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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the advances of the last 50 years&#44; strategies for cardiovascular prevention have not had an equivalent impact to the progress of knowledge&#46; Although the majority of deaths from cardiovascular disease &#40;CVD&#41; are preventable or treatable&#44; CVD remains the leading cause of death in most developed countries&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The development of atherosclerotic disease is a continuum in which the vessel passes from a healthy state&#44; through an intermediate stage that is influenced by traditional&#44; genetic and environmental risk factors&#44; until it reaches the clinical stage&#46; In recent decades evidence has accumulated on cardiovascular risk throughout life&#58; risk exposure begins with influences during pregnancy and continues into childhood&#44; adolescence and adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Children and young people who have a high value of a risk factor will keep it throughout life&#44; but achieving lower levels of this factor when young will have a greater impact on the disease than if it is detected and treated in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nevertheless&#44; strategies for CVD prevention are designed mainly for patients and high-risk individuals&#44; particularly middle-aged and elderly adults&#46; Furthermore&#44; the most common approach has been based on the individual and on medication&#46; Attempts to raise awareness and to promote changes in lifestyles have had little success&#44; even in secondary prevention&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but prevention in young people could have many benefits&#46; Its guiding principles are those of a community-based approach to prevention&#44; based on health education and individual attitudes that are also dependent on the environment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Indeed&#44; deviant behaviors result from the dynamics between biological and social factors that favor or limit the diversity of individual characteristics&#46; At the same time&#44; the World Health Organization &#40;WHO&#41; recognizes that the most prominent non-communicable diseases &#40;NCDs&#41;&#44; namely cardiovascular disease&#44; cancers&#44; chronic respiratory diseases and diabetes&#44; are linked to tobacco use&#44; alcohol abuse&#44; an unhealthy diet&#44; and physical inactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As a corollary&#44; the WHO&#44; working in partnership with other organizations with decision-making powers in public health&#44; has developed strategic action plans for the prevention and control of NCDs&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Obesity also merits special attention because it results from some of the same factors and is implicated in other NCDs&#46; This does not mean that all factors are associated with each disease to the same extent&#44; but they are considered together in action plans and education strategies to emphasize their common causes and to highlight potential synergies in prevention&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To facilitate comparative studies the WHO and the US Centers for Disease Control and Prevention have drawn up 10 model questionnaires&#44; the Global School-based Student Health Survey&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Nevertheless the single-factor approach is still predominant and estimates of total cardiovascular risk in adolescents are limited&#46; The present study&#44; <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> &#40;&#8220;Young Heart&#8221;&#41;&#44; developed by the Portuguese National Institute of Health &#40;INSA&#41;&#44; is guided by the same principles as the National Network of Health-Promoting Schools &#40;REPS&#41;&#44; which is supported by the Council of Europe and the European Commission via the Schools for Health in Europe network&#46; The purpose of REPS is to establish model schools to demonstrate the impact of health promotion&#44; through health education with the involvement of the education community&#46; The <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> study covers three areas&#58; health behaviors &#40;diet&#44; physical activity&#44; and smoking&#41;&#44; seven cardiovascular risk factors&#44; and the relationship between these characteristics&#46; It also has a pedagogical component&#44; its results being presented and debated in each school with the involvement of the students in these actions&#46; Although its purpose was basically diagnostic&#44; it also aimed to motivate adolescent schoolchildren to change their behaviors with regard to health&#46; Specifically&#44; the main aims were to characterize physical activity&#44; diet and smoking&#59; to define cardiovascular risk profiles&#59; and to assess the relationship between variables and their implications in cardiovascular prevention and overall health&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This cross-sectional study was approved by the National Commission for Data Protection and the Institutional Ethics Committee&#46; The minimum number of participants was calculated &#40;n&#61;777&#41; on the basis of 95&#37; confidence intervals&#44; population size&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> estimated prevalence of overweight &#40;15&#37;&#41; and a 2&#46;5&#37; standard error&#46; Schools were selected from the list of private and public secondary schools in the Lisbon region in order to achieve a balance between participants by school type&#46; All students meeting the inclusion criteria &#40;15&#8211;18 years old&#41; were invited to participate&#46; The measuring instruments consisted of structured self-completion questionnaires &#40;on physical activity&#44; eating and smoking habits for students&#59; on premature cardiovascular events for parents&#41;&#44; an Omron sphygmomanometer &#40;blood pressure measured twice&#41;&#44; and scales for weight &#40;in kg&#41; and height &#40;in cm&#41;&#46; Biochemical assays on fasting capillary blood samples measured total cholesterol&#44; triglycerides &#40;Accutrend GCT&#41; and glucose &#40;Accu-Chek Aviva&#41;&#46; The chart for relative risk of 10-year cardiovascular mortality &#40;SCORE&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> was used&#46; The fieldwork was preceded by validation of the biochemical equipment &#40;Cobas Integra analyzer&#41; and a pre-test performed on 30 volunteers&#46; The fieldwork took place in three stages&#58; &#40;1&#41; presentation and planning of the project in schools&#59; &#40;2&#41; visits to obtain the list of participants and their informed consent and application of the questionnaires to parents&#59; and &#40;3&#41; physical examinations and biochemical assays in fasting state and application of the questionnaire to students&#46; Data collection took place in 2009&#46; Biological variables were classified according to international recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> Tests of independence&#44; the chi-square test&#44; Fisher&#39;s exact test and logistic regression analysis were used to analyze the relationships between the variables&#46; A value of p&#60;0&#46;05 was considered significant&#46; SPSS<span class="elsevierStyleSup">&#174;</span> version 15&#46;0 was used&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study population</span><p id="par0025" class="elsevierStylePara elsevierViewall">Of the total of 2549 students aged between 15 and 18 years enrolled in the eight selected schools in four Lisbon municipalities&#44; 854 participated &#40;54&#37; female and 46&#37; male&#41;&#44; corresponding to 34&#37; adherence&#46; Participation in private schools &#40;n&#61;3&#41; was higher than in public schools &#40;51&#37; vs&#46; 26&#37;&#41;&#46; Mean age was 16&#46;3&#177;0&#46;9 years&#44; similar in boys &#40;16&#46;1&#177;0&#46;9 years&#41; and girls &#40;16&#46;3&#177;0&#46;8 years&#41;&#46; The study population was composed of 209 adolescents aged 15 years&#44; 291 aged 16 years&#44; 281 aged 17 years and 73 aged 18 years&#44; with a predominance of students from the private sector &#40;n&#61;492&#44; 58&#37;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Quality control</span><p id="par0030" class="elsevierStylePara elsevierViewall">Comparing the measurements of cholesterol&#44; triglycerides and glucose in capillary blood and plasma&#44; the difference between mean cholesterol was minimal &#40;&#8722;0&#46;3&#177;11&#46;9 mg&#47;dl&#41;&#44; not significant&#44; but was greater for triglycerides &#40;35&#46;9&#177;34&#46;69&#41; and glucose &#40;12&#46;6&#177;10&#46;1&#41; &#40;p&#60;0&#46;001&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lifestyles</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data on health behaviors &#40;lifestyles&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Physical activity</span>&#46; When asked how much time they spent in extracurricular physical activities with an intensity that left them out of breath or sweating&#44; 29&#37; responded &#8220;never&#8221; and 53&#37; responded between 30 min and less than 4 hours&#46; Only 19&#37; did this type of exercise for four hours a week or more&#44; of whom more were at private schools &#40;22&#37; vs&#46; 17&#37;&#44; p&#61;0&#46;002&#41; and more were boys &#40;30&#37; vs&#46; 10&#37;&#44; p&#60;0&#46;001&#41;&#46; The majority &#40;54&#37;&#41; had less than one hour per week of out-of-school physical activity