Date of Award

6-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr.Romaina Iqbal

Second Advisor

Mr.Iqbal Azam

Third Advisor

Ms.Sabahat Naz

Department

Community Health Sciences

Abstract

Introduction: Ischemic heart disease (IHD) associated with coronary artery problems, remains a prevalent cause of hospitalization and mortality globally and is a leading cause of heart failure. Coronary artery disease is typified by obstructive plaques, restricting coronary blood flow, and causing myocardial ischemia, ultimately leading to heart failure. IHD is a significant contributor to global fatalities, it was responsible for one-third of all deaths, with a 53% rise in IHD-related deaths between 1990 and 2019. In Pakistan, where IHD affects over 5 million individuals, it's observed more in males across all age groups. The study aims to unravel the relationship between dietary intake (macro and micronutrients), multivitamin and mineral (MVM) use, and IHD, adjusting for modifiable and non-modifiable risk factors.
Methods: This study was conducted in a tertiary care hospital in Karachi Pakistan. It included 150 cases of ischemic heart disease (IHD) and 150 non-IHD controls, utilizing a case-control design. Data collection involved administering a brief questionnaire to assess demographic and lifestyle factors. Dietary patterns were assessed by estimating nutrient content from consumed items, including macronutrients like carbohydrates, proteins, fats, and various vitamins and minerals. MVM supplement intake was assessed by asking about the use of MVM supplements, its frequency, amount, and brand of MVM supplements. Patients with newly diagnosed IHD or those who had been receiving treatment for less than or equal to six months were recruited as cases. The control group, consisted of people with no history of IHD and were enrolled from the AKU Family Medicine Department. Simple logistic regression was carried out to compute unadjusted odds ratios comparing IHD cases and controls for macronutrients intake, micronutrient intake, and lifestyle variables such as stress, physical activity, job status and education. Subsequently, multiple logistic regression was done to understand the association of macronutrients, micronutrients, MVM use along with physical activity, gender, age, and BMI to make a predictive model for IHD. Adjusted odds ratios were reported with a significance level set at p < 0.05. All analyses were conducted using STATA software (version 16.0). vii
Results: Individuals diagnosed with IHD were typically older (average age of 51± 13 years) compared to non-IHD individuals (41±11.5 years), with a higher proportion of males (85% vs. 15%) and lower educational attainment (27% with Matric/O’levels vs. 49% non-IHD). Factors such as family history of IHD, higher BMI, and elevated total cholesterol levels were more prevalent among IHD patients. The study observed a notable difference in multivitamin and mineral (MVM) supplement use, with higher usage among non-IHD patients (57% non-IHD vs 35% in IHD participants). In the adjusted logistic regression model, higher carbohydrate intake was associated with a 4% increase in the odds of ischemic heart disease (AOR = 1.04, 95% CI: 1.02, 1.07). While participants who reported using multivitamins/minerals (MVM) showed a reduction in the odds of ischemic heart disease (AOR = 0.26, 95% CI: 0.05, 1.31), although this association did not reach statistical significance. In this study, each 1g increase in carbohydrate intake is associated with 4% higher odds of IHD (OR: 1.04), and each additional mg of iron intake is linked to 20% higher odds of IHD (OR: 1.20). Conversely, each additional mg of calcium intake is associated with 1% lower odds of IHD (OR: 0.99). Regarding sociodemographic characteristics, being male is strongly associated with increased odds of IHD compared to being female (OR: 14.6, 95% CI: 2.63, 80.63), and higher BMI is linked to increased odds of IHD, with each unit increase in BMI contributing to a 25% increase in the odds (OR: 1.25).
Conclusion: These findings underscore the importance of dietary factors, advocating for a healthy diet with lower carbohydrate intake and considering MVM use, for reducing the risk of ischemic heart disease. Future research with larger cohorts is essential to delve deeper into these relationships, providing valuable insights for targeted interventions and preventive strategies aimed at reducing the burden of IHD within the population of Karachi and beyond.

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