Abstract Background Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable. Objective To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers. Methods This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05). Results According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (<5%), intermediate (5-10%), and high (>10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity <85% (22.2%), coronary calcium score >0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score. Conclusion Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) ‘eutrophic non-OSA’ (n = 13); b) ‘eutrophic OSA’ (n = 5); c) ‘obese non-OSA’ (n = 6); d) ‘obese OSA’ (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing ‘eutrophic OSA’ and ‘obese OSA’ (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the ‘eutrophic non-OSA’, ‘eutrophic OSA’, ‘obese non-OSA’ and ‘obese OSA’ groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Resumo Fundamento: A mortalidade por doença cardiovascular entre as mulheres permanece elevada. Estudos observacionais são controversos sobre a participação dos antecedentes de distúrbio hipertensivo gestacional no risco cardiovascular. Objetivo: Verificar a associação entre aterosclerose de carótidas em mulheres no climatério que tiveram hipertensão na gestação. Métodos: Estudo de caso-controle, sendo os casos compostos por mulheres com aterosclerose de carótida, definida como espessura íntima-média carotídea > 1 mm e/ou presença de placas de carótidas; os controles não apresentavam estas alterações. Adotou-se nível de significância de 95%. Resultados: Foram avaliadas 504 mulheres sem doença cardiovascular prévia, sendo 126 casos e 378 controles. Eram hipertensas 67% delas; 76% eram dislipidêmicas; e 16%, diabéticas. Cerca de 10% referiram antecedentes de hipertensão na gestação. As mulheres com aterosclerose de carótidas apresentaram valores maiores dos níveis de pressão arterial sistólica (134,18 mmHg vs. 128,59 mmHg; p = 0,008) e de LDL-colesterol (156,52 mg% vs. 139,97 mg%; p = 0,0005). Não foi encontrada diferença estatística em relação à presença de aterosclerose de carótidas e ao antecedente de hipertensão na gestação (OR 1,672; IC 95% 0,893-3,131). Conclusão: O antecedente de hipertensão na gestação não foi associado à aterosclerose subclínica de carótidas em mulheres na pré e pós-menopausa. No entanto, verificou-se a associação entre a aterosclerose de carótida e os fatores de risco clássicos, como pressão arterial sistólica elevada e altos níveis de LDL-colesterol.

Abstract Background: Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk. Objective: To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension. Methods: Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%. Results: A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol (156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131). Conclusion: The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels.

INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente associada com piores indicadores de saúde. A qualidade do sono pode ser medida objetiva e subjetivamente por métodos como a polissonografia, que é o padrão de referência, ou por meio de testes e questionários, como o índice de qualidade de sono de Pittsburgh (IQSP).OBJETIVO: Correlacionar a qualidade do sono com a tolerância ao esforço em pacientes portadores da síndrome da apneia/hipopneia obstrutiva do sono (SAHOS).MÉTODOS: Participaram do estudo 63 indivíduos (57 mulheres e seis homens), média de idade de 51,7 ± 6,6 anos; índice de massa corpórea (IMC) média de 28,2 ± 5,0 kg/m2); índice de apneia/hipopneia (IAH) médio de 7,3 ± 10,50 eventos/hora, verificado através da polissonografia. Para a avaliação da qualidade do sono, os participantes responderam ao IQSP, e para a avaliação da tolerância ao esforço, realizaram o teste de caminhada de 6 minutos (TC6M).RESULTADOS: Não houve correlação entre o IQSP e o TC6M (Rs= -0,103620, p = 0,419), assim como entre o IAH e o TC6M (Rs= -0, 000984, p = 0,9939). Podemos sugerir que a qualidade do sono e a gravidade da SAHOS não afetam a tolerância ao esforço dos indivíduos com SAHOS.CONCLUSÃO: Estudos com uma amostra maior, levando-se em consideração a estratificação pela gravidade da SAHOS e utilizando métodos mais acurados de avaliação da capacidade funcional, devem ser realizados, a fim de que resultados mais abrangentes possam ser obtidos.

INTRODUCTION: Sleep is a natural and recurring state, in which important neurobiological processes take place. Poor quality of sleep is directly associated with worse health indicators. Sleep quality can be measured objectively and subjectively by methods such as polysomnography, which is the gold standard, or tests and questionnaires as the Sleep Quality Index in Pittsburgh (PSQI).OBJECTIVE: To correlate the quality of sleep with exercise tolerance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).METHODS: The study included 63 subjects (57 women and 6 men) aged 51.7 ± 6.6 years, with body mass index (BMI) 28.2 ± 5.0 kg/m2,apnea/hypopnea index (AHI) 7.3±10:50 events/hour, assessed by polysomnography. To assess the quality of sleep, participants responded the PSQI instrument and were submitted to the exercise tolerance test through the 6-minute walk test (6MWT).RESULTS: There was no correlation between the PSQI and the 6MWT (Rs = -0.103620, p = 0.419), and between the 6MWT and the AHI (R = -0, 000984, p = 0.9939). According to the results of this work, we suggest that the quality of sleep and the severity of OSAHS did not affect the exercise tolerance of individuals with OSAHS.CONCLUSION: Studies with a larger sample, taking into account the stratification by severity of OSAHS and using more accurate methods of functional capacity evaluation should be conducted, so that more comprehensive results can be obtained.

INTRODUCCIÓN: El sueño es un estado natural y recurrente durante el cual acontecen procesos neurobiológicos importantes. La mala calidad del sueño está asociada directamente con peores indicadores de salud. La calidad del sueño puede ser medida objetiva y subjetivamente mediante métodos como la polisomnografía,, que es el estándar de referencia, o pruebas y cuestionarios como el índice de calidad de sueño de Pittsburgh (ICSP),OBJETIVO: Correlacionar la calidad del sueño con la tolerancia al esfuerzo en pacientes portadores del síndrome de la apnea/hipopnea obstructiva del sueño (SAHOS).MÉTODOS: Participaron en el estudio 63 individuos (57 mujeres y seis hombres), edad promedio de 51,7 ± 6,6 años; índice de masa corpórea (IMC) 28,2 ± 5,0 kg/m2); índice de apnea/hipopnea (IAH) 7,3 ± 10,50 eventos/hora, verificado por medio de la polisomnografía. Para la evaluación de la calidad del sueño, los participantes respondieron al ICSP y para la evaluación de la tolerancia al esfuerzo, realizaron la prueba de caminata de 6 minutos (PC6M).RESULTADOS: No hubo correlación entre el ICSP y la PC6M (Rs= -0,103620, p = 0,419), ni entre el IAH y la PC6M (Rs= -0, 000984, p = 0,9939). Podemos sugerir que la calidad del sueño y la gravedad del SAHOS no afectan a la tolerancia al esfuerzo de los individuos con SAHOS.CONCLUSIÓN: Se deben realizar los estudios con una muestra mayor, teniéndose en consideración la estratificación según la gravedad del SAHOS y utilizándose métodos más precisos para evaluación de la capacidad funcional, a fin de que se puedan obtener resultados de más alcance.