American Heart Journal
Volume 150, Issue 2 , Pages 221-226, August 2005

Heart disease epidemic in Pakistan: Women and men at equal risk

  • Tazeen H. Jafar, MD, MPH

      Affiliations

    • Corresponding Author InformationReprint requests: Dr. Tazeen H. Jafar, Clinical Epidemiology Unit, Department of Community Health Sciences and Medicine, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
    • Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
    • ,
  • Fahim H. Jafary, MD

      Affiliations

    • Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
    • ,
  • Saleem Jessani, MD

      Affiliations

    • Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
    • ,
  • Nish Chaturvedi, MD, MRCP

      Affiliations

    • National Heart and Lung Institute, Imperial College London, London, United Kingdom

Received 30 April 2004; accepted 19 September 2004.

Objective

We conducted this study to determine the prevalence of coronary artery disease (CAD) and its risk factors in Karachi, Pakistan.

Background

Migrant South Asians residing in the West have one of the highest rates of CAD in the world. Estimates of disease in nonmigrant populations are conflicting.

Methods

We conducted a population-based cross-sectional survey on 320 randomly selected adults aged ≥40 years. Coronary artery disease was defined as the composite outcome of (1) abnormalities indicative of definite or probable CAD based on the Minnesota classification of electrocardiogram or (2) past history of heart attack.

Results

The overall prevalence of CAD (95% CI) was 26.9% (22.3%-32.0%): 23.7% (17.8%-30.9%) in men vs 30.0% (23.4-37.5%) in women (P = .12). Risks did not differ substantially by age group. The factors (odds ratio, 95% CI) independently associated with CAD were current tobacco use (2.12, 1.21-3.73), systolic blood pressure (1.08, 1.02-1.15, for each 5 mm Hg increase), and proteinuria (2.49, 1.04-5.95). Coronary artery disease odds for women vs men (1.38, 0.84-2.62) increased to 1.60 (0.93-2.75), when adjusted for key risk factors.

Conclusions

One in 4 middle-aged adults in Pakistan has prevalent CAD. Risks are uniformly high in the young and in women. Concerted efforts are needed to prevent the epidemic of cardiovascular disease in South Asia, focusing on hypertension, diabetes, smoking, and dyslipidemia.

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 Supported by a grant from the Wellcome Trust, UK.

PII: S0002-8703(04)00657-X

doi:10.1016/j.ahj.2004.09.025

American Heart Journal
Volume 150, Issue 2 , Pages 221-226, August 2005

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