Epidemiology – ABC CARDIOL

IJCS

Editorial

The Importance of Observational Studies

Paolo Blanco Villela et al. Larissa Franco de Andrade

Discussing coronary artery disease without beginning with the traditional phrase “cardiovascular diseases are the leading cause of death worldwide” becomes challenging – especially because that statement, unfortunately, is no longer sufficient. There is no way to avoid it except by expanding upon it: in addition to leading global mortality statistics, cardiovascular diseases represented the primary cause of disability-adjusted life years (DALYs) in 2023, accounting for 437 million (95% UI: 401–465 million) DALYs worldwide – a 1.4-fold increase compared with 1990.

Naturally, ischemic heart diseases are included in this group and ranked first, with 193 million DALYs in 2023 and an age-standardized mortality rate of 99.8 (89.9–108.4) per 100,000 inhabitants, according to data from the Global Burden of Disease (GBD).

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Original Article

Hypertension in Older Adults: Associations With Female Sex, Insufficient Physical Activity, Abdominal Obesity, Diabetes Mellitus, And Falls – A Cross-Sectional Study

Emylly Carlos da Silva et al. Paulo da Fonseca Valença Neto Cezar Augusto Casotti Claudio Bispo de Almeida … Débora Jesus da Silva Saulo Sacramento Meira Beatriz Cardoso Roriz Janayna Araújo Viana Vanessa Silva Souza Viana Renata de Sá Ribeiro Késia Chaves da Silva Dennis Gonçalves Novais Maiara Bernardes Marques Lunalva Aurelio Pedroso Sallet Lucas dos Santos

Abstract

Background:

Systemic Arterial Hypertension (SAH) is a major public health issue, particularly among older adults, due to its high prevalence and impact on morbidity and mortality.

Objective:

To investigate factors associated with SAH in older adults from a small municipality in northeastern Brazil.

Methods:

A population-based cross-sectional epidemiological study was conducted among 232 community-dwelling older adults. Independent variables included socioeconomic, behavioral, and health-related factors, with SAH as the outcome. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated using Poisson regression with a robust estimator. Crude models were followed by a hierarchical multiple explanatory model (Level 1: socioeconomic variables; Level 2: behavioral aspects; Level 3: health conditions). Associations were considered statistically significant at the 5% level (p < 0.05).

Results:

The prevalence of SAH was 59.1% (men: 50.0%; women: 65.4%). An increased likelihood of SAH was associated with female sex (PR: 1.33; 95% CI: 1.05–1.68), insufficient physical activity (PR: 1.24; 95% CI: 1.01–1.54), abdominal obesity (PR: 1.40; 95% CI: 1.09–1.79), diabetes mellitus (PR: 1.30; 95% CI: 1.03–1.64), and falls (PR: 1.37; 95% CI: 1.07–1.74).

Conclusion:

A high prevalence of SAH was identified, particularly among women and those with insufficient physical activity, abdominal obesity, diabetes mellitus, and a history of falls.

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Editorial

Infective Endocarditis Epidemiology Over Time: An Analysis of a National Registry Between 1996 and 2023

Alfredo Jose Mansur

One of the approaches of studying diseases is how they evolve over time in different scenarios. Time may refer to years, decades, even centuries; scenarios may refer to different geographic peculiarities, epidemiological conditions, clinical and surgical therapeutic medical facilities available, access to proper health care, access to the diagnosis, and access to the treatment.

Infective endocarditis has been subject to this approach over time after the description of the disease in seventheenth century. Among the historical outstanding contributions were the three famous Gulstonian Lectures delivered by William Osler. As a rare disease, incidence of infective endocarditis was estimated to be between 3 and 10 episodes per 100,000 person-years in different surveys. Decades ago, institutional reports of large series of patients over time were traditional in the literature.^– Some of these series were published before the advent of large epidemiological studies that were feasible due to new technologies related to data science and data analyses. More recent reports have studied the changing nature of the disease over time: in France, in an American county, in England, in Italy, in Europe, in an international collaboration, and in one Brazilian institution over a four-decade period.

