Screening premorbid metabolic syndrome in community pharmacies: a cross-sectional descriptive study

Abstract

Background: Premorbid metabolic syndrome (pre-MetS) is a cluster of cardiometabolic risk factors characterised by central obesity, elevated fasting glucose, atherogenic dyslipidaemia and hypertension without established cardiovascular disease or diabetes. Community pharmacies are in an excellent position to develop screening programmes because of their direct contact with the population.The main aim of the study was to determine the prevalence of pre-MetS in people who visited community pharmacies for measurement of any of its five risk factors to detect the presence of other risk factors. The secondary aims were to study the presence of other cardiovascular risk factors and determine patients' cardiovascular risk.

Methods: Cross-sectional, descriptive, multicentre study. Patients meeting selection criteria aged between 18 and 65 years who visited participating community pharmacies to check any of five pre-MetS diagnostic factors were included.The study involved 23 community pharmacies in Catalonia (Spain). Detection criteria for pre-MetS were based on the WHO proposal following IDF and AHA/NHBI consensus. Cardiovascular risk (CVR) was calculated by Regicor and Score methods. Other variables studied were smoking habit, physical activity, body mass index (BMI), and pharmacological treatment of dyslipidemia and hypertension. The data were collected and analysed with the SPSS programme. Comparisons of variables were carried out using the Student's T-test, Chi-Squared test or ANOVA test. Level of significance was 5% (0.05).

Results: The overall prevalence of pre-MetS was 21.9% [95% CI 18.7-25.2]. It was more prevalent in men, 25.5% [95% CI 22.1-28.9], than in women, 18.6% [95% CI 15.5-21.7], and distribution increased with age. The most common risk factors were high blood pressure and abdominal obesity. About 70% of people with pre-MetS were sedentary and over 85% had a BMI ≥25 Kg/m2. Some 22.4% had two metabolic criteria and 27.2% of patients with pre-MetS had no previous diagnosis.

Conclusions: The prevalence of pre-MetS in our study (21.9%) was similar to that found in other studies carried out in Primary Care in Spain. The results of this study confirm emergent cardiometabolic risk factors such as hypertension, obesity and physical inactivity.Our study highlights the strategic role of the community pharmacy in the detection of pre-MetS in the apparently healthy population.

Figure 1

General study schema. Cross-sectional, descriptive, multicentre study to determine the prevalence of premorbid metabolic syndrome in patients who visit community pharmacies.

Figure 2

Prevalence of premorbid metabolic syndrome based on the WHO proposal and their five diagnostic factors by gender. Data are expressed as percentages. Pre-MetS: premorbid metabolic syndrome; TG: Triglycerides; GLU: fasting glucose; HDLc: HDL-cholesterol; BP: blood pressure; AO: abdominal obesity.

Figure 3

Error Bars (95% CI) of body mass index according to the diagnosis of premorbid metabolic syndrome and gender. CI: Confidence Interval; BMI: body mass index.

Figure 4

Error Bars (95% CI) of Cardiovascular Risk (Regicor) according to the diagnosis of premorbid metabolic syndrome and physical inactivity. CI: Confidence Interval.

Figure 5

Error Bars (95% CI) of Cardiovascular Risk (Score) according to the diagnosis of premorbid metabolic syndrome and physical inactivity. CI: Confidence Interval.