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Little is known about vitamin D status in older adults in South America, where exposures to ultra-violet radiation are high. We examined the distribution of serum 25-hydroxyvitamin D (25OHD) concentration and its determinants in a nationally representative sample of Brazilians aged 50 years and older. Explanatory variables included environment and individuals’ characteristics from the ELSI baseline survey (2015–16). Among the 2,264 participants (mean age = 62.6 years), the geometric mean of 25OHD concentration was 66.8 nmol/L. The prevalence of vitamin D deficiency (

Diabetes has been associated with cognitive changes and an increased risk of vascular dementia and Alzheimer’s disease, but it is unclear whether there are associations between diabetes and early alterations in cognitive performance. The present study consisted of a cross-section analysis of 14,444 participants aged 35–74 years and from a developing country at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA–Brasil); these participants were recruited between 2008 and 2010. We investigated whether there was an association between diabetes and early changes in the cognitive performance of this Brazilian population. To assess cognitive domains, we used the word-list learning, word-list delayed recall and word recognition tests along. Phonemic verbal fluency tests included semantic phonemic test (animals) and a phonemic test (words beginning with the letter F). Executive functions associated with attention, concentration and psychomotor speed were evaluated using the Trail Making Test B. The exposure variable in the study was defined as diabetes. Multiple linear regression was used to estimate the association between diabetes and cognitive performance. The results were adjusted for age, sex, education, hypertension, coronary disease, depression, physical activity, smoking, alcohol consumption, and the cholesterol/HDL-C ratio. We found a significant association between diabetes and decreased memory, language and executive function (attention, concentration and psychomotor speed) performance in this population from a country with a distinct epidemiological profile, even after adjusting for the main intervening variables.

Objective: To evaluate changes in selected laboratory tests in the population included in the Brumadinho Health Project, according to the exposure to the dam failure. Methods: Cross-sectional study carried out on representative sample of residents (≥12 years) in Brumadinho, Minas Gerais, including: 1) non-exposed; 2) directly affected by tailings sludge; 3) residents in mining area. The prevalence of abnormal results of blood count, total, HDL and LDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, estimate of glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) were estimated. The Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) of having an abnormal laboratory finding were estimated using Generalized Linear Models with Poisson probability distribution. Crude and adjusted models were estimated for age range, gender, diabetes, body mass index, smoking, hypertension. Results: After adjusting, there was no difference in PR between the three populations for most tests, with the exception of the population residing in an area with mining activity and not directly affected by the mud, with a lower chance of having altered total cholesterol (PR: 0.84; 95%CI 0.74–0.95) and a higher chance of having altered HDL cholesterol (PR: 1.26; 95%CI 1.07–1.50), hs-CRP (PR: 1.19; 95%CI 1.04–1.37), and eGFR

Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p

There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women. Resumo: Há uma controvérsia na literatura a respeito da associação entre níveis de ácido úrico sérico (AUS) e glicemia. Portanto, avaliamos a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diabetes mellitus), além da resistência insulínica, em uma amostra grande no Brasil. O estudo transversal observacional incluiu 13.207 participantes com idade entre 35 e 74 anos na linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foi realizada análise de regressão multivariada para testar a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diagnóstico novo de diabetes tipo 2 na linha de base da coorte) depois de ajustar para idade, sexo, cor, índice de massa corporal, atividade física, tabagismo, consumo de álcool, comorbidades e uso de medicação. O modelo de regressão logística foi usado para avaliar a associação entre AUS e resistência insulínica por HOMA-IR. Foram realizadas análises estratificadas por sexo. A média de idade (DP) foi 51,4 (8,9) anos, e 55,2% dos participantes eram mulheres. Houve 1.439 novos diagnósticos de diabetes. Depois de todos os ajustes, o AUS esteve associado à glicemia em jejum alterada, intolerância glicêmica e diabetes, com odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33) e 1,37 (IC95%: 1,24; 1,51), respectivamente. Houve uma associação entre níveis de AUS e resistência insulínica, com OR = 1,24 (IC95%: 1,13; 1,36). Na análise estratificada por sexo, persistiu a associação independente entre AUS elevado e glicemia. Os resultados sugerem que níveis elevados de AUS estão associados de maneira significativa com a glicemia em uma população latino-americana grande, sobretudo entre mulheres. Resumen: Hay un conflicto en la literatura respecto a la asociación entre los niveles de ácido úrico sérico (AUS) y el estado glucémico. Por eso, evaluamos la asociación entre el nivel AUS y el estatus glucémico: glucosa alterada en ayunas (GAA), tolerancia a la glucosa alterada (TGA) y diabetes mellitus (diabetes), comparados con la resistencia a la insulina en un amplio estudio en Brasil. Se realizó un estudio transversal, observacional con 13.207 participantes, con edades comprendidas entre los 35-74 años, en la base de referencia del Estudio Longitudinal de Salud entre Adultos brasileños (2008-2010) (ELSA-Brasil). Se realizó un análisis de regresión multinomial para probar la asociación entre AUS y el estado glucémico (GAA, TGA y de nuevo la diabetes tipo 2, diagnosticada en la cohorte como base de referencia) tras los ajustes por edad, sexo, color de piel, índice de masa corporal, actividad física, fumar, consumo de alcohol, comorbilidades, uso de medicinas. Se usó el modelo de regresión logística para evaluar la asociación entre AUS y la resistencia a la insulina por el HOMA-IR. Se realizó también un análisis estratificado por sexo. La media de edad (desviación estándar) fue 51,4 (8,9) años, un 55,2% de los participantes eran mujeres. Hubo 1.439 nuevos casos de diabetes diagnosticados. Tras todos los ajustes, una AUS más alta estuvo asociada con GAA, TGA y diabetes, con odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33), y 1,37 (IC95%: 1,24; 1,51), respectivamente. Hubo asociación entre los niveles AUS y la resistencia a la insulina con OR = 1,24 (IC95%: 1,13; 1,36). En el análisis estratificado por sexo, una AUS más alta persistía independientemente asociada con un estado glucémico alterado. Nuestros resultados sugieren que unos niveles más altos de AUS estuvieron significativamente asociados con el estado glucémico en una amplia población latinoamericana, principalmente entre mujeres.

BackgroundHigh-sensitivity C reactive protein (hsCRP) has been proposed as a marker of incident cardiovascular disease and vascular mortality, and may also be a marker of non-vascular mortality. However, most evidence comes from either North American or European cohorts. The present proposal aims to investigate the association of hsCRP with the risk of all-cause mortality in a multiethnic Brazilian population.MethodsBaseline data (2008–2010) of a cohort of 14 238 subjects participating in the Brazilian Longitudinal Study of Adult Health were used. hsCRP was assayed with immunochemistry. The association of baseline covariates with all-cause mortality was calculated by Cox regression for univariate model and adjusted for different confounders after a mean follow-up of 8.0±1.1 years. The final model was adjusted for age, sex, self-rated race/ethnicity, schooling, health behaviours and prevalent chronic disease.ResultsThe risk of death increased steadily by quartiles of hsCRP, from 1.45 (95% CI 1.05 to 2.01) in quartile 2 to 1.95 (95% CI 1.42 to 2.69) in quartile 4, compared with quartile 1. Furthermore, the persistence of a significant graded association after the exclusion of deaths in the first year of follow-up suggests that these results are unlikely to be due to reverse causality. Finally, the HR was unaffected by the exclusion of participants who had self-reported medical history of diabetes, cancer and chronic obstructive pulmonary disease.ConclusionsOur study shows that hsCRP level is associated with mortality in a highly admixed population, independent of a large set of lifestyle and clinical variables.

Aim The aim of the study is to investigate whether adiposity markers, insulin resistance and prediabetes are associated with cognitive performance in middle-aged men and women without diabetes. Methods Cross-sectional study with 11,115 adults without diabetes (34–64 years old). Cognitive performance was tested by word-list learning, word-list delayed recall, word recognition tests, semantic and phonemic verbal fluency tests and trail making test B. Linear regression models and generalized linear regression with logarithmic links between the cognitive tests and anthropometric indicators (body mass index [BMI]), insulin resistance (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR]), and prediabetes (impaired glucose tolerance) were stratified by sex. The results were adjusted for age, education, comorbidities, health-related behaviors, waist circumference, and lipids. Results Among women, higher BMI was associated with poorer performance on phonemic verbal fluency test (β-0.02 [−0.04; −0.01]) and memory tests (β-0.05 [−0.07; −0.02]). Higher HOMA-IR was associated with poorer cognitive performance in memory (β-0.11 [−0.19; −0.01]) and phonemic verbal fluency tests (β-0.12 [−0.20; −0.04]). In men, HOMA-IR (β-0.15 [−0.25; −0.04]) and prediabetes (β-0.35 [−0.69; -0.03]) were associated with poorer performance on memory tests. Conclusions We found a significant association of BMI and HOMA-IR with cognitive performance in young and middle-aged adult women without diabetes. In men, we found an association between HOMA-IR and prediabetes and poorer performance on memory tests.

Background and aims Non–high-density lipoprotein cholesterol (non-HDL-C) goals are defined as 30 mg/dL (0.78 mmol/L) higher than the respective low-density lipoprotein cholesterol (LDL-C) goals. This definition, however, do not consider the population distribution of non-HDL-C, which could represent a more appropriate individual goal when both markers are discordant. The aim of this study is to establish non-HDL-C goals at the same population percentiles of LDL-C. Methods Non-HDL-C values were assigned at the same percentiles correspondent to the LDL-C treatment goals for 14,837 participants from the Longitudinal Study of Adult Health (ELSA-Brasil) with triglycerides levels ≤ 400 mg/dL (4.52 mmol/L). We also assessed the frequency of reclassification, defined as the number of subjects with LDL-C levels in the recommended therapeutic category, but with non-HDL-C levels above or below the category. Results The non-HDL-C values, based on correspondent LDL-C population percentiles, were 92 (2.38), 122 (3.16), 156 (4.04), 191 (4.95), and 223 mg/dL (5.78 mmol/L). Among participants with LDL-C Conclusions Our results demonstrated that non-HDL-C percentiles-based goals were up to 8 mg/dL (0.21 mmol/L) lower than the guidelines recommended goal and had a profound impact on the reclassification of participants, notably when LDL-C was

Introduction The time for inflammatory markers of former smokers to revert to never smoker levels is still controversial, ranging from 5 to 20 years. We aimed to determine the time from smoking cessation for white blood cell (WBC) count and serum C-reactive protein (CRP) levels to return to those of never-smokers, after adjusting for confounding factors and for secondhand smoke (SHS) exposure among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods Cross-sectional analysis of baseline participants of ELSA-Brasil. We used linear regression analysis and generalized linear models with gamma distribution and logarithmic link function to estimate the association of WBC count and CRP levels with time from smoking cessation. The following confounding factors were considered: sex, age, education, SHS, alcohol consumption, leisure-time physical activity, BMI, total cholesterol/HDL ratio, hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease (COPD). Results: After all adjustments, time from smoking cessation