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Original Article

Endocarditis – A 27-Year Epidemiological Analysis of Mortality in Brazil

Leticia da Costa Santana Silva et al. Luana Yasmim Fernández Avelaneda Castanheira Maria Dalila Santos Salim Ruy Felipe Melo Viegas … Gilson Fernandes Ruivo Sheila Cavalca Cortelli Davi Romeiro Aquino Taciana Mara Rezende Fortes Viégas

Abstract

Background:

Infective endocarditis (IE) is frequently caused by viridans streptococci. Short-term in-hospital mortality in high-income settings ranges from 11% to 25%. In Brazil, rheumatic heart disease remains a leading valvular substrate; however, its declining prevalence in developing nations has limited country-specific analyses.

Objective:

To describe the epidemiological profile of mortality from IE in Brazil, characterizing its magnitude and temporal trend.

Methods:

We conducted a retrospective, exploratory epidemiological study with descriptive and analytic components using data from the Mortality Information System of the Department of Informatics of Brazil’s Unified Health System. Chi-square tests of independence were applied (p < 0.05), and results were summarized in tables and figures. Variables included International Statistical Classification of Diseases and Related Health Problems, 10th Revision categories, year of death, region, and sex.

Results:

From 1996 to 2022, 40,157 deaths associated with IE were recorded in Brazil (chi-square = 1,701.43). The Southeast region accounted for the greatest burden, with 21,429 deaths (53.36%; chi-square = 15,236.00). By sex (chi-square = 999.32), men were more affected than women (55.57% [22,315] vs 44.41% [17,835]); in 0.02% of records, sex was unspecified.

Conclusions:

IE remains a condition of national and international concern, with substantial mortality in Brazil over the last 27 years. This overview of mortality patterns highlights regional disparities and sex differences and can inform public-health strategies and evidence-based interventions.

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Editorial

The Burden of Cardiovascular Disease in Brazil: Insights From a Decade of Emergency Hospital Admissions

Fernando Yue Cesena

Cardiovascular disease (CVD) remains the leading cause of death both globally and in Brazil.^, Although cancer has surpassed CVD as the top cause in some countries, projections indicate that CVD will continue to be the primary cause of mortality in Brazil for the decades to come.^,

Epidemiological analyses are essential for evaluating current public health strategies and informing future policy decisions. In this issue of the International Journal of Cardiovascular Sciences, an epidemiological study of recent emergency hospital admissions for CVD in Brazil is presented. Using data from the Department of Informatics of the Brazilian Unified Health System (DATASUS), the authors report data from over eight million hospital admissions from 2013 to 2023.

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Original Article

Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023

Yago Souza Luiz et al. Vitor Moreira Alvarenga Mikaela de Miranda Lopes Lara Gomes Silva

Abstract

Introduction:

Cardiovascular diseases (CVDs) remain among the leading causes of morbidity and mortality worldwide, posing a significant public health challenge. Thus, analyzing their prevalence over time is crucial.

Objective:

To perform an epidemiological analysis of emergency hospital admissions due to CVD in Brazil between 2013 and 2023.

Methods:

This is an ecological, descriptive study based on data from the DATASUS database. Cardiovascular morbidities classified by ICD-10, along with variables such as sex and age group, were selected for analysis. Data was collected in October 2024 and organized into graphs and tables.

Results:

From January 2013 to December 2023, 8,208,282 patients were admitted for emergency cardiovascular conditions, 53.7% of whom were male, with 26% aged between 60 and 69 years. A significant reduction in hospital admissions was observed in 2020 and 2021. Ischemic heart diseases were the most frequent cause of hospitalization, accounting for 29.72% of cases. A notable increase in mortality was recorded in 2021 and 2022, with higher mortality rates among male patients and those admitted for cerebrovascular diseases.

Conclusion:

The observed increase in hospitalizations is attributed to the demographic transition occurring in the country, while the sharp decline in 2020 and 2021 appears to be a consequence of COVID-19-related measures, which is a trend also observed in other countries. These findings underscore the importance of studying the epidemiology of CVD in Brazil and reinforce the need for public investment aimed at reducing their prevalence.

