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O crescente aumento no número de idosos na população mundial aumenta a preocupação, pelos profissionais da saúde, com relação à prevenção e manejo de doenças associadas ao envelhecimento. A demência, uma das doenças mais comuns e mais devastadoras em idosos, incide em 4,6 milhões de casos em todo o mundo e manifesta-se em idosos acima de 65 anos e principalmente acima de 85 anos de idade. Os dois tipos mais comuns de demência é a doença de Alzheimer (DA), seguida da demência vascular (DV), as quais partilham muitas características comuns patológicas, sintomáticas e neuroquímicas. Entre os principais fatores de risco para demência estão a idade, baixa escolaridade, hipertensão (HAS), cardiopatias, dislipidemias (DLP), sobrepeso/obesidade, genética, tabagismo, etilismo, acidente vascular cerebral (AVC) e o diabetes. Diante da sobreposição de causas e fatores de risco para as demências mais comuns, a identificação das alterações cognitivas associada à identificação de doenças cardiovasculares, seria extremamente importante. A associação dos principais fatores de risco cardiovasculares (FRCV) com a idade e o tipo das demências foi avaliada neste estudo, em 2 grupos de idosos diabéticos com DA (n=47) e demência mista ou vascular (n=49). Os resultados foram obtidos pelo teste t-student, qui-quadrado e apresentados os valores de Odds Ratio Bruto e Ajustado. O controle glicêmico não apresentou diferença entre os indivíduos das duas demências nem relação com a idade do caso novo. A presença de hipertensão e dislipidemia foram os principais FRCV encontrados. Estes e outros fatores como obesidade, tabagismo e fibrilação atrial não demonstraram associação com a idade e o tipo da demência. O AVC e o gênero masculino tiveram associação com a demência vascular. A presença marcante de FRCV além do diabetes nos dois tipos principais de demência, reforça a hipótese de sobreposição de causas e das formas de manifestação das demências e a dificuldade em identificá-las. / The increase in the number of elderly in the world population increases concern by health professionals, regarding prevention and management of diseases associated with aging. Dementia , one of the most common and devastating diseases in the elderly, falls at 4.6 million cases worldwide and is manifested in the elderly over 65 and mostly above 85 years of age. The two most common types of dementia is Alzheimer\'s disease (AD), followed by vascular dementia ( VD), which share many common pathological features, symptomatic and neurochemical. Among the main risk factors for dementia are age, low education, hypertension( HBP) , heart disease , dyslipidemia( DLP ) , overweight / obesity, genetics, smoking, alcoholism, cerebral vascular accidents (CVA) and diabetes. Given the overlapping causes and risk factors for the most common dementia, identification of cognitive changes associated with identification of cardiovascular diseases would be extremely important. The association of major cardiovascular risk factors (CVRF) with age and type of dementia was assessed in this study in two groups of elderly diabetic patients with AD ( n = 47 ) and mixed or vascular ( n = 49 ) dementia. The results were obtained by Student\'s t test , chi-square values and presented Adjusted Odds Ratio . Glycemic control did not differ between individuals of the two dementias or relationship with the age of the diagnosis. The presence of hypertension and dyslipidemia were the main CVRF found. These and other factors such as obesity, smoking and atrial fibrillation showed no association with age and type of dementia . The CVA and male gender were associated with vascular dementia. The striking presence of CVRF besides diabetes in the two main types of dementia reinforces the hypothesis of overlapping causes and manifestations of dementia and the difficulty in identifying them.

