October 2016 by ejima

BURDEN OF RISK FACTORS AND VULNERABILITY TO CORONARY HEART DISEASE — SINGH ET AL

J INDIAN MED ASSOC, VOL 114, NO 10, OCTOBER 2016

Table 3 — Association of Risk Factors with Hypertension & Elevated RCBG Risk Factors

Association with HTN n (percent ) Statistical test p value 203 (39.80) χ = 17.329 Male – 183 χ = 19.57 (71.7%) Female – 127 χ = 15.01 (49.8%) 471 (92.35) χ = 26.92 97 (19.02) χ = 23.34 78 (15.29) χ = 27.801 36 (7.05) χ = 2.64 2

Body Mass Index Waist Circumference

Waist Height Ratio Tobacco Alcohol Physical Inactivity

Association with Elevated RCBG n (percent ) Statistical test p value

0.000* 0.000* 0.000* 0.000* 0.000* 0.000* 0.067

χ = 5.78 χ = .014

0.014* 0.906

χ = 4.258

0.139

χ = .913 χ = .010 χ = .174 χ = .640

0.172 0.919 0.677 0.424

290 (35.37) Male = 278 (59.4) Female = 154 (43.75) 721 (87.93) 102 (12.44) 72 (8.78) 283 (34.51)

*P-value<0.05 is significant. df = 1 for χ test 2

obesity indicators was higher in females as compared to males. Waist circumference more than 90 cm in males and 80 cm in females was taken to be a risk factor in for development of metabolic syndrome and measure of CHD risk . Recently there has been exponential increase in the evidence from other investigations showing the superiority of waist height ratio (WHtR) as a predictor of metabolic and cardiovascular risk based on studies in both adults and children . Using the International Diabetes Federation (IDF) criteria, waist circumference was high in 50.45 percent of the study population. Misra et al reports 12 percent and the ICMR Task Force 31percent in Delhi slums using higher cut offs . New research shows that WHtR and not BMI is a better assessment tool for diabetes & CHD risk and WHtR represents the best predictor of the risk and mortality . with a relative risk of 2.75 of cardiovascular mortality . WHtR was abnormal in 86.5percent in this study, it was 82percent in a study on anthropometric indices and coronary risk factors in a study on railway employees . Tobacco consumption in either smoky or chewable form was found to 12.54 percent in the study population which is less than the prevalence rate of 22.75percent in those above 15 years and both sexes and all social classes in Bihar . Several studies from developing countries have shown the presence of hypertension and other risk factors for CHDs in urban compared with rural populations . Based on available trends, by 2020 CVDs are predicted to account for 73 percent of deaths and 60percent of disease burden globally . WHO has developed guidelines for the identification of the magnitude and patterns of major risk factors by countries which is fundamental for their prevention of urban poor . The study at 8 purposively selected communities of Chandigarh and Haryana during 2004-05, on 400 adults 11

14,17

>or =30 years of age, selected by cluster sampling, the prevalence of hypertension was found in urban (39%; 95% CI 29.5%-49.2%), slum (35%; 95% CI 27.2%-42.9%) and rural (33%; 95% CI 25.4%-40.8%) communities was found to be statistically similar after controlling for age, gender and education. The prevalence of physical inactivity (17% versus 12%), central obesity (90% versus 88%), overweight (20% versus 19%) and hypertension (34% versus 36%), were found to be statistically similar among literate and illiterate population after controlling for the effect of age, sex and place of residence. However, the risk of tobacco use was significantly lower among literates (OR 0.3, 95% CI 0.1-0.8). The researchers concluded that in selected communities of northern India, most of the cardiovascular disease risk factors did not have a social gradient except tobacco use, which was more common in the lower social group . 26

20,21

In a cross-sectional survey conducted on male employees working in an urban industrial male population in Chennai the prevalence of the metabolic syndrome was 41.3% and 51.4% using IDF and AHA/NHLBI criteria respectively. Risk factors were age above 35 years, family history of diabetes and body mass index (BMI) above 23.9 kg/m2 . 27

A cross-sectional study was conducted on urban poor in New Delhi on 531 using the WHO STEPS-1 questionnaire. About 73 (13.7%) were known hypertensives; 40.3%) did not partake in any kind of specific physical activity . 28

In this study valuable baseline data on the health status of slum dwellers was obtained and it underlines the vulnerability of the slum dwellers to CHD risk and the necessity of interventions.. The health camp approach enrolled 3118 participants which probably would not have been possible by any other methodology, however other risk factors such as dietary intake and dyslipedemia

could not be studied. It also endorses the fact that the traditional categorization of CHDs as a diseases of affluence needs to be changed. The use of RCBG testing for screening of elevated blood glucose level has the advantage that it can be done at any time of the day. does not require venpuncture and can be carried out even by lay people with training. Though the association of these risk factors with disease is well established, there were no such studies in Bihar; more studies including multivariate analysis can be undertaken in future. The magnitudes of CHD risk factors in slum population of Patna is a matter of concern; there is necessity of including them in the ambit of preventive care and intervention. Since the poor also have the burden of communicable diseases, it could very well be that all major diseases are diseases of the poor. The finding of this study will assist in developing targeted programs and monitoring intervention on CHDs. ACKNOWLEDGMENT

We are grateful to State Health Society Bihar for giving us an opportunity to conduct this baseline study of the risk factors of coronary heart disease with particular focus on hypertension and hyperglycemia. The study was conducted as directed by Government of Bihar by Department of Community Medicine, Patna Medical College with logistic support of District Heath Society, and Civil Surgeon Patna. REFERENCES 1 National Cardiovascular Disease Database sticker no SE/04/233208 IC Health supported by Ministry of Health and Family Welfare and World Health Organization 2002. Available at www.whoindia.org/linkfiles/NMH resources. Accessed on 12/08/2011. 2 Cardiovascular diseases on a global scale: No longer a disease of the rich. Available at http://theheart.org/article/45381.do accessed on 20th Aug 2011. 3 Census of India 2011. Provisional Population Totals. Paper 2 Volume 1 of 2011 Rural-Urban Distribution India Series 1:7-8. Available at www.censusindia.gov.in accessed on 12 Aug 2011. 4 Census of India. 2001. Metadata and Brief Highlights on Slum Population. Available at www.censusindia.gov.in /Data_Products/Data_Highlights. accessed on 12/08/2011. 5 Planning commission 11th Five year plan (vol 2) :Government of India 2008:78-80. 6 WHO STEP wise approach to chronic disease risk factor surveillance. Available at www.who.int/chp/steps/en Accessed on 10th Nov 2010. 7 The 7th Report of National Committee on Prevention, Detection, Evaluation of high blood pressure. 2004; 11-18. Available at www.nhlbi.nih.gov/guidelines /hypertension/jnc-7 Accessed on 10th Nov 2010. 8 Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia 2005; Report of WHO/IDF Consultation:1-17 9 Somannavar S, Ganesan A, Deepa M, Datta M, Mohan V— Random Capillary Blood Glucose Cut point For Diabetes and Pre-Diabetes derived from Community Based Opportunistic Screening in India. Available at http://care.diabetesjournals.org/content/ early/2008/12/10/ accessed on 12th Aug 2010. 10 Kasper DL, Braunwald E, Fauci AS et al, Diabetes Mellitus,

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