EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS
Autor(a) principal: | |
---|---|
Data de Publicação: | 2023 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.58043/rphrc.48 |
Resumo: | Introduction: Cerebrovascular diseases (CerVD) are the first and second cause of dead among women and men, respectively, in industrialized countries. The main cardiovascular risk factor (CVRF) is hypertension. This information is provided by large international cohorts, however, local reality can be different and remains uncharacterized. We seek to clarify the association of CVRF and CerVD coding in a primary care setting, to tune the risk perception of professionals and its transmission to the patients. Methods: observational retrospective study with exploratory data analysis, in an anonymized convenience sample of a primary care setting, with 18 years or above and at least one arterial systolic pressure (ASP) evaluation registered before 31/12/2018. We considered CerVD the ICPC-2 coding in MIMUF until the mentioned date, with K89 – transient cerebral ischemia, K90 – thrombosis/stroke and K91 – cerebrovascular disease. We characterized the registered CVRF (age, ASP, arterial diastolic pressure (ADP), total cholesterol (TC), high density lipoprotein cholesterol (HDL), triglycerides, obesity, smoking, dyslipidemia and diabetes) through histograms for the continuous variables and cardinality diagrams of CVRF combinations partitioned boxplots, produced in R 3.4.2 software. For the multivariate analysis of CerVD case associations according to the combination of CVRF, we created a logistic regression model with the major CVRF. Results: We included 8.769 individuals for analysis, mean age 53,43 years, mainly females (58,5%), of whom 278 with CerVd. The sample included 41,8% individuals with dyslipidemia, 35,0% with hypertension, 21,5% with obesity, 18,4% smokers and 12,6% diabetics. The most frequent CVRF was the combination of hypertension + dyslipidemia, followed by isolated smoking and dyslipidemia. We observed a prevalence of 3,2% for CerVD, including 2,0% for stroke. Hypertension, diabetes and dyslipidemia prevalence was higher in the presence of CerVD, while obesity and smoking prevalence was lower. Systolic and diastolic pressure were higher in males and those with CerVD, whose majority had a systolic pressure above 140 mmHg (54%). Coding of CerVD had a later in life peak in women (80-90 years) compared to men (70-80 years). The logistic regression model did not retrieve any significant differences between the predicted and observed results (Hosmer-Lemeshow, chi-square=6.5781; df=8; p=0.5828) and included the following predictors: age, female gender, smoking, diabetes, hypertension, dyslipidemia and obesity. According to our model the odds of a given case to be coded for CerVD is: 1/[1+exp(-z)], where z = -7.00757 - 0.08618(female gender) + 0.04785(age) + 0.22364(smoking) - 0.35407 (diabetes) + 0.88350(hypertension) + 0.38920(dyslipidemia) -0.23875(obesity) and exp(x) is the natural exponential of x. Based on this model the odds ratio did not include the unit for the predictors age, dyslipidemia and hypertension, for which we can affirm the association. Discussion: The results are in line with the raw prevalence of estimated stroke in Portugal. Also, CVRF distribution in congruent with international descriptions. It is relevant that 54% of the patients coded with CerVD present with systolic pressure above 140 mmHg, probably representing a sub-optimal control of this CVRF after event. The regression model is valid to our sample, and showed that age (p<0,00001), hypertension (p<0,001) and dyslipidemia (p<0,05) are associated with CerVd coding in a primary care center. The conclusions are limited to our sample, given it is an observational, exploratory and unicentric study, subjected to problem coding by the clinicians. |
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EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTSANÁLISE EXPLORATÓRIA DA ASSOCIAÇÃO DE FATORES DE RISCOCARDIOVASCULARESEMDOENTESCOMESEMDOENÇA CEREBROVASCULARIntroduction: Cerebrovascular diseases (CerVD) are the first and second cause of dead among women and men, respectively, in industrialized countries. The main cardiovascular risk factor (CVRF) is hypertension. This information is provided by large international cohorts, however, local reality can be different and remains uncharacterized. We seek to clarify the association of CVRF and CerVD coding in a primary care setting, to tune the risk perception of professionals and its transmission to the patients. Methods: observational retrospective study with exploratory data analysis, in an anonymized convenience sample of a primary care setting, with 18 years or above and at least one arterial systolic pressure (ASP) evaluation registered before 31/12/2018. We considered CerVD the ICPC-2 coding in MIMUF until the mentioned date, with K89 – transient cerebral ischemia, K90 – thrombosis/stroke and K91 – cerebrovascular disease. We characterized the registered CVRF (age, ASP, arterial diastolic pressure (ADP), total cholesterol (TC), high density lipoprotein cholesterol (HDL), triglycerides, obesity, smoking, dyslipidemia and diabetes) through histograms for the continuous variables and cardinality diagrams of CVRF combinations partitioned boxplots, produced in R 3.4.2 software. For the multivariate analysis of CerVD case associations according to the combination of CVRF, we created a logistic regression model with the major CVRF. Results: We included 8.769 individuals for analysis, mean age 53,43 years, mainly females (58,5%), of whom 278 with CerVd. The sample included 41,8% individuals with dyslipidemia, 35,0% with hypertension, 21,5% with obesity, 18,4% smokers and 12,6% diabetics. The most frequent CVRF was the combination of hypertension + dyslipidemia, followed by isolated smoking and dyslipidemia. We observed a prevalence of 3,2% for CerVD, including 2,0% for stroke. Hypertension, diabetes and dyslipidemia prevalence was higher in the presence of CerVD, while obesity and smoking prevalence was lower. Systolic and diastolic pressure were higher in males and those with CerVD, whose majority had a systolic pressure above 140 mmHg (54%). Coding of CerVD had a later in life peak in women (80-90 years) compared to men (70-80 years). The logistic regression model did not retrieve any significant differences between the predicted and observed results (Hosmer-Lemeshow, chi-square=6.5781; df=8; p=0.5828) and included the following predictors: age, female gender, smoking, diabetes, hypertension, dyslipidemia and obesity. According to our model the odds of a given case to be coded for CerVD is: 1/[1+exp(-z)], where z = -7.00757 - 0.08618(female gender) + 0.04785(age) + 0.22364(smoking) - 0.35407 (diabetes) + 0.88350(hypertension) + 0.38920(dyslipidemia) -0.23875(obesity) and exp(x) is the natural exponential of x. Based on this model the odds ratio did not include the unit for the predictors age, dyslipidemia and hypertension, for which we can affirm the association. Discussion: The results are in line with the raw prevalence of estimated stroke in Portugal. Also, CVRF distribution in congruent with international descriptions. It is relevant that 54% of the patients coded with CerVD present with systolic pressure above 140 mmHg, probably representing a sub-optimal control of this CVRF after event. The regression model is valid to our sample, and showed that age (p<0,00001), hypertension (p<0,001) and dyslipidemia (p<0,05) are associated with CerVd coding in a primary care center. The conclusions are limited to our sample, given it is an observational, exploratory and unicentric study, subjected to problem coding by the clinicians.Introdução: As doenças cerebrovasculares (DCerV) são a primeira causa de mortalidade em mulheres e a segunda causa de morte em homens nos países industrializados. O principal fator de risco cardiovascular (FRCV) é a hipertensão arterial (HTA). Esta informação advém de grandes cohorts internacionais, mas a realidade local poderá ser diferente e não se encontra caracterizada. Procurámos assim clarificar a associação de FRCV com a codificação de DCerV numa unidade de saúde familiar (USF), para afinar a perceção de risco pelos profissionais e a sua transmissão aos utentes. Métodos: Estudo observacional retrospetivo com análise exploratória de dados (EDA), numa amostra de conveniência anonimizada de utentes de uma USF, com 18 ou mais anos e pelo menos uma medição da pressão arterial sistólica (PAS) registada até 31/12/2018. Considerámos DCerV a codificação com K89 - isquémia cerebral transitória, K90 - trombose/acidente vascular cerebral (AVC) e K91 - doença vascular cerebral, no MIMUF até essa data. Caracterizámos os FRCV registados (idade, PAS, pressão arterial diastólica (PAD), colesterol total (CT), colesterol de lipoproteínas de alta densidade (HDL), triglicerídeos, obesidade, tabagismo, dislipidemia e diabetes mellitus (DM)) através de histogramas para as variáveis contínuas e boxplots das mesmas, particionadas por combinações de FRCV em diagramas de cardinalidade, produzidos em software R* 3.4.2. Para a análise multivariada da