Frederieke S. Diemer

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study.

Introduction Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. Methods and analysis In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. Ethics and dissemination Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease.

Hypertension and Cardiovascular Risk Profile in a Middle-Income Setting: The HELISUR Study

BACKGROUND Hypertension is the leading risk factor responsible for premature death worldwide, but its burden has shifted to low- and middle-income countries. Therefore, we studied hypertension and cardiovascular risk in the population of Suriname, a middle-income country with a predominantly urban population of African and Asian ancestry. METHODS A random sample of 1,800 noninstitutionalized men and women aged 18-70 years was selected to be interviewed at home and examined at the local hospital for cardiovascular risk factors, asymptomatic organ damage, and cardiovascular disease. RESULTS The 1,157 participants examined (37% men) were mainly of self-defined Asian (43%) or African (39%) ancestry, mean age 43 years (SD 14). The majority of the population (71%) had hypertension or prehypertension, respectively, 40% and 31%. Furthermore, 72% was obese or overweight, while 63% had diabetes or prediabetes. Only 1% of the adult population had an optimal cardiovascular risk profile. Hypertension awareness, treatment, and control were respectively 68%, 56%, and 20%. In line with this, 22% of the adult population had asymptomatic organ damage, including increased arterial stiffness, left ventricular hypertrophy, microalbuminuria, or asymptomatic chronic kidney disease. CONCLUSIONS In this first extensive cardiovascular assessment in the general population of this middle-income Caribbean country, high prevalence of hypertension with inadequate levels of treatment and control was predominant. The findings emphasize the need for collaborative effort from national and international bodies to prioritize the implementation of affordable and sustainable public health programs that combat the escalating hypertension and cardiovascular risk factor burden.

Health literacy in Suriname

ABSTRACT Background: Low health literacy is an independent predictor of cardiovascular mortality. However, data on health literacy in low- and middle-income countries are scarce. Therefore, we assessed the level of health literacy in Suriname, a middle-income country with a high cardiovascular mortality. Methods: We estimated health literacy in a convenience sample at an urban outpatient center in the capital and at a semirural health center, using the validated Rapid Estimate of Adult Literacy in Medicine adapted for the Dutch language (REALM-D) instrument. REALM-D scores vary from 0 to 66 (all correct). The primary outcome was the level of health literacy. Furthermore, we assessed the effect of age, sex, ethnicity, disease history, research location, and level of education on health literacy with multivariable linear regression. Results: We included 99 volunteers (52% men; 51% urban research location) with a mean age of 44.9 years (SD 13.4). The mean REALM-D score was moderate: 48.6 (SD 8.1). Greater health literacy was associated with male sex, an urban research location, and a higher educational level. Conclusion: Health literacy was moderate in these Surinamese participants. Health care workers should take health literacy into account, and targeted interventions should be developed to improve health literacy in Suriname.

Physical activity and obesity: is there a difference in association between the Asian- and African- Surinamese adult population?

ABSTRACT Objective: The role of different physical activity (PA) characteristics, i.e. domain, duration and intensity in obesity prevention still requires investigation. Furthermore, ethnicity can modify the effect of PA on body composition. Therefore, we aim to describe the association between obesity and PA characteristics across the Asian- and African-Surinamese population, living in the capital of Suriname. Design: Between February 2013 and July 2015, we included 1157 healthy subjects, 18–70 years, from the Healthy Life in Suriname (HELISUR) study. We measured height, weight, hip and waist circumference and defined general and central obesity according to World Health Organization (WHO) recommendations. The International Physical Activity Questionnaire was used to assess PA and to calculate the duration (minutes/week) and the total volume (METs-minutes/week) of activity. Ethnicity was self-reported. Results: Out of 1157 participants we included 1079 (42.6% Asian-Surinamese, 40.1% African-Surinamese and 17.3% of other ethnicity), mean age 42.6 ± 13.6 years for analysis. Obesity prevalence ratio (PR) was significantly lower in participants meeting WHO PA recommendations [PR= 0.81 (0.68–0.97)], especially within the commuting [PR= 0.66 (0.47–0.91)] and leisure time domains [PR= 0.67 (0.47–0.94)], compared to participants that did not meet the recommendations. Active minutes/week and total volume of activity were inversely associated with obesity and waist circumference, in the overall (p < 0.05) and in the African-Surinamese population (p < 0.05), but not in the Asian-Surinamese population. Conclusion: Meeting PA recommendations, particularly within the commuting and leisure time domains, is associated with lower obesity prevalence in the total population. Among the African-Surinamese population, PA within the leisure time domain, more active minutes/week and higher levels of total volume are associated with a lower obesity prevalence. This is not found in the Asian-Surinamese population.

LBOS 03-02 PREHYPERTENSION AND HYPERTENSION IN URBAN SURINAME: THE HELISUR STUDY.

