Cardiovascular Diseases In Brazil Research Articles

Associations of RAASi Discontinuation with Mortality Among Hospitalized Patients with Cardiovascular Disease in Brazil

Associations of RAASi Discontinuation with Mortality Among Hospitalized Patients with Cardiovascular Disease in Brazil

The Impact of COVID-19 Pandemic on Cardiovascular Diseases in Brazil

Background: The novel coronavirus pandemic is an international public health emergency due to the high contagious potential of the virus on a global scale and, similarly to what happened globally, Brazilian authorities took measures to reduce its impact on the healthcare system, including social distancing. In this context of exhaustion of the system, it is worth questioning the situation of patients who need medical care for other diseases, such as the cardiovascular ones. Objectives: Describe the changes in the epidemiological profile of hospitalizations cardiovascular diseases during the COVID-19 pandemic in Brazil. Methods: Assessment of relative variations on the number of hospitalizations, associated average time, mortality rate and financial investments. Results: After the beginning of the pandemic, there was reduction of 21.46% in hospitalizations, more accentuated in females and in the Northern region, and increase of 14.14% in mortality, of greater significance in the Midwestern region. In younger ages, mortality and permanence time presented more accentuated positive variations. In elective admissions, growth in mortality and in hospital expenses were more significant. Conclusion: The pandemic impacted on cardiovascular diseases in a multifactorial way. The number of hospitalizations decreased, and the mortality rate increased, as efforts concentrated on moderate and severe cases. Therefore, there is a need for policies that minimize mid- and long-term impacts, as well as studies that investigate possible late complications of infections by the novel coronavirus.

Adherence of females to Fitcor’s cardiopulmonary and metabolic rehabilitation program during 34 years

Introduction: In recent decades the number of deaths from heart disease among women in Brazil has increased a lot considerably, however those who accumulate more risk factors do not practice physical exercises. Objective: to investigate the adherence behavior of women aged between 12 and 80 years, to a specialized cardiac prevention and rehabilitation program (CPRP). Method: This cross-sectional descriptive study was carried out in a clinic specialized in cardiology diagnosis and CPRP between 1972 and 2006. Patients were separated into two groups, prevention (PG) and rehabilitation (RG) after physical evaluation and diagnosis. Both groups of women were separated by age and by the date of beginning CPRP. Results: Based on the entry diagnosis in the records of 958 women who attended the CPRP, we identified that 655 of them were in the prevention group (PG) and 303 in the rehabilitation group (PG). In both groups, the adherence to the program decreased with advancing age and worsening of risk factors. Conclusions: Contrary to the increase on statistics of women victims of cardiovascular diseases in Brazil, the number of those who seek CPRP through physical exercises has decreased and, what is worse, the number or places that facilitate women’s access to this type of intervention has also decreased.

Factors associated with diet quality among Brazilian individuals with cardiovascular diseases.

An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.

Frailty in Patients With Valve Disease: How to Assess?

Introduction Valvular heart disease contributes to an important portion of hospital admissions. It can progress to heart failure and death, and it ranks eighth among the causes of mortality due to cardiovascular diseases in Brazil. From the moment that a valve disease becomes anatomically important and has clinical repercussions, only interventional treatment (conventional surgery or transcatheter technique) is able to alter the natural course of the disease., The choice of intervention leads to the need for individualized evaluation of the [...]

The direct and indirect costs of cardiovascular diseases in Brazil.

To evaluate the direct and indirect costs of cardiovascular diseases (such as coronary heart disease and stroke) by sex and age group, attributed to the excessive consumption of salt, saturated fat and trans fat in Brazil. The data for estimating the Population Attributable Fraction (PAF) corresponding to the consumption of salt, saturated fat and trans-fat were obtained from the Household Budget Survey 2017-2018. The calculation of direct costs for cardiovascular diseases (CVD) was made from the accounting sum of costs with hospitalizations and outpatient care found in the National Health System (Hospital Information System and Outpatient Information System), from 2017 to 2019, including the costs of treatment, such as medical consultations, medical procedures, and drugs. Regarding the indirect costs, they were measured by the loss of human capital, given the premature death, resulting in loss of productivity. To define the attributable costs, they were multiplied by the PAF. Higher burden of CVD attributable to the consumption of salt, saturated fat and trans fat were observed in younger individuals, which progressively decreased with advancing age, but still generated economic costs in the order of US$ 7.18 billion, in addition to 1.53 million productive years of life lost (YLL) to premature death, if considering salt as an inducer. Although attributable burden of CVD is higher among younger individuals, the highest costs are associated with males aged 45 to 74 years old for direct costs and 45 to 64 years old for indirect costs. The attributable fractions to consumption of salt are the ones that cause the most effects on CVD, followed by saturated fat and trans fat, with direct and indirect costs being higher for males.

