ABC | Volume 114, Nº2, February 2020

Original Article Trends in Mortality Rates from Cardiovascular Disease and Cancer between 2000 and 2015 in the Most Populous Capital Cities of the Five Regions of Brazil Wolney de Andrade Martins, 1 Maria Luiza Garcia Rosa, 1 Ricardo Cardoso de Matos, 2 Willian Douglas de Souza Silva, 2 Erito Marques de Souza Filho, 2, 3 Antonio José Lagoeiro Jorge, 1 Mario Luiz Ribeiro, 2 Eduardo Nani Silva 2 Universidade Federal Fluminense - Programa de Pós-Graduação em Ciências Cardiovasculares, 1 Niterói, RJ – Brazil Universidade Federal Fluminense - Departamento de Medicina Clínica, 2 Niterói, RJ – Brazil Universidade Federal Rural do Rio de Janeiro (UFRRJ), 3 Seropédica, RJ – Brazil Mailing Address: Wolney de Andrade Martins • Universidade Federal Fluminense - Departamento de medicina clínica - Rua Marques do Paraná, 303, 6º Andar. Postal Code 24030-215, Centro, Niterói, RJ – Brazil E-mail: wolney_martins@hotmail.com Manuscript received October 25, 2018, revised manuscript February 18, 2019, accepted March 20, 2019 DOI: https://doi.org/10.36660/abc.20180304 Abstract Background: In many cities around the world, the mortality rate from cancer (CA) has exceeded that from disease of the circulatory system (DCS). Objectives: To compare the mortality curves from DCS and CA in the most populous capital cities of the five regions of Brazil. Methods: Data of mortality rates fromDCS and CA between 2000 and 2015 were collected from the Mortality Information System of Manaus, Salvador, Goiania, Sao Paulo and Curitiba, and categorized by age range into early (30-69 years) and late (≥ 70 years), and by gender of the individuals. Chapters II and IX of the International Classification of Diseases-10 were used for the analysis of causes of deaths. The Joinpoint regression model was used to assess the tendency of the estimated annual percentage change of mortality rate, and the Monte Carlo permutation test was used to detect when changes occurred. Statistical significance was set at 5%. Results: There was a consistent decrease in early and late mortality from DCS in both genders in the cities studied, except for late mortality in men in Manaus. There was a tendency of decrease of mortality rates from CA in São Paulo and Curitiba, and of increase in the rates from CA in Goiania. In Salvador, there was a decrease in early mortality from CA in men and women and an increase in late mortality in both genders. Conclusion: There was a progressive and marked decrease in the mortality rate from DCS and a maintenance or slight increase in CA mortality in the five capital cities studied. These phenomena may lead to the intersection of the curves, with predominance of mortality from CA (old and new cases). (Arq Bras Cardiol. 2020; 114(2):199-206) Keywords: Cardiovascular Diseases/mortality; Coronary Artery Diseases/physiopathology; Neoplasms/mortality; Epidemiology. Introduction Cardio-oncology has emerged as a new area of study and practice, resulting from numerous epidemiological and clinical interactions between diseases of the circulatory system (DCS) and cancer (CA). This interrelationship is supported by the prevalence of common risk factors, population aging, advances in diagnostic and treatment techniques, and cardiovascular injuries secondary to CA treatment. One of the common questions in cardio-oncology is where the intersection point between the curves of mortality for DCS and CA will be, i.e., when DCS will become the leading cause of mortality thereafter. 1 Circulatory diseases have become the most prevalent causes of death in Brazil, followed by CA, since the decrease in the prevalence of infectious diseases. 2,3 In developed countries, there has been a fall in the mortality fromDCS since the mid-1960s, 4,5 and deaths fromCA outweigh deaths from DCS. 6 In Brazil, there has been a reduction in the rate of mortality from DCS since the 1980s, for both sexes, especially in the South and Southeast regions. 7 Concomitantly with this trend, the number of deaths due to CA in Brazil has grown; it went from the fifth to the third cause of death from 1980 to 2000, and today, CA is the second cause of mortality. 8 Cancer is the leading cause of death in half of the United States of America (USA) and in some Western European countries. It has a close relationship with population aging. The drop in mortality fromDCS is partly attributed to improved diagnosis and treatment. 9-11 However, both DCS and CA have a complex relationship mediated by several risk factors common to both, like smoking and alcoholism, overweight and obesity, eating pattern, sedentary lifestyle; hypertension, and diabetes mellitus. 12,13 There are few studies that seek to understand the relationship between CA and DCS in the Brazilian population. Patterns of morbidity and mortality in Brazil have changed 199