Cigarette smoking and risk of epithelial ovarian cancer (Australia)

Objectives: We studied the association between cigarette smoking and ovarian cancer in a population-based case-control study. Methods: A total of 794 women with histologically confirmed epithelial ovarian cancer who were aged 18-79 years and resident in one of three Australian states were interviewed, together with 855 controls aged 18-79 years selected at random from the electoral roll from the same states. Information was obtained about cigarette smoking and other factors including age, parity, oral contraceptive use, and reproductive factors. We estimated the relative risk of ovarian cancer associated with cigarette smoking, accounting for histologic type, using multivariable logistic regression to adjust for confounding factors. Results: Women who had ever smoked cigarettes were more likely to develop ovarian cancer than women who had never smoked (adjusted odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.2-1.9). Risk was greater for ovarian cancers of borderline malignancy (OR = 2.4; 95% CI = 1.4-4.1) than for invasive tumors (OR = 1.7; 95% CI = 1.2-2.4) and the histologic subtype most strongly associated overall was the mucinous subtype among both current smokers (OR = 3.2; 95% CI = 1.8-5.7) and past smokers (OR = 2.3; 95% CI = 1.3-3.9). Conclusions: These data extend recent findings and suggest that cigarette smoking is a risk factor for ovarian cancer, especially mucinous and borderline mucinous types. From a public health viewpoint, this is one of the few reports of a potentially avoidable risk factor for ovarian cancer.

Phyllodes tumors of the breast: Correlation of nucleolar organizer regions with histopathological malignancy grading, flow cytometric DNA analysis and clinical outcome

To examine whether nucleolar organizer regions detected by argyrophilia (Ag-NOR counts) can be used as a prognostic indicator in phyllodes tumors of the breast, and to compare its usefulness with that of DNA flow cytometric analysis, 28 cases of breast phyllodes tumors (including 15 benign, two borderline and 11 malignant tumors) were subjected to Ag-NOR staining and counting as well as DNA flow cytometric analysis. S-phase fraction and DNA ploidy analysis showed useful trends for improving outcome predictions in malignant phyllodes tumors. However, high Ag-NOR counts were significant in predicting survival status (P = 0.013) and reached near statistical significance in predicting survival times (P = 0.07). In predicting survival status, results for Ag-NOR counts were significantly better than those for ploidy analysis (P = 0.02) and S-phase fraction (P < 0.01). Only S-phase fraction was significantly predictive of survival times (P = 0.025). It is concluded that Ag-NOR counts and DNA flow cytometric analysis, easily performed using paraffin sections, give information that can improve predictions made by histopathological classification. Ag-NOR counts are significant in predicting survival in the presence of histopathological features of malignancy.

Genetic and environmental risk factors and their interactions for Parkinson's disease in a Chinese population

The interaction between genetic and environmental factors for PD was examined in a Chinese population. It was found that although the intron 2 MAOB (GT)(n) repeat polymorphism was not associated with PID in the population, a relationship might have been masked by the protective effect of tea drinking. In individuals who did not drink tea (<1 cup/day), the possession of short length less than or equal to 178 bp (GT), alleles conferred a borderline significant increased risk for PD (adjusted OR = 1.47; C.l. = 1.03-2. 1). As the extent of tea consumption increased, the association between the less than or equal to178 bp allele and PD disappeared. This result suggests that the MAOB gene may be associated with PD in Chinese if the putative protective effect of tea drinking is taken into account. The significance of this finding is unclear as the study may be limited because of its marginal significance and limited numbers. However, it does demonstrate the importance of considering putative positive and negative environmental risk factors in any examination of genetic risk factors for PD. (C) 2003 Elsevier Science Ltd. All rights reserved.

