Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 3 - Jul/Sep - 2018

Original Article Imprimir 

Páginas 27 a 35


Evaluation of cardiovascular risk factors in adolescents

Evaluación de los factores de riesgo cardiovascular en adolescentes

Avaliação dos fatores de riscos cardiovasculares em adolescentes

Autores: Gilberto Gomes de Amorim1; Edna Ferreira Pinto2; Gabriel Bezerra Vieira Lima3; José Fernando Vila Nova de Moraes4; Carlos Antonio Bruno da Silva5

1. Master in Collective Health from the University of Fortaleza (UNIFOR). Professor of the Federal Institute of Ceará (IFCE) - Rectory. Cedro, CE, Brazil
2. Specialist in Exercise Physiology and Special Groups. Doctor León Sampaio University Center (UNILEÃO). Juazeiro do Norte, CE, Brazil. University Professor - Collegiate of Physical Education - Regional University of Cariri. Iguatu, CE, Brazil
3. Graduated in Physical Education. Regional University of Cariri (URCA). Iguatu, CE, Brazil. Teacher at Muscle Gym - Starfitness. Cedro, CE, Brazil
4. Doctor in Physical Education from the Catholic University of Brasilia (UCB). DF, Brazil. Adjunct Professor II - Collegiate of Physical Education - Federal University of Vale do São Francisco (UNIVASF). Petrolina, PE, Brazil
5. Doctorate in Health Sciences from the University of Brasilia. DF, Brazil. University Professor - Collegiate Collective Health - University of Fortaleza (UNIFOR). Fortaleza, CE, Brazil

Gilberto Gomes de Amorim
Rua 25 de Março, nº 144, Bairro Paraná
Iguatu, CE, Brasil. CEP: 63500-595
(gilbertokg@hotmail.com)

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Keywords: Adolescent, risk factors, cardiovascular diseases.
Palabra Clave: Adolescente, factores de riesgo, enfermedades cardiovasculares.
Descritores: Adolescente, fatores de risco, doenças cardiovasculares.

Abstract:
OBJECTIVE: Evaluate cardiovascular risk factors in high school students of Iguatu city-CE.
METHODS: An exploratory, crosssectional analytical study with a quantitative approach carried out with high school students of 14 to 18 years old, enrolled in public and private schools of the city of Iguatu-CE. Data were collected through an International Activity Physical Questionnaire (IPAQ). The anthropometric measurements were: body mass, height, skinfold, abdominal circumference and blood pressure measurement. Through a structured questionnaire were collected behavioral data (smoking, alcoholism, sedentarism) and family history for cardiovascular diseases. A biochemical evaluation was performed for glucose, total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL) and low density lipoproteins (LDL). For the data analysis the statistical program SPSS, version 22.0 was used and descriptive statistics procedures were employed: distribution in frequencies and percentages, calculation of central tendency (average) and dispersion (standard deviation) Measures. The Chi-Square (Cχ2) and Fisher's Exact tests were used to verify the association between variables. The level of significance was set at 5% (p <0.05).
RESULTS: The risk factors that presented the highest prevalence were: sedentarism (75.4%), dyslipidemia (68.3%), high body fat (67%), alcoholism (36%), family history of cardiovascular diseases, obesity (20%) and hypertension (16.5%).
CONCLUSION: This study identified that all students had at least one risk factor for cardiovascular disease and that the highest prevalence was between 2 and 5 factors with proportions ranging from 18.7% to 21.5%.

