Cardiovascular disease risk factor patterns and their implications for intervention strategies in Vietnam

The prevalence of excess weight among Vietnamese adults: A pooled analysis of 58 studies with more 430 thousand participants over the last three decades

BACKGROUND

Chronic noncommunicable diseases (NCDs) associated with excess weight as a significant risk factor, but few studies have been sufficient enough to examine the magnitude of excess weight of Vietnamese adults. This review aimed to provide a generalized estimate of the prevalence of excess weight among Vietnamese adults.

METHODS

PubMed, Scopus and national database were used to identify articles published up to May 2022. The Newcastle-Ottawa Quality Assessment Scale was used to rate the study quality. The data was analyzed using RStudio software, and the combined effects were estimated using random-effects meta-analysis. The Cochran's Q-test and the I2 test were employed to examine heterogeneity, and subgroups were conducted. Egger's test and visual inspection of the symmetry in funnel plots were used to determine publication bias.

RESULTS

58 studies with 432,585 participants from 1998 to 2020 were suitable for inclusion in the final model after meeting the prerequisites. Over the last three decades, the combined pooled prevalence of excess weight among adults in Vietnam was 20.3% (95% CI: 15.2-26.6). Notably, this proportion has a tendency to go up between 1998 and 2020. Moreover, rates of excess weight were found to be substantially higher in non-national studies (23.1%, 17.3-30.1) compared to national studies (8.4%, 3.6-18.3) and significantly higher when Asian and Pacific cut-offs (27.6%, 20.0-36.7) were used rather than WHO classification (11.2%, 6.7-18.0).

CONCLUSION

The findings suggest healthcare professionals and policymakers should focus more on designing and implementing preventive initiatives to lower the rising prevalence of excess weight adults in Vietnam.

Social Determinants of Health, Cardiovascular Risk Factors, and Atherosclerotic Cardiovascular Disease in Individuals of Vietnamese Origin

In 2022, the Vietnamese population in the United States (US) comprises 2.2 million individuals, and Vietnam ranks as the sixth most frequent country of origin among immigrants in the US. The American Heart Association and the National Institutes of Health have called for research to define the burden of cardiovascular risk factors, cardiovascular disease, and their determinants across Asian American subgroups, including Vietnamese Americans. Despite these calls, Vietnamese Americans remain remarkably overlooked in cardiovascular research in the US. Studies in Vietnam, small cross-sectional surveys in the US, and research using US mortality data point to a high prevalence of hypertension and tobacco use among men and a high incidence of gestational diabetes among women. Moreover, Vietnamese Americans have one of the highest rates of cerebrovascular mortality in the country. Adverse social determinants of health-including frequent language barriers, limited health literacy, and low average income-have been suggested as important factors that contribute to cardiovascular risk in this group. In this narrative review, we summarize the existing knowledge in this space, highlight the distinct characteristics of cardiac risk in both Vietnamese and Vietnamese American individuals, discuss upstream determinants, and identify key knowledge gaps. We then outline several proposed interventions and emphasize the need for further studies in this underrepresented population. Our aim is to increase awareness of the significant burden of risk factors and cardiovascular disease shouldered by this large-but thus far overlooked-population in the US, boost research in this space, and help inform tailored, effective preventive interventions.

Adherence to hypertension and dyslipidemia treatment and its implication on control of cardiovascular disease in Vietnam: A semi-systematic review

BACKGROUND

To understand the prevalent issues and challenges in the provision of care for dyslipidemia and hypertension in Vietnamese adults, quantification of patient journey stages (awareness, screening, diagnosis, treatment, adherence, and control) was performed in this semi-systematic review.

METHODS

The EMBASE and MEDLINE databases were searched for English articles published between 2010 and 2019. Thesis abstracts, letters to the editor, editorials, case studies, and studies on patient subgroups or nationally unrepresentative studies, were excluded. Articles from Google, the Incidence and Prevalence Database, the World Health Organization, Vietnam's Ministry of Health, and those suggested by the authors were also included. The last search was run on December 10, 2019 for dyslipidemia and hypertension.

