Several factors that increase the risk of heart attack are already known, such as high glucose (hyperglycemia), obesity, high cholesterol, hypertension and smoking. And now a study published in the journal PLOS ONE has measured the impact of each of them on death statistics from cardiovascular disease. Hyperglycemia showed an association with this outcome five to ten times greater than other factors.
Data from government sources, such as the Ministries of Social Development and Health and the Brazilian Institute of Geography and Statistics (IBGE), registered between 2005 and 2017, were used. The numbers were compared with information from other banks, such as the Global Health Data Exchange (GHDx) and the repository of the Institute for Health Metrics and Evaluation (IHME), University of Washington (United States).
Using statistical methods, the researchers determined the number of deaths attributed to each risk factor. The objective of the research, supported by FAPESP, was to help find more effective strategies to reduce the incidence of cardiovascular diseases – which are still the biggest causes of death in the country.
“Regardless of the control we used – and we tested different types of variables, statistical models and methods – diabetes was always associated with mortality from cardiovascular diseases. More than that: it is an association that was not restricted to the year analyzed, but lasted for up to a decade”, explains Renato Gaspar, a postdoctoral fellow at the Vascular Biology Laboratory of the Instituto do Coração (InCor), linked to the Faculty of Medicine of the University of São Paulo (FM-USP).
Previous studies have established an equation to calculate the number of deaths prevented or postponed due to changes in risk factors. Thus, it was also possible to analyze the rates of “premature” deaths, calculated in relation to the standard life expectancy. The authors concluded that about 5,000 people would not have died from cardiovascular disease in the analyzed period if diabetes rates were lower in the population. On the other hand, the research also led to the conclusion that at least 17,000 deaths were avoided only by reducing cigarette consumption during these 12 years.
“Our findings provide evidence that strategies to reduce smoking were critical to reducing mortality from cardiovascular disease,” the authors point out.
Another point that caught the attention of scientists was the gender differences. “Sexual disparities echo other studies that point to diabetes and hyperglycemia as stronger risk factors for cardiovascular disease in women than in men,” they warn.
Mortality and incidence of cardiovascular diseases decreased by 21% and 8%, respectively, between 2005 and 2017 in Brazil. In addition to the reduction in smoking, greater access to basic health is listed as one of those responsible for the improvement in rates. This observation took into account the issue of hypertension, often associated with heart problems. However, it accounted for seven times fewer deaths from cardiovascular disease than hyperglycemia. One of the possibilities is that access to the universal health system, with an increase in primary care coverage, has made the rate of hypertension control high in the population.
This finding is supported by the fact that the association between hyperglycemia and mortality from cardiovascular disease was independent of socioeconomic status and access to health care. The researchers inserted covariates into the analyzed models to account for data such as family income, Bolsa Família benefit, gross domestic product (GDP) per capita, number of doctors per inhabitant, and primary care coverage.
“In addition to increasing income, reducing inequality and poverty and expanding quality and access to health care, we need to look at diabetes and hyperglycemia in a specific way”, points out Gaspar, noting that the country has rarely discussed issues such as high sugar consumption.
“We need a nutritional education policy. Debating whether it is worth putting a label on sugary products with an alert, such as on cigarette packages, or taxing products with added sugar in order to encourage industries to reduce this ingredient. debated in other countries and that need to be discussed here.”
To mitigate the rates of cardiovascular disease in Brazil, health policies should aim to directly reduce the prevalence of hyperglycemia, whether through nutritional education, restriction of foods with added sugar or wider access to new classes of drugs capable of reducing the chance of a diabetic patient dying from a heart attack.
The article Analyzing the impact of modifiable risk factors on cardiovascular disease mortality in Brazil is available here.