ABC | Volume 110, Nº3, March 2018

Original Article Armstrong et al Urbanization and CV mortality among indigenous populations Arq Bras Cardiol. 2018; 110(3):240-245 Figure 1 – Mortality distribution for indigenous communities in the Sao Francisco Valley (Northeast Brazil) according to age groups. 2007–2009 2010–2011 Years 30-49 50-64 50-64 65-74 65-74 75+ 75+ 30-49 Age Groups Figure 2 – Cardiovascular mortality (≥ 30 y/o) in indigenous and urban populations in the Sao Francisco Valley (Northeast Brazil). Total indigenous refers to total deaths among indigenous populations in the Sao Francisco Valley, Northeast Brazil. 35 33 31 29 27 25 23 21 19 2007 2008 2009 2010 2011 Years CV mortality (%) Total indigenous City of Petrolina City of Juazeiro Discussion For the first time in the literature, we show indigenous mortality in the Sao Francisco Valley (Northeast Brazil) tending to a younger age over time, with increasing trends in the proportion of CV deaths. Increases in CV mortality rates in indigenous people living in an area of rapid infrastructural development may indicate that these populations are in harm’s way due to changes related to the urbanization process. The knowledge of CV risk and mortality may aid in health policy planning for endangered traditional indigenous populations. We assessed the available mortality rates – usually a reliable source of information – to explore the indigenous CV burden in Northeast Brazil’s Sao Francisco Valley. This area has been through accelerated infrastructural development, such as construction of large canals and dams. Along recent year, hydroelectric power plants have been constructed along the Sao Francisco River, which now the highest concentration of power plants in Brazil. 9 Our findings indicate that the traditional indigenous populations affected by a rapid urbanization process are at increased risk of CV mortality. Urbanization may be related to CV risk beyond ethnicity. In this regard, African Americans have shown higher coronary heart disease mortality rates than Whites, but apparently there are additional disparities according to the urbanization level of the population. The coronary disease‑related mortality rates in large metropolitan areas showed a decline over the years in a higher magnitude compared to rural areas. 13 Similar findings have been reported in diverse countries. 14-16 There are few reports on indigenous health 242