Dietary influences on survival after ovarian cancer

We evaluated the effects of various food groups and micronutrients in the diet on survival among women who originally participated in a population-based case-control study of ovarian cancer conducted across 3 Australian states between 1990 and 1993. This analysis included 609 women with invasive epithelial ovarian cancer, primarily because there was negligible mortality in women with borderline tumors. The women's usual diet was assessed using a validated food frequency questionnaire. Deaths in the cohort were identified using state-based cancer registries and the Australian National Death Index (NDI). Crude 5-year survival probabilities were estimated using the Kaplan-Meier technique, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained from Cox regression models. After adjusting for important confounding factors, a survival advantage was observed for those who reported higher intake of vegetables in general (HR = 0.75, 95% CI = 0.57-0.99, p-value trend 0.01 for the highest third, compared to the lowest third), and cruciferous vegetables in particular (HR = 0.75, 95% CI = 0.57-0.98, p-value trend 0.03), and among women in the upper third of intake of vitamin E (HR = 0.76, 95% CI = 0.58-1.01, p-value trend 0.04). Inverse associations were also seen with protein (p-value trend 0.09), red meat (p-value trend 0.06) and white meat (p-value trend 0.07), and modest positive trends (maximum 30% excess) with lactose (p-value trend 0.04), calcium and dairy products. Although much remains to be learned about the influence of nutritional factors after a diagnosis of ovarian cancer, our study suggests the possibility that a diet high in vegetable intake may help improve survival. (C) 2003 Wiley-Liss, Inc.

Reported Use of Anabolic Steroids and Ergogenic Substances in Gym/Health Club Settings: Associations with Psychosocial and Exercise Behavior Factors

The industry of ergogenic supplements is increasing rapidly (Cole et al., 2003). Supplements may constitute an important aid for some vigourous exercise routines, but they may also be used as a hypothetical mean to achieve increases in muscular mass. This supposed effect of suplements can lead to its use by individuals who have high levels of drive for muscularity, a condition that is known to be associated with muscular dismorphy (or as it has been called recently vigorexia, Pope et al., 1997). Another psychological factor which can influence supplement consumption is exercise dependence, a borderline problem, as most studies present a prevalence of less than 10% in regular exercisers (Palmeira & Matos, 2006). Symptoms like tolerance or continuity could lead to the use of ergogenic aids to maintain the exercise levels. Also of interest for the understanding of the use of suplements are exercise frequency, volume and intensity, which could explain the ratesof consumption on a more physicological level.

Índice de exposição à sílica na atividade de mineração de ouro

OBJETIVO: Propor um índice que sintetize a exposição cumulativa à sílica, incluindo intensidade, duração e época da exposição e testá-lo em relação à presença e gravidade de silicose. MÉTODOS: Estudo transversal realizado com 140 ex-mineiros de ouro, residentes em duas localidades do Estado de Minas Gerais, examinados entre 11/1997 e 12/1999. Foram analisadas informações sobre história clínica e ocupacional, radiografia de tórax e espirometria. Casos borderline de silicose pela radiografia foram submetidos à tomografia computadorizada de alta resolução. O índice representa a soma dos escores extraídos da transformação logarítmica das taxas de concentração de sílica respirável nas diversas funções, minas e períodos trabalhados. Foram aplicados testes paramétricos para comparação das médias entre os grupos de interesse. RESULTADOS: O índice proposto apresentou-se discriminativo em relação ao desfecho principal (silicose) e aos desfechos secundários (enfisema e tuberculose) pulmonar no grupo total, incluindo os diversos estágios da doença, com valores p: 0,008, 0,016 e <0,001 respectivamente. Em relação às quatro categorias principais da silicose, o teste de Tukey evidenciou diferenças nas médias do índice entre as categorias 0 e 3 e 1 e 3. Porém, no subgrupo constituído pelos casos borderline, a discriminação entre os desfechos não foi satisfatória, tanto com diagnósticos obtidos pela radiografia quanto pela tomografia. CONCLUSÕES: O índice proposto representa um avanço na síntese da exposição ocupacional dos participantes, podendo ser usado para outras profissões. Entretanto, torna-se importante a incorporação de fatores clínicos e funcionais para entender a evolução da doença em expostos à sílica, especialmente nos casos duvidosos.

