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The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)
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Spilack, Aída de Melo

; Goulart, Alessandra C.

; Almeida-Pititto, Bianca de

; Janovsky, Carolina Castro Porto Silva

; Lotufo, Paulo A.

; Santos, Itamar de Souza

; Benseñor, Isabela M.

Clinics

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2023, Volume 78 elocation 100154

Abstract: En | Text: En | PDF: En

Abstract Introduction: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval – 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. Results: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). Discussion: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected.

https://doi.org/10.1016/j.clinsp.2022.100154

Liver steatosis as a predictor of incident diabetes in adults: a prospective evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
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Faria, Luciana Costa

; Diniz, Maria de Fátima Haueisen Sander

; Giatti, Luana

; Schmidt, Maria Inês

; Goulart, Alessandra Carvalho

; Duncan, Bruce Bartholow

; Barreto, Sandhi Maria

Cadernos de Saúde Pública

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2023, Volume 39 N. 3 elocation e00090522

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Evidências epidemiológicas crescentes sugerem uma relação bidirecional entre a doença hepática gordurosa não alcoólica (DHGNA) e o diabetes tipo 2 e que a DHGNA pode preceder e/ou promover o desenvolvimento de diabetes. O objetivo deste estudo foi investigar se a esteatose hepática está associada à incidência de diabetes no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O ELSA-Brasil é um estudo de coorte ocupacional com servidores públicos ativos ou aposentados, com idades entre 35 e 74 anos, de seis capitais do Brasil. Foram excluídos os participantes com diabetes no início do estudo, aqueles que relataram consumo excessivo de álcool ou com falta de informações sobre covariáveis relevantes e indivíduos com hepatite ou cirrose autorreferida. No total, 8.166 indivíduos participaram e o tempo médio de seguimento foi de 3,8 anos. O modelo de regressão proporcional de Cox foi utilizado para estimar a razão de risco (HR) ajustada para as associações. A ultrassonografia abdominal foi utilizada para detectar esteatose hepática. No período de seguimento, a incidência cumulativa de diabetes foi de 5,25% em todo o grupo de participantes e de 7,83% e 3,88% nos grupos com e sem esteatose hepática, respectivamente (p < 0,001). Em comparação com aqueles sem esteatose, os indivíduos com esteatose hepática apresentaram um risco elevado de desenvolver diabetes (HR = 1,31; IC95%: 1,09-1,56) após o ajuste para potenciais fatores de confusão, incluindo o índice de massa corporal (IMC). A esteatose hepática foi um preditor independente de diabetes incidente no ELSA-Brasil. Os médicos devem incentivar mudanças no estilo de vida e a triagem para diabetes para pacientes com fígado gorduroso.

Increasing epidemiological evidence suggests a bidirectional relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes, and that NAFLD may precede and/or promote the development of diabetes. This study aimed to investigate whether liver steatosis is associated with the incidence of diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ELSA-Brasil is an occupational cohort study of active or retired civil servants, aged 35-74 years, in six capital cities in Brazil. We excluded participants with diabetes at baseline, those who reported excessive alcohol consumption or with missing information on relevant covariates, and those with self-referred hepatitis or cirrhosis. In total, 8,166 individuals participated, and the mean duration of follow-up was 3.8 years. The Cox proportional regression model was used to estimate the adjusted hazard ratio (HR) for the associations. Abdominal ultrasonography was used to detect liver steatosis. In the follow-up period, the cumulative incidence of diabetes was 5.25% in the whole sample, 7.83% and 3.88% in the groups with and without hepatic steatosis, respectively (p < 0.001). Compared to those without steatosis, individuals with hepatic steatosis had an increased risk of developing diabetes (HR = 1.31; 95%CI: 1.09-1.56) after adjustment for potential confounders, including body mass index (BMI). Hepatic steatosis was an independent predictor of incident diabetes in the ELSA-Brasil cohort study. Physicians should encourage changes in lifestyle and screen for diabetes in patients with fatty liver.

