cvd egypt clinical diabetes reprint summer 2010

www.diabetes.org/clinicaldiabetes

v o l u m e 9 n u m b e r 3

An Official Journal of the

summer 2010

Practical Information for Primary Care

[Middle East Edition]

Screening for Diabetes and Cardiovascular Risk Factors among Egyptian population

Gamela M Nasr, MD 1, Hamdy Sliem, MD 2, Amira Gamal, MD 3, Hayam Refaat, PhD 4 & Mahmoud Ibrahim, MD 5.From the 1 Department of Cardiology; the 2 Department of Internal Medicine ; the 3 Department of Community Medicine- Faculty of Medicine Suez Canal University, Ismailia , Egypt ; the 4 Department of Pediatrics, Ain Shams University, Cairo , Egypt; the 5 EDC , Center for Diabetes Education, McDonough , GA , USA.

DIABETES.ORG/CLINICALDIABETES

9 32010

2010

127Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)

L O C A L A R T I C L E S

Screening for Diabetes and Cardiovascular Risk Factors among Egyptian population

Gamela M Nasr, MD, Hamdy Sliem, MD, Amira Gamal, MD, Hayam Refaat, PhD & Mahmoud Ibrahim , MD.

Background and Aim: Recently major cultural changes have oc-curred in Egypt to promote the

development of non-communicable dis-eases. The global cardiovascular risk is the probability of suffering from coronary event or stroke in a given period of time. Limited information is available about cardiovascular risk factors and diabetes In Egypt. Therefore, the aim of this study was to describe the prevalence, clinical and laboratory characteristics of the key cardiovascular risk factors like obesity, hypertension, dyslipidemia, and smoking along with diabetes in Egypt.

Methods: A descriptive retrospective, cross-sectional study in which Six thou-sand, seven hundred and seventy three patients , mean age (48 years + 4), (2845 males, 42%) and (3928 females, 58%) were screened for the key cardiovascular risk factors and diabetes . They attended the central Insurance outpatient clinics of cardiology as a nationally representative sample over a period of six years. They were subjected to history taking, anthro-pometric measures (waist circumference, height and weight). Lipid profile, uric acid , fasting and post prandial blood sugar (FBS and PBS) were assessed. So-dium, Potassium and serum creatinine (S.Cr) were also assessed.

Results: Cardiovasculr risk factors were more among females (57.7%) and in pa-tients who lived in urban areas (72.2%). Diabetics were 22.9%, hypertensives were 30.7%, dyslipidemics were 33.4% and smokers were 43% in the studied population. Smoking was more common in men than women (91%vs 9%). Of the studied population 29% were obese.

Mean waist circumference for males was 111cm + 3and for females 101+ 5cm with a p 0.04. Females were significantly different regarding BMI where p 0.001, PPBS p 0.04 and HDL p 0.01. Obesity had a statistically significant correlation with diastolic blood pressure (p < .001). Patients with family history of diabetes had higher BMI p 0.007, waist circumfer-ence p 0.05, FBS p 0.008, PPBS p 0.002, TG p 0.001 and lower HDL p 0.04.

Conclusions: Prevalence of the key car-diovascular risk factors are high among Egyptians with a need for a national prevention program to combat obesity, diabetes , hypertension ,dyslipidemia, smoking and related co-morbidities. Consideration of early prevention and control is of utmost importance.

Key words: Cardiovascular risk factors, diabetes, dyslipidemia, smoking , obesity and hypertension

Introduction: Diabetes is a risk factor for ischemic vascular diseases as MI and ischemic stroke and it also seems to pose a significant risk across the spectrum of other forms of vascular disease, includ-ing hemorrhagic stroke, suggested by a meta-analysis encompassing almost 700 000 patients1. Moreover, it showed that the elevated risks were largely in-dependent of conventional cardiovascu-lar risk factors, suggesting that diabetes must be raising vascular risk through less familiar mechanisms. However, contrary to expectations, very little of the ex-cess cardiovascular risk associated with diabetes is explained by obesity, blood pressure, lipids, inflammatory markers, or renal function. Controlling of these factors had little effect on the approxi-