A loucura e o cinema: representações cinematográficas de personalidade limite

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Audiovisual e Multimédia.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study

^len^lpt^aOBJETIVO: Descrever a prevalência de pressão arterial limítrofe (PAL) e hipertensão (HT) entre adultos jovens e avaliar a associação entre tamanho ao nascer e PAL/HT. MÉTODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirão Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recém-nascidos de parto único hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliação antropométrica e obtidas informações sobre ocupação, escolaridade, hábitos de vida e doenças crônicas. Pressão arterial (PA) foi classificada em: 1) PAL: PA sistólica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastólica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressão logística politômica. RESULTADOS: A prevalência de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), índice de massa corporal (IMC) ≥ 30 kg/m² (RR 3,23; 2,02; 5,15) e circunferência de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m² (RR 3,68; 2,23;6,06), circunferência de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas não com comprimento ao nascer. CONCLUSÕES: As prevalências de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas não com HT, enquanto peso ao nascer não foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.^les^aOBJETIVO: Describir la prevalencia de presión arterial limítrofe (PAL) e hipertensión (HT) entre adultos jóvenes y evaluar la asociación entre tamaño al nacer y PAL/HT. MÉTODOS: : Los datos fueron colectados en el primer estudio de cohorte de nacimientos brasileño en Ribeirao Preto (sureste de Brasil), iniciado en 1978/79. De 6.827 recién nacidos de parto único hospitalario, 2.060 fueron evaluados a los 23/25 años. Se realizaron colecta de sangre, evaluación antropométrica y obtenidas informaciones sobre ocupación, escolaridad, hábitos de vida y enfermedades crónicas. Presión arterial (PA) fue clasificada en: 1) PAL: PA sistólica (PAS) ≥ 130 y < 140 mm Hg y/o PA diastólica (PAD) ≥ 85 y < 90 mm Hg; 2) HT: PAS ≥ 140 y/o PAD ≥ 90 mm Hg. Se aplicó modelo de regresión logística politómica. RESULTADOS: La prevalencia de PAL fue de 13,5% (hombres 23,2%) y la de HT, 9,5% (hombres 17,7%). PAL fue independientemente asociada con sexo masculino (Riesgo Relativo - RR) 8,84; 95%IC: 6,09;12,82), estatura al nacer ≥ 50 cm (RR 1,97; 1,04; 3,73), índice de masa corporal (IMC) ≥ 30 kg/m2 (RR 3,23; 2,02; 5,15) y circunferencia de cintura alterada (RR 1,61; 1,13;2,29), mientras el HT se asoció con sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m2 (RR 3,68; 2,23;6,06), circunferencia de cintura alterada (RR 2,68; 1,77;4,05) y glicemia elevada (RR 2,55; 1,27;5,10), pero no con estatura al nacer. CONCLUSIONES: Las prevalencias de PAL y HT entre los adultos jóvenes de la cohorte fueron mayores en hombres que en mujeres. Mayor estatura al nacer fue asociado con PAL, pero no con HT, mientras que el peso al nacer no estuvo asociado con PAL o HT. Factores de riesgo de adulto explicaron la mayoría de los aumentos de PAL o HT.

Acute renal failure after rifampicin

A patient with miliary tuberculosis and a chronic urogenital focus is described, who had a borderline renal function at diagnosis and developed overt renal failure upon daily treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB). This is the first Brazilian report of BMP induced renal damage. A renal biopsy taken on the third day of oliguria showed recent tubular necrosis with acute interstitial inflammation and granuloma formation. The aspect of the granulomatous lesion hightly suggested drug etiology because of the lack of palisading, high incidence of neutrophils and absence of facid-fast bacilli. This is the first presentation of an acute granulomatous interstitial nephritis probably due to RMP. Furthermore the pathogenesis of the renal damage caused by tuberculosis and RMP are discussed.

HLA and malaria in four colombian ethnic groups

HLA antigens and their relationship with malaria infection were studied in four different ethnic groups in Colombia (South America): two groups of indians (Kunas and Katios), one of negroes and a group of mixed ancestry. A total of 965 persons were studied, 415 with malaria and 550 as controls. HLA-A,B, and C antigen frequencies in the four groups are reported. The association of each HLA antigen with malaria infection due to P. vivax and to P. falciparum was evaluated. Negroes, Kunas and Katios indians variously lack from 6 to 9 of the HLA antigens found in the mixed group. In the designated ethnic groups, antigens B5, B13, B15, Cw2 and Cw4 showed borderline association with malaria infection. However, in the mixed ethnic group, statistically significant associations were found with malaria infection and the presence of A9, Aw19, B17, B35, and Z98 (a B21-B45: crossreacting determinant) with few differences when P. vivax infection and P. falciparum infection were considered individually. This finding may represent a lack of general resistance to malaria in the group that harbors antigens of Caucasian origin. These individuals have been in direct and permanent contact with malaria only in the past 65 years. In contrast, indians, both Kunas and Katios, and Negroes have lived for centuries in malaria endemic areas, and it is possible that a natural selection system has developed through which only those individuals able to initiate an acute immune response to malaria have survived.

Potential infectivity of blood from HBsAG asymptomatic carriers due to the presence of HBV-DNA and comparison with other markers of hbv infection

Serum samples from 356 HBsAg positive asymptomatic carriers, which were titrated by reverse passive hemagglutination, were analysed for the presence of HBV-DNA, HBsAg and IgM anti-HBc. The samples were divided in three classes, according to the titers of HBsAg and IgM anti-HBc and the distribution of HBV-DNA and HBsAg among these classes was studied. In the high titer class of HBsAg, 65% of samples have one or both markers against only 19% in the low titer class. From the total of 356 samples, 121 gave positive results for IgM anti-HBc (33.9%). From these, 38.9% of HBV-DNA and 47.9% of HBeAg were observed, whereas in samples with absence of IgM anti-HBc, 18.3% and 16.6% were respectively found. A higher frequency of agreement between all these markers was found in the class of high titers of HBsAg; however, HBV-DNA was detected in the low titer class of HBsAg and little or no IgM anti-HBc, showing potential blood infectivity even in HBsAg positive borderline samples.

Psychosocial Morbidity and its Correlates in Cancer Patients of the Mediterranean Area: Findings from the Southern European Psycho-Oncology Study

BACKGROUND: A few and partial data are available on psychosocial morbidity among cancer patients in Mediterranean countries. As a part of a more general investigation (Southern European Psycho-Oncology Study-SEPOS), the rate of psychosocial morbidity and its correlation with clinical and cultural variables were examined in cancer patients in Italy, Portugal and Spain. METHODS: A convenience sample of cancer outpatients with good performance status and no cognitive impairment were approached. The Hospital Anxiety-Depression scale (HAD-S), the Mini-Mental Adjustment to Cancer scale (Mini-MAC), and the Cancer Worries Inventory (CWI) were used to measure psychological morbidity, coping strategies and concerns about illness. RESULTS: Of 277 patients, 34% had pathological scores ("borderline cases" plus "true cases") on HAD-S Anxiety and 24.9% on HAD-S Depression. Total psychiatric "caseness" was 28.5% and 16.6%, according to different HAD cut-offs (14 and 19, respectively). Significant relationships of HAD-S Anxiety, HAD-S Depression, HAD-S Total score, with Mini-MAC Hopeless and Anxious Preoccupation, and CWI score were found. No differences emerged between countries on psychosocial morbidity, while some differences emerged between the countries on coping mechanisms. Furthermore, Fatalism, Avoidance and marginally Hopeless were higher compared to studies carried out in English-speaking countries. LIMITATIONS: The relatively small sample size and the good performance status prevent us to generalize data on patients with different cancer sites and advanced phase of illness. CONCLUSIONS: One-third of the patients presented anxiety and depressive morbidity, with significant differences in characteristics of coping in Mediterranean countries in comparison with English-speaking countries.

Risk-factors for non-adherence to antiretroviral therapy

Cross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002), daily dose (p = 0.046), use of alcohol (p = 0.030) and past drug use (p = 0.048), and borderline p-values were found for educational level (p = 0.093) and family monthly income (p = 0.08). In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence. Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers.

Incapacidade Funcional na Doença de Hansen - Estudo Retrospectivo, Descritivo, e Analítico de 243 Doentes Tratados Antes e Depois da Terapêutica da OMS

Introdução: A doença de Hansen pode resultar em incapacidade funcional pelo compromisso do sistema nervoso periférico. A prevenção de incapacidade constitui o objectivo dos actuais programas de tratamento, nomeadamente da terapêutica tripla da Organização Mundial de Saúde. Objectivos: Caracterizar e comparar dois grupos de doentes de Hansen, tratados antes (“antigos”) e depois (“recentes”) da introdução da terapêutica tripla da Organização Mundial de Saúde, analisando o benefício desta na redução de incapacidade. Identificar as características dos doentes mais favorecidos nesta potencial redução e, nos doentes “recentes”, determinar se o prolongamento da duração da terapêutica beneficia a redução de incapacidade. Material e Métodos: Estudo retrospectivo e comparativo de 243 doentes, distribuídos em dois grupos, 164 “antigos” e 79 “recentes”, caracterizados quanto ao sexo, idade à data do diagnóstico, intervalo entre início de sintomas e diagnóstico, forma clínica (Ridley e Jopling), ocorrência de reacção, índice bacteriológico (IB) inicial, presença de sintomas neurológicos iniciais, duração da terapêutica anti-leprótica e presença e grau de incapacidade. Resultados: A comparação da presença de incapacidade nos dois grupos mostrou que esta é mais elevada nos doentes “antigos”, sendo significativamente superior no sexo masculino, forma lepromatosa borderline, ocorrência de reacção, IB inicial positivo e com sintomas neurológicos iniciais. A incapacidade grau 2 é também significativamente superior nos doentes “antigos” . Nos doentes “recentes” não se verificou relação entre a duração da terapêutica da Organização Mundial de Saúde e a presença de incapacidade. Conclusão: A prevenção e redução de incapacidade na doença de Hansen é possível através de um diagnóstico precoce e tratamento adequado com a terapêutica tripla da Organização Mundial de Saúde.

Caracterização da aterosclerose sub-clínica e doença coronária em doentes com síndrome metabólica e diabetes mellitus

