Background: Previous research has shown that sexual minority individuals (SM) are twice as likely to smoke, twice as likely to be overweight or obese, and less likely to be physically active than heterosexual persons; all of which place SMs at an increased risk for cardiovascular disease (CVD). While information on CVD risk by race/ethnicity and socioeconomic status is well documented, there is scant literature examining race, gender, and the potential CVD risk in SMs. The purpose of this study was to examine CVD risk in sexual minorities. Method: The current study used data from the National Longitudinal Study of Adolescent Health (Add Health). The Framingham multiple-risk assessment, which uses a calculation of age, smoking, BMI, and blood pressure, was used to predict vascular age and the risk of experiencing CVD event in the next 10 years. 54% of the sample was male, 62% white, and 4% identified as a SM. The sample was split into three groups: 1) 100% heterosexual (N=4363); 2) mostly heterosexual (N=509); and 3) SM (N=188). Results: There was a trend towards significance, p = .056, for mean differences in vascular age/actual age, for SM participants (M=10.07), compared to 100% heterosexual (M=9.1) and mostly heterosexual (M=8.66) participants. Mostly heterosexual participants were 1.62 times more likely, and SM participants were 1.97 times more likely to be current smokers when compared to 100% heterosexual participants. SM participants endorsed having significantly more drinks (M = 4.50) when compared to both 100% heterosexual (M = 3.80) and mostly heterosexual (M = 3.38) participants. SM participants were 1.7 times more likely to endorse having 5 or more drinks on one occasion. SM participants also reported significantly higher stress levels than the other two groups Conclusion: While the data for the current study did not provide sufficient evidence to suggest sexual orientation differences in Framingham risk scores, the findings remain noteworthy. SM showed increased risk in smoking and stress levels. Additionally, the Population-based longitudinal studies and surveillance data are essential and necessary in order to minimize disparities in risk factors and to reduce the likelihood of subsequent disease in SM population.

Faculty of Sicence, Charles University Aleš Urban, Praha 2012 Effects of temperature extremes on hospital admissions for cardiovascular diseases The thesis compares differences in the impacts of warm and cold days on both excess mortality and hospitalizations for individual cardiovascular diseases (CVDs) in Prague and a selected rural region (southern Bohemia - JČ) consisting of the Jihočeský kraj and Vysočina districts in the period 1994- 2009. Population size and age structure are similar in the two regions. The differences are compared between selected population groups (men and women; < 65 and 65+ years). Value of the 90% (10%) percentile of daily mean air temperature in summer (winter) during the period were used for the definition of warm (cold) days for each region separately. The excess mortality and hospitalizations were determined as the difference from standardized daily counts of death and hospital admissions, adjusted for epidemics of influenza/acute respiratory infections, long-term changes, and for annual and weekly cycles of mortality and hospitalizations. Generally higher relative excess CVD mortality on warm days was identified in Prague, while for cold days we found higher excess mortality in south Bohemia. In contrast to mortality, weak excess CVD hospitalizations were observed for both...

Les vésicules extracellulaires telles que les microvésicules et les exosomes sont libérées lors de l’apoptose ou de l’activation cellulaire. Ce sont des médiateurs importants dans la communication intercellulaire, suggérant que ces vésicules pourraient jouer un rôle physiopathologique, en particulier dans les maladies cardiovasculaires. L'athérosclérose est une maladie inflammatoire chronique de la paroi artérielle qui résulte de l’interaction entre les lipoprotéines, les cellules inflammatoires, et les cellules vasculaires. L'infarctus du myocarde est une complication aiguë et grave de l'athérosclérose. La réaction inflammatoire post-infarctus joue un rôle central dans la formation de néovaisseaux sanguins et la cicatrisation. Cependant, les mécanismes de l’inflammation sont encore mal connus dans ces pathologies. Mon travail de thèse a porté sur les effets des vésicules extracellulaires isolées de tissus pathologiques sur les cellules inflammatoires. Nous avons montré dans un premier travail que les microvésicules s’accumulant dans les lésions d’athérosclérose humaines contribuent à la surcharge en cholestérol et en triglycérides des macrophages et facilitent la formation de cellules spumeuses. L’accumulation des lipides intracellulaires induite par ces microvésicules est contrebalancée par une augmentation de l’efflux du cholestérol associée à une activation d’ABCA1. Dans un deuxième travail, nous avons examiné les effets des vésicules produites dans le cœur post-infarctus sur la réponse inflammatoire. Nos résultats montrent : 1- une augmentation de la libération in situ des microvésicules majoritairement d’origine cardiomyocytaire et des exosomes 15 heures après infarctus ; 2- la stimulation de la production de VEGF monocytaire par les vésicules extracellulaires ; 3- l’incapacité en ce qui concerne les vésicules isolées de cœur diabétique infarci à reproduire cet effet sur les monocytes des souris contrôles. Afin de clarifier les déterminants de l’angiogenèse post-ischémique, nous avons également étudié les profils de miARNs des vésicules contrôles et diabétiques. Après infarctus du myocarde, l’expression de miR-126-3p et de miR-92a-3p est significativement diminuée dans les vésicules diabétiques en comparaison avec les vésicules contrôles. Par ailleurs, nous avons observé une augmentation de miR-126-3p et de miR-92a-3p respectivement