Associação do tempo de comportamento sedentário com a saúde cardiovascular ideal em pessoas idosas

Abstract

The increase in the number of elderly people in Brazil is due to the demographic transition, marked by changes in birth and death rates. Due to increased longevity, chronic non-transmissible diseases are more prevalent, with cardiovascular diseases. In 2009, the American Heart Association (AHA) developed criteria, called Ideal Cardiovascular Health (CVH), aimed at preventing these diseases, focusing on healthier lifestyles. The objective of this study was to evaluate the prevalence of ideal cardiovascular health in the elderly, and to analyze its association with the time of exposure to sedentary behavior (SB). A systematic review of the PubMed, BVS and Scopus databases was performed to analyze observational studies that assessed the prevalence of ideal cardiovascular health in subjects aged ≥60 years of both sexes, four studies were eligible for the review and showed that the prevalence of ideal CVH is low in this population. Subsequently, a cross-sectional study was carried out to evaluate the direct and indirect associations of SB with the ideal CVH. The sample consisted of 170 elderly people of both sexes, enrolled in the Family Health Strategy and living in the urban area of the city of Alcobaça, Bahia. To collect the data, a blood sample was collected and a structured questionnaire containing sociodemographic, health and behavioral information was applied. The time exposed to SB was defined based on two questions from the International Physical Activity Questionnaire (IPAQ), and the ideal cardiovascular health metrics evaluated using the criteria proposed by the AHA (current smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, fasting glycemia). Indirect associations between SB and ideal CVH, mediated through health perception, number of diseases, health perception and self-esteem were found. In view of the presented results, it is necessary interventions aimed at favoring the ideal CVH and reducing the time exposed to the sedentary behavior, considering the factors that influence this relationship.

Introdução: com o envelhecimento as doenças crônicas não transmissíveis vêm se desenvolvendo, entre elas as doenças cardiovasculares. Visando melhorar a saúde cardiovascular de todos os americanos, a American Heart Association (AHA) definiu o conceito de Saúde Cardiovascular (SCV) Ideal, por meio da presença simultânea de sete métricas de saúde (tabagismo, índice de massa corporal, atividade física, dieta, colesterol total, pressão arterial, glicemia de jejum). Objetivo: analisar estudos observacionais que avaliaram a prevalência de saúde cardiovascular ideal em indivíduos com idade ≥ 60 anos, de ambos os sexos. Métodos: A revisão sistemática foi realizada segundo as recomendações do Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). As bases de dados selecionadas para a busca foram National Library of Medicine (PUBMED), Biblioteca Virtual em Saúde (BVS) e SCOPUS. Os artigos selecionados foram publicados até 15 de janeiro de 2019 e analisados por dois revisores de forma independente, para avaliação da qualidade metodológica foi utilizada a escala de Loney. Resultados: foram encontrados na busca inicial 625 artigos, porém quatro estudos atenderam aos critérios de inclusão e foram elegíveis para a revisão sistemática. Houve divergências em relação às características dos estudos, mas todos apresentaram baixa prevalência de saúde cardiovascular ideal em idosos. Foi observada a falta de padronização no método de avaliação e classificação da SCV ideal. Conclusão: a prevalência de SCV ideal em idosos é baixa, tornando-se necessário a incorporação de medidas com foco nas métricas de SCV voltadas para essa população.

Introduction: with aging, chronic noncommunicable diseases have been developing, among them cardiovascular diseases. In order to improve the cardiovascular health of all americans, the American Heart Association (AHA) defined the Ideal Cardiovascular Health (CVH) concept through the simultaneous presence of seven health metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, fasting blood glucose). Objective: to analyze observational studies that evaluated the prevalence of ideal cardiovascular health in subjects aged ≥ 60 years, of both sexes. Methods: The systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The databases selected for the search were PUBMED, BVS and SCOPUS. The selected articles were published until January 15, 2019 and analyzed by two reviewers independently, to evaluate the methodological quality was used the scale of Loney. Results: 625 articles were found in the initial search, but four studies met inclusion criteria and were eligible for systematic review. There were differences regarding the characterization of the studies, but all presented low prevalence of ideal cardiovascular health in the elderly. The lack of standardization was observed in the method of evaluation and classification of ideal CVH. Conclusion: the prevalence of ideal CVH in the elderly is low, making it necessary to incorporate measures that focus on CVH metrics for this population.

Introdução: com o aumento da expectativa de vida há o aumento da prevalência de doenças crônicas, a exemplo das doenças cardiovasculares. A American Heart Association (AHA) desenvolveu critérios voltados para a prevenção das doenças cardiovasculares com foco em estilos de vida mais saudáveis. Objetivo: avaliar as associações diretas e indiretas do tempo de exposição ao comportamento sedentário (CS) com a saúde cardiovascular (SCV) ideal em idosos. Materiais e Métodos: estudo transversal realizado com 170 indivíduos de ambos os sexos e idade ≥ 60 anos, cadastrados nas Estratégias de Saúde da Família da área urbana do município de Alcobaça, BA. O tempo exposto ao comportamento sedentário foi avaliado pelo Questionário internacional de Atividade Física, e as métricas de saúde cardiovascular ideal avaliadas por meio dos critérios propostos pela AHA (tabagismo atual, índice de massa corporal, atividade física, dieta, colesterol total, pressão arterial, glicemia de jejum). A percepção de saúde, número de doenças e autoestima foram avaliados por instrumentos de autorrelato. A análise de trajetórias (Path Analysis) foi utilizada para análise dos dados, a partir do software AMOS 20.0. Resultados: Foram encontradas associações indiretas entre CS e SCV ideal, mediadas pela percepção de saúde (β= -0,030), número de doenças (β= -0,041), percepção de saúde e autoestima (β= -0,012). Conclusão: O CS está associado com a SCV ideal por mediação de outros fatores que devem ser considerados em intervenções para melhora da SCV na população idosa.

Introduction: with the increase in life expectancy there is an increase in the prevalence of chronic diseases, such as cardiovascular diseases. The American Heart Association (AHA) has developed criteria aimed at preventing cardiovascular disease with a focus on healthier lifestyles. Objective: to evaluate the direct and indirect associations of the time of exposure to sedentary behavior (SB) with ideal cardiovascular health (CVH) in the elderly. Materials and Methods: a cross-sectional study with 170 individuals of both sexes and age ≥ 60 years, enrolled in the Family Health Strategies of the urban area of the city of Alcobaça, Bahia. The time exposed to sedentary behavior was assessed by the International Physical Activity Questionnaire, and the ideal cardiovascular health metrics evaluated using the criteria proposed by the AHA (current smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, fasting glycemia). The perception of health, number of diseases and self-esteem were evaluated by self-report instruments. Path analysis was used to analyze the data from the AMOS 20.0 software. Results: Indirect associations were found between SB and ideal CVH, mediated by health perception (β = 0.030), number of diseases (β = -0.041), health perception and selfesteem (β = - 0.012). Conclusion: CS is associated with the ideal SCV by means of other factors that should be considered in interventions to improve SCV in the elderly population.