Doença aterosclerótica subclínica: Comparando dois biomarcadores de risco cardiovascular

Abstract

INTRODUCTION: Cardiovascular diseases are among the main causes of death in both genders in Brazil, and their outcomes have been affecting more and more young adults. In childhood and adolescence, diseases such as atherosclerosis already occur, which presents slow and silent progression, and may result in cardiocerebrovascular outcomes in adulthood. In this sense, institutions have been searched for biomarkers for the early identification of atherosclerotic diseases. AIMS: To verify association and to compare sensitivity, specificity, likelihood ratios, predictive values and accuracy of cardiovascular risk biomarkers, ultra- sensitive C-Reactive Protein and Pathobiological Determinants of Atherosclerosis in Youth score for the detection of the MATERIAL AND METHODS: This is a cross-sectional study developed between 2012 and Carotid Artery Intima-Media Complex Thickening. 2013 in public high schools of the city of Campina Grande - PB. The sample consisted of 512 adolescents aged 15-19 years. The variables used were socio-demographic, clinical, biochemical and behavioral. For the evaluation of the cardiovascular risk, ultra -sensitive C- reactive Protein and the Pathobiological Determinants of Atherosclerosis in Youth scores were used, considering altered values greater than or equal to three and five, respectively. The presence of a subclinical atherosclerotic disease was considered through the verification of carotid thickening greater than or equal to + 2 Z-score, evaluated by Doppler ultrasonography. Absolute, relative, central tendency and dispersion values were measured. The association of cardiovascular risk factors and carotid thickening with nutritional status was evaluated using the ANOVA test and the C-reactive protein with score and its components and carotid thickening, the chi-square test, using the Fisher exact test whenever necessary. The relationship between carotid thickening and biomarkers was tested using Simple Linear Regression. Likelihood, specificity, likelihood ratios, predictive values and accuracy of cardiovascular risk biomarkers were determined for the detection of marked carotid thickening. Statistical analysis was performed using the Statistical Package for the Social Sciences software and 5% significance level was considered. RESULTS: Among adolescents evaluated, 17.8% were overweight / obese. Acute carotid thickening was present in 4.3% of adolescents. Although the prevalence of cardiovascular risk assessed by the two biomarkers was similar, around 10%, only the Pathobiological Determinants of Atherosclerosis in Youth score was associated with the presence of marked carotid thickening (p <0.001). This score had high specificity, positive likelihood ratio, negative predictive value and accuracy in all parameters and better results than those presented by the ultra-sensitive C-reactive protein. CONCLUSIONS: The pathobiological determinants of Atherosclerosis in Youth score seems to be the best biomarker for the screening of subclinical atherosclerotic disease in adolescents, but its low sensitivity and positive predictive power may limit its use. Thus, studies with longitudinal design should be developed to consolidate the use of this score.