| PREVALENCE OF
CORONARY HEART DISEASE IN AN URBAN COMMUNITY OF
GOA |
| VG Pinto, DD Motghare,
AMA Ferreira, MS Kulkarni |
 |
Department of
Preventive and Social Medicine, Goa Medical
College, Bambolim, Goa 403202 |
|
| |
 SUMMARY |
| |
| Currently coronary heart disease in
the largest cause of death and is fifth largest
in terms of disease burden. A community based cross
sectional study was conducted in the urban population
of Goa to find the prevalence of coronary heart
disease. 371 individuals in the age-group 35-64
years of both male and female gender were recruited
in the study by simple random sampling. Prevalence
of coronary heart disease in the sample population
is 132/1000. In males the prevalence was 147/1000
while in females it was 116/1000. When the data
for both genders was combined the prevalence was
significantly associated with family history, smoking,
obesity, diabetes mellitus, hypertension, total
cholesterol, LDL cholesterol and HDL cholesterol
It is important to estimate the prevalence of coronary
heart disease in order to implement community based
heart health interventions. |
| |
|
INTRODUCTION |
| |
| It has been predicted that cardiovascular
diseases will be the most widespread cause of death
in India by 2015.1
With increase in life expectancy, many more people
will survive to ages at which the ravages of vascular
diseases with become clinically manifest. The toll
exacted by coronary heart disease in developed and
developing countries is not an unavoidable consequence
of economic development. It can be obviated by appropriate
and timely preventive action that will enhance the
economical and technological advances in the country.
In this research article an attempt has been made
to estimate the prevalence of coronary heart disease
in the urban population of Santa Cruz in Goa. |
| |
| Table 1: Prevalence of coronary
heart disease by age and gender |
| |
| Age-group |
Males |
Females |
Total |
| |
Total |
CHD(%) |
Total |
CHD
(%) |
Total |
CHD
(%) |
| 35-39 |
34 |
1
(2.9) |
32 |
0
(0) |
66 |
1
(1.5) |
| 40-44 |
34 |
2
(5.9) |
33 |
1
(3.0) |
67 |
3
(4.4) |
| 45-49 |
33 |
4
(12.2) |
30 |
3
(10.0) |
63 |
7
(11.1) |
| 50-54 |
32 |
5
(15.6) |
31 |
3
(9.7) |
63 |
8
(12.7) |
| 55-59 |
29 |
7
(24.2) |
28 |
6
(21.4) |
57 |
13
(22.8) |
| 60-64 |
28 |
9
(32.2) |
27 |
8
(29.6) |
55 |
17
(30.9) |
| Total |
190 |
28
(14.7) |
181 |
21
(11.6) |
371 |
49
(13.2) |
|
| |
|
METHODS |
| |
| A cross sectional population survey
was conducted using a simple random sampling method
in an urban area of Goa, Santa Cruz. The sample
size of 371 individuals was calculated with the
help of EpiInfo Version 6.03 statistical programme. |
| |
| The protocol for the study was based
on WHO recommended model for field surveys of diabetes
and other non-communicable diseases.2
Coronary heart disease has been defined as per the
Epstein criteria on the basis of electrocardiography
according to the Minnesota code.3
Subjects were administered a structured questionnaire
followed by clinical examination and laboratory
investigations. |
| |
| Diabetes mellitus and hypertension
have been defined according to WHO criteria.4,5
The National Cholesterol Education Program criteria
(1993) were used to identify desirable limits for
the lipid profile.6
Smoking status has been categorized as smokers,
non-smokers and former smokers.7
Plasma glucose levels were estimated by Folin-Wu
method.8 Estimation
of serum total cholesterol, serum triglycerides,
and serum HDL cholesterol was done by Varley's method.8
Serum LDL and VLDL cholesterol were calculated using
the Friedwald's formula.8 |
| |
| The results of the study were tabulated
and statistical tests were carried out with the
help of EpiInfo-6 statistical package. |
| |
| Table 2: Prevalence of Electrocardiographic
Abnormalities |
| |
| Electrocardiographic
abnormalities |
Minnesota
Code |
CHD
cases (%) |
| QS
pattern/ Q waves |
1.1,
1.2 |
2
(4.1) |
| ST
segment depression |
4.1.1,
4.1.2 |
13
(26.5) |
| T
wave inversion |
5.1,
5.2 |
15
(30.6) |
| Left
bundle branch block |
7.1.1 |
2
(4.1) |
| QS
pattern and ST segment depression |
1.1,
1.2, 4.1.1, 4.1.2 |
2
(4.1) |
| ST
segment depression and T wave inversion |
4.1.1,
4.1.2, 5.1, 5.2 |
9
(18.4) |
| QS
pattern, ST segment depression and T wave
inversion |
1.1,
1.2, 4.1.1, 4.1.2, 5.1, 5.2 |
2
(4.1) |
|
| |
|
RESULTS AND DISCUSSION |
| |
| A total of 371 people (190 males
and 181 females) in the age-group of 35-64 years
were selected to participate in the study. |
| |
| 49 cases of coronary heart disease
were detected among 371 individuals giving a prevalence
of 132/1000. In males the prevalence of coronary
heart disease was 147/1000 (28 cases in 190 males)
while in females the prevalence was 116/1000 (21
cases in 181 females) and male:female ratio was
1.2:1. There is a progressive increase in the prevalence
of coronary heart disease as the age advances in
both male and female gender (Table 1). The mean
age for males with coronary heart disease was 48.9±8.5
years and for females was 49.0±8.5 years.
