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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As doen&#231;as cardiovasculares &#40;DCV&#41; constituem a principal causa de morbilidade e mortalidade a n&#237;vel mundial&#46; Em Portugal&#44; o problema &#233; tamb&#233;m relevante&#44; n&#227;o s&#243; no que respeita &#224; doen&#231;a coron&#225;ria como particularmente no que concerne ao acidente vascular cerebral&#44; cuja incid&#234;ncia &#233; das mais elevadas em todo o mundo<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Al&#233;m disso&#44; a incid&#234;ncia destas doen&#231;as tem aumentado nos pa&#237;ses ocidentais e em desenvolvimento&#44; como consequ&#234;ncia da modifica&#231;&#227;o dos estilos de vida e do aumento da preval&#234;ncia dos fatores de risco cardiovasculares<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A dislipidemia &#233; um fator de risco relevante para DCV&#44; j&#225; que o colesterol &#233; um elemento essencial na composi&#231;&#227;o da placa de ateroma&#46; Encontra-se claramente demonstrada a rela&#231;&#227;o entre os n&#237;veis de colesterolemia e o risco de doen&#231;a coron&#225;ria ou doen&#231;a cerebrovascular<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Estima-se que a hipercolesterolemia esteja implicada em 56&#37; da ocorr&#234;ncia de doen&#231;a coron&#225;ria e 18&#37; da ocorr&#234;ncia de doen&#231;a cerebrovascular<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Por outro lado&#44; tem sido demonstrado que a diminui&#231;&#227;o dos n&#237;veis de colesterol total &#40;CT&#41; e da sua fra&#231;&#227;o de baixo peso molecular &#40;colesterol-LDL &#91;C-LDL&#93;&#41;&#44; nomeadamente com inibidores da HMG-coenzima A redutase &#40;estatinas&#41;&#44; reduz a incid&#234;ncia de DCV &#40;preven&#231;&#227;o prim&#225;ria<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> e diminui o risco da sua recorr&#234;ncia &#91;preven&#231;&#227;o secund&#225;ria<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#93;&#41;&#46; Os benef&#237;cios produzidos na mortalidade justificam que a avalia&#231;&#227;o do risco cardiovascular global assuma atualmente relev&#226;ncia primordial&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">As sociedades m&#233;dicas internacionais t&#234;m revisto sucessivamente os n&#237;veis de colesterol considerados &#243;timos na popula&#231;&#227;o geral e nos indiv&#237;duos com risco acrescido&#44; e por conseguinte tem-se reduzido o limiar para o diagn&#243;stico de hipercolesterolemia<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Aceita-se hoje que outras altera&#231;&#245;es do perfil lip&#237;dico predisp&#245;em a DCV em idade precoce&#46; A dislipidemia aterog&#233;nica tem sido definida pela conjuga&#231;&#227;o de n&#237;veis aumentados de triglic&#233;ridos &#40;TG&#41;&#44; apolipoprote&#237;na B e pequenas part&#237;culas LDL&#44; associada a n&#237;veis diminu&#237;dos de colesterol-HDL &#40;C-HDL&#41;&#46; Al&#233;m disso&#44; a dislipidemia aterog&#233;nica est&#225; frequentemente associada a outros fatores de risco cardiovascular sob a forma de s&#237;ndrome metab&#243;lica&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A dimens&#227;o do problema da dislipidemia em Portugal foi previamente abordada em v&#225;rios estudos epidemiol&#243;gicos a n&#237;vel regional<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a> e nacional<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#44; e foi estimado em revis&#227;o sistem&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; No entanto&#44; esses estudos apresentavam grande heterogeneidade nos crit&#233;rios diagn&#243;sticos de dislipidemia&#44; caracter&#237;sticas metodol&#243;gicas&#44; popula&#231;&#245;es-alvo e m&#233;todos laboratoriais de doseamento dos l&#237;pidos&#46; Assumir&#225; por isso especial relev&#226;ncia a presente an&#225;lise do perfil lip&#237;dico nos utentes adultos avaliados nos cuidados de sa&#250;de prim&#225;rios em Portugal&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O presente estudo pretende caracterizar a distribui&#231;&#227;o dos n&#237;veis de CT&#44; C-LDL&#44; C-HDL e TG e estimar a preval&#234;ncia de dislipidemia na popula&#231;&#227;o utente dos cuidados de sa&#250;de prim&#225;rios em Portugal&#46; Adicionalmente&#44; pretendeu-se determinar a preval&#234;ncia da utiliza&#231;&#227;o de terap&#234;utica hipolipidemiante e avaliar o controlo do perfil lip&#237;dico nesses doentes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">O estudo VALSIM foi desenhado como um estudo observacional transversal de utentes adultos dos cuidados de sa&#250;de prim&#225;rios em Portugal<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Participaram no estudo 719 m&#233;dicos de fam&#237;lia&#44; segundo distribui&#231;&#227;o estratificada e proporcional por distrito e regi&#227;o de Portugal continental&#44; Madeira e A&#231;ores&#46; O estudo decorreu entre abril de 2006 e novembro de 2007&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os dois primeiros utentes adultos que cumprissem os crit&#233;rios de inclus&#227;o foram convidados a participar&#44; independentemente do motivo da consulta e da presen&#231;a