Ciência & Saúde Coletiva

cienciaesaudecoletiva.com.br DOI: 10.1590/1413-81232025304.08822023EN

ISSN 1413-8123. v.30, n.4

Association between cardiovascular health and self-reported 1

depression: 2019 National Health Survey

THEMATIC ARTICLE
Maria Luiza Sady Prates Pinheiro (https://orcid.org/0000-0001-6199-7092) 1
Luís Antônio Batista Tonaco (https://orcid.org/0000-0001-9660-2900) 2
Mariana Santos Felisbino-Mendes (https://orcid.org/0000-0001-5321-5708) 2
Jorge Gustavo Velásquez-Meléndez (https://orcid.org/0000-0001-8349-5042) 2
Deborah Carvalho Malta (https://orcid.org/0000-0002-8214-5734) 2
Alexandra Dias Moreira (https://orcid.org/0000-0002-4477-5241) 2

Abstract The aim is to analyze the association between the ideal cardiovascular health score and the self-reported
diagnosis of depression in Brazilian adults. Cross-sectional study, with 57,898 Brazilian adults from the 2019 National
Health Survey. Presence of self-reported depression. Exposures: behavioral scores (BMI, smoking, diet, physical activity,
ideal if ≥3 ideal factors), biological (smoking, dyslipidemia, hypertension and diabetes, ideal if ≥3 ideal factors) and
cardiovascular health (all factors, ideal if ≥4 ideal factors), based on the score proposed by the American Heart Asso-
ciation. They were categorized as poor/intermediate or ideal. Associations were tested using logistic regression models
adjusted for sociodemographic characteristics. The prevalence of depression was 11.1%. All scores classified as ideal
were inversely associated with depression after adjustments for sociodemographic variables (Ideal behavioral score: OR:
0.58 [95%CI: 0.48-0.70], ideal biological score: OR: 0.48 [95%CI: 0.43-0.53] and ideal cardiovascular health: OR: 0.53
[95%CI: 0.48-0.59]). The ideal cardiovascular health score was inversely associated with the self-reported diagnosis of
depression among Brazilian adults.
Key words Depression, Cardiovascular diseases, Risk Factors for Heart Disease, Epidemiological Surveys

1
Programa de Pós-
Graduação em Enfermagem,
Escola de Enfermagem,
Universidade Federal de
Minas Gerais (UFMG). Av.
Prof. Alfredo Balena 190,
Santa Efigênia. 30130-100
Belo Horizonte MG Brasil.
malusady@gmail.com
2
Departamento de
Enfermagem Materno
Infantil e Saúde Pública,
Escola de Enfermagem,
UFMG. Belo Horizonte MG
Brasil.
Cien Saude Colet 2025; 30:e08822023
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Pinheiro MLSP et al

