Prevalence Of Modifiable Cardiovascular Risk Factors Research Articles

Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database.

To investigate the prevalence of modifiable cardiovascular risk factors (CVRFs), including dyslipidaemia, obesity and high glycated haemoglobin (HbA1c) concentration, in patients with type 1 diabetes (T1D), and to evaluate their association with blood pressure (BP) categories. We analysed 21 634 children and adolescents with T1D from the SWEET international database with office BP values assessed at a three or more visits within a year from 2010 to 2021. Participants were classified into a normotensive group, a group with elevated BP (90 to 94th percentile) or a hypertensive group (≥95th percentile), based on the median BP for the visits within the last treatment year. The prevalences of dyslipidaemia [cholesterol ≥ 5.18 mmol/L (200 mg/dL) and/or HDL cholesterol ≤ 1.036 mmol/L (40 mg/dL) and/or LDL cholesterol ≥ 2.59 mmol/L (100 mg/dL)], obesity (body mass index ≥2 standard deviation score) and elevated HbA1c [≥ 75 mmol/mol (9%)] were evaluated in patients within each BP group. Patients with hypertension/elevated BP had less favourable lipid profiles, and a higher prevalence of obesity and HbA1c ≥ 75 mmol/mol than normotensive patients. A total of 38.4% of hypertensive patients and 36.0% of those with elevated BP had one CVRF, 15.1% and 10.1%, respectively, had two CVRFs, and 2.3% and 0.8%, respectively, had three CVRFs. Patients with hypertension/elevated BP had a higher prevalence of one or more CVRFs versus normotensive patients (P< 0.001). Obesity was the CVRF most strongly related to hypertension. Girls had a higher prevalence of one or more CVRFs than boys. Similar results were found in patients aged ≥13 years with hypertension compared to those aged <13 years. The prevalence of modifiable CVRFs is higher in children and adolescents with T1D who have elevated BP/hypertension than in those with normotension, suggesting that they are more vulnerable to future morbidity and mortality requiring early detection and intervention.

Reply to Letter to the Editor: The proper blood pressure may impaire cardiovascular risk factors

We are very delighted about the international interest in ourpaper “Uncontrolled arterial hypertension in primary care –patient characteristics and associated factors” (Swiss MedWkly. 2012;142:w13693). We are especially delighted thatour work obviously is not only recognised by primary carephysicians, but also by specialists as the letter to the editorby Sait Demirkol [1] reflects.We are also thankful for the comment regarding the crosssectional design of our study. We agree with Demirkol andcolleagues that a cross sectional design can only show cor-relations but not prove any causality. This would only bepossible – as suggested by Demirkol et al. – by a followup. The data presented in our paper are derived from thebaseline-assessment of the CoCo trial, a randomised, con-trolled trial aiming at improving blood pressure control byusing a colour coded booklet for patients to note their bloodpressure measurements (Trials. 14 April 2010;11:38).It is our aim to follow the patients included in CoCo forat least one year. Therefore, we will be able – controlledfor the intervention – to analyse the influence of the de-tected risk factors for elevated blood pressure, namely age,smoking and a high body mass index over time. We arelooking forward to present these data soon.We agree with Demirkol and colleagues that patients withestablished cardiovascular diseases have a dysregulation ofvascular tone thus further promoting atherosclerosis. Asa consequence, blood pressure control by pharmacologic-al agents might differ depending on pleiotropic effects ofthese agents beyond blood pressure lowering, includinganti-oxidative and anti-inflammatory actions (Curr VascPharmacol. 2011 Mar;9(2):145–52, Clin Exp Hypertens.2012 Nov 30. [Epub ahead of print]). To investigate theeffect of various pharmacological agents was beyond thescope of the current study and unfortunately as stated inthe strengths and limitations section of our paper, co-mor-bidities were not systematically assessed. Therefore we arenot able to stratify for the factors: coronary artery disease,hypercholesterolemia or diabetes mellitus. Nevertheless,there is sufficient evidence that successful modification oflifestyle risk factors have a beneficial effect on blood pres-sure control irrespective of cardiovascular co-morbidities.Our cross-sectional results confirmed that the prevalence ofmodifiable cardiovascular risk factors is high in unselectedpatients with uncontrolled blood pressure thus demonstrat-ing the potential of successful lifestyle change programmesas mentioned by Demirkol and colleagues (Oman Med J.2012;27(6):511).

Riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana en España. Cohorte CoRIS, 2011

Current information on cardiovascular risk (CVR) in HIV-infected patients in Spain is limited. An analysis was made of a prospective multicentre cohort of Spanish HIV-infected patients (CoRIS) between January-2010 and July-2011. CVR was evaluated using Framingham, REGICOR and SCORE equations. The study included 1019 patients (76% males, mean age 40 years) recruited from 13 hospitals belonging to 10 autonomous communities in Spain. Almost two-thirds (65.4%) of patients were on antiretroviral therapy (ART), 36.7% with non-nucleoside analogs, 24% with protease inhibitors (PIs) (52% with atazanavir/r or darunavir/r) and 4,6% with raltegravir. More than half (56.2%) of the patients had an HIV viral load <50 copies/ml. Smoking prevalence was 46%, HDL cholesterol (HDL-C) <40mg/dl 36.1%, total cholesterol (total-C) >200mg/dl 27.8%, age >45years 27.2%, metabolic syndrome 11.5%, hypertension 9.4%, cocaine use 7%, and diabetes 2.9%. ART was associated with higher total-C and LDL-C concentrations, although also higher HDL-C and lower total-C/HDL-C ratio; patients receiving PIs boosted with a high ritonavir dose showed higher total-C levels and higher total-C/HDL-C ratio. According to Framingham cardiovascular, and coronary, REGICOR, and SCORE equations, 15.2%, 6.4%, 4.2% and 3.9% of patients, respectively, were classified as having moderate or high CVR. In HIV-infected patients from CoRIS, prevalence of modifiable CVR factors is still high. Commonly used scores identify a relatively low number of patients with high CVR.