Tobacco Use Disorder – ABC CARDIOL

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Special Article

Cardiovascular Statistics – Brazil 2026

Gláucia Maria Moraes de Oliveira et al. Luisa Campos Caldeira Brant Carisi Anne Polanczyk Deborah Carvalho Malta … Andreia Biolo Bruno Ramos Nascimento Maria de Fatima Marinho de Souza Andrea Rocha De Lorenzo Antonio Aurélio de Paiva Fagundes Júnior Arthur Gus Manfro Beatriz D. Schaan Christina Grüne de Souza e Silva Fábio Morato de Castilho Fernando Henpin Yue Cesena Gabriel Porto Soares Gesner Francisco Xavier Junior Jose Augusto Soares Barreto Filho Lucia Campos Pellanda Luciana Nicolau Aranha Luis Eduardo Paim Rohde Luiz Guilherme Passaglia Marcelo Martins Pinto-Filho M. Julia Machline-Carrion Marcio Sommer Bittencourt Octavio M. Pontes Neto Paolo Blanco Villela Paulo Henrique Godoy Renato Azeredo Teixeira Ricardo Stein Roney Orismar Sampaio Thais Rocha Salim Thomas A. Gaziano Pablo Perel Gregory A. Roth Antonio Luiz Pinho Ribeiro

Cardiovascular Statistics – Brazil was established to provide a periodic, comprehensive, evidence-based assessment of cardiovascular health in Brazil and to support clinical practice, research, public health planning, and policy development. Developed under the auspices of the Brazilian Society of Cardiology, the initiative brings together a multidisciplinary network of investigators from academic institutions across the country who are responsible for reviewing, analyzing, and interpreting data from multiple complementary sources. Since its first edition in 2020, Cardiovascular Statistics – Brazil has sought not only to quantify the burden of cardiovascular diseases (CVDs) and their risk factors but also to identify temporal trends, regional disparities, gaps in care, and emerging challenges for the Brazilian health system. The project is modeled on international initiatives such as the American Heart Association’s Heart Disease and Stroke Statistics Update, while incorporating data sources and perspectives that reflect Brazil’s unique epidemiological, demographic, and healthcare characteristics.

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Editorial

Genetic Evidence Supports a Causal Role for Smoking in Cardiac Arrest

José S. L. Patané et al. Fernando R. Giugni

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Original Article

A Two-sample Mendelian Randomization Study of Air Pollution/Smoking and Cardiac Arrest

Xuelin Tian et al. Yu Wang Qingzhao Tan Liying Liu

Abstract

Background

Observational studies have suggested a connection between air pollution/smoking and cardiac arrest (CA); nevertheless, the causal role of air pollution/smoking in CA remains uncertain.

Objectives

This study aimed to elucidate the causal association between air pollution/smoking and CA using a two-sample Mendelian randomization (MR) approach.

Methods

This study utilized summary data from genome-wide association studies (GWAS). The primary analysis employed the inverse-variance weighted (IVW) method, supplemented by MR-Egger, weighted median, and weighted mode methods. For sensitivity analysis, MR-Egger and MR-PRESSO were employed to address horizontal pleiotropy. Cochran’s Q test was used to assess heterogeneity, and leave-one-out analysis was applied to identify the influence of outliers. A two-sided p-value < 0.05 was considered statistically significant for the causal estimates.

Results

IVW method showed a significant association between smoking status and CA (OR = 2.182, 95% CI: 1.137 – 4.188, p = 0.019). No significant causal associations were found for any of the air pollution metrics or other smoking-related traits. Results of MR Egger and weighted median methods revealed an insignificant causal association between air pollution/smoking and CA. Horizontal pleiotropy or outliers were not detected by sensitivity tests.

Conclusions

Findings of this MR study indicate that smoking has a causal effect on the incidence of developing CA. However, the null findings for air pollution should be interpreted with caution, as the statistical power to detect modest effects was limited. More studies are warranted to verify the outcomes of this study.