Aim: - This research project was a community based intervention study of the impact of increased access to exercise opportunities and kangaroo meat on diabetes and cardiovascular disease risk factors in the Aboriginal community of Woorabinda. The exercise and dietary interventions were based on principles of community development including: training of community members to conduct exercise programmes; supply of exercise equipment; training of community members to harvest kangaroos; establishment of a butcher’s apprenticeship; and establishment of the kangaroo meat processing in the community. Methodology: - The impact of the kangaroo meat and exercise interventions on diabetes and cardiovascular disease risk factors was determined by pre- and post-intervention assessment. Pre-intervention baseline data was obtained by community clinical assessment, household meat surveys,and community exercise surveys. The post-intervention assessment was a repeat of modified meat and exercise surveys. A post-intervention community clinical assessment was not conducted due to unresolved difficulties encountered in conducting the research project. The Study Population: - The study population for the community clinical assessment and exercise surveys were volunteer adults B 15 years of age. Approximately one third of the adult population participated in the community clinical screening, 29% in the pre-intervention exercise survey, and 20.2% in the post-intervention exercise survey. The meat surveys were conducted on a household basis. There was 84% household participation in the pre-intervention meat survey and 44.3% postintervention. Findings and Discussion: - It was found that the exercise and kangaroo meat interventions did not follow the planned linear trajectory but rather proceeded in an episodic and incremental manner. The community clinical assessment found a high prevalence of diabetes (18.6%; 95% CI, 13.04 – 24.36%) and impaired glucose tolerance (13.2%; 95% CI, 8.3 – 18.1%) comparable to that found in other Indigenous communities. There was a low prevalence of hypercholesterolaemia (30.9%; 95% CI, 24.2 – 37.6%) and hypertension (19.7%; 95% CI, 13.9 – 25.5%). High prevalence for other diabetes and cardiovascular disease risk factors were found including: current smoking (48.3%;95% CI, 40.95 – 55.64%); and obesity as measured by body mass index (35%; 95% CI, 27.9 – 42%), waist circumference (83.7%; 95% CI, 76.5 - 90.86% in women; and 55.5%; 95% CI, 43.9 – 61.1% in men), and waist / hip ratio (75.5%; 95% CI, 66.9 – 84% in women; and 57.1%; 95% CI,46 – 68% in men). A high prevalence of abnormal ACR was found: the prevalence ACR 3.4 – 33.9g/mol was 11.7% (95% CI, -ve2.39 – 25.7%), and the prevalence ACR B 34g/mol was 7.6% (95% CI, -ve6.8 – 22%). The prevalence of proteinuria was 67.8% (95% CI, 59.3 – 76.3%). It was found that this high prevalence of renal disease indicators coincided with an escalating incidence of end-stage renal disease in the community. Analysis of the kangaroo meat surveys found evidence of positive dietary change including reduction in the amount of fat used to cook non-kangaroo meats, and a positive shift in stage of change for cooking for family health. In regard to kangaroo meat however it was found that the most common cooking method was unfavourable with the nutritional value of the meat being compromised by a significantly higher prevalence of frying than other meats. It was further found that this method for cooking kangaroo meat was unchanged by the research intervention. Evidence of positive change was also seen in analysis of the exercise surveys. It was found that at baseline, and post-intervention, that the majority of adults in the community met the recommended duration for exercise per week through activities of daily living. There was a positive shift in stage of change for exercise behaviour with a significant movement beyond the ‘precontemplation' towards the ‘action’ and ‘maintenance’ stages of change. This positive shift in thinking about exercise corresponded with a significant increase in the proportion of people exercising specifically for health and fitness. Conclusion: - Though not all the proposed intervention objectives were accomplished the research project contributed to furthering community aspirations and capacity. The community clinical assessment provided a useful overview of the health status of Woorabinda, and an opportunity of a thorough health check for community members. The community clinical assessment drew attention to future projections of disease in Woorabinda and prompted a concentrated health system response. Evidence of positive change in regard to meat consumption and exercise behaviours were found, changes however were slow and uneven. Improved infrastructure was important to increasing community capacity for kangaroo meat supply and exercise, but essential to the sustainability of community initiatives is skilled people, and on-going maintenance and support. The findings of this study indicate that simplistic assumptions around the health benefits of ‘traditional’ diet need to be reconsidered cognisant that communities such as Woorabinda are cultures in transition. Whilst limitations in the methodology require the findings to be considered with caution, this study provides useful evidence for planning future health education and health promotion initiatives for Woorabinda.

