Fenótipo cintura hipertrigliceridêmica em indivíduos com diagnóstico de hipertensão arterial e, ou diabetes mellitus
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2019-07-31
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Universidade Federal de Viçosa
Resumo
Introdução: as doenças crônicas não transmissíveis (DCNT) principalmente as Doenças Cardiovasculares (DCV) figuram como a maior causa de óbito no mundo, sendo responsáveis por aproximadamente 31% de todas as mortes em nível global. A medida que as DCV aumentam no Brasil e no mundo a utilização de indicadores para a identificação do risco cardiovascular e metabólico é necessária, dentre eles destaca-se: a razão Triglicerídeos e Colesterol HDL (TG/HDL-c), o Escore de Framinghan (EF), a Síndrome Metabólica (SM) e o Fenótipo Cintura Hipertrigliceridêmica (FCH). O FCH foi proposto por ser um indicador de fácil aplicabilidade e de baixo custo, pois envolve a mensuração de medidas simples de serem obtidas, o perímetro da cintura e os triglicerídeos, que devem estar aumentados simultaneamente. Objetivos: identificar a prevalência e os fatores associados ao Fenótipo Cintura Hipertrigliceridêmica (FCH) em indivíduos com Hipertensão Arterial e, ou Diabetes Mellitus do município de Viçosa- Minas Gerais, Brasil, bem como comparar o FCH ao escore de Framingham, Síndrome Metabólica e razão Triglicerídeos e colesterol HDL em relação a capacidade de predizer alterações cardiovasculares e metabólicas. Métodos: estudo do tipo transversal realizado com indivíduos diagnosticados com HA e, ou DM no município de Viçosa- MG entre os meses de agosto de 2017 a abril de 2018. Os dados do estudo foram coletados por meio de avaliação antropométrica, aferição de pressão arterial e exames bioquímicos de sangue, bem como, entrevistas semiestruturadas contendo informações sociodemográficas, clínicas, de hábitos de vida e cuidados de saúde. Foi estimada a prevalência do FCH e investigada a sua associação com as características dos indivíduos utilizando o teste de qui-quadrado, teste t de Student ou de Mann- Whitney de acordo com a normalidade das variáveis. Para todos os testes foi fixado o nível de significância de 95%. A regressão logística bivariada e multivariada foi utilizada para avaliar os fatores associados ao FCH. Considerando FCH como referência em comparação aos outros indicadores de risco cardiovascular e metabólico (razão triglicerídeos e HDL colesterol, SM e o escore de Framingham), foram calculados as seguintes medidas: correlação tetracórica, índice kappa, sensibilidade, especificidade, curva ROC e acurácia. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de Viçosa (UFV), sob número de parecer 1203173 / 2015. Resultados: dos 788 indivíduos investigados 21,5% apresentaram o FCH. No modelo ajustado permaneceram associados a maior chance de apresentar o FCH as seguintes variáveis: sexo, idade, IMC e VLDL-c. Entre os indicadores de risco cardiovascular e metabólico analisados, o FCH se correlacionou melhor com TG/HDL-c apresentando coeficiente de correlação 0,71 (correlação moderada) para o sexo masculino e coeficiente de 0,84 (correlação forte) para o sexo feminino. A concordância entre TG/HDL-c e o FCH examinada através do índice Kappa foi considerada razoável para o sexo masculino (0,28) e forte para o sexo feminino (0,63). Conclusões: A prevalência do FCH encontrada no estudo foi de 21,5% e esteve associada ao sexo feminino, a maior idade, maior IMC, maior VLDL-c e RCQ de risco. Os dados encontrados neste estudo sugerem a implementação do FCH como um indicador para prever o risco cardiovascular e metabólico nos diversos serviços de saúde. Entre os indicadores comparados ao FCH a razão TG/HDL-c foi o que apresentou melhor correlação É importante investigar constantemente diferentes indicadores de risco cardiovascular e metabólico a fim de inseri-los e executá-los na prática.
Introduction: Chronic noncommunicable diseases (CNCDs), mainly Cardiovascular Diseases (CVD), are the largest cause of death in the world, accounting for approximately 31% of all deaths globally. In Brazil 31.2% of the deaths are caused by CVD (WHO, 2018). As CVDs increase in Brazil and the world, the use of indicators for the identification of cardiovascular and metabolic risk is necessary, among them the Triglycerides and HDL Cholesterol ratio (TG / HDL-c), the Framinghan score (EF), the Metabolic Syndrome (SM) and the hypertriglyceridemic waist phenotype (FCH). FCH was proposed as an indicator of easy applicability and low cost, since it involves the measurement of simple measures to obtain, waist circumference and triglycerides, which must be increased simultaneously. Objectives: To identify the prevalence and factors associated with the Hypertriglyceridemic Waist Phenotype (HCF) in individuals with Hypertension and / or Diabetes Mellitus in the city of Viçosa- Minas Gerais, Brazil, as well as to compare the FCH to the Framingham score, Metabolic Syndrome and reason Triglycerides and HDL cholesterol in relation to the ability to predict cardiovascular and metabolic changes. Methods: cross-sectional study with individuals diagnosed with HA and / or DM in the city of Viçosa- MG between the months of August 2017 to April 2018. The data of the study were collected through anthropometric evaluation, blood pressure measurement and biochemical blood tests, as well as semi - structured interviews containing sociodemographic, clinical, lifestyle and health care information. The prevalence of HCF was estimated and its association with the characteristics of individuals was investigated using the chi-square test, Student's t- test or Mann-Whitney test according to the normality of the variables. For all tests the significance level of 95% was set. Bivariate and multivariate logistic regression was used to evaluate the factors associated with FCH. Considering FCH as a reference in comparison to other cardiovascular and metabolic risk indicators (triglyceride and HDL cholesterol ratio, SM and the Framingham score), the following measures were calculated: tetrameric correlation, kappa index, sensitivity, specificity, ROC curve and accuracy. The research project was approved by the Ethics Committee on Research with Human Beings of the Federal University of Viçosa (UFV), under number 1203173/2015. Results: Of the 788 individuals investigated, 21.5% presented FCH. In the adjusted model, the following variables were associated with a higher probability of presenting FCH: sex, age, BMI and VLDL. Among the cardiovascular and metabolic risk indicators analyzed, FCH correlated better with TG / HDL-c, with correlation coefficient 0.71 (moderate correlation) for males and coefficient of 0.84 (strong correlation) for females. The concordance between TG / HDL-c and the FCH examined using the Kappa index was considered reasonable for males (0.28) and strong for females (0.63). Conclusions: The prevalence of CHF found in the study was 21.5% and was associated with female gender, age, higher BMI, higher VLDL-c, and CRC at risk. The data found in this study suggest the implementation of FCH as an indicator to predict cardiovascular and metabolic risk in different health services. Among the indicators compared to FCH the TG / HDL-c ratio was the one that presented the best correlation It is important to investigate constantly different indicators of cardiovascular and metabolic risk in order to insert them and to execute them in practice.
Introduction: Chronic noncommunicable diseases (CNCDs), mainly Cardiovascular Diseases (CVD), are the largest cause of death in the world, accounting for approximately 31% of all deaths globally. In Brazil 31.2% of the deaths are caused by CVD (WHO, 2018). As CVDs increase in Brazil and the world, the use of indicators for the identification of cardiovascular and metabolic risk is necessary, among them the Triglycerides and HDL Cholesterol ratio (TG / HDL-c), the Framinghan score (EF), the Metabolic Syndrome (SM) and the hypertriglyceridemic waist phenotype (FCH). FCH was proposed as an indicator of easy applicability and low cost, since it involves the measurement of simple measures to obtain, waist circumference and triglycerides, which must be increased simultaneously. Objectives: To identify the prevalence and factors associated with the Hypertriglyceridemic Waist Phenotype (HCF) in individuals with Hypertension and / or Diabetes Mellitus in the city of Viçosa- Minas Gerais, Brazil, as well as to compare the FCH to the Framingham score, Metabolic Syndrome and reason Triglycerides and HDL cholesterol in relation to the ability to predict cardiovascular and metabolic changes. Methods: cross-sectional study with individuals diagnosed with HA and / or DM in the city of Viçosa- MG between the months of August 2017 to April 2018. The data of the study were collected through anthropometric evaluation, blood pressure measurement and biochemical blood tests, as well as semi - structured interviews containing sociodemographic, clinical, lifestyle and health care information. The prevalence of HCF was estimated and its association with the characteristics of individuals was investigated using the chi-square test, Student's t- test or Mann-Whitney test according to the normality of the variables. For all tests the significance level of 95% was set. Bivariate and multivariate logistic regression was used to evaluate the factors associated with FCH. Considering FCH as a reference in comparison to other cardiovascular and metabolic risk indicators (triglyceride and HDL cholesterol ratio, SM and the Framingham score), the following measures were calculated: tetrameric correlation, kappa index, sensitivity, specificity, ROC curve and accuracy. The research project was approved by the Ethics Committee on Research with Human Beings of the Federal University of Viçosa (UFV), under number 1203173/2015. Results: Of the 788 individuals investigated, 21.5% presented FCH. In the adjusted model, the following variables were associated with a higher probability of presenting FCH: sex, age, BMI and VLDL. Among the cardiovascular and metabolic risk indicators analyzed, FCH correlated better with TG / HDL-c, with correlation coefficient 0.71 (moderate correlation) for males and coefficient of 0.84 (strong correlation) for females. The concordance between TG / HDL-c and the FCH examined using the Kappa index was considered reasonable for males (0.28) and strong for females (0.63). Conclusions: The prevalence of CHF found in the study was 21.5% and was associated with female gender, age, higher BMI, higher VLDL-c, and CRC at risk. The data found in this study suggest the implementation of FCH as an indicator to predict cardiovascular and metabolic risk in different health services. Among the indicators compared to FCH the TG / HDL-c ratio was the one that presented the best correlation It is important to investigate constantly different indicators of cardiovascular and metabolic risk in order to insert them and to execute them in practice.
Descrição
Palavras-chave
Sistema cardiovascular - Doenças, Cintura hipertrigliceridêmica, Avaliação de riscos de saúde, Hipertensão, Diabetes mellitus
Citação
BORGES, Luiza Delazari. Fenótipo cintura hipertrigliceridêmica em indivíduos com diagnóstico de hipertensão arterial e, ou diabetes mellitus. 2019. 70 f. Dissertação (Mestrado em Ciência da Nutrição) - Universidade Federal de Viçosa, Viçosa. 2019.