2009;93(5) – ABC CARDIOL

Point of view

Beta-blockers and non-cardiac operations what will change after the POISE study?

Danielle Menosi Gualandro et al. Daniela Calderaro Pai Ching Yu Andre Coelho Marques Bruno Caramelli

POINT OF VIEW

Beta-blockers and non-cardiac operations what will change after the POISE study?

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Artigo Original

Maternal-fetal monitoring during dental procedure in patients with heart valve disease

Itamara Lucia Itagiba Neves et al. Walkiria Samuel Avila Ricardo Simões Neves Dante Marcelo Artigas Giorgi … Jorge Francisco Kuhn dos Santos Ricardo Martins Oliveira Filho Cesar José Grupi Max Grinberg José Antonio Franchini Ramires

BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.

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Review Article

Metabolic abnormalities, antiretroviral therapy and cardiovascular disease in elderly patients with HIV

Andréa Sebben Kramer et al. Alexandre Ramos Lazzarotto Eduardo Sprinz Waldomiro Carlos Manfroi

One of the most recent phenomena related to the acquired immunodeficiency syndrome (AIDS) is the emergence of a new vulnerable population: the elderly. One of the factors that account for this increase is the development of combination antiretroviral therapy (ART), which has provided better quality of life and life expectancy for HIV-positive patients. However, ART is associated with adverse effects such as dyslipidemia, diabetes mellitus and insulin resistance, which are risk factors for cardiovascular disease. Due to the impact of ART on lipid and glucose metabolism, many studies were published involving HIV infection and cardiovascular disease, as well as their risk factors and the use of ART, but few of them reported on the cardiotoxicity of this therapy in the elderly. The objective of this study is to review the main metabolic changes caused by the use of antiretroviral therapy and its impact on an increased risk of cardiovascular disease in elderly people with HIV.

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Artigo Original

Safety of transesophageal echocardiography in adults: study in a multidisciplinary hospital

Alexandre Ferreira Cury et al. Marcelo Luiz Campos Vieira Claudio Henrique Fischer Ana Clara Tude Rodrigues … Adriana Cordovil Claudia Monaco Gustavo Alberto Naccarato Glaucia Tavares Edgar Bezerra Lira Filho Laise Antonia Guimarães Samira Saady Morhy

BACKGROUND: TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety. OBJECTIVE: to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate. METHOD: prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose. RESULTS: All patients (65±16 yrs; 58% males) finished the examination. The mean doses of MZ and FL were 4.3±1.9 mg and 0.28±0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4±6.1 minutes and 60±9%, respectively. Mild hypoxia (SO2<90%) was the most common event (11 patients); 3 patients (2%) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8%) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7%). The multivariate analysis showed that severe MR, MP (EF5mg) were associated with events (p<0.001). The EF was 40%, in the group with MP and 44% in the group with severe MR and it can be a factor associated with clinical events in the last group. CONCLUSION: TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations.

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Review Article

Myocardial revascularization surgery (MRS): results from National Health System (SUS)

Leopoldo S. Piegas et al. Olímpio J. Nogueira V. Bittar Nagib Haddad

BACKGROUND: Myocardial revascularization surgery (MRS) is the most common surgery in this country, with most being performed through the National Health System(SUS). OBJECTIVES: To assess MRS results when not associated to other procedures. METHODS: The information from the Hospital Information System (SIH/DATASUS) made available online was submitted to analysis. The data include information on gender, age, hospital stay period, hospital admission authorization (AIH) costs, number of surgeries at each hospital, and in-hospital mortality rate. Only MRS with no associated procedures were analyzed. RESULTS: A total of 63,529 surgeries were performed in the period between 2005 and 2007 at 191 hospitals. Sixteen hospitals reporting very low surgery volume were excluded. The remaining total number of surgeries came down to 63,272 for the final analysis. In-hospital mortality rate was 6.22%, with small surgery volume hospitals reporting higher rate than high volume hospitals (≥300 surgeries in the time period under study), 7.29% versus 5.77% (p<0.001). Average hospital stay time length was 12 days, with no difference having been reported between low (12.08±5.52) and high volume (12.15±7.70) hospitals. Males reported lower mortality rate than females – 5.20% versus 8.25% (p<0.001), similarly to younger individuals when compared to the elderly (≥ 65 years of age), 4.21% versus 9.36% (p<0.001). A slight variation was observed in AIH values between the Southern Region (R$ 7.214,63 – approximately US$ 3,600.00) and the Northeastern Region (R$ 6.572,03 – approximately US$ 3,280.00) (p<0.01). Regional distribution of surgeries was not comparable in all regions in the country, with Southern and Southeastern Regions having reported 77% of them. CONCLUSION: MRS performed by SUS has reported high mortality rate in low volume hospitals, among women, and among the elderly. Future prospective studies are deemed to be necessary.

