The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Cardiovascular Diseases Risk Factors Among Young Adults: A STEPwise-Approach-Based Study in Three University Setups in Morocco



Hamza Loukili1, 2, *, Gabriel Malka1, Helene Landrault1, Driss Frej2, Mohamed Amine3
1 Epidemiology and Biostatistics Research Unit, Interface-Center for Medical Applications, Mohammed VI Polytechnic University, Ben Guerir, Morocco
2 Applied Economics Laboratory, Mohammed V University, Rabat, Morocco
3 Community Medicine and Public Health Department, PCIM Laboratory, School of Medecine, Cadi Ayyad University, Marrakech, Morocco

Abstract

Background:

Although chronic diseases, particularly cardiovascular diseases, are more likely to emerge during adulthood, their development begins earlier during childhood and adolescence. In this respect, we explored cardiovascular disease risk factors among students in three elite schools in Morocco.

Method:

The data collecting process was carried out using the French version of the STEPwise approach developed by the WHO to monitor Non-Communicable Diseases risk factors, producing thus standardized data and allowing wide comparability across similar studies. The investigation was conducted through on-site and online configurations. We only relied on the first and second sequences of the STEPS questionnaire in order to collect behavioral and physical data, on which our analysis was based. The choice of the population of Moroccan high intellectual potential youth is interesting, as they represent future physicians and leading engineers of tomorrow.

Results:

A total number of 325 subjects were surveyed. The prevalence of auto-reported diabetes and hypertension was respectively 3.31% and 8.54%. Alarmingly, a large proportion of respondents had undiagnosed hypertension. Besides, the prevalence of obesity was found to reach 6.17%, with no significant difference between gender groups.

Conclusion:

Hypertension appears to be largely undiagnosed which urges taking actions towards raising awareness among youth about chronic diseases and their risk factors as well as highlighting their preventability to prevent their future development.

Keywords: Obesity, Hypertension, Public health, Young adults, STEPwise approach.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 464
Last Page: 469
Publisher Id: TOPHJ-13-464
DOI: 10.2174/1874944502013010464

Article History:

Received Date: 4/05/2019
Revision Received Date: 01/08/2020
Acceptance Date: 07/08/2020
Electronic publication date: 22/09/2020
Collection year: 2020

© 2020 Loukili et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at Epidemiology and Biostatistics Research Unit, Interface-Center for Medical Applications, Mohammed VI Polytechnic University, Ben Guerir, Morocco; E-mail: hamza.loukili@um6p.ma





1. INTRODUCTION

The rise of Non-Communicable Diseases4 (NCDs henceforth) and the subsequent shifts in the worldwide morbidity and mortality trends have placed the issue of NCDs at the top of the research agenda for health officials as well as other stakeholders, in all countries irrespective of their development stages. Research treating the issue has explored the implications of NCDs from different perspectives, including medical, epidemiological, social and economic standpoints.

Currently, NCDs are the leading cause of mortality and disability worldwide [1Global status report on noncommunicable diseases 2014: attaining the nine global noncommunicable diseases targets; a shared responsibility Genev’a 2014.] yet the associated risk factors are identifiable and preventable [2Franco M, Cooper RS, Bilal U, Fuster V. Challenges and opportunities for cardiovascular disease prevention. Am J Med 2011; 124(2): 95-102.
[http://dx.doi.org/10.1016/j.amjmed.2010.08.015] [PMID: 21295188]
]. In fact, etiologic research has shed light on the causal and preventable nature of factors associated with the development of NCDs, especially for the case of cardiovascular diseases, which represent the main NCD that claims most lives globally [3Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736-88.
[http://dx.doi.org/10.1016/S0140-6736(18)32203-7] [PMID: 30496103]
]. The development of NCDs is related to behavioral factors such as tobacco and alcohol consumption as well as sedentary lifestyles, and other factors that exhibit complex interdependencies with these behavioral factors, such as obesity and hypertension.

