Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos

Fundamento: A obesidade abdominal apresenta elevada prevalência em mulheres com síndrome dos ovários policísticos (SOP) e está associada a um aumento do risco cardiovascular. Objetivo: Verificar a acurácia da circunferência da cintura (CC), da relação cintura-quadril (RCQ), da relação cinturaestatura (RCEST) e do índice de conicidade (índice C), no que se refere à detecção de fatores de risco cardiovascular (FRCV) em mulheres com SOP. Métodos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnóstico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerídeos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia após teste oral de tolerância à glicose (TOTG) e a pressão arterial (PA) foram avaliados em todas as pacientes, além das variáveis antropométricas. Resultados: A relação cintura-estatura foi o marcador que apresentou correlações positivas significativas com o maior número de FRCV (PA, TG e glicemia após TOTG), destacando-se ainda a correlação negativa com HDL-C. Todos os marcadores antropométricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlação positiva também com TG. No tocante à acurácia para detecção de FRCV, os indicadores antropométricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclusão: A RCEST demonstrou ser o indicador antropométrico com a melhor acurácia para a predição de FRCV. Nesse sentido, propõe-se a inclusão desse parâmetro de fácil mensuração na avaliação clínica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 ± 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF

Avaliação da fidedignidade dos ensaios de esteróides fecais realizados no Laboratório de Medidas Hormonais do Departamento de Fisiologia da UFRN

NASCIMENTO, H. G. ; FERNANDES, L. C. ; SOUSA, M. B. C. . Avaliação da fidedignidade dos ensaios de esteróides fecais realizados no Laboratório de Medidas Hormonais do Departamento de Fisiologia da UFRN. Publica , v. 2, p. 39-48, 2006.

Mortalidade da população em idade ativa (PIA) por doença cardiovascular e câncer nas capitais e nas regiões metropolitanas brasileiras: associação com indicadores socioeconômicos

Universidade Estadual do Rio Grande do Norte

Síndrome metabólica e risco cardiovascular na pós- menopausa: avaliação por diferentes critérios diagnósticos e influência de fatores sócio-econômicos

The metabolic syndrome (MetS) involves a group of risk factors and is associated with a significantly higher risk of developing cardiovascular diseases (CVD) and type 2 diabetes. Recent studies have shown the importance of preventing CVD through early diagnosis and treatment of patients with MetS. The objective of our study was to determine the prevalence of MetS by different diagnostic criteria in postmenopausal women and analyze the influence of socioeconomic factors on cardiovascular risk in this sample of the population. A cross-sectional study involving 127 postmenopausal women (45 to 64 years) from Natal and Mossoró, Brazil. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. The experimental protocol consisted of applying structured interview, clinical examination and implementation of dosages blood. The diagnosis of MetS was based on NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) and IDF (International Diabetes Federation) criteria. The research was accomplished with the participation of an interdisciplinary team in their several phases. The result of the sample studied had mean age of 53.9 ± 4.6 years and per capita income of 54.5 dollars. The prevalence of MetS, according to NCEP-ATP III and IDF criteria, was 52.8% and 61.4$, respectively. The agreement rate between NCEP-ATP III and IDF criteria was 81.9%, with a kappa value of 0.63 (CI 95%, 0.49-0.76), indicating good agreement between the two definitions. The most prevalent cardiovascular risk factor was HDL < 50 mg/dl, observed in 96.1% of the women analyzed, followed by increased waist circumference (≥ 80 cm) in 78.0%, elevated blood pressure in 51.2%, triglycerides ≥ 150 mg/dl in 40.9% and glycemia ≥ 100 mg/dl in 37.0% of the women. The occurrence of MetS was significantly associated with schooling and body mass index (BMI). High blood pressure was significantly associated with low family income, low schooling and weight gain. There was no significant association between the intensity of climacteric symptomatology and the occurrence of MetS. The conclusions of the research were that MetS and its individual components show a high prevalence in postmenopausal Brazilian women, and significant associations with weight gain and low socioeconomic indicators. The data point to the need for an interdisciplinary approach at the basic health care level, directed toward the early identification of risk factors and the promotion of cardiovascular health of climacteric women.

