Search

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Introduction: Vascular calcification related to severe secondary hyperparathyroidism (SHPT) is an important cause of cardiovascular and bone complications, leading to high morbidity and mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). The present study aimed to analyze whether ankle-brachial index (ABI), a non-invasive diagnostic tool, is able to predict cardiovascular outcomes in this population. Methods: We selected 88 adult patients on HD for at least 6 months, with serum iPTH>1,000pg/mL. We collected clinical data, biochemical and hormonal parameters, and ABI (sonar-Doppler). Calcification was assessed by lateral radiography of the abdomen and by simple vascular calcification score (SVCS). This cohort was monitored prospectively between 2012 and 2019 for cardiovascular outcomes (death, myocardial infarction (MI), stroke, and calciphylaxis) to estimate the accuracy of ABI in this setting. Results: The baseline values were: iPTH: 1770±689pg/mL, P: 5.8±1.2 mg/dL, corrected Ca: 9.7±0.8mg/dL, 25(OH)vit D: 25.1±10.9ng/mL. Sixty-five percent of patients had ABI>1.3 (ranging from 0.6 to 3.2); 66% had SVCS≥3, and 45% aortic calcification (Kauppila≥8). The prospective evaluation (51.6±24.0 months), provided the following cardiovascular outcomes: 11% of deaths, 17% of nonfatal MI, one stroke, and 3% of calciphylaxis. After adjustments, patients with ABI≥1.6 had 8.9-fold higher risk of cardiovascular events (p=0.035), and ABI≥1.8 had 12.2-fold higher risk of cardiovascular mortality (p=0.019). Conclusion: The presence of vascular calcifications and arterial stiffness was highly prevalent in our population. We suggest that ABI, a simple and cost-effective diagnostic tool, could be used at an outpatient basis to predict cardiovascular events in patients with severe SHPT undergoing HD.

The NEPHROS is a randomized controlled trial which applied a 16-week aerobic and resistance training to patients with chronic kidney disease (CKD) and high blood pressure. This report describes a long-term post-trial follow-up, comparing survival, health-related quality of life (HRQoL), and estimated glomerular filtration rate (GFR) change between the intervention and control groups according to in-trial cardiovascular risk factors. Three years after the original trial, NEPHROS participants were re-evaluated. Cox proportional hazards model was used to compare survival time and linear regression for changes in GFR and physical and mental HRQoL summary scores between intervention and control groups according to age, sex, and in-trial GFR, C-reactive protein, glucose, lipids, ankle-brachial index (ABI), functional capacity, and blood pressure. Of the 150 participants of NEPHROS, 128 were included in the long-term analysis. The previous exercise training had no effects on survival, GFR, or HRQoL. Baseline in-trial GFR (HR = 0.95, 95%CI: 0.92; 0.98) and ABI (HR = 0.03, 95%CI: 0.002; 0.43) were positive independent predictors for survival. Lower ABI (coefficient = 9.00, 95%CI: 0.43; 17.5) and higher systolic blood pressure (coefficient = -0.13, 95%CI: -0.24; -0.03) were independent predictors for GFR decline. A 16-week exercise program had no long-term effect on survival, quality of life, or glomerular filtration in patients with CKD stages 2 to 4. Lower GFR and ABI and higher systolic blood pressure were associated with poorer prognosis among CKD patients.

Objective: To investigate the concordance between the modified Framingham score using the ankle-brachial index and the high-sensitivity C-reactive protein with the other scores. Materials and method: Cross-sectional study nested with a cohort, with elderly population, from January to March, 2018. The population characterization was presented as mean, median, absolute and relative frequencies according to degree of normality. The Kappa concordance of the modified Framingham score was calculated with the Framingham score itself, with the Systematic Coronary Risk Evaluation (Score) and with the Prospective Cardiovascular Munster (Procam). Results: The modified Framingham score shows moderate Kappa concordance with the Framingham score and the Score (p <0.001), but weak with Procam. The ultra-sensitive C-reactive protein presented more reclassification of individuals among risk strata than the ankle-brachial index. Conclusions: The Framingham score modified with the Framingham score itself, and then with the Score obtained a higher proportion of concordant cases in the high-risk stratum. High-sensitivity C-reactive protein and the ankle-brachial index modify cardiovascular risk as emerging factors to provide an accurate risk stratification and to infer better management of the therapy. Thus, the Framingham score with its reclassification is the best screening tool for cardiovascular risk. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depression are highly prevalent neuropsychiatric conditions and are associated with chronic diseases, pain, loss of autonomy, dependence on others to perform routine activities, and loneliness. Depression often has a cause-and-effect relationship with other diseases, such as: acute myocardial infarction (AMI), systemic arterial hypertension (SAH), diabetes mellitus (DM) and peripheral arterial disease (PAD). Objectives: To estimate the frequency of anxiety and depression in patients of both sexes with PAD admitted to a tertiary hospital. Methods: This is a descriptive, cross-sectional study, with a non-random sample selected consecutively. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression, and the ankle-brachial index (ABI) was used to assess PAD. Results: The prevalence of anxiety in these patients was 24.4%, with associations between anxiety and monthly family income, smoking, and SAH. The prevalence of depression was 27.6%, with associations between depression and the female gender, being married or in a stable relationship, living on a family income of one minimum wage or less, not being an alcoholic, and having hypertension. Conclusions: There are high prevalence rates of anxiety and depressive disorders among patients with PAD, which are underdiagnosed and, hence, not properly treated. [ABSTRACT FROM AUTHOR]

FUNDAMENTO: A associação do índice tornozelo-braquial (ITB) com a medida do complexo médio intimal das artérias carótidas (MCMI) não está amplamente estudada. OBJETIVO: Objetivamos avaliar se pacientes com ITB < 0,9 apresentam maior prevalência de placa aterosclerótica carotídea do que aqueles com ITB > 0,9. MÉTODOS: No período de janeiro a dezembro de 2011, recrutamos 118 pacientes (48 homens e 70 mulheres) que tiveram seus ITB e MCMI mensurados. Os pacientes foram divididos em grupo 1 (ITB < 0,9) e grupo 2 (ITB > 0,9). Utilizamos os testes de Mann-Whitney, qui-quadrado e Fischer para comparações entre os grupos. Para avaliar correlação entre ITB e MCMI empregamos a correlação de Pearson. RESULTADOS: A prevalência de ITB < 0,9 foi 29,7%, enquanto a da MCMI > 1,5 mm de 34,7%. Não houve diferença de características clínicas entre os grupos 1 e 2: idade média (64 ± 9 vs. 62 ± 7,2 anos, p = 0,1), homens (40% vs. 41%, p = 0,9), hipertensão (74% vs. 59%, p = 0,1), diabetes melito (54% vs. 35%, p = 0,051), dislipidemia 26% vs. 24%, p = 0,8), tabagismo (57% vs. 65%, p = 0,4). A prevalência de placa carotídea foi maior no grupo 1 (48,6% vs. 28,9%, p = 0,04). A correlação de Pearson entre o ITB e a MCMI foi de - 0,235, com valor de p = 0,01. CONCLUSÕES: Pacientes com ITB < 0,9 apresentaram maior prevalência de aterosclerose carotídea. Houve correlação negativa entre o ITB e a MCMI.BACKGROUND: The association between the ankle brachial index (ABI) and the measurement of intimal medial thickness (IMT) has not been fully studied. OBJECTIVE: We aimed to evaluate whether the prevalence of carotid atherosclerosis was higher in patients with ABI < 0.9 than in those with ABI > 0.9. METHODS: From January 2011 to December 2011, 118 patients (48 men and 70 women) were enrolled. ABI and IMT Measurements were performed in all patients. Patients were divided in Group 1 (ABI < 0.9) and Group 2 (ABI > 0.9) according to ABI values. Mann-Whitney, Chi-square and Fischer tests were used for comparison among the groups. Pearson's correlation was used to assess correlation between ABI and IMT. RESULTS: The prevalence of ABI < 0.9 was 29.7%, whereas carotid atherosclerosis > 1.5 mm was 34.7 %. Clinical characteristics were similar between groups 1 and 2: mean age (64 ± 9 vs. 62 ± 7.2 years, p = 0.1), male gender (40% vs. 41%, p = 0.9), hypertension (74% vs. 59%, p = 0.1), diabetes mellitus (54% vs. 35%, p = 0.051), dyslipidemia (26% vs. 24%, p = 0.8), smoking (57% vs. 65%, p = 0.4). The prevalence of carotid atherosclerosis was higher in group 1 (48.6% vs. 28.9%, p = 0.04). Pearson's correlation between ABI and IMT was -0.235, with a p value = 0.01. CONCLUSION: Patients with ABI < 0.9 showed a higher prevalence of carotid atherosclerosis. There was a negative correlation between ABI and IMT.

OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral). MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular), as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1%) fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4%) estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7%) e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index. These measurements were associated with the classical risk factors of atherosclerosis and the specific factors of those infected by HIV (duration of disease, length of treatment, kind of treatment, kind of antiretroviral therapy used, CD4 and viral load). METHODS: Seventy cases infected by HIV were assessed by automatic measurement of the intima-media complex in the carotids and of the ankle brachial index. The classical risk factors of atherosclerosis (age, gender, systemic arterial hypertension, smoking, hypercholesterolemia, hypertriglyceridemia, obesity, and family history of cardiovascular events), anthropometric measurements and the variables related to HIV were taken into consideration. The adopted level of significance was 5%. RESULTS: The mean time of HIV diagnosis was 104.9 months, mean duration of treatment was 97.9 months. As regard to the type of treatment, 47 (67.1%) used protease inhibitor for more than six months and 36 (51.4%) are using it recently. The ankle brachial index was increased in one patient (0.7%), and the intima-media complex was not thickened in any individual. There was no significant association of the measurement of the intima-media complex of the right common carotid with any of the variables analyzed. CONCLUSIONS: Young individuals under the use of antiretroviral therapy for five years or more did not show increase in thickness of the intima-media complex or increase in the ankle brachial index, and there was no difference in the intima-media complex thickness associated with the therapeutical scheme of antiretroviral used or the viral load level.

FUNDAMENTO: O índice tornozelo-braço (ITB) reduzido, inflamação e distúrbio mineral ósseo (DMO) estão associados com aumento no risco de morte e complicações cardiovasculares em pacientes em hemodiálise (HD), mas a relação entre esses fatores necessita ser elucidada. OBJETIVO: Avaliar a associação entre ITB anormal e DMO com inflamação em pacientes em HD. MÉTODOS: Esta análise transversal avaliou 478 pacientes em HD por pelo menos 1 ano. O ITB foi avaliado através de um Doppler portátil e manômetro de coluna de mercúrio. Os pacientes foram divididos em três grupos, de acordo com o ITB (baixo: 1,3). As medidas de proteína C-reativa foram utilizadas como marcador inflamatório, enquanto a DMO foi avaliada através dos níveis de cálcio, fósforo e hormônio paratireoidiano intacto (iPTH). RESULTADOS: Os participantes tinham 54 (18 a 75) anos, 56% eram do sexo masculino, 17% eram diabéticos e estavam em HM por 5 (1 a 35) anos. A prevalência de ITB baixo, normal e alto AAI foi 26,8%, 64,6% e 8,6%, respectivamente. Usando um modelo de regressão logística condicional com procedimento backward, idade (p6 mg/L (p= 0,006) estavam associados com a presença de ITB baixo, enquanto o sexo masculino (pFUNDAMENTO: El índice tobillo-brazo (ITB) reducido, la inflamación y el trastorno mineral óseo (TMO) se asocian con mayor riesgo de muerte y complicaciones cardiovasculares en pacientes sometidos a hemodiálisis (HD), pero la relación entre estos factores debe ser aclarada. Objetivos: Evaluar la asociación entre el ITB anormal la TMO con inflamación en paciente en HD. MÉTODOS: Este análisis transversal evaluó a 478 pacientes en HD durante al menos 1 año. El ITB se midió con un Doppler portátil y manómetro de columna de mercurio. Los pacientes fueron divididos en tres grupos, de acuerdo al ITB (bajo: < 0,9, normal: 0,9 a 1,3, y alto: > 1,3). Las mediciones de proteína C-reactiva se utilizaron como marcador inflamatorio, mientras que la TMO se evaluó a través de los niveles de calcio, fósforo y hormona paratiroidea intacta (iPTH). RESULTADOS: Los participantes tenían 54 (18-75) años, el 56% eran del sexo masculino, el 17% eran diabéticos y estaban se encontraban en HD por 5 (1 a 35) años. La prevalencia de ITB bajo, normal y alto ITB fue de un 26,8%, un 64,6% y un 8,6% respectivamente. Al utilizar un modelo de regresión logística condicional con el procedimiento backward (hacia atrás), diabetes (p < 0,001), y niveles de proteína C-reactiva > 6 mg/l (p = 0,006) estaban asociados con la presencia de ITB bajo, mientras que el sexo masculino (p < 0,001), diabetes (p = 0,001) y producto calcio x fósforo elevado (p = 0,026) estaban asociados con ITB alto. CONCLUSIÓN: En los pacientes en HD, la presencia de la diabetes estaba asociada con ITB alto y bajo. El riesgo de tener ITB bajo parece aumentar con la edad y la inflamación, mientras que la TMO estaba asociada con ITB alta. (Arq Bras Cardiol 2011;96(5):405-410)BACKGROUND: Reduced ankle-arm index (AAI), inflammation and mineral bone disorder (MBD) are all associated with increased risk of death and cardiovascular complications in patients on hemodialysis (HD), but the association between them deserves clarification. OBJECTIVE: To evaluate the association between abnormal AAI with MBD and inflammation in patients on HD. METHODS: This was a cross-sectional analysis of 478 patients on hemodialysis for at least one year. The AAI was evaluated using a portable Doppler and mercury column manometer. Patients were divided into 3 groups, according to AAI (low: 1.3). C-reactive protein measurement was used as an inflammatory marker, whereas MBD was evaluated by calcium, phosphorus and intact parathyroid hormone levels. RESULTS: Participants were 54 (18 to 75) years old, 56% males, 17% diabetics, and had been on hemodialysis for a mean of 5 (1 to 35) years. The prevalence of low, normal and high AAI was 26.8%, 64.6% and 8.6%, respectively. Using a backward conditional logistic regression model, age (p6 mg/L (p= 0.006) were associated with the presence of low AAI, whereas male gender (p

Background: Peripheral occlusive arterial disease has been found to be a sensitive marker of systemic atherosclerosis and a predictor of other cardiovascular diseases. In spite of the high prevalence of the cardiovascular diseases, there are few studies about peripheral occlusive arterial disease in patients with chronic renal failure under hemodialysis treatment. Objective: To determine the prevalence of peripheral occlusive arterial disease in patients with chronic renal failure under hemodialysis treatment at a center of excellence in the State of Sergipe, Brazil. Methods: A cross-sectional study was conducted from June to November 2008 at a center of excellence for the treatment of patients with chronic renal failure. Those patients with the ankle-brachial index (ABI) ⩽ 0.9 were diagnosed as having peripheral occlusive arterial disease. Results: From a population of 239 individuals with chronic renal failure, 201 were evaluated. Of that, 28 (14%) had peripheral arterial insufficiency with ABI ⩽ 0.9. Their age ranged from 24 to 82 years (mean age = 52 years). Hypertension and dyslipidemia were the more frequent risk factors. Among the patients with peripheral occlusive arterial disease, 89% had dyslipidemia; 71% had high blood pressure; and 29% had coronary diseases. Conclusion: The prevalence of peripheral occlusive arterial disease in patients with chronic renal failure was 14%. [ABSTRACT FROM AUTHOR]

This study aimed to investigate factors associated with orthostatic hypotension in 14,833 individuals 35-74 years of age. This was a cross-sectional study of baseline data (2008-2010) from the Longitudinal Study of Adult Health (ELSA-Brasil). Postural testing was performed after 20 minutes resting in supine position and active adoption of orthostatic posture. Blood pressure was measured in supine position and at 3 minutes in orthostatic position with an oscillometer (HEM 705 CP, Omron, São Paulo, Brazil). Orthostatic hypotension was defined as a drop of ≥ 20mmHg in systolic blood pressure and/or a drop of ≥ 10mmHg in diastolic blood pressure. The target covariates were sex, age bracket, race/color, schooling, nutritional status, waist circumference, alteration in the ankle-brachial index, pulse wave velocity, systolic and diastolic blood pressure, hypertension, diabetes, use of antihypertensives, cholesterol, triglycerides, Chagas disease serology, symptoms, and heart rate variation in the postural test, self-reported heart disease, acute myocardial infarction (AMI)/revascularization, and stroke. Orthostatic hypotension was significantly associated with higher age bracket, OR = 1.83 (95%CI: 1.14-2.95); alteration in the ankle-brachial index, OR = 2.8 (95%CI: 1.13-6.88); AMI/revascularization, OR = 1.70 (95%CI: 1.01-2.87); report of heart disease, OR = 3.03 (95%CI: 1.71-5.36); increased systolic blood pressure, OR = 1.012 (95%CI: 1.006-1.019); positive Chagas disease serology, OR = 2.29 (95%CI: 1.23-4.27); and occurrence of symptoms with postural change, OR = 20.81 (95%CI: 14.81-29.24). Presence of orthostatic hypotension can be a warning sign for cardiovascular disorders and thus a useful tool for screening and prevention.