RESULTS

A reviewer independently screened 586 retrievals for dyslipidemia and 177 retrievals for hypertension, and extracted data from 2 articles on dyslipidemia and 6 articles on hypertension that were included in the final synthesis.

CONCLUSION

The data generated in this review will help overcome these issues and barriers to patient care in populations with these 2 conditions.

Modifiable cardiovascular disease risk factors among adults in southern Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the prevalence, magnitude and factors associated with the number of major modifiable cardiovascular disease (CVD) risk factors.

DESIGN

Community-based cross-sectional study.

SETTING

General population in urban and rural Wolaita, southern Ethiopia.

PARTICIPANTS

A total of 2483 adults aged 25-64 years were selected using the three-stage random sampling.

OUTCOME MEASURES

Prevalence of major modifiable CVD risk factors, co-occurrences and the number of modifiable CVD risk factors.

RESULTS

The major modifiable CVD risk factors documented in the Wolaita area were smoking with a weighted prevalence of 0.8%, hypercholesterolaemia 5.0%, hypertriglyceridaemia 15.5%, low high-density lipoprotein cholesterol (HDL-C) 31.3%, high systolic blood pressure 22.2%, high diastolic blood pressure 22.4%, physical inactivity 44.1%, obesity 2.8% and hyperglycaemia 3.7%. The numbers of participants having ≥1, ≥2 and ≥3 major modifiable CVD risk factors in the study area were 2013, 1201 and 576 with a weighted prevalence of 75.8%, 42.3% and 19.4%, respectively. In general, there were 28 different combinations of major modifiable CVD risk factor co-occurrences. The combination of physical inactivity with low HDL-C was found in 19.7% of the study participants, followed by physical inactivity with hypertension of 17.8%. Urban residence, male gender, sugar-sweetened food consumption and older age had a positive association with the number of major modifiable CVD risk factors, while being a farmer had a negative association.

CONCLUSIONS

The prevalence and magnitude of major modifiable CVD risk factors in the study area were high. The components of the most prevalent combinations of major modifiable CVD risk factors should be targeted. Therefore, public health measures against major modifiable CVD risk factors such as promotion of physical exercise and reduction of sugar-sweetened food consumption have to be taken, targeting the vulnerable groups such as urban residents and older age.

Non-achievement of the Low-Density Lipoprotein Cholesterol Goal in Older Patients with Type 2 Diabetes Mellitus and a Very High Cardiovascular Disease Risk: A Multicenter Study in Vietnam

Background

Lowering the low-density lipoprotein cholesterol (LDL-c) level is important for reducing cardiovascular (CV) events. However, little is known about the management of LDL-c in older patients with type 2 diabetes mellitus (T2DM). This study investigated the prevalence and factors associated with the non-achievement of LDL-c goals in older T2DM patients with a very high risk of CV diseases.

Methods

This multicenter cross-sectional study measured the LDL-c levels of 733 T2DM outpatients from December 2019 to July 2020. The patients were aged ≥60 years, had very high risks of CV disease, and had been on LDL-c-lowering therapy for 6 months or more. The goal of lipid concentrations were assessed based on the recent guidelines of the European Society of Cardiology. We applied logistic regression analysis to identify the factors associated with the non-achievement of the LDL-c goal.

Results

The mean age of the patients was 68.6±7.2 years. In total, 654 patients (89.2%) did not achieve the aggressive LDL-c goal of <1.4 mmol/L. In the adjusted model, the factors associated with the non-achievement of the LDL-c goal were obesity defined by body mass index (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.13–4.81; p=0.022) and high-intensity statin therapy (OR=0.03; 95% CI, 0.01–0.05; p<0.001), while age, sex, education level, smoking habit, and comorbidities were not associated.

Conclusion

Older patients with T2DM who are at a very high CV disease risk are often unable to achieve their LDL-c goal. Obesity can increase the probability of not achieving the LDL-c goal, whereas high-intensity statin therapy can decrease this probability.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60–69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.

Estimation of the cardiovascular risk using world health organization/international society of hypertension risk prediction charts in Central Vietnam

Introduction

Cardiovascular disease (CVD) being the leading cause of the morbidity and mortality in Vietnam, the objective of this study was to estimate the total 10-year CVD risk among adults aged 40–69 years by utilizing World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in Central Vietnam.

