Health Vulnerability – ABC CARDIOL

ABC

Editorial

Is it Fair to Contraindicate Cardiac Defibrillator Implantation for Patients with Socioeconomic or Psychological Vulnerability?

Marcelo de Paula Martins Monteiro et al. Helena Nogueira Brasil Carlos Roberto Martins Rodrigues Sobrinho Eduardo Arrais Rocha

The authors Cavalcanti et al. published an article demonstrating that patients undergoing implantation of internal cardiac defibrillators (ICD) for secondary prevention, with ejection fraction (EF) <50%, and who had high socioeconomic or psychological vulnerability presented high mortality in 1 year. The authors analyzed four variables of economic and psychosocial markers (EPSM): 1-socioeconomic vulnerability; 2-self-care capacity; 3-pharmacological adherence; 4- mood disorders. There were no deaths in 1 year in the group without the presence of these variables. The study encompassed a multidisciplinary network of pre-implant analysis called Device-team.

The importance of the study lies in identifying some new markers of worse prognosis after this procedure, particularly in certain population areas. Factors that are subject to modification must be rigorously monitored and modified, enabling evolutionary improvement and ensuring the benefit of increased survival that ICDs provide.

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IJCS

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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Is it Fair to Contraindicate Cardiac Defibrillator Implantation for Patients with Socioeconomic or Psychological Vulnerability?

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

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