Combined Hypercholesterolemia and Hypertension Among Turkish Adults: Prevalence and Prediction of Cardiovascular Disease Risk

The prevalence and the excess cardiovascular disease (CVD) risk imparted by coexistent hypercholesterolemia and hypertension in Turkish adults was investigated in the database of the Turkish Adult Risk Factor Study. Prevalence and associations were analyzed in the cross-sectional data of the survey 2002/03 as a whole, while the relative risk was evaluated based on the prospective analysis of the 5-year follow-up of the 1997/98 survey. Mean age of 2750 comprised in the cross-sectional survey was 51 (±12) years, whereas it was 48.8 ± 12.8 among 2225 subjects free of CVD at baseline in the prospective study. Participants receiving antihypertensive medication, or having a systolic blood pressure (BP) ?140 mmHg or a diastolic BP ?90 mmHg, were considered as hypertensive. Hypercholesterolemia >200 mg/dl, or LDL-cholesterol levels >130 mg/dl were regarded as hyperlipidemia. CHD was diagnosed by clinical findings and Minnesota coding of resting electrocardio-grams. Hypercholesterolemia coexistent with hypertension was found in 7.7% of men, and 13.4% of women; corresponding to 3.3 million Turkish adults. On the other hand, individuals displaying LDL-C levels >130 mg/dl combined with hypertension was noted to be 9.2%, corresponding to 2.9 million adults. In these persons, age, waist circumference, body mass index and triglyceride concentrations were significantly higher compared to the remaining cohort. In the prospective study, high LDL-C levels coexistent with high BP (receiving antihypertensive drugs, or having a systolic BP ?130 mmHg or a diastolic BP ?85 mmHg) were analyzed for CVD risk by logistic regression. Compared to the remaining persons, the relative risk was 2.4-fold (95%CI 1.7; 3.44), after adjustment for sex and age. The sex- and age-adjusted relative risk was 4.4-fold (95%CI 2.5; 7.7) in comparison to those who had neither elevated LDL-C nor elevated BP levels. The contribution to the risk of elevated BP appeared to be substantially greater than that of elevated LDL-C. It was concluded that one of every 10 Turkish adults 30 years of age or over is estimated to harbor coexistent hypercholesterolemia and hypertension, which imposes a high absolute and a higher than twice the CVD risk compared to the rest of adults. Measures to reduce the individual's global risk should be implemented. (Türk Kardiyol Dern Arş 2004; 32: 533-541)