Introduction presence of these factors to be a metric of ideal

cardiovascular health status17.
In Brazil, it is estimated that depressive disor- Some studies show that physical activity18,19,
ders affect around 16.3 million people1. Accord- good nutrition20, controlled blood pressure21,22,
ing to the World Health Organization (WHO), controlled glycaemia23 and not taking nicotine24
the number of cases of depression increased by reduce symptoms of anxiety and depression. On
18% between 2005 and 20152. This condition is the other hand, the presence of depression is in-
considered a preventable multifactorial disorder dependently associated with poor cardiovascu-
characterized by sadness or irritability, disinter- lar health25-27.
est or displeasure, cognitive difficulties, feelings Data from the Longitudinal Study of Adult
of guilt or low self-esteem, sleep or appetite dis- Health (Elsa-Brazil) showed that the risk of
orders and recurrent ideas of death3, which can depression is tripled in the presence of poor
be occasional or last for days, months or years2. cardiovascular health10, considering the score
Depression is a public health problem due proposed by the AHA17. However, there are few
to its high prevalence, repercussions on gener- publications relating this score to the occur-
al health and its psychosocial impact4. In 2019, rence of depression. It should also be empha-
depressive disorders led to a global total of more sized that there is a need for publications on
than 125 million years lived with disability this association in a representative sample of the
(YLD), making it the thirteenth leading cause of Brazilian population.
disability-adjusted life years (DALYs)5. Based on the above, the aim of this study
Global spending equivalent to lost produc- was to assess the association between the ideal
tivity due to anxiety and depression costs the cardiovascular health score and self-reported
global economy US$ 1 trillion and is estimated diagnosis of depression in Brazilian adults, us-
to rise to approximately US$ 6 trillion by 20306. ing data from the 2019 National Health Survey.
People with mental disorders have poor physi-
cal health and are therefore at greater risk of de-
veloping physical illnesses, such as cardiomet- Methods
abolic diseases, obesity, diabetes7, heart disease
and oncological problems8,9. This, places a high This is a cross-sectional study using data from
social and economic burden on individuals, the National Health Survey (PNS) 2019, carried
families, governments and society. out by the Ministry of Health in partnership
Previous studies have revealed a bidirection- with the Brazilian Institute of Geography and
al association between cardiovascular disease Statistics (IBGE). The PNS is a national house-
(CVD) and depression10,11. Depression is a risk hold-based survey containing a questionnaire
factor for cardiovascular mortality and morbid- divided into three parts: firstly, focused on the
ity, both in the healthy population and in those characteristics of the household, secondly, all
with established cardiovascular diseases12,13, and the residents of the household and thirdly, one
cardiac morbidity is a risk factor for depres- resident of each selected household aged 15 or
sion14. The correlation between these diseases over. To calculate the sample size of the PNS, the
can be explained by the increase in inflammato- average values, variances and effects of the sam-
ry markers14,15, since inflammation is a compo- pling plan were considered, and a non-response
nent present in both depression and cardiovas- rate of 20% was assumed. More detailed infor-
cular diseases16. This is due to mental stress, a mation on the PNS can be found in a specific
common feature between CVD and depression, publication28.
which causes changes in the autonomic nervous For the analyses in this study, data from in-
system and contributes to inflammation12. dividuals aged 18 and over were analyzed, with
In 2010, the American Heart Association the presence of self-reported depression (no/
(AHA) proposed a cardiovascular health score yes) as the outcome and ideal cardiovascular
to reduce morbidity and mortality from CVD. health as the exposure. Of the 90,846 residents
The score includes 7 protective factors for car- selected, pregnant participants, those who did
diovascular health, behavioral factors (not not know they were pregnant, individuals aged
smoking, physical activity, having a Body Mass <18 years and those who did not have complete
Index (BMI) below 25 kg/m² and adequate information on all the variables that make up
nutrition) and biological factors (not having this study were excluded.
hypertension and having adequate glycaemia Ideal cardiovascular health was analyzed as
and cholesterol levels). The AHA considers the proposed by the American Heart Association
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Ciência & Saúde Coletiva, 30(4):1-11, 2025

