Increased cardiovascular risk and role of metabolic syndrome in hypertensive elderly
Aumento del riesgo cardiovascular y el papel del síndrome metabólico en personas hipertensas de la tercera edad
Risco cardiovascular aumentado e o papel da síndrome metabólica em idosos hipertensos
Manoela Vieira Gomes da Costa; Luciano Ramos de Lima; Izabel Cristina Rodrigues da Silva; Tania Cristina Morais Santa Barbara Rehem; Silvana Schwerz Funghetto; Marina Morato Stival
Abstract
Objective: To evaluate metabolic syndrome and cardiovascular risk for hypertensive elderly patients treated in primary care.
Methods: A cross-sectional study carried out with 154 hypertensive elderly from a Basic Health Unit in the Federal District. A structured instrument investigated the profile of the elderly. For classifying the metabolic syndrome, the criteria proposed by the National Cholesterol Education Program - Treatment Panel for Adults III were considered. For cardiovascular risk analysis, the Framingham risk score was used. Statistical and inferential analysis was performed using ANOVA, chi-square test and Fisher's exact test, in addition to Odds Ratio and its 95% confidence interval to estimate cardiovascular risk among the groups.
Results: 64.9% of the hypertensive elderly were obese. Metabolic syndrome was evidenced in 70.8%. It was noted that 27.2% had low, 46.8% moderate, and 26.0% high cardiovascular risk, and that being a woman and of advanced aged negatively influenced the risk. Older adults with metabolic syndrome showed 7.19 times more likelihood to have high cardiovascular risk.
Final considerations and implications for the practice: The hypertensive elderly patients had high metabolic syndrome prevalence, which significantly increased cardiovascular risk. This result allows for a better planning of nursing care by the nurses in primary health care.
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Resumen
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Resumo
Objetivo: avaliar a síndrome metabólica e o risco cardiovascular de idosos hipertensos atendidos na atenção primária.
Métodos: estudo transversal realizado com 154 idosos hipertensos de uma Unidade Básica de Saúde do Distrito Federal. Um instrumento estruturado investigou o perfil dos idosos. Para a classificação da síndrome metabólica, consideraram-se os critérios propostos pela National Cholesterol Education Program – Adult Treatment Panel III. Para análise do risco cardiovascular, utilizou-se o escore de risco de Framingham. Foi realizada análise estatística e inferencial com a utilização da ANOVA, teste qui-quadrado e exato de Fisher, além da odds ratio e seu intervalo de confiança de 95% para estimar o risco cardiovascular entre os grupos.
Resultados: 64,9% dos idosos hipertensos eram obesos. Síndrome metabólica foi evidenciada em 70,8%. Observou-se que 27,2% apresentaram baixo, 46,8% moderado e 26,0% elevado risco cardiovascular, sendo que o sexo feminino e a idade avançada influenciaram negativamente o risco. Idosos com síndrome metabólica apresentaram 7,19 vezes mais chances de terem elevado risco cardiovascular.
Considerações finais e implicações para a prática: os idosos hipertensos apresentaram uma elevada prevalência de síndrome metabólica que aumentou significativamente o risco cardiovascular. Este resultado possibilita um melhor planejamento da assistência de enfermagem pelo enfermeiro da atenção primária à saúde.
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References
1 Malachias M, Plavnik FL, Machado CA, Malta D, Scala LCN, Fuchs S. 7a Diretriz Brasileira de Hipertensão Arterial: Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária. Arq Bras Cardiol. 2016;107(3, Suppl):1-6.
2 Ministério da Saúde (BR). Estratégias para o cuidado da pessoa com doença crônica: hipertensão arterial sistêmica [Internet]. Brasília: Ministério da Saúde; 2013 (Cadernos de Atenção Básica, 37). [citado 2019 Dez 5]. Disponível em:
3 Moreira AACM, Costa EFA, Miranda RD, Wajngarten M, Galera SC, Alencar Filho AC et al. Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol. 2019;112(5):649-705.
4 Oliveira JEP, Vencio S. Diretrizes da Sociedade Brasileira de Diabetes 2017-2018 [Internet]. São Paulo: Ed Clannad; 2017 [citado 2019 Dez 5]. Disponível em:
5 Félix NDC, Nóbrega MMLD. Síndrome metabólica: análise conceitual no contexto da enfermagem. Rev Lat Am Enfermagem. 2019;27:e3154.