O crescente aumento no número de idosos na população mundial aumenta a preocupação, pelos profissionais da saúde, com relação à prevenção e manejo de doenças associadas ao envelhecimento. A demência, uma das doenças mais comuns e mais devastadoras em idosos, incide em 4,6 milhões de casos em todo o mundo e manifesta-se em idosos acima de 65 anos e principalmente acima de 85 anos de idade. Os dois tipos mais comuns de demência é a doença de Alzheimer (DA), seguida da demência vascular (DV), as quais partilham muitas características comuns patológicas, sintomáticas e neuroquímicas. Entre os principais fatores de risco para demência estão a idade, baixa escolaridade, hipertensão (HAS), cardiopatias, dislipidemias (DLP), sobrepeso/obesidade, genética, tabagismo, etilismo, acidente vascular cerebral (AVC) e o diabetes. Diante da sobreposição de causas e fatores de risco para as demências mais comuns, a identificação das alterações cognitivas associada à identificação de doenças cardiovasculares, seria extremamente importante. A associação dos principais fatores de risco cardiovasculares (FRCV) com a idade e o tipo das demências foi avaliada neste estudo, em 2 grupos de idosos diabéticos com DA (n=47) e demência mista ou vascular (n=49). Os resultados foram obtidos pelo teste t-student, qui-quadrado e apresentados os valores de Odds Ratio Bruto e Ajustado. O controle glicêmico não apresentou diferença entre os indivíduos das duas demências nem relação com a idade do caso novo. A presença de hipertensão e dislipidemia foram os principais FRCV encontrados. Estes e outros fatores como obesidade, tabagismo e fibrilação atrial não demonstraram associação com a idade e o tipo da demência. O AVC e o gênero masculino tiveram associação com a demência vascular. A presença marcante de FRCV além do diabetes nos dois tipos principais de demência, reforça a hipótese de sobreposição de causas e das formas de manifestação das demências e a dificuldade em identificá-las. / The increase in the number of elderly in the world population increases concern by health professionals, regarding prevention and management of diseases associated with aging. Dementia , one of the most common and devastating diseases in the elderly, falls at 4.6 million cases worldwide and is manifested in the elderly over 65 and mostly above 85 years of age. The two most common types of dementia is Alzheimer\'s disease (AD), followed by vascular dementia ( VD), which share many common pathological features, symptomatic and neurochemical. Among the main risk factors for dementia are age, low education, hypertension( HBP) , heart disease , dyslipidemia( DLP ) , overweight / obesity, genetics, smoking, alcoholism, cerebral vascular accidents (CVA) and diabetes. Given the overlapping causes and risk factors for the most common dementia, identification of cognitive changes associated with identification of cardiovascular diseases would be extremely important. The association of major cardiovascular risk factors (CVRF) with age and type of dementia was assessed in this study in two groups of elderly diabetic patients with AD ( n = 47 ) and mixed or vascular ( n = 49 ) dementia. The results were obtained by Student\'s t test , chi-square values and presented Adjusted Odds Ratio . Glycemic control did not differ between individuals of the two dementias or relationship with the age of the diagnosis. The presence of hypertension and dyslipidemia were the main CVRF found. These and other factors such as obesity, smoking and atrial fibrillation showed no association with age and type of dementia . The CVA and male gender were associated with vascular dementia. The striking presence of CVRF besides diabetes in the two main types of dementia reinforces the hypothesis of overlapping causes and manifestations of dementia and the difficulty in identifying them.

