Assessment of risk factors for coronary artery disease among Adults residing in rural area– A cross sectional study

Abstract

BACKGROUND AND OBJECTIVES The globe is witnessing a rapid epidemiological transition. Cardiovascular diseases which include coronary artery disease (CAD) account for 60% of all deaths and 47% of burden of diseases which is progressively increasing in rural population in terms of absolute numbers. The majority of the individuals who experience coronary events have one or more cardiovascular risk factors. Most of these events are preventable if meaningful intervention is taken against the risk factors which reduce the mortality by 35 – 60%. Hence this study was undertaken to assess the risk factors for coronary artery disease among adults residing in rural area and also to predict the future risk of cardio vascular events. METHODOLOGY A community based cross sectional study, conducted from January to December 2012 among rural adults aged between 20 to 60 years residing in Kakati – A sub centre under PHC, Vantamuri, Belgaum. Total 980 participants were included in study. After obtaining the ethical clearance, pilot study was conducted. Written informed consent was obtained from every participant. Data was collected by house to house visit using a predesigned questionnaire, which included socio demographic variables; behavioral risk factors (tobacco and alcohol use, decreased fruits and vegetable consumption and physical inactivity); the biological risk factors (self reported hypertension and diabetes mellitus, over weight and obesity); and family history of CAD. Statistical analysis was done using chi square test and ‘P’ value less than 0.05 was considered significant. RESULTS In the present study, 48.8% were men and 51.2% were women. The prevalence of behavioral risk factors which included; smoking tobacco (10.9%), smokeless tobacco (35.7%), alcohol consumption (21.4%); non-consumption of fruits (8.0%); work, leisure time and travel related sedentary activity among 18.3%, 50.4% and 22.8% of the participants respectively. These risk factors were in higher proportion among men (P < 0.0001). Biological risk factors which included; self reported hypertension (20.2%), diabetes mellitus (6.3%); overweight (26.7%), obesity (7.0%) reported a significant gender difference (P < 0.0001). About half of the participants had 1 to 2 risk factors (51.3%) and One fourth of the participants had 3 or more coronary risk factors (25.9%). Bio-chemical risk factors viz., FBS, TC and TGL levels showed a significant increase in their mean values with increase in number of risk factors. HDL was more in those with lesser number of risk factors. Advancing age, lesser or no formal education, sedentary work status and lower socio economic status were significantly associated with majority of behavioral and biological risk factors for coronary artery disease (P < 0.001) CONCLUSION AND INTERPRETATION Our study demonstrated a significant higher prevalence of behavioral and biological risk factors for CAD in rural population in south India, with a significant gender difference. Three fourth of the participants had one or more risk factors for CAD. Men had higher prevalence of CAD risk factors; whereas women exhibited a significant higher risk of CAD as predicted by charts. Burden of CAD risk factors in this population reflects epidemiological transition which requires an immediate attention.