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international Heart and Vascular Disease Journal • Volume 8, № 26, June 2020
Journal of the Cardioprogress Foundation
ORIGINAL ARTICLES
Association of prevalence of metabolic
syndrome and its components and family status changes in men of an open urban
population
E. V. Akimova, A. A. Gakova
Tyumen Cardiovascular Research Center, Tomsk National Medical Research Center of the The Russian
Academy of Sciences, Tomsk, Russia.
Authors
Akimova V. Ekaterina*, M.D., PhD., Head of the Cardiovascular Disease Epidemiology and Prevention Laboratory of Tyumen Cardiovascular Research Center, Tomsk National Medical Research Center of the the Russian Academy of Sciences, Tomsk, Russia.
Gakova A. Anastasia, researcher at the Cardiovascular Disease Epidemiology and Prevention Laboratory of Tyumen Cardiovascular Research Center, Tomsk National Medical Research Center of the the Russian Academy of Sciences, Tomsk, Russia.
To assess the association of prevalence of metabolic syndrome and its components with family status changes in men of an open population in a moderately-urbanized Siberian city. Materials and methods
We conducted a cross-sectional epidemiological study of a representative sample formed from the electoral lists of Tyumen. The sample consisted of men aged 25-64 years, the response rate was 85.2 %. We used IDF criteria (2005) to assess metabolic syndrome. We evaluated family stress including the stress from family status changes during the last 12 months using the WHO questionnaire "Knowledge and Attitude towards Health".
Metabolic syndrome prevalence in Tyumen men aged 25-64 years was 15.0 %% (3 or more criteria per IDF). In an open Tyumen population 20 °% of men lacked stable family status, the same number of men were not able to rest at home, and in one third of men family conflicts were noted. In an open urban population of working age men with both a high prevalence of metabolic syndrome and high levels of family stress we identified certain groups with
Objective
Results
* Corresponding author. Tel. 8-912-920-60-43. E-mail: akimovaev@infarkta.net
both metabolic syndrome and arterial hypertension (per IDF criteria) who on average had a more stable family
status.
Conclusion
As such, when formulating regional preventive programs in the open population of the city of Tyumen and other moderately urbanized Siberian cities it is important to use standardized methodologies and accumulated data. This is necessary to achieve objective monitoring of the epidemiological situation in regards to cardiovascular disease and chronic stress factors such as availability of social care and family status. Keywords: Epidemiological study, male population, metabolic syndrome, family stress.
Conflict of interest: none declared.
Received: 27.12.2019 Accepted: 28.01.2020
Introduction
According to the Russian Society of Cardiology metabolic syndrome (MS) is characterized by visceral adipose tissue accumulation, peripheral insulin resistance, and hyperinsulinemia that lead to carbohydrate, lipid and purine metabolism disoreders as well as arterial hypertension (AH) [1]. A meta-analysis of major epidemiological studies found the frequency of MS in adult population to be 10 % in China and up to 24 % in the USA. The World Health Organization (WHO) consider MS to be the XXI century pandemic and predict that the rate of MS incidence will rise by 50 %o in the following 25 years [2]. The European Botnia Study carried out in Finland in Sweden, showed the independent prognostic role of MS. Mortality in the MS group was 1 %o compared with 2.2 %o in the control group. The Botnia Study results showed that MS was a more significant risk factor than any of its components [3].
MS is characterized by polygenic predisposition that rarely causes any disease in the absence of specific risk factors associated with modern way of life. The specific risk factors that play the leading role in the development of MS are not clear at this time. The research is currently focused on psychosocial and dietary factors [4-6]. Stress affects the development of cardiovascular disease both in direct way and via irregular adaptation mechanisms (smoking, overeating, alcohol consumption) [7-9]. Many researchers consider the divorced, retired and unemployed individuals to be at the highest risk of stress [10, 11]. Long-standing excess stress and neuroendocrine trophic effects in MS also lead to structural adaptation of the cardiovascular system [2]. The effects of these risk factors are further aggravated by various maladaptive behaviors such as alcohol and drug
abuse, smoking, overeating and lack of physical exercise [12, 13].
As such, the latest decade of the XXI century can be characterized by a strong interest in MS, as all its components are conventional risk factors of cardiovascular disease (CVD). The several-fold increase in total cardiovascular risk determines the medical and social significance of MS problem. At the same time, with an incredible material progress of the modern society comes the greater demand for the psychobio-logical knowledge. The lack of these knowledge may lead to loss of health and wellbeing.
Materials and methods
We conducted a simultaneous epidemiological study of a representative sample of the Central district of Tyumen population. The sample, formed using the random number generation method, included 1000 men aged 25-64 years (response rate 85.0 %o), 250 people in each age group: 25-34; 35-44; 45-54; 55-64 (Figure 1).
We used IDF criteria (2005) to assess metabolic syndrome: waist circumference (WC)s 94 cm in Caucasian men plus 2 of the following criteria: tri-glyceridess 1.7 mmol/l, HDL-C< 1.0 mmol/l+ hypolipidemic therapy, blood pressures 130/85 mmHg or previous antihypertensive therapy, blood glucoses 5.6 mmol/l or type 2 diabetes mellitus (T2DM).
We evaluated family stress including the stress form family status changes during the last 12 months using the WHO questionnaire "Knowledge and Attitude towards Health".
The study was carried out with the accordance with the principles laid down in the Declaration of Helsinki. Study protocol was approved by the Ethical Committees of all the involved clinical centers.
Figure 1. The association between metabolic syndrome prevalence and family status changes in the population of men aged 25-64 years, %.
Written informed consent was obtained from all participants prior to being enrolled.
Statistical analysis was completed using the IBM SPSS Statistics 21.0 software. The results are presented as proportions (in percent) for categorical variables in the four age groups that were analyzed. To correctly compare our data with the data form other epidemiological studies we performed age adjustment by direct standardization based on the age structure of Russian Federation urban population aged 25-64 years. In order to assess statistical significance of the differences we used Pearson's chi- squared test (%2) with Bonferroni correction. A p-value less than 0.05 was considered statistically significant.
The aim of this study was to assess the association of prevalence of metabolic syndrome and its components and family status changes in men of an open population in a moderately-urbanized Siberian city.
Results
Metabolic syndrome prevalence in Tyumen men aged 25-64 years was 15.0 %% (3 or more criteria per IDF) — age adjusted value. Prevalence of MS was significantly higher in the 45-54 age group (10.0-19.8 %o, p<0.001) and in the 55-64 age group (19.8-31.2 %%, p<0.01). Statistically significant differences in MS prevalence were found in the following age groups: 25-34 years — 6.8-17.3 %, p<0.001; 35-44 years — 10.0-17.3 %, p<0.001; 55-64 years — 31.2-17.3 %, p<0.001 (Table 1).
At the same time, around 20 %% of men in the open Tyumen population lacked stable family status, the
same amount of men were not able to rest at home, and 1/3 of men family had frequent family conflicts.
Individuals with MS were found to have more stable family status compared with those without MS. Of all participants, 89.8 %% individuals with MS and 78.1 % individuals without MS didn't have any family status changes during the last 12 months (p<0.05) (Figure 1).
Table 2 shows the association of MS components and family-related stress in the male population aged 25-64 years. Both individuals with and without MS answered questions from the "family-related stress" category (severe disease in close relatives, death of a relative, family conflicts during the last 12 months and the ability to rest at home) in a similar way.
At the same time, we identified a more stable family status in individuals with AH compared with the individuals without AH. Of all participants, 88.0 %% of
Table 1. The prevalence of metabolic syndrome (according to IDF criteria) in Tyumen men aged 25-64 years
Age, years n MS
Absolute number %
25-34 177 12 6.8"""
35-44 228 23 10.0"""
45-54 231 46 """19.8
55-64 214 67 ""31.2"""
25-64 850 148 17.3
Age adjusted value 15.0
Comment: 1*1 on the left marks statistically significant differences in two age groups, (*) on the right marks statistically significant differences in the age group compared with the general population: * - * - p<0.05; **- p<0.01; *** - p<0.001; n -number of people examined, MS — metabolic syndrome.
Table 2. Family-related stress and metabolic syndrome components in the population of men aged 25-64 years
Question/attitude Metabolic syndrome components
Abdominal obesity n=390 Arterial hypertension n=581 Hyperglycemia n=162 Hypertriglyceridemia n=97 Low HDL -C n=42
Abs. % Abs. % Abs. % Abs. % Abs. %
1. Severe disease or death of a close relative during the last 12 months?
1.1. Yes 96/108 24.7/23.5 136/68 23.4/25.5 37/167 22.8/24.3 22/182 22.7/24.2 11/193 26.2/23.9
1.2. No 293/351 75.3/76.5 445/199 77.1/74.5 125/519 77.1/75.7 75/569 77.4/75.8 31/613 73.8/76.1
2. Has your family status changed over the last 12 months (married, divorced, left family, widowed, child born, other)?
2.1. No changes 337/378 86.682.2 512/203 88.1/75.7""" 137/578 84.6/84.1 86/629 88.7/83.6 35/680 83.3/84.3
2.2. One change 34/57 8.7/12.4 44/47 7.6/17.5""" 14/77 8.6/11.2 7/84 7.2/11.2 6/85 14.3/10.5
2.3. Several changes 18/25 4.6/5.4 25/18 4.3/6.7 11/32 6.8/4.7 4/39 4.1/5.2 1/42 2.4/5.2
3. Were there any serious conflicts in your family during the last 12 months?
3.1. No conflicts 271/312 69.7/67.8 401/182 69.0/67.9 112/471 69.3/68.2 74/509 76.3/67.4 27/556 64.3/68.9
3.2. One conflict 34/36 8.7/7.8 51/19 8.8/7.1 15/55 10.4/8.0 7/63 7.2/8.6 4/66 9.5/8.2
3.3. Several conflicts 70/94 18.0/20.4 107/57 18.4/21.3 31/133 17.8/19.8 14/150 14.4/20.1 10/154 23.8/19.1
3.4. Frequent conflicts 14/18 3.6/3.9 22/10 3.8/3.7 4/28 2.5/3.9 2/30 2.1/3.9 1/31 2.4/3.8
4. Is there anything that prevents you from getting good rest at home?
4.1. Yes 68/110 17.4/24.0" 120/58 20.7/21.7 32/146 19.8/21.3 17/162 17.5/21.6 10/168 23.8/20.8
4.2. HeT 322/348 82.6/76.0" 461/209 79.3/78.3 130/540 80.2/78.7 80/589 82.5/78.4 32/638 76.2/79.2
Comment. (*) marks statistically significant differences in the presence and absence of metabolic syndrome components: * — p<0.05; **- p<0.01; ***-p<0.001; Abs.-absolute number
men with AH and 75.9 % of men without AH didn't have any family status changes during the last 12 months (p<0.001); 7.5 %% of men with AH had one change compared with 17.3 %o of men without AH (p<0.001). Concerning other components of MS, we identified no significant differences related to family status changes in the last 12 months.
Discussion
Over the last two decades the psychosocial component of population health and its effects on CVD development have been a very important topic in contemporary research. It's gradually becoming one of the most important and complicated problems in modern medical science. Modern Russian society is currently undergoing major transformations that is inevitably leading to the formation of a new social structure and to the development of even stronger stratification [7, 10]. Chronic social stress results in the development of multiple adaptational diseases, and, undoubtfully, MS is one of them [1,4].
Chronic psychosocial stress increases the risk of MS development in a great number of ways. The formation of a specific behavioral pattern leads to activation of the sympathetic nervous system (SNS), secretion of catecholamines and, eventually, blood pressure elevation. Many studies have assessed the connection between stress and blood pressure changes [6, 8, 12]. Some traditional behavioral risk factors such as smoking, lack of physical activity and alcohol abuse as well as socioeconomic status in
general are also associated with increased CVD risk in the presence of chronic psychosocial stress [9, 13].
In an open Tyumen population 20 %o men lacked stable family status, the same number of men were not able to rest at home, and in one third of men family conflicts were noted. At the same time, men aged 25-64 years with MS and AH (a component of MS according to the IDF criteria) were found to have a more stable family status compared with individuals without MS and AH. At the first sight, the identified pattern contradicts the majority of epidemiologic studies that found the CVD risk to be higher in single men [10]. However, according to the results of our previous studies in the Tyumen population, married men were better informed about CVD risk factors and showed more responsibility for their health and readiness to participate in preventive activities [11]. Therefore, more stable family status in men with MS seems reasonable enough. Marriage is considered to be one of the strongest types of social support. Widowhood and divorce, on the contrary, are difficult and stressful life situations. CVD mortality in divorced, widowed and single men who never married was significantly higher compared with married men [3]. As such, married men are considered to be the most protected social group and individuals with MS are in great need of social protection [9].
Conclusions
In conclusion, in working-age men with high prevalence of MS and its components and high levels of
family-related stress we identified a more stable family status. As such, when formulating regional preventive programs in the open population of the city of Tyumen and other moderately urbanized Siberian cities it is important to use standardized methodologies and accumulated data. This is necessary to achieve
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Conflict of interests: None declared.
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