The publication Cardiovascular Statistics – Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil.  The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke.  Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Network and an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG). 

A publicação Estatística Cardiovascular – Brasil tem por objetivo fornecer uma compilação anual dos dados e das pesquisas sobre a epidemiologia das DCV no Brasil.  Este documento integra as estatísticas oficiais do Ministério da Saúde do Brasil e outras entidades governamentais ao lado de dados do projeto GBD, coordenado pelo IHME da Universidade de Washington. Além disso, incorpora dados derivados de várias fontes e estudos científicos, inclusive coortes e registros, relacionados às DCV e fatores de risco associados. Esta publicação destina-se a um público variado, incluindo pesquisadores, clínicos, pacientes, formuladores de políticas de saúde, profissionais da mídia, o público em geral e todos aqueles que buscam dados nacionais abrangentes sobre DCV e acidente vascular cerebral. Pesquisadores voluntários de várias universidades e instituições de pesquisa brasileiros realizaram este projeto. O grupo é liderado por um comitê diretivo com cinco membros (ALPR, CAP, DCM, GMMO e LCCB). A Sociedade Brasileira de Cardiologia apoia integralmente esta iniciativa e o projeto recebe colaboração da Rede GBD Brasil1 e do GBD International Committee (GAR, PP e TAG) do IHME/Universidade de Washington (GAR) e da World Heart Federation (PP e TAG). 

ABSTRACT The aim of this experimental study was to evaluate acute responses to oxidative stress (OS) after a single session of two HIIT protocols. 24 Wistar rats were divided into three groups (n= 8): sedentary control (SC), HIIT with a 7-minute volume (LW) and HIIT with 14-min (HW). After the protocol, blood was collected for the measurement of uric acid (UA), and the liver and the gastrocnemius muscle were collected for OS assessment by measuring malondialdehyde (MDA) and total antioxidant capacity (FRAP). The LW and HW groups showed a reduction in hepatic MDA (51.9 and 29.9%; p< 0.05) compared to SC. However, the muscle of the HW group increased the MDA (12.6%; p< 0.05) compared to SC. As for FRAP, LW and HW reduced values (78.3 and 75.3%; p< 0.05) compared to SC, respectively. UA in the LW group was higher when compared to SC (64.7%; p< 0.05), HW group was similar to SC (p> 0.05). Among the different HIIT protocols, the LW group showed an increase in UA compared to the HW group (44%; p< 0.05). Compared to SC, the LW and HW groups did not promote acute OS in the liver tissue. However, HW caused OS in muscle tissue after a single exercise session.

RESUMO Objetivou-se identificar a evidência quanto às associações entre atividade física (AF) e saúde mental (SM) em adolescentes escolarizados brasileiros. Trata-se de um estudo de Revisão Sistemática. Os estudos foram selecionados em português e inglês e identificados por meio de uma busca sistemática em seis bases de dados eletrônicas: PubMed, Web of Science, SPORTDiscus/Ebsco, ScIELO, ERIC, e LILACS, que compreendeu publicações até o final de 2019. Os critérios de inclusão foram: estudos com um desenho de coorte, descritivo de caráter exploratório, transversal, ou qualitativos; realizados com crianças e adolescentes; estudos que analisaram a relação entre AF e SM; estudos que investigaram adolescentes que praticavam AF nas escolas; estudos realizados no Brasil e os que obtiveram a pontuação mínima estabelecida de 60% conforme os critérios da qualidade metodológica do instrumento STROBE. A Educação Física oferecida no currículo da educação básica tem um efeito protetor sobre a SM no ambiente escolar. Além disso, mais de 300 min/semana de AF foi associado positivamente com a SM. Algumas associações foram negativas entre a AF e a SM, tais como: tempo excessivo de TV; isolamento social; insatisfação com o peso corporal. A AF escolar está associada positivamente à SM por promover bem-estar físico e psicológico, impactando na redução dos índices de problema de insônia, atenuando a solidão e melhorando a aparência física.