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Special Article

Cardiovascular Statistics – Brazil 2023

Gláucia Maria Moraes de Oliveira et al. Luisa Campos Caldeira Brant Carisi Anne Polanczyk Deborah Carvalho Malta … Andreia Biolo Bruno Ramos Nascimento Maria de Fatima Marinho de Souza Andrea Rocha De Lorenzo Antonio Aurélio de Paiva Fagundes Júnior Beatriz D. Schaan Christina Grüne de Souza e Silva Fábio Morato de Castilho Fernando Henpin Yue Cesena Gabriel Porto Soares Gesner Francisco Xavier Junior Jose Augusto Soares Barreto Filho Luiz Guilherme Passaglia Marcelo Martins Pinto Filho M. Julia Machline-Carrion Marcio Sommer Bittencourt Octavio M. Pontes Neto Paolo Blanco Villela Renato Azeredo Teixeira Ricardo Stein Roney Orismar Sampaio Thomaz A. Gaziano Pablo Perel Gregory A. Roth Antonio Luiz Pinho Ribeiro

ABOUT THESE STATISTICS

The publication Cardiovascular Statistics – Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil. The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke. Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Networkand an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG).

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Original Article

Effects of Smoking on Very-Long Term Mortality after First ST Elevation Myocardial Infarction

Emrullah Kızıltunç et al. Yusuf Bozkurt Şahin Salih Topal Mehmet Akif Düzenli … Ekrem Karakaya Nazif Aygül Ramazan Topsakal Kurtuluş Özdemir Adnan Abacı

Abstract

Background

The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released.

Objective

To explore the effect of smoking on very long-term mortality after ST Elevation myocardial infarction (STEMI).

Methods

This study included STEMI patients who were diagnosed between the years of 2004-2006 at three tertiary centers. Patients were categorized according to tobacco exposure (Group 1: non-smokers; Group 2: 40 package*years users). A Cox regression model was used to estimate the relative risks for very long-term mortality. P value <0.05 was considered as statistically significant.

Results

There were 313 patients (201 smokers, 112 non-smokers) who were followed-up for a median period of 174 months. Smokers were younger (54±9 vs. 62±11, p: <0.001), and the presence of cardiometabolic risk factors were more prevalent in non-smokers. A univariate analysis of the impact of the smoking habit on mortality revealed a better survival curve in Group 2 than in Group 1. However, after adjustment for confounders, it was observed that smokers had a significantly increased risk of death. The relative risk became higher with increased exposure (Group 2 vs. Group 1; HR: 1.141; 95% CI: 0.599 to 2.171, Group 3 vs Group 1; HR: 2.130; 95% CI: 1.236 to 3.670, Group 4 vs Group 1; HR: 2.602; 95% CI: 1.461 to 4.634).

Conclusion

Smoking gradually increases the risk of all-cause mortality after STEMI.

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Original Article

Sleep Quality Associated with Habitual Physical Activity Level and Autonomic Nervous System of Smokers

Iara Buriola Trevisan et al. Luiz Carlos Marques Vanderlei Mahara Proença Tiago V. Barreira … Caroline Pereira Santos Tamara Santos Gouveia Ercy Mara Cipulo Ramos Dionei Ramos

Abstract

Background

Few studies have examined the relationship of one’s habitual physical activity level and autonomic nervous system (ANS) modulation on sleep quality in smokers.

Objective

The aim of this study was to identify changes in the sleep quality of smokers and its relation with their habitual physical activity level and ANS modulation.

Methods

Forty-two smokers were divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA). Sleep quality was assessed using the Mini-sleep Questionnaire, and ANS modulation was assessed by indices of heart rate variability (HRV). To examine the possible mean differences, the analysis of covariance (ANCOVA) was used, adjusted for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10, not including qualitative data, such as sex and beta-blockers. Correlations were made by using the Spearman rank correlation. The statistical significance was set at 5%

Results

The smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF (un) index (p=0.033) and LF/HF ratio (p=0.040). A positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038).