The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study.

Ultra-processed foods (UPF) have been associated with an increased risk of cardiovascular diseases (CVD). This study aimed to estimate CVD premature deaths, incident cases, and disability adjusted life-years (DALYs) attributable to the consumption of UPF in Brazilian adults in 2019. A validated a comparative risk assessment model was adapted to estimate the burden of major CVD outcomes (coronary heart disease and stroke) attributable to the consumption of UPF in Brazilian adults aged 30 to 69 years. The model inputs included nationally representative data of the UPF contribution to the total energy of the diet, national official demographic records, CVD outcomes (incidence, deaths and DALYs) from the Global Burden of Disease study for 2019, and relative risks from meta-analysis studies. We estimated that approximately 19,200 premature deaths (95% uncertainty intervals - UI, 7,097 to 32,353), 74,900 new cases (95% UI, 25,983 to 128,725), and 883,000 DALYs/year (95% UI, 324,279 to 1,492,593) from CVD were attributable to the consumption of UPF in Brazil, corresponding to about 22% of the premature deaths from CVD and to 33% of the total premature all-cause deaths attributable to UPF intake among Brazilian adults. Reducing UPF consumption by 10% in the adult population would avert approximately 11% of the premature CVD deaths, equivalent to 2,100 deaths/year (95% UI, 697 to 4,511). A 20% reduction in UPF intake would avert approximately 21% of the premature CVD deaths or 4,100 deaths (95% UI, 1,413 to 8,047), and a 50% reduction in UPF intake would avert about 52% of the premature CVD deaths, corresponding to 9,900 deaths/year (95% UI, 3,682 to 17,820). If UPF consumption among adults was reduced to that of the first quintile of UPF intake in the baseline scenario, approximately 81% of the premature CVD deaths would be averted, corresponding to some 15,600 deaths/year (95% UI, 5,229 to 27,519). Our study estimated a high burden of premature CVD outcomes attributable to the consumption of UPF in Brazil. Our findings support food policies aimed at reducing the consumption of UPF, such as fiscal and regulatory policies, which are imperative to prevent CVD in Brazil.

Inflammation as a Prognostic Marker in Heart Failure.

Background: Heart failure (HF) is a chronic cardiac disease of great importance worldwide and responsible for one-fifth of hospitalizations for cardiovascular disease in Brazil. Pro-inflammatory mediators are involved in the pathophysiology of HF. However, the impact of inflammatory markers on the prognosis of the disease remains uncertain.Objective: We aimed to evaluate inflammation as a prognostic marker in chronic HF.Methods: In this prospective, single-center, observational cohort study conducted from June 2018 through December 2019, we included outpatients with HF from a specialized service of a teaching hospital. Patients with decompensated HF requiring hospitalization in the last 30 days were excluded. At the time of inclusion, serum C-reactive protein (CRP) and albumin were collected and the presence of inflammation was defined as CRP/albumin ≥1.2. Patients with CRP/albumin ratio <1.2 (group A) and CRP/albumin ratio ≥1.2 (group B) were compared. The primary outcome was all-cause mortality. The secondary outcomes were hospitalization for decompensated HF, number of hospitalizations, and number of days of hospitalization in the 12-month follow-up.Results: We included 77 patients, 49 (63.3%) in group A and 28 (3.4%) in group B. Six patients in group A (12.2%) and 10 patients in group B (35.7%) required at least one hospitalization during follow-up (p=0.01). The rate of hospitalizations for decompensated HF for every 100 patients was 16.3 in group A vs 50.0 in group B (p=0.0001) and the average in-hospital length of stay was 12.2 vs 14.2 days per hospitalized patient (p=0.36) in groups A and B, respectively. The mortality rate was 6.1% in group A vs 7.1% in group B (p=0.86).Conclusion: In HF outpatients with inflammation evidentiated by the CRP/albumin ratio ≥1.2, the risk of death was similar to patients without inflammation criteria. However, the presence of inflammation led to a three-fold higher risk of hospitalization for HF decompensation.

