Effect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study

Background and aimsTo elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events.MethodsThe analysis included 14,983 males and females aged 45–75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software.ResultsAfter adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively.ConclusionAmong males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.     

Impacto da Concentração de Ácido Úrico Sérico no Risco de Doença Cardiovascular: Um Estudo Coorte Realizado no Norte da China

BackgroundThe results of previous studies of the relationship between serum uric acid (SUA) and the risk of cardiovascular disease (CVD) have been inconsistent due to confounding factors caused by other known cardiovascular risk factors.ObjectivesThis study aimed to evaluate the relationship between SUA and incident CVD in middle-aged and elderly Chinese people, who were stratified according to body mass index (BMI).MethodsThis study recruited 5,721 participants of 40–75 years of age, who were free of CVD at baseline and who underwent follow-up from 2008 to 2017. Participants were categorized in SUA quintiles. Cox proportional hazard and Kaplan-Meier survival analysis were used to compare CVD incidence among the SUA groups. The correlations between SUA and CVD incidence in groups with differing BMI and waist circumference (WC) were also analyzed. A P value <0.05 was considered statistically significant.ResultsDuring a mean follow-up period of 7.6 years, CVD incidence increased with SUA (log-rank test p<0. 001). Compared with the first quintile, the adjusted hazard ratios (95% confidence interval (CI)) for the development of CVD were 1.08 (0.78–1.65), 1.17 (0.88–1.77), 1.47 (1.12–2.21), and 1.68 (1.28–2.44) for the second to fifth quintiles, respectively. This relationship was clearer in participants with normal BMI and WC. The adjusted hazard ratio for each 100 μmol/L increase in SUA was 1.13 (95% CI: 1.02–1.39) for CVD events.ConclusionsHigh SUA is an independent risk factor for CVD in middle-aged and elderly northern Chinese people. This effect is maintained even after stratification according to measures of leanness/obesity.     

评估肥胖的四种指标与缺血性心脑血管病的关系

目的评价肥胖的4种指标与缺血性心脑血管病(ICCVD)风险关系。方法从国家卒中防治工程委员会2014年度对我国31省整群抽样建立的"脑卒中筛查和干预项目"数据库中,筛选年龄≥60岁的老年人111 472例,以是否发生ICCVD分为病例组17 420例和对照组94 052例,记录入选者体质量指数(BMI),腰围(WC),腰臀比(WHR),腰围身高比(WHtR)等,用BMI、WC、WHR、WHtR的现有标准评价肥胖,并比较4种指标评价肥胖与ICCVD风险关系,用非条件logistic回归模型和ROC曲线评价4种指标对中、高危ICCVD的风险效果。结果病例组BMI、WC、WHR、WHtR高于对照组(P<0.05)。在全因素校正logistic模型中,男女性超出正常体质量(18.50 kg/m^2≤BMI<24.00 kg/m^2)时,ICCVD风险增加,但仅女性相关显著(P趋势<0.01);男性肥胖(WC≥85.00 cm、WHR≥0.90、WHtR≥0.50),女性肥胖(WC≥80.00 cm、WHR≥0.85、WHtR≥0.50)时,ICCVD风险增高(P<0.01)。男性WC≥89.00 cm、WHtR≥0.515,女性WC≥84.00 cm、WHtR≥0.535时,与ICCVD风险呈正相关(OR>1.0,P<0.05),趋势效应优于BMI、WHR。ROC曲线分析显示,WHtR预测中、高ICCVD风险时,男性和女性ROC曲线下面积分别为[0.629(95%CI:0.623~0.634)、0.637(95%CI:0.632~0.640)],且均优于另外3种指标。结论 WC和WHtR对老年人群中、高危ICCVD风险均具有较好的预测效果,其中WHtR更具优越性。     

A comparison of body mass index and waist-to-hip ratio as indicators of hypertension risk in an urban Argentine population: a hospital-based study

BACKGROUND AND AIM: To examine the relationship between 24-h ambulatory blood pressure monitoring (ABPM) and three commonest anthropometric measurements for obesity [body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)] in patients with essential hypertension never treated or after a 3 week placebo period, living in Buenos Aires. METHODS AND RESULTS: Cross-sectional survey among outpatients at the Hypertension Program of Buenos Aires University Hospital de Clinicas. Three-hundred seventy-seven essential hypertensives, aged 18-86 years, of either sex, were consecutively recruited. All subjects underwent 24 h ABPM performed with a blood pressure (BP) device. The prevalence of overweight-obesity was 56.76% in women and 75.86% in men. High WHR prevalence in non-obese women was 4.5% and 4.1% in non-obese men while high values of WC were observed in 3.0% of non-obese women and in 0% of non-obese men. The two-way ANCOVA showed that in women with high values of WHR, 24 h DBP was higher in those with BMI<25 than in those with BMI> or =25. Those females with a BMI> or =25 had a higher prevalence of top tertile values of PP (> or =68 mmHg) (P<0.05) than non-obese females. Only in women was mean pulse pressure (PP) significantly correlated with age (r=0.38; P<0.0001), WC (r=0.22; P<0.005), WHR (r=0.21, P<0.008), and BMI (r=0.20; P<0.01) while in men there was no significant correlation between variables. Logistic regression showed that the odds of morning blood pressure surge (MBPS) increased with age, central obesity (represented by high WHR and dipper status), while the odds of higher mean PP increased with age and high WHR. CONCLUSION: These results indicated a high prevalence of overweight-obesity (more than 56% of women and 75% of men) in our hospital-based sample of essential hypertension and that the WHR offers additional information beyond BMI and WC to predict the hypertension risk according to the ABPM.     

Obesity measures at baseline,their trajectories over time,and the incidence of chronic kidney disease: A 14 year cohort study among Korean adults

Background and aimsWe investigated the association of baseline obesity measures, i.e. body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR), and their trajectories over time with incident chronic kidney disease (CKD).Methods and resultsUtilizing data from 2001 to 2014 for 9796 Korean adults without CKD at baseline, the association of baseline obesity measures with incident CKD was evaluated using logistic regression. Further, among 5605 subjects with repeated measures, the effect of the trajectories in obesity measures on CKD incidence was investigated via Cox regression.Baseline obesity in terms of BMI, WC, and HC increased the odds of incident CKD (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05–1.33; OR 1.22, 95% CI 1.07–1.38; and OR 1.25, 95% CI 1.11–1.41, respectively), while baseline WHR did not show such an association. A “became non-obese” BMI, WC, or WHR trajectory, and a “constantly not large” HC trajectory decreased the hazard of incident CKD (hazard ratio (HR) 0.70, 95% CI 0.50–0.99; HR 0.61, 95% CI 0.40–0.92; HR 0.55, 95% CI 0.35–0.85; and HR 0.81, 95% CI 0.69–0.95, respectively) when compared with a “constantly obese or became obese” trajectory.ConclusionBoth baseline obesity and obesity trajectories over time were associated with CKD incidence. BMI and WC were equally good measures of CKD risk, while WHR was not. Separately examining WC and HC components of WHR (= WC/HC) may explain WHR's inconsistency, and WHR's usefulness as a measure of CKD risk should be reevaluated.     

Correlação entre a Circunferência de Cintura e Medidas Centrais da Pressão Arterial

Background:Arterial stiffness is a strong predictor of cardiovascular disease (CVD). Body fat measures such as waist circumference (WC) have been associated with CVD in adulthood.Objectives:The objective of this study was to evaluate the association of arterial stiffness, measured by applanation tonometry-Sphygmocor, with WC.Methods:Observational study with 240 participants who make routine consultations at the outpatient clinic of a university hospital. Participants were interviewed and had central blood pressure measurements (CBPM), anthropometric parameters, abdominal fat and visceral fat measured. Paired and unpaired t and chi-square tests were used. A significance level of 5% was adopted.Results:Of the 240 participants, 51.82% were male with a mean age of 59.71(±14.81) years and a mean WC of 99.87 (11.54) cm. Mean CBPM values were: Central arterial pressure (CAP) = 130.23 (91-223) mmHg, pulse wave velocity (PWV) = 9.8 (5.28-19.6)m/s and Augmentation Index [Amplification Index (AI)] = 29.45 (-14-60). PWV and CAP were highly correlated with WC with p<0.001 and p=0.02, respectively; however, the same positive correlation was not found between WC and AI (p=0.06).Conclusion:The present study showed a positive association between WC and arterial stiffness, through the femoral carotid pulse wave velocity (cf-PWV) and AI, being stronger with cf-PWV, suggesting the evaluation of the effect of WC in vascular health as a method of aid in the early treatment of CVD and in the prevention of clinical outcomes.     

