Burden of premature atherosclerotic cardiovascular disease and its risk factors among young and middle-aged adults in primary care clinics of Karachi, Pakistan

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OBJECTIVE: Premature Atherosclerotic cardiovascular disease (ASCVD) is an aggressive form of ASCVD with high occurrence among South Asians. Pakistan lacks the capacity and funds for proper primary prevention programs targeting premature ASCVD. We aimed to estimate the burden of premature ASCVD and its risk factors in the young and middle-aged adults presenting to the primary-care clinics. METHODS: A cross-sectional study was conducted from 1st September 2022 to 28th August 2023 in 4 Primary-care clinics in Karachi. All participants visiting these clinics between 18 and 50 years for men and 18 and 60 years for women, who had at least one known risk factors of ASCVD were included. The WHO risk charts for South Asia region were utilized to predict 10-year risk for CVD event in those 40 years and above (very low risk (< 5%), Low risk (5%–10%), Moderate risk (10% to < 20%), High risk (20% to < 30%).For those < 40 years of age an ASCVD risk factor count of all the variables used in WHO ASCVD was calculated. The ASCVD risk factor count was categorized into low ASCVD risk factor count (< 5 risk factor count) and upper ASCVD risk factor (≥ 5 risk factor count ). RESULTS: A total of 614 adults were enrolled. The mean (SD) age was lower in men than women; 40.1 (8.2) vs. 43.0 (9.7) years. Obesity was prevalent in 83% (509) and overweight was present in 46(7.5) individuals with no significant difference between genders, whereas central obesity was prevalent in 87.6% (538) of participants. The prevalence of premature ASCVD was 3.7% (n = 23) with most patients (n = 21) falling within the > 40 years age group. Out of these 23 patients 10 (43.5%) had a stroke, 9 (39.1%) had a myocardial infarction, 3 (13.0%) had angina, and 1 (4.3%) had both stroke and myocardial infarction. In adults aged > 40 years of age(n = 377), 46.2% (174) were at moderate to high 10-year risk of a CVD event. Mean(SD) ASCVD risk factor counts for adults aged < 40 years of age (n = 237) was 4.9(1.4) and 65.8% (156) had high ASCVD risk factor count. Women reported less physical activity over seven days in age groups of 30–40 and 40–50 years spending 64 and 69 min per week, respectively (p < 0.05). CONCLUSION: The prevalence of atherosclerotic cardiovascular disease (ASCVD) among young and middle-aged adults in our study population was 3.7%. This occurred in the context of a notably high prevalence of overall and central obesity, with central obesity being more predominant among women, while tobacco use was more prevalent among men. A third of participants were at moderate to high 10-year risk of a CVD event and 90% of participants were overweight or obese and a substantial proportion were physically inactive.

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