IJCS | Volume 32, Nº5, September/October 2019

518 Cabral Cardiovascular risk and metabolic syndrome Int J Cardiovasc Sci. 2019;32(5):517-526 Original Article In the present study we evaluated cardiovascular risk and MS in individuals with psychiatric disorders attending CAPS in the city of Teresina, Brazil. Methods This was a cross-sectional, analytical study conducted from October 2015 and February 2016. The sample was composed of 729 individuals of both sexes, older than 18 years, that attended weekly CAPS of Teresina, Brazil, as part of the multidisciplinary treatment program. The sample size calculated to allow estimation of the parameters with an error margin of 5% and 95% confidence level was 298 participants. The sample was selected using Thompson parameters, by simple random sampling (shuffling) and proportionally stratified according to the district zone. The eligibility criteria were the presence of the tutor and/or caregiver with the patient and agreement with participation in all phases of the study – 1) interview for the collection of sociodemographic (sex, age, race, educational level, family situation and income) and clinical (psychiatric diagnosis and smoking status) data; 2) blood sample collection for laboratory measurements (glucose, HDL cholesterol, LDL cholesterol and triglycerides); 3) obesity-related anthropometric measurements (weight, height, body mass index – BMI – waist circumference, abdominal circumference, hip circumference, waist-to-hip ratio – WHR); and 4) blood pressure measurement. Patients who did not attend CAPS weekly, who received medical care seen at home, pregnant women or those with previous pregnancy in the last six months were considered ineligible. Diagnosis of psychiatric disorders were grouped into eight categories according to the International Classification of Diseases ICD 10: F00-F09 Organic Mental Disorders; F20-F29 Schizophrenia, schizotypal disorder, and persistent delusional disorders; F30-F39 Mood (affective) disorders; F50-F59 Behavioral syndromes; F60-F69 Disorders of adult personality and behavior; F70-F79 Intellectual disabilities; F80-F89 Psychological Developmental Disorder; and unspecified ICD-10 codes.O, 10,11 In case of two or more diagnoses, we considered the first diagnosis recorded in the medical records. Smokingwas defined as any smoking, i.e., independent of the number, frequency (daily or occasionally) and duration of the habit. 12 BMI was calculated by dividing body weight (kg) by height (m) squared. 13 Body weight was measured using a weighing scale (180 kg capacity; 100 precision), and height was measured using a stadiometer (graduated in cm), with maximum height measurement of 200 cm. Waist circumference was measured using ameasuring tape at the smallest point between the rib and the iliac crest (hip bone). Abdominal circumference was determined at the midpoint between the tenth rib and the iliac crest, and hip at the maximum protrusion of the gluteal region. 14 Bloodpressurewasmeasuredusing a semi-automated, digital device, from the individual at rest, in sitting position. Three measures were taken, with a minimal interval of one minute between them, and the mean of these measurements was considered for analysis. Metabolic syndrome was defined according to the World Health Organization (WHO), the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria. According to the WHO, MS was defined as the presence of diabetes, glucose intolerance or insulin resistance, in addition to two or more of the following: central obesity (waist-to -hip ratio > 0.90 in men and > 0.85 in women, and/or BMI ≥ 30 kg/m 2 ; systolic blood pressure ≥ 140 or diastolic blood pressure ≥ 90 mmHg or treatment for hypertension; plasma triglycerides ≥ 150 mg/dL or HDL cholesterol < 35 mg/dL in men and < 39 mg/dL in women. 13 For NCEP, MS was defined as the presence of three or more of the following: glucose > 110 mg/dL; central obesity (waist circumference > 102 cm in men and > 88 cm in women); systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85mmHg; plasma triglycerides ≥ 150 mg/dL or HDL cholesterol < 40 mg/dL inmen and < 50 mg/dL inn women. 15 The International Diabetes Federation criteria for MS consider waist circumference > 90 cm inmen and > 80 cm in women together with the presence of two or more of the following: glucose ≥ 100mg/dL or previous diagnosis of diabetes, triglycerides ≥ 150 mg/dL or treatment for dyslipidemia, HDL cholesterol < 40mg/dL inmen or < 50 mg/dL in women or treatment for dyslipidemia, systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg or treatment for hypertension. 16 Cardiovascular risk was determined according to the Framingham risk score – a low, intermediate or high 10-year risk were defined as a risk ≤ 10%, 10-20% and ≥