ABC | Volume 110, Nº6, June 2018

Original Article Soares et al Cardiovascular risk in an indigenous population Arq Bras Cardiol. 2018; 110(6):542-550 Table 1 – Cardiovascular risk indicators (mean and standard deviation) by sex in Xavante adults in Sao Marcos and Sangradouro reserves, Brazil, 2008-2012 Variables Mean ± SD p-value* Total Women Men Age (years) 42.8 ± 19.2 42.5 ± 19.4 43.2 ± 19.0 0.586 Total cholesterol (mg/dl) 146.4 ± 43.1 146.8 ± 43.2 146.0 ± 43.0 0.757 HDL-cholesterol (mg/dl) 38.9 ± 8.0 40.6 ± 8.2 37.1 ± 7.5 < 0.001 LDL-cholesterol (mg/dl) 70.4 ± 24.6 70.0 ± 23.3 70.8 ± 26.0 0.621 Triglycerides (mg/dl) 199.1 ± 171.2 196.4 ± 180.0 202.1 ± 161.7 0.615 Castelli index I (CT/HDL-c) 3.9 ± 1.3 3.7 ± 1.3 4.0 ± 1.3 < 0.001 Castelli index II (LDL-c/HDL-c) 1.8 ± 0.7 1.8 ± 0.6 2.0 ± 0.8 < 0.001 TG/HDL-C ratio 5.4 ± 5.1 5.2 ± 5.3 5.7 ± 4.8 0.107 Framingham risk score 5.7 ± 6.5 5.1 ± 6.8 6.3 ± 6.1 0.006 Apo B (mg/dl) 72.9 ± 18.9 73.2 ± 17.8 72.5 ± 17.9 0.577 Apo A1 (mg/dl) 106.8 ± 4.7 110.1 ± 14.4 103.4 ± 14.1 < 0.001 ApoB/ApoA1 ratio 0.69 ± 0.18 0.67 ± 0.16 0.71 ± 0.18 0.001 High-sensitivity C-reactive protein 6.1 ± 11.6 6.3 ± 12.7 5.8 ± 10.3 0.543 Waist circumference (cm) 97.3 ± 10.9 98.6 ± 11.1 95.9 ± 10.4 < 0.001 Body mass index (kg/m 2 ) 30.3 ± 5.1 30.7 ± 5.6 29.9 ± 4.6 0.011 Baseline glucose level (mg/dL) 152.5 ± 104.9 163.7 ± 112.4 140.8 ± 95.3 0.001 Glucose level at 2 hours (mg/dL) 148.9 ± 51.8 158.6 ± 49.0 140.2 ± 52.8 < 0.001 Diastolic blood pressure (mm/Hg) 72.7 ± 10.8 71.5 ± 10.6 74.0 ± 10.9 < 0.001 Systolic blood pressure (mm/Hg) 122.3 ± 17.4 119.7 ± 18.4 125.1 ± 15.8 < 0.001 * Student’s t-test; LDL: low-density lipoprotein; HDL: high-density lipoprotein. Studies have reported a considerable increase in the prevalence of overweight and obesity in indigenous populations. 4,5,24 Studies conducted in specific populations have shown a high proportion of overweight and obese adults, greater than 50% in some age groups. 25-27 Obesity is an important risk factor for CVDs. It is independently associated with risk for coronary disease, atrial fibrillation and heart failure. On the other hand, obesity, particularly abdominal or visceral obesity, is associated with other factors known to increase cardiovascular risk, such as systemic arterial hypertension (SAH), diabetes mellitus, hypertriglyceridemia and low HDL-c. 23 More recently, HW has also been used as an indicator of cardiometabolic risk. HW is defined as the simultaneous presence of increased WC and increased TG levels, and may be used in the screening of patients likely to have the atherogenic metabolic triad – fasting hyperinsulinemia; hyperapolipoprotein B; and high proportion of small, dense LDL-c. For this reason, HW has been used as a practical, viable, low-cost tool in the identification of patients with high cardiovascular risk. 12,28 The prevalence of HW found in our study group (50.6% in women and 38.0% in men) was higher than that reported in other Brazilian studies. 29,30 Diabetic subjects have from twice to three times the risk to suffer a cardiovascular event. 31 Besides, cardiovascular and cerebrovascular diseases are important causes of death in diabetes mellitus patients, accounting for up to 80% of deaths. 32,33 Altered glucose levels is a health problem of large magnitude in Xavante people. In the present study, 70.2% of women and 46.8% of men had diabetes and decreased glucose tolerance, indicating that they constitute a vulnerable group. This was a much higher prevalence as compared with that in the Brazilian population. 34 SAH is also an important risk factor for CVDs. 17 The prevalence of SAH in Xavante people – 14.7% in women and 18.0% in men – was lower than mean values reported in Brazilian adult populations, ranging from 20.0% 35 to 24.1%. 36 As compared with the Xavantes of Pimentel Barbosa reserve, there was a tendency of increase in the prevalence of SAH. In 1962, no cases of HAS was observed in this population. 37 In 2009, however, the prevalence reached 8.1% among men and 5.8% among women. 38 This may result from social, cultural, economic and environmental changes in Xavante people, that culminated in reduction of physical activity and changes in eating habits with increased consumption of packaged foods high in sugar, fat and sodium. 4,27 This study has some limitations. Despite the large sample size, it corresponded to only 60% of the total estimated subjects aged 20 years or older in these communities, suggesting 545