Evaluation of Coronary Heart Disease Risk Factors and Risk Stratification: A Study of 200 Asymptomatic Subjects attending Master Health Checkup

Muralidharan, A (2006) Evaluation of Coronary Heart Disease Risk Factors and Risk Stratification: A Study of 200 Asymptomatic Subjects attending Master Health Checkup. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: The recognition of risk factors for coronary heart disease is one of the major achievements of coronary heart disease epidemiology in the 20th century. Widespread interest in coronary heart disease and its prevention grew from the observation of increased rate of fatal and non-fatal myocardial infarction, particularly in men of relatively young age in westernized societies during the 1950s, 1960s and early 1970s. This led to landmark studies, such as the Framingham heart study initiated in 1948 and including close to 5000 men and women living in town of Framingham, near Boston USA. This cohort study together with several other similar studies, has subsequently demonstrated the importance of a number of risk factors1. A major shift in recent thinking has led to a preference for coronary heart disease risk profiling instead of the diagnosis and treatment of individual risk factors such as elevated blood pressure and cholesterol. By the year 2020, the burden of atherosclerotic coronary heart disease in India will surpass that in other regions of the world2. Hence the current study has been undertaken to assess the coronary heart disease risk profile and stratify the risk of persons attending the master health checkup in our institution. AIM OF THE STUDY: 1. To evaluate the coronary heart disease risk factors of persons attending the Master Health Checkup Clinic of Government Stanley Hospital. 2. To evaluate and stratify the risk according to National cholesterol education programme - Adult Treatment Panel III (NCEP-ATPIII) guidelines. MATERIAL AND METHODS: This study was conducted at Govt. Stanley Medical College & Hospital, Chennai. This study was conducted during the period of one year Jan 2005 - December 2005, 200 asymptomatic subjects attending the MASTER HEALTH CHECKUP CLINIC of Govt. Stanley Medical college & hospital were taken up for the study. Inclusion Criteria: Men aged ≥45 years and women aged 55 years with no previous history Of coronary heart disease, cerebrovascular disease, peripheral vascular disease, Diabetes mellitus, Hypertension were taken up for the study. Exclusion Criteria: Subjects with known history Of coronary heart disease, cerebrovascular disease, peripheral vascular disease, Diabetes mellitus, Hypertension. METHODS: A total of 200 asymptomatic subjects were taken up for the current study. All were subjected to history taking, thorough clinical examination and investigations that included past history of diabetes, dyslipidemia, hypertension, coronary heart disease, cerebrovascular disease, peripheral arterial disease and renal disorder; family history of hypertension, diabetes, dyslipidemia, premature coronary heart disease, cerebrovascular disease and renal disorder; personal history of physical activity and smoking. RESULTS: 200 subjects were taken up for the study out of which 128(64%) were men and 72(36%) were women. The mean age was 52.1 in men and 57.9 in women. The mean, range and standard deviation of the various clinical and biochemical variables of the subjects. The most common overall major coronary heart disease risk factor was physical inactivity present in 97.5% of subjects. Next common risk factor was low HDL Cholesterol, present in 57% of subjects. LDL Cholesterol ≥130mg/dl (54.5%), Total cholesterol ≥200mg/dl (51%),TGL ≥150mg/dl (32.5%) were the dyslipidemias noted. Hypertension was noted in 45% of subjects. Dysglycemia (IFG/IGT) was seen in 30.5% of subjects. Newly diagnosed Diabetes mellitus was noted in 15.5% of subjects.30% of subjects were overweight(BMI 25-29.9) and 12%obese (BMI>30). Truncal obesity (53.5%) and abdominal Obesity (48%) were noted. Metabolic syndrome was present in 39% of subjects. Family history of premature CHD (4%) was rare. Abdominal obesity and metabolic syndrome were significantly higher in women. Hypertriglyceridemia (TGL≥150mg/dl) and Low HDL<40mg/dl were significantly higher in men. SUMMARY: 1. Total no of subjects-200. Men-128(64%), women-72(36%) 2. The overall major risk factors were: (a) physical inactivity (97.5%), (men-96.1%, women-100%), (b) Dyslipidemia: HDL - C<40mg/dl-57%, (men-63.3%, women-45.8%), LDL - C≥130mg/dl-54.5% (men-54.7%, women-54.2%), Total cholesterol ≥200mg/dl-51% (men-52.3%, women-48.6%), TGL ≥150 mg/dl - 32.5% (men-37.5%, women-23.6%). (c) Truncal obesity: 53.5% (men-50%, women-55.1%), (d) Dysglycemia (IFG/IGT) - 30.5% (men-33.6%,women-25%), (e) Diabetes mellitus - 15.5% (men-15.6%, women-15.3%) (f) Abdominal obesity - 48% (men-39.1%, women-63.9%), (g) Overweight - 30% (men-28.9%, women-31.9%), (h) obesity - 12% (men-9.4%, women-16.7%), (h) Smoking - 26% (only in men), (i) Family H/o premature CHD was rare - 4% (men-3.9%, women-4.2%). 3. Metabolic syndrome -39% (men-32.8%, women-50%) and abdominal obesity significantly more in women. 4. Hypertriglyceridemia and low HDL significantly more in men. 5. Multiple risk factors modifying LDL goal (2+ risk factors) present in 84.4% men, 73.6% women. Two risk factors (32.1% men, 41.6% women) three risk factors (39.8% men , 29.2% women), four risk factor combination (12.5% men, 2.8% women) 6. Framingham 10 year CHD risk score <10% 10 yr CHD risk-men 32.8%, women 88.9%. 10-20% 10 yr CHD risk-men 46.9%, women 11.1%. >20% 10 yr CHD risk-men 20.3%, women 0%. 7. Risk categorization: Low risk (0-1 risk factor) - men 10.9%, women 19.4%. Moderate risk (2 or more risk factors+ 10 yr risk <10%) - men 10.7%, Women 50%. Moderately High risk (2 or more risk factors+10 yr risk 10-20%) Men-35.9%, Women-11.1%. High risk (CHD or CHD risk equivalents/10 year risk>20%) Men-32.8%, Women-19.5%. CONCLUSION: I. Evaluation of coronary heart disease risk factors utilizing (a) Multiple risk, factor analysis, (b) Framingham 10 year CHD risk score, (c) Risk categorization according to NCEP-ATP III guidelines was valuable. It is essential to utilize all these parameters to evaluate coronary heart disease risk factors. II. This study has highlighted that asymptomatic subjects attending MASTER HEALTH CHECKUP CLINIC had various grades of risk Factors which required intensive intervention for risk modification utilizing NCEP-ATPIII guidelines. This would be very valuable to select asymptomatic high risk individuals for intensive management. It is also essential that moderate and moderately high risk groups be also targeted for risk management. III. Metabolic syndrome was present in a significant number of subjects. Evaluation for metabolic syndrome targets a set of multiple risk factor Groups who might have high or moderate to moderately high risk for CHD which needs intensive management for risk modification.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Coronary Heart Disease ; Risk Factors ; Risk Stratification ; 200 Asymptomatic Subjects ; Master Health Checkup
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 03:30
Last Modified: 24 Mar 2018 03:51
URI: http://repository-tnmgrmu.ac.in/id/eprint/6441

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