Objective:To investigate the association between the intake of selected food groups and beverages and serum uric acid (UA).Design:Cross-sectional study using the baseline data (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Food intake was assessed by food frequency questionnaire with 114 items. Linear and logistic regressions investigated the associations between the daily intake of each food group (servings/d) and UA (mg/dl) and hyperuricemia (UA ≥ 6·8 mg/dl), respectively. All the analyses were adjusted for potential confounders, energy intake and all food groups.Setting:Teaching and research institutions from six Brazilians states.Subjects:The participants were 14 320 active and retired civil servants, aged 35–74 years.Results:Higher intake of dairy products was associated with lower serum UA levels in both sexes, with a statistical dose-response gradient. High meat intake was associated with high UA only in women, and high intake of organ meats, in men. Intake of fish and fruits, vegetables and legumes were not associated with serum UA. In men, moderate and high intake of alcoholic beverages, specifically beer and spirits, but not wine, increased UA. In women, only high intake of alcoholic beverages, specifically beer, was associated with increased serum UA. Similar associations were seen for hyperuricemia.Conclusions:Results suggest a potential beneficial role of dairy products consumption on UA levels. The association between alcohol intake and UA differed according to type of beverage and between sexes. Results reinforce the need to consider the whole diet in the analysis and to conduct sex stratified analysis.

BACKGROUND Subclinical changes on the electrocardiogram are risk factors for cardiovascular mortality. Recognition and knowledge of electrolyte associations in cardiac electrophysiology are based on only in vitro models and observations in patients with severe medical conditions.OBJECTIVES This study sought to investigate associations between serum electrolyte concentrations and changes in cardiac electrophysiology in the general population.METHODS Summary results collected from 153,014 individuals (54.4% women; mean age 55.1 +/- 12.1 years) from 33 studies (of 5 ancestries) were meta-analyzed. Linear regression analyses examining associations between electrolyte concentrations (mmol/l of calcium, potassium, sodium, and magnesium), and electrocardiographic intervals (RR, QT, QRS, JT, and PR intervals) were performed. The study adjusted for potential confounders and also stratified by ancestry, sex, and use of antihypertensive drugs.RESULTS Lower calcium was associated with longer QT intervals (-11.5 ms; 99.75% confidence interval [CI]: -13.7 to -9.3) and JT duration, with sex-specific effects. In contrast, higher magnesium was associated with longer QT intervals (7.2 ms; 99.75% CI: 1.3 to 13.1) and JT. Lower potassium was associated with longer QT intervals (-2.8 ms; 99.75% CI: -3.5 to -2.0), JT, QRS, and PR durations, but all potassium associations were driven by use of antihypertensive drugs. No physiologically relevant associations were observed for sodium or RR intervals.CONCLUSIONS The study identified physiologically relevant associations between electrolytes and electrocardiographic intervals in a large-scale analysis combining cohorts from different settings. The results provide insights for further cardiac electrophysiology research and could potentially influence clinical practice, especially the association between calcium and QT duration, by which calcium levels at the bottom 2% of the population distribution led to clinically relevant QT prolongation by >5 ms. (C) 2019 by the American College of Cardiology Foundation.

This article presents a costing method for a Support Foundation, based on the study of its case. A survey was carried out to map their areas, whose data collection techniques used were: consultation of archives and internal documents, semi-structured interviews and non-participant observations. As results were identified the procedures, resources activities developed. The analysis, by triangulation, allowed defining the apportionment metrics for each cost center, which allowed the comparisons with the theoretical constructs available and the description on how the absorption costing method fits the pricing needs and decision-making. It was possible to identify that the foundation presents as final product the activities carried out by the Personnel, Purchasing, Import and Accountability Areas. From the results obtained in this process, we propose future studies and reflections on the potential of applying the mapping procedures and the costing method adopted to organizations of the same nature.

BACKGROUND: There is increased interest in understanding why chronic kidney disease (CKD) rates vary across races and socioeconomic groups. We investigated the distribution of estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR) and CKD according to these factors in Brazilian adults. METHODS: Using baseline data (2008-2010) of 14 636 public sector employees (35-74 years) enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA)-Brasil multicentre cohort, we estimated the prevalence of CKD by sex, age, race and socioeconomic factors. CKD was defined as ACR≥30 mg/g and/or eGFR

Platelet volume indices (PVI) are associated with hematological and non-hematological diseases, notably cardiovascular and cerebrovascular diseases. The establishment of PVI reference intervals (RIs) are essential to evaluate whether these indices are useful in clinical practice. Healthy-associated RIs have not yet been established for the Brazilian population. Here, we determined RIs of PVI for a health adult population, participants of the Brazilian Longitudinal Study of Adult Health ELSA-Brasil. A total of 580 individuals out of an initial sample of 3115 subjects constituted the healthy reference sample. To be part of the study, individuals had to fulfill the following criteria: blood count within 2 hours of collection, no use of continuous medication, self-rated health as good or very good, no reported diagnosis of diabetes and/or arterial hypertension, not smoking, lack of metabolic syndrome, body mass index (BMI)

Objectives The fructosamine test is used in the monitoring of diabetes mellitus, particularly in cases with restrictions on the use of glycated hemoglobin (mainly in the setting of altered red blood cell lifespan and interference by hemoglobin variants). It could also provide additional information on shorter-term glycemic control. The objective of the study is to establish the reference range of the fructosamine in the Brazilian population. Design and methods The reference interval was defined as suggested by the Clinical and Laboratory Standards Institute (CLSI). The study participants were from a Brazilian cohort (The Longitudinal Study of Adult Health – ELSA-Brasil) with baseline data collected between 2008 and 2010. A total of 466 subjects were selected after exclusion of diabetic individuals, and those with altered glycemic markers and renal function tests. Results The reference interval was 186–248 μmol/L for women and 196–269 μmol/L for men. Fructosamine levels were higher in men than in women (p = 0.006) and in the non-white population (p = 0.034) and had a negative correlation with the body mass index (r = −0.117; p = 0.011). Conclusions The reference intervals for fructosamine were affected by sex. Reference intervals stratified by sex would be more adequate in the interpretation of the fructosamine test., Highlights • Reference intervals for fructosamine in serum. • The reference intervals for fructosamine were affected by sex. • The reference intervals for fructosamine are different for different population.