Objective: The global burden of disease attributable to high blood pressure showed that 54% of stroke and 47% of ishaemic heart disease worldwide were due to hypertension. Hypertension is still the main risk factor for premature death worldwide and, in particular, in low- and middle-income countries. We aimed to assess prehypertension and hypertension prevalence among a predominantly Asian and African population living in urban Suriname, a middle-income country in South America. Design and Method: We used data from the Healthy Life in Suriname study, in which 1,152 men and women aged 18–70 y living in the capital were randomly selected. Demographic factors, disease history, and use of medication were recorded. Ehtnicity was self-defined. Sitting blood pressure was measured in duplo after a 5-minute rest. The prevalence of prehypertension and hypertension were determined according to international guidelines (JNC 7). Differences between sex and ethnic groups were tested using &khgr;2 tests and logistic regression analyses. Results: Participants with missing blood pressures (n = 4) and of other/mixed ethnicity (n = 199) were excluded. Of the remaining 949 participants (64% women; mean age 43 ± 13 y), 494 subjects were Asian-Surinamese (52%) and 455 were African-Surinamese (48%). The overall prevalence of prehypertension and hypertension was, respectively, 31 and 41% (Figure 1A). Regarding ethnic subgroups analysis, the crude prevalence of prehypertension and hypertension did not differ between Asian and African-Surinamese (p = 0.79 and p = 0.13, respectively). In logistic regression analysis, African-Surinamese showed higher sex-age odds ratios of having hypertension. However, after including BMI in the model, this difference was not statistically significant (Figure 1B). Conclusions: We found a high prevalence of prehypertension (31%) and hypertension (41%) in this urban middle-income population, with no differences between Asian and African-Surinamese. With only 29% having optimal blood pressure levels.Therefore, drastic preventive measures prioritizing screening and control of hypertension need to be taken for cardiovascular health in Surinamese population.

[PP.03.24] ARTERIAL STIFFNESS IN A RANDOM SAMPLE OF A MULTI-ETHNIC POPULATION IN SURINAME: THE HELISUR STUDY

Objective: Patients of South Asian and African descent are known to have a high cardiovascular risk. Increased arterial stiffness has been shown to be independently associated with cardiovascular risk and mortality, however, at present, few studies have investigated ethnic differences in aortic pulse wave velocity (PWV), as measure of arterial stiffness, in these groups. Therefore, we studied PWV in South Asians, Indonesians, Creoles and Maroons, living in Suriname, South America. Figure. No caption available. Design and method: In a cross-sectional setting we selected a random representative sample of 864 participants living in an urban setting in Paramaribo, Suriname. We estimated the aortic pulse wave velocity (PWV) non-invasively in the supine position by analysis of the oscillometric pressure curves registered on the upper arm, using the Arteriograph (TensioMed, Budapest, Hungary). We used the mean of two consecutive measurements for our analyses by age and ethnicity, and by blood pressure and ethnicity. Results: We included 864 participants (mean age 44 years, 46% man, 41.2% hypertensive, 12% hypercholesterolemia, 14.6% diabetes). The mean PWV value was 8.5 ± 2.4 m/s. The distribution of mean PWV values classified by age, ethnicity, and blood pressure are summarized in the Table. Conclusions: We found relatively high mean PWV values across ethnic groups, compared to the mean values with optimal blood pressure, reflecting the high prevalence of hypertension and possible early vascular ageing in these groups with high cardiovascular risk.

[OP.LB01.08] THE ASSOCIATION BETWEEN OBESITY AND PARITY IN SURINAMESE WOMEN.

Objective: An important risk factor for cardiovascular disease is obesity, which is more common in women than men. Pregnancy has frequently been cited as a contributor to overweight in women due to gestational weight gain and postpartum weight retention. Obesity prevalence is rapidly rising in urban women in Suriname. The main objective of this study was to assess whether parity is associated with obesity, as measured by body mass index (BMI). Design and method: The Healthy Life in Suriname (HELISUR) study randomly selected 1,800 subjects of different ancestries living in Paramaribo. Questionnaires on demographic factors, disease history, use of medication, and womens health were collected. Height, weight, blood pressure and serum glucose and cholesterol were measured. We used multiple linear regression analysis to explore the association between obesity and parity, independent of several covariates. Results: Of the 1,800 subjects, 1,159 participated in the physical examination, of which 728 were women (309 Asian; 299 African and 120 of mixed/other ancestry). With increasing parity, crude mean BMI raised significantly (Figure 1, panel A), with a more prominent effect in African-Surinamese compared to Asian-Surinamese women (Figure 1, panel B). Figure. No caption available. In multivariable regression analysis, BMI increased by 0.32 kg/m2 (95% CI 0.07 – 0.56) per child, after adjustment for age, ancestry, educational level, current breastfeeding, menopausal status, use of hormonal contraceptives, fasting serum glucose, serum total cholesterol, and systolic blood pressure. Systolic blood pressure, glucose and cholesterol increased respectively 7.36 (95% CI 5.49 – 9.23) mmHg, 0.49 (95% CI 0.29 – 0.70) and 0.18 (95% CI 0.08 – 0.28) mmol/L with each parity group. However, this association was abolished after adjustment for age. Conclusions: Our study demonstrated that parity is associated with a higher BMI in urban Surinamese women, even after adjustment for several covariates. The effect of parity seems to be stronger in African-Surinamese women compared to Asian-Surinamese women. The higher BMI was not accompanied by a worse metabolic profile. Preventive programs for pre- and postpartum women should focus on education about their increased risk of developing obesity.