ABSTRACT The aim of this study was to identify evidence regarding associations between School Physical Activity (PA) and Mental Health (MH) in Brazilian school-aged adolescents. This is a systematic review study. Studies were selected in Portuguese and English and identified by a systematic search in six electronic databases: PubMed, Web of Science, SPORTDiscus / Ebsco, ScIELO, ERIC, and LILACS, which comprised publications until 2019. Inclusion criteria were: studies with cohort, descriptive, cross-sectional or qualitative design; performed with children and adolescents; studies that analyzed the relationship between PA and MH; studies that investigated adolescents who practiced PA in schools; studies carried out in Brazil; and studies that reached minimum of 60% of methodological quality criteria according to STROBE. Physical education, as curricular activity in basic education, has protective effect on MH in the school setting. In addition, more than 300 min/week of PA was positively associated with MH; while associations between PA and excessive TV time; social isolation; and body weight dissatisfaction were negatively associated. School PA is positively associated with MH as it promotes physical and psychological well-being, impacting on the reduction of insomnia rates, attenuating loneliness and improving physical appearance.

Abstract Aim: This study aimed to examine the association between physical activity (PA) indicators and TV viewing as a function of the Human Development Index (HDI). Method: This cross-sectional study was based on data from the National School Health Survey, which was composed of 102,072 students (14.28±1.03; 51.3% girls). Total PA, active commuting to school (ACS) and TV viewing were assessed by questionnaires and classified through a gradual scale ranging from “F” (low) to “A+” (high). The correlation between total PA, ACS, TV viewing and HDI was verified by Spearman’s Correlation and presented in rs. Results: HDI was positively associated with total PA [girls: rs = 0.572 (p < 0.001); boys: rs = 0.843 (p < 0.001)] and ACS [girls: rs = 0.433 (p < 0.001); boys: rs = 0.554 (p < 0.001)]; while a negative correlation was found between HDI and TV viewing [girls: rs = -0.330 (p < 0.001); boys: rs = -0.348 (p < 0.001)]. Conclusions: Brazilian adolescents from states with higher HDI were more active and spent more time watching TV than their counterparts from states with lower HDI.

Resumo – O objetivo desta revisão sistemática foi identificar a associação entre excesso de peso, obesidade e nível de atividade física em crianças e adolescentes brasileiros, no ambiente escolar. A busca eletrônica foi realizada nas principais bases de dados de referência (PubMed, LILACS, SciELO, SPORTDiscus, Web of Science, ERIC). A pesquisas nas bases resultaram em 3265 títulos potencialmente relevantes (2775 títulos após análise duplicada); 21 estudos preencheram todos os critérios de inclusão e foram analisados. Os estudos foram realizados entre 2007 e 2019, 47,6% deles foram realizados no sul do Brasil, e apenas uma pesquisa foi realizada a nível nacional. Foi identificado prevalências de 5,4% a 21% para sobrepeso, 3,5% a 16,9% para obesidade e 11,8% a 40,1% para excesso de peso (obesidade + sobrepeso). De acordo com os resultados, 64,3% dos jovens com sobrepeso, 69,8% dos obesos e 37,7% daqueles com excesso de peso foram considerados insuficientemente ativos. A não padronização dos instrumentos para avaliar os níveis de atividade física e a pouca representatividade de outras regiões brasileiras foram classificadas como lacunas importantes. Os resultados reforçam o aumento da prevalência de excesso de peso em crianças e adolescentes no Brasil, e a alta prevalência de inatividade física entre estes jovens. A cada dez jovens acima do peso, seis são insuficientemente ativos.

Abstract – The objective of this systematic review was to identify the association between overweight/obesity and level of physical activity in Brazilian children and adolescents in the school setting. For search strategy, the main reference databases (PubMed, LILACS, SciELO, SPORTDiscus, Web of Science, ERIC) were used. Baseline searches resulted in 3,265 potentially relevant titles (2,775 titles after removal of duplicate studies); 21 studies met all inclusion criteria and were included for analysis. Studies were carried out from 2007 to 2019; 47.6% of them were conducted in Southern Brazil, and only one study had nationwide approach. Prevalence from 5.4% to 21% was identified for overweight, 3.5% to 16.9% for obesity and 11.8% to 40.1% for overweight + obesity. According to results, 64.3% of overweight, 69.8% of obese and 37.7% of young overweight people were considered insufficiently active. The non-standardization of instruments to assess levels of physical activity and the lack of information regarding other Brazilian regions were classified as important limitations. The results reinforce the increase in the prevalence of overweight in Brazilian children and adolescents, and the high prevalence of physical inactivity among them. For every ten overweight children/adolescents, six are reported to be insufficiently active.

Resumo: Introdução: A educação interprofissional (EIP) desenvolve competências colaborativas, aprimora a segurança do paciente e melhora a qualidade da atenção à saúde. A disponibilidade para aprendizagem compartilhada relaciona-se diretamente com a EIP. Objetivo: Este estudo teve como objetivo analisar a disponibilidade dos estudantes para a EIP, de acordo com os ciclos e cursos. Método: Trata-se de estudo transversal, descritivo, de abordagem quantitativa. Utilizou-se a Readiness for Interprofessional Learning Scale (RIPLS) via formulário eletrônico. Os testes Mann-Whitney e qui-quadrado foram utilizados para analisar respectivamente variáveis contínuas e categóricas. Nas análises para verificar as diferenças nas pontuações dos fatores 1. trabalho em equipe e colaboração (TEC), 2. identidade profissional (IP) e 3. atenção à saúde centrada no paciente (ACP), além da pontuação global da RIPLS, os cursos e ciclos foram comparados por meio do teste Kruskal-Wallis. Resultado: Participaram do estudo 506 estudantes, com taxa de respostas de 32,6%, dos cursos de Enfermagem, Farmácia, Fisioterapia, Fonoaudiologia, Medicina, Nutrição, Odontologia e Terapia Ocupacional de uma universidade pública brasileira. As pontuações dos fatores 1, 2 e 3 e a pontuação global da RIPLS não apresentaram diferenças entre os sexos. Os estudantes do curso de Farmácia apresentaram menor disponibilidade para o fator 3 (ACP) quando comparados com os alunos de Enfermagem, Fisioterapia, Medicina, Odontologia e Terapia Ocupacional (p = 0,007). Os discentes de Fonoaudiologia e Nutrição apresentaram menor pontuação no mesmo fator em comparação com os de Odontologia e Terapia Ocupacional (p = 0,007). Os estudantes de Farmácia (p = 0,004) e Medicina (p = 0,016) foram menos propícios a obter maior pontuação no fator 1 (TEC), enquanto os de Terapia Ocupacional obtiveram maior chance para maior disponibilidade no mesmo fator (p = 0,024). No fator 2 (IP), os estudantes do quinto ciclo foram menos propensos a atitudes positivas (p = 0,046). Observou-se que os estudantes de Terapia Ocupacional apresentaram atitude mais favorável para a EIP expressa tanto no fator 3 (p = 0,034) quanto na pontuação global (p = 0,027), enquanto os alunos do curso de Farmácia apresentaram menor chance para melhor disponibilidade no fator 3 (p = 0,003) e na pontuação global (p = 0,003). Conclusão: Considerando a relevância da EIP no processo de reorientação da formação de profissionais de saúde para a construção da integralidade do cuidado e alinhamento com o Sistema Único de Saúde, este estudo pretende contribuir para a reflexão acerca das diferenças na disponibilidade para EIP entre cursos de graduação na área da saúde.

