Cause Of Death In Brazil Research Articles

Wearable sensors for cardiological monitoring in the SUS: regulatory challenges and impacts on Brazilian Public Health

Cardiovascular diseases are the leading cause of death in Brazil, with approximately 400,000 deaths annually, which corresponds to almost 30% of all deaths in the country. In addition to the impact on mortality, these conditions generate an enormous economic burden for the health system, with costs associated with the treatment of diseases such as heart attack and heart failure exceeding R$50 billion per year. In this context, the use of wearable devices for continuous monitoring of cardiovascular parameters emerges as an opportunity to improve the management and prevention of these diseases. This study conducts a scoping review of the regulatory challenges involved in the incorporation of wearables into the Unified Health System (SUS), with a focus on cardiological monitoring. Articles published between 2019 and 2024 were analyzed, discussing issues such as data accuracy, interoperability between systems, protection of sensitive data, and training of health professionals. In addition, the study examines the economic and social implications of the adoption of these technologies in a context of profound socioeconomic inequalities. The results indicate that, although wearables have the potential to transform cardiovascular care in Brazil, regulatory and technical barriers still limit their large-scale adoption in the SUS. Adequate regulation, aligned with the General Data Protection Law (LGPD), and investments in infrastructure and training are essential for the safe and effective integration of these technologies into public health.

Transition towards cancer mortality predominance over cardiovascular disease mortality in Brazil, 2000–2019: a population-based study

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs=CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil. National Council for Scientific and Technological Development (CNPq).

INEQUALITIES IN STROKE CARE: AN INTEGRATIVE REVIEW OF SOCIAL DETERMINANTS OF HEALTH

Stroke disproportionately affects developing countries and is among the leading causes of death in Brazil. Social determinants of health reflect not only the risk of stroke, but also post-treatment health outcomes. In order to identify which social determinants of health influence post-stroke treatment, an integrative literature review was conducted. Articles indexed in the Scopus, Scielo and Pubmed databases were consulted, using controlled descriptors in the English language, from the last five years, with 33 articles analyzed by title, author, year, objective, methodology, social determinants analyzed and related to stroke treatment and main results. Income was the social determinant with the greatest relation to stroke treatment, leading to higher health costs, mortality and morbidity. Analyzing and recognizing the relationships between stroke and its social determinants allows for a better definition of public and health policies, adjusted to the real needs of patients in recovery.

Underreporting of diabetes mellitus as the cause of death in Bauru, State of São Paulo, Brazil over 40 years: a documental study.

To evaluate, characterize and search for trends in the underreporting of diabetes mellitus (DM) as the cause of death in Bauru, São Paulo, Brazil, over 40 years. This was a documental study. Clinical and mortality data were collected from individuals known to have type 1 (DM1) and type 2 diabetes mellitus (DM2), residing in Bauru, State of São Paulo, followed at a local endocrinology clinic from 1982 to 2021, who deceased during this period. A significant underreporting of DM as the cause of death (64.41%) was found, mostly associated with male gender (OR = 1.59 [95% CI: 1.18; 2.15]; p < 0.01), DM2 (OR = 2.64 [95% CI: 1.32; 5.26]; p < 0.01), dying in the first decade of the study (OR = 4.07 [95% CI: 1.54; 10.71]; p < 0.001) and shorter DM duration (OR = 1.02 [95% CI: 1.01; 1.04]; p < 0.01). Age, type of treatment, body mass index, marital status and ethnicity, did not show a significant association with DM underreporting. There was a decreasing trend in DM1 underreporting (Decade Percentual Change = -7.10 [95% CI: -11.35; -3.40]), but a stationary trend for DM and DM2. The main primary cause of death was cardiovascular-related complications. The underreporting of DM as the cause of death was very frequently found, and was associated with male gender, decade of death, shorter DM duration and DM2. If our data could be applied to the whole country, DM would possibly emerge as a more prominent cause of death in Brazil. Future studies in other cities and geographic regions are warranted to confirm our findings.

The Challenge Of Clinical And Surgical Management Of An Acute Myocardial Infarction Simultaneously With An Acute Compressive Neurological Syndrome Due To Pituitary Adenoma: A Case Report

The term acute coronary syndrome represents a group of signs and symptoms in a patient who exhibits clinical and/or laboratory evidence of the occurrence of acute myocardial ischemia. This concept encompasses acute myocardial infarction, which represents the most important cause of death in Brazil and the world. Pituitary adenomas, in turn, are benign tumors, and are among the most common intracranial tumors, corresponding to 9 to 15% of intracranial tumors detected in autopsy series, and in radiological series, they can reach up to 22 to 23%. of cases. This study is a case report of the simultaneous occurrence of an acute myocardial infarction and an acute compressive neurological syndrome, due to pituitary adenoma, both serious, and the challenges encountered in making medical decisions regarding treatment priority. In daily practice, differentiating between urgency and emergency can be complex. In the case in question, although neurological compression implied the risk of irreversible vision loss, the team decided to prioritize the cardiac approach, to the detriment of the immediate attempt to preserve vision. The decision considered the imminent risk of death due to hemodynamic instability due to any decompensation during the neurological procedure.

Non-stationary Bayesian spatial model for disease mapping based on sub-regions.

This paper aims to extend the Besag model, a widely used Bayesian spatial model in disease mapping, to a non-stationary spatial model for irregular lattice-type data. The goal is to improve the model's ability to capture complex spatial dependence patterns and increase interpretability. The proposed model uses multiple precision parameters, accounting for different intensities of spatial dependence in different sub-regions. We derive a joint penalized complexity prior to the flexible local precision parameters to prevent overfitting and ensure contraction to the stationary model at a user-defined rate. The proposed methodology can be used as a basis for the development of various other non-stationary effects over other domains such as time. An accompanying R package fbesag equips the reader with the necessary tools for immediate use and application. We illustrate the novelty of the proposal by modeling the risk of dengue in Brazil, where the stationary spatial assumption fails and interesting risk profiles are estimated when accounting for spatial non-stationary. Additionally, we model different causes of death in Brazil, where we use the new model to investigate the spatial stationarity of these causes.

Exploring the Feasibility of a Cancer Awareness Program for High School Students in a Brazilian School: A Pilot Study.

Cancer is a leading cause of mortality globally and is projected to be the primary cause of death in Brazil by 2030. Yet, for high school students, information and understanding about cancer are primarily offered through standard biology lessons. This study aimed to assess the feasibility of a brief educational intervention related to cancer among high school students in a Brazilian private school. Participants attended a 1-h online session regarding different aspects of cancer. A self-reported questionnaire about the main topics addressed in the session was filled out before [pre] and after [post] the educational intervention and the results were compared by McNemar's chi-square test. From 900 parents invited, 44 (4.9%) responded to the invitation and agreed with their children's participation, and 24 students attended the activity. The questionnaire was easy to fill out for the students and allowed us to measure differences after the educational intervention. The high school students considered the most interesting topics cancer myths and protective/risk factors. The project was feasible and showed easy application and better knowledge after the educational intervention. The main challenge is related to the access to parents to authorize their children's participation. Designing interventions that focus on cancer education might be a viable way to increase prevention and early diagnosis with implications for students, their families, and the community.

Processed foods, nitrosamines, and increased risk of colorectal cancer

Cancer, the second leading cause of death in Brazil, results from uncontrolled cell growth due to dietary choices or organic alterations affecting nutrition. Colorectal cancer affects the large intestine, manifesting as polyps that slowly develop on the intestinal wall, often associated with diets rich in red meats, processed foods, and saturated fats. A healthy diet, exercise, and a balanced lifestyle are fundamental preventive measures against cancer, emphasizing the importance of adopting healthy habits. This study aims to conduct a literature review to assess the relationship between the consumption of processed foods rich in nitrosamines and the development of colorectal cancer. This research involves a bibliographic review with searches in scientific databases such as Bireme, Lilacs, SciELO, PubMed, and Google Scholar covering the years from 2007 to 2017 with bibliographic updates between 2018 and 2023. Predominantly, articles focusing on cancer and antioxidants were highlighted in the review. From this review, it can be concluded that processed and convenience foods significantly contribute to various health complications due to their excessive amounts of salt and chemical additives. However, simple lifestyle modifications, such as adopting a balanced and adequate diet, avoiding the consumption of readily prepared products, along with regular physical activity, can significantly improve overall quality of life and health.

The Six Pillars of Lifestyle Medicine in Managing Noncommunicable Diseases - The Gaps in Current Guidelines.

Noncommunicable diseases (NCDs), also known as chronic diseases that are long-lasting, are considered the major cause of death and disability worldwide, and the six pillars of lifestyle medicine (nutrition, exercise, toxic control, stress management, restorative sleep, and social connection) play an important role in a holistic management of their prevention and treatment. In addition, medical guidelines are the most accepted documents with recommendations to manage NCDs. The present study aims to analyze the lack of lifestyle pillars concerning the major Brazilian medical guidelines for NCDs and identify evidence in the literature that could justify their inclusion in the documents. Brazilian guidelines were selected according to the most relevant causes of death in Brazil, given by the Mortality Information System, published by the Brazilian Ministry of Health in 2019. Journals were screened in the PUBMED library according to the disease and non-mentioned pillars of lifestyle. Relevant causes of deaths in Brazil are acute myocardial infarction (AMI), diabetes mellitus (DM), and chronic obstructive pulmonary diseases (COPD). Six guidelines related to these NCDs were identified, and all address aspects of lifestyle, but only one, regarding cardiovascular prevention, highlights all six pillars. Despite this, a literature search involving over 50 articles showed that there is evidence that all the pillars can help control each of these NCDs. Rarely are the six pillars of lifestyle contemplated in Brazilian guidelines for AMI, DM, and COPD. The literature review identified evidence of all lifestyle pillars to offer a holistic approach for the management and prevention of NCDs.

The Epidemiology of Heart Disease in Brazil Between 2021 and 2022

Introduction: Cardiovascular disease (CVD) is the leading cause of death in Brazil. CVDs are multifactorial pathologies, defined by the combination of genetic, environmental and behavioral factors, and are characterized as one of the main causes of death in Brazil and worldwide. Objectives: To discuss through a literature review the causes and consequences of the main heart diseases and to present the epidemiological results in Brazil of data collected through the DATASUS System between the years 2021 and 2022. The data observed shows the frequency of the six main causes of death from CVD in the Brazilian population. Results: Between 2021 and 2022, IHD and CVD were responsible, respectively, for 32% / 23% of deaths from CVD in the general population in 2021 and 37% / 14% in 2022, being pointed out as the main causes, with the highest prevalence among the male public and the age group between 60 and 79 years, when analyzed by regions and federative units of Brazil, the highest rates were found in the Southeast region, followed by the Northeast region. When analyzing deaths in terms of place of occurrence, it was observed that the majority occurred in the hospital environment, followed by the home environment. Final considerations: CVD is still the leading cause of death in Brazil. Thus, primary prevention of CVD should be a priority, intensifying control of the main risk factors for CVD, which would also affect incidence and improve early diagnosis.

Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of São Paulo City, Brazil

BackgroundCommunity-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. MethodsThe aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. ResultsA total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. ConclusionOur study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics.

Smoking in Brazil

Introduction: Tobacco use through its different forms continues to be one of the leading preventable causes of death in Brazil. As a remarkable success story, Brazil has achieved one of the largest significant declines in smoking prevalence since 1990. However, worryingly, the rate of decline in tobacco consumption has decreased in recent years, as suggested by surveys. Objectives: The current study aimed to compare the results of three household surveys carried out by the Brazilian Institute of Geography and Statistics (IBGE). Methods: We compared the prevalence of tobacco use among informants aged 18 years or older and the percentage of prevalence changes between 2008, 2013, and 2019 using data from 3 surveys: The Global Tobacco Adult Survey (2008) and the Brazilian National Health Survey (2013 and 2019). In addition, we analyzed the prevalence for Brazil and states according to age, gender, educational level, and race. Results: The prevalence of active smoking decreased by 19% between 2008 and 2013, from 18,2% (95% CI: 17,7;18,7%) in 2008 to 14.7% (95% CI: 14.2;15.2%) in 2013. However, in 2019, the prevalence was 12.6% (95% CI: 12.2;13.0%) revealing a 14.3% reduction. Smoking was higher among low educational levels population, lower income status, and black and mixed race/skin color. Conclusion: The prevalence of smoking has decreased in Brazil in the past three decades. However, recently there has been a reduction in the intensity of decrease, demanding attention and careful analysis of smoking prevention and cessation strategies.

Cerebrovascular Disease Mortality Trends in Brazil: An In-Depth Joinpoint Analysis.

Background Cerebrovascular disease is the second leading cause of death and the third leading cause of disability following heart disease. In 2019, there were over 101 million people living with a stroke and 12.2 million incidents of stroke globally. For the past three decades, stroke has remained the leading cause of death in Brazil, causing over 100,000 fatalities annually, along with numerous functional impairments among those who survive.The Brazilian healthcare system has witnessed notable advancements in the last decade, including the establishment of additional hospitals and a rise in the count of healthcare professionals specializing in cardiovascular and neurological surgery. However, there exists a gap in the research landscapefor continuous comprehensive studies aimed at exploring the evolving mortality rates related to cerebrovascular diseases, of which the last one included data up to 2019. This study aimed to address this gap by meticulously analyzing the trends in cerebrovascular disease mortality in Brazil from 2000 to 2021, for the variables age, sex, state of residence, and geographic region. Methods This is a descriptive, ecological, and time series study. Nationwide data for annual cerebrovascular mortality from Brazil were used for the period 2000-2021. Age-adjusted mortality rates (AAMRs)by direct standardization, encompassing people above 20 years of age, were calculated and expressed per 100,000 persons.Mortality trends were assessedusing joinpoint regression analysis by calculating the annual percentage change (APC) and its corresponding 95% confidence interval (CI) across categories of age, sex, and state and region of residence. Results The mortality rates decreased for the sex categories over the analyzed years. The AAMR for the categories decreased as follows: males and females (95 deaths/100,000 to 52 deaths/100,000 inhabitants), males (108 deaths/100,000 to 63 deaths/100,000 inhabitants), and females (83 deaths/100,000 to 44 deaths/100,000 inhabitants).The most substantial reduction inAAMR for males occurred in the 30-39-year age group (APC: -4.10), while the smallest decline was observed in the 20-29-year age group (APC: -1.44).All five macro-regions demonstrated statistically significant and downward AAPC values in mortality rates. The south and midwest regions decreased at a stable rate, as denoted by the sameAPC and AAPC values (-4.05 and -3.11, respectively).The north and northeast regions exhibited anincrease in AAMR, followed by a decrease (APC: 0.68 to -1.42 and 2.63 to -2.35, respectively). Conclusions Our comprehensive analysisrevealed a downward trend in cerebrovascular disease mortality rates across diverse demographic groups and macro-regions. Females experienced a more substantial reduction compared to males. Despite higher mortality rates among individuals aged 50 and above, all age groups displayed a marked decrease. The continuous decline can be attributed to policy interventions aimed at enhancing healthcare delivery, increased awareness, and healthier diets and lifestyles. With regard to the macro-regions, the regions in the southern zone demonstrated a more significant decrease as compared to the northern part. In Brazil, a more significant decline in cerebrovascular disease mortality rates could be achieved through increased focus on prevention measures and efforts toward mitigating disparities and inequalities between macro-regions.

Assessment of Medical Students' Knowledge of Imaging Methods for Bone Sarcomas.

Cancer is a leading cause of death in Brazil and worldwide. However, Brazilian medical education fails to include oncology as an essential topic. This creates a gap between the health status of the population and medical education. Bone sarcomas fall into both the group of malignant neoplasms and rare diseases and are thus doubly influenced by misinformation. To assess medical students' knowledge of imaging diagnostic methods for bone sarcomas. A cross-sectional, quantitative study was undertaken by obtaining the responses of medical students to a questionnaire containing radiographic images and questions about the radiological aspects of bone sarcomas. The categorical variables were compared using the chi-square test. The level of significance was 5% for all the tests. SPSS software version 25.0 was used for the analysis. A total of 325 responses were collected, with 72% of the participants having no interest in oncology and 55.6-63.9% not knowing how to diagnose a periosteal reaction on bone radiography. Only 11.1-17.1% of the students correctly interpreted the radiographic image of osteosarcoma. Medical students fail to correctly interpret images of bone sarcomas. It is important to promote oncology undergraduate education in general and to include the approach to bone sarcomas in this context.

Ischemic Stroke of Cardioembolic Origin Systematic Review

Ischemic stroke corresponds to 80% of cases in Brazil, which demonstrates the epidemiological importance in Brazil. The magnitude of this fact reflects the reason why stroke is considered the second cause of death in the world, and the first cause of death in Brazil, in addition to being the second cause of cognitive losses. The main causes that favor the occurrence of ischemic stroke determine the situation of risk groups. Such factors can be classified as modifiable, non-modifiable and potential risk group.

Relationship between Ischemic Stroke and Atrial Fibrillation, Systematic Review

Introduction: Atrial Fibrillation (AF) is not only one of the main causes of stroke, but it is also the most common sustained cardiac arrhythmia. As a result of population aging, an increase in the prevalence of AF and other associated chronic cardiovascular diseases, such as Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM), is expected, contributing to a higher incidence of stroke. The magnitude of this fact reflects the reason why stroke is considered the second cause of death in the world, and the first cause of death in Brazil, in addition to being the second cause of cognitive losses. The main causes that favor the occurrence of ischemic stroke determine the situation of risk groups. Such factors can be classified as modifiable, non-modifiable and potential risk group. Objective: The aim of this study was to systematically review the public health literature on the relationship between ischemic stroke and atrial Fibrillation. Methods: Systematized literature review performed by searching the Web of Science database (Clarivates), Science Direct (Scopus), Wiley Online Library (John Wiley and Sons), Taylor and Francis (Taylor &amp; Francis Group) and PubMed (NIH), using the descriptors Relationship between Ischemic Stroke and Atrial Fibrillation and other cardiovascular diseases in primary care, both in English and Portuguese. A total of 3860 articles were found, of which 64 were selected for the review by six evaluators independently. The articles surveyed are from the period 2015 to 2022. Results: In addition to the epidemiological magnitude, AF is important for its clinical consequences, including thromboembolic occurrences, with an increase, on average, of 4 times the probability of a stroke, in addition to being correlated with the high risk of all-cause mortality and other circumstantial determinants, such as heart failure. Conclusion: The analyzed studies demonstrated that there may be an adjusted incidence of ischemic stroke associated with AF and other cardiovascular diseases by stroke age, being age dependent in men. Social factors may contribute to the late discovery of the association between stroke, AF and other cardiovascular diseases.

Quality of life of women with and without cardiovascular risk

Introduction and Objectives: Cardiovascular diseases are the main cause of death in Brazil and in the world, furthermore, affect the quality of life of people affected by these diseases. The objective of this study was to compare the quality of life of women with cardiovascular risk (WCR) and without cardiovascular risk (WTCR). Methods: The G- power software was used to calculate the sample. Cardiovascular risk stratification was performed using the Framingham Risk Score, available in the “ER calculator version 2017”. Quality of life was assessed using the Brazilian version of Short Form Health Survey-36 (SF-36) Questionnaire. Statistical analyzes were performed using SPSS software, version 20. Results: 116 women were stratified into two groups; WCR (n=66) and WTCR (n=50). Mean age, weight, body mass index (BMI), total cholesterol (TC), high density lipoprotein cholesterol (HDL-c), triglycerides (TG), low density lipoprotein cholesterol (LDL-c), systolic blood pressure (SBP) and glycemia differed significantly between groups. Among the domains of quality of life, pain (p&lt;0.02) and limitation due to physical aspects (RP, p&lt;0.01) differed significantly. The cardiovascular risk factors (CRF), age and BMI influenced the domain social aspects, TG in physical capacity and BMI in the general health status of women with risk. LDL-c and CT influenced the emotional aspects of WTCR women. Conclusions: The scores of the quality-of-life domains of WCR women are lower (except for SF) than those of WTCR women, differing significantly in pain and limitation due to physical aspects.

