Associação de pré-diabetes com marcadores precoces de lesão cardiovascular
Autor(a) principal: | |
---|---|
Data de Publicação: | 2021 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFSCAR |
Texto Completo: | https://repositorio.ufscar.br/handle/ufscar/14251 |
Resumo: | Introduction: Diabetes mellitus type 2 (DM2) is responsible for about 90% of diabetes cases and its mortality is associated with micro and macrovascular complications. Individuals who are at a higher risk of developing DM2 are called prediabetics (PD). It is estimated that approximately 25% of individuals with PD will develop DM2 in three to five years. It is not yet clear in the literature how is the cardiovascular function of these patients. It is believed that there are early markers of cardiac and endothelial dysfunction in this population and that they may be associated with impaired quality of life. Objectives: To assess the presence of early markers of impairment in endothelial and cardiovascular function in PD patients compared to normoglycemic individuals and to investigate if there is an association of these markers with worsening of the quality of life. Methods: Cross-sectional clinical study with the composition of two groups: Prediabetics (PD): who met the criteria for PD and are not on hypoglycemic medication; and Normoglycemic Control (NG): who do not meet the criteria for DM and PD. Patients in both groups had no known cardiovascular disease. They underwent clinical and physical evaluation, echocardiogram, evaluation of carotid intima-media thickness (CIMT), evaluation of arterial stiffness (AR) through pulse wave velocity (PWV), SF-36 quality of life questionnaire, and sedentary lifestyle IPAQ questionnaire. Statistical analysis: comparison of groups using the Chi-square test for categorical variables, T Student test for variables with normal distribution and Man-Whitney for variables with non-normal distribution. Associations between variables in the same group were assessed by linear regression. Results: The groups were homogeneous in relation to baseline and clinical variables. In the PD group, a greater association with dyslipidemia (p<0.001) was observed, in addition to early signs of diastolic dysfunction assessed by the E wave velocity of the Mitral flow E (E (cm/s): NG 84.08 ± 13.56 vs PD 77.70 ± 11.82, p = 0.03) and greater RA (VOP (m/s): NG 7.16 ± 1.54 vs PD 7.92 ± 1.75, p = 0.04). In the linear regression model, the presence of impaired glucose tolerance was an independent factor associated with the E wave of the Mitral flow, even adjusting for confounding variables (p = 0.02). There was more prevalence of right ventricle diastolic dysfunction, regarding to E/A ratio of Tricuspid Inflow (p = 0.03) and E’ Tricuspid of Tissue Doppler (p = 0.04). The PD group also showed greater impairment in quality of life in functional capacity (p = 0.03), pain (p = 0.03), vitality (p = 0.03) dominoes and also a higher degree of sedentary lifestyle by the IPAQ score (p = 0.006). Glucose intolerance was associated with a higher degree of physical inactivity. Conclusion: PD individuals, compared to NG patients of similar age and sex, already have early markers of cardiac and endothelial dysfunction, in addition to greater impairment in quality of life. Decreased glucose tolerance, despite the association with other risk factors, such as dyslipidemia and physical inactivity, is an independent factor associated with thereductio of E mitral wave velocity. |
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Firmino, Stella MarisRoscani, Meliza Goihttp://lattes.cnpq.br/1298051150234135Leal, Ângela Merice de Oliveirahttp://lattes.cnpq.br/7202663545989206http://lattes.cnpq.br/4613374023699883474bf38a-0298-4897-9cdf-d0a3c7088f5e2021-05-11T12:53:43Z2021-05-11T12:53:43Z2021-04-16FIRMINO, Stella Maris. Associação de pré-diabetes com marcadores precoces de lesão cardiovascular. 2021. Tese (Doutorado em Biotecnologia) – Universidade Federal de São Carlos, São Carlos, 2021. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14251.https://repositorio.ufscar.br/handle/ufscar/14251Introduction: Diabetes mellitus type 2 (DM2) is responsible for about 90% of diabetes cases and its mortality is associated with micro and macrovascular complications. Individuals who are at a higher risk of developing DM2 are called prediabetics (PD). It is estimated that approximately 25% of individuals with PD will develop DM2 in three to five years. It is not yet clear in the literature how is the cardiovascular function of these patients. It is believed that there are early markers of cardiac and endothelial dysfunction in this population and that they may be associated with impaired quality of life. Objectives: To assess the presence of early markers of impairment in endothelial and cardiovascular function in PD patients compared to normoglycemic individuals and to investigate if there is an association of these markers with worsening of the quality of life. Methods: Cross-sectional clinical study with the composition of two groups: Prediabetics (PD): who met the criteria for PD and are not on hypoglycemic medication; and Normoglycemic Control (NG): who do not meet the criteria for DM and PD. Patients in both groups had no known cardiovascular disease. They underwent clinical and physical evaluation, echocardiogram, evaluation of carotid intima-media thickness (CIMT), evaluation of arterial stiffness (AR) through pulse wave velocity (PWV), SF-36 quality of life questionnaire, and sedentary lifestyle IPAQ questionnaire. Statistical analysis: comparison of groups using the Chi-square test for categorical variables, T Student test for variables with normal distribution and Man-Whitney for variables with non-normal distribution. Associations between variables in the same group were assessed by linear regression. Results: The groups were homogeneous in relation to baseline and clinical variables. In the PD group, a greater association with dyslipidemia (p<0.001) was observed, in addition to early signs of diastolic dysfunction assessed by the E wave velocity of the Mitral flow E (E (cm/s): NG 84.08 ± 13.56 vs PD 77.70 ± 11.82, p = 0.03) and greater RA (VOP (m/s): NG 7.16 ± 1.54 vs PD 7.92 ± 1.75, p = 0.04). In the linear regression model, the presence of impaired glucose tolerance was an independent factor associated with the E wave of the Mitral flow, even adjusting for confounding variables (p = 0.02). There was more prevalence of right ventricle diastolic dysfunction, regarding to E/A ratio of Tricuspid Inflow (p = 0.03) and E’ Tricuspid of Tissue Doppler (p = 0.04). The PD group also showed greater impairment in quality of life in functional capacity (p = 0.03), pain (p = 0.03), vitality (p = 0.03) dominoes and also a higher degree of sedentary lifestyle by the IPAQ score (p = 0.006). Glucose intolerance was associated with a higher degree of physical inactivity. Conclusion: PD individuals, compared to NG patients of similar age and sex, already have early markers of cardiac and endothelial dysfunction, in addition to greater impairment in quality of life. Decreased glucose tolerance, despite the association with other risk factors, such as dyslipidemia and physical inactivity, is an independent factor associated with thereductio of E mitral wave velocity.Introdução: Diabetes mellitus tipo 2 (DM2) é responsável por cerca de 90% dos casos de diabetes e sua mortalidade está associada a complicações micro e macrovasculares. Os indivíduos que apresentam maior risco de desenvolvimento de DM2 são denominados pré-diabéticos. Estima-se que aproximadamente 25% dos indivíduos com pré-diabetes desenvolverão DM2 em três a cinco anos. Ainda não está esclarecido na literatura como se comporta a função cardiovascular desses pacientes. Acredita-se que possam existir marcadores precoces de disfunção cardíaca e endotelial e que estejam associados a prejuízo na qualidade de vida (QV) dessa população. Objetivos: Avaliar a presença de marcadores precoces de prejuízo na função endotelial e cardiovascular de pacientes pré-diabéticos comparados a indivíduos normoglicêmicos e investigar se há associação desses marcadores com QV. Métodos: Estudo clínico transversal com composição de dois grupos: Pré-diabéticos (PD; N = 43): que preencheram os critérios para PD e não estão em uso de medicação hipoglicemiante; e Controle Normoglicêmicos (NG; N = 37): que não preencherem os critérios de DM e de pré-diabetes. Os pacientes de ambos os grupos não apresentavam doença cardiovascular conhecida. Foram submetidos à avaliação clínica e física, ecocardiograma transtorácico, avaliação da espessura médio-intimal carotídea (EMIC), avaliação da rigidez arterial (RA) através velocidade de onda de pulso (VOP), questionário de QV SF-36, e de grau de sedentarismo IPAQ. Análise estatística: comparação dos grupos através de teste de Qui-Quadrado para variáveis categóricas e teste T para variáveis com distribuição normal e Man-Whitney para variáveis de distribuição não normal. Associações entre variáveis do mesmo grupo foram avaliadas por regressão linear. Análise de regressão múltipla também foi realizada para identificar preditores independentes relacionados com intolerância à glicose. Resultados: Os grupos foram homogêneos em relação às variáveis basais e clínicas. No grupo PD, foi observada maior associação com dislipidemia (p<0,001), além de menor velocidade da onda E do fluxo mitral (E (cm/s): NG 84,08 ± 13,56 vs PD 77,70 ± 11,82, p = 0,03) e maior RA) (VOP (m/s): NG 7,16 ± 1,54 vs PD 7,92 ± 1,75, p = 0,04). Também foi observada maior prevalência de disfunção diastólica do ventrículo direito no grupo PD avaliada pela relação E/A fluxo tricúspide (p = 0,03) e E’ do Doppler tecidual tricúspide (p=0,04). No modelo de regressão múltipla, a presença de tolerância diminuída à glicose foi fator independente associado com a velocidade da onda E do fluxo Mitral, mesmo ajustando para variáveis confundidoras (p = 0,02). O grupo PD também apresentou maior prejuízo na QV nos quesitos capacidade funcional (p = 0,03), dor (p = 0,03), vitalidade (p=0,03) e também maior grau de sedentarismo pelo score de IPAQ (p = 0,006). Também foi encontrada associação entre intolerância à glicose e maior grau de sedentarismo. Conclusão: Indivíduos PD, comparados a pacientes NG de idade e sexo semelhante já apresentam marcadores precoces de disfunção cardíaca e endotelial, além de maior prejuízo na QV. Tolerância diminuída à glicose, apesar da associação com outros fatores de risco, como dislipidemia e sedentarismo, é fator independente associado à redução da velocidade de pico da onda E do Doppler mitral.