dans les microvésicules et les exosomes chez les souris contrôles post-infarctus. En conclusion, ce travail apporte des éléments nouveaux sur les fonctions des vésicules extracellulaires générées localement dans les tissus inflammatoires, en particulier leur capacité à promouvoir la transformation des macrophages en cellules spumeuses dans la plaque. Par ailleurs, les vésicules isolées du cœur ischémique pourraient favoriser l’angiogenèse post-infarctus en stimulant la production de VEGF monocytaire. La disparition de cet effet bénéfique dans le diabète pourrait être associée à des modifications d’adressage des miARNs dans les vésicules extracellulaires au cours de cette pathologie. / Extracellular vesicles, such as microvesicles and exosomes, are released during cell apoptosis or activation. They are important mediators of intercellular communication, suggesting that these vesicles could play a pathophysiological role, especially in cardiovascular diseases. Atherosclerosis is a chronic inflammatory disease of the arterial wall which results from the interaction between lipoproteins, inflammatory cells, and vascular cells. Myocardial infarction is an acute and severe complication of atherosclerosis. The postinfarction inflammatory response plays a central role in the formation of new blood vessels and scarring. However, the mechanisms of inflammation are still poorly known in these pathologies. My thesis concerned the effects of extracellular vesicles isolated from pathological tissues on inflammatory cells. We showed in the first work that microvesicles accumulating in human atherosclerotic lesions contribute to cholesterol and triglyceride overload in macrophages and facilitate foam cell formation. The accumulation of the intracellular lipids induced by those microvesicles is offset by an increase in cholesterol efflux associated with activation of ABCA1. In the second study, we examined the effect of vesicles produced in the infarcted heart on the inflammatory response. Our results showed : 1- an increased release in situ of microvesicles mostly of cardiomyocyte origin and exosomes 15 hours after infarction ; 2- the stimulation of monocyte VEGF production by extracellular vesicles ; 3- the incapacity of diabetic vesicles isolated from infarcted heart to reproduce that effect on control mice monocytes. In order to clarify the determinants of postischemic angiogenesis, we also studied miRNA profiles of control and diabetic vesicles. After myocardial infarction, the expression level of miR-126-3p and miR-92a-3p was significantly decreased in diabetic vesicles compared to control vesicles. Furthermore, we observed an increased expression of miR-126-3p and miR-92a-3p respectively in the microvesicles and the exosomes isolated from control mice heart after myocardial infarction. In conclusion, this work provides new information on the functions of extracellular vesicles locally generated in inflamed tissues, particularly in promoting macrophage transformation into foam cells in the atherosclerotic plaque. Furthermore, vesicles isolated from ischemic heart could enhance postinfarction angiogenesis by stimulating monocyte VEGF production. The loss of this beneficial effect in diabetes may be associated with changes of miRNA cargo in extracellular vesicles in this pathology.

As doenças cardiovasculares estão entre as principais causas de mortalidade no mundo. Entre estas doenças, a hipertensão arterial tem apresentado um dos índices mais significativos. A hipertensão arterial é uma doença multifatorial e, dentre os fatores desencadeantes, está o consumo excessivo de sal pela população. Segundo a OMS, a ingestão diária de sal por pessoa não deve ultrapassar o limite de 5g; porém, a maior parte dos países, incluindo o Brasil, ultrapassa o consumo de 10g de sal por pessoa por dia. Se considerarmos que o consumo de sal por dia ultrapassa os limites aceitáveis e que grande parte da população não apresenta hipertensão, surge como questionamento de como essa sobrecarga salina se relaciona com o desenvolvimento da hipertensão arterial e quais os mecanismos fisiológicos envolvidos numa fase pré-hipertensiva. Nossa hipótese é a de que a sobrecarga salina induz alterações na regulação hemodinâmica bem como adaptações vasculares independente de alterações na pressão arterial. Para responder nossa hipótese, foram utilizados ratos Wistar machos, distribuídos em três grupos experimentais: 1) controle (Cont), com acesso a água de beber livre de NaCl); 2) Sal-2, tratado com NaCl 1% na água de beber por 2 semanas; e 3) Sal-12, tratado com NaCl 1% na água de beber por 12 semanas. Os grupos experimentais foram usados para avaliar o modelo experimental (com acompanhamento de peso corporal e de ingestão de água e exceção de urina em gaiola metabólica), bem como para os estudos propostos: avaliação hemodinâmica (Estudo 1), avalição de fluxo regional (Estudo 2), estudo biomecânico da aorta (Estudo 3), e estudo do remodelamento vascular (Estudo 4). Para estes estudos, foi feita medida da pressão arterial e frequência cardíaca, teste biomecânico da aorta, avaliação de fluxo tecidual, avaliação histológica dos conteúdos de colágeno e lamelas elásticas; estudo de marcadores de fibrose vascular por imunohistoquímica e avaliação de metaloproteinases. Os principais resultados obtidos mostram que a sobrecarga salina não altera a pressão arterial, mas leva ao aumento da atividade simpática e redução da atividade parassimpática, além de reduzir a variabilidade da frequência cardíaca, normalmente relacionada ao aumento de risco cardiovascular. Os resultados indicam uma redução de fluxo tecidual, como no intestino e na aorta, sugerindo que pode haver remodelamento vascular reduzindo o aporte sanguíneo nestes tecidos. O estudo do remodelamento vascular sustenta a ideia de que a sobrecarga salina impõe tanto a artérias de condução como de resistência um importante remodelamento, aumentando a deposição de