Lipid Profile Abnormalities and Cardiovascular Risk among Hypertensive Patients in Al-Hussein Teaching Hospital in Al-Samawa, Iraq, 2023-2024
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Background: Hypertension is a major public health challenge globally and in Iraq, serving as a primary risk factor for cardiovascular disease (CVD). The coexistence of dyslipidemia significantly amplifies this risk. Understanding the local pattern of lipid abnormalities and the aggregated cardiovascular risk is crucial for effective preventive strategies. This study aimed to assess the prevalence of lipid profile abnormalities and estimate the 10-year cardiovascular risk among hypertensive patients attending Al-Hussein Teaching Hospital in Al-Samawa, Iraq. Methods: A cross-sectional study was conducted at the outpatient cardiology clinic of Al-Hussein Teaching Hospital from January 2023 to December 2024. A total of 384 adult patients with a confirmed diagnosis of essential hypertension were enrolled. Data on sociodemographics, clinical characteristics, and lifestyle factors were collected through interviews and medical records. Fasting blood samples were analyzed for total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). The 10-year risk of fatal and non-fatal CVD was calculated using the WHO/ISH risk prediction charts for the Eastern Mediterranean Region. Statistical analysis was performed using SPSS version 26, with a p-value <0.05 considered significant. Results: The prevalence of dyslipidemia among hypertensive patients was 78.1%. The most common abnormality was low HDL-C (54.9%), followed by high LDL-C (48.7%), hypertriglyceridemia (41.1%), and hypercholesterolemia (35.9%). According to the WHO/ISH risk stratification, 28.9% of patients were in the high to very high 10-year CVD risk category (>20%). A significant association was found between increasing age, male gender, smoking, obesity, and higher CVD risk categories (p<0.05). Conclusion: Lipid profile abnormalities, particularly low HDL-C, are highly prevalent among hypertensive patients in Al-Samawa, leading to a substantial proportion being at high risk for future cardiovascular events. These findings underscore the urgent need for routine screening and integrated management of both blood pressure and lipid levels in this population to mitigate the burgeoning burden of CVD in Iraq.
World Health Organization, Cardiovascular diseases (CVDs), Geneva: WHO, 2021.
GBD 2019 Risk Factors Collaborators, “Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019,” Lancet, vol. 396, no. 10258, pp. 1223-1249, 2020.
F. D. Fuchs and P. K. Whelton, “High Blood Pressure and Cardiovascular Disease,” Hypertension, vol. 75, no. 2, pp. 285-292, 2020.
W. B. Kannel, “Risk stratification in hypertension: new insights from the Framingham Study,” Am J Hypertens, vol. 13, no. 1 Pt 2, pp. 3S-10S, 2000.
K. T. Mills, A. Stefanescu, and H. He, “The global epidemiology of hypertension,” Nat Rev Nephrol., vol. 16, no. 4, pp. 223-237, 2020.
Q. N. Dinh, G. R. Drummond, C. G. Sobey, and S. Chrissobolis, “Roles of inflammation, oxidative stress, and vascular dysfunction in hypertension,” Biomed Res Int., vol. 2014, p. 406960, 2014.
R. H. Nelson, “Hyperlipidemia as a risk factor for cardiovascular disease,” Prim Care, vol. 40, no. 1, pp. 195-211, 2013.
P. Libby, J. E. Buring, L. Badimon, G. K. Hansson, J. Deanfield, M. S. Bittencourt, et al., “Atherosclerosis,” Nat Rev Dis Primers, vol. 5, no. 1, p. 56, 2019.
V. Chobanian and R. W. Alexander, “Exacerbation of atherosclerosis by hypertension: potential mechanisms and clinical implications,” Arch Intern Med., vol. 156, no. 17, pp. 1952-1956, 1996.
R. Jackson, C. M. Lawes, D. A. Bennett, R. J. Milne, and A. Rodgers, “Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk,” Lancet, vol. 365, no. 9457, pp. 434-441, 2005.
D. K. Arnett, R. S. Blumenthal, M. A. Albert, A. Buroker, Z. D. Goldberger, E. J. Hahn, et al., “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease,” Circulation, vol. 140, no. 11, pp. e596-e646, 2019.
World Health Organization, Prevention of cardiovascular disease: guidelines for assessment and management of total cardiovascular risk, Geneva: WHO, 2007.
S. Mendis, L. H. Lindholm, G. Mancia, J. Whitworth, M. Alderman, S. Lim, et al., “World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries,” J Hypertens, vol. 25, no. 8, pp. 1578-1582, 2007.
T. K. Al-Hilfi, R. Lafta, and G. Burnham, “Health services in Iraq,” Lancet, vol. 381, no. 9870, pp. 939-948, 2013.
H. Y. Hussain and R. A. Abdul-Razzaq, “Prevalence of hypertension and its associated risk factors in a sample from Baghdad, Iraq,” J Fac Med Baghdad, vol. 57, no. 3, pp. 198-203, 2015.