Estado nutricional antropométrico, perfil lipídico e consumo alimentar como fatores de risco para doença cardiovascular em adolescentes

The dyslipidemia and excess weight in adolescents, when combined, suggest a progression of risk factors for cardiovascular disease (CVD). Besides these, the dietary habits and lifestyle have also been considered unsuitable impacting the development of chronic diseases. The study objectives were: (1) estimate the prevalence of lipid profile and correlate with body mass index (BMI), waist circumference (WC) and waist / height ratio (WHR) in adolescents, considering the maturation sexual, (2) know the sources of variance in the diet and the number of days needed to estimate the usual diet of adolescents and (3) describe the dietary patterns and lifestyle of adolescents, family history of CVD and age correlates them with the patterns of risk for CVD, adjusted for sexual maturation. A cross-sectional study was performed with 432 adolescents, aged 10-19 years from public schools of the Natal city, Brazil. The dyslipidemias were evaluated considering the lipid profile, the index of I Castelli (TC / HDL) and II (LDL / HDL) and non-HDL cholesterol. Anthropometric indicators were BMI, WC and WHR. The intake of energy, nutrients including fiber, fatty acids and cholesterol was estimated from two 24-hour recalls (24HR). The variables of lipid profile, anthropometric and clinical data were used in the models of Pearson correlation and linear regression, considering the sexual maturation. The variance ratio of the diet was calculated from the component-person variance, determined by analysis of variance (ANOVA). The definition of the number of days to estimate the usual intake of each nutrient was obtained by taking the hypothetical correlation (r) ≥ 0.9, between nutrient intake and the true observed. We used the principal component analysis as a method of extracting factors that 129 accounted for the dependent variables and known cardiovascular risk obtained from the lipid profile, the index for Castelli I and II, non-HDL cholesterol, BMI, and WC the WHR. Dietary patterns and lifestyle were obtained from the independent variables, based on nutrients consumed and physical activity weekly. In the study of principal component analysis (PCA) was investigated associations between the patterns of cardiovascular risk factors in dietary patterns and lifestyle, age and positive family history of CVD, through bivariate and multiple logistic regression adjusted for sexual maturation. The low HDL-C dyslipidemia was most prevalent (50.5%) for adolescents. Significant correlations were observed between hypercholesterolemia and positive family history of CVD (r = 0.19, p <0.01) and hypertriglyceridemia with BMI (r = 0.30, p <0.01), with the CC (r = 0.32, p <0.01) and WHR (r = 0.33, p <0.01). The linear model constructed with sexual maturation, age and BMI explained about 1 to 10.4% of the variation in the lipid profile. The sources of variance between individuals were greater for all nutrients in both sexes. The reasons for variances were  1 for all nutrients were higher in females. The results suggest that to assess the diet of adolescents with greater precision, 2 days would be enough to R24h consumption of energy, carbohydrates, fiber, saturated and monounsaturated fatty acids. In contrast, 3 days would be recommended for protein, lipid, polyunsaturated fatty acids and cholesterol. Two cardiovascular risk factors as have been extracted in the ACP, referring to the dependent variables: the standard lipid profile (HDL-C and non-HDL cholesterol) and "standard anthropometric index (BMI, WC, WHR) with a power explaining 75% of the variance of the original data. The factors are representative of two independent variables led to dietary patterns, "pattern 130 western diet" and "pattern protein diet", and one on the lifestyle, "pattern energy balance". Together, these patterns provide an explanation power of 67%. Made adjustment for sexual maturation in males remained significant variables: the associations between puberty and be pattern anthropometric indicator (OR = 3.32, CI 1.34 to 8.17%), and between family history of CVD and the pattern lipid profile (OR = 2.62, CI 1.20 to 5.72%). In females adolescents, associations were identified between age after the first stage of puberty with anthropometric pattern (OR = 3.59, CI 1.58 to 8.17%) and lipid profile (OR = 0.33, CI 0.15 to 0.75%). Conclusions: The low HDL-C was the most prevalent dyslipidemia independent of sex and nutritional status of adolescents. Hypercholesterolemia was influenced by family history of CVD and sexual maturation, in turn, hypertriglyceridemia was closely associated with anthropometric indicators. The variance between the diets was greater for all nutrients. This fact reflected in a variance ratio less than 1 and consequently in a lower number of days requerid to estimate the usual diet of adolescents considering gender. The two dietary patterns were extracted and the pattern considered unhealthy lifestyle as healthy. The associations were found between the patterns of CVD risk with age and family history of CVD in the studied adolescents

