Prevalência de alto risco cardiovascular na população adulta brasileira segundo diferentes critérios: estudo comparativo

Abstract

Resumo O estudo visa comparar a proporção de indivíduos classificados como portadores de alto risco cardiovascular (RCV) na população adulta brasileira, segundo seis diferentes calculadoras de risco, visando analisar a concordância entre as medidas. Estudo transversal, no qual foram utilizados dados laboratoriais da Pesquisa Nacional de Saúde (PNS). As prevalências do RCV em 10 anos para a população entre 45 e 64 anos foram: Escore de risco global (ERG) da Sociedade Geral de Cardiologia (SBC):38,1%, “American College of Cardiology” e “American Heart Association” ACC/AHA, 44,1%, “Framingham Heart Study”/ERG 19,4%, SCORE da “European Society of Cardiology”, 14,6, Organização Mundial da Saúde/Sociedade Internacional de hipertensão (OMS/ISH) e Lim et al. As calculadoras de RCV apresentaram baixa concordância para identificar os indivíduos de alto risco e alta concordância dos de risco baixo/moderado, exceto pela ACC/AHA. O emprego de diferentes calculadoras resultou em diferentes populações elegíveis para iniciar a terapia farmacológica para prevenção cardiovascular, o que pode implicar em percepções de risco inadequadas, baixo custo efetividade desse tratamento e dificuldade de implementação de políticas públicas.

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“…Por isso, a identificação de pacientes com elevado risco cardiovascular ou doenças cardiovasculares preexistentes é uma ação prioritária para a detecção e gerenciamento precoce desses riscos na Atenção Primária de Saúde (MALTA et al, 2021a).…”

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“…Another suggestion by Mello et al is to use the information promptly available in primary care to calculate CVR, such as previous examinations or blood pressure measurements. Malta et al 17 highlight how differences between CVR scores can derive from different aspects: the eligible population, predictors, and the weight of each predictor and/or outcomes (Table 1). 17 Finally, the cut-offs recommended by CVR calculators differ and are arbitrarily defined.…”

“…Malta et al 17 highlight how differences between CVR scores can derive from different aspects: the eligible population, predictors, and the weight of each predictor and/or outcomes (Table 1). 17 Finally, the cut-offs recommended by CVR calculators differ and are arbitrarily defined. 17 These divergences can confuse clinicians and result in misperceptions of risk and difficulties in implementing public policies, as emphasized in other international 18 and national 17 studies.…”

“…17 Finally, the cut-offs recommended by CVR calculators differ and are arbitrarily defined. 17 These divergences can confuse clinicians and result in misperceptions of risk and difficulties in implementing public policies, as emphasized in other international 18 and national 17 studies. In Brazil, the prevalence of individuals aged 45 to 64 years classified as intermediate or high CVR using data from the NHS had a large variation, from 2.5% (95%CI 1.8-3.3) to 44.1% (95%CI 39.7-47.3), according to which of the six scores was used.…”

“…Some scores calculate only the risk of cardiovascular deaths, while others include non-fatal cardiovascular events. 13 According to Malta et al, 17 "the choice for which CVR calculator should be used in Brazil is under debate, in the sense that there is no equation derived from a study conducted in the Brazilian population that considers the characteristics of our population, such as the racial composition, socioeconomic and geographic conditions. " For that, longitudinal data evaluating MACE are needed but are not yet available in the country.…”