de fatores de risco cardiovascular&#46; O crit&#233;rio de inclus&#227;o foi a exist&#234;ncia de doseamentos da glicemia em jejum&#44; C-HDL e triglic&#233;ridos realizados no &#250;ltimo ano&#46; Constituiu crit&#233;rio de exclus&#227;o a presen&#231;a de condi&#231;&#245;es cl&#237;nicas que pudessem condicionar o diagn&#243;stico de s&#237;ndrome metab&#243;lica&#44; como disfun&#231;&#227;o tiroideia&#46; Ap&#243;s a obten&#231;&#227;o de consentimento informado&#44; foi aplicado um question&#225;rio para caracteriza&#231;&#227;o sociodemogr&#225;fica&#44; antropom&#233;trica&#44; cl&#237;nica &#40;antecedentes pessoais&#44; medica&#231;&#227;o em curso&#44; h&#225;bitos alimentares e pr&#225;tica de exerc&#237;cio f&#237;sico&#41; e laboratorial&#46; A doen&#231;a coron&#225;ria foi definida pela exist&#234;ncia desse diagn&#243;stico assumido pelo m&#233;dico assistente&#44; sem que tenham sido exigidos exames confirmat&#243;rios e sem distin&#231;&#227;o do quadro cl&#237;nico implicado &#40;angina de peito&#44; s&#237;ndrome coron&#225;ria aguda ou enfarte do mioc&#225;rdio&#41;&#46; O acidente vascular cerebral foi tamb&#233;m definido pela exist&#234;ncia desse diagn&#243;stico assumido pelo m&#233;dico assistente&#44; sem que tenham sido exigidos exames confirmat&#243;rios e sem distin&#231;&#227;o do subtipo &#40;AVC isqu&#233;mico ou AVC hemorr&#225;gico&#41;&#46; A diabetes <span class="elsevierStyleItalic">mellitus</span> foi definida pela presen&#231;a de glicemia em jejum &#8805;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl ou abaixo desse limiar mediante terap&#234;utica com antidiab&#233;ticos orais ou insulina&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O risco de morte por causa cardiovascular em dez anos foi estimado para a popula&#231;&#227;o com idade superior a 40 anos aplicando o sistema de estratifica&#231;&#227;o <span class="elsevierStyleItalic">SCORE</span> na vers&#227;o destinada a pa&#237;ses com baixo risco de doen&#231;a cardiovascular<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; Os indiv&#237;duos com idade inferior a 40 anos n&#227;o foram considerados nessa suban&#225;lise&#46; Os indiv&#237;duos com idade superior a 65 anos foram inclu&#237;dos na mesma e o seu risco foi estimado pela aplica&#231;&#227;o das f&#243;rmulas de c&#225;lculo para a idade de 65 anos&#46; Considerou-se existir elevado risco cardiovascular <span class="elsevierStyleItalic">a priori</span> nos doentes com hist&#243;ria de doen&#231;a coron&#225;ria&#44; acidente vascular cerebral&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> ou hipercolesterolemia grave &#40;CT &#8805;<span class="elsevierStyleHsp" style=""></span>320<span class="elsevierStyleHsp" style=""></span>mg&#47;dl ou C-LDL &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; Entre os restantes indiv&#237;duos&#44; considerou-se existir elevado risco cardiovascular ap&#243;s estratifica&#231;&#227;o naqueles cujo risco estimado de morte por causa cardiovascular em dez anos fosse &#8805;<span class="elsevierStyleHsp" style=""></span>5&#37;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Tendo em vista a possibilidade de compara&#231;&#227;o com os estudos pr&#233;vios realizados na popula&#231;&#227;o portuguesa&#44; a preval&#234;ncia de hipercolesterolemia foi determinada aplicando diferentes defini&#231;&#245;es&#58; &#40;1&#41; como a presen&#231;a de n&#237;veis s&#233;ricos de CT &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; &#40;2&#41; pela presen&#231;a de CT &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl ou abaixo desse limiar mediante terap&#234;utica hipolipidemiante e &#40;3&#41; aplicando diferentes limiares em fun&#231;&#227;o do risco estimado de morte por causa cardiovascular aos dez anos&#46; Relativamente a esta &#250;ltima classifica&#231;&#227;o&#44; considerou-se existir hipercolesterolemia&#58; nos indiv&#237;duos com baixo risco cardiovascular que apresentassem CT &#8805;<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#59; nos indiv&#237;duos com risco cardiovascular elevado &#40;<span class="elsevierStyleItalic">a priori</span> ou ap&#243;s estratifica&#231;&#227;o&#41; que tivessem CT &#8805;<span class="elsevierStyleHsp" style=""></span>175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;4&#44;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#59; e independentemente do risco cardiovascular estimado&#44; em todos aqueles que estivessem medicados com f&#225;rmacos hipolipidemiantes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Consideraram-se eleg&#237;veis para terap&#234;utica hipolipidemiante os doentes que apresentassem risco cardiovascular elevado e CT &#8805;<span class="elsevierStyleHsp" style=""></span>175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;4&#44;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#44; bem como aqueles que j&#225; estivessem sob terap&#234;utica hipolipidemiante&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0055" class="elsevierStylePara elsevierViewall">As vari&#225;veis categ&#243;ricas foram avaliadas com determina&#231;&#227;o da frequ&#234;ncia absoluta e da frequ&#234;ncia relativa&#44; com intervalos de confian&#231;a a 