A. Mansour, A. A. Al-Maliky, B. Kasem, A. Jabar, K. A. Mosbeh, “Prevalence of diagnosed and undiagnosed diabetes mellitus in adults aged 20 years and older in Basrah, Iraq,” Diabetes Metab Syndr., vol. 8, no. 3, pp. 144-147, 2014.
R. K. Lafta and M. A. Al-Nuaimi, “Obesity in Iraq: a review of current evidence,” East Mediterr Health J., vol. 26, no. 2, pp. 234-240, 2020.
P. C. Webster, “Iraq's health system yet to heal from ravages of war,” Lancet, vol. 378, no. 9794, pp. 863-866, 2011.
Ministry of Planning, Iraq, Iraq National Development Plan 2018-2022, Baghdad: Ministry of Planning, 2018.
H. F. Al-Tukmagi and M. A. Al-Bustan, “Prevalence of dyslipidemia in hypertensive patients attending a primary health care center in Baghdad,” Iraqi J Community Med., vol. 31, no. 2, pp. 45-50, 2018.
K. A. Rashid and A. A. Hassan, “Lipid profile abnormalities among hypertensive patients in Erbil city,” Zanco J Med Sci., vol. 23, no. 1, pp. 55-62, 2019.
B. Williams, G. Mancia, W. Spiering, E. Agabiti Rosei, M. Azizi, M. Burnier, et al., “2018 ESC/ESH Guidelines for the management of arterial hypertension,” Eur Heart J., vol. 39, no. 33, pp. 3021-3104, 2018.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, “Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III),” JAMA, vol. 285, no. 19, pp. 2486-2497, 2001.
S. Yusuf, S. Rangarajan, K. Teo, S. Islam, W. Li, L. Liu, et al., “Cardiovascular risk and events in 17 low-, middle-, and high-income countries,” N Engl J Med., vol. 371, no. 9, pp. 818-827, 2014.
M. Ebrahimi, S. M. Kazemi-Bajestani, M. Ghayour-Mobarhan, and G. A. Ferns, “Coronary artery disease and its risk factors status in Iran: a review,” Iran Red Crescent Med J., vol. 13, no. 9, pp. 610-623, 2011.
M. M. Al-Nozha, M. R. Arafah, Y. Y. Al-Mazrou, M. A. Al-Maatouq, N. B. Khan, M. Z. Khalil, et al., “Coronary artery disease in Saudi Arabia,” Saudi Med J., vol. 25, no. 9, pp. 1165-1171, 2004.
P. P. Toth, P. J. Barter, R. S. Rosenson, W. E. Boden, M. J. Chapman, M. Cuchel, et al., “High-density lipoproteins: a consensus statement from the National Lipid Association,” J Clin Lipidol., vol. 7, no. 5, pp. 484-525, 2013.
L. F. Van Gaal, I. L. Mertens, and C. E. De Block, “Mechanisms linking obesity with cardiovascular disease,” Nature, vol. 444, no. 7121, pp. 875-880, 2006.
J. C. Fruchart, F. Sacks, M. P. Hermans, G. W. Assmann, W. V. Brown, R. Ceska, et al., “The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia,” Am J Cardiol., vol. 102, no. 10 Suppl, pp. 1K-34K, 2008.
M. Miller, N. J. Stone, C. Ballantyne, V. Bittner, M. H. Criqui, H. N. Ginsberg, et al., “Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association,” Circulation, vol. 123, no. 20, pp. 2292-2333, 2011.
M. F. Piepoli, A. W. Hoes, S. Agewall, C. Albus, C. Brotons, A. L. Catapano, et al., “2016 European Guidelines on cardiovascular disease prevention in clinical practice,” Eur Heart J., vol. 37, no. 29, pp. 2315-2381, 2016.
H. Doroodchi, M. Abdolrasulnia, J. A. Foster, E. Foster, M. P. Turakhia, K. A. Skelding, et al., “Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events,” BMC Fam Pract., vol. 9, p. 42, 2008.
L. Mosca, E. Barrett-Connor, and N. K. Wenger, “Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes,” Circulation, vol. 124, no. 19, pp. 2145-2154, 2011.
World Health Organization, WHO global report on trends in prevalence of tobacco use 2000-2025, Geneva: WHO, 2019.
M. Ng, T. Fleming, M. Robinson, B. Thomson, N. Graetz, C. Margono, et al., “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013,” Lancet, vol. 384, no. 9945, pp. 766-781, 2014.
B. Everett and A. Zajacova, “Gender differences in hypertension and hypertension awareness among young adults,” Biodemography Soc Biol., vol. 61, no. 1, pp. 1-17, 2015.
S. Ebrahim and G. D. Smith, “Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease,” BMJ, vol. 314, no. 7095, pp. 1666-1674, 1997.