colágenos fibrilares e de colagenos IV e VII (não fibrilares), além de aumentar a marcação positiva para TGF-beta e Galectina 3. Este remodelamento é reforçado pela diferente marcação positiva para MMP-2, enzima importante da degradação da matriz colágena. A sobrecarga salina em períodos mais crônicos (Sal-12) apresenta redução da resistência da parede da aorta no teste biomecânico, sugerindo que o remodelamento observado possa não ser eficiente na manutenção fisiológica da estrutura vascular. Desta forma, mesmo que a sobrecarga salina não induza um efetivo aumento da pressão arterial para se considerar que estes animais normotensos estejam desenvolvendo hipertensão, é evidente seu efeito sobre os mecanismos regulatórios como o sistema nervoso simpático e parassimpático e sobre a estrutura vascular, levando à alteração na deposição de elementos da matriz extracelular e à modificação de suas características mecânicas. Tais características sugerem que a sobrecarga salina crônica está associada ao desenvolvimento de um estado semelhante aos níveis iniciais da hipertensão / Cardiovascular diseases are among the leading causes of mortality in the world. Among these diseases, hypertension has presented one of the most significant indexes. Arterial hypertension is a multifactorial disease and among the triggering factors is excessive salt intake by the population. According to WHO, the daily intake of salt per person should not exceed the limit of 5g; however, most countries, including Brazil, exceed 10 grams of salt per person per day. If we consider that salt intake per day exceeds acceptable limits and that a large part of the population does not present hypertension, it appears as a question of how this saline overload is related to the development of arterial hypertension and which physiological mechanisms involved in a prehypertensive phase. Our hypothesis is that saline overload induces changes in hemodynamic regulation as well as vascular adaptations independent of changes in blood pressure. To answer our hypothesis, we used male Wistar rats, distributed in three experimental groups: 1) control (Cont), with access to drinking water free of NaCl); 2) Salt-2, treated with 1% NaCl in drinking water for 2 weeks; and 3) Salt-12, treated with 1% NaCl in drinking water for 12 weeks. Experimental groups were used to evaluate the experimental model (with monitoring of body weight and water intake and urine exception in metabolic cage), as well as for the proposed studies: hemodynamic evaluation (Study 1), regional flow assessment (Study 2), biomechanical study of the aorta (Study 3), and study of vascular remodeling (Study 4). For these studies, blood pressure and heart rate were measured, aortic biomechanical test, evaluation of tissue flow, histological evaluation of collagen contents and elastic lamellae; study of vascular fibrosis markers by immunohistochemistry and evaluation of metalloproteinases. The main results show that saline overload does not alter blood pressure, but leads to increased sympathetic activity and reduced parasympathetic activity, as well as reducing heart rate variability, usually related to increased cardiovascular risk. The results indicate a reduction of tissue flow, as in the intestine and aorta, suggesting that there may be vascular remodeling reducing the blood supply in these tissues. The study of vascular remodeling supports the idea that saline overload imposes an important remodeling on both the conduction and resistance arteries, increasing the deposition of fibrillar collagens and collagens IV and VII (non-fibrillar), besides increasing the positive marking for TGF-Beta and Galectin 3. This remodeling is reinforced by the different positive labeling for MMP-2, an important enzyme of collagen matrix degradation. Saline overload in more chronic periods (Salt-12) presents a reduction of aortic wall resistance in the biomechanical test, suggesting that the observed remodeling may not be efficient in the maintenance of the vascular structure. Thus, even if the saline overload does not induce an effective increase in blood pressure to consider that these normotensive animals are developing hypertension, its effect on the regulatory mechanisms such as the sympathetic and parasympathetic nervous system and on the vascular structure is evident, leading to alteration in the deposition of elements of the extracellular matrix and the modification of its mechanical characteristics. Such characteristics suggest that chronic saline overload is associated with the development of a state similar to the initial levels of hypertension

No description available.

The aim of this study was to investigate gene expression of cardiovascular miRNAs in peripheral blood of mothers after delivery. MiRNAs are small non-coding RNAs, which significantly modulate posttranscriptional adjustments of mRNA and thus regulate gene expression across biological processess. Dysregulation of miRNAs is associated with many pathological phenomena, thanks that we can use them for diagnosis and potentionaly we can treat these diseases by the manipulation of miRNA gene expression. We examined gene expression of circulating miRNAs associated with cardiovascular diseases, and we investigated, how the expression profile depends on pregnancy course and manifestation of pregnancy-related complications. For this purpose we examined material from 221 mothers 3-10 years after delivery. A group with identical pregnancy-related complication was always compared with a group of mothers after physiological pregnancy. Gene expression of 29 cardiovascular miRNAs in peripheral blood was studied using reverse transcription and quantitative real-time PCR. It was confirmed, that the expression profile of miRNAs differed between pregnancy-related complications and physiological controls. We also confirmed, that the profile of gene expression discovered at mothers 3-10 years after delivery was different...

Introdução: Vários trabalhos prévios demonstraram o efeito protetor da dieta vegetariana na prevalência de DCV (doenças cardiovasculares). Entretanto ainda restam questionamentos sobre a reprodutibilidade desses estudos em grupos populacionais de países em desenvolvimento e de outros que relacionem diretamente dieta neste grupo com o uso de escore de cálcio coronário. Objetivos: 1) Analisar a relação entre dieta vegetariana e aterosclerose subclínica em uma população etnicamente diversa. 2) Observar a relação entre dieta vegetariana e o escore de cálcio coronário 3) Analisar outros fatores clínicos, laboratoriais, e de imagem na prevalência de aterosclerose subclínica. Métodos: Participantes foram incluídos consecutivamente entre março de 2013 e agosto de 2016, no Hospital Universitário da USP, adventistas do sétimo dia, entre 35 e 74 anos, residentes no estado de São Paulo. Realizada entrevista clínica, exames laboratoriais, determinação de variáveis nutricionais e exames de imagem e cardiológicos como escore de cálcio coronário, medida da íntima de carótida e bordo hepático e velocidade de onda de pulso. O padrão dietético foi avaliado através de questionário de frequência alimentar (QFA) validado para a dieta brasileira, com base em medidas e períodos padronizados. Resultados: Os 1404 participantes incluídos foram divididos em 3 grupos: 548 onívoros, 617 ovo-lacto-vegetarianos e 239 vegetarianos estritos. Não houve diferenças nos grupos em relação à idade, raça ou sexo. Foram observadas diferenças estatisticamente significativas entre os grupos onívoro, ovo-lactovegetariano, e vegetariano estrito favoráveis ao vegetarianismo em suas formas para várias medidas antropométricas (peso, índice de massa corporal, frequência cardíaca em repouso, pressão arterial sistólica, pressão arterial diastólica, percentual de gordura abdominal e circunferência abdominal), índice de gordura abdominal e membros, e à bioimpedância. Houveram diferenças significativas entre os grupos para fatores laboratoriais associados a aterosclerose subclínica (hemoglobina glicada, sódio urinário de 12h, cálcio urinário de 12h, creatinina sérica, alanina transaminase, gama GT, ácido úrico, colesterol total, LDL colesterol, não HDL colesterol, triglicérides, glicemia de jejum e após 2h de carga glicêmica, insulinemia de jejum e 2h após carga glicêmica, proteína C reativa ultrassensível, fósforo urinário e dosagem de 25-OH-Vitamina D). Dos exames complementares, foram observadas diferenças favoráveis aos grupos vegetarianos na ultrassonografia para espessura de íntima de carótidas, e do bordo hepático, Velocidade de Onda de Pulso (PWV) e Escore de Cálcio Coronário (CAC). Conclusão: No grupo estudado observou-se que a dieta vegetariana, dentro de suas variantes (vegetariana estrita e ovo-lacto-vegetariana) conferiram um menor risco cardiovascular associado a marcadores de aterosclerose subclínica dentro de uma população adulta na faixa de 35-74 anos residentes no estado de São Paulo / Introduction: Previous studies have demonstrated the protective effect of the vegetarian diet on the prevalence of CVD (cardiovascular diseases). However, there are still questions about the reproducibility of these studies in populations from developing countries or regarding the association of diet and the coronary calcium score. Objectives: 1) To analyze the relationship between vegetarian diet and subclinical atherosclerosis in an ethnically diverse population from Brazil. 2) To describe the relationship between a vegetarian diet and coronary calcium score. 3) To analyze the association between diet and other clinical, laboratory, and imaging variables associated with the prevalence of subclinical atherosclerosis. Methods: Participants were consecutively included between March 2013 and August 2016 at the University Hospital of the University of Sao Paulo, seventhday adventists, aged 35-74 years, living in the state of São Paulo. Clinical interview, laboratory tests, determination of nutritional variables and imaging and cardiological exams such as coronary calcium score, measurement of the carotid intima and hepatic border, and pulse wave velocity were performed. The dietary pattern was evaluated through a validated food frequency questionnaire (FFQ) for the Brazilian diet, based on standardized measures and periods. Results: The 1,404 participants included were divided into 3 groups: 548 omnivores, 617 ovo-lacto-vegetarian and 239 strict vegetarians. There were no differences in the groups in relation to age, race and gender. Statistically significant differences were observed between the omnivore, ovo-lactovegetarian, and strict vegetarian groups favoring vegetarianism in their forms for various anthropometric measures (weight, body mass index, resting heart rate, systolic blood pressure, diastolic blood pressure, percentage of abdominal fat and abdominal circumference), abdominal fat index and limbs. There were significant differences between groups for laboratory factors associated with subclinical atherosclerosis (glycated hemoglobin, 12h urinary sodium, 12h urinary calcium, serum creatinine, alanine transaminase, GT range, uric acid, total cholesterol, LDL cholesterol , non-HDL cholesterol, triglycerides, fasting glycemia and insulinemia and after 2h of glycemic load, ultra-sensitive C-reactive protein, urinary phosphorus and 25-OH-Vitamin D dosage). From the complementary examinations, favorable differences were observed in the vegetarian groups on carotid and hepatic border ultrasound, pulse wave velocity (PWV) and Coronary Calcium Score (CAC). Conclusion: In the studied groups, it was observed that vegetarian diet, within its variants (strict vegetarian and ovo-lacto-vegetarian), was associated with a reduced odds of subclinical atherosclerosis and its risk markers within an adult population in the 35-74 age group living in the state of São Paulo, Brazil

