IJCS | Volume 31, Nº2, March / April 2018

DOI: 10.5935/2359-4802.20180007 87 EDITORIAL International Journal of Cardiovascular Sciences. 2018;31(2)87-89 Mailing Address: Claudio Tinoco Mesquita Professor da Universidade Federal Fluminense. Programa de Pós-Graduação em Ciências Cardiovasculares. Hospital Universitário Antonio Pedro. Av. Marquês do Paraná 303, Centro, Niterói, RJ – Brazil E-mail: claudiotinocomesquita@id.uff.br Relationship between Social Factors and Cardiovascular Diseases Claudio Tinoco Mesquita Universidade Federal Fluminense, Niterói, RJ – Brazil Cardiovascular Diseases / mortality; Cardiovascular Diseases / epidemiology; Cardiovascular Diseases / prevention and control; Myocardial Ischemia; Risk Factors; Socioeconomic Factors. Keywords “It’s a recession when your neighbor loses his job; it’s a depression when you lose your own.” – Harry Truman For decades, western countries have witnessed cardiovascular diseases leading the statistics for cause of death. In Brazil, diseases of the circulatory system (DCS) represent a major cause of death, accounting, in 2011, for 28.6% of all mortality causes. 1 In amultinational endeavor, the reduction in the risk of premature death due to cardiovascular diseases has been defined as a United Nations Organization sustainable development goal for 2030. 2 Although DCS are the major cause of death worldwide, industrialized countries have shown a decline in death due to DCS. This reduction in cardiovascular mortality has also occurred in Brazil. Mansur & Favarato 3 have shown that significant and constant reduction from1980 to 2012, probably secondary to the easier diagnosis and treatment of systemic arterial hypertension, the main cardiovascular risk factor. Of the several actions that contributed to decrease cardiovascular mortality, the following stand out: cardiovascular preventionwith better control of risk factors; access to new drugs to manage dyslipidemia and prevent myocardial infarction, such as aspirin; fighting smoking and sedentary lifestyle; and themost effective treatment of cardiovascular diseases already established, cardiovascular surgeries and percutaneous procedures. 2 In this issue of the International Journal of Cardiovascular Sciences , Soares et al. 4 report on relevant and innovative data in cardiology: the relationship of cardiovascular mortality with macroeconomics indicators. Correlating gross domestic product per capita (GDPpc) data from several municipalities of the Rio de Janeiro state in recent decades with the reduction in mortality due to DCS, those authors have reported that the decline in mortality has been preceded by a GDPpc elevation, with a strong correlation between that indicator and the mortality rates. Those authors have concluded that the GDPpc variation associated strongly with the decline in mortality due to DCS. 4 Although relevant, the association between social factors and cardiovascular diseases has been little studied. In 2015, the American Heart Association published a document aimed at raising awareness about the influence of social factors on the incidence, treatment and outcomes of cardiovascular diseases. 5 The World Health Organization defines the social components of health as “the circumstances under which individuals are born, grow, live, work and age, in addition to the systems used to cope with diseases”. Of the several social factors related to cardiovascular diseases, education stands out, and studies have shown that individuals with lower educational levels have greater prevalence of cardiovascular risk factors, higher incidence of cardiovascular events and higher cardiovascular mortality rate regardless of other demographic factors. 5 A lower educational level is associated with several risk factors, such as higher sedentary lifestyle rates. 6 Other studies have pointed to the combination of emotional stress and low socioeconomic status in patients experiencing an episode of acute coronary syndrome as a determinant of greater vulnerability to subsequent anxiety and depression, factors associated with worse prognosis. 7 Andrade et al. 8 have reported that certain social factors, such as the number of elderly people, the illiteracy rate and the human development index,