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CORONARY
ARTERY DISEASE IN BANGLADESH Dr.
Shams Munwar MRCP(UK), D.Card(London) Consultant Cardiologist
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South
Asians (Bangladeshis, Pakistanis and Indians) have much higher incidence
of coronary artery disease than any other ethnic group in the world .
The World Bank estimates that the death rate from the disease will
increase dramatically in the subcontinent and is expected to contribute
to more quality adjusted life years lost than any other part of the
world. In the Bangladesh scene, it was also observed that among all the
south Asian immigrants in UK, Bangladeshis had the highest mortality
rate from coronary artery disease Nobody knows the exact incidence and
prevalence rate of coronary artery disease in Bangladesh, because there
is no scientific data available at the moment in this regard. However,
every cardiologist and physician will tell from his or her personal
experience that it is very high and the incidence is rising every year.
In fact, if the hospital admission records are examined, it may not be
erroneous to assume that this has reached an epidemic proportion.
It
is a general saying that coronary artery disease is a disease of rich
people, and people from lower income groups are immune to this
particular problem. However this is not anymore true in the perspective
of Bangladesh. It is affecting every socioeconomic group, but may be
because of expenses involved, it is only the affluent group that comes
to seek medical advice. Most unfortunate part of the problem is that, it
is increasingly affecting younger groups in their 40s. This is an age
when they are at the peak of their career and have a lot of duties to
their families and a lot to contribute to the society. This premature
nature of the disease was quite unheard of in this country only 25 years
ago.
Nobody
knows why the incidence of coronary artery disease and particularly the
extreme premature nature of it are rising in Bangladesh. It may be
because of increasing tobacco smoking by younger people, rising
incidence of diabetes, and hyperlipidaemia. Apart from these traditional
risk factors, malnourishment leading to deficiency of vitamins, like
folate and vitamin B12, leading to arteriosclerosis, may be relevant for
Bangladesh. In addition, chronic low grade infections, which are
increasingly point of focus for the researchers as to be the cause of
coronary artery disease is also important. In a country like Bangladesh,
these infections are extremely common because of poor sanitation and
Treatment
of coronary artery disease is very expensive, hence comes the question
of preventing it in the first place. By stopping to smoke, going to a
healthy diet, taking regular physical exercises can prevent the problem
to a large extent. Those who are unfortunate to have the disease, if
treatment is started early enough, dreadful complications of the disease
can be halted. These treatments are easy to administer, safe and much
more sophisticated than it used to be. These modem treatments are now
available in this country at a much lower cost. Preventive strategies
through health education in combination with early diagnosis and
treatment of this condition can go a long way to prevent unnecessary
premature mortality and morbidity of this disease.
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