Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/BUOS-9UHN95 |
Resumo: | Gestational diabetes is carbohydrate intolerance that begins or is first diagnosed in pregnancy and its prevalence rate varies between 2 and 7%. It is an opportunity to evaluate early stage of diabetes because these patients face 7.5 times higher risk of developing type 2 diabetes and the consequent increase in cardiovascular risk. Objective: To determine whether women with previous gestational diabetes (GDM) have signs of subclinical atherosclerosis and whether this would be an independent risk factor for this outcome. Methods: We evaluated 175 women between 18 and 47 years, non-smokers: 79 with previous GDM (pGDM), 30 with two or more cardiovascular risk factors (RFg) and 66 in the control group (CG). They underwent physical examination, automatic measurement of intima-media thickness (IMT) in segments of common carotid, internal and bifurcation bilaterally and laboratory evaluation. To validate the chosen method for assessment of subclinical atherosclerosis, the measurement of carotid IMT, a literature review of the technique, indications and interpretation of the examination was performed. The software used in this research for automated measuring the IMT was subsequently validated, with comparisons between automated and manual measurements and interobserver agreement by Bland-Altman. Clinical characteristics, prevalence of diabetes, hypertension (HT) and metabolic syndrome (MS), and the measures of the IMT of the groups were compared. It was rated the overall cardiovascular risk of the groups. Then, a univariate and multivariate linear regression with composed IMT as the dependent variable and age, study groups, blood glucose, waist, HDLc, total cholesterol, triglycerides, MS and HT as covariates. Results: This study demonstrated that automated measurement is faster, reproductible and had no systematic erros compared to manual measurement. The differences between measurements were not clinicaly important in most part of the time. Global cardiovascular risk of 94% of the patients was in the range of low risk. Previous GDM and RF groups showed, as expected, higher levels of blood pressure, blood glucose, total cholesterol, cLDL, triglycerides and lower levels of HDLc than the CG. Obesity and waist were more frequently observed in groups pGDM and RFg, and significantly higher in the RFg compared to pGDM. Mean IMT of almost all segments analyzed was higher in group pGDM compared with CG, except in the carotid bifurcation and right common carotid. The RFg only showed greater IMT than control in the composite measure, and less than the group pGDM the left carotid bifurcation. After univariate linear regression analyses, a multiple regression model was developed using composite IMT as the dependent variable and study groups, blood glucose, total cholesterol, cHDL, triglycerides, age, waist circumference and hypertension as covariates. In the final model, age, cholesterol and belonging to pGDM group were independently associated with IMT composite. This final model explains 36.6% of IMT variability by the variables included. Conclusion: previous GDM is associated with increased carotid IMT as an independent risk factor, along with total cholesterol and age. The increased IMT in this population of women, similar to those with two or more known cardiovascular risk factors, should encourage early primary care prevention in patients with pregnancy complicated by GDM. |
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Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascularEspessura médio-intimal carotídeaDiabetes gestacionalAterosclerose subclínicaDoença cardiovascularDiabetes na gravidezComplicações cardiovasculares na gravidezDoenças cardiovascularesDiabetes gestacionalEspessura intima-media carotídeAteroscleroseGestational diabetes is carbohydrate intolerance that begins or is first diagnosed in pregnancy and its prevalence rate varies between 2 and 7%. It is an opportunity to evaluate early stage of diabetes because these patients face 7.5 times higher risk of developing type 2 diabetes and the consequent increase in cardiovascular risk. Objective: To determine whether women with previous gestational diabetes (GDM) have signs of subclinical atherosclerosis and whether this would be an independent risk factor for this outcome. Methods: We evaluated 175 women between 18 and 47 years, non-smokers: 79 with previous GDM (pGDM), 30 with two or more cardiovascular risk factors (RFg) and 66 in the control group (CG). They underwent physical examination, automatic measurement of intima-media thickness (IMT) in segments of common carotid, internal and bifurcation bilaterally and laboratory evaluation. To validate the chosen method for assessment of subclinical atherosclerosis, the measurement of carotid IMT, a literature review of the technique, indications and interpretation of the examination was performed. The software used in this research for automated measuring the IMT was subsequently validated, with comparisons between automated and manual measurements and interobserver agreement by Bland-Altman. Clinical characteristics, prevalence of diabetes, hypertension (HT) and metabolic syndrome (MS), and the measures of the IMT of the groups were compared. It was rated the overall cardiovascular risk of the groups. Then, a univariate and multivariate linear regression with composed IMT as the dependent variable and age, study groups, blood glucose, waist, HDLc, total cholesterol, triglycerides, MS and HT as covariates. Results: This study demonstrated that automated measurement is faster, reproductible and had no systematic erros compared to manual measurement. The differences between measurements were not clinicaly important in most part of the time. Global cardiovascular risk of 94% of the patients was in the range