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Colesterol, triglicerídeos e tensão arterial em crianças e adolescentes

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1S.C. Guerra, 1J.A. Mota, 2J.A. Duarte
1 Gabinete de Recreação e Tempos Livres, 2 Gabinete de Biologia do Desporto, Faculdade de Ciências do Desporto e de Educação Física, Universidade do Porto, Portugal.

 

INTRODUÇÃO

 

É sabido que as doenças cardiovasculares (DCV) são um dos mais sérios problemas de saúde pública nos países industrializados, sendo mesmo reconhecidas como um problema pediátrico (1). Apesar das manifestações clínicas das DCV aparecerem tipicamente na vida adulta, estudos anatomo-patológicos pós-mortem referem que lesões avançadas de aterosclerose podem já ser identificadas em crianças (2). Sabe-se que esta doença é o resultado de um complexo processo patológico que afecta as diferentes artérias e certas zonas de uma artéria mais do que a outras (3). Os mesmos autores referem que a aterosclerose tem uma evolução longa, silenciosa e insuspeita, tornando-se apenas notório quando se alcança a fase de insuficiência renal, situação que poderá demorar longas décadas de vida do indivíduo ou até nunca acontecer, sendo que as manifestações clínicas desta doença, não são, com poucas excepções, aparentes antes dos 40 anos de idade (4) Estudos epidemiológicos têm demonstrado que, para além da idade, do sexo e dos antecedentes familiares, um elevado número de factores, intrínsecos e extrínsecos ao próprio indivíduo, os denominados factores de risco, condicionam também o aparecimento e a gravidade daquelas lesões vasculares. Desta forma a aterosclerose é uma doença de múltiplas etiologias e que está influenciada por uma diversidade de factores ambientais e genéticos (1).

Os níveis elevados da tensão sanguínea, de colesterol total e triglicerídeos favorecem o desenvolvimento deste tipo de lesões arteriais (5) e, de facto, existem evidências de que os níveis exagerados destes parâmetros persistem desde a infância até à vida adulta jovem (6). Assim, duas descobertas são particularmente significantes: (I) é o facto da aterosclerose se iniciar com a idade, aumentando os factores de risco das doenças cardiovasculares (DCV) para o indivíduo (7). Deste modo, a prevalência da doença aterosclerótica nas artérias coronárias e a incidência dos eventos cardíacos aumenta com o avançar da idade. (II) há evidências que a hipercolesterolemia, a hipertensão, a obesidade e a inactividade física "persistem" desde a infância através da adolescência e até à vida adulta (8,9,10,11).

Considerando os elevados níveis de morbilidade e mortalidade da aterosclerose, bem como os elevados custos de saúde associados, existe um elevado interesse em programas de prevenção de tais condições. Assim o objectivo deste trabalho foi o de estudar a prevalência e incidência destes factores de risco das DCV em crianças de escolas da área do grande Porto, permitindo uma detecção precoce dos indivíduos com elevado risco destas doenças na vida adulta. Foi utilizada uma amostra constituída por 544 crianças entre os 8 e os 15 anos de idade escolhidas aleatoriamente, pertencentes a diferentes estabelecimentos escolares dispersos pela área do grande Porto. O tratamento dos dados foi efectuado agrupando as idades duas a duas, criando deste modo quatro grupos etários: 8-9 anos; 10-11 anos; 12-13 anos; 14-15 anos. De facto observamos que os valores de colesterol, triglicerídeos, tensões arteriais sistólica, diastólica e média aumentam com a idade em ambos os sexos.

Uma vez que as crianças que apresentam níveis elevados de colesterol têm mais probabilidade, comparativamente à população em geral, de manterem esses níveis na vida adulta, é de extrema importância reduzir esses valores, em particular devemos encorajar a adopção de uma actividade física regular durante a infância, sendo uma base adquirida para um estilo de vida saudável (12). E, de facto a promoção do exercício nas crianças está assente nos seguintes pressupostos: (I) as doenças vasculares ateroscleróticas, a maior causa de morte nas sociedades ocidentais, são um processo longo que se inicia nos anos pediátricos e se revela clinicamente na idade adulta como coronariopatias, enfartes ou doenças cardiovasculares periféricas; (II) a aterosclerose está ligada a um conjunto de factores de risco identificáveis, a maioria dos quais relacionados com o comportamento, e desse modo potencialmente modificáveis; (III) de uma redução destes factores de risco cedo na vida pode esperar-se um impacto favorável na incidência das doenças vasculares ateroscleróticas na idade adulta (13)

 

* Este trabalho foi realizado ao abrigo do Projecto Praxis XXI / 122 / 96

 

Bibliografia

  1. Coronary Prevention Group. (1988): Children Risk: Should prevention of coronary heart disease begin in childhood? A Policy Statement from the Scientific and Medical Advisory Committee. The Coronary Prevention Group. May:1.
  2. Strog, J.P.; McGill, H.C. (1969): The paediatric aspects of atherosclerosis. J. Atheoscl. Res. 9: 251-65.
  3. Lenfant, C.; Savage, P. (1995): The early natural history of atherosclerosis and hipertension in the young: national institutes of health perpectives. Am. J. Sci. 310 (suppl): S3-S7.
  4. Bergstrom, E. (1995): Cardiovascular Risk Indicators in Adolescents. The Umea Youth Study. Umea University Medical Dissertations.
  5. Berenson, G.S. (1886): Causation of cardiovascular risk factors in children. Perpectives on Cardiovascular Risk in Early Life. Gerald S. Berenson (Ed.). Raven Press.
  6. Berenson, G.S.; Wattigney, W.A.; Tracy, R.E.; Newman, W.P.; Webber, L.S.; Dalferes, E.R.; Strong, J.B. (1992): Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons 6 to 30 years and studied at necropsy (the Bogalusa Heart Study). Am. J. Cardiol. 70: 851-8
  7. Berenson, G.S.; Srinivasan, G.R.; Freedman, D.S.; Radhakrishnamurthy, B.; Dalferes, B.S. (1987): Review: Atherosclerosis and its evolution in childhood. Am. J. Med. Sci. 294: 429-440.
  8. Wynder, E. (1988): Coronary heart disease prevention: should it begin in childhood? Should the prevention of coronary heart disease begin in childhood?In coronary prevention group (Eds). London. Coronary Prevention Group: 3-12
  9. Armstrong, J. (1990): New Direction in Physical Education. Human Kinetics Book
  10. Riddoch, C.; Boreham, C. (1995): The health-related physical activity of children. Sports Med. 19 (2): 86-102.
  11. Crespo, C. /1994): Physical activity and hipertention. Med. Sci. Sports Exerc. 29 (10): 1295-1296.
  12. Montoye, H.I. (1985): Risk factors for cardiovascular disease in relation to physical activity in youth. Binkhorst, R.A.; Kemper, H.C; Saris, W.H. eds. Children and Exercise, XI. Champaign, IL: Human Kinetics. 3-25
  13. Rowland, T.W. (1991): Influence of physical activity and fitness on coronary risk factors in children: how strong an argument?. Pediatric Exerc. Sci. 3: 189-191.

 

Este trabalho foi efectuado ao abrigo do Projecto Praxis XXI

 

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