Heart Disease Risk Factors – ABC CARDIOL

IJCS

ORIGINAL ARTICLE

Physical-Functional Profile of Obese Individuals With or Without Metabolic Syndrome Classified by Cardiovascular Risk

Daniela Barreto de Moraes et al. Vanessa Kelly da Silva Lage Joyce Noelly Vitor Santos Jaqueline de Paula Chaves Freitas … Ana Carolina Barbosa Farnezi Gabriele Teixeira Gonçalves Maria Thereza Otoni Figueiró Tamara Cunha Thyago José Silva Jousielle Márcia dos Santos Elizabethe Adriana Esteves Alessandro Sartorio Redha Taiar Ana Cristina Rodrigues Lacerda Vanessa Amaral Mendonça

Abstract

Background:

Obesity is strongly associated with increased cardiovascular risk (CVR) and the development of metabolic syndrome (MS), conditions that negatively affect body composition, metabolic profile, and functional capacity. CVR stratification may contribute to a better understanding of these alterations and to the development of early intervention strategies.

Objectives:

To evaluate the physical–functional profile of obese individuals with and without MS, classified according to CVR, and to compare biochemical, body composition, and functional parameters among these groups.

Methods:

This cross-sectional study included 212 obese individuals allocated into four groups: control with low CVR (CLR, n = 63), control with intermediate/high CVR (CHR, n = 33), MS with low CVR (SLR, n = 55), and MS with intermediate/high CVR (SHR, n = 61). Body composition, blood metabolic parameters, and functional performance were assessed using sit-to-stand tests. Group comparisons were performed using one-way ANOVA or Kruskal–Wallis tests, followed by Tukey’s or Dunn’s post hoc tests, with significance set at p < 0.05.

Results:

MS was present in 54.7% of the sample, and approximately 44% exhibited intermediate/high CVR. The CLR group showed lower visceral adiposity and waist circumference (WC) values (p 0.05).

Conclusions:

Individuals with lower CVR showed better sit-to-stand performance, while poorer performance was observed in participants with MS, particularly when associated with higher CVR. Sit-to-stand tests may provide useful complementary information for assessing physical performance in this population.

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IJCS

Letter to the Editor

Metabolic Challenges in The Semiarid Region: A Critical Analysis of Nutritional Transition and Early Cardiovascular Risk

Leonardo Alves Santos et al. Álvaro Eduardo Santos Oliveira Beatriz Vitória Carvalho Lordêlo Luis Antonio Cavalcanti Matias … Rodrigo Mendes Pedro Pereira Tenório

Dear Editor,

We had the opportunity to review the article entitled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia.” We would like to congratulate the authors for their initiative in investigating a pediatric cohort in a region marked by social and climatic vulnerability, frequently underrepresented in scientific literature, as well as for highlighting the relevance of addressing childhood obesity and arterial hypertension – two major cardiovascular risk factors with direct impact on future morbidity and mortality.

[…]

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IJCS

Original Article

Evaluation of Cardiovascular Risks Associated with Calcium Use: A Systematic Review and Meta-Analysis

Paulo Henrique Gouveia et al. Joyce da Silva Guimarães Astrid Wiens

Abstract

Background

Calcium plays vital roles in both physiological and pathological processes, and its use as a therapeutic agent is primarily indicated for osteoporosis and osteopenia. It may increase cardiovascular risk, thereby increasing cardiovascular morbidity and mortality.

Objective

To synthesize the available evidence on cardiovascular risks in patients using calcium-based medications and supplements.

Methods

This systematic review and meta-analysis utilized three major international databases and included intervention studies and comparative observational studies with data on the intake of calcium-based medications or supplements in adult populations and associated cardiovascular outcomes. A p-value < 0.05 was considered for all analyses, and the certainty of evidence was assessed using the GRADE approach.

Results

A total of fourteen articles were included: three pivotal intervention studies, four post hoc analyses, and seven observational studies. The outcomes assessed were mortality from cardiovascular events, myocardial infarction, stroke, and coronary artery disease. Although an increased incidence of coronary artery disease was observed among users of calcium-based medications or supplements when considering only observational studies (RR 1.08; 95% CI 1.02–1.15), this finding was not confirmed in interventional studies. Therefore, further investigation is warranted. No increased risk of cardiovascular mortality, myocardial infarction, or stroke was observed. The quality of the evidence was considered low or very low for all outcomes due to the risk of bias and limitations inherent to the meta-analyses themselves.

