Prevalence of coronary heart disease indicated by electrocardiogram abnormalities and risk factors in developing countries

doi:10.1016/0895-4356(94)90208-9

Journal of Clinical Epidemiology

Volume 47, Issue 6, June 1994, Pages 599-611

https://doi.org/10.1016/0895-4356(94)90208-9 Get rights and content

Abstract

A cross-sectional population survey was carried out in 15 population groups (ethnicity includes Melanesian, Polynesian, Micronesian, Asian Indian and Chinese) in 9 developing countries: Fiji, Nauru, Kiribati, Cook Island, Niue, Western Samoa, New Caledonia, Mauritius and China (Beijing) in 1978–1987. The total sample included 4594 men and 4988 women aged 35–59 years. The aim of study is to report the prevalence of coronary heart disease (CHD) as indicated by ECG Minnesota coding, and risk factor levels and to describe the individual and ecological relationship between CHD prevalence and CHD risk factors among different ethnic groups in developing countries. Mauritians had the highest prevalence of CHD of these countries. Total serum cholesterol concentration and the prevalence of CHD were higher in Mauritius Chinese than in Beijing Chinese. Mean total cholesterol was lower than or equal to 5.2 mmol/l (200 mg/dl) in all population groups, except in Mauritians. Hypertensive subjects in most populations had a low cholesterol concentration. The prevalence of hypertension varied from 7 to 35% and mean body mass index (BMI) from 22.9 to 37.0 kg/m². Smoking was more common in men (36–82%) than women (0.8–65%). Multiple logistic regression analysis using individuals as a unit of analysis showed that cholesterol and systolic blood pressure were significant independent predictors of CHD prevalence. When fasting or 2 hr post-load blood glucose was included in the model total cholesterol was no longer significant in men but remained significant in women. Ecological analysis using populations as units of analysis showed that the combination of several CHD risk factors could explain about 90% of the interpopulations variance of the CHD prevalence in women. The best models were those where 2 hr post-load glucose was included. Our study has demonstrated that the total cholesterol concentration of the population was consistent with the prevalence of CHD in the population. A considerable proportion of the variation in CHD prevalence across populations in developing countries can be explained by well-known risk factors. These data support the concept that retaining traditional balanced dietary habits and limiting salt intake together with avoiding smoking use are important activities for the prevention of cardiovascular disease (CVD) in developing countries.

References (52)

G. Egusa et al.
Hyperlipidemia and arteriosclerotic cardiovascular disease in the Polynesian population of Rarotonga
Atherosclerosis
(1984)
L.O. Watkins
Coronary heart disease and coronary disease risk factors in black populations in underdeveloped countries: The case for primordial prevention
Am Heart J
(1984)
M. Uusitupa et al.
Sensitivity and specificity of Minnesota code Q-QS abnormalities in the diagnosis of myocardial infarction verified at autopsy
Am Heart J
(1983)
R.A. Sicree et al.
Electrocardiographic abnormalities amongst Melanesian and Indian men of Fiji: prevalence and associated factors
Int J Cardiol
(1988)
P.M. McKeigue et al.
Coronary heart disease in South Asians overseas-a review
J Clin Epidemiol
(1989)
A.R. Omran
The epidemiologic transition. A theory of the epidemiology of population change
Milbank Mem Q
(1971)
S.R.A. Dodu
Emergence of cardiovascular diseases in developing countries
Cardiology
(1988)
S.R.A. Dodu
Coronary heart disease in developing countries: the threat can be averted
WHO Chron
(1984)
O.O. Akinkugbe
Epidemiology of cardiovascular disease in developing countries
J Hypertension
(1990)
J.K. Ghali
Should cardiovascular diseases be a health priority for developing countries? A brief overview of the mortality data
Ethnicity Dis
(1991)

A.D. Lopez

Causes of death: an assessment of global patterns of mortality around 1985

World Health Stat Q

(1990)

P. Zimmet et al.

The prevalence of diabetes melitus and impaired glucose tolerance in Melanesians and part-Polynesians in rural New Caledonia and Ouvea (Loyaty Islands)

Diabetologia

(1982)

P. Zimmet et al.

The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa

Diabetes

(1981)

J. Tuomilehto et al.

ECG abnormalities in relation to glucose tolerance and other risk factors in men of the developing Pacific nation of Kiribati

Nutr Metab Cardiovasc Dis

(1991)

P. Zimmet et al.

The high prevalence of diabetes mellitus, impaired glucose tolerance and diabetic retinopathy in Nauru-The 1982 survey

Diabetes Res

(1984)

P. Zimmet et al.

Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison

Am J Epidemiol

(1983)

H. King et al.

Epidemiological studies of cardiovascular disease and diabetes in Polynesians from Rarotonga (Cook Islands) and Niue

South Pacific Commission, Technical Paper

(1984)

C.H. Yao et al.

Risk factors of cardiovascular diseases in Beijing

Chin Med J

(1988)

G.K. Dowse et al.

High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritius

Diabetes

(1990)

R.T. Prineas et al.

The Minnesota Code Manual of Electrocardiographic Findings

(1982)

G. Rose et al.

Prevalence and prognosis of electrocardiographic findings in middleaged men

Br Heart J

(1978)

S. Greenland et al.

Ecological bias, confounding, and effect modification

Int J Epidemiol

(1989)

R. Taylor et al.

Societies in transition: mortality patterns in Pacific Island populations

Int J Epidemiol

(1989)

Risk factors for cardiovascular disease in the developing world. A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

J Clin Epidemiol

(1992)

J. Tuomilehto et al.

The prevalence of coronary heart disease in the multiethnic and high diabetes prevalence population of Mauritius

J Intern Med

(1993)

Y. Liao et al.

Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 1165 year follow-up findings of the Chicago Heart Association Detection Project in Industry

Circulation

(1987)

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Original articlePrevalence of coronary heart disease indicated by electrocardiogram abnormalities and risk factors in developing countries

Abstract

Atherosclerosis

Am Heart J

Am Heart J

Int J Cardiol

J Clin Epidemiol

The epidemiologic transition. A theory of the epidemiology of population change

Milbank Mem Q

Emergence of cardiovascular diseases in developing countries

Cardiology

Coronary heart disease in developing countries: the threat can be averted

WHO Chron

Epidemiology of cardiovascular disease in developing countries

J Hypertension

Should cardiovascular diseases be a health priority for developing countries? A brief overview of the mortality data

Ethnicity Dis

Causes of death: an assessment of global patterns of mortality around 1985

World Health Stat Q

The prevalence of diabetes melitus and impaired glucose tolerance in Melanesians and part-Polynesians in rural New Caledonia and Ouvea (Loyaty Islands)

Diabetologia

The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa

Diabetes

ECG abnormalities in relation to glucose tolerance and other risk factors in men of the developing Pacific nation of Kiribati

Nutr Metab Cardiovasc Dis

The high prevalence of diabetes mellitus, impaired glucose tolerance and diabetic retinopathy in Nauru-The 1982 survey

Diabetes Res

Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison

Am J Epidemiol

Epidemiological studies of cardiovascular disease and diabetes in Polynesians from Rarotonga (Cook Islands) and Niue

South Pacific Commission, Technical Paper

Risk factors of cardiovascular diseases in Beijing

Chin Med J

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Diabetes

The Minnesota Code Manual of Electrocardiographic Findings

Prevalence and prognosis of electrocardiographic findings in middleaged men

Br Heart J

Ecological bias, confounding, and effect modification

Int J Epidemiol

Societies in transition: mortality patterns in Pacific Island populations

Int J Epidemiol

Risk factors for cardiovascular disease in the developing world. A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

J Clin Epidemiol

The prevalence of coronary heart disease in the multiethnic and high diabetes prevalence population of Mauritius

J Intern Med

Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 1165 year follow-up findings of the Chicago Heart Association Detection Project in Industry

Circulation

Original article
Prevalence of coronary heart disease indicated by electrocardiogram abnormalities and risk factors in developing countries