Hyperglycemia has the greatest impact on mortality from cardiovascular disease

Several factors increase the risk of 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 from the Brazilian population collected between 2005 and 2017, determining the number of deaths attributed to each risk factor. The objective 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, supported by FAPESP, quantified the impact of each factor associated with death from cardiovascular disease. Hyperglycemia was five to ten times more correlated than the other factors.

The dataset comes from government sources such as the Department of Health, Department of Social Development and IBGE, 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 mortality from cardiovascular disease. Moreover, the association was not limited to the year analyzed but lasted up to a decade,” said Renato Gaspar, one of the FAPESP-supported authors. Gaspar conducts postdoctoral research at the Heart Institute’s Vascular Biology Laboratory (InCor) attached to the Faculty of Medicine of the University of São Paulo (FM-USP).

Previous research has established an equation to calculate the number of deaths averted or delayed by changes in risk factors. On this basis, the researchers calculated the “premature” mortality rate in relation to the average life expectancy, concluding that approximately 5,000 people would not have died of cardiovascular diseases during the period analyzed if the incidence of diabetes had been lower. In contrast, at least 17,000 deaths were averted by reducing smoking over the 12 years in question.

According to the authors, the results provide evidence that strategies aimed at reducing smoking were essential in reducing mortality from cardiovascular disease.

Differences between men and women were also important to the scientists, who note that gender-specific disparities reiterated findings from other studies showing that diabetes and high blood sugar are more important risk factors for women than for men.

Socio-economic impact

Mortality and incidence of cardiovascular diseases decreased by 21% and 8% respectively between 2005 and 2017 in Brazil, mainly due to improved access to basic health care as well as reduced smoking. This discovery took into account the importance of hypertension, which is frequently associated with heart disease. Nevertheless, the contribution of hyperglycemia was seven times greater than that of hypertension, possibly because access to universal health service and better coverage of primary care have elevated hypertension control in the whole population at a higher level.

This analysis was supported by the finding that the association between hyperglycemia and cardiovascular disease mortality was independent of socioeconomic status and access to health care. The researchers inserted covariates into the analyzed models, to adjust household income, government cash transfer programs such as Bolsa Família, gross domestic product (GDP per capita), number of doctors per 1,000 inhabitants and coverage. primary care.

“Along with the importance of increasing incomes, reducing inequality and poverty, and improving access and quality of health care, we need to look at diabetes and high blood sugar in a specific way,” said Gaspar, noting that excessive sugar consumption and related issues are not widely discussed in Brazil. “We need a nutrition education policy. We should discuss whether to put warnings on foods high in sugar, as we already do on cigarette packs, or to levy an additional tax to incentivize manufacturers to reduce the amount of sugar in these products. Other countries discuss such things and we should do it here.”

To help combat cardiovascular disease, health policy should aim directly at reducing the prevalence of hyperglycaemia, through nutrition education, restrictions on foods and beverages with added sugar, or better access to new classes of drugs that reduce the risk of fatal heart attacks faced by diabetics, he said.


São Paulo Research Foundation (FAPESP)

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