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Cardiovascular risk factors of the Circassian population in Israel
Tuesday June 27, 2000: Read by Title Abstracts T:W9 Geographic Epidemiology of Atherosclerosis
140
Methods: Consecutively, 230 male patients before 50 years of age (mean age 43 + 5 years), who were admitted to our Coronary Care Unit as result of an episode of coronary disease, were prospectively studied. Smoking habits, arterial hypertension, diabetes and dyslipemia were determined during the acute phase by means of a questionnaire, physical examen and fasting analysis. Levels of Total cholesterol (Tchol), HDL cholesterol (HDL), triglycerides (TG), apoolipoprotein AI (Apo AI), apolipoprotein B (APO B), Lp(a), LDL cholesterol (LDL) and total corrected cholesterol (TCC) were analysed after patients had fasted for more than 12 hours. In order to determine new coronary events a mean follow-up of 32 4- 13 months was carried out. Results: mg/dl ApoB LDL
Smokers(214) 100 4- 26 151 4- 48
No smokers(16) 117 4- 34 177 4- 43
p <0.05 <0.05
No differences were found in the levels of Apo AI, Tchol, HDL, TCC, Lp(a) and TG nor in the prevalence of hypertension and diabetes. No differences were seen during follow-up in relation to the number of coronary events, mortality and prevalence of angina, myocardial infarction, heart failure and the need for coronary revascularisation. Conclusions: Patients with early-onset coronary disease under the age of 50 years and without smoking habits present higher levels of L D L and Apo B than those patients with the same characterisctics and smokers, which suggest that the control of lipid profile in smokers must be higher.
Isfahan, 1ran
S. Castillo, A. Cenarro, E Mozas, G. Reyes, M. Pocovf, E Mata, R. Alonso, E Puzo, E Civeira. On behalf of the Spanish Group ofFH; Departamento de
Bioqu[mica, Universidad de Zaragoza, Spain Familial Hypercholesterolemia (FH) is a common autosomal disorder associated with increased LDL-cholesterol levels, presence of xanthomas and premature coronary artery disease (CAD). In the last two years, the Spanish FH Foundation has been developing a national register of this lipid metabolic disease. Objective: To determine FH phenotye in a Mediterranean sample and to confirm if the paradox that C A D is less frequent in the Mediterranean countries is applicable for this hyperlipidemia. Methods: 231 index cases, selected by application of MedPed clinical criteria to diagnose a definite FH, were studied. The sample was representative from the Spanish FH population. Results: The main results are indicated in the next table. Age 51.2 48.8 53.9 30.8 30.4 45.6 45.5 55.3 55.0 65.8 68.8
LDL-C 340 336 344 363 334 339 323 317 357 326 354
TG 124 135 115 117 94 124 114 152 124 155 116
HDL-C 50.0 44.6 55.2 42.5 46.4 47.3 59.9 43.5 54.6 43.6 55.3
CHD % 31.1 42.4 23.6 30.4 16.7 25.0 25.0 61.0 30.8 61.9 20.5
I TuT7:W9 I Hypertension and diabetes prevalence, awareness, treatment and control among the eastern mediteranean countries N. SarrafZadegan, E Sajadi. Isfahan Gardiovascular Research Center,
TuT5:W9 [ F a m i l i a l hypercholesterolemia phenotype in Spain
All (n = 231) Males(n = 106) Females(n = 125) <41 yrs M (n = 23) F (n = 19) 41-50 yrs M (n = 36) F (n = 24) 51~50 yrs M (n = 26) F (n = 39) >60 yrs M (n = 21) F (n = 39)
tion). Data collection was carded out by means of personal questionnaires (cigarette smoking, Leisure time physical activity), laboratory tests (Total Cholesterol (TC), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglycerides (TG), Glucose, mutation in three genes: MTHFR 677C > T, A P C R 1691 G > A, Prothrombin 20210A), blood pressure and BMI measurements and information from medical files. Results: The rate of CHD in the Circassian population > 35 is 7.3% (men 11.4% and women 4.6%) according to medical files. Age-adjusted prevalence rate of diabetes was 12.5 (according to new instructions of the ADA) and prevalence rate of hypertension (according to W H O ) was 25%. The prevalent risk factors among the Circassian population was obesity (BMI > 30) (48% of the women and 35% of the men), physical inactivity (81% of the women and 52% of the men), and smoking (33% among men and 10% of women). Genotype distribution for three mutations in the Circassian population was within the described rates in white populations and conformed to the HardyWeinberg equilibrium. In multivariate analysis prevalence of CHD among Circassians was significantly and independently related to age, diabetes, BMI and smoking. Diabetes was the strongest risk factor. Conclusion: Prevalent behavioral risk factors in the Circassian population combined with familial risk factors (diabetes and hypertension) in this endogamous community, present a population at risk for cardiovascular disease.