Various electrocardiographic findings are reported
in Table 2. |
| |
| Coronary
heart disease was significantly associated with
family history, smoking, obesity, diabetes mellitus,
hypertension, total cholesterol, HDL cholesterol
and LDL cholesterol (Table 3). |
| |
| Published studies on coronary heart
disease in urban Delhi reported a prevalence of
96.7/10009 and in
the city of Jaipur the prevalence was 76/1000.10
Overall, the findings in this study appear to be
in agreement with these studies although the prevalence
is slightly greater. Age group studied in Delhi
was similar to the present study while in Jaipur
the age group (>20-70 years) was younger. In
the present study conventional coronary risk factors
have a significant association with coronary disease.
This finding is similar to the studies from developed
countries where a significant association is seen
with family history, smoking, diabetes, hypertension
and hypercholesterolemia. 11-13 |
| |
| Table 3: Cardiovascular risk
factors among study subjects |
| |
| Risk
factor |
Total
subjects |
CHD
present |
CHD
absent |
Chi-square |
P-value |
Family
History+
Family history - |
70 |
27
(38.6) |
43
(61.4) |
48.42 |
<0.001 |
| 301 |
22
(7.3) |
279
(92.7) |
Smoking
+
Smoking - |
145 |
36
(24.8) |
109
(75.2) |
28.04 |
<0.001 |
| 226 |
13
(5.8) |
213
(94.2) |
Obesity
+
Obesity - |
204 |
35
(17.2) |
169
(82.8) |
6.16 |
<0.01 |
| 167 |
14
(8.4) |
153
(91.6) |
Diabetes
+
Diabetes - |
59 |
36
(61.0) |
23
(39.0) |
139.89 |
<0.001 |
| 312 |
13
(4.2) |
299
(95.8) |
Hypertension
+
Hypertension - |
53 |
40
(75.5) |
13
(24.5) |
209.12 |
<0.001 |
| 318 |
9
(2.8) |
309
(97.2) |
Cholesterol
 200
Cholesterol <200 |
127 |
38
(29.9) |
89
(70.1) |
47.06 |
<0.001 |
| 244 |
11
(4.5) |
233
(95.5) |
HDL
<35
HDL 35 |
44 |
28
(63.6) |
16
(36.4) |
110.75 |
<0.001 |
| 327 |
21
(6.4) |
306
(93.6) |
LDL
130
LDL <130 |
65 |
38
(58.6) |
27
(41.4) |
140.79 |
<0.001 |
| 306 |
11
(3.6) |
295
(96.4) |
| Figures
in parentheses are percent. Lipid levels in
mg/dl. |
|
| |
|
SUMMARY |
| |
| Prevalence of coronary heart disease
was 132/1000. The present study revealed that the
prevalence of coronary heart disease was higher
in males. Coronary heart disease was significantly
associated with family history, smoking, obesity,
diabetes mellitus, hypertension, and abnormal lipids.
In order to limit the growing epidemic a dual approach
is recommended: screening and intervention in high
risk cases and population-wide prevention activities. |
| |
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