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Original Article

Hypertension, Hypercholesterolemia, and Insufficient Physical Activity Associated with Diabesity in Older Adults: A Cross-Sectional Study

Gabriel Alves Godinho et al. Paulo da Fonseca Valença Neto Claudio Bispo de Almeida Saulo Sacramento Meira … Beatriz Cardoso Roriz Raquel dos Santos Barbosa Cezar Augusto Casotti Lucas dos Santos

Abstract

Background

During aging, physiological and behavioral changes occur that lead to the development of diabesity (diabetes + obesity). Hence, the hypothesis that behavioral and health aspects can increase the probability of this outcome is plausible. In this framework, it is essential to carry out health surveys to investigate the factors that increase the probability of diabesity, as this information could be used to help monitor this outcome in the older population more accurately.

Objective

To verify the factors associated with diabesity in older adults.

Methods

This is an epidemiological survey, with a cross-sectional design, conducted with 211 older adults (58.80% women) from Aiquara, Bahia, Brazil. To assess the outcome, body mass index (BMI > 27 kg/m²) and the concomitant presence of diabetes mellitus were used. In the inferential analyses, crude models and, subsequently, a multiple hierarchical explanatory model were constructed (level 1: socioeconomic variables; level 2: behavioral aspects; level 3: health conditions). This was performed using Poisson regression, with a robust estimator, calculations of prevalence ratios (PR) and their relevant 95% confidence intervals (CI).

Results

The prevalence of diabesity observed was around 9.50%. Furthermore, older adults who were insufficiently active (RP: 2.55; 95% CI: 1.20 to 6.36), those with arterial hypertension (PR: 5.32; 95% CI: 1.10 to 25.73), and those with hypercholesterolemia (PR: 2.80; 95% CI: 1.08 to 7.23) were more likely to have this outcome.

Conclusion

In the older population of Aiquara, Bahia, Brazil, the factors associated with diabesity were insufficient level of physical activity (PA), arterial hypertension, and hypercholesterolemia.

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Editorial

Analyzing the Impact of Stroke in the Southeast Region of Brazil

Gabriel Porto Soares et al. Thais Rocha Salim

Stroke is among the main causes of death in the world, a fact that is no different in Brazil. It is grouped in diseases of the circulatory system that correspond to almost 30% of deaths in Brazil; in this group of diseases, ischemic heart diseases hold first place, immediately followed by cerebrovascular diseases.

It is impossible not to mention the fact that stroke, when it does not lead to death, generates disabilities and different degrees of deficiency, maintaining survival, but generating a great reduction in quality of life, in addition to inability to work and reduced autonomy with limitations in carrying out daily tasks.

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Original Article

The Burden of Stroke in the Southeast Region of Brazil in 2019: an Estimate Based on Secondary Data from the Brazilian United Health System

Marcio Fernandes dos Reis et al. Alfredo Chaoubah

Abstract

Background:

Stroke is one of the main causes of morbidity and mortality in the Southeast Region of Brazil, and it is impacted by socioeconomic conditions and the age of the population in the region.

Objectives:

The objective of this study was to estimate the burden of stroke in the adult population, for both sexes, in different age groups, in the Southeast Region of Brazil, in the year 2019.

Methods:

This descriptive study was conducted with secondary data on stroke, obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE), to calculate years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY).

Results:

In the year 2019, in the Southeast Region of Brazil, a total of 713,132 DALY were estimated, 80% from YLD and 20% from YLL. The highest values were from the state of São Paulo, as it is the most populous state; in the female sex, due to the greater number of female inhabitants; and in the age group between 40 and 59 years. However, when adjusted to a rate of 100,000 inhabitants, the greatest impact was for the male sex in the state of Minas Gerais, mainly in the age group between 70 and 79 years.

Conclusions:

YLD were more relevant in the composition of DALY, due to higher stroke morbidity than mortality, and high stroke DALY burdens impact the economically active population in this region.

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Editorial

Epidemiological Profile: An Important Step in the Organization of Medical Care

Ana Paula Damiano

The demographic-epidemiological study of a disease allows for a more accurate characterization of situations involving the care of this pathology and a better distribution of resources, often scarce, thereby optimizing patient care. In a scenario of general lack of financial, technological, and professional resources, it is necessary to develop a program that addresses all processes, streamlining the care network flow and,m consequently, that produces a positive impact on the outcome. Continuous reassessment of methods and criteria are necessary in order to evaluate the need for the reorganization and redirection of resources.