Background: Increases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients., Objective: To describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease., Methods: This cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05., Results: Patients spent in average of 640 ± 121 min/day, 269 ± 94 min/day, 36 ± 27 min/day and 15 ± 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05)., Conclusion: The patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations.

Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population., Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls., Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant., Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17])., Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

Background: The Walking Estimated-Limitation Calculated by History (WELCH) questionnaire has been proposed to evaluate walking impairment in patients with intermittent claudication (IC), presenting satisfactory psychometric properties. However, a Brazilian Portuguese version of the questionnaire is unavailable, limiting its application in Brazilian patients., Objective: To analyze the psychometric properties of a translated Brazilian Portuguese version of the WELCH in Brazilian patients with IC., Methods: Eighty-four patients with IC participated in the study. After translation and back-translation, carried out by two independent translators, the concurrent validity of the WELCH was analyzed by correlating the questionnaire scores with the walking capacity assessed with the Gardner treadmill test. To determine the reliability of the WELCH, internal consistency and test-retest reliability with a seven-day interval between the two questionnaire applications were calculated., Results: There were significant correlations between the WELCH score and the claudication onset distance (r = 0.64, p = 0.01) and total walking distance (r = 0.61, p = 0.01). The internal consistency was 0.84 and the intraclass correlation coefficient between questionnaire evaluations was 0.84. There were no differences in WELCH scores between the two questionnaire applications., Conclusion: The Brazilian Portuguese version of the WELCH presents adequate validity and reliability indicators, which support its application to Brazilian patients with IC.

Background: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD)., Objective: This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH., Methods: The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL., Results: The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049)., Conclusion: Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

Objective: To evaluate the relationship between peripheral arterial disease and elevated levels of C-reactive protein in the Japanese-Brazilian population of high cardiovascular risk., Methods: We conducted a cross-sectional study derived from a population-based study on the prevalence of diabetes and associated diseases in the Japanese-Brazilian population. One thousand, three hundred and thirty individuals aged e" 30 underwent clinical and laboratory examination, including measurement of ultrasensitive C-reactive protein. The diagnosis of peripheral arterial disease was performed by calculating the ankle-brachial index. We considered with peripheral arterial disease patients who had ankle-brachial index d" 0.9. After applying the exclusion criteria, 1,038 subjects completed the study., Results: The mean age of the population was 56.8 years; 46% were male. The prevalence of peripheral arterial disease was 21%, with no difference between genders. Data analysis showed no association between peripheral arterial disease and ultrasensitive C-reactive protein. Patients with ankle-brachial index d" 0.70 showed higher values of ultrasensitive C-reactive protein and worse cardiometabolic profile. We found a positive independent association of peripheral arterial disease with hypertension and smoking., Conclusion: The association between low levels of ankle-brachial index and elevated levels of ultrasensitive C-reactive protein may suggest a relationship of gravity, aiding in the mapping of high-risk patients.

Elevated risk of fatal and non-fatal cardiovascular events is associated with high prevalence of peripheral arterial disease, with assessment through the ankle-brachial index (ABI). This study aimed to demonstrate that the ABI and the Edinburgh Claudication Questionnaire are tools to be used by nurses in prevention and/or treatment of CVD (cardiovascular disease). A cross-sectional study was carried out with patients from a cardiovascular clinic. The Edinburgh Claudication Questionnaire was applied and the ABI was measured with the formula (ABI= Blood Pressure Ankle/Blood Pressure Brachial). A total of 115 patients were included, most were females (57.4%), aged 60.6 ± 12.5 years. The most prevalent risk factors were hypertension (64.3%), physical inactivity (48.7%) and family history (58.3%). The study showed that abnormal ABI was frequently found and 42.6% of the patients with abnormal ABI showed intermittent claudication. The method to evaluate the ABI associated to the Edinburg Claudication Questionnaire, can be easily used by nurses in the clinical evaluation of asymptomatic and symptomatic CVD patients.

