Document Detail

The impact of a community trial on the pharmacological treatment in the individuals with the metabolic syndrome: findings from the Isfahan Healthy Heart Program, 2001-2007.
Jump to Full Text
MedLine Citation:
PMID:  23319975     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Pharmacological therapy is a crucial step in the management of individuals with the metabolic syndrome, when lifestyle modifications alone cannot achieve the therapeutic goals. The present study aimed to evaluate the efficacy of comprehensive interventions with the pharmacological treatment in individuals with the metabolic syndrome.
MATERIAL AND METHODS: A cross-sectional population-based survey examined a sample of adults before and after conducting a community trial. Physical examination and blood sampling, data regarding the demographic characteristics, medical status and history of medication use were obtained. Pharmacologic treatment related to metabolic syndrome's components was also determined.
RESULTS: The most common pharmacologic agents consumed by individuals with metabolic syndrome were β-blockers (26.1% and 30.4% in 2001 and 2007, respectively), followed by lipid-lowering agents (5.4% and 14% in 2001 and 2007, respectively), with significant differences before and after intervention. The prevalence of metabolic syndrome was higher in women than in men both before (36.4% vs. 14%) and after the community trial (26.1% vs. 16%, respectively) in the intervention areas (p < 0.001).
CONCLUSIONS: We found a significant increase in medication use to control blood pressure and dyslipidemia among the individuals with the metabolic syndrome, notably in the intervention areas. In addition to the population approach, the high-risk approach should be considered in community trials for prevention and control of non-communicable diseases.
Authors:
Mojgan Gharipour; Roya Kelishadi; Alireza Khosravi; Shahin Shirani; Mohsen Masjedi; Nizal Sarrafzadegan
Related Documents :
21815185 - Cyclophosphamide and prednisone induction followed by cyclophosphamide mobilization eff...
21838075 - Bilateral exertional compartment syndrome of the forearm: evaluation and endoscopic tre...
22073835 - Update on cardiorenal syndrome: a clinical conundrum.
21920075 - Neuroleptic malignant syndrome in adolescents: four probable cases in the western cape.
2433135 - Discrimination of idiopathic pain syndromes from neurogenic pain syndromes and healthy ...
22117835 - Proteomic analysis of saliva: a unique tool to distinguish primary sjögren's syndrome ...
Publication Detail:
Type:  Journal Article     Date:  2012-12-19
Journal Detail:
Title:  Archives of medical science : AMS     Volume:  8     ISSN:  1734-1922     ISO Abbreviation:  Arch Med Sci     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-01-15     Completed Date:  2013-01-16     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101258257     Medline TA:  Arch Med Sci     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  1009-17     Citation Subset:  -    
Affiliation:
Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Arch Med Sci
Journal ID (iso-abbrev): Arch Med Sci
Journal ID (publisher-id): AMS
ISSN: 1734-1922
ISSN: 1896-9151
Publisher: Termedia Publishing House
Article Information
Download PDF
Copyright © 2012 Termedia & Banach
open-access:
Received Day: 06 Month: 12 Year: 2010
Revision Received Day: 23 Month: 3 Year: 2011
Accepted Day: 30 Month: 4 Year: 2011
Electronic publication date: Day: 19 Month: 12 Year: 2012
Print publication date: Day: 20 Month: 12 Year: 2012
Volume: 8 Issue: 6
First Page: 1009 Last Page: 1017
PubMed Id: 23319975
ID: 3542491
Publisher Id: 19913
DOI: 10.5114/aoms.2012.32407

The impact of a community trial on the pharmacological treatment in the individuals with the metabolic syndrome: findings from the Isfahan Healthy Heart Program, 2001-2007
Mojgan Gharipour1
Roya Kelishadi1
Alireza Khosravi2
Shahin Shirani2
Mohsen Masjedi3
Nizal Sarrafzadegan1
1Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2Hypertension Research Center, Isfahan University of Medical Sciences, Iran
3Department of Immunology, Isfahan University of Medical Sciences, Iran
Correspondence: Corresponding author: Mohsen Masjedi PhD, Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Postcode: 8174673461, Isfahan, Iran. Phone: +983117922416. Fax: +983117922431. E-mail: masjedi@med.mui.ac.ir

Introduction

The metabolic syndrome is a great public health concern, and patients with this cluster of risk factors are at significantly increased risk of developing diabetes and cardiovascular disease (CVD) [1]. This condition is highly prevalent in both developed and developing countries and carries a risk of diabetes, cardiovascular morbidity and mortality [2]. The metabolic syndrome has recently aroused universal attention from the scientific societies and healthcare managers [3]. The main goal of treatment for the metabolic disease is to reduce cardiovascular risk [4]. Components of the metabolic syndrome that need control are atherogenic dyslipidemia, elevated blood pressure, elevated fasting glucose, prothrombotic factors, and proinflammatory state [4]. Pharmacological therapy is a critical step in the management of subjects with the metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals [5].

In addition to weight loss, there is no single best therapy, and the treatment should consist of treatment of the individual components of the metabolic syndrome [6]. Although lifestyle change is the first line of therapy, medical treatment is usually needed for the optimal control [7].

A recent community-based interventional program, named the Isfahan Healthy Heart Program (IHHP), is a community-based interventional program for CVD and control of related risk factors. The goal of the IHHP study was to make a strategic shift towards prevention and control of non-communicable diseases (NCDs) and their risk factors and promote healthy lifestyles by using comprehensive population and high-risk approaches to prevention [8]. Several interventional trials have reported the effects of lifestyle intervention programs among the high-risk populations [9]. However, the pooled effects suggest that multiple risk factor intervention has no effect on mortality. In spite of recent meta-analyses there is doubt about whether lifestyle interventions actually help to reduce the cardiovascular disease risk factors [10].

The present study aimed to evaluate the efficacy of IHHP on drug compliance in the individuals with the metabolic syndrome after comprehensive intervention in both sexes in an intervention area compared with a reference area. The hypothesis for intervention was that participants in the intervention area would achieve greater compliance in the management of the metabolic syndrome components than found in the reference area.


Material and methods

The Isfahan Healthy Heart Program, a comprehensive integrated community-based action-oriented study with a reference community, has been conducted by the Isfahan Cardiovascular Research Centre since 2001 to 2007 [11]. Two intervention counties (Isfahan and Najafabad) and a reference area (Arak), all located in the central part of Iran, were included in the study. According to the 2000 National Census, the population was 1,895,856 in Isfahan and 275,084 in Najafabad – a county neighboring Isfahan. Arak, located 375 km North-West of Isfahan, with a population of 668,531, was selected as a reference area because of socioeconomic, demographic and health profile similarities to the intervention areas. In each community, a random independent sample of adults was selected by multi-stage cluster sampling. Clusters were chosen from three counties in the central part of Iran, based on their demographic and socioeconomic characters. The effect of confounding has been addressed by using random, stratified household sampling, based on age and sex groups. The IHHP was conducted as three phases: the situational analysis or baseline phase, the second or implement interventional activities in the interventional area, and the last phase or outcome evaluation phase. During the second phase, we carried out an organized approach to program evaluation including each activity (i.e. process evaluation) and program annual monitoring (i.e. impact evaluation).

The participants were more than 19 years old. The samples underwent a 30-minute interview to complete validated questionnaires containing questions on demography, socioeconomic status, smoking behavior, physical activity, nutritional habits and other behavior regarding CVD [12].

Written informed consent was obtained from subjects after full explanation of the procedure. The study was approved by the Ethics Committee of the Isfahan Cardiovascular Research Center. IHHP was covered under IRB protocol FW A00008578 and was performed at the Isfahan Cardiovascular Research Center with the collaboration of Arak University. The details of the program, inclusion and exclusion criteria, have previously been reported elsewhere [1113].

Anthropometric measurements

Waist circumference (WC) was measured at the level of the umbilicus and recorded in centimeters using standard WHO methods [13].

Biochemical measurements

Blood lipids were measured enzymatically with the commercially available reagents (Cholesterol/HP, cat. no. 816302, and Triglycerides/GPO, cat. no. 816370, both from the Boehringer Mannheim). HDL cholesterol was measured in the clear supernatant after precipitating the other lipoproteins with heparin and MnCl2 (1.3 g/l and 0.046 mol/l, respectively) and removing excess Mn2+ by precipitation with NaHCO3. Fasting glucose was measured using the Glucose Standard Assay (Sigma chemical, St Louis) [14].

Metabolic syndrome definition

The updated ATP-III definition of the metabolic syndrome was met when three or more of the following criteria were present: waist circumference ≥ 102 cm (40 inches) in men and 88 cm (35 inches) in women; HDL > 1.03 mmol/l (40 mg/dl) in men and 1.30 mol/l (50 mg/dl) in women or specific treatment for this lipid abnormality; triglycerides ≥ 1.7 mmol/l (150 mg/dl) in men and women or specific treatment for this lipid abnormality; systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mm Hg in men and women or treatment of previously diagnosed hypertension; and fasting glucose ≥ 5.6 mmol/l (100 mg/dl) in men and women [15].

Pharmacological treatment

The pattern of medication use was defined by the drugs used to control and treat each component of metabolic syndrome, including chemical and herbal drugs, determined by validated questionnaire. Anti-hypertension drugs (e.g. calcium channel blocker, β-blocker and angiotensin-converting enzyme (ACE) inhibitors) were considered relevant. Insulin resistance treatment drugs such as, thiazolidinediones, and statins for dyslipidaemia were taken into account. Aspirin was recommended by physicians for primary prevention of prothrombotic factors and the proinflammatory state in patients with the metabolic syndrome. We asked the participants about the herbal drugs, since the Iranian subjects are interested in using the herbal drugs for different health disorders including dyslipidemia, hypertension and hyperglycemia.

