The majority of Lebanese have an unmet goal for ideal cardiovascular health contributing to increasing their cardiovascular risk age
Introduction
The recent European Society of Cardiology (ESC) Prevention Guidelines [2016] have set the goals for ideal cardiovascular (CV) health. Furthermore, these guidelines re-emphasized the utilization of cardiovascular health SCORE to calculate cardiovascular disease (CVD) risk and guide management (1). One major drawback to the SCORE system is that it needs to be adjusted in a certain population before it can be used. The ESC Guidelines highlighted that cardiovascular risk age (CRA), on the other hand, can be used in any population regardless of baseline risk and secular changes in mortality, and therefore avoid the need for recalibration. CRA also has the advantage of being independent of the cardiovascular (CV) endpoint used, which bypasses the dilemma of whether to use a risk estimation system based on CV mortality or on total CV events (1-3). As CVD risk factors are increasing in the Arab world, and very few countries, if any, have recalibrated the SCORE system, CRA utilization appears quite appealing (4,5). In this study, we evaluated the unmet risk factor goals in a representative Lebanese sample and we calculated the mean CRA of the sample and compared it to the actual mean age.
Methods
The data collection for this study took place at the American University of Beirut (AUB). The Institutional Review Board at the American University of Beirut provided approval to conduct the study.
Study population and sampling technique
The sample used in our study was a random sample of Lebanese adults, residing in the GBA and aged above 18 years. Pregnant women, mentally disabled people and patients on dialysis were excluded from the sample. All participants were invited to present to AUB. A detailed data collection form was filled out for each subject, through interviews, physical exams, and blood tests. After applying the exclusion criteria for the CRA equation on the sample population, CRA was calculated for the remaining group (2).
Data was entered into a database using SPSS 22 for Windows (SPSS Inc., Chicago, IL, USA). A P value ≤0.05 was used to indicate statistical significance.
Results
Out of the 490 participants who were enrolled in the study, 199 participants fit the criteria for CRA calculation. Participants of the total study population had a mean age of 45.4±15 years; whereas the 199 participants had a mean age of 53.3±8.4 years and a mean CRA of 60±11.1 years. Table 1 shows the demographics and prevalence of various clinical CV risk factors in the sample population. Figure 1A shows the percentage of study population with different numbers of unmet targets. Figure 1B shows the percentage of the study population that had met versus unmet goals for each of the target risk factors.
Table 1
| Variables | N=490 [%] |
|---|---|
| Gender | |
| Male | 176 [36] |
| Female | 314 [64] |
| BMI categorical (kg/m2) | |
| <30 | 285 [58] |
| ≥30 | 205 [42] |
| Smoker | |
| Never | 124 [25] |
| Ex | 50 [10] |
| Current | 316 [65] |
| Family member diagnosed with CAD | |
| No | 305 [62] |
| Yes | 185 [38] |
| Diagnosed hypertension | |
| No | 374 [76] |
| Yes | 116 [24] |
| Diagnosed diabetes | |
| No | 416 [85] |
| Yes | 74 [15] |
| Diagnosed dyslipidemia | |
| No | 373 [76] |
| Yes | 117 [24] |
CVD, cardiovascular disease; CAD, coronary artery disease.
Discussion
More than two thirds of individuals within this representative cohort have at least three unmet goals for ideal CV health. The most unmet targets were physical activity, obesity and smoking. Target cholesterol levels were obtained in nearly half of the cohort. These findings contributed to the seven-year difference between the mean CRA and the mean actual age showing that there is room for improvement in community preventive efforts. Calculating the CRA of individuals would provide them with valid information about their risk for developing CVD using a number that is independent of the CV endpoint used. For this reason we created a digital calculator that calculates CRA and provides individuals with unmet target goals; the digital calculator can be found by following this link (http://www.aub.edu.lb/fm/vmp/Documents/ESC/esc.html) (6). We anticipate that this would help raise public and professional awareness towards diminishing CVD risk factors.
Acknowledgments
Funding: The American University of Beirut-Medical Practice Program (AUB-MPP) funded this project.
Footnote
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jxym.2017.07.01). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
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Cite this article as: Isma’eel H, Hakim A, Sakr G, Mailhac A, Nasreddine L, Tamim H. The majority of Lebanese have an unmet goal for ideal cardiovascular health contributing to increasing their cardiovascular risk age. J Xiangya Med 2017;2:60.
