Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxembourg: findings from ORISCAV-LUX study.

BACKGROUND: In the absence of evidence-based information, assessment of population awareness and management of diabetes, hypertension and dyslipidemia (treatable and preventable cardiovascular risk factors) are important to halt coronary and cerebrovascular diseases and to improve public health. METHODS: The analysis was based on a nationally representative sample of 1432 adult subjects, recruited for the ORISCAV-LUX survey (2007-2008). Descriptive and multivariable logistic regression analyses were performed. The 10-year Framingham risk score was calculated for each participant who classified at low, intermediate and high risk. RESULTS: Among the diagnosed cases, 32%, 60%, and 85% were respectively unaware of their diabetes, hypertension and dyslipidemia. Increasing age and BMI were the strongest protective factors against unawareness of hypertension and dyslipidemia. Having a family history decreased the risk of unawareness of hypertension (OR = 0.57; 95% CI 0.36, 0.92; P = 0.021), whereas, not having a family doctor increased double-fold the odd of being unaware of hypertension (P = 0.048). Poor health perception reduced significantly the risk of unawareness of dyslipidemia (OR = 0.27; 95% CI 0.11, 0.68). Concerning the management, diabetes was markedly better treated than hypertension and dyslipidemia. Among diabetic subjects (constituting 4% of the population), 3% were treated vs. 1% not treated. In contrast, 22% of the hypertensive participants (35% of the population) were not treated vs. 13% treated. Concerning dyslipidemia, only 9% of those with lipid disorder (70% of the population) were under medication vs. 61% not treated. For the treated cases of these pathologies, almost only one-third was under control. Framingham risk of developing CHD within 10 years was moderate to high among 62%, 27%, and 17% of the unaware/untreated diabetic, hypertensive, and dyslipidemic participants, respectively. CONCLUSION: The considerable lack of awareness and insufficient management underscore the urgent need for intensive efforts to reduce the gap in prevention strategies, and control of cases according to explicit clinical guidelines.

Acculturation, immigration status and cardiovascular risk factors among Portuguese immigrants to Luxembourg: findings from ORISCAV-LUX study.

BACKGROUND: No previous study has examined the prevalence of cardiovascular risk factors and explored the influence of immigration status and acculturation on overweight/obesity among the Portuguese immigrants to Luxembourg. Our objectives were to (1) compare the prevalence of cardiovascular risk factors between native Luxembourgers and Portuguese immigrants, (2) examine the relationship between immigrant generation status, proportion of life spent in Luxembourg and language proficiency or preference (as proxy variables of acculturation) and overweight/obesity among Portuguese immigrants, and (3) elucidate the role of underlying socioeconomic, behavioral and dietary factors in overweight/obesity differences among the two populations. METHODS: Recent national cross-sectional data from ORISCAV-LUX survey 2007-2008, composed of 843 subjects were analyzed. Overweight/obesity was defined as body mass index (BMI) >25 kg/m(2). Acculturation score was measured by using immigrant generation status, proportion of life spent in Luxembourg, and language proficiency or preference. Univariable and multivariable logistic regression analyses were performed to examine the association between acculturation markers and overweight/obesity. Further, a series of successive models were fitted to explore the separated and added impact of potential mediators (socioeconomic status, physical activity, dietary factors) on overweight/obesity among Luxembourgers and Portuguese immigrants. RESULTS: Compared to Luxembourgers, Portuguese immigrants of first and second generation were younger and currently employed. About 68% of first generation Portuguese had only primary school, and about 44% were living below poverty threshold. Although the cardiovascular risk factors were comparable, Portuguese immigrants were more frequently overweight and obese than Luxembourgers, even after age and gender standardization to the European population. Overweight/obesity was significantly higher among Portuguese of first generation compared to second generation (P=0.028). Although we observed a tendency of lower risk with higher acculturation, none of the acculturation markers, both individually and taken together as a score, was statistically significant after controlling for age and gender. Compared to Luxembourgers, odds of overweight/obesity were significantly higher among Portuguese immigrants, in unadjusted model 1 (P=0.043), in age and gender-adjusted model 2 (P<0.0001), in socioeconomic status adjusted model 3 (P= 0.01), in physical activity adjusted model 4 (P=0.007). However, this difference was attenuated and statistically disappeared after controlling for dietary factors (P=0.09). CONCLUSIONS: These findings address a lack of heterogeneity between Portuguese immigrants and Luxembourgers regarding hypertension, hyperlipidemia, diabetes mellitus, physical inactivity, and current cigarette smoking. However, Portuguese immigrants to Luxembourg were more likely to be overweight/obese than Luxembourgers participants. This risk may be explained by different dietary practice. An in-depth comparative assessment of dietary habits of Luxembourgers and Portuguese immigrants is warranted.