Role Of Hypertension and Obesity as Risk Factors for Ihd

Background: Hypertension and obesity are two major modifiable risk factors for CAD, most of the time there will be more than two risk factors in an IHD. Obesity itself cause insulin resistance to initiate type -2 DM. is the most common and significant RFs for IHD, and proper BP management is the cornerstone of both direct and indirect prevention. Overweight and obesity account for more than 80% of CHD patients. Obesity is sometimes viewed as a "minor" CHD RF; however, it is a widely effective risk-factor approach. A range of "major" risk factors have been proven to be significantly influenced by weight loss, including HTN, hyperlipidemia and insulin resistance/T2DM. 

Aim: To assess arterial hypertension and obesity as risk factors of IHD. 

Methods: This cross-sectional study which was done retrospectively by collecting data from database of "Scientific Research Institute of Cardiology and Internal Diseases" Almaty city, Kazakhstan during 2020. IHD confirmed by history, physical exam, angiography and other lab findings.

Result: The research involved a total of 649 participants. The mean age of study population was 64.2±9.24 (P = 0,000). Mean of SBP and DBP were 180.73±34.9; 99.48±14.28 mmHg respectively. Number of females with normal BMI 50(21.6%), overweight 93(40.10%), obesity class – 1, 59(25.4%), obesity class – 2, 23(9.90%) and obesity class – 3, 7(3%), (P = 0.486). Number of males with underweight BMI 1(0.20%), normal BMI 96(23%), overweight 190(45.6%), obesity class – 1, 89(21.3%), obesity class – 2, 29(7%) and obesity class – 3, 12(2.9%). (P = 0.486). The Mean BMI in both genders was (28.72±11.79). 

Conclusion: The burden of CVDs and their related risk factors are significant in Almaty, posing a major public health concern. For accurate management and implementation of preventive measures in this area, effective strategies in management, education, and healthcare centers are needed.

The most compelling evidence of causality, as well as a high prevalence of exposure, is related to high blood pressure. There is, however, considerable evidence that a physiologically normal blood pressure in humans is significantly lower than what is often used in clinical practice and science, leading in underreporting of blood pressure as a CVD risk factor [1]. 

HTN and diabetes mellitus are two conditions that are intricately related and increase the risk of cardiovascular disease [2]. HTN was seen in 57.2 % of acute myocardial infarction (AMI) patients in South Korea, while diabetes was discovered in 32.3 percent [3].Hypertension is a substantial independent predictor of all-cause mortality and cardiac death (CD) in people who have had an AMI [4].In individuals with ST-segment elevation MI, DM is a significant independent prognostic factor of restenosis following percutaneous coronary intervention (PCI) and is linked to an increased risk of both early and late death (STEMI) (5Despite the fact that HTN and diabetes are well-known RFs for coronary heart disease, there have been few face investigations assessing their impact on long-term clinical outcomes in AMI patients following coronary artery stenting.

Obesity is an independent risk factor for coronary artery disease [6]. Obesity has also been associated to a faster deterioration of CHD after a diagnosis. Obesity and overweight people are more prone to insulin resistance and T2DM, which can lead to CHD and make the prognosis worse [7]. As a result, CHD progresses more quickly, and the prognosis deteriorates. Furthermore, insulin resistance and T2DM are associated to renal, ophthalmic, neurologic, and cerebrovascular problems. Obesity is a widely successful intervention, even though it is often viewed as a "small" independent CHD risk factor.

Weight loss may have a major impact on hypertension, dyslipidemia, and insulin resistance/T2DM, among other "big" risk factors [8]. Unlike other CHD risk factor mitigation methods like exercise and, more broadly, cardiac rehabilitation, cardiac rehabilitation (CR) recommends at least 150 minutes of moderate activity each week to avoid numerous chronic diseases, according to the Physical Activity Guidelines for Americans. However, this quantity of exercise has not been demonstrated to be sufficient for weight loss in overweight/obese persons, and weight loss is assisted when physical activity is combined with calorie restriction in the diet. Despite some evidence of an inverse relationship between overweight/obesity and mortality, described as the "obesity paradox," weight loss recommendations are provided for almost all obese CHD patients. Obesity and health outcomes have a contradictory link, according to studies that looked at people with CAD, HF, hypertension, and peripheral artery disease [9]. Even in the absence of comorbidities, as extra adipose tissue grows in excess amounts, a variety of adaptations/alterations in heart shape and function occur [10]. 

