Family Doctor Program Research Articles

Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: analyzing the attitudes of midwifery experts

BackgroundIn recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran.MethodsThis was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method.ResultsThe main themes extracted from the participants’ statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making.ConclusionThis study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study.

The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.

PTSD Predicts Smoking Cessation Failure in a Trauma-Exposed Population

Objective The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population. Methods: Participants were 310 smokers who attempted quitting smoking, either successfully (quitters, n = 213) or not (relapsers, n = 97), who lived in slums and were attending a family doctor program. Measurements included a general questionnaire covering sociodemographic characteristics, clinical status and life habits, and the Posttraumatic Stress Disorder Checklist – Civilian Version. Differences in sociodemographic, clinical and lifestyle characteristics between quitters and relapsers were compared using a chi-square test. Because of the small sample size, full and partial PTSD were collapsed into a single category. Results: Significant differences (p ≤ .15) between quitters and relapsers were found in age, body mass index (BMI), income, alcohol consumption, and in the presence of full/partial PTSD diagnosis and of all three symptom clusters separately. Four logistic regression models predicting smoking cessation were modeled to control for confounding factors and included as independent variables a full/partial PTSD diagnosis and the three posttraumatic symptom clusters. The avoidance/numbing cluster presented the strongest association with relapse status (ORa 2.04, 95% CI [1.15, 3.63], p = .015), followed by the full/partial PTSD (ORa 1.80, 95% CI [1.04, 3.14], p = .038). The re-experiencing and the hyperarousal clusters were non-significantly associated with smoking cessation (ORa 1.34, 95% CI [0.80, 2.31], ns and ORa 1.65, 95% CI [0.96, 2.84], ns, respectively). Conclusions: Full/partial PTSD and posttraumatic symptom clusters uniquely predict risk for smoking relapse and thus may be a useful therapeutic target in trauma-exposed smokers.

Nocturia: Prevalence and associated factors in community-dwelling subjects - a population- based study

OBJECTIVES To assess the prevalence of nocturia and identify factors associated with it in a community-dwelling population. METHODS A cross-sectional study was conducted in subjects aged 45 years or more and registered with a Family Doctor Program. Information was collected about nocturia, other urinary symptoms, physical examination, co-morbidities, demographics, socio-economic, and lifestyle factors. Multiple logistics regression models were developed to analyze associated factors for nocturia according to gender and the number of nocturnal micturitions(≥1 and ≥2). RESULTS Out of the 661 individuals included in the study, 62.3% were women. Among the women, the prevalence rates for nocturia ≥1 time and ≥2 times were, respectively, 68.4% and 49%, whereas, among the men, they were 64.3% and 43.8%. Among the women, nocturia ≥1 time was associated with brown skin, a higher BMI, lower schooling, and calcium channel blockers(CCB) use, while nocturia ≥2 times showed association with higher BMI, lower schooling, obstructive sleep apnea (OSA), and the use of CCB. Among the men, nocturia ≥1 time was associated positively with age, alcohol intake, and OSA, and negatively with angiotensin receptor blockers and beta-blockers use. Besides, nocturia ≥2 times was associated with age, not having health insurance, and OSA. CONCLUSIONS Nocturia is a condition highly prevalent in the studied population. For the female subjects, a higher BMI, lower schooling, and the use of CCB were associated with nocturia regardless of the definition used, whereas, among the men, that same association was found with age, not having health insurance, and OSA.

