Acurácia da versão simplificada do escore de risco global na detecção do risco cardiovascular em mulheres brasileiras afrodescendentes

Abstract

Cardiovascular diseases (CVD) represent 31% of deaths worldwide and remain a serious public health problem, causing a negative impact on the quality of life of the general population. This situation is even more worrying in women of African descent, especially those who are part of quilombola communities These consist of ethnic-racial groups that, even with the end of slavery, suffer consequences that persist to the present day, among which institutional racism stands out, a difficulty in accessing health services and the implementation of public policies, situations that interfere with quality of life and health standards. In particular, it concerns the cardiovascular health of these individuals due to exposure to multiple risk factors. The World Health Organization recommends the identification of individuals at greatest cardiovascular risk (CVR), aiming at prevention and timely treatment. The RCV stratification methods are not validated for the Brazilian population, but considering the interaction between the risk factors that trigger atherosclerotic disease, the Ministry of Health recommends the Framingham score (EF), version 2002, as an RCV stratification instrument . On the other hand, the Brazilian Society of Cardiology recommends the global risk score (ERG). However, for both the calculation of EF and ERG, there is a need to include among the risk factors, data on total cholesterol and HDL, and such information is not always easily accessible in the contexts of less infrastructure. However, there is a simplified version of the ERG, in which these data from the lipidogram are replaced by the Body Mass Index (BMI), so that the adoption of the simplified ERG (ERGs) would facilitate its implementation in contexts of scarcity of laboratory resources in primary health services. However, there are no studies that have analyzed the accuracy of this instrument when used as a screening resource to select patients under higher cardiovascular risk. Therefore, this dissertation was carried out in order to address the problem presented. For that, it is organized in two chapters. The first concerns a literature review addressing the epidemiology of CVD, cardiovascular prevention, CVR scores, public policies for cardiovascular health care and characteristics of quilombola peoples. The second chapter consists of an original article, whose objective was to identify the accuracy of EF and ERGs in quilombola women from Alagoas, adopting ERG as a reference. This is a cross-sectional study involving a random sample of 1,015 quilombola women (19 to 59 years old) from Alagoas. To calculate the CVR scores, the following information was obtained: age, total cholesterol, HDL, LDL, systolic and diastolic blood pressures, use of antihypertensive drugs, diabetes, smoking and BMI. EF, ERG and ERGs were calculated from the sum of the scores assigned according to their respective scales. The ROC curve was used to compare the accuracy of EF (2002) and ERGs as predictors of CVR, assuming ERG as the standard. The prevalence of high CVR obtained with ERG or ERGs was similar (20.1% vs. 20.7%; p <0.001), but both were higher than that found with EF, (4.5%; p> 0.05 ). Considering the area under the curve (AUC), the EGRs showed discriminatory power (AUC = 0.98; 95% CI: 0.98-0.99) higher than that of EF (AUC = 0.91; 95% CI: 0.90 - 0.93). It was concluded that, in black women living in scenarios with less infrastructure, the ERGs produce results similar to those obtained with the ERG, despite its greater operational simplicity.