VALERIA APARECIDA DA COSTA HONG
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- Resting spontaneous baroreflex sensitivity and cardiac autonomic control in anabolic androgenic steroid users(2018) SANTOS, Marcelo R. dos; SAYEGH, Ana L. C.; ARMANI, Rafael; COSTA-HONG, Valeria; SOUZA, Francis R. de; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.OBJECTIVES: Misuse of anabolic androgenic steroids in athletes is a strategy used to enhance strength and skeletal muscle hypertrophy. However, its abuse leads to an imbalance in muscle sympathetic nerve activity, increased vascular resistance, and increased blood pressure. However, the mechanisms underlying these alterations are still unknown. Therefore, we tested whether anabolic androgenic steroids could impair resting baroreflex sensitivity and cardiac sympathovagal control. In addition, we evaluate pulse wave velocity to ascertain the arterial stiffness of large vessels. METHODS: Fourteen male anabolic androgenic steroid users and 12 nonusers were studied. Heart rate, blood pressure, and respiratory rate were recorded. Baroreflex sensitivity was estimated by the sequence method, and cardiac autonomic control by analysis of the R-R interval. Pulse wave velocity was measured using a noninvasive automatic device. RESULTS: Mean spontaneous baroreflex sensitivity, baroreflex sensitivity to activation of the baroreceptors, and baroreflex sensitivity to deactivation of the baroreceptors were significantly lower in users than in nonusers. In the spectral analysis of heart rate variability, high frequency activity was lower, while low frequency activity was higher in users than in nonusers. Moreover, the sympathovagal balance was higher in users. Users showed higher pulse wave velocity than nonusers showing arterial stiffness of large vessels. Single linear regression analysis showed significant correlations between mean blood pressure and baroreflex sensitivity and pulse wave velocity. CONCLUSIONS: Our results provide evidence for lower baroreflex sensitivity and sympathovagal imbalance in anabolic androgenic steroid users. Moreover, anabolic androgenic steroid users showed arterial stiffness. Together, these alterations might be the mechanisms triggering the increased blood pressure in this population.
- Prevalence of Metabolic Syndrome and Framingham Risk Score in Apparently Healthy Vegetarian and Omnivorous Men(2018) NAVARRO, Julio Cesar Acosta; ANTONIAZZI, Luiza; OKI, Adrian Midori; BONFIM, Maria Carlos; HONG, Valeria; BORTOLOTTO, Luiz Aparecido; ACOSTA-CARDENAS, Pedro; SANDRIM, Valeria; MINAME, Marcio Hiroshi; SANTOS FILHO, Raul Dias dosBackground: Recent studies have shown a lower prevalence of metabolic syndrome (MSyn) in vegetarians (VEG) despite the inconclusive evidence from others. Objective: To verify the association between diet and other lifestyle characteristics and the prevalence of MSyn, cardiovascular risk factors (CRF), and Framingham Risk Score (FRS) in apparently healthy VEG and omnivorous (OMN) men. Methods: In this cross-sectional study, 88 apparently healthy men >= 35 years, 44 VEG and 44 OMN, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C-reactive protein (CRP) and FRS. To test the association between lifestyle and MSyn, Student t test, chi-square test, and multiple logistic regression model were used. A significance level of 5% was considered in all statistical analyses. Results: Several CRF were significantly lower in VEG than in OMN: body mass index, systolic blood pressure, diastolic blood pressure, fasting serum total cholesterol, LDL-cholesterol, apolipoprotein b, glucose, and glycated hemoglobin (all p < 0.05). The FRS mean was lower in VEG than in OMN (2.98 +/- 3.7 vs 4.82 +/- 4.8, p = 0.029). The percentage of individuals with MSyn was higher among OMN than among VEG (52.3 vs.15.9%) (p < 0.001). The OMN diet was associated with MSyn (OR: 6.28 95%CI 2.11-18.71) and alterations in most MSyn components in the multiple regression model independently of caloric intake, age and physical activity. Conclusion: The VEG diet was associated with lower CRF, FRS and percentage of individuals with MSyn.
- Reversal of Improved Endothelial Function After Bariatric Surgery Is Mitigated by Exercise Training(2018) DANTAS, Wagner Silva; GIL, Saulo; MURAI, Igor Hisashi; COSTA-HONG, Valeria; PECANHA, Tiago; MEREGE-FILHO, Carlos Alberto Abujabra; SA-PINTO, Ana Lucia de; CLEVA, Roberto de; SANTO, Marco Aurelio; PEREIRA, Rosa Maria Rodrigues; KIRWAN, John P.; ROSCHEL, Hamilton; GUALANO, Bruno
- Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?(2018) FATURETO-BORGES, Fernanda; JENNER, Raimundo; COSTA-HONG, Valeria; LOPES, Heno F.; TEIXEIRA, Sandra H.; MARUM, Elias; GIORGI, Dante A. M.; CONSOLIM-COLOMBO, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; KRIEGER, Eduardo M.; DRAGER, Luciano F.Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55 +/- 9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mmHg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9 +/- 11.8 versus -0.3 +/- 10.3 mmHg; 18 months, -6.7 +/- 11.1 versus -1.2 +/- 10.6 mmHg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3 +/- 1.9 versus 9.2 +/- 1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.
- Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension(2018) COSTA-HONG, Valeria Aparecida; MUELA, Henrique Cotchi Simbo; MACEDO, Thiago Andrade; SALES, Allan Robson Kluser; BORTOLOTTO, Luiz AparecidoBackground: Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods: In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels >= 140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results: Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 +/- 9.8% vs. 20.1 +/- 11.7%, p < 0.01), AIx75 (29.6 +/- 6.7% vs. 18.3 +/- 9.4%, p < 0.01) and central systolic blood pressure (136 +/- 30 vs. 125 +/- 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women. Conclusion: Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status.
- Applicability of the Test of Variables of Attention – T.O.V.A in Brazilian adults(2018) MEMÓRIA, Cláudia M.; MUELA, Henrique C.S.; MORAES, Natália C.; COSTA-HONG, Valéria A.; MACHADO, Michel F.; NITRINI, Ricardo; BORTOLOTTO, Luiz A.; YASSUDA, Monica S.ABSTRACT The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) and the Trail Making Test. Results: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.
- Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients(2018) HARMON, Rebeca R.; LIMA, Jose Jayme G. De; DRAGER, Luciano F.; PORTILHO, Natanael P.; COSTA-HONG, Valeria; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; CANZIANI, Maria Eugenia F.BackgroundObstructive sleep apnea (OSA) is common in hemodialysis (HD) patients. The reasons for the high prevalence and whether OSA is associated with vascular impairment, end-organ damage, and prognosis are not completely clear.MethodsWe evaluated patients with low cardiovascular risk on HD, not treated by CPAP. Laboratory tests, sleep questionnaires (Berlin and Epworth) and polysonography studies, echocardiography, and markers of arterial stiffness and atherosclerosis were performed. After the initial evaluation, patients were followed up until cardiovascular events, renal transplantation, or death.ResultsFifty-five patients (49% male, 509years, body mass index 24.7 +/- 4.5kg/m(2)) were included. OSA (apnea-hypopnea index 5 events/h) occurred in 73% of the patients. The proportion of patients with interdialytic weight gain >2kg was higher in patients with OSA than those without OSA (96 vs. 55%; p=0.002). Left ventricular (LV) posterior wall thickness (10.0 +/- 1.9 vs. 11.3 +/- 1.8mm; p=0.04) and LV diastolic diameter (48 +/- 5 vs. 53 +/- 5mm; p=0.003) were higher in patients with OSA than in patients without OSA, respectively. Sleep questionnaires did not predict OSA. No significant differences were found in pulse wave velocity, carotid intima-media thickness, and ankle-brachial index between the groups. Multivariate analysis showed that interdialytic weight gain >2kg and LV diastolic diameter were independently associated with OSA. On follow-up (median 45months), OSA was found to be associated with a higher incidence of cardiovascular (CV) events (28 vs. 7%, log-rank=0.042).ConclusionsOSA was associated with increased risk of CV events. Significant (>2kg) interdialytic weight gain was independently associated with OSA.
- Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension(2018) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo C.; MANSUR, Alfredo J.; MASSARO, Ayrton R.; NITRINI, Ricardo; MACEDO, Thiago A.; BORTOLOTTO, Luiz A.Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8 +/- 2.1 vs 27.3 +/- 2.1 vs 28.0 +/- 2.0, P=.003) or the Montreal Cognitive Assessment test (23.4 +/- 3.5 vs 24.9 +/- 2.9 vs 25.6 +/- 3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.
- There Is No Impact of Diabetes on the Endothelial Function of Chronic Kidney Disease Patients(2018) COUTINHO, Mariana Nogueira; CARVALHO, Aluizio Barbosa; DALBONI, Maria Aparecida; MOURO, Margaret Gori; HIGA, Elisa Mieko Suemitsu; COSTA-HONG, Valeria; BORTOLOTTO, Luiz Aparecido; FIGUEIREDO, Rejane Augusta de Oliveira; CANZIANI, Maria Eugenia FernandesBackground. Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients. Methods. We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1 alpha), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group). Results. CKD-DM group had a higher prevalence of obesity (P < 0 01), previous myocardial infarction (P = 0 02), myocardial revascularization (P = 0 04), and a trend for more peripheral artery disease (P = 0 07). Additionally, CKD-DM group had higher EPC (P = 0 001) and PWV (P < 0 001) values. On the other hand, no difference in SDF-1 alpha and serum or urinary NO and FMD was observed between the groups. Conclusions. Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.