Indicador antropométrico para risco cardiovascular e calcificação de artérias coronárias : uma revisão de escopo

Orientador: Prof. Dr. Emilton Lima JuniorCoorientador: Prof(a). Dr(a). Claudia ChomaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde. Defesa : Curitiba, 20/02/2020Inclui referências: p. 45-55Resumo: Introdução: As doenças cardiovasculares são a principal causa de mortalidade e incapacidade em todo o mundo. Sendo assim, a identificação de indivíduos assintomáticos com maior risco de desenvolver eventos cardiovasculares futuros é fundamental. O exame de imagem para CAC é considerada o padrão ouro para identificar risco cardiovascular. Por ser um método de alto custo é necessário desenvolver estratégias validadas para identificar adequadamente esses pacientes de forma rápida, objetiva e acessível. Esses fatores tornam interessante a investigação do uso da antropometria como método de avaliação de risco de doença cardiovascular. Objetivo: compreender e descrever de forma abrangente os indicadores antropométricos utilizados em estudos que abordam sua associação com a calcificação arterial coronariana (CAC) para identificar o risco cardiovascular na população adulta. Métodos: Utilizando a metodologia de revisão de escopo de Arksey e O'Malley como guia, a revisão de escopo iniciou com a pesquisa em bancos de dados (Cadastro Central Cochrane de Ensaios Controlados (CENTRAL) na Biblioteca Cochrane, Medline Completa (EbscoHost), Embase (Ovídio SP), LILACS (BIREME), Web of Science, Scopus e SciELO. Além disso, foi pesquisado na Plataforma Internacional do Registro de Ensaios Clínicos da Organização Mundial da Saúde (www.who.int/ictrp); ClinicalTrials.gov; Transforming Research into Practice (TRIP). Foram estabelecidas estratégias de busca e dois revisores selecionaram independentemente as pesquisas elegíveis para a seleção final do estudo. Os dados foram coletados e analisados por meio de uma ferramenta desenvolvida pela equipe de pesquisa. Para avaliar a qualidade dos estudos incluídos, foi utilizado 11 indicadores. Foi realizado um resumo narrativo que descreve como os resultados se relacionam com o objetivo e a pergunta da revisão. Resultados: A amostra compreendeu 21 artigos, publicados entre os anos de 2004 e 2019, a maior parte dos estudos foi publicado nos Estados Unidos (n=10), seguido pela Coréia (n=5). Cerca de 81% das investigações (n=15) teve como parte do estudo a aplicação do índice de massa corporal (IMC), seguido pelo perímetro de cintura (PC) (n=13; 62%) e a relação cintura-quadril (RCQ) (n=8; 38%). Os demais métodos de avaliação antropométrica encontraram-se em menor frequência, sendo totalizados 15 métodos diferentes. Discussão: Existem dados conflitantes sobre a associação potencial entre IMC e medidas de CAC, devido a sua incapacidade de quantificar com precisão a adiposidade visceral e subcutânea em pacientes com aumento de peso corporal. A PC mostrou-se efetiva na identificação de RC, pois é uma medida indireta de concentração de gordura visceral e isso, por sua vez, está associado com resistência à insulina e compensatório hiperinsulinemia, que contribui para a progressão da aterosclerose. RQC apresentou resultados similares a PC. Conclusão: Em conclusão, a medida do perímetro da cintura e a razão cintura/quadril são bons parâmetro para a avaliação de obesidade abdominal, podendo ser um dado clínico adicional para a identificação de situações clínicas que representem risco cardiovascular aumentado. A RCQ e a PC são preditores independentes para uma série de distúrbios metabólicos, porém essa pesquisa recomenda a utilização dessas medidas seja combinada ao índice de massa corporal (IMC), para potencializar a capacidade preditiva de complicações cardiovasculares. Palavras-chave: 1.Antropometria; 2.Calcificação arterial coronariana; 3. Risco cardiovascular.Abstract: Introduction: Cardiovascular diseases are the leading cause of mortality and disability worldwide. Therefore, the identification of asymptomatic individuals with a higher risk of developing future cardiovascular events is important. Imaging for CAC is considered the gold standard for identifying cardiovascular risk. As it is a high-cost method, it is necessary to develop validated strategies to properly identify these patients in a fast, objective and accessible way. These factors make it interesting to investigate the use of anthropometry as a method of assessing the risk of cardiovascular disease. Objective: to comprehensively understand and describe the anthropometric indicators used in studies that address their association with coronary artery calcification (CAC) to identify cardiovascular risk (CVR) in the adult population. Methods: Using Arksey and O'Malley's scope review methodology as a guide, the scope review started with database research (Cochrane Central Registry of Controlled Trials (CENTRAL) at the Cochrane Library, Medline Complete (EbscoHost), Embase (Ovídio SP), LILACS (BIREME), Web of Science, Scopus and SciELO In addition, it was researched on the World Health Organization International Clinical Trials Registration Platform (www.who.int/ictrp); ClinicalTrials.gov ; Transforming Research into Practice (TRIP). Search strategies were established and two reviewers independently selected the studies eligible for the final selection of the study. Data were collected and analyzed using a tool developed by the research team. of the included studies, 11 indicators were used, and a narrative summary was made describing how the results relate to the objective and the question of the review. Results: The sample included 21 articles, published between 2004 and 2019, most studies were published in the United States (n = 10), followed by Korea (n = 5). About 81% of the investigations (n= 15) had as part of the study the application of the body mass index (BMI), followed by the waist circumference (WC) (n = 13; 62%) and the waist-hip ratio ( WHR) (n = 8; 38%). The other methods of anthropometric assessment were less frequent, with a total of 15 different methods. Discussion: There are conflicting data on the potential association between BMI and CAC measures, due to their inability to accurately quantify visceral and subcutaneous adiposity in patients with increased body weight. WC has been shown to be effective in identifying cardiovascular risk, as it is an indirect measure of visceral fat concentration and this, in turn, is associated with insulin resistance and compensatory hyperinsulinemia, which contributes to the progression of atherosclerosis. RQC presented results similar to WC. Conclusion: In conclusion, the measurement of waist circumference and waist / hip ratio are good parameters for the evaluation of abdominal obesity, which can be an additional clinical data for the identification of clinical situations that represent increased cardiovascular risk. WHR and WC are independent predictors for a series of metabolic disorders, however this research recommends the use of these measures to be combined with the body mass index, to enhance the predictive capacity of cardiovascular complications. Keywords: 1.Anthropometry; 2.Coronary artery calcification; 3.cardiovascular risk

Cryptic diversity between two imparfinis species (siluriformes, heptapteridae) by cytogenetic analysis and DNA barcoding

Five Imparfinis mirini and one Imparfinis minutus populations were studied using basic cytogenetic and molecular techniques. Cytogenetic analysis showed that I. mirini individuals presented the same diploid number 2n=58 (FN=116). However, they presented two distinct karyomorphs: karyomorph A (36m+18sm+4st) for the Mogi-Guaçu and Paranapanema basin populations, and karyomorph B (42m+12sm+4st) for the Tietê basin populations. I. minutus populations from the Paraíba do Sul basin presented a karyotype identical to karyomorph A of I. mirini. C-banding also presented distinct patterns, with a greater amount of heterochromatin, most of which was pericentromeric and interstitial for karyomorph A I. mirini and I. minutus. There was a minor amount of heterochromatin in karyomorph B, most of which was terminal and interstitial. Simple and interstitial nucleoli organizer regions were located in the biggest metacentric pair of the complement in all populations with GC-rich nature, and this location was confirmed by the fluorescent in situ hybridization technique with 18S ribosomal DNA with 5S rDNA synteny. In molecular analysis by DNA barcoding, two other populations from the Tietê basin were added. The phylogram showed that the populations were more related to the intrabasin. Cytogenetic resemblance among specimens from distinct basins may be the result of either recent convergence or ancestral feature retention not followed by mutations in mitochondrial DNA. © 2014, Mary Ann Liebert, Inc

Studies in two allopatric populations of Hypostomus affinis (Steindachner, 1877): the role of mapping the ribosomal genes to understand the chromosome evolution of the group

Several cytogenetic markers show chromosomal diversity in the fish such as "armoured catfish". Although studies have characterized many species in the major genera representing these Siluridae, particularly in the genus Hypostomus Lacépède, 1803, trends in chromosome evolution of this group remain unclear. The Paraíba do Sul river basin contains the armoured catfish Hypostomus affinis Steindachner, 1877, which is unique because of its distribution of repetitive DNAs, the 5S and 18S rDNA. Identified samples and registered collections in Brazilian museums were identified as the same typological species, while we observed wide variations in the physical location of this gene in the karyotype based on fluorescent in situ hybridization results. In this study, we propose that these species can represent evolutionarily independent units, as these fish frequently undergo processes such as dispersion and vicariance and that the rDNA is associated with DNA that spreads in the genome, such as transposons. Additionally, the absence of gene flow due to the distance of the sample location could intensify evolutionary processes. The phenotypes found for the 18S rDNA showed minor changes in relation to the number of sites between the lower and upper drainage regions of Paraíba do Sul. The large difference in the number of sites found for the 5S rDNA entered the same region (upper drainage of the basin) and the literature data could represent a population dynamics where an expansion of the 5S rDNA sites provides an extinct or non-sampled cytotype in this work

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author