A Spanish study has challenged the long-held belief that people in the Mediterranean all enjoy more healthy diets and lifestyles, after discovering alarmingly high cardiovascular risk factors similar to those found in the UK and USA.

Research published in the January issue of IJCP, the International Journal of Clinical Practice, also found strong links between low levels of education and increased risk.

"Cardiovascular diseases account for 33 per cent of deaths in Spain, making it the main cause of mortality in the country" says Dr Ricardo Gómez-Huelgas from the Internal Medicine Department at Hospital Carlos Haya, Malaga.

The study was carried out on a random selection of 2,270 adults attending a healthcare centre in Malaga, Andalucia, a region with one of the highest rates of cardiovascular disease in Spain. The participants ranged from 18 to 80, with an average of just under 44 years, 50.3 per cent were female and 58 per cent had low educational levels.

More than 60 per cent were overweight or obese and 77 per cent did not get enough exercise. The researchers also found that 28 per cent smoked, 33 per cent had high blood pressure, seven per cent had diabetes and 65 per cent had high cholesterol levels.

Just under 30 per cent of the patients had three or more cardiovascular risk factors that could be modified by changes to their lifestyle or diet.

"Most of the cardiovascular risk factors increased with age, with the exception of smoking and low levels of 'good' cholestererol, and we noted some differences between the sexes" says Dr Gómez-Huelgas.

"We also found that a low education level was associated with a high prevalence of cardiovascular risk factors and this association was significant when it came to smoking, obesity, abdominal obesity and high levels of fatty molecules.

"The prevalence of obesity, diabetes, high blood pressure and high cholesterol in Spain have all risen at an alarming rate over the last 20 years and this is likely to cause future increases in bad health and death due to cardiovascular disease."

Other key findings of the study include:

* Men had a higher prevalence of smoking, high blood pressure, high levels of fatty molecules and impaired fasting glucose - which can lead to diabetes - than women.

* Women were more likely to demonstrate a higher prevalence of physical inactivity and abdominal obesity. Young female smokers with sedentary lifestyles were a particular concern.

* Obesity increased with age - 84 per cent of people over 50 were overweight or obese and 82 per cent had abdominal obesity, compared with 61 per cent and 56 per cent for the study as a whole.

"Our findings are cause for concern" says Dr Gómez-Huelgas. "We found high rates of obesity, abnormal lipid and fat levels and hypertension in the study group. And the high rates of smoking and sedentary lifestyles in young women raises fears for a large increase in cardiovascular deaths in this group in the near future. There are also issues around public health messages for people with lower education levels who tend to have higher risk factors.

"The drive to reduce cardiovascular disease by tackling these risk factors poses a real challenge for the healthcare profession. We hope that our findings can help to reduce risk factors among the most vulnerable sections of the community."

"The study by Dr Gómez-Huelgas and colleagues challenges the belief that cardiovascular disease, one of the fastest growing diseases in the developing world, is more likely to affect the chilly north than the sunny south" says Dr Anthony Wierzbicki, a London-based Consultant in Metabolic Medicine.

"In fact, the risk levels found in this study show parallels with the USA and are worse than those reported by recent UK studies.

"The myth that the Mediterranean diet and lifestyle is so healthy is based on 40-year old data from rural areas and so much has changed during those four decades. Studies like this are invaluable because they identify those people most at risk and provide valuable information that helps us to improve both screening and prevention strategies."