Cardiovascular Risk, Obesity, and Sociodemographic Indicators in a Brazilian Population

Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study

AIMS

Despite notable population differences in high-income and low- and middle-income countries (LMICs), national guidelines in LMICs often recommend using US-based cardiovascular disease (CVD) risk scores for treatment decisions. We examined the performance of widely used international CVD risk scores within the largest Brazilian community-based cohort study (Brazilian Longitudinal Study of Adult Health, ELSA-Brasil).

METHODS

All adults 40-75 years from ELSA-Brasil (2008-2013) without prior CVD who were followed for incident, adjudicated CVD events (fatal and non-fatal MI, stroke, or coronary heart disease death). We evaluated 5 scores-Framingham General Risk (FGR), Pooled Cohort Equations (PCEs), WHO CVD score, Globorisk-LAC and the Systematic Coronary Risk Evaluation 2 score (SCORE-2). We assessed their discrimination using the area under the receiver operating characteristic curve (AUC) and calibration with predicted-to-observed risk (P/O) ratios-overall and by sex/race groups.

RESULTS

There were 12 155 individuals (53.0±8.2 years, 55.3% female) who suffered 149 incident CVD events. All scores had a model AUC>0.7 overall and for most age/sex groups, except for white women, where AUC was <0.6 for all scores, with higher overestimation in this subgroup. All risk scores overestimated CVD risk with 32%-170% overestimation across scores. PCE and FGR had the highest overestimation (P/O ratio: 2.74 (95% CI 2.42 to 3.06)) and 2.61 (95% CI 1.79 to 3.43)) and the recalibrated WHO score had the best calibration (P/O ratio: 1.32 (95% CI 1.12 to 1.48)).

CONCLUSION

In a large prospective cohort from Brazil, we found that widely accepted CVD risk scores overestimate risk by over twofold, and have poor risk discrimination particularly among Brazilian women. Our work highlights the value of risk stratification strategies tailored to the unique populations and risks of LMICs.

Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis

Background

Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019.

Methods

This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná.

Results

A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected.

Conclusion

In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.

The Epidemiological Characteristics of Noncommunicable Diseases and Malignant Tumors in Guiyang, China: Cross-sectional Study

Background

Studies that address the changing characteristics of diseases are of great importance for preventing and controlling the occurrence and development of diseases and for improving health. However, studies of the epidemiological characteristics of noncommunicable diseases (NCDs) and malignant tumors (MTs) of the residents in Guiyang, China, are lacking.

Objective

The aim of this study was to evaluate the prevalences of NCDs and MTs in residents of Guiyang, Guizhou Province, China, and analyze differences among ages, genders, and regions.

Methods

A multistage stratified cluster sampling method was used. Based on the inclusion and exclusion criteria, 81,517 individuals were selected for the study. Of these, 77,381 (94.9%) participants completed the study. Structured questionnaires were used to collect information on demographic characteristics, NCDs, and MTs. The chi-square test (with 95% confidence intervals) was used to analyze differences in disease prevalence among genders, ages, and geographical regions.

Results

The major chronic NCDs of Guiyang residents are obesity, hypertension, and diabetes. MTs in women are mostly breast cancer, cervical cancer, and endometrial cancer, whereas in men, MTs are mainly lung cancer, rectal cancer, and gastric cancer. The prevalences of hypertension and diabetes in women are higher than in men, but the prevalences of lung cancer and gastric cancer in men are higher than in women. The epidemiological characteristics of individuals in different life stages are dissimilar. In terms of regional distribution, the prevalences of the above diseases in the Baiyun and Yunyan districts of Guiyang are relatively high.

Conclusions

Several NCDs (obesity, hypertension, and diabetes) and MTs (women: breast cancer, cervical cancer, and endometrial cancer; men: lung cancer, rectal cancer, and gastric cancer) should be the focus for the prevention and control of chronic diseases in the future. In particular, the Baiyun and Yunyan districts of Guiyang are the important regions to emphasize.