Cardiovascular risk assessment in Portugal's primary health care system: SCORE vs. SCORE2.

INTRODUCTION AND OBJECTIVES: The 2021 European Society of Cardiology guidelines on cardiovascular disease (CVD) prevention introduced the more accurate SCORE2 risk model as a replacement for the earlier SCORE, which is still used in primary care software in Portugal. Our objective is to determine whether the difference between risk assessment using SCORE and SCORE2, in the same patient population, is statistically significant. METHODS: A total of 1642 patients aged 40-65 without previous CVD, from the medical records of two Family Health Units, were included in this cross-sectional study. SCORE and SCORE2 were calculated using the variables gender, age, smoking status, lipid profile and systolic blood pressure. A statistical analysis was performed on the results. RESULTS: Using SCORE, 98% of the patients were in the low-moderate risk categories and 2% in the high or very high risk categories. When using SCORE2, the corresponding percentages were 55% and 45%, respectively. Reclassification with SCORE2 into higher categories was more often observed in younger (under 50 years of age) and male patients. With SCORE, 38.61% of patients were within the LDL-C target range; this figure fell to 20.28% with SCORE2. These differences are statistically significant (p<0.0001). CONCLUSION: Our findings show that a significant number of patients in this cohort who were classified through SCORE at lower risk levels were reclassified into higher risk categories with SCORE2. Similarly, the number of patients within the LDL-C target range for LDL-C was also lower using SCORE2.

A pilot observational study to identify reference values for the 6-minute walk test in Brazilian people with hypertension / Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46-59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Resumo Introdução A hipertensão arterial sistêmica (HAS) é respon-sável por 9,5 milhões de mortes na população mundial. Con-dições do estilo de vida, incluindo a inatividade física, são importantes fatores de risco modificáveis no desenvolvimento da HAS. Desse modo, o exercício físico tem se mostrado eficaz no controle da HAS e, antes da prescrição, o teste de caminhada de seis minutos (TC6) tem sido comumente utilizado para ava-liar a capacidade física. Objetivo Propor valores de referência para o teste de TC6 em brasileiros com HAS. Métodos Realizou-se um estudo observacional transversal com 302 hipertensos (62,61 + 10,93 anos) admitidos em um programa de reabilitação cardíaca. Os participantes foram divididos em diferentes quartis de idade e submetidos ao TC6. Os dados de distância percorrida foram comparados entre os quartis e ajustados por análise de regressão linear múltipla. Resultados Os hipertensos caminharam 388,07 + 115,03 m durante o TC6. Não encontrou-se diferença significativa entre os gêneros. No entanto, quando comparados os quartis de idade, para a faixa etária de 46 a 59 anos, as mulheres caminharam menos do que os homens. As comparações intragrupo mostraram que a distância percorrida no TC6 diminuiu com o aumento da idade, tanto em homens quanto em mulheres. Conclusão O presente estudo fornece valores de referência para o TC6, tanto para homens quanto para mulheres brasileiras de diferentes faixas etárias. Esses dados podem ser um parâmetro importante para futuros estudos clínicos, estratégias de prevenção e intervenção clínica.

Impact of the COVID-19 pandemic isolation concerning physical activity and cardiovascular health / Impacto do isolamento da pandemia de COVID-19 na atividade física e na saúde cardiovascular

Background: Regular physical activity (PA) is essential for health maintenance and disease prevention. COV-ID-19 and its social isolation affected patients with cardiovascular (CV) disease. This is a scoping review aiming to map, analyze, and summarize the impacts caused by the isolation of the COVID-19 pandemic concerning PA and CV health in adults. Methods: The review was based on PRISMA-ScR. PubMed, PubMed Central, BVS/BIREME, Scopus, Web of Science, CINAHL, Brazilian Digital Library of Theses and Dissertations, and SciELO databases were selected to search. Two search phases were performed: May 2021 and March 2022. English-language full-text papers were included. Initially, the titles and abstracts of the retrieved documents were read and screened based on the research question. A third reviewer resolved disagreement through consensus meetings. An assessment form was adapted for data extraction. The study was registered in the Open Science Framework platform under the DOI https://doi.org/10.17605/OSF.IO/AH6P8. Results: 11 papers were included and demonstrated that regular PA could be challenging in social isolation environments. Most participants were moderately active and performed low-intensity PA. Confinement led to the limitation of everyday activities, nutritional disorders, and reduced PA, contributing to weight gain. Quarantine was associated with stress and depression, leading to an unhealthy diet (AU).