or none&#44; especially students aged 18&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sedentary time</span>&#46; Regarding the number of hours watching television&#44; 55&#37; spent more than one hour&#44; and 8&#37; spent three hours or more per day&#46; There were no statistically significant differences according to school type &#40;public or private&#41;&#44; gender or age&#46; Every day&#44; 61&#37; spent over one hour sitting&#44; using computers and&#47;or games consoles&#44; and 14&#37; spent over three hours&#46; The difference between the proportion using such devices for over one hour daily in private &#40;67&#37;&#41; and public schools &#40;58&#37;&#41; was statistically significant &#40;p&#61;0&#46;007&#41;&#44; as was the difference between boys &#40;69&#37;&#41; and girls &#40;55&#37;&#41; &#40;p&#60;0&#46;001&#41;&#46; The percentage of schoolchildren with &#8805;2 hours screen time &#40;TV and&#47;or computer&#47;games console&#41; daily was almost 80&#37;&#44; the majority attending private schools &#40;83&#37; vs&#46; 76&#37;&#44; p&#61;0&#46;03&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Diet&#46;</span> Soup&#44; salad or vegetables&#44; and fruit were consumed daily&#44; respectively&#44; by 63&#37;&#44; 61&#37; and 76&#37; of students and less than once a week by 14&#37;&#44; 13&#37; and 6&#37;&#46; Differences in gender&#44; age and type of school were not significant&#46; Regarding the number of daily meals&#44; a large majority &#40;77&#37;&#41; had five or more meals a day but 6&#37; had three or fewer&#44; while 17&#37; had four&#46; The difference reached significance only for age&#44; with a tendency to decrease with age &#40;p&#60;0&#46;01&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Smoking&#46;</span> Most &#40;87&#37;&#41; did not smoke&#46; Of the 13&#37; who smoked&#44; 5&#37; did so occasionally and 8&#37; every day&#44; with no differences according to type of school or gender&#46; Mean daily consumption was 5&#177;6 cigarettes&#46; They reported having started smoking at 14&#177;1&#46;6 years and the modal class was 18 years&#46; There was a significant increase in consumption with age in both sexes &#40;p&#60;0&#46;01&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Risk factors</span><p id="par0060" class="elsevierStylePara elsevierViewall">The main data on cardiovascular risk factors are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Overweight&#47;obesity</span>&#46; Most respondents &#40;81&#37;&#41; were normal weight&#59; only 3&#37; were low weight&#44; while 11&#37; were overweight and 5&#37; were obese&#44; giving a figure for overweight&#47;obesity of 16&#37; in these adolescents&#44; with a higher prevalence in boys than in girls &#40;21&#37; vs&#46; 12&#37;&#44; p&#61;0&#46;001&#41;&#46; Differences by school type and age were not significant but the highest prevalence of overweight was in 15-year-olds&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hypertension</span>&#46; Blood pressure was high-normal in 28&#37; and with criteria for hypertension in 11&#37;&#46; Systolic blood pressure was more determinant than diastolic blood pressure in the classification of hypertension &#40;46&#37; vs&#46; 30&#37;&#41;&#46; The prevalence of hypertension in boys was higher than in girls &#40;15&#37; vs&#46; 7&#37;&#44; p&#60;0&#46;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cholesterol&#46;</span> Total cholesterol was normal in most adolescents &#40;73&#37;&#41; but 5&#37; had values &#8805;200 mg&#47;dl&#46; The prevalence of hypercholesterolemia in girls was higher than in boys &#40;7&#37; vs&#46; 3&#37;&#44; p&#60;0&#46;005&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Triglycerides&#46;</span> The prevalence of hypertriglyceridemia &#40;&#8805;150 mg&#47;dl&#41; in girls was higher than in boys &#40;12&#37; vs&#46; 5&#37;&#44; p&#60;0&#46;001&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Impaired glucose metabolism</span>&#46; According to the American Diabetes Association classification 9&#37; had impaired fasting glucose &#40;IFG&#41; and 0&#46;5&#37; were diabetic&#46; The prevalence of IFG and diabetes was higher in boys &#40;11&#37;&#41; than in girls &#40;7&#37;&#41; &#40;p&#61;0&#46;06&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Family history of premature CVD</span>&#46; Approximately 6&#37; of the students&#8217; parents reported a history of premature cardiovascular events&#44; more of them mothers &#40;aged 46&#177;4&#46;7 years&#41; than fathers &#40;aged 48&#177;5&#46;7 years&#41;&#46; This family history was more frequent with older students &#40;p&#60;0&#46;05&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the prevalence of individual risk factors in both sexes&#46; The leading modifiable cardiovascular risk factors in boys were overweight&#47;obesity&#44; hypertension and smoking&#44; while in girls they were smoking&#44; overweight&#47;obesity and hypertriglyceridemia&#46; Moreover&#44; approximately half &#40;49&#37;&#41; already had at least one modifiable risk factor &#40;35&#37; had one&#44; 11&#37; had two and 3&#37; had &#8805;3 risk factors&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Relationships between variables</span><p id="par0105" class="elsevierStylePara elsevierViewall">The relationships between the variables studied in the 15&#8211;18 age-group obtained by multivariate logistic regression analysis are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46; Overweight&#47;obesity was associated with number of meals &#40;&#8804;3 meals daily&#41;&#44; abnormal blood pressure levels &#40;grade 2 hypertension&#41;&#44; impaired glucose metabolism and hypertriglyceridemia&#46; The variables associated with hypertension were male gender and overweight&#47;obesity&#46; Impaired glucose metabolism was associated with hypertension&#44; especially grade 2&#44; and with overweight&#47;obesity&#46; Variables related to elevated triglycerides were female gender and overweight&#47;obesity&#44; while those associated with high cholesterol were female gender and impaired glucose metabolism&#46; Smoking increased with age&#44; especially at age 17&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ten-year relative risk for cardiovascular mortality</span><p id="par0110" class="elsevierStylePara elsevierViewall">According to the table of relative risk &#40;RR&#41; of cardiovascular mortality based on blood pressure&#44; total cholesterol and smoking&#44; not discriminated by gender&#44; 27&#37; of respondents had RR &#8805;2&#46; Of these&#44; 3&#37; had RR &#8805;3&#46; Estimated cardiovascular risk in boys was significantly higher than in girls &#40;38&#37; vs&#46; 17&#37;&#44; p&#60;0&#46;001&#41; and overall increased from 21&#37; at age 15 to 43&#37; at age 18 &#40;p&#60;0&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Participants were included from both public and private secondary schools in order to test the hypothesis that there were differences in students attending these two school types&#46; The sample was balanced for school type&#44; gender and age&#46; The measuring instruments and laboratory tests were subjected to quality control to assess the reliability of the results&#46; Operational definitions of the variables and cut-offs were those defined by medical societies and international organizations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> The fact that all the schools invited agreed to participate is an indication that they recognized the importance of the research&#44; going so far as to make it part of the projects element of the curriculum&#44; even though only one school was a member of REPS and supported the study under the aegis of the Promotion and Education for Health project and of the School Health Agenda&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The assessment of physical activity included the 180 min per week of physical education included in the curriculum&#46; On this basis&#44; 19&#37; of the participants met the WHO recommendation that children and young people aged 5&#8211;17 should accumulate at least 60 min daily of moderate to vigorous intensity physical activity&#44; and that amounts greater than that provide additional health benefits&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This figure is slightly higher than the 15&#37; of the 2006 Health Behavior in School-aged Children &#40;HBSC&#41; study<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and confirms that males take more physical activity than females&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> a tendency that can be explained by different habits&#44; tastes and goals of leisure activities&#46; However&#44; several factors influence levels of physical activity&#58; self-esteem&#44; opportunities&#44; motivation&#44; childhood and adolescence habits&#44; local resources and costs of transport and equipment&#44; and others&#46; Some of these may underlie the higher levels of physical activity in students who attend private schools&#46; Nevertheless&#44; as shown in other studies&#44; levels of physical activity and sports tend to decrease with age&#44; particularly in females&#44; and so schools must be able to motivate young people to remain active&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">With regard to screen time&#44; the time spent at computers and games consoles reflects children&#39;s interest in technological innovations and content&#46; Gender differences suggest that such activities are more popular among boys and imply that&#44; in this