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      Prevalência de saúde cardiovascular ideal na população brasileira - Pesquisa Nacional de Saúde (2013) Translated title: Ideal cardiovascular health prevalence in the Brazilian population - National Health Survey (2013)

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          Abstract

          RESUMO: A prevenção primordial é definida como a prevenção inicial de fatores de risco, por meio da adoção de comportamentos mais saudáveis. Dentro desse conceito, a American Heart Association (AHA) definiu sete métricas, baseadas em evidências, para se alcançar uma saúde cardiovascular (SCV) ideal. O objetivo deste trabalho foi avaliar a prevalência de SCV na população brasileira, segundo sexo, faixa etária e região de moradia, utilizando os dados da última Pesquisa Nacional de Saúde (PNS), de 2013. Foram avaliados, como preconizado pela AHA, de forma conjunta (número de fatores) e isolada, quatro fatores comportamentais (tabagismo, atividade física, índice de massa corporal e dieta) e três biológicos (pressão arterial, glicemia e níveis de colesterol). A população brasileira atingiu prevalências menores de 1%, de sete fatores em nível ideal. Isoladamente, 3,2% da população apresentaram a dieta em nível ideal, seguido da atividade física (23,6%) e índice de massa corporal (43,7%). A população entre 18 e 35 anos apresentou a maior prevalência de número de métricas conjuntas em nível ideal (0,5%), valor também atingido pela população geral da Região Norte. Os resultados indicam que devem ser realizados ainda maiores esforços por meio de políticas públicas de prevenção primordial para atingir metas adequadas de SCV na população brasileira.

          Translated abstract

          ABSTRACT: Primordial prevention is defined as the initial prevention of risk factors, through the adoption of healthier behaviors. Within this concept, the American Heart Association (AHA) has defined seven metrics, based on evidence, to achieve ideal cardiovascular health. The aim of this study was to evaluate the prevalence of cardiovascular health in the Brazilian population, according to sex, age, and region of residence, using data from the latest National Health Survey (2013). We assessed the risk factors, as recommended by the AHA, combined (number of factors) and individually: four behavioral (smoking, physical activity, body mass index and diet) and three biological factors (blood pressure, blood glucose and cholesterol levels). The Brazilian population has reached very low prevalence (1%), for the sum of 7 factors in ideal level. Individually, 3.2% of the population consumed ideal diet, followed by physical activity (23.6%) and body mass index (43.7%). The subjects aged between 18 and 35 years showed higher prevalence of metrics combined at the optimal levels (0.5%), which was also reached by the population of the Northern region. These results indicate that greater efforts are urgent by public policies at the level of primordial prevention in order to achieve appropriate targets of cardiovascular health in the Brazilian population.

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          Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.

          Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet. To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk. Study of a nationally representative sample of 44,959 US adults (≥20 years), using data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994, 1999-2004, and 2005-2010 and the NHANES III Linked Mortality File (through 2006). All-cause, CVD, and ischemic heart disease (IHD) mortality. Few participants met all 7 cardiovascular health metrics (2.0% [95% CI, 1.5%-2.5%] in 1988-1994, 1.2% [95% CI, 0.8%-1.9%] in 2005-2010). Among NHANES III participants, 2673 all-cause, 1085 CVD, and 576 IHD deaths occurred (median follow-up, 14.5 years). Among participants who met 1 or fewer cardiovascular health metrics, age- and sex-standardized absolute risks were 14.8 (95% CI, 13.2-16.5) deaths per 1000 person-years for all-cause mortality, 6.5 (95% CI, 5.5-7.6) for CVD mortality, and 3.7 (95% CI, 2.8-4.5) for IHD mortality. Among those who met 6 or more metrics, corresponding risks were 5.4 (95% CI, 3.6-7.3) for all-cause mortality, 1.5 (95% CI, 0.5-2.5) for CVD mortality, and 1.1 (95% CI, 0.7-2.0) for IHD mortality. Adjusted hazard ratios were 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.24 (95% CI, 0.13-0.47) for CVD mortality, and 0.30 (95% CI, 0.13-0.68) for IHD mortality, comparing participants who met 6 or more vs 1 or fewer cardiovascular health metrics. Adjusted population-attributable fractions were 59% (95% CI, 33%-76%) for all-cause mortality, 64% (95% CI, 28%-84%) for CVD mortality, and 63% (95% CI, 5%-89%) for IHD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of total and CVD mortality, but the prevalence of meeting all 7 cardiovascular health metrics was low in the study population.
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            Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke.

            Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively. We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91 698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006-2007). Cox proportional hazards models were used to estimate stroke risk. During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69-1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01). We observed a clear inverse gradient relationship between the number of ideal CVH metrics and the risk of stroke in a Chinese population, supporting the importance of ideal health behaviors and factors in stroke prevention.
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              Life's Simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study.

              The American Heart Association developed Life's Simple 7 (LS7) as a metric defining cardiovascular health. We investigated the association between LS7 and incident stroke in black and white Americans. The Reasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based cohort of 30 239 blacks and whites, aged ≥45 years, sampled from the US population from 2003 to 2007. Data were collected by telephone, self-administered questionnaires, and an in-home examination. Incident strokes were identified through biannual participant contact followed by adjudication of medical records. Levels of the LS7 components (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet) were each coded as poor (0 point), intermediate (1 point), or ideal (2 points) health. An overall LS7 score was categorized as inadequate (0-4), average (5-9), or optimum (10-14) cardiovascular health. Among 22 914 subjects with LS7 data and no previous cardiovascular disease, there were 432 incident strokes over 4.9 years of follow-up. After adjusting for demographics, socioeconomic status, and region of residence, each better health category of the LS7 score was associated with a 25% lower risk of stroke (hazard ratios, 0.75; 95% confidence interval, 0.63-0.90). The association was similar for blacks and whites (interaction P value=0.55). A 1-point higher LS7 score was associated with an 8% lower risk of stroke (hazard ratios, 0.92; 95% confidence interval, 0.88-0.95). In both blacks and whites, better cardiovascular health, on the basis of the LS7 score, is associated with lower risk of stroke, and a small difference in scores was an important stroke determinant.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbepid
                Revista Brasileira de Epidemiologia
                Rev. bras. epidemiol.
                Associação Brasileira de Pós -Graduação em Saúde Coletiva
                1415-790X
                December 2015
                : 18
                : suppl 2
                : 97-108
                Affiliations
                [1 ] Universidade Federal de Minas Gerais Brazil
                [2 ] Universidade Federal de Minas Gerais Brazil
                [3 ] Ministério da Saúde Brazil
                Article
                S1415-790X2015000700097
                10.1590/1980-5497201500060009
                27008606
                d3f73b7f-1bed-45ec-a395-7d0ab0d94a0f

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=1415-790X&lng=en
                Categories
                Health Policy & Services

                Public health
                Doenças cardiovasculares,Prevenção de doenças,Promoção da saúde,Fatores de risco,Epidemiologia,Prevalência.,Cardiovascular diseases,Disease prevention,Health promotion,Risk factors,Epidemiology,Prevalence.

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