mately twofold increase in vascular risk associated with diabetes 1. Global burden of the risk was identified through World Health Organization. Obesity, hyperten-sion, hypercholesterolemia and smok-ing were among the top 10 risk factors for premature death and disability2. In a study for prevalence of cardiovascu-lar risk factors and their relation to the level of blood pressure in Egypt, it was for obesity 33 % and 47% in hyperten-sive men and women, respectively3. After adjusting for age, hypertensive men had significantly higher heart rate, total cho-lesterol (TC), triglycerides (TG), fasting blood sugar (FBS), post-prandial blood sugar (PBS), body mass index and waist/hip (W/H) ratio than their non-hyper-tensive counterparts. In addition, hyper-tensive women had higher low-density lipoprotein cholesterol (LDL-C). The prevalence of elevated LDL-C and FBS increased with age. All risk factors were more prevalent in urban populations3. On the other hand, the INTERHEART study has shown that nine modifiable risk fac-tors are responsible for more than 90% of the population attributable risk factors for cardiovascular diseases 4. Prevalence of cardiovascular risk factors in Middle East including Egypt was also high in another metanalysis5, 6.

The ADVANCE trial has demonstrated that a combined approach of routine blood pressure lowering and intensive glucose control resulted in substantial reductions in major renal events and all-cause death. For the major renal out-comes, the separately significant benefi-cial effects of the two interventions were additive. This suggests that the multi-factorial management of type 2 diabetes

128 Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)


should incorporate routine blood pres-sure lowering and more intensive glucose control to reduce the burden of adverse clinical sequelae in individuals with es-tablished diabetes. The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically rel-evant outcomes 7.

The new analyses of the Action to Con-trol Cardiovascular Risk in Diabetes (ACCORD) trial clearly shows that the intervention (intensive glucose & blood pressure lowering) does seem to be hav-ing a beneficial effect on cardiovascular disease, there were fewer MIs, for in-stance. But there is a mortality signal that remains unexplained today8. Prevalence of cardiovascular risk factors and diabetes in Egypt is needed to demonstrate the risk to develop strategies for risk reduction. Methods Study population:A descriptive, retrospective, cross-sec-tional study in which Six thousand and seven hundred and seventy three patients , mean age (48 years + 4), (2845 males, 42%) and (3928 females, 58%) were screened for the key cardiovascular risk factors and diabetes mellitus. They at-tended the central insurance outpatient clinics of cardiology as a nationally rep-resentative sample for duration of six years (2004-2009). They were subjected to interview questionnaire for careful his-tory taking.

Measurements: Height, weight, BMI, and waist circum-ferences measurements were recorded. Weight in kg and height in cm were mea-sured to the nearest 0.5 cm and 0.1 kg, respectively. Normal weight, overweight and obesity were defined as BMI less than 25, 25-29.9 and 30 or higher, respec-tively9, 10. Blood sampling for Sodium, Potassium, fasting blood sugar (FBS), serum creatinine (S.Cr), serum uric acid and lipid profile were measured.

Definitions:Cardiovascular risk factors studied were:Obesity, waist circumference (WC), hy-pertension, diabetes , dyslipidemia, hy-pertriglyceridemia, reduced HDL choles-terol, high LDL cholesterol or high total cholesterol 11 Hypertriglyceridemia was defines as ≥150 mg/dl, low HDL cholesterol was defined as <40 mg/dl in men and <50 mg/dl in women11. Diabetes was diagnosed according to American Diabetes Associa-tion12. A fasting blood sugar level below 100 (mg/dL) is considered normal while level between 100 and 126 (mg/dL) con-firms the presence of Impaired Fasting Glucose IFG, and more than 126 (mg/dL) confirms the presence of diabetes in two separate occasions12

Hypertension was defined according to the guidelines of the Joint National Com-mittee on Detection, Evaluation, and Treatment of High Blood Pressure, which are: a systolic blood pressure >140 mm Hg, a diastolic blood pressure >90 mm Hg or the use of antihypertensive medi-cation. Subjects in the 130–139/80–89 mm Hg blood pressure range were classi-fied as pre-hypertensives13. Among the measures of abdominal obe-sity, waist circumference measured as >102 cm in men and 88 cm in women 14

Statistical analysis:Data was revised, coded and entered into SPSS Statistical Software Version 15.0. Quantitative data was summarized by arithmetic mean and standard devia-tion. Numerical data was presented as frequencies and percentages and trans-formed into graphs as appropriate. Cor-relation coefficient was calculated for cardiovascular diseases risk factors, met-abolic profile and obesity.

Ethical considerations:A verbal consent was obtained from all subjects enrolled in this study. All data are confidential for the research use only. Data were coded and kept in safe place.