La creciente evidencia epidemiológica sugiere una relación bidireccional entre la enfermedad del hígado graso no alcohólica (EHGNA) y la diabetes tipo 2 y que la EHGNA puede preceder y/o desarrollar la diabetes. El objetivo de este estudio fue investigar si la esteatosis hepática está asociada con la incidencia de diabetes en el Estudio Longitudinal de Salud del Adulto (ELSA-Brasil). ELSA-Brasil es un estudio de cohorte ocupacional, realizado con funcionarios públicos activos o jubilados, con edades entre 35 y 74 años, de seis capitales en Brasil. Se excluyeron a los participantes con diabetes al inicio del estudio, aquellos que informaron consumir excesivamente alcohol o que carecían de información sobre las covariables relevantes, y los individuos con hepatitis o cirrosis autorreportada. En total participaron 8.166 sujetos, y el tiempo medio de seguimiento fue de 3,8 años. Se utilizó el modelo de regresión proporcional de Cox para estimar la razón de riesgo ajustada (HR) en las asociaciones. Se realizó ecografía abdominal para detectar esteatosis hepática. En el periodo de seguimiento, el grupo de participantes tuvo incidencia acumulada de diabetes del 5,25%, y en los grupos con y sin esteatosis hepática fueron del 7,83% y el 3,88%, respectivamente (p < 0,001). Los individuos con enfermedad de hígado graso tuvieron mayor riesgo de desarrollar diabetes (HR = 1,31; IC95%: 1,09-1,56) después de ajustar los posibles factores de confusión, incluido el índice de masa corporal (IMC), en comparación con aquellos sin esteatosis. La esteatosis hepática fue un predictor independiente de diabetes incidente en ELSA-Brasil. Los médicos deben alentar cambios en el estilo de vida y la detección de diabetes a los pacientes con hígado graso.

https://doi.org/10.1590/0102-311xen090522

Liver steatosis as a predictor of incident diabetes in adults: a prospective evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
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Faria, Luciana Costa

; Diniz, Maria de Fátima Haueisen Sander

; Giatti, Luana

; Schmidt, Maria Inês

; Goulart, Alessandra Carvalho

; Duncan, Bruce Bartholow

; Barreto, Sandhi Maria

Cadernos de Saúde Pública

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2023, Volume 39 N. 3 elocation e00090522

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311xen090522

Prognóstico Relacionado à Terapia de Reperfusão Pós-Síndrome Coronariana Aguda na Atenção Secundária: Análise de Sobrevida em Longo Prazo na Estratégia ERICO
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Bruno, Tatiana C.

; Bittencourt, Márcio S.

; Quidim, Alessandra V. L.

; Santos, Itamar S.

; Lotufo, Paulo A.

; Benseñor, Isabela M.

; Goulart, Alessandra C.

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 5 elocation e20220849

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A relação entre terapia de reperfusão após a síndrome coronariana aguda (SCA) e mortalidade na atenção secundária não é bem conhecida. Objetivos Avaliar o impacto de três estratégias terapêuticas: (1) terapia medicamentosa exclusiva, (2) Angioplastia Transluminal percutânea coronaria (ATPC) e (3) revascularização do miocárdio (RM) na sobrevida em longo prazo de participantes da Estratégia de Registro de Insuficiência Coronariana Aguda (ERICO). Métodos Análises de sobrevida para mortalidade por todas as causas, mortalidade por doença cardiovascular (DCV) e mortalidade por doença arterial coronariana (DAC) foram realizadas de acordo com três estratégias terapêuticas (tratamento clínico exclusivo, ATPC ou RM). Modelos de regressão de Cox foram usados para estimar o hazard ratio (HR) com intervalo de confiança de 95% (IC95%) de 180 dias a quatro anos de acompanhamento após a SCA. Os modelos são apresentados como modelo sem ajuste ou ajustado quanto à idade, sexo e DAC prévia, tipo de SCA, tabagismo, hipertensão, dislipidemia, fração de ejeção do ventrículo esquerdo e de acordo com o número de artérias coronárias principais obstruídas (≥50%). Resultados Entre os 800 participantes, as piores taxas de sobrevida (mortalidade por todas as causas e DCV) foram detectadas entre os indivíduos que se submeteram a RM. Houve correlação entre RM e DAC [HR: 2,19 (IC95% 1,05-4,55)], mas o risco perdeu significância no modelo multivariado. A ATPC foi associada a uma menor probabilidade de eventos fatais durante os quatro anos de acompanhamento: mortalidade por todas as causas [HR, análise multivariada: 0,42 (IC95% 0,26-0,70)], por DCV [HR: 0,39 (95% CI: 0,20-0,73)] e DAC [HR, análise multivariada: 0,24 (IC95% 0,09-0,63)] em comparação aos submetidos ao tratamento clínico exclusivo. Conclusão No ERICO, a ATPC após a SCA foi associada a um melhor prognóstico, principalmente sobrevida por DAC.

