ABC | Volume 110, Nº3, March 2018

Original Article Scherr et al Cardiovascular risk in teenager athletes Arq Bras Cardiol. 2018; 110(3):248-255 It is worth mentioning that the association between diet, physical exercise and control of risk factors, with improvement of cardiovascular prognosis, has also been demonstrated in interventional studies. The STRIP (Special Turku Coronary Risk Factor Intervention Project) study followed approximately 530 children from 7 months of age until early adulthood. The intervention group participated in a nutritional counseling program, based on a low-cholesterol, low-saturated fat diet, whereas the control group followed a conventional diet. In the intervention group, there was a significant, favorable impact on the parameters of endothelial function and on reducing cholesterol serum levels. 21 A study on diabetic adolescents undergoing a physical exercise program showed a better glycemic control and greater reduction in serum lipid levels in those individuals with type 1 diabetes. 22 In the study by Högström et al., 23 healthy Swedish boys at the age of 18 were followed-up for a median period of 34 years. After this time, higher incidence of myocardial infarction was observed in those adolescents with better aerobic fitness as compared with the low fifth of aerobic fitness. 23 Interestingly, in our study, the practice of regular physical activity was more frequently reported by parents/guardians of the students enrolled at the EOG. These individuals also showed a lower rate of previously diagnosed SAH. It is possible that the attitude of these parents/guardians could have influenced the interest of the students in competitive sports, which corroborates the idea that support and encouragement of parents/guardians for their children to engage in regular physical activity is crucial. A previous study demonstrated that children’s healthy behavior in terms of eating habits and physical activity is influenced by parents’ behavior, as parents of athletic adolescents used to practice more exercises than those of sedentary adolescents. 24 Study limitations Limitations of the present study included the lack of data on nutritional aspects of these adolescents during periods outside school hours, and how long these students have been engaged in competitive sports (for at least one year). Even greater differences between the groups may have been mitigated by the limited period of competitive sports and the high percentage of missing data on TG in the EOG group. Besides, assessment of nutritional status only by BMI may not be conclusive. However, there is no current consensus on the best BMI classification system to diagnose overweight and obesity in adolescents. 25 Finally, with respect to our sample, in addition to being adherent to the program, the EOG students came from all parts of the city, and thereby composed a representative sample. On the other hand, the FP group came from a limited number of areas and was composed by convenience sampling, which may represent a limiting factor, since adherence of students who attended school in the afternoon was lower. Conclusions Altered blood pressure, BMI and blood lipid profile were frequent in adolescents enrolled at these public schools. Although more effective public health measures are still required, regular sports training program combined with little influence of their eating habits outside school seem to contribute to a better metabolic profile and reduction in cardiovascular risk factors in students. Author contributions Conception and design of the research, Statistical analysis, Obtaining financing, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Scherr C; Acquisition of data: Scherr C, Fabiano LCC, Guerra RL, Câmara ACG, Campos A; Analysis and interpretation of the data: Scherr C, Fabiano LCC, Guerra RL, Bel m LHJ, Câmara ACG, Campos A. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Funda ão Pró Cardíaco. Study Association This article is part of the thesis of master submitted by Carlos Scherr, from Instituto do Cora ão. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Instituto Nacional de Cardiologia under the protocol number CAAE 14549513.1.0000.5272 and 248825 - 02/04/201. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. World Health Organization (WHO). Global status report on noncommunicable diseases - 2014. [Cited in 2016May 8]. Available from: http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_ eng.pdf?ua=1 2. World Health Organization (WHO). Prevention of cardiovascular disease. Pocket guidelines for assessment and management of cardiovascular risk. Geneva; 2007 3. Angelini A, Thiene G, Frescura C, Baroldi G. Coronary arterial wall and atherosclerosis in youth (1-20 years): a histologic study in a northern Italian population. 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