of low risk. Previous GDM and RF groups showed, as expected, higher levels of blood pressure, blood glucose, total cholesterol, cLDL, triglycerides and lower levels of HDLc than the CG. Obesity and waist were more frequently observed in groups pGDM and RFg, and significantly higher in the RFg compared to pGDM. Mean IMT of almost all segments analyzed was higher in group pGDM compared with CG, except in the carotid bifurcation and right common carotid. The RFg only showed greater IMT than control in the composite measure, and less than the group pGDM the left carotid bifurcation. After univariate linear regression analyses, a multiple regression model was developed using composite IMT as the dependent variable and study groups, blood glucose, total cholesterol, cHDL, triglycerides, age, waist circumference and hypertension as covariates. In the final model, age, cholesterol and belonging to pGDM group were independently associated with IMT composite. This final model explains 36.6% of IMT variability by the variables included. Conclusion: previous GDM is associated with increased carotid IMT as an independent risk factor, along with total cholesterol and age. The increased IMT in this population of women, similar to those with two or more known cardiovascular risk factors, should encourage early primary care prevention in patients with pregnancy complicated by GDM.O diabetes gestacional é a intolerância ao carboidrato, que começa ou é primeiramente diagnosticada na gravidez cuja prevalência varia entre 2 e 7%. É a oportunidade de avaliar seu estágio inicial, pois essas pacientes enfrentam risco 7,5 vezes mais alto de evoluir para diabetes tipo 2 e consequente elevação do risco cardiovascular. Objetivo: determinar se mulheres com passado de diabetes gestacional (DMG) apresentam sinais de aterosclerose subclínica e se isso seria fator de risco independente para o seu aparecimento. Métodos: avaliaram-se 175 mulheres entre 18 e 47 anos, não-tabagistas: 79 com passado de DMG (pDMG), 30 com dois ou mais fatores de risco cardiovascular (gFR) e 66 saudáveis como grupocontrole (GC). Elas foram submetidas a exame físico, medida automática da espessura médio-intimal (EMI) em segmentos da carótida comum, interna e bifurcação bilateralmente e avaliação laboratorial. Primeiro, realizou-se revisão da literatura sobre avaliação da aterosclerose subclínica por EMI, incluindo técnica, indicações e interpretação do exame à luz dos conhecimentos atuais. Após, estudouse a validação do software de medida automática da EMI utilizado nesta pesquisa, com comparações entre as medidas manuais e automáticas e concordância interobservadores pelo método de Bland-Altman. Posteriormente, compararam-se características clínicas e prevalências de diabetes, hipertensão arterial (HA), síndrome metabólica (SM), risco cardiovascular global e medidas da EMI dos grupos. Em seguida, regressão linear uni e multivariada foi realizada, definindo-se a EMI composta como variável dependente; as covariáveis foram: idade, grupos de estudo (pDMG e gFR), glicemia, cintura, cHDL, colesterol total, triglicérides, SM e HA. Resultados: na validação do software desta pesquisa, demonstrou-se que a medida automática reduz o tempo de exame, é reprodutível e não apresenta erros sistemáticos em relação à manual. Além disso, esses erros não alcançaram os limites clínicos estabelecidos na maioria das medidas. O risco cardiovascular global era baixo em 94% dessas mulheres. Os grupos FR e pDMG mostraram, como esperado, níveis mais elevados de pressão arterial, glicemia, colesterol total, cLDL, triglicérides e níveis mais baixos de cHDL do que o GC. Obesidade e cintura aumentada foram mais frequentes nos grupos pDMG e gFR, mas significativamente mais elevados no gFR em relação ao pDMG. A EMI média de quase todos os segmentos avaliados foi maior no grupo pDMG quando comparado com o GC, exceto na bifurcação carotídea e carótida comum direitas. O gFR só mostrou maior EMI do que o controle na medida composta; e menor do que o grupo pDMG na bifurcação carotídea esquerda. Após regressão linear univariada foi desenvolvido modelo de regressão múltipla tomandose a EMI composta como a variável dependente e os grupos de estudo glicemia, colesterol total, cHDL, triglicérides, idade, cintura, SM e hipertensão como covariáveis. No modelo final, a idade, o colesterol e pertencer ao grupo pDMG foram independentemente associados à EMI composta. Esse modelo final explica 36,6% da variabilidade de EMI pelas variáveis incluídas. Conclusão: o passado de DMG está associado a aumento da EMI carotídea como fator de risco independente, juntamente com colesterol total e idade. O aumento da EMI nessas mulheres com passado de diabetes gestacional, semelhante àquelas sabidamente com dois ou mais fatores de risco cardiovascular, deve estimular cuidados de prevenção primária precoce.Universidade Federal de Minas GeraisUFMGAntonio Ribeiro de Oliveira JuniorAntonio Luiz Pinho RibeiroMaria do Carmo Pereira NunesBruno CaramelliMárcia Melo BarbosaClaudia Maria Vilas Freire2019-08-14T18:53:58Z2019-08-14T18:53:58Z2010-06-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfhttp://hdl.handle.net/1843/BUOS-9UHN95info:eu-repo/semantics/openAccessporreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMG2019-11-14T19:29:16Zoai:repositorio.ufmg.br:1843/BUOS-9UHN95Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oairepositorio@ufmg.bropendoar:2019-11-14T19:29:16Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.none.fl_str_mv |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
title |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
spellingShingle |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular Claudia Maria Vilas Freire Espessura médio-intimal carotídea Diabetes gestacional Aterosclerose subclínica Doença cardiovascular Diabetes na gravidez Complicações cardiovasculares na gravidez Doenças cardiovasculares Diabetes gestacional Espessura intima-media carotíde Aterosclerose |