Abstract Background Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known. Objectives To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries. Results Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy. Conclusion In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.

https://doi.org/10.36660/abc.20220849

Consumo de bebidas alcoólicas e obesidade abdominal: resultados da linha de base do ELSA-Brasil
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Torres, Gabrielle Guidoni

; Siqueira, Jordana Herzog

; Martinez, Oscar Geovanny Enriquez

; Pereira, Taísa Sabrina Silva

; Meléndez, Jorge Gustavo Velásquez

; Duncan, Bruce Bartholow

; Goulart, Alessandra Carvalho

; Molina, Maria del Carmen Bisi

Ciência & Saúde Coletiva

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feb 2022, Volume 27 N. 2 Pages 737 - 746

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivou-se analisar a associação entre consumo de bebidas alcoólicas e adiposidade abdominal em adultos. Estudo transversal realizado com dados da linha de base do ELSA-Brasil (2008-2010). A amostra foi constituída por 15.065 servidores públicos de seis instituições de ensino e pesquisa (35 a 74 anos, ambos os sexos). Para identificar adiposidade central por meio das medidas de circunferência da cintura (CC) e relação cintura/quadril (RCQ), utilizou-se os pontos de corte preconizados pela Organização Mundial da Saúde. Para as análises estatísticas foi utilizado o teste qui-quadrado e modelos de regressão de Poisson ajustados por variáveis potencialmente confundidoras. Cerca de 40% da amostra apresentava CC e RCQ elevadas. A probabilidade de apresentar CC elevada foi 5% e 3% maior no grupo mais exposto de consumo de cerveja em homens e mulheres quando comparado ao grupo de referência [RP = 1,05 (IC 95% 1,02-1,08) e RP = 1,03 (IC 95% 1,00-1,07)]. Também foi encontrada maior probabilidade de apresentar RCQ elevada entre os maiores consumidores de cerveja [RP = 1,03 (IC 95% 1,00-1,07) em homens e RP=1,10 (IC 95% 1,04-1,15) em mulheres]. Maior número de doses/semana de bebida alcoólica aumentou a probabilidade de ocorrência de CC e RCQ elevadas, sendo mais importante a contribuição da cerveja.

Abstract The objective was to analyze the association between alcohol consumption and abdominal adiposity in adults. Cross-sectional study conducted at baseline data from ELSA-Brasil (2008- 2010). The sample consisted of 15,065 civil servants from six education and research institutions (35 to 74 years old, both sexes). To identify central adiposity by measuring waist circumference (WC) and waist-to-hip ratio (WHR), the cutoff points recommended by the World Health Organization were used. Poisson regression models adjusted for potentially confounding variables were tested. About 40% of the sample had elevated WC and WHR. The probability of having elevated WC was 5% and 3% higher in the most exposed group of beer consumption in men and women when compared to the reference group [PR= 1.05 (95% CI 1.02-1.08) and P R= 1.03 (95% CI 1.00-1.07)]. A higher probability of having a high WHR was also found among the highest beer consumers [PR = 1.03 (95% CI 1.00-1.07) in men and PR = 1.10 (95% CI 1.04-1.15) in women]. A greater number of doses/week of alcoholic drink increased the probability of occurrence of high WC and WHR, with the beer contribution being more important.

https://doi.org/10.1590/1413-81232022272.02282021

Association between neck circumference and non-alcoholic fatty liver disease: cross-sectional analysis from ELSA-Brasil
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Santos, Laura Luiza Menezes

; Diniz, Maria de Fátima Haueisen Sander

; Goulart, Alessandra Carvalho

; Barreto, Sandhi Maria

; Figueiredo, Roberta Carvalho

Sao Paulo Medical Journal

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feb 2022, Volume 140 N. 2 Pages 213 - 221

Abstract: En | Text: En | PDF: En

Abstract BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become a public health problem worldwide. Neck circumference (NC) is a simple anthropometric adiposity parameter that has been correlated with cardiometabolic disorders like NAFLD. OBJECTIVES: To investigate the association between NC and NAFLD, considering their obesity-modifying effect, among participants from the Longitudinal Study of Adult Health (ELSA-Brasil) baseline study. DESIGN AND SETTINGS: Cross-sectional study at the ELSA-Brasil centers of six public research institutions. METHODS: This analysis was conducted on 5,187 women and 4,270 men of mean age 51.8 (± 9.2) years. Anthropometric indexes (NC, waist circumference [WC] and body mass index [BMI]), biochemical and clinical parameters (diabetes, hypertension and dyslipidemia) and hepatic ultrasound were measured. The association between NC and NAFLD was estimated using multinomial logistic regression, considering potential confounding effects (age, WC, diabetes, hypertension and dyslipidemia). Effect modification was investigated by including the interaction term NC x BMI in the final model. RESULTS: The frequency of NAFLD and mean value of NC were 33.6% and 33.9 (± 2.5) cm in women, and 45.8% and 39.4 (± 2.8) cm in men, respectively. Even after all adjustments, larger NC was associated with a greater chance of moderate/severe NAFLD (1.16; 95% confidence interval [CI] for women; 1.05, 95% CI for men; P < 0.001). Presence of multiplicative interaction between NC and BMI (P < 0.001) was also observed. CONCLUSION: NC was positively associated with NAFLD in both sexes, regardless of traditional adiposity indexes such as BMI and WC. The magnitude of the association was more pronounced among women.

https://doi.org/10.1590/1516-3180.2021.0095.r2.22062021

Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil
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Santos, Itamar S.

; Lotufo, Paulo A.

; Goulart, Alessandra C.

; Brant, Luisa C. C.

; Pinto Filho, Marcelo M

; Pereira, Alexandre C.

; Barreto, Sandhi M.

; Ribeiro, Antonio L. P.

; Thomas, G Neil

; Lip, Gregory Y. H.

; Bensenor, Isabela M.

; Arasalingam, Ajini

; Beane, Abi

; Bensenor, Isabela M

; Brocklehurst, Peter

; Cheng, Kar Keung

; El-Bouri, Wahbi

; Feng, Mei

; Goulart, Alessandra C

; Greenfield, Sheila

; Guo, Yutao

; Guruparan, Mahesan

; Gusso, Gustavo

; Gooden, Tiffany E

; Haniffa, Rashan

; Humphreys, Lindsey

; Jolly, Kate

; Jowett, Sue

; Kumarendran, Balachandran

; Lancashire, Emma

; Lane, Deirdre A

; Li, Xuewen

; Lip (Co-PI), Gregory Y.H.

; Li, Yan-guang

; Lobban, Trudie

; Lotufo, Paulo A

; Manseki-Holland, Semira

; Moore, David J

; Nirantharakumar, Krishnarajah

; Olmos, Rodrigo D

; Paschoal, Elisabete

; Pirasanth, Paskaran

; Powsiga, Uruthirakumar

; Romagnolli, Carla

; Santos, Itamar S

; Shantsila, Alena

; Sheron, Vethanayagam Antony

; Shribavan, Kanesamoorthy

; Szmigin, Isabelle

; Subaschandren, Kumaran

; Surenthirakumaran, Rajendra

; Tai, Meihui

; Neil Thomas (Co-PI), G

; Varella, Ana C

; Wang, Hao

; Wang, Jingya

; Zhang, Hui

; Zhong, Jiaoyue

Arquivos Brasileiros de Cardiologia

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2022, N. ahead

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15–0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19–2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.

https://doi.org/10.36660/abc.20210970

Chronic inflammatory diseases, subclinical atherosclerosis, and cardiovascular diseases: Design, objectives, and baseline characteristics of a prospective case-cohort study ‒ ELSA-Brasil
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Bensenor, Isabela M.

; Goulart, Alessandra C.

; Pereira, Alexandre C.

; Brunoni, André R.

; Alencar, Airlane

; Santos, Raul D.

; Bittencourt, Márcio S.

; Telles, Rosa W.

