Evaluation of cardiovascular and metabolic risk profile in a young adult population assisted by the family health strategy - LapARC Study

Abstract

Abstract Background The LapARC study is a population-based cohort study designed to evaluate the cardiovascular (CV) risk profile of a young adult population (aged between 20 and 50 years old). It is an unprecedented project as it takes a closer look at a population who is expected to be healthy and, therefore are generally neglected when dealing with their CV health. The study indicates that this public can benefit not only from the early identification of CV risk factors but from public policies for primary prevention, most likely changing cardiovascular morbidity and mortality in the future. Purpose To evaluate the CV and metabolic risk profile of a young adult population living in a Brazilian metropolis, in the coverage area of the Family Health Strategy. Methods This is a cross-sectional study divided into two phases: The first one designed for the recruitment and registration of individuals and the second one being a longitudinal phase with the purpose of searching for CV outcomes within these patients. Sociodemographic characteristics, anthropometric measurements, body composition analysis (electrical bioimpedance) and traditional CV risk factors were all recorded. Hypertension was diagnosed by office blood pressure (OBP) and home blood pressure monitoring (HBPM) with a 7-day protocol. The metabolic profile was evaluated by blood biochemistry testing lipid profile (total and fractions) and glycemic levels (glucose, glycated hemoglobin, and insulin for HOMA-IR calculation). Kidney function was assessed by serum creatinine and spot urine albuminuria. Obstructive Sleep Apnea (OSA) was screened by STOP-BANG questionnaire (SB) and Epworth Sleepiness Scale (ESS). Those with a high risk of OSA underwent portable home polysomnography monitoring. Results Of the 741 registered participants, 60% were female (mean age of 36.5 ± 9.0 years). Of these, 29% presented 3 or more risk factors. The prevalence of overweight, obesity, and abdominal obesity was 37%, 25% and 39%, respectively. A total of 44% of individuals were classified as sedentary and 15% smokers. Regarding the metabolic profile, 72% had dyslipidemia, 10% were diagnosed with metabolic syndrome, 9% had glucose intolerance and only 3.1% had type 2 diabetes. The prevalence of hypertension was 28,7%. By refining the diagnosis through HBPM, the study identified that 9.9% of these individuals had masked hypertension and 9.1% white-coat hypertension, revealing that sustained hypertension had an actual prevalence of 9,7 %. Within the OSA screening, 28% were at high risk by the SB and 36% by the ESS, while 13% were at high risk by both questionnaires. For the diagnosis of OSA by polysomnography, 46% of the participants had OSA and from these, 23% had moderate/severe OSA. Conclusion Despite being a young and apparently healthy population, we identified a high CV risk within these participants, pointing to the importance of public policies aimed at this population concerning primary prevention of CV diseases.