Influência do diabetes mellitus nos efeitos da poluição atmosférica
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Data
2007
Tipo
Dissertação de mestrado
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Introdução: O diabetes tipo 2 aumenta o risco de mortalidade cardiovascular e os indivíduos diabéticos, mesmo sem ter antecedentes coronarianos, tem um risco para doenças coronarianas fatais similar aos indivíduos não diabéticos que sobreviveram a um infarto do miocárdio. Foram acumuladas evidências de que a poluição atmosférica por material particulado está associada a aumento da morbidade e mortalidade por causas cardiopulmonares. Estudos epidemiológicos observaram a associação entre a exposição ao material particulado e aspectos específicos da doença cardiovascular como a redução da variabilidade da freqüência cardíaca, o aumento da viscosidade sanguínea e o aumento dos níveis de marcadores inflamatórios. Este estudo foi realizado com o intuito de avaliar o efeito modificador da poluição atmosférica sobre as doenças cardiovasculares em pacientes com diabetes. Métodos: Utilizando um estudo de série temporal, adotamos modelos de regressão linear de Poisson para calcular os efeitos de PM10, CO, NO2, SO2 e O3 sobre os atendimentos de pronto-socorro por doenças cardiovasculares em diabéticos e não diabéticos no período de 2001 a 2004, controlando as sazonalidades de curta e longa duração e as variáveis metereológicas usando um atenuador semi-paramétrico (spineline). Resultados: Um aumento interquartil na média móvel de dois dias para SO2, equivalente a 8.0 µg/m3 , estava associado a aumentos de atendimentos de pronto-socorro da ordem de 7.0% e 20.0% para não diabéticos e diabéticos respectivamente. Conclusão: este estudo demonstrou que a poluição atmosférica tem um importante efeito sobre a morbidade cardiovascular, sobretudo num grupo de risco cardiovascular como os diabéticos, reforçando a necessidade de serem realizados estudos adicionais para confirmar estes achados.
Introduction: type 2 diabetes increases the risk of cardiovascular mortality and its patients, even those without previous myocardial infarction, run the risk of suffering from fatal coronary heart disease similarly to non-diabetic patients surviving to myocardial infarction. Cumulative evidences show particulate matter air pollution as being associated with increases in cardiopulmonary morbidity and mortality. Epidemiologic studies have shown that particulate matter exposures is associated with specific physiologic end points such as reduced heart rate variability, increased blood plasma viscosity and increased inflammation markers. This study was made aiming at estimating the effects changes induced by diabetes mellitus on the association between air pollution and cardiovascular emergency room visits in the City of Sao Paulo. Methods: through time-series approach, and adopting generalized linear Poisson regression models, we assessed the effects of daily variation in PM10, CO, NO2, SO2, and O3 on daily counts of cardiovascular diseases emergency room visits of diabetic and non-diabetic patients, from 2001 to 2004. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear terms seasonal usage and weather variables. Results: the observed increase on inter-quartiles range within the two-day moving average of SO2 (8.0 µg/m3) was associated with 7.0% (95% CI: 4.0 – 11.0) and 20.0% (95% CI: 5.0 – 44.0) increases on cardiovascular diseases emergency room visits for non-diabetic as well as diabetic groups, respectively. Conclusion: This study indicates that air pollution produces a remarkable impact on cardiovascular morbidity and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.
Introduction: type 2 diabetes increases the risk of cardiovascular mortality and its patients, even those without previous myocardial infarction, run the risk of suffering from fatal coronary heart disease similarly to non-diabetic patients surviving to myocardial infarction. Cumulative evidences show particulate matter air pollution as being associated with increases in cardiopulmonary morbidity and mortality. Epidemiologic studies have shown that particulate matter exposures is associated with specific physiologic end points such as reduced heart rate variability, increased blood plasma viscosity and increased inflammation markers. This study was made aiming at estimating the effects changes induced by diabetes mellitus on the association between air pollution and cardiovascular emergency room visits in the City of Sao Paulo. Methods: through time-series approach, and adopting generalized linear Poisson regression models, we assessed the effects of daily variation in PM10, CO, NO2, SO2, and O3 on daily counts of cardiovascular diseases emergency room visits of diabetic and non-diabetic patients, from 2001 to 2004. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear terms seasonal usage and weather variables. Results: the observed increase on inter-quartiles range within the two-day moving average of SO2 (8.0 µg/m3) was associated with 7.0% (95% CI: 4.0 – 11.0) and 20.0% (95% CI: 5.0 – 44.0) increases on cardiovascular diseases emergency room visits for non-diabetic as well as diabetic groups, respectively. Conclusion: This study indicates that air pollution produces a remarkable impact on cardiovascular morbidity and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.
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Citação
PEREIRA FILHO, Manoel Amador. Influência do diabetes mellitus nos efeitos da poluição atmosférica. 2007. 78 p. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.