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Prevalence and risk factors for hypertension in rural Nepali women
– Reported, June 08, 2013
Low and middle-income countries bear a large burden of cardiovascular disease (CVD), accounting for 80% of the global CVD-related deaths and 87% of disability adjusted-life years lost. CVD rapidly has become a major cause of mortality and morbidity in low income South Asian countries as well . In developed countries, age adjusted death rates from CVD are declining due to preventive interventions and improved treatments. Thus, CVD in developed countries is considered a disease of the aged, where only 23% of deaths occur below the age of 70 years; however, in South Asia, 52% of CVD deaths occur among people under 70 years . Additionally, it has been estimated that the age of onset of acute myocardial infarction was an average of 6 years of age earlier in South Asia compared to other regions. This trend has led to substantial loss of potential human productive years. Early identification and rigorous control of intermediate risk factors are needed to prevent and control CVD in this part of the world.
Hypertension is one of the leading risk factors for CVD and the prevalence of hypertension has been increasing in the South Asian region including Nepal. Despite rapid urbanization, about 83% of Nepals inhabitants live in rural areas. Few studies have attempted to describe the burden and determinants for hypertension in rural Nepal and such data are limited in the South Asian context. Exploration of such data in rural Nepal will help to understand the etiology of CVD in a population at the cusp of the epidemiologic and nutrition transition, with findings that may be generalizable to other parts of rural South Asia.
A number of reports suggest that cardiovascular disease and hypertension are rapidly increasing both in urban and rural areas of South Asia, yet there have been few population based studies and prevalence estimates vary widely. The only evidence from rural Nepal comes from a 1981 study in which the prevalence of hypertension among people aged 20 or more was about 6% in the hill areas and 8% in the plains. The reported prevalence of hypertension in rural areas of India, Bangladesh and Pakistan is in the range of 4.5 – 22% . These studies varied in the included age groups, study settings, and criteria for classifying hypertension. Nevertheless, the prevalence of hypertension among our cohort based on a cut-off of 140/90 mm Hg was 3.3%, one of the lowest reported estimates among rural communities in South Asia. One likely explanation is the young age of our participants, in contrast to many of the aforementioned studies which were among older participants. None of the previous studies reported the prevalence of pre-hypertension. Individuals with pre-hypertension have a high likelihood of progression to hypertension over the subsequent 5 years. We have also seen a significant positive association between age and prevalent hypertension and it is likely that many of the women who currently have pre-hypertension will progress to hypertension as they age. Moreover, pre-hypertension itself is also a risk factor for cardiovascular disease and cardiovascular mortality.
We have found that a total of 72.3% of women had low HDL cholesterol, a pattern of dyslipidemia that was also observed in studies mainly from India, where the prevalence of low HDL cholesterol has ranged from 41-68%. These studies also reported that the prevalence of high TG was between 10-48%. In addition, a recent study of urban Nepalese women reported a similar pattern– 40% of them had lower HDL cholesterol and 36% had high TG. Such lipid patterns observed in South Asia are different from patterns in Western countries. By comparison, a nationally representative sample from the United States reported that 30% of females had low HDL cholesterol and 21% had high TG. Some of the apparent difference between regions could be explained by the wide usage and availability of lipid lowering drugs in developed world or could be reflective of a distinct South Asian diet pattern largely dependent on carbohydrates, which may contribute to hypertriglyceridemia and lower HDL cholesterol.
Although the prevalence of hypertension was low in this relatively young cohort, nearly 18% were classified as either pre-hypertensive or hypertensive. We found a negative association between SES and hypertension, which could be an indication of the maturation of CVD epidemic in that region. This epidemic has to be prevented because across the South Asian region, it has been predicted that if rigorous and early preventive measures are not taken, treatment costs of CVD will become a substantial burden on national economies. It is also predicted that a reduction in the population distribution of systolic blood pressure of 2 mm Hg results in 6%, 4% and 3% reductions in 1-year stroke related mortality, coronary heart disease related mortality and overall mortality, respectively. It also has been projected that reducing chronic disease mortality even by only 2% per year by 2015 could save 10% of the expected loss of income and around $8 billion collectively in South Asian and other middle or low income countries . We have shown that different cardiovascular risk factors including blood pressure tend to be strongly associated with each other. Identification of these risk factors at an early stage of life is an important opportunity for primary prevention of hypertension through lifestyle modification to prevent disease progression.
CREDITS.
Rumana J Khan, Christine P Stewart, Parul Christian, Kerry J Schulze, Lee Wu, Steven C LeClerq, Subarna K Khatry, and Keith P West, Jr
http://www.ncbi.nlm.nih.gov/
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