Epidemiology of cardiovascular diseases risk factors and hypertension in a community-based suburban population in Nepal

Background: The epidemiology of cardiovascular diseases (CVD) risk factors and the CVD risk profile, in the Nepalese population is not fully understood. Almost a third of the adult Nepalese population is estimated to be hypertensive, but there is still lack of information on the associations of socio-demographic characteristics and other CVD risk factors with hypertension. The level of knowledge, awareness, treatment and control of hypertension, and their associated factors is also poorly understood.;Objectives: This dissertation aimed to determine the prevalence of CVD risk factors including smoking, hypertension, low physical activity, low consumption of fruits and vegetables, diabetes, high total cholesterol and triglycerides, low HDL; describe CVD risk profiles and their relationship with socio-demographic factors; investigate the association of prevalent hypertension with socio-demographic characteristics and CVD risk factors; and assess knowledge, awareness, treatment and control of hypertension, in a random sample of adults residing in Dhulikhel, Nepal.;Methods: In this cross-sectional study, we enrolled 1073 participants (18 years and older) from a random selection of one third of households in the town of Dhulikhel in central Nepal. Prevalence of CVD risk factors was ascertained using standard case definitions and cut-offs.;Results: Among the 1073 participants, 41.6% were males and 58.4% were females. The mean age of the participants was 40.3 years (SD: 16.3). Age standardized prevalence showed that more than a third of the participants were obese or overweight in both sexes (31.7% in males and 37.2% in females). Both former and current smoking rates were nearly double among males compared to females [current (27.7% versus 13.4%) and former (11.1% versus 5.6%)]. Nearly half of the participants had less than 5 servings of fruits and vegetables per day in both sexes. In the multivariate model, males had significantly higher risk of hypertension (OR: 2.52, 95% CI: 1.69-3.75, p=<0.001) compared to females. Age was also significantly associated with hypertension prevalence (p<0.001). The Newar ethnic group had 5.65 times higher risk of hypertension (95% CI: 3.12-10.21, p<0.001) compared to Brahmins. Being overweight or obese were associated with an increased risk of 2.61 (95% CI: 1.81-3.77, p<0.001) and 6.74 (95% CI: 3.75-12.11, p<0.001) times respectively.;A total of 43.1% of the participants were not able to mention a single risk factor for hypertension. In the multivariate model, males were almost twice as likely to have knowledge of hypertension compared to females (OR: 2.04; 95% CI: 1.22-3.40, p=0.006). Among different ethnic groups, Newars were most likely to have knowledge of hypertension (OR: 2.13; 95% CI: 1.26-3.57, p<0.001) when compared to Brahmins.;Conclusions: Overall, the findings reported here suggest that the burden of CVD risk factors in Nepal might be greater than previously estimated. The CVD risk profile in this population was also very concerning. Newar ethnicity appears to be independently associated with hypertension compared to Brahmins. The levels of knowledge, awareness, treatment and control of hypertension were very low. The lack of knowledge of hypertension was associated with women gender, Brahmin ethnicity and no formal education. We did not find significant associations of hypertension awareness with socio-demographic or other CVD risk factors. (Abstract shortened by UMI.).