Background: The association between the ankle brachial index (ABI) and the measurement of intimal medial thickness (IMT) has not been fully studied., Objective: We aimed to evaluate whether the prevalence of carotid atherosclerosis was higher in patients with ABI < 0.9 than in those with ABI > 0.9., Methods: From January 2011 to December 2011, 118 patients (48 men and 70 women) were enrolled. ABI and IMT Measurements were performed in all patients. Patients were divided in Group 1 (ABI < 0.9) and Group 2 (ABI > 0.9) according to ABI values. Mann-Whitney, Chi-square and Fischer tests were used for comparison among the groups. Pearson's correlation was used to assess correlation between ABI and IMT., Results: The prevalence of ABI < 0.9 was 29.7%, whereas carotid atherosclerosis > 1.5 mm was 34.7 %. Clinical characteristics were similar between groups 1 and 2: mean age (64 ± 9 vs. 62 ± 7.2 years, p = 0.1), male gender (40% vs. 41%, p = 0.9), hypertension (74% vs. 59%, p = 0.1), diabetes mellitus (54% vs. 35%, p = 0.051), dyslipidemia (26% vs. 24%, p = 0.8), smoking (57% vs. 65%, p = 0.4). The prevalence of carotid atherosclerosis was higher in group 1 (48.6% vs. 28.9%, p = 0.04). Pearson's correlation between ABI and IMT was -0.235, with a p value = 0.01., Conclusion: Patients with ABI < 0.9 showed a higher prevalence of carotid atherosclerosis. There was a negative correlation between ABI and IMT.

Analysis of flow-mediated vasodilation (FMV) of the brachial artery by use of ultrasound allows assessing endothelial function, and provides pathophysiological, diagnostic and prognostic information. This systematic review was aimed at assessing the literature level of evidence of the predictive capacity of endothelial function, measured through brachial artery FMV by use of ultrasound, regarding cardiovascular events in individuals with atherosclerosis. The MEDLINE, SCIELO and LILACS databases were searched, and prospective cohort studies on human beings about the prognostic value of endothelial function, measured by use of brachial artery FMV in individuals with peripheral or coronary atherosclerosis, were selected. Studies with clear methodological biases were excluded. The final selection consisted of 15 studies. Of the 13 studies that on univariate analysis showed statistical significance of the FMV method to predict cardiovascular events, 12 showed independent predictive capacity on multivariate analysis. None of the studies reviewed described the incremental predictive value of FMV to the traditional predictive models, such as the Framingham score. Results of three studies have suggested that the method adds prognostic value to isolated markers such as ankle-brachial index (ABI), diabetes, and high-sensitivity C-reactive protein (hsCRP). In conclusion, brachial artery FMV predicts cardiovascular risk, but its incremental predictive value to clinical prognostic models has not been established. In addition, solid evidence supporting its use in routine clinical practice to predict cardiovascular risk still lacks.

The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5%), who were included in Group I; seven patients (17.5%) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m(2) (Group I) and 150.29 ± 34.06 g/m(2) (Group II) (p = 0.009). The prevalence of LVH was 4% (Group I) and 35.3% (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.

Background: Reduced ankle-arm index (AAI), inflammation and mineral bone disorder (MBD) are all associated with increased risk of death and cardiovascular complications in patients on hemodialysis (HD), but the association between them deserves clarification., Objective: To evaluate the association between abnormal AAI with MBD and inflammation in patients on HD., Methods: This was a cross-sectional analysis of 478 patients on hemodialysis for at least one year. The AAI was evaluated using a portable Doppler and mercury column manometer. Patients were divided into 3 groups, according to AAI (low: <0.9, normal: 0.9 to 1.3, and high: >1.3). C-reactive protein measurement was used as an inflammatory marker, whereas MBD was evaluated by calcium, phosphorus and intact parathyroid hormone levels., Results: Participants were 54 (18 to 75) years old, 56% males, 17% diabetics, and had been on hemodialysis for a mean of 5 (1 to 35) years. The prevalence of low, normal and high AAI was 26.8%, 64.6% and 8.6%, respectively. Using a backward conditional logistic regression model, age (p<0.001), diabetes (p= 0.001), and C-reactive protein levels >6 mg/L (p= 0.006) were associated with the presence of low AAI, whereas male gender (p<0.001), diabetes (p= 0.001) and elevated calcium x phosphorus product (p= 0.026) were associated with high AAI., Conclusion: In patients on hemodialysis, the presence of diabetes was associated with both low and high AAI. The risk of having low AAI seems to be increased by aging and inflammation, whereas BMD was associated with high AAI.

