IJCS | Volume 32, Nº5, September/October 2019

521 Table 2 - Frequency of metabolic syndrome according to the World Health Organization, National Cholesterol Education Program and International Diabetes Federation criteria by sex Sex Total (n = 298) p-value Male (n = 122) Female (n = 176) Qualitative variables N % N % N (%) MS – WHO No 118 (96.7) 164 (93.2) 282 (94.6) 0.2839 Yes 4 (3.3) 12 (6.8) 16 (5.4) MS – NCEP No 83 (68.0) 92 (52.3) 175 (58.7) 0.0094** Yes 39 (32.0) 84 (47.7) 123 (41.3) MS – IDF No 74 (60.7) 87 (49.4) 161 (54.0) 0.056 Yes 48 (39.3) 89 (50.6) 137 (46.0) p-value – chi-square test with Yates' correction and Fisher’s exact test; * significant at 5%; ** significant at %. MS: metabolic syndrome; WHO: World Health Organization; NCEP: National Cholesterol Education Program; IDF: International Diabetes Federation. Cabral Cardiovascular risk and metabolic syndrome Int J Cardiovasc Sci. 2019;32(5):517-526 Original Article sex. The causes of such association have not been defined, although there are evidences of a social and biological predisposition, in which both neuroendocrine and social play a role in increasing the susceptibility in women. 26 Besides, women are generally more influenced by psychological and hormonal factors. 27 On the other hand, some authors have not found an association between sex and MS, indicating the need for further investigations, aiming at better elucidating the relationship between these variables. 28,29 Educational attainment is known to contribute to a better quality of life, in addition to influence healthy behaviors. Consequently, it can improve the access of patients to healthcare, facilitating the early identification of health changes, including metabolic ones, and timely treatment. 30 Job instability, low salaries, and lack of social benefits and protection of labor laws can contribute to the development of anxiety and depression among informal workers or unemployed individuals. 31 These factors could explain the relatively higher frequency of individuals with a low family income in our study. Also, being a member of lower income families is associated with the incidence of and mortality for cardiovascular diseases, probably due to the combination of risk factors. 32 Although the purpose of the present study was not to analyze specific diagnosis of the study population, Gonçalves et al., 22 have reported the high prevalence of anxiety disorders in Brazil and attribute this finding to the generalized urban violence and adverse socioeconomical conditions. Besides, the high levels of noise and the lack of recreational areas in Brazilian big cities may be also be related. 22 The prevalence of MS was markedly different considering the different evaluation criteria, i.e., WHO, NCEP and IDF’s. The lower frequency of MS by the WHO criteria compared with NCEP and IDF criteria is explained by the fact that diabetes mellitus was considered a criterion forMS definition by theWHOonly. Regarding investigations on the prevalence of MS in patients withMT, Teixeira et al., 33 conducted a systematic review of MS prevalence in patients with schizophrenia and schizotypal disorders. The review included eleven studies, with a prevalence varying from 28.4% to 62.5% (NCEP) in 9 studies. The lowest prevalence (28.4%) was observed in a study conducted in the Netherlands, which was twice the prevalence of MS in the general population in the country, according to the authors. 33 Similar to recent studies, 34,35 the present study confirm the increased prevalence of MS among women with