The impact of the strategic action plan to combat chronic non-communicable diseases on hospital admissions and deaths from cardiovascular diseases in Brazil.

Chronic Non-Communicable Diseases (NCDs) are the main causes of death worldwide, responsible for millions of hospital admissions per year, especially cardiovascular diseases (CVD). Several strategies for controlling and coping with these diseases have been developed in several countries. The aim of the study was to evaluate the impact of the Strategic Action Plan to Combat NCDs (2011-2022) on hospital admissions, deaths and mortality rate in Brazil, classified by CVD. This is a descriptive study, with secondary data from the Hospital Information System of the Unified Health System (SIH/SUS). Hospital admissions, deaths and mortality rate due to CVD in the Brazilian population aged over 20 years were analyzed, according to region, sex and age group. Statistical analysis was performed using the GraphPad Prism program. Data normality was assessed using the Komogorov Smirnov test and the comparison between groups and year periods was performed using the two-way ANOVA test with Tukey's post hoc test. A value of p<0.05 was considered significant. In this study, in most analyses, a reduction in the hospitalization rates of the adult population was observed after the implementation of the plan, however, there was no improvement in relation to the number of deaths and mortality rate from CVD. This shows that there is still a long way to go to reduce the impact of these diseases in Brazil, and they reaffirm the need for and importance of maintaining the prevention of their risk factors, the social determinants of health and the reorganization of care in the face of to population aging. Such findings contribute with information that allow better control and monitoring of CVD and should be considered when implementing new strategies for prevention, care and control of risk factors.

Covid-19 in Brazil in 2020: impact on deaths from cancer and cardiovascular diseases.

ABSTRACTOBJECTIVE To analyze the impact of the covid-19 pandemic on mortality from cancer and cardiovascular diseases (CVD) as underlying cause and comorbidity in Brazil and Brazilian regions in 2020.METHODS We used the 2019 and 2020 databases of the Mortality Information System (SIM) to analyze deaths occurring between March and December of each year that had cancer or CVD as the underlying cause or comorbidity. Deaths from covid-19 in 2020 were also analyzed. To estimate the Standardized Mortality Ratio (SMR) and the excess of deaths, 2019 data were considered as standard.RESULTS Between March and December 2020, there were 181,377 deaths from cancer and 291,375 deaths from cardiovascular diseases in Brazil, indicating reduction rates of 9.7% and 8.8%, respectively, compared to the same period of the previous year. The pattern was maintained in the five Brazilian regions, with lower variation for cancer (-8.4% in the South to -10.9% in the Midwest). For CVD, the variation was greater, from -2.2% in the North to -10.5 in the Southeast and South. In the same period of 2020, these diseases were classified as comorbidities in 18,133 deaths from cancer and 188,204 deaths from cardiovascular diseases, indicating a proportional excess compared to data from 2019, of 82.1% and 77.9%, respectively. This excess was most significant in the Northern Region, with a ratio of 2.5 between observed and expected deaths for the two conditions studied.CONCLUSIONS Excess deaths from cancer and CVD as comorbidities in 2020 may indicate that covid-19 had an important impact among patients with these conditions.

Abstract 14223: Unfavorable Recent Trends in Smoking in Brazil - A Call for Innovation?

