Ischemic heart disease-related mortality in Brazil, 2006 to 2020. A study of multiple causes of death

CONTEXT

Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health.

OBJECTIVES

To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region.

METHODS

Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs.

RESULTS

When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South.

CONCLUSIONS

Several diseases - including AMI, AH, CIHD, HF, and DM - were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions.

Mortality from diseases of the circulatory system in Brazil and its relationship with social determinants focusing on vulnerability: an ecological study

Background

Deaths from diseases of the circulatory system and ischemic heart diseases are declining, but slowly in developing countries, emphasizing its probable relationship with determinants of social vulnerability.

Objectives

To analyze the temporal progression of mortality rates of diseases of the circulatory system and ischemic heart diseases from 1980 to 2019 and the association of the rates with the Municipal Human Development Index and Social Vulnerability Index in Brazil.

Methods

We estimated the crude and standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and analyzed the relationship between the obtained data and the Municipal Human Development Index and Social Vulnerability Index. Data on deaths and population were obtained from the DATASUS. The Municipal Human Development Index and the Social Vulnerability Index of each federative unit were extracted from the websites Atlas Brazil and Atlas of Social Vulnerability, respectively.

Results

The age-standardized mortality rates of diseases of the circulatory system and ischemic heart diseases showed a downward trend nationwide, which was unequal across the federative units. There was an inversely proportional relationship between the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and the Municipal Human Development Index. The downward mortality trend was observed when the indices were greater than 0.70 and 0.75, respectively. The Social Vulnerability Index was directly proportional to the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases. An upward mortality trend was observed with a Social Vulnerability Index greater than 0.35.

Conclusions

Social determinants represented by the Municipal Human Development Index and the Social Vulnerability Index were related to mortality from diseases of the circulatory system and ischemic heart diseases across the Brazilian federative units. The units with most development and least social inequalities had the lowest mortality from these causes. The most vulnerable die the most.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14294-3.

Social determinants and mortality from cardiovascular disease in Brazil

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.

6132Trends in mortality from heart failure between 1980 and 2016

Background

Heart failure (HF) is a highly prevalent disease with high mortality rates worldwide, representing the final stage of a large set of cardiovascular diseases.

Purpose

To evaluate the trend of mortality rates fromHF, by sex and Brazilian geoeconomic region, between 1980 and 2016.

Methods

Time series analysis of the underlying causes of death from HF between 1980 and 2016. Population and death-related data were obtained from the Information Technology Department of the Brazilian Unified Health System (DATASUS/MS). Annual crude mortality rates per 100,000 inhabitants were calculated. Standardized rates were estimated according to the age structure of the Brazilian population in the year 2000. Mortality rates were evaluated in all federal units (FedUs) that comprise the Braziliangeoeconomicregions (Northern, Northeastern, Southeastern, Southern and West-Central).

Results

In Brazil, of the 35,348,374 deaths recorded between 1980 and 2016, 3.2% had HF as the underlying cause. The crude mortality rates from HF in both sexes showed a similar reduction trend over the period. In men, those rates ranged from 13.77 in 1980 to 6.69 per 100,000 inhabitants in 2016, while in women, those rates ranged from 13.15 in 1980 to 7.27 per 100,000 inhabitants in 2016 (Figure 1). Despite the relative stability in the last decade, the standardized rates (Figure 1 - Std) showed a similar trend, but with lower values at the end of the study period. Of all FedUs, only Maranhão (Northeastern region) showed a mortality rate similar to that observed in 1980 (10.44 per 100,000 inhabitants in 1980 and 10.65 per 100,000 inhabitants in 2016). All the other FedUs showed a reduction over the period. The FedUs of the Southeastern, Southern and West-Central regions had the highest reductions, especially Espírito Santo (Southeastern region), Rio Grande do Sul (Southern region) and the Federal District, which decreased from 38.98, 53.34 and 28.56 in 1980 to 3.43, 8.49 and 4.33 per 100,000 inhabitants in 2016, respectively.

Figure 1

Conclusions

The crude and standardized mortality rates from HF decreased in the last 37 years, probably because of the better control of risk factors and the advances in HF treatment. The most important reductions occurred in the richest regions of the country, which may be related to the improvement of socioeconomic factors.

Allergic recurrent coronary stent thrombosis: A mini-review of Kounis syndrome

Kounis syndrome (KS) consists of an association between hypersensitivity reactions triggered by various environmental and pharmacological factors and acute coronary syndromes. Blood supply may be compromised by either vasospasm (type I), native plaque destabilization (type II) or stent thrombosis (type III). Although the prognosis is generally favorable, treatment should include aggressive anti-thrombotic and anti-allergic therapies. A case compatible with type III KS, manifested as a macular rash followed by two episodes of stent thrombosis after primary angioplasty (PCI) of the right coronary artery is presented, and complemented by a review on the topic.