; Machado, Luciana Andrade Carneiro

; Barreto, Sandhi Maria

; de Almeida-Pititto, Bianca

; Janovsky, Carolina Porto Silva

; Sgarbi, José Augusto

; Tebar, William R.

; Meneghini, Vandrize

; Barbosa Junior, Fernando

; Ribeiro, Ana Cristina de Medeiros

; Pasoto, Sandra Gofinet

; Pereira, Rosa Maria R.

; Bonfá, Eloísa

; Sipahi, Aytan M.

; Santos, Itamar de S.

; Lotufo, Paulo A.

Clinics

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2022, Volume 77 elocation 100013

Abstract: En | Text: En | PDF: En

Abstract Objectives This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. Conclusions The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.

https://doi.org/10.1016/j.clinsp.2022.100013

ELEIÇÕES E EXTREMISMO NO BRASIL: ANÁLISE DOS PROGRAMAS DE GOVERNO DE HADDAD E BOLSONARO
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Faria, Alessandra Maia Terra de

; Silva, Mayra Goulart da

; Jorge, Vladimyr Lombardo

Revista Brasileira de Ciências Sociais

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2022, Volume 37 N. 110 elocation e3711008

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: O presente artigo analisa as eleições presidenciais de 2018 no Brasil por meio da utilização da metodologia desenvolvida pelo Comparative Manifesto Project (CMP-Marpor), conciliando abordagens teóricas e empíricas sobre extremismo. O estudo indaga sobre quais conteúdos indicam que a eleição de 2018 foi polarizada e podem ser considerados marcadores de posicionamentos políticos extremistas. Na análise qualitativa dos programas de governo dos candidatos Fernando Haddad (PT) e Jair Bolsonaro (PSL) que disputaram o segundo turno, adotamos a definição de polarização para verificar se: há dissenso entre os candidatos quanto à interpretação dos problemas brasileiros; as perspectivas dos candidatos são inconciliáveis; e se algum dos candidatos questiona o sistema político e as regras do jogo. Ao final, demonstramos que Bolsonaro foi um candidato de extrema-direita, enquanto Haddad foi um candidato de esquerda, porém não um extremista. Sendo assim, concluímos que a eleição de 2018 é um exemplo de extremismo, que em contexto de sucesso eleitoral, abre espaço para tendências que reforçam assimetrias na cena política nacional.

ABSTRACT: This article analyzes the 2018 presidential elections in Brazil based on the methodology developed by CMP-Marpor, reconciling theoretical and empirical approaches on extremism. The study asks about what content indicate that there was a polarized election in 2018 and can be considered markers of extremist political positions. In the qualitative analysis of government programs, we use a definition of polarization to examine government programs and to verify whether: there is dissent among candidates about the interpretation of Brazilian problems; the candidates' perspectives are irreconcilable; the candidate questions the political system and the rules of the game. In the end, we demonstrate that Jair Bolsonaro was an extreme right-wing candidate, but Fernando Haddad was a left-wing candidate, however not an extremist. Thus, we conclude that the 2018 election is an example of extremism, which in case of electoral success, opens space for trends that reinforce asymmetries in the national political scene.

https://doi.org/10.1590/3711008/2022

10.

Consumo de bebidas alcoólicas e obesidade abdominal: resultados da linha de base do ELSA-Brasil
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Torres, Gabrielle Guidoni

; Siqueira, Jordana Herzog

; Martinez, Oscar Geovanny Enriquez

; Pereira, Taísa Sabrina Silva

; Meléndez, Jorge Gustavo Velásquez

; Duncan, Bruce Bartholow

; Goulart, Alessandra Carvalho

; Molina, Maria del Carmen Bisi

Ciência & Saúde Coletiva

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2022, Volume 27 N. 2 Pages 737 - 746

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232022272.02282021

11.

Incidence of TPOAb over a 4-year follow-up period: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
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Benseñor, Isabela M.

; Janovsky, Carolina Castro Porto Silva

; Goulart, Alessandra C.

; Santos, Itamar de Souza

; Diniz, Maria de Fátima Haueisen Sander

; Almeida-Pititto, Bianca de

; Sgarbi, José Augusto

; Lotufo, Paulo A.

