Cardiovascular disease risk factors in homeless people

Abstract

BackgroundCardiovascular diseases (CVD) are associated with significant morbidity and mortality, which is highest in Eastern Europe including Estonia. Accumulating evidence suggests that life-style is associated with the development of CVD. The aim of this study was to evaluate the informative power of common CVD-related markers under unhealthy conditions.SubjectsSubjects (n = 51; mean age 45 years; 90% men) were recruited from a shelter for homeless people in Tallinn, Estonia, and consisted of persons who constantly used alcohol or surrogates, smoked, and were in a bad physical condition (amputated toes, necrotic ulcers, etc.).MethodsBlood pressure, pulse rate, and waist circumference were measured, and body mass index (BMI) was calculated. The following markers were measured in blood serum: total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), plasma triglycerides (TG), apolipoproteins A-l (ApoA1) and B (ApoB), lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), glucose (Gluc), high-sensitivity C-reactive protein (hsCRP), serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Except smoking, the anamnestic information considering eating habits, declared alcohol consumption and medication intake were not included in the analysis due to the low credibility of self-reported data.ResultsMore than half of the investigated patients had values of measured markers (hsCRP, TChol, LDL-Chol, TG, HbA1c, ApoA1, ApoB, Lp(a), Gluc) within normal range. Surprisingly, 100% of subjects had HDL-Chol within endemic norm.ConclusionThis study demonstrates that traditional markers, commonly used for prediction and diagnosis and treatment of CVD, are not always applicable to homeless people, apparently due to their aberrant life-style.

Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness

“…Previous studies of CVD risk in homeless populations have similarly observed a high prevalence of CVD risk factors and an increased risk for CVD among homeless individuals [ 14 , 28 , 42 , 43 ]. However, many of these studies have been limited in scope, often focusing on particular subsets of the homeless population and/or examining only one risk factor [ 16 , 44 - 47 ], or conducted outside of North America [ 42 , 43 , 48 , 49 ].…”

“…Among the modifiable CVD risk factors, high rates of smoking are consistently reported in studies of both homeless and mentally ill populations [ 13 , 14 , 42 , 43 , 50 - 52 ]. An estimated 73 to 80% of homeless adults smoke [ 53 , 54 ]; tobacco companies have targeted people who are homeless in past intensive marketing strategies, including distributing free cigarettes at homeless shelters [ 55 ].…”

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal

“…Higher prevalence of hypertension and higher average blood pressure values observed in the general population are essentially due to the high proportion of overweight and obese individuals 57 . Previous studies conducted among the homeless yielded prevalence of hypertension ranging between the 14% and 51% 14,15,17,18,19,20,21 .…”

“…In comparison with the general population, mortality rates are reported to be higher among the homeless and premature death is more common 9,10,11 , especially due to cardiovascular disease 11,12 . In addition to a high prevalence of diabetes and hypercholesterolemia, the increased risk of cardiovascular disease has been attributed essentially to a high prevalence of hypertension and substance abuse 12,13,14,15,16 . Several studies reported prevalence of hypertension among the homeless ranging from 14% to 51% 14,15,17,18,19,20,21 , and prevalence of tobacco and alcohol consumption of almost 80% and 30% respectively 12,14,22 .…”

“…In addition to a high prevalence of diabetes and hypercholesterolemia, the increased risk of cardiovascular disease has been attributed essentially to a high prevalence of hypertension and substance abuse 12,13,14,15,16 . Several studies reported prevalence of hypertension among the homeless ranging from 14% to 51% 14,15,17,18,19,20,21 , and prevalence of tobacco and alcohol consumption of almost 80% and 30% respectively 12,14,22 . Furthermore, the fact that the homeless population experiences difficulties in obtaining and maintaining stable sources of medical care has also been described as a barrier to appropri-ARTIGO ARTICLE ate healthcare 23,24,25 that contributes to a lack of awareness of these health problems and difficulties in adhering to treatment regimens 26 .…”