MARINA GABRIELA BIRCK
Projetos de Pesquisa
Unidades Organizacionais
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Thyroid-Stimulating Hormone and Thyroid Hormones and Incidence of Diabetes: Prospective Results of the Brazilian Longitudinal Study of Adult Health (ELSA-BRASIL)(2022) BIRCK, Marina Gabriela; ALMEIDA-PITITTO, Bianca de; JANOVSKY, Carolina C. P. S.; GOULART, Alessandra Carvalho; SANTOS, Itamar S.; TEIXEIRA, Patricia de Fatima dos Santos; SGARBI, Jose A.; BARRETO, Sandhi M.; DUNCAN, Bruce B.; SCHMIDT, Maria Ines; LOTUFO, Paulo A.; BENSENOR, Isabela M.Background: There are conflicting data regarding the association of thyroid function with incident diabetes. We prospectively investigated thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and its conversion ratio (fT3:fT4) with the risk of developing diabetes in euthyroid subjects and those with subclinical thyroid dysfunction. Our hypothesis is that this relationship is a U-shaped curve since both subclinical thyroid diseases may be associated with diabetes.Methods: ELSA-Brasil is a highly admixed cohort study of 35-74 years old at baseline (2008-2010). Levels of TSH, fT4, fT3, and fT3:fT4 ratio were evaluated at baseline and incident diabetes was estimated over an 8.2-year follow-up (2017-2019). Diabetes was identified based on medical diagnosis, prescriptions, and laboratory tests. The risk of diabetes was evaluated according to quintiles of TSH, fT4, fT3, and fT3:fT4 ratio using Poisson regression with robust variance presented as relative risk (RR) with confidence interval [CI] of 95% after multivariable adjustment for sociodemographic and cardiovascular risk factors (reference third quintile), and as continuous variables.Results: We included 7948 participants (mean age, 50.2 [standard deviation 8.6] years; 54.4% female): 7177 euthyroid, 726 with subclinical hypothyroidism, and 45 with subclinical hyperthyroidism. Incidence of diabetes was 14.8%. No association was found for TSH, fT4, fT3, and fT3:fT4 ratio quintiles with incident diabetes. Using continuous variables, the increase of 1-unit (1-U) of fT4 decreased the risk of diabetes (RR 0.94 [CI 0.91-0.99]), while the increase of 1-U of the fT3:fT4 ratio increased the diabetes risk (RR 1.37 [CI 1.15-1.63]). The increase of 1-U of fT3 was associated with an increased risk of diabetes, but without significance after multivariable adjustment. In body mass index-stratified analysis, people with overweight or obesity presented a modest significantly higher risk of diabetes in the lowest quintile of fT4 (RR 1.04 [CI 1.01-1.07]) and an inverse association with incident diabetes in the first quintile of fT3:fT4 ratio (RR, 0.95 [CI 0.93-0.98]). The analyses using continuous variables presented similar findings.Conclusion: These findings suggest that fT4 and fT3 levels and the conversion rate might be additional risk factors associated with incident diabetes, especially in the presence of overweight or obesity. However, they need to be confirmed in future studies. (ClinicalTrials.gov Identifier: NCT02320461).
- Secondary prevention of coronary heart disease: a cross-sectional analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2019) BIRCK, Marina Gabriela; GOULART, Alessandra Carvalho; LOTUFO, Paulo Andrade; BENSENOR, Isabela MartinsBACKGROUND: Coronary heart disease (CHD) remains a major cause of mortality worldwide and in Brazil. Use of standard medications after CHD has been proven to avoid new events and reduce early mortality. OBJECTIVES:This study aimed to analyze secondary prevention of CHD and its association with the baseline characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional analysis on ELSA-Brasil data. METHODS: Secondary prevention of CHD recommended in standard guidelines (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without angiotensin-converting enzyme inhibitors, ACEI, or angiotensin receptor blockers, ARB) was evaluated in relation to sociodemographic data and the time since the coronary event. The chi-square test, one-way analysis of variance (ANOVA) and Mann-Whitney test were performed, as necessary. RESULTS: Among 15,094 participants, 2.7% reported a previous diagnosis of CHD. Use of recommended drugs for secondary prevention was reported by almost 35% of the participants. Medication use for secondary prevention was generally more frequent among high-income participants than among low-income participants. Use of ARB and ACEI was different between participants who had private heath insurance and those who only used the public healthcare system. Men were more likely to use medication than women. The frequency with which participants used the recommended drugs was similar in all time periods after CHD, but use of only one drug increased progressively across time periods. CONCLUSION: The use of medication for secondary prevention of CHD was lower than what is recommended in standardized guidelines, especially among women and lower-income participants.