(AHA)17, based on three self-reported scores: 1) per week or at least 75 minutes of vigorous PA
behavioral score (BMI, smoking, diet, physical per week were considered ideal33. The ideal BMI
activity [PA]); 2) biological score (smoking, dys- was considered to be less than or equal to 25 kg/
lipidemia, hypertension and diabetes), where in m²34, based on self-reported weight and height,
this study the behavioral and biological scores as proposed by the AHA17.
were considered ideal in the presence of 3 or Smoking was assessed using the following
more factors and poor/intermediate in the pres- questions: “Do you currently smoke any tobacco
ence of less than 3 factors; and 3) cardiovascu- products?” and “Have you smoked any tobacco
lar health score, made up of the 7 factors (BMI, products in the past?”. Individuals who did not
smoking, diet, physical activity, dyslipidemia, currently smoke and who reported never having
hypertension and diabetes). In this study, the smoked in the past were considered to be in the
presence of 4 or more factors was considered ideal category.
ideal cardiovascular health. This cut-off point Bivariate analyses of the association be-
has previously been associated with cardiovas- tween behavioral, biological and cardiovascular
cular protection and a reduction in the inci- scores, as well as the factors that make them up,
dence of coronary heart disease29,30. It should be and self-reported depression were carried out
noted that, in accordance with AHA guidelines, using the chi-square test, considering a signif-
the variable smoking was included in both the icance level of 5%. Associations between car-
behavioral score and the biological score, due to diovascular health scores and depression were
the importance of not smoking or quitting this tested using logistic regression models adjusted
habit for health promotion and the prevention for gender, age, race/color, education and mari-
of cardiovascular diseases17. Thus, the variables tal status. These adjustment variables were con-
that are part of the scores were classified as poor/ sidered because they were associated with both
intermediate or ideal. The self-reported cardio- the exposure (cardiovascular health) and the
vascular health score was validated in relation to outcome (depression), according to previous
that measured for the Brazilian population in a studies35-45, and according to the analyses in this
previous study31. study. In the final model, scores with a p-value
The presence of depression was self-report- of <0.05 were considered associated. All the
ed using the question: “Has a doctor or mental analyses were carried out using Stata software
health professional (such as a psychiatrist or version 12.0 and sample and post-stratification
psychologist) ever diagnosed you with depres- weights were considered.
sion?”. Hypertension, diabetes and cholesterol The PNS project was approved by the Na-
were assessed using the questions: “Has any tional Research Ethics Committee (process No.
doctor ever diagnosed you with hypertension 3.529.376, dated August 23, 2019) and all in-
(high blood pressure)?”; “Has any doctor ever terviewees signed an Informed Consent Form
diagnosed you with diabetes?” and “Has any agreeing to take part in the research at the time
doctor ever diagnosed you with high cholester- of the interview.
ol?”, with “no” being considered the ideal an-
swer for all questions.
Diet was assessed based on four criteria: 5 Results
portions of fruit, vegetables and legumes (FLV)
5 times a week; consumption of fish 2 times a In this study, data from 57. 898 individuals
week; no soft drinks and less than 5g of salt a were analyzed. 52.5% (95%CI: 51.8-53.2) were
day32, with the presence of all 4 factors being female, 59.0% (95%CI: 58.2-59.8) were aged 18-
ideal. As the PNS 2019 does not estimate the ex- 49, 47.1% (95%CI: 46.3-48) were white, 40.2%
act amount of salt consumption in the Brazilian (95%CI: 39.5-41) reported that high school was
population, the following question was adapted: the highest level of education they had attended
“Considering freshly prepared food and pro- and 48.8% (95%CI: 48.08-49.7) were married
cessed food, do you think your salt consump- (data not shown).
tion is:”, with those who answered “very high” Of the Brazilian adults, 8.70% of men and
and “high” being considered to consume more 10% of women had the ideal behavioral score.
than 5g of salt per day, and those who answered Regarding the biological score, 78.80% of men
“adequate”, “low” and “very low” being consid- and 76.70% of women were classified as ide-
ered to consume less than 5g. al. As for the cardiovascular score, 65.00% of
In terms of physical activity, individuals who men and 64.00% of women were classified as
performed at least 150 minutes of moderate PA ideal. These results, as well as a description of
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Pinheiro MLSP et al

the components of the scores by gender, are de- al category. In the behavioral score, 11.51%
scribed in Table 1, also considering stratification (95%CI: 11.01-12.02) prevalence of depression
by age group. was observed in the poor/intermediate category
The prevalence of depression was 16.18% and 7.2% (95%CI: 6.12-8.46) in the ideal cate-
(95%CI: 15.42-16.98) in women and 5.49% gory. In the biological score, 17.51% (95%CI:
(95%CI: 5.03-5.99) in men, 9.80% (95%CI: 16.36-18.72) had depression in the poor/inter-
9.15-10.41) in individuals aged 18-49, 13.20% mediate category and 9.27% (95%CI: 8.8-9.76)
(95%CI: 12.09-14.37) aged 50-59 and 12.90% in the ideal category (Table 2).
(95%CI: 11.98-13.90) aged 60 or over. These and Having ideal cardiovascular health scores
other prevalences of depression by sociodemo- was found to be inversely associated with self-re-
graphic characteristics are described in Table 2. ported diagnosis of depression among Brazil-
The prevalence of depression was higher in ian adults in the unadjusted logistic regression
the poor/intermediate categories for all scores. models. Furthermore, statistical significance
The prevalence of depression was higher in in- was maintained after adjusting for sociodemo-
dividuals with a score in the poor/intermediate graphic variables (Model 1), with the following
category, with 15.27% (95%CI: 14.43-16.14) in OR values for self-reported depression: 0.53
the cardiovascular health score, while 8.77% (95%CI: 0.48-0.59) for ideal vs. intermediate/
(95%CI: 8.26-9.31) were classified in the ide-