Materials and methods

In this cross-sectional study, multi-staged sampling was used to select 938 participants from a general population aged from 40 to 69. The CVD risk factors were then collected throughout the interviews with a standardized questionnaire, anthropometric measurements and a blood test. The cardiovascular risk was calculated using the WHO/ISH risk prediction charts.

Results

According to the WHO/ISH charts, the proportion of moderate risk (10–20%) and high risk (>20%) among the surveyed participants were equal (5.1%). When “blood pressure of more than 160/100 mmHg” was applied, the proportion of moderate risk reduced to 2.3% while the high risk increased markedly to 12.8%. Those proportions were higher in men than in women (at 18.3% and 8.5% respectively, p-value <0.001, among the high-risk group), increasing with age. Male gender, smoking, ethnic minorities, hypertension and diabetes were associated with increased CVD risk.

Conclusions

There was a high burden of CVD risk in Central Vietnam as assessed with the WHO/ISH risk prediction charts, especially in men and among the ethnic minorities. The use of WHO/ISH charts provided a feasible and affordable screening tool in estimating the cardiovascular risk in primary care settings.

Patterns of behavioral risk factors for non-communicable diseases in Vietnam: A narrative scoping review

This review describes both magnitude and patterns of major behavioral risk factors for NCDs. Positive changes in tobacco use were identified, though this is far to meet the established expectation. Harmful alcohol consumption was reported, especially for males. Only small proportion of the population consumed an adequate amount of fruits and vegetables daily. Average salt intake was approximately doubled, in comparison to WHO's recommendations. Physical activity has shifted gradually negatively, but future trends are unpredictable. An organized surveillance system should be developed initially with adequate tools and public resources to maintain and ensure sustainability over time.

Alcohol Consumption and Binge Drinking Among Adult Population: Evidence From the CHILILAB Health and Demographic Surveillance System in Vietnam

CONTEXT

Alcohol contributes to severe social and health problems and is a major risk factor for noncommunicable diseases in Vietnam. Over the years, there has been an increase in consumption per capita as well as a rapid expansion of commercially prepared alcohol.

OBJECTIVE

To describe the prevalence of alcohol consumption and binge drinking in a random sample of people 15 years of age and older living in Chi Linh who were also a part of the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) and to determine the association between alcohol use and sociodemographic characteristics.

DESIGN

Data on alcohol consumption of 5438 people 15 years of age and older were extracted from the CHILILAB HDSS information collected in 2016. Descriptive statistics and multiple logistic regression were utilized to assess the association between current drinkers and binge drinkers with socioeconomic groups.

RESULTS

The overall prevalence of alcohol use 1 month prior to interview was 41.1%, which is composed of 75.1% males and 17.3% females. Among the 41% of alcohol drinkers, 31.7% reported binge drinking over the last 30 days. The proportion of binge drinking was also found to be higher among males than among females. The association between current drinkers, binge drinkers and gender, area of residence, education, and family income level was statistically significant.

CONCLUSIONS

This study confirms that alcohol use among current and binge drinkers is common among males in Vietnam and that it is also a rising issue among females. Alcohol use is also associated with sociodemographic factors and income level. The results of this study provide evidence of harmful alcohol use among the Vietnamese population, which could help policy makers further advocate for the approval of the Vietnamese alcohol harm reduction law in the coming years. The results of this study reaffirm the need for public health strategies, including the formulation of laws and policies to reduce the harmful effects of alcohol consumption in Vietnam.

Prevalence of Hypertension in Vietnam: A Systematic Review and Meta-Analysis

Studies on the prevalence of hypertension in Vietnam have reported various estimates. There is no up-to-date assessment of the evidence on the magnitude of hypertension in Vietnam. Search engines for scientific and gray literature were used to identify relevant records for eligibility screening and quality assessment. Data from selected articles were extracted using standardized spreadsheets. Statistical analysis included estimating pooled prevalence and odds ratio, heterogeneity evaluation, meta-regression, and subgroup analysis, in addition to sensitivity analysis and publication bias evaluation. The pooled prevalence of measured hypertension in Vietnam was 21.1% (95% confidence interval = 18.5-23.7) based on 10 studies, and 18.4% (95% confidence interval = 15.2-21.8) based on 3 national surveys. Lower pooled prevalence was estimated for hypertension awareness (9.3%) and hypertension treatment (4.7%). The pooled prevalence of measured hypertension is significantly higher among men. The pooled prevalence of measured hypertension and hypertension awareness and treatment were significantly lower in rural settings. There is a need to strengthen efforts for primary and secondary prevention and disease management to reduce morbidity and mortality, especially in rural residence settings.

