Hypertension is a serious public health problem among elderly Egyptians. The prevalence of overweight/ obesity is also increasing in alarming proportions among the elderly, and it is correlated with the prevalence of hypertension, one of the major risk factors for cardiovascular diseases, and also strongly correlated with atherogenic dyslipidemia parameters. We aimed to determine the correlation between lipid profile, and high sensitivity C-reactive protein (hs-CRP) with anthropometric indices, as indicators of additional cardiovascular risk in a population of elderly hypertensive Egyptian patients.119 elderly hypertensive patients of both genders were enrolled in this study divided into three groups according to age. Height, weight, BMI, WC, WHR, blood pressure, lipid profile, and hs-CRP were measured for all participants. No statistical difference between the different age groups in both genders as regard height, weight, BMI, and WHR. WC tends to decrease significantly with age in both genders. A statistically significant difference was noted between different age groups only in women as regards; total cholesterol (p< 0.013), and HDL-chlevels (p< 0.015). While, a statistical significant difference between was noted in both women and men regarding; LDL-ch (p< 0.016, and p< 0.021 respectively), and triglyceride (TG) levels (p< 0.011, and p< 0.032 respectively).Both SBP, and DBP tend to increase with age, with no statistical significant difference was noted between the different age groups in both genders. (p<0.136 and p<0.0.365 in women, p<0.251, and p<0.152 in men).hs-CRP values tend to increase progressively with age with, a statistical significant difference between the three studied groups in both genders. (p<0.036, and p<0.013 respectively). In group I, BMI, WC, and WHR all were correlated with lipid profile and blood pressure, while, in group II, BMI and WC, but not WHR were correlated with lipid profile and blood pressure, and in group III, none of these indices were correlated with lipid profile or blood pressure. In all studied age groups; total cholesterol, LDL-ch, and triglycerides were positively correlated, and HDL-ch was negatively correlated with systolic and diastolic blood pressure. Total cholesterol, LDL-ch, and triglycerides were positively correlated, and HDL-ch was negatively correlated with hs-CRP. Both systolic and diastolic blood pressures were positively correlated with hs-CRP. We concluded that anthropometric indices are strongly correlated with hypertension, one of the major risk factors for cardiovascular diseases, and also strongly correlated with atherogenic dyslipidemia parameters. Assessing the hs-CRP levels may thus provide additive value in predicting cardiovascular risks.

Keywords: Hypertension, Elderly Egyptians, Anthropometric indices, Lipid panel, Cardiovascular risk, hs-CRP

1.      TJ Kizhakekuttu, ME Widlansky. Natural antioxidants and hypertension: promise and challenges. CardiovascTher 2010; 28 (4): pp. e20–e32.

2.      Lewington, S; Clarke, R; Qizilbash, N; Peto, R; Collins, R; Prospective Studies, Collaboration. "Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies”. Lancet 2002; 360 (9349): 1903–13.

3.      Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012 Jan 3. 125(1):e2-e220.

4.      The World Health Report 2002-Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization; 2002.

5.      Cornoni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States. The National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med. 1989 Apr. 149(4):780-8.

6.      Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995 Mar. 25(3):305-13.

7.      Carretero OA, Oparil S; Oparil. "Essential hypertension. Part I: definition and etiology". Circulation 2000; 101 (3): 329–35.

8.      Rule AD, Fridley BL, Hunt SC, Asmann Y, Boerwinkle E, Pankow JS, et al. Genome-wide linkage analysis for uric acid in families enriched for hypertension. Nephrol Dial Transplant. 2009 Aug. 24(8):2414-20.

9.      O'Brien, Eoin; Beevers, D. G.; Lip, Gregory Y. H. ABC of hypertension. London: BMJ Books.2007.

10.  Grossman E, Messerli FH; Messerli. "Drug-induced Hypertension: An Unappreciated Cause of Secondary Hypertension". Am. J. Med 2012; 125 (1): 14–22.

