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 Chart 12.2 – 669 Sustainable development goals 1. Eradicate poverty 2. End hunger 3. Promote health and well-being 4. Quality and inclusive education 5. Gender equality 6. Clean water and sanitation 7. Clean, renewable energy 8. Employment, decent work and economic growth 9. Innovation in Resilient Infrastructure 10. Reduce inequalities within and between countries 11. Sustainable cities and communities 12. Sustainable production and consumption 13. Tackle climate change 14. Use the seas and marine resources sustainably 15. Promote sustainable use of terrestrial ecosystems; 16. Peace, justice and sound institutions 17. Implement global partnership mortality from circulatory system diseases was analyzed. The decrease in mortality was preceded by an increase in GDPpc, with a strong association between the indicator and mortality rates, showing the importance of improving the living conditions of the population in the reduction of CVmortality. 664 The American Heart Association Document , on the influence of social factors on CVD, revealed that populations with lower educational levels have a higher prevalence of CV risk factors, a higher incidence of CV events, and a higher CV mortality rate, regardless of other demographic factors. 665 12.10. Health and Sustainable Development Health is a timeless value. Good health is a precondition for work and a measure of sustainable development. 666 The WHO created the “Commission of Social Determinants of Health” in 2005 to define health promotion directed at “health equity” in populations, and a global movement to reach it. In an extensive evidence-based publication, WHO prioritized the following actions: early childhood education, healthy housing, urban and rural infrastructure, universal access to health and other services, employment, quality social protection, inclusion social, gender equality. Regardless of policy options, it advocated health equity in all Policies, Systems and Programs through fair financing and “Good Global Governance”. It recommended, as an example, the United Nations (UN) Millennium Project, prepared in 2000 during the Millennium Summit, the largest meeting of world leaders, aimed at establishing a global partnership to reduce extreme poverty. 667,668 The 2015 goals, known as the “Millennium Development Goals (MDG)”, represented a paradigm shift to improve the health of vulnerable and disadvantaged groups. They are: eradicate extreme poverty and hunger; implement a universal basic education; promote gender equality and empower women; reduce child mortality; improve maternal health; combat AIDS, malaria and other infectious diseases; ensure environmental sustainability and develop a global partnership for development. Subsequently, in 2015 the WHO Health report “Health in 2015: from MGDs to SDGs” highlighted health progress on the MDG and redefined priority actions to achieve the new “Goals for Sustainable Development” (SDG). 668 The SDG, which make up Agenda-2030, contain more numerous and ambitious actions (17 goals, 169 goals) than the MDG (8 goals, 21 goals). 668 It recognizes that improving the health of people depends on social justice, environmental protection (climate change, heat waves, droughts, fires, storms, floods), polluting energies, antibiotic resistant agents, aging, migrations, increased global burden of NCD, indivisible pillars of sustainable development. 669 (Chart 12.2). In this context, Brazil launched the “Strategic Action Plan for Coping with NCD in Brazil, 2011-2022” at the UN assembly and implemented a CNCD Surveillance System (VIGITEL) over the last decade that allows the national and global monitoring of NCD targets, representing a breakthrough in NCD Surveillance in the country. 670 Between 2000 and 2011, Brazil recorded an average decline of 2.5% per annum in all major NCD, with a significant decrease of 3.3% in CVD, observed in both sexes and in all regions of the country. 671 However, between 2015 and 2016 there was a trend of stability in mortality rates due to NCD, which may be a consequence of the change in risk factor behavior and worsening of risk factors, living conditions (access to services, unemployment) caused by the economic and the social crisis. 672,673 If these trends are maintained, Brazil may not meet the WHO-UN target set for the reduction in premature mortality from NCD in Agenda – 2030. 12.11. Cardiovascular Prevention, Environment, Sustainability and Associated Diseases Hippocrates, the author of “Airs, Waters, and Places” (400 BC) was probably the first to recognize a relationship between disease and the environment, including the effects of climate and lifestyle. 674 Numerous aspects regardinf the quality of the physical environment (air pollution, cycle paths, green areas, parks) and behavioral factors (smoking, high-fat diets, physical inactivity) are determining factors for increasing or decreasing risks for CVD. 675 Since 2004, the American Heart Association has recognized exposure to air pollution as an important modifiable risk factor for CVD morbidity and mortality in populations, with a higher risk attributable to particulate matter (PM) over gaseous components. 676 Particulate matter < 2.5 μm (PM2.5) is the most important environmental risk factor, with higher risk than gaseous components, posing a major threat to public health. 677 Short-term PM2.5 elevations increase the relative risk of acute CV events by 1% to 3% within a few days. Long-term exposures (years) increase the risk by ± 10%, which is partly attributable to the development of cardiometabolic disorders such as high blood pressure, diabetes mellitus, among others. 677 866