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 representatives or leaders can bring comfort, balance and better management and can contribute to a desired consensus. The approach of spirituality and religiosity topics in medical consultation in an area such as cardiology, where the patient is generally in a situation of fragility, and more sensitive and stressful, increases the complexity of the multiple variables already mentioned and may generate some conflicts. The misunderstanding or intolerance of the parties involved are major factors and can generate conflicts of various kinds and at all interfaces involving the patients, their families and their relationships, within the multidisciplinary team itself and between the team and the patient. All these problems can be prevented by good management of the doctor-patient relationship which, once consolidated, will make all other situations less influential. Conflicts can be avoided even for untrained professionals, as long as some important steps are followed: conduct spiritual anamnesis without prejudice, showing deep interest and respect for the patient, seeking to understand their religion, beliefs, and practices, 363 encourage questions to help patients clarify their feelings and thoughts about the spiritual perspective of what is going on or even their possible spiritual problems. 393 In questions related to spirituality and religiosity, it should be kept in mind that it is always better to understand than to advise. Concepts involving evidence-based medicine have also been applied in the realm of spirituality, but the available evidence is not always ideal and definitive. In these scenarios, available evidence should be used to improve this practice, also contributing to the revision of old concepts, the development of new research and the advancement of science in the field of spirituality. In Chart 9.4, GEMCA gathers recommendations that may be useful for improving cardiology practice in our country. Chart 9.4 – Practices in spirituality and health. Recommendation class and level of evidence Recommendation Recommendation class Level of evidence References Brief tracking of spirituality and religiosity. I B 388-391,429 Spiritual anamnesis of patients with chronic diseases or with poor prognosis. I B 386,387,393,429,432 Respect and support the patient’s religions, beliefs and personal rituals that are not harmful to treatment. I C 361,365,366, 384 Support from trained professional for patients suffering or with spiritual demands. I C 361,365,366,393 Organizational religiosity is associated with reduced mortality I B 370,371,373,375 Hospital program for training in spirituality and religiosity. IIa C 365,438 Spiritual anamnesis of stable individuals or outpatients. IIa B 384,386,387 DUREL, FICA, HOPE, or FAITH questionnaire to assess spirituality. IIa B 380,386,393,394 Meditation, relaxation techniques and stress management. IIa B 406,424-426 Spirituality and religiosity potentially increase survival. IIa B 370,371,373,375 Spiritual empowerment techniques such as forgiveness, gratitude and resilience. IIb C 412,413,417-420 Evaluate spirituality and religiosity in patients in acute and unstable situations. III C 384,387,439 Prescribe prayers, religious practices or specific religion. III C 365,381,382 10. Associated Diseases, Socioeconomic and Environmental Factors in Cardiovascular Prevention 10.1. Introduction In the last century, humanity has undergone an epidemiological transition in relation to the causes of death; infectious diseases are no longer the leading cause of death while chronic degenerative diseases, especially CVD now take the lead. Although they are still the leading causes of mortality worldwide, from the late 1950s, a decline in CVD mortality began in industrialized countries. In Brazil, this decrease in CVD mortality began to be observed in the late 1970s, with a significant reduction in these rates, despite significant regional differences. 2,440,441 It is not possible to only associate the reduction in mortality due to CVD to the better control of classic CV risk factors such as diabetes, hypertension, obesity, dyslipidemia and smoking, since all of these, except smoking, have increased in prevalence in recent decades. This led to new concepts about occupational, behavioral and environmental risk factors, which are directly influenced by the socioeconomic conditions of the populations and have an important relationship with the causes of mortality. In this chapter, we describe important conditions associated with increased CV risk that require concomitant assessment with classic CV risk factors when addressing CVD as a complex relationship between patients and the context in which they live. 10.2. Socioeconomic Factors and Cardiovascular Risk The health conditions of populations are influenced in a complex way by social determinants such as income 841