Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland

Trends and determinants of prevalence, awareness, treatment and control of dyslipidaemia in canton of Geneva, 2005-2019: Potent statins are underused

We assessed 1) trends in prevalence, awareness, treatment and control rates of dyslipidaemia and associated factors, 2) the effect of statin generation/potency on control levels and 3) the effect of ESC lipid guidelines, on lipid management. Data from multiple cross-sectional, population-based surveys conducted between 2005 and 2019 in the canton of Geneva, Switzerland, were used. Prevalence, awareness, treatment and control rates of dyslipidaemia were 46.0% and 34.9% (p < 0.001), 67.0% and 77.3% (p = 0.124), 40.0% and 19.9% (p < 0.001), and 68.0% and 84.0% (p = 0.255), in 2005 and 2019, respectively. After multivariable adjustment, only the decrease in treatment rates was significant. Increasing age, higher BMI, history of hypertension or diabetes were positively associated with prevalence, while female sex was negatively associated. Female sex, history of diabetes or CVD were positively associated with awareness, while increasing age was negatively associated. Increasing age, smoking, higher BMI, history of hypertension, diabetes or CVD were positively associated with treatment, while female sex was negatively associated. Female sex was positively associated with control, while increasing age was negatively associated. Highly potent statins increased from 50.0% to 87.5% and third generation statins from 0% to 47.5% in 2009 and 2015, respectively. Increased statin potency was borderline (p = 0.059) associated with dyslipidaemia control. ESC guidelines had no effect regarding the prescription of more potent or higher generation statins. We conclude that in the canton of Geneva, treatment of diagnosed dyslipidaemia is low, but control is adequate. Women are undertreated but better controlled than men. The most potent hypolipidemic drugs are underused.

Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland: the CoLaus|PsyCoLaus Study

AIM

To assess the 15-year trends in the level of glycemic, blood pressure, and cholesterol control in adults with diabetes in a Swiss population-based cohort.

RESEARCH DESIGN AND METHODS

CoLaus|PsyCoLaus is a prospective cohort study of 6733 adults aged 35-75 years in Lausanne, Switzerland. Baseline recruitment was conducted in 2003-6 and was followed by three subsequent follow-ups in 2009-12, 2014-17 and 2018-21. In adults with diabetes, glycemic control was defined as fasting plasma glucose <7 mmol/L, blood pressure control as systolic and diastolic pressures of <140/90 mm Hg, and lipid control as non-high-density lipoprotein (non-HDL) cholesterol control <3.4 mmol/L.

RESULTS

Rates of glycemic control improved from 23.2% (95% CI 19.5 to 27.3) in 2003-6 to 32.8% (95% CI 28.1 to 37.8) in 2018-21. Blood pressure control also improved, from 51.5% at baseline (95% CI 46.8 to 56.2) to 63.3% (95% CI 58.2 to 68.1) 15 years later. The largest improvement was in cholesterol control, from 29.1% (95% CI 25.1 to 33.6) in 2003-6 to 56.3% (95% CI 51.1 to 61.4) in 2018-21. Overall, simultaneous control of all three improved from 5.5% (95% CI 3.7 to 8.1) at baseline to 17.2% (95% CI 13.7 to 21.5) 15 years later. Improvements in risk factor control tallied with an increase in the use of glucose-lowering agents, blood pressure-lowering medication, and statins. Men were less likely to achieve blood pressure control but presented with a better control of non-HDL cholesterol. Caucasians were less likely to achieve simultaneous control than non-Caucasians.

CONCLUSION

Cardiovascular risk factor control in adults with diabetes in Switzerland has increased in the last 15 years, but there remains a margin for improvement.

Thirteen-year trends in the prevalence of diabetes in an urban region of Switzerland: a population-based study

AIM

To assess trends in prevalence of total and diagnosed diabetes, and in the probability of detecting undiagnosed diabetes in the Swiss population.

