Primordial and primary prevention programs for cardiovascular diseases: from risk assessment through risk communication to risk reduction. A review of the literature

The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms ‘effectiveness AND primary prevention AND risk factors AND cardiovascular diseases’ for systematic reviews, meta-analyses, randomized clinical trials, and controlled clinical trials in the English language. A descriptive analysis of the employed strategies, theories, frameworks, applied activities, and measurement of the variables was conducted. Nineteen primary studies were analyzed. Heterogeneity was observed in the outcome evaluations, not only in the selected domains but also in the indicators used to measure the variables. There was also a predominance of repeated cross-sectional survey design, differences in community settings, and variability related to the randomization unit when randomization was implemented as part of the sample selection criteria; furthermore, particularities related to measures, limitations, and confounding factors were observed. The employed strategies, including their advantages and limitations, and the employed theories and frameworks are discussed, and risk communication, as the key element of the interventions, is emphasized. A methodological process of selecting and presenting the information to be communicated is recommended, and a systematic theoretical perspective to guide the communication of information is advised. The risk assessment concept, its essential elements, and the relevant role of risk perception are highlighted. It is fundamental for communication that statements targeting other people’s understanding be prepared using systematic data.

Estilo de vida e saúde cardiovascular em adolescentes de escolas do município de São Paulo / Lifestyle and cardiovascular health in school adolescents from São Paulo

FUNDAMENTO: A doença cardiovascular é a principal causa de mortalidade no mundo. Há evidências que demonstram a associação dessa patologia com fatores de risco cardiovascular, relacionados ao estilo de vida, incorporados na fase da adolescência. OBJETIVO: Identificar, em adolescentes, a prevalência de sobrepeso e do estilo de vida associado a risco para o desenvolvimento de doenças cardiovasculares, além dos fatores que os influenciam. MÉTODOS: Foi realizado um estudo observacional de dados individuais, transversal, com adolescentes matriculados em escolas públicas e privadas do município de São Paulo, englobando as séries de 5ª a 8ª do ensino fundamental; as informações foram obtidas através da aplicação de um questionário anônimo e da realização de medidas de peso e altura. RESULTADOS: Foram analisados 2.125 adolescentes, com idade média de 12,9 anos. Do total estudado: de 14,4 por cento a 32,1 por cento não praticaram esporte ou competição; de 56,0 por cento a 73,6 por cento ficaram mais de duas horas à frente de TV, videogame ou computador; aproximadamente 80 por cento consumiram frutas e legumes de forma considerada inadequada; de 34,9 por cento a 45,3 por cento relataram consumo aumentado de sal; e de 60,9 por cento a 74,4 por cento consumo de refrigerantes. A prevalência de sobrepeso variou de 18,7 por cento a 41,6 por cento. CONCLUSÃO: É alta a prevalência em adolescentes escolares de fatores de risco associados ao desenvolvimento de doenças cardiovasculares no adulto. Outros estudos são necessários para compreender melhor como esses fatores de risco se correlacionam e, assim, possibilitar a implementação de medidas preventivas, na fase da adolescência, com vistas à prevenção das doenças cardiovasculares do adulto.

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE: To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular diseases, and the factors that influence them. METHODS: It was conducted an observational study of individual cross-sectional data with adolescents enrolled in public and private schools in São Paulo, covering grades 5 to 8 of elementary school. The information was obtained through the application of an anonymous questionnaire and weight and height measurements. RESULTS: 2,125 adolescents with mean age of 12.9 years were studied. From the total sample: 14.4 percent to 32.1 percent did not practice sports or competitions; 56.0 percent to 73.6 percent remained more than two hours watching TV, playing video game or working on the computer; approximately 80 percent consumed fruits and vegetables improperly; 34.9 percent to 45.3 percent reported high salt consumption; and 60.9 percent to 74.4 percent reported consumption of soft drinks. Prevalence of overweight ranged from 18.7 percent to 41.6 percent. CONCLUSION: In school adolescents, this study found high prevalence of risk factors associated with the development of cardiovascular disease in adults. Further studies are required to better understand how these risk factors are related and thus enable the implementation of preventive measures in adolescence in order to prevent cardiovascular disease in adults.

Cardiologistas de um hospital escola adotam as diretrizes para o tratamento da insuficiência cardíaca? / Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure?

OBJECTIVE: To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following: use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in functional classes II or III, use of spironolactone for patients in functional classes III or IV. METHODS: We analyzed the prescriptions of 199 patients. All these patients had ejection fraction (EF) <=0.50, their ages ranged from 25 to 86 years, and 142 were males. Cardiomyopathy was the most frequent diagnosis: 67 (33.6 percent) patients had dilated cardiomyopathy, 65 (32.6 percent) had ischemic cardiomyopathy. RESULTS: Angiotensin-converting enzyme inhibitors were prescribed for 93 percent of the patients. 71.8 percent also had a prescription for digitalis, 86.9 percent for diuretics, 27.6 percent for spironolactone, 12 percent for beta-blockers, 37.2 percent for acetylsalicylic acid, 6.5 percent for calcium channel antagonists, and 12.5 percent for anticoagulants. In regard to vasodilators, 71 percent of the patients were using captopril (85.2mg/day), 20 percent enalapril (21.4mg/day), 3 percent hydralazine and nitrates. In 71.8 percent of the cases, the dosages prescribed were in accordance with those recommended in the large studies. CONCLUSION: Most patients were prescribed the same doses as those recommended in the large studies. Brazilian patients tolerate well the doses recommended in the studies, and that not using these doses may be a consequence of the physician's fear of prescribing them and not of the patient's intolerance