Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = –2.15 mg/dL, 95%CI –3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period. © / Revisión por pares

Suboptimal cardiovascular health among African American (AA) women contributes to high costs of care related to acute illness, chronic illness, and disability. Using the health promotion model, this needs assessment project examined risk factors that predispose adult AA women between the ages of 21 to 64 years of age to higher incidence of cardiovascular disease (CVD). Seventy of the 300 charts that met the inclusion criteria (female AA patients, 21 to 64 years of age, receiving care in a community clinic in an urban city of Texas) were audited for this project. Descriptive analysis showed that 66% of the women did not have a diagnosis of CVD, 32% were noted as being at risk for CVD, and risk for diagnosis of CVD was not listed in 3% of the charts. The audit also showed that 7% of the AA women did not monitor their diet, 60% monitored their diet, and 33% lacked knowledge of heart healthy diet. Sixty-seven percent of charts audited noted a family history of CVD, 33% noted no family history of CVD, while 3% noted an unknown family history of CVD. The ages of the patients ranged from 21-64 (M = 24.9 years). Weight ranged from 104-225 lbs. (M = 172.5 lbs.) and height ranged between 52-73 inches (M = 61.13 inches). Body mass index (BMI) calculated showed 1.43% of the women were underweight, 11.4% showed normal BMI, 32.86% were overweight, and 54.29% were obese. Study recommendation included implementation of a patient education that will help increase awareness of CVD among the patient population at the clinic. Findings from this project could increase awareness on the importance of creating cultural congruent education program that will help educate minority populations more effectively in the management of cardiovascular disease.

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Introdução: estudos recentes demonstram que o aumento do colesterol na lipoproteína de alta densidade (HDL-C), induzido por medicamentos ou mutações genéticas, não é associado à redução de eventos coronarianos. A lipoproteína de alta densidade (HDL) apresenta aspectos funcionais distintos em relação ao seu papel cardioprotetor. Objetivo: desenvolver um escore de funcionalidade da HDL (EFH) e avaliar a sua associação com algoritmos de predição de risco cardiovascular e aterosclerose subclínica em indivíduos brasileiros. Metodologia: trata-se de um estudo transversal composto por duas etapas. Na 1ª etapa, o EFH preditor de risco cardiovascular (EFH-RCV) foi desenvolvimento e validado a partir de uma subamostra do estudo CARDIONUTRI (n=354). Na 2ª etapa, o EFH preditor de aterosclerose subclínica (EFH-AS) foi desenvolvido e validado com dados de uma subamostra do estudo ELSA-Brasil (n=4549). No estudo CARDIONUTRI foram avaliadas a atividade da paraoxonase 1 (PON1) e da proteína de transferência de ésteres de colesterol (CETP), a concentração da apolipoproteína AI (APOAI), a capacidade antioxidante da HDL (lag time) e as subfrações da HDL pelo método Lipoprint®. O estudo ELSA-Brasil avaliou as subfrações da HDL pelo método Vertical Auto Profile (VAP) e Ressonância Magnética Nuclear (RMN), e a aterosclerose subclínica por tomografia computadorizada, quantificação da calcificação da artéria coronária (CAC) e calculo do escore da CAC. Resultados: no desenvolvimento do EFH-RCV, a HDL grande apresentou maior força de associação com o risco cardiovascular no modelo múltiplo final (OR = 0,797; p <0,001). O EFH-RCV demonstrou bom desempenho em relação ao escore de risco de Framingham (AUC = 0,899; p <0,001), escore de risco de Reynolds (AUC = 0,722; p <0,001) e Adult Treatment Panel III/2013 (AUC = 0,864; p <0,001). Além disso, apresentou boa reprodutibilidade e correlação com aterosclerose subclínica, quando testado na amostra do estudo ELSA-Brasil, utilizando medidas da HDL grande derivadas do método VAP (AUC = 0,864; p <0,001 e r = 0,252 p <0,001) ou do método de RMN (AUC = 0,876; p <0,001 e r = 0,277; p <0,001). O EFH-AS foi desenvolvido a partir do tamanho da HDL (nm), que apresentou a associação mais forte com aterosclerose subclínica no modelo múltiplo final (OR = 0,549; p <0,001) e demonstrou bom desempenho (AUC = 0,769; p <0,001). Conclusão: o EFH apresentou associações mais fortes com o risco cardiovascular e a aterosclerose subclínica, independente do HDL-C, com destaque para a HDL grande. Os resultados controversos entre as subfrações da HDL e o risco cardiovascular parecem manter relação com as metodologias distintas utilizadas nas análises. Portanto, a