RESUMO- Introdução: A obesidade e a Síndrome Metabólica (SM) são atualmente um importante problema de saúde pública, com prevalências crescentes, que se acompanham também por aumento da prevalência de Diabetes Mellitus (DM).Estudos prévios demonstram associação destas entidades com o aumento de risco de eventos cardiovasculares, em particular a DM. A SM tem sido uma entidade muito debatida nos últimos anos, com aparecimento de diversas definições, contribuindo para resultados díspares no que diz respeito à influência da SM nas doenças cardiovasculares. Também têm sido descritas variações étnicas e regionais. Para além de alguns estudos epidemiológicos na população geral, a informação relativamente à sua influência na presença de doença cardiovascular é desconhecida em Portugal, em particular em populações com suspeita de doença coronária. Objetivos - Esclarecimento de questões relacionadas com a prevalência de SM e a sua influência na evolução de doença ateroclerótica arterial por avaliação de uma população com suspeita de doença coronária. População e Métodos - Estudo observacional, transversal, com inclusão prospetiva de indivíduos admitidos letivamente para realização de angiografia coronária por suspeita de doença coronária, tendo sido também efetuadas análises laboratoriais e ecografia carotidea para avaliação da espessura intima-média carotidea (EIMc) e da presença de placas carotídeas. Efetuou-se avaliação dos parâmetros demográficos, antropométricos, determinação do perfil lipídico, glicémia e insulinémia. Os exames angiográficos foram analisados por análise quantitativa semi-automática. Foram excluídos indivíduos com antecedentes conhecidos de doença cardíaca. Resultados - Incluíram-se 300 doentes, com idade média de 64 ± 9 anos, 59% do género masculino. A prevalência de SM de acordo com a definição da AHA/NHLBI foi 48,4% (ajustada para idade e género da população portuguesa) e a prevalência de DM foi 14,8% (ajustada). A concordância global das três definições mais recentes de SM foi de apenas 43%. A prevalência de SM aumenta com a idade e é também mais elevada no género feminino. O componente mais frequente foi a hipertensão arterial, seguido pela obesidade abdominal, a elevação da glicémia e por fim as alterações dos triglicéridos e do colesterol HDL. Por outro lado, a presença de doença coronária significativa (lesões ≥50%) ocorreu em apenas 51,3% dos doentes, sendo ainda mais baixa no género feminino. Demonstrou-se também uma baixa capacidade preditiva para doença coronária dos testes não invasivos clássicos, em particular no género feminino. A prevalência de doença coronária significativa foi idêntica nos indivíduos com SM comparativamente com indivíduos sem alterações metabólicas (46,3% vs. 48,2%, respectivamente), sendo mais elevado nos diabéticos (65,2%). Os fatores predizentes independentes de doença coronária significativa foram a idade, o género masculino, a elevação da glicémia e dos triglicéridos. Pelo contrário, o Índice de Massa Corporal (IMC) mostrou uma associação protetora relativamente à presença de doença coronária. A SM não é fator predizente de doença coronária. Relativamente às dimensões dos vasos coronários, o IMC correlaciona-se positivamente e a glicémia / DM correlacionam-se negativamente. A EIMc aumenta com o aumento da idade e no género masculino. A EIMc foi intermédia nos doentes com SM (0,88 ± 0,31 mm) comparativamente com os doentes diabéticos (0,97 ± 0,34 mm) e os indivíduos “Normais” (0,85 ± 0,34 mm). Os fatores predizentes independentes de EIMc foram a idade, o género masculino, o colesterol HDL e a insulinémia. A EIMc permite predizer com uma acuidade moderada a presença de doença coronária significativa (AUC 0,638), em particular no género feminino, sendo um fator predizente independente de presença de doença coronária (OR 2,35, IC 95% 1,04-5,33. p=0,04). Apesar de não se correlacionar com o número de vasos coronários com doença, correlacionou-se com a gravidade da doença (pelo score de Gensini). A insulinémia e o índice HOMA aumentam diretamente com a idade e com o IMC, sendo contudo sobreponíveis em ambos os géneros. Os fatores predizentes de índice HOMA (resistência à insulina) foram o IMC, bem como os restantes componentes de SM, estando o índice HOMA relacionado com a presença de SM e o número dos seus componentes presentes. O limiar para resistência à insulina foi de 2,66 e para SM foi 2,41. Ao contrário das restantes definições de SM, a definição da AHA/NHLBI não é predizente da presença de DM no género masculino. A associação da resistência à insulina com doença coronária foi limiar (OR 1,13, IC 95% 1,00-1,28, p=0,045). Conclusões - Numa população com suspeita de doença coronária, a prevalência de SM é muito elevada (superior a 50%), sendo a prevalência de DM de 23%. Também a obesidade e o excesso de peso foram extremamente prevalentes nesta população. A concordância entre definições de SM é baixa. A hipertensão arterial e a obesidade abdominal são os componentes mais frequentes de SM, sendo menos prevalentes as alterações lipídicas. Pelo contrário, a presença de doença coronária significativa foi muito baixa, em particular nas mulheres. A SM não se associou à presença de doença coronária significativa, estando esta mais dependente das alterações do metabolismo glicídico e dos triglicéridos, bem como de outros fatores de risco não modificáveis, nomeadamente a idade e o género. A EIMc da carótida comum e a presença de placas carotídeas é mais elevada nos indivíduos diabéticos, estando também ligeiramente aumentada nos doentes com SM, sendo os fatores predizentes de EIMc apenas a idade, o género, a hiperinsulinémia bem como os níveis baixos de colesterol HDL. A utilização da avaliação da EIMc na estratificação de risco pré-angiografia coronária, poderá ser útil no género feminino. A hiperinsulinémia e o índice HOMA (índice de resistência à insulina), estão relacionados com o IMC e consequentemente com a presença de obesidade, embora também se correlacione de forma independente com os outros componentes de SM. A resistência à insulina associou-se à presença de SM. Relativamente à capacidade preditiva da coexistência com DM, verificou-se associação com a definição da NCEP-ATP III e da IDF, contudo, a definição da AHA/NHLBI só foi predizente de DMnas mulheres. -------------ABSTRACT - Introduction: Obesity and Metabolic Syndrome (MS) are a major public health problem, with increasing prevalence, that follows the increase in diabetes prevalence. Previous studies showed an association of both entities with increased cardiovascular risk, particularly diabetes. MS has been debated in the last few years, with several definitions and different results when analysed the influence of MS on cardiovascular diseases. There are also some regional and ethnical variations. Beyond general population epidemiological studies, information about the influence on cardiovascular disease in Portugal is unknown, particularly in patients with suspected coronary disease. Objectives- To clarify several questions regarding the prevalence of MS and the influence in arterial atherosclerotic disease by evaluation of a population with suspected coronary artery disease. Population and Methods- Observational, cross-sectional study with prospective inclusion of individuals admitted electively for coronary angiography with suspicion of coronary artery disease. All individuals also performed laboratorial evaluation and carotid ultrasound to evaluate carotid intima-media thickness (cIMT) and carotid plaques. We also evaluated demographic, anthropometric parameters, lipid profile, blood glucose and blood insulin. Angiographic data was obtained by semi-automated quantitation. Individuals with previously known cardiac history were excluded from the study. Results- We included 300 individuals with a mean age of 64 ± 9 years, 59% males. MS prevalence according to AHA/NHLBI definition was 48.4% (adjusted for age and gender of the Portuguese population) and the adjusted prevalence of diabetes was 14.8%. Global agreement between the more recent three definitions of MS was only 43%. MS prevalence increases with age and is also higher in women. The most frequent components were hypertension and abdominal obesity, followed by elevated glucose and triglicerides and low HDL-cholesterol. Significant coronary artery disease (stenosis ≥50%) was present in only 51.3% of patients, being lower in females. Non-invasive tests also had a low predictive capacity, particularly in females. The prevalence of significant coronary disease was identical in patients with MS compared with normal metabolism individuals (46.3% vs. 48.2%, respectively), being higher in diabetics (65.2%). Independent predictive factors for coronary disease were age, male gender, high blood glucose and triglycerides. On the contrary, Body Mass Index (BMI) was a protective factor for coronary disease. MS wasn’t a predictor of coronary disease. BMI showed a positive correlation with coronary vessel diameter and glucose /diabetes had a negative correlation. CIMT increased with age and was higher in males. CIMT was intermediate in patients with MS (0.88 ± 0.31 mm) when compared to diabetic patients (0.97 ± 0.34 mm) and “Normal” individuals (0.85 ± 0.34 mm). Independent predictors for cIMT were age, male gender, HDL-cholesterol and insulin. CIMT had a moderate predictive accuracy for coronary disease (AUC 0,638), particularly in females and is an independent predictor of the presence of significant coronary disease (OR 2.35, 95% CI 1.04-5.33. p=0.04). Although it did not correlate with the number of diseased coronary arteries, it correlated with coronary disease severity by the Gensini score. Insulin and HOMA index increase directly with age and BMI, but were identical in both genders. Predictive factors for HOMA index (insulin resistance) were BMI as well as the other MS components. HOMA index is related to MS and the number of its components. The cut-off for insulin resistance was 2.66 and for MS 2.41. Unlike other MS definitions, AHA/NHLBI definition is not a predictor of diabetes in males. There was a borderline association between insulin resistance and coronary disease (OR 1.13, 95% CI 1.00-1.28, p=0.045). Conclusions - In a population of patients with suspected coronary disease, MS prevalence is extremely high (above 50%) with a diabetes prevalence of 23%. Also obesity and overweight are very prevalent in this population. Global agreement between MS definitions is however low. Hypertension and abdominal obesity are the most frequent components, with a lower prevalence of lipid abnormalities. Coronary disease prevalence was low, particularly in women. MS wasn’t associated with coronary disease. Coronary disease was related to glucose and triglycerides, as well as with other non-modifiable factors such as age and gender. CIMT and carotid plaques are increased in diabetic patients, and also slightly elevated in patients with MS, but cIMT independent predictors were age, male gender, insulin and HDLcholesterol. CIMT can be useful in risk stratification before coronary angiography particularly in women. Elevated insulin and HOMA index (an insulin resistance index) are related with BMI and consequently with obesity, and it was also correlated with other MS components. Insulin resistance was associated with MS. The presence of diabetes was associated with the presence of MS by NCEP-ATP III and IDF definitions; however, AHA/NHLBI definition was only predictive of diabetes in females.