Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-12T15:21:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese de Zoraya versão definitiva 131015 aceita.pdf: 2706371 bytes, checksum: 83da3cf5bbbffb2d66214831901498f3 (MD5) / Made available in DSpace on 2016-04-12T15:21:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese de Zoraya versão definitiva 131015 aceita.pdf: 2706371 bytes, checksum: 83da3cf5bbbffb2d66214831901498f3 (MD5) Previous issue date: 2015-02-27 / Esta tese teve como objetivo estudar um marcador de aterosclerose subclínica, a rigidez aórtica, medida através da velocidade de onda de pulso aórtica, diante da importância de se identificar os pacientes com risco maior de desenvolver doenças cardiovasculares (DCV), hoje, uma das principais causas de morbidade e mortalidade, não relacionada à síndrome da imunodeficiência adquirida (AIDS) em pessoas vivendo com o vírus da imunodeficiência humana (PVHIV). Entre setembro de 2011 e janeiro de 2013, a população do estudo composta por homens e mulheres vivendo com o vírus da imunodeficiência humana (HIV), participantes da coorte HIV/AIDS-PE, no nordeste do Brasil, iniciada em 2007, foi submetida a dois desenhos de estudos visando identificar os fatores de risco cardiovasculares tradicionais e emergentes associados com a rigidez aórtica e sua progressão.Visando identificar fatores de riscos cardiovasculares emergentes, incluindo a perda de massa óssea, realizamos um estudo transversal em mulheres vivendo com HIV que haviam realizado densitometria mineral óssea, no período entre Outubro de 2010 a Novembro de 2011. A densidade mineral óssea (DMO), foi medida pela absorciometria de energia dupla de raio-x de (DXA) nas regiões da coluna lombar, colo de fêmur e fêmur total e a rigidez aórtica, foi medida pela velocidade de onda de pulso aórtica (VOPa). O resultado principal deste estudo foi a correlação negativa significante entre a DMO do colo de fêmur e do fêmur total com a VOPa mesmo ajustada para idade, síndrome metabólica e pressão arterial média. Sugerindo que mulheres vivendo com HIV com perda de massa óssea deverão ser avaliadas para doença cardiovascular aterosclerótica. Para investigar a progressão da rigidez aórtica, foram acompanhados por uma média de 2,9 anos, homens e mulheres vivendo com HIV que haviam realizado a primeira avaliação da rigidez aórtica entre Abril e Novembro de 2009. O achado mais importante deste estudo foi a verificação de uma acelerada progressão da rigidez aórtica associada a fatores de risco tradicionais, idade, sexo masculino e hipertensão arterial e uma correlação negativa com a duração da infecção em uma população sob bom controle virológico. Os dados favorecem intensificar medidas para melhor controle da hipertensão arterial e da imunodeficiência. / This thesis aimed to study a marker of Subclinical Atherosclerosis, aortic stiffness measured by aortic pulse wave velocity, given the importance of identifying the patient with higher risk of developing cardiovascular diseases, today, one of the leading causes of morbidity and mortality, not related to AIDS. Between September 2011 and January 2013, the study population comprised of men and women living with human immunodeficiency virus (HIV), HIV/AIDS cohort participants-PE, in northeastern Brazil, initiated in 2007, have undergone two designs of studies aimed at identifying the factors of traditional and emerging cardiovascular risk associated with aortic stiffness and its progression. Aiming to identify emerging cardiovascular risk factors, including the loss of bone mass, we performed a cross-sectional study in women living with HIV who had performed bone mineral densitometry in the period between October 2010 to November 2011. Bone mineral density was measured by dual-energy x-ray absorptiometry (DXA) in regions of the lumbar spine, neck femur and total femur and aortic stiffness was measured by aortic pulse wave velocity (aPWV). The main result of this study was the significant negative correlation between the BMD of the femoral neck and total femur aPWV even adjusted for age, metabolic syndrome and mean arterial pressure. Suggesting that women living with HIV with low of bone mass should be assessed for atherosclerotic cardiovascular disease. To investigate the progression of aortic stiffness, were accompanied by an average of 2.9 years, men and women living with HIV who had carried out the initial evaluation of aortic stiffness between April and November 2009 .The most important finding of this study was the verification of an accelerated progression of aortic stiffness associated with traditional risk factors, age, male and hypertension and a negative correlation with duration of infection in a population under good viral control. The data favor the aggressive measures of intensify and immunodeficiency hypertension.

Arterial system is a system of vessels distributing blood. Ageing of arterial system leads to two distinct pathologies: atherosclerosis and arteriosclerosis - stiffening of arterial wall. These pathologies can coexist and interfere; however, they differ in their pathogenesis, location, scope and consequences. Progressive loss of elastic properties of large arteries is natural part of vascular ageing. It is directly responsible for several age dependent consequences, such as increase of central systolic pressure or prevalence of isolated systolic hypertension in the elderly. Clinically, central arteries stiffness manifests as aortic pulse wave velocity, which can be quantified, among other methods, using applanation tonometry. There is abundant evidence that aortic pulse wave velocity represents an independent predictor of cardiovascular mortality and morbidity. The most important mechanism in arterial stiffening is repeated mechanical damage which leads to fractures, fragmentation and thinning of elastin. Stiffening of large arteries can be accelerated by several other mechanisms, e.g. deposition of several substances (calcium, advanced glycation end-products, etc.), metabolic turnover of key elements of vascular extracellular matrix (collagen and elastin) or individual genetic susceptibility. In...