The potential that telemedicine interventions may have in effectively delivering remote specialized cardiovascular care to large numbers of patients with heart diseases has recently come under question. In the first phase of this thesis, a systematic review and meta-analysis was conducted to compare the impact of a basic form of telemedicine that is regular patient follow-up by telephone, with usual care for individuals with coronary artery disease following their discharge. In the second phase of this thesis, a network meta-analysis, using Bayesian methods for multiple treatment comparisons, was conducted to compare the more complex forms of telemedicine for patients with heart failure. In the third and final phase of this thesis, a randomized controlled trial was designed to compare the impact of two forms of telemedicine, identified in the earlier two phases as being the most promising, on clinical outcomes, cardiac risk factors and patient reported outcomes.

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.

Psichosocialiniai veiksniai turi įtakos išeminės širdies ligos (IŠL) vystymuisi ir komplikacijų atsiradimui. Depresijos ir nerimo patogenezėje dalyvauja pagumburio-hipofizės-antinksčių ašis. Skydliaukės hormonų pokyčiai taip pat dažnai randami sergantiesiems IŠL bei depresija. Nuovargis ir su sveikata susijusi gyvenimo kokybė priklauso ne tik nuo geros fizinės sveikatos, bet ir nuo psichoemocinės būklės, todėl svarbu kompleksiškai įvertinti hormoninių žymenų ir elgesio veiksnių (depresijos, nerimo ir nuovargio) sąveikos įtaką sergančiųjų IŠL gyvenimo kokybei, ligos eigai bei baigtims. Šio tyrimo tikslas buvo išnagrinėti kortizolio ir skydliaukės ašies hormonų koncentracijų ryšį sergantiesiems IŠL su N-galinio smegenų tipo natriuretinio propeptido (NT-proBNP) koncentracija bei subjektyviomis sveikatos būklėmis: depresijos, nerimo simptomais, nuovargiu ir su sveikata susijusia gyvenimo kokybe. Tyrimas parodė skydliaukės hormonų ir kortizolio koncentracijų reikšmingą ryšį su subjektyviu sveikatos vertinimu sergantiesiems IŠL. Mažesnė bendrojo T3, laisvojo T4 ir didesnė reversinio T3 koncentracija susijusi su didesne NT-proBNP koncentracija, depresijos simptomų pasireiškimu, didesniu nuovargiu ir blogesniu su sveikata susijusios gyvenimo kokybės vertinimu. Didesnė rytinio kortizolio koncentracija susijusi su depresijos simptomų pasireiškimu moterims. Gauti duomenys gali būti panaudoti sergančiųjų IŠL depresijos bei nerimo simptomams, ligos eigai, prognozei ir gyvenimo kokybei... [toliau žr. visą tekstą] / Psychosocial factors affect the occurrence of coronary artery disease (CAD) disease and development of complications. People with depression or anxiety symptoms have the activate hypothalamic-pituitary-adrenal axis. Thyroid hormone changes are also found in patients with CAD. Fatigue and health-related quality of life (HRQoL) depends not only on good physical health, but also on psychoemotional state, especially on the presence of depression and anxiety disorders. Therefore, it is important to evaluate complex of hormonal markers and behavioral factors (depression, anxiety and fatigue) interaction on patients with CAD for quality of life, disease course and outcome. The aim of this study was examine relationship of cortisol and thyroid axis hormones concentrations with NT-pro B type natriuretic peptide (NT-proBNP) concentrations and with patient oriented outcomes such as depressive symptoms, fatigue and HRQoL in CAD patients. Study demonstrates relationship between thyroid axis hormones and cortisol concentrations with depression, anxiety symptoms, fatigue and HRQoL in CAD patients. Low T3, free T4 and higher RT3 concentrations are associated with higher NT-proBNP levels, depression symptoms, higher fatigue and worse HRQoL. Higher morning cortisol concentrations are associated with depression symptoms in women. The data obtained can be used in patients with coronary artery disease and depressive anxiety disorder, disease progression, and prognosis and quality of life... [to full text]

Didėjant vyresnių žmonių populiacijai amžinė geltonosios dėmės degeneracija (AGDD) yra vis dažnesnė vyresnio nei 50 metų amžiaus žmonių negrįžtamo regos netekimo priežastis. AGDD prevencinės priemonės bei gydymo galimybės ribotos, nes ligos etiopatogenezė iki šiol nėra visiškai aiški. Disertacinio darbo metu įvertintos AGDD ir išeminės širdies ligos (IŠL) sąsajos, atsižvelgiant į vainikinių arterijų aterosklerozinius pažeidimus. Pirmą kartą analizuota SCARB1 rs5888 C/T genotipų įtaka AGDD ir IŠL pasireiškimui. Tyrimo rezultatai parodė, kad AGDD ir IŠL, kai vainikinėse arterijose yra aterosklerozinių pažeidimų (IŠLath+), sieja bendri, šių ligų pasireiškimo galimybę didinantys, klinikiniai veiksniai ir oksidacinis stresas. Nustatytas „apsauginis“ SCARB1 rs5888 T/T genotipas, mažinantis AGDD ir IŠLath+, bei „rizikingas“ SCARB1 rs5888 C/T genotipas, didinantis AGDD+IŠLath+ galimybę. Pritaikius matematinės morfologijos metodus, nustatyta, jog sergantiems vėlyvąja AGDD SCARB1 rs5888 „rizikingas“ genetinis variantas susijęs su didesniu centrinės tinklainės dalies pažeidimo plotu. Bendrų AGDD ir IŠL patogenezinių grandžių tyrimas suteikia naujos informacijos apie AGDD etiologiją, patogenezę ir galbūt pasitarnaus efektyvaus gydymo bei prevencijos krypčių kūrimui. Tyrimo metu taikyti morfometriniai geltonosios dėmės pažaidos ploto matavimai gali būti naudojami gydytojų-oftalmologų klinikinėje praktikoje, siekiant tiksliau įvertinti centrinės tinklainės dalies pokyčius dinamikoje... [toliau žr. visą tekstą] / Age-related macular degeneration (ARMD) is the commonest cause of blindness among persons over the age of 50 and its prevalence is likely to increase as a consequence of population ageing. ARMD is a disorder of unknown cause and pathogenesis, therefore current options for ARMD prevention and treatment are limited. In the recent study the associations between ARMD and CAD, according the angiographic findings of atherosclerosis in the coronary arteries, were analyzed. The oxidative stress impact and clinical factors determining susceptibility to ARMD and CADath+, separately and common susceptibility factors for both diseases prediction were ascertained. Analysis of novel genetic biomarker, the rs5888 variant of SCARB1 gene, identified the „protective“ SCARB1 rs5888 TT genotype, associated with the lower risk of ARMD and CADath+, and a „risk-determining“ CT genotype, determining higher ARMD+CADath+ risk. The evaluation of macular lesion area by using the methods of mathematical morphology revealed that in late stage ARMD subjects carriers of SCARB1 rs5888 CT genotype the area of macular lesion was larger than in TT genotype carriers. New information about ARMD and CAD discovered additional knowledge about ARMD etiopathogenesis and might be helpfull in search of new treatments or strategies for ARMD prevention. Evaluation of macular lesion area by mathematical morphology methods used in this study may be useful in ophthalmological practice to monitor the dynamics of ARMD.