Table 1. Prevalence of the variables that make up the cardiovascular health score and self-reported depression
among Brazilian adults according to sex and age group. National Health Survey, 2019.
Sex Age group
Variables Male Female 18 to 49 50 to 59 years 60 and
(%) (%) years old (%) old (%) over (%)
Smokinga,b
Ideal 58.15 64.85 69.80 53.30 47.00
Dieta,b
Ideal 1.20 2.35 1.20 2.20 1.80
Physical Activitya,b
Ideal 35.20 29.30 36.15 28.80 24.00
BMIa,b
Ideal 36.40 40.85 40.35 34.30 38.20
Behavioral Score*a,b
Ideal 8.70 10.00 11.60 7.00 5.30
Blood Pressurea,b
Ideal 76.00 72.85 8.80 6.45 45.00
Diabetesb
Ideal 92.00 91.55 9.70 88.40 79.40
Cholesterola,b
Ideal 86.50 81.00 90.50 77.00 83.60
Biological Score**a,b
Ideal 78.80 76.70 91.00 68.10 5.00
Cardiovascular score***b
Ideal 64.60 63.70 77.40 52.35 38.30
Depressiona,b
Yes 5.50 16.20 9.80 13.20 12.90
Notes: 95%CI: 95% Confidence Interval; BMI: Body Mass Index. *3 or more ideal factors (BMI, diet, smoking, physical activity);
**3 or more ideal factors (smoking, dyslipidemia, hypertension and diabetes); ***4 or more ideal factors (BMI, diet, smoking,
physical activity, dyslipidemia, hypertension and diabetes). a P-value of the chi-square test between sex and components of the
cardiovascular health score <0.05; b P-value of the chi-square test between age group and components of the cardiovascular
health score <0.05.

Source: Authors.
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Ciência & Saúde Coletiva, 30(4):1-11, 2025

Table 2. Prevalence of depression in the Brazilian population according to sociodemographic characteristics
and cardiovascular health score and its components. National Health Survey, 2019.
Depression Depression
Variables Yes P Variables Yes P
% (95%CI) value* % (95%CI) value*
Sociodemographic characteristics Physical Activity
Sex Poor/ 11.90 (11.34-12.48) p<0.001
Male 5.50 (5.03-5.99) <0.001 Intermediate
Female 16.20 (15.42-16.98) <0.001 Ideal 9.40 (8.63-10.31) p<0.001
Age group BMI
18-49 years 9.80 (9.15-10.41) <0.001 Poor/ 12.10 (11.46-12.68) p<0.001
50-59 years 13.20 (12.09-14.37) <0.001 Intermediate
60 years or older 12.90 (11.98-13.90) <0.001 Ideal 10.00 (8.94-10.29) p<0.001
Marital status Behavioral score
Married 10.70 (10.03-11.40) <0.001 Poor/ 11.50 (11.01-12.02) p<0.001
Divorced/ 18.40 (16.50-20.40) <0.001 Intermediate
separated Ideal 7.20 (6.12-8.46) p<0.001
Widower 16.60 (14.90-18.41) <0.001 Blood pressure
Single 9.10 (8.43-9.85) <0.001 Poor/ 15.90 (14.71-17.17) p<0.001
Race/color Intermediate
White 13.30 (12.52-14.07) <0.001 Ideal 9.45 (8.94-9.98) p<0.001
Brown 9.15 (8.57-9.75) <0.001 Diabetes
Black 9.50 (8.29-10.78) <0.001 Poor/ 14.55 (12.71-16.6) p<0.001
Other 7.90 (5.34-11.44) <0.001 Intermediate
(indigenous/ Ideal 10.80 (10.32-11.29) p<0.001
yellow) Cholesterol
Education Poor/ 19.55 (18.1-21.04) p<0.001
Fundamental 12.10 (11.36-12.94) <0.001 Intermediate
Medium 9.30 (8.66-10.05) <0.001 Ideal 9.45 (8.99-9.94) p<0.001
Superior 12.60 (11.61-13.61) <0.001 Biological Score
Cardiovascular health score and components Poor/ 17.50 (16.36-18.72) p<0.001
Smoking Intermediate
Poor/ 13.00 (12.24-13.85) p<0.001 Ideal 9.30 (8.8-9.76) p<0.001
Intermediate Cardiovascular
Ideal 9.90 (9.33-10.52) p<0.001 Score
Diet Poor/ 15.30 (14.43-16.14) p<0.001
Intermediate
Poor/ 11.10 (10.62-11.57) p<0.58
Intermediate Ideal 8.80 (8.26-9.31) p<0.001
Notes: 95%CI: 95% Confidence Interval. *Bivariate analysis
Ideal 12.00 (8.87-16.03) p<0.58 using the chi-square test, considering a 5% significance level.
it continues
Source: Authors.

poor cardiovascular score, 0.58 (95%CI: 0.48- self-reported diagnosis of depression, compared
0.70) for ideal vs. intermediate/poor behavioral to having intermediate/poor cardiovascular
score and 0.48 (95%CI: 0.43-0.54) for ideal vs. health. This relationship was significant for both
intermediate/poor biological score (Table 3). the biological, behavioral and cardiovascular
health components, and was maintained even
after adjusting for sociodemographic variables.
Discussion In relation to the variables that make up the
cardiovascular health score and the analysis of
The study showed that having ideal cardiovas- the association with the diagnosis of depression,
cular health was inversely associated with a it is known that some studies have already shown
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Pinheiro MLSP et al

Table 3. Unadjusted and adjusted odds ratios (OR) of depression in relation to cardiovascular health scores.
National Health Survey, 2019.
Not adjusted Model 1
Depression
OR (95%CI) OR (95%CI)
Ideal biological score*** vs. Bad 0.48 (0.43-0.53)** 0.48 (0.43-0.54)**
Behavioral score**** ideal vs. Bad 0.58 (0.48-0.70)** 0.58 (0.48-0.70)**
Ideal cardiovascular score***** vs. Bad 0.53 (0.48-0.59)** 0.53 (0.48-0.59)**
Notes: 95%CI: 95% Confidence Interval. Model 1: adjusted for sociodemographic values (gender, race, age, education and
marital status). **p<0.01. ***Sum of factors: smoking, dyslipidemia, hypertension and diabetes, ideally ≥3 factors. ****Sum of
factors: BMI, smoking, diet and physical activity, ideally ≥3 factors. *****Sum of the 7 factors, ideally ≥4 factors.

Source: Authors.

the effects of physical exercise in the prevention tective factors for cardiovascular diseases, and
and treatment of depression46,47, as well as the the inverse association with depression found
effects of good nutrition20, controlled blood in this study, is consistent with national and in-
pressure24,25 and controlled blood glucose26. The ternational evidence10,25,30. A prospective study
components of the cardiovascular health score of 732 Finnish female employees who were not
showed direct and significant associations be- initially depressed assessed ideal cardiovascular
tween unhealthy behaviors (smoking, physical health metrics by means of physical examina-
inactivity) and a diagnosis of depression48, cor- tion and laboratory tests, medical history and
roborating the findings of this study. self-assessment, and showed a higher risk of de-
There is evidence that there is a bidirectional pressive symptoms in those with poor/interme-
association between CVD and depression. The diate cardiovascular health25.
association of these disorders arises because of a In Dallas, Texas, another prospective epide-
series of shared factors; biological and behavior- miological study was carried out between 1987
al mechanisms and risk factors10,14. Individuals and 1998 with 5,510 participants in the Aerobics
with CVD are two to three times more likely to Center Longitudinal Study. The authors con-
develop depression49, and individuals with de- cluded that the ideal components of cardiovas-
pression are more likely to develop CVD49,50. cular health show an inverse relationship with
Although there are few studies on the mech- depressive symptoms, which was significant
anisms involved in the cardiovascular health in the case of cardiovascular health behaviors,
score and the development of depression, there but not for cardiovascular health factors such
are studies on the mechanisms of isolated score as total cholesterol, blood pressure and fasting
variables and the predisposition to develop de- glycemia30.
pression18,20-24,51. One study showed that a lower Additionally, in agreement with the findings
intake of FV is related to depressive symptoms52, of this study, Elsa-Brasil, a multicenter cohort
due to the influence of minerals, vitamins, ami- study of 15,105 active or retired civil servants
no acids, phytochemicals and antioxidant com- aged 35 to 74, showed that poor cardiovascular
pounds, which in low concentrations interfere health precedes the development of depression.
with inflammatory markers, oxidative stress and In addition, adults without a diagnosis of de-
arterial stiffness53. pression were followed up for an average of 3
In this study, consumption of the ideal years and 8 months, and it was found that poor
diet was low in relation to 2 important indica- cardiovascular health tripled the risk of depres-
tors, FVG and fish, which showed low preva- sion10.
lence (7.23% and 24.44%, respectively) (data It should be noted that depression is one
not shown). For this reason, public policies of the conditions that contributes most to the
are needed to enable greater access to healthy global burden of mental health-related diseases
food and thus promote the fight against chronic in the world55, despite its underdiagnosis56. Due
non-communicable diseases (CNCDs) and con- to its high prevalence, repercussions on general
tribute to achieving sustainable development health and psychosocial impact, it constitutes a
goals54. serious public health problem57.
It should be noted that the ideal cardiovas- Nowadays, the prevalence of unhealthy life-
cular health score, made up of potential pro- style habits and depressive symptoms may be
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Ciência & Saúde Coletiva, 30(4):1-11, 2025

higher than in the present study. In addition to data from the 2013 PNS estimated an average
changes in lifestyles, in terms of tobacco and consumption of 9.34g of salt per day, in which
alcohol consumption, diet and physical activity 95% of the adult population had excessive salt
during the period of social restriction resulting consumption63.
from the COVID-19 pandemic, studies point In this study, when composing the cardio-
to an increase in feelings of sadness, anxiety vascular health score, we used the ideal BMI
and nervousness, as well as sleep-related prob- cut-off point of <25 kg/m², as recommended
lems49,58. In the first year of the pandemic alone, by the AHA17 and used in national and inter-
anxiety and depression increased by more than national publications10,64. On the other hand,
25%32. there is a clinical recommendation to consider a
In Brazil, the Unified Health System (SUS) different cut-off point for the elderly, consider-
serves around 190 million people, 71% of whom ing those with a BMI<27 kg/m² to be eutrophic,
receive their healthcare exclusively through the due to the fact that the body composition of the
public network59. Primary Health Care (PHC), elderly is different from adults, associated with
the first level of the Health Care Network and the aging process65,66. In a sensitivity analysis, in
the citizen’s preferred gateway to SUS health order to test the possible impact of a different
services, is a privileged space for welcoming the cut-off point for elderly individuals in deter-
individual and working on actions to prevent mining the cardiovascular health score and its
and control mental disorders, aimed at health relationship with depression, a cardiovascular
promotion and protection, disease prevention, health score was created considering an ideal
diagnosis and treatment and rehabilitation ac- BMI of less than 27 kg/m² for people aged 60
tions in the individual and collective spheres60. or over and less than 25 kg/m² for individuals
Despite this, there is a large gap between the under 60. We then tested the logistic regression
need for treatment of mental disorders and the model between this new cardiovascular health
provision of care56. score and self-reported depression, obtaining
Mental health is not dissociated from gener- an OR adjusted for sociodemographic variables
al health, so recognizing that mental health de- of 0.56 (95%CI: 0.51-0.62) (data not shown). It
mands are present in various complaints report- should be noted that the adjusted OR, consid-
ed by users of health services is fundamental61. It ering the ideal BMI below 25 kg/m² for the en-
should be emphasized that encouraging lifestyle tire population, was 0.53 (95%CI: 0.48-0.59), as
changes and reducing risk factors are useful in- shown in this study. There was therefore a min-
terventions for preventing mental health prob- imal difference in the ORs in terms of magni-
lems and this should be agreed between users tude, maintaining the meaning and significance
and health professionals18,20-24, always based on of the association. It was therefore decided to
the principle of equity and the leading role of maintain the 25 kg/m² cut-off point for the gen-
the individual involved in their health produc- eral population to support the comparability of
tion process. the findings with the literature.
Among the limitations of the study, as it is This study makes progress by referring to
a self-report survey, the results are subject to a representative sample of the Brazilian pop-
memory limitations and underdiagnosis of hy- ulation in assessing the association between
pertension, diabetes and dyslipidemia, i.e. some cardiovascular health and self-reported depres-
of the interviewees are unaware of the disease sion. It also highlights the robustness and meth-
and do not mention the diagnosis62. Likewise, it odological rigor of the PNS, which configures
is inferred that the prevalence of self-reported the importance of these findings to emphasize
diagnosis of depression by the participants may public programs and policies aimed at compre-
be underestimated, as it is a limited indicator for hensive care for users of health services, which
estimating the prevalence of depression in the should include interprofessional actions aimed
population, which should preferably be mea- at the modifiable factors of the score.
sured using a standardized and validated diag-
nostic instrument or clinical assessment55.
In addition, in the 2019 PNS, salt consump- Conclusion
tion was not measured using the sodium/creati-
nine ratio in a casual urine sample, but through The dimension of the ideal cardiovascular
the participant’s self-report, which may under- health score was inversely associated with the
estimate its prevalence; 80.59% reported con- self-reported diagnosis of depression among
suming little salt, however, studies of laboratory Brazilian adults. In this context, we believe that
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Pinheiro MLSP et al

the use of this score in the clinical practice of score can contribute to comprehensive individ-
health professionals could help raise awareness ual and collective health care, through interven-
of the importance of healthy lifestyle habits tions that promote the prevention of diseases
aimed at promoting health and preventing ill- and the investigation and screening of chronic
nesses. In addition, the implementation of the conditions.

Collaborations

All authors worked on the conception and de-

sign of the study, data analysis, writing and criti-
cal review of the article, and approval of the final
version to be published.
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Ciência & Saúde Coletiva, 30(4):1-11, 2025

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