo [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Rodrigues, Cassio Jose de Oliveira [UNIFESP]; Carmona, Silmara de Melo [UNIFESP]; Kuniyoshi, Mariana [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Tufts Univ; Hosp Israelita Albert Einstein
    Background: Hypertension has a significant relevance as a cardiovascular risk factor. A consistent increase on world's Metabolic Syndrome (MetS) incidence has been associated with an epidemic cardiovascular risk in different populations. Dislipidemia plays a major role determining the epidemic CV burden attributed to MetS. Apolipoprotein E (ApoE) is involved on cholesterol and triglycerides metabolism regulation. Once ApoE polymorphism may influence lipid metabolism, it is possible that it brings on individual susceptibility consequences for the development of MetS and cardiovascular risk. the objective of the study is to measure the discriminatory power of ApoE polymorphism in determining cardiovascular risk stratification based on the presence MetS in a cohort of hypertensive patients.Methods: It was enrolled 383 patients, divided in two groups, classified by MetS presence (IDF criteria): Group 1: 266 patients with MetS (MetS +) and Group 2: 117 patients without Mets (MetS -). Patient's data were collected by clinical evaluation, physical exam, file reviews and laboratory testing. Polymorphic ApoE analysis was performed by PCR amplification. Groups were compared on clinical and laboratory characteristics as well as allele and genotype distribution towards ApoE polymorphism. Mets CVD prevalence was analysed according to E4 allele prevalence.Results: the results evidenced 184 men (48%), 63,7% whites, 45,1% diabetics and 11,7% of patients were smokers. Mean age was 64,0 +/- 12,0 years. When genotypic distribution was analyzed, E3/3 genotype and E3 allele frequencies were more prevalent. Among patients with MetS, we observed an independent association between CVD prevalence and E4 allele frequency (OR 2.42 (1.17-5.0, p < 0,05)). On the opposite direction, in those without MetS, there was lesser CVD burden in E4 allele carriers (OR 0,14 (0,02-0,75)). These associations remained significant even after confounding factor corrections.Conclusions: the results presented demonstrate that the association between ApoE gene and CVD may be modulated by the presence of MetS, with an increased CV burden observed among E4 allele carriers with the syndrome. On the opposite way, E4 allele carriers without visceral obesity had lesser prevalence of CVD.
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    Early developmental exposure to high fructose intake in rats with NaCl stimulation causes cardiac damage
    (Springer Heidelberg, 2016) Araujo, I. C. [UNIFESP]; Andrade, R. P.; Santos, F.; Soares, E. S.; Yokota, R. [UNIFESP]; Mostarda, C.; Fiorino, P.; De Angelis, K.; Irigoyen, M. C.; Morris, M.; Farah, V. [UNIFESP]
    Metabolic syndrome (MS) increases the risk of type 2 diabetes and cardiovascular disease. High consumption of fructose is a proposed cause of increased MS, manifested through hypertension, obesity, insulin resistance, and dyslipidemia. High NaCl also increases the risk of CD. The purpose of this study is to evaluate the influence of fructose and sodium on autonomic dysfunction and its relation with CD in MS. Fructose overload was started at weaning and continued through adulthood. Male Wistar rats (21 days) were divided into four groups: Control (C), fructose consumption (10 %, F), NaCl consumption (salt 1 % for the 10 last days, S), and fructose and NaCl (FS), and monitored for 8 weeks. Metabolic evaluations consisted of Lee index, glycemia, insulin and glucose tolerance tests, triglycerides, and total cholesterol measurements. Cardiovascular parameters measured were arterial pressure (AP) and cardiac function performed by echocardiography. They also measured the influence of renin angiotensin (RAS) and autonomic nervous systems by drug blockage with losartan, atropine, and atenolol. Energy analysis showed no change between groups. Fructose overload induced a MS state, confirmed by insulin resistance, glucose intolerance, and dyslipidemia. Fasting glucose was increased in F and FS rat groups compared with C and S groups. AP was higher in F, S, and FS groups in comparison with the C group. The hypotensive response after sympathetic blockade was increased in F, S, and FS versus C. The cardiac vagal tonus was reduced in F and FS animal groups. The intrinsic heart rate was decreased in the FS group (372 +/- A 9 bpm) compared with the C group (410 +/- A 13 bpm). The morphometric measurements evaluated through left ventricular diameter during diastole and the left ventricular diameter during systole decreased in the FS group (16 and 26 %, respectively). Diastolic function was reduced in F and FS. The depressor response induced by losartan was increased in the F group in comparison with other groups. However, there was a uniform increase in plasma ACE activity in all treated groups compared with the C group. Data suggest that early exposure to high fructose intake produced marked alterations in metabolic and cardiovascular function. When stimulated by NaCl, the fructose-fed subjects showed further impairment in cardiac function.
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    Early developmental exposure to high fructose intake in rats with NaCl stimulation causes cardiac damage
    (Springer Heidelberg, 2016) Araujo, I. C. [UNIFESP]; Andrade, R. P.; Santos, F.; Soares, E. S.; Yokota, R. [UNIFESP]; Mostarda, C.; Fiorino, P.; De Angelis, K.; Irigoyen, M. C.; Morris, M.; Farah, V. [UNIFESP]
    Metabolic syndrome (MS) increases the risk of type 2 diabetes and cardiovascular disease. High consumption of fructose is a proposed cause of increased MS, manifested through hypertension, obesity, insulin resistance, and dyslipidemia. High NaCl also increases the risk of CD. The purpose of this study is to evaluate the influence of fructose and sodium on autonomic dysfunction and its relation with CD in MS. Fructose overload was started at weaning and continued through adulthood. Male Wistar rats (21 days) were divided into four groups: Control (C), fructose consumption (10 %, F), NaCl consumption (salt 1 % for the 10 last days, S), and fructose and NaCl (FS), and monitored for 8 weeks. Metabolic evaluations consisted of Lee index, glycemia, insulin and glucose tolerance tests, triglycerides, and total cholesterol measurements. Cardiovascular parameters measured were arterial pressure (AP) and cardiac function performed by echocardiography. They also measured the influence of renin angiotensin (RAS) and autonomic nervous systems by drug blockage with losartan, atropine, and atenolol. Energy analysis showed no change between groups. Fructose overload induced a MS state, confirmed by insulin resistance, glucose intolerance, and dyslipidemia. Fasting glucose was increased in F and FS rat groups compared with C and S groups. AP was higher in F, S, and FS groups in comparison with the C group. The hypotensive response after sympathetic blockade was increased in F, S, and FS versus C. The cardiac vagal tonus was reduced in F and FS animal groups. The intrinsic heart rate was decreased in the FS group (372 +/- A 9 bpm) compared with the C group (410 +/- A 13 bpm). The morphometric measurements evaluated through left ventricular diameter during diastole and the left ventricular diameter during systole decreased in the FS group (16 and 26 %, respectively). Diastolic function was reduced in F and FS. The depressor response induced by losartan was increased in the F group in comparison with other groups. However, there was a uniform increase in plasma ACE activity in all treated groups compared with the C group. Data suggest that early exposure to high fructose intake produced marked alterations in metabolic and cardiovascular function. When stimulated by NaCl, the fructose-fed subjects showed further impairment in cardiac function.
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    Gordura visceral e síndrome metabólica: mais que uma simples associação
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Ribeiro Filho, Fernando Flexa [UNIFESP]; Mariosa, Lydia Sebba Souza [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Metabolic syndrome (MS) is seen nowadays as a worldwide epidemic event associated with high cardiovascular morbi-mortality and high socioeconomic cost. The ponderal gain is an independent predictor for the development of MS, although not all obese individuals present it. On the other hand, some populations with low obesity prevalence present high prevalence of MS and cardiovascular mortality. The distribution of corporal fat is relevant and visceral fat (VF), specifically, seems to be the link between adipose tissue and insulin resistance (IR), a mean feature of MS. Adipose tissue is now considered a complex organ with multiple functions. VF presents metabolic properties, which are different from the gluteo-femoral subcutaneous fat and related to IR. Several studies show the narrow relationship of abdominal adiposity with the glucose tolerance, hyperinsulinemia, hypertriglyceridemia and arterial hypertension. More than a simple association, recently it is thought that the VF plays a central part in the physiopathology of MS. Consequently, the quantification of VF plays an important role to identify individuals with larger risk for development of MS, who should be chosen for early interventions in the attempt of reducing the impact of metabolic abnormalities on cardiovascular mortality. This article discusses particularities of the central distribution of fat in MS context, possible physiopathogenic mechanisms related to the VF and available methods for the evaluation of abdominal adiposity.
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    Importância do exercício físico recreativo na infância sobre o número das células progenitoras endoteliais
    (Universidade Federal de São Paulo (UNIFESP), 2017-03-31) Souza, Livia Victorino de [UNIFESP]; Franco, Maria do Carmo Pinho [UNIFESP]; Clemente, Ana Paula Grotti [UNIFESP]; http://lattes.cnpq.br/5415221153107290; http://lattes.cnpq.br/0138099513326464; http://lattes.cnpq.br/8960557679660947; Universidade Federal de São Paulo (UNIFESP)
    Cardiovascular diseases (CVD) are the leading causes of death in the world. Characterized by morphofunctional changes in the arteries defined by changes in the stiffness, thickness and decrease of the lumen of the vessel, as well as the atherosclerotic process and the formation of the atheroma plaque that give rise to adverse cardiac events. In addition, it is clear in the literature that the atherosclerotic process is a result of natural aging. What's more, the key to these cardiovascular changes that occur from birth to death of the individual is endothelial function. In this sense, some recent studies in the literature have shown that the development of cardiovascular diseases begins in the childhood period as a result of the natural development of the individual associated with endogenous and exogenous factors. It is therefore important to develop strategies to prevent CVD during childhood. Considering that it is important that physical exercise is a playful and functional practice for children, it is important to evaluate whether recreational physical exercise is capable of promoting the benefits observed in response to physical training. Thus, the present study evaluated the effects of 10 weeks of recreational physical exercise in healthy children on the number of circulating endothelial progenitor cells. For that, 74 children were evaluated. Anthropometric assessments of physical abilities and biomarkers of endothelial function (VEGF-A, NO, MMP-9 and MMP-2) were performed. In addition, we evaluated endothelial progenitor cells (EPCs) by flow cytometry (triple labeling, CD34 / CD133 / CD309 and CD34 / CD133 / CD45) and cell culture (colony forming units). After 10 weeks of recreational physical exercise, there was a significant reduction of body weight, increase of lean mass, muscle strength and flexibility. Endothelial biomarkers VEGF-A, NO, MMP-9 showed a significant increase. Regarding CPEs, a significant increase in number and efficiency was observed. Therefore, with the data obtained in the present study we can conclude that recreational physical exercise was able to increase the number of CPEs, in addition to improving metabolic, anthropometric and physical fitness parameters and, consequently, to reduce cardiovascular risks in healthy children.
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    Microalbuminúria: fator de risco cardiovascular e renal subestimado na prática clínica
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Determination of microalbuminuria has been shown to be useful to identify patients with type 2 diabetes (DM2) at high risk of renal and cardiovascular (CV) diseases. The determination of the albumin/ creatinine (Cr) ratio in an isolate sample of urine has been shown to be sufficient for the diagnosis as well as for the evaluation of the efficacy of the therapy employed to reduce microalbuminuria. Values of urinary albumin >30 mg/g of Cr or 3,4 mg/mmol of Cr are evidence of microalbuminuria. This condition is frequently associated with high blood pressure levels, which increases dramatically not only the progression of renal disease but also de risk of a CV event. Epidemiologic studies have demonstrated that the presence of microalbuminuria is predictive of higher morbi-mortality independent of the presence of other CV risk factors. It appears to reflect a generalized vascular lesion not confined to the glomeruli. The capacity of reducing blood pressure, intraglomerular pressure and the permeability of the glomerular membrane, which are important factors in the progression of renal disease, may explain the renoprotective effects of the angiotensin converting enzyme inhibitors (ACEIs) and the angiotensin II receptors blockers (ARBs). In the treatment of diabetic nephropathy, the control of blood pressure, which has to be maintained near or below 130/80 mmHg associated to the blockade of the renin-angiotensin system with ACEIs or BRAs are the best strategies to promote renal and CV protection.
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    Orlistat and cardiovascular risk profile in hypertensive patients with metabolic syndrome: the ARCOS study
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Zanella, Maria Teresa [UNIFESP]; Uehara, Marcelo Hiroshi [UNIFESP]; Ribeiro, Artur Beltrame [UNIFESP]; Bertolami, Marcelo; Falsetti, Ana Claudia; Yunes, Mirela A.; Universidade Federal de São Paulo (UNIFESP); Instituto Dante Pazzaneze de Cardiologia Service of Cardiology; Roche Laboratories
    Weight loss improves metabolic abnormalities and reduces cardiovascular risk in obese hypertensive patients. To evaluate the impact of a sustained weight loss on coronary risk, 181 hypertensive patients with metabolic syndrome underwent to orlistat therapy, 120 mg, t.i.d., plus diet for 36 weeks. During therapy, Framingham risk scores (FRS) were calculated for determination of coronary heart disease risk in ten years. Body mass index decreased from 35.0 ± 4.2 to 32.6 ± 4.5 kg/m² (p< 0.0001) and waist circumference from 108.1 ± 10.1 to 100.5 ± 11.1 cm (p< 0.0001), at the end of the study period (week 36). Systolic and diastolic blood pressure showed reductions after the two first weeks, which were maintained up to the end of the study. A clear shift to the left in FRS distribution curve occurred at the end of the study, compared to baseline, indicating a reduction in coronary risk. Over all patients at risk, 49.2% moved to a lower risk category. A weight loss > 5% occurred in 64.6% of all patients, associated with improvement in glucose metabolism. Among those with abnormal glucose metabolism, 38 out 53 patients (71.7%) improved their glucose tolerance (p< 0.0005). In conclusion, long-term orlistat therapy helps to reduce and maintain a lower body weight, decreasing risk of coronary disease and improving glucose metabolism, thus protecting against type 2 diabetes.
