ABC | Volume 112, Nº4, April 2019

FSCLP Statement Oliveira et al 2019: Recommendations for reducing tobacco consumption in Portuguese-Speaking countries Arq Bras Cardiol. 2019; 112(4):477-486 Table 2 – Percentage of deaths and attributed risk of tobacco consumption in the various Portuguese-speaking countries 3 Year 2017 Ischemic heart disease Stroke Lung, trachea, and bronchial cancer Chronic obstructive pulmonarydiseases Alzheimer's disease and other dementias DEATH ATTRIBUTED RISK Tobacco Use % (95% CI) DEATH ATTRIBUTED RISK Tobacco Use % (95% CI) DEATH ATTRIBUTED RISK Tobacco Use % (95% CI) DEATH ATTRIBUTED RISK Tobacco Use % (95% CI) DEATH ATTRIBUTED RISK Tobacco Use % (95% CI) Angola 4.79 (4.06 -5.60) 3.99 (3.43-4.59) 0.62 (0.50-0.74) 1.24 (1.01-1.67) 0.90 (0.78-1.03) 22.51 (19.74-25.50) 42.00 (13.13-17.78) 56.32 (51.09 -61.04) 32.93 (26.55-38.62) 13.26 (8.21-18.66) Brazil 13.03 (12.7-13.27) 9.10 (8.88 -9.29) 2.40 (2.35-2.46) 4.83 (4.71-4.96) 5.44 (5.37-5.50) 24.41 (22.31-26.56) 16.60 (14.77-18.51) 64.01 (61.19-66.66) 46.63 (41.89-51.37) 13.29 (7.94-19.28) Cape Verde 15.39 (14.47-16.41) 7.28 (6.43-8.07) 1.65 (1.51-1.79) 2.11 (1.85-2.63) 5.49 (5.16-5.81) 8.78 (7.34-10.32) 7.35 (5.99-8.71) 32.99 (28.26-37.79) 19.03 (14.88-22.74) 2.93 (1.37-4.84) Equatorial Guinea 3.80 (3.24-4.40) 2.95 (2.52-3.40) 0.65 (0.46-0.84) 1.30 (0.96-1.89) 1.35 (1.12 -1.60) 11.38 (9.12-13.65) 7.65 (6.09-9.26) 36.74 (28.63-45.08) 19.91 (15.15-24.66) 6.77 (3.43- 10.67) Guinea-Bissau 6.22 (5.36-7.04) 5.59 (4.87-6.31) 0.44 (0.33-0.55) 1.30 (1.07-1.53) 0.90 (0.75-1.14) 11.6 (9.60-13.87) 8.16 (6.45-10.09) 32.58 (26.63-38.67) 19.19 (14.65-23.83) 2.99 (1.43-5.07) Mozambique 3.77 (3.31-4.26) 5.58 (4.86-6.35) 0.39 (0.33-0.45) 0.91 (0.77-1.08) 0.88 (0.71-1.01) 18.74 (15.5-22.23) 14.00 (11.2616.60) 48.74 (43.34-54.23) 32.06 (26.60-37.33) 8.56 (4.20-13.38) Portugal 12.1 (11.53-12.70) 13.91 (13.31-14.53) 3.87 (3.61-4.11) 5.11 (4.81-5.42) 9.49 (9.07-9.86) 12.69 (11.61-13.74) 7.72 (6.92-8.54) 64.32 (61.42-66.93) 31.71 (27.32-36.26) 7.29 (4.37-10.45) São Tomé and Príncipe 9.77 (8.63-10.92) 8.61 (7.60-9.93) 1.39 (1.06-1.73) 5.19 (4.23-6.07) 2.28 (2.07-2.48) 8.59 (6.9-10.34) 5.51 (4.36-6.79) 33.33 (26.09-40.32) 18.26 (14.46-22.25) 3.26 (1.62=5.33) East Timor 13.00 (10.30-15.20) 15.26 (13.18-17.24) 2.03 (1.65-2.68) 4.34 (3.59-5.08) 2.66 (2.22-3.07) 24.67 (20.66-28.66) 17.21 (14.23-20.33) 59.83 (53.01-66.64) 47.43 (38.34-54.27) 12.18 (6.20-18.91) CI: confidence interval of atrial fibrillation and ventricular tachycardia, and with an increased risk of heart failure and related morbidity and mortality. 13,14 The main tobacco-related diseases and their relative percentages (in parentheses) include coronary diseases and myocardial infarction (25%); chronic obstructive pulmonary diseases (85%); pulmonary neoplasms (90%); neoplasms of the mouth, pharynx, larynx, esophagus, stomach, pancreas, kidney, bladder, cervix, breast (30%); and cerebrovascular diseases (25%). 1,15 The risk of ischemic heart disease and related mortality increase with the smoking duration (in years) and the number of cigarettes smoked per day; the risk of disease occurs at all levels of cigarette consumption, even for individuals consuming fewer than five cigarettes per day and passive smokers. In addition, patients who stop smoking after coronary artery bypass surgery have a reduced risk of hospitalization for heart disease. Smoking cessation is the only effective treatment to prevent progression of thromboangiitis obliterans, improving symptoms and reducing the risk of amputation throughout life. 15,16 Smokingcessationhasseveralbenefitsthatshouldbementioned to smokers during consultation (Table 3). Cigarettes contain more than 7,000 toxic substances, which contribute to CVD in different ways, including adverse hemodynamic effects like increased blood pressure and heart rate, imbalance between supply and consumption of oxygen, changes in coronary blood flow, dysfunction and endothelial damage, hypercoagulability and thrombosis, chronic inflammation, and lipid abnormalities, in addition to serving as a substrate for the occurrence of arrhythmias and cardiovascular events. These effects can be observed even in passive smokers. 13,17 Factors associated with tobacco consumption Tobacco use must be considered a chronic disease that can begin in childhood and adolescence, since about 80% of the individuals who experiment tobacco do so under the age of 18 years. Also, there is a direct relationship between the onset of smoking and the maintenance of the habit in adult life. Thus, primordial prevention is an essential step in smoking control. Primordial prevention of smoking is understood as the prevention of smoking initiation among children and adolescents. Children who use tobacco for 12 months inhale the same amount of nicotine per cigarette as adults do and experience the symptoms of addiction and withdrawal, which usually develop very quickly at this age. One way to approach primordial prevention is by age groups, by observing five main items (“5 As”) for each group: ask , in the sense of inquiring, questioning; advise smoking cessation; assess the motivation and symptoms of tobacco dependence; assist in the attempt to quit smoking; and arrange periodic follow-up. 19-21 479