Archives of Endocrinology and Metabolism

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dec 2021, Volume 65 N. 6 Pages 832 - 840

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Materials and methods: This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results: Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion: Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.

https://doi.org/10.20945/2359-3997000000422 2 downloads

12.

O Prognóstico da Doença Arterial Coronariana em um Hospital Público no Brasil: Achado do Estudo ERICO
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Bruno, Tatiana Cristina

; Bittencourt, Marcio Sommer

; Quidim, Alessandra V. L.

; Santos, Itamar

; Lotufo, Paulo

; Bensenor, Isabela

; Goulart, Alessandra

Arquivos Brasileiros de Cardiologia

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nov 2021, Volume 117 N. 5 Pages 978 - 985

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento O prognóstico de longo prazo pós síndrome coronária aguda (SCA) no cuidado secundário não é bem conhecido. A gravidade da doença arterial coronariana (DAC) como preditor de mortalidade no longo prazo foi avaliada em um hospital público no Brasil. Objetivo O objetivo deste estudo foi comparar o prognóstico de curto e longo prazo após um evento de SCA, de acordo com a gravidade da doença obstrutiva, em pacientes atendidos em um hospital público secundário para um coorte prospectivo sobre DAC no Brasil (o Estudo de Registro de Insuficiência Coronariana, estudo ERICO) Métodos Foram realizadas análises de sobrevida por curvas de Kaplan-Meier e modelo de risco proporcional de Cox [razão de risco (RR) com o respectivo intervalo de confiança (IC) de 95% para avaliar mortalidade cumulativa global, por DCV e DAC, de acordo com a obstrução arterial coronária: sem obstrução (grupo de referência), doença de um vaso, doença de dois vasos, doença de múltiplos vasos] entre 800 adultos do estudo ERICO durante 4 anos de monitoramento. As RR são apresentadas como dados brutos e posteriormente padronizadas quanto a possíveis fatores de confusão, no período de 180 dias até 4 anos de monitoramento após a SCA. O p-valor <0.05 foi considerado estatisticamente significativo. Resultados Taxas de sobrevida mais baixas foram detectadas entre indivíduos com a doença de múltiplos vasos (global, DCV e DAC, p de teste de Log-rank <0,0001). Depois da padronização multivariada, a doença de múltiplos vasos [RR; 2,33 (IC 95%; 1,10-4,95)] e doença de um vaso obstruído [RR; 2,44 (IC 95%; 1,11-5,34)] tiveram o risco mais alto de mortalidade global comparadas aos índices dos sujeitos sem obstrução no monitoramento de 4 anos. Conclusões Não só os pacientes com doença de múltiplos vasos como também os com doença de um vaso tiveram alto risco de mortalidade no longo prazo pós-SCA. Esses achados destacam a importância de se ter uma abordagem melhor no tratamento e no controle de fatores de risco cardiovascular, mesmo em indivíduos com risco aparentemente baixo, atendidos em cuidado secundário.

Abstract Background Long-term prognosis post-acute coronary syndrome (ACS) in secondary care is not well-known. The severity of coronary artery disease (CAD) as a predictor of long-term mortality was evaluated in a community hospital in Brazil. Objective We aimed to compare short and long-term prognosis after an ACS event according to severity of obstructive disease in patients attended in a secondary community hospital from prospective CAD cohort in Brazil (the Strategy of Registry of Acute Coronary Syndrome, ERICO study). Methods Survival analyses were performed by Kaplan-Meier curves and Cox proportional hazard models (hazard ratios (HR) with respective 95% confidence interval (CI) to evaluate cumulative all-cause, CVD and CAD mortality according the coronary artery obstruction: no-obstruction (reference group), 1-vessel-disease, 2-vessel-disease, multivessel-disease) among 800 adults from an ERICO study during a 4-year-follow-up. HR are presented as crude and further adjusted for potential confounders from 180 days to 4-year follow-up after ACS. A p-value <0.05 was considered statistically significant. Results Poorer survival rates were detected among individuals with multivessel-disease (all-cause, CVD and CAD, p-log rank< 0.0001). After multivariate adjustments, multivessel-disease |(HR; 2.33 (CI 95%; 1.10-4.95)) and 1-vessel-disease obstructed (HR; 2.44 (CI 95%; 1.11-5.34)) had the highest risk for all-cause mortality compared to those with no obstruction at 4-year follow-up. Conclusions Not only multivessel-disease, but also 1-vessel-disease patients showed a high long-term mortality risk post-ACS. These findings highlight the importance of having a better approach in the treatment and control of cardiovascular risk even in apparently low-risk individuals attended to in secondary care.

https://doi.org/10.36660/abc.20200399 3 downloads

13.