Supplemental Digital Content is available in the text, The primary aim of this study was to evaluate metabolically healthy status (MHS) among participants in obesity, overweight, and normal weight groups and characteristics associated with this phenotype using baseline data of Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The secondary aim was to investigate agreement among 4 different MHS criteria. This cross-sectional study included 14,545 participants aged 35 to 74 years with a small majority (54.1%) being women. Of all participants, 22.7% (n = 3298) were obese, 40.8% (n = 5934) were overweight, and 37.5% (n = 5313) were of normal weight. Socio-demographic, behavioral, and anthropometric factors related to MHS were ascertained. Logistic regression models estimated the odds of associations. We used 4 different criteria separately and in combination to define MHS: the National Health and Nutrition Examination Survey (NHANES), the National Cholesterol Education Program (NCEP-ATPIII), the International Diabetes Federation (IDF) and comorbidities, and the agreement between them were evaluated by Cohen-kappa coefficient. MHS was present among 12.0% (n = 396) of obese, 25.5% (n = 1514) of overweight, and 48.6% (n = 2582) of normal weight participants according to the combination of the 4 criteria. The agreement between all the 4 MHS criteria was strong (kappa 0.73 P

Multi-center epidemiological studies must ascertain that their measurements are accurate and reliable. For laboratory measurements, reliability can be assessed through investigation of reproducibility of measurements in the same individual. In this paper, we present results from the quality control analysis of the baseline laboratory measurements from the ELSA-Brasil study. The study enrolled 15,105 civil servants at 6 research centers in 3 regions of Brazil between 2008–2010, with multiple biochemical analytes being measured at a central laboratory. Quality control was ascertained through standard laboratory evaluation of intra- and inter-assay variability and test-retest analysis in a subset of randomly chosen participants. An additional sample of urine or blood was collected from these participants, and these samples were handled in the same manner as the original ones, locally and at the central laboratory. Reliability was assessed with the intraclass correlation coefficient (ICC), estimated through a random effects model. Coefficients of variation (CV) and Bland-Altman plots were additionally used to assess measurement variability. Laboratory intra and inter-assay CVs varied from 0.86% to 7.77%. From test-retest analyses, the ICCs were high for the majority of the analytes. Notably lower ICCs were observed for serum sodium (ICC=0.50; 95%CI=0.31–0.65) and serum potassium (ICC=0.73; 95%CI=0.60–0.83), due to the small biological range of these analytes. The CVs ranged from 1 to 14%. The Bland-Altman plots confirmed these results. The quality control analyses showed that the collection, processing and measurement protocols utilized in the ELSA-Brasil produced reliable biochemical measurements.

Background: Regular physical activity (PA) induces desirable changes in plasma levels of high- and low-density lipoproteins (HDL and LDL, respectively) and triglycerides (TG), important risk factors for cardiometabolic diseases. However, doubts whether intensity and duration have equivalent benefits remain. Objective: To assess the association of PA intensity and duration with HDL, LDL and TG levels. Methods: Cross-sectional study with 12,688 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline, who were not on lipid-lowering medication. After adjustment for important covariates, multiple linear regression was used to assess the association of PA intensity and duration with HDL, LDL and TG (natural logarithm) levels. Results: Both moderate and vigorous PA and PA practice ≥ 150 min/week were significantly associated with higher HDL and lower TG levels. Vigorous PA was associated with lower LDL only on univariate analysis. After adjustments, moderate and vigorous PA increased mean HDL level by 0.89 mg/dL and 1.71 mg/dL, respectively, and reduced TG geometric mean by 0.98 mg/dL and 0.93 mg/dL, respectively. PA practice ≥ 150 min/week increased mean HDL level by 1.05 mg/dL, and decreased TG geometric mean by 0.98 mg/dL. Conclusion: Our findings reinforce the benefits of both PA parameters studied on HDL and TG levels, with a slight advantage for vigorous PA as compared to the recommendation based only on PA duration.

Background:Platelet volume indices (PVI), an easy and inexpensive surrogate measure of platelet function, have been associated with cardiovascular diseases (CVD) and their risk factors. However, results are conflicting because of the lack of standardized procedures. The purpose of this study is to investigate the relationship of PVI with the Framingham risk score (FRS).Methods:Baseline data (2008–2010) of 3115 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were used. PVI measurements were strictly controlled. The cohort was distributed according to risk factors and the general FRS was estimated. Multiple linear regression analysis was used to estimate the association between PVI and FRS.Results:Mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) independently correlated (p≤0.01) with FRS after adjustment for confounding variables. One unit increase in MPV, PDW, or P-LCR increased the FRS by 0.59%, 0.40%, and 0.08%, respectively. Diabetics had higher (p≤0.004) MPV, PDW, and P-LCR, and hypertensive individuals had higher (p≤0.045) PDW and P-LCR.Conclusions:Increased PVI was independently correlated with higher CVD risk based on the FRS, diabetes, and systolic hypertension. Prospective follow up of this cohort is warranted to confirm that PVI is associated with the development of CVD.

