PARIS, September 24 /PRNewswire/ --

- Survey Highlights Need to Follow-up and Manage Both Classical and Emerging Cardiometabolic Risk Factors to Change Risk

Results from a survey conducted in 28 countries to coincide with World Heart Day, 30th September 2007, reveal an increase in physician awareness about the link between too much fat around the waist (abdominal obesity) and the development of diabetes and heart disease.(1) However the study indicates that physicians are still more likely to screen and manage classical cardiovascular and metabolic risk factors such as type 2 diabetes, high levels of bad cholesterol and high blood pressure than emerging risk factors such as abdominal obesity, low levels of good cholesterol (HDL-Cholesterol) and high levels of fat in the blood (also known as triglycerides). Additionally over 80 percent of physicians feel their patients are not adequately educated about how they can reduce risk factors for cardiovascular and metabolic diseases (cardiometabolic risk) in order to lower their risk.

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Global cardiometabolic risk represents the overall risk of developing type 2 diabetes and heart disease, which is due to a cluster of modifiable risk factors such as: high blood sugar, unhealthy cholesterol (high levels of LDL- or low levels of HDL-cholesterol in the blood), high levels of triglycerides in the blood, high blood pressure or too much fat around the waist (as measured by waist circumference).(2,3) Recent evidence has shown that this cluster of modifiable factors can increase the risk of people developing type 2 diabetes and heart disease.(2,3) Therefore it is important that these cardiometabolic risk factors are measured regularly in order to assess the risk of type 2 diabetes and heart disease and to provide the basis for intervention with preventive therapies.

Results released today from the Shape of the Nations 2007 survey show that about three-quarters of physicians rate classical risk factors such as type 2 diabetes, high blood pressure, smoking and high of LDL-cholesterol (bad cholesterol) as the highest risk for heart disease. However they are considerably less likely to state a high level of concern for emerging cardiometabolic risk factors that put their patients at risk, such as abdominal obesity, high levels of triglycerides in the blood and low levels of HDL-cholesterol (good cholesterol).

The survey also demonstrates that only six percent of the general population and 11 percent of at-risk patients recognise that type 2 diabetes is a cardiometabolic risk factor. Furthermore, only about one in three at-risk patients reported that their doctor or nurse had ever measured emerging cardiometabolic risk factors.

"Heart disease and stroke are largely preventable if the main risk factors, including high blood pressure, high levels of cholesterol and blood glucose, tobacco use, inadequate intake of fruit and vegetables, overweight and obesity, and physical inactivity are reduced," said Professor Sidney Smith, Chairman of the World Heart Federation's Scientific Advisory Board.

"The results of the Shape of the Nations 2007 Survey demonstrate the need for continuing education, assessment and follow up of risk factors. On World Heart Day we're calling for physicians worldwide to team up with their patients and support them in living longer, healthier lives," said Professor Smith.

Shape of the Nations 2007

Shape of the Nations 2007 is a joint initiative between sanofi-aventis, the World Heart Federation, the International Association for the Study of Obesity and the International Diabetes Federation and coincides with World Heart Day each year. This year's World Heart Day under the theme "Team Up for Healthy Hearts", encourages people to join together and create heart-healthy communities. Communities - from families to schools, social groups, workplaces and religious circles - can encourage smoke-free environments, regular physical activity and healthy food choices. World Heart Day falls on 30th September this year and is run by the World Heart Federation and its member organisations in over 100 countries. For more information visit

Over 11,000 people across 28 countries took part in the Shape of the Nations 2007 Survey.(1) The survey assessed awareness, understanding and behaviours with respect to cardiometabolic risk factors, across three groups: primary care physicians, a population at-risk for heart disease and the general population.

A high percentage of primary care physicians are able to identity classical risk factors for heart disease - such as high blood sugar, high levels of bad cholesterol, high blood pressure and smoking. The survey showed that recognition of high blood pressure as a cardiometabolic risk factor has increased to 71 percent from 57 percent in 2006, 68 percent of physicians recognise general obesity as a risk factor versus 61 percent in 2006 and 64 percent recognise smoking versus 43 percent in 2006.

However, only 24 percent of physicians recognize abdominal obesity as a cardiometabolic risk factor, 24 percent recognise high levels of triglycerides in the blood and 12 percent recognize low levels of good cholesterol as cardiometabolic risk factors

Results from the Shape of the Nations 2007 Survey show that while physicians recognize and treat classic cardiovascular risk factors, fewer than two-thirds regularly assess and follow-up emerging cardiometabolic risk factors. Physicians still routinely measure more of the classical risk factors such as high blood pressure (96 percent), high blood sugar (87 percent) and high levels of bad cholesterol (79 percent) than emerging risk factors: such as abdominal obesity (66 percent), low levels of good cholesterol (72 percent) and high levels triglycerides in the blood (76 percent). In addition to a need for further education, these results highlight the need for patients to team up with their doctors to measure and regularly follow-up the emerging cardiometabolic risk factors as well as classical cardiovascular risk factors. This is easily achieved through a five point healthy heart check which includes waist circumference, blood sugar, good and bad cholesterol, blood fat and blood pressure.

Abdominal obesity and cardiometabolic risk factors

Current clinical strategies for the management of heart disease still focus on treating individual risk factors. Despite major advances in reducing the prevalence of certain well recognized risk factors, such as smoking, high cholesterol, high blood pressure and diabetes and other emerging risk factors, it is estimated that nearly a third of all deaths every year are still caused by heart disease.(4) In addition, 246 million people worldwide currently have type 2 diabetes and the number of people affected is expected to reach 380 million by 2025.(5) Every year, nearly four million deaths are attributable to diabetes.(6)

Cardiometabolic risk factors tend to cluster with the dominant feature being abdominal obesity (easily measured by waist circumference).(2,3) Studies show that people with a cluster of cardiometabolic risk factors known as the metabolic syndrome have an elevated global cardiometabolic risk, i.e. more than double the risk of developing atherosclerotic cardiovascular disease events and nearly a five-fold risk of developing type 2 diabetes, compared to those without any cardiometabolic risk factors..(7,8). Emerging cardiometabolic risk factors, such as low levels of good cholesterol (HDL - Cholesterol) and high levels of triglycerides in the blood, are frequently found among people with abdominal obesity, especially those with excessive intra-abdominal adiposity.(9)

Emerging risk factors, such as low HDL-cholesterol and elevated triglycerides, are frequently found among people with abdominal obesity, especially those with excessive intra-abdominal adiposity.(10) Recently, research has identified the endocannabinoid system (ECS), a network of receptors throughout the body that tends to be overactive in individuals who struggle with weight and weight-related health risks. This over-activity contributes to high blood glucose, an unhealthy lipid profile and the storage of fat as excess weight and midsection weight. (11,12,13,14)

Change My Risk for a Healthy Heart

The Shape of the Nations 2007 Survey findings demonstrate a clear need for education among both patients and physicians to better understand cardiometabolic risk factors. It is particularly important that people with abdominal obesity who are at risk of type 2 diabetes or heart disease have regular 5-point healthy heart check for waist circumference, blood sugar, good and bad cholesterol, blood fat and blood pressure so that their doctor can follow-up all their cardiometabolic risk factors and take action to reduce global cardiometabolic risk and change their risk.

Notes to the Editor

Survey Methodology

The Shape of the Nations 2007 survey, funded by sanofi-aventis and endorsed by the World Heart Federation, was carried out with the main aim of assessing awareness, understanding and behaviours with respect to cardiometabolic risk factors. The survey involved 11,183 participants in 28 countries and was conducted via telephone or in-person interviews among three target audiences:

- General population (approximately 200 participants per country except US = 400, Malaysia =150), total of 5,796 interviews

- At-risk population identified as being at-risk for heart disease due to being overweight or obese (approximately 80 per country except US = 400, Malaysia = 60), total of 2,556 interviews

- Primary care physicians (approximately 100 participants per country except Canada = 130, Malaysia = 70), total of 2,831 interviews

The countries surveyed were: 1. Australia 11. Greece 21. South Korea 2. Austria 12. Hungary 22. Spain 3. Belgium 13. Ireland 23. Sweden 4. Brazil 14. Italy 24. Switzerland 5. Canada 15. Malaysia 25. Taiwan 6. Czech Republic 16. Mexico 26. Turkey 7. Denmark 17. Norway 27. United Kingdom 8. Finland 18. Portugal 28. United States 9. France 19. Russia 10. Germany 20. South Africa

About sanofi-aventis

Sanofi-aventis is one of the world leaders in the pharmaceutical industry, ranking number one in Europe. Backed by a world-class R&D organisation, sanofi-aventis is developing leading positions in seven major therapeutic areas: cardiovascular, thrombosis, oncology, metabolic diseases, central nervous system, internal medicine and vaccines. Sanofi-aventis is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).

About the World Heart Federation

The World Heart Federation, a non-governmental organization based in Geneva, Switzerland, is committed to helping the global population achieve a longer and better life through prevention and control of heart disease and stroke, with a particular focus on low and middle-income countries. It is comprised of 195 member societies of cardiology and heart foundations from 100 countries covering the regions of Asia-Pacific, Europe, the Americas and Africa. For further information visit:


(1) Shape of the Nations Survey, 2007. Conducted by IFOP North America. Data on file sanofi-aventis

(2) Vasudevan AR, Ballantyne CM. Cardiometabolic risk assessment; an approach to the prevention of cardiovascular disease and diabetes mellitus. Clin Cornerstone 2005; 7:7-16.

(3) Université Laval. Establishment of a Chair on Cardiometabolic Risk. (press release on the Internet) Ontario, C2006. (last accessed 6th July 2006) Available from:é ic_Risk.htm.

(4) World Health Organization. Cardiovascular Disease - Prevention and Control. (fact sheet on the Internet) Geneva: 2007. (last accessed 21st April 2007). Available from:

(5) International Diabetes Federation. Diabetes e-atlas 3rd Edition. (Publication on the Internet). Brussels; 2006 (cited 29th March 2007) Available at:

(6) International Diabetes Federation. Diabetes e-atlas 3rd Edition. (Publication on the Internet). Brussels; 2006 (cited 21st April March 2007) Available at:

(7) Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ; Pio JR et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004; 110:1245-50.

(8) Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus. Circulation 2005; 112:3030-2.

(9) Wajchenberg, BL. Subcutaneous and visceral adipose tissue: Their relation to the metabolic syndrome. Endocr Rev 2000; 21:697-738.

(10) Sharma, A. M. Adipose tissue: a mediator of cardiovascular risk. International Journal of Obesity, 2002, 26, S5 - S7

(11) Di Marzo V, Matias I. Endocannabinoid control of food intake and energy balance. Nat Neurosci. 2005 8:585-9

(12) Osei-Hyiaman D, DePetrillo M, Pacher P, Liu J, Radaeva S, Batkai S, et al. Endocannabinoid action at hepatic CB1 receptors regulates fatty acid synthesis: role in diet-induced obesity. J Clin Invest. 2005;115:1298-1305.

(13) Catalano KJ, Bergman RN, Ader M. Increased susceptibility to insulin resistance associated with abdominal obesity in aging rats. Obesity Research. 2005; 13:11-20

(14) Pouliot MC, Després JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460-8

For more information, contact: Media contact: Wendy Gerber, MS&L PR, Tel: +44-20-7878-3259, E-mail:; World Heart Federation media contact: Clare Courtney, Cohn & Wolfe PR, Tel: +41-22-908-40 72, E-mail: