The objective of this chapter is to identify cardiovascular risk factors in the elderly and their prevalence in the elderly population of Alentejo. The research question was elaborated according to the PI[C]OD methodology. The prevalence studies included allow the authors to identify the risk factors with the greatest impact on cardiovascular diseases, with the analysis of at least one of the factors (hypertension, diabetes, smoking, obesity, hypercholesterolemia, alcoholism, and sedentary lifestyle) and their prevalence in the elderly from the region of Alentejo. The results present the prevalence of cardiovascular risk factors, mainly at the national level, compared to those at the regional level, with a small number of exclusive studies in the Alentejo region, while simultaneously disaggregating the results by age group. From the data obtained, it can be concluded that the prevalence of risk factors is generally increased in the elderly population and, consequently, in Alentejo, because it is a region in the interior of the country that is predominantly rural and very old.
TopIntroduction
According to the World Health Organization [WHO] (2017), cardiovascular diseases [CVD] are a group of disorders that affect the circulatory system. They are currently the leading cause of death worldwide and represented 31% of global deaths in 2015.
In Portugal, the analysis of health indicators shows that deaths associated with CVD have progressively decreased; however, there has been a reversal of this trend since 2014, after which they were observed to be one of the main causes of death (greater than 30%) and contributed to a 26% increase in the number of hospitalizations (Direção Geral de Saúde [DGS], 2016; DGS, 2017).
At the time of the 2011 Census, according to data from the National Institute of Statistics (INE, 2011), a total of 10,047,083 inhabitants lived in mainland Portugal, of whom 19% were 65 years old or older. By 2020, it is estimated that the Portuguese population aged 65 years old or older will increase by 21%; of these, 6% will be of individuals aged 80 years old and older. Alentejo is the oldest region of the country; in 2011, there were 182,988 elderly individuals living in Alentejo, and an increasing trend in the elderly population was observed in the region.
According to the Alentejo 2020 Regional Operational Program, the Alentejo region presents values below the mean relative to health resources and health professionals. The constraints facing access to primary health care are related to the long distances involved, limitations in mobility and centralization of health care in urban areas (Comissão de Coordenação e Desenvolvimento Regional do Alentejo [CCDRA], 2014).
According to the INE (2002), the Iberian border area formed by some subregions (Upper Alentejo, Central Alentejo and Lower Alentejo on the Portuguese side and the Extremadura region, with Cáceres and Badajoz, on the Spanish side) has a high rate of old agedness in its population, and the area shares typical characteristics with the countryside, such as a relatively low population density, which greatly contributes to its increasing desertification.
The INE estimates from 2012 showed that 124,283 elderly individuals (24.8% of the population) were enrolled in the Regional Health Administration of Alentejo; this age group constitutes an important focus of national attention due to the various morbidities inherent to it. In the Alentejo region, the percentages of deaths due to CVD among individuals aged 65-74 years old and those aged 75 years old or older were 29.6% and 37.85%, respectively (DGS, 2013).
The heart of an elderly individual undergoes several physiological changes associated with aging, a condition that makes him more vulnerable and increases his predisposition to cardiovascular risk factors [CVRFs]. The term “risk factor” [RF] was first proposed in 1948 in the pioneering Framingham Heart Study, which allowed the identification of some of the RFs for CVD (Dórea & Lotufo, 2001).
According to the World Health Organization [OMS], most CVD is caused by the presence of a combination of RFs, divided into modifiable and nonmodifiable factors and further divided into four categories: biological (high blood pressure, elevated blood sugar, high cholesterol and excess weight), lifestyle-associated (smoking, unhealthful diet, excessive alcohol consumption and sedentarism), other modifiable factors (income, education, living conditions, work conditions) and fixed factors (gender, age, ethnicity and genetics) (Sociedade Portuguesa de Cardiologia, 2007).