Background: Chronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender. Methods and Findings: Our analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend ,0.001). The metabolic alterations were the most important mediator between cumulative SEP and CRP. This mediation path accounted for 49.5% of the total effect of cumulative SEP on CRP among women, but only 20.2% among men. In consequence, the portion of the total effect of cumulative SEP on CRP that was mediated by risk behaviors and metabolic alterations was higher among women (55.4%) than among men (36.8%). Conclusions: Cumulative SEP across life span was associated with elevated systemic inflammation in adulthood. Although health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men.

Introduction: Modifications in the Brazilian Unified Health System (SUS) have led to a significant improvement in the national health indexes. However, some challenges still need to be faced, especially concerning SUS patients' access to high-quality laboratory support services.Objective: To evaluate the present status of laboratory services in SUS in 31 cities of Minas Gerais, Brazil, between 2008 and 2011.Material and method: This analysis was performed through data from the Information Technology Department of SUS (DATASUS) and through interviews with local public health managers with structured questionnaires.Results: Among all the studied cities, 21 had their own laboratory, 90.2% of which were in precarious conditions, not meeting the requirements established by the legislation in force, and employing inappropriate procedures and techniques, in addition to using obsolete equipment. The range of available laboratory tests was limited, what demanded the services of supporting laboratories. None of the evaluated laboratories developed any systematic activity on quality management, including control of analytical quality, maintenance of laboratory equipment, calibration and performance evaluation of critical equipment, continuing education programs, and safety and biosecurity.Conclusion: The effective role of laboratory test results in medical decision is unquestionably impaired, risking the safety of SUS patients. The present work reveals the deficiencies of public laboratory services in Minas Gerais, and proposes a new management model, which is able to associate operational quality, technological development and optimization of human and material resources with higher productivity. Introdução: Desde a sua criação, modificações no Sistema Único de Saúde (SUS) levaram a uma melhoria significativa nos índices nacionais de saúde. No entanto, alguns desafios ainda precisam ser enfrentados, especialmente o acesso de pacientes do SUS aos serviços de apoio de laboratório de qualidade.Objetivo:Avaliar a situação atual da assistência laboratorial no SUS em 31 municípios de Minas Gerais, Brasil, entre 2008 e 2011.Material e método: Foi realizado levantamento de dados do Departamento de Informática do SUS (DATASUS) e de entrevistas com gestores utilizando questionário estruturado.Resultados: Dos municípios estudados, 21 possuíam laboratório próprio, sendo que 90,2% deles apresentavam instalações físicas precárias, fora das especificações previstas na legislação vigente, e empregavam procedimentos e técnicas inadequadas, com utilização de equipamentos obsoletos. O perfil de exames era restrito, necessitando da utilização de laboratórios de apoio. Nenhum dos laboratórios avaliados apresentava programas de educação permanente, de controle da qualidade dos exames laboratoriais, de manutenção dos equipamentos analíticos, de aferição de instrumentos críticos e de segurança e biossegurança.Conclusão: O papel efetivo dos resultados dos testes de laboratório na decisão médica mostrou-se, sem dúvida, prejudicado, acarretando risco à segurança dos pacientes usuários do SUS. O presente trabalho revelou a precariedade da assistência laboratorial pública em MG e propõe a mudança para um modelo de gestão capaz de aliar qualidade operacional, desenvolvimento tecnológico, otimização de recursos humanos e materiais e maior produtividade.

Objective. To describe, for the first time in Brazil, the prevalence of risk factors and the use of preventive health care services among adults 60 years and older. Methods. This population-based study was conducted during 1996-1997 in the state of Minas Gerais, in the town of Bambuí, which is located in the municipality of the same name. In 1996 the town had 14 950 inhabitants. For the study, all the town's residents aged > or = 60 years were selected, along with a comparison sample of persons aged 18-59 years. Data were gathered using interviews and physical examinations. Results. Of the 1 742 inhabitants of the town of Bambuí aged > or = 60 years, 1 606 (92.2%) participated in the interview and 1 495 (85.8%) were examined (blood pressure, anthropometric measurements, and blood tests). Among the 1 020 younger adults selected for the survey, 909 of them (89.1%) participated in the interview, and 820 of them (80.4%) underwent the physical examination. The prevalence of the following risk factors was higher among older adults than among younger adults: physical inactivity (47.7% vs. 28.0%); blood pressure 140-159 mmHg (systolic) or 90-99 mmHg (diastolic) (25.8% vs. 8.7%); blood pressure > or = 160 mmHg (systolic) or > or = 100 mmHg (diastolic) (19.1% vs. 4.1%); total cholesterol > or = 240 mg/dL (40.6% vs. 9.8%); and blood glucose > or = 126 mg/dL (12.4% vs. 2.2%). The daily consumption of fruits and vegetables was similar among the older adults and the younger ones (51.9% and 51.7%), as was also body mass index > or = 25 kg/m² (51.6% and 56.2%). Smoking was lower among the older adults (18.7%) than among the younger ones (31.1%). The proportion of participants whose blood pressure had been checked in the preceding year was high (86.8% among the older adults and 61.2% among the younger ones), suggesting that the high prevalence of uncontrolled hypertension was not due to limited access to health care. Conclusions. For a long time it was believed that the kinds of risk factors that we found in the urban section of the municipality of Bambuí were public health problems only in large Brazilian cities. Around 72% of the municipalities in Brazil have

