Download prevalence of metabolic syndrome in the portuguese population

PREVALENCE OF METABOLIC SYNDROME IN THE PORTUGUESE POPULATION:
THE VALSIM REGISTRY
M. M. Fiuza, A. Belo, S. Martins, N. Cortez-Dias, on behalf of the Valsim Investigators
University Hospital Santa Maria, Portuguese Society of Cardiology
Background
The Metabolic syndrome (MS) is a constellation of risk
factors of metabolic origin that are accompanied by
increased risk for cardiovascular disease and type 2
diabetes mellitus. These risk factors are atherogenic
dyslipidemia, elevated blood pressure, elevated plasma
glucose, a prothrombotic state and a proinflammatory state.
Community-based and regional studies on MS have been
performed in Portugal, but they do not provide an overall
picture of the situation in the country as a whole.
Aims
• To determine the prevalence of MS in the portuguese adult
population (mainland Portugal, islands of Madeira and
Azores), and to stratify prevalence by region, gender and
age-group.
• To identify the prevalence of MS components: abdominal
obesity, elevated blood pressure and hypertension, impaired
fasting glucose and type 2 diabetes, elevated triglycerides
and reduced HDL-cholesterol.
• To evaluate the association between MS and
sociodemographic variables, diet, sedentary lifestyles and
smoking.
Results
A total of 16,333 subjects were analised (mean age:59±14
years; 61% women).
The age and sex-adjusted MS prevalence was NCEP-ATPIII
29.5%, IDF 51.3% and AHA/NHLBI 53.2% (Table 1). There
was lack of diagnostic agreement between different
definitions. Only 53.5% had the diagnosis of MS using the
three definitions, 23.9% according to IDF and AHA/NHLBI
criteria and 7.1% using only one definition.
Figure 1. Geographical variation in age- and sex-adjusted
prevalence of Metabolic Syndrome according to NCEP-ATP III
criteria (by region and by district). Analysis by region revealed that
the islands of Madeira had the lowest prevalence (24.5%) and Alentejo
had the highest (49.5%).
<25%
25-27,4%
27,5 - 30%
>30%
Table 1. Prevalence of Metabolic Syndrome in the adult
portuguese population according to 3 different definitions
60%
53,69%
53,89%
53,22%
51,26%
53,51%
48,56%
50%
Overall prevalence of each MS component in the portuguese
adult population was (total;men;women): high blood
pressure (57%;62%,53%); central obesity (46%;33%;58%);
hypertriglyceridemia
(31%;37%;25%),
low
HDL-C
(26%;19%;32%) and fasting hyperglicemia (20%;23%;17%).
Among men with MS by NCEP-ATP III criteria (Table 3), the
most frequent MS-components were elevated blood
pressure and impaired fasting glucose. These MScomponents were also very common in women, but the
frequencies of abdominal obesity and low HDL-C were
comparatively higher.
MS was present in 60% of the obese adults (≥30kg/m2).
However, even non-obese population had an unexpected
high prevalence of MS, particularly in upper normal-weigh
(23.0-24.9kg/m2) and overweight individuals (25-29.9kg/m2),
18.3% and 37.1%.The odds ratio for MS in overweigh and
obese was three and nine times, respectively.
<30%
40%
30-35%
>35%
31,28%
29,47%
27,47%
30%
Table 3. Frequency of each MS-component by sex, in patients
with Metabolic Syndrome according to NCEP-ATP III criteria
20%
80%
74%
70%
68%
70%
10%
60%
0%
52%
50%
Overall
Men
Women
Overall
NCEP-ATP III
Men
Women
Overall
IDF
Men
41%
Women
40%
39%
40%
AHA/NHLBI
34%
30%
30%
18%
20%
Methods
Descriptive cross-sectional study performed in a primary care
setting, envolving 1487 general practicioners (GP) representative
of each of the 20 portuguese districts (continent and islands).
Subjects older than 18 years consulting their GP, irrespective of
the reason for consulting and independently of the presence of
any cardiovascular risk factor, were asked to participate in the
national registry of MS prevalence (VALSIM). The participant GP
enrolled the first 2 patients each day. After informed consent, a
questionnaire was used to collect sociodemographic,
antropometric, clinical and laboratory data, as well as smoking,
nutricional and physical activity habits.
For purposes of determination of overall MS prevalence, MS was
diagnosed by NCEP-ATP III, IDF and AHA/NHLBI criteria and
compared according to these three definitions. To evaluate
gender and age-specific MS prevalence and relative frequencies
of each MS component, NCEP-ATPIII definition was used.
Geographical variation in the prevalence of MS was evaluated,
being considered for analytic purposes 7 territorial regions (North,
Center, Lisbon and Tagus Valley, Alentejo, Algarve, Madeira and
Azores). Multivariate regression analysis was used to estimate
the odds ratio (OR) of MS by age, gender and region.
Considering NCEP-ATP III definition, the prevalence of MS
increased from 7% among participants aged 18-30 years, to
46% for patients aged 60 years or older. In patients <50
years, there was a male preponderance, but this trend was
reversed in older patients, being the overall age-adjusted
prevalence statistically higher in women (women:31.2%,
men:27.5%, p<0.001).
Table 2. Prevalence of Metabolic Syndrome by sex and by agegroup according to NCEP-ATP III criteria
10%
0%
However, in the multivariate regression analysis (Figure 2)
the highest age- and sex-adjusted risks were found in North
(OR:1.11) and Center regions (OR:1.08), whereas the lowest
were present in Algarve (OR:0.78) and Lisbon and Tagus
Valley regions (OR:0.83).
Figure 2. Geographical variation in the age- and sex-adjusted risk
of Metabolic Syndrome (Odds Ratio, 95% Confidence Interval, p-Value)
Region
60%
0
0,5
1
1,5
2
P-Value
52,2%
50,0%
48,6%
North
0.03
Center
0.045
Lisbon and Tagus Valley
<0.001
Alentejo
0.099
Algarve
0.002
Madeira Islands
0.295
Azores Islands
0.245
50%
42,4%
40,2%
37,7%
40%
37,7%
32,7%
30,7%
29%
30%
23,8%
Abdominal
obesity
Impaired fasting
glucose
Men
Elevated
triglycerides
Low HDL-C
Women
Conclusions
These results from a representative sample of portuguese
adults shows that the MS is highly prevalent, irrespective of
the definition used.
The risk of MS is significantly higher among women, older
subjects and residents in the North and Center regions.
High blood pressure and central obesity were the most
frequent MS associated components in the portuguese
population.
These results demand vigorous lifestyle interventions, as
well as comprehensive preventive public health efforts.
18%
20%
10%
Elevated BP
7,8%
6,5%
0%
18-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
≥80 years
Sources of Support: The VALSIM registry received a grant-inaid from Novartis and technical and statistical support from the
Portuguese Society of Cardiology.