2022;35(3) – ABC CARDIOL

IJCS

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Editorial

The Role of Pharmacists in Antihypertensive Pharmacotherapy

Christianne Bretas Vieira Scaramello et al. Flavia Valeria dos Santos Almeida

Hypertension encompasses a preventable risk factor associated with a significant global burden of cardiovascular disease (CVD) and premature death. Its prevalence is rising worldwide due to population aging, unbalanced diets, and sedentary, especially in low- and middle-income countries. Prevalence data in Brazil vary according to the database. However, about 30% of adults present blood pressure of 140/90 mmHg or more, with CVD representing 22.6% premature passing. This link between hypertension and CVDs-related deaths highlights the relevance of blood pressure control.

In 2021, the World Health Organization elaborated evidence-based guidance for the pharmacological treatment of nonpregnant adults with an accurate diagnosis of hypertension who have already received counseling for lifestyle modification. It is crucial to set blood pressure threshold to pharmacological therapy beginning and treatment targets. In addition, the determination of follow-up visits to adjust monotherapy or dual therapy embracing single or dual pill combination medications is mandatory. Comorbidities, unwanted effects, cost, and acceptability must also be evaluated. In 2020, the Brazilian Society of Cardiology also published decision and therapeutic goals for hypertension management.

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Editorial

Advanced Echocardiographic Techniques for the Diagnosis of Subclinical Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease

Silvio Henrique Barberato

Chronic obstructive pulmonary disease (COPD) is a common and treatable disease in the general population, accounting for high morbidity and mortality rates. In patients with severe COPD, hypoxemia is the main cause of complications such as pulmonary hypertension (PH) and right ventricle (RV) dysfunction. However, the presence of RV vascular structural and functional changes may occur in the early stages of COPD, even before significant hypoxemia or PH. Subclinical RV dysfunction often precedes the development of signs and symptoms of RV failure; thus, there is an evident need to detect it from the onset of the disease.

The importance of the RV in cardiovascular physiology has been underestimated for decades. Previously considered a mere conduit, the chamber is now known to play a major role in maintaining global cardiac function intact. Impairment of RV systolic function is an essential determinant of clinical outcomes in different scenarios and should thus be considered in the individualized management of patients.^,

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Editorial

Why is Physical Activity Important to Study in Childhood and Adolescence?

Klebia Castello Branco et al. Isabela de Carlos Back

One of the most important concerns of pediatrician in this pandemic/post-pandemic period is the damage caused by COVID-19 on children’s daily habits, especially physical activity. Children and teenagers were kept indoors during these 2 years, living their lives through digital interactions and becoming forcefully sedentary.

Studies conducted worldwide have shown that the average daily screen time of children and adolescents was greater than 2 hours a day, with the vast majority of them having a higher time than that recommended for any age.

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Erratum

ERRATUM

Int J Cardiovasc Sci. 2021 Issue vol 35(1), pages 107-112.

In Original Article “Effectiveness of Mindfulness Meditation Programs in the Promotion of Quality of Life in Patients with Heart Failure: A Systematic Review”, with DOI number: , published in the journal International Journal of Cardiovascular Sciences, 35(1):107-142, in page 107, correct the Keywords “Heart Failure awarence; Mindfulness; Knowledge; Meditation; Quality of life” to “Heart Failure; Awareness; Mindfulness; Knowledge; Meditation; Quality of life”.

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Original Article

Public Programs for Essential Medicine Access in a Small Municipality: A Cross-Sectional Analysis

Zeó Jaime Lacerda Chaves et al. Luiz Sérgio Silva Renata Cristina Rezende Macedo do Nascimento

Abstract

Background:

Public programs that provide access to essential medications have played an important role in the care of hypertensive and diabetic patients. However, access in small municipalities has been poorly studied.

Objectives:

To describe the sociodemographic profile and the medication and health service usage of patients with systemic arterial hypertension and/or diabetes mellitus in a small municipality who use the public medication access programs Health has no Price (Saúde Não Tem Preço – SNTP) and the Minas Pharmacy Network.

Methods:

This cross-sectional study with 341 participants was conducted in 2019. Home interviews were conducted using a standardized, semi-structured questionnaire. The data are expressed as absolute and relative frequencies, and Pearson’s chi-square test was used for comparisons between proportions (α = 5%).

Results:

Most of the participants (70.68%) had hypertension only, 11.14% had diabetes only, and 18.18% had both. Regarding the origin of the hypertension medications, 82.67% were provided by the Minas Pharmacy Network and/or SNTP programs. Regarding oral hypoglycemic agents and insulins, 88.61% were provided by the Minas Pharmacy Network and/or SNTP. Most participants were female (63.1%), at least 65 years of age (50.30%), non-White (66.96%), resided in an urban area (67.16%), were illiterate or had a low education level (89.94%), and had a maximum income ≤ 2 times the federal minimum salary (89.19%). Overall user perception was significantly better for SNTP (p=0.010).

Conclusion:

The results of this study indicate that programs which provide access to essential medications are important sources of hypertension and diabetes medications in the study area, especially for people with low incomes.

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Original Article

Chronic Obstructive Pulmonary Disease: The Role of Myocardial Deformation Indices and Right Ventricle Three-Dimensional Echocardiography

Claudia Myriam Amaral Botelho et al. José Luiz Barros Pena Bruno Rezende Passos Paulo Roberto Latorre Fortes Maria da Consolação Vieira Moreira

Abstract

Background:

Right ventricular dysfunction is a major complication in chronic obstructive pulmonary disease (COPD) and, despite its prognostic implications, is rarely considered in routine clinical analysis.

Objectives:

To compare RV function variables with standard and advanced echocardiographic techniques in patients with stable COPD and controls.

Methods:

Twenty COPD patients classified as GOLD ≥ II (13 men aged 68.4 ± 8.3 years) and 20 matched controls were compared. Myocardial strain/strain rate indices were obtained by tissue Doppler and two-dimensional speckle tracking echocardiography. Right ventricular ejection fraction was obtained with three-dimensional software. Free wall myocardial thickness (FWMT) and tricuspid annular systolic excursion (TAPSE) were also measured. Numerical variables were compared between groups with Student’s t-test or the Mann-Whitney test. Associations between categorical variables were determined with Fisher’s exact test. P-values < 0.05 were considered statistically significant.

Results:

All myocardial deformation indices, particularly global longitudinal strain (-17.2 ± 4.4 vs -21.2: ± 4.4 = 0.001) and 3D right ventricular ejection fraction (40.8 ± 9.3% vs 51.1 ± 6.4% p <0.001) were reduced in COPD patients. These patients presented higher right ventricular FWMT and lower TAPSE values than controls.

Conclusion:

Myocardial deformation indices, either tissue Doppler or speckle tracking echocardiography and 3D right ventricular ejection fraction, are robust markers of right ventricular dysfunction in patients with stable COPD. Assessing global longitudinal strain by speckle tracking echocardiography is a more practical and reproducible method.

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Original Article

Family History of Hypertension: Impact on Blood Pressure, Anthropometric Measurements and Physical Activity Level in Schoolchildren

Tatiana Affornali Tozo et al. Beatriz Oliveira Pereira Francisco José de Menezes Junior Cristianne Morgado Montenegro … Carla Marisa Maia Moreira Neiva Leite

Abstract

Background:

A family history of arterial hypertension (AH), combined with environmental risk factors, is directly related to the development of AH.

Objectives:

To evaluate the frequency of AH, anthropometric indicators and level of physical activity and their association with a family history (FH) of AH in school children.

Methods:

Cross-sectional study with 118 students, aged between 11 and 17 years, of both sexes. Waist circumference (WC), weight, height, level of physical activity and FH of HA were collected. Body mass index z score (BMI-z) and waist-to-height ratio (WHtR) were calculated. Binary logistic regression model was used to verify the chance risk, with significance p <0.05.

Results:

Of the 118 parents who answered the questionnaire, 34.7% had a positive FH of AH. Girls with a positive FH had higher means of WC (p= 0,004), BMI (p=0,020), and systolic blood pressure (SBP) (p=0,006) than boys, and a higher risk of being overweight (OR=4,48; 95%CI:1,55–12,94), and having elevated WHtR (OR=5.98; 95%CI:1.66– 21.47) and SBP (OR=3,07; 95%CI:1,03–9,13) than girls without a FH, but they practice more vigorours moderate physical activity (MVPA) (p=0,039). On the other hand, no differences in these parameters were observed between boys with and without a FM of AH.

Conclusion:

Overweight and a FH of hypertension were associated with an increased risk for AH in girls. This was not observed among boys, perhaps due to more active lifestyle.

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Original Article

Cognitive Alterations in Elderly Patients with Heart Failure’

Fernanda Guedes Afiune et al. Salvador Rassi Abrahão Afiune Neto

Abstract

Background:

Among the various pathologies that affect the elderly, Heart Failure (HF) stands out. Recently, an attempt has been made to verify the existence of cognitive impairment associated with HF.

Objectives:

To compare the cognitive performance of elderly people with heart failure with that of age-matched individuals without this pathology. Check the existence of marked impairment in some cognitive functions in the clinical group.

Methods:

The sample consisted of 78 elderly people, whose inclusion criterion was the presence of HF and no HF (control group); age over 60 years, both sexes, and any level of education. The control group consisted of 37 individuals (with a median age of 68 years – Interquartile range of 12) and the HF group, with 41 individuals (with a median age of 67 years – Interquartile range of 11). The subjects were matched in terms of education level, with a predominance of elderly people with 0 to 4 years of education (65.9% in the Clinical Group and 59.5% in the Control Group). Eleven neuropsychological tests covering cognitive functions were used: attention, language, memory, mood, and executive function. Statistical analysis was performed using SPSS software, version 23, with a significance level of 5%. The Chi-square test and the Mann-Whitney test were applied.

Results:

The results showed significant differences between the groups, mainly in executive functions, which include the ability to plan, switch, and recall previously stored information.

Conclusion:

Our study showed differences between the cognitive performance of elderly people with HF and elderly people without HF. The main alteration was found in the so-called executive functions, attention, and memory.

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Original Article

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Ilvia Silva Gomes et al. Elaine Menezes Rossi Samara Jamile Mendes Brigitte Rieckmann Martins dos Santos Wilson Sabino

Abstract

Background:

Uncontrolled blood pressure has been associated with poor adherence to drug treatment.

Objectives:

To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil.

Methods:

Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers – one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%.

Results:

Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001).

Conclusion:

An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

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Original Article

Prevalence of Atrial Fibrillation in Pacemaker Patients

Mario Augusto Cray da Costa et al. Jorge Felipe do Lago Pereira dos Santos Marcelo Derbli Schafranski

Abstract

Background:

Current pacemakers allow for the continuous recording of the occurrence of arrhythmic events. One of the most frequent arrhythmias after implantation of a device is atrial fibrillation (AF), an important risk factor for embolic events. The frequency of this arrhythmia in pacemaker patients has not been widely studied.

Objectives:

This study aimed to evaluate the prevalence, incidence, and predictors of the occurrence of AF in patients with double-chamber pacemakers and without a history of atrial fibrillation prior to implantation.

Methods:

A dynamic, retrospective, and prospective cohort study was carried out with 186 patients undergoing biannual follow-up of the double-chamber pacemaker, without previous AF, in a single service, between 2016 and 2018. Clinical data were collected from the medical records and the telemetry of the device and the prevalence, incidence rate, relative risk by univariate analysis (by chi-square), and risk ratio were calculated by multivariate analysis (by Cox regression); values of p<0.05 were considered significant.

Results:

There was a prevalence of 25.3% FA, with an incidence of 5.64 cases / 100 persons-year. The median time for the development of arrhythmia was 27.5 months. Multivariate analysis identified 5 statistically significant predictors: male gender, OR: 2.54 [1.04–6.15]; coronary artery disease, OR: 2.98 [1.20–7.41]; hypothyroidism, OR: 3.63 [1.46–9.07]; prior heart surgery, OR: 2.67 [1.01–7]; and left atrial enlargement, OR: 2.72 [1.25–5.92].