When treating congenital heart disease (CHD), the estimated prevalence may seem insignificant, when compared to other more prevalent cardiac pathologies, such as coronary artery disease. In Brazil, a prevalence of 12:1,000 live births with CHD has been estimated, corresponding to 25,757 new cases per year. These were responsible for 6% of all deaths in children < 1 year of age, according to data from Pinto Jr., Salim et al., observed that the main cause of death in young people under 20 years of age between 2000 and 2015 was circulatory system malformation. The clinical presentation of diseases is extremely variable, with symptoms that can start from the fetal period to adulthood and the correct diagnosis at an appropriate time is a determining factor for better therapeutic management and success. Lopes et al. demonstrated a lethality of 64.7% for critical CHD, which proved to be higher during the neonatal period. However, data on mortality must be interpreted in the context of available medical care in the studied region.

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Original Article

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Luan George Xavier et al. Renato Sampaio Mello Neto Marcos Henrique de Oliveira Morais Pedro Jorge Cronemberger … Maria do Carmo Carvalho Martins Marta Rosal

Abstract

Background

In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH).

Objective

To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease.

Methods

A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05.

Results

Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters.

Conclusions

This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

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Editorial

Sex and Gender Equity in Research and Publishing: International Journal of Cardiovascular Sciences endorses SAGER Guidelines

Claudio Tinoco Mesquita et al. Aline Goneli de Lacerda

According to the recently published “Cardiovascular Statistics – Brazil 2020”, mortality from cardiovascular diseases (CVD) is proportionally higher in women compared to men. The INTERHEART study demonstrated that the population attributable risk for myocardial infarction associated with modifiable risk factors of smoking, alcohol use, high-risk diet, and physical inactivity, was significantly higher among women than men. Evidence from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction [AMI] Patients) indicates that both health professionals and women are unaware or neglect the development of cardiovascular heart disease (CHD) and the presence of cardiovascular risk factors in women.

Women are underrepresented in cardiovascular disease trials despite known sex differences across a broad range of risk, prevention, treatment, and outcome parameters. Gender influences many aspects of disease like its pathophysiology and clinical presentation, response to treatment, clinicians’ behavior, and access to health care,^, and now it is clear that research must consider this to promote better diagnosis and treatment, and gender equity in health care.

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Editorial

The Present and Future of the Cardioprotective Food Model for the Brazilian Population

Thais de Rezende Bessa Guerra

In recent decades, researchers have found important changes in the health pattern and food consumption of the Brazilian population. These changes have been associated with chronic non-communicable diseases, especially cardiovascular disease.

The Global Burden of Disease Study (2019), which analyzed data on chronic non-communicable diseases in 204 countries and territories between 1990 and 2019, estimated that cardiovascular disease, which is attributable to modifiable risk factors such as cholesterol level, is the main health care burden worldwide. High LDL cholesterol and its associated mortality remain a major threat to public health. The report recommends that national health systems focus on new approaches that can reverse these trends, since there is an urgent need to implement effective policies and interventions to achieve a 30% reduction in premature mortality from non-communicable diseases.

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Original Article

Associated Factors with Congenital Heart Disease in the Most Populated State of Brazil Between 2010 and 2018

Isabela Madruga et al. Tatiane Dunder de Moraes Caroline Prado Carlos Eduardo Slateff Baldini Alfésio Luís Ferreira Braga

Abstract

Background

Cardiac anomalies are the most prevalent congenital malformations among live births in the world. In Brazil, it is estimated that nearly 25,757 new cases occur each year, and the Southeast region presents the highest prevalence, with 10 new cases/1,000 live births.

Objective

The aim of this study is to evaluate the epidemiology of congenital heart disease (CHD) in the state of São Paulo.

Methods

This is a cross-sectional and time-series observational study with data from the Brazilian Information System on Live Births. Heart-related cardiac malformation cases — International Classification of Diseases (ICD) 10th revision Q20.0 to Q24.9 — were selected from January 2010 to December 2018, in the state of São Paulo, Brazil. This study analyzed rates of malformations per year and investigated associated factors, using single and multiple logistic regression models. The significance level adopted in this study was 5%.

