Cerebrovascular disease (CBVD) remains the leading cause of death in Rio de Janeiro, with poverty, poor fitness and education levels, and increasing rates of obesity contributing to these deaths annually, said Dr. Regina Fonseca from the Federal University of Rio de Janeiro.
Slums, or favelas sometimes scattered amongst the city’s many beautiful and affluent neighbourhoods, contribute to a striking geographical pattern of CBVD mortality that is directly linked to socioeconomics, said Dr. Fonseca, who presented her findings at the ESC Congress in Amsterdam earlier this month.
The study scored areas of Rio based on socioeconomic status and showed higher death rates corresponding to lower socioeconomic scores, with male gender, older age and poor education increasing the risk across all regions.
“Lower social development correlates with poor access to health care, poor therapeutic adherence and also higher incidence of infectious diseases since childhood, which, according to previous studies, may be associated with persistent inflammation and development of atherosclerosis,” said Dr. Fonseca.
“Low education also leads to poor knowledge about CBVD, troubled doctor-patient relationships and especially a misunderstanding of the need to prevent risk factors.”
This is particularly true of hypertension, she added. “In Brazil, despite increasing health campaigns, currently only 20-30% of hypertensive patients are controlled on medication.”
The data from Dr. Fonseca’s study highlights a problem that is also very common in Europe, said Professor Fausto Pinto, president-elect of the European Society of Cardiology (ESC), which will deliver an educational programme at the BSC congress - the largest cardiology conference in Latin America.
“The under-treatment of hypertension is responsible for a high number of complications associated with this very important risk factor, such as acute coronary syndromes and stroke,” he said. “During our recent ESC Congress in Amsterdam several studies highlighted this problem, including the new ESC-ESH Guidelines on Hypertension(1) and an update on the PURE study(2).”
Investigators from the PURE study showed that while higher income countries battle more cardiovascular risk factors compared to less prosperous countries, they have lower cardiovascular mortality rates largely due to superior healthcare. Among the 17 countries in the PURE study, Brazil was classified as “upper-middle income” along with Argentina, Chile, Poland, Turkey, South Africa, and Malaysia.
While deficiencies in national healthcare programs play a major role in under-diagnosis and treatment of cardiovascular problems, the new ESC-ESH Guidelines on Hypertension also emphasise that lifestyle factors, lack of patient and physician awareness, and physician “inertia” are significant contributors to hypertension.
During the two half days, faculty from Europe and Brazil will present and discuss some of the clinical trials and guidelines presented in Amsterdam, “following previous similar events in the last years that proved to be very successful,” said Professor Pinto.
“This activity will certainly provide an excellent opportunity for an exchange of information and ideas that, at the end, will be very important to improve patient management."
The BSC is an affiliated society of the ESC and has around 13,000 members.