New findings about atherosclerosis in Brazil from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

Do not panic if you confuse "atherosclerosis" and "arteriosclerosis". Few people, including teachers and researchers in the medical world, can describe in few words the difference between these pathological conditions, which have distinct impacts on clinical practice and epidemiological studies. The confusion has become very well established. The American Heart Association publishes a journal called "Arteriosclerosis, Thrombosis, and Vascular Biology" in which most of the articles address the experimental, clinical and epidemiological aspects of atherosclerosis. In contrast, the same association publishes "Hypertension", which has a permanent section on "arteriosclerosis". The differentiation between arteriosclerosis and atherosclerosis comes from one of the fathers of modern cardiology, George Pickering.1 I prefer to summarize this discussion with two clear definitions:1. Atherosclerosis is a complex inflammatory process associated with the presence of oxidized low-density lipoprotein (LDL)-cholesterol in the intima and media of the arterial wall. Arteriosclerosis consists of functional depletion of large-artery elasticity.My assessment is supported by a recent meta-analysis on 76 studies that revealed that only blood pressure and age correlate with the pulse wave velocity (i.e. arteriosclerosis), thereby explaining more than half of the variability of pulse wave velocity. 2 On the other hand, it is well known that high cholesterol, hypertension, diabetes and smoking are risk factors for atherosclerosis.Fifty years ago, Professor Mario Montenegro led a seminal study addressing atherosclerosis in Brazil and the Americas using autopsy cases. 3,4 However, subsequently, the approach towards atherosclerosis remained not very well developed in Brazil or elsewhere until the emergence of non-invasive imaging tools. For epidemiological and clinical studies such as the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), atherosclerosis was assessed through measuring the intima-media thickness (IMT) in the common carotid arteries, either by means of ultrasound or from determination of calcium scores in the coronary artery tree through computed tomography. On the other hand, arteriosclerosis was measured by determining the carotid-femoral pulse wave velocity. 5-13ELSA-Brasil was the first observational study to report in our population both the IMT and coronary artery calcium (CAC), thereby enabling comparison of these measurements in clinical practice. 6,7 Moreover, ELSA-Brasil was able to verify associations with migraine, 8 anxiety/depression, 9 cognition, 10 insulin resistance, 11 inflammatory biomarkers 12 and neck circumference. 13One fascinating finding was the association found in ELSA-Brasil between ideal cardiovascular health as proposed by the American Heart Association and the presence of coronary calcium. 14 The relationship is not exactly direct and linear (i.e. the higher the frequency of risk factors, the greater the quantity of calcium in the coronary tree also would be). ELSA-Brasil enrolled 4,077...

Arteriosclerosis in Brazil. Findings from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…Few people, including teachers and researchers in the medical world, can describe in few words the difference between these pathological conditions, which have distinct impacts on clinical practice and epidemiological studies (Lotufo PA, SPMJ, 2016). 1 Briefly, arteriosclerosis relates to increased stiffness of the walls of major arteries and is correlated with greater age and higher blood pressure. On the other hand, atherosclerosis is a pathological process involving the endothelium of the tunica media and intima and relates to oxidation of cholesterol followed by a complex inflammatory chain.…”

Prevenção secundária da doença isquêmica coronariana na linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

“…A hipertensão arterial, dislipidemia, diabetes e tabagismo são fatores relevantes para o desenvolvimento da aterosclerose. É importante ressaltar que mesmo indivíduos saudáveis e sem sintomas podem apresentar aterosclerose subclínica e, consequentemente, desenvolver a DIC clínica (Pipe, Papadakis & Reid, 2010;Marzilli et al, 2012;Lotufo, 2016).…”

“…A mudança no estilo de vida, com hábitos mais saudáveis (alimentação e atividade física), atua diretamente nos fatores causais da DIC -hipertensão arterial, diabetes, dislipidemia e tabagismo (Fung et al, 2001;Cole et al, 2011). (Kooy et al, 2007;Lotufo, 2016 (Fauler, 2009;Angiolillo, 2012;Gaglia & Clavjio, 2013;Mega & Simon, 2015).…”

“…Neste estudo, as mulheres estavam utilizando menos antiplaquetários (60,5% vs 67,0%), hipolipemiantes (48,1% vs 55,8%) e a combinação entre os medicamentos recomendados (p<0,001) quando comparadas aos homens (Koopman et al, 2013) (Manteuffel et al, 2014). Lotufo et al, 2016). Esses dados sugerem que os medicamentos podem não estar sendo prescritos tão frequentemente para mulheres do que para os homens (Lotufo et al, 2016), possivelmente pela influência dos sintomas atípicos e subestimação da gravidade da DIC em mulheres (Koopman et al, 2013;Manteuffel et al, 2014).…”

“…Lotufo et al, 2016). Esses dados sugerem que os medicamentos podem não estar sendo prescritos tão frequentemente para mulheres do que para os homens (Lotufo et al, 2016), possivelmente pela influência dos sintomas atípicos e subestimação da gravidade da DIC em mulheres (Koopman et al, 2013;Manteuffel et al, 2014).…”