Cardiovascular disease morbidity and mortality and its relationship with risk factors in Kelantan population
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Date
2009
Authors
Abu Bakar, Roselina
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Abstract
Objectives of this study were to determine the incidence of cardiovascular disease
and investigate its associations with cardiovascular risk factors in the Kelantan population.
This study was a retrospective cohort study with a multistage cluster sampling design. A
cohort of 1710 people identified in a previous cross-sectional study in 1992 was followed
up. There were 911 (53.3%) subjects traceable and participated in this study. Of the rest,
249 (14.6%) have died and 550 (32.2%) were untraceable. Individual baseline data on
cardiovascular risk factors had been collected when the cohort was first examined 12 years
earlier. Cardiovascular disease morbidity, that is, the occurrence of non-fatal events (cases
of coronary heart disease and cerebrovascular disease) was assessed using Rose and strokefree
status questionnaire. The mortality was assessed by WHO verbal autopsy
questionnaire.
A total of 580 cardiovascular events developed after 12-years follow-up of 1160
subjects. There were 460 cardiovascular disease morbidity identified from 911 subjects.
Cumulative incidence rate for coronary heart disease was found to be 315 per 1000 and 337
per 1000 for cerebrovascular disease. There were 120 deaths from cardiov~scular disease
identified among 249 recorded deaths, 78 deaths due to coronary heart disease and 42 due
to cerebrovascular disease. Cardiovascular mortality rate was found to be 48.2% of all
deaths. This study showed that smokers had a higher risk of developing total cardiovascular
events (adjusted OR: 1.37; 95% CI: 1.03-1.79) and coronary heart disease morbidity
(adjusted OR: 1.40; 95% CI: 1.00-1.97) compared to non-smokers. Males had a higher risk
of developing cardiovascular morbidity (adjusted OR: 1.39; 95% Cl: 1.02-1.88) and
cerebrovascular disease morbidity (adjusted OR: 1.47; 95% CI: 1.09-2.02) compared to
females. Systolic blood pressure positively predicted cardiovascular mortality (adjusted
OR: 1.02; 95% CI: 1.0 1-1.03). Triglyceride positively predicted the risk for cardiovascular
mortality (adjusted OR: 1.72; 95% CI: 1.20-2.48) and cerebrovascular disease mortality
(adjusted OR: 1.27; 95% CI: 1.03-1.56) but, negatively predicted the risk for cardiovascular
disease morbidity (adjusted OR: 0.85; 95% CI: 0.74-0.98).
This study was also conducted to observe the evolution of cardiovascular risk
factors over a 12-year period. Among subjects who did not have risk factors at baseline,
198 (43.5%) developed hypertension, 97 (13.5%) developed diabetes, 23 (4.5%) developed
obesity, 145 (37.4%) developed hypercholesterolemia and 68 (11.3%) developed elevated
LDL cholesterol after 12 years of follow-up. This represented a 3.6% of conversion rate per
year for hypertension, 1.1% for diabetes, 0.4% for obesity, 3.1% for hypercholesterolemia
and 0.9% for elevated LDL cholesterol. Subjects with prehypertension and overweight at
baseline have been shown to have a risk of developing hypertension and obesity of 4.7%
and 3.3% per year, respectively. The conversion rates of progression to diabetes for
subjects with IFG and IGT. at baseline were 2.1% and 1.9% per year, respectively.
Predictors of progression to each cardiovascular risk factor were ideqtified. Age and
systolic blood pressure positively predicted the progression from baseline normal blood
pressure and prehypertension to hypertension. Diastolic blood pressure positively predicted
the progression from baseline prehypertension to hypertension. Females had a higher risk
of developing hypertension from baseline normal blood pressure. Diastolic blood pressure,
fasting blood glucose and triglyceride positively predicted the progression from normal
blood glucose to diabetes. Age negatively predicted the progression from baseline normal
blood glucose to diabetes. Body mass index (BMI) positively predicted the progression
from baseline IGT to diabetes. Age negatively predicted the progression from baseline
normal BMI to obesity. Female had a higher risk of getting hypercholesterolemia compared
to male. LDL cholesterol positively predicted the risk for hypercholesterolemia. Total
cholesterol positively predicted the risk for elevated LDL cholesterol.
In conclusion, smokers had a higher risk of developing total cardiovascular events
compared to non-smokers. Males had a higher risk of developing cardiovascular morbidity
than females. Triglyceride and systolic blood pressure significantly predicted the risk for
cardiovascular mortality. Therefore, efforts in the prevention and control of cardiovascular
disease and its risk factors in Kelantan should take into consideration these findings.
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Keywords
Morbidity , Mortality