Abstract: Introduction: Interprofessional Education (IPE) helps develop collaborative skills, enhance patient safety and improve the quality of health care. Readiness for shared learning is directly related to IPE. Objective: To analyze Readiness for IPE among students, according to the cycles and courses. Method: This cross-sectional, descriptive study adopted a quantitative approach and used the Readiness for Interprofessional Learning Scale (RIPLS) via an electronic form. Mann-Whitney and chi-square tests were used to analyze the continuous and categorical variables, respectively. Analyses to ascertain differences between scores for the factors (1) Teamwork and Collaboration (TEC), (2) Professional Identity (IP), (3) Patient-Centered Health Care (ACP), and the overall RIPLS score, used the Kruskal-Wallis test to compare courses and cycles. Result: A response rate of 32.6% was attained from a sample of 506 students from the Nursing, Pharmacy, Physiotherapy, Speech Therapy, Medicine, Nutrition, Dentistry and Occupational Therapy courses of a Brazilian public university. The scores for factors 1, 2 and 3, and the overall RIPLS score did not differ between genders. Pharmacy students reported a lower Readiness for factor 3 (ACP) compared to students in Nursing, Physiotherapy, Medicine, Dentistry and Occupational Therapy (p=0.007). Speech therapy and Nutrition reported lower scores for the same factor compared to Dentistry and Occupational Therapy (p=0.007). Pharmacy students (p=0.004) and medicine students (p=0.016) were less likely to obtain a higher score in factor 1(TEC), while Occupational Therapy students were more likely to report greater Readiness in the same factor (p=0.024). In factor 2 (IP), fifth grade students were less likely to have positive attitudes (p=0.046). It was observed that Occupational Therapy students showed a more favorable attitude towards IPE expressed both in factor 3 (p=0.034) and in the overall score (p=0.027), while students in the Pharmacy course were less likely to report better readiness in factor 3 (p=0.003) and in the overall score (p=0.003). Conclusion: Considering the relevance of IPE in the process of redirecting health care training to build comprehensive care and ensure alignment with the Unified Health System, this study aims to reflect on the differences in readiness for IPE between undergraduate courses in health area.

RESUMO O objetivo do estudo foi identificar as estruturas para atividades físicas (AF) nas escolas brasileiras e relacioná-las ao Índice de Desenvolvimento Humano (IDH), Índice de Desenvolvimento da Educação Básica (IDEB) e indicadores de qualidade do Report Card Brasil (RCB). Trata-se de estudo descritivo que utilizou dados secundários do INEP-Brasil para a identificação e classificação da estrutura para prática de AF nas escolas brasileiras, a partir da existência de “pátio”, “quadras” e “materiais esportivos”, organizadas por escolas do nível “fundamental” e “médio”. Os dados foram organizados por Região Macroeconômica e relacionados com os Índices IDH, IDEB e os Critérios de Classificação de Qualidade do RCB. Assim, para o “Ensino Fundamental”, verificou-se relação positiva entre o IDH e a existência de “pátio” (r=0,53; p=0,004), “quadra” (r=0,855; p<0,01) e material esportivo (r=0,764; p<0,01), o IDEB também apresentou relação positiva com a existência de “pátio” (r=0,475; p=0,01), “quadra esportiva” (r=0,676; p<0,01) e “material esportivo” (r=0,535; p<0,01). Para o “Ensino Médio”, verificou-se relação entre o IDH e a existência de quadras (r=0,517; p<0,01) e materiais esportivos (r=0,499; p < 0,01), enquanto para o IDEB, apenas houve relação com a existência de materiais esportivos (r=0,508; p<0,01). Conclui-se que as Regiões Norte e Nordeste possuem escolas com menores frequências de estrutura para Atividade Física e que há relação positiva desta estrutura com o IDH, IDEB e classificação de qualidade RCB.

ABSTRACT The purpose of this study was to identify structures for the practice of physical activities (PA) in Brazilian Schools and relate them to the Human Development Index (HDI), Basic Education Development Index (IDEB) and quality indicators from the Report Card Brazil (RCB). This is a descriptive study that used secondary data from INEP-Brazil to identify and classify structures for the practice of PA in Brazilian schools based on the presence of “schoolyards”, “sports courts” and “sporting materials”, organized by elementary and high schools. Data were organized by Macroeconomic Region and related to HDI, IDEB and Report Card Brazil Quality Classification Criteria. Thus, for “Elementary School”, positive and significant relationship was observed between HDI and the presence of “schoolyards” (r=0.53; p=0.004), “sports courts” (r=0.855; p<0, 01) and “sporting materials”(r=0.764; p<0.01), while for IDEB, values followed the same logic, associated to the presence of “schoolyards” (r=0.475; p=0.01), “sports courts” (r=0.676; p<0.01) and “sporting materials” (r=0.535; p<0.01). For “High School”, relationship was observed between HDI and the presence of “sports courts” (r=0.517; p<0.01) and “sporting materials” (r=0.499; p<0.01), while for IDEB, relationship was only observed with the presence of “sporting materials” (r=0.508; p<0.01). It could be concluded that the Northern and Northeastern regions of Brazil have schools with lower presence of structure for the practice of Physical Activity and that there is positive relationship of this structure with HDI, IDEB and quality indicators of the Report Card Brazil.