11.  Blood pressure Lowering Treatment Trialists' Collaboration. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Br. Med. J 2008; 336, 1121–7.

12.  Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42(6):1206-52.

13.  Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999 Jul 6; 131(1):7-13.

14.  Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial. Circulation 1990 Nov; 82(5):1616-28.

15.  Rosini N, Machado MJ, Xavier HT. Study of the prevalence and multiplicity of cardiovascular risk factors in hypertensive individuals from the city of Brusque, SC, Brazil.  Arq Bras Cardiol 2006; 86(3):219-22.

16.  Fabijanic D, Banic M, Kardum D. C-reactive protein in cardiovascular risk evaluation. LijecVjesn 2006; 128(5-6):167-74.

17.  Barbosa AR, Souza JMP, Lebrão ML, Laurenti R, Marucci MFN. Anthropometry of elderly residents in the city of São Paulo, Brazil. Cad SaúdePública. 2005; 21(6):1929-38.

18.  Boyko EJ, Leonetti DL, Bergstrom RW, Newell-Morris L, Fujimoto WY. Visceral adiposity, fasting plasma insulin, and blood pressure in Japanese-Americans. Diabetes Care 1995; 18: 174-81.

19.  Spiegelman D, Israel RG, Bouchard C, Willett WC. Absolute fat mass, percent body fat, and body-fat distribution: which is the real determinant of blood pressure and serum glucose? Am J ClinNutr 1992; 55: 1033-44.

20.  Mueller WH, Wear ML, Hanis CL, Emerson JB, Barton SA, Hewett-Emmett D, Schull WJ. Which measure of body fat distribution is best for epidemiologic research? Am J Epidemiol 1991; 133: 858-69.

21.  Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ. Waist circumference and abdominal sagittal diameter: best simple anthropometric indices of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460-8.

22.  Ko FT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC, Wai HP, Li JK, So WY, Cockram CS. Simple anthropometric indexes and cardiovascular risk factors in Chinese. Int J ObesRelatMetabDisord 1997; 21: 995-1001.

23.  Pfützner A, Forst Th. High-Sensitivity C - reactive protein as Cardiovascular Risk Marker in Patients with Diabetes Mellitus. Diabetes Technology & Therapeutics 2006, 8(1): 28-36.

24.  Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am CollCardiol 2007; 29;49(21):2129-38.

25.  De Groot LC, Sette S, Zajkas G, Carbajal A, Amorim JA. Euronut SENECA investigators. Nutritional status: anthropometry. Eur J ClinNutr 1991; 45(45s3):31-42. 

26.  World Health Organization. Obesity preventing and managing the Global Epidemic: Report of a WHO consultation on obesity. Geneva: World Health Organization, 1998.

27.  National Cholesterol Education Program Expert Panel. Summary of the second report of the National Cholesterol Education Program Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults. JAMA 1993; 269, 3015–23.

28.  E. T. H. Yeh , J. T. Willerson, “Coming of age of C-reactive protein: using inflammation markers in cardiology,” Circulation 2003; 107( 3):370–2.

29.  The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(11):3160-7. 

30.  MM Ibrahim. Problem of hypertension in Egypt. The Egyptian heart journal 2013; 65(3):233–4.

31.  The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(11):3160-7.

32.  Ibrahim MM, Rizk H, Appel LJ, El Aroussy W, Helmy S, Sharaf Y, et al. Hypertension prevalence, awareness, treatment, and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). NHP investigative team. Hypertension 1995; 26 (6): 886–90.

33.  Amery A et al. Mortality and morbidity results from the European Working Party on High Blood Pressure In The Elderly Trial. Lancet 1985; 1:1349-54.

34.  Huang KC, Lin WY, Lee LT, Chen CY, Lo H, et al. Four anthropometric indices and cardiovascular risk factors in Taiwan. Int J ObesRelatMetabDisord 2002; 26: 1060-8.

35.  Zhu S, Wang Z, Heshka S, Heo M, Faith MS, et al. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. Am J ClinNutr 2002; 76: 743-9.

36.  Huang KC, Lee MS, Lee SD, Chang YH, Lin YC, et al. Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan. Obes Res 2005; 13: 170-8.

37.  Abolfotouh MA, Soliman LA, Mansour E,Farghaly M, et al.Central obesity among adults in Egypt: prevalence and associated morbidity.Eastern Mediterranean Health Journal; 2008, 14 (1).

38.  Carr DB, Utzschneider KM, Hull RL et al. Intra-abdominal fat is a major determinantof the National Cholesterol Education Program Adult Treatment Panel III criteria forthe metabolic syndrome. Diabetes 2004; 53(8):2087-94.

39.  Janghorbani M, Amini M, Walter C, et al.First Nationwide Survey of Prevalence of Overweight, Underweight, and Abdominal Obesity in Iranian Adults. Obesity 2007; 15(11): 2797–2808.

40.  Steering Committee, International Association for the Study of Obesity. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia, 2000.

41.  Mueller WH, Wear ML, Hanis CL, Emerson JB, Barton SA, Hewett-Emmett D, Schull WJ. Which measure of body fat distribution is best for epidemiologic research? Am J Epidemiol 1991; 133: 858-69.

42.  Bjorntorp P. The associations between obesity, adipose tissue distribution and disease. Acta Med Scand 1988; 723: (Suppl): 121-34.

43.  Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ. Waist circumference and abdominal sagittal diameter: best simple anthropometric indices of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460-8.

44.  Mykkanen L, Laakso M, Pyorala K. Association of obesity and distribution of obesity with glucose tolerance and cardiovascular risk factors in the elderly. Int J ObesRelatMetabDisord 1992; 16: 695-704.

45.  Spiegelman D, Israel RG, Bouchard C, Willett WC. Absolute fat mass, percent body fat, and body-fat distribution: which is the real determinant of blood pressure and serum glucose? Am J ClinNutr 1992; 55: 1033-44.

46.  Yusuf, S., S. Hawken and S. Ounpuu. Is waist to hip ratio a better marker of cardiovascular risk than body mass index? Lancet 2005; 366: 1640-9.

47.  Zhu, S., S.B. Heymsfield, H. Toyoshima, Z. Wang, A.Pietrobelli and S. Heshka. Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am. J. Clin. Nut 2005; 81: 409-15.

48.  GavelerJS, Rosenblum E. Predictors of postmenopausal body mass index and waist hip ratio in the oklahoma postmenopausal health disparities study. J. Am. Coll. Nut 2003; 22: 269-76.

49.  Brown CD, Higgins M, Donato KA, et al.Body mass index and the prevalence of hypertension and dyslipidemia. Obesty Res 2000; 8: 605-19.

50.  Després, J.P., I. Lemieux, G.R. Dagenais, B. Cantin and B. Lamarche. HDL-cholesterol as a marker of coronary heart disease risk: The québec cardiovascular study. Atherosclerosis 2000; 153: 263-72.

51.  Assmann, G., H. Schulte, A. von Eckardstein and Y. Huang. High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport. Atherosclerosis 1996; 124: S11-S20.

52.  Halcox JP, Roy C, Tubach F, BanegasJR,et al. C-reactive protein levels in patients at cardiovascular risk: EURIKA study.BMC Cardiovasc Disord. 2014 Feb 24; 14:25.

53.  Seo SM, Baek SH, Jeon HK, Kang SM, et al.Correlations between the level of high-sensitivity C-reactive protein and cardiovascular risk factors in Korean adults with cardiovascular disease or diabetes mellitus: the CALLISTO study.J AtherosclerThromb. 2013; 20(7):616-22

Marwa A. Saad M.D

Lecturer of Internal Medicine, Geriatric Department

Faculty of Medicine, Alexandria University