Introdução: A prática regular de atividade física (AF) é essencial para a manutenção da saúde e prevenção de doenças. A COVID-19 e seu isolamento social afetaram pacientes com doenças cardiovasculares (CV) na prática dessas atividades. Desta forma, realizou-se uma revisão de escopo com o objetivo de mapear, analisar e sintetizar os impactos causados pelo isolamento da pandemia de COVID-19 na realização de AF e na saúde CV em adultos. Métodos: A revisão foi baseada no PRISMA-ScR. Foram selecionadas para a pesquisa a PubMed, PubMed Central, BVS/BIREME, Scopus, Web of Science, CINAHL, Biblioteca Digital Brasileira de Teses e Dissertações e bases de dados SciELO. Duas fases de busca foram realizadas: maio de 2021 e março de 2022. Foram incluídos artigos que possuíam texto completo em inglês. Inicialmente, os títulos e resumos dos documentos recuperados foram lidos e triados com base na questão de pesquisa. Um terceiro revisor foi utilizado para avaliar os desacordos por meio de reuniões de consenso. Um formulário de avaliação foi adaptado para extração de dados. O estudo foi registrado na plataforma Open Science Framework sob o DOI https://doi.org/10.17605/OSF.IO/AH6P8. Resultados: 11 artigos foram incluídos neste estudo e demonstraram que a AF regular pode ser desafiadora em ambientes de isolamento social. A maioria dos participantes era moderadamente ativa e praticava AF de baixa intensidade. O confinamento levou à limitação das atividades cotidianas, distúrbios nutricionais e diminuição da AF, contribuindo para o ganho de peso. A quarentena foi associada ao estresse e à depressão, levando a uma dieta pouco saudável. Possíveis soluções apontam para a realização de AF domiciliar, considerando a saúde basal e o estado CV. Conclusão: A era pós-COVID-19 e suas consequências apontam para a necessidade de planejamento de estratégias que aumentem e mantenham a AF domiciliar como medida protetora para a população em geral, considerando saúde CV, recursos e espaço domiciliar (AU).

Dieta mediterrânea para prevenção de doenças cardiovasculares: overview de revisões sistemáticas / Mediterranean diet for prevention of cardiovascular diseases: overview of systematic reviews

Contextualização: As doenças cardiovasculares (DCV) representam a principal causa de morte no Brasil e no mundo e a dieta mediterrânea (DM) surgiu como possibilidade de prevenção dessas doenças. Ela envolve o alto consumo de frutas, vegetais, frutos do mar, nozes, legumes, grãos e azeite, e ingestão moderada de vinho nas refeições, além de menor ingestão de carnes vermelhas e processadas, gordura saturada, doces e bebidas açucaradas. Objetivo: Avaliar a efetividade da DM para prevenção de DCV. Métodos: Trata-se de overview de revisões sistemáticas. Procedeu-se à busca por estudos que associavam a DM às DCV em quatro bases eletrônicas de dados: Cochrane - Central de Registros de Ensaios Clínicos - CENTRAL (2023), PubMed (1966-2023), Portal BVS (1982-2023) e EMBASE (1974-2023). Dois pesquisadores, independentemente extraíram os dados e avaliaram a qualidade dos estudos para a síntese. O desfecho primário de análise envolveu a prevenção de doença cardiovascular e a redução de mortalidade. Resultados: 5 revisões sistemáticas foram incluídas, totalizando 74 ensaios clínicos (n = 124.820) e 16 coortes prospectivas (n = 722.495). Discussão: Embora os estudos incluídos relatem benefícios favoráveis à DM para prevenção de DCV, as evidências são de baixa a moderada qualidade, diante da heterogeneidade e fragilidades metodológicas. Sugere-se a realização de novos estudos clínicos com padronização de relato dos resultados. Conclusão: Parece haver benefício da DM para prevenção de DCV, mas diante das evidências limitadas, há incertezas que tornam lícita a recomendação por novos ensaios clínicos com comparação a outras dietas, para maior robustez dos achados.

The association between multiple cardiovascular risk factors and overweight in Brazilian adolescents: an analysis based on the grade of membership / A associação entre múltiplos fatores de risco cardiovascular e o excesso de peso em adolescentes brasileiros: uma análise baseada no grade of membership

Abstract The aim of the current research is to analyze the coexistence of modifiable risk behaviors for cardiovascular disease (CVD) in 12-to-17-year-old adolescents living in Brazil and their influence on overweight. National, cross-sectional, school-based epidemiological study focused on estimating the prevalence of cardiovascular risk factors and metabolic syndrome in 12 to 17 year old adolescents enrolled in public and private schools in Brazilian counties accounting for more than 100 thousand inhabitants. The grade of membership method was used to identify the coexistence of risk factors among adolescents. The analytical sample comprised 71,552 adolescents. According to the two herein generated profiles, adolescents classified under Profile 2 have shown behaviors such as smoking, alcohol consumption and diet rich in Ultra-processed food intake ≥ 80% of the percentage of total caloric value. In addition, adolescents presenting CVD risk profile have shown increased likelihood of being overweight. The study has found coexistence of risk factors for CVD in Brazilian adolescents, with emphasis on tobacco smoking and alcoholic beverage intake. In addition, it heads towards the analysis of the association between CVD risk factors and health outcomes, such as overweight.

Resumo O objetivo desta pesquisa é analisar a coexistência de comportamentos de risco modificáveis para doenças cardiovasculares (DCV) em adolescentes de 12 a 17 anos residentes no Brasil e sua influência no excesso de peso. Estudo epidemiológico nacional, transversal, de base escolar, com foco em estimar a prevalência de fatores de risco cardiovascular e síndrome metabólica em adolescentes de 12 a 17 anos matriculados em escolas públicas e privadas de municípios brasileiros que somam mais de 100 mil habitantes. O grade of membership foi utilizado para identificar a coexistência de fatores de risco entre os adolescentes. A amostra analítica foi composta por 71.552 adolescentes. De acordo com os dois perfis gerados, os adolescentes classificados no Perfil 2 mostraram comportamentos como fumar, consumo de álcool e dieta rica em alimentos ultraprocessados ≥ 80% da porcentagem do valor calórico total. Além disso, adolescentes com perfil de risco para DCV mostraram maior probabilidade de apresentar excesso de peso. O estudo encontrou coexistência de fatores de risco para DCV em adolescentes brasileiros, com destaque para tabagismo e consumo de bebidas alcoólicas. Além disso, demonstra associação entre fatores de risco para DCV e desfechos de saúde, como o excesso de peso.

Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy / Fatores de risco cardiovascular na insuficiência ovariana prematura em uso de terapia hormonal

Abstract Objective Premature ovarian insufficiency (POI) is characterized by early hypoestrogenism. An increased risk of cardiovascular (CV) disease is a long-term consequence of POI. A challenge of hormone therapy (HT) is to reduce the CV risk. Methods Cross-sectional study with lipid profile analysis (total cholesterol, LDL-C, HDL-C, VLDL-C and triglycerides), blood glucose levels and arterial blood pressure of women with POI using HT, compared with age and BMI-matched women with normal ovarian function (controls). Results The mean age and BMI of 102 POI patients using HT and 102 controls were 37.2 ± 6.0 and 37.3 ± 5.9 years, respectively; 27.0 ± 5.2 and 27.1 ± 5.4 kg/m2. There wasn't difference between groups in arterial systolic and diastolic blood pressure, blood glucose levels, total cholesterol, LDL-C, VLDL-C and triglycerides. HDL-C levels were significantly higher in the POI group (56.3 ± 14.6 and 52 ± 13.9mg/dL; p = 0.03). Arterial hypertension was the most prevalent chronic disease (12% in the POI group, 19% in the control group, p = ns), followed by dyslipidemia (6 and 5%, in POI and control women). Conclusion Women with POI using HT have blood pressure levels, lipid and glycemic profile and prevalence of hypertension and dyslipidemia similar to women of the same age and BMI with preserved gonadal function, in addition to better HDL levels.

Resumo Objetivo A insuficiência ovariana prematura (IOP) é caracterizada pelo hipoestrogenismo precoce. Risco aumentado de doença cardiovascular (CV) é uma consequência a longo prazo da IOP e um desafio da terapia hormonal (TH) é reduzir o risco CV. Métodos Estudo transversal com análise do perfil lipídico (colesterol total, LDL-C, HDL-C, VLDL-C e triglicerídeos), glicemia e pressão arterial de mulheres com IOP em uso de TH, em comparação a mulheres com função ovariana normal (controles) pareadas por idade e IMC. Resultados A média de idade e IMC de 102 pacientes com IOP em uso de TH e 102 controles foi de 37,2 ± 6,0 e 37,3 ± 5,9 anos, respectivamente; 27,0 ± 5,2 e 27,1 ± 5,4 kg/m2. Não houve diferença entre os grupos na pressão arterial sistólica e diastólica, glicemia, colesterol total, LDL-C, VLDL-C e triglicerídeos. Os níveis de HDL-C foram significativamente maiores no grupo IOP (56,3 ± 14,6 e 52 ± 13,9mg/dL; p = 0,03). A hipertensão arterial foi a doença crônica mais prevalente (12% no grupo POI, 19% no grupo controle, p = ns), seguida da dislipidemia (6 e 5%, no grupo POI e controle). Conclusão Mulheres com IOP em uso de TH apresentam níveis pressóricos, perfil lipídico e glicêmico e prevalência de hipertensão e dislipidemia semelhantes às mulheres da mesma idade e IMC com função gonadal preservada, além de melhores níveis de HDL.

Global warming and heat wave risks for cardiovascular diseases: A position paper from the Portuguese Society of Cardiology.

Global warming is a result of the increased emission of greenhouse gases. The consequences of this climate change threaten society, biodiversity, food and resource availability. The consequences include an increased risk of cardiovascular (CV) disease and cardiovascular mortality. In this position paper, we summarize the data from the main studies that assess the risks of a temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently support global warming/heat waves (extreme temperatures) as cardiovascular threats. Achieving neutrality in emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent steps are required to adapt the society and individuals to this new climatic context that is potentially harmful for cardiovascular health. Multidisciplinary teams should plan and intervene healthcare related to temperature changes and heat waves and advocate for a change in environmental health policy.

High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal: The PICT2RE observational study.

INTRODUCTION AND OBJECTIVES: Portugal is a country with a high prevalence of type 2 diabetes (T2D) and cardiovascular disease (CVD). The prevalence of CVD and cardiovascular (CV) risk factors among T2D patients followed in hospitals in Portugal is not known. The primary objective of this study was to assess the prevalence of CVD and CV risk factors among T2D patients in a hospital setting in Portugal. The clinical management of CVD in the hospital setting was also assessed. METHODS: We performed a non-interventional, multicenter, cross-sectional study with a retrospective phase. T2D patients were consecutively invited to participate. Data were collected retrospectively. RESULTS: A total of 715 patients were included in the study. Mean age and diabetes duration were 66.6 and 17.4 years, respectively. Of these, 286 patients (40.0%) had been diagnosed with CVD, mostly ischemic heart disease (50.4%). All patients had at least one CV risk factor. CVD was significantly associated with hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia and smoking. During the three years prior to study inclusion, the incidence of hyperglycemic episodes and T2D complications increased among patients with established CVD, but the numbers of hospitalization episodes and specialist appointments remained stable. An improvement was observed in key cardiometabolic risk factors. CONCLUSIONS: Our study revealed a high prevalence of CVD and CV risk factors among a sample of T2D patients in a hospital setting. Patients with established CVD seem to be adequately managed but further efforts are needed at the prevention stage for better control of risk factors and morbidity.

