Community of Portuguese- Speaking Countries

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Original Article

Burden of Cardiovascular Diseases Attributable to Risk Factors in Portuguese-Speaking Countries: Data from the “Global Burden of Disease 2019” Study

Bruno Ramos Nascimento et al. Luisa Campos Caldeira Brant André Dias Nassar Naback Guilherme Augusto Veloso … Carisi Anne Polanczyk Antonio Luiz Pinho Ribeiro Deborah Carvalho Malta Albano Vicente Lopes Ferreira Gláucia Maria Moraes de Oliveira

Abstract

Background:

The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known.

Objectives:

We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study.

Methods:

We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant.

Results:

Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 – -61.2) and in Brazil (-49.8%, 95%CI -52.5 – -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023).

Conclusions:

In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.

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Editorial

Cardiovascular Diseases in Portuguese: The Importance of Preventive Medicine

Fausto J. Pinto

Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. Because several CVD have sequelae that significantly impact the life of affected individuals, knowing the importance of those diseases, as well as their associated factors, is essential to develop preventive measures to reduce that impact.^–

The study published in this issue of the Arquivos Brasileiros de Cardiologia conducts an epidemiological assessment of CVD in Portuguese-speaking countries (PSC) from 1996 to 2016, being, in that context, unprecedented and relevant. Despite some limitations, always present in that type of study, the analysis has considerable merit and allows us to draw very important conclusions. That study assesses, from an innovative perspective, CVD in a set of countries scattered around the world, which share a common language and cultural base, but have totally distinct geographic locations. In that type of analysis, the impact of local aspects, such as sanitation structures, health policies, economic and political conditions, on the parameters assessed must be properly considered, and that study does it in a very elegant way. The authors clearly indicate that the relative importance of the burden of CVD differs in the different PSC, and they directly relate those differences to the socioeconomic conditions of the countries. Of the CVD, ischemic heart disease is the major cause of death in all PSC, except for Mozambique and Sao Tome and Principe. In addition, the authors report that the most relevant risk factors for CVD, arterial hypertension and dietary factors, are common in the PSC. Furthermore, they conclude that “Genetic factors, implicit in the cultural identity, the factors inherent in the host, as well as the huge social inequality might have contributed to explain the mortality rates observed.” It is worth noting that the authors report the general reduction in mortality from CVD as a common denominator among all the PSC, although the intensity of that reduction differs in the countries.

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Special Article

2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries

Gláucia Maria Moraes de Oliveira et al. Miguel Mendes Marcus Vinícius Bolívar Malachias João Morais … Osni Moreira Filho Armando Serra Coelho Daniel Pires Capingana Vanda Azevedo Irenita Soares Alda Menete Beatriz Ferreira Miryan Bandeira dos Prazeres Cassandra Soares Mário Fernandes

Introduction

The World Health Organization (WHO) goal to reduce mortality due to chronic non-communicable diseases (CNCD) by 2% per year requires a huge effort from countries.^–This challenge for health professionals asks for a global political action on control of social measures, with cost-effective population interventions to reduce CNCD and their risk factors (RF). Health professionals should demand from their government the implementation of acceptable cost measures, such as tobacco cessation counseling, guidance on healthy feeding practices and need for regular physical exercise, systemic arterial hypertension (SAH) control, and promotion of teaching and updating activities in programs directed to those issues. Those measures would contribute with around 70% of the goal of 2% per year reduction in CNCD.^,Dyslipidemia, SAH and obesity are highly prevalent multifactorial diseases in Portuguese language countries (PLC).^,Systemic arterial hypertension is the major RF for complications, such as stroke, acute myocardial infarction and chronic kidney disease, corresponding in importance to dyslipidemia and obesity for the development of atherosclerotic diseases.^,In addition to their significant epidemiological impact, the non-pharmacological treatment of those cardiovascular RF plays a relevant economic role in the expenditures of the Ministries of Health, Social Security and Economy, because those affections are major causes directly or indirectly involved with absenteeism in the workplace. There is evidence that preventive actions are more promising in the primary health care setting.

The number of adults with SAH increased from 594 million in 1975 to 1.13 billion in 2015, being 597 million men and 529 million women. That increase might be due to both population aging and increase in number. When analyzing the trends in blood pressure (BP) levels of 19.1 million adults from several population studies in the past four decades (1975-2015), the elevated levels shifted from high-socioeconomic-level countries to low-intermediate-socioeconomic-level countries of South Asia and Sub-Saharan Africa. However, BP levels remain high in Eastern and Central Europe and Latin America.

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Burden of Cardiovascular Diseases Attributable to Risk Factors in Portuguese-Speaking Countries: Data from the “Global Burden of Disease 2019” Study

Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

Cardiovascular Diseases in Portuguese: The Importance of Preventive Medicine

2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries

Introduction

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