Resumen:
OBJETIVO: Evaluar los factores de riesgo cardiovasculares en estudiantes de enseñanza media de la ciudad de Iguatu-CE.
MÉTODOS: Estudio transversal, del tipo analítico exploratorio con un abordaje cuantitativo realizado con estudiantes de enseñanza media con 14 a 18 años, matriculados en las escuelas públicas y privadas de la ciudad de Iguatu-CE. Los datos fueron recolectados a través del cuestionario International Activity Physical Questionnaire (IPAQ). Las medidas antropométricas fueron: masa corporal, estatura, doblado cutáneo, circunferencia abdominal y medición de la presión arterial. A través de un cuestionario estructurado fueron recolectados datos comportamentales (tabaquismo, etilismo, sedentarismo) e histórico familiar para enfermedades cardiovasculares. Se realizó una evaluación bioquímica de glucosa, colesterol total (CT), triglicéridos (TG), lipoproteínas de alta densidad (HDL) y lipoproteínas de baja densidad (LDL). Para el análisis de los datos se utilizó el programa estadístico SPSS, versión 22.0 y se emplearon procedimientos de estadística descriptiva: distribución en frecuencias y porcentajes, cálculo de medidas de tendencia central (media) y de dispersión (desviación estándar). Se utilizaron las pruebas de Chi-Cuadrado (C2) y Exacto de Fisher para verificar la asociación entre las variables. Se adoptó el nivel de significancia del 5% (p <0,05).
RESULTADOS: Los factores de riesgo que presentaron la mayor prevalencia fueron: sedentarismo (75,4%), dislipidemia (68,3%), grasa corporal elevada (67%), etilismo (36%), histórico familiar para enfermedades cardiovasculares (30) %), obesidad (20%) e hipertensión (16,5%).
CONCLUSIÓN: Se detectó que todos los estudiantes presentaron al menos un factor de riesgo para enfermedades cardiovasculares y que las mayores prevalencias fueron entre 2 a 5 factores con proporciones que varían de 18,7% a 21,5%.

Resumo:
OBJETIVO: Avaliar os fatores de risco cardiovasculares em estudantes do ensino médio da cidade de Iguatu-CE.
MÉTODOS: Estudo transversal, do tipo analítico exploratório com uma abordagem quantitativa realizado com estudantes de ensino médio com 14 a 18 anos, matriculados nas escolas públicas e privadas da cidade de Iguatu-CE. Os dados foram coletados através de questionário International Activity Physical Questionnaire (IPAQ). As medidas antropométricas foram: massa corporal, estatura, dobra cutâneas, circunferência abdominal e aferição da pressão arterial. Através de um questionário estruturado foram coletados dados comportamentais (tabagismo, etilismo, sedentarismo) e histórico familiar para doenças cardiovasculares. Foi realizada avaliação bioquímica referentes a glicose, colesterol total (CT), triglicerídeos (TG), lipoproteínas de alta densidade (HDL) e lipoproteínas de baixa densidade (LDL). Para a análise dos dados utilizouse o programa estatístico SPSS, versão 22.0 e foram empregados procedimentos de estatística descritiva: distribuição em frequências e percentuais, cálculo de medidas de tendência central (média) e de dispersão (desvio-padrão). Foram usados os testes de Qui-Quadrado (C2) e Exato de Fisher para verificar a associação entre as variáveis. Adotou-se o nível de significância de 5% (p< 0,05).
RESULTADOS: Os fatores de risco que apresentaram a maior prevalência foram: sedentarismo (75,4%), dislipidemia (68,3%), gordura corporal elevada (67%), etilismo (36%), histórico familiar para doenças cardiovasculares (30%), obesidade (20%) e hipertensão (16,5%).
CONCLUSÃO: Foi detectado que todos os estudantes apresentaram pelo menos um fator de risco para doenças cardiovasculares e que as maiores prevalências foram entre 2 a 5 fatores com proporções que variam de 18,7% a 21,5%.

INTRODUCTION

Cardiovascular diseases (CVD) are defined as problems or complications that affect the circulatory system or the heart itself. The World Health Organization1 points to cardiovascular diseases as one of the biggest public health problems in the world and affects developed and developing countries. Only in 2012, the LCAs were responsible for about 17.5 million deaths worldwide2.

According to the report presented by the Pan American Health Organization on health in the Americas, it is estimated that in the coming years thousands of deaths related to diseases affecting the circulatory system and the heart will occur3.

According to the study conducted by Ribas e Silva4 to identify the prevalence of cardiovascular risk factors in children of school age, 20% of them were overweight, 48.1% had dyslipidemia and 66% were sedentary. In the literature, research shows a strong trend in the increase of risk factors for cardiovascular diseases in children and adolescents, showing that risk exposure already begins to manifest itself in childhood5,6,7,8,9.

Concerned about the progress of CVD in children and adolescents, in 2005 the Brazilian Society of Cardiology10 launched the first Guidelines for the Prevention of Atherosclerosis in childhood and adolescence. This document indicates a series of preventive measures to avoid cardiovascular risk factors in the youngest population, bearing in mind that many of these factors can last into adult life. In this context, the present study aimed to evaluate the risk factors for CVD in adolescence.


METHODS

Sample

The total analyzed population was composed of 1,730 adolescents, with 224 being selected for the final sample. The adolescents came from four schools, two from the public network and two from the private network of the city of Iguatu Ceará, where 74 were male and 150 were female, aged between 14 and 18 years. All students were encouraged to participate in the research, but those under 18 who didn´t bring the TCLE (Free and Informed Consent Term) duly signed by the parents and/or responsible persons were excluded from the study, as well as those over 18 who didn´t sign the TCLE. The study was approved by the Ethics Committee of the University of Fortaleza (on opinion 2,216,859 of August 2017).

Anthropometric evaluation

The body mass was verified by means of a digital scale from the Filizola brand, tested and calibrated, with a capacity of 150 kg and a precision of 100 grams. The stature was measured by means of portable stadiometer of the Sanny brand, with a retractable braid and extension of 210 cm with an accuracy of 0.1 cm. The height record of each participant was recorded in centimeters. At the time of the measurement, the evaluator adopted the following procedures: ask the evaluated to be barefoot, place the evaluated in the center of the team, keep standing in an orthostatic position, with the feet parallel to the body, arms extended throughout of the body time and keep the head upright, with the gaze fixed on the horizontal the height of the eyes and without dressing on the head. The BMI was determined by the equation of body mass (kg) divided by the height elevated to the second power (m2) and the data were adjusted according to age according to the World Health Organization (2007)11.

Properly tested and calibrated skin-fold compass of the Lange brand (North American). The subscapular (DCSE) and tricipital (DCT) skin folds were evaluated. The reference measurement of the DSE was executed obliquely in relation to the longitudinal axis, following the orientation of the coastal arcs, being located two centimeters below the inferior angle of the scapula. The measurement of the DCT had as reference the posterior face of the arm, parallel to the longitudinal axis, at the point that comprises half the distance between the upper lateral edge of the acromion and the olecranon.

Measurement of Blood Pressure

The measurement of blood pressure (BP) was determined and classified according to the Brazilian Guidelines on Hypertension12 and the results adjusted to age and sex as foreseen in the report for the diagnosis, evaluation and prevention of hypertension for childhood and adolescence. The measurement was made with a sphygmomanometer with a mercury column of the Trademark brand; a cuff was used with a rubber bag suitable for the circumference and brachial compliance of the students. For the measurement of the PA, the students were invited in the classroom to go to a heated room in the school to control the ambient temperature. The students had to stay five minutes in absolute rest and shortly after the measurements. This measurement procedure was performed three consecutive times with an interval of two minutes between them, and the value of the mean of the measurements was considered.

Statistical analysis

The data were tabulated in the Excel 2010 program and analyzed through the statistical program Statistical Package for the Social Sciences SPSS, version 22. To characterize the variables of the study were used: distribution in frequencies and percentages, calculation of measures of central tendency (mean) and dispersion (standard deviation). The Pearson Chi-Square tests (c2) were used to verify the association between the variables and to compare the correlations, and for the effect size the Cramer V and Fi with adjusted residual standardized data were used. The 95% confidence interval (CI) and a level of significance of 5% were adopted (p <0.05). The results of the investigation were distributed in sociodemographic data, family history for cardiovascular diseases, anthropometric data and biochemical evaluation data for dyslipidemias.


RESULTS

The descriptive analysis of the data presented in table 1 showed that female students represented 67% of the sample and male students represented 33%. The data related to the distribution by age revealed a greater representation of students in the age group of 16 and 17 years, corresponding to 66% of the total of participants. The values referring to the self-referred color identified a higher prevalence of the brown and white race. Regarding the type of school, 27.7% are students of the private school and 72.3% of students of the public school. The data referring to the housing area showed that 76.8% of the students reside in the urban area and 23.2% in the rural area.




The data in Table 2 show a frequency of cardiovascular risk factors in the family history of 30.8%, smoking presented a frequency of 0.4%, alcoholism 36.2%, physical inactivity was 75.5 % the percentage of high fat was detected in 33.1%, arterial hypertension presented a frequency of 16.6% and dyslipidemia presented a frequency in 68% of the participants.




