sábado, 9 de agosto de 2014

Preventing Chronic Disease | Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013 - CDC

full-text ►

Preventing Chronic Disease | Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013 - CDC

Preventing Chronic Disease Logo

Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013

Rouham Yamout, MD, MPH; Salim M. Adib, MD, DrPH; Randa Hamadeh, MPH; Alia Freidi, PharmD, MPH; Walid Ammar, MD, PhD

Suggested citation for this article: Yamout R, Adib SM, Hamadeh R, Freidi A, Ammar W. Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013. Prev Chronic Dis 2014;11:140089. DOI:http://dx.doi.org/10.5888/pcd11.140089External Web Site Icon.


In 2012, the Ministry of Public Health in Lebanon piloted a service of multifactorial cardiovascular screening in the publicly subsidized Primary Health Care (PHC) Network. We present an epidemiological analysis of data produced during this pilot to justify the inclusion of this service in the package of essential services offered through PHC and to present a preliminary cardiovascular risk profile in an asymptomatic population.
A total of 4,205 participants (two-thirds of which were women) aged at least 40 years and reportedly free from diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD) were screened. The screening protocol used a questionnaire and direct measurements to assess 5 modifiable cardiovascular risk factors; total cardiovascular risk score was calculated according to a paper-based algorithm developed by the World Health Organization and the International Society of Hypertension.
Approximately 25% of the sample displayed metabolic impairments (11% for impaired blood glucose metabolism and 17% for impaired systolic blood pressure), and 6.6% were classified at total cardiovascular risk of 10% or more. Just over one-quarter of the sample was obese, almost half had a substantially elevated waist circumference, and 41% were smokers. Men were significantly more likely to screen positive for metabolic impairment than women, and women were more likely to be obese.
The implementation of a multifactorial screening for CVD among asymptomatic subjects detected a substantial proportion of previously undiagnosed cases of high metabolic risk, people who could now be referred to optimal medical follow-up.


The pilot phase was supported technically and financially by the WHO country office in Beirut, Lebanon. The authors thank the following colleagues for their input during the design and the implementation of this project: Dr Mohamad Sandid (Director of the National Diabetes Program), Mr Ali Roumani (MOPH Information Technology Manager), and the staff of the MOPH Primary Health Care Department: Ramia Assad, Zeinab Berry, Rabha Charafeddine, Safa Hajj Suleiman, Jaafar Jabak, Wafaa Kanaan, Faten Moustafa, and Fadi Wehbe. The authors also thank Drs Samer Jabbour, Mohamad Samir Arnaout, and Ghassan Hamadeh.

Author Information

Corresponding Author: Rouham Yamout, MD, MPH, Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Telephone: 011-961-374-7031. E-mail: rouham@gmail.com.
Author Affiliations: Salim M. Adib, Faculty of Public Health, Lebanese University, Beirut, Lebanon; Randa Hamadeh, Ministry of Public Health, Beirut, Lebanon; Alia Freidi, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Walid Ammar, Faculty of Health Sciences, American University of Beirut, and Ministry of Public Health, Beirut, Lebanon.