Além das alterações autonômicas, a síndrome metabólica (SMet) causa disfunção vascular relacionada a eventos cardiovasculares e morte. Considerando que a resistência à insulina é associada à hiperativação simpática, testamos a hipótese de que a presença da glicemia de jejum alterada (GLI) é a principal causa das alterações estruturais e funcionais em grandes e pequenos vasos, via aumento do tônus simpático nesses pacientes. Foram avaliados pacientes com SMet recém diagnosticados (ATP-III) e não medicados, divididos em: glicemia de jejum alterada >=100mg/dL (SMet+GLI, n=35; 50±1 anos) e glicemia normal < 100mg/dL (SMet-GLI, n=24, 46 ± 1). Um grupo de indivíduos saudáveis foi estudado como controle (CS, n=17, 50±1 anos). Foram medidas rigidez arterial (velocidade de onda de pulso, VOP), atividade nervosa simpática muscular (ANSM, microneurografia) fluxo sanguíneo muscular (FSM, pletismografia), pressão arterial média (PAM, oscilométrico), resistência vascular periférica (RVP=PAM/FSM) e dimetilarginina assimétrica (ADMA). SMet+GLI apresentou maior VOP que SMet-GLI e CS (8,0[7,2-8,6], 7,3[6,9-7,9] e 6,9[6,6-7,2]m/s, respectivamente, P=0,001), não havendo diferença entre SMet-GLI e CS. Além disso, SMet+GLI foi similar ao SMet-GLI mas teve maior RVP que CS (P=0,008), não havendo diferença entre SMet-GLI e CS. Adicionalmente, SMet+GLI teve maior ANSM que SMet-GLI e CS; enquanto SMet-GLI teve maior ANSM que CS (31+-1; 26+-1; 19+-1 disparos /min, P < 0,001). ADMA foi similar entre os grupos (0,62 [0,56-0,71], 0,67 [0,59-0,92] e 0,60 [0,54-1,43] umol/L). Dentre os fatores de risco da SMet, GLI foi preditor do aumento da ANSM. ANSM foi associada à VOP (R=0.39; P=0,002) e à RVP (R=0,30, P=0,034). Em conclusão, a hiperativação simpática, que está aumentada na presença da glicemia alterada, é o mecanismo básico que pode explicar, pelo menos em parte, o aumento na VOP e na RVP. GLI parece ser o principal fator de risco no prejuízo da função e estrutura vascular nos pacientes com SMet / Besides autonomic alterations, metabolic syndrome (MetS) causes vascular dysfunction related to cardiovascular events and death. Since insulin resistance is associated with sympathetic hyperactivation, we tested the hypothesis that the presence of impaired fasting glucose (IFG) is the main cause of structural and functional changes of large and small vessels via elevated sympathetic tonus in these patients. We evaluated never treated, newly diagnosed MetS (ATP-III) patients divided into: impaired fasting glucose >100mg/dL (MetS+IFG, n=35; 50±1 y) and normal fasting glucose <100mg/dL (MetS-IFG, n=24, 46±1 y). A healthy control group was also studied (C, n=17, 50±1 y). We measured the arterial stiffness (pulse wave velocity, PWV), muscle sympathetic nerve activity (MSNA, microneurography), forearm blood flow (FBF, plethysmography), mean blood pressure (MBP, oscillometric), peripheral vascular resistance (PVR=MBP/FBF) and asymmetric dimethylarginine (ADMA). MetS+IFG had higher PWV than MetS-IFG and C (8.0[7.2-8.6], 7.3[6.9-7.9] and 6.9[6.6-7.2]m/s, respectively, P=0.001), whereas SMet-GLI was similar to CS. Moreover, MetS+IFG was similar to MetS-IFG, but had higher PVR than C (P=0.008) and SMet-GLI was similar to CS. In addition, MetS+IFG had higher MSNA than MetS-IFG and C; whereas MetS-IFG had higher MSNA than C (31 +- 1; 26+- 1; 19+-1 bursts/min, P < 0.001). ADMA were similar among groups (0.62 [0.56-0.71] vs 0.67 [0.59-0.92] and 0.60 [0.54-1.43] umol/L). Among MetS risk factors, IFG was predictor of increased MSNA. Further, MSNA was associated with PWV (R=0.39; P=0.002) and PVR (R=0.30, P=0.034). In conclusion, sympathetic hyperactivation, which is enhanced in the presence of high blood glucose, is the basic mechanism that could explain, at least in part, the increase in PWV and PVR. IFG appears to be the main risk factor in the vascular function and structure damage in MetS patients

Os fatores de risco cardiovascular (FRCV) podem estar associados com pior funcionamento cognitivo em idosos e afetar a estrutura cerebral. Usando ressonância magnética (RM) e morfometria baseada em voxel (voxel-based morphometry; VBM), foram avaliados neste estudo volumes regionais de substância branca (SB) cerebral em uma amostra de base populacional de indivíduos saudáveis com idades entre 65-75 anos (n = 156). Usando o escore de risco de Framingham (ERF) como índice de risco cardiovascular, subdividimos a amostra total em três subgrupos de acordo com a gravidade de FRCV. Comparamos os volumes regionais cerebrais de SB entre estes grupos, e investigamos a relação entre volume de SB e desempenho cognitivo. Por fim, dada a possível influência de variações no gene que codifica a apoliproteína E (APOE) sobre cognição, anatomia cerebral e FRCV, avaliamos possíveis mudanças nos resultados das análises volumétricas cerebrais dependendo da presença do alelo APOE?4. No subgrupo de alto risco, detectamos clusteres com volume significativamente menor de SB na região pré-frontal direita dorsolateral juxtacortical em comparação com ambos os subgrupos de baixo e médio risco cardiovascular. Estes achados permaneceram os mesmos quando a análise estatística levou em conta a presença do alelo APOE?4 como covariável de confusão. O desempenho em tarefa cognitiva de controle inibitório foi inversamente correlacionado com o volume de SB pré-frontal direita, em proporção direta com o grau de risco cardiovascular. Redução significativa na SB parietal profunda também foi detectada bilateralmente no subgrupo de alto RCV em comparação com os outros dois subgrupos. Este é o primeiro estudo de VBM usando amostra grande de idosos a documentar a topografia de déficits volumétricos de SB associados com alto ERF em todo o cérebro. A associação significativa entre menor volume de SB e pior desempenho cognitivo em termos de resposta inibitória indica que as mudanças de volume de SB pré-frontal relacionadas com FRCV são clinicamente significativas, uma vez que o controle inibitório é uma operação cognitiva amplamente reconhecida por depender da integridade cortical pré-frontal / Cardiovascular risk factors (CVRF) may be associated with poor cognitive functioning in elderlies and affect brain structure. Using magnetic resonance imaging (MRI) and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of healthy individuals aged 65-75 years (n=156). Using the Framingham Risk Score (FRS) to assess the severity of CVRF, we subdivided the sample in three subgroups. We compared regional WM volumes in the brain between these subgroups, and investigated the relationship between WM volumes and cognitive performance. Also, given the possible influence of variations in the gene that code the apoliprotein E (APOE) on cognition, brain anatomy and CVRF, we evaluate changes in the results of our volumetric analysis depending on the presence of the APOE?4 allele. In the high-risk subgroup, we detected one cluster of significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low- and intermediate-risk subgroups. This finding remained unchanged when the analysis was repeated taking into account the presence of the APOE?4 allele as a confounding covariate. Inhibitory control performance was negatively related to right prefrontal WM volume, in direct proportion to the degree of CVRF. Significantly reduced deep parietal WM was also detected bilaterally in the high-risk CVRF subgroup. This is the first large VBM study documenting the topography of WM volume deficits associated with high FRS across the whole brain. The significant association regarding poor response inhibition indicates that prefrontal WM volume changes related to CVR are clinically meaningful, since inhibitory control is a cognitive operation widely known to rely on prefrontal cortical integrity

Introdução: As características do trabalho dos profissionais de enfermagem podem influenciar na presença de fatores de risco cardiovascular e entre aqueles que atuam na assistência a pacientes com câncer, as doenças cardiovasculares representam uma das principais causas de absenteísmo. A hipertensão arterial é um dos principais fatores de risco cardiovascular e o seu desenvolvimento está relacionado ao estresse crônico. A carga alostática tem sido utilizada para avaliar indiretamente o estresse crônico, a partir do funcionamento dos sistemas cardiovascular, imunológico, metabólico e neuroendócrino e, predizer morbidade e mortalidade em alguns segmentos populacionais. No entanto, até o momento, não foi realizado estudo em âmbito nacional no Brasil, avaliando a relação da carga alostática com variáveis biopsicoemocionais. Objetivos: Avaliar o risco cardiovascular e prevalência de fatores de risco, com destaque para a hipertensão arterial, e a carga alostática em profissionais de enfermagem que atuam na assistência oncológica. Método: Participaram do estudo 231 profissionais de enfermagem [63,6% técnicos/auxiliares de enfermagem; 82,7% mulheres; idade de 39,6 (DP=8,3) anos] selecionados por amostragem aleatória simples. A medida casual da pressão arterial foi realizada com aparelho automático validado e a Monitorização Ambulatorial da Pressão Arterial (MAPA) com aparelho oscilométrico validado, durante 24 horas. Foram realizadas medidas antropométricas e avaliação de bioimpedância. A hipertensão foi considerada na vigência de pelo menos um dos critérios: medida casual 140/90 mmHg, hipertensão arterial referida ou uso de anti-hipertensivos. As variáveis psicoemocionais foram mensuradas através de instrumentos: a) Burnout, Maslach Burnout Inventory; b) transtornos mentais comuns, Self Reporting Questionnaire (SRQ 20); c) estresse no desempenho das atividades de trabalho, Escala de Estresse no Trabalho (ETT); e d) sono, Pittsburg Sleep Quality Index (PSQI). Foi realizada coleta de sangue dos participantes, com 12 horas de jejum para exames de: glicemia, colesterol total e frações, triglicérides, hemoglobina glicada, cortisol plasmático, fibrinogênio, proteína C-reativa ultrassensível e creatinina. A estratificação de risco cardiovascular foi realizada por meio do Escore de Risco Global (ERG) e Risco pelo Tempo de vida (ETV) e, o estresse crônico por meio do Índice de Carga Alostática (ICA), obtido através de Biomarcadores do Estresse. As variáveis que apresentaram associações estatisticamente significativas na análise univariada foram submetidas à análise multivariada por meio da regressão de Poisson com variância Robusta, estimando-se razões de prevalência (RP) e seus respectivos intervalos de confiança de 95%. Valores de p0,05 foram considerados significantes. O estudo foi aprovado pelos Comitês de Ética em Pesquisa (CAAE:13329513.3.0000.5392) das instituições envolvidas. Resultados: A prevalência de hipertensão arterial referida foi 25,5% e, a identificada, 35,1%. As prevalências de níveis pressóricos alterados pela MAPA foram: 24 horas-30,0%, vigília-26,0% e sono-40,4%. Os fatores de risco cardiovascular referidos foram: sedentarismo-65,4%, dislipidemia-28,1%, etilismo-10,1%, diabetes mellitus-6,5%, tabagismo-6,1%. Verificou-se ainda, que os participantes apresentaram: sobrepeso ou obesidade (69,7%), circunferência da cintura aumentada (70,1%), gordura corporal alta/muito alta (81,0%), músculo esquelético baixo (50,2%), idade corporal acima da real (73,2%), proteína C reativa alterada (80,1%), HDL-colesterol limítrofe/baixo (62,4%), colesterol total limítrofe/alto (42,4%), fibrinogênio elevado (19,1%), cortisol elevado (49,4%) e 2,2% com cortisol diminuído, com hemoglobina glicada alterada (25,4%), creatinina > 1,3 mg/dL (0,4%) e 0,9% com doença renal crônica. A síndrome metabólica esteve presente em 25,1%. A hipertensão do avental branco ocorreu em 8,2%, a hipertensão mascarada em 19,8%, descenso do sono atenuado ou ausente sistólico (52,5%) e (30,5%) diastólico. Quanto às características relacionadas ao trabalho observou-se que 46,7% tinham 2-3 vínculos empregatícios, trabalhavam em média 51,9 (DP=15,0) h/semana, 53,2% eram plantonistas diurnos, 59,7% trabalhavam em turnos e 40,0% tinham formação com residência ou especialização. Em relação às variáveis psicoemocionais, a maioria dos profissionais apresentou estresse moderado/alto (66,6%), transtornos mentais comuns (57,6%) e má qualidade do sono (78,8%). A prevalência de burnout foi de 39,0% e a maioria apresentou alto nível nas três subescalas (exaustão emocional=55,0%; despersonalização=64,1% e baixa realização profissional=73,2%). A prevalência de carga alostática elevada foi de 58,0%, e 28,2% apresentaram risco cardiovascular intermediário/alto pelo ERG e 3,0% alto risco cardiovascular pelo ETV. As variáveis associadas, independentemente, ao risco cardiovascular foram (RP: razão de prevalência; IC95%: intervalo de confiança): maior número de filhos (1,19;1,02-1,40); formação com residência, especialização ou mestrado (0,38; 0,24-0,58); maior idade corporal (1,02;1,002-1,030); fibrinogênio elevado (2,07; 1,19-3,60); hipertensão arterial referida (0,34; 0,23-0,53); concordar em parte que o controle existente no trabalho irrita (0,51; 0,32-0,82) e que a falta de informações sobre as tarefas no trabalho incomoda (1,76; 1,09-2,87). As variáveis associadas à carga alostática elevada foram: concentração diminuída durante o plantão raramente/nunca (1,36; 1,05-1,76); hipertensão do avental branco (1,82; 1,39-2,38); comer alimentos doces entre 1 e 4 dias por semana (1,48; 1,13-1,93) e entre 5 a 7 dias por semana (1,53; 1,16-2,02); e, pressão arterial sistólica média da MAPA do período de 24 horas (1,01; 1,003-1,021). As variáveis associadas independentemente à hipertensão arterial foram: idade 50 anos (2,41; 1,15-5,07); maior idade corporal (1,02; 1,01-1,03); hábito de medir a pressão arterial regularmente (0,68; 0,50-0,93); e fazer tratamento de saúde (1,48; 1,09-2,01). As variáveis associadas independentemente aos níveis pressóricos alterados na MAPA de 24 horas foram: idade 50 anos (3,66; 1,16-11,60); idade corporal a idade real (0,46; 0,27-0,81); e hipertensão arterial referida (0,53; 0,34-0,80). Para a MAPA de vigília foram: tempo de formação profissional entre 10 a 14 anos (2,95; 1,06-8,20) e entre 15 a 24 anos (RP=3,16; 1,14-8,76); maior idade corporal (1,02; 1,001-1,032); e hipertensão arterial referida (0,45; 0,28-0,74). Para a MAPA do período de sono foram: sexo masculino (1,62; 1,18-2,24); idade 50 anos (2,50;1,13-5,60); trabalhar como plantonista diurno (2,38; 1,04-5,45) ou como plantonista noturno (2,47; 1,07-5,70); uso anterior ou atual de antidepressivos (1,43;1,05-1,94); sobrepeso/obesidade (2,45; 1,42-4,23); síndrome metabólica (1,64; 1,21-2,22) e hipertensão arterial identificada (1,53; 1,13-2,09). Conclusões: A prevalência de hipertensão foi elevada, a maioria dos profissionais de enfermagem apresentou sobrecarga alostática e aproximadamente um terço risco cardiovascular intermediário/alto, sugerindo que o processo de trabalho possa estar relacionado a esses achados. / Introduction: Work characteristics of nursing professionals can influence the presence of cardiovascular risk factors and among those working in the care of patients with cancer, cardiovascular diseases are a major cause of absenteeism. The arterial hypertension is the major risk factor for this type of diseases and its development is related to chronic stress. The allostatic load allows assessing indirectly the chronic stress based on the cardiovascular, immune, metabolic and neuroendocrine systems and predicts morbidity and mortality in few population segments. However, until now, we did not find Brazilian studies evaluating the relationship of allostatic load with bio-psycho-emotional variables. Objectives: To assess the cardiovascular risk and the prevalence of risk factors, with emphasis on hypertension and allostatic load of a nursing team working in oncology setting. Method: The study included 231 nursing professionals [63.6% nursing aides/36.4% nurses; 82.7% women; mean age 39.6 (SD=8.3) years] selected by simple random sampling. We applied a validated automatic device to measure the casual