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    Preferências entre funcionalidades de aplicativos de smartphone para monitorar a atividade física em adultos de acordo com o risco cardiovascular
    (Universidade Federal de São Paulo, 2021-07-30) Gomes, Gabriela Ferreira [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Ostolin, Thatiane Lopes Valentim Di Paschoale [UNIFESP]; http://lattes.cnpq.br/4675570734968007; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/6857075844053972; Universidade Federal de São Paulo (UNIFESP)
    Introdução: No Brasil, o perfil de usuários de aplicativos de smartphone para atividade física é pouco conhecido. Em países desenvolvidos, os usuários são jovens com maior escolaridade e renda comparados aos não-usuários. Diante do crescimento da m-health, analisar as preferências das funcionalidades é imperativo, especialmente dos indivíduos de maior risco cardiovascular (RCV) que mais se beneficiam do aumento da atividade física habitual. A partir disso, é possível desenvolver e aprimorar as funcionalidades, principalmente para indivíduos com RCV aumentado. Objetivo: Identificar as preferências de funcionalidades para aplicativos de smartphone para monitorar a atividade física em indivíduos estratificados segundo a avaliação do RCV.Materiais e método: Trata-se de estudo transversal com 238 adultos selecionados do Estudo Epidemiológico do Movimento Humano (#186.796/2013) e do Projeto Playful data-driven Active Urban Living (#0499/2018). Os participantes forneceram dados sociodemográficos e informações sobre problemas de saúde prévios, uso regular de medicamentos e fatores de risco cardiovascular. Consideramos como RCV baixo < 2 fatores de risco e RCV moderado/alto > 2. Avaliamos as preferências dos participantes segundo: Personalização/individualização, Treinamento, Desempenho, Aspecto social, Feedback, Motivação, Dicas, Outras gerais, Outras sugestões de funcionalidades. Para determinar as preferências, comparamos a proporção de participantes com RCV baixo e moderado/alto para cada funcionalidade por meio do teste x2.Resultados: Nossa amostra foi composta por 238 indivíduos, sobretudo brancos inativos e hipertensos de meia-idade com sobrepeso e maior escolaridade. Os não-usuários têm maior média de idade e maiores prevalências de RCV comparados aos usuários. Em nossa amostra, 73,5% dos participantes apresentaram RCV baixo, enquanto 26,5% tiveram RCV moderado/alto. Apenas 36% e 14,3% dos participantes com RCV baixo e moderado/alto, respectivamente, foram considerados usuários. Para o grupo RCV baixo, a personalização/individualização é mais importante do que para moderado/alto. Contudo, o grupo RCV moderado/alto considera menos importante o aplicativo “oferecer um programa de treinamento” e “ter a opção de salvar e revisar dados do treinamento”. Embora referido por ambos os grupos, “Monitorar o próprio progresso” é mais importante para o RCV baixo. Os grupos não julgam tão importante “competir com amigos”, porém preferem “ser parte de uma comunidade/grupo”. Para o RCV baixo, “receber feedback sobre meu desempenho” e “ter pequenos objetivos/tarefas ou desafios a cumprir” são importantes, enquanto participantes com RCV moderado/alto preferem “receber mensagens motivadoras ou notificações”. Acima de 80% dos participantes preferem as funcionalidades relacionadas às dicas, exceto “receber sugestões de rotas ou locais para praticar a atividade”. Adicionalmente, indivíduos com RCV moderado/alto preferem “ter opção de navegação por voz no aplicativo”, enquanto aqueles com RCV baixo preferem “ter a opção de monitorar o percurso percorrido”.Conclusão: A navegação por voz e o recebimento de mensagens motivadoras são as funcionalidades preferidas por indivíduos com RCV moderado/alto, reforçando a necessidade de aprimorar e/ou desenvolver aplicativos com funcionalidades para atividade física baseados em evidências sólidas e orientados aos indivíduos, que precisam aumentar os níveis de atividade e aptidão físicas.
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    Acesso aberto (Open Access)
    Síndrome dos ovários policísticos, síndrome metabólica, risco cardiovascular e o papel dos agentes sensibilizadores da insulina
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Silva, Regina do Carmo [UNIFESP]; Pardini, Dolores P. [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The Polycystic Ovary Syndrome (PCOS) affects 6 to 10% of women of childbearing age. Insulin resistance and hyperinsulinemia are present in nearly all PCOS patients and play a central role in the development of both hyperandrogenism and metabolic syndrome (MS). MS occurs in approximately 43% of PCOS patients, raising the cardiovascular risk to up seven fold in these patients. Several serum, functional and structural markers of endothelial dysfunction and subclinical atherosclerosis were described in PCOS patients, even those young and non-obese. However, despite the fact that PCOS adversely affects the cardiovascular profile, long-term studies did not demonstrate a consistent raise in cardiovascular mortality, which seems to be more observed in the post-menopausal period. Recently, oral contraceptives are being substituted for insulin sensitizing agents (metformin and glitazones) in the PCOS treatment, due to their effects on insulin resistance and cardiovascular risk.