Despite rapidly increasing rates of type 2 diabetes and heart disease around the world, findings from a recent international survey suggest that the majority of the global population is still unaware of the factors that put them at increased risk of developing these diseases, according to the World Heart Federation.
Cardiometabolic risk represents the overall risk of developing type 2 diabetes and heart disease, which is due to a cluster of modifiable risk factors including: high blood sugar, unhealthy cholesterol (high levels of LDL-cholesterol or low levels of HDL-cholesterol in the blood), high levels of triglycerides in the blood, high blood pressure or too much fat around the waist (as measured by waist circumference).
Recent evidence has suggested that this cluster of modifiable factors can increase the risk of people developing type 2 diabetes and heart disease. Therefore it is important that these risk factors are measured regularly in order to assess the risk of type 2 diabetes and heart disease.
Risk factors poorly understood
Results released yesterday from the Shape of the Nations 2006 survey suggested that globally, less than a quarter (24 percent) of the general population is familiar with the term ‘global cardiometabolic risk’. In South Africa, only 23 percent of the general population were familiar with the term.
Additionally, less than 20 percent of both the general population as well as patients at risk of developing type 2 diabetes or heart disease and just over half (52 percent) of physicians understand that global cardiometabolic risk refers to the relationship between multiple risk factors and the risk of developing heart disease. In South Africa 15 percent of the general population and 68 percent of physicians understand this relationship.
How the study was conducted
The Shape of the Nations 2006 survey was conducted in 27 countries among 11 353 people (including members of the general population, people identified as at risk of heart disease as well as primary care physicians) with the main aim of assessing awareness, understanding, attitudes and behaviours with respect to cardiometabolic risk factors and their link to type 2 diabetes and heart disease.
Generally, it appears doctors are not treating all risk factors equally. Risk factors most often evaluated and managed by doctors include high levels of LDL (bad) cholesterol, blood pressure and blood glucose. However, other emerging risk factors such as abdominal obesity, high levels of triglycerides and low levels of HDL (good) cholesterol in the blood have traditionally commanded less attention.
The survey found that almost half of physicians are able to spontaneously identify classical risk factors for heart disease such as type 2 diabetes, overall cholesterol levels, blood pressure and smoking. However, they are significantly less likely to remember emerging risk factors that put their patients at risk, such as abdominal obesity (as measured by waist circumference), high levels of triglycerides and low levels of HDL (good) cholesterol in the blood.
In South Africa only 33 percent recognise abdominal obesity, 27 percent recognise high levels of triglycerides in the blood and 25 percent recognise low levels of HDL-cholesterol in the blood as cardiometabolic risk factors.
Measure your abdomen
Abdominal obesity is emerging as an important driving force behind the deterioration of cardiometabolic risk in the general population. Patients with evidence of cardiovascular disease often display abdominal obesity and observational studies have identified abdominal obesity as a predictor of adverse metabolic or cardiovascular outcomes independently of body mass index (BMI).
This was confirmed by The International Day for the Evaluation of Abdominal Obesity (IDEA) study, which showed that a high waist circumference is associated with cardiovascular disease independently of age and body mass index.
Nevertheless, both age and waist circumference are important determining factors for cardiovascular disease. Every 16-year increase in age triples the likelihood of an adult having cardiovascular disease and each increase in waist circumference of 14 cm for men and 14.9 cm for women increases the likelihood of a person having cardiovascular disease by between 21 percent and 40 percent.
The IDEA study, conducted on over 170 000 people and involving a random sample of more than 6 000 primary care practitioners in 63 countries, suggested that abdominal obesity is highly prevalent worldwide among people in a primary care setting.
The study suggested that abdominal obesity can be measured by waist circumference and is an indicator of intra-abdominal adiposity, the hidden fat present deep within the abdomen associated with the development of other cardiometabolic risk factors. Waist circumference is therefore considered a more accurate predictor of the development of other cardiometabolic risk factors than general obesity.
97 percent of patients agreed to have their waist circumference measured by their primary care physician, suggesting that waist circumference can be easily measured and included in clinical practice worldwide.
However, in the Shape of the Nations 2006 survey, globally nearly 9 out of 10 (94 percent) of at-risk patients and a similar number of the general population (96 percent) were unable to automatically identify abdominal obesity as a cardiometabolic risk factor. – (the World Heart Federation)
Source: Press release from the World Heart Federation