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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.