METHODS

The Bus Santé study is an annual cross-sectional study of adults residing in Geneva state, Switzerland. We included 8532 participants (51% women) from the years 2005 to 2017, when fasting plasma glucose data became available. Total diabetes was defined as the sum of diagnosed and undiagnosed diabetes, while diagnosed diabetes was defined as having a previous diagnosis, and undiagnosed diabetes as having fasting plasma glucose level of ≥7 mmol/l and no previous diagnosis. We calculated the probability of finding undiagnosed diabetes among participants without a diagnosis. We examined for linear and quadratic trends, grouping survey years into five survey periods.

RESULTS

In total, 711 diabetes cases were identified over 13 years. The age- and gender-standardized prevalence of total diabetes decreased between the periods 2005-2009 and 2012-2013 from 9.6% (95% CI 8.3, 10.9) to 7.1% (95% CI 5.8, 8.4), but increased to 8.6% (95% CI 7.3%, 9.9%) by 2016-2017 (P-quadratic <0.01). For diagnosed diabetes, the prevalence decreased between 2005-2009 and 2014-2015 from 8.3% (95% CI 7.0%, 9.5%) to 6.1% (95% CI 5.0%, 7.2%), but increased slightly again to 7.0% (95% CI 5.8%, 8.2%) by 2016-2017 (P-quadratic = 0.01). Men generally had a higher prevalence of total and diagnosed diabetes than women, except in 2016-2017, when the prevalence of total diabetes was 9.5% (95% CI 7.6, 11.5) among men and 7.7% (95% CI 6.0, 9.5) among women (P >0.05). The probability of finding undetected diabetes among participants without a diabetes diagnosis decreased slightly between 2005-2009 and 2012-2013 from 1.5% (95% CI 0.9, 2.0) to 1.0% (95% CI 0.5, 1.5), but increased afterwards to 1.7% (95% CI 1.0, 2.3) by 2016-2017 (P-quadratic = 0.06); in 2016-2017, it was 2.6% (95% CI 1.5, 3.7) among men and 0.7% (95% CI 0.1, 1.3) among women (P <0.01).

CONCLUSION

The prevalence of diabetes has remained relatively constant over time. However, the probability of finding undetected cases of diabetes in the population without diabetes may be increasing among men.

Temporal and Geospatial Trends of Hypertension Management in Korea: a Nationwide Study 2002-2016

Background and Objectives

Geographic distribution of hypertension management in Korea has never been reported. We investigated temporal and regional trends of hypertension management in Korea.

Methods

For each calendar year from 2002 to 2016, we identified 2,423,245 to 7,549,989 persons aged ≥30 years treated for hypertension (total 80,564,109 cases). We calculated yearly age-sex standardized rates for medication adherence, combination therapy, blood test, and urine test according to geographic regions. We then used multivariate logistic regression to calculate odds ratios for hypertension management adjusted for individual-level sociodemographic factors.

Results

Adherence rates have markedly increased from 24.4% (2002) to 71.6% (2016) nationwide. Regional difference was prominent in 2002 (highest, 31.7% in Seoul; lowest, 14.4% in Jeonbuk), but has become less noticeable over 15 years (highest, 73.1% in Daejeon; lowest, 69.0% in Jeonnam, 2016). Combination therapy rates increased from 42.8% (2002) to 61.0% (2011), but are in decreasing trend after 2011. Blood test rates were 58.8% in 2016, whereas urine test rates have been stagnant below 50% across all regions. Geographic variations of combination therapy and complication screening rates were not profound. Results from multivariable logistic regression, adjusted for age and sex, were in agreement with trends observed by standardized rates. The odds ratios remained unchanged when the models were further adjusted for employment status and household income.

Conclusions

Regional difference in hypertension management was evident in the past, but has become less apparent over the last 15 years in Korea.

