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 11. Child and Adolescence .................................................................853 11.1. Introduction ....................................................................................853 11.2. Childhood and Adolescent Nutrition ................................................853 11.3. Physical Activity in Childhood and Adolescence ..............................854 11.4. Smoking in children and Adolescence ............................................855 11.5. Obesity in Childhood and Adolescence ...........................................855 11.5.1. Diagnosis ....................................................................................855 11.5.2. Consequences .............................................................................855 11.5.3. Etiology .......................................................................................855 11.5.4. Treatment ....................................................................................855 11.6. Systemic Arterial Hypertension in Childhood and Adolescence .......856 11.7. Dyslipidemia in Childhood and Adolescence ...................................857 11.7.1. Causes .........................................................................................857 11.7.2. Normal Value ..............................................................................857 11.7.3. Treatment ....................................................................................857 12. Populational Approach to Risk Factors for Cardiovascular Diseases ................................................................................................860 12.1. Introduction ....................................................................................860 12.2. Population Aspect of Smoking ........................................................862 12.3. May 31 st - World No Tobacco Day ....................................................862 12.4. Population Aspects of Obesity and Overweight ...............................862 12.5. Population Aspects of Hypertension ...............................................863 12.6. Population Aspects of Dyslipidemia ................................................863 12.6.1. General Practice Measures .........................................................863 12.7. Population Aspects of Physical Activity ...........................................864 12.8. Population Approach to Increased Physical Activity ........................864 12.9. Socioeconomic and Environmental Factors and Associated Diseases in Cardiovascular Prevention ....................................................................865 12.10. Health and Sustainable Development ...........................................866 12.11. Cardiovascular Prevention, Environment, Sustainability and Associated Diseases ................................................................................866 12.12. Conclusion ....................................................................................867 References ............................................................................................869 Introduction Cardiovascular disease (CVD) is the leading cause of death worldwide and in Brazil, leading to increased morbidity and disability-adjusted life year (DALY). Despite the decrease in mortality rates and DALY standardized by age in Brazil, possibly as a result of successful health policies, their total number is increasing, mainly due to aging and illnesses in the population. 1 Classical risk factors (hypertension, dyslipidemia, obesity, sedentary lifestyle, smoking, diabetes, and family history) raise the pre-test probability of CVD – particularly of coronary artery disease (CAD) – and determine primary and secondary prevention. Several other factors, including sociodemographic, ethnic, cultural, dietary, and behavioral aspects, can also explain the differences in CVD burden among populations and their trends over the decades. The implementation of health policies, among them, encouraging healthy lifestyle habits and providing access to primary and secondary CVD prevention measures, associated with the treatment of cardiovascular (CV) events are essential to control CVD in all countries, including Brazil. The I Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology ( Sociedade Brasileira de Cardiologia – SBC), published in 2013, 2 aimed at helping reduce CV mortality, as established by the World Health Assembly in May 2012; SBC reaffirmed its commitment to decreasing the premature CVD mortality rate by 25%. 3 However, the reduction in CVD mortality has reached a plateau in the past five years in Brazil, with significant regional variation, suggesting the need for renewing strategies to combat these diseases. 4 With this purpose, SBC revisited its CV prevention guideline, 2 proposing to update themes related to the primary prevention of CVD and suggesting strategies that could assist Brazilian cardiologists in reducing morbidity and mortality from these groups of causes. The Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology – 2019 updates the strategies that address classical risk factors and discusses new concepts, such as the need to gather knowledge about emerging risk factors – for instance, spirituality –, socioeconomic and environmental factors, as well as additional strategies, like the use of vaccines. We hope to contribute to renew the SBC commitment with the Brazilian society and the Strategic Action Plan for tackling Chronic Non-Communicable Diseases (NCD), 5 of which CVD is the main component, with an instrument that will allow systematized access to the current literature, disseminating the knowledge necessary to resume the decreasing trend in CV mortality in Brazil. 1. Risk Stratification 1.1. Cardiovascular Risk Stratification to Prevent and Treat Atherosclerosis The first manifestation of atherosclerotic disease in approximately half of the people who have this complication is an acute coronary event. Therefore, identifying asymptomatic individuals with higher predisposition is crucial for effective prevention associated with the correct definition of therapeutic targets. The so-called risk scores and algorithms based on regression analysis of population studies were created to estimate the severity of CVD, substantially enhancing the identification of overall risk. The Framingham gloal risk score (GRS) 6 included the estimate of 10 years of coronary and cerebrovascular events, peripheral arterial disease, or heart failure (HF) and was the score adopted by the Department of Atherosclerosis of SBC ( Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia – SBC-DA). 7 In addition, individuals who have multiple risk factors for CV, subclinical atherosclerosis, or already had manifestations of CVD have a high risk for events and can be classified differently. Thus, the new CV risk stratification proposed by the SBC- DA defines four levels of CV risk: • Very high risk • High risk • Moderate risk • Low risk 795