ObjectivesTo correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease.SourcesA systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012.Summary of findingsRisk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents.ConclusionsStudies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century.

Objective: The identification of populational levels of maximum oxygen uptake (VO 2max ) is an aid to studies that propose to relate physical fitness to cardiovascular risk, and also for prescribing exercise and analyzing the effects of training. To date, there is no information with which this parameter can be classified in samples of adolescents from the Brazilian population. This study is, therefore, the first to propose the determination of mean VO 2max levels in a sample of the Brazilian population.Methods: A sample of 380 schoolchildren (177 boys and 203 girls, aged 10 to 14 years) was selected at random from public schools in Vitória, ES. After anthropometric assessment they underwent cardiopulmonary exercise testing, VO 2max was measured directly and results were classified according to quintiles calculated from the study sample.Results: The mean VO 2max values observed ranged from 42.95 to 49.55 mL.kg -1 .min -1 for boys and from 36.76 to 38.29 mL.kg -1 .min -1 for girls.Conclusions: This paper proposes mean VO 2max ranges as a classification parameter for cardiorespiratory fitness, in addition to contributing to a definition of normal values for the Brazilian population. This classification will also be of use for establishing cutoff points in future studies.J Pediatr (Rio J). 2006;82(6):426-30: Maximum oxygen uptake, adolescents, aerobic fitness, cardiopulmonary exercise testing. ResumoObjetivo: A identificação de valores populacionais do consumo máximo de oxigênio (VO 2 máx) auxilia nos estudos que se propõem a relacionar a aptidão física ao risco cardiovascular, bem como na prescrição do exercício e na análise do efeito do treinamento. Em amostras de adolescentes da população brasileira, ainda não existem informações para classificação desse parâmetro. Portanto, a proposta inédita deste estudo foi de determinar os valores médios de VO 2 máx de uma amostra da população brasileira.Métodos: Foi selecionada aleatoriamente uma amostra de 380 escolares (177 meninos e 203 meninas) da rede pública de Vitória (ES), com idade de 10 a 14 anos. Após avaliação antropométrica, foram submetidos a teste cardiopulmonar para medida direta do VO 2 máx, cujos valores foram classificados de acordo com o quintil calculado a partir da amostra estudada.Resultados: Os valores médios de VO 2 máx encontrados para os meninos foram de 42,95 a 49,55 mL.kg -1 .min -1 e, nas meninas, entre 36,76 e 38,29 mL.kg -1 .min -1 .Conclusões: O presente trabalho propõe faixas de valores médios de VO 2 máx como parâmetro para classificação de aptidão cardiorrespiratória, além de contribuir para a definição dos valores de normalidade da população brasileira. Essa classificação auxilia também no estabelecimento de pontos de corte para estudos posteriores. O sedentarismo é um problema crescente que tem atingido um número cada vez maior de crianças e adolescentes. Autores relatam que há uma tendência entre os adolescentes de se envolverem menos nas atividades de educação física escolar e em atividades vigorosas e de aumentarem o tempo d...

ResumoObjetivo: Avaliar a ocorrência de síndrome metabólica (SM) e fatores de risco associados em adolescentes de Vitória (ES). Métodos:Foram avaliados 380 adolescentes de 10 a 14 anos de idade estudantes de escolas públicas. Foram mensurados: índice de massa corporal, pressão arterial em repouso, dosagens séricas em jejum das concentrações de colesterol total, LDL-colesterol, HDL-colesterol, triglicerídeos e glicose.Resultados: Identificou-se prevalência de sobrepeso em 9,6% dos meninos e em 7,4% das meninas, enquanto que obesidade foi observada em 6,2 e 4,9%, respectivamente. As concentrações de triglicerídeos foram limítrofes ou altas em 6,8 e 3,4% dos meninos e em 11,8 e 5,9% das meninas. A concentração de HDL-colesterol estava abaixo dos níveis padronizados em 8,5% dos meninos e em 9,9% das meninas. A pressão arterial em repouso foi limítrofe para 5,1% dos meninos e 7,9% das meninas, enquanto que 3,4% tanto dos meninos quanto das meninas foram considerados hipertensos. Glicemia de jejum foi alta em 0,6% dos meninos e em 0,5% das meninas. No grupo estudado, 2,8% dos meninos e 2,5% das meninas apresentaram dois fatores de risco associados a SM. A prevalência de SM foi de 1,1% para meninos e 1,5% para meninas e a total foi de 1,3%. Conclusões:Fatores de risco cardiovasculares associados a SM são condições clínicas importantes nessa faixa etária. Um número significativo de adolescentes apresentou resultados limítrofes, os quais podem aumentar a prevalência de SM ou de fatores de risco independentes em curto prazo. Mais investimentos devem ser feitos na prevenção primária, considerando que o diagnóstico precoce é uma questão de fundamental importância. J Pediatr (Rio J). 2009;85(1):55-60:Síndrome metabólica, adolescentes, fatores de risco cardiovasculares, colesterol, obesidade. AbstractObjective: To evaluate the occurrence of metabolic syndrome (MS) and independent associated risk factors in adolescents in the city of Vitória, Brazil. Methods:We assessed 380 adolescents aged 10 to 14 years attending public schools. Body mass index and blood pressure at rest were measured. Fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and glucose were also obtained. Results:The prevalence of overweight was 9.6% for boys and 7.4% for girls, while obesity was found in 6.2 and 4.9%, respectively. Triglyceride concentrations were borderline or high in 6.8 and 3.4% of the boys and in 11.8 and 5.9% of the girls. HDL-cholesterol was below recommended levels in 8.5% of the boys and in 9.9% of the girls. Blood pressure at rest was borderline for 5.1% of the boys and 7.9% of the girls, while 3.4% of both boys and girls were hypertensive. Fasting glycemia was high in 0.6% of the boys and in 0.5% of the girls. In the group studied, 2.8% of the boys and 2.5% of the girls had two risk factors associated with MS. Prevalence of MS was 1.1% for boys and 1.5% for girls, and overall prevalence was 1.3%. Conclusions:MS and associated cardiovascular risk factors are serious clinical conditions in...

