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Controversies surround risk factors for cardiovascular diseases

Experts from different areas warn of the importance of preventive care

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Research related to risk factors for cardiovascular diseases and which tests what has already been established by the scientific community tends to confuse people about what is actually proven in relation to the topic. It is the case of considering, for example, the consumption of saturated fat to be beneficial. “There are major studies in major journals showing that, sometimes, consuming a high-fat diet does not substantially affect cholesterol levels or can lead to myocardial infarction,” explains professor Dennys Esper Corrêa Cintra, from the Center for Lipid Studies in Nutrigenomics (CELN) from the Faculty of Applied Sciences (FCA) at Unicamp.

In this case, adds Cintra, this is a person who, despite being obese, is not hypertensive or has altered levels of fat in the blood, nor does he have insulin resistance. “But the fact of being obese means that the individual already has an inflammatory process installed and, if we cannot measure this inflammation in the blood, this is molecularly possible. Because inflammation is systemic, all cells are getting into trouble. Becoming obese and, especially, consuming saturated fat will cause problems. It's only a matter of time".

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Professor Dennys Esper Corrêa Cintra: the emergence of problems is a matter of time in obese people

As well as the consumption of saturated fat, there are recent studies with considerable impact that concern other risk factors for cardiovascular diseases such as obesity, diabetes or hypertension. The themes were discussed in the latest edition of the Faculty of Medical Sciences (FCM) Research Week. The event presented a panel of the most recent research developed at Unicamp and several universities.

The topic of obesity was addressed by Professor Bruno Geloneze, from the Metabolism and Diabetes Research Laboratory, LIMED. “Obesity, by definition, is bad for the heart. When we discuss exceptions, it is because there is a subgroup of people with obesity who have a beneficial distribution of fat and functional adipose tissue without negative repercussions for the heart,” he explains.

According to the professor, the subgroup is generally made up of young women, with accumulation of fat on the hips and who do not have a family history of cardiovascular disease. “These are people who will only accumulate fat where they can and will not promote chronic subclinical inflammation or insulin resistance. This would be the benign form of obesity.” Another subgroup “protected” from heart failure would be elderly people, who are losing muscle mass and when they accumulate fat in the body it can be beneficial.

 

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Professor Bruno Geloneze: “Obesity, by definition, is bad for the heart”

On the other hand, Geloneze highlights, there is the non-benign form of thinness. “These are people who are underweight, but when they gain weight, they end up accumulating fat in the liver, around the heart, near the blood vessels. The person has a tendency not to accumulate fat where there would be no problems, such as thighs and hips. In general, they are older, male people who accumulate fat in the trunk and abdomen. It’s the one who says he’s not obese, and that he only has a belly.”

Therefore, there is the metabolically sick skinny and metabolically healthy obese. “This confuses the population. We cannot go in front of the obese person and just check their weight. We must understand the person’s background, whether there is a history of vascular disease, high blood pressure, that is, build their clinical history.” Experts also advise measuring neck and abdominal circumference and insulin resistance. In short, it is not possible to simplify things based on scales. The risks always depend on where the fat is deposited.

The risks of diabetes for cardiovascular diseases were described by the coordinator of the Center for Clinical Research in Endocrinology and Diabetes at Unicamp, Marcos Tambascia. The professor and researcher stated that thinking only about controlling the disease is not enough to reduce the risks. “There are several risk factors and diabetes is among them. Treating just one of these factors and not treating the other does not reduce mortality from cardiovascular diseases. For example, a patient who has mild diabetes but smokes needs to worry about smoking and all other risk factors.”

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Professor Marcos Tambascia: “There are several risk factors and diabetes is among them”

Sacramented

Quitting smoking, exercising regularly and keeping stress levels under control are already established measures to protect the heart and vascular system. Studies developed at the Faculty of Physical Education (FEF) and presented during the research week by professor Bruno Rodrigues proved that the practice of aerobic physical exercises not only prevents complications arising from a myocardial infarction, but also helps in the treatment of its consequences. “Physical training has presented numerous benefits such as a smaller area affected in the case of myocardial infarction in previously trained animals, better ventricular function response, preservation of autonomic function and reduction of the inflammatory profile after myocardial infarction”, he highlighted.

 

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Professor Bruno Rodrigues: practicing physical exercise is important

Hypertension is proven to be the risk factor with the greatest impact on stroke and myocardial infarction, according to cardiologist Wilson Nadruz. “From a prevalence point of view, it is the most common acquired risk factor found in the population.” The research presented by the professor was developed at the Cardiovascular Biology Laboratory. The group led by the researcher seeks to find risk markers in hypertensive patients in the Campinas region. “At the outpatient clinic we found that hypertensive women who discovered the problem during pregnancy and continued to be hypertensive after the birth of their child constitute a population at risk for difficult control of hypertension. That would be a marker.”

Another study, with more than 400 individuals, showed that there is a certain carotid measurement that predicts risk, that is, those who have this measurement altered are more likely to have a heart attack or stroke. The group is also researching a genetic variant associated with greater production of free radicals and oxidative stress. “Those who have this variant tend to have more cardiac hypertrophy (which is as if the heart becomes thicker), and those who are hypertensive and have this genetic variant tend to have more diabetes and be more obese. Maybe it’s a risk marker.”

 

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Cardiologist Wilson Nadruz: highlighting the prevalence of hypertension

As for smoking, it is a risk factor that is even neglected, says the attending physician at the pulmonology outpatient clinic at Hospital de Clínicas (HC) Paulo Roberto Mendes. “Usually when we think about risks for cardiovascular disease, we refer more to diabetes, high blood pressure, etc. However, the number of acute and chronic smoking-related events is greater than the lung disease itself,” he noted. In other words, smokers have more cardiovascular problems than lung problems.

The good news is that the latest research shows that quitting smoking reduces or even eliminates your risk. Mendes presented data from a work published in British Medical Journal evaluating the drop in cardiovascular risk of individuals who stopped smoking according to the length of abstention in a universe of more than 500 thousand people. The study concluded, according to Mendes, that when patients over 60 years of age stop smoking, the cardiovascular risk is equivalent to non-smoking individuals after 20 years of abstention.

Psychiatrist Amilton dos Santos Junior spoke about the relationships between emotions and cardiovascular risk. According to him, although there is a lot of evidence of these associations, only recently have studies begun to prove cause and effect relationships between psychosocial factors and risks. “We have a line of research that believes that changes in the so-called amygdalo-hematopoietic-arterial axis could be a causal link in how chronic stress can cause cardiovascular diseases or worsen pre-existing conditions.”

 

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The risks of obesity have been emphasized by doctors | Photo: Antonio Scarpinetti

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