Obesity and overweight are linked to both traditional and unconventional CVD risk factors, resulting in CVD in general and CHD in particular. Obesity is frequently considered a risk factor. The metabolic syndrome, of which central obesity is a prominent component, is associated to CVD, including heart disease, as an independent risk factor. There is a lot of epidemiologic evidence to suggest that being overweight and having heart disease are linked. Postmortem study and coronary artery imaging investigations provide less convincing evidence [11]. Almaty, like other nations, experienced an epidemiological change. NCDs are the top causes of death in Almaty, Kazakhstan. The majority of the information comes from a hospital database. The purpose of this research is to establish a relationship between hyperlipidemia and hypertension with coronary heart disease, as well as to determine whether systolic or diastolic hypertension is linked to IHD, and to determine the function of overweight and obesity as a key modifiable risk factor for IHD.

Aim: To study the hypertension and obesity as risk factor of IHD.

Objectives

• Relationship of hypertension, obesity with gender in IHD patients.
• Relationship of hypertension, obesity with age category.
• Contribution of multiple risk factors in presence of IHD.

Methodology

This is a descriptive and retrospective cross-sectional study of 649 IHD registered patients in "Scientific Research Institute of Cardiology and Internal Diseases" Almaty city, Kazakhstan during 2020.A consecutive non random sampling was adopted by combining all patients with IHD. Hypertension, obesity as major modifiable risk factors were compared with age, sex, DM, lipid profile and previous IHD. Patients were not included if they treated in emergency room, left hospital before optimal hospitalization date and without echocardiography report. For statistical analysis IBM SPSS statistics 22 and Excel were used. Chi squire test, is used to compare categorical variables and P <0>

The study enlisted the participation of 649 participants. The individuals' socio-demographic characteristics and the burden of cardiovascular risk factors are shown. Data was seen according to age group distribution and gender. The mean of age in study population is 64.2 years (63.15 in male and 66.09 in female), (P= 0,000).

Systolic blood pressure:6(2.6%) of female and 17(4.1%) of male had normal arterial blood pressure, 5(2.2%) of female and 26(6.2%) of male had elevated arterial blood pressure, 2(0.9%) female and 12(2.9%) of male had stage – 1 HTN,44(19%) female and 140(33.6%) of male had stage – 2 HTN,175(75.4%) of female and 222(53.2%) of male had hypertensive crisis, (P =0,000). Mean of SBP 180.73mmHg±34.956, number of participants with SBP equal to 180 mmHg were more (Mode). Maximum and minimum of SBP were 300mmHg, 90 mmHg respectively.

Diastolic blood pressure: 3(1.3%) of female and 2(0.5%) of male had normal arterial blood pressure, 4(1.7%) of female and 16(3.8%) of male had elevated arterial blood pressure, 23(9.9%) female and 62(14.9%) of male had stage – 1 HTN,189(81.5%) female and 333(79.9%) of male had stage – 2 HTN,13(5.6%) of female and 4(1%) of male had hypertensive crisis(P =0.001).Mean of DBP 99.48 mmHg,100mmHg, number of participant with DBP equal to 100 mmHg were more(Mode). Maximum and minimum of DBP were 150mmHg,60 mmHg respectively.

Note: In this study I include maximum of peak of SBP and DBP.

Table 1: Comparison of SBP, DBP mean with sex

Table 2: Comparison of SBP, DBP mean with sex

Number of females with normal BMI 50(21.6%), overweight 93(40.10%), obesity class – 1, 59(25.4%), obesity class – 2, 23(9.90%) and obesity class – 3, 7(3%). (P = 0.486). Number of males with underweight BMI 1(0.20%), normal BMI 96(23%), overweight 190(45.6%), obesity class – 1, 89(21.3%), obesity class – 2, 29(7%) and obesity class – 3, 12(2.9%). (P = 0.486). Mean of BMI in each gender was (28.72±11.79). Lipid profile analysis in our study showed that mean of total cholesterol was 4.714±2.09 mmol/l, HDLc1.1135± 0.3374mmol/l, LDLc 3.017±1.046mmol/l, triglyceride 1.7589± 0.951mmol/l. 28.5% had abnormal total cholesterol (high, intermediate), 91.6% had low and intermediate level of HDLc, 34.5% with abnormal level of LDLc (high, intermediate), 60.4% had abnormal triglyceride level (high and intermediate).

