Analysing the impact of modifiable risk factors on cardiovascular disease mortality in Brazil

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PLOS ONE, v.17, n.6, 2022
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ObjectivesWe have examined the impact of changes in modifiable risk factors on CVD mortality in 26 Brazilian states from 2005 to 2017. MethodsData were acquired from the Global Burden of Diseases study (GBD) and official sources of the Brazilian government, totalling 312 state-year observations. Population attributable fractions (PAFs) were calculated to determine the number of deaths attributed to changes in each risk factor. Fixed-effects multivariable linear regression models were performed, adjusting for income, income inequality, poverty and access to healthcare. ResultsBetween 2005 and 2017, CVD deaths reduced by 21.42%, accompanied by a decrease in smoking (-33%) and increases in hyperglycaemia (+9.5%), obesity (+31%) and dyslipidaemia (+5.2%). Reduction in smoking prevented or postponed almost 20,000 CVD deaths in this period, while increased hyperglycaemia exposure resulted in more than 6,000 CVD deaths. The association between hyperglycaemia and CVD mortality was 5 to 10 times higher than those found for other risk factors, especially in women (11; 95%CI 7 to 14, deaths per 1-point increase in hyperglycaemia exposure). Importantly, the association between hyperglycaemia and CVD mortality was independent of socioeconomic status and access to healthcare, while associations for other risk factors after the same adjustments. ConclusionReduction in smoking was the risk factor that led to the highest number of CVD deaths prevented or postponed, while hyperglycaemia showed the most deleterious association with CVD mortality. Health policies should aim to directly reduce the prevalence of hyperglycaemia to mitigate the population burden of CVD in Brazil in the future.
  1. Backlund E, 1996, ANN EPIDEMIOL, V6, P12, DOI 10.1016/1047-2797(95)00090-9
  2. Ettehad D, 2016, LANCET, V387, P957, DOI 10.1016/S0140-6736(15)01225-8
  3. Ford ES, 2007, NEW ENGL J MED, V356, P2388, DOI 10.1056/NEJMsa053935
  4. Gaspar RS, 2021, LANCET REG HEALTH-AM, V2, DOI 10.1016/j.lana.2021.100042
  5. Griffin SJ, 2017, DIABETOLOGIA, V60, P1620, DOI 10.1007/s00125-017-4337-9
  6. Hone T, 2020, PLOS MED, V17, DOI 10.1371/journal.pmed.1003357
  7. Hone T, 2019, LANCET GLOB HEALTH, V7, pE1575, DOI 10.1016/S2214-109X(19)30409-7
  8. Krieger J, 2021, ANNU REV PUBL HEALTH, V42, P439, DOI 10.1146/annurev-publhealth-090419-103005
  9. Kruk ME, 2018, LANCET, V392, P2203, DOI 10.1016/s0140-6736(18)31668-4
  10. Lopez AD, 2019, INT J EPIDEMIOL, V48, P1815, DOI 10.1093/ije/dyz143
  11. de Rezende LFM, 2016, INT J CARDIOL, V217, P64, DOI 10.1016/j.ijcard.2016.04.176
  12. Malta DC, 2020, ARQ BRAS CARDIOL, V115, P152, DOI 10.36660/abc.20190867
  13. Marinho F, 2018, LANCET, V392, P760, DOI 10.1016/S0140-6736(18)31221-2
  14. Mikkola TS, 2013, PLOS ONE, V8, DOI 10.1371/journal.pone.0063347
  15. Peters SAE, 2014, LANCET, V383, P1973, DOI 10.1016/S0140-6736(14)60040-4
  16. Popkin BM, 2021, LANCET DIABETES ENDO, V9, P462, DOI 10.1016/S2213-8587(21)00078-4
  17. Rasella D, 2014, BMJ-BRIT MED J, V349, DOI 10.1136/bmj.g4014
  18. Regensteiner JG, 2015, CIRCULATION, V132, P2424, DOI 10.1161/CIR.0000000000000343
  19. Rosengren A, 2019, LANCET GLOB HEALTH, V7, pE748, DOI 10.1016/S2214-109X(19)30045-2
  20. Russo I, 2017, CARDIOVASC DIABETOL, V16, DOI 10.1186/s12933-017-0550-6
  21. Shei A, 2014, BMC INT HEALTH HUM R, V14, DOI 10.1186/1472-698X-14-10
  22. Stanaway JD, 2018, LANCET, V392, P1923, DOI 10.1016/s0140-6736(18)32225-6
  23. Wiviott SD, 2019, NEW ENGL J MED, V380, P347, DOI 10.1056/NEJMoa1812389
  24. Wooldridge J.M., 2015, INTRO ECONOMETRICS M
  26. Wright AK, 2019, CIRCULATION, V139, P2742, DOI 10.1161/CIRCULATIONAHA.118.039100
  27. Yusuf S, 2020, LANCET, V395, P795, DOI 10.1016/S0140-6736(19)32008-2
  28. Zhao WH, 2014, DIABETOLOGIA, V57, P918, DOI 10.1007/s00125-014-3190-3
  29. Zhou B, 2021, LANCET, V398, P957, DOI 10.1016/S0140-6736(21)01330-1