ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Content Introduction ..........................................................................................795 1. Risk Stratification ............................................................................795 1.1. Cardiovascular Risk Stratification to Prevent and Treat Atherosclerosis ........................................................................................795 1.2. Very High Risk ...................................................................................796 1.3. High Risk ..........................................................................................796 1.4. Moderate Risk ..................................................................................796 1.5. Low Risk ...........................................................................................796 2. Dyslipidemia ....................................................................................799 2.1. Introduction ......................................................................................799 2.1.1. Familial Hypercholesterolemia .....................................................800 2.2. Dyslipidemia Treatment ....................................................................800 2.2.1. Non-Pharmacological Therapy .....................................................800 2.2.2. Drug Treatment Focused on Hypercholesterolemia .....................800 2.2.3. Drug Treatment Focused on Hypertriglyceridemia ......................802 3. Diabetes and Metabolic Syndrome ..............................................804 3.1. Myocardial Risk ................................................................................804 3.1.1. Myocardial Risk Estimate ..............................................................804 3.1.2. Preventive Therapies for Individuals at High and Very High Risk for Heart Failure in 5 Years and Secondary Prevention for Those with Clinical Heart Failure ...........................................................................................805 3.1.3. Therapies Focused on Cardiac Remodeling .................................805 3.2. Atherosclerotic Risk ..........................................................................806 3.2.1. Metabolic Syndrome, Diabetes Mellitus, and the Continuous Corollary of Coronary Artery Disease .....................................................806 3.2.2. Primary Prevention Strategies for Coronary Artery Disease in Individuals with Metabolic Syndrome and Diabetes Mellitus ................807 3.2.3. Individual Risk Prediction for Coronary Artery Disease in Patients with Diabetes Mellitus and Metabolic Syndrome ...................................807 3.2.4. Risk Calculator ..............................................................................808 3.2.5. Coronary Artery Calcium Score ....................................................808 3.2.6. Lipid Targets in Primary Prevention for Individuals with Metabolic Syndrome and Diabetes Mellitus ...........................................................808 3.2.7. Aspirin in Primary Prevention .......................................................809 3.2.8. Hypoglycemic Agents in Patients with Diabetes Mellitus ............809 4. Obesity and Overweight .................................................................810 4.1. Introduction ......................................................................................810 4.2. Primary Prevention ...........................................................................811 5. Arterial Hypertension ......................................................................812 5.1. Introduction ......................................................................................812 5.2. Physical Activity and Hypertension ....................................................812 5.3. Psychosocial Factors .........................................................................813 5.4. Diets that Promote the Prevention and Control of Arterial Hypertension ...........................................................................................813 5.5. Alcohol and Hypertension .................................................................814 5.6. Weight Loss and Prevention of Arterial Hypertension ........................815 5.7. Low-Sodium Diet in the Prevention of Arterial Hypertension ..............815 5.8. Antihypertensive Control in Primary Prevention of Diabetes Mellitus and Metabolic Syndrome .........................................................................816 6. Vitamins and Omega-3 Fatty Acids ..............................................817 6.1. Introduction ......................................................................................817 6.2. Carotenoids ......................................................................................817 6.3. Vitamin E ..........................................................................................818 6.4. Vitamin D ..........................................................................................818 6.5. Vitamin K ..........................................................................................819 6.6. Vitamin C ..........................................................................................819 6.7. B Vitamins and Folate .......................................................................819 6.8. Omega-3 Polyunsaturated Fatty Acids of Marine Origin (Docosahexaenoic Acid and Eicosapentaenoic Acid) ................................819 6.9. Effects of Omega-3 on the Lipid Profile .............................................820 6.10. Omega-3 and Cardiovascular Outcomes .........................................820 6.11. Omega-3 in Heart Failure ................................................................820 6.12. Omega-3 Polyunsaturated Fatty Acids of Plant Origin .....................821 7. Smoking ............................................................................................821 7.1. Introduction ......................................................................................821 7.2. Strategies in Combating Smoking Initiation ......................................822 7.3. How to Treat Smoker’s Psychological Dependence ............................822 7.4. Pharmacological Treatment of Smoking ...........................................823 7.4.1. Secondary Intervention Smoking ..................................................823 7.5. Anti-Smoking Drug Combinations .....................................................825 7.6. Future Proposals ...............................................................................826 7.7. Nicotine Electronic Devices (Electronic Cigarette, Heated Cigarette, Pen Drives) .....................................................................................................826 7.8. Hookah .............................................................................................827 7.9. Conclusion ........................................................................................827 8. Physical Activity, Physical Exercise and Sport ............................829 8.1. Introduction ......................................................................................829 8.2. Relevant Concepts and Expressions in Physical Activity ....................829 8.3. Main Acute and Chronic Effects of Exercise .......................................829 8.4. Epidemiological Rationale of the Benefits of Physical Exercise .......829 8.5. Risks of Physical Activity, Physical Exercise and Sport ......................830 8.6. Recommendations for Exercise and Physical Activity ........................830 8.7. Prescription for Exercises ..................................................................831 8.8. Formal and Informal Physical Activity: Encouraging Referral, Implementation and Adherence ..............................................................833 8.9. Final Messages .................................................................................833 9. Spirituality and Psychosocial Factors in Cardiovascular Medicine ................................................................................................833 9.1. Concepts, Definitions and Rationale .................................................833 9.1.1. Introduction ..................................................................................833 9.1.2. Concepts and Definitions .............................................................833 9.1.3. Rationale and Mechanisms ...........................................................834 9.2. Spiritual History and Scales for Measuring Religiosity and Spirituality ...............................................................................................835 9.2.1. Why Address Spirituality and Religiosity ......................................835 9.2.2. Objectives of Spirituality and Religiosity Assessment ..................835 9.2.3. How to Address Patient Spirituality and Religiosity .....................835 9.2.4. Scales and Instruments for Evaluating Spirituality and Religiosity ...............................................................................................835 9.2.5. Attitudes and Behaviors after Spiritual Anamnesis ......................836 9.3. Primary Prevention ...........................................................................838 9.4. Secondary Prevention .......................................................................838 9.5. Recommendations for Clinical Practice ............................................839 10. Associated Diseases, Socioeconomic and Environmental Factors in Cardiovascular Prevention ...............................................841 10.1. Introduction ....................................................................................841 10.2. Socioeconomic Factors and Cardiovascular Risk ............................841 10.3. Environmental Factors and Cardiovascular Risk ..............................842 10.4. Vaccination for People with Heart Disease ......................................843 10.4.1. Prevention of Respiratory Tract Infections in People with Heart Disease ...................................................................................................843 10.4.2. Which Vaccines? .........................................................................843 10.5. Lower Extremity Peripheral Artery Disease .....................................844 10.5.1. Context ........................................................................................844 10.5.2. Interrelationship between the Various Cardiovascular Risk Factors and Lower Extremity Peripheral Artery Disease .....................................845 10.5.3. Summary of Anatomical Location of Atherosclerotic Lesions of Lower Extremity Peripheral Artery Disease ............................................846 10.5.4. Preventive Management of Lower Extremity Peripheral Artery Disease ...................................................................................................846 10.6. Autoimmune Diseases and Cardiovascular Risk .............................847 10.7. Chronic Kidney Disease ...................................................................849 10.8. Obstructive Sleep Apnea .................................................................850 10.9. Erectile Dysfunction ........................................................................850 10.10. Prevention of Rheumatic Heart Disease .......................................851 794