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Artigo Original

Cardiovascular mortality by gender and age range in the city of Sao Paulo, Brazil: 1996 to 1998, and 2003 to 2005

Norma Farias et al. José Maria Pacheco de Souza Ruy Laurenti Soraya Martins de Alencar

BACKGROUND: Knowledge on the trends of cardiovascular mortality is important to make hypotheses on its occurrence as well as to support prevention and control measures. OBJECTIVES: To compare mortality for the group of cardiovascular diseases and their main subgroups (ischemic heart diseases and cerebrovascular diseases) in the city of Sao Paulo by age and gender between the periods of 1996 to1998 and 2003 to 2005. METHODS: Data on deaths from the Programa de Aprimoramento das Informações de Mortalidade para o Município(Program of Improvement of Information on Mortality for the City), and population estimates from the SEADE Foundation of the State of Sao Paulo were used. The magnitude of mortality and its changes between the three-year periods were measured using the description of coefficients and relative percentage variation. The Poisson regression model was also used to estimate the change in mortality between the periods. RESULTS: A significant reduction was observed in cardiovascular mortality. The coefficients increased with age in both genders, and were higher in the male population in comparison to the female population, and in the age range of 70 years and older. Mortality coefficients for ischemic heart diseases were higher than those for cerebrovascular diseases among men and women aged 50 years or older. The reduction in the group of cardiovascular diseases was greater among women aged 20 to 29 years (-30%), and among men aged 30 to 39 years (-26%). CONCLUSION: The intensity of cardiovascular mortality decreased between 1996 and 1998, and 2003 and 2005, however with differences between the groups. This reduction may reflect, in part, a greater access to diagnostic and therapeutic methods.

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Artigo Original

Circuit weight training vs jogging in metabolic risk factors of overweight/obese women

Carlos Alexandre Fett et al. Waléria Christiane Rezende Fett Julio Sérgio Marchini

BACKGROUND: Resisted and aerobic exercises are recommended to reduce weight and improve health, but which exercise modality offers the best results is still unclear. OBJECTIVE: The aims of this study were to compare circuit weight training (CWT) with jogging (JOGG) on multiple cardiovascular disease (CVD), metabolic risk factors and fitness of overweight and obese women (body composition, lipid profile, uric acid, glucose, metabolic equivalent (MET), heart rate, blood pressure, flexibility, resting energy expenditure (REE) and nitrogen balance (NB)). METHODS: Fifty women were randomly divided in two groups, but only 26 finished it: CWT (n=14; 36±12 years old; body mass index, BMI=32±7 kg/m²) and JOGG (n=12; 37±9; BMI=29±2). The first month of training consisted of 60 min x 03 days/week and the second month of training consisted of 04 days/week for both protocols and a dietary reeducation. RESULTS: Both groups reduced total body mass, fat body mass, BMI, plasma uric acid and increase in MET (p<0.05); there was no change in lean body mass, REE and resting heart rate. CWT reduced total cholesterol, plasma triglycerides, NB and increased flexibility; JOGG reduced waist/hip ratio, glucose, systolic blood pressure, high-density lipoprotein cholesterol, and increased the total cholesterol/high-density lipoprotein cholesterol ratio (p<0.05). CONCLUSION: Both protocols improved CVD and metabolic risk factors. The CWT presented favorable changes regarding lipid profile and flexibility; JOGG on glucose, waist/hip ratio and blood pressure. These results suggest that resisted exercise combined with aerobics should be considered for obese people. Nevertheless, regarding some basal differences between the groups , it was not possible to conclude that changes were due to exercise type or intra-group variability.