Conclusions:

The prevalence and incidence of AF in this population are high. Risk factors for AF were: male gender, coronary artery disease, hypothyroidism, prior heart surgery, and left atrial enlargement.

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Original Article

Poor Trunk Flexibility is Associated with Cardiovascular Risk Factors

Rafael Felipe Cardoso et al. Maria Sebastiana Silva Cristiane Cominetti Maria Margareth V. Naves

Abstract

Background:

Poor flexibility is a predictor of reduced physical activity. The association between trunk flexibility and cardiovascular risk factors (CVRFs) is not well understood.

Objective:

To identify the prevalence of CVRFs and their association with trunk flexibility in individuals participating in a community-based health education program.

Methods:

Volunteers (51 men, 48 women) aged 20-85 years old, participants in a community-based health education program in the city of Santo Antônio de Goiás, Brazil, were selected for this study. Anthropometric measures including body mass, height, body mass index (BMI), waist circumference (WC) and waist/height ratio (WHtR) were evaluated. Physical activity level was evaluated based on leisure activity participation, and trunk flexibility was evaluated by the sit and reach test. Data distribution was assessed using the Shapiro-Wilk test; Pearson’s chi-square or Fisher’s exact and Student t tests were performed for comparisons. To analyze the association between trunk flexibility and concomitant CVRFs, Spearman’s correlation test and linear regression were employed. Statistical significance was defined as p < 0.05.

Results:

7.2% of the volunteers had no CVRF, 10.3% had only one CVRF and 82.5% had two or more CVRFs, with no differences between sexes. Increased abdominal adiposity, as assessed by WHtR (p = 0.0097), and systemic arterial hypertension (p = 0.0003) were the most prevalent CVRFs, with differences between age groups. A strong negative correlation was found between mean trunk flexibility and the number of concomitant CVRFs (r = -0.96, p < 0.0028).

Conclusion:

The strong negative correlation between trunk flexibility and concomitant CVRF indicates an increased risk for cardiovascular events. Therefore, trunk flexibility measurement may be an additional tool for health promotion and prevention of cardiovascular and associated diseases in community health programs.

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Original Article

Association of Anti-β1 and Anti-M2 Antibodies with Autonomic Nervous System Modulation in Patients with Chronic Chagas Cardiomyopathy

Delma Maria Cunha et al. Pedro Cunha Tzirulnik Patricia Cristina dos Santos Costa Danton Machado Cunha Ademir Batista da Cunha

Abstract

Background:

Different immune mechanisms of myocardial damage involved in the pathophysiology of Chagas disease coexist with high titers of autoantibodies induced by T. cruzi . There are few studies in the literature about the adaptive role of anti-β1 and anti-M2 antibodies in chronic Chagas cardiomyopathy (CCC).

Objectives:

To evaluate the association between anti-β1 and anti-M2 antibodies with heart rate variability (HRV) parameters on 24h Holter monitoring and the rate-pressure product (RPP) on cardiopulmonary exercise testing (CPET).

Methods:

Anti-β1 and anti-M2 antibody titers were measured by enzyme-linked immunosorbent assay (ELISA) in 64 patients affected by CCC. Analysis of HRV was performed through the time-domain indices NNs, mean NN, SDNN, SDANN, SDNN index, NNNs, RMSSD, and pNN50. Spearman’s correlation coefficient was used to assess the association between antibody titers and numerical variables. The Mann–Whitney test was used for comparison between two groups. Multiple linear regression was used to identify independent variables capable of explaining anti-β1 and anti-M2 antibody titers at the 5% significance level.

Results:

On 24h Holter, during the period of greatest parasympathetic activation (2:00-6:00 a.m.), an inverse association was found between anti-β1 titers and SDNN (r_s=-0.13, p =0.041, n=43), as well as a direct association between anti-M2 titers and SDANN ( r _s=0.317, p =0.039, n=43). Regarding CPET variables, anti-β1 titers were directly associated with RPP (r_s=0.371, p =0.005, n=56). The subgroup of patients with a normal chronotropic response showed higher anti-β1 titers than the subgroup with an impaired response (p=0.023). RPP was an independent explanatory variable for anti-β1 titers, although with a low coefficient of determination (R²=0.147).