Results:A descriptive, retrospective cross-sec-tional study in which Six thousand and seven hundred and seventy three patients , mean age (48 years + 4), (2845 males, 42%) and (3928 females, 58%) were screened for the key cardiovascular risk factors and diabetes. They attended the central Insurance outpatient clinics of cardiology as a nationally representative sample over a period of six years. Cardiovasculr risk factors were more among females (57.7%) and in patients who lived in urban areas (72.2%). Diabetics were 22.9%, hypertensives were 30.7%, dyslipidemics were 33.4% and smokers were 43% in the studied population

Table 1 showed characteristics of patients having cardiovascular risk factors of whom 2845 were males (42%) and 3928 were females (58%). It has been shown that 28% (1922) of patients were living in rural areas, while 4851 (72%) of patients were living in urban areas. Regarding smoking habits it was shown that 57% (3861) were smokers, while 2912 (43%) were non smokers.

Occupation-related differences among studied patients with cardiovascular risk factors showed that intellectuals’ pa-tients had a mean of (42.3), while manual workers had a mean of (20.2) and house wives had a mean of (38.3).Table (2) showed the cardiovascular risk factors according to gender difference.Females had significant difference re-garding BMI where p0.001, waist cir-cumference p 0.04, PPBS p 0.04 and HDL p 0.01 Patients with cardiovascular disease risk factors had complains like palpitation (42%), chest pain among (33%), easy fatigue among (52%), dyspnea NYHA1 (9.3%), dyspnea NYHA2 (4.8%), dys-pnea NYHA3 (1.9%) (Figure1).

Current illnesses among the studied pa-tients with cardiovascular disease risk



factors were shown in (Figure 2). Bio-chemical profile among the studied pa-tients with cardiovascular disease risk factors was shown in (Figure 3). Figure (4) showed the main clinical fea-tures among the studied patients with car-diovascular disease risk factors. Cardiovascular disease risk factors start-ed at early age in those patients with fam-ily history of diabetes mellitus with a mean age of (43.6±3.4) years old versus those patients with mean age of (55±3) years old in patients without family histo-ry of diabetes mellitus (p value <0.001).

Central obesity (waist circumference) had a statistically significant direct cor-relation with diastolic blood pressure (p <0.001). Central obesity alone had a statistically significant direct correlation with uric acid (p value <0.01). Mean waist circumference for males was 111±3 cm and for females it was 101±5 cm. Waist circumference and BMI were high-er in females than males (125.5 versus 122.1 cm) and (39 versus 37.1 kg/m2) re-spectively, with a statistically significant difference (p value <0.05). Total body obesity (BMI) had a statistically signifi-cant direct correlation with systolic and diastolic blood pressure (p value <0.05).

Table (3) showed that total body obesity (BMI) and central obesity (waist circum-ference) had a statistically significant direct correlation with HDL p 0.01vs p 0.02, TG p 0.013 vs p 0.04, FBS p.003 vs p 0.30, PPBS p 0.016 vs p 0.0039 and uric acid p 0.092 vs p 0.01.

Patients with family history of diabetes had higher BMI p 0.007, waist circumfer-ence p 0.05, FBS p 0.008, PPBS p 0.002, TG p 0.001 and lower HDL p 0.04 than patients without family history of diabe-tes. Patients with cardiovascular disease risk factors and family history of hyper-tension had higher diastolic blood pres-sure p 0.007, waist circumference p 0.03, TG p 0.01 and lower HDL than patients without family history (p 0.02) as shown in Table (4).

Figure (5) showed the percentage of di-agnosed cardiovascular disease risk fac-tors referred from different areas, while percentage of males and females diag-nosed as cardiovascular disease risk fac-tors referred from different areas from Egypt were shown in figure (6). It is evi-dent that cardiovascular risk factors are affected by lifestyle of patients as well as environment. Cairo, the capital had the highest risk with prevalence more in fe-males. Prevalence of cardiovascular risk in Greater Cairo was 37.1% where Upper Egypt 26.4%, coastal areas 18.6% and Delta17.9%. Females are more prevalent in risk factors where p 0.009 for Greater Cairo, p 0.006 for coastal areas, p 0.01 for Delta and p 0.004 for Upper Egypt

Discussion The current work estimated the relatively high prevalence of diabetes and other cardiovascular risk factors in a vulnera-ble group of patients attending the central national insurance hospital as a common pool from all over the country. Our find-ings revealed a high prevalence of obe-sity, diabetes, hypertension, and smok-ing in Egypt. It does not represent the prevalence in the general population but it points out to the current change among the Egyptians in lifestyle and urbaniza-tion. This of course should urge health care officials to conduct a national pre-vention program at both community and hospital level.