Conclusions

Smokers with lower levels of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation; (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Original Article

Passive Cigarette Smoking Impact on Blood Pressure Response to Epinephrine and Felypressin in 1K1C Hypertensive Rats Treated or not with Atenolol

Camila A. Fleury et al. Elizandra P. M. Almeida Thiago J. Dionisio Adriana M. Calvo … Gabriela M. Oliveira Sandra L. Amaral Carlos F. Santos Flávio A. C. Faria

Abstract

Background:

Cigarette smoking is usually associated with hypertension and may modify vasoconstrictor response.

Objective:

The present study aimed to analyze and compare the interaction of passive cigarette smoking and hypertension on epinephrine and felypressin blood pressure effects after intravascular injection.

Method:

45-day male Wistar rats had the main left renal artery partially constricted and the right kidney removed (1K1C model). Rats were placed in the chamber for exposition to passive cigarette smoking (10 cigarettes) during 10 min (6 days a week). Hypertensive rats received atenolol (90 mg/kg/day) by gavage for two weeks. Hypotensive and hypertensive response, response duration and heart rate were recorded from direct blood pressure values. The significance level was 5%.

Results:

Passive cigarette smoking increased maximal hypertensive response to epinephrine in normotensive and 1K1C-atenolol treated rats and to felypressin only in 1K1C-atenolol treated rats; it also reduced epinephrine hypotensive response. Epinephrine increased heart rate in normotensive and hypertensive passive smokers or non-smoker rats. Comparing the two vasoconstrictors, epinephrine showed greater hypertensive response in normotensive smokers, 1K1C-atenolol treated smokers and non-smokers. However, in normotensive-nonsmoker rats, felypressin showed a greater and longer hypertensive effect.

Conclusions:

Our results suggest that passive cigarette smoking may reduce epinephrine vasodilation and increase hypertensive response when compared to felypressin. Therefore, felypressin may be safe for hypertensive patients to avoid tachycardia and atenolol interaction, but for normotensive and non-smoker patients, epinephrine may be safer than felypressin.

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Editorial

Short Editorial – Effect of Passive Smoking on Blood Pressure Response to Epinephrine and Felypressin in 1K1C Hypertensive Rats Treated or not with Atenolol

Paulo J. F. Tucci

I begin this text highlighting the importance of multidisciplinarity in the development of knowledge.

In 1842, Johann Christian Doppler, an Austrian physicist, defined that the frequency of the star’s light changed with its motion, as it moved closer or away. One and a half century later, such “useless curiosity” started to be applied for the diagnosis of congenital heart diseases. And for a long time, we do know when the train is coming or going.

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Editorial

Short Editorial: Hypertension in Special Populations: An Epidemiological Challenge

Rui Póvoa

Arterial hypertension (AH) is the most prevalent chronic disease worldwide and the main risk factor for most cardio-cerebrovascular diseases. The true prevalence in Brazil is still unknown, and the available data are from the Vigitel Study, where the information is obtained by telephone contact. The prevalence of hypertension in Brazil is estimated at around 31% in adult individuals. In recent data from the Vigitel Study, the prevalence was 25.7% of the adult Brazilian population. Knowledge of the real prevalence and geographic distribution is not only important for prevention and treatment measures, but also contribute to the knowledge of the genesis of the disease.

In some populations, particularly individuals of African descent, AH has its own characteristics, including prevalence, therapeutic response and severity.^, The multifactorial aspect of AH is only understood when assessing special populations considering their own habitats and habits, as in the case of quilombolas, where individuals with African ancestry still retain some genetic and cultural characteristics of the African origin. The analysis in this context is important, since we can detect aspects inherent to factors related to AH development.

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Original Article

Association between Smoking and Alcohol Consumption and the Severity of Coronary Artery Injuries in Patients with AMI

Luis Gustavo Albuquerque et al. Daniel Medeiros Moreira Roberto Léo da Silva Tammuz Fattah

Abstract

Background:

Smoking is the most important risk factor for coronary heart disease (CHD) and ischemic events; alcohol consumption, on the other hand, appears to have a protective role.

Objective:

Assess the association between smoking and alcohol consumption with the severity of coronary artery injuries in patients with acute myocardial infarction (AMI).

Methods:

Cross-sectional study, performed in Santa Catarina. Variables were evaluated using the Chi-squared T/Fisher’s exact test, Kendall’s correlation coefficient, Student’s t test or Mann-Whitney U test. Values of p < 0.05 were considered significant.

Results:

Between August 2016 to June 2017, 226 patients were evaluated with first episode of AMI. There was a difference in sex distribution, showing that 59.7% of men and 85.4% of women were not alcoholic (p < 0.001). There was a higher prevalence of non-hypertensive patients who consumed alcohol than hypertensive ones (40.7% vs. 24.4% and p = 0.010) and patients without diabetes who had drinking habits than those diabetic (36.4% vs. 12.0% and p = 0.001). There was also a higher prevalence of non-diabetic patients who smoked than diabetic ones (38.1% vs. 22.0% and p = 0.035). A weak and negative correlation was found between the number of cigarettes per day and the pack-year with the TIMI frame count (r = -0.174 and p = 0.041 and r = -0.192 and p = 0.027, respectively). The other associations did not show statistical significance.

Conclusion:

The study showed that the number of cigarettes consumed per day and the pack-year is related to a smaller TIMI frame count, i.e., to a better coronary flow, which may be related to the Smoker’s Paradox. There was no correlation between the beverage type and quantity with the SYNTAX score, Ejection fraction and TIMI frame count.

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Original Article

Prevalence of Peripheral Artery Disease and Associated Risk Factors in a Brazilian Rural Population: The Baependi Heart Study

Rafael de Oliveira Alvim et al. Fernando Augusto Lavezzo Dias Camila Maciel de Oliveira Andréa Roseli Vançan Russo Horimoto … Anderson Zampier Ulbrich José Eduardo Krieger Alexandre da Costa Pereira

Abstract

Background:

The identification of peripheral artery disease (PAD) can help prevent further progression of the disease and additional complications, considering that this condition is a risk factor for all-cause mortality and cardiovascular death.

Objective:

To assess the prevalence of PAD in the Baependi Heart Study and investigate associated risk factors in different age groups.

Methods:

A total of 1,627 individuals (of both genders and aged 18 – 102 years) residing in the municipality of Baependi (Minas Gerais, Brazil) were selected for this study. Anthropometric and biochemical parameters were evaluated by standard techniques. Physical activity level was determined by the International Physical Activity Questionnaire – Short Form (IPAQ-SF). The screening of PAD was performed by determination of the ankle-brachial index (ABI). The level of statistical significance was set at 5%.

Results:

In the overall sample, the prevalence of PAD was 1.05%, and reached 5.2% after the age of 70 years. The frequency and intensity of smoking were higher in individuals with PAD. A prior history of myocardial infarction and a higher prevalence of hypertension, diabetes, obesity, and sedentary lifestyle were also associated with PAD. In addition, PAD was more frequent in blacks than whites. In multivariable analysis, age, diabetes, smoking, and physical inactivity remained independently associated with PAD.

Conclusion:

The prevalence of PAD was low and increased clearly with age in our sample from a Brazilian rural population. Furthermore, the main risk factors for PAD in the investigated sample were smoking, sedentary lifestyle, diabetes mellitus, and age. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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Atualização

Smoking: what has been addressed in brazilian journals

Gustavo Faibischew Prado et al. Elisa Maria Siqueira Lombardi Anna Miethke Morais Stella Regina Martins Ubiratan de Paula Santos

The topic of tobacco smoking, in its several aspects, has been receiving increasing attention among researchers over the past few years, which has been reflected in more data and more solid scientific literature on the subject in national journals. This article aims to review the studies that focused on smoking published between January 2010 and June 2012, in Arquivos Brasileiros de Cardiologia (Brazilian Archives of Cardiology), Brazilian Journal of Medical and Biological Research, Clinics (Sao Paulo), Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology), Revista da Associação Médica Brasileira (Journal of the Brazilian Medical Association) and Revista Brasileira de Cirurgia Cardiovascular (Brazilian Journal of Cardiovascular Surgery). During the aforementioned period 58 articles were published, 52 of which were original ones, addressing several aspects of smoking, such as effects on health, epidemiology, cessation and experimental studies.

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