Introdução: As alterações metabólicas associadas ao sistema cardiovascular, em especial a doença arterial coronariana (DAC) secundária à aterosclerose, constituem as principais causas de morbidade e mortalidade no mundo. De forma semelhante ao que ocorre em adultos, os fatores de risco cardiovascular estão presentes em crianças e adolescentes como a obesidade, a obesidade abdominal e a hipertensão arterial. Objetivo: Estudar a presença de algumas variáveis consideradas fatores de risco cardiovascular em adolescentes, matriculados em rede publica de ensino de Brodowski-SP. Metodologia: Foi realizado um estudo transversal com 668 escolares de 10 a 16 anos da rede pública municipal de ensino de Brodowski-SP. Dados de antropometria foram coletados (peso, altura e circunferência da cintura).Os adolescentes foram avaliados de acordo com seu estado nutricional segundo os escores IMC para a idade, a composição corporal foi avaliada pela bioimpedância, a pressão arterial foi avaliada por aparelho automático. Os dados foram analisados por meio do Teste Exato de Fisher e Regressão Logística (Odds Ratio Bruto e Ajustada). Resultados: A faixa etária predominante foi de 11 a 13 anos de idade. Os dados sobre sobrepeso e obesidade foram alarmantes e perfazem um total de 32,3% de adolescentes com excesso de peso, sendo 22,6% dos adolescentes com sobrepeso e 9,7% com obesidade. Dos alunos avaliados, 26 (3,9%) foram classificados como hipertensos e 116 (17,4%) como pré-hipertensos; no total foram encontrados 142 (21,3%) escolares com pressão arterial elevada. O excesso de gordura corporal pela bioimpedância foi evidenciado em 26,6% dos escolares e 20,7% dos escolares apresentaram obesidade abdominal. O modelo de regressão logística (Odds Ratio ajustada) mostrou significativa associação entre a faixa etária (alunos entre 14 a 16 anos), presença de obesidade abdominal, presença de excesso de peso, escolaridade materna com a alteração da pressão arterial. Conclusão: As prevalências encontradas de excesso de peso, pressão arterial alterada, excesso de gordura corporal e obesidade abdominal foram relevantes na população estudada, e associação entre pressão arterial elevada e indicadores de adiposidade foram evidenciadas. São necessárias dessa forma intervenções que tenham por objetivo o controle e prevenção dessas condições consideradas fatores de risco cardiovascular. / Introduction: Metabolic abnormalities related to the cardiovascular system, specially coronary artery disease (CAD) secondary to atherosclerosis, are worldwide the main cause of morbidity and mortality. Similarly to what happens among adults, cardiovascular risk factors are also present in children and adolescents, as obesity, abdominal obesity and arterial hypertension. Objective: To investigate the presence of some variables classified as cardiovascular risk factors in adolescents, registered in public schools in the city of Brodowski-SP. Methodology: A cross-sectional study was carried out with 668 students aged 10 to 16 years from public schools of Brodowski-SP. Anthropometric data (weight, height and waist circumference) were collected. The adolescents were classified according to their nutritional status by the age-BMI scores; body composition was evaluated by bioimpedance and blood pressure by an automated equipment. Data were analyzed by the Fisher Exact Test and logistic regression (crude and adjusted odds ratio). Results: The predominant age-group was 11 to 13 years. Data about overweight and obesity were alarming and comprise 32.3% of the adolescents, being 22.6% with overweight and 9.7% obesity. Hypertension was found in 26 (3.6%) students and 116 (17.4%) were classified as pre-hypertension; in the overall, 142 (21.3%) students had elevated blood pressure. The excess of body fat detected by bioimpedance was found in 20.7% of the students. The logistic regression model (adjusted odds ratio) showed significant association between age-group (students from 14-16 years), abdominal obesity, presence of weight excess, and maternal level of education with blood pressure abnormality. Conclusion: Prevalence rates of weight excess, abnormal blood pressure, excess of body fat and abdominal obesity were relevant in the study population. There is a need for interventions focused in the control and prevention of these conditions considered cardiovascular risk factors.