A rapid, sensitive, specific, and reliable enzyme-linked immunosorbent assay (ELISA) is proposed for determination of the levels of anti-Trypanosoma cruzi IgM in acute chagasic sera (ACD). The efficiency of this ELISA as a diagnostic method was compared with that of parasite DNA detection by polymerase chain reaction (PCR) and that of indirect immunofluorescence (iIF) anti-T. cruzi IgM detection. We tested whether this ELISA using fixed epimastigotes (epi) could detect anti-T. cruzi IgM in serum samples from two groups of children with acute Chagas' disease from a hyperendemic area in Bolivia. In a comparison of the ELISA method with other techniques, 95% and 71% of the results correlated with PCR and iIF findings, respectively. At the serum dilution applied (1:250), rheumatoid factor (RF) did not influence the results, and samples from patients carrying leishmaniasis or mixed Leishmania and T. cruzi infection could also be excluded from ACD. Highly specific and reliable results were obtained, a great number of the sera could be tested in only one assay, and a quantitative index of reactivity (IR) could be calculated without serial titration. Using test samples in triplicate, the method provides a useful tool for the detection of early acute-phase T. cruzi infection in humans.

O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) é um estudo de coorte multicêntrico com o objetivo de identificar os fatores de risco associados ao diabetes tipo 2 e à doença cardiovascular na população brasileira. O artigo descreve as estratégias de coleta, processamento, transporte e de controle de qualidade dos exames de sangue e urina no ELSA. O estudo optou pela centralização dos exames em um único laboratório. O processamento das amostras foi realizado nos laboratórios locais, reduzindo o peso do material a ser transportado e diminuindo os custos do transporte para o laboratório central no Hospital da Universidade de São Paulo. O estudo incluiu exames para avaliação de diabetes, resistência à insulina, dislipidemias, alterações eletrolíticas, hormônios tireoidianos, ácido úrico, alterações de enzimas hepáticas, inflamação e hemograma completo. Além desses exames, foram estocados DNA de leucócitos, amostras de urina, plasma e soro. O laboratório central realizou aproximadamente 375.000 exames. The ELSA (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health) is a multicenter cohort study which aims at the identification of risk factors associated with type 2 diabetes and cardiovascular diseases in the Brazilian population. The paper describes the strategies for the collection, processing, transportation, and quality control of blood and urine tests in the ELSA. The study decided to centralize the tests at one single laboratory. The processing of the samples was performed at the local laboratories, reducing the weight of the material to be transported, and diminishing the costs of transportation to the central laboratory at the Universidade de São Paulo Hospital. The study included tests for the evaluation of diabetes, insulin resistance, dyslipidemia, electrolyte abnormalities, thyroid hormones, uric acid, hepatic enzyme abnormalities, inflammation, and total blood cell count. In addition, leukocyte DNA, urine, plasma and serum samples were stored. The central laboratory performed approximately 375,000 tests.

Background: New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambu, Brazil Study of Aging when added to traditional risk factors. Methods: From 1997 to 2007, 1,470 community-dwelling individuals (>= 60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI). Results: 544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p

As hematúrias são achados comuns nos exames de urina de rotina e nem sempre são sinais de doenças. A presença de hematúria associada a outras alterações urinárias, especialmente a proteinúria, sugere comprometimento do trato urinário e merece investigação. Na literatura são inúmeros os trabalhos que valorizam a sedimentoscopia urinária, principalmente a morfologia das hemácias, como indicativo do local do sangramento: se glomerular ou não-glomerular. Neste artigo, os autores revisam o estudo do dismorfismo eritrocitário, enfatizando a definição, a fisiopatologia, os métodos, os valores de referência e as limitações apontadas na literatura. As comparações com demais marcadores de hemorragia glomerular também foram discutidas. No final, os autores relatam como a literatura interpreta e utiliza os resultados da pesquisa do dismorfismo eritrocitário para guiar a propedêutica complementar na investigação da origem da hematúria. The hematurias are a frequent finding in urinary routine exams and do not necessarily indicate illness. The presence of hematuria associated with other urinary disturbances, especially proteinuria, indicates urinary tract pathology and should be investigated. In the literature, several studies point out the importance of urinary sedimentoscopy, specially the red cells morphology, to determine the source of bleeding: glomerular or non-glomerular. In this article, the authors review the dysmorphic erythrocyte, emphasizing on the meaning, the physiopathology, the methods, the cut-of values, and the limitations according to the literature. The comparisons with other markers of glomerular bleeding were also discussed. At the end, the authors exposed how the literature analyses and applies the dysmorphic erythrocyte results to guide the complementary research for investigation the source of urinary bleeding.

The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil) aged > or = 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for counfounders, those under exclusive public coverage (n = 1,296), compared with those holding a private health plan (n = 310), presented some evidence of having worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.

OBJECTIVE: To assess the prevalence of intermittent claudication in the aged population of Bambuí, Brazil, and to identify the factors associated with this disease. METHODS: Population-based cross-sectional study of the aged population ( > or = 60 years of age) of Bambuí. Participants were interviewed and examined, after written consent. Intermittent claudication was defined based on a standardized questionnaire. Analysis was performed using multiple logistic regression. RESULTS: Of the 1,742 elderly living in Bambuí, 1,485 (85.2%) were enrolled in the study. Thirty-seven individuals (2.5%) with intermittent claudication were identified: 28 (1.9%) males and 9 (0.6%) females. Their age brackets were: 16 (1.08%) individuals between 60 and 69 years of age, 17 (1.15%) between 70 and 79 years, and 4 (0.27%) > or = 80 years. A significant association between intermittent claudication and the following characteristics was found: male sex (OR=5.1; CI 2.4-11.0), smokers (OR=3.1; CI 1.2-8.5), ex-smokers (OR=3.4; CI 1.3-8.7), and more than 2 hospital admissions in the last 12 months (OR=2.8; CI 1.1-7.2). CONCLUSION: Disease prevalence was similar to that of other countries. The association between intermittent claudication and smoking strengthens the significance of tobacco in peripheral artery disease pathogenesis. The association of intermittent claudication and a higher number of hospital admissions suggests greater morbidity in the elderly affected.

