EVALUATION OF PATIENTS WITH CORONARY ARTERY DISEASE FOR MAJOR MODIFIABLE RISK FACTORS FOR ISCHEMIC HEART DISEASE
Abstract
Background: Incidence of cardiovascular diseases is on the rise in developing countries. Deaths due toischemic heart disease can be reduced by modifying the risk factors. The present study was conductedto evaluate the patients scheduled for Coronary Artery Bypass Surgery for the presence of majormodifiable risk factors for ischemic heart disease (IHD). Methods: It was a descriptive study. Allpatients who underwent elective Coronary Artery Bypass cardiac surgery between November 1, 2008and February 28, 2009 at Rehman Medical Institute, Peshawar, were included in the study. Presence ofDiabetes, Hypertension, Smoking, Dyslipidemia, Sedentary life style, and Obesity was looked for inthese patients. Results: A total of 104 patients were studied during this period. Majority (97.11%) ofpatients had at least one major modifiable risk factor for IHD. Sedentary life style (53.84%) was themost common risk factor present in these patients followed by hypertension and dyslipidemia (47.11%each), smoking (43.27%), diabetes (35.57%), and obesity (9.61%). Multiple risk factors (two or more)were found in 78 (75.0%) of patients. Conclusion: Most of the patients with coronary artery disease,severe enough to warrant coronary artery bypass grafting, have at least one of the major modifiable riskfactors for IHD. Modification of these factors may well reduce the disease burden of CAD and reducethe cardiovascular mortality.Keywords: Coronary Artery Bypass Surgery, Ischemic Heart Disease, Major Modifiable Risk Factors,Hypertension, Smoking, Diabetes, Dyslipidemia, Sedentary Life Style, ObesityReferences
Murray CJL, Lopez AD, Eds. The global burden of disease: a
comprehensive assessment of mortality and disability from
diseases, injuries, and risk factors in 1990 and projected to 2020.
Boston: Harvard School of Public Health;1996.
J Ayub Med Coll Abbottabad 2012;24(2)
http://www.ayubmed.edu.pk/JAMC/24-2/Zahidullah.pdf 105
Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of
cardiovascular diseases, part I: general considerations, the
epidemiologic transition, risk factors, and impact of urbanization.
Circulation 2001;104:2746–53.
Gupta M, Singh N, Verma S. South Asians and cardiovascular
risk: what clinicians should know. Circulation 2006;113:924–9.
Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K et al. Risk
factors for early myocardial infarction in South Asians compared
with individuals in other countries. JAMA 2007;297:286–94.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray Cl.
Global and regional burden of disease and risk factors, 2001:
systematic analysis of population health data. Lancet
;367:1747–57.
Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener
SJ, et al. Prevelence of Conventional risk factors in Patients With
Coronary Heart Disease. JAMA 2003;290:898–904.
US Dept of Health and Human Services The Health Benefits of
Smoking cessation: A Report of the Surgeon General. Rockville,
Maryland: CDC; 1990. Available at:
http://profiles.nlm.nih.gov/ps/access/NNBBCT.pdf
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other
risk factors, and 12-years cardiovascular mortality for men
screened in the Multiple Risk Factor Intervention trial. Diabetes
Care 1993;16:434–44.
Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D,
Menotti A, Aravanis C et al. Serum Total Cholestrol and Longterm coronary Heart Disease Mortality in Different Cultures.
JAMA 1995;274(2):131–36.
MacMahon S, Peto R, Collins R, Godwin J, MacMahon S, Cutlar
J, et al. Blood pressure, stroke, and coronary heart disease.
Lancet. 1990;335:765–774.
Moving into action: promoting heart-healthy and stroke-free
communities (health care leaders). Atlanta: center for disease
Control and Prevention, 2005.
Brown JR, O’Connor GT. Coronary Heart disease and Prevention
in the United States. N Engl J Med 2010;362: 2150–53.
Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow
GC, et al. AHA/ACC Guidelines for Secondary Prevention for
Patients With Coronary and Other Atherosclerotic Vascular
Disease: 2006 Update. J Am Coll Cardiol 2006;47:2130–9.
Hennekens CH. Increasing Burden of Cardiovascular Disease.
Current Knowledge and Future Direction for Research on Risk
Factors. Circulation. 1998;97:1095–102.
Futterman LG, LembergL. Fifty percent of patients with
coronary artery disease do not have any of the conventional risk
factors. Am J Crit Care 1998;7:240–4.
Department of Health. 2004. At Least Five a Week. Evidence on
the impact of physical activity and its relationship to health. A
report from the Chief Medical Officer. London: Department of
Health.
McPherson K, Britton A, Causer L. 2002. Monitoring on the
progress of the 2010 target for coronary heart disease mortality:
Estimated consequences on CHD incidence and mortality from
changing prevalence of risk factors. London: National Heart
Forum.
Physical Activity Guidelines Committee. Physical Activity
Guidelines Advisory Committee Report. Washington DC: Dept
of Health and Human Services; 2008.
Nocon M, Hiemann T, Muller-Riemenschneider F, Thalau F,
Roll S, Willich SN. Association of physical activity with allcause and cardiovascular mortality: a systematic review and
meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239–46.
Mora S, Cook N, Burning JE, Ridker PM, Lee IM. Physical
activity and reduced risk of cardiovascular events: potential
mediating mechanisms. Circulation 2007;116:2110–8.
Stamatakis E, Hamer M, Lawlor DA. Physical activity, mortality,
and cardiovascular disease: is domestic physical activity
beneficial? The Scottish Health Survey-1995, 1998, and 2003.
Ann J Epidemiol 2009;169:1191–200.
van Dam RM, List, Spiegelman D, Franco OH, Hu FB,.
Combined impact of lifestyle factors on mortality: prospective
cohort study in US women. BMJ 2008;337:1440.
Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ,
Kannel WB, et al. Impact of high-normal blood pressure on the
risk of cardiovascular disease. N Engl J Med
;345(18):1291–7.
Hyman DJ, Pavlik VN. Characteristics of patients with
uncontrolled hypertension in the United States. N Eng J Med
;345:479–86.
van den Hoogen PCW, Feskens EJM, Nagelkerke NJD, Menotti
A, Nissinen A, Kromhout D. The relation between blood
pressure and mortality due to coronary heart disease among men
in different parts of the world. N Engl J Med 2000;342:1–8.
Npolstad I, Arnesen E, Larsen PG. Smoking, serum lipids, blood
pressure and sex difference in myocardial infarction. Circulation
;93:450–6.
Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking
and risk of myocardial infarction in women and men:
longitudinal population study. BMJ 1998;316:1043–7.
US Dept of Health and Human Services. Reducing the Health
Consequences of Smoking: 25 years of Progress. A Report of the
Surgeon General. US Department of Health and Human
Services, Public Health Service, Centers for Disease Control,
Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health;1989. DHHS Publication (CDC)
-8411.
Anderson KM, Wilson PW, Odell PM, Kannel WD. An updated
coronary risk profile: a statement for health professionals.
Circulation 1991;83:356–62.
Ockene JK, Kuller LH, Svendsen KH, Meilahn E. The
relationship of smoking cessation to coronary heart disease and
lung cancer in the Multiple Risk Factor Interventin Trial
(MRFIT). Am J Public Health 1990;80:954–58.
Elantz SA, Parmly WW. Passive smoking and heart disease.
Mechanisms and risk. JAMA 1995;273:1047.
Wells AJ. Passive smoking and heart disease. J AM Coll Cardiol
;24:546.
Chen Z, Peto R, Collins R, MacMahon S, Lu J, Li W. Serum
cholesterol concentration and coronary heart disease in
population with low cholesterol concentrations. BMJ
;303:276–82.
Eaton SB, Konner M, Shostak M. Stone agers in the fast lane:
chronic degenerative diseases in evolutionary perspective. Am J
Med 1988;84:739–49.
Arthaud JB. Cause of death in 339 Alaskan natives as determined
by autopsy. Arch Pathol 1970;90:433–8.
Howard BV, Rodriguez BL, Bennett PH, Harris MI, Hamman R,
Kuller RH, et al. Prevention Conference VI: Diabetes and
Cardiovascular disease: Writing Group I:
epidemiology. Circulation 2002;105:132–7.
Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM,
Orchard TJ, et al. Intensive diabetes treatment and cardiovascular
disease in patients with type 1 diabetes. N Engl J Med
;353:2643–53.
Dluhy RG, McMahon GT. Intensive glycemic control in the
ACCORD and ADVANCE trials. N Engl J Med
;358:2630–3.
Holman RR, Paul SK, Bethel MA, H. Andrew W. Neil, David R.
Matthews. Long-term follow-up after tight control of blood
pressure in type 2 diabetes. N Engl J Med 2008;359:1565–76.
Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz
GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart
disease in women. JAMA 1998;280(21):1843–8.
World Health Organization. Obesity: preventing and managing
the global epidemic. Report of a WHO consultation on obesity.
Geneva: World Health Organization; 1998.
National Institutes of Health, National Heart, Lung, and Blood
Institute. Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults: the evidence
report. Obes Res 1998;6:S51–210.
Allison DB, Zhu SK, Plankey M, Faith MS, Heo M. Differential
associations of body mass index and adiposity with all-cause
mortality among men in the first and second National Health and
Nutrition Examination Surveys (NHANES I and NHANES II)
follow-up studies. Int J Obes Relat Metab Disord 2002;26:410–6.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.