Introdução: As alterações metabólicas associadas ao sistema cardiovascular, em especial a doença arterial coronariana (DAC) secundária à aterosclerose, constituem as principais causas de morbidade e mortalidade no mundo. De forma semelhante ao que ocorre em adultos, os fatores de risco cardiovascular estão presentes em crianças e adolescentes como a obesidade, a obesidade abdominal e a hipertensão arterial. Objetivo: Estudar a presença de algumas variáveis consideradas fatores de risco cardiovascular em adolescentes, matriculados em rede publica de ensino de Brodowski-SP. Metodologia: Foi realizado um estudo transversal com 668 escolares de 10 a 16 anos da rede pública municipal de ensino de Brodowski-SP. Dados de antropometria foram coletados (peso, altura e circunferência da cintura).Os adolescentes foram avaliados de acordo com seu estado nutricional segundo os escores IMC para a idade, a composição corporal foi avaliada pela bioimpedância, a pressão arterial foi avaliada por aparelho automático. Os dados foram analisados por meio do Teste Exato de Fisher e Regressão Logística (Odds Ratio Bruto e Ajustada). Resultados: A faixa etária predominante foi de 11 a 13 anos de idade. Os dados sobre sobrepeso e obesidade foram alarmantes e perfazem um total de 32,3% de adolescentes com excesso de peso, sendo 22,6% dos adolescentes com sobrepeso e 9,7% com obesidade. Dos alunos avaliados, 26 (3,9%) foram classificados como hipertensos e 116 (17,4%) como pré-hipertensos; no total foram encontrados 142 (21,3%) escolares com pressão arterial elevada. O excesso de gordura corporal pela bioimpedância foi evidenciado em 26,6% dos escolares e 20,7% dos escolares apresentaram obesidade abdominal. O modelo de regressão logística (Odds Ratio ajustada) mostrou significativa associação entre a faixa etária (alunos entre 14 a 16 anos), presença de obesidade abdominal, presença de excesso de peso, escolaridade materna com a alteração da pressão arterial. Conclusão: As prevalências encontradas de excesso de peso, pressão arterial alterada, excesso de gordura corporal e obesidade abdominal foram relevantes na população estudada, e associação entre pressão arterial elevada e indicadores de adiposidade foram evidenciadas. São necessárias dessa forma intervenções que tenham por objetivo o controle e prevenção dessas condições consideradas fatores de risco cardiovascular. / Introduction: Metabolic abnormalities related to the cardiovascular system, specially coronary artery disease (CAD) secondary to atherosclerosis, are worldwide the main cause of morbidity and mortality. Similarly to what happens among adults, cardiovascular risk factors are also present in children and adolescents, as obesity, abdominal obesity and arterial hypertension. Objective: To investigate the presence of some variables classified as cardiovascular risk factors in adolescents, registered in public schools in the city of Brodowski-SP. Methodology: A cross-sectional study was carried out with 668 students aged 10 to 16 years from public schools of Brodowski-SP. Anthropometric data (weight, height and waist circumference) were collected. The adolescents were classified according to their nutritional status by the age-BMI scores; body composition was evaluated by bioimpedance and blood pressure by an automated equipment. Data were analyzed by the Fisher Exact Test and logistic regression (crude and adjusted odds ratio). Results: The predominant age-group was 11 to 13 years. Data about overweight and obesity were alarming and comprise 32.3% of the adolescents, being 22.6% with overweight and 9.7% obesity. Hypertension was found in 26 (3.6%) students and 116 (17.4%) were classified as pre-hypertension; in the overall, 142 (21.3%) students had elevated blood pressure. The excess of body fat detected by bioimpedance was found in 20.7% of the students. The logistic regression model (adjusted odds ratio) showed significant association between age-group (students from 14-16 years), abdominal obesity, presence of weight excess, and maternal level of education with blood pressure abnormality. Conclusion: Prevalence rates of weight excess, abnormal blood pressure, excess of body fat and abdominal obesity were relevant in the study population. There is a need for interventions focused in the control and prevention of these conditions considered cardiovascular risk factors.