OBJECTIVE - A population-based prospective study was analysed to: a) determine the prevalence of hypertension; b) investigate the clustering of other cardiovascular risk factors and c) verify whether older differed from younger adults in the pattern of clustering. METHODS - The data comprised a representative sample of the population of Bambui, Brazil. Multiple logistic regression was used to investigate the independent association between hypertension and selected factors. RESULTS - A total of 820 younger adults (82.5%) and 1494 older adults (85.9%) participated in this study. The overall prevalence of hypertension was 24.8% (SE=1.4 %), being higher in women (26.9±1.5%) than in men (22.0± 1.7%) (p=0.033). Hypertension was positively and significantly associated with physical inactivity, overweight, hypercholesterolemia hyperglycemia and hypertriglyceridemia. The coexistence of hypertension with 4 or more of these risk factors occurred 6 times more than expected by chance, after adjusting for age and sex (OR=6.3; 95%CI: 3.4-11.9). The pattern of risk factor clustering in hypertensive individuals differed with age. CONCLUSION - Our results reinforce the need to increase detection and treatment of hypertension and to approach patients' global risk profiles.

BACKGROUND The prevalence of Chagas' disease is decreasing in Brazil. Due to cohort effect, the disease might remain a public health problem for some time among older individuals. The present burden of Trypanosoma cruzi infection for the elderly living in areas where the transmission has been interrupted has not been studied. METHODS The prevalence of T. cruzi infection and its association with indicators of health status and health services use were assessed among the elderly living in one of the oldest endemic areas in Brazil (Bambui, MG). Seropositivity was determined by blood tests (IHA and ELISA) performed in 85.6% of all residents aged 60+ (1496/1742) and in 83.1% of sampled residents aged 5-59 years (1212/1458). RESULTS Seropositivity showed a cohort effect, with no cases below 20 years and high prevalence among those aged 60+ years (37.7%). After adjustment for confounders, seropositivity was associated with self-rated health reasonable (OR = 1.43; 95% CI : 1.03-1.98) and bad/very bad (OR = 1.89; 95% CI : 1.30-2.75), staying in bed in past 2 weeks (OR = 1.88; 95% CI : 1.21-2.92), hospitalization in past 12 months (OR = 1.41; 95% CI : 1.05-1.89) and use of 5+ prescribed medications in past 3 months (OR = 1.75; 95% CI : 1.15-2.59). IMPLICATIONS Our results are an example of how survival of individuals with past exposure to infectious disease may lead to a different picture of ageing in the developing world. Policy makers need to consider the extra burden imposed by increasing rates of non-infectious disease among the elderly (as observed in Brazil) including the consequences of T. cruzi infection in areas where the infection was widespread in the past.

Thirty-five Trypanosoma cruzi strains were isolated from chronic chagasic patients, triatomines and opossums from different municipalities of the State of Rio Grande do Sul. Parasites were characterized by means of mice infectivity, enzyme electrophoresis and randomly amplified polymorphic DNA (RAPD) analysis. Twenty-nine strains were isolated from chagasic patients, 4 from triatomines (2 from Triatoma infestans and 2 from Panstrongylus megistus) and 2 from opossums Didelphis albiventris. Thirty-three T. cruzi strains were of low and 2 strains of high virulence in mice. Both virulent strains were isolated from P. megistus. Isoenzyme analysis of the strains showed 3 different zymodemes. Eleven strains isolated from chagasic patients and 2 from D. albiventris were Z2. Eighteen strains from patients and 2 from T. infestans were ZB and 2 T. cruzi strains isolated from P. megistus were Z1. RAPD profiles obtained with 4 random primers showed a high genetic heterogeneity of the T. cruzi strains. Zymodeme 2 and ZB strains were the more polymorphic. A band sharing analysis of the RAPD profiles of Z2 and ZB strains using 3 primers, showed a very low percentage of shared bands, 20% among 13 ZB strains and 14% among 13 Z2 strains. According to the isoenzyme results, 3 T. cruzi populations were present in State of Rio Grande do Sul. Zymodeme 2 and ZB strains were found infecting man (domiciliar transmission cycle) whereas Z1 strains were found infecting the sylvatic vector P. megistus.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior O problema foco desta tese é a incompatibilidade entre os determinantes para inovação no sistema setorial de inovação farmacêutico e o acesso a medicamentos, elemento fundamental do direito humano à saúde. Do lado econômico, o estímulo à inovação se dá por meio de garantia de apropriabilidade, principalmente por meio de monopólios; pelo financiamento público as atividades inovativas, de modo a estimular o investimento privado; e pela demanda e estimativa de retorno financeiro, que está vinculada a renda do público consumidor. Do lado social, o reconhecimento de direitos humanos universais determina que a saúde é indissociável do direito à vida, todavia, ele é dependente de um mercado caracterizado por diversas falhas, que fazem com que o acesso a tecnologias de saúde seja extremamente desigual entre os países e dentro dos mesmos. A inovação farmacêutica está na interface entre estas dimensões, já que os medicamentos são ao mesmo tempo um produto de alto valor agregado, proveniente de uma das indústrias mais lucrativas do mundo e uma tecnologia indispensável para o cuidado. O financiamento é um dos determinantes para a inovação no setor e também um dos principais gargalos. Esse problema vem sendo discutido a quase duas décadas nos foros internacionais multilaterais, em especial a OMS. Foi feita uma análise do sistema de inovação farmacêutico atual, das discussões na OMS sobre o assunto e das iniciativas implementadas por este órgão para Covid-19. Observou-se o surgimento de novos atores no setor, tais como parcerias para o desenvolvimento produtivo e financiadores sem fins lucrativos. Todavia, mesmo com a disrupção significativa causada pela pandemia, a dinâmica de funcionamento do sistema setorial de inovação farmacêutico permaneceu inalterada, privilegiando critérios econômicos e não de saúde pública, e os países de alta renda, de onde se originam as grandes empresas multinacionais globais. Com isso, manteve-se o acesso desigual a medicamentos e outras tecnologias de saúde. Apesar de haver propostas e diretrizes para o enfrentamento deste problema conciliadas nos foros internacionais que tratam da saúde, a implementação prática dos mecanismos não é suficiente. É preciso reorientar o sistema de inovação farmacêutico e seus determinantes neste sentido, para que se estabeleça um novo paradigma. The focus problem of this thesis is the incompatibility between the determinants for innovation in the pharmaceutical innovation sector system and access to medicines, a fundamental element of the human right to health. On the economic side, the stimulus to innovation takes place through the guarantee of appropriation, mainly through monopolies; by public financing as innovative activities, in order to stimulate private investment; and by demand and estimated financial return, which is linked to consumer income. On the social side, the recognition of universal human rights determines that health is inseparable from the right to life, however, it is dependent on a market characterized by several flaws, which make access to health technologies extremely unequal between countries and within them. Pharmaceutical innovation is at the interface between these dimensions, as medicines are at the same time a product with high added value, coming from one of the most profitable industries in the world and an indispensable technology for healthcare. Financing is one of the determinants for innovation in the sector and one of the main bottlenecks. This problem has been discussed for nearly two decades in international multilateral forums, especially the WHO. An analysis was made of the current pharmaceutical innovation system, the WHO discussions on the subject and the initiatives implemented by this body for Covid-19. The emergence of new actors in the sector was observed, such as partnerships for product development and non-profit financiers. However, even with the disruption caused by the pandemic, the working dynamics of the pharmaceutical sectoral innovation system remained unchanged, privileging economic rather than health criteria, and high-income countries, from which originate the large global multinational companies. As a result, unequal access to medicines and other health technologies was maintained. Although there are proposals and guidelines reconciled in the international health forums for dealing with this problem, the implementation of mechanisms is not sufficient. It is necessary to reorient the pharmaceutical innovation system and its determinants in this sense, so that a new paradigm can be established.

Introdução: O RDW (do inglês Red Cell Distribution Width) é uma medida da variabilidade do tamanho dos eritrócitos. Estudos recentes mostraram que o RDW é um marcador preditivo e prognóstico de mortalidade e de doenças cardiovasculares (DCV). Este estudo teve como objetivos investigar a associação entre RDW e (i) o risco de DCV em 10 anos, (ii) a incidência de Hipertensão Arterial Sistêmica e (iii) a incidência de Diabetes Mellitus em participantes do Estudo Longitudinal de Saúde ELSA - Brasil. Métodos: Uma subamostra de participantes da linha de base (2008 a 2010) e que compareceram à segunda visita (2012 a 2014) da coorte ELSA - Brasil foram incluídos (n = 4481). Na abordagem transversal, a análise de regressão múltipla foi utilizada para investigar a associação entre o RDW e o Escore de Risco de Framingham (ERF). Na análise longitudinal, foi utilizado o modelo de regressão linear misto para avaliar se o RDW na linha de base foi capaz de predizer mudança no risco de DCV na segunda visita. A associação entre RDW e a incidência de hipertensão e diabetes foi investigada usando a regressão de riscos proporcionais de Cox. Nesses modelos, a variável resposta (incidência de hipertensão e diabetes) foi avaliada na segunda visita, enquanto o RDW foi medido na linha de base do estudo. Resultados: Participantes no quarto quartil (Q4) da distribuição do RDW apresentaram um ERF 30% maior do que aqueles no primeiro quartil (Q1: p < 0,001), mostrando que o RDW foi associado com ERF avaliado na linha de base do estudo, mesmo após os ajustes das variáveis potenciais de confusão. Os modelos de regressão linear misto confirmaram os achados da análise transversal e mostraram associações significativas entre RDW e ERF avaliado na segunda visita. O termo de interação entre o RDW e a covariável tempo não foi estatisticamente significativo (Q4: p = 0,577), indicando que a inclinação da associação não mudou ao longo do tempo. O RDW não foi associado com a incidência de hipertensão (eβ = 1,077; valor de p = 0,192; IC95% = 0,963 - 1,205) e diabetes mellitus na segunda visita (eβ = 0,999; valor de p = 0,991; C95% = 0,841 - 1,186). Conclusões: Nesta coorte de brasileiros adultos, o RDW foi independentemente associado com o aumento do risco de DCV, porém não foi capaz de prever uma piora do risco cardiovascular na trajetória longitudinal desses indivíduos ao longo de quatro anos. O RDW não se relacionou com a incidência de hipertensão e diabetes mellitus no período estudado. O acompanhamento prospectivo dessa população poderá auxiliar a esclarecer a relação entre RDW e risco de DCV em 10 anos, hipertensão e diabetes mellitus