Comparison of different obesity indices related with hypertension among different sex and age groups in China

Background and aimsTo compare the relationships of five obesity-related routine anthropometric indicators (body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR)) for hypertension in both sexes and among different age groups of the Chinese population.Methods and resultsA total of 12,064 adult participants (5638 males and 6426 females) were included. Odds ratios (OR) and 95% confidence intervals were used with binary logistic regression models to estimate the risk of hypertension for each obesity index. For the males, WHtR had the highest OR value in all age groups. The degrees of correlation between hypertension and the obesity indices for different age groups were different among the females. WC, BMI, and WHtR were the highest in the 18–44, 45–59, and ≥60 years age groups, respectively. Furthermore, we compared the area under the ROC curve (AUC) of each obesity index for the criterion of hypertension under the influence of risk factors. For the males, the AUC of WHtR was the largest (0.814, 0.710, and 0.662). WC (AUC = 0.820), BMI (AUC = 0.765), and WHtR (AUC = 0.668) tended to be the best criteria for hypertension among females in the 18–44, 45–59, and ≥60 years age groups respectively. In addition, BAI, as an obesity indicator proposed in recent years, has a positive association with hypertension except in 18–44 years women, which was not stronger than other obesity indicators.ConclusionsFor males, WHtR appears to be the best obesity index related with hypertension. For young, middle-aged, and elderly women, the best obesity indices related with hypertension are WC, BMI, and WHtR, respectively.     

Variabilidade da Pressão Arterial em Única Visita e Risco Cardiovascular em Participantes do ELSA-Brasil

BackgroundBlood pressure variability (BPV) is of prognostic value for fatal and non-fatal cardiovascular outcomes.ObjectiveThis study aimed to evaluate the association between within-visit BPV and cardiovascular risk among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).MethodsThe present cross-sectional study was carried out using baseline data (2008-2010) of 14,357 ELSA-Brasil participants with no prior history of cardiovascular disease. Within-visit BPV was quantified by the coefficient of variation of three standardized systolic blood pressure (SBP) measurements using an oscillometer. Anthropometric measurements and laboratory tests were also performed. Cardiovascular risk was assessed using the atherosclerotic cardiovascular disease risk estimator (ASCVD) and multivariate logistic regression analysis was employed with a significance level of 5%.ResultsSignificantly higher cardiovascular risk was determined by increased BPV for both sexes. A significantly higher prevalence of high risk was found in men than women across all quartiles, with the highest difference observed in the fourth quartile of variability (48.3% vs. 17.1%). Comparisons among quartiles in each sex revealed a significantly higher cardiovascular risk for men in the third (OR=1.20; 95%CI: 1.02 - 1.40) and fourth quartiles (OR=1.46; 95%CI: 1.25 -1.71), and for women in the fourth quartile (OR=1.27; 95%CI: 1.03 - 1.57).ConclusionAnalysis of baseline data of the ELSA-Brasil participants revealed that blood pressure variability was associated with increased cardiovascular risk, especially in men.     

Volume de Gordura Epicárdica está Associada com Disfunção Endotelial,mas Não com Calcificação Coronariana: Do ELSA-Brasil

BackgroundThe increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification.ObjectivesTo evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function.MethodsIn 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant.ResultsMean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0.ConclusionHigher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.     

Central obesity in males affected by a dyslipidemia-associated genetic polymorphism on APOA1/C3/A4/A5 gene cluster

Background:

Central obesity is a rising epidemic, and often occurs in parallel with dyslipidemia. Furthermore, enhancement of ectopic fat deposition has been observed in both human studies and animal models of altered lipidemic control. Though APOA1/C3/A4/A5 genetic polymorphisms are associated with dyslipidemia, their effect on central obesity is less known.

Method:

The anthropometric and metabolic parameters were taken from obese (body mass index (BMI) ⩾25 kg m⁻²) and non-obese healthy (BMI <25) Taiwanese patients at the initiation weight-loss intervention and 6 months later. The effects of APOA1/C3/A4/A5 genetic polymorphisms were analyzed cross-sectionally and longitudinally. Gender contributions were specifically examined.

Patients:

Three hundred and ninety-eight participants (obese n=262; non-obese healthy n=136) were recruited in total, and 130 obese patients underwent weight-loss treatments.