Acurácia dos índices antropométricos de obesidade central na determinação de síndrome metabólica e fatores de risco cardiovascular em mulheres com síndrome dos ovários policísticos

A síndrome dos ovários policísticos (SOP) é a desordem endócrina mais comum em mulheres com idade reprodutiva. Seu diagnóstico é firmado através do consenso de Rotterdam na presença de dois dos seguintes critérios: anovulação crônica, sinais clínicos e/ou bioquímicos de hiperandrogenismo e presença de micropolicistos nos ovários. Na SOP, além das características específicas da síndrome é comum a presença de marcadores de risco cardiovascular aumentado como dislipidemia, hipertensão arterial, resistência à insulina e obesidade central Objetivos: Analisar a acurácia diagnóstica da circunferência da cintura (CC), relação cintura-estatura (RCEst), razão cintura-quadril (RCQ) e índice de conicidade (Índice C) para detecção de fatores de risco cardiovascular (FRCV) e síndrome metabólica (SM) em mulheres com síndrome dos ovários policísticos (SOP). Metodologia: Foi realizado estudo transversal envolvendo 108 mulheres na faixa etária de 20-34 anos, com diagnóstico de SOP de acordo com o consenso de Rotterdam. Foram considerados parâmetros clínicos, antropométricos e bioquímicos de avaliação do risco cardiovascular. A análise dos dados foi desenvolvida em duas etapas, conforme descrito a seguir. Fase 1: análise da acurácia dos pontos de corte previamente determinados na literatura nacional para CC, RCEst, RCQ e Índice C, para predição de FRCV; Fase 2: determinação de pontos de corte dos índices antropométricos supracitados, específicos para mulheres com SOP, para discriminação de SM, através da análise da curva ROC (Receiver Operating Characteristic). Resultados: Com base nos achados da fase 1 do estudo, a RCEst foi o marcador que apresentou correlações positivas significativas com o xi maior número de FRCV (pressão arterial, triglicerídeos e glicemia após teste oral de tolerância à glicose), além de correlação negativa com HDL-colesterol. Os demais marcadores antropométricos se correlacionaram positivamente com pressão arterial, enquanto CC e RCQ apresentaram correlação positiva também com triglicerídeos. Todos os indicadores antropométricos apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEst que apresentou sensibilidade superior a 70%. Na fase 2 da pesquisa observamos que a CC, RCEst e RCQ apresentaram desempenho semelhante na predição de SM, sendo superiores ao Índice C. Os valores de ponto de corte dos índices antropométricos para discriminar SM foram: CC = 95 cm; RCEst = 0,59; RCQ = 0,88; e Índice C = 1,25. Utilizando esses pontos de corte as taxas de sensibilidade e especificidade da CC e RCEst foram superiores às observadas para RCQ e Índice C. Conclusões: Nossos dados enfatizam a importância da avaliação antropométrica no rastreamento do risco cardiovascular em mulheres com SOP, destacando-se a relevância da RCEst na predição de FRCV clássicos e a necessidade de considerar pontos de corte específicos para mulheres com SOP para discriminação de SM

Risco de doença cardiovascular em mulheres com história de distúrbio hipertensivo da gravidez

OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pré-eclâmpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbuminúria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (± 4.8) while this ratio in normotensive women was of 23.5 (± 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension

Doença cardiovascular em mulheres com histórico de pré-eclâmpsia e seguimento no sistema único de saúde

The aim of the present study was to analyze cardiovascular risk of women with a history of preeclampsia, as well as its follow-upin the National Health System.This is a cross-sectional quantitative research conducted at the Januário Cicco Maternity School. The study population was composed of 573 women selected from a databank belonging to the Women s Health Research Group of the Gynecology Department at Universidade Federal do Rio Grande do Norte, with a history of preeclampsia, and normotensives who gave birth at this institution five years before. The final sample consisted of 147 women, 64 in the group with a history of PE and 83 normotensives. Data were collected on a questionnaire containing the following: sociodemographic aspects, anthropometric measures, life habits, personal and family history of pregnancy-induced hypertension, family history of cardiovascular diseases and frequency of measuring current blood pressure levels. In relation to the association between cardiovascular risk and altered blood pressure (≥130x85 mmHg), the likelihood of exhibiting the latter condition was significantly higher in women with a history of preeclampsia (CI 95% 4.12-38.92), the overweight and obese (CI 95% 1.70-20.75), and in those with a family historyof CVD and personal history of PIH (CI 95% 0.78-47.07 and CI 95% 3.20-25.39) respectively. Likewise, the probability of having altered blood pressure was higher in women with fasting glycemia ≥100mg/dL (CI 95% 2.09-24.73), as well as in those with triglycerides ≥150mg/dl (CI 95% 1.72-9.66). After fitting the logistic model, diagnosis previous preeclampsia and altered triglycerides remained as explanatory variables.The women with a history of preeclampsia five years before exhibited altered blood pressure levels, clinical and laboratory manifestations suggestive of elevated risk for cardiovascular disease, as well as family and personal history of hypertension. There is no differential treatment or adequate outpatient follow-up for this population in basic health care units

Avaliação da prevalência de Síndrome Metabólica, Microalbuminúria e Risco Cardiovascular em mulheres com Síndrome dos Ovários Policísticos

Avaliar fatores de risco cardiovascular em mulheres brasileiras com síndrome dos ovários policísticos (SOP), através da utilização de múltiplos parâmetros, incluindo a determinação da prevalência de síndrome metabólica e seus componentes e pesquisa de microalbuminúria como marcador de um possível dano renal precoce nessas pacientes. Métodos: Foram avaliadas 102 mulheres de 20-34 anos de idade, com diagnóstico de SOP pelo Consenso de Rotterdam, tendo sido analisados parâmetros clínicos, antropométricos, bioquímicos e hormonais. Para diagnóstico de síndrome metabólica, foram adotados critérios do National Cholesterol Education Program s Adult Treatment Panel III (NCEP-ATP III). Para avaliação da microalbuminúria foi utilizada a relação albumina/creatinina (A/C), calculada a partir dos níveis de albumina e creatinina em amostra isolada de urina. Foram realizados testes estatísticos para avaliar associações e correlações entre variáveis, bem como comparação de médias ou medianas, adotando-se nível de significância de 5%. Resultados: A prevalência de síndrome metabólica foi de 28,4% (29 em 102 pacientes), estando associada ao aumento do índice de massa corporal (IMC). Quanto à análise da prevalência dos componentes individuais da síndrome metabólica, evidenciou-se: HDL-colesterol < 50 mg/dl em 69,6%, circunferência da cintura ≥ 88 cm em 57,9%, triglicerídeos ≥150 mg/dl em 31,7%, pressão arterial ≥130/85 mmHg em 18,6% e glicemia de jejum ≥110 mg/dl em 2,9%. Quando definida pelos limites convencionais para a relação A/C (3,5 35 mg/mmol), a microalbuminúria esteve presente em apenas três pacientes (3,3%). Entretanto, considerando diferentes limites de corte estabelecidos em recentes estudos que demonstraram aumento do risco cardiovascular associado a níveis muito baixos da relação A/C, a prevalência em mulheres com SOP foi alta, variando de 17,7 a 43,3% (para valores ≥ 0,58 e ≥ 0,37 mg/mmol, respectivamente). Mulheres com intolerância à glucose apresentaram nível significativamente mais elevado da relação A/C, quando comparadas às mulheres com normoglicemia. Os valores de microalbuminúria não apresentaram correlação significativa com IMC, níveis pressóricos, índices de sensibilidade insulínica ou perfil lipídico. Conclusões: Os dados evidenciam uma alta prevalência de síndrome metabólica e seus componentes individuais em mulheres brasileiras com SOP. Além do mais, observou-se elevado percentual de mulheres com níveis de excreção urinária de albumina em faixas significativamente associadas com aumento do risco para eventos cardiovasculares. Em conjunto, esses dados alertam para a necessidade da abordagem interdisciplinar e multidisciplinar das pacientes com SOP, visando à instituição de medidas voltadas para a prevenção primária cardiovascular

Efeito do ácido alfa-lipóico sobre biomarcadores de estresse oxidativo, inflamação e fatores de risco cardiovascular em hipertensos

