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Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men

¹ Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
² International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK

Correspondence to:
Dr T H Jafar, Clinical Epidemiology Unit, Department of Community Health Sciences and Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan; tazeen.jafar{at}aku.edu

ABSTRACT
Indo-Pakistani populations have one of the highest risks of coronary artery disease (CAD) in the world. A population-based, cross-sectional survey was conducted on 3143 adults aged 40 years from 12 randomly selected communities in Karachi, Pakistan. Apart from smoking, women had more CAD risk factors (diabetes, hypertension, obesity, dyslipidaemia) than men. Definite CAD (history and Q waves on ECG) was more prevalent in men than in women (6.1% vs 4.0%; p = 0.009). In contrast, ischaemic and major ECG changes were twice as prevalent in women as in men (29.4% vs 15.6%, and 21.0% vs 10.5%; p<0.001 for each, respectively). All measures of CAD were strongly predicted by the metabolic syndrome, but that failed to account for the greater prevalence of ECG abnormalities in women than in men. The findings indicate that one in five middle-aged adults in urban Pakistan may have underlying CAD. Women are at greater risk than men.

Trial registration number: NCT00327574 [ClinicalTrials.gov]