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Artigo Original

Prevalence of metabolic syndrome in outpatients of the Institute of Cardiology of Rio Grande do Sul

Márcia Bopp et al. Sandra Barbiero

BACKGROUND: Metabolic syndrome (MS) is considered a very important factor in the development of cardiovascular diseases (CVD). OBJECTIVE: To assess the prevalence of metabolic syndrome (MS) in outpatients undergoing secondary prevention of coronary artery disease in the Institute of Cardiology, University Foundation of Cardiology – IC-UFC, as well as to detect excess weight through body mass index (BMI) and the prevalence of abdominal obesity in patients with cardiovascular disease (CVD). METHODS: The final sample was comprised of 151 individuals (aged between 26 and 84 years) whose data were obtained from the first visit in which the following parameters were available: fasting blood tests, blood pressure (BP) measurement, waist circumference (WC) in centimeters, weight and height, gender and age. The NCEP-ATP III criteria were used for the assessment of MS. RESULTS: 64.9% of the sample was comprised of males. The overweight and obesity rates found were 50% and 21.3%, respectively; increased WC was found in 30.8% of the individuals, 20 of whom were men and 25 were women. The prevalence of MS, as diagnosed according to the NCEP-ATP III criteria, was 61.5%, including 54 men and 39 women. CONCLUSION: We verified that the prevalence of MS in patients with CVD in the outpatient clinic for secondary prevention of CAD at IC-UFC is high, and so are the prevalences of overweight, obesity and increased WC.

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Artigo Original

Constant use of oral anticoagulants: implications in the control of their adequate levels

Francieli Giachini Esmerio et al. Emiliane Nogueira Souza Tiago Luz Leiria Rosana Lunelli Maria Antonieta Moraes

BACKGROUND: Inappropriate and subtherapeutic anticoagulants dosages may result in severe thromboembolic and bleeding complications. The use of this treatment requires special attention and strict clinical and laboratory follow-up. OBJECTIVE: To identify factors associated with appropriate control of the oral anticoagulant use, assessing the patients’ knowledge and perception of the treatment. METHODS: A cross-sectional study which included 140 patients followed in the oral anticoagulation outpatient clinic from November 2005 to June 2006. A structured questionnaire was drafted and applied to obtain the clinical characteristics of the patients and their knowledge about the treatment, their compliance with the treatment (Morisky´s test) and their perception of the treatment. RESULTS: The main indications for the use of oral anticoagulation therapy were atrial fibrillation (61.4%) and a prosthetic heart valve (55%). The duration of anticoagulation ranged from 24 to 72 months, and phenprocoumon (58%) was the most commonly used anticoagulant. As to the perception of the treatment, 95% of the patients mentioned concern about daily use of this medication. Periodic blood tests (21.4%) and the strict intake of oral anticoagulant (12.8%) were considered limiting factors. Adequate knowledge was outstanding in patients with an international normalized ratio (INR) outside the therapeutic range (64%), compared to patients with an INR within the therapeutic range (62%), as well as compliance with treatment in patients with an INR within the therapeutic range (54%), but with no statistical significance. CONCLUSION: The results of this study show a prevalence of patients using oral anticoagulant with an INR within optimal values, although a high percentage of patients do not comply with the treatment. In this population it is clearly seen that they do not fully understand the treatment.

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Artigo Original

Nutritional and cardiovascular profiles of normotensive and hypertensive rats kept on a high fat diet

Silvio A. Oliveira Júnior et al. Katashi Okoshi Ana Paula Lima-Leopoldo André S. Leopoldo … Dijon H.S. Campos Paula F. Martinez Marina P. Okoshi Carlos R. Padovani Maeli Dal Pai-Silva Antonio C. Cicogna

BACKGROUND: Although a high fat diet (HFD) promotes nutritional and heart disorders, few studies have assessed its influence in normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). OBJECTIVE: To evaluate and compare the nutritional and cardiovascular profiles of WKY and SHR on a high fat diet. METHODS: 20 WKY and 20 SHR were divided into four groups: Control-WKY (C-WKY), HFD-WKY, Control-SHR (C-SHR) and HFD-SHR. The C and HFD groups received, respectively, a normocaloric diet and a HFD for 20 weeks. The following features were evaluated: body weight (BW), adiposity, blood glucose, serum lipids, with measurements of total cholesterol and triacylglycerol levels, insulin and leptin. The cardiovascular study included the systolic blood pressure (SBP), a cardiopulmonary anatomical evaluation, an echocardiography and heart histology. RESULTS: The SHR had BW, adiposity, glucose, cholesterol, triacylglycerol, leptin and insulin levels lower than the WKY. In SHR, the caloric intake increased with HFD. In WKY, the HFD increased energy efficiency, adiposity and blood leptin, and reduced glucose. In the cardiovascular assessment, the SHR had SBP, pulmonary moisture, myocardial hypertrophy and interstitial fibrosis higher than the WKY (p <0.01); the cardiac function was similar in both strains. The HFD reduced the ventricular systolic diameter in the WKY and increased the mitral E/A ratio, the diastolic thickness of the interventricular septum and the posterior wall, as well as the interstitial fibrosis of the left ventricle. (Arq Bras Cardiol 2009; 93(5) : 487-494) CONCLUSION: Although it had not significantly affected the nutritional profile of the SHR, the treatment increased cardiac remodeling and precipitated the emergence of ventricular diastolic dysfunction. In WKY, the diet increased adiposity and leptinemia, and promoted non-significant cardiovascular changes.

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Brief Communication

Modification of an old procedure (Vineberg) in the stem cell era: a new strategy?

Luís Alberto Oliveira Dallan et al. Luis Henrique Wolff Gowdak Luís Augusto Ferreira Lisboa Adriano Márcio de Melo Milanez … Fernando Platania Luís Felipe Moreira Noedir Antônio Groppo Stolf

BRIEF COMMENTS

Modification of an old procedure (Vineberg) in the stem cell era a new strategy?

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Point of view

Prevention of cardiovascular diseases in perimenopausal women and the influence of hormone replacement therapy: an evidence-based guideline

Otavio C. E. Gebara et al. Cesar Fernandes Marcelo C. Bertolami

POINT OF VIEW

Prevention of cardiovascular diseases in perimenopausal women and the influence of hormone replacement therapy: an evidence-based guideline

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Página do Presidente

ABC award finalists conﬁrm Archives as a channel of diffusion of the Brazilian scientiﬁc production

Antonio Carlos Palandri Chagas

THE PRESIDENT’S PAGE

ABC award finalists confirm Archives as a channel of diffusion of the Brazilian scientific production

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Anatomopathological Session

Case 5: 50-year-old woman with restrictive cardiomyopathy, renal failure and proteinuria

Odilson Marcos Silvestre et al. Henrique Barbosa Ribeiro Leonardo Jorge C. de Paula Sérgio Ricardo V. Macêdo Jussara Bianchi Castelli

ANATOMOPATHOLOGICAL SESSION

Case 5 50-year-old woman with restrictive cardiomyopathy, renal failure and proteinuria

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Artigo Original

Nutritional status and adequacy of energy and nutrient intakes among heart failure patients

Bárbara Hatzlhoffer Lourenço et al. Lis Proença Vieira Alessandra Macedo Miyoko Nakasato … Maria de Fátima Nunes Marucci Edimar Alcides Bocchi

SUMMARY: Increased knowledge about nutritional status and energy and nutrient intakes is required to improve the treatment of patients with heart failure (HF). OBJECTIVES: To verify the nutritional status and evaluate the adequacy of energy, macronutrient and micronutrient intakes in patients with HF in outpatient clinical settings. METHODS: We collected anthropometric and habitual dietary intake data of 125 patients (72% men, 52.1 ± 9.8 years, BMI 26.9 ± 4.4 kg/m2). Anthropometric variables were compared between genders, and the adequacy of energy and nutrient intakes was analyzed according to current recommendations. RESULTS: Muscle depletion or risk of depletion was present in 38.4% of patients (association with male gender, p <0.0001). In 69.6% of cases the mean energy intake was lower than the one required (p <0.0001). Among the micronutrients evaluated in this study, there was an important prevalence of inadequacy in magnesium, zinc, iron and thiamine intakes, and most patients had calcium and potassium intakes below the adequate levels, and sodium intake above the adequate levels. CONCLUSIONS: Outpatients with HF showed muscle depletion, and inadequate energy and nutrient intakes. There was no significant association between habitual dietary energy intake and nutritional status. Multidisciplinary care should be encouraged to better assess the general condition of these patients.

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Artigo Original

Predictors of atrial fibrillation after ablation of typical atrial flutter

Sissy Lara de Melo et al. Maurício Scanavacca Cristiano Pisani Rodrigo Nascimento … Francisco Darrieux Denise Hachul Carina Hardy Eduardo Sosa

BACKGROUND: The occurrence of atrial fibrillation (AF) after successful ablation of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) is an important medical event, but predictors of this event are still controversial. OBJECTIVE: To determine the incidence of AF and its predictors in patients undergoing ablation of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL). METHODS: Fifty two patients with CTI-AFL underwent ablation from January 2003 to March 2004, in Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: During the mean follow-up period of 26.2 ± 9.2 months, 16 (30.8%) patients presented AF. The univariate analysis revealed two clinical variables as predictive of the occurrence of AF after ablation of CTI-AFL for three years or longer (RR: 3.00; p = 0.020). In the multivariate analysis, these factors were independent variables associated with the occurrence of AF after ablation of CTI-AFL. CONCLUSION: AF is frequently observed during the follow-up of patients undergoing ablation of CTI-AFL. Persistent CTI-AFL and history of arrhythmia for more than three years are predictors of the occurrence of AF during the clinical follow-up.

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Editorial

Transesophageal echocardiography: how safe is it?

Márcia de Melo Barbosa

EDITORIAL

Transesophageal echocardiography: how safe is it?

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Case Report

Late restenosis related to Cypher stent fracture

Michel Pereira Cadore et al. Henrique Pereira Abelin Romualdo Bolzani dos Santos Paulo Ricardo Avancini Caramori

Drug-eluting stents represent a significant evolution in the therapy of coronary artery disease. Recently, restenosis and thrombosis related to drug-eluting stent fractures have been described. This work reports a case of fracture of a drug-eluting stent 18 months after implantation, associated with restenosis.

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Case Report

Apical ballooning syndrome secondary to nasal decongestant abuse

Ricardo Wang et al. Newton F. Stadler Souza Jose Augusto Ribas Fortes Gilmar Jorge dos Santos … Jose Rocha Faria Neto Lidia Zytinski

We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain.

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Artigo Original

Epidemiologic transition in mortality rate from circulatory diseases in Brazil

Antonio de Padua Mansur et al. Adriano Ibrahim A. Lopes Desidério Favarato Solange Desirée Avakian … Luíz Antonio M. César José Antonio F. Ramires

BACKGROUND: Circulatory diseases (CD) are the major cause of death in Brazil, being cerebrovascular diseases (CVD) predominant. In developed countries ischemic heart diseases (IHD) predominate. OBJECTIVE: The objective of the present study was to investigate the ratio between cerebrovascular diseases/ischemic heart diseases (CVD/IHD) in males and females who were 30 years of age and older. METHODS: Population estimates and mortality data for CD, IHD and CVD were provided by the Ministry of Health for the period between 1980 and 2005. The risk of death from IHD and CVD per 100,000 Brazilians and CVD/IHD ratio were analyzed in 10-year age ranges as of 30 years of age. The risk of death was adjusted by direct method by using 1960 world population as the standard population. RESULTS: It was observed that the risk of death from IHD and CVD increased exponentially as age advanced. CVD was the major cause of death in Brazil until 1996, when IHD took the lead. In the period between 1980 and 2005 a 33.25% reduction in death risk from CD was observed in the Brazilian population. In that same period, the metropolitan area of the capital city of São Paulo reported a 45.44% reduction. The CVD/IHD ratio was shown to be higher among younger women – from 2.53 in 1980 down to 2.04 in 2005 in the Brazilian population, and from 2.76 in 1980 down to 1.96 in the metropolitan area of the capital city of São Paulo, with decreasing figures for subsequent age ranges. Among males, the CVD/IHD ratio was close to < 1 in all age ranges. CONCLUSION: A transition in death risk from CD could be observed in Brazil, with current predominance of IHD.

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Point of view

Medical conduct in a Jehovah's Witness patient from the bioethics point of view

Max Grinberg et al. Graziela Zlotnik Chehaibar

POINT OF VIEW

Medical conduct in a Jehovah’s Witness patient from the bioethics. Point of view

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Artigo Original

Different levels of Hsp72 in female rat myocardium in response to voluntary exercise and forced exercise

Stéphano Freitas Soares Melo et al. Wellington Lunz Elizabeth Pacheco Batista Fontes Cristina Maria Ganns Chaves Dias … Miguel Araujo Carneiro Júnior Anselmo Gomes de Moura Ricardo Junqueira Del Carlo Antonio Jose Natali

BACKGROUND: Physical exercise induces hemodynamic stress. OBJECTIVE: To evaluate if voluntary running and forced running induced different levels of stress protein (Hsp72) in the myocardium of female Wistar rats. METHODS: Female rats were randomly assigned to the following groups: forced treadmill running group (FR; n= 6), voluntary running group (VR; n=6) and control group (C; n=6). VR group animals had free access to running wheels, and those from FR group underwent a running program on a treadmill (18 m/min, 60 min/day, 5 days/wk) for 8 weeks. Left ventricle (LV) and right ventricle (RV) fragments were collected at sacrifice, and the relative immunoblot contents of stress protein (Hsp72) were determined. RESULTS: VR animals ran on average 4.87 km/wk, and FR rats ran 4.88 km/wk. Animals from VR and FR groups had less body weight gain (p0.05) among VR, FR and C groups (4.54 ± 0.79 mg/g vs 4.94 ± 0.89 mg/g vs 4.34 ± 0.87 mg/g, respectively). FR group animals had levels of Hsp72 (p<0.05) higher than those from VR, both in LV (287.45 ± 35.86 % vs 135.59 ± 5.10 %, respectively) and RV (241.31 ± 25.83 % vs 137.91 ± 45.20 %, respectively). CONCLUSION: Voluntary running and forced running induced different levels of Hsp72 in the myocardium of female Wistar rats.

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Artigo Original

Mortality trends due to circulatory system diseases in Brazil: 1950 to 2000

Eduarda Ângela Pessoa Cesse et al. Eduardo Freese de Carvalho Wayner Vieira de Souza Carlos Feitosa Luna

BACKGROUND: The circulatory system diseases (CAD), one of the most important current health problems, have started to show a declining trend in mortality in several countries, although they are still proportionally the number one regarding the statistics of morbimortality. OBJECTIVE: To analyze the mortality trend due to CAD in Brazilian capital cities, during the period of 1950 to 2000. METHODS: Temporal series study, of Standardized Mortality Ratios by CAD. We used secondary data on death from the statistical annual reports from IBGE (the Brazilian Institute of Geography and Statistics) and from the Mortality Information System. We carried out a linear trend analysis of the Standardized Mortality Ratios due to CAD in the Brazilian capital cities that presented complete mortality series, considering the census years during the study period (1950 to 2000). RESULTS: Although proportionally the CAD represent the main cause of death in the Brazilian population, as well as presenting a proportional increase during the period of analysis of this study, the risk of death, represented by the Standardized Mortality Ratios, have been decreasing, particularly from the eighties onward. It is noteworthy the fact that Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro and São Paulo presented elevated Standardized Mortality Ratios, however with a decreasing trend (p<0.05 and p<0.10), since the start of the analyzed period. CONCLUSION: The behavior of the risk of death due to CAD suggests that this group of diseases is the first to be established, following the increase in industrialization observed from the thirties onward and after the Second World War in Brazil, as it occurred in Sao Paulo and Rio de Janeiro, cities that historically experienced a process of development and urbanization earlier and at a higher extent, when compared to the other capital cities.