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Indian Journal of Community Medicine

Risk factors of Coronary Heart Disease in a Selected Community

Author(s): P. Mohanan, Asha K., A. Rajeev, B.S. Sajjan

Vol. 30, No. 4 (2005-10 - 2005-12)

Introduction:

The WHO has drawn attention to the fact that coronary heart disease (CHD) is our modern "epidemic" i.e. disease that affects population, not an unavoidable attribute of aging. It is estimated that if incidence of CHD is brought to zero it would increase the life expectancy by 3 to 9%1. It is associated with a high social cost. It strikes ambitious active men in the prime of career and productivity depriving the society of a number of of productive years, which they could have contributed. In economic terms, the cost of the care to survivors is also high. The developing countries have started the "epidemic" only recently and no clear trend can be described due to the limited time frame. Various studies have been done by different authors on CHD and related factors in different parts of India2.

Materials and Methods:

A community based epidemiological study was conducted over a period of 9 months. A total of 610 adults in the age group of 35 to 75 years living in a semi urban area of DK were selected to determine the prevalence of coronary heart disease and its risk factors. Of this (for the present study) only 128 respondents who formed a church prayer group, a high risk population with one or the other psycho-social problems were considered. The study was supported by electrocardiogram (ECG) examination, analysis of blood sugar estimation and blood pressure variations. The risk factors such as family history of CHD, hypertension, diabetes mellitus, addictionssmoking and alcohol, physical activity were studied.

All were subjected to standard 12 lead Electro Cardiography (Cardiart 109T-MK-IV, BPL). Ischaemic / infarction was diagnosed as per Minnesota coding guidelines. The electro cardiogram findings were consulted and verified with a competent physician for expert opinion. Estimation of blood glucose was done using a hand held electronic glucometer. Fasting blood sugar level more than or equal to 120mg/dl (capillary blood) was taken as impaired glucose tolerance or potential case of diabetes mellitus. Urine sugar was checked in all such cases. Blood pressure was measured using electronic BP apparatus using a wrist cuff, which eliminated problems due to the muscle tone. A cut-off defining high blood pressure (HBP) was defined as blood pressure of more than or equal to 140/90 mm. of Hg. Isolated systolic BP of over(>) 140mm. of Hg with diastolic blood pressure (DBP) > 90mm of Hg3. A history of treatment for HBP, classified a person as hypertensive. Mean blood pressure (MBP) was calculated as diastolic BP+1/3rd of pulse pressure wherein pulse pressure = difference between systolic and diastolic blood pressure.

For physical activity, subjects were divided into three subgroups (light, moderate and heavy) depending on the nature of their activities. Smoking status was evaluated by self reporting of cigarette and bidis smoked or tobacco chewed by the respondents. Persons who smoked 10 cigarettes/bidis or more or chewed tobacco at least twice a day were classified smokers/tobacco users. Casual smokers were not included in the study. Alcoholism was evaluated by consumption of alcohol thrice a week more. Body mass index (BMI) i.e., the ratio of weight in Kg. to the square of the height in meters, was used as an indicator of obesity. Appropriate statistical tests were done to find out the significance of risk factors to CHD.

Results:

The study group comprised of 64% females and 36% males. The mean age of the sample was 52.88 and 51.84 for females and males respectively. 33.6% (43 out of 128) of them were unemployed or retired, 19.5% (25 out of 128) were unskilled workers.

Higher proportion of males 17.4% (8 out of 46) had a history of diabetes than the females 9.8% (8 out of 82). The onset of diabetes was earlier in males than in females. The average age of males who had a history of diabetes was early 47.88 compared to female 57.88. The mean age of the people with a history of hypertension in the family was 53.46. The subjects with risk factors of CHD were studied(a). The subjects with CHD had a higher mean age when compared to subjects without CHD the difference in mean age was found to be statisticially significant (P>0.0001) and the 95% Confidence interval was (5.672, 12.568). (b) Diabetes Mellitus was present in 20% of the subjects with CHD while it was only 11.9% among the subjects without CHD (c) Hypertension was seen among 30% of the subjects with CHD (3/10) as against 21.2% among subjects without CHD (d) Dependency ratio of people with CHD was 2.36 as against 2.11 among the subjects without CHD (e) Mean BP of the subjects with CHD was 108.5mm of Hg which was higher than that of the people without CHD. The 95% confidence interval was (-2.53, 15.53), (f) 9 out of the 10 (90%) CHD subjects had sedentary life style while it was 36.4% among the people without CHD which was statistically significant (P>0.0001, CI=0.298, 0.735).

Discussion:

The prevalence of CHD in the present study was 74.1 per 1000 (10 out of 128). The prevalence is significantly more in comparison to the following studies done in rural populations of Delhi and Chandigarh, where the prevalence was 27 per 1000 and 3.8 per 1000 respectively. The higher prevalence in this study may be because the subjects are church prayer group who had one or the other psychological problems adding to tension or worry.

Hypertension, as already known was found to be a risk factor for CHD in this study also. The various other risk factors like gender, family history, diet pattern, lifestyle, alcoholism and diabetes were found to be associated with an increased mean blood pressure, which in turn is a risk factor for CHD.

A detailed analysis of the risk factors for CHD showed that the mean age of people with CHD was 60.47 years. This is in conformity with the study by Chadha4. Males (108.7 per 1000) are affected more than the females (60.9 per 1000). Many people are still incubating for CHD.

90% of people with CHD had sedentary life style. None of the people with CHD had indulged in moderate exercise which has shown to be a protective factor against the development of CHD. The dependency ratio of people with CHD was 2.36%. Dependency ratio of females with CHD was 2.88%. Higher dependency ratio may lead to CHD5. The proportion of Diabetes among CHD was marginally higher than that of the subjects without CHD.

Acknowlegements:

The authors are thankful to the Rotary Foundation and Rotary club of Kinver, UK, for providing the financial support and we are very grateful to the faculty of Medicine for their expert opinion in interpreting ECG.

References:

  1. Kulkarni AP, Baridi JP Textbook of Community Medicine, Kaushik K Gada, Vora Medical Publishers, Mumbai, 1st edition, 1998: 418-419.
  2. Padmavati S, Epidemiology of cardiovascular disease in India II, Ischaemic heart disease. Circulation 1962: 25: 711- 717.
  3. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure Special Article. Arch Intern Med 1997:24: 157: 2413-2416.
  4. Chadha SL, Radhakrishnan S, Ramchandran K, Kaul U, Gopinath N, Epidemiological study of coronary heart disease in urban population of Delhi. Ind J Med Res 1990: 92: 424-430.
  5. Dawber TR. The Frmingham Study Cambridge, M.A. Harvard University Press, 1980.

Deptt. of Community Medicine, Kasturba Medical College, Manipal
Academy of Higher Education Mangalore, Karnataka, India.
e-mail: [email protected]

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