Incidence of thyroid diseases: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
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Benseñor, Isabela M.

; Sgarbi, José Augusto

; Janovsky, Carolina Castro Porto Silva

; Pittito, Bianca Almeida

; Diniz, Maria de Fátima Haueisen Sander

; Almeida, Maria da Conceição Chagas de

; Alvim, Sheila Maria

; Barreto, Sandhi M.

; Giatti, Luana

; Duncan, Bruce B.

; Schmidt, Maria Inês

; Fonseca, Maria de Jesus M.

; Griep, Rosane H.

; Molina, Maria del Carmen B.

; Mill, José Geraldo

; Santos, Itamar de Souza

; Goulart, Alessandra C.

; Lotufo, Paulo A.

Archives of Endocrinology and Metabolism

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aug 2021, Volume 65 N. 4 Pages 468 - 478

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To evaluate incidence of subclinical and overt hyperthyroidism and hypothyroidism. Subjects and methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of 15,105 civil servants, examined at baseline and over a 4-year follow-up. This analysis included 9,705 participants with normal thyroid function at baseline, follow-up information about thyroid function and with no report of using drugs that may interfere in the thyroid function. Thyroid function was defined by TSH/FT4 levels or routine use of thyroid hormones/anti-thyroid medications. Annual and cumulative (over 4-year) incidence rates were presented as percentages (95% Confidence Intervals). Results: The incidence of all overt and subclinical thyroid disease was 6.7% (1.73%/year): 0.19% for overt hyperthyroidism (0.048%/year), 0.54% for subclinical hyperthyroidism (0.14%/year), 1.98% for overt hypothyroidism (0.51%/year), and 3.99% for subclinical hypothyroidism (1.03%/year). The incidence of all thyroid diseases was higher in women, when compared to men, with a low women:men ratio (1.36). For Blacks the highest incidence was for overt hyperthyroidism, while for Whites, the highest incidence was for overt hypothyroidism. However, the highest incidence of overt hyperthyroidism was detected in Asian descendants. The presence of antithyroperoxidase antibodies at baseline was associated with higher incidence of overt thyroid diseases. Conclusion: These results showed a high incidence of hypothyroidism, which is compatible with a country with a more-than-adequate iodine intake. The low women:men ratio of the incidence of thyroid dysfunction highlights the importance of the diagnosis of thyroid diseases among men in Brazil.

https://doi.org/10.20945/2359-3997000000348 273 downloads

14.

Withdrawal period for seeding cotton after chemical control of cotton stalks
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Francischini, Alessandra Constantin

; Constantin, Jamil

; Matte, Willian Daróz

; Oliveira Junior, Rubem Silvério de

; Mendes, Rafael Romero

; Machado, Fellipe Goulart

Arquivos do Instituto Biológico

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2021, Volume 88 elocation e00392020

Abstract: En | Text: En | PDF: En

ABSTRACT A very limited amount of information is available in relation both to the residual effect of herbicides destinated to the destruction of cotton stalks and to the time interval required to prevent that development and yield of the following crop be affected. This work aimed to identify the residual activity of herbicides intended to eliminate cotton stalks and to estimate the safety interval (SI) of time for the next cotton sowing. Two trails were simultaneously carried out, the first one for a single application and a second one for the two sequential applications of herbicide treatments, in a 15×5 factorial design organized in randomized complete blocks with four replications. Levels of first factor were constituted by herbicide treatments and the levels of the second factor were composed five periods of time for cotton sowing after herbicide application (0, 30, 60, 90, and 120 days). Herbicides were 2,4-D, glyphosate, saflufenacil, [imazapic + imazapyr], dicamba, fluroxypyr and sulfentrazone. Results provided an indication of residual activity of herbicide treatments in soil and indicated that a single application or two sequential applications of glyphosate + dicamba + saflufenacil have a considerable potential to affect cotton and a period exceeding 100 days for a single application and exceeding 120 days for two sequential applications was necessary. Treatments with 2,4-D and 2,4-D + glyphosate provided the shortest safe interval and may be used for cotton stalk destruction with no risks for the crop sowing after the withdrawal period.

https://doi.org/10.1590/1808-1657000392020 1 downloads

15.

