Prevalence of Metabolic Syndrome in Urban Low Socioeconomic Group Patients with Symptomatic Coronary Artery Disease

Jayaprakash, K P (2008) Prevalence of Metabolic Syndrome in Urban Low Socioeconomic Group Patients with Symptomatic Coronary Artery Disease. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: It is estimated that more than one fifth of world’s population lives in India. Today, India is one of the fastest growing economies in the world. Urbanization is rapid as ever. Young and old abandoning healthy Indian lifestyle and culture for western culture in the name of modern living. Sedentary lifestyle, low fibre, high fat and energy rich foods have penetrated even the rural India in the name of globalization. All these will come not without cost. India is now facing paradox of malnutrition on one hand and epidemic of obesity on the other. Indians three times higher risk of developing Coronary Artery Disease (CAD) compared to Chinese and are 20 times more likely to die due to CAD compared to native black or white South Africans. The SHARE study demonstrated that South Asians had higher prevalence of cardiovascular disease compared to Europeans and Chinese living in Canada. In India 2.78 million deaths are due to cardiovascular diseases, of which over 50% is due to CAD, making CAD the number one killer disease in our country. In Jaipur Heart Watch – 2 study conducted in 2002, prevalence of CAD was reported to be 8.2%. Over 35 million diabetic patients live in India, making India the diabetic capital in the world. These numbers expected to double by the year 2030. Thus India faces the dangerous dual epidemic of diabetes and CAD. The major root of both epidemics lies in “Metabolic Syndrome”. Lots of studies from west on metabolic syndrome represent middle and higher socioeconomic classes of society. Those studies which assess the burden of metabolic syndrome in CAD patients living below poverty line in India is still lacking. Thus it is worthwhile effort to find out the burden of metabolic syndrome in less privileged poor CAD patients of Chennai city. Kilpauk Medical College Hospital is being a Government run institution serves these patients either free of cost or with minimal fee. Majority of patients attending the OPDs of the hospital are poor, hence giving good opportunity to study the problem pertaining to these patients. AIM: 1. To find out the prevalence of metabolic syndrome in urban low socioeconomic group patients with symptomatic coronary artery disease using modified International Diabetic Federation (IDF) consensus worldwide definition of the metabolic syndrome, 2005. 2. To analyze the differences in the prevalence of metabolic syndrome among age groups, sex, social class and chronic and acute coronary syndromes. OBJECTIVES: 1. To diagnose symptomatic coronary artery disease in low socioeconomic group patients. 2. To classify patients in to social classes based on family income. 3. To measure waist circumference, blood pressure, fasting blood sugar, fasting high density lipoprotein (HDL) cholesterol and triglyceride. 4. To find out the prevalence of Central Obesity, Hypertension, Impaired Fasting Glucose or Diabetes mellitus, Hypertriglyceridemia and low HDL cholesterol and to analyze the differences in their prevalence among the age groups, sex, social class and chronic and acute coronary syndromes. 5. To apply modified IDF, 2005 definition for metabolic syndrome to the data and diagnose metabolic syndrome. 6. To find the prevalence of metabolic syndrome and analyze the differences in its prevalence among the age groups, sex, social class and chronic and acute coronary syndromes. MATERIALS AND METHODS: Study Design: A cross sectional study, with analysis of the metabolic parameters for differences. Criteria for MS: Modified International Diabetic Federation consensus worldwide definition of the Metabolic Syndrome, 2005. Study Period: September, 2006 to August, 2007 (12 months). Study Population: All patients belonging to low socioeconomic group (family income <Rs.5100 per month), attending medical outpatient department or those who are getting admitted in medical ward of Govt. Kilpauk Medical College (KMC), Chennai with coronary artery disease (CAD). Sample Size: 113 patients, i.e. 38 female patients and 75 male patients. Inclusion Criteria: Patients’ 1. Those who attend medical outpatient department or getting admitted in medical ward at KMC. 2. With family income less than Rs.5100 per month. 3. Who live in Chennai city. 4. With age more than 20 years. 5. With symptoms suggestive of CAD. 6. With ECG features suggestive of CAD or significant CK-MB elevation. Exclusion Criteria: Patients’ 1. Children, adolescents and those with age less than 20 years. 2. With nonanginal chest pain. 3. With asymptomatic CAD. 4. With ECG changes which are not due to myocardial ischemia or infarction. RESULTS: Total 113 patients with coronary artery disease whose income less than Rs. 5100 per month participated in the study. 38 (33.6%) were females. 75 (66.4%) were males. Age groups were near normally distributed with the sample mean being 54.27years (CI: 54.3±23years). Maximum numbers of patients (70) are in the age groups 40 – 60 years. Youngest patient is 25years and oldest being 80years old. Mean of age for males (CI: 55.49± 22years) and females (CI: 51.87±24.7years) lie within one standard deviation from sample mean. Males represent older age (>60 years) group more than females. Age distribution in males is negatively skewed. Social class distribution is positively skewed, i.e., income being negatively skewed. Class I & II (i.e., Rs.1200 – 5100) represent > 70% of sample both in males and females. There has been no representation of lower income groups, i.e., social class IV and V, from < 40 years and >60 years. Since there is inadequate representation of the social classes, especially, class IV and V, social classes were excluded from further analysis. 49 (43.4%) patients had chronic CAD and 64 (56.6%) patients had ACS. Among males 37 had chronic CAD and 38 had ACS. Among females 12 had chronic CAD and 26 had ACS. Social groups IV and V had lesser representation in both chronic CAD and ACS. CONCLUSION: The result of present study suggests that in urban patients who live below poverty line with symptomatic coronary artery disease there in increased prevalence of metabolic syndrome, central obesity, hyperglycemia, hypertension and dyslipidemia. The higher prevalence particularly noticeable in those with the premature coronary artery disease and that might have resulted in earlier onset of CAD in them. Moreover presence of central obesity and other risk factors might lead to more severe CAD, i.e., acute coronary syndrome. It is assumed that adapting unhealthy life styles such as sedentary work, rich calory and imbalanced diet, malnutrition among antenatal mothers might be the cause for this occurrence. Coronary artery disease and its management pose a significant economical challenge and these patients who poor may not be able to meet the challenge, resulting in higher mortality and morbidity. Metabolic syndrome which is the emerging as a major risk factor for coronary artery disease in rich and poor further complicates the situation for these patients. So prevention of metabolic syndrome is better than cure for metabolic syndrome in these patients. There is an urgent need to explore nutrition and physical activity and their role in the prevention and treatment of disorders directly or indirectly related to the metabolic syndrome. It is possible that by diet, exercise, changes in lifestyle, and most impotantly by education the prevalence of metabolic syndrome and hence prevalence of coronary artery disease can be reduced and such a preventive strategy is urgent need of the hour for our country which is facing a twin epidemic of diabetes and coronary artery disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Metabolic Syndrome ; Urban Low Socioeconomic Group Patients ; Symptomatic Coronary Artery Disease.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 10 Mar 2018 04:51
Last Modified: 10 Mar 2018 04:51

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