The shift of focus from infectious diseases to NCDs and the emergence of the notion of risk factors are the result of the landmark epidemiological study of Framingham initiated in 1947 [4Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 2007; 335(7611): 136-6.
[http://dx.doi.org/10.1136/bmj.39261.471806.55] [PMID: 17615182]
]. This –still ongoing– study has established causal links between cardiovascular diseases and physical, behavioral, as well as psychosocial factors. Further epidemiological research has been developed upon these causal liaisons and strove to enhance the predictability of cardiovascular events through more refined methodologies. In particular, cardiovascular disease forecasting algorithms, such as the ones developed under the QRESEARCH study, namely QRISK1 and QRISK2 algorithms, which have been developed using medical files of a cohort of more than 24 million subjects [4Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 2007; 335(7611): 136-6.
[http://dx.doi.org/10.1136/bmj.39261.471806.55] [PMID: 17615182]
, 5Hippisley-Cox J, Coupland C, Vinogradova Y, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008; 336(7659): 1475-82.
[http://dx.doi.org/10.1136/bmj.39609.449676.25] [PMID: 18573856]
]. However, this research criticized conclusions drawn from Framingham-study-based algorithms that may overestimate risk in affluent areas and underestimate it in poor ones, hence introducing variables related to socioeconomic inequalities in the first forecasting equation [5Hippisley-Cox J, Coupland C, Vinogradova Y, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008; 336(7659): 1475-82.
[http://dx.doi.org/10.1136/bmj.39609.449676.25] [PMID: 18573856]
] and variables related to clinical conditions in the second one [6Hippisley-Cox J, Coupland C, Robson J, Brindle P. Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database. BMJ 2010 déc 9; 341(dec09 1): c6624-4.
[http://dx.doi.org/10.1136/bmj.c6624]
].

Moreover, epidemiological research highlighted the fact that NCDs, mainly cardiovascular disease risk factors, are easily identifiable and quite preventable. In that respect, the literature insisted on the preponderance of hypertension as the most important risk factor. Hypertension is present in the etiology of ischemic cardiomyopathy, renal diseases and dementia, and it is the most frequent factor in stroke cases [7Blacher J, Levy BI, Mourad J-J, Safar ME, Bakris G. From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century. Lancet 2016; 388(10043): 530-2.
[http://dx.doi.org/10.1016/S0140-6736(16)00002-7] [PMID: 26856636]
]. Thus, immediate and intensive treatment of hypertension would reduce the mortality risk associated with its complications.

Accordingly, controlling and preventing cardiovascular risk factors would decrease the risk of cardiovascular events. In fact, a reduction to recommended levels of HbA1c, Systolic Blood Pressure (SPB), tobacco consumption and High-Density Lipoprotein (HDL) have decreased the occurrence of coronary heart diseases among a cohort of American adults with diabetes by 38% for 10 years [8Wong ND, Patao C, Malik S, Iloeje U. Preventable coronary heart disease events from control of cardiovascular risk factors in US adults with diabetes (projections from utilizing the UKPDS risk engine). Am J Cardiol 2014; 113(8): 1356-61.
[http://dx.doi.org/10.1016/j.amjcard.2013.12.042] [PMID: 24581920]
]. However, a more drastic reduction to below-recommended levels would prevent up to 55% of coronary heart disease events, for over 10 years (8). Further- more, preventive actions are not only effective in reducing the epidemiological burden, but they also are cost-effective. A study done by Barton et al. showed that reducing the risk of a cardiovascular event by 1% would prevent 25 000 cases of cardiovascular diseases and 3 500 related deaths, as well as savings achieving £265 million [9Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study. BMJ 2011 juill 28; 343(jul28 1): d4044-4.
[http://dx.doi.org/10.1136/bmj.d4044]
]. In sum, prevention is a key factor in controlling the burden of chronic diseases; however, its time-deferred effect makes it politically less attractive.