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CAPES: Código de Financiamento 001FAPESP: 2019 / 08945-0FAPESP: 2019 / 10011-6porUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Biotecnologia - PPGBiotecUFSCarAttribution-NonCommercial-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nc-nd/3.0/br/info:eu-repo/semantics/openAccessDisfunção cardiovascularDisfunção endotelialPré-diabetesCardiovascular dysfunctionEndothelial dysfunctionPrediabeticsCIENCIAS DA SAUDE::MEDICINACIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIAAssociação de pré-diabetes com marcadores precoces de lesão cardiovascularAssociation of prediabetes with early markers of cardiovascular injuryinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis600600d3b9b9ec-d811-4770-bb49-98e2ec24f2e3reponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARORIGINALtese final stella repositorio 10-05-21.pdftese final stella repositorio 10-05-21.pdfArtigo principalapplication/pdf2172821https://repositorio.ufscar.br/bitstream/ufscar/14251/3/tese%20final%20stella%20repositorio%2010-05-21.pdfc40fe9be4a7e994f2a665e4f32ff00cbMD53Carta comprovante do Orientador.pdfCarta comprovante do Orientador.pdfCarta comprovanteapplication/pdf433166https://repositorio.ufscar.br/bitstream/ufscar/14251/4/Carta%20comprovante%20do%20Orientador.pdf45343a9f8d4d51575282f36e4ce55c40MD54CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufscar.br/bitstream/ufscar/14251/5/license_rdfe39d27027a6cc9cb039ad269a5db8e34MD55TEXTtese final stella repositorio 10-05-21.pdf.txttese final stella repositorio 10-05-21.pdf.txtExtracted texttext/plain176719https://repositorio.ufscar.br/bitstream/ufscar/14251/6/tese%20final%20stella%20repositorio%2010-05-21.pdf.txt644f3f444ae8b63f77fcd0662c828a35MD56Carta comprovante do Orientador.pdf.txtCarta comprovante do Orientador.pdf.txtExtracted texttext/plain1172https://repositorio.ufscar.br/bitstream/ufscar/14251/8/Carta%20comprovante%20do%20Orientador.pdf.txtc4d552eff985cf9615f222fdfd77a533MD58THUMBNAILtese final stella repositorio 10-05-21.pdf.jpgtese final stella repositorio 10-05-21.pdf.jpgIM Thumbnailimage/jpeg6704https://repositorio.ufscar.br/bitstream/ufscar/14251/7/tese%20final%20stella%20repositorio%2010-05-21.pdf.jpg47c97fe8ca665b3dd23df70214504597MD57Carta comprovante do Orientador.pdf.jpgCarta comprovante do Orientador.pdf.jpgIM Thumbnailimage/jpeg5628https://repositorio.ufscar.br/bitstream/ufscar/14251/9/Carta%20comprovante%20do%20Orientador.pdf.jpg42b10518eeae289749cad238273be676MD59ufscar/142512023-09-18 18:32:10.757oai:repositorio.ufscar.br:ufscar/14251Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:32:10Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false |
dc.title.por.fl_str_mv |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
dc.title.alternative.eng.fl_str_mv |
Association of prediabetes with early markers of cardiovascular injury |
title |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
spellingShingle |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular Firmino, Stella Maris Disfunção cardiovascular Disfunção endotelial Pré-diabetes Cardiovascular dysfunction Endothelial dysfunction Prediabetics CIENCIAS DA SAUDE::MEDICINA CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA |
title_short |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
title_full |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
title_fullStr |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
title_full_unstemmed |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
title_sort |
Associação de pré-diabetes com marcadores precoces de lesão cardiovascular |
author |
Firmino, Stella Maris |
author_facet |
Firmino, Stella Maris |
author_role |
author |
dc.contributor.authorlattes.por.fl_str_mv |
http://lattes.cnpq.br/4613374023699883 |
dc.contributor.author.fl_str_mv |
Firmino, Stella Maris |
dc.contributor.advisor1.fl_str_mv |
Roscani, Meliza Goi |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/1298051150234135 |
dc.contributor.advisor-co1.fl_str_mv |
Leal, Ângela Merice de Oliveira |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/7202663545989206 |
dc.contributor.authorID.fl_str_mv |
474bf38a-0298-4897-9cdf-d0a3c7088f5e |
contributor_str_mv |
Roscani, Meliza Goi Leal, Ângela Merice de Oliveira |
dc.subject.por.fl_str_mv |
Disfunção cardiovascular Disfunção endotelial Pré-diabetes |
topic |
Disfunção cardiovascular Disfunção endotelial Pré-diabetes Cardiovascular dysfunction Endothelial dysfunction Prediabetics CIENCIAS DA SAUDE::MEDICINA CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA |
dc.subject.eng.fl_str_mv |
Cardiovascular dysfunction Endothelial dysfunction Prediabetics |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA |
description |
Introduction: Diabetes mellitus type 2 (DM2) is responsible for about 90% of diabetes cases and its mortality is associated with micro and macrovascular complications. Individuals who are at a higher risk of developing DM2 are called prediabetics (PD). It is estimated that approximately 25% of individuals with PD will develop DM2 in three to five years. It is not yet clear in the literature how is the cardiovascular function of these patients. It is believed that there are early markers of cardiac and endothelial dysfunction in this population and that they may be associated with impaired quality of life. Objectives: To assess the presence of early markers of impairment in endothelial and cardiovascular function in PD patients compared to normoglycemic individuals and to investigate if there is an association of these markers with worsening of the quality of life. Methods: Cross-sectional clinical study with the composition of two groups: Prediabetics (PD): who met the criteria for PD and are not on hypoglycemic medication; and Normoglycemic Control (NG): who do not meet the criteria for DM and PD. Patients in both groups had no known cardiovascular disease. They underwent clinical and physical evaluation, echocardiogram, evaluation of carotid intima-media thickness (CIMT), evaluation of arterial stiffness (AR) through pulse wave velocity (PWV), SF-36 quality of life questionnaire, and sedentary lifestyle IPAQ questionnaire. Statistical analysis: comparison of groups using the Chi-square test for categorical variables, T Student test for variables with normal distribution and Man-Whitney for variables with non-normal distribution. Associations between variables in the same group were assessed by linear regression. Results: The groups were homogeneous in relation to baseline and clinical variables. In the PD group, a greater association with dyslipidemia (p<0.001) was observed, in addition to early signs of diastolic dysfunction assessed by the E wave velocity of the Mitral flow E (E (cm/s): NG 84.08 ± 13.56 vs PD 77.70 ± 11.82, p = 0.03) and greater RA (VOP (m/s): NG 7.16 ± 1.54 vs PD 7.92 ± 1.75, p = 0.04). In the linear regression model, the presence of impaired glucose tolerance was an independent factor associated with the E wave of the Mitral flow, even adjusting for confounding variables (p = 0.02). There was more prevalence of right ventricle diastolic dysfunction, regarding to E/A ratio of Tricuspid Inflow (p = 0.03) and E’ Tricuspid of Tissue Doppler (p = 0.04). The PD group also showed greater impairment in quality of life in functional capacity (p = 0.03), pain (p = 0.03), vitality (p = 0.03) dominoes and also a higher degree of sedentary lifestyle by the IPAQ score (p = 0.006). Glucose intolerance was associated with a higher degree of physical inactivity. Conclusion: PD individuals, compared to NG patients of similar age and sex, already have early markers of cardiac and endothelial dysfunction, in addition to greater impairment in quality of life. Decreased glucose tolerance, despite the association with other risk factors, such as dyslipidemia and physical inactivity, is an independent factor associated with thereductio of E mitral wave velocity. |
publishDate |
2021 |
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2021-05-11T12:53:43Z |
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2021-05-11T12:53:43Z |
dc.date.issued.fl_str_mv |
2021-04-16 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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dc.identifier.citation.fl_str_mv |
FIRMINO, Stella Maris. Associação de pré-diabetes com marcadores precoces de lesão cardiovascular. 2021. Tese (Doutorado em Biotecnologia) – Universidade Federal de São Carlos, São Carlos, 2021. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14251. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufscar.br/handle/ufscar/14251 |
identifier_str_mv |
FIRMINO, Stella Maris. Associação de pré-diabetes com marcadores precoces de lesão cardiovascular. 2021. Tese (Doutorado em Biotecnologia) – Universidade Federal de São Carlos, São Carlos, 2021. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14251. |
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https://repositorio.ufscar.br/handle/ufscar/14251 |
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Attribution-NonCommercial-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nc-nd/3.0/br/ info:eu-repo/semantics/openAccess |
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Attribution-NonCommercial-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nc-nd/3.0/br/ |
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openAccess |
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Universidade Federal de São Carlos Câmpus São Carlos |
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Programa de Pós-Graduação em Biotecnologia - PPGBiotec |
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UFSCar |
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Universidade Federal de São Carlos Câmpus São Carlos |
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