Frequência e Motivos para a não Administração e Suspensão de Medicamentos durante um Evento de Síndrome Coronariana Aguda. Estudo ERICO
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Santos, Rafael C. O.

; Bensenor, Isabela M.

; Goulart, Alessandra C.

; Lotufo, Paulo A.

; Santos, Itamar S.

Arquivos Brasileiros de Cardiologia

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nov 2020, Volume 115 N. 5 Pages 830 - 839

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamentos: Poucos estudos discutiram causas para o subtratamento medicamentoso na SCA. Objetivos: Avaliar a não-administração e suspensão de medicamentos durante o tratamento intra-hospitalar da SCA na Estratégia de Registro de Síndrome Coronariana Aguda (estudo ERICO). Métodos: Analisamos prontuários de 563 participantes ERICO para avaliar a frequência e motivos da não administração e/ou suspensão de medicamentos. Construímos modelos de regressão logística para avaliar se sexo, idade ≥65 anos, nível educacional ou subtipo de SCA estavam associados com (a) não administração de ≥1 medicamentos; e (b) não administração ou suspensão de ≥1 medicamentos. O nível de significância foi 5%. Resultados: A amostra é composta por 58,1% de homens e com idade mediana de 62 anos. Em 183 (32,5%) participantes ≥1 medicamentos não foram administrados e 288 (51,2%) apresentaram ≥1 medicamentos não administrados ou suspensos. As causas mais frequentes foram risco de sangramento (aspirina, clopidogrel e heparina), insuficiência cardíaca (betabloqueadores) e hipotensão (inibidores da enzima conversora da angiotensina e bloqueadores dos receptores da angiotensina). Indivíduos com idade ≥65 anos (razão de chances [RC]:1,51; intervalo de confiança de 95% [IC95%]:1,05-2,19) e com angina instável (RC:1,72; IC95%:1,07-2,75) tiveram maior chance de não-administração. Considerando apenas pacientes com infarto do miocárdio, idade ≥65 anos foi associada tanto à não administração quanto à não administração ou suspensão. Conclusões: A não administração ou suspensão de ≥1 medicamento não foi rara no estudo ERICO. Indivíduos com idade ≥65 anos ou com angina instável tiveram maior chance de não administração e podem ser subtratados nesse cenário.

Abstract Background: Few studies have discussed the reasons for pharmacological undertreatment of Acute Coronary Syndrome (ACS). Objectives: To determine the frequency and reasons for the non-administration and suspension of medications during in-hospital treatments of ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods: The present study analyzed the medical charts of the 563 participants in the ERICO study to evaluate the frequency and reasons for the non-administration and/or suspension of medications. Logistic regression models were built to analyze if sex, age ≥65 years of age, educational level, or ACS subtype were associated with (a) the non-administration of ≥1 medications; and (b) the non-administration or suspension of ≥1 medications. The significance level was set at 5%. Results: This study's sample included 58.1% males, with a median of 62 years of age. In 183 (32.5%) participants, ≥1 medications were not administered, while in 288 (51.2%), ≥1 medications were not administered or were suspended. The most common reasons were the risk of bleeding (aspirin, clopidogrel, and heparin), heart failure (beta blockers), and hypotension (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers). Individuals aged ≥65 (odds ratio [OR]:1.51; 95% confidence interval [95% CI]:1.05-2.19) and those with unstable angina (OR:1.72; 95% CI:1.07-2.75) showed a higher probability for the non-administration of ≥1 medication. Considering only patients with myocardial infarction, being ≥65 years of age was associated with both the non-administration and the non-administration or suspension of ≥1 medication. Conclusions: Non-administration or suspension of ≥1 medication proved to be common in this ERICO study. Individuals of ≥65 years of age or with unstable angina showed a higher probability of the non-administration of ≥1 medication and may be undertreated in this scenario. (Arq Bras Cardiol. 2020; 115(5):830-839)

https://doi.org/10.36660/abc.20190317

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