Background:Down syndrome is known to cause premature aging in several organ systems. However, it remains unclear whether this aging effect also affects the structure and function of the large arterial trunks. In this controlled study, the possibility of changes in the large arteries due to aging was evaluated in patients with Down syndrome.Methods:Eighty-two subjects of both genders were selected. The Down syndrome group had 41 active subjects consisting of 19 males and 22 females (mean age 21 ± 1, range 13–42 years) without cardiovascular complications and who did not use vasoactive drugs. The control group consisted of 41 healthy individuals without trisomy 21 of the same gender and age as the Down syndrome group and who did not use vasoactive medication. Carotid–femoral pulse wave velocity was obtained as an index of aortic stiffness using an automatic noninvasive method.Results:Individuals with Down syndrome had significantly lower blood pressure than those in the control group. Systolic blood pressure for the Down syndrome group and control group was 106 ± 2 mmHg vs 117 ± 2 mmHg (P < 0.001), respectively; diastolic blood pressure was 66 ± 2 mmHg vs 77 ± 2 mmHg (P < 0.001); and mean arterial pressure was 80 ± 1 mmHg vs 90 ± 1 mmHg (P < 0.001). Only age and systolic blood pressure were shown to correlate significantly with pulse wave velocity, but the slopes of the linear regression curves of these two variables showed no significant difference between the two study groups. Pulse wave velocity, which was initially significantly lower in the Down syndrome group (7.51 ± 0.14 m/s vs 7.84 ± 0.12 m/s; P <0.05), was similar between the groups after systolic blood pressure adjustment (7.62 ± 0.13 m/s vs 7.73 ± 0.13 m/s).Conclusion:Despite evidence in the literature that patients with Down syndrome undergo early aging, this process does not seem to affect the large arterial trunks, given that values of carotid-femoral pulse wave velocity were similar in individuals with or without trisomy 21. Considering that Down syndrome presents with chronic hypotension, it is reasonable to propose that the prolonged reduction of arterial distending pressure may contribute to functional preservation of the arteries in patients with Down syndrome.

Background The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35–32 °C, for stage 2 is < 32–28 °C, for stage 3 is < 28–24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model. Methods We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage. Results We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C). Conclusions Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.

Epidemiological and clinical evidence suggests that a judicious diet, regular physical activity and blood pressure (BP) monitoring must start in early childhood to minimize the impact of modifiable cardiovascular risk factors. This study was designed to evaluate BP and metabolic parameters of schoolchildren from Vitória, Espírito Santo State, Brazil, and correlate them with cardiovascular risk factors. The study was conducted on 380 students aged 10-14 years (177 boys, 203 girls) enrolled in public schools. Baseline measurements included body mass index, BP and heart rate. The students were submitted to exercise spirometry on a treadmill. VO 2max was obtained from exercise testing to voluntary exhaustion. Fasting serum total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), and glucose were measured. Nine point nine percent of the boys and 11.7% of the girls were hypertensive or had pre-hypertensive levels. There was no significant correlation between VO 2max and TC, LDL-C, or TG in prepubertal children, but a slight negative correlation was detected in post-pubertal boys for HDL-C and TG. In addition, children with hypertension (3.4%) or prehypertensive levels (6.6%) also had comorbidity for overweight and blood lipid abnormalities (14% for triglycerides, 44.7% for TC, 25.9% for LDL-C, 52% for low HDL-C). The present study shows for the first time high correlations between prehypertensive blood pressure levels and the cardiovascular risk factors high TC, high LDL-C, low HDL-C in schoolchildren. These are important for the formulation of public health policies and strategies.