Introduction: Tobacco use is one of the leading preventable causes of death in Brazil and worldwide. In addition, tobacco consumption through different forms of smoking is associated with an increased risk of cardiovascular events. Objectives: We analyzed the prevalence of smoking among adults in Brazil, and cardiovascular mortality rates attributable to tobacco, from 1990 to 2019 Methods: The prevalence of current smokers was estimated using data from a cross-sectional, nationally representative survey (National Health Survey) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) from 2006 to 2019. Age-standardized mortality rates and the absolute number of deaths attributable to tobacco were obtained from the Global Burden of Diseases 2019. Results: The results indicate that 12.8% (95% CI, 12.4-13.2%) of adults use some tobacco product, being the use higher in males (16.2%; 95% CI, 15.6-16.9%) than in females (9.9%; 95% CI, 9.3-10.3%). The proportion of people over 18 years of age who smoke in 2019 was 12.6% (95% CI, 12.2-13.0%), 15.9% (95% CI, 15.3-16.6%) in males, and 9.6% (95% CI, 9.2-10.1%) in females, showing a significant decrease in the last three decades (34.8% in 1989). However, there was an increase of 0.5% in the prevalence compared to 2018, suggesting a change in the trends. In 2019, smoking was responsible for 65,693 deaths from cardiovascular disease in Brazil (39% of all deaths attributed to tobacco). Cardiovascular mortality attributable to smoking decreased from 88.0/100,000 inhabitants (95%UI, 81.3-94.3) in 1990 to 26.3/100,000 inhabitants (95% UI, 23.8-28.9) in 2019. Conclusions: The prevalence of tobacco consumption and cardiovascular mortality attributed to tobacco has decreased in Brazil in the past three decades. However, recent opposite trends call for attention, demanding innovation in addressing the prevention and reduction of smoking in Brazil.

Social determinants and mortality from cardiovascular disease in Brazil

Abstract Introduction Cardiovascular diseases (CVD) are the main cause of death in Brazil and worldwide, with Ischemic Heart Diseases (IHD) of great importance among them. This relevance increases with the aging of the world population and seems to be related to each country's social determinants. Objectives To analyze the temporal evolution of mortality rates due to CAD and IHD by sex, age group, Federation Unit (FU), and Geographic Regions (GR) in Brazil, from 1980 to 2019, and the associations with the Municipal Human Development Index (MHDI). Methods Ecological study of time series of deaths from CVD and IHD in Brazil. We analyzed the crude and standardized mortality rate by CVD and IHD by sex, age group, FU, and GR between 1980 and 2019 and correlated with the MHDI. Deaths and the population were obtained from DATASUS to estimate mortality rates per 100,000 inhabitants, crude and standardized (direct method with the Brazilian population in 2000). The MHDI for each FU was extracted from the Atlas Brasil website (ATLAS BRASIL, 2017). Results Between 1980 and 2019, there were 10,836,004 deaths from CVD and 3,264,828 from IHD in Brazil, 52.86% and 58.39%, respectively, in men. The mortality rate analysis due to CVD and IHD standardized by age showed a downward trend nationwide. The relationship between the variations in these rates between the years 1980 and 2019 and the MHDI 2010 demonstrated a reduction in mortality in UFs with an MHDI above 0.7 (Figures 1 and 2). Conclusion The social determinants, represented by the MHDI, correlate with mortality from CVD and IHD in Brazil's UF, where the most developed ones have less mortality from these causes. Funding Acknowledgement Type of funding sources: None.

Exposure to Chemical and Biological Agents at Work and Cardiovascular Disease in Brazil: A Population-Based Study.

Investigating the relationship between exposure to chemical and biological agents at work and the occurrence of cardiovascular diseases in a Brazilian national health survey. A cross-sectional study using the database of 36.442 participants from the Brazilian National Health Survey. Logistic Regression analysis was performed for multivariable models. After adjustments for key confounders, we observed that those individuals exposed to chemical agents and biological materials at work had 62% (95% CI: 1.20; 2.20) and 66% (95% CI: 1.03; 2.65), respectively, higher odds of having cardiovascular disease compared to employed individuals who did not report exposure to biological materials/chemical agents at work. This study draws attention to the role of chemical and biological risks in the occurrence of cardiovascular diseases. In this sense, it is necessary developing systematic and intersectoral actions for Workers' Health Surveillance to promote health and prevent chronic non-communicable diseases.

