ASSESSMENT OF CARDIOVASCULAR DISEASE AND ASSOCIATED RISK FACTORS IN RURAL GARO POPULATION

Abstract

Background: Cardiovascular diseases (CVDs) are the leading causes of death all over the world. These are associated with various genetic and lifestyle risk factors. Many risk factors like diabetes, high blood pressure, dyslipidemia, obesity and smoking may be potentially controlled or minimized leading to huge benefits in the control and prevention of the CVDs. Since cardiovascular diseases risk factors vary considerably in population to population it is important to explore those factors in different ethnic groups. In Bangladesh, few studies related to CVD risk have been conducted among Bangalee population, but data on other ethnic groups have not yet been reported. Garo indigenous are one of the important ethnic groups in Bangladesh. But, so far, CVD risk has not been assessed among them. Under this context, the present research work was undertaken to assess the prevalence of hypertension (as a marker of CVD) and its associated risk factors in a rural Garo population. Objectives: The objectives of this study were to assess cardiovascular diseases (with hypertension as a surrogate marker) and its associated risk factors among a rural Garo Population. Subjects and Methods: It was an observational analytical study conducted under a crosssectional design. Recruited through a purposive sampling, the subjects comprised of 289

Garos

(age 18-60 yrs.) located in a rural area (Modhupur) of Tangail district. Blood Pressure (SBP and DBP) were measured by an aneroid sphygmomanometer. Anthropometric measurements such as Body Mass Index, Waist-Hip Ratio were done by standard methods. Dietary intake and dietary habits were assessed by 24-hr recall and 7day FFQ methods respectively. Fasting blood glucose was estimated in all subjects and a

standard OGTT as per WHO Study group criteria was done in some cases. Serum glucose

at

fasting and 2h after 75g oral glucose load, and total cholesterol were estimated by enzymatic methods using a semi-autoanalyzer. Data were analyzed by univariate and multivariate statistical techniques, as appropriate, using SPSS for Windows v23.

Results: Of the total 289 subjects, the mean age was 43.24 years with a standard deviation of 14.34 years. BMI was 23.39 (±5.74) and mean Waist-Hip Ratio was 0.81 (± 0.125). Regarding addiction history, 18% respondents had smoking habit and 24.9% were used to drink alcohol. About 34.6% of the male subjects were within the normal ranges of nutritional status (as assessed by BMI); 37.5% were overweight. 15.4% were underweight and 12.5% were obese. The corresponding percentages in females were 34.6, 31.4, 14.6 and 19.5, respectively, and there was no substantial difference between males with females (X =2.68, p=0.222). The mean calorie intake among all the subjects was 1854 kcal and carbohydrates were the dominant (mean percentage 73.6) source followed by fat (16.7) and protein (only 10.7). As per present RDA for calories, only 32% of the males consume optimum calorie; 59% suffer from underconsumption and 9% suffer from overconsumption. The calorie intake scenario is slightly better in case of females with underconsumption proportion at 40% and optimum proportion at 48%. The mean intake of salt among Garos is 6.81 g/day (SD 2.30). Among males 92% were smokers in contrast to only 7% among females. The mean (± SD) Fasting and 2hr PPG blood glucose levels (mmol/l) were 5.12±2.2 and 6.63 ± 2.94, respectively, among all the subjects. Based on FBG, 6.6% were diabetic and 9.8% had Impaired Fasting Glucose (IFG), and based on PPG, 5.4% had diabetes and 10.4% had IGT. There has no significant statistical difference between males and females. At time of combined analysis of both FBG and PPG, the prevalence of diabetes was 5.2% and that of IGT was 8.7% among all the subjects. Regarding serum cholesterol level, 26.9% of the subjects were found to present with hypercholesterolemia and 8.99% had low cholesterol as per AHA criteria. There was no significant difference between males and females regarding cholesterol levels overall, The prevalence of hypertensive CVD respondents was 8%. The mean (+SD) systolic BP and diastolic BP (mmHg) were 118+16 and 79+06 respectively and the proportion of hypertensive subjects did not show significantly difference between males (7.7%) and females (8.0%). Also, the prevalence of systolic hypertension (overall, 4.5%), did not differ between males (4.8%) and females (4.3%). In case of diastolic hypertension female respondents (5.9%) were a little more hypertensive as compared to males (4.8). Hypertension did not show any relation with smoking habits, alcohol intake and nutritional status. The systolic blood pressure (SBP) was positively correlated with Age (r=0.217, p<0.001), WHR (r = 0.240, p < 0.001), PPG (r = 0.193, p < 0.05), blood total cholesterol (r=0.14, p < 0.05) levels. On the other hand, a positive correlation was found between DBP with age (r = 0.19, p < 0.01), WHR (r = 0.269, p<0.001), fasting blood glucose (r = 0.13, p < 0.05), PPG (r = 0.199, p < .003) and blood total cholesterol (r = 0.219, p < 0.001). On logistic regression analysis it was found that hypertensive CVD is only significantly associated with age (p < .001, odds = 1.09), SBP is significantly related to age (p <0.001, odds=1.111) and total calorie intake (p<.05, odds=1.001). DBP is significantly related to age (p < 0.001, odds = 1.082) and fasting blood glucose (p < 0.05, odds = 0.650) level. Conclusions: Deficient calorie intake is still a major problem among the Garos contributed by low amount of dietary protein and fat. At the same time, rising overweight and obesity among some subgroups is a growing concern among this community. CVD (with hypertension as a marker) has already started to create substantial disease problems among the Garo communities and the problem seems to be greater among males compared to females. Overweight and DM seem to be the major factors underlying hypertension in this community. A comprehensive strategy (using evidence-based guidelines) to prevent CVDs should be designed and implemented in this population to prevent a surge of this NCD among the Garo indigenous communities.