Xanth. % 47.2 50.9 48.8 47.8 38.9 58.3 54.2 46.2 61.5 47.6 35.9
Condusious: The incidence of C A D in Spanish FH males is similar to that reported for other occidental countries. No significant differences have been found between subjects with or without xanthomas and CAD with respect to fipid values. I TuT6:W9 I Cardiovascular risk factors of the Circassian population in i
Israel Y. Haron I , O. Hussein 2, S. Linn I . 1 Unit of Epidemiology, The Bruce
Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; 21nternal Medicine A, Rebecca Sieff Government, Safed, Israel
Objective: To estimate the prevalence of cardiovascular risk factors in the Circassian community in Israel. Circassians, an indigenous people originating in the noithern Caucasus region of eastern Europe. In Israel, they live as an endogamous community in cultural and geographical isolation for over a century. Methods" Study sample comprised 450 women and 289 men aged 35 and over from both villages (70.5% of the total Israeli Circassian popula-
Objectives: As policy makers need more data (preferably age and sex-based) on the prevalence, the number of diagnosed, treated and controlled hypertensive or diabetic patients to use for the future needs for health care and preventive actions, this study has been done. Methods: We reviewed all the studies performed since 1971 in each country in the region using M E D L I N E database, publications in medical international and national journals ect. Also, the results were given for each gender separately. Results: Results showed that although the percentage of awared and treated patients were relatively good, however the control rates is very low and far from developed countries. Of particular interest was the fact that although hypertension and diabetes were more prevalent among women compared to men, but women tended to be more aware and achieved better treatment than men. The control rate was similar between men and women. The following tables showed some of the main results obtained from this study. Frequencyof hypertensionawareness,h'eatmentand controlrates amonghypertensivemen and women in somecountriesin the region. Country Sex Age No Def Prevalence Awareness Treatment Control Period % % SandiArabia Men >10 1936 Women >-10 2033 Both >10 4000 Pakistan Women >-3 151 Egypt Men >-3 Women >-3 Ins Men >-19 3249 Women >-19 5300 Both >-19 3624
>-140.90 >-140.90 >-140.90 >-140.90 >-140.90 >-140.90 >_160.95 >-160.95 >-160.95
10.6 11.5 11.1 26 25.7 26.9 16.8 19.4 18
38 34.2 38.9 43.8 60.6 55
24 21 250 39.6 56.4 50
8 72 8 12.9 126 127
1995 1995 1995 1997 1995 I995 1996 1996 1996
Prevalencerate of diabetesand IGT and the level of awarenessamong men and women in different populationin die EMR. Country Prevaience(%) Age Sample Period DefiniIGT+ Awareness Men Women Total size tion Men Women Total Men Women Total Bahrain 36.4 3 35 >_30 573 1996 *3pp 18.9 16.7 14.7 16.7 18.4 17.8 Iran 4.6 5.5 5 30.69 800 1997 3pp 7.8 7.7 2.4 43 60 65 Kuwait 14.7 t4.8 14.8 >-30 3003 1996 **FBS Sandi 3.6 5.5 4.6 >-10 1450 1992 3pp 14 74 10.6 36 Arabia *2hpp: Two hour post prandial.**FBS: Fastingbloodsuger.+: IGT: Intolerantglucosetest.