Socioeconomic Inequalities in Health-Related Quality of Life among Patients with Cardiovascular Diseases in Vietnam

Purpose

This study aims to explore the sociodemographic differences in health-related quality of life (HRQOL) among Vietnamese patients with cardiovascular diseases (CVD).

Methods

A cross-sectional survey of 600 cardiovascular disease patients (300 inpatients and 300 outpatients) being treated at the Hanoi Heart Hospital was completed between July and December 2016. Data about HRQOL were collected by using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EuroQOL-visual analogue scale (VAS). Sociodemographic characteristics were collected. A multivariate Tobit regression was used to detect the correlations between HRQOL and sociodemographic factors.

Results

Our sample had an average EQ-5D index of 0.82 (SD=0.21) and VAS score of 77.8 (SD=13.6). Participants were most likely to report problems in pain/discomfort (38.8%) and anxiety/depression (35.2%) and were least likely to report problems related to self-care (19.8%). Age and sex were strongly associated with the EQ-5D index and the VAS. Having health insurance and the number of hospital visits were negatively associated with HRQOL, while participation in the chronic disease management program had the positive relationship.

Conclusions

HRQOL among patients with CVD was moderately lower compared to the Vietnamese general population. Sociodemographic characteristics were strongly associated with HRQOL suggesting that addressing these inequalities should be prioritized in delivering services. Patients should also be encouraged to participate in the chronic disease management program due to its positive effects on quality of life.

Prevalence, Awareness, Treatment, and Control of Hypertension and Its Risk Factors in (Central) Vietnam

Introduction

The objective of this study is to describe the prevalence, awareness, treatment, and control of hypertension and its associated risk factors in (Central) Vietnam.

Methods

In this cross-sectional study, a multistage sampling was used to select 969 participants from the general population aged from 40 to 69 years. The cardiovascular risk factors were collected throughout the interviews with a standardized questionnaire. Multivariate logistic regression analysis was conducted to test the relationship between the prevalence, awareness, treatment, and control of hypertension and the prevalence of risk factors.

Results

The prevalence of hypertension was 44.8%. It was higher in men than in women (51.3% versus 39.7%, p < 0.001). In total 67.3% (74.5% in women, 60.1% in men; p = 0.001) of the participants were aware of their hypertension, 33.2% (37.5% in women, 28.9% in men; p = 0.01) of the participants were treated, and 12.2% (16.7% in women, 7.8% in men; p < 0.001) of the hypertensive participants' hypertension was controlled. Age, gender, place of residence, body mass index, and diabetes were found to be independent risk factors for hypertension.

Conclusion

The prevalence of hypertension in Vietnam is high, and the proportion of treated and controlled patients is rather low.

Inconsistencies of Breast Cancer Risk Factors between the Northern and Southern Regions of Vietnam

Background: In recent decades the amount of new breast cancer cases in the southern region has been reported to increase more rapidly than in the northernVietnam. The aim of this study is to compare breast cancer risk factors between the two regions and establish if westernized influences have an impact on any reported differences. Method: Data was collected from the two largest oncology hospitals in the north and the south of Vietnam in 2015. Breast density, demographic, reproductive and lifestyle data of 127 cases and 269 controls were collected in the north and 141 cases and 250 controls were gathered from the south. Baseline differences in factors between cases and age-matched controls in each region were assessed using chi-square tests and independent t-tests. Odds ratios (OR) for independent risk factors for breast cancer were obtained from conditional logistic regression. Results: In northern Vietnam significantly increased risks in developing breast cancer were observed for women with age at first menstrual period less than 14 years old (OR=2.1; P<0.05), post-menopausal status (OR=2.6; P<0.0001), having less than 2 babies (OR=2.1; P<0.05). Southern Vietnamese women having a breast density of more than 75% (OR=2.1; P<0.01), experiencing post-menopause (OR=1.6; P<0.05), having a history of less than 3 pregnancies (OR=2.6; P<0.0001) and drinking more than a cup of coffee per day (OR=1.9; P<0.05) were more likely to be diagnosed with breast cancer. Conclusion: We found that women living in the south had some breast cancer associations, such as increased mammographic density and coffee consumption, which are closer to the risks in westernized populations than women in the north.

