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 Such individuals should be evaluated very carefully, since the identification of obesity is not so simple, but mainly because of its association with musculoskeletal diseases, diabetes and AMI. 619 12.5. Population Aspects of Hypertension The treatment of hypertension is known to be effective in relation to the individual, but from the population point of view, it has been frustrating for many reasons. 620-624 These begin with the lack of education in general and particularly in health, which prevents knowledge about the disease and its importance as one of the main CV risk factors. 594-599 They go through the difficulty of accessing health services for the correct diagnosis, proper treatment with guidance on lifestyle and medication use and end with the great challenge of treatment compliance. 620-624 These assumptions alone are sufficient to definitively indicate the actions that can effectively modify the natural history of hypertension and interfere with the equation CV risk, morbidity and mortality. These actions, at the collective level and focusing on primary and primordial prevention, will have a great interface with other CVD risk factors. 10,620-626 Primordial (prevention of risk factors) and primary (actions on installed risk factors) prevention actions, although presenting much better cost effective results, demand more time for their appearance. For this reason, huge amounts are spent on secondary or even primary prevention measures, but with a focus on medicalization which, in an misleading way, shows favorable changes in short-term statistics and may even give political results with immediatist benefits. 10,620-626 It is evident that population intervention must involve the involvement of society as a whole. It should be part of a government policy, and linked in a partnership with organized civil society, non-governmental organizations, and industries in general, especially food producers and beneficiaries. Every action will only achieve the expected objectives if it is developed collectively, with multidimensional action. 10,620-626 It must be highlighted, particularly for hypertension, but has a strong interface with other CV risk factors: • Education as a whole and, in particular, health education for the dissemination of knowledge about CV risk factors and the understanding of the importance of healthy lifestyles; 10,620-626 • Legislation enforcement which encourages the production of healthy foods, and discourages and foods harmful to health; 10,624,625 • The encouragement of families to have healthy lifestyles, with the possibility of monetary benefits in case of lifestyle changes (maintenance of ideal weight, decreased sodium intake, regular physical activity, increased fruit intake, vegetables and cereals, smoking cessation); • The provision of safe areas for the practice of regular physical activity; • Provision of a simplified means for basic assessment of key CV risk factors (BP, body mass index, blood glucose, cholesterol and smoking status); 2,620 • Access to basic medicines when preventive measures fail and the use of drugs to prevent disease is needed. 10,620 12.6. Population Aspects of Dyslipidemia Scientific knowledge leaves no doubt about the relevance of dyslipidemias as an important risk CV factor. 2,628 There is also a general recognition that individual or even collective actions aimed at treatment, although useful and beneficial, are very expensive and much lower cost effective, even in developed countries. 2,627-631 From these premises we have opened a huge door of opportunity. It is unthinkable to admit that the health system, especially in developing countries, such as Brazil, can adequately afford the high costs of treating established diseases. 2,629,630,632 Thus, population-based primary prevention becomes a cost-effective and absolutely sustainable long-term alternative. 633-636 This must be the fundamental mission of any government. Public policies for food quality control, health education at all levels, with priority for young people and, finally, a health system that allows universal access to care and when necessary, drugs as the last option. 633,637,638 It should be noted that small reductions in each of the risk factors may promote large reductions in CV events. Additional benefit can be obtained through the adoption of healthy lifestyles in society that will bring benefits to all risk factors that are completely interconnected (smoking, poor diet, overweight, dyslipidemia, AH and physical inactivity). 632,634,636 Thus the entire population, with an initial focus on children and adolescents, should be encouraged to adopt healthy diets, maintain adequate weight or decrease weight for this purpose, practice regular physical activity with at least moderate intensity and smoking cessation. The government should offer political, legal and financial conditions for the implementation of these actions in the educational field for the entire population. 2,627,628,636 12.6.1. General Practice Measures 639 • Encourage exclusive breastfeeding up to at least 6 months; • Decrease salt content in the preparation of processed and industrialized foods; • Encourage the consumption of fruit and vegetables, as well great supply and accessibility; • Decrease intake of saturated and trans fats, replacing with unsaturated fats; • Decrease sugar content in industrialized beverages; • Reduce food portion sizes and limit excessive caloric intake; • Healthy food supply in all public institutions; • Incentive and collaboration policies with producers for the production and commercialization of healthy foods; • Incentives and continuous health education policy for the population as a whole (with emphasis on children and adolescents; • Improved labeling of processed and industrialized foods. 863