Objective: The aim of this study was to evaluate the prevalence of hemodynamically significant infrainguinal bypasses stenosis using reverse great saphenous vein graft., Methods: From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 out of 56 patients were submitted to vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition, the diagnosis of stenosis was related to the clinical and surgical characteristics of the patients. The variables analyzed at the moment of diagnosis were the localization of the graft stenosis, the risk factors associated with stenosis and the association of vascular ultrasonography findings with ankle brachial pressure index (ABI)., Results: The overall prevalence of significant graft stenosis was 48.4%. Out of the total number of observed stenosis, 19.4% were considered severe, and 29% mild or moderate. There was no significant association between the presence of significant stenosis and the following variables: gender, diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. There was a weak agreement between ABI and vascular ultrasonography in detecting stenosis in general (K = 0.30; CL95% 0.232 - 0.473; p = 0.018). However, there was a substantial agreement in detecting severe stenosis (K = 0.75; CL95% 0.655 - 0.811; p = 0.0001)., Conclusion: There was a high prevalence of stenosis on the 30th post-operative day, mostly localized in the proximal half of the vein graft. There was no significant association of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had weak agreement with the diagnosis of stenosis in general and an important agreement for the diagnosis of severe stenosis.

Introduction: Microalbuminuria, as determined by the urinary albumin to creatinine (AC) ratio, is a marker of target organ damage (TOD) in hypertensive patients. Pulse pressure (PP) predicts arterial elasticity and the ankle-brachial index (ABI) is a marker of cardiovascular morbidity. TOD reduction should be achieved through improvements in these indices., Objective: To determine whether ABI, calculated as the ratio between mean PP in the upper and lower limbs, is associated with a reduction in renal damage, as measured by the AC ratio., Methods: This was a prospective interventional study based on an intention-to-treat analysis in an opportunity sample of patients treated by three specialists in family medicine, with three-monthly follow-up over a total of six months. Blood pressure was measured in arms and ankles, and PP was calculated and used to determine right and left ABI and mean overall ABI. The AC ratio was determined by urine dipstick test. Descriptive and inferential statistical analysis was performed., Results: A sample of 75 patients were studied (42.4% women), of whom(42.4% women), of whom 27.6% were diabetic, 46.7% overweight/obese and 49.3% dyslipidemic. overweight/obese and 49 dyslipidemic. There were statistical differences for right ABI (as determined by PP) and for mean overall ABI (as determined by mean PP in lower and upper limbs). Bivariate correlation analysis showed that in the group with improved PP between the first and the third observations, n=23 (40%), there was a statistically significant reduction in AC ratio (r = -0.924, two-tailed p < 0.001); the opposite was observed in the group with reduced PP, in which the AC ratio increased., Discussion: ABI determined by systolic blood pressure is an excellent predictor of hemodynamic alterations. Increased ABI, based on PP, was accompanied by improved urinary AC ratio. These results are in line with the international literature., Conclusions: An improvement in urinary AC ratio--a predictor of TOD--is observed when an improvement in the ankle PP/brachial PP ratio is achieved.

Background: The Walking Impairment Questionnaire (WIQ) has been used to evaluate walking impairment in subjects with intermittent claudication (IC). However, this questionnaire has yet to be translated to Brazilian Portuguese, which limits its use in Brazilian subjects., Objective: To translate and analyze the validity and reliability of WIQ in Brazilian subjects with IC., Methods: Forty-two patients with IC, determined by the ankle-brachial index < 0.90, participated in the study. After translation and re-translation, carried out by two independent translators, the construct validity of the WIQ was analyzed by correlating the WIQ scores with the Medical Outcome Study Questionnaire Short Form 36 (SF-36) scores and the physical fitness performance (treadmill and strength tests). The reliability was analyzed with a 7-day interval between two questionnaire applications., Results: Significant correlations between the WIQ domains and the SF-36 (functional capacity, physical aspects, bodily pain and emotional aspects) and physical fitness performance (treadmill and strength tests) were observed. Moreover, the intraclass coefficient correlation ranged from 0.72 to 0.81, and there were no differences in WIQ scores between the two questionnaire applications., Conclusion: The Brazilian Portuguese version of the WIQ is valid and reliable to be used in Brazilian subjects with IC.