Prevalence of ideal cardiovascular health in the Brazilian adult population - National Health Survey 2019

Motta, Ana Carolina Souto Valente; Bousquet-Santos, Kelb; Motoki, Isabela Harumi Lopes; Andrade, Joanlise Marco De Leon

doi:10.1590/S2237-96222023000300006

Ana Carolina Souto Valente Motta

All authors contributed significantly to the study design, data analysis and interpretation and drafting of the manuscript. Collaborated with data analysis and interpretation, drafting and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

Universidade de Brasília, Departamento de Estatística, Brasília, DF, Brazil

https://orcid.org/0000-0001-9016-4794

Kelb Bousquet-Santos

All authors contributed significantly to the study design, data analysis and interpretation and drafting of the manuscript. Collaborated with the study conception and design, analysis and interpretation of the results, drafting and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

Universidade de Brasília, Colegiado de Bases Biológicas e da Saúde, Brasília, DF, Brazil

https://orcid.org/0000-0002-4687-4681

Isabela Harumi Lopes Motoki

All authors contributed significantly to the study design, data analysis and interpretation and drafting of the manuscript. Collaborated with data analysis and interpretation, drafting and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

Universidade de Brasília, Departamento de Estatística, Brasília, DF, Brazil

https://orcid.org/0000-0002-8316-921X

Joanlise Marco De Leon Andrade

All authors contributed significantly to the study design, data analysis and interpretation and drafting of the manuscript. Collaborated with the study conception and design, analysis and interpretation of the results, drafting and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

Universidade de Brasília, Departamento de Estatística, Brasília, DF, Brazil

https://orcid.org/0000-0002-3984-3799

Correspondence:
Ana Carolina Souto Valente Motta.
E-mail:
anacarolina_souto@hotmail.com

AUTHOR CONTRIBUTIONS

All authors contributed significantly to the study design, data analysis and interpretation and drafting of the manuscript. Motta ACSV and Motoki IHL collaborated with data analysis and interpretation, drafting and critical reviewing of the manuscript content. Bousquet-Santos KB and Andrade JML collaborated with the study conception and design, analysis and interpretation of the results, drafting and critical reviewing of the manuscript content. All authors have approved the final version of the manuscript and declared themselves to be responsible for all aspects of the work, including ensuring its accuracy and integrity.

CONFLICTS OF INTEREST

The authors declare they have no conflicts of interest.

Associate editor:

Doroteia Aparecida Höfelmann - https://orcid.org/0000-0003-1046-3319

Figures (1)
Tables (5)

Thumbnail

Figure 1
- Distribution of population frequency according to the values obtained in the cardiovascular health (CVH) score^a with respective 95% confidence intervals, estimated for the adult population, Brazil, 2019

Thumbnail

Study contributions Main results The prevalence of ideal cardiovascular health (CVH) was 0.5% in Brazil in 2019. The prevalence of behavioral and biological CVH metrics was 0.7% and 63.3% respectively. Diet metric showed the lowest prevalence in the study population (4.3%). Implications for services The results obtained can contribute to the development of public policies aimed at health promotion, surveillance and care. The prevalence estimates of the CVH metrics indicate which targets and population segments efforts should be directed to. Perspectives Topics for future studies include estimating the prevalence of CVH metrics for population subgroups, identifying demographic and socioeconomic variables that affect that prevalence, and evaluating new CVH criteria.

Thumbnail

Box 1
Cardiovascular health metrics adapted from the American Heart Association

Thumbnail

Table 1
Characteristics of the adult Brazilian population (n = 77,494), 2019 National Health Survey

Thumbnail

Table 2
Prevalences (and 95% Confidence Intervals) of Brazilian adults (n = 77,494) with adequate behavioral and biological metrics and ideal cardiovascular health, National Health Survey, Brazil, 2019

Thumbnail

Supplementary Table 1
- Construction and methods of calculating variables, National Health Survey 2019, Brazil

Metrics	Metric used
Behavioral	4 behavioral metrics achieved simultaneously
Smoking	Never smoked or quit smoking for more than 12 months.
Body mass index (BMI)	< 25 kg/m² (based on self-reported weight and height).
Physical activity	exercises or sports ≥ 150min./week
Healthy diet	4 diet metrics achieveds simultaneously:
	i) fruits and vegetables: consumption 1 or more times/day;
	ii) fish: consumption ≥ twice/week;
	iii) sodium: salt intake in freshly prepared food and processed foods in adequate, low or very low amounts; and
	iv) sugar: consumption of soft drinks and/or industrialized fruit juices < 5 days/week.
Biological	3 biological metrics achieved simultaneously
Total cholesterol	Absence of self-reported medical diagnosis of high cholesterol.
Blood pressure	Absence of self-reported medical diagnosis of arterial hypertension.
Glucose	Absence of self-reported medical diagnosis of diabetes mellitus.

