Dr. Sunita Dodani A Assistant professor, Family Medicine The Aga Khan University Karachi, Pakistan Dr. David MacLean Professor, Simon Fraser University, Vancouver, Canada & Dr. Michel Joffres sk factors for coronary Artery disease in Pakistanis: A cross–sectional Study
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A Dr. Sunita Dodani Assistant professor, Family Medicine The Aga Khan University Karachi, Pakistan Dr. David MacLean Professor, Simon Fraser University,
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Dr. Sunita Dodani AAssistant professor, Family Medicine
The Aga Khan UniversityKarachi, Pakistan
Dr. David MacLean Professor, Simon Fraser University,
Vancouver, Canada &
Dr. Michel Joffres Associate Professor, Dalhousie
University, Halifax, Canada
Risk factors for coronary Artery diseases in Pakistanis: A cross–sectional Study
Presentation Outline• Burden of CVD• CVD Mortality: Developed Vs Developing Countries• Eastern Mediterranean Region• Pakistan: a Developing Country• CVD in Pakistan: National Health Survey• Study Rationale
Presentation Outline Contd.
• Study Objectives• Study Design and Methods• Results• Limitations• Conclusion and Recommendations
Burden of CVD
Cardiovascular diseases (CVD), defined as Coronary Artery diseases (CAD) and Cerebrovascular diseases account for over 16 million deaths, or about 30% of total global deaths
• Mortality and morbidity data on CVD risk factors are inadequate
• Age-specific mortality rate is declining• Increasing prevalence of the risk factors for CVD • Diets have high fat content, increasing diabetes with
increase in obesity• Smoking, widespread, especially among younger people • Physical activity is insufficient• Clustering of risk factors
What About Situation in Pakistan?
Pakistan: A Developing Country• Multiethnic and linguistic diversity
• 4 provinces & 2 territories• Population ~ 130 million• Growth Rate: 2.6%• Per capita income: $390
– <3% Gov Health Budget– Most of the money spent on
tertiary care hospital curative services
• Very limited health insurance
CVD in PakistanNational Health Survey of Pakistan 1990-1994 (NHSP)
Limited, population and hospital -based studies on CVD in Pakistan and many have significant limitations
• In 1990, first countrywide survey was done using random cluster sampling method
CVD in Pakistan NHSP 1990-1994 Contd.
• 4-year community based survey• Adult mortality of Ischaemic Heart Disease (IHD)
was reported as 12% • Risk factor prevalence assessed
Survey limitations:•Generalization. Covering 2.6% population•Methodological errors•All risk factors not defined by globally acceptable criteria
Study Rationale• Available data is of inadequate quality, limiting the
assessment of true magnitude of the problem Inability to debate and appropriately assess the
priorities in CAD prevention and health promotion on the basis of NHSP data in high socio economic class
Risk factors of CVD - prime target for surveillance, especially people in higher socio-economic class, considered as “early adopters” and ‘high risk’
Study Objectives:
• To estimate the prevalence of CAD and its risk factors and risk behaviors in patients attending preventive check-up clinics of a teaching hospital in Karachi, Pakistan.
• To assess the association of risk factors with CAD
Study Methodology and Sample Design
Routine general physical check-up clinics at the Aga Khan University Hospital (AKUH)- a teaching hospital in Karachi, Pakistan. Run by trained family physicians, 5 days a week
Design:Set up:
Cross sectional descriptive study
Study Methodology and Sample Design
(Contd.)• Mainly from the educated higher socioeconomic class
• General preventive check-up package: history and physical examination; laboratory investigations [complete blood count, total blood lipid profile, fasting glucose levels, electrolytes, urine detailed report]; chest X-ray and exercise tolerance test (ETT)
• Usually 3-5 patients are booked in one clinic • Total appointment time: 40-50 minutes
• Assumed prevalence of 50% given largest sample size possible• Margin of error ± 4%• Stratified on age and gender…dichotomized into < 35 years, and > 35 years• Total patients interviewed: 600
Sample size estimation:
Study Methodology and Sample Design
(Contd.)1. Demographic variables…
Mean & SD for continuous variables Frequencies and percentages for categorical variable
2. Risk factor distribution…. frequencies and percentages3. Multi-variate analysis…
Univariate variate (P< 0.05) Logistic regression model (Odds ratio with 95% CI)
Dependent variable: heart diseases
Analysis:
Study Results
Socio-demographic variables in the study group
Variable n=600 %Age Group18-3435-6465+
46.1†73
51314
10.2‡12.285.5 2.3
GenderMaleFemale
471129
78.521.5
Employment StatusFull Time (> 35hrs/wk)UnemployedRetired / StudentHousehold personRefused
4105
60115
3
68.30.810
19.20.5
Variablen=600 %Work Type
Professional ClericalSkilled ForemanManager/official/proprietierSales workerNon skilledRefusedMissing
Conclusion and Recommendations• Study adds significant knowledge of increased prevalence of CVD risk factors and behaviors
in a high-risk group of a developing country• This group need to be targeted for risk factor modification… public health and clinical
approaches• Need for lifestyle interventions, screening and management of risk factors• Limited resources available… there is a need of population-based studies with the help of
NGOs• Further research needed to look into the causes of high CVD in Pakistanis e.g. insulin