Coronary Heart Disease Risk Factors and Outcomes in the Twenty-First Century: Findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract

REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify “microsize infarcts,” caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.

Síndrome metabólica, aterosclerose e inflamação: tríade indissociável?

“…According to the International Diabetes Federation -IDF (2005), one quarter of the global adult population has the syndrome. [5][6][7] The MS was originally named Metabolic Syndrome X and there are a large number of criteria for its diagnosis, including the EGIR -European Group for the These criteria for diagnosis include glycemia disorders related to insulin resistance (IR); elevated BMI; elevated triglycerides and low HDL-c (high density lipoprotein); and high blood pressure. 5,[8][9][10] There is consensus in the recent literature that there are at least six criteria that define the presence of MS: obesity, waist circumference (> 102 cm in males or > 88 cm in females), IR (fasting glycemia greater than 100mg/dL), elevated triglycerides (> 150 mg/dL) and low HDL-c (< 40 mg/dL no male sex or < 50 mg/dL in female sex), arterial hypertension (BP > 130⁄85 mm Hg) and a proinflammatory and pro-thrombotic state.…”

“…People who have three or more of the criteria listed above are considered to have the syndrome. 4,7,[11][12][13][14] It is possible to detect MS in people with normal BMI and so obesity can be defined as a risk factor, but is not present in all those with the syndrome.…”

Aspectos oxidativos da síndrome metabólica e aterosclerose

“…Caracteriza-se pela presença de um conjunto de fatores que elevam o risco de desenvolver DM2 e DCV, como obesidade, dislipidemia, pressão arterial elevada, resistência à insulina e estado pró-inflamatório e pró-trombótico [5][6][7][8]. Com objetivo de adotar uma definição unificada para a SM, foi delineada e organizada pela International Diabetes Federation uma definição de consenso.…”

“…Com objetivo de adotar uma definição unificada para a SM, foi delineada e organizada pela International Diabetes Federation uma definição de consenso. Nesse consenso atribuiu-se papel importante à obesidade, aferida pela circunferência abdominal e pelo índice de massa corpórea; à elevação nos valores sanguíneos de glicose (resistência à insulina ou intolerância à glicose) e de triacilglicerídeos; à diminuição nos valores da lipoproteína de alta densidade ligada ao colesterol (HDL-c); e à presença de hipertensão arterial [3,8,9].…”

“…No Brasil, a I Diretriz Brasileira de SM [10] considera como portador da SM o indivíduo que possuir pelo menos três das seguintes alterações metabólicas: glicemia de jejum alterada, triglicerídeos ≥150 mg dL, HDL-c <50 mg dL para mulheres e 3/7 [8,[10][11][12].…”