INTRODUCTION

Life style related risk factors are the ones whose presence increases the chances of getting cardiovascular disease and are part of a person’s life style. Since a person’s life style can be changed, they are regarded as modifiable. Lack of physical exercise can be regarded as an example of life style related risk factor for cardiovascular disease.

Modifiable behavioral risk factors lead to cardiovascular diseases that are leading causes of mortality. The prevalence of modifiable risk factors for cardiovascular disease, such as tobacco use, inappropriate diet and physical inactivity, are responsible for significant morbidity and mortality.¹

There is evidence to suggest that the control of cardiovascular risk factors, particularly smoking, has resulted in a decline in mortality due to Coronary artery disease.^2-4 It is for this reason, that a need for a more preventive orientation in health care is felt, even in the developed world.¹

Cardiovascular disease is reported to be the leading cause of mortality in parts of Karachi.⁵ The adoption of an urbanized life style, is thought to be among the major determinants of Coronary Heart Disease morbidity and mortality in Pakistan.⁶ The control of cardiovascular disease risk factors in Pakistan have been attempted, but with limited success.⁷

Based on above stated background, we established a need to conduct a survey of family practice patients, to study the prevalence of life style related risk factors for cardiovascular disease. It is expected that identification and correction of modifiable risk factors will lead to a decrease in morbidity and mortality due to cardiovascular disease in the target population.

MATERIAL AND METHODS

We interviewed fifty patients, at the Family Practice Clinic, Aga Khan University Hospital, Karachi, in February 2004. The Aga Khan University Hospital is a private facility and offers primary, secondary and tertiary level services. One hundred and fifty patients are seen daily at the clinic by ten Family Physicians.

Patients presenting at this clinic are family practice patients with different primary and secondary care level problems. The surveyed patients were not screened for cardiovascular disease and those who consented for participation, were included in the study regardless of the nature of their presenting problem.

We used convenience sampling. Patients sitting in the waiting area were requested to participate after the study objective was explained. Written, informed and voluntary consent was taken and confidentiality assurance was provided to those who agreed to participate in the study.

The interview was questionnaire-based and recorded the demographic profile of the patients, in addition to the questions on modifiable life style related risk factors for cardiovascular disease. We measured patient height and weight, in order to determine whether they were normal weight, over weight or obese. SPSS computer software was used for data management.

RESULTS

Fifty patients were surveyed and included 28 (56%) men and 22 (44 %) women. Thirty seven (74 %) respondents were married, nineteen (38%) had graduate education, Twenty five ( 50%) were in private service, and twelve (24 %) were housewives ( Table-1) The prevalence of life style related risk factors for cardiovascular disease are listed in Table-2.

Table-1: Demographic profile of the patients (n=50)

Parameter

Number (% )

SEX:

Males

Females

28 (56)

22(44)

Mean Age (In years)

38.14

Marital Status:

Single

Married

13 (26)

37 (74)

Educational Status:

Illiterate

Primary

Matriculation

Intermediate

Graduate and above

06(12)

05(10)

11(22)

09(18)

19(38)

Occupational status:

Private service

Government service

Housewife

Jobless

Student

25(50)

04(08)

12(24)

05(10)

04(08)

Table-2: Life style related cardiovascular disease risk factors (n=50)

Parameter

Number (%)

Body Weight:

Normal weight

Overweight

Obese

24 (48)

10 (20)

16 (32)

Dietary consumption:

Butter/Cream/Margarine

Red meat (Beef/Mutton)

Organ meat(Liver/kidney)

White meat (Chicken/fish)

Eggs

Vegetables

Pulses/Beans

Fresh fruits

Sweets

Dry fruits & nuts

17 (34)

32 (64)

30 (60)

19 (38)

38 (76)

31 (62)

29 (58)

02 (04)

03 (06)

Type of oil used in cooking:

Oil from animal sources

Oil from vegetable sources

01 (02)

49 (98)

Add table salt to the food:

Never

Occasionally

Always

23 (46)

18 (36)

09 (18)

Physical exercise:

At least 20 minutes, three

times a week

27 (54)

Smoking:

Current smokers

Ex-smokers

11 (22)

12(24)

DISCUSSION

The study sample comprised of relatively well educated and better socio-economically placed individuals. Moreover, we interviewed a small sample of fifty patients. It is for these reasons that we cannot generalize the findings of our study, to the rest of the population. Nonetheless, findings of our study offer an insight into the magnitude of the problem, and can be the basis for future studies on the subject, including interventional strategies.

An earlier study from Pakistan, has reported obesity as high as 23% and 40% among 45-64 year olds urban men and women respectively⁸. It is significant to note that over half the respondents in our study population were either overweight or obese. This could be partly because of high prevalence of consumption of butter, cream, margarine, red meat, eggs, sweets and dry fruits that has been reported. These are the areas where intervention is required to prevent cardiovascular disease.

A protective effect of fruit and vegetables for stroke and coronary heart disease has been reported⁹. A preference for consumption of pulses, beans, fresh vegetables and fruits among our study population is encouraging, and needs to be reinforced.

The role of cooking oil in the development of Coronary Heart Disease is hotly debated in literature¹⁰. It is indeed heartening to note that majority of the respondents have a preference for the consumption of oil from vegetable sources.

Since dietary sodium is associated with elevation of blood pressure¹¹, there is a need to discourage the addition of table salt to food. Fortunately, such practice is carried out by only a few respondents in our study population, showing the effectiveness of preventive measures already in place. However, we must remember that our study sample included very educated patients and the situation in the community may be entirely different. This outlines the need for a community based survey of cardiovascular risk factors.

More than half of the respondents were exercising for more than 20 minutes and at least three times a week. We have earlier reported 47% respondents exercising on a regular basis, in another study sample¹². Even though we have a biased sample population, comprising of well educated and motivated patients, visiting a teaching hospital for treatment, it is indeed a healthy trend that we are seeing in our society.

It is unfortunate that 11 (22 percent) respondents were smokers. Earlier studies have reported prevalence of smoking between 21-33%, in Karachi¹³. This is an area which is crucial in the prevention of cardiovascular disease. It is the decline in smoking prevalence in the developed world that has led to a reduction in the mortality from cardiovascular disease.²Our efforts to control cardiovascular disease will not be successful unless we control tobacco use in our population.

We have documented the frequency of cardiovascular risk factors, among a small selected group of family practice patients. There is a need to conduct such a survey on a larger scale in the community. There is an urgent need to control modifiable risk factors for cardiovascular disease, among our population. Only such preventive measures are likely to reduce morbidity and mortality from cardiovascular disease.

CONCLUSIONS

We have studied the frequency of life style related modifiable behavioral risk factors for cardiovascular disease among our patient population. The results of our study demonstrates the existence of an unique opportunity to practice preventive medicine by identifying and correcting risk factors for cardiovascular disease among patients.

Such surveys, if conducted globally and on a larger scale, can lead to identification and correction of cardiovascular disease risk factors. Such a planned interventional, it can be hoped, will eventually lead to help prevent cardiovascular disease in the community and thereby decreased morbidity and mortality due to it. strongly recommended at all heath care facilities in the country.

References

1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291(10):1238-45

2. Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation 2004;109(9):1101-7

3. Critchley JA, Capewell S, Unal B. Life-years gained from coronary heart disease mortality reduction in Scotland: prevention or treatment? J Clin Epidemiol 2003;56(6):583-90

4. Aldana SG, Greenlaw R, Thomas D, Salberg A, DeMordaunt T, Fellingham GW, et al. The influence of an intense cardiovascular disease risk factor modification program. Prev Cardiol 2004;7(1):19-25

5. Bhurgri A, Bhurgri Y, Khan Y, Sharih U, Naqvi F, Soomro IB. Mortality statistics in South Karachi. J Pak Med Assoc 2001;51(12):446-9

6. Hakeem R, Thomas J, Badruddin SH. Urbanisation and coronary heart disease risk factors in South Asian children. J Pak Med Assoc 2001;51(1):22-8.

7. Aziz KU, Dennis B, Davis CE, Sun K, Burke G, Manolio T, et al. Efficacy of CVD risk factor modification in a lower-middle class community in Pakistan: the Metroville Health Study. Asia Pac J Public Health 2003;15(1):30-6

8. Nanan DJ. The obesity pandemic--implications for Pakistan. J Pak Med Assoc 2002;52(8):342-6

9. Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997;26(1):1-13

10. Rastogi T, Reddy KS, Vaz M, Spiegelman D, Prabhakaran D, Willett WC, et al. Diet and risk of ischemic heart disease in India. Am J Clin Nutr 2004;79(4):582-92.

11. Srinath Reddy K, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr 2004;7(1A):167-86.

12. Qidwai W, Saleheen D, Saleem S, Andrades M, Azam SI. Physical exercise as a key health determinant among patients. J Coll Physicians Surg Pak 2003; 3(7):421-2

13. Maher R, Devji S. Prevalence of smoking among Karachi population. Pak Med Assoc 2002;52(6):250-3.