IJCS | Volume 31, Nº2, March / April 2018

88 10.0 8.0 4.0 6.0 2.0 0.0 –2.0 –4.0 –6.0 1977 1982 1987 1992 2002 2012 1997 2007 2017 Annual percentage variation of the GDP in Brazil between 1979 and 2016 Figure 1 – Annual percentage variation of the gross domestic product (GDP) in Brazil between 1979 and 2016. Source: Fundação Getúlio Vargas - National Account Center - several publications from 1947 to 1989; IBGE. Research Executive Board. National Account Coordination. https:// agenciadenoticias.ibge.gov.br (accessed on February 19, 2018). ClaudioTinoco Relationship Between Social Factors and Cardiovascular Diseases Int J Cardiovasc Sci. 2018;31(2)87-89 Editorial contribute to mortality due to ischemic heart disease in Brazil. Those authors have found an inverse relationship between GDP and cardiovascular mortality, as well as a lower cardiovascular mortality rate in the most populous cities, which might have more resources to cope with acute complications of ischemic heart disease. It is worth noting that those authors have found a relationship of cardiovascular mortality with the distance between the patients’ household and the healthcare centers, indicating that patients living on the periphery of larger cities have higher cardiovascular complication rates. 8 Figure 1 shows worrisome data by illustrating the behavior of GDP in Brazil in recent decades. After a variable period of GDP growth, Brazil faced two consecutive years of GDP reduction, and the Rio de Janeiro state was particularly affected from the social viewpoint, with regression in several social development indicators, consequent to the significant crisis in the oil sector. Such data added to the increase in obesity and in the prevalence of diabetes in Brazil might have accounted for the interruption in the decline in cardiovascular mortality reported by Mansur & Favarato 3 since 2010 in Brazil, contributing to the unprecedented increase in cardiovascular mortality after years of progressive drops. In the United States, a similar phenomenon has been recently observed and has raised adverse expectations regarding the cardiovascular mortality decline trajectory. 9 We congratulate the authors on their study that evidences the importance of improving the population’s life conditions to reduce cardiovascular mortality. Public health managers should strive not to miss any opportunity in that area.