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Coronary artery disease epidemic in Pakistan - more electrocardiographic evidence of ischemia in women than in men
  1. Tazeen H Jafar (tazeen.jafar{at}
  1. Aga Khan University, Pakistan
    1. Zeeshan Qadri
    1. Aga Khan University, Pakistan
      1. Nish Chaturvedi
      1. Imperial College London, United Kingdom


        Background Indo-Pakistani populations have one of the highest risks of coronary artery disease (CAD) in the world. We have previously reported a substantially higher burden of CAD risk factors in women compared to men, and wished to determine whether this gender imbalance is reflected in prevalent CAD.

        Methods We conducted a population-based cross sectional survey on 3143 adults aged 40 years or over from 12 randomly selected communities in Karachi, Pakistan. CAD was assessed by history, Rose angina questionnaire, and Minnesota coding of the electrocardiogram. Blood pressure and anthropometry were measured, and fasting blood assessed for glucose and lipids. Metabolic syndrome status was assigned using these data. Prevalent CAD, and its association with risk factors by gender was assessed

        Results Apart from smoking, women had a greater burden of CAD risk factors (diabetes, hypertension, obesity and dyslipidaemia) compared to men. Definite CAD (history and Q waves on ECG) was twice as prevalent in men compared to women (6.1 vs 4.0% (p=0.009). In contrast, ischaemic and major ECG changes were twice as prevalent in women compared to men (15.6 vs 29.4, and 10.5 vs 21.0%, p<0.001 for each, respectively). The same risk factors were associated with definite CAD as well as ischaemic ECG changes in men and women. All measures of CAD were strongly predicted by the metabolic syndrome, however, that failed to account for the greater prevalence of ECG abnormalities in women compared to men.

        Conclusions One in five middle aged adult in urban Pakistan may have underlying CAD. Women are at greater risk than men. Concerted efforts are needed to reduce the burden of conventional risk factors for CAD, and must target both women and men in this population.

        • Asian
        • cardiovascular
        • coronary artery disease
        • hypertension
        • ischemic heart disease

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