Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)
Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)
Mahbube Ebrahimpur,,1Erfan Mohammadi-Vajari,2,*Yasaman Sharifi,3Moloud Payab,4Bagher Larijani,5Afshin Ostovar,6
1. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 2. Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran 3. Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 4. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 6. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Introduction: Human life expectancy continues to increase rapidly. In fact, life expectancy has increased at least by 20 years since 1950 worldwide. Nowadays, countries all around the world is facing increase in elderly and their complications. It is anticipated that in 2030, 1 in 6 people in the world will be aged over 60 years. Chronic disorders affecting the elderly such as diabetes, hypertension, and hyperlipidemia have a considerable impact on health care costs. Presently, with improvement of global basic health measures, cardiovascular disorders are the most common cause of death. But hopefully, many of these cardiometabolic disorders are preventable or manageable. Increasing cardio metabolic diseases in elderlies could be reasoned with numbers of etiologies. In summary, the two major pathophysiological cause of age-related disease are chronic, low-grade inflammation and increased cellular oxidative stress.With increased longevity, the prevalence of many chronic diseases rises up. Canadian Community Health Survey (CCHS) state that about 37% of elderly report having at least two of the ten common chronic diseases. Diabetes mellitus (DM) is the most common metabolic disorder that based on the international diabetes federation state, globally, 1 in 11 adults has diabetes. 90% of diabetic patients have type 2 DM which is commonly diagnosed later in life. The Middle East and North African regions have the world’s second highest age-adjusted diabetes prevalence, with nearly 49% still undiagnosed. Thus, effective prevention, early diagnosis and treatment could be cost-effective for countries. Hypertension (HTN) mentioned as the most common preventable and potentially reversible risk factor of cardiovascular disease. Hypertension affects approximately 20% of the global population, and the prevalence of HTN is currently between 14.7 and 26.4% in various Eastern Mediterranean countries, based on the WHO report. In America, only 37% of adults with hypertension have their condition properly under control. One of the most important risk factors for developing HTN is increasing age. Aging is inevitable but early diagnosis, life style change, appropriate pharmacological treatment which targeting the mechanisms of HTN could diminish adverse effects. Dyslipidemia is attributed to more than half of all cases of coronary heart disease worldwide. According to World Health Organization (WHO) estimates, the worldwide prevalence of increased total cholesterol in adults (≥ 5.0 mmol/l) was estimated to be 39%. Prevalence of hyperlipidemia, another important cardio metabolic disorders increase with age. Because of its causative role in the development of atherosclerosis and often clinically asymptomatic before subsequent cardiovascular disease, screening and treatment of hyperlipidemia is important. Primary prevention in elderly is important because most of first cardiovascular events occur after 65 years old. Management of hyperlipidemia needs accurate risk stratification of elderlies. The value of secondary prevention clarified by studies that have shown the benefits of lipid-lowering drugs on mortality of patients. Despite the high importance of screening for metabolic risk factors such as diabetes, blood pressure and dyslipidemia, many of these disorders remain undiagnosed. For this reason, for example, in the case of diabetes, a screening recommendation has been changed to the age of over 35. By early diagnosis of these risk factors and their treatment, the possibility of their complications such as stroke, cardiovascular events or chronic complications of diabetes will be reduced or delayed.
Methods: Sampling and setting
This is a cross-sectional approach to data gathered from the second phase of Bushehr Elderly Health Program (BEHP). The BEHP was community-based prospective in Bushehr, a provincial capital city in the south of Iran with 3000 participants. The sampling of this study was a multistage stratified random sampling method accomplished in neighborhoods of Bushehr. The second phase of this study (considered musculoskeletal and cognitive outcomes) was started in 2015. In this phase, more than 2700 participants of phase I was enrolled again. The study design and protocol were explained separately.
Data gathering
The participants were interviewed by trained interviewers to collect data on their socio-demographic status, lifestyle (physical activity and smoking), medical history, and medication use. The questionnaire used for data gathering has been previously published elsewhere. Anthropometric measurements were performed manual based on the National Health and Nutrition Examination Survey (NHANES). Assessments of anthropometric parameters, physical activity level (PAL), and blood pressure were discussed in detail separately. By using two tools (Mini-Cog and categorical verbal fluency test; CFT) dementia was evaluated and depression mood assessed by Patient Health Questionnaire (PHQ-9).
Biochemical measurements
To determine the values of fasting blood sugar (FBS), hemoglobin A1c (HbA1c), and lipid profile, blood sample was taken after a 12 h overnight fast. FBS was measured by the enzymes (glucose oxidase) colorimetric method using a commercial kit (Pars Azmun, Karaj, Iran). HbA1c was also measured by Boranate affinity method using a CERA-STAT system (CERAGEM MEDISYS, chungcheongnam-do, Korea). Lipid profile and total cholesterol were measured by enzymatic (CHOD-PAP) colorimetric method using a commercial kit (Pars Azmun). Diabetes was defined on the basis of at least one of the following: A1C ≥ 6.4% or fasting plasma glucose ≥ 126 mg/dl or previous diagnosed diabetes history or diabetes medication use. Hyperlipidemia was defined as the presence of one of the following: total cholesterol ≥ 200 mg/dl or LDL-C ≥ 130 mg/dl or triglyceride ≥ 150 mg/dl or hyperlipidemia medication use. Hypercholesterolemia was defined as LDL-C ≥ 130 mg/dl or hypercholesterolemia medication use.
Statistical analysis
Concerning statistical analysis, results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Categorical variables were compared using the chi-square test. The logistic regression models were used to evaluate the association between various variables with untreated hypertension, diabetes, dyslipidemia and hypercholesterolemia. The proportions were carried out age-standardization based on World Health Organization (WHO) population 2000–2025. For the statistical analysis, the software STATA version 12 for windows (StataCorp, Texas 77,845 USA) was used. P values < 0.05 was considered as statistically significant.
Results: A total 2381 participants were included. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20–2.15), older adults (OR = 1.02, 95%CI = 1.00–1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52–0.92). Males (OR = 2.16, 95%CI = 1.64–2.84) and current smokers (OR = 1.42, 95%CI = 1.05–1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08–0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29–0.89) and dementia (OR = 0.78, 95%CI = 0.61–1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19–2.66) and males (OR = 1.66, 95%CI = 1.21–2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53–6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28–1.01).
Conclusion: Compared to other countries in this region, the prevalence of cardio metabolic diseases, such as diabetes, hypertension, and hyperlipidemia, was higher in our cohort population. Males and older adults were more likely to have untreated diabetes. Untreated HTN prevalence was higher for males and smokers, and lower for people with higher education levels and married participants. Untreated dyslipidemia is more common in smokers and males, while untreated hypercholesteremia is more common in males and is reported lower in people with dementia. These potential risk factors need to be evaluated further to confirm their impact on the prevalence of cardiometabolic diseases among the elderly. Additionally, future studies should examine screening plans for these cardiometabolic risk factors in younger adults as well as exploratory studies to determine the probable causes of patients who do not receive appropriate treatment despite confirmed diagnoses.