Nas mulheres com SOP é comum uma série de alterações do ponto de vista cardiometabólico, dentre elas a síndrome metabólica. Nesse sentido, já havia sido conduzido um importante trabalho de Doutoramento nessa linha de
investigação no PPGCSA-UFRN, realizado pela Dra. Elvira Mafaldo Soares –
Avaliação da prevalência de síndrome metabólica, microalbuminúria e risco
cardiovascular em mulheres com síndrome dos ovários policísticos – sob a
orientação da Profa. Dra. Técia Maria de Oliveira Maranhão e co-orientação do
Prof. Dr. George Dantas de Azevedo. Essa pesquisa gerou um banco de dados importante, contendo vários parâmetros relacionados à temática risco cardiovascular e SOP.
Ao analisar o banco de dados supracitado, vislumbrei a possibilidade de utilizar medidas antropométricas para avaliação da obesidade centralizada como “ferramenta clínica” para triagem de pacientes com SOP com possível risco cardiovascular aumentado. Isso poderia ter uma repercussão positiva do ponto de vista do uso clínico e no âmbito da saúde pública, pelas medidas antropométricas serem de baixo custo e fácil aplicabilidade. Nesse sentido, com manuseio de uma simples fita antropométrica há possibilidade de uma triagem acurada de mulheres com SOP que serão investigadas de forma mais profunda (do ponto de vista da média complexidade) no que diz respeito aos fatores de risco cardiometabólico.
De forma relevante, nenhum trabalho na literatura havia sido conduzido com esse objetivo, ou seja, utilizar medidas antropométricas para avaliação da obesidade central para discriminar FRCV e SM em mulheres com SOP. Nesse
sentido, durante o Mestrado dois manuscritos foram produzidos com esse fim (artigo 3 e 4), gerando uma contribuição significativa, além de inédita pelo menos em nível nacional.
Além dos manuscritos finalizados, outros trabalhos foram publicados em anais de congressos versando sobre a temática “risco cardiovascular, obesidade e SOP”. Os mesmos foram produzidos conjuntamente com alunos de Iniciação Científica do curso de Medicina da UFRN integrantes do Grupo de pesquisa “Saúde da Mulher” – vinculado ao Departamento de Tocoginecologia e registrado no Diretório Nacional dos Grupos de Pesquisa do CNPq –, do qual também faço parte.
1. Farias DCR, Neto AP, Carvalho JCGS, Cavalcante PAG, Costa EC, Lemos TMAM, Azevedo GD. Análise da distribuição central de gordura e fatores de risco cardiovascular em mulheres magras com e sem síndrome dos ovários policísticos. In: XXIX Congresso Norte/Nordeste de Cardiologia, 2009, Natal/RN.
2. Neto AP, Farias DCR, Carvalho JCGS, Cavalcante PAG, Costa EC, Lemos TMAM, Azevedo GD. Fatores de risco cardiovascular em mulheres com sobrepeso com e sem síndrome dos ovários policísticos atendidas no ambulatório de ginecologia endócrina da maternidade escola Januário Cicco. In: XXIX Congresso Norte/Nordeste de Cardiologia, 2009, Natal/RN.
3. Neto AP, Farias DCR, Carvalho JCGS, Cavalcante PAG, França RL, Costa EC, Azevedo GD. Obesidade central: risco cardiometabólico na síndrome dos ovários policísticos. In: V Congresso Médico do Rio Grande do Norte e I Simpósio de Medicina de Família e Comunidade do RN, 2008, Natal/RN.
Por ter formação em Educação Física e Fisioterapia e trabalhar especificamente com avaliação e prescrição de exercício físico voltado para condições especiais, vislumbro como seguimento dessa linha de pesquisa a intervenção em mulheres com SOP utilizando exercício físico e avaliando seus efeitos em diversos aspectos relacionados à saúde dessa parcela da população feminina. Para tal, produzi de forma inicial, conjuntamente com outros colegas do PPGCSA-UFRN pertencentes à base de pesquisa “Saúde da Mulher”, um artigo de revisão (artigo 1) tratando dessa perspectiva.
Nesse sentido, para o Doutorado já tenho projeto aprovado pelo Comitê
de Ética em Pesquisa do Hospital Universitário Onofre Lopes (parecer no
222/08) intitulado “Risco cardiovascular na síndrome dos ovários policísticos: efeito de diferentes programas de exercício físico nos aspectos hormonais,
cardiovasculares, metabólicos, reprodutivos e qualidade de vida”. Como
indicadores da nossa intenção de prosseguirmos a investigação nessa linha de pesquisa, recentemente submetemos partes do referido projeto de pesquisa a editais de fomento à pesquisa (Edital Universal 2009 e Edital Pesquisa para o SUS/FAPERN).
Atualmente, sou Prof. Substituto do Departamento de Educação Física da UFRN e tenho como objetivo aprofundar-me na linha de pesquisa sobre os
efeitos de diferentes modelos de exercício físico na SOP e aspectos relacionados a saúde da mulher.
Considero que a experiência do Mestrado pelo PPGCSA reforçou mais ainda minhas convicções sobre a prática da pesquisa científica como instrumento de melhoria e transformação das práticas profissionais nas áreas da saúde, com objetivo final de avanço no que diz respeito à saúde e bem estar social. Nesse sentido, acredito que esses aspectos podem ser potencializados quando são trabalhados de forma inter e multidisciplinar, conforme preconizado pelo PPGCSA e exercitado no Grupo de Pesquisa “Saúde da Mulher” da UFRN.
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Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The diagnostic is realized by the presence of at least two of the following three features: oligo-ovulation and/or anovulation, clinical and/or biochemical signs of androgen excess and ultrasonographic findings of ovarian polycystic morphology. PCOS is associated with an adverse cardiovascular profile, including dyslipidemia, hypertension, insulin resistance and central obesity.
Objectives: To analyze diagnosis accuracy of waist circumference (WC), waist-
to-height ratio (WHtR), waist-to-hip ratio (WHR) and conicity index (C-Index) to detect cardiovascular risk factors (CVRF) and metabolic syndrome (MetS) in women with polycystic ovary syndrome (PCOS). Methods: A cross-sectional study was conducted involving 108 women between 20-34 years with diagnosis of PCOS according to the Rotterdam criteria. We analyzed clinical, anthropometric and biochemical parameters of cardiovascular risk. Data analysis was performed in two phases as following. Phase 1: To analyze the accuracy of cut-off values previously defined for the Brazilian population for WC, WHtR, WHR and C-Index in predicting classic CVRF; Phase 2: To determine cut-off points of anthropometric indices above-mentioned for discriminate MetS using ROC (Receiver Operating Characteristic) curve analysis. Results: Based on the findings of phase 1 of study the WHtR showed significant positive correlations with the highest number of CVRF (blood pressure, triglycerides and glucose after oral glucose tolerance test), and a negative correlation with HDL-Cholesterol. All evaluated anthropometric indices correlated positively with blood pressure; on the other hand WC and WHR
showed positive correlation with triglycerides. About diagnosis accuracy for detection of CVRF, the anthropometric indices studied showed sensitivity rates exceeding 60%, emphasizing WHtR which showed sensitivity exceeding 70%. In phase 2 of this study we observed through ROC curve analysis that WC, WHtR and WHR had similar performance in predicting MetS and these parameters were better than C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index. Conclusions: Our results emphasized the importance of anthropometric evaluation in the screening of cardiovascular risk in PCOS women, highlighting the relevance of WHtR in predicting classic CVRF and requirement to consider specific cut-off values for discriminate MetS in PCOS women.
Key-words: polycystic ovary syndrome, obesity, cardiovascular risk factors,