https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/235 Sun, 02 Jul 2017 14:45:41 +0000 Abstract Background and Aims: The prevalence of cardiovascular diseases (CVD) are on the increase worldwide and more in the developing countries. Coronary artery disease (CAD) constitutes the major brunt of CVD. Despite the increasing morbidity and mortality, Bangladesh has a few published data on CAD in rural population. This study addressed the prevalence of CAD and its risk factors in rural population of Bangladesh. Study methods: Sixteen villages were purposively selected in a rural area. A population census was conducted in the selected area. The census yielded eligible participants, who reached at least eighteen years of age. Those who willingly consented to participate were enlisted. Each participant was interviewed regarding CAD risk (age, sex, social class, occupation, illness, family history). Anthropometry (height, weight, waist- and hip-girth) was recorded. Resting blood pressure (BP) was measured. Blood sample was collected for fasting blood glucose (FBG), total cholesterol (Chol), triglycerides (Tg), low density lipoproteins (LDL), very low density lipoproteins (VLDL) and high density (HDL). All participants having FBG>5.5mmol/l or systolic (SBP) ³135 or diastolic BP (DBP) ³85mmHg underwent electrocardiography (ECG). A team of cardiologists selected and accomplished exercise tolerance test (ETT) and echocardiography (Echo). Results: The prevalence of CAD was 4.5% (95% CI: 3.85 – 5.15). Compared with the female (3.5%, CI, 2.76 – 4.24) the male participants had significantly higher prevalence of CAD (6.0%, CI, 4.83 – 7.13). Comparison of characteristics between participants with and without CAD showed that age, SBP, DBP and FBG were significantly higher in CAD group. Bivariate analysis showed that age, sex, social class, glycemic status, metabolic syndrome (MetS) and smoking were significantly related to CAD. Stepwise logistic regression proved only male sex, rich social class, hypertension and diabetes had independent risk of CAD; whereas, age, obesity and dyslipidemia were proved not significant. Conclusions: The study concludes that the prevalence of CAD in a Bangladeshi rural population is comparable to other developed countries. The male sex, rich social class, hypertension and diabetes were proved to have excess risk of CAD. Neither obesity nor dyslipidemia were found significant for CAD. The younger people had similar risk as the aged ones, which necessitate primordial and primary prevention of CAD. Further study may be undertaken, which should include and consider physical activity and diet; and if possible, C-reactive protein, Vitamin D and homocysteine level. IMC J Med Sci 2017; 11(2): 61-69. DOI: https://doi.org/10.3329/imcjms.v11i2.33098 Address for Correspondence: Prof. M. Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue Shahbag, Dhaka-1000. email: sayeed@imc.ac.bd   Introduction The burden of atherosclerotic diseases is progressively increasing [1]. The projected deaths from cardiovascular diseases (CVD) in 2030 is estimated to reach 23.6 million (34.8%) of the world population. Thus, it is clear that the clinical and socioeconomic impact of CVD is considerable. The World Health Organization (WHO) statistics of 2004 showed that CVD represents the number one cause of death worldwide, approximating 30% of total mortality [1]. Considering these facts, WHO and its partners launched a new initiative “Global Hearts” on 22 September, 2016 [2]. The initiative aimed to minimize the global threat of cardiovascular disease, the world’s leading cause of death. The questions remained still unanswered how to minimize the global threat and how to prevent morbidity and mortality of CVD. Though multiple risk factors like adiposity and metabolic disorders have been identified, these are found inconsistent in different studies. For example, some studies observed that obesity is a significant risk for coronary artery disease (CAD) [3,4]. In contrast, some studies reported that non-obese people also had risk for cardiovascular deaths [5] and different populations with an obesity paradox by BMI showed different risk [6]. As regards Bangladesh, there are few published data that estimated the magnitude of CVD and its related morbidity or mortality. Some investigators showed several known risks (obesity, smoking, lipids) prevalent amongst the south Asians (India, Pakistan, Bangladesh, Sri Lanka and Nepal) [8]. But these risk factors have not been studied in relation to CAD, and no study investigated which of the risks and how much of it significantly related to CAD. This study aimed to determine the prevalence of CAD in a rural community of Bangladesh. Additionally, the study attempted to investigate some known risk factors attributed to CAD.   Study design The study proposal was approved by the Ethical Review Committee of Bangladesh Diabetic Samity (BADAS). According to protocol, sixteen villages were purposively selected in a rural area - located north-east of Dhaka city and inhabited mostly by the population involved in agrarian occupation. The area is connected to Dhaka city by110 km of paved and 10 km of non-paved road. A census was conducted in these villages. The census included socio-demographic information (age, sex, education, occupation and family income). It also included family history of non-communicable diseases (NCD). Individual equal to or greater than 18 years of age was considered eligible. The eligible participants (≥18years) were randomized. The eligible participants were detailed (objectives, methods) about the study. Those who consented to volunteer the study were invited for stepwise investigations.   Step 1 Interviewing - In the morning, the participant was interviewed about occupation, education, income, illness (present or past) and medication. Interviewing on family-history included diabetes, hypertension (HTN), stroke, coronary heart diseases (CHD), peripheral vascular disease (PVD), foot-ulcer and leg amputation. The information was recorded based on medical reports (investigation, prescription) and verbal autopsy. Anthropometric and blood pressure (BP) measurements: Height, weight, waist- and hip-girth were measured. Body mass index (BMI = weight in kg / height in met sq.), waist-to-hip ratio (WHR = waist / hip) and waist-to-height ratio (WHtR =Waist / height) were calculated. Blood pressure was taken after 10 minutes of rest.   Step 2 Collection of blood sample: Five milliliter of fasting blood sample was collected aseptically for estimation of fasting blood glucose (FBG mmol/l) and lipids (total cholesterol, triglycerides, low-density lipoprotein, high-density and very high density lipoproteins). While collecting blood sample a drop of blood was taken on a finger strip for rapid assessment of FBG. The participants, who showed SBP / DBP ≥ 135 / 85 mmHg and/ or FBG ≥5.6 mmol/l were referred to electrocardiography (ECG) tracing. Step 3 A team of cardiologists examined all ECG tracings. According to the need of the cardiologists the ECG was repeated and for confirmation the participants were referred to the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka for ehocardiography (Echo) and exercise tolerance tests (ETT). Diagnosis of CAD was based on - a) history of angina plus ischemic change in ECG either at rest or on stress; b) post-myocardial infarction (MI) with Q-wave MI or non-QMI.     2026 Ibrahim Medical College. All rights reserved.