Cardiovascular disease in developing countries

Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation

OBJECTIVE

The Mashhad stroke and heart atherosclerotic disorder (MASHAD) study is a 10-year cohort study that aims to evaluate the impact of various genetic, environmental, nutritional and psychosocial risk factors on the incidence of cardiovascular events among an urban population in eastern Iran.

METHODS

The MASHAD study comprises a cohort of 9704 individuals aged 35-65 years using a stratified cluster random sampling design. This cohort will be followed up until 2020, with follow-up examinations being undertaken every 3 years. Ten-year cardiovascular disease (CVD) risk estimation was determined using NCEP ATP III criteria.

RESULTS

Overall, 88.4 % of women and 79.2 % of men (P < 0.001) had at least one lipid abnormality. The 10-year risk for CVD of <10, 10-20 and >20 % were observed to be 86.6, 11 and 2.5 %, respectively. Predicted risk of CVD > 10 % using the Framingham algorithm was considerably higher in men compared to women. Overall, 9.5 % [95 % confidence interval (CI) 8.9-10.1 %] of our subjects had prevalent CAD.

CONCLUSION

The prevalence of CVD risk factors within our population is high compared to Western countries, indicating the necessity for interventional risk modifications.

Cardiovascular disease risk in a semirural community in Malaysia

BACKGROUND AND AIM

It has been argued that cardiovascular disease (CVD) is not very prevalent in developing countries, particularly in a rural community. This study examined the prevalence of CVD risk of a semirural community in Malaysia through an epidemiological survey.

METHODS

Subjects were invited to a free health screening service carried out over a period of 6 weeks. Then, a follow-up study of the initial nonresponders was done in the villages that showed a poorer response. The survey was conducted using a standardized questionnaire. Hypertension was defined as blood pressure > or =140/90 mm Hg. The Framingham Coronary Disease Risk Prediction Score (FRS) was used as a measure of CVD risk.

RESULTS

A total of 1417 subjects participated in this survey. The response rate was 56%. A follow-up survey of the nonresponders did not show any differences from the initial responders in any systematic way. The prevalence of CVD risk factors was high in both men and women. The mean (+/-SD) FRS was 9.4 (+/-2.5) and 11.3 (+/-4.1) for men and women, respectively. The mean predicted coronary heart disease (CHD) risk was high at 20% to 25% for men and medium at 11% to 13% for women. Overall, 55.8% of the men had >20% risk of having a CHD event in the next 10 years whereas women's risk was lower, with 15.1% having a risk of > or =20%.

CONCLUSION

The prevalence of CVD risk even in a semirural community of a developing country is high. Every effort should be made to lower these risk factors.