Abdominal obesity is associated with ineffective control of cardiovascular risk factors in primary care in France

Abstract

Aim Insufficient control of cardiovascular risk factors is observed in primary care. The goal of the present study was to evaluate the association of abdominal obesity with achievement of treatment targets for HbA 1c, LDL cholesterol, triglycerides, HDL cholesterol and blood pressure in primary care. Methods In this cross-sectional observational epidemiological study, primary-care practitioners completed a questionnaire covering demographic and socioeconomic data, medical history, drug treatment, and clinical and biological characteristics for 3351 patients (1630 men and 1721 women). Therapeutic targets were HbA 1c < 7%, LDL cholesterol < 1.6 g/L, triglycerides < 1.5 g/L and SBP/DBP < 140/90 mmHg. Multivariate analyses were performed to assess the relationship between waist circumference and a lack of cardiovascular risk-factor control. Results The patients’ mean ages were 58 ± 14 years and 55 ± 16 years for men and women, respectively. A large waist circumference was positively and significantly ( P < 0.0001 for all) associated with diabetes, hypercholesterolaemia, hypertriglyceridaemia, low HDL cholesterol and hypertension. The prevalence of patients not achieving therapeutic targets increased across waist-circumference quartiles. For treated patients, the odds ratios (95% CI) (adjusted for age, gender, education, smoking status and medical specialty) for not achieving treatment targets were 17.6 (2.2–142) for triglycerides, 2.8 (1.3–6.1) for HbA 1c and 1.4 (0.9–2.0) for blood pressure on comparisons with extreme quartiles of waist-circumference distribution. Conclusion In primary care, a lack of control of triglycerides, HbA 1c and, to a lesser extent, blood pressure increases with waist circumference independently of confounders. This suggests that abdominal obesity is associated of poor results in the treatment of diabetes and hypertriglyceridaemia.