pré-hipertensão e risco cardiovascular

Hypertension. 2008;52:652

Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort
The Suita Study
Few prospective studies have examined the association between high-normal blood pressure and cardiovascular disease (CVD) in Asia. We examined the impact of high-normal blood pressure on the incidence of CVD in a general urban population cohort in Japan. We studied 5494 Japanese individuals (ages 30 to 79 years without CVD at baseline) after completing a baseline survey who received follow-up through December 2005. Blood pressure categories were defined on the basis of the ESH-ESC 2007 criteria. In 64 391 person-years of follow-up, we documented the incidence of 346 CVD events. The frequencies of high-normal blood pressure and hypertension Stage 1 and Stage 2 were 18.0%, 20.1%, and 10.1% for men and 15.9%, 15.6%, and 8.8% for women, respectively. Antihypertensive drug users were also classified into the baseline blood pressure categories. Compared with the optimal blood pressure group, the multivariable hazard ratios (95% confidence intervals) of CVD for normal and high-normal blood pressure and hypertension Stage 1 and Stage 2 were 2.04 (1.19 to 3.48), 2.46 (1.46 to 4.14), 2.62 (1.59 to 4.32), and 3.95 (2.37 to 6.58) in men and 1.12 (0.59 to 2.13), 1.54 (0.85 to 2.78), 1.35 (0.75 to 2.43), and 2.86 (1.60 to 5.12) in women, respectively. The risks of myocardial infarction and stroke for each blood pressure category were similar to those of CVD. Population-attributable fractions of high-normal blood pressure and hypertension for CVD were 12.2% and 35.3% in men and 7.1% and 23.4% in women, respectively. In conclusion, high-normal blood pressure is a risk factor for the incidence of stroke and myocardial infarction in a general urban population of Japanese men

gama gt e risco cardiovascular

Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1857

Change in Serum Gamma-Glutamyltransferase and Cardiovascular Disease Mortality. A Prospective Population-Based Study in 76 113 Austrian Adults

Abstract
Objective— The purpose of this study was to investigate the association of longitudinal change in serum -glutamyltransferase (GGT) with mortality from cardiovascular disease (CVD).
Methods and Results— A population-based cohort of 76 113 Austrian men and women with 455 331 serial GGT measurements was prospectively followed-up for a median of 10.2 years after assessment of longitudinal GGT change during an average period of 6.9 years. Cox proportional hazards regression with time-varying covariates was used to evaluate GGT change as an independent predictor for CVD death. Independently of baseline GGT and other classical CVD risk factors, a pronounced increase in GGT (7-year change >9.2 U/L) was significantly associated with increased total CVD mortality in men (P=0.005); the adjusted hazard ratio (95% confidence interval) in comparison to stable GGT (7-year change –0.7 to 1.3 U/L) was 1.40 (1.09 to 1.81). Similarly, total CVD risk was elevated for increasing GGT in women, although effects were less pronounced and statistically significant only in subanalyses regarding coronary heart disease. Age of participants significantly modified the relation between GGT change and CVD mortality, with markedly stronger associations to be observable for younger individuals.
Conclusion— Our study is the first to demonstrate that a longitudinal increase in GGT, independently of baseline GGT and even within its normal range, significantly increases risk of fatal CVD.
We prospectively investigated the association of longitudinal GGT change with CVD mortality in 76 113 men and women. We found increasing GGT, even within its normal range, to significantly increase risk of fatal CVD, independently of baseline GGT and other classical CVD risk factors.
Key Words: cardiovascular disease mortality • -glutamyltransferase • longitudinal change • risk factor • epidemiology

Adiposidade e risco cardiovascular: razão cintura/altura

J Am Coll Cardiol. 2008 Aug 19;52(8):605-15.
Measures of obesity and cardiovascular risk among men and women.
Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE, Kurth T.
OBJECTIVES: This study examined associations between anthropometric measures (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio [WHtR]) and risk of incident cardiovascular disease (CVD) (including nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death). BACKGROUND: Controversy exists regarding the optimal approach to measure adiposity, and the utility of body mass index has been questioned. METHODS: Participants included 16,332 men in the Physicians' Health Study (mean age 61 years in 1991) and 32,700 women in the Women's Health Study (mean age 61 years in 1999). We used Cox proportional hazards models to determine relative risks and 95% confidence intervals (CIs) for developing CVD according to self-reported anthropometric indexes. RESULTS: A total of 1,505 CVD cases occurred in men and 414 occurred in women (median follow-up 14.2 and 5.5 years, respectively). Although WHtR demonstrated statistically the strongest associations with CVD and best model fit, CVD risk increased linearly and significantly with higher levels of all indexes. Adjusting for confounders, the relative risk for CVD was 0.58 (95% CI: 0.32 to 1.05) for men with the lowest WHtR (<0.45)>/=0.69; vs. WHtR 0.49 to <0.53).>/=0.68; vs. WHtR 0.47 to <0.52).>

Qualidade de vida no portador de doença coronariana

Patient-Reported Health Status in Coronary Heart Disease in the United States
Age, Sex, Racial, and Ethnic Differences Circulation. 2008;118:491-497

Jipan Xie, MD, PhD; Eric Q. Wu, PhD; Zhi-Jie Zheng, MD, PhD; Patrick W. Sullivan, PhD; Lin Zhan, MS; Darwin R. Labarthe, MD, MPH, PhD
E-mail jipan.xie@gmail.com
Background— Coronary heart disease (CHD) affects 15.8 million Americans. However, data on the national impact of CHD on health-related quality of life, particularly among people of different age, sex, racial, and ethnic groups, are limited.
Methods and Results— Using data from the 2000 and 2002 Medical Expenditure Panel Survey, we examined various measures of patient-reported health status, including health-related quality of life, in the CHD and non-CHD populations and differences in the measures among demographic subgroups. These measures included short-form generic measures (Short Form 12; Mental Component Summary-12 and Physical Component Summary-12) and EuroQol Group measures (EQ-5D index and EQ visual analog scale). Ordinary least-squares regressions were used to adjust for sociodemographic characteristics, risk factors, comorbidities, and proxy report. The adjusted difference between the CHD and non-CHD populations was –1.2 for Mental Component Summary-12 (2.4% of the score in the non-CHD population), –4.6 for Physical Component Summary-12 (9.2%), –0.04 for EQ-5D (4.6%), and –7.3 for EQ visual analog scale (9.0%) (all P<0.05).>