95&#37;&#46; Na estimativa das preval&#234;ncias procedeu-se &#224; padroniza&#231;&#227;o das taxas com corre&#231;&#227;o para o sexo e idade atrav&#233;s do teorema da probabilidade total&#44; tendo em conta a composi&#231;&#227;o demogr&#225;fica da popula&#231;&#227;o adulta residente em Portugal&#44; por distrito e regi&#227;o&#44; no ano 2000 &#40;CENSUS 2001&#44; INE&#41;&#46; As vari&#225;veis categ&#243;ricas foram comparadas com o teste do qui-quadrado&#46; Em rela&#231;&#227;o &#224;s vari&#225;veis num&#233;ricas&#44; calculou-se o n&#250;mero de observa&#231;&#245;es &#40;N&#41;&#44; m&#233;dia&#44; desvio padr&#227;o&#44; mediana e an&#225;lise de vari&#226;ncia &#40;teste de Levene&#41;&#46; As vari&#225;veis num&#233;ricas com distribui&#231;&#227;o normal &#40;avaliada pelo teste de Kolmogorov-Smirnov&#41; foram comparadas utilizando-se os testes t-Student e as vari&#225;veis com distribui&#231;&#227;o n&#227;o normal foram comparadas mediante testes n&#227;o param&#233;tricos &#40;Kruskal-Wallis&#41;&#46; A an&#225;lise estat&#237;stica foi efetuada em SPSS&#44; sendo considerado o n&#237;vel de signific&#226;ncia de 5&#37; nas an&#225;lises comparativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Caracteriza&#231;&#227;o da popula&#231;&#227;o</span><p id="par0060" class="elsevierStylePara elsevierViewall">No Estudo VALSIM foram avaliados 16 856 indiv&#237;duos &#40;61&#44;6&#37; do sexo feminino&#41; com a idade m&#233;dia de 58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 anos&#46; Disp&#244;s-se de determina&#231;&#227;o dos n&#237;veis s&#233;ricos de CT&#44; C-LDL&#44; C-HDL e TG em 95&#44;9&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16 159&#41;&#44; 59&#44;1&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9956&#41;&#44; 95&#44;4&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16 074&#41; e 97&#44;9&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16 494&#41; da popula&#231;&#227;o&#44; respetivamente&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Entre os indiv&#237;duos avaliados&#44; 14 251 tinham idade &#8805;<span class="elsevierStyleHsp" style=""></span>40 anos &#40;homens &#91;H&#93;&#58; 5573&#59; mulheres &#91;M&#93;&#58; 8678&#41;&#46; Nessa popula&#231;&#227;o&#44; 29&#44;5&#37; &#40;H&#58; 34&#44;4&#37;&#59; M&#58; 25&#44;4&#37;&#41; cumpriam pelo menos um crit&#233;rio para serem considerados como tendo elevado risco cardiovascular <span class="elsevierStyleItalic">a priori</span>&#58; 8&#44;2&#37; dos doentes tinham doen&#231;a coron&#225;ria &#40;H&#58; 9&#44;5&#37;&#59; M&#58; 7&#44;2&#37;&#41;&#59; 3&#44;3&#37; tinham hist&#243;ria de doen&#231;a cerebrovascular &#40;H&#58; 3&#44;7&#37;&#59; M&#58; 2&#44;8&#37;&#41;&#59; 22&#44;1&#37; tinham diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;H&#58; 25&#44;3&#37;&#59; M&#58; 19&#44;4&#37;&#41; e 1&#44;5&#37; apresentavam hipercolesterolemia grave &#40;CT &#8805;<span class="elsevierStyleHsp" style=""></span>320<span class="elsevierStyleHsp" style=""></span>mg&#47;dl ou C-LDL &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; H&#58;1&#44;8&#37;&#59; M&#58; 1&#44;2&#37;&#41;&#46; Adicionalmente&#44; 3&#44;7&#37; foram alocados ao grupo de elevado risco ap&#243;s estratifica&#231;&#227;o &#40;H&#58; 6&#44;9&#37;&#59; M&#58; 0&#44;8&#37;&#41;&#44; visto o risco estimado aos dez anos ser &#8805;<span class="elsevierStyleHsp" style=""></span>5&#37;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">N&#237;veis s&#233;ricos dos l&#237;pidos</span><p id="par0070" class="elsevierStylePara elsevierViewall">Na popula&#231;&#227;o estudada a concentra&#231;&#227;o m&#233;dia de CT foi de 206<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; O CT m&#233;dio ajustado para o sexo e idade foi de 200<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; sem diferen&#231;as entre os sexos &#40;H&#58; 200<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; M&#58; 200<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; A concentra&#231;&#227;o m&#233;dia de C-LDL foi de 126<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; traduzindo um n&#237;vel ajustado para o sexo e idade de 122<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;H&#58; 123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; M&#58; 120<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; Os n&#237;veis de CT e C-LDL evolu&#237;ram com a idade em crescendo-decrescendo &#8211; <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a> e <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46; At&#233; &#224; 5&#46;<span class="elsevierStyleSup">a</span> d&#233;cada de vida&#44; o CT e sua fra&#231;&#227;o LDL foram mais elevados no sexo masculino&#46; Entre os indiv&#237;duos mais idosos&#44; foram mais elevados nas mulheres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Os valores m&#233;dios dos TG ajustados ao sexo e idade foram 132<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>81<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; tendo sido significativamente mais elevados nos homens &#40;H&#58; 146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>96<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; M&#58; 