Cardiovascular risk assessment using the lipid accumulation product index among primary healthcare users: a cross-sectional study

The aim of this study was to describe the cardiovascular risk of primary healthcare users through the LAP index and correlate it with anthropometric and biochemical indicators.

DESIGN AND SETTING:

Cross-sectional study in primary care units in a city in northeastern Brazil.

METHODS:

The subjects responded to a structured questionnaire that contained questions about their sociodemographic condition, and then underwent an anthropometric nutritional assessment. The LAP index values were expressed as three degrees of cardiovascular risk intensity: high risk (above the 75^th percentile), moderate risk (between the 25^th and 75^th percentiles) and low risk (below the 25^th percentile).

RESULTS:

The median LAP index was 52.5 cm.mmol/l (range: 28.2-86.6), and there was no statistically significant difference between the sexes: 57.7 cm.mmol/l (24.5-91.1) and 49.5 cm.mmol/l (29.8-85.2) for females and males, respectively (P = 0.576). Among all the subjects, 67.2% were overweight and there was a statistically significant difference in mean LAP index between those who were and those who were not overweight. Statistically significant differences in anthropometric and biochemical markers for cardiovascular risk were observed among individuals who had higher LAP index values. There were significant correlations between the LAP index and all of the biochemical variables.

CONCLUSIONS:

These significant correlations between the LAP index and the traditional biochemical risk markers may be useful within conventional clinical practice, for cardiovascular risk screening in primary healthcare.

KEY WORDS:
Obesity; Overweight; Cardiovascular diseases; Primary health care; Waist circumference

Variable	n = 437	%
Sex
Male	115	26.3%
Female	322	73.7%
Occupation
Retired	93	21.3%
Housework (unemployed)	69	15.8%
Farmer	47	10.9%
Self-employed	37	8.5%
Teacher	11	2.5%
Domestic worker	19	4.3%
Other	155	35.5%
Marital status
Married	275	62.9%
Single	118	27%
Widower	26	5.9%
Divorced	18	4.1%
Economic class
A/B	0	0%
C	198	45.3%
D/E	239	54.7%
Active physically
Yes	141	31.3%
No	296	67.7%
Smoker
Yes	67	15.6%
No	312	71.4%
Former smoker	57	13%

	Total	Male	Female	P-value*
Obesity	133 (30.5%)	38 (33%)	95 (29.6%)	0.834
High waist circumference	84 (19.2%)	42 (36.5%)	42 (13.0%)	< 0.01
High waist-to-hip ratio	202 (64.1%)	74 (84.1%)	128 (56.4%)	< 0.01
High lipid accumulation product index (P75)	109 (24.9%)	34 (31.2%)	75 (23.3%)	0.182

	Body mass index	Waist-to-hip ratio	LAP index
Glycemia	r = 0.106 P = 0.03	r = 0.249 P ≤ 0.01	r = 0.183 P ≤ 0.01
Total cholesterol	r = 0.013 P = 0.79	r = 0.112 P = 0.05	r = 0.248 P ≤ 0.01
HDL-cholesterol	r = -0.314 P ≤ 0.01	r = -0.295 P ≤ 0.01	r = -0.296 P ≤ 0.01
LDL-cholesterol	r = 0.040 P = 0.52	r = 0.096 P = 0.13	r = 0.151 P ≤ 0.01

Variables	LAP percentile 75	Mean ± SD	P-value
Triglycerides (mg/dl)	Below P75	136.87 ± 56.36	< 0.01^a
Triglycerides (mg/dl)	Above P75	297.17 ± 146.50	< 0.01^a
Total cholesterol (mg/dl)	Below P75	197.18 ± 45.29	0.19^b
Total cholesterol (mg/dl)	Above P75	222.0 ± 54.575	0.19^b
HDL-cholesterol (mg/dl)	Below P75	51.22 ± 13.98	< 0.01^b
HDL-cholesterol (mg/dl)	Above P75	42.10 ± 10.03	< 0.01^b
LDL-cholesterol (mg/dl)	Below P75	118.75 ± 39.61	0.17^a
LDL-cholesterol (mg/dl)	Above P75	125.80 ± 42.84	0.17^a
Glycemia (mg/dl)	Below P75	101.09 ± 38.37	< 0.01^a
Glycemia (mg/dl)	Above P75	120.46 ± 57.35	< 0.01^a
Body mass index (kg/m²)	Below P75	27.31 ± 5.68	< 0.01^b
Body mass index (kg/m²)	Above P75	32.88 ± 5.35	< 0.01^b

Associação Paulista de Medicina - APM APM / Publicações Científicas, Av. Brigadeiro Luís Antonio, 278 - 7º and., 01318-901 São Paulo SP - Brazil, Tel.: +55 11 3188-4310 / 3188-4311, Fax: +55 11 3188-4255 - São Paulo - SP - Brazil
E-mail: revistas@apm.org.br

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[1] Address for correspondence: Ana Paula Trussardi Fayh Programa de Pós-Graduação em Nutrição, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN) Avenida Senador Salgado Filho, 3.000 Natal (RN) - Brasil Tel. +55 84 3342-2291 E-mail: apfayh@yahoo.com.br