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Aim: To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. Methods: Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results: Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46–0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40–0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions: The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; 22: 715–722.

The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases.To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05.The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis.No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares.Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil).Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05.A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA.Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Background Some religious dimensions have been associated with different health-related outcomes over many years. Attending religious services is one of these dimensions that were associated with hypertension, with inconsistent results. And religious involvement seems to be closely influenced by sociodemographic factors, such as education. Therefore, this study aimed to investigate the association between religious service attendance and hypertension according to levels of education. Methods We analyzed baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Frequency of religious service attendance and presence of hypertension were assessed in all 15,105 participants at baseline. The analyses were stratified by two levels of education (less than high school and high school or more). Logistic regression models were used to obtain the association between religious service attendance and hypertension in both groups. Results For those with high school or more, attending religious services was positively associated with hypertension (adjusted odds ratio [OR] = 1.14, 95% confidence interval [CI] 1.02–1.28). In contrast, for those with less than high school, attending services was inversely associated with presence of hypertension (adjusted OR = 0.73, 95% CI 0.55–0.96). Conclusions There seems to be a paradox in the association of religious service attendance and hypertension depending on the level of education.

Introduction: The relationship between the level of religiosity and health-adverse outcomes has been controversial. One reason should be that how "religiosity" is measured or by a self-declaration (meaning more a cultural variable than a manifestation of the spirituality) of by regular religious practices attendance. Several studies pointed out that educational attainment has a close relationship with the practice of religion. In Brazil, the non-practice religious persors have a higher level of formal education than the general population. Therefore, researchers have focused on risk factors, such as hypertension, studying the effect of religious service attendance, besides other religious dimensions, on blood pressure. Hypothesis: This study has a premise that attending to religious ceremonies are associated with hypertension according to levels of education. Methods: At baseline of the ELSA-Brasil study (15105 adults aged 35-74years old), we asked about the frequency of attendance to religious services. Hypertension was defined as systolic or diastolic blood pressures higher than 140/90 mm Hg or under antihypertensive drugs. Educational attainment was categorized as less or more than high school.Logistic regression models were used to obtain odds ratio (OR) and 95% confidence intervals (95%CI) for the association between frequency of attendance and hypertension adjusted for age, sex, race, income, physical activity and salt consumption (estimated by 12-hour urinary sodium excretion). Further, we added variables that are potential mediators of the religion-hypertension association as smoking, alcohol consumption and body-mass index, depending on the level of education. Results: Three-quarters (76.9%) of the participants reported to be religious (mean age of 51.6 years, 58.7% women; 51.8% white), and 49.8% of them declared religious attendance at least weekly. For those with a higher educational level, no association was found an inverse association between frequent religious service attendance and the presence of hypertension, also concerning sociodemographic variables, and between religious practice attendance and hypertension after adjusting for covariates (OR = 1.10, 95% CI 0.98-1.23). However, for subjects with lower educational attainment, religious attendance was inversely associated with hypertension (OR = 0.71, 95%CI 0.53-0.96), after adjusting for covariates. We did not find differences in each educational attainment strata related to association religious attendance and hypertension when stratified by gender, race, family income, and to be Roman Catholic and non-Roman Catholic. Conclusion: The effects of religious involvement on hypertension seem to diverge according to socioeconomic status, represented here by educational attainment.