Although chronic diseases are more likely to emerge during adulthood, their development begins earlier during childhood and adolescence [10Biddle SJ, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci 2004; 22(8): 679-701.
[http://dx.doi.org/10.1080/02640410410001712412] [PMID: 15370482]
]. As a matter of fact, this aspect is still overlooked in the cardiovascular epidemiology literature, especially the relationship between asymptotic atherosclerosis and cardiovascular risk factors at young ages [11Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338(23): 1650-6.
[http://dx.doi.org/10.1056/NEJM199806043382302] [PMID: 9614255]
]. In particular, cardiovascular events are mainly caused by thrombosis emerging from the long and complex process of atherosclerosis, which begins in early childhood [12Hoffmann B. A look inside the arteries: moving from event rates to subclinical measures of disease. Occup Environ Med 2015; 72(10): 687-8.
[http://dx.doi.org/10.1136/oemed-2014-102640] [PMID: 26150672]
, 13Buffart LM, van den Berg-Emons RJ, Burdorf A, Janssen WG, Stam HJ, Roebroeck ME. Cardiovascular disease risk factors and the relationships with physical activity, aerobic fitness, and body fat in adolescents and young adults with myelomeningocele. Arch Phys Med Rehabil 2008; 89(11): 2167-73.
[http://dx.doi.org/10.1016/j.apmr.2008.04.015] [PMID: 18835477]
], as well as the apparition of fibrotic lesions in the coronary arterial system later in adolescence [14Rowland TW. The role of physical activity and fitness in children in the prevention of adult cardiovascular disease. Prog Pediatr Cardiol 2001; 12(2): 199-203.
[http://dx.doi.org/10.1016/S1058-9813(00)00074-6] [PMID: 11223348]
], as the severity of atherosclerotic lesions are not only related to the mere presence of risk factors but also to the overtime exposure to disease factors, which are likely to reinforce each other [11Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338(23): 1650-6.
[http://dx.doi.org/10.1056/NEJM199806043382302] [PMID: 9614255]
]. Correspondingly, results from Berenson et al. [11Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338(23): 1650-6.
[http://dx.doi.org/10.1056/NEJM199806043382302] [PMID: 9614255]
] show an increase in the prevalence of fatty streaks in the coronary arteries from an age as early as 2 years old, to 85% at the age of 21-39 years [11Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338(23): 1650-6.
[http://dx.doi.org/10.1056/NEJM199806043382302] [PMID: 9614255]
]. Accordingly, the promotion of physical activity during childhood and early adolescence is shown to reduce the risk of future occurrence of cardiovascular diseases in middle age [10Biddle SJ, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci 2004; 22(8): 679-701.
[http://dx.doi.org/10.1080/02640410410001712412] [PMID: 15370482]
].

The present study aims to analyze cardiovascular diseases risk factors trends among students in three elite engineering and medical schools. The study of this particular population is of interest because: firstly, the development of cardiovascular begins early in life and preventive actions may be efficient during early adulthood. Secondly, the assessment of health behaviors of medical and engineering students in these elite schools is interesting as they represent the physicians of tomorrow as well as role models in the Moroccan society.

2. METHODS

2.1. Research Design

The present paper describes epidemiological data collected in a cross-sectional framework at 3 university setups in Morocco. The study surveyed essentially young adults, aged between 18 and 29 years old. The data collecting process was carried out using the French version of the STEPwise approach developed by WHO to monitor NCDs risk factors, producing thus standardized data and allowing wide comparability.

The STEPwise approach is based on a sequential procedure. The first step consists of collecting demographic and behavioral data. This first part is divided into six modules, addressing past and present tobacco consumption and tobacco smoke exposure, alcohol consumption frequency and quantity, eating habits, physical activity including occupational, leisure and traveling from one place to another, and history of high blood pressure and diabetes. The second step is concerned with physical measurements, such as height, weight, waist and hip circumferences, as well as heart rate and blood pressure. These measurements provided data to compute the Body Mass Index (BMI), and the waist to hip ratio. A third step is included in the questionnaire, which is related to biochemical measurements using blood samples. These measurements concern blood glucose, blood lipids, urinary sodium and creatinine, triglycerides and high-density lipoprotein (HDL) cholesterol.

In the present paper, we only rely on the first and second sequences of the STEPS questionnaire in order to collect behavioral and physical data, on which our analysis was based. We excluded subjects who refused to take part in the study and signed consents were collected from subjects who wished to participate. This study was conducted in compliance with the Helsinki Declaration and the ethical standards of the responsible institution on human subjects. Also, the study was approved by the Ethics Committee of the Mohammed VI University Hospital of Marrakesh.

2.2. Data collecting and Analysis Process

The investigation was conducted through on-site and online configurations. In the on-site configuration, the investigators were physically present on the site and proceeded manually to collect data through the administration of a paper version of the STEPS questionnaire and taking physical measurements with the help of trained paramedical personnel. As for the online version of the survey, it was developed by a group of engineering students, which provided more flexibility in the data collecting process. The online version was designed to ensure maximum confidentiality, as every potential subject received a secure and personalized link to the survey. However, in that configuration, subjects proceeded themselves to take physical measurements and put them in the online form.

The study was conducted on three university setups from the region of Marrakesh-Safi, Morocco, including a top-tier engineering school and a medical school. The paper-based version of the survey was present in both the first and the second sites. However, only the online version was administered to subjects in the third site. Subjects have been informed by email about the study and were asked to participate actively.

The data analysis process consisted of piling up data from the three investigation sites and merging them into a single database. Then, a series of descriptive statistical analyses were run to sort out the main trends in the data, and two-sample t-tests were performed to compare the means between gender groups, as shown in the next section.

It should be noted that our sample may be subject to selection bias, as the participation in the study was solely based on the volunteering of participants.

3. RESULTS

The descriptive and analytical characteristics of the surveyed sample are reported in Table 1. A total of 325 subjects were surveyed, of which 200 (60.54%) were females. On average, the age of the subjects was 20.99 (±2.741) years, and 91.41% of the sample falls between 18 and 25 years. The global response rate was quite low for the online version of the survey, since a total of 2 627 emails were sent. Setups, where paper surveys were available, had slightly higher response rates, ranging from 30.5% in the first setup to 74.7% in the second.

The prevalence of smoking was reported to be 7.58% in our sample, with daily consumption of 5.84 cigarettes a day (3.272–8.419). Additionally, 75% of our sample began smoking at the age of 19 or earlier.

Data analysis showed that respondents had an average fruit intake of 2.52 servings per day (2.058–2.992), with no significant difference between gender groups [females: 2.77 (2.056–3.501), males: 2.08 (1.862–2.299), P-value=0.069]. As for the vegetable intake, respondents reported having an average intake of 3.147 servings/day (2.502–3.792), with no significant difference between genders [females: 3.357 (2.349–4.366), males: 2.787 (2.475–3.099)]. In addition, an average leisure physical activity of 2.2 hours/day (2.009–2.404) was reported, with a significant difference between genders [females: 1.946 (1.699–2.193), males: 2.513 (2.204–2.822), P-value=0.005]. Moreover, the prevalence of obesity was 6.17%, with no difference between gender groups [females: 3.09%, males: 3.09%], and that of overweight attained 16.62% [females: 9.88%, males: 6.79%].

The prevalence of auto-reported diabetes and hypertension was respectively 3.31% and 8.54%. At the same time, according to our measurements of the systolic and diastolic blood pressure, the prevalence of raised blood pressure attained 42.69%, with a mean systolic and diastolic blood pressure of 118.046 mmHg (116.403–119.689) and 73.799 mmHg (72.509–75.089), respectively.

Table 1
Frequencies and prevalence of risk factors among enrolled young adults.


4. DISCUSSION

In our study, we investigated the distribution of cardiovascular risk factors among students in three elite engineering and medical schools. The investigated risk factors include the consumption of tobacco and alcohol, eating habits, physical activity levels, obesity, hypertension, and self-reported cases of diabetes mellitus.

4.1. Tobacco and Alcohol Consumption

Smoking is known to be the most important public health issue and also the most preventable cardiovascular risk factor [15Detels R, Gulliford M, Karim QA, Tan CC. Oxford Textbook of Global Public Health 6th éd.. 2015; 1717 p..]. In our sample, we found that nearly 7.58% of young adults in our sample are currently smoking, and six in ten young adults who are current smokers consume tobacco daily, with an average consumption of 5.84 cigarettes per day (3.272-8.419). These findings are in line with those of a 2008 STEPS survey in Iran, where the prevalence of tobacco smoking among youngsters aged between 15 and 24 years was 9.1% (6.8–11.9), with daily consumption of 13.1 (6.1–20.1) industrial cigarettes [16Meysamie A, Ghaletaki R, Haghazali M, et al. Pattern of tobacco use among the Iranian adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007). Tob Control 2010; 19(2): 125-8.
[http://dx.doi.org/10.1136/tc.2009.030759] [PMID: 20008159]
]. However, according to a STEPwise-approach-based study in Brunei in 2016 [17Ong SK, Lai DTC, Wong JYY, et al. Cross-sectional STEPwise Approach to Surveillance (STEPS) Population Survey of Noncommunicable Diseases (NCDs) and Risk Factors in Brunei Darussalam 2016. Asia Pac J Public Health 2017; 29(8): 635-48.
[http://dx.doi.org/10.1177/1010539517738072] [PMID: 29082745]
], the prevalence of smoking was 20.0% (17.2–22.7) among youth aged between 18 and 29 years. On a national scale, the prevalence of smoking in 2017 was reported to be 45.4% among the population above 15 years old [18Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results [Internet]. Institute for Health Metrics and Evaluation (IHME) 2018. Disponible sur: http://ghdx.healthdata.org/gbd-results-tool].

Even though it is prohibited to sell alcohol to Muslims in Morocco, heavy drinking is frequent among Moroccan people, with a proportion of 53.7% of heavy drinkers among current drinkers [19Clausen T, Rossow I, Naidoo N, Kowal P. Diverse alcohol drinking patterns in 20 African countries. Addiction 2009; 104(7): 1147-54.
[http://dx.doi.org/10.1111/j.1360-0443.2009.02559.x] [PMID: 19426287]
]. In our sample, the prevalence of alcohol drinking is estimated to be 13.82%, with no significant difference between genders. The same trend was observed among youth from the province of Khemisset, Morocco, where the prevalence of alcohol consumption is estimated to be 15.6% [20Ben El Jilali L, Benazzouz B, El Hessni A, Ouichou A, Mesfioui A. Prevalence of alcohol consumption and alcohol use disorders among middle and high school students in the province of Khemisset, Morocco: a cross-sectional study. Int J Adolesc Youth 2020; 25(1): 638-48.
[http://dx.doi.org/10.1080/02673843.2019.1700807]
].

4.2. Hypertension

Hypertension appears to be highly undiagnosed in our sample. In fact, a proportion of 42.69% in our sample had high levels of blood pressure, with 9.09% may be having either stage 1 or stage 2 hypertension. These findings are in line with Al-Majed & Sadek (2012) [21Al-Majed HT, Sadek AA. Pre-hypertension and hypertension in college students in Kuwait: a neglected issue. J Family Community Med 2012; 19(2): 105-12.
[http://dx.doi.org/10.4103/2230-8229.98296] [PMID: 22870414]
]which is based on a similar sample with a mean systolic and diastolic blood pressure of 116.16 and 76.02, compared to the mean systolic and diastolic blood pressure in our sample that was estimated to be 118.046 mmHg (116.403–119.689) and 73.799 mmHg (72.509–75.089), respectively [21Al-Majed HT, Sadek AA. Pre-hypertension and hypertension in college students in Kuwait: a neglected issue. J Family Community Med 2012; 19(2): 105-12.
[http://dx.doi.org/10.4103/2230-8229.98296] [PMID: 22870414]
].

4.3. Diet, Obesity and Physical Activity

As for fruit and vegetable consumption, we reported that subjects consume on average 2.52 fruit servings and 3.15 vegetable servings per day, which is way below the recommended five servings a day [22Painter J, Rah J-H, Lee YK. Comparison of international food guide pictorial representations. J Am Diet Assoc 2002; 102(4): 483-9.
[http://dx.doi.org/10.1016/S0002-8223(02)90113-6] [PMID: 11985405]
]. Correspondingly, youth in Iran have less fruit and vegetable intake than recommended, as they consume on average 1.49 fruit servings and 1.40 vegetable servings per day.

The prevalence of obesity reached in our sample to 6.17% and nearly two in ten young adults have either obesity or overweight, with a mean BMI of 23.30%. Wittekind et al. [23Wittekind SG, Edwards NM, Khoury PR, et al. Association of Habitual Physical Activity With Cardiovascular Risk Factors and Target Organ Damage in Adolescents and Young Adults. J Phys Act Health 2018; 15(3): 176-82.
[http://dx.doi.org/10.1123/jpah.2017-0276] [PMID: 29172989]
] reported a mean BMI of 36 using a similar sample, and Baig et al. [24Baig M, Gazzaz ZJ, Gari MA, Alattallah HG, AlJedaani KS, Mesawa AT, et al. Prevalence of obesity and hypertension among University students’ and their knowledge and attitude towards risk factors of Cardiovascular Disease (CVD) in Jeddah, Saudi Arabia. Pak J Med Sci [Internet] 2015; [cité 13 sept 2018]31(4) Disponible sur: http://pjms.com.pk/index.php/pjms/article/view/7953] reported an obesity prevalence of 18.6% in a similar university setup.