case&#44; accessibility is not a reason for the differences between those who attend public and private schools&#46; These results are similar to those of other studies&#44; in which young people spend an average of 3&#8211;5 hours per day using these media&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The role of diet in obesity and atherosclerosis prevention is well defined in reports and guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;16&#44;17</span></a> One of the recommendations is that the first balanced meal should be taken soon after waking up&#44; but 11&#37; of the students reported not taking breakfast&#46; Soup&#44; a characteristic component of the Mediterranean diet that is known to be protective against some chronic diseases&#44; including coronary heart disease and cancer&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> was reported as never consumed or no more than once a week by 37&#37; of the participants&#46; Diet should be varied and divided between at least five meals a day&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> but almost a quarter of the participants did not follow this guidance&#46; The negative relation between overweight and number of meals corroborates the evidence and reinforces the recommendation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this population&#44; 13&#37; smoked&#44; although 5&#37; only did so occasionally&#46; These figures are higher than those of the HBSC study&#44; both in 2002 &#40;8&#46;5&#37;&#41; and in 2006 &#40;5&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> but those students were also younger than those in the present study&#46; However&#44; they are lower than in the 15&#8211;24 age-group &#40;24&#37;&#41; in the 4th Portuguese National Health Survey &#40;INS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> although in line with the upward trend in the proportion of female smokers&#46; The higher prevalence of smoking in public than in private schools is probably not by chance&#44; but the effect of differences in health education and promotion&#46; Determining the most common age to start smoking &#40;15 years&#41; identifies a risk group that should be a priority in smoking prevention&#44; since it is easier not to start smoking than to quit&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The prevalence of body mass index &#40;BMI&#41; above the 85th percentile was high &#40;16&#37;&#41; and that of obesity &#40;&#62;95th percentile&#44; 5&#37;&#41; was higher than that reported in the 4th INS in the 15&#8211;24 age-group &#40;&#60;2&#37;&#41;&#46; However&#44; these figures are similar to those obtained in 2002 in Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The percentage of overweight or obesity was higher in boys than in girls&#44; as also found in population studies<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> as well as the 4th INS&#44; up to age 25&#44; although the opposite was found over age 55&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In the four years between ages 15 and 18 there were no differences in overweight&#47;obesity&#44; since this problem starts earlier&#44; before age 15&#44; as can be seen in the COSI study&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In Portugal&#44; obesity has increased tenfold relative to the 1970s&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The obstacles to reversing this trend are enormous&#44; and no country has succeeded in overcoming them&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; unless there are changes&#44; more health problems &#40;psychological&#44; cardiovascular&#44; osteoarticular and others&#41; can be expected&#46; Urbanization and technological development have brought great benefits but are contributing to worsening dietary habits&#44; increasing physical inactivity and stress in various forms&#44; from childhood onwards&#46; What is needed is an environment that promotes health and reduces obesity&#44; which requires concerted policies and collaboration&#44; both nationally and internationally&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The prevalence of hypertension &#40;11&#37;&#41; lies within the range of other studies &#40;7&#46;5&#37; and 16&#46;5&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;24</span></a> including one on university students &#40;10&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> It was higher in males&#44; as in another study of young adults&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> This may be explained by hormonal changes after puberty&#44; although the effect of overweight&#47;obesity&#44; more prevalent in males and positively associated with blood pressure&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> should not be ignored&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">According to the criteria of the American Academy of Pediatrics<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the prevalence of elevated cholesterol &#40;&#62;200 mg&#47;dl&#41; was 5&#37;&#44; lower than in US studies &#40;13&#37;&#41; but close to values in the Portuguese population observed in a systematic review that included children and adolescents&#44; and that found that hypercholesterolemia was also more common in females&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> As plasma cholesterol is the most stable lipid variable and since it showed the best agreement according to quality control of the biochemical studies&#44; this proportion in particular should be close to the true figure in this age-group&#46; The prevalence of hypertriglyceridemia &#40;7&#37;&#41;&#44; higher in girls than in boys&#44; is slightly lower than in a study of children aged between 5 and 14 &#40;11&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Comparisons are not easy since triglycerides&#44; although not presenting significant circadian or seasonal variations&#44; have far greater intra-individual variability than cholesterol&#44; so results on triglycerides should be regarded with caution&#46; Moreover&#44; the pre-test reliability of the method applied was not optimal&#44; so this value may differ from the true prevalence&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Blood glucose levels corresponding to impaired glucose metabolism &#40;9&#37;&#41; were more frequent than expected&#44; with 0&#46;5&#37; being classified as diabetic&#46; Overall&#44; there was a high prevalence of all glucose metabolism abnormalities&#44; although a study in 2006 of 4370 American teenagers aged between 12 and 19&#44; with a fasting period of at least 8 hours&#44; obtained similar values &#40;0&#46;5&#37; diabetic and about 11&#37; with IFG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Most studies in this area are in the adult population and epidemiological information on type 1 diabetes is limited&#46; The incidence calculated for Portugal in joint international studies was approximately 8 per 10 000 population&#44; lower than in other countries&#46; However&#44; according to the Diabetes Atlas of the International Diabetes Federation in 2010&#44; it was 13&#46;2 per 10 000 population in those aged under 15 years&#46; Even so&#44; the prevalence of type 1 diabetes in our population was higher&#46; The proportion of young people with impaired glucose metabolism may be overestimated because of the method&#39;s unreliability &#40;quality control agreement was not ideal&#41; and&#47;or failure to observe the 12-hour fasting period&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Certain related characteristics are frequently associated &#40;obesity&#44; inflammatory factors&#44; hereditary factors&#44; hypertension&#44; dyslipidemia&#44; impaired glucose metabolism&#44; and lifestyles&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Such relationships are more thoroughly documented in epidemiological and clinical studies in adults than in children and adolescents&#44; but the pathophysiology underlying these associations remains the same&#46; Although further longitudinal studies from infancy to adulthood are required to clarify how these characteristics change over time&#44; it has been confirmed that there is a degree of tracking in some cases&#44; for example in weight and blood pressure&#44; the more so when high blood pressure levels in childhood are associated with obesity or a family history of hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The relationship between overweight&#47;obesity and blood pressure levels was confirmed in our study but the association with impaired glucose metabolism was a surprise&#44; although it would not have been if the study had been performed in the adult population&#46; The association of impaired glucose metabolism&#44; obesity and documented hypertension&#44; three components of the metabolic syndrome&#44; suggests that this syndrome is already prevalent at these ages&#46; The higher levels of lipids&#44; triglycerides and total cholesterol observed in girls is undoubtedly related to hormonal influences &#40;estrogen&#41; during adolescence&#44; but the negative influence of less physical activity cannot be excluded&#46; However&#44; as boys had higher BMI and more physical activity&#44; it appears that diet has more influence on weight and BMI than physical activity&#46; Nevertheless&#44; at a time when all these teenagers had at least 180 min of physical activity per week&#44; the difference between this duration and daily exercise may not be sufficient to separate the groups in terms of influence on weight evolution&#46; It should be noted that overweight&#47;obesity was associated with three risk factors &#40;hypertension&#44; impaired glucose metabolism&#44; and increased triglycerides&#41; and was dependent on dietary habits &#40;&#60;4 meals a day&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">For adolescents at school aged 15&#8211;18 years&#44; the data obtained show that&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Most were physically inactive &#40;81&#37; had insufficient physical activity and 79&#37; spent &#8805;2 hours per day watching TV or at a computer&#47;games console&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Many did not meet dietary recommendations concerning choices of food and number of meals per day&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Approximately half &#40;49&#37;&#41; already had at least one modifiable risk factor &#40;in descending order&#58; overweight&#47;obesity 16&#37;&#44; smoking daily&#47;occasionally 13&#37;&#44; hypertension 11&#37;&#44; diabetes&#47;IFG 9&#46;5&#37;&#44; hypertriglyceridemia 9&#37;&#44; family history of premature cardiovascular events 6&#37;&#44; and hypercholesterolemia 5&#37;&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">&#8805;2 risk factors coexisted in 14&#37; of the participants&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Approximately a quarter &#40;27&#37;&#41; had a &#8805;2 10-year relative risk of fatal cardiovascular events&#59;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Overweight&#47;obesity showed a positive association with blood pressure&#44; impaired glucose metabolism and elevated triglycerides&#44; and a negative association with number of meals per day&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">The results demonstrate the need for action in providing and encouraging healthy choices&#44; with an emphasis on behavioral and lifestyle changes&#44; particularly diet&#44; physical activity&#44; and smoking&#46; Preventive actions should be integrated and interventions should be aimed at individuals and at families and communities&#46; Regular monitoring of levels and patterns of risk factors is required for planning and evaluating preventive interventions&#46; Prevention based on lifelong health behaviors can be effective and should be seen as a vital investment in health&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protection of human and animal subjects</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidentiality of data</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Right to privacy and informed consent</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> study was funded by a research grant from the Foundation AstraZeneca&#44; obtained following a competitive call&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Disease prevention should begin in childhood and lifestyles are important risk determinants of cardiovascular disease&#46; Awareness and monitoring of risk is essential in preventive strategies&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To characterize cardiovascular risk and the relationships between certain variables in adolescents&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In a cross-sectional study&#44; 854 adolescent schoolchildren were surveyed&#44; mean age 16&#46;3&#177;0&#46;9 years&#46; Data collection included questionnaires&#44; physical examination&#44; charts for 10-year relative risk of mortality&#44; and biochemical assays&#46; In the statistical analysis continuous variables were studied by the Student&#39;s t test and categorical variables by the chi-square test and Fisher&#39;s exact test&#44; and each risk factor was entered as a dependent variable in logistic regression analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Physical activity was insufficient in 81&#37; of students&#46; The daily consumption of soup&#44; salad or vegetables&#44; and fruit was&#44; respectively&#44; 37&#37;&#44; 39&#37; and 21&#37;&#46; A minority &#40;6&#37;&#41; took &#8804;3 and 77&#37; took &#8805;5 meals a day&#46; The prevalence of each risk factor was as follows&#58; overweight 16&#37;&#59; smoking 13&#37;&#59; hypertension 11&#37;&#59; impaired glucose metabolism 9&#37;&#59; hypertriglyceridemia 9&#37;&#59; and hypercholesterolemia 5&#37;&#46; Out-of-school physical activity&#44; hypertension and overweight were more prevalent in males &#40;p&#60;0&#46;001&#41;&#46; Females had higher levels of cholesterol &#40;p&#60;0&#46;005&#41; and triglycerides &#40;p&#60;0&#46;001&#41;&#46; A quarter of the adolescents had a relative risk score for 10-year cardiovascular mortality of &#8805;2&#46; Overweight showed a positive association with blood pressure&#44; changes in glucose metabolism and triglycerides&#44; and a negative association with number of daily meals&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The results demonstrate the need for action in providing and encouraging healthy choices for adolescents&#44; with an emphasis on behavioral and lifestyle changes aimed at individuals&#44; families and communities&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A preven&#231;&#227;o deve come&#231;ar na inf&#226;ncia e o estilo de vida &#233; um determinante importante da doen&#231;a cardiovascular&#46; O conhecimento e monitoriza&#231;&#227;o do risco cardiovascular s&#227;o essenciais numa estrat&#233;gia preventiva&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracterizar o risco cardiovascular e as rela&#231;&#245;es entre algumas vari&#225;veis em adolescentes escolarizados&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foram observados 854 estudantes&#44; 16&#44;3&#177;0&#44;9 anos de idade&#44; num estudo transversal&#46; A colheita de dados incluiu question&#225;rios&#44; exame f&#237;sico&#44; tabela do risco relativo da mortalidade cardiovascular a dez anos&#44; doseamentos bioqu&#237;micos&#46; A an&#225;lise estat&#237;stica incide sobre vari&#225;veis cont&#237;nuas e categoriais e fatores de risco como vari&#225;veis dependentes &#40;regress&#227;o log&#237;stica&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Atividade f&#237;sica insuficiente 81&#37;&#46; Consumo di&#225;rio de sopa&#44; salada&#47;legumes e frutas caracterizou 37&#44; 39 e 21&#37; dos alunos&#46; Uma minoria &#40;6&#37;&#41; fazia diariamente &#8804;3 refei&#231;&#245;es e 77&#37; &#8805;5 refei&#231;&#245;es&#46; Preval&#234;ncia dos fatores de risco&#58; excesso de peso 16&#37;&#59; tabagismo 13&#37;&#59; hipertens&#227;o arterial 11&#37;&#59; anomalias do metabolismo da glicose 9&#37;&#59; hipertrigliceridemia 9&#37;&#59; hipercolesterolemia 5&#37;&#46; Atividade f&#237;sica extracurricular&#44; hipertens&#227;o e excesso de peso mais prevalentes no sexo masculino &#40;p&#60;0&#44;001&#41;&#44; enquanto nas adolescentes foram a hipercolesterolemia &#40;p&#60;0&#44;005&#41; e hipertrigliceridemia &#40;p&#60;0&#44;001&#41;&#46; Um quarto dos adolescentes com risco relativo de mortalidade cardiovascular a dez anos &#8805;2&#46; Excesso de peso revelou rela&#231;&#227;o positiva com press&#227;o arterial&#44; altera&#231;&#245;es metabolismo da glucose e triglicer&#237;deos e negativa com n&#250;mero de refei&#231;&#245;es di&#225;rias&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Os resultados evidenciam a necessidade de a&#231;&#245;es de fomento e incentivo de escolhas saud&#225;veis pelos adolescentes&#44; com &#234;nfase nas mudan&#231;as de comportamento ao n&#237;vel dos indiv&#237;duos&#44; fam&#237;lias e comunidades&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Out-of-school physical activity &#40;weekly&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30 min to &#60;4 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;4 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Screen time &#40;daily&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;2 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;2 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">316&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Occasional smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Daily smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">787&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">358&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">303&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">484&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:2 [
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                0 => """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Biological characteristics and family history of cardiovascular disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Underweight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal weight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">690&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood pressure</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High-normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 1 HT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 2 HT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">853&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">459&nbsp;\t\t\t\t\t\t\n
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                  """
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Original Article
Cardiovascular risk profile of high school students: A cross-sectional study
Perfil de risco cardiovascular de adolescentes escolarizados: um estudo transversal
Teresa Rochaa,
Autor para correspondência
teresa.rocha1778@gmail.com
teresa.rocha@episystem.eu

Corresponding author.