Variables	N	%	95%CI^a
Sex
Male	63,359,986	45.2	(44.6;45.9)
Female	76,676,523	54.8	(54.1;55.4)
Age group (years)
18-24	16,797,883	12.0	(11.5;12.5)
25-39	40,026,391	28.6	(28.0;29.2)
40-59	51,822,239	37.0	(36.4;37.6)
≥60	31,389,996	22.4	(21.8;23.0)
Race/skin color
Mixed race	59,763,814	42.7	(42.0;43.4)
White	62,440,066	44.6	(43.8;45.4)
Black	15,752,118	11.2	(10.8;11.7)
Asian/Indigenous/ignored	2,080,511	1.5	(1.3;1.7)
Marital status
Single	55,627,974	39.7	(39.0;40.4)
Married	64,089,556	45.8	(45.1;46.5)
Separated/divorced/widowed	20,318,979	14.5	(14.1;14.9)
Schooling (level of education)
Up to incomplete elementary education	46,739,391	33.4	(32.7;34.1)
Complete elementary education and incomplete high school	19,367,870	13.8	(13.4;14.3)
Complete high school and incomplete higher education	49,745,301	35.5	(34.9;36.2)
Complete higher education	24,183,947	17.3	(16.6;18.0)
Employment situation
With a job	86,692,821	61.9	(61.3;62.5)
Without a job	53,343,688	38.1	(37.5;38.7)
Chronic disease
At least one	63,178,438	45.1	(44.4;45.8)
Without disease	76,858,071	54.9	(54.2;55.6)
Region
North	10,178,075	7.3	(7.0;7.6)
Northeast	35,417,215	25.3	(24.7;25.9)
Southeast	63,001,662	45.0	(44.1;45.9)
South	20,852,598	14.9	(14.4;15.3)
Midwest	10,586,959	7.5	(7.3;7.9)
Urban-Rural status
Urban	122,412,326	87.4	(87.0;87.8)
Rural	17,624,183	12.6	(12.2;13.0)

Sociodemographic characteristics	Behavioral metrics					metrics Biological				Ideal cardiovascular health (sum of the 7 metrics)
Sociodemographic characteristics	Behavioral metrics (sum of the 4 metrics)	Non-smoking	Adequate body weight	Physical activity	Healthy diet	Behavioral metrics (sum of the 3 metrics)	Normal cholesterol levels	Normal blood pressure	Normal blood sugar levels	Ideal cardiovascular health (sum of the 7 metrics)
Total	0.7 (0.6;0.8)	86.0 (85.6;86.5)	34.1 (33.4;34.7)	27.4 (26.8;28.1)	4.3 (4.0;4.5)	63.3 (62.7;63.9)	84.1 (83.6;84.6)	73.0 (72.4;73.6)	91.4 (91.0;91.7)	0.5 (0.4;0.6)
Sex
Male	0.5 (0.4;0.6)	82.7 (82.0;83.4)	38.3 (37.4;39.2)	29.3 (28.4;30.2)	3.1 (2.8;3.3)	68.1 (67.3;69.0)	87.5 (86.8;88.1)	77.2 (76.4;77.9)	92.3 (91.8;92.8)	0.4 (0.3;0.5)
Female	0.9 (0.8;1.1)	88.8 (88.3;89.3)	41.7 (40.9;42.6)	25.9 (25.1;26.6)	5.2 (4.9;5.6)	59.2 (58.4;60.1)	81.3 (80.6;81.9)	69.6 (68.8;70.3)	90.6 (90.1;91.1)	0.7 (0.5;0.8)
Age group (years)
18-24	0.5 (0.2;0.9)	86.6 (85.0;88.2)	61.6 (60.0;63.7)	35.7 (33.4;37.9)	1.6 (1.0;2.1)	92.0 (90.8;93.1)	95.8 (94.9;96.7)	96.4 (95.6;97.2)	99.0 (98.6;99.4)	0.5 (0.2;0.9)
25-39	0.6 (0.5;0.8)	86.7 (85.9;87.5)	39.9 (38.6;41.2)	31.3 (30.2;32.4)	2.6 (2.3;2.9)	83.3 (82.4;84.2)	92.6 (91.9;93.3)	90.1 (89.4;90.8)	97.8 (97.5;98.2)	0.6 (0.4;0.7)
40-59	0.8 (0.7;1.1)	84.6 (83.9;85.4)	34.1 (33.2;35.1)	26.4 (25.3;27.4)	5.0 (4.6;5.3)	58.3 (57.2;59.3)	81.2 (80.4;82.0)	70.4 (69.4;71.4)	91.2 (90.7;91.8)	0.6 (0.4;0.7)
≥60	0.8 (0.7;1.0)	87.3 (86.5;88.0)	39.1 (38.1;40.2)	19.9 (18.9;20.9)	6.7 (6.1;7.2)	30.6 (29.6;31.6)	71.8 (70.7;72.9)	43.0 (41.9;44.2)	79.3 (78.4;80.2)	0.3 (0.2;0.4)
Race/skin color
Mixed race	0.7 (0.5;0.8)	85.4 (84.7;86.1)	(40.5) (39.7;41.3)	26.1 (25.3;26.9)	3.9 (3.6;4.2)	64.6 (63.7;65.4)	85.1 (84.5;85.6)	73.4 (72.6;74.2)	91.5 (91.1;92.0)	0.5 (0.3;0.6)
White	0.9 (0.7;1.0)	87.0(86.3;87.6)	40.2 (39.2;41.3)	29.0 (27.9;30.0)	4.6 (4.2;5.0)	62.4 (61.4;63.3)	82.8 (82.0;83.6)	73.3 (72.4;74.2)	91.4 (90.9;91.9)	0.7 (0.5;0.8)
Black	0.4 (0.2;0.5)	85.0 (83.6;86.3)	37.8 (36.1;39.6)	26.5 (24.9;28.1)	3.9 (3.3;4.5)	62.4 (60.6;64.2)	85.5 (84.2;86.9)	70.5 (68.9;72.1)	91.0 (90.0;91.9)	0.3 (0.2;0.4)
Asian/Indigenous/ignored	1.3 (0.6;2.0)	84.3 (80.6;87.9)	47.7 (41.8;53.7)	27.0 (22.1;31.8)	5.9 (3.6;8.1)	59.7 (53.9;65.4)	83.1 (78.5;87.7)	70.1 (65.0;75.2)	87.9 (84.2;91.7)	0.8 (0.2;1.3)
Marital status
Single	0.7 (0.5;0.8)	82.4 (81.5;83.2)	47.2 (46.2;48.2)	29.8 (28.8;30.8)	3.1 (2.8;3.4)	76.7 (75.9;77.5)	89.7 (89.1;90.3)	84.0 (83.3;84.7)	95.4 (95.1;95.8)	0.5 (0.4;0.7)
Married	0.8 (0.7;1.0)	89.8 (89.3;90.4)	35.0 (34.1;35.9)	26.9 (26.0;27.8)	4.7 (4.3;5.1)	57.6 (56.7;58.5)	81.7 (81.0;82.5)	68.9 (68.0;69.8)	89.9 (89.4;90.5)	0.5 (0.4;0.7)
Separated/divorced/widowed	0.9 (0.7;1.1)	84.1 (83.1;85.2)	37.4 (36.0;38.8)	22.5 (21.3;23.7)	6.1 (5.5;6.7)	44.5 (43.1;45.9)	76.0 (74.8;77.3)	55.8 (54.4;57.3)	84.7 (83.8;85.7)	0.4 (0.3;0.6)
Schooling (level of education)
Up to incomplete elementary education	0.4 (0.3;0.5)	81.7 (80.9;82.5)	39.1 (38.1;40.0)	15.6 (14.8;16.3)	3.7 (3.3;4.0)	48.4 (47.4;49.4)	78.7 (77.8;79.5)	58.9 (57.9;59.9)	85.6 (84.9;86.2)	0.2 (0.1;0.3)
Complete elementary education and incomplete high school	0.5 (0.3;0.7)	82.8 (81.5;84.1)	40.4 (38.7;42.0)	22.9 (21.5;24.4)	3.2 (2.7;3.7)	67.3 (65.7;69.0)	87.4 (86.3;88.5)	75.3 (73.9;76.8)	92.6 (91.7;93.4)	0.3 (0.1;0.5)
Complete high school and incomplete higher education	0.8 (0.6;0.9)	88.7 (88.0;89.4)	40.1 (39.8;41.2)	32.0 (31.0;33.1)	3.8 (3.5;4.2)	72.9 (71.9;73.9)	87.7 (86.9;88.5)	81.8 (81.0;82.7)	94.7 (94.2;95.1)	0.6 (0.4;0.7)
Complete higher education	1.7 (1.4;2.1)	91.6 (90.8;92.4)	40.6 (39.0;41.1)	44.5 (43.0;46.0)	7.2 (6.4;7.9)	68.9 (67.5;70.3)	84.4 (83.4;85.5)	80.2 (79.0;81.3)	94.9 (94.3;95.5)	1.3 (0.9;1.6)
Occupation
Employed	0.7 (0.6;0.8)	86.1 (85.5;86.6)	39.0 (38.2;39.8)	29.6 (28.8;30.4)	3.8 (3.6;4.1)	71.3 (70.5;72.0)	87.1 (86.5;87.7)	80.5 (79.8; 81.1)	94.6 (94.2; 94.9)	0.6 (0.5;0.7)
Unemployed	0.8 (0.7;1.0)	86.0 (85.3;86.7)	42.0 (41.1;43.1)	23.9 (23.0;24.7)	4.9 (4.6;5.3)	50.3 (49.3;51.3)	79.2 (78.4;79.9)	60.8 (59.9; 61.8)	86.2 (85.5;86.8)	0.5 (0.3;0.6)
Chronic disease
Without disease	0.9 (0.7;1.0)	86.9 (86.3;87.5)	42.6 (41.6;43.5)	29.2 (28.4;30.1)	4.0 (3.7;4.3)	73.3 (72.6;74.1)	90.2 (89.7;90.8)	81.0 (80.3; 81.6)	93.9 (93.5;94.2)	0.7 (0.5;0.8)
With disease	0.7 (0.5;0.8)	85.0 (84.3;85.7)	37.3 (36.4;38.2)	25.2 (24.4;26.0)	4.6 (4.2;4.9)	51.6 (50.1;52.0)	76.6 (75.8;77.4)	63.3 (62.4; 64.2)	88.3 (87.8;88.9)	0.4 (0.3;0.5)
Region
North	0.7 (0.5;0.9)	89.5 (88.7;90.3)	42.4 (41.6;43.7)	25.9 (24.7;27.1)	4.9 (4.3;5.5)	69.9 (68.6;71.2)	86.3 (85.4;87.2)	79.4 (78.4;80.5)	93.4 (92.8;94.1)	0.4 (0.3;0.6)
Northeast	0.9 (0.7;1.0)	88.4 (87.8;89.1)	42.7 (41.7;43.7)	27.2 (26.4;28.1)	5.4 (5.0;5.8)	63.9 (63.0;64.9)	83.9 (83.2;84.7)	73.4 (72.6;74.2)	91.9 (91.4;92.4)	0.6 (0.4;0.7)
Southeast	0.8 (0.6;0.9)	84.9 (84.1;85.7)	39.8 (38.6;41.0)	28.1 (26.9;29.3)	4.0 (3.6;4.4)	61.5 (60.4;62.6)	83.3 (82.4;84.2)	71.7 (70.7;72.8)	90.7 (90.1;91.4)	0.6 (0.4;0.7)
South	0.6 (0.5;0.8)	83.9 (82.9;85.0)	36.1 (34.7;37.5)	25.1 (23.8;26.4)	3.2 (2.8;3.7)	63.0 (61.6;64.3)	84.7 (83.8;85.7)	72.2 (70.9;73.4)	91.2 (90.5;92.0)	0.5 (0.3;0.6)
Midwest	0.8 (0.5;1.1)	85.9 (84.9;86.9)	40.0 (38.6;41.4)	29.8 (28.4;31.3)	3.6 (3.1;4.2)	65.8 (64.3;67.4)	85.6 (84.4;86.7)	74.6 (73.3;76.0)	91.7 (90.9;92.6)	0.5 (0.3;0.8)
Urban-Rural status
Urban	0.8 (0.7;0.9)	86.1 (85.6;86.6)	39.5 (38.7;40.2)	29.1 (28.4;29.8)	4.4 (4.2;4.7)	63.2 (62.6;63.9)	83.9 (83.3;84.4)	73.1 (72.5;73.8)	91.2 (90.9;91.6)	0.6 (0.5;0.7)
Rural	0.4 (0.2;0.5)	85.5 (84.5;86.6)	45.3 (44.1;46.6)	15.8 (14.8;16.9)	3.1 (2.7;3.5)	63.4 (62.2;64.6)	85.7 (84.8;86.5)	71.9 (70.8;73.1)	92.5 (91.9;93.1)	0.2 (0.1;0.3)

Variables	Description of the variables of the PNS^a 2019 questionnaire	Calculation method
Smoking	P050. Do you currently smoke any tobacco products? Answer options: 1-Yes, daily; 2-Yes, less than daily; 3-I do not currently smoke. P052. In the past, did you smoke any tobacco products? Answer options: 1-Yes, daily; 2-Yes, less than daily; 3-Never smoked. P05901. How long they quit smoking. Options: number of years.	Favorable outcome (1) If the individual is a nonsmoker [P050 =3 and P052 =3] or a former smoker for more than one year [P050=3 and P052 = (1 or 2) and P05901 > 1)]
Body mass index (BMI)	P00104. Weight - Final (in kg) Options: 3 integers and 1 decimal place P00404. Height - Final (in cm) Options: 3 integers	Favorable outcome (1) Weight [P00104] divided by Height squared [P00404] < 0.0025
Physical activity	P035. How many days a week do you usually (did you use to) do physical activities or play sports? Options: 1 to 7 days or 0 - Never or less than once a week. P03701. In general, on the day that you exercise or play sports, how long (in hours) does this activity last? Options: number of hours. P03702. In general, on the day that you (used to) exercise or play sports, how long (in minutes) does this activity last? Options: number of minutes.	Favorable outcome (1) Amount of exercise performed in minutes per day [P03701*60+P03702] multiplied by the number of days per week [P035] ≥ 150
Diet	P015. How many days a week do you usually eat fish? Options: 1 to 7 days or 0 - Never or less than once a week. P02001. How many days a week do you usually drink carton/canned juice or powdered fruit juice? Options: 1 to 7 days or 0 - Never or less than once a week. P02002. How many days a week do you usually drink soda? Options: 1 to 7 days or 0 - Never or less than once a week. P018. How many days a week do you usually eat fruit? Options: 1 to 7 days or 0 - Never or less than once a week. P00901. How many days a week do you usually eat at least one type of vegetable (with the exception of potatoes, manioc, cassava, or yam), such as lettuce, tomatoes, green cabbage, carrots, chayote, eggplant, zucchini? Options: 1 to 7 days or 0 - Never or less than once a week. P02601. Considering freshly prepared food and processed foods, do you think your salt intake is: Options: 1-Very high; 2-High; 3-Adequate; 4-Low; 5-Very low.	Favorable outcome (1) Individuals who achieved all 4diet metrics: (i) Consumption of fruits and vegetables every day [P018 = 7 and P00901 = 7]; (ii) Consumption of fish twice a week [P015 ≥ 2]; (iii) Adequate, low, or very low salt intake [P02601≥3]; and (iv) Consumption of soft drinks and/or industrialized fruit juices less than 5 days a week [P02001+P02002 < 5].
Total cholesterol	Q060. Has any doctor ever diagnosed you with high cholesterol? Options: 1-Yes; 2-No.	Favorable outcome (1) Absence of medical diagnosis of high cholesterol [Q060 = 2].
Blood pressure	Q00201. Has any doctor ever diagnosed you with arterial hypertension (high blood pressure)? Options: 1-Yes; 2-No.	Favorable outcome (1) Absence of medical diagnosis of hypertension (high blood pressure) [Q00201 = 2].
Glucose	Q03001. Has any doctor ever diagnosed you with diabetes? Options: 1-Yes; 2-No.	Favorable outcome (1) Absence of medical diagnosis of diabetes [Q03001 = 2].

[1] Correspondence:
Ana Carolina Souto Valente Motta.
E-mail:
anacarolina_souto@hotmail.com

Brasil

Brasil

Prevalence of ideal cardiovascular health in the Brazilian adult population - National Health Survey 2019

Prevalencia de salud cardiovascular ideal en la población adulta brasileña - Encuesta Nacional de Salud 2019

Abstract

Objective:

Methods:

Results:

Conclusion: