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 12. Populational Approach to Risk Factors for Cardiovascular Diseases 12.1. Introduction The population is aging, in Brazil and in the world. The Brazilian population has maintained an aging trend in recent years and has gained 4.8 million elderly people since 2012, surpassing the 30.2 million mark in 2017, according to the National Household Sample Survey – PNAD. 594 In 2012, there were 25.4 million people aged 60 and over. The 4.8 million new elderly in five years correspond to an 18% growth in this age group, which has become increasingly representative in Brazil. Women are the majority in this group, with 16.9 million (56% of the elderly), while elderly men are 13.3 million (44% of the group). 594 Between 2012 and 2017, the number of elderly grew in all units of the federation, with Rio de Janeiro and Rio Grande do Sul being the states with the highest proportion of elderly, both with 18.6% of their populations within this age group. Amapá, in turn, is the state with the lowest percentage of the elderly, with only 7.2% of the population (Figure 12.1). 594 According to the WHO, the world’s population of elderly people is increasing, and in the coming decades the world’s population of people over 60 years of age will grow from the current 841 million to 2 billion by 2050, making chronic diseases and well-being new global public health challenges. 595 “By 2020 we will have for the first time in history more people over 60 than children under five,” reported the WHO in a health and aging series in The Lancet medical journal, noting that 80% of older people will live in low- and middle- income countries. 595 The WHO also states that the increase in longevity, especially in high-income countries, is mainly due to the decline in CVD deaths - such as stroke and ischemic heart disease, through simple and cost-effective interventions to reduce smoking and high BP. 595 Old people or very old people (aged 85 and over) will increase by 351% between 2010 and 2050, compared with an increase of 188% for the population aged 65 and over and an increase of 22% for the 65-year-old population (Figure 12.2). 596 Over the next 10 to 15 years, people in every region of the world will suffer more deaths and disabilities from noncommunicable diseases such as heart disease, cancer, and diabetes. 596 These data are directly linked to inadequate lifestyles of the population, such as physical inactivity, obesity and stress, leading to an increased prevalence of risk factors such as hypertension, smoking, diabetes and dyslipidemia, with consequent increase in mortality and CV morbidity. AH is the leading risk factor for death and CVD worldwide 597,598 Figure 12.3. 597-599 The deaths attributable to CV risk factors can be seen in Figure 12.3. Figure 12.1 – Population distribution by sex and age group - 2017. Source: Number of elderly grows 18% in 5 years and exceeds 30 million in 2017. IBGE. 1 https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/20980-numero-de-idosos-cresce-18-em-5-anos-e-ultrapassa-30-milhoes- em-2017.html Years % of the population Years 80 or older 75 - 79 70 - 74 65 - 69 60 - 64 55 - 59 50 - 54 45 - 49 40 - 44 35 - 39 30 - 34 25 - 29 20 - 24 15 - 19 10 - 14 5 - 9 0 - 4 80 or older 75 - 79 70 - 74 65 - 69 60 - 64 55 - 59 50 - 54 45 - 49 40 - 44 35 - 39 30 - 34 25 - 29 20 - 24 15 - 19 10 - 14 5 - 9 0 - 4 860