1. www.diabetes.org/clinicaldiabetes
v o l u m e 9 n u m b e r 3
An Official Journal of the
summer 2010
Practical
Information
for Primary
Care
[Middle East Edition]
Screening for Diabetes and Cardiovascular
Risk Factors among Egyptian population
Gamela M Nasr, MD 1
, Hamdy Sliem, MD 2
, Amira Gamal, MD 3
, Hayam
Refaat, PhD 4
& Mahmoud Ibrahim, MD 5
.From the 1
Department of
Cardiology; the 2
Department of Internal Medicine ; the 3
Department of
Community Medicine- Faculty of Medicine Suez Canal University, Ismailia ,
Egypt ; the 4
Department of Pediatrics, Ain Shams University, Cairo , Egypt;
the 5
EDC , Center for Diabetes Education, McDonough , GA , USA.
DIABETES.ORG/CLINICALDIABETES
9 3
2010
2010

3. 127Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
Screening for Diabetes and Cardiovascular
Risk Factors among Egyptian population
Gamela M Nasr, MD, Hamdy Sliem, MD, Amira Gamal, MD, Hayam Refaat, PhD & Mahmoud Ibrahim , MD.
B
ackground and Aim: Recently
major cultural changes have oc-
curred in Egypt to promote the
development of non-communicable dis-
eases. The global cardiovascular risk is
the probability of suffering from coronary
event or stroke in a given period of time.
Limited information is available about
cardiovascular risk factors and diabetes
In Egypt. Therefore, the aim of this study
was to describe the prevalence, clinical
and laboratory characteristics of the key
cardiovascular risk factors like obesity,
hypertension, dyslipidemia, and smoking
along with diabetes in Egypt.
Methods: A descriptive retrospective,
cross-sectional study in which Six thou-
sand, seven hundred and seventy three
patients , mean age (48 years + 4), (2845
males, 42%) and (3928 females, 58%)
were screened for the key cardiovascular
risk factors and diabetes . They attended
the central Insurance outpatient clinics of
cardiology as a nationally representative
sample over a period of six years. They
were subjected to history taking, anthro-
pometric measures (waist circumference,
height and weight). Lipid profile, uric
acid , fasting and post prandial blood
sugar (FBS and PBS) were assessed. So-
dium, Potassium and serum creatinine
(S.Cr) were also assessed.
Results: Cardiovasculr risk factors were
more among females (57.7%) and in pa-
tients who lived in urban areas (72.2%).
Diabetics were 22.9%, hypertensives
were 30.7%, dyslipidemics were 33.4%
and smokers were 43% in the studied
population. Smoking was more common
in men than women (91%vs 9%). Of
the studied population 29% were obese.
Mean waist circumference for males was
111cm + 3and for females 101+ 5cm
with a p 0.04. Females were significantly
different regarding BMI where p 0.001,
PPBS p 0.04 and HDL p 0.01. Obesity
had a statistically significant correlation
with diastolic blood pressure (p < .001).
Patients with family history of diabetes
had higher BMI p 0.007, waist circumfer-
ence p 0.05, FBS p 0.008, PPBS p 0.002,
TG p 0.001 and lower HDL p 0.04.
Conclusions: Prevalence of the key car-
diovascular risk factors are high among
Egyptians with a need for a national
prevention program to combat obesity,
diabetes , hypertension ,dyslipidemia,
smoking and related co-morbidities.
Consideration of early prevention and
control is of utmost importance.
Key words: Cardiovascular risk factors,
diabetes, dyslipidemia, smoking , obesity
and hypertension
Introduction: Diabetes is a risk factor
for ischemic vascular diseases as MI and
ischemic stroke and it also seems to pose
a significant risk across the spectrum of
other forms of vascular disease, includ-
ing hemorrhagic stroke, suggested by
a meta-analysis encompassing almost
700 000 patients1
. Moreover, it showed
that the elevated risks were largely in-
dependent of conventional cardiovascu-
lar risk factors, suggesting that diabetes
must be raising vascular risk through less
familiar mechanisms. However, contrary
to expectations, very little of the ex-
cess cardiovascular risk associated with
diabetes is explained by obesity, blood
pressure, lipids, inflammatory markers,
or renal function. Controlling of these
factors had little effect on the approxi-
mately twofold increase in vascular risk
associated with diabetes 1
. Global burden
of the risk was identified through World
Health Organization. Obesity, hyperten-
sion, hypercholesterolemia and smok-
ing were among the top 10 risk factors
for premature death and disability2
. In
a study for prevalence of cardiovascu-
lar risk factors and their relation to the
level of blood pressure in Egypt, it was
for obesity 33 % and 47% in hyperten-
sive men and women, respectively3
.After
adjusting for age, hypertensive men had
significantly higher heart rate, total cho-
lesterol (TC), triglycerides (TG), fasting
blood sugar (FBS), post-prandial blood
sugar (PBS), body mass index and waist/
hip (W/H) ratio than their non-hyper-
tensive counterparts. In addition, hyper-
tensive women had higher low-density
lipoprotein cholesterol (LDL-C). The
prevalence of elevated LDL-C and FBS
increased with age. All risk factors were
more prevalent in urban populations3
. On
the other hand, the INTERHEART study
has shown that nine modifiable risk fac-
tors are responsible for more than 90% of
the population attributable risk factors for
cardiovascular diseases 4
. Prevalence of
cardiovascular risk factors in Middle East
including Egypt was also high in another
metanalysis5, 6
.
The ADVANCE trial has demonstrated
that a combined approach of routine
blood pressure lowering and intensive
glucose control resulted in substantial
reductions in major renal events and
all-cause death. For the major renal out-
comes, the separately significant benefi-
cial effects of the two interventions were
additive. This suggests that the multi-
factorial management of type 2 diabetes

4. 128 Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
should incorporate routine blood pres-
sure lowering and more intensive glucose
control to reduce the burden of adverse
clinical sequelae in individuals with es-
tablished diabetes. The effects of routine
blood pressure lowering and intensive
glucose control were independent of one
another. When combined, they produced
additional reductions in clinically rel-
evant outcomes 7
.
The new analyses of the Action to Con-
trol Cardiovascular Risk in Diabetes
(ACCORD) trial clearly shows that the
intervention (intensive glucose & blood
pressure lowering) does seem to be hav-
ing a beneficial effect on cardiovascular
disease, there were fewer MIs, for in-
stance. But there is a mortality signal that
remains unexplained today8
. Prevalence
of cardiovascular risk factors and diabetes
in Egypt is needed to demonstrate the risk
to develop strategies for risk reduction.
Methods Study population:
A descriptive, retrospective, cross-sec-
tional study in which Six thousand and
seven hundred and seventy three patients
, mean age (48 years + 4), (2845 males,
42%) and (3928 females, 58%) were
screened for the key cardiovascular risk
factors and diabetes mellitus. They at-
tended the central insurance outpatient
clinics of cardiology as a nationally rep-
resentative sample for duration of six
years (2004-2009). They were subjected
to interview questionnaire for careful his-
tory taking.
Measurements:
Height, weight, BMI, and waist circum-
ferences measurements were recorded.
Weight in kg and height in cm were mea-
sured to the nearest 0.5 cm and 0.1 kg,
respectively. Normal weight, overweight
and obesity were defined as BMI less
than 25, 25-29.9 and 30 or higher, respec-
tively9, 10
. Blood sampling for Sodium,
Potassium, fasting blood sugar (FBS),
serum creatinine (S.Cr), serum uric acid
and lipid profile were measured.
Definitions:
Cardiovascular risk factors studied were:
Obesity, waist circumference (WC), hy-
pertension, diabetes , dyslipidemia, hy-
pertriglyceridemia, reduced HDL choles-
terol, high LDL cholesterol or high total
cholesterol 11
Hypertriglyceridemia was defines as
≥150 mg/dl, low HDL cholesterol was
defined as <40 mg/dl in men and <50 mg/
dl in women11
. Diabetes was diagnosed
according toAmerican DiabetesAssocia-
tion12
. A fasting blood sugar level below
100 (mg/dL) is considered normal while
level between 100 and 126 (mg/dL) con-
firms the presence of Impaired Fasting
Glucose IFG, and more than 126 (mg/dL)
confirms the presence of diabetes in two
separate occasions12
Hypertension was defined according to
the guidelines of the Joint National Com-
mittee on Detection, Evaluation, and
Treatment of High Blood Pressure, which
are: a systolic blood pressure >140 mm
Hg, a diastolic blood pressure >90 mm
Hg or the use of antihypertensive medi-
cation. Subjects in the 130–139/80–89
mm Hg blood pressure range were classi-
fied as pre-hypertensives13
.
Among the measures of abdominal obe-
sity, waist circumference measured as
>102 cm in men and 88 cm in women 14
Statistical analysis:
Data was revised, coded and entered
into SPSS Statistical Software Version
15.0. Quantitative data was summarized
by arithmetic mean and standard devia-
tion. Numerical data was presented as
frequencies and percentages and trans-
formed into graphs as appropriate. Cor-
relation coefficient was calculated for
cardiovascular diseases risk factors, met-
abolic profile and obesity.
Ethical considerations:
A verbal consent was obtained from all
subjects enrolled in this study. All data
are confidential for the research use only.
Data were coded and kept in safe place.
Results:
A descriptive, retrospective cross-sec-
tional study in which Six thousand and
seven hundred and seventy three patients
, mean age (48 years + 4), (2845 males,
42%) and (3928 females, 58%) were
screened for the key cardiovascular risk
factors and diabetes. They attended the
central Insurance outpatient clinics of
cardiology as a nationally representative
sample over a period of six years.
Cardiovasculr risk factors were more
among females (57.7%) and in patients
who lived in urban areas (72.2%).
Diabetics were 22.9%, hypertensives
were 30.7%, dyslipidemics were 33.4%
and smokers were 43% in the studied
population
Table 1 showed characteristics of patients
having cardiovascular risk factors of
whom 2845 were males (42%) and 3928
were females (58%). It has been shown
that 28% (1922) of patients were living in
rural areas, while 4851 (72%) of patients
were living in urban areas. Regarding
smoking habits it was shown that 57%
(3861) were smokers, while 2912 (43%)
were non smokers.
Occupation-related differences among
studied patients with cardiovascular risk
factors showed that intellectuals’ pa-
tients had a mean of (42.3), while manual
workers had a mean of (20.2) and house
wives had a mean of (38.3).
Table (2) showed the cardiovascular risk
factors according to gender difference.
Females had significant difference re-
garding BMI where p0.001, waist cir-
cumference p 0.04, PPBS p 0.04 and
HDL p 0.01
Patients with cardiovascular disease risk
factors had complains like palpitation
(42%), chest pain among (33%), easy
fatigue among (52%), dyspnea NYHA1
(9.3%), dyspnea NYHA2 (4.8%), dys-
pnea NYHA3 (1.9%) (Figure1).
Current illnesses among the studied pa-
tients with cardiovascular disease risk

5. 129Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
factors were shown in (Figure 2). Bio-
chemical profile among the studied pa-
tients with cardiovascular disease risk
factors was shown in (Figure 3).
Figure (4) showed the main clinical fea-
tures among the studied patients with car-
diovascular disease risk factors.
Cardiovascular disease risk factors start-
ed at early age in those patients with fam-
ily history of diabetes mellitus with a
mean age of (43.6±3.4) years old versus
those patients with mean age of (55±3)
years old in patients without family histo-
ry of diabetes mellitus (p value <0.001).
Central obesity (waist circumference)
had a statistically significant direct cor-
relation with diastolic blood pressure
(p <0.001). Central obesity alone had a
statistically significant direct correlation
with uric acid (p value <0.01). Mean
waist circumference for males was 111±3
cm and for females it was 101±5 cm.
Waist circumference and BMI were high-
er in females than males (125.5 versus
122.1 cm) and (39 versus 37.1 kg/m2
) re-
spectively, with a statistically significant
difference (p value <0.05). Total body
obesity (BMI) had a statistically signifi-
cant direct correlation with systolic and
diastolic blood pressure (p value <0.05).
Table (3) showed that total body obesity
(BMI) and central obesity (waist circum-
ference) had a statistically significant
direct correlation with HDL p 0.01vs p
0.02, TG p 0.013 vs p 0.04, FBS p.003
vs p 0.30, PPBS p 0.016 vs p 0.0039 and
uric acid p 0.092 vs p 0.01.
Patients with family history of diabetes
had higher BMI p 0.007, waist circumfer-
ence p 0.05, FBS p 0.008, PPBS p 0.002,
TG p 0.001 and lower HDL p 0.04 than
patients without family history of diabe-
tes. Patients with cardiovascular disease
risk factors and family history of hyper-
tension had higher diastolic blood pres-
sure p 0.007, waist circumference p 0.03,
TG p 0.01 and lower HDL than patients
without family history (p 0.02) as shown
in Table (4).
Figure (5) showed the percentage of di-
agnosed cardiovascular disease risk fac-
tors referred from different areas, while
percentage of males and females diag-
nosed as cardiovascular disease risk fac-
tors referred from different areas from
Egypt were shown in figure (6). It is evi-
dent that cardiovascular risk factors are
affected by lifestyle of patients as well as
environment. Cairo, the capital had the
highest risk with prevalence more in fe-
males. Prevalence of cardiovascular risk
in Greater Cairo was 37.1% where Upper
Egypt 26.4%, coastal areas 18.6% and
Delta17.9%. Females are more prevalent
in risk factors where p 0.009 for Greater
Cairo, p 0.006 for coastal areas, p 0.01
for Delta and p 0.004 for Upper Egypt
Discussion
The current work estimated the relatively
high prevalence of diabetes and other
cardiovascular risk factors in a vulnera-
ble group of patients attending the central
national insurance hospital as a common
pool from all over the country. Our find-
ings revealed a high prevalence of obe-
sity, diabetes, hypertension, and smok-
ing in Egypt. It does not represent the
prevalence in the general population but
it points out to the current change among
the Egyptians in lifestyle and urbaniza-
tion. This of course should urge health
care officials to conduct a national pre-
vention program at both community and
hospital level.
Central obesity presented by increased
waist circumference was markedly high
in both men and women participating in
the study. In addition, BMI which reflects
total body obesity was also high. It is es-
timated in the current study to be 29%
with a more prevalence in women. This
is comparable to what was reported from
several western countries, such as the
United States (28.0% of men and 34.0%
of women) 15
and the United Kingdom
(23.0% in men and 25.0% in women) 16
.
This similarity could be due to common
exogenous factors existing in the devel-
oping countries leading to the develop-
ment of the metabolic syndrome such as
sedentary life, psychosocial stressors and
obesity. Obesity is a corner stone of the
metabolic syndrome as an etiology or a
sequel17.
It constitutes one of the elements
of metabolic syndrome diagnosis18
.
Among different countries in the Middle
East region there was significant hetero-
geneity between studies. Arab countries
including Jordan showed a prevalence of
(49.7%), Oman (30.8%), Qatar (40.8%),
and Gaza & West Bank (41.5%) which is
an extremely high prevalence of obesity
5
. Overall, obesity was also found to be
more prevalent in urban areas compared
with rural regions. This is most likely
because of rapid economic and nutri-
tional transitions in this region as well as
definite lifestyle changes. People became
less sedentary and consuming more calo-
ries through non-healthy fast foods.
The analysis of Motlagh et al 5;
showed
that the overall prevalence of obesity in
the Middle East region was consider-
ably higher among women compared
with men in agreement with our study .
Although the exact explanation of such
gender variations is not entirely clear, it
has been reported that women are less
active compared with men in certain ar-
eas 19, 20
. Physical and cultural barriers
to physical activity have been reported
among women in Egypt and Saudi Ara-
bia5
. These include climatic conditions of
extreme heat in the summer, limited exer-
cise facilities devoted solely for women,
lack of physical education or an emphasis
on its importance in schools, and absence
of women’s participation in organized
sports. Physical inactivity and sedentary
lifestyle are major risk factors for the de-
velopment of obesity and CVD21
. New
Egyptian waist circumference cutoff
points for abdominal obesity were devel-
oped based upon data from the Egyptian
National Hypertension Project (NHP) 22
.
These are 97.5 cm for men and 92.3 cm
for women. Cutoff points recommended
by IDF were 94 cm for men and 80 cm
for women derived from the European
cutoff points23
. The prevalence of ab-

6. 130 Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
dominal obesity in Egyptians based upon
these European cutoff points is 30.2% for
men and 70.9% for women while based
on new Egyptian criteria, the prevalence
of abdominal obesity in men is 37.1%
and in women 50.8%. In this study we
adopted rather higher cutoff points since
the start of data collection of six years
duration; it is supposed that even much
higher values would have been obtained.
A positive correlation was found be-
tween waist circumference and most of
the cardiovascular risk factors. Obesity
may present as an etiology leading to
progression of Insulin resistance, which
is another corner stone of the metabolic
syndrome24
. Obesity of the predominant-
ly abdominal type leads to higher non-
esterifed fatty acids (NEFA) levels than
does obesity occurring predominantly in
the lower body (gluterofemoral obesity).
This may account for the greater Insulin
resistance observed in persons having ab-
dominal obesity25
Epidemiologic studies show a linear re-
lation between levels of plasma triglyc-
eride and cardiovascular risk. Increasing
levels of plasma triglyceride are often
associated with accumulation of remnant
lipoproteins typically characterized by a
high ratio of cholesterol to triglyceride.
Hydrolysis of the triglyceride-rich VLDL
particles by lipoprotein lipase yields LDL
particles containing elevated amounts of
triglycerides, which is highly atherogen-
ic and leads to hypertension, Ischemic
heart disease, peripheral arterial disease
and stroke. Few HDL particles would be
available for reverse cholesterol trans-
port or for protection against oxidative
damage of remnants and LDL lipopro-
teins26
.However the definitions used for
elevated cholesterol, LDL, and triglyc-
eride levels, varied considerably among
studies. These variations, as well as the
availability of limited data from Middle
East region make it difficult to conduct
any cross-country comparisons with
confidence5
.The prevalence of elevated
LDL in the Middle East ranged between
6.6–36.3% for men and 9.0–38.7% in
women. Similar to this the current data
showed dyslipidemia to be 33%. No-
table observations include the very high
prevalence of hypercholesterolemia
(>5.2mmol/l) in Kuwait and Oman 27,28
,
and the very low levels of HDL (<35mg/
dl) in Turkey, Oman, and Saudi Arabia5
.
The prevalence of hypertension in the
Middle East, is similar to rates observed
in North America (28%), but lower than
Europe (44%)29
. Overall, hypertension
was more prevalent in women than men-
in agreement with this study. This may,
in part, be explained by the higher preva-
lence of obesity in women, as several
studies have reported an association be-
tween obesity and hypertension 30,31
. The
number of the studies that have compared
rates of hypertension in urban and rural
areas in the Middle East is limited with a
prominent study in Egypt.
Hypertension is a major health problem
in Egypt with a prevalence rate of 26.3%
22
among the adult population (> 25 years)
and 31% in our hospital based study. Its
prevalence increases with aging, approxi-
mately 50% of Egyptians above the age
of 60 years suffer from hypertension.
About seven million Egyptians had high
blood pressure in the year 199322.
The prevalence of smoking is high in the
Middle East in men, but it is relatively
uncommon in women5
, in large part be-
cause it is still not culturally acceptable
for women to smoke in this region. The
rates of smoking in Turkey were among
the highest in the region, with one study
reporting a prevalence of 64.8% between
men and 20.1% women 32
. In agreement
with this the current study showed smok-
ers to be 43 % in our studied popula-
tion. Smoking is known to play a major
role in cardiovascular mortality. In a
recent study, 33
an estimated 11% of to-
tal global cardiovascular deaths in 2000
were attributed to smoking, half of which
occurred in developing countries. To
health professionals this seems to be very
alarming . The proportion of deaths at-
tributed to smoking in developing nations
is predicted to increase, as smoking rates
continue to increase in these countries,
whereas gradually declining in the devel-
oped world 34
. Worldwide, the number
of smokers continues to increase and is
estimated to reach 1.7 billion by 2025 35,36
The prevalence of diabetes also varied
among studies, with highest rates in some
Arab Countries as Jordan, Qatar and
Saudi Arabia. Surprisingly Motlagh et al
5
did not observe a difference in preva-
lence of diabetes mellitus between men
and women given differences observed
for prevalence of obesity. However, in
studies that reported the prevalence of
both diabetes mellitus and obesity Mot-
lagh et al 5
found a significant correlation
between the prevalence of these two risk
factors. According to the World Health
Report 2002 2
, approximately 58% of
diabetes globally occurs in individuals
with a BMI above 21 kg/m2 37
. The com-
bined prevalence of diagnosed and undi-
agnosed diabetes in the Egyptian popula-
tion > or = 20 years of age was estimated
to be 9.3%6
. Approximately half the dia-
betics were diagnosed. The prevalence of
diabetes in Egypt is high even on hospi-
tal based study as the current one it was
estimated to be 23%, and the gradient in
risk factors and disease from rural to ur-
ban areas suggest that diabetes is a major,
emerging clinical and public health prob-
lem in Egypt. For countries that included
studies separated by approximately 10
years or more (Turkey, Oman, and Saudi
Arabia). It was suggested that there is an
increasing prevalence in diabetes similar
to trends observed for obesity5. In our
suggestions it seems that both go hand
in hand. However, the limited number
of studies included precludes definitive
conclusions.
Prevalence of cardiovascular risk fac-
tors in Egyptian study done by Herman
et al 6
showed that prevalence of obesity
was 41%, Diabetes Mellitus was 17.9%
while prevalence of hypertension was
25.7% among males over 25 years old
and 26.3% among females38
It is evident that cardiovascular risk is

7. 131Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
more in the more-urbanized areas. Cairo
, the capital shows the highest risk with a
prevalence more in females. This focuses
upon impact of environment upon this
kind of risk. Anyhow cardiovascular risk
factors and diabetes among the Egyp-
tians are really alarming and prevention
is mandatory both at community level
through qualified nurses and physicians
as well as hospital care.
Conclusion:
The prevalence of key cardiovascular
risk factors is high in Egypt and it in-
creases with worsening obesity. Thus
there is a need for a national prevention
program to combat obesity, diabetes , hy-
pertension , dyslipidemia ,smoking and
related co-morbidities. Consideration of
early prevention and therapy is of great
importance.
Study limitations:
Larger-sized community–based prospec-
tive studies covering wider areas in Arab
countries.
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Gamela M Nasr, MD 1
, Hamdy Sliem, MD 2
,
Amira Gamal, MD 3
, Hayam Refaat, PhD 4
&
Mahmoud Ibrahim, MD 5
.
From the 1
Department of Cardiology;
the 2
Department of Internal Medicine ;
the 3
Department of Community Medicine-
Faculty of Medicine Suez Canal Univer-
sity, Ismailia , Egypt ; the 4
Department of
Pediatrics, Ain Shams University, Cairo ,
Egypt; the 5
EDC , Center for Diabetes
Education, McDonough , GA , USA.
Table 1: Cardiovascular disease risk factors
characteristics of the studied population
Frequency
(N=6773)
%
Gender:
Male
Female
2845
3928
42
58
Residence:
Urban
Rural
4851
1922
72
28
Smoking:
Smokers
Non smokers
2912
3861
43
57

9. 133Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
Parameters
Male (N=2845) Female (N=3928)
P value
Mean ± S.D. Mean ± S.D.
Age (years) 52.3 7.9 54.2 4.9 0.36
BMI (kg/m2
) 37.1 7.5 39.0 6.5 0.001**
Waist circumference (cm) 122.1 5.8 125.5 8.3 0.04*
FBS (mg/dl) 127.3 10.5 129.4 10.8 0.07
PPBS (mg/dl) 156.1 16.6 163.8 17.1 0.04*
BPr s (mmHg) 159 12.9 154.2 10.5 0.06
BPr d (mmHg) 95 5.1 93.7 5.8 0.63
TG (mg/dl 179 19.5 191.1 21 0.07
HDL (mg/dl) 39 6.8 42.7 5.3 0.01**
Table 2: Cardiovascular disease risk factors characteristics according to gender difference
Figure 1: Common Complaints among patients with cardiovascular risk factors
Palpitation
60
50
40
30
20
10
0
Easy
fatigue
Dyspnea
NYHA 1
Dyspnea
NYHA 2
Dyspnea
NYHA 3
chest pain

10. 134 Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
91
69
36
16
6
0
10
20
30
40
50
60
70
80
90
100
HTN NIDDM IHD CHF PVD
%
Figure 2: Current illnesses among patients
with cardiovascular risk factors
HTN; Hypertension. NIDDM: Non Insulin
Dependent Diabetes Mellitus, IHD; Ischemic
Heart Disease, CHF; Congestive heart failure
and PVD; Peripheral vascular diseases
Figure 3: Biochemical profile
among patients with cardiovascular
risk factors
183
141
169
8.2 4.6
0
20
40
60
80
100
120
140
160
180
200
PPBS
(mg/dl)
Na (mg/dl) FBS (mg/dl) uric acid
(mg/dl)
K (mg/dl)
Mean
153
118
92.8 86.9
38.1
0
20
40
60
80
100
120
140
160
BPr s
(mmHg)
W C (cm) BPr d
(mmHg)
Pulse
(bpm)
BMI
(kg/m2)
Mean
Figure 4: Main clinical fea-
tures among patients with
cardiovascular risk factors

11. 135Volume 9, Number 3, 2010 • CLINICAL DIABETES (MIDDLE EAST EDITION)
L O C A L A R T I C L E S
Parameters
BMI (kg/m2) Waist
circumference (cm)
R value R value R value R value
FBS (mg/dl) 0.192(**) .003 0.009(*) 0.30
HDL (mg/dl) 0.276(**) 0.01 0.193(*) 0.02
TG (mg/dl 0.152(*) 0.013 0.217(*) 0.04
PPBS 0.163(*) 0.016 0.171(**) 0.0039
Uric acid (mg/dl) 0.116 0.092 0.355(*) 0.01
Table 3:Relation between metabolic profile of the Car-
diovascular risk factors characteristics and obesity
Parameters
Family history of hypertension
P valueYes No
Mean ±S.D. Mean ±S.D.
Age 53.5 7.7 55.3 7.8 0.6
BMI (kg/m2) 39.6 3.5 37.8 1.7 0.04*
Waist circumference (cm) 120.4 7.9 113.5 5.6 0.03*
FBS (mg/dl) 138.8 11.6 136.0 5.5 0.72
PPBS 183.7 16.1 179.3 22.0 0.9
BPr s (mmHg) 159.3 10.4 153.3 9.2 0.028*
BPr d (mmHg) 95.3 6.4 90.0 5.6 0.007*
TG (mg/dl) 244.4 36.4 235.0 27.3 0.01*
HDL (mg/dl) 33.5 3.2 36.9 2.7 0.02*
Table 4: Relation between family history of hypertension and the Cardiovascular risk factors

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L O C A L A R T I C L E S
Figure 5: Percentage of Cardiovascular e risk factors referred from different areas
17.9%
Delta
26.4%
Upper Egypt
18.6%
Coastal areas
37.1%
Greater Cairo
Greater Cairo
Coastal areas
Upper Egypt
Egypt Delta
Figure 6: Percentage of males and females diagnosed with cardiovascular
disease risk factors referred from different areas
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