Fatores de risco e complicações de doenças crônicas não transmissíveis

Introdução: A prevalência de hipertensão arterial sistêmica (HAS) e o diabetes mellitus (DM) no Brasil é elevada. Estas enfermidades possuem fatores de risco e complicações em comum e o conhecimento da dimensão destas pode auxiliar no planejamento de ações de promoção da saúde.Objetivo: Traçar o perfil clínico-epidemiológico da HAS, DM, fatores de risco e complicações em seis módulos do Programa Médico de Família de Niterói/RJ selecionadas aleatoriamente.Materiais e Métodos: Utilizou-se como fonte de dados os sistemas de informação Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, e o sistema Klinikos Kadastro. Realizou-se análise descritiva das variáveis de gênero, grupo etário, renda, escolarização para diagnóstico da situação socioeconômica. Foi calculada a distribuição proporcional de fatores de risco e complicações de usuários matriculados em SisHiperdia.Resultados: Observou-se que dentre os usuários cadastrados a maioria era do sexo feminino (62,30%), maiores de 40 anos (91,10%), sendo que 83,97% possuíam renda familiar menor que 3 salários mínimos e 65,31% não haviam completado o ensino fundamental. Mesmo sendo usuários portadores de HAS e DM isolados ou associados com acompanhamento regular nas unidades de saúde, os dados apontam elevada taxa tabagistas (21,30%), fisicamente inativos (60,30%) e com excesso de peso (49,50%). Também foram encontrados pacientes portadores de complicações decorrentes de HAS e DM.Conclusão: A partir destes dados, pode-se então planejar e repactuar as ações de educação em saúde intersetoriais com o objetivo de promover o autocuidado e controle dos fatores de risco para doenças crônicas não transmissíveis e prevenção das co-morbidades.

Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care.

BackgroundHypertension is the most prevalent risk factor for cardiovascular disease, and its proper control can prevent the high morbidity and mortality associated with this disease.ObjectiveTo assess the degree of compliance of antihypertensive prescriptions with the VI Brazilian Guidelines on Hypertension and the blood pressure control rate in primary care.MethodsCross-sectional study conducted between August 2011 and November 2012, including 332 adults ≥ 45 years registered in the Family Doctor Program in Niteroi and selected randomly. The analysis included the prescribed antihypertensive classes, doses, and frequencies, as well as the blood pressure (BP) of the individuals.ResultsThe rate of prescription compliance was 80%. Diuretics were the most prescribed medications, and dual therapy was the most used treatment. The most common non-compliances were underdosing and underfrequencies. The BP goal in all cases was < 140/90 mmHg, except for diabetic patients, in whom the goal was set at < 130/80 mmHg. Control rates according to these goals were 44.9% and 38.6%, respectively. There was no correlation between prescription compliance and BP control.ConclusionsThe degree of compliance was considered satisfactory. The achievement of the targets was consistent with national and international studies, suggesting that the family health model is effective in BP management, although it still needs improvement.

Gender and obesity interaction in quality of life in adults assisted by family doctor program in Niterói, Brazil.

Obesity impacts the quality of life (HRQL). Studies about the effects of a possible interaction between gender and body mass are rare. The objective of the present paper is to estimate the biological interaction between gender and obesity on HRQL. This was a cross-sectional study based on data from CAMELIA study with population assisted by the Family Doctor Program of Niteroi visited between June 2006 and December 2007. HRQL was assessed by the SF-36. The exposure categories were: obese women, non-obese women, obese men and non-obese men, the reference category. Obese women showed higher percentages of low overall, physical and mental quality of life with the largest associations in the physical component. The excess risk due to interaction was statistically significant in physical dimension: RERI = 1.97 (0.40-3.52) and RERIa = 1,97 (0.40-1.7). Among the Brazilian population aged 20-64 years, obesity was independently associated with low HRQL. This association differed by gender, being significant for women. The possibility of the combined effect takes greater importance in the context of increasing incidence of obesity globally. Healthcare professionals in primary care settings should pay attention to gender differences in the impact of obesity on HRQL.

Historical Reflections on the Post-Soviet Cuban Health-Care System, 1992–2009

La extensa literatura sobre el sistema de salud cubano ha enfatizado tradicionalmente el vínculo entre los resultados obtenidos por el sistema y la implementación de ciertas estrategias de salud como los policlínicos, el Programa de Medico de la Familia y las campañas de vacunación masiva. Si bien estas estrategias sólo representan una parte de las iniciativas generales implementadas en el país, podría decirse que ellas son un aspecto crítico vinculado a una gama de importantes índices de salud. Este artículo propone analizar el grado en que estas estrategias de salud fueron institucionalizadas en la era pos-soviética y en qué medida éstas correspondían a tendencias positivas en la mejora de la salud. Centrándose en el periodo comprendido entre la depresión económica del Periodo Especial y la crisis domestica de Cuba, este articulo proporciona una revisión histórica de la eficacia de las estrategias de salud implementadas y sugiere que su éxito se explica por seis principios claves fundamentados en la ideologia y la agenda politica de la epoca. Se afirma que más allá del diseño e implementación de un conjunto de estrategias bien pensadas de salud pública; la supervivencia, la adaptabilidad y la resiliencia del sistema de salud cubano durante la era pos-soviética se entienden mejor en el contexto de estas características políticas fundamentales.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care.

BackgroundObstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women.ObjectiveTo study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied.MethodsObservational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05).ResultsOf the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III.Conclusion BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Central and peripheral fat body mass have a protective effect on osteopenia or osteoporosis in adults and elderly?

This cross-sectional study involves randomly selected men aged 50 to 99years and postmenopausal women. Either central fat mass or peripheral fat mass were associated to osteoporosis or osteopenia independently from fat-free body mass and other confounding factors. Obesity and osteoporosis are public health problems that probably share common pathophysiological mechanisms. The question if body fat mass, central or peripheral, is protective or harmful for osteoporosis or osteopenia is not completely resolved. This study aims to investigate the association between osteoporosis or osteopenia, and fat body mass (central and peripheral) independently from fat-free body mass, in men aged 50 to 99years old and postmenopausal women randomly selected in the community. This is a cross-sectional investigation with a random sample of registered population in Niterói Family Doctor Program (FDP), State of Rio de Janeiro, Brazil. Bone mineral density (BMD) and fat-free mass were assessed by dual X-ray absorptiometry (DXA). There was statistically significant bivariate association between bone loss with gender, age, skin color, alcohol consumption at risk dose, use of thiazide, fat-free body mass, and fat body mass (central and peripheral). In the multiple analysis of fat-free body mass, central and peripheral fat body mass showed an independent and protective effect on the presence of osteoporosis or osteopenia (p value <0.001). Since both obesity and osteoporosis are public health problems worldwide, strategies aimed at preventing both conditions should be encouraged during aging.

Men's health in question: seeking assistance in primary health care.

The scope of this study was to analyze the socio-demographic profile, morbidity and frequency of seeking of adult men enrolled in a Family Doctor Program for health care in Niterói in the State of Rio de Janeiro. It is a cross-sectional study using secondary data, files and records of the first care visit in November 2003 through August 2009. The frequencies of the variables studied and the prevalence rates among those who sought and those who did not seek attention were calculated. Among the 323 men registered, 56% sought attendance. The main reason given for the first visit was a routine appointment. It was observed that 43 men were overweight, 26 were obese and 44 had abnormal blood pressure. The profile of the men who sought and those who did not seek care presented statistically significant differences (p< 0.05) for: age, education level, social security and reference to morbidity at the time of registration. Older men with social security reporting some morbidity sought health services more often. It is necessary to broaden the studies to acquire more input for public health actions and policies that contemplate this population segment and its specificities.

Brazil’s staple food and incident diabetes

ObjectiveThe aim of this study was to investigate the association of Brazil’s staple food, rice, beans and manioc, and the incidence of type 2 diabetes mellitus type 2 (T2DM) in adults assisted by a Brazilian Family Doctor Program (FDP). MethodsThe baseline information was collected on visits to 13 units of the FDP from July 2006 to December 2007 (CAMELIA Study). The units were revisited by trained researchers between July and December 2011, who reviewed medical records of all participants of the baseline. Biochemical, anthropometrical and blood pressure measurements, new diagnoses, and medical prescriptions were collected. Individuals ages ≥20 y, who were non-diabetic at baseline were included (N = 409). Food consumption was estimated using a validated semi-quantitative food frequency questionnaire. Incident of diabetes was classified according to fasting serum glucose (≥126 mg/dL), individual’s use of antidiabetic drugs, and/or diagnosis of diabetes described in the medical record. Individuals who were negative at baseline and also were negative for the above conditions were classified as non-diabetics. ResultsIndividuals who developed T2DM (N = 30) reported higher consumption of red meat and beans and less consumption of cassava flour, independent of the interval between visits and other potential confounding variables. The cassava flour showed a protective effect (relative risk, 0.910; 95% confidence interval, 0.842–0.982). ConclusionsThe consumption of cassava flour, a low-cost product, could be considered in diets for the prevention and control of diabetes. The hypothesis must be investigated in cohorts from different populations and tested in randomized controlled trials.