Table 3: Blood pressure stages, BMI category in IHD patients

We considered the role of hypertension and obesity as risk factors of IHD among patients who visited "Scientific Research Institute of Cardiology and Internal Diseases" Almaty city, Kazakhstan during 2020.This is the first study after COVID - 19 pandemic in Almaty, Kazakhstan.

Mean of SBP according to sex are[male(175.4±34.382),female(190.987±33.987)],and mean of DBP based on sex are[ male (97.52±13.184), female (103.02±15.471) , but mean of SBP in general was 180±34.956  and DBP mean was 99.48±14.278 .Male vs female ratio was 1:79.In comparison with  another study which was done by Dhungana, et al in 2018 on 347 participant showed that 34.4% had high blood pressure, and mean of SBP was 122.6±16.9 (P = 0.07), and mean of DBP was 81.1±9.9(P = 0.017),(13),which has significantly differences from our findings.

The same as described study, there were 39 840 participants (18–86 years, mean age 47.9±16.2 years), 17964 (45.1%) men and 21 876 (54.9%) women. mean of SBP 123.3±16( male125.1±14.7 ; female 121.8±16.8),DBP mean was 78.7±9.6( male 80.1±9.3 ;female 121.8±16.8) (14).Reasons of high SBP and DBP in our study may be due to; In this study we selected peak of SBP and DBP during whole life of patients, beside that number of vegetarians in compare to non – vegetarians were low, level of knowledge regarding to hypertension prevention, benefit of daily physical activities was lower than aforementioned study, furthermore  some of participant did not remember the correct value of their blood pressure.

In our study mean of BMI was 28.72±5.152 (male 28.52±5.04; female 29.09±5.33).  77.7% had obesity and overweight. Number of females with normal BMI 50(21.6%), overweight 93(40.10%), obesity class – 1, 59(25.4%), obesity class – 2, 23(9.90%) and obesity class – 3, 7(3%). Number of males with underweight BMI 1(0.20%), normal BMI 96(23%), overweight 190(45.6%), obesity class – 1, 89(21.3%), obesity class – 2, 29(7%) and obesity class – 3, 12(2.9%).  (P = 0.486).In 2016, the global burden of disease (GBD) for risk profiles in the Middle East and North Africa (MENA) showed that 80.7% of participant had obesity and over weight( P less than 0.001), (15). Dhungana, et al in 2018 performed on  347 participant .15.3% were obese and.mean of BMI in this study was 26.2±5.1.mean of BMI was more in female than male (26±5.1 , 25.4±5.3) respectively (P = 0.03),(13). In one another performed study mean of BMI was 23.4±3.2 ( male 23.6±3 ; female 23.2±3.3) ,(14).Strenuous daily physical activities, being vegetarian will be the reasons for decline BMI in this study. Finding of lipid profile in our study showed that mean of total cholesterol was 4.714±2.09 mmol/l, HDLc1.1135± 0.3374 mmol/l, LDLc 3.017±1.046 mmol/l, triglyceride 1.7589± 0.951 mmol/l. 28.5% had abnormal total cholesterol (high, intermediate), 91.6% had low and intermediate level of HDLc, 34.5% with abnormal level of LDLc (high, intermediate), 60.4% had abnormal triglyceride level (high and intermediate).In a study which was done in Palastine showed ; 8.8% had total cholesterol level≥6.2mmol/l( P <0 xss=removed xss=removed xss=removed>

This single center-based study exhibited significant differences in arterial blood pressure for both genders. There was an ascending link between increasing age and elevation of systolic blood pressure in IHD patients.

In Almaty, the burden of IHD and their associated risk factors were high and included; arterial hypertension, diabetes mellitus, obesity, previous IHD, and hyperlipidemia that made a major public health concern. Effective strategies in administration, education, and healthcare centers are needed for accurate management and implementation of preventive measures in this field.

Ethical Approval

This article was approved by the Ethical committee of Al-Farabi Kazakh National University and the administration of Scientific Research Institute of Cardiology and Internal Diseases and Professor Kuat Abzaliev is the Dean of this hospital (abzaliev_kuat@mail.ru).

Competing Interests

The authors have no interest in financial aspects; they just need the journal's cooperation for next article publication.

Funding

We wrote this article with our own financial support.

Availability of data and materials

The row data was compiled from the Almaty-based National Research Institute of Cardiology and Internal Medicine's database. (abzaliev_kuat@mail.ru).