Conclusion:

The findings of this study suggest that, in patients with CCC, anti-β1 and anti-M2 antibodies may affect HRV parameters. RPP was directly associated with higher anti-β1 titers.

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Original Article

Cardiovascular Risk Factors in Haul Truck Operators of the Mining Sector Working a Rotational Schedule

Rafaela Aparecida Mendonça Marques et al. Priscila Pena Camargo Gabriela Guerra Leal Souza Graziela Dutra Rocha Gouvea … Virgínia Capistrano Fajardo Raimundo Marques do Nascimento Neto André Luis Silva Fernando Luiz Pereira de Oliveira

Abstract

Background:

Due to the growing concern about work-related social and health aspects, occupational health and safety has become relevant.

Objective:

This work aims to develop a model to assist cardiovascular risk management in a team of haul truck operators, who work in rotating shifts at a mining company in Brazil.

Methods:

This longitudinal study evaluated risk factors for cardiovascular diseases of 191 mineworkers at three times points – 2010, 2012, and 2015. In addition, the risk of developing cardiovascular diseases was calculated, and the risk factors were analyzed using the chi-square test, the U Mann-Whitney test, and binary logistic regression. The significance level was set at 5%.

Results:

In the study period, body weight, body mass index (BMI), waist-to-height ratio (WHR), systolic (SBP), and diastolic blood pressure (DBP), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides levels of the study group increased. In 2015, there was a high prevalence of alcohol intake, overweight or obesity, central obesity, inadequate WHR, high blood pressure, total cholesterol above 190 mg/dL, and triglycerides above 150 mg/dL. An association was identified between increased cardiovascular risk and age, SBP, HDL-C, low-density lipoprotein cholesterol (LDL-C), and elevated glucose levels.

Conclusion:

Intense interventions for reduction and prevention of elevated alcohol intake, blood pressure levels, WHR, metabolic syndrome, blood glucose, and LDL-C levels, and low HDL-C levels are needed. In addition, a close monitoring of mine workers over 38 years of age who smoke, consume alcoholic beverages, and have altered blood glucose levels is important.

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Original Article

Physical Activity and Cardiovascular Risk Factors in Children: a Meta-Analysis Update

Claudia Ciceri Cesa et al. Gabriela Oliveira Gonçalves Molino Júlia Lima Raquel Barbiero Pereira … Bruna Eibel Sandra Mari Barbiero Beatriz D. Schaan Lucia Campos Pellanda

Abstract

Background

Obesity and overweight in childhood can increase the risk of developing cardiovascular disease throughout live.

Objectives

This study provides an update of a meta-analysis of randomized clinical trials (RCT) published in 2014, to assess the effects of physical activity interventions on preventing cardiovascular risk factors in childhood.

Methods

This update combines data from the previous search with new data obtained from June 2013 to June 2020. Searches were performed on PubMed, EMBASE and Cochrane CENTRAL. The RCTs enrolled used interventions with physical activity longer than six months in school children aged 6-12 years, and evaluated body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels. Data analysis was performed using a random-effects model and a P value <0.05 was considered statistically significant.

Results

A total of 28,603 articles were retrieved, and 17 RCTs (11,952 subjects) were included. Physical activity interventions were associated with reduction in SBP [−2.11mmHg (95%CI −3.67, −0.54), I²43%], DBP [−2.08mmHg (95%CI −3.68, −0,49), I²65%] and TG [-0.08mmol/L (95% CI -0.13, -0.03), I²0%], and increase in TC [0.17mmol/L (95%CI 0.04, 0.30), I²0%]. However, the interventions were not associated with reductions in BMI [−0.03 kg/m² (95%CI −0.17, 0.10), I²0%].

Conclusion

This update confirms and reinforces the beneficial effects of physical activity intervention in reducing systolic and diastolic blood pressure and TG levels.