Results

The highest cardiac malformation rate was in the São Paulo metropolitan region (2.84:1000), while the lowest was found in the region of Franca (0.3:1000). The most frequent defect was interatrial communication (38.2%). The main associated factors observed in this study were prematurity of 22 to 27 weeks (OR=4,401 95% CI: 3,796-5,104) — CI: Confidence Interval; OR: Odds ratio —, mother’s age between 35 and 49 years of age (OR=1,602 95% CI: 1,525-1,682), yellow race (OR=1,481 95% CI: 1,235-1,775), triple or more pregnancy (OR=1,438 95% CI: 1,004-2,060), and history of a dead child (OR=1,213 95% CI: 1,152-1,277).

Conclusion

The main factors associated with this outcome, which are part of the obstetric history of mothers, should be addressed and considered when pregnancy is a planned event.

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Original Article

Diet Quality and Associated Factors in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes at a Specialized Outpatient Clinic in the City of Pelotas, Brazil

Fernanda Vighi Dobke et al. Aline Longo Bruna Luiza Paulina Ribas Bernardete Weber … Eduardo Gehling Bertoldi Lúcia Rota Borges Renata Torres Abib Bertacco

Abstract

Background

In most cases, atherosclerotic cardiovascular disease (ACVD) is preventable through primary prevention and control of traditional risk factors, such as smoking cessation, regular physical activity, and adherence to healthy dietary patterns. The assessment of diet quality of ACVD patients would be important for a dietary intervention.

Objectives

This study aimed to evaluate diet quality of ACVD patients and its association with clinical conditions.

Methods

This cross-sectional study was nested within a randomized clinical trial entitled “Programa Alimentar Cardioprotetor Brasileiro.” Baseline data of 80 patients from Pelotas, Brazil, were obtained. Food consumption was assessed using 24-h food recall and the Revised Diet Quality Index (IQD-R). Data on smoking status and comorbidities were reported by the patients during medical history taking. To analyze the associations between IQD-R and clinical variables, unpaired Student’s t-test or the analysis of variance was performed. The significance level was 5%.

Results

Most of the sample consisted of men (66.5%), elderly individuals (52.50%), patients with hypertension (78.75%), dyslipidemia (58.75%), and overweight (73.75%). The average IQD-R score was 56.7 ± 12.6 points. Better quality of diet was observed for patients with diabetes compared to those without diabetes (61.1 ± 11.8 versus 54.0 ± 12.6 points; p=0.014).

Conclusion

There is a need to improve diet quality of ACVD patients. Patients ACVD and diabetes had better diet quality compared to those without diabetes.

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Editorial

The Role of Pharmacists in Antihypertensive Pharmacotherapy

Christianne Bretas Vieira Scaramello et al. Flavia Valeria dos Santos Almeida

Hypertension encompasses a preventable risk factor associated with a significant global burden of cardiovascular disease (CVD) and premature death. Its prevalence is rising worldwide due to population aging, unbalanced diets, and sedentary, especially in low- and middle-income countries. Prevalence data in Brazil vary according to the database. However, about 30% of adults present blood pressure of 140/90 mmHg or more, with CVD representing 22.6% premature passing. This link between hypertension and CVDs-related deaths highlights the relevance of blood pressure control.

In 2021, the World Health Organization elaborated evidence-based guidance for the pharmacological treatment of nonpregnant adults with an accurate diagnosis of hypertension who have already received counseling for lifestyle modification. It is crucial to set blood pressure threshold to pharmacological therapy beginning and treatment targets. In addition, the determination of follow-up visits to adjust monotherapy or dual therapy embracing single or dual pill combination medications is mandatory. Comorbidities, unwanted effects, cost, and acceptability must also be evaluated. In 2020, the Brazilian Society of Cardiology also published decision and therapeutic goals for hypertension management.

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Editorial

The Medical Burden of Heart Failure and Cancer in Brazil. Fact or Fiction?

Ricardo Mourilhe-Rocha et al. Pedro Fernandes Ribeiro

Cardiovascular disease and cancer are the leading causes of mortality in most high-income countries around the globe. It is estimated by the Brazilian Ministry of Health that circulatory diseases and cancer are the leading causes of mortality in patients over 50 years of age, which makes them the main public health concerns in absolute numbers. This is not only true in treatment-related costs, but also in terms of social harm imposed on an economically productive population and the health system this population subsidizes.

Recently, Almeida et al. have published a comparative analysis on mortality rates for patients with heart failure. The paper performed a retrospective comparative analysis with data retrieved from DataSUS, an administrative database from brazilian’s public health system and was able to reach the conclusion that heart failure has a prognosis that is worse than many types of cancer. As the author himself says, the paper is limited by the administrative characteristics of the database itself, and, as already mentioned in the BREATHE registry, this kind of data has inherent limitations.

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Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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Case Report

Cardiac Magnetic Resonance and Positron Emission Tomography in the Diagnosis and Follow-Up of Acute Rheumatic Fever – Case Report

David Salazar et al. Cristhian Espinoza Romero Mariana Pezzute Lopes Carlos Eduardo de Barros Branco … José Soares Junior Antonio de Santis Roney Orismar Sampaio Flávio Tarasoutchi

Introduction

Rheumatic fever (RF) is a prevalent condition in developing countries, accounting for a cardiac mortality of rate 7.9% in Brazil (DATASUS). Cases of rheumatic fever are often underdiagnosed and recognized only after permanent valve damage due to previous carditis. Secondary prevention of RF aims to limit the development and/or progression of valvular lesions and their complications. However, even on therapy with benzathine penicillin every 21 days, patients may experience recurrence of acute RF, making diagnosis a greater challenge. The development of new diagnostic methods can contribute to the early detection of rheumatic carditis (RC) considering that 90% of cases are subclinical. In addition, not only the usual gallium-67 scintigraphy, but also, tests such as cardiac nuclear magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) may have the potential to be diagnostic tools in acute rheumatic carditis. However, more studies are needed to validate these methods.^,

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Original Article

The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil

Dirceu Rodrigues de Almeida et al. Antonio Carlos Pereira-Barretto Francisco Jose Forestiero Juliana S. Nakamuta André Bichels

Abstract

Background:

Due to its poor prognosis and mortality rates, heart failure (HF) has been recognized as a malignant condition, comparable to some cancers in developed countries.

Objectives:

To compare mortality from HF and prevalent cancers using data from a nationwide database in Brazil.

Methods:

This was a descriptive, cross-sectional study using secondary data obtained from Brazilian administrative databases of death records and hospitalization claims maintained by the Ministry of Health. Data were analyzed according to main diagnosis, year of occurrence (2005-2015), sex and age group. Descriptive analyses of absolute number of events, hospitalization rate, mortality rate, and in-hospital mortality rate were performed.

Results:

The selected cancers accounted for higher mortality, lower hospitalization and higher in-hospital mortality rates than HF. In a group analysis, HF showed mortality rates of 100-150 per 100,000 inhabitants over the period, lower than the selected cancers. However, HF had a higher mortality rate than each type of cancer, even when compared to the most prevalent and deadly ones. Regarding hospitalization rates, HF was associated with a higher risk of hospitalization when compared to cancer-related conditions as a group.

Conclusions:

Our findings indicate that HF has an important impact on mortality, hospitalization and in-hospital mortality, comparable to or even worse than some types of cancer, representing a potential burden to the healthcare system.

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Original Article

Mortality from Cardiovascular Diseases: A Comparative Analysis between the Medical and Non-Medical Populations in Brazil

Giulia Guimarães Matos et al. Roberta Luise Carrilho Bittencourt Pacheco Lucélia Batista Neves Cunha Magalhães Katia de Miranda Avena

Abstract

Background:

Cardiovascular disease (CVD) is the leading cause of death worldwide, including among physicians. Professional peculiarities increase cardiovascular risk in this population, making it relevant to analyze mortality in the medical population (MPop) and non-medical population (NMPop).

Objectives:

To compare the CVD mortality coefficient (MC) in between MPop and NMPop in Brazil by analyzing the epidemiological profile and the main causes of deaths from CVD.

Methods:

Time-series study with data obtained from the Mortality Information System of the Federal Council of Medicine and the Brazilian Institute of Geography and Statistics, from 2014 to 2018. The variables age group, sex, race, occupation, and CVD that caused the death were assessed in MPop and NMPop. MC, relative risk and odds ratio between the populations were calculated. Tests for difference in proportions, with approximation to the normal distribution, and chi-squared tests were performed, assuming p<0.01 as statistically significant.

Results:

Both MPop and NMPop had a predominance of men (86.7% and 52.3%), senior citizens (85.9% and 79.7%) and white individuals (86.4% and 52.2%). The MCs of the MPop and NMPop was 92.2 and 255.1 deaths/100,000 individuals, respectively. The main cause of death was acute myocardial infarction (AMI) (32.5% and 24.6% in MPop and NMPop, respectively) followed by cerebrovascular accident (CVA) (5.1% and 10.5% in MPop and NMPop, respectively).

Conclusion:

In Brazil, mortality from CVD was more prevalent in white elderly males, and mainly caused by AMI and CVA. Being a doctor, man and over 60 years old represents a greater chance of death from CVD in comparison with non-physicians.

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Original Article

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Ilvia Silva Gomes et al. Elaine Menezes Rossi Samara Jamile Mendes Brigitte Rieckmann Martins dos Santos Wilson Sabino

Abstract

Background:

Uncontrolled blood pressure has been associated with poor adherence to drug treatment.

Objectives:

To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil.

Methods:

Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers – one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%.

Results:

Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001).

Conclusion:

An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

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Original Article

9p21 Locus Polymorphisms: Risk and Severity Factors of Coronary Artery Disease in Venezuelan Patients

Susana Blanco Sobrino et al. Eva Salazar Alcalá Asdrúbal Alfonzo Reyes Jesus Flores-Soler … Romina Leras Mirabal Yettana Luti Ingrid Márquez Mercedes Teresita Fernandez Mestre

Abstract

Background:

The 9p21 region is the most relevant locus associated with coronary heart disease in different populations. However, there are no studies that prove that this region is a risk factor in the Venezuelan population.

Objectives:

To analyze whether or not the 9p21 rs1333049 polymorphism is a risk factor for acute myocardial infarction (AMI) in Venezuelan patients, as well as to investigate its correlation with cardiovascular risk factors (CVRF), age of occurrence, type and severity of infarction, and the correlation of the rs10757274 polymorphism with severity of coronary artery disease.

Methods:

This was an association study, including 487 unrelated Venezuelan individuals, grouped in 354 patients with AMI and 133 controls. The rs1333049 and rs10757274 polymorphisms were determined using the polymerase chain reaction (PCR) technique with sequence-specific primers. The analysis of association was determined using the SNPStats tool. The continuous variable description and the correlations were performed using the SPSS statistical software. Significance was established at p<0.05.

Results:

A positive correlation was observed between the rs1333049 polymorphism and the presence of hypertension ( r: 0.145, p: 0.006), and between hypertension and heart infarction ( r: 0.318, p: <0.0001). A positive correlation was found between the rs10757274 polymorphism and the number of coronary vessels that presented obstructive lesions in patients aged ≤ 55 years ( r: 0.276, p: 0.0078).

Conclusion:

The rs1333049 polymorphism at the 9p21 locus is correlated with hypertension in Venezuelan patients, while the rs10757274 polymorphism is associated with the progression of coronary atherosclerosis, suggested by the correlation with the number of coronary vessels that presented significant obstructive lesions.

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IJCS

Editorial

Immigrants, Descendants and the Risk of Coronary Heart Disease

Antonio Carlos Palandri Chagas et al. João Fernando Monteiro Ferreira

Cardiovascular disease remains the leading cause of death worldwide and in all regions of Brazil. Racial, cultural, and environmental factors contribute to different prevalence rates of risk factors and presentations of the disease. Differences have been found between Whites, Hispanics, Asians, and Afro-descendants, and even within each race, due to migratory movements.^,

Changes in the socio-demographic profile of migrant populations have resulted in health transitions, considering the country of origin (some of them with a high risk for certain diseases) and changes in lifestyle and diet in the new country. Several studies have found a significant linear relationship between migration and acculturation, alcohol consumption, lipid profile, blood pressure, body mass index and physical activity.^–

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