Impact of dyslipidemia on cardiovascular risk stratification of hypertensive patients and association of lipid profile with other cardiovascular risk factors: results from the ICEBERG study

Giray Kabakci¹, Nevres Koylan², Baris Ilerigelen³, Omer Kozan⁴, Kemalettin Buyukozturk² on behalf of the ICEBERG Investigators

¹Hacettepe University, Hacettepe School of Medicine, Department of Cardiology, Ankara, Turkey; ²Istanbul University, Istanbul School of Medicine, Department of Cardiology, Istanbul, Turkey; ³Istanbul University, Cerrahpasa School of Medicine, Department of Cardiology, Istanbul, Turkey; ⁴Dokuz Eylul University, Dokuz Eylul School of Medicine, Department of Cardiology, Izmir, Turkey

Background: Hypertension, dyslipidemia, and other cardiovascular risk factors are linked epidemiologically, clinically, and metabolically. Intensive/Initial Cardiovascular Examination regarding Blood Pressure levels, Evaluation of Risk Groups (ICEBERG) study focuses on the effect of dyslipidemia on cardiovascular risk evaluation and association of lipid profile with other risk factors.

Patients and methods: The ICEBERG study consisted of two sub-protocols: ICEBERG-1, conducted at 20 university hospitals (Referral Group) and ICEBERG-2, conducted at 197 primary healthcare centers (Primary Care Group). Sub-protocol had two patient profiles: patients previously diagnosed with essential hypertension and under medical treatment (Treated Group) and patients with systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, with no antihypertensive treatment for at least 3 months before inclusion (Untreated Group). Dyslipidemia was evaluated and cardiovascular risk stratification was performed according to ESC/ESH guidelines.

Results: More than half of the treated and untreated subjects were classified into high or very high cardiovascular risk groups. In a total of 1817 patients, the percentage of patients in “high” plus “very high” added risk groups increased to 55.2% in Treated Referral Group (p < 0.001), to 62.6% in Untreated Referral Group (p = 0.25) and to 60.7% in Untreated Primary Care Group (p < 0.001), by re-evaluation of patients’ lipid values.

Conclusions: Serum lipid levels are useful in stratifying hypertensive patients into cardiovascular risk groups more accurately, for appropriate antihypertensive treatment.

Keywords: hypertension, dyslipidemia, cardiovascular disease