validação dos métodos e a inclusão do tamanho da HDL como marcador de risco cardiovascular revela um futuro promissor como adjuvante na estimativa do risco cardiovascular, manejo de medicamentos e tomada de decisões na prática clínica. / Introduction: current studies have not presented association between high density-lipoprotein cholesterol (HDL-C) increase, induced by drugs or genetic mutations, and coronary events reduction. HDL plays different functional cardioprotective role. Objective: to develop a HDL functionality score (HFS) and to assessment its association with predictive cardiovascular risk algorithms and subclinical atherosclerosis outcomes in Brazilian subjects. Methods: cross-sectional study based in two steps. In the first step, the HFS predictor of cardiovascular risk disease (HFS-CVR) was developed and validated on CARDIONUTRI study subsample (n=354). In second step the HFS predictor of subclinical atherosclerosis (HFS-SA) was developed and validated on ELSA-Brasil study subsample (n=4549). CARDIONUTRI study evaluated paraoxonase 1(PON1) and cholesterol ester transfer protein (CETP) activity, apolipoprotein AI (APOAI) concentration, HDL antioxidant capacity, and HDL subfractions by standard Lipoprint® method. ELSA-Brasil study evaluated the size of HDL and subfractions by Vertical Auto Profile (VAP) and Nuclear Magnetic Resonance (NMR) method, and the diagnosis of subclinical atherosclerosis by computed tomography, quantifying coronary artery calcification (CAC) and CAC score. Results: in the development of HFS-CVR, the large HDL presented greater strength of association with cardiovascular risk in the multiple final model (OR = 0.797; p <0.001). The HFS-CVR showed satisfactory performance by Framingham risk score (AUC = 0.899; p <0.001), Reynolds risk score (AUC = 0.722; p <0.001) and Adult Treatment Panel III/2013 guidelines (AUC = 0.864; p <0.001). In addition, HFS-CVR presented satisfactory reproducibility and was associated with subclinical atherosclerosis on ELSA-Brasil sample using large HDL measurements derived from the VAP method (AUC = 0.864; p <0.001 and r = 0,252; p <0,001) or the NMR method (AUC = 0.876; p <0.001 and r = 0.277; p <0,001). HFS-AS was developed from the HDL size (nm), because presented greater association with subclinical atherosclerosis in the final multiple model (OR = 0.549; p <0.001). HFS-AS demonstrated satisfactory performance (AUC = 0.769; p <0.001). Conclusion: the HFS demonstrates strong association with cardiovascular risk and subclinical atherosclerosis, independent of HDL-C, with emphasis on large HDL. Controversial results, between HDL subfractions and cardiovascular irsk seem to maintain a relation with the different methodologies used in analysis. Therefore, the validation of the methods and the inclusion of the HDL size as a cardiovascular risk marker reveal a promising future as an adjunct in the estimation of cardiovascular risk, drug management and decision making in clinical practice.

Background: In the past 37 years, increased efforts have been directed toward a better understanding of the importance of Hcy in disease and it has now become clear that hyperhomocysteinemia is a major independent risk factor for CVD. Extensive research on the influence of vitamin supplementation leading to reductions in Hcy levels and improvements in cardiovascular function has been done. The importance of exercise in the lowering of cardiovascular risk factors, as well as its favourable influence on cardiovascular function has also been indicated in several studies, however, the limited number of studies investigating the effect of exercise on Hcy concentrations revealed contradicting results. Furthermore, a relationship between Hcy concentration and cardiovascular function with the intervention of an exercise training and a vitamin supplementation programme respectively has also not been investigated. Objective: The objective of this study was to examine the effect of a 12-week exercise training and a 12-week vitamin supplementation intervention respectively on tHcy concentrations and cardiovascular function, and whether the change in tHcy concentration within the different interventions correlated with the change in cardiovascular function. Methods: In a randomised controlled cross-over intervention study, 52 men matched for age, cardiorespiratory fitness levels and cardiovascular risk factors were randomly assigned to one of 3 groups (Group A = exercise training programme, 20-30min. at 70-80% of HRmax; Group B = 400 g folic acid and 25 g vitamin B12 supplement; Group C = control). Group A and B were crossed over for phase 11, and Group C remained the control. The questionnaires were completed, and the body composition variables (BMI, WHR and body fat percentage), cardiovascular function (Finometer), tHcy concentrations and VO2max, were measured before and after each 12-week intervention period. A 6-week washout period separated the crossovers. Results: The ANCOVA, adjusted for age and BMI, showed that the percentage change from baseline to end, corrected for baseline of the tHcy concentration increased significantly (p ≤ .05) by 9.7% with the exercise training intervention and decreased significantly (p ≤ .05) by 12.9%, with the vitamin supplementation intervention. The ANCOVA of the percentage change from baseline to end in cardiovascular function showed that the vitamin supplementation intervention resulted in improvements in cardiovascular function (decreased resting MAP, TPR and increased resting SV, CO, Cw) in comparison to the impairment in cardiovascular function with the exercise training intervention (increased resting DBP, MAP and TPR). The relationship between the tHcy concentration and cardiovascular function at baseline and within each of the different interventions were assessed by partial correlations adjusted for age, BMI and VO2max. Significant (p ≤ .05) relationships only occurred within the vitamin supplementation intervention, where decreased percentage change in tHcy concentration significantly correlated with increased percentage change of resting SV and CO and decreased percentage change of resting TPR. Conclusion: The general conclusion that can be drawn is that a 12-week vitamin supplementation intervention showed increased health related results, e.g. a significant reduction in tHcy concentration, an improvement in cardiovascular function and a significant positive relationship between these b o factors, in comparison to the 12-week exercise training intervention that significantly increased the tHcy concentration and did not show increased health related results. Due to inadequate compliance to the exercise training intervention, no conclusion can be drawn with regard to the effect of exercise training on tHcy concentrations and cardiovascular function. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2007

Current treatments for obesity have been unsuccessful. It is essential that a patient-centred approach for obesity management is developed and for this to be successful other diet and lifestyle approaches need to be considered. A systematic review comparing low carbohydrate vs. low fat diets for the treatment of obesity was carried out. It found that low carbohydrate/high protein diets are as effective as, if not better, for treating obesity and cardiovascular disease risk factors. A randomised controlled trial investigating dietary approaches for the treatment of obesity and its co morbidities was carried out. Variables including weight and body composition, cardiovascular risk factors, adipokines, liver and kidney function, and health and lifestyle factors were measured. Those with metabolic syndrome were also examined. It was hypothesised that there are alternative ways of treating obese subjects depending on their phenotype. Those with a higher BMI tend to have a higher carbohydrate intake rather that a higher fat intake so may be better suited to a low carbohydrate/high protein diet rather than the conventional low fat/energy reduced diet. Subjects were initially treated with the standard dietary approach for obesity (health eating, HE) and if not successful after 3 months were randomised to either a very low calorie diet (Lighterlife, LL) or a protein sparing modified fast (PSMF). All three groups showed a significant weight loss and reduced risk for CVD at 12 months. Significant improvements were seen for plasminogen-activated receptor-1, adiponectin, leptin and IL-6 on HE and LL, but only adiponectin significantly improved on the PSMF. Neither diet showed any detrimental effects for those with a healthy liver and kidney function. Quality of life and levels of depression improved at 12 months. Of the 54 subjects with metabolic syndrome at baseline, 12 remained on HE and 32 were randomised to LL and PSMF. This indicates that most subjects did not suit a low fat dietary approach. They were successful at losing weight on LL and PSMF and showed improvement in MS risk factors, and adipokine levels at 12 months. In conclusion, the study demonstrates that a low fat diet may not necessarily be the first line of approach to treat obese subjects with a BMI over 35 kg/m2, including those with MS. A very low calorie diet such as LL or a PSMF may be better suited to the subject.

Introdução: Existe crescente interesse em identificar marcadores de risco para eventos cardiovasculares em pacientes com HIV/aids. Atualmente observa-se alteração do perfil epidemiológico desses pacientes, com diminuição da mortalidade por infecção e comorbidades e aumento por eventos cardiovasculares. A elasticidade arterial, principalmente dos pequenos vasos, tem sido investigada como alteração precoce de evento cardiovascular. Objetivo: Avaliar a relação entre elasticidade arterial e outros indicadores de risco cardiovascular como fatores demográficos e socioeconômicos, hábitos de vida, estado nutricional e marcadores inflamatórios. Métodos: Foram selecionados aleatoriamente 132 indivíduos voluntários em tratamento regular com antirretrovirais em ambulatório especializado em HIV/aids, com idade entre 19 e 59 de ambos os sexos. A elasticidade arterial dos grandes vasos (LAEI) e pequenos vasos (SAEI) foi investigada pelo equipamento HDI/ PulseWaveTM CR-2000 Cardio Vascular Profiling System®. Foram determinados colesterol total e frações, triglicérides, proteína C-reativa, fibrinogênio, medidas antropométricas e de avaliação de composição corporal, fumo, consumo de bebidas alcoólicas, uso de drogas, prática de atividade física, além de avaliação de fatores demográficos e socioeconômicos e imunológicos (carga viral, T-CD4, T-CD8). Para investigar a associação entre LAEI e SAEI e outros fatores de risco cardiovascular utilizou-se análise de regressão linear múltipla. Resultados: Em relação à elasticidade dos grandes e pequenos vasos, 71,97 por cento e 32,58 por cento , respectivamente, dos participantes foram classificados com elasticidade normal. Observou-se associação positiva entre LAEI e peso (p<0,001) e associações negativas entre LAEI e prega cutânea subescapular (p<0,001) e linfócitos T-CD4 (p<0,02). Verificou-se associação negativa de LAEI com sexo (p<0,02), mostrando que o sexo feminino está relacionado com menor elasticidade. Houve associação positiva entre SAEI e peso (p<0,001) e associações negativas entre SAEI e prega cutânea subescapular (p<0,001), idade (p<0,01) e linfócitos totais (p<0.01). Conclusão: As alterações de elasticidade arterial em pacientes HIV/aids apresentaram relação com outros fatores de risco cardiovascular. SAEI mostrou-se diminuído na maioria dos participantes, sendo uma alteração que pode identificar a disfunção endotelial antes que a doença se torne clinicamente aparente. A monitoração constante da elasticidade arterial através de método não invasivo pode se tornar uma importante ferramenta na predição e prevenção de eventos cardiovasculares em pacientes HIV/aids / Introduction: There is a growing interest in identifying markers of risk for cardiovascular events in patients with HIV / AIDS. Currently there is a change in the epidemiological profile of patients with reduced mortality from infections and comorbidities and increased cardiovascular events. The arterial elasticity, mainly of small vessels, has been investigated as early alteration of cardiovascular events. Objective: To evaluate the relationship between arterial elasticity and other cardiovascular risk factors such as demographic and socioeconomic factors, lifestyle habits, nutritional status and inflammatory markers. Methods: We randomly selected 132 individuals volunteers, ages between 19 and 59, of both sexes, regularly treated with antiretrovirals in specialized clinics on HIV / AIDS. Arterial elasticity of the large (LAEI) and small (SAEI) vessels were investigated by the equipment HDI/ PulseWaveTM CR-2000 Cardio Vascular Profiling System®. We determined total cholesterol, HDL, triglycerides, C-reactive protein, fibrinogen, and anthropometric assessment of body composition, smoking, alcohol consumption, drug use, physical activity, and evaluation of demographic, socio-economic and immunological (viral load, T-CD4, T-CD8) factors. The association between LAEI and SAEI and other cardiovascular risk factors were assessed by multiple linear regression. Results: Regarding the elasticity of large and small vessels, 71.97 per cent and 32.58 per cent , respectively, of the participants were classified as having normal elasticity. We observed a positive association between LAEI and weight (p <0.001) and negative associations between LAEI and subscapular skinfold (p <0.001) and CD4 counts (p <0.02). There was a negative association of LAEI with gender (p <0.02), showing that female gender is associated with lower elasticity. There was a positive association between SAEI and weight (p <0.001) and negative associations between SAEI and subscapular skinfold (p <0.001), age (p <0.01) and total lymphocytes (p <0.01). Conclusion: Changes in arterial elasticity in patients with HIV / AIDS correlate with other cardiovascular risk factors. SAEI was altered in most participants, a change that can identify endothelial dysfunction before the disease becomes clinically apparent. The constant monitoring of arterial elasticity through noninvasive method may become an important tool in the prediction and prevention of cardiovascular events in HIV / aids patients

Trata-se de um estudo descritivo de intervenção quase experimental, com abordagem quantitativa, realizado com 154 estudantes do ensino médio de escolas públicas do interior paulista, realizado no período de agosto a dezembro de 2010, tendo por objetivos identificar entre os estudantes do ensino médio, valores de PA alterados, exposição aos fatores de risco para a doença hipertensiva e o conhecimento, por meio de jogos educativos, sobre os fatores de risco para a doença hipertensiva. Para a coleta de dados foram utilizados três instrumentos: um relativo a dados sociedemográficos, da medida da pressão arterial (PA) e do estilo de vida; os planos de aulas para realização da atividade educativa e o jogo de cruzadas de Moreira (2007), para avaliar o conhecimento dos alunos pré e pós-intervenção com a atividade educativa. Os sujeitos possuíam idade entre 14 e 17 anos, 86 (55,8%) eram do sexo feminino, 100 (65%), brancos e 63 (40,9%) cursavam o 10° ano; 7 (4,5%) apresentaram valores de PA > percentil 95 e <= percentil 99, 3 (1,9%) apresentaram valores de PA > percentil 99; 35 (22,8%) apresentaram sobrepeso, destes, 5 (14,3%) apresentaram valores de PA alterados, 8 (5,2%) apresentaram obesidade, destes, 3 (37,5%) apresentaram valores de PA alterados; 45 apresentaram circunferência da cintura (CC) > percentil 75, destes, 6 (13,3%) estavam com valores de PA alterados. As principais comorbidades apresentadas relativas aos antecedentes familiares foram: Hipertensão Arterial Sistêmica (HAS) (71,4%), Infarto Agudo do Miocárdio (IAM) (61,7%) e Acidente Vascular Cerebral (AVC) (40,3%). Dos estudantes com valores de PA alterados, 8 (80%) apresentaram algum antecedente familiar para doenças cardiovasculares (DCVs). Quando questionados sobre o entedimento do que é pressão alta, 56 (36,4%) responderam corretamente e 41 (26,6%) sabiam indicar o tratamento da pressão alta. Quando questionados sobre a exposição aos fatores de risco para a HAS, 28 (18,2%) indicaram não praticar atividade de física, destes, 7 (24,9%) apresentaram valores de PA alterados, 15 (9,7%) eram fumantes, destes, 8 (53,3%) possuiam valores de PA alterados, 66 (42,9%) consumiam bebida alcoólica, sendo que, 4 (6,1%) apresentaram valores de PA alterados, 93 (60,4%) consideravam-se estressados, dos quais, 9 (9,7%) possuiam valores de PA altterados. Quando comparamos as questões do jogo de cruzadas no pré e pós- intervenção com a atividade educativa, identificamos que o conhecimento dos estudantes foi adquirido, pois apresentaram 32,5 % de acertos nas questões (pré-intervenção) e 76,2% de acertos nas questões (pós-intervenção). A aplicação do teste t Student, mostrou resultado p= 000, sendo estatisticamente significativo. Diante desses resultados permanece o deasafio de desenvolver programas educativos nas escolas como processo de ensino para que os estudantes adquiram conhecimento para buscar melhor qualidade de vida, pois é nesta faixa etária que se desenvolvem hábitos saudáveis. / This quasi-experimental descriptive intervention study with a quantitative approach involved 154 secondary-education students from public schools in the interior of São Paulo State, Brazil. It was carried out between August and December 2010. The goals were to identify altered BP levels among the students, as well as exposure to risk factors for hypertensive disease and knowledge on the risk factors for hypertensive disease, using educative games. Three instruments were used for data collection: one addressing socio-demographic, blood pressure (BP) measurement and lifestyle data; lesson plans to accomplish the educative activity and Moreira\' crossword game (2007) to assess the students\' knowledge before and after the intervention and after the educative activity. Subjects were between 14 and 17 years old, 86 (55.8%) were female, 100 (65%) white and 63 (40.9%) were taking the 10th year; 7 (4.5%) displayed BP > 95th percentile and <= 99th percentile, 3 (1.9%) showed BP > 99th percentile; 35 (22.8%) presented overweight, 5 (14.3%) of whom with altered BP levels, 8 (5.2%) were obese, 3 (37.5%) of whom with altered BP levels; 45 presented waist circumference (WC) > 75th percentile, 6 (13.3%) of which with altered BP levels. The main comorbidities related to family antecedents were: systemic arterial hypertension (SAH) (71.4%), acute myocardial infarction (AMI) (61.7%) and cerebrovascular accident (CVA) (40.3%). Among students with altered BP levels, 8 (80%) presented some family antecedent for cardiovascular illnesses (CVIs). When asked about their understanding of high blood pressure, 56 (36.4%) answered correctly and 41 (26.6%) were able to indicate high BP treatment. When asked about exposure to risk factors for SAH, 28 (18.2%) indicated that they did not practice physical exercise, 7 (24.9%) of whom with altered BP levels; 15 (9.7%) were smokers, 8 (53.3%) of whom with altered BP levels; 66 (42.9%) consumed alcoholic beverages, 4 (6.1%) of whom with altered BP levels, and 93 (60.4%) considered they were stressed, 9 (9.7%) of whom with altered BP levels. The comparison of questions in the crossword game before and after the intervention with the educative activity showed that the students gained knowledge, with 32.5% (pre-intervention) and 76.2% of correct answers (post-intervention). The result of Student\'s t-test was p= 000, with statistical significance. In view of these results, the challenge remains to develop educative programs in schools as a teaching process for students to gain knowledge with a view to a better quality of life, as it is in this age range that healthy habits are developed.