According to the results, the distribution of cardiovascular risk factors of high school students shows that all 224 students had at least one cardiovascular risk factor (Figure 1). The frequency of the risk factors showed that eight students (3.6%) presented a factor, 42 (18.8%) presented two factors, 45 (20.1%) presented three factors, 48 (21.4%) In all four factors, 44 (19.6%) presented five factors, 14 (6.3%) presented six factors, 12 (5.4%) presented seven factors, seven (3.1%) presented eight factors and only four (4) 1.8%) presented the nine risk factors.


Figure 1. Distribution of cardiovascular risk factors of high school students analyzed in the present study.



DISCUSSION

The values found in this study showed that 0.4% of the population analyzed is young smokers, which differs from the results of two national surveys of prevalence of smoking. The first was carried out by the National Institute of Science and Technology for Public Policies,13 which revealed a prevalence of 3.4% of young smokers, with this rate being higher in males (5.2%) compared to sex. female (1.6%). The second was performed by Figueiredo14 and found a prevalence of 2.5% of student smokers. This same investigation also showed that the northeast region had the lowest prevalence of smoking among adolescents. However, it detected similar data with the study conducted by Ribas and Silva4 that showed a prevalence of 0.7% of young smokers. In this way, the students of the present study presented a low exposure to smoking in relation to smokers in Brazil in general, although the values found resemble those of the northeast region.

A significant number of participants in this study (36.6%) reported that they consume alcoholic beverages, this value being higher than the study carried out by Coutinho15 (19%), which makes the students of the Iguatu - CE schools almost two. sometimes more exposed to alcohol consumption. This result is worrisome, since Roereckey Rehm16 shows that 1.4% of all deaths in the world are related to excessive alcohol consumption.

The regular practice of physical activity can be used as a protective effect against several chronic-degenerative diseases such as hypertension, obesity, diabetes, osteoporosis and coronary diseases17. The results indicate that 75.4% of the students of this research were classified as insufficient assets. It was opposed to the study conducted by Rangel, Freitas and Rombaldi18 that identified sedentary behavior of 23.4% in adolescents aged 11 to 18 years.

Faced with the results of this research, a 67% prevalence in the fat percentage of the students was also evidenced, being found statistical difference in relation to the female sex, which presented higher values. This result contrasts with that found by Gonçalves6 who found a lower prevalence of fat percentage (26.6%) in his study. The high rates of body weight among children and adolescents in Brazil serve as a warning to the public power to direct policies of incentive to the practice of physical activity and healthy eating19.

Alterations in BP have been growing a lot among Brazilian adolescents. Gonçalves et al.20 show an average of 8% of hypertension among Brazilian children, and in fact they were prevalent in 16.5% of the schoolchildren analyzed in the present study, corroborating also with other studies21,22,23.

Dyslipidemia is a metabolic disorder characterized by abnormal concentrations of lipids in the blood, being determined by genetic and environmental factors23. The results indicate that 68.3% of the students analyzed had dyslipidemias, being that for HDL it was classified as low in 60.7% of the participants. Other studies reported lower values of dyslipidemias24,25,26,27.

Limitation

This study presents a limitation in the detail of the diagnosis, since this delineation of a population-based cross-sectional study restricts the interpretations of the results because it doesn´t accompany the population over time and makes the association between the investigated variables difficult.


CONCLUSION

All students had at least one risk factor associated with cardiovascular diseases. The prevalences of the most relevant research factors for the studied population were: sedentary lifestyle, dyslipidemia, excess weight, alcoholism and family history for cardiovascular diseases. The majority of the population investigated presented two to five risk factors for cardiovascular diseases, being that the highest prevalences were identified in female students. A recommendation for these adolescents to reduce sedentary time inside the school, in the recess schedule / interval between classes, since the lack of exercise can bring harm to health, especially cardiovascular problems. It is recommended that the school offer spaces with materials for the practice of physical exercises, such as: tracks with cones, slackline, a climbing wall, spirobol, etc., introducing the exercise in an entertaining way during the periods where those students usually remain idle and sitting.


ACKNOWLEDGMENT NOTE

Special thanks to the Ministry of Health of the city of Iguatu-CE for the support in the resources for the blood collections and the participating schools of the study.


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