Alpha-lipoic acid (ALA) is a potent antioxidant with favourable anti-inflammatory, metabolic and endothelial effects, and has been widely investigated due to its potential against cardiovascular risk factors. This study aimed to evaluate the effect of oral ALA supplementation on oxidative stress biomarkers, inflammation and cardiovascular risk factors in patients with hypertension. This is a double-blind placebo-controlled randomized clinical trial, where the intervention was evaluated prospectively comparing results in both groups. The sample consisted of 64 hypertensive patients who were randomly distributed into ALA group (n = 32), receiving 600 mg / day ALA for twelve weeks and control group (n = 32), receiving placebo for the same period. The following parameters were evaluated before and after intervention: lipid peroxidation, content of reduced glutathione (GSH), enzymatic activities of glutathione peroxidase (GPx) and superoxide dismustase, ultrasensitive C-reactive protein (hs-CRP), triglycerides, total cholesterol and fractions, fasting glucose and anthropometric indicators. There was a statistically significant reduction (p <0.05) in serum concentrations of total cholesterol, very low density lipoprotein (VLDL), high density lipoprotein (HDL), triglycerides and blood glucose. There was a reduction in body weight and waist, abdominal and hip circumferences in the group that received ALA. In addition, there was a statistically significant increase (p <0.05) in the contents of reduced glutathione (GSH) and glutathione peroxidase (GPx) in the group receiving ALA. Oral administration of ALA appears to be a valuable adjuvant therapy, which may contribute to decrease the damage caused by oxidative stress and other risk factors associated with the atherosclerotic process

Herdabilidade de preditores do risco cardiovascular

genetic and environmental factors contribute to the development of cardiovascular risk and that influence can be differentiated by factors characteristic of each population, age and sex. Aim: To investigate the heritability of anthropometric and biochemical markers as predictors of cardiovascular risk in men and women of different age groups, using the method of twins. Methods: A sample of 88 subjects and of these 52 children and adolescents (08-17 years old) 32 monozygotic (20 female and 12 male) and 20 dizygotic (12 female and 08 male) and 36 adults (18-28 years age) 24 monozygotic (08 female and 16 male) and 12 dizygotic (06 female and 06 male), living in the metropolitan region of Natal / RN, Brazil. Anthropometric measures were taken as the height, body mass, waist circumference (WC), sum of skinfolds (ΣDC), fat percentage CUN-BAE, BMI and conicity. Biochemical markers analyzed were: fasting glucose (GLU), total cholesterol (COL), HDL-C, LDL-C and triglycerides (TG). After processing the data the index of heritability (h2) = (S ² MZ) / S ² DZ (DZ S ²) X100 was applied disaggregated by sex and age. Results: The variables showed differential heritability of behavior for men and women, depending on age. The variables with the highest heritability values were ΣDC, GLU, HDL, TG, in men and BMI, WC, ΣDC, GLU, HDL-C and TG in women. And more influenced by the environment variables were: body mass, BMI, Chol, LDL-C in men; body mass and LDL-C in women. Conclusion: Differences index of heritability by gender for cardiovascular risk predictors may assist in planning specific intervention strategies according to gender and stage of life of that individual. It is from the level of environmental influence that can run interventions for changes of components related to cardiovascular risk

Relação entre a doença periodontal e doença cardiovascular: há uma preocupação por parte dos que fazem clínica médica e odontológica na cidade de Natal?

The relationship between periodontal and cardiovascular diseases is a reality in the current days. The knowledge about the role of periodontal disease as a risk factor to cardiovascular disease from dentistry and physicians is very important to try to eliminate this risk factor. The aim of this work was to investigate, using a questionary, if physicians and dentistry are aware about this relationship and if they think that it is important. These forms were distributed in 4 groups: cardiologists (n=90), physicians from other specialist (POS) (n=110), periodontists (n=35) and dentistry from other specialist (DOE) (n=85). We had a loss off 32,4% of the total sample due to a lack of response of some professionals. Our results showed that all cardiologists, all dentists and 68,2% of POE said that they had gotten information about the relationship between periodontal and cardiovascular disease, and just 6 POS don t believe that this relationship can occur. When questioned if, even when a periodontal disease is diagnosed, there is a habit to treat or orient the patient for treatment, 29,5% of cardiologists answered no, 25,5% of POE also answered that they did not orient and only 1 DOE answered that he did not treat nor orient. All periodontists said that treat their patients when periodontal disease was identify. The physicians seem not to find important the relationship that exist between periodontal and cardiovascular diseases and the dentistry have shown a good knowledge about this subject. Maybe, if physicians and dentistry work together, the incidence of cardiovascular disease decreases