Conclusions

Caution is recommended when interpreting the results, particularly in the development of clinical protocols. The importance of pharmacotherapeutic monitoring for patients using these medications is emphasized, and further research to explore additional outcomes is suggested.

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Original Article

Cardiovascular Risk Stratification and Low-Density Lipoprotein Cholesterol Target Achievement in Primary Health Care: A Cross-Sectional Study

Gabriel Olivo Leandro et al. Pedro Henrique Daniel Abreu Samantha Cristiane Lopes Silvia Rozauria Froes Toniazzo

Abstract

Background:

Cardiovascular diseases (CVDs) remain the leading cause of mortality in Brazil. Effective dyslipidemia management is essential for preventing major adverse cardiovascular events (MACE); however, previous studies have reported low rates of lipid target achievement and inadequate statin prescribing in primary health care (PHC) settings.

Objective:

To evaluate low-density lipoprotein cholesterol (LDL-C) target achievement and the appropriateness of statin prescriptions according to cardiovascular risk among patients receiving PHC in a medium-sized Brazilian city.

Methods:

This cross-sectional study was conducted in 18 PHC units in Rio do Sul, Santa Catarina, Brazil, between January 13 and May 30, 2025. The study included 180 adults aged 30-59 years of both sexes who had been followed for at least 6 months and had a lipid profile assessment within the previous year. Cardiovascular risk was estimated using the Framingham Risk Score. Data were analyzed using the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Statistical significance was set at p < 0.05.

Results:

Among the 180 participants, 95 (52.7%) did not achieve LDL-C targets. LDL-C goal attainment was more frequent among low-risk (85.7%) and intermediate-risk (23.9%) individuals and less frequent among high-risk (15.1%) and very high-risk (0.0%) individuals. Cardiovascular risk was significantly associated with lipid control (p < 0.05). Median LDL-C was 106.8 mg/dL (Interquartile Range (IQR), 88.4-136.2), with significant differences across risk categories (p < 0.05). Among the 56 statin prescriptions identified, only 26 (46.4%) were consistent with guideline-recommended statin intensity.

Conclusion:

The low rate of LDL-C target achievement and the high prevalence of inadequate statin therapy highlight the need for more effective lipid management strategies and structured interventions in PHC.

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Original Article

Analysis of the Lipid Profile and Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients from an Academic Health Institution in Belo Horizonte

Sarah Mattos Moraes et al. Matheus Evangelista da Costa Flávia Carvalho Leão Reis Kleisson Antônio Pontes Maia

Abstract

Background:

There is a lack of epidemiological data regarding the cardiovascular risk profile of patients with chronic kidney disease (CKD) undergoing hemodialysis in the Brazilian state of Minas Gerais.

Objective:

To analyze the lipid profile and assess the prevalence of traditional cardiovascular risk factors among patients with CKD on hemodialysis treated at an academic healthcare institution in Belo Horizonte, Minas Gerais, Brazil.

Methods:

This was a cross-sectional, observational, and non-interventional study. The researchers obtained clinical, laboratory, and demographic data from medical records and conducted structured individual interviews with all participants. The chi-square test of independence, Fisher’s exact test, and the Wilcoxon rank-sum test were applied. A significance level of 0.05 was adopted to establish the statistical validity of comparisons.

Results:

A total of 66 patients were included, representing 91.6% of all individuals undergoing hemodialysis at the study center. The mean age was 56 years. Among participants, 59% were male, and 89% self-identified as mixed race. A high prevalence of traditional cardiovascular risk factors was observed, including hypertension (95%), physical inactivity (69%), dyslipidemia (55%), diabetes mellitus (27%), current smoker (19%), and obesity (15%). The lipid profile analysis showed a median total cholesterol level of 170.9 mg/dL (interquartile range: 142.05 to 195.78 mg/dL) and Low-Density Lipoprotein (LDL-cholesterol) of 98.55 mg/dL (interquartile range: 77.80 to 121.98 mg/dL).

Conclusion:

This study demonstrated a high burden of cardiovascular risk factors among hemodialysis patients, with systemic arterial hypertension, dyslipidemia, physical inactivity, and diabetes mellitus being the most prevalent conditions. Furthermore, the lipid profile findings suggest suboptimal control of this lipid fraction in the studied population.

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Original Article

Assessment of Cardiovascular-Metabolic Risk in Wistar Rats Fed a Hypercaloric Diet Supplemented with Selenium: A Preclinical Animal Study

Matheus Von Jelita Salina et al. Vitor Hugo Moro Pironatto André Amaro Mamédio dos Santos Tiago Daniel Gueiber … Luiz Gustavo Lima Eduardo Machado Dechandt Camila Cury Caruso Pedro Henrique Karpinski Thiago Martins Figueiredo Alceu de Oliveira Toledo-Junior Camila Marinelli Martins Ricardo Zanetti Gomes

Abstract

Background:

Residual cardiovascular risk persists even with adequate serum LDL-c control through statins, possibly due to dysfunctions in serum triglycerides and HDL-c. Elevated TG and reduced HDL-c are associated with metabolic syndrome and cardiovascular diseases. The TG/HDL-c ratio may predict these risks. Selenium, an antioxidant cofactor, may modulate these alterations, especially in diets that dysregulate serum lipid metabolism.

Objectives:

To evaluate the effects of selenium supplementation on the cardiometabolic risk (CMR) of Wistar rats exposed to a high-fat hyperglycemic diet (HHD).

Methods:

For 11 weeks, 55 female Wistar rats were divided into the following five groups: standard diet (SD), SD + _ContinuousSe, HHD, HHD + _LateSe, and HHD + _EarlySe. Selenium was supplemented using sodium selenite (1 mg/kg). We performed one-way ANOVA, Kruskal–Wallis, and post hoc tests, adopting a significance level of p < 0.05.

Results:

Total cholesterol increased in HHD + _LateSe compared to SD (p = 0.032) and to HHD (p = 0.013). HDL-c increased in HHD + _LateSe compared to SD (p = 0.004) and to HHD (p = 0.008). LDL-c increased in HHD + _LateSe compared to HHD (p = 0.008). TG decreased in HHD + _LateSe (p = 0.006) and in HHD + _EarlySe (p = 0.016) compared to SD. TG/HDL-c ratio decreased in HHD + _LateSe compared to SD (p < 0.001) and SD + _ContinuousSe (p = 0.013); and in HHD + _EarlySe compared to SD (p = 0.005).

Conclusion:

Selenium supplementation showed potential to increase HDL-c and reduce TG, key diagnostic components of metabolic syndrome. It also demonstrated potential to lower the TG/HDL-c ratio, a possible predictor of CMR, in rats fed HHD. Further studies are needed in subjects with high CMR and statin use to better define the clinical response to this therapy.

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IJCS

Editorial

What is the Best Cardiovascular Risk Score in Our Daily Practice?

Glaucia Maria Moraes de Oliveira

Preventing cardiovascular disease (CVD) involves lifestyle modifications, risk factor management at the individual level (identifying high-risk patients and setting targets to reduce CVD risk), and public health strategies at the population level (targeting the overall population and aiming to minimize the risk throughout the entire population). The intervention, with a slight reduction in overall CVD risk, is unexceptionally significant but difficult to achieve. Both strategies must be combined to reduce the burden of CVDs. Moreover, it is essential to consider that younger patients are often classified as low risk in most risk-prediction models. However, the future lifetime risk of CVD is much greater in younger patients with multiple risk factors than in older patients.

Population-level prevention is implemented through broad strategies, such as policy and community interventions, to reduce risk factor prevalence, including tobacco control through bans and taxes, salt/trans fat reduction in foods, the promotion of physical activity via urban planning, and mass media campaigns for healthy eating and alcohol moderation. Community settings, such as faith-based organizations, schools, workplaces, and social services, deliver evidence-based programs (e.g., nutrition education, activity policies), using multilevel strategies, including training implementers, audits, incentives, and partnerships for equity.

[…]

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IJCS

Original Article

Evaluation of Prevalence, Management and Recording of Risk Factors in Outpatient Patients with Coronary Artery Disease

Alexandre Felipe Pacini et al. Gerson Luiz Bredt Junior Eline da Rós Moro Alcirley de Almeida Luiz Ana Paula de Oliveira Francez

Abstract

Background

Coronary artery disease (CAD) is the leading cause of mortality worldwide. Adequate management of risk factors is directly correlated with better outcomes.

Objectives

This study aims to identify risk factors and evaluate the indicated medical treatment (both pharmacological and non-pharmacological) in patients with CAD.

Methods

Epidemiological data were collected from electronic medical records of patients treated at Cardiology outpatient clinics of a Tertiary Hospital and a descriptive analysis of the data was performed.

Results

Patients with documented CAD (n = 230) were selected for the study, with a predominance of white (60%) men (62%), most of whom were monitored following an Acute Coronary Syndrome (ACS) (63.9%). High prevalence and irregular control of risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and sedentary lifestyle were observed. Target blood pressure was achieved in 52.6% of patients, low-density lipoprotein (LDL) in 5.7%, and HbA1c in 50.8%, despite appropriate prescriptions for most patients – 100% were prescribed statins, and over 90% received antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers, and beta-blockers. Few patients were encouraged to quit smoking and engage in physical activities.

Conclusion

Significant recording errors were noted in the medical records, along with inadequate control of CAD-related risk factors. Improvements in both recording and management of these risk factors are necessary to enhance CAD outcomes. The study utilized a straightforward and cost-effective model, which effectively mapped the local population profile and managed CAD risk factors.

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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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Original Article

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

José Icaro Nunes Cruz et al. Adelle Cristine Lima Cardozo Enaldo Vieira de Melo Juliana Maria Chianca Lira … Giulia Vieira Santos Gabriela de Oliveira Salazar Bruna Oliveira Mariano César de Souza Reis Diego Maldini Borba de Lima Philipi Santos Soares Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

Abstract

Background:

Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades.

Objectives:

To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events.

Methods:

This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests.

Results:

The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001).

Conclusions:

A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

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Original Article

Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Guilherme de Andrade Costa et al. Jamary Oliveira Filho Luana Ferreira-Campos Alex Cleber Improta-Caria … Cristiano Macedo Marcelo Vincenzo Sarno Filho Leonardo Silva Roever Borges Roque Aras Júnior

Abstract

Background

Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking.

Objectives

To evaluate the association between RfH and stroke.

Methods

We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke.

Results

We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06).

Conclusion

RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

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Original Article

The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil

Humberto Villacorta et al. Diane Xavier de Ávila Tulio Possati de Souza Ana Luíza Carraro de Souza … Gabriel Alverca Meyas Mayara Cristina Villela Santos Jonatas da Costa Mendonça Luciene Maria Mendes da Costa Beatriz de Paula Sousa Maria Victoria Borges de Oliveira Júlia Correia Cardoso Guimarães Ulisses Melo

Abstract

Background

Cardiovascular risk factors are prognostic factors in coronavirus disease 2019 (COVID-19) and have been scarcely studied in Brazil.

Objective

The aim of this study was to assess the impact of cardiovascular risk factors on the outcomes of patients admitted for COVID-19.

Methods

From July 2020 to February 2021, 200 patients from two public hospitals were enrolled. Patients were included if they had typical symptoms or signs of COVID-19, a positive real-time polymerase chain reaction test (RT-PCR) for COVID-19, and an age above 18 years. This is a prospective, observational, and longitudinal study. Data were collected within 24 h of admission. The primary endpoint was a combination of hospital lethality, mechanical ventilation, hemodialysis, or length of hospital stay >28 days. Continuous variables were compared with the Student’s t-test for independent samples or the Mann-Whitney test. For comparisons of proportions, the χ ² test was applied. ROC curves and survival curves were constructed. Multivariate logistic regression was performed to identify independent predictors of events. The level of significance was 0.05.

Results

There were 98 (49%) events during the hospital course, and 72 (36%) died in the hospital. Patients with a primary endpoint were older and more likely to have a history of hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Vital signs at admission associated with events were diastolic blood pressure, respiratory rate, and oxygen saturation in ambient air (O ₂ Sat). Serum creatinine >1.37 mg/dL at admission had a sensitivity of 51.6 and a specificity of 82% to predict the primary endpoint, with an area under the curve (AUC) of 0.68. In multivariate analysis, age, diabetes, CKD, and COPD were independent predictors of the primary endpoint. Age and CKD were independent predictors of in-hospital lethality.

Conclusion

Cardiovascular risk factors, such as diabetes and CKD, were related to a worse prognosis in patients hospitalized with COVID-19 in this sample from two public hospitals in the state of Rio de Janeiro.

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Editorial

Daily Consumption of Soft Drinks and Cardiovascular Risk in Adolescents

Karine Brito Beck da Silva

Cardiovascular disease (CVD) includes a group of diseases that affect the heart. These are considered a major public health problem and remain one of the main diseases of the 21st century due to their high morbidity and mortality. CVDs have also been appearing themselves more often even in childhood and adolescence.

Among the factors associated with the increase in the prevalence of CVD are the increase in physical inactivity and reduced physical activity, as well as inadequate eating habits, such as a high intake of ultraprocessed foods, long intervals between meals, and a low consumption of fruits and vegetables, common especially among adolescents. The short and long-term effects of such behaviors are worrisome, as they contribute to fat mass gain, risk factors for Chronic Noncommunicable Diseases (NCDs), responsible for 70% of annual deaths, representing an important cause of morbidity during adolescence.

[…]

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Original Article

Possible Effects of Oriented Magnetic Fields on Human Blood Pressure

Eugenio E. Vogel et al. Nataly Belmar Benjamín Stockins

Abstract

Background:

There have been scattered reports indicating the possibility that applied magnetic fields can lower human blood viscosity, which has been considered as encouraging for decreasing blood pressure as a result of greater fluidity. Additional motivation comes from partial studies in animals showing some response of vascular variables to magnetic fields. Recently developed FeNbB magnets enable topical application to appropriate sites of much stronger permanent magnetic fields than previously available.

Objectives:

To establish whether powerful magnetic fields permanently applied along important arteries of the human body can lower blood pressure and, if so, to what extent.

Methods:

Ambulatory blood pressure tests were performed on 70 patients, half of them wearing real magnets, while the other 35 patients were wearing a similar placebo. Magnets or placebo devices were assigned at random. Each patient underwent two consecutive ambulatory 24-hour blood pressure (BP) tests; the first without a device and the second one with a device.

Results:

Results were compiled and analyzed only after the last measurement was completed. Individual responses, average values, standard deviations, information content, and Student’s t test showed that no difference was found between measurements in either group.

Conclusion:

Permanent strong magnetic fields applied along the main arteries of the human body do not alter blood pressure. This was observed both in statistical terms and in individuals as well.

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Editorial

Cardiovascular Risk in Women from a Quilombo Settlement: The Effect of Aggregated Vulnerabilities

Deborah Carvalho Malta et al. Luisa Campos Caldeira Brant

Cardiovascular risk (CVR) is a field of great relevance with a growing number of studies throughout the country due to the magnitude of cardiovascular diseases (CVD), which have caused nearly 18 million deaths in 2016 and represent 31% of worldwide deaths.^– In Brazil, CVD also lead the mortality and disability-adjusted life years (DALYs) rates,^4.5 with negative effects on the quality of life of individuals, family members, and societies.^3.5 It is noteworthy that CVD has an unequal effect on populations, with greater morbidity and mortality among low-income and least educated individuals.6 In this context, it is important to identify the modifiable risk factors (RF) associated with CVD, such as behavioral (tobacco, alcohol, unhealthy diet, sedentarism) and metabolic RF (obesity, diabetes, hypertension, dyslipidemia); given that the risk of death from CVD attributable to metabolic RF is 74%, revealing great potential for prevention.^,

CVR scores are important because evidence has shown that when RF are aggregated, they have synergistic effects on the risk of major adverse cardiovascular events (MACE).^, As such, CVR scores identify high-priority individuals for specific primary preventive interventions against MACE, making them cost-effective measures that are useful in primary care.^,^– Beyond the incentive for a healthy lifestyle, individuals with higher CVR should be offered statin prescriptions and be evaluated for hypertension treatment at a lower threshold. A meta-analysis showed that statins can prevent 23% (relative risk [RR] 0.77 95% confidence interval [CI] 0.71–0.84) of MACE. However, for primary prevention this benefit is positively correlated with CVR and non-high-density lipoprotein (HDL) cholesterol values.

[…]

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