Impact of metabolic syndrome on lipid target achievements in the Arabian Gulf: findings from the CEPHEUS study

Abstract

Background: The aim of this study was to determine the impact of metabolic syndrome (MetS) on lipid target achievements in the Arabian Gulf.

Methods: The centralized pan-middle east survey on the undertreatment of hypercholesterolemia (CEPHEUS) included 4171 high and very high atherosclerotic cardiovascular disease (ASCVD) risk patients from six Arabian Gulf countries. Analyses were performed using univariate statistics.

Results: The overall mean age was 57 ± 11 years, 41 % were females and 71 % had MetS. MetS patients were less likely to attain their HDL-C (34 vs. 79 %; P < 0.001), LDL-C (27 vs. 37 %; P < 0.001), non HDL-C (35 vs. 55 %; P < 0.001) and Apo B (35 vs. 54 %; P < 0.001) compared to those without MetS. Within the MetS cohort, those with very high ASCVD risk were less likely to attain their lipid targets compared to those with high ASCVD risk [HDL-C (32 vs. 41 %; P < 0.001), LDL-C (24 vs. 43 %; P < 0.001), non HDL-C (32 vs. 51 %; P < 0.001) and Apo B (33 vs. 40 %; P = 0.001)]. In those with MetS and very high ASCVD risk status, females were less likely to attain their HDL-C (27 vs. 36 %; P < 0.001), LDL-C (19 vs. 27 %; P < 0.001) and Apo B (30 vs. 35 %; P = 0.009) compared to males.

Conclusions: MetS was associated with low lipid therapeutic targets. Women and those with very high ASCVD risk were also less likely to attain their lipid targets in the Arabian Gulf.

Keywords: Arabian Gulf; Blood pressure; Cardiovascular diseases; HDL cholesterol; LDL cholesterol; Metabolic syndrome; Obesity; Triglycerides.

Fig. 1

Number of metabolic syndrome (MetS) risk factors (increased abdominal obesity, elevated triglycerides, reduced HDL-C, elevated blood pressure, and elevated blood glucose) in atherosclerotic cardiovascular disease (ASCVD) risk patients (N = 4171). As per recent unified definition by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) using the modified National Cholesterol Education Program–Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was defined as having three or more of the following criteria: (1) increased abdominal obesity (waist circumference of ≥94 cm for men and ≥80 cm for women for Middle Eastern (Mediterranean/European) populations), (2) elevated triglycerides of ≥150 mg/dL (1.7 mmol/L), (3) reduced HDL-C of <40 mg/dL (1.04 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females, (4) elevated BP ≥130 mmHg for systolic and/or ≥85 mmHg for diastolic, and (5) elevated fasting blood glucose of ≥100 mg/dL (5.6 mmol/L). Criteria for ASCVD risk status was adapted from the National Lipid Association criteria for atherosclerotic cardiovascular disease. High risk group included patients with ≥3 major ASCVD risk factors, diabetes mellitus (type 1 or 2) with 0/1 major ASCVD risk factor and LDL-C ≥190 mg/dL (5.02 mmol/L) (severe hypercholesterolemia). Very high risk group included ASCVD (CHD, PAD, CVD), diabetes mellitus with ≥2 other major ASCVD risk factors

Fig. 2

Lipid target achievements (HDL-C, LDL-C, non HDL-C and Apo B) in metabolic syndrome patients stratified by atherosclerotic cardiovascular disease (ASCVD) risk status (N = 2948). HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, Apo B apolipoprotein B. As per recent unified definition by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) using the modified National Cholesterol Education Program–Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was defined as having three or more of the following criteria: (1) increased abdominal obesity (waist circumference of ≥94 cm for men and ≥80 cm for women for middle eastern (Mediterranean/European) populations), (2) elevated triglycerides of ≥150 mg/dL (1.7 mmol/L), (3) reduced HDL-C of <40 mg/dL (1.0 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females, (4) elevated BP ≥130 mmHg for systolic and/or ≥85 mmHg for diastolic, and (5) elevated fasting blood glucose of ≥100 mg/dL (5.6 mmol/L). Criteria for ASCVD risk status was adapted from the National Lipid Association criteria for atherosclerotic cardiovascular disease. High risk group included patients with ≥3 major ASCVD risk factors, diabetes mellitus (type 1 or 2) with 0–1 major ASCVD risk factors, LDL-C ≥190 mg/dL (severe hypercholesterolemia). Very high risk group included ASCVD (CHD, PAD, CVD), diabetes mellitus with ≥2 other major ASCVD risk factors. Despite the lack of a recommended HDL-C goal by guidelines, satisfactory HDL-C was defined as <40 mg/dL (1.03 mmol/L) for males or <50 mg/dL (1.29 mmol/L) for females. Therapeutic lipoprotein targets for the highest risk group were LDL-C <1.8 mmol/L, apo B <0.80 g/L and non-HDL-C <2.6 mmol/L

Fig. 3

Lipid target achievements (HDL-C, LDL-C, non HDL-C and Apo B) in patients with metabolic syndrome and very high atherosclerotic cardiovascular disease (ASCVD) risk status stratified by gender (N = 2373). HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, Apo B, apolipoprotein B. As per recent unified definition by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) using the modified National Cholesterol Education Program–Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was defined as having 3 or more of the following criteria: (1) increased abdominal obesity (waist circumference of ≥94 cm for men and ≥80 cm for women for Middle Eastern (Mediterranean/European) populations), (2) elevated triglycerides of ≥150 mg/dL (1.7 mmol/L), (3) reduced HDL-C of <40 mg/dL (1.0 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females, (4) elevated BP ≥130 mmHg for systolic and/or ≥85 mmHg for diastolic, and (5) elevated fasting blood glucose of ≥100 mg/dL (5.6 mmol/L). Criteria for ASCVD risk status was adapted from the National Lipid Association criteria for atherosclerotic cardiovascular disease. High risk group included patients with ≥3 major ASCVD risk factors, diabetes mellitus (type 1 or 2) with 0–1 major ASCVD risk factors, LDL-C ≥190 mg/dL (severe hypercholesterolemia). Very high risk group included ASCVD (CHD, PAD, CVD), diabetes mellitus with ≥2 other major ASCVD risk factors. Despite the lack of a recommended HDL-C goal by guidelines, satisfactory HDL-C was defined as <40 mg/dL (1.03 mmol/L) for males or <50 mg/dL (1.29 mmol/L) for females. Therapeutic lipoprotein targets for the highest risk group were LDL-C <1.8 mmol/L, apo B <0.80 g/L and non-HDL-C <2.6 mmol/L

Fig. 4

Lipid target achievements (HDL-C, LDL-C, non HDL-C and Apo B) in patients with metabolic syndrome and high atherosclerotic cardiovascular disease (ASCVD) risk status stratified by gender (N = 575). HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, Apo B apolipoprotein B. As per recent unified definition by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) using the modified National Cholesterol Education Program–Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was defined as having 3 or more of the following criteria: (1) increased abdominal obesity (waist circumference of ≥94 cm for men and ≥80 cm for women for Middle Eastern Mediterranean/European) populations), (2) elevated triglycerides of ≥150 mg/dL (1.7 mmol/L), (3) reduced HDL-C of <40 mg/dL (1.0 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females, (4) elevated BP ≥130 mmHg for systolic and/or ≥85 mmHg for diastolic, and (5) elevated fasting blood glucose of ≥100 mg/dL (5.6 mmol/L). Criteria for ASCVD risk status was adapted from the National Lipid Association criteria for atherosclerotic cardiovascular disease. High risk group included patients with ≥3 major ASCVD risk factors, diabetes mellitus (type 1 or 2) with 0–1 major ASCVD risk factors, LDL-C ≥190 mg/dL (severe hypercholesterolemia). Very high risk group included ASCVD (CHD, PAD, CVD), diabetes mellitus with ≥2 other major ASCVD risk factors. Despite the lack of a recommended HDL-C goal by guidelines, satisfactory HDL-C was defined as <40 mg/dL (1.03 mmol/L) for males or <50 mg/dL (1.29 mmol/L) for females. Therapeutic lipoprotein targets for the high risk patients were LDL-C <2.6 mmol/L, apo B <0.90 g/L and non-HDL-C <3.3 mmol/L