Trends in Productive Years of Life Lost to Premature Mortality Due to Coronary Heart Disease

OBJECTIVE: To estimate the number of productive years of life lost to premature death due to coronary heart disease in Brazil and to report their trends over a 20-year period. METHODS: The Brazilian Ministry of Health raw database on death due to coronary heart disease from 1979-1998 was used. The productive years of life lost to premature death were estimated using 20 and 59 years of age as the cut points for the productive years, replacing the potential years of 1 and 70 of the original formula. A descriptive analysis was provided with adjustments, means, proportions, ratios, percentages of increase or reduction, and mobile means. RESULTS: A 35.8% increase in death for males and 51.3% for females was observed, +43.3% being the relative difference for females. The annual means of the productive years of life prematurely lost were analyzed in 140,865 males and 58,559 females, with the differential ratio between the age groups ranging from 2.3 to 2.5. The annual means were less favorable for males. Within each group (intragroup), the ratios decreased with the increase in age, and the age means at the time of death remained constant. The raw tendencies decreased in the 20- to 29-year age group and increased in the 40- to 59-year age group for females and the 40- to 49-year age group for males. When adjusted, the raw tendencies decreased. CONCLUSION: The 43.3% increase in the number of female deaths as compared with that of males and the ascending tendency in the productive years of life lost in the 40- to 59-year age group point to the influence of unfavorable changes in female lifestyles and suggest a deficiency in programs for prevention and control of risk factors and in their treatment in both sexes.

Quantifying the risk of coronary artery disease in a community: The Bambuí Project

OBJECTIVE: To determine the coronary risk profile in adults and elderly in a community. METHODS: The study comprised a sample of adults (30-59 years, n=547) and the entire elderly population (60-74 years, n=1165) residing in Bambuí town, Brazil. The Framingham score based on sex, age, smoking, diabetes mellitus, systolic and diastolic blood pressure, total cholesterol, and HDL-C was used. The score based on age and sex was defined as "expected" and compared with the mean score obtained by the sum of all risk factors in each age group and sex (score "observed"). RESULTS: The difference between the scores "observed" and "expected" increased with aging in both sexes. Smoking increased the difference from 30 years of age onwards, in both sexes, and hypertension was important in men above the age of 30 years and in women above the age of 50 years. Diabetes and elevated total cholesterol increased the risk of the disease above the age of 50 years in both sexes. A higher level of HDL-C reduced the risk among men above the age of 30 years, with no significant difference among women. Less schooling (< 4 years versus ³ 4 years) was associated with a higher score in adults of both sexes, but not among the elderly. CONCLUSION: Based on these results, in the community studied, the risk of coronary artery disease may be reduced up to 44% in men and 38% in women.

Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease

Abstract Background: Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy. Objective: To determine the risk factors associated with cardiovascular and neonatal complications. Methods: We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories. Results: Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity. Conclusion: The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).