Prevalence and determinants of diabetes and prediabetes among Vietnamese adults

AIMS

We estimated the prevalence of diabetes and prediabetes among Vietnamese adults, and quantitatively evaluated association with known risk factors.

METHODS

Subjects were 5602 men and 10,680 women in North Vietnam aged 30-69 years participating in community diabetes screening programs during 2011-2013. We calculated standardized prevalence rates and demographic projections for 2035, and used multinomial regression analysis to examine the associations of multiple risk factors with diabetes and prediabetes.

RESULTS

The age-, sex- and area of residence-standardized prevalence of diabetes was 6.0% and of prediabetes was 13.5%, with higher prevalence among men than women. Population aging is projected to raise the prevalence of diabetes to 7.0% and of prediabetes to 15.7% by 2035. Older age, obesity, large waist-to-hip ratio and hypertension were each associated with higher prevalence of diabetes, whereas the opposite direction of association was observed for underweight and minority ethnicity. In addition, diabetes was positively associated with family history of diabetes in women, but inversely related to physically heavy work among men.

CONCLUSIONS

One in 17 and one in 7 adults had diabetes and prediabetes, respectively, in Vietnam. Urbanization, population aging, increased adiposity, hypertension and sedentary work are associated with the increasing prevalence of diabetes.

Female breast cancer in Vietnam: a comparison across Asian specific regions

Breast cancer is one of the most commonly diagnosed malignancies and the leading cause of cancer death of women over the world. A large number of females with breast cancer in Vietnam and other Southeast Asian (SEA) countries present at an early age with more aggressive tumors compared with women in Australia. Despite experiencing a low incidence rate, the increasing incidence rate among SEA countries exceeds that of the Westernized world. Changes in reproductive factors, environmental exposures, and lifestyle are the possible causes of this trend. However, limited evidence shows that these factors are associated with breast cancer in the Vietnamese population. Breast cancer incidence rates within Vietnam are not uniform and appear to be dependent on geographic location. Findings from this review have important implications for breast cancer control and treatment in Vietnam. A good understanding of the morphology of the breast and the type and nature of breast cancers presenting in Vietnam is required to facilitate the introduction of an effective national breast screening program.

Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia

Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization's STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25-64 years). Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (<9 years) than among those with postsecondary education (>12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends.

Direct costs of hypertensive patients admitted to hospital in Vietnam- a bottom-up micro-costing analysis

Background

There is an economic burden associated with hypertension both worldwide and in Vietnam. In Vietnam, patients with uncontrolled high blood pressure are hospitalized for further diagnosis and initiation of treatment. Because there is no evidence on costs of inpatient care for hypertensive patients available yet to inform policy makers, health insurance and hospitals, this study aims to quantify direct costs of inpatient care for these patients in Vietnam.

Methods

A retrospective study was conducted in a hospital in Vietnam. Direct costs were analyzed from the health-care provider’s perspective. Hospital-based costing was performed using both bottom-up and micro-costing methods. Patients with sole essential or primary hypertension (ICD-code I10) and those comorbid with sphingolipid metabolism or other lipid storage disorders (ICD-code E75) were selected. Costs were quantified based on financial and other records of the hospital. Total cost per patient resulted from an aggregation of laboratory test costs, drug costs, inpatient-days’ costs and other remaining costs, including appropriate allocation of overheads. Both mean and medians, as well as interquartile ranges (IQRs) were calculated. In addition to a base-case analysis, specific scenarios were analyzed.

