Prevalence of Risk Factors for Cardiovascular Diseases in Bangladesh: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the rising incidence of cardiovascular diseases (CVDs) in Bangladesh, an improved understanding of the epidemiology of CVD risk factors is needed. Therefore, we reviewed published studies on CVD modifiable risk factors e.g., Type 2 Diabetes Mellitus (T2DM), hypertension (HTN), dyslipidemia and smoking as well as studies on CVDs and conducted a meta-analysis of risk factors and disease prevalence. METHODS: We searched the GLOBAL HEALTH, MEDLINE, EMBASE 'BanglaJol' databases for all studies in English on CVDs and its associated modifiable risk factors. Random effects meta-analysis methods were used to estimate pooled prevalence. RESULTS: There were 74 eligible studies (outcome: T2DM = 32, HTN = 24, dyslipidaemia = 8 and smoking = 25; CVDs = 10). Due to high between study heterogeneity (p<0.001, I2> 95%) in the prevalence of CVD risk factors, we presented median and interquartile range (IQR) instead of the pooled estimates as the summary measures. Median (IQR) prevalence of T2DM, HTN, dyslipidemia and smoking were 5.9% (1.97%-8.25%); 15.1% (10.52%-17.60%); 34.35% (10.66%-48.50%) and 40.56% (0.80%-55.95%), respectively. The prevalence of T2DM and dyslipidemia were significantly higher in urban compared to rural populations (13.5 vs 6%, p<0.001; 41.5 vs 30%, p = 0.007, respectively). CONCLUSIONS: The prevalence of risk factors for CVDs is high in Bangladesh, more so in urban areas. Ageing of the population may be a factor but urbanization seems to have an influence, possibly related to changes in dietary and physical activity patterns. Further research, in particular longitudinal studies, is needed to explore the complex interaction of these factors and to inform policies and programs for the prevention and management of CVDs in Bangladesh.

Short-term predictive ability of selected cardiovascular risk prediction models in a rural Bangladeshi population: a case-cohort study.

BACKGROUND: Prediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population. The present study was undertaken to test the hypothesis that both laboratory-based (Framingham equation and WHO/ISH laboratory-based charts) and non-laboratory-based tools may be used to predict CVDs on a short-term basis. METHODS: Data from a case-cohort study (52989 cohort and 439 sub-cohort participants), conducted on a rural Bangladeshi population, were analysed using modified Cox PH model with a maximum follow-up of 2.5 years. The outcome variable, coronary heart diseases (CHDs), was assessed in 2014 using electrocardiography, and it was used as a surrogate marker for CVDs in Bangladesh. The predictive power of the models was assessed by calculating C-statistics and generating ROC curves with other measures of diagnostic tests. RESULTS: All the models showed high negative prediction values (NPVs, 84 % to 92 %) and these did not differ between models or gender. The sensitivity of the models substantially changed based on the risk prediction thresholds (between 5-30 %); however, the NPVs and PPVs were relatively stable at various threshold levels. Hypertension and dyslipidaemia were significantly associated with CHD outcome in males and ABSI (a body shape index) in females. All models showed similar C-statistics (0.611-0.685, in both genders). Overall, the non-laboratory-based model showed better performance (0.685) in women but equal performance in men. CONCLUSIONS: Existing CVD risk prediction tools may identify future CHD cases with fairly good confidence on a short-term basis. The non-laboratory-based tool, using ABSI as a predictor, may provide better predictive accuracy among women.

Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population.

OBJECTIVES: To estimate the absolute cardiovascular disease (CVD) risk burden in a remote rural Bangladeshi population using the 'With' and 'Without' Cholesterol versions of the WHO/International Society of Hypertension (WHO/ISH) CVD risk assessment chart (particularly suitable for low and middle-income countries due to less reliance on laboratory testing) and to evaluate the agreement between the two approaches. DESIGN: Cross-sectional study using data from a large prospective cohort of the North Bengal Non-Communicable Disease Programme (NB-NCDP) of Bangladesh. SETTING: General rural population from Thakurgaon district of Bangladesh. PARTICIPANTS: 563 individuals who were categorised as having 'no CVDs' on screening by a questionnaire-based survey using the 'WHO CVD-Risk Management Package' developed in 2002. MAIN OUTCOME MEASURES: Absolute CVD risk burden assessed using two versions of the WHO/ISH risk assessment charts for the South-East Asian Region-D. RESULTS: 10-year risk (moderate, high and very high) positivity was present among 21.5% and 20.2% of participants, respectively, using with and without cholesterol versions of the tool. The overall concordance rate for the two versions was 89.5% and they did not differ significantly in estimating the proportion of overall participants having higher levels of CVD. The projected drug requirement, however, showed a significant overestimation in the proportion of participants at both the threshold levels (p<0.002) on using 'without' as compared to 'with' cholesterol versions. CONCLUSIONS: About one-fifth of the adult population in Bangladesh, even in a remote rural area, seem to be at risk of developing CVDs (25% of them at high risk and 25% at very high risk) within 10 years with males and females being almost equally vulnerable.

Clinical and biochemical characterization of high risk and not high risk for cardiovascular disease adults in a population from peripheral region of Bangladesh.

BACKGROUND: A group of 63708 Bangladeshi adults from a rural area were screened in 2011-12 for cardiovascular diseases (CVD) risk using a questionnaire based tool developed as part of the 'WHO CVD-RISK Management Package for low-and medium resource setting'. In the current study participants who were found to be high risk and a sample of the not high risk participants from the screening were further characterized clinically and biochemically to explore the burden and determinants of CVD risk factors in a remote rural Bangladeshi population. METHODS: The high risk participants comprised all 1170 subjects who screened positive in 2011-12 and the not high risk group comprised 563 randomly sampled participants from the 62538 who screened negative. Socio-demographic, behavioral, anthropometric, clinical and biochemical data (glucose and lipids) were collected by standardized procedures. Body Mass Index (BMI) was classified following Asian BMI criteria. Data was analyzed using univariable and multivariable methods. RESULTS: On univariable analysis in high risk and not high risk participants respectively, age in years (M ± SD) was 50 ± 11 for both groups, ratio of male: female was 40:60 and 66:44, current smoking 28.5% and 50.6%; smokeless tobacco use 37.1% and 34.8%; overweight and obesity measured by body mass index (BMI) was 39.1% and 20.5%; high waist circumference (WC) 36.1% and 11.9%; high waist to hip ratio (WHR) 53.8% and 26.3%; and with high waist to height ratio (WHtR) 56.4% and 28.4%, existence of hypertension (HTN) was 15.8% and 3.6%, pre-HTN 43.8% and 12.1%, diabetes (DM) 14.0% and 10.5%, pre-DM 16.9% and 12.1% and dyslipidaemia 85.8% and 89.5%. In multivariable logistic regression analysis female sex, BMI, WC, WHR and WHtR, HTN and dyslipidaemia remain significantly more common among high risk participants (p < 0.05 and p < 0.001). CONCLUSIONS: The prevalence of clinical and biochemical risk factors of CVDs are quite high even in this rural population and this may be related to the socioeconomic and cultural transition in Bangladeshi society. Surprisingly more of the high risk group was female and there were fewer smokers. Obesity and hypertension were more frequent in high risk participants.