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and a non-significant decrease with the salt reduction regulation&#44; although the ability of the study to prove direct associations was limited&#46; Reducing salt intake in 2010 was an important public health strategy&#44; but the results fell short of the effects seen in other countries where much more restrictive measures were imposed&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> In recognition of this shortfall&#44; an agreement was established in 2018 between the Directorate-General of Health &#40;DGS&#41;&#44; the National Health Institute Doutor Ricardo Jorge &#40;INSA&#41;&#44; and the Portuguese Association of Bakery&#44; Confectionery and Related Products &#40;ACIP&#41;&#44; aiming for a gradual reduction of salt from 1&#46;4 g to 1 g per 100 g of bread by 2021&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors point out that by 2009&#44; the health policies implemented were accompanied by a consistent decrease in ACS mortality&#44; but there has since been a slowing of this trend&#46; Contrary to what would be expected&#44; in the analysis by age groups&#44; they did not observe a reduction in mortality due to coronary heart disease &#40;CHD&#41; in those aged under 65 years&#46; This finding is consistent with data from the Portuguese National Program for Cerebrocardiovascular Diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> which reports unchanged mortality from ischemic heart disease between 2011 and 2015&#44; with an increase in premature mortality before the age of 70 years&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Increases in epidemiological phenomena such as obesity&#44; physical inactivity and diabetes are mainly responsible for the attenuation of the trend&#46; In Portugal&#44; almost half the population are overweight and close to a million adults are obese&#46; Regarding the prevalence of physical inactivity in Portugal&#44; Eurobarometer data &#40;2014&#41; revealed that 72&#37; of Portuguese adults never or rarely exercised or played sports&#44; and only 23&#37; complied with World Health Organization &#40;WHO&#41; recommendations&#46; According to a recent <span class="elsevierStyleItalic">Lancet</span> article&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> more than 1&#46;4 billion adults worldwide are at risk of developing or exacerbating diseases linked to inactivity&#46; Portugal is even worse than the average for high-income countries&#44; with over 40&#37; of adults falling short of recommended levels of healthy physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> According to the WHO&#44; the abandonment of the Mediterranean diet associated with the economic crisis in southern European countries has also contributed to the high levels of obesity&#46; It is estimated that diabetes affects 13&#46;3&#37; of the Portuguese population aged 20 to 79&#44; and that 44&#37; of these are unaware of having the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> According to the DGS&#44; the factors that have contributed most to the total number of healthy life years lost by the Portuguese population are inappropriate diet&#44; high blood pressure and high body mass index&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Changing the recent trend toward early mortality from cardiovascular disease requires comprehensive and multisectoral measures involving policy-makers&#44; public health authorities&#44; medical societies&#44; the medical community and civil society&#44; to implement collective measures to promote physical activity&#44; healthy diet&#44; smoking cessation&#44; and control of risk factors such as hypertension and hypercholesterolemia&#44; and to improve health care access and health literacy in the population&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the secondary prevention level&#44; strict objectives should be set regarding the control of risk factors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Wider national primary angioplasty coverage has significantly increased reperfusion rates in ST-elevation myocardial infarction&#46; However&#44; reperfusion times still need to be improved&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Access to cardiac rehabilitation care should be guaranteed&#46; In central European countries&#44; 30-50&#37; of potential candidates are enrolled in rehabilitation programs&#44; much higher levels than in Portugal&#44; where only 10&#37; have such access&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The success of these measures requires a close relationship between hospital and outpatient care&#44; to support behavioral changes and to improve outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Editorial comment
Preventing premature mortality from cardiovascular disease: A prime goal
Prevenir a mortalidade cardiovascular precoce: um objetivo primordial
José Eduardo Aguiar
Department of Cardiology, Hospital Espírito Santo de Évora, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease remains the leading cause of death in Portugal and in most European Union member states&#44; despite significant declines in mortality in recent decades&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The article by Abreu et al&#46; in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> analyzes the impact of three health policies&#44; the coronary fast-track system &#40;FTS&#41;&#44; the smoking ban and the salt reduction regulation&#44; implemented respectively in 2007&#44; 2008 and 2010&#44; on mortality due to acute coronary syndrome &#40;ACS&#41; in Portugal between 2000 and 2016&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Analysis of the individual policies showed an immediate reduction in ACS event rates with the FTS and the smoking ban&#44; and a non-significant decrease with the salt reduction regulation&#44; although the ability of the study to prove direct associations was limited&#46; Reducing salt intake in 2010 was an important public health strategy&#44; but the results fell short of the effects seen in other countries where much more restrictive measures were imposed&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> In recognition of this shortfall&#44; an agreement was established in 2018 between the Directorate-General of Health &#40;DGS&#41;&#44; the National Health Institute Doutor Ricardo Jorge &#40;INSA&#41;&#44; and the Portuguese Association of Bakery&#44; Confectionery and Related Products &#40;ACIP&#41;&#44; aiming for a gradual reduction of salt from 1&#46;4 g to 1 g per 100 g of bread by 2021&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors point out that by 2009&#44; the health policies implemented were accompanied by a consistent decrease in ACS mortality&#44; but there has since been a slowing of this trend&#46; Contrary to what would be expected&#44; in the analysis by age groups&#44; they did not observe a reduction in mortality due to coronary heart disease &#40;CHD&#41; in those aged under 65 years&#46; This finding is consistent with data from the Portuguese National Program for Cerebrocardiovascular Diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> which reports unchanged mortality from ischemic heart disease between 2011 and 2015&#44; with an increase in premature mortality before the age of 70 years&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Increases in epidemiological phenomena such as obesity&#44; physical inactivity and diabetes are mainly responsible for the attenuation of the trend&#46; In Portugal&#44; almost half the population are overweight and close to a million adults are obese&#46; Regarding the prevalence of physical inactivity in Portugal&#44; Eurobarometer data &#40;2014&#41; revealed that 72&#37; of Portuguese adults never or rarely exercised or played sports&#44; and only 23&#37; complied with World Health Organization &#40;WHO&#41; recommendations&#46; According to a recent <span class="elsevierStyleItalic">Lancet</span> article&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> more than 1&#46;4 billion adults worldwide are at risk of developing or exacerbating diseases linked to inactivity&#46; Portugal is even worse than the average for high-income countries&#44; with over 40&#37; of adults falling short of recommended levels of healthy physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> According to the WHO&#44; the abandonment of the Mediterranean diet associated with the economic crisis in southern European countries has also contributed to the high levels of obesity&#46; It is estimated that diabetes affects 13&#46;3&#37; of the Portuguese population aged 20 to 79&#44; and that 44&#37; of these are unaware of having the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> According to the DGS&#44; the factors that have contributed most to the total number of healthy life years lost by the Portuguese population are inappropriate diet&#44; high blood pressure and high body mass index&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Changing the recent trend toward early mortality from cardiovascular disease requires comprehensive and multisectoral measures involving policy-makers&#44; public health authorities&#44; medical societies&#44; the medical community and civil society&#44; to implement collective measures to promote physical activity&#44; healthy diet&#44; smoking cessation&#44; and control of risk factors such as hypertension and hypercholesterolemia&#44; and to improve health care access and health literacy in the population&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the secondary prevention level&#44; strict objectives should be set regarding the control of risk factors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Wider national primary angioplasty coverage has significantly increased reperfusion rates in ST-elevation myocardial infarction&#46; However&#44; reperfusion times still need to be improved&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Access to cardiac rehabilitation care should be guaranteed&#46; In central European countries&#44; 30-50&#37; of potential candidates are enrolled in rehabilitation programs&#44; much higher levels than in Portugal&#44; where only 10&#37; have such access&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The success of these measures requires a close relationship between hospital and outpatient care&#44; to support behavioral changes and to improve outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
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