Trends in cardiovascular risk factor prevalence (1995-2000-2005) in northeastern Spain

Abstract

Background

High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain.

Design

Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain.

Methods

An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age.

Results

A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol > 3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.913.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends < 0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends = 0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends = 0.018).

Conclusions

The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs. Eur J Cardiovasc Prev Rehabil 14:653-659 © 2007 The European Society of Cardiology

Keywords

blood pressure cardiovascular disease cholesterol coronary disease epidemiology lipids risk factors

Get full access to this article

View all access options for this article.

References

1 World Health Statistics. Monograph on the Internet. Geneva, World Health Organization; 2000. [Cited 2006 January 08]. Available from: http://www.who.int/ncd_surveillance/infobase/web/InfoBaseCommon/.

Tunstall-Pedoe

Kuulasmaa

Amouyel

Arveiler

Rajakanjas

Pajak

Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90:583–612.

3 Greenland

Knoll

Stamler

Neaton

Dyer

Garside

. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290:891–897.

4 Yusuf

Hawken

Ounpuu

Dans

Avezum

Lanas

. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937–952.

Rose

Sick individuals and sick populations. Int J Epidemiol 1985; 14:32–38.

Abadal

Varas

Lorenzo C

Perez

Puig

Balaguer

Vintro I.

Risk factors and 28 year morbidity and mortality of coronary heart disease in a cohort with a low incidence of disease: the Manresa study. Rev Esp Salud Publica 2004; 78:229–241.

7 Masia

Pena

Marrugat

Sala

Vila

Pavesi

. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators. J Epidemiol Community Health 1998; 52:707–715.

Medrano

Cerrato

Boix

Delgado-Rodriguez

Cardiovascular risk factors in the Spanish population: metaanalysis of cross-sectional studies. Med Clin (Barc) 2005; 124:606–612.

9 Kuulasmaa

Tunstall-Pedoe

Dobson

Fortmann

Sans

Tolonen

. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet 2000; 355:675–687.

10.

10 Població de Catalunya [Monograph on the Internet]. Barcelona, Institut d'Estadística de Catalunya; 2002. [Cited 2006 Jan 08]. Available from: www.idescat.net.

11.

11 Manual of The MONICA Project [Manual on the Internet] Geneva, World Health Organisation; 2000. [Cited 2006 Jan 08]. Available from: http://www.ktl.fi/publications/monica/manual/index.htm.

12.

12 Chobanian

Bakris

Black

Cushman

Green

Izzo

Jr. . Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42:1206–1252.

13.

Blackburn

Classification of the electrocardiogram for population studies: Minnesota Code. J Electrocardiol 1969; 2:305–310.

14.

14 Marrugat

D'Agostino

Sullivan

Elosua

Wilson

Ordovas

. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health 2003; 57:634–638.

15.

15 Marrugat

Subirana

Comín

Cabezas

Vila

Elosua

., For the VERIFICA Investigators. Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study. J Epidemiol Community Health 2007; 61:40–47.

16.

Elosua

Garcia

Aguilar

Molina

Covas

Marrugat

Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish women. Investigators of the MARATDON Group. Med Sci Sports Exerc 2000; 32:1431–1437.

17.

Elosua

Marrugat

Molina

Pons

Pujol

Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish men. The MARATHOM Investigators. Am J Epidemiol 1994; 139:1197–1209.

18.

Ahmad

Boschi-Pinto

Lopez

Murray

CJL

Lozano

Inoue

Age standardization of rates: a new WHO standard GPE Discussion Paper Series: No. 31. Geneva: World Health Organization; 2000.

19.

Capuano

Bambacaro

D'Arminio

Del Regno

D'Antonio

Lanzara

Changes in total serum cholesterol for cardiovascular disease in a Mediterranean area, 1989-1999. Eur J Epidemiol 2003; 18:27–32.

20.

20 Marques-Vidal

Ruidavets

Amouyel

Ducimetiere

Arveiler

Montaye

. Change in cardiovascular risk factors in France, 1985-1997. Eur J Epidemiol 2004; 19:25–32.

21.

Arnett

McGovern

Jacobs

Jr Shahar

Duval

Blackburn

Luepker

RV.

Fifteen-year trends in cardiovascular risk factors (1980-1982 through 1995-1997): the Minnesota Heart Survey. Am J Epidemiol 2002; 156:929–935.

22.

22 Carroll

Lacher

Sorlie

Cleeman

Gordon

Wolz

. Trends in serum lipids and lipoproteins of adults, 1960-2002. JAMA 2005; 294:1773–1781.

23.

Houterman

Verschuren

WMM

Oomen

Boersma-Cobbaert

Kromhout

Trends in total and high densitylipoprotein cholesterol and their determinants in The Netherlands between 1993 and 1997. Int J Epidemiol 2001; 30:1063–1070.

24.

Regidor

Gutierrez-Fisac

Calle

Navarro

Dominguez

Trends in cigarette smoking in Spain by social class. Prev Med 2001; 33:241–248.

25.

25 Wolf-Maier

Cooper

Banegas

Giampaoli

Hense

Joffres

. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289:2363–2369.

26.

Manuel

Lim

Tanuseputro

Anderson

Alter

Laupacis

Mustard

CA.

Revisiting Rose: strategies for reducing coronary heart disease. BMJ 2006; 332:659–662.

27.

27 Gil

Martí

Elosua

Grau

Sala

Masiá

. Analysis of trends in myocardial infarction case-fatality, incidence and mortality rates in Girona, Spain, 1990-1999. Rev Esp Cardiol 2007; 60:349–356.

28.

Ferrieres

The French paradox: lessons for other countries. Heart 2004; 90:107–111.

29.

Artaud-Wild

Connor

Sexton

Connor

WE.

Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox. Circulation 1993; 88:2771–2779.

30.

30 Verschuren

Jacobs

Bloemberg

Kromhout

Menotti

Aravanis

. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the Seven Countries study. JAMA 1995; 274:131–136.

31.

31 De Backer

Ambrosioni

Borch-Johnsen

Brotons

Cifkova

Dallongeville

. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2003; 24:1601–1610.

32.

32 Marrugat

Elosua

Aldasoro

Tormo

Vanaclocha

Segura

. Regional variability in population acute myocardial infarction cumulative incidence and mortality rates in Spain 1997 and 1998. Eur J Epidemiol 2004; 19:831–839.