Cardiovascular risk factors in Kuwaiti adults with type 2 diabetes.

T 2 diabetes is associated with a marked increased risk for cardiovascular disease (CVD) morbidity and mortality.1 The United Kingdom Prospective Diabetes Study (UKPDS) identified several modifiable risk factors associated with CVD in patients with type 2 diabetes.2 These factors were increased concentrations of low density lipoprotein cholesterol (LDL-C), decreased concentrations of high density lipoprotein cholesterol (HDL-C), raised blood pressure, hyperglycemia, and smoking. The American Heart Association (AHA) and the American Diabetes Association (ADA) have published guidelines for cardiovascular disease prevention.3 The recommended targets for glycosylated hemoglobin (HbA1c) and blood pressure is <7% and <130/80 mm Hg. The optimal level for triglycerides and LDL-C is <1.7 mmol/l and <2.6 mmol/l. The optimal HDL-C levels for men and women are >1.1 mmol/l and >1.4 mmol/l. Cardiovascular disease is the first leading cause of death in Kuwait and diabetes is a major public health problem.4 The aim of this study was to determine the prevalence of CVD risk factors in Kuwaiti adults with type 2 diabetes according to UKPDS factors and ADA targets. All Kuwaiti adults (aged ≥20 years) who presented to the diabetes outpatient clinic at Al-Sabah Hospital, Kuwait between October 2000 and March 2005 were screened for CVD risk factors. The inclusion criteria were type 2 diabetes based on the treatment with diet alone or; treatment with diet and oral antihyperglycemic agent(s) or; treatment with diet and insulin provided that insulin was prescribed at least one year after diagnosis. Other data collected included age, gender, duration of diabetes, and body mass index (BMI). Hypertension was defined as history of hypertension or systolic and/or diastolic blood pressure on examination was ≥140/90. Subjects were classified as normal-weight if BMI =18.5-24.9, overweight if BMI=25-29.9, and obese if BMI≥30. Glycemic control was diagnosed as good, acceptable, or poor when HbA1c% was <7.0, 7.08.0, and >8.0. Glycosylated hemoglobin was performed using turbid metric inhibition immunoassay (Roche HB1c II kit, Indianapolis, USA). Serum cholesterol and triglycerides were measured by the enzymatic method. History of CVD was defined as history of angina with ECG changes, positive stress thallium scan or dobutamine echocardiogram, history of nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or nonfatal stroke. Data were analyzed using the SPSS program. Data are presented as means ± SD, or as numbers and percentages. The χ2 test and ANOVA were used as appropriate. A p-value of <0.05 was considered to be statistically significant. Multiple linear regression analysis was performed to determine the independent effects of the studied variables. During the study period, a total of 170 patients were screened (113 were women). Mean age was 49.6 ± 10.5 years and mean disease duration 8.0 ± 7.1 years. Mean BMI was 33.3 ± 7.5 kg/m2 and mean HbA1c level 9.4 ± 2.4%. Mean systolic blood pressure and diastolic blood pressure was 135.8 ± 22.1 and 81.4 ±10.4 mm Hg. Mean level of LDLand HDL-C was 3.7 ± 1.0 and 1.2 ± 0.3 mmol/l. The majority (59.3%) of patients were hypertensive, 26.3% were overweight, and 65% were obese. The majority (64.1%) of patients had poor glycemic control whereas 16.2% had good, and 19.8% had acceptable levels. Only 11.8% of the patients received lipid lowering therapy, and 45.7% were given antihypertensive medication. History of CVD was present in 10% of the patients. Hypertension was more prevalent among women compared to men (69.6% versus 38.2%, p=0.0001). The overall prevalence of history of smoking was 13.3%, which was solely prevalent among men (40%). The BMI, systolic and diastolic blood pressure, and HDL-C were significantly higher in women than men (35.3 versus 29.4; 140.4 versus 126.5 mm Hg; 83.4 versus 77.2 mm Hg; 1.3 versus 1.1 mmol/l, p=0.0001). The percentage of patients with levels of LDL-C, HDL-C, systolic and/or diastolic blood pressure, and HbA1c outside the target levels according to the studied variables are summarized in Table 1. Overall, 86.2% and 63.2% of the patients had LDL-C and HDL-C outside the target levels. In addition, 55.3% of the patients had levels of LDL and HDL-C combined out of the targets. There was no difference in the prevalence of elevated LDL-C by the studied variables. However, there was an increasing trend for lower HDL-C levels as age advanced. Elevated systolic or diastolic blood pressure and elevated HbA1c values occurred in 84.6% and 83.8% of the patients. Although elevated systolic and/or diastolic blood pressure occurred more often in women than men, BMI was the independent factor for elevated blood pressure. Male gender and those who were treated with sulfonylurea and/or insulin were the independent factors associated with elevated HbA1c. Although history of smoking was higher among those with lower BMI, regression analysis Brief Communication