Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study

Abstract

Older age and low socio-economic conditions are associated with poor control of cardiovascular risk factors (RFs). We assessed the prevalence and awareness of cardiovascular RFs in 503 elderly outpatients of low social status attending two public Internal Medicine clinics in Naples, and studied the interaction of education and employment level with risk profile. The therapeutic intervention was oriented to improve patients' motivation through a positive patient-physician relationship, in keeping with the current guidelines for hypertension. The effect of treatment was evaluated by comparing retrospectively the level of cardiovascular RFs at baseline and at the last follow-up examination performed within 31 October 2005. Only 33.3% of patients (age ¼ 6876 years) had attended primary school. Overall (current or previous) employment level was also low. Obesity, hypertension and dyslipidaemias were present in most patients, diabetes in 17.3% of them. In all 8.0% of hypertensives, 16.1% of diabetics and 24.7% of dyslipidaemics were unaware of their diseases. Cardiovascular risk profile was worse at lower educational and employment levels. Odds ratios for the metabolic syndrome were 0.28 (95% confidence interval (CI) ¼ 0.15-0.52) and 0.35 (0.20-0.62) in the most qualified of three education and employment groups, respectively, compared to the lowest ones. The level of all cardiovascular RFs was effectively reduced during treatment. Control rate of most RFs improved significantly (for hypertension, from 12.8 to 36.5%, Po0.001). These patients had a high prevalence of cardiovascular RFs, which correlated with their educational and work activity levels. Awareness of their health status was unsatisfactory. Treatment, specifically addressing patient-physician relationship, favourably affected cardiovascular risk profile.

Triglyceride‐to‐HDL‐cholesterol Ratio and Metabolic Syndrome as Contributors to Cardiovascular Risk in Overweight Patients

“…Procedures for recruitment and clinical evaluation of ICON patients have been described in detail (11). Briefly, all people over 60 years consecutively seen between 1 September 1996 and 30 September 2007, in the Internal Medicine office of two National Health Service Outpatient Clinics located in Naples, were studied.…”

“…In the Improving Cardiovascular risk profile in Older Neapolitans (ICON) study, we have recently described a wide sample of elderly, low‐socioeconomic‐level outpatients, attending two public medical facilities in the city of Naples. Prevalence of MS was 54–65%, depending on the diagnostic criterion (11). In the present study, we aimed at assessing cardiovascular risk profile in the overweight ICON patients, according to their TG/HDL ratio and to the presence of MS. Beside the patients enrolled in our previous study, we have now included those visited in the same clinics for 2 years after the end of the original observation.…”

Association of Hyperuricemia With Conventional Cardiovascular Risk Factors in Elderly Patients

“…The population of the Improvement of Cardiovascular Risk Profile in Older Neapolitans (ICON) study was included in this analysis. All outpatients older than 60 years seen from September 1996 to October 2005 in the Internal Medicine Clinic of two facilities of the Italian National Health Service comprised the original study group.…”

Review: Hypertension, a health economics perspective

“…The prevalence of hypertension was 19.1% in patients with a high SES and 30.4% in patients with a low SES, giving an odds ratio of 0.647 [95% CI 0.535-0.802]. A study by Marotta et al [2007] in an elderly Italian population showed that the metabolic syndrome was more frequent in patients with a low education (no schoolleaving qualification), and in patients with no current employment.…”