Impact of dyslipidemia on cardiovascular risk stratification of hypertensive patients and association of lipid profile with other cardiovascular risk factors: results from the ICEBERG study

Abstract

Background: Hypertension, dyslipidemia, and other cardiovascular risk factors are linked epidemiologically, clinically, and metabolically. Intensive/Initial Cardiovascular Examination regarding Blood Pressure levels, Evaluation of Risk Groups (ICEBERG) study focuses on the effect of dyslipidemia on cardiovascular risk evaluation and association of lipid profile with other risk factors.

Patients and methods: The ICEBERG study consisted of two sub-protocols: ICEBERG-1, conducted at 20 university hospitals (Referral Group) and ICEBERG-2, conducted at 197 primary healthcare centers (Primary Care Group). Sub-protocol had two patient profiles: patients previously diagnosed with essential hypertension and under medical treatment (Treated Group) and patients with systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, with no antihypertensive treatment for at least 3 months before inclusion (Untreated Group). Dyslipidemia was evaluated and cardiovascular risk stratification was performed according to ESC/ESH guidelines.

Results: More than half of the treated and untreated subjects were classified into high or very high cardiovascular risk groups. In a total of 1817 patients, the percentage of patients in "high" plus "very high" added risk groups increased to 55.2% in Treated Referral Group (p < 0.001), to 62.6% in Untreated Referral Group (p = 0.25) and to 60.7% in Untreated Primary Care Group (p < 0.001), by re-evaluation of patients' lipid values.

Conclusions: Serum lipid levels are useful in stratifying hypertensive patients into cardiovascular risk groups more accurately, for appropriate antihypertensive treatment.

Keywords: cardiovascular disease; dyslipidemia; hypertension.

Figure 1

Distribution of patients in study groups into different grades of hypertension (A) and into CV risk groups according to existing risk factors before additional tests (B). Distribution into different groups showed significantly different patterns for both panels (p < 0.001, by Kruskal-Wallis test). Group comparisons were as follows: (A) p < 0.001 for Treated Referral Group vs other groups; p = 0.001 for Untreated Referral vs Untreated Primary Care Groups; (B) p < 0.001 for Treated Referral vs Untreated Primary Care groups, and p = 0.06 for Treated vs Untreated Referral Groups by Mann-Whitney U test.

Figure 2

The percentages of Treated, Untreated Referral and Untreated Primary Care patients in “high” plus “very high” added risk groups according to medical history and physical examination (HPE), and medical history and physical examination plus serum lipid profile (plus lipid profile). ^***p < 0.001 vs HPE (McNemar test).