Jafar Tazeen H
Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, Pakistan.
Int J Cardiol. 2006 Jan 26;106(3):348-54. doi: 10.1016/j.ijcard.2005.02.013.
Migrant South Asian population in the West, particularly women, is more predisposed to central obesity and metabolic syndromes than native Caucasians. However, the burden of coexistence of clinical risk factors for cardiovascular disease (CVD) and associated gender disparities in native population of South Asia are not known. We analyzed the National Health Survey of Pakistan (NHSP) (1990-1994) data to study the same in the population of Pakistan.
Data from 9442 individuals age 15 years or over from the National Health Survey of Pakistan (NHSP) (1990-1994) was analyzed. The primary outcome was defined as the coexistence of at least two of the following five clinical risk factors for CVD. Hypertension (systolic blood pressure > or = 140 mm Hg, or diastolic blood pressure > or = 90 mm Hg, or current therapy with antihypertensive medications); diabetes (non-fasting blood glucose > or = 140 mg/dl (7.8 mmol/l), or known history of diabetes); proteinuria (dipstick urine protein > 1+); hyperlipidemia (random blood cholesterol > or = 200 mg/dl (5.17 mmol/l)), and central obesity (waist circumference of > or = 80 cm in women and > or = 90 cm in men.
The overall prevalence (95% confidence intervals) of the coexistence of risk factors for CVD was 17.2% (16.4-18.0%): 13.0% (12.1-14.1%) in men and 20.9% (19.8-22.0%) in women (p < 0.001). Multivariate analysis revealed that men had at significantly lower odds of coexistence of risk factors than women with OR, 95% CI of 0.53, 0.47-0.61, and this difference increased in magnitude with age (interaction p < 0.001). In addition to Muhajir, Sindhi and Pashtun vs Punjabi ethnicity, factors independently associated with primary outcome were age (OR, 95% CI) (1.06, 1.05-1.06, for each one year increase), urban dwelling vs rural dwelling (1.45, 1.24-1.70), high (1.97, 1.61-2.45) and mid (1.44, 1.23-1.70) vs low socioeconomic status, body mass index (1.17, 1.15-1.18, for each one kg/m(2) increase), and high consumption of meat (1.77, 1.52-2.06) and ghee (1.26, 1.00-1.54).
Potentially modifiable factors including obesity and saturated fat intake are associated with increased prevalence of CVD risk factors. The high burden of multiple CVD risk factors in women compared to men highlight the need for targeting this vulnerable segment of population in CVD prevention programs in Pakistan, and, possibly neighbouring countries.
在西方的南亚移民群体，尤其是女性，比当地白种人更容易出现中心性肥胖和代谢综合征。然而，南亚本地人群中心血管疾病（CVD）临床风险因素共存的负担以及相关的性别差异尚不清楚。我们分析了巴基斯坦国家健康调查（NHSP）（1990 - 1994年）的数据，以研究巴基斯坦人群中的上述情况。
分析了来自巴基斯坦国家健康调查（NHSP）（1990 - 1994年）的9442名15岁及以上个体的数据。主要结局定义为以下五种CVD临床风险因素中至少两种因素共存。高血压（收缩压≥140 mmHg，或舒张压≥90 mmHg，或正在接受抗高血压药物治疗）；糖尿病（非空腹血糖≥140 mg/dl（7.8 mmol/l），或已知糖尿病病史）；蛋白尿（尿试纸检测尿蛋白＞1 +）；高脂血症（随机血胆固醇≥200 mg/dl（5.17 mmol/l）），以及中心性肥胖（女性腰围≥80 cm，男性腰围≥90 cm）。
CVD风险因素共存的总体患病率（95%置信区间）为17.2%（16.4 - 18.0%）：男性为13.0%（12.1 - 14.1%），女性为20.9%（19.8 - 22.0%）（p＜0.001）。多变量分析显示，男性风险因素共存的几率显著低于女性，比值比（OR）为0.53，95%置信区间为0.47 - 0.61，且这种差异随年龄增大而增大（交互作用p＜0.001）。除了穆哈吉尔人、信德人和普什图人与旁遮普人种族外，与主要结局独立相关的因素包括年龄（OR，95%置信区间）（每增加一岁为1.06，1.05 - 1.06）、城市居住与农村居住（1.45，1.24 - 1.70）、高（1.97，1.61 - 2.45）和中等（1.44，1.23 - 1.70）与低社会经济地位、体重指数（每增加1 kg/m²为1.17，1.15 - 1.18），以及肉类（1.77，1.52 - 2.06）和酥油（1.26，1.00 - 1.54）的高摄入量。
包括肥胖和饱和脂肪摄入在内的潜在可改变因素与CVD风险因素患病率增加有关。与男性相比，女性中多种CVD风险因素的高负担凸显了在巴基斯坦以及可能在邻国的CVD预防项目中针对这一弱势群体的必要性。
