Mental Stress and Multiple Risk Factors of Cardiovascular Diseases with Regional Variations in Women of Urban and Rural Areas of Sindh, Pakistan
Abstract
Khalida Soomro, Muhammad Ali Soomro
Introduction: The high prevalence of risk factors in women in developing countries of South Asia appears to have been translated into early and severe CHD in contrast to their counterpart in the first world nations, which has been related to obesity and insulin resistance and genetically determined increased lipoprotein Lp(a) levels. Mental stress due to urbanization, sedentary life style and physical inactivity may be the most important factor initiating obesity and the clustering of all other risk factors hypertension, dyslipidaemia and (WHR). These risk factors vary in different regions of South Asia.
Aims and Objectives: Our aim of the study was to describe and analyse differences between the frequency of risk factors such as psychological stress due to, socio-economical aspects, life style especially physical activity, and health behaviours which may contribute in the course of CAD in women of both rural and urban areas of Pakistan because no such significant data is available in women with CAD.
Study Design: This descriptive cross-sectional comparative study was conducted in Cardiology Department of Dow University of Health and Sciences Karachi, Pakistan, from March 2014 to March 2016 by filling a questionnaire and laboratory data. The study group comprised female subjects around 577 (Urban 347 {60.1%} and Rural 230 {39.9%}) women ranged from 25-65 years of age who underwent coronary angiography and had definite coronary atherosclerotic diseases. Our study was conducted by examining the psychological stress in women of both areas and its strength of association with frequency of other risk factors in female patients of urban and rural areas with definite CHD taking account the difference in age and education level into account.
Result: Analysis of this study conducted at department of Cardiology in Dow University Karachi from March 2014 to March 2017 revealed that the women of rural area were comparatively more physically active then women of urban area. Prevalence of mental stress, hypertension, diabetes, obesity, higher BMI, hyperlipidaemia (especially TC) waist and hip circumference of both areas were found to be different after adjustment made for age. A considerable association was found between psychological stress and other factors in ischemic heart disease patients showing the p-value (p=0.043). Psychological stress was found 82% in both groups and (13%) women had no stress rated as normal more in rural (26%) vs (04%) in urban population. Physical inactivity in women with CHD was found in 92% urban in contrast to 45% in rural population, (p=0.009). Hypertension prevalence was more in urban 253 in comparison to 151 women in rural area. Diabetes Mellitus was also found more in urban than rural population, especially in age below 50, 79 (23%) urban vs 60 (26%) in rural population. Women beyond 50 years of age, 85 (24%) urban vs 64 (27%) rural area had prevalence of obesity comparatively higher in urban residents 71 (20%) than 44(%) in rural dwellers and 32 (9%) urban vs 16 (7%) in rural women in age range below 50 years. Higher waist circumstance was observed more in urban residents (4.8 cm) whereas BMI was more (1.8 unit) in women of rural area than urban women. Prevalence of smoking and nicotine chewing was relatively higher in urban population in below 50 years of age with 30 (09%) urban vs 13 (05%) in rural women and in age beyond 50, 11 (03%) urban vs 10 (04%) in rural women was witnessed. Average total cholesterol, serum triglycerides and LDL were found to be higher in urban compared to rural area residents and HDL was comparatively lower in urban area group. Mean cholesterol level was seen at average of 353 mg% in urban vs 223 mg% in rural population. Serum cortisol level showed significant variation in urban group 19.1 vs 14.2 in rural group (sample, as well as serum fibrinogen was raised more raised in urban population).
Conclusion: Our study shows increased prevalence of mental stress and physical inactivity in female residents of urban area leading to Higher blood pressure, DM, dyslipidaemia and central obesity specially in Waist circumference than rural area. The mental stress induced by excessive demands of work at home and at working place with too little control is not unique to women of urban areas.