Results

230 patients were included in the study (147 cases with I10 code only and 83 cases with I10 combined with E75). Median length of hospital stay was 6 days. Median total direct costs per patient were US$65 (IQR: 37 -95). Total costs per patient were higher in the combined hypertensive and lipid population than in the sole hypertensive population at US$78 and US$53, respectively. In all scenarios, hospital inpatient days’ costs were identified as the major cost driver in the total costs.

Conclusions

Costs of hospitalization of hypertensive patients is relatively high compared to annual medication treatment at a community health station for hypertension as well as to the total health expenditure per capita in Vietnam. Given that untreated/undetected hypertension likely leads to more expensive treatments of complications, these findings may justify investments by the Vietnamese health-care sector to control high blood pressure in order to save downstream health care budgets.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-014-0514-4) contains supplementary material, which is available to authorized users.

To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.

Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia

Background

The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia.

Methods

We used data from the cross-sectional World Health Organization’s STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25–64 years).

Results

In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29–0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34–0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29–4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08–2.73, p = 0.006) than unemployment. For all participants, income > $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43–3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43–2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56–5.78, p < 0.001) than those unemployed.

Conclusion

Our analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-895) contains supplementary material, which is available to authorized users.

Association between high sensitivity C-reactive protein and dietary intake in Vietnamese young women

BACKGROUND/OBJECTIVES

High sensitivity C-reactive protein (hsCRP) is a strong independent predictor of future cardiovascular disease (CVD) risk. We evaluated the relationship between hsCRP and dietary intake in apparently healthy young women living in southern Vietnam.

SUBJECTS/METHODS

Serum hsCRP was measured and dietary intake data were obtained using the 1-day 24-hour recall method in women (n = 956; mean age, 25.0 ± 5.7 years) who participated in the International Collaboration Study for the Construction of Asian Cohort of the Korean Genome and Epidemiology Study (KoGES) in 2011.

RESULTS

Women in the high risk group (> 3 mg/L) consumed fewer fruits and vegetables, total plant food, potassium, and folate than those in the low risk group (< 1 mg/L). A multiple regression analysis after adjusting for covariates revealed a significant negative association between hsCRP and fruit and vegetable consumption. A logistic regression analysis showed that the odds ratio (OR) of having a high hsCRP level in women with the highest quartiles of consumption of fruits and vegetables [OR, 0.391; 95% confidence interval (CI), 0.190-0.807], potassium [OR, 0.425; 95% CI, 0.192-0.939] and folate [OR, 0.490; 95% CI, 0.249-0.964] were significantly lower than those in the lowest quartiles.

CONCLUSIONS

These results suggest that, in young Vietnamese women, an increased consumption of fruit and vegetables might be beneficial for serum hsCRP, a risk factor for future CVD events.

Models to Predict the Burden of Cardiovascular Disease Risk in a Rural Mountainous Region of Vietnam

OBJECTIVE

To compare and identify the most appropriate model to predict cardiovascular disease (CVD) in a rural area in Northern Vietnam, using data on hypertension from the communities.

METHODS

A cross-sectional survey was conducted including all residents in selected communities, aged 34 to 65 years, during April to August 2012 in Thai Nguyen province. Data on age, sex, smoking status, blood pressure, and blood tests (glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were collected to identify the prevalence of high blood pressure and to use as input variables for the models. We compared three models, Asian, Chinese Multiple-provincial Cohort Study (CMCS), and Framingham, to estimate cardiovascular risk in the coming years in this context and compare these models and outcomes.

RESULTS

The prevalence of high blood pressure in these communities was lower than reported nationally (12.3%). CVD risk differed greatly depending on the model applied: approximately 21% of the subjects according to the CMCS and Asian models, but 37% using the Framingham model, had more than 10% risk for CVD. In the group without current CVD, these numbers decreased to 9% using the CMCS and Asian models but increased to 28% according to the Framingham model. There were no significant differences between the Asian and CMCS models, but differences were highly significant when comparing Asian versus Framingham or CMCS versus Framingham model.

