Risks find the owner: another example of cardiovascular risk screening

    Authors

    Keywords

    cardiovascular risk factors, public-health initiative, cardiovascular prevention

    DOI

    https://doi.org/10.15836/ccar2016.492

    Full Text

    **Introduction:** The results of conducted public health actions we have had so far indicate a high presence of unregulated cardiovascular (CV) risk (1, 2) factors, which explains a continuously high CV mortality in the Republic of Croatia (3). We show the continuation of the initiated research with the purpose of detecting an effective combination of risk factors applicable to screening on increased CV risk beyond primary healthcare. **Patients and Methods:** After being announced in the media, interested persons joined the free, open public health action included in the program of promoting cardiovascular health, “Guardians of the Heart”, which was held on the occasion of the Day of the City of Zagreb in June 2016. After taking the demographic data, data on cigarette smoking and diabetes, they underwent the measurement of the body mass index, waist circumference, glucose and lipid values in the capillary blood and blood pressure. Persons aged 40-65 have been diagnosed CV risk using SCORE (Systematic Coronary Risk Evaluation) risk charts. Participants had the opportunity to choose to undergo an examination of all or certain risk factors, take educational materials and consult health professionals. The data was analyzed in groups, depending on gender. Descriptive statistics of data obtained by counting was performed by using absolute numbers and relative frequencies, whereas testing of the relation was done by using χ2-test. The data obtained by measurements was analyzed by t-test. **Results:** The action was joined by 132 persons (44.7% men and 55.3% women), most of whom was aged over 65 years (63.6%). Dyslipidemia (74.6%), obesity (60.6%), central obesity (56.1%) and hypertension (51.1%) were most common. The analysis of the present factors by gender is shown in **Table 1**. The values ​​of total cholesterol and LDL were higher in men, and HDL values were higher in women. One third of the participants had a glucose value > 6.4mmol/L. Most diabetics did not have a satisfactory regulated glycemia. According to SCORE risk charts (**Table 2**) middle age men were commonly found in high risk category, while women were found in the moderate risk category. ### Table 1: Risk factors in group of patients according to gender. | | **Men (N=59)** | **Women (N=73)** | **P value** | | --- | --- | --- | --- | | **Age (years)** | | | | | mean ± SD | 70.56 ± 11.98 | 66.90 ± 11.09 | 0.0713 | | minimum | 30 | 32 | | | maximum | 95 | 87 | | | 65 | 43 (72.9%) | 41 (56.2%) | | | **Body mass index (kg/m2)** | | | | | mean ± SD | 26.92 ± 3.09 | 26.28 ± 4.78 | 0.3763 | | 102 & women > 88 | 28 (47.5%) | 46 (63.0%) | 0.0807 | | **Lipids (mean value ± SD (mmol/L))** | | | | | total cholesterol | 5.36 ± 0.97 | 6.01 ± 0.93 | **0.0001** | | LDL cholesterol | 2.65 ± 0.91 | 3.02 ± 1.08 | **0.0493** | | HDL cholesterol | 1.70 ± 0.79 | 1.96 ± 0.59 | **0.0318** | | triglycerides | 2.15 ± 1.23 | 2.03 ± 0.95 | 0.5519 | | **Capillary Blood Glucose** | | | | | mean value ± SD (mmol/L) | 7.18 ± 2.78 | 6.39 ± 2.06 | 0.0641 | | > 6.4 mmol/L | 20/59 (33.9%) | 24/73 (32.9%) | 1.0000 | | > 11.1 mmol/L in diabetic patients | 4/8 | 2/3 | | | **Known diabetes** | 8/59 (13.6%) | 3/72 (4.2%) | 0.0642 | | **Arterial hypertension** | 35/59 (59.3%) | 32/72 (44.4%) | 0.1142 | | **Heart rate ≥ 80 beats per minute** | 22/59 (37.3%) | 39/72 (54.2%) | 0.0780 | | **Total cholesterol > 5.0 mmol/L** | 39/58 (67.2%) | 58/72 (80.6%) | 0.1054 | | **Triglycerides > 1.7 mmol/l** | 32/58 (55.2%) | 44/72 (61.1%) | 0.5916 | | **Active smokers** | 8/58 (13.8%) | 8/73 (11.0%) | 0.5906 | ### Table 2: 10-years cardiovascular risk estimation in subjects aged 40 to 65 according to Systematic Coronary Risk Evaluation (SCORE) risk charts. | **SCORE** **risk categories** | **Men** | **Women** | | --- | --- | --- | | **Low-risk** **(< 1%)** | 0 | 3/31 (9.7%) | | **Moderate risk** **(≥ 1% and <5%)** | 5/14 (35.7%) | 25/31 (80.6%) | | **High-risk** **(≥ 5% and <10%)** | 8/14 (57.1%) | 3/31 (9.7%) | | **Very high-risk** **(≥ 10%)** | 1/14 (7.1%) | 0 | **Conclusion:** The measurement of waist circumference, as a quick and simple method, should be considered in future public health activities. Monitoring of glycaemia is useful in diabetics, while others should undergo it only on an empty stomach. People having moderate to high CV risk should consult a general practitioner. Considering a high presence of variable CV factors, a more aggressive approach to screening is required, that in addition to providing information on the priorities of CV prevention (4) should also focus on the cardiometabolic risk.

    Literature

    1. Krstačić G, Ivanuša M, Škerk V. Prevalence of Cardiovascular Risk Factors in the Participants of the Public Health initiative on the Occasion of the 2014 World Heart Day in Zagreb. Cardiol Croat. 2014;9(11-12):558–62. https://doi.org/10.15836/ccar.2014.558
    2. Ivanuša M, Škerk V, Heinrich M, Hrstić N, Krstačić G, Portolan Pajić I. Prevention of Chronic Non-Communicable Diseases: Quo Vadis? A New Example from Zagreb. Cardiol Croat. 2015;10(11-12):274–82. https://doi.org/10.15836/ccar2015.274
    3. Kralj K, Brkić Biloš I, Ćorić T, Silobrčić Radić M, Šekerija M. Chronic Noncommunicable diseases — Burden of disease in the population of Croatia. Cardiol Croat. 2015;10(7-8):167–75. https://doi.org/10.15836/ccar.2015.167
    4. Authors/Task Force Members, Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016;23(11):NP1–96. https://doi.org/10.1177/2047487316653709
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    Risks find the owner: another example of cardiovascular risk screening

    Extended Abstract
    Issue10-11
    Published
    Pages492-493
    PDF via DOIhttps://doi.org/10.15836/ccar2016.492
    cardiovascular risk factors
    public-health initiative
    cardiovascular prevention

    Authors

    Mario Ivanuša*ORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Nada HrstićORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Goran KrstačićORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Ivana Portolan PajićORCIDCroatian Heart House Foundation, Zagreb, Croatia

    *Correspondence email: mivanusa@gmail.com

    Full Text

    Introduction: The results of conducted public health actions we have had so far indicate a high presence of unregulated cardiovascular (CV) risk (1, 2) factors, which explains a continuously high CV mortality in the Republic of Croatia (3). We show the continuation of the initiated research with the purpose of detecting an effective combination of risk factors applicable to screening on increased CV risk beyond primary healthcare.

    Patients and Methods: After being announced in the media, interested persons joined the free, open public health action included in the program of promoting cardiovascular health, “Guardians of the Heart”, which was held on the occasion of the Day of the City of Zagreb in June 2016. After taking the demographic data, data on cigarette smoking and diabetes, they underwent the measurement of the body mass index, waist circumference, glucose and lipid values in the capillary blood and blood pressure. Persons aged 40-65 have been diagnosed CV risk using SCORE (Systematic Coronary Risk Evaluation) risk charts. Participants had the opportunity to choose to undergo an examination of all or certain risk factors, take educational materials and consult health professionals. The data was analyzed in groups, depending on gender. Descriptive statistics of data obtained by counting was performed by using absolute numbers and relative frequencies, whereas testing of the relation was done by using χ2-test. The data obtained by measurements was analyzed by t-test.

    Results: The action was joined by 132 persons (44.7% men and 55.3% women), most of whom was aged over 65 years (63.6%). Dyslipidemia (74.6%), obesity (60.6%), central obesity (56.1%) and hypertension (51.1%) were most common. The analysis of the present factors by gender is shown in Table 1. The values ​​of total cholesterol and LDL were higher in men, and HDL values were higher in women. One third of the participants had a glucose value > 6.4mmol/L. Most diabetics did not have a satisfactory regulated glycemia. According to SCORE risk charts (Table 2) middle age men were commonly found in high risk category, while women were found in the moderate risk category.

    Table 1: Risk factors in group of patients according to gender.

