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Master's Dissertation
DOI
10.11606/D.5.2006.tde-10102006-142452
Document
Author
Full name
Alessandra Macedo
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2006
Supervisor
Committee
Santos Filho, Raul Dias dos (President)
Bertolami, Marcelo Chiara
Maranhao, Raul Cavalcante
Title in Portuguese
"Avaliação de parâmetros clínicos e nutricionais em pacientes com hipercolesterolemia familiar heterozigótica"
Keywords in Portuguese
Arteriosclerose coronária
Fatores de risco
Fibra na dieta
Gorduras na dieta
Hipercolesterolemia familiar
Índice de massa corporal
Síndrome X metabólica
Abstract in Portuguese
A hipercolesterolemia familiar (HF) é caracterizada por concentrações elevadas de LDL-c e alta prevalência de doença arterial coronária (DAC) precoce. Entretanto, o curso da DAC nos portadores de HF é variável e pode ser influenciado por outros fatores de risco. O objetivo foi avaliar parâmetros clínicos e nutricionais de adultos portadores de HF heterozigótica por estudo do tipo transversal. Coletou-se do prontuário dos pacientes resultados de exames laboratoriais, medidas de pressão arterial e diagnósticos clínicos. Verificou-se a concordância ou não entre as categorias de risco pelos escores de Framingham (ERF) e pelos critérios estabelecidos para os portadores de HF. Antecedentes pessoais e familiares para DAC, tabagismo, atividade física, consumo alimentar de gorduras, fibras e bebidas alcoólicas foram obtidos por questionário e medidas antropométricas foram aferidas. Foram comparados os grupos com e sem Síndrome Metabólica (SM) e os grupos com e sem DAC por análise univariada. Após, foram verificados os fatores determinantes para o desenvolvimento da DAC mediante modelo de regressão multivariada. Foram entrevistados 110 pacientes (68 mulheres) com média de idade de 48,9 ± 16,2 anos. A presença de história familiar de DAC precoce foi relatada por 67 (61,5%) pacientes. A hipertensão foi encontrada em 59 (53,6%), SM em 38 (34,9%), DAC em 30 (27,3%), HDL-c baixo em 28 (25,5%), diabete melito em 17 (15,5%), 25 (22,7%) eram ex-fumantes e 12 (10,9%) tabagistas. Com a comparação das categorias de risco observou-se discrepância em 77,5% dos casos entre os ERF e os critérios estabelecidos para a população de HF. Quanto ao estado nutricional, 47 (42,7%) eram pré-obesos e 61 (55,4%) com circunferência da cintura alterada. O consumo de gorduras, fibras e bebidas alcoólicas foi considerado adequado. Encontrou-se grande número de sedentários (77%). O grupo dos pacientes com SM tinha idade mais avançada (55 vs 46 anos; p = 0,002), maior número de mulheres (76,3%; p = 0,02) e portadores de DAC (42,1%; p = 0,013). O grupo dos coronarianos tinha idade mais avançada (55 vs 47 anos; p = 0,004), mais pacientes do sexo masculino (60%; p = 0,004), maior presença de hipertensos (90%; p = 0,001), exfumantes (40%; p = 0,008), com SM (53,3%; p = 0,013), HDL-c baixo (53,3%; p = 0,001) e antecedente de infarto agudo do miocárdio (IAM) em irmãos (50%; p = 0,012). As medidas antropométricas, o consumo alimentar e a atividade física não foram diferentes entre os grupos. Após análise de regressão multivariada os fatores de risco determinantes para o desenvolvimento da DAC foram HDL-c baixo (OR 8,4; IC 95% 2,7-27,6), sexo masculino (OR 7,3; IC 95% 2,1-24,7), história de IAM em irmãos (OR 3,4; IC 95% 1,1-10,5) e idade avançada (OR 1,06; IC 95% 1,02-1,1). Em nossa população, HDL-c baixo, sexo masculino, história de IAM em irmãos e idade foram fatores independentes para o desenvolvimento da DAC.
Title in English
Assessment of clinical and nutritional parameters in subjects with heterozygous familial hypercholesterolaemia
Keywords in English
Body mass index
Coronary arteriosclerosis
Dietary fats
Dietary fiber
Hypercholesterolemia familial
Metabolic syndrome X
Risk factors
Abstract in English
Familial hypercholesterolaemia (FH) is characterized by raised concentrations of LDL-c and high prevalence of premature coronary artery disease (CAD). However, the course of the CAD in the FH is variable and can be influenced by other risk factors. The aim of the study was to assess clinical and nutritional parameters in adults with heterozigous FH by a cross sectional study. Laboratory exams, blood pressure measurement and clinical diagnosis were collected. Agreement or not between the categories of risk by Framingham scores and for established criteria for the FH subjects was verified. Personal and familial history for CAD, smoken habit, physical activity, fats, fibers and alcohol consumption were assessed by questionnaire and anthropometric measurement were verified. The groups with and without Metabolic Syndrome (MS) and groups with and without CAD were compared by univariated analysis. After, multivaried analysis (MVA) was used to assess the significance of differences in risk factors. The sample was composed by 110 patients (68 women) with average of age of 48.9 ± 16.2 years. The presence of familial history of premature CAD was detected in 67 (61.5%)subjects. Hypertension was found in 59 (53.6%), MS in 38 (34.9%), CAD in 30 (27.3%), low HDL-c in 28 (25.5%), diabetes in 17 (15.5%), 25 (22,7%) and 12 (10,9%) were respectively former and current smokers. In the comparison of the risk categories discrepancy was observed in 77.5% of the cases between the Framingham scores and the established criteria for the FH population. Analyzing the nutritional profile, 47 (42.7%) were overweight and 61 (55.4%) had increased waist circumference. The consumption of fats, fibers and alcohol were considered satisfactory. A great number of sedentary subjects was found (77%). The patients with MS were older (55 vs. 46 years; p = 0.002), had a greater number of women (76.3%; p = 0.02) and CAD (42.1%; p = 0.013). CAD subjects were older (55 vs. 47 years; p = 0.004), had a higher prevalence of males (60%; p = 0.004), hypertension (90%; p = 0.001), former smokers(40%; p = 0.008), MS (53.3%; p = 0.013), low HDL-c (53.3%; p = 0.001) and history of myocardial infarction in brothers (50%; p = 0.012). There were no differences between the groups regarding anthropometric measurements, consumption of fats, fiber and alcohol and physical activity. After MVA, independent risk factors for CAD were low HDL-c (OR 8.4; CI 95% 2.7-27.6), male gender (OR 7.3; CI 95% 2.1-24.7), history of myocardial infarction in brothers (OR 3.4; CI 95% 1.1-10.5) and advanced age (OR 1.06; CI 95% 1.02-1.1). In our population, low HDL-c, male gender, history of myocardial infarction in brothers and age were independently associated with the risk of CAD.
 
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Publishing Date
2006-10-20
 
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