CONCLUSIONS

The Asian and CMCS models provided similar results in predicting CVD risk in the Vietnamese population in Thai Nguyen. The Framingham model provided vastly different results. The suggestion may be that for the specific Vietnamese setting, the Asian and CMCS models provide most valid and reliable results; however, this has to be investigated in further analyses using real-life data for potential confirmation.

Socio-ecological risk factors for prime-age adult death in two coastal areas of Vietnam

BACKGROUND

Hierarchical spatial models enable the geographic and ecological analysis of health data thereby providing useful information for designing effective health interventions. In this study, we used a Bayesian hierarchical spatial model to evaluate mortality data in Vietnam. The model enabled identification of socio-ecological risk factors and generation of risk maps to better understand the causes and geographic implications of prime-age (15 to less than 45 years) adult death.

METHODS AND FINDINGS

The study was conducted in two sites: Nha Trang and Hue in Vietnam. The study areas were split into 500×500 meter cells to define neighborhoods. We first extracted socio-demographic data from population databases of the two sites, and then aggregated the data by neighborhood. We used spatial hierarchical model that borrows strength from neighbors for evaluating risk factors and for creating spatially smoothed risk map after adjusting for neighborhood level covariates. The Markov chain Monte Carlo procedure was used to estimate the parameters. Male mortality was more than twice the female mortality. The rates also varied by age and sex. The most frequent cause of mortality was traffic accidents and drowning for men and traffic accidents and suicide for women. Lower education of household heads in the neighborhood was an important risk factor for increased mortality. The mortality was highly variable in space and the socio-ecological risk factors are sensitive to study site and sex.

CONCLUSION

Our study suggests that lower education of the household head is an important predictor for prime age adult mortality. Variability in socio-ecological risk factors and in risk areas by sex make it challenging to design appropriate intervention strategies aimed at decreasing prime-age adult deaths in Vietnam.

Diabetes in the Western Pacific Region--past, present and future

In the 2013 issue of the International Diabetes Federation (IDF) Diabetes Atlas, the prevalence of diabetes in the Western Pacific (WP) Region was reported to be 8.6% in 2013, or 138 million adults, and estimated to rise to 11.1%, or 201 million adults, in 2035. The prevalence estimates of impaired glucose tolerance in 2013 and 2035 were 6.8% and 9.0%, respectively. Over 50% of people with diabetes were undiagnosed. In 2013, 187 million deaths were attributable to diabetes, 44% of which occurred in the under the age of 60. The WP Region is home to one quarter of the world's population, and includes China with the largest number of people with diabetes as well as Pacific Islands countries with the highest prevalence rates. There is a rapid increase in diabetes prevalence in the young-to-middle aged adults, possibly driven by high rates of childhood obesity and gestational diabetes as well as rapid demographic and sociocultural transitions. Differences in genetics, ethnicity, cultures and socioeconomic development have led to complex host-environment-lifestyle interactions with marked disease heterogeneity, further influenced by access to care and treatment. Despite these challenges, the WP Region has provided notable examples to prevent and control diabetes.

Global estimates of diabetes prevalence for 2013 and projections for 2035

INTRODUCTION

Diabetes is a serious and increasing global health burden and estimates of prevalence are essential for appropriate allocation of resources and monitoring of trends.

METHODS

We conducted a literature search of studies reporting the age-specific prevalence for diabetes and used the Analytic Hierarchy Process to systematically select studies to generate estimates for 219 countries and territories. Estimates for countries without available source data were modelled from pooled estimates of countries that were similar in regard to geography, ethnicity, and economic development. Logistic regression was applied to generate smoothed age-specific prevalence estimates for adults 20-79 years which were then applied to population estimates for 2013 and 2035.

RESULTS

A total of 744 data sources were considered and 174 included, representing 130 countries. In 2013, 382 million people had diabetes; this number is expected to rise to 592 million by 2035. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years.

CONCLUSION

The new estimates of diabetes in adults confirm the large burden of diabetes, especially in developing countries. Estimates will be updated annually including the most recent, high-quality data available.

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs.

Risk factors for chronic disease in Viet Nam: a review of the literature

INTRODUCTION

Chronic diseases account for most of the disease burden in low- and middle-income countries, particularly those in Asia. We reviewed literature on chronic disease risk factors in Viet Nam to identify patterns and data gaps.