    Age (years)
    mean ± SD
    Men (N=59)
    70.56 ± 11.98
    Women (N=73)
    66.90 ± 11.09
    P value
    0.0713
    minimum
    Men (N=59)
    30
    Women (N=73)
    32
    maximum
    Men (N=59)
    95
    Women (N=73)
    87
    < 40
    Men (N=59)
    2
    Women (N=73)
    1
    40-65
    Men (N=59)
    14 (23.7%)
    Women (N=73)
    31 (42.5%)
    > 65
    Men (N=59)
    43 (72.9%)
    Women (N=73)
    41 (56.2%)
    Body mass index (kg/m2)
    mean ± SD
    Men (N=59)
    26.92 ± 3.09
    Women (N=73)
    26.28 ± 4.78
    P value
    0.3763
    < 25
    Men (N=59)
    20 (33.9%)
    Women (N=73)
    32 (43.8%)
    P value
    0.2846
    25-29.9
    Men (N=59)
    27 (45.8%)
    Women (N=73)
    29 (39.7%)
    ≥ 30
    Men (N=59)
    12 (20.3%)
    Women (N=73)
    12 (16.4%)
    Waist circumference (cm)
    mean ± SD
    Men (N=59)
    101.36 ± 9.86
    Women (N=73)
    92.73 ± 12.52
    P value
    < 0.0001
    men < 94 & women < 80
    Men (N=59)
    11 (18.6%)
    Women (N=73)
    12 (16.4%)
    P value
    0.8191
    men > 102 & women > 88
    Men (N=59)
    28 (47.5%)
    Women (N=73)
    46 (63.0%)
    P value
    0.0807
    Lipids (mean value ± SD (mmol/L))
    total cholesterol
    Men (N=59)
    5.36 ± 0.97
    Women (N=73)
    6.01 ± 0.93
    P value
    0.0001
    LDL cholesterol
    Men (N=59)
    2.65 ± 0.91
    Women (N=73)
    3.02 ± 1.08
    P value
    0.0493
    HDL cholesterol
    Men (N=59)
    1.70 ± 0.79
    Women (N=73)
    1.96 ± 0.59
    P value
    0.0318
    triglycerides
    Men (N=59)
    2.15 ± 1.23
    Women (N=73)
    2.03 ± 0.95
    P value
    0.5519
    Capillary Blood Glucose
    mean value ± SD (mmol/L)
    Men (N=59)
    7.18 ± 2.78
    Women (N=73)
    6.39 ± 2.06
    P value
    0.0641
    > 6.4 mmol/L
    Men (N=59)
    20/59 (33.9%)
    Women (N=73)
    24/73 (32.9%)
    P value
    1.0000
    > 11.1 mmol/L in diabetic patients
    Men (N=59)
    4/8
    Women (N=73)
    2/3
    Known diabetes
    Men (N=59)
    8/59 (13.6%)
    Women (N=73)
    3/72 (4.2%)
    P value
    0.0642
    Arterial hypertension
    Men (N=59)
    35/59 (59.3%)
    Women (N=73)
    32/72 (44.4%)
    P value
    0.1142
    Heart rate ≥ 80 beats per minute
    Men (N=59)
    22/59 (37.3%)
    Women (N=73)
    39/72 (54.2%)
    P value
    0.0780
    Total cholesterol > 5.0 mmol/L
    Men (N=59)
    39/58 (67.2%)
    Women (N=73)
    58/72 (80.6%)
    P value
    0.1054
    Triglycerides > 1.7 mmol/l
    Men (N=59)
    32/58 (55.2%)
    Women (N=73)
    44/72 (61.1%)
    P value
    0.5916
    Active smokers
    Men (N=59)
    8/58 (13.8%)
    Women (N=73)
    8/73 (11.0%)
    P value
    0.5906

    Table 2: 10-years cardiovascular risk estimation in subjects aged 40 to 65 according to Systematic Coronary Risk Evaluation (SCORE) risk charts.

    Low-risk (< 1%)
    Men
    0
    Women
    3/31 (9.7%)
    Moderate risk (≥ 1% and <5%)
    Men
    5/14 (35.7%)
    Women
    25/31 (80.6%)
    High-risk (≥ 5% and <10%)
    Men
    8/14 (57.1%)
    Women
    3/31 (9.7%)
    Very high-risk (≥ 10%)
    Men
    1/14 (7.1%)
    Women
    0

    Conclusion: The measurement of waist circumference, as a quick and simple method, should be considered in future public health activities. Monitoring of glycaemia is useful in diabetics, while others should undergo it only on an empty stomach. People having moderate to high CV risk should consult a general practitioner. Considering a high presence of variable CV factors, a more aggressive approach to screening is required, that in addition to providing information on the priorities of CV prevention (4) should also focus on the cardiometabolic risk.

    Literature

    1. 1.
      Krstačić G, Ivanuša M, Škerk V. Prevalence of Cardiovascular Risk Factors in the Participants of the Public Health initiative on the Occasion of the 2014 World Heart Day in Zagreb. Cardiol Croat. 2014;9(11-12):558–62.DOI
    2. 2.
      Ivanuša M, Škerk V, Heinrich M, Hrstić N, Krstačić G, Portolan Pajić I. Prevention of Chronic Non-Communicable Diseases: Quo Vadis? A New Example from Zagreb. Cardiol Croat. 2015;10(11-12):274–82.DOI
    3. 3.
      Kralj K, Brkić Biloš I, Ćorić T, Silobrčić Radić M, Šekerija M. Chronic Noncommunicable diseases — Burden of disease in the population of Croatia. Cardiol Croat. 2015;10(7-8):167–75.DOI
    4. 4.
      Authors/Task Force Members, Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016;23(11):NP1–96.DOI