Cardiovascular diseases in women: a differentiated view and risk stratification.

Cardiovascular diseases are the main cause of mortality in men and women worldwide, surpassing mortality from all associated neoplasms. In women, its prevalence and mortality increase at menopause, but complications of reproductive age, such as preeclampsia and eclampsia, lead to increased cardiovascular risk throughout their lives. Coronary ischemic disease is is the leading cause of death in Brazil and worldwide, with atherosclerotic disease being the principal pathophysiological mechanism. However, in women, other mechanisms are associated with myocardial ischemia, such as microcirculation disease and/or vasospasm, due to the anatomical and hormonal characteristics of women in different stages of their lives. Knowledge of the most prevalent cardiovascular diseases in women, as well as the specific risk factors, the traditional ones with the greatest impact, and the under-recognized ones, is of fundamental importance in their risk stratification, diagnosis, and management, fundamentally aiming at reducing mortality.

REABILITAÇÃO CARDIOVASCULAR BASEADA NO TREINAMENTO AERÓBICO E RESISTIDOEM PORTADORES DE SÍNDROME CORONARIANA CRÔNICA

Cardiovascular diseases (CVD) are the leading cause of death in Brazil and, among them, coronary artery disease (CAD) was the leading cause of death in the country. CAD includes symptomatic and asymptomatic clinical conditions related to reduced blood flow to the heart muscle. Chest pain caused by myocardial ischemia, known as angina pectoris, is usually brought on by exertion or emotional stress. Physical exercise has numerous benefits on cardiovascular risk factors and the cardiovascular system, such as improvement in angina through increased myocardial oxygen delivery and increased exercise capacity, an independent predictor of increa-sed survival. Cardiovascular rehabilitation (CVR) based on physical exercises has consistently demonstrated its effectiveness in reducing cardiovascular mortality and hospitalizations in patients with CAD. CVR is recommended for a healthy lifestyle and for managing cardiovascular risk factors by prescribing 30 to 60 minutes of moderate-intensity aerobic activity five or more days a week, and resistance exercise to maintain muscle mass, strength and function two to three days a week. CVR has been recommended as a treatment also for refractory angina. Although CVR has already been considered a feasible and safe therapeutic possibility for these patients, cardiac rehabilitation centers are reluctant to accept patients with angina or complicated cardiovascular history due to fear of adverse events during physical training despite scientifically proven safety.

MUDANÇAS EPIDEMIOLÓGICAS NA DOENÇA ARTERIAL CORONÁRIA NO BRASIL

Cardiovascular diseases (CVD) are the leading cause of death in Brazil. The main etiologies are ischemic heart disease (IHD) and stroke. Since 1984, we have observed a continuous and significant reduction in mortality from these diseases in men and women, but the death rate was consistently higher in men than in women. The prevalence and death rate from CVD predominated in the South and Southeast and capitals in the 1990s. In the 2000s, we observed the proximity of CVD mortality in the five regions due to the more significant reduction in mortality in the South and Southeast. The proximity of stroke mortality trends occurred earlier than those due to IHD, reflecting the population's greater awareness of hypertension control. Between 2007 and 2012, we had a short interruption in the downward trend in the IHD death rate in women and men, but not for all CVD and stroke, which continued to decline. However, from that period, the downward trend continued. Recent studies showed that mortality from all causes of cancer would exceed mortality from CVD in the population aged between 35 to 74. The intensification of primary prevention with greater access to a healthy life and control of risk factors can have an even more significant impact on reducing mortality from CVD.