Comparative case control study on risk factors of Coronary Artery Disease among Sedentary and Heavy Workers

 

Arathy Sen A S1, Raji Raju2

1Lecturer, Medical Surgical Nursing Department, Vijaya College of Nursing, Kottarakkara, Kollam.

2Guide and Professor, Vijaya College of Nursing, Kottarakkara, Kollam.

*Corresponding Author Email: dawiknadh@gmail.com

 

ABSTRACT:

Introduction: Coronary artery disease is most common heart disease among people in this world. It is a preventable lifestyle disease. Certain life style changes will influence the risk factors of developing coronary artery disease in sedentary workers and heavy workers. Objectives: the primary objective of the study was to compare the risk factors of coronary artery disease among sedentary and heavy workers. Methodology: A quantitative approach and non-experimental comparative case control was adopted for the study. Total 120 samples (60 sedentary workers and 60 heavy workers) selected by convenient sampling technique. Data were collected by interview method using structured questionnaire method. The collected data were analyzed by frequency and percentage distribution. Results: The results showed that there was a significant association between the risk factors of CAD among sedentary workers such as BMI (χ2=8.58, p=0.014), types of work (χ2=45.50, p=0.001), age (χ2=18.99, p=0.001) and exercise (χ2=0.00, p=0.001). And there was a significant association between the risk factors of CAD in case among sedentary and heavy workers such as monthly family income (χ2=6.74, p=0.034), alcohol (χ2=12.43, p=0.006), coffee (χ2=19.47, p=0.001) and mode of transportation (χ2=34.35, p=0.001) and there was a significant association between the risk factors of CAD in control among sedentary and heavy workers such as BMI (χ2=19.36, p=0.001), alcohol (χ2=20.26, p=0.001), smoking (χ2=8.11, p=0.044), coffee (χ2=30.97, p=0.001), and mode of transportation (χ2=30.00, p=0.001). Conclusion: The study concluded that the risk factors of coronary artery disease is more common in sedentary workers than heavy workers. Being aware of the risk factors will help the peoples become aware of their chances of developing coronary artery disease and therefore will encourage them to adopt healthy lifestyle.

 

KEYWORDS: Case Control, Risk Factors, Coronary artery disease, Sedentary workers, Heavy workers.

 


BACKGROUND OF THE STUDY

Coronary arteries are the heart’s network of blood vessels. They exist on the surface of the heart, and they supply the heart muscle with oxygen. When plaque builds up, it narrows your coronary arteries, decreasing blood flow to your heart.


Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack1.

 

CAD develops in men at earlier age itself but in women risks gets 10 folds of men after menopause. And the factors contributing to CAD can be classified as modifiable and non-modifiable factors. Non modifiable factors are the factors that we cannot control such as age, gender, ethnicity and genetic disposition and modifiable factors such as hyperlipidemia, hypertension, diabetes, smoking, poor diet, nutrition and physical inactivity, being overweight and high blood cholesterol2.

 

The 2019 Heart Disease and Stroke Statistics update of the American Heart Association (AHA) has recently reported that 116.4 million, or 46% of US adults are estimated to have hypertension. On an average someone dies with cardiovascular disease about 2,303 deaths and about 389.4 deaths from stroke. Approximately 1 of every 13 Americans aged 18 years and older has coronary artery disease. It is the leading cause of death for people of most racial and ethnic groups in the United States3.

 

Sedentary workers are the workers who work in prolonged sitting position and not involving in physical activities. Physical inactivity is also associated with increased risk of morbidity or worsening of many chronic diseases and health conditions including cardiovascular diseases4.

 

Heavy workers are the workers who work for more than 6-8 hours with prolonged strenuous activities, which overload the muscular and skeletal systems. A heavy worker lifestyle includes they are doing whole body actions involving pushing, pulling, lifting, playing, moving and carrying heavy objects. Dietary pattern also varies as compared to sedentary workers. Due to heavy work, more calories burns in all activities. So it leads to prevention of further diseases. Heavy workers were considerably more likely to be smokers. Smoking contain nicotine it is a colourless, poisonous alkaloid substance which is higher risk for atherosclerosis5.

 

SIGNIFICANCE OF THE STUDY:

Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity in both developed and developing countries. It is a leading cause of death in India and its contribution to mortality is rising. The number of deaths due to coronary artery disease in 1985 is expected to have doubled by 20156. According to AHA 2018 statistics, about 92.1 million American adults are living with some form of cardiovascular disease or the after effects of stroke. Direct and indirect costs of total cardiovascular diseases and stroke are estimated to total more than 329.7 billion; that includes both health expenditures and lost productivity. Coronary Heart Disease is the leading cause (43.8 %) of deaths attributable to cardiovascular disease in the US, followed by Stroke (16.8 %), Heart Failure (9.0 %), High Blood Pressure (9.4 %), diseases of the arteries (3.1 percent), and other cardiovascular diseases (17.9 percent)7.

 

During  the  year  2020  to  2021  coronary  heart  disease alone is anticipated to increase by 120% for women and 137% for men in developing countries. The annual number of deaths from CVD in India is projected to rise from 2.26 million (1990) to 4.77 million (2020). Coronary heart disease prevalence rates in India have been estimated over the past several decades and have ranged from 1.6% to 7.4% in rural populations and from 1% to 13.2% in urban populations. The Major risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post- menopausal for women and being older than 45 for men, and obesity may also be a risk factor8.

 

During the clinical posting, the investigator has given care to several patients with heart disease, in the majority of patient was CAD. While collecting history from the patients most of them are sedentary workers and some of them are heavy workers. In that most of them were middle aged, peoples and old aged peoples, had family history of CAD, hypertension, hyperlipidemia, diabetes mellitus which are the contributing factors of CAD. In sedentary lifestyle they were doing less physical activities. But in case of heavy workers they were doing straneous physical activities. During the interaction with the patients and bystanders I feel that some people were not much aware of their health habits, as they were not taking medications for diabetes mellitus, hyperlipidemia and hypertension. The people were not even checking their blood sugar level, blood pressure and cholesterol. They used to go hospital when any health problems encounters. The investigator felt that even though some common people are aware of health and promoting behaviours like regular exercise, avoiding smoking, alcohol they are not following the measures may lead to chronic diseases. According to WHO 80% of the heart attack can be prevented by appropriate management and prevention strategies by reducing coronary risk factors in the population. So the investigator was enthusiastic to know the comparison of risk factors of coronary artery disease among sedentary and heavy workers.

 

STATEMENT OF THE PROBLEM:

A comparative case control study on risk factors for Coronary Artery Disease among sedentary and heavy workers in selected areas at Kollam district.

 

OBJECTIVES:

1.         To assess the risk factors of coronary artery disease among sedentary workers in case and control

2.         To assess the risk factors of coronary artery disease among heavy workers in case and control

3.         To compare the risk factors of coronary artery disease between the case and control in sedentary workers

4.         To compare the risk factors of coronary artery disease between the case and control in heavy workers

5.         To compare the risk factors of coronary artery


disease between the cases among sedentary workers and heavy workers

6.               To compare the risk factors of coronary artery disease between the controls among sedentary workers and heavy workers

7.               To test the association between the risk factors of coronary artery disease and selected demographic variables among sedentary workers

8.               To test the association between the risk factors of coronary artery disease and selected demographic variables among heavy workers

 

METHODOLOGY:

Research Approach: A quantitative research approach was used in this study

 

Research Design: A Non-experimental comparative case control study was used.

 

Research Setting: The study was conducted at Vijaya Hospital, selected banks, construction sites and selected community areas.

 

Population: The population selected for the study were both gender in the age of 35 to >50 years in Kottarakkara, Kollam District.

 

Sampling Technique: Non probability convenience (consecutive) sampling technique.

 

Sample:120samples,60 Sedentary workers (30 in case and 30 in control) and 60 Heavy workers (30 in case and 30 in control)

 

Instrument Used:

Section A: Demographic variables This section consists of demographic variables includes educational status, diagnosis of CAD, previous information, cardiac health check-up, and lipid profile. Data on demographic variables were collected by self-report Interview method.

 

Section B: Questionnaire to assess the risk factors of coronary artery disease among sedentary and heavy workers This section consists of 33 items focus on the risk factors of coronary artery disease in cases and controls among sedentary and heavy workers. Data on risk factors of CAD among sedentary and heavy workers were collected by self-report Interview method.

 

DATA COLLECTION PROCESS:

Data collection is the systematic gathering of information relevant to the research purpose or specific objectives or hypothesis of a study." After approval of ethical committee data were obtained. The period of data collection was from 28/01/19 to 23/02/19. The selected samples were informed about the purpose of the study and verbal consent was obtained. A total of 60 sedentary


workers (30 case and 30 control) and 60 heavy workers (30 case and 30 control) satisfying inclusion and exclusion criteria were selected by non-probability convenience (consecutive) sampling method. Data were collected by interview method, physical examination and lab analysis using risk factor questionnaire. On the first 15 days, data were collected from case of 30 sedentary workers and 30 heavy workers attending OP and IP in Vijaya Hospital at Kollam district. On the second 10 days, data were collected from control of 30 sedentary workers from selected banks and the last 5 days data were collected from control of 30 heavy workers from construction sites, quarry workers. At the end, the participants were thanked for their cooperation.

 

RESULTS:

Table:1 Data on demographic variables of sedentary workers were analyzed by frequency and percentage distribution.           N=60

Sl No

Socio demographic variables

Sedentary Workers

 

 

Case

Control

F

%

F

%

1.

Educational status

 

 

 

 

 

Certified courses

13

43

17

57

 

Under graduates

6

20

8

27

 

Post graduates

0

0

5

17

 

Above

0

0

0

0

2.

Duration of illness

 

 

 

 

 

<1yr

4

13

0

0

 

1-5 yrs

19

63

0

0

 

>5yrs

7

23

0

0

 

None

0

0

0

0

3.

Sources of previous information

 

 

 

 

 

Social media

5

23

4

29

 

Friends

4

18

2

14

 

Relatives

4

18

3

21

 

Health care professionals

8

36

2

14

 

Others

1

5

3

22

4.

Frequency of checking lipid profile

 

 

 

 

 

Monthly

2

7

0

0

 

0-3 months

0

0

0

0

 

3-6 months

4

13

1

14

 

6-1yr

7

23

2

29

 

1-2yrs

14

47

4

57

 

>2yrs

3

10

0

0

5.

Religion

 

 

 

 

 

Hindu

13

43

15

50

 

Christian

8

27

10

33

 

Muslim

8

27

5

17

 

 

Table 2: Data on demographic variables of heavy workers were analyzed by frequency and percentage distribution. N=60

Sl no

Socio demographic variables

Heavy Workers

 

Case

Control

F

%

F

%

1.

Educational status

 

 

 

 

 

Illiterate

10

33

17

57

 

Primary education

8

27

6

20

 

High school education

10

33

7

23

 

Higher secondary

2

7

0

0

2.

Duration of illness

 

 

 

 

 

<1yr

7

23

0

0

 

1-5 yrs

15

50

0

0

 

>5yrs

8

27

0

0

 

None

0

0

0

0

3.

Sources    of             previous information

Social media Friends Relatives

Healthcare professionals Others

 

1

1

7

2

3

 

7

7

50

14

22

 

2

4

2

0

3

 

18

37

18

0

27

4.

Frequency of checking lipid profile

Monthly

0-3 months

3-6 months 6-1yr

1-2yrs

>2yrs

 

0

2

4

9

9

0

 

0

8

17

38

37

0

 

0

0

0

2

5

0

 

0

0

0

29

71

0

5.

Religion Hindu Christian

Muslim

 

15

10

5

 

50

33

17

 

21

8

1

 

70

27

3

 

 

 

 

 

 

 

Table 3: Risk factors of coronary artery disease in case and control among sedentary workers and heavy workers were analyzed by frequency and percentage distribution.                                                                                 N=60

Sl no

Category

Sedentary workers

Heavy workers

Case

Control

Case

Control

 

 

F

%

F%

 

F

%

F%

 

1.

Hypertension Hypertensive (140/90mmHg) NonHypertensive

(120/80mmHg)

 

30

 

0

 

100

 

0

 

17

 

13

 

57

 

43

 

30

 

0

 

100

 

0

 

15

 

15

 

50

 

50

2.

Cholesterol

 

 

 

 

 

 

 

 

 

Desirable <200mg/dl

15

50

13

43

14

47

19

63

 

Borderline

 

 

 

 

 

 

 

 

 

200-239 mg/dl

7

23

12

40

11

37

5

17

 

High risk

 

 

 

 

 

 

 

 

 

>240mg/dl

8

27

5

17

5

16

6

20

3.

BMI

 

 

 

 

 

 

 

 

 

<18.5-Underweight

0

0

0

0

0

0

0

0

 

18.5-24.9-Normal

7

23

0

0

12

40

11

37

 

25-30-Overweight

17

57

19

63

16

53

18

60

 

>30-obese

6

20

11

37

2

7

1

3

4.

Type of work

 

 

 

 

 

 

 

 

 

Bank employees

1

3

22

73

 

IT Professionals

4

13

8

27

 

Hospitalemployees

2

7

0

0

 

School teachers

3

10

0

0

 

Others

20

67

0

0

5.

Type of work

 

 

 

 

 

 

 

 

 

Welding

2

7

22

73

 

Loading worker

8

27

8

27

 

Painter

2

6

0

0

 

Farmers

3

10

0

0

 

Others

15

50

0

0

6.

History of chronic

 

 

 

 

 

 

 

 

 

diseases

 

 

 

 

 

 

 

 

 

HTN

11

37

6

38

11

37

5

42

 

DM

0

0

3

19

0

0

1

8

 

HTNandDM

9

30

3

19

8

27

3

26

 

DMandCOPD

0

0

2

12

0

0

1

8

 

HTNandCOPD

5

17

1

6

5

16

0

0

 

HTNandOther

5

16

0

0

6

20

1

8

 

DMandOther

0

0

1

6

0

0

1

8

7.

Food preference

Non vegetarian Vegetarian

 

23

7

 

77

23

 

24

6

 

80

20

 

25

5

 

83

17

 

30

0

 

100

0

8.

Alcohol

Never Party time

 

8

6

 

27

20

 

8

10

 

27

33

 

12

5

 

40

17

 

2

2

 

7

7

 

Occassionally Daily

16

0

53

0

12

0

40

0

6

7

20

23

15

11

50

36

 

It was analyzed using frequency and percentage distribution. Findings of the study revealed that in case of hypertension, among 30 case in sedentary workers all of them 100% (30) were hypertensive, whereas in control 57% (17) of them were hypertensive and 43% (13) were non hypertensive. Based on 146 cholesterol, among 30 case 50% (15) were had desirable cholesterol level, 27% (8) were had high risk of cholesterol level and 23% (7) were had borderline cholesterol level, whereas in control 43% (13) were had desirable cholesterol level, 40% (12) were had borderline cholesterol level and 17% (5) were had high risk of cholesterol level.

 

Regarding BMI, among 30 case 57% (17) were overweight, 23% (7) were normal BMI and 20% (6) were obese and none of them are under weight, whereas in control 63% (19) were overweight, 37% (11) were obese and none of them are underweight and normal.

 

Among 30 case in sedentary workers, 3% (1) were bank employees, 13% (4) were IT Professionals, 7% (2) were hospital employees, 10% (3) were school teachers and 67% (20) were other types of work. Whereas in control, 73% (22) were bank employees, 27% (8) were IT Professionals and none of them are hospital employees, school teachers and others. Based on food preference, among 30 case 77% (23) were non vegetarian and 23% (7) were vegetarian, whereas in control 80% (24) were non vegetarian and  20% (6) were vegetarian. Regarding alcohol, among 30 case 53% (16) were taking alcohol occasionally, 27% (8) were never taken alcohol, 20% (6) were taking alcohol party time and none of them were taking alcohol daily, whereas in control 40% (12) were taking alcohol occasionally,  33% (10) were taking alcohol party time, 27% (8) were never taken alcohol and none of them were taking alcohol in daily.

 

Table 4: Chisquare test showing the comparison of risk factors of coronary artery disease disease between cases and controls among sedentary workers and heavy workers. N=60+60=120 N=60+60

Sl No

Risk factors

Sedentary workers

Heavy workers

χ2‘

p’value

χ2

‘p’value

1.

Cholesterol

2.15

0.341

3.09

0.212

2.

BMI

8.58

0.014*

0.49

0.781

3.

Type of work

45.50

0.000*

36.66

0.001**

4.

Age

18.99

0.000*

12.51

0.006*

5.

Religion

0.88

0.642

3.88

0.143

6.

Monthly     family income

0.60

0.740

0.001**

0.001**

7.

Stress

4.05

0.132

2.39

0.302

8.

Exercise

0.001**

0.001**

0.001**

0.001**

9.

Alcohol

1.57

0.456

13.17

0.004**

10

Smoking

3.67

0.452

3.05

0.383

*= Significant ‘p’ at 0.05 Level of significance

**= Significant ‘p’ at 0.01 Level of significance


 

Table 4 shows that there was a significant association between the risk factors of CAD among sedentary workers such as BMI (χ2=8.58, p=0.014), types of work (χ2=45.50, p=0.001), age (χ2=18.99, p=0.001) and exercise (χ2=0.000, p=0.001). And there was no significant association between the risk factors of CAD among sedentary workers such as cholesterol (χ2=2.15, p=0.341), religion (χ2=0.88, p=0.642), monthly family income (χ2= 0.60, p=0.740), feel stress (χ2=4.05, p=0.132), alcohol (χ2=1.57, p=0.456), smoking (χ2=3.67, p=0.452).

 

Also shows that there was a significant association between the risk factors of CAD among heavy workers such as type of work (χ2 =36.6, p=0.001), age (χ2=12.51, p=0.006), monthly family income (χ2=0.001, p=0.001), exercise (χ2=0.001, p=0.001) and alcohol (χ2=13.17, p=0.004), Hence null hypothesis (H03) was rejected and research hypothesis (H3) was accepted for these variables. And there was no significant association between the risk factors of CAD among heavy workers such as cholesterol (χ2 =3.09, p=0.212), BMI (χ2 =0.49, p=0.781), religion (χ2=3.88, p=0.143), feel stress (χ2=2.39, p=0.302), smoking (χ2=3.05, p=0.383).

 

DISCUSSION:

Coronary Artery Disease (CAD) is the most common type of heart disease. CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the build up of cholesterol and other material called plaque on the inner and outer walls result in complicated lesions with  fibrous atherosclerosis. Due to the narrowing of the coronary arteries reducing the blood flow to the heart it leads to chest pain (angina) or a heart attack or CAD. CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias10. Coronary artery disease was thought to be a man's disease. CAD develops in men at earlier age itself but in women risks gets 10 folds of men after menopause11. And the factors contributing to CAD can be classified as modifiable and non modifiable factors. Non modifiable factors are the factors that we cannot control such as age, gender, ethnicity and genetic disposition and modifiable factors such as hyperlipidemia, hypertension, diabetes, smoking, poor diet, nutrition and physical inactivity, being overweight and high blood cholesterol9.

 

A comparative study was conducted to compare the risk factors of coronary artery disease in urban and rural community of district Patiala, Punjab. Sample of 400 individuals belonging to high income group were selected by stratified simple random sampling technique. Data were selected using semi structured questionnaire. Data were analyzed using descriptive and inferential statistics. Results revealed that 22% and 11%


hypertensive’s in urban and rural population respectively. Diabetes was more (10.5%) in urban as compared to 3.5% in rural population, 14.5% obese were found in urban setting than 03% in rural community. Rural people smoked more (18%) as compared to urban (25%). Type A personality was detected almost double (83.5%) in urban than 48.8% in rural people. Study concluded that the risk factors for coronary artery disease in urban and rural population diabetes mellitus, hypertension and obesity were common in urban and rural community while smoking was more common in rural people. The study recommended that after the identification of various factors, further intervention could be planned to prevent the development of coronary artery disease in the study participants10. This study findings are supported the present study findings.

 

A comparative study was conducted to compare the coronary heart disease patients and non coronary heart disease individuals in relation to stress, anxiety and type A behaviour in Cardiac Care Unit (CCU) of hospitals from Pune. The objectives of the study were to investigate the relation of stress, anxiety and type A behaviour in the development of CHD. In the present study, 121 samples were selected by convenient sampling method. Data were collected by structured questionnaire by interview method. Data analysis were done using descriptive and inferential statistics. Results revealed that there was a significant-differences exist between CHD patients and Non CHD individuals on stress, anxiety and type A behaviour. The CHD patients scored more on stress, anxiety and type A behaviour. Study concluded that there was a contribution of stress, anxiety and type A behaviour in the development of CHD. The study recommended that the same study can be conducted with larger population11. This study findings are supported the present study findings.

 

A case control study was conducted to assess the risk factors for acute myocardial infarction in central India, (ICCU) of Government Medical College, Nagpur. Sample of 265 were selected by convenient sampling method. Data were collected using structured questionnaire by interview method. Data were analyzed by descriptive and inferential statistics. Results showed that risk factors of AMI included 11 risk factors at p=They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C reactive protein. The study concluded that not only common modifiable and non-modifiable risk factors are responsible for CHD, but infectious disease can also contribute to developing CHD. The study recommended that the role of conventional risk factors for cardiac disease and highlight the need for research in to the association between chronic infections and AMI12. This study findings are supported the present study findings.

 

CONCLUSION:

Based upon above findings it was concluded that the risk factors of Coronary Artery Disease is more common in sedentary workers than heavy workers. Being aware of the risk factors will help the people become aware of their chances of developing coronary artery disease and therefore will encourage them to adopt healthy lifestyle.

 

REFERENCE:

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2.        Lekha Adik Pathak, Salil Shirodkar, Ronak Ruparelia, Jaideep Rajebahadur. Coronary artery disease in women. Indian Journal. Elsevier. 69(4).2017.532–538.

3.        American Heart Association. Heart Disease Statistics2019 Update. Available from: https://professional.heart.org.

4.        Shirin Panahi, Angelo Tremblay. Sedentariness and health: is sedentary behavior more than just physical inactivity. Frontiers in public health journal. 6. 2018. 258.

5.        R Michael Pittilo. Cigarette smoking, endothelial injury and cardiovascular disease. International Journal. 2000 81(4).2000. 219–230.

6.        Tanmay Nag and Arnab Ghosh. Cardiovascular disease risk factors in Asian Indian population. Journal of cardiovascular disease research. Elsevier. 4(4).2013.222–228.

7.        Heart disease Statistics 2018. Availablefrom: https://healthmetrics.heart.org

8.        Heart Disease. Available from: https://www.heart.org

9.        A H E M Maas. Y E A Appelman. Netherland Heart Journal. 18(12).2010. 598-602

10.      Sangeeta Gulati, AS Sekhon, NK Geol. A comparative study was conducted to compare the risk factors in coronary artery disease in urban and rural community of district Patiala, Punjab. Indian Journal. Volume 35. 18(11).19978. 28-35

11.      Sushama J Bhosale, BR Shejwal. A comparative study of coronary heart disease patients and non- coronary heart disease individuals in relation to stress, anxiety and type-A behaviour in Pune city Indi, a. Indian Journal. 14(2). 2013. 146-51.

12.      Sanjay P. Zodpey, Sunanda N. Shrikhande, Himanshu N. Negandhi. Risk factors for acute myocardial infarction in central India: a Case-Control study. Indian Journal of Community Medicine. 40(1).2015. 19–26.

 

 

Received on 19.04.2021                Modified on 15.05.2021

Accepted on 30.05.2021            ©AandV Publications All right reserved

Asian J. Nursing Education and Research. 2021; 11(4):555-560.

DOI: 10.52711/2349-2996.2021.00130