Statistical analysis

Results are reported as mean ± standard deviation (SD). An independent t-test was used to examine the difference between the quantitative variables, and a χ2 test was used to examine the difference between the qualitative variables in individuals with or without the metabolic syndrome according to sex. P of 0.05 or less was considered statistically significant. Logistic regression was conducted to assess the determinants of the pharmacological treatment among subjects with the metabolic syndrome before and after interventions. Antihypertensive, diabetes drugs and lipid-lowering agents were entered in the model to estimate their independent effects in each area and study phase. P of < 0.05 was considered to be statistically significant. All statistical analyses were performed using SPSS (SPSS Inc., Chicago, IL, USA) version 15.


Results

Total participants of IHHP in the intervention areas were 6175 in 2001, and 4719 in 2007 (the corresponding figures in the reference area were 6339 and 4853, respectively). The number of the individuals with the metabolic syndrome in 2001 and 2007 was 1570 and 982 in the intervention areas, and 1245 and 973 in the reference areas. The prevalence of the metabolic syndrome was 25.5% in 2001 and 21.1% in 2007 in the intervention areas and 19.9% in 2001 and 20.2% in 2007 in the reference area (p < 0.05). The prevalence of the metabolic syndrome was higher in women than in men both before (36.4% vs. 14%) and after the community trial (26.1% vs. 16%, respectively) in the intervention areas (p < 0.001). The average age of individuals with the metabolic syndrome was 47.67 ±14.59 years in women, and 49.75 ±15.25 years in men (p < 0.001). In 2001 the mean age of women in the intervention and reference areas was 45.99 ±14.28 and 47.95 ±14.4, and in men 50.16 ±14.31 and 49.98 ±14.58, respectively (p < 0.001), while in 2007, in women the mean age was 49.45 ±14.78 and 48.48 ±14.92 and in men 49.83 ±15.66 and 48.88 ±16.56 in the intervention and reference areas, respectively. The minimum and maximum age was 19 and 89 years (p < 0.001).

Demographic data of participants are shown in Table I. The prevalence of abdominal obesity, hypertriglyceridemia and high blood pressure decreased significantly after intervention in both sexes and study areas, whereas the frequency of low HDL cholesterol increased significantly from 2001 to 2007 in both sexes and in both areas. Table II presents the number of patients for each category of recommended medications for the different components of the metabolic syndrome according to sex. Medications were categorized in five groups as antihypertensive, lipid-lowering, antidiabetic, aspirin and herbal. The most common single medication for control of hypertension was a β-blocker (26% in 2001 and 34% in 2007), without significant differences before and after intervention. The most common drug to control diabetes taken by the subjects in the intervention areas was glibenclamide, without a significant difference after interventions (females: 47.5% in 2001 and 49.1% in 2007; males: 43.6% in 2001 and 46.2% in 2007). Among lipid-lowering agents statins were the least frequent medication used in males and females before intervention (2.9% and 1.1%, respectively), whereas after intervention the total number of statin users was increased from 2.4% to 14% (p < 0.001). The total number of aspirin users was 8% in 2001 and 18.0% in 2007 (p < 0.001). There was a significant difference in the use of herbal medicine before and after interventions; 8.3% of the participants used herbal medicine in 2001 and 18.0% in 2007 (p < 0.001). After the IHHP interventions hypertension was managed more frequently by β-blockers (34%) (p < 0.004) and diabetes with glibenclamide (47.8%) (p < 0.699) than before the intervention. No significant difference was observed between males and females regarding the type of medications used. Table III shows the number of patients for each category of drugs for the different components of the metabolic syndrome according to sex in the references area. Our results showed that the rate of using β-blockers, ACE inhibitors, statins, metformin, and aspirin increased in the intervention areas after intervention. Table IV shows the association of some variables with the pharmacological treatment in both the intervention and reference areas before and after interventions. Based on the logistic regression analysis, the male sex decreased the medication use 0.69-fold from 2001 to 2007 (p < 0.001). The older subjects had approximately 8 times higher use of antihypertensive medications than the younger participants (p < 0.001). Education did not show a significant relationship with any type of drug in both the intervention and reference areas in 2001 and 2007.

Living in an urban area increased the rate of using lipid-lowering agents 1.85-fold after interventions in the intervention areas (p < 0.05). In the intervention areas, the rate of using antidiabetic agents had not changed after interventions, based on age, sex and education, but living in an urban area increased this figure 2.7-fold from 2001 to 2007 in the intervention area among the study population (p < 0.05). Our results revealed a significant relationship between some social determinants and the pharmacological treatment among subjects with the metabolic syndrome between the intervention and reference areas from 2001 to 2007 (p < 0.001).