Until recently, tests of vascular structure, function and compliance have been used predominantly for assessing the efficacy of treatment – for example, aggressive medical therapy may yield improvements in vascular structure and function with a concomitant decrease in cardiac events. However, the role of abnormal vessel function in the development of atherosclerosis, and the relationship of structural changes in peripheral vessels with coronary disease might suggest that these tests could be used as a screening test for patients with subclinical coronary disease. At present, there is insufficient evidence to support the theory that normal vascular structure and function can rule out significant coronary disease, and indeed, such an association may be confounded by the presence of risk factors that alter these test results in the absence of significant coronary artery disease (CAD). The overall hypothesis of the studies undertaken in this thesis was that utilizing contemporary technology during ultrasonic and tonometric assessment of arterial structure, function and compliance, it is possible to non-invasively characterise both early and advanced arterial dysfunction and identify patients both at risk and with cardiovascular disease. The aim of these studies was to determine whether these tests can be used to guide intervention when arterial dysfunction is diagnosed and whether they are robust enough as a follow-up tool. The thesis initially reviews arterial structure, function and compliance and their relationship to cardiovascular risk and in particular, CAD. This review provides a rationale for the studies undertaken here to resolve clinical and technical issues as well as provide an insight into the tests chosen to assess arterial function. The second chapter discusses the methodology used in these studies to assess arterial structure, function and compliance, diagnose coronary artery disease and determine cardiovascular risk. They range from stress echocardiography for the diagnosis of CAD to tests for arterial structure (carotid intima-media thickness [IMT]), endothelial function (brachial artery reactivity [BAR]), local arterial distensibility (distensibility coefficient [DC]) and systemic or total arterial compliance (TAC). In addition, several methods will be discussed for assessing local arterial elasticity with a novel imaging technique. The rationale for using tests for arterial structure, function and compliance in patients with CAD as well as cardiovascular risk is examined in chapter 3. Chapter 3 examines the use of TAC, IMT and BAR in patients undergoing dobutamine stress echocardiography (DSE) in a group of patients with and without disease. TAC was neither an independent predictor of CAD risk or patients having CAD in this study. BAR was a predictor of risk status but not of patients having CAD. Only IMT was an independent predictor of both patients at risk for CAD and those with CAD. In chapter 3 both pulse pressure and total arterial compliance were only univariate predictors of risk for CAD. Chapter 4 examines three different methods of estimating TAC, all based on the two-element Windkessel model in 320 patients with and without cardiovascular risk. The pulse-pressure method (PPM) is based on a combination of pressure, obtained using applanation tonometry of the radial artery, and an estimate of stroke volume obtained by Doppler echocardiography of the left ventricular outflow and by 2D echocardiographic dimension of the left ventricular outflow tract. The area method (AM) is an integral variation of the Windkessel equations and is based on the derived central pressure waveform. The stroke volume-pulse pressure method (SVPP) is a simple ratio of stoke volume and pulse pressure. We conclude that they correlate well and show similar differences between groups with and without risk. The PPM had the smallest difference from the mean and standard deviation in Bland Altman analysis and we therefore used the PPM for most future studies. Chapter 5 discusses the use of tissue Doppler for the derivation of central pressure and determination of distensibility coefficient, a marker of local arterial elasticity. Tissue Doppler can be used to evaluate the low frequency, high amplitude signals which come from tissue by changing filtering settings on an ultrasound machine. Using off-line software, the tissue velocities can be extracted and with a processing algorithm, vessel wall displacement values over time can be generated. These vessel wall displacement values which are in microns (µm) can then be used to calculated distensibility coefficient which is calculated as 2*((net displacement/minD)/PP). We studied a large group of patients with and without cardiovascular risk and conclude that DC using tissue Doppler correlates highly with DC by B-mode and M-mode imaging and is also very reproducible. In a subgroup, the vessel displacement values were “calibrated” using mean and diastolic pressure and with specialised software and a transfer function, central pressure wave forms were reconstructed. In this study we conclude that the central pressure obtained using tissue Doppler displacement of the carotid artery correlates highly with that obtained using applanation tonometry although there are technical challenges involved. With the known prognostic value of pulse pressure, chapter 6 explores whether there is added benefit to measuring total arterial compliance over pulse pressure alone. Once again patients with and without disease were studied and we conclude that brachial pulse pressure correlates well with TAC in men with normal cardiac function. However, in women and in patients at the low and high extremes of function, and in patients with preclinical and overt cardiovascular disease, there appears to be incremental value in measuring TAC. The role of cardiovascular risk factors in association with TAC is examined in chapter 7. Several studies have shown that TAC is lower in certain groups due to age, height, hypertension, hyperlipidaemia or other factors. We studied 720 patients with and without cardiovascular risk factors and did several multiple linear regression models based on anthropomorphic variables. Age was an independent correlate of TAC in most of the regression models and we conclude that TAC is associated with multiple risk factors, but age is a major determinant. The influence of age and other correlates may dwarf the contribution of individual risk factors and therefore their alteration with therapy. Chapter 8 examines the correlates of preclinical cardiovascular disease in both indigenous and non-indigenous Australians with and without diabetes mellitus (DM). DM is a major health problem in the Indigenous population in Australia and CVD occurs earlier in this group than in caucasians and is responsible for 1/3 of all deaths. We studied a large group of indigenous Australians with and without DM and matched them to a caucasian population. There were no differences in BAR between the groups probably due to large standard deviations in the measurements. In assessing DC, both DM groups had significantly lower DC than the non-DM groups. However, in the IMT analysis both of the indigenous groups had significantly higher IMT than their caucasian counterparts and even after IMT was corrected for age, Indigenous patients even at an early age had significantly higher IMT. We conclude that despite a high incidence of risk factors in indigenous Australians both with and without DM, ethnicity (and various other risk factors for which it is a marker) appears to be an independent predictor of preclinical cardiovascular disease. In chapter 3 we determined that TAC was not an independent correlate of patients either at risk of CAD or with CAD. Chapter 9 discusses the results of a study of patients presenting for stress echocardiography for either detection of CAD or risk stratification. Ischaemia was detected in 25% of cases and TAC was similar in those with and without ischaemia. In multiple linear regression models however, in addition to cardiovascular risk factors TAC was independently associated with both the presence of CAD and the extent of ischaemia at stress echocardiography. Several studies have used vascular function as an outcome measure in intervention trials, either lifestyle or pharmacologic. In chapter 10 we undertook a lifestyle and diet intervention study in a large group of healthy patients with type-II DM. The tests for IMT, BAR and TAC were used in addition to biochemical markers and fitness assessment. At follow-up the intervention group had significant changes in weight and BMI and significantly increased fitness but failed to show any changes in any of the vascular parameters. We conclude that while metabolic and fitness parameters respond to treatment in patients with type-II DM, the early changes seen in vascular structure, function and compliance may not change in the long term. Although TAC has been correlated with hypertension, LVH, myocardial ischaemia and heart failure there are few data existing regarding the relationship of TAC to outcome. In the final chapter of this thesis we sought whether TAC was predictive of outcome in a large, primary prevention group of patients with varying degrees of cardiovascular risk. We followed up 719 patients who were studied between 2001 and 2008 in Brisbane, Australia and examined TAC in relation to mortality and a composite endpoint of death or hospital admission. There were significant differences in groups having low and normal TAC for both death and the composite endpoint and in patients with intermediate and high Framingham 10-year risk TAC was an independent predictor of both death and the composite endpoint. We conclude that TAC correlates with outcome in patients with varying degrees of cardiovascular risk and also adds incremental benefit to Framingham risk alone in patients with intermediate risk.

Thesis (Ph.D. in Epidemiology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 100-117). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Ces travaux de thèse portent sur le développement d’outils et de méthodologies innovantes permettant la caractérisation de la paroi artérielle coronarienne. Ce développement est nécessaire pour aider au diagnostic des maladies cardiovasculaires. L’approche mécanique a été utilisée pour mettre en place des méthodes de résolution inverse restituant des informations clés sur les propriétés mécaniques des tissus. La résolution du problème inverse en mécanique utilise entre autres des champs de déformation dont l’estimation est réalisée à l’aide d’algorithmes d’élastographie de déformation. Deux outils de caractérisation ont été étudiés : l’un visant à faciliter la détection par une palpation virtuelle et l’autre l’identification par la reconstruction de cartographies locales du module de Young. Ces outils de palpographie et de modulographie peuvent faciliter la caractérisation in vivo des plaques d’athérosclérose. Les contributions apportées portent successivement sur l’élastographie, la palpographie et la modulographie.Nous avons tout d’abord amélioré l’outil de modulographie iMOD (application existante de reconstruction du module de Young) en l’adaptant aux nouvelles contraintes liées aux modalités IVUS dites de haute définition (HD-IVUS). Les performances de ce nouvel outil perfectionné nommé E-iMOD (Extended iMOD) ont été évaluées en l’appliquant sur des données d’élastographie simulées.Ensuite, nous avons développé une nouvelle version de l’algorithme d’élastographie de déformation. En effet, l’estimation des déformations est un point critique conditionnant la bonne résolution du problème inverse en mécanique. Il a été montré que les améliorations introduites permettent l’amélioration des estimations sur des données simulées et sur des données expérimentales de fantôme.Dans un troisième temps, une analyse de l’apport de la technologie HD-IVUS vis-à-vis de l’imagerie IVUS actuelle a été menée sur données simulées et expérimentales. Elle a montré que les résultats peuvent être prometteurs mais que des efforts de développement sur l’élastographie sont encore nécessaires afin d’exploiter pleinement les avancées techniques de la HD.Une dernière partie traite de l’outil de palpographie relatif à la détection des lésions. Tout d’abord, ce volet est l’occasion de mettre en œuvre une phase expérimentale sur des acquisitions d’artères animales. Le traitement de ces données participe à une phase de validation d’une technique de palpographie développée dans l’équipe. Dans un second volet, une revue de littérature de différentes techniques de palpographie nous permet de mettre en avant les points forts et les faiblesses de ces techniques sur des données simulées. Nous introduisons également un nouvel indice de palpation adapté aux milieux anisotropes. Enfin, une méthode théorique originale repensant les résultats de la palpographie a été proposée. Cette approche permet le calcul d’un premier modulogramme pouvant améliorer le pré-conditionnement des processus d’optimisation de type E-iMOD / This work focuses on the development of innovative tools and methodologies for coronary artery wall characterization. These tools are required to support the diagnosis of cardiovascular disease. A mechanical approach was used to implement inverse resolution methods that provide key data about the mechanical properties of tissues. Resolution of inverse problems in mechanics uses strain fields, which are computed thanks to elastography algorithms. Two main characterization tools were used: one aimed to allow lesions detection by applying a virtual palpation technique and the other aimed to identify a reconstructed distribution of the Young's modulus. Palpography and Modulography tools can facilitate in vivo atherosclerotic plaques characterization. The current dissertation brings contribution in the elastography, palpography and modulography fields.We started by improving the iMOD Modulography tool (previously developed application to compute the Young's modulus map). We adapted iMOD to the new constraints related to high definition IVUS modality (HD-IVUS). This new advanced tool was named E-iMOD (Extended iMOD) and its performances were was evaluated with simulated elastography data.In next step, we developed a new version of the strain elastography algorithm. Indeed, strains estimations are critical to solve of the inverse problem in mechanics. It was shown that the introduced enhancements improved estimation for both vessel simulations and phantom experimental data.In a third stage, an analysis was lead to access the contribution of HD-IVUS technology to current IVUS imaging on simulated and experimental data. Even though hopeful results were showed, further efforts in the elastography algorithm are required in order to fully exploit the HD improvements.The last part of this work deals with the palpography tool that allows the detection of lesions. First, experimental ultrasound acquisitions from animal arteries were processed. These data were involved in a validation prototcol of palpography technique developed in our team. In a second part, a review of several palpography techniques allowed us to highlight their strengths and weaknesses on simulated data. A new palpation index adapted to anisotropic material was also introduced. Finally, an original theoretical method rethinking the results of palpography was proposed. This approach computes a first modulogram to improve the prior preconditioning of optimization processes, such as the optimization process of E-iMOD

A prevalência de sobrepeso e obesidade entre crianças e adolescentes tem aumentado em países em desenvolvimento e desenvolvidos, ocasionando um sério problema de saúde pública. A obesidade na adolescência pode alterar o perfil lipídico, principalmente quando acompanhada de uma baixa aptidão cardiorrespiratória. A obesidade, bem como as dislipidemias são considerados importantes fatores de risco para a doença arterial coronariana. O presente estudo teve como objetivo avaliar a correlação entre o perfil lipídico, bem como outros marcadores de risco para doença arterial coronariana, e a aptidão cardiorrespiratória de crianças e adolescentes obesos, de ambos os gêneros. Um total de 63 crianças e adolescentes obesos, entre 11 e 17 anos, foi incluído em um estudo transversal, realizado na cidade de Porto Alegre. Foi utilizado o pacote estatístico SPSS, versão 10.0 para Windows. Foram aplicados o teste t para amostras independentes e o teste de Mann-Whitney para identificar diferenças entre gêneros e estágio maturacional quando a distribuição apresentava-se normal e não-normal, respectivamente. Utilizou-se a correlação de Pearson ou Spearman para dados paramétricos e não-paramétricos, respectivamente. Não encontramos correlação significativa entre o pic2 o V& O e os marcadores de risco para doença coronariana TG, CT, HDL-C, LDL-C, ApoA1, ApoB, Não-HDL-C, CT/HDL, LDL-C/HDL-C, insulina, glicose, índice HOMA-IR e PCRus. Do total de crianças e adolescentes avaliados, somente um indivíduo, do gênero masculino, não apresentava nenhum parâmetro metabólico alterado. Encontramos uma prevalência precoce importante de indivíduos com hipercolesterolemia (15,0%); hipertrigliceridemia (23,3%); hiperglicemia (35,6%); hiperinsulinemia (40,4%); valores altos de LDL-C (16,7%), PCRus (38,3%) e Não-HDL-C (26,7%); e valores baixos de HDL-C (21,7%) e do VO2pico (93,5% da meninas e 100% dos meninos). Concluindo, apesar de não encontrarmos correlação significativa entre o perfil lipídico e a aptidão cardiorrespiratória de crianças e adolescentes obesos neste estudo, uma prevalência alta de dislipidemias e outros marcadores de risco coronariano alterados foram encontrados. / The prevalence of overweight children and adolescents has been increasing in both developed and developing countries, creating a serious public health problem. Obesity in adolescence can alter the lipid profile mainly when accompanied by a low cardiorespiratory fitness. Obesity and dislipidemy are well-established risk factors for the coronary artery disease. The aim of the present study was to evaluate the correlation among the lipid profile, as well as other risk markers for the coronary artery disease, and the cardiorespiratory fitness of obese children and adolescents of both genders. A total of 63 children and adolescents between 11 and 17 years old were included in this cross-sectional study, developed in the city of Porto Alegre. Statistical analysis was performed by the software SPSS, version 10.0 for Windows. The T-test for independent samples and the Mann-Whitney test were applied to identify differences among gender and pubertal stage when the distribution was normal and abnormal, respectively. The Pearson’s or the Spearman’s correlation was used for parametric and nonparametric data, respectively. We did not find significant correlation between pea2 k V& O and the risk markers for the coronary disease TG, TC, HDL-C, LDL-C, non-HDL-C, TC/HDL, insulin, glucose, HOMA-IR values, and PCRus. Among all individuals evaluated, only one person – a male – did not show any altered metabolic parameter. We found an important precocious prevalence of individuals with hypercholesterolemia (15%); hypertriglyceridemia (23.3%); borderline hyperglycemia (35.6%); hyperinsulinemia (40.4%); high values of LDLC (16.7%), PCRus (38.3%), non-HDL-C (26.7%); and low values of HDL-C (21.7%) and 2 peak V& O (93.5% of the girls and 100% of the boys). In conclusion, although we did not find any significant correlation between lipid profile and cardiorespiratory fitness in obese children of both genders in this study, a high prevalence of undesirable lipid levels and other altered coronary risk markers were found.

A prevalência de sobrepeso e obesidade entre crianças e adolescentes tem aumentado em países em desenvolvimento e desenvolvidos, ocasionando um sério problema de saúde pública. A obesidade na adolescência pode alterar o perfil lipídico, principalmente quando acompanhada de uma baixa aptidão cardiorrespiratória. A obesidade, bem como as dislipidemias são considerados importantes fatores de risco para a doença arterial coronariana. O presente estudo teve como objetivo avaliar a correlação entre o perfil lipídico, bem como outros marcadores de risco para doença arterial coronariana, e a aptidão cardiorrespiratória de crianças e adolescentes obesos, de ambos os gêneros. Um total de 63 crianças e adolescentes obesos, entre 11 e 17 anos, foi incluído em um estudo transversal, realizado na cidade de Porto Alegre. Foi utilizado o pacote estatístico SPSS, versão 10.0 para Windows. Foram aplicados o teste t para amostras independentes e o teste de Mann-Whitney para identificar diferenças entre gêneros e estágio maturacional quando a distribuição apresentava-se normal e não-normal, respectivamente. Utilizou-se a correlação de Pearson ou Spearman para dados paramétricos e não-paramétricos, respectivamente. Não encontramos correlação significativa entre o pic2 o V& O e os marcadores de risco para doença coronariana TG, CT, HDL-C, LDL-C, ApoA1, ApoB, Não-HDL-C, CT/HDL, LDL-C/HDL-C, insulina, glicose, índice HOMA-IR e PCRus. Do total de crianças e adolescentes avaliados, somente um indivíduo, do gênero masculino, não apresentava nenhum parâmetro metabólico alterado. Encontramos uma prevalência precoce importante de indivíduos com hipercolesterolemia (15,0%); hipertrigliceridemia (23,3%); hiperglicemia (35,6%); hiperinsulinemia (40,4%); valores altos de LDL-C (16,7%), PCRus (38,3%) e Não-HDL-C (26,7%); e valores baixos de HDL-C (21,7%) e do VO2pico (93,5% da meninas e 100% dos meninos). Concluindo, apesar de não encontrarmos correlação significativa entre o perfil lipídico e a aptidão cardiorrespiratória de crianças e adolescentes obesos neste estudo, uma prevalência alta de dislipidemias e outros marcadores de risco coronariano alterados foram encontrados. / The prevalence of overweight children and adolescents has been increasing in both developed and developing countries, creating a serious public health problem. Obesity in adolescence can alter the lipid profile mainly when accompanied by a low cardiorespiratory fitness. Obesity and dislipidemy are well-established risk factors for the coronary artery disease. The aim of the present study was to evaluate the correlation among the lipid profile, as well as other risk markers for the coronary artery disease, and the cardiorespiratory fitness of obese children and adolescents of both genders. A total of 63 children and adolescents between 11 and 17 years old were included in this cross-sectional study, developed in the city of Porto Alegre. Statistical analysis was performed by the software SPSS, version 10.0 for Windows. The T-test for independent samples and the Mann-Whitney test were applied to identify differences among gender and pubertal stage when the distribution was normal and abnormal, respectively. The Pearson’s or the Spearman’s correlation was used for parametric and nonparametric data, respectively. We did not find significant correlation between pea2 k V& O and the risk markers for the coronary disease TG, TC, HDL-C, LDL-C, non-HDL-C, TC/HDL, insulin, glucose, HOMA-IR values, and PCRus. Among all individuals evaluated, only one person – a male – did not show any altered metabolic parameter. We found an important precocious prevalence of individuals with hypercholesterolemia (15%); hypertriglyceridemia (23.3%); borderline hyperglycemia (35.6%); hyperinsulinemia (40.4%); high values of LDLC (16.7%), PCRus (38.3%), non-HDL-C (26.7%); and low values of HDL-C (21.7%) and 2 peak V& O (93.5% of the girls and 100% of the boys). In conclusion, although we did not find any significant correlation between lipid profile and cardiorespiratory fitness in obese children of both genders in this study, a high prevalence of undesirable lipid levels and other altered coronary risk markers were found.

O diabetes melito (DM) é um fator de risco independente para doença arterial coronariana, acidente vascular cerebral, doença vascular periférica e insuficiência cardíaca, que são as principais causas de morte nesses pacientes. Além disso, pacientes com DM e doença cardiovascular têm pior prognóstico, por apresentarem menor sobrevida, maior risco de recorrência da doença e pior resposta aos tratamentos propostos. Os avanços diagnósticos e terapêuticos das últimas décadas já mostram uma redução do risco de eventos cardiovasculares nesses pacientes, mas o risco absoluto dos mesmos é ainda duas vezes maior em relação ao dos pacientes não diabéticos. Portanto, é prioritária a adoção de um manejo intensivo, com controle rígido dos fatores de risco cardiovasculares. Esta revisão trata das principais características clínicas e apresenta uma abordagem prática do rastreamento, diagnóstico e tratamento da doença macrovascular nos pacientes com DM. / Diabetes mellitus (DM) is an independent risk factor for coronary heart disease, stroke, peripheral arterial disease and heart failure, which are the main causes of death in these patients. Moreover, patients with DM and cardiovascular disease have a worse prognosis than nondiabetics, present lower short-term survival, higher risk of recurrence of the disease and a worse response to the treatments proposed. In the last decades, diagnostic and therapeutic progress had already shown benefits concerning cardiovascular risk reduction in these patients, but their absolute mortality risk is still twice that of non-diabetic patients. Because of this, the adoption of intensive treatment, with strict cardiovascular risk factor control, is a priority. The present study presents the main clinical characteristics and also the practical approach for screening, diagnosis and treatment of patients with diabetic macrovascular disease.