Several factors increase the risk of a heart attack, such as high blood sugar (hyperglycemia), obesity, abnormal cholesterol levels, high blood pressure (hypertension), and smoking. A study conducted in Brazil and reported in an article published in the journal PLOS ONE measured the impact of these factors. The researchers analyzed data for the Brazilian population collected between 2005 and 2017 and determined the number of deaths attributed to each risk factor. The aim of the study was to contribute to the development of more effective strategies to reduce the incidence of cardiovascular diseases, which have long been the leading causes of death in Brazil.
The study, which was supported by FAPESP, quantified the impact of each factor associated with death from cardiovascular disease. Hyperglycemia correlated five to ten times more than other factors.
The data set comes from government sources such as the Department of Health, Department of Social Development and BIM, the National Bureau of Statistics, as well as foreign sources such as the Global Health Data Exchange (GHDx) and the Institute for Health Metrics at the University of Washington and Evaluation (IHME).
“Regardless of the control we used – and we tested variables, statistical models and methods of different types – diabetes was also associated with death from cardiovascular disease. Moreover, the association was not limited to the year analysed, but lasted up to ten years,” said Renato Gaspar, one of the authors supported by FAPESP. Gaspar conducts postdoctoral research at the Vascular Biology Laboratory of the Heart Institute (InCor), affiliated with the University of São Paulo’s Medical School (FM-USP).
Previous research has established an equation to calculate the number of deaths prevented or delayed by changes in risk factors. Based on this, the researchers calculated the ‘premature’ death rate compared to average life expectancy, and concluded that some 5,000 people would not have died from cardiovascular disease over the period analyzed if the incidence of diabetes had been lower. By contrast, in the 12 years in question, at least 17,000 deaths were avoided through reduced smoking.
According to the authors, the findings provide evidence that smoking-reduction strategies were key to reducing mortality from cardiovascular disease.
Differences between men and women were also significant for the scientists, who noted that sex-specific inequalities echoed the findings of other studies showing that diabetes and hyperglycemia are more significant risk factors for women than for men.
The mortality and incidence of cardiovascular disease decreased by 21% and 8% respectively in Brazil between 2005 and 2017, mainly due to improved access to basic health care and the reduction of smoking. This finding took into account the importance of hypertension, which is often associated with heart disease. Nevertheless, the contribution of hyperglycemia was seven times that of hypertension, possibly because access to universal health service and better coverage of primary care took the control of hypertension in the total population to a higher level.
This analysis was confirmed by the finding that the association between hyperglycemia and cardiovascular disease death was independent of socioeconomic status and access to health care. The researchers inserted covariates into the models analyzed to adjust for household income, government money transfer programs such as Bolsa Família, gross domestic product (GDP per capita), number of physicians per 1,000 residents, and primary care coverage.
“In addition to the importance of increasing income, reducing inequality and poverty, and improving access and quality of health care, we need to look at diabetes and hyperglycemia in a specific way,” Gaspar said, pointing out that excessive consumption of sugar and related matters are not much discussed in Brazil. “We need a nutrition education policy. We need to discuss whether it’s worth putting warnings on high-sugar foods, like we already do on cigarette packs, or levying an additional tax to get manufacturers to cut the amount of sugar in these products. Other countries discuss such things and we should do that here.”
To help fight cardiovascular disease, health policies should focus directly on reducing the prevalence of hyperglycemia, through nutritional education, restrictions on foods and drinks with added sugar or improved access to new classes of drugs that reduce the risk of a fatal heart attack. diabetics face reduce, he said.
About Sao Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution whose mission is to support scientific research in all fields of knowledge by awarding grants, fellowships and grants to researchers affiliated with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by collaborating internationally with the best researchers. Therefore, it has established partnerships with funding agencies, higher education, private companies and research organizations in other countries known for the quality of their research, and has encouraged scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit the FAPESP news agency at www.agencia.fapesp.br/en to stay informed about the latest scientific breakthroughs that FAPESP is helping to achieve through its many programs, awards and research centers. You can also subscribe to the FAPESP news agency at https://agencia.fapesp.br/subscribe