associação dos casos com DCerV tendo em conta a combinação de FRCV, criámos um modelo de regressão logística com os FRCV major. Resultados: Foram incluídos 8.769 indivíduos, com média de 53,43 anos, maioritariamente do género feminino (58,5%), dos quais 278 com DCerV. Na amostra havia 41,8% de indivíduos com dislipidemia, 35,0% hipertensos, 21,5% com obesidade, 18,4% com tabagismo e 12,6% de diabéticos. O FRCV mais frequente foi a combinação de HTA + dislipidemia, seguido de tabagismo e de dislipidemia isolados. Obtivemos uma prevalência de DCerV de 3,2%, incluindo 2,0% com acidente vascular cerebral (AVC). A prevalência de HTA, DM e dislipidemia foi superior na presença de DCerV, contudo a prevalência de obesidade e tabagismo foi inferior. A PAS e PAD era superior no género masculino e naqueles com DCerV, que se encontravam na sua maioria com PAS ≥ 140mmHg (54,0%). A codificação de DCerV foi mais tardia nas mulheres (pico 80-90 anos) que nos homens (pico 70-80 anos). O modelo de regressão logística não apresentou diferenças significativas entre os resultados previstos e as observações da amostra (teste Hosmer-Lemeshow, X2=6.5781; df=8; p=0.5828) e incluiu as variáveis preditoras: idade, género feminino, tabagismo, DM, HTA, dislipidemia e obesidade. De acordo com o modelo a probabilidade de um dado caso apresentar codificação de DCerV é de: 1/[1+exp(-z)], em que z = -7.00757 - 0.08618(género feminino) + 0.04785(idade) + 0.22364(tabagismo) - 0.35407(DM) + 0.88350(HTA) + 0.38920(dislipidemia) - 0.23875(obesidade) e exp(x) é a função exponencial natural de x. Com base nesse modelo a razão de chances não incluiu a unidade para as variáveis: idade, dislipidemia e HTA, pelo que apenas com estas se pode afirmar o sentido da associação. Discussão: Os resultados estão em linha com a prevalência bruta de AVC estimada em Portugal. Também a distribuição dos FRCV é congruente com o descrito internacionalmente. É relevante que 54% dos utentes codificados com DCerV apresentem PAS ≥ 140 mmHg, podendo significar um controlo subótimo deste FRCV após evento. O modelo de regressão é válido para a nossa amostra, e mostrou que a idade (p<0,00001), a HTA (p<0,001) e a dislipidemia (p<0,05) estão associados ao registo de DCerV numa USF. As conclusões são limitadas à presente amostra não podendo ser generalizadas por ser um estudo exploratório, unicêntrico, observacional e sujeito à existência de codificação dos problemas pelos clínicos.Revista Portuguesa de Hipertensão e Risco Cardiovascular2023-02-13info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.58043/rphrc.48https://doi.org/10.58043/rphrc.48Revista Portuguesa de Hipertensão e Risco Cardiovascular; N.º 90 (2022): Julho/Agosto; 30-391646-8287reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revistahipertensao.pt/index.php/rh/article/view/48https://revistahipertensao.pt/index.php/rh/article/view/48/64Direitos de Autor (c) 2023 André Gomes Roque, Lara Cabrita, Ana João Taveira, Pedro Damião, Eliana Bonifácioinfo:eu-repo/semantics/openAccessGomes Roque, AndréCabrita, LaraTaveira, Ana JoãoDamião, PedroBonifácio, Eliana2024-02-03T07:36:49Zoai:ojs.revistahipertensao.pt:article/48Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:46:56.559539Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS ANÁLISE EXPLORATÓRIA DA ASSOCIAÇÃO DE FATORES DE RISCOCARDIOVASCULARESEMDOENTESCOMESEMDOENÇA CEREBROVASCULAR |
title |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
spellingShingle |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS Gomes Roque, André |
title_short |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
title_full |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
title_fullStr |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
title_full_unstemmed |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
title_sort |
EXPLORATORY ANALYSIS OF CARDIOVASCULAR RISK FACTORS ASSOCIATION IN PRIMARY CARE PATIENTS WITH OR WITHOUT CEREBROVASCULAR EVENTS |
author |
Gomes Roque, André |
author_facet |
Gomes Roque, André Cabrita, Lara Taveira, Ana João Damião, Pedro Bonifácio, Eliana |
author_role |
author |
author2 |
Cabrita, Lara Taveira, Ana João Damião, Pedro Bonifácio, Eliana |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Gomes Roque, André Cabrita, Lara Taveira, Ana João Damião, Pedro Bonifácio, Eliana |
description |
Introduction: Cerebrovascular diseases (CerVD) are the first and second cause of dead among women and men, respectively, in industrialized countries. The main cardiovascular risk factor (CVRF) is hypertension. This information is provided by large international cohorts, however, local reality can be different and remains uncharacterized. We seek to clarify the association of CVRF and CerVD coding in a primary care setting, to tune the risk perception of professionals and its transmission to the patients. Methods: observational retrospective study with exploratory data analysis, in an anonymized convenience sample of a primary care setting, with 18 years or above and at least one arterial systolic pressure (ASP) evaluation registered before 31/12/2018. We considered CerVD the ICPC-2 coding in MIMUF until the mentioned date, with K89 – transient cerebral ischemia, K90 – thrombosis/stroke and K91 – cerebrovascular disease. We characterized the registered CVRF (age, ASP, arterial diastolic pressure (ADP), total cholesterol (TC), high density lipoprotein cholesterol (HDL), triglycerides, obesity, smoking, dyslipidemia and diabetes) through histograms for the continuous variables and cardinality diagrams of CVRF combinations partitioned boxplots, produced in R 3.4.2 software. For the multivariate analysis of CerVD case associations according to the combination of CVRF, we created a logistic regression model with the major CVRF. Results: We included 8.769 individuals for analysis, mean age 53,43 years, mainly females (58,5%), of whom 278 with CerVd. The sample included 41,8% individuals with dyslipidemia, 35,0% with hypertension, 21,5% with obesity, 18,4% smokers and 12,6% diabetics. The most frequent CVRF was the combination of hypertension + dyslipidemia, followed by isolated smoking and dyslipidemia. We observed a prevalence of 3,2% for CerVD, including 2,0% for stroke. Hypertension, diabetes and dyslipidemia prevalence was higher in the presence of CerVD, while obesity and smoking prevalence was lower. Systolic and diastolic pressure were higher in males and those with CerVD, whose majority had a systolic pressure above 140 mmHg (54%). Coding of CerVD had a later in life peak in women (80-90 years) compared to men (70-80 years). The logistic regression model did not retrieve any significant differences between the predicted and observed results (Hosmer-Lemeshow, chi-square=6.5781; df=8; p=0.5828) and included the following predictors: age, female gender, smoking, diabetes, hypertension, dyslipidemia and obesity. According to our model the odds of a given case to be coded for CerVD is: 1/[1+exp(-z)], where z = -7.00757 - 0.08618(female gender) + 0.04785(age) + 0.22364(smoking) - 0.35407 (diabetes) + 0.88350(hypertension) + 0.38920(dyslipidemia) -0.23875(obesity) and exp(x) is the natural exponential of x. Based on this model the odds ratio did not include the unit for the predictors age, dyslipidemia and hypertension, for which we can affirm the association. Discussion: The results are in line with the raw prevalence of estimated stroke in Portugal. Also, CVRF distribution in congruent with international descriptions. It is relevant that 54% of the patients coded with CerVD present with systolic pressure above 140 mmHg, probably representing a sub-optimal control of this CVRF after event. The regression model is valid to our sample, and showed that age (p<0,00001), hypertension (p<0,001) and dyslipidemia (p<0,05) are associated with CerVd coding in a primary care center. The conclusions are limited to our sample, given it is an observational, exploratory and unicentric study, subjected to problem coding by the clinicians. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-02-13 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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https://doi.org/10.58043/rphrc.48 https://doi.org/10.58043/rphrc.48 |
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https://doi.org/10.58043/rphrc.48 |
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por |
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https://revistahipertensao.pt/index.php/rh/article/view/48 https://revistahipertensao.pt/index.php/rh/article/view/48/64 |
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info:eu-repo/semantics/openAccess |
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application/pdf |
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Revista Portuguesa de Hipertensão e Risco Cardiovascular |
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Revista Portuguesa de Hipertensão e Risco Cardiovascular |
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Revista Portuguesa de Hipertensão e Risco Cardiovascular; N.º 90 (2022): Julho/Agosto; 30-39 1646-8287 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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