title: Usefulness of circulating E-selectin to early detection of the atherosclerotic process in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  This cross-sectional analysis evaluated whether determination of E-selectin concentrations could identify deterioration of cardiometabolic risk profile or subclinical atherosclerosis in individuals at low-to-moderate risk included in The Brazilian Longitudinal Study of Adult Health-ELSA-Brasil.
  
  
  METHODS
  A sample of 984 individuals from ELSA-Brasil (35-54 years) without cardiovascular disease or diabetes was stratified according to E-selectin tertiles. Traditional risk factors, inflammatory markers and categories of coronary artery calcium (CAC) scores were evaluated across the tertiles by ANOVA or Chi-squared test. In linear regression models, associations of E-selectin levels with insulin resistance index, adjusted for age, sex and adiposity were tested.
  
  
  RESULTS
  The mean age of the participants was 45.8 (SD 4.9) years and 55 % were women. Mean values of age, anthropometric data, biochemical variables and inflammatory status increased across E-selectin tertiles. Also, a gradual deterioration of the cardiometabolic profile was reflected by increments in frequencies (95 % CI) of BMI ≥ 25 kg/m(2) [53.7 % (48.5-58.8), 61.0 % (56.1-66.5) and 64.2 % (59.0-69.4), p = 0.019], hypertension [18.0 % (14.1-22.8), 19.8 % (15.4-24.6) and 24.8 % (20.4-29.9), p = 0.048], pre-diabetes [62.5 % (57.4-68.3), 63.1 % (58.4-69.6) and 73.8 % (68.8-78.3), p = 0.003] and hypertriglyceridemia [22.4 % (17.9-27.2), 27.3 % (22.5-32.8) and 33.4 % (28.3-38.5), p = 0.013]. Insulinemia and HOMA-IR were independently associated with E-selectin concentration. A greater proportion of individuals with CAC scores different from zero was found in the third tertile when compared with the first and second tertiles (16.1 versus 11 %, p = 0.04, respectively).
  
  
  CONCLUSIONS
  Direct associations of E-selectin with traditional risk factors slightly above their normal ranges, components of the metabolic syndrome, insulin resistance and presence of CAC suggest that this biomarker may indicate an initial atherogenic process.
authors.affiliation: School of Public Health, University of São Paulo, Av. Dr Arnaldo, 715, São Paulo, SP CEP: 01246-904 Brazil.
authors.forename: Bianca
authors.initials: B
authors.lastname: de Almeida-Pititto
authors.affiliation: Department of Internal Medicine, Federal University of Pará, Rua Augusto Corrêa, 01-Guamá, Belém, PA CEP: 66075-110 Brazil.
authors.forename: Fernando Flexa
authors.initials: FF
authors.lastname: Ribeiro-Filho
authors.affiliation: Department of Internal Medicine, Centro de Pesquisa do Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 4th floor, São Paulo, SP CEP: 05508-000 Brazil.
authors.forename: Marcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Department of Internal Medicine, Centro de Pesquisa do Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 4th floor, São Paulo, SP CEP: 05508-000 Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Department of Internal Medicine, Centro de Pesquisa do Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 4th floor, São Paulo, SP CEP: 05508-000 Brazil.
authors.forename: Isabela
authors.initials: I
authors.lastname: Bensenor
authors.affiliation: School of Public Health, University of São Paulo, Av. Dr Arnaldo, 715, São Paulo, SP CEP: 01246-904 Brazil.
authors.forename: Sandra R G
authors.initials: SR
authors.lastname: Ferreira
keywords: Atherosclerosis; Cardiovascular risk factors; E-selectin; Endothelial dysfunction; Insulin resistance