ABSTRACT The purpose of this study was to analyze the factors associated with negative Health Perception and Quality of Life (QoL) of older adults. This was a cross-sectional study composed of 224 older adults with a median age of 70.58±6.43 years old. A questionnaire was designed to incorporate ABEP (socio-economic questionnaire), WHOQOL-bref, IPAQ, and Senior Fitness Test (SFT). Binary logistic regression with p>0.05, organized in univariate and multivariate models in SPSS version 22. Variables upper extremities poor flexibility OR = 2.43 (1.37 - 4.31) and lower extremities poor flexibility OR = 2.69 (1.54 - 4.69) were significantly associated with negative health perception. Being not financial responsible OR= 0.33 (0.12 - 0.85) presented lower odds of negative QoL perception. The variable Lower extremities poor flexibility univariate OR= 2.52 (1.45 - 4.39) and multivariate model OR= 2.42 (1.38 - 4.24) showed almost three times higher probabilities of negative QoL perception.

Resumo O envelhecimento compreende um processo dinâmico e progressivo. Caracteriza-se por alterações fisiológicas e funcionais, sendo a modificação na composição corporal com o acréscimo de gordura corpórea considerada relevante, podendo ocasionar comprometimento da aptidão física e alterações cardiometabólicas. O objetivo deste estudo foi avaliar a influência do sobrepeso na capacidade funcional em idosas praticantes de exercício físico. Foi realizada uma pesquisa de campo correlacional com 24 idosas praticantes de exercício físico. Todas as idosas foram submetidas a anamnese, analise antropométrica com avaliação da massa corporal e estatura, capacidade funcional com a bateria de testes de Rikli e Jones (Sênior Fitness test), flexibilidade com o banco de Wells e força de prensão manual com o teste de preensão manual. Utilizou-se o teste de correlação de Pearson e a regressão logística multivariada pelo método Stepwise para verificar a associação entre sobrepeso e capacidade funcional. Observou-se que a flexibilidade de Quadril (R=-0,494, p=0,014) e a flexibilidade dos membros inferiores pelo banco de Wells (R=-0,446, p=0,02) apresentaram forte correlação negativa com o índice de massa corporal (IMC). Após a regressão logística multivariada, percebeu-se uma forte correlação negativa com a flexibilidade do quadril (B=-0,035, p=0,014). Assim, a flexibilidade do quadril entre as idosas ativas com sobrepeso reduziu com o aumento do IMC.

Abstract Aging comprises a dynamic and progressive process, characterized by physiological and functional changes. Among these changes, increase in body fat is considered relevant, since it can leads to impaired physical fitness and augmented cardiometabolic risks. Considering this, the objective of this study was to evaluate the influence of overweight on functional capacity of physically active older women. A field survey was performed with 24 older women who practiced physical exercise. Participants were submitted to anamnesis, anthropometric measures (i.e., body mass and height); the Senior Fitness test; sit and reach flexibility test; and handgrip strength test. Pearson’s correlation test and multivariate logistic regression were used to verify the association between overweight and functional capacity. It was observed that hip flexibility (R=-0.494, p=0.014) and flexibility of the lower limbs (i.e., sit and reach test) showed negative correlation with the body mass index (R=-0.446, p=0.02); and after the multivariate logistic regression, negative correlation of lower limbs flexibility (B=-0,035, p=0,014) and the body mass index was observed. Thus, higher the body mass index among participants, lower hip flexibility they presented.

