Trends in cardiovascular risk factors in diabetic patients in comparison to general population in Iran: findings from National Surveys 2007–2016

Abstract

to determine levels of change in risk factors for cardiovascular disease among people with and without a previous diagnosis of diabetes from 2007 to 2016 in Iran. Data were obtained from five rounds of the World Health Organization STEPwise approach to Surveillance (STEPS) cross-sectional surveys. Participants were 7665 and 93,733 adults with and without known diabetes, respectively, aged 25-65 years. We used logistic and linear regressions to assess the trends of risk factors. Individuals with known diabetes compared to those without the condition, experienced greater reductions in mean levels of systolic blood pressure (3.0 vs. 0.5 mmHg among women and 3.9 vs. 1.6 mmHg among men), diastolic blood pressure (6.4 vs. 5.11 mmHg in women and 3.3 vs. 1.8 mmHg in men), and non-HDL cholesterol (42.4 vs. 27.2 mg/dL among women and 30.3 vs. 21.0 mg/dL among men) throughout these years. Men with diabetes also showed a greater reduction in the prevalence of daily cigarette smoking compared to their non-diabetic counterparts (7.3% vs. 2.3%). Fasting plasma glucose decreased among subjects with diabetes but increased among those without diabetes. Significant increases were observed in proportions who met goals for blood pressure, triglycerides, non-HDL cholesterol and LDL cholesterol in both groups; however, almost half of diabetic subjects did not achieve risk factor goals in 2016. Secondary prevention in diabetic patients was more effective than primary prevention in the general population; however, the rate of diabetic patients who met the designated goals for each risk factor was still suboptimal. Diabetes is associated with premature mortality from different causes, including cardiovascular diseases (CVD) 1. Previous studies have demonstrated the vitality of CVD risk factor control to decrease the fast-rising trend of this mortality and CVD events in people with diabetes 2-4. Furthermore, evidence suggests that the use of more intensive targets for blood pressure and cholesterol in individuals with diabetes results in a more significant reduction in the incidence of CVD events 5-7. However, several studies report that people with diabetes are less likely to achieve target goals for control of CVD risk factors than those without diabetes 8,9. Nationally representative data that investigate trends in CVD risk factors in both the general population and people with diabetes in Middle Eastern countries such as Iran are scarce. Moreover, due to the lack of proper investigations that compare secular trends for CVD risk factors in individuals with and without diabetes in

Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005–2015)

“…These trends are similar to those found in population-based serial cross-sectional studies in Iran. For example, in the STEPS (2007–2016) studies in Iran, total cholesterol, LDL-C, and triglycerides decreased substantially over the course of the study [ 30 ]. Decreasing trend of non-HDL-C was also observed in most western countries, Japan, and South Korea [ 31 ].…”

“…Serum HDL-C levels, however, changed only modestly. HDL-C has mostly genetic determinants but lower physical activity, smoking, and carbohydrates consumption may also lower HDL-C levels [ 30 , 31 ].…”

“…While studies conducted in the general population also show increasing trends of BMI and FBS, trends of hypertension have been on the decline. Data from the STEPS studies in the Iranian general population [ 30 ] show that, from 2007 to 2016, BMI was increasing in non-diabetic men population; but there was no significant trend in non-diabetic women, nor in the diabetic population. In this study, FBS had an increasing trend among non-diabetic population [ 30 ].…”

“…Data from the STEPS studies in the Iranian general population [ 30 ] show that, from 2007 to 2016, BMI was increasing in non-diabetic men population; but there was no significant trend in non-diabetic women, nor in the diabetic population. In this study, FBS had an increasing trend among non-diabetic population [ 30 ]. However, both systolic and diastolic pressure in the general population were decreasing [ 33 ].…”

Detection of High Risk People for Diabetes by American Diabetes Association Risk Score in PERSIAN Guilan Cohort Study

“…This signi cant increase in DM prevalence and also in DM complications, implementation of prevention and control programs seems to be substantial. Finding from Iranian National Surveys (2007-2016) on 7665 and 93,733 adults with and without known diabetes showed secondary prevention in individual level was effective to control of FBS level but primary prevention in non diabetic people had no positive effect[22].…”