IJCS | Volume 31, Nº6, November / December 2018

604 Brajkovich et al. Metabolic syndrome inVenezuela Int J Cardiovasc Sci. 2018;31(6)603-609 Original Article obesity (waist circumference ≥ 94 cm in men and ≥ 90 cm in women) in the Latin American population has been proposed. 7 Considering that the level of fat mass linked to MS differs among regions, applying these abdominal obesity ethnic-specific cutoffs can improve the detection of cardiometabolic risk factors. Comparing with Caucasians and similar to Asian populations, 8 MS is present at lower levels of waist circumference in Latinos 7 and Venezuelans. 9 Two major studies have reported the MS prevalence in Venezuela. Florez et al., 10 evaluating 3,108 adults from the Zulia Region, found the prevalence of MS according to the NCEP/ATP-III 11 to be 31.2%, and the prevalence of atherogenic dyslipidemia (elevated triglycerides and low high-density lipoprotein cholesterol [HDL-c]) to be 24.1%. In Barquisimeto city, located in the western region of the country, the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study, 12 which applied the NCEP/ATP-III definition 11 and included 1,848 adults, reported a prevalence of MS of 25.8%. The limitation of these studies was that they only included one Venezuelan region, prompting the design of the Venezuelan Metabolic Syndrome, Obesity and Lifestyle Study (VEMSOLS). This article presents the results of this study, specifically, theMS prevalence in five populations of three regions of Venezuela. Methods Design and subjects An observational, cross-sectional study was designed to determine the prevalence of cardiometabolic risk factors in a subnational cohort in Venezuela. Five municipalities were evaluated in three regions in the country: Palavecino Municipality in Lara State (urban), located in the western region; EjidoMunicipality (Mérida city), in Mérida State (urban) and Rangel Municipality (Páramo area) inMérida State (rural), both located in the Andes region; and Catia La Mar Municipality in Vargas state (urban) and Sucre Municipality in Capital District (urban), both in the Capital Region. During the years 2006 and 2010, a total of 1,320 subjects aged ≥ 20 years who had lived in their homes for at least 6 months were selected by two-stage random sampling. The assessment included three different geographic regions in the country – the Andes, mountains in the south; Western, Llanos in the middle; and Capital District, coast in the north. Each region was stratified by municipalities, and one was randomly selected. Map and census of each locationwere required to delimit the streets or blocks, and to select the households to visit in each municipality. After selecting the sector to be surveyed at each location, the visits to the households started at house number 1 and moved up, skipping every two houses. Pregnant women and individuals unable to stand up and/or communicate verbally were excluded. The sample size was calculated to detect a prevalence of hypercholesterolemia (the lowest prevalent condition reported in Venezuela) of 5.7% 12 with a standard deviation of 1.55%, which allows the calculation of a 95% confidence interval (95%CI). The minimum estimated number of subjects to be evaluated was 830. Overall, 1,320 subjects were evaluated (89.4% in the urban and 10.6% in the rural area). Clinical and biochemical data All subjects were evaluated in their homes or in a nearby health center by a trained health care team according to a standardized protocol. Each home was visited twice. In the first visit, the participants received information about the study and a written informed consent was obtained. Demographic and clinical information was obtained using a standardized questionnaire. Blood pressure was measured twice in the right arm supported at the level of the heart, with the subject in the sitting position, after 5 minutes of rest, and obtained with a calibrated aneroid sphygmomanometer. Weight was measured with the use of a calibrated scale with the individuals wearing as few clothes as possible and without shoes. Height was measured using a metric tape attached to the wall. Waist circumference was measured at the iliac crest, in a horizontal plane with the floor at the end of expiration. Body mass index (BMI) was calculated with the formula weight (in kg) divided by the squared height (in m 2 ). In the second visit, blood samples were drawn after 12 hours of overnight fasting, centrifuged during 15minutes at 3000 rpmwithin 30-40minutes from the collection, and transported in dry ice to the central laboratory where the samples were properly stored at -40°C until analysis. Questionnaire information from the participants absent during the first visit was collected during this second visit. Plasma glucose, triglycerides, and HDL-c were determined by standard enzymatic colorimetricmethods. The study was conducted according to the Declaration of Helsinki. The only invasive procedure performed was venipuncture, and no complications occurred.