6 Sales MC, Oliveira LP, Liberalino LCP, Cunha ATO, Sousa SES, Lemos TMAM et al. Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals. Clin Interv Aging. 2018 nov;13:2453-64.
7 Paula EA, Paula RB, Costa DMN, Colugnati FAB, Paiva EP. Cardiovascular risk assessment in hypertensive patients. Rev Lat Am Enfermagem. 2013 jun;21(3):820-7.
8 Saad MAN, Cardoso GP, Martins WA, Velarde LGC, Cruz RA Fo. Prevalence of metabolic syndrome in elderly and agreement among four diagnostic criteria. Arq Bras Cardiol. 2014;102(3):263-9.
9 Calixto SCS, Vinagre RMFD, Rocha GF, França TG. Prevalência da Síndrome Metabólica em Idosos. Saúde em Foco. 2017;3(2):119-35.
10 Vieira EC, Peixoto MR, Silveira EA. Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System. Rev Bras Epidemiol. 2014 dez;17(4):805-17.
11 Silva JF, Freire JAP, Frota KMG, Júnior AJS. Fatores de risco cardiovascular e prevalência de síndrome metabólica em idosos. Rev Bras em promoção da Saúde. 2014 dez;27(4):477-84.
12 van Herpt TTW, Dehghan A, van Hoek M, Ikram MA, Hofman A, Sijbrands EJG et al. The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: The Rotterdam study. Cardiovasc Diabetol. 2016 dez 27;15(1):69.
13 Li W, Song F, Wang X, Wang D, Chen D, Yue W et al. Relationship between metabolic syndrome and its components and cardiovascular disease in middle-aged and elderly Chinese population: a national cross-sectional survey. BMJ Open. 2019 ago;9(8):e027545.
14 Jahangiry L, Farhangi MA, Rezaei F. Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome. J Health Popul Nutr. 2017 nov;36(1):36.
15 Mastroeni MF, Mastroeni SSBS, Erzinger GS, Marucci MFN. Antropometria de idosos residentes no município de Joinville-SC, Brasil. Rev Bras Geriatr Gerontol. 2010 abr;13(1):29-40.
16 Abd Elaziz KM, Gabal MS, Aldafrawy OA, Abou Seif HA-A, Allam MF. Prevalence of metabolic syndrome and cardiovascular risk factors among voluntary screened middle-aged and elderly Egyptians. J Public Health (Oxf). 2015 dez;37(4):612-7.
17 Dussaillant C, Echeverría G, Villarroel L, Yu C, Rigotti A, Marín P. Metabolic syndrome prevalence is not associated with diet quality in the Chilean elderly population: a cross sectional analysis from the National Health Survey 2009–2010. J Aging Res Clin Pract. 2016;5:132-8.
18 Pradeepa R, Surendar J, Indulekha K, Chella S, Anjana RM, Mohan V. Prevalence of metabolic syndrome and its association with coronary artery disease among an urban elderly south Indian population (CURES-145). J Assoc Physicians India [Internet]. 2016 [cited 2020 Feb 15];64(5):20-5. Available from:
19 Ortiz-Rodríguez MA, Yáñez-Velasco L, Carnevale A, Romero-Hidalgo S, Bernal D, Aguilar-Salinas C et al. Prevalence of metabolic syndrome among elderly Mexicans. Arch Gerontol Geriatr. 2017 nov;73:288-93.
20 França SL, Lima SS, Vieira JRDS. Metabolic syndrome and associated factors in adults of the amazon region. PLoS One. 2016 dec;11(12):1-14.
21 Simão AF, Precoma DB, Andrade JP, Correa Filho H, Saraiva JFK, Oliveira GMM et al. I Diretriz brasileira de prevenção cardiovascular. Arq Bras Cardiol. 2013;101(6):1-63.
22 Silva PAB, Sacramento AJ, Carmo CID, Silva LB, Silqueira SMF, Soares SM. Fatores associados à síndrome metabólica em idosos: estudo de base populacional. Rev Bras Enferm. 2019;72(2 Suppl):221-8.
23 Oguoma VM, Nwose EU, Skinner TC, Richards RS, Digban KA, Onyia IC. Association between metabolic syndrome and 10-year risk of developing cardiovascular disease in a Nigerian population. Int Health. 2016 set;8(5):354-9.
24 Santos LB, Lima WL, Souza JMO, Magro MCS, Duarte TTP. Risco cardiovascular em usuários hipertensos da atenção primária à saúde. Rev enferm UFPE line. 2018;12(5):1303-9.
25 Fogaça EM, Theodoro H, Mendes KG, Olinto MTA. Prevalência de obesidade em mulheres na pós-menopausa atendidas em um ambulatório no sul do Brasil. Rev da Assoc Bras Nutr [Internet]. 2019 [cited 2020 Jan 10];10(1):46-52. Available from:
26 D’Amico MM, de Souza RKT. Simultaneidade de fatores de risco cardiovascular controláveis: estudo de base populacional. Rev Bras Cardiol [Internet]. 2014 [cited 2020 Jan 10];27(5):318-26. Available from:
27 Young DR, Hivert M-F, Alhassan S, Camhi SM, Ferguson JF, Katzmarzyk PT et al. Sedentary behavior and cardiovascular morbidity and mortality: A science advisory from the american heart association. Circulation. 2016 set 27;134(13):e262-79.
28 Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary Behavior, Exercise, and Cardiovascular Health. Circ Res. 2019 mar;124(5):799-815.
29 Leiva AM, Martínez MA, Cristi-Montero C, Salas C, Ramírez-Campillo R, Díaz Martínez X et al. El sedentarismo se asocia a un incremento de factores de riesgo cardiovascular y metabólicos independiente de los niveles de actividad física. Rev Med Chil. 2017 abr;145(4):458-67.
30 Soares TS, Piovesan CH, Gustavo AS, Macagnan FE, Bodanese LC, Feoli AMP. Alimentary habits, physical activity, and framingham global risk score in metabolic syndrome. Arq Bras Cardiol. 2014;102(4):374-82.
31 Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018 dez 31;17(1):122.
32 Kopin L, Lowenstein CJ. Dyslipidemia. Ann Intern Med. 2017 dez 5;167(11):ITC81-96.
33 Gurka MJ, Filipp SL, Pearson TA, DeBoer MD. Assessing baseline and temporal changes in cardiometabolic risk using metabolic syndrome severity and common risk scores. J Am Heart Assoc. 2018 ago 21;7(16):e009754.
34 Faulkner JL, Belin de Chantemèle EJ. Sex hormones, aging and cardiometabolic syndrome. Biol Sex Differ. 2019 dez 1;10(1):30.
35 Arnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010 jan 19;121(2):230-6.
36 Carvalho MHC. I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Arq Bras Cardiol. 2005 abr;84:3-28.
37 Motamed N, Rabiee B, Roozafzai F, Zamani F, Faraji AH, Maadi M et al. Metabolic syndrome and cardiovascular risk assessment tools’ estimations of 10-year cardiovascular risk: A population-based study. Acta Cardiol. 2018 set 3;73(5):439-46.
38 Yang W, Ma R, Zhang X, Guo H, He J, Mao L et al. Comparison between metabolic syndrome and the framingham risk score as predictors of cardiovascular diseases among Kazakhs in Xinjiang. Sci Rep. 2018 dez 7;8(1):16474.
39 Pinho PM, Machado LMM, Torres R S, Carmin SEM, Mendes WAA, Silva ACM et al. Síndrome metabólica e sua relação com escores de risco cardiovascular em adultos com doenças crônicas não transmissíveis. Rev Soc Bras Clín Méd [Internet]. 2014 [citado 2020 Feb 2];12(1):22-30. Disponível em:
40 Pierdomenico SD, Pierdomenico AM, Di Tommaso R, Coccina F, Di Carlo S, Cuccurullo F et al. Metabolic Syndrome and Cardiovascular Risk in Elderly Treated Hypertensive Patients. Am J Hypertens. 2015 jul 29;29(3):hpv121.
41 Aghakhanian F, Wong C, Tan JSY, Yeo LF, Ramadas A, Edo J et al. Metabolic syndrome and cardiometabolic risk factors among indigenous Malaysians. Public Health. 2019 nov;176:106-13.
42 Chang S-H, Chien N-H, Yu C-Y. Long-term lifestyle intervention in elderly with metabolic syndrome. Clin Nurs Res. 2019 jul 24;28(6):658-75.
Submitted date:
03/09/2020
Accepted date:
05/22/2020