Objetivo: O consumo máximo de oxigênio tem sido sugerido como medida preferível em relação a questionários de atividade física para expressar a aptidão cardiorrespiratória, por sua maior objetividade e menor possibilidade de erros. Estudos indicam que essa medida se correlaciona melhor com as doenças cardiovasculares. Este trabalho propõe-se a associar fatores de risco cardiovasculares em adolescentes ao nível de aptidão cardiorrespiratória. Métodos:Foram selecionados 380 escolares, 177 meninos e 203 meninas (10 a 14 anos), que foram divididos em dois grupos de acordo com a aptidão cardiorrespiratória. Realizou-se avaliação antropométrica, medidas hemodinâmicas (pressão arterial e freqüência cardíaca), teste cardiopulmonar e perfil bioquímico (triglicerídeos, colesterol total e frações).Resultados: Nos meninos, observou-se diferença significativa entre grupo "fraco" e "não fraco" para as médias de freqüência cardíaca basal, consumo máximo de oxigênio, índice de massa corporal e triglicerídeos. Nas meninas, as diferenças significativas foram nas médias de freqüência cardíaca basal, consumo máximo de oxigênio e índice de massa corporal. Em ambos os sexos, o grupo classificado como "fraco" apresentou maior número significativo de indivíduos com excesso de peso em relação ao grupo "não fraco" (χ2 = 25,242; p = 0,000; χ2 = 12,683; p = 0,000, para meninos e meninas, respectivamente). Associação significativa entre aptidão cardiorrespiratória e triglicerídeos (χ2 = 3,944; p = 0,047) observou-se apenas para o sexo masculino. Conclusões:A aptidão cardiorrespiratória mais baixa parece ter influência negativa sobre os fatores de risco cardiovasculares em adolescentes, especialmente em relação ao excesso de peso em ambos os gêneros e ao perfil bioquímico no sexo masculino, evidenciando para a necessidade de intervenções preventivas precoces. Methods:The study enrolled 380 schoolchildren, 177 boys and 203 girls (10 to 14 years old), who were divided into two groups according to their cardiorespiratory fitness. Anthropometric assessment was carried out, hemodynamic measurements (arterial pressure and heart rate) were taken, cardiopulmonary exercise testing was performed and biochemical tests were run (triglycerides, total and partial cholesterol).Results: Among the boys, significant differences were observed between boys defined as "weak" and those classed as "not weak" in terms of baseline heart rate, maximum oxygen uptake, body mass index and triglycerides. Among the girls, significant differences were detected between baseline heart rates, maximum oxygen uptake and body mass indices. In both sexes, the group classified as "weak" exhibited a significantly greater number of overweight individuals that the "not weak" group (χ2 = 25.242; p = 0.000; χ2 = 12.683; p = 0.000, for boys and girls, respectively). A significant association between cardiorespiratory fitness and triglycerides (χ2 = 3.944; p = 0.047) was observed among the boys only. Conclusions:A low level of cardiorespiratory fitness appears to have a negative influen...

Objective: The identification of populational levels of maximum oxygen uptake (VO 2max ) is an aid to studies that propose to relate physical fitness to cardiovascular risk, and also for prescribing exercise and analyzing the effects of training. To date, there is no information with which this parameter can be classified in samples of adolescents from the Brazilian population. This study is, therefore, the first to propose the determination of mean VO 2max levels in a sample of the Brazilian population.Methods: A sample of 380 schoolchildren (177 boys and 203 girls, aged 10 to 14 years) was selected at random from public schools in Vitória, ES. After anthropometric assessment they underwent cardiopulmonary exercise testing, VO 2max was measured directly and results were classified according to quintiles calculated from the study sample.Results: The mean VO 2max values observed ranged from 42.95 to 49.55 mL.kg -1 .min -1 for boys and from 36.76 to 38.29 mL.kg -1 .min -1 for girls.Conclusions: This paper proposes mean VO 2max ranges as a classification parameter for cardiorespiratory fitness, in addition to contributing to a definition of normal values for the Brazilian population. This classification will also be of use for establishing cutoff points in future studies.J Pediatr (Rio J). 2006;82(6):426-30: Maximum oxygen uptake, adolescents, aerobic fitness, cardiopulmonary exercise testing.