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 Based on the above data, strategies to address these risk factors, as well as disease prevention and health promotion actions for at-risk populations should be implemented as soon as possible, and start as early as possible. Some considerations related to the population aspects of risk factors will be discussed specifically in this chapter and others. 12.2. Population Aspect of Smoking Cigarette smoking is one of the leading and preventable causes of mortality in the world. This habit accounts for 12% of adult mortality worldwide, which corresponds to 5 million people; if this persists, 10 million people per year will die and 70% of these deaths will occur in developing countries. Specifically in Brazil, the National Congress approved the text of the Global Framework Convention on Tobacco Use (FCTC) through Legislative Decree 1012 of October 28, 2005, and the Brazilian government ratified the 2005 Convention which entered into force on February 1, 2006. The primary goal of the FCTC is to preserve present and future generations from the devastating health, social, environmental and economic consequences of smoking and exposure to tobacco smoke. It establishes some of its obligations to draft and update smoking control policy, establish an international coordination and cooperation mechanism with other States Parties, and protect national policies against the interests of the tobacco industry. World No Tobacco Day was created in 1987 by the member states of the World Health Organization to draw the world’s attention to the epidemic of smoking and preventable tobacco-related diseases and deaths; there are over 1 billion smokers in the world and 80% of them are in low- and middle-income countries where the effects of smoking-related illnesses and deaths is highest; current smokers are presumed to consume around 6 trillion cigarettes every year. 12.3. May 31 st - World No Tobacco Day Federal Law 12546/2011 in force since December 2014 was published and must be known and respected by all, as well as be adequately enforced the Health Surveillance Sectors in particular. 601 Data on VIGITEL released in April 2012 revealed a 14.8% drop in smokers in Brazil in people over 18 years. Among men, the percentage of smokers was 18.1% and in women 12%. The capitals with the most smokers are: Porto Alegre 23%, Curitiba 20% and São Paulo 19%; and Maceió 8%, João Pessoa, Aracaju and Salvador are the capitals with the lowest incidence of smoking in the Northeast with 9%. 602 There are strategies for tobacco control: a) Prevention It is essential to prevent young people from trying cigarettes, because if they do, there is a 50% chance that they will become addicted. Hence the importance of education from family and schools. Enforcement of the Anti-smoking Act which bans the advertisement of tobacco products and other actions directed at underage young people. 603 b) Protection Protect the population from the effects of environmental tobacco smoke and the influences that lead to smoking, particularly those related to the social group. Strictly enforce the anti-smoking law, which among other rules, prohibited smoking in public environments. 603 12.4. Population Aspects of Obesity and Overweight Relationships between sociodemographic characteristics and lifestyle habits such as income, socioeconomic status, nutritional status, and physical inactivity with weight gain have been established. 604-610 In addition, especially in the last two decades, international authorities have strongly recommended the implementation of effective obesity prevention policies. However, no country in the world has succeeded in reversing the obesity epidemic. 611,612 A number of factors may explain the failure to combat obesity, but perhaps the most important is the way it is still understood by most people. Instead of being perceived as a chronic, complex disease, the result of the interaction of genetic and environmental variables, strongly influenced by socio-economic and cultural factors with a highly obesogenic environment, obesity is seen as a personal failure. Obese people are often blamed for their disease, being judged lazy, undisciplined, unmotivated and negligent. 611,612 From a population standpoint several measures have already been tested and found to be successful locally or for a predetermined period of time. The great challenge is to institute these measures in a more comprehensive and lasting way, and to identify cultural and regional particularities that allow adaptations of these policies to each of the realities. 613,614 Interventions in schools are the most common and most promising, precisely because of their educational and anti- obesity character in the early stages of life. Modifications in school lunches, sedentary lifestyle, health education are examples of measures that have been beneficial not only for the children and adolescents involved, but also for adults in the same circle. Fighting physical inactivity in an organized way, with mass campaigns, in addition to more regionalized actions, focused on a particular exercise practice has also been shown to be beneficial for reducing obesity. There is also a lot of research focused on reducing the amount of physical activity required to achieve the weight reduction benefit. Such studies arise precisely from the lack of time to devote to exercise, which ends up being the justification for the sedentary lifestyle of most people. 615 Finally, there are still population actions aimed at improving people’s diets. Such measures are extremely varied, but ultimately use mostly financial interventions to target dietary choices and habits that are associated with overweight/obesity. There are examples of taxing sweetened beverages, financial incentives to purchase healthy foods, types of financial penalties for buying unhealthy foods, reductions in health-care-related health insurance costs, and maintaining healthy diets. 618 A concern that should be highlighted in view of population aging is the high prevalence of obesity in older populations. 862