The rates of coronary heart disease are lower in Asia than in developed countries. Singapore has undergone rapid urbanization over the past several decades. In the several decades between the 1960s and 1980s, a rapid increase in the rates of ischemic heart disease was observed, to the extent that Singapore exhibits one of the highest rates of mortality from cardiovascular disease in the Asia-Pacific region, higher even than the rates in North America. Rates of cardiovascular disease have now stabilized, and are declining. This is, a pattern that has been observed in many developed countries. Increased life expectancy has resulted in an epidemiologic transition that has seen chronic non-communicable diseases replace malnutrition and infections as the major causes of mortality. At the same time, there have been changes in nutrient intake and physical activity as well as rapid increases in the levels of several cardiovascular risk factors including obesity, hypertension, hyperlipidemia, diabetes mellitus and systemic inflammation. Furthermore, when present, there is a lack of awareness and sub-optimal treatment of these risk factors. In addition to the changes in environmental exposures related to socio-economic development, it does appear that specific populations are particularly prone to the development of cardiovascular disease and its risk factors. In particular, Asian Indians experience a high rate of coronary heart disease and diabetes mellitus. Emerging data suggests that Chinese may be particularly prone to the adverse effects of obesity in relation to insulin resistance and inflammation. A concerted effort to change lifestyles to prevent the development of coronary heart disease risk factors, and to improve awareness and treatment of risk factors when then develop, is required to halt the epidemic of coronary heart disease that is occurring in Asia.
Background: Metabolic syndrome(MetS) is an aggregation of multiple metabolic risk factors shown to lead to the development of cardiovascular disease. The International Diabetes Federation(IDF) and the modified National Cholesterol Education Program Adult Treatment Panel Ⅲ(mNCEP) criteria are used in identifying MetS. This report will determine the prevalence of MetS and its component risk factors of the Philippine cohort of the LIFE course study in CARdiovascular disease Epidemiology(LIFECARE). Methods: Our study recruited 3,072 participants aged 20-50 years old from Metro Manila and four nearby provinces. Baseline anthropometric and clinical parameters were measured. Prevalence of MetS and its component factors were determined. Associations with socio-demographic factors were determined. Results: The prevalence of MetS was 19.7% and 25.6% by IDF and mNCEP, respectively(kappa 0.83). Both were associated with increasing age, urban residence, and employed status. It was higher in females by IDF and in males by mNCEP. IDF missed 40% of males and 10% of females identified with MetS by mNCEP. More males were identified by the mNCEP as MetS despite relatively normal waist circumference. Conclusion: MetS is common in the Philippines among older, educated, and urban residents. The mNCEP criteria identified more MetS than the IDF criteria.
Coronary heart disease(CHD) is the leading cause of death worldwide in both men and women. Hypercholesterolemia is a major factor contributing to the incidence of CHD. Many lipid-lowering trials have shown statins to be effective medications for the primary and secondary prevention of CHD. Some studies have suggested that statins are as or more effective in women than in men. However, there is a substantial gender gap in lipid goal attainment with respect to primary care guidelines, as reported in observational studies. In this article, we attempt to explain gender differences in lipid control in individuals with or at risk of CHD in order to improve awareness of and narrow gaps in gender disparities in lipid management.
There has been a rapid increase in the prevalence of obesity, type 2 diabetes and metabolic syndrome(MetS) over the past two to three decades in most Asian countries. According to the Korean National Health and Nutrition Examination Survey(KNHANES), the prevalence of MetS significantly increased from 24.9% to 31.3% between 1998 and 2007. The clinical significance of MetS is based on the increased risk for the development of cardiovascular disease(CVD). We analyzed the 8-year follow-up data of 2,435 healthy subjects and found that MetS was associated with an increased risk of CVD in both men and women(OR: 1.98, 95% CI: 1.30-3.03 in men; OR: 4.04, 95% CI: 1.78-9.14 in women). MetS was significantly associated with the risk for future coronary heart disease(CHD) in men(OR: 3.68; 95% CI: 1.93-7.01) and stroke in women(OR: 3.96; 95% CI: 1.58- 9.94). We also analyzed the echocardiographic findings of 1,600 healthy subjects to evaluate the relationship between metabolic syndrome and left ventricular diastolic dysfunction(LVDD). The patients with MetS exhibited significant differences in parameters of cardiac structure and the LV diastolic function compared to that observed in the patients without MetS. MetS was associated with an increased risk of LVDD(OR: 1.67; 95% CI: 1.18-2.37). These results suggest that the presence of MetS is associated with an increased risk for the development of serious CVD and abnormal changes in the LV structure and diastolic function, even before the development of overt CVD.
Background: Elderly patient group is increasing quickly. The same phenomenon is seen in Vietnam. The prevalence of coronary artery disease(CAD) also increases with age. This was seen at Thong Nhat hospital, where was a high proportion of elderly patients admitted with acute coronary syndrome(ACS). This is why there was a need for studies on the risk factors and prevention of ACS for the elderly patients in Vietnam. Objectives: We assess the prevalence of common risk factors in the elderly patients with ACS admitted to Thong Nhat hospital. Method of Study: A retrospective cross-sectional descriptive study was conducted at Thong Nhat hospital in Ho Chi Minh city from 1/2009 to 1/2011, in which 338 patients with ACS were divided in two groups: 214 patients over 65 years(62 females and 152 males) formed elderly group and 124 patients ≤65 years(21 females and 103 males) formed non-elderly group. The cardiovascular risk factors of ACS were hypertension(HT), diabetes mellitus(DM), smoking, dyslipidemia and obesity(BMI ≥23 kg/m2). A comparison of risk factors between the two group was done by Chi square. Results: The number of female with was higher in the elderly group with ACS. Most of the elderly group had multiple risk factors. The percentage of 1, 2, 3 and 4 risk factor were 3.3; 32.2; 41.1% and 23.4%, respectively and they were similar to non-elderly group. In the elderly group, the prevalence of HT and DM were 84.6% and 29.0% higher than that in the non elderly group; the prevalence of smoking and dyslipidemia were 22.0% and 56.9% lower than that in the non-elderly group. The prevalence of the elderly patients with angina pectoris was 41.1% higher than that in the nonelderly group but the prevalence of non-typical angina was 42.1% higher than that in the non-elderly group(16.1%). The prevalence of prior myocardial infarction in elderly group was 18.2%, while the prevalence of obesity was 35.8% similar to that of the non-elderly group. Conclusion: In elderly patients with ACS, multiple risk factors were common. The prevalence of HTN and DM was higher, smoking and dyslipidemia were lower, being overweight and having a prior myocardial infarction was similar to that of the non-elderly group.