Annals of PIMS-Editorial Board

Background: World Health Organization (WHO) estimates that in the low-income countries the number of deaths due to cardiovascular disease (CVD) is on steady rise Eighty percent of the deaths due to CVD and 86% of the global burden of CVD are in the developing countries including Pakistan.
Objectives: It is a pilot study meant to determine the disease burden and risk factors for ischemic heart disease (IHD) in the Pakistani population.
Study Design: Cross Sectional study
Materials and Methods: Information was gathered according to the WHO MONICA protocol from 2000 persons in the population of Islamabad selected randomly. Keeping in view the population distribution in Pakistan, 33% of persons selected were from urban and 67% from rural areas to get balanced results. Of the 2000 persons studied half were males and half females. All persons were over 20 years of age. The parameters studied included age, gender, ethnic origin, marital status, socioeconomic status, blood pressure measurement, smoking history, weight, hip measurement, waist measurement, height, history of documented IHD, family history (of cardiovascular disease, diabetes mellitus, hypertension), serum levels of cholesterol, HDL cholesterol, LDL cholesterol, glucose, urea and haemoglobin and other optional investigations as per WHO MONICA protocol¹ where possible.
Results: Of the 2000 persons studied 125 (6.25%) had documented IHD. Pakistan’s population is currently estimated as 163 million. Only half this population is more than 20 years old. Therefore the results are applicable to 81.5 million persons. The disease burden of IHD is therefore estimated as 5.09375 million. IHD was seen more commonly in men compared to women in all age groups despite variation in other risk factors. Relative difference in CHD prevalence between sexes was largest among the youngest subjects up to 50 years old and smallest among the subjects 58-65 years old. Smoking was much more common in men. Total cholesterol was higher and LDL cholesterol was lower in women, whereas HDL cholesterol was higher in women compared to men. In all age groups and both sexes HDL cholesterol was lower than the desirable levels. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher than desirable in both men and women and increased further with increasing age. BMI was higher among women in all age groups and was more marked in the older age groups. The prevalence of Type 2 Diabetes Mellitus was higher in women with and without established IHD compared to men, in all age groups and increased in both men and women with increasing age but more so in women.
Conclusion: Pakistan has a high disease burden of ischemic heart disease and also its risk factors
Key Words: Ischemic heart disease, burden, Pakistan, risk factors, gender, smoking, cholesterol, blood pressure, BMI, diabetes mellitus

Introduction

The world today is seeing a new epidemic that would have a devastating effect unless it is stopped. In 2001, 56.5 million people died in the world.^1,2 Roughly one third of these deaths were due to cardiovascular disease (CVD). CVD would be the cause of more than half the deaths worldwide by the year 2010. In addition every year not less than 20 million people have an acute myocardial infarction (MI) or stroke but survive.

CVD is not only the problem of the West.³ Eighty percent of the deaths due to CVD and 86% of the global burden of CVD are in the developing countries. Despite the high death rates due to non-communicable diseases, by 2010 the leading cause of death in the developing countries including Pakistan would be CVD. For planning preventive and treatment strategies, the prevalence of the disease and its risk factors must be known. This study was therefore carried out to determine the disease burden of ischemic heart disease in Pakistan as well as that of its risk factors.