blood pressure and an oscillometric device validated during 24 hours to assess the Ambulatory Blood Pressure Monitoring (ABPM). Anthropometric measurements and bioimpedance evaluation were also done. Hypertensive individuals were those who met at least one of next criteria: casual measurement 140 / 90 mmHg, referred hypertension or use of antihypertensive drugs. Psycho-emotional variables were measured by means of the instruments: a) Burnout, Maslach Burnout Inventory; b) Common mental disorders, Self Reporting Questionnaire (SRQ 20); c) Stress in the performance of work activities, Scale of Stress at Work (ETT) and d) sleep, Pittsburgh Sleep Quality Index (PSQI). Blood collection was carried out with participants under 12-hour fasting for: blood glucose, total cholesterol and triglyceride levels, glycated hemoglobin fractions, plasma cortisol, Fibrinogen, C-reactive protein ultrasensitive and creatinine. The cardiovascular risk stratification was performed through the Global Risk Score and Risk for Lifetime; and the chronic stress through allostatic load index, obtained for stress biomarkers. The variables showed statistically significant associations in the univariate analysis that were subjected to multivariate analysis by Poisson regression with robust variance, with prevalence ratio estimative and 95% confidence interval. The Committees on Research Ethics of the participant institutions approved this study (CAAE: 13329513.3.0000.5392). Results: 25.5%, of the sample referred hypertension, but we identified 35.1% with this disease. The prevalence of blood pressure changed according ABPM: 24 hours-30.0%, daytime-26.0% and nighttime-40.4%. The prevalence of cardiovascular risk factors was: physical inactivity-65.4%, dyslipidemia-28.1%, alcohol consumption-10.1%, diabetes mellitus-6.5% and smoking-6.1%. We also verified: overweight or obesity (69.7%), increased waist circumference (70.1%), body fat high/very high (81.0%), low skeletal muscle (50.2%), body age above the real age (73.2%), changed c-reactive protein levels (80.1%), and borderline/low HDL cholesterol (62.4%) and borderline/high total cholesterol (42.4%). Additionally, 19.1% of nursing team showed high Fibrinogen levels, 49.4% high cortisol, 2.2% decreased cortisol, 25.4% high levels of changed glycated hemoglobin, 0.4% creatinine above 1.3 mg/dL and 0.9% chronic kidney disease. The metabolic syndrome (25.1%), the white coat hypertension (8.2%), the masked hypertension (19.8%), and the attenuated or absent sleep decline systolic (52.5%) and diastolic (30.5%) were also diagnosed. Regarding the work-related characteristics, 46.7% of the population had 2-3 employments - working 51.9 (SD = 15.0) h / week in average- 53.2% were daytime workers, 59.7% worked on shifts and 40.0% had residency or specialization degrees. About the psycho-emotional variables, most professionals presented moderate/high stress (66.6%), mental disorders (57.6%) and poor sleep quality (78.8%). The prevalence of burnout was 39.0% and the levels in the MBI subscales were high: emotional exhaustion = 55.0%, depersonalization= 64.1%, and low professional accomplishment= 73.2%. Allostatic load was high (58.0%), the cardiovascular risk was intermediate / high for ERG (28.2%) and high for ETV (3.0%). The variables associated with cardiovascular risk included (PR: prevalence ratio, 95% CI: confidence interval): more children (1.19; 1.02 to 1.40); accomplishment of residency, specialization or masters degrees (0.38; 0.24 to 0.58); high body age (1.02; 1.002 to 1.030); high fibrinogen (2.07; 1.19 to 3.60); reported hypertension (0.34; 0.23 to 0.53); agree in part that \"the existing control at work irritates\" (0.51; 0.32 to 0.82) and that \"the lack of information about the tasks at work bothers\" (1.76; 1.09 to 2,87). The variables associated high allostatic load were: concentration decreased during the call often/sometimes (1.36; 1.05 to 1.76); white coat hypertension (1.82; 1.39-2.38); intake of sweet food between 1 and 4 days per week (1.48; 1.13 to1.93) and 5 to 7 days a week (1.53, 1.16 to 2.02); and and systolic mean in 24-hour ABPM (1.01; 1.003-1.021). The variables associated with hypertension were: age 50 years (2.41; 1.15 to 5.07); age (1,02; 1,01 to 1,03); habit to measure blood pressure regularly (0,68; 0,50 to 0,93); and health treatment (1.48; 2.01 to 1.09). The variables associated with the changed pressure levels in 24-hour ABPM were: age 50 years (3.66; 1.16-11.60); body age below the actual age (0.46; 0.27-0.81); and reported hypertension (0.53; 0.34-0.80). The variables independently associated with pressure levels changed in the daytime ABPM were: training time from 10 to 14 years (2.95; 1.06 - 8.20) and between 15 to 24 years (3.16; 1.14-8.76); higher body age (1.02; 1.001 - 1.032); and reported hypertension (0.45; 0.28-0.74). The variables associated with the changed pressure levels in the nighttime ABPM were: male (1.62; 1.18-2.24); age 50 years (2.50; 1.13-5.60); the work as daily (2.38; 1.04-5.45) or night duty (2.47; 1.07 - 5.70); previous or current use of antidepressants (1.43; 1.05-1.94); overweight / obesity (2.45; 1.42-4.23); metabolic syndrome (1.64; 1.21-2.22) and identified arterial hypertension (1.53; 1.13-2.09). Conclusions: The hypertension prevalence was high, most professionals presented high allostatic load and about one third had intermediate / high cardiovascular risk. It suggests that the work setting may be related to these findings.