METHODS

All population-based studies published from 2000 to 2012 that reported chronic disease risk factors were considered. We used standard chronic disease terminology to search PubMed and assessed titles, abstracts, and articles for eligibility for inclusion. We summarized relevant study information in tables listing available studies, risk factors measured, and the prevalence of these risk factors.

RESULTS

We identified 23 studies conducted before 2010. The most common age range studied was 25 to 64 years. Sample sizes varied, and sample frames were national in 5 studies. A combination of behavioral, physical, and biological risk factors was studied. Being overweight or obese was the most common risk factor studied (n = 14), followed by high blood pressure (n = 11) and tobacco use (n = 10). Tobacco and alcohol use were high among men, and tobacco use may be increasing among Vietnamese women. High blood pressure is common; however, people's knowledge that they have high blood pressure may be low. A high proportion of diets do not meet international criteria for fruit and vegetable consumption. Prevalence of overweight and obesity is increasing. None of the studies evaluated measured dietary patterns or total caloric intake, and only 1 study measured dietary salt intake.

CONCLUSION

Risk factors for chronic diseases are common in Viet Nam; however, more recent and context-specific information is required for planning and monitoring interventions to reduce risk factors and chronic disease in this country.

Time trends in blood pressure, body mass index and smoking in the Vietnamese population: a meta-analysis from multiple cross-sectional surveys

Introduction

Data for trends in cardiovascular disease (CVD) risk factors are needed to set priorities and evaluate intervention programmes in the community. We estimated time trends in blood pressure (BP), anthropometric variables and smoking in the Vietnamese population and highlighted the differences between men and women or between rural and urban areas.

Methods

A dataset of 23,563 adults aged 25–74 from 5 cross-sectional surveys undertaken within Vietnam from 2001 to 2009 by the Vietnam National Heart Institute was used to estimate mean BP, weight, waist circumference (WC), body mass index (BMI), the prevalence of hypertension, adiposity or smoking, which were standardised to the national age structure of 2009. Multilevel mixed linear models were used to estimate annual changes in the variables of interest, adjusted by age, sex, residential area, with random variations for age and surveyed provinces.

Findings

Among the adult population, the age-standardised mean systolic and diastolic BP increased by 0.8 and 0.3 mmHg in women, 1.1 and 0.4 mmHg in men, while the mean BMI increased by 0.1 kgm⁻² in women, 0.2 kgm⁻² in men per year. Consequently, the prevalence of hypertension and adiposity increased by 0.9 and 0.3% in women, 1.1 and 0.9% in men with similar time trends in both rural and urban areas, while smoking prevalence only increased in women by 0.3% per year. A U-shaped association was found between age-adjusted BP and BMI in both sexes and in both areas.

Conclusions

From 2001 to 2009, mean BP, weight and WC significantly increased in the Vietnamese population, leading to an increased prevalence of hypertension and adiposity, suggesting the need for the development of multi-sectoral cost-effective population-based interventions to improve CVD management and prevention. The U-shaped relationship between BP and BMI highlighted the hypertension burden in the underweight population, which is usually neglected in CVD interventions.

Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study

Background

Health promotion is a key component for primary prevention of cardiovascular disease (CVD). This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors (CVDRF) in the general population in the context of a community-based programme on hypertension management.

Methods

A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009. In the intervention commune, a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated, while no new programme, apart from conventional healthcare services, was provided in the reference commune. Health promotion campaigns focused on smoking cessation, reducing alcohol consumption, encouraging physical activity and reducing salty diets. Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure (BP) and behavioural CVDRFs (smoking, alcohol consumption, physical inactivity and salty diet) in both communes before and after the 3-year intervention.

Results

Overall 4,650 adults above 25 years old were surveyed, in four randomly independent samples covering both communes at baseline and after the 3-year intervention. Although physical inactivity and obesity increased over time in the intervention commune, there was a significant reduction in systolic and diastolic BP (3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively) in the general population at the intervention commune. Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption.

Conclusion

Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span. Limited effects on a context-bound CVDRF like smoking suggested that higher intensity of intervention, a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention.