4.1. Cardiovascular Risk Factors among Socioeconomically Disadvantaged Populations in Western Romania: A Comparative Analysis with National and International Studies
This study highlighted a significant prevalence of cardiovascular risk factors among the socioeconomically disadvantaged population in West Romania. PPA conditions such as arterial hypertension (35.58%), dyslipidemia (21.28%), and diabetes (7.39%) were notably prevalent. These findings are consistent with numerous studies that emphasize the disproportionate burden of CVRFs in low-socioeconomic-status populations. For example, a study conducted by Barnett et al. found that individuals in lower SES brackets have a higher prevalence of risk factors such as hypertension, diabetes, and smoking compared to higher SES groups. This is attributed to limited access to healthcare, unhealthy lifestyle choices, and greater psychosocial stress [
23]. Furthermore, Kanjilal et al. highlighted that low SES is strongly associated with higher incidences of hypertension and dyslipidemia, paralleling the findings in this West Romania study [
24].
The analysis showed significant differences in the median ages of subjects with and without CVRFs. For example, individuals with diabetes had a median age of 65 years, compared to 51 years for those without diabetes. Similarly, those with coronary disease and arterial hypertension also had higher median ages. These findings are similar to others that demonstrated that SES-related disparities significantly impact the onset and progression of CVD. Higher-SES individuals tend to have better access to preventive measures and treatment options, delaying the onset of CVD. Disadvantaged neighborhoods exhibited higher CVD prevalence and poorer health outcomes, emphasizing the role of social determinants in health [
25,
26,
27].
Our data showed a distribution of BMI classifications among a group of individuals, with the majority falling into the overweight category (33.77%), followed by normal weight (27.63%), obese (21.21%), morbidly obese (15.07%), and underweight (2.30%). This distribution highlights the prevalence of higher BMI categories within the group, which is a common trend observed in various populations globally. Comparing these results with similar studies, a study using the UK Biobank cohort identified similar trends, with a significant portion of the population classified as overweight or obese. This study also highlighted the complexity of obesity, considering various factors like societal influences, individual psychology, and physical activity. Such findings underscore the multifaceted nature of obesity and the need for comprehensive strategies to address it [
28,
29]. Furthermore, they highlight the ongoing global challenge of obesity and the need for comprehensive approaches to address it. Understanding these trends and their implications can help in developing targeted interventions to improve health outcomes [
30,
31].
For the HCA of diabetes, the BMI of subjects with diabetes (29.62) was significantly higher than that of those without (27.74), with a
p-value of 0.011. This finding aligns with the existing literature, which suggests higher BMI is a risk factor for developing diabetes, particularly in individuals with a family history of the condition [
32].
In the case of the cardiovascular HCA, the difference in BMI between subjects with cardiovascular conditions (28.30) and those without (28) was not statistically significant (
p-value 0.847). This suggests that while BMI is an important factor, other hereditary factors might play a more critical role in cardiovascular health [
33,
34]. This suggests that while BMI is a factor, other elements such as genetic predisposition, lifestyle, and other comorbidities play a crucial role in cardiovascular health. Similar findings were reported in a study in the
Journal of the American College of Cardiology, which emphasized the multifactorial nature of cardiovascular disease [
1,
35].
Regarding the PPAs of diabetes, coronary disease, arterial hypertension, and dyslipidemia, the BMI of subjects with these conditions was significantly higher than that of those without. This strong association underscores the impact of personal health history on these diseases’ risk, consistent with the finding that higher BMI is a significant risk factor for diabetes, coronary disease, arterial hypertension, and dyslipidemia [
36,
37].
The active smoking rate of 31.71% is notably high. This is consistent with other research indicating a higher smoking prevalence in socioeconomically disadvantaged populations compared to the general population. Nationally, the smoking rate tends to be lower, often around 14–15% in many developed countries [
38]. Furthermore, the percentage of ex-smokers (9.79%) is relatively low. This suggests potential barriers to quitting smoking within this population, such as limited access to smoking cessation programs, lack of healthcare support, and higher levels of stress and mental health issues, which are known to affect smoking cessation efforts. Studies consistently show higher smoking rates among socioeconomically disadvantaged groups. For example, research published in the USA indicated that smoking prevalence in the lowest income brackets can be as high as 30–35%, aligning with the 31.71% observed in our data [
39,
40].
Regarding smoker status, the BMI of smokers (27.66) was slightly lower than that of non-smokers (28), with a
p-value of 0.031. This finding is intriguing and aligns with the hypothesis that smoking may suppress appetite and increase metabolism, leading to lower body weight. Furthermore, this small but significant difference is consistent with findings in the
American Journal of Public Health, which suggest that smokers tend to have a lower BMI but higher risks of other health issues [
41,
42].
Regarding the BMI of the subjects, the analyzed data highlighted significant differences in cardiovascular risk factors between males and females. Firstly, males have a higher median BMI compared to females, with a statistically significant difference (
p = 0.021). This aligns with studies showing that males in disadvantaged populations often have higher BMI due to lifestyle factors and limited access to healthy food options [
3]. Both systolic and diastolic blood pressures were higher in males, with highly significant
p-values (<0.0001 and 0.001, respectively). These findings are similar to those of the SEPHAR study, which included people from the same geographic area [
43,
44]. High blood pressure is more prevalent in socioeconomically disadvantaged areas, often due to stress, poor diet, and lack of healthcare access, contributing to increased cardiovascular risk [
2,
36,
45]. Also, males had higher blood glucose levels than females, with a significant
p-value (<0.0001). This is consistent with findings that disadvantaged populations have higher rates of diabetes and poor glycemic control due to limited healthcare access [
17,
46].
It is important to note that the occurrence of diabetes, based on their medical records, was 7.39%. However, 16.41% of individuals had a fasting glucose level exceeding 126 mg/dL. In contrast, the PREDATORR study, conducted from 2012 to 2014, found a diabetes prevalence of 11.6% among the adult Romanian population [
46]. A deep analysis of these data showed that impaired glucose regulation (prediabetes, known and unknown diabetes) was found in 28.1% of the study population in the PREDATORR study, compared to 68.11% of our study population with fasting glucose levels higher than 100 mg/dL [
46]. The early diagnosis of diabetes is crucial in preventing or delaying the progression of the disease and the onset of complications, such as cardiovascular diseases, neuropathy, and nephropathy, which significantly impact patient outcomes and healthcare resources [
47,
48,
49].
Total cholesterol levels were slightly higher in females, but the difference was not statistically significant (
p = 0.062). HDL levels were significantly higher in females (<0.0001), while LDL levels showed no significant difference (
p = 0.562). Disadvantaged populations often have poor lipid profiles due to dietary habits and lack of preventive care [
11]. However, regardless of fasting triglyceride levels, males had increased levels. Elevated triglycerides are common in socioeconomically disadvantaged groups, linked to diet and metabolic syndrome [
11,
50].
The results of this study align with existing research on cardiovascular risk factors in socioeconomically disadvantaged populations, highlighting significant associations between these risk factors and health outcomes. The strong relationship between diabetes and a family history of the disease (HCA) underscores the genetic predisposition in these populations, as supported by studies like those by Sirdah et al. and Wang et al. [
51,
52]. Furthermore, the significant increase in the risk for elevated blood glucose levels in individuals with higher BMI (≥25 kg/m
2 and ≥30 kg/m
2) is consistent with findings from Wondmkun’s research, which noted a strong link between obesity and impaired glucose regulation in low-income populations [
53]. The progressive increase in the risk of hypertension with elevated blood glucose levels also mirrors the Framingham Heart Study’s findings, which highlighted the connection between hyperglycemia and hypertension in at-risk populations [
54,
55]. Additionally, the observed, albeit not statistically significant, association between coronary disease and a family history of cardiovascular disease suggests a hereditary component that may be influenced by lifestyle and environmental factors, as noted in the INTERHEART study [
56,
57]. Overall, these findings emphasize the compounded cardiovascular risks faced by disadvantaged populations, reinforcing the need for targeted public health interventions that address both genetic predispositions and socioeconomic factors.
4.2. Comparative Analysis of Cardiovascular Risk Factors in Socioeconomically Disadvantaged Populations: Insights from Recent Romanian Studies
Our study’s findings align with and expand upon those in the attached article by Simionescu et al., which examined CVD risk factors and mortality in Romania. Both studies highlight the significant burden of CVDs, particularly among socioeconomically disadvantaged populations, with our research identifying a high prevalence of arterial hypertension, dyslipidemia, and diabetes, which mirrors Simionescu et al.’s emphasis on hypertension as a leading risk factor. While Simionescu et al. discuss the persistent high mortality rates despite increased healthcare infrastructure, our study adds depth by examining the significant correlations between BMI, smoking, and cardiovascular risk factors, reinforcing the complex interplay of lifestyle factors and CVD risk. Both studies underscore the need for enhanced healthcare access and targeted public health policies to address these risk factors, particularly in disadvantaged communities, presenting a compelling case for prioritizing cardiovascular health in Romania’s public health strategy [
9].
The findings of our study, which highlighted a significant prevalence of CVRFs such as arterial hypertension, dyslipidemia, and diabetes among a socioeconomically disadvantaged population in West Romania, align closely with the results of several key studies in Romania, including those by Simionescu et al., Rosu et al., Weiss et al., and Cinteza et al. (CARDIO-Zone study) [
9,
58,
59,
60]. Both our study and the CARDIO-Zone study reveal high rates of hypertension and diabetes, although our study found even higher rates of undiagnosed cases, particularly of hypertension and dyslipidemia, suggesting gaps in healthcare access and preventive care. Additionally, while the CARDIO-Zone study emphasized regional differences in CVRF prevalence, our research adds to this by examining the complex interplay of BMI, smoking, and CVRFs, further reinforcing the role of lifestyle and socioeconomic factors in cardiovascular health [
60]. Moreover, the prevalence of obesity and smoking in our study mirrors that observed in broader Romanian studies, indicating consistent patterns across different populations and regions. Overall, these findings collectively underscore the urgent need for targeted public health interventions and improved healthcare accessibility to mitigate the burden of cardiovascular diseases in Romania, particularly among disadvantaged communities.
All of these findings align with broader research indicating that socioeconomically disadvantaged populations face higher cardiovascular risks due to a combination of biological, behavioral, and psychosocial factors [
4,
61]. Furthermore, the data from the current study and the PREDATORR and SEPHAR studies collectively indicate high rates of hypertension and metabolic disorders among the Romanian population, particularly in socioeconomically disadvantaged groups. The high prevalence of active smokers in the current study (31.71%) exacerbates these health conditions, highlighting the need for targeted interventions [
8,
43,
44,
46].