Correção de leak paravalvar mitral extenso com três dispositivos oclusores por acesso transapical: um relato de caso

Heart valve diseases account for a significant portion of hospitalizations due to cardiovascular diseases in Brazil. Prosthetic heart valves, which are often part of treatment, are susceptible to complications, such as paravalvular leak. Surgical intervention remains the treatment of choice for correcting this defect. However, transesophageal echocardiography-guided catheter correction has emerged as a less invasive alternative for paravalvular leak treatment in patients at high surgical risk. We report a case of extensive mitral paravalvular leak in a patient who had two previous cardiac surgeries and a high surgical risk, who underwent successful transcatheter closure with three prosthesis implantation by transapical access.

Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil.

ResumoFundamentoNa pandemia pela COVID-19, o aumento da ocorrência e da mortalidade por doenças cardiovasculares (DCV) vem sendo reconhecido no mundo. No Brasil, é essencial que o impacto da COVID-19 na DCV seja analisado.ObjetivosAvaliar o impacto desta pandemia nos números de internações hospitalares (IH), óbitos hospitalares (OH) e letalidade intra-hospitalar (LH) por DCV a partir de dados epidemiológicos do Sistema Único de Saúde (SUS).MétodosEstudo observacional de séries temporais por meio da análise comparativa das taxas de IH, OH e LH por DCV registrados entre janeiro e maio de 2020, usando como referência os valores obtidos no mesmo período entre 2016 e 2019 e os valores projetados por métodos de regressão linear para o ano de 2020. O nível significância estatística utilizado foi de 0,05.ResultadosEm comparação com o mesmo período de 2019, houve um decréscimo de 15% na taxa de IH e de 9% no total de OH por DCV entre março e maio de 2020, acompanhado de um aumento de 9% na taxa de LH por esse grupo de doenças, sobretudo entre pacientes com idade de 20-59 anos. As taxas de IH e LH registradas em 2020 diferiram significativamente da tendência projetada para o corrente ano (p=0,0005 e 0,0318, respectivamente).ConclusõesDurante os primeiros meses da pandemia, observou-se um declínio na IH associado a um aumento da LH por DCV no Brasil. Esses dados possivelmente são consequência do planejamento inadequado no manejo das DCV durante a pandemia, sendo necessária a implementação de ações imediatas para modificar esse cenário. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Factors associated with cardiovascular disease in the Brazilian adult population: National Health Survey, 2019.

to estimate the prevalence and investigate the sociodemographic, health, and lifestyle factors associated with the self-reported diagnosis of Cardiovascular Disease (CVD) in the adult Brazilian population. Data from the National Health Survey (PNS 2019) were analyzed. The presence of CVD was self-reported through the question: "Has any doctor ever given you a diagnosis of heart disease?". Sociodemographic factors, health conditions, and lifestyle were evaluated. For data analysis, Poisson Regression with robust variance was used. 5.3% (95%CI 5.04-5.57) of Brazilian adults reported CVD, of which, 29.08% (95%CI 27.04-31.21) underwent coronary artery bypass surgery or angioplasty and 8.26% (95%CI 7.09-9.6) reported severe limitation in usual activities due to CVD. The factors associated with CVD were advanced age; being male; white race/color; complete middle school and incomplete high school education; have health insurance; self-assessing health as regular or bad/very bad; self-reported hypertension, high cholesterol, and diabetes; being a former smoker; consuming fruits and vegetables as recommended; not consuming alcohol in excess; and not practicing leisure-time physical activity. CVD is associated with sociodemographic, health, and lifestyle factors. It is important to support public policies, programs, and goals for the reduction of cardiovascular diseases in Brazil, especially in the most vulnerable groups.

Impacts of heat stress conditions on mortality from respiratory and cardiovascular diseases in Brazil

This study assesses the risk of exposure to heat stress conditions and their potential impact on mortality from cardiovascular and respiratory diseases in Brazilian capital cities for warming levels of 1.5 °C, 2.0 °C and 4.0 °C in the RCP8.5 scenario. The risk of exposure and the impact of heat stress conditions on mortality were measured by the Wet Bulb Globe Temperature (WBGT) index. The impact on health was estimated by applying exposure-response curves between WBGT and health outcomes in the projections. The potential impact on mortality was measured by attributable fraction of mortality due to heat stress. The results showed an increase in heat stress conditions for Brazil, especially in the Northern and Center-Western regions. The estimated curves showed an association between the WBGT and mortality by cardiovascular and respiratory diseases in Brazil, with an upward impact trend, according to the levels of warming and heterogeneous results among the capitals.