ABSTRACT CONTEXT AND OBJECTIVE: Sarcopenia is an emerging public health issue in Brazil. Because of its high prevalence and the lack of national data, the objective here was to identify cutoff points for appendicular skeletal muscle (ASM) and handgrip strength in relation to fear of falling among Brazilian older adults. DESIGN AND SETTING: Cross-sectional study; in the community. METHODS: Participants underwent morphological and functional evaluations; and were asked about previous falls and fear of falling. Different adjustments to ASM and handgrip strength were used. Slow walking speed was defined as < 0.8 m/s or 1.0 m/s. Gender and age groups were compared using t tests, analysis of variance (ANOVA), chi-square test or Fisher’s exact test. Receiver operating characteristic curves were used to identify cutoffs for ASM and handgrip strength in relation to fear of falling. RESULTS: 578 older adults participated in this study. Function levels decreased with increasing age, and body composition differed between the sexes. In relation to fear of falling, the cutoffs for ASM adjusted for body mass index (BMI) were < 0.85 for men and < 0.53 for women; the cutoffs for absolute handgrip strength and relative handgrip strength (adjusted for BMI) were 30.0 kgf and 21.7 kgf, and 1.07 and 0.66, for men and women, respectively. CONCLUSION: The values presented can be used as references in clinical practice and research. We recommend use of ASM adjusted for BMI and choosing between absolute and relative handgrip strength for men and women, according to study needs.

RESUMO CONTEXTO E OBJETIVO: Em idosos, diversas ferramentas antropométricas podem apresentar complicações durante a mensuração. Embora a circunferência do pescoço pareça evitar tais problemas, os pontos de corte e fatores de risco cardiovascular associados a essa ferramenta em idosos permanecem desconhecidos. Este estudo foi desenvolvido para identificar os valores de ponto de corte e fatores de risco cardiovascular associados à circunferência do pescoço em idosos. DESENHO E LOCAL: Estudo transversal, realizado em dois centros comunitários para idosos. MÉTODOS: 435 idosos (371 mulheres e 64 homens) foram recrutados. Os voluntários foram submetidos a avaliação morfológica (índice de massa corporal e cintura, quadril, e circunferência do pescoço) e hemodinâmica (valores da pressão arterial e frequência cardíaca). A análise pela curva receiver operating characteristic foi usada para determinar o valor preditivo dos valores de ponto de corte da circunferência do pescoço para identificação de sobrepeso/obesidade. Análise multivariada foi usada para identificar os fatores de risco cardiovascular associados com circunferência do pescoço larga. RESULTADOS: Os valores de corte para circunferência do pescoço (homens = 40,5 cm e mulheres = 35,7 cm) para detectar adultos idosos obesos, de acordo com o índice de massa corporal, foram identificados. Depois da segunda análise, circunferência do pescoço larga foi associada com elevado índice de massa corporal em homens e mulheres e elevados valores de pressão arterial, prevalência de diabetes mellitus tipo II e hipertensão em mulheres. CONCLUSÃO: Os dados indicam que a circunferência do pescoço pode ser utilizada como ferramenta de rastreio para identificar sobrepeso/obesidade em idosos. Ademais, altos valores de circunferência do pescoço podem estar associados com fatores de risco cardiovascular.

ABSTRACT CONTEXT AND OBJECTIVE: In elderly people, measurement of several anthropometric parameters may present complications. Although neck circumference measurements seem to avoid these issues, the cutoffs and cardiovascular risk factors associated with this parameter among elderly people remain unknown. This study was developed to identify the cutoff values and cardiovascular risk factors associated with neck circumference measurements among elderly people. DESIGN AND SETTING: Cross-sectional study conducted in two community centers for elderly people. METHODS: 435 elderly adults (371 women and 64 men) were recruited. These volunteers underwent morphological evaluations (body mass index and waist, hip, and neck circumferences) and hemodynamic evaluations (blood pressure values and heart rate). Receiver operating characteristic curve analyses were used to determine the predictive validity of cutoff values for neck circumference, for identifying overweight/obesity. Multivariate analysis was used to identify cardiovascular risk factors associated with large neck circumference. RESULTS: Cutoff values for neck circumference (men = 40.5 cm and women = 35.7 cm), for detection of obese older adults according to body mass index, were identified. After a second analysis, large neck circumference was shown to be associated with elevated body mass index in men; and elevated body mass index, blood pressure values, prevalence of type 2 diabetes and hypertension in women. CONCLUSION: The data indicate that neck circumference can be used as a screening tool to identify overweight/obesity in older people. Moreover, large neck circumference values may be associated with cardiovascular risk factors.