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  • The ORISCAV-LUX is a cross-sectional population-based cardiovascular risk factors survey, conducted between November 2007 and January 2009 in Grand-Duchy of Luxembourg. A representative random sample of 4 496 non-institutionalized subjects residing in Luxembourg, stratified according to gender, age (5-year categories) and geographic district (Luxembourg, Diekirch and Grevenmacher) was drawn from the regularly updated national health insurance registry, with a 98% social coverage rate. The minimal necessary representative sample size was calculated to 1 285 subjects to ensure statistical power, i.e. to ensure a statistical precision of at least 2% for the estimation of the prevalence of the risk factors at the 95% confidence level. However, a total of 1 432 subjects took part in the survey, yielding a participation rate of 32.2%. The distribution of selected subjects in each stratum was proportional to their distribution in the source population. A comprehensive description of the protocol, survey design, sampling method and sample representativeness has been published in previous reports [3], [4]. Briefly, selected persons were invited through an official letter followed by a phone contact to confirm the appointment. The trained research nurses either visited participants in their households or invited them to the nearest study investigation center. At the time of interview, the participants initially signed the informed consent form and then filled in the auto-administered questionnaire, to collect data on subject’s demographic, socioeconomic characteristics, history of hypertension, diabetes and dyslipidemia and the use of respective medications. Minimum 8-h fasting blood samples were analyzed for glucose, total cholesterol (T-C), HDL cholesterol (HDL-C) and triglycerides (TG). For blood pressure measurement, systolic blood pressure (SBP, mmHg) and diastolic blood pressure (DBP, mmHg) were measured at least 3 times with a minimum of 5-min interval, by using Omrom® MX3 plus automated oscillometric Blood Pressure Monitor (O-HEM-742-E) (Matsusaka, Japan) [5], according to standard operating procedure. Measurements were only performed after the participants had been seated for at least 5 minutes after questionnaire completion and at least 30 minutes after blood intake and refrained from smoking. The average of the last 2 readings was used in the analysis. The rationale behind discarding the first reading was based on literature review; to avoid false positive classification for reactive subjects with otherwise normal blood pressure fluctuations, and because taking the average of the second and third readings in case of triplicate measurements may best predict the awake SBP [6]. Presence of diabetes was based on self-reporting of anti-diabetic medications, and/or fasting plasma glucose value (FPG)≥126 mg/dl [7]. For glycaemic control, persons with glycosylated hemoglobin (HbA1c) level <6.5% were considered as controlled [8], [9]. If the participants reported that they had ever been told by their doctor that they had diabetes and/or if they self-reported anti-diabetic medication intake, they were considered as clinically diagnosed (aware) of their diabetes. All clinically undiagnosed or non-treated participants were thus considered as unaware of their diabetes. Hypertension was defined as a mean SBP≥140 mmHg and/or DBP≥90 mmHg, and/or the use of antihypertensive medications [10]. Treated hypertensive participants were considered controlled if they had an average SBP<140 mm Hg and DBP<90mm Hg. If the participants answered “yes” to the question: “Have you ever been told by your doctor that you had high BP?” and/or if they self-reported antihypertensive medication intake, they were considered as clinically diagnosed (aware) of their hypertension. All clinically undiagnosed or non-treated participants were thus considered as unaware of their hypertension. Subjects with lipid disorder (dyslipidemia) were defined as having at least one of the following anomalies: T-C≥190 mg/dl, TG≥150 mg/dl, LDL-C≥115 mg/dl, and HDL-C <40 mg/dl for men and <46 mg/dl for women [11], and/or taking lipid-lowering medications. A treated person was classified as controlled if his/her T-C<190 mg/dl, TG<150 mg/dl, LDL-C<115 mg/dl, and HDL-C≥40 mg/dl for men and ≥46 mg/dl for women. Similar to other pathologies, dyslipidemia participants were considered as clinically diagnosed (aware) of their lipid disorders if they reported that they had ever been told by their doctor that they had dyslipidemia and/or if they self-reported lipid-lowering medication intake. All clinically undiagnosed or non-treated participants were thus considered as unaware of their lipid disorders. For every participant, the Framingham risk score (FRS) to predict 10-year CHD risk was calculated using the adapted simplified model of Wilson et al. [12]. Those with personal history of myocardial infarction were excluded from the risk analysis. A risk of CHD greater than 20 percent in 10 years is considered high risk; intermediate risk ranges from 10 percent to 20 percent; less than 10 percent is considered low risk. To account for the complex sampling design and for non-response, the prevalence rates were weighted to produce nationally representative estimates of the total population residing in Luxembourg, aged 18 to 69 years. The weights were calculated based on the lastly available national census data. All analyses were performed with PASW® for Windows® version 18.0 software (formerly SPSS Statistics Inc. Chicago, Illinois) and survey procedure for complex sampling design. By using descriptive statistics, the level of management of hypertension, diabetes and dyslipidemia was compared to illustrate, via pie chart, the proportion of three groups: treated; non-treated subjects, in addition to those free of the conditions. Among treated cases, the proportions of controlled and uncontrolled cases were also presented. Multivariable logistic regression analysis was performed to identify the independent contribution of health perception, socio-demographic and lifestyle factors to the risk of having hypertension or dyslipidemia but being unaware of these conditions. We measured several variables that might affect the likelihood of unawareness, including age, gender, country of birth (Luxembourgish; Portuguese; Europeans; non-Europeans), educational level (primary; secondary; tertiary), economical status (living above; below poverty threshold), family history of same pathologies (yes; no), BMI, and perceived health status (excellent/very good; good; and fair/poor), tobacco consumption (smokers; non-smokers), and regular family doctor (yes; no). The estimation of odds ratios and 95% confidence interval were computed for the unaware participants of their hypertension or lipid disorder. We calculated the 10-year Framingham risk score for each participant and determined the proportion of people unaware of their increased risk of developing CHD or dying from heart attack within 10 years. All participants were duly informed and provided their written consent prior to take part in the study, which was approved by the National Research Ethics Committee and the National Commission for Private Data Protection.
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