Temperature and morbimortality due to respiratory and cardiovascular diseases in Brazil and future impacts by global warming scenarios

Aim:This study aims to evaluate the association between temperature and morbimortality due to respiratory and cardiovascular diseases in the Brazilian capitals cities in the baseline period from 2000 to 2010 and to evaluate the future impacts of this relationship according to Global Warming scenarios of 1.5ºC, 2°C and 4ºC. Methods:It was an ecological time-series study in the 26 Brazilian capitals cities and the Federal District. Health outcomes were daily counts of deaths and daily counts of hospital admissions due to respiratory diseases in the elderly aged 60 or more, and cardiovascular diseases in adults aged 45 or more. The exposure variable was the daily mean temperature from ERA-INTERIM reanalysis project.The associations were estimated from a two-stage time series analysis method. The results were presented as overall effects of 21 days for mortality and overall effects of 7 days for hospitalization.The impact projections were calculated using the daily mean temperature modelled from the Eta-HadGEM2S Regional Model, projected to rise in the future RCP8.5 scenario. The following periods for the Global Climate Change were considered: (i) baseline - 1965 to 2005; (ii) Global warming of 1.5ºC - 2010 to 2039; (iii) Global warming of 2°C - 2040 to 2069; Global warming of 4ºC - 2070 to 2099. We assumed a constant population growth for the future projections. Results and Conclusions:Our results suggest that climate change has the potential to produce a substantial increase in mortality and hospital admissions related to the association of temperature with respiratory and cardiovascular outcomes in the target population in most Brazil capital cities. Projections about the impact will be of increased hospitalizations and deaths attributable to temperature, as global warming increases, especially the increment in the excess of deaths attributable to extreme heat.

Reduction of mortality and predictions for acute myocardial infarction, stroke, and heart failure in Brazil until 2030

Cardiovascular diseases (CVD) are responsible for the majority of deaths in Brazil and worldwide, and constitute an important share of non-transmissible diseases. The objective of this study is to analyze the mortality trends of the three main CVD in Brazil and its geographic regions: acute myocardial infarction, stroke, and heart failure. Data predictions until 2030 were also carried out. An ecological study is presented herein, with data for the period 2001–2015. Mortality from these diseases was evaluated by annual trends, and grouped in five-year intervals for the predictions until 2030. All data are publicly available. Acute myocardial infarction was the leading isolated cause of death. Brazilian trends revealed a decrease in the three diseases, with different patterns across geographic regions. The Southeast, South, and Midwest regions presented reductions for the three diseases. The predictions indicated higher rates for men. There was also a reduction in the risk of death from these diseases for Brazil and, despite the different mortality patterns for the three diseases, the Southeast region presents, primarily, lower predicted rates than the other regions. The assessment of trends and predictions for the three main CVD in Brazil revealed general decreasing trends with differences across the geographic regions.

Quality of diet and daily spending on food by adults with cardiovascular disease in Brazil

Adherence to a healthy diet depends on factors such as food prices, while studies in developed countries have identified higher costs of more nutritional foods. The current study aimed to assess the direct food expenditures by adults with cardiovascular disease in Brazil, investigating the relationship between cost and quality of diet. The study used data from a randomized clinical trial, the BALANCE Program. The current study is a cross-sectional baseline analysis of participants with high adherence to the trial, conducted in 35 sites in all five major geographic regions of Brazil. Food consumption by 1,160 individuals was collected with a 24-hour dietary recall (24HR), quality of diet was measured with the Diet Quality Index Revised (DQI-R), and direct food costs were estimated from market prices. No significant differences were observed between tertiles of adherence in the direct costs of food or individual characteristics. When all the 24HR were analyzed, there was no correlation between cost and quality of diet (r = 0.38; p = 0.17), while analysis by tertiles showed a weak correlation in the lowest tertile of adherence (r = -0.112; p = 0.03). The study showed absence of differences between direct costs of healthy versus unhealthy foods, a finding that can serve as an incentive for adherence to food recommendations in Brazil, thereby minimizing barriers to the adoption of healthy lifestyles.