Central obesity presented by increased waist circumference was markedly high in both men and women participating in the study. In addition, BMI which reflects total body obesity was also high. It is es-timated in the current study to be 29% with a more prevalence in women. This is comparable to what was reported from several western countries, such as the United States (28.0% of men and 34.0% of women) 15 and the United Kingdom (23.0% in men and 25.0% in women) 16. This similarity could be due to common exogenous factors existing in the devel-oping countries leading to the develop-

ment of the metabolic syndrome such as sedentary life, psychosocial stressors and obesity. Obesity is a corner stone of the metabolic syndrome as an etiology or a sequel17. It constitutes one of the elements of metabolic syndrome diagnosis18. Among different countries in the Middle East region there was significant hetero-geneity between studies. Arab countries including Jordan showed a prevalence of (49.7%), Oman (30.8%), Qatar (40.8%), and Gaza & West Bank (41.5%) which is an extremely high prevalence of obesity 5. Overall, obesity was also found to be more prevalent in urban areas compared with rural regions. This is most likely because of rapid economic and nutri-tional transitions in this region as well as definite lifestyle changes. People became less sedentary and consuming more calo-ries through non-healthy fast foods.

The analysis of Motlagh et al 5; showed that the overall prevalence of obesity in the Middle East region was consider-ably higher among women compared with men in agreement with our study . Although the exact explanation of such gender variations is not entirely clear, it has been reported that women are less active compared with men in certain ar-eas 19, 20. Physical and cultural barriers to physical activity have been reported among women in Egypt and Saudi Ara-bia5. These include climatic conditions of extreme heat in the summer, limited exer-cise facilities devoted solely for women, lack of physical education or an emphasis on its importance in schools, and absence of women’s participation in organized sports. Physical inactivity and sedentary lifestyle are major risk factors for the de-velopment of obesity and CVD21. New Egyptian waist circumference cutoff points for abdominal obesity were devel-oped based upon data from the Egyptian National Hypertension Project (NHP) 22. These are 97.5 cm for men and 92.3 cm for women. Cutoff points recommended by IDF were 94 cm for men and 80 cm for women derived from the European cutoff points23. The prevalence of ab-



dominal obesity in Egyptians based upon these European cutoff points is 30.2% for men and 70.9% for women while based on new Egyptian criteria, the prevalence of abdominal obesity in men is 37.1% and in women 50.8%. In this study we adopted rather higher cutoff points since the start of data collection of six years duration; it is supposed that even much higher values would have been obtained. A positive correlation was found be-tween waist circumference and most of the cardiovascular risk factors. Obesity may present as an etiology leading to progression of Insulin resistance, which is another corner stone of the metabolic syndrome24. Obesity of the predominant-ly abdominal type leads to higher non-esterifed fatty acids (NEFA) levels than does obesity occurring predominantly in the lower body (gluterofemoral obesity). This may account for the greater Insulin resistance observed in persons having ab-dominal obesity25

Epidemiologic studies show a linear re-lation between levels of plasma triglyc-eride and cardiovascular risk. Increasing levels of plasma triglyceride are often associated with accumulation of remnant lipoproteins typically characterized by a high ratio of cholesterol to triglyceride. Hydrolysis of the triglyceride-rich VLDL particles by lipoprotein lipase yields LDL particles containing elevated amounts of triglycerides, which is highly atherogen-ic and leads to hypertension, Ischemic heart disease, peripheral arterial disease and stroke. Few HDL particles would be available for reverse cholesterol trans-port or for protection against oxidative damage of remnants and LDL lipopro-teins26 .However the definitions used for elevated cholesterol, LDL, and triglyc-eride levels, varied considerably among studies. These variations, as well as the availability of limited data from Middle East region make it difficult to conduct any cross-country comparisons with confidence5 .The prevalence of elevated LDL in the Middle East ranged between 6.6–36.3% for men and 9.0–38.7% in

women. Similar to this the current data showed dyslipidemia to be 33%. No-table observations include the very high prevalence of hypercholesterolemia (>5.2mmol/l) in Kuwait and Oman 27,28, and the very low levels of HDL (<35mg/dl) in Turkey, Oman, and Saudi Arabia5.

The prevalence of hypertension in the Middle East, is similar to rates observed in North America (28%), but lower than Europe (44%)29. Overall, hypertension was more prevalent in women than men-in agreement with this study. This may, in part, be explained by the higher preva-lence of obesity in women, as several studies have reported an association be-tween obesity and hypertension 30,31. The number of the studies that have compared rates of hypertension in urban and rural areas in the Middle East is limited with a prominent study in Egypt. Hypertension is a major health problem in Egypt with a prevalence rate of 26.3% 22 among the adult population (> 25 years) and 31% in our hospital based study. Its prevalence increases with aging, approxi-mately 50% of Egyptians above the age of 60 years suffer from hypertension. About seven million Egyptians had high blood pressure in the year 199322.

The prevalence of smoking is high in the Middle East in men, but it is relatively uncommon in women5, in large part be-cause it is still not culturally acceptable for women to smoke in this region. The rates of smoking in Turkey were among the highest in the region, with one study reporting a prevalence of 64.8% between men and 20.1% women 32. In agreement with this the current study showed smok-ers to be 43 % in our studied popula-tion. Smoking is known to play a major role in cardiovascular mortality. In a recent study, 33 an estimated 11% of to-tal global cardiovascular deaths in 2000 were attributed to smoking, half of which occurred in developing countries. To health professionals this seems to be very alarming . The proportion of deaths at-tributed to smoking in developing nations

is predicted to increase, as smoking rates continue to increase in these countries, whereas gradually declining in the devel-oped world 34 . Worldwide, the number of smokers continues to increase and is estimated to reach 1.7 billion by 2025 35,36

The prevalence of diabetes also varied among studies, with highest rates in some Arab Countries as Jordan, Qatar and Saudi Arabia. Surprisingly Motlagh et al 5 did not observe a difference in preva-lence of diabetes mellitus between men and women given differences observed for prevalence of obesity. However, in studies that reported the prevalence of both diabetes mellitus and obesity Mot-lagh et al 5 found a significant correlation between the prevalence of these two risk factors. According to the World Health Report 2002 2 , approximately 58% of diabetes globally occurs in individuals with a BMI above 21 kg/m2 37 . The com-bined prevalence of diagnosed and undi-agnosed diabetes in the Egyptian popula-tion > or = 20 years of age was estimated to be 9.3%6. Approximately half the dia-betics were diagnosed. The prevalence of diabetes in Egypt is high even on hospi-tal based study as the current one it was estimated to be 23%, and the gradient in risk factors and disease from rural to ur-ban areas suggest that diabetes is a major, emerging clinical and public health prob-lem in Egypt. For countries that included studies separated by approximately 10 years or more (Turkey, Oman, and Saudi Arabia). It was suggested that there is an increasing prevalence in diabetes similar to trends observed for obesity5. In our suggestions it seems that both go hand in hand. However, the limited number of studies included precludes definitive conclusions. Prevalence of cardiovascular risk fac-tors in Egyptian study done by Herman et al 6 showed that prevalence of obesity was 41%, Diabetes Mellitus was 17.9% while prevalence of hypertension was 25.7% among males over 25 years old and 26.3% among females38

It is evident that cardiovascular risk is



more in the more-urbanized areas. Cairo , the capital shows the highest risk with a prevalence more in females. This focuses upon impact of environment upon this kind of risk. Anyhow cardiovascular risk factors and diabetes among the Egyp-tians are really alarming and prevention is mandatory both at community level through qualified nurses and physicians as well as hospital care.

Conclusion:The prevalence of key cardiovascular risk factors is high in Egypt and it in-creases with worsening obesity. Thus there is a need for a national prevention program to combat obesity, diabetes , hy-pertension , dyslipidemia ,smoking and related co-morbidities. Consideration of early prevention and therapy is of great importance.

Study limitations:Larger-sized community–based prospec-tive studies covering wider areas in Arab countries.

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Gamela M Nasr, MD 1, Hamdy Sliem, MD 2, Amira Gamal, MD 3, Hayam Refaat, PhD 4 & Mahmoud Ibrahim, MD 5.From the 1 Department of Cardiology; the 2 Department of Internal Medicine ; the 3 Department of Community Medicine- Faculty of Medicine Suez Canal Univer-sity, Ismailia , Egypt ; the 4 Department of Pediatrics, Ain Shams University, Cairo , Egypt; the 5 EDC , Center for Diabetes Education, McDonough , GA , USA.

Table 1: Cardiovascular disease risk factors characteristics of the studied population

Frequency (N=6773) %

Gender: Male Female

28453928

4258

Residence: Urban Rural

48511922

7228

Smoking: Smokers Non smokers

29123861

4357



ParametersMale (N=2845) Female (N=3928)

P valueMean ± S.D. Mean ± S.D.

Age (years) 52.3 7.9 54.2 4.9 0.36

BMI (kg/m2) 37.1 7.5 39.0 6.5 0.001**

Waist circumference (cm) 122.1 5.8 125.5 8.3 0.04*

FBS (mg/dl) 127.3 10.5 129.4 10.8 0.07

PPBS (mg/dl) 156.1 16.6 163.8 17.1 0.04*

BPr s (mmHg) 159 12.9 154.2 10.5 0.06

BPr d (mmHg) 95 5.1 93.7 5.8 0.63

TG (mg/dl 179 19.5 191.1 21 0.07

HDL (mg/dl) 39 6.8 42.7 5.3 0.01**

Table 2: Cardiovascular disease risk factors characteristics according to gender difference

Figure 1: Common Complaints among patients with cardiovascular risk factors

Palpitation

60

50

40

30

20

10

0Easy

fatigueDyspnea NYHA 1

Dyspnea NYHA 2

Dyspnea NYHA 3

chest pain



91

69

36

166

0

10

20

30

40

50

60

70

80

90

100

HTN NIDDM IHD CHF PVD

%

Figure 2: Current illnesses among patients with cardiovascular risk factors

HTN; Hypertension. NIDDM: Non Insulin Dependent Diabetes Mellitus, IHD; Ischemic Heart Disease, CHF; Congestive heart failure and PVD; Peripheral vascular diseases

Figure 3: Biochemical profile among patients with cardiovascular risk factors

183

141169

8.2 4.60

20

40

60

80

100

120

140

160

180

200

PPBS(mg/dl)

Na (mg/dl) FBS (mg/dl) uric acid(mg/dl)

K (mg/dl)

Mean

153

11892.8 86.9

38.1

0

20

40

60

80

100

120

140

160

BPr s(mmHg)

W C (cm) BPr d(mmHg)

Pulse(bpm)

BMI(kg/m2)

Mean

Figure 4: Main clinical fea-tures among patients with cardiovascular risk factors



ParametersBMI (kg/m2) Waist

circumference (cm)

R value R value R value R value

FBS (mg/dl) 0.192(**) .003 0.009(*) 0.30

HDL (mg/dl) 0.276(**) 0.01 0.193(*) 0.02

TG (mg/dl 0.152(*) 0.013 0.217(*) 0.04

PPBS 0.163(*) 0.016 0.171(**) 0.0039

Uric acid (mg/dl) 0.116 0.092 0.355(*) 0.01

Table 3:Relation between metabolic profile of the Car-diovascular risk factors characteristics and obesity

Parameters

Family history of hypertension

P valueYes No

Mean ±S.D. Mean ±S.D.

Age 53.5 7.7 55.3 7.8 0.6

BMI (kg/m2) 39.6 3.5 37.8 1.7 0.04*

Waist circumference (cm) 120.4 7.9 113.5 5.6 0.03*

FBS (mg/dl) 138.8 11.6 136.0 5.5 0.72

PPBS 183.7 16.1 179.3 22.0 0.9

BPr s (mmHg) 159.3 10.4 153.3 9.2 0.028*

BPr d (mmHg) 95.3 6.4 90.0 5.6 0.007*

TG (mg/dl) 244.4 36.4 235.0 27.3 0.01*

HDL (mg/dl) 33.5 3.2 36.9 2.7 0.02*

Table 4: Relation between family history of hypertension and the Cardiovascular risk factors



Figure 5: Percentage of Cardiovascular e risk factors referred from different areas

17.9% Delta

26.4%Upper Egypt

18.6%Coastal areas

37.1%Greater Cairo

Greater Cairo

Coastal areas

Upper Egypt

Egypt Delta

Figure 6: Percentage of males and females diagnosed with cardiovascular disease risk factors referred from different areas

CLINICALDIABETESME.ONLINEDIABETES.NET

DIABETES.ORG/CLINICALDIABETES

9 32010

2010

cvd egypt clinical diabetes reprint summer 2010

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