- Thyroid-stimulating hormone levels and incident depression: Results from the ELSA-Brasil study(2021) VARELLA, Ana C.; BENSENOR, Isabela M.; JANOVSKY, Carolina C. P. S.; GOULART, Alessandra C.; BIRCK, Marina G.; SANTOS, Itamar S.; BRUNONI, Andre R.; LOTUFO, Paulo A.Objective This study aimed to prospectively evaluate whether TSH levels at baseline were associated with incident depression after four years of follow-up in a cohort of middle-aged adults, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods TSH and free-thyroxine (FT4) levels were evaluated at baseline. Depression diagnoses were performed using the Clinical Interview Schedule-Revised (CIS-R) at baseline and after a 4-year follow-up. Poisson regression models (95% Confidence Intervals) were built to evaluate the association between TSH quintiles at baseline and incident depression. All analyses were stratified by sex. Models were presented crude, adjusted for age and sex; and further adjusted for race, education, BMI, smoking, alcohol consumption, use of antidepressants/benzodiazepines, kidney function and comorbidities. Results Mean age was 51.5 years, and 51.2% were women. Overall, low TSH levels (1(st) quintile) were associated with incident depression (adjusted RR = 1.36, 95% CI 1.02-1.81), remaining significant for women (adjusted RR = 1.64, 95% CI 1.15-2.33), but not for men. The same results were found when restricting analysis to euthyroid participants (adjusted RR = 1.46, 95% CI 1.08-1.99), also significant for women only (adjusted RR = 1.63, 95% CI 1.12-2.38). Conclusions Our results showed that low TSH levels were positively associated with incident depression, particularly among women. Similar results were found when restricting the analysis to euthyroid participants. In contrast, high TSH levels were inversely associated with incident depression, also among women.
- Stroke at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis(2018) ABREU, Fernanda Gabriela de; GOULART, Alessandra Carvalho; BIRCK, Marina Gabriela; BENSENOR, Isabela MartinsBACKGROUND: Secondary prevention of stroke is a very important goal for achieving continuous reduction in stroke mortality rates over the next decades. DESIGN AND SETTING: Cross-sectional analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), with data from Salvador, Vitoria, Belo Horizonte, Rio de Janeiro, Sao Paulo and Porto Alegre. METHODS: This descriptive analysis focused on secondary prevention of stroke among participants who self-reported a medical diagnosis of stroke at the baseline of ELSA-Brasil, and its association with sociodemographic characteristics. RESULTS: Overall, 197 participants (13%) reported a prior medical history of stroke. Participants with stroke were older and less educated and had lower mean monthly family income, compared with nonstroke participants. Among all stroke cases, 23.7% did not use any medication for secondary prevention of stroke. Use of secondary prevention was higher among men than among women (respectively, 59.6% versus 40.4%; P = 0.02 for aspirin; and 71.4% versus 28.6%; P = 0.04 for other antiplatelet drugs). Having private health insurance was associated with greater use of less cost-effective and more expensive medications (like angiotensinogen receptor blockers) and a tendency to use antiplatelet drugs other than aspirin, among participants reporting stroke, compared with others. Use of medication decreased as time passed after suffering a stroke. CONCLUSIONS: In this sample of individuals with better access to healthcare services, use of secondary prevention for stroke was low, which may suggest that the situation in the general population is worse. Sex was the most important sociodemographic variable associated with low use of secondary prevention.