Introdução: Estudos prévios analisaram a associação entre fatores de risco cardiovascular (FRCV) associados ao diagnóstico de demência vascular (DV) provável ou possível. No entanto, não foram encontrados estudos que analisassem a associação entre FRCV e a ocorrência de DV definitiva. Dessa maneira, ainda permanece obscura a associação entre os FRCV e a ocorrência de DV definitiva, ou seja, aquela diagnosticada por meio do exame neuropatológico, no qual se apresenta como padrão ouro. Objetivo: Avaliar a associação entre os FRCV e a ocorrência de DV definitiva, pura e mista. Método: Por meio de um estudo transversal foram analisados 707 casos pertencentes à casuística do Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento (BEHGEEC) da FMUSP, que respeitaram os critérios de inclusão. A existência de fatores de risco cardiovascular em vida (Hipertensão Arterial, Diabetes Mellitus, Dislipidemia, Tabagismo, Etilismo, Obesidade e Sedentarismo), reportada por um informante com convivido minimamente semanal durante a autópsia, foi associada ao diagnóstico neuropatológico de demência vascular emitido por um neuropatologista. Modelos de regressão logística (sem e com ajuste para sexo, idade e raça) foram construídos para testar a associação entre os FRCV e o diagnóstico de DV, DV pura e DV mista. Foi testada a capacidade preditiva dos fatores que se mostraram preditores de DV por meio da Curva ROC. Resultados: O sedentarismo foi um preditor independente de DV (OR 1,943; IC95% 1,198 3,151; p= 0,007) e DV pura (OR 3,148; IC95% 1,428 6,941;p= 0,004). A HAS foi um preditor independente de DV mista (OR 2,240; IC95% 1,216 4,126; p= 0.01). O sedentarismo não apresentou boa capacidade preditiva para a DV e DV Pura (AUC = 0,380 e 0,337, respectivamente), assim como a HAS para a DV Mista (AUC = 0,459). Conclusões: Dentre os FRCV o sedentarismo e a HAS foram os que se associaram a um aumento no risco de DV. / Introduction: Previous studies have analyzed the association between cardiovascular risk factors (CVRF) associated with the diagnosis (probable or possible) of vascular dementia (VaD). However, there are no studies that have analyzed the association between CVRF and the occurrence of definitive VaD. The association between CVRF and the occurrence of definite VaD, neuropathologically defined and considered as gold-standard, remains obscure. Objectives: To evaluate the association between CVRF and the occurrence of definitive VaD, pure and mixed. Methods: This is a cross-sectional study which evaluated 707 cases belonging to the Bain Bank of the Brazilian Aging Brain Study Group (BBBABSG) of FMUSP, respecting the inclusion criteria. The history of existence of cardiovascular risk factors in life (hypertension, diabetes mellitus, dyslipidemia, smoking, alcoholism, obesity, and sedentarism) reported by a knowledgeable next-of-kin, with at least weekly contact with the deceased, was associated with the neuropathological diagnosis of vascular dementia reported by a neuropathologist after the autopsy exam. Logistic regression models (with and without adjustment for sex, age and race) were tested to show the association between CVRF and the diagnosis of VaD, pure Vad and mixed VaD. It was also tested the predictive capacity of the factors that proved to be predictors of VaD through the ROC Curve. Results: Sedentary lifestyle was an independent predictor of VaD (OR 1,943, CI 95% 1,198 - 3,151, p = 0.007) and of Pure VaD (OR 3,148, 95% CI, 1.428 - 6.941, p = 0.004). Hypertension was an independent predictor of Mixed VaD (OR 2,240, 95% CI 1,216 - 4,126, p = 0.01). Sedentary lifestyle did not present good predictive capacity for VaD and Pure VaD (AUC = 0.380 and 0.337, respectively), as Hypertension for Mixed DV did not either (AUC = 0.459). Conclusions: Among the CVRF, sedentarism and hypertension were those associated with an increase VaD risk.

Introdução: As doenças cardiovasculares permanecem como a principal causa de morbimortalidade entre as mulheres no Brasil e no mundo. Estratégias de prevenção primária baseadas na detecção dos fatores de risco tradicionais para aterosclerose, têm sido pouco eficazes para reduzir as altas taxas de mortalidade nessa população. O presente estudo tem como objetivo primário detectar e quantificar a presença de aterosclerose na sua fase subclínica, em mulheres climatéricas e pós-menopausadas. Métodos: Foram estudadas 823 mulheres de 45 a 65 anos de idade (idade média 54,3 ± 5,3 anos), no período peri e pós-menopausa, sem doença cardiovascular conhecida, ou em uso de terapia de reposição hormonal, residentes em Recife, Nordeste do Brasil. Todas foram submetidas a avaliação clínica e dosagens bioquímicas, que incluíram os níveis de glicose, lipídios, proteína C-reativa, hormônio folículo-estimulante, adiponectina e aldosterona. Ultrassonografia modo B foi utilizada na avaliação carotídea; medidas da espessura íntima média carotídea (EIMC) foram determinadas na parede posterior da artéria carótida comum (ACC) utilizando-se um \"software\" de leitura automatizada; aterosclerose carotídea foi definida quando da presença de placa carotídea e/ou EIMC > 1mm. Resultados: De 823 mulheres, 10,2% eram fumantes, 58% tinham hipertensão e 9,9% eram diabéticas. A prevalência de doença aterosclerótica subclínica entre a população analisada foi de 12,7%, e a média da EIMC foi de 0,645 ± 0,124 milímetros. Na análise univariada, foram detectadas associações significativas entre presença de aterosclerose carotídea e: a idade (p < 0,001), o fumo (p=0,014), a hipertensão (p=0,002), a pressão arterial sistólica (p=0,003), o colesterol total (p=0,001) e o LDL-colesterol (p=0,001). No modelo ajustado, a idade (p < 0,001), o fumo (p=0,001), a pressão arterial sistólica (p=0,030) e o colesterol total (p=0,008) se correlacionaram de forma significativa e independente com a aterosclerose carotídea. Conclusão: O presente estudo revelou uma alta prevalência de aterosclerose carotídea entre as mulheres brasileiras a partir do climatério. Assim como a idade, os fatores de risco clássicos se correlacionaram de forma independente com aterosclerose carotídea. Esses resultados são de particular relevância, visto que as estratégias para redução do risco cardiovascular são baseadas em modelos de predição de risco onde as mulheres são frequentemente classificadas no grupo de baixo risco cardiovascular. Consequentemente, as oportunidades de envolvê-las mais cedo na prevenção da doença aterosclerótica são muitas vezes perdidas / Aims: Cardiovascular diseases continue to be the main cause of morbidity and mortality among women in Brazil and worldwide. Strategies of primary prevention, based on the detection of traditional risk factors for atherosclerosis, have had a small impact in reducing the high rates of mortality in this population. Therefore, the main purpose of this study was to analyse the prevalence of subclinical carotid atherosclerosis in peri- and postmenopausal women. Methods: We studied 823 peri- and postmenopausal women, 45 to 65 years-old (mean age 54.3±5.3 years), from Recife city, without known cardiovascular disease and hormone therapy utilization. All of them were submitted to a careful medical evaluation, and biochemical analyses that included glucose and lipids levels, C-reactive protein, follicle-stimulating hormone, adiponectin and aldosterone. B-mode ultrasound was utilized for carotid evaluations; intima-media thickness (IMT) measures were determined on the far wall common carotid artery (CCA) with automated reading software; presence of carotid atherosclerosis was defined as either the presence of plaque and/or IMT >= 1.00mm. Results: Of the 823 women, 10.2% were current smokers, 58% had hypertension and 9.9% were diabetics. The prevalence of subclinical atherosclerotic disease among the analyzed population was 12.7%, and the mean CCA-IMT was 0.645±0.124 mm. By univariate analyses, a positive and statistically significant correlation was found between carotid atherosclerosis and age (p < 0.001), current smoker (p=0.014), hypertension (p=0.002), systolic blood pressure (p=0.003), total cholesterol (p=0.001) and LDL cholesterol (p=0.001). In the adjusted model, age (p < 0.001), current smoker (p=0.001), systolic blood pressure (p=0.030) and total cholesterol (p=0.008), remained correlating significantly and independently with carotid atherosclerosis. Conclusion: Our study showed a high prevalence of carotid atherosclerosis among asymptomatic pre- and post-menopausal Brazilian women. As well as age, classic risk factors correlated independently with carotid atherosclerosis. These findings are of particular relevance as strategies for reducing cardiovascular risk are based on risk prediction models in which women are often classified as having low cardiovascular risk, and opportunities for engaging them in prevention at a younger age are very often missed

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T17:19:42Z No. of bitstreams: 1 FernandoSilva.pdf: 1534368 bytes, checksum: 7c9b884aebd1e19aef49b96cb13c3cc4 (MD5) / Made available in DSpace on 2017-05-11T17:19:42Z (GMT). No. of bitstreams: 1 FernandoSilva.pdf: 1534368 bytes, checksum: 7c9b884aebd1e19aef49b96cb13c3cc4 (MD5) Previous issue date: 2017-02-20 / Cardiovascular risk factors contribute to increased morbidity and mortality and should be prevented. Socioeconomic status and social mobility that occurred in our country in recent decades have contributed to a new reality from the point of view of health care. There have been a possibility of improve in risk factors due to epidemiological transition as occurred in developed countries where there were improvements in them. Thus it aimed to assess how the behavior of these risk factors in a cohort started at birth in 1978/79 and reviewed in 2002/04 in the state Ribeirão Preto to 23/24 years of age for a total of 2069 individuals. Socio-demographic characteristics were used, and cardiovascular risk factors including diabetes, insulin resistance, obesity, metabolic syndrome, lipid profile, blood pressure, physical activity, alcohol use and smoking. There was the income classification relating the minimum wage at birth and in early adulthood. Logistic regression models were used. The results were improvement in obesity, HDLCholesterol, physical activity, insulin resistance in high-income women and physical activity and HDL-Cholesterol in high-income men; there was worse of alcohol consumption in both groups. We concluded that high-income adults especially women presented cardiovascular risk factors profiles similar to those in high-income countries. / Os fatores de risco cardiovascular contribuem para o aumento da morbidade e mortalidade e devem ser prevenidos. A situação socioeconômica e a mobilidade social ocorrida no nosso país nas últimas décadas contribuíram para uma nova realidade sob o ponto de vista de cuidados de saúde. Há possibilidade de ter iniciado alterações nos fatores de risco com a chamada transição nutricional como a ocorrida nos países desenvolvidos nos quais houve melhoras nos mesmos. Dessa forma objetivou-se avaliar qual o comportamento desses fatores de risco em uma coorte iniciada ao nascimento em 1978/79 e reavaliada em 2002/04 na cidade paulista de Ribeirão Preto aos 23/24 anos de idade num total de 2069 indivíduos. Foram utilizadas as características sócio-demográficas, e fatores de risco cardiovasculares incluindo diabetes, resistência insulínica, obesidade, lipidograma, hipertensão arterial, atividade física, uso de álcool e hábito de fumar. Houve a classificação da renda relacionando ao salário mínimo no nascimento e na idade adulta jovem. Modelos de regressão logística foram utilizados. Os resultados evidenciaram melhorias na obesidade, atividade física, resistência insulínica, HDL-Colesterol, síndrome metabólica nas mulheres de maior renda. Nos homens de maior renda houve melhorias no HDL-Colesterol e atividade física; houve piora no consumo de álcool em ambos. Concluímos que os indivíduos pertencentes à classe com maior renda em especial as mulheres apresentaram perfis de fatores de risco cardiovascular semelhantes aos países com maior renda.

First degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in the index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and non-traditional cardiovascular risk factors to carotid ultrasound and coronary calcium scoring findings. B-mode carotid ultrasound was used to assess the combined intima-media thickness and plaque burden in 111 FDRs. The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity and BMI. Odds ratios indicate that FDRs are more likely to have positive carotid ultrasound findings compared to controls; 2.23 (95% CI 1.14 – 4.37) for intima-media thickness and 2.3 (95% CI 1.22 - 4.35) for average total thickness. In multivariate analysis positive carotid ultrasound findings were higher in FDRs independent of age, gender, total cholesterol over HDL-c ratio, systolic blood pressure and smoking but not homocysteine which had higher values in FDRs compared to controls. In conclusion FDRs of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Coronary artery calcium scoring (CAC), assessed by 64-slice multi-detector computed tomography (MDCT), was used to assess burden of subclinical atherosclerosis in 57 FDRs compared to controls. FDRs have a two-fold increase in risk of having CAC positive findings; odds ratios for the 75th percentile was 1.96 (95%CI 1.04 – 3.67, p<0.05) while for the 90th percentile odds ratio was 2.59 (95% 1.232 – 5.473, p<0.05). In summary, the risk of significant CAC findings, measured by 64-slice MDCT, is two-fold higher in FDRs than controls. These findings correlate highly with carotid ultrasound findings in the same cohort. Different thresholds for CAC may be appropriate when assessing male versus female FDRs. Together increased carotid ultrasound findings and CAC scoring results in FDRs of patients with validated early onset of CHD suggest these imaging techniques as potentially useful tools in cardiovascular risk assessment that will go above and beyond the current diagnostic algorithms.