, Evangelista Rochaa, Ana Catarina Alvesb, Ana Margarida Medeirosb, Vânia Franciscob, Sónia Silvab, Isabel Mendes Gasparc, Quitéria Ratod, Mafalda Bourbonb
a Unidade de Epidemiologia, Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, Lisboa, Portugal
b Grupo de Investigação Cardiovascular, UID, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
c Serviço de Genética Médica, Hospital de Santa Maria, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal
d Serviço de Cardiologia, Hospital S. Bernardo, Centro Hospitalar de Setúbal, EPE, Setúbal, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the advances of the last 50 years&#44; strategies for cardiovascular prevention have not had an equivalent impact to the progress of knowledge&#46; Although the majority of deaths from cardiovascular disease &#40;CVD&#41; are preventable or treatable&#44; CVD remains the leading cause of death in most developed countries&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The development of atherosclerotic disease is a continuum in which the vessel passes from a healthy state&#44; through an intermediate stage that is influenced by traditional&#44; genetic and environmental risk factors&#44; until it reaches the clinical stage&#46; In recent decades evidence has accumulated on cardiovascular risk throughout life&#58; risk exposure begins with influences during pregnancy and continues into childhood&#44; adolescence and adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Children and young people who have a high value of a risk factor will keep it throughout life&#44; but achieving lower levels of this factor when young will have a greater impact on the disease than if it is detected and treated in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nevertheless&#44; strategies for CVD prevention are designed mainly for patients and high-risk individuals&#44; particularly middle-aged and elderly adults&#46; Furthermore&#44; the most common approach has been based on the individual and on medication&#46; Attempts to raise awareness and to promote changes in lifestyles have had little success&#44; even in secondary prevention&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but prevention in young people could have many benefits&#46; Its guiding principles are those of a community-based approach to prevention&#44; based on health education and individual attitudes that are also dependent on the environment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Indeed&#44; deviant behaviors result from the dynamics between biological and social factors that favor or limit the diversity of individual characteristics&#46; At the same time&#44; the World Health Organization &#40;WHO&#41; recognizes that the most prominent non-communicable diseases &#40;NCDs&#41;&#44; namely cardiovascular disease&#44; cancers&#44; chronic respiratory diseases and diabetes&#44; are linked to tobacco use&#44; alcohol abuse&#44; an unhealthy diet&#44; and physical inactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As a corollary&#44; the WHO&#44; working in partnership with other organizations with decision-making powers in public health&#44; has developed strategic action plans for the prevention and control of NCDs&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Obesity also merits special attention because it results from some of the same factors and is implicated in other NCDs&#46; This does not mean that all factors are associated with each disease to the same extent&#44; but they are considered together in action plans and education strategies to emphasize their common causes and to highlight potential synergies in prevention&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To facilitate comparative studies the WHO and the US Centers for Disease Control and Prevention have drawn up 10 model questionnaires&#44; the Global School-based Student Health Survey&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Nevertheless the single-factor approach is still predominant and estimates of total cardiovascular risk in adolescents are limited&#46; The present study&#44; <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> &#40;&#8220;Young Heart&#8221;&#41;&#44; developed by the Portuguese National Institute of Health &#40;INSA&#41;&#44; is guided by the same principles as the National Network of Health-Promoting Schools &#40;REPS&#41;&#44; which is supported by the Council of Europe and the European Commission via the Schools for Health in Europe network&#46; The purpose of REPS is to establish model schools to demonstrate the impact of health promotion&#44; through health education with the involvement of the education community&#46; The <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> study covers three areas&#58; health behaviors &#40;diet&#44; physical activity&#44; and smoking&#41;&#44; seven cardiovascular risk factors&#44; and the relationship between these characteristics&#46; It also has a pedagogical component&#44; its results being presented and debated in each school with the involvement of the students in these actions&#46; Although its purpose was basically diagnostic&#44; it also aimed to motivate adolescent schoolchildren to change their behaviors with regard to health&#46; Specifically&#44; the main aims were to characterize physical activity&#44; diet and smoking&#59; to define cardiovascular risk profiles&#59; and to assess the relationship between variables and their implications in cardiovascular prevention and overall health&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This cross-sectional study was approved by the National Commission for Data Protection and the Institutional Ethics Committee&#46; The minimum number of participants was calculated &#40;n&#61;777&#41; on the basis of 95&#37; confidence intervals&#44; population size&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> estimated prevalence of overweight &#40;15&#37;&#41; and a 2&#46;5&#37; standard error&#46; Schools were selected from the list of private and public secondary schools in the Lisbon region in order to achieve a balance between participants by school type&#46; All students meeting the inclusion criteria &#40;15&#8211;18 years old&#41; were invited to participate&#46; The measuring instruments consisted of structured self-completion questionnaires &#40;on physical activity&#44; eating and smoking habits for students&#59; on premature cardiovascular events for parents&#41;&#44; an Omron sphygmomanometer &#40;blood pressure measured twice&#41;&#44; and scales for weight &#40;in kg&#41; and height &#40;in cm&#41;&#46; Biochemical assays on fasting capillary blood samples measured total cholesterol&#44; triglycerides &#40;Accutrend GCT&#41; and glucose &#40;Accu-Chek Aviva&#41;&#46; The chart for relative risk of 10-year cardiovascular mortality &#40;SCORE&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> was used&#46; The fieldwork was preceded by validation of the biochemical equipment &#40;Cobas Integra analyzer&#41; and a pre-test performed on 30 volunteers&#46; The fieldwork took place in three stages&#58; &#40;1&#41; presentation and planning of the project in schools&#59; &#40;2&#41; visits to obtain the list of participants and their informed consent and application of the questionnaires to parents&#59; and &#40;3&#41; physical examinations and biochemical assays in fasting state and application of the questionnaire to students&#46; Data collection took place in 2009&#46; Biological variables were classified according to international recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> Tests of independence&#44; the chi-square test&#44; Fisher&#39;s exact test and logistic regression analysis were used to analyze the relationships between the variables&#46; A value of p&#60;0&#46;05 was considered significant&#46; SPSS<span class="elsevierStyleSup">&#174;</span> version 15&#46;0 was used&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study population</span><p id="par0025" class="elsevierStylePara elsevierViewall">Of the total of 2549 students aged between 15 and 18 years enrolled in the eight selected schools in four Lisbon municipalities&#44; 854 participated &#40;54&#37; female and 46&#37; male&#41;&#44; corresponding to 34&#37; adherence&#46; Participation in private schools &#40;n&#61;3&#41; was higher than in public schools &#40;51&#37; vs&#46; 26&#37;&#41;&#46; Mean age was 16&#46;3&#177;0&#46;9 years&#44; similar in boys &#40;16&#46;1&#177;0&#46;9 years&#41; and girls &#40;16&#46;3&#177;0&#46;8 years&#41;&#46; The study population was composed of 209 adolescents aged 15 years&#44; 291 aged 16 years&#44; 281 aged 17 years and 73 aged 18 years&#44; with a predominance of students from the private sector &#40;n&#61;492&#44; 58&#37;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Quality control</span><p id="par0030" class="elsevierStylePara elsevierViewall">Comparing the measurements of cholesterol&#44; triglycerides and glucose in capillary blood and plasma&#44; the difference between mean cholesterol was minimal &#40;&#8722;0&#46;3&#177;11&#46;9 mg&#47;dl&#41;&#44; not significant&#44; but was greater for triglycerides &#40;35&#46;9&#177;34&#46;69&#41; and glucose &#40;12&#46;6&#177;10&#46;1&#41; &#40;p&#60;0&#46;001&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lifestyles</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data on health behaviors &#40;lifestyles&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Physical activity</span>&#46; When asked how much time they spent in extracurricular physical activities with an intensity that left them out of breath or sweating&#44; 29&#37; responded &#8220;never&#8221; and 53&#37; responded between 30 min and less than 4 hours&#46; Only 19&#37; did this type of exercise for four hours a week or more&#44; of whom more were at private schools &#40;22&#37; vs&#46; 17&#37;&#44; p&#61;0&#46;002&#41; and more were boys &#40;30&#37; vs&#46; 10&#37;&#44; p&#60;0&#46;001&#41;&#46; The majority &#40;54&#37;&#41; had less than one hour per week of out-of-school physical activity or none&#44; especially students aged 18&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sedentary time</span>&#46; Regarding the number of hours watching television&#44; 55&#37; spent