Physical inactivity caused economic burden depends on regional cultural differences

Physical inactivity is a major risk factor for numerous non-communicable diseases which dominate the overall burden of disease in Switzerland. We aimed to estimate the burden attributable to adult physical inactivity in Switzerland and its three culturally different language regions from a societal perspective in terms of disability-adjusted life years (DALYs), medical costs, and productivity losses. The burden of physical inactivity was estimated with a population attributable fractions (PAFs) approach. PAFs were calculated based on the prevalence of physical inactivity in the Swiss Health Survey and literature-based adjusted risk ratios of disease incidence. These PAFs were then applied to the total burden of the diseases related to physical inactivity. Physical inactivity was responsible for 2.0% (95%CI 1.7%-2.2%) of total DALYs lost and 1.2% (95%CI 1.0%-1.3%) of total medical costs in 2013. This is equivalent to 116 (95%CI 99-135) Swiss francs per capita per year. Productivity losses were valued at 117 (95%CI 94-142) Swiss francs per capita per year. The two diseases which caused the highest economic burden were low back pain and depression. The analysis of regional differences revealed that the per capita burden of physical inactivity is about twice as high in the French- and Italian-speaking regions compared to the German-speaking region. Reasons include a higher prevalence of physical inactivity, higher per capita health care spending, and higher disease prevalence. Cost-effectiveness analysis of related interventions should consider regional differences for optimal resource allocation in physical activity promotion policies.

Dietary intake of subjects with diabetes is inadequate in Switzerland: the CoLaus study

PURPOSE

To characterize the dietary intake of subjects aged 40-80 years according to self-reported diabetes and presence of an anti-diabetic diet.

METHODS

Cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne.

RESULTS

Of the 299 (7 %) participants with self-reported diabetes, only 151 (51 %) reported an anti-diabetic diet. Compared to participants not reporting diabetes, participants with self-reported diabetes (with or without a diet) had a higher consumption of artificial sweeteners (0.3 ± 0.7 vs. 0.4 ± 0.8 and 0.8 ± 1.0 times/day) and a lower consumption of honey/jam (mean ± standard deviation: 0.5 ± 0.5 vs. 0.4 ± 0.4 and 0.4 ± 0.4 times/day) or sugar (0.6 ± 0.9 vs. 0.4 ± 0.7 and 0.2 ± 0.5 times/day) for participants not reporting diabetes, participants with self-reported diabetes not on a diet and on a diet, respectively. Compared to participants not on a diet, participants on a diet had a higher consumption of vegetables (1.8 ± 1.3 vs. 1.4 ± 1.0 portions/day), while no differences were found regarding all other food groups and nutrients. Participants with self-reported diabetes on a diet had a higher consumption of meat (5.6 ± 3.6 vs. 4.8 ± 2.9 portions/week) and a lower consumption of simple carbohydrates (21.0 ± 7.9 vs. 23.5 ± 8.4 % total energy intake) than participants not reporting diabetes.

CONCLUSION

People with diabetes eat less simple carbohydrates, but do not comply with current advice on fish, nuts, fruits and vegetables. Improvement of the dietary intake in persons with diabetes in Switzerland is needed.

Prevalence and management of cardiovascular risk factors in Portuguese living in Portugal and Portuguese who migrated to Switzerland

BACKGROUND

Information regarding the health status of migrants compared to subjects who remain in the country of origin is scarce. We compared the levels and management of the main cardiovascular risk factors between Portuguese living in Porto (Portugal) and Portuguese migrants living in Lausanne (Switzerland).

METHODS

Cross-sectional studies conducted in Porto (EPIPorto, 1999 to 2003, n = 1150) and Lausanne (CoLaus, 2003 to 2006, n = 388) among subjects aged 35-65 years. Educational level, medical history and time since migration were collected using structured questionnaires. Body mass index, blood pressure, cholesterol and glucose levels were measured using standardized procedures.

RESULTS

Portuguese living in Lausanne were younger, more frequently male and had lower education than Portuguese living in Porto. After multivariate adjustment using Poisson regression, no differences were found between Portuguese living in Porto or in Lausanne: prevalence rate ratio (PRR) and (95% confidence interval) for Portuguese living in Lausanne relative to Portuguese living in Porto: 0.92 (0.71 - 1.18) for current smoking; 0.78 (0.59 - 1.04) for obesity; 0.81 (0.62 - 1.05) for abdominal obesity; 0.82 (0.64 - 1.06) for hypertension; 0.88 (0.75 - 1.04) for hypercholesterolemia and 0.92 (0.49 - 1.73) for diabetes. Treatment and control rates for hypercholesterolemia were higher among Portuguese living in Lausanne: PRR = 1.91 (1.15 - 3.19) and 3.98 (1.59 - 9.99) for treatment and control, respectively. Conversely, no differences were found regarding hypertension treatment and control rates: PRR = 0.98 (0.66 - 1.46) and 0.97 (0.49 - 1.91), respectively, and for treatment rates of diabetes: PRR = 1.51 (0.70 - 3.25).

CONCLUSIONS

Portuguese living in Lausanne, Switzerland, present a similar cardiovascular risk profile but tend to be better managed regarding hypercholesterolemia than Portuguese living in Porto, Portugal.

Cardiovascular Risk Assessment and Effects on Behavior in Switzerland The Swiss Heart Foundation HerzCheck(®)/Cardio-Test(®)

Background:

“CardioTest^®” is a tool for cardiovascular risk assessment. The aim of this study was to evaluate if this test used in Swiss pharmacies provides risk stratification and if it had impact on individual behaviour.

Methods:

Individuals were evaluated (blood pressure, body waist circumference, random blood samples and coronary artery disease risk factors). The cardiovascular risk was calculated (AGLA Risk Score (ARS) a modified PROCAM Score) and participants were informed about their result. One year after the initial testing individuals were followed up by questionnaire with respect to the action they had taken based upon the ARS results. The relation between ARS results and events during follow-up were assessed. Events were defined as cardiovascular events due to chest pain, myocardial infarction or stroke.

Result:

A total of 1415 individuals were contacted for follow-up, 746 (53%) with a mean age of 62.7 (±12.8) years (60% were male) returned their questionnaire. The cardiovascular risk throughout the study-population turned out to be low: 73.9% had a low ARS <10%, 21.7% an intermediate ARS 10-20% and 4.4% had a high ARS >20%. Significantly more participants with ARS >20% consulted their family doctor (46.2%) than those with ARS 10-20% (25.2%) and ARS <10% (10.4%), respectively (p<0,01 for both comparisons). Sixty-four individuals (9%) suffered a cardiovascular event. The event rates increased as a function of ARS.

Conclusion:

The overall cardiovascular risk of individuals participating in a pharmacy based risk assessment program seems to be low. CardioTest ^® provided risk stratification with respect to future cardio-vascular events. CardioTest ^® seems to have impact on individual behavior and lifestyle modification. Other settings and locations for screening might be considered to reach higher risk individuals at an earlier stage.

Age and gender differences in the social patterning of cardiovascular risk factors in Switzerland: the CoLaus study

OBJECTIVES

We examined the social distribution of a comprehensive range of cardiovascular risk factors (CVRF) in a Swiss population and assessed whether socioeconomic differences varied by age and gender.

METHODS

Participants were 2960 men and 3343 women aged 35-75 years from a population-based survey conducted in Lausanne, Switzerland (CoLaus study). Educational level was the indicator of socioeconomic status used in this study. Analyses were stratified by gender and age group (35-54 years; 55-75 years).

RESULTS

There were large educational differences in the prevalence of CVRF such as current smoking (Δ = absolute difference in prevalence between highest and lowest educational group:15.1%/12.6% in men/women aged 35-54 years), physical inactivity (Δ = 25.3%/22.7% in men/women aged 35-54 years), overweight and obesity (Δ = 14.6%/14.8% in men/women aged 55-75 years for obesity), hypertension (Δ = 16.7%/11.4% in men/women aged 55-75 years), dyslipidemia (Δ = 2.8%/6.2% in men/women aged 35-54 years for high LDL-cholesterol) and diabetes (Δ = 6.0%/2.6% in men/women aged 55-75 years). Educational inequalities in the distribution of CVRF were larger in women than in men for alcohol consumption, obesity, hypertension and dyslipidemia (p<0.05). Relative educational inequalities in CVRF tended to be greater among the younger (35-54 years) than among the older age group (55-75 years), particularly for behavioral CVRF and abdominal obesity among men and for physiological CVRF among women (p<0.05).

CONCLUSION

Large absolute differences in the prevalence of CVRF according to education categories were observed in this Swiss population. The socioeconomic gradient in CVRF tended to be larger in women and in younger persons.