  1. World Health Organization. Cardiovascular diseases (CVDs). Fact sheet no. 317; 2013. http://who.int/mediacentre/factsheets/fs317/en/. Accessed February 14, 2013.
  2. Noncommunicable diseases country profiles 2011. Geneva (CH): World Health Organization; 2011.
  3. World Health Organization. Global status report on noncommunicable diseases, 2010. Geneva (CH): World Health Organization; 2012.
  4. Sibai A, Hwallah N. WHO STEPS chronic diseases risk factor surveillance. American University of Beirut; 2010. http://www.who.int/chp/steps/2008_STEPS_Le. Accessed February 14, 2013.
  5. National Household Health Expenditure and Utilization Survey (NHHEUS). The Lebanese Ministry of Public Health; 1999. http://www.pcm.gov.lb/Cultures/ar-LB/Menu. Accessed February 14, 2013.
  6. Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. Geneva (CH): World Health Organization; 2007.
  7. Mendis S. Cardiovascular risk assessment and management in developing countries. Vasc Health Risk Manag 2005;1(1):15. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  8. Berger JS, Jordan CO, Lloyd-Jones D, Blumenthal RS. Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol 2010;55(12):1169–77. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  9. Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva (CH): World Health Organization; 2010.
  10. Cardiovascular risk prediction charts for 14 WHO epidemiological sub-regions, page 21. World Health Organization, International Society of Hypertension; 2010. http://ish-world.com/downloads/activities/colour_charts_24_Aug_07.pdf. Accessed February 14, 2013.
  11. Cardiovascular risk prediction charts: strengths and limitations. World Health Organization, International Society of Hypertension. http://www.who.int/cardiovascular_diseases/publications/cvd_qa.pdf. Accessed February 14, 2013.
  12. Ammar W. Health system and reform in Lebanon. Geneva (CH): World Health Organization, Ministry of Public Health; 2010.
  13. Ammar W. Health beyond politics. Geneva (CH): World Health Organization, Ministry of Public Health; 2010.
  14. Sibai AM, Tohme RA, Saade GA, Ghanem G, Alam S, Lebanese Interventional Coronary Registry Working Group. The appropriateness of use of coronary angiography in Lebanon: implications for health policy. Health Policy Plan 2008;23(3):210–7. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  15. Sfeir R. Strategy for national health care reform in Lebanon; 2007. http://www.fgm.usj.edu.lb/files/a62007.pdf. Accessed February 14, 2013.
  16. [Constituents/standard specifications and detailing services of the Primary Health care centres]. Ministry of Public Health, Lebanon; 2013. Arabic. http://www.moph.gov.lb/Prevention/PHC/Documents/HSServices.pdf. Accessed February 14, 2013.
  17. Diabetes atlas — updated guidelines for the definition, diagnosis, and classification of diabetes. Press conference, 19th World Diabetes Congress, Cape Town, South Africa. International Diabetes Federation; 2006.
  18. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. Geneva (CH): World Health Organization, International Diabetes Federation; 2006.
  19. Obesity: preventing and managing the global epidemic. Technical report series, 894. Geneva (CH): World Health Organization; 2000.
  20. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117(6):743–53. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  21. The Framingham Health Study, interactive cardiovascular risk calculator. http://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php#. Accessed February 14, 2013.
  22. Yaacoub N, Badre L. Education in Lebanon, statistics in focus. Issue no. 3, Lebanon, tables. Central Administration of Statistics; 2013. http://www.cas.gov.lb/index.php/en/training-stat-en/83-english/images/Mics3/Tables/CAS_MICS3_9_Education.xls. Accessed February 14, 2013.
  23. Regitz-Zagrosek V, Lehmkuhl E, Weickert MO. Gender differences in the metabolic syndrome and their role for cardiovascular disease. Clin Res Cardiol 2006;95(3):136–47. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  24. Martorell R, Khan LK, Hughes ML, Grummer-Strawn LM. Obesity in women from developing countries. Eur J Clin Nutr 2000;54(3):247–52. CrossRefExternal Web Site IconPubMedExternal Web Site Icon
  25. Sibai A, Obeid O, Batal M, Adra N, El Khoury D, Hwalla N. Prevalence of metabolic syndrome in Lebanese adult population: findings from the first epidemiological study. CVD Prev Contr 2006;3(2):83–90. CrossRefExternal Web Site Icon
  26. Diabetes atlas. 5th edition. Brussels (BE): International Diabetes Federation; 2011.
  27. Tohme RA, Jurjus AR, Estephan A. The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population. J Hum Hypertens 2005;19(11):861–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  28. Operational and management guidelines for the national noncommunicable disease screening program. Ministry of Health, Sultanate of Oman; 2010. http://www.moh.gov.om/en/reports/GuidelinesManual_for_the_national_NCD-screening_program.pdf. Accessed February 14, 2013.
  29. Alowaish R, Al Asi T, Adly L. Risk factors for cardiovascular diseases: Kuwait Heart Foundation’s mobile screening. J Saudi Heart Assoc 2012;24(4):295–6. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  30. Smith SC Jr, Greenland P, Grundy SM. AHA conference proceedings: prevention conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary: American Heart Association. Circulation 2000;(101):111–6. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon

No hay comentarios: