Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study

Journal of Human Hypertension volume 21, pages 76–85 (2007)Cite this article

Abstract

Older age and low socio-economic conditions are associated with poor control of cardiovascular risk factors (RFs). We assessed the prevalence and awareness of cardiovascular RFs in 503 elderly outpatients of low social status attending two public Internal Medicine clinics in Naples, and studied the interaction of education and employment level with risk profile. The therapeutic intervention was oriented to improve patients' motivation through a positive patient–physician relationship, in keeping with the current guidelines for hypertension. The effect of treatment was evaluated by comparing retrospectively the level of cardiovascular RFs at baseline and at the last follow-up examination performed within 31 October 2005. Only 33.3% of patients (age=68±6 years) had attended primary school. Overall (current or previous) employment level was also low. Obesity, hypertension and dyslipidaemias were present in most patients, diabetes in 17.3% of them. In all 8.0% of hypertensives, 16.1% of diabetics and 24.7% of dyslipidaemics were unaware of their diseases. Cardiovascular risk profile was worse at lower educational and employment levels. Odds ratios for the metabolic syndrome were 0.28 (95% confidence interval (CI)=0.15–0.52) and 0.35 (0.20–0.62) in the most qualified of three education and employment groups, respectively, compared to the lowest ones. The level of all cardiovascular RFs was effectively reduced during treatment. Control rate of most RFs improved significantly (for hypertension, from 12.8 to 36.5%, P<0.001). These patients had a high prevalence of cardiovascular RFs, which correlated with their educational and work activity levels. Awareness of their health status was unsatisfactory. Treatment, specifically addressing patient–physician relationship, favourably affected cardiovascular risk profile.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Hyman DJ, Pavlik VN . Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345: 479–486.

    Article  CAS  Google Scholar 

  2. Shah S, Cook DG . Inequalities in the treatment and control of hypertension: age, social isolation and lifestyle are more important than economic circumstances. J Hypertens 2001; 19: 1333–1340.

    Article  CAS  Google Scholar 

  3. Chapman RH, Benner JS, Petrilla AA, Tierce JC, Collins SR, Battleman DS et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med 2005; 165: 1147–1152.

    Article  Google Scholar 

  4. Boden-Albala B, Litwak E, Elkind MS, Rundek T, Sacco RL . Social isolation and outcomes post stroke. Neurology 2005; 64: 1888–1892.

    Article  CAS  Google Scholar 

  5. Bachmann MO, Eachus J, Hopper CD, Davey Smith G, Propper C, Pearson NJ et al. Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabetic Medicine 2003; 20: 921–929.

    Article  CAS  Google Scholar 

  6. Mayer Jr O, Šimon J, Heidrich J, Cokkinos DV, De Bacquer D . Educational level and risk profile in the EUROASPIRE II substudy. J Epidemiol Community Health 2004; 58: 47–52.

    Article  Google Scholar 

  7. Rutledge T, Reis SE, Olson M, Owens J, Kelsey SF, Pepine CJ et al. Socioeconomic status variables predict cardiovascular disease risk factors and prospective mortality risk among women with chest pain. The Wise Study. Behav Modif 2003; 27: 54–67.

    Article  Google Scholar 

  8. Neuwirth ZE . Physician empathy – should we care? Lancet 1997; 350: 606.

    Article  CAS  Google Scholar 

  9. Rosengren A, Hawken S, Ôunpuu S, Sliwa K, Zubaid M, Almahmeed WA et al., for the INTERHEART investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls fron 52 countries (the INTERHEART study): case–control study. Lancet 2004; 364: 953–962.

    Article  Google Scholar 

  10. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al., and the National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42: 1206–1252.

    Article  CAS  Google Scholar 

  11. Martin DJ, Garske JP, Davis MK . Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 2000; 68: 438–450.

    Article  CAS  Google Scholar 

  12. European Society of Hypertension – European Society of Cardiology Guidelines Committee. 2003 guidelines for the management of arterial hypertension. J Hypertension 2003; 21: 1011–1053.

  13. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20: 1183–1197.

  14. Executive summary of the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

  15. Alberti KGMM, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – a new worldwide definition. Lancet 2005; 366: 1059–1062.

    Article  Google Scholar 

  16. SPSS for Windows. http://www.spss.com/spss.

  17. Vannoni F, Spadea T, Frasca G, Tumino R, Demaria M, Sacerdote C et al. Association between social class and food consumption in the Italian EPIC population. Tumori 2003; 89: 669–678.

    Article  Google Scholar 

  18. Seccareccia F, Zuccaro P, Farchi G, Giampaoli S, Vanuzzo D . e Gruppo di Ricerca dell'Osservatorio Epidemiologico Cardiovascolare. Fumo e prevenzione delle malattie cardiovascolari in Italia. Ital Heart J Suppl 2000; 1: 910–918.

    CAS  PubMed  Google Scholar 

  19. Celentano E, Palmieri L, Galasso R, Poce A, Panico S, Giampaoli S . Cardiovascular risk factors and social classes: a comparison between adult female populations in rural and urban areas. G Ital Cardiol 1999; 29: 692–697.

    CAS  PubMed  Google Scholar 

  20. Cirera L, Tormo MJ, Chirlaque MD, Navarro C . Cardiovascular risk factors and educational attainment in Southern Spain: a study of a random sample of 3091 adults. Eur J Epidemiol 1998; 14: 755–763.

    Article  CAS  Google Scholar 

  21. Giampaoli S, Palmieri L, Dima F, Pilotto L Vescio MF, Vanuzzo D, a nome del Gruppo di Ricerca dell'Osservatorio Epidemiologico Cardiovascolare. Aspetti socio-economici e fattori di rischio cardiovascolare: l'esperienza dell'Osservatorio Epidemiologico Cardiovascolare. Ital Heart J Suppl 2001; 2: 294–302.

    CAS  PubMed  Google Scholar 

  22. Appel LJ . Lifestyle modification as a means to prevent and treat high blood pressure. J Am Soc Nephrol 2003; 14: S99–S102.

    Article  Google Scholar 

  23. de Koning JS, Klazinga N, Koudstaal PJ, Prins A, Borsboom GJ, Peeters A et al. Deprivation and systematic stroke prevention in general practice: an audit among general practitioners in the Rotterdam region, The Netherlands. Eur J Public Health 2003; 13: 340–346.

    Article  Google Scholar 

  24. Mancia G, Volpe R, Boros S, Ilardi M, Giannattasio C . Cardiovascular risk profile and blood pressure control in Italian hypertensive patients under specialist care. J Hypertens 2004; 22: 51–57.

    Article  CAS  Google Scholar 

  25. de Gaudemaris R, Lang T, Chatellier G, Larabi L, Lauwers-Cancès V, Maître A et al. Socioeconomic inequalities in hypertension prevalence and care. The IHPAF study. Hypertension 2002; 39: 1119–1125.

    Article  CAS  Google Scholar 

  26. Pekkanen J, Tuomilehto J, Uutela A, Vartiainen E, Nissinen A . Social class, health behaviour, and mortality among men and women in eastern Finland. BMJ 1995; 311: 589–593.

    Article  CAS  Google Scholar 

  27. Diez-Roux AV, Northridge ME, Morabia A, Bassett MT, Shea S . Prevalence and social correlates of cardiovascular disease risk factors in Harlem. Am J Public Health 1999; 89: 302–307.

    Article  CAS  Google Scholar 

  28. Lidfeldt J, Nyberg P, Nerbrand C, Samsioe G, Schersten B, Agardh CD . Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes Obes Metab 2003; 5: 106–112.

    Article  CAS  Google Scholar 

  29. Cuspidi C, Meani S, Fusi V, Severgnini B, Valerio C, Catini E et al. Metabolic syndrome and target organ damage in untreated essential hypertension. J Hypertens 2004; 22: 1991–1998.

    Article  CAS  Google Scholar 

  30. Mulè G, Nardi F, Cottone S, Cusimano P, Volpe V, Piazza G et al. Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257: 503–513.

    Article  Google Scholar 

  31. Eckel RH, Grundy SM, Zimmet PZ . The metabolic syndrome. Lancet 2005; 365: 1415–1428.

    Article  CAS  Google Scholar 

  32. Carnethon MR, Loria CM, Hill JO, Sidney S, Savage PJ, Liu K . Risk factors for the metabolic syndrome. The Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001. Diabetes Care 2004; 27: 2707–2715.

    Article  Google Scholar 

  33. Wamala SP, Lynch J, Horsten M, Mittleman MA, Schenck-Gustaffson K, Orth-Gomér K . Education and the metabolic syndrome in women. Diabetes Care 1999; 22: 1999–2003.

    Article  CAS  Google Scholar 

  34. Dallongeville J, Cottel D, Ferrières J, Arveiler D, Bingham A, Ruidavets JB et al. Household income is associated with the risk of metabolic syndrome in a sex-specific manner. Diabetes Care 2005; 28: 409–415.

    Article  Google Scholar 

  35. Alegrìa E, Cordero A, Laclaustra M, Grima A, León M, Casanovas JA et al. Prevalence of metabolic syndrome in the Spanish working population: MESYAS registry. Rev Esp Cardiol 2005; 58: 797–806.

    Article  Google Scholar 

  36. Stelmach W, Kaczmarczyk-Chalas K, Bielecki W, Drygas W . How education, income, control over life and life style contribute to risk factors for cardiovascular disease among adults in a post-communist country. Public Health 2005; 119: 498–508.

    Article  CAS  Google Scholar 

  37. Kim MH, Kim MK, Choi BY, Shin YJ . Educational disparities in the metabolic syndrome in a rapidly changing society. The case of South Korea. Int J Epidemiol 2005; 34: 1266–1273.

    Article  Google Scholar 

  38. World Health Organization. World Health Report 2005 – make every mother and child count. Geneva 2005. http://www.who.int/whr/2005/en (accessed on 11 September 2005).

  39. Swales JD . Current status of hypertensive disease treatment: results from the Evaluation and Interventions for Systolic Blood pressure Elevation: Regional and Global (EISBERG) project. J Hypertens Suppl 1999; 17: S15–S19.

    Article  CAS  Google Scholar 

  40. Lloyd-Jones DM, Evans JC, Levy D . Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA 2005; 294: 466–472.

    Article  CAS  Google Scholar 

  41. Mancia G, Ambrosioni E, Agabiti-Rosei E, Leonetti G, Trimarco B, Volpe M, ForLife study group. Blood pressure control and risk of stroke in untreated and treated hypertensive patients screened from clinical practice: results of the ForLife study. J Hypertens 2005; 23: 1575–1581.

    Article  CAS  Google Scholar 

  42. Mancia G, Pessina AC, Trimarco B, Grassi G ; SILVIA (Studio Italiano Longitudinale sulla Valutazione della Ipertensione Arteriosa nel 2000) Study Group. Blood pressure control according to the new guidelines targets in low- to high-risk hypertensives managed in specialist practice. J Hypertens 2004; 22: 2387–2396.

    Article  CAS  Google Scholar 

  43. Abraha I, Montedori A, Stracci F, Rossi M, Romagnoli C . Statin compliance in the Umbrian population. Eur J Clin Pharmacol 2003; 59: 659–661.

    Article  CAS  Google Scholar 

  44. Cuspidi C, Lonati L, Sampieri L, Macca G, Valagussa L, Zaro T et al. Blood pressure control in a hypertension hospital clinic. J Hypertens 1999; 17: 835–841.

    Article  CAS  Google Scholar 

  45. Bansal N, Tendler BE, White WB, Mansoor GA . Blood pressure control in the hypertension clinic. Am J Hypertens 2003; 16: 878–880.

    Article  Google Scholar 

  46. Ohta Y, Tsuchihashi T, Fujii K, Matsumura K, Ohya Y, Uezono K et al. Improvement of blood pressure control in a hypertension clinic: a 10-year follow-up study. J Hum Hypertens 2004; 18: 273–278.

    Article  CAS  Google Scholar 

  47. Lied TR, Kazandjan VA . A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care 1998; 6: 201–204.

    CAS  PubMed  Google Scholar 

  48. Wood D, DeBacker G, Faergeman O, Graham I, Mancia G, Pyöralä K, For the Task Force. Prevention of coronary heart disease in clinical practice: recommendations of the second joint Task Force of European and other Societies on coronary prevention. Atherosclerosis 1998; 140: 199–270.

    Article  CAS  Google Scholar 

  49. Hojat M, Gonnella JS, Nasca T, Mangione S, Vergare M, Magee M . Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002; 159: 1563–1569.

    Article  Google Scholar 

  50. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J . Influence of context effects on health outcomes: a systematic review. Lancet 2001; 357: 757–762.

    Article  CAS  Google Scholar 

  51. Medical Professionalism Project. Medical professionalism in the new millennium: a physicians' charter. Lancet 2002; 359: 520–522.

  52. Royal College of Physicians. Doctors in Society: Medical Professionalism in a Changing World. RCP: London, 2005.

  53. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JAC et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–732.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Mrs Rosanna Scala for her careful language revision.

Author information

Authors and Affiliations

  1. Azienda Sanitaria Locale Napoli 1, Unità Operativa Assistenza Sanitaria di Base, Naples, Italy

    T Marotta

  2. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    S Viola, F Ferrara & L A Ferrara

Authors
  1. T Marotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Viola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Ferrara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L A Ferrara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T Marotta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marotta, T., Viola, S., Ferrara, F. et al. Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study. J Hum Hypertens 21, 76–85 (2007). https://doi.org/10.1038/sj.jhh.1002098

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002098

Keywords

This article is cited by

Search

Advanced search

Quick links