title_short |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
title_full |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
title_fullStr |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
title_full_unstemmed |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
title_sort |
Avaliação de aterosclerose subcliníca e fatores de risco matabólicos em mulheres jovens com risco de doença cardiovascular |
author |
Claudia Maria Vilas Freire |
author_facet |
Claudia Maria Vilas Freire |
author_role |
author |
dc.contributor.none.fl_str_mv |
Antonio Ribeiro de Oliveira Junior Antonio Luiz Pinho Ribeiro Maria do Carmo Pereira Nunes Bruno Caramelli Márcia Melo Barbosa |
dc.contributor.author.fl_str_mv |
Claudia Maria Vilas Freire |
dc.subject.por.fl_str_mv |
Espessura médio-intimal carotídea Diabetes gestacional Aterosclerose subclínica Doença cardiovascular Diabetes na gravidez Complicações cardiovasculares na gravidez Doenças cardiovasculares Diabetes gestacional Espessura intima-media carotíde Aterosclerose |
topic |
Espessura médio-intimal carotídea Diabetes gestacional Aterosclerose subclínica Doença cardiovascular Diabetes na gravidez Complicações cardiovasculares na gravidez Doenças cardiovasculares Diabetes gestacional Espessura intima-media carotíde Aterosclerose |
description |
Gestational diabetes is carbohydrate intolerance that begins or is first diagnosed in pregnancy and its prevalence rate varies between 2 and 7%. It is an opportunity to evaluate early stage of diabetes because these patients face 7.5 times higher risk of developing type 2 diabetes and the consequent increase in cardiovascular risk. Objective: To determine whether women with previous gestational diabetes (GDM) have signs of subclinical atherosclerosis and whether this would be an independent risk factor for this outcome. Methods: We evaluated 175 women between 18 and 47 years, non-smokers: 79 with previous GDM (pGDM), 30 with two or more cardiovascular risk factors (RFg) and 66 in the control group (CG). They underwent physical examination, automatic measurement of intima-media thickness (IMT) in segments of common carotid, internal and bifurcation bilaterally and laboratory evaluation. To validate the chosen method for assessment of subclinical atherosclerosis, the measurement of carotid IMT, a literature review of the technique, indications and interpretation of the examination was performed. The software used in this research for automated measuring the IMT was subsequently validated, with comparisons between automated and manual measurements and interobserver agreement by Bland-Altman. Clinical characteristics, prevalence of diabetes, hypertension (HT) and metabolic syndrome (MS), and the measures of the IMT of the groups were compared. It was rated the overall cardiovascular risk of the groups. Then, a univariate and multivariate linear regression with composed IMT as the dependent variable and age, study groups, blood glucose, waist, HDLc, total cholesterol, triglycerides, MS and HT as covariates. Results: This study demonstrated that automated measurement is faster, reproductible and had no systematic erros compared to manual measurement. The differences between measurements were not clinicaly important in most part of the time. Global cardiovascular risk of 94% of the patients was in the range of low risk. Previous GDM and RF groups showed, as expected, higher levels of blood pressure, blood glucose, total cholesterol, cLDL, triglycerides and lower levels of HDLc than the CG. Obesity and waist were more frequently observed in groups pGDM and RFg, and significantly higher in the RFg compared to pGDM. Mean IMT of almost all segments analyzed was higher in group pGDM compared with CG, except in the carotid bifurcation and right common carotid. The RFg only showed greater IMT than control in the composite measure, and less than the group pGDM the left carotid bifurcation. After univariate linear regression analyses, a multiple regression model was developed using composite IMT as the dependent variable and study groups, blood glucose, total cholesterol, cHDL, triglycerides, age, waist circumference and hypertension as covariates. In the final model, age, cholesterol and belonging to pGDM group were independently associated with IMT composite. This final model explains 36.6% of IMT variability by the variables included. Conclusion: previous GDM is associated with increased carotid IMT as an independent risk factor, along with total cholesterol and age. The increased IMT in this population of women, similar to those with two or more known cardiovascular risk factors, should encourage early primary care prevention in patients with pregnancy complicated by GDM. |
publishDate |
2010 |
dc.date.none.fl_str_mv |
2010-06-30 2019-08-14T18:53:58Z 2019-08-14T18:53:58Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/BUOS-9UHN95 |
url |
http://hdl.handle.net/1843/BUOS-9UHN95 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais UFMG |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais UFMG |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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Universidade Federal de Minas Gerais (UFMG) |
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UFMG |
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UFMG |
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Repositório Institucional da UFMG |
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Repositório Institucional da UFMG |
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Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG) |
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repositorio@ufmg.br |
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1816829832153006080 |