Correlação entre MCP-1, HbA1c e a filtração glomerular em pacientes não diabéticos

This study aims investigate if nondiabetic subjects with fasting glucose < 126 mg/dL but altered HbA1c already have lower estimated glomerular filtration (eGFR) and high serum MCP-1 levels in comparison to nondiabetics with normal HbA1c, independent of other metabolic changes. Data were derived from the database of the CAMELIA (cardio-metabolic-renal family) study, a cross sectional study performed between July 2006 and December 2007, with participants recruited from the Family Doctor Program, Niterói, RJ. An independent association between changes in HbA1c (≥ 5.7 and < 6.5% versus < 5.7%) and decreased eGFR rate was found. The HbA1c was shown to be a marker of metabolic changes in nondiabetic subjects with fasting glucose < 126 mg/dL, particularly in women and blacks. These observations support the use of HbA1c levels in strategies for early intervention and prevention of chronic diseases such as diabetes mellitus and chronic kidney disease.

Racial differences in HbA1c: A cross-sectional analysis of a Brazilian public primary care population

BackgroundBlacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications. AimsThe study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c. MethodsThe study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment. ResultsWe compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p<0.20) as higher levels of HbA1c (p<0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively. ConclusionThose results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.

Low quality of life as an additional criterion for the clinical diagnosis of heart failure in primary care

ObjectiveThe aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) – typical symptoms of HF – with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). MethodsThis cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. ResultsThe prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p<0.10). ConclusionThe combination of SOB and fatigue with low QOL can increase the positive predictive value for a clinical diagnosis of HF and is a possible alternative for prioritizing patients for closer investigation in a primary care setting.

Low quality of life as an additional criterion for the clinical diagnosis of heart failure in primary care

ObjectiveThe aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) – typical symptoms of HF – with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). MethodsThis cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. ResultsThe prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p<0.10). ConclusionThe combination of SOB and fatigue with low QOL can increase the positive predictive value for a clinical diagnosis of HF and is a possible alternative for prioritizing patients for closer investigation in a primary care setting.

SP1-70 Inadequate control of blood pressure in hypertensive patients assisted by a Family Doctor Program

IntroductionHypertension is a major risk factor for cardiovascular disease. Despite the availability of various classes of anti-hypertensive medications, blood pressure (BP) control often remains poor. Lifestyle changes, if adopted, are...

Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program

To estimate the association between food intake and metabolic syndrome (MetS). Cross-sectional design conducted from July 2006 to December 2007. Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil. Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12-19 years and boys aged 12-14 years or <45 mg/dl for boys aged 15-19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model. MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012). High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.

Dietary habits and inadequate control of blood pressure in hypertensive adults assisted by a Brazilian Family Doctor Program

To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP). A cross-sectional study. FDP units, Niterói, Rio de Janeiro, Brazil. We included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated. Individuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95% CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95% CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95% CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance. The results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.

Environmental factors, familial aggregation and heritability of total cholesterol, low density lipoprotein-cholesterol and high density lipoprotein-cholesterol in a Brazilian population assisted by the Family Doctor Program

To estimate familial aggregation and the heritability of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) in families assisted by the Family Doctor Program in a Brazilian city, and to evaluate associations between some environmental factors and familial aggregation of these lipids. Cross-sectional familial study. The association of lipids with sociodemographic factors, lifestyle factors and comorbidities (e.g. physical activity, alcohol consumption, smoking, hypertension, impaired glucose tolerance, body mass index) was estimated using linear models and generalized estimating equations. Correlation of TC, LDL-C and HDL-C between pairs of relatives was estimated with the familial correlation procedure, and heritability was estimated with the ASSOC procedure. All associations were statistically significant. There was familial aggregation of TC (parent/offspring, r=0.33; sibling/sibling, r=0.37), LDL-C (parent/offspring, r=0.29; sibling/sibling, r=0.37) and HDL-C (parent/offspring, r=0.25; sibling/sibling, r=0.48), but less than 3%, 6% and 14%, respectively, which was explained by lifestyle factors. Correlation between pairs with genetic sharing (parent/offspring and sibling/sibling) was higher than that observed between father and mother. Heritability estimates ranged between 0.32 (HDL-C) and 0.50 (TC). Similar results were found for the two approaches used to estimate the contribution of genetic and environmental factors in the correlation of TC, LDL-C and HDL-C between the family pairs. The results showed that there is familial aggregation of TC, LDL-C and HDL-C, and point to the predominance of genetic factors because little influence of environmental variables was found.