ABC | Volume 110, Nº6, June 2018

Original Article Cardiovascular Disease Epidemiology in Portuguese-Speaking Countries: data from the Global Burden of Disease, 1990 to 2016 Bruno Ramos Nascimento, 1 Luisa Campos Caldeira Brant, 1 Gláucia Maria Moraes de Oliveira, 2 Marcus Vinícius Bolívar Malachias, 3 Gabriel Moreira Alves Reis, 1 Renato Azeredo Teixeira, 1 Deborah Carvalho Malta, 1 Elisabeth França, 1 Maria de Fátima Marinho Souza, 4 Gregory A. Roth, 5 Antonio Luiz P. Ribeiro 1 Universidade Federal de Minas Gerais (UFMG), 1 Belo Horizonte, MG – Brazil Universidade Federal do Rio de Janeiro, 2 Rio de Janeiro, RJ - Brazil Faculdade Ciências Médicas de Minas Gerais, 3 Belo Horizonte, MG - Brazil Ministério da Saúde, Brasília, 4 DF - Brazil University of Washington, 5 Seattle, WA - USA Mailing Address: Gláucia Maria Moraes de Oliveira • Universidade Federal do Rio de Janeiro – R. Prof. Rodolpho P. Rocco, 255 – Prédio do HU 8º andar – sala 6, UFRJ. Postal Code 21941-913, Cidade Universitária, RJ – Brazil E-mail: glauciam@cardiol.br , glauciamoraesoliveira@gmail.com Manuscript received December 08, 2017, revised manuscript March 21, 2018, accepted March 21, 2018 DOI: 10.5935/abc.20180098 Abstract Background: Portuguese-speaking countries (PSC) share the influence of the Portuguese culture but have socioeconomic development patterns that differ from that of Portugal. Objective: To describe trends in cardiovascular disease (CVD) morbidity and mortality in the PSC between 1990 and 2016, stratified by sex, and their association with the respective sociodemographic indexes (SDI). Methods: This study used the Global Burden of Disease (GBD) 2016 data and methodology. Data collection followed international standards for death certification, through information systems on vital statistics and mortality surveillance, surveys, and hospital registries. Techniques were used to standardize causes of death by the direct method, as were corrections for underreporting of deaths and garbage codes. To determine the number of deaths due to each cause, the CODEm (Cause of Death Ensemble Model) algorithmwas applied. Disability-adjusted life years (DALYs) and SDI (income per capita, educational attainment and total fertility rate) were estimated for each country. A p-value < 0.05 was considered significant. Results: There are large differences, mainly related to socioeconomic conditions, in the relative impact of CVD burden in PSC. Among CVD, ischemic heart disease was the leading cause of death in all PSC in 2016, except for Mozambique and Sao Tome and Principe, where cerebrovascular diseases have supplanted it. The most relevant attributable risk factors for CVD among all PSC are hypertension and dietary factors. Conclusion: Collaboration among PSC may allow successful experiences in combating CVD to be shared between those countries. (Arq Bras Cardiol. 2018; 110(6):500-511) Keywords: Cardiovascular Diseases; Epidemiology; Mortality; Global Burden of Disease / trends. Introduction Cardiovascular diseases (CVD) are a major cause of death worldwide. Although CVD are not the first cause of death in many low- and middle-income countries, they account for 80% of the deaths and 88% of the premature deaths in those countries. 1 The control of infectious, maternal and child diseases, the increase in life expectancy and the growing urbanization have contributed to the trend towards increasing the importance of CVD in low- and middle-income countries. The implementation of health policies, such as promotion of a healthy lifestyle, access to primary and secondary prevention of CVD and treatment of acute cardiovascular events, is, thus, essential for CVD control in all countries. 1 Portuguese-speaking countries (PSC) were culturally influenced by Portugal at different levels. 2 The study of the trends in morbidity and mortality from CVD in those countries can provide us useful data regarding the similarities and differences between them. Those data can provide an exchange of information between countries regarding well‑succeeded actions for fighting CVD, in addition to allowing reflections on the influence of culture on the burden of CVD. The “Global Burden of Disease Study” (GBD Study) is an important epidemiological observational study that uses metrics of morbidity and mortality related to major diseases, injuries and risk factors at global, at national and regional levels. One of the GBD Study objectives is to understand, by assessing the trends, the changes in the profile of the diseases that affect the 21st century populations. 3 This study was aimed at describing the trends of CVD morbidity and mortality in the PSC between 1990 and 500