more than one hour&#44; and 8&#37; spent three hours or more per day&#46; There were no statistically significant differences according to school type &#40;public or private&#41;&#44; gender or age&#46; Every day&#44; 61&#37; spent over one hour sitting&#44; using computers and&#47;or games consoles&#44; and 14&#37; spent over three hours&#46; The difference between the proportion using such devices for over one hour daily in private &#40;67&#37;&#41; and public schools &#40;58&#37;&#41; was statistically significant &#40;p&#61;0&#46;007&#41;&#44; as was the difference between boys &#40;69&#37;&#41; and girls &#40;55&#37;&#41; &#40;p&#60;0&#46;001&#41;&#46; The percentage of schoolchildren with &#8805;2 hours screen time &#40;TV and&#47;or computer&#47;games console&#41; daily was almost 80&#37;&#44; the majority attending private schools &#40;83&#37; vs&#46; 76&#37;&#44; p&#61;0&#46;03&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Diet&#46;</span> Soup&#44; salad or vegetables&#44; and fruit were consumed daily&#44; respectively&#44; by 63&#37;&#44; 61&#37; and 76&#37; of students and less than once a week by 14&#37;&#44; 13&#37; and 6&#37;&#46; Differences in gender&#44; age and type of school were not significant&#46; Regarding the number of daily meals&#44; a large majority &#40;77&#37;&#41; had five or more meals a day but 6&#37; had three or fewer&#44; while 17&#37; had four&#46; The difference reached significance only for age&#44; with a tendency to decrease with age &#40;p&#60;0&#46;01&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Smoking&#46;</span> Most &#40;87&#37;&#41; did not smoke&#46; Of the 13&#37; who smoked&#44; 5&#37; did so occasionally and 8&#37; every day&#44; with no differences according to type of school or gender&#46; Mean daily consumption was 5&#177;6 cigarettes&#46; They reported having started smoking at 14&#177;1&#46;6 years and the modal class was 18 years&#46; There was a significant increase in consumption with age in both sexes &#40;p&#60;0&#46;01&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Risk factors</span><p id="par0060" class="elsevierStylePara elsevierViewall">The main data on cardiovascular risk factors are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Overweight&#47;obesity</span>&#46; Most respondents &#40;81&#37;&#41; were normal weight&#59; only 3&#37; were low weight&#44; while 11&#37; were overweight and 5&#37; were obese&#44; giving a figure for overweight&#47;obesity of 16&#37; in these adolescents&#44; with a higher prevalence in boys than in girls &#40;21&#37; vs&#46; 12&#37;&#44; p&#61;0&#46;001&#41;&#46; Differences by school type and age were not significant but the highest prevalence of overweight was in 15-year-olds&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hypertension</span>&#46; Blood pressure was high-normal in 28&#37; and with criteria for hypertension in 11&#37;&#46; Systolic blood pressure was more determinant than diastolic blood pressure in the classification of hypertension &#40;46&#37; vs&#46; 30&#37;&#41;&#46; The prevalence of hypertension in boys was higher than in girls &#40;15&#37; vs&#46; 7&#37;&#44; p&#60;0&#46;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cholesterol&#46;</span> Total cholesterol was normal in most adolescents &#40;73&#37;&#41; but 5&#37; had values &#8805;200 mg&#47;dl&#46; The prevalence of hypercholesterolemia in girls was higher than in boys &#40;7&#37; vs&#46; 3&#37;&#44; p&#60;0&#46;005&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Triglycerides&#46;</span> The prevalence of hypertriglyceridemia &#40;&#8805;150 mg&#47;dl&#41; in girls was higher than in boys &#40;12&#37; vs&#46; 5&#37;&#44; p&#60;0&#46;001&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Impaired glucose metabolism</span>&#46; According to the American Diabetes Association classification 9&#37; had impaired fasting glucose &#40;IFG&#41; and 0&#46;5&#37; were diabetic&#46; The prevalence of IFG and diabetes was higher in boys &#40;11&#37;&#41; than in girls &#40;7&#37;&#41; &#40;p&#61;0&#46;06&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Family history of premature CVD</span>&#46; Approximately 6&#37; of the students&#8217; parents reported a history of premature cardiovascular events&#44; more of them mothers &#40;aged 46&#177;4&#46;7 years&#41; than fathers &#40;aged 48&#177;5&#46;7 years&#41;&#46; This family history was more frequent with older students &#40;p&#60;0&#46;05&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the prevalence of individual risk factors in both sexes&#46; The leading modifiable cardiovascular risk factors in boys were overweight&#47;obesity&#44; hypertension and smoking&#44; while in girls they were smoking&#44; overweight&#47;obesity and hypertriglyceridemia&#46; Moreover&#44; approximately half &#40;49&#37;&#41; already had at least one modifiable risk factor &#40;35&#37; had one&#44; 11&#37; had two and 3&#37; had &#8805;3 risk factors&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Relationships between variables</span><p id="par0105" class="elsevierStylePara elsevierViewall">The relationships between the variables studied in the 15&#8211;18 age-group obtained by multivariate logistic regression analysis are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46; Overweight&#47;obesity was associated with number of meals &#40;&#8804;3 meals daily&#41;&#44; abnormal blood pressure levels &#40;grade 2 hypertension&#41;&#44; impaired glucose metabolism and hypertriglyceridemia&#46; The variables associated with hypertension were male gender and overweight&#47;obesity&#46; Impaired glucose metabolism was associated with hypertension&#44; especially grade 2&#44; and with overweight&#47;obesity&#46; Variables related to elevated triglycerides were female gender and overweight&#47;obesity&#44; while those associated with high cholesterol were female gender and impaired glucose metabolism&#46; Smoking increased with age&#44; especially at age 17&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ten-year relative risk for cardiovascular mortality</span><p id="par0110" class="elsevierStylePara elsevierViewall">According to the table of relative risk &#40;RR&#41; of cardiovascular mortality based on blood pressure&#44; total cholesterol and smoking&#44; not discriminated by gender&#44; 27&#37; of respondents had RR &#8805;2&#46; Of these&#44; 3&#37; had RR &#8805;3&#46; Estimated cardiovascular risk in boys was significantly higher than in girls &#40;38&#37; vs&#46; 17&#37;&#44; p&#60;0&#46;001&#41; and overall increased from 21&#37; at age 15 to 43&#37; at age 18 &#40;p&#60;0&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Participants were included from both public and private secondary schools in order to test the hypothesis that there were differences in students attending these two school types&#46; The sample was balanced for school type&#44; gender and age&#46; The measuring instruments and laboratory tests were subjected to quality control to assess the reliability of the results&#46; Operational definitions of the variables and cut-offs were those defined by medical societies and international organizations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> The fact that all the schools invited agreed to participate is an indication that they recognized the importance of the research&#44; going so far as to make it part of the projects element of the curriculum&#44; even though only one school was a member of REPS and supported the study under the aegis of the Promotion and Education for Health project and of the School Health Agenda&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The assessment of physical activity included the 180 min per week of physical education included in the curriculum&#46; On this basis&#44; 19&#37; of the participants met the WHO recommendation that children and young people aged 5&#8211;17 should accumulate at least 60 min daily of moderate to vigorous intensity physical activity&#44; and that amounts greater than that provide additional health benefits&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This figure is slightly higher than the 15&#37; of the 2006 Health Behavior in School-aged Children &#40;HBSC&#41; study<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and confirms that males take more physical activity than females&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> a tendency that can be explained by different habits&#44; tastes and goals of leisure activities&#46; However&#44; several factors influence levels of physical activity&#58; self-esteem&#44; opportunities&#44; motivation&#44; childhood and adolescence habits&#44; local resources and costs of transport and equipment&#44; and others&#46; Some of these may underlie the higher levels of physical activity in students who attend private schools&#46; Nevertheless&#44; as shown in other studies&#44; levels of physical activity and sports tend to decrease with age&#44; particularly in females&#44; and so schools must be able to motivate young people to remain active&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">With regard to screen time&#44; the time spent at computers and games consoles reflects children&#39;s interest in technological innovations and content&#46; Gender differences suggest that such activities are more popular among boys and imply that&#44; in this case&#44; accessibility is not a reason for the differences between those who attend public and private schools&#46; These results are similar to those of other studies&#44; in which young people spend an average of 3&#8211;5 hours per day using these media&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The role of diet in obesity and atherosclerosis prevention is well defined in reports and guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;16&#44;17</span></a> One of the recommendations is that the first balanced meal should be taken soon after waking up&#44; but 11&#37; of the students reported not taking breakfast&#46; Soup&#44; a characteristic component of the Mediterranean diet that is known to be protective against some chronic diseases&#44; including coronary heart disease and cancer&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> was reported as never consumed or no more than once a week by 37&#37; of the participants&#46; Diet should be varied and divided between at least five meals a day&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> but almost a quarter of the participants did not follow this guidance&#46; The negative relation between overweight and number of meals corroborates the evidence and reinforces the recommendation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this population&#44; 13&#37; smoked&#44; although 5&#37; only did so occasionally&#46; These figures are higher than those of the HBSC study&#44; both in 2002 &#40;8&#46;5&#37;&#41; and in 2006 &#40;5&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> but those students were also younger than those in the present study&#46; However&#44; they are lower than in the 15&#8211;24 age-group &#40;24&#37;&#41; in the 4th Portuguese National Health Survey &#40;INS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> although in line with the upward trend in the proportion of female smokers&#46; The higher prevalence of smoking in public than in private schools is probably not by chance&#44; but the effect of differences in health education and promotion&#46; Determining the most common age to start smoking &#40;15 years&#41; identifies a risk group that should be a priority in smoking prevention&#44; since it is easier not to start smoking than to quit&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The prevalence of body mass index &#40;BMI&#41; above the 85th percentile was high &#40;16&#37;&#41; and that of obesity &#40;&#62;95th percentile&#44; 5&#37;&#41; was higher than that reported in the 4th INS in the 15&#8211;24 age-group &#40;&#60;2&#37;&#41;&#46; However&#44; these figures are similar to those obtained in 2002 in Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The percentage of overweight or obesity was higher in boys than in girls&#44; as also found in population studies<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> as well as the 4th INS&#44; up to age 25&#44; although the opposite was found over age 55&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In the four years between ages 15 and 18 there were no differences in overweight&#47;obesity&#44; since this problem starts earlier&#44; before age 15&#44; as can be seen in the COSI study&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In Portugal&#44; obesity has increased tenfold relative to the 1970s&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The obstacles to reversing this trend are enormous&#44; and no country has succeeded in overcoming them&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; unless there are changes&#44; more health problems &#40;psychological&#44; cardiovascular&#44; osteoarticular and others&#41; can be expected&#46; Urbanization and technological development have brought great benefits but are contributing to worsening dietary habits&#44; increasing physical inactivity and stress in various forms&#44; from childhood onwards&#46; What is needed is an environment that promotes health and reduces obesity&#44; which requires concerted policies and collaboration&#44; both nationally and internationally&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The prevalence of hypertension &#40;11&#37;&#41; lies within the range of other studies &#40;7&#46;5&#37; and 16&#46;5&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;24</span></a> including one on university students &#40;10&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> It was higher in males&#44; as in another study of young adults&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> This may be explained by hormonal changes after puberty&#44; although the effect of overweight&#47;obesity&#44; more prevalent in males and positively associated with blood pressure&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> should not be ignored&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">According to the criteria of the American Academy of Pediatrics<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the prevalence of elevated cholesterol &#40;&#62;200 mg&#47;dl&#41; was 5&#37;&#44; lower than in US studies &#40;13&#37;&#41; but close to values in the Portuguese population observed in a systematic review that included children and adolescents&#44; and that found that hypercholesterolemia was also more common in females&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> As plasma cholesterol is the most stable lipid variable and since it showed the best agreement according to quality control of the biochemical studies&#44; this proportion in particular should be close to the true figure in this age-group&#46; The prevalence of hypertriglyceridemia &#40;7&#37;&#41;&#44; higher in girls than in boys&#44; is slightly lower than in a study of children aged between 5 and 14 &#40;11&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Comparisons are not easy since triglycerides&#44; although not presenting significant circadian or seasonal variations&#44; have far greater intra-individual variability than cholesterol&#44; so results on triglycerides should be regarded with caution&#46; Moreover&#44; the pre-test reliability of the method applied was not optimal&#44; so this value may differ from the true prevalence&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Blood glucose levels corresponding to impaired glucose metabolism &#40;9&#37;&#41; were more frequent than expected&#44; with 0&#46;5&#37; being classified as diabetic&#46; Overall&#44; there was a high prevalence of all glucose metabolism abnormalities&#44; although a study in 2006 of 4370 American teenagers aged between 12 and 19&#44; with a fasting period of at least 8 hours&#44; obtained similar values &#40;0&#46;5&#37; diabetic and about 11&#37; with IFG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Most studies in this area are in the adult population and epidemiological information on type 1 diabetes is limited&#46; The incidence calculated for Portugal in joint international studies was approximately 8 per 10 000 population&#44; lower than in other countries&#46; However&#44; according to the Diabetes Atlas of the International Diabetes Federation in 2010&#44; it was 13&#46;2 per 10 000 population in those aged under 15 years&#46; Even so&#44; the prevalence of type 1 diabetes in our population was higher&#46; The proportion of young people with impaired glucose metabolism may be overestimated because of the method&#39;s unreliability &#40;quality control agreement was not ideal&#41; and&#47;or failure to observe the 12-hour fasting period&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Certain related characteristics are frequently associated &#40;obesity&#44; inflammatory factors&#44; hereditary factors&#44; hypertension&#44; dyslipidemia&#44; impaired glucose metabolism&#44; and lifestyles&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Such relationships are more thoroughly documented in epidemiological and clinical studies in adults than in children and adolescents&#44; but the pathophysiology underlying these associations remains the same&#46; Although further longitudinal studies from infancy to adulthood are required to clarify how these characteristics change over time&#44; it has been confirmed that there is a degree of tracking in some cases&#44; for example in weight and blood pressure&#44; the more so when high blood pressure levels in childhood are associated with obesity or a family history of hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The relationship between overweight&#47;obesity and blood pressure levels was confirmed in our study but the association with impaired glucose metabolism was a surprise&#44; although it would not have been if the study had been performed in the adult population&#46; The association of impaired glucose metabolism&#44; obesity and documented hypertension&#44; three components of the metabolic syndrome&#44; suggests that this syndrome is already prevalent at these ages&#46; The higher levels of lipids&#44; triglycerides and total cholesterol observed in girls is undoubtedly related to hormonal influences &#40;estrogen&#41; during adolescence&#44; but the negative influence of less physical activity cannot be excluded&#46; However&#44; as boys had higher BMI and more physical activity&#44; it appears that diet has more influence on weight and BMI than physical activity&#46; Nevertheless&#44; at a time when all these teenagers had at least 180 min of physical activity per week&#44; the difference between this duration and daily exercise may not be sufficient to separate the groups in terms of influence on weight evolution&#46; It should be noted that overweight&#47;obesity was associated with three risk factors &#40;hypertension&#44; impaired glucose metabolism&#44; and increased triglycerides&#41; and was dependent on dietary habits &#40;&#60;4 meals a day&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">For adolescents at school aged 15&#8211;18 years&#44; the data obtained show that&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Most were physically inactive &#40;81&#37; had insufficient physical activity and 79&#37; spent &#8805;2 hours per day watching TV or at a computer&#47;games console&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Many did not meet dietary recommendations concerning choices of food and number of meals per day&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Approximately half &#40;49&#37;&#41; already had at least one modifiable risk factor &#40;in descending order&#58; overweight&#47;obesity 16&#37;&#44; smoking daily&#47;occasionally 13&#37;&#44; hypertension 11&#37;&#44; diabetes&#47;IFG 9&#46;5&#37;&#44; hypertriglyceridemia 9&#37;&#44; family history of premature cardiovascular events 6&#37;&#44; and hypercholesterolemia 5&#37;&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">&#8805;2 risk factors coexisted in 14&#37; of the participants&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Approximately a quarter &#40;27&#37;&#41; had a &#8805;2 10-year relative risk of fatal cardiovascular events&#59;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Overweight&#47;obesity showed a positive association with blood pressure&#44; impaired glucose metabolism and elevated triglycerides&#44; and a negative association with number of meals per day&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">The results demonstrate the need for action in providing and encouraging healthy choices&#44; with an emphasis on behavioral and lifestyle changes&#44; particularly diet&#44; physical activity&#44; and smoking&#46; Preventive actions should be integrated and interventions should be aimed at individuals and at families and communities&#46; Regular monitoring of levels and patterns of risk factors is required for planning and evaluating preventive interventions&#46; Prevention based on lifelong health behaviors can be effective and should be seen as a vital investment in health&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protection of human and animal subjects</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidentiality of data</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Right to privacy and informed consent</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Cora&#231;&#227;o Jovem</span> study was funded by a research grant from the Foundation AstraZeneca&#44; obtained following a competitive call&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Disease prevention should begin in childhood and lifestyles are important risk determinants of cardiovascular disease&#46; Awareness and monitoring of risk is essential in preventive strategies&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To characterize cardiovascular risk and the relationships between certain variables in adolescents&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In a cross-sectional study&#44; 854 adolescent schoolchildren were surveyed&#44; mean age 16&#46;3&#177;0&#46;9 years&#46; Data collection included questionnaires&#44; physical examination&#44; charts for 10-year relative risk of mortality&#44; and biochemical assays&#46; In the statistical analysis continuous variables were studied by the Student&#39;s t test and categorical variables by the chi-square test and Fisher&#39;s exact test&#44; and each risk factor was entered as a dependent variable in logistic regression analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Physical activity was insufficient in 81&#37; of students&#46; The daily consumption of soup&#44; salad or vegetables&#44; and fruit was&#44; respectively&#44; 37&#37;&#44; 39&#37; and 21&#37;&#46; A minority &#40;6&#37;&#41; took &#8804;3 and 77&#37; took &#8805;5 meals a day&#46; The prevalence of each risk factor was as follows&#58; overweight 16&#37;&#59; smoking 13&#37;&#59; hypertension 11&#37;&#59; impaired glucose metabolism 9&#37;&#59; hypertriglyceridemia 9&#37;&#59; and hypercholesterolemia 5&#37;&#46; Out-of-school physical activity&#44; hypertension and overweight were more prevalent in males &#40;p&#60;0&#46;001&#41;&#46; Females had higher levels of cholesterol &#40;p&#60;0&#46;005&#41; and triglycerides &#40;p&#60;0&#46;001&#41;&#46; A quarter of the adolescents had a relative risk score for 10-year cardiovascular mortality of &#8805;2&#46; Overweight showed a positive association with blood pressure&#44; changes in glucose metabolism and triglycerides&#44; and a negative association with number of daily meals&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The results demonstrate the need for action in providing and encouraging healthy choices for adolescents&#44; with an emphasis on behavioral and lifestyle changes aimed at individuals&#44; families and communities&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A preven&#231;&#227;o deve come&#231;ar na inf&#226;ncia e o estilo de vida &#233; um determinante importante da doen&#231;a cardiovascular&#46; O conhecimento e monitoriza&#231;&#227;o do risco cardiovascular s&#227;o essenciais numa estrat&#233;gia preventiva&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracterizar o risco cardiovascular e as rela&#231;&#245;es entre algumas vari&#225;veis em adolescentes escolarizados&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foram observados 854 estudantes&#44; 16&#44;3&#177;0&#44;9 anos de idade&#44; num estudo transversal&#46; A colheita de dados incluiu question&#225;rios&#44; exame f&#237;sico&#44; tabela do risco relativo da mortalidade cardiovascular a dez anos&#44; doseamentos bioqu&#237;micos&#46; A an&#225;lise estat&#237;stica incide sobre vari&#225;veis cont&#237;nuas e categoriais e fatores de risco como vari&#225;veis dependentes &#40;regress&#227;o log&#237;stica&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Atividade f&#237;sica insuficiente 81&#37;&#46; Consumo di&#225;rio de sopa&#44; salada&#47;legumes e frutas caracterizou 37&#44; 39 e 21&#37; dos alunos&#46; Uma minoria &#40;6&#37;&#41; fazia diariamente &#8804;3 refei&#231;&#245;es e 77&#37; &#8805;5 refei&#231;&#245;es&#46; Preval&#234;ncia dos fatores de risco&#58; excesso de peso 16&#37;&#59; tabagismo 13&#37;&#59; hipertens&#227;o arterial 11&#37;&#59; anomalias do metabolismo da glicose 9&#37;&#59; hipertrigliceridemia 9&#37;&#59; hipercolesterolemia 5&#37;&#46; Atividade f&#237;sica extracurricular&#44; hipertens&#227;o e excesso de peso mais prevalentes no sexo masculino &#40;p&#60;0&#44;001&#41;&#44; enquanto nas adolescentes foram a hipercolesterolemia &#40;p&#60;0&#44;005&#41; e hipertrigliceridemia &#40;p&#60;0&#44;001&#41;&#46; Um quarto dos adolescentes com risco relativo de mortalidade cardiovascular a dez anos &#8805;2&#46; Excesso de peso revelou rela&#231;&#227;o positiva com press&#227;o arterial&#44; altera&#231;&#245;es metabolismo da glucose e triglicer&#237;deos e negativa com n&#250;mero de refei&#231;&#245;es di&#225;rias&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Os resultados evidenciam a necessidade de a&#231;&#245;es de fomento e incentivo de escolhas saud&#225;veis pelos adolescentes&#44; com &#234;nfase nas mudan&#231;as de comportamento ao n&#237;vel dos indiv&#237;duos&#44; fam&#237;lias e comunidades&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Out-of-school physical activity &#40;weekly&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30 min to &#60;4 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;4 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Screen time &#40;daily&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;2 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;2 hours&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">316&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Occasional smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Daily smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">787&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">358&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">303&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">484&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:2 [
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                0 => """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Biological characteristics and family history of cardiovascular disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Underweight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal weight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">690&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood pressure</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High-normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 1 HT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 2 HT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">853&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">459&nbsp;\t\t\t\t\t\t\n
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                  """
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2014.01.024
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2024 Abril 53 21 74
2024 Maro 47 25 72
2024 Fevereiro 40 21 61
2024 Janeiro 40 30 70
2023 Dezembro 30 19 49
2023 Novembro 35 25 60
2023 Outubro 34 13 47
2023 Setembro 29 18 47
2023 Agosto 43 27 70
2023 Julho 29 10 39
2023 Junho 32 9 41
2023 Maio 56 28 84
2023 Abril 25 0 25
2023 Maro 44 29 73
2023 Fevereiro 31 17 48
2023 Janeiro 36 21 57
2022 Dezembro 51 18 69
2022 Novembro 58 23 81
2022 Outubro 49 30 79
2022 Setembro 35 33 68
2022 Agosto 32 32 64
2022 Julho 60 36 96
2022 Junho 40 25 65
2022 Maio 36 32 68
2022 Abril 53 29 82
2022 Maro 41 35 76
2022 Fevereiro 28 15 43
2022 Janeiro 31 21 52
2021 Dezembro 19 35 54
2021 Novembro 45 31 76
2021 Outubro 35 46 81
2021 Setembro 21 34 55
2021 Agosto 35 29 64
2021 Julho 33 23 56
2021 Junho 39 28 67
2021 Maio 33 19 52
2021 Abril 58 65 123
2021 Maro 62 13 75
2021 Fevereiro 72 17 89
2021 Janeiro 39 14 53
2020 Dezembro 36 16 52
2020 Novembro 36 15 51
2020 Outubro 13 11 24
2020 Setembro 56 8 64
2020 Agosto 17 5 22
2020 Julho 47 6 53
2020 Junho 48 4 52
2020 Maio 60 4 64
2020 Abril 67 9 76
2020 Maro 39 9 48
2020 Fevereiro 134 11 145
2020 Janeiro 38 7 45
2019 Dezembro 40 2 42
2019 Novembro 40 6 46
2019 Outubro 34 3 37
2019 Setembro 26 10 36
2019 Agosto 30 5 35
2019 Julho 36 13 49
2019 Junho 41 9 50
2019 Maio 44 13 57
2019 Abril 25 21 46
2019 Maro 73 9 82
2019 Fevereiro 46 13 59
2019 Janeiro 59 6 65
2018 Dezembro 105 12 117
2018 Novembro 155 10 165
2018 Outubro 424 29 453
2018 Setembro 86 12 98
2018 Agosto 48 13 61
2018 Julho 35 4 39
2018 Junho 71 7 78
2018 Maio 78 10 88
2018 Abril 133 11 144
2018 Maro 158 8 166
2018 Fevereiro 38 10 48
2018 Janeiro 26 7 33
2017 Dezembro 70 16 86
2017 Novembro 47 14 61
2017 Outubro 33 9 42
2017 Setembro 45 12 57
2017 Agosto 43 14 57
2017 Julho 46 13 59
2017 Junho 58 10 68
2017 Maio 40 10 50
2017 Abril 34 5 39
2017 Maro 34 6 40
2017 Fevereiro 27 3 30
2017 Janeiro 33 7 40
2016 Dezembro 33 9 42
2016 Novembro 37 10 47
2016 Outubro 25 1 26
2016 Setembro 91 3 94
2016 Agosto 22 0 22
2016 Julho 13 2 15
2016 Junho 6 5 11
2016 Maio 5 0 5
2016 Abril 22 3 25
2016 Maro 55 11 66
2016 Fevereiro 60 26 86
2016 Janeiro 48 10 58
2015 Dezembro 43 4 47
2015 Novembro 47 8 55
2015 Outubro 42 8 50
2015 Setembro 38 11 49
2015 Agosto 38 11 49
2015 Julho 44 8 52
2015 Junho 25 5 30
2015 Maio 42 9 51
2015 Abril 41 13 54
2015 Maro 38 8 46
2015 Fevereiro 40 6 46
2015 Janeiro 38 6 44
2014 Dezembro 33 11 44
2014 Novembro 58 23 81
2014 Outubro 123 85 208
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