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Review Article

The Role of the Immune System on the Cardiac Complications Observed in SARS-CoV-2

Larissa Carvalho Vigário et al. Guilherme Muradas Claudia Neto Paiva Emiliano Medei

Abstract

An acute respiratory syndrome caused by SARS-CoV2 was declared a pandemic by the World Health Organization. Current data in the world and in Brazil show that approximately 40% of patients who died have some type of cardiac comorbidity. There are also robust reports showing an increase in IL-6 / IL-1B / TNF-alpha and the presence of lymphopenia in patients with COVID-19. Our team and others have shown that increased cytokines are the link between arrhythmias/Left ventricular dysfunction and the immune system in different diseases. In addition, it has been well demonstrated that lymphopenia can not only be a good marker, but also a factor that causes heart failure. Thus, the present review focused on the role of the immune system upon the cardiac alterations observed in the SARS-CoV2 infection. Additionally, it was well described that SARS-CoV-2 is able to infect cardiac cells. Therefore, here it will be reviewed in deep.

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Case Report

ST-Elevation in a Patient with Acute Chagas Disease

Guilherme Dantas Campos Pinto et al. José Henrique Martins Pimentel Maria das Neves Dantas da Silveira Barros Carolina de Araújo Medeiros … Cristina de Fátima Velloso Carrazzone Silvia Marinho Matins Wilson Alves de Oliveira Júnior

Introduction

Chagas disease (CD) is classically reported as a neglected disease of vectorial transmission and is endemic in 21 Latin America countries. While it has long been stigmatized as a mere tropical pathology, CD has recently gained prominence, since new means of infection have become more common, including blood transmission and consumption of food contaminated with feces from a given vector. Taking immigration into account, the disease is currently spreading beyond the limits of endemic areas and has become a global issue.

Many acute CD (ACD) outbreaks have been reported since 1965, by oral accidental routes, in Brazil and in other Latin American countries.^, That phase of the disease is, in general, asymptomatic or presents unspecific symptoms, such as fever, fatigue, myalgia, facial and lower limb edema, abdominal pain, diarrhea, vomiting, and dyspnea. One to five percent of the patients develop severe disease, most commonly perimyocarditis, acute heart failure, and/or meningoencephalitis, with a mortality rate of around 5%.^,

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Case Report

Complete Pericardial Agenesis in a Pregnant Patient: A Clinical Dilemma

Carolina de Souza Galvão et al. Sterffeson Lamare Lucena de Abreu Magda Luciene de Sousa Carvalho Gardenia Nogueira e Silva … Júlio Cezar Uchoa Serra Ana Bárbara Silva dos Santos Leite

Abstract

Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.

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Editorial

An Updated View on the Approach to Tricuspid Regurgitation

The incidence of tricuspid regurgitation (TR) associated with left valvular disease is significant ranging from 8% to 35% of cases.^, This is most common in conjunction with mitral valve disease but association with aortic valve pathology is not uncommon and frequently related to rheumatic valve disease and much rarer in association with degenerative mitral valve disease. In most cases, the tricuspid regurgitation is so called “functional”, in other words, secondary to dilatation of the annulus as a consequence of right ventricular (RV) dilatation and pulmonary hypertension. The functional tricuspid regurgitation is a progressive disease that does not always resolve with the correction of the left-side lesion. The recommendations that existed were generally conservative, late in timing, and reflective in large measure of the historically poor outcomes with Tricuspid Valve (TV) surgery in the context of delayed referral, advanced heart failure symptoms, and RV dysfunction

It has become evident that in a significant number of cases, secondary TR does not regressed after appropriate correction of the left-side disease leading to a more aggressive conduct.^,

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Editorial

Mortality from Cardiovascular Disease in Bahia

The adoption of preventive measures against cardiovascular diseases based on greater knowledge and dissemination of information regarding the risk factors that determine their occurrence, has positively modified the incidence of these diseases, especially those of atherosclerotic or hypertensive nature. This is a worldwide record.

However, two factors must be considered: first, cardiovascular disease continues to be the main cause of death in the contemporary world, and second, this favorable reduction behavior is not seen evenly everywhere.

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