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Cardiometabolic Risk Factors in Venezuela. the EVESCAM Study G Model PCD-925; No. of Pages 9 ARTICLE IN PRESS Primary Care Diabetes xxx (2020) xxx–xxx Contents lists available at ScienceDirect Primary Care Diabetes j ournal homepage: http://www.elsevier.com/locate/pcd Original research Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults a,b,c,d e,b,d,∗ d,f Ramfis Nieto-Martínez , Juan P. González-Rivas , Eunice Ugel , d g h i j Maritza Duran , Eric Dávila , Ramez Constantino , Alberto García , Jeffrey I. Mechanick , d María Inés Marulanda a LifeDoc Health, Memphis, TN, USA b Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA c Department of Physiology, School of Medicine, University Centro-Occidental “Lisandro Alvarado” and Cardio-metabolic Unit 7, Barquisimeto, Venezuela d Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela e International Clinical Research Center (ICRC), St Anne’s University Hospital (FNUSA) Brno, Czech Republic f Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela g Department of Internal Medicine, School of Medicine “Dr. Luis Razetti”, Universidad Central de Venezuela (UCV), Caracas, Venezuela h Department of Internal Medicine, School of Medicine, Universidad de Carabobo, Valencia, Venezuela i Department of Physiology. School of Medicine “Dr. Luis Razetti”, Universidad Central de Venezuela (UCV), Caracas, Venezuela j The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA a r t i c l e i n f o a b s t r a c t Article history: Background: No previous study in Venezuela and few in the Region of the Americas have reported national Received 22 February 2020 cardiometabolic health data. Objectives: To determine the prevalence and distribution of cardiometabolic Received in revised form 4 July 2020 risk factors (CMRF) in adults of Venezuela. Accepted 16 July 2020 Methods: A population-based, cross-sectional, and randomized cluster sampling national study was Available online xxx designed to recruit 4454 adults with 20 years or older from the eight regions of the country from July 2014 to January 2017. Sociodemographic, clinical, physical activity, nutritional, and psychological ques- Keywords: tionnaires; anthropometrics, blood pressure, and biochemical measurements were obtained. The results Venezuela were weighted by gender, age, and regions. Risk factors Results: Data from 3414 participants (77% of recruited), 52.2% female, mean age of 41.2 ± 15.8 years, Cardiovascular disease Tobacco were analyzed. CMRF adjusted-prevalence were: diabetes (12.3%), prediabetes (34.9%), hypertension Dyslipidemia (34.1%), obesity (24.6%), overweight (34.4%), abdominal obesity (47.6%), underweight (4.4%), hyperc- Diabetes holesterolemia (19.8%), hypertriglyceridemia (22.7%), low HDL-cholesterol (63.2%), high LDL-c (20.5%), Obesity daily consumption of fruits (20.9%) and vegetables (30.0%), insufficient physical activity (35.2%), anx- iety (14.6%) and depression (3.2%) symptoms, current smoker (11.7%), and high (≥ 20%) 10-year fatal cardiovascular risk (14.0%). CMRF prevalence varied according to gender, age and region of residence. Conclusions: Cardiometabolic risk factors are highly prevalent in Venezuelan adults. This situation can be affected by the severe socio-economic crisis in the country. The joint action of different stakeholders to implement public health strategies for the prevention and treatment of these risk factors in Venezuela is urgently needed. © 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. 1. Introduction Cardiovascular disease (CVD) is the leading global cause of death [1]. High adiposity, hypertension, high cholesterol, and hyper- ∗ glycemia are their most important risk factors. Between 1980 and Corresponding author at: International Clinical Research Center, St Anne’s Uni- 2010, the mortality burden of cardiometabolic risk factors (CMRF) versity, Hospital Brno Pekarska 53, 656 91 Brno, Czech Republic. shifted from high-income to low and middle-income countries [2]. E-mail addresses: nietoramfi[email protected] (R. Nieto-Martínez), [email protected] (J.P. González-Rivas). In Latin America, coronary heart disease and stroke cause 42.5% https://doi.org/10.1016/j.pcd.2020.07.006 1751-9918/© 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. Please cite this article in press as: R. Nieto-Martínez, et al., Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults, Prim. Care Diab. (2020), https://doi.org/10.1016/j.pcd.2020.07.006 G Model PCD-925; No. of Pages 9 ARTICLE IN PRESS 2 R. Nieto-Martínez et al. / Primary Care Diabetes xxx (2020) xxx–xxx and 28.8% of the CVD mortality, respectively [3]. But, it is neces- participate in the study by not signing the informed consent. Then, sary to identify the magnitude of the CMRF not only in each region identification data and a social status questionnaire were collected but in each country. Well-designed studies using sub-national sam- from each subject in their home. Finally, subjects were invited to ples have reported the prevalence of CMRF in Peru [4] and South assist to the physical and metabolic evaluation in a nearby health Cone (Argentina, Chile, and Uruguay) [5]. In the Americas, only 14 center and an instructive that includes a detailed explanation of of 37 countries have reported national studies, and most of them the evaluation procedures was provided and explained. The evalu- are based on self-reported data. ations were carried out in a total of 47 community health centers Venezuela is a middle-income country privileged on geographic throughout the country. localization, oil resources, and climate, but immersed in a politi- The main objective of the EVESCAM was to determine the preva- cal turmoil, hyperinflation, and socio-economic changes that can lence cardiometabolic risk factors and diseases in Venezuela. The influence the prevalence of non-communicable (NCD), especially target sample size was calculated in 2940 participants based on a cardiometabolic and nutritional diseases. Previous data in diabetes previous report on diabetes (prevalence 7.7%, standard deviation and CMRF in Venezuela has come from communities [6], a city 1.55%, and confidence level 95%) [6]. Therefore, considering a mini- [7], a state [8], and a sub-national study in three regions [9–13], mal expected response rate of 70%, the final target sample size was or from the calculation of weighted prevalence from available increased to 4200, representing the proportions of the country in studies [14]. Therefore, the objective of the Venezuelan Study of terms of age, sex, and proportion of rural and urban populations. In Cardiometabolic Health (EVESCAM, for the acronym in Spanish) each region, at least 525 subjects were recruited. The sampling also is to determine the prevalence of cardio-metabolic risk factors in considered that is necessary to evaluate at least 70% of recruited adults in a national sample of Venezuela. subjects in each region. Thus, if after recruiting 525 subjects the evaluation of at least 70% has not been achieved, the recruitment 2. Methods was to continue until that response rate was reached in each region. For this study, 4454 subjects were recruited (86.3% urban and 13.7% 2.1. Study design rural areas), of which 3414 were evaluated, corresponding to a net response rate of 76.7%. The study design, sampling, and implementation were The study protocol complied with the Helsinki declaration and described previously [15,16]. In brief, the EVESCAM was a approved by the National Bioethics Committee (CENABI). Consent population-based, observational, cross-sectional, and cluster sam- from all participants was obtained and filed. The present report is pling study, designed to evaluate cardiometabolic risk factors presented according to the Strengthening the Reporting of Obser- among subjects aged ≥ 20 years in Venezuela from July 2014 to vational Studies in Epidemiology (STROBE) [17]. January 2017. 2.4. Clinical and biochemical measures 2.2. Population A customized questionnaire was used to collect information The Bolivarian Republic of Venezuela consists of 23 states, a on demographics, family and personal history, including type 2 capital district, federal entities, and 335 municipalities distributed diabetes (T2D) and CV risk, socioeconomic status (SES) [18], use in 8 regions (Capital, Central, Western, Northeast, Guayana, of health care facilities, tobacco history, and depression and/or Andeans, Zulia, and The Llanos). The population size reported by anxiety symptoms [19]. Dietary intake was ascertained using the Venezuelan National Institute of Statistics (www.ine.gov.ve; both a food frequency questionnaire adapted to the Venezuelan accessed on January 21, 2018) was 31,431,164 inhabitants in 2017, population. Questionnaires, anthropometrics, and other physical of whom 65.3% were 20 years or older and 50% were female. measurements were obtained by trained and certified health per- sonnel. Blood pressure was measured twice, with five minutes 2.3. Sampling and recruitment intervals, in the right arm, supported at heart level, in a sitting position, after five minutes of
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