Furthermore, by examining pairwise correlation coefficients, it appears that subjects with higher physical activity levels had lower, but non-significant, Body Mass Index [BMI/Total physical activity time: -0.05, P-value=0.432]. Similarly, there was no significant correlation between fruit and vegetable intake, and BMI [fruit and vegetable intake/BMI: -0.0337, P-value=0.6452]. On the other hand, subjects with higher fruits and vegetable intake had significantly lower waist circumference, as suggested by the pairwise correlation coefficients [fruit and vegetable intake/waist circumference: -0.250, P-value=0.001]. Likewise, there was a negative and significant correlation between tobacco consumption and physical activity levels [Cigarettes smoked/total physical activity time: -0.751, P-value=0.019].

This exploratory study showed that cardiovascular risk factor trends among elite young adults can be of concern and urge the need for an in-depth exploration via a thorough nationwide study to provide a strong basis for preventive actions.

CONCLUSION

In summary, exploring the distribution of cardiovascular risk factors among youth is primordial as the development of chronic diseases begins in the early stages of life, yet it is a neglected issue in the literature [21Al-Majed HT, Sadek AA. Pre-hypertension and hypertension in college students in Kuwait: a neglected issue. J Family Community Med 2012; 19(2): 105-12.
[http://dx.doi.org/10.4103/2230-8229.98296] [PMID: 22870414]
]. This study showed that young population is not completely exempt from cardiovascular disease risk factors, as hypertension is quite prevalent among young adults in our sample, which is considered as the most important risk factor for cardiovascular diseases [7Blacher J, Levy BI, Mourad J-J, Safar ME, Bakris G. From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century. Lancet 2016; 388(10043): 530-2.
[http://dx.doi.org/10.1016/S0140-6736(16)00002-7] [PMID: 26856636]
]. Furthermore, hypertension appears to be largely undiagnosed in our sample, which urges taking actions towards raising awareness among youth about chronic diseases risk factors and highlighting their preventability as well as promoting healthy lifestyles in order to prevent future disease development. Thus, this study needs to be extended to include a nationally representative sample and further “steps” in the WHO STEPwise process for collecting risk factors data to ensure rigor, comparability, and reduce risk of selection and information bias.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No human or animals were used in this research.

INFORMED CONSENT

Potential participants were informed about the objectives of the study and provided signed consents before enrolment in the study.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions

FUNDING

This research was fully funded by Mohammed VI Polytechnic University in Ben Guerir, Morocco.

CONFLICT OF INTEREST

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

ACKNOWLEDGMENTS

The authors wish to thank Mohamed Soussou, Zaid Lemouakni, and Rania Msiyah for developing the online version of the survey and ensuring the complete confidentiality of the collected data.

REFERENCES

[1] Global status report on noncommunicable diseases 2014: attaining the nine global noncommunicable diseases targets; a shared responsibility Genev’a 2014.
[2] Franco M, Cooper RS, Bilal U, Fuster V. Challenges and opportunities for cardiovascular disease prevention. Am J Med 2011; 124(2): 95-102.
[http://dx.doi.org/10.1016/j.amjmed.2010.08.015] [PMID: 21295188]
[3] Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736-88.
[http://dx.doi.org/10.1016/S0140-6736(18)32203-7] [PMID: 30496103]
[4] Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 2007; 335(7611): 136-6.
[http://dx.doi.org/10.1136/bmj.39261.471806.55] [PMID: 17615182]
[5] Hippisley-Cox J, Coupland C, Vinogradova Y, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008; 336(7659): 1475-82.
[http://dx.doi.org/10.1136/bmj.39609.449676.25] [PMID: 18573856]
[6] Hippisley-Cox J, Coupland C, Robson J, Brindle P. Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database. BMJ 2010 déc 9; 341(dec09 1): c6624-4.
[http://dx.doi.org/10.1136/bmj.c6624]
[7] Blacher J, Levy BI, Mourad J-J, Safar ME, Bakris G. From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century. Lancet 2016; 388(10043): 530-2.
[http://dx.doi.org/10.1016/S0140-6736(16)00002-7] [PMID: 26856636]
[8] Wong ND, Patao C, Malik S, Iloeje U. Preventable coronary heart disease events from control of cardiovascular risk factors in US adults with diabetes (projections from utilizing the UKPDS risk engine). Am J Cardiol 2014; 113(8): 1356-61.
[http://dx.doi.org/10.1016/j.amjcard.2013.12.042] [PMID: 24581920]
[9] Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study. BMJ 2011 juill 28; 343(jul28 1): d4044-4.
[http://dx.doi.org/10.1136/bmj.d4044]
[10] Biddle SJ, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci 2004; 22(8): 679-701.
[http://dx.doi.org/10.1080/02640410410001712412] [PMID: 15370482]
[11] Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338(23): 1650-6.
[http://dx.doi.org/10.1056/NEJM199806043382302] [PMID: 9614255]
[12] Hoffmann B. A look inside the arteries: moving from event rates to subclinical measures of disease. Occup Environ Med 2015; 72(10): 687-8.
[http://dx.doi.org/10.1136/oemed-2014-102640] [PMID: 26150672]
[13] Buffart LM, van den Berg-Emons RJ, Burdorf A, Janssen WG, Stam HJ, Roebroeck ME. Cardiovascular disease risk factors and the relationships with physical activity, aerobic fitness, and body fat in adolescents and young adults with myelomeningocele. Arch Phys Med Rehabil 2008; 89(11): 2167-73.
[http://dx.doi.org/10.1016/j.apmr.2008.04.015] [PMID: 18835477]
[14] Rowland TW. The role of physical activity and fitness in children in the prevention of adult cardiovascular disease. Prog Pediatr Cardiol 2001; 12(2): 199-203.
[http://dx.doi.org/10.1016/S1058-9813(00)00074-6] [PMID: 11223348]
[15] Detels R, Gulliford M, Karim QA, Tan CC. Oxford Textbook of Global Public Health 6th éd.. 2015; 1717 p..
[16] Meysamie A, Ghaletaki R, Haghazali M, et al. Pattern of tobacco use among the Iranian adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007). Tob Control 2010; 19(2): 125-8.
[http://dx.doi.org/10.1136/tc.2009.030759] [PMID: 20008159]
[17] Ong SK, Lai DTC, Wong JYY, et al. Cross-sectional STEPwise Approach to Surveillance (STEPS) Population Survey of Noncommunicable Diseases (NCDs) and Risk Factors in Brunei Darussalam 2016. Asia Pac J Public Health 2017; 29(8): 635-48.
[http://dx.doi.org/10.1177/1010539517738072] [PMID: 29082745]
[18] Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results [Internet]. Institute for Health Metrics and Evaluation (IHME) 2018. Disponible sur: http://ghdx.healthdata.org/gbd-results-tool
[19] Clausen T, Rossow I, Naidoo N, Kowal P. Diverse alcohol drinking patterns in 20 African countries. Addiction 2009; 104(7): 1147-54.
[http://dx.doi.org/10.1111/j.1360-0443.2009.02559.x] [PMID: 19426287]
[20] Ben El Jilali L, Benazzouz B, El Hessni A, Ouichou A, Mesfioui A. Prevalence of alcohol consumption and alcohol use disorders among middle and high school students in the province of Khemisset, Morocco: a cross-sectional study. Int J Adolesc Youth 2020; 25(1): 638-48.
[http://dx.doi.org/10.1080/02673843.2019.1700807]
[21] Al-Majed HT, Sadek AA. Pre-hypertension and hypertension in college students in Kuwait: a neglected issue. J Family Community Med 2012; 19(2): 105-12.
[http://dx.doi.org/10.4103/2230-8229.98296] [PMID: 22870414]
[22] Painter J, Rah J-H, Lee YK. Comparison of international food guide pictorial representations. J Am Diet Assoc 2002; 102(4): 483-9.
[http://dx.doi.org/10.1016/S0002-8223(02)90113-6] [PMID: 11985405]
[23] Wittekind SG, Edwards NM, Khoury PR, et al. Association of Habitual Physical Activity With Cardiovascular Risk Factors and Target Organ Damage in Adolescents and Young Adults. J Phys Act Health 2018; 15(3): 176-82.
[http://dx.doi.org/10.1123/jpah.2017-0276] [PMID: 29172989]
[24] Baig M, Gazzaz ZJ, Gari MA, Alattallah HG, AlJedaani KS, Mesawa AT, et al. Prevalence of obesity and hypertension among University students’ and their knowledge and attitude towards risk factors of Cardiovascular Disease (CVD) in Jeddah, Saudi Arabia. Pak J Med Sci [Internet] 2015; [cité 13 sept 2018]31(4) Disponible sur: http://pjms.com.pk/index.php/pjms/article/view/7953
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open