Factors and Estimation of Risk for Cardiovascular Diseases among Patients in Primary Health Care in Central Serbia

INTRODUCTIONCardiovascular diseases present a major cause of morbidity and mortality in the world as well as in Central Serbia. It is a large public health problem because cardiovascular diseases may cause disablement. More than the third of deaths among middle aged people are caused by cardiovascular diseases (1).According to the database of the World Health Organization, 17 million of deaths in the whole world are caused by cardiovascular diseases annually (2).Atherosclerosis, as the main pathology process for diseases of coronary and cerebral blood vessels, is encouraged by using tobacco, unhealthy nutrition and physical inactivity, hypertension, dyslipidemia, and diabetes (3).The primary health care insists on early identification of patients with high risk for developing cardiovascular diseases. The main reason is to preserve health by applying suitable measure on time.This study focuses on modifiable risk factors like: hypertension, smoking, nutritional status, diabetes and increased level of cholesterol, and triglycerids in blood serum.The aim of this research is to analyze the frequency of risk factors and to estimate the risk for the development of cardiovascular diseases in the population under study.MATERIALS AND METHODSThis epidemiological study included patients aged 40-65 years, who had periodical medical check-ups conducted in the period between 1 March and 30 September 2013. The data were collected during this time period from medical records of the Health Centre of Kragujevac located in the city centre. The following parameters were monitored: gender, age, smoking habits, anthropometrical measures, and Body Mass Index, systolic and diastolic blood pressure, diabetes, cholesterol, and triglyceride levels. The subjects were divided into the following age categories: 40-49 years old, 50-59 years old and more than 60 years old.We observed the following anthropometrical parameters: body height, body weight and waist circumference. Body Mass Index (BMI) was used for estimating the degree of nutritional status. The World Health Organization suggests these parameters: ≤ 18.4 kg/m2 underweight, 18.5-24.9 kg/m2 normal BMI, 25-29.9 kg/m2 overweight, 30-34.9 kg/m2 obesity level I, 35-39.9 kg/ m2 obesity level II and ≥ 40 kg/m2 massive obesity. We used the waist circumference as a parameter to identify the level of fat. WHO recommends the following waist measures: 95-102 cm for men and 81-88 cm for women at increased risk, and the waist circumference over 102 cm for men and over 88 cm for women correspond to the very high risk for metabolic complications of obesity.We monitored the following biochemical parameters: cholesterol and triglycerids, whose higher level can significantly contribute to the development of cardiovascular diseases. The guidelines of the national clinical practice suggest that a desirable total cholesterol level should be below 5.2 mmol/l, while the levels of 5.2-6.19 mmol/l and more than 6.2 mmol/l correspond to high levels and high-risk levels, respectively. The levels of triglycerids should be below 1.7 mmol/l, the levels from 1.7-2.29 mmol/l and the levels exceeding 2.30 mmol/l are considered high and very high, respectively.We noted the records that include patients with hypertension and the levels of systolic and diastolic blood pressure with regular monthly check. According to the national clinical practice guidelines, the targeted blood pressure in treated hypertensive patients should be 140/90 mmHg, and these levels of hypertension indicated how to divide patients into two groups: the group of well regulated hypertension, and the group with the poorly regulated, with a pressure of 140-159/90-99 mmHg; 160-179/100-109 mmHg; over 180/over 110 mmHg; the isolated systolic hypertension with a systolic pressure is predicted above 140 mmHg and diastolic below 90 mmHg.We made reports of the patients with the metabolic syndrome. …