Abstract
BackgroundTo examine the trend of cardiovascular diseases (CVD) risk factors among a Middle Eastern population with prevalent CVD during a median follow up of 12 years.MethodsPatients with prevalent CVD (n = 282, men = 167), with a mean age of 60.76 years were evaluated in four study phases of the TLGS (Tehran lipid glucose study), 2002–2005, 2005–2008, 2008–2011, and 2011–2014. Trends of CVD risk factors were estimated using generalized estimation equation (GEE) models, by adjusting for gender, age and propensity scores.ResultThe adjusted prevalence of general and central adiposity, diabetes and physical inactivity at baseline was 25.18, 60.14, 25.03 and 43.74%, respectively and had increasing trends during the study period, reaching 41.32, 66.74, 43.20 and 50.32%, respectively, at the last visit. Although systolic, but not diastolic blood pressure, decreased from 134.88 to 129.86 mmHg, the prevalence of hypertension did not decrease (64.21% vs 68%, p value = 0.326). The prevalence of low high density lipoprotein cholesterol (HDL-C), hypertriglyceridemia and high non-HDL-C at baseline was 74.54, 59.89 and 96.53%, respectively, and showed improved trends reaching 44.87, 47.12 and 96.06% respectively; however, the favorable trend was not observed for high low density cholesterol. Significant increasing trends were observed in the consumption of anti-hypertensive, lipid and glucose lowering medications, but not for aspirin. The prevalence of current smoking (11.05 vs 16.83%, p value = 0.042) and chronic kidney disease (44.16 vs 51.65%, p value = 0.054) increased during follow up.ConclusionExcept for lipid profile status, dangerous trends for other CVD risk factors were demonstrated among CVD patients, which can be a harbinger for high rates of CVD mortality; these findings highlight the need for urgent implementation of multicomponent interventions to control CVD risk factors among these patients.
Highlights
Patients with a history of cardiovascular disease (CVD) are considered to be at highest risk of recurrent major vascular events and mortality [1,2,3]
Except for lipid profile status, dangerous trends for other CVD risk factors were demonstrated among CVD patients, which can be a harbinger for high rates of CVD mortality; these findings highlight the need for urgent implementation of multicomponent interventions to control CVD risk factors among these patients
The Generalized Estimation Equation (GEE) [26] method was used to assess secular longitudinal trends of continuous variables including Body mass index (BMI), waist circumferences (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), high density lipoprotein cholesterol (HDL-C), TG, total cholesterol (TC), non-HDL-C, Low density lipoprotein cholesterol (LDL-C) and Estimated glomerular filtration rate (eGFR) and for dichotomous variables, including general and central obesity, current smoking, Chronic kidney disease (CKD), low physical activity, and medication usage; separate generalized estimation equation (GEE) models with link function of logit and family of binomial were fitted for each variable
Summary
Patients with prevalent CVD (n = 282, men = 167), with a mean age of 60.76 years were evaluated in four study phases of the TLGS (Tehran lipid glucose study), 2002–2005, 2005– 2008, 2008–2011, and 2011–2014. Trends of CVD risk factors were estimated using generalized estimation equation (GEE) models, by adjusting for gender, age and propensity scores. Data Availability Statement: All relevant data are included within the paper and its Supporting Information file. Additional data are available upon request to the head of the RIES Ethics Committee, Dr Azita Zadeh Vakili, (azitavakili@endocrine.ac.ir). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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