119<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>69<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Os TG evolu&#237;ram com a idade em crescendo-decrescendo&#44; tendo sido mais elevados no sexo masculino em todos os grupos et&#225;rios &#8211; <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#46; Al&#233;m disso&#44; os valores m&#233;dios mais elevados foram atingidos mais precocemente entre os homens&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A concentra&#231;&#227;o m&#233;dia de C-HDL ajustada ao sexo e idade foi 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; tendo sido significativamente inferior no sexo masculino &#40;H&#58; 51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; M&#58; 58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Os n&#237;veis de C-HDL n&#227;o variaram significativamente com a idade &#8211; <a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Preval&#234;ncia da dislipidemia</span><p id="par0085" class="elsevierStylePara elsevierViewall">A preval&#234;ncia estimada de hipercolesterolemia na popula&#231;&#227;o utente dos cuidados de sa&#250;de prim&#225;rios foi de 47&#44;0&#37; &#40;preval&#234;ncia n&#227;o ajustada &#91;PNA&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#44;2&#37;&#41;&#44; considerando o limiar de CT de 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Cerca de 57&#44;9&#37; &#40;PNA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#44;4&#37;&#41; da popula&#231;&#227;o apresentou CT &#8805;<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl e os n&#237;veis de CT foram &#8805;<span class="elsevierStyleHsp" style=""></span>250<span class="elsevierStyleHsp" style=""></span>mg&#47;dl em 11&#44;4&#37; &#40;PNA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44;4&#37;&#41;&#46; Em termos globais&#44; a preval&#234;ncia de hipercolesterolemia foi compar&#225;vel nos dois sexos &#40;Tabela&#41;&#44; mas variou significativamente com a idade&#46; Entre os indiv&#237;duos de meia-idade tendeu a ser maior no sexo masculino&#44; enquanto nos grupos et&#225;rios mais avan&#231;ados tendeu a predominar entre as mulheres &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#44; <a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a>&#46; Detetou-se C-LDL elevado &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 38&#44;4&#37; da popula&#231;&#227;o&#44; tendo essa propor&#231;&#227;o sido compar&#225;vel em ambos os sexos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Detetou-se hipertrigliceridemia &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 12&#44;7&#37; e C-HDL diminu&#237;do &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 12&#44;8&#37; da popula&#231;&#227;o&#46; A hipertrigliceridemia foi mais frequente nos homens &#40;OR&#58; 1&#44;43&#59; IC 95&#37; 1&#44;37-1&#44;48&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; o mesmo sucedendo com a ocorr&#234;ncia de C-HDL diminu&#237;do &#40;OR&#58; 1&#44;59&#59; IC 95&#37; 1&#44;55-1&#44;63&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A preval&#234;ncia das diversas anomalias do perfil lip&#237;dico evoluiu com a idade em crescendo-decrescendo &#8211; <a class="elsevierStyleCrossRefs" href="#fig0010">Figuras 2 e 3</a>&#46; As preval&#234;ncias mais elevadas foram atingidas na 4&#46;<span class="elsevierStyleSup">a</span> d&#233;cada de vida nos homens &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a>&#41; e uma a duas d&#233;cadas mais tarde nas mulheres &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Se a hiperlipidemia for definida como a presen&#231;a de CT &#8805;200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl ou abaixo desse limiar mediante terap&#234;utica hipolipidemiante&#44; a sua preval&#234;ncia atingiu 63&#44;7&#37; &#40;PNA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#44;5&#37;&#41;&#44; sem diferen&#231;a significativa em fun&#231;&#227;o do sexo &#40;H&#58; 63&#44;9&#37;&#59; M&#58; 63&#44;4&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Tendo em considera&#231;&#227;o simultaneamente a estratifica&#231;&#227;o do risco cardiovascular aos dez anos e os n&#237;veis s&#233;ricos de CT&#44; a preval&#234;ncia de hipercolesterolemia na popula&#231;&#227;o atingiu 82&#44;2&#37; &#40;H&#58; 83&#44;1&#37;&#59; M&#58; 81&#44;4&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Terap&#234;utica hipolipidemiante</span><p id="par0110" class="elsevierStylePara elsevierViewall">Considerando a popula&#231;&#227;o com idade &#8805;<span class="elsevierStyleHsp" style=""></span>40 anos&#44; 54&#44;1&#37; dos indiv&#237;duos cumpriam crit&#233;rios de elegibilidade para terap&#234;utica hipolipidemiante &#40;H&#58; 57&#44;8&#37;&#59; M&#58; 50&#44;8&#37;&#41;&#46; A elegibilidade para terap&#234;utica hipolipidemiante foi significativamente mais frequente nos homens &#40;OR&#58; 1&#44;45&#59; IC 95&#37; 1&#44;31-1&#44;61&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e aumentou com a idade &#8211; <a class="elsevierStyleCrossRef" href="#fig0020">Figura 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Entre os indiv&#237;duos com idade &#8805;<span class="elsevierStyleHsp" style=""></span>40 anos&#44; 44&#44;7&#37; estavam medicados com estatinas &#40;H&#58; 45&#44;4&#37;&#59; M&#58; 44&#44;0&#37;&#41;&#46; Entre os doentes com indica&#231;&#227;o potencial para terap&#234;utica hipolipidemiante&#44; 77&#44;7&#37; estavam medicados&#44; tendo essa propor&#231;&#227;o sido maior no sexo feminino &#40;H&#58; 73&#44;6&#37;&#59; M&#58; 81&#44;4&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Entre os doentes medicados com estatinas&#44; apenas 16&#44;0&#37; apresentavam CT em n&#237;veis &#243;timos de controlo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; &#8211; H&#58; 18&#44;6&#37;&#59; M&#58; 13&#44;8&#37;&#46; Al&#233;m disso&#44; apenas 12&#44;8&#37; apresentavam controlo simultaneamente dos n&#237;veis de CT &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; e C-LDL &#40;&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; &#8211; H&#58; 15&#44;1&#37;&#59; M&#58; 10&#44;8&#37;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">O presente estudo mostrou que a preval&#234;ncia de dislipidemia &#233; elevada entre os utentes adultos dos cuidados de sa&#250;de prim&#225;rios em Portugal&#46; Assim&#44; detetou-se hipercolesterolemia &#40;considerando o limiar de CT de 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 47&#37; da popula&#231;&#227;o e 38&#44;4&#37; dos indiv&#237;duos possu&#237;am n&#237;veis de C-LDL &#8805;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; A hipertrigliceridemia &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; e o C-HDL diminu&#237;do &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; foram menos prevalentes&#44; afetando menos de 13&#37; da popula&#231;&#227;o&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A preval&#234;ncia das doen&#231;as cardiovasculares tem aumentado progressivamente&#44; inicialmente nos pa&#237;ses desenvolvidos e mais recentemente naqueles em vias de desenvolvimento&#44; a par com a modifica&#231;&#227;o dos estilos de vida e o aumento do peso da popula&#231;&#227;o&#46; Em Portugal&#44; a preval&#234;ncia da obesidade aumentou tamb&#233;m na &#250;ltima d&#233;cada<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#44; estimando-se que afete atualmente 16&#44;8&#37; dos homens e 21&#44;8&#37; das mulheres<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; O impacto epidemiol&#243;gico desfavor&#225;vel dos fatores de risco cardiovasculares s&#243; n&#227;o ser&#225; provavelmente maior porque t&#234;m sido implementadas estrat&#233;gias preventivas que t&#234;m melhorado o controlo de v&#225;rios deles&#46; Assim&#44; a melhoria da dete&#231;&#227;o e tratamento da hipertens&#227;o arterial conduziu &#224; redu&#231;&#227;o progressiva dos valores m&#233;dios de press&#227;o arterial a n&#237;vel mundial nas &#250;ltimas tr&#234;s d&#233;cadas<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Por&#233;m&#44; o efeito das diversas interven&#231;&#245;es sobre o perfil lip&#237;dico das popula&#231;&#245;es tem sido provavelmente mais limitado&#46; N&#227;o obstante estarem dispon&#237;veis f&#225;rmacos hipolipidemiantes muito potentes e apesar de os mesmos serem utilizados generalizadamente&#44; a concentra&#231;&#227;o m&#233;dia de CT permaneceu praticamente inalterada a n&#237;vel mundial durante o mesmo per&#237;odo de tempo<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Por isso&#44; assume especial relev&#226;ncia a avalia&#231;&#227;o do perfil lip&#237;dico da popula&#231;&#227;o e a determina&#231;&#227;o do controlo da dislipidemia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A concentra&#231;&#227;o m&#233;dia de CT ajustada ao sexo e idade por n&#243;s estimada nos utentes adultos dos cuidados de sa&#250;de prim&#225;rios em Portugal &#40;200<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; &#233; compar&#225;vel &#224;quelas atualmente registadas nos pa&#237;ses desenvolvidos da Europa Ocidental&#44; Am&#233;rica do Norte e Sudoeste Asi&#225;tico &#40;H&#58; 203<span class="elsevierStyleHsp" style=""></span>mg &#91;196-208<span class="elsevierStyleHsp" style=""></span>mg&#93;&#59; M&#58; 202<span class="elsevierStyleHsp" style=""></span>mg &#91;195-210<span class="elsevierStyleHsp" style=""></span>mg&#93;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#41;&#46; Apesar de os valores m&#233;dios de CT terem sido globalmente similares dos dois sexos&#44; diferiram significativamente na sua evolu&#231;&#227;o em fun&#231;&#227;o da idade&#46; Os n&#237;veis de CT&#44; C-LDL e TG aumentaram com a idade at&#233; valores m&#225;ximos atingidos nos homens aos 40-49 anos e nas mulheres aos 50-59 anos&#46; Nas faixas et&#225;rias mais jovens&#44; as diferen&#231;as entre os sexos foram muito acentuadas&#44; sendo os n&#237;veis lip&#237;dicos significativamente mais elevados entre os homens&#46; Nos indiv&#237;duos mais idosos a diferen&#231;a entre os sexos atenuou-se e tendeu a ocorrer invers&#227;o da rela&#231;&#227;o&#44; com valores discretamente mais elevados entre as mulheres&#46; A varia&#231;&#227;o observada do perfil lip&#237;dico com a idade est&#225; tamb&#233;m de acordo com as observa&#231;&#245;es noutros estudos<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A preval&#234;ncia da dislipidemia em Portugal foi previamente abordada em v&#225;rios estudos epidemiol&#243;gicos a n&#237;vel regional<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a> e nacional<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> e foi estimada em revis&#227;o sistem&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; 71&#37; por cento desses estudos utilizaram como crit&#233;rio de hipercolesterolemia um valor de CT &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl e estimaram uma preval&#234;ncia entre 47-75&#37;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; O estudo BECEL &#40;Projeto Epidemiol&#243;gico de Caracteriza&#231;&#227;o do Perfil Lip&#237;dico da Popula&#231;&#227;o Portuguesa&#41;&#44; conduzido em 2001&#44; incluiu 1500 indiv&#237;duos com idades entre os 18-96 anos<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; Foi observada hipercolesterolemia &#40;definida por CT &#8805;<span class="elsevierStyleHsp" style=""></span>190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 68&#44;5&#37; &#40;66&#44;4-70&#44;5&#59; 95&#37; IC&#41; e 23&#44;4&#37; dos indiv&#237;duos tinham CT &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Nesse estudo&#44; 71&#37; dos indiv&#237;duos apresentavam C-LDL &#8805;<span class="elsevierStyleHsp" style=""></span>115<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; O estudo ALTO-MAR &#40;2001&#41; incluiu 16&#46;763 indiv&#237;duos&#46; Nesse estudo&#44; 23&#44;4&#37; dos indiv&#237;duos apresentavam CT &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl e em 21&#44;8&#37; foi &#8805;<span class="elsevierStyleHsp" style=""></span>250<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;22-24&#41;&#46; A compara&#231;&#227;o dos resultados destes estudos &#233; dificultada pela aplica&#231;&#227;o de diferentes defini&#231;&#245;es de dislipidemia&#44; justificada pela diversidade de limiares diagn&#243;sticos propostos pelas sociedades cient&#237;ficas internacionais&#46; O estudo VALSIM foi desenhado tendo por base as recomenda&#231;&#245;es NCEP ATP-III<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> e os resultados constantes neste artigo s&#227;o sumarizados de acordo com esses limiares&#46; No entanto&#44; para facilitar a compara&#231;&#227;o com estudos epidemiol&#243;gicos baseados noutras defini&#231;&#245;es&#44; apresent&#225;mos tamb&#233;m estimativas de preval&#234;ncia considerandos os outros limiares mais frequentemente empregues&#46; Os nossos resultados sugerem menores valores de preval&#234;ncia da dislipidemia entre os utentes dos cuidados de sa&#250;de em Portugal&#58; 47&#37; dos indiv&#237;duos exibiam CT &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl e 16&#37; apresentaram CT &#8805;<span class="elsevierStyleHsp" style=""></span>240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Estes valores est&#227;o em linha com as estimativas de preval&#234;ncia de hipercolesterolemia nos pa&#237;ses pr&#243;ximos&#46; Em particular&#44; em Espanha estima-se que 20&#37; dos adultos apresentem CT &#62;<span class="elsevierStyleHsp" style=""></span>250<span class="elsevierStyleHsp" style=""></span>mg&#47;dl e 50&#37; tenham CT &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O nosso estudo indica ainda que 44&#44;7&#37; dos utentes dos cuidados de sa&#250;de prim&#225;rios com idade superior a 40 anos estar&#227;o medicados com estatinas&#46; Estes resultados est&#227;o de acordo com a evolu&#231;&#227;o da despesa com f&#225;rmacos hipolipidemiantes em Portugal&#46; De acordo com o estudo de Teixeira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; o n&#250;mero de doses di&#225;rias definidas por 1000 habitantes&#47;dia passou de 10&#44;21 em 1995 para 67&#44;93 em 2004&#46; Assim&#44; a utiliza&#231;&#227;o de estatinas teve um crescimento m&#233;dio anual de 34&#44;5&#37; e a despesa com f&#225;rmacos hipolipidemiantes atingiu 5&#37; dos encargos com medicamentos em ambulat&#243;rio &#40;123 milh&#245;es de euros em 2003&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A documenta&#231;&#227;o de uma preval&#234;ncia de hipercolesterolemia t&#227;o elevada e da insufici&#234;ncia do seu controlo justificam a necessidade de se implementarem medidas de estrat&#233;gia populacional&#44; em particular no &#226;mbito de uma alimenta&#231;&#227;o saud&#225;vel&#44; que complementem as medidas farmacol&#243;gicas destinadas aos subgrupos populacionais de alto risco&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limita&#231;&#245;es</span><p id="par0155" class="elsevierStylePara elsevierViewall">O presente estudo foi realizado no contexto dos cuidados de sa&#250;de prim&#225;rios&#44; uma vez que em estudos populacionais esta &#233; uma forma de fidedigna de recrutar grandes n&#250;meros de indiv&#237;duos&#44; representativos das v&#225;rias regi&#245;es de um pa&#237;s&#46; No entanto&#44; o desenho do estudo obriga a grande precau&#231;&#227;o na extrapola&#231;&#227;o dos resultados para a realidade populacional global&#44; j&#225; que poder&#227;o existir diferen&#231;as relevantes entre a popula&#231;&#227;o seguida nos cuidados de sa&#250;de prim&#225;rios e os demais indiv&#237;duos&#46; Al&#233;m disso&#44; o m&#233;todo de sele&#231;&#227;o &#40;os primeiros dois utentes de cada dia de consulta&#41;&#44; pretendendo-se aleat&#243;rio&#44; pode ser afetado pelas limita&#231;&#245;es no acesso aos servi&#231;os de sa&#250;de&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Atendendo &#224; dimens&#227;o do estudo&#44; as determina&#231;&#245;es anal&#237;ticas n&#227;o foram efetuadas num laborat&#243;rio central&#46; No entanto&#44; em Portugal&#44; os laborat&#243;rios de an&#225;lises est&#227;o sujeitos a processos de certifica&#231;&#227;o e controlo de qualidade&#44; o que limita a variabilidade dos valores de refer&#234;ncia e torna aceit&#225;vel a compara&#231;&#227;o dos resultados&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Para o c&#225;lculo do risco de morte por causa cardiovascular em dez anos foi considerada apenas a popula&#231;&#227;o com idade superior a 40 anos&#44; sem que fosse estabelecido limite superior de idade&#46; Para o efeito&#44; os indiv&#237;duos com idade superior a 65 anos foram avaliados pela aplica&#231;&#227;o das f&#243;rmulas de c&#225;lculo para a idade de 65 anos&#46; Admite-se que esta op&#231;&#227;o metodol&#243;gica poder&#225; subestimar o risco cardiovascular efetivo no subgrupo dos indiv&#237;duos mais idosos&#44; mas n&#227;o comprometer&#225; a interpreta&#231;&#227;o global dos resultados&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o da preval&#234;ncia da medica&#231;&#227;o com terap&#234;utica hipolipidemiante considerou-se que todos os doentes sob medica&#231;&#227;o eram eleg&#237;veis para a mesma&#46; Com efeito&#44; este estudo n&#227;o pretendeu avaliar a adequa&#231;&#227;o da decis&#227;o de institui&#231;&#227;o de terap&#234;utica hipolipidemiante pelos m&#233;dicos assistentes&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclus&#245;es</span><p id="par0175" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de dislipidemia &#233; elevada entre os utentes adultos dos cuidados de sa&#250;de prim&#225;rios em Portugal&#44; detetando-se n&#237;veis aumentados de CT &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 47&#37;&#46; Estes dados contribuir&#227;o para a melhor caracteriza&#231;&#227;o epidemiol&#243;gica do risco cardiovascular na popula&#231;&#227;o portuguesa&#44; imprescind&#237;vel para o adequado planeamento das estrat&#233;gias preventivas de sa&#250;de p&#250;blica&#46; Al&#233;m disso&#44; atualizam as estimativas de preval&#234;ncia fornecidas pelos estudos pr&#233;vios e fornecem a determina&#231;&#227;o das frequ&#234;ncias por sexo e idade com base nos diferentes limiares diagn&#243;sticos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiamento</span><p id="par0180" class="elsevierStylePara elsevierViewall">O estudo Valsim recebeu o patroc&#237;nio cient&#237;fico da Sociedade Portuguesa de Cardiologia&#44; da Direc&#231;&#227;o Geral de Sa&#250;de&#44; da Associa&#231;&#227;o Portuguesa de M&#233;dicos de Cl&#237;nica Geral e o patroc&#237;nio financeiro do Laborat&#243;rio Novartis Farma&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflito de interesses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "N&#237;veis s&#233;ricos dos l&#237;pidos"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Preval&#234;ncia da dislipidemia"
            ]
            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Terap&#234;utica hipolipidemiante"
            ]
          ]
        ]
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          "titulo" => "Discuss&#227;o"
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            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Limita&#231;&#245;es"
            ]
          ]
        ]
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          "identificador" => "sec0055"
          "titulo" => "Conclus&#245;es"
        ]
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          "identificador" => "sec0060"
          "titulo" => "Financiamento"
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflito de interesses"
        ]
        12 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-02-05"
    "fechaAceptado" => "2013-06-25"
    "PalabrasClave" => array:2 [
      "pt" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec281722"
          "palabras" => array:4 [
            0 => "Hipercolesterolemia"
            1 => "Dislipidemia"
            2 => "Hipertrigliceridemia"
            3 => "Preval&#234;ncia"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abreviaturas"
          "identificador" => "xpalclavsec281723"
          "palabras" => array:6 [
            0 => "DCV"
            1 => "CT"
            2 => "C-LDL"
            3 => "C-HDL"
            4 => "PNA"
            5 => "TG"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec281724"
          "palabras" => array:4 [
            0 => "Hypercholesterolemia"
            1 => "Dyslipidemia"
            2 => "Hypertriglyceridemia"
            3 => "Prevalence"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar a distribui&#231;&#227;o dos n&#237;veis de colesterol total &#40;CT&#41;&#44; colesterol LDL &#40;C-LDL&#41;&#44; colesterol HDL &#40;C-HDL&#41; e triglic&#233;ridos nos utentes dos cuidados de sa&#250;de prim&#225;rios em Portugal&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal envolvendo 719 m&#233;dicos de fam&#237;lia&#44; segundo distribui&#231;&#227;o estratificada e proporcional &#224; densidade populacional de cada regi&#227;o&#46; Os primeiros dois utentes adultos de cada dia de consulta foram convidados a participar independentemente do motivo de consulta&#46; Foi utilizado um inqu&#233;rito para recolha de dados sociodemogr&#225;ficos&#44; cl&#237;nicos e laboratoriais&#44; incluindo o perfil lip&#237;dico avaliado nos 12 meses precedentes&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados 16&#46;856 indiv&#237;duos &#40;61&#44;6&#37; do sexo feminino&#44; 58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 anos&#41;&#44; dispondo-se da determina&#231;&#227;o de CT&#44; C-LDL&#44; C-HDL e triglic&#233;ridos em 95&#44;9&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#46;159&#41;&#44; 59&#44;1&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#46;956&#41;&#44; 95&#44;4&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#46;074&#41; e 97&#44;9&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#46;494&#41;&#44; respetivamente&#46; Detetou-se hipercolesterolemia &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 47&#37; e n&#237;veis aumentados de C-LDL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; em 38&#44;4&#37;&#46; A hipertrigliceridemia &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; e o C-HDL diminu&#237;do &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; foram menos prevalentes&#44; afetando 13&#37; da popula&#231;&#227;o&#46; A dislipidemia foi mais frequente nos homens entre os 30-60 anos e nas mulheres p&#243;s-menopausa&#46; Considerando a popula&#231;&#227;o com idade &#8805;<span class="elsevierStyleHsp" style=""></span>40 anos&#44; 54&#44;1&#37; dos indiv&#237;duos cumpriam crit&#233;rios de elegibilidade para terap&#234;utica hipolipidemiante e 44&#44;7&#37; estavam medicados com estatinas &#40;mas apenas 16&#44;0&#37; desses apresentavam CT &#8804;<span class="elsevierStyleHsp" style=""></span>175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de dislipidemia &#233; elevada entre os utentes adultos dos cuidados de sa&#250;de prim&#225;rios em Portugal&#46; Al&#233;m disso&#44; &#233; particularmente frequente nos homens entre os 30-60 anos e nas mulheres ap&#243;s a menopausa&#44; que dever&#227;o constituir grupos-alvo nas estrat&#233;gias preventivas de sa&#250;de p&#250;blica&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To characterize the distribution of total cholesterol &#40;TC&#41;&#44; LDL cholesterol &#40;LDL-C&#41;&#44; HDL cholesterol &#40;HDL-C&#41; and triglycerides in primary health care users&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a cross-sectional study in a primary care setting&#44; involving 719 general practitioners based on stratified distribution proportional to the population density of each region of Portugal&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The first two adult patients scheduled for an appointment on a given day were invited to participate&#46; A questionnaire was applied to assess sociodemographic&#44; clinical and laboratory data including lipid profile&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 16 856 individuals &#40;mean age 58&#46;1&#177;15&#46;1 years&#59; 61&#46;6&#37; women&#41;&#46; Data on TC&#44; LDL-C&#44; HDL-C and triglycerides were available for 95&#46;9&#37; &#40;n&#61;16 159&#41;&#44; 59&#46;1&#37; &#40;n&#61;9956&#41;&#44; 95&#46;4&#37; &#40;n&#61;16 074&#41; and 97&#46;9&#37; &#40;n&#61;16 494&#41; of the population&#44; respectively&#46; Hypercholesterolemia &#40;TC &#8805;200 mg&#47;dl&#41; was detected in 47&#37;&#44; and 38&#46;4&#37; had high levels of LDL-C &#40;&#8805;130 mg&#47;dl&#41;&#46; Hypertriglyceridemia &#40;&#8805;200 mg&#47;dl&#41; and low HDL-C &#40;&#60;40 mg&#47;dl&#41; were less prevalent&#44; affecting roughly 13&#37; of the population&#46; Dyslipidemia was more common in middle-aged men and in post-menopausal women&#46; Of the population aged over 40&#44; 54&#46;1&#37; met eligibility criteria for lipid-lowering therapy and 44&#46;7&#37; were medicated with statins&#44; but only 16&#46;0&#37; of these had TC &#8804;175 mg&#47;dl&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dyslipidemia is highly prevalent in primary health care users in Portugal&#46; It is particularly common in middle-aged men and post-menopausal women&#44; who should be considered target groups for preventive public health measures&#46;</p>"
      ]
    ]
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de hipertrigliceridemia &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; na popula&#231;&#227;o&#44; por sexo e idade&#46;</p>"
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      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de colesterol-HDL diminu&#237;do &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; na popula&#231;&#227;o&#44; por sexo e idade&#46;</p>"
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        "etiqueta" => "Figura 4"
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Elegibilidade para terap&#234;utica hipolipidemiante&#46;</p>"
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