Conclusion: We conclude that although higher awareness level was observed among hypertensive and diabetic women than men, still the figures are far from western population and public education programs are needed.
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
140
Methods: Consecutively, 230 male patients before 50 years of age (mean age 43 + 5 years), who were admitted to our Coronary Care Unit as result of an episode of coronary disease, were prospectively studied. Smoking habits, arterial hypertension, diabetes and dyslipemia were determined during the acute phase by means of a questionnaire, physical examen and fasting analysis. Levels of Total cholesterol (Tchol), HDL cholesterol (HDL), triglycerides (TG), apoolipoprotein AI (Apo AI), apolipoprotein B (APO B), Lp(a), LDL cholesterol (LDL) and total corrected cholesterol (TCC) were analysed after patients had fasted for more than 12 hours. In order to determine new coronary events a mean follow-up of 32 4- 13 months was carried out. Results: mg/dl ApoB LDL
Smokers(214) 100 4- 26 151 4- 48
No smokers(16) 117 4- 34 177 4- 43
p <0.05 <0.05
No differences were found in the levels of Apo AI, Tchol, HDL, TCC, Lp(a) and TG nor in the prevalence of hypertension and diabetes. No differences were seen during follow-up in relation to the number of coronary events, mortality and prevalence of angina, myocardial infarction, heart failure and the need for coronary revascularisation. Conclusions: Patients with early-onset coronary disease under the age of 50 years and without smoking habits present higher levels of L D L and Apo B than those patients with the same characterisctics and smokers, which suggest that the control of lipid profile in smokers must be higher.
Isfahan, 1ran
S. Castillo, A. Cenarro, E Mozas, G. Reyes, M. Pocovf, E Mata, R. Alonso, E Puzo, E Civeira. On behalf of the Spanish Group ofFH; Departamento de
Bioqu[mica, Universidad de Zaragoza, Spain Familial Hypercholesterolemia (FH) is a common autosomal disorder associated with increased LDL-cholesterol levels, presence of xanthomas and premature coronary artery disease (CAD). In the last two years, the Spanish FH Foundation has been developing a national register of this lipid metabolic disease. Objective: To determine FH phenotye in a Mediterranean sample and to confirm if the paradox that C A D is less frequent in the Mediterranean countries is applicable for this hyperlipidemia. Methods: 231 index cases, selected by application of MedPed clinical criteria to diagnose a definite FH, were studied. The sample was representative from the Spanish FH population. Results: The main results are indicated in the next table. Age 51.2 48.8 53.9 30.8 30.4 45.6 45.5 55.3 55.0 65.8 68.8
LDL-C 340 336 344 363 334 339 323 317 357 326 354
TG 124 135 115 117 94 124 114 152 124 155 116
HDL-C 50.0 44.6 55.2 42.5 46.4 47.3 59.9 43.5 54.6 43.6 55.3
CHD % 31.1 42.4 23.6 30.4 16.7 25.0 25.0 61.0 30.8 61.9 20.5
I TuT7:W9 I Hypertension and diabetes prevalence, awareness, treatment and control among the eastern mediteranean countries N. SarrafZadegan, E Sajadi. Isfahan Gardiovascular Research Center,
TuT5:W9 [ F a m i l i a l hypercholesterolemia phenotype in Spain
All (n = 231) Males(n = 106) Females(n = 125) <41 yrs M (n = 23) F (n = 19) 41-50 yrs M (n = 36) F (n = 24) 51~50 yrs M (n = 26) F (n = 39) >60 yrs M (n = 21) F (n = 39)
tion). Data collection was carded out by means of personal questionnaires (cigarette smoking, Leisure time physical activity), laboratory tests (Total Cholesterol (TC), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglycerides (TG), Glucose, mutation in three genes: MTHFR 677C > T, A P C R 1691 G > A, Prothrombin 20210A), blood pressure and BMI measurements and information from medical files. Results: The rate of CHD in the Circassian population > 35 is 7.3% (men 11.4% and women 4.6%) according to medical files. Age-adjusted prevalence rate of diabetes was 12.5 (according to new instructions of the ADA) and prevalence rate of hypertension (according to W H O ) was 25%. The prevalent risk factors among the Circassian population was obesity (BMI > 30) (48% of the women and 35% of the men), physical inactivity (81% of the women and 52% of the men), and smoking (33% among men and 10% of women). Genotype distribution for three mutations in the Circassian population was within the described rates in white populations and conformed to the HardyWeinberg equilibrium. In multivariate analysis prevalence of CHD among Circassians was significantly and independently related to age, diabetes, BMI and smoking. Diabetes was the strongest risk factor. Conclusion: Prevalent behavioral risk factors in the Circassian population combined with familial risk factors (diabetes and hypertension) in this endogamous community, present a population at risk for cardiovascular disease.
Xanth. % 47.2 50.9 48.8 47.8 38.9 58.3 54.2 46.2 61.5 47.6 35.9
Condusious: The incidence of C A D in Spanish FH males is similar to that reported for other occidental countries. No significant differences have been found between subjects with or without xanthomas and CAD with respect to fipid values. I TuT6:W9 I Cardiovascular risk factors of the Circassian population in i
Israel Y. Haron I , O. Hussein 2, S. Linn I . 1 Unit of Epidemiology, The Bruce
Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; 21nternal Medicine A, Rebecca Sieff Government, Safed, Israel
Objective: To estimate the prevalence of cardiovascular risk factors in the Circassian community in Israel. Circassians, an indigenous people originating in the noithern Caucasus region of eastern Europe. In Israel, they live as an endogamous community in cultural and geographical isolation for over a century. Methods" Study sample comprised 450 women and 289 men aged 35 and over from both villages (70.5% of the total Israeli Circassian popula-
Objectives: As policy makers need more data (preferably age and sex-based) on the prevalence, the number of diagnosed, treated and controlled hypertensive or diabetic patients to use for the future needs for health care and preventive actions, this study has been done. Methods: We reviewed all the studies performed since 1971 in each country in the region using M E D L I N E database, publications in medical international and national journals ect. Also, the results were given for each gender separately. Results: Results showed that although the percentage of awared and treated patients were relatively good, however the control rates is very low and far from developed countries. Of particular interest was the fact that although hypertension and diabetes were more prevalent among women compared to men, but women tended to be more aware and achieved better treatment than men. The control rate was similar between men and women. The following tables showed some of the main results obtained from this study. Frequencyof hypertensionawareness,h'eatmentand controlrates amonghypertensivemen and women in somecountriesin the region. Country Sex Age No Def Prevalence Awareness Treatment Control Period % % SandiArabia Men >10 1936 Women >-10 2033 Both >10 4000 Pakistan Women >-3 151 Egypt Men >-3 Women >-3 Ins Men >-19 3249 Women >-19 5300 Both >-19 3624
>-140.90 >-140.90 >-140.90 >-140.90 >-140.90 >-140.90 >_160.95 >-160.95 >-160.95
10.6 11.5 11.1 26 25.7 26.9 16.8 19.4 18
38 34.2 38.9 43.8 60.6 55
24 21 250 39.6 56.4 50
8 72 8 12.9 126 127
1995 1995 1995 1997 1995 I995 1996 1996 1996
Prevalencerate of diabetesand IGT and the level of awarenessamong men and women in different populationin die EMR. Country Prevaience(%) Age Sample Period DefiniIGT+ Awareness Men Women Total size tion Men Women Total Men Women Total Bahrain 36.4 3 35 >_30 573 1996 *3pp 18.9 16.7 14.7 16.7 18.4 17.8 Iran 4.6 5.5 5 30.69 800 1997 3pp 7.8 7.7 2.4 43 60 65 Kuwait 14.7 t4.8 14.8 >-30 3003 1996 **FBS Sandi 3.6 5.5 4.6 >-10 1450 1992 3pp 14 74 10.6 36 Arabia *2hpp: Two hour post prandial.**FBS: Fastingbloodsuger.+: IGT: Intolerantglucosetest.
Conclusion: We conclude that although higher awareness level was observed among hypertensive and diabetic women than men, still the figures are far from western population and public education programs are needed.
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000