Cardiovascular disease risk factor patterns and their implications for intervention strategies in Vietnam

Abstract

Background. Data on cardiovascular disease risk factors (CVDRFs) in Vietnam are limited. This study explores the prevalence of each CVDRF and how they cluster to evaluate CVDRF burdens and potential prevention strategies. Methods. A cross-sectional survey in 2009 (2,130 adults) was done to collect data on behavioural CVDRF, anthropometry and blood pressure, lipidaemia profiles, and oral glucose tolerance tests. Four metabolic CVDRFs (hypertension, dyslipidaemia, diabetes, and obesity) and five behavioural CVDRFs (smoking, excessive alcohol intake, unhealthy diet, physical inactivity, and stress) were analysed to identify their prevalence, cluster patterns, and social predictors. Framingham scores were applied to estimate the global 10-year CVD risks and potential benefits of CVD prevention strategies. Results. The age-standardised prevalence of having at least 2/4 metabolic, 2/5 behavioural, or 4/9 major CVDRF was 28%, 27%, 13% in women and 32%, 62%, 34% in men. Within-individual clustering of metabolic factors was more common among older women and in urban areas. High overall CVD risk (≥20% over 10 years) identified 20% of men and 5% of women-especially at higher ages-who had coexisting CVDRF. Conclusion. Multiple CVDRFs were common in Vietnamese adults with different clustering patterns across sex/age groups. Tackling any single risk factor would not be efficient.

Figure 1

Average number of cardiovascular disease risk factors among men (a) and women (b), stratified by age group.

Figure 2

Trends of average overall cardiovascular disease risk by the number of risk factors.

Figure 3

Estimation of cardiovascular burden and potential benefits of intervention strategies for the adult population of Vietnam, extrapolated from the average of individual overall CVD 10-year risks in a studied population. ¹ Overall cardiovascular (CVD) risk, residual risk, absolute risk reduction (ARR), and predicted CVD events or predicted event reduction were estimated by both versions of Framingham general risk score, one used lipid profile and the other used BMI, and weighted by national age structure of the Vietnamese population in 2009. ² In assumption that the prevalence of current smoking will reduce by 50%. ³ In assumption that the effect of healthy diet (especially salt reduction) will reduce 5 mmHg of systolic blood pressure (SBP). ⁴ In assumption that the obesity (BMI ≥ 23) will reduce 10% of weight, the risk was only estimated by BMI version of Framingham general risk score. ⁵Approach for hypertensive alone included drug therapy to control BP (targeted SPB ≤ 140 for any hypertensives and ≤130 for diabetes). ⁶Approach for community included healthy lifestyle promotion campaigns: quitting smoking (in assumption of 50% reduction of current prevalence), healthy diet (salt reducuon, low-fat and high-fiber diet, in assumption of 5 mmHg reduction of SBP), and encouraging physical activity and 10% weight reduction for obesity (BMI ≥ 23). ⁷ Approach for high-risk people (overall CVD 10-year risk ≥20%) included quitting smoking (100%), drug therapy to control BP (targeted SBP ≤ 140 for any hypertensives and ≤130 for diabetes), statin for dyslipidaemia (in assumption of 20% reduction of total cholesterol, 10% increase HLD-C), and 10% weight reduction for obesity (BMI ≥ 23).