Trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes (1993–2003)

Abstract

Previous studies have observed high prevalences of high blood pressure (HBP), high blood cholesterol (HBC), obesity, and sedentary lifestyle among Spanish diabetic adults. These cardiovascular risk factors and unhealthy lifestyle behaviors occur more often in subjects with diabetes than in the general population. The aim of this study was to examine the trends in cardiovascular risk factors and lifestyle behaviors among Spanish adults with diabetes over the decade 1993–2003.

Methods

We used individualized data drawn from the 1993 (N=20,880) and 2003 (N=21,650) Spanish National Health Surveys. Subjects were classified as diabetes sufferers if they answered affirmatively to either or both of the following questions: “Has your doctor told you that you are currently suffering from diabetes?” and/or, “Have you taken any medication to treat diabetes in the last two weeks?” Cardiovascular risk factors analyzed included self-reported HBP and HBC. Lifestyle behaviors included obesity (body mass index ≥30), smoking status, and physical activity. We estimated and compared the prevalences and analyzed the time trends using logistic regression models.

Results

In both years studied, the prevalence of obesity and sedentary lifestyle was significantly higher among persons with than among those without diabetes, and current smoking was less frequent. The proportions of diabetes patients with HBP and obesity increased significantly from 39.5% and 20.1% in 1993 to 46.7% and 29.8% in 2003, with adjusted odds ratios of 1.32 (95% CI 1.07–1.62) for HBP and 1.88 (95% CI 1.44–2.46) for obesity.

Conclusions

The overall prevalence of cardiovascular risk factors and unhealthy lifestyle behaviors among diabetes patients has shown no improvement in the decade 1993–2003, and there have been significant setbacks, in particular the rise in obesity and HBP.

Introduction

Heart disease is the most frequent cause of death among persons with diabetes (Centers for Disease Control and Prevention, 2003, Haffner et al., 1998 Adults with diabetes have heart disease mortality rates approximately two to four times higher than those of adults without diabetes, and their risk of stroke is likewise two- to fourfold higher (Centers for Disease Control and Prevention, 2003, Haffner et al., 1998).

Based on the results of major clinical trials, the American Diabetes Association (ADA) recommends that individuals with diagnosed diabetes should tightly control glycemia, high blood pressure (HBP), and blood lipid levels, in order to prevent acute complications and reduce the risk of long-term complications; and in the case of overweight and obese individuals, the ADA additionally recommends that such subjects lose weight. All individuals with diabetes should also engage in regular physical activity and cease smoking (American Diabetes Association, 2007).

Prevalence of diabetes mellitus in the Spanish general population is approximately 5–6%, a figure that increases with the aging of the population (Jimenez-Garcia et al., 2008, Oliva et al., 2004). Several studies have observed high prevalences of cardiovascular risk factors and unhealthy lifestyle behaviors among Spanish diabetic adults (Botas Cervero et al., 2002, Castell et al., 1999, Lahoz-Rallo et al., 2007, Larranaga et al., 2005, Masia et al., 2004, Orozco-Beltrán et al., 2007). These authors report that HBP, high blood cholesterol level (HBC), obesity, and sedentary lifestyle occur more often in subjects with diabetes than in the general population (Arteagoitia et al., 2003, Botas Cervero et al., 2002, Castell et al., 1999, Lahoz-Rallo et al., 2007, Larranaga et al., 2005, Masia et al., 2004, Orozco-Beltrán et al., 2007).

The aim of this study was to examine the trends in self-reported cardiovascular risk factors and lifestyle behaviors among adults with diabetes in Spain over the course of a decade, using data from two national health surveys conducted in 1993 and 2003, respectively. Specifically, HBP, HBC, obesity, tobacco use, and sedentary lifestyle were analyzed.

To our knowledge, our study is the first nationwide study to examine time trends in cardiovascular risk factors and modifiable lifestyle behaviors among persons with diabetes in Spain.