Impact of genetic information on coronary disease risk in Madeira: The GENEMACOR study.

INTRODUCTION: Coronary artery disease (CAD), characterized by an atherogenic process in the coronary arteries, is one of the leading causes of death in Madeira. The GENEMACOR (GENEs in MAdeira and CORonary Disease) study sought to investigate the main risk factors - environmental and genetic - and estimate whether a genetic risk score (GRS) improves CAD prediction, discrimination and reclassification. METHODS: Traditional risk factors and 33 CAD genetic variants were considered in a case-control study with 3139 individuals (1723 patients and 1416 controls). The multivariate analysis assessed the likelihood of CAD. A multiplicative GRS (mGRS) was created, and two models (with and without mGRS) were prepared. Two areas under receiver operating characteristic curve (area under curve (AUC)) were analyzed and compared to discriminate CAD likelihood. Net reclassification improvement (NRI) and integrated discrimination index (IDI) were used to reclassify the population. RESULTS: All traditional risk factors were strong and independent predictors of CAD, with smoking being the most significant (OR 3.25; p<0.0001). LPA rs3798220 showed a higher CAD likelihood (odds ratio 1.45; p<0.0001). Individuals in the fourth mGRS quartile had an increased CAD probability of 136% (p<0.0001). A traditional risk factor-based model estimated an AUC of 0.73, rising to 0.75 after mGRS inclusion (p<0.0001), revealing a better fit. Continuous NRI better reclassified 28.1% of the population, and categorical NRI mainly improved the reclassification of the intermediate risk group. CONCLUSIONS: CAD likelihood was influenced by traditional risk factors and genetic variants. Incorporating GRS into the traditional model improved CAD predictive capacity, discrimination and reclassification. These approaches may provide helpful diagnostic and therapeutic advances, especially in the intermediate risk group.

Myocardial T1 mapping with magnetic resonance imaging - a useful tool to understand the diseased heart.

Cardiac magnetic resonance imaging (MRI) is increasingly used in clinical practice due to its versatility. T1 mapping of the myocardium, a recently introduced MRI technique that is becoming available enables quantitative tissue characterization, overcoming some of the limitations of late enhancement. This promising technique has the ability to identify diffuse myocardial fibrosis and is beginning to be used in the diagnostic and prognostic assessment of several heart diseases. In this review, we start by explaining the physical principles of myocardial T1 mapping and possible confounding factors in its measurement. We then analyze the evidence supporting its potential usefulness as a complement to the existing cardiac MRI methods. Finally, we discuss the current limitations of T1 mapping and possible areas of future research.

Long-term outcomes of primary cardiovascular prevention: A retrospective study at a referral center in Portugal.

INTRODUCTION AND OBJECTIVES: Lifestyle changes are frequently insufficient to reduce cardiovascular (CV) risk in patients with dyslipidemia. This study aims to characterize the long-term evolution of lipid profile and CV risk of patients under primary prevention. METHODS: A retrospective study was performed of outpatients at a Portuguese cardiovascular risk clinic with ≥2 CV risk factors, followed for ≥2 years between 1995 and 2015. Statin therapy had been initiated early, in accordance with the clinic's practice. After written informed consent was obtained, sociodemographic and clinical characteristics were collected from medical charts, at baseline and last visit. Changes in lipid profile and CV risk scores were estimated. Associations between HDL-C or LDL-C changes and gender, age, observation time and treatments were assessed through bivariate analysis and multiple linear regression models. RESULTS: Out of 516 participants with mean follow-up of 11.4±4.3 years, 56.6% were female and 91.5% received statins. Lipid profile showed statistically significant improvement, including median changes in LDL-C and HDL-C of -77.0 mg/dl and +19 mg/dl, respectively. CV risk also showed statistically significant improvements according to all scores. Statin therapy resulted in a mean HDL-C increase of 7.4 mg/dl (independently of gender and other treatments) and a mean LDL-C reduction of 51.8 mg/dl (irrespective of age and other treatments). CONCLUSION: Results from this long-term real-life study indicate that primary prevention, specifically early and continuous therapy with intermediate-intensity statins as an add-on to lifestyle interventions, was important in obtaining consistent and adequate metabolic correction in patients with additional risk factors.

Air pollution and cardiovascular diseases: A position paper.

Air pollution is one of the main environmental risk factors for health and is linked to cardiovascular diseases, which are the leading cause of mortality worldwide. In this position paper, we discuss the main air pollutants and how they can promote the development of cardiovascular disease or cardiovascular events. We also summarise the main evidence supporting the association between air pollution and cardiovascular events, such as coronary events (acute coronary syndromes/myocardial infarction; chronic coronary syndromes), stroke, heart failure and mortality. Some recommendations are made based on these data and the European Society of Cardiology guidelines on cardiovascular disease prevention, acknowledging that it is important to increase awareness and literacy on this topic in Portugal.

Carga de Doenças Cardiovasculares Atribuível aos Fatores de Risco nos Países de Língua Portuguesa: Dados do Estudo "Global Burden of Disease 2019" / Burden of Cardiovascular Diseases Attributable to Risk Factors in Portuguese-Speaking Countries: Data from the "Global Burden of Disease 2019" Study

Resumo Fundamento: O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido. Objetivo: Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019. Métodos: Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo. Resultados: A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023). Conclusões: Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.

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.

O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID / The Impact of COVID-19 on Diagnosis of Heart Disease in Latin America an INCAPS COVID Sub-analysis

Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

Enfoque de género en la rehabilitación cardiaca

RESUMEN Introducción: La enfermedad cardiovascular en la mujer es subvalorada como problema de salud. Entre las opciones terapéuticas se encuentra la rehabilitación cardiaca que contribuye a la disminución de la morbimortalidad y la hospitalización en ambos géneros. Objetivo: Evaluar el comportamiento inicial y los resultados de un programa de rehabilitación cardiaca en pacientes atendidos en el departamento de Rehabilitación Cardiaca del servicio de Cardiología del Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, durante el período 2015-2019. Método: Se realizó un estudio descriptivo, prospectivo y longitudinal. El universo lo constituyeron 667 pacientes incorporados al Programa de Rehabilitación Cardiaca. Se estudiaron los factores de riesgo, parámetros ergométricos dados por tiempo de ejercicio, frecuencia cardiaca, tensión arterial y la clase funcional. Se aplicó un programa de rehabilitación que incluyó ejercicios físico-aeróbicos y de resistencia, se realizaron evaluaciones mediante pruebas ergométricas, y lípidos séricos al inicio y a los 6 meses. Resultados: Existe un perfil de riesgo diferente entre ambos géneros, la obesidad es el factor de riesgo más prevalente en el género femenino (62,9 %) y el tabaquismo activo en el masculino (78,0 %). El mejoramiento de la capacidad física fue mayor en hombres que en mujeres. Se exponen los parámetros utilizados para mejorar la participación y adherencia de las mujeres al programa. Conclusiones: Las mujeres cuentan con grandes barreras para la incorporación a los programas de rehabilitación cardiaca. Es necesario ofrecerles información sobre sus beneficios para mejorar el acceso y la permanencia en el programa.

ABSTRACT Introduction: Cardiovascular disease in women is undervalued as a health problem. Among the therapeutic options is cardiac rehabilitation, which contributes to the reduction of morbidity and mortality and hospitalization in both genders. Objective: To evaluate the initial behavior and the results of a cardiac rehabilitation program in patients attended in the Rehabilitación Cardiaca (Cardiac Rehabilitation) department of the Cardiology service of the Hospital General Docente "Dr. Agostinho Neto", from Guantanamo, during the period 2015-2019. Method: A descriptive, prospective and longitudinal study was carried out. The population was made up of 667 patients enrolled in the Cardiac Rehabilitation Program (CRP). Risk factors, ergometric parameters given by exercise time, heart rate, blood pressure, and functional class were studied. A rehabilitation program was applied that included physical-aerobic and resistance exercises, evaluations were carried out through ergometric tests, and serum lipids at the beginning and at 6 months. Results: There is a different risk profile between both genders; obesity is the most prevalent risk factor in females (62.9%) and active smoking in males (78.0%). The improvement in physical capacity was greater in men than in women. The parameters used to improve the participation and adherence of women to the program are exposed. Conclusions: Women have great barriers to the incorporation into cardiac rehabilitation programs. It is necessary to offer them information about their benefits to improve access and permanence in the program.

RESUMO Introdução: A doença cardiovascular em mulheres é subvalorizada como um problema de saúde. Dentre as opções terapêuticas está a reabilitação cardíaca que contribui para a redução da morbimortalidade e hospitalização em ambos os sexos. Objetivo: Avaliar o comportamento inicial e os resultados de um programa de reabilitação cardíaca em pacientes atendidos no setor de Reabilitação Cardíaca do serviço de Cardiologia do "Dr. Agostinho Neto", de Guantánamo, no período 2015-2019. Método: Estudo descritivo, prospectivo e longitudinal. O universo foi composto por 667 pacientes incorporados ao Programa de Reabilitação Cardíaca. Foram estudados fatores de risco, parâmetros ergométricos dados por tempo de exercício, frequência cardíaca, pressão arterial e classe funcional. Foi aplicado um programa de reabilitação que incluiu exercícios físico-aeróbicos e resistidos, foram realizadas avaliações por meio de testes ergométricos e lipídios séricos no início e aos 6 meses. Resultados: Há um perfil de risco diferente entre ambos os sexos, a obesidade é o fator de risco mais prevalente no sexo feminino (62,9%) e o tabagismo ativo no sexo masculino (78,0%). A melhora na capacidade física foi maior nos homens do que nas mulheres. São expostos os parâmetros utilizados para melhorar a participação e adesão das mulheres ao programa. Conclusões: As mulheres têm grandes barreiras para a incorporação em programas de reabilitação cardíaca. É necessário oferecer a eles informações sobre seus benefícios para melhorar o acesso e a permanência no programa.

Diretrizes de 2021 da Organização Mundial da Saúde sobre o tratamento medicamentoso da hipertensão arterial: repercussões para as políticas na Região das Américas / 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the Americas / Directrices de la Organización Mundial de la Salud del 2021 sobre el tratamiento farmacológico de la hipertensión: implicaciones de política para la Región de las Américas

RESUMO A doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Esta publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.

ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.

RESUMEN Las enfermedades cardiovasculares son la principal causa de muerte en la Región de las Américas y la hipertensión es la causa de más del 50% de ellas. En la Región, más de una cuarta parte de las mujeres adultas y cuatro de cada diez hombres adultos tienen hipertensión y su diagnóstico, tratamiento y control son deficientes. En el 2021, la Organización Mundial de la Salud (OMS) publicó directrices actualizadas sobre el tratamiento farmacológico de la hipertensión en personas adultas. En este artículo se destaca el papel facilitador de la iniciativa mundial HEARTS de la OMS y la iniciativa HEARTS en las Américas para catalizar la implementación de estas directrices, a la vez que se proporciona asesoramiento específico sobre políticas para dicha implementación y se destaca la necesidad de adoptar un enfoque estratégico general para el control de la hipertensión. Los autores instan a quienes abogan por la salud y a los responsables de las políticas a priorizar la prevención y el control de la hipertensión para mejorar la salud y el bienestar de la población, y a reducir las disparidades de salud en relación con las enfermedades cardiovasculares dentro de la población y entre las poblaciones de la Región de las Américas.