Freqirency of Ischaemic Heart Disease Within Metabolic Syndrome

Background: The common clustering of glucose intolerance, abdominal adiposity, high triglyceride level, low highdensity hpoprotein cholesterol level and high blood pressure in a single individual is referred to as Metabolic Syndrome (MS) and it is associated with ischaemic heart disease (IHD). Objectives: To find out the relationship between MS and IHD Design: Cross sectional observational study. Materials : 100 subjects were selected following simple random sampling technique. 50 patients of MS and another 50 non MS were enrolled as case and controlled respectively in the departrnent of medicine and cardiology at Sylhet M. A. G. Osmani medical college hospital. Results: Proportion of IHD was found to be high among the MS (40olo) compared to non MS (160lo) and the difference was statistically significant (p=0.008) indicating there is a relationship between MS and IHD. Among the components of MS proportion of hypertension (39.2olo), diabetes mellitus (41.9o/o), dyslipidemia (42.6Vo) and family history of cardiovascular disease (47.1o/o) had significant higher association with patients with IHD (p<0.05). Conclusion: The MS has a significant association with IHD by electrocardiogram criteria.

The MS is expected to be diagnosed in millions of subjects in the near future worldwide by either WHO or I{CEP-ATPIII criteria.The prevalence of MS has been reported to be 247o in the US adult populationl.
Address for Correspondence: Md.Ashfaqul Islam Chowdhury Assistant Prof.
Dept. of Medicine Sylhet M A G Osmani Medical College, Sylhet.
Mobile no.01710 l3l l4L Email: ashfaqul_md@yahoo.com108 IHD, cardiovascular disease (CVD) and total mortalrty are significantly higher in US adults with MS than in those without MS2.There is a evidence that the MS plays a pivotal role in the development of CVD by providing a multitude of risk factors which tend to multiply the effect of each other on the vascular system.This effect is particularly pronounced in persons of south Asian origin3.
The risk of death from all causes and CVD increased with increased numbers of metabolic abnormalities in both man and woman 4,5.The risk of IHD increased three fold with the MS and cardiovascular mortality markedly increased with MSs.
The prevalence of MS in the adult population in Bangla- desh is 9.47o6 and in other developed countries is 22-397o and varies depending on the definition used and on ethnicityT.MS is also common in Asian Indians and was presentin 4l.lVo in urban Asian Indian adults using modi- fied ATP III criterias.There is high prevalence of MS in Freouencv Of Ischaemic Heaft Disease Within Metabolic Svndrome.
Md. Ashfaqul Islam Chowdhurv et aI urban Asian Indian in the age group X 40 yearse.A few prospective analysis have applied definitions from the NCEP-ATP III or the WHO and reported that the MS is associated with an approximate twofold increase in CVD4.Resting electrocardio gram (ECG) abnormalities suggestive of IHD, arrgrna, myocardial Infarction (MI) have been shown to predict an increased risk of future coronary heart disease (CHD) events in prospective population studies and in clinical trials and are utilized to define subclinical IHDlO.South Asian populations show lower muscle mass and there is selective increase in central obesityll.As a result, at a BMI of 24 Kglm2, 7 57o of individuals from such ethnic groups display insulin resistance12.This explains their increased risk of diabetes mellitus (DM) and 111P11'12.
The main objective of this study is to find out the relationship of MS and its major components with IHD using resting ECG criteria.If we can detect the features of MS in an early stage then we can take measures to prevent or postpone DM, IHD and other complication.

Methods:
A Cross-sectional observational study was carried out in patients attending in the department of medicine and cardiology at Sylhet M. A. G. Osmani medical college hospital, Sylhet during the period from July 2007 to June 2008.A total of 100 participants were selected following simple random sampling technique.Everyday first admitted case who fulfilled the inclusion criteria for MS was enrolled as case.After every case subsequent admitted patient who has no features of MS was enrolled as controlled.In this way 50 patients of MS were enrolled as case and anothe t ageand sex matched 50 were enrolled as controlled.Subjects were informed about the nature and purpose of the study and informed written consent were taken from them.Information regarding personal history and physical findings and risk factors for IHD, treatment history were collected, relevant physical examinations like height, weight, WC, hip Circumference, waist-hip ratio (WHR), BP was recorded..The MS was diagnosed with the criteria indicated by the NCEP-ATP III.The diagnosis of IHD was based on Clinical history and resting ECG finding (According to Minnesota coding crtterta) and fVO previous MI.
For extra : Control: a) healthy subjects without MS, Both male and female, Age matched (5 yrs ) with case were included.a) Acutely ill patients.b) Age less than 30 years.c) Abdominal distention due to any cause ( eg.Ascitis, pregnancy) were encluted.
A fasting blood sample was taken for estimation of fasting lipid profile, fasting plasma glucose (FPG) and ECG were done.
Data was analyzed with the help of Statistical Package for the Social Science (SPSS) software package windows version 12. Statistical method used in data analysis: a) Unpaired student's t-test, b) XZ r test, c) Discussion: family history of CVD were higher among the MS than the control.The mean composite risk factors were found *p value reached from chi square to be high among the cases (3.7t0.9)In this study proportion of IHD was found to be high among the MSX4OEB compared to control X16EE and the difference was statistically significant Elp=0.008Xindicating there is a relationship between MS and IHD.Iraj Nabi- pour et a117, found that among the northern Persian Gulf adults, there was a highly significant association between MS and resting ECG evidence of IHD.This association remained after controlling of sex and age and provide information on IHD and MS using resting ECG In this study IHD was found to be high among the MS (40o/o) compared to control (160/o) and the difference was statistically significant (p=0.008)indicating there is a relationship between MS and IHD.Among the compo- nents of MS proportion of HTN(39.2olo),DM (4l.9o/o), dyslipidemia (42.60/o) and family fVO CVD (47 .Lo/o) had significant higher association with patients with IHD.
There are certain limitation of this study .The use of population based sample would provide greater support for such type of study.Large multi-centre study need to confirm the findings of this study.Still we believe this study will help in many respects for the future researcher.

Table - I
'p' value of <0.05 was considered statistically signifi- cant.The data was presented in frequencies, percentages, Distribution ofthe patients by riskfactors arlLd 957o confidence intervals (CI).Ethical clearance was taken from ethical committee of Syhet MAG Osmani Ri*k Medical College.Sylhet.Table.rl).IHD was found to be high among the is a relationship between MS and IHD (Table-III).NoThe mean composite risk factors was 3.2)1.8and 1.8).02Smoking among the patients with IHD and the non-IHD respecyes tively (p= 0.001).Analysis shows that the proportion of No HTN, DM, dyslipidemia and family history of CVD was Family higher among the pt.with IHD than the non IHD (p<0.05).The distribution of major cardiovascular risk factors *xComposite among case and control revealed a statistically significant risk factors difference in terms of HTN, DM, dyslipiaedimia A there (Table-IV).

Table - II
Distribution of the Patients by labor-atory investigation Lab.The lipid profile of this study shows that-among the MS group the mean TC were 2I2.1XF;2.0mgldl, LDL choles- terol were 1I7.3 x38.4 mg/dl, TG were 305.1 N162.5 mgldl, HDL cholesterol were 32.8N 5.2 mg/dl respectively.vrjay Achari has found the mean TC 205.3x 31.7mgldl,LDL-C 121.6 X31.8 mg/dl, TG 167.39W 99.8mg/dl, HDL-C 43.65X8.32mg/dl respectively which almost support the findings of the present study16.The high TG level in this study may be due to lifestyle and dietary habit of the study population as the use of saturated fat and hydrogenated fat (eg-Dalda) is high in this area.
than the control *xpvaluereachedfrornunpairedstudent'stes (0.7t0.6) and Frequencv Of Ischaemic Heart Disease Within Metabolic Syndrome.Md.Ashfaoul Islam Chowdhurv et aL patient with or without MS14.In this study raised fasting glucose was found in 84Vo.Deep a et.al. found raised fasting glucose in 14.'77oL5.111 0.088

Table - IV
Distribution of the patients by risk factors and IHD *p value reached from unpaired student's t test abnorm-alities suggestive of IHD11.The prevalence of IHD in MS Pt. were 55.67o; and 23.87o according to Vijay Achari;16 and Deepa et.a1.15 which support the finding of this study.The mean composite risk factors was 3.2W.8among the patients with IHD and 1.8X.02among the non-IHD.FPG level, TG and TC EXp<0.05X and negatively correlated with HDL, LDL and female sex, but Of Ischaemic Heart Disease Within Metabolic Syndrome.Md.Ashfaqul Islam Chowdhury et al risk factors, FPG level, TG and TC mp<0.05X and negatively correlated with HDL, LDL and female sex, but the correlation was not statistically significant mp>0.05X.Snehalatha et.al. has similar findingsg.Association between MS components and prevalent IHD were investigated in a cross-sectional, community-based study of elderly men and women in Rancho Bernardo, California, in 1984-1987; in this study, there was also a significant association between resting ischemic ECG and all common components of the MS.11In prospective data from the Bruneck Study/Italy which also used a l}-lead ECG at the baseline and at the follow-up, subjects with MS had an increased incidence of CHD during follow-up: 8%o vs. 37o in control subjectslS.Comparing prevalence of MS among persons with IHD and without IHD in middle-aged Kaunas population/ Lithuania, MS was associated with IHD in men aged 45-64 years19.Iraj Nabipour et allT found a positive association between increasing number of ATP III MS components and IHD by ECG, their analysis indicate that the individual compo- nents of elevated FPG, elevated BP and low HDL choles- terol have significant association with ECG evidence of is common in Bangladeshi population as in other countries of South East Asia.
*Frequency MS