Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries.

Riki Tesler,Rotem Maor,Yael Sela,Oya Ercan,Concepción Moreno-Maldonado,Gizell Green,Orna Reges,Avi Zigdon,Adilson Marques,Yossi Harel-Fisch,Sharon Barak,Tânia Gaspar,Kwok Ng

doi:10.3390/healthcare10020268

Abstract

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

Highlights

Cardiovascular disease (CVD) is a term that encompasses various heart and blood vessel disorders mostly caused by atherosclerosis [1,2]
Understanding possible differences in physical activity barriers/facilitators between youth and different countries would enable those designing health promotion interventions to develop more specific and effective interventions to increase physical activity among youth. Older adolescents and those from lower socioeconomic status reported a higher likelihood of belonging to the high-risk group
In the absence of scientific agreement regarding the role of socioeconomic status and healthy lifestyle behaviors, such as smoking, among youth, the current study indicates the need for specific policies and interventions for different target groups in order to increase healthy lifestyle behaviors associated with reduced CVD

Summary

Introduction

Cardiovascular disease (CVD) is a term that encompasses various heart and blood vessel disorders mostly caused by atherosclerosis (e.g., hypertension, coronary heart disease, congestive heart failure, stroke, atrial fibrillation) [1,2]. CVD can evolve throughout one’s lifetime, often displaying no symptoms. Symptoms can lead to severe deterioration or may manifest as sudden death [3]. 60% of all cardiovascular-related deaths occur among asymptomatic people who had not previously suffered a cardiovascular incident [4]. CVDs remain the leading cause of death globally [5]. CVD cases have nearly doubled from 271 million in 1990 to 523 million in 2019. The number of CVD deaths has increased from 12.1 million in 1990 to 17.9 million lives in 2021 [6]. By 2030, the annual rate of premature CVD-related deaths is expected to reach roughly 24 million worldwide [7]

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