Results:

APOA5 rs662799 minor allele carriage was associated with unfavorable metabolic profiles in obese but not non-obese individuals at baseline. Further analysis identified gender–genotype interactions in waist-hip ratio (WHR), and that one rs662799 minor allele increased 0.032 WHR unit in obese males as analyzed by linear regression adjusted for age, BMI and plasma triglyceride (TG) (95% confidence interval (CI)=0.014–0.050, P=0.001). The rs662799-associated WHR elevation resulted in increased frequency of central obesity (WHR ⩾1.0) in rs662799 carrying obese males as analyzed by binary logistic regression adjusted for age, BMI and plasma TG (odds ratio=6.52, 95% CI=1.87–22.73, P=0.003). In contrast, APOA5 rs662799 and central obesity were no longer correlated 6 months into weight-loss treatments, owing to significant WHR reductions in male rs662799 minor allele carriers (P=0.001). Meanwhile, hypertriglyceridemia was more prevalent in both male and female obese rs662799 minor allele carriers at baseline (males, P=0.034, females, P=0.007).

Conclusion:

This study highlights the gender-specific and weight-sensitive effects of APOA5 rs662799 on central obesity in Taiwanese individuals, and that these effects are dyslipidemia-independent and weight-loss responsive.     

The association of differing measures of overweight and obesity with prevalent atherosclerosis: the Dallas Heart Study.

OBJECTIVES: This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort. BACKGROUND: Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden. METHODS: Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging. RESULTS: In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC). CONCLUSIONS: We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.     

Predicting metabolic syndrome by anthropometric measures among adults 35–65 years in the west of Iran; a cross sectional study from an Iranian RaNCD cohort data

AimsAnthropometric indices have been proposed for the early detection of metabolic syndrome (MetS) and its risk factors. The present study aimed to determine optimal cutoff points for the Body Mass Index (BMI), Waist Circumference (WC), and Waist Hip Ratio (WHR) in the prediction of MetS.MethodsThis cross-sectional study was performed on 9746 adults 35–65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort. The receiver operating characteristic (ROC) curve analysis was used to compare the predictive validity and determine optimal cutoff values.ResultsThe optimal cutoff points for BMI, WC and WHR were 27.3 kg/m² (AUC: 78.6; 95%CI 77.1, 80.1), 97 cm (AUC: 63.8; 95%CI 60.4, 67.2) and 0.95 (AUC: 75.5; 95% CI 73.9, 77.1), respectively in men for the prediction of MetS. But in women the optimal cutoff points for BMI, WC and WHR were 28.6 kg/m² (AUC: 65.7; 95%CI 62.1, 69.4), 98.1 cm (AUC: 65.6; 95%CI 62.4,68.8) and 0.95 (AUC:62.39; 95%CI 60.9,63.9). The risk of MetS in men and women with a BMI higher than the optimal cutoff point was respectively 2.23 and 2.30 times higher than that in those with a WC lower than the cutoff point.ConclusionsBMI is a better predictor of MetS than WC and WHR in adults 35–65 years. We recommend that the optimal cut off point be set for men 27.3 kg/m² and for women 28.6 kg/m².     

Medidas Hipertensivas em Escolares: Risco da Obesidade Central e Efeito Protetor da Atividade Física Moderada-Vigorosa

BackgroundThe proportion of arterial hypertension (AH) has increased in children and adolescents and is associated with several comorbidities.ObjectiveTo verify the association of arterial hypertension with central and general obesity as well as according to the level of physical activity in schoolchildren.Methods336 children and adolescents aged 11 to 17 participated in the study. Height, body weight, waist circumference (WC) and blood pressure (BP) were measured. The body mass index z-score (BMI-z) was calculated. The level of physical activity was assessed by the short form of the International Physical Activity Questionnaire (IPAQ) according to the practice of moderate-to-vigorous physical activities (AF-mv). Students with systolic (SBP) and/or diastolic blood pressure (DBP) higher than the 95^thpercentile according to sex, age and height or ≥120/80 were considered hypertensive. Statistical tests of t-Student, Chi-square, Mann-Whitney and binary logistic regression model were used, considering the significance level of p<0.05.ResultsIt was found that 40.5% of the students had AH, 35.11% were overweight (12.5% obese), 13.39% had high WC and 40.2% were considered insufficiently active in AF-mv. The chances of AH were related to high WC (OR = 6.11; 95% CI: 2.59¬–14.42) and overweight (OR = 2.91; 95% CI: 1.76–4.79). In addition, adolescents who practiced AF-mv had a lower risk of high DBP (OR = 0.33; 95% CI: 0.15–0.72).ConclusionCentral obesity was the best predictor of AH in children and adolescents, as well as general obesity and males. The practice of AF-mv demonstrated a protective effect on high DBP in schoolchildren. (Arq Bras Cardiol. 2020; 115(1):42-49)     

Association between hypertension and adiposity indicators: A study among the Muslim population of Uttar Pradesh

BackgroundHypertension and obesity have become a global issue and an important public health concern due to an unhealthy lifestyle. The present study aims to determine the prevalence of hypertension and its association with various adiposity indicators among Sunni Muslim population of Lucknow, Uttar Pradesh.Materials and methodsA cross-sectional study was conducted among 214 individuals using purposive sampling method. Somatometric measurements were taken using the ISAK protocol. Correlation analysis and odds ratio were calculated to determine the best predictor of hypertension.Results41% of males and 42.1% of females were found to be in Stage-II hypertension. BMI and WC were found to have the highest correlation with SBP among males and females, respectively. WHR followed by WC and BMI, was found to be the strongest predictor of hypertension in males. In the case of females, WHtR Followed by, BMI and WHR were found to be the strongest predictors of hypertension.ConclusionAmong the presently studied Muslim population of Lucknow, a high prevalence of hypertension was found among both males and females. Also, WHR among males and WC among females were found to be better predictors of hypertension. Thus, for better prediction of risk of hypertension, sex and ethnicity-specific adiposity indicator should be used in clinical practice.     

Diagnóstico de Fibrilação Atrial na Comunidade Utilizando Eletrocardiograma e Autorrelato: Análise Transversal do ELSA-Brasil

Background:Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America.Objective:The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.Methods:This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%.Results:Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04–1.07), hypertension (OR:1.44; 95%CI: 1.14–1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85–6.79), heart failure (OR:7.37; 95%CI: 5.00–10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28–5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055).Conclusions:At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.     

O Papel dos Níveis Séricos de ANP na Perda de Peso,Risco Cardiometabólico e Composição Corporal de Adolescentes com Obesidade Submetidos a Terapia Interdisciplinar

BackgroundThe action of atrial natriuretic peptide (ANP) on natriuresis, diuresis and vasodilatation, insulin resistance, liver, kidney, and adipose tissue may contribute to the healthy metabolic and cardiovascular development. Even though the circulating level of ANP is reduced in patients with obesity, its response to weight loss remains poorly explored in pediatric populations.ObjectiveTo evaluate the effects of ANP variations in response to interdisciplinary weight loss intervention on metabolic syndrome (MetS) and cardiometabolic risks in adolescents with obesity.Methods73 adolescents with obesity attended a 20-week clinical interdisciplinary weight loss therapy including clinical, nutritional, psychological and exercise training approach. Body composition, biochemical analyses and blood pressure were evaluated. MetS was classified according to the International Diabetes Federation (IDF) (2007). After the treatment, volunteers were divided according to Increasing (n=31) or Decreasing (n=19) ANP plasma levels.ResultsBoth groups present significant reduction of body weight, Body Mass Index (BMI), waist, neck and hip circumferences (WC, NC and HC, respectively) and increasing fat-free mass (FFM). Interestingly, a significant reduction in body fat, TG/HDL-c ratio and MetS prevalence (from 23% to 6%) was observed in the Increased ANP group only.ConclusionThis study suggests that an increase in ANP serum levels after weight loss therapy could be associated with improvements in cardiometabolic risks and the reduced prevalence of MetS in adolescents with obesity.     

Achados Ecocardiográficos Anormais em Pacientes Internados com Covid-19: Uma Revisão Sistemática e Metanálise

BackgroundCoronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction.ObjectiveIn this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19.MethodsWe systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21^st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05.ResultsFrom 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I²93%), abnormal global longitudinal strain 34% (95% CI 23, 45; I²90%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I²90%), pericardial effusion 17% (95%CI: 9, 26; I²97%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37).ConclusionAmong hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.     

Obesidade Visceral e Hipertensão Sistólica como Substratos da Disfunção Endotelial em Adolescentes Obesos

Background:Obesity affects adolescence and may lead to metabolic syndrome (MetS) and endothelial dysfunction, an early marker of cardiovascular risk. Albeit obesity is strongly associated with obstructive sleep apnea (OSA), it is not clear the role of OSA in endothelial function in adolescents with obesity.Objective:To investigate whether obesity during adolescence leads to MetS and/or OSA; and causes endothelial dysfunction. In addition, we studied the possible association of MetS risk factors and apnea hypopnea index (AHI) with endothelial dysfunction.Methods:We studied 20 sedentary obese adolescents (OA; 14.2±1.6 years, 100.9±20.3kg), and 10 normal-weight adolescents (NWA, 15.2±1.2 years, 54.4±5.3kg) paired for sex. We assessed MetS risk factors (International Diabetes Federation criteria), vascular function (Flow-Mediated Dilation, FMD), functional capacity (VO²peak) and the presence of OSA (AHI>1event/h, by polysomnography). We considered statistically significant a P<0.05.Results:OA presented higher waist (WC), body fat, triglycerides, systolic (SBP) and diastolic blood pressure (DBP), LDL-c and lower HDL-c and VO²peak than NWA. MetS was presented in the 35% of OA, whereas OSA was present in 86.6% of OA and 50% of EA. There was no difference between groups in the AHI. The OA had lower FMD than NWA (6.17±2.72 vs. 9.37±2.20%, p=0.005). There was an association between FMD and WC (R=-0.506, p=0.008) and FMD and SBP (R=-0.493, p=0.006).Conclusion:In adolescents, obesity was associates with MetS and caused endothelial dysfunction. Increased WC and SBP could be involved in this alteration. OSA was observed in most adolescents, regardless of obesity. (Arq Bras Cardiol. 2021; 116(4):795-803)     

Which obesity index is the best predictor for high cardiovascular disease risk in middle-aged and elderly population?

Background and aimsThe aim was to investigate the relationships between visceral fat rating scale (VFR), waist circumference (WC), body mass index (BMI) and cardiovascular disease (CVD) risk.MethodsIn this cross-sectional, community-based study, participants completed questionnaire that included personal and medical history, and underwent anthropometric measurement and blood sampling. The 2008 general CVD risk model was used to predict CVD risk. Associations between CVD risk and VFR, WC, BMI were evaluated by means of analysis of covariance (ANCOVA) with gender as covariate, Chi-squared test, Pearson’s correlation, Cochran-Armitage test, multivariate logistic regression and receiver operating characteristic curves.ResultsA total of 377 people were enrolled. A significant association was identified between VFR, WC, BMI, and CVD risk, with coefficient of determination (r²) of 0.32 (p < 0.001), 0.18 (p < 0.001) and 0.03 (p = 0.001), respectively. There was a trend toward increasing prevalence of high CVD risk as VFR, WC, and BMI increased (all p values <0.05). Multivariate logistic regression revealed VFR (OR = 1.21; 95%CI = 1.02–1.24), WC (OR = 1.07; 95%CI = 1.04–1.11) and BMI (OR = 1.11; 95%CI = 1.02–1.21) to be independent predictors of high CVD risk. In male, the area under curves of VFR and WC are greater than BMI: 0.641, 0.647 and 0.562. In female, the area under curves of VFR and WC are also greater than BMI: 0.656, 0.688 and 0.601.ConclusionsVFR and WC were more strongly associated with high CVD risk than BMI among middle-aged and elderly persons in Taiwan.     

Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals

OBJECTIVE: To determine the cut-off points of indices of obesity for detecting hypertension, dyslipidemia and diabetes mellitus in Japanese individuals. DESIGN: Cross-sectional study. SUBJECTS: A total of 2728 Japanese individuals (768 males and 1960 females, aged 20-79 y) who attended the Fukuoka Health Promotion Center, Japan for health check-up. MEASUREMENTS: Body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) were measured. Percentage fat mass (%FM), trunk fat mass (FM(trunk)) and trunk fat mass-leg fat mass ratio (FM(trunk)/FM(legs)) were obtained by dual-energy X-ray absorptiometry (DXA). Cardiovascular risk factors were determined by blood pressure, serum lipids, fasting blood glucose and hemoglobin A(1C). RESULTS: The cut-off points of BMI, WC and WHR were around 23.5 kg/m(2), 84 cm and 0.9 for males, and 22.5 kg/m(2), 72 cm and 0.8 for females. The cut-off points of %FM, FM(trunk) and FM(trunk)/FM(legs) were around 24%, 8 kg and 1.6 for males, and 35%, 9 kg and 1.4 for females. WHR and FM(trunk)/FM(legs) most accurately detected the risk factors. CONCLUSIONS: For Japanese individuals, the cut-off points for detecting cardiovascular risk factors are lower than the criteria by the World Health Organization. Indices of fat distribution detected the cardiovascular risk factors more accurately than those of overall adiposity. The accuracy of detecting the risk factors was comparable between the anthropometric indices and indices obtained by DXA.