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| ORIGINAL ARTICLE |
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| Year : 2006 | Volume
: 7
| Issue : 4 | Page : 132-135 |
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A hospital-based study on future approaches to combat cardiovascular diseases
Hamzullah Khan1, Sultan Mahmood2
1 Final year MBBS, Khyber Medical College, Peshawar, Pakistan
2 Professor Sultan Mahmood, Professor of Medicine, Khyber Medical College, Peshawar, Pakistan
| Date of Web Publication | 17-Jun-2010 |
Correspondence Address:
Hamzullah Khan
Room No 104, Qasim hall hostel, Khyber medical college, Post office: campus branch, University of Peshawar, Postal code: 25120, Peshawar
Pakistan
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
Objectives: To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases (CVD).
Methods: The study was a descriptive observational survey conducted in Khyber Teaching Hospital (KHT), Hyderabad Medical Complex (HMC) and Department of Community Medicine, Khyber Medical College, Pehawar. The study was conducted from June 20 to August 15, 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study.
Results: According to the clinicians' and general physicians' opinion, the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment (60%), national physical activity policy (70%), check on food quality (21.66%), research promotion in the field of CVD (36.66%), conducting workshops and seminars to educate people about CVD (30%) etc. Community approaches should be more specific towards promotion of healthy activities (71.66%), discouraging smoking (96.66%), and conducting local workshops to increase awareness (26.66%). Individual approaches to combat CVD include screening of blood pressure, glucose and lipid profile regularly (85%), cessation of smoking (96.66%), weight control with exercise (75%), compliance in medication (46.66%), and leadership and advocacy to increase awareness and decrease stigma (43.33%).
Conclusion : While establishing a strategy to CVD, there is a need to offer multiple approaches on national, community and individual levels. Keywords: future strategies, CVD, Peshawar
How to cite this article:
Khan H, Mahmood S. A hospital-based study on future approaches to combat cardiovascular diseases. Heart Views 2006;7:132-5 |
| Introduction | |  |
In most countries, the response to CVD prevention and control is still based on the infectious disease paradigm. Consequently, the global and national capacity to respond to CVD epidemic is woefully inadequate. The gap between the need for CVD prevention, control, and capacity to meet them will go even wider unless urgent steps are taken [1].
In Pakistan, the National Action Plan for Non-Communicable Disease Prevention (NAP-NCD) incorporates prevention and control of cardiovascular diseases (CVD) as part of a comprehensive and integrated non-communicable Disease (NCD) prevention effort. The program aims to revise the current policy on diet and nutrition to expand its focus on under-nutrition; the development of a physical activity policy; strategies to limit the production of and access to ghee as a medium for cooking and agricultural and fiscal policies that increase the demand for and make healthy food more accessible [2] .
Heart-file in Pakistan has started a program that focuses on cardiovascular disease prevention and health promotion, includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches [3].
In the USA, guidelines of the American Heart Association/American Stroke Association have shown new set of risk factors. Its aim is to have a policy that covers all or nearly all risk factors to combat CVD. According to their report, non-modifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection [4] .
The present study was designed as to determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases (CVD) in our country.
| Methods | | |
A descriptive observational study was conducted in Khyber teaching hospital (KHT), Postgraduate Medical Institute Hyderabad Medical Complex (PGMI, HMC) and Department Of Community Medicine Khyber Medical College Peshawar, from June 20 to August 15, 2006.
Inclusion criteria were medical specialists, general physicians and community experts posted in Khyber Teaching Hospital (KHT), Postgraduate Medical Institute Hayatabad Medical Complex (PGMI, HMC) and Department Of Community Medicine Khyber medical college Peshawar. Exclusion criteria were experts in all specialties other than general medicine and cardiology.
A questionnaire, prepared in accordance with the objectives of the study, was utilized. The Questionnaire contained few questions from the physicians regarding the national, community and individual approaches to prevent CVD. These questionnaires were distributed among the physicians. A total of 60 experts returned the completed questionnaires, 48 from KHT/KMC and 12 from HMC.
Finally, the filled in returned questionnaires were collected and the information provided were statistically analyzed.
| Results | | |
A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included.
National approaches towards cardiovascular disease prevention
According to the clinicians' and general physicians' opinion the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment (60%), national physical activity policy (70%), check on food quality (21.66%), research promotion in the field of CVD (36.66%) etc. [Table 1]
Individual attempts to prevent cardiovascular disease prevention
Individual approaches to combat CVD are to screen their blood pressure, glucose and lipid profile regularly (85%), stop smoking (96.66%), decrease their weight with exercise (75%), take appropriate medicine in time if a patient or at risk (46.66%) and leadership and advocacy to increase awareness and decrease stigma (43.33%).[Table 2]
| Discussion | | |
The World health organization reinforces national approaches to combat cardiovascular diseases if the Framework Convention On Tobacco Control (FCTC) is ratified in the country. Tobacco control legislation are enacted and enforced. Multi-sectorial actions are required to reduce fat intake, reduce salt and promote fruit and vegetable consumption. It includes stakeholders in the policy formulation and service planning. Capability for health research is built within countries by encouraging research studies on CVD [5] . According to the comments of the physicians, community approaches should be more specific towards promotion of healthy activities, discouraging smoking, and conducting local workshops to increase awareness.
Our study correlates with World health report 2002 [6] . Individual attempts to prevent CVD also have its role and should be therefore addressed. A study on risk factors for cardiovascular disease in school children at Karachi showed that 29% of the children were physically inactive, 31% were taking unhealthy diet daily, 21% were overweight and 6% were smokers. Family history of cardiac disease, hypertension and diabetes were positive in 4%, 23% and 16% of the children respectively [7] .
Risk factors of CVD show great variations in various regions of the world. Therefore, strategies towards prevention programs should be more specific. Hypertension and stroke occur in Asians. In Australia, New Zealand and Japan, lower social class is a risk factor for hypertension and stroke [8] . We would need epidemiological research studies and trials to make long-term effective policies to prevent and control the increasing burden of cardiovascular disease. What is so far observed is not satisfactory. In our country, only twelve research publications on cardiovascular diseases were reported in 1999-2001 whereas 12502 were reported in the USA, 2667 in the UK, and 294 in India [9] .
| Conclusion | | |
While establishing a strategy for combating CVD, there is need to offer multiple approaches on national, community and individual levels. Prevention programs should be started based on cross-sectional surveys and case studies. The majority of people have modifiable risk factors for cardiovascular disease that are easily preventable. Prevention efforts are required early in life, using strategies for behavioral modification and health promotion.
| References | | |
| 1. | Alwan A, Maclean D, Mandil A. Assessment of national capacity for non-communicable disease prevention and control. Geneva, World Health Organization, 2001.  |
| 2. | Nishtar S, Faruqui AM, Mutta MA, Muhammad KB, Ahmed A. The National Action Plan for the Prevention and Control of Non-communicable Diseases and Health Promotion in Pakistan--Cardiovascular diseases. J Pak Med Assoc 2004; 54(12 Suppl 3): S14-25. |
| 3. | Nishtar S. Cardiovascular disease prevention in low resource settings: lessons from the Heart file experience in Pakistan. Ethn Dis 2003; 13(2 Suppl 2): S138-148. |
| 4. | Goldstien LB, Adams R, Albers MJ, Apples LJ, Brass LM et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council. Circulation 2006; 20; 113(24): e873-923. |
| 5. | World Health's Report 2003. Tonga commitment to promote healthy lifestyle and supportive environment. Manila, World Health Organization, Regional Office For Western Pacific, 2003. |
| 6. | The World Health Organization global reports 2002. Non-communicable disease and mental health, innovative care for chronic conditions; building blocks for health action. Geneva, World Health Organization/CDC, 2002: 67-68. |
| 7. | Khwaja AK, Fatmi Z, Soomro WB, Khwaja NK. Risk factors for cardiovascular disease in school children--a pilot study. J Pak Med Assoc 2003; 53(9): 396-400. |
| 8. | Singh RB, Suh IL, Singh VP, Chaithiraphan S, Laothavorn NA, Sy RG et al. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens, 2000; 14(10-11):749-63. |
| 9. | World Health Organization, The world health Report, 2003. The Atlas of heart disease and Stroke. Geneva, WHO 2003, Annex Table 1:88-89. |
[Table 1], [Table 2]
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