Behavioral pattern, life style and socio economic status in elderly Normolipidemic Acute Myocardial Infarct Subjects - A case control study from South Asia

摘要

BACKGROUND: Mortality due to CAD is increasing at an alarming rate in developing countries and it is going to be the largest killer by 2020. Major risk factors include rapid urbanization, physical inactivity, stressful employment and the personality of an individual, all of which act synergistically resulting in increased CAD rates. Though Indians have less conventional risk factors, they are more susceptible to this disease. The current study was focused on impact of behavioral aspects, lifestyle and physical activity influence on CAD, as these risk factors are not properly established by recent research. AIM: The study was undertaken to evaluate the impact of behavior, lifestyle and physical activity in predicting CAD risk in normolipidaemic acute myocardial infarct patients and to compare the findings with healthy subjects. SETTING & DESIGN: Lipid profile and behavioral aspects and lifestyles were determined in 165 normolipidaemic acute myocardial infarct patients and compared with 165 age/sex-matched controls. MATERIAL & METHODS: Total cholesterol, triglycerides, and HDL-cholesterol were analyzed enzymatically using kits obtained from Randox Laboratories Limited, Crumlin, UK. Plasma LDL-cholesterol was determined from the values of total cholesterol and HDL- cholesterol using the Friedwald's formula. The lifestyle and behavioral aspects of the subjects were determined using pre-tested questionnaires. STATISTICS: The values were expressed as means ± standard deviation (SD) and data from patients and controls were compared using students 't'-test. RESULTS AND CONCLUSION: Lipid profiles were higher in case of patients than with controls .apart from HDL-c levels (p<.001), which were significantly lower in patients (p<.001). Patients had higher serum cholesterol and blood pressure compared to controls in each behavioral assessment parameters. Physical activity was found to be lower in patients compared to controls. Hyperactive, irrelevant thinkers and highly ambitious subjects had higher cholesterol and blood pressure in each category. Mostly the middle socioeconomic class was affected (71%) by AMI. In conclusion, our findings indicated a high prevalence of various behavioral risk factors among the myocardial infarct patients. Remedial measures are needed to minimize future morbidity burden and there by minimizing medical expenses. In regard to the risk factor of smoking, a strict public policy in restricting the behaviour and .cigarette distribution may be considered. Although the Government has taken steps in this regard, it is the individual and community who should reduce the risk factor, especially the high risk groups such as lower social status groups. Introduction Emerging epidemics of cardiovascular disease (CVD) have attracted attention as major causes of global disability and mortality [1] . In 1990, fifteen million deaths were attributable to CVD, and among those deaths 63% occurred in developing countries [2] . CVD (mainly heart disease and stroke) was responsible for approximately half of non communicable disease (NCD) mortality and one quarter of the NCD morbidity rate in 1999, mainly in low- and middle-income countries [3] . Ischemic heart disease and stroke are projected to increase further by 2020, and developing countries will experience the highest burden. The disease pattern is increasing drastically among Indians compared to the Westerners [45] . The CAD rates in India are almost four fold compared to the United States, which had similar rates in 1968 . CAD is expected to be the largest killer by 2015 [6]Although Indians have less conventional risk factors still we succumb to the claws of this disease [78] . Rapid urbanization, lifestyle modifications, demanding and stressful employment, sedentary lifestyle and low rates of physical activity have increased the risk of coronary artery disease. Prospective studies have indicated the risk of CVD is almost 50% increased due to stress induced at work [9] . Lowe