Circunfer?ncia do pesco?o e risco cardiovascular em 10 anos : diferen?as por sexo. an?lise seccional da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSA-Brasil).
Programa de P?s-Gradua??o em Sa?de e Nutri??o. Escola de Nutri??o, Universidade Federal de Ouro Preto.INTRODU??O: A circunfer?ncia do pesco?o (CP) ? uma estimativa da gordura do pesco?o e da gordura subcut?nea da parte superior do corpo, cujo aumento parece conferir risco cardiovascular adicional ?quele conferido pela adiposidade geral e abdominal. O Framingham Global Risk Score (FGRS) fornece uma estimativa do risco de desenvolver DCV em 10 anos, utilizado para identificar indiv?duos sob maior risco de DCV, inclusive na pr?tica cl?nica. OBJETIVO: O objetivo da presente disserta??o foi verificar a associa??o entre a circunfer?ncia do pesco?o e o risco de evento cardiovascular em 10 anos em homens e mulheres participantes da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSA-Brasil). M?TODOS: Trata-se de estudo de corte transversal com participantes da linha de base do Estudo Longitudinal de Sa?de do Adulto (ELSABrasil) (2008-2010). O ELSA-Brasil ? uma coorte multic?ntrica com 15.105 servidores p?blicos, ativos e aposentados de institui??es de ensino e pesquisa de seis capitais de estados brasileiros. Para a presente an?lise, foram exclu?dos os indiv?duos com relato de DCV (n=738) e sem informa??es para DCV (n=26), CP (n=11), FGRS (n=28) e covari?veis (n=382), permanecendo 13.920 participantes. As caracter?sticas da popula??o do estudo e dos componentes do FGRS foram descritas por meio de frequ?ncias absolutas e relativas, m?dias e desvio padr?o (?DP) ou medianas (1? e 3? quartis) e utilizados testes compara??o dessas medidas. A associa??o entre a CP (utilizada como vari?vel cont?nua e agrupda em quartis) e o risco DCV em 10 anos, mensurado pelo FGRS, foi estimada por meio de Modelos Lineares Generalizados (MLG), com distribui??o gama e fun??o logar?tmica, cujo exponencial do coeficiente de regress?o fornece a Raz?o da M?dias Aritm?ticas com intervalo de 95% de confian?a (RMA, IC95%). Foram realizados ajustes por idade, escolaridade, ra?a/cor autorreferida, consumo de ?lcool, atividade f?sica no lazer, ?ndice de massa corporal (IMC) e circunfer?ncia da cintura (CC). RESULTADOS: A m?dia de idade dos participantes foi de 51,7 anos (DP?7,6), sendo 55% mulheres. A m?dia da CP aumentou com o incremento do risco de DCV em 10 anos agrupado em categorias de risco (risco baixo 20%) em ambos os sexos. Ap?s todos os ajustes, incluindo as demais medidas de adiposidade corporal, a CP permaneceu independentemente associada a um aumento de 3% na m?dia aritm?tica do risco DCV em 10 anos (RMA= 1,03; IC 95% 1,01-1,03) nos homens e de 5% (RMA= 1,05; IC 95% 1,04-1,06) nas mulheres. Nos modelos de regress?o utilizando a CP agrupada em quartis, ap?s todos os ajustes, observamos que comparados ao primeiro quartil todos os demais apresentaram aumento gradual na m?dia aritm?tica no risco de DCV em 10 anos, que chegou a um incremento de 18% entre os que estavam no ?ltimo quartil (IC95%: 1,13-1,24) entre os homens e a 35% (IC95%: 1,28-1,43) entre as mulheres. Foram realizadas an?lises de sensibilidade com a exclus?o de participantes em uso de hipolipemiantes, uso de corticoides, e de mulheres em uso de anticoncepcional ou em reposi??o hormonal e essas exclus?es n?o levaram a altera??o nos resultados observados. CONCLUS?O: Nossos resultados sugerem uma associa??o entre a circunfer?ncia do pesco?o e o risco DCV em 10 anos, mensurado pelo Framingham Global Risk Score em ambos os sexos, mas indicando maior for?a de associa??o entre as mulheres. Contudo, novos estudos em outras popula??es e an?lises longitudinais s?o necess?rios.INTRODUCTION: The effect of adipose tissue on the development of CVD varies between different fat deposits. Neck Circumference (NC) provides an estimate of neck fat and upper body subcutaneous fat that has been singled out as the sole body fat deposit that confers additional cardiovascular risk above and beyond general and central body fat. OBJECTIVE: The objective of this dissertation was to verify the association between neck circumference and cardiovascular risk in 10 years in men and women participants from the baseline of the Longitudinal Study of Adult Health (ELSA-Brazil). METHODS: A cross-sectional study was conducted with participants from the Study of the Longitudinal Study of Adult Health (ELSA-Brazil) baseline (2008-2010). ELSABrazil is a multicentre cohort composed of 15,105 civil serventes from institution of education and research institutions in six Brazilian state capitals. For the present analysis, individuals with a history of CVD (acute myocardial infarction, heart failure, stroke and coronary artery bypass grafting) (n = 738), missing information for CVD (n = 26), for NC = 11), for the Framingham Global Risk Score (n = 28) and for covariables (n = 382) were excluded. At the end the sample analytic was composed by 13,920 participants.The characteristics of the study population and the FGRS components were described by means of absolute and relative frequencies (categorical variables) and means and standard deviation (? SD) or medians (1st and 3rd quartiles) (continuous variables). Pearson's Chisquare test was used for comparison of frequencies, Student's t-test for comparison of means and Kruskal-Wallis test for comparison of medians. The association between NC (continous variable and agrouped in quartiles) and the10-years CDV risk, measured by the FGRS, was estimated using Generalized Linear Models (MLG), with gamma distribution and logarithmic function, whose exponential regression coefficient gives the Arithmetic Mean Ratio with 95% confidence interval (RMA, 95% CI). Potential confounding factors were age, schooling, self-reported race / color, alcohol consumption, leisure time physical activity, body mass index (BMI) and waist circumference (WC). RESULTS: The mean age of participants was 51.7 years (SD ? 7.6), being 55% female. The mean NC increased according to risk categories of the 10-year CVD risk (low risk 20%) in both sexes. In the crude analysis, it was observed that the increase of one centimeter in NC was associated with an increase of 5% (RMA = 1.05, 95% CI: 1.04-1.05) in the mean 10-year CVD risk in men and 11% (RMA = 1.11, 95% CI: 1.10-1.12) in women. After all the adjustments, including the other measures of body adiposity, NC remained independently associated with a 3% increase in the arithmetic mean of CVD risk in 10 years (RMA = 1.03, 95% CI, 1.01- 1.03) in men and 5% (RMA = 1.05, 95% CI 1.04-1.06) in women. In the regression models using NC grouped in quartiles, after all the adjustments, we observed that, compared to the first quartile, all the others presented a gradual increase in the arithmetic mean in the risk of the 10-years CVD risk, which reached an increase of 18% in men who were in the last quartile (95% CI: 1.13-1.24) and 35% (95% CI: 1.28-1.43) in women. Sensitivity analyzes were performed with the exclusion of participants taking lipidlowering drugs, corticosteroids, and women taking contraceptives or hormone replacement, and these exclusions did not lead to alteration in the observed results. CONCLUSION: Our results suggest an association between NC and 10-years CVD risk as measured by the Framingham Global Risk Score in both sexes, but indicating a greater strength of association among women