Discussion

The present study aimed to evaluate the efficacy of IHHP on drug compliance in the individuals with the metabolic syndrome after comprehensive intervention in both sexes in an intervention area compared with a reference area. We found that after implementation of a community-based program, the pharmacologic treatment for the management of the different components of the metabolic syndrome increased significantly. These findings suggest that there is national interest in monitoring and managing the CVD risk factors in our population, and it seems that intensive educational programs with a high-risk approach might be successful in increasing the population awareness for screening and control of the CVD risk factors.

The prevalence of the metabolic syndrome is considerably high in Iran [18]. The IHHP study reported that in the urban Iranian populations, the age-adjusted prevalence of the metabolic syndrome was 10.7% in men and 35.1% in women [19]. The age-adjusted prevalence of the metabolic syndrome decreased from 23.3% to 21% in the intervention areas. However, it showed an insignificant increase from 19.9% to 20.2% in the reference area. Primary care physicians and cardiologists in the community practice are on the front lines, when it comes to battling the epidemic of the metabolic syndrome. The first item physicians need to measure the patient's size and the size of waistline at the first visit. Because obesity predisposes individuals to several risk factors that comprise the metabolic syndrome [20].

Community interventions in the IHHP program were designed to improve the lifestyle indicators and behavior among the high-risk groups. Our previous studies showed that the improvement in nutritional habits, smoking and physical activity was significantly higher in the high-risk population, such as individuals with the metabolic syndrome, in the interventional areas compared to the reference area [8]. The IHHP holds comprehensive training courses and effective Continuing Medical Education (CME) programs in order to increase the attitude, knowledge and practice related to the cardiovascular disease risk factors among the health professionals including cardiologists, internists, general physicians, and nurses. Continuing Medical Education could help greatly to increase the knowledge and practice in the health professionals. Prevention, early detection, improved management of cardiovascular disease, as well as improvement in healthy lifestyle were our training goals [21].

The strength of the study is that patients and physicians were not trained about the metabolic syndrome and its components in 2001, whereas during IHHP interventions, health professionals underwent extensive training about the lifestyle modification, drug compliance, monitoring and control of CVD risk factors. Given the multiplicity of comprehensive training programs, IHHP has apparently increased drug acceptance in individuals with the metabolic syndrome. We suggest that the increased medication use, has resulted from the improved knowledge about the risk factor control and optimum medication use.

In this study, the most common pharmacologic agents consumed by individuals with the metabolic syndrome were, β-blockers (26.1% and 30.4% in 2001 and 2007, respectively), followed by lipid-lowering agents (5.4% and 14% in 2001 and 2007), with significant differences before and after intervention. On one hand, the prevalence of hypertension was decreased significantly among both sexes from 2001 to 2007, and on the other hand, the percentages of all types of hypertensive drugs, especially β-blockers, increased significantly from 2001 to 2007. It is supposed that on one hand, as hypertension is one of the most common risk factors among our study subjects, the use of antihypertensive drugs is significantly higher than other types of treatment. On the other hand, our population has higher awareness and practice as regards control and treatment of hypertension [22]. This is in line with another study in our population showing that β-blockers were the most prevalent anti-hypertensive drug used by the Iranian hypertensive patients [23]. However, it is established that most β-blockers have adverse effects on insulin sensitivity and carbohydrate and lipid metabolism, and are not recommended in the metabolic syndrome. However, it seems that in Iran, most subjects with the metabolic syndrome have been treated for the individual risk factors. Furthermore, the new generation of β-blockers, such as carvedilol and nebivolol, have better effects on metabolism [24].

Lifestyle interventions are crucial for the control and management of major risk factors in the metabolic syndrome, but pharmacological interventions to specifically target all the risk factors are crucial as well. The focus on the individual risk factor medication involves a multipronged strategy to control the borderline high LDL cholesterol (statins, statin-ezetimibe combination); high triglycerides (fibrates, fibrate-statin combination, omega-3 fatty acids); low HDL cholesterol (niacin, fibrates); high blood pressure (ACE inhibitors, angiotensin receptor blockers, β-blockers, and others); and insulin resistance (metformin, acarbose, thiazolidinediones). However, population-based lifestyle interventions are critical, and are the best evidence-based approaches in the Iranian populations as well as South Asian [2230]. Our results revealed a significant relationship between some social determinants and pharmacological treatment among subjects with the metabolic syndrome between the intervention and reference areas from 2001 to 2007. We found that the rate of treatment increased among the older females with a low level of education who lived in an urban area from 2001 to 2007.

Our results also showed that this community trial succeeded in increasing the pharmacologic treatment among individuals with metabolic syndrome in the intervention areas, whereas the reference population did not follow the same pattern.

This study relies on two sets of cross-sectional data to test hypotheses in the different study phases; thus we cannot conclude about just personal compliance. Finally, we could not determine the comorbid factors affecting individuals with the metabolic syndrome over time.

In conclusion, our results revealed a significant increase in the pharmacologic treatment to control blood pressure and lipid profile among the individuals with the metabolic syndrome. In addition to the population approach, the high-risk approach should be considered in community trials for prevention and control of non-communicable diseases.

Further research is needed to evaluate the impact of community trials on control and prevention of CVD risk factors and compliance behavior of patients who have been diagnosed with the metabolic syndrome.


Acknowledgments

This study was part of the Isfahan Healthy Heart Program that was supported by Grant No. 31309304 from the Iranian Budget and Programming Organization in the Department of Health, Ministry of Health and Medical Education, Isfahan Cardiovascular Research Centre and the Isfahan Provincial Health Centre, both affiliated to the Isfahan University of Medical Sciences. The authors would like to acknowledge the editorial assistance of Dr. Belinda Peace.


References
1. Tankova TI,Chakarova NV,Dakovska LN,Kalinov KB,Atanassova IA. Assessment of the risk for metabolic syndrome in prediabetes and newly-diagnosed type 2 diabetesJ DiabetolYear: 2010215
2. Yusuf S,Reddy S,Ounpuu S,Anand S. Global burden of cardiovascular diseases. Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategiesCirculationYear: 200010428556411733407
3. Lopes N,Zanini AC,Casella-Filho A,Chagas AC. Metabolic syndrome patient compliance with drug treatmentClinics (Sao Paulo)Year: 2008635738018925314
4. Grundy SM,Cleeman JI,Daniels SR,et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific StatementCirculationYear: 200511227355216157765
5. Deedwania PC,Gupta R. Management issues in the metabolic syndromeJ Assoc Physicians IndiaYear: 20065479781017214277
6. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final reportCirculationYear: 2002106314342112485966
7. Bertrais S,Beyeme-Ondoua JP,Czernichow S,Galan P,Hercberg S,Oppert JM. Sedentary behaviors, physical activity, and metabolic syndrome in middle-aged French subjectsObes ResYear: 2005139364415919848
8. Baghaei A,Sarrafzadegan N,Rabiei K,et al. How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart ProgrammeArch Med SciYear: 20106243122371716
9. Grundy SM. Primary prevention of coronary heart disease: integrating risk assessment with interventionCirculationYear: 19991009889810468531
10. Chobanian AV,Hill M. National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure: a critical review of current scientific evidenceHypertensionYear: 2000358586310775551
11. Sarraf-Zadegan N,Sadri G,Malek Afzali H,et al. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experienceActa CardiolYear: 2003583092012948036
12. Sarrafzadegan N,Kelishadi R,Esmaillzadeh A,et al. Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of IranBull World Health OrganYear: 200987395019197403
13. Sarraf-Zadegan N,Sadri G,Malek Afzali H,Baghaei M,Mohammadi Fard N,Shahrokhi S. Isfahan Healthy Heart Program: evaluation of comprehensive, community-based interventions for non-communicable diseasePrev Control JYear: 200627384
14. Sarrafzadegan N,Kelishadi R,Baghaei A,et al. Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart ProgramInt J CardiolYear: 200813190618190978
15. Ford ES,Giles WH,Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination SurveyJAMAYear: 2002287356911790215
16. Agrawal V,Shah A,Rice C,Franklin BA,McCullough PA. Impact of treating the metabolic syndrome on chronic kidney diseaseNat Rev NephrolYear: 20095520819636332
17. Expert Bianchi C,Penno G,Romero F,Del Prato S,Miccoli R. Treating the metabolic syndromeRev Cardiovasc TherYear: 20075491506
18. Delavari A,Forouzanfar MH,Alikhani S,Sharifian A,Kelishadi R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East: the national survey of risk factors for noncommunicable diseases of IranDiabetes CareYear: 2009321092719279302
19. Gharipour M,Kelishadi R,Toghianfar N,et al. Pharmacological treatment of cardiovascular risk factors in individuals with metabolic syndrome: findings from Isfahan Healthy Heart ProgramAfrican J Pharm PharmacolYear: 201153116
20. Deedwania PC,Gupta R. Management issues in the metabolic syndromeJAPIYear: 20065479781017214277
21. Fordis M,King JE,Ballantyne CM,et al. Comparison of the instructional efficacy of internet-based CME with live interactive CME workshops: a randomized controlled trialJAMAYear: 200529410435116145024
22. Khosravi A,Mehr GK,Kelishadi R,et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart programBMC Cardiovasc DisordYear: 2010106121172033
23. Khosravi A,Shirani S,Shahrokhi S,Mohammadifard N,Ansari R. Antihypertensive drugs used by hypertensive patients in the provincial cities of Isfahan, Najafabad and ArakARYA Atherosclerosis JYear: 2006127580
24. Carella AM,Antonucci G,Conte M,Di Pumpo M,Giancola A. Antihypertensive treatment with beta-blockers in the metabolic syndrome: a reviewAntonucci Curr Diabetes RevYear: 2010621521
25. Rabiei K,Kelishadi R,Sarrafzadegan N,Sadri G,Amani A. Short-term results of community-based interventions for improving physical activity: Isfahan Healthy Heart ProgrammeArch Med SciYear: 2010632922371717
26. Tavassoli AA,Gharipour M,Siadat ZD,Bahonar A,Sadry GH. Are obesogenic behavioral, socioeconomic and metabolic determinants different in Iranian men and women?J Health Popul NutrYear: 201028602921261206
27. Kanjilal S,Shanker J,Rao V,Mukherjee M,Iyengar SS,Kakkar V. Association of metabolic syndrome with atherothrombotic blood phenotypes in Asian Indian families with premature coronary artery diseaseArch Med SciYear: 2008414551
28. Gluba A,Mikhailidis DP,Lip GY,Hannam S,Rysz J,Banach M. Metabolic syndrome and renal diseaseInt J CardiolYear: 2012 [Epub ahead of print].
29. Barylski M,Małyszko J,Rysz J,Myśliwiec M,Banach M. Lipids, blood pressure, kidney – what was new in 2011?Arch Med SciYear: 2011710556622328891
30. Bielecka-Dabrowa A,Aronow WS,Rysz J,Banach M. The rise and fall of hypertension: lessons learned from Eastern EuropeCurr Cardiovasc Risk RepYear: 20115174921475621

Tables
[TableWrap ID: T0001] Table I 

Characteristics of participants by sex and living area


Intervention area Reference area
Female (n = 1767) Male (n = 785) Value of p Female (n = 1632) Male (n = 586) Value of p
2001, n (%) 2007, n (%) 2001, n (%) 2007, n (%) 2001, n (%) 2007, n (%) 2001, n (%) 2007, n (%)
1150 (65.1) 617 (34.9) 420 (53.5) 365 (46.5) 963 (59) 669 (41) 282 (48.1) 304 (51.9)
Age [years] 45.99 ±14.28 50.16 ±14.32 50.16 ±14.32 49.84 ±15.66 < 0.0001 47.95 ±14.44 48.48 ±14.92 49.98 ±14.58 48.88 ±16.57 0.94
Central obesity 1116 (97.5) 575 (93.8) 280 (67.1) 190 (52.9) < 0.0001 148 (52.7) 138 (53.9) 1026 (82.6) 696 (81.3) < 0.0001
Raised FBS or known case of type 2 diabetes 205 (17.9) 166 (26.9) 125 (28.9) 117 (32.1) < 0.0001 86 (30.6) 79 (26.0) 261 (21.1) 221 (22.7) 0.485
Low HDL cholesterol 897 (78.9) 543 (88.6) 254 (60.0) 308 (84.4) < 0.0001 200 (72.2) 253 (83.2) 974 (79.1) 850 (87.4) < 0.0001
Hypertriglyceridemia 1026 (89.8) 468 (76.1) 397 (94.5) 323 (89.0) < 0.0001 265 (94.3) 285 (93.8) 1106 (89.0) 854 (87.8) 0.004
High systolic blood pressure 539 (46.9) 256 (41.8) 278 (66.3) 219 (60.2) 0.041 180 (63.8) 181 (59.5) 660 (53) 492 (50.6) 0.073
High diastolic blood pressure 422 (36.7) 217 (35.5) 221 (52.7) 196 (53.8) 0.615 138 (49.3) 114 (37.5) 465 (37.4) 316 (32.5) 0.758

Central obesity: waist circumference > 88 cm in females and > 102 in males; triglycerides ≥ 1.65 mmol/l and/or those under treatment; HDL-C < 1.04 mmol/l in men and < 1.3 mmol/l in women; systolic/diastolic blood pressure ≥ 130/80 mm Hg and/or those under treatment; FBS (fasting blood sugar) ≥ 6.1 mmol/l and/or those under treatment; p < 0.001


[TableWrap ID: T0002] Table II 

The pattern of the pharmacological treatment 2001-2007 by sex in the intervention areas (intervention population – Isfahan and Najaf-Abad)


Variables Female 1767 Male 785 Total 2552
2001 1150 2007 617 Value of p 2001 425 2007 365 Value of p 2001 963 2007 669 Value of p
Anti-hypertensive treatment Calcium channel blockers 33 (9.1%) 13 (8.0%) 0.683 15 (7.4%) 5 (3.1%) 0.073 48 (8.5%) 18 (5.6%) 0.109
β-Blockers 142 (30.1%) 111 (42.7%) 0.001 40 (17.6%) 46 (22.8%) 0.183 182 (26.1%) 157 (34.0%) 0.004
ACE inhibitors 25 (7.1%) 27 (15.3%) 0.003 8 (4.1%) 18 (10.3%) 0.019 33 (6.0%) 45 (12.9%) < 0.0001
Thiazides 2 (0.6%) 5 (3.2%) 0.023 0 (0.0%) 5 (3.1%) 0.015 2 (0.4%) 10 (3.2%) 0.001
A-ARB 0 (0.0%) 4 (2.6%) 0.003 0 (0.0%) 4 (2.5%) 0.030 0 (0.0%) 8 (2.6%) < 0.0001
Lipid-lowering treatment Fibrates 65 (6.0%) 31 (5.8%) 0.917 10 (2.6%) 9 (2.8%) 0.882 75 (5.1%) 40 (4.7%) 0.659
Nicotinic acid 49 (4.6%) 31 (5.8%) 0.271 7 (1.8%) 8 (2.5%) 0.555 56 (3.9%) 39 (4.6%) 0.402
Statins 30 (2.9%) 99 (16.6%) < 0.0001 4 (1.1%) 33 (9.1%) < 0.001 34 (2.4%) 132 (14.0%) < 0.0001
Statins, fibrates 69 (6.3%) 99 (16.6%) < 0.0001 10 (2.6%) 33 (9.5%) < 0.001 79 (5.4%) 132 (14.0%) < 0.0001
Gemfibrozil 32 (3.0%) 40 (7.4%) < 0.0001 4 (1.1%) 13 (4.0%) 0.012 36 (2.5%) 53 (6.1%) < 0.0001
Anti-diabetic treatment Metformin/phenformin 4 (4.0%) 28 (32.2%) < 0.0001 2 (3.1%) 12 (19.7%) 0.003 6 (3.7%) 40 (27.0%) < 0.0001
Glibenclamide 87 (47.5%) 57 (49.1%) 0.788 48 (43.6%) 42 (46.2%) 0.721 135 (46.1%) 99 (47.8%) 0.699
Insulin-crystal-NPH 8 (7.7%) 11 (15.7%) 0.096 1 (1.6%) 8 (14.0%) 0.010 9 (5.4%) 19 (15.0%) 0.006
Herbal drugs 49 (4.3%) 11 (1.8%) 0.006 16 (3.8%) 5 (1.4%) 0.034 65 (4.2%) 16 (1.6%) < 0.0001
Aspirin 80 (7.0%) 93 (15.8%) < 0.0001 51 (12.1%) 76 (21.8%) < 0.001 131 (8.3%) 169 (18.0%) < 0.0001

Value of p < 0.001


[TableWrap ID: T0003] Table III 

The pattern of the pharmacological treatment 2001-2007 by sex in the reference area (reference population – Arak)


Variables Female 1632 Male 586 Total 2218
2001 963 2007 669 Value of p 2001 282 2007 304 Value of p 2001 2007 Value of p
Anti-hypertensive treatment Calcium channel blockers 9 (2.7%) 9 (4.6%) 0.237 2 (1.6%) 3 (2.5%) 0.632 11 (2.4%) 12 (3.8%) 0.260
β-Blockers 83 (20.3%) 79 (29.8%) 0.005 34 (21.7%) 33 (21.7%) 0.991 117 (20.7%) 112 (26.9%) 0.023
ACE inhibitors 15 (4.4%) 21 (10.1%) 0.008 8 (6.1%) 15 (11.2%) 0.141 23 (4.9%) 36 (10.6%) 0.002
Thiazides 0 (0.0%) 2 (1.1%) 0.062 2 (1.6%) 5 (4.0%) 0.246 2 (0.4%) 7 (2.2%) 0.024
A-ARB 0 (0.0%) 6 (3.1%) 0.001 0 (0.0%) 4 (3.3%) 0.030 0 (0.0%) 10 (3.2%) < 0.001
Lipid-lowering treatment Fibrates 59 (6.4%) 28 (4.6%) 0.137 14 (5.4%) 7 (2.5%) 0.088 73 (6.2%) 35 (4.0%) 0.025
Nicotinic acid 27 (3.0%) 22 (3.7%) 0.511 4 (1.6%) 6 (2.2%) 0.63 31 (2.7%) 28 (3.2%) 0.536
Statins 25 (2.8%) 68 (10.5%) < 0.001 4 (1.6%) 23 (7.8%) 0.001 29 (2.6%) 91 (9.7%) < 0.001
Statins and fibrates 61 (6.6%) 74 (11.3%) 0.001 15 (5.7%) 24 (8.2%) 0.266 76 (6.4%) 98 (10.3%) 0.001
Gemfibrozil 24 (2.7%) 29 (4.8%) 0.035 3 (1.2%) 6 (2.2%) 0.393 27 (2.4%) 35 (4.0%) 0.042
Anti-diabetic drugs Metformin, phenformin 2 (2.5%) 21 (25.6%) < 0.001 2 (4.4%) 11 (22.9%) 0.010 4 (3.2%) 32 (24.6%) < 0.001
Glibenclamide 67 (45.9%) 60 (49.6%) 0.547 26 (37.7%) 32 (46.4%) 0.301 93 (43.3%) 92 (48.4%) 0.298
Insulin-crystal-NPH 3 (3.7%) 4 (6.2%) 0.480 2 (4.4%) 0 (0.0%) 0.194 5 (3.9%) 4 (3.9%) 0.995
Herbal drugs 69 (7.2%) 12 (1.8%) < 0.001 9 (3.2%) 4 (1.3%) 0.117 78 (6.3%) 16 (1.7%) < 0.001
Aspirin 44 (4.6%) 49 (7.3%) 0.017 19 (6.7%) 34 (11.2%) 0.059 63 (5.1%) 83 (8.6%) 0.001

[TableWrap ID: T0004] Table IV 

The relationship between the pharmacological treatment and determinants in 2001-2007 by sex among subjects with the metabolic syndrome


Anti-hypertensive treatment Lipid-lowering treatment Anti-diabetic drugs Total drugs
Intervention
2001 Sex Female
Male 0.44 (0.30-0.64)** 0.37 (0.2-0.67)** 0.82 (0.49-1.36) 0.66 (0.49-0.89)**
Education 0-5
6-12 1.17 (0.74-1.86) 0.85 (0.48-1.49) 0.69 (0.36-1.34) 0.74 (0.52-1.04)
> 12 1.41 (0.51-3.88) 0.52 (0.12-2.24) 1.94 (0.4-9.33) 0.69 (0.34-1.43)
Age group [years] 19-39
40-59 8.72 (3.87-19.65)** 3.2 (1.73-5.92)** 1.01 (0.47-2.16) 5.97 (3.91-9.15)**
≥ 60 16.07 (7.01-36.89)** 3.46 (1.75-6.87)** 1.97 (0.9-4.32) 15.25 (9.66-24.06)**
Residency Urban
Rural 1.17 (0.78-1.74) 1.2 (0.74-1.97) 1.27 (0.69-2.32) 1.15 (0.84-1.57)
2007 Sex Female
Male 0.41 (0.27-0.62)** 0.55 (0.35-0.86)** 0.81 (0.46-1.41) 0.69 (0.51-0.96)*
Education 0-5
6-12 1.41 (0.86-2.33) 0.71 (0.51-1.05) 0.83 (0.43-1.6) 0.88 (0.62-1.26)
> 12 1.11 (0.5-2.45) 0.74 (0.29-1.85) 1.03 (0.24-4.52) 0.87 (0.46-1.64)
Age group [years] 19-39
40-59 3.54 (1.76-7.11)** 3.52 (1.82-6.78)** 1.65 (0.62-4.36) 3.9 (2.49-6.12)**
≥ 60 7.24 (3.51-4.94)** 4.65 (2.31-9.35)** 1.1 (0.42-2.9) 10.5 (6.42-17.17)**
Residency Urban
Rural 0.58 (0.34-0.99)* 0.54 (0.29-0.99)* 0.37 (0.16-0.89)* 0.45 (0.29-0.7)**
Reference
2001 Sex Female
Male 0.99 (0.64-1.56) 0.8 (0.44-1.45) 0.67 (0.37-1.22) 1.19 (0.85-1.67)
Education 0-5
6-12 1.24 (0.62-2.48) 0.73 (0.34-1.6) 1.55 (0.62-3.86) 1.03 (0.64-1.66)
> 12 1.77 (0.61-5.15) 0.93 (0.21-4.09) 2.36 (0.35-15.73) 1.45 (0.63-3.36)
Age group [years] 19-39
40-59 4.47 (1.78-11.2)** 2.18 (1.11-4.28)* 2.94 (1.03-8.36)* 4.91 (2.97-8.09)**
≥ 60 7.02 (0.36-0.92)** 2.27 (1.08-4.73)* 4.73 (1.56-14.29)** 10.2 (6.02-17.27)**
Residency Urban
Rural 0.57 (0.36-0.92)* 0.74 (0.43-1.27) 0.86 (0.44-1.67) 0.68 (0.48-0.95)*
2007 Sex Female
Male 0.76 (0.49-1.17) 0.7 (0.42-1.16) 0.79 (0.43-1.47) 0.95 (0.68-1.33)
Education 0-5
6-12 0.95 (0.46-1.97) 0.92 (0.48-1.76) 1.06 (0.46-2.45) 0.77 (0.48-1.24)
> 12 1.96 (0.49-7.82) 0.48 (0.06-3.87) 5.78 (0.55-60.72) 1.34 (0.51-3.55)
Age group [years] 19-39
40-59 2.15 (1.08-4.27)* 2.63 (3.84-10.72)** 2.48 (0.98-6.3) 3.06 (1.98-4.74)**
≥ 60 3.14 (1.57-6.27)** 2.58 (1.28-5.21)** 2.16 (0.81-5.77) 5.47 (3.41-8.78)**
Residency Urban
Rural 0.75 (0.5-1.12) 0.51 (0.33-0.79)** 0.68 (0.37-1.25) 0.62 (0.46-0.85)**

*p < 0.05

**p < 0.001



Article Categories:
  • Clinical Research

Keywords: metabolic syndrome, pharmacological treatment, community trial, Iran.

Previous Document:  The influence of oral water